Walking the path

Well… I shall end this year with a crap story…

Many years ago, I was staying over in
Dennis’s place. He is a good friend from meds school. The next
morning, while he was busy preparing a simple breakfast, I went to
pooh in his toilet.

“CH, you very ‘kengchao’ (ie great),
can shit so early in the morning! I can’t do that… I can only shit
after eating my breakfast…”

“I never have that problem,  I can
shit anytime. Well… maybe you should try sitting on the toilet
early morning before breakfast, I am sure you can do it…”

“Really cannot lah… before
breakfast, no 灵感(Ling2
Gan3, ie inspiration) to  shit. Must be something to do with the
pressure in the stomach; after eating the pressure built up, then it
push the shit out the other end…”

Well… many years after graduating
from meds school, I was preparing for a talk about management of
constipation in childhood, I came a cross this article suggesting to
sit children with constipation on a potty after meal time to
encourage defecation. The physiology explanation for doing so is to
make full use of the Gastrocolic reflex.

When food enter the stomach, there is a
reflex increase in muscle contraction in the colon, this is the
gastrocolic reflex. This reflex also explained why newborn baby pooh
every time they have a breast feed. It also explained why Dennis was
able to shit after breakfast.

The moral of the story are..

• It is never too late to learn
  physiology…

• My friends who are scattered
  around the world… I still think about you guys (or at least your
  crap stories) even though we are not in constant contact. Thanks
  guys for the card from BELFAST…

Happy New Year!

Last week a 6 weeks old baby attended
with bilateral inguinal hernia. The consultant paediatrician and
myself spent more than an hour explaining about hernias and the risk
of strangulation, bowel ischaemia and associated complications.

With Christmas and New year coming up
soon, it was difficult to secure a slot for theaters, after much
difficulty we managed to find theater slot, but parents refused
surgery in the last minute.

They have found a Chinese medicine man
who claim to be able to fix hernias with herbal medicine  without
surgery.

I really wonder how patient’s parents
make up this decision. Elective inguinal hernia repair is a
straightforward simple procedure with low complication rate. But this
parents choose to have herbs that have not been proven to work, and
probably have unknown side effects profiles. They are also putting
their child at risk of the hernia being strangulated. Putting their
child’s life at risk… Besides irrational and irresponsible, I am
not sure if there is another words to describe these parents.

The world is becoming very strange…
patients (and in paediatrics cases, their parents) like to  think
that  they know the best…

In adult medicine, it probably more
acceptable for patients to have this attitude. If the patients have
been given all the information and decided to act against medical
advice, the patients will be responsible for their own act, they may
suffer from their own poor judgment. No one else will suffer from
their poor judgment.

But in the case of a child, it is a
child’s life that is involve. Not my life as a doctor, not the
parents life… Poor judgment by the parents against medical advice
putting the child’s life at risk. How much can the paediatrician
advocate for the child? When will a paediatrician be labeled as
paternalistic? Does it matter being paternalistic if a child’s life
is saved as the results?

This child was not immunized too…
I hope I will not see him coming in with epiglotitis or measles one
day…

I thought I saw a pussy cat…  I did I
did!

This week could be more exciting… but
it was not. My yellow little tweedy bird end up getting most of the
attention. Hehe… bought a pair of yellow sunglasses to match the
car.  Midlife crisis…