Wednesday, November 12, 2008

Bryan and Mike to the Rescue...

Good Evening,

I just returned from the showers where Spc. Troxel used up all of the hot water and I and Spc. Eldridge had to take cold showers. I will proceed with court martial charges against Spc. Troxel in the morning. Hey, for those of you who have been in the military or been to summer camp, will testify to the high crime of using the last of the hot water.
Well, I have to share my debt of gratitude to Mike and Bryan. About a week ago, I had a Master Sergeant come in to the clinic with a complaint of a lump under his left breast. He is a 40+ year old gentleman and he had had the mass there for quite a while. He was concerned about the lump as he had read that men can sometimes develop breast cancer. I did my exam and sure enough he had a moveable, painless, mass under his left areola. So, I discussed the pt. options here in theater and gave him the opinion that it was most likely a fatty tumor. I offered to remove the lesion and send it to the lab or at least a portion of it to the lab for diagnosis. He agreed. So, I performed the procedure that you see below. The patient gave consent to take these photographs and to publish them on this blog.
Here I've made my initial incision and am dissecting down. At this point, I am praying that this lump is nothing more than a cyst or a lipoma.
Here I can see the top of the mass.
Trying to figure out how deep this goes. I always try to use the smallest incision possible.
I am getting there.
Here I have removed the lump and am exploring the wound with my finger to see if I left any other cyst behind.
The lump is removed and the wound looks clean. Time to close.
My prayer is answered, it appears to be a lipoma, which is benign.

Here I have closed the incision and am finished...or am I?

Here's the rest of the story. After I finished with this procedure, I went to the gym to workout. When I returned from the gym, I went to my room grabbed my clothes and showered. Our showers are in the clinic. When I finished, I was leaving the clinic when one of the medics grabbed me and said that my patient had returned and that his incision was leaking blood. I went into the procedure room and there was Bryan and Mike with the patients wound open and blood everywhere. What happened was the patient had left the clinic and went to a meeting. After the meeting he was walking back to his office when he started to bleed from the wound.

So, Bryan and Mike were trying to find the vessel that had rupture. As soon as I entered the room I grabbed a pair of gloves and went to work. Mike stepped out as three was too many people for such a small wound, but Bryan stayed on. It tooks us over an hour and a half to get that bleeding under control. What happened was a blood vessel had broken open and retracted up superior to the areola. It is amazing how much blood can come from a small blood vessel.
Well, we finally got the bleeding under control by using epinephrine, ties, and good old fashion direct pressure. Bryan stayed the entire time to help me out and I am so thankful to him.

It is always a providers nightmare when someone else has to repair your work. But Bryan has been kind and hasn't made fun of me or anything. Which is nicer than I would have been. If it were his patient, I would make him pay me 12 dollars to keep my mouth shut. ;-)

It is always great to have friends who can cover your backside.

1 comment:

Tony C said...

Wow...I'm speechless. That is truly amazing, and you do this every day. What a blessing from God to have such a talent!

Your photographer also does outstanding work. It's like being there.

Your blog is better than anything on TV! Keep it coming.