My Medical Journey

Breast Cancer is one of the most dangerous cancer in the world. It also becomes the numero uno for death in women because of cancer. The incidents are higher each year. One critical prevention is by doing self examination of the breast.

Breast cancer can be from the parenchym, stroma, areola, or papilla mammae. The incident is higher in women above 35 years old. It rarely happens in women below 20 years old.

The risk factors for breast cancer are:

1. Age, the risk is higher in old women

2. Family, if your mother has it, then you will likely has it too

3. Genetic and hormone, breast cancer usually happens with hormone changing

4. Menarch, or first menstruation

5. Hormone theraphy

6. Diet, fat consumtion is known as one of the risk factor

7. Breast tumor, if you happen to had breast tumor then the risk for getting breast cancer is higher than people who hadn’t

8. Alcohol

9. Smoking

10. etc

There are many kinds of breast cancer : In site cancer, ductal cancer, lobular cancer, invasive cancer, medular cancer, Paget’s disease, papillare cancer, and some more.

The clinical signs are :

1. Mass in the breast

2. Changing in the breast’s diameter or shape  

3. Retraction in breast

4. Pus from the nipple

5. Pain and awful smell

The examinations for breast cancer are by doing:

1. Self examination

2. Mammography

3. USG

4. Chest X-Ray

The Therapies for breast cancer are :

1. Surgery ( I’ll explain in other post)

2. Radiation

3. Chemotheraphy

One important thing to know is… Breast cancer also can happen in men!

A single tooth is very important in human’s life. If a single tooth is broken, it may be the root is still there. It is an indication for extraction.

The root can be a gangrenous root. This situation is happen because the root will become an infection focal.

We can assume that the nerve is already died if there is only root.  Normally the duct is filled with nerve, but because the nerve is died then the duct is filled with waste and bacteries. That is how it can be an infection focal.

Healty tooth is very important in human. It has a lot of functions, like to chew food, make voice, and make the face-look.

Carries can happen if the tooth has dental plaque on it. Dental plaque consists of saliva and micro-organism. The acid from the bacteria can make the tooth soft. So there will be carries on the tooth.

The carries can be superficial, media or deep. Deep carries is happen in the tooth’s pulp which make pulpitis, either acute or chronic. After that, it can get a lot worse. It is can make the tooth become non-vital, or we called it Gangraen Pulp. In this stage, the tooth nerve is already died.

From this stage, there are also can be periodontitis and abcess. If the abcess is going into the soft tissue, then there can be swelling and fistel.

My final examination case in surgery division is a male, just called him Mr.S, 62 years old, with chief complaint his urine is tea-colored.

He was taken by his wife by force because well, just say that he is a difficult person to handle.

His wife started to suspicious when she washed her husband underwear there is a tea-colored mark.

When she asked about it, Mr.S said that it was already 3 months his urine had tea-colored.

When I first met the patient I was suprised that he was so yellow. Every part of his skin was yellow. His eyes was yellow too, we called it icteric sclera.

Icteric or Jaundice can happen in many ways (read my past article). In my physical examination, the Murphy Sign and the Fist Percussion test was positive.

My final working diagnose was the patient had Icteric Obstructive with Cholelithiasis (billiary stone) which causes Cholecystitis (billiary tract infection).

I’m dissapointed when I heard the surgery resident suspect Papilla Vateri Tumor as the cause of the icteric. I don’t follow the case after my examination until I heard that he was passed away.

Glasgow Coma Scale is a useful neurologic examination to know the condition of the patient. A doctor can prognose the patient death or alive by this examination. Usually GCS is used in head injury or accident. There are three components of GCS, Eye, Verbal and Movement. The most important component is movement.

These are the Scale:

Eye    : 1. None

           2. Response  in pain

           3. Response in voice

           4. Spontaneously

Verbal  : 1. None

              2. Incomprehensible sound

              3. Inappropriate words

              4. Confused

              5. Oriented, normal

Movement    : 1. None

                      2. Extension by pain

                      3. Abnormal Flexion by pain

                      4. Withrawal from pain

                      5. Localizes the pain

                      6. Obey commands

Normal scale is GCS 15 = E4V5M6, but someone is predicted :

- Mild : if the GCS is more than 13

- Moderate : if the GCS is more than 9

- Severe : if the GCS is below 8

The GCS above is for adult, children use another GCS.                      

Icteric is a situation where your skin or your eyes become yellow because the bilirubin in your blood is more than 2 mg/dL.

There are 3 kinds of hyperbilirubin.

1. Pre Hepatic

This kind of hyperbilirubin happens because there are too much uncojugated bilirubin in your blood. The cells that change unconjugated bilirubin (UB) to conjugated bilirubin (CB) can’t handle all the work. Usually this situation is happen in haemolitic disorder.

2. Hepatic

There are disorder in hepatic cells. This situation happens in Hepatitis, or usually in all the liver disorder.

3. Post hepatic

There are nothing wrong in the production, conjugation, or secretion of the bilirubin. The problem is that the bili

Ileus is a term for a difficulty of intestine passage. Ileus is divided into two, Ileus obstructive and Ileus paralytic. Ileus obstructive is caused by an obstruction. Ileus is paralytic is caused by nerve problems.

Ileus obstructive mechanic is divided into two, simple ileus obstructive and strangulated ileus obstructive. Thing that differs them is in strangulated ileus obstructive there is vascular problems.

Ileus obstructive usually happen in recto-sigmoid part of the body, but it also can happen in other colon part.

Things that caused ileus obstructive mechanic are various, for example are peritonitis, ascariasis, fecalith, hernia, etc.

The most useful radiologic examination is abdomen 3 position. We can see many air fluid level with step-ladder imaging.

The therapy for ileus obstructive are by conservative and operative. Conservative is by doing decompression, rehydration, after that operative therapy is needed.

Hemangioma is an abnormal condition of blood vessels. This condition may happen in any vascularized tissue. The cause of hemangioma is unknown.

There are three types of hemangioma :

1. Capillary hemangioma (Strawberry), which is a visible red skin lesion that may be in the top skin layers.

2. Cavernous hemangioma, which is deeper than capillary hemangioma.

3. The mixture of both types.

Hemangioma usually take place in birth. Furthermore, normally it will partially dissappear in 7-8 months, and completely dissappear after one years.

Over one-half hemangioma patients heal completely with no cosmetic matters without treatment.

Hemangioma can be a problem sometimes when a vital organ is involved, bleeding, ulceration, crusting, and rapid growth with deformity.

Hemangioma therapy are using cortisone, laser therapy, antibiotics, and surgical removal. 

The problem in the intervertebral disc usually happens because of the length between vertebrae is become narrowed. This could happen with degeneration or vertebrae injury.

Disc herniation will happen if the annulus pulposus is being broke from the intervertebral disc and make the nucleous pulposus come out. Nucleous pulposus will make the patient feel pain. This process happen because the nucleous pulposus touch the spinal cord. It will also give back and leg pain.

If the dics become ruptured, the patient will fell more pain and the trouble become very serious.

The symptoms form disc herniation are : tingling and numbness, electric shock pain, muscle weakness, bladder or bowel problem,  etc.

Disc herniation can be diagnosed by radiology imaging.

 In the X-Ray imaging, we can only see the arthrosis or calsificated bone, but it can not show the disc herniation.

The CT scan show the disc herniation but it is still can not clealy show the soft tissue arround it.

MRI maybe the best way in showing the herniated disc. It will clearly show the soft tissue beside the bone part. In the picture above we can see the cannalis spinalis become narrowed.

Hangman’s Fracture is a fracture of the arc in 2nd cervical spine which also make the 2nd cervical spine dislocate from the 3th cervical spine. Usually it is happens in a neck injury.

Eventhough is is an unstable fracture, sometimes there are also correlation with spinal cord injury because the canalis spinalis diameter is the biggest in this area.

This fracture can be diagnosed just with simple cervical x-ray lateral position photo.

The fracture is located in the 2nd cervical spine. Just look at the picture above.