Bangkok Patana Students visit Pinklao Foot Care Clinic 2
The internship with Dr. Cherdpong in Pinklao hospital was a very informative and useful experience for us students of Bangkok Patana. Those of us who attended are interested in becoming doctors or are seeking a career in the medical field, and this provided us with a good sneak-preview of the challenges that will be presented to us.
Our first task in the Foot Clinic was to interview a man named Khun Suthit. We did this determine the “suffering” or the problems he has been experiencing with his right foot, which was wrapped in a cast. It was a good exercise; Dr. Cherdpong explained that this is the first thing a doctor does when he receives a patient and it allows the doctor to determine the condition that is disturbing patient.
As we interviewed Khun Suthit, he told us that he had difficulty walking around; Three months ago, doctors had to amputate 4 of his toes due to his diabetes. This operation has caused him difficulty to walk around, limited his ability to do his job (he sold certain items which involved the need to walk around) and resulted in a pungent smell to exude from his foot. He needs his wife to help him walk around and do certain chores and he contemplates retiring after the doctor decides to remove permanently remove the cast around his foot, indicating that his amputated foot has been fully healed.
Khun Suthit has type two diabetes. In a nutshell, his body has developed a considerable resistance to the effects of insulin, which is produced by the pancreas. This increases his blood glucose level and causes certain enzymes to react with the glucose in his blood, which may form a blood clot. Body parts exposed to high pressure (such as the foot) are the areas where blood clots of this nature often form.
This problem first presents themselves to the patient through a lasting pain in the area where the clot has begun to form. At this stage, an individual must see the doctor right away to avoid irreversible damage to blood clotted area. Unfortunately, some individuals, who believe this pain is normal (due to age etc), dismiss and wait for it to subside. This is when the problem develops into an irreversible dilemma. Over time, the pain in the clotted area subsides due to “muscle memory”. Yet, the clot actually develops into a bigger clot that begins to block oxygen transport to the area blocked by the clot. Tissues beyond the clot now begin to die due to the lack of oxygen and infections start to form in the oxygen-deficient. Eventually, the oxygen-deficient area becomes highly infected and the only solution would be amputation.
Dr. Cherdpong asked Toby, Patrick and me to aid him in removing the cast of Khun Suthit. As we began opening his cast, the smell from the cast started to get much stronger. Once we took the cast of, what I saw was nothing like I imagined that we would see and the image I saw was purely describable by pictures alone. It was not the most pleasant image I’ve seen, but I was glad I had been given the opportunity to see this since it gave me a better understanding of what I’d be seeing if I ever became a doctor. This experience also helped me realize the reality and magnitude of this condition among different individuals, and it encouraged me to help these types of individuals one day like Dr.Cherdpong has been doing, such as people like monks who walk around today and may carry this condition.
After this, Dr.Cherdpong led us to the hyperbaric chamber owned by the Navy Hospital. The hyperbaric chamber is a giant machine used to remove the bubbles present in an individual, part of the Navy or not, which were caused by quick ascension from deep water levels. The machine was primarily made to treat the Navy’s troops as well as to treat the individuals who made the Chao Praya bridge a number of decades ago.
When one is goes deep underwater, such as scuba-divers or navy troops, one exposes him/her body to pressure higher than 1 atm that our bodies normally experience. This is due to the additional pressure added by the weight of water surrounding the body, forcing certain gases such as nitrogen into the blood plasma. When one rises to the surface too fast, the rapid change in pressure causes nitrogen bubbles to form in the blood stream. Since nitrogen is an inert gas, these bubbles cannot be removed by waiting for an extended period of time. These nitrogen bubbles not only cause extreme pain in areas where they form (they usually form at joints), but they also pose a threat to one’s own life since these bubbles can act as clots which restrict metabolism at certain parts of the body. The hyperbaric chamber, where individuals breathe 100% oxygen, removes this bubble through the principle of Boyle’s law (Pressure is inversely proportional to Volume). The high pressure causes the volume of the bubble to decrease so that it does not pose a threat to the individual, while oxygen breathed in displaces the nitrogen bubble in the blood stream. Oxygen bubbles are more tolerated by the body that nitrogen bubbles probably because oxygen is used for aerobic respiration.
The navy troop who specialized in operating the hyperbaric chamber also explained to us the other uses of the machine. At certain times, the machine is used as a last alternative in preventing the amputation of a body part due to blood clots. Hemoglobin, a protein which carries oxygen, is blocked by the blood clot present in the blood stream. The high pressure in the hyperbaric chamber forces oxygen into the blood plasma and as a result, haemoglobin is no longer needed to supply the areas, blocked by the clot, with oxygen. Instead, the blood clot is overcome through the presence of oxygen in the plasma itself. This allows oxygen to reach the oxygen-deficient parts of the body, allowing metabolism to occur in that area yet again and repair of tissues.
As well as this, the navy troop also explained to us that another chamber, called a hypobaric chamber, is used in order to cure conditions caused by low pressures such as those experienced by air force troops.
ความเห็น (0)
ไม่มีความเห็น