This is a case of a 45-year old female who was referred by another hospital on her island with chief complaint of body weakness and pain while urinating or dysuria.
She was diagnosed with cervical cancer stage IIA with vaginal extension in a local hospital on her island. PAP smear in May 2010 showed HGSIL/CIS or High grade squamous intraepithelial lesion, or HGSIL for short, is a medical term given to a category of cervical dysplasia detected through a Pap smear. Cervical dysplasia is mild to severe abnormal changes that can occur in the lining of the cervix. Her biopsy then showed poorly differentiated squamous cell carcinoma.
A Pap smear is a test used to detect cervical cancer or abnormal changes in the cervical cell. It is done by taking sample of cells by the use of a small spatula.The cells are then placed in a tube with a preservative, or placed on a slide and sent to laboratory to tests.
If HGSIL is found through a Pap smear, a colposcopy is then done to confirm results. A colposcopy is an in-office procedure that allows a doctor to examine the cervix more in-depth. It is done by using a colposcope, a lighted microscope that magnifies the cervix.
Since we do not have that type of equipment, the patient procedure was done in another hospital.

During the colposcopy, the doctor may also do a cervical biopsy, the removal of small pieces of cervical tissue. The tissue samples are then sent to a lab for further examination.
Due to lack of resources in her place then, colposcopy was never performed. The OB –Gyne to whom she was referred to immediately requested for such.

A colposcopy is performed in the doctor’s office and normally takes less than an hour to perform. Results are available within two weeks, depending on the lab the doctor uses.
It was actually my first encounter with the OB-Gyne from another hospital and I was really impressed by his ability to show genuine concern with the patient who hardly understand English and took her time discussing the matter with the patient’s niece. I have learned from him that the patient’s condition is not actually cervical cancer but as he termed “pre-cancer”.
Although there are other procedures done to destroy the abnormal tissue formation that cause the vaginal extension, he chose to have the patient on Cryotherapy.
Cryotherapy is a technique used to destroy abnormal tissue by freezing it. It is also called crysosurgery. Since our hospital cater to operable clean cases, the patient had to be brought again to another hospital where the OB-Gyne could perform the surgery.
Cryosurgery is method of treatment used for cervical dysplasia, or abnormal cells on the cervix. It may also be performed in very early staged cervical cancer. If left untreated, these abnormal cells may develop into cervical cancer. Cryosurgery is also called cryotherapy. Cryosurgery kills pre-cancerous and cancerous cells by freezing them.
During cryosurgery, a doctor will insert a speculum into the vagina. A probe is inserted into the vagina that releases a gas that freezes the abnormal cells. It is left in for three minutes until ice crystals form on the cells. The process may be repeated after waiting for an additional three minutes. (Source: about.com)
It only took her half a day in that hospital and she was brought in our hospital again and she was already able to ambulate.
According to the doctor, she might have blood-tinged discharges that will go away after a couple of days.
The patient has been discharged and was then advised to come to an OB-Gyne in her place for follow up check up.
Also, it is important that every woman should get vaccinated to prevent cervical cancer.
It is just amazing how God sends his angels to heal those who are sick.

I was busy charting when I got a glimpse of The Philippine Star. The Sun Cellular advertisement almost occupied the full page and my attention was caught by that familiar charming smile. Dr. Juan Javier Lichauco, Internist, Rheumatologist and Entrepreneur.
It was my indeed my caring doctor.
It now occurred to me that I have an appointment and I have not been back for more than three months now.
I wonder if he has raised his professional fee now that he is now celebrity.

My co-staff nurse was beaming every so often and we are just puzzled by her consistent glowing aura.
She was extra cheerful and helpful that day and wondering continued until the end of our shift. As we were on our way to punch out, she whispered to me that her boyfriend has finally proposed. I looked at her finger and saw this sparkling huge rock on it. I am no gemmologist but I think that one that her boyfirned has gotten her is one of the certified diamonds. Isn’t sweet and fabulous?

Today is the last day of our favourite Micronesian patient who has undergone coronary artery bypass graft. Luckily, it is our unit meeting so the staff members were almost complete so when they requested for a group picture, it was almost hard to squeeze in everyone in the camera phone. But just before the picture was taken, the patient’s wife has asked for a minute to say something that sent chills to our spines. She and her husband were so thankful for making our institution their second home. She almost broke down into tears saying how they appreciated what we have done for them. I almost cried myself when I saw his husband, a tall man with a body of a wrestler, wiping his tears. The man rarely speaks English and his wife usually communicates with us for him. She even added that the staff members in our institution are like loose diamonds which are hard to find.

Exactly seven days have passed when Ka Erdy has been laid to his resting place yet, I still feel sad thinking that our “tatay” is gone. Last night, I was watching the special tribute to him and I again wept.
I am so thankful to him for taking time out speaking with my dad and giving him God’s words about family and marriage.
Dad accepted that his marriage to my mom was over and chose to raise us alone. He did not seek annulment nor look for another woman he could live with.
A very noble person he is.
Although my heart is broken due to his passing, my faith will never be shaken.

My rotation in the ward for my BST at the LCP has started last Monday and although sleep has been elusive, I still feel the adrenalin rush through my vein.

It is like I am an energizer bunny.

My feet are still swollen and although this signals me to follow the red light, I have no intentions of taking leave of absence. Although we are allowed to have 6 absences for the entire training period, I feel that it is just proper to maximize my training fee by taking the opportunity to be in the ward and learn new things about bedside care.

Aside from the bedside care, we are expected to perform admission and discharge procedures and to carry out doctor’s orders. If you want to excel in something you must not stop at just learning the 411 but you have to progressively learn the craft.

While I feel so pumped up in my training days, there are instances that sadness sucks the joy in my highly cholesteroled heart.

After every endorsement and rounds, I usually review the patient’s chart to check on the diagnosis, doctor’s progress notes, medications and everything I could wrap my mind around.

Last night, I managed only two patients.  One has so many medications needed to be given at certain intervals. The other has just prn (pro re nata) or as needed medications.  It was for pain.

The doctors made their rounds so I was not able to scan the charts of my patients.

At past 6:00 pm, I was asked by the charge nurse to assist the attending – an oncologist in medicating my patient (who only has prn med).  He was given Etoposide – a chemotherapy drug.

After regulating the drug, I looked for the patient’s chart and found out that he has bronchogenic cancer with non small cancer cells.  The cancer has metastatized in his brain.

He is undergoing 6-cycle chemotherapy.  I was really surprised because he looked healthy, not experiencing alopecia and he kept on playing tricks on me every time I entered his room.

I am imagining, If were in his bed, would I still be the same bubbly person that I used to be? Chemo is a very scary and horrible experience based on people who have undergone it.

I know that as a medical practitioner, emotion should not get in the way of my profession.  I was supposed to handle three patients that day but my third patient who had a DNR order expired. It is sad when you are in the room with the relatives to witness the doctor to pronounce the patient dead.

Every training day is a tiring and edematous day but at the end of the day, I do not feel exhausted.

This is what I wanted to do. Screw the odds, Death is not an option.

All I need now is my Trodat so that my hands will be spared from scribbling my complete name and license number on each page of the patient’s chart.