Report
and photos compiled by Rithy Chau, Telemedicine Physician Assistant at
SHCH On
Wednesday, August 18, 2004, Rattanakiri Referral Hospital (RRH) staff
began their TM clinic. There
were 3 new cases and 2 follow-up patients.
The patients were examined and the data were transcribed along
with digital pictures of the patient, then transmitted and received
replies from their TM partners in Boston and Phnom Penh. The
following day, Thursday, August 19, 2004, the TM clinic opened again to
receive the same patients for further evaluations, treatments and
management. One more
patient presented to RRH and was evaluated through the TM Clinic that
afternoon. On Friday, August 20, 2004, two more patients were presented
as TM special surgical case due their complex presentation of their
illnesses. These last
three patients continued to received care and management through the TM
Clinic for the next few more days as both replies from SHCH and Boston
were received. Finally, the
data for treatment and management would then be transcribed and
transmitted to the PA Rithy Chau at SHCH who compiled and sent for
website publishing. The followings detail e-mails and replies to the medical inquiries communicated between TM clinic at RRH and their TM partners in Phnom Penh and Boston : -----Original
Message----- Dear
All, Dear All, We have 3 new cases and two follow-up for this month TM Clinic. Here is the first case and photos will follow (since there seem to be some problem attaching multiple items. Regards, Rithy/San Please
send all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any review, retransmission, dissemination or other use of or
taking of any action in reliance upon, this information by persons or
entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the
sender and delete material from any computer. Rattanakiri
Provincial Hospital Telemedicine Clinic Patient: PN#0005, 38F, Village I
Please send
all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any
review, retransmission, dissemination or other use of or taking of any
action in reliance upon, this information by persons or entities other
than the intended recipient is prohibited.
If you received this e-mail in error, please contact the sender
and delete material from any computer. -----Original
Message----- -----Original
Message----- I'm glad her respiratory symptoms are better. Definitely continue the solbutemol and albuterol as needed. Treating H. Pylori empirically is a great idea since her symptoms are continuing on high doses of anti acids. I'm not sure giving her atenalol as need is a good idea since it is a beta blocker and you're giving her a beta agonist for her respiratory symptoms. She does have several PVCs on her ECG and I'm not sure why; maybe checking her electrolytes could give a clue? Jonathan Sadeh, M.D. -----Original
Message----- Dear Rithy and Dr. San: I agree with your management for this patient. Jack -----Original
Message----- Dear All, Here is case EB#00078. Regards, Rithy/San
Please
send all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any review, retransmission, dissemination or other use of or
taking of any action in reliance upon, this information by persons or
entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the
sender and delete material from any computer. Rattanakiri
Provincial Hospital Telemedicine Clinic Patient: EB#00078, 40F
Please send
all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any
review, retransmission, dissemination or other use of or taking of any
action in reliance upon, this information by persons or entities other
than the intended recipient is prohibited.
If you received this e-mail in error, please contact the sender
and delete material from any computer. -----Original
Message----- Dear Rithy and Dr. San: I agree with your management of this patient. I discussed the issue of medications with Rithy yesterday and we agreed that if the patient will continue to be followed by us, we can provide her with these medications. Jack -----Original
Message----- From:
Guiney, Timothy E.,M.D. [mailto:TGUINEY@PARTNERS.ORG] Sent:
Thursday, August 19, 2004 9:38 AM To:
'kirihospital@yahoo.com' Subject:
FW: >
-----Original Message----- >
From: Guiney,
Timothy E.,M.D. >
Sent: Wednesday,
August 18, 2004 10:36 PM >
To: 'kirhospital@yahoo.com' >
Cc: 'tmed_rithy@online.com.kh';
Fiamma, Kathleen M. >
Subject: >
>
Although I don't have the data from her previous examinations,it appears
that >
the diagnosis of cardiomyopathy is probably correct, and it is improving
under >
treatment. >
An ECG,Chest film, and if available,an echocardiogram would be helpful. >
After three months treatment with furosemide and aldactone it would be
useful >
to check her electrolytes(especially potassium)BUN and Creatinine >
It may be possible to cut back a bit on her furosemide to 40 mg q12
hours and >
consider cutting back on Aldactone to25 mg q 12 hours. >
Would leave digoxin at present dose and try to get her on a small dose
of beta >
blocker such as metoprolol if she can tolerate it. >
Timothy E. Guiney,M.D. >
-----Original
Message----- Dear All, Here is case KP#00082. Regards, Rithy/San
Please
send all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any review, retransmission, dissemination or other use of or
taking of any action in reliance upon, this information by persons or
entities other than the intended recipient is prohibited.
If you received this e-mail in error, please contact the sender
and delete material from any computer. Rattanakiri
Provincial Hospital Telemedicine Clinic Patient: KP#00082,
61F, Village II
Please send
all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any
review, retransmission, dissemination or other use of or taking of any
action in reliance upon, this information by persons or entities other
than the intended recipient is prohibited.
If you received this e-mail in error, please contact the sender
and delete material from any computer. -----Original
Message----- Hello Olga: Thank you very much for participating in this month's clinic. I really appreciate your support. Best
regards, -----Original
Message-----
-----Original
Message----- kp#00082 The patient has a neck mass which has been increasing in size in the past 3 months. The mass is of considerable size and it could possibly press on her Trachea, causing her to have a sensation of dyspnea and which explains her tachypnea, breathing at 24 times a minute. She will need a chest xray at some point to rule out that the mass doesn't extend into the Thorax/lungs. The patient is not tachycardic, and barely hypertensive, so most likely her thyroid mass is not a functioning, T4 producing tumor. It is very superficial, right under the skin, and very amendable for a Fine Needle biopsy, which will be key to her diagnosis, and her management. You can treat some of the symptoms, but it will be essential to know the pathology of this expanding tumor. She has epigastric pain radiating to he shoulders which could be consistent with Gallstones. Is there a history of pain after a big meal, or is her pain worse when hungry?, the first being more consistent with gallstones and the latter with PUD. It is advisable to treat with Cimetidine for 4-6 weeks, and see if she responds, but if she has persistent symptoms, she will need further medical work up including an Upper GI, to r/u Peptic Ulcer disease, or a gastric malignancy as well as a RUQ abdominal ultrasound to ensure she does not have gallstones. For now biopsy of the neck mass is the next step. Olga Smulders-Meyer, MD
-----Original
Message----- Dear Rithy and Dr. San: My first suggestion is to ask the patient to stop taking all her previously prescribed "unknown" medicines. If the neck mass has really been present for 50 years, it is unlikely to be anything dangerous. I agree with your plan to evaluate her thyroid function with the laboratories you are requesting. Since her BP is 130/70, it would be reasonable to wait until next month's follow-up to recheck her BP and make a diagnosis of HTN before starting atenolol. A trial of cimetadine for her dyspepsia is also reasonable; if she does not improve, I would consider starting H. pylori eradication. Jack -----Original
Message----- Dear all Here is case ND#00083. Regards, Rithy/San Please
send all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any review, retransmission, dissemination or other use of or
taking of any action in reliance upon, this information by persons or
entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the
sender and delete material from any computer. Rattanakiri
Provincial Hospital Telemedicine Clinic Patient: ND#00083
Please send
all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any
review, retransmission, dissemination or other use of or taking of any
action in reliance upon, this information by persons or entities other
than the intended recipient is prohibited.
If you received this e-mail in error, please contact the sender
and delete material from any computer. -----Original
Message----- -----Original
Message----- This patient almost certainly has a toxic nodular goiter, but it's also possible she has Graves' disease or iodine-induced hyperthyroidism. She was probably treated for this in past but did not follow up to get adequate treatment. Yes, you should send a TSH and FT4. Also, please send a pregnancy test to see if she is pregnant. She would likely benefit from radioactive iodine ablation. To make sure we have the diagnosis correct, she needs a radio-iodine update and scan.
-
Danny Daniel Z. Sands, MD, MPH
V: (617) 667-1510 -----Original
Message----- Dear Rithy and Dr. San: Given this patient's symptoms and physical exam, I think your assessment of possible hyperthyroidism is a good one. I agree with your plan to check thyroid function tests and think it would be reasonable to give her atenolol for her palpitations and tachycardia pending the results. Jack
-----Original
Message----- Dear all Here is case SM#00084. Regards, Rithy/San
Please
send all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any review, retransmission, dissemination or other use of or
taking of any action in reliance upon, this information by persons or
entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the
sender and delete material from any computer. Rattanakiri
Provincial Hospital Telemedicine Clinic Patient: SM#00084,
M, 48 Y.O, 3 SROK Village
Please send
all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any
review, retransmission, dissemination or other use of or taking of any
action in reliance upon, this information by persons or entities other
than the intended recipient is prohibited.
If you received this e-mail in error, please contact the sender
and delete material from any computer. -----Original
Message----- Hello Dr. Cusick: Thanks again for all of your support Kathy -----Original
Message----- I agree with the assessment of diabetes mellitus and renal stones. He needs better diabetes control to avoid dehydration due to polyuria and formation/exacerbation of kidney stones. Using an oral hypoglycemic agent and intravenous hydration is important. he needs medication for pain if necessary for the kidney stones. If he has a fever or chills or pyuria on the urinalysis or if urine culture/gram stain reveal an infection, then he needs an antibiotic. he also needs to lose weight for diabetes management and to lower his dietary intake of concentrated sweets and sugars. If his blood pressure remains elevated when his pain is treated, you may want to consider a medication for lowering blood pressure (an angiotensin converting agent for kidney protection) If he can catch a kidney stone and try to submit it to the laboratory to determine stone composition. Good luck. I hope that this helps.. Paul
Cusick -----Original
Message----- Dear Rithy and Dr. Sovita: As you know, diabetics are considered higher risk patients when deciding on the proper treatment of pylonephritis. For this reason I agree that the patient should be treated with intravenous antibiotics until his vital signs become normal. I would suggest restarting the gentamycin in addition to the ampicillin. (As a side note, I question the reported allergy to penicillin if he has already received ampicillin in the hospital without any adverse reactions.) I do not think steroids are indicated. When he becomes clinically stable-- normal temperature, pulse and respiration-- you could switch him to an oral floroquinolone, like ciproflaxacin, for a total treatment duration of 3 weeks with close follow-up for treatment failure. I would use caution giving glyburide or any other renally-cleared antidiabetic drugs while he has pylonephritis. It would be helpful to know his creatinine so you could adjust the dose (of gentmycin as well); if creatinine measurement is unavailable, I would monitor his blood glucose carefully while on glyburide until his acute illness passes. Jack Special
Case Presentation -----Original
Message----- Dear All, I am writing you to inform that we have received all replies for the five cases presented to you last night (both Boston and SHCH). There will be a special case which I am writing with Dr Sovitha concerning an interesting problem with a young man presenting with oral bleeding and generalized body petechia and ecchymoses x 2 days. I will write up his H&P this afternoon and send to you with photos. If any of you can help with this case would be much appreciated. Doctors here at RPH are quite perplexing about this case when he walked in this AM. Regards, Rithy -----Original
Message----- Dear All, Here is a special case (YC#00085) presentation for this month TM Clinic. Photos will be sent later. Regards, Rithy/San Please
send all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any review, retransmission, dissemination or other use of or
taking of any action in reliance upon, this information by persons or
entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the
sender and delete material from any computer. Rattanakiri
Provincial Hospital Telemedicine Clinic Patient: YC#00085,
20M, Laong Village
Please send
all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any
review, retransmission, dissemination or other use of or taking of any
action in reliance upon, this information by persons or entities other
than the intended recipient is prohibited.
If you received this e-mail in error, please contact the sender
and delete material from any computer. -----Original
Message----- Dear All, Here is the last photo for YC#00085. Some lab results returned as follows: WBC = 8,600 RBC = 3,910,000 Plt = 210,000 Hct = 40 Hb = 13.2 TC = 3 min (clotting time) TS = 3 min (bleeding time) Regards, Rithy/San Please
send all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any review, retransmission, dissemination or other use of or
taking of any action in reliance upon, this information by persons or
entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the
sender and delete material from any computer. -----Original
Message----- Dear Rithy: This is a puzzling case indeed-- usually gum bleeding and petechiae are indicative of a platelet disorder, yet the patient has a normal platelet count. Stranger still, he has no other symptoms of an infectious disease. After discussing the case with Gary, Paul, and Tim Keenan, we all agree that there is no clear indicacation for urgent therapy: he has a normal hemoglobin and normal vital signs. Gary suggested a 10 day course of doxycycline as empiric therapy for a possible zoonotic infection from the chipmonk bite. If you feel better "doing something," this is something you could try. Perhaps the brains at Harvard will come up with something better.... Jack -----Original
Message----- From:
hopestaff@online.com.kh [mailto:hopestaff@online.com.kh] Sent:
Friday, August 20, 2004 9:10 AM To:
Kiri Hospital Cc:
Ruth Tootill; Rithy Chau; jmiddleb@camnet.com.kh; Heather Brandling-Bennett;
Joseph Kvedar; Kathleen M. Kelleher; Paul Heinzelmann;
Nancy Lugn; Noun SoThero; Gary Jacques; Ed & Laurie Bachrach Subject:
Re: August 04 Rattanakiri TM Clinic Special case YC#00085 Dear
All, I
am wondering if this patient has an HIV related oral mucosa problem.
Kaposi' I
agree to do some work up at SHCH. We might need to take a biopsy from
the big Thanks Dr.
Cornelia Haener Surgeon
SHCH -----Original
Message----- Hi Dr. Ryan: Here it is! Thank you. Kathy -----Original
Message----- Not sure what he has. I don't have an explanation for his bleeding with a normal CBC, normal platelet count, apparently normal CT and BT (but we don't use those assays; but they do not appear to be prolonged). Toxins possible, good story for snake bite (but missing the snake and missing DIC), chipmunks associated with rat bite fever, tularemia, plague, la crosse virus but ID less likely with no fevers, but would empirically treat with Augmentin (amox-clavulinic acid) 500 mg po TID if available and doxycycline 100 mg po BID x 5-7 days. Would repeat CBC and check HIV. Edward T. Ryan, M.D., DTM&H Administrative Office Tel: 617
726 6175 The
information transmitted in this email is intended for the person or
entity to which it is addressed and may contain confidential and/or
privileged material. Any review, retransmission, dissemination or
other use of, or taking of action in reliance upon this information by
persons or entities other than the intended recipient is prohibited.
If you receive this email in error, please contact the sender and
delete the material from any computer. -----Original
Message----- Dear All, Here is the first surgical cases of two we are sending to you during this month TM at RPH. Please try to rely to this first one as soon as possible due to its urgency of the problem. Thank you for your additional time assisting us at RPH. Regards, Sovitha/Rithy Rattanakiri
Provincial Hospital Telemedicine Clinic Patient: T#00086,
20M, Village I
Please send
all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any
review, retransmission, dissemination or other use of or taking of any
action in reliance upon, this information by persons or entities other
than the intended recipient is prohibited.
If you received this e-mail in error, please contact the sender
and delete material from any computer. -----Original
Message----- From:
hopestaff@online.com.kh [mailto:hopestaff@online.com.kh] Sent:
Friday, August 20, 2004 4:56 PM To:
Kiri Hospital Cc:
Ruth Tootill; Heather Brandling-Bennett; Joseph Kvedar; Kathleen M. Kelleher;
Paul Heinzelmann; Bernie Krisher; Nancy Lugn; Noun SoThero; Rithy
Chau; Gary Jacques; jmiddleb@camnet.com.kh; Ed & Laurie Bachrach Subject:
Re: August 04 Rattanakiri Special Surgical Case T#00086
Dear
All, the
images show extensive soft tissue necrosis down to the tendons, bone not
Penicillin
and lincomycin/clindamycin, or ceftriaxone. With
kind regards Dr.
Cornelia Haener Surgeon
SHCH -----Original
Message----- From:
Fiamma, Kathleen M. [mailto:KFIAMMA@PARTNERS.ORG] Sent:
Friday, August 20, 2004 10:36 PM To:
'kirihospital@yahoo.com' Cc:
'tmed_rithy@online.com.kh' Subject:
FW: Consult
Rattanakiri
Provincial Hospital Telemedicine Clinic Patient: T#00086,
20M, Village I Chief
Complaint: Cobra
Snake bite x 15d August 20, 2004 Dear
Sirs: I
have reviewed the well-documented case that you have presented and it is
apparent that your initial care has been extremely effective.
This patient has been spared the systemic complications of
envenomation from his Cobra bite, but the consequence of local necrosis
of the index finger was unavoidable. This is due to the fact of
its relative
inability to
tolerate tissue swelling. The finger is essentially a closed space and
because of the small diameter, the elastic limit of the skin is rapidly
reached. We are therefore left with the problem of an essentially
useless index finger as well as an unknown degree of more proximal
tissue necrosis that appears to be concentrated largely within the
territory of the index ray. The palmar surface of the hand looks to be
in good condition. Although
initial local tissue excision was for many years thought to be effective
in the treatment of snakebite, more recent study has failed to prove its
effectiveness. However, this wound is essentially now a problem in
elimination of infected and necrotic tissue with reestablishment of
functional skin coverage, I would recommend a radical excision of the
entire index ray, removing the metacarpal to its articulation with the
carpus and debridement of all necrotic tissue including poor skin on the
dorsum of the hand. The wound would be gently packed open with frequent
dressing changes and subsequent debridement if necessary. The skin of
the palm could then be rotated to cover the remaining defect after all
remaining tissues are healthy. The
functional result in the presence of the other intact fingers should be
good. I
hope that this has been of help to you and would be most interested in
the follow-up after he has been released from the Hospital Center. Sincerely
yours,
Robert
D. Leffert, M.D. Venom levels
might remain high 48 h after snakebite. Two or more vials of specific
antivenom administered soon after snakebite were effective in
neutralizing the circulating venom as revealed by ELISA. Higher doses of
antivenom may be indicated in cases of cobra venom-induced local tissue
destruction. The
dosage of antivenin used to treat patient bitten by cobra was less
than that recommended by the poison control center, and the
complication of skin necrosis requiring skin grafting was more severe
than that of the other species.
-----Original
Message----- Dear All, Here is the next surgical case SK00087. Photos will be sent later. Regards, Sovitha/Rithy
Please
send all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any review, retransmission, dissemination or other use of or
taking of any action in reliance upon, this information by persons or
entities other than the intended recipient is prohibited. If you received this e-mail in error, please contact the
sender and delete material from any computer. Rattanakiri
Provincial Hospital Telemedicine Clinic Patient: SK#00087,
30M, THMEY Village
Please send
all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
. The
information transmitted in this e-mail is intended only for the person
or entity to which it is addredded and may contain confidential and/or
priviledged material. Any
review, retransmission, dissemination or other use of or taking of any
action in reliance upon, this information by persons or entities other
than the intended recipient is prohibited.
If you received this e-mail in error, please contact the sender
and delete material from any computer. -----Original
Message----- From:
hopestaff@online.com.kh [mailto:hopestaff@online.com.kh] Sent:
Friday, August 20, 2004 5:18 PM To:
Kiri Hospital Cc:
Ruth Tootill; Heather Brandling-Bennett; Joseph Kvedar; Kathleen M. Kelleher;
Paul Heinzelmann; Bernie Krisher; Nancy Lugn; Noun SoThero; Subject:
Re: August 04 Rattanakiri Special Surgical Case SK#00087 Dear
all, the
AP X-ray shows severe compression of Th 12. We need a lateral X-ray to Please
do a lateral film with focus on thoracolumbar area. Patient
needs to be in bed in flat position, pillow under thoracolumbar area to Further
management depends on his lateral film: If
posterior ligament intact, conservative with bedrest for at least 6
weeks, Thanks
Dr.
Cornelia Haener Surgeon SHCH
-----Original
Message-----
We are two lateral thoracolumber Rx's films sent to you. Here are the lateral picture and it dosn't clear and in the hospital we don't have three point brace for mobilizing. There will be one more picture to sent later. Thanks you for your helping, Best regards, Channarith/Sovitha -----Original
Message----- From:
hopestaff@online.com.kh [mailto:hopestaff@online.com.kh] Sent:
Tuesday, August 24, 2004 10:32 AM To:
Kiri Hospital Cc:
Gary Jacques; Jennifer Hines; Bunse Leng; Rithy Chau; Ruth Tootill; Heather
Brandling-Bennett; Joseph Kvedar; Kathleen M. Kelleher; Nancy Lugn;
Paul Heinzelmann; Noun So Thero; Bernie Krisher; Montha Subject:
Re: August 04 Rattanakiri Special Surgical Case SK#00087 Dear
All, thanks
for the additional X-rays. I showed the images to our orthopedic surgeon
1.
Keep on absolute ( 24 hour ) bed rest in flat position for 6 weeks. Turn
2.
Bring him to Phnom Penh to the rehabilitation center Kien Klieng, run by
For
both options, a physiotherapist should teach him exercises to strengthen
For
both options, you need a very compliant patient. If he is not up to
that, I
hope this helps. Thanks Dr.
Cornelia Haener Surgeon
Sihanouk Hospital Center of HOPE -----Original
Message-----
Heng
Soon
Tan, M.D. Thursday, August 19, 2004Follow-up Report for
Rattanakiri TM Clinic There
were new and follow-up patients seen during this month TM clinic at
Rattanakiri Referral Hospital (RRH).
The data of all cases were transmitted and received replies from
both Phnom Penh and Boston. Per
advice sent by Partners in Boston and Phnom Penh Sihanouk Hospital
Center of HOPE, the following patients were managed and treated per
local staff: [Please
note that in general the practice of dispensing medications at RRH for
all patients is usually limited to a maximum of 7 days treatment with
expectation of patients to return for another week of supplies if needed
be. This practice allows
clinicians to monitor patient compliance to taking medications and to
follow up on drug side effects, changing of medications, new arising
symptoms especially in patients who live away from the town of Banlung
and/or illiterate.] 1. PN#0005, 38F, Village I ( follow up) 1. Asthma 2. Allergic Rhinitis 3. GERD 4. PUD A. Amoxicillin (875mg) 1 tab bid for 14 days B. Metronidazole(250mg ) 2 tab bid for 14 days C. Omeprazol(20mg) 1tab bid for one month D. Albuterol Inhaler 2 puffs bid prn exascerbation E. Azmacort Inhaler 2 puffs bid SHCH will continue to send medications for this patient’s asthma condition during her care through the TM clinic at RRH 2. EB#00078, 40F, Village I ( follow up) 1. Cardiomyopathy? A. Spironolactone (25mg) 2 tab bid for 100 days B. Captopril (25mg ) ½ tab bid for 100 days C. Digoxin (0.25mg) 1 tab qd for 100 days D. Furosemide (40mg) 2 tab po bid for 100 days E. MTV 1 po bid SHCH
will continue to send medications for this patient during her care
through the TM clinic at RRH 3. KP#00082, 61F , Village II
1.
Dyspepsia 2.
r/o PUD A.Cimetidine (200mg) 2 tab po qd for one month 4. ND#00083, 38F 1. Hyperthyroidism A. Atenolol(50mg) qd for 14 days This patient went home to give offering to the spirits before blood was drawn for thyroid function tests and did not return to RRH. 5. SM#00084, 48F, Bey Srok Village
1. Diabetes
2. Nephrolithiasis A.
Spasfon 1 Amp
tid iv B. Indomethacin (25mg) 1 tab po tid for 5 days C. Glibenclamide (25mg ) 1 tab po qd everyday . 6. YC#00085, 20M, Laong Village. 1. DIC 2. Animal (chipmonk) bite 3. GI bleeding A. Doxycycline 100mg 1 tab po tid for 14 days B. Multivitamin 1 tab po qd for 10days C. Paracetamol 500mg 1 tab po q6h for 10days D. B-complex 1 tab po qd for 10days 7. T#00086, 20M, Village I 1.Cobra Snake Bite A. Ceftriaxone 1 g 2 vial IV bid for 7days B. Multivitamin 1 tab po bid for 7 days C. Indomethacine 25mg 1 tab po tid for 7days This patient was scheduled for digit amputation after a thorough wound debridement that showed ligament involvement almost 1 week later after this TM clinic. However, the family of the patient in PP refused to have this done in Rattanakiri and requested permission to have this amputation done and follow-up in PP instead. RRH Dr. Sovitha granted this permission. 8. SK#00087, 30M, Thmey Village 1.Thoracolumbar fracture with possible compression T12 A. Multivitamin 1 tab po bid for 7 days B. Winagin 1 amp IM tid (condition) -----Original
Message----- From:
Bernard Krisher [mailto:bernie@media.mit.edu] Sent:
Wednesday, August 25, 2004 5:25 PM To:
Kiri Hospital Cc:
aafc@camnet.com.kh; thero@cambodiadaily.com; Sovann Nop; tiann monie;
Samnang; Kiri; gjacques@bigpond.com.kh; Rithy Chau; Sing Seda; Kvedar,
Joseph Charles,M.D. Subject:
Re: Urgent: Patient referral from August TM clinic Dear
Channarith We
generally provide ground transportation, or air transportation for Best
regards, Bernie >Dear
Bernie, > >I
am writing to you to
request for some money from the fund to >refer
the patient from our August 04 TM clinic to Phnom Penh. >The
patient SK#00087, 30 y,Male diagnosed with probable >Thoracolombar
Column fracture (compression T12) .During the clinic >Doctors
at SHCH and Boston advised to refer him to Phnom Penh.This >patient
will need financial assistance with Air transportation, food >and
accommodation.He also need a relative to accompany him on the >flight
to PP. >Please
let me know as soon as you can ,so that I may prepare the >patient
medical record before he goes to Phom Penh. >Could
you please ask Mr sovan to arrange them and communicate with >Kiri
when they arrieve in PP. >Thank
you for your kindness. >Best
regards, > >Channarith BERNARD
KRISHER 4-1-7-605
HIROO, SHIBUYA-KU, TOKYO (150-0012) Tel:
+81-3-3486-4337; Fax: +81-3-3486-6789 Email:
bernie@media.mit.edu cellular:
+81-90-30-888-493, in Japan: 090-30-888-493 Faxes
sent to USA 1-212-658-9419 will reach me via e-mail Web:
www.cambodiaschools.com, www.villageleap.com, www.futurelight.org, www.save3lives.com,
www.cambodiadaily.com, www.sihosp.org,www.ratanakiri,com, www.TravelWithaHeart.com,www.povertyredux.com
(under construction) -----Original
Message----- Dear all, This telemedicine pt with a spine fracture is flying down. May appear here. Perhaps over the weekend, I don’t know yet. Cornelia, can you coordinate care and advice if he comes to SHCH? I recall you suggesting Kleeng Klang rehab unit could fit a brace. Ortho can see (Boyet or Tim). May need analgesics. Keep me in the loop with all advice, referrals and care of this patient. Thero, will you call me when plans and times are finalized? Best Regards to all, Gary -----Original
Message----- Dear Channarith, I did not get Thero's reply. Go ahead and fly them both in. Thero can get a discounted ticket (half price for patients). Ask Sovann to contact Thero about the arrangements. Next time I hope to get this coordinated better. Best regards, Bernie Dear Bernie,
What about our communication?.Did you ask Thero to confirm on this patient SK#00087 because patient is waiting for our treatment.
Best regards,
Channarith -----Original
Message----- From:
Rithy Chau [mailto:tmed_rithy@online.com.kh] Sent:
Monday, August 30, 2004 4:56 PM To:
Channarith Ly Cc:
So Thero Noun; Jack Middlebrooks; Gary Jacques; Ed & Laurie Bachrach;
Cornelia Haener; Bernie Krisher Subject:
Rattankiri TM Dear
Dr. San, Dr. Sovitha and Channarith, Dr.
San: Please do send the
list of treatment plan for each patient seen at August 04 TM Clinic as
soon as you get it done. Dr.
Sovitha: I have visited
Kean Kleing today again and talked to the manager and his technicians
concerning request for a 3-point or hyperextension body supporter for
patient SK#00087. However, they informed me that this was not possible because
they need to have the patient in front of them for precise measuremet
for the supporter and also need to be fitted properly on him. After discussing with Dr. Boyet (SHCH orthopedic surgeon)with
the approval of Dr. Gary, the following plan should be taken: 1. Dr. Boyet and I will do a demonstration on how-to do a body
cast with step-by-step photos to show you how to do this on your own at
RRH. Once done, the photos
with appropriate instruction will be sent to you via e-mail.
We plan this on Thursday afternoon. 2. Meanwhile, keep the patient prone (lying on his belly or
stomach) and avoid lying supine (flat on his back) on the hard surface
to prevent further flexion of the body thus lessen the deformity of his
back. 3. Please retake another spine x-ray with a lateral view and
send the digital photo to us as soon as you get this. 4. Try to inform the patient that this process of caring for his
condition will take quite a bit of time.
Try to convince him not hurry home if he desires proper care for
his back problem. As
a result, this patient do not need to be transport to PP. Channarith:
Our next TM Clinic (in 09.04) will be held on the week of the
13th, correct? Do you still
want me to teach you basic operation of powerpoint presentation program
while I stay in Rattanakiri? Thank
you all for your hard work and dedication to care for these TM patients. Regards, Rithy -----Original
Message----- From:
Gary Jacques [mailto:gjacques@online.com.kh] Sent:
Tuesday, August 31, 2004 9:01 AM To:
'Rithy Chau'; 'Channarith Ly' Cc:
'So Thero Noun'; 'Jack Middlebrooks'; 'Ed & Laurie Bachrach'; 'Cornelia
Haener'; 'Bernie Krisher'; Pat Gempel (E-mail); Boyet Dela Costa Subject:
RE: Rattankiri TM Dear
TM team, I
want to congratulate everyone for the good discussion centered on this It
will be an interesting demonstration to show via the internet how to Rithy
can follow up on his next trip. Please confirm in the interim that Gary -----Original
Message----- From:
Rithy Chau [mailto:tmed_rithy@online.com.kh] Sent:
Thursday, September 02, 2004 3:20 PM To:
Channarith Ly Cc:
So Thero Noun; Bunse Leang; Jack Middlebrooks; Gary Jacques; Ed & Laurie
Bachrach; Bernie Krisher Subject:
Concerning SK#00087 Dear
Dr Sovitha/Channarith, We
did a video on a demonstration of doing a 3-point or hyperextension body
cast this afternoon and once edit and record onto a CD, I will send it
along with some materials which you do not have there for you to start
on the body cast on the patient by plane on Saturday.
Remember to wait about 30-40 mins for drying before cutting hole
in the belly area to release tension.
Once dried, patient can return home and follow up when the cast
begins to loosen on his body. Please have him come to the next TM clinic on Sept. 14. If
any other question, please call me or e-mail me.
Call me on the phone on weekends. Regards, Rithy -----Original
Message----- Dear Rithy, I have already receiced your video demonstration for make hyperextention body cast and I done it this afternoon but I made it when the patient sit down on the chair because he is pain, he can't stand for a long time and after I do it, he can't stand up or sit down for a long time also. This is the first hypertextention body cast's photo that we sent to you. If any question, please e-mail me . Regards, Sovitha __________________________________________________
-----Original
Message----- Dear Dr. Sovitha/ Channarith, Thank you for the photos of body cast for SK#00087 and congratulations on getting it done. It must be a relief for both the patient and us. I am glad this work out well for you and save much on transporting patient to PP as well as avoiding other complications on transporting such patient with possible spinal fx. I let Dr. Boyet and Dr Bunse looked at the photos you sent and they were well pleased with the result you did. I will see you next week. Regards, Rithy
-----Original
Message----- Dear Rithy, This is the last hypertextention body cast's photo that we sent to you. Regards, Sovitha __________________________________________________ SHCH sent some additional medication for this patient, SK#00087: · Codeine 30mg 1 po tid prn pain · Bisacodyl 5mg 1 po bid prn constipation · MTV 1 po qd The
next Rattanakiri TM Clinic will be held on
|
especially prominent on right upper
chest.
left index finger while he
was catching it for selling. Soon after, his finger was swollen
progressively increasing with pain and he applied some herb medicine in
traditional method and after that patient was sent to Rattanakiri
Hospital at 5PM on the same day. We cleansed his bite wound and treated
with antivernin ( Ophiophagus Hannch) 2 doses, at 5:20 PM on his right
deltoid and another at 5:50 PM 10cc IV), hydrocortisone 100mg IV
infusion for 7 days and continued with
metronidazol 500mg 1 tablet tid for 7 days, Indomethacine 25mg 1 tablet
bid, paracetamol 500mg 1tb tid, but a few days after accident his arm
and his hand was with some blisters and edema with warmth but no
erythema up to his elbow and the pain decreased but the edema did not
decreased and his right index finger became blue progressively and index
finger's joint became stiff. Now we cleaned and debried wound every day;
After 15 days of tx and wound care, there was slight improvement with
less smell at wound site.
Dexasmethasone 4mg 2amp tid i.v, Ampicillin 2g tid i.v and infusion LR
1000ml per day. On 20/08/2004 morning he became better, unable to stand
up due to pain also pain on coccyx region with radiation to his both
legs when he sit up and lie down on his back.
kyphosis.
