Report
and photos compiled by Rithy Chau, Telemedicine Physician Assistant
at SHCH On
Wednesday, August 20, 2003, Ratanakiri Provincial Hospital (RPH) staff
with their Telemedicine(TM) Partners from Sihanouk Hospital Center of HOPE
(SHCH) in Phnom Penh, Cambodia and the TelePartners from Boston, USA,
opened and participated in the TM clinic.
The patients were examined by clinicians from RPH and their data
were transcribed along with digital pictures of the patients, then
transmitted and received replies from their TM partners in Boston and
Phnom Penh. SHCH staff (Rithy
Chau, PA-C and Somontha Koy, RN) were
present during the clinic hours to assist in recording and translating
H&P (from French/Khmer into English) and to monitor and facilitate the
data transmission and communication.
There were three doctors participating in this month TM clinic
along with Pharmacist Ly Channarith and RPH Director, Tha Bunthak, who
managed and directed the clinic. There
were six new cases and two follow up patients from last month clinic
present. All their data and
photos were transmitted. Another follow-up (simulated) case (MP#00017) from last month
clinic was briefly seen by Dr. Kok San to provide her with medication (Captopril)
bought in Phnom Penh and her data was not transmitted during this month
clinic. [Please
note that the patients’ data collected, transcribed, and communicated
were done by the RPH staff and were left in its crude form so as for
viewers to understand the challenge of medicine practiced in remote, rural
setting of Cambodia. The
CamShin satellite was operating smoothly the entire time during this month
TM clinic. However, there
were some computer viruses infecting the system causing the transmission
rate to be very slow and three cases with their photos were sent the
following morning after many failures of sending data late at night (until
11:00 PM).] The
following day, Thursday, August 21, 2003, the TM clinic opened again to
send the rest of the cases and receive the same patients for further
evaluations, treatments and management.
Clinicians from SHCH discussed briefly case by case with the local
(RPH) telemedicine staff concerning each patient’s treatment and
management using information/replies received from the TM partners that
morning. In the afternoon,
trhe local medical staff would then followed up with the agreed plan of
treatment and management with each patient seen.
Finally, the data of the follow-up for patient treatment and
management would then be transcribed and transmitted to the PA Rithy Chau
at SHCH who compiled and sent for website publishing. [Of
the six new cases, two were referred to SHCH for further work-ups and two
to Calmette for 2D echocardiographic procedure.] The followings detail e-mails and replies to the
medical inquiries communicated between TM clinic at RPH and their TM
partners in Phnom Penh and Boston : -----Original Message----- Dear All, Please be informed that the next TM clinic at the Ratanakiri Provincial Hospital will be held On Wednesday, August 20 at 8:00AM local time for one full day. The data of the patients are expected to entered and transmitted to those of you in SHCH and partner (Boston) that evening. Please try to make your replies by noontime the following day, Thursday 21 August. The patients will be asked to return that afternoon on Thursday to receive treatments and plan of follow-up or refer. Thank you for your cooperation and service. Best regards, Channarith
-----Original Message----- Dear Channarith, Thanks for the notice for August TM clinic schedule. Next time please include also Dr. Jennifer Hines (sihosp@online.com.kh), Dr. Ruth Tootill (ruth_tootill@online.com.kh), and Dr. Cornelia Haener (hopestaff@online.com.kh) on your list. The last two doctors are surgeons at SHCH. Please take note the new address for Dr. Ruth Tootill and make correction in your address book as well as on the H&P form for data transmission. Is your satellite dish working now? Is the broken computer fixed yet? No simulated patient this month? Thanks, Rithy -----Original Message----- Dear Rity on 18/03 patient [#00017],we have not captopril , coversyl in hospil.I decided to give her with nifedipine ,furosemide,asp,amox.she told me her symptoms are relieved.but she meet me this morning on 18/03 ,her camplaint of same previous symptoms.I give her buy captopril at market.she take with captopril(25mg) 6.25mg bd for 10 d,asp 1/4 poqd for 10days,furosemide 1 po bd for 5 d ,amox 2po bd for 10days. regard san [Patient MP#00017 could not buy Captopril or Coversyl at the Balung Market. SHCH staff Rithy Chau was asked and bought for this patient Captopril 25mg (#30 tablets) in Phnom Penh and brought to Dr. Kok San to give to this patient on his arrival in Ratanakiri, Tuesday, August 19, 2003. Dr. San prescribed to her ½ tab po bid.] Wednesday/Thursday, August 20-21, 2003 -----Original
Message----- Dear All, Here is a follow-up case from last month. We'll send the photos next. Rithy/Channarith Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners S:
Patient TC#00018, 70F from Thouy
Village was seen in July 03 (simulated patient) and was diagnosed with
psoriasis and was treated with Whitefield ointment, Mebendazole, and
prednisolone presented at August 03 TM clinic for follow up on her
condition and treatment management. Her
skin lesions and symptoms have been improving quite a bit, but there was
another skin eruption with vesicular rashes on her right flank spreading
to her anterior abdomen 1 week ago. The
lesions were painful with burning sensation, but not pruritic.
She did complained of mild fever during the first few days, but now
resolved. Patient has come
earlier to see me at RPH but no treatment was given except the medications
given earlier for her psoriasis. She
has been using ground up traditional medicine made from tree barks and
leaves to put on her new lesions. O:
Psoriatic lesions appeared to be
much improved (see photos). Multiple
open lesions with erythema and tenderness covered by her traditional
medicine of reddish-brown color crust on right flank spreading to anterior
of abdomen in a dermatome pattern. No
lymphadenopathy.
P: 1.
Continue Whitefield ointment, chlorpheniramine and prednisolone as
previously prescribed. 2.
Cloxacillin 500mg 1 tab po q6h x 7d 3.
Paracetamol 500mg 1 tab po q6h prn pain and fever Comments/Notes: Any
other suggestion? Examined by: Dr. Kok San Date: 20/08/03 Please
send all replies to kirihospital@yahoo.com
and cc: to tmed_rithy@online.com.kh
and tmed1shch@online.com.kh. -----Original
Message----- Dear Channarith and Rithy, I am afraid that she had herpes zoster due to steroid. In our SHCH nephrotic syndrome cohorts on steroids we have seen several cases of herpes zoster, and also severe bacterial pneumonia, abscesses, TB, lung/skin nocardiosis, and a few cases of fatal strongyloides hyperinfection (SH). After albendazole (not mebendazole!!!) 400 mg BID for 5 days before long-term steroid, this SH is never seen for the last 4 years, except cases refer in to SHCH. We would suggest to taper off steroid. The case should be evaluate by dermatologist from Boston telemedicine partner Dr. Abrar Qureshi (as in case CR#00023). With best regards, Jennifer/Bunse -----Original
Message----- Dear All, We seem to have much difficulty in attaching photos of patients. We are sending the data ahead so that you may have them to reply to us. This is the last patient to be sent today for this month clinic. If possible we will forward the photos of the ones not yet sent to you. Thank you for your assistance. Channarith/Rithy
Ratanakiri
Provincial Hospital Telemedicine Clinic with Sihanouk
Hospital Center of HOPE and TelePartners
S:
Patient SS#00021, 17F, Village I
seen during July 03 diagnosed with possible hyperthyroidism and was
treated with Atenolol 50mg ¼ tab po bid presented at August 03 TM clinic
for follow up visit. The
patient has been complaining of dizziness, fatigue and vertigo when she
started taking Atenolol. One
week later, her dosage was lowered to 1/6 tab po bid which helped to
improve her tremor and blurry vision, but palpitation only mildly reduced.
No other new sx. O:
Unchanged from previous visit.
03August03 TSH=1.85uUI/mL (0.34-5.6), free T4=0.80ng/dL
(0.58-1.64). Studies
done today: CXR=Normal,
EKG=Normal. A: 1.
Euthyroid
2. Palpitation P: 1.
Atenolol 50mg 1/4 tab po qd. 3.
Vit C 500mg 1 tab tid 4. Recheck TSH and free T4 in two months.
Comments/Notes: Any
other suggestion? Examined by: Dr. Kok San Date: 20/08/03 Please send all replies to kirihospital@yahoo.com and cc: to tmed_rithy@online.com.kh and tmed1shch@online.com.kh.
-----Original
Message----- Dear Channarith and Rithy, Her TSH is normal, CXR normal, EKG possible 1st degree AV block, I would discontinue her atenolol. No anemia (hgb=12.8g/dL in previous telemed), no fever noted, could she just have anxiety? I would just reassure her and have her follow-up next month. Jennifer/Bunse -----Original
Message----- Dear all, There will be more photos for this patient CR#00023. Channarith/Rithy
Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: CR#00023, 10M, Village I
-----Original Message----- The attached letter is from Dr. Abrar Qureshi. Thank you. DIFFERENTIAL DIAGNOSIS
RECOMMENDED PLAN Salient features on history and physical
examination are as follows:
The following
information will be important to further diagnosis:
With regards
management, based on the information provided, here are our
recommendations:
-----Original Message----- Dear All, There are the patient data and photos CT#00024. Channarith Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: CT#00024, 47 years old female Ratanakiri Province
-----Original Message----- Dear Channarith and Rithy, EKG shows LVH by voltage. We agree with atenolol once a day, perindopril (Coversyl). We do not know the reason why digoxin, LVH does not need digoxin, so should be stopped. Since BP is still high, may add hydrochorothiazide (HCTZ) 12.5 to 25 mg q D. For HTN, atenolol and perindopril combination works less better than either of them with HCTZ. In attachment please find guideline on HTN. Jennifer/Bunse -----Original Message----- Dear all, There will be more photos to be sent for this patient KP#00025. Channarith/Rithy Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: KP#00025, 35F, Village II
-----Original
Message----- -----Original
Message----- I have reveiwed the availble information on the referred patient. This 35 year old female first presented with hypertension, which was the focus of therapy with atenolol and furosemide, with the replacement of atenolol with nifedipine. She developed acute pulmonary edema and was appropriately treated. The reported physical exam is generally unrevealing, with a systolic murmur, and ?hepatomegaly. Her BP is now under adequate control. The supporting lab data documents a profound anemia with borderline leuco penia and adequate platelets. The WBC differential suggests a lymphocytosis. The following data was reviewed: Ultrasound: Difficult to interpret a static image Chest x-ray: Cardiomegaly with clear lung fields Eye pictures: Difficult to interpret EKG: Borderline LVH, probably WNL Head Picture: Non diagnostic; the neck veins appear normal in the standing position. Review of the above data suggests that the profound anemia, with Hb 4.2, HCT 15%, is the primary problem. The cardiac decompensation, with cardiomegaly, can be seen with profound and chronic anemias, and the EKG is not definitive in pinpointing a cardiac etiology. Accordingly, I would focus on a complete workup of the anemia, with the underlying concern that the hepatosplenomegaly may be associated with the explanation. Is liver spleen scan possible? Is liver biopsy possible? Is it possible to transfuse the patient to an acceptable HCT? Specific Questions: Digoxin and nifedipine can be continued indefinitely during work up of the anemia. Cardiac Echocardiogram seem less urgent that other W/U, included possible liver biopsy. Respecffully submitted, G.H. Mudge, M.D. -----Original
Message----- Dear Channarith and Rithy, Clinically and CXR proved that this patient, 35 F, has congestive heart failure (CHF), especially left sided, and now is stable on furosemide 40 mg q D with KCl, nifedipine 20 mg BID, digoxin, FeSO4, folic acid and multivitamin. Since she got worse while on furosemide 40 mg q D, just be aware that she may need it BID. I would love to know the cause of her CHFand if possible do an echocardiogram. We would like to replace nifedipine with captopril but her creatinin is high, thus if available, amlodipine 2.5 mg q D should be used instead. History of high blood pressure and now elevated creatinine. I would request a UA, urine microscopy and ultrasound of the kidneys (size and structure) and the urinary tract. Anemia that fall from Hct 18% (7 Aug.) to 15% (19 Aug.) with reticulocytes count 105,000/mm3 suggests a hyperproliferative bone marrow. She has hepatosplenomegaly, so more of hemolysis than blood loss. A good urine dipstick (10 items inside) would reveal that. If Coomb's test is available I would request it. In attachment is approach to anemia lecture from SHCH to Sothnikum referral hospital. Are there any blood bank there? If there is and it is a safe one, we would recommend blood transfusion with packed red cells. Since she has multiple sexual partners, would you plan for a second HIV test? Jennifer agrees that if the patient could pay for transportation, food, housing, long-term medication; then it is OK for us to accept the patient for assessment. With best regards, Jennifer/Bunse -----Original Message----- Dear All, There will be more photos for this patient CK#00026. Channarith/Rithy Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: CK#00026, 21M, Village I
-----Original
Message----- Dear Channarith/Rithy, Thanks for the history, physical and pictures. It looks slightly low to be a parotid mass, but I think it porbably is a pleomorphic adenoma that has recurred. Did the ultrasound say whether it was solid or cystic? You can bring the patient to the SHCH for surgical assessment. Logistically I am not sure how this would be done. Ideally the patient should come to our surgical clinic on Wednesday afternoon, but I understand this may be impractical. This being the case, bring the patient when suitable and either let me, Cornelia or Dr Chantha know and we'll sort it out from there. Ruth Tootill -----Original
Message-----
-----Original
Message----- I do not really know what the underlying disease is and the case report is rather vague in that it states what the original biopsy did not show rather than what it did show. I am not familiar enough with the infectious diseases in SE Asia to ascribe this to an infectious process.It would be unusual for a lymphoma to present as such a large mass. If the patient is HIV positive, lymphoma and sarcoma would be high on the list of possible causes.It is possible for alone biopsy to be negative in the case of lymphoma and often several biopsies must be performed before the diagnosis is established. Irrespective of the underlying cause, the mass is large enough to pose a threat to both swallowing and eventually airway. It needs re-biopsy to establish a diagnosis - if it is an abscess it needs to be drained. I would put a needle in it to see if it is filed with pus and if so an I and D can be performed locally .If no pus is obtained I would send the patient back to Pnom Pen. David Rattner, MD -----Original
Message----- Dear All, There will be more photos for this patient SS#00027. Channarith/Rithy
Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: SS#00027, 67M, Village I
-----Original
Message----- From:
Kelleher-Fiamma, Kathleen M., Telemedicine [mailto:KKELLEHERFIAMMA@PARTNERS.ORG] Sent:
Thursday, August 21, 2003 8:22 AM To:
'kirihospital@yahoo.com' Cc:
'tmed1shch@online.com.kh'; 'tmed_rithy@online.com.kh'; Kvedar, Joseph
Charles,M.D.; Lugn, Nancy E. Subject:
FW: August TM clinic patient SS#00027 >
-----Original Message----- >
From: Guiney,
Timothy E.,M.D. >
Sent: Wednesday, August 20, 2003 8:53 PM >
To: Kelleher-Fiamma, Kathleen M., Telemedicine >
Subject:
RE: August TM clinic patient SS#00027 >
>
He has a left inguinal hernia in need of repair,and therefore needs at a >
minimum a rectal exam and preferably a sigmoidoscopy. >
>
The ECG shows normal sinus rhythm, incomplete right bundle branch block >
and left atrial enlargement. Those
findings,without evidence of prior >
MI,normal blood pressure and cardiomegaly with prominent pulmonary >
vascularity, suggest at least the possibility of a left to right shunt, >
and in particular a secundum ASD. > >
Next step should be an echocardiogram. > Timothy
Guiney, M.D. -----Original
Message----- Dear Channarith and Rithy, 67 M, dump, heavy smoker, intermittent cough with white sputum, complaining of left chest discomfort and SOBOE for last 2 or 3 months. CXR has hypervascular marking, EKG sinus with incomplete RBBB and atrial abnormality. We would suggest to try nitrate at time of chest discomfort to see if it helps or not. Need to rule out other cause of chest discomforts: costochondritis, musculoskeletal pain, pleuretic... SOBOE and intermittent cough with white sputum could be COPD due to heavy smoking, may try salbutamol inhalation. Agree with sputum AFB and chemistries panel. Jennifer/Bunse -----Original
Message----- Dear all, There will be more photos to be sent for this patient KP#00028. Channarith/Rithy -----Original
Message----- Dear All, Sorry for the error in patient number. For this patient it is not KP#00028, but it is CM#00028 as in the "subject". Rithy/Channarith
Ratanakiri Provincial Hospital Telemedicine Clinic with Sihanouk Hospital Center of HOPE and TelePartners Patient: CM#00028,
14 years old, female, from
Konmom district Ratanakiri province
-----Original
Message----- Hi Dr. Pallin: Please let me know if you will be able to opine on this case. The patient is only 14, but if you can do it, I would be very grateful. In another email, I will send you the response of Dr. Gilbert Mudge for another patient and I will be happy to send other responses if needed. Best
regards, -----Original
Message----- Dear
Kiri Hospital Staff,
Thank you for letting me try to help you take
care of Chhorn mom. She is a beautiful girl.
Her case is very worrisome. The shortness of
breath is very concerning.
To begin with, it is important to know more
about her heart. What was done at Ratanakiri Hospital when the diagnosis
of cardiac insufficiency was made? Most likely, she has congenital cardiac
abnormalities. Or maybe she has valvular disease, perhaps from rheumatic
fever. She may also have pulmonary hypertension. Has she had an
echocardiogram? We really need to know the results.
Regarding the data you have provided, her
heart rate of 160 and respiratory rate of 35 are very concerning. On the
EKG, the heart rate is only about 110 – was this done on the same day as
the vital sign measurement?
On the physical exam, it would be very
important to know if she has jugular venous distention, and to describe
the lung sounds – are there rales (crackles), suggestive of pulmonary
edema? Are there decreased breath sounds at the bases suggestive of
pleural effusions?
Thank you for sending the pictures. I do not
think she has clubbing. Her fingernails look normal to me.
The EKG shows right atrial enlargement and
digoxin effect, but nothing acute.
The white blood cell count of 19,000 is very
concerning.
I do not know why she has extremity numbness.
This may be the result of poor perfusion (poor blood flow) to the
extremities.
I think she should be sent back to
Ratanakiri Hospital right away. She should have two goals: (1) to feel
better now, which may require surgery, and (2) to have the doctors there
write down the details of her problems and a plan for what to do when her
shortness of breath gets worse. If surgery is not necessary, then they
will recommend some combination of digoxin, diuretics, nitrates, and
perhaps ACE inhibitors and low-dose beta-blockers. She will need to take
some of these medicines all the time, and she will need to take some of
them only when she feels worse.
It is very important to know the results of
an echocardiogram done during the last five years.
If it is not possible for her to go to
Ratanakiri Hospital, here are some suggestions.
- If she has pulmonary rales or decreased
breath sounds at the lung bases, you might try gentle diuresis with Lasix
(furosemide); if you do this, also give a little potassium with it.
- Find out if the elevated white blood cell
count is new. If she has an infection such as pneumonia, then you can give
antibiotics. An infection would explain why she got worse suddenly.
- There is no reason to take the aspirin two
times a day. She can take 500 mg once a day, along with the digoxin.
Please email me to let me know what happens.
Please tell (CM)
that I send my love and I hope she feels better soon. Yours
truly, Dr.
Danny Pallin ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Danny
Pallin, MD, MPH -----Original
Message----- Dear Channarith and Rithy, Are there any CXR done? EKG shows LVH by voltage and left atrial enlargement (large notched P at lead II > 0.12 sec). No clubbing fingers noted, history of SOB on exertion 4 years. She may have mitral regurgitation or aortic stenosis. If echocardiogram is possible I would request it. Since she is having exertional SOB, I would add furosemide 20 mg q D (morning) along with your digoxin and aspirin q D. Hct of 30% needs a work-up. Start with reticulocytes count and peripheral smear. Please find approach to anemia form SHCH to Sothnikum referral hospital in attachment case KP#00025. WBC 19,100/mm3 and RR=35. Since she doesn't have cough or fever, please look for other possible sources of infection, or may repeat the test. With best regards, Jennifer/Bunse Thursday,
August 21, 2003 Follow-up Report for Ratanakiri TM
Clinic
Three
follow up patients returned for this month TM clinic. The other 6 patients seen were new to the TM clinic at
Ratanakiri Provincial Hospital (RPH). Two
of three follow-up patients were included in this month TM clinic.
Their data were transmitted and received replies during this month TM
clinic. Per advice sent by Boston
TelePartners and Phnom Penh Sihanouk Hospital Center of HOPE, the following
patients were managed and treated per local medical staff: [Please note that in general the practice of dispensing medications at RPH for all patients is 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.] Patient MP#00017, 37F, Village IFinal
assessment: 1)
Post-partum dialated cardiomyopathy
2) Pneumonia This
patient was prescribed with medications from RPH pharmacy (otherwise
indicated) as follows:
Patient TC#00018, 70F, Thouy VillageFinal
assessment: 1)
Herpes Zoster secondary to steroid use
2) Psoriasis This
patient was prescribed with medications from RPH pharmacy (otherwise
indicated) as follows: 1. Whitfield Ointment apply on affected skin qd 2. Chlorpheniramine 4mg 1 tab po tid prn itching 3. Taper off with Prenisolone 5mg 3 tab po bid x 2 wks, then 2 tab po bid x 2 wks, then 1 tab po bid x 2 wks, stop afterward 4. Cloxacillin 500mg 1 tab po q6h x 7d 5. Paracetamol 500mg 1 tab po q6h prn pain Patient SS#00021, 17F, Village IFinal
assessment: 1)
Anxiety?
2) Palpitation Discontinue
atenolol with this patient due to possible 1st degree AV block
in EKG. Reassure patient that
she does not seem to have any major problem to her health.
Patient is advised to return for follow up during next TM clinic in
September. Patient CR#00023, 10M, Village IFinal
assessment: 1)
Helminthic infection 2)
Scabies 3)
Eczematous dermatitis
4) Facial edema with
dermatitis due to prolong use of steroid? 5)
Impetigo due to scratchings This
patient was prescribed with medications from RPH pharmacy (otherwise
indicated) as follows: 1. Benzoyl benzoate soln. apply in all affected areas of body qhs then wash off in AM x 3d 2. Mebendazole 100mg 1 tab bid x 3d 3. Cloxacillin 500mg 1 tab po bid x 7d 4. Chlorpheniramine 4mg 1 tab po tid prn itching Patient CT#00024, 47FFinal
assessment: 1)
HTN
2) Cardiomiopathy
3) Elevated TG This
patient was prescribed with medications from RPH pharmacy (otherwise
indicated) as follows: 1. Atenolol 40mg 1 po qd x 7d 2. HCTZ 50mg ¼ tab po qd x 7d Patient KP#00025, 35F, Village IFinal
assessment: 1)
Cardiac Insuffiency 2)
Severe Anemia
3) VHD
4) Renal
Insufficiency?
5) Anorexia This
patient was prescribed with medications from RPH pharmacy (otherwise
indicated) as follows: 1. Amlodipine 2.5mg 1 tab po qd 2. Furosemide 40mg 1 tab po bid 3. Digoxine 0.25mg 1 tab po qd 4. FeSO4 150mg 1 tab po tid 5. Mult Vit 1 tab po tid Patient was
referred to SHCH in Phnom Penh for further work-up on her anemia and
related sx. Patient CK#00026, 21M, Village IFinal
assessment: 1)
Pleomorphic adenoma 2)
Cystic neck mass This patient was referred to SHCH in Phnom Penh as a surgical case. Patient SS#00027, 67M, Village IFinal
assessment: 1)
COPD 2)
RBBB
3) Cardiomegaly
4) ASD?
5) r/o TB
6) Mute This
patient was prescribed with medications unavailable at RPH pharmacy and
thus needs to buy in Phnom Penh: 1. Salbutamol inhaler 2 puffs bid prn for SOB 2. NTG 0.5mg SL 1 under tongue prn chest pain q5min 3. Patient education for diet and exercise, smoking cessation, and reduce or discontinue EtOH consumption Patient was
sent to have 2D echocardiogram done (at Calmette Heart Center in Phnom
Penh). Patient CM#00028, 14F, Konmom VillageFinal
assessment: 1)
LVH/cardiomyopathy 2)
VHD
3) LAE
4) Anemia
5) Pneumonia This
patient was prescribed with medications from RPH pharmacy (otherwise
indicated) as follows: 1. Furosemide 40mg ½ tab po qd x 5d 2. Digoxin 0.25mg 1 tab po qd x 5d 3. ASA 500mg 1 tab po qd x 5d 4. KCL 700mg 1 tab po qd x 5d 5. Amoxicillin 500mg 1 tab po tid x 7d Patient was sent to have 2D echocardiogram done (at Calmette Heart Center in Phnom Penh). -----Original Message----- Dear Bernie/Thero, I am writing to you to request for fund for Patients referral from our TM clinc to Phnom Penh This month. -Patient KP#00025, 35F, dignosed with CHF, severe anemia, valvular heart dz, and cardiomyopathy, renal insuffiency and bone marrow hyperproliferation and patient CK#00026, 21M, was dignosed with Pleomorphic Adenoma (neck mass) during TM clinic were advised by SHCH to be referred to SHCH. -Patient CM#00028, 14F, dignosed with Mitral regurgitation or Aortic stenosis and patient SS#00027, 67M, dignosed with Incomplete RBBB(Right Bundle Branch Block) And COPD(Chronic Obstuctive Pulmonary Disease). They need to do Cadiac Echogram at Calmette Hospital as recommended by SHCH and Boston. We will communicate with Boston and SHCH to look at the results of these 2D echoes of the heart with recommendations to the treatment plans. Patients KP#00025 and CM#00028 will need financial assistance with transportation, food/board, and certain medications not available at SHCH. The other two have relatives in Phnom Penh whom they can stay and eat with. But I would like to request for hiring a taxi to transport all four patients plus 4-5 people who will accompanied them totaled of 8-9 people. Patient KP#00025 will need two relatives/friends to accompany her because she may need two blood donors for possible transfusion for her severe anemia while seeing MDs at SHCH in Phnom Penh. Best Regards, Channarith/San/Bunthak -----Original Message----- Dear Channarith/San/Bunthak, -----Original Message----- Dear Thero Tomorrow I will send 4 patients with their escorting family in total of 8 people to phnom penh by public taxi, it is Bernie approval with the hospital and TM team. Taxi wil leave for Ratanakiri at 9.00am tomorrow and reach in Phnom Penh at around 8.00am on Monday. Please assign someone to get and send them to the hosptal. You can contact with Mr Rithy or someone wether wich the hospital they have to be sent. Thanks, Best regards Bunthan
The
next Ratanakiri TM Clinic will be held on Wednesday and Thursday,
September 17-18, 2003
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