WHAT IS THE DIAGNOSIS?

Thyrotoxicosis with Exophthalmos. Once we get this man's disease medically controlled we will perform a total thyroidectomy. His eyes will probably not improve, however.

GETTING GOING

Yesterday, we did 11 surgeries including 2 orchiectomies (for prostate cancer), 2 thyroidectomies, a gastrectomy (for gastric outlet obstruction),  a fistula in ano, an inguinal hernia, a recurrent ureterocutaneous fistula,  2 pediatric hernias, and a bone biopsy. We have done a total of 35 surgeries in 5 days. There are 30 patients waiting for surgery. The hospital is full and patients are sleeping on mattresses on the floor. We are just warming up!

MOTHER OF ALL GOITERS 1

This lady has had a growing thyroid mass for 10 years. Today we removed it. The gland  weighed 850 grams-almost 2 pounds. The piece on the right was substernal, lying on top of the aortic arch.

Dr. Mike and I operated on their lady yesterday. She has a large parotid tumor. We were able to find the 7th nerve and save it. These are some of our most difficult and tedious cases but can be much easier with a great assistant like Mike.

WHAT IS YOUR DIAGNOSIS?

This young man came in with nausea and vomitting. He is holding a film from his upper GI series.

He has a gastric outlet obstruction. We operated today and did a subtotal gastrectomy with a Billroth l anastomosis. His stomach was quite distended with barium from the previous day.

MONDAY, MONDAY

Yesterday was so busy that I didn't get to the blog. It was the first Monday since my arrival and the word had gotten out that I was around. Patients pored in to the hospital. Between the 9 surgeries, I saw about 50 patients with all types of horrendous problems.

We are glad that Eric, the chief nurse anesthetist, is feeling better. He has chicken pox!!! He and his children are all recovering. Nonetheless, he came to work and helped us. We now have 3 anesthetists-Wison, Prince and Eric. All 3 are experts. With their help we were able to do nine surgeries today including a splenectomy, a goiter, a LN biopsy, fuguration of skin cancers, a breast lumpectomy, bilateral salpingoophorectomy rectopexy, excision of an abdominal wall mass and an incarcerated, strangulated ovary in a  pediatric hernia.The last case was very interesting from an anesthesia viewpoint. I saw the patient in clinic and decided to operate. Eric had the 3 month-old baby asleep within 15 minutes. A record for any part of the world.

We had a great surprise. Ngozi, our patient from last trip with advanced dermatofibosarcoma protuberans, came for a check up. You may remember that we did a radical resection of her shoulder area including her pectorals muscle, deltoid muscle, upper trapezius muscle, upper breast and clavicle. We transposed her lower breast for tissue coverage over the shoulder joint. She later had a skin graft. She is doing great!!!

This little girl came in with a thyroglossal duct cyst. I was surprised when I asked her to open her mouth. She has several accessory teeth.

Our patient, Chinaka, from last trip came for a check-up. We performed a left hemimandibulectomy for an ameloblastoma. He is doing great and gaining weight despite the loss of most of his right mandible.

We have 21 patients waiting for surgery and many more are still coming.

THYROIDS AND SPLEENS

The first case of the day was a very difficult thyroidectomy. The goiter was substernal and very vascular. We got it out but it was a struggle. Fortunately. the recurrent laryngeal nerves and parathyroids are intact. 

We followed with a giant spleen. The patient was somewhat unhealthy. When we entered the abdomen, we found a hemoperitoneum! I think this was caused by small areas of infarct in the spleen due to its size.

The team is growing. Dr. Bock left but Uche arrived. We also have Drs. Eze, Charles, Kelechi, John, as well as Wilson, our nurse anesthetist (far right), and Smart, our surgical technician (3rd from left). Tomorrow will be a big day. Patients will pour into the hospital joining the 15 we already have waiting.

BUS STOP-YOUNG SHALL GROW

After traveling from Dallas to Frankfort, then Frankfort to Lagos, I soon found out that there was a general strike in Nigeria and domestic flights were not flying. I was stuck in lagos!. Finally, I decided to take a bus from Lagos to Aba-no small feat. The picture shows the bus stop for Young Shall Grow motors. When I got on the bus, the driver told me "Don't sleep during the trip". He wouldn't say why. This did make me slightly insecure. The bus left at 10P and traveled through the night -arriving in Aba at 6A. Then the hospital driver picked me up. I arrived at NCH at 0700 and was rounding on patients by 0730. The poor lady below was on the female ward with an advanced breast cancer. She has already received 1 course of chemotherapy and, apparently, the tumor has shrunk and she is much better! I will operate before I leave. There are about 25 patients waiting for surgery.