what do you want guys?

[steve]

I am a medical doctor. some members are also medical doctors I think. So I can't do wrong things. They will point out if I send a wrong message here. That's good.

Ok, first of all, what do you want to know? But dont ask me about birth control pills or sexual health what I dont know. Ask me about your brain, heart, lungs, kidney problem. OK?

[steve]

Thanks for your question.

Well you are quite young.

I suspect that you had Spontaneous Pneumothorax if you did not have any big lung problem prior to the event. You are not alone. I saw many patients like you before.

What I still dont know is
1. the type of operation.
2. And why you had to go surgery?
3. do you have any lung problems like TB and Pneumonia when you're too young.

Basically , we dont refer to surgeons for operation (opening chest wall and stapling lung) provided that there is not a frequent recurrence or there is not a likelihood of recurrent attack due to underlying problem. Most uncomplicated pneumothorax patients stay 2 days in hospital and can go home.

Yes, if you had chest opening operation, pain is very common among those people for months to years. We need to try with different medications to get better.

I think you are my first genuine patient. if you answer my questions, I can explain more and I could give you an advice.

All the best.
Steve

Myo Kyaw Htun said:

I suffered Pneumothorax in late december 2007. After operation, I am still not feeling well and don't think like normal. Whenever I get chest pain, I go and check in hospital. It is still normal. But feeling tight inside chest is uncomfortable to me. Doctor always told me that it always happened to those who took operation. What I found myself is that I get chest pain (both side) whenever I get stress, feeling bad/sad and lack of sleep. Do you want to give me any suggestion?

my age: about to be 23
height: 5' 10"
weight: 57 kg
neither smokie nor drinker

p.s: I also checked heart. It is okie.

Regards,

Myo Kyaw Htun

[Myo Kyaw Htun]

Yes, doctor. I had Spontaneous because of my body type and age.

I took operation as soon as doctor knew that there are so much air between my body and lung when I went to hospital and checked with the chest doctor for the first time (really first time). I think i had TB when I was young. They put chest tube inside my body and I stayed there about 3 days to took out the air completely from my body. I still remembered that I asked the doctor "what If I don't take operation, doctor?" He replied me "You'll die of shortness of breath if somebody can't bring you hospital on time". He also added lung doesn't work very well because of too much air occupied in the body and It can't expand as we see in normal person. Then I took operation on that time.

Yes, if you had chest opening operation, pain is very common among those people for months to years. We need to try with different medications to get better.

Yep, they also told me like this too. Not too much pain I get but feeling tight is uncomfortable for me.

Thank so much for your quick answer, doctor.

[steve]

Hello

I understand that you may have a scar in your lung. The would be the reason you had to go operation.

But, I've never seen before the patient who has only one pheumothorax and he has to undergo operation. We normally consider the benefit of operation, its consequence and how many recurrence and many more factors. I mean we balance ?with or ?without operation. We have British Thoracic Society guideline. Basically different county, different guide line, according to the previous evidence ( best outcomes). I don't know where you had operation and who decided.

Again, regarding your pain, we need to think about you should take the new medications or not.. Basically, you must not get restricted on your daily activities because of pain. At the same time, you must not suffer from unwanted effects of pain killers unnecessarily. That is what we do in our practice.

Well known complication of chest surgery is pain after operation. What actually happens is that there are many nerves running along the ribs. During the operation, some nerves are damaged inevitably. As a consequence, a long term pain or discomfort ensues.

It is the nerve pain. So normal pain killers are not so helpful sometime.

If you want to go further as your pain is distressing, you may contact me through one of my websites. I also need to know what medications you have tried.

All the best.

[Junior]

ဝင္ၿပီး စြက္ဖက္တာ မဟုတ္ပါဘူး ကို steve ေရ။ Paracetamol 4gm/day ကို က်ေနာ္ေတာ့ လက္ခံပါတယ္။ က်ေနာ္ မွတ္ထားတာေတာ့ 60 kg လူတစ္ေယာက္အတြက္ အဆိပ္သင့္ႏုိင္တဲ့ ပမာဏက ၁၀ ဂရမ္နဲ႔ အထက္ပါ။ အဲဒီ ပမာဏ ေက်ာ္သြားရင္ အဓိက ထိႏုိင္တာက အသည္းလို႔ပဲ က်ေနာ္ ေတြ႔ဖူးပါတယ္။ က်ေနာ္တို႔ ဆီးႏွင့္ေက်ာက္ကပ္ေဆးပညာက ဆရာသမားေတြလည္း ပါရာေၾကာင့္ ရတဲ့ ေက်ာက္ကပ္ ေရာဂါသည္လို႔ အမည္တပ္ေလ့ မရွိပါဘူး။ အကုိက္အခဲ ေပ်ာက္ေဆး အမ်ားစု ကေတာ့ renal toxicity အနည္းႏွင့္ အမ်ား ရွိႏုိင္ပါတယ္။ ဒါေပမယ့္ ပါရာကေတာ့ safe အျဖစ္ဆံုး ျဖစ္ႏုိင္ပါတယ္။

ေနာက္တစ္ခ်က္က ပိုလို ေသာက္ရင္ ကယ္လို႔ ရေပမယ့္ ပါရာေသာက္ရင္ (overdose) ျဖစ္ရင္ ရွုင္ဖို႔ နည္းပါတယ္ ဆိုတဲ့ ကိစၥက ဒီလို လြယ္လြယ္ ေျပာလို႔ ရမယ္ မထင္ပါဘူး။
အဆိပ္သင့္ လူနာတုိင္းမွာ အခ်ိန္မွီ ေရာက္ရွိမႈ၊ ေဆးဝါး ေဆးကိရိယာ ရရွိႏုိင္မႈ၊ Intensic Care Unit ရွိမရွိ အေပၚမွာ မူတည္တာပါ။ ဘယ္ဟာက ပိုဆိုးတယ္ဆိုတဲ့ general rule မရွိပါဘူး။ ေနာက္္ဆက္တဲြ ျပႆနာအရ ဆိုရင္ေတာ့ paracetamol က irreversible liver function damage ရႏုိင္တယ္ လို႔ ဆိုပါတယ္။

ကို ခ်စ္သူေမာင္က အသက္အရြယ္အရ က်ေနာ္တို႔ အတန္းေလာက္ကပဲ ျဖစ္မွာပါ။ ေဆး (၁) ကဆိုရင္ေတာ့ သိမွာပဲ။

[Junior]

ဖုိရမ္မွာ တိုင္ပင္ရတာ ေတာ္ေတာ္ ခက္မွာပဲ ကို steve ေရ၊ ေရာဂါရဲ့ သမုိင္းေနာက္ေၾကာင္ေလးတစ္ခုပဲ သိရၿပီး စမ္းသပ္မႈ မလုပ္ရ၊ ဓါတ္ခြဲ ဓါတ္မွန္ စစ္ေဆးမႈေတြ မလုပ္ရနဲ႔ ဆိုေတာ့ တိက်တဲ့ အေျဖတစ္ခု ထြက္ဖို႔ မလြယ္ဘူးေနာ္။ က်ေနာ္ထင္တာေတာ့ က်ေနာ္တို႔တစ္ေတြ local ဆရာဝန္ေတြဆီမွာ ျပသၿပီး ဆရာဝန္ ေျပာလိုက္တဲ့ ေရာဂါအမည္ကို ေျပာၿပီး ကုိ steve ကို ေမးရင္ေတာ့ ဒီထက္ပို အဆင္ေျပလိမ့္မယ္ ထင္တယ္ဗ်။

[steve]

As you know very well, some conditions can be diagnosed by history. Most need routine blood tests, special tests and imaging. It depends. At the same time, the diagnosis made by someone? Can I trust it? Again it depends.

I dont know about now. But when i was in Burma, MCV is not easily available. Withouth MCV, how can we give further management for anaemic patient.

Junior said:

ဖုိရမ္မွာ တိုင္ပင္ရတာ ေတာ္ေတာ္ ခက္မွာပဲ ကို steve ေရ၊ ေရာဂါရဲ့ သမုိင္းေနာက္ေၾကာင္ေလးတစ္ခုပဲ သိရၿပီး စမ္းသပ္မႈ မလုပ္ရ၊ ဓါတ္ခြဲ ဓါတ္မွန္ စစ္ေဆးမႈေတြ မလုပ္ရနဲ႔ ဆိုေတာ့ တိက်တဲ့ အေျဖတစ္ခု ထြက္ဖို႔ မလြယ္ဘူးေနာ္။ က်ေနာ္ထင္တာေတာ့ က်ေနာ္တို႔တစ္ေတြ local ဆရာဝန္ေတြဆီမွာ ျပသၿပီး ဆရာဝန္ ေျပာလိုက္တဲ့ ေရာဂါအမည္ကို ေျပာၿပီး ကုိ steve ကို ေမးရင္ေတာ့ ဒီထက္ပို အဆင္ေျပလိမ့္မယ္ ထင္တယ္ဗ်။

[Junior]

CP (coulter) including MCV is now readily available in Yangon, Mandalay and some cities.
However, there are still many tests need to be done in neighbour countries.


steve said:

As you know very well, some conditions can be diagnosed by history. Most need routine blood tests, special tests and imaging. It depends. At the same time, the diagnosis made by someone? Can I trust it? Again it depends.

I dont know about now. But when i was in Burma, MCV is not easily available. Withouth MCV, how can we give further management for anaemic patient.

Junior said:

ဖုိရမ္မွာ တိုင္ပင္ရတာ ေတာ္ေတာ္ ခက္မွာပဲ ကို steve ေရ၊ ေရာဂါရဲ့ သမုိင္းေနာက္ေၾကာင္ေလးတစ္ခုပဲ သိရၿပီး စမ္းသပ္မႈ မလုပ္ရ၊ ဓါတ္ခြဲ ဓါတ္မွန္ စစ္ေဆးမႈေတြ မလုပ္ရနဲ႔ ဆိုေတာ့ တိက်တဲ့ အေျဖတစ္ခု ထြက္ဖို႔ မလြယ္ဘူးေနာ္။ က်ေနာ္ထင္တာေတာ့ က်ေနာ္တို႔တစ္ေတြ local ဆရာဝန္ေတြဆီမွာ ျပသၿပီး ဆရာဝန္ ေျပာလိုက္တဲ့ ေရာဂါအမည္ကို ေျပာၿပီး ကုိ steve ကို ေမးရင္ေတာ့ ဒီထက္ပို အဆင္ေျပလိမ့္မယ္ ထင္တယ္ဗ်။