By: Errol Casiano, M.D. (Class 2000)
Posted: April 17, 2007

     Despite migration of Filipino healthcare professionals abroad, medical tourism in the country is growing. Medical tourism is a term referring to travel to other countries to obtain medical, dental and surgical care while at the same time enjoying the attractions of the country being visited. In Asia, the Philippines is fast becoming a favourite destination not only for those who want to take a vacation but also for those seeking quality medical care at affordable prices. The other day, seven patients from the Marshall Islands arrived at the Ninoy Aquino International Airport. Marshall Islands is a Micronesian island nation located in the western Pacific Ocean. The patients were conducted to St. Luke's Medical Center, a medical tourism partner of the Department of Health who has conferred upon the hospital the Gintong Sigla (Golden Enthusiasm) Seal of Approval.

     Below are the cases of the seven patients. They are such interesting cases for further evaluation and management.

     Patient #1 is a 46-year-old male who presented with pancytopenia with microcytic normochromic profound anemia for investigation. The patient was given four units of fresh whole blood. Ultrasound of the abdomen revealed enlarged liver and spleen. Negative for ascites or abdominal mass. The patient is a known diabetic and random blood sugar was found to be 250.

     Patient #2 is a 19-year-old male who was apparently sick for a period of two months with symptoms of inconsistent intermittent spiking temperature of moderate to high grade fever of 101-102 F with progressive anorexia, weight loss, night sweats and generalized body weakness/fatigue and malaise. Over the past two weeks, the patient also had productive cough with yellowish to greenish phlegm and was given cloxacillin 500 mg every six hours for one week. Impression of this case was AML or acute myelogenous leukaemia.

     Patient #3 is a 43-year-old male who was confined due to worsening of diffuse chronic rashes all over the body. Patient was treated as a case of psoriasis. On physical exam, the patient was found to have massive hepatosplenomegaly. Impression of this case was CLL or chronic lymphocytic leukaemia.

     Patient #4 is a 55-year-old male who is a diagnosed case of chronic open angle glaucoma in both eyes. He is for perimetry and OCT or optical coherence tomography. He has a history of poorly controlled diabetes mellitus for two to three years now but with negative history of hypertension.

     Patient #5 is a 60-year-old female who complained of sudden painless blurring of vision in the left eye four days prior to consultation. She has no history of hypertension, diabetes mellitus or trauma to the eye. One eye examination, she had corrected vision of 20/20 at the right and hand movement at the left. Intraocular pressure was 12.6 mmHg in both eyes. Anterior segment is quiet with no RAPD or relative afferent pupillary defect noted in both eyes. There was poor orange reflex in the left. Dilated eye exam in the right revealed good foveal reflex, no hemorrhages or exudates, and flat peripheral retina. Left fundus cannot be visualized. Impression was vitreous hemorrhage in the left and patient was advised this would resolve gradually. Patient returned after two weeks and vision on the left eye improved to 20/40. Dilated eye exam in the left was still difficult due to poor visualization of the posterior segment. B-scan showed no evidence of retinal detachment. After another two weeks, vision of the left eye further improved to 20/30. Dilated eye exam in the left revealed resolving vitreous hemorrhage, but with vitreo-proliferative changes and tractional retinal detachment.

     Patient #6 is a 23-year-old male who was admitted with clinical acute left ventricular failure precipitated by bilateral lower respiratory tract infection. He was given IV penicillin one gram every six hours for one week, then shifted to IV ceftriaxone one gram every 12 hours for another week and then to oral ciprofloxacin 500 mg twice a day. The patient was found to have multiple valvular heart disease, predominantly aortic stenosis with co-existing aortic regurgitation and moderate mitral regurgitation. He was also diagnosed with cardiomyopathy and malnutrition.

     Patient #7 is a 32-year-old female who presented with severe abdominal pain in the right upper quadrant. Four months prior to consultation, pain was initially vague and not very severe. Pain increased in intensity with radiation to the right flank. The patient was found to have obstructive jaundice, to rule out common bile duct stricture versus pancreatic duct tumor. She underwent open cholecystectomy with no preoperative cholangiogram or common bile duct exploration. Histopathology showed cholecystitis with multiple gallstones. Since the patient's religion is Jehovah's Witnesses, who object to blood transfusion, this case would present ethical and clinical challenges to the physician. Patient is a known hypertensive and diabetic.

     I appreciate a number of our readers who are not in the medical field. They would even "google" the medical terms in my column while reading in order to learn and understand the articles. Anyway, the rest of the members of wvsumedaa.com would be very willing to help explain the medical terms for those not in the medical field. And since some of the patients I mentioned above are specialty cases, perhaps our specialists on board could give a comment or two in the Forum on Article Discussions.

     I want to share this feedback I received in my email last 25 March 2007.

Hello Errol,

I enjoyed reading your article from medskul.com. You are very clever and funny person.

Sincerely,

Gabriel J. Sapalaran, Jr.RN
Clinical Research Nurse - Surgical Oncology
Comprehensive Cancer Center
University of Alabama in Birmingham

     Happy Easter everyone!

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