西表島

On Saturday, we visited Iriomote Island.  Iriomote island is one of the big islands among yaeyama islands. 90% of the island is surrounded by nature: forests, rivers, falls and so on. People live in the remaining parts. We headed to Iriomote island by  ferry. It usually takes 50-60 minutes. The island has two harbors: Uehara and Oohara. We got off the ferry at Uehara harbor. We joined an adventure tour which included canoeing and snorkeling. First, we went to ピナイサーラ falls by a canoe. ピナイサーラ falls is the tallest fall on Iriomote island. We went up the river, which is located in the mangrove forests . It was such a so sunny day that the wind and the sounds of  nature were so comfortable. After reaching the shore, we began to climb the mountain. We finally reached ぴないさーら fall after 20-minute walk.  At the falls, there is a natural pool. We jumped into the water. It was so cool and comfortable. I stood under the water fall. It made me feel refreshed. We ate our lunch boxes near the fall.

Next we visited バラス island by  ship. 　バラス island is made up of corals, so we can only see the island during low tide. The white coral island, surrounded by the sky-blue sea waters, was so beautiful.  We enjoyed snorkeling around the island. There were many types of tropical fishes. We saw a sea turtle as well. The way the sea turtle swam was really attractive to us.

Cerebral hemorrhage

The patient is 89 years old, who have cerebral hemorrhage. The hemorrhage expanded from left Thalamus to Putamen, which caused intracerebral hemorrhage. According to CT scan, the brain has already mid-line shift. She has right hemiplegia and has difficulty to communicate due to the brain damage. She also has involuntary movement on her right side of her body, which is probably caused by midline shift. She has a nasogastric tube for taking nutrition. The hemorrhage is so huge that it is difficult to recover her consciousness and higher brain function. Her family choose DNAR. Btw, She has high body temperature(around 38) when she come to this hospital. There is no certain source of infection and inflammatory reaction in L/D. Therefore, we consider this fever as central one due to cerebral hemorrhage. We need to care about infection because she has some devices such as nasogastric tube and urethral balloons.

cause unknown CO2 narcosis

The patient is a 92 years old female suffering from cause unknown CO2 narcosis. She came to this hospital for rehabilitation after a lumbar compression fracture.

3 days after she came to this hospital, she caused CO2 narcosis. According to the letter of reference, she was diagnosed as COPD(chronic obstructive pulmonary disease) although she never smokes. Her respiratory assistant muscle is not developed. We could hear coarse crackles in her lungs though we don’t know why. There is no sign of pulmonary enphysema in CT scan.  From these observations above, we concluded CO2 narcosis is not caused by COPD.

We suspected she has some sort of neuromuscular disease. We checked respiratory function test. That test says she has restrictive lung disease. She doesn’t have honey cone lung in CT scan. Fine crackles are not heard. As you can see, structural disorder is seemed to be negative. For these reasons above, we decided to consult Neurologist.

I observed his neurological examination. His knowledge is so sophisticated that I admired so much. I learn some new technique of neurological examination. He realized her muscle weakness of proximal muscle, so he doubted that she has myopathy, but her CK level is normal not high. There are no neurological signs which indicate ALS or MG.  In the end, it is difficult to diagnose what happened to her body.

Tell me if you have any other differential diagnosis.

石垣島

After work, I headed to Naha airport to visit Ishigaki island. I was going to take a trip with my parent. We stayed at a five star hotel :https://kariyushi-ishigaki.jp/. We treated ourselves. The room is very large and comfortable. We can see the sea from the room. The breakfast is buffet style. They have many kinds of local meals of Okinawa, such as ジーマミー豆腐、さーたーアンダーぎ―、ミミガー. Every dish was so delicious.

 We rented a car to go around the city. We ate dinner at marusa: https://tabelog.com/okinawa/A4705/A470501/47001646/. We ordered 海ブドウ、ジーマミー豆腐、sashimi,and Ishigaki beef.　ジーマミー豆腐 is deep fried, which is like rice cake and taste good. The fish in ishigaki is lightly seasoned perhaps because the water from the sea is warm;they don’t need to be fat.  After eating dinner, we went to the dam to see the stars, but it was a full moon. The light of the moon was too strong to see stars. The light of moon made a shadow of us. I had never seen a shadow by the moon. I only ever seen shadows made by the sun, not the moon.Though the light of the moon was strong, I could see a shooting star.

08/06/2017

The patient is 89 years old, who have cerebral hemorrhage. The hemorrhage expanded from left Thalamus to Putamen, which caused intracerebral hemorrhage.

According to CT scan, the brain has already mid-line shift.  She has right hemiplegia and has difficulty to communicate due to the brain damage. She also has involuntary movement on her right side of her body, which is probably caused by midline shift.

She has a nasogastric tube for taking nutrition.

The hemorrhage is so huge that it is difficult to recover her consciousness and higher brain function. Her family choose DNAR.

Btw, She has high body temperature(around 38) when she come to this hospital. There is no certain source of infection and inflammatory reaction in L/D. Therefore, we consider this fever as central one due to cerebral hemorrhage.

We need to care about infection because she has some devices such as nasogastric tube and urethral balloons.

I played tennis. 07/06/2017

Every Wednesday, some medical stuff enjoy to play tennis at 那覇運動公園.

I was invited to this event. I didn’t have a racket,but the attending lent it to me.

Actually, I am in playing tennis right now, so I really enjoyed it.

I learned how to serve from him.

We played it for two hours. The temperature was so high, and it is so humid that we were sweating so much.

You can enjoy tennis every Wednesday if you want!

Btw, there is a swimming pool at 那覇運動公園. I haven’t swum for more than 1 week. If I had enough time, I might go swimming.

LOW BLOOD SUGAR 06/06/2017

What do you think from the title?

…Yeah. You are right! Ordinary, we predict one elderly person has hypoglycemia because of the drug(SU,insuline) or something. However, this expectation is not right this time.

So, who has low blood sugar? 

The answer is ,,, me…

In the afternoon:around 16 o’clock, I felt the feeling I had experienced 3 years ago. I had felt that kind of sense after the training of swimming. I began to feel rapid heartbeat, sudden mood changes ,unexplained fatigue and sweating. Yeah, that’s right. These are the symptoms of hypoglycemia.  I asked my attending to give me a break because I cannot stop sweating. Some gentle nurse and PT give me some snacks（ちんすこう等）for relieving hypoglycemia. Thanks to their help, cold sweating and unexplained fatigue were quickly disappeared. I checked the level of blood sugar by the simple kit; it tells that my blood sugar is 90. I should have looked up when I had felt the sense of hypoglycemia; It must be 70 or so.

Btw, what causes this low blood sugar? I am not sure,but it is perhaps because I didn’t eat breakfast very much though I ate lunch as usual. I again realized how important breakfast is.