Rubber issue

 

The new Fe came with PC6 when we took her in. I had a flat tire noted after 2 weeks of driving and nail pricking had been karma for the new F since then. For the past 2 years, she had 5 patching session over the 59000+km drive.

The last one happened 4 weeks ago; when I glanced through the panel while stopping at the traffic light during my drive to the hospital for work and I found out that the left rear tyre psi had dropped 15%(20% dropped will cause the light to lit on). Definitely a leak and I had pulled over at the first petrol station available and pumped the pressure up. I saw a nail on the tyre during the pumping process.

I googled and found out that a tyre shop was still opened around my hospital at the late hour.

I had an early start that day and if the shop still opened when I arrived, I would not be late for the job that night.

The mechanic cum boss was an elderly uncle. He jacked up new Fe and removed the tyre. I told him that I just needed to patch it from outside instead of inner part as the tyre is due for change. He told me that he always patches from inside and if I requested to patch from outside, he would still remove the tyre from the hub as it was easier for him to access the leak part. Some old fashion guy still believe patching from inside of the tyre is better for the tyre.

I had a good look when he removed the tyre from the hub. The wear was way beyond the thread wear indicator and I need to changed it soon

I usually changed my tyres at around 40k and this was the longest distance I had travelled on a set of tyres.

I contacted my usual mechanic and told him that I needed a change. I opted for the PC7 but it was not available and he recommended PS4 which was same standard as PC7. The PC series was noted with better noise reduction than the PS but yet PS is better at control and grip.

The replacement was done 4 days later. The price was 2.5x of the Bibendum’s tyres I used previously on my Z. The control and grip was better than the PC6 but yet it was noisier as review. You gain some and you lose some...

Well, safety come first and since 20 inch tyre doesn’t come cheap and there would be another pain again 2 years later. 20 inch tyre ? I would think twice next time I buy a car….

game of balls

 

I had always hated testis pain who presented to ED. The examination includes an ultrasound which need the physician to touch the sensitive part of the patient. The difficulty is increased as the ball will be sliding as you glide the probe over the surface. If the testis is painful the patient would start to resist and the scanning is more hazardous. Without the power doppler mode, you can only diagnosed testicular torsion if no definite flow is noted and it would be too late by if you see this….

Someone had told me this story months ago; A middle-aged patient was seen few times for abdominal pain with each consultation separated by 12 hours apart; even though CT scan was done twice(enhancement and none enhancement) during the visits, he had still ended with ball removal.

The unless proven otherwise rule was not applied in the case where the pain was not proper diagnosed and patient was discharged. The patient was treated as urinary stone where radiation pain to testis was an acceptable symptom. The key in the case was no stone was noted by the scan and a negative UFEME was noted.

I had been more cautious lately and I met a few cases of ball pain lately where I performed ultrasound without hesitation.

It was an embarrassed moment for everyone, the physician, the chaperon and the patient. Especially the chaperon who mostly is the nurse or nursing aide available and most of them were female.

Frankly said, I hate doing it as flow noted in the ball does not exclude torsion as we had no power doppler mode on our ultrasound and there is a 50% chance a urological consult was unavailable. Our urology consult was supported by two inhouse staff and half of the time the consult was covered by visiting staff who was reluctant to come...

I crossed my finger on every discharge…

we are one.....

ML was sitting on the bench opposite the triage area holding her belly while I walked into the ED. I thought she would be my first patient but her name did not show up on my screen after I seen three patients. I asked around and found out that she was turned by K today morning and G last night as she was just discharged from ward few days ago.

ML was a female with a sorrow past. A schizo since her young age and victim of a fire incident leaving scar over her appearance. She was jobless since the accident and living on subsidy.

Her visit to our setting had increased markedly since last years as she developed liver cirrhosis and massive ascites which required frequent tapping. She had visited us on an irregular basis. Her psy stat plus her noncompliance to medication behavior had led her ascites to increase great speed.

She was turned down from time to time as she tapping request sometimes was too frequent.

Prior to her arrival yesterday, she was admitted to our ward and tapping was done 3 times during her 11 days stay. A good 20000cc was removed and you could she her walking past by our desk with a tea drink jumbo cup on her hand.

After K and G turned her down, I was in no position to help her even though I estimated 10000cc in her peritoneal cavity judging from her belly size.

She had wandered around the hospital since then and I had asked one of nursing staff to hint her that to come back tomorrow morning and someone would proceed the tapping for her if she do so.

She however ignored those advice and kept bothering us from time to time.

I stood the ground as it was not an emergency situation which demand urgent management. The integrity of the EP team is important if no medical emergency is involved. She had then shifted to the OPD and later referred to our department gain but yet the staff did not attend to her.

She was still hanging around the hospital when I went off by 10pm.

When I arrived to work the next day by 9:30am, she was still wandering at the convenient store in front of our hospital; her belly was taken care of apparently.

Well, I logon to my account and found that G had settled her problem after midnight. Even though her problem was solved but yet she was still wandering around…. nothing to shout and comment as my decision to keep the integrity of our team was correct. No hard feeling of delaying the tapping.