My Tiaong patient: first visit

The first home visit was really more like a look-see as I was not sure if ASI would even consider an alternative management. But i packed a foot-long kamoteng kahoy, anyway, for pain management plus what was needed for a wash&rinse deodorizer for her breast, just in case.

I gave over the kamoteng kahoy to ASI’s husband as soon as we arrived, explained what it was for and, in case ASI cared to try it, asked that he prepare it for me, cutting a thin slice of no more than 2 mm., peel it with just his thumb nail, then to quarter it.

ASI was crimped on the hammock so there was not much to see of her breast. She grimaced at the mere mention of having to get out of her cocoon. It occurred to me that if her pains could be alleviated right then and there, she could move to the bed in the other room with less angst, so I decided to show her the kks (kamoteng kahoy slice), and explained how it would help her. ASI was all for trying it!

She was to chew only on a quarter (1/4) piece at a time, swallow only the juice, discard the pulp, and to stop when dizzy. She was on the 4th quarter when she became dizzy. I told her husband that, from then on, he was to give ASI no more than 3 quarters to chew on for pain relief.

After a while, the dizziness passed and her pains eased in about 30 minutes, I told her to keep the 30-minute time lapse in mind, take advantage of it, prepare herself to enjoy a meal and eat better, or even look forward to getting a good night’s sleep.

ASI’s right breast was the only one affected, and which, fortunately, was not ulcerated. However, the weight of both the breast mass and the one just over her shoulder had ASI bent forward at a crouch, squeezing down the swollen bunch of grape-like vesicles against her lower ribs, which caused them to ooze.

I impressed on ASI that, while the zonrox/saline mix would serve as a wash&rinse solution for her breast and clear the bothersome smell, a daily bath and shampoo before the wash&rinse was just as important as it would remove layers of dead skin and allow wastes and toxins to exit the body thru her pores.

ASI at first resisted lying back on the bed: the coirflex mattress was too firm, the nodules on her back made it difficult to lie flat, parang ang hirap huminga; she complied when assured that she could get up, if and when, she needed to get off her back.

Though she was eager to learn how to do the wash and rinse which would clear the odor from her breast, she was not keen on having to do the procedure in bed, felt she could do just as well in the bathroom after her bath. I had to make her understand that she just had to suffer her numerous bumps every morning after her daily bath as there was no way other than lying on her back that the underside of the mass, where the vesicles were, could benefit from the wash&rinse.

Plus, there was the precious B-17 powder which would help dry up the vesicles where the ooze/smell was coming from; it would be such a waste if it were not properly applied.

We lined the bed with a large plastic bag; this was topped with a towel, folded several times over, to soak up flow from the rinse as there was no way a kidney basin could have been used without causing ASI further discomfort.

Having everything by the bedside before she started would help lessen her anxieties; I was confident that, before long, she’d get the hang of the procedure and soon find it all as easy as pie.

Preparation

Zonrox 30cc (2 tbsp) was measured off and mixed well into the liter of intravenous 0.9% Sodium Chloride sterile solution; about a cupful was poured into a clean bowl where as much could be readily aspirated into a 10 cc syringe as needed.

Filling the syringe and setting it aside, I showed ASI how to lightly tamp the capsule of B17 with a fingernail to clear powder from off one end so it can be cleanly snipped off with a sharp pair of scissors without wastage.

To avoid spilling the precious B17 powder (a 500mg capsule costs P65) should there be no one around to hold the capsule upright, I showed her how she could safely sit the capsule in a cup of rice till ready to use.

Wash & Rinse & Dry

To do the wash&rinse, a wad of cotton soaked with the zonrox/saline solution was swabbed lightly on and around the vesicles to clean and soften encrusted ooze.  The syringe was used to carefully squirt the mixed solution into the valleys and crevices around the vesicles to loosen ooze which might have collected there.

To dry the affected area without leaving strands of cotton sticking to the wet surface, a wad dipped in the solution then squeezed dry, was dabbed around lightly to soak up as much excess solution as possible over and around the vesicles.

Allowing a few minutes to air-dry the area, I showed her how to hold the B-17 capsule between thumb and middle finger, and while lightly tapping on the capsule with the index finger, disperse the B-17 powder over the vesicles; should the powder come out in clumps, use the index finger to spread it.

It was while I washed and rinsed that I had remarked on how fortunate it was that the small pockets of pus seemed all well-contained. Duon nagkuwento si ASI: she thought the pus was the cause of the offensive odor and so, with the aid of a mirror, tried to clean off the largest spot of pus with cotton. There was the sudden spurt of blood followed by a seemingly endless gush na di nya mapatigil for what seemed the longest time, and even as she applied pressure it took a while for it to stop. The incident, she said, left her trembling with fright and weak in the knees and there was no one around to help her.

Don’t make it worse

I warned ASI not to even use a washcloth on the affected areas and just to soap it well when bathing and that she should take extra care not to cut or bruise the vesicles and/or nodules.

I cited Dr. Kelley contention that “when making biopsies, the malignant tumor is often cut across which tends to spread or accelerate the growth. Needle biopsies can accomplish the same tragic result.” (OAC, p.12)

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