Tuesday March 20

       Today we thought we would be busier than we were, but a couple of cases were cancelled. One was a planned thyroidectomy for goiter. She has a large goiter, but she is mildly hypothyroid, so we decided that taking out a large part of her poorly functioning thyroid would not be beneficial for her except from a cosmetic standpoint. We had a bit of discussion with the anesthesiologist who was concerned that she was hyperthyroid and might have post-operative problems as a result; after a time he agreed with us that hyperthyroidism was not the issue. Sandeep then had a text discussion with one of our ENT surgeons in CT, and we decided to encourage her to increase her iodine intake and come back in September. If her thyroid function is better, surgery might be considered then.
       Two of the other cancellations were planned biopsies: one was a man who had some sort of tumor excised from his left shoulder 10-15 years ago, and it has now grown back as quite a large protuberant mass. Additionally, he appears to have another similar growth starting on the right side. Reportedly he declined biopsy because he thought it would cause it to grow faster. We have seen these worries before, and there really isn't much to do; they generally don't respond to reason.The other was a woman with a strange nodular eruption on her left lower leg which I  have never seen before. We planned to biopsy one of the nodules to make a diagnosis, but apparently Prof Golokai thinks this is elephantiasis, and she should be treated with anti-worm medication; he won the day lol!
        My 10 year old patient J went home today feeling good after removal of that 10 pound cyst. Hopefully her aunt will bring her to see us in September.
        We did finally get around to some surgery today: I did a couple of cases each with a Liberian resident. Nothing big, but it was fun to impart some teaching. Gbozee. and Sandeep and Albertha Clark did a thyroid for goiter, and they did a good job. I was in and out supervising, but trying to let them get the feel of independent operating. Sandeep said he was nervous to start, but then got into it and felt quite comfortable by the end.