Some body may ask why I chose this title for my posts, that is because I decided to write about how a patient suffers in Iraq, when he had a serious or chronic illness.
I personally have some medical problem. Although I am a doctor and know all the excellent doctors in Mosul and always get somehow a special management, I still suffered a lot.
Today I get rid of some (not all of the suffers), I did passed 3 stones with urination, without surgical intervention. Those stone cause me a severe pain over the last 30 days.
The story from the beginning.
In 1982 I was in the military service as medical doctor for some of the military units during the Iraq-Iran war. It was July and we were in a desert area with no clean water supply, It was Ramadan our fasting season, I was fasting at that time , although it was very difficult but I was still 36 year old and feel strong and youth, our fasting last for one month, we stop from eating and drinking from about an hour before the sun rise to the sunset. At that time the doctors serve in the army as an ordinary soldiers, but as far as I am the only doctor in the camp. I got somewhat a special treatment, this was true specially when there is fight near by us. Our staff consists of one doctor (me), one medical assistant (male nurse), an ambulance and driver.
Our equipments are all brand new, all the drugs and medicine are available, and our ambulance was Chevrolet 1982. There were no other facilities, as laboratory test or x-ray. All what we could offer to the patients is the first aids for the casualties and some medicine for the common illnesses. The more serious condition, we refer them to the military hospital, and this take a complex routine procedure.
At that time I started to have some pain in my right loin, the pain was mild at the start and I was a strong youth man, I have a lot of medicine at my hand. So I treated my self with simple analgesic and antispasmodics. Also the general condition of the whole situation was not encouraged me to consult the military hospital.
Two years later, I still in the military service but this time in the north front, I started to complain of more severe loin pain and occasional renal colic, I was the only doctor in that unit, we have no any facilities as X ray, or lab. exam. But we have almost all type of medicine we need. when I discharged from the military service at the mid of 1984, I started to check my self. The result was surprising to me, there was a large stone in my right kidney filling all the renal pelvis. I consult the best urology surgeon in Mosul, he decided surgery with possibility of kidney removal if there is a noticeable damage to the kidney. During the operation he decided to preserve the kidney as he found it still in a healthy condition.
The stone was very big and friable it fragmented in his hands during removal, although he made washing to the area but many fragments are left in place, to become multiple new stones afterward. That mean I started with single big stone, and ended with multiple small stones.
I tried to take some medication to dissolve the stones, both pharmaceutical and traditional drugs that prepared from herbs. The result I get; I ended with three stones in the renal pelvis, there sizes are 8-10 mm. in diameter. These stones continue to enlarged and cause more pain.
The decision come again from the urology surgeon, operation.
In 1986 I had the second operation to remove the renal stones. This time the stones were solid and non friable, but, this happen only to me, the surgeon remove two stones and lost the third. He couldn't found it. At that time, the facilities in the hospital was too poor, they didn't have portable x-ray machine or an ultra sound devise. So the close the wound when they give up and can't found the stone.
That mean I ended with one large stone in my kidney after two major operations.
At 1988 the date of introduction of a shock wave therapy in Iraq (a procedure of breakdown the stones by supersonic waves) .
I was the first who try this procedure in Iraq. I did it in Baghdad in a private hospital, several sessions one month a part.
The stone breakdown and most of it get out with urine, but little pieces left, built their selves to more stone later on.
That mean I ended with multiple renal stones again.
From 1989 to 1995, I had several shock wave therapy with transient relieve of pain, the stone and pain relapsed within few months to about a year. During this period the sanction against Iraq was started and involved the medical appliances and most of the known drugs.
Our instruments get old and without maintenance. In 1995, one of the urology surgeon who was worked previously in x ray department, with the help of the medical city (the biggest and best general hospital in Iraq), introduced a recent way of removing renal stones by a method called percutaneous nephrolithotripsy.
what is percutaneous nephrolithotripsy? :
"Percutaneous nephrolithotripsy (PNL): A technique for removing large and/or dense stones and staghorn stones.
PNL is done via a port created by puncturing the kidney through the skin and enlarging the access port to 1 cm (about 3/8 inch) in diameter. There is no surgical incision.
PNL is done under anesthesia and real-time live x-ray control (fluoroscopy). Because x-rays are involved, a super-specialist in radiology (an interventional radiologist) may perform this part of the procedure.
The urologist (an endourologist, another super-specialist) then inserts instruments via this port into the kidney to break up the stone and remove most of the debris from the stone."
I did the PNL in 1995, but it was not as easy as it looks to be, may be that happen to me only, during the procedure I felt a severe pain that made be shout "Aayyee" loudly, by the way this is never happened to me before this time, the surgeon asked the anesthetist," why he feel pain" guess what? She forgot to give the anesthesia before the operation!!. But at the end, this time, I get rid of the stones for very long time! About 8 years of stone free life, thanks God because they were very hard years on all Iraqi peoples.
Two years ago I started to have the same pain again, and the x ray showed multiple stones in the same kidney!
This time I have a decision, "No more operations". I started some diet modification and plenty fluid, no more fasting in summer time.
It was OK till last month when me and the family were in Baghdad for the holiday of the Aid, when I developed a severe renal colic, there were no hospitals, but plenty of relative doctors, they gave me the strongest analgesic available,but with limited response.
The colic lasted for 10 days with no relapse, I managed to returne to Mosul driving all the way back. It was the days before the election, there were curfew for the cars, and also no hospital and no doctors.
At the end of the election days when every thing returned to its ordinary state. I took an x ray, there were three stones in the right ureter in the lower third.
They took about 20 days of suffering and taking different analgesic.
Today the Tuesday 22 after I get back home from the hospital, I passed one stone with the urine, it was 6 mm. in size, at night about 11:30 pm, I passed two stones the larger one about 9 mm the other about 7 mm in diameters.
By the way, all these problems are in my right kidney only. The left kidney is perfectly normal.
I told you it is great day for me.
I hope I didn't make you bored. If I did , let me know.