A typical clinic day

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Today I spent in the clinic seeing patients with ENT problems.  It has been a steady pace but not overwhelming.  I see all ages.  Probably the biggest complaint is throat pain.  This is a concern that can not be ignored.  Esophageal cancer is endemic in this region.  The patients that are developing these cancers do not have the typical risk factors of smoking and alcohol.  Local research has shown that it could be due to the fermentation process of their milk.  It is a custom here to drink Chai tea at least twice a day and some will have 5-6 times a day.  This is Kenyan tea mixed with fermented whole milk and sugar.  the fermentation process varies with the Kenyan tribe.  Studies have shown a higher rate of cancer in certain tribes and their fermentation process has been studied.  high levels of alcohol and acetaldehyde (by product of ethanol) which are known irritants of mucous membranes have been found.  I purchased an endoscope to look at the voice box and upper esophagus and this has been incredibly useful.  every patient with the complaint of throat pain is screened for cancer.

Large right sided tumor of the tonsil region spread to the tongue

58 year old male presenting with throat cancer.  He has been seen previously in surgery clinic and CT scan has been performed.  His appearance is thin and he has obvious malnutrition.  Exam reveals a large stage IV cancer originating from the tonsil region.  Surgery would require removal of the entire tongue and voice box.  Reconstruction would be difficult.  His chance of cure small and left with the inability to speak.  This is a typical patient who presents with end stage disease.  Multiple modes of therapy are their best chance to control the disease including surgery, radiation and chemotherapy.  Unfortunately, none of these patients have the finances for radiation and presently the wait time can be up to 2 years for radiation therapy.  My heart breaks when I tell them the situation.  Prayer always helps and seems to give them peace.

I continue to pray that God will show me the patients he wants me to operate on.  Only several days left in the operating room this year.  My days are filling up.  Thank you for your continued prayers.

God bless,
chase and family

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