“A swollen throat can be life-threatening”
Transforming from a first aid provider to an otolaryngologist.
“Our survival is limited to just four minutes without oxygen. Our narrow respiratory passageway is easily affected by swelling or tumors.”
Weather fluctuations can impact allergies. In this edition of MedPark Stories, we ventured into the ENT (Ear, Nose, and Throat) Clinic at MedPark Hospital. This specialized clinic caters to patients of all genders and ages, dealing with a spectrum of ENT disorders, from run of the mill issues like tonsillitis, rhinitis, allergies, snoring, thyroid problems, sinusitis, and tinnitus to more severe conditions such as thyroid cancer, nasopharyngeal cancer, and head and neck cancers.
Throughout her career, “Paprae” - Dr Phakanun Tanamittramanee, has seen nasal discharge, blood, pus, mucus, and wounds daily. While some might find these aspects unsettling, she greets her patients and colleagues with a warm smile and a twinkle in her eye. On the surface, she may seem well-groomed, but in this edition of MedPark Stories, we delve deeper into her true character.
Angel of Her Group
Dr Phakanun, a loving sister to her two younger brothers, held the role of a benevolent “angel" among her childhood friends. When inevitable scuffles broke out, Paprae was the go-to person for administering first aid. She recalled her passion for aiding others during her elementary school years, saying,
“I developed a passion for helping people even in elementary school. In my neighborhood, there was a group of around ten children. Whenever one of them fell and got injured, there were tears. Since I had no fear of blood, I often took on the role of providing first aid. Some kids were quite rascally, acting tough and eager to fight, but they would usually be teary-eyed when they got hurt. I would step in and say, “Alright, I'll take care of it.””
Excelling in school, she and her close friends aspired to study medicine, dentistry, or pharmacy. After graduating from the Prince of Songkla University, Faculty of Medicine, she pursued a residency in otolaryngology at Chulalongkorn University.
Surgery and Wound Care, Not as Simple as She Thought
Dr Paprae's passion for medical procedures led her to choose a residency in otolaryngology. Her childhood experiences with colds and allergies made her familiar with the ENT department. However, becoming an otolaryngologist shattered her perception of ENT disorders as routine conditions.
She reflected, “During my time in medical school, we encountered only a limited number of medical procedures, which, I admit, were enjoyable and not overly challenging to learn. However, the reality of clinical practice in the medical field presents a different scenario, filled with varied procedures, including those as intricate as laryngeal and salivary duct surgery.”
“Surgical wounds can be unpleasant, especially in head and neck cancer patients. This type of cancer is notably aggressive, and the cleaning and dressing of the wound process can be rather prolonged, intensifying the suffering experienced by the patients. It is noteworthy even basic activities like swallowing become arduous for these patients. While individuals with other ailments might continue to eat normally, those battling head and neck cancer face unique difficulties for what we take for granted.”
Stressing the importance of early diagnosis, she added, “The speedier the diagnosis for head and neck cancer, the better it is for the patient. Physicians can detect small lesions that should resolve within 1-2 weeks of treatment. If these lesions persist for 3-4 weeks or longer, the doctors would advise a biopsy. I understand that patients might feel apprehensive and refuse; however, trusting me, a small cancerous tumor is far easier to treat, and the treatment outcomes are typically more favorable.”
Don’t be inured to the symptoms of ENT disorders
Drawing from her extensive experience in treating ENT disorders, Dr Phakanun's primary concern is patients overlooking the seriousness of their conditions. Many people mistakenly believe that symptoms like sneezing, coughing, a sore throat, or nasal congestion are minor issues not requiring specialist attention. Moreover, patients often grow accustomed to these symptoms, thinking that early and expensive antibiotic use will hasten recovery.
She noted, “I had a patient who complained of nasal congestion and a runny nose. Oddly, they couldn't pinpoint when they started mouth breathing. Alongside these issues, they also experienced tinnitus, ear pain, and a persistent sore throat. I've noticed that patients with these symptoms often suffer from nasal swelling, and some even contend with recurring sore throats and tonsillitis. The usual course is to rely on antibiotics until antibiotic resistance sets in. Interestingly, once we addressed the nasal swelling, the patient's sore throat disappeared a few months later. This case highlights the importance of engaging in meaningful conversations, conducting a meticulous patient history, and diligently searching for the root cause, as it can lead to more effective treatment.”
A life-saving moment, an emergency tracheotomy
Dr Phakanun had the privilege of working in three public hospitals, and in doing so, she encountered a wide range of severe cases. Many of these cases have been heart-wrenching, as she witnessed patients suffering while awaiting treatment. One particular experience stood out, an unusual and rarely encountered situation that impacted her as an otolaryngologist.
“We know our bodies can survive only about four minutes without oxygen. The respiratory tract, being narrow, to begin with, becomes even more stenotic when affected by swelling or tumors. In cases where we cannot clear obstructions like mucus or blood clots from the airway, the risk of death looms large. I vividly remember an accident patient sustaining only a minor neck injury. An astute emergency physician noticed an unusual sound from the patient, quite different from what is typical in patients with lung diseases or asthma. Concerned, the physician consulted me.”
“As the minutes ticked by, his condition deteriorated, struggling to breathe. A nasopharyngoscopy revealed severe swelling in the larynx. The need for a tracheotomy was evident, but the patient hesitated initially. As oxygen levels rapidly dropped from 100% to 90% and then 80%, I urgently requested an operating room, and the nurses swiftly sprang into action. Once it was clear that this was a life-threatening airway obstruction, everyone performed their roles efficiently. The patient was rushed to the operating room, experiencing increased distress en route. Without the opportunity to move the patient to a surgical bed or administer general anesthesia, I had to give local anesthesia and promptly perform the tracheotomy. The patient, remarkably cooperative throughout this ordeal.”
This case of airway obstruction serves as a poignant reminder that disorders in the field of otolaryngology are far from typical. It may take time for patients to grasp this reality, but regardless of the severity of the disorder, a physician must exude confidence and provide immediate treatment.
“MedPark Hospital has an unwavering commitment to education, with comprehensive plans for growth and excellence. I take great pride in being a staff of this institution and aspire to contribute to its continued advancement. Furthermore, the presence of some of the most esteemed medical educators in Thailand -- I have previously collaborated -- at MedPark Hospital bolsters my confidence that patients seeking care here will receive the best diagnosis, treatment, and all-encompassing medical attention.”
