A Trinidad-born orthopaedic surgeon has made a discovery in the field of medicine. Dr Jabari Martin, 33, who is from Petit Valley, found that a person can have cancer of the lymph nodes but it can be mistaken by doctors for an infection at the site of previous surgery.
Martin attended Queen’s Royal College before heading off to the prestigious Howard University where he studied biology, medicine and then orthopaedic surgery. He is currently completing a fellowship in sports medicine at the American Sports Medicine Institute.
The discovery was made while Martin was still a resident at Howard University Hospital but was completing a rotation at the US Veteran Affairs Hospital in Washington DC.
The ground-breaking case is featured in this month’s edition of the Journal of the American Academy of Orthopaedic Surgeons and is co-authored by Drs Jasmine Bauknight; Vincent Desiderio and Bahman Sadr.
According to the case, a 49-year-old man with a history of skin cancer and skin infections came to the hospital with increasing pain in the left shoulder that was exacerbated by overhead activities; the pain was even felt during sleep. When questioned by a team of doctors, the man repeatedly denied that he had any history of trauma.
In an interview with the Sunday Guardian, Martin noted that the man “had previously undergone shoulder surgery to repair the rotator cuff. He healed uneventfully, with no shoulder pain, and improved function of the shoulder but three years after the initial surgery he began having recurrent left shoulder pain. It was recommended that he undergo physical therapy and pain management but that did not help him improve”.
Martin and the co-authors noted that an MRI was subsequently done and it revealed that the patient had a surgically amenable re-tear of the rotator cuff and therefore a decision was made to go back into surgery and fix the tear. The man then showed the expected improvements after surgery but began suffering recurrent pain five months later that could only be attributed to secondary tendonitis. Anti-inflammatory medications were recommended and prescribed soon after.
This was ineffective and, according to the journal, the patient returned with fevers, chills and swelling over the anterior aspect of the shoulder. He was admitted to the hospital and underwent surgical removal of all infected tissues.
It was during this third hospital admission that the patient began exhibiting the symptoms of night sweats. The article describes in detail, “While in the hospital, the patient had drenching night sweats, copious serosanguinous wound drainage, an elevated erythrocyte sedimentation rate and C-reactive protein level, and a mildly elevated white blood cell count, all attributed to infection from his presumed osteomyelitis.”
However, blood cultures, as well as capsule and synovial tissue samples and swabs obtained during surgery, showed no bacterial growth. According to the journal, “Over the next three months, the patient underwent three additional open débridements, each time with more aggressive removal of tissue, suture, and implants from prior surgeries. A total of 25 cultures was obtained, with the initial débridement cultures held for only seven days but subsequent cultures were held for 14 days and four to six weeks for fungal and mycobacterial cultures.”
Martin admitted that the team was perplexed as the cultures did not grow as expected. However, they encountered a breakthrough when, on closer examination, a swelling was noticed on the left side of the back of the man’s neck.
The swelling was not characteristically tender, prompting the team to test a sample. This led to the surprising diagnosis of cancer of the lymph nodes.
On Martin’s recommendation, the patient at once underwent chemotherapy and within days of starting chemotherapy, drainage from the shoulder decreased, and the pain improved. Within one month, the wound had healed, and at five months, the lymphoma was in complete clinical remission. At that point, the shoulder was minimally painful and remarkably functional considering the extensive multiple débridements of the rotator cuff and its footprint.
The study noted that one year following the last surgical procedure, the patient was re-evaluated and the lymphoma was in remission. His left shoulder ached intermittently on exertion, with the pain favourably rated between zero and six on a ten-point visual pain scale.
Source: Trinidad Guardian
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