18 OPINION
18 OPINION
13 SEPTEMBER 2024 ausdoc . com . au
| THE | WOMEN ’ S AND MEN ’ S HEALTH SPECIAL
Insight
My patient ’ s cut penis
Dr Robert Richardson GP in Brisbane , Queensland .
He had travelled to the Kimberley for a subincision .
THE Kimberley is a vast , spectacular area of rivers , mountains and non-stop surprises . On arrival at the hospital for a locum a few years back , I noticed the reception had a filing system where Aboriginal people were listed under first names and white people ( Europeans ) under their surnames .
I asked , if a Japanese person came
Write-off here and ideally three lines if possible please , thankyou Obitius molupienime quat im num nume sust , simus doluptas
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* Repatha ® is indicated for the prevention of CV events ( MI , stroke and coronary revascularisation ) in adults with established CVD in combination with an optimally dosed statin and / or other lipid-lowering therapies , as an adjunct to diet and exercise . 1 ‘ Power ’: 15 % relative risk reduction with Repatha ® vs placebo in the composite of the primary endpoint beyond optimised statin ± ezetimibe ( HR : 0.85 ; 95 % CI : 0.79 – 0.92 , p < 0.001 ). 2
Pull Quote here Si odi totatiatem faccusa erovid magnimus , sitatum asitiis eariatio es qui cuptiorDolupid quam , sunt . Nis ne as recto et facia qui ut quiam , quis ma nullorest inctum ligendaerum
PBS Information : Authority required ( STREAMLINED ). Non-familial and familial hypercholesterolaemia . Criteria apply . Refer to PBS Schedule for full authority information .
Refer to full Product Information before prescribing ; available from Amgen Australia Pty Ltd , Ph : 1800 803 638 or by scanning the QR code :
For more information on Repatha ® or to report an adverse event or product complaint involving Repatha ® , please contact Amgen Medical Information on 1800 803 638 or visit www . amgenmedinfo . com . au .
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Abbreviations : CI , confidence interval ; CV , cardiovascular ; CVD , cardiovascular disease ; HR , hazard ratio ; LDL-C , low-density lipoprotein cholesterol ; MI , myocardial infarction ; PBS , Pharmaceutical Benefits Scheme .
References : 1 . Repatha ® ( evolocumab ) Approved Product Information . 2 . Sabatine MS , et al . N Engl J Med . 2017 ; 376 ( 18 ): 1713 – 1722 . 3 . Pharmaceutical Benefits Scheme . Evolocumab . Available at : https :// www . pbs . gov . au / medicine / item / 10958R [ Accessed June 2024 ].
Amgen Australia Pty Ltd . ABN 31 051 057 428 , Sydney NSW 2000 . © 2024 Amgen Inc . All rights reserved . AUS-145-0624-80014 . AMG4138 . Date of preparation : July 2024 . into the hospital , what would you file them under ?
But it was there that I met Logan , a young Aboriginal man who was doing a computer program to translate one local language into another . He was super energetic and enthusiastic and helped me recognise cultural differences between groups .
Some things he didn ’ t warn me about .
* 1,2
A young man came to outpatients with a groin problem . He dropped his pants and had lymphadenopathy and varicoceles .
When he lifted up his penis , I saw his urethra was split partway down .
It turned out , when he was 12 , he ’ d had a traditional subincision , where a piece of bone is pushed down the urethra and then cut down along the bone . I had never heard of it .
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I asked him what he thought , and he said : “ I think it ’ s f *** ed . I had no say in it .”
I asked him if he wanted to see a specialist to have it repaired , but he said it was 12 years ago and he couldn ’ t be bothered .
Then he grinned and said : “ Never stand next to me at a urinal , Doc . I have to hold the head up , and it sprays everywhere .”
We both laughed , and I almost forgot his other medical problems .
A few days later , another young guy came in — with a five-day-old subincision .
But he was a trendy white guy from Sydney who had wanted to go to the Kimberley to have a traditional subincision to identify with a tribal group .
His penis had been opened about a third of the way along the urethra . It had then been smoked over a small fire .
There was blistering , a dirty anal area , a partly opened urethra , urine and the smell of cooked rotting tissue .
I was worried about a possible septicaemia — but with what bacteria ?
He had no systemic signs of septicaemia . He was treated with oral cefalexin and IV cefotaxime with Betadine .
This was going on while I had a waiting room full of sick children and other patients , including one who had been stabbed in the neck .
Luckily , my latest subincision patient got better rapidly and walked out a few days later .
But while he was with us , he was a terrible patient : he wandered the wards with his rotting undercarriage bothering other patients and wouldn ’ t allow female clinicians to treat him .
The next day , I asked Logan if he wanted to go to the pub for lunch . He told me about his dreams for the future , working with computers .
We went to a table , and I ordered a steak : medium rare . The waiter ignored Logan .
I eventually asked Logan what he would like , and he said he ’ d have a steak too .
There was more silence from the waiter . I asked Logan how he would like it when the waiter suddenly butted in : “ They all like it well done .”
Logan and I said nothing but looked at each other with silent understanding .
I thought about the hypocrisy later .
Apparently , subincision is still legally performed on some under-age Aboriginal boys even though female genital mutilation is banned in Australia for other cultures .
AMG4138 _ Repatha _ Streamlined Authority _ AusDoc _ A4 _ 210x273mmH _ AUG _ R1 _ FA . indd 1 10 / 7 / 2024 11:38 AM