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Photography: The story behind the image

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Blenny

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They are brave. A couple of photographers clustered around with some big cameras and shot this guy for quite a few minutes. Then I drifted in and got a shot too. The enlargement is a tribute to the camera and its resolution. The big cameras get the enlarged image right off. I am beginning to have camera envy.

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The point and shoot has pretty good resolution. Certainly it is good enough for an average blog post. And I having serious strobe light envy too. But along with envy is a serious price tag. A dive buddy flooded her strobe immediately as she entered the water recently. That was painful. It started as a hobby…

Clean Me Please

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Yes these guys cannot scratch their nose either. And yes there is no need. They have no nose. But the cleaning is free and included in the service that the little fish perform. And I happened to click at the perfect moment. Doesn’t it look easy taking this image? If you only knew…

Playing Around

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This is the male version of the fairy basselet. I know this from reading the book. Otherwise they would all be the same to me. The fish is tiny. So it is no surprise that my noisy bubbles and my size make them swim for the coral as soon as I come along.

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Rarely, then, do they hang around. But… once in a while and it was this day that they were brave and almost challenging. Perhaps it is mating time. I drifted up close and shot away. Dumb fish, I could have eaten them all… in a single gulp. So much for male stupidity when there are girls around.

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Oh, the girls are golden seen above. They vastly outnumber the males on the reef. So maybe my theory has merit.

Open Mouth

IMG_5446Don’t Eat With Your Mouth Open

These are very small and skittish fish. So it was a rare event that they would pose. And even more rare is for me to catch one with it’s mouth open. Yes, yes they do this all the time. I can tell you that it is not common to get it on film. With all the amazing photography around these days we take unusual images for granted. All I say is that what is not common remains so.

Many Windows

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This is a classic landmark building in the old city. No one lives in it at the moment. The wood treatments are all different and in need of some repairs. Someday it will be renovated handsomely. Meanwhile it is still a nice photo op._DSC1728

Yes Sir

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I was leaning over to take a shot of the fountain in the background when the street sweeper saw me. He thought I was taking a shot of him. He immediately stopped and struck a pose. Then he pulled out his broom and posed again. He was pretty proud for me to take his picture. So my fountain did not get shot. We both walked away happy.

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End of the Day

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Side view: Mass pressing against the spinal cord

 

We were on a roll. The same day as the previous case I was introduced to the patient who was weak in both legs and could not walk. She had involvement of her spine with breast carcinoma. The lower mass was about to make her permanently paralyzed.

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Side view: cervical thoracic with tumor around spinal cord

 

There is another large mass in the cervical thoracic junction which was not yet symptomatic. The lower mass at the thoracolumbar junction was the culprit. So instead of going home we took her to the operating room and removed the tumor. It had compressed her spinal cord.

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Top down thoracic spinal with tumor distorting spinal cord

 

Timely decompression gave her a chance to walk again. The next morning she was moving her legs and several days later she stood and walked again. Yes, we were pretty happy for her. And she thanked us too. It was a privilege to be able to save her neurological function and get her to walk again.

Spinal Tumor

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Side view: the gray mass below the white column is the tumor

 

This is a spine tumor. On the day we did this surgery I operated in the neck, in the thoracic spine (chest) and in the lumbosacral spine. We followed that with brain surgery. It’s always interesting. This poor patient was treated for an infection but was not improving. Several biopsies were unsuccessful to establish a diagnosis. Now he was weaker and in more pain. The mass invaded his sacrum – pelvic bone – and surrounded his spinal nerves and was threatening to take his leg strength and bowel and bladder function. It was pretty serious stuff. And previous procedures had everyone guessing what this lesion represented on the MRI scan.

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Top down: the bone and spinal canal are all filled with tumor

 

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Head is toward left: this is the spinal sac – the tubular structure.

Surgery was difficult as expected. The mass was completely in front of the spinal sac. It’s partly why the diagnosis was so difficult to establish with a extensive surgery. You can see the nerve sac. This turned out to be a tumor lying stuck tightly among the nerve roots. It had been growing slowly. About six hours later and the nerves and spinal sac were decompressed. We worked slowly under the operating microscope to get the pressure off the nerves. It was most rewarding to hear the patient tell me the next day that his severe debilitating pain was much improved. Some days end up pretty nice.

Slow Growing

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Side view: nose and mouth to the lower front left

 

This is a brain tumor. And if it is in your head this is big trouble. It is benign and grew slowly. The only noticeable symptom was that the patient lost his sense of smell. It did not act like a stroke so the symptom was ignored until now. And there is swelling around this tumor so it is actively growing. Now it can no longer be ignored. Surgeons like fisherman like to exaggerate about size so here are the images and you can make your own guess. This one Is on the extra large side of the equation. It is not the largest tumor I have removed. My assistant shook his head in amazement because it was the largest he has seen me remove while he worked with me. But hey! I’m older. The task at hand is to get this tumor out without causing any disturbance to the surrounding brain.

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Face on view: the back of the eye nerves are the dots – nose in the middle

 

Oh? Yes it is benign. And the sense of smell is gone because the tumor origin is right from that area. There are a lot of serious neurological structures to worry about like the nerves for vision and major arteries into the brain. Of course it requires a complex approach to just expose the mass. As large as the tumor grew, it is still a matter of millimeters between trouble and success. We spent some hours taking this out. In fact it was close to six. And… the end result was that the patient was fine! That is the only thing that matters in the end. I just wish I had met this tumor when it was a lot smaller. But since I’ve been here there are lots of people who have refused surgery in favor of just waiting. Gee!

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Top down view: things are turned around left and right. Lots of swelling around the tumor

 

And the patient – he will make a good recovery except for the sense of smell which was taken by the tumor growing.

Meningomyelocele

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This is a birth defect. Once in a while you have a run of cases that are interesting. In Jeddah everyone is wary of surgery. The reasons are myriad but mostly people are just plain afraid. I had some recent successes so for a few days I’ll post up some medical things.

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This child was born with a failure of the spine to close over into a proper canal. So the lump is a combination of nerves and skin exposed to the air. The spinal cord begins as a plate which rolls into a tube which is surrounded by the muscle bone and skin. Failure of the tube to roll up results in this defect. It is largely unseen in the US for many years. Prenatal vitamins has pretty much made this so rare that I have not cared for such a patient in many years.

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You can see that the nerve sac is incomplete and sticking out through the spine at its lower end.

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Fortunately the defect may be low enough that the child will walk. His bowel bladder function may be incomplete. The repair is shown.

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The wound is several days after surgery so there is a lot of swelling and bruising but the defect is covered and repaired now. Many more problems will face this child as he grows. This is the first step. The biggest challenge now was to make a proper closure and to prevent infection.

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