That SAMJ wedding ring paper

Incoming DM on twitter:

This seems to be potential blog-fodder for you.

I looked. It was. Oh my, it was.

Are you married? Of course you are. Or perhaps you’re not. Maybe “it’s complicated”, although to be honest, it really shouldn’t be too difficult to work out since it’s a rather binary state of affairs (no pun intended).

We all recognise that one of the enduring symbols of marriage is the wedding ring. If you are married, you can always glance down and instantly remember that you are married. How far do most of us glance down? To the fourth finger on our left hand, of course, as tradition dictates. I say “most of us”, because if you’re in rural Limpopo, there is somewhere else you can stick it.

Hence a recent paper (A Fhima & N Lahouel, 2016) in the South African Medical Journal:

We report a case of penile strangulation with a wedding ring in an adult man who presented at Van Velden Hospital casualty department, Limpopo, South Africa.

Meh. Penile strangulation with a wedding ring. We’ve all done it*.

Penile strangulation is a rarely described medical emergency. Removal of the strangulating object is challenging, with a lack of proper guidelines.

Already, this is good. But the detail is better. Much, much better:

A 28-year-old man presented to the casualty department of Van Velden Hospital, which is in a rural part of Limpopo Province, South Africa…

Yes. And?

…accompanied by his mother.

u wot m8?


Ag, nooit! How do we think that phone call went, then?

Hi Mum. Hoe gaan dit?
No, no, I’m fine thanks.
Er… just wondering if you were doing anything this evening? Any plans?
I… er… It’s just I need a lift.
Where? Oh, nowhere really. Maybe the… hospital. A bit.
Why? Oh, no particular reason. Just…

[whispers] …please hurry.

And when they got there…

His penis was severely swollen and blue, and constricted with a ring (wedding ring) at the middle section. The patient reported that he had applied the ring 4 hours previously…

Why would anyone do that?

…for erotic reasons…

My question still stands. Why would anyone do that?
What were you thinking?
Where on earth do you get that sort of idea? The idea that putting an inflexible metal band of limited diameter around a bit of your body that is… well… that is known for “getting bigger” is a good idea?

…on the recommendation of friends.

Ah. Suddenly all is explained. “Friends”, ne? Again, let’s try to place ourselves as a fly on the wall when that conversation took place. How do you get to the point in a chat with your mates when one (or more) of them suggest that slipping your wedding ring off your finger and over your winkie might be a good way to obtain some sort of sexual gratification? I mean, I remember at the braai on Sunday when my group of friends were recommending putting an orange in one’s mouth and a bin bag over one’s head in an effort to improve the quality of one’s (self) love life, but they’d never suggest putting one’s wedding ring… well… anywhere.
Still, let’s have a bit of superfluous information to complete the horrific mental picture, shall we?

His wife had delivered 2 weeks ago by caesarean section.

At this point, I was most amazed that someone who would choose to do something like this was actually married.
Then I remembered what he’d got stuck on his willy. Look, it’s been a long day. Already.

The penis was erect and blue and the patient was in severe pain.

Now, I should point out right now that there are some pictures. I thought long and hard (STOP SNIGGERING AT THE BACK!) about putting them on here. And I thought that I wouldn’t. It’s up to you if you want to click through and see… see “stuff”.

If you do want to see the effect of four hours of penile strangulation with a wedding ring in an adult man click here.

What’s wrong with you?

Back to the story. Once you’ve got a wedding ring stuck on your bits, how do the doctors get it off?

With difficulty.

First off, you try the string method:

We first attempted to use the string method to remove the ring, with the patient under sedation with ketamine. However, this failed because of excessive swelling.

Then you try…

…using an orthopaedic oscillating saw.

*involuntary clench* But:

The ring proved too wide and strong, with limited space due to swelling.

And then… well, then you try using an aspiration method.

Multiple puncture aspirations were applied with a 20 mL syringe and a pink needle.

*immediate reclench* But suddenly:

The oedema subsided and the ring was successfully removed.

Oedema being the clinical term for swelling. Because being stabbed multiple times with a 20mL syringe and a pink needle in your… er… pink needle will cause your oedema to subside. Fairly rapidly, I’d imagine.

The patient was admitted and treated with broad-spectrum antibiotics and analgesia. Within 3 days he had recovered completely and was discharged. One month later, the patient was reviewed as an outpatient. He reported full recovery.

And they all lived happily ever after.

Possibly, anyway.

If you take nothing away from this clearly cautionary tale, then you’re an idiot. If you do take something away from this cautionary tale, then it’s surely got to be that you should refrain from putting your (or anyone else’s) wedding ring on your member.

Just. Don’t.


* obviously no. No, we haven’t.

“Thanks” Jacques

Worth repeating?

Worth repeating? Given the lack of action on this issue, despite the repeated warnings from people far more qualified and eminently more important than me, you could be excused for thinking not. However, given the gravity of the situation being described and the impact it will have on our ability to survive as a species – yeah, probably.

We’re back on that old chestnut of antibiotic resistance, I’m afraid. The topic rearing its ugly head on here thanks to this guest editorial in the South African Medical Journal for May 2015, penned by Marc Mendelson of UCT and Malebona Precious Matsoso from the DoH. It’s a local journal, written by local people, about local issues. Just like the Southern Suburbs Tatler. Except sane.
It makes such happy reading:

If our overuse and misuse of antibiotics is not halted now, about 10 million people will die annually from drug-resistant bacterial infections within 35 years. The hammer blow will fall hardest on Africa and Asia, accounting for 4.1 and 4.7 million deaths, respectively, and the world’s economy will lose more than 7% of its gross domestic product (USD210 trillion) by 2050.

If 10 million deaths sounds terrible, it’s because it is terrible. Put in context, annual deaths from HIV worldwide are around 1.5 million. TB accounts for 1.4 million deaths. Heart disease kills about 2.5 million people each year. Three big killers and we’re only just halfway there.

Fortunately, this is all way in the future, isn’t it? Well, no. It’s not:

This is not a futuristic scenario … it is being played out right here, right now, in South Africa and other countries across the globe. Decisions to withhold surgery based purely on the patient being colonised by pan-resistant bacteria are being made, and people are dying of untreatable infections in our hospitals and communities. Quite simply, our abuse of antibiotics is destroying modern medicine as we know it. Unless the international community can alter its path, we will lose the ‘miracle of antibiotics’.

So it’s here, and it’s going to get much worse, so why isn’t something being done about it? We’ve touched on this here before:

Of course, if this problem wasn’t so insidious, we’d all be panicking about it already. If there were a 9/11 or a Hurricane Sandy – a single event – there would be far more awareness. (Not that mere awareness would really help anyway.)
But that’s not the case with the antibiotic resistance problem. It’s sneaking up on us and, for those of us in the know, it’s rather worrying.

And on that note, for me, probably the most significant line in Mendelson’s and Matsoso’s musings:

These numbers should make people sit up, listen and change behaviour. But more often than not, it has to be personal to achieve this.

Yes. Sadly, that’s probably what it will take. And sadly, this will happen to people as well. It’s happened to me already this year.

I was reminded of this satirical piece by Andy Borowitz, penned in reference to climate change, but with a nice, ironic “resistance” twist:

Scientists have discovered a powerful new strain of fact-resistant humans who are threatening the ability of Earth to sustain life, a sobering new study reports…
While reaffirming the gloomy assessments of the study, Logsdon held out hope that the threat of fact-resistant humans could be mitigated in the future. “Our research is very preliminary, but it’s possible that they will become more receptive to facts once they are in an environment without food, water, or oxygen,” he said.

Maybe the same will be true once we find ourselves without antibiotics as well.

We live in hope. Briefly.