Sunday, July 26, 2009

Yasmin Ahmad 1958-2009


Yasmin Ahmad
1958 - 2009

I feel like writing something about the demise of Yasmin Ahmad.
It was confirmed that Yasmin Ahmad, aged 51 years old has passed away at 11.15pm yesterday in Damansara Specialist Hospital.She was in a coma for 3 days(I think!) after suffering from a haemorrhagic stroke.3 days prior to admission, she was in a midst of a discussion with Dato Siti with her old husband wtf in TV3 HQ Bandar Utama before collapsed.

To me, she was an icon legend.It came as a shocking to me becoz she was one of the few directors in Malaysia who can actually made a difference in the local entertainment scene.She was well known with her movies such as Gubra and the latest Talentime.Though I didnt watched all of them but from the outstanding reviews and the awards that were received, I am sure Malaysia is and will always be proud of her.

This prolific director has her own unique way of reaching to Malaysians heart through her tv commercials for Petronas.Some of them were witty,funny and some were of coz deadly sad.Nonetheless, all of them had special meaning to it.
This was a big loss for Malaysia.Great minds like these dont come very often.Let us all pray for her peace and may Allah bless her soul.Amin.

p/s I went to the gym early in the morning and work my a** out and currently energy-less .zzZZzzz...Have a nice weekend everyone! =)

Thursday, July 23, 2009

Critical appraisal

My groupmates and I are currently doing critical appraisal on a medical journal.The title is

'Effect of long-acting Nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatmet (ACTION trial): randomized clinical trial'

Doing clinical appraisal is not an easy task.Now is the time to apply all the knowledge and thats when then the problem comes.
I'm tired and I juz wanna sleep.

edited at 9.15pm today.

This posting is good coz one of its main objective is to ensure u on how to critically appraise a journal so that u wont be duped by a short-wearing skirt drug representative,promoting their drugs later when you work as a doctor.Sadly, there are significant numbers of doctors out there who are clueless/confused about evidence based medicine, therefore become prey for drug companies.
I didnt know that there are a lot of types of medical journals out there .eg diagnostic,prognostic,therapeutic etc.Tomorrow is exam.byebye.



p/s: The Good Clinical Practice (GCP) certificate exam is next week.comon bebeh, nak jadi certifified medical researcher.

p/s2: omg.so many technical terms involved

Thursday, July 16, 2009

Bersosial

Went for workout at the gym just now.Currently having abs cramp, contracting intermittently...

Will be having elective proposal presentation with Prof Khairul tomorrow at 1.30pm....

Will be watching the NEW Harry Plotter movie at Cineleisure tomorrow with a couple of friends....

Will be watching Nik's band performing at the Laundry The Curve Damansara tomorrow night...

Who says medical students cant have social life?

Tuesday, July 14, 2009

And so the NEW semester starts

Yes, and so the new semester starts.Will be doing a posting called 'Research and Evidence Based Medicine' or in short 'REBM'.
I quote from my course handout:

'It is crucial and indeed critical for future doctors to be trained in Evidence Based Medicine and how to apply it in daily practice.Many universities neglect this topic, some do not even teach it formally at the post graduate level.Clinical epidemiology is the basis of Evidence Based Medicine, a mantra repeated by many,understood by a few and practice by very few'.

Learning on how to think (critically, laterally and creatively) are essential in a doctor's life.We wudn't want to be duped by the drugs rep when we work later.We need to be able to critically appraise medical journal which are needed to know which facts are fake, which facts are true.Critical and analytical mind plays vital role in the success in this field.

This course will only be for 4 weeks, in which I will b sitting an internationally recognised exam in order to obtain 'Good Clinical Practice (GCP) certificate'.Passing this test will mean that I'll be an internationally accredited as a researcher in medicine( so I was told.I wasnt interested yet upon hearing this).I will b able to conduct experiments using humans!(Now I'm all hyped up!Conducting tests with humans, how cool is that!!!)This course are usually offered at post graduate level but I am indeed lucky to sit this test during my undergrad.It is indeed expensive to sit for this test if u r an independent candidate,probably need to pay a few thousand RM.I dont need to pay a single cent.Now how cool is that.I hope and I will try my best to pass the test.

REBM looks challenging.

ps: I didnt know until about few days ago that there actually people who consistently, diligently read my blog.Looks like I have to take blogging a little bit more serious.yeah?

Friday, June 12, 2009

And so the semester ends....

Alhamdulillah...

Maka dengan ini tamatlah pengajian perubatan saya untuk tahun ini...

Had my long case clinical exam last Monday.Dapat COAD case.Malangnye patient was rather a poor historian.History was rather here and there.Rasa nk menangis pun ade masa clerking.However, I still managed to get good differential diagnosis in the end.Differential diagnosis sangat penting because without them we cannot suggest relevant investigations to the examiner which carries 20 marks in exam.Discussion part was okay except kantoi sket bila ditanya pasal 'What do you know about H1N1 epidemic?Like need to know how many positive cases so far, mortality rate etc'Nampak sgt tak tekun membaca newspaper...

Theory paper was today.The questions looked easy but actually tricky.Quite frustrated with the Single best answer section.SAQ and EMQ were okay I guess.I seriuosly cannot forget my pre clinical basics because they will still ask them in clinical exams.Like how am I supposed to remember the name of the stain used for Cryptococcus neoformans.The answer is Indian stain by the way....

Went to help my juniors with revision later in the evening.They are about to sit for their first paper tomorrow.Professional exam babe...jgn main-main punya exam.An exam that will determine them whether they are fit,worthy and most importantly safe competent medical students to roam the wards.Good luck guys.

Its 2am,just got back frm 'lepaking' with my old friends around KL.Its good to update myself with their latest gossips hahaha.just kidding

Okla.1 month holiday.Any suggestions on how to spend the holiday?

p/s: Finally Ronaldo is leaving Old Trafford for Bernabeu at a whooping price tag of 80million pound sterling.A warm goodbye to Ronaldo-he's been a good servant , and all parties got what they wanted.Let's leave it at that.

Friday, June 5, 2009

Air mata

Dear blog, u know what....I have a confession to make.I cried this week!

It happened 2 days ago during bedside teaching with prof.I had a patient who had stroke 2 days ago.She is a 43 yr old Indonesian lady, came to Malaysia about 6 months ago utk mencari rezeki yg halal,workin as babysitter.But she developed stroke and now is paralyzed on her right side.Everything went ok, but soon after I performed neuroligical examination of the lower limb on her in front of prof and my colleagues, she suddenly grab my prof's arm and start to say things like, 'Tuan dokter, tolong obati saya.Saya tak mahu jadi begini.Tolong.Tolong.Tolongg..." Allah...dats when my lacrimal gland starts to produce tears.Ok.I was like wtf, stop crying silly!(umm..I was saying silly to myself n not to d patient)Anyway,its not like tears running down the cheek.Its more like 'air mata bergenang-genang di kelopak mata"I can see that my colleagues are experiencing the same thing.We tahan.Try to look professional.But again, we are also human beings and the emotion sort of transcends right into our hearts.
Similar things happened towards another patient.It occurs the same day.She is a middle-aged Malay lady, came in with intermittent vertigo(dizziness).It was rather an interesting case because she had cerebellar signs such as nystagmus, intentional tremor,ataxia,dysdiadochokinesis etc. Again, after Hanan performed physical examination to elicit cereballar signs on her, she started to say ," Tuan dokter, ni can... can... cancer ker?"...and she started crying.I really admire the way how prof handled and tackled these emotional moments.He motivates patient.He tell them to think positive and be optimistic.By the way, we dont think its cancer because the history does not suggest that it is.Moreover, the cerebellar signs are not vivid.Even if it is a CP(Cerebello-pontine) angle tumour, the ENT surgeon can easily remove them.
It break our hearts to be in this situation.Its hard to be optimistic when you know that the disease such as stroke do not have a good prognosis.There is nothing much we can offer!Once kena stroke, poof... its hard to predict.The only thing to do is to motivate patient,telling them that they cannot lose hope.Patient come to us because they trust us.They hope that, with the help of Allah and to our utmost capabilities ....we can cure them.Ok.This is dilemma right there.I better stop now.Nak pegi dinner......

p/s: My long case clinical exam for internal medicine is on this Monday(3 hari lagi!)at 2.30pm.Doakan ye.... =)

Sunday, May 31, 2009

Paeds Surgery



Me and Hannan went to the Paeds Surgery ward in UMMC for the second time(and yes during the Sunday).Today we followed the morning ward round, headed by Dr Syariz Izri the Paeds surgeon MO (he is my cousin by the way).Managed to see a few cases such as pancreatic pseudo cyst, cystic hygroma, Hirschprung's disease, imperforated anus etc.

Later, we discussed about the topic regarding stoma, since that it can come out in our short case surgery exam.Stoma literally 'mouth' in Greek or Latin.The other name for stoma is colostomy or ileostomy.Depends on where the stoma bag is.There are many types of stoma but the popular ones are loop-type and double-barrel type.We also discussed about the important points that we need to mention during the short case exam.They are:

1.Sitting of a stoma (as a rule of thumb, stoma must be placed away from bony prominences such as the ASIS and away from the umbilicus)
2.Type ( Loop or Double-barrel)
3.Content of a stoma bag (feces colour, consistency etc)
4.Complications ( skin excoriations, paracolostomal hernia etc if visible)

We discussed about few other things la such as indication and complications of stoma.Umm malas nk type dah....
We pinjam-ed a baby who has Hirschprung's disease.Did rectal examination and boy there was a sudden gushed of feces coming out just right after removing our finger out from the anal canal.A sudden gushed of feces is a pathognomonic feature of a Hirschprung's by the way.

Later that day, spend a few hours in the gym and later rushed to Shah Alam for Eda's sister wedding.

ps: OMG logbook internal medicine masih agakkk kosong.Abeslaa 2 minggu lagi dh nak kena hantar

Thursday, May 28, 2009

XM

Final exam of Internal Medicine in 2 weeks time.I must admit that I am starting to feel a lil nervous.

My patient, the 15 year old boy who has hypokalaemic periodic paralysis dh discharge petang tadi.I hope he will achieve his dream of becoming an architect.Rajin.Bile dtg kat katil mesti tgk dia tengah buat soalan latihan.Pastu cepat-cepat sorokkan buku tu.Malu.Haha.Remember dik, poverty should not become your 'batu penghalang' in achieving your dreams.I shall pray for your success!

P:s What a long day.Bedside teaching sampai pukul 8pm.I'm not too sure wht I've learned juz now

Tuesday, May 26, 2009

Disbelief

Dear blog, sorry for not updating u for quite some time.It has been a busy weekdays and weekends.Yes, I have to come to the hospital even on Saturdays and Sundays.Saturday in HPJ.Sunday in UMMC at Paeds Surgery department.It's all becoz I am teman-ing my groupmate Hannan who will be doing her elective in Paeds surgery in the UK next month in the prestigious,world-famous Paeds surgery hospital, the Great Ormond Street Hospital.Its good for her to get some early exposure before going there.Good luck Hannan!

I am surprised and totally taken aback by the lack of history taking as well as presentation skills among houseman(HO).Particularly who graduated from that country.I tried not to be prejudiced.But so far I've met 1,2 and 3 HOs graduated from that country who shows similar trait.Tell me, how can you diagnosed a patient without knowing on how to take a proper history.As we all know, 90% of the diagnosis is made thru history taking alone.The rest are confirmatory.Izzit due to the lack of clinical exposure during clinical years?Are they not trained to take history?Lack of practice? Lack of patient access in the wards?Lackadaisical attitude of their lecturers?Easy passing mark during exams?or simply unmotivated during clinical years?Enlightened me.How can you make a diagnosis of chronic liver disease when you cant name any signs of chronic liver disease- palmar erythema, Dupuytren's contracture,spider naevi,caput medusae,gynacomastia and testicular atrophy-to support your diagnosis?I thought these are basic stuff that should have been taught during meds school.These are a must know knowledge!

Consequently,who will suffer the most?Yes,its none other than the patient.It serves as a reminder to myself.I hope that I could improve on my history taking as well as presentation skills.As for now, I tend to jump to the associated symptoms before even giving a good elaboration to the chief complaint.I pray to Allah in every step that I make.

ps:Sorry.I'm being frank here.I dont talk this stuff to anyone.I do this only in my blog.

Wednesday, May 13, 2009

Altered sensorium

Today was a bad day la I guess.

Went to the female medical ward early in the morning before the ward round starts.As usual, went to the nurses counter.The usual question came out ,"A'kum dan selamat pagi.Staff nurse, ada brape patient baru admit ke ward petang semalam?" I was a bit unlucky becoz the Sister(Ketua Jururawat) was moody.'Staff nurse, buat ape u layan sgt medical student ni?Jgn layan sgt.Kalau kite layan kerja kita takkan siap.U medical student dh buat orientasi kan?Haa tak faham lagi ka?'
I swear to God that I almost take the BP set and throw at her fat face.Wasnt she listening?My question was simple.'How many new patients admitted to the ward yesterday?'I need to know becoz I have to freakin go and clerk and do physical examination to those new patients.Preparing b4 the ward rounds becoz the Specialist would surely to either ask us to present the case or give the case summary to them.It's not that I am asking that staff nurse to bring me and show me every single new patients one by one!I'm sure that big fat old hippopotamus with that st*pid looking white hat sticking on her freakin hair has sensorineural deafness.Pardon me.Yes,I was pissed.I admit and rela dimarahi if I've done something wrong.But I got irritated if I was freely being lectured for some unknown,unjustified reasons.I dont know.Some nurses and sisters are downright cocky to the core.

At a different note...

Multiple sclerosis,Lung ca with secondary metastases to the brain as well as iatrogenic Cushing's secondary to exogenous steroid-are some of the new cases admitted to the ward yesterday.

PS: Currently doing case write up( 2 long cases and 2 short cases to be submitted tomorrow).Another sleepless night...

Tuesday, May 12, 2009

Think what patient's think

So many things have been happening for the past 2 days.On Monday, we witnessed the launching of 'Minggu Kesihatan Angkatan Tentera' bersempena dengan ulang tahun Kor Kesihatan Angkatan Tentera Malaysia yang ke ...... .Ntah, saya pun tak tahu.Will post the video perbarisan once I copied it from a friend of mine.

Did you know that stroke or 'angin ahmar' is believed to be associated w
ith serangan syaitan?That's what some of the Malays thought.I've heard this notion before but had never ever thought that I would come across a patient who believe this so soon.One of my assigned patient suffers from right sided limb weakness associated with facial assymmetry 4 hours prior to admission.He was admitted 4 days ago.He is a known case of uncontrolled hypertension as a result of non compliant to medication.His systolic BP upon admission was unrecordable,while his diastolic blood pressure was 150 mmHg.Thats super duper high.We would grade his hypertension as 'Stage III Hypertensive emergency' under the new CPG guideline.Anyway,during history taking that patient started to tell his own version regarding the 'pathophysiolgy' of stroke.According to him, he believed that a devil would penetrate his body through the heart before being disseminated throughout the body.The most vulnerable part of the body will eventually manifest as limb weakness.He believes that stroke is curable especially when treated by powerful shamans or 'bomohs'.He even suggested me to learn from a few bomohs and that he could recommend me to them if I am interested.
Its interesting to think what patient's think sometimes.
Scary.

Pic1: Pic was taken today.This is a tophi at the right elbow.This patient is having chronic tophaceous gout

Pic2: This pic was taken yesterday.The chest x-ray shows 'Boot-shaped' heart.This patient has ischaemic dilated cardiomyopathy.

Sunday, May 10, 2009

Happy Mother's Day


Happy Mother's Day to my mother and to all mothers throughout this world.


Woke up at 8.30am this morning.Its Sunday, I was lazy indeed.However, we had to carry out a medical check-up in Bandar Tun Razak.Waqi contacted me yesterday saying that they need some men to run the booth.The medical check up is part of the activities being held during the Mother's Day celebration anjuran Puteri UMNO bahagian Bandar Tun Razak.Kak Sha was the contact person.

Arrived late, around 9.30am.Sesat.The signboard for Taman Tenaga was nowhere to be seen.We opened the booth as soon as all of arrived at the scene.Once the registration booth were opened, a hoard of people menyerbu.My god.I manned the Blood Pressure taking booth.Bayangkan orang beratur mcm nk mengundi je.Line panjang.I was taking the BP for almost 2 hours straight without getting a rest!Nobody was kind enuff to give me at least a mineral water.Anyway, had a little bit of fun when I get to practice my 'counselling' skill to makcik and pakcik.PLease take care of your diet,stop smoking,exercise more etc etc.Yes.Its important.Doctors ( or future doctor as in my context ) should play roles as a teacher to patients.Educate them with knowledge that they supposed to know.It makes things easier in the end.

PS: I am curretnly back inTerendak.Will have to go to the medical ward tonight to clerk and update new patients.

Wednesday, May 6, 2009

The Bashing up day

Today was a bashing up day by prof.From bedside teaching to our TBL session.Extremely tired.The day starts at 8am and finished at 7pm.Extremely tiring, physically,mentally and emotionally.We have the knowledge but the problem is that is how to apply it in a real situation-ie translate it into our working environment such as using those knowledge during history taking so that we could ask relevant questions,looking for focused,relevant physical signs,ordering for relevant investigations etc.

If I were to stop pursuing medicine, this day would justify it

ps: I do not know what to think about myself right now

ps:Patient case presentation for today was about 1) Unstable angina 2) Acute exacerbation of asthma secondary to rhinosinusitis 3)Beta Thalassaemia major.TBL was on "Approach to DM and Dyslipidaemia"

Tuesday, May 5, 2009

Internal Meddicine Week 3

Another reason why I dislike Paeds.Sometimes while clerking patients (a.k.a kids) will b busy doing somethingelse.This pic was taken yesterday when adik H was admitted due to Poorly controlled asthma (classification based on the latest Asthma classification-the GINA classification).My friend Hanan was so into clerking his history while he , on the other hand was busy playing with Gameboy.She had to come to the ward at night to clerk his history.And at the end, this is what she gets!

No lar, I'm not making a big fuss out of it.What is more interesting is the chest x-ray findings.His chest x-ray shows tramline and ring shadows which is consistent with the diagnosis of bronchiectasis.We r doing CT Scan tomorrow morning to confirm the diagnosis.Will try to take the chest x-ray pic and paste it here. =)

Ps: Internal Medicine is so tiring.But luckily it is interesting at the same time.

Ps: Had 2 TBL today- 'Lethargy' and 'Cough n Wheezing'.The second TBL was done with Dr Rosman.We have to change to our sports gear and went to a place near the sea shore and had our discussion there in the late afternoon.Dpt tengok sunset skali.......

Ps: Spend 2 hours in the clinic today.Got to clerk and see cases like Asthma, Migraine and Beta Thalassaemia major.

Ps: My patient with Unstable angina is stable.Dr Pakar are keeping him in the ward to stabilise his blood pressure

Friday, May 1, 2009

HO,MO,Specialist,Consultant

Its labour day.Still, no holiday.Drove from Terendak and reached KL yesterday evening.Attended 2 teaching sessions by Dr Rafizie and Dr Shuhaila this morning in Hospital Putrajaya.Did I mention that they are married together?Hehe.They are so motivated in teaching us.May Allah bless the couple.Seriously, they are both good and nice.

According to Dr Rafizie,

HO = Hamba Orang
MO= Makan Orang
Specialist = Syphilis
Consultant= Con-setan

LOL

Ps: Revision mania syndrome

Wednesday, April 29, 2009

Critical vs cynical

Serious hari yg penat.Went to hospital at 7am.Do necessary stuffs such as taking blood and updating patients info regarding blood test and PE.Followed the ward round with Dr Rosman.Bombarded by him with a lot of questions.Siap soalan physiology pasal Virchow's triad pun ditanya tadi sebab gatal sangat nak gune term 'laminar flow' and 'turbulence flow of blood'.

Had bedside teaching with Prof Rashid just now.Hannan presented a case about bilateral leg swelling in a patient with poorly controlled DM.Again, bombarded with lots and lots of question.Dari history taking,PE,Investigation sampai la ke management of patient.

Later on that day, had TBL session with yet again Prof Rashid.Tajuk 'Cough,Fever and Sputum'.Again, bombarded with questions.Siap prof ketuk ketuk meja lagi.

One thing really important that I learn today is that as a doctor we should not do things blindly.We should not have this tunnel vision mind set.We should think,think and think.Do not simply do things because it is routinely done.I like all the teaching session today becoz they teach us on how to think.How to solve case.They prepare us for the real working environment as a doctor.Like prof said, teaching how to do physical examination is easy but teaching how to think is far more difficult.

ps: Think critically not cynically

Monday, April 27, 2009

Bakti Siswa & Anak Anak Angkat program


I spent 3 days and 2 nights in a kampung called Kg Air Lapis Bangas in Parit Sulong,Johor.I want to retract back my words in my previous post.It was worth it going there after all.The mak,abah and family angkat were super nice.We were treated as if we are their own sons and daughters.At one point, I came to think that their real sons and daughters have become their own anak tiri.For example, Nik and I was with this one family who have 2 sons and 2 daughters.Their son had to sleep on the floor when both of us happily sleeping on his bed.We were also given their cars and motorcycles.We used them as if they were ours.Therefore, there is no surprise when one of us terbabas masuk dalam kolam while learning to ride motorcycles.The food? Owh its super duper good.One of our main activities were eating and eating.We had like 3 dinners everyday.Nasi Ambang, Mee Bandung, Sup gearbox u name it, we ate it.Therefore,it comes to know surprise when I weigh myself this morning and found out that I have gained 1 kg.Gaining 1kg in a 3 days time is a lot.

We had programs like membaja pokok kelapa sawit when the ahli parlimen Dato Noraini Ahmad (Ex Ketua Puteri UMNO) actually came to see the programme,program pemeriksaan kesihatan percuma for the penduduk kampung, program motivasi para pelajar so on and so forth.

Just like in previous medical check-up activity, our Prof Latiff would surely do some clinical teachings there whenever there is an interesting sign and symptoms discovered among the patients during the event.This time, I managed to see things such as chronic tophaceous gout, Marcus-Gun eye sign, Pterygium eye ,Podagra,Heberden's node as well as Bouchard's nodes of Osteoarthritis,symptomatic viral hepatitis,classical chronic uraemia signs and symptoms etc

Pic 1: Pterygium.One of the signs of hypercholesterolaemia
Pic 2: Podagra.Swelling and pain of the first metatarsophalangeal joint in GoutPic3: Heberden's node(at distal interphalangeal -DIP join) and Bouchard's node ( at proximal interphalangeal-PIP joint) in Osteoarthritis.They are caused by formation of osteophytes(calcific spurs) of the articular cartilage

Note1 : I'm currently in Terendak now.3 weeks posting in Hospital Angkatan Tentera Terendak.

Thursday, April 23, 2009

Internal Mad-icine

There are so many things that I want to share regarding my experience in the medical ward so far.There are so many things that I have learnt.So many signs and symptoms that I saw and has intrigued me to do better in this field.So many interesting cases!!!!

Ward round
I particularly love ward round.The specialists is super nice, Dr Nurain.She frequently asked questions to the HOs and also medical students.Many HOs have forgotten their basic knowledge.I DO NOT WANT to become that kind of HOs.Its a pain in the a** to forgot basic things and at the end of the day you will screw yourself becoz u need to do some serious revision for something that u knew before.God, please please prevent me from being dyslexic and receptive aphasia.

History taking and physical examination
I managed to shortened the time taken for history taking and doing physical examination.It is important to try to time yourself.This is a good training becoz as an HO later, I need to work efficiently.Anyway, this should not compromise patient's satisfaction towards the level of care and attention that we are giving to them

Case presentation
I am more able to organize my presentation.Presentation should be sweet and simple and interesting at the same time, without compromising the important details.I am still working on my 'negative relevants'.I still need to elaborate more on my chief complaint.Need at least 10 points before moving to associated symptoms!

Formulating diagnosis
This is particularly a challenging part but interesting at the same time.We were taught on how to think systematically

Interesting case of the day

1.Mr Y, 56 yo, chronic alcoholism.Admitted yesterday for SOB.On PE, hepatomegaly.He had signs of right ventricular failure secondary to dilated cardiomyopathy

2. Mr T, 49,Central chest pain which lasts for 5 hours, occured 2 days prior to admission.ECG done had ST elevated MI with elevated cardiac enzymes

3.Mrs R, 60 yo, came in with diabetic ulcers secondary to chronic venous insufficiency

Ada byk lagi malas nk tulis...

Quiz of the day.
Question 1.Give me 5 predisposing factors for the development of diabetic foot ulcers
Question 2.Types of myocardial infarction (anterior,lateral and inferior),its respective coronary vessels involvement and from which ECG leads that we can see them from.

Answer:In next post!

Note: I need to pack my stuff now.We are having 3 days and 2 nights of program Bakti Siswa in Batu Pahat over this weekend.Program anak angkat and medical check-up stuff.Sigh, I am already tired with this type of programme...............................they should allow us to sleep more at home during the weekend.

Wednesday, April 22, 2009

Of elective posting and research

Finally, I have decided to do my elective posting at the National Heart Institute (IJN) during this coming 1 month break somwehere in August .I am interested in Interventional Cardiology.U know , cardiologist who can do procedures like stenting etc. I love cardiothoracic surgery but I heard that that field is nomore in demand in the market,compared to other surgical sub-specialties.I would love to know more about the world of Cardiology....yezzaaaaa.I have also found the person who is going to be my internal supervisor, a cardiologist in IJN himself Dr Rosli.Thx Dr for accepting me =)

Tuesday, April 21, 2009

IM mini homework

We presented our patient case today to prof Latif.Prof taught us another structured,more interesting way of presenting our case.He reminded us that the first few sentences in history presentation is important because that would determined whether we are an 'A' doctor or a 'D' doctor.He went on correcting stuffs such as by saying its wrong if we say 58 years old where in fact it should be 58 year old (minus the 'S').

Before ending the session, we were given a mini IM homework.Terasa macam budak darjah 1 pulak.

Our IM mini homework for today are to find answers for the questions below.

1.List 15 signs and symptoms of thyrotoxicosis
2. List five macrovascular and five microvascular complications of diabetes mellitus
3.Lists 5 causes of massivesplenomegaly
4. Five causes of palmar erythema and five causes of finger clubbing
5 List as many as you can the major differences between COPD and Asthma
6. Diagnosis criteria for Acute Myocardial Infarction
7. The differences between transmural,subendocardial infarct and acute angina
8. The clinical features of uraemia in CRF(Chronic renal failure)
9. Indication for emergency dialysis
10.The five different types of stroke
11. List all the features of cerebellar signs with its causes
12. The clinical features of SLE(Systemic Lupus Erythematosus) and the criteria for diagnosis.

He says that internal medicine is so wide, that it requires doctors to specialise into certain field in th eend.But as a medical student, we have to know everything under the sun.No short cut.He also added that as physician, we need to be able 'to recognise disease pattern'.Its like getting the bits and pieces of a jigsaw puzzle together.Those who are sharp and well equipped with good background theoretical knowledge will be able to become a good physician.

Looks like I need to do a lot of stuff right now.My otak is so berkarat!

p/s: Prof also reminded us the importance of study group.This is not the time to study alone!Yes you can spend 2 hours a day to have a quality time studying alone but the rest should be in a form of a discussion with your groupmates.I agree with him 100%.There is no way that we can survive medicine if we study alone.Its simply impossible to cover everything alone!

Monday, April 20, 2009

IM first day

Hmm today is the first day of internal medicine.My first impression: Wowww there is a lot of things to be revised man.Most of the theories have been taught during pre clinical years.

Clerked my first patient.It was a 49year old Malay gentleman from Putrajaya.Guess what is he having? Stroke! So young and yet dah dapat stroke.My impression was that this guy ada left ischaemic stroke with right hemiparesis.A known hyptertensive patient who is non compliant to drugs.He also have hyperlipidaemia.I havent seen his investigation result such as CT scan of the brain.But clinically I think he had an ischaemic stroke of the middle cerebal artery.
In IM,the challenging part would be to take a thorough history and also a thorough physical examination.A bit blur sebab dah tak masuk hospital selama 2 bulan after public health posting.I had to sit down at a corner first, trying to revise back my theory.I did Neurological examination both for motor and sensory functions for both upper and lower limb.Not forgetting the cranial nerve examination since this patient ada facial paralysis.CVS examination terlupa buat.Arghh...

Each of us are in-charge of one cubicle in that ward.There will be 4 patients at one particular time in a cubicle.Each of us must know everything about those 4 patients.Tomorrow will be our first case presentation.Prof Latif will randomly pick any patient in any cubicle that he like.I didnt clerk all the patient in my cubicle because tak sempat.Hmm ntah la, the possibility to be bombed is high tomorrow.Hahaha...

Sunday, April 19, 2009

How to succeed IM(Internal Medicine)-pesanan dari Fana hey!



Hmm...so nice of my friends.We r helping each other out.Dats the spirit mannn...nway, ni email yg dpt dari Fana hey.I dont edit this.Saje nk post kat blog ni.At least bleh baca slalu.Enjoy reading(to me)!


How to succeed in IM (hehe, insyaAllah)


1. Read and read n read

- based on ur patient's case
- cth nyer kalau dia ade DM ke HPT ke then read about it and must know
the basic things about it (eg how to dx, what are the types, its definition
the classification)
- dont forget to refer books and old folios pls..
- recommended books:
--> oxford handbook of clinical med (a must have)
--> kumar n clark or davidson's
--> tally o'connor or hutchinson
--> old folios

2. Getting the history

- get the history right, HOPI very important (LORD SANFARO)
- all the what where when why where who how
- the chief complaint
- assoc sympts n other hx
- after getting all the hx, karangkan n try to present to ur frens
- get their opinion and ask them if there is anything not complete or missing
or if there is a gap in ur hx
- dont be afraid to dig from ur patients
- and dont salah interpret what ur patient is trying to say (u know pening and
sakit kepala might mean something else to ur patients)

3. Doing physical examination (PE)

- the first day u should already know how to perform PE for every system
- they include :
>CVS (paling senang n best)
>respi
>abdomen (as in GIT)
>musculo (some r integrated in CNS)
>CNS (upper n lower limbs)
>cranial nerve
-must have:
>stethoscope (kalau takde bkn med student la..)
>pen torch
>tendon hammer (optional coz bole pinjam from ward, but its better to hv ur own
or at least share)
>orange stick n cotton n tongue depressor for CNS (can always get it from ward)
- pls jgn buat sorang2 takut nnti syok sendiri
- at least the other frens tgk n check anything yg tertinggal or silap
- this might sound cliché but practice makes perfect
- especially for the patients that u want to present to prof ke dr ke u MUST do ALL the
systems (CVS --> CNS)
- jgn buat short cut buat betul2 cam nak exam
- when ur used to it it will only take few mins (awal2 mmg la slow skit)

4. Presentation

- always karangkan the hx [intro, hopi, assoc symt, past med hx, hospitalised/surgical hx,
drug hx, family hx, social hx(wife? anak? work? house where brape tngkat, tepi jln ke?)
dont forget the public health component people, also bout smoking, illicit drugs, sexual promiscuity]
- then followed by the summary of hx
- then present the physical findings (pls include BP, PR, RR, T)
- then PE summary
- finally summary of hx plus summary PE
- a good presentation : by the time uve finished presenting the listeners will have an idea which
system is the prob or at least a differential dx

-not to be included when presenting but have to know:
> must know what drugs patient is having, what doc plan to do, all the investigation findings
must know the nilai dont just say its N or not normal (in case prof or dr wants to know)

5. Long case n short case

- pls do it whole heartedly
- not just cincai2 lorh
- must have good, lengthy, informative, relevant, important, meaningful learning issues (dont
forget the academic n non academic learning issues)
- refer books n include any discussions about the patient

6. Must have your own 'kitab'

- well its actually a notebook (or many notebooks) which contains important n must know knowledge
- knowledge from books, ward rounds, profs n drs, ur own 'michael jackson kene halau balik
india utara' (pneumonics) kinda thing to remember stuff
- the main idea is so that u dont have to refer to books many times because u can just refer to ur
own self made kitab
- u must revise every week n add any valuable new info into the books..
- this is also another cliché but dont study last minute
- prof will give u guys a registered online examination website where there are many questions for
revision.. so bole la practice..

7. Miscellaneous

- during ward round, u guys should contribute to any new info from the history that uve taken
- all of u will meet 2 wonderful doctors dr shu and dr rafizi (dr shu's husband). they're really nice
and determined to make all of us pass our IM posting..
- the terendak people..dont take terendak for granted.
- the lack of patients should not be an excuse to be laid back. in fact u should take the opportunity
to know the patients in depth.

thats all. all the best


Yours truly, <----- Ok ni aku yang tambah.
Fana hey

p/s: Thx Fana~~~!

Monday, April 13, 2009

Holiday

Yup....u heard it right mister, ITS HOLIDAY~!!! Its only a week holiday, but who cares...I need all the sleep that I can get.Plus, its going to be my last posting this semester-Internal Medicine.For that, there will b a lot of things to revise.Yes, revision honey.Preclinical stuffs!

Cardiovascular system
Respiratory system
Urinary system
Gastrointestinal tract system
Endocrinology
Neurology
Musculoskeletal system
Haematology
etc.

Im goin to concentrate only on CVS,Neuro and Urinary system for the time being inshaAllah.

Happy holidays everyone~~~=) =) =)

Note1: By the way, the semester break after Internal Med will b shortened to only 1 month instead of 2 =( .We have to carry out a research paper for 1 month.Prior to that, we will b having a posting named 'Research and Evidence Based Medicine' for 1 monthDuring this posting, we will be taught on how to do a proper research paper, journal appraisal and stuff.I'm actually excited and sad at the same time.Life is indeed confusing...

Note2: My internal supervisor is a Paediatrician...surprise surprise! I still have about 2 weeks before submitting my research proposal.I still cant think of any interesting research topic...sigh

Wednesday, April 8, 2009

Viva

Disclaimer
**This post is meant for the next public health group posting.Ni soalan compilation ni.Haha**

Today was viva day.From what I know,viva is a method of assesment used during preclinical years for students who failed their written paper twice.Tapi tak sangka pulak ada viva masa clinical years ni.We do not use patients for public health final exam coz there is no long case exam.Instead, viva is used as part of assessment method.
So layanje la

I was the 9th person to be called for viva.Again, only god knows how jittery and nervous I was.Two professors became the examiners.Both are public health specialists.The Viva can be divided into three components.

A.Public Health Journal
During the posting, we are required to read as many as public health journal that we can.In the end, we are required to list down 10 journals in our logbook.Those journals can be asked during viva.I was given the liberty to pick a journal which I am most confident with.For this purpose, I chose a journal with the title of ,

'The short-term impact of National Smoke-free workplace legislation for passive smoking and tobacco used"

Questions asked were:
1.About the study
2.Study design ( Ans: 2 time cross sectional study, before and after legislation enforcement)
3.Sampling method (Ans: They used cluster sampling method)
4.Other sampling method that you know off and their differences and features.(Ans: Simple random sampling,Systematic random sampling, Stratified random sampling,Cluster sampling,Multiphase sampling and Multistage sampling)
5.Statistical tests that were used
For this journal, they have used various tests.Eg: Chi squared test to assess 2 categorical variables which are exposure to tobacco smoke(ETS)-"Not at all""Less than an hour","1-4 hours","more than 4 hours" and smoking prevalences among employee in various workplaces-industry,services and offices.They have also used a non-parametric test named Mann Whitney U test and test of normality for continous variables such as Kolmogorov-Smirnov,Skewness and kurtosis and histogram.
6.Result and conclusion of the study.
-ETS declined considerably after the legislation.Eg;Exposure was halved in 1-4 hours group.
-Daily smoking prevalences among employees decreased significantly,from 30% to 25%.
-etc.

B.Health Intervention Programme (HIP)
The second part of the viva was about things regarding our HIP.Questions asked in this section were:
1.Sampling method (Ans: We used Stratified Systematic random sampling.The population were stratified according to the income group, roughly by looking at their type of houses-single storey and double-storey house)
2.Type of study (Ans:Again, this would be a cross sectional study)


C.Regarding attachment to district hospital,health clinic and community clinic.

1.Roles of Medical and Health Officer(M&HO) as compared to medical officer (MO).
Ans: 1. Patients-M&HO's patients consists of the population under its sub-district.Eg.If I am an M&HO in Salak, then I am responsible for the health of the whole community in Salak, and patients consists of the sick as well as the healthy ones.
2.Plays role in administration and management of a health clinic
3.Plays role in health prevention and health promotion.For this question I was asked the differences between 'prevention' and 'promotion'.Annoying gile...

2.Next, I was asked about the weightage system for evaluation of food premises done by the health inspector from food and quality control unit of district health office.
Answer:
Based on de-merit system.Deduction of marks out of 100 marks.Minimum passing mark is 50marks.Failure to achieve will result in the closure of food premise for 14 days.Can be charged under Food Act 1983
Food-30%
Food handlers-20%
Sewerage system-10%
Waste dumping-10%
Food containers and utensils-10%
Premise's floor-5%
Toilet-5%
Water source-2%
Others-8%
I was asked," Why do you think that the weightage for water source is only 2%?If you can answer this you can get an A+"LoL.I dont think I answer this question convincingly.It has something to do with primary prevention and primordial prevention method.Pre clinical stuff.So tak boleh ingat.

3.What is the required temperature for hot food in kedai mamak for example.
Answer: 63 Celcius

The end.

Below are the questions asked to my friends:
1.Malaysian Immunization Programme and the 'Cold Chain' system
2.Program Doktor Muda-10 scopes in their module
3.National Indicator Approach/District Specific Approach/Hospital Specific Approach
4.Lists of communicable diseases that must be notified to authority within 24 hours and within 1 week of diagnosis
5.Prevention of the spread of dengue-method,preparation before fogging,fogging mixture,equipments etc.
6.Things that a community nurse do during home visits
7.Recycle plastic bags-types,colour
8.Steps taken in a Needle prick injury
9.Expanded scope programme for health clinic

Tuesday, April 7, 2009

Busy bee


Marilah tengok aktiviti saya dalam seminggu ni...

1.Health Intervention Programme stuff - Busy buat plan of action, jumpe orang ni, jumpe orang tu.Bak kate prof, we shud be able to MARRY the needs between penduduk taman desa vista and klinik kesihatan as well as pejabat kesihatan daerah.Proposal and plan of action dah kasi kat klinik kesihatan.Lepas ni nak konfemkan date for the programmes

2. Revision for public health and community medicine posting final exam bersama rakan-rakan
-banyak kena revise.Semua benda pasal district hospital, klinik kesihatan, klinik desa, skop tugasan, national indicator approach,SPSS(Biostatistics),occupational hazards etc etc.Dont ever make me start talking about these stuff!!!

3. Gym with personal trainer -gluteus maximus,medius and minimus tengah sakit ni. -selain daripada tidur beribadat, inilah salah satu cara nak releasekan stress Ok.Pray for my viva(tomorrow) and written test(the day after tomorrow)

Monday, March 23, 2009

SPM 2008

Dengan ini saya ingin mengucapkan tahniah kepada junior-junior saya.Tak lupa juga kepada Makcik DS yang telah berpenat lelah memasakkan makanan untuk kami.Juga kepada warden-warden block yang sibuk suruh 'lightsoff' setiap malam.

SPM2008: Ranking mengikut Sekolah-sekolah di Malaysia.

  1. MRSM Langkawi (1.4041)
  2. MRSM Taiping (1.5391)
  3. MRSM Pengkalan Chepa (1.5439)
  4. SASER (1.612)
  5. KISAS (1.68)
  6. MRSM Tun Ghafar Baba (1.6865)
  7. ASIS (1.754)
  8. SAMURA (1.83)
  9. SESTER (1.841)
  10. SBPI GOMBAK (1.883)
  11. SAINS JOHOR (1.906)
  12. MRSM Alor Gajah (1.9326)
p/s: PCian...kita aummm skali..Auummmmm! <---- gile tak cheer kitorang dulu mcm ni?

Thursday, March 19, 2009

E-hospital

Much have been said about the letter 'e' here in Malaysia.e-government,e-commerce,e-ni ,e-tu and of course e-hospital.Just like in any system or policy, there would be pros and cons.

E-hospital

Points for E-hospital
1.Patients data will be key-in and kept more efficiently.
No need to take the trouble to find the file in the store room.Patient's history, diagnosis, investigations, x-ray,MRI,CT scan record is just a click a way.I've visited the Medical Record room , a place where medical records are being kept.They are being kept neatly and meticulously with the colour coding and all.I'd go nuts if I were to be the person in-charge of that department.

2.More safety?
Umm...probably since password is needed before access is gained into the Hospital Integrated System (HIS) developed by Microsoft company for Malaysian hospitals.But, again we never know.Hackers are getting smarter and smarter by the minute.


Points against E-hospital
Both of my teaching hospitals are E-hospitals(Hospital Serdang and Hospital Putrajaya).Next year baru pergi Hospital Kuala Lumpur( not an e hospital, more like an eeeeuww hospital.LOL).So at least my points below are valid and reliable.

1.Lack of personal touch from doctors to patients
I've managed to ask the doctors who uses this system, particularly when in the clinic.All they cud say is that they prefer the 'oldies' method.ie writing in papers.Just imagine patient is seating on your right while the computer is either on your left or in front of you.So your gaze is not towards patients but rather at the computer.

2.Computer hang!
Haha this is the usual complaint.Kalau tak hang komputer tu lembab.I've seen a lot of cases where the doctors were frustrated becoz they need to restart the computers quite oftenly.

Note: Pray for me.I have an SPSS exam in about an hour time.Sronok gak dpt apply statistic knowledge yg tak seberapa ni.Faham? ok takpe

Thursday, March 12, 2009

Jem

Jem atau JM atau nama penuhnya Jururawat Masyarakat merupakan anggota kesihatan primer yang sangat penting di peringkat kesihatan awam.Mcm mana nak bezakan mereka dengan Staff Nurse? Mereka ni pakai riben warna ungu dekat tudung.Kalau Staff Nurse pakai riben warna biru.

Tadi pergi ke Klinik Desa Ulu Chuchoh dekat Sepang.Belajarla skop tugasan JM ni.Tak sangkanya tugas mereka ni berat.Perlu mengenal ahli masyarakat setempat dengan rapat.Pergi buat home visit,program bakul JM,tanam benih sayur-sayur dekat halaman rumah etc.Sangat respek dengan profession nursing ni.

Petang lepas tu pergi ke Taman Desa Vista.Nak continue buat community survey.Alangkah sakitnya hati.Tak perlu cerita kat sini.Maghrib dekat surau sana.Nak bina good rappot dengan Kelab Rukun Tetangga sebab tak lama lagi nak anjurkan program intervensi kesihatan berdasarkan result bancian.Ada juga diadakan mesyuarat dengan AJK KRT.Sekarang tengah menulis segala jenis surat-surat yang nk diberi kepada Majlis Perbandaran, Ketua Pegawai Kesihatan Daerah etc.

Esok pegi ke sekolah berdekatan.Nak tengok 'School Unit' dari Klinik Kesihatan menjalankan program dekat sana.Of coz, report tak dilupakan.Semua visit mesti dibuat reportnyaaa......Tak larat sgt

Sunday, March 8, 2009

Voice yillekkk

-Melawat tapak pelupusan sampah utama Sepang.Busuk yang amat k-


Hari ni first day kami buat community survey.The survey or bancian is based on our own Questionnaires ( ada 104 questions kesemuanya).Questionnaires ni melingkupi banyak aspek kesihatan, namely tabiat merokok, iklan merokok (mcm gamba kat bawah ni) women's health, injury, traditional and complementary medicine etc).Soalan2 dibuat berdasarkan fakta yg diperolehi oleh journal jounral public health and epidemiology yang kami baca.Tensyen gak ar.Kena edit Questionnaires tu sampai 5 kali sebab prof suruh.Anyway, dah siap questionnaires, satu hal pulak nak repeat 104 soalan2 sama utk setiap orang yang dibanci.At the end of the day, HILANG SUARA.padan muka.yeay.

Hasil bancian akan direkodkan ke dalam software yang dinamakan Statistical Package for Social Sciences (SPSS).Famousla software statistic ni.Semua medical students tau gune kan kut.Bile ade research je, mesti kena gune ni.Time kerja pun akan gunakan software ni.


-Tengah suruh akak ni rank kan gamba2 iklan merokok -

-We work in pairs la basically-

Pada 28 Mac ni nanti akan ada "Health Intervention Programme".Segala hasil bancian akan dibentangkan kepada penduduk2.Disamping itu nanti akan diadakan aktiviti2 promosi kesihatan seperti medical check up,pap spmear, dental check up,derma darah.Aktiviti2 ni akan berjalan dengan kolaborasi Pejabat Kesihatan Daerah Sepang,Klinik Kesihatan Salak dan JKKK Tmn Desa Vista.Datanglah,semestinya karnival ni lebih berfaedah dari Sure Heboh TV3 yang tak mendatangkan ape ape tu.LOL

Sunday, March 1, 2009

Tidak mahu balik


Boleh tak tajuk post kali ni macam tu? LOL.Hari ni saya membelenggukan diri di bilik.Menyiapkan report District Health Office (Pejabat Kesihatan Daerah -PKD) report.Banyak kemain.Nak masukkan gambar-gambar lagi.Gambar sampah.Gambar dapur kedai mamak.Gambar jejentik nyamuk aedes.Gambar persampelan air.Gambar tandas orang asli.Gambar tempat buang sampah org asli.Segala bagai gambar la.Report tak siap lagi.Rabu kena hantar.Adey.Esok masih ade sehari lagi attachment dekat PKD Sepang.Tinggal unit Enforcement sahaja lagi yang nk kena cover.Tolong.Aku tak larat dah nak belajar unit-unit dalam PKD ni.Namun, aku tabah.


Lepas lunch aku selsema.Kepala pening.Lalu pergi menerjah ke Fitness First gym berdekatan.Perpeluhan dapat mengelakkan diri demam.Kunun.Please, I cant afford to fall sick.So many things to do.Lari di treadmill for 10 minutes, 10 km/h.Sambil dgr Viva la Vida di iPod nano burukku.Cukuplah, sekadar nak panaskan badan.Lepas tu buat weight training pulak.Namun aku masih berselsemaan lagi nih.Mood lebih ceria.Iyalah, lebih banyak endorphine yang telah dirembeskan ke dalam sistem badan.Better than nothing.

Sebelah malamnya pergi KLCC.Makan bersama famili.Lama dah tak keluar dinner sama-sama.Walaupun aku lambat sepuluh minit.Terpaksa drive ke sana sendiri.Tak gune punye mesin isi minyak.Kad Shell ada masalah.Di KLCC, aku pergi mentry perfume Christian Dior Sport for Men baru.Tengah ada harga promosi katanye.'I'll think about it.Nanti saya dtg balik'.Jawapan standard bila tak jadi beli.Terus salesgirl/salesboy to menjawap ,'Kedai dah nak tutup dah ni bannnng'.Amboi.Begitu sekali nada beliau.Lembut kemain.

OKlah.Nak packing.Esok pukul 9am dah kena berada di Pejabat Kesihatan Daerah Sepang.Tolong.One more day lagi.Aku tabah.

Ps1: Malaysia's latest GDP is only 0.1%.Our economy is totally in a dipsh*t hole right now.And yet we can still talk about politics.

Ps2: I miss Surgery sob sob sob

Friday, February 27, 2009

Ada Apa Dengan Kedai Mamak

Sekali pandang, nampak sedap betul kan makanan dekat kedai mamak ni?Mana tak sedap,kuah kari yang berusia empat hari yang telah dipanaskan berkali-kali maka teramat concentrated karinya.

Tetapi, mari kita lihat dibelakang dapur mereka.


Wow, lalat sedang menari-nari diatas tempat memotong.Tak mustahil terjumpe Cik Lat kat dalam nasi or lauk satu hari nanti ya.Hm perisa tambahan


Peti sejuk? Memang tak payah cakap lah. Amat terserlah akan kebersihannya.


Semalam pergi bersama-sama dengan Inspektor Kesihatan ( nama baru Penolong Pegawai Kesihatan Persekitaran) membuat rondaan kedai-kedai.Untuk makluman tuan puan, sekiranya skor restoran tak melepasi score "50", kedai mereka akan diarahkan untuk tutup selama 14 hari bagi menjalankan kerja-kerja pembersihan.Sekiranya gagal, pemilik restorang bileh didakwa dibawah Akta Makanan 1983.

Sekarang tengah attach dengan Pejabat Kesihatan Daerah.Esok nak melawat tempat pelupusan sampah, kampung orang asli dan dan belajar cara-cara menjalankan persampelan air SYABAS.Ya itulah dia posting kesihatan awam dan perubatan komuniti.Tersangat adventure.


ps: Tak teringin nak makan dekat kedai mamak lagi. Memang aku bagi score 'Fail' la kat kedai mamak tu

Tuesday, February 24, 2009

Kami Sedia Membantu

=Pic taken from The Star newspaper =

The Ministry of Health Malaysia, through its latest campaign has reaffirm its commitment in making positive changes towards our healthcare system.

Personally, I think our healthcare system are good.It is something that we can be proud off.A lot of statistics that can proved that.We are efficient.We are tech savvy.Yes, there are a few things that needs to be improved eg: communication skills towards patients.Some might disagree probably due to the long waiting hours that patients have to endure, but hey we are swallowing more than we could chew.

I support the move by the ministry.But please dont forget that we ( or rather me , in the future insyaAllah) are working our A** OFF 24/7 for the citizen of Malaysia.Do not forget our needs.After all, we are also human beings ( not robots ).

Note : Dear patients, please be a good story-teller about yourselves.80 percent of diagnosis come from YOUR story.No, dont believe most of the thing that you see in Dr House.Good doctors have good clinical acumen, they dont rely too much on CT scan or MRI hullo-balloo.

Monday, February 23, 2009

PR

= Gambar group semasa Jamuan End of Posting, kami bersama 2 lady surgeons=


In medicine, PR may bring two meanings


PR = Pulse Rate

PR = Per Rectal examination

Tapi saya nak bercerita tentang the second meaning of PR.Per rectal examination is part of the abdominal examination.It usually done during Surgery posting for surgical cases.Bagi orang biasa mungkin PR ni setakat memasukkan jari telunjuk ke dalam lubang dubur (anus).Tetapi, percayalah, banyak information yang boleh didapati dari PR.Sebab tu lah doktor diwajibkan buat PR bila ada indikasi.Banyaklah PR yang telah dibuat oleh aku semasa Surgery posting dulu.Memang aku practice betul-betul.

Nak la bercerita tentang seorang patient aku ni.Dia dah tua, umur 75 tahun.Dia ada obstructive jaundice secondary to para aortic lymph nodes metastasis ( Faham? Kalau tak buat buat faham =) )Patient ni tersangatlah comel.Suara pun comel.

Tapi satu benda yang paling comel bila masa buat PR.Tak tahu kenapa, patient ni selalu terkentut. Bile kentut, dia akan cakap ,

" Eh, terkentut pulak.he he he"

"Takpelah nek, kentut lah puas puas".Itu je yang mampu aku reply.LOL

I dont know how is she right now.I hope that she is in good health.Pesanan terakhir, tolonglah bagi consent or permission sekiranya seseorang doktor tu nak periksa.Kami bukan suka-suka nak periksa.Ada reasonnya.

Komen1: Entry ni ditulis semasa public health proposal presentation.Aku mengantuk ni.Balik rumah pukul 5 am semalam.Tidur 3 jam je.krrrohh krrohhh zzZZzz.Tolong tolong, kelopak mata dah layu dah ni.

Komen2 : Public Health specialist ni merupakan seorang yang analytical dan tersangat statistical.Otak asyik nak buat statistic.Tolong, aku mungkin jadi gila kalau lama-lama dekat sini.

Komen3: Nasib baik aku pegi Gym skrg.Kalau tak mesti dah jatuh sakit

Sunday, February 22, 2009

Kelinit Kesihatan

Ya.Kelinit dan bukan Klinik ye tuan-tuan dan puan-puan.Comel betul la patient saya ni.Pergi rumah dia terus terasa macam ahli keluarga.Ramah yang teramat.Jamu kuih ini dan itu.Air dipaksanya minum sampai 3 gelas, kalau tidak tak boleh balik.

"Pakcik, bila appointment pakcik dekat KK Salak?"

'Owh, minggu depan dekat Kelinit tu"

Deym, tak tahu kenapa tapi memang terasa nak gelak guling-guling dekat situ jugak.

PS: Banyak g*le kerja okay.Esok presentation for Questionnaires and Proposal for our Health Intervention Programme.

Tuesday, February 17, 2009

Public Health and Community Medicine posting

Baru sahaja hari kedua, tapi dah banyak kerja.

-Journal reports
by this Friday (Power point and Narrative form), encompassing the big 4 areas ( Nutrition, Exercise, Smoking and Mental Health) + Women's Health + Injury and 1 special topic.We chose TCM (Traditional and Complementary Medicine).These journals are important for us to develop Objectives and questionnaires for our Community Survery's Health Interventional program at the end of the posting

-Field visit and reports
will be having a few field visits reports such as Klinik Kesihatan, Klinik Desa, District hospital.The not so nice part will be reports for each visits

-Patients Health Community Studies
I have been given a patient from Klinik Kesihatan Salak yesterday.I have to update him from time to time, in Public Health point of view.Kena call patient petang ni untuk buat temujanji

-Learning SPSS (Statistical Package for Social Sciences)

Public Health plays a vital role in ensuring health of the community.It plays an important role in prevention of diseases.Public Health looks upon the community as a whole in order to come out with what we called as comunity diagnosis.

This posting, I think will enhanced my view regarding Medicine.Medicine is a very very wide discipline.It not only revolves aorund things in the hospital.

Nota: Ok.Saya pun masih dalam kegelapan.


Saturday, February 14, 2009

Jogathon

Saya yakin,anda semua pasti pernah memasuki acara jogathon.Regardless, suka atau benci saya pasti anda semua perlu berlari pada hari tersebut.Saya sangat tak suka jogathon ni.Saya pasti mencari alasan untuk tidak mahu datang ke sekolah pada hari tersebut.Pun begitu, ibu saya seorang yang strict.Ibu seorang yang tidak akan melayan karenah anak-anaknya, lebih-lebih lagi dalam hal memonteng sekolah ni.

Saya nak bercerita tentang dua perkara; sebelum jogathon dan juga semasa jogathon.Apabila kita menyebut jogathon,the the first thing that comes to my mind is mengutip derma.Alah, masih ingatkah kamu semua kepada kad-kad jogathon yang diperbuat dengan kad-kad manila itu.Pada setiap tahun, 2,3 bulan sebelum menjelangnya jogathon kami semua akan dikerah untuk mengutip derma bagi jogathon tu.Frankly speaking, I hate this part right here.I really hate the idea of begging for money in the shopping malls or along the street.Apatah lagi kalau kalau terjumpa dengan sanak saudara along the way.Mana la nak letak muka beb!Anyway, ramailah rakan-rakan kelas yang berlumba-lumba kutip duit.Selalunya mereka semua akan meminta dari makcik or pakcik dikampung.Paling best kalau dapat bawa kad jogathon tu balik kampung semasa hari raya.Tak kurang juga yang akan top up kan kutipan derma tu menggunakan duit raya sendiri.Al kisahnya,adalah seorang rakan sekelas masa darjah enam ni.Dia anak orang kenamaan.Ayahnya merupakan Bendahari Kerajaan Negeri Selangor.So bayangkan networking yang dia ada.Aku masih ingat lagi,hasil kutipan jogathon beliau membolehkan kelas kami membuat school trip ke Melaka.Masa tu Melaka tak diiktiraf UNESCO lagi.Dengar khabar angin, beliau telah menggunakan sampai 4 hingga 5 keping kad manila jogathon tu.Habis penuh setiap ruang.Nak tahu aku gune berapa kad masa tu? Tak payah sembang la berapa kad.Aku hanya menggunakan satu kad yang mana hanya penuh 1/4 sahaja.Semua derma bersen sen je.Paling tinggi pun hanya RM1 je.Hasil kutipan aku? Adalah dalam rm15 je.Hebat tak?

Sekarang nak bercerita pasal hari jogathon pula.Selalunya aku akan mempunyai beberapa geng semasa 'berlari' jogathon.Excuse me, kami berlari juga ya, tetapi larian kami boleh dikategorikan sebagai 'lari lari anak' sahaja.Sori, saya bukan atlet olahraga sekolah.Badan pun chubby masa tu.Semput kalau lari kuat kuat.Setiap kali jogathon, aku akan pastikan supaya ada RM2 dalam poket seluar PJK aku.Manalah tau, kalau kalau tak larat nak 'berlari' nanti boleh la aku tahan teksi kat tepi jalan.Kalau tak tahan teksi, duit tu akan digunakan dengan cara yang lain.Aku dan geng geng akan singgah ke kedai Ah Hong kat tepi jalan.Kami akan tukar duit kertas tadi kepada duit syiling.Nak tahu kami buat apa lepas tu? Kami gunakan duit tu untuk menikam.Alah, permainan yang kita masukkan duit syiling ke dalam mesin yang berhabuk tu.Kalau lucky, dapatlah kad dragon ball satu atau dua.Kalau unlucky, dapatlah kacang kuda.Sedap juga kacang kuda tu sebenarnya.Last sekali, kami pasti membeli ais krim.Bukan ais krim Paddle pop rainbow ya.Kami tak mampu nak beli aiskrim yang mahal-mahal.Duti belanja sikit.Kami beli aiskrim dalam plastik berperisa asam boi je.Nikmat sungguh dapat makan ais krim tu ditengah tengah panas.Kasihan tengok rakan rakan yang semangat berlari tu.Bukan dapat hadiah hebat kalau menang pun.Dapatlah hamper Mamee dan Maggi.

Pun begitu,aku dan geng geng aku selalu dapat tempat pertama dalam larian jogathon.Tempat pertama dari belakang.

Friday, February 13, 2009

Perluaskan

Perluaskan.Ya aku rasa aku perlu meluaskan jaringan ataupun rangkaian kawan-kawanku.Takde lah dikalangan budak budak medic sahaja.Tapi, jangan salah sangka.Aku masih mempunyai kawan kawan yang membuat course selain dari medic, terutamanya kawan-kawan yang aku semasa aku di sekolah rendah yang aku masih keep in touch.

To tell you the truth, aku sangat terkilan kerana aku kurang keep in touch dengan rakan-rakan di sekolah menengah rendah( SMK St John, KL ) dan juga rakan-rakan di sekolah menengah atas ( MRSM Pengkalan Chepa,KB ).Memori suka-duka kita bersama masih terpahat di memori ini.Adakah salah mereka ataupun aku?Bila difikir-fikirkan balik, rasanya salah aku.Iya lah.Aku ni busy.Tapi nak kata busy sampai tak boleh bersosial rasanya tak betullah statement tu.Ada je masa tengok wayang ataupun berkaraoke dekat Redbox dengan rakan-rakan lama.

Sorry kawan-kawan, bukan nak kata anda membosankan aku.Tetapi, to tell you the truth aku rasa minda kita tak berkembang kalau asyik membincangkan case-case medical ni.Kadang-kadang nak termuntah asyik mengulang benda-benda yang sama sahaja.Aku rasa susah orang lain nak faham kalau kita asyik bercakap menggunakan bahasa medik yang bombastic, yang sampai aku sendiri pun tak tahu nak menyebutnya dengan betul.

So,persoalannya sekarang, bagaimana hendak perluaskan networking? To start with, aku sekarang baru mendaftar diri.Alah, masuk gym Fitness First.Ada banyak reason aku masuk gym ni.Pertama untuk menjaga kesihatan.Tak best la kalau kita asyik suruh patient jaga kesihatan tapi kita sendiri neglect kesihatan diri kita sendiri.Kedua, gym ni menjadi salah satu tempat untuk release tension.Ketiga, untuk menambahkan kenalan.Masuk minggu ni dah minggu kedua dah.Tapi baru hari ni rasanya aku nampak 2,3 orang yang aku rasa berpotensi untuk menjadi kenalan baru.Maybe next session kalau aku jumpa aku nak tegur.Selambalah.Maybe nak tegur ala-ala James Bond.My name is Azmi, Nabil Azmi

Nota1 : Sorrylah entry mengarut

Monday, February 9, 2009

Childhood Cancer Support Programme Fund Raising Dinner

Juz got back from the dinner.I think it was superb!Good food, good performances (Adibah Nor ade) and of coz...good girls! Congrats to my dear juniors in Young Mercy Malaysia Group 3.I'm so proud of you man...will update with the pics and prolly videos as well later...

'till then..zzzZZZzzz

Friday, February 6, 2009

O&G final

Wah lama sungguh tak update blog ni.Almaklumlah baru habis O&G posting Final Exam.The exam was tough I guess, especially the Long case clinical exam part.I got a GDM(Gestational Diabetes Patient).My patient was:

-at 37 weeks of gestation
-Gravida 7 Para 3+3 ( into her 7th pregnancy, with two history of miscarriages and 1 ectopic pregnancy)
- a Previous scar ( meaning a history of lower segment caesarean section due to GDM with macrosomic baby in previous pregnancy)
-3 previous MOGTT done ( ujian minum air gula, sampai kena minum 3 kali pulak tu due to various indications)
-Blood Sugar Profile (BSP) ranges 6.5-7.Poor diet control.Not on insulin therapy
-1 history of Dilatation and Curettage for miscarriage and one laparoscopic gynae surgery for the removal of ectopic pregnancy.
- 2 Pap smear done
-history of Menorrhagia

Diagnosis: GDM with previous scar.Poor diet control

In short, gile eventful k history patient aku ni AND I've got around 20 minutes to do the clerking.The most frustrating part was when my examiner Dr S said to me: 'Okay u have only 1 minute left"Adey tensyen tensyen.
Physical examination was alright I guess.The symphysio-fundalheight measured 39 cm.The abdomen is grossly overdistended.My impression was: Uterus larger than date with polyhydramnios.Bleh pulak tu aku lupe nk buat fluid thrill for confirmation.dang!
The discussion part was okay except when the examiner asked me,'So Nabil, what do you want to do with this patient".Daym, you know why I didnt say that we should deliver the baby as soon as possible is becoz she is at 37 weeks.Thats like borderline.My answer should sounded like this ' I would like to deliver the fetus by Caesarean section and not via Vaginal delivery considering that she had many previous gynae surgery.The fetus should be delivered as soon as possible (altho the fetal movement is more than 10 times per day) becoz poorly controlled GDM is associated with Sudden Intrauterine Death(SIUD)". Kan best aku cakap cam tu je....frust frust...

Written exam was fair.MCQ single best answer was rather tough, EMQ alright and SAQ was super fine.We had 3 SAQs-Preeclampsia, GDM and Ectopic pregnancy.

All of us went to Bentong utk mandi manda waterfall the next day.Many thanks to Ridzwan and family for their great hospitality!Will upload some pics in the next entry

Note 1: I'm just glad the examiner didnt asked me to give a counselling session to the patient.A few of my friend were asked to do some counselling to their respective patients during the long case clinical exam.Fiuhhh....

Wednesday, January 28, 2009

Deprived

Yes, I am deprived of my social life.

A buddy of mine called me this morning, ajak main Pool and lepas tu Karaoke tonight.But I had to reject those offer.Sorry dude, I have final O&G exam next week.I still got tons of stuff to be revised.However, being me I always offer another alternative date.

Pray for my success.Nak success with flying colours lagi~

By the way, Octuplets were born today via Caesarean section in California, USA.I just cant imagine how could 8 babies being stuffed together in a uterus!I have personally have had the chance to observed twin deliveries, and all I can tell is that it is not an easy task both for the mother and the hospital staff to manage the situation.There is a suspicion that the 8 babies were not there by chance.I suspect that an IVF( In vitro fertilisation) were done.Yes the doctors in the US claimed that it has got something to do with ovulation induction drug( ubat kesuburan) and not IVF.But come on, you think you can fool me?What are the odds of having 8 fertilised embryos in the uterus thru ovulation induction drugs?In my opinion, it was very unethical for the doctors to do that.Multiple pregnancies is never good to both the mother and the babies.It has a significant increase in so many complications such as preterm birth, congenital defects and even death to the mother.Would you risk so many lives just to attained personal glory?

Note 1: I never karaoke-ed before.Ntah kena rasuk ape tetibe nk try haha.Pool pun lama dah tak main.Oh yeah, I forgot.I am deprived.I dont have the luxury of time.

Note 2: Currently addicted to a band called Dishwalla.Genre= Alternative rock .Underground band je tapi lagu best best.One of their song called Angels or Devils were made as a theme song for one of the episode of Smallville. <---- WHY AM I TELLING YOU ALL THESE????

Friday, January 23, 2009

Baby bengkak


(Apela punye title)



Anyway, hari ni ade case Intrauterine death -Hydrops fetalis.The first pregnancy ada hydrops fetalis.This time the second pregnancy pun ade hydrops fetalis.I wonder whether her Obstetrician have identified the cause.My best bet: She must be a Thalassaemia trait while her husband is also a Thalassaemia trait.So that wud make the baby Thalassamia major.However, there are many causes of hydrops fetalis which I will not deal here.I did not clerk her case so I dont know her story.

Dah la nak tido.Penat + mengantuk.Besok pagi pukul 7.50am dah kena ada kat seminar room for morning pass over...sigh...

Note 1: Pic above:Thats me assisting Dr Dahlia.We were doing Caeserean section on a lady.It was a GDM (Gestational Diabetes Mellitus) mother with macrosomic baby, 4.1kg

ZZzzzzzzZZZZzzzzzzzz.........

Wednesday, January 21, 2009

Gaza

I would like to ask everyone to pray for the safety and success of the mision for two of my beloved professors who has just entered Gaza yesterday.Both of them are:

Prof Dr Ikram Saleh ( An Anesthesiologist)

and

Mr Al-Amin Daud ( Hepatobiliary surgeon )

Let us pray so that Allah will always be with them,ensuring their mission under the banner of MERCY Malaysia will be successful.

Masih igt lagi patient yg ada anak takde tempurung kepala tu? She gave birth to the baby at 8.20am today.Didn't manage to see the delivery sbb tgh bekpesmasa tu.Member call, ape lagi berlari lari la dari cafe ke labour room.However, I still manage to see the baby.Excited pun ade, kesian pun ade.Excited sbb dpt tgk Anencephaly bedebuk depan mata.Kesian sebab simpati dgn mak dia.The baby has already passed away masa kat dalam kandungan lagi.Really want to take the picture buat kenangan, tapi tak sampai hati nak mintak permission dari mak dia.The baby was taken away by the father at 9 am camtu.
Anencephaly, or fetus without the skull is due to lack of folic acid in the body.Folic acid is essential for the development of the central nervous system during the period of embryogenesis (at first trimester ).Inadequacy will result in neural tube defects such anencephaly.In Malaysia,folic acid will be prescribed to expecting mothers during the booking date.However, theoretically folic acid should be taken 3 months prior to pregnancy, I repeat 3 months prior to pregnancy.This is to give some time for the body to store adequate folic acid before a mother became pregnant.Tapi iyela, sapa la yang nk makan folic acid saja saja kan?Tapi kan, kenapa ada still pregnant lady yang malas mengambil ubat-ubat doktor.Beringatlah bahawa semua benda yang doktor berikan adalah untuk kebaikan anda dan juga kandungan anda.Semuanya ada sebabnya.fullstop.

Note 1: Mr Al-Amin is one of my idol to become a surgeon.

Note 2: Just came back from on-call.Presented my case to the MO on-call, Dr Dahlia.She is super duper nice.I learn a lot from her, particularly tips regarding the long case exams.Thank you so much Dr Dahlia.I will definitely give u some small present at the end of this posting =)