Monday, February 20, 2012
Kuching the Miao Miao Land
6 of us took Airasia to Sarawak Kuching for a long stay from 8th to 14th January. It's really fortunate to have friends from Kch to host us and bring us around. Kch is a peaceful and quiet city charaterised by lots of well-preserved heritage buildings, small shop lots and plenty of roundabouts. You will be surprised to see HUGE roundabouts, with housings in the middle. Mother of roundabouts! Win hands down. Imagine yourself telling your friend over the phone you stay at the roundabout. HAHA.
Kolo mee is the best noodle i have ever tasted in my life. It is the specialty in Kch and there's many versions of it. I wish i could have Kolo mee for breakfast, lunch and dinner. Midin and Manicai are also my favourite local dishes. There's one night when we had dinner at one of the seafood restaurant at Damai Beach. They served Bamboo Clams, which my dear friend claimed to be crunchy. gg. epic friend is epic xD
The most enjoyable moment for me in Kch was the walk in Sarawak Cultural Village. We got to appreciate the life and housing of different races living there. The staircase of the long house is so simplistic that it is nearly impossible to climb without the handle. I guess noob people like us will just jump down from the second floor during emergencies. The cultural dance performance was spectacular and it lasted for an hour in the auditorium. The pipe blowing skill of the Iban has left a great impression on me. The eagle dance, which put most of my friends to sleep, amazed me with their graceful footwork and buoyant movement.
There was one unpleasant and unforgettable moment at the waterfront in Kch. 8 of us were separated unfortunately by the road traffic. So 2 groups of us agreed to meet at the fort across the river. We were conned by a boatman who brought us to a route that we were not told was a shortcut to the fort. 4 of us, luckily all guys, have to brave through tall grasses on soft ground with all the mud and puddles, with just SLIPPERS. We could not see the ground until we set foot onto it. So we tried our luck. Thank goodness there's no snake. Some of us got stained with mud. Luckily my white shorts were spared because i tried to walk like a robot.
Jong's Crocodile farm and zoo was an awesome place to hang out with friends. Lazy crocodiles lying motionlessly in the puddles entertained us with their pretentious smile. Some camouflaged with algae all over the face, swim in the lake like a moving log in disguise. Deadly and stealthy as always, this humongous beast change their pace in movement in a split of a second to hunt their prey down. The weather wasn't good on that day. It was pouring when we ran from one feeding center to another to watch the show. A piece of meat hung over a wire was transported above the lake to lure the hungry beasts. A swarm swam below it, making circles around the meat, as if they were planning when to strike. It's not surprising to see some turned out to be a clash between the titans. Greedy crocodiles that didn't utilise their brain lost the hanging meat from their first bite as they started to chew in the air rather than pulling it down to the water using their body weight. There was one which approached the bait but missed it a few times due to its horrible gauge of distance. We were so amused and called it the crocodile with diplopia!
Damai beach is an awesome place to relax especially during this off peak season. There's no one at the beach except us! The sand is so fine and the ground is quite flat, suitable for beach games like volleyball or beach soccer. But it was disappointing to realise that there's no volleyball or frisbee for rent. I regretted for not bringing my own onto the plane :( We did nothing much on the beach, just soaking ourselves in the water and bombing each other with wet sand. No jumpshots taken, no sports played. It was poorly planned.
Bako National Park was the hightlight of the week! We traveled from island to island and observed enormous mine stones erected at the seashore. We then jungle-trekked the park with SLIPPERS. Each destination was like a few kilometers walk which took about an hour to complete, so we had to plan our route. Fortunately in jungle like this there's no leeches. Only soil, puddles, ponds, branches, twigs, grasses, sand, rocks and some man-made stairs at places where it's impossible to climb. It was not shaded at some places and those who got sunburn the day before at the beach, turned into red lobsters at the end of the day. Most of the time, i bet, we kept looking at our steps and forgot to look around the scenery. True story.
We also visited the Hot Spring at Annah Rais. In the middle of the cooling river there was a site where the sand turned hot as you sink into it. It was incredibly hot and your feet will get burn if you stand there for more than 2 seconds! It's amazing to move your foot and feel the difference in temperature, as if the water is compartmentalised by nature into hot water and cold water.
Kuching is a nice place to chill and relax, with mouthwatering delicacies and tropical weather. It is an attraction to those who love the sun, the rain, the beach and the forest.
Friday, February 17, 2012
Myanmar the Golden Land.
Early at 6am we trudged our way to the Swedagon Temple to catch the sunrise. It is the iconic and magnificent landmark in Yangon. At dawn, it was lit brightly with artificial lights which stripped away its original beauty. Surprising at this unearthly hour, the temple was already crowded. We were immediately recognised as foreigners when we set foot onto the icy marble floor, and was asked to pay 5 USD entrance fee. Fail. Because among the crowd, we were the only ones who wore t-shirt and jeans. Local costumes, being formal or informal, are always sarong with slippers. Yes, people wear long sleeves collar formal top with sarong and slippers to work.
As the sun rose, Swedagon was immediately turned into life, like a giant golden African snail. Symbolised by its conservative design of the temple yet rich in colours, it reflected back to the development of Buddhism in Myanmar people which is simplistic and from all walks of life.
On the second night we rented a van to Bagan, the pagoda desert. It was a freaking 10 hours bumpy ride throughout the night. Most of the time my head was bouncing against the seat like a basketball. It was a loooong night. Midnight, we stopped twice at the rest station. The temperature difference between day and night was incredibly huge that i was almost frozen to a rock when i peed. It was freezing cold especially my poor feet, because they were only covered with SLIPPERS. Burmese! Y U NO WEAR SHOES?
Bagan is a dry and cooling desert with numerous erected pagodas and temples. Each temple has its own story. Among all, there was one that struck me the most. Back in the ancient times, there was a king who found a ruby on this land, therefore he happily built a temple here like nobody's business. lol. I don't see a need to build so many temples on this stretch of land, as if they were meant for housing thousands of followers. The architecture was beyond my imagination. It's godlike. The walls were decorated with paintings telling tales of the ancient time. The pagoda was built of bricks that stretched all the way to the top. The interior was embraced with cool air and darkness as there were no openings to the outside world. Footwear was strictly prohibited in temples. The floor that was shaded from sunlight was icy cold. Every steps sends the chill through my spine. lol, literally. It is impossible to plod through the steep stairs, narrow tunnels, and the rocky floor without a torch. Up to the top, the view is splendid. Giving me the bird eye view, I can see ALL the temples sprouting on this beautiful golden land, with the sky painted with orange clouds and hot-air balloons. It's absolutely a feast for our eyes.
These 3 days in Bagan were basically visiting temples, temples and temples. They were more or less the same. Once we got off of our van, the villagers will flock towards you, asking you to buy souvenirs. Our arrival seemed to bring lots of hope for them to make both ends meet.
"Postcard? One for one thousand! You are handsome. You buy my postcard, I be with you."
"What about some paintings? Lookey lookey! Lookin's free! This one story of Buddha. This one lucky elephant, got 7 trunks. Which animal you like?"
It's impossible for me to buy from all of them. They were too many. And it is heart-wrenching to see lots of children not going to school but selling postcards to tourists who step-footed in this poverty stricken country. Some even followed us all the way to our van. Even with the door closed, these children were still exchanging gestures through the transparent window, asking you to buy their postcards.
At night we all stayed at Class One Hotel. A lot of Eurasians stay there. The hotel breakfast was awesome, in western style. At noon we had buffet at a local restaurant. They filled up our table with ALL the local delights and specialties until there's barely a space to put my rice bowl. Burmese food is always salty, spicy and sour. We were so happy and stuffed. The food was uniquely delicious and surprisingly cheap (1100 kyat/person). In Burmese, Pakshashimeh means "pay bill".
Mount Popoa is the last place we went before we headed back to Yangon. It is a sacred mountain that has a temple at the top, which was 777 steps of stairs away. We bought sarong and face paint before we came to disguise ourselves as villagers. Along the way, those selling souvenirs started laughing on us, as if we were the entertainment of the day. Some commented our sarong was worn wrongly. Fail. HAHA! This place is full of monkeys and monkey's shit. While climbing the stairs we can hear the footsteps of monkeys roaming on the roof. Some followed us along the way, trying to snatch our bags. The view from the top is very scenic. I can see the rainforest carpeting the horizon.
The security in Myanmar has put Malaysia into shame. I feel a lot more safer walking in Myanmar's street. People there are poor, but crime rate is astonishingly low. We left our bicycles at the road side while visiting different cultural houses in the National Park. At the end of the day, our bicycles were still there not stolen.
We watched "Underworld: The Awakening" at the cinema in Yangon. Though I had watched the movie before, this time it was a whole new experience. My attention was not entirely on the story, but the spectators. People were mumbling at their own will and the whole movie was featured with extra "background music". The movie has no subtitles, so i guess most of them could not appreciate the show. At the end of the show, when the lights were up, I was stunned. The neighbouring seats and the aisles were full of watermelon seeds, paper cups, bottles, tissue paper, you name it...I felt really sorry for the cleaners.
We visited a lot of temples, but I cannot remember which is which. We ate Burmese food everyday. We walked barefooted most of the time. We spent 20 hours in the van travelling. We braved through the icy cold shower at night when the heater was malfunctioning.
We didn't buy all the souvenirs cos the Bojio Market was closed on the Reunion Day. That's the only regret because we saved up our money for the last day so that we can ALL IN!!! A lot of spare cash left at the end of the trip. Looking back, it's really worth going to myanmar. Want to thank my Burmese friend who brought us around and let us stay at his house. Also, the van driver who not only endured the long hours driving marathon, but also told us stories of the pagodas like a tour guide. Myanmar hospitality, thumbs up!
Monday, November 14, 2011
virtual reality
i went to a shopping mall with my sis in a hurry. we decided to park outside the mall coz there were too many cars inside. as we stride towards the mall from my car, i felt my sis no longer beside me. i turned back and looked. "oh shit!" she was surrounded by 3 gangsters with one holding her hand refusing to let her go. she looked at me quietly. apparently she's very scared. 3 against 1 is obviously a losing struggle, and apparently they were going to abduct her with their motorbikes. without further ado i jumped towards them and break off his grip with my sole. the gangsters looked stunned and annoyed. "RUNNN!" i shouted to my sis. hoping she could make full use of these few seconds to escape. we started running to the mall. and omg she ran so slow becos of the heels she's wearing! i knew they were going to catch up soon. as i turned back the gangster was already 1 meter away from me and he's ready to strike. i dodged to his side and execute a front kick to his groin. he crouched in pain. i wanted to give him a fatal blow to his head but i realised the other 2 gangsters were catching up. OMG THIS IS THE CLIMAX AND I WOKE UP.
my heart was bounding rapidly and i was lying on the bed. i looked at the clock it was 3:30am. luckily, it was just a stupid dream-.- i swear i will not park outside the mall if im alone with a girl who needs protection.
Saturday, July 30, 2011
Life should be as exciting as it can be.
I have been misinterpreting the meaning of "You are who you are" in Buddha's teaching. All the while I always thought that we should not define ourselves because by doing so we will be living in our own image and be led astray from attaining the state of enlightenment, which is our true inner-self. You define who you are. If you think u cant do it, you really can't. If you think you are stupid, you are. Our perception, our concept, the knowledge we share, our values and our beliefs, set boundaries and define who we are, such a way that they imprison us.
Thus I always thought that I shall not define myself, as it will create an image of me that I will be living in.
I was partially wrong.
All of us are actually as perfect as Buddha, the only difference is we are not enlightened yet. We are imprisoned by our perception that kept our true potential locked. Since we are actually as perfect as Buddha, there's no harm defining our own self in a positive way. This lead me to another point that self-esteem is very important for a person's identity, and it can only be built up by first believing in yourself. It is good to recognise your strength and talent as it builds up your confidence and makes you a better person. Self-esteem empowers.
Nevertheless, bear in mind that everything good or bad about yourself are not eternal. We are once handsome and pretty when young, but no longer so as we ages. This brings us to a point that we shall not cling on to the very perception of ourselves. We must be ready to accept losing or gaining our traits, and be ready to accept the changes.
Since life is short and precious, it is not wise to make this trip wasted. Life shall be lived to its fullest. Dare to pursue, dare to dream and dare to love. But know to drop it, leave it, and let it go when everything comes to an end, in order to free ourselves and embark on the journey of enlightenment.
Friday, July 29, 2011
KK, Sabah trip 2011
Just came back from a one week vacation at kota kinabalu, Sabah, a land of beautiful people, beaches and mountains. Bryon was the most awesome host who opened up his house for 11 of us to put up our nights at, with free and efficient laundry service and a chilling living room to play monopoly deal and watch "How To MATE Your Dragon". There were too many of us that the poor water tank could handle with xD Special thanks to bryon's friends who came to drive us around KK. It's really not easy to drive 2 hours back and forth to Mount K Park. It was really a beautiful place to appreciate sunset. The weather there was like a combination of air-con + high speed fan. We were shiv-v-vering instead of shuffling. haha.
Island hopping and snorkeling were the highlight of the trip! I love the sizzling hot sun kissing my skin when I was soaked in the sea appreciating the corals and fishes. I was pretty afraid of getting stung by jelly fishes, sea urchins or any other underwater creatures residing at the corals so I was all time alert. As I happily found a clear ground to land, a few seconds later my leg got bitten by a fish. LOL, do i really look like food? It was quite painful actually. I got a few wounds that resembled the jaw of the fish-.- damn it. After repeated episodes of TERRIFYING experience, I decided to swim alone to the shore. Half way through the water became more and more blur and I couldn't see any single shit. damn. ahh what to do, just keep swimming =.= Felt relieved when I literally hit the shore. I actually headbutted the land. LOL
Taken lots of funny photos at the beach. Apparently the sea water had washed away my UV protection and actually got me sun burnt. And I wasn't the only one :/ Haha aloe vera gel has become a necessity for 4 of us to cool off the heat radiating from our reddish skin.
I love soaking my feet in the icy waterfall with tadpole-sized fishes biting off the dead skin. It was kind of ticklish feeling, very pleasurable. It's my first time being so close to nature. I actually took photo with a dragonfly that I found surprisingly not afraid of human. It calmly rested on my index finger unwilling to fly. It kind of liked my finger.
Canopy walking was another interesting experience and to appreciate that, you gotta climb lots and lots of stairs until you actually reached the top of the forest. We walked at the canopy level, from trees to trees along the rocking hanging bridges. You can actually see the rainforest in a bird's-eye view. It's like a carpet of broccoli. While walking you can hear bird's chipping and sound of swirling water underneath. We also never missed the Poring hot spring and the Sabah tea garden nearby. Nothing special about these two. Poring smelled like egg's shell. And it was quite lame cos there are actually man-made bathtubs with hot and cold taps. The natural one was not accessible cos it is 80 degrees. Any men who dare to jump in may have their balls cooked...
Gaya street was like the pasar malam we used to see but it was held in sunday morning. Basically it sells what our pasar malam does but more souvenirs and handicrafts. There was a lot of people especially tourists and you can count yourself lucky if you can find parking. Very 'touring' atmosphere except it was very humid. Oh something interesting about Sabah is the TIME and Pace. Sunrise at 530am instead of 7am; pitch dark at 6pm unlike 8pm in KL. Not much traffic on the road unlike in KL where you seem to always slow everybody down-.-Less traffic lights and hums but LOTS OF round-abouts. Round-about is actually the most efficient way of controlling traffic i think. Oh another interesting fact I observed: Sabahans like to drive big cars! Maybe because it's more convenient to drive on hilly roads.
Im not really a foody person, that's why i recall it the last. What really struck me was the cooling COCONUT PUDDING! Imagine the head of a coconut was cut open, all you see inside is not juice but PUDDING :D The whole coconut was served chilled. Awesome! Another delicacy was the fried dumplings (Guo Tie) served at the very first night. mmhhhmm...Oh ya not forgetting the awesome seafood dinner at our last night. awesome because it was only rm27 per person, inclusive of fruit juice, prawn, chicken, fish, tofu, veg and 5kilos of CRABS. Also, we dined in Little Italy in one of those nights. I found it ok la =3
PS: YOYO was a dessert shop that survived becos of the girls. We went there almost everyday :/
Thursday, July 7, 2011
GP posting #2
Stomach flu is actually what we meant by viral/bacteria gastroenteritis, while some food poisoning may not only be due to infectious agent but also chemicals and toxins or allergens contaminating the food. There's one patient I thought to had food poisoning but was diagnosed as stomach flu by the doctor. He had fever, vomiting, diarrhoea and exacerbated abdominal pain during deep palpation. Gentamycin was injected at the upper outer quadrant of the buttock. Doc said food poisoning doesn't come with fever but i doubt so. why not?
There's one lady came with head trauma. X-ray revealed intact skull. BP rose due to head injury (Cushing reflex). The pathology is as such: if the intracranial vessel ruptures, intracranial pressure will build up and compress the visual center, causing double image and dizziness. Dizziness can be broken down into a few types: vertigo (spinning ceiling), disequilibrium(floating sensation), Presyncope(lightheadedness, fainting). If the fluid build-up compresses the respiratory center, the patient will die from respiratory arrest. 48 hours after a head trauma is the crucial period and requires close monitoring. There are a few things to look out for during this period:
1. is there any bleeding(eyes, nose, ear)
2. vomiting
3. dizziness, visual worsen
4. blurr, lack concentration or stupor
If there's any of this signs get hospitalised IMMEDIATELY and get a brain CT scan.
There are 2 types of stroke: Ischaemic or Hemorrhagic.
If the stroke is ischaemic, non-progressive and not life-threatening, normally the patient will recover after 3 months, depending whether the acute phase was managed well and also the size of the lesion. Normally if the lesion is small, the brain tissues surrounding the lesion will be temporarily compressed by odema, contributing to various stroke symptoms. But rest assured that this will subside after 3 months. That's the reason why some stroke patients can walk and move normally like nothing had happened.
Since a patient can be recovered from stroke after 3 months, the health-care providers will be deemed as demigods if the stroke patient so happened to see them during the recovery phase. That's why some people believe that some sinseh can cure stroke. Just a few testament can make them instantaneously famous.
There's one lady came with an abscess right beside the anus. Doc suspected anal fistula since it is very close to the anus. She had fever, probably due to this big abscess. Anal fistula originate from anal glands, which are located between 2 layers of anal sphincters and which drain into the anal canal. When the outlet becomes blocked, an abscess can form. When the abscess is opened or ruptures, a fistula is formed.
Fortunate to see CIRCUMCISION done in a GP clinic =D A 20 year old teenager has a long foreskin. Because of the long foreskin covering over the glans, it is not able to be stretched as wide as possible and will therefore cause pain during erection. Furthermone, it hinders the flow of the urine and may cause some to be retained under the overlapping skin, rendering it unhygienic and prone to infection. The purpose of circumcision is to uncover the glans. Patient may feel sensitive initially and will get used to it later. The doc cut off the foreskin and left a little bit near the edge of the glans connecting to the shaft, then stitched them back, leaving the glans fully exposed. There were numerous of hematoma and had to be stopped by ligation.
There were one couple came opting for abortion. Since there's no way for us to stop the patient, we referred them away to a professional(gynae). For the safety and health of the patient we rather it was illegally done by a professional than a unqualified personnel. It's like choosing the best between 2 evils in this kind of dilemma.
Now the new trend of controlling diabetes is early administration of insulin as it prolonged the survival of the diabetic patient for another 10-20 years more! It's the "Legacy Believe" if im not mistaken. Insulin should not be the last resort or to be dragged for too long a time. The reason patients dislike insulin is mainly because it is done by needles. Without needles aka 'insulin pump' device is available but it is very expensive.
Subconjunctiva hemorrhage can be due to the following causes:
1. sleep deprivation
2. straining of the eyes like staring at the computer for long hours
3. rubbing of the eyes, physical trauma
4. coughing, sneezing (high pressure)
The first 2 will cause the vessels to be fragile. The last 2 will trigger the rupture of the already fragile vessels, causing hemorrhage.
It is self-limiting and takes 1 week to completely goes off. The WBC will clean it up for you (=
One man came with fever and flu + TONSILITIS. His tonsils are swollen and filled with white pus. Some people are more prone to tonsilitis. Their flu or cold will always be accompanied with tonsilitis. In the long run, infection is harder to cure and may require stronger antibiotic, which may contribute to the emergence of MRSA. The best option is to remove the tonsils since you no longer need it unless you're a growing child. Tonsils is like your appendix, you need it when you are little, you can remove them when you hit adult.
From the doc's conversation i learnt that QuantiFERON®-TB Gold is the gold standard for TB testing now. it claimed to be 99% accurate. Mantoux is not accurate because of the BCG vacination, which is still compulsory in malaysia and singapore but abolished in Europe. It is recommended to give a final boost during primary 6. If the antibody hits to zero, need another 3 japs all over again =/
For people who has allergic rhinitis, i have learnt that Omnaris is a local acting steroid that can give relieve effectively. It has to be inhale daily like a nasal spray but it will only take effect 1-2 weeks after. Even the doc and his family are using because they find it effective. It was prescribed to a patient who complained of allergic rhinitis that is easily irritable by dust and smoke.
Hairline fracture will heal by itself as long as its position is not moved. A cast is thus required and painkiller and anti-inflammatory drugs may be prescribed if the patient needs them.
On the side note, people who has medical problem can take loan to buy a house, but will find it difficult to buy insurance. If anything happen, touch wood, the bank has the right to confiscate the house if im not mistaken.
Don't try to claim insurance over a small matter like cough and cold. The insurance company will rate their customers according to their pattern of claiming. If you are 'blacklisted', you may face some trouble when you really need it. The company may want to do a thorough investigation over your case. So why do you abuse them in the first place? Save it for raining days! (=
Those suspected dengue because of fever, a blood test is recommended.
1. Platelet low in dengue
2. WBC low in dengue, high in bacteria infection
if the platelet count ever drops below 100, please go to the hospital (=
Monday, July 4, 2011
GP posting #1
Today was my first day learning from Dr. C at ***Clinic through observation. I would say it was awesome (= At first i was worried that i will be ill-treated or neglected as the staffs are very busy. And i was wrong.
Doc was actually a very friendly guy who's willing to teach. He even treated me coffee and toast at the nearby coffee shop at 3pm. He also joked around with his nurses, allowing them to go buy ice-cream and chill when there's no patient.
Gotta see a few cases of dressing done by the nurses. Dr said his nurses mastered it within 3 days, why couldn't i? errr...im flattered.
Cough and cold was the most common case. In a GP setting, it is impractical to treat based on the knowledge of causative agent, where 80% is viral and 20% is bacteria. Because it takes at least 1 week to differentiate by culture and lab diagnosis. It is impossible to ask the patient to come back 5 days later to treat his cough and cold, right? Weak empirical antibiotic is thus the drug of choice to take care of the bacteria; viral will resolve itself and often requires only symptomatic treatment. Furthermore, using weak first-line drug will prevent the emergence of MRSA in the patient you treating.
As a GP you have to know your limitation. Don't try to take dangerous and high risk case, unless you are uber sure you are capable of it. Referring to a specialist or a hospital will not only save your ass but the patient's too. (= Also, treat the most serious/urgent complaint, or the underlying problem first, then come back to other non-threatening illness and treat them symptomatically. If everything returns to normal for a long period of time, no need to pursue the underlying cause, which may require expensive, tedious and time-wasting tests.
The case of the day was a young male construction worker who had a crushed ankle due to a bad fall from a height of 2 stories. The medial malleolus was fractured and protruding outwards to the underlying skin, causing torrent of blood spilling from the deep wound. When doc unwrap the bandages to examine, the blood spilled onto his face. Shit. Poor doc risking his safety. An X-ray was required for diagnosis and treatment and the process of taking it was disastrous. Blood kept pooling on the X-ray plate and it could hardly stopped unless somebody pressed hard against the wound, which is also, bloody painful for the patient. For the survival of the patient, I was asked to apply pressure on his wound to stop bleeding while the doc made his diagnosis. A young strong man yelling and trembling in pain. The pain was clearly beyond my imagination. The patient was carried by 2 of his friends back to the lorry and was referred to ***General Hospital for an emergency surgery.
There's another case of head trauma suffered by a small boy due to falling down. He had a fever lasted for 3 days, but he was conscious, alert and communicative. Doc suspected he had a head hematoma and referred him to a hospital for a head CT scan. His parents, in their 60s to 70s, who accompanied him to the clinic, were unwilling to pay for the scan as it will cost rm400. Here comes the problem.
There's one patient came with a complaint of blood in urine. He had a history of renal stone and had undergone one week of medical treatment. Doc performed renal punch on his back but he had no pain. The patient suspected he had renal infection but the previous urine test showed no pus. To reassure the patient, the doc fulfilled his wish and performed another urine test on the spot. The result, again showed no infection. The possible explanation would be the medicine was working and it may not be necessary a bad news to see blood in the urine during treatment. As the medicine dissolved the stone and allowed it to travel down the ureter, the stone might scratch upon the wall and cause bleeding. But if the symptoms persist, an ultrasound will be recommended.
Today when there's no patient, i read a medical journal and came across an article entitled "Less sleep, early death". "If you sleep less than 6 hours/night and have disturbed sleep pattern, you stand a 48% chance of developing or dying from heart dissease and 15% greater chance of developing or dying from stroke." -Professor Francesco Cappuccio, University of Warwick Medical School.
There's one lady came with complaint of fainting spells. Her BP ok, heart sounds ok. But she was diabetic, old and complained of having a weak beating heart and a stiff neck. Doc prescribed her some medicine and asked for follow-up 2 days later to check ECG and blood glucose level. When she was about to walk out of the room, she nearly fainted again o.O Luckily her daughter was aside to hold her.
One old man in his 60s came with chest pain which he claimed exacerbated especially after meal. He had high BP. Two things came into my mind: either Gastric ulcer or Myocardial Ischemia. X-ray was normal. ECG shows small changes which was not significant enough to pick up anything. This was a high risk case and he was referred to a specialist or hospital to rule out heart disease, which can be life-threatening and rampant in this age and sex group.
There's one boy, around age of 10, came with high fever with no other symptoms. He was crying in fear for injection. No choice, a blood test has to be done and it could only be done by a needle reaching your blood. His mother caught him from running away and I had to assist in grabbing his arms too lol. Doc said if this first poke fail the boy would have to bear a second poke. LOL. the mum covered his eyes and that calmed him down. A lot. It was a good strategy haha!
There's one pregnant woman, who happened to be the doc's niece, came for antenatal screen as she complained of whitish discharge through her vagina. From the ultrasound i can clearly see the baby kicking in the womb. So cute. From head to bottom the baby was 5.2 cm, which was estimated to be 12 weeks and 3 days old. Pregnant women of less than 3 months of gestation are better left untreated if the disease is not a threat to the mother's and baby's health. As the first 3 months of gestation the baby is very prone to teratogenic effect of medicine. And we have to avoid that undesirable repercussion. A topical cream will be good to treat the infection in this case but not through oral medication which has systemic effects. Folic acid and progesterone pill were prescribed to stabilise pregnancy and to prevent still birth.
There were 2 couples came with fever and low platelet count. The husband had rashes over his thighs. Suspected to have dengue but all we have to do is keep monitoring the platelet count everyday and if it falls lower than 100, they would have to be hospitalised.
The nurses are very friendly and willing to teach. Two of them are diploma holder in nursing. One called "Owl" taught me how to dress wound, take an x-ray and do an ECG today :D She aspired to be a doc but her dream never came true due to lack of one A. She's only 20. Younger than me and already working. Nursing is after all a noble job. All nurses have my utmost respect.
JAY CHOU @ IMU
Friends were spreading news through facebook yesterday about JAY CHOU AND CREW were shooting a scene at MY UNI. IMU. HOLYMAMA!! WHY DID THEY CHOOSE TO SHOOT THAT WHEN I WAS AWAY AT HOMETOWN T.T nevertheless, i felt so proud that they choose imu. I gonna revisit my uni and kiss the floor wherever they left their trail at.
According to a few spectators, they were shooting a hospital scene at our Dewan Chancellor hall. lol. imu is so honored.
Thursday, February 24, 2011
during the week of internal med, i got to see oesophageal-gastroduodenal scopy. compared to bronchoscopy which will take abt 30-45mins, OGDS was just a short 10mins operation. excited to see the real rugae with bile in the stomach at the LCD screen. biopsy was performed at the upper duodenal segment. this patient complaint of frequent epigastric pain, but the upper GI appears to be normal...
on the other day, i was fortunate to witness the whole process of threadmill. A man suspected with MI has his chest hair shaven for the leads :P there were different stages of exercise, and different categories too. An ECG report was constantly generated throughout the process to jot down any changes of the electrical activity of the heart. the inclination and speed of the walk were increased gradually observe any significant changes. Clearly, there's a sharp dip on ST of -2.20 at stage 3 and the patient appeared breathless after the exercise. he was rested on the bed for recovery. the nurse chatted with me after the whole procedure, and surprisingly. gave me an angpao! :D
during the clinical consultation of internal med, there's one special case of a patient suffering from depression. apparently there's sad story behind her radiant smile she put up to while chatting with the doctor. her prejudice over her son's marriage seemed to consume her a lot, to the extent of excessive weight loss, sleep deprivation and loss of appetite. the medicine the doctor prescribe her, other than the usual drugs that treat symptomatically, was an advise to her to put down her prejudice and accept whatever has happened. she smiled with reluctance, and said she'd try. sometimes, a certain condition can only be reversed by oneself, not medication.
cardio department.
basically it's about managing and controlling the symptoms: painkillers, drugs for lowering BP, statins for cholesterol, warfarin for anticoagulation, cardio-echogram and stress-test for monitoring the performance etc. curative of severe MI would be the stenting operation (as for cardiology dept. coronary bybass surgery is only done by surgeons)
from the cases i saw and from wad the doctors say, i have made a few observations in our general population:
1. coronary heart diseases normally attack the middle and older age group due to atherosclerosis caused by high cholesterol, high bp and diabetes.
2. people who get coronary heart diseases early in their age, say their mid- twenties, are due to smoking. there was one 16 year old teen admitted to A&E due to myocardial infact, the reason being: drug abuse.
3. "the only vege that u shud avoid is tobacco" LOL the doctor will always advise the patient to quit smoking, if not all effort will be put into waste. if the patient says: I'll try , that means he will not stop smoking. LOL. that's so true...if u wanna stop it, u can stop it. if there's always cigarettes available in your pocket, by habit and addiction, u can never abstain from it. the most effective way is to not buy it!
Wednesday, February 23, 2011
weird dream
i dreamed of something very preposterous again! hahaha!
our city was invaded by an army of zombies. intriguingly i dunno why they don't look as gory as they seemed in tv shows. they just appear...green. that's all. we were evacuating from one place to another, hoping to find a temporarily shelter that will shield us from their radar. before crossing the alley, we spotted a troop of 6 marching, searching for any victims left hidden. we swiftly made our way into a bunker after the troop had went far, waiting for reinforcements to come as soon as possible. we had nothing, no guns, no armor, no food. all we had was companionship. Just as we were to settle down, a big troops found us, blocking the gateway, mocking at our impending doom. I was late to realise that they had actually spotted us while crossing the road. in fact, they were just acting ignorant of our presence and calling for reinforcement. i regretted for not annihilating the small troop we met just now, for the reason being to stay low profile. now we have to face a bigger army, and it's gonna be a losing battle. their number kept increasing, sending a chill down my spine. for there's no way to run, and for the rest of the people whom we kept protecting, we couldn't care less but charged towards the zombies in hope of breaking through. No guns, no weapons, just kicks and punches! the fight was very chaotic coz they were too many people involved. but i was astonished by the fact that these zombies were easily defeated; they hardly survived under an iron fist and a turning kick. after we defeated the army, we were left with a few fighters. we stormed into an apartment to search for any survivors. in the event of searching we were all time alert, in case a zombie jump onto you from a sharp corner. to our disappointment, the whole apartment were ransacked with no signs of living.
my dream ended here. to be continued...LOL
