Tuesday, October 30, 2012



Esok medicine.

Bace tak habes lagi.

Yang dah bace belum tentu ingat.

Otoke?

Yang penting habiskan.

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Saturday, October 27, 2012

Faces in Medicine








Must see post
From left to right:
1. Acromegalic facies
2. Adenoid facies
3. Amiodarone facies

4. Bell's palsy
5. Bird facies
6. Asymmetric crying facies
7. Bovine facies
8. Chipmunk facies
9. Cushingoid facies
10. Elfin facies
11. Gargoyle facies
12. Leonine facies
13. MEN-2B Syndrome
14. Parkinsonian facies
15. Flat facies
16. Mitral facies
17. Hatchet facies
18. Snarling facies
19. Thyrotoxic facies
20. Myxedematous facies

Acromegalic facies (Acromegaly)
Large supraorbital ridge and frontal
bossing, thickened lips, enlarge
tongue, lower jaw firm and square
(protruding jaw = prognathism)

Adenoid facies (Adenoid
hypertrophy)
Long, open-mouthed, dumb-looking
face of children

Amiodarone facies
Deep blue discoloration around malar
area and nose

Bell’s palsy (Facial nerve
dysfunction)
The eyelids on the paralyzed side can’t
close. The mouth is drawn to the
unparalyzed side, producing a
somewhat grotesque appearance.
Food and drink dribble from the
mouth on the paralyzed side. The eye
with the involved lid dries due to
decreased tear production.

Bird facies (Pierre Robin
Malformation)
Small lower jaw, a slit like hole in the
palate of mouth (called cleft palate)
and the tongue appear to fall into the
throat (condition called as
retroglossoptosis)

Assymeteric crying facies (Cayler
cardiofacial syndrome)
Asymmetric appearance of the oral
aperture and lips at rest, but
significant depression of one side of
the lower lip with animation (crying or
smiling)

Bovine facies (Craniofacial
Dysostosis or Crouzon syndrome)
Convex nasal profile, shortened
mandible, macroglossia

Chipmunk facies (B-Thalassemia
major, Bullimia nervosa, Parotid
swelling)
Expanded globular maxillae, with BM
hyperexpansion into facial bones,
combined with prominent epicanthal
folds

Cushingoid facies (Cushing
syndrome)
A rounded face with a double chin,
prominent flushed cheeks, and fat
deposits in the temporal fossa and
cheeks

Elfin facies (William’s Syndrome)
Sunken nasal bridge, puffiness
around eyes, epicanthal fold, blue
starry eyes, long upper lip length,
small and widely spaced teeth, small
chin

Gargoyle facies (Hurler syndrome)
Head is large and dolichocephalic,
Tywith frontal bossing and prominent
sagittal and metopic sutures, with
mid-face hypoplasia, depressed nasal
bridge, flared nares, and a prominent
lower 1⁄3 of face, thickened facies,
widely spaced teeth and attenuated
dental enamel, gingival hyperplasia

Leonine facies (Lepromatous
Leprosy)
Peculiar, deeply furrowed, lionlike
appearance of the face

MEN 2B Syndrome
Usually there are numerous
yellowish-white, sessile, painless
nodules on the lips or tongue, with
deeper lesions having normal
coloration. There may be enough
neuromas in the body of the lips to
produce enlargement and a
“blubbery lip” appearance. Similar
nodules may be seen on the sclera
and eyelids.

Parkinsonian facies (Parkinsonism)
Mask-like, tremor of head, absence of
blinking, dribbling of saliva, weakness
of upward gaze, seborrhoea and
sweatiness

Flat facies (Down syndrome)
Flat appearing face, small head, flat
bridge of the nose, smaller than
normal, low-set nose, small mouth
which causes the tongue to stick out
and to appear overly large, upward
slanting eyes, epicanthal fold,
rounded cheeks, small misshapen
ears

Mitral facies (Mitral stenosis)
Rosy, flushed cheeks and dilated
capillaries

Myotonic or Hatchet facies
(Myotonic dystrophy)
Tented, open mouth, elongated face
and blunt affect

Snarling or Myasthenic facies
(Myasthenia gravis)
Drooping of the eyelids and corners of
the mouth and weakness of the facial
muscles

Thyrotoxic facies (Grave’s disease)
Alert, startled, flushed and anxious
appearance. Protrusion of of one or
both eyes (exopthamlos) associated
with retraction of the upper eyelids
(lid lag) which results in the exposure
of white conjunctiva above the cornea
(Von-Graef’s sign)

Torpid or Myxedematous
(Myxedema)
Skin generally thickened, alopecia,
periorbital oedema, xanthelasma,
coolness and dryness of skin and hair,
thinning of scalp hair, tongue swelling.

Others:
1. Ashen gray facies (Myocardial
infarction)
2. Cockayne facies (Cockayne
syndrome)
3. Frog like facies (Intranasal disease)
4. Hepatic facies (Chronic liver disease)
5. Hippocratic or Cachectic facies (close
to death after severe and prolonged
illness like Malignancy)
6. Marshall halls facies (Hydrocephalus)
7. Monkey facies (Marasmus)
8. Mouse facies (Chronic renal failure)
9. Pagetic facies (Paget’s disease)
10. Ricketic facies (Rickets)
11. Uremic facies (Uremia)


Monday, October 22, 2012

OBG : Presentation day again


1st Day. Unit 1.

Its going to be a free-willy journey. The stafs arent so scary and arent emotinal either.

They looked 'tamed' and full of love and passion to teach. Heheh.
Maybe i wont have to be so stiff around them during viva.

I just finished copying history and examination from fellow tempe. Today,i just need to palpate and tally everything with what i have written. At least i have to see and palpate her myself when my friend had already helped me with the case writing.

Let her finish partography and within 20 minutes i can palpate her.

Will i continue to be as consistent as i am right now?

Do pray for me.

Know what? I had my MCQ Obg today evening.
Only 3 questions were given but i failed to do well.
Maybe next time. So,please get ready tomorow. Dr LM will read the most interesting answers...

(--__--)"

Q.
.
1) Define caeserean section. Mention absolute indication for caeserean section.

2)Name the layers insiced and the layers sutures according to chronological order.

3) Name the complications that can occur during c.sect. Mention the difficulties of thus procedure.

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Sunday, October 21, 2012

OBG : Final day with ease

Saturday, final day unit 2 OBG.

Ho yeah~! *\(*u*)/*

No more hospital melodrama. No more kena leter dan kena marah.

Last day in unit 2 was magnificent! Although i was a bit nauseated and a bit uneasy during normal vaginal delivery at  labour theater, i finally realized that how much strength Allah gave to women to endure the pain during labour. At first , that female was yelling and screaming "amma appa..ayyooo" in so much pain and accompanied by the yelling of the PGs who tried to calm her down, my ear and my head began to be in pain. "Amma, chill madi!", said the male PG in charge while he was holding a episiotomy scissor  getting ready to cut her 'down' there. I can see everyone's forehead fill with wrinkles and sneering faces. Cut her some slack please! She was in pain! I can't help my self but to frown too. But, i had different reason. I just want the staff to treat her better. No wonder lah, many people said that during labour, the staffs always yells at the pitiful mothers who doesn't even have their husbands to accompany them. I wonder if my-husband-to-be will be able to hold my hand and be with me along the way in labour. Maybe, one day i can have my own hospital exclusive for women in labour where all the staff are nice and caring and most importantly, i want to hire only FEMALE staffs to work with me. At least, i can provide a choice to mothers who are unwilling to have a male doctor putting his hands in side her vagina, slicing them and watching them in pain.

I knew that all medical students have to master in every subject reagardless of the gender monopoly (im trying to say that male doctors have to learn and see female anatomy, and vice versa), but as a Muslim, i have responsibility to provide healthcare that emphasizes not only to medical care and supervision but also supervision and care from aurh( areas where non marriable people can't see) invasion.

After watching the delivery in a cloudy-state-of-mind, we dashed off to wards to finish writing our history presentation case.This time my teammates pleaded me to present the case as i have the non-jackable-non-anger inducing-face regardless of my mistakes i do during presentation. Like what they have predicted, Dr S who was known to be very aggresive  in taking viva and presentation didn't even bother to get angry as i was caught bluffing with a smiling face. I can clearly remember her saying " if you want  to bluff the vitals score or the examintion, at least put it at a normal level..." with a sinister face. Hihih, gomenne mera dhosti! I was in a hurry to copy the case sheet and present it without noticing the abnormal levels! Haha, i told you i can't lie with a straight face! Cikgu, sorilah. We didnt mean to cheat you by not taking the measurement and examined her ourselves,its just that we don't have adequate time to finish taking the case.Plus, the patient went to USG examination. So, we had to make up the history ourselves! Teehee! Sorry! (--_--)''



Baru teringat nak update pasal pesakit cancer ovari. Yup, haritu, sempatlah jugak palpate patient ni. Abdomen dia penuh ngan air(ascites). So, bila masuk OT cegu sedutlah segala air dalam abdomen tu. Teringat jugaklah yang dia panggil cekgu surgery untuk buat stage laparoscopy. Puihhh, buakan main banyak lah ketul-ketul air(cyst) yang dah merebak kat usus kecil dia. Impression diagnosis : Sero-mucinous ovarian cyst.

p/s: Argh...sakit hati pulak bila tak sempat nak tengok macam mana PG tu suture episiotomy incision tu. 

Wednesday, October 17, 2012

OBG : Its a BOY

Day three,week three in unit 2.


Tak lama lagi masuk unit 1 yang cool and sporting.
Sila sabar untuk tiga hari lagi.



Today we got to see a baby. Finally after two weeks posted in unit 2 i can finally see a baby being born into this world. It was an elective caesarean section. The babt was healthy and cried immediately after cord was clamped. Seronok betol bila dengar baby nangis.

Heheh, BYu memang suke menyakat budak. Suka sangat buat diorang nangis. Dah maen,pukkk huaawaaawaaa. ...lepas tu lari jauh-jauh. Jahat tol kak awe ni.

Ok. Viva di OT hari ni.

- caeserian section
- adnexal tu sebenarnya ovary n tube.
-management of pre, during n post c section patients
-Absolute indication n relative indication of c sec.
-steps of c sec.
-suturing the layers of incised uterine layers.ar lower part,how long,which material,which method of suturing.
-advice to patients after discharge.

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Monday, October 15, 2012

OBG : Week Three 9th term

Day 13.

Its OT day again. Every alternate days in unit 2 OBG, we have OT. On wednesdays at 11am we have theory class with Dr. DKS in OPD.

Case we've seen in fibroid uterus. Its a 34 yr old female,unmarried,had h/o bleeding pv, abdominal mass... It was BIG! Maybe around 3-4kg. Lots of bleeding during myomectomy. She was conscious all the way due to epidural anaesthisia.

The HUGE BUT!

Before we were allowed to enter the room,i could see the VULGARITY of surgical procedure. She is unmarried and we could assume that she had not been sexually active,hence had never been exposed physically in front of anyone in her life.
However,like what my mom uses to tell ;

"Once in the OT, everything will be EXPOSED and you are no longer subjected to privacy."

It felt horrible towards the lady,who is conscious and aware that a lot of people are staring at her lower private part including the OT male assistant(the one who angkat her onto the bed since she is quite obese),male OT assistant,the male interns, the male medical students, the doctors and the anaestheticians.

Yeah. I knew that in a teaching hospital, this kind of situation is common.Nevertheless,if we put ourselves in her place,imagine the trauma and horrifying experience of being exposed in front of so many people that she had never seen in her life. I can just geleng kepala aje.

Well,what to do kan? If you want a cheaper cost of treatment at the expense of infiltration of your body privacy, teaching hospitals in the usual way out of financial insufficiency.

It is unbelievable that the ones that offer complete care of women physical privacy makes their patients pay for what supposed to become their human rights. Yeap,it is the 'special service,special price policy' nowadays.

*sighs*

Sempat jugak borak about my very first experience of warching normal vaginal delivery and reminincing the joy of endorphins running through my veins all day. It was an AWESOME feeling i had ever had. I just couldnt stop smiling! Hekk, it is even better from getting all A1's in SPM or getting having had to receive thr scholarships etc... It is a complete PURE OF JOY and HAPPINESS that i felt that day. It is a miracle of the birth of a life to this world and that feeling of ecstacy is what i am searching for in this path i have chosen.

Come on dear ME!

Wake up and remember that feeling!
Yosh!

Gosh! Tomorow we will have MCQs on caesarean section in class. Wish me luck! ^_^


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Sunday, October 14, 2012

OBG :Lesson learned

Dr D.K.S. Graduated in Europe,did his internship there andcame to his homeland to serve his people.

Today,i've bewn reminded again how difficult to vain knowledge in medicine.

"You people are all USELESS peole! "

"You people dont even know the basic!"

"You are all BLOODY LAZY! "

"You don't even have any initiatives to read and find the basics in clinicals. Theory is important but during end of posting, your understanding in assessing the case is much more superior than your theory knowledge. "

Shame on me.

Shame.

Than goes on and on asking the basic questions. Nk one dared to answer. All of us are quiet as people at the funeral. He kept saying that we have to speak up and do mistakes now and nog during exams in which good examiners will never let IGNORANT medic students to PASS.

Passing is all i need. Distinction or first class won't even matter anymore. To pass is almost a miracle to me.

Dear me,please dont be disheartened by what they say. They are just doing their job as a teacher. Without them,you wont be here.

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Monday, October 8, 2012

OBG - Ot day


Yup,it is the second week of OBG postings. Today,the weather is super awesome!

Imagine yourself sitting in a nearly empty bus,the chilled breeze blew softly to your cold face,when you outside through the window, the only thing your eyes could see thick-magical-like mist surrounding the bridge. The bus ride seems more like a cloud ride to Alice's Wonderland.

What a good feeling to start your day.


Today, we were posted in OT. Again,got scolded by Dr N.

"You people never take the case before coming to OT! "

"Always shaking heads when asked!"

"You people dont know anything at all. Already ninth term but donno anything!"

"You people should come and see the case first before coming to OT."

Scoldings,nagging,smirking,jagging. All become our daily breakfast in OBG.

Ahah. I shall stop here. No more complaints ok. This was all things they should do. At least they nag and say something to wake us up. It would be worse to have staffs who doesnt even care to nag when we dont know the answers... Let them do their job dear.



Now..coming to the viva in OT.

-Differrence between thr pseudo and true broad ligament in fibroid uterus?

- Indications of hysterectomy and myomectomy. Age wise,family completion,recurrence,

-History findings in ovarian mass and uterus mass.

-Clinical features in mass per abdomen in ovarian mass and uterus mass.

-Complications of ureter injuri during operation.

-Post menopausal bleeding causes.

-Dysfunctional uterine bleeding.

-What can you feel when palpating mass per abdomen? Give differential diagnosis.

-Cystic feeling,firm consistency,Grooves sign.Bimanual feeling,continouity of mass in uterus through cervical examination.

-DNC,Currete instrument,Abortion.

-Menstrual irregularities in mass per abdomen.

-Why there is menorhagia in post menopausal women?
=Increase surface area,hyperplasia of the endometrium due to oestrogen level increase.

- DX of Surgical causes of mass per abdomen.TB,retroperitoneal carcinoma,...

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Saturday, October 6, 2012

The Health Benefits of Water Fasting


By Stephen Harrod Buhner

Written 2003
Copyright © 2003 Stephen Harrod Buhner

Fasting is an exceptionally ancient, and powerful, approach to healing many common disease conditions. It allows the body to rest, detoxify, and to heal. During fasting the body moves into the same kind of detoxification cycle that it normally enters during sleep. It uses its energy during a fast, not for digesting food, but for cleansing the body of accumulated toxins and healing any parts of it that are ill. As a fast progresses the body consumes everything that it can that is not essential to bodily functioning. This includes bacteria, viruses, fibroid tumors, waste products in the blood, any build up around the joints, and stored fat. The historical record indicates that human beings are evolutionarily designed to fast. It is an incredibly safe approach to healing and the body knows how to do it very well.

The Physiological Changes of Fasting
Many of the most dramatic changes that occur in the body during fasting take place on the first three days of the fast. These occur as the body switches from one fuel source to another. Normally, the primary form of energy the body uses for energy is glucose, a type of sugar. Most of this is extracted or converted from the food we eat. Throughout the day, the liver stores excess sugar in a special form called glycogen that it can call on as energy levels fall between meals. There is enough of this sugar source for 8-12 hours of energy and usually, it is completely exhausted within the first 24 hours of fasting. (However, once the body shifts over to ketosis or fat as fuel, this new fuel is used to also restore the body's glycogen reserves.)
Once the liver's stores of glycogen are gone, the body begins to shift over to what is called ketosis or ketone production - the use of fatty acids as fuel instead of glucose. This shift generally begins on the second day of fasting and completed by the third. In this interim period there is no glucose available and energy from fat conversion is insufficient but the body still needs fuel. So it accesses glucose from two sources. It first converts glycerol, available in the body's fat stores, to glucose but this is still insufficient. So it makes the rest that it needs from catabolizing, or breaking down, the amino acids in muscle tissue, using them in the liver for gluconeogenesis, or the making of glucose. Between 60 and 84 grams of protein are used on this second day, 2-3 ounces of muscle tissue. By the third day ketone production is sufficient to provide nearly all the energy the body needs and the body's protein begins to be strongly conserved. The body still needs a tiny amount of glucose for some functions, however, so a very small amount of protein, 18-24 grams, is still catabolized to supply it - from 1/2 to 1 ounce of muscle tissue per day. Over a 30 day water fast a person generally loses a maximum of 1-2 pounds of muscle mass. This conservation of the body's protein is an evolutionary development that exists to protect muscle tissue and vital organs from damage during periods of insufficient food availability.
From the third day onward the rate of the breakdown of fatty acids from adipose or fat tissue continues to increase, hitting its peak on the tenth day. This seven day period, after the body has shifted completely over to ketosis, is where the maximum breakdown of fat tissue occurs. As part of protein conservation, the body also begins seeking out all non-body-protein sources of fuel: nonessential cellular masses such as fibroid tumors and degenerative tissues, bacteria, viruses, or any other compounds in the body that can be used for fuel. This is part of the reason that fasting produces the kind of health effects it does. Also, during this period of heightened ketosis the body is in a similar state as the one that occurs during sleep - a rest and detoxification cycle. It begins to focus on the removal of toxins from the body and the healing and regeneration of damaged tissues and organs.

Fasting and Healing
Fasting has been found to help a number of disease conditions, often
permanently. There have been a number of intriguing clinical trials and studies treating numerous disease conditions with fasting. Here are some of those findings.

* In one clinical trial of hypertension and fasting, 174 people with hypertension were prefasted for 2-3 days by eating only fruits and vegetables. They then participated in a 10-11 day water only fast, followed by a 6-7 day post fast in which they ate only a low-fat, low- sodium vegan diet. Initial blood pressure in the participants was either in excess of 140 millimeters of mercury (mm HG) systolic or 90 diastolic or both. Ninety percent of the participants achieved blood pressure less than 140/90 by the end of the trial. The higher their initial blood pressure the more their readings dropped. The average drop for all participants was 37/13. Those with stage 3 hypertension (over 180/110) had an average reduction of 60/17. All those taking blood pressure medication prior to fasting were able to discontinue it. Fasting has been shown in a number of trials like this one to be one of the most effective methods for lowering blood pressure and normalizing cardiovascular function. Blood pressure tends to remain low in all those using fasting for cardiovascular disease once fasting is completed.

* Fasting is exceptionally beneficial in chronic cardiovascular disease and congestive heart failure, reducing triglycerides, atheromas, total cholesterol, and increasing HDL levels.

* Fasting has been found effective in the treatment of type II diabetes, often reversing the condition permanently.

* Because of its long term effects on metabolism, fat stores in the body, leptin, and disease conditions associated with obesity, fasting has been found to be one of the most effective treatments for obesity.

* A number of studies have found that fasting is beneficial in epilepsy, reducing the length, number, and severity of seizures. Fasting is especially effective for helping alleviate or cure childhood epilepsy.

* In a 1988 trial of 88 people with acute pancreatitis, fasting was found better than any other medical intervention. Neither nasogastric suction or cimetidine were found to produce as beneficial effects as those from fasting. Symptoms were relieved irrespective of the etiology of the disease.

* A number of studies have found that fasting is effective for treating both osteoarthritis and rheumatoid arthritis. Fasting induces significant antiinflammatory actions in the body and researchers found decreased ESR, arthralgia, pain, stiffness, and need for medication.

* Autoimmune diseases such as lupus, rosacea, chronic urticaria, and acute glomerulonephritis have all responded well to fasting.

* Severe toxic contamination has been shown to be significantly helped with fasting. Clinical trials have found that people poisoned with PCB experienced "dramatic" relief after 7-10 day fasts.

* Poor immune function improves during fasting. Studies have found that
there is increased macrophage activity, increased cell-mediated immunity,
decreased complement factors, decreased antigen-antibody complexes, increased immunoglobulin levels, increased neutrophil bactericidal activity, depressed lymphocyte blastogenesis, heightened monocyte killing and bactericidal function, and enhanced natural killer cell activity.

* Other diseases that have responded to fasting are: psychosomatic disease, neurogenic bladder, psoriasis, eczema, thrombophlebitis, varicose ulcers, fibromyalgia, neurocirculatory disease, irritable bowel syndrome, inflammatory bowel disease, bronchial asthma, lumbago, depression, neurosis, schizophrenia, duodenal ulcers, uterine fibroids, intestinal parasites, gout, allergies, hay fever, hives, multiple sclerosis, and insomnia.

* The historically lengthy claim that fasting increases life span is beginning to garner some support in research literature. Regularly repeated 4-day fasting has been found to increase the life span in normal and immunocompromised mice.

* Although the use of fasting in the treatment of cancer is controversial, there is some emerging data SHOWING that fasting helps prevent cancer. Intermittent fasting (2 days weekly) has shown an inhibitory effect on the development of liver cancer in rats.

People Who Should Not Fast
Although most people can fast, there are a few who, because of special
conditions, should not.

* People who are extremely emaciated or in a state of starvation
* Those who are anorexic or bulemic
* Pregnant, diabetic women
* Nursing mothers
* Those who have severe anemia
* Those with an extreme fear of fasting
* Those with porphyria. Porphyria refers to a genetic metabolic defect that affects the body's ability to manage porphyrins. Porphyrins are a group of compounds that combine with iron to produce blood, are involved in the control of electron transport systems, and, within mitochondria, are intricately involved in the production, accumulation, and utilization of energy. Porphyria can cause malfunctions in the liver, bone marrow, and red blood cells and produces a wide range of symptoms including seizures.
* People with a rare, genetic, fatty acid deficiency which prevents THE INITIATION OF KETOSIS. This is a deficiency involving the enzyme acetyl-CoA, a mitochondrial fatty acid oxidation enzyme, that is essential to ketosis. Those with this deficiency who do fast can experience severe side effects, including hepatic steatosis, myocardial lipid accumulation, and severe hypoglycemia.

A Note on Pregnancy, Children, and Fasting
Although many fasting texts suggest that pregnant women not fast, those that have been found to suffer side effects were also diabetic. Ketosis during pregnancy can seriously harm the fetus if the mother is diabetic. Fasting during pregnancy if a woman is not diabetic has not been found harmful to either mother or fetus. However, fasts for nondiabetic pregnant women should be no longer than 2-3 weeks duration and be monitored by a health care provider. Children, even infants, can also fast without complications if the fasts are of relatively short duration. For infants 2-3 days, children 1-2 weeks depending on age. These fasts should also be monitored by a health care provider unless of short duration. The need for infants and young children to fast is rare.

Those Who Should Fast Under Health Care Supervision
While most people can fast safely there are some that should do so only under the supervision of a health professional experienced in fasting for healing.

* Those with serious disease conditions
* Pregnant women
* Infants and young children
* Type I diabetics
* Those with insufficient kidney function
* Those who are extremely afraid of fasting yet wish to do so anyway
* People with a high toxic contamination level of DDT. DDT is stored by the body in a highly concentrated form in fat tissue. Fasting can release huge levels of DDT into the bloodstream as the fat stores are released. This can be quite dangerous.



Why i want to become a doctor.


This is NOT my story.,

I found it when rearranging my documents in my lappy. Read all the files that were not needed. I saved this article few years ago during my KTT years.Hope you will be inspired by this story.Author unknown.


My mother often recounts a story about me following around my father, our small town’s internist, on a certain home visit. Upon finding a woman with a swollen, painful belly, he began palpating her abdomen -- when he noticed two tiny hands of a toddler, emulating his own. I cannot remember a time when I was not interested in health care. As I finished high school and entered college, however, I had my doubts. I grew up watching my father suffer the hardships of his career, from long hours and disappointments to the difficulty of providing adequate care under insurance regulations. Additionally, I wondered whether I was genuinely dedicated to medicine or whether I was simply infatuated with the idea of imitating the extraordinary individual that is my father. Indeed, with three members of my immediate family in medicine, I felt as though I was simply falling into the occupation. Today, however, I have come to realize that I did not merely fall into medicine -- I fell in love with the profession on my own accord.

One notable memory often reminds me that when I am providing any type of patient care, no matter how minor, I have the feeling that I am at home. As a lifeguard, I had the chance to provide first aid on several occasions, and I recall one such event very clearly. During the summer after a particularly difficult sophomore year in college, I was left with many questions, including whether medicine truly offered the best career path for me. Then, one afternoon I was watching the pool when a young girl, slipping from the waterslide, collided with another swimmer. She struggled out of the water in a panic, fearing a broken leg. Rushing over, as I calmed her and assessed her right leg, I suddenly had that familiar feeling: this was my calling. To date, nothing in my life has felt more natural than when I was caring for Marie by the pool that day. Consequently, in the past two years I have only sought to expand on my opportunities to participate in and provide medical care to others. Last year I completed my training and gained certification as an emergency medical technician, and only recently, I began volunteering with the Orange County Rescue Squad. Finally getting the chance to participate actively in patient care has proven tremendously fulfilling and has further solidified my commitment to the medical field.

Hoping to learn more about health care within hospitals, I volunteered at the University of North Carolina’s Resident OB/GYN Clinic in the Women’s Hospital. Here, the nurses and residents have taken extra time to explain their procedures and courses of treatment, while I have also actively taken part in the care of the patients. In the past year I have gained experience taking blood pressures, weights, and patient histories. I also spent a memorable night following Dr. Lois Aronson in the labor and delivery ward. During this period, I observed two deliveries and two surgeries, and I also learned to perform pelvic exams and find fetal heartbeats. My favorite part of the whole volunteering experience, however, must have been the chance to witness Dr. Aronson’s thoughtful and compassionate interaction with patients during normal prenatal checkups. While observing her careful communication skills, I developed my own approach to conversing honestly and caringly with patients.
To complement my hands-on experience preparing for my career as a physician, I have devoted my energy to preparing for the rigorous scientific education that must preface the training of any thoughtful and capable physician. When reflecting on my college career, one experience stands out as the most enjoyable learning experience of all: teaching an introductory biology lab at UNC for two semesters. This endeavor allowed me to assume the role of a mentor and an instructor. As I was responsible for the laboratory education of 25 students each semester, this undertaking taught me to become a communicative leader who can guide others in their educational development. Moreover, the sheer amount of pleasure I received from helping my students achieve their goals reflects my commitment to a career of service.
My mother always said, “Don’t be a doctor unless you have to.” I feel that I am truly beginning to understand what she means. I know that becoming a physician is a long, difficult path. I have witnessed the realities of medicine in my own home and have spoken with an exhausted medical student on the thirtieth hour of her shift. I also know that for me it is worth it. Nothing would make me happier than devoting my life to becoming a physician and delivering quality, compassionate health care. To achieve my goals, I look forward to medical school as the next necessary and welcome step.
When a pod of 55 pilot whales recently beached themselves on a stretch of Cape Cod, vacationers and beach-goers came to the rescue. By high tide, they managed to save 46 whales. In explaining his motivation for jumping in to help, one volunteer simply answered, “Life.” The same purpose inspires my ambition to become a physician.

Medicine appeals to my deep appreciation for human life, inculcated by studying man as both a human being and biological machine. The decision to practice stems from a perpetual fascination with science combined with this basic love for life. I grew up capturing insects and watching PBS, always questioning the complexities of how the body works. Through academics and medical research, I have begun to answer this question.

My passion for knowledge of the inner workings of the human body led to proactive involvement in medical research, enriching my view of medicine as well as nurturing the desire to continue research endeavors throughout my medical career. For the past two years, I have studied the relationship between structural damage and preserved clinical function in multiple sclerosis patients through functional MRI, under the tutelage of Drs. Cranston and Mahoney. Although unsure how these two factors correlate, we hypothesize that a critical period exists when the brain undergoes reorganization. In a concurrent study, I am investigating the role of the pelvic veins in cryptogenic stroke, funded through a grant awarded by the American Heart Association. The objective is to determine, via MRV, whether the pelvic veins are the source of thrombolytic emboli in cryptogenic stroke patients who also harbor a patent foramen ovale. The results of these studies not only will contribute to the advancement of medicine, but may also hold therapeutic benefits for those afflicted with such neurological damage.

The rewards of medical research lie in its practical application, and there is no better place to observe the miracle of life than in the NICU. Each day, newborns struggle to survive, illustrating the inherent advancements and limitations of medicine. I have witnessed preemies, from 24 weeks of gestation and on, live and die. Exposure to patients revealed that people are much more than collections of cells and organs -- we all share the special gift of life. My role in helping to care for them abounded with both challenge and joy.

My first patient, Baby S, arrived nine weeks prematurely and spent the first month of life in the NICU. Due to the presence of an extrachromosomal fragment, he suffered slight mental retardation. His mother, who had the same condition, visited infrequently during his hospital stay. When she did, her visits were brief and inattentive. I grew quite fond of Baby S, often watching him snuggle into the blankets like a small burrito. Although his sky blue eyes moved in a spastic manner, they gave life to his somewhat immobile body. He rarely showed signs of discomfort, whether hungry or needing a change. I tried to give him the extra attention he lacked. At times, he rewarded my efforts to interact with a smile; other times, he gave me a dirty diaper.

Reflecting on my experiences, I realize that the practice of medicine entails more than remembering and dispensing scientific facts. It requires exercising both mind and heart, along with a genuine respect for life. Baby S and my other NICU patients instilled in me a sense of how precious life is, and I am certain that my current EMT training and planned medical mission to southeast Asia will reaffirm my conviction to improve the lives of others.

The career of a physician will allow me to balance an intellectual curiosity with my desire to help those in need. By helping man at his best and his worst, combining a passion for life with the pursuit of scientific knowledge, I can help heal and comfort others. I eagerly anticipate a vocation in which my patients fuel my search for knowledge, and that search embodies reciprocal benefits to my patients. When asked why I have chosen a medical career, I can confidently respond, “Life.”

To this day, the very thought of red oak bark tea nauseates me; my mouth still retains that bitter flavor. As a child in a rural community in the foothills of the Rocky Mountains, even the threat of home remedies like red oak bark tea was usually sufficient to scare the sickness out of me. Once, when my mother administered powdered alum to my sore throat, I concluded that my family must have had enough of me. They assured me, however, that alum was not supposed to make you gag quite that much.

I never considered becoming a doctor as a child. My family could rarely afford the luxury of proper medical treatment. Thus, unpleasant home remedies were my earliest experiences of healthcare, and I cannot say that they were exactly prepossessing. Nor was my opinion unusual in my environment: in my rural farming town, doctors were the people you went to when all your family remedies had failed, and you couldn’t get out of bed to go to work anymore. Medicine was seen less as a way to improve your quality of life than as an expensive method of postponing the inevitable.

I could not point to a specific date as the day I decided that I wanted to commit my life to medicine. Rather, it was a gradual realization that grew out of my love for biology and my sense that the path I was taking was not meant for me.

Merely attending junior college was an enormous achievement for me, as none of my family had ever graduated from high school. Initially, I intended to earn my associate's degree in biology. Unfortunately, my family’s difficult financial situation prevented me from following my interest in this field, for I soon had to find a full-time job to help out at home. I continued taking classes at night, but unfortunately, no lab courses were offered in the evening. Finally, after four years, I completed the requirements for an associate’s degree in economics. That was when I realized that I wanted to explore biology further. At moments, I even began to think of attending medical school, only to dismiss these daydreams as no more plausible than winning the lottery.
I soon married and entered a very difficult period in my life. Trying to keep my husband happy and my marriage together, after earning my associate's degree I quit the job I had enjoyed since high school graduation. I proceeded to change jobs every six months or so for the next two years before separating from my husband. When I knew there would be no reconciliation, I decided to follow the dream I had put on hold, and I applied to the institution I now attend to study biology. Being a doctor may not have been a lifelong dream for me, but it is my calling.

The first time I met Carla, she was sitting on the floor alone in the middle of the lunchroom while the rest of her cabin played outside. Carla was a frizzy-haired 11-year-old girl with autism. It was her first time away from home, and she was struggling to adjust to the new patterns, people, and places. At the same time, as her camp counselor, I was trying desperately to figure out her needs. Carla could not communicate spontaneously, and she responded to my questions only by repeating them. It was difficult helping her transition from one activity to the next, because whenever a game ended, Carla would just flop down on the ground and refuse to budge. I tried singing songs, dancing, and playing "follow the leader, " but nothing uprooted Carla. Then suddenly, after a few days of working with her, I noticed that Carla was fascinated with hands. Although she would not hold people’s hands, she liked to touch them and look at them, and I soon discovered that I could use her interest to motivate her to participate in life around her. For the next two weeks, I transformed my hands into butterfly wings, and the two of us flew around camp together. Although we could not communicate verbally, we found a connection more powerful than conversation, and I discovered how deeply satisfying it is to help other people, particularly those who cannot speak for themselves.

I have dreamed of becoming a physician since childhood, because medicine offers the rare opportunity to combine science and humanism to make a real difference in other people’s lives. I have a longstanding love of science, which led me to major in engineering in college because I enjoyed working on applied scientific questions. Most of my course work and extracurricular activities were science-related, but my interest in medicine solidified, ironically, during the summer when I took my first break from science. During the fall semester of my junior year, I began to feel overwhelmed by conflicting responsibilities in my course work, part-time employment, and various extracurricular activities. I realized that I had spent most of the previous decade enrolled in academic, research, and community service projects to prepare myself for the challenge of medical school, but I had not yet confirmed that aspiration. I tried to focus on what made me happy at the time, and I realized my most beloved experiences occurred while I volunteered at a pre-school with disabled children. Whether I spent my time helping the children swim, reading to them, or simply chasing after them, I always left with the feeling that I had made a small impact on their lives.
I researched camps for children with special needs, and after talking with directors and former counselors at numerous programs, I chose to become a counselor at the Frost Valley YMCA Mainstreaming at Camp program. I started that summer both excited and daunted by what lay ahead. The counselors and directors warned me that the job would be emotionally, mentally, and physically exhausting, but I had no idea what I would encounter. That summer became the hardest and most rewarding time of my life. Every two weeks a new group of children with a wide range of developmental disabilities entered my life and became dependent upon me for almost all of their care. I quickly realized how different each child was and tried to adjust my counseling style to fit their individual needs. Motivating and communicating with children who cannot -- or will not -- reciprocate your efforts requires a great deal of patience and creativity. Working with this special group of children tested me greatly, but I found that the hardest part was saying goodbye at the end of each two-week session.

During my last weeks at Frost Valley, one of my campers, a 19-year-old girl with mental retardation, began having seizures. I recognized her symptoms, but one night her seizures became continuous. We called an ambulance, and I jumped on board so that I could spend the night with her, holding her hand and acting as her medical advocate. Because she looked quite “normal, ” it was difficult for the medical staff to understand that she had the communication skills of a 9-year-old. After I explained her condition several times, however, the staff realized that although Jackie looked “normal, ” she required special care. After a long and scary night, Jackie was released from the hospital and sent back to camp. Fortunately, she recovered completely and was happy and healthy for the rest of her time at camp.

I am sure she will never remember how frightened she was that night -- or even my holding her hand -- but I know I will never forget it. That summer, particularly that night, reaffirmed my desire to become a doctor. I realized how critical it is for medical professional to understand the needs of special populations, to work directly with them and their families. I also understood that I could join my two loves by working as a pediatrician for children with special needs. Caring for a child who cannot tell you what is wrong requires a person with patience, skill, and compassion; it is my dream to become one of those people.

Wednesday, October 3, 2012

OBG : OT Day

Day 2.



Its OT day.

Today, we had seen the common.
A known case of ovarian cancer, its seromucinous type which produces ascitic-like fluid in the peritoneum. From tip-toeing behind Dr N and Dr L, i could see grain-like thingy scattered all over the bowel. They decided to do colonoscopy and sent us all out. Instead Dr L asked one of the unfortunate PG to take a class on ovarian tumour. As expected,she taught us whatever she knew,and let us go early.

Pheww,

Today,it is so much like a pasar malam or a kindergarten. There are people screaming,some runs,some frowns,some giggling at the corner and so on.

It is going to be alternate days of pure boredomeness in OT in which much better than having class in OPD.Why? Coz it is so boring and most importantly NO AIRCOND!





Bring flip flops!


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Monday, October 1, 2012

OBG: The womenhood and maternity world


DAY-1 9th term


Instead of watching educational videos..try this!



Heheh..that one is a korean drama. Do watch the drama. I haven't seen it yet.I found it in Youtube asi was trying to search for antenatal examination.
Hihih...









Sunday, September 30, 2012

End of Paediatrics Posting


I will miss these kids!



She had thalasemia major with hepatospleenomegaly.

Classic clinical presentations of Nephrotic syndrome.Aged 4 years old.

In theory class.

My lovely friends trying to console this baby. ughh!


Bye-bye...See you again kids next year!!!


Monday, September 24, 2012

21st century patients end era of ‘doctor knows best’


Source: here.

March 12, 2012
FMT LETTER: From M Saravanabavan, via e-mail
There has been a sharp increase in the number of medical negligence claims mounted in the courts in Malaysia throughout the years and as a result, the Courts have granted sizeable awards to victims of medical negligence.
In 2011, the High Court in Penang awarded RM150,000 in damages to a former salesman who had been wrongly diagnosed as being HIV positive by a private hospital. In the same year, on another instance, the High Court awarded RM100,000 in damages to a deceased woman’s family for failure of a private hospital to investigate and diagnose that the deceased suffered from colon cancer.
Recently, on Jan 21, 2012, the High Court in Johor awarded a couple a total of RM870,000 due to medical negligence by two hospitals and the Government during the child’s birth.
These cases do not indicate a healthy trend for the country. Neither the doctor nor the patient would want to undergo the painful process of litigation. Large awards will probably deter future omissions and negligence but it will also damage the reputation of the healthcare system.
Perhaps a greater understanding of the law in relation to medical negligence may do some good. Given the growing demands of accountability by the society, it is imperative that medical service providers are made knowledgeable about the legal issues affecting them in their daily practice.
A good starting point would be to define negligence. Negligence is defined in law as the breach of a duty to use reasonable care as a result of which there is damage to another. In simple terms, this means fault.
Indeed it is trite law that a doctor owes a duty of care to his patients. Therefore, medical negligence will occur if a medical practitioner has in some way harmed a patient or caused harmed to patient due to the fault of his own. He will be considered to be in breach of his duty of care and in turn as negligent.
Of course, the law does not simply attach negligent liability to a medical practitioner by default, proof of negligent conduct is required and it will not be easy to show that a particular medical practitioner had been negligent. Who proves the negligent act? Under the law, the person claiming that he had been negligently treated bears the burden of proving medical negligence. There are two stages to prove this, firstly, the plaintiff must establish that there was a professional standard of care owed to him by the doctor and secondly, the plaintiff must prove the fact that the doctor has abandoned that professional standard.
The most commonly accepted manner of proof of the professional standard of care is another doctor’s testimony. This is where the Bolam principle is applied. This principle was established in the 1957 case of Bolam v Friern Hospital Management Committee. According to this authority, if the doctor manages to prove that what he did is accepted as a standard practice by even one responsible body of medical opinion, he will not be held liable for negligence. This is even so when there are other responsible bodies of medical opinion that take a stand to the contrary.
The Bolam principle allows the doctor to rely upon a body of responsible peer professional opinion to absolve him of professional medical negligence. The popular idiom ‘One man’s meat is another man’s poison’ is of relevance here in that whilst doctors are relieved that the law allows them to be judged by their own peers, the Bolam principle had clearly made it difficult for the patient to prove that the doctor had positively breached a standard of care owed in the circumstances. As a result, for the patients, the existence of the Bolam principle hinders them from getting justice and the fair trial that they deserve.
The Bolam principle was then subject to considerable scrutiny in the 1997 decision of Bolitho v City and Hackney H.A. In this case, the courts qualified the Bolam principle and formed a view that a doctor could be held negligent notwithstanding peer professional opinion which purportedly represents evidence of responsible medical practice if that opinion is determined by the court to be “not capable of withstanding logical analysis”, or is otherwise “unreasonable” or “irresponsible”.
Professor Rachael Mulheron explains the impact of the Bolitho case in her 2010 paper ‘Trumping Bolam: A critical legal analysis of Bolitho’. She states that the judiciary has pointed out that Bolithoturned Bolam on its axis, in that the court, and not the medical profession, became the final arbiter of medical breach. Since then, it has become a challenging legal question as to what features particularly characterise a peer professional opinion as one that is “illogical”, “irresponsible”, and “indefensible”.
Apart from Bolam principle and its subsequent qualification in Bolitho, there is another principle commonly applied in medical negligence cases. This principle is derived from the Australian case ofRogers v Whitaker. In this case, it was accepted that the doctor’s negligent act cannot be conclusively determined by “any profession or group in the community” but it should be determined upon consideration of complex factors, namely, “the nature of the negligent act; the nature of the treatment; the desire of the patient for information; the temperament and health of the patient; and the general surrounding circumstances.”
This is an obvious departure from the Bolam principle explained above. Under the Rogers principle, the Courts had the license to scrutinise professional practices to ensure that they accord with the standard of reasonableness imposed by the law. The ultimate question is not whether the defendant’s conduct accords with the practices of his profession or some part of it, but whether it conforms to the standard of care demanded by the law.  In short, the Courts will decide whether the doctors’ have been negligent or not. This will not depend wholly on the practices of the profession or opinion of the doctors’ peers.
Which of these approaches have been followed in Malaysia? Since the 1960s, the Bolam principle has been routinely applied by the Malaysian courts to medical negligence cases . Traditionally Malaysia has taken the classic doctor-centric approach. The court will not examine the reasonableness of the treatment. Malaysian Courts have uncompromisingly followed Lord Denning’s words in the 1954 case ofRoe v Minister of Health where he states:
“But we should be doing a disservice to the community at large if we were to impose liability on hospitals and doctors for everything that happens to go wrong. Doctors would be led to think more of their own safety than of the good of their patients. Initiative would be stifled and confidence shaken. A proper sense of proportion requires us to have regard to the conditions in which hospitals and doctors have to work. We must insist on due care for the patient at every point, but we must not condemn as negligence that which is only a misadventure.”
However, a 2007 Federal Court decision, Foo Fio Na v Hospital Assunta & Anor expunged the Bolamprinciple. The Courts applied the Rogers principle in preference to the Bolam principle to decide whether a doctor was negligent in failing to inform the patient of the risk of paralysis that is inherent in a spinal cord operation.
The Courts held that the test enunciated in Rogers would be “a more appropriate and a viable test of this millennium.” They concluded that the Bolam principle has no relevance in the determination of medical negligence.
The Federal Court has clearly made a policy statement in regard to the Bolam principle and put a potentially onerous task for the medical practitioners. The rejection of the Bolam principle means that evidence of medical practice is just another factor that the courts should take into account in determining medical negligence. Professor Dr Puteri Nemie in her paper Medical Negligence Litigation in Malaysia argues that professional practice and opinion will still be relevant and not denied in setting the standard of care. What will be denied is its conclusiveness.
It appears from the above that the traditional approach of “doctors know best” has been discarded. It is not the medical men but the courts who decide whether a doctor was negligent towards the patient.
Such is the position of the law in relation to medical negligence in Malaysia today. Professor Dr Puteri Nieme argues that this position can be attributed to the trend nowadays that patients no longer want to be treated as passive recipients of medical care. Instead, they want to be treated as co-producers or partners able to manage their illnesses.
This sentiment is not new. It was already echoed two decades ago by the Honourable Justice Michael Kirby, the former President of New South Wales Court of Appeal in his 1983 paper Informed Consent: What does it mean. In his concluding remarks, he states:
“… the days of paternalistic medicine are numbered. The days of unquestioning trust of the patient also appear numbered. The days of complete consent to anything a doctor cared to do appear numbered. Nowadays, doctors out of respect for themselves and their patients must increasingly face the obligation of securing informed consent from the patient for the kind of therapeutic treatment proposed…”
To state the obvious, 21st century patients expect more from their doctors. Patients are better informed and more aware of their legal rights.
Therefore, it is pertinent for medical practitioners to have a strong grasp of the law in relation to medical negligence and conduct themselves in ways to ensure the highest standards of medical practice.
The writer is an advocate and solicit

Sunday, September 9, 2012

Paediatric: Its time to play!


With kids lah, but don't play-play. They are cute, lovely, induces mothers instinct like feeling compelled to carry them on your shoulder, wanting to cuddle them, play cikk-boooboo ,yada yada.

But, once they cry with highly shrieking voice,and demanding attitude, they aint cute or cuddly anymore.

But still have to think how to get the measurements.

The circumferences, the rates the sounds,the reflexes, the power and tones, and the developments.

These kids are sick,irritable and suspicious.

Hah! They tend to cry and hug their amma and appa upon seeing strangers.

In wards,these kids dont see us as medical guy, but rather apparent to them as ALIENS. Yes!

Aliens in white coats,with spectacles covering the eyes, with 'scary' instruments dangling around their neck and pockets, who were trying so hard at making a stable contact. To them,we are aliens trying to figure out how to communicate with them using keys,coins,phones and anything that is available in the wide wards.

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Thursday, August 2, 2012

OBG


Saturday, July 28, 2012

Medicine Posting Story : Language Barrier

 Fuhhh..fuhhh..!!! Its dusty here!

Its Saturday and i just finished making my bed. I've been waiting so long to update my story during my medicine posting.


In our 9th term posting, we had 6 weeks of medicine posting. Never thought that weeks gone by in a blink and suddenly the time to shift from Unit 2 to Unit 1 will come so soon. Head Unit 2(HOD) ,Dr A was so nice and very helpful. He always smiles       and treat us well. No hard hitting questions asked and always gives very detailed explanation in regard of the case presented.

It had been 3 weeks in the unit 2 and i find myself finding cases that i really want to see. This time we had 3 cases of ascites which i find very difficult to deal with during junior times. Now, that i have mastered the history taking skills as well as the physical examination part, all went well and i was lucky enough to get such a cooperative patient. Why is it important to get co operative patient?

Well, imagine if you were a poor and absolutely incapable of financial support. You were so sick and had to take a leave from work for a very long time. You had no choice but to go to either a government funded hospital or a charitable hospital so as not to worry about the money when you were so sick to pay for the bills. Our hospital is a charitable hospital in which the hospital reduce the doctor's charge, and medications were so cheap. However, since this is a teaching hospital, all patients in huge wards have to be willing to be inspected and used as subject during class( if they want more privacy, pay the tenth fold price of a private deluxe room).

At least, all patients who are well enough are expected to co operate with the students learning in this hospital. If the patient does not give their consent, even if the case filled with interesting positive findings, you can't force them to be palpated by so many students and at the same time give you detailed history of their sickness.I heard from my friends living in Egypt, as well as in hospitals where majority of the patient came from a very financially capable background were so reluctant to cooperate with the students. Yeah, it is well understood.You were sick and sensitive, you had to pay high bills and you want to be treated well and you expect no one bothering you every hour asking the same questions and touch your body for so many different reasons.

Sometimes, i do respect and amazed of the poor people who came to our hospital and become so cooperative to us. Thank You anna! Thank you amma! Thank you for being such a lovely understanding patient! I've learnt a lot from you guys!



You know what?In Indian culture, patients regardless of financial background were so respectful towards doctors that when they came to to the out patient clinic, they would open their snickers/slippers/chappals outside the door cubicle! They did that in spite of knowing the floor was not carpeted and dusty and we were all wearing our shoes inside. It shows how respectful they were towards the doctors! Not to mention towards the doctors-to-be too! In Malaysia, i think no one will give themselves to be examined or less getting an advice from a medical student. I think , all well educated patients are highly suspicious to doctors and would never see quack doctor for treatment. Nowadays, patients are willing to trust the internet rather than doctors advice and prescription. Thank you God for sending me to India instead of Poland. I hoped that my choice of staying in India instead of Malaysia were the best. Yes, it did in terms of clinical cases and as well as polishing my skills. Read How i end up in India.




Ehem,back to track. What we do exactly in medicine posting? Posting are divided to two. The wards and the out patient department(OPD) also known as clinics in Malaysia. On Tuesday and Saturday we had OPD and the other days we had to go to wards and take cases to be presented at the end of 3 hour class.

In OPD, we went there by 9.30am. Divided ourselves and go to respective doctors in charge at different cubicles. Lagi bagus kalau pegi kat head unit lah. Banyak cabaran!Heheh, dirang suka ajar dan tanya soalan. Kalau anak-anak buah dia, buat kerja dia je. Malas nak layan kitorang. Lagipun ramai patient nak layan lagi. 


Me and my unit friends in OPD!


We stood there and wait till the Dr say something.This time, HOD want do some inspection on how well i took blood pressure. With so many patients during OPD, i doubt that my skills will go rusty. Do everything the way it should be. The beginners way. No shortcut to take blood pressure. It took me twice or thrice the time needed to take blood pressure compared to him. Dr A said, as time goes by you will get your way to find the blood pressure in a short time. You have to find your way. If one day a doctor have 50 patients at evening, how much time does he need to ask the history,examine the patient and give the diagnosis? Practice! Practice!Practice! Be fast and save your and patient's precious time!

Other than taking blood pressure, we had to auscultate the heart and lung sounds if there is a case with positive findings. If the interns we busy clerking, and the doctors were busy talking to patient, he would ask us to take the height,weight and find the BMI.To all readers aspiring to study in India, please learn a bit of their language if you don't want to be blurry and spaced out in class. Majority of the patients here in Mangalore  spoke Kannada and Malayalam. Only few well educated Mangaloreans speak Hindi. Some patient also speak other language like Tulu and Bangla in which we had to us our God-given limbs to try to communicate through sign language although we looked like clowns at circus.

Language barrier is a problem if you don't have the initiative to learn basic orders and common words used in wards and OPD. At least learn how to say : here,there,pain here?,flex you leg,extend your arm etc... I tell you, it will be useful during examination where no translators are provided for us foreign students as well as the non-local students. Haha! Believe it or not, only locals speaks their language. 40 % of Indian students coming from other state like the northern area only speaks Hindi. Most of our patients don't speak Hindi which puts my fellow Northern Indian friends in the same shoes as mine.

Be friendly and ask nicely!

In ward, we came early at 9am and started to take history from the patients. We looked through the patients files lied on the bed which were meant for doctors doing rounds. We looked through each and every files to see whether it is worthy of being presented or not and it must be adequate with findings. Once we did, we jot down the name,age,place of the patient. Read the history ,findings and impressions in advance.Never believe what is written in there. The history could be wrong and doctors expect you to take the history yourselves. They want to know the history in  detail and expect you examine the patient before presenting the case. Wrong moves could sent you to bottom of self-mood-destroying-mode.

So, the challenge here is how to take the history in detail if you don't even speak their language? How do i do it? Easy! Even though you don't ask the questions directly, you can at least prompt the questions to you fellow friend. He or she might be submerged in the conversation especially when talking to old folks. So, your  job is to bring them on track by asking questions pertinent to the case. Involve more in conversation and remember the details translated. Doctors expect us to present the case without looking at the case sheet. Most of them will took the case sheet away anyway.Be prepared of the investigations and treatments needed by the patient. Find the differential diagnosis if you have more spare time. In the end, doctors will ask other diseases that comes with the same sign and symptoms and teach you how to rule out each one to come down the real diagnosis.

Fuhhh...

Its a long essay for now. I should stop here or else my arms won't move at all.

Da!



Saturday, July 7, 2012

So, which one are you?







Choose wisely! 



How To Choose Your Medical Speciality



Monday, July 2, 2012

Surgery : End Posting 9th term

Surgery end posting will soon come around the corner. What will i do?

Again, i'd like to write what i have to prepare for end posting which consist of viva  as well as case presentation.What shall i do?

First, prepare all the proforma for important topics based on Dass Surgery Clinical Manual. Reading proforma is much easier than reading right off the book.Read all the little notes you wrote.

Next, read the differential diagnosis part. You always left that particular part behind! Don't leave any SMALL printed words. It may come back to you some day somehow.

Prepare a bunch of viva questions in your mind. Don't slack off at the very last minute. Come On!! You can do it!

Practice the examination part and please remember all the test names! Don't confuse Brodie's-trendelenburgh test , Swartz and Perthe's test!

Last but not least, prepare the materials needed for physical examination. Don't forget to buy the AAA Batery for torch light!



P/S: Please read some theory part from Manipal Manual Of Surgery and SRB!!


Saturday, June 30, 2012


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Tuesday, June 26, 2012

Surgery : Breast Carcinoma



Today, we had a great class of breast carcinoma. It is a very important class. Dr M taught us on the do's and the dont's of breast carcinoma examination.Yeah, and he did that in between the time when patient comes in and out of the OPD. Sometimes, after listening to Medical Representatives suggesting their companies drugs to be used in OPD.After 3 postings of surgery in India, i am now adapting well to norms of system.Well,  Dr M asked us  to present the case and yada yadda we told him about patient's history,inspection and palpation of breast while he expressionlessly  nit-picking using flat toned manner with tons of viva-style questions.


Picture courtesy from Radiology Malaysia.org

Now, here we go and present the case.

Chief complaint :She complains of painful left breast  since 1 month ago.

Long case made short.

Among positive findings that we encountered are :

On inspection there is presence of single ulcer at  the left breast with multiple nodules. The breast of affected site sags and the skin of breast seems normal. The nipple of the left breast is destroyed and floor of ulcer is covered by slough and seropurulent discharge.

By palpation we could feel the hardness of the breast lump which is multiple in number,varied in size between 5mm to 1.5cm. The breast ulcer is tender  and bleeds on touch, fixed to the breast tissue and have sloping edge with indurated margin. Single solitary axillary lymph node is appreciated.

Diagnosis :

 T4b Tumour with involvement of the skin in the form of eodema,ulceration and satellite skin nodules.

N1 Mobile ipsilateral axillary lymph node.

Note: Wear gloves  and wash your hands in between patients dear doctors!

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Seminar! Hate it!

Seminar... I hate seminar. Why? Because i have to speak and present my topic in front of class. Well, pretty much there is a HUGE chance of me getting interogated like a criminal. Making power point. LOVE it. Presenting part, HEARTLESS. Interogation part, HATE it ! Pfft! My topic today : Flexible Fibre Optic in Broncoscopy and Oesophagoscopy. Wish me luck!
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Sunday, June 24, 2012

Surgery posting

Our teacher teaching us anatomy.

Syabas lah cikgu ni!

Penat mengajar sampai jadi tulang aje!

Tuesday, June 12, 2012


Wednesday, May 30, 2012



Berbekam baik untuk melancarkan pengaliran darah!







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