Commit suicide part 2

Pagi khamis lepas, wad macam biasa sibuk.
2 gerombolan team sedang buat ward round.
Tiba tiba terdengar suara perempuan jerit dari koridor.
Sempat la nampak kawan sy, Chin Hai  a.k.a hero of the day, lompat tingkap dari bahagian wad  ke koridor.
Wad terus jadi gamat.
Ada sorang girl age 22 tu kalo x silap try nak lompat koridor tu ke bawah.
dari tingkat 7 kowt~

Adik ni initially presented to ward with diarrhoea and fever, so she was treated as typhoid.
But then. noticed adik ni ade discoid rash.
And kat ward pun die developed hematuria ngan oral ulcer.
So she was investigated for SLE.
Unlucky la untuk adik ni, memang die tengah active phase of SLE.
And da developed lupus nephritis and lupus cerebritis.

Hmmm,...
back to cite die nak terjun bangunan tu.
Pastu adik ni kena ikat kat katil die and transferred to acute bed la.
Lepas dr inject haloperidol, ambik CBS seme,
Dr Zul psychiatrist datang n wat assesessment.
Actually bukan niat niat adik ni pun nak terjun bangunan tu.
Dia buat tanpa sedar.
Sebab lupus cerebritis la.
Maybe die develop psychosis watsoever.

Kitorang shocked!
Mak die lagilah.
Huhu.. what a day!

......................................................

Systemic Lupus Erythematosus

Multisystemic autoimmune disease whereby the immune system akan attack your own body tissue.
Nak diagnose ni, need at least 4 criteria out of eleven ( A RASH POIN MD)

1. Athritis (Non erosive)
2. Renal abnormalities ( proteinurea .0.5g/day atau > 3 cellular cast)
3. ANA antibodies
4. Serositis (ECG, rub effusion) - pleuritis /pericarditis
5. Hematological do
6. Photosensitivity
7. Oral ulcer
8. Immunological do
9. Neurological do (seizure, psychosis)
10. Malar rash
11. Discoid rash

cOmmIt sUIcIdE

Hari ni ambik darah K.azwa, tapi fail. haha, sian die, sib baik die ni rock2 je... siap suh ambil lagi sekali..
Cerita kenape fail ambik darah ni .. BERSEBAB..
I have hand tremor .. kalau buat tremor test tu memang positive findinglah.
Tapi bukan ambik darah je, any fine work ni memang x sah kalau x tremor esp tangan kiri ni.
Dok saje2 pun tremor..hahha.. parkinson ke? eh x la....

So tadi K.Azwa ambil darah saya n kami hantar ke lab untuk cek TSH, and T4 level...
Huhu, T I update the result later.
I hope my problem ni ade solutionnye.
X confidentlah nak ambik darah ngan tremor hand ni.
kan kan kan... hahaha

Haaa... kenapa tajuk entry ni commit suicide??
Nak tahu x, tadi ade patient kat ward ade intention nak terjun bangunan..
Suspen x?
hahhahaa... Ok, t I cite later..
Nak g kelas ni...
ehehhehe.. Tapi nak jugak kan conteng2 kat sini dulu.
Babai juta juta kali... haha~

HIV screening

Assalamualaikum wbt.

Hi...
Theres a case in the ward where in the folder stated that the patient was  HIV positive.
But he was currently presented with the problem of end stage renal failure requiring haemodialysis.
So he was treated for the current problem la.

The problem is, I cannot see anywhere in the ticket, nor in the medication chart, mentioning that the patient was on HAART.
The doctor also never discus about the HIV during the ward round.
I mean, yela kan since the CD4 level pon da getting low, 143...
Not to mention, his wife and his son pon seems educated and bukan like orang2 kampung.

I was so curious how did the patient get HIV, but I just dont know how can I ask the patient.
He doesnt seems like a drug addict, but yelah, we never know.
So I just forget the issue until after two weeks, one of my college raised the issue back,
and here we goes, doing some private investigation by tracking the old notes.
Pon the same thing, it doesnt stated clearly why, how , what treatment bla bla bla...
It was like an isolated case.

Until, our investigation reached the right source.. Wink! ^^
Oh, rupe rupenye the patient was never been declared as HIV.
I mean, he never undergo any proper follow up and so on.
and the family also DOESNT KNOW that the patient is a HIV positive.
He got the virus before the marriage due to homosexual lifestyle.
And try U imagine what is the risk for the family members of having the same virus inside their body?
I just wondering, when and how the breaking bad news process will be.
Its gonna be very heartbreaking for sure.
Lagilah kalau the wife and children was infected with the same virus jugak kan.

The point here, lucky us, nowadays the goverment have put the HIV screening test as compulsary test before marriage.
Marriaging someone with HIV is a different isssue with marriaging someone with not knowing to have HIV.
At least, there is some way to prevent the spread to the children by ceserean section and starting the HAART during the pregnancy.
Oh well, I just hope the pakcik and the family to be okay.

HIV is just a stigma.
A disease where everyone was trained to be afraid of.
Padahal same je macam sakit sakit lain.
Sampai masa semua akn mati juga.

Wallahua'lam... K bye... enjoy the medical posting ! *_^

S.T.R.E.S.S state

I cant sleep. I cant sleep. I cant sleep.
My brain is lack of glucose. I feel like dying.
Tell U, brain depends 100% on glucose unless U are in prolong starvation whereby the brain can use ketone bodies as the main fuel.
But I am not in starvation yet, I just run out of my glucose.
My tank is empty.
I cant sleep. I cant study. I cant finish my write up.
Because I have no energy.
Whos the culprit huh?

Somehow, I still have some in my store.
It is my liver which store glucose as glycogen.
Also my adipose tissue which store trigliseride which can be converted to glucose later after undergo lipolysis.

No worries huh?
After my body detect my hypoglysemic state a.k.a stress state,
theres glucagon, cortisol, growth hormone, adrenaline released more and more.
To start the lipolysis, gluconeogenesis, glycolysis, and protein breakdown process.

I am breathing more than usual,
My Blood pressure is spiking.
My metabolic rate is increasing.
Oh keje si cortisol rupenye..
Sape suh U stress2 lagi...

Oh no wonder la I am becoming thin and thinner...
hahhaha... perasannya....

K peeps, nite.

P/s: Certain things and certain times, things just go out of control. :D

take care of your kidney guys!

Dalam ward 7s @ wad lelaki, kebanyakan kes adalah masalah jantung dan kegagalan buah pinggang. For me, both diasease are scary, but the scariest one is bila buah pinggang anda sudah gagal berfingsi. Budak medik panggil end stage  renal failure (ESRF).

Semalam, dr consult satu pak cik untuk undergo the first time dialysis. Peritoneal dialysis lah before buat fistula and permanently haemodialysis. Pakcik tu degil, refuse and takleh terima kenyataan buah pinggang die dah rosak. Yelah kan, try U imagine bile ur kidney dah fail, thats mean U have to undergo three times haemodylisis per week for the whole of your life. Hilang satu nikmat hidup. Nak pergi melancong pun susah. Kena book mesin dialysis kat tempat kita nak pergi melancong dululah. Contoh nak wat haji ke... even nak gi umah anak kat Key El pon. Nanti sure2lah banyak kali kena admit kat ward sebab complication of dialysis and ESRF tu sendiri.

Thats the kidney to those yang da lupe kidney tu ape..  fungsi dia tapis darah, buang toxin, release erythropoeitin untuk hasilkan darah merah, vit D ,kontrol zat galian lam badan.

So, sy nak share care2 jaga buah pinggang. Perlu amalkan sekarang, so that x merana later.

1. Minum air banyak2. Lebih kurang 3 L, 8 gelas. Bantu buang toxin lam badan and elak batu karang/ renal stone.

2. Jaga pemakanan. Elakkan kencing manis dan darah tinggi. 2 ni penyumbang utama kerosakan buah pinggang kite. So, kurangkan gula especially air bikarbonat. Takyah ambik langsung pun xpe. Minum time raye je..hehhehe ... Air yg banyak pewarna, jajan2 tu semua tak yah makanlah. Kalo nak makan, makan sikit2 je, macam sy.

3. Jangan tahan2 buang air kecil. takut develop batu karang. To those yang ade symptom2 urinary tract infection, terus jumpe dr. Awal2 kite bg antibiotic je, kalo x rawat, sampai buah piggang rosak through ascending infection, haemodialysis lah jawabnye. Nauzubillahiminzalik.

4. Jangan suke2 ambik ubat tanpa refer to farmacist or clinician dulu. X kisahla ubat kurus ke, ubat tahan sakit, ubat nak cantik bagai. X kidney pun, liver U pulak rosak.

5. Jauhi dehydration. Kurangkan kafein sebab die ade diuretik effect yg menyebabkan U nak keennciii aje.

6. Yang merokok tu, stop jelah. Takyah degil2.

7. Hidop dengan sihat dan banyak kan bersenam.

Ok, cukoplah kooot... Okay sekarang mari ikut sy sebut " SAYA SAYANG BUAH PINGGANG SAYA" 

boRinG~~

me, presenting the seminar. hahha... fake fake fake. actually it was taken while waiting for dr helmi, radiologist yang well known garang.. hihi, tp baik je aritu.

busy meh? reading while walking, eating while running. Ive experienced them all. There was also time when we are free. So what do we do? clerking patient in the ward. Untuk orang rajinla. Me, serving my bed in the room.hikhik

While waiting for class to start, this is what we do. STUDY. Except for K.Azwa ngan Ajeng.hahahha.. K.Azwa of coz la dengan handphonnye. Ajeng? See... the one hok dok berbual tu... He is the kaki berbual.

Aiman aiman aiman. ^^

P/s : Chest pain. Thightness in nature. On and off. A/w shaking. Increase appetite. Diagnosis?

september 2o12

Assalamualaikum wbt.

hihu... a week dy being a super senior... best2.. tapi x best cam kat skewl dulu.. leh suh junior amik air, kemas bilik, gosokkan baju... hehheee..

super senior kat sini, sama je cam super junior. not much changes. Cume adela few perubahan dari segi environment.

1. kalo dok kat red square, x sorang pun kelibat yg i knal. semua muke2 junior gitu. so, sy da x duduk red sq da skang sebab x de senior da nak usha...hikhikhik.. 

2. dah x beratur menjerit melalak beli nota kat kdai che din... masuk che din, beli air je skang nih.. " che din, nak nota no 5 sepuluh copy"... hihi.. sistematik sungguh che din ni.

3. skang ni rase knowledgable la sikit follow round, kalo time 4th year dulu, siyesly zombi berjalan aje.  n hafal je management kat ticket, x faham pun..Untung2, jadi tukang tarik langsir... btw, now i understand nape 5th year suke dok blkang2, 4th year konker depan... cam i dulu, time 4th year gile semangat kot nak tengok ape dr wat kat patient, now i focus nak tengok management yg dr plan je... so 5th year ni cool sikit. dok blkang2, pas dr blah, baru bace ticket patient... tayah rebut2 ngn 4th year. cool kan? hehek. padahal pemalas!

4.da x rase sangat debar2 nak mati nak present clinical teaching kat dr. cume takut tu still ade la so that, we can prepare better... hihu.

5. rindu nak masuk mpg lah... nak tengok mikroskop gitu, pastu nak borak2 cam kat pasar malam ngn teman kuliah.. 

6. hahha, good bye merit.. skang ni memang duduk goyang kakilah... tade kad2 putih bagai...

Ihihi.. Klah, ngantok sudah. sejak duduk bilik baru ni, tenet superlah laju  slow cam kambing patah kaki. ahhahha, btw my supervisor pengarah kampuuuusss tuuuuuuuu... bangge siket... respek sama U lah prof. cool n sangat baik... regardless bab yg kna signature mo lam logboook tu... atttoooooiii!

esok, short case ngn dr amri kol 7.30. doa2 i bangun awal k... hahha... cam last wik, cheah yg present short case instead of me kat prof zulkarnain sbb i lambat 5 minit .. hihi... tq cheah... canelah nak bangun awal ni ek? 

ethics

ethics ethics ethics..
The simple rule pun U xtau..
Its very basic basic and basic.
But still mistake is done done and done.
repeated repeated and repeated.
Im getting frustrated frustrated and frustrated.

Hahha, tomorrow my mom n my shi gonna be in Kelantan.
Yeah, my mind should go wild.
So that I can go ease ease and ease.

Tapi still, among those thing, there is something I cannot tolerate.
the thing. thats it. thats only it.
please get rid get rid get rid of it.
hahahha..

sounds funny?
hahahah, im laughing also.

Opick - Bila waktu telah berakhir

Bagaimana kau merasa bangga
Akan dunia yg sementara
Bagaimanakah bila semua hilang dan pergi
Meninggalkan dirimu

Bagaimanakah bila saatnya
Waktu terhenti tak kau sadari
Masihkah ada jalan bagimu untuk kembali
Mengulangkan masa lalu

Dunia dipenuhi dengan hiasan
Semua dan segala yg ada akan
Kembali padaNya

Bila waktu tlah memenggil
Teman sejati hanyalah amal
Bila waktu telah terhenti
Teman sejati tingallah sepi

P/s : Nice song kan? Bila waktu telah terhenti, teman sejati tinggallah sepi. Huhuuu...

Hari 1 tahun 5

We are updating about our day. The day of becoming super senior.

The day that we doubt ourselves, do we will make it in time?

The day which full of surprise, joyful as well as tears.

The day of becoming final year student.

You see, I am not graduating yet, but just to step in the fifth year, I am extremely glad and thankful enough. 

The path is not easy. We registered in a number, and we graduate with a different number.

Our path is not just filled with effort, instead fate and spirit. Without the spirit, for every failure that I have gone through, it will pull me down. Every of us has taste the failure, but we taste them in different aspects. Different ways. Ways that each of us could never imagine unless we are in the same boat during the event. Ways that might separate the date of our convocation day. Somehow, at the end of the day, all of us will have our own medical doctor degree if we dont surrender to the word 'failure'.

Sometimes, failure failed us, and sometimes success failed us. We are not putting effort just to pass the exam, but we are putting effort in shaping our inner self. What kind of doctor we are one day. How strong we are to face all the blame from seniors and nurses. How strong we are to overcome the stress and fear.

I have a lot of fear. especially in doing the procedures. I afraid of needles, I afraid of VIP patients. I afraid of attention. I afraid of doing mistakes. During my 4th year O&G posting, I observed the nurse doing veinpuncture   for a week before I can do it on my own. I had to do it btw, to fill in my log book. And yet, I still have the fear.

Whatever it is, fear wont bring us ahead right? I have to overcome it by hook or by crook. I wish that I can make use my fifth year to overcome all my fears and prepare myself for housemenship soon.