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.
