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Tuesday, August 31, 2010

MERDEKA & Cleaning DAY

Selamat hari merdeka MALAYSIA!!!

Mendalam maksud merdeka nie sebenarnye.
Jadi apa yang kita nampak & faham??hehe

Malam tadi merupakan malam ambang kemerdekaan~
Tepat jam 12 malam, pasti ada sorakan...well, tak salah pun...hehe
Tapi sedarkah malam tadi juga adalah malam 21 ramadhan?? *wink =P *
Sama-sama kita ambil iktibar

Adakah kita sudah betul-betul merdeka??

Selalunya pagi hari begini, kami sekeluarga selalunya bangun pagi...
Breakfast bersama sambil melihat siaran langsung di TV
Katanya sambutan kalinie ada sedikit kelainan...
Husband bitau, kalinie takde perarakan & wat ala2 combat...
Nak komen pun tak reti coz tak tengok...hehe

Nak TV kat bilik!!!waaa~ =P
Sudah2..5tahun takde TV kat bilik tak penah bising pun...
Harinie ngada-ngada nak TV...hahahaha

Apa-apapun, since harinie cuti...
Banyak leh dibuat walaupun hanya sehari.

Jadinya saya ambik harinie tuk tido dengan cukup...Yeayyy~ =P
Paling mahu dibuat adalah ROOM CLEANING DAY

So dapatla harinie membuang habuk-habuk yang dah bermukim kat bilik ni
So bye-bye En Dusty...I dont want to see u again in my room...haha

Berjaya cuci kipas, buang habuk atas almari, bersihkan tingkap-tuka pembalut baru, basuh cadar & sarung bantal, basuh kain telekung, sapu lantai, korek-korek hujung meja yang terselit-selit habuk..euuuwww~
Now my room luks refreshing!!!
Kipas pun macam gembira...terasa pusingan & anginnya sangat laju & luar biasa....hehe

Cuti sehari ini, akan dimanfaatkan sungguh-sungguh untuk cover topic klass esok
Post partum hemorrhage.
Kes common di wad, ofkosla kena cover kan...hehe

Im Enjoying This Holiday Very Much..Alhamdulillah

Ouhh ye, petangnie ada buka puasa bersama usrah...
hope it went well =)

Monday, August 30, 2010

Mode of delivery

Another case that we discussed was....
wic actually presented by junior...
gud try, please read wut prof had taught us & keep it up =)

39 yo malay lady G7P4+2 @ 30weeks POG

the issue that's been highlight here was her obstetric history
patient came to plan for her mode of delivery
So this history must be taken in detail

1st pregnancy:
term, 2.9kg, girl, LSCS, late onset PIH

Prof ask, why do u think she undergo LSCS???
her baby weight is 2.9kg, cudnt be IUGR
answer: she was dx PIH at 38weeks, her BP was very high but no proteinuria, no IE symptoms
Her baby was actually breech, so Emergency LSCS was done
if delay, she might go into labour

2nd pregnancy:
She was dx to have ectopic pregnancy & terminated at ?? weeks of pregnancy
(i cudnt remember the weeks)

prof: what is the operation done on her???
further asking the patient, she actually had ruptured ectopic pregnancy
laparotomy salphingectomy of right side was done

3rd pregnancy:
term, SVD, macerated stillbirth

prof: what happened to the baby??
she had chicken pox at that time
upon antenatal check up, her baby was already died few hours
the next day, she went to hospital for IOL
prostin was inserted
the baby had all 4limbs (cukup sifat)
there is desquamation of the skin of whole body
doctor said the baby died due to the infection,
damaged the brain
no syndromic facies noted

4th pregnancy:
missed carriage, ERPOC done

5th pregnancy:
term, weight saya xingt, girl, LSCS due to patient had severe pain & request for ceaser??

prof:did doctor do ceaser upon patient request??
answer: No

prof:then, why dis patient had LSCS??
answer: patient had contraction pain
at that time, she was in APOL - 4cm
but after 5hours, she still 4cm
she was augmented
afterwards, patient had severe pain
what do u think she had??
probably hyperstimulation patient might go into uterine rupture
so LSCS was done to this patient

6th pregnancy:
38weeks, weight xingt juga, girl, LSCS because she had 2 previous scar

prof: in our practice. in what week we do elective LSCS??
we answer 38weeks, but prof macam xagree.huhu
sape bole tlg???37 kah??hermmmm

No complication of surgery
-no abdominal pain, constipation - adhesion
-placenta previa/accreta
- wound dehiscence
- xingat dah..huhu

dont forget anaest cx-
difficult intubation (1 of her LSCS was under GA, other 2 under spinal)
failed to locate site for under spinal insertion wic later converted to GA
difficult ventilation eventho success for intubation

prof: So this patient already had 3 previous scar. Why does she allowed to pregnant again??
answer: all her 3 living children were girls. The doctor gave her chance to get a boy in her next pregnancy.
(prof did asked wether did the doctor taught her how she cud get a boy??patient said yes. hermm macam menarik je untuk tahu..hehe )

prof: what is her mode of delivery for her current pregnancy??
answer: LSCS with BTL

Aicardi Syndrome

Today is my first day in O&G department.
Hearing my friend's experiences as HO in O&G department really makes me excited.

At 8am, I joined briefing given by Prof Hamizah for year 5 students.
Prof Hamizah adviced me to see Prof Mukhtar but he was not in his room
I end up seeing him at 2pm today

Basically as usual I will join year 5 classes
However, next week they will have Hari Raya break
& I will end up following Prof mukhtar's session with his 3rd year mentees
Actually Im having an idea to arrange classes with Dr Bahiyah
May Allah ease my way through

This morning, I followed Prof Hamizah's Clinic
Look up few cases

30+ year old malay lady G2P1 @ 31 weeks of POA
LCB 5 years ago
Actually her first child was dx as Aicardi syndrome

Prof Hamizah said in Taiwan, these syndrome will be diagnosed earlier & will be terminated
But in Malaysia, the doctors are not used to detect this syndrome

What is Aicardi Syndrome??
- X-linked dominant disorder
- only been observed in girls
- if boys, proved to have Klinefelter syndrome
- lethal to normal males

this syndrome characterised of following triad of features
  1. Partial or complete absence of the corpus callosum in the brain (agenesis of the corpus callosum);
  2. Eye abnormalities known as "lacunae" of the retina that are quite specific to this disorder;
  3. The development in infancy of seizures that are called infantile spasms.
- often first recognized during the neonatal period and infancy
- Symptoms typically appear before a baby reaches about 5 months of age


Ocular
Pathognomonic lesions - chorioretinal lacunae
commonly cluster around the optic disc of the eye and are described as punched-out, white- or yellow-colored defects

Other common ocular lesions include the following:
  • Microphthalmos
  • Retrobulbar cyst
  • Cataract
  • Coloboma
  • Retinal detachment
  • Iris synechiae
  • Remnants of fetal pupillary membrane
Craniofacial

Microcephaly, hemifacial asymmetry, microphthalmia, or plagiocephaly may be present.
Cleft lip & palate
also occur with increased frequency.

Musculoskeletal

-skeletal malformations
- Costovertebral abnormalities, such as hemivertebrae, fused or butterfly vertebrae, and rib abnormalities, may be present.
- Scoliosis resulting from these deformities can be disfiguring and disabling.

Neurodevelopmental
- profound mental retardation
- Some children may walk and speak, although rarely.
- If present, hypotonia, spasticity, or hemiplegia may complicate gross motor development
- intractable epilepsy, and pulmonary cx

others
include porencephalic cysts and hydrocephalus, and gastro-intestinal problems-omphalocele

- often leads to death in the first decade. Sudden, unexplained death is common.
- Less severely affected individuals may live into childhood and adolescence

Diagnosed:
- in female infants only after the onset of seizures or when the presence of dysmorphic facies prompts further evaluation.
Some children are diagnosed in utero with brain-structure abnormalities.

If only visual abnormalities or developmental delays are present, the condition may not be recognized until the onset of seizures

or if ophthalmologic evaluations demonstrate characteristic chorioretinal lacunae, which are considered pathognomonic for Aicardi syndrome

The mother said the syndrome was detected at her 39wks of pregnancy
Its too late to be terminated.
In Taiwan, if it was detected late, the baby's heart will be injected with KCL in utero
But i think this is killing. Huhu

Currently, the child age was 5 years old & her weight only 9kg
She was completely bed ridden, quadriplegic & had scoliosis + eye problems
Feeding : given in bottle ; milk, water & blended porridge
On follow up with neuro clinic in HKL

For this current pregnancy, US done by prof hamizah & found out to be normal & correspond to the date
No abnormality found

From her red book stated his patient was subjected to MOGTT in her early pregnancy
Result : Normal
Prof hamizah asked, does she actually indicated for MOGTT??
Answer: No. There's no association btwn GDM/DM cx preg to Aicardi Syndrome

Hope it benefits =)

Sunday, August 29, 2010

IFTAR

This weekend I had the opportunity to have iftar with nenek & family in laws

Friday - 27th August 2010



After we went to JPA, me & my husband went back to Bangi.
I miss my home.
Lots of memories.
Lots of ups & downs. Laughter. Crisis. Happiness. Tears.
This house is like a dream house of my parents.
They wish for a corner lot & it stood opposite to a mosque
Alhamdulillah Allah granted their wish.


Daddy chose himself the cabinets, lamps & fans for the house
Daddy planted the grass with both of his hands
Mommy framed all my brother's drawings & put it up on the wall along the stairs
& many more
And...here we are...happily living in the house

Last July, my family moved to Saudi.
The house was left alone.
But sometimes we did visit the house.
This ramadhan nenek is staying in the house.
Easy for her to go to mosque & it has lots of activities during this month; tadarus, arabic class,etc
Nenek also had a lot of friends here =)

So we had iftar with nenek.
Nenek cooked for us 'gulai ayam'
Nenek said she liked to eat roti john& ikan bakar
So we bought for her.
Nenek took good care of the house & is very comfortable with the house.
Next week nenek will go back to Kuala Lipis.
InsyaAllah we will see each other again in 3rd day of raya



28th August 2010

Yesterday, me, my husband, abah, mak & along (brother in law) went back to Sg Besar
This is abah's kampung.
Abah has a BIG family.
And we stayed in Beeza's homestay. Hehe
I always looking forward going back to Sg Besar
This time most of abah's siblings will be gathering here to have iftar together
I followed abah & mak to bazaar
Reminds me of bazaar in Kuantan
We bought all sorts of drinks - jagung, mata kucing,tembikai, kelapa, cincau, soya =P
We were joined by:

Mbokde
Paman Darus's family - all were here except nisa'
Paman Jamil's family
Paman Dong's family - only kakchik & hilmi

Over here, everything we did together.
Chit chatting, watching TV, taking nap, eating except for one thing which Im longing to see.
I will always pray that my wish will come true =)

Among the above the best part was eating together.
Abah warned me many times to take the food quickly before it finished.Hehe
This family known to clean up the plates in just minutes!!! =P
Mak even saved air tembikai for me. TQ mak. I appreciate that.
But actually I dont mind if it was finished by someone else
Cause we share everything here =)
Abah said in his family dont ever worry of food being left overs...
But worried food is not enough for everybody. Hehe
Here, there are a lot of cousins that really enjoy eating.
Its fun to see them full of appetite.

Eventhough it was just a short stay
But indeed it was a memorable one & everybody was very happy
I really enjoyed staying with everybody but there is still a little shyness in me
Seeing this family always make me smile
And believes me, my smile comes from the bottom of my heart

Thank you beeza & mbokde for the kind hospitality
Thank you for sparing a room for me

LaiLatuL QadaR




Akhirnya sahabat-sahabat kite telah sampai ke sepuluh malam terakhir.
Sekejap sungguh rasanya kan kan~

Diantara malam-malam ini Allah janjikan ganjaran yang maha hebat. Pahala seribu bulan.

Dinyatakan dgn jelas di dalam Surah Al-Qadr:

Bismillahirrahmanirrahim.... Sesungguhnya kami telah menurunkannya (Al-Quran) pada malam qadar (1) (p/s - diturunkan AlQuran dari Lauh mahfuz kpd Nabi Muhammad SAW ) Dan tahukah kamu apakah malam kemuliaan itu? (2) Malam kemuliaan itu lebih baik daripada seribu bulan (3) Pada malam itu turun para malaikat & ruh (jibril) dgn izin tuhannya untuk mengatur semua urusan (4) Sejahteralah (mlm itu) sampai terbit fajar (5)

Sebagaimana kata Abu Hurairah:

Malaikat akan turun pada malam lailatul qadar dengan jumlah tak terhingga.
Malaikat akan turun membawa kebaikan dan keberkahan sampai terbitnya waktu fajar.
(Zaadul Maysir, 6/179)

Nabi Muhammad SAW juga bersabda:

“Carilah lailatul qadar di malam ganjil dari sepuluh malam terakhir di bulan Ramadhan.” (HR. Bukhari no. 2017)
Lailatul qadar lebih baik dari 1000 bulan. An Nakho’i mengatakan,
“Amalan di lailatul qadar lebih baik dari amalan di 1000 bulan.”

Mujahid dan Qotadah berpendapat bahwa yang dimaksud dengan lebih baik dari seribu bulan adalah shalat dan amalan pada lailatul qadar lebih baik dari shalat dan puasa di 1000 bulan yang tidak terdapat lailatul qadar.

Menghidupkan malam lailatul qadar dengan solat akan mendapatkan pengampunan dosa.

Dari Abu Hurairah, Nabi Muhammad SAW bersabda,
“Barangsiapa melaksanakan shalat pada malam lailatul qadar karena iman dan mengharap pahala dari Allah, maka dosa-dosanya yang telah lalu akan diampuni.”
(HR. Bukhari no. 1901)

Doa yang disarankan:

Aishah radhiyallahu ‘anha berkata,
”Katakan padaku wahai Rasulullah, apa pendapatmu, jika aku mengetahui suatu malam adalah lailatul qadar. Apa yang aku katakan di dalamnya?”
Beliau menjawab,
”Katakanlah: ‘Allahumma innaka ‘afuwwun tuhibbul ‘afwa fa’fu anni’
(Ya Allah sesungguhnya Engkau Maha Pemaaf lagi Maha Mulia yang menyukai permintaan maaf, maafkanlah aku).”

(HR. Tirmidzi dan Ibnu Majah)

Sebahagian isi-isi di atas dipetik daripada
http://buletin.muslim.or.id/fiqih/menantikan-malam-lailatul-qadar

lagi satu yang mahu dikongsi.....

Jika pada musim hujan, seseorang itu tidak mendapat secawan air pun, mungkinkah dia akan mendapat secawan air pada musim kemarau???

Kata-kata di atas bermaksud:

Sekiranya pada bulan ramadhan yang penuh limpahan kurnia, ampunan & rahmat,
seseorang itu tidak mendapat apa-apa pun, apatah lagi tidak berusaha untuk meraih segala yang Allah janjikan untuk hambanya yang beriman,

Mungkinkah pada bulan-bulan yang lain, dia mendapatnya???
Mungkinkah pada bulan-bulan yang lain dia akan berusaha mencari kurniaan & ganjaran daripada Allah.

Renung-renungkan =)

......I LOVE ISLAM..... AND PROUD TO BE A MUSLIM....
......AND PRACTICE ISLAM AS A WAY OF LIFE...........

Friday, August 27, 2010

Second Time

Again my JPA matters cannot be solved yet. Frankly, I nearly gave up to apply for the extension of my sholarship. I said to my husband I had more than enough saving to finish my 6months extension happily rather than bothering about all this. But my husband adviced me not to give up.

This morning me & my husband went to submit the form. I was asked by Kak Oya to submit to Puan Hasaliza Ashikin. Ok, so we went there. Turns out that Puan hasaliza was in a meeting & the other staff look at my documents. I did try contact her for so many days but to no avail.

In the form, it has 4 parts. Students only need to fill up part A & the rest will be filled by KOM office. The staff came to the counter & told me that the last part (part D) also need to be filled by UIA's Office. I was confused. Back than I did ask Kak ...... (after I received the documents from office), she said that part will be filled by JPA. So I called Kak Oya for clarification. She said yeah, the staff was right. Part D need to be filled by Prof Nasuruddin and Kak Oya said Kak .... should know about this. Why is there so many miscommunications!!! Only Allah know how I felt that time. Kuantan & Putrajaya is not just 1 block apart. Sabar...sabar....

Another thing was the staff asked me to get support letter from the department to recommend me extending my scholarship. This one was funny. Since the department was the one who filled part B and C of the form, why still need another letter plus it does not mentioned in the document to attach extra letter from department. If the department does not recommend me to extend the scholar in the first place, the department will refused to fill in the form. So where is the relevance of the letter she asked. Even my other colleague does not need to attach this extra letter. Even Kak Oya confused why this letter was need. Previously they just submit the form.

Hermm...as usual I just do what they ask. For me this is the last. After I did what they asked but they still asked more. Then that said. You guys know what Im planning to do.

But for now, sabar & serahkan pada Allah sahaja. Ada rezeki ada. Takde rezeki than that said. Tak guna nak penin-penin kepala. Just happy for what you already have.

Hyaluronic Acid Injection

Yesterday, my mum officially had her knee problem treated. Alhamdulillah. Its a new experience for me. I could see & experience myself as a patient waiting to be treated by a doctor. Wish in future I will look after my patient as best as possible & still concern about their social history. What do I mean about this is that a doctor must ensure the money value that been paid by the patient for the treatment & how a doctor should know how to deal with insurans company. ING, Prudential is known to cover all the cost of treatment without questions. But the problem comes when the patient use ETIQA. The patient still need to pay 10% out of all the cost (this is not a problem) but the problem arise when actually there are certain treatment that this company does not cover for example hyaluronic acid injection which cost rm1800 per injection.


Here the story goes...


The night when we had the appointment, the doctor said the injection did cover by insurans company, but the patient need to be warded first in order to cover by his or her insurans. The plan was to give 2 injections to my mother; 1 at each side. This is because she actually had OA at both knees. So, in total need to pay around 4K+ (2injections+doctor+etc)


The next morning at 10am we reached Putra Medical Centre. We waited for them to contact my mum's insurans company to get GL & sent her to ward. Before coming to hospital, my mother did call her insurans agent & ask wether this injection is covered or not. The answer given was yes & only need to pay 10% out of the bill. Ok~


At 10.30am, my mum was brought upstairs by wheel chair (its a protocol, patient need to be sent upstairs by this. Haha). My mum asked to be warded in standard room. I mean not single room. Because we were not plan to stay overnight & the procedure was just for 10-15 minutes. We were given room of 4. It was a nice room. We had our own TV. I brought along my laptop, maxis broadband & O&G book while waiting for my mother. We chose bed closest to the toilet near the window.


After about 10minutes rest, a staff came in. She actually came to clarify to us that this injection was not covered by my mum's insurans. Its happen before last week & they had big headache to settle the bill. My mum was in shock but she still calm down. I could feel by her expressions. Her worries proved by her raised in BP even up to 160/110 each time the nurses took her BP. She said she was not informed of that & this morning the agent said it was covered. So my mum called the insurans company free toll line & indeed it was not covered & the agent might not know of this because they are just agents. Duhhh~ If you work with the company, you should know all about your company's policy.


So the dilema was to proceed or not.


My mum called the agent & told her she gave her wrong informations. The agent was surprised too & appologized. Later she did came to the hospital & visit my mother. 0-0 then. Since my mother was in pain, she said she agree to pay for the injection (initially we thought only 1injection & only pay rm2k) & other the rest definitely will be cover by her insurans. But she request to see the doctor before the procedure.


At 3.30pm the doctor came & clarify everything. He said this injection was covered by other insurans without knowing actually my mums insurans did not. This one particular company always gave him problems & advice my mum to change to other company. Haha. Serves this company right.


He did called the company & talked to them how important the injection was to the patient. But they still refused to pay. The company pay for other modes of OA treatment such as arthroscopic debridement & big surgery but not this injection which only cost rm2k. The doctor did tell them based on research the efficacy of this injection & arthroscopic debridement are the same & why must the patient undergo more invasive treatment. But they still refuse. Even the doctor panel overthere refused to talked to our doctor.


Since his plan was to give 2 injections; 1 injection per knee, the solution was my mum only need to pay for only 1injection. In the bill sent to the insurans company, he will split the cost of other injection in ward & OT as if my mother warded for 3-4 days & the procedure did in OT. The doctor tried his best to give the best for the patient's need & make my mum happy. So we agreed with his explanation. The doctor then invite me to see the procedure in the procedure room & i was very happy =)


Around 4pm, we went to the procedure room. The doctor handed me over the injection box. It was Synvac one - 6ml injection. Content per ml was hylan 8mg, sodium chloride 8.5mg, disodium hydrogen phosphate 0.16mg, sodium dihydrogen phosphate hydrate 0.04mg, water for injections. Injection maybe repeated 6months after the first injection, if justified by the patient's symptoms.



After my mum's knees were swab by alcohol, a staff came in & said the GL was rejected. So the doctor stop. We discussed with the doctor & came up with this. If the company reject the bill, my mum will pay for both injections (rm4k+) as my mum want this pain to go away badly & the hospital will not charged my mum for the ward. Later, the doctor talked to the company again &they will try to push for GL from the company.



The procedure went smoothly. My mum sat at the end of the bed with both of his feet dangled at the side of bed. The doctor locate the medial joint line & flex and extend my mum's knee to confirm the site. The site for injection was the same site for arthroscopic. He did not give local to my mother as he said its not needed. My mum sometimes did grimaced. She said its only mild pain. The procedure went smoothly for both sides. I did assist him in opening 10ml cc syringe & hand over povidone.


Afterwards the doctor asked my mum to try to walk & explained how she felt. My mum kinda afraid to walk (haha) & said it did felt different but my mum couldnt explain it well. Doctor advice for us to buy brace as extra support for my mum's knee. next week, the agent for the brace will come to the house & lend my mum the brace for about a week until her next appointment which is 7th september. We thanked the doctor for his helped & we was sent back to the ward.



My mum was discharged with 2 painkillers ( I wonder why 2. hermm~) ; celebrex & ibuprofen. Later abah fetched us & went home happily. Abah giggled seeing mum being pushed in a wheel chair & abah asked mum to run in order to test the treatment. Haha~ My mum currently could walk pain free & motivated to take good care of her knee. At home she really comply with the supplements & other non-supportive measurements such as control weight, avoid high heels & avoid overusage of the knee.Yesterday indeed was an unforgetable moment for us.


As a daughter, I felt very happy I could help my mother. If we didnt help our parents, who else you expect to help them?? Again, thanx to putra medical centre, Mr Sivalingam & his staffs for their concern & hospitality =)



Wednesday, August 25, 2010

Home Sweet Home

Semalam merupakan End Blok exam pertama untuk tahun 5. Jadinya tak boleh masuk wad & jika ke klinik, pastinya tiada doktor UIA. Ini kerana semuanya terlibat sebagai examiner.

Mengenangkan begitu, takkan nak duduk-duduk sahaja. Jadinya yana menyatakan hasrat yana kepa Zira untuk membuat diskusi bersama junior tahun 3. Ajakla beberapa orang. Korang pick topik, baca before hand & kita bincang apa yang korang tak paham. Mereka memilih 2 topik. Upper GI Bleeding- PUD & Varices & Colorectal Carcinoma.

Yana seperti biasa awal pagi sudah di JHC. Berjanji dengan mereka di JHC jam 8.30 pagi. Diskusi disertai oleh Zira, Wada, dan 2 lagi (ouhh, yana selalu masalah nak ingat nama. Haha. Malu dengan Mr Shuk yang mampu ingat nama whole group of students)

It was really a good one, we discuss to the very great detail & did few questions. I would like to show to them, learning medicine is not as tough as they think. They can share the load of reading with their group mates & distribute work of doing notes among them. I encourage them to have their own notes. It will be easier when they enter fifth year in 2 years time.

Hoping the discussion will make them feel happy & motivated to study more =)

Tepat jam 2 petang, saya meminta kak raihan untuk menghantar saya ke terminal. Disebabkan semalam adalah tengah minggu, jadinya lebih kurang 15 penumpang sahaja. Saya dijemput oleh abah (ayah mertua) di pekeliling. Selalunya saya akan berjumpa abah di CIMB bersebelahan sogo. Tapi kalini, abah mahu datang pekeliling kerana beliau keluar ofis awal & jalan untuk ke pekeliling tidak sesak lagi. Saya sampai pekeliling jam 4.50pm dan abah sudah menanti di sana. Bestnya ada abah boleh jemput. TQ abah~

Semalam happily berbuka bersama - me, encik suami, abah & mak =)

Tepat jam 8 malam, kami menuju ke Putra Medical Centre, Sg Buloh. Mak ada temujanji bersama pakar ortopedik di sini. Kami dapat giliran no 4. Kami menunggu lebih kurang sejam setengah sebelum sampai giliran kami. Saya dapat perhatikan doktor meluangkan 'ample' time dengan setiap pesakit. Akhirnya saya dapat melihat sendiri doktor yang selalu disebut mak, Dr Siva. Melihatkan doktor nie teringat Mr Jacob. Cuma Dr Siva berisi sedikit. & beliau memang ada aura orthopedic. Very nice doctor & explains well. hehe. Terkenang our orthopedic lecturers.

Previously he gave these options:
1) Medication - Glucosamine & chondroitin
2) 1 + hyaluronic acid injection (rm2000)
3) 1 + 2 +operation scope (bersih sendi) - rm8000
4) 1 + 2 + 3 + stem cell (rm10 000)
5) 1 + 2 + 3 + 4 + brace (rm6000)

Previously my mother was only on supplement. Supplement is just a supplement,. If the problem progress, the supplement is not beneficial. Since her problem recurred. Doctor did advice for surgery or stem cell- to correct the angulation. For him, correct the problem since it is mild & once and for all.
(in knee xray - reduce join space & mild angulation of leg leg but from PE no obvious malalignment, no swelling, no joint line pain, no hyperextension )
But as expected, my mother refuse for surgery due to raya is just around the corner. After discussion, he suggest on option no 2.

If my mother is an athelete, he would really suggest for surgery. Since my mother is a housewife & already stop working, he can be linient & give other option.hehe

Hyaluronic injection can last about 9months to 2 years per injection depends on patient activity. To improve the effect of hyaluronic acid, he suggest usage of OA brace. Use it while walking & cooking. I did asked Mr Shuk regarding brace & Mr Shuk said its not indicated in OA patient unless it is post operative or injury secondary to trauma. But based on Mr Siva experience, the usage of brace really helped patient that refuse for surgery & can correct the mild malalignment my mother has.

But for now, we chose hyaluronic injection first. Brace is an option. Doctor said ,he can give it straightaway after he finished up seeing all his patient. But since in private,its quite costly. My mum asked wether this injection covered by insurans & he said yes but she need to be warded first. So we agree and plan to be warded at 10am today.

Before we end our meeting, Mr siva asked....
Mr siva: are u a nurse?? (smiling~)
Me : Doctor, I look like a nurse eh??? hehe
Mr Siva : Laugh~ Then what are you??
Me: Medical student.
Mr Siva: Where?what year are you??
Me: UIA kuantan. reaching to the end. smiling~
Mr Siva: Ooooo, I know all your lecturers - Mr hafiz, Mr kamarul, Mr zamzuri, etc2. Previously, i work in kuantan. Mr kamarul, is he still having class at 2am with his students??
Me : hehe. yup. (dlm hati - dah agak dah. if dia tau yana medical student&kat kuantan mesti dia kenal our lecturer. Our orthopedic lecturer kan famous.haha)
Mr Siva: he never change & i bet he still bring his student out after oncal at the same place. (i agree) Oh, why dont you consult mr hafiz??he's approachable person
Me: I just smile & agree with him. But Mr hafiz is quite busy. Maybe one day. Hehe

Afterwards, we went home & have supper at Maju Ahmad - ni macam ala2 taj point kat kuantan. Hehe.

Tuesday, August 24, 2010

Sambal Ikan Bilis

Sejak minggu lepas selera makan memang berkurangan. Sahur pun ala kadar. Berbuka pun ala kadar. Menyuarakan apa yang dirasa pada suami & emak mertua di rumah. Setiap hari akan msg tanye mereka berbuka apa & mak masak apa. Selalunya pun sedap-sedap. Huhu. Kadang-kadang apa yang dimasak biasa-biasa sahaja, tapi makan satu meja beramai-ramai yang membuatkan makanan jadi sangat lazat.

Hujung minggu baru nie, giliran suami datang ke kuantan. Seperti biasa, pagi-pagi saya stadi di library JHC dahulu. Kalinie menghabiskan revision sambil membuat nota Venous thromboembolism berdasarkan CPG. Menarik. Banyak tahu benda baru. Ada masa nanti saya share dgn kalian ok. Sedar-sedar sudah pukul 12!!! Ya Allah, tak sangka sudah pukul12. Tak rasa langsung. Punyala khusyuk baca. haha

Suami tibe di terminal tepat jam 12.30. Seperti biasa, book grand city hotel. Sesampai2nya di sana, suami terus mengeluarkan satu bungkusan plastik. Dalamnya berbentuk 4 segi. Sambil mengatakan, ini benda yang dia hutang dengan saya. Aik?? ape plak nie.

Rupa-rupanya satu tupperware kecik dalamnya berisi sambal ikan bilis. Iskkkk~ terharu sangat. Encik suami masak malam sebelum dia bertolak. Memang mata berair dan hampir-hampir nak nangis dek kerana sangat terharu. Semoga Allah mudahkan urusan suamiku seperti mana beliau selalu memudahkan urusanku.

So, sejak daripada itu, menu utama minggu ini nasi berlaukkan ikan bilis. Makanan yang dimasak dengan kasih sayang, memang takkan jemu dimakan. Haha. Harini, hanya membeli nasi goreng untuk dimakan dengan sambal + karipap & air tembikai. Itu pun dah cukup kenyang & menyelerakan. Sesungguhnya banyak pahala bagi mereka yang menyediakan lauk berbuka bagi orang yang berpuasa. Thank You Encik Suami. I always love & miss you dearly =)

p/s - malamnie prepare tuk diskusi bersama junior esok. Kemas beg tuk pulang. Tidak dilupakan buku-buku O&G. Minggu depan mula posting baru. Jadinya kena stadi before hand =)

P.E.L.A.N.G.I


When I wake up every morning. I will always say to myself. This is a new day. What ever you want, you are the one who need to make it happen & Allah will help you along the way. Think this way, if you are hungry & u want to eat. BUT you just stay in the room. Definitely you will starve the whole day. The solution is, get out from the room & buy some food. Hehe.

As usual, before I went to class, its a routine, look at the mirror & smile as much as you can. Look in the eyes and said YOU CAN DO IT!!!! Haha. Macam tak betul kan. But it always work for me!! Yeayyy~ I hate being pessimistic & really hate it when the head full of negativities. For me, if kita mulakan hari dengan negatif, baru rezeki nak sampai, dah terbantut. Haha

Islam itu indah.

Fikir kembali, kenapa pada zaman nabi. Hidup mereka susah, ditekan oleh pihak Quraisy. Tapi mereka masih bersemangat...kenapa??kenapa??Cuba fikir.

Fikirkan juga kisah Nabi Yusuf di dalam Quran. Ditindas, dibuang & ditinggalkan oleh sedara sendiri sampai beliau dijual oleh orang yang menjumpai beliau di dalam perigi. Ada ketikanya beliau difitnah cuba melakukan perkara buruk pada Zulaikha. Tapi beliau tidak pernah putus asa @ membuat sesuatu yang merosakkan kehidupan beliau.

Tidak seperti orang zaman sekarang, mak ayah tak beri perhatian sedikit, ada masalah hidup sikit, terus terlibat dengan masalah sosial. Nauzubillah. Langsung tiada akal & iman yang dapat membimbing. Memang dugaan kadang kala berat. Tapi yakinlah, Allah itu maha mengetahui.

Jawapannya pasti kerana keyakinan pada Allah. Iman yang tinggi. This is from my humble oppinion. Others, might have their own oppinion =)

Sangat bersyukur harinie Allah sangat sangat mudahkan urusan saya.

Pagi-pagi selepas selesai review patient di wad, tengok patient OT. Menemankan junior ke ICU. Patient yang dia mahu present untuk case discussion petang ini telah masuk ke ICU walhal semalam beliau stabil sahaja.

Melihatkan jam masih awal, saya menuju ke wad ortho. Review patient di sana. Tak semena-mena, Mr Shuk baru selesai kelas bersama junior. Semalam seharian saya berpusing mencari Mr Shuk di IMC tapi tak jumpa, punyala takde rezeki. Huhu. Hari ini, beliau terus bertanyakan hal saya. Baik sungguh Mr Shuk. Berkali-kali dia menekankan jangan risau pasal exam hujung tahun ini. Ia pastinya mudah. Sebenarnya, lagi mudah, lagi menakutkan because you are expect to know everything!!! haha.

Selepas, bersoal jawab hal akademik. Saya consult beliau tentang ibu mertua saya dengan masalah lututnya. alhamdulillah, sekarang sudah terang dengan apa yang perlu dibuat & apa option yang ada. Lagi sekali LEGAAA~ hehe

Petangnya saya join kelas tahun 3. Ulangkaji tentang Upper GI Bleeding. Mr Junaini sangat-sangat welcome saya ke kelas beliau. Dia meminta attendance daripada ketua kelas & memanggil nama satu persatu. Kata beliau, cara ni macam zaman sekolah-sekolah amik kedatangan. Haha. Tidak ketinggalan, nama saya turut disebut. Haha. Mr Junaini ada sahaja lawaknya. Laughter is the best medicine.

Untungnya mereka ada sistem case discussion ni. Awal-awal lagi mereka boleh memahami dengan secara mendalam tentang topik ini. Tapi jika yang datang kelas petang ini tidak memberi tumpuan & tidak membaca sebelum kelas. Pastinya mereka akan kekal 'blur'. Dek kerana saya sudah tahun 5, saya nampak ape kesilapan yang kita selalu lakukan pada tahun 3. Insaf~

Seusai kelas, nekad untuk membeli tiket pulang pada esok petang dengan niat untuk menemankan mak ke hospital esok malam. Paling best niat saya bagai sangat-sangat diraikan. Sampai je di depan 7-11, terus ada parking. Alhamdulillah. Saya mahu tahu apa yang doktor akan plan untuk mak & saya tak mahu komplikasi osteoarthritis berlaku pada emak. Semangat untuk pulang ini datang sejurus selepas berdiskusi dengan Mr Shuk. Juga teringat kata-kata Cik Fiza, kalau hati tiba-tiba mendesak untuk pulang, maka pulanglah. Pasti ada sesuatu di rumah nanti.

Kemudian, saya bergerak ke bazar berhampiran. Nak jalan kaki dari depan 7-11 ke bazar. Macam jauhje. Bawakla kete. Cari parking berhampiran. Lagi sekali alhamdulillah, sampai betul2 tepi bazar, satu kereta keluar dari parking. Terus saya masuk di situ. Syukur-syukur sangat. Rasa harini, saya sangat-sangat digembirakan. Hehe. TQ Allah

Menelefon suami & mak, memberitahu sudah membeli tiket untuk pulang esok. Mak sangat-sangat gembira. Rupa-rupanya, semalam mak susah hati. Mak risau jikalau mak tak faham ape option yang doktor akan terangkan padanya esok seperti 3 bulan yang lalu. Bile mendengar saya mahu pulang, Terbang semua kerisauan mak. Mendengarkan ini, saya jadi lagi gembira. Semoga saya dapat membantu mak setakat yang saya mampu sebelum saya terikat dengan tugas pada tahun depan. Huhu.

P/s- Jikalau, apa yang dihajati tidak termakbul. Tak bermakna Allah tak sayang. Pasti Allah mahu berikan yang lebih baik pada kita pada masa hadapan. Jadinya bersabarlah & jangan merungut =)

Pelangi tidakkan mucul jika tiada hujan sebelumnya.....

Monday, August 23, 2010

Berbelah Bahagi

This week is my last week of surgical posting. At the same time, this week is the exam week for final year students. We have no schedule class this week. Prof Azmi advised us to follow third year classes. On the other hand, Mr Zailani said we dont have to follow the third years as we will get bored. he told us just go home. Haha.

Not sure of what to do this morning, i end up went to urology clinic. Its better to learn something than nothing. I havent get the chance to go to urology clinic as I always have class every Monday & Wednesday. I followed Mr Nazli's clinic and asked him what I dont understand regarding the patients. In exam we usually will be asked a straight forward case. Mr Nazli always gave me encouragement whenever I joined his class. There were patients who were not fasting eventhough their condition was not life threatening. Mr Nazli try to give solution to the patient.

One pakcik came in for follow up regarding his operation 2 months ago. He underwent Percutaneous Vesicolithotomy. Afterwards, he no longer had LUTS. When Mr Nazli asked why he did not fast. He said his stomach 'masuk angin' if he did not eat. Sometimes associated with abdominal pain & he could not stand it. He had not fast since 3 years ago. He admit to have gastritis before. So Mr Nazli prescribed him omeprazole for his gastritis. He was advised to take this medication and try to fast tomorrow. Mr nazli gave him reassurance that patient with gastritis are still able to fast.

Second pakcik having diabetes mellitus. This year he was started on insulin. The problem arise when he was not counselled on how to take insulin during ramadhan. Expectedly, he had episodes of hypoglycemia. He kinda traumatized with the experience. So he adjust the dosage by himself. He had no blood sugar monitoring at home. He will eat whenever he feels tremor. His appointment with medical team is in 6months time.

Afterwards, i went back to the library. Early this morning, i received msg from my mum saying she's having recurrent left knee pain.

She was newly diagnosed OA in May dis year. It is only mild. On Knee Xray there were just narrow joint space. No malalignment, no other cardinal sign.

She was started on medication taken only one tablet 500mg TDS - glucosamine. This ramadhan she only took 2 tablets per day. One during sahur & one during iftar. I overlooked about her medication. huhu. End up last week, she called me & said her knee pain recurred. She asked me what to do?? Im frustrated that i only know what medication to give but I dont know about the dosage.


I try to find Mr Shukrimi but to no avail. I end up message Mr Kamarul in FB & seek his advised. He said my mothers medication was not in maximum dose. Advised to take 2 tablets BD. Then i tried to find in MIMS

light or moderate arthrosic symptoms - 2 cap BD for atleast 6weeks
severe - initially 2cap TDS for atleast 8weeks. maintenance: 2cap BD for 3-4 months. Long term:repeat every other 6months or less

Meaning all dis while my mum's dosage was not enough. As we all know, OA is progressing disease if not treated well can lead to pain, malalignment& limited ROM. So I believe she needs proper follow up. I believe the speacialist that inchadrged had planned for my mother. There might be miscommunication or is it my mum defaulted??? Haha.

Upon my advised, she make a new appointment which was this wednesday night. How I wish I want to be there & can asked the doctor myself regarding his plan for my mother. As complication of OA can be avoided with proper treatment.


How i wish im an orthopedic doctor, know what to do with my mum. really need advised =(

p/s- have no class in thursday. Planning to go back wednesday afternoon. Is this a right thing to do?? Thursday will be my last day in surgery as Tomorrow evening & wednesday will be used for examination. Sangat berbelah bahagi......

Sunday, August 22, 2010

13th of Ramadhan

Tomorrow is day 13th of Ramadhan. Time really flies as fast as they could. Like they are chasing for something. Definitely no turning back. This is the time you grab all the opportunities that lies ahead of you. It will be a BIG LOST for those who only concentrate in their worldly affairs.

"Ya Allah, please open up our eyes , hearts and minds for your words and your wisdom is so much beyond our knowledge. Please forgive us for what we not see and show us the way to the straight path."


I promised not to miss any of terawih prayer this time. Unfortunately, I already missed 2 times. It was because of unavoidable circumstances. Huhu.

First one, I had a very bad stomach ache. Really bad one. Memang serik!!! Not due to food poisoning. Awal-awal puasa, perut meragam sikit. Hoho

Second one was yesterday, my husband was tired & not feeling well. His cough was worse than I thought. I advised him to sleep early, had a good rest & I take good care of him =)

Just now, as usual, went to musolla CF sister for terawih prayer. I like to pray there because of the cool aircond. It makes me comfortable & didnt realise of the time until we reached the last rakaat. Haha

However, since last week, I noticed the number of people went for terawih starts to decreasing. Today, its even less than before.

I really enjoy this ramadhan.

The time I had.

Really enjoy the food, once in awhile go to the mosque, iftar with roommates, family & in laws, waking in the morning for sahur, reading quran as much as i can in a day & keep the positivities in the air.


BUSAHA!!

Thursday, August 19, 2010

Rezeki

Harinie i have low mood. huhu. Nape,kenapa, why??i dono~
Ikutkan hati mcm tak mahu beli apa-apa untuk berbuka.
(mula la tue nak wat perangai childish=P)
Tapi teringat En suami yang setiap hari akan bertanya berbuka makan apa&akan susah hati jika isterinya kata tak mahu makan. Yana kuatkan semangat&pegi juga ke bazar.

Setiap hari, rahmat Allah sentiasa melimpah ruah. Cuma kite sedar atau tidak sahaja.
Hujan renyai-renyai mengiringi langkahku di bazar.
Rezekinya, sampai-sampaije ada satu tempat kosong untuk park kereta. Parking penuh. Mungkin orang bekerja tak pulang lagi.
Herm, tak ramai orang kat bazar coz baru lepas hujan, camnie barula nampak fud betul-betul. hehe

Pusing satu bazar, since takde selera, kat tangan hanya roti jala rm2&popia rm1 (alhmdulillah,murah rezeki harinie, makcik tue letak kuih jala lebih. time kasih makcik~)
pusing lagi satu pusingan, masih tak terbuka nafsu nak makan ape-ape.
akhirnya nekad, perut ni sensitif. If tak makan, nanti meragam. Beberapa harinie perut yana 'behave' alhamdulillah. hehe.
So akhirnya, yana beli jugaklaa, sebungkus nasi lemak kecik&sebungkus air tembikai makcik tue busaha isi sepenuh mungkin sebagai alas perut untuk berbuka.

Cukupla nie~ janji ada makanan.

Sebelum balik singgah satu kedai tudung.
Dari 2 hari lepas, terpandang satu tudung yang sgt menarik minat yana. Hari ada banyak masa. Jadinya, singgahla. Pakcik empunya kedai sgt peramah. Tudung yang yana berkenan ternyata longgar bahagian leher. Setelah belek-belek tudung yang lain&mencuba beberapa helai. Dapatla hasil tangkapan yang memuaskan hati. Hehe. Pakcik siap bagi diskaun. Time kasih pakcik =)

Alhamdulillah perjalanan ke mahalah lancar. Tapi abis basah stokin & kasut kena hujan. Kena jemur~ huhu

p/s- sentiasa terasa perjalanan ulang alik ke kelas sejak sesi baru ini sangat-sangat dimudahkan. Jalan selalunya hijau. Thank You Allah. Ya Allah, kau kuatkanlah semangat kami. Jauhkanlah diri kami dari berputus asa, berkeluh kesah, bermuram durja & limpahkanlah kami dgn rahmatMu =)

p/s - i miss my family in saudi very much~

Monday, August 16, 2010

JPA oh JPA

Sebelum bercuti slama sebulan tempoh hari, saya mengikut saranan kak oya utk selesaikan berkenaan JPA sebelum pulang ke rumah. Dengan tekunnya, saya mengisi borang. Borang tersebut ada 3 slot. Slot pertama perlu diisi oleh pemohon & 2 lagi oleh dean. Kemudian, borang itu akan diserahkan oleh office KOM kepada One stop centre untuk dihantar kepada JPA.

Saya memulakan pembelajaran pada 5 Julai. Apa2pun sudah sedia maklum pasti scholar akan masuk sedikit lewat. Saya sendiri 'follow up' di One Stop Centre & akak di situ meminta no penuh, IC & no fon saya untuk mengetahui status permohonan. Janji hanya tinggal janji. Setelah 3 minggu, masih tidak menerima apa2 berita.

Memandangkan Kak Oya sekarang di dept surgery, saya adukan hal tersebut kepadanya. Dia dgn senang hati mengatakan dia akan membantu saya. Beliau menelefon Encik yg incaj di OSC untuk mengetahui status saya. Jawapan yang diterima adalah negatif. Jadinya, beliau menelefon kepada pihak JPA ( kak oya sudah dikenali org di sana kerana sudah 8thn beliau menguruskan berkenaan hal ini). Setelah 2minggu kak Oya berusaha, barulah diketahui status saya bahawa mereka tidak menerima apa2 permohonan penyambungan scholar dari saya (sabar...sabar).

2 minggu lepas juga saya menerima surat daripada JPA yang meminta saya mendaftar kerana tarikh belajar saya sudah tamat & meminta saya dtg dengan membawa salinan fotostat sekian sekian. Saya sangat hairan dgn surat yang diterima & saya sampaikan hal berkenaan kepada Kak Oya.

Jadinya, benda dah berlaku, nak menyelesaikan masalah. terpaksalah saya mengisi semula borang JPA tersebut & serahkan kepada pejabat KOM sekali lagi untuk disahkan. Tapi kali ini, saya dinasihatkan oleh Kak Oya untuk menghantar borang itu sendiri di JPA. kepada puan ......... Marah2 pun tak guna. So buat sajalah seperti yang disarankan. Dalam hati, hanya Allah sahaja yg tahu. Macamanelah diorang nie wat keje. Nasib baik, saya ada simpanan yang cukup. Kalo perkara ini berlaku pada keluarga yang susah, kan aniaya orang namanya. Geram dgn cara mereka bekerja.

Inilah dia tanggungjawab. Inilah yang akan Allah persoalkan pada kite kelak. Tak kisahla berkenaan perkara kecil@besar. Tanggungjawab tetap tanggungjawab. Cuma kite sedar atau tidak.

Dalam konteks kite sebagai doktor, rawatlah pesakit seperti kite merawat ahli keluarga kite sendiri. Prof Nasser banyak highlightkan berkenaan ini di dalam kelas beliau.
"If this is ur uncle, u will want to know each &everything about him but since he is nobody to you. U just ignored him & cover other patients & u didnt follow up this patient"

Kepada kawan2 yang sudah berkerja, pasti anda lebih memahami maksud kepada ayat prof nasser itu kan =)

Semoga kite ketemu lagi

p/s- lega dah keluar semua yang terbuku.....huahuahua =P

Sunday, August 15, 2010

Teachings

Last week, i had 2 days of teachings in a row. Should be 3days of teaching in a row. But last friday class was cancelled. All of us got to know it on dat very morning itself. I was like~ duh~ shoulf tell us earlier.huhu.so dat i can bought earlier ticket to go home & have iftar with dear family

11th August 2010

We had class with the HOD. We discussed about inflammatory bowel disease. Simple class indeed. Mostly his comments were about the way of presentation & attitude of presentation. Thats is soooo his style. He also correct our way of answering questions. Being a doctor, u got to know how to highlight the important of the case you are presenting. So, the MO&specialist that listens to you could understand the problem of this patient & could evaluate wether it is an urgent case to treat or the other way round.

12th August 2010 (10am)

Today we had 2 classes. am classes was with prof naseer. Im so excited that i able to have class with him. At the same time i pray that i read enough to answer his questions. It turns out unexpectedly & a very memorable one.

We were asked about a patient with gastric ca. He was successfully operated. Usually, person succumb to gastric ca will presented in advanced stage & undergo palliative treatment. But this uncle was quite lucky. When he presented to us, he was T3N1Mo. Still operable. During operation, found to have mets to liver which not detected by CT. Total gastrectomy & liver resection (seg 2&3) was done. He was stable after the surgery & his condition improves gradually. After the operation, non of us follow up his progression. We were busy covering other patients. When Prof asked us why is this patient in the ward & what was his issue. Non of us could answer his operation. So he stopped the class & order us to write about the patient from history to today's progression & submit to him before 5pm. We did as he said. I admit it was our fault.

Later, we got to know that this patient had hypoalbuminemia & hypokalemia on day 4 post operation. On day 2, he started on TPN. Guess, he needs more nutrients & at the same time he develop diarhea in the ward which worsen his pottasium level. The electrolytes need to be corrected as soon as possible especially pottasium. Before his pottasium&protein were increased in his TPN, he was given fast correction for his pottasium level. Currently, his electrolytes normalised.

Day 7 post operation, he complained of dysuria. Otherwise, no frequency, no nocturia & no hematuria. I suspect he had UTI secondary to infected CBD. Urinalysis was done on him. The result havent come out yet on friday. InsyaAllah i follow up with him tomorrow (if he still in the ward=P)

12th August 2010 (3pm)

Our second class was with Mr Zailani. I didnt know that he still remember my name. Haha. This shows our lecturer actually cares about us. Its just sometimes they didnt show it to us. So we are not spoilt & learn more.

The junior presented a case of 63 years old chinese gentleman who has been diagnosed t have hemorrhoids for 30 years with underlying hypertension & history of stroke. Currently presented with per rectal bleeding. First impression was to rule out Colon Ca. After assessment & investigation, its was just hemorrhoids after all. Lucky uncle.

Mr Zailani discussed with us to very great detail. I still remember his teaching back when im in surgery posting previously. Alhamdulillah, i can answer most of his questions. Learning about colon cancer, reminds me of nazu's father. Hope his father recovering well. Last time, i heard his father's condition was just fair. may Allah give uncle strength in this ramadhan

13th August 2010

As usual, i went to ward early. Examined a thyroid case - multinodular goitre with one prominent nodule turned malignant. I kinda like thyroid cases since 3rd year. Hehe. The other day in the clinic, four of us were called by prof naseer to examine a new case of thyroid. he asked us to examine the patient in front of him. As expected, he always highlight to us 5 points u need to elicit in thyroid examination
1) confirm the swelling is thyroid
2) the character - solitary, nodular or diffuse
3) any obstructive symptoms
4) any malignant symptoms
5) thyroid status

Since we managed to answer his questions, we were given chance to ask him questions. so i asked about role of isotope & biopsy. Compulsory investigations with thyroid patient are thyroid function test & ultrasound of the neck.

Isotope scan currently done in patient
1)who is hyperthyroid but no mass was palpable
2) post operative for patient with thyroid cancer - to check any residual thyroid tissue left which can cause recurrence later. If still present, it needs to be removed

Biopsy
1) done for solitary thyroid nodule
2) MNG patient which one prominant nodules turn malignant
otherwise, no need to be done.

Indication for thyroidectomy
1) failed medication / non compliance
2) malignant
3) compressive symptoms
4) patient with retrosternal goitre
5) cosmetic reasons

hope it benefits =)

Wednesday, August 11, 2010

We Never Walk Alone

Lesson for today:
Our lecturers always support us no matter where they are. So let us always pray for them.
May Allah give them strength to pursue their dreams, ease their way through their undertakings & they are blessed with supportive family who will always stand by their side.Thank you doctor for your advice =)


Assalamualaikum Liyana,

Selamat menyambut Ramadhan. Semoga Ramadhan kali ini menjadi lebih baik dari yg telah lalu.
Alhamdulillah, dah dekat 2 bulan saya cuti belajar. Saya buat subspecialty training in neuroanesthesia, maklumlah UIA dah ada ramai neurosurgeon, jadi kena ada la neuroanesthetist. Buat masa ni saya ada kat HUSM Newcastle (Kota Bharu daa..) sampai bulan Januari 2011 dan kemudian ke GHKL sampai Januari 2012. Ada hajat dihati nak pergi cari ilmu kat tempat orang, tapi saya balik ke UIA dulu sebabnya insya Allah hospital UIA akan siap pada tahun 2014, jadi kena la berkhidmat dahulu. Lagipun saya nak timba pengalaman dahulu lepas tu baru pergi oversea.

Sebenarnya, dalam hidup kita sebagai doktor, pengalaman adalah perkara yg paling berharga. Kita lebih dinilai dari sudut pengalaman berbanding pengetahuan walaupun kedua duanya sama penting. Secara terus terangnya, saya agak terperanjat apabila dapat tahu result Liyana. Biasalah, dah jadi lumrah lecturer, kitorang dah ada list students yg bermasalah dari segi akademik dan kitorang rasa akan bermasalah juga dalam exam tetapi Liyana was not one of them.

Dari pengalaman saya selama 2 minggu masa Liyana buat anaesth posting, saya tak nampak any reason that you couldn't make it. Walau bagaimanapun, dalam exam dan juga sama dalam hidup kita, aspek rezeki dan ketentuan Allah tu kita tak boleh ketepikan. Walau apa pun yg terjadi, ambil perkara ni dgn positif dan Allah lebih mengetahui yg terbaik buat hambaNya. Secara hakikatnya, tiada seorang pun pelajar yg mahu menemui kegagalan namun apabila berlaku juga, ia akan mematangkan kita. Cuma kali ini Liyana dah tahu bagaimana exam tu dijalankan jadi itu adalah satu kelebihan buat Liyana. Kadang2 kita rasa cukup malang apabila sesuatu yg dihajati tu tak tertunai tapi kita patut sedar ada orang yg lebih malang dari kita.

Saya ada beberapa kawan yg menghabiskan masa sepuluh tahun cuma untuk dapatkan MBBS. Kawan saya masa buat master dulu berumur 51 ketika dia lulus master, yang mana secara purata kebanyakan org lulus master dlm umur 35 tahun. Sebabnya dia ambil masa yg agak lama nak lulus MBBS, tapi masih bersemangat nak buat master. Saya secara peribadi pernah menyatakan kekaguman saya padanya dan kalaulah saya ditempatnya, belum tentu saya buat Master. Jadi kegagalan bukanlah satu titik hitam dalam hidup kita, setiap org pasti merasainya (Rasulullah S.A.W pun pernah mengalaminya) cuma bezanya bagaimana kita perlu menghadapinya.

Kegagalan bukanlah satu lesen untuk kita (dan org lain juga) mengatakan yg diri kita kurang pandai kerana kegagalan adalah multifactorial. Saya pasti Liyana mengahadapinya dengan baik. Saya rasa Liyana sudahpun mengetahui dimana kelemahan Liyana dan cuba perbaiki. Final exam adalah exit exam jadi apa yg kita cari adalah kualiti bakal doktor yg selamat untuk pesakit..itu sahaja. Dlm exam, kita akan tanya soalan yg menjurus ke arah tersebut. Jadi perkuatkan basic knowledge and at this time you should learn how to answer. Belajar utk jadi doktor dan belajar untuk pass exam nak jadi doktor adalah dua perkara berbeza yg berjalan serentak.

Jadi, dalam masa yg tak berapa lama lagi ni, saya rasa Liyana patut lebih exam oriented, banyakkan discussion, perkuatkan basic knowledge and skill. Kalau ada sparring partner lebih baik...boleh sentiasa diajak berbincang dalam masa yg sama, pemikiran dan pertuturan akan jadi lebih tersusun masa klinikal exam nanti.

Saya doakan yg terbaik buat Liyana dan keluarga. Berdoalah terutamanya dlm bulan Ramadhan ni dan saya yakin kejayaan untuk Liyana sudah ada cuma masanya akan tiba nanti.
Wassalam.

Tuesday, August 10, 2010

Ramadhan

Its ramadhan atlast....

I love to be in ramadhan...
this month, i will luk back wut deeds&ibadah i had done in the past 11 months..
this month gives me strength..
this month 'rezeki sgt mencurah-curah'...
in this month, at night is a time we spend for ibadah& no lecturers will said anything about covering da patient at nite...
everybody will be in their very best attitude & saying only gud words from their mouth....
sape nk pkai tudung..masanielaa akan pakai...

but sadly in syawal...everybody change...
xlagi byk solat, xlagi rajin ngaji, xlagi ke masjid, xlagi berkata kata yg baik2 & xlagi memakai tudung&menutup aurat....
lets us take dis as a lesson from those who did all of the above
& pray dat Allah give hidayah to their hearts

from personal point of view..
- this is the first time i spend ramadhan far from my parents who had moved to saudi
- first time, celebrating ramadhan with in laws
- first time celebrating as a wife
- & probably da first time i had to wake up earlier&prepare for sahur
(selalunye mak yg wat&tggl gerak kitorg je~ hahahaha...i mz all those times)

As im still a student, i still have lots of time for myself & can do usual routine i had undergo since i was a kid...

" mengaji 1juzu' 1hari & pray night time "

hope dis month, me & my husband will be given strength by Allah to find 'lailatul qadr'

May this ramadhan blessed us with all the nikmah Allah had promised for His faithful servant=)

selamat berpuasa semua =)

Tuesday, August 3, 2010

Second Day


Alhamdulillah saya semakin menyukai posting surgery. Keluar dari bilik seawal 7pagi. Duduk di JHC sementara menunggu library buka. Sempatla saya memahami satu topik. Janji untuk berjumpa dgn prof azmi tepat jam 9. Tapi malangnya terpaksa ditangguh lagi kerana prof azmi ada OT.

Buat makluman semua, Kak Oya (akak yang menguruskan SPA kita), telah berpindah ke Surgery Department. Beliau bertuka tempat dengan kak wawa surgery. Kak Oya sangat lemah lembut,peramah&baik orangnya. Sangat senang berurusan dgn beliau. Hari ini, Kak Oya ada menyuarakan sedikit ketidakpuasan beliau tentang salah seorang daripada batch kita. Setelah mendengar cerita penuh dari Kak Oya, memang tak bukan salah Kak Oya jika dia terasa. Sepatutnya, apabila menelefon Kak Oya, perkenalkan nama dahulu. Budi bahasa kan amalan kita. Ini tidak, dia terus sahaja menggesa Kak Oya untuk mendengar ketidakpuasan&kegusaran hati dia. Kemudian, apabila Kak Oya telah mendengar semua & bertanye ini siapa, dia enggan memberitahu namanya. Kesian Kak Oya, org terbabit menelefon berkali-kali. Kak Oya pada waktu itu puasa&sedang dalam proses menyediakan makanan untuk keluarganya. Akhir sekali, Kak Oya mengambil keputusan untuk tidak lagi melayan panggilan tersebut. Kak Oya ada menyuarakan kesian juga, tak angkat. Tapi apakan daya, masa tak mengizikan. Jadinya, kepada kawan-kawan, sila layan Kak Oya baik-baik ye. Beliau sudah banyak berjasa kepada kita terutamanya dalam hal graduasi&menyediakan dokumen2 kita apabila kite grad.

Hari ini, saya nekad untuk ke wad. Niat asal untuk clerk case urology. Sekarang ni banyak kes malignancy di wad. Baru 5 minit sahaja saya berbual dengan pesakit. Mr Junaini muncul. Saya terus mengikuti round beliau. Terkejut apabila Mr Junaini menyebut nama saya. Mati-mati ingatkan Doc tak ingat.Hehe. Selesai wad round, Mr Junaini bagi words of encouragement. Terharu betul. He's really concern about what happened to me & he even said, 'exam is always unfair but for me, apala sangat 6months tu. Just blaja&improve your weakness& if you need any help, just tell me." Serius terharu. he even asked what's my plan. I said as usual, extra classes&bedside teaching. He said, following year 5 classes is more than enough. Then i mentioned to him, my focus would be to learn more on the acute management as preparation for my HO-ship. He straightaway, nodded his head&agree with it.

Later, i followed him to clinic. He said today, he does not have any new cases, just follow up cases. On the way, we had a chitchat, sampai masuk pasal en Shue saya =P

Mr J: "Uve married right"
Me: Alhamdulillah~
Mr J: Where does he works?
Me: Shah Alam. Panasonic
Mr J: Dia blaja mane dulu
Me: Oooo, dia gi OC
Mr J: Nie cite dari sekolah la nie
Me: A'ah
Mr J: menengah sama??
Me: Nope. sekolah rendah (dlm hati..adoii malunye nak sebut.haha)
Mr J: kecik2 dah bercinta!!
Me: eh tak doc...tak...(geleng bsungguh2) kawan2 camtu je. Lepas dia balik OC baru siyes =P
Mr J: xlost contact??
Me: Tak. Kecik2 dulu ada satu grup yg rapat&selalu gi raya sama2 =P
Mr J: mcm saya dgn isteri saya laa...bercinta lepas kawen baru best. Bercinta awal2 nanti bosan
Me: angguk2~ samalaa kite doc =P
Mr J: How ur husband accept ur Pro result??
Me: alhamdulillah. Dia okje. As long as saya ok, dia okje
Mr J: HOD ada bitau, ur husband met him before exam. He even said to ur husband insyaAllah everything will be alrite. Skali tue......
Me: hahahaha. takpe doc. HOD sgt baik. byk nasihat bagi, siap kata kat suami, if saya nak sambung blaja, sile bg sokongan penuh pada dia. Asalnya, kebetulan kitorang gi umah kenalan HOD. rupanya HOD dtg sekali & lepas tue, ada makan2. husband saya dtg nak fetch saya & langsung kena jemput masuk rumah. Kat situla jumpanya. Takpe doc jgn risau. Kami ok. Hehe

Later, i hang up with Mr Junaini & few juniors joined us. Zira, faruq & 2 others (xsempat tanye nama.huhu). After wards, had small discussion with the juniors. Later, I had lunch with Zira. She said, she havent get used to surgery posting. Still blur. So, i said to her. If ada rezki, kite wat short case kat wad ok. U has discussion group rite. Jom diskas sesama, the topik yang korg blur. Kite buat any of the weekends =) She looks brightened up. Then, we go separate ways

In the evening, i had seminar urological malignancies. Supervised by Mr Nazli. I already read this topic before hand. Alhamdulillah, I could easily understand all that had been discussed & asked few questions that need clarifications from doctor. Thank You Allah. After, the class, I introduced myself to doctor. He said, no wonder I never see you in class before. Yes, ure welcum to my clinic anytime. But do you think Im suitable to teach you?? U should go&find professors. I just laugh and said. But You & Mr Hamid are the one that handling urological cases, of course youre most suitable. Doktor nie, humble betul. Semoga kite semua ada kualiti seperti ini juga. Makin berisi, makin tunduk =)

So hari ini, saya sgt bersemangat untuk meneruskan usaha saya mengulangkaji. Semoga esok lebih baik daripada hari ini.

Monday, August 2, 2010

Adaptation


Well, new posting had arrived. So, here i go again. As usual, meeting the HOD & get few words of encouragement& reassurance from him ( appointment had been set to tomorrow at 9am. Today he took EL). Go to respective wards, make our presence noticed by them, get to know the juniors especially getting to know their leaders, catch up their latest schedule & exchange phone numbers with them.

Today, im a bit moody. Usually I went to hospital around 7am. But, today, my stomach feels sooooo different. I kinda felt nauseated. So i woke up at 6.40am & when to JHC at 7.30am. My husband called me at 6.10am but i refused to woke up, hoping the nauseated thingy go away with addition of few more minutes of sleeping. Guess what, it still there!!!Huhu. I dragged my feet to bathroom with a thinking of cold fresh water will make the feelings goooo away. Unfortunately, it's just wont work. Is this what u called as monday blues. Haha

I gathered all the remaining positivities & I went to JHC. Instructing myself to SMILE, held your head high & looking for a bright future. At that time, i noticed i received a message from a colleague, telling she would like to go with me. Oh my!!!I totally forgot about her. Atlast, she went to class for the first time today. Good for her. Being denial wont bring any good. Just go on with your life. Look around, there must be something good that you can do despite being .......... ( No, liyana no!!!!U promised not to said&think about it anymore. Uve already locked it up in a wooden box, throw it into the deepest sea in the world with the key inside & not to open it anymore. Ever!!!Look forward. Be hepy with everybody. They've got theirs, u will got yours soon. Allah's with you). Ok2...haha.There's just my monolog. Abaikan=P

Yesterday, I did a minor revision. Today, in the ward, i did scheme down all the common cases in the ward & look at the management. so tonight, i know what to revised & in what way i can improve my knowledge. Met Cikun & Tini at the ward. They are doing their very best-clerking cases, updating the patient. Just say 'hai' to them, xmo kacau & sgt2 faham dah jadi HO nie mmg busy. In between, something tak best jadi - but guess what, berlapang dada saja. They will have grand round at 2pm. They looked scared of being scolded. May Allah give them the strength to pursue whats best for them.

Apart from studying, i need side activity. I dont want to be dull. I want to have life & enjoy it everyday. In the evening, i set aside time for whatever i wanna do. I resumed my jogging activity last week. Building back the stamina is my target. I want to be fit. Saying ure once a fit person is no used if u dont maintain it. So I make a few plans. Jogging, skipping & do aerobics - crunch or cardio exercise. Jogging is easy. I just went to taman bandar & jog there. I tried to buy skipping rope & VCD for aerobics & it turns out to be frustrated. Tak jumpa!!!sape sorok nie.haha. Tapi baruje cari kat KP. Guess, i need to go to ECM for that. Adoii,bile nak pegi tue.

I have this idea at the back of my mind nak gi facial. Mesti very soothing & relaxing. haha. Did few times before tapi tak consistent due to class yang tak tentu masa. Once in awhile, bawak diripun best jugak.Hehe.Jalan sorang2. Gi TC, jalan2 mane2laa yang boleh jalan, go to any of the restaurant, find a personal& private place & take out a book & read. I did it yesterday.hehe. Go to sushi King, duduk meja paling selesa&tak bising. enjoy my meal leisurely & read books. I sat there for 2 hours - undisturbed by anybody. Good!!!

Already being here for 1month, I starting to noticed that I used to be alone by myself. Indulge in my own thinking, planning & imagination. Sometimes call my dear honey, asking what he's doing & have a lovey-dovey chitchat - "dear, i always pray for your safety out there". Above of all, I start to love it!!! (oh no, am i suddenly being anti-social???=P - penyalahgunaan perkatan di sini dari sudut pandangan psychiatrist.hehe - but i believe u guys know what i meant. kan kan ) Rationalize the thing back. Its I have no choice. Setiap orang ada masa lapang&busy masing2, tak perlu susahkan mereka. Im already 25, gonna have my own career&be a mother soon (Amiin~). So, Ive got to be independant & find what I want to do in life. Plus, i have Allah, my family & friends that always at my side eventho all of them are far away. (saying the word far - makes me my eyes rolled up with tears T_T - dont worry not going to cry.haha )

Whenever you go. Mind setting is very important. Saya selalu berkata kepada diri sendiri, Im just a student like any other. Thinking that ure doing an extension will cause you to stress up. Why not just go with the flow until you reach the end. You'll definitely do wonders!!!

Everyday, just enjoy the bright sunshine. Enjoy the nikmat of vision that Allah gave you. Enjoy the nikmat of able to use your hands and feets. Enjoy the nikmat of taste- able to eat all the delicacies that you like. Enjoy the nikmat of learning - Allah grant you such an intelligence & healthy mind & many more. Most important is to enjoy the nikmat of Iman & Islam. This will keep you in the straight path & memberi ketenangan di dunia&akhirat.

Until then~

Sunday, August 1, 2010

FaiRyTaLeS~

Just wanna share wit u guys...This is my all time fav fairytales...hehe
I always hear this songs as it reminds me to always believe in ur dreams...
when we are positive, we will work towards our dreams, as long as it cums with a gud niat...
Allah will definitely help us along the way...

ENJOY listening & do sing-a-long..haha~




the other part that i love is when da prince cum to cinderella & they dance all night loooonggg~
They are sooo in love....just by looking at the person. U just know that he or she is the one....hahahaha...berangan lagi =P



p/s- when i was a kid..i want to be just like cinderella
pretty, kind hearted & married to a prince charming...haha =P