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......

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