Revision & Weekend

Tomorrow will be my first day in Orthopedic department. Its only for 2 weeks.

Last 2 days, I already went to ortho office & inform them of our presence. I did this because they also a human beings & human sometimes do forget. However, the staff there told me to call Mr Shukrimi as previously he was the one who will arrange teachings for us. So, I did.

Mr Shukrimi asked me to informed HOD ; Mr Nazri. BUt since Mr Nazri is about to leave Malaysia for conference next week, he will be the one who will call Mr Nazri. So far the plan for Monday is follow rounds & go to clinic until further notice.

So, here I am. studying for ortho & cancelled my plan to go home his weekend. Yesterday, I went to traumatic course & yeah it did help me in revising the important points in the topic.

Wish me luck in orthopaedic. Hope I can bring my positivities in it.

p/s - Topic for 1st stage revision - common diseases in ortho
- Open Fracture (as well as close fracture)
- Complications of open fracture - compartment syndrome, fat embolism, shock
- Non-union, delayed union, malunion
- Traction, POP
- Diabetic foot ulcer (classification, pathophysio, management & short cases)
- Antibiotics
- Anatomy of Upper Limb & Lower limb
- Nerves (brachial plexus, lumbosacral plexus)
- Peripheral nerves (ulna, median, radial)
& Important physical examinations

=== Islam Is A Way Of Life ===Proud Covering My Aurah ==== Proud To Be A Muslim====

Trauma Seminar: Management of Open Fracture

Yesterday (30th October) I attended a one day course organised by Orthopaedic department.


(I will complete this entry later. Hehe)

From This Moment

A Song From Shania Twain...

I always love this song as it reminds me of something which I adore very much =)
Yes, you are right...its My Dear Husband~

This will be the longest time we are not be able to meet each other..... for 3 weeks~

But both of us know, we gotta do what we gotta do....
And eventhough you are far from my sight but you are always close to my heart...

As always, lets keep praying for each other & hope to see you soon~




p/s- next week, Im going to start another new posting. Orthopedic
Tomorrow Ill be joining an Orthopedic Course which is Open Fracture Management =)
I believe it will be a good revision for me, insyaAllah

"Ya Allah, engkaulah yg maha kuasa, maha kasih & maha penyayang. Kau berikanlah aku kekuatan & semangat & sinarkanlah hidup kami dengan cahaya RahmatMu. Ameen~"

HectiC

This week is the last week of paeds posting. Same applied to the current final year students. So lots of classes had been cramped into this very precious weeks.

Since yesterday, I had classes non stop. Thank you to our lecturers for the time they had spend & knowledge that they share with us.

This morning, we had seminar at 8.30am (for 3 hours) & then I went to the ward to clerk & review patients. At 2.30pm, I had a short case session with Dr Nargis. Just now, I just finished another class with Dr Siti Noor at 1140pm. Eventhough, it was a late night class but learning with Dr Siti Noor always makes you energetic. Hehe. Lots of things had been discussed eventhough only 1 case had been presented just now. (was so tired to write about the case. HUhu. Sori~)

Tomorrow has another session with Prof Wahab at 9am & followed with short case session with Dr Aye Aye. Frankly, Im starting to feel tired but I have to bear it for the sake of knowledge.

But I really looking forward for last session with Dr Nargis this Friday =)

p/s - havent had proper meal today. Huuu~ & noticed time went by very fast~

==== Time & tide waits for no man ====

Physical Examinations

I always find that practicing physical examination is fun.

But to make it fun of course we need to read before hand. The atmosphere become much more fun and interesting when we do short cases with close friends We will present to each other & others will act like an examiner & ask questions.

This I believe a very good practice. Practice always makes perfect right.

In my previous professional exam, I will always came early to hospital at 7.30am to do short cases with friends until 9am. We will do 2 to 3 cases. Do a little bit of questions and answers until management. Sometimes, we will use saturday or sunday morning to do short cases. The colleagues that I shared doing this activity are Ijat, Cik Nana, Cik Nun, Kakti & ck Yana Nordin. Oh, how I missed them right now.

Short cases need a lot of practices in order to make the flow go smoothly & present fluently. Everyday I will review my l'ittle book of causes' to refresh back the common causes that will be asked by doctors depending on the systems. But as time goes by, it will just come naturally because you understand the topics.

And today, I still continue to practice short cases every morning. But this 2 weeks I could not make it because of classes in early morning. Huhu.

Sometimes, I asked few juniors to join me & do some teachings with them. This could also enhanced my memory & I always love to teach dear juniors.

I always believe that our lecturers could instantly know wether the student did practice a lot just by looking how we handle patient & how we perform the examinations.

And as usual, I always enjoy doing short cases =)

p/s- currently practicing the examinations using pillows by myself (I already sent back home my little teddies.Huhu) & you know what, Im practicing with my imaginary friends. Hahahaha =P

=== Always make the best of what you have & Move forward ===

Specific Management of CKD

By Dr MOhd Ramly Seman, Nephrologist HTAA

Purpose of the management
1) To delay the progression or to regress the CKD
2) To manage the associated complications of CKD
3) To prepare patient for RRT

A) To Delay The Progression or To Regress the CKD

In research it proves that, slowing the progress of renal disease will retard the progression of renal failure.
For example, renal disease usually progress slowly about about 3ml/mins/year. By this, the person will had renal failure at the age of 55. But slowing the progression for example to 1ml/min/year, will delay the age of occurence at more than 75 years old.

What are the factors that leads to the progression??
1) Angiotensin II plays central role in the renal damage
- Artherosclerosis & vasoconstriction which can lead to STROKE
- Vascular hypertrophy & endothelial dysfunction can lead to HYPERTENSION
- Left Ventricular hypertrophy, Fibrosis, Remodelling & Apoptosis can lead to HEART FAILURE / MI
- Reduce GFR, Increase Proteinuria, increase aldosterone release & glomerular sclerosis can lead
RENAL FAILURE

All this if not treated can cause death to the patient

2)Aldosterone ( in the presence of No & CVS disease - HTN, renal disease, DM, heart failure,etc) can cause vascular damage (vasculopathy) & microischemia
There will be vascular inflammation (activation of cytokines,prostaglandins, etc)
--> cause necrosis & inflammatory cells infiltration --> fibrosis which leads to abnormal tissue remodelling & organ dysfunction
Lastly, the patient end up having Renal failure, Heart failure, MI or stroke

3) Hypertension.
Based on research, the lower the BP, the more renal function will be preserved

4) Diabetes Mellitus.
Good glycemic control will reduce the incidence of complications
retinopathy by 20%
nephropathy by 30%
Macrovascula disease by 16%

5) Proteinuria
A study on renal survival in adult FSGS based on proteinuria
for non nephrotic patient, the survival was very much longer compared to Nephrotic patient
Nephrotic pt only 50% survival in 8 years
Much more worse in pt with GFR >14gm/24H, the whole renal survival is only for 5-6 years

6) Family History in relation to microalbuminuria
In the research: interaction between FMHx of CVA in 1st degree relatives & glycemic control with the prevalence of microalbuminuria
Family hx + HbA1c >8% - dev microalnuminuria in 48%
either have FMHx or HbA1c >8% - only about 2% dev microalbuminuria
Non of both - 0%

7) Obesity
Mechanisms of kidney damage in obesity
1) mechanical: can cause hyperfiltration
2) Metabolic: can cause Insulin resistance, inflammation, hypertension & dyslipidemia
All this cause renal damage

8) Smoking
can cause vasoconstriction, thrombosis & direct toxin effect
& cause the vascular endothelium to increase in urine protein excretion & induce declines in renal function

9) Anemia
CKD patient with Hb <11.2>13
The more severe the anemia, the greater the risk

10) Usage of chinese herbs

So what should be done??

-Glycemic control
Pt with type 2 DM with 3/more injections of insulin per day resulted in lower rate in new or progresive nephropathy over a period of 6years compared to conventional therapy of 1/2 injections of insulin per day

- Control BP
130/80 in pt with proteinuria <1g/day>1g/day

- Use ACE / ARB
Based on research could reduce in getting nephropathy even in pt who is nondiabetic or normotensive compared to given placebo or other types of hypertensive medication such as CCB

So, choice of antihypertensive in:-
1) Diabetic Kidney Disease (DKD) - ACEI / ARB
2) Non-DKD + Urine PCR >200mg - ACEI/ARB
3) Non-DKD + Urine PCR <200mg style="font-style: italic;">Avoid NSAIDs. Use aspirin or tramadol
acute usually reversible decline in GFR
idiosyncratic forms of membranous nephropathy
interstitial nephritis
progressive nephrotoxicity - chronic usage

- dietary protein restriction: 0.6 - 0.8g/kg/day

B) Manage the associated complication of CKD

- Anemia
Early treatment has good impact in increasing the Hb over months compared to late treatment.
The best is given IV iron - Raises & effectively increase Hb compared to oral form
which one is better?? Either given IV iron alone / combine with erythropoitin??
ans: IV iron alone is beneficial enough for treatment. But if patient could afford erythropoietin, you can suggest the usage

- Cardiovascular disease
CVD is already well established at the onset of ESRD
Cause of death in dialysis patient: about 50 - 60% is due to cardiovascular

- Renal Bone disease (renal osteodystrophy)
CRF will cause phosphate retention ( phosphate excrete by kidneys) & will decreased the active Vit D. All this leads to hypocalcemia & later develop hyperparathyroidism
As CKD progressing from stage I - stage 4, there will be reduced in Vit D & increasing of PTH
Increasing of phosphate & calcium (secondary to PTH) - deposits at vessels, soft tissue, joints & viscera

Pt with GFR <60>65 starts given vitamin D therapy or started in pt with stage 3

Elevated phosphate increase mortality

- Metabolic acidosis
adverse effect on bone, nutrition & metabolic
Maintain Bicarbonate - 22mmol

- Depression, anxiety & denial stage
watch out for this in patient. all this could lead to non compliance & later progression of CKD

C) How To Prepare Patient for RRT

- Ultrasound Kidney - mainly TRO reversible cause esp obstruction
- Screen for Viral status - HbSAg, HBSAb, HIV, HCVAb
Done as dialyse patient will be divide according to status & we do not want negative patient to be infected with these.
Done 6 monthly. Extra caution with HCVAb - lots of false positive - so if result not consistent. repeat the test
- Cardiac Status - ECG, KIV ECHO, ask for symptoms of angina
- Eye referral to diabetic patient.
Could cause blindness if start dialysis in severe one
- Preserve the vein
- ?? Connective tissue screening
SHould be done in selected patient. NOt all patient
- Social history, family history, occupation or previous occupation
Important, as the treatment is costly
regarding ex-army. They will be given more money if sponsored by army compared to SOCSO
SOme patient did not know that they are elligible for SOCSO

- Predialysis Education
Goals:-
- Slow progression of CKD
-treat comorbidities of CKD
- educate patient to make informed decisions
- ensure timely selection of treatment modalities
- reduce hospitalization
- improve psychosocial, physical & rehabilitative outcomes
- save healthcare dollars

Who is collaborative team
Nurses, physicians, social workers, dieticians, pharmacist, other healthcare professional & staffs, patient & family

Important fact
Early referral is very important
Late referral will cause 40% of 1 year mortality, longer the hospitalization needed & increase cost

=== Nephrology Update ===

Nephrology Update 2010

Alhamdulillah, This weekend Im able to join Nephrology Update. Organised by IIUM in collaboration with HTAA. I think this is the first Nephrology Update that had been done. by IIUM. Previously, there was only medical update.

Initially 30 seats were allocated for students & it is for free. But later, HOD - Dr Che Rosle changed his mind by saying, students who would like to join must pay RM30 - student rate. But since I already gave my name like 1 month before the conference, I just agreed with the term given. Frankly, I nearly changed my mind. But in my oppinion, if you plan to do good things but suddenly there comes second thought, wouldnt it always came from syaitan, doesnt it???hehe. I guess so~

And Im glad that I made a right decision. Stick to the initial plan. I learnt a lot from it & I enjoyed the session very much. Its sad to say only 4 students attend the conference - Me, Asma, Nabilah & Najwa. But I think it is expected though~ the fifth year students will be having their exams just around the corner.

The speakers invited are the 'OTAI' in this fields (I hope u guys understand what I meant by using the word OTAI. hehe =P) Among the speakers apart from our HOD, Dr Marzuki & Mr Nazli(urologist) are :-
- AP Dr Kamaliah Mohd Daud - Consultant/Physician Nephrologist from HUSM
- Dr Zawawi Nordin - Consultant Nephrologist from Hosp Sultanah Nur Zahirah
- Dr Mohd Ramly Seman. Nephrologist HTAA

I felt very lucky to get lectures from them & they provide so many informations in each topic until the management. You dont have to worry of being ask or need to prepare anything regarding the topics. They just tell you from A to Z. The best part, the speakers acknowledged the students & keep saying, "I believe there is students here so I would like to show this this & this" or "in student days, this thing is very confusing for students but think this way". Oh, how I wished lots of students attending the conference too.

The conference was held for 2 days. The topics that had been covered:-

First Day
1) Epidemiology of CKD (AP Dr Kamaliah)
2) Screening & classification of CKD ( Dr Che Rosle)
3) Nephrotic Syndrome (Dr Zawawi )
4) Diabetes And Kidney ( Dr Marzuki)
5) Lupus Nephritis ( AP Dr Kamaliah)
6) Medical Management Of Stone Disease ( Dr Zawawi)
7) Hypertension And Kidney ( Dr Ng Kok Huan - Cardiologist HTAA)

Second Day
1) Specific Management of CKD ( Dr Mohd Ramly)
2) Obstructive Uropathy ( Mr Nazli)
3) Renal Replacement Therapy Option & Outcome (Mr Mohd Ramly)

As you can see, this course was very extensive & I listened to all the speakers very attentively & I did not sleep at all. In the middle, of course there was break for breakfast, lunch & even tea. The food was very delicious. Hehe. This morning, the menu was nasi goreng, nasi lemak, karipap & doughnut. After the session, we found out that there was still many foods left. So we took back some of it for our lunch. I heard that the caterer is the wife of one of JHC's guard =)

So now, I realised (more than before) how important it is to take good care of our kidney. Dont wait until we had DM or hypertension to worry about the kidneys. But its important to prevent it from happen starting from this very instant.

I purposely ask about additional salts taken in our foods - home made cooking @ outside cooking. The speaker answered to the question by saying, there is no doubt the relation of salt intake & kidney damage. Long term impact of taking additional salts could cause fibrosis to the kidneys which leads to scarring & renal failure.

So our role now is to educate our family members to take good care of their kidneys. Once the problem occurs, it will progress slowly & think about the cost to take care of the damage kidney if a person succumb to peritoneal dialysis or hemodialysis. As well as its impact to the psychosocial of a person.

All in all, Im glad I made a right decision after all. Thank You Allah.

P/s-Unfortunately I accidently left my folders given for the course in the LH3. Huhu. I still had the memory of putting the folders inside my bag. But found out I might just hallucinated it as I cant find it in the beg or in my car. I hope the folder still at the place I left it. Huhu. But for tonight, Im lucky I have the soft copies of the lectures =)

P/s- The medical book that I lost last week still hadnt been found yet. I put on a search everywhere. In my room, the car,the library, common room, all lecture halls & even the wards which I dont bring that book to the ward since Im in paeds posting. Even to the extend I look at the roads ( I had a thinking of did I put the book on top of my car???) I remember it clearly I put it in the car. Guess I might left it somewhere else also & think I did bring the book to my room which the same that happened today. Huuu~ That book is my fav book & in it I put some of my important notes. Ya Allah, please help me in bringing back my book. (Ada sape2 ada doa untuk cari barang yang hilang??)

Peranan Doa

Harinie hari Jumaat. As usual, petang jumat jika saya tidak pulang ke KL. Pastinya saya akan mengajak rumet pergi ke pasar malam.

Tapi semasa perjalanan pulang, sesuatu hampir terjadi & alhamdulillah Allah selamatkan kami.
Kami satu kereta hampir-hampir mahu dilanggar oleh bas yang laju dibelakang. Mungkin penumpang belakang tidak perasan kerana kereta saya sudah berhenti dengan selesa, & masing-masing tengah berbual tetapi saya melihat perkara ini melalui cermin pandang belakang. Huhu~

Ceritanya begini....
Jika orang kuantan pasti tahu trafik lite simpang empat besar depan Masjid Tengku Ampuan Afzan, dekat dengan pasar malam...

Jalan itu lurus, saya selalu berhati-hati kerana di situ kereta selalunya sangat laju walaupun sudah mahu menghampiri trafik lite.

Setelah masuk ke 'main road' saya mahu masuk ke len kanan untuk ke UIA. Jalan itu ada 2 lorong kan. Bile masuk dari bahu jalan, semestinya berada di len kiri dahulu. Tapi untuk ke UIA, kena berada di len kanan kerana lepas trafik lite kena belok kanan.

Jadinya apabila line clear, saya masuk len kanan & rupanya barisan kereta di len kanan itu sangat panjang dari trafik lite sampai ke depan masjid & dengan segera kena berhenti. Memang mengejutkan jugak. Kereta depan pun berhenti mengejut jugak kerana dia pun laju & tak sangka kereta depannya kena berhenti.

Sebelum menekan brek sempat saya mengerling cermin tuk melihat ada kereta dibelakang atau tak. Alhamdulilah tidak ada. Tapi saya melihat sebuah bas yang jauh di belakang. Tapi kelihatan agak laju. Walaupun pada mulanya bas itu agak jauh, sekelip mata saja dia sudah mahu menghampiri kereta saya.

Apabila bas itu menghampiri kereta saya yang sudah berhenti, ia masih laju & saya sudah risau bas tersebut tidak sempat brek. Bas itu kelihatan cuba memintas masuk ke len kiri kerana ia menekan brek tapi momentumnya yang besar menyebabkan ia masih meluncur kehadapan tetapi dia di hon oleh bas lain yang berada di len kiri & dibawa dlm keadaan laju juga.

Menyedari keadaan bas tersebut yang sudah memusingkan sedikit kepala depannya ke kiri untuk memberi ruang sedikit supaya tidak menghentam saya & ia juga sempat berhenti, saya juga menggerakkan kereta saya ke hadapan & ke kanan sedikit dengan harapan sedikit ruang yang saya bagi itu, cukup-cukup untuk momentum bas itu berhenti.

Dan alhamdulillah ianya berhenti sangat rapat dibelakang kereta saya.

Saya sangat bersyukur kerana tidak terjadi drama di situ petang tadi & Allah telah selamatkan kami. Saya terkenang ini mesti berkat doa emak, ayah di perantauan yang senantiasa mendoakan keselamatan & kejayaan anaknya di mana sahaja berada. Tidak lupe juga kepada Encik suami yang sentiasa mendoakan isterinya dalam lindungan Allah. Juga pastinya doa mak, ayah mentua, adik-adik diperantauan dan sebagainya.

Paling penting, diri sendiri juga perlu sentiasa berdoa & sentiasa mengingati Allah walau dimana sahaja berada kan kan =)

Acute Post-Streptococcal Glomerulonephritis

CP with Prof Wahab =)
(Im sooo happy that Prof Wahab likes my style of presentation *Elated mode* )

Its a simple case. But we know since our 3rd years Prof Wahab likes to emphasise on your style of presentation & always scrutinise the contents which I think is good. But I believe currently my way of presentation already mature compared to before. Thank you Allah =)

The case:-
9 years old Malay girl presented with fever for 5 days duration & facial puffiness 4 days which associated with hematuria. She also was diagnosed to have tonsilitis since 1 year ago. The last episode was 2 months ago.

On physical examination:- (day 4th of admission)
General - Alert, conscious, No facial puffiness, not pale, BP-normotensive, afebrile, fundoscopy not done (papilloedema), throat-no enlarge tonsils & throat not injected.

Other systems - (to find complications)
CVS - no signs of failure
Respiratory - no signs of pulmonary edema
CNS - Alert, conscious, GCS 15/15, normal tone, power 5/5, reflex normal & sensation intact

Discussions:-
Provisional diagnosis:- Acute Post-Streptococcal Glomerulonephritis

Do you think the cause is due to tonsilitis??
May or may not be since the last episode was 2 months ago which post-streptococcal is acute presentation& should manifest earlier. But I could not find any other source of infection.

What complications must you anticipate in this patient?
Acute renal failure
Fluid overload -Heart failure & pulmonary edema
Hypertensive encephalopathy

What investigation you would like to do??
1) urine
- gross examination to confirm the dark color urine
-urinalysis & culture - RBCs, RBCs cast, proteinuria can be negative/trace

2) confirmatory test
- ASOT titre - Normal- >200 (this patient 1600IU/ml)
- complement levels - reduced in C3, normal in C4

3) other supportive investigations
- FBC - Hb - Patient had hematuria & by history the mother said the child is pale
(patient - Hb on admission 12, D4 - go down to 7)
- RP - urea & creatinie - looks for any renal impairment (high in this patient)
- BUSE - looks for hyperkalemia - also for renal impairment (patient:normal)

How do you treat this patient??
Non-pharmacological
- Monitor this patient blood pressure & put her on BP chart
- Put her on ROF - 400mls/day - to avoid for any fluid overload
-monitor her input & output strictly
- advice to avoid salt intake

Questions:
What you want to restrict the childs fluid??

Patient came with facial puffiness & high blood pressure
The pathology behind it is due to hypervolemia
So I would like to prevent complication such as fluid overload in this patient.

Prof added- but make sure you look at her input output first. Some patient might already be in diuresis when admitted to the ward

What is the cause of hypervolemia??
sodium & water retention due to reduced GFR

How do you know patient in diuresis??
when no longer has facial puffiness & her BP normalise
This we can allow her free fluid intake

Pharmacological
Treat her BP - diuretics - can treat her hypervolemia & her hypertension as well
Treat the infection - IV Penicillin

I wasnt given any questions anymore.
But actually I expect Prof to give more scenarios like CP in real exams =) Anyhow, I still appreciate that Prof was very satisfied with my presentation....

But I would like to highlight the points you must know in this case:
1) Pathophysiology of AGN & how the complications occurs
2) Definition & causes of hypertension in paeds (like what Dr Zain taught us)
3) Types of hypertensive medications
4) Reasons behind the treatment given & why the drug is the choice of treatment
5) Try to remember normal values of important investigations & simple2 drug dose

Nothing Like A Fren

I think lately, my life is a bit stereotype. My daily routine is just the same. But I always said to myself that I must be thankful & enjoyed each & everyday of my life.

In order to be happy, it is not necessary to have the best in life but always make the best of what we have. We always want & longing for the things that we dont have. We always compare with others. Saying they are more lucky, happier, prettier, wealthier than us. But we never look at what we already have & utilise it to the maximum.

Thats why in Islam, we are taught to be grateful with what we already have.

Orthopedic department is currently organising A Diabetic Foot Conference for 3 days (20/10 - 22.10). Anor & Wahida came along the way from Kedah to join this conference.

This afternoon, the 5 of us (me, anor, wahida, wahed, kraihan) had lunch at gerai keropok sagu, tanjung lumpur. We ordered quite alot & finished everything in no time. We talked & laughed like a kid. Hehe. It feels so good to be able to spend time with them.

Anor as usual always had stories to share & wahida was known among the HOs of her dept to be a strict & dont-messed-up-with-me person. Haha. She also wearing new style of tudung & a pair of pretty+unique spectacles.

Anor & wahida sharing same postings & staying in a same room. They look like a grown up persons with responsibilities on their shoulders. I know they are doing their job the best they could. Im very happy to see them.

Just now, after maghrib, we (the 5 of us+waena) had dinner at Tanjung Lumpur. Initially, Wahida craving for chilli crab. But due to some circumstances, we changed the plan. So this time we ordered ikan aji aji bakar petai, ikan siakap 3 rasa, sotong goreng tepung, udang sambal petai, tomyam, sayur kailan & sayur kangkung. Everybody was very hungry at that time. As usual, we ate while sharing about current issues, working, studying, etc.

I felt soooo relieved having half day outing with friends. Hehe. I guess, I really missed my friends very much.

Tomorrow, Anor & Wahida are going back to KL. They want to drop by at Kamal Bookstore (wahida lost her stethoscope & anor would like to buy some books) before they proceed their journey to their hometown.

I wish each & everybody all the best in whatever they are doing. Make sure we start our day with a good niat & intentions. May Allah ease our way through & leads us along the way =)

Classes Back To Back

Today was quite hectic. But I learnt a lot today. Thank you Allah~

This week we have 3 days session with Dr Zain. Yeah, I admit that he always put up a very long session. But if you listen carefully to what he said, you will find out that each & every sentence of his words is very beneficial. It is exactly the same question being ask by other lecturers & even what is being ask in MCQs.

I found out that re-entering his session makes me understand better about the topics & makes my revision easier. I even noticed that I could answer other lecturers questions based on what had been taught in Dr Zain's classes. Thank you doctor =)

Session with Dr Zain:
Yesterday - enuresis & chronic constipation+encopresis
Today - functional abdominal pain, lymphadenopathy & part I:fainting
Tomorrow - part II:fainting & hypertension

After finishing each session, I was able to come out with a note regarding the topic. What's being taught by Dr Zain was very easy to understand & very systematic. He explained the topic very well & I guarantee everybody could understand 100% of the lectures if nobody doozed off in his classes.

Alhamdulillah, I managed to stay awake the whole session & enjoy answering his question. Indeed he is a very passion lecturer who wants to share his VAST knowledge with a new generation of doctors-to-be.

May Allah bless you always, Dr Zain....

And just now at 9pm, I had a class with Dr Siti Noor. I always mesmerised by her beauty =P
Dr Siti Noor is also another lecturer who taught us with passion. She always makes us realised which is the important thing that needs to be highlighted in a certain diseases.

Just now, one of the juniors presented about a case of a 4 years old Malay girl presented with chronic skin rashes for 2 years which the condition worsens in this 1 month. The diagnosis was atopic dermatitis with cellulitis.

Apart from learning the disease based on academic purposes, Dr Siti Noor highlighted about the emotional part of a child. The child is a girl. Since age of 2 years. she's having skin problems which later could lead to scar if not well taken care off. The doctors need to educate the mother that this problem will need continuous treatment. If not taken seriously,the child might develop inferiority complex when she sees another girl with flawless skin & able to wear skirts. She will be teased by her friends in the future. She will refuse to go to school & this will impair her development & learning process.

This shows that doctors is not just treating the disease physically, but a good muslim doctors will look at the patient as a whole.

Wallahualam.....

Frustrated

Im soooooo frustrated right now.

When I woke up this morning at 6am, I was so excited, energetic, looking forward for another teaching session with Prof Wahab. I arrived early this morning and had good breakfast. Initially Im planning to do short cases in the ward from 7.30 - 8.30am. However, the team leader (current paediatrics posting) said, prof wahab would like to do their seminar this morning & prof Wahab might combine CP session with the seminar.

So, I cancelled my plan to go to ward & review back my clerking sheets. I would like to present the case the best that I could. It turns out Prof Wahab will start class as 10am & he said my CP will be afterwards, after the class finished. As usual I joined the class, the seminar was about NTD, hydrocephalus, primary immunodeficiency & solid tumors. I enjoyed & understand the class. But I still cannot grasp about few malignancies presented by the juniors. Guess, I need to refer to the books after this.

My other colleague was absent today. She messaged me AFTER I sent her SMS at 9am reminding her of our class this morning. She replied she currently not feeling well. Initially, I said Ok. What else can I say.

After the class ended, Prof gestured me to follow him to his room in Level3. When I arrived at the department, Prof said, "where is your other colleague??" I replied "She said she's not feeling well". Then Prof straightaway said " I want to see both of you at the same time. So you present this friday together with her." Im soo frustrated.

Initially, I still kindly asked prof Wahab to continue the session as I had prepared & she just told she cannot make it this morning. For next session, I will prepare another case. But Prof Wahab refused & told me 'dont worry'.

Im not being selfish. But the class was scheduled this morning. She the one who asked me to present today & she asked her turn to be this friday. I prepare for the case last week despite I went home yesterday. She should stick & follow the schedule & inform earlier (like yesterday) ask for re-arrangement of class because she's not feeling well. Im so frustrated with this kind of attitude.

Time & tide waits for no man. In Quran also mentioned 'wal-asr'.

That said, Im not going to tolerate this kind of behaviour from her anymore. This is my peak of being patient with her attitude.

I have expectance from my family to fulfill. Im being positive & accept everything with open heart & mind. Only 2months left. So, Im not going to let her behaviour to trash all my efforts.

"Ya Allah, kau kurniakanlah ku kekuatan, kau kuatkanlah kesabaranku, kau ampunilah dosa kami & mudahkanlah urusan kami."

Im Back

Alhamdulillah, laptop sudah pulih sepenuhnya. Rasa seperti menggunakan laptop baru. Laju betul!! haha. Terima kasih to Encik suami & Abah. Encik suami bertungkus lumus membaiki software & abah memasukkan antivirus yang baru. Sekarang semua sudah seperti sediakala.

Sebelum ini banyak sangat nak cerita. Tapi tak berkesempatan nak online update blog, Hanya sempat few minutes untuk cek email & kemas kini apa-apa yang perlu. Masa begitu berharga buat yana sekarang. Petang-petang after kelas, akan memastikan mengulangkaji sekurang-kurangnye satu topik & membuat soalan mcq topik berkenaan.

Tapi terus terang saya katakan minggu lepas quite stressful juga. Mungkin saya pun ada harapan pada diri sendiri. Mungkin tak mahu kecewakan diri sendiri lagi. Jadinya push diri sampai keterlaluan juga. Tak elokkan. Hehe. Alhamdulillah~ weekend baru ni balik ke rumah. Berehat dan mengikuti update keluarga (family di saudi & in law). Jadinya hati menjadi tenang kembali dan dapat berfikir dengan waras bukan mengikut perasaan.

Kadang-kadang kita terlalu mengejar cita-cita sehingga menekan perasaan sendiri. Tapi jika terlalu relaks tidak bagus juga kan. Kesimpulannya, bersederhana, buat yang termampu. Selebihnya doa & serahkan kepada Allah. Buat apa nak stress dan pening-pening kan. Allah selalu membantu hambanya. Tetapi hambanya yang sering terlupa.

Buku Medical Baru
Minggu lepas, saya kehilangan buku IM kesayangan saya. Medicine Prep Manual For Undergraduates by George Matthew. Sangat misteri. Yakin membawa buku itu pulang ke bilik. Tapi keesokan paginya, buku tersebut tidak berada di bilik. Puas mencari di kereta, library dan wad(yakin tidak tinggalkan di wad. Tapi cari sajalah~) Tapi usaha tidak juga berhasil. Akhirnya, nekad tak mahu pening-peningkan kepala, saya membeli buku baru di Kedai Kamal. Jika ada rezeki selepas ini terjumpa buku tersebut. Buku baru ni saya berniat sedekah sahaja pada junior. Tak rugi pun kan.

Seluar Hitam Baru
Saya berpeluang membeli seluar hitam baru semalam. Kebetulan Jaya Jusco ada sale especially pada empunya kad Jusco. Actually kad tersebut kepunyaan mak mertua. Hehe. Seluar lama hitam itu adalah seluar kesayangan saya. Ala-ala bantal busuk budak. Memang seluar fav saya. Pakai basuh, esok@ lusa akan pakai lagi. Haha. Ia sangat selesa, tidak ketat & stretchable. Saya pakai sampai lusuh dan benang dia dah ter-over stretch. Akhirnya, sekarang tidak boleh pakai lagi. Huhu. Kat lutut dia dah ada lubang. Haha. Kesan over stretch dan bukan sebab jatuh.

Rumah Bangi
Semalam berpeluang jenguk rumah bangi. Gembiranya dapat pulang ke bangi walaupun hanya untuk seketika. Cek pos box, kumpulkan bil bulan ni, cek rumah, siram pokok bunga, tengok TV sekejap. Hehe. Ada rezeki nanti nak ajak encik suami bermalam di rumah bangi pula lah. I miss that house. Sebelum pulang saya babai rumah (walaupun ini tak pernah dibuat orang. Haha). Tak tahu bila dapat jenguk rumah lagi.

Oh ye, nenek akan pulang ke KL minggu depan. Tapi katanya mungkin tak ke bangi terus.

Naza Ria
Jika saya ke bangi, mesti dengan niat untuk memanaskan enjin Naza. Sudah sebulan tidak berpeluang memanaskan enjin naza. Tup tup, rupanya bateri sudah sangat weak & tak dapat diselamatkan lagi. Huhu. Rasabersalah pada ayah pula. Saya dan suami ting tong rumah jiran untuk pinjam jumper untuk jump stat naza. Tapi tak berhasil juga. Kami dibantu oleh pakcik jiran. Baik sungguh jiran di sini. Tuela gunanya kenal jiran kan kan.

Saya memaklumkan pada ayah perihal naza. Ayah kata bateri naza sudah sampai waktu untuk ditukar. Sudah setahun lebih digunakan. Tapi encik suami kata, jika maintain bateri itu patut boleh tahan lama. Huhu. Nanti bile-bile free encik suami tolong tukarkan bateri Naza untuk ayah.

Masak
Minggu ini berpeluang masak untuk suami lagi. Rasanya ni baru kali ketiga kot. Selalunya jadi assisstant mak di dapur. Hehe. Mak sangat pandai masak. Suka tolong mak masak. Banyak belajar benda baru. Hari ini pukul 11, Abah & mak keluar menghadiri kenduri kahwin kawan mak. Jadinya tinggal saya, suami & abang ipar di rumah. Jadinya, takkan nak biarkan semua orang kelaparan. Mak pun dah tolong keluarkan ikan & udang yang sudah di garam kunyit. Jadinya saya masak lauk simple untuk kami bertiga. Ikan kembung masam manis, goreng nugget & sayur kailan. Encik Suami bermurah hati tolong masak nasi. Paling best kerja sama-sama kan. Hehe

Ayah, Mak, Maryam & Ahmad
InsyaAllah 1hb Disember, keluarga saya akan balik malaysia. yaahhhoooo~ hehe. Keluarga saya akan berada di Malaysia sehingga 17 Disember. Tapi saya pula akan exam 14 &15 Disember. Jadinya mungkin ayah akan datang ke kuantan pada hujung minggu. Ayah sudah warning sekarang tak boleh balik KL dah. Stadi sahaja di kuantan. Huhu. Baik ayah~

Walau bagaimanapun, Sekeluarga akan berangkat ke Melbourne pada 6/7hb Disember sehingga 12 Disember. Adik saya yang kedua - Izyan sudah tamat pengajiannya. Dia akan konvo pada 9hb Disember ini. Bestnye!!!

Esok
Esok kemungkinan ada CP with Prof Wahab. Tapi dengar-dengarnya macam dia nak bawak seminar dia yang minggu lepas ke pagi esok. Konfius pulak saya. Tapi apa-apapun, saya prepare sahaja satu kes untuk beliau. We just do our part kan =)

Minggu Ini
Masa berlalu dengan sangat pantas. Kadang-kadang terasa sesak di dada mengenangkan masa yang tidak pernah menunggu sesiapa. Minggu ini sesi bersama Dr Zain lagi. Ikut kelas Dr Zain, banyak betul dapat revise. Selepas itu, selalu dapat jawab soalan doktor lain apabila ditanyakan tentang topik berkaitan dengan kelas Dr Zain. Beliau memang ajar perkara yang penting dan wajib diingat.

LapTopKu

Semalam tatkala mahu meng 'update' blog, terjadi satu perkara yang tak diduga.

Laptop rosak. Isk~

Ia mengeluarkan skrin biru yang memberi arahan itu & ini.

Tergamam seketika melihat skrin tersebut sambil berusaha memahami isi tulisan yang dipapar.

Ternyata setelah berusaha membetulkannya dengan bantuan En suami via handphone, ia tidak juga berhasil. Memang bukan tangan engineer. Haha

Kebetulan selepas itu, abah message menyuruh saya online & saya nyatakan pada abah tentang laptop yang meragam. Abah dengan pantas menyatakan "balik rumah minggunie, abah boleh baiki." Gembira seketika.

Tapi kegembiraan terus lenyap mengingatkan sudah berniat untuk mengikuti kelas Dr Siti Noor hujung minggu ini & sudah berjanji pada diri untuk sambung mengulangkaji memandangkan peperiksaan pro sudah begitu hampir. Aduss~

Nampaknya terpaksalah saya berpuasa menggunakan laptop buat seminggu lebih ini. Hanya berpeluang menggunakan internet di library pada siang hari.

Jadi pastinya, akan tergendala seketika aktiviti 'blogging'. Banyak yang mahu dikongsi terutamanya tentang apa yang dipelajari bersama Dr Zain. tapi apakan daya....

Okey, terpaksa pergi kerana library sudah mahu tutup...

p/s- semoga dapat curi masa esok untuk menulis sesuatu di sini =)

CHOCOLATES

Lately I noticed that I always craving for chocolates.
My love for chocolates also had been noticed by my husband & in laws.

Previously, I do love chocolates very much. Chocolate bars, ice cream chocs, chocolate biscuits, Nutella, hot chocolate, chocolate ice blend, Gardenia choc raisin, chocolate bun, etc. Everything must be chocolate. But Im not a die hard chocolate fan who would go to nearby shop just to by a bar of chocolate. Hehe
Im not until today~ =P

I went back home last thursday & found a big box of ferrero rocher in the fridge. Still havent been opened by anybody. Must be abah's chocolate. Hehe. At that time, Abah&mak already went back to Kampung that morning.

I stared at the chocolates inside. Ferrero rocher is my all time fav chocs!!Yummmy~ How I wish I could eat one of it. I know abah wont mind. But Islam taught us to ask permission before you take something that belongs to others. So I said to myself, please be patient for 1 day until abah came back after our cousin's wedding in Sg Besar. Each time I opened the fridge, I will look at the chocs. Isk~

The next day (Friday), Abah called asking at what time will we driving to Sg Besar for the Kenduri??I talked to abah but forget to ask about the chocs. Hehe. After that, I sms Abah asking to eat one of the chocs. Abah laughed & replied by saying....
"Abah beli chocolate tue untuk menantu abah.If yana menantu abah, makanla sampai habis.."
& abah continued to laugh....

Yeayyy~ Its for me. Baiknye Abah!! But its a manner not to finish eating the chocolates bought by others in one go. Ferrero is an expensive chocs. So you also must share with others. Abah also must be exaggerating when saying all the chocs for me!!!hahaha =P

At kampung is quite busy. So I totally forgot about the chocs thingy. Sibbaik~ haha

During on my way back to Kuantan by bus, I called my husband telling my whereabouts & later abah talked to me asking...
"Yana, abah nak tanye.. nape tak bawak balik skit chocolate dlm peti tue..."
Later I screamed (though only heard by me..huhu)..I totally forgot to take some of the ferrero with me...huhu. I said to abah. Please save for me. & abah said..
"Dah. abah dah simpan tuk yana dah. Abah dah bagi orang len sorang satu. Lebih-lebih tue untuk yana." Yeayyy...TQ abah. But I wonder when I be able to come back home again. huhu

Again today, I started to crave for chocs.
After the class, I went to the store & bought many chocs in small packets. Though now, Im in tight badget & not able to buy ferrero myself. huhu. Well, to be frank, I can just take out money from my bank Islam easily. But Im teaching myself not to take out the money leisurely without strong indications=P So, I must make sure these chocs last for 1 week!! haha. All this is sooo funny!!!!haha. Part of growing up, I guess. Hehe

Right now, Im eating one of the chocs slowly & enjoyed each bite of the chocs melting in the mouth...Yummm...

p/s- I started my peadiatrics posting today =)