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 =)

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 =)

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...........

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 =)