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Friday, October 22, 2010

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 =)

Thursday, October 21, 2010

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 =)

Wednesday, October 20, 2010

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.....

Sunday, October 17, 2010

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.

Thursday, October 7, 2010

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 =)