Seremban Trip

ALL the NICE Food in Seremban!!!!











The seremban trip was just fantastic. We visited 2 gardens,2 temples, Jusco Seremban, tried homecook yummy dishes. Really thanks so much to our Xin Ku der "Dao You"..She drove us here and there. Hmm...driving skill not bad la.4 of us took turn to drive, quite fun...There are Sarawak, Johor, Penang and Seremban driver. Well, guess who is the best?? Of course is Sarawak driver...lol..SS-ing!!! (Actually not..hehe!)

First, we reached Seremban train station and were picked up by Miss Belle, with Silver Myvi. Went to have breakfast at "Chang Fa Mei Shi Zhong Xin". Yummy yummy. Then went to "Wu Kong" temple. Took a lot of pictures there. After that, we went to a park. A very nice park, where there are a lot of fishes and tortoises, but too bad there is no bicycle to ride. After that,Jusco to drink Big Cup Milk Shake. Went to a place with a lot of stalls to try 4 types of food for our lunch.After lunch, we spent the evening in another garden park, met a old man with sacksophone ( He said he felt sad deep in his heart, I bet he had experienced something very traumatic when he was in America. Last visiting destination is to a God-Ghost Temple, then headed back to Miss Belle's house. Tasted the chicken with alcohol, Haw ger likes the soup a lot, hmm...Spent our time watching News too, lol!!! At night, Miss Belle dropped us at the KTM Station and our Seremban trip had ended. It was overall interesting and fun!!!!

Babies R CUTE...

I love babies,
They are always cute,
They are always innocent,
They are always naive,
They are always no worries,
Wish I am like them---cute, innocent, naive and no worries...

Want to know how are babies developing from embryo to fetus and to a newborn baby??

Visit http://www.medicinenet.com/stages_of_pregnancy_pictures_slideshow/article.htm

3 trimester and it's not easy..so people,you should be glad that U were born into this world, appreciate & enjoy life!!!!

Getting Old....

Orientation is always fun for me. I still remembered the first time becoming an OO, I have enjoyed so so much and even felt that it's my orientation instead of the junior's. Started when I first joined IMU, I was assigned to Group 13 (MEDT1/08)-The lucky 13, then become Head OO of Group 8 (ME2/08)-Freakin' Gr8,after that become spy of Group 8 (MEDT1/09) again-We R Str8, and now OO of Group 8 once again (ME2/09)-Infinity. Wow, there are 4 generations now in a group, haha!!! Time really flies, now I am in Sem 4 already, suddenly felt that everything had been changed since I first joined IMU. That time I am just a naive and happy person who enjoy all the time. Now, I felt that I am less excited and enthusiastic towards orientation and a lot of stuff, seriously don't know why? Maybe I am just getting older?? Or maybe it's just the routine which makes me felt that there is nothing new? I am giving up eventually...hope that I still can hold on to it...

p/s: I like the Orientation Indoor Concept, it's very creative!!! Well done, Wen Peng & See Wei...

Busy or Free, Which 1 Would U Prefer??

When we are busy, we complaint that we have no time to go out, do the stuff that we actually enjoy and prefer to do.

When we are free, we complaint again.This time we will complain there is too much time and we do not know what to do to kill the time, haih...

Why?? Why human always complain and never satisfy???

Life is Indeterminable

Went to Hospital Sungai Buluh this morning, hehe! Woke up at about 6.30am, then sit in Kala's car, reached the hospital at about 7.50am. Went to A & E department to see stuff.We wore surgical masks, actually I was quite scared because Hospital Sungai Buluh is one of the place where a lot of H1N1 cases. There were not much cases in the morning until teh siren rang, we knew that there was a red zone critical case edy. We rushed to the red zone to see what was going on. An old man was sent inside. He had a really bad injury, seriously bad. Both the femoral bones were broken, a big laceration on his right arm, a lot of bruises and cuts around the body and legs. What made it worse was his head was bleeding non-stop too. The skull was ruptured, deep cuts on the right parietal and occipital bone, haih...When he was admitted, he had lost his heart beat, breathing. The houseman and others were pressing the chest non-stop. There was a lot of blood in the mouth, most of teeth were broken. The doctor sucked the blood out from the mouth using tube. The situation was really panic as the doctor trying to save him for like 15-20 minutes. They even use the defribrillator for 2 times, but in the end the guy still cannot fight over the death and passed away. I was standing at the side, couldn't do anything, watching live in front of the medical team, praying in my heart that the guy can survive but in the end still....really can't accept how to cope with this kind of stress and tension if work in A& E department. I will definitely not choose this department, it's just too much for me!!! Suddenly realized that life is short. We did not know when we will end our life, maybe today. later, 2moro, in a month, in a year?? So, we seriously should appreciate everyone beside us especially our family members, friends, lover...Hmm...the guy just now was a motorcyclist who was ridden over by a lorry, and yet his family did not know the accident when he was admitted. They could not even meet him at the last moment of his life, I really could not imagine how they were going to accept this bad news.....Life, why r u so cruel???

Survey Poll

Hey, everyone, do spend a few seconds to help me to complete a short survey poll at the sidebar, so that i would know what kind of blog entries you guys prefer to read, hehe. Thanks a lot!!! Have a great day!!!!

I Am Not Yet A Doctor

People always ask, why you choose to study Medicine? I will always answer because there is no other choice that I can take besides Medicine. I am not interested in Pharmacy, Accounting, Engineering, Architecture, etc. Although I am quite ok with business, but I think it is not necessary to get a business degree to start a business, that's why I have chosen medicine. Now, I discovered the truth behind that why I chose Medicine. The truth is horrible---I chose it mainly because for my own pride, wisdom & dignity.I wanted to feel proud, and look proud in the eyes of everyone.And also partly because I wish I to be able to help my family members when they are in need. By studying Medicine, I knew exactly how to take care of my family members--as a doctor, how to give advices to them--what can they eat and cannot eat. I didn't want to just care for them but cannot do anything to help/cure them. I wish I am smart enough to detect and diagnose their diseases earlier.But recently when my father kept on asking Why this and Why that about his headache/hand pain.He expected me to be as pro as a doctor.I couldn't answer why? This prove that I am still couldn't help him.I feel terribly bad for not able to help even though I am now studying Medicine.I felt myself so dumb.I wish I can be smarter and graduated a doctor very soon so I can help them..Time, please let me become a doctor faster and please grant me the knowledge, pls!!!!

p/s:I will erase my pride & selfishness. I will work hard & strive further, so I can be more successful to be able to love, care & help my family members and my patients!!! Must always remember, patients are our priority!!!

Btw LOVE & HATE

I LOVE to sleep, but I HATE being disturbed when I am asleep..
I LOVE to plan, but I HATE to plan everything alone and by myself..
I LOVE to go out, but I HATE to be rushed to go out..
I LOVE to think, but I HATE to think too much..
I LOVE to play, but I HATE to play when exams is around the corner..
I LOVE you, but I HATE being rejected by u..

A Car Driver without License

Finally, after the poor owner drive without license for almost 1 year, he got his car license made & renewed!!! He went to make a police report (lost car license), took 4 passport size pictures.Hmm...quite satisfied with my Leng Zai look on the new car license, lol!!! I can never surpassed my dad. The way he did things is very organised, unlike me. He listed all the things he needs to do and finish it one by one. On the other hand,I am just keep on delaying things which I should have done much more earlier. Visited Ah Gong today. Bought new shirts!! Ate Bubu Caca cooked by mum, hmm...I still missed the translucent flour added in the Bubu Caca which I enjoyed eating them when I was a kid (at my neighbour's house last time), but sadly my mum didn't put in those,hmm....but, they tasted good too!!!

I

I release my grip slowly,
I start to accept the fact,
I am delaying the problems,
I am not an efficient person,
I am neither an independent person,
I am just a tiny little dust in the air,
I am small & yet not helpful at all...

A Complicated Feeling

I have this feeling, it's compressing against my heart, it's controlling my thoughts,emotions, behaviours. I really don't know what is it?? I am just feeling not happy, I am worried about something, I am doomed for my life..although I am really in happy surroundings, with my family and friends. Haih..life, why do you make me so complicated?? Why don't you make my life easier? Why don't you just make everyone happy when they deserve the happiness?? I seriously need cure for this. Anyone can help me and tell me what to do?? Please, don't make yourself think too much, Ickes!


U Need to Learn NOT to THINK TOO MUCH...

Last Day of Elective

Last Day of elective, really a bit "Bu She De". These 12 days elective was a wonderful experience!!! Hang around with doctors, saw a lot of things, learnt a lot too. We even made cards for the doctors we had attached to, hmm...haha! This morning stayed in Pediatrician department. It's very interesting to see babies. Some are very cool (Not crying even when poked by needle), some are very young (5-6 days only). Hmm...there is one thing called withdrawal bleeding.Uterine bleeding that occurs in response to the withdrawal of oral contraceptives, or other hormone treatments.Well, in these female babies cases, it's normal to have bleeding from the uterus because of the progesterone hormone from the mother. Green stool is normal too in early babies. We saw some jaundice babies, 1 kid got fever for 2 weeks plus cough(suspect for H1N1?), kid with lost of appetite. Today is a busy day for Dr. Alex (Pediatrician) because all the babies went to see specialist in private hospital as the General Hospital not operates on weekend? Most of them came for vaccination....Chicken pox, whooping cough, tetanus, polio, etc. Hmm...pediatrician is a interesting job!! Half day today, went to Faye's house to have lunch. Pizza, pasta, salad, garlic bread, mushroom soup, champagne, wow...cool lunch!!! Supposed wanna go Sarawak Cultural village, reached there at about 3.55pm, but damn the counter was closed edy, but the main gate still open, wanna go in for the show but they didn't allow. Haih...then, went to Damai Puri instead...Had our dinner at bouquet (Shan Chuan), then went to Sunday market...

Lesson of the Day:

Dr. Alex Lu (Pediatrician's action:


Tu, tu, tu, tu..... (Injection going on)..baby is crying, doctor throws the toys up, play all kind of sounds from the toys,lol!!! Nice skill to prevent baby from crying.

11th Day of Elective

2day is quite rewarding!!! It's a Pharmacology Day!!! Was sent to the pharmacy department in the morning. Followed Pharmacist-Stephanie for a while, then we were asked to find CVS drugs from the shelves. Wow, there are plenty of drugs there, really salute pharmacist and pharmacy students, damn a lot of drugs to be memorized, haha! We brought back a lot of templet too,wakaka! Hmm...let's c...CVS Drugs: Brand Name: Diovan---Generic name: Valsartan--Angiotensin II antagonist for hypertension. Brand name: Enahexal---Generic name: Enalapril maleate--ACE inhibitor for hypertension and heart failure. Brand name: Exforge---Generic name: Combination between Amlodipine( Ca ion channel blocker) & Valsartan (Angiotensin II antagonist), Brand name: Rasitol---Generic name: Furosemide--Diuretic agent, Brand name: Ezetrol---Generic name: Ezetimibe--lipid-lowering drug...Huh...too much drugs dy, scary..then went to Physio Department to learn from Miss Su LeeNa,head of physiotherapist. Saw a patient with cerebellar ataxia and another with ataxia with bleeding in brain. Both cannot really control the movement of limbs, the sight really makes me feel terribly sad, but happy to see when they are improving in term of movements from day to day, and I am really salute the family for not giving up on them. So doctor too, don't ever give up on your patients so easily next time!!! We need to help them! In the afternoon, went to Nephrology department to find Dr. Bill Chau. Hmm...he explained to us about haemodialysis in a very detailed way, great great. Learn quite much from him. He gave us some advices on our medical pathway too...really appreciate that!!! Hmm....ENT, Ophthalmologist, Pediatrician, which 1 should I choose? Should listen to crackles on child when they are crying first before I can make any decision, hehe. It's a great day!!!

Lesson of the day:

Dr. Bill Chau (Nephrologist) said:

You have to like what you have chosen. To be a good doctor, you need to know that you have to do constant reading to keep you updated. It is because Medical field is always evolving!




P/s: Movie at night...
My parents are here!!!

10th Day of Elective

In fact, 2day is the shortest day, not yesterday,lol.Went back at around 2pm. U know what happened? I supposed to meet up Dr. Harith (Radiographer) in the morning and Dr. Manjit(Pathologist) in the afternoon, but because of my blurness (I woke up at 9am),need to meet with them at 9am. I rushed to the hospital at 9.10am and straight away went to join Natasha and Gaik Si for Dr. Manjit, however I should join Dr. Harith at that time. I didn't know, and Dr. Manjit seemed to be annoyed about my late arrival (They were there since 8.50am, wth!). Dr. Manjit is a pathologist. He is nice. He asked us to give the PBL trigger by ourselves and asked us about the case, like how to find differential diagnosis? how to investigate? Although It was very scary, but it really helped us to think as a medical student or even a doctor, hmm...not bad not bad. Gaik Si got some sort of hearing problems with Dr. Manjit,lol. She lost for like 4-5 times. And I bet Dr. Manjit will like me because I treated him coffee, haha! He said he can then easily remember my name,lol! Went to visit around the laboratory after that---blood bank, room for Culture & Sensitivity, room for preparing wax slides, etc...At about 11am, I just got to know that I supposed to follow Dr. Harith, went to find him after that. He didn't scold me, luckily, haha! Saw 2 cases of ultrasound with him.He also showed us some CT scan and X-rays of the patients and explained a little bit, hmm...At about 1pm, went for Tumour Board Conference, got free lunch!!!! Yeah! Active participants of the conference including Dr. Lau, Dr. Teo, Dr. Kho, Dr. Manjit, Dr. Wong, Dr. Lei, hmm...quite interesting the cases they presented. And I have noticed all the doctors were joking around, damn funny! Hmm...wish I can be like that next time when become a doctor, don't be so serious,lol! So, in the afternoon, I have nothing to do because I have done both, swt!

Lesson of the Day:

Dr. Manjit (Pathologist) said:

You have to be intelligent of what you are going to say/do. There must be a reason for it. So, before you say/ do anything,think twice & make it an intelligence one. Normally, doctor only can make provisional diagnosis. Laboratory is the place to confirm the diagnosis!!!!!


P/s: Visited UNIMAS and Sabrina Ting, Bowling session at BDC Everise.

9th Day of Elective

Today is the shortest day of my weekday elective, went back home earlier at about 2.30pm. This whole morning followed Dr. Peter Wong (Cardiologist), saw an invasive angiogram done.So, what is the non-invasive angiogram huh? He taught us how to detect blockage and stenosis. We then followed him to his office to see patients. There were a lot of patients, we need to research on DSE (Dobutamine Stress Echo), TKR (Total Knee Replacement).What is epigastric paraesthesia? Vertigo? Cozaar=losartan.It is in a group of drugs called angiotensin II receptor antagonists. It keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow and helps the kidneys to eliminate extra fluid.It is used to treat high blood pressure (hypertension). It is sometimes given together with other blood pressure medications.Hyzaar=hydrochlorothiazide and losartan.Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.It is used to treat high blood pressure (hypertension) and to reduce the risk of stroke in people with hypertension.Caduet=amlodipine and atorvastatin.Atorvastatin is in a group of drugs called HMG CoA reductase inhibitors, or "statins." Atorvastatin blocks the production of cholesterol (a type of fat) in the body.Amlodipine is in a group of drugs called calcium channel blockers. Amlodipine relaxes the blood vessels, improving blood flow and making it easier for the heart to pump.
Caduet is used to treat high blood pressure (hypertension) or chest pain (angina) that occurs with high cholesterol or triglyceride levels. Trigeminal neuralgia? It is also known as tic douloureux, is a pain syndrome recognizable by the patient's history alone. The condition is characterized by pain often accompanied by a brief facial spasm or tic. Pain distribution is unilateral and follows the sensory distribution of cranial nerve V, typically radiating to the maxillary (V2) or mandibular (V3) area. At times, both distributions are affected. Lunch time spent in cafetaria with all IMU students including Elaine, esther and Joyce. After lunch, attended a X-Ray conference with all the doctors including Dr. Wong, Dr. Lei, Dr. Lim, Dr. Haruth, Dr. Loong, Dr.Bujang. Hmm...need to research on few things later...Science,physics and principle of 4 diagnostic imaging-MRI, CT scan, Ultrasound, plain X-ray, whipple's disease, SOL (Space Occupying Lesion), Sagittal Sinus thrombosis, Cholangiosarcoma. Tomorrow will be sent to Lab and x-ray department and there will be a Tumour Board Conference...

Lesson of the day:

Dr. Peter Wong's action:

Tap patient on the shoulder, lol!!!


P/s: Haih...no movie, yamcha!!!!

Types of Diagnostic Imaging

Magnetic Resonance Imaging (MRI)


MRI is a noninvasive medical test that helps physicians diagnose and treat medical conditions.

MR imaging uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. The images can then be examined on a computer monitor, printed or copied to CD. MRI does not use ionizing radiation (x-rays).
Detailed MR images allow physicians to better evaluate various parts of the body and certain diseases that may not be assessed adequately with other imaging methods such as x-ray, ultrasound or CT scan.

Computerized (Axial) Tomography





CT scanning—sometimes called CAT scanning—is a noninvasive medical test that helps physicians diagnose and treat medical conditions.

CT scanning combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. These cross-sectional images of the area being studied can then be examined on a computer monitor or printed.

CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity and reveal more details than regular x-ray exams.
Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as cancers, cardiovascular disease, infectious disease, trauma and musculoskeletal disorders.

Ultrasound



Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use ionizing radiation (as used in x-rays). Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.

Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions.
Conventional ultrasound displays the images in thin, flat sections of the body. Advancements in ultrasound technology include three-dimensional (3-D) ultrasound that formats the sound wave data into 3-D images. Four-dimensional (4-D) ultrasound is 3-D ultrasound in motion.

Doppler ultrasound is a special ultrasound technique that evaluates blood velocity as it flows through a blood vessel, including the body's major arteries and veins in the abdomen, arms, legs and neck.

There are three types of Doppler ultrasound:

•Color Doppler uses a computer to convert Doppler measurements into an array of colors to visualize the speed and direction of blood flow through a blood vessel.
•Power Doppler is a newer technique that is more sensitive than color Doppler and capable of providing greater detail of blood flow, especially when blood flow is little or minimal. Power Doppler, however, does not help the radiologist determine the direction of blood flow, which may be important in some situations.
•Spectral Doppler. Instead of displaying Doppler measurements visually, Spectral Doppler displays blood flow measurements graphically, in terms of the distance traveled per unit of time.

Plain X-Ray




X-rays are very short wavelengths of electromagnetic radiation that can penetrate matter to produce an image of bones and internal organs. X-ray images are tools used by physicians and practitioners to confirm a diagnosis or a clinical finding such as extremity fracture or pneumonia.

Most x-ray examinations consist of at least two views of a body part at right angles to one another. X-ray dye or contrast mediums are used in some examinations to make certain structures, such as the kidneys or bowel, appear visible on an x-ray image. Other imaging techniques or procedures such as nuclear medicine, ultrasound, MRI, CT, or PET (position emission tomography) may be necessary to view anatomy or to determine a diagnosis.

8th Day of Elective

2day woke up at around 9am, shit, going to be late, luckily could make it on time before Dr. Lim came to the office, haha. Was with Dr. Lim the whole morning. Saw colonoscopy and gastroscopy.Colonoscopy found a polyp and diverticuli. Gastroscopy discovered an erosion near the pylorus end and some abnormal mucosal (suspect of Helicobacter pylori but the urea test was negative), acid reflux into lower part of esophagus causing some inflammation.This is the first time for me to see gastroscopy.Putting endoscope from the mouth is really torturing, have to swallow the endoscope and cannot have any vomiting reflex. Hmm...so how long is the rectum?? 6 inches...what other structures are 6 inches? Well, duodenum, ureter and even an erect penis.Remember, diverticuli are always adjacent to the taenia, because it is the place where the blood vessels going into the mucosal layer, so that's the weakest point and is prone to Diverticuli (Outpouching of the gutwall). What is the complication of diverticular disease? Hmm...start from the most important 1 first- Diverticulitis, then bleeding and then perforation. Treatment-high fibre intake to soften the stools, antispamodic(anticholinergic) drugs to relax the smooth muscle of the gutwall. There are 2 types of diverticuli-left and right. Sites prone to it is cecum (in Asia) and sigmoid colon(in UK/US??). Risk of inflammation is higher for the left diverticular disease because of the harden stool instead of watery stool which can cause blockage and inflammation. Well, we also were asked about left and right vagus nerves, muscarinic and nicotinic receptors. Saw 2 surgeries today. First surgery is ORIF (Open Reduction Open Fixation) of the right humerus and biopsy.Open reduction internal fixation is a method of surgically repairing a fractured bone. Generally, this involves either the use of plates and screws or an intramedullary (IM) rod to stabilize the bone.It was done by an orthopedic surgeon-Dr. Francis Ting. Second surgery is a heart surgery. It is to close up an ASD (Atrial Septal Defect) on a young man. We missed the cutting open the sternum part, but can saw the pericardium, heart was pounding, cool!!There were a lot of blood pumped out into the machine.Traditionally,Coronary artery bypass graft (CABG) surgery is performed with the assistance of cardiopulmonary bypass (Bypass machine, formerly known as heart-lung machine). The heart-lung machine allows the hearts beating to be stopped, so the surgeon can operate on a surface which is blood-free and still. The heart-lung machine maintains life despite the lack of a heartbeat, removing carbon dioxide from the blood and replacing it with oxygen before pumping it around the body.


Lesson of the day:

Dr. Lim (General Surgeon) & Dr. Francis Ting (Orthopedic Surgeon) said:

ANATOMY is very important!! We suck in anatomy because our teaching system is different from others. We learnt by system so there will be missing gaps in our knowledge of anatomy.As a surgeon, you really need to know the anatomy well so not to injure any vessels or nerves around the part you are going to operate on...

p/s: Sunny Hill Ice-cream, yummy!!

7th Day of Elective

1st day of the new week, I was attached to a neurologist, Dr. Kho Lay Kun. Well, she is a very nice doctor. She taught me a lot of things. I followed her to visit around the wards to see patients. First case is a patient present with dysphagia, a bit of confusion, stroke. The brain screen showed that 70-80% of brain vessels had been damaged and there were silent infarcts, the patient will then treated as TIA (Transient Ischemic Attack). The patient went home, had another similar episode, but now present with unilateral stiffness of the limbs and some jerking. It is then confirmed to be seizure. Stroke is divided into 2 groups- Blockage and Hemorrhage. TIA is classified into the blockage group. When the vessels suddenly got clot up, the patient suddenly suffered from lack of oxygen in the brain. After a while, the vessels open up but some tissues already suffered from ischemic. I got to visit rehabilitation centre. There were physician helping patient to do exercises. I saw my secondary teacher with her husband there and a poor baby. The baby has one side cramp leg. Another interesting case is a woman came with loss of left supraclavicular fossa.She couldn’t elevate the left shoulder too. Chest X-ray was taken but showed no masses and ultrasound was taken and it showed muscle hypertrophy. What causes hypertrophy. 1st: Exercise too much (Unlikely because impossible only exercise one side of shoulder), 2nd: Recurring damages to the muscle, hypertrophy by repairing, 3rd: Abnormal growth of muscle (Tumour)-very rare disease. The woman said the disease is progressive. So, if it is a tumour, muscle tissue biopsy need to be taken to determine the malignancy of the tumour.I saw a case of tension vascular headache, epilepsy, adverse effect towards contrast used in colonoscopy, moderate Alzheimer's disease, epilepsy, etc. And, one more interesting thing that happened today is I got sent by Dr. Kho to Dr. Ching, neurosurgeon. At first, when Dr. Kho said I can follow the neurosurgeon to know more a bout the case, I felt very happy because for me, neurosurgeon is like damn pro and cool. However, when I saw him and just suddenly realized that the neurosurgeon is actually Dr. Ching.Lol, it scared the hell out of me. Well, fyi, Dr. Ching is the medical director here, he don't like medical students. He shouted at Natasha and Gaik Si before and he told Dr. Lim before that he didn't want to see us in his OT. Lol. But, there was nothing happened. He just asked me: What's your name? Where r u from? Are your parents doctors? Have you learnt CNS? I told him I just learn the basic and he shot me with questions. What are the 12 cranial nerves? Which 1 is sensory, which is motor? What are the branches of facial nerve? Haih...I couldn't answer most of them, swt! The case I saw in his room is a rare disease, known as Tolosa-Hunt Syndrome.In Tolosa-Hunt syndrome, inflammation of the cavernous sinus (behind the eyes) causes severe eye pain and irritation or damage of the nerves of the face.Tolosa-Hunt syndrome begins with severe pain behind or around one eye that comes on suddenly. The pain can be constant and intense. As the sinus inflammation increases and spreads, nerves in the face can be affected, producing symptoms such as drooping eyelid (ptosis) of the affected eye or numbness and tingling in the forehead. Difficulty controlling eye movements (ophthalmoplegia) and the pupil may cause sensitivity to light and double or blurred vision. If left untreated, vision loss is possible. I saw the patient's eyelids are dropped and had to be lifted up using celofon tape.It can be treated with steroid medication such as prednisone but some do have recurrence of the Tolosa-Hunt Syndrome. O ya,Dr. Kho also brought me to visit the library and relaxation centre, hehe!! Neurologist and neurosurgeon r really smart!


Lesson of the day:

Dr.Kho (Neurologist) said:

Medicine is not straightforward,
Sometimes you cannot find the definite diagnosis,and it stresses you up.
But don't worry, TRUST your judgement,
Let time to proof everything, closely monitor the progression of the disease.
Don't ever let patient's opinion to affect your decision,
For what we did we believe it's for the good of patients!!!




P/s: There was a war outbreak early in the morning, haih...

A Free Sunday...

Duke
Ana


Sunday is a good day. It's day for you to unwind yourselves, relax fully. Today we can wake up very late compared to normal day,hehe.No elective. Went to sing K with Chiang Lung and his friend, Faye, Gaik Si and Natasha at Popwave 2. Lol, most songs were sand by me, Faye and Chiang Lung, swt. Went to Boulevard after that. Had my dinner there, while others want to have dinner at Richmond (Western Restaurant). Went to Star to buy ticket first, then rushed to Richmond to eat, then hustled back to Cinema to watch GI Joe. It's a very nice movie, caught your attention for every actions they have. And there are lots of lenglui inside, lol. Hmm...storyline not bad too, graphic very cool. Rate it 4.2 out of 5.0. Must go and watch it when you all are free wor. Went to Open air market to eat Sio Bee and soya milk!!! Day end....

6th Day of Elective

2day is Saturday, but we still go to Normah Hospital, but it's half day only. Reached Normah at about 9.25am, saw Dr. Kho performed flexiblescope. The patient was very nervous, complaint of dysphagia for 1-2 years, but on and off, he said the food can be swallowed, but he felt something stucked inside the throat. There are no cough, no epistaxis, ear and nose function normal. The doc investigated and found everything is normal and good, it's probably due to the stress the patient had, or what we called Psychosomatic Syndrome. We then got to see colonoscopy screening test. The woman's mum had colon cancer, so she came here to check for tje colon, the endoscope went in until ileocaecum valve, Doc found a quite big polyp (5mm)and took it out to be sent for laboratory testing. I went to Ophthalmology department and met Dr. Dennis Kong. Saw a diabetic patient with diabetic retinopathy. The patient suffered from macular hemorrhage at quite severe stage, need urgent laser surgery to prevent leakage, blockage or abnormal angiogenesis of the eye blood vessels.So for every diabetic patients, control your blood sugar level and get your eyes checked every year before it's too late!!! Common eye diseases including Glaucoma and cataract too..Learnt quite a lot from Dr. Kho today, a kid came with parents. He had epistaxis (nose bleed), the parents were so worried. Dr. Kho said in this case he is treating the parents, not the kid, lol! In children, epistaxis is very common, it's spontaneous, self-limiting and most probably caused by burst of vessels on near the nasal openings, so there is no serious problem, just need to know what to do when there is nose bleed, press on the correct position and tilt your head slightly downwards, press till the blood stops. Besides, we got to see NPC (Nasopharyngeal Carcinoma). Common signs we can see are cervical swelling, history of nose bleeding, unilateral conductive deafness, eustachian tube blocking with fluid in middle ear. How to differentiate it from parotid gland infection? By pressing on it, if your fingers can get in between the mandibular bone, then it's unlikely to be parotid gland infection, it will be NPC. We got to meet the case of hemorrhoids, phylloides tumour (mostly benign rarely malignant), hirsutism, polycystis ovarian syndrome and etc. Went back at 12.30pm today, wohoo!!!! Later will be going Damai Beach..


No OT today!!!

Lesson of the day:

Dr. Dennis Kong (Ophthalmologist) said:

In Medicine, History taking is very important, 70 % of the diagnosis comes from the history!!!!

5th Day of Elective

2day was a sleepy day, didn't get enough sleep I guess. Went to Normah at 7.30am to see birth C section, first entered the OT but were chase out by the Head of OT because the patient not willing to let us see, then went to the next room,luckily the allowed us to go into the room. The surgeon is Dr. Elizabeth. Super excited first time saw newborn was taken out from the abdomen, cool!!! This case is a bridge presentation, placenta privia (Placenta blocking the uterus), CVD (Cephalo-pelvic Dysfunction), so natural birth is not possible as it may rupture the scar. The legs came out first, then followed by buttock, body, hands and finally head. The baby was immediately suppplied with oxygen mask to help him breathing. After a while, we can hear the baby's cry. So cute the baby!!!Amniotic fluid + blood are 950ml, measured by the container. Second surgery we saw is excision of neck node. The patient is conscious though, and she was quite nervous, the doc injected local anesthesia to numb the area of operation, there was 1 time when the doc cut the artery and the blood ooze out, lol! The group of neck node was quite big, around 2.5cm, whitish and red in colour. Third surgery we saw on today is Mastoidectomy (Removal of mastoid bone-because of chronic middle ear infection), Dr. Kho showed us the chordae tympanic, remnant of Incus, malleus, mastoid cavity, middle ear cavity, Dura layer of meninges. In this case,the stapes had disappeared already. We could see the outer ear was twisted 90 degree, from vertical to horizontal, quite gross though. OT was damn cold, that's why when we had our lunch in cafe, we were sitting outside to photosynthesis, lols, everyone was looking at us, including all the doctors. We also got to see ESWL again this time,there are different types of stone blocking the ureter>If the patient has staghorn stone or if he/she has scoliosis(will push the stone near aorta), the stone cannot be blast as it will cause complication such as hematoma and the patient will suffer from renal injury. Today we got to clerk a patient suffered from appendicitis, saw a patient with Grave's disease---with features enophthalmos, slightly enlarged throid gland, decreased appetite. Upon investigation of throid test, T3-increased, T4 normal, TSH decreased. Hmm...quite cool too to see this case. We had seen 1 case in the ENT department. The guy complaint of ulcer in the mouth,painful while swallowing, snoring loudly while sleeping and sometimes will choke, this is quite a serious condition. Upon doing mouth endoscopy, the doc found out he has very large tonsils, with infection which explained why he had loud snoring and choking because the tonsils had block the airway when sleeping. The doc suggested tonsillectomy. We went back home early today!!! Yahoo, can sleep, and I slept from 3.45pm to 6pm I guess..hehe.

Lesson of the day:

Dr. Kho (ENT Surgeon) said:

For early years medical students, FUNDAMENTAL is important. U need to build your fundamental nicely so that it can help you to achieve higher. Power of observing is also one of the important element. You need to learn how to observe subtle changes.As a doctor,safety of the patient is paramount!!!....so guys and girls, now start to build up your fundamental so that your medical pathway in the future will be smooth and easier!!

It's not the quantity of sleep you have is good, but rather the quality of sleep!!
Some people sleep a lot but still feel tired in the morning because they were always in stage 1 and 2 of sleeping stages, which is known as shallow sleeping level.


I want to sleep adequate & well!!! Sleeping is the best thing to do!!! ZZZZzzz......

4th Day of Elective

2day is slightly different,we were sent to the department which we are going to learn in Sem 4--Reproductive, so things are not that familiar. We were divided into different docs under O & G department. Faye and Matt are under Dr. Azizah, Gaik Si & Natasha are under Dr. Elizabeth and I am under Dr. Suriah. Gaik Si and Natasha got scolded by Dr. Elizabeth for coming late, supposed to come at 7.30am, but we thought 9am, btw, we only came at(9.30am because I overslept and only woke up at 9am,lol). Dr. Suriah is a kind doc, she taught me quite a lot of stuff, seeing 3 cases with her.I joined Matt and Faye with Dr. Azizah after 11.30am, and I have learnt some more from Dr. Azizah. After that, we went out to have lunch at KFC. We went back hospital at about 2pm and see Dr. Lim,we supposed to follow Dr. Suriah but she went back because she was not feeling well, so we were assigned to Dr. Khor (ENT Department). He was my dad's doc. He showed us an overview of nose, ear, throat pictures of pathology, and some of them are really gross, but yet quite exciting. We followed him to walk the ward after that to see 2 patients. One is with down syndrome suffering from chronic middle ear infection, pansinusitis, had surgery edy, but have cholesteatoma affected both sides ear drum, need to do surgery again in the future too, damn pitiful. Down's syndrome patiet is more likely to suffer from middle ear infection because of their configuration of eustachiann tibe (more horizontal), second case is sinus operation, what is important in ENT is Media turbinate (especially the middle 1, cannot be observed directly by looking into the nose). We have learnt quite a lot from the gynaecologists. Hmm...What is CA125? It's a tumour marker for Ovary cancer,What is the term used to decribe decrese in motility but normal count of sperm? Asthenospermia... how to count expected delivery date? What is para? What is gravida? 2day we got to see a surgery too, BCF (Brachio-cephalic Fistula), damn cool can see the surgeon cut open the skin and expose the vessels, then tie them up and sew them together, the operation took up to almost 2 hours. The patient was conscious. The vessels were sew using non-absorbable wire because vessels, joint, etc heals slowly, absorbable wire will cause rupture of vessels. Hmm...a cool day for me too!!!! Anticipating to see a C-section delivery tomorrow if possible!!!

Lesson of the day:

Dr. Suriah (Gynaecologist) said:

You don't have to score 4 A's to be a good doctor, but rather to have interest in it!!! If you like the subject very much, you will still excel well in this field. Although the top student scored well, but if they din't like it, they will not be a good doctor too or will give up in the end. There is a real story that a top student gave up medicine when he was in housemanship and wanted to work in a bank. He was overqualified for that and got rejected.He was finally back to medicine field after advised by friends. The act of giving up on medicine would have been avoided if we just simply like Medicine!!! So,dear medical students, if you really like medicine and have a passion in it,no matter not so well or average you scored in exam,don't worry,you will sure excel well in this field in the future!!!!


P/s: Ivory gave birth to 9 puppies, but 1 died...sad.

3rd Day of Elective

I am super tired today....u know why? because I woke up at 5.30am, then just sleep back for a while (not really sleep) and get up at 6.10am to prepare. Today there will be a surgery at 7.30am. My dad fetched us to Normah this morning, and we were not late for the surgery! This time is Cystoscopy for ureterocele + vesico-litho-tripsy (urinary bladder-stone-cut off). The cystoscopy went through the urethra into the urinary bladder showed that there is a elevated mucosal surface containing stone, at the right ureter orifice, the stone had partially blocked the orifice and causing pain, so it needed to be removed. The operation was very short and fast. Just break the mucosal surface and suck out the stone..well, the stone is quite small compared to gallstone. If a young patient comes with dysuria, pain when passing urine,it's probably because of blocking of the orifice by the stone. If the patient has repeated UTI, just do ultrasound to investigate! And 2day I saw 3 more operations. Amazing huh? Haha, Faye, Natasha and Gaik Si they all saw 6 operations le.I missed those 2 operations including spinal surgery(cut open vertebrae segment disc) and AVF. Btw, the second operation I saw today was take out foreign bodies + suturing. The wound is quite huge and open and the surgeon can't really seal it up completely as there is lost skin, moreover can drain the pus if left open 1 small hole. Dressings need to be changed often. H2O2 (antiseptic) was used to wash the wound before the suturing was done. Straight after the 2nd surgery, Doc proceeded to do the 3rd surgery for me of the day-appendicectomy. Where's the Mc. Burney's Point? It's 2/3 medial from the line from the umbilicus to the ASIS. It's the place to cut open the skin. We could see different layers before reaching the appendix...from skin, then superficial fascia, external oblique, tranverse abdominis, internal oblique,transversalis fascia, extraperitoneal fat. The appendix was cut off and suturing was done using absorbable type. The appendix appeared to be quite normal but it's causing pain to the young man. The last surgery of the day for me to see was stenting to dilate the ureter so that the stone in the calyx can flow out when passing urine. This case was the same as the case which the woman wants to do ESWL but failed. This operation finished very soon too. O ya, we need to go out for a while the X-ray was taken after the contrast was pumped in, if not our balls will be cooked, lol!!! There was a brain surgery-Craniotomy + Excision of Left Meningioma which require 8 hours long operation by expert doc, we followed Doc to go in but the neurosurgeon said to the doc if you don't mind I don't want to see them here, he is a fierce doc who don't like medical students, I wondered why? Natasha, faye and gaik Si were shouted and scolded by him today. Smart people really weird la...Hmm...other interesting things are Me and Matt followed Dr. Teo to visit patients at ward. I like the way he explained to patients,he explained clearly and makes patient satisfy,although sometimes he used too much medical jargons, haha! He alao asked us what we think about H1N1 and discuss the different views/perspective between politicians and medical doctors. He taught us about the basic of medicine, how to think as a medical doctor, hmm..that's very good. The cases at the ward including Polyarteritis Nodosa, SLE likely, renal failure, hepatitis A suspect,multiple myeloma related, diabetic patients, acute dengue fever + breast cancer. Why we need to change normal saline drop to dextran sugar to diabetic patient who is fasting? It's so that they will not use up amino acid which will cause diabetic acidosis. O ya, today 1pm we also went into the conference room and sat at the side to listen to various surgeons, radiographer to discuss about the cases and X-ray slides, although we still not understand completely what were they saying, but it's kind of cool!!!

Lesson of the day:

Dr. Gabriel Teo (Physician) said:

What is the Basic of Medicine? It's....(9 letter words)..DIAGNOSIS!
Without diagnosis we cannot really do anything.For example in the case of H1N1, the hospital just always reject the cases and push them all to GH becasue they don't have a test to do and confirm DIAGNOSIS...H1N1 needs laboratory diagnosis, but not clinical diagnosis. Hence, the test is really very important. With diagnosis, everything becomes so easy in medicine because it's all written down. The books teach us management and treatment but not diagnosis, we have to learn it!!!! So do diagnose Correctly wor!!!!! But there is exception too, when we fall into situations where diagnosis cannot be made and patient's life is in danger, then we have to guess the diagnosis according to experience so that to save patient's life.

Stages of anesthesia on patient

Stage 1---Conscious
Stage 2---Stage of excitement, inhibits thoughts, will cause laryngeal spasm, usually want to skip this stage
Stage 3---Unconscious
stage 4---Patients die

3 components of anesthesia

1. Conscious
2. Lack of pain
3. Muscle relax


p/s: Canteen's food sucks, lol, I accidentally ate chicken's butt, swt!
Went for fish spa today!

2nd Day of Elective

2day is great too!!!! Reached the hospital at 8.35am, rushed into Dr. Lim's room, thought that we were late, but there was no one inside, lol. The nurse told us the doc usually come at about 9.30am, swt. So we just sat there, then wandered around the hospital to kill time. Finally, Dr. Lim came. Yeah, went inside the room,a old lady came in, complaining about pain from the back down to the front right iliac fossa, and progress down the right leg 3 days ago. Past medical history involves gallbladder operation. There are some cysts in her kidneys(bilateral). The doc said that the pain most like ly not due to back bone pain.A male patient came in, complaining of recurrent swelling and discharge of perianal fistula. Last time he saw Dr. Lim was on 2002, then between 2002-2005, everything is cool, but after that the problem returns. He is a busy person, so he bought cream to apply and it does help to relieve the pain. MRI need to be taken to locate the fistula ulcer of where is it links to, if it is a low fistula, then simple surgery will be done.If it is a long fistula, then more complicated surgery need to be done. We then got to see Colonoscopy.It is like playing a video game, doc's hands need to be agile, haih...I wish I can train my hands more. Midazolam(generic)-Dormicum(brand) was given to the patient before the colonoscopy was done. They found some polyps inside and took it out for biopsy, no tumor was detected.Guess the yellow thingy are what? They are faeces, haha! Besides, that, we got to see the machine for ESWL (Extracorporeal Shock Wave Lithotripsy)-a technique that employs high energy shock waves to disintegrate urinary stones in the body into fine particles so that it may pass spontaneously out of the body through the urine. The procedure was stopped when the X-ray taken showed that the location of the stone is not consistent, so they need to take MRI first to locate it. Side effect after the procedure is usually haematuria 2-3 times a day but will disappear spontaneously after few days. O ya, we got to see Laparoscopic Cholecystectomy on an old women , it is damn cool wei. Imagine watching live to see how the surgeon trying to burn the fats around gallbladder, clip the cystic duct and cystic artery, cut them, twist here and there, operation took over 1 hour, again the surgeon is playing video game again, haha. We got to touch the gallbladder and gallstone. The stones are black, very hard and with irregular surfaces, wow...



Hehe, 2day we also got free lunch, thanks to the Clarithromycin Talk!!! The talk focused mainly on the Immunomodulatory effects of Clarithromycin, almost all the specialist docs were present there, wow...cool!! We followed Dr. Tang (Cardiologist) to visit ICU (Intensive Care Unit). There was a patient who admitted the day before because of acute MI. The doc is good, he taught us how to think and make diagnosis, for them, when the phone call came, said patient came in after badminton,Complaint gripping pain,breatlessness, sweating, low BP, the doc then said OK, hang up the phone then straight away drive to hospital,ECG graph pattern, angiogram picture of the heart vessels were all printed in his head and to no surprise edy, damn cool...He helped the patient to do angioplasty and the blood can then flows through. Time is myocardium!!!! Every seconds count, the more you delay the time, the more heart muscles will damage, that's why time is really very very important in CVS case.How you going to explain in lay man term to the patient if they don't understand? You just use to describe the house (heart) is on fire(damaging in process), can you ask the Bomba to come 2moro (recover the vessels), nope right?? haha...Dr. Lim bombed us with lots of questions(medical and non-medical)--What is dermatome? How many segments of spinal nerves and spinal veterbrae? Where we did our Pre-U course? What we got for our Pre-U course? Is EOS 3 tough? What we got for it? Lol, we didn't answer the last question.


Lesson of the day:

Dr. Lim (General Surgeon) said:

Medical students should learn how to internalise the information and knowledge, not just study for exam. Know the significance of it!!! We cannot forget the knowledge after we have studied. They are all important to save lives!!!!

Typical Malaysian students are afraid to ask, shy. We should talk more, don't be afraid of wrong but dare to ask. Don't let the language difficulties or barriers prevent us from asking! There is no harm but only gains in asking more questions!!!!

English is a very important language especially for overseas students. We must master the language itself. Communication skill and teamwork are vital. without them, no matter how knowledgeable you are as a doctor, you are guaranteed not a good doc and no one will like you.

Acute Coronary Syndrome: Unstable Angina, ST elevation of MI, non ST elevation of MI

Why is surgery only developed after (Year 1820-1840??) in Sarawak---because anesthesia was introduced!!!!Haha,Dr. Chew (Anesthetist) really proud of it!!!


2moro going to see surgery to remove the stone in the ureter in early morning, haha!! Cool cool! 2moro we will be splitted, I will be under Dr. Teo (Physician + partial cardiologist), Natasha will be under Dr. Lau (Haematologist) and Gaik Si will be under Dr. Tang (Cardiologist), wish us luck!!!

A Transit Period

Jenna said:

I have just discovered that not only are you soon going to live through an event of great astrological importance but also that you were going to blessed with a period of chance and opportunities

A Transit period is on the way and you are perfectly positioned to get the very best out of the opportunities it is set to bring . This is very clear in your astrological configuration and to be honest in a very short time indeed you will find yourself in the glare of several powerful astrological influences. These influences will place you in a rare astrological Transit which will not occur again in your skies before a very long time.

During this period you can expect some very positive financial changes in your life. It seems that one very important opportunity will be made to you and this opportunity is linked to an unexpected sum of money. As a matter of fact your astral configuration shows me that this sum of money should allow you to finish a project which you have been thinking about for a long time. 3 main points stand out clearly:

- First of all, you must realize why this period is so important for you and this is simply because these 30 days are linked to a large sum of money
- It seems that this sum of money will help you with your projects, ambitions and investments
- At this stage of my analysis it is difficult to say exactly how you can get hold of this sum of money but it seems that it is linked to a notion of games or lottery. You will certainly gain this sum when you least expect it and this will also be a moment when your natural chance and good luck are boosted to their maximum. This does indicate a win through a game of some sort.

This period will be very important for you on a whole range of different levels however as far as your love-life is concerned you can expect some great news and you will experience an intense joy! You are going to have the opportunity to reach a new turning point in your life, and you can expect changes in your relationship with this special person you have in mind. This will all happen in a number of different stages which will take place during these 30 days and it is very important that you know exactly how you should act to make the most of these moments. I must warn you however that you could encounter certain difficulties which may try to prevent you from establishing a relationship with this individual but don't worry, you will be able to overcome them. You just need to be aware of everything that is set to happen.

You need to be ready to seize all of the opportunities which are going to be open to you during this period as it represents a real chance in your life!

Is it really true??
Hmm...

First Day of Elective

Hmm...first day of elective,I have realised that how much I didn't know about medicine. I have discovered that my all Sem 1 & Sem 2 medical knowledge had gone edy, even the Sem 3 medical knowledge already broken into pieces, can only recall few parts of them...sad, kena shot with questions badly, but I know it's good!!!It's a way to train us,to make us feel stress,to motivate us,to tell us that the pathway to become a doctor is not easy.It really needs a lot of effort and hard works.It needs constant self revision, better with passion and enthusiasm. I am happy, today is my first time to enter into OT (Operating Theater), get to stand at one side to observe doctor excise a lump at patient's left cheek.He cut open the lump,pus filled the cavity and he drained the pus out, using forceps to take out some granulation tissues to be sampled and investigated. Quite cool..The patient is a small kid who fall down and the toothpick pierced through the left cheek. It gets infected and grows bigger after 2 months.We visited the relaxation centre (Got massaging service wor), oncology department (Doc is away..lol).We also got to see ultrasound on a woman's abdomen---we can see gallstone which casts shadowing on the ultrasound. Besides, we got to see the doctor performed live Digital Rectal Examination, GIT Examination to check for tenderness, BS station (The mum almost cry out dy when the doc said his son has alpha-thalassemia, she said: " We know that there's something wrong with him, but we can't do anything to it???" , really very sad. But, thalassemia only causes problems if marry to someone who is thalassemia too la, so dont worry too much ya..the kid also complaints about having pain (location not consistent upon GIT examination) on the abdomen,which according to doc , this is quite common among young kid because some has school phobia or stress but this kid has none of them, haha! So, the reason is unknown. But hope that he will get well soon.. We also got to visit cardiologist--Dr. Peter Wong, a very funny doc. Wish I will be like him after becoming a doc. He asked us to read pulse---important!! Rate, Volume, Character, Rhythm and 1 more, he himself also forgot. He also asked us to read ECG, stress test graph (3 stages), teached us how to read Chest X-ray (Heart failure case and pulmonary edema case). Moreover, we got to see perianal absecess, ERCP (Endocopic Retrograde Cholangiopancreaticography)---it will cook the eggs(don't ever play play wor), cabuncle on diabetic patient (Cut open to drain out the pus). We were shot with a lot of questions, such as what is CNS? How to detect virus? How to diagnose thalassemia? what is cabuncle? Treadmill test, what type of protocol used? When to stop the treadmill test? How to interpret the result? What is normal and abnormal graphs? About Helicobacter Pylori. Fews about anatomy...etc. Hmm...2moro there is AVF(Arterial-venous Fistula) to see, I guess...wohoo..


To all the medical students,

Dr. Lim (General Surgeon) & Dr. Tang (Cardiologist) said:

In medicine, the terminology is very important!!!
The term itself is very precise, they hold the same principle, concept.
The meaning of the jargon is all worked out, we just need to know clearly what our term means.
And, you just need to know a little bit about everything.
Only when you specialize in the future, then only you need to know a lot about the particular field you have chosen,
So, this is
MEDICINE....


Looking forward for 2moro!!!!