Misi Jubah Merah 2012: 2nd posting-Internal Medicine

I've reached the end of my 2nd posting which is Internal Medicine. In 7 weeks we were devided into 3 groups and posted to HUKM, Hosp. Teluk Intan (HTI) and KL General Hospital in rotation of 2 weeks each. Every hospital has its own different approach & experience. So, a quick adaptation to the environment is important.

My experience for IM:

1. Hospital UKM (HUKM/PPUKM)
since this is our prime hospital, we were expected to be ready & be the best. So, most of us are more 'rajin' here. I went to the ward morning, evening and night....with breaks in between. We are entrust with 6- 7 patients per person and expected to know the patients condition & daily management. We are expected to help the housemans doing minor procedures. Follow the rounds and present any new case (thats why we need to come every night to cover the beds).. However, it depends on the Medical officer or specialist. Not all of them expect or wants you to present.......

2. Hospital Teluk Intan (HTI)
Shall i say it as a vacation??? haha...I might after 2 weeks of so call 'hardship' at HUKM. We are send to Perak and stays at a terrace house with given a driver to pick us up. Acceptable accomodation & service given by UKM. HTI patients and medical staff are nice...I mean VERY nice. It is obvious especially the nurses if i compare it with PPUKM nurses. They are VERY nice. Now, I've said it twice. Better not to 'mengumpat' here, coz my life will be miserable in HUKM if i wrote it down. The patients respect you and very humble. However, i do notice some language difference. They are not city people. Therefore, the words we choose must not be too formal. Not all, but most of them...

3. General Hospital (HKL)
We were send here to do Dermatology for a week and general medicine for a week. HKL is a very busy hospital. And yes, the nurses are NICE too even they have twice more patients than HUKM....(ok tak nak mengumpat disini pasal nurse HUKM).The general ward gave me a lot of experience with HIV and intravenous drugs users (IVDU) patients. In HUKM i rarely seen them. In HKL they are admitted almost everyday.There are also a lot of TB patients.

Dermatology was also intresting...Get to see various type of psoriasis, Herpes Opthalmicus and Lepramatous Leprae. Others are contact dermatitis and venous stasis..

Thats all for Internal Med....Next stop is SURGERY...The list is out. I'll be in Hepatobilliary team..wish me all da best (>,<)

Unintentional Weight loss in elderly: Should we be worried?

Salam,

It my 2nd week of posting in Family Medicine & Society (FMS)....

Last week, I our weekly Clinical Pathology Conference (CPC) in UKM Medical Center was presented by FMS department. The main topic was about Isolated Unintentional Weight Loss in elderly.It is a diagnostic challenge for the doctors in primary care ( clinics/ general practitioner) since it can be either apart of aging process or pathological. The doctors cannot just simply refer to specialist.them without knowing the reason to do so.

Clinical scenario:

A 71 years old Malay lady, married with 4 children with background history of chronic illness under medication & follow up
* hyertension for 30 years
* diabetes mellitus (DM) for 6 years
* hyperlipidemia for 6 years

There was a history of stroke in 2005 (6 years ago) that was treated.
She also had peptic ulcer disease.

Current problem:
She came to primary care (klinik kesihatan) with problem of loss of appetite and loss of weight for 2 months.
No fever or sign and symptoms pf Upper respiratory tract infection (URTI) and Urinary tract infection (UTI).
She was not depressed.

On physical examination: she is pale but no other abnormalities found. There is no lymphadenopathy.

Investigation on occult blood test: negative

Ultrasound of the abdomen does not reveal any abnormality.

Management at Primary care:
* come again to the clinic in a week.
* with-hold Oral hyperglycemic agent(OHA) since she is hypoglycemic
*continue hypertensive medication
*communicate with family members: bring patient to the nearest health care center if the patient is deteriorating.

HOWEVER>>>>>>

A week later, her condition suddenly worsen and she deteriorates. She is jaundice. Immediately,she was admitted to the medical ward in the hospital..

Further investigation was done and the rults as follows:
*Low Hemoglobin level
*Occult blood test positive
*Increase CA19-9 tumor marker
*Increase Liver function test (LFT)

Final diagnosis : Periampullary carcinoma metastasis to gastric mucosa with obstructive jaundice and impending gastric outlet obstruction...

(what an unexpected complicated diagnosis??....)

Prognosis: The patient had Whipples' Procedure surgery and biliary stenting via ERCP.

click here for the Source of photo

ISOLATED UNINTENTIONAL WEIGHT LOSS IN ELDERLY
Definition: Weight loss of >5% over 6 months (as high as 15-20% in >65 years old)

It's always present with other problems (in this patient: DM, Hypertension, hyperlipidemia). However, there is NO published guideline to manage it.

SO,(in primary care context) either (1) do nothing and accept it as aging process or (2) refer patient for further investigation and management.
What may be the cause???

(1) the most fearful one : MALIGNANCY
(2) should be worried but it is treatable if manage early : NON-MALIGNANCY (60% of the cases) eg: chronic disease(ie DM), Tuberculosis infection.
(3) PSYCHIATRIC ILNESS (10-20% of weight loss) eg: depression
(4) not to worry: ANOREXIA of AGING- physiological change due to decrease smell, taste, chewing and periodontal disease.criteria: 0.1-0.2kg per year.
(5) IDIOPATHIC (25%) unknown cause...

So,
The risk factor for MALIGNANCY(cancer) are Male, increase weight loss, decrease hemoglobin, increase erythrocyte sedimentation rate(ESR), increase ALT,increase LDH
Tumor marker in not the initial investigation, but it it is useful (like in this case)

What can we do if a patient comes to you with unintentional weight loss??

(1) Full history taking
(2) physical examination
(3) investigation: Full blood count (FBC), Renal profile(RP), Liver function test (LFT), ESR/CRP, Chest X-ray, Stool occult blood test.(in there is suspicious/abnormal finding, refer the patient to respective specialist.However, if the findings are normal,observe the patient 3 months later)

Source: notes taken by writer during weekly Clinical Pathological Conference(CPC) on June 15th by Family Medicine & society (FMS) at Universiti Kebangsaan Malaysia Medical Center (UKMMC)

Sites for futher information:
(1) Evaluating and treating unintentional weight loss in Elderly patient-American Academy of Family Physician
(2) An approach to management of unintentional weight loss in elderly people-Canadian Medical Journal Association

Contact dermatitis...a suprising culprit , I've learned!

Salam & Hi,

I've been to family medicine posting for just a week and there are a lot of common-everday problems I saw at the outpatient clinic. It is interesting because these problems usually does not need admission and requires simpler management.

Here I would like to share a case that is quite common due to misunderstanding and white lie given by the advertising company regarding the everyday soap for bathing or hand washing.

Clinical Scenario:


Source of picture:Wikimedia Commons

A 51 years old senior police officer came with first onset of generalised pruritus (itchiness) for a month. It is more severe at his limbs and abdominal area. It also cause him to have dry skin.

On further questioning on possible allergen contact he denied any allergy towards food,dust,aerosol, current detergent,animals etc. He did not engaged in recent outdoor activites like swimming, travelling or jungle tracking. Moreover, his occupation nature requires him to be inside an air-conditioned room. However he mentioned that he had changed his bathing soap to a antimicrobial soap recently ( I won't mention the brand here...but, it is the commonest anti-microbial being advertised nationwide)

He did seek medical help from private clinic and was given topical cream. His problem relieved by the appliance of the cream temporarily but the symptom persist afterwards.

Other medical illness: sinusitis under medication. There is no chronic illness

He does not smoke or consume alcohol.No fever, loss of appetite or weight. There is no other significance found on other history asked.

On examination of his skin : There skin looks dry with scratch marks.There is no abnormality of the skin indicting skin infection or atopy.

Discussion:
What could be the possible cause of his problem????
* from history, he is not allergic to any possible allergen
* there is no sign of infection

However, the answer is : THE ANTI-MICROBIAL BATHING SOAP!!!

Reason: Anti microbial bathing soap have strong anti microbial properties but LACK of MOISTURIZER. It may not cause problem to younger people since the skin can still produce some naturel moisturizer itself. However, in older people,it will cause dryness of skin and eventually DERMATITIS!!

* Eventhough, Malaysia have high humidity index, our skin still need some moisturizer effect!

So, plan of management:
1. Stop using 'the soap'. Choose a normal soap with good moisturizer properties.
2. Give anti-histamine (Piritone)
3, Moisturizer aqueous to be applied to dry skin
4. Steroid(Hydrocortisone) cream to be applied at the MOST itchy part.
5. Do come back if the symptom persist after a week...(it may due to other cause)

Take home message:
* Choose your hygiene care product that suitable for your skin. If there is any signs of irritation i.e ithciness do change to another product.
* anti-microbial soap is not to be used regularly in people with dry skin type and elderly.

p/s: this case is quite common in primary health care due to lack of knowledge on this kind of matter.
other cause of contact dermatitis : sun light and specific allergens(metals, jewellery...etc)

To my juniors : 3rd year books at UKM

Salam my dear Juniors TWP'08...

Congratulation in advanced for able to be back home. I am looking forward to meet you all at UKMMC.

Ok..about Year3 UKM books, you can buy it once you entered UKM. So, you can save your energy.There will be a book sale at our college by PERSIAP. They get the books from Kamal bookstore.

There are 4 postings and departments in year 3.therefore i list out the books based on that. However i recommend you to see the books first and also ask you other seniors' opinion about it.


Internal Medicine:

1. Oxford handbook of clinical medicine


2. X'press revision in short case, aids to undergraduate medicine,UM


3. sarawak emergency medicine



Surgery:

1. Browse's Introduction to the symptoms and signs of surgical disease


2. principle & practice of surgery


3. In a page surgery-just photocopy this one


4. Churchill's pocketbook of surgery



Obstetric & gynecology:


1.labour room protocol HUKM-buy this at O&G department


2.obstetric UM- original version is cheaper than photocopy version


3.gynecology UM- original version is cheaper than photocopy version



Medicine & society:


It is UNPAD version of PHOP & CHOP...so, you can photocopy the lecture notes from your UKM friends. for this posting,you will have to stay at Tanjung karang for 7 weeks.



For more info, please visit this blog created by the current final year.


http://www.medicalpblukm.blogspot.com/



Let me five you some brief sharing of experience on what happen to me fro the past 2 years.Basically, being the first batch, I don't know what to expect from my new collegues and lecturers. My self esteem is slightly low than it was in UNPAD. I was involved with a LOT of activities and had a GREAT life at UNPAD. Being in UKM, i thought i had to say GOODBYE to all the student activities i enjoyed and focus on my study alone.

haha...NOT>..it is soo not true :)

We are well accepted in the community of UKM. However, there are certain things that never will be same. Just want to say DO NOT WORRY, rest assured...insyaallah you will have a great time here. However, BEAR IN MIND...please do not carried away with the activities and neglect your studies..try not to fail any of your postings (",)


as for student activities...you can join a lot of them and gain merit for you to stay in the college. There are 3 student bodies : JAKSA (manage all about our college-KTDI), PERSIAP (all about academics, management,schedule) and AMSA.


As for me, i think the student activities here are broader...I hold a position at PERSIAP for a term(2010), i join & handle a lot of student programmes inside UKM and outside UKM.


with PERSIAP 2010 committee members..during our outing..


with my nasyeed band..CIMOLEN(Cimol+molen..you can watch our performance in utube,posted by Izmeer..


For guys who LOVE Sports..there are 4 games that you can join each year


1. Sukan antara kolej UKM (SUKEM)

2. Intervarsity Sports Game by AMSA-an inter medic school game

3. Liga Antara Tahun by PERSIAP-an inter batch game among UKM medic

4. KTDI Sports day by JAKSA-our college sports day


there are also games organized by other universities that we sometimes received by invitation.


(yeay...i join them too...FUTSAL WOMEN's team )


for those who like long distance run or marathon...u can join KTDI runners club...hehe..speaking of 5km,10km,15km,20+ run.u can personally contact me for this :) there is tasik permaisuri in front of the hospital for you to jog every sunny morning or evening. Free public aerobic every sunday. For those who likes to swim, u can go to Pusat renang cheras (also in front of HUKM).personally, i never go there because there is no womens' day..huhu.


some of the medals gained during year 3 and 4...there are 3 others not included in the photo :)

Again BEAR in MIND..do not neglect your studies. you will find a lot of distrations here..my advice to you is form a study group, makes discussions. read the gudiebook and identified the important topics. learn how to answer the exam questions. Go to the library, there are a lot of books you can borrow (5 books for 2 weeks).


verily,along with every hardship is relief
verily,along with hardship is relief
so when you finished(your occupation),devote yorself to Allah's worship
and to you lord(alone) turn (all your) intentions and hopes
verses 5-8, Al-Inshirah


That's all for now... All the best my dear Juniors :) see ya at HUKM

FUTSAL...can't get enough of it :)

Yes.. that's right.. i was introduced to futsal during my 1st year at Bandung. My team was the underdog. the only game we won was when my left front teeth broke into half...haha..worth the damage. Lucky the minor recostructive procedure is covered under my medical insurance :) only tell my 2nd brother about it cause i know he won't freak out and prevent me from playing. Mama only knows about it months later..hehe

then..I stop...because the team don't want to continue anymore...lack of players..etc...

when I came back to UKM..jeng..jeng jeng..I was shock..They actually have games for girls it FUTSAL. I was Thrilled...yeay. However, my batch(year 3) don't have a team. The year 4 seniors do play and have their own team. So, I start my search...gather some friends to form a team. The seniors was very encouraging. They let us play to represent our college and university. however, the team is still new, lacking of people and skills.

Because of us, we girls get a turn to play at the only court available in the hospital (next to rumah McD). Every thursday is our day. Occasionally, we rent the futsal court at Challangerz. they have girls night discount..hehe. We usually play at night.

Our enthusiasm and chemistry started to built up.We learn the skills and tactic by ourselves and some help from the seniors and friends.Techically we don't have a coach. We only started to win...and win BIG during the 4 th game at SUKEM in 2010. We got 2nd place in UKM (if we got first we have the chance to represent UKM in MAKSUM-sukan antara universti). Then we got 3rd place during inter varsity game.

Our team had play against each other during futsal 3 by 3 match for our sport's day. My team get the 1st place. we got the big hamper :)

The last game was the BIGGEST win ever. we got GOLD...yeay!




I hope, we don't have to retire from the games in final year. we do give the opportunities to the juniors. however, there's always something that hold them from joining. Therefore,we will be GLAD to play if they can't play for any tournament this year :)

1. Sukan antara kolej UKM (SUKEM) 2009 at UKM,Bangi
2. AMSA Inter-varsity game-medical students 2009 at UKM, Bangi
3. SMMAMS' Inter-varsity game-medical students UPM 2010 at UPM Serdang.
4. Sukan antara kolej UKM (SUKEM) 2010 at UKM, Bangi
5. AMSA Intervarsity game-medical students 2010, at UKM, Bangi
6. Kolej Tun Dr Ismail (KTDI) Sports day 2011
6. Inter-medical varsity Debate & Sports 2011, at UM, Jln Pantai

TRIAD (ENT,OPthal,Anaesth) Posting!

Salam,



Yesterday, I officially ended this three minor postings group all togather and called TRIAD posting. It was definitely tiring with so many things to catch up in such a little time. We also log book to fill in and case reports(case write up) to be made for each minor posting. Regardless all, it is indeed an intresting posting as I won't encounter it as houseman (HO) again.


We get 3 weeks for Ear, Nose & Throat (ENT) posting, 3 weeks for ophthalmology and 2 weeks for Anaesthesiology. So total duration like a major posting = 8 weeks !! oh ya, for this posting we need to have an otoscope and opthalmoscope that cost about RM600 altogather. The advantage is you can practice it at people anytime you want.


Anaesthesiology
This is the last minor posting of triad which I am most intrested on. Anaesthetist are also known as perioperative doctor. They manage patient whenever a surgery is involved and will see the patient before. during and after surgery (during recovery). The triad of anesthesiology on the effect aimed during surgery is: anesthesia (unconscious), muscle relaxant and analgesia (no pain).

In this posting, knowledge about drugs & medication is vital. We need to know the types of drug, mechanism of action, effects, indication...all the pharmacology parts. I used to dislike memorizing pharmacology. However, since the posting teaches us the relation and importance of these drugs, it makes pharmacology interesting!


Anesthetist need to be skilled in inserting needles to patient and life saving procedures. We need to do 5 intravenous cannulation at Accident & emergency(OT)within 2 weeks for this posting and see general and regional anaesthesia procedures at Operation Theater(OT). We also took Basic Life course(BLS), learn about defibrillator and type of mask use during the last week(2nd week).
Source of picture : http://mediconet.blogspot.com/2009_11_01_archive.html

Yup,maybe I want to be an anaesthetist...put people to sleep..and wake them up after the surgery..hehe :)

Ear,nose & throat (ENT)-Otolaryngology

From the name itself, you can guess which area it involves. It is the first minor posting frm TRIAD. SInce my supervisor is specialize in nose, i see a lot of cases related to nose. In this posting, we need to know how to use the otoscope to see the eardrum clearly. The most intresting thing I was able to see is the presence of Aspergillus Nigra inside the ear (looks like fungi at the bread). The doctor later clean it with the ear toilet (suction of the fungi out from the ear).

normal eardrum that can be viewed via otoscope



Source of picture :
http://www.eardoc.info/news/swimmers-ear-overview/

An ear infected with Aspergillus Niger. Diagnosis : otomycosis



Source of picture:
http://lessons4medicos.blogspot.com/2008/07/inflammation-of-ear-canal.html


Some common cases seen are allergic rhinitis. They have special clinic day called allergic clinic. Another intresting thing to see is the needle prick test. There will be about 20 antigens of common triggers of allergic like dust mite, prawn an nuts that will be tested. The staff will make a small pricked on the patient's forearm(palmar side) with a blunt pin without bleeding. It is painless. Although, it may cause anxiety to certain people...hehe

Ophtahlmology
Your eyes do not see what your mind does not know!! It is all about eyes and everything related to it. So, the basic science of eyes needed to be revised. I am amzed to know that we can suspect a systemic disease by looking at the eyes. The eyes will effected in most systemic disease know especially diabetes mellitus. We have to learn to use opthalmoscope to see the retina (an area further behind, inside your eyeball) with the help of pupil dilator. We need to draw 20 significant findings of retinal disorder in our log book that needed doctor's sign.

It needs a lot of practice to get the skill of using a direct opthalmoscope. It can be tiring to us as we need to strain our eyes to see the area of retina and find if there's anye significant finding.

However, regardless all, i like the picture of retina..its' beautiful (subahanallah!)



Source of picture:
http://faculty.washington.edu/alexbert/MEDEX/Fall/HEENT_PE_Obj.htm

Next posting will be PSYCHIATRY(my LAST posting for year 4) and then I'll be a FINAL YEAR student after the final exam... (",)

Revised topic:Muslim Government Doctors Criteria

Salam...this is an entry written by a friend (also my batch mate) as a feedback on Malaysian GOvernment Doctors Criteria. It is something we all medical students should read and think of!!

1. There is life outside medicine. Who said so you can't have life outside medicine. That's ridiculous. Think! There is doctor who is married with doctor in the same hospital. Also, there is doctor who is dating with staff in the hospital, including nurses! Well, that's what I call dating. Sport? Walking, running in the hospital isn't that call sport? Don't be "closed-minded" Think! There is doctor who joins the Fitness First. Clubbing? A muslim should avoid this. You know that. Think! Can't do chores for your parents? Of course you can’t if you are not living with them in the same house. But wait, praying Dua’ for your parents isn’t that one’s must do? That’s one simple chore you can do for your parents. Think! Even, there are doctors who become a member of NGO of Islamic Society eg. IKRAM, KARISMA, JIM, others as to dakwah. Think! The is life outside medicine. It’s just you who make your life in such a cocoon. Think!

2. When you are in the working profession, you earn your own money. You have your own life. Still living with parents under one roof and being pampered by them? Of course not. And of course you can, if you want to. Well, not only doctors who are not living with their parents! Don't you think so? Think! Move out of the house ASAP because your parents wouldn’t understand your job? Please don’t follow this advice. Don’t run away from your parents. They wouldn’t understand your job? They’ve raised you up until you are able to stand on your own feet. They know you. They will know. They never come to hospital watching how a doctor working? I bet your mom had admitted to any Gynecology ward before this. Think!

3. Bila jodoh dah sampai seru dan berkemampuan, berkahwinlah. Sememangnya fitrah manusia ingin saling mencintai dan dikasihi. No need to wait until you have complete for the Govt compulsory services. There is medical student who married during study. There is houseman who married her registra. Think! There is life outside medicine.

4. Get baby as soon as possible after getting married. Well, depend on your luck. Rezeki Allah bg lain-lain. Fikir balik. Apekah tujuan berkahwin? Tak mau anak? Panjangkanlah zuriatmu yang baik-baik sementara nyawa masih ada. Think!

5. Follow the work protocols in your hospital. That what keeps you safe. Think!

6. 36 hours working non stop? Trust me, you can sleep in between. Yes, I’ve seen doctors doing it. Are you really sure non stop? Muslim has break for prayers. Isn’t that enough? How many doctors have died because of this? None. Think! Everybody can do it. Allah akan bagi ujian yang hanye setimpal dengan kemampuanmu.

7. Don’t drive if you know that you are drowsy or disoriented. Don’t be stupid. Get a taxi. Be smart, be safe. Think!

8. Coffee contain caffeine, and some how it can cause tolerance. If you are a coffee lover, of course you need constant supply of it. For coffee hater like me, better to avoid it. Find a better way to keep you fresh. Think!

9. Managing stress is very important. I’m sure you have had experienced any stressful event in your life. But yet, you managed to get over it. How? Nicotine patch? Definitely not. You are doctor. Don’t abuse drug. That’s why you learn psychiatry aren’t you? Think!

10. Don’t get over influenced by the media. That’s are all movies to be watched by the people all over the world. Of course the story line are all made up and making its much interesting. Don’t you think so? Do you think that the doctors’ life in the movies (House, Scrubs, Grey Anatomy) resembles its own doctors’ life in its country? Do you think so? Think! Do you think that you can get better life in other hospital than in Malaysia? How better is better? Think!

11. There are doctors who have gardens at their houses. Yes, they have maid. So?

12. Try to walk around with houseman in the hospital during your practical year. Don’t forget to smell them. Do they smelly? Never in my experience! They have time to take a break, and have bath. Think!

13. Fasting. Islam has trained you to stay empty stomach, right? Sacrificing yourself to save someone’s life isn’t that beautiful? Think!

14. Doctors do deserve MCs. Who says so that they’re not deserve to get one?! Remember, we are all human being and human gets sick when they get sick. Don’t you think so? Nobody is perfect. My supervisor had MC because she had sore throat. What?! Sore throat? Think!

15. Scolding, destructive criticism, racial bias, finger pointing from your supervisors are nothing. I am very sure you have trained to become resistant with all of these negative tortures during your practical years. Think! Why they do that? They love you. They want to make you a better doctor. They don’t want you to make mistakes. This profession involving lives. This is not a playground. Think! You want being pampered by them? Being nicely treated by them? This is not kindergarten anymore. Think! I love being scolded. That what keeps me moving on.

16. You think your life will be just confined to the hospital only? How many doctors having fun with families, travelling around the world, win noble prizes, etc, etc, etc………..? Think!

Never regret of what you are doing now, Medical Students…
Isn’t this your school-age AMBITION?Yer cikgu, saye nak jadi dokter. Saye nak bantu orang sakit.
Wasn’t that your kiddy answer?
Yes, you wanted to be here. Yes you are.Think! Think back.

Its not easy to get you here. Yes, here. How many years had you struggled to get you in this profession. You are now half-step distance to become a doctor. Never turn back.

I do believe that my life has been planned by Allah. Why am I here? Because Allah had planned for me to be here. Ouh, I need to find the hikmah behinds these. Allah knows what is the best for His servants.

Never let negative thought under estimate yourself, your capability. If other doctors who can do it, why not you? WHY NOT YOU? Of course there is NO SHORTCUT to be one. A consultant. You think it is easy to become one? They also had struggled through tough years to be one. Yes.

Every king was once a weak baby, and every awesome building was once just a drawing on a piece of paper. And you? THINK!

Jadi dokter, satu pekerjaan yang mulia. Yes, doctors playing God. But yet, everything happen dengan IzinNya. Saving lives, isn’t that mulia? Imagine you save someone’s life or making someone to have a better quality of life. And that person able to beribadat and do good things because you’ve helped that person. Don’t you think “saham pahala” gets to you? Allah knows.
What other profession yang the customer really trust the person? None can beat doctor profession. So, use this opportunity to dakwah as well.
THINK PLEASE!

Positive mind set will definitely deliver Positive attitude!

written by Muhd Izmeer

Dealing with cute beings..

Salam..



Hi. Finally I can relax a bit as my study week just started. The term ends with Paediatric posting. It's not just dealing with cute beings(children). We have to win their hearts and modified certain techniques in dealing with our small patients.



During this posting, i am officially an aunt as my nephew was born on August 18th...new member of the family : Umar Khalish (haven't meet him in person yet..busy playing with other children in Paediatric posting..huhu)



I was susprised that i am more mentally exhausted for this posting (I rather be exhausted due to physical stress).I was quite depressed towards the end of it as I had to faced the small practical exam called short-case and also other factors that is to private to be mentioned here. Its funny cause I think, I am more stress in this posting compared to Obs& Gyne. Lucky, it happen in Ramadhan,where we will find back the ease of mind during this holy month.

The most enjoyable part of this posting is playing with the small children and determine their age based on their performance. We call it Developmental Assessment! So, now i have the skill of guessing the age of small kids..yeay! We also have to be competent in neonatal screening where we check any abnormalities in babies less than 24 hour of life. Now i can hold babies less than one day without fear of breaking their delicate bodies.

Doctors in paediatrics are considered as those who wants to produce a perfect & safe doctors out of the students. Their intention is good! The process of making us realizing how we should work hard is quite eye-opening. Medicine is not just memorizing..it is more to understanding!

In paediatric, we have to understand the impact of the problem towards the social factor of the child. I encounter a lot of patinents under 'Orang Kurang Upaya' (OKU) and go to special class. It's a bonus for me as I did my elective posting there last semester.Moreover, the effect towards the family economical status is tremendous in chronically ill patients. Belive me, medical treatment& management is not cheap!



I also also discover that even a few months old child can have a lots of problem more or equal to patients we see in the adult medical ward. It is intresting to see how critically ill babies were managed with my posting at neonatal intensive care unit (NICU). Paediatrics and obstetric & gynecology(O&G) are siblings. I understand more about the hazards and risk for the babies that can effect their future. We are exposed to so many hazards and yet we are able to be normal...hehe.



Wasalam.

Extra lesson at Operation Theater (OT)

Salam,

Entering Operation Theater(OT) room is our routine in certain postings. I had this experience in previous postings ( Surgery and O&G). However, today it is quite different with the rest of my experiences in OT room. We received tazkirah, philosopy insight and teaching by Mr Halim, an Ortho-Paediatric specialist of UKMMC. We cover a lot of topics today and as adult self directed learner, we had to revise Apley's(our ortho book) to learn more rather than spoon feed by our lecturers.

Extra things we learn besides orthopaedic are :

1. We get to use to mp3 player playing music in OT room to make working environment less intense. Sometimes they even put al-Quran recital which make the surrounding calm & soothing. I even encounter an OT room where the registrar from middle east recite alquran that he bought during a sugery of a muslim man during my surgical posting.

Mr Halim inform us that its better to play Al-Quran recital than other songs. It makes people talk less inside the OT (to respect the recital) and less tense. Besides, we don't frequently recite al-Quran therefore, why not we listen more.

2. He did mention about prayers that doctors usually always try to fullfill during their busy day. Never leave your prayers,he said.DUring Friday prayers, he advise us the girls to help the Muslim male doctors in covering them during the prayers. It is a win-win situation coz they have to cover female doctors during maternal leave. Have to agree with that!

3. It is also important for us students to be change our attitude and become adult learner. We all are given the freedom of choice in choosing how we want to learn and become the doctor who saves people. It is quite related to a forum done just a few days ago for our juniors during their orientation before entering clinical world.

Malaysian education system is so used to spoon-feeding in giving education since kindergaten and suddenly, during university they want us to be matured with self-directed learning. The adjustment have to be made and the mind set have to change into a better insight. We are already adults and given the freedom of choice on how to learn without being told. We have to be proactive in the sense of seeking knowledge.

We cannot wait the lecturers to give silver spoon-feeding or attach a ryles tube to channel the knowledge to us. Knowledge is at the tips of your finger. There are internet to be the source of knowledge if books is a burden for you. There are friends that we can form a group and study togather for better understanding.

4. Never talk or give information about something you are not sure. Rather say that you don't know rather than not sure about what you trying to convey. People tends to hold to what we say. For example when we give the possible diagnosis to a patient saying that the patient might has cancer but it can be possible an infection. The patient will prefer to hold to the better progosis one which is cancer as the diagnosis. We are humans. We do prefer the good things rather than the bad one. So, we might give them false hope(s)!

5. Our priority is as a STUDENT! Do not involve with things that can jeoparadise your study and future. Be a student who do his/her part as a student-study adequately and follow the flow. Adjustment to the situation is important!

Actually this is his comment on some issues faced by our medical students' society,PERSIAP(we are a NATURAL organization!!) being the blacksheep of the university family due to student's & university political issues..He gave his point of views base on his exprience as student leader during his time. From his concern of PERSIAP, I think he was probably one of PERSIAP committee...hehe

We have to seek knowledge, don't wait for it to come!

Tips in becoming surgeon...you have to have:

Eyes like an eagle,Heart like a lion, Hands like a lady,

Wasalam.

Getting bussier in Year 4..

Salam,

My year 4 starts with a lot of activities & commitments as a committee in Student society here (Welfare Exco). I did try to reduced my extra curicular activities by restraining myself from taking responsiblities. The reason is, I don't want to damage myself or breaking people's trust with bad quality of performance.Learning to say NO to certain things you desire but unable to cope is IMPORTANT! However, i can't stop myself from joining activites as participants..hehe

Today, I met my SSM supervisor a cardiothoracic surgeon with my other group members. We discuss on our research topic with literature review we have gathered beforehand. The topic is the relationship of left main stem coronary artery with carotid stenosis.Its gonna be BIG and I like it!

We will have to go to Institut Jantung Negara (IJN) to collect data for 6 months with the manpower of 5 people.I don't mind the extra work because our research will have the significance in managing peolpe with heart disease due to left main stem artery stenosis in Malaysia setting.

We will have SSM scientific presentation of our research next year.It is also a competition as the best presentation will present their research in a conference between 3 countries (Malaysia.Indonesia & Brunei). To gain some experience, I will join the 2nd SSM scientific presentation by our final year(year 5) next week.I did join the 1st Malaysian International Medical Conference(MIMSC) last yr and 2nd MIMS at UM last week and gets an overview of what research & research presentation really is.

With 2nd MIMSC ended, I already end my term as Society of Malaysian Medical Accociation-MedicalStudents (SMMAMS) committee member. However, i did not finish my responsibility for SMMAMS yet. There is CME for Malaysian Medical students, a program under me as Director at UKMMC on July 10th.there will be 30 participant from ten medical schools.Hopefully it will become a success like the 2nd MIMSC last week.

Society of Malaysian Medical Accociation-Medical Students (SMMAMS) committee members,2009/2010 session ( what a great team!)

from left: Melvin(UM),Kar Yee(UM),Justin(IMU),Thanesh(PMC),Aishah(UKM),Syazwani(USIM) & Benjamin (UM).

My cycle of posting in Year 4 is quite similar to Year 3 because the 2 heavy & considered tough postings are in my 1st semester. In year 3 I started my semester I with Surgery and O&G while this year I have Ortho & Paediatric in my 1st semster.LAst yr I also manage a big event in my 1 st semester (World health day as vice-director).

This year,the same cycle goes. I will manage Continuing Medical Education (CME) for Medical Students-national level, as the director.Hopefully with the experience of fortunate survival last year, I can improve myself to be better this year regardless the extra responsibility I willing to take.Insyallah!

Excited faces before entering a posterior instrumentation and fusion on congenital scoliosis arthrogryphosis patient under Spine Team



Year 4 is indeed a busier year compare to year 3. We have extra postings & assignments to be cover despite our four major postings:

1. 4 major postings:Orthopaedic, Paediatric,Triad-Ophtal,ENT,Anaes and Psychiatry.
2. Special Study Modul(SSM): need to do research in a group of 5 ppl.
3. Forensic: need to observed 10 autopsy and assist 2 autopsies

* extra things for us Twinning UKM-UNPAD students is our Pengurusan Masa(TIme management) class (university subject) on saturday. THis class is a compulsory,that we have to take in order to graduate.

Orthopaedic & Traumatology is indeed an intresting field of surgery.Its mainly about muscle & bones of your body.It consist of 8 teams: Athroplasty, Spine, Rehab, Trauma, Oncology-ortho, Paediatric-ortho,Hands & Sports.During waiting for my SPM result to come out (2005), I did an attachment at Gleneagles Hospital.I met a Rehab-Ortho specialist that introduced me to bed sores. Little did i know about bed sores until I enter medical school. However, the exposure that I got from the doctor somehow making me intrested and motivated to be in Medical field. I did consider taking intrest in Rehab.But, I will decide after completing my undergrad.

The good thing in Ortho rotation is we get to experience various teams each week during our 8weeks posting at UKMMC,cheras. There are 4 wards as our 'libraries' and one ward for ortho-paeds, with 26 bed per ward as our 'books'.We learn through understanding the patient's problems.Ortho also means a lot of revision of ANATOMY!! Now i know the importance of unnderstanding anatomy in details.

an x-ray film of Galeazzi fracture...a case for my traumatology case write up(case studies that we have to write from history taking until management including personal thoughts on it)

extra info: According to E-medicine article published in February 11th, 2010: ‘Galeazzi Fracture is an injury pattern involving a radial shaft fracture with associated dislocation of the distal radioulnar joint (DRUJ); the injury disrupts the forearm axis joint’
In laymans' term: its a fracture of bone at your forearm, specifically at lower third of your forearm that also affect your wrist.

with the complex medical term above, I rest my case!

Thanks for reading my CURHAT (Curahan Hati). I don't mind getting busy if its for the benefit of others.

Life is to SHORT to be EASILY taken. Thus,making everyday BENEFICIAL becomes MEANINGFUL!

Wasalam (",)

Elective Posting with special kids (",)

Salam,

During end of year 3 holiday, I am required to do an elective posting that is preferably more to community work rather than anything to do with medical. It is a must for medical students of UKM to fulfill this requirement before graduate.

My mum prefers me to spend most of my holidays at home.Therefore, I choose a place near my house & only do a half day work.Therefore, I choose volunteering at Kelas khas(Special need class). In Malaysia, we have 'Kelas Khas' at normal government schools to let them be in the society and not feel left out. I'm fortunate to have Puan Azizah,Penolong Kanan 1 of SK Bukit Beruang,Melaka as my neighbour who kindly give me the ride to school every morning.

At first, Puan Aishah the coordinator(yes, we share the same name..hehe) doesn't know what kind of work to give me. They never receive medical student for an attacthment before. The pogram just entering it's 2nd year at the school. They only receives their first elective teacher a week earlier than my application. I did variety of things : entering students data,entertain them, decorating the class, teaching & managing the childrens(including make them wash their hands before they eat).

Bulliying the kids or being bullied by the kids..huhu..



decorating...

The 'Kelas Khas' consists of 20 children devided into 3 classes based on their IQ : Pintar(low), Bestari(moderate) and Arif(good). They have four teachers with one coordinator. They are having shortage of teachers since I was told that the teacher to student's ratio should be 1:4.

How the children was detected and advised to enter the school??
Some of them was detected by parents earlier who later seek advice from the doctor. However most of them gets recomendation from their teacher/school to do check up at the nearest Policlinic. They will be screened by the doctor that decides weather the child have learning disorder or not.If they have certain disorder, they will be advised for further management and registered under OKU (orang kurang upaya-disable people). These children will recives RM3OO per month(if i'm not mistaken) from government.

Not all children with learning difficulties are considered as OKU and send to 'Kelas khas'.Every primary school in Malaysia have to make sure that their students can fulfill 3M (Membaca,menulis,mengira-reading,writing,counting) by standard 3 (9 years old).Teachers who detect their students cannot read or count by that time will be send to 'Kelas Pemulihan' under qualified teachers.This program is under LINUS. Teachers at 'Kelas Pemulihan' will detect weather the child can be considered as OKU or not and make referal letter for check-up with the doctor.

I had a GREAT time there and the childrens are cute & adorale(naughty at the same time..hehe). I experienced variety of disorders: DOwn syndrome,autistic,mild conductive hearing loss with with isolated speech delay,slow learner. Most of them have Attention deficit hypertensive disorder(ADHD).

{DOwn syndrome:extra genetic material at chromosome 21 causing Trisomy 21 developemntal delays and abnormalities mentally & physically, Autism:neural development disorder that impaired social interaction & communication, COnductive hearing loss: hearing loss due to defect on conducting sound to the inner ear,Isolated speech delay: speech disorder limited to language expression or production,Slow learner a.k.a Lembam(in Malay language), ADHD: either attentional problem is greater than hyperactivity or vice versa or both in a child which is a neurobehavioral developmental disorder)

During my elective posting there,I am fortunate to have opportunity to join Hari OKU Peringkat Negeri Melaka 2010 as the 'Guru Pengiring' as the class sends some children for drawing contest.I also join their Bowling therapy (held once a month) and gardening with them to upgrade their class backyard. The school also receives a visit from Thailand teachers during my 2nd week of posting.

Hari OKU Peringkat Negeri Melaka 2010

Bowling therapy

Gardening day

Visit form Thailand teachers..



The best thing of all, i was adressed as CIKGU when i was there. The kids know me as their teacher .I used to have the ambition to become a teacher until I develop more passion towards medical world. Most of my families(mom,aunt,uncles & cousins) are teachers. Therefore, this opportunity fulfill a part of me. Indeed "Giving is Rewarding"

Thank you to all the teachers and supporting staff of Kelas Khas,SKBB including 2 practical teachers in the picture and 2 male teachers not in the picture..


Everyday fills with colors of life and I learned to cope with it. Emotionally win the childs’ heart and trust is a reward for me. Receiving hug and kisses or able to make them fulfill small task is a huge success for me.

Wasalam

P/s: DO correct me if there is any correction one the facts of special class and special children.

Health screening at SMK Teknik Sepang.

Salam,

Alhmdulillah, I've passed my year 3 without problems & happilly appreciating my 2 months break. The 1st month of my break fills with a few activities spend at KL,Kelantan & Malacca.

The lastest activity done is becoming a volunteer for health screening booth set up by our UKM Medical Society (PERSIAP). We received the invitation from Science & Social Faculty of UKM for their event Hari Jantung Sedunia at that school on 27/04/2010.

The girls setting up the banner


What we did there? Basic health check up: Height,weight,body fat measurement,Blood pressure(BP) and blood type. At the end of session, everyone will be given counselling on their health check-up result.

For the first hour, I have to manage the counselling booth.I always wonder, what kind of problem they want to know? Porblems faced by these form 4 students(16 years old)
1. Most of them have low blood pressure.
2. Some are overweight or have low/normoweight but with high fat index.

Blood Pressure is tension exerted on walls of arteries(a type of blood vessel that brings blood from heart to body cells) by the strength of contraction of the the heart.

Masitah with her favourite elctronical BP set


Example of the normal reading 120/90. 120 is called the Systolic BP while 90 is the Diastolic BP. Systolic BP indicates the blood flow into your heart while Diastolic BP indicates the blood flow from heart to body.

Therefore, low blood pressure indicates low flow of blood to your body & other vital organs. It is normal to have low BP if you are atheletes & people who exercise regularly.They also have low risk for stroke,kidney disease and heart disease. Thus, low BP is acceptable as long as it is not low enough to cause symptoms(dizziness,fainting) and problems to the body(chest pain/heart attack when insufficient blood supply to heart).

Me & the adik-adik


Weight issues & high fat index can be manage with eating in a small amount 5 times per day and choose the food according to the food pyramid. Excercise is very important.For those who doesn't involve with sports, brisk walking for more than 45 minutes,3 times per week is good for health. However, for weight reduction, for effort in cutting the calories & increasing fequency of excercise should be done.

guy's booth


girl's booth


Wasalam (",)

Live to serve..

Salam..

We live to serve or being served?

This entry is based on a motivational talk given by my beloved role model Prof. Dr Muhaya Haji Mohamad,titled: Doctors Extraordinaire at PPUKM Auditorium last night (18/02/2010)

still in a procees in finishing her book...


This talk was organised by our final year seniors. Unfortunately it was done during our study week (3rd yr final exam started on 22/2) and during 4th years final year break( they finished their final exam about 2 weeks ago). Therefore not many choose to attend the talk. Credit to Alia who become the precipitating factor of my attendence (",)

Here are some of the notes I took that can be shared.Hopefully the recording by our university will be made into CD and distributed widely among us (as what Prof wish).

1. Life is about controlling your mind. We have to live the life by design not by default.

2. Regarding my question earlier. We should live to serve not live to served!! Every doctors should have this thoughts when they wake up in the morning. We should be the person who patients feel betters when they see us not vice versa.

3.Dare to dream!! Scientifically,there is neurolinguistic programming inside our body making our thoughts influnce our body.Therefore dream of what you want(with all your heart), you will get it one day. Not 'angan-angan Mat Jenin' - In my opinion, It is proven by the birth of 'The Secret'-a worldwide bestselling motivational book by Rhonda Byrne.Therefore, picture yourself of the future you want,and insyaallah(with the will of ALlah/God) it will happen.

4.To dream you must have roadmap in life: What you achieve is based on:
definitions of your vision
firmness of your purpose
steadiness of your faith
depth of our gratitude

5.Just do it!! Don't think. I really like this idea.Thinking before doing something is good,however it usually becomes too much preventing you of doing something good. Believe in yourself when your intention is for the good. I applied this right after the talk by initiating the taking picture session with Prof..causing others to take picture with her too (",)

6.Power of word is tremendous. When you tell a lie you will become weak. In my opinion, it is human's nature because we are created to do good as chaliph of the world.Therefore, don't cheat/lie in life,especially exam!!

7.Create a very good cirlce of influence by people you meet and books you read. I would like to suggest a few which influnce the talk also.I guess Prof also read these books. She did mention The 7th Habit of Highly Effective People by Stephen Covey. Another book I would like to suggest is The Secret by Rhonda Byrne. Credit to Lutfi for introducing me to these two books and Prof 2years ago (",) To be in circle of winners we should have this 3 focus in life : Health,wealth & wisdom.

8.Life is a MISSION.Keep on asking yourself how can I serve instead of ho can I bes served.How??
*help people as much to get God's help
*do things to best of your ability
*becoming the reason for people excelent
*forgive people

9.Before healing others heal yourself physically,spiritually,emotionally and socially.

10.
What your thoughts, they lead to attitude
what your attitudes, they lead to words
what your words, they lead to actions
what your actions ,they lead to habits
what your habits ,they determine your character
what your character, it determine your destiny.

11. Lets become host to God by
* be creative instead of competitive
* be kind instead of being 'right'wannabe
* be beauty
* be LOVE : Listen,overlook people mistake,Voice out good things,make Effort for it to work)
* be expansive
* be abundance
* be receptive-accept people(appreciate,acknowledge and Do NOT criticise them)

12. THe Magic 3-doing that we should have:
* Think of good thoughts
* Speak kind words
* Take good actions

These are all I can share. I hope I can do more than just that. The best always come from Prof Muhaya herself.
My dream & wishes:
1. able to have her as one of the speaker for National Medical Student CME(continuous Medical education) done at UKM in July by PERSIAP with SMMAMS(society of Malaysia Medical Association Medical Student) this year.
2. Get Prof's signature for her book: How to become a good & successful medical student, A holistic approach ( forgot to bring her book last night)

'change is permanent, personal development is a choice'

take one step at a time for change(s)..It takes 3 weeks to establised new habit(",)


May readers have benefit from this post..
For my medical student friends:May we become Extraordinary Doctors!!

Wasalam (",)

Unity & 1 Malaysia in Interfaith discussion..

Salam,

Yesterday, clinical medical students (especially 3rd years) were invited to attend an interfaith forum regarding medical proffesion. It was arranged by our Personal & Professional Develepment Modul Coordinator-Assctd Prof Harlina Siraj. It was very interesting, interactive and motivating.

SInce it was done on friday evening (where the mind of most of us towards weekends activities & going home), the attendence was between poor to satisfactory. Well, its everybody choice. ATTITUDE problem is one of the main reason. However, there are some who have teachings & long case(practical assessment) during that time.

SO, in summary here are some of things that were discussed. I only point out things that i'm confident of to share with some addition of my opinion.

In Islam, The prophet reminded us to remember about 5 things before 5 things like in Surah Al-Asr(Time) :

1.Health before ill
2.youth before old
3.wealth before poor
4.free before busy
5.life before death

WHY?? Life for Muslim is the intermediate phase as we belive in afterlife. The 5 things are the motivation for us to amal ma'aruf, nahi mungkar(do good and leave the bad things)as the preparation for afterlife later. In life we receives challanges to strenghten our faith to Allah (god).One of the challange is ILLNESS. A good believer will accept his fate but never stop losing hope to cure him/herself. Therefore, it does not mean that if you are extremely ill, you can kill yourself.

The Speaker from Buddhism(Dr Phang, a Psyhciatrist from UPM) mentioned about Karma. Karma is a concept of action or deed that causing the cycle of causes and effects.It was originating in India and applied in Eastern religions : Hinduism, Jain, Sikh and Buddhist. Basically Karma relates more to the power of your mind control.

Quoted from Wikipedia :Buddhism links karma directly to the motives behind an action. Motivation usually makes the difference between "good" and "bad" actions, but included in the motivation is also the aspect of ignorance such that a well-intended action from an ignorant mind can subsequently be interpreted as a "bad" action in the sense that it creates unpleasant results for the "actor".

There are mental and physical health.The mind can effect the health and vice versa.In medical we call the condition psychosomatic when someone thinks that he is sick but actually nothing wrong with him (physically).However, eventually he will get the physical problems also, as his minds make hime thinks he is sick.

Speaker from Christianity, Dr Lopez(Oncology Specialist) focused his presentation on abortion and ethuanasia. In Malaysia, 50 million abortions done yearly. A suprising fact indeed because Malaysia population is about 22-25 millions. Only the minority of the whole are due to medical reasons. Sad fact isn't it?/

Euthanasia..Eu means good, Thanasia means death..GOOD DEATH??Is there such thing? Ethuanasia is a mercy killing; the delibrate ending of a life of a person suffering from an incurable disease(Dorland's dictionary).However, all religion against it. Dr Lopez mentioned that Christians believed that life is sacred and humans was given the right to lead the world. In Islam, life is a GIFT from Allah(god)that we have to accept and makes good things out of it.It is not our decision to take our own life,and not even others.So far, only Netherlands legally allowed euthanasia.

Sadly, I was half awake during the 4th & last presentation from Dr Bala, Hinduism representative due to lack of sleep for long case assesment preparation (I had my long case assessment earlier on that day). Therefore, I googled and found an intresting article about Hinduism & Medical care. The basic concepts in Hinduism are Ahimsa (non-violence) and Karma. Ahisma is cause no harm either by action, word or thought(one of the reason why Hidus are vegetarian).

Karma in Hinduism is quite similar to Budddhism about good and bad that helps balance the person's soul. The Karma lets their believer ACCEPT challenges in life (eg: illness,death,fate)by thinking of the positive things out of the bad things that happens. Can read more about it from here http://www.angelfire.com/az/ambersukumaran/medicine.html

In Islam we believed in 'Qada' & 'Qadar' which is fate & Allah's will that we have to learn to accept and go through because in everything that happens there's always the 'hikmah'(good & benificial things) behind it.Only those who make an effort to find it,will able to feel it.This is because humans created with 'fitrah'(human nature) of finding goodness in life no matter how bad he was before.

During the Question & Answer(Q&A) session, a friend ask about what if the patient wants something (eg : sperm donation) that against the doctors' religion??
ANswer: Assctd Prof Harlina says, according to International Federation of Gynecology & Obstetrics (FIGO)on FIGO committee for study of ehtical aspects of Human reproductive and Women's Health published November 2006: If a physician is either unable or unwilling to provide a desired medical service for nonmedical reasons, he or she should make every effort to achieve appopriate refferel.

in simple word: if you decided that what patient wants is against your religion, you should respect them and reffered to a colleague that share the patient's belief.

In conclusion of the forum, i would like to quote the points by Dr Munnawar Hatta,the Islamic speaker in encouraging us to learn more about other religions for better understanding and respect among each other.

We live in the world of diversity.DOn't make the interfaith discussion as a battlefield to damage the relationship among us. Isn't the reason why Allah creates us in diversity is for us to learn to accept,learn about each other and be friends??

Therefore:
1. lets join interfaith forum in future
2. Learn about the similarity and differences
3. Respect other's belief
4. Don't be afraid or have stigma in interfaith discussion if the purpose to find an agreement instead of argument.



May readers have benefit from this post.

1 MALAYSIA!!

Wasalam (",)

Music & lyrics works togather...

Salam,

Anugerah Juara Lagu fever just cured... I'm glad that all my favourite songs win the prizes.I love music...Maybe its the influence from my passion on playing instruments (piano & violin).

Whenever i hear a song i will concentrate on the music more and ignore the lyrics. Not until a couple years ago, a friend changed me to appreciate the lyrics also.

At the same time, the movie 'Music & lyric' came out played by Hugh Grant and Drew Barrymore. It makes me changed my perception on songs. To give a good impact to the listener, both music & lyrics have to be good. This is because, it have to be appreciated and understand altogather.

After i did that i realise that not all songs with good musics have nice lyrics. Some even have some bad and indecent meaning.

Last weekend during UKM Medical Student Society aka PERSIAP 35 years celebration Dinner, i played piano as a backup for my friend who sang solo. Eventhough its a nasyeed (islamic song), i think the song can be applied to anyone who's in sadness and feel loss. It is suitable for anyone who believes and put trust in god.

I was given the task a week earlier, within the day, i manage to play the whole song. It have a beautiful music & lyrics..

Insyaallah ( With god's willing)
by Maher ZAin

Everytime you feel like you cannot go on
You feel so lost
That your so alone
All you is see is night
And darkness all around
You feel so helpless
You can`t see which way to go
Don`t despair and never loose hope
Cause Allah is always by your side

Insya Allah3x
Insya Allah you`ll find your way

Everytime you can make one more mistake
You feel you can`t repent
And that its way too late
Your`re so confused,wrong decisions you have made
Haunt your mind and your heart is full of shame


Don`t despair and never loose hope
Cause Allah is always by your side
Insya Allah3x
Insya Allah you`ll find your way
Insya Allah3x
Insya Allah you`ll find your way

Turn to Allah
He`s never far away
Put your trust in Him
Raise your hands and pray
OOO Ya Allah
Guide my steps don`t let me go astray
You`re the only one that showed me the way,
Showed me the way 2x
Insya Allah3x
Insya Allah we`ll find the way



source: http://media.photobucket.com/image/hope/dramadiva_photo/My%20Favorites/Spritual/hope.jpg

Candid picture at dinner...



Another favourite song of my is a theme song of a box office Indonesian Movie, Laskar Pelangi. It's about someone trying to persue his dream with enthusiasm and high spirit believing that one day he /she will prevail.

At the same time, the song keep reminding the listener to appreciate life eventhough life is hard. Lif is indeed WONDERFUL & MEANINGFUL Isn't it a good motivational song??

LASKAR PELANGI (soldier of the rainbow)by Nidji (an indonesian band)

Mimpi adalah kunci
Untuk kita menaklukkan dunia
Berlarilah tanpa lelah
Sampai engkau meraihnya

Laskar pelangi
Takkan terikat waktu
Bebaskan mimpimu di angkasa
Warnai bintang di jiwa

Menarilah dan terus tertawa
Walau dunia tak seindah surga
Bersyukurlah pada yang kuasa
Cinta kita di dunia

Selamanya...

Cinta kepada hidup
Memberikan senyuman abadi
Walau hidup kadang tak adil
Tapi cinta lengkapi kita

Laskar pelangi
Takkan terikat waktu
Jangan berhenti mewarnai
Jutaan mimpi di bumi

Menarilah dan terus tertawa
Walau dunia tak seindah surga
Bersyukurlah pada yang kuasa
Cinta kita di dunia

Menarilah dan terus tertawa
Walau dunia tak seindah surga
Bersukurlah pada yang kuasa
Cinta kita di dunia

Selamanya...

Selamanya...

Laskar pelangi
Takkan terikat waktu...



source: http://www.cartoonmotivators.com/MotivatorCartoons/images/Road2Success(b).jpg

Becoming a part of PERSIAP committee family..This picture was taken after the voting & announcement with the previous committee during the PERSIAP 35th Annual Grand Meeting.Thanks for the vote and trust on me. An extra task and responsibility that will be handle with effort and diligence(A promise to myself..hehe)




WAsalam (",)

A patient's request..

Salam,

Its been a while i take my break from writing. Time is the most precious and valueable thing right now. However, since i have something i want to share i'll spend some of my time for this post.

This post is about what i've experienced from a patient I've met during my frist week at internal medicine ward..

One of clinical student's routine in the ward is talk to patient and gain their history of their disease/problem (a.k.a. history taking/clerking). So, i came across this patient, a middle age Malay gentleman. Generally he does not look ill or depressed.

He actually suffers from a mild stroke..and some other common stroke patients background history: Diabetes mellitus, hypertension, hyperlipidemia,history of chronic smoking..

The conversation about his illness is about 15 minutes but he talks about his insight and hopes on us future doctors and doctors for nearly an hour.hehe..imagine that..

Lesson 1 : Never do something to a patient without telling them what you are doing and things that the patient can anticipate...

Only recently, the ethical stduies is included in the medical school syllybus. The medical personnel who treat the Pak Cik fails to give proper 'informed consent'. That is the among the first thing to do which is provide an adequate infromation and get agreement from patient in anything you want to do to them.

What happen to him was he was injected with TB antigen for Mantoux test to see the presence of Tuberculosis. He was not informed on the effect which there will be a small rash at the side of injection and it can cause itchiness. What happen to him was, he scratch the injected site due to the itchiness and causing him to get a big swollen bump there. It happen to him years ago when he was admitted for TB at a governemnt hospital in our country.

Positive result of Mantoux test...it is only a temporary effect..

(Extra info: matoux test is a method to support the TB diagnosis. It is injected intradermally and the cell mediated response is within 48-72 hours is recorded. The response is usually shown as rash. COmmon Side effects is itchiness.Positive result is when the induration is >10mm(in people with moderate risk factor and high prevelance country).Induration is palpable raised hardened area of the skin


Lesson 2 : when someone is physically sick, they'll need more attention from their closed one(family,spouse& closed friends). If not, pshycologically the will get sick too..
He did mention that when he is warded, he feels lonely when nobody he knows around. When his children visit him, they didn't bother to talk to him or entertain him. It makes him feels sad and become a burden. He later inform his family members and they started to paying attention to him and visit often. it makes him feel happy and accept his stay at hospital.


My postulation is when someone is sick, the coping mechanism is also disturb. Therefore, it is helpful when there is something that can trigger your coping mechanism to become well and eventually that person will motivated to recover.

That is why people always bring something when they visit a sick person. Isn't it common to see a Get Well Soon card send with a basket full of fruits or a bouquet of flower???


This e-card was taken from http://www.123greetings.com/aff-bin/card/464/101594



Pshycological health can influence the major portion of our physical health.

However, the most important support is from the people you love..Money can't by happiness, Money can't buy love, Money can't buy health as well.


It is easily to get bored to be hospitalised.Therefore, pshycological health is easily affected also. It is much more worst because the is stay beacuse of our illness and we cannot do anything. They have to be independent and have to rely and trust on the medical personnels.The question is, are we capable enough to be trust on??


Wasalam (",)