Monday, September 26, 2011

DeSTRESSing Activity: Cameron Highland (>,<)V

After 2 postings in final year, i've found a group of posting mates that we can 'ngam & kamcheng' togather despite our differences. Circumstances had made us housemate for almost 2 weeks at Teluk Intan (during Internal Medicine) and immediately we fall in love with each other..haha. We even throw an Open House at Teluk Intan..

Ok, enough about the gushy-mushy feeling..So, we went to Cameron Highland for a 2 days and a night.I'm willing to sacrifice my Siemens 10 km run for this vacation. yeah..i need some de-Stressing activity. Cameron Highland's weather reminds me a LOT like BAndung and Jatinangor...oh how i miss dat place..hurmm. The food was superb..We go there and eat A LOT.. I hope i don't gain weight..hehe

A picture of us playing bubbles (thanks to Miss Nina Hoklai's influence) on a suspension bridge..oh ya da guys are addition to the Mag7. They are our Pak Supir+Sappam (driver+ guard in indo language)

Time tunnel museum is like a collectors display of things from before independence up till 90's. I just like the desk....

We also went to usual place at cameron like strawberry farm, bee farm,cactus valley and tea plantation. The strawberry + yougurt + honey just made my day more sweet & happy...nyum..nyum..

Fresh salad.........grrr

Boh tea plantation was superb. The road was tricky to. It was there since 1920's (some knowledge gain from the video at the museum). I just fell in love with the cafe which was built at the edge of the hill..Wish i have a villa there...haha. They fertilize the tea with, u can imagine how bis is the place., now back to reality. After 4 hours journey.Thanks to our Pak Supir for his driving skill & effort. We went back home safely,alhamdulillah without injuries or accident. Will start surgical posting the next day...Hepato-billiary team here I come (>,<)

Sunday, September 25, 2011

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 (>,<)

Tuesday, September 13, 2011

Best birthday gift ever!!!

For my 23rd birthday, my 1st brother bought me ticket for YUNA's concert at Dewan Filharmonik Petronas (DFP). I was soooo thrilled about it. We LOVE music and we spend our teenage life playing trios together during our free time (saxaphone,violin & piano).It turn out to be our siblings night out since both of my brothers decided to come along. SO, their job description that night was driver,photographer,chaperone & bodyguard...hehe

My brothers: Anas, Azhar(excluding Adam cause he got UPSR the next day) and me...

Why I like Yuna?? Simply because of I fall in love with her songs:
1. I can relate with the songs cause some of it related to events in my life.
2. Her music got soul in it..
3. Definitely ORIGINAL!!
4. It is different than other Malaysian artist.
5. The music just suits me..a mixture of everything I like..Just nice.The EP in US is much more better.She has improve a lot.

SO....about the concert. It was brilliant & awesome!! I sat about 10 meters from her.The whole 90 minutes gives me goosebumps.The band was wonderful too. Her music was presented 10 times nicer than the CD. And of course, i'll be biased and say her voice was PERFECT!!

I found out that the concert ticket was sold out and they make another concert the next day. But that additional concert ticket was sold out too...incredible response from her fans!

with some of Yuna's band members Effry(bass), Shafiq (2nd guitar) & Adam (keyboard)...they deserved some compliment too!!

my dream comes true....yeay!!

A 'syok sendiri' poem using some of Yuna song titles:

SHe's just a'GADIS SEMASA'
with 'GREEK GODDESS' aura
who says 'Raya oh Yeah'

She 'DECORATE' her lyrics with musics
they are 'RANDOM AWESOME'!!
'ROCKET' to fame,there she goes..
ain't she just a SUPER SOMETHING?

Saturday, September 10, 2011

Raya & my holiday project in the kitchen (>,<)

Happy Eid to muslim bloggers!!

FInally,After 4weeks of hectic life as medical student at Medical department, i get to be a mad scientist in the lab...(meaning the chef in the kitchen) was fun to try out the recipes and experiment on your own cook food.

This year i learned how to make 'ketupat daun palas'. I was suprised that they sell daun palas at Malacca. My mum told me the leave is also used by Malacca people to make desert (kueh)..We made it,Since this food rarely found in Malacca (origin from Kelantan-terengganu).

It takes me quite some time to master this triangle shape casing.

Another food i miss but hard to get in KL is Kerabu Mangga !! The kerabu mangga i found in KL does not have fish in it.Time to make one at home..yippeee

This year is the 3rd eid celebration at my new house in Malacca. This year decided to host a small feast (open house) for our neighbours and extended family around KL, Malacca & Muar. We also celebrate my 1st nephew 1 year old birthday. It was fun. Since our lawn is quite spacious the childrens love to play football and fireworks there.

Birthday boy with his cousin in his Bumblebee (A gift from Mama Tok)

Other projects are some biscuits and my very own bread pudding. Love the oven so much. I wish i can have one at college..with a set of my own kitchen..

Last but not least, I still get 'duit raya'..haha..Even 2 of my cousin (same age as me) who just started working,also gave me their very own duit raya..Oh, i just love being a student. This will be the last year.The privilage will expired & i have to started giving next year (>,<) Insyallah..Misi Jubah Merah 2012!!

Thursday, June 23, 2011

Unintentional Weight loss in elderly: Should we be worried?


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.


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

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...

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

Saturday, June 18, 2011

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.

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)

Saturday, June 11, 2011

Final year at last...


I just got back from 5days 3rd Professional & Personal Development (PPD)camp and BTN at Kem Bina Negara at Ulu Sepri, Rembau. I won't comment on the place or cetain issues as we are forbidden to do that. However, i would like to share about what I learned during PPD session.

First of all PPD is the only subject that is compulsory for medical students of UKM. They are starting to implement this program in other faculties in UKM. The 3rd PPD camp is made to prepare us for House officer(HO) life.

The reality of HO life is not short and sweet. I like to quote what was told by a houseman during the video session:" You choose to be a doctor, so do not complaint". She is totally right! We were told about the reality which is not pretty at all. We have to sacrifice a lot of things: missing family functions, no sports,lack of sleep & rest etc..this will continue for 2 years.

Photo of my group members for the LDK session with our facilitator..Thank you very much for sharing your experience with us.

A few lessons learned from my fasilitator who is a professor (peadiatric):
*the most dangerous thing is yourself...(EGO)..
* doctors should realize that they are only the INSTRUMENT OF GOD...
* every success they made is from god...your effort contributes to it
* every mistake you make is from yourself because you don't try hard enough to be competent.
* therefore, do not be cocky, think yourself are great because you are the healer!
* treat your parents, siblings,relatives,colleagues, friends and patients right.

2. Be HONEST!!
* do not lie to yourself or others.
* be frank and tell the truth in a nice way. Do not give political correct answer.

3. Cry for HELP!
* being a doctor is not an easy job...ventilate your problems(without mentioning names) to your trusted person (spouse,family,friends)

4. AVOID using CREDIT CARD! * don't event use credit card because you will fall into the financial trap easily.
* our pay won't make us rich but it is adequate for a secure life if we manage it wisely.

5. Treat your patients like your own mother, father and siblings...

To all my batchmates. Hopefully 256 of us will graduate next year...MISI JUBAH MERAH 2012!! Just remember:that a HERO lies in (each of) you!-from our PPD theme song(HERO by Mariah Carey)...

P/S: I was included in mass celebration for people born in June. Thank you to all. It was very special as we get to celebrate it with the whole batch (>,<)V