Vaccine

Just got the new influenza vaccination for 2007 jab today. This was a different brand from last year's. This one supposed to cause less pain during injection and less febrile reaction.

Ascaris

Ascaris Lumbricoides

Close up view.

20 cm in length!

After reading what Jimbo blogged about Ascaris, here I would like to share a funny incident happened to me while I was a surgical HO in Seremban Hospital.

A young lady was admitted to the surgical ward with severe epigastric pain. Half way through the clerking, the patient vomited out a worm in front of me. It was so shocking, yet interesting, and I decided to keep it in the formalin.

I also remembered during my diploma years, I helped a lecturer in Parasitology in a project where I was assigned to counting the eggs in the faecal samples collected randomly from a population in Kampung Cherang Laut. Believe it or not, the result showed more than 90% of the population were infested with the Ascaris worm.

Interesting facts about Ascaris lumbricoides:
1. It is the largest intestinal nematode.
2. A gravid female produces 200,000 to 250,000 eggs daily.
3. The eggs are resistant to various disinfectants and can survive in the soil for many years.

The adult worm stays in the small intestine. It was believed that when the female population exceeds the male population, the female worms would migrate to other sites to find mates, causing various complications, though, worm migration may be stimulated by anesthetic agents or subtherapeutic anti-helmintic treatment or by use of certain anti-helmintic (e.g. pyrantel pamoate).

How to prevent infection?
1. Eat cooked food and avoid taking green vegetables or salads, especially in places where human faeces are used as fertilizer and where sanitary conditions are poor.
2. Deworm every 6 months with anti-helmintic.

My memories

Ah, the good old bed I used to sleep.

Feel like an old duck retiring. 3 and a half years have passed, this was the longest period I served in a place. There were many fond memories to cherish. It was usually the on-call time that interesting events happened. I'd never stayed still, I used to move, find and do; time would passed by soon, before I knew, it was usually past 2 midnight before I could peacefully retired to rest.

Time to give space and move.

Ta Siu Yan.

Work meant work to me, I was a serious obsessive-compulsive worker. There were many ups and downs. In my darkest moment, after so much hard work, I was rewarded with a pair of slippers. I was so angry that I wanted to use it to 'ta siu yan', to get rid of all the bad luck. Eventually, I stepped and stepped on it numerous times.

The heat has turned cold now, fire is put off. I am leaving the slippers there for other emotionally tortured souls to step use, when they are cooling themselves in the bathroom.

Sales Rep

Missing Georgetown.

Being a physician, especially if one is new, has certain advantages, because medical sales rep love us a lot. Being new and enthusiastic, many reps want to meet us to promote their products. New and young physicians are seen as targets because they are the ones who are adventurous and would try anything new and trendy. The market is so competitive especially so if there are many drug choices to choose from. The drug companies also invest heavily on good looking and pretty reps to sweet talk us. We'd be invited for product launch, sponsored for courses, showered with gifts (and pens) as well as treated for a lunch. It was like an overnight fame.

They are now gone, as I ceased to become 'physician'.

Well, congratulation to all our new physicians who had passed the MRCP in KL recently.

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Medical sale reps do have special role in the health care. They are around to constantly update us on their products as well new evidence found from clinical trials or studies. However, we need to be discreet when come to prescribing drugs. We should consider various factors, like cost effectiveness, clinical risks, compliance and side effect profile, before we prescribe to patients. We should use our professional judgment and not subjecting ourself to personal gain.

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I was particularly pissed off with one sale rep who sells anti-obesity drug. I was asked to sign a form to have 2 sample boxes for patients. It has been 9 months and I still don't received my sample despite two earlier reminders. When I called her up yesterday, she had the gut to tell me that she didn't get to see me in the clinic, when the fact that she visited the clinic less often after that. I had asked her to cancel the form and I am contemplating to lodge a complaint with her manager.

Word of cautions: Never put down your signature unless you receive those sample.

Coal Tar

Tar-coals?

Being always a Cinapek, I don't really fancy Western food, but today I invited Ms Teh for lunch. Being an 'americanized' person she is, all she could only think of, was American food. So, she recommended me Chicken Tar-coals, what a name?

Actually, it was CHICKEN CLUB TACOS: Three flour tortillas (one already in the mouth) filled with mesquite chicken, chopped applewood smoked bacon, chipotle-ranch dressing, diced tomatoes, mixed cheeses and lettuce. Served with rice and black beans; RM 29.95.

I'm real sua pa (jungle) kau (monkey).

TEN

Generalized, dusky, erythematous rashes with extensive bullae and skin detachment.

This patient presented with acute onset of fever associated with oral mucosa and genital erosions. She developed the above rashes after two days. She was on nifedipine, enalapril, gliclazide, metformin and lovastation for more than a year. Two weeks prior to the onset, she was started on allopurinol for hyperuricaemia.

Many doctors are still so ignorant about the fact that, there is no indication to start allopurinol for asymptomatic hyperuricaemia. Allopurinol is one of the most notorious drugs that can cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis.

In the first place, there should not be a routine to do blood uric acid level, unless clinically indicated. It is sad that many GPs as well as private laboratories performing routine blood tests fail to understand such principle.

Last

Last day and last call.

Every beginning has an ending. Life's like migratory bird, never get rooted in a place. Guess, by change, only we can progress. Yet, it's another flight, where new beginning awaits discovery.

I am now trying to figure out, how to finish my 38-day leaves this year.

Charity

I am still counting, 5 more days to go.

What a shocking news! Our 690 million new hospital is being built to cater for 30% foreigners and most of them don't pay their bills.

Sooner, we should rename all our hospitals with a prefix 'charitable' hospitals.

Even right now, we are having some foreigners in our ward. One is a Myanmarese with dengue shock syndrome. He was intubated in the ICU for few days. Though he recovered from the initial episode, right now he is still fighting for nosocomial pneumonia.

Another one is a Bangladeshi admitted for typhoid fever and liver abscess. This Bangla, who doesn't understand a single word of BM, is so uncooperative today. He refused branula for IV antibiotics and even refused to have his blood taken.

Come to think of it, he should be damned lucky. Currently, he is being nursed in a single room, equipped with ceiling fan, air-conditioned and attached bathroom while our poor locals are being cramped into "refugees camp" outside.

He should be damned grateful, because, at the end of the day, his stay and treatment here are FOC, taking advantage of our weakness. According to our MOH's policy for communicable diseases, all patients with notifiable diseases are to be given treatment FOC irregardless of their nationalities.

Otherwise, these foreigner will never get enough to pay for the medical bills, even if they work ten years and eating grass.

I think our government has only two choices, perhaps consider collecting back the unpaid money from their countries' representatives, or start promoting our 'Health Tourism with Free Medical Treatment" world wide.

Santa's coming

Here are some of the pictures I snapped recently showing early Xmas mood.

Hundred Santas over Hot Market.

Found this little Santa on the roof of the cupboard in one of the Paediatric ward.

Esplanade

1914-1918, OVR-GLORIOVS-DEAD

Just wondered, what this giant tomb was all about.

Just felt how peaceful seeing these uncles relaxing by the beach side, how I wish I could be as free as them.

The soft wind blew me on the face, as I was walking on at such a slow pace, as slow as this uncle who was executing Tai Chi.

I was here for a reason, OK.

I attended the certificate presenting ceremony for the excellence service award in conjunction with the Q day.

There were total of 618 recipients last year with which, only 10% were doctors. However, most of the doctors did not turn up, probably too busy with clinical works. Even then, right after receiving the photostated copy of the certificates, everyone just left, guessed, patients were waiting to be seen back in the hospital.

Guess what other excellences were awarded?

Can't they have thing like cutest doctor of the year award? I might be the first recipient, who knows. At least Fibrate got the sweetest smile award. So jealous.

MPPP building.

However, I gave face a bit and left at 12pm after watching some choir and dance performances. Furthermore, I didn't have enough time left in the parking meter.

My childhood place.

On the way back, I passed by Burma Road and decided to turn in for lunch at Swatow Lane. While having Wan Than Mee, I had flash back of an incident happened last week.

An elderly man was admitted with stroke. I instantly recognized him as the Wan Than Mee seller who used to cycle around the neighborhood some thirty years ago, taking orders for breakfast. Surprised with my memory, after 30 years.

The now Nagore Road.

Thankful

One of the greatest songs sang by Josh Groban in the album Noel.


Somedays, we forget to look around us,
Somedays, we can't see the joy that surrounds us,
So caught up inside ourselves,
We take when we should give.

So for tonight we pray for,
What we know can be,
and on this day we hope for,
What we still can't see,
It's up to us, to be the change,
and even though we all can still do more,
There's so much to be thankful for.

Look beyond ourselves,
There's so much sorrow,
It's way to late to say, I'll cry tomorrow,
Each of us must find our truth,
It's so long overdue.

So for tonight we pray for,
What we know can be,
and everyday, we hope for,
What we still can't see,
It's up to us, to be the change,
and even though we all can still do more,
There's so much to be thankful for.

Even with our differences,
There is a place we're all connected,
Each of us can find each others light.

So for tonight, we pray for,
What we know can be,
and on this day, we hope for,
What we still can't see,
It's up to us, to be the change,
and even though this world can still do so much more,
There's so much to be thankful for.

Change

Change.

Looked like change is imminent.
This phase is going to end soon while a new chapter begins.
Everything's been pre-planned, the outline has been written.
I am having mixed feeling, but I 'll take it as challenge, a transition to where I transpired to be.
As the journey continues, the book of life, a new chapter is opened soon.

Sick

Life is like hell without my note book. After the worm infestation, I thought everything's alright till my laptop crashed two days later. Luckily, I got all my data salvaged and had the whole hardisk reformatted. Unfortunately now, the LCD screen crashed on me. I was told I needed to change the LCD costing me RM350 for a 2nd hand one or RM900+ for an original one. Gosh, my presentation is three days away. I pray for a fast recover by this evening.

Worm infestation

I once spent two weeks in the Parasitology lab playing with faeces and counting worm's eggs.

Celaka, my computer was infected by a very contagious worm that spread through the USB drive. Only one penetration. I wonder if there is condom for pendrive that could prevent infection.

A grumpy lady

This lady got so much to complaint.

She was quite upset, upset because her problem went undiagnosed for the last one year.

She had bilateral hand deformities for few years which were preceded by numbness. She had been seeking treatment in the OPD for DM and HPT as well.

After a few requests to be referred to specialist, one fine day, a caring MO referred her to the neurologist for nerve conduction test.

It just makes a good physician to diagnose her problem without even doing the NCS by just the appearance of such rashes over the face.

For the past one year, the OPD MOs have been prescribing her local cream for the facial rashes but without any improvement.

Yes, this is LEPROSY.

But then, we can't really blame the juniors, cause they might just had one week of dermatology posting throughout their student+medical life.

FAQ:
Is it leprosy or is it some other skin disease?

The 3 definitive diagnostic signs of leprosy are:
1. Reduction or loss of sensation in skin lesions.
2. Enlargement and tenderness of one or more peripheral nerves.
3. Presence of acid-fast bacilli in a skin smear.

* Diagnosis is made when one or more of these signs are present.

Christmas Soon

Just got this album.

Reminds me that Christmas is coming soon. November is time to play all the joyous songs again.