ADR

Toxic epidermal necrolysis (TEN)

Steven Johnson Syndrome (SJS)

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

What do these three cases have in common?

1. They are not uncommon.
2. They are major adverse drug reaction (ADR), which are serious and potentially life-threatening.
3. These three patients had ADR secondary to ALLOPURINOL.
4. All three were prescribed without indication, i.e. asymptomatic hyperuricaemia.

Again, come to a question, why check uric acid level in the first place?

*Although a raised serum uric acid level is an important risk factor for gout, the use of serum uric acid as a diagnostic test is limited. It can be normal during acute gout, whilst patients with hyperuricaemia may never develop an attack. (EULAR guidelines)

*Asymptomatic hyperuricaemia per se is generally NOT considered an indication for use of Allopurinol. (GSK)

*Treating hyperuricaemia does not retard the progression of renal failure and can not be recommended for this indication. (CARI Guidelines)

Links:
Hyperuricemia (eMedicine).
Fatal Allopurinol Hypersensitivity Syndrome after Treatment of Asymptomatic Hyperuricaemia. (BMJ)
Asymptomatic hyperuricaemia: To treat or not to treat?
Hyperuricaemia and gout.
Treatment of Asymptomatic Hyperuricemia: When do you have a good reason to provide therapy?

Questions to ponder:
When will our doctors ever learned?
Is it just pure ignorance or stubborn?
What is the legal implication?

Kettle on the floor

This is just to show how irresponsible and uncivilized certain people can be, stealing electricity in the common walk way.

Opera

My internet connection was finally restored, after two weeks and three visits to the local TM Point, and on top of that, I was charged RM50 for the service.

What kind of service? Damn!

I was browsing through some of the blogs I missed out for months and I chanced upon a videoclip in YouTube from Hellfried's blog.

This guy was simply amazing.

Just wanna shared this video.

Somewhere over the rainbows

I just found out that that is a night market over the Rainbow city every Tuesday, and it was just fun as I've not been to night market for more than ten years.

The atmosphere was so colourful with many traders started selling CNY decorations and cookies.

Also, I was so surprised to see Penang Asam Laksa over here, and I quickly ordered a bowl to satisfy my crave. It tasted not too bad and cost RM3.00.

Also embarrassedly, I bumped into an auntie patient I saw few days ago and she kept pushing to me a bag of apples despite my refusal.

LCM

Recently, I have started doing some locum again, usually by covering friends who last minute couldn't make it due to personal problem. I don't usually tell other people that I do locum, but recently when I told my colleague, I was questioned on why did I downgrade myself to such a level of doing GPs' stuffs and with such lower rate? Don't I get tired of sitting in the clinic all day seeing the same kind of patients?

There are several reasons I want to do GPs locum:

1) I like helping friends in need.
2) Earn some extra money of course, but who doesn't want money when it is thrown at you?
3) Boredom of staying here.
4) Curious and adventurous, I want to experience what other people are doing in their working life, which I'd probably never be, like GP, Surgeon, Psychiatrist, etc.

For example, I didn't know that people are still using 'thermometer' to measure temperature in the clinic, and what's more, people are still using 'recycled' plastic tongue depressor!

Anyway, I have been rather selective, and I prefer doing short hours and seeing less patients. Though the rate may not be high for some people, but I find that money from 3 hour of locum could cover my one week of expenses.

Think of those days, some 15 years ago, I did some waiter job for a chicken shit of RM12 for 3 hours. I learned to value money much more.

There is one weird aspect about myself is that, I usually don't spend the money I earned from locum. There's why, my drawer has been stacking thousand of Ringgit, and some are still in the original envelopes.

I am very OCD.

Home2

Living room.

Just settled in my new unfurnished apartment. It is quite big, about 800 sq feet and I am alone at the moment.

My nest.

When I first shifted in, there were only the dining table and chair left by the previous tenant, which I now use as study table.

Still wandering what to do with the other two rooms, whether to rent them out or not. If I rent it out, at least it would cover part of my expenses. On the other hand, it is not very convenient to share house because I like moving around on bare skin.

Dinner

Wandered off in town hunting for food for dinner. Sometimes, it could be such a tough task to decide on what to have for dinner. Why so difficult?

Anyway, I would be packing food back as I am so lazy to come out once I reach home.

Home2

Some nice Malay food stores nearby.

When I am away, I missed Home1, and when I am in Home1 now, I missed Home2. So, I have 2 homes to take care now. Can't wait to go back to Home2 cause I have a lot of things to settle these weekends. First thing is to get a clean up. Next, my presentation to prepare. Hope to get my Streamyx on next week, cause I am totally dependent on it.

Hot, hot now

Sorry, I don't mean to be political, but I find this poster in Mob's Crib quite funny. There are lots more controversially doctored pictures over here.

Seriously, there are lots of comments and criticisms been thrown at our former boss I don't know whether good or bad, but I am quite sad to see him go, after so much he had done to try to improve the health care system. Worse still, to see him fell in such a humiliating way.

Besides the PHFSA thing where he received strong opposition from the private medical practitioners who disagreed with such Acts, I could see at least we have got some improvement in term of salary rise and better allowances in the government sector, during his four-year tenure.

To say that he had not contributed enough, is wrong, at least I believe, he as a medical doctor himself (and his son too), would always do things in favor of our own medical community. I believe we would have a better fight in our request for improvement for our well beings if our minister is from our own people.

Despite what many people depict him as 'dirty' for the exposure of his sexual adventures, I don't judge him based on this aspect and I still respect him for what he had contributed, and at least also for his boldness in admitting that he was the 'man' in the DVD.

I personally opine that, he need not resign from all his posts and he should fight (till the last drop of his blood) for his own rights to his privacy as well as his rights to practice what he believe he is morally right to practice, and not what other people think otherwise.

Well, I just hope that the new Health Minister would perform as 'good' as him, if not better.

Home sweet home

Nothing really beats this home-cooked lotus root with peanut soup, my favorite.

I am back home for a short break after enduring a two-week daily standby calls. Can't imagine the stress I experienced everytime the handphone started ringing especially after office hour.

My mood has been very irritable, especially the last one week. There were so many referrals I had to see, what was more irritating, most of the cases were non-urgent which could be seen as out-patient.

I could sense an overly 'referring culture' over here. People just refer every single thing to each other without even bother to do a bit of investigations or work-up, irregardless whether the cases are related or not.

Sometimes, I could be sarcastic over the phone, but I really couldn't help it when there were so many cases to be cleared in the clinic, on top of that, the referrals kept coming in.

Most of the time, the HOs were the victims because they just helped execute what their bosses asked them to do.

I am now able to gasp a breath of fresh air but hope to recuperate before another round of irritable calls again.

Economy rice

Chap Fun.

I finally found a place where one can have good economy rice for lunch or dinner. As economy as the rice, there are many choices and the price is very reasonable. What's more attractive to me is, they have soup as well, though not as 'ka liu' as home-cooked one.

Nevertheless, shops selling economy rice are scarce to find. So far, there are few, four to be exact that I managed to locate, but their prices can be 'cut throat'. I could imagine a few theories, either people over here eat more home-cooked meals, or they don't eat rice, or there is monopoly in the bussiness.

As far as Chap Fun bussiness is concern, there is no competition. I suppose this is one of the reasons why the price can be so 'cut throat'.

Happy New Year 2008

Greeting from the south.

I just want to wish all friends a Happy Prosperous New Year 2008.

I pray for the smooth sailing throughout the year, good luck and most importantly is to stay healthy always.