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treatment we will still accepts them the same way everyone has their choice this i have to constantly remind myself so not to impose my own value on them posted by unknown at 7 59 pm 0 comments labels asthma traditional medicine wednesday july 2 2008 doctor how is my daughter doctor how is my father mother brother son daughter neighbour s uncle s friends this is the single most asked question i faced during ward rounds and especially visiting hours in the ward and the most irritating one as well if you answer only once to the above question it s perfectly well however when the second visitor come to take shift they ask the same question again and then come the third shift again then they asked again and again generally i would predict the worst for the family members oh your daughter her condition looks grave she might need surgery but everything is 50 50 we can t guarantee her to be 100 perfect after the surgery she might need intensive care support and ventilator after the surgery why would doctors generally do so we were generally on a very tight schedule i wake up 5 30 am in the morning reaching the ward by 6 30 am start working until 7 pm on on call days the working hours will be till the next day non stop we are generally overworked and underpaid on top of that the ministry had slashed 50 of my cost of living allowance rm 100 and 100 of my housing allowance rm 250 for a shared triple room per month others get a single room with nice and clean bathroom imagine rm 1050 350 x 3 for a room that is so horrible patient conditions varies by day no one will remain the same for the same period of time some family member taking advantage by showing their filial piety by using doctors scolding doctors for not doing what they think is doctor s job or not doing fast enough there is no simple data to what the prognosis is everything is calculated based on 50 of the patients with the same illness and there can be no same patient in this whole wide world what you can do to help the poor doctor please keep your relatives informed about patient s general condition we will help to bring updates not to start storytelling one by one no bs in front of the doctors we shall know who is the real and who is the fake help doctors to help your love one let us do more important things to help your important persons in life we can t work alone as doctors we need collaboration from all area so please help us help me posted by unknown at 9 24 pm 0 comments tuesday march 18 2008 ocd when heart and mind are not functioning as one have you ever have a feeling that you need to go and check the car strong urge that it wasn t lock only to find out later that it already was what about waking up in the middle of the night fearing that you didn t shut the gas stove properly and the thoughts keep on haunting you until you need to go and check it what about having all this symptoms but en core over and over again say 10 times until you exhaust yourself this is what an obsessive compulsive disorder person is going through let me share a story mr garry 38 year old gentleman assistant research personnel in a well known company married for 15 years with 2 children since his teenager years he started to experience excessive worrying whenever he is stressed out or under pressure at times the symptoms worsen until he felt like going to die with the attack he heart beats faster and he feels suffocated out of breath as well he tends to avoid crowded places whenever possible and seldom like to adress in front of his colleague he is afraid of losing control of himself generally speaking his functions deteriorate with the symptoms he smoked cannabis in the teenagers years but denied sharing habit now this persist until 8 years ago his wife noted he starts to act strange he would drive his wife to school everyday but halfway through the journey he would turn back to go and check the door again this does not happen only once but up to 7 to 8 times in a day halfway though work he also can t fight the urge to go back and check on every electrical switch and gas stove subsequently his wife is always late to school the employer in his company aren t too happy for his absence from work despite knowing that the door is lock there is repeated intrusive thoughts of not locking the door and internal urge to go and check again this problem has worsen the relationship between he and his wife his problem came to medical attention when he went for a general practitioner who subsequently referred him to a psychiatrist proper assessment of his problem was done and a diagnosis of ocd was made he was given medications and behaviour therapy his symptoms improved but there is still some degree of checking behaviour so he device a method using his phone he took photos of the lock the electrical switches and gas stove before he left whenever the thoughts came back he would just check at the photos brilliant there are a few types of obsessional behaviours obsessional o thoughts is the repeated thoughts that intrudes the patient and patient will try to exclude them labeling them as unreal this differs from delusions where patient entertains the thoughts and believe them as real furthermore you can t change their false beliefs o images are intrusive pictures usually obscene and related to abnormal sex practices o rumination is the internal debates that keeps on going on and on o doubts is where patient have repeated doubts on locking the door or turning off the tap o impulses is a form of urge to perform a violent act o rituals are repeated senseless activity o phobias is fear that one would loss control and harm someone else o slowness is the recurrent thought that eventually leads to the slowness of the person the aetiology is believed to arise from genetic factor organic factors and early childhood experience family members with history of ocd running among the members will have higher risk of getting ocd organic factors refers to lesion of the brain medication or drugs used and early experience that shape a person s personality is thought to be important to the development of ocd treatment is by avoiding the rituals medications and behaviour therapy this disease is usually recurrent and requires long term treatment posted by unknown at 9 03 am 0 comments labels ocd psychiatry sunday february 3 2008 da blues developmental assessment da has always been a crucial part of learning in paediatrics you will never be complete in paediatrics if you do not know about da it is single most frequent task to be asked during our short case examination even a post graduate student can fail their final clinical exam when they fail this da da is easier said than done it requires the full cooperation with the child if the child mood is not good you can imagine what will happen then it is like a minefield waiting to be stepped on if the child cries we won t be able to finish the assessment hence the examiner will penalized us this week i was at home for my chinese new year break exam is scheduled to be next week so there are a lot of things to practice naturally my nephew is the good practice candidates he is about 3 years old very cute and active little chap now he loves scribbling and drawing and he kept a book for his drawings mostly were pointless scribbles but there was a page that caught my attention at 3 he was drawing a man already the features of his man are a big round head with 2 eyes a nose and a mouth the torso and limbs are sticks what amused me is that he must add in a penis in every man that he drew the reason the man need to pee drawing a man is usually started at 5 years old there is always give and take in assessing the developmental status da has four parts gross motor functions fine motor functions visual and speech and social behaviours some children has slower aspect of certain developmental status than others but eventually most will catch up most importantly is adequate stimulations from the parents and caregivers at this point of time he is able to speak 2 languages fluently which is mandarin and malay thanks to the maid stimulations from the start will ensure a good developmental status keep on stimulating guys posted by unknown at 1 08 pm 0 comments labels child developmental assessment thursday january 31 2008 life in an incubator it s just a norm we human will not appreciate certain things around us when the things are aplenty we take things for granted here i want to share 2 stories last week i was posted into the neonatal icu and i was taking care of this little life he is just a premature boy born at 26 weeks a normal pregnancy would go to 40 weeks he is 14 weeks short weighing just a little bit over 900 gram he has a dark complexity and a body covered with fine hair lanugo he is slightly bigger than my palm there was a respiratory machine hooked up with countless of continuous monitoring going on in him this little soul was moving his tiny hand when i first saw him every breath he took seems so full of effort and every minute passed is a blessed moment that he is still alive although he had a number of complications from being very preterm the will to survive is very strong on the contrary i have a friend that had quited medical school just at the dawn of the final examination heard that medical life was not his thing and that he will never walk down this road again it was a shock to all of us as a friend as the move he took was drastic everyone was screaming that this is a very big waste alas the life is his whatever path that he chose to take in the future i just wish him good luck and he will find his way someday someone is letting go yet someone is striving very hard to live this is how contrary a life can be hope you found your way posted by unknown at 9 34 pm 0 comments labels leisure friday january 25 2008 hunter s hunted i write this post as a tribute to a young little soul that had laid to rest in peace earlier this week in paediatrics students are trained to do a quick but thorough general examination as that yields the most findings and guide our further examination most of the time we like to divide the patients into syndromic facies and non syndromic facies so one fine day in teluk intan i came across this boy with a typical syndromic facies i couldn t make out what syndrome he has but generally he looks too small for his age there were abnormal movements as well he loved to do scratching activities which is purposeless from my point of view the main reason that he came in was due to pneumonia he had multiple episode of similar illnesses in the pass according to his sister as usual when we as student do not understand certain things we go straight to the case note he had what we called a mucopolysaccaride metabolism disorder leading to what we called as hunter syndrome that raised further questions to me that night as i never heard of this illness before usually hunter syndrome is a progressive illness with no successful therapy so far the victims will live up to adolescent or late teens and usually die of the complication of the disease this is one of the rare illness that we don t want to get maybe that is why he succumbed this time i talked to the mother before she was already in the stage of acceptance before the child passed away she said it will do both of them good as he doesn t need to suffer any longer and the parents can concentrate on the other siblings so she opted not for intubation in case her child fails to breath by himself and refuses any artificial ventilatory support when the child was gone that day the mother cried her heart out the whole family cried for his loss that makes me think again no matter what the mother opted for i will support her decision anyway they were the one that faced him everyday sometimes there were no right or wrong answers there is only choice with any choice made we sacrifice certain things what matters is how big the price we pay when we earn something we will give up something isn t that the way of life i just hope that this boy found his lasting peace sadhu posted by unknown at 11 58 pm 0 comments labels death health hunter syndrome saturday january 19 2008 neglected child last week i just came back from a district hospital in perak nothing great about this hospital just a small facilities to serve the local population doesn t even have a ct scan machine i was posted to paediatrics in that hospital for a week the patient populations mainly from the lower socio economic status mostly are children of estate workers lorry drivers and fishermans however there was one little girl that caught my attention she was admitted on tuesday she was about 8 or 9 short haired dirty ragged shirts and worn shorts the first look give me the impression that she is a boy she had a very red lips generally she looks undernourished there were multiple healed scars over the shins she was crying frantically and the father threaten to throw her into the ditch omg the father was a middle aged man dark skin and was having walking difficulties evidenced by his walking sticks mother was no where to be seen a closer up with the father revealed nothing much except that this is his daughther he didn t even know whether she was born full term or not vaginally or through caesarian and what illness that she is having so i checked out the case note she was a case of dengue fever not quite further down the page there was a segment mentioned that she had a heart surgery done in institut jantung negara ijn they were supposed to be followed up in ijn but the parents did not able to make it due to extreme financial constraints this poor girl had a hole in the heart that requires a 2 stage surgery yet she had only completed first part and the second part was already long due so i examined her heart was not only enlarged there was also cardiac murmurs she was in cardiac failure but not taking any anti failure maedications this is like a time bomb waiting for the moment to come furthermore she had sacral agenesis most likely due to mother having uncontrolled diabetes mellitus when she was pregnant subsequently she is not toilet trained till now there was walking difficulty as well as both her limbs were stiff in fact she was not able to attend the elementary school for this reason despite already 8 years old she had 4 other sibling 2 already given out as adoption to some other family members because the parents weren t able to rear them now left with an elder brother at 13 years old the brother loved the sister very much they slept in the same cot together despite not able to fit both of them together and the sister seems much happier when the brother is around father had accident a year ago left him with weakness and was unable to work as fisherman instead he is doing some odd job now the income shrink from rm 1500 a month to rm 250 mother is a housewife they received a minimal monetary support from government for their daughther for about rm 190 a mo...