Friday, June 13, 2014
6 months
Its been 6 months now, since im attached to a machine that helps me breathe at night
It looks awful
sounds awful
Taste awful
but it gives me my life back
Back in first month of diagnosis, i was doing a lot of bargaining with God
Why me
why not others
why this age
Why not my next decade of life
Well, if one ask me , how i view myself now
I am no more stronger that i was before
i am very sensitive
I am easily irritated
i was less calm
Thursday, June 7, 2012
ALONE
i am alone today. mum, d, ana , ira all went o visit historical places in malacca. i bet they really have fun. but unfortunately, is is a one day visit, cause there was no hotels opened for reservation, so need to go back to kl.
well im working on night shift today,, and yet i do not have anything ANTICIPATE
Wednesday, May 16, 2012
does singular cause behavioural side effect
Question:
Answer: In April 2009, the Food and Drug Administration (FDA) finished its review of the clinical information regarding the possibility that Singulair (montelukast) is related to psychiatric side effects. Reported symptoms include agitation, aggression, anxiousness, dream abnormalities and hallucinations, depression, insomnia, irritability, restlessness, suicidal thinking and behavior (including suicide), and tremor.
This investigation was a result of reports of people attempting suicide while taking Singulair. While there were no reports of suicidality or behavioral changes involving 11,000 patients taking Singulair during the manufacturers' safety studies, there have been reports of these symptoms in people taking the medication since it has been marketed. The FDA announced its initial concerns in March 2008, and updated these concerns on June 12, 2009.
As a result of these findings, the FDA has required the makers of Singulair (and related medicines, Zyflo (zilueton) and Accolate (zafirlukast) ) include a warning statement in their labeling regarding the possibility of psychiatric side effects. Patients are advised to contact their healthcare provider if these side effects occur, but should not discontinue taking Singulair unless directed by their healthcare provider, since the sudden stopping of Singulair could result in worsening asthma symptoms.
Singulair is an allergy and asthma medication that blocks leukotrienes, chemicals released from mast cells and other immune cells that are involved in causing inflammation of the respiratory tract.
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teachers day 2012
today is teachers day. well, i did wished mummy and dad. but i didnt wished it to my any other teachers. i had a post night shift today, since got back, ive been so short of breath and barely walk around my house, for sure i knew i have not taken my singulair for 2 weeks already since it has been out of stock
well, then , i should read on singulair sudden discontinuation main effect
Wednesday, March 14, 2012
14 march 2012
14 march 2012
today is my birthday. its nothing unusual, its just a lame 14th march.
i worked am shift today, being left alone all day long, as another team of mine went to ot.
i am quite sick today, and it happens to be on my birthday
i had a flu shots (my yearly influenza shot) last monday during my respiratory clinic appoinment. it winded me up with a fever, a little bit of asthma exacerbation, and of course , and uncomfortable left hand.
was thinking what to wish for. now im turning 24, and yet i have no idea how much have achieved so far. what i knew was: i want to be healthy, i dont want to take any meds anymore, i wish never have to come to clinic appoinment seeing other doctors.
the fact is that i just hope and pray that i would not be sick for such a long time. need time to grow out of this sickness, and think carefully on what i should be doing in this life.
today is my birthday. its nothing unusual, its just a lame 14th march.
i worked am shift today, being left alone all day long, as another team of mine went to ot.
i am quite sick today, and it happens to be on my birthday
i had a flu shots (my yearly influenza shot) last monday during my respiratory clinic appoinment. it winded me up with a fever, a little bit of asthma exacerbation, and of course , and uncomfortable left hand.
was thinking what to wish for. now im turning 24, and yet i have no idea how much have achieved so far. what i knew was: i want to be healthy, i dont want to take any meds anymore, i wish never have to come to clinic appoinment seeing other doctors.
the fact is that i just hope and pray that i would not be sick for such a long time. need time to grow out of this sickness, and think carefully on what i should be doing in this life.
Tuesday, February 21, 2012
liver abscess. bargaining from mr azmi
liver abscess
-pyogenic, amoebic
-suspect liver absces
-do us
-in ultrasound: hypoechoic : if single : amoebic, if multiple locules: pyogenic
abx: size less that 6cm
size abscess more than 6 cm: percutanoues drainage
c/i for percuatneous drainage:
1. ruptured abscess
2. inacessible site, dome of liver
3. non liquiefied liver abscess
treatment: cefobid, flagyl (flagyl also cover amoebiasis)
-pyogenic, amoebic
-suspect liver absces
-do us
-in ultrasound: hypoechoic : if single : amoebic, if multiple locules: pyogenic
abx: size less that 6cm
size abscess more than 6 cm: percutanoues drainage
c/i for percuatneous drainage:
1. ruptured abscess
2. inacessible site, dome of liver
3. non liquiefied liver abscess
treatment: cefobid, flagyl (flagyl also cover amoebiasis)
Wednesday, February 15, 2012
i am a doctor , but i am different
i am not just a doctor, who go to work everyday, come back, and repeat the same rituals everyday. i am also a patient, and yet on the same time i am a doctor too. i had a lot of hospital admission, despite being a doctor. my nurses , knows me as not only their daily doctor, but also their occasional patient. i went through my final year in medical school not just like any other doctors, as i had to battle with my health as well. to some doctors, maybe getting a medical degree is just fighting with books and exam.
it's different for me, i had to battle with my health, i had to manage my own medications to keep me going, i need to take care of myself well and not to get sick at times when i cannot afford to be at. it's tough , and i would never have words to describe them. i don't even look at the doctors whom are my friends who get flying colors in their medical degree, as to me, they don;t have to fight against health and other issues as i am.
i am not a loser, for seeking help at time of sickness, for asking my own nurses to help me move on hospital beds, for asking my own college to take care of me and review my progress daily during every hospital admission, i am not a loser, i am a fighter .
i will always fight as long as i am alive. and to me , being a patient and also a doctor at the same time, makes me a different one, not just to say i understand how difficult it is to be a patient, but ive gone through almost all of it, that none of my patients can tell me that i don;t understand
it's different for me, i had to battle with my health, i had to manage my own medications to keep me going, i need to take care of myself well and not to get sick at times when i cannot afford to be at. it's tough , and i would never have words to describe them. i don't even look at the doctors whom are my friends who get flying colors in their medical degree, as to me, they don;t have to fight against health and other issues as i am.
i am not a loser, for seeking help at time of sickness, for asking my own nurses to help me move on hospital beds, for asking my own college to take care of me and review my progress daily during every hospital admission, i am not a loser, i am a fighter .
i will always fight as long as i am alive. and to me , being a patient and also a doctor at the same time, makes me a different one, not just to say i understand how difficult it is to be a patient, but ive gone through almost all of it, that none of my patients can tell me that i don;t understand
Monday, February 13, 2012
a hectic night call day
inserted a second chest tube succesfully in surgical posting this early morning
it was hectic, 3 icb, where all are intubated, requring cp
didn';t sleep the whole night.
today, just happens to be the last night of surgery
hope it is uneventful
just need a rest today
had enough since yesterday night
cause we are out of intensive care beds already
it was hectic, 3 icb, where all are intubated, requring cp
didn';t sleep the whole night.
today, just happens to be the last night of surgery
hope it is uneventful
just need a rest today
had enough since yesterday night
cause we are out of intensive care beds already
Friday, February 10, 2012
grief
lend me a minute of your time, and please let me teach you on grief
this is not a lecture, or a boring factual thing, its just something that we all should take a minute, and think about it
the process of grief start with denial state. for example, a 28 year old pt of mine, who has acute leukemia, (has 95% of blast cells in peripheral blood) , took an AOR discharge and refusing chemo and bone marrow.
--> the thing is , he is not stupid, he is not selfless , or an idiot, he is jst in a state of denial, where he should be given some time, to think about it and learn.
he whom in a state of denial, thinks that this is wrong, this couldn't happen to me.
denial state is follow by anger. i was once had an episode of pulmonary embolism. it had left me with severe disability to do my daily chores. i was angry, full of remorse. i start to think,, what ive done wrong to receive such a bad situation as this, i was so angry, that i refuse anticoagulation, i refuse blood examination to find the cause of my unprovoked pul embolism. i was in an anger state. i start to blame people around me, i blame my mummy for not taking good care of me. i was angry with my doctors, to tell me what i should do.** i was lucky enough that my anger did not last long.**
anger state, once it resolved, is follow by acceptance, acceptance is when u accept and redha on what had happened and is happening on you.like for example, the boy with acute leukemia, finally accept chemo, like an SLE pt who had severe disease with sever vasculitis, accept that she should spent a whole lot of her young adulthood in hospital and wards, rather that at shopping malls , and parties enjoying with friends at the same age. While acceptance in me comes with : i began to realize that i need to be anticoagulated, and i start taking warfarin, i went for my vq scan appoinment, i had my blood withdrawl very often to check my INR. i also begin to realize that my
asthma is getting worst despite maximum medical medications for asthma. i accept the fact that sometimes , and oftenly, i need admission to the ward for acute exacerbation. i also do not mind if my friends and my colleague who are house officer like me , knows my complicated medical illness. i was never embarrassed, i don't care what they'll say( of course they are profesional enough not to say anything), and most of all i don't care what they will think. ( i learn to change my thoughts know, thanks to dr lazli and dr firdaus). well that is acceptance for me
thant is grief. i looks simple, but it is not as simple as it looks like, once you understand grief, you will learn not just how you react, but also how you think, and direct your thoughts to something right.
this is not a lecture, or a boring factual thing, its just something that we all should take a minute, and think about it
the process of grief start with denial state. for example, a 28 year old pt of mine, who has acute leukemia, (has 95% of blast cells in peripheral blood) , took an AOR discharge and refusing chemo and bone marrow.
--> the thing is , he is not stupid, he is not selfless , or an idiot, he is jst in a state of denial, where he should be given some time, to think about it and learn.
he whom in a state of denial, thinks that this is wrong, this couldn't happen to me.
denial state is follow by anger. i was once had an episode of pulmonary embolism. it had left me with severe disability to do my daily chores. i was angry, full of remorse. i start to think,, what ive done wrong to receive such a bad situation as this, i was so angry, that i refuse anticoagulation, i refuse blood examination to find the cause of my unprovoked pul embolism. i was in an anger state. i start to blame people around me, i blame my mummy for not taking good care of me. i was angry with my doctors, to tell me what i should do.** i was lucky enough that my anger did not last long.**
anger state, once it resolved, is follow by acceptance, acceptance is when u accept and redha on what had happened and is happening on you.like for example, the boy with acute leukemia, finally accept chemo, like an SLE pt who had severe disease with sever vasculitis, accept that she should spent a whole lot of her young adulthood in hospital and wards, rather that at shopping malls , and parties enjoying with friends at the same age. While acceptance in me comes with : i began to realize that i need to be anticoagulated, and i start taking warfarin, i went for my vq scan appoinment, i had my blood withdrawl very often to check my INR. i also begin to realize that my
asthma is getting worst despite maximum medical medications for asthma. i accept the fact that sometimes , and oftenly, i need admission to the ward for acute exacerbation. i also do not mind if my friends and my colleague who are house officer like me , knows my complicated medical illness. i was never embarrassed, i don't care what they'll say( of course they are profesional enough not to say anything), and most of all i don't care what they will think. ( i learn to change my thoughts know, thanks to dr lazli and dr firdaus). well that is acceptance for me
thant is grief. i looks simple, but it is not as simple as it looks like, once you understand grief, you will learn not just how you react, but also how you think, and direct your thoughts to something right.
d-dimer
ive been reading few things regarding d-dimer
( by courtney et al. : sensitivity 93%, specificity 51%)
-d-dimer has a very high negative predictive value
-d-dimer also need to be clinically interpretated from pretest probability)
-in high risk pt( wells score >4: d-dimer has no role in diagnosis)
high risk pt should just be asses straight by imaging
-as aforementioned, low risk pt, with -ve d-dimer , can exclute VTE
false +ve d-dimer: elderly, infection, inflammation)
false negative d-dimer in pt with pre existing on warfarin , or any anticoagulant
( by courtney et al. : sensitivity 93%, specificity 51%)
-d-dimer has a very high negative predictive value
-d-dimer also need to be clinically interpretated from pretest probability)
-in high risk pt( wells score >4: d-dimer has no role in diagnosis)
high risk pt should just be asses straight by imaging
-as aforementioned, low risk pt, with -ve d-dimer , can exclute VTE
false +ve d-dimer: elderly, infection, inflammation)
false negative d-dimer in pt with pre existing on warfarin , or any anticoagulant
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