RedApple

Scabies Infestation

noreply@blogger.com (Wolfie) — Sat, 6 Feb 2016 09:19:00 -0800

Scabies can be something non-harmful but rather troublesome and disturbing. It is a form of mite infestation whereby it usually transmits via human contact ( sexual or close contact ). Scabies are documented to live from 48 to 72 hrs of which they may die on themselves if there was no human contact. However, if one infested then they can live upto 2 months and cause severe pruritus which may be difficult to diagnose especially when they can only be visualised via a microscope rather than naked eyes. Treatments are usually rather simple either via Local Application of Permethrin 5% cream as first line or Lindane Lotion 1 % ( risk of seizure)

It's been a long time

noreply@blogger.com (Wolfie) — Sun, 26 Apr 2015 05:00:00 -0700

I guess it's been a long time since i post in this blog ever since few years back... i supposed it's time to re-post here again as everyone needs and will move on...

Where should i be in the future..?

noreply@blogger.com (Wolfie) — Thu, 9 Feb 2012 07:39:00 -0800

Noww....thinking about the future..am still very unsure of my future.. a part of me really wanting to stay in psychiatry but then another part of me was unsure of the future that psychiatry can offer me in term of financial status and chance to further overseas... Am really confused now.. should i take the less traveled road or should i take the commonly traveled road (MRCP)?

Long Distance Love (LDL)

noreply@blogger.com (Wolfie) — Thu, 2 Feb 2012 21:29:00 -0800

"Distance is just a test to see how far love can travel."

Found these few quotes while i was searching for some answers in my life.. didn't really thought about it deeply until recently until i was reminded again that i am having a LDR.

Every words of the article sank through my heart, how true it is.. How i am out of control for this relationship.. and how helpless i am for not being able to be with her side by side when she needed me the most... How i wish we could be together all days long...But all these are just wishes that probably will never comes true again...

Perhaps the relationship are just too much for her that i am demanding too much.. Perhaps this is the love where it requires full commitment from both sides and we have never agreed for any from the day we have started as we were so unsure of the future...

There are just too much in this reality to catch on, work, career, financial status, future and all the other never ending concern.. But, in the end, what do we want our life to be in the future? I used to likes challenges in life but as years goes by, i have become a more "calm" person and just wanting to lead a normal life.. I have been chasing my dreams here and there but finally end up losing myself and the normal life i wanted..

I don't really know what mousie is trying to pursue for her future.. and i don't know what she want for our future.. saddest part, i couldn't provide a future that she can visualise after half of decades of us being together.. How sad...

2010 Christmas

noreply@blogger.com (Wolfie) — Fri, 24 Dec 2010 06:34:00 -0800

Hmm..not sure where was i during the last christmas dy... But probably i was in Batu Pahat?

Anyway, this year; am only planning to stay home and having a peaceful christmas Night as it's really been a long time that i didnt have a long break after entering Paediatric Posting IN HSJ.

Looking Back for the Past 7 mth, it's been eventfu. I am a Dr now and i was amazed at how much i have grown and changed since the last 4 month. Of course i am more competent now as compared to last time.. But, all this hectic works and life make everything passed too fast that i hardly find any joy and fun in it...

Day 2 of clinic life

noreply@blogger.com (Wolfie) — Mon, 7 Jun 2010 05:35:00 -0700

Clinic life is as much fun as i can imagine. Good ventilation, less workload and best of all you usually don't need to think of the new management.

Ward work as in comparison, is much more heavy and hectic. Everything from head to toe needs to be managed yourself without much guidance; just based on what you might have studied before.

Today was a second day of clinic life of mine which was rather interesting as i seen quite some patient and most of them actually appreciate what have been done to them. Anyway, i think i need to start learning to just ask whatever necessary rather than confirming about everything with the MO and not depending too much of on those HO which might not know more than me...

It's better to sit with specialist as guidance will be provided and probably more updated info can be acquired indirectly...Have to make a smarter choice next time.

Yet Another New Stage of Life..

noreply@blogger.com (Wolfie) — Tue, 4 May 2010 20:07:00 -0700

Before i realize about it, it's almost time to go for induction and entering into a new plateform of life- the working life.

The working life is going to deprive me of plenty of pleasure in life but i hope at the same time i will be able to enjoy it at the same time so that the 2 years of suffering is better tolerated.

Should start thinking of what my future plan is; choosing field for specialisation. Psychiatry? Medicine? What field in medicine? Surgery? Neurosurgery?

I know i am very much attracted to the mystery of mind but i am totally not sure of the prospect of psychiatry but at the same time i realised i wouldn't be able to treat the patients with psychiatric issue fully without the help of medications. On the other hand, i am disappointed by the treatments given by the psychiatrist. Most of them prescribe medicine-only treatment. Is this the way of life i wanted?

TCM- Traditional Chinese Medicine? well, i am really interested in getting to know about it. But where and how? I might not have time for it. By the time i finished my housemanship? would be too late probably as the whole course will take another 5 years of study...

And, i am yet to finish with my study of hypnotherapy. This is probably going to take a few more years.. Another CBT-cognitive behavioural hypnotherapy practitioner diploma to be taken before i can proceed to the Master programme. That is also not that guaranteed. Probably will have to take the bridging programme as the course i am studying is not accreditated by the overseas university at the moment.

Where to go???

Free Online Medical Resources

noreply@blogger.com (Wolfie) — Sun, 2 May 2010 20:43:00 -0700

Just wana packed up all the reliable online resources that is freely available for public or medical views.

Medical :

1) http://emedicine.medscape.com/
This website provide a wide range of medical information including detailed management of specific disease therefore is very useful for medical personals.

2) http://www.webmd.com/

3) http://medlineplus.gov/

4) http://www.imaios.com/en/

5) Internet Scientific Publications
http://www.ispub.com/
- covers a wide range of medical and surgical specialties

6) British Medical Journal - Student Site
http://student.bmj.com/student/archive.html
pretty much a revision website for medical students.

7) National Comprehensive Cancer Network
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp
- providing information from the range of basic oncology/ tumour to specific tumours and its management.

8) Family Practice Notebook
http://www.fpnotebook.com/
- useful wide range of common medical illnesses and the treatment.

9) Oxford Journals
http://www.oxfordjournals.org/subject/medicine//

10) British Society of Rheumatology
http://www.rheumatology.org.uk/Resources/
- provide information on joints diseases.

11) Endotext
http://www.endotext.org/
- resources for endocrinology.

Surgery :

1)Bailey and Love. com
http://www.baileyandlove.com/links.htm
- multiple essential links in multiple surgical specialties including general surgery, vascular surgery, cardiothoracic surgery and etc for information of surgically-treatable diseases.

Orthopedic :

1) http://www.orthopaedicweblinks.com
2) http://www.wheelessonline.com/

Obstetric and Gynaecology

1) Royal college of Obstetricians and Gynaecologists
http://www.rcog.org.uk/
- privide useful O & G guidelines for medical and lay persons.

Anaesthesia

1) Anaesthesia UK
http://www.frca.co.uk/
- importatn organization in UK with plenty of Anaesthesia guidelines

Opthalmology

1) http://www.opt.indiana.edu/riley/HomePage/1lecturenotes.html

Dermatology / Skin Diseases

1) Derm Net NZ
http://www.dermnetnz.org/
- provide brief and simple information for reference. easy to read and understand.

2) European Academy of Dermatology and Venereology
http://www.eadv.org/
- give of vital info regarding skin diseases and venereal / sexually transmitted skin diseases.

Online Medical Resources

noreply@blogger.com (Wolfie) — Sun, 2 May 2010 20:43:00 -0700

United Kingdom and Malaysia

noreply@blogger.com (Wolfie) — Tue, 20 Apr 2010 20:35:00 -0700

i managed to make a few conclusions after my one month trip to UK - leeds and London.

Weather - UK weather is much colder as compared to Malaysia. One can basically freeze to death if you're outside without thick covering. Even in a seemed hot and sunny day, the breeze/wind can be quite cold. Malaysia at the moment is damn hot probably about 40 degree Celsius as compared to UK below 10 degree Celsius during my visit.

Environment - the environment in UK looks serene and at the same time merry. Most of the area is clean, the river are having least trashes.

Transport - almost most part of UK can be reached either by train or buses. If booked earlier, the bus ticket can be as cheap as 50 pence. Malaysia? the buses wouldn't come until it's at least 30 minutes late...

Waiting Period

noreply@blogger.com (Wolfie) — Mon, 19 Apr 2010 23:45:00 -0700

It's really a pain the the ass when you have to keep on waiting and busy rushing here and there for all the unnecessary procedure just to be a doctor in the hospital...

sitting at home for months is no fun at all when you have got nothing really to do instead of just sitting at home. Luckily i have installed a new broadband at home orelse i am gonna just be bored till death...Sigh..

Meanwhile, i am still waiting for tomorrow to come as my medical check up is dated tomorrow. Fortunately my mum reminded me to look at the date orelse i would have go there on Monday for the check up..

I need to collect my chest x-ray, my urine test for drugs and of course complete my medical examination as required.

Leaving & Arriving in UK Leeds

noreply@blogger.com (Wolfie) — Wed, 10 Mar 2010 01:12:00 -0800

I finally reached UK Leeds after so much of consideration and problems. It was a place different from my hometown but does share some similarity with Msia, just with the Bald headed tree along the way...

The other day, i was still taking my flight from Penang to KL just to take the flight from Kl to UK leeds. It was really early in the morning that i need to reach Penang Bayan Lepas Airport.. I was somehow awaken rather early that morning, probably around 5am in the morning. I should be waking up only by 5:30am as i couldn't continue the sleep anymore somehow; maybe too excited? i am not too sure. Subsequently, i have to wake my brother up just for him to send me to the airport

Graduated with MBBS Officially..So happy..

noreply@blogger.com (Wolfie) — Thu, 25 Feb 2010 16:13:00 -0800

It has finally come to the end of all the studying, writing portfolio and waiting; waiting for the result at least...

It was a time of happy and sorrow both at the same time, as we all will be leaving from IMU for our own journey soon somewhere inside Msia..

Waiting for the result wasn't something enjoyable. I was waking up early in the 5am morning and ended up waiting for hours before i can start driving from PJ to Sban. And, i think i reached there quite early, almost the first to be there for the result, in fact too early. some of them only came after 10:30am or 11am.. Grrrrr....

The result was released about 11:15 am in the morning whereby we were allowed to collect our trascript from the AAD. After that was the waiting for the Declaration Oath to become doctors. It was full of inspiring and wisdom speech from the new dean and some of the other lecturers.

Then, there was a small "feast" for all of us to enjoy before we all left. Throughtout the session, there was a lot of photo taking with friends and lecturer.

Honestly, it still seems like a dream to me. I still remember seeing the seniors graduated happily, congratulating each others a few years ago. We were wondering when will that day come for us. But, look, we are here... with MBBS and Dr title in front

5 Year for One Day of Exam

noreply@blogger.com (Wolfie) — Tue, 23 Feb 2010 16:02:00 -0800

We have been anticipating this exam for so long, finally the 5 year has come to an end for another new journey to begin with...

Preparing for this final exam isn't easy at all as any case could have come out for the long case and the one and only one case determine our pass or fail. Portfolio discussion also need to be go through again a few times to make sure we do not do any gross mistake or miss and important stuff...

Furthermore, the exam is after the chinese new year which makes everything tougher. I have expected not to study much stuff at home during the chinese new year period. What to be blamed? myself of course, there were just too many temptations at home. The TV, the nice environment to sleep and rest..everything is just so against studying.

Two days before the exam, i moved down to PJ area in my uncle house for preparation of the exam and also for the study group..ANd, luckily that was what happened orelse i might just screwed up in the exam..at least i can finish 1 round of study.. Though throughout this few days my bowel weren't helping out me, i was still fine except that i need to go to the toilet several times a day for my IBS. Even when i was staying in the hotel which cost me rm110 for a night, it never left me. Thought it has leaved me but i was proved wrong..haha

Exam day was the most stressful time for all of us, i was scheduled in the afternoon session for the exam.. was in so much of hoping that i wouldn't get a "combo" case which usually has 4-5 diagnoses and makes the history everywhere...

Anyway, i got a patient with liver cirrhosis and UGIB for that day. Prof Y and Dr C from BP were two of my examiner whereelse i got Dato J and Prof N for my portfolio discussion. Both the session went quite smoothly except a few lagging as i was wondering what they were trying to ask me..

Around 4pm, it finally come to the end..what a relief everytime we come out from the exam room..i can see different faces of either confused, happy and partially sad coming out from the rooms. ANyway, 5 year of study for 1 day of exam; that's what we have for the day..

Exam coming !!!!

noreply@blogger.com (Wolfie) — Wed, 10 Feb 2010 04:57:00 -0800

20, 19, 18, 17, 16... it's gonna be just another 13 days before the arrival of the final exam..time just flies without anyone knowing it.. and still, i am sitting here not reading much of what i should have been reading..

another chinese new year (2010 tiger year) is coming soon and my final exam will be just less than 1 week after the chinese new year. I dun think i am gonna be reading much prior or after CNY but hope that i manage to read most of the major topic..lets hope so..

New element in Life

noreply@blogger.com (Wolfie) — Tue, 12 Jan 2010 07:30:00 -0800

Tomorrow is going to be another big day of my life... it's probably gonna more or less going to determine where i would start of my carrier as a qualified doctor here..

It's interview day!!! we need to wear blazer with formal wear. Basically, you can just bring the smartest out of you..that's the most important part. I was worried earlier where am i gonna get a coat for tommorow's interview...Anyway, luckily i managed to borrow from friend and that's also because his interview is going to be the next day after me..

I will be the fifth to start tomorrow, it will probably gonna be something like final exam..going into the exam hall anxiously..

Anyway..let's see how it goes...

Hiking Trip

noreply@blogger.com (Wolfie) — Fri, 6 Nov 2009 02:38:00 -0800

O & G Posting

noreply@blogger.com (Wolfie) — Fri, 6 Nov 2009 02:19:00 -0800

O & G Posting in Batu Pahat has been a fruitful period for all of us who come here, We are required to conduct 5 deliveries from 0 experience and 2 episiotomy. Of course, all these can be achieved "fighting" with the student nurses and the community nurses.

The first 2 weeks has been a busy period as all the portfolio (reports x 2) which are long winded and telling grandma story need to be submitted by dateline. Operation Theatre quota also need to be fulfilled as we are required to scrub in for OT with 2 cases of Obstetric cases and 2 cases of gynaecological cases. It will be easier to scrub in for LSCS and Bilateral Tubal Ligation (BTL)as it is counted as 1 obstetric and 1 gynaecological procedure. On top of all that, there is possibility of getting detention class over the weekend if the ward jobs were not covered well.

After the first 2 weeks, everyone become less tense and starting to play slow as almost all of them would have fulfilled their quota. For me, i already signed 5 of my deliveries in the first week and signed another 3 of them for assisting deliveries on the second week. Planning to do more this week for the detention and weekend call. For OT procedure, i also managed to signed all my cases of 4 in the OT week. Somehow life just gets easier on me for this week.

Nice Foods in Batu Pahat

noreply@blogger.com (Wolfie) — Sun, 11 Oct 2009 07:42:00 -0700

Gerai Rakyat

Mee Racun from Gerai Rakyat (Opposite Putra Hospital)

Mee Bandung from Gerai Rakyat

HoneyDew Drink from Rose Selinda Tomyam House (Behind SquareOne Mall)

Lemonade Fried Chicken from Rose Selinda

Tomyam Dish from Rose Selinda (The best i tried in Batu Pahat)

Long Forgotten..

noreply@blogger.com (Wolfie) — Mon, 20 Jul 2009 06:48:00 -0700

In the past, i used to

1) indulged in nice songs/music sometime even until the next morning without sleeping. it purified my soul and emotion..but i no longer

2) enjoy reading books ,plenty of thick books, fiction stories..found so many of excitement there inside the cover itself..now? hardly finish a chapter...

3) involve myself in martial art, looks so high upon what i might achieve with what my potential will be..until i realised the other way around..

4)work very hard just to prove that i am really on the right track of taking up medicine. Almost anything come up as common sense. but it no longer appear to be the truth

5) so confidence that i can remember even i have just read once on certain topic and be able to recollect whatever necessary, but it seems impossible now..

What has happened to me? i wonder...

Acute Immune Thrombocytopenic Purpura (ITP)

noreply@blogger.com (Wolfie) — Sat, 11 Jul 2009 02:38:00 -0700

1) ITP :

Immune Thrombocytopenic Purpura (ITP) is believed to be a immunological reaction which follows an acute viral infection causing antibody binding to platelet membrane thereby allowing destruction of the antibody-coated platelets to be destroyed in reticuloendothelial system. It’s usually a clinical diagnosis with exclusion. However, those presenting with atypical features such as knee pain, inguinal mass and back pain should be investigated with bone marrow aspiration to rule out leukemia1. Platelet – associated IgG can also be tested in him and 90% of those with ITP will be tested positive1.

2) Approach in treating acute ITP :

As most of the patients of ITP achieve spontaneous remission within 8-12 weeks, it’s recommended that only those patients having platelet count of less than 20,000/mcL and significant mucous membrane bleeding or platelet count < 10,000/mcL and minor purpura be treated. He therefore fulfilled the criteria. First line of treatment would be using Prenisolone 1-2mg/kg/day until platelet count becomes normal and taper off. Prednisolone alone would be able to achieve 70% remission rate. Otherwise, intravenous gamma globulin is also effective in children usually given over 5 days or 1g/kg/day for 2 days. It’s proved to enable platelet count raise more rapidly and cost-effective than corticosteroid in acute ITP3. Platelet transfusion however is to be reserved for life threatening condition only whereas splenectomy is not indicated in the case of ITP unless severe uncontrollable haemorrhage developed. Research shows that about 22-27% of those with acute ITP will develop chronic ITP that persisted more than 6 months 4. It’s shown that active treatment do accelerate platelet count recovery however do not avert the development of chronic ITP or reduce morbidity during follow up 4. However, treatment with immunoglobulin G , intravenous Anti-D or high-dose pulse steroids have been showing promising results in delaying the need of splenectomy in chronic ITP.

Reference :
1) Jeffrey T. Kirchner Idiopathic Thrombocytopenic Purpura Diagnosis in Children
http://www.aafp.org/afp/981015ap/tips.html#12
2) Nelson Essential of Paediatrics Fifth Edition 2006 pg 714-719
3) Beck et al . Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials. 2005 Oct;147(4):521-7.
http://www.ncbi.nlm.nih.gov/pubmed/16227040?dopt=Abstract
4) Treutiger I et al Does treatment of newly diagnosed idiopathic thrombocytopenic purpura reduce morbidity? Arch Dis Child. 2007 Aug;92(8):704-7. Epub 2007 Apr 25.
http://www.ncbi.nlm.nih.gov/pubmed/17460024?dopt=Abstract

Avoidable..

noreply@blogger.com (Wolfie) — Fri, 10 Jul 2009 17:51:00 -0700

I had my lovely egg smashed on the floor this morning just because i am not careful enough..all the protein just splashed on the floor ..Wasted

I have started my regime of protein increasing diet by taking eggs white but not sure whether it will be working. Hopefully it will..

Anyway, about the falling egg, its just to remind me not to do something which will lead to bad stuff because i am careless. Worst when it's something which i am expecting

Canthus twitching

noreply@blogger.com (Wolfie) — Tue, 30 Jun 2009 08:33:00 -0700

It's been few days after that my right eyes external canthus has been twitching involuntarily.

Hmm...Not really signalling something good. I think it's giving me hint that something bad is coming.

Well, i am not sure if it's true enough. On the first day of twitching itself, my external hard disc somehow was claimed by my computer as "corrupted and unreadable"; And that was really of a "great help".

I promised TY to send over some stuff through the internet but finally didn't manage to send it as my external hard disc crashed. At that moment, it was really creating a sense of impending doom as all my data including my academic stuff that i will be needing in sem 10 are all inside and i have just got 1 copy of it

Sigh...i wasted almost 1-2 hours just to find the solution to it..Luckily, i manage to repair it using the repair procedure..Or else, all the data would have been lost into ash..

Today itself, i had my shoe torn with "Open mouth view" to become a flip-flop after V accidentally step on it. Well, i am expecting it to be worn out soon but not so soon...real sad. Guess i will have to send it to the butler shop to have it repaired. I likes that shoe as it was a comforting shoe and the only shoe which lasted me for about 2 years without needing to change one. I am considered lucky as it only got torn off at the end of the day and not the start of the day. Otherwise, i just can't imagine how will be the day like..haha

Status Does Matter

noreply@blogger.com (Wolfie) — Thu, 25 Jun 2009 07:36:00 -0700

Was discussing on a matter of "clock" reading with a few of them where the conversation lead to a mess..

And, finally, it comes to a answer which i already gave. But, this time, it's from a word of distinguished person.

Status does matters isn't it? How realistic can a human being be...

so, next time, make sure you quote something from a distinguished person to validate your answer.

How irony...

Aging = Seeing More Weddings & Funeral..

noreply@blogger.com (Wolfie) — Sat, 20 Jun 2009 07:39:00 -0700

Perhaps, as the days and time keep flying off ; we might not even realise that we are actually getting older and older as the time leave some track on our body.

And, i am reminded today that one of the thing which might make you realise that you are actually getting old is through SEEING MORE WEDDINGS AND FUNERALS.

True enough, as we grow up to a certain age; we might be realising that more and more of our old-time friend or relatives are getting married. Certainly, you are seeing even more funeral rituals going on in the town if you are living in a small town.

How true the statement is...as reminded. I guess i am facing it too..since long time ago when i wasn't really concern about it..