Recent Posts

61

Doctor Blogs (Public) / The end and start of journey

« Last post by lywuu on November 19, 2024, 07:42:02 PM »

The end and start of journey

 I had always been a pet lover; raising pets were like raising kids to our family. Losing each of them had been a big pain for us. The leaving of Fatty and Titi was two major event during our life. I knew that it would be intolerable when the Dragoncat’s day come.

For the past 3 years, Dragoncat condition had deteriorated slowly. Her spine problem had become worst and slowly she lost her ambulatory ability. We would bring her around in a cage initially and later as her back condition become worst, we would carry her in our arms whole day.

Ving had given up the chance of going back to Malaysia during CNY and we had tried our best of staying with her, comforting her. She could no longer feed herself and we had to spoon fed her. She was in no pain and no fear as her appetite was good. She had been tamed like a domestic pet instead of being a prey. I knew that the day would come sooner and later and Ving had hoped that she would returned to the land peacefully in her sleep.

As my in law condition was fluctuating, Ving had however decided to pay a visit back to Boleh land earlier this year. I had arranged a window of 1 weeks so that Ving could go back for a visit. I would look after Dragoncat with the assistance of Yun during the period while Ving is gone. 10 days before the departure, Dragoncat had started to show sign of shortness of breath. The visit to the Vet had confirmed my suspicion, she had probably pulmonary malignancy leading to her respiratory failure. I knew before the consultation but yet at the time the Vet broke the news, I was still unable to control my tears….. We had to put her to sleep as only in the ICU box, she could maintain her O2 saturation. There was no way we could carrying her in our arm while giving any oxygen supplement. The decision was simple and straight forward then…

On our way back, we bough a few oxygen can for use on the returning journey and rented an oxygen machine. We decided to keep her one more night and summoned the kids to share the last night with her. At the grace of the great one, it was the last day for the school final. We picked up Yun and Xian on our way home.

I held her in my arm with the oxygen tube beside her nose that whole night. She slept well with all of us gathering in the living room with her that night.

The next day, we had taken her to the Vet as scheduled. We gathered around her during the final journey. She slept peacefully after the intramuscular sedation was given. We bid farewell to her and completed the final prayer thanking the Great one for his Grace. The sadness was beyond description for all of us…

We headed to the crematorium and the ritual was completed later that evening.

We had been through many events with Dragoncat. I complete level 100 as sorcerer in D4 during the last season with her in my arm. Ving had been pampering her whole day for the last 1 year and we had treated her as our third child. We had traveled with her thousands of kilometer during the 2 years; we had taken her north and south visiting Yun in her university and other places. She would show a smile after she had a good meal and we shared her joyfulness with her. She had been the longest living rabbit with the most travelling mileage in the island….

She did not leave us as in the way we had hope for however the Great one had arranged everything to pacify ours grieve in another way.

We had the chance to gather around her for her last journey; if what had gone as we hope for, she would had left us suddenly and the pain would be much intolerable…..

Source: The end and start of journey

62

Doctor Blogs (Public) / Crow mouth....

« Last post by lywuu on November 19, 2024, 07:42:02 PM »

Crow mouth....

 

 

After years of
practice, most of the physician would have some instinct/experience guessing diagnosis with
only a small piece of history of findings. Most of the time you would be happy
that you have gotten the correct diagnosis….

K was sitting with
me at the desk and a 10 years old girl had sent to his side by the local rescue
service. The complaint was right thigh deformity after fall during a basket
ball game.

While the patient
being sent for imaging, I had chatted with K and told him that most probably it would be cancer(osteosarcoma most probably) as the impact during a basket ball
game is not strong enough to break a 10 years child’s femur.

Well, I regretted what I had said instantly and loaded the film once it showed
up at the imaging list… Crow mouth I had…

K notified the
orthopedic surgeon and after reviewing the image, the surgeon had told K to refer
the patient as she would need to be managed by a multidiscipline team in a
tertiary medical facility.

No one wanted to break
the bad news, K had to tell the mother that the fracture is complicated and
need to be managed by orthopedic surgeon who is specialized in that field.

I had regretted
sharing my spot diagnosis….10 years old girl with a total hip amputation and a
long course of chemotherapy waiting for her; even with such aggressive treatment
she is still facing a 30% 5 years survival rate….

The incident had haunted me and I had paid my price during the level 3 IDPA competition 2 days later....

Source: Crow mouth....

63

Doctor Blogs (Public) / Trust no one.....

« Last post by lywuu on November 19, 2024, 07:42:02 PM »

Trust no one.....

 

The central line insertion
was definitely a heart pounding procedure for a medical trainee during the first
few years of their training. The localization of the central vein is the most challenging
part especially for patient with thick adipose tissue.

The introduction
of ultrasound into ED practice had eased the process and raised the successful
rate of central line catheterization.

Most of my young
colleagues practice the actual ultrasound guided method, but I usually used the
ultrasound to confirmed the position of vein and proceed with the procedure
using the traditional method. We got a small amount of incentive if we use
ultrasound to guide our catheterization. I am more confident during the venous
puncture part as the imaging had given me a rough idea of the position and size
of the vein. 

The catheterization was always a one man show until recent few years, the head of department had wanted the surgical aide to assist in the procedure as someone would need to hold the probe during the puncture. Well, as I did not use the probe during the puncture, frankly said, I am not very particular about having an assistant. However with an assistant, the secure with stitches part would usually be done by the aide and I would left the scenario early after fully insertion of the catheter.

I did remember in
the past that one of my senior had told me that when the catheter is inserted down the guide
wire, we would need to make sure that the tail of the wire is visualized and properly grabbed hold on so that the wire is not fully inserted into the center vein which might need a vascular
surgery to extract out the wire.

I had always being
cautious and would teach my staff that the tail of the wire needed to be secured
by the operator before the catheter is fully inserted.

All of our
surgical aides knew the rules as I had always insisted that part is clearly done.

However, few
months ago, one of our junior colleague had met the worst case scenario above
mentioned.

It was an easy
femoral puncture and our junior colleague had left the table prematurely after
the guide wire was being inserted. The insertion of catheter was left alone to our senior surgical aide. The wire was not secured before the catheter was inserted. When
the aide noted the wire is not seen at the tail of the catheter; he got panic
and removed the catheter immediately; the act had left the wire fully inside the
femoral vein. What he should have done is to clamp the catheter with a forceps
and remove the catheter hoping the wire would be removed with the catheter.

When notified, our junior
colleague however was bold enough to do a small cut down with the aid from the
senior surgical aide. The wire was noted and removed from the femoral vein without complication.

It was a heart
pumping scenario which was compensated without a scratch.

When my junior
colleague told me about the incident, both of us sighed and agreed that it was an
narrow escape.

The surgical aide
was senior enough and capable enough to perform many procedures ….but yet
accident do happens..

My conclusion
-----“Trust no one”

Source: Trust no one.....

64

Medical News (Public) / Taking Intense Cold Therapy Daily May Improve Sleep Quality: Study Finds

« Last post by Ketua Dobbs on November 19, 2024, 07:41:52 PM »

Taking Intense Cold Therapy Daily May Improve Sleep Quality: Study Finds

The study found that undergoing daily cryostimulation, spending five minutes in a chamber cooled to -90°C, could improve sleep quality after five consecutive sessions.
Source: Taking Intense Cold Therapy Daily May Improve Sleep Quality: Study Finds

65

Medical News (Public) / Chewing gum to prevent preterm birth

« Last post by Ketua Dobbs on November 19, 2024, 07:41:49 PM »

Chewing gum to prevent preterm birth

Xylitol-containing gum during pregnancy significantly reduces preterm births and low birth weights, offering a simple solution for improving maternal health.
Source: Chewing gum to prevent preterm birth

66

Doctor Blogs (Public) / urn run - final leg and the price

« Last post by lywuu on November 19, 2024, 08:41:57 AM »

urn run - final leg and the price

 

The sip of cask
strength did not give us a hangover. We had awakened up early and enjoyed a good
continental breakfast at the restaurant of the hotel. From nasi lemak to roti
canai and fried egg; It was perfect for a good start.

We packed
everything and headed to the thousand buddha temple with the help of the google
map. The temple was situated around the largest cemetery in KL. The huge cemetery
held over 10000+ of graves. The cemetery was separated into different part
which were managed by different organizations. 

We arrived at the temple and I found out that the temple had
expanded; a few more new building  were constructed around the main temple.

We found the office
and was greeted by a female staff. After signing a
few documents and paying up the relevant fee; she had directed us we to the old columbarium for the pickup process.

There was another young
female and a foreign worker waiting for us at the praying desk with the urn. The
detail on the urn was verified by us and I proceeded with the final prayer before
the journey.

I had prepared 3
red packs just in case my parents wanted the prayer to be done by the monks.
However my brother told me that it was not necessary. I left those red packs to the
young female and asked her to share it with the foreign worker and the office lady staff.

I knew that both
the female staff were orphans which was adopted by the temple as I heard the
story about temple was running an orphanage and some of the orphan would stay
back to serve the temple.

My brother had
given me a surprise look when I placed the urn in the Ikea basket and fixed it
securely with the safety belt around the backseat. I told him that I am not
stupid enough to carry the urn on my lap for the whole journey. I had more than
20 years securing object on the backseat with safety belt…..

The drive was
smooth and we had stopped over around the Pagoh R&R for lunch. The Malay mixed
rice with the ayam masak merah was tasty and up to standard. After the brief
stop we managed to arrive at Kulai around 1+pm.

We had met up with
my sister in law who had arranged the cubical purchase at the P memorial park. A
middle-aged male was assigned to us and we had headed to the columbarium for
the relocation.

It was indeed a
good spot with good view. There was this strange smell which was quite
irritating during the drive from the office to the columbarium. I did not ask
around but was aware that something was interfering the process, all I could do
was prayed….

The position of
the cubicle was just as promised, eye level and nicely located near the exit of
the hall. I placed the urn and did the final ritual. The smell had gone away
after the placement.

Everything was set
and three of us had headed back home.

I enjoyed my dinner at a food court later that evening with my family; I discovered that nothing was below RM5; a decent meal with drinks would cost more than RM10. The price hike was steeper than I expected for the past few months.

The next day, I
had driven my parents to the memorial park again after breakfast. It was time to let them see the effort we had put in for the past few months.

My parents expression told me that they were satisfied with our arrangement when they saw the final
setting.

I waited for a
while as they offered their chanting. I looked at the cloudy sky and flashed
back what had happened many years ago. The final days of my grandfather, the
funeral, the cremation….

Once, my dad had
told me that he would like to move the urn to a better position if he could afford it;
well, wish had come true finally…..

I had taken a
flight that night from Senai airport to KLIA2 as my flight back to K city which operated by double A was scheduled at 8am the next day.

While passing the security
check, the alarm rang and how careless I was to misplaced my Leatherman knife
in my hand carry bag…..Worst of all, my parents had left the airport and only
thing I could do was to surrender it to the Imigressen.

It had accompanied
me for more than 10 years and travel with me thousands of miles across the continent.
I got my final hit later when I reached KLIA2. The staff at  tune hotel at KLIA2 front desk had told me that
I had wrongly booked the hotel at Aeropolis.

I mumbled the 4
letters word start with F and rebooked a room as I was too tired to move on….

While laying on bed
after a refreshing hot bath, I had tried to think back what had happened; the pocket
knife and room booking were the price that I had to pay for dealing with the
dark side. The heavy smell was the final warning and I had ignored it and proceeded
with the final ritual. There were so many obstacles during the tour; all of the
tricks that aim to let my ancestor laying elsewhere was the work of the dark side.

I had fallen into Alam
Bunian and awaken early after a few hours of deep sleep. I had done the final
packing and headed toward KLIA2.

A smooth check in though
but I did not lay my hand on the salted sesame pancake (Ham Jin Bang) as the
stall was not open yet at that early hour (it had also closed early on the day
of my arrival)

The rest of the
journey was uneventful and I was greeted by Ving and Xian at the airport few hours
later.

Apart from the
money and time spent with a loss of precious belonging, I had never regret of
taking a walk down the path….

Source: urn run - final leg and the price

67

Doctor Blogs (Public) / urn run - the first leg

« Last post by lywuu on November 19, 2024, 08:41:57 AM »

urn run - the first leg

 

My anxiety had
growth over the waiting period; my shifts were packed as usual as I need to do
20 shifts in 25 days before I hit the airport. I later found out that the
window I had planned was within the  school holidays and it also collided with Hari
Raya Haji. No wander the flight ticket was expensive and hard to book.

After reminder
from my dad about the holiday matter 3 weeks before the journey. I had to
discard my plan of doing a last minute hotel booking. The best choice was hotel
around the Mid Valley Mega Mall. The drive should be 20 mins or less; I had wanted to get something nearer preferably breakfast not included but yet it was not a good area for some food apparently. I had to settle with the Cititel Hotel which came with
breakfast. 

During the scarce
off day Ving and I had gone to IKEA and bought a basket made with rotan.
It would be my container to hold the urn during the drive. I had done some math
and estimated that the basket could hold the urn properly and could be secured
with the safety belt on the back seat without any difficulty.

I had packed a
simple luggage and booked the connecting flight from JB to KL 2 weeks before
the journey.

Ving, dragon cat
and I left home at 10am. It was a smooth drive and we reached the airport by
11am. I kissed Ving good bye and headed to the double A counter. The queue was
long even with the frequent flyer lane.

I managed to check
in my luggage after 40 min of lining up at the counter. The security and immigration
check was fast though. In no time, I was patronizing the free duty shop and
trying to get a cask strength whiskey for my brother.

My brother was
lucky as I had managed to land my hand on a Omar Shirley Cask Strength produced
by Nantou Distillery which he had sourcing for sometimes.

The boarding was
smooth and I had fallen into dreamland as usual before the flight take off.

The Pak Nasir nasi
lemak was tasty as usual; it had been 4 years since I had it. Not surprisingly, the ‘not
enuf’ sensation had emerged when I swallowed the last piece of it.

Peace was with me
as I closed my eyes and flashing back of what had happened since the CNY trip…Everything
was in order and yet I had prepared for the worst as anything could go wrong
especially when one is dealing with the dark side…..

The flight had landed uneventfully and I was greeted by my brother at the exit. 

We had had dinner at the Nine dragon ice shop where we had noodle and red bean ice campur(HK style of course). Nice meal but expensive though(no the price only, but later both of us had suffered from diarrhea the next day).

We had arrived late at the hotel  and enjoyed a sip from the whiskey which I purchased few hours earlier....

Source: urn run - the first leg

68

Doctor Blogs (Public) / Misuse

« Last post by lywuu on November 19, 2024, 08:41:57 AM »

Misuse

 

I had this medical
certificate request placed on my desk 2 weeks ago. I reviewed the medical chart
grumbled a little while I figured how to write down the diagnosis.

There medical
certificate here is something different than the Bolehland. During my service
with the MOH, medical certificate a.k.a MC served as a permission for sick
leave. It was very crucial for those people especially the laborer group. There
were tons of reasons asking for one. It could allow them to take a day off
either for rest or run some errant. The issuance of such MC had truly test the
wisdom of the relevant MOs.

The medical
certificate however was something more like a medical summary with a column for
diagnosis and another column for comment. I had always been cautious to write
down the diagnosis as it is an official document with possibility of landing
into a medico-legal swamp.

The case of a
bed-ridden patient who was brought into ED by ambulance for generalized
weakness. I attended the patient 10 mins before the end of my shift. I reviewed
the chart and found that the patient was seen in our ED the day before for head
injury due to fall cause by weakness and poor intake.

The patient was
alert on arrival with no sign of cerebral injury. I did not repeat the CT scan
but order some blood test before I passed it to my colleague.

The patient was
later discharged after 10+ hours of retaining in ED by the day shift physician.
A diagnosis of R53.1 (Weakness ) was placed as diagnosis by the physician who
discharged him.

The blood test
came back normal and the reason of weakness was poor intake….

I was reluctant to
issue the MC upon request but had to do so as my named was put under the
attending physician column.

Few days later as
young lady came and asked for my explanation about the diagnosis and content of
the certificate. She identified herself as the daughter of the patient. Judging
from her outlook, she appeared to live in urban area.

She had queried
about the decision of discharging the patient. The conversation was not a
comfortable one as she had a misconception regarding patient discharge. From
her point of view which was based on common sense -> all patients discharge
should be able to walk out from the hospital without aid. She had questioned
our decision of letting a bed-ridden patient to leave the hospital.

She had expected a
very detailed medical summary on the MC and asked us why we didn’t write any
plan nor detailed instruction of discharge. She had barked on me claiming that
she as scolded by my colleague who had discharged her father on that day.

I had asked around
later and found out that an unpleasant conversation had occurred between the
lady and my colleague. The daughter had requested an admission and was turned
down; the reason of admission was that she was busy and she had wanted the
hospital to act as an interim care node for temporary settlement. She was
offended by the conversation and later she had come to us requesting medical
certificate. After obtaining the certificate, she had utilized the diagnosis
and the simple notation on the paper to query our decision; stupid but
effective one.

The beat up and no
retaliate strategy had worked out though and the daughter was in no ground to proceed
as I had avoided the provocation by the relative.

The feeling was a
strange one, I felt like a ghost being hit by a truck; no scratch over the
body. However part of my soul was engulfed by something which I cannot
describe.

It was difference
from emptiness resulting from a successful striking back. Frankly said, I don’t
like both of the feeling; but I need to make a choice…

Source: Misuse

69

Doctor Blogs (Public) / urn run - prep

« Last post by lywuu on November 19, 2024, 08:41:56 AM »

urn run - prep

Lack of man power
had been haunting the medical field for the past 8 months. Since the loosening
of Covid control; hospitals around the island had been flooded with patients. Wards
were full and admitted patients had been backlogged and kept in the ED. The major
element leading to such condition was the lack of nursing staffs. The wave of
resignation had swept through the island and we ward were closed down. We had similar
problem and a whole floor was shut down. My name was marked on our roster
for 22 times instead of the usual 15. Any straight leave would land me on a very
long streak of continual shift. It was inevitable for me to tolerate such hardship
should I decided to proceed with the mission.

K was the roster
master and he would do everything to satisfy our need; thence the deciding
factor would be availability of the flight.

Price was not much
a difference as I was buying the ticket on a very close date.

Not much choice to
choose from however it still took me 10 days to make the final decision.

I had consulted my
parents about the ritual of moving when I finally get all the info and completed
the relocation site selection. My parents had been followers of Soka Gakai for
a long time and my bro was currently with Tzi Chi. I had asked them if they
wanted to bring some local followers up for chanting/praying and they had told
me it was not necessary. I had hesitated for a while about performing the
ritual all by myself. I had experience facing the dark side but yet performing
the ritual alone? It would be my first time for such ritual; not sure if I could
handle the price to be paid....

The date was fixed
eventually and I had planned to rent a car, put up one night in KL, proceed the
relocation on D2 and returned to KL on D3 for final preparation of taking flight
back on D4. I was still confused about getting someone accompanied me for the
whole process.

The great one had however
answered to my call; when I informed my bro about my decision and date of return.
He told me that he would be back during that period and would pick me up in KL and
complete the mission together.

The process had actually
stretched over few weeks before everything was finalized. The uneasy sense
cause by uncertainty was an agonizing event for me. Disturbance and unrest were
diluted by stress resulted from overworking.

I did not feel any
relief when I booked the flight ticket. There were so many events to worry
about; the extraction process, the 380km journey, the return flight from Senai
to KLIA and much more. I knew I would have to put my faith upon the Great one to
take me through the process.

Source: urn run - prep

70

Doctor Blogs (Public) / urn run - the first step

« Last post by lywuu on November 19, 2024, 08:41:56 AM »

urn run - the first step

I had fragmented
information about the temple and location of the urn. The Jalan Kerayong had 2
entry; one around the palace and the other around the old airport. All I know
was the name of the temple and the number on the rack (3033 or 3303). I need to
identify if the urn was still there before I proceed further.

The 1^st
part was simple, just Googled and I had the address and phone number. The
street view confirmed that it was truly the site I last visited 5 years ago. I Whatsapped
the number as indicated from the FB. I got a late reply asking me to provide
the information about the urn's cubical.

All I knew was the
name of my grandfather and the cubical position of 3033 or 3303. It took the admin
a few days before she replied me that no name similar was noted at both the
position. However she showed a two letter name name which she thought might be relevant
to what I described. I grinned when I saw the name; the surname was the same
but the name was “進” instead of the “进” which I sent. It was traditional Chinese vs
simplified Chinese; my bad for not knowing some of the young Malaysian Chinese did
not learnt traditional Chinese.

It was the first step
of starting the journey. A further inquiry about the procedure and payment
needed was done and I proceeded to the next step.

Sourcing the
relocation site was not an easy job as I had set down a requirement which I
considered as crucial.

The cubical would
have to be at eye level; so that when we visit the columbarium we could have a
good view without torturing our neck or back. The sourcing job had to be
trusted to my sister in law. She had visited two of the memorial park around
Kulai. Movie clips and photos were taken to aid our selection process. For the
N memorial park, most of the cubical were purchased and only a few leftover.
The new one was undergoing construction and could only be available by the end
of the year. The leftovers were either to high( 4 meter up !) or located at a very strange position. 

The P memorial park had however provided us with more choice but most the cubical
were meant for couple with larger space to contain 2 urns. We were considered lucky as
there was still some cubical that met my condition.

The price was
however a little bit weird; a 25% discount would be given if you paid by
installment. If the cubical was to be used before the installment end; the full
amount would need to be paid up immediately upon the cubical usage. In our case
as we need to use it stat, the price would be RM26k. I was satisfied with the
result and my bro had agreed with my choice. Prior to the payment, the staff had however
offered a 40% discount to my sister in law and we had taken up the offer with
grace.

The procedure had
however involved 2 police reports to be done prior to the shifting of my
grandfather urn. One would be done in KL and the other would be done in Kulai.
The ashes was considered as remnant of the deceased and would be treated as
control item; the police would need to monitor such process according to the
law. The temple side told me that the police reporting would be done by them and
my sister in law would make the report with the Kulai police station 1 day
prior to the relocation.

Everything was set
though and I would need to fix the day of travel….  

Source: urn run - the first step