65/365 - The 3rd Malaysia Reproductive Congress

It's about the latest updates on ways aiding the subfertile to get pregnant and deliver. Wonderful eye opener and learning opportunity though it seems a little too sub-specialised for me. In the mean time of gaining knowledge, I learnt that KLCC is such beautiful place, to my surprise!

65/365 - The 3rd Malaysia Reproductive Congress

Date: 16th - 19th April 2013

Venue: Kuala Lumpur Conventional Centre

60/365 - Sardin packed

Day 1 attending course back in KL. It has been a while since I last used public transport extensively. You can literally smell the sweat on the person next to you. I'd still prefer it over the hassle of jam though! Welcome home!

60/365 - Sardin packed 

Super tiring. Yawn…

48/365 - I passed!

It was when YY sent me a congratulate message that I knew the good news. Hallelujah! I am tearfully happy! All hard works are finally rewarded. All praise be to God!

48/365 - I passed!

46/365 - Hiatus

Counting down 12 more days to battleship! Super duper stressed! 

Why am I still subjecting to exam stress at such old age :'(

Colleague has gone for long study leave leaving this message.

Let's do it, friends!

46/365 - Hiatus

Till I'm back.

MRCOG Part 1 recent past papers

mrcog1 pastpapers 2001-2005 Mrcog Part 1 Recalls 2005-2009 Mrcog Past Papers

Four more precious days to go... God speed us!

Hang on there

My discipline, stamina to stay up to study and memory are failing me. 

Or are those signs of aging? 

It is only 28 days left. 

God grant us the wisdom, the ability to excel. 

To Ernest, Dr Abi, Dr Myat and myself, hang on there!

Picture taken 25/12/2010 at Olives' house, by my humble Sony Ericsson U10i, AINO.

Perhaps it's time

It's day 2 post-call. Yet I was still up with some lousy sense of lethargic feeling, right sided headache and signs of impending URTI. Nonetheless, waking up after the sunrise today without alarm clock was luxurious!

Going oncall is a norm, 8 calls per month now after what DG has implemented. So on the day when you're post-call, the next day is another pre-call day. Exhaustive at times but it isn't too bad since our one day off in a week has started. What else can I grumble on?

Met 2 medical students who stayed overnight in labour ward to complete procedures. They reminded me of my old days. Go around labour ward asking for permission to conduct deliveries, gloved up and got scolded by staff nurse just like the way I did. The difference was, they addressed me doctor and introduced themselves to me with respect. I thought it was too formal and actually felt uneasy. Hey, I was at their position not too long ago!

It has been 6 months since I started working. I am half passed O&G posting. It is a field of litigation. A little mismanagement or mis-documentation can be easily a loop hole in the future. Most of the time our specialists hold high responsibilities to cover all blunters we made. It has always been a demanding field that requires big commitment.

However, I've decided to involve myself in it. Perhaps it's time. Time to subject myself back to exam stress. Time to get the study momentum back on toes. Starting with zero confidence but I will give my best!

Guide me, Lord.

So long, medical student!

Today is the last day bearing the name of a medical student, inofficially. Everything seemed a little extraordinary. The walk way to the hospital, the last patient I clerked in Hospital Batu Pahat, the on-going cameras' snap, the thought of whom haven't I dropped by to say bye...

The final hurdle comes a week later. Yet the feel of getting over is overwhelming. A sigh of relief for my 5 months hard works on portfolios had come to an end I supposed? Allow me to take few hours off, and I shall get back to study soon.

Longing to graduate, all graduation trips are well planned. Mummy is waiting to see me in my robe and hood. And it's time to join the earning society. So I can't afford to fail.

Faith is the substance of things hope for, the evidence of things not seen. Let's make it through!

Our very last, End of Semester 10 Examination:
3rd - 6th August 2009
Do pray with us.

St. Mary's school song

UNITED AND STRONG

United and strong, sing we a glad song
Of the School and the rules that guide us
Of our colours and crest, our work and the rest
Of the things that our School provides us

Chorus:
For God and for School
Afar be it known
We stand, by the badge of our School
The yellow and blue
Shall ever be seen
To the fore, in sports and pure knowledge

We'll aye seek her fame
Yea make good her claim
To a name and a fame the dearest
So work for the whole
And sing from your soul
For the sake of St. Mary's the dearest
(Chorus)

In the attempt to complete my resume that requires my ex-school's address, I browsed through the school song.

Oh~ How I miss singing that!

The final count down

An outstanding doctor makes a dead ward alive! I am just inspired by the way he deals with patient. Sometimes it isn't by how knowledgeable you are, but how much knowledge you can convey to patient.

Give a person a fish and it sustains him a meal.
Teach him to fish and he will fish for his living.

Patients themselves are ultimately their own doctor if they are motivated enough to get well.

In the mean time of thanking God for bring me thus far as a medical student, I admit I did feel inferior at times of not knowing enough for what I should.

Give a final push my friends! We will graduate together!

The angel smiles

He smiles, so wide and sun-shinny. A 9-year-old boy came tightly held by his mother in his broad based gait. I attempted rapport building. He spurted me saliva all over. He has Angelman syndrome with most of the following features:

Consistent (100%)

• Developmental delay, functionally severe
• Speech impairment, none or minimal use of words; receptive and non-verbal communication skills higher than verbal ones
• Movement or balance disorder, usually ataxia of gait and/or tremulous movement of limbs
• Behavioral uniqueness: any combination of frequent laughter/smiling; apparent happy demeanor; easily excitable personality, often with hand flapping movements; hypermotoric behavior; short attention span

Frequent (more than 80%)

• Delayed, disproportionate growth in head circumference, usually resulting in microcephaly (absolute or relative) by age 2
• Seizures, onset usually less than 3 years of age
  
• Abnormal EEG, characteristic pattern with large amplitude slow-spike waves

Associated (20 - 80%)

• Strabismus
  
• Hypopigmented skin and eyes
• Tongue thrusting; suck/swallowing disorders
• Hyperactive tendon reflexes
• Feeding problems during infancy
• Uplifted, flexed arms during walking
• Prominent mandible
• Increased sensitivity to heat
• Wide mouth, wide-spaced teeth
• Sleep disturbance
• Frequent drooling, protruding tongue
• Attraction to/fascination with water
• Excessive chewing/mouthing behaviors
• Flat back of head

Half way through history taking, again he spurted me saliva.

"Don't play with saliva." I said, not knowing earlier that impaired swallowing mechanism and saliva drooling are the features. Mother warned him by a gentle slap on his lips. He was still smiling. Happily and contented.

He is the only child. The diagnosis was certainly life changing to the family. To expect a child is joyous, but who would anticipate a needful kid? I saw his mother teaching him patiently. I noticed the mother's cross pendant. I saw motherly love.

They stepped out the clinic meeting his father. The touch his dad offered was tender. The whole family walked away with much laughter. Staring at their shadows, I am glad for such loving and supportive family. He remains the angel of the family despite being a little extraordinary.

His smile will stay with me vividly. It is indeed the happiest disease I have ever seen. Hope my ignorance was forgiven.

So smile back if somebody is smiling at you. It may be the only way he communicates.

Porty my love

Porty porty I love you!
I love portfolios!
I so love portfolios!

.......
......
.....
....
...
..
.

Just tried hypnotizing myself. Obviously it failed.
Motivation's needed :(

Greetings from Batu Pahat

By God's grace, I have reached my final semester of medical school. Yeppie!

Passed by the fountain below for times, never know what's the significance of the stone and hammer until I finally being enlightened that: Hey, I am in Batu Pahat!
Much settled down with my three housemates namely (from the left) loyal housemate Khung Ying and two new housemates Wan and Nana.
It has been a long awaiting weekend. Workload has been crazily heavy. It makes me treasure my weekend and sleeping time more. Nonetheless, life is fun so far and I am keeping well. I am yet to explore the nice places around!

Excitement aside, being in the final semester pushes me to be firm in decision making. Housemanship is around the corner if everything is smooth sailing. The trend of me leaving home seems further away each destination. So where is next?

A lot of uncertainties. Responsibilities might tie me down. And home is where a heart belongs? Sigh.
Into Your hand, I commit again.

I passed Semester 9!

I passed! Not with flying colours though but nothing can be happier than our 100% passing rate!

All glory to God! Appreciate all your supports and prayers.

I am super duper happy ^^

Happy holidays pals, more fun is awaiting in Batu Pahat! Woohoo~

She needs space

In her late twenties, she came to the Gynaecology clinic with a few complaints. She is married with 2 children, the youngest being 5-year-old and unable to conceive there after. Her menstruation was irregular but heavy. She complained of something coming down through her coital passage. After detail history, physical examination and relevant investigations, she was diagnosed polycystic ovarian syndrome and reducible second degree uterovaginal prolapse with retroverted uterus and cervical elongation. (For the benefit of the non-medical personnel, it means the prolapse of part of the genital tract just enough to block the vagina passage.)

Doctor explained to her regarding her conditions and the available treatment options, including surgical treatment of cervical shortening. Out of which she was advised only for conservative treatments such as weight reduction, pelvic floor muscle exercise and to minimize straining. The patient didn't seem to be satisfied and repeatedly questioned the doctor of the ways to get rid of the prolapse. She started tearing and expressed how this problem had interfered her sexual intercourse and the relationship with her husband. She couldn't meet her husband's pleasure.

Things must have been bothering enough for a woman to tear in front of public (9 medical students, a doctor and a staff nurse). Her major concern wasn't how to get pregnant or why is she menstruating abnormally but how to restore the husband and wife relationship.

Bearing in mind that the conservative treatments take time and the efficiency is very much less than that of surgical intervention, I would want to sign her for cervical shortening and simultaneously advise her for the above mentioned modifications to reduce the risk of recurrence. My idea got rejected by the doctor, I felt helpless.

She needs a space, in her vagina just enough for sexual intercourse. She needs a space in her husband's heart. She needs a little more consideration.

Undoubtedly, sex is an important act to a marriage. But why should it comes to take a place in causing marital disharmony? Isn't love supposed to be greater? Why are women always the ones silly enough to consider for everyone else except for themselves?

Perhaps I am not being realistic enough. Or I am just too emotional...

I regretted of not going after the patient to talk to her more. She must have stepped out of the consultation room feeling more miserable than she just stepped in.

Sincerely, hope things are fine with her.

*Useful facts

That little organ

One little organ, as big as a fist.

Oh how great, as it shelters fetus.
It bleeds monthly, and contracts badly.
Oh how joyous, as it grows a person.
A woman's joy, but it brings pain.
Hollow little organ, uterus by its name.
That little organ, wonderful creation.

P/S: Just found the pantie interesting, not mine by the way. Haha.

Chikungunya

Bearing in mind the Chikungunya fever has an outbreak in Malaysia, let's learn something about it today.

Chikungunya is an Aedes mosquito borne disease which transmits Alphavirus. The incubation period is from 2-4 days, with dengue-like symptoms including fever (>39℃), petechial or maculopapular rash, arthralgia or arthritis. Non-specific features include headache, injected conjunctiva, slight photophobia and insomnia.

Distinct differences between Chikungunya and dengue:
- Chikungunya fever normally lasts 2 days and ends abruptly; dengue fever shows saddle back feature which pit on day 4 or 5 lasting 7-8 days.
- Chikungunya reports no mortality rate so far but arthritis may persist for months to years.
- Chikungunya specific IgM is present.

It is symptomatically managed:
- Ensure hydration
- Paracetamol as anti-pyretic
- NSAIDs (ibuprofen) for joint pain; Chloroquine can be used for persistent arthritis.

References: Wikipedia, Mahsuri.

With this, I would like to introduce two of my friends, CheeKoonKhungYing, whose birthdays are only one day apart.

With the coordination of Wan on the other side, we successfully threw a surprise to the birthday girl. It was a long tiring day from the ward but the fun and laughter we shared were memorable. I'm definitely going to miss night like this.

Next came our usual birthday celebration spot in JJ, Seremban with Chee Koon.
Time really flies. The celebrations with them a year ago are still remaining vivid in my mind. It's the last birthday celebration before everyone embarks their own journeys after graduation. It did mingle with some extend of nostalgic feeling undeniable.

To Khung Ying my all time fun housemate. A person that I can count on when I need a listening ear. I cherish every moment spent with you. Who knows we may be posted to the same place for houseman in time to come :)

And Chee Koon, one whom I've known for 6 years! I remember what you wrote on my autograph during the college leaving day. I feel the same too. Thanks for being such a supportive friend.

Have a great year ahead Chee Koon and Khung Ying! I am truly blessed to have you both as friends!

Paediatrics' fun

In the second meet with Dr. SG Ling, we learned how to make balloon animals. It had actually cheered up my stressful long day. I am all ready to fulfill my dream of being a free lance clown after acquiring this skill!

With Hai Liang, our leader. And my master piece was the tallest blue giraffe on the right.

Group snap by Hang Cheng, missing Harveen, Chi Wooi and Joo Ee.

Next up, rabbit!

I brought home mine instead of giving to the kids in the ward. Wanna practice making, too bad it leaked after repeated twists.

Paeds' exam is in few days time. I think I had too much fun...

Drawing class

We had Dr. SG Ling few days ago for class. He is well known of asking interesting questions to get to know us. So this time around, his question was:

"Draw two things to describe yourselves."

After a quick sketch, my two representative objects are:

1) Smiling sun - Jovial

2) My home - Homely
(Bigger scale implies I'm the eldest of five.)

Drawing is a good tool to understand each other, and I agree that it is a good way to remember things too. What my friends had drawn are pretty much sticked with me now.

Surgery posting, done!

Yeppie! It's the long awaiting one week break again! The one month strive had been tiring yet fulfilling. I shall proudly announce that I've found a way to cut down my net surfing and napping time!

Just thought of sharing this picture showing my lonely bag in the library pigeon hole around the time I went home most of the days for the last few weeks. Yea, I started to find joy staying in the library finally, by which a two-third of my day was spent in uni and ward. What a life! Hope I can continue to work on my discipline.

Surgery posting done, next comes Paediatrics. Babies and kids, I'm coming!

Selamat Hari Raya kepada kawan-kawanku yang menyambut! Happy holidays guys, and fully utilize the last long break before the EOS exam!