Tuesday, November 18, 2014

Piala Dr Adli Azam 2014

Adli leaves his legacy by sponsoring 2 trophies.. for football and badminton. This was the first ever named challenged cup for the students. He is the Pengetua therefore it would be timely to have his trophy up for grabs. As how it was last year, of course we as the lecturers would not miss out to join the tournament. Unfortunately only one team is available comparedt o last year. Being sporting, i would reckon our involvement would make the students appreciate more of us. 
 Obviously we knew we would not win the cup and it is the participation that counts.. haha mana ada.. kecewa woo tak lepas first round pun! Playing regular futsal on Thursdays have not brought us anywhere.. hahaha Whats the point when suddenly i have to play keeper for this tourney? Well, its fun anyway. 

 It is a good outing among friends and we enjoy doing this together. This is our ukhwah as teachers. We do try to maintain social relationship on top of our professional relationship.


I went back home at 1230am!! That was how busy I was. My my.. i felt young as it was like when i was an MO before doing cases till midnight.. hahaha
What is important is we have done justice to the patient and they are comfortable in tolerating the pain post operatively.
And today.. i am back in OT at 8am. 
Wow.. this is private practice... 
Kais pagi..makan pagi.. kais petang.. makan petang.. hahahaha

Monday, November 17, 2014

ACLS in UiTM 2014

In a way, it was some sort of reunion for us the teaching faculty. It was this exact core group which initiated the ACLS in UM and again we are reunited  for this edition of ACLS. Izzat was organizing this for the doctors in CTC and i was invited to be part of their "invited" faculty which include Tint and Prof Ezwan from UM.It was also a reunion for me and Lanud (ex-IMU mate) whom i last met perhaps 10 years ago? and now, he himself is an established EP. Cayalah bro :) 
 We are reviving this in UiTM because it is timely to do so. As it will not just be an in house thingy but in establishing a proper training centre for healthcare workers across the country. Most of us are recognized trainers and it would be a waste not to utilize this. We have done this before and the structure will not be way off from the one we did in UM. 

What made it more manageable was the presence of the training video which became a standard to the participants. It is from our previous experience that we found out at times different instructors may teach different things which would create a conflict during assessment. 

ACLS training is important because as care providers in the hospital, it is something we cannot not know. There will be times when acute situation arises and the patient collapse. The ability to organize own's thoughts in the chaos is desirable. I have been in a lot of codes in my career and i have seen how people handling it from my eye point as a house officer, medical officer, registrar and consultant. It is just so easy to do the wrong thing as during that time, a second seems like an eternity! 
It was a successful course despite only 2 passed. The standard is high as one needs to score 34/40 to pass. The MCQ can be really hard to those who choose not to read the text. Sometimes we reckon the answers can be logical but the technicality in the question can kill!! I was happy to note that my Sister from KPJ scored the highest mark in the class. hehe.. memang power lah :)
Insha Allah, we will be opening our ACLS course to the public but i cannot give you guys any dates as yet. I am sure there are lots of you who are keen to have a go to be certified as ACLS provider! 

Friday, November 14, 2014

100th post for 2014

Haha! saja je.. historic 100 post for this year after a long lapse of a century :)

Supracondylar fracture episode

Qayyum had an unfortunate call a fortnight ago during his riding class. I was quite worried when wifey called me telling that he fell off the horse. There was no loss of conciousness but apparently his elbow was swollen. And i thought.. man.. hopefully he doesn't need surgical intervention. The x-ray done did not show significant displacement, but there was vague evidence of fracture. After consulting my colleague, he only needed backslab for 2 weeks before review.
 As a boy, once the pain is gone do you reckon he'll keep his backslab? Haha of course not and i had a torrid time reminding him about the backslab everyday. Curi-curi tu taknak pakai.. of course, in the beginning it was a glamour thing for him as when he went to accept his certificate for his duties as a class monitor during assembly, the was a momentary gasp. (according to him lah) 
Yesterday, we had his repeat x-ray and after reviewing it with Ikram, Alhamdulillah it looked well to heal and all he needs now is physio to settle his stiffness.
Well, i guess a common boy thingy when they grow up. I did not have this, am i a normal boy then? hahahaha 

AFF 2014 is here.. will Malaysia do well? gulp...

Again, we were in stadium. This time, it was a friendly game between Malaysia and Syria. This was supposed to be one of the last few to identify the squad for AFF Cup. We were excited and i guess a number of Malaysians were. The crowd was not too bad for a weekday game, i would estimate it to be nore than 10 000. There was no significance in this game, just a weekday friendly but the fans were there to brave the ront despite the earlier rain.
 With Dollah Salleh as the new head coach, expectations were there. He is the current most successful coach in the local team, being able to bring up average teams to win honours in the Malaysian league. He was himself and exceptional player. Rajagopal has been too long with the national team and that is why he left in a rush. Rajagopal brought up the standard of national team therefore recovering the lost support from the mass Malaysia team fans. It is very unfortunate that towards the end of his contract people were against him. I thought it was unfair but then again in football, define fair? haha 
 All of us were dissapointed with the performance. We played badly and what made people angry was the attitude of the players. No determination was seen and the performance was rubbish! This was rajagopals team but i seriously don't know what happened. It was as mediocre as the team before Sathianathan and Rajagopals. The typical crap Malaysian team i saw in my earlier days. Ohh.. and seeing how the fans were really patient that it was on the 85th minute when suddenly the fans vented! And for Ultras to sing.. "Dollah Salleh... apa kau dah buat?" really summed up the game. Pure frustration to the core. What happened? what happened to our team? 
It is unfair to blame Dollah for now as this is his second assignment in a very short time. It is not fair to judge him but his magic seems not working at the moment. What the fans want is the fighting spirit and doing their best.. thats all seriously! Nothing less.. a loss will be taken in pride seeing the lions playing their heart out. That is all that we want. 
AFF.. totally crossing my fingers.. 

She is brilliant

I must say i am proud of Qaisya for her achievement in her exams. For SRA, She is the best student being the one with the highest mark for all of standard one. In SKBJ, She is first in her class and 4th overall! Hoyeee... I reckon if she was to improve in her arts, she would be no 1 hahaha I guess, she picked that bit from both of us. Art has always been the subject that brought my marks down when i was in SMTTDI.
Well, for Qayyum i am sure he has the potential but being a boy, i don't expect him to excel that much. I am happy with his performance especially with his social skills. I was quite surprise to note that he as the class monitor for both SRA and SKBJ. Well, looking at how he brings himself he is very popular and friendly :) 
Tercapai cita-cita nak pergi tengok anugerah cemerlang anak.. hahaha 

Monday, November 10, 2014

Ada berani? sensory motor test post spinal..

I was looking through some literature about intrathecal spread when i came across this:

Bier's 1899 description of spinal anaesthesia documented the many tests that he used to determine the spread, including

a)sensual perception of needle pricks to the thigh, 
b)tickling of the soles of the feet, 
c) a small incision in the thigh, 
d) pushing a large helved needle down to the femur, 
e)strong pinching with dental forceps, 
f)application of a burning cigar,
g) pulling out pubic hairs, 
h)a strong blow with an iron hammer against the tibia, 
i)vigorous blows with the knuckles against the tibia, 
j) and strong pressure on a testicle” (1)

1 Bier A. Versuche uber Kokainiserung des Ruchenmarkes. Dtsche Z Chir 1899;51361–9

Hahaha... i can imagine him trying to do all that in ensuring that the block works. option f with a burning cigar is certainly something i would not like to resort to in proving my point!! hahahaha 

Friday, November 07, 2014

mini ASEAN SUN meeting 4-5 Nov

I was involved with this meeting organized by Izzat to be in UiTM. It was a small scale meeting but very important for networking purposes. Simulation User Network is slowly growing and this was my chance to be part of it. Forthe past few years it was not possible because of my commitments. Izzat roped me in to run 1 station and i took up the challenge! It was worrying though as i did not know who my participants were! This is ASEAN level thus it should be at a certain standard.
 Initially we thought of running a simulation but i changed my mind because in this workshop, what the participants want to learn would be about handling simulation. I tackled the toughest bit which is debriefing. Though our station was named paediatric crisis resource management, i was focusing on the debriefing bit as it is the most important part of any simulation. None of us were trained formally and the lacking of such training is glaringly obvious. Being asians i guess we concentrate a lot on the technical fidelity aspect that we forget that being the facilitator is at its toughest during the debriefing period!
Both days were interesting because i had to cater 2 different crowds. Of course the first day i had more people so the adjustment was minimal. The second day i only had 5 participants so i had to change my approach! I thought the reverse simulation was an innovation as i had the participants to be the facilitator and having a go at the debriefing! It was not easy to start off with but i am sure the participants were encouraged by the session. 
Simulation teaching is the way to go and i do hope to be part of it despite me being out of the academia. I was trained in this and it is only natural that i should share this with others. Its something i do really enjoy and perhaps now with my clinical work focused i can be more active in SUN group.

The readings that you do

Was looking through the books i have bought for the past few years.. hmm.. certainly i am keen about the country :)

Pacesetter 3030 Padang Merbuk 2/11/14

Any run routes organized mainly by pacesetters will be exciting. After the disappointing last minute thingy that made my 42km SCMKL tak jadi, I was looking forward for this run as in the past it has always given me the ultimate challenge especially hills. Though i did not clock good mileage in the run up to this run, i did emphasize on hill training and to a certain extent and it paid off. Looking at the initial map i knew i will be in for a suffering at the last 5 km haha double hill tu..
 I was at my usual parking spot along tugu negara by 5am. What made me uncomfortable was my tummy despite me having done my bit earlier. I did try to queue for the toilet in Padang Merbuk but it was too late. I thought hmm.. might as well settle it along the run!At 530am sharp we were flagged off. I saw the 3hr 3:30hr pacers lining up and i thought.. wow.. takkan orang tera pun tak bole buat sub-3 for the 30K? And of course the answer to that was unveiled during the run. 
What is important in these long runs is the mileage for the muscles. I did manage to fit in runs in between the days for the past few weeks but i knew it wasn/t enough. I was crossing my fingers hoping that i can last the distance and not DNF!! My cramps can be really bad :)
The first 6km was not too bad i thought. My pace was good and i was not puffing despite the elevation going to the famous 2 hills of kenny hills. I was positive about this run but at the same time holding myself not to overdo in the earlier distance. Of course, my tummy had to give in and i had to wait almost 10 minutes for the toilet break! hahaha but after the dumping, the body felt so light and i cruised through.. And then i saw the mosque.. Haiiyaa.. i should have waited a bit and could have done the 2 in 1, subuh and dumping in a more comfy place!!
 I was running my pace comfortably and indeed i was happy with myself. This was during the 2 rounds of hartamas route. The sun rose but the weather was perfect as it was not humid. I was happy but at the same time cautious. At the halfway point i was happy and i thought yup.. perhaps it can be a miracle. I was doing a good pace and i thought the 3:30 was very possible. The water stations were excellent and my kurma was doing me good in keeping my energy level. The elevation can be damming but it was not too bad.
 Coming to the second loop.. ooo..oo.. my legs were twitching so i reduced my speed and aggression. Haha.. now it is slowly showing itself. Surpassing the 22km mark, my thighs were pulling and i started walking. Ok.. confirm tak cukup mileage! I was flying if i were to do the 20k race but definitely my muscles were not ready for the 30k route. I held on and walked more than i run in the next 10km. The pain was bearable but i if i overdo it, it can be to the point of no return! I want to finish this race!
 And so i struggled even to walk at a comfy pace. the elevation wasn't helping as you knew what you were up to.. haha this is the beauty of pacesetter race! Siksa.. jgn tak siksa!! COming off publika and towards kenny hills was a relief but the hills there was even worse! i wish i had done enough mileage as it would have been fun to run up those hills after the 25km mark! I was limping and walking.. it was indeed a struggle. And of course 3:30 was off! I was wondering if it was possible to do a sub-4.. jadilah! haha
 Reaching the final stretch was a relief! Of course you want to end it in style so the running must be there.. at least for the picture hahaha And when i saw the clock was at 3:59.. yeehhaa.. jadila sub-4 hahaha

 Alhamdulillah finish the gruelsome run at 3:58;20 (official result) and gun time of 3:59! I thought not bad!! And now i am looking forward for PJ half.. which the 21km i should aim to get close to my PB.. Tapi kalau dapat sub 2 kira cool ah.. :)

Saturday, November 01, 2014

Rimau Biru or Gajah?

Its that time of the year again. Its the Malaysia Cup finals today.!As a true Malaysian football fan no matter how crap they may perform on the pitch, the romantiscm is everlasting :) 
JDT vs Pahang with Pahang the favourites as the defending champion. It has been an interesting season and both teams deserve to be in the finals. I wish Selangor was in it but unfortunately they faltered in the quarter finals due to management issues. 
JDT is the star studded team like Man City or Chelsea, as most are national players brought together by money. TMJ has certainly revamped the state football team. Johor was unfortunately at its low 5 years ago unlike in the past. Their supporters are legendary and it is such fun to be in a stadium full of JDT fans.
Pahang coached by Zainal Abidin Hassan is a strong team with good tactical strategies which started last year when they won as underdogs against Kelantan. This year, they look strong and consistent. Honestly i have my bets on Pahang to win it again based on thier whole season performance.
I want JDT to win because Johor has always been my second team to support after Selangor. However, their defensive display is a dismal throughout the season and i am not sure whether it will be any different tonight.
But..its the adrenaline and cup finals may bring a different kind of energy to the players. I would love to see our national players shine but unfortunately, they are not consistently played throughout the season because of the import players. 
Viva Malaysia! Viva football!! 

Friday, October 31, 2014

A different life to rekindle past interest

Somehow, i find myself to have more time now. I guess its because the compartments in my brain has been unleashed from unnecessary storage. I used to have lots of things in my mind; besides my patients in my daily work, the students, my teaching, projects, future research proposals, hospital committee, the future.. waaaaa... memang banyaklah! And since moving to private...

a different kind of freedom..... peace... 

(except my obsessiveness browsing at my daily charges everyday! hahaha)

And perhaps..  the main reason you see me writing actively again. Not just about what i do or my activities but about what i feel. I've been browsing through my blog and wow.. the blogs in 2006-2009 were really from the heart. A true sharing. I guess being occupied with work and responsibilities, the time in front of your PC is limited. 

Compared to few other doctor's blog, mine may not be as artistic and interesting (mcm Dr Ben punya..) but i don't plan to be him! We are who we are, unique and individual. Its ok to not have fanatic fans and stalkers... hahaha

To my silent readers, thank you for spending a bit of your time here. I do appreciate your presence as how I love to browse and read your blogs :) 

So you wanna be an anaesthetist? Pre Op Assesment Part 2

Ok.. now you are seeing the patient. Why? Obviously the meeting is for rapport but at the same time to discuss the options of anaesthesia available to the patient which is appropriate to the procedure. Sounds like a straight forward job right? Just refer to the guidelines in assessing the patient
Its not that simple. When i was doing this job in my early days, my focus was on the well being of the patient, his suitability, his risks and the consent. It was only about my job and role. Pretty isolated.We were to assess patient's history, medical problems and their compliance to their medication, basic effort tolerance review, airway assessment etc. A review of the investigation was a must and it was a BIG point in HKL then that if the investigations are not ready we will not review the patient.(which has its advantages but that is never the point!!)
What i discovered through the years is its more than that. Anaesthetist are supposed to be the brilliant bunch. Therefore, the depth of knowledge is important and it is not limited to anaesthesia but holisticly. Ie its not enough to know what surgery but the whole process of the surgery itself should be well known from the actual surgery to their recovery in ward. That is why we are perioperative physicians 
Serious! Thats how much an anaesthetist should know. Experience is virtue and should not be compromised for whatever reason. I reckon it should be a pre-requisite for anaesthetist to do compulsory medical and surgical posting before being admitted into the programme. It is a good idea to know whats on the other side and by understanding the whole picture, any miscommunication can be avoided.( i will certainly blog about this in more detail!! haha interesting stories to tell).There was a time during my infancy days that what i care was only when they were in the OT - which is a totally no-no. 
Knowing what surgeon does to the patient is important as there can be times during the surgery that they may request funny things for us to do. EG in PCNL, the urologist may ask us to halt the ventilation when he is puncturing the kidney. THis should be momentary but sometimes it takes more than 5 minutes for them to do so and in due time causing a lot of stress on my side! haha 
I remember when i was a junior MO having an argument with Mr Rohan (Consultant Urologist) in Selayang during his PCNL procedures because i thought it was not right to stop the ventilation for so long! hahaha No wonder he was pissed off when i continued to ventilate. It is through experience that i learn, we can assist the surgeon to make things easier and more convenient for them. eg in off pump CABG while doing the circumflex graft ; sometimes it is necessary for me to intermittently stop the ventilation to ensure my surgeon suture the graft perfectly. This will in fact reduce the possibility of post op graft complication. 
In government hospitals, some surgeons view anaesthetist job is mainly to cancel the cases until proven otherwise.In a way this can be true as any patients not optimized will be cancelled! Unfortunately, the decision to cancel are often  unilateral without a professional colleague to colleague discussion. The word "optimization" can be subjective. The long line of listed patients can be a burden but cancelling and rescheduling is troublesome for the patient. I am glad my training in anaesthesia in multiple centres had taught me how to properly manage a patient. It is not about the anaesthesia so much but more about the quality of care and patient satisfaction.Imagine being the patients themselves, having cases cancelled because the young ASA 1 patient with the pottasium being 3.0 for an I&D case is ridiculous! 
I know a lot of anaesthetist can be really petty about trivial things but by making decisions unilateral does not help the situation. Of course, i have come across surgeons who are interested in just doing their cutting with no regards to the patient's general condition! However i am sure these type of surgeons are a dying breed. 
Anaesthetist i reckon should lead the way to educate teamwork care in a respectable manner. A lot of criterias should be considered before deciding not to proceed with the case. It has to do a lot with communication. How many times have we heard shoutings between a male surgeon and a female anaesthetist arguing about case being cancelled? Haha However, it is not bounded to the gender or place, as when i was abroad these issues are similar!