Saturday, November 29, 2008

SOOO KNACKERED !!!


I just came back from the FRISCO Nuffnang Family day out event in Sports Gym , One Utama. Woww... I am soo damn tired and the kids.. hahahaha.. lagi la !! I really had my hands full trying to take things into control but children will always be children !!! Hhahahaha Memang penat ahh nak jaga budak 2 orang sekali gus.. :) MY right bicep is a bit sore now and i reckon had fast- track isometric workout today carrying Qaisya !
I will write more about what happened today later.. I am too knackered to blog it out at the moment !! I got interviewed by NST too focusing blogger dad !! Hahahaha tak tau bila keluar but of course , i will post it when it is out !

RM100 MPH voucher I won for blogging this entry. This would answer wifey's continuous sceptical question to the benefits and perks of blogging !!

Saturday, November 22, 2008

Tale of two souls

My little ARDS kiddo was perfectly well this morning upon pass over. I guess she didn't need the BiPAP so much ; her gases were acceptable and I quickly changed her to nasal prong.
I asked my nurse to give their parent's a call ; to bring her favourite drink as she has not been eating/drinking for the past 2 weeks ! ( She was otherwise well nuorished with TPN and N/G feeding ! ). In a flash his father came and I could see the joy in his face. Iasked him what is her favourite drink and he said Coke... Hmmm.. opps.. i think maybe not that now ! I asked if she liked ribena and the father said definitely.. and within a minute he was back with the cute little packs of ribena !
Seeing her wheeled out of ICU this afternoon really made me feel satisfied and a bit sad. Sad because of my attachment ; she'd be the first patient that I'd visit every morning and see her overnight progess. She's not fully fit yet , but she definitely improved and on the road to recovery !
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I somehow knew ; when i blogged about the ailing meningitic young mother that I would see her go when it was her time. The brain stem death test criteria was not fulfilled on Wednesday , therefore she could not be pronounced dead yet. Her brain function however deteriorated ; almost textbook stepwise with one by one brainstem regulating centres affected. When i took over this morning , her haemodynamics were not so great.
I confronted the family and informed them of my concern ; and I guess they've expected the worse sooner or later.I'm always personal when it comes to this , because i feel that the family should be by one's side during one's last moment.
At 1614 I pronounced her death with all the family members around reciting syahadah for her on her final second. And it was my name ; certifying her unfortunate death.

Alfatihah...

Friday, November 21, 2008

ARDS kiddo part 3.

It's 2 weeks today ; her admission to ICU. Her infection settled but the ARDS was a nightmare for the ICU team to manage. We've tried everything to open up her lungs and improved her oxygenation.We recruited and last week ; the bronchoscopy.. still her oxygenation was bad. In a way , we were baffled. Why can;t we improve her PF ratio ?
It was paradoxical through ; the numbers did not correlate at all with the clinical picture. Her hypoxaemia was evident , but .. she was comfortable. After the sepsis settled , her ventilation was never a problem. Her SPO2 was 98 - 100% but her ABG did not show good PaO2 at all ! There was no difference increasing or decreasing the Inspired O2 ; 1.0 or 0.4 !! Slowly we reduced the PEEP ; and her oxygenation remained as it is. She was totally comfortable. The question was , to extubate or not to extubate ?

We theorized that since she has chromosomal abnormality ; her bodily physiological function must have compensated itself and regulate on different limits. The readings that we get maybe totally normal to her because she was never admitted and investigated. She was ruled out of any congenital heart problems ; but somehow her physiology is unique and different. her Oxygen Dissociation Curve does not comply to the norm and maybe a mixture of fetal haemoglobin type ODC. Her SPO2 was amazingly 100% eventhough her PaO2 is barely 60mmHg!!
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And today afternoon ; after a successful spell of 24 hours spontaneous ventilation ; we extubated her and immediately on BiPAP. She was OK amazingly !! She was comfortable ; and the look on the parents' face was rewarding to me :) I reckon she will not deteriorate and hopefully in the near future to be transfered out to normal ward for rehabilitation...

Wednesday, November 19, 2008

Brain stem death


Brain Stem Death was first formally introduced in 1976 and has been ratified by the Department of Health and Medical Royal Colleges on several occasions since, most recently in October 2008. Its equation with human death is based on the concept that when essential elements of the brain stem - the stalk of the brain which connects its bulk (the cerebral hemispheres and mid-brain) to the spinal cord - are permanently out of action it is reasonable to disregard continuing activity (life) elsewhere in the brain, e.g. in the thalamus and "higher centres", because there can never again be consciousness or spontaneous breathing. That concept has not found acceptance in the USA (and many other countries) where the irreversible cessation of all functions of the entire brain must be established for the legal certification of death on neurological grounds. ( taken from wikipedia )

How do you tell the family that this is the condition that your son/daughter is having now ? How do you think the family will accept that their child is considered dead ? Is it easy to accept that nothing can be done anymore when you see your child helpless with all the machines making noises assuming to function and regulate ?
Identification of this syndrome was held, by the Conference of the Medical Royal Colleges in 1976, to require withdrawal of "further artificial support" - particularly fruitless mechanical ventilation of the comatose patient - thus "sparing relatives from the further emotional trauma of sterile hope". The diagnostic criteria being accepted by this authoritative body as "sufficient to distinguish between those patients who retain the functional capacity to have a chance of even partial recovery and those where no such possibility exists", no legal problems with this withdrawal of life-support measures, in the sole interests of the patient and his relatives, were likely to be encountered.
How do you tell the spouse that you need to pull the plug and within minutes ; she will die ? How scientific can one be losing one's dear heart and soul ? Are you sure that nothing more can be done ? How do you show your empathy and actually tell the family there is nothing can be done now and it will be over soon ?
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After 4pm today , the 2nd brain stem function test will be performed ; and the fate of the unconscious lovely innocent mother who is still breastfeeding her child will be determined.

Monday, November 17, 2008

Friso Brings My Family Out

( for this competition )

Hi ! My name is Dzaeffran. I've just turned 3 last Sunday! They say that your 17th will be the most memorable but I guess I just have to wait huh.. ( 17 is after 16 right ? )
This is my first time blogging. I've observed my Walid ( dad ) doing this almost everyday and how hard can it be ? I can bet that most of you will doubt this posting and wonder how did I ever learn about typing my thoughts on the computer? Heard of Mozart ?? ( You should watch Little Einstein ..its educational ! )

Both my parents are Doctors. Honestly , I don't know what they do but they are always busy at the hospital. I went to there once and got poked ! It was an unpleasant experience ( Uncle ( the doctor who took my blood ) .. watch out , I'm gonna get ya ! ). Anyway , it had been quite some time since the whole family went out for a holiday. Walid and Umi are busy with their work and exams ; and everyday becomes a routine for us. Both me and my sister , Qaisya go to the nursery everyday , sometimes Nenek or Tok Ma will pick us up from school. It can be pretty boring watching Disney Channel Play House everyday :(

I just love having day out with the family. It is so much fun ! Everytime i see my parents bring the big bags out , I know we are going for a long journey out! I become excited and Qaisya somehow knows it too.
When we are away from home , everybody is cheerful ! Walid will be singing and singing non stop while Umi busy taking care of our milk and food. I love to see Walid and Umi laugh at our antiques ; me and my sister can get along really well at times ! Walid can become angry at times especially when I poo or pee ; I dunno whats his problem with that though ?
The other day , I saw an AD over the internet while Walid was surfing the Internet ; Its the NUFFNANG FRISO FAMILY DAY OUT !! Its coming soon and I am so excited !! I tried to tell both Walid and Umi that we all should go for it but somehow the message did not get across. We tried may ways :

we took all our soft toys out and pretended the event but my parents thought we were just being naughty...

Qaisya gave a convincing lobby speech but it was in ladybird language . I performed yoga to express my feelings but still , Walid and Umi can't seem to understand our cryptic message !!

Since both Qaisya and me are really determined to go for the event , we came out with our own plan.. hmmmm.. We'll go there without Walid and Umi !!!
Since then , we've been training hard.

Qaisya has learnt the art of fitting into travel bags so that she can sneak out when Umi goes to work.

I am now the master of disguise... When I have tepung kormak over me , I am invisible !!

We've both mastered the art of survival. We know how to make the sand as our staple food . However , one needs a lot of imagination for this skill though. I still prefer my milk.

And come 29th of November , You'll see us both in One Utama proud on our ride !!

Opppsss... Walid is awake now .I better log off and hide this post ; the MASTER PLAN for our mission to NUFFNANG FRISCO BRINGS MY FAMILY OUT !!

Kakii's best buddies competition

I'm putting this post up as a pre-requisite for this competition. Hopefully dapatlah something since gambar Mafiz pun ada sekali... hahahahha
I must say , I've shared my wonderful outdoor experiences this year with my best buddies. Latest being the Genting Trailblazer !! The badminton , 10k , 21k , trail runs were awesome ! Finishing the mission together is certainly an achievement ; priceless...

Camp Lolo , Nuang 2008

peak of Mt Trusmadi , Sabah 2008

TrusmadiTambuyokon expedition 2008

post badminton carbo-loading

KL Marathon 2008

Duathlon UM 2008

McDonalds run 2008

post Genting trailblazer 2008


The picture says it all !

Sunday, November 16, 2008

Dzaeff's Ultra-3rd birthday

We celebrated Dzaeff's birthday on a small scale ; bought him( pre - ordered ) a cake and families from both imen and wifeys were invited to our SS2 home.Too bad Doya can't attend because she's overseas and Elly had her classes on. It was not a taxing job though as the food prepared were mostly fast food ; the usual Pizza hut , KFC and Sate Samuri !! The theme was Ultraman ( surprise ! surprise ! ) and it was certainly cute watching both the siblings enjoy their day.


family pic

nice cake !

its very nice !
We bought Dzaeff his first bicycle the night before. It was raining heavily and I must thank the KSH owners for waiting and not close ASAP when they saw us coming ! It was a simple bike but he will be able to use it for a long time. Hopefully join me one day ! We had to buy another 4 wheel bike ride for Qaisya and that certainly brought the tension off.
his real present is the bike in green !
Happy birthday Myftzal Dzaeffran Qayyum. Semoga Allah memberkati serta sentiasa merahmati hidupmu..

Birthday cake cool giller !


Happy birthday my dear Dzaeffran !!! You're 3 today !!
Its Cheese Choc from Secret Recipe tau ! Excellent !!

Saturday, November 15, 2008

Habit


I have this funny habit. I know that woman like to go window or real-shopping when they want to escape from the real world. I have a similar bug since med school. I just love to go and roam around in hypermarkets !! Hahahahah... Seriously !! There is something about wheeling your trolley cart in the hypermarket.It brings peacefulness to your mind.Hahahah pelik tak ?
I guess i picked up this funny habit when I was in UK. It started of with KwikSave in Shrewsbury. That was the place that the whole bunch of us would go during weekends to get our stuff.I ended up goingthere alone during times of despair as well!! Nearing exams , before the results or when you feel down...

Then when we were in Manchester , my favourite was TESCO. It was huge ! I was TESCO-bias compared to other hypermarkets in UK ; SAINSBURY , SAFEWAY , ASDA and ALDI. Everything was TESCO for me when it came to NO FRILLS products ! HAhahaha Mama had her favourite ALDI in Leicester and there was this cool chocolate wafer from ALDI which was so nice! My all-time favourite TESCO product was their 99p 10 piece jam doughnuts which was damn cheap if you wanna compare with our current J-CO or BIG APPLE.
When I came back home , it was during the time of hypermarket boom. I was never a favourite of MACRO which was the leading hypermarket that people go to then. GIANT moved in and wow.. she became my second love. I would regularly go to GIANT in Senawang which was complete and spend my weekend there if i have nothing to do. I remembered going there straight after finishing my exams and somehow the place really relaxes me !! HAhahahahha
Nowadays , GIANT Kelana Jaya is the place I go to . Sometimes I would just wheel my cart around without really buying many stuff ; most of the time my kids' diapers would be my major buy !!!

And of course , to top it up. My all time favourite KFC Snack plate !!

Friday, November 14, 2008

Weird experience

I am blogging this "real time".It just happened a few minutes ago. I reckon I will be the first person to report this to the world ( through my blog) as it happens. 4 am 14th November 2008. Due to certain legality issues which may arise , I will only comment about my experience being called to be involved in the assessment.

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The phone rang hard , waking me up from my short nap. It was 4 am in the morning.
" Hello... "
" Hello Dr. , sorry ye.. ni nak mintak tolong tengok patient kejap.. "
I said.. rats.. must be that patient again desaturating..
" Patient mana ? " I asked.
" Ada satu patient dekat tepi bilik 10 , jatuh bangunan "
" What ??? dekat mana ? " I asked again. My eyes opened up wide ! Am i dreaming ?
" Patient jatuh dari tingkat XXX. JAtuh dekat bumbung tepi bilik 10. Nampak mcm breathing. Nak mintak tolong dr assess "
I quickly moved out from my bed , an express face wash and proceeded to the scene of crime.
There were a number of my ICU staff there along with the security guards beside the window. Outside , there were two men safeguarding the patient.
I climbed through the window seal and immediately was on the 3rd floor roof. It was dark and only the torch light became the beacon for assessment.The patient was already on cervical collar ; spontaneous breathing was present eventhough she was unconcious. Good sign.. I may not have to airway protect this patient in this very odd place and position ! She initially did not respond to my call. Pupils were both reactive. According to the A&E staff ( who was coincidentally in ICU when this happened ) the patient was prone when they found her. They slowly repositioned and had the cervical collar on. We gave her oxygen after seeing her saturation to be just there.
Moments later , she woke up.
E4 spontaneous eye opening.
V5 able to talk and communicate , obeying my command.
M6 able to move her arms and legs.
She complained of lower back pain , and can't mobilize her left leg without inflicting pain.
The A&E crew arrived shortly and she was brought to the emergency department for reassessment and stabilization.
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too dark for a clear pic on the roof
Hahahahaha.. that was a totally wierd experience while managing ICU. Today , the ICU care went across borders ; through the window literally !

Thursday, November 13, 2008

ARDS kiddo PART 2


For the past few days , her oxygenation never improved. We tried to recruit her lung many times ; still it was not great.Pa)2 was 60 - 90 then back to 50 mmHg.Lai did a good smacking chest physio ; which showed promise but unfortunately premature. I guess the team has exhausted our ways to improve the kid. Her lungs is the only organ which has not recovered. It just did not tally , her x-ray showed a lot of improvement but her blood gases were otherwise. There was however a lower lobe collapse which persisted. Input from the CHest team was much appreciated.I have this theory before , seeing ARDS patients that if the high settings cause worse ABG , then it is time to revert to normal ventilation.
I had a small chat with the parents ; and of course they were very afraid for her outcome. I updated on her progress and I was glad that the parents were very cool and calm . They really love their daughter more than anything else.
We bronchoscopied her today at a PEEP of 20! That would have been very dangerous because if we were to loose her oxygenation ; then it can be a point of no return. We had to do it ; we had no choice for now. We proceeded and Alhamdulillah , nothing bad happened. She was able to maintai nher oxygenation eventhough her ETT was almost blocked by our bronchoscope. Her airways did not show it was in bad shape but there were lots of thick mucoid secretions which we could not suck out all. We did some and hoped so much that she will improve.
The Chest team Prof had a word with me. HE was quite happy with the chest xrays and suggested that we wean her off . He was optimistic that we could extubate her really soon.
Tonight , it's my turn to watch over her again ; and perhaps with Prof's input ; just pray for the best..

Tuesday, November 11, 2008

Tazkirah

A reminder i received from a friend. Good to ponder..
Weakness In Morals : Proof Of Lack Of Faith
Faith is imperfect without morality. Faith is such a power that it keeps men away from low attributes and mean acts, and encourages him to achieve high attributes and clean morals. That is why whenever Allah called his slaves towards virtue or whenever He wanted them to hate evil, He declared it as an essential requirement of the Faith in their hearts. For example when He, in Surah Tauba, commands men to adopt righteousness and to speak truth, He addresses them as "0 you who have faith" (or "O you who believe") : "0 you, who have faith ! Fear Allah and be with the truthful people." .....(Surah At-Tauba : 119)
Allah's Messenger has nicely explained it that when faith is firm and belief is strong, then strong and lasting moral will be developed, and if the moral character is low then faith will accordingly be weak. A man, who is immodest and ill-mannered and who adopts bad habits without caring for others, is like the person about whom the holy Prophet has said, "Modesty and faith are twins. One who gives up one has to lose the other too."
Once the Prophet passed by an Ansari who was scolding his brother about his immodesty. The Prophet advised him to let him go as modesty was a branch of faith. A man who harasses his neighbor and makes him suffer any kind of damage is called cruel and stone hearted by the religion. In this connection the decision of the Prophet is:"By God, he cannot be a Momin; by God, he cannot be a Momin; by God, he cannot be a Momin. He was asked: "who"? He answered: "He from whose misdeeds his neighbor is not safe." .....(Sahih Bukhari)
The holy Prophet advises his companions to keep away from the talk that is trash, the acts that are wicked, and the deeds that are senseless.
He says:"A person who believes in Allah and the Hereafter should speak about good things or else should keep quiet." .....(Sahih Bukhari)
In this way through the truth of faith and by means of its perfection noble qualities are nurtured and developed and they are guarded and kept secure till they bear fruits.
A true Muslim should avoid having rows of prayers disrupted, hearts sad, and prayers tasteless. However, you will also find such people, who will be calling themselves Muslims, yet they will be lazy in offering compulsory prayers, and will be posing in the public as if they are very keen on establishing these prayers. But they will not lag behind at the same time in acting in such a way that will be contrary to the demands of the noble character and perfect faith. Such people have been warned by the holy Prophet and the Ummah has been asked to be careful of them.

ARDS kiddo Part 1

( I apologize for my technicality in this entry.. )

I was not able to rest properly on early Monday morning.Usually the nurse will call me in my room at the end of ICU , telling me about red flags that I have set earlier. Phone consultations sometimes is adequate because I know which patient needs what and thats why I asked them to inform me as I have my limited rest.
I was literally in front of the little girl till 6 am whose oxygenation had gone from bad to worse. It started off at midnight when she desaturated to 90%. After some adjustments on the settings , it further worsened. This was the 13 year old girl i mentioned in the earlier blog ; having a severe bronchopneumonia which tipped her off to ARDS ( Acute respiratory distress syndrome ). Despite the lung protecting strategy we initiated earlier , she was not improving at all. The worse thing that could devastate her parents was she could just die because of hypoxia that night.The bad thing about that was I may not be able to do anything much ! I was looking at her , seeing the innocent body lying there helplessly.
It was at 2am that I decided , i should recruit her lungs. ( Recruitment is a method used in ICU setting to improve patient's oxygenation for ARDS ) It was scary , because of the high possibility that things can go wrong at the middle of the night . But her PaO2 was a mere 30 mmHg and that is with 100% oxygen ! I knew I had to do something.
So there it was , after paralysing ; pushing up her PEEP , 15 to 20 .. to 25... to 30... to 35.. Waahhh... I was really afraid in causing barotrauma for this young kid but what choice do I have. I need to improve her oxygenation somehow. It was dramatic when she desaturated on me then , but I remembered what Tuxen ( the ARDS expert ) mentioned in his July ICU conference. CARRY ON !!!
After twice recruiting her lungs , I was sitting in front of her ventilator ; watching closely all the settings ; PEEP , rate , Minute volume , Compliance, Fi02 ; titrating it to patient's best condition. ABG after ABG ; I dunno why i did not feel sleepy then , perhaps the thought of seeing the parents watch her die in front of their eyes affected me so much. I mean , imagine if it was your kid ! I knew she could become better and I guess thats why I persisted. Perhaps , my upmost attention in my ICU posting so far in the training..

At 530am .. Her PaO2 was 75 mmHg , FiO2 65%.....

Sunday, November 02, 2008

It was dirty and wet.. we ran wild !

Genting TrailBlazer was awesome !! At the end of it , we were filth dirty but it was worth it !
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We started the Sunday @nd November 2008 really early. I had to miss the Spurs Liverpool game because I wanted enough sleep before engaging on a physically challenging activity in the Morning. ( luckily i missed... huh.. ) By 5 am I was up and drove to my mum's place in TTDI. Edrin and Mafiz then picked me up at about 530am and we were off to Genting Highlands. It drizzled as we were driving up and that was an indication how the race would develop into ! We had to cross really thick fog and at times we were not able to visualize anything 5m in front of us !! Hahaha.. Belum apa apa dah adventure..

We registered ourselves to receive our numbers. I was very unhappy with the staff which handled our registration. SHe was REALLY RUDE !!( wearing green coloured sleeveless ) PAgi-pagi dah buat SPOIL ! SHe shouted at us when I asked for XL T-shirt ( which we confirmed our registration SINCE AUGUST??.. Organizer take note ) . SHe mumbled at us with a bitchy face saying they ran out of stock and can only give us M. WTF ??????? I could have appreciated if she'd say it nicely to us WITHOUT SHOUTING for NO REASON ?? Memang BAPAK tak pernah ajar MANNERS kot ?? Hahaahahaha..
The race for our category started at 840am ; abit late for any usual run! However , we were in higher ground so it was still cool and windy. I must say , the weather was perfect for our race. The fact that it rained the day before , after a week of rain exodus certainly made the track something to remember. The race required us to run in pairs ; which i support fully as this was a trail run. Mafiz was my partner , Azad partnered with Edrin , Ruslan was with Halim and Shahrul was with Lim.

We ran down along the Awana golf course. It was on a normal tarmac road so it was not that bad. However , there were few hills which challenged our fitness and I guess the Kiara Hill training was worth it ! Itupun still pancit !! Then we moved into the jungle trek. Weehhh... it was very slippery !! My shoes had enough grip but my concern was safety first ! There was no way for me to win the race , so i better not make myself injured. The jungle trail had lots of ups and downs. It was more tricky because hundreds of us were running at the same time. Of course the soil consistency becomes slippery and more slippery ! I felt at a few points but it was part of the fun ! I wanted to take more pics inside the jungle but i decided to wrap my handphone because of my past trauma !
My thighs were cramping and i was walking after we ended the jungle trek. Mafiz and I did not bring any supplementary food for energy booster consumption.( which we later found out the Power Gel was in Mafiz's water bladder all the time !! Hahahaha ) I was trying hard to heal myself because I didn't want the cramp to spoil my race !
Towards the end , there it was .. the famous Genting trailblazer obstacle course ! It was designed to make all the participants REALLY REALLY DIRTY ! We were to jump into 5 POOLS of mud ! We were required to put our whole body into the mud which was umbilicus high !! During this time my cramp suddenly dissapeared and I felt my energy boosted !! hahahahahaha IT was so dirty but it made the day !! Kah kah





We were placed 58 out of 139 pairs in the Adventure group. Weeh..ok lah tu !!! Time , roughly 2 hours and 40 minutes. And after crossed the finishing line , we went to the MILO stall right away !!! MAfiz was so hungry that he ate before taking his shower !! hahahaha Azad and Edrin arrived later but till the time we had to go , Ruslan and Halim was still nowhere to be seen. ( Need to see their blog later ahh.. )


Thank you guys !!! We shall do it again next year !! Hahahaha... STAMINAX POWER !!