Friday, April 18, 2014

Intensive Care Nephrology in Penang

I had the opportunity to join the programme by the Intensive Care Society of Malaysia in collaboration with the HK Univ BASIC course. I am handling the CRRT (Continuous Renal Replacement Therapy) machine in CTC UiTM therefore i should well equip myself with the latest practice and do's.I know it will be good because of the mechanical ventilation workshop i attended earlier which was under their wing as well.
 Of course, once it is organized by a Hong Kong Based Institution, exams will be one important aspect of the course! We had a pre test to do which me and Azman did atthe very last minute! 
This was my first road trip with Azman, going to Penang! We drove in from CTC on Wednesday evening and arrived in Penang via the new bridge at 9pm. Of course, right after arriving we had to go for Nasi Kandar and it was my first time going to Nasi Kandar Line Clear! It was really really nice and amazingly cheap as compared to the Kandars in KL.

I enjoyed the course thoroughly. I definitely learnt a lot and thats what one wants when going to these courses. We of course had an exam to solidify what we've learnt.. typical kiasuness.. hahaha And of course now, i am more confident to give my dose for RRT :)

Thursday, April 17, 2014

The myth of High Thoracic Epidurals

 Inserting high thoracic epidurals is another new dimension in my current practice. The last time i used to have a go at this was during my Selayang days when we did a lot of open liver work. A good analgesic cover for post op was important in liver impaired patients as opioids will certainly stay longer in them, and the analgesic requirements can be plentiful with the rooftop incision.
Now i do it for all open thoracic works and a new thing is selected cases of CABGs. Yup believe it or not, open heart surgeries! According to evidence, the morbidity and mortality is the same for epidural or non peidural patients, however for post op analgesia, extubation and cheat expansion, it is very significantly SUPERIOR to other modes of analgesia. Patients do become comfortable and earlier extubation time is achieved. 
Everybody is worried of the minute chance of dural haematoma which can be very damaging. This is true for patients who has the easiest chance to become coagulopathic post op; thus making things tricky in terms of usage and displacement of the catheter. I have decided to embark because evidence show that the possible complications is minute and as a university, why not? Prof did mention that we wanna have a go at awake CABG one day and i definitely have to upskill myself to ensure my high thoracic epidural is top notch.

Previously when i learned to insert T6-T7-T8 epidurals,( Sifu Hashim who is now in Ampang Puteri) it was easier insertion and success with  paramedian approach. But for my CABG with T2-T3-T4, the midline approach seems to bring more success. I have always thought that paramedian would be the first choice but somehow for the past few patients it was otherwise. I have stopped trying initially with paramedian and on to midline instead.
Interestingly when i looked at the japanese and korean literature, they indicated their technique is midline rather than the western text books who mentioned it is better to perform paramedian approach. I guess it has to do something with our Asian physique and spine anatomy.
 Alhamdulillah, it was obvious those with epidural in my patient population to have better analgesia and the lung expansion post op is superb. Smokers do need to keep their lungs open post op as the secretions can be a nightmare to both patients and the nurses. I am glad that i embarked into this technique despite limited practice and observation during my masters training ( in CABG that is).

MSA ASC 2014 Scientific committee

This month began hecticly with MSA Annual Scientific Congress.This year it was different because the venue changed from the boring Shangri-La to Berjaya Times Square! It was time to breath in a new air into the meeting when held in KL!
 I was roped into the scientific committee and we've been meeting regularly since last year. It was not an easy job; lead by Dr Ina of UM we did have a good team. A good mixture of youth and experience. I am the youngest hehe in the group, with Dr Rohisyam, Muhammad, Vanitha and Ina herself. I thought we did a great job. It was not easy to ensure our contacts; the visiting speakers to come over and join the congress. Krishna was my main invite and it was good that he managed to make it. I was a bit worried in the beginning as i was not sure how his response would be in delivering the talks. 
I was involved with the Paediatric Airway workshop as well! Reason being 
1. it was held in UiTM skills lab 
2. there was a simulation involved and Ina roped me in

I enjoyed myself and of course thanks to Hambali and Shikin who were amazing actors in the process. The simulation was also good as we somehow managed to emulate the ot scene with the limited resources that we had. Kudos to the team.
I gave 2 lectures; really didactic ones but i thought the audience loved it! One was on RA and anticoagulants while the other airway management for nurses.I handled the poster presentation session which was different from previous meetings. We brought in international flavour with E-posters and best 10 posters for evaluation. It felt good and the judges were happy that we ran it this way this year! New dimension of ASC!
It was an interesting experience being involved in a big event and i do hope to be given the opportunity again in the future. *despite my ketidakpuashatian on higher management appreciation issues.. haha :)

Wednesday, April 16, 2014

Simple things first

Why can't you understand?
the concept of being humble.. the concept of humility?
Why is it hard to just say sorry for the statement, none of it your intention?
Why do you have to be defensive and be arrogant about your statements?
Don't you get it? Don't you ever get it?

Sometimes it is just simpler to say..oh was it how you felt?
Sorry.. it was not my intention. What I meant was..

Would not that be an easier way to handle a confrontation?
I can't teach you this..
Because it comes from the heart..
None that can really be taught.
Mannerism can be well explained,
but the way one expresses their manners is intrinsic..

Simple things first.. i lead a simple life

Proposals, publications and the fear of rejection

Suddenly last month i became active in writing proposals for grants. As university lecturers, by right this should be my bread and butter. It is one part of my career which i thought i have not progressed so far with yet. The main reason probably because in my current department, we don't really have naybody publishing extensively. I believe to publish in high impact journals, the journet is by mentorship. One needs to have an excellent mentor and continue his legacy.I do have a senior Prof with me, PK but publishing is not his forte.
After the last Research meeting, i sort of change my stratergy. Instead of moaning our pity of not haing our own hospital and patients to do research I have moved to .. lets look what grant is available and apply. It'll be more practical and more goal oriented. The outcome maybe variable but at least i've put in the effort.I feel it is better than trying to propose something clinical and end up just talking and doing nothing. Lets try to do something and let the efforts produce results. Sounds fair kan?

Of course, I am really bitter with my last experience sending a proposal.ERGS. It was not the rejection but on the manner of explanation of why it did not make through. Everybody had high hopes with that project and thought it would have been really good. Therefore, i've submitted it again but to Escience fund this time with my colleague as the project manager. Hopefully it will be good to start.. a very extensive project and if it happens, hurrah for the department!
I am having high hopes for my other innovation project to be recognized and called for pitching in the incoming innovateur competition in UiTM. It is an interesting innovation which i shared and made the prototype with my perfusionist. Haha suddenly this grant and competition came and i thought why not try.. Try dying rather than talk a lot and nothing is done :) Sometimes you have to be a bit eccentric to come up with all the ideas, a bit of courage to just step in and try one's luck. Not anything serious but i am sure marketable. 
Its not easy to juggle in between being a clinician, a lecturer and a researcher. In Malaysia there are not that many of them and if they are, sometimes we do not know whether their work-life balance exist. I am not attempting to be one but i am sure any ideas we have in mind should be translated and realized. I am definitely a professor material but i am close enough to having tonnes of ideas in my mind.. I remembered those days when i can't sleep and had to wake up to my drwaing table to chart down my running mind.
Watch the space.. lets see whether i will be more motivated or my enthusiasm shot down straight up !

Almost Lolo day trip with the kids

Of course a retrospective entry.. haha
Sometime early March Fiqar asked me about having a short trip in the jungle to introduce to kids about such activities. I thought it was a good idea; an introductory trip fro Qayyum. Of course, i've always missed those wonderful time during my school days camping and trekking.I had the thought of bringing Qaisya as well but only for 1 second... naaah.. she would just complain probably on the first minute of the trip hahaha budak tu mmg banyak complain :)
That last Saturday in March, me fiqar ilham and qayyum made the trip. I went to see Azad the night before for his mobile stove because we were thinking of doing bbq as well.. worth the trip instead of the typical maggi and sardine to some! BBQ was our gold standard:) 
We started early, Fiqar picked us up at 730am and we were off to Ulu Pangsun.We arrived at the starting post at about 830am. The last time i was here maybe 5 years ago! A lot have hanged but somehow there were not many people around. The combination of the weened before school starts and the hot drought must have contributed to this. I remembered seeing lots of enthusiast along the river bank either picnicing or camping the last time around.
Interestingly, there was a new trek leading up to Lolo. The usual trek to Lolo would be the big trail for the big balak trucks up the hill. I've never went up Nuang using this trek so i thought why not have the kids to experience it. The trek was fair but after 2 hours i thought it was a bit too hard for the kids! haha but then i guess this is part and parcel of jungle trekking because it can never be straight forward!I still remember Ilhan's expression:
"Uncle.. why are we going down? " after a significant uphill climb which was tough.
"Oh. we're going down because we'll be climbing up again.."
"Haaa??? " he was shocked listening to my answer.. haha
"Yup.. thats how it goes in the jungle.." and i could sense his demotivation. To his credit, he was a fighter and managed to complete the trek.
Why i called this the almost Lolo trip because we did not make it up to Lolo but perhaps the last waterfall before the camp. The reason why i decided to step and camp up was due to the time and also the weather did not look too promising as it was drizzling. We were crossing the same river at least 7 times before reaching the waterfall and i  feared for the "bah" if it rains heavily and having to bring them across. Mind you they are still small therefore it was impossible for them to follow how i tip toe on the stones to cross the river! hahaha
Of course we had our BBQ and maggi. I set up the camp and cooked. It was such a nostalgic experience and i really loved it. I am sure Qayyum saw me in a different light of how i transformed from being the normal dad to an outdoor person handling everything while we were there. 
"Walid masak?" he asked in astonishment :)
Overall, it was a good trip. We somehow came out through a different way and we saw the dam. And damn... the dam was really in dire straits. I guess seeing the emptiness of the hulu Langat dam made me understand why we had to ration our water use daily.
Thanks Fiqar for the suggestion and I am sure i;ll do this again

As busy as a bee

It has been a busy month for me. I've really made myself so busy that i could not find to do my usual social media rounds! Imagine having the issue of not being active on FB/twitter more so with my blog! I did aim to be more active on blogging for 2014 but somehow that aim seemed to sleep away during this March and April period.
Every weekend in March was about attending a course, giving talks, organizing conferences, preparing presentations, submitting research proposals, video for my innovateur project on top of my open heart cases to do!! btw we are 50 now :) Golden jubilee of cases done in CTC! :)
I was so knackered that on the last weekend, i had to give a critical care update in IJN up! My mind was too saturated with things that i was wobble and honestly i have to recall what i did! haha 
It just so happened that during this time, the mystery saga of MH370 is still going on. I guess by now the sensationalism of the dissapearance had toned down. The SAR team is busy trying to identify where the black box is, very deep in the Indian Ocean almost 5000km away from Perth. Still ..we have no confirmation of any physical connection to MH370.. very very bizzare still..
I guess i am having my breather now thus this entry. I am trying really hard to make myself available for updates on this blog.I totally love this blog (infactuation with myself! haha) and i really wanna keep it going. At least something that will make my passion of writing to remain constant! :)