Phuket trip

The Phuket trip was a gamble. It was our first time travelling , our means wifey me and the kids without extra help! And this was going overseas as well:) We have been postponing our holiday for quite sometime and despite Qayyim still being 5 months old.. Hantam sajalah!
We started really early, having to wake up kids at 3+am is not easy with 4am being the time as we departed from Bukit Jelutong for LCCT!
Phuket was fun and everybody enjoyed their time. Luckily I took wifey's advice to go for the island trips as it was worth it and the children love it! James BOnd Island trip and Phi Phi Island trip was excellent and if I had known this earlier, we would have done it!

jalan-jalan Viewing Point Phuket

kenalah naik gajah..wajib:)

kids and me on our way to James Bond.. free flow Coke:)

Dzaeff konon2 kayak..

blazing hot on the ferry

Phi-Phi entrance

It was enjoyable and we certainly would like to do this again!

Help Dr House.. I need a diagnosis!

This has not been a productive year for my blog. Entries for this year is appauling if compared to previous years. I must be careful or this blog may go into extinction without me realizing it! In my previous posts, I've given few excuses which was valid mind you! However, one must remember that once one starts blogging, one must continue till one's last breath!
Let me tell you what happened to me since late May. I was sick. I fell sick. The reason why I'm blogging this is so that I can look back at this entry to recall the bitter 2 months experience.
I have no previous history of allergy nor any chronic illnesses. It all started in one of my calls. Initially i had a bit of itchiness in unspecific areas of my body but i thought it was due to the scrub's detergent. But after a procedure where i used the sterile glove, i had a bad urticaria attack. My whole body was red as a lobster and i needed a stat dose of IV antihistamine and steroid! Imagine, me doing the call with an IV branula on the dorsum part of my hand!
The call itself was busy and that created more stress to my body. By the next morning, my urticaria remained and i felt numb over my extremities. It got worse during the Saturday list and on my way back home, it was throbbing. I cant feel my fingers as it felt like exploding. I was in pain and needed a strong analgesic and a short nap to wear it off. The whole week, my symptom was severe urticaria.I was on piriton TDS.
The next week, the symptom changed and I had high grade fever.Of course, it came with a really bad headache where i had to sleep to wear it off. At the same time i was starting to have knee joint pain. Waah.. multiple symptoms! It looked like some connective tissue disease thingy so i had my blood worked up. I recovered from the fever but then the joint pain became more prominent but not static. It went from one joint to another and i remembered waking up with my fingers swollen like mad! The pruritis was bad and i needed to take the pirition regularly to settle the itchiness. It was a terrible time. I was in charge a lot of things then and i dont know how i managed to do it then. I guess I was lucky to have a team around me so when the time came, the plan was executed well. I had my SHOES ( Shadow Housemanchip Oncall Emergency Simulation) programme, State level CVC course and numerous meetings. My head was not right and it was terrible getting off and on bed during that period. I lost my appetite really badly and had to go for early night for weeks.
When i appeared for a meeting about 1 month after my symptoms started, everybody was shocked to see my state. I lost quite significant weight and it was obvious to many. Due to the worry that there was malignancy, an urgent imaging study was done to ascertain that we're not missing something sinister.At the same time, I prepared to ICU in case I react badly to the contrast given; anaphylaxis during the contrast study.
Of course, as with all my previous investigations the result was normal. The pruritis was really bad and I didnt know how to control it. It caused a lot of excoriations on my body and currently I'm having to live with the "injury" inflicted.Everyday I recited the syifa' after my prayers to make it go away as nobody could offer me an explanation or reason what is happening. The symptoms took turns and I was going nowhere.
At this stage, a lot of alternative explanation was offered to me. I went for cupping hoping that it could relief my agony but it did not really work. I lost 7 kilos during this period of time. Bukan senang woo nak hilang berat!!
Somehow, the symptoms reduced and slowly i am recovering. My head is clear and I am able to think straight without feeling drowsy or not in the right state of mind. My appetite was restored but I am not a keen food muncher as I used to be. At least to me, the positive side of al this is i need to maintain the weight i've lost so far! hahahaha
I've gone for two short holidays with the family the last 2 weeks. Hopefully it will help me to recover and Insya Allah, with every disease or illness there is a cure somewhere somehow..

A step to adulthood

early admission

happy n brave

Syariz n Yoke moi

weng lagi..

settle..bloodless.. painless..

and of course.. the promise :)

Tokoh Bestari KRS

Thank u Ustaz Ahmad for nominating me to receive this award. My involvement in KRS or during my time Kadet Putera Islam maybe brief but meaningful.

I was oncall that day but how can I dissapoint Ustaz! A very memorable day meeting other recepients with their interesting achievements.

Ultrasound.. the way to go..

I am fortunate that i am able to attend courses organized by the WINFOCUS group. I went for the Trauma Life Support a month ago and currently attending the one focussed on echocardiography. Its a structured simple course organized for critical care use and I am thankful that I've been blessed to take up this opportunity.Besides regional anaesthesia, this would be the other new thing i've really learnt recently.

Ultrasound usage for critical care is essential for my everyday clinical practice. This is more so during oncall. I've had few cases previously where i thought having the necessary skill in ultrasound imaging could give me advantage in determining the most possible diagnosis for me to proceed with the management.

I've been blindly using the ultrasound machine in ICU for the last one year. (blind as in no formal teaching telling my how to do it properly).I did not have too much difficulty to handle the machine as I'm quite used to it with my blocks and IV access. Its just when it comes to echo, you just learn it as you see how your consultant doing it. The results? i was only able to see whether the heart is contracting or not.. or the contraction is good or otherwise.. hahahaha but at least its better than nothing right?
I'm very impressed with how they came up with the syllabus as it was easy to understand and brings a whole new spectrum to my future practice. Understanding concepts and answering why and how certainly satisfied my intellectual hunger. Having the world expert to teach is a plus point and i must thank WINFOCUS Malaysia to initiate such a wonderful project. Of course the highlight of the day was doing the simulation training and having an all anaesthetist team (Hady, Shahnaz) & cardiac surgeon(Adli) is not as easy to handle as you think it is! hahahaha

Can you speak up please?

I took my IELTS Listening, Reading and Writing components yesterday and tomorrow I will have my short interview for my speaking component in KL. I took the exam in 2006 before joining the Masters programme as a pre-requisite.At that time i just took it without any practice. Unfortunately it is valid for only two years and i have to renew my so called "standards".
This time around there is a bit of pressure as i have to obtain a band score of 7 in all components. I managed to do so the last time around with zero practice and hopefully this time around should not be a problem. But then.. hahaha nanti kena resit baru tau.. ahahaha
I did feel that bit of pressure especially during the start of the essay paper.. ingatkan dah tera nak amik exam2 ni.. still i was obviously startled :) The funny thing about the essay was i am so used to the "keyboard" blogging style that i kept writing and then erasing before writing again. With the keyboards you just press backspace isn't it? hhahaha
Well.. another clue of what my future plan will be? TUUNGGGUUU..

Floating like a butterfly

It was my dean's vision : to have his staff "floating" around the world in between airports, catching one conference after another to present our latest findings. Our presence in the faculty was only for necessary obligations with students & juniors wanting to follow our footsteps towards academic glory. Waa... macam real..
Well, i had a go at this last month and indeed March was such a busy month for me. Juggling teaching, clinical work, oncall with conferences week after week is not an easy job i must say! I had a preview of this "vision" but at local-regional level. Still young to establish myself internationally.. hahaha but Insya Allah.

Basic Life Support Ultrasound Course WINFOCUS
It started off with me attending a 2 day course in basic critical care ultrasound organized by WINFOCUS Malaysia. It was an important event because of the increasing usage of ultrasound in my daily clinical practice. Being oncall is tough especially making important decisions and ultrasound imaging is helpful to assist me in that. I was a participant in this course and glad that i went for it!

AMEA Medical Education COnference IMU

I was then in my Alma Matter; IMU for Asian Medical Education Conference. I was slotted in the IMU Rhimes rejected Awards oral presentation session ( it was too good to be true if it was selected!). It was good to be back in Bukit Jalil and I am certainly impressed with the current infrastructure that they have. The facelift was done well that I was then proud to tell Hady and Suraya this was the place i was from :) A lot have changed and meeting back Mei Ling ( The Pro-Vost) was good:0 She was enthrilled to see her alumni there. She remembered me for my involvement in students activities then.Of course, i can never answer when she asked, " Why UiTM not IMU ?" hahaha.. maybe later eih?


sapa tu?

President and Provost of IMU.
Presenting my idea on simulation emergency training for medical students was an experience because i had international fellow presenters in my session. Honestly, i did not expect the conference to attract such interest from the medical educationist fraternity around the world! I had butterflies in my stomach before my presentation! hahaha and was glad when it was over!
Another thing which i did not expect was when i saw myself in the Alumni shout-out board in IMU's lobby. Wow.. hahahaha I knew about the exact presentation in the website but i did not expect to see myself there.. malu jugak hehehe

Acute Care Workshop MSQH

Prof YK Chan was given the honour by MSQH to run this workshop in HKL and i must thank her for including me in her team. I've been involved with her interest for the past few years and getting her recognition to give a talk and as a fascilitator is such a priviledge. Its not easy to be recognized by Professors and i guess meritocracy did pave the way. I gave a talk on "Transport of The Critically Ill" and it was well received.

3rd World Congress of TIVA/TCI, Singapore

My poster was accepted for this Congress and it was an opportunity that i could not resist. This was my first participation in World level conference. I was nervous to present the poster as i knew it did not have enough merit to compete amongst the best. The experience was overwhelming and something for me to have at the back of my mind the next time we are to present in ternationally.


It was an overwhelming experience being side by side with the world renowned anaesthetists who methods i use in my daily practice. Remifentanil-MINTO? Propofol-SHNIDER? It was cool to have a picture with them:)

Minto & Shnider

April will be the MSA ASM ; and being in the fascilitators' team for our advanced regional workshop will be a first for me.
I have a lot of invites to talk in the coming months... hmmm.. truly academic am i? siapa sangka...

Dzareif >60 days

MDQ4 aka Dzareif has really grown! He was 3.3kg at birth and looked small then. With breast milk power? waaaa.. a whopping 6.2 kg during his 2 month's scheduled immunisation! He is heavy to carry anyway.. hahaha and the way he fits nicely into the sink during our trip to Singapore was cute!
Dzareif is certainly different when compared to his elder siblings; he is much more demanding and tend not to settle easily. A "breast" session is not enough for him as he needs to be held closely before going to sleep. It was a far contrast from Dzaeffran who'll just doze off after milk, and only making "some" noise when its the next session! Wifey was weary during her 2 month's maternity leave.. hahaha

We tried to catch the hot air balloon in Putrajaya l;ast month with Dzareif having a go on a trip before Singapore. It rained though and we did not see high flying balloons.. but bringing all four for a trip hmm.. is not an easy job for an individual with your eldest being 6?! And i can't imagine how wifey will cope with them when i leave for ..... ( hehehe.. a new venture which i will reveal when everything is confirmed.. :)

Destination forever

This past one month has been on sad theme all along. Deaths were all over. Of course, the Tsunami that hit Japan became the news of the year. My condolonces to all the families affected by the natural disaster. News everyday seems to surface the dearth destruction which initially seemed mild. The Japan government is really smart in revealing as well as witholding information from the public. It looked not so bad but as time goes on, we saw what mother earth can do to even the most prepared population of the earth. Of course, the Nuclear crisis which has brought Fukushima out of Japan's map for the next 20 years is another story.

A legendary Mountain climber, Zaidi Bidin passed away early this month while climbing Nambuyokon. A beautiful blog was written by the person who resuscitated him during that trip. Thank you Gideon. It was a surprise, as he had been doing this all his life but when its time, it will be itself no matter where you are. Alfatihah to somebody i never really knew personally but a personality which shone during his burial. I was fortunate to be there and looking at those who came , who like me never really knew him that well was a blessing.

Nurleena's dad passed away peacefully at home one fine morning. It was only a few year's back she lost her mum after a brave fight against cancer. Her father became sick recently and just deteriorated. I was asked for opinion in that early stage but kept mum about it on her request. Brave on Nurleena, I'm sure your dad was glad to know you are around to take care the rest of the family when he is gone. My condolonces again.

Auntie Jau, Nurrun's mum passed away last weekend i her sleep. She herself was battling cancer and her death was unexpected. Nurrun came back with her children a day after and i guess having another death in a short span from her dad must have been difficult.

Well, we can never tell when our turn will be next. However, we have to always keep that thought in everything that we do.

NYSORA Asia Bangalore

Guilty as charged!!

I've left my blogging again for almost a month, ok lets be realistic from now on.. i will try as much as possible to ensure i have at least i entry per month.. fair? hahaha apa la yg busy sangat ni!!

February ended with my trip to Bangalore. I was invited as an associate faculty ; fascilitator in the 5th Pan Asian NYSORA-Asia workshop in Le Meredien. It was during the heavy duty weekend in Bangalore.. why? because it was India vs England then and you know how fanatic the Indians can be about cricket!! haha

It was a good experience mingling around with world renowned Regional Anaesthesiologists like Admir Hadzic himself, Manoj Kamarka, Phillipe Guttier and lots of others. I never thought the day would come especially as a junior specialist to be with them. There were lots of things learnt from their experience. Of course, catching the other side of them was fun too!

dinner trip

late night meet up.. mana ada mamak kat bangalore?

Malaysia's Sifu of RA.. I'm the padwan..

Bangalore was too big to be discovered by foot. I tried to do the usual thing i do when travelling but the scale from the map given to the actual thing was totally wrong! hahaha I did not manage to go anywhere, just the night trips for dinner as the whole day was packed with talks and workshops.

I enjoyed the Symposium a lot and hopefully i would be given the priviledge to join them again next year :) Thank you everybody !

p/s Credit to Colleen for the pics :)

MIZAN DZAREIF QAYYIM

Introducing the latest family member..
MIZAN : BALANCED
DZAREIF: CHEERFUL
QAYYIM : LEADER

And may he be one of the sollehins.. :)

And of course, officially now.. I have my own office :)

Harimau Malaya mengaum.. first for Dzaeff..

I cant really remember when was it.. circa 1994-95? not really sure. Most likely before the big clear out of match fixing. But what happened shook me, it was a post Malaysia game ; not too sure which game it was and which competition. maybe one of the qualifiers. we lost badly and by the 70th minute, the supporters were booing the team and most of the crowd were leaving.One who sat in front of me who during the time he was there, totally insulted the team to the amazement of the crowd. Not sure whether he was just venting out due to his own problems. What i was sure; before he left, he was kicking and stepping Jalur gemilang.. and threw it away whilst spitting on it. After the game, i took the flag with me.. took it back home and hoped that one day i can bring it back to see it waved in glory.

Today.. it became the day.Me and my son, waving that same flag which was battered down almost 17 years ago. To wave proudly as Malaysians!

It was my first visit to footie stadium with dzaeffran. I wanted him to feel the electrifying experience in supporting team Malaysia. If not for the house moving, i would have been in the stadium to witness the first leg of the AFF Cup. But the friendly against Hong Kong was a small time game. Rarely people would go to watch and having it in Shah Alam stadium, it would have been a sin not to bring dzaeff.

But i was wrong.. due to the hope that the current Harimau Malaya gave as AFF champions, people were flocking the stadium. It was not full house, but for a friendly it was an amazing crowd. To witness Dzaeff's expression as we were walking into the stadium was priceless. The fanatic fans were chanting and singing; a rare scene in Malaysian football.

And when we scored just before the first half ends was something that the crowd was waiting for. We played well, it was nice passing and game play with skill. Dzaeff may not have concentrated fully on the game but when we scored.. he was jumping in joy as well and that was what we were all there for!

It was just a friendly but the mood and hope that was given to us, shown on the team's determination. The confidence were oozing and obvious from all the player's body language. It was a good father-son bonding as well and I was glad i persevered to go eventhough i was feeling a bit out after maghrib.

Kudos Malaysia.. viva Malaysia!

People power in Egypt

I was glued to the tv till midnite, switching from Aljazeera, BBC and CNN ; updates of the current ongoing revolution March of the millions y the people of Egypt. I was witnessing another history epic in the making, how people when they come together as one with one sole reason can make the difference. It was something unexpected by Mubarak himself i guess, as people in mass forces flocked the main cities of egypt; cairo, alexandria. protesting "LEAVE... LEAVE.." The years of suppression by mutiple regime through the years seemed to break out of its pandora's box today..

Wow.. i never thought i would see another similar scene which mimicked the Iranian Revolution in 1979 in my lifetime. With our current media coverage, it is possible to witness it closely. The Egyptian government ordered an internet blackout to forbid information coming out directly from the people.

Across middle east Tunisia, Jordan.. the revolution heat is sweeping through.. slowly but surely. People are standing up, risking their lives in the name of reformation. Brave brave people. Determination and sincerity of wanting change says it all. Of course, it is easy to say that there is a manipulation of political will but when you see rakyat in the masses coming out, can you pinpoint to anybody leading them? Egypt is making another feat in history. SOmething that will mark a big change in how the middle east would shape itself in this century. It marks the sure future of interesting things to come.

I pray to the egyptian people that god would reward their intentions.

The latest batch of egypt bound medical students i met last September.. my prayers for their safety..

DU52 up DU54.. brain drain continues..

I've been with my institution for 5 years and loved the plan, ambition and aspiration. The inspiration and optimism grew and as a young member, I definitely had plans to make the institution great. You can call it utopian but thats where all dreams start right?
Being with the faculty thus far, is more challenging than what i can imagine. The institution thrives on a vision where those from the outside would think us to be totally insane! I dont blame them to think of us as such but its always the impossible dreamer who would achieve greatness. Having team members who i thought was selected based on their potential was another factor where i reckon the dream vision can achieve exceding expectations!
Unfortunately, the ancient set up of my institution seemed to somehow discourage the dream. Call it a curse, but it is very venomous. Money seemed to be the issue, but being in the 21st century, can you expect less? Money talks.. money is everything! Doctors cum academician are doing more things out of the job spec compared to everybody else. THe duty in ensuring patients do live in joy is a huge responsibility that one can imagine. Its the appreciation gesture which if it was taken into consideration from the start, would only attract more people to join the academics in rank.
I don't blame my big boss on this but my critique is sometimes he takes too much of the responsibility. When the plan is becoming bigger with time, the delegation of responsibility should be emphasised and the burden shared somehow. Some may say he is difficult to work with but each leader has their own way.. and the outcome would justify their action.
DU45 , DU 52, DU 54 .. So far we've lost few excellent colleagues to the lure of the "under" world.. but then can't blame them for their action. Its the big planner who should follow through and inspire.. thats what leaders are for.. to inspire others to greatness, and polishing the potentials of his men and make them greater than who he is..
I am still idealistic but i am not sure if i am too naive. I believe that i should support the vision and do my best to achieve it.

Whats my timeline then?

29 January 2011.. Welcome to the world!

MDQ4 ( macam nama prototype la pulak... hahaha) was delivered vaginally yesterday at 336pm, weighing 3.22kg in Pantai Hospital.
Alhamdulillah..truly a blessing and all praises to Allah for his graciousness.
I am really proud to accept his gift and i guess it struck me, as I was reciting azan as the baby was delivered. I stutterred out of nowhere.. i guess it can be overwhelming to one without realizing it subconsciously.
Again. thank you to all well wishers and please pray for him to be one of the sollehins..


MAfeitz Mamat

Resuscitating dilemma

Resuscitation is an art. It is highly stressful and definitely not for the faint hearted. I chose anaesthesia because i saw anaesthetists dealing with such ordeals in a composed manner unlike my discipline's registrars then. It is a combination of skills but most importantly a fast logical mind by the team leader to solve problems.it can be straight forward or it can be mind boggling, but need to think and ACT fast. Otherwise, CHAOS would be the order of the day.

AHA revised its guidelines last October. the emphasis for good CPR, push hard push fast becomes the main ingredient for a successful return of spontaneous circulation. Patient struggling between life and death is not a good sight. Most would not be keen to be responsible for that and i guess this gives us ( Critical Care) the edge to take the challenge.

Being a clinical specialist in Anaesthesia & Critical Care is not easy. Most of the decisions to continue, to stop, to act would be upon us. All Anaesthesiologist graduates are expected to master this skill and time and time again it will be tested.

I had 2 patients yesterday; both young patients collapsed and CPR commenced. One i stopped as it was about to start because there was absolute poor prognosis based on her current injuries. My MO initially refused to do that but being a young MO and seeing a young patient, i can understand why. I told her sometimes we as doctors must think as a whole especially the Critical carers; we are of a different breed. We dont compartmentalized our care and we always look things from a far and the bigger picture. Doctors tend to resuscitate more for to their benefit rather than the patient's. The guilt of being there and not doing anything will glare and becomes a nightmareto some. However, we are carers that will try to save lives with good quality and not to prolong death and suffering. The distinction must be clear and to do this, knowledge and experience would be the key.

The 2nd patient collapsed and needed intensive CPR. He was shocked twice and given appropriate drug intervention and we got him back. ROSC would not be complete without a proper cooling and cerebral protection management. What was the cause? I am not sure myself but i have settled the acute problem. Now we pray that there was minimal insult to his brain during his collapse and we will see how.

It is never easy when decisions are in your hands. Just need to tawakkal and make sure that you do your job the the best of your ability.

new frontier new challenge for my good friend

A good friend of mine, Shakti went to Melbourne yesterday. He'll be working there for a year hmm.. perhaps more! He brought his family there and i am sure it will be an experience of a lifetime! I must salute him for all his efforts taking FANZCA exams and all .. and look where he is now.

If you meet him on the streets, Im sure you wont reckon he is a doctor at all! He has the built of a bodyguard ( former Mr KL 2000 hehe) and he acts like one. He's a very "sempoi" man, wearing his CROCS slippers even to formal functions! Looks can be deceiving and I can tell you that he has exceptional brains because academically he is superior!
He is a workaholic, and it has been a priviledge to work with him. We click well and the things that we did during our medical MO days in HKL remains fresh in my mind. His change of heart into anaesthesia i am sure had something to do with me. We went seperate ways at one time, me joining UiTM and him into the private world. Fate has made it that he rejoined me in UM and again the partnership grew. Our sons were born a week a part and I guess to them I will hope to continue the legacy
To my good friend Shaktivel.. i wish you well in your endevour. Your antics will be missed and I really hope that you can join me when you're done with Australia :) or who knows it will be the other way around, me going there instead.. hehehe All the best bro! Live long and prosper.. :)