Salam Aidilfitri 2008 !!

Its Aidilfitri tomorrow !! MY best wishes to all Malaysians who are celebrating it !! Maaf Zahir dan Batin sekiranya ada tersilap bahasa budi bicara.
Aidilfitri is the day that I really adore as long as I can remember. Its a day of celebration with families getting together. I have my own nuclear family now and I do hope to teach my young ones to appreciate the meaning of Syawal post Ramadhan ! I will be driving down to Muar tomorrow afternoon after spending time with MAk and the family in Damansara Jaya.
The challenge for me this year is not to turn into a mentekedarah with the feast ! Difficultto resist good food.. the ketupat , rendang , lodeh ..etc.. yum..yum.. Hahahaha..Macamana ni ? I hope to maintain my lucky 77 .. heks.. kita tengok lepas raya !!

The holy ramadhan..

Syawal this year would be a bit different as my youngest sister is away to pursue her dreams in UK. She was always there yo accompany my parents and the scenario has changed now. I salute my dear sister for her efforts ; obtaining dean's list in her diploma and that was her ticket to UK. She's a fighter and very determined. She is very hardworking and I believe that she will succeed in her life .. Insya Allah..
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It was only today that I managed to bring the family for raya shopping. We went to One Utama and I was glad that the crowd was not full packed as expected. I reckon most families had gone back to their hometown . Only a handful , the throughbred locals qho are still around . I did met a few of them and we exchanged raya greetings.
Me and wifey had been busy doing calls and our postings that for the last three weekends we rarely saw each other. I went to Shah Alam alone during one of my post calls days for my kids' raya clothings. It was more practical that way and I don't like to wait till the very last minute. Today was a breather , me and the small nuclear family enjoying ourselves. ( well..stress jugak bila budak2 nangis because penat !! aHAHAHAHa )

santai.. watching the show..

One Utama's decoration is marvelous

First bunga api experience for Qaisya..

Mencari Lailatul Qadar

Running up Genting twice in one week is certainly something "crazy" I did this year. Last week was a killer , and this week I invited Azad and Mafiz to join me. To lure them to this temptation , I suggested that we go up half way - 9km from Gohtong Jaya to the top. My left ankle is still nagging me and because i want it to recover well before my Genting trail blazer ; I decided not to stress it too much.
However due to unforeseen circumstances , both of them had to skip the event at the very last minute leaving me alone to decide; to go or not to go. At that time if i wanted to "belasah" the 21k , I was late ! So .. thinking on achieving my target to get my weight down to BMI 25 by raya ; I said... GO LAH !!

like one of those weird ghost pictures.. check me out at the back !!

I was waiting in front of Seri Malaysia Hotel when i saw the first group of people running straight up without stopping at the mamak. Hmmm.. i thought.. might as well I start now rather than wait for everyone to come ; I am not that fast anyway ; people will surely catch up ! Therefore , with my bladder bag i proceeded with my short 9km run up to Genting. It was alright and of course , just starting I was full of energy and power. However at the 5 km point , my left ankle started to wiggle ; signalling it is in distress despite my Celebrex earlier. I slowed down and only ran when necessary ; because it was DAMN COLD !!!
Of course , the hardcore fit runners went pass me easily despite them having to run 12 k earlier ..hahaha..itupun dah semput... hahahaha.. tu la.. baru "soft porn" stage , belum graduate to hardcore lagi.. hahahahaha It was a nice feeling reaching the top again but this time my fingers were freezing cold. We were received by Genting PR fellas and the hot coffee was certainly nice !
I did not stay long though and looked for a lift down because my original transport plan did not materialize !! Thanx Adzim and Stupe for the ride down to Gohtong Jaya !! All in all , it was a good experience and mind you.. I don't mind being a part of it again next year..

P/s I was worried for a while when Stupe suggested that I start from Genting Sempah to get back to my car in Gohtong Jaya !! hahahaha...

Genting 3 Group pic..

the people behing great group pics :)

Kurang kerja

Yes.. I'm running up to Genting again Friday nite.. maybe not the full distance but once you've felt the "high" , I guess thats it ! I'll definitely blog about the last run before Syawal ! I dunno where i did manage to push the limited energy left post iftar for this run.. hahahaha

Today is my last day of SMO call ; wow.. a certainly tough and demanding job. I will not be doing this call till next year ; when it is compulsory for me to do it ! Fuuuhh... And now , I am still awake at 230am in the morning because the supposed to be appendix case became a laparotomy. SHe seems stable but so far she's lost 1 L of blood . Hmmm....
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Its heartbreaking to see parents coming for their children who are in distress. Everytime they are in trouble eg involved in an accident and requiring emergency operations , the parents will be contacted and the next of kin in giving consent for the anaesthesia and surgery. Most of the time , it comes as a shock becuase they do not know what their children did ; and when the news arrive ; they are in severe distress.
I get goosebumps everytime meeting them and explaining about what we were to anaesthetized for major operations. Most of the time you can see it in their eyes , the shock and at the same time hope. Certain injuries , i know have detrimental and bleak outcomes and that makes it hard to look into their eyes. I cannot imagine if one day I am in their position ; having to give consent and having the possibility that your fragile child has the possibility of mortality before you.

Things i learnt yesterday..

1.SMO JOB IS NOT EASY... Maybe i am not ready yet and i guess that is why only final year trainees do this job. One needs a lot of previous experience to make decisions. I am still "mentah".Its not easy being anaesthetist and a Clinical Specialist at the same time.

2.CONSULTANT ANAESTHETIST DO READ YOUR BLOG... so have to be careful of my "hot" pics postings ; must adhere to blogging ethics.had a friendly advice.. hek..hek..

3.FOLOW THE LEADER... Yesterday , i saw how a Consultant of mine charted his GA form.We rarely had chance to be in OT with him and the experience was one in a million!! Wow.. it was complete and no wonder people talk about it. Good examples should be followed.

4.KNOW YOUR PATIENT WELL, EVENTHOUGH YOU FEEL GROGGY IN THE MORNING.... before speaking to the consultant. Despite the pressure from the nurses for you to settle a task , be mindful and don't just follow BLINDLY. I embarrassed myself by talking about a different patient to him and only realized it after i put down the phone !!

Hanya Orang gila yg buat kerja gila.. Ramadhan Genting 21K

I was reading through Stupe's and DocHisyam's blog ; and saw their story and pictures about this crazy yearly Ramadhan thingy they do every year. It was the run up to Genting Highlands and the starting point is from Genting Sempah. Hmmm... certainly tempting and challenging ! I never thought I would join this group of totally adrenaline junkie group of people until yesterday... Gila tu 21K from ground zero at 1800 ft to 5800 ft !

Courtesy of Stupe : pinjam blog ek bang profile ni... thanx !!

It was DocHisyam who extended the invitation in my last blog posting.He told me Doc Amir was going to be there too Hahaha.. he was the only one that i would know before joining the run last night. Pandai dia racun.. I was lured and succumbed to the ultimate self torture ! I went there as a lone ranger , mana kenal sapa2 ! HAntam sajalah !! hahahaha
We assembled at Genting Sempah McDonalds by 930 pm. Seriously ! sorang pun tak kenal and they don't know who in the hell is this guy either ! I guess, its the common interest that brings us together. Doc Hisyam and Amir would be starting from the halfway point ; Gohtong Jaya where Doc Hisyam will be riding his mountain bike up and down.
At about 1015pm we started the run up. Obviously , they were the elites ; all with traithlon , ironman etc experience ! Hardcore stuff man ! I met few good friends and end up with Louie to the top ! I was OK with the run for the first 9 km , only walking on few really inclining road. Tapi..memang mcm nak pecah dada ! Definitely first class stamina training. Up up and away all the way ! I brought my backpack High Sierra bladder with me and it was a wise move. It was dark and we had to wear our headlamps and redlight so that the fast moving cars would be alerted by our presence. I never knew , SO MANY people drive up to Genting on Friday night...

I had a bad fall in KM 7 . It was dark and the road was uneven. I twisted my left ankle and fell hard ! It must have been like nangka busuk coz Elicia and Luvis who was quite a distance away ran back to see whether i was ok !! Hahahahaha I was glad that my left ankle was not that bad ; but i guessed it was adrenaline that made the pain bearable. I was still able to run till the first regrouping point in Gohtong Jaya.

By the time we arrived there at 1130pm , the first grouphas gone ! Fuiyyoo.. itu memang tera punya gang !! Then it was the next 9 km uphill track. Mak aiiii !! It was hell and the ankle was hurting so much ! I was not able to maintain my run and ended up walking / trekking up to Genting ! Memang tak boleh GO ... hahahaha.. It was steep and easy for one to just say , Ok I've had enough.. but i knew I had to finish the run. Orang gunung maahh ! I was walking with Luvis and he made the mistake of not bringing any water with him which resulted him being dehydrated and tired ! Glimpse of my Tambuyokon climb came into the picture .. hehehe.. And i shared my water with him. It was good in a way to have a partner for motivational factor and I had a great company. The kurmas i brought was an excellent substitute for power gel.
It was cold... circa 15oC and we were wearing only our running gear. I had to limit Luvis' stops because the wind was blowing hard and I was freezing ! And there it went... 1km... 0.9...0.8... Move ! Move ! Move !

It was certainly a nice feeling reaching the top. We were at the usual end meeting point : Genting Starbucks .Everybody was very encouraging and I did it ! It was a lousy 4 hours ; non-comparable with the guys who did 2 hours to reach the top.. Memang hebat !! Thank you for the opportunity and I certainly enjoyed that rush of adrenaline up from midnight to mid morning.... :)

Malaysia.. the future

Calling PAk Lah & DSAI

Cukuplaa..

Maaammmm...

Some more comments after 16 september

Malaysiakini , 16 September 2008 ; Letters to the Editor

The fact is the non-Malays never accepted the concept of Ketuanan Melayu nor the special privileges of the Malays as laid down by the Federal Constitution. This is the main culprit which became the stumbling block to the development of non-racial partisan politics in Malaysia.

The insincerity in honouring the constitution became obvious after 51 years of independence, made clear by the recent spats amongst the leaders of the different races in Malaysia. The ghostly image of May 13 is resurfacing and everybody is suspicious of each other now.

Families are constantly being reminded by their elderly about that black day in our history and the misery it caused. We are also being cautioned that we are eerily treading the same path to destruction, just like in 1969.

Pakatan Rakyat is playing a devious mind game which is making the components in Barisan Nasional question each other. It has been six months since the ‘tsunami’ general election but unfortunately we are not seeing any progress from either side.

One side is busy day dreaming about taking over the country through unethical methods, while the other is busy with various leadership crises. The coalition, which has so far been regarded to be as strong as a diamond, is turning out to be as precarious as a sand-castle.

Meanwhile, the rakyat are struggling to make ends meet amidst the burden of inflation and a weak economy, though the government might beg to differ.

We are often reminded how lucky we are compared to our neighbours in Thailand and Indonesia, who go from one national crisis to another. At least we can still do trade and live our lives normally. But should we even be comparing ourselves to these nations? Didn’t we surpass them ages ago? When did we regress?

At the rate we are going , we may end up destroying ourselves. We claim to be a tolerant society comprised of non-racists, but everyone is suspicious of each other. We claim to be neutral and fight for equality but still protest when we think someone is having a better deal than ours, especially if they are of another race.

Why are we not helping those in need? Why is race and religion so important suddenly? Surely principles are just, if not more, important? If we truly believe in building a better Malaysia together, this paradigm shift must happen.

Community leaders must vocally emphasise the constitution and act to bring the various communities in the country together. The day the Chinese and Indian communities fight for the rights of the Malaysa and vice-versa will be the day I believe in a true Bangsa Malaysia. Only then will we be truly united.

16 September 2008

169 ? 916 ? Life goes on eih... Yesterday Ortho list , Today Surgical list , tomorrow Radiology list. I had two gastrectomies today and still I get to go home late.. hahahaha Everybody is still waiting for the new government thingy which is somehow delayed according to the toppling party.. Apa la politicians ni.. cakap ; Just do it la... ini ye ye je... Poker game betul...But you have to give credit to DSAI lor for destabilizing the country. To make every ali , ah meng and muthu to wonder the possibility is certainly a victory for the psych warfare.
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The economy doesn't look good at the moment. World stock markets were in decline again today, a day after the collapse of one of the largest investment banks in the U.S. contributed to the worst day on Wall Street in seven years. The domino effect is affecting everybody ; a worrying future indeed.
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The gang is having potluck iftar this Sunday and I am oncall.. Haiiyaa.. was looking forward for the gathering because its always good to meet and catch up with the best of your friends..

Baju raya..

Liverpool won.. yeah !!! Long awaited deserved victory.. at last , we humbled Man U !!
I guess our TT trip t-shirt which is RED in colour , will be proudly worn to Anfield one day !! Hehehehe

Ortho list and R&D

I had a fancy anaesthesia technique day during my Orthopaedics list today. It could have been one those boring lists but of course , one has to have their own imagination and creativity to make it interesting !
I have always wanted to do a CSA ( Continuous Spinal Anaesthesia ) since reading about it ; however I've not had a chance in my two years in UM so far. I don't know whether it is just ignorance or unfamiliarity in the faculty ; but since I'm in the third year now we have to take our own initiative. I am blogging this out today because it was my 2nd successful attempt of this technique ! ( in record i have attempted 4 ; 2 had to be abandoned )
CSA offers the attractive possibility of extending the block during surgery when needed. It provides an easy technique to reach an adequate level and duration of anaesthesia with small intermittent doses of local anaesthetic, which also minimizes the risk of possible cardiovascular and respiratory disturbances. Evidence found that it gives a lot of advantage in the elderly population.

The technique is fairly similar to the CSE technique , but this time around you WANT to thread the catheter in the subarachnoid space when doing epidural , it is totally the opposite.
I had an 86 year old Malaysian lady who was senile and fragile coming for Interlocking nail after suffered a femur fracture. Having multiple diseases with a fairly weak heart ; GA will not be the first choice. Giving a "simple" spinal can be dentrimental as the risk of unstable haemodynamics may happen. Epidural anaesthesia was possible but hey.. CSA was more fancy ! It was not easy to mobilize her and giving the initial Fascia Iliaca block certainly help to ease the pain for positioning.
I proceeded to do the CSA in the induction room ; it was easy enough to identify the epidural space. Then comes the difficult part in negotiating the thin catheter into the intrathecal space. I was using the spinocath set which has a slightly different technique from PAJUNK catheters. Honestly , i learnt the technique more through the company video then from anybody else. Alhamdulillah , it was in and worked well .. too well that the Auntie was worried that we were about to chop of her legs !! hahahaha...
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I wish I had inserted the CSA in my first 77 year old lady patient with hip fracture ; initially the orthopods were looking into inserting a BIPOLAR but after 2 hours.. then they told me they need to do the WHOLE TOTAL HIP REPLACEMENT ! She was only on spinal anaesthesia and gulpp... I dunno whether we should GA her. The surgeons did suggest that but after explaining that i have to put the patient back in supine from her lateral position , they went like OOHHH... Hmmm.. talk about expecting the unexpected and i guess the reason why most anaesthetist don't trust surgeons so much !!
I told them to proceed and see how it goes. Meanwhile , I was ready to GA her at any time ; by inserting LMA SUPREME for her in lateral position ! It would have been cool... We were ready man !! Alhamdulillah , my spinal anaesthesia duration was prolonged maybe with the help of the fascia iliaca block that I've given earlier before positioning her. Guess how long it lasted with only 2.6ml of local anaesthetic in the subarachnoid space ?

4.5 HOURS !!!! Lama tu... hahahaha.. we didn't need to convert but it was wearing off when they were closing the skin. Auntie still managed to smile while thanking me at the ned of Op..
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We then had a 26 year old gentleman with irreducible recurrent shoulder dislocation. They tried to reduce him the night before but it was futile as he was fairly awake despite tonnes of sedative given. He has this history of drug dependence making the whole thing more complicated.

We decided to give the brachial plexus Interscalene block for a change as we didn't want the patient requesting for opioids post op to satisfy his needs rather than as a pain relief. The block was simple enough to do but at the same time the complication was obvious as well ! He developed Horner's syndrome and he looked like he was winking at everybody he looked at !This would happen in 10 - 25% of people. He is young therefore I guess his phrenic nerve paralysis was not obvious . He was pain free on his shoulder site but he was trembling in all other organs despite saying not ! I gave my own SPECIAL COCKTAIL ( hehehehe.. apa rahsianya ? ) and just held my mask over his face when the orthopods reduced the dislocation !

MORAL OF TODAYS EVENT : A Boring list can be the most interesting day in your practice !

They are back !! Death magnetic !

I rarely do music review ..because i don't really listen to them religiously. I don't follow any artist personally ( Dulu.. cam Feminin ada la jugak.. hahaha ) , i only appreciate what is good. Nice songs , i will attempt them in my karaoke sessions.. hahahaha..
However , I've just listened to Metallica's new album..
Woooooooooooooo... puas hati bro...
Apa laga.. download.. jgn tak download... ( if you are not keen to support the music industry )

Life of an Anaesthetist

As doctors working in OT , we do have our fair share of ups and downs. It can be really exciting or depressing at the same time . If you are a fan of ER , Grey's Anatomy or Nip and Tuck ; they are based on our lives and things that they go through are real . However , maybe too much drama and "sleep overs" being over emphasized ! We do have our normal routine days as well where it can be a bit dull and boring at times. Thats how our jobs are isn't it ?
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I gave gas to a small infant , 1 year old but is only 6 kg in weight. He suffers from Gut dismotility syndrome with failure to thrive and developmental delay; and so far intervention to his life has not been remarkable. His prognosis is bad but of course , as doctors we try to play god at times. Hoping that our manipulation would give him and his family better quality of life.
The Anaesthesia initially was stormy but we managed to secure his ariway and get his gases right. The Op done was to reverse his colostomy as it was not functioning how it was expected to be. It was uneventful except for an unexpected delay brought over from next door. Initially we wanted the little boy to be observed in PICU , but he was alright after an hour's observation in our recovery post extubation. I did reassure the mother that he would be alright ; and to ensure if his secretions are aplenty ; to be sucked out by the ward staff.
" Mafeitz... remember our kid yesterday ? " My Specialist came by to my OT the next day.
" Oh yeah.. Did he survive ? " I thought she was referring to the baby who bled like nobody's business next door.
" He died... at midnight.. irreversible bronchospasm.. "
and I said... " What ???? " and my heart just dropped.
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" Uncle.. How are you ? Ada " tong" ka ? " I asked.
Uncle looked at me and gives his thumbs up ! "Mana ada sakit ? " he ridiculed me.
Uncle Lai was this 65 year old gentleman who I just extubated and brought him to PASCA for post op observation. He underwent a major procedure to remove his bladder and "neobladder" reconstruction.Of course he lost 4 L of blood but we managed to balance his fluids intraoperatively. He was worried of the pain that he might get post operatively which I totally agreed. Post Op can be really hell if the pain control is substandard.
I inserted the epidural catheter at level T12/L1 ; and i guess it worked wonders as it was a morphineless Anaesthesia. Post Op pain ; as how he smiled and showed his thumbs up for me.
" Dr Mafeitz.. my father cakap you bagusla ; dia cakap tak sakit langsung lepas operation ! " her daughter told me ( our OT staff ) in glee..
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" boss .. I wanna post a case la from resus.. " The Urology MO approached me.
I was the SMO on call that day and happened to be at the reception.
" One 40+ year old schizo... he cut off his ear , his toe and his penis ! " he stopped for a while trying to stop his bursting laughter.. he was smiling ear to ear.. Of course , I was smiling too..
" Guess what.. he ate it all last night !! "
" WHAATT ??? Can you repeat that again ?? "
" Yup..he ate up his penis.. and now he's organless... " I was shocked but at the same time find the incident to be really bizzare ! The buzz spread around like wildfire and of course when the patient arrived in OT , it was like a VIP coming to OT !
And of course , being me.. I just had to ask him..
" You , lepas potong you punya benda aa.. u ada goreng dulu ka sebelum makan ? "
" No.. i ate it all raw.. " he told us with a non-affect expression.
( P/S I did take some pic for future reference.. don't think it is ethical to post it up on this blog ! But if you happen to see me , mintakla.. hahaha.. )

rambut sudah panjang oo....

Tengok tu Qaisya... Walid mid life crisis..

I was looking for my baju melayu suit to wear to work as usual on Fridays when suddenly..hmmm.. lets try out my wedding baju melayus . Surprisingly it fitted well!!! I showed it to wifey and was bragging about how i am now able to fit into the trousers comfortably and baju melayu without looking super fat ; which i never manage since the wedding day !! Hahahaha... My waistline actually shrinked !!!
Of course , wifey with her "menyampah" face uttered...
" Tengok tu Qaisya , Walid mid life crisis !! " and as if my 1.5 year old child can understand ! Hahahahaha Dzaeddran as usual is fast asleep and untouchable !
A certainly good motivation for me to be mindful of my food intake during iftar.. hahaha

1 Ramadhan 1429

In view of the current government's recommendation of "BIJAK BERBELANJA" , i present you my iftar for the first day of ramadhan this year !! Hahahahahha
Just felt like having simple plain sardine and fried egg with kicap for iftar.. Mmm... home cooked food is irresistable eventhough it is not fancy or plentiful.. Anyway , lama dapur tak berasap..
SELAMAT BERBUKA PUASA !! RAMADHAN AL MUBARAK !!

Ramadhan Al Mubarak

Its hard to believe that Ramadhan Al Mubarak is here again. Of course as usual , I missed the first night of tarawikh because of on call !! And now I can proclaim my SMO call in August was SO COOL... hahahaha Tunggu la September pulak.. Its good however to wake up today and not work on 1st of Ramadhan .. hahahaha
My tummy is growling and it is still very early in the morning !
Salam Ramadhan to everybody and hopefully our iman will be refreshed during this holy month..