Today , this was our R n D

In the strong tradition of Sifu-Ling's Regional Anaesthesiasm , we did the Continuous Interscalene Brachial Plexus Block for a 73 year old man who was about to undergo a shoulder operation ; Rotator Cuff repair. The technique was more for post operative pain control rather than anaesthesia for procedure. The position for the patient can be really uncomfortable and that is the reason why we GA patients for this procedure. It is a common fact that knee and shoulder operations can be DAMN PAINFUL post op !!

According to NYSORA , he most difficult aspect of this technique is stabilization of the needle for catheter insertion after the brachial plexus is localized. This was Ling's first ever interscalene catheter insertion under ultrasound guidance. We did it meticulously and we were lucky Uncle was very cooperative ! he even laughed when his shoulder "moved" when we stimulated it !

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Continuous nerve blocks require the use of larger needle gauges and thus intraarterial placement (e.g., carotid artery) has greater implications and IT IS NOT FUNNY !! That is why , ultrasound guidance is gold standard to do this procedure ..and WALAH !! MAlaysia Boleh !!

Chameleon

It is not easy to be somebody you are not. It becomes an internal crisis and affects one psychologically .. slowly but surely munching the real you. It threatens to maul your spirit and soul ; infiltrating the darkness over what hope is left. One tries to imagine light at the end of a dark tunnel but WTF ? The energy of such focus cannot sustain as how one thought it could be.
Some say it is easy to forgive and forget , but what if it is not ? Which is better ; to forgive or to be the unforgiven ? How long can tolerance prevail.. how long can one accept suffering? Some might say its all in the mind but others may beg to differ and perceive it as real.
Apa apa pun.. SIVAJI THE BOSS.. you're the MAN !!!

What is normal ?

The jitters of Genting-trailblazer is getting tenser. I do try to fit in either post call morning runs or evening near Maghrib runs in the past 2 weeks. The Syawal food indulgence certainly became a motivation to burn all the carbo ( more of fat i reckon !!) that is being loaded way to early before the competition day. The weather is getting much warmer and its damn hot by 9am in the morning !!
I do feel that i am fitter now compared to when i did my first 21k early this year ( KLIM 2008 ). It is a good feeling really and somehow nowadays i do feel more confident. My weight loss is still minimal but people did notice somehow ! It must have been my eating habits which is way different !! This is my hobby nowadays and its my health which is benefitting.
Its going to be wet and wild this Sunday ; but it'll be fun !! Hahaha

You know him ?

I received 2 similar birthday presents from Azad and Nor. ( the above illustrated biography ) Eventhough they did not plan it , somehow when they saw this "comic" ; they remembered me. I must say I am flattered to be remembered after a great personality and idol in Malaysia ! Hahaha.. Untung jugak sharing the same initials... Thank you ! Thank you !!
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It was unplanned ; we were at the MACY warehouse sale to look for bargained curtains for the BJ house. We did not achieve that target , instead we bought TWO BEDS with mattresses and bed ! Hahaha totally unplanned and that adds my accounts DEFICIT.My EZYPAY installments are getting bigger and bigger each day.. hahaha

How I nearly grew older

I am 32 now.. ( I'm not sure how old Sultan Pahang is though.. ) A year older , A year wiser they say. The denial factor is always strong but one has to accept the reality that one is getting old ! I must say , this year's birthday was a lot different from the ones before. People around me somehow celebrated it with me ; and of course I felt happy !! Thanks to facebook as well , the birthday wishes streamed from right , left and centre through sms , emails and of course on my facebook wall !! Hahahaha.. gile overwhelmed.. Thank you everybody for your warm gesture !
HOW MY COLLEAGUES DID IT
I was on call on the 23rd . Jahan ( the lecturer ) on call did mention that we should celebrate the occasion because it was Suana's birthday and she was oncall as well ! I was the only male in the team and that qualified me to own the single room that night ! The call was pretty cool because by 6pm we were almost done. The last case then was a finger tendon and nerve repair which we easily did a brachial plexus block ; so its the surgeon's den to settle ! Jahan bought the oncall team pizza hut and it was pure indulgence !! Hahaha.. thanx boss for the food and the whole oncall team was certainly all smiles !

23rd October oncall team
Then Edmund joined us and of course , being the "generous"one after the dinner he went out with Jahan to get us a birthday cake ; and the memorable TGIF starter to indulge us some more ! Woohohoo.. apa lagi , makan tak ingat la gang ! It was a memorable birthday and I must say well celebrated! Thank you everybody ! ( eventhough i had to get up at 4am to continue a hand case which went on and on and on and on.... )

Sedapnyyee...

birthday boy and girl
HOW MY WIFE DID IT
I got a surprise phone call in the morning from wifey that she was picking me up. I was all set to take the bus home and it was a surprise !! Hahaha.. mentang-mentangla birthday! I should not get into details what happened when we got home ( keh keh.. ) but she surprised me later with a booking at a spa in KL !! Waahh... imagine having your wife's permission to be touched by another woman !! Hahahahahahaha We went to Body Countour in KL as they were having the couple spa promotion. It consisted of a jacuzzi session and followed by body massage. Wifey wanted the massage as her pregnancy now is really taxing her back and legs. As for me it was such a pleasure after the oncall. I slept half way and dunno whether i snored ! hahaha

memang jakun.. hahaha
Initially we wanted to go to KLCC's chillis for lunch. However , the spa was just behind Pavilion ; thus we had to reroute our plan. After my friday prayers me and wifey dined at Tony Romas !! Waah.. memang indulgence !! They were having steak promotion and of course , it is a chance i would not miss for the world ! The steak was excellent with its rich texture and taste.. ( hmmm.. i can still imagine it now ) It was a good outing and I certainly appreciated wifey's effort and plan!
Thank you Ja !! *muahs* its going to be a challenge for me to go one level higher in celebrating her birthday next time..

Sudah puas... hahahaha

Being brave

We had a 16 year old girl for Op today. She had lymphoma and with it a big mass inside her chest cavity ( mediastinal mass ) . It is compressing one of her lungs which impairs her respiratory function. Thus; the very visible shortness of breath and bad oxygen saturation. On top of that , her pleural effusion which needed regular tapping is not helping the situation. She CANNOT lie flat at all and needed to sit up and crouch her body to make herself comfortable.
She was due for excisional biopsy of her big cervical nodes ( along her neck ). If it was assymptomatic , I don't think the surgeon would have called for our help. She was very breathless and cannot sit still ; more over to lie her down and do the excision. As fast as any surgeon can do , it would take more than 10 minutes. Having a patient who moves because of breathlessness will slow things down and mistakes are due to happen !
Of course ,General anaesthesia was out of the question as her mediastinal mass was compressiong 50% of her airway( the big pipe !! ) and shifted her heart to the right side of the chest. It is her muscle tone which is sustaining her and obtunding this will result catastrophy and that maybe the last time we'll see her alive !
Of course , SI-FU LING ; was the person to consult ! Our regional block master concurred with my plan to block her superficial cervical plexus. We had one advantage , the girl was very co-operative and that was really helpful to make this procedure succesful and avoiding GA.On top of that , she would be pain free ! The only risk is , her "good" lung was the right side and the surgeon was keen on taking out the nodes on her right side of the neck. If my block is too deep , then I will be blocking the phrenic nerves and that may impair her breathing effort some more !

We had to perform the procedure with the patient 60 degrees propped up becuase that was her most comfortable position.
" MAfeitz ahh.. u better make sure it works ! "
Yeah right.. Thanx for the encouragement !! Hahahaha
The girl was very brave as I gently performed the block. She did not cry nor sulk eventhough she was just 16 , I guess she was suffering so much that "simple" things like this doesn't affect her at all.
Alhamdulillah , the block worked well and the biopsy was done with the patient pain free. She smiled at me when I brought her to recovery area.
"Ada sakit tak ? "
She said no... " Thank you Doctor.. " she smiled , eventhough she was still breathless.

Picking your leader

I dunno if anybody realized this ; ( after the MCA elections during the weekend )

MCA is led by an IR ; engineer , 2nd in command a doctor. The vice presidents being a pharmacist and a doctor. The other two i'm not so sure about their education background but one served as the Deputy Minister of Science n Tech Ministry as well as Finance Ministry. Therefore I conclude ; all of them were from the Science stream.
A lot different from the UMNO scenario huh ? hahaha
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Its good to see Malaysia scoring freely against their opponents in the ongoing Merdeka Tournament. It is sad however to note the bad turnout from the higher ranked teams invited. Our ASEAN country mates certainly do not see Merdeka Cup as a challenge. Its sad that our standard is at par with Nepal and Afghanistan. To make things look worse , we paid them to play in this tournament !!!
I dunno whether I would go to watch the team in the finals.. but being a hardcore fan.. MESTILAH !!! JOM !!!

The Untouchables

What can I say .. I had a wonderful call yesterday ! One of those zombie 24 hour call but honestly I had fun with the guys ! It was Hady and Adam doing the OT call with Aktar as our SMO. I was the "Crash" person ; and being an all boys group ( few parties were jealous of us... !! ) we had Vas doing his virgin Lecturer call. And how "sumbang mahram" it was !!!
I had to do Cerebral Aneurysm Coiling in the radiology deparment to do in the morning. We had our interventionalist who came back from training in Turkey to do it and I must say , me and Dr Ling were impressed with his plan and work. It is always nice working in an environment when 2 working parties communicate well.
For my crash call last night , my pager was behaving well because I was hardly paiged overnight. I " converted" my call to OT because of the 2 interesting cases that cam up after 7pm. The first was a fairly middle aged mum who had massive pulmonary embolism ( blockage in the pulmonary circulation ) and she was due for surgical embolectomy( removing the blockage out literally ! ) .It was a high risk case with chances of mortality > 70% while doing the procedure. I always find by pass amazing and it was still amazing yesterday seeing the perfusionist manipulating the normal body.
We finished at 4am.. and thought that a good night chocolate milk in Delifrance was the last toast for the night..

picture taken after the embolectomy..
And boy were we wrong !! immediately , there was a trauma involving a young foreigner where it was suspected that her pulmonary ( lung ) vessels were ruptured ! She bled > 3 liters from her chest tube before coming to us in OT.
The four of us was there and I can tell you , we were SO tired by then. Hady could not open his eyes and Adam shook his head in disbelief when he was informed of another craniectomy that was to be done at the same time ! but because we had an impending death upon us ; the adrenaline certainly brought us to another level. It was difficult inserting arterial line and central venous line for this lady as she was bleeding away and in hypovolaemic shock. We pumped in blood like nobody's business wooo !! And because it is a requirement for the patient to be on double lumen tube we tried all our might and Aktar is a really supercool anaesthetist ! Tabik spring bro !! He managed to insert it well and although we did not properly confirm the placement after the right lateral positioning ( with me holding it in position tight after that lah.. hahaha ) ..but when it was time , the lung which was required to be collapsed was collapsable ! She became haemodynamically stable after the surgeon found what was causing the massive haemorrhage. And we felt good...
The case was taken over the the next day's oncall team at 830 am.. but we were still in our elements but the fatigue came but honestly , I felt the satisfaction eventhough it was one of the most ridiculous call I've ever had !!
We felt like... we were the Untouchables !!

camwhoring outside the cardiac theatre..
p/s the dates on the pic.. bukti tu !!

Klang 12K

The day started early as this was our official run after raya. Mafiz picked me up at 0530 from my MIL's place as we were sleeping there because Mak was away. We made our way to Azad's in Shah Alam and to our surprise he was still asleep when we rang him up in front of his house gate !!! I dunno why Edrin did not make it ; we were supposed to meet him at Azads but i guessed something must have came up.
Azad was not sure of where the starting point would be but being a Sunday morning , it will not be difficult to see swarm of yellow shirts ( the official running gear ) walking to a similar point. The run started at 7am sharp and off we went !! The weather was excellent but after 8am it became a bit too hot ! We were running on a busy two lane state road and I guess on a normal day it will be almost impossible to complete the track ! I was not happy with the only one water station they provided in this Klang run ; but i guess seeing the crowd today it must have been something expected. I decided not to wear my usual black Adidas top and in exchange was the German Adidas. Nak tukar sikit la gambar asyik baju sama je.. hahaha.. However , the shirt injured my nipple and I was holding my shirt off on the last 2km. It was painful !! Mak ai.. i really need to use vaseline or tape my nipple off because it became more painful during the shower after !!!
I am happy with the run because I felt good doing running. The whole 12K was flat and I went all out. I wanted to see how long I can last. I did not puff nor did i feel exhausted while running. I guess the runs I manage to squeeze in after Trusmadi & Tambuyokon during ramadhan did the trick. I guess I am much fitter now compared to earlier this year. I did roughly 12K in 80 minutes which i think is not too bad for my standard. I better start timing myself from now on eih ? Congrats Azad and Mafiz !! It was indeed a good outing !

another cert and medal as proof !!

Gigit medal gambar wajib !!
And guess what ??!! Mafiz who's always the lucky one when it came to lucky draws got lucky again !! We were looking at the "MAPIAU" before our usual photo taking session when suddenly Mafiz screamed... "Hey..323.. thats my number !!!" Hahahaha.. We looked closely and yes , it was his number ! Damn lucky guy !!

Hujan di tengah hari

I was pushing out my patient from the OT , when suddenly i heard a loud GASH!! It was waterfall like and I quickly rushed to the counter.
To my amazement , water was pouring down from the ceiling of our OT entrance !! Waaahh... a sudden flash flood appeared and everybody came to the scene ( typical Malaysian style la tengok accident !! ) One patient who was due for Op went out of his bed and stood looking at the "small" disaster ! ( He was due for BKA - below knee amputation - mind you... hahaha ) The scene was like when you were back in kampung ; hahaha. The OT is having its feel of raya as well I guess.
Our UMMC appropriate staff came to the rescue , and the matter was resolved pretty soon.. hahaha.. what an event to celebrate my first call post raya holidays..

Aidlifitri blog entry

I was a bit too tired to type last night , I ended up downloading pictures which i went through few times and smiled. Each picture had its own story and i believe that is the beauty ; seeing your offsprings grow.
Pre raya : weight 77kg..
Raya day 5 : weight 79kg... hmm..not looking great huh ? hahaha

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I was technically still working on Raya eve , however as there was no OT list I was put on standby. I was with Dzaeff and Qaisya at home as wifey was working half day. We went over to Maks on Raya eve and spent the night there. It was the first time , everybody in the family under that DJ roof. Wifey helped Mak to prepare dishes for raya . Rendang was my favourite but I tried very hard to control the desire to wallop the food !! Hahaha I slept in the living room which was a bit uncomfortable ; but its raya and that is acceptable ! We had fun with the fireworks Yo brought back from Kulim and the finale "KLCC" 25 shots was a blast ! According to YO , that was the cheapest and mildest but I can tell you , it shook the neighbourhood off !!
I prayed in TTDI but this year I did not manage to find my peers around. I only met DIl but there were a lot of juniors around ; thanks to Facebook the faces are now familiar !!

After the picture taking session , we went to Pak ngah's house and Acik's place . It is the usual routine that we do every raya. However it was different this year because we only started our journey back to Muar at 4pm ! Its the kids ! Its not efficient anymore but then hey.. I am not complaining !
Muar was "kecoh" as it was full house ! It was congested with my family , Auntie Nor's and Auntie Roha's !! This was the raya experience Iwant my children to enjoy !! Hahahaha.. It was fun doing the tidur lambak and having to queue for your turn to use the toilet. Luckily Uncle Malik stays next door as for "emergency" use , we run next door !! hahahaha
I tried very hard to resist the temptation to control my appetite , but its raya folks ! After the first day raya binge , I did something which I've never done before ! I ran from Parit Setongkat to the Muar bridge and back ! Its a different Muar in the morning and I've never been on my two feet crossing the bridge. The total distance was 8 km and I felt really great after doing it ! hahaha.. memang dah kena penangan adrenaline. When I came back , everybody was still asleep . A definitely different approach to fitness doing raya this time around.
We came back from Muar on Friday afternoon and surprisingly the traffic was mild. We continued our raya in KL as most of wifey's family is from KL anyway.
This year eventhough my leave was till the weekend , it was not as hectic as how it used to be. Preparing your children and taking care of them is not as easy as one thought it is ! Qaisya was certainly very moody and Dzaeff had his eccentric moments as well! I really dunno how we'll cope with the third next year for Raya !

Alfatihah..

Aidilfitri 2008 family moments

Malam raya bunga api madness..

Salam2 with Pak Long

After many years , everybody was back and the picture is complete !

Tok Ma and Meng

Salam Aidilfitri 2008@ Raya sebulan ooi...

Understanding the young

" Oh..oh..oh.. balik kampung.... " Dzaeffran was singing this as we were driving back to Muar. I dunno who taught him this but he was happy ! This will be his 3rd raya and he had begun to appreciate more about this festive season.
"Dzaeffran balik kampung sapa ? "
" Tok ma... " he answered... smart.
"Jumpa sapa ?"
" Atok GOYANG... " " Sapa ??? " .. " Atok Goyang.... " i paused.. and i laughed !! I get it !!!
Hahahaha... He was referring to ATOK MOYANG !!! Its just that he cannot gather to utter Moyang but Goyang instead !!
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"Bagi Walid.." i offered myself to keep the angpow money he received.

" Tak Nak... Dzaeffran simpan.. "
"Walid bagi yang ni..dzaeffran bagi walid yang tu... "
He gazed at me , looking disinterested in the RM1 that i am offering.
" Nak Puluh..puluh... " he told me sternly . Hahahaha.. He knows that I am cheating his RM 10 / 50 for a mere RM 1 !!
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Qaisya was crying non stop after we woke her up as we arrive in Muar that evening. She was certainly very moody and wifey was struggling with Dzaeffran. I offered to pick Qaisya up and brought her outside.
Her volume was immediately reduced when we were outdoors and the "chicken" family , the rooster , the hen and the small chicks were crossing our path.
The rooster decided to crow and that stole Qaisya's attention.
" Hmmmmm..." she said.. pointing at the rooster.. , she looked at me and sort of asked.. " Dog... dog.... "
hahahahaha... I guess it was the first time she came in contact with a rooster and thought that it was some dog species !
Suddenly from behind... MOOOOOOOOO...... Both of us turned heads back .
" Ooooohhh... " she said again with excitement. " Dog... dog !!... " as she pointed to the cow!!
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"Kenapa Dzaeffran nangis tu ? " I asked my wife as I entered the room. I could here Dzaeffran screaming his lungs out for quite sometime. Dzaeffran was still crying , refusing.
" Hmmm... dia taknak pakai jubah ni "wifey told me. She just bathed Dzaeffran after our first day of raya.
" Nak baju handsome... " he pleaded.. referring to the silver baju melayu with the sampin that he wore the whole day that day..
Hahahahaha... anak Walid ni... melaram la pulak !!