How to describe your poo?

 

Types 1 and 2 indicate constipation, types 3 and 4 are usually the most comfortable to pass, types 5-6 tend to be associated with urgency and type 7 is diarrhea.

In type 2-3 basically the stool is very hard and you need to use a stool softener like liquid paraffin. Do not use bulking agents or fiber as this will only make it worse.

In types 4-5 you can use a bulking agent like Forlax or psyllium husk or fibre. Irritants like prune juice, dulcolax or senokot will also work, but be careful not to abuse it.

In type 6-7 basically the faeces/stool is impacted and the wattery bits are being sqeezed through the sides of the stool. This will probably need manual disimpaction (look out for the explosive disimpaction)

[Credits to Docfiles]

p/s: FAQ is updated. You might wanna go read that some times.

Postgraduate medical training in New Zealand and Australia

First of all, don’t forget to change time setting an hour forward fellow Nizhnians.

When I say New Zealand, what comes to mind? Lord of The Rings? No… I was thinking about the ad “susu lembu New Zealand” when I was a little boy  

Wanna try postgrad medical training in New Zealand?

Dr Powell said a fifth year registrar in New South Wales earned around $NZ102,800 a year, while the same registrar would earn just $66,200 in New Zealand.

Well, don’t be too awed by the number figures. Taxes not included. But we can see here that medical training in Australia provides more competitive market than New Zealand. Even this news says it. The doctors in New Zealand are unhappy about their salaries and what more is that many New Zealand doctors move to Australia.

So how do I qualify to be a medical graduate in New Zealand? Click here to read the steps from Medical Council of New Zealand. You can even self-assess yourself and figure out the pathway to be registered in New Zealand Medical Council.

Ok so I decided to add up Australia as well.

Do you know that Australia is suffering acute shortage of physicians and are boosting their efforts to lure foreign medical graduates to the Aussie land? That’s why New Zealanders complain that they produce 300 graduates per year only to let the same amount move out to Australia, annually.

Read more about the qualifying exam for practicing medicine in Australia.

How to irritate your doctor

Apologies dear friends, making you anxiously waiting for this blog to reopen after settling some “spam comments”. Now that it’s reopened, shall we take it a little lightly?

What you can do to irritate your already irritated (by the previous patient) doctor. This is a good way to make sure you get substandard care:

1. Come in already talking loudly on your handphone…
2. After you hang up your phone, demand for a referral letter to see a specialist for your URTI
3. Cough in your doctor’s face (to show him how serious your cough is)
4. Ask for 5 days MC, 2 days back dated and 3 just in case.
5. Tell your doctor that s/he looks like s/he doesn’t know what he’s doing and demand for a specialist
6. Tell your doctor your bomoh or sinseh asked him to do an xray or mri. Insist that your bomoh is right and your doctor knows nuts, and you want a referral to hospital based on your bomoh’s recommendation. You can also replace the word ‘bomoh’ with ‘pharmacist’ or ‘next door neighbour’
7. Bargain huge discount for the consultation and medicine as if you are in a fleamarket
8. Sell some traditional medicine to your doctors and tell him/her that s/he needs a beauty product.
9. Fart on your way out

[credits to docfiles]

The long road to becoming a specialist

I personally think it’s foolish of a medical student like me to think too much of becoming specialist when one still hasn’t mastered the essence of venipuncture and holding the surgical scissors wrongly. But I just can’t help it. I was browsing through blogs and here’s what I’ve got:

Starting year 2008, there will be at least 2000 Malaysian fresh medical graduates from the various public and private universities sprouting throughout the country, not to forget graduates returning from Russia, Indonesia, India and Ukraine. This number is likely to rise over the coming years. Will MOH be able to cope with the demand for training posts? Will the ministry of health be able to provide enough housemenship positions, and if yes, will these posts provide high quality training, as the saying goes ‘too many cooks spoil the soup’? In the long term, will the ministry of health be able to provide enough specialist opportunities, considering its eagerness to do away with MRCP*** and only recognize the local masters program?

***There is a rumor about MRCP (the entrance exam to being a specialist in the UK) being derecognized.

So, what’s the issue here again? Can’t you people see it?

1.  Super stiff competition to become a specialist, worse still specialization in the UK has shut its door.
2. The varied levels of knowledge and skills among housemen from different graduate countries; so this will certainly discriminate the graduates (of a certain region/country) who perform badly. Given the circumstances, Russian graduates will most likely be the underdog (unless the esteemed seniors can rock the public healthcare perception). Thus the lower chance for specialization.
3. Longer years of queuing to become a specialist if we aren’t that good at the first time of application, not to mention that 5-year long HOMOship.
4. Even if one manages to obtain specialization overseas, there’s 18 months period of gazzettement (trial period) for an overseas-trained specialist before being able to be registered as specialist in Malaysia.
5. Many will seek specialization in developing or third world countries which can accommodate training more specialists, but yet to be recognized by Malaysian government (India, Pakistan, Russia, China, Indonesia etc)

Hehe I wonder if any of those can be true. Perhaps it’s just in my head, or maybe I’m too raviolized from Sbarro just now ;)

Good luck to us?

Postgraduate medical training in the UK

Doctors resident outside the EU will no longer be able to apply for postgraduate training posts in the UK under new immigration rules.

The Home Office announcement follows sustained criticism from doctors’ bodies that UK graduates are unable to find work due to the competition.

The new rules will come into effect for the 2009 recruitment round.

Read the BBC news dated 6th February 2008 here.

Does anyone know about PLAB? The Professional and Linguistic Assessment Board test (PLAB) is the assessment procedure conducted by the General Medical Council of the United Kingdom that is required for overseas doctors outside the European Union before they can practice medicine in the UK. For more information on PLAB – read here.

Here are the summaries underlined by Palmdoc of Malaysian Medical Resource on pursuing postgraduate medical education in the UK:

1. All doctors wishing to work in the UK from outside the European Union (EU) will be required to have a work permit from April 2006. The move means that any NHS trust wishing to employ a doctor from outside the EU will have to prove that a ‘home-grown’ doctor cannot fill the vacant post, ending the current permit free training arrangement for international doctors. If there is one British or EU applicant for a certain training post, Malaysian doctors who have no Permanent Resident (PR) status in UK will not be eligible to apply. Practically, Malaysian doctors in UK without PR status can forget about post-graduate training in UK
2. Non-EU doctors who studied in UK universities are allowed permit free training to complete their TWO years Foundation Programme which is equivalent to the previous Pre-registration House Officer (PRHO) & first year Senior House Officer (SHO) level of training. This is to enable them to register with the General Medical Council (GMC). Thereafter, they too will be subjected to Work Permit requirement practically excluding them from further post-graduate training in UK.
3. Malaysian doctors who are currently working in UK will be allowed to complete their remaining contracts. After then they will not be eligible for further application or extension of post-graduate unless the Work Permit condition can be fulfilled (which is practically impossible). Those whose permit free visas are expiring but whose employment contracts remain valid will be allowed to extend their visa in the form of Work Permit to complete the remaining terms of their employment. There after they too will only be eligible to apply for posts that cannot be filled by EU or UK doctors. Effectively, if you are in the Type I Specialist Registrars’ post, you are safe. As for the rest, you have missed the boat.
4. Malaysian doctors who are in the process of applying for jobs will find their CVs literally thrown into the bins.
5. Those short-listed will be barred to proceed in their job application.
6. This is a tragedy to many Malaysian doctors affected by the new ruling. It means they will have to uproot their families, sell their houses and cars etc, come home and start from the bottom again, unless the Malaysian government is prepared to do something to bridge and complete their post-graduate training. The announcement came with virtually no warning and no grace period for people to adjust or make necessary arrangement.
7. Those who intend to sit the PLAB exam please stop doing it. PLAB has practically lost its reason to exist.
8. Malaysian prospective students and parents SHOULD NOT send their children to UK unless they are certain that they only want to come to UK for undergraduate training only. JPA on the other hand no longer has to worry about the issue of non-returning scholars.

Neurology rotation

Neurology cycle finished today. I’ve seen a lot of interesting cases, but probably the esteemed neurologists and neurosurgeons are bored to death with the cases that I have seen during the past 2 weeks.

Unfortunately for the neuro patients, there’s a very good chance that their quality of lives will deteriorate by time. The main task for neurodoctors is to keep them alive.

My patient for example has  a secondary progressive subtype of multiple sclerosis (MS), a significant MS history for 30 years. He’s been talking inappropriate jokes (at first I couldn’t understand until teacher said it was inappropriate). Whatever.  MS has increased frequency proportional to increased distance from equator. Seriously. So might as well learn here becoz MS is not really frequent in Malaysia (honestly I don’t really know the frequency of MS in Malaysia).

My classmate’s patient is a hit-and-run-and-comeback victim of spinal trauma at level of L1-2 (apparently the drunk driver came back to pay for the surgery). It’s sad tho, he’s just 18 years old and he’s paraplegic. If the trauma could hit a little bit lower than L2, that dude could have a better prognosis. Whatever. God has His own plans.

There are also tumor patients; post-op pituitary adenoma with acromegaly. Nyeh nyeh I caught that acromegaly tho. Hehe. Not that the neuroguys cannot diagnose acromegaly for themselves but since the patient has been talking about cannot fit his feet into his socks (enlarged feet) and enlarged hands, I decided to check for the tongue. Macroglossia with teeth gapping. More test is needed of course, but those are positive signs of acromegaly though. Probably the neuroguys have called endocrinologist’s consult and starting on octreotide… I’m glad the patient has improved his vision after suffering homonymous hemianopsia for quite a while.

Then there’s one with post-op unilateral acoustic neuroma. Unfortunately he’s got Bell’s palsy because he couldn’t close his left eye plus some signs of left-sided facial paralysis. Since he couldn’t close his left eye, he gets infection and develops keratitis. At first, I was quite horrified to see this patient coz he’s got half-sided satan-like face and a big scar at the back of his head which totally looks like a hardcore skinhead! Right side of his face is the normal one, left side has a satan-like look with that keratitis and bulging eyeball… But a patient is a patient, right? He may look satanic, but what he has been thru from there is much more horrifying to him than to us!

Well, those are just some patients that I have seen and remembered to write here. If I write more, probably a neurologist who happens to drop by would say “Amateur kid bragging over acromegaly!” Hehe… Whatever. The tiring neuro cycle has finished, final neuro exam in June awaits. Coming next is medical genetics – studying with the same neurologist.

The meaning of handwriting

What Your Handwriting Says About You

You are a fairly energetic person. You know how do pace yourself, and you deal well with stress. You are reserved and not very outgoing. You are deeply thoughtful and introspective. You have a lot of control over your actions and emotions. You are extravagant, over the top, and indulgent. You set trends and influence people. You need a bit of space in your life, but you’re not a recluse. You expect people to give you a small amount of privacy, and you respect their privacy as well. You are somewhat traditional, but you are also open to change. You listen to your head and your heart. You are a decent communicator. You eventually get your point across, but sometimes you leave things a bit ambiguous.

What Does Your Handwriting Say About You?

credits to Sarah Repin

Greatness

Greatness – What about it?

Once we accomplished that greatness, what do we do of it?

Do we search for a greater height of greatness?

Once we were great high schoolers. Then we planned for med school.

We do great in med school. Then we plan for graduate medical education.

We do great as junior doctors. We choose specialty.

We are great specialists. We upgrade our ranks (senior registrar à junior consultants à senior consultants à department chief à dean of medicine) or perhaps leave for private practice.

Then we resign… and die eventually. Where is the greatness that we felt?

I’m unsure what defines us; the greatness we accomplished or the journey we took in between?

p/s: A little philosophical today because I’ve kept thinking why ex-captain Aizen Sosuke who absconded Gotei 13 chose a different path to achieve greatness, leaving his fellow captains behind. Maybe I’m on sugar high? Nyeh nyeh…

Ayat-Ayat Cinta

 

I just watched a romantic Indonesian movie AYAT-AYAT CINTA which is very superb! This movie’s setting is in Al-Azhar university, Egypt… tho I find it funny all Egyptians in that movie speaks Indonesian. Not impossible though. Many Arabs in Makkah and Madinah speaks the language.

As you can see from the pic above, Fahri, the main character and the hero of this story, is kinda every Muslim girls’ prince charming; selfless, humble, helpful, good-looking and innocent. Every girl in the movie has the hearts for him. But then, the bad thing about being selfless prince charming is that you’re easily framed, like Prophet Yusuf ‘alaihis salam.

The left girl is Maria, a Coptic Christian girl neighbouring with Fahri. She fell for Fahri as well. At the second half of story, luck has been sucked out of her.

And my favorite is that lady on the right with niqab, Aishah, a rich and beautiful german lady who is willing to sacrifice everything for Maria and Fahri. OMG, don’t ask me how strong she is when crisis hits her, because I am really turned on! And her eyes are very hypnotic!!! A woman with pride and rare beauty…

Hehe, I think I am too carried away when a niqabist is involved. I got a thing for these people tho…

But the end is quite depressing. Just some heads up. 

Only Compression for Cardiac Arrest? (CPR vs MICR)

Source: Malaysian Medical Resource 

In those who experience cardiac arrest outside of the hospital, resuscitation efforts that focus on keeping the blood flowing through the heart and brain result in better survival than traditional cardiopulmonary resuscitation (CPR), according to an article published in the Journal of the American Medical Association.

Here are some facts about CPR and cardiac arrest:

• Cardiac arrest is when the heart stops beating in a regular rhythm to the point that it can no longer pump blood throughout the body.

• If you come across someone experiencing cardiac arrest, the best way to help them is by calling for emergency services and starting CPR.

• CPR is an emergency technique involving chest compressions and artificial respiration that helps restore blood flow while emergency services arrive.

Researchers from the Mayo Clinic in Scottsdale compared if people lived after having a cardiac arrest outside of a hospital setting before and after training emergency personnel in a new resuscitation technique. This new technique, called minimally interrupted cardiac resuscitation (MICR), involves focusing efforts on using over 200 chest compressions and not breathing into the patients mouth.

Overall, 886 patients experienced cardiac arrest. Among those who went into cardiac arrest before emergency personnel were trained in MICR only 1 in 50 patients survived. This rate jumped to 1 in 20 after emergency personnel were trained in MICR. In a second analysis, evaluating over 1700 patients, 4 out of 100 survived with traditional techniques, whereas 1 in 10 who received MICR survived.

 

Efenem: Traditional CPR uses ABCD methods                                                      

A for Airway – secure airway by ensuring the person isnt choking anything

B for Breathing – tilt the head backward, do mouth-to-mouth artificial breathing

C  for Compression – Chest compressions. Some argue 15:2 (15 chest compressions and 2 artificial breathing), some say 30:1.

D for Defibrillation – find a defibrillator if any, especially if the cardiac arrest patient is in hospital.

Maybe MICR (Minimally Interrupted Cardiac Resuscitation) proves more superior, not wasting time on other things besides perfusing the brain and heart (minimal interruption) with uninterrupted chest compressions. Of course, defibrillation is still important to revive the electrical activity of the heart.

Instead of reviving heart and lung in cardiopulmonary resuscitation (CPR), this new medical advance is focusing on saving the heart and brain (Cardiocerebral resuscitation – CCR). Should we talk about this with our teachers in med school, introduce the MICR thing in their hospitals, be a part in a global cohort study on this new medical advancement?

Not to say this is far more hygienic than doing that mouth-to-mouth thing

Say bye-bye to CPR… maybe!

Silly Utusan Letters

I’ve never been so interested in local politics since this election. Well, as of this entry, I’m referring Utusan’s Forum page (Reader’s Letters on 10^th March 2008) which I haven’t read in months.

Not that I want to stress how silly those comments are, but I just felt Utusan is really lowering its standard down the toilet; allowing unilateral, biased comments which have zero intellectual values. Only Malay and Muslim sentiments are played from time to time.

Quote In Letter 1:

Di Wilayah Persekutuan, penguasaan DAP juga mencerminkan monopoli politik Cina. Ada wakil Pas dan Keadilan pun, mereka kecil dan tidak bersatu dari segi ideologi.Kejayaan DAP ini semuanya adalah hasil ‘bantuan’ Pas dan PKR. Itu belum bercakap tentang bagaimana PKR dan Pas turut sama melonjakkan DAP ke persada kuasa di Pulau Pinang dan begitu juga di Perak.

Ternyata pilihan raya kali ini menyaksikan sentimen perkauman yang kuat dimainkan oleh masyarakat Cina dan India kononnya untuk menghukum BN khususnya UMNO. Antara sebab UMNO ditekan kerana mempertahankan agenda Melayu selain berasa tidak puas hati terhadap beberapa isu kononnya masyarakat India dipinggirkan dan isu keris oleh Pergerakan Pemuda UMNO.Sebab itu, hampir 100 peratus pengundi Cina dan India memberi undi kepada pembangkang.

Nampaknya yang menjadi mangsa kepada muslihat politik ini, ialah orang Melayu. Lebih menyedihkan ramai orang Melayu yang tidak mendaftar sebagai pengundi dan mereka yang mendaftar pula, ambil mudah dengan tidak keluar mengundi.

Great! Blame the voters and play the racial sentiments. Yeah yeah, UMNO and BN never made mistakes. They are the godsend angels who have done so many great things to the people.

Bapa saya, seorang bekas pegawai tentera menitiskan air mata bagaimana ‘Melayu membunuh Melayu’, angkara politik kepentingan sempit. Inilah realiti terbaru bagaimana kealpaan dan percaturan emosi akhirnya melemahkan politik Melayu.

Ask the father to be a brave soldier already and put on his big boy pants. It’s kinda sad after decades, people are still thinking that Malaysia is just for Malays. 50 years ago, this might be the hot issue. Now, the younger generations refuse to live in their world and want to live in ours. Younger generations are much more global and much more connected than them elders. Maybe Merdeka should really be redefined.

Quote in Letter 2:

Kini rakyat akan menilai semua perkara dari segi janji hinggalah kepada kepimpinan. Janganlah jadi seperti di Kelantan di mana Pas masih gagal mentadbir dengan cekap.

The opposition had never been given a real chance before even to govern Kelantan. The central government just controlled everything; from education, health, security… and the state power has authority for small things only. The political system in Malaysia systematically oppress the state which does not support their politics.

Take a cue from the states for example: the “geniuses” in DC are republicans, but we never see Democrat-supporting state such as Montana get discriminated…

Quote in Letter 3:

Pilihan raya kali ini menyaksikan BN telah ditohmah dan difitnah dengan cukup hebat tetapi BN gagal melawan tohmahan-tohmahan sehingga orang Melayu pun masuk ke perangkap DAP. Ini pun orang Melayu tidak sedar. Sedarlah orang Melayu, sepatutnya kita berbangga dengan kejayaan anak bangsa tetapi kita bertelagah.

Nyeh nyeh! BN is framed?? Nyeh nyeh! It’s good to laugh! Even the UPSR-year-old me can see politics much clearer on who framed who when Anwar was fired in September 1998. I was damn good back then even my BM teacher in MRSM PDRM who is pro-BN had lost cause… Everyone predicted BN’s downfall in 1999 but lucky Mahathir was cunning and could handle blasts from his enemies.

I don’t think Abdullah Badawi is a bad guy. He’s the Mr. Nice Guy. That’s the problem. Nice people shouldn’t be leading the country. Only jerks and bitches who know their own way round politics should. Look at Angela Merkel, she’s a pain-in-the-ass bitch. Yet she still runs the country well and I personally can’t get enough of Germany.

I hope Utusan stops playing the Malay card. It’s getting real cheap. I feel humiliated as a professional-to-be Malay.

P/s: I stopped reading Utusan after they’re 6 months late reporting the worldwide press freedom index in 2006 and I had to remind them they are late.

P/s: I’m not really fond of opposition either. If they make mistake, I’d blast them too. If I don’t, someone else would and the world will still rotate on its axis.

Malaysian General Election – The Change

Opposition takes over  Penang, Kedah, Selangor, Perak and still retains Kelantan. Sounds just fine by me. People want change. Previous government was lousy. Quite interesting to see the results of this election. Perhaps I should’ve voted after all.

As a Malay and a Muslim, I feel insulted to have political party shouting out “We will take care of you Malays and your privileges” or “We will take care of you Muslims and your privileges” as if generalizing us Malays and Muslims the poor weaklings. As long as racial and religious rights are fairly practiced, I don’t think any particular people needs a privilege.

Is there such thing as special privilege to certain kind of people in constitution when prophet Muhammad (peace be upon him) ruled Madinah?

Not that I am saying poor weaklings shouldn’t be helped, but those people needed help no matter religion or race. No race or religion needs special attention. It’s up to individual. Either your survive, or you don’t!

If a vote is just for the sake of “my people”, maybe nothing has really changed after all, except for the choice of political party.

This election already denied BN 2/3 majority. It’s a change, not necessarily a good one, but not necessarily bad either. Let’s hope for better Malaysia.

Women’s Day Special

It’s been a very fine week…  lets review:

1. I got that pathology audio lectures for my board exams… thank God for that, and those who have helped, I appreciate it very many.
2.  I watched this very inspiring movie; Freedom Writers, which films about troubled multicolored teenagers somewhere in California in 1994, and there is this teacher who helped them change from racial cliques to very united classmates. The thing is; that teacher (Hilary Swank) was my hero back in Bradford because she was this actress in The Next Karate Kid, and the unsupportive husband is the beloved McDreamy! Nyeh nyeh…
3. I got a haircut. My chocoblonde days are over… Totally over… Haha big deal! I will make it platinum this time!
4.  I had a talk with a friend; he said my blog is very inspiring. Not that anyone hasn’t praised my blog before, but to know that from someone I less expect to read all the craps that came out of my mind, I really feel good about it. I get this funny feeling that somewhere someone is making my blog his/her main homepage wahahahahaha!!!
5. Just finished my internal medicine rotation, finished the cardiology subspecialty (feels like a specialist when talking like that). If a subsubspecialty of reading ECGs really existed, I think one of my classmates who is totally similar to Peter Griffin, can be one of the best ECGologist in the universe!~ Guess who??!
6. My friend is gonna send some downloaded stuffs from Moscow tomorrow.  Will enjoy some good laughs for the whole damn semester!!
7. I think I am autoimmune because when my classmates and roomate got the flu thing, I didn’t. Hopefully will never get it. Maybe I am Legend???

Happy Women’s Day for ladies out there. Imaginary hugs and kisses from Efenem.

Malaysian Doctors Salary Doubled

PUTRAJAYA: At least 2,000 graduate house officers in government hospitals will get an automatic promotion to grade UD44 upon completion of their two-year housemanship in 2010. 

They will be getting at least RM6,000 including allowances every month which is almost double what the present graduate house officers are getting. At present, graduate house officers come under UD41 with a monthly income of RM3,768.39 including allowances. Most of them are stuck under the grade for at least six to seven years or more. 

“This is a hefty jump,” Health Ministry director-general Tan Sri Dr Ismail Merican announced at a press conference here on Wednesday.  

He said the promotion exercise was expected to cost RM1.7mil annually. 

Dr Ismail said at least 7,000 house officers under UD41 and UD44, who were appointed before 2008, would also get their long overdue promotions, which would cost RM9.8mil. 

He said those who had been stuck under the grade for many years would however be placed under the higher scale of UD44.  

“Hopefully, this promotion opportunity will indirectly encourage many doctors to remain in the civil service,” he said, adding that at least 70% of young doctors under UD41 resigned to join the private sector. 

The Health Ministry extended the housemanship from one year to two years in January following several complaints including the unsatisfactory quality of service.

News from The Star

Yey! Now, will I stop bitching about how underpaid Malaysian doctors are?

Nope! The whole idea of being a Malaysian is to complain about how awful the goverment is, right? Proud to be Malaysian…

Good move just right before the election tho…