Raya Shopping

This is my first Raya shopping as a wife and a young mother. I got married last year and 'accidentally' (but Alhamdulillah) conceived and have a baby born in June this year ;)... However without my husband for this coming Raya because he's in military operation in Sabah, I have to do Raya shopping alone. I can't go for shopping together with my mum as were in previous years, because we have alternate shift to take care of baby Nuha at home. When my mum and sisters went out for shopping, I will take care of baby Nuha and vice versa. The shopping spirit has begun since early Ramadhan went I started to browse and shop online. But shopping online not giving me satisfaction like the true shopping when we can see, feel, try the things. Out of many shopping paradise in KL, i like Sogo because it is the place where I can get cheap yet quality things suitable with my financial status.

So, last Saturday i went to Sogo alone and to my surprise the complex was like a depot for refugees where thousands of people hurried for shopping. It was only 1030am when the parking already full and I had to park in KWSP's building which was half Km away! When arrived in Sogo building, suddenly just felt wanted to go back ASAP!..Wonder if I had developed Agoraphobia in a short time. I quickly grabbed anything in the list (my shopping list) that I saw and left Sogo. When i went out from the building, i just realized that i only got a pack of Mamy Poko diapers, three pairs of mitten and booties, three gowns size of 0-6 months, and....that's all..shoosh! None of it belong to me or anyone but baby Nuha's. I wanted to buy a new pair of shoes. The one that I have currently was bought one and half year ago. So, I turned back to see Bonia outlet which is situated just beside the main entrance, but its full of people too (mostly ladies and they even tried shoes on floor and some were squatting while trying 3-4 shoes with different colours)..how sad that I missed Bonia sales that only once in a year, but I just can't stand to stay long in that kind of situation and I don't know how ladies out there have extra energy when it comes to shopping. But mind you, Malaysia economy will just collapse without women! They do shopping not only during festives seasons, but its a monthly routine. Go back to my shopping hunt, for not going back with nothing new in hands to show to my mum, at last I went to Selayang Mall which only a stone throw away from my house to buy a pair of baju kurung and several scarfs. ;-)..bought nothing for my husband as he surely will celebrates Raya in his army uniform in island of no man and let him do his shopping when he came back end of September. He's sometimes choosy anyway.

On the other story, to my surprise, in the middle of crowd there were a lot of young parents brought their newborn babies too (some of them still smell like liqour) and I just prayed that those babies will stay well and healthy at least until the Raya or otherwise they will celebrate Raya in Paediatrics ward if the babies caught infections during the shopping spree. Reflecting back to myself, I only bring out my 3 month old baby Nuha for her immunization visits...heh! Poor Nuha, well just pray that your mummy will pass the Exit Exam this coming October and we can go for your first outing when you reached 5 months and of course it will not be in Sogo but in healthier environment...

Siput Babi Yang Confuse...

I was told by a lecturer an analogue of Siput Babi Yang Confuse until it become so slow in moving...it is confuse on why it being called as babi although it is a siput. That's true where in certain time we will become so slow especially when we are in a state of hesitancy. I can feel myself become very slow in doing things that I was unsure and unprepared. For example when presenting a case in front of the lecturer and in the middle of presentation I feel that it become more tougher because I was unsure about the case, the presentation and discussion will become so slow and ended up with failure. It is the same when i'm doing physical examination that I rarely practice it, everything will become so slow and unsystematic. Today, the story of Siput Babi Yang Confuse has reminded me that it is not easy to handle situation in a confusion and unsure state. To be a good doctor, I have to be sure on my knowledge and skills and learn it by heart so that the knowledge will sticked longer rather than just being stored in the short term memory pathway...When we are sure, we become confident and only then, we can perform well hence our presence is recognized by others like a sore thumb. Sticking out and counted!

Is That After One and Half Year? ...Serioussly?!!

The last time i updated this blog was about one and a half year ago July,14th, 2009...so many things happened in between from the small events in my life to the big events. Not to mention much about the small-small things like being in the Top 10 list of best student for Anaest posting where i'm receiving an original Palestine shawl from my professor, Prof Ikram (Deputy President of MERCY Malaysia) when he was just came back from medical/humanitarian mission from Gaza City. I still remember in that posting, I managed to intubate two paediatrics patients in the OT (prior Appendicectomy and Herniotomy) under Prof's supervision. The big event occurred in my life is that I've got married at the end of 4th year holiday on 25th September 2009 (Nikah) and 27th September 2009 (Sanding)...I knew my husband since our school day and he was my senior in secondary school. During that time, I was so naive to involve in puppy love. We were just a friend in the school cadet that we were active in those days. But, everything are in God's hand when we finished school and met in an interview for selection of army cadet officer in Kota Bharu, Kelantan somewhere around early 2003. He was already studying in a local university in Bachelor of Mechanical Engineering where he suddenly thinking about joining the military. Me at that time was just finished my SPM and also went for the same interview as I very much wanted to become an army doctor not knowing that the Military Academy (now National Defence University) was not offering Medicine course at that time. So we met and fall in love to each other (i can't remember the mechanism). As I wanted so much to study in medicine, my parent sent me to Ukraine for Pre-Medical Faculty (like foundation for Medicine) for one year. We (my husband and I) were still kept in touch although we were far. When MMC derecognized my University, I've decided to study in Malaysia after returned for summer holiday. I got mouth to mouth news that one new Medical college (my University, CUCMS) was having walk-in interview for their 1st batch, and I went for it and passed the interview and got an offer to further for MBBS programme. To cut it short, my husband and I decided to get engaged after he graduated from National Defence University ( Bachelor of Computer Science ) and he was posted to 3rd Royal Malay Regiment, Kota Kinabalu. I was in third year in CUCMS at that time. We then decided to get married early from schedule (initially was planned after my graduation), but I think I want to get married early after another big event occuring in my life when my father was diagnosed with Advanced Stage Prostate Cancer at the end of 3rd Year MBBS. I was so sad at that time and indeed i felt that it was a very difficult time for our family too. I wanted that my father being my 'wali' during 'nikah' and it was my dream to see my future husband to shake hand with father during the solemnization ceremony. I told my mum about the changes and it seems like both families agreed to proceed with our marriage and it took one year for the preparation of the wedding and I'm married in September, 2009 when I was 24 years old and my husband was 26. Soon after the marriage (about 8 weeks), I was announced pregnant of 6 week. The whole family was shocked and of course it was an unplanned but wanted pregnancy. I did my early U/sound to confirm and it is 6 weeks. The embryo was just 0.5cm i lenght at that time. The pregnancy went uneventful until at 28 weeks my obstetrician found that the Femur length of my baby is behind 2-3 weeks from the gestational age. At 32 weeks, she found out that my uterus was smaller that date and I was sent for detail scan. However, I was told that there was no obvious structural abnormalities and diagnosed of SGA has been made. Being a mother, my mum always care about me when at time I couldn't care less about myself except busy preparing for 2nd Professional Exam in Final Year. My mum contacted one of her friend to see me for antenatal check-up and she did Doppler of Umbilical artery and found to have resistance. Diagnosis of IUGR was made and I also had oligohydramnios at that time. At 37 week, I was induced (my request for trial of vaginal delivery) and delivered 1.95kg baby Girl on 4th June 2010. The super senior consultant (Dr Paramjothi) that handling my case said that this is one of the best/ successful case he had. He said that sometime God prooved him wrong (initially he suggested for me to opt for ELLSCS). However, the progress of labour was so fast after they put Prostin and I delivered after six hours after they augment with Pitocin. I wonder if I had a precipitated labour because not many primigravida like me will progress that fast! The story was not end there when my daughter developed several of apnoeic episode and has to be kept under observation for 12 days in NICU. Diagnosis of presumed sepsis was made and they did lumbar puncture on my daughter on the 3rd day of life to confirm the diagnosis but the result turned out to be negative finding. I'm who supposed to be discharged on the second day but decided to rooming-in with my baby in NICU for the next 12 days. There was when the physical and mental challenges as a young mother started. Experienced to live in the NICU made me learnt a lot of things especially on sacrifies. I've seen a mother who rooming-in for almost 3 months (her baby was born at 25 weeks with birth weight of 950gm) and have to wait until 1.8kg for discharge. I can't imagine staying in the small space in NICU for such a long duration and if it happened to me, it means that Bye-bye Medical School. I'm very grateful and yet He is the Most Merciful. After my daugther discharged from NICU at Day 13, i have to continue my posting in Internal Medicine as our University only allows 14 Days of Maternity Leave for student which is not happened in other medical school. (The uniqueness of my University). I have only to replace with Short semester to complete my Mock BHT and what not and I've done it. Currently, I am just finishing my 3rd rotation (Paediatrics posting) and another 6 weeks more for the coming Exit Exam..oh Allah ...Help me...and that's the story of what was happening to me in the one and a half of colourful year (April 2009-August, 2010) in my life. Now i'm grateful that my father is in remission state after hormonal therapy (Zoladex), i become a wife to Capt. Mohd Fahezal and a mother to Nuha Qaisara (now 2 months and 2 weeks old), and my parent will go for Hajj for the second time end of this year and my younger brother graduating in Bachelor of Law (LLB) and me graduating in MBBS inshaAllah...

D-day...on 27th September 2009


Abah & Mak


the sword crossing...


for the lecturers...


the cuppies......


outdoor...


Nuha Qaisara Day 2 of Life (born on 4th June 2010, two days after my birthday)


Nuha Qaisara Day 10 of Life


Nuha Qaisara Day 12 of Life


Nuha Qaisara Day 17 of life (Laughing to me and her father and she did it like 5mo old baby)


Nuha with her Granny


She was tiny and skinny


Nuha at 40 Days of Life (see how chubby she is)


Nuha at 40 days of life ..simply adorable


Nuha , 2 months 2 week old... (in her usual jovial mood)

What Dr_Shark say about PPSMI cancellation...

I oppose to teach maths n science in Bahasa Malaysia.

From my own experience, i feel it's easier to catch up maths and science in english.
In addition, it's really difficult to translate every wordings from English into Malay, and the translation might be wrong and not meaningful at all sometimes.
Besides, if primary and secondary school students learning maths and science in Bahasa Malaysia, they might find it super tough with this transition when they further their studies in universities which teach mostly in English. I didn't have any chance to study math and science in English during my school time. As a medical student, i think that this government's decision was sooo dissapointing.

Domestic Violence

It is defined as physical, sexual, or emotional harm inflicted by one party upon another in one unit of family. Violence against women and girls is the most common form of domestic violence and is major health and human rights issue. At least one in five women in the world has been sexually abused by a man or men in their lifetime.

Domestic violence has indirect effects on the society. It represents a drain on economic productive work force and generates a climate of fear and insecurity. Malaysia has enacted the Domestic violence Act in1994 to curb this problem. The objective of the Act is to provide legal protection in situations of domestic violence.

Domestic violence means commission of any the following act:

1. Placing a victim in fear or physical injury.
2. Causing physical injury.
3. Force to engage in any act, sexual, or otherwise.
4. Detain against the victims will.
5. Destruction to property, causing distress to victim.

What Is a Personality Disorder?

Those with psychological personality disorders have traits that cause them to feel and behave in socially distressing ways, typically resulting in discord and instability in many aspects of their lives. Depending on the specific disorder, these personalities are generally described in negative terms such as hostile, detached, needy, antisocial or obsessive.

While many other psychological disorders fluctuate in terms of symptom presence and intensity, as with normal personality, personality disorders typically remain relatively constant throughout life, although they do vary in severity from individual to individual.

Classification of Personality Disorders

According to the Diagnostic and Statistical Manual (DSM-IV-TR), the reference used to clinically define mental illnesses, there are ten different personality disorders categorized into three main groupings or clusters.

Cluster A: Odd or Eccentric Behaviors

Schizoid Personality Disorder

Individuals with schizoid personality are characteristically detached from social relationships and show a restricted range of expressed emotions. Those with SPD may be perceived by others as somber and aloof, and often are referred to as "loners."

Paranoid Personality Disorder

Those with this disorder are typically distrustful and suspicious of others. Although they are prone to unjustified angry or aggressive outbursts when they perceive others as disloyal or deceitful, those with PPD more often come across as emotionally “cold” or excessively serious.

Schizotypal Personality Disorder

This disorder is characterized both by a need for isolation as well as odd, outlandish, or paranoid beliefs. In social situations, they may show inappropriate reaction or not react at all, or they may talk to themselves.

Cluster B: Dramatic, Emotional, or Erratic Behavior

Antisocial Personality Disorder

APD is characterized by lack of empathy or conscience, a difficulty controlling impulses and manipulative behaviors. This disorder is sometimes also referred to as psychopathy or sociopathy, however, Antisocial Personality Disorder is the clinical terminology used for diagnosis.

Borderline Personality Disorder

This mental illness interferes with an individual’s ability to regulate emotion. The characteristic emotional instability results in dramatic and abrupt shifts in mood, impulsivity, poor self-image and tumultuous interpersonal relationships. Borderlines are highly sensitive to rejection, and fear of abandonment may result in frantic efforts to avoid being left alone, such a suicide threats and attempts.

Narcissistic Personality Disorder

NPD is characterized primarily by grandiosity, need for admiration, and lack of empathy. Narcissism occurs in a spectrum of severity, but the pathologically narcissistic tend to be extremely self-absorbed, intolerant of others’ perspectives, insensitive to others’ needs and indifferent to the effect of their own egocentric behavior.

Histrionic Personality Disorder

Individuals with this personality disorder exhibit a pervasive pattern of excessive emotionality and attempt to get attention in unusual ways, such as bizarre appearance or speech. With rapidly shifting, shallow emotions, histrionics can be extremely theatrical, and constantly need to be the center of attention.

Cluster C: Anxious, Fearful Behavior

Avoidant Personality Disorder

Those with avoidant personalities are often hypersensitive to rejection and unwilling to take social risks. Avoidants display a high level of social discomfort, timidity, fear of criticism, avoidance of activities that involve interpersonal contact.

Dependent Personality Disorder

People with dependent disorder typically exhibit a pattern of needy and submissive behavior, and rely on others to make decisions for them. Dependent personalities require excessive reassurance and advice, and are extremely sensitive to criticism or disapproval.

Obsessive-Compulsive Personality Disorder

Individuals with OCPD, also called Anankastic Personality Disorder, are so focused on order and perfection that their lack of flexibility interferes with productivity and efficiency. They can also be workaholics, preferring the control of working alone, as they are afraid that work completed by others will not be done correctly.

Aerosinusitis @ Barosinusitis

Aerosinusitis, also called barosinusitis, sinus squeeze or sinus barotrauma is a painful inflammation and sometimes bleeding of the membrane of the paranasal sinus cavities, normally the frontal sinus. It is caused by a difference in air pressures inside and outside the cavities. Most cases occur in Scuba divers and fliers, and are easily diagnosed when presented to physicians immediately after exposure. However, the problem may remain undiagnosed when the history fails to relate the symptoms to exposure to environmental pressure changes or if the focus is on other etiologies.

Typically, sinus barotrauma is preceded by an upper respiratory tract infection or allergy. The affected person suffers a sudden sharp facial pain or headache during descent, which increases as the aircraft approaches ground level. The pain can ultimately become disabling unless the ambient pressure is reversed.

The pressure difference causes the mucosal lining of the sinuses to become swollen and submucosal bleeding follows with further difficulties ventilating the sinus, especially if the orifices are involved. Ultimately fluid or blood will fill the space.

In most cases of sinus barotrauma, localized pain to the frontal area is the predominant symptom. This is due to pain originating from the frontal sinus, it being above the brow bones. Less common is pain referred to the temporal, occipital, or retrobulbar region. Epistaxis or serosaquineous secretion from the nose may occur. Neurological symptoms may affect the adjacent fifth cranial nerve and especially the infraorbital nerve.

Referred pain from barosinusitis to the maxilla consists about one-fifth of in-flight barodontalgia (i.e., pain in the oral cavity caused by barometric-pressure change) cases.

Although the environment of fighter pilots produces the most stressful barometric changes, commercial flying has changed the picture of the disease.

The pathology of sinus barotrauma is directly related to Boyle's law, which states that the volume of a gas is inversely proportional to the pressure on it, when temperature is constant (P1 × V1 = P2 × V2). Two types of acute barotrauma are observed: squeeze and reverse squeeze.

On ascent, the air in the paranasal sinuses will expand according to Boyle's law, contracting during descent. Normally, the sinuses drain into the nasal cavity through small ostia, which permit mucocilliary clearance and ventilation that equilibrates pressure. However, when the opening is obstructed due to inflammation, polyps, mucosal thickening, anatomical abnormalities, or other lesions, pressure equilibration is impossible. Squeeze is produced on descent when trapped air in the sinuses contracts and produces negative pressure. The pressure differentials are directed to the center of the sinuses producing mucosal edema, transudation, and mucosal-or submucosal-hematoma, leading to further occlusion of the sinus ostium. The sinus will fill with fluid or blood unless the pressure differential is neutralized.

If the outlet is blocked during ascent, the situation is reversed and "reverse squeeze" appears. Pressure inside the sinus increases, affecting the walls of the sinus and producing pain or epistaxis.

Epistaxis

Weissman defined three grades of sinus barotraumas according to symptomatology.

• Grade I includes cases with mild transient sinus discomfort without changes visible on X-ray.
• Grade II is characterized by severe pain for up to 24 h, with some mucosal thickening on X-ray.
• Patients with grade III have severe pain lasting for more than 24 h and X-ray shows severe mucosal thickening or opacification of the affected sinus; epistaxis or subsequent sinusitis may be observed.

The majority of episodes of sinus barotrauma occur in the frontal sinuses with pain localized over the frontal area. Possible explanations for this might be the relatively long and delicate nasofrontal duct that connects the narrow frontal recess with the frontal sinuses.

Barotrauma located in the maxillary, ethmoidal, or sphenoid sinuses is observed less frequently and appears when the ostia are blocked; the majority of cases are probably caused by an acute upper respiratory tract infection. The magnitude of the pressure difference needed to produce a barotrauma probably shows great individual variation and is related to the size of the sinus ostium and the rate of ambient pressure change. Due to this, even commercial flying may produce severe cases of barotraumas, although most of the cases are observed in high performance aircraft with lower pressurized cabins.

Paranasal Sinuses

Treatment:
1. Topical Decongestant
2. Pain killer
3. Surgery - Functional Endoscopic Sinus Surgery: to re-establish drainage and ventilation of the sinuses ( For Severe Cases )