Radiological Modalities

Hah!.. hari yg boring.. Christmas yg boring.. already two days attached to the radiology department. Feel like been into the dungeon. I'm tagged to the Angio Room..diz room is for the angiography procedure. Among the procedures done are fistuloplasty, image-guided stenting, ultrasound guided pleural tap, ultrasound guided biopsies, radiofrequency ablation (RFA).. and a lot more.

The fistuloplasty is actually to fix or repair the arteriovenous fistula in patient who their AVF was blocked due to thrombosis. This image-guided procedure done after the patient had sedated wif midazolam and fentanyl. It requires the administration of radiocontrast medium to see the blockage and after that a stent will be inserted to dilate back the fistula. There will be certain condition that will cause failure in this procedure such as vasospasm (due to irritation by the probe), and the blockade located not in the fistula but in the main branch of the blood vessels (usually the vein). If this procedure fails to repair the AVF, surgical intervention has to be carried out to create another fistula and by the mean time, patient will undergo haemodialisis via internal jugular vein catheter until the new fistula mature.

for RFA, this procedure is carried out as intervention to treat cancer cell usually in hepatocellular carcinoma. In this procedure, a needle will be inserted to the location of tumour cell ( via image guided ultrasound ). Then the cancer cell was killed by radiofrequencies or heat. One cycle will takes about 12 minutes. The heat will killed the lesion around 2-3 cm in diameters. However, if the lesion is too big, 99.7% ethanol will be administered to kill the peripheral area around the lesion.

I can't believe it, they did it in Selayang!.. and that the advance of today's medicine!

Non-academically,... today i planned for outing to KLCC.. movies maybe.. or jalan2 cari makan.. as usual, alone... Lame!.. ajak my several colleagues from UiTM, but they have usrah in Titiwangsa.. nak join.. tp tak ngam dgn geng usrah depa lak.. and ada some of them doctors in Selayang jugak.. kang dengan kehadiran anak pengarah ini takut lak depa nak mengutarakan isu2 semasa or ketidakpuashatian... huhu.. so.. go for movie!

Department of Ophtalmology - Elective

Maka tamatlah elective kami di Opthal Dept Hospital Selayang... Sungguh best department nih. Kami yg dtg dgn zero knowledge in ophtal secara tiba-tibanya tahu mcm2 lepas 3 weeks attachment kat sini. Thanks to Dr Mariam Ismail, Head Department of Ophtalmology & a National Consultant of Ophtalmologist (Vitreoretinal Surgeon), Dr Wan Zalina Mohamad Zain (Consultant Ophtal, Oculoplastic Surgeon), & Dr Nor Fariza Ngah (Consultant Ophtal, Medical Retina) and all doctors and staffs of this department.

Yang best sepanjang elektif kat sini:

1. Dr Mariam schedulekan 'must know thing' for us according like what they did for UiTM students before.
2. Dr-dr sangatlah baik, peramah, dan suka mengajar.
3. Dr Wan and Dr Fariza, who became our supervisor and research mentor adalah sangat kelakar giler, sweeeeet, very comited and suka mengajar. Kencang siap depa bg exam kat kami and ada hadiah lak tuh..Home Kit Vision Test.. tp Nadia dapt sbb exam dpt markah plg tinggi and Dr Wan bg sume orang key-chain yg dia bli kat Melaka, sooo sweeet...
   
4. Saya dah tahu guna slit-lamp & direct opthalmoscope & take photo fundus guna machine, guna ultrasound and do OCT, and measure IOP & baaaanyak lg...yeayy!
5. Dapat tgk kes2 best sbb Hosp. Selayang is a tertiary centre and the department itself is a National Eye Referral Centre.
6. Kami dpt collect data guna Diabetic Eye Registry yg amat menyenangkan kerja2 research kami on Diabetic Eye Complication.
   

me, Nadhila, Sabie, Ariff, Nadia,
Dr Fariza, slit lamp yg mahal (Nikon..haha), & Dr Wan

Nad, me, Nadia, Ariff & (Sabi tgh amik gambar)

so next week akan ke Department of Diagnostic & Imaging pulakk.. haha tak sabar nak blajo interpret x-ray, CT, MRI, U/sound, and sume2 tu.. hopefully depa baik2 gak cam org kat Ophtal tuh... then next next next week going to Padang, Indonesia... hmm..

Jubli Perak Alumni Doktor Perubatan Batch 83' UKM

Hello all.. Yesterday night (Friday 19/12/2008) I accompanied my mum to the alumni dinner in Kelab Tasik Putrajaya. This is the dinner for Medical graduates Batch of 1983 of University Kebangsaan Malaysia. The VVIP of this event was Vice Chansellor of UKM, Prof Datuk Dr Sharifah Hapsah Syed Hasan Shahabudin. This annually event was organized by Persatuan Doktor Perubatan UKM wif Persatuan Medic 83. We met my mum's tutorial-mate, groupmates, housemates... Among them was Dr Lo'Lo' Ghazali ( now is Member of Parliament of Titiwangsa from PAS ), Dr Salmah Mahamat, Prof Dr Muhaya ( UKM ), Dato' Dr Zainuddin Md Wazir (a cardiothoracic surgeon, the CEO of KOPISANG & Allianze College of Medical Sciences ), Datin Dr Hjh Zailan Dato' Adnan ( Ministry of Health ), Mej.Jen Datuk Dr Samiran Sarijan (Mindef), Mej. Jen Dato' Dr Abd Razak Yusoff (Mindef), Mej. Jen Dato' Dr Abdul Hasif Husin (Mindef), Datuk Dr Abd Jalil Jidon ( Plastic Surgeon, Ampang Puteri ), Prof Datuk Dr Lokman Saim ( Dean Medical Faculty UKM), Dr Abdullah Sani Mohamed ( ENT Surgeon UKM ) and some of familiar face who I dont know their name. Besides, i also met Prof Dr Hamid ( anatomist ) and his wife Prof Dr Khatiza ( physiologist ) who were my mum's lecturer in UKM. Prof Hamid also my visiting lecturer in Cyberjaya, he taught me Anatomy of the reproductive system when i was in 2nd year. And also Dr Elizabeth George (hematologist) and she also teach me in several topics in Haematology during 2nd year. I can't believe that i'm sharing the teachers with my mother. huh...

diriku yg da sleepy...


mak wif Dr Lo' Lo'

mak xbley bla dok depan skali wif Datin Dr Zailan

mak receive plaq from VC UKM ... most right Dato' Dr Zainuddin Wazir

mak and Prof Hamid & Prof Khatiza

mak & friends

Alternative Medicine

I dont know why i'm sooooo keen of this branch of Alternative Medicine that is 'Reflexology'!....I just came back from foot massaging in Time Square. It cost RM23.00 for 40 minutes massage.

As usual, my tukang urut is the 'akak indon' from Surabaya yg dah lama gila jd tukang urut kat Time Square nih.. dah 2 taun gi urut kaki ngan dia... N sangat best akak ni urut.. dia nih reti cakap Arab sbb penah keje kat Arab Saudi lama. So I learn to speak Arabic from her while she massaging me... Not only that, our conversation also touch on several political issues in South East Asia especially comparing Malaysia and Indonesia. Siap compare Sukarno dengan Suharto lagi. N also comparing Malaysian Education system wif Indonesian Education system which not emphasize English at all.

Dan kata la masa tgh urut tu i was screaming like mad when she using her knuckle to massage my sole. Huh...gile kau.. mcm rasa nak koyak kakikuuuu.. Then she was saying that maybe I have problem with my digestive system apparently my large colon.. My God! haha.. I was struggle to remember if I had any changes in bowel habit recently... tp mcm takde perasan pape pun.. And rasanya kaki ni teramatla sakit sbb asyik berdiri je kat clinic masa elective kat ophtalmology skang nih.. possible la kan dpt sakit kaki...

Lepas urut kaki, rasanya malam ni bolehlah diri ini tidur dengan bahagia... with some improvement in my lower limb blood circulation!.. daa...

Reflexology Foot Chart

Diabetic Retinopathy

Diabetic Retinopathy refers to retinal changes seen in patients with Diabetes Mellitus.
It is the leading cause of blindness worldwide.

Risk Factors includes;

1. Duration of diabetes
2. Sex in which female > males (4:3)
3. Poor metabolic control
4. Heredity
5. Pregnancy
6. Hypertension
7. Other; smoking, obesity, hyperlipidaemia.

DR is essentially a 'microangiopathy' affecting retinal precapillary arterioles, capillaries, & venules. The speculative pathogenesis is depicted in the flow-chart;

Vascular changes seen in DM

• thickening of capillary basement membrane
• capillary endothelial cell damage
• changes in RBCs
• increased stickiness of platelets
• loss of capillary pericytes

this loss of pericytes will causes loss of architecture of the micro vessels thus will cause,

Microvascular occlusion

which will then lead to,
Retinal Ischaemia
&
Capillary leakage
Microaneurysm
Haemorrage
Retinal oedema
Hard exudates
Arteiovenous shunt ( Intraretinal Microvascular Abnormalities - IRMA )
Neovascularization

Classification

Latest Classification of Diabetic Retinopathy are as follows;

1. Non Proliferative Diabetic Retinopathy (NPDR)
- Mild NPDR
- Moderate NPDR
- Severe NPDR & Very Severe NPDR

2. Proliferative Diabetic Retinopathy (PDR)
3. Diabetic Maculopathy
4. Advance Diabetic Eye Disease (ADED)

hmm.. i got this from Dr Fariza Ngah, Consultant Ophtalmologist (Medical Retinal Diseases) Hospital Selayang, during my attachment there. There's a lot of info from her slides actually, but i put this on first. Our research project during elective posting in Hospital Selayang is regarding Diabetic Eye Complications... and Diabetic Retinopathy is among the hot topic discussed nowadays. One of the consultant mentioned that the Diabetes is the most popular topic to be discussed and even the PTK questions (the competency test for government servant) also asked them on Diabetes.

I'm very grateful dat i have a chance to do elective posting in this department.
( Department of Ophtalmology Hospital Selayang, National Referral Centre of Ophtalmology).

Everybody...( including the Head of Department, Consultants, Specialists, PostGraduate Trainees, and Medical Officers) gather around 7.30am and do the ward rounds, or CME, or Case Presentations, and they finished it all around 8.45am. Then all of them going breakfast together and about 9.00am all of them go to the clinics or OT together gether...which I found it is sooooo harmonious working in this department. It seems to be less stressful and everybody enjoying their work and also teach each other (which i haven't seen in any of my clinical traning hospital before. They are not only helpful to each other, but also willing to teach us, the elective students whom they never know before.. Best kan?

lalala...

Hi.. i just came back from Batu Pahat my luvly hometown. It had been a loonnggg time travelled BP-KL with bus. This remind me several years back when I used to use this transportation BP-KL-IPOH, or BP-IPOH... when i was studying in Perak Matriculation college. It was in 2003... the year which i met back my Mr F which later become my fiance. I still remember that I & Tasha (my classmate in MRSM Muar & roommate in Matric Programme) travelled to Ipoh once in 2-3 months when we was studying there. We were used to travel wif Transnasional, KKKL, Sri Maju Sarata, Cepat Ekspres (which i hate most), and Hasry. At that time, ( 5 years ago ) the ticket BP-KL was just RM 13.50, but now is RM 20.30 which surprised me a lot.

Tasha is married now and working as engineer in KL while I still 'kehulu-kehilir' wif my medical textbook. See... how suffer medical students are. No wonder one of my dream now is to get married A.S.A.P. Huuuuu... Tp agak susahla skarang... my fiance is really busy wif his work and he has a lot of courses to go through as a young officer in an infantry unit... and I have to wait. Insyallah one more year to go...

and Mr Fiance latest appearance
wif baju yg rasanya mcm bukan baju dia


and Mr Fiance during Konvo in 2007

and us during mess night last year 2007 gak...

and his mess night diz year 2008..
wif muka yg mature sedikit
...and 'pingat' ape tah

and Mr Fiance in Lok Kawi Sabah (kekurusan sedikit)

Urggh am alone in Selayang rite now, parent and two sis in Malacca, two bro still in BP. I have to go back early for elective purposes, one week to go in Ophtalmology Department in Hospital Selayang, and continue in the Diagnostic & Imaging Department next week... One week break for data analysis and depart to Padang, Indonesia for my selective.

Btw, Congratulation to my mum who receiving A.M.N from YDP Agong in Istana Negara diz Thursday. Last year, my abah received the same 'pingat'.

and my abah and mak


n my family last Raya 1/10/2008
sis Sarah, Mak, Abah, sis Aisyah, bro Lokman, and & I and (bro Ariff wuz not in pic)

'Unfair' PC Fair...

yeay.. i went to the PC Fair yesterday... alone and 'lame' as usual. Wanted to browse DSLR Camera, Colour Laser Printer, and HSDPA modem actually but found it to be more expensive than usual. Last month i went to Lowyat Plaza and the Nikon D60 only RM1899 but sold at RM2k++ in da PC Fair which is very unfair. Ther a few of Colour Laser Printer with reasonable prize but i was dissapointed that none of it was from Samsung. Wanted Samsung CLP-300 Colour Laser Printer. this PC Fair is not really being 'fair' for a middle class people like me. The promoter urged me to buy a high-end laptop cost about RM4k++ which is totally unnecessary for me. However, for someone who loves tiny gadgets, theres loads of it sold at reasonable prize.. I saw 8gb pendrive sold at RM49. Ok la kan.

Today, i woke up early in the morning and drove my mum to Grand Season Hotel Jln Pahang for Malaysian Society for Quality in Health (MSQH) meeting which my mum is a Chairperson for this annually meeting. Then wif abah drove back to Selayang bought our 'brunch'. Today we're going back to Batu Pahat to collect the sister's school uniforms from our family tailor and also spend weekend in our lovely home there.

mahu ini... Nikon D80

Why 'shark' ?

I always using 'dr_shark' for my nickname. Many of my colleagues asked me why is 'shark'? Eventually it comes from an abbreaviation from my own name (created by myself ).

'dr' is doctor

s.h.a.r. is stands for

s ...........siti
h ..........hashimah
a ..........abd
r ..........rahman

n

k?

'kesihatan' or 'health'...

see...
its all about me and medicine... open with 'dr' and close wif 'health' ...
and of course its not that 'shark' animal that many had think off before.

So.. its 'dr_shark'

dr_shark is now blogging?

Assalamualaikum to all...

Today... 11th December 2008 at 1838H.. Entah kenapa setelah sekian lama minat fotografi saya berpindah pada blogging.. Life is about sharing.. so i think dat i wanna start sharing something wif people outside there.. kan? Dulu pernah terfikir for this.. tapi malas melebihi segalanya.. lebih suka baca blog orang n read their thought.. n learn from their experience. Mungkin tiba masanya saya berkongsi sesuatu kepada orang pulak.

So..saya sgt la berharap agar saya dpt mendisiplinkan diri untuk mengupdate blog ini sebilang masa... and semoga memberi manfaat kepada org lain juga. Thanks.