Kalau kamu sakit kepala

cuba try minum segelas 100plus campur dengan segelas air minuman biasa, kuantiti 1:1.
Sakit kepala biasanya kerana kandungan electrolytes dalam badan kita tak seimbang.
InshaAllah akan lega lah.

100 plus tu adalah sebagai contoh kepada minuman isotonik. Boleh je air apa-apa asalakan isotonik. Minuman isotonik ni kesannya adalah segera. Sebab bila kita minum, die masuk ke dalam perut tanpa apa-apa proses pencernaan dan terus ke usus kecil untuk diserap ke dalam darah dalam masa 5 minit. Hu, cepat kan? Dan kadar penyerapannya adalah 95%. Cepat dan berkesan.

Untuk diarrhoea, ia tidak sepatutnya diubati dengan ubatan komersial, gunakan 100 plus. Sama ada diminum terus atau dicampur air biasa dalam kuantiti 1:1 dengan frequent dose diberi kepada pesakit.

Untuk muscle cramp, ia disebabkan kekurangan garam atau air. Urut perlahan dengan cream panas, dan bagi minum 100 plus.

100 plus juga bagus untuk demam biasa, dan untuk demam denggi pun doktor akan cadangkan minum 100 plus banyak-banyak.

Jika di luar negara, isotonic drink ini termasuk dalam bekas first-aid mereka. Saya biasa minum 100 plus apabila saya berkerja kuat dengan maksud banyak menggerakkan badan dan berjalan. Saya hanya minum bila rasa sangat penat dan perlukan tenaga segera untuk kekal aktif meneruskan kerja-kerja seterusnya.

Biasanya sebotol kecil sudah lebih dari cukup bagi saya, but there's a time during I-QUEST 08 where I asked a friend to find me a bottle of 100 plus, but end up he gave me one large bottle and I manage to finish it within half an hour. Biasanya setengah jam itu untuk sebotol kecil. Mungkin sebab orang dah bagi botol besar, minum jelah tanpa sedar sebab sedang ralit dengan kerja-kerja.

Pesanan khas:

Jangan amalkan asyik amik panadol setiap kali rasa sakit. Panadol adalah pain killer, makin banyak kita ambil panadol, makin menurun kite punya daya tahan kepada kesakitan.

Sebagai contoh, wanita. Kalau yang muda-muda, dah biasa amalkan ambil panadol, later in life bila nak melahirkan bayi, bius biasa cenderung untuk tidak memberi sebarang kesan sebab badan dah penuh dengan panadol. Bila badan sudah terbiasa dengan pain killer, jadi kamu akan memerlukan bius yang lebih berbanding mereka-mereka yang jarang atau tidak mengambil panadol.

Panadol adalah toxic kepada badan, sekurang-kurang ia akan reside dalam badan selama 5 tahun. Ada je kes-kes di usia 30-an dah mula kena dialisis buah pinggang sebab kerap ambil panadol. Kalau di luar negara mereka memang ada ambil database pesakit yang medical history nye begini.

This is my tips for you, to increase your endurance level towards pain. Ini kesakitan yang membuatkan anda cenderung ambil panadol, paracetamol dan adik beradik die.

Ini berdasarkan pengalaman sendiri, walau bagaimanapun ia bergantung kepada setiap individu.
Bila rasa sakit, cuba untuk bertahan. Terutama sakit-sakit biasa. Macam pening kepala, migrain, menstrual pain dan sebagainya. Jika tidak tahan, berbaring lah dan tidur. Owh petua ini tidak berkesan untuk saya, saya sukar tidur! :D

Jadi biasanya saya akan buat kerja-kerja yang akan alihkan tumpuan saya kepada kesakitan seperti designing, berjalan-jalan, angkat barang, kerja persatuan dsb. Saya akan cuba untuk sibukkan diri.

Owh jika cuba untuk revise pada waktu sebegini, memang langsung tidak menjadi kerana fokus anda telah teralih kepada kesakitan. Jadi buatlah kerja-kerja lain yang kamu rasa patut dan okay, terutama sekali non-academic of course.

Jika mahu lakuan sesuatu kepada kesakitan, cuba gunakan home remedy seperti urutan, hot cream, ice bag dan sebagainya pada tempat sakit. Minum 100 plus untuk sakit yang berkaitan juga boleh seperti yang dinyatakan awal tadi.

Jika kamu berada di tahap sakit sangat-sangat sakit, bolehlah ambil ubatan yang di bawah kategori NSAID (non steroidal anti inflammatory drug). Contoh macam sakit gigi, menstrual pain, joint pain dan sebagainya. Antara contoh NSAID adalah synflex dan arcoxia.

Boleh ambil ubat di farmasi sahaja atau dengan preskripsi doktor. Sesetengah farmasi yang well known seperti Watson dan Guardian, mereka agak restrict pada pemberian ubat ini dan memerlukan preskripsi dari doktor. Jika di farmasi biasa mereka biasanya akan bagi sahaja jika kita minta ubat-ubatan ini.

Perlu diingatkan, lebih baik jika kamu mendapatkan konsultasi daripada ahli farmasi di farmasi tersebut atau padangan doktor sendiri melainkan jika kamu memang sudah biasa dengan jenis-jenis ubat. NSAID bukan untuk diambil sesuka hati, tetapi HANYA apabila terlampau sakit sahaja dan biasanya HANYA sebiji sehari untuk beberapa hari cuma. Pengambilan ubat over the counter ini sepatutnya perlu handle with care untuk mengelakkan salah guna atau overdose.

Untuk migraine, rasanya ini paling common dalam masyarakat. Migraine setakat ini yang saya jumpa, cafergot dapat membantu. Ia agak unik, kerana fungsinya adalah mengelakkan sakit kepala dan bukan mengubati sakit kepala yang sedia ada. Jadi ia dimakan tika terasa seperti hendak sakit kepala. Jika sudah migraine teruk dan baru hendak ambil cafergot, harap maaf lah jawapannya.

Saya tidak cadangkan kamu ambil cafergot, tapi saya pinta kamu minta konsultasi doktor, ubat apa yang sesuai untuk migraine kamu. Penerangan di atas sekadar untuk kamu faham bagaimana biasanya ubat migraine berfungsi. Kerana ramai yang berfikir ubat migraine tidak berkesan, sedangkan mereka ambil ubat itu tika sakit sudah kuat. Ramai doktor yang tidak berpesan kepada pesakit tentang pengambilan ubat yang betul bagi sesetengah ubat. Dan ramai juga pesakit yang teringatkan ubat ini hanya apabila kesakitan sudah tahap teruk.

Untuk diri saya sendiri, saya lebih memilih untuk bertahan dengan kesakitan daripada mengambil ubat. Jadi semakin hari daya tahan diri saya pada kesakitan semakin meningkat. Jika saya sakit kepala atau migraine, saya rasa ia perkara biasa. Seperti sudah immune. Saya masih boleh teruskan aktiviti harian.

Mungkin kerana itu, 2-3 jam selepas prosedur mengambil air tulang belakang (lumbar puncture) sebelum ini, saya sudah minta untuk keluar ward dan malamnya saya terus boleh hadiri majlis. Mungkin kerana itu juga saya tidak minta ubat tahan sakit selepas surgery. Mungkin kerana itu saya masih boleh teruskan pelbagai aktiviti lain ketika sakit kuat, kecuali untuk ulangkaji pelajaran, ia agak terganggu. Boleh je, tapi hanya sekadarnya itupun selepas pemaksaan diri dan kekejaman tahap tinggi.

Pesanan penaja untuk hari ini, hargai hidup anda, fikir dulu sebelum kerap amalkan pengambilan panadol/paracetamol yang sangat familiar dengan kehidupan seharian kita itu. Cuba untuk bertahan, lama-kelamaan akan jadi 'alah bisa tegal biasa'. Malaysia boleh!


Cekgu yang memberi pengesahan:
1. Ganong, WF Review of Medical Physiology, 13th ed. Norwalk, CT Appleton & Lange, 1987.
2. Journal of Pharmaceutical Sciences
3. www.myhealth.gov.my
4. banyak banyak lagi tak larat nak state :D

amaran: Entry ini lebih merujuk kepada golongan remaja dan young adult. Ia hanyalah pandangan daripada pengalaman sendiri dan pembacaan lebih 6 tahun. Bukan sebagai seorang yang ahli dalam bidang ini. Sila dapatkan pengesahan pakar-pakar tentang entri ini :)

update:
Ada sesetengah orang allergy kepada paracetamol/panadol, NSAID dan aspirin. Ini sikit sekadar apa yang saya tahu. Tak silap saya, allergy jenis ini hanya akan tahu bila mereka consume ubatan ni. Sebab itu sesetengah parents yang mengetahui, tidak akan langsung benarkan anak mereka mengambil ubatan ini. Jadi, untuk mengelakkan shock or further adverse reaction, rawatan segera haruslah diberikan apabila munculnya tanda-tanda allergy seperti kemerahan pada kulit, gatal-gatal pada mata hidung tekak, conjunctivitis etc2.

Owh jika mahu tahu lanjut saya perlu buat entri lain. Ada beberapa lagi ubatan/chemical drug yang saya belajar boleh membawa kepada allergy reaction. Ini pun perlu masuk entri lain :D

p/s: hopefully somebody would correct me if ade salah info memana. Nak tambah info pun boleh. tq.

I was trying to make an ordinary miracle

warning: follow up from here, beware, it's going to be a long entry. This entry has a lot of hidden pictures, please click the link I give for clear understanding on my words.


Thanks for your concern and everyone is curious on my sickness. I've told you about the pain here but not the diagnosis.
It is a series of sicknesses. If doctors say when they ask about my medical history,

"banyaknya sakit awak ni..isk3..macam-macam ye.."

Then I would like to tell them,

"saya pun bosan nak cerita, tapi doctor tanya sangat."

Heh, dalam hati je lah. A doctor should not say that way. You're actually depressing the patient.

To recall back a doctor I met last April in my journey to settle down one of the sicknesses I have, he asked about my medical history using these words,

" I know many doctors have asked you about this, and surely dah bosan kan bercerita, but could you please share it with me this time?"

Yes, to have the empathy. To put yourself in the patient's shoes. Full stop.

note: alhamdulillah, that sickness have been eliminated from my life. It is now not as severe as before. - Brain-CSF related problem.

note: Gov hosp.

***********

note: Private hosp.

Then I continue my journey to heal another terrible pain. I was waiting for 2 years for this surgery in government hosp, but my doctor told me there's no need for any surgery and there's so much restriction from the University. Thus, I went to seek consultation in private hosp. during the examination period as it seems to be worsen. And there I learn new term, "shopping doctor".

For my surgery this time, my physician is not just a good doctor, but also generous :D
Dirinya dilengkapi dengan sikap-sikap doktor yang merawat pesakit jasad dan ruhani, and not money-oriented. *Glad

I've had an arthroscopy surgery for Left knee, a diagnostic and therapeutic surgery. The main aim is to repair the meniscus tear and remove the plicae if the need arise. But when I look at the MRI film, actually I cannot locate where's exactly the tear located. And I confirmed my view when the doctor said the same.

One thing in our mind, it is something wrong with the meniscus. No other things (but I don't know if my doctor hide it). Thus, the surgery is aiming to totally remove the terrible pain I've had for few years.

I was relief it would be that way, and for me it's such a miracle, an ordinary miracle. My life without terrible pain at the knee, as when it's in pain, it's not only the pain at the knee, but associated with terrible pain at the ankle and half of the body. I think it's because of the nerve relation.

Usually, I cannot walk normally, I cannot go to class many times, I cannot focus for revision etc2. I'm so much in love with sport activities, but the pain stops me to be so vigorous in it. Even how tough you try to bear with the sickness, but still somehow it would at least affect your daily activities, especially academic.

That's the key point why sick people get depress. The pain is one thing, but the things that affected by the pain, that's much more painful. Trust me. Read here, for further understanding how pain affect daily activities.

The surgery was done last week. Two hours after surgery, the surgeon came in.

"Nothing wrong with the meniscus, but we found a defect on the cartilage, it is very severe."

Doktor sambung lagi
"Very rare. It's laterally, and at a young age like you. We've shaved the defect, but I'm sorry, the pain is still there, but reduced."

Lagi,
"Rasanya this is due to repeated direct impact trauma. We'll administer medications to slow the progression of the defect later on in your life. It's a lifetime pain, please slow down (baca: stop) all heavy activities-not to give extra harm to your injury, ok? You might have another surgery, but later on in your life."

Aku rasa macam ada halilintar sekejap lalu, kalaulah boleh buat efek terkejut macam drama seberang :D tapi muka aku maintain relax ah, kan aku pelakon pentas dunia (:
kebahagiaan hidup kena tarik, sedey gila senanye..orang yang tak suka sport tak faham ah, heh. (no offense ah)

First, I thought I could really do the ordinary miracle, I wanted to live without pain at my knee (knee je dulu sebab pain dekat body parts laen belum pegi heal-kan). It is normal for having no pain, but being able to live normally is a miracle to me. Everyday everytime, the pain is there, not only the knee, but also other parts as I mentioned here.

Second, lain yang diharapkan, lain yang terjadi. Seperti yang telah aku nyatakan di atas. Dan jalanan masih jauh, banyak lagi aku nak guna kaki ni. Pheww..

Third, daripada 3 hari restriction berjalan, dah jadi 3 minggu takleh jalan, depend on crutches and wheelchair untl now. Jatuh, rebah tersungkur, perkara biasa untuk 4-5 hari ini :)

Fourth, daripada sepatutnya tak banyak ubat, jadi bertimbun dalam sehari. Hu, rasa nak muntah pun ada :D one of the medication require me to reduce glucose intake in food, haih..

Fifth...(wei ape gunanya kita duduk mengira segala ketidak-bahagiaan diri). Mari, positifkan minda, legakan hati.

ok, mula.

All this while I've been living with the pain, why couldn't I bear with them for the rest of life. Mungkin aku terfikir dengan usia aku sekarang, jalanan kehidupan aku masih jauh. Banyak lagi nak guna kaki neh. Dan banyak lagi aktiviti yang tak boleh terganggu dengan kesakitan ni. Tapi, dunia ni hanya sementara, entah esok lusa aku dijemput pergi. We never know.

Kita merancang, tapi Allah terlebih dahulu merancang untuk kita. Kita hanya boleh berusaha sebaik mungkin, selebihnya Tuhan yang menentukan kesudahannya. Aku terfikir mungkin semasa pembedahan, doktor sendiri rasa serba salah bila tengok something else rupanya, but they also tried to give the best for the patient's QOL (quality of life). I believe in that.

Aku cukup bernasib baik Tuhan tak bagi ujian lumpuh seluruh badan dan sebagainya. Sekadar defect sebelah kaki, aku dah sangat2 bernasib baik. Aku bersyukur, Tuhan. Cuma ada masa aku agak down. Tika dan saat itu Tuhan, aku harap aku tak menyimpang dari landasanMu. Patients will go back and forth, sometimes the mind is stable, sometimes not, due to the pain, That's normal. Subject Patient Care dan subjek Health Communication banyak membantu aku faham keadaan diri aku. Haha.

To think of what you cannot do is painful, but to think of what you could do is great! Actually there're a lot more awaiting you. Right now, to take care of the remaining ni'mah is essential, aite? Sama jugak bila kita lost one of our family members, hargai sebaiknya mereka yang masih di sisi kita, dan jangan terlalu meratap sayu insan yang dah pergi. Kenangan tetap kekal, sedih itu pasti. Live on your life for people around you.

Tiba-tiba teringat lak..in remembrance of Mak.. -_-"

Kau tahu tak ape aku tengah fikirkan sekarang? Aku rasa aku tengah deviate gila daripada main point sekarang. Haha.

Two days after surgery I try to recall back the so-called repeated direct impact trauma. Yes, sume daripada sukan. Dan satu jugak sebab eksiden tercampak ke jalan dulu. I guess somehow ia menyumbang suara pada hal ini.

Other possible reason, my ankle (distal end fibula tibia) separated 1 cm from its origin, the image is somehow like here, it should be held close together by the ligament. I always fall down due to the condition and as always, my knee will kiss the ground first ;)
Sebab knee begitu sejak 7 tahun lepas, thus I've been living with this since a year ago..

ankle brace

23 hours at my ankle for the first 5 months, irritating. The next 7 months, rarely been used. If you knock it, the sound is like you knock the door ;) I cannot wear sandals and shoes if I wear this, and only scholl won't give harm to the leg, haih..

Bila berjalan, teman suka usik,
"kaki as saje dah beratus, ankle brace beratus, slipper beratus..nak rompak ah kaki as..haha."
Teman, aku sabar jelah. Haih. Bukan aku pinta segala susah nih, aku suka bata lebih daripada yang len. Aku rasa korang leh try pakai brace tu tengok apa rasa, nak cuba? :P
Heh, aku tau korang maen2 je :D

Tulah yang aku rasa penyebabnye. People will always find the reasons for things that happen, either as hikmah or as real reason. The real reason will help others not to fall on the same condition, while hikmah will always help us to feel better and be grateful to Allah. Pendek kata, supaya rasa redha lah. Haha, sounds easy aite? Huu..

To slow the progression and to ease the pain throughout life, I will be dependent on injections, medications, physiotherapy and most crucial part, no heavy activities. Yeah!
Ok, nampaknya aku kena sabar (erk..sabar? :D )

I was trying to make an ordinary miracle, but it doesn't happen, maybe God wants me to stay...

note: terima kasih atas kesabaran membaca sampai sini. Moga ada nilai2 berguna.

Radiotherapy, kenapa kena buat berulang kali II

Pape hal, sila baca sini dulu
--> Radiotherapy, my perspective I

ok sambung dalam bahasa layman, supaya semua umat sejagat di negara2 berbahasa melayu faham, barulah bermakna sket ilmu. Pasal pasal pape pun, biasanya website English yang lebih informatif dan selesa baca. Haih.

layman = To put something in layman’s terms is to describe a complex or technical issue using words and terms that the average individual (someone without professional training in the subject area) can understand, so that they may comprehend the issue to some degree.

susah jugak nak susun kata jadi bahasa camni, lebey senang mengarang dalam exam, guna bahasa sains. heh~

-----------------------------------------------

ok, kenapa pesakit kanser yang menerima rawatan radiotherapy perlu datang berulang kali. Banyak pendapat berdasarkan bidang masing-masing dan di sini hanya diterangkan salah satu daripada sebab-sebab tersebut. Sebab ni je yang dipelajari selaku bukan pelajar perubatan, iaitu kaitan radiotherapy dan reoxygenation.

Reference: Eric J Hall (2000), Radiobiology for the Radiologist

Radiotherapy biasanya menggunakan radiation sama ada sinar X atau sinar gamma. Ada jugak sekarang dipanggil neutron radiotherapy, sebab bagi kesan yang lebih pada cancer cells. Maka side effects die lebih severe daripada conventional radiotherapy.

Untuk radiation memusnahkan human cells, oksigen mesti presence pada cells. Bila ada oksigen, barulah semua reactions boleh berlaku yang akhirnya membebaskan free radicals untuk memusnahkan cells.

Bila kepekatan oksigen meningkat, maka makin sensitif cells pada sinar radiasi. Ada patient, cancer cells die jenis yang memang macam takde langsung kepekatan oksigen (hypoxic cells), ini yang menyebabkan radiotherapy susah nak jadi efektif. Bila dah macam ni kita akan gunakan neutron radiotherapy.

figure1: reoxygenation

Gambar rajah kat atas ni, bulatan yang atas sekali belah kiri menunjukkan tumour cell yang mempunyai bahagian ber-oksigen (aerated --> gray) dan takde oksigen (hypoxic--> black). Lepas radiotherapy, aerated area akan musnah dan tinggal hypoxic area je yang seterusnya akan melalui proses reoxygenation (proses bg hypoxic cells untuk menghasilkan aerated area ada semula).

Untuk cell ade oksigen semula, kita akan mintak die balik dulu then datang semula pada tempoh masa tertentu. Proses tu akan berulang-ulang sampailah tumour cells terhapus sepenuhnya. Sebab tulah kena banyak kali buat radiotherapy, tak jadi pape jika buat sekali dua je. Faham takat tu?

Jadi, macam mana kita nak pastikan cell tu da ada oksigen semula?

Untuk sesetengah patient, kita akan implant-kan sejenis electrode kat tumour area untuk measure oxygen concentration. Ini digunakan sebelum rawatan. Tapi, hypoxic cells ni kadang2 jadi indikasi yang tumour tu makin aggresive sebenanrya. -_-"

Status oksigen dalam tumour cells, die tak static sentiasa berubah-ubah. Ada sesetengah tumour cells proses reoxygenation ni berlaku dengan rapid, dan ada yang tak. Jadi mereka simpulkan patient yang tak terkesan dengan rawatan radiotherapy adalah patient yang tumour cell-nya tak rapidly undergo reoxygenation.

ok, skang da faham kan kenapa kena berulang kali jalani rawatan radiotherapy daripada perspektif ni.

Macam mana pulak dengan side effect radiotherapy memandangkan sinar radiasi ni die bukan tau mana satu tumour cells mana satu normal cells. Die tibai je musnahkan semua sekali. Yang ni ada rumour mengatakan normal cell boleh repair semula tapi tumour cell takleh repair diri die, jadi sebab tu tak teruk kesan die pada manusia.

Tapi takpe, jangan berpegang lagi yang tu. Di lain siaran akan dikongsi pulak camane oncologist a.k.a therapeutic radiographer atasi masalah ni bersama-sama dengan doctor dan pharmacist. :D

------------------------------------------

Remember: Bukan semua benda doktor tahu, bukan semua benda pharmacist tahu dan seterusnya. Ia bergantung pada bidang masing-masing. Bila dah klasifikasikan betul-betul, kita akan nampak betapa limit-nya kerja-kerja doktor sebenarnya sebab sama level dengan doktor ada ramai healthcare personnel yang arif bidang masing-masing.

Nilah yang dipraktikkan di private hospitals. Masa nilah akan nampak indahnya teamwork dalam healthcare team jika semua kerja diberi pada yang berhak, yang lebih mengetahui bidang masing-masing. Sebab tu cam agak hampeh tengok citer house MD. Semua benda doktor buat dan sangat tak logik :D Jadi kalau macam tu, ape gunanya ada pegawai biomedic, biotech, radiographers etc..

Dalam House MD, apa yang healthcare personnel yang lain belajar selama 4 tahun semua doktor boleh buat, macam termasuk sekali 4 tahun tu dalam 5 tahun pembelajaran mereka, itu satu mind-setting yang tak bagus diserapkan oleh media kepada masyarakat yang memandang semua benda doktor je lebih tahu. Kat Malaysia ni jika klasifikasikan betul-betul bidang kerja dalam KKM (kementerian kesihatan Msia), takdelah penat sangat semua benda doktor kena buat. Aite?

Kat hospital kerajaan masih belum wujud jawatan radiographer U41 sebab my course pun KKM belum approve which means, I cannot work in government hospital yet. So do our seniors yang newly grad last April. They are all over Malaysia working in private sectors, be it as a lecturer in private colleges or radiographers in private hospitals. I'm looking forward for the accreditation from JPA (:

ok, jumpa lagi lain siaran pada waktu dan hari yang berlainan, tempat tetap sama ok!

yang benar,
penyampai radioIIUM.fm :D

MH series 0007

The part which I like most for this clinical posting is the ‘morning prayer’ or the ‘morning gathering’. Every day at 8am all staffs including intern students will have a halaqah for morning gathering. It started with a prayer which could be divided into three parts; the first part: showing our thankfulness for His blessings, second part: ask Allah to help us to give out our best for the service and lastly: prayer for our patients to be tough, enduring and to get well soon.

The prayer is quite long, but meaningful, more towards the hope to see the patients making a full recovery from their sickness. I do think that it could be better if; one, make up the gathering 10 minutes before 8am, thus everyone can start the service exactly on 8am. Two, if they make the prayer to be heard through the speakers all over the hospital, hence, everyone including the patients could say ‘ameen’ together with us.

Another interesting part is the CME (Continuous Medical Education) which been held every Wednesday (hospital’s CME) and every Thursday (department’s CME-in every dept.). As far as what I observe, the hospital’s CME is focusing more towards current issues and also rare cases while Radiology Department’s CME is more into bringing up the concern among staffs regarding current problems and things which could be improved.

I did not know whether these been practice in any other hospitals, but I do find them very interesting and great enough for all staffs. To know on this, surely I need to travel here and there other than asking others for their experience. As what stated in Qur’anul kareem in Surah At-Taubah verse 122;

فلو لا نفر من كل فرقة منهم طائفة ليتفقهوا في الدين ولينذروا قومهم اذا رجعوا اليهم لعلهم يحذرون

And it is not for the believers to go forth all at once. For there should separate from every division of them a group to obtain understanding in the religion and warn their people when they return to them that they might be cautious.

Wallahu'alam

MH series 0005

Edited series

It was something to be shared, I got this from my blog’s comment form, for the entry ‘MH series 0003’ and I would like to add up something. Here it goes, from dinousar :)

the CT Scan machine

“totally agree :) I went for nose scanning-CT Scan. the procedure require patient to swallow 10 tabs corticosteroid, 12hrs b4 and 12 hrs after for patient having history of allergy. prophylaxis of corticosteroids only needed for scanning procedures which need contrast. Based on my experience, I know CT scan for nose didn't need contrast. Having background of pharmacy, I don’t want to experience unnecessary adverse effect of corticosteroids so I lied about my history and successfully avoid the unnecessary procedure. :) “

1) Prophylaxis = an advance guard or a measure taken for the prevention of a disease or condition.

2) Corticosteroid = have great potential in the treatment of a variety of conditions, from rashes to lupus to asthma. But corticosteroids also carry a risk of side effects. It was use to avoid allergy reaction due to the usage of contrast media on patient with history of allergy. Prednisolone also could be use.

Alhamdulillah this patient has the background knowledge. Corticosteroid only should be given to patient with history of allergy, itupun if there's a usage of contrast media during the CT scanning. If it is just a plain CT, the need for corticosteroid is not arise. Corticosteroid will give side effects, thus if it is not necessary, please don't give extra harm to patients.

Wallahu'alam..

Malaysian hospital series 0004

Series 0004: Code of ethics for radiographers

Hari ini temani dia ke klinik. Sakit pada tapak kaki katanya.
Doktor minta lakukan x-ray, jadi temani dia jalani foot x-ray.

Kemudian kami menunggu untuk dipanggil kembali berjumpa doktor selepas radiograph siap diproses.

Selepas beberapa ketika, radiographer tersebut hendak menyerahkan radiograph (x-ray film) kepada doktor, tetapi kebetulan melalui kami. Apabila terpandang dia, radiographer tersebut terus menyapa dia.

"Tengok ni, ada benda tajam kat kaki." Katanya. "Sebab tulah rasa sakit...bla bla bla.." Dan dia masih meneruskan kata-kata.

Saya yang sedang ralit membaca terus teringatkan sesuatu patologi yang pernah dipelajari di kelas. 'Calcaneal Spur!'
Dan serentak itu saya mengangkat kepala melihat film tersebut.




'Betullah calcaneal spur. Tak sangka..' Hati saya berbicara lagi.

Setelah radiographer itu berlalu pergi, dia bertanya beberapa perkara kepada saya berikutan kata-kata radiographer tersebut. Saya menjelaskan serba sedikit sahaja.

Calcaneal spur ataupun flower horn (ini panggilan oleh para doktor), lebih kurang boleh dikatakan cangkuk yang terbentuk daripada tulang (read: hook of bone). Biasanya terbentuk di tulang tumit (read: calcaneus).

[note: I have to continue in English, it's hard to explain in Malay..]

This kind of heel spur is not the primary caused of the pain. It is due to the irritation to the soft tissues (read: fascia) when the spur pressed on them. Thus, the pain occured when the patient is in prolonged standing or walking. This condition also get worsen every morning after sleep, when they tried to have the first step on the day.

If you wanted to know why and further infos, you can always google them, aite?

Back to the main topic, the radiographer is actually not following the code of ethics even though he has a good intention (read: ni'at baik).

In Malaysia, the KKM (read: Ministry of Health Msia) has set up a list of ethics for radiographers (read: grade U41 and below, above than that, I am not sure). One of them is the radiographer could not deliver any information or suggestion, diagnosed from the film to the patients. The word suggestion here is in the term of bahasa isyarat dan yang sama waktu maghrib dengannya. Heh, I'm just kidding.

In other countries, those radiographers have the right to do the report for each film, being at the same level as radiologists (read: Radiologist is a medical practitioner who makes a speciality in radiology). It is only in Malaysia where radiographer could not say anything. It is going to be hard if the patients are our family members.

Thus, I do think the KKM should revise back on this issue for the U41 radiographers (read: Ni level degree holder). Because they have the knowledge on the pathology, and tell you what, in Msia, most of the radiographers are better than doctors in analyzing a radiograph. This is what happened in real life.

Why did I say that? Before giving evidence, I would like to give a logical reasoning on this matter. Radiographers saw various films every day, reaching hundreds every week (read: for GH etc usually in the range of 800 every week). They really could differentiate between a normal and abnormal anatomy shown on the radiograph as they have diagnosed many of them every day. Practise makes better, isn’t it?

A case for example; a patient complained on having pain and being x-rayed. The doctor looked up on the film and said everything is normal. Luckily, her brother who accompany her is a radiographer and found a fracture on the film. He quickly went back to the doctor, and show up the fracture. And the doctor admit that she missed it.

The patient might be going home and suffer if the fracture was not found. And the doctor is actually almost giving harm to her. This is where the importance of team work. I mean, the doctor can easily ask for other doctors’ opinions to avoid this, just for reassurance that everything is alright.


I am not understood why the KKM has set up the limit. Looking at the condition in Malaysian hospitals, many radiographers who have talents and knowledge were not treated so just because they are not radiologists. For example, ultrasound scanning could only be performed by radiologist, even though radiographers also have the specific skills on the machine. Hey, we know how to handle the probe. =P

For this issue, it is like an ‘adat’ (read: tradition) for this to happen. Radiographers’ knowledge, skills and status is lower than radiologist, one tradition. Ultrasound is only to be performed by radiologists, one tradition. Means, we do learn and practise on this in our university, but the knowledge is nowhere to be applied in working place as they won’t allow us to. Thus, takyah ar susah2 blaja kalo da memang hanya jadi hak radiologists ;p (read: takpe, additional knowledge)
Hey you, the future health practitioner to be will change this environment, inshaAllah.

We have once being practise in a condition where we do scanning for our cousin who admitted to A&E due to trauma (read: accident). The film showed a bleeding inside the brain. The real challenge began after the scanning where the family members asked us what is the condition. Sedangkan kod etika cakap kami takleh bitau pape.

The lecturer being as the family member, and ask us one by one. Really, buntu fikir the best answer. Nak bitau hal sebenar, langgar etika. Nak cakap tatau, takkanlah tatau. One more thing, our lecturer akan bidas balik our answer as a view from a family member. So, when I were asked what will I do, I said,

"Sir, I wont do the scanning, I will pass the job to Najwa." Pointing to a friend besides me.

"So, you are escaping, huh? Means that, in the future you have to be in the same hospital with her." He said.

Heh, dah kena balik. The easiest solution is, work at the place where you have no relatives there. Hehe.

note: Bila sampai turn najwa untuk jawab soklan sir, she said,
"If it were my relatives, then, I will pass the job to Hasanah!" Hoho, macam tu eh. :)

For this issue, remember, ni'at tidak menghalalkan cara. Tapi pandai-pandai jelah. Bila da masuk bab ni, susah jugak, tapi pasti ada cara. Just avoid where you can, and deal secara saksama where you cannot avoid. Applicable for all issues in life. InshaAllah.

wallahu'alam.

Malaysian hospital series 0003

Series 0003: The contrast injection and the CT scanning

Below is probably stories to be shared for radiographers to be, nurses to be and radiologists to be. Edited series.

Last few months, I went for CT (computed tomography) scanning for brain once again. Plain and with contrast. Plain means usual examination using high dose radiation while contrast means they use contrast to enhance the region for interest (i.e. brain), with CT as the imaging modality. I won’t mind about the scanning but I am worried if there’s a usage of contrast.

Like what I expected to be, they do extra harm to me (which they could avoid). I was there around 10.30am giving the CT examination form. Then asked to go to the treatment room and I know they will insert in a needle for the contrast and leave the needle there until the procedure was done for about 20 minutes.
“Adik, kat mana senang sikit nak masuk jarum ni?”


The nurse asked me, if I’m a first timer surely I won’t know which one is better. I showed up my left hand. She refused, she wanted the right hand. I showed up my right hand which already been paste with cotton.

“Owh, amik darah ke tadi tangan kanan ni?” The nurse asked again and I just nodded my head. That is why I showed up left hand. Isk3..

“Senang tak tangan kiri ni ye?”

“InshaAllah, biasa senang je tangan ni.” I said.

Then I pointed my finger to the blood vessel, it is obviously seen. When she was about to insert the contrast needle, I reconfirmed with her because she was like teragak-agak.

The needle goes in and I know something wrong, because she pointed at the wrong insertion eventhough the vessel could be seen clearly. It was not going into the blood vessel at all. Oh my, painful. For your information, needle for contrast media is bigger than usual needle which u seen.

“Alamak, silap la dik.” She looked at me, and I just relaxed looking at her. “Sakit tak ni?”

“Tak.”

Yelah, kalau bitau kita sakit lagilah dia cuak buat. The most unaccepted part is when she pointed the needle (which is already in my hand), finding the blood vessel. She moves the needle here and there, to the right and to the left, pointing it deeper and deeper till she reached the vessel. It was very much painful.

“Sakit tak ni?” She asked again. I just keep in silence. No words. Ni belum insert contrast lagi. I said in my heart, because the blood dah membuak-buak keluar. A simple procedure yet so painful, it should be not.


I then waited outside, till they called out my name. With the needle in my hand, maybe area left brachial or left basilic I’m not sure. Painful because of the improper procedure. That was the first part.

Nurse’s view: Macam agak tak confident nak buat
Patient’s view: Kena yakin, patient put the trust on yOu!

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The second part is where they asked me to put off my scarf. I remembered what my lecturer told me, there’s no need to put off your scarf and reveal your hair for this kind of examination. Yes, I know very well, scarf is not a radio opaque material. There shouldn’t be any problems. I fight a bit because I know what I am talking about; I do learn this procedure, but they still sticked with what they said. Thus I just follow their order for not giving any uncomfortable conditions. (Wah, tak puas hati.)

It was always like that in any procedures. It is hard to find health practitioners who really care and concern on patient’s dignity and rights. There was some, as always, but very rare.

Back to the case, they start with the plain scanning, then with contrast, in a large quantity (large to be inserted in the body through venous, I saw the big syringe, very big, never seen before, huhu).

I feel the contrast goes everywhere in the vessel, goes up to the face and the brain. The whole body feel so hot, very hot inside. I feel like to vomit (luckily I’m fasting, no food inside). My eyes become watery, really wanted to vomit. I can smell the contrast, hard odour, even though it was inside the body. It’s end up at 11.30am.

This is what lacking in radiographers and radiologist, they did not know exactly what the patient faced after having the contrast and also what is happening when the machine is functioning, for example the MRI, it produces terrible sound like the machine wanted to burst, this would scared the patients. If they know, they can inform the patient earlier before the scanning. This is important for not giving extra harm to the patients, emotionally or physically.

Radiographer’s view: Kalau buang je tudung and scarf kan senang sket. Lagipun bukan pape.
Patient’s view: It was our dignity which you take as a small matter. Plus, bukan ade radiopaque material.
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To all healthcare practitioners to be, don’t add up what is not necessary and please be concern for what is necessary. Thank you Mr. Zainul for the great advices! InshaAllah IIUM grads from IMC will be much better, amen.
Wallahu’alam.

--Narrated by Anas Bin Malik--

The Prophet said: Facilitate things to people (concerning religious matter), and do not make it hard for them and give them good tidings and do not make them run away (from Islam).

wallahu'alam

Malaysian Hospital series 0002

Dealing many times with the hospitals, both private and government taught me many things on hospital’s procedures. Even though people will say private hospitals will have everything to be done in a short period because of the money, and so I will deny.

In the case of a close friend, trauma case (trauma = accident), the whole family involve in the accident. Some were bring to government hospital and some were bring to private hospital by the layman. In ‘that’ government hospital (not to mention where), any emergency procedure were done only when the family members were confirmed to have the money to pay for the diagnosis and treatment.

Compared to private hospital where treatment comes first no matter what (they cannot assume whether the patient could afford to pay or not because it was an emergency case and the accident took place near to their hospital, thus the victims were just brought there). It was sad for me to know that the staffs of that government hospital would rather did not do anything in order to save the patient but they only wait till one of the family members of the victim who came to visit said something to the doctor. It goes like this,

“Awak ingat ayah dia ni orang susah? Gaji sebulan 15 ribu dalam tangan je!”

It was just to mention for them to make necessary actions (read: maybe dah geram, tahla), but that was true. Only then they make up something which is too late to be done. The other son was then being transferred from that government hospital to the private hospital. Once he arrived there, the private hospital quickly did the necessary diagnosis and treatments without bothering on other conditions.

The little sister also been sent to the government hospital. The doctor in charge at the A&E (the doctor was pregnant). She instruct to the radiology department to have a CT scan to the brain as the blood comes out from the mouth. But no abnormalities found in the brain. So the doctor just said,

“Kami tak dapat jumpalah kat mana bleeding dalam badan die.”

“Cuba scan badan pulak, mana tahu..” The mum replied.

“Doktor, cuba scan perut, bleeding dalam perut kot.” This little kid, her sister is a medical student studying at the university near the hospital requested to the doctor.

“No, kalau bleeding dalam perut takkan keluar ikut mulut, keluar ikut bawah je.” The doctor replied.

And she just leave the kid like that and said, nothing could be done as they cannot found the bleeding site. I do think rather than just waiting, it is always better to continue the diagnosis. The kid is someone’s daughter and someone’s little sister. Nyawa manusia ni, sangat berharga la…. After dah lama, only then the doctor slowly talk to the family,

“Betullah ade bleeding kat usus, sekarang takleh nak buat ape dah..” Best je inform the family members.

And the family lost the kid, she is only 7 years old and very adorable. I am really sad..yes I am. I am sad as she died sebab the doctor give up and did not continue further diagnosis, as long as she is still alive at the time even nyawa-nyawa ikan. That was my opinion, I don’t know what exactly should be done and what not to be done as a doctor. I mean the procedure at that time. Or is it only me yang sangat terpengaruh dengan ER drama series or what..??

Just a part of my friend’s story which I would like to display here for sharing, I don’t have the gut to share more on what had happened to other family members in the hospital. It was not the matter of money actually; it was the matter how keen you are in order to make patient’s life better and to make them alive. And not giving any extra harms. It was an issue of having this and this procedure, for the sense of giving trouble to others. But there was and always certain government hospitals which really have good conduct and practice. Yes, there are.

And for this case, I do not know what to say. Surely family members terkilan, and the doctor, maybe sedey, regret. And the brother of the kid keep blaming himself saying that he caused the death of her little sister. He himself received banyak2 jahitan kat muka, teruk, taknak jumpa sape-sape. And the family is in traumatic mode for few months. Tambah lagi, the kid, banyak shown up "tanda-tanda nak pergi..." before the accident. She goes just like that....I guess. There's always hikmah behind each things decided by Him. Wallahu khairul maakirin..

Clinician’s view: I myself cannot think what actually she is thinking, do you have any idea??

Patient’s view: I’m not giving up yet, so please don’t give up on me. Maybe she said like that or what..??

Wallahu’alam, a reminder for me and for you. Till then, wassalam.

P/s: to be continued on the next series, inshaAllah

Malaysian Hospital Series 0001

Malaysian hospital series 1 - the IM injection


When I've been sent to the A&E (Accident & Emergency) department, again that morning, this early April, as usual they transport me to the critical/less critical observation room using the stretcher. Even though I am about in an unconscious condition, but I try to focus on their conversation in order to get the updates. The doctor asked me few questions and I hardly answered them, having to repeat my words few times, and end up with misunderstanding. I do think they could easily dig up everything from those who accompany me (Najwa & Bro Halim) to the A&E rather than asking me on my condition.

I was at that time vomiting non-stop and having terrible pain in the brain. I cannot lift my head even a bit and need to be in recumbent supine position (baring kepala mengadap atas) in order not to cause greater pain in the brain. Mengiring pun tak boleh, duduk pun tak boleh, ape pun tak boleh. Hanya baring sahaja dibenarkan oleh kepala selama hampir 3 hari. That was actually due to a procedure i received few days before in the ward.


Then, I heard they wanted to do the IM (intramuscular: which means within the muscle) injection as the first procedure to reduce the pain I suffered of.

“Please, no...” I refused slowly right before they take out the drug (sambil geleng-geleng kepala kot). Few times I refused as they kept arguing with me.

Firstly because it will lead me to vomit, this is the effect of some drugs to the body. At that particular time, I already vomited non-stop every minute. Hence, considering my own QOL (Quality Of Life) for not giving extra harm, so I refused to. Even I did not know what type of drug they wanted to give, but I don’t care. I am afraid it will become worst, I will vomit more. I prefer to bear with the pain rather than having some more drug and keep vomiting.

Secondly, as you know, IM injection is very much painful, during and after, even this is not realy the reason why as Im used to the injections. IM is not like the pain with IV (intravenous: within a vein), it is very much different. Instead, IV is actually not painful at all. I am not really sure why IM is much more painful as I’ve seen many people end up with tears after IM injection. And I myself have experienced of IM many times, previously it was given to me at least every month.

In addition of that, the night before, the doctor on duty already did the injection for me through IM at the A&E. After that she let me go back to UIA and requested me to come back tomorrow morning if it’s becoming worst. It did. Thus, there I am the next day with the half conscious condition. I went only after a very bad condition. The bloody-minded me (read: degil).

So, that was the third reason. Even though, the doctor still argued with me. For sure I did not give any reasons, just refusing (read: geleng kepala). I do think the doctor should understand why, just by looking at my condition and applying the patient’s QOL without having to ask to. If not, after the injection of the drug through IM, they need to give me another injection to reduce the vomiting (fast action rather than orally) [please correct me if I am wrong].

I wonder why IM injection is painful. For some people, the pain is still there for two to three days later. From logical assumption with some friends, it might be due to the reaction of the drug as IM would not caused pain if it is done properly (read: ye eh..? What does it mean with proper technique?). For IV, logically it would not cause any pain as it goes through the blood vessel. Aite?

Just logical assumption, I tried to search, but did not found any information. So, this is only one part of it which I wanted to share. I guess I’ve talked a lot about needle, syringe and so on in my previous post. Yet, this is not the last, there will some more soon, Insha’Allah, in another sharing corner, because sharing is caring.

The moral value? Maybe before taking any further actions, we have to consider patient’s condition. Something which is looks necessary is not always right. This could be applied not only in the healthcare field, but also in our daily life. Again, patient is a living entity. Thus, please beware!

Wallahu’alam, a reminder for me and for you. Till then, wassalam.

P/s: to be continued on the next series, inshaAllah

Declaration on Malaysian Hospital the Series

Declaration :

I will create posts on the Malaysian Hospital in series, slowly. This series is specially devoted to all healthcare-professional-to-be, everyone who deal with patients (i.e: Doctors-to-be, Dieticians-to-be, Radiographers-to-be, Nurses-to-be, etc). Basically it is based on my own experience as a patient and my understanding as a healthcare-personnel-to-be. My experience, how I deal, what the procedure, what they did and anything regarding the issue. With the main aim to improve the quality of a personnel, and for patients to understand. Dan bukan untuk mencari kesilapan. Kemarahan itu langsung tidak wujud, sekadar perkongsian untuk yang lebih baik, akan datang. Dengan izinNya.

If you are a non-medical-related-person, Insha’Allah you could understand this Malaysian Hospital series. May this series gives benefit to you especially to the healthcare personnel. I will display the cons instead of the pros, for us to value and to avoid the unnecessary procedures, Insha’Allah (sebab yang bagus-bagus sume ade dalam buku, yang tak okay maybe tak terjumpa, thus, here it is, in this continuous series).

Alhamdulillah, Allah gives me the advantage of having both understanding and experience as a healthcare personnel and also as a patient. Thus I wanted to share the things which is not in the book, I guess. Trying to have the empathy, understand others and to be understood. Both sides, the healthcare personnel and patients.

It's hard for me to reveal my stories, but inshaAllah for our benefit and for us to change the view in the future. I hope from this series, we can try to avoid giving extra harm to patients and avoid unnecessary procedures. Because what's being learn is not necessarily applicable to all conditions, and also what's being learn is did not been applied, for many times.

I hope Allah will guide me and ease my path, helping me to benefit the ummah even with a very small contribution. Moga dalam redhaNya. May Allah gives me the strength as it cause me in great pain even to type the posts. Huu..inshaAllah I will try, continuous, but not so often. Various issues, but in random. InshaAllah.

I have no intention to show others' mistakes, or pointing hand to others, this series is just for sharing, as sharing is caring. Manusia melakukan kesilapan, itu pasti, namun harapnya, selain belajar daripada kesilapan sendiri, kita jua belajar dari kesilapan orang lain. InshaAllah.
I am ready for any critiques from you guys, and please correct me if I goes wrong. Thank you very much. Wassalam.

P/s: I hope KKM wont sue me, hehe.
(KKM = ministry of health -> in msia, it is known as KKM among healthcare personnel)

Wallahu’alam, a reminder for me and for you. Till then, wassalam.