Tuesday, January 26, 2010

Tardive Dyskinesia


Bismillahirrahmanirrahim

Today is my turn to interview a patient in our routine psychiatry posting. Maybe it's not a good start for me as today there are not so many patients available; either in OPD or in the ward. I went up and down twice between the ward and psychiatry OPD to ask for patients from S/N Aishah but no positive answer it seemed. Same as the ward. At first, I were given a patient who looks quite 'normal' but it ended up that she didn't want to talk to us and she claimed to have headache every time I asked her question. Fine.

Next, I got another patient - 18 years of age Muslim Malay girl student. The most striking feature that was obvious to everyone of us is that she's having tardive dyskinesia; an abnormal movement disorder associated with long term treatment with neuroleptic drug. This girl had been taking drugs like lorazepam, benzhexol and risperidone since she was 15. It was very sad actually to see a sweet girl like her developing all the symptoms like choreiform movements of the buccal-lingual-facial muscles e.g.pursing lips, excessive blinking of eyes, irregular movements of the cheeks and abnormal gait and postures movements. I cant really dig out what her problem was and what made her received all the medications. A friend of mine said,"Hey, built rapport with her first la..." I was like, Duh...what do you think I'm doing right now? [self-monologue only] I AM trying to befriend her, put her at ease so that she's willing to share her problems with US, not only me. I do felt a bit restrained just now. Huhu.

Then later, she filled us with her delusions of grandiosity, which I think I dont want to share it here. Maybe she was a chronic bipolar disorder patient. Her mood was euphoric, she's singing and talking...but honestly in spite of all the things she said, we cant really get our eyes away from her abnormal movements. It looked very dis-comfortable but when I asked her, she said that she liked it, loved it. I dont know whether she's being sarcastic or she really meant that. It is very pitiful because this is the adverse effect of drugs given to her previously. Meaning, it is iatrogenic in nature. Very unlucky for this girl to have it as it is irreversible. Of all the patients who received these medications, we cant really say whose going to develop what adverse effect and when. So, the possibility is always there. And just now, while interviewing her, suddenly she "fall asleep". I tried waking her up by calling her name but she didnt respond. Dr Rajagopal banged the table in front of her but she remained unmoved. The situation became havoc for a while. Dr. Rajagopal asked me to check her pulse - whether it is in sinus rhythm, and someone else checking her carotid. Then, he tried eliciting painful stimuli by putting pressure on her mastoid prominences, do the glabella tap and all but she maintained inattentive. After quite some times passed, she regained herself but Dr Raja asked me to send her back to ward.

At the ward, she became quite normal so Dr.Raja asked us to continue interviewing her there. She's in an elated mood and playful. She rhymed, punned at words and finding cues in environment. We observed her while she's drinking water from a bottle. Her abnormal movements all subsided as she tried to open the bottle, and later while she wrote on a paper. These, as said by Dr.Raja, are the features seen in tardive dyskinesia.

Hurm, I dont know how to conclude this story... What I knew, I fumbled a lot today which showed how incompetent I was. Felt like I'm not myself. Oh, and as for the case, I think we should have more sympathy and empathy and become a humane doctor rather than a merely human doctor when dealing with cases that challenged our emotional quotient (EQ). Okay. Till next post. Daa...

Saturday, January 23, 2010

Kerja Kawen

picture courtesy of Hafiidz Baharudin - cilok from facebook. ^^,

Bismillahirrahmanirrahim

Sahabat2 MMMC sekalian dijemput ke majlis kerja kawen depan sport complex dr jam 11 sampai 3pm hari ini. Tuan rumah jemput. Spread ya..
Sent: 23-Jan-2010, 10:40:26. Sender:Eizzah


When I got this message, I sincerely felt a bit reluctant to go. The reason is simple - I dont know the house owner (tuan rumah). Weird isn't it? You go to a house where you dont know who is the owner, you eat the food there and then you walked away. It felt so wrong. So, at around 12noon, I went down to the canteen to buy lunch but it was closed. A bit lazy to walk a further distance to outside cafe`, I went up to my room-frustrated. Huhu. Then, at 1pm, Eizzah rang me on the phone saying that no one replied to her sms. So later on we agreed to go to the wedding together after Zuhur prayer.

1400 ~ We arrived at the house. Eizzah, Nurani and me. We felt very awkward (salah tingkah). No recognizable face around. With nervous smile, we went under the tent and queued for food, with the rest of the guest. There, I saw Dr Ahmed As-Sayyed, enjoying his food. When my turn came, an aunty (whom I presumed must be one of the bride's family) asked me, "Ni kawan sekerja Aus ke?" I was like...,"Err..tak. Kami datang saja je ni. Ada orang ajak." See how inappropriate my answer was. I felt so frail. Huhu.

After a while, I saw some familiar faces came in. A few seniors from batch 17 and later a bunch of friends from batch 20. Alhamdulillah. A bit feeling of relief touched my heart. :) There also we got to know Akh Rahim's dad. Finished eating, we wanted to thank the tuan rumah before leaving but we went to the wrong house so we just leaved quietly. Huhu. :(

Thus, moral of the day:
"O mankind! We created you from a single (pair) of a male and a female, and made you into nations and tribes, that ye may know each other (not that ye may despise (each other). Verily the most honoured of you in the sight of Allah is (he who is) the most righteous of you. And Allah has full knowledge and is well acquainted (with all things)."-Al-Hujuraat,49:13

"Abu Huraira reported Allah's Messenger (may peace be upon him) as saying: Six are the rights of a Muslim over another Muslim. It was said to him: Allah's Messenger, what are these? Thereupon he said: When you meet him, offer him greetings; when he invites you to a feast accept it. When he seeks your counsel give him, and when he sneezes and says:" Alhamdulillah (All praise is due to Allah)," you say YarhamukAllah (may Allah show mercy to you); and when he falls ill visit him; and when he dies follow his bier."-H.R.Bukhari wa Muslim.

These two dalil are enough I think to make a very good ibrah for me and you. May Allah opens to us the roads to goodness and give us goodness from His side. Ameen.

Wednesday, January 20, 2010

Graf Iman

Bismillahirrahmanirrahim.

Kaifa haluk ya usrati? Kaifa hal imanukum? Saja rasanya nak berkongsi tentang iman. Bukan Muhammad Iman sahabat kita, tetapi IMAN yang di dalam dada kita.



Bagi kita yang seringkali terdedah kepada melakukan pelbagai jenis dosa dan maksiat, iman itu turun dan naik. Kadang terasa malas sekali untuk melakukan kebaikan dan ibadah kepadaNya. Kadang iman itu teruji dengan indahya dunia. Moga tatkala iman kita turun, kita merasainya dan cepat-cepat berusaha untuk naik kembali. Moga kita tidak terus tenggelam dalam asyiknya nafsu yang membuai sehingga graf iman kita turun tak naik-naik. Moga kita punya teman di sekeliling yang mampu menghulur tangan menaikkan kita yang terkapai kelemasan.

Betapa indah dan bijaknya nasihat sahabat Rasulullah SAW, Ali bin Abi Thalib ra berkata: "Hati ini terkadang memiliki kecenderungan menerima dan terkadang menolak. Bila ia dalam kondisi menerima, ajak ia untuk melakukan ibadah yang sunat. Tapi apabila ia dalam kondisi menolak, ajak dia untuk melakukan yang wajib saja. Sampai kondisi menolak itu hilang, ajaklah kembali ia melakukan yang sunat.

Ya Allah, sungguh aku hamba yang sentiasa lupa
Ya Tuhan, sungguh aku hambaMu yang selalu lagha
Ya Rabb, sungguh aku hamba yang sentiasa leka.

Aku mohon moga Kaumaafkan saat aku tersasar.

Kembalikan aku pada jalanMu
Panggilku semula untuk ingatMu
Maafkan aku atas laghaku
Ampunkan aku untuk lekaku.

Kerana aku manusia dijadikan Engkau begini
Yang punya nafsu, akal, dan iman
Tikaku tewas pada nafsu,
Ampunkan aku.

Ya Rahman, aku ingin sekali merasa nikmat lazatnya tenggelam dalam khusyuk ibadah kepadaMu
Aku ingin sekali merasa manisnya cinta padaMu
Tariklah aku kembali padaMu
Andai hatiku mula jauh…

Tidak ingin kulemas dalam fana indah dunia
Hingga kulupa pada hidup kedua yang abadi
Kerana matiku hanya sekali
Jadi biarlah hidup pertamaku yang singkat ini kumanfaatkan untukMu.
Supaya nanti tinggal untukku menuai hasil semata
Sebagaimana janjiMu.

Ampunkan aku Tuhan.
Sebelum Kau panggilku mengadapMu nanti...

Thursday, January 14, 2010

Layu

Bismillahirrahmanirrahim.

Sesungguhnya tiada yang lebih menyayat
Dari melihat bangsaku terjajah
Tidak ada yang lebih menyedihkan
Dari membiarkan bangsaku terhina


Aku lihat layu dalam Melayu
Aku pasti bukan aku seorang sahaja yang nampak
Ada juga bercadang bertanya tuan punya
Tapi bercampur risau dengan tak tergamak
Nanti dikata tak bersyukur , dikata tak sedar diri
Jadi aku menyendiri, memerhati dan akhirnya mengakui
Yang kita sendiri
Membiarkan bunga raya melayu ke kanan
Dan dibiar bunga tak cantik mekar di kiri
Aku lihat layu dalam Melayu
Tanah air kita yang punya
Kita siram, kita baja tapi angin api kita lupa

Mereka merancang masa menjilat bangsa
13 harimau bertukar menjadi mangsa
Kita lupa nenek moyang kaya raya
Jangan sekali-kali digadai harta bendanya

Kulihat layu dalam Melayu
Kulihat layu dalam Melayu
Kulihat layu dalam Melayu

Takkan Melayu hilang di dunia
Ya, tapi apa guna tak hilang di dunia
Kalau kewujudan tidak dirasa
Petah berbahasa kudrat tak berjasa
Orang berbudi kita hanya tahu merasa

Selalu lari bila dirapat
Selalu malu bila soalan diaju
Selalu segan memberi pendapat
Rela mengikut dari meneraju
Belum nyanyi sudah bersorak
Suka berjanji dalam borak
Bukan kata tak ada otak
Cuma tak berfikir di luar kotak

Kulihat layu dalam Melayu
Kulihat layu dalam Melayu
Kulihat layu dalam Melayu

Aku jadi sayu
Bunga menangis dia mendayu
Mahu jadi cantik tetapi ragu
Aku merayu
Bangunlah semula hidup kembali
Jangan tunggu matahari mati
Cepatlah mekar sebelum terlerai

Perjuangan kita belum selesai
Perjuangan kita belum selesai
Perjuangan kita belum selesai

Perjuangan kita belum selesai
Kerana hanya yang cekal dan tabah
Dapat membina mercu tanda bangsanya yang berjaya


Malique ft. Dr Mahathir

Tuesday, January 12, 2010

The Accident

Bismillahirrahmanirrahim.

This vid really makes me ponder upon myself; do we perform solah as soon as the muadzin finished the azan or we play with time until it's too late? What if Allah takes back our soul before we do the solah? Aqim solataka qabla mamataka (Pray your solah, before your death)

video

Sunday, January 10, 2010

Rahsia taugeh

Bismillahirrahmanirrahim

Menu TAUGE untuk hidangan makan tengah hari mahupun makan malam sering kali dipandang sebelah mata oleh kebanyakan kita. Tauge dilihat sebagai hidangan yang langsung tidak menyelerakan.


Tapi tahukah anda, tauge yang kerap kali menjadi pilihan terakhir untuk dijadikan sayur ini sebenarnya mempunyai banyak khasiat.

Tauge dikatakan mampu menyumbang kepada kesuburan lelaki dan wanita. Pengambilan tauge oleh kaum lelaki mampu membuatkan sperma yang dihasilkan oleh golongan ini makin baik. Begitu juga wanita, ia cukup berkesan membantu kesuburan telur yang dihasilkan.

Bagaimanapun, khasiat tauge tidak sekadar penyumbang kesuburan, ia juga terbukti melalui kajian mengandungi bahan yang dapat melumpuhkan bibit kanser, usus besar, pankreas dan juga penyakit leukimia.

Mengikut kajian yang dijalankan tauge sama ada dari jenis kacang hijau, alfalfa dan sebagainya mengandungi banyak unsur fitokimia ya berkhasiat. Salah satunya ialah kanavanin (canavanine), sejenis asid yang amino. Kanavanin, dikatakan mampu melumpuhkan bibit kanser leukimia, usus besar dan pankreas.

Selain itu, tauge juga mempunyai estrogen semulajadi berfungsi sama dengan estrogen sintesis. Estrogen dalam tauge dapat meningkatkan kepadatan dan susunan tulang, serta mencegah kerapuhan tulang (osteoporosis)

Pengambilan tauge oleh wanita secara kerap dapat membantu mereka menghindar mereka dari kanser payudara, gangguan menjelang menstruasi,simptom pra-menopaus, dan gangguan akibat menopaus.

Sewaktu kacang-kacang dicambahkan untuk dijadikan tauge secara umum kadar saponinya meningkat sehingga 450 peratus.

Mereka yang berisiko penyakit strok dan serangan jantung, gara-gara kadar lemak darah yang tinggi dianjurkan lebih banyak mengambil tauge dalam menu harian mereka.

Saponi dalam tauge, menghalau "lemak jahat" LDL, tanpa mengganggu kandungan lemak baik HDL.

Selain sarat DNA, tauge padat dengan antioksida kuat yang menghalang tubuh dari radikal bebas perosak sel DNA. Pelindungan ini menguatkan kesimpulan tauge merupakan sayuran yang membuat anda menjadi lebih muda.

Satu lagi khasiat tauge yang tidak kurang hebat adalah membantu membuang kotoran dalam usus besar kerana mengandungi banyak serat dan air. Inilah yang menjadi tunjang utama tauge dalam memerangi sel kanser.

Apabila kotoran segera meninggalkan usus besar, tiada lagi zat-zat racun dalam kotoran yang yang dapat diserap tubuh. Ia akan mencegah pengumpulan bahan beracun yang dapat merangsang berseminya benih kanser.

Selepas membaca kebaikan sayur tauge janganlah ragu-ragu lagi untuk mengambilnya.
Jadi apalagi, JOM kita ramai-ramai makan tauge hari-hari!



p/s: Dedikasi buat kawan-kawan yang tak suka makan tauge. :)
pp/s: Sorry Sarah,Dayana,Aishah ~ takde rupanya untuk kawal diabetes mellitus. Hehe.

Friday, January 8, 2010

Surgery posting

Bismillahirrahmanirrahim

Finally it's over; 6 weeks full of tortures, humiliations and harassment (not to forget the assignments). Some people think that it's good to teach by all these means, because sometimes people work better under pressure, through the hard way. But in my humble opinion, a teacher shouldn't use offensive words towards the students like "bloody idiot", "donkey", "fool" etc. In Islam, we believe that words that we utter are like do'a. And what most, it comes out of a teacher's mouth. It can affect a student psychologically and spiritually. What if the student really, really becomes a "bloody idiot"; difficult to understand the knowledge that is being taught because every day what he/she heard are those do'a.

Other than that, I cant deny the fact that a student need to study, do revision and pay a great deal of attention during learning session. These are among the keys towards excellence in studies, which, everyone knows [but not everyone practicing, including me. :( ] And, in our prayer we should ask from His Almighty to open our heart to receive the knowledge and purify our heart from sin that always darken it.

Anyhow, I hope all of us can be a good servant to Allah, a good ummat for Rasulullah, a good child to our parents, a good student to our teachers, a good friend to a friend, and later, a good doctor to the society (you can add the 'later' list by yourself...^^,)

Okay. That's all for now. What's important, I finished my Semester 6 Surgery posting. Alhamdulillah! Yeah!