smokers. i can never totally say i'm against them. some knows why.

they are friendly, chattable, some even irritable. probably the pumped in nicotine into the bloodstream, no matter how they insist of being just cigarette puffers. the years and counting that counts.

my main concern of course my little princess who has a chance by 50€€ €percent to end up with a smoker or having a circle of friends who live on smoking so badly. even her grandfather is.

nicotine. what's so great about it?

According to wikipedia, well yup it's just a small percentage of tobacco's dry weight. About 0.6 % to 3 %. Pharmacologically, it is a substance that can surely passes the blood brain barrier. Hey, so then just imagine! Whatever you do, in addition to smoking nicotine, chewing or dipping nicotine-containing substances would surely give you some souvenir to the brain.

No wonder all of the newer generation is an euphoric generation. Nicotine, I would say one of the biggest constituent of our air!

Nicotinic effects are as follow:
euphoria - elated mood
relaxation
muscle contractions
respiratory paralysis

oopsss.. got to go... OGDS waiting!! :P

happy birthday

it has been quite some time this blog being dormant. i have been keeping titles in mind to write and insyaallah when i'm more settle than i already am, they would appear in written form.

this is just a dedicated entry to my dad. happy 55th birthday. thank you for everything and thank you for being the best out of the rest :)

i'm very tired. let the rest take me in to a beautiful morning tmr. god bless.

hernia

"... Allah will grant after hardship, ease. " [V65:7]

I have been longing to write a new entry, but still the pressure of time on me is unbearable and I guess not till next week, I'd be 'free'. It is something that I've learnt today that doing things together worth more than anything else in the world. Co-operation that is. However, still I'd say people would only appreciate it with the constraint of time rather than being persistent. After all we are only human.

I have not any topic to discuss on today but as I am revising my Surgery, guess I'd like to chip an entry on a not very interesting yet the most common exam questions on earth- Scrotal lumps/swelling.

It is simple to be said really but when it comes to examination spot, I guess with the stress on you, patient and examiners, with the ethical issue when comes to examining such a restricted part of the body would be a big challenge, you'd find yourself clueless - well, I'd fine myself so in fairness.

In cases where the patient presented with an scrotal swelling, the top most differentials are:
- indirect inguinal hernia
- hydrocoele
- testicular tumor

Usually by saying this, you'd next be directed by the examiners to the next question. But don't hesitate on saying ..'Next, I'd like to differentiate between those differentials with few simple examinations'. Bring along your pen-torch for this assessment. Assess the separatability of the swelling, the transilluminability, comment the character of the swelling be it cystic or solid in nature, try to get above the swelling and most importantly listen with your stethoscope for any bowel sound.

In summary,
-separated or not?
-transilluminate?
-solid or cystic?
-can get above the swelling?
-any bowel sound heard over the swelling?

Based on the findings, if the swelling is able to be seperated and transilluminate on light examination and cystic in nature, then it is a most possibly a hydrocoele. If you can't get above the swelling, which means you can't assess the upper border of the swelling, the most likely diagnosis is an inguinal hernia. You can confirm this by a positive gurgling bowel sound heard on auscultation. At this stage a direct or indirect inguinal hernia cannot be yet differentiated. Further test still need to be done.

So, if it is an inguinal hernia, mention next that you'd like to do further test on differentiating whether it is a direct or indirect hernia.

How? Locate the pubic tubercle, to outline the inguinal ligament. Track up laterally (to the side) towards the Anterior superior iliac spine (ASIS). Mid point of this line between ASIS and pubic tubercle is the mid point of the inguinal ligament corresponding to the deep inguinal ring. Use two fingers, one to occlude or press on the mid point and another on the pubic tubercle (superficial ring). Ask the patient to cough, and look for any bulges. If there is any bulges seen, then it is a direct hernia, but if the 'bulge' is held by the fingers then it is more consistent with an indirect hernia. Repeat the cough test with patient standing up. Finish the examination and thank the patient.

Next, the accessories questions.
1) how to differentiate whether the swelling is a tumor or hydrocoele if it is seperated?
-- Depending on the age of the patient, testicular tumor are more common in younger and vice verse for hydrocoele.

2) Further investigation you'd like to do
-- Ultrasound and plain film abdomen (? bowel coming down towards the scrotum)

3) Risk factors for indirect inguinal hernia
-- patent processus vaginalis, premature male infant, 4% of male infant, chronic cough, straining, post surgical


***

Well, I guess that's all about it!
And seemed that I don't have to be worried of any of that for my baby! ;) She'll be well beyond prematurity by now. Alhamdulillah.

See you!

Starving

Have any of you been really starved? Starved to death? Was it on purposed? (winkz) I have been doing much reading on the acid base balance lately, and I supposed I probably have to read it again if I were to be asked about it again. (damn!)

It isn't hard, it is understandable, doable, but I guess, a little familiarity to this area would help- aka practice. Wait till I am a nephrologist one day and this would be my daily jokes.

Starving is one of the million causes of acidosis (build up of acid in the body) due to metabolic derangement. It can occur in a normal individual or anyone suffering from any of the types of Diabetes Mellitus. When a person starves, he or she will be breaking down energy from sources other than glucose, which is normally fats. It does sound good, but the breaking down metabolic product from fat metabolism isn't normal to the body, yet it is bad. Free fatty acids from breakdown of fats would be breakdown again to ketone bodies and energy. By the way, do remember the names of the ketone bodies to impress the examiners - acetone, acetoacetic acid and beta-hydroxybutyric acid.

What's not good about these? Ketone bodies are acidic in nature, and their accumulation in the blood will bring down the blood pH (acidic).

In general acidosis can be caused either by abnormalities in metabolism or respiratory (due to hypoventilation- reduced breathing causing build up of carbon dioxide which is acidic). Starvation would fit under metabolic acidosis because the lowering of blood pH as a result of insult to the body normal metabolism.

Acidosis also can be differentiated by the mechanism the pH is lowered, either by increase in acidity or decrease alkaline buffer in the body which is the bicarbonate ion. So, if for example any loss of bicarbonate from the kidney, that would cause the body to be acidotic as well.

I would not go further explaining this, as there is one better website (the best I supposed) in doing so. So, do visit this link (http://emedicine.medscape.com/article/768268-overview)

**

Starving isn't fun especially when you are hungry or when you are craving - PREGNANT! Talking from experience, and I still am going nuts craving for foods (luckily it's food!) that I should be careful on the amount of my intakes, it is really hard to put them off. Really hard!

Never ever liked lucozade all my life, but I can finished a litre of them in a day, ending up hyperosmolar (dehydrated) at the end of the day. No fancy chocolates, never have the heart for of course cooked red meat for every meal, and never would be awake in my sleep just for another meal - but now I do. And worse, it is happening everyday. Really a challenge to adapt to the new 9months ME.

However, I have to starve myself, starve for I know I cant simply be taking or eating anything that come across my mind. I can list all of the do's and don'ts I have to teach myself to adapt. No breakfast coffee, at least for most of the days of the week; no fancy kebabs, no salty food, no instant noodles, no cheesecakes, no McDonalds' or Supermacs' etc. No matter how deep my thoughts for them, I have to keep restraining myself from them, and lucky me, I succeeded most of the times. (anyway am still wondering why I put on 20kilos?? though)

Not till I found out I was lack of iron, and my haemoglobin was only 10, and got to know it a month later (phuh!), I have to rearrange my menus. Iron supplement, vitamin C and multivitamins are my everyday menus. Add up to that, almonds, cereals, orange juice, fruits (excluding grapes- enzyme inhibitors) spinach, and red meat everyday. To maximise the intake of iron, I have to avoid everything that impede its absorptions. No coffee, tea, and milk. Oh goodness, you really keep my brain working all the time baby. (alyya or umar)
I am so scared of losing any teeth out of the pregnancy, just like my mom- a tooth gone each pregnancy, so I'd try my best to drink at least a pint of milk before sleep. But now, I have to reschedule. And well, for knowing that gastric emptying is a little delayed in pregnancy means I have to take my iron or any food that contains it about 6 hours before any milk or my coffee! (I have switched to decaff now ahahaha) ... busy me!

Doesn't all of that sounds familiar? - It is life. Without those, I am just nothing, plain old haggard me. (drama queen)

**

Anyway, to my baby, I cant wait to see you. It'd be years before you're able to read this anyway. Just wanna let you know, I love you, always and forever. And I'm proud of you. You've been a good baby since the start. (oh, a small kick I feel there, she surely just know whenever I said she's a good baby) xx

I love you too dear husband. Goodnight. I miss you. xx

Bleed

Have been busy the past two weeks. Anyway, this rhyme really hit me, thought of sharing it. It was by John Fletcher...

A man of words and not of deeds,
Is like a garden full of weeds,
And when the weeds begin to grow,
It's like a garden full of snow
And when the snow begins to fall
It's like a bird upon the wall
And when the bird away does fly
It's like an eagle in the sky
And when the sky begins to roar
It's like a lion at the door
And when the door begins to crack
It's like a stick across your back
And when your back begins to smart
It's like a penknife in your heart
And when your heart begins to bleed
You're dead, and dead, and dead indeed.

Intro

Hi. I haven't write in for quite awhile. Not to say I have nothing to say lest I have a life tale to share (or probably ruin). winkz. I am thinking of making a new blog for my new life, even it has started pretty ago nonetheless my readiness in it has just bloomed!

Since (I thought) I quite know myself, I have always thought myself as being a girl who have almost everything I wanted. Yet, I realised that I haven't really put a demand in my life - and for that I concluded I have everything? - probably a little too much, well I was a kid.

Supposed now I've grown, I hope I've grown beautifully. Life taught me hardships, love and misery. Mixture of all feelings. I admit that in order to feel the warmth of life I do have to first encounter 'bad hair days'. Not denying the feeling pretty down but all I had was the will to get up and move on. It wasn't that bad for that I've met the love of my life, and the life of my life.

Not every single wish I had in mind was granted. And I like to think of it as Allah gives those that I really need and not what I wanted - (crude, but I truly don't know what I wanted). He knows what's best for me, and I believe in every single promises He made.

***

Enough for the introduction part. I am not keen to make this blog another personal touch. I am more towards sharing this time. In a month time, I'll finish medical school, and I am going to make it happen nevertheless! InsyaAllah.

I am trying to write in posts that are beneficial to my juniors, coming juniors and to the rest of this blog reader. I am going to post in medically related articles, either my own writing or my analysis of current epidemics or on-going endemics.

Life is only once. It still teaches me, and I hope out of it I'll be able to teach a little. The rests are all belong to Allah, and I hope for me a better ending. Amin.