Kesihatan : Angin dalam badan, apa yang anda perlu tahu

Bismillah

Sedikit informasi kesihatan yang ingin saya kongsikan

Selepas pulang daripada Jordan menamatkan pengajian, beberapa kenalan yang saya temui bertanyakan masalah kesihatan mereka. Saya menjawab dan menerangkan mana yang termampu berpandukan ilmu yang saya ada.


Sepanjang pemerhatian saya, masalah yang sering ditanyakan dan diminta diberi penjelasan ialah masalah angin dalam badan. Buurrrrp..!!! Jika sendawa selepas makan, ramai yang tidak risau, sendawa kekenyangan katanya. Tetapi jikalau selalu sendawa walaupun dalam keadaan perut kosong, tidakkah pelik namanya..? Kembung perut. Mereka yang bertanya runsing memikirkan kenapa dan bagaimana mengatasinya.



SENDU SENDAWA

Di sini, suka saya kongsikan maklumat dan penerangan seperti yang diterangkan oleh seorang Pakar Perunding Perubatan dan Gastroenterologi, Pusat Perubatan Kelana Jaya, Dr. Abdul Malik Jamal Buhari kepada akhbar sisipan Kesihatan Mingguan Malaysia beberapa minggu lepas.


Dalam wawancara bersama beliau, Dr. Abdul Malik menafikan seseorang yang dijangkiti demam mempunyai kaitan dengan masalah angin di dalam badan. Bagaimanapun, masalah stres serta komplikasinya seperti sakit kepala, pening, berdebar-debar dan sebagainya berkemungkinan berpunca daripada masalah angin.


Jelasnya, masalah angin dalam badan khususnya sistem penghadaman disebabkan oleh sistem usus yang 'lembap' atau kurang aktif. Ini menyebabkan angin dalam usus tidak dapat dikeluarkan dari badan secara efektif.


Angin di dalam badan berpunca daripada gas di dalam sistem penghadaman atau sistem gastro usus (gastroenterologi). Sistem tersebut mengandungi gas yang tidak berbau iaitu 99% gas buangan dari usus manakala gas yang tidak menyenangkan pula mungkin disebabkan oleh gas yang mengandungi sulfur.

" Ia dilepaskan oleh bakteria di dalam usus besar. Angin disebabkan gas atau angin dalam sistem penghadaman badan datang daripada dua sumber iaitu udara yang disedut dan bakteria dalam usus besar.

Bakteria ini terjadi akibat gangguan daripada makanan yang tidak dihadamkan dengan baik, " katanya.


Secara umumnya,penyakit atau masalah angin adalah perkara biasa bagi kebanyakan orang. Walaupun tiada statistik sebenar, anggaran 30 hingga 40 peratus masyarakat mengalami masalah angin iaitu minimum sekali dalam hidup mereka. Realitinya, masalah angin tidak menyebabkan kemudaratan yang teruk. Ia hanya perasaan tidak selesa dan kurang menyenangkan serta mengganggu kerja harian.



RAWATAN

Seperti kebanyakan penyakit lain, angin di dalam badan sering dikaitkan dengan pemakanan. Justeru ia boleh diatasi dengan melebihkan makanan berzat serat (fiber), sayur-sayuran, buah-buahan dan senaman harian.

"Jikalau kesemua di atas tidak mendatangkan manfaat, kita boleh memberikan ubat-ubatan tertentu," ujarnya.

Selain itu, berurut, sauna, bersenam dan gaya hidup sihat dapat membantu mengatasi masalah stres.

Terdapat kepercayaan amalan mandi waktu malam menjadi punca masalah tersebut. Namun, menurut Dr Abdul Malik, tiada bukti saintifik mandi waktu malam boleh menyebabkan angin dalam badan.

Seseorang boleh mengesan dia mengalami masalah angin di dalam badan jika sentiasa sendawa, dan mengalami kembung perut. Keadaan itu menyebabkan rasa kurang selesa, sakit dan seterusnya mengurangkan selera makan dan juga sakit kepala.

Beliau menasihatkan orang ramai yang mengalami gejala tersebut mendapat rawatan doktor di samping menjaga pemakanan serta bersenam.



TAMBAHAN

Ini pula informasi yang saya kumpul berkaitan angin dalam badan menerusi internet. Terma 'aerophagia' yang bermaksud 'makan angin/udara' ada kaitan dengan satu sebab berlebihan angin dalam badan, iaitu berpunca daripada udara yang disedut. Sebab kedua sepertimana yang disebutkan Dr. Malik di atas ialah berpunca daripada bakteria di usus besar yang cuba memecahkan makanan-makanan yang tidak dapat dihadamkan dengan baik.

Perhatikan artikel di bawah..

GAS IN THE DIGESTIVE TRACT (ANGIN DALAM SISTEM PENGHADAMAN)

Everyone has gas and eliminates it by burping or passing it through the rectum. However, many people think they have too much gas when they really have normal amounts. Most people produce about 1 to 4 pints a day and pass gas about 14 times a day.

The digestive tract.

Gas is made primarily of odorless vapors—carbon dioxide, oxygen, nitrogen, hydrogen, and sometimes methane. The unpleasant odor of flatulence, the gas that passes through the rectum, comes from bacteria in the large intestine that release small amounts of gases containing sulfur.

Although having gas is common, it can be uncomfortable and embarrassing. Understanding causes, ways to reduce symptoms, and treatment will help most people find relief.

What causes gas?

Gas in the digestive tract—the esophagus, stomach, small intestine, and large intestine—comes from two sources:

• swallowed air
• normal breakdown of certain undigested foods by harmless bacteria naturally present in the large intestine, also called the colon

1. Swallowed Air

Aerophagia, or air swallowing, is a common cause of gas in the stomach. Everyone swallows small amounts of air when eating and drinking. However, eating or drinking rapidly, chewing gum, smoking, or wearing loose dentures can cause some people to take in more air.

Burping, or belching, is the way most swallowed air—which contains nitrogen, oxygen, and carbon dioxide—leaves the stomach. The remaining gas moves into the small intestine, where it is partially absorbed. A small amount travels into the large intestine for release through the rectum. The stomach also releases carbon dioxide when stomach acid mixes with the bicarbonate in digestive juices, but most of this gas is absorbed into the bloodstream and does not enter the large intestine.

2. Breakdown of Undigested Foods

The body does not digest and absorb some carbohydrates—the sugar, starches, and fiber found in many foods—in the small intestine because of a shortage or absence of certain enzymes that aid digestion.

This undigested food then passes from the small intestine into the large intestine, where normal, harmless bacteria break down the food, producing hydrogen, carbon dioxide, and, in about one-third of all people, methane. Eventually these gases exit through the rectum.

People who make methane do not necessarily pass more gas or have unique symptoms. A person who produces methane will have stools that consistently float in water. Research has not shown why some people produce methane and others do not.

Foods that produce gas in one person may not cause gas in another. Some common bacteria in the large intestine can destroy the hydrogen that other bacteria produce. The balance of the two types of bacteria may explain why some people have more gas than others.

Which foods cause gas?

Most foods that contain carbohydrates can cause gas. By contrast, fats and proteins cause little gas.

Sugars

The sugars that cause gas are raffinose, lactose, fructose, and sorbitol.

Raffinose. Beans contain large amounts of this complex sugar. Smaller amounts are found in cabbage, brussels sprouts, broccoli, asparagus, other vegetables, and whole grains.

Lactose. Lactose is the natural sugar in milk. It is also found in milk products, such as cheese and ice cream, and processed foods, such as bread, cereal, and salad dressing. Many people, particularly those of African, Native American, or Asian background, normally have low levels of lactase, the enzyme needed to digest lactose, after childhood. Also, as people age, their enzyme levels decrease. As a result, over time people may experience increasing amounts of gas after eating food containing lactose.

Fructose. Fructose is naturally present in onions, artichokes, pears, and wheat. It is also used as a sweetener in some soft drinks and fruit drinks.

Sorbitol. Sorbitol is a sugar found naturally in fruits, including apples, pears, peaches, and prunes. It is also used as an artificial sweetener in many dietetic foods and sugar-free candies and gums.

Starches

Most starches, including potatoes, corn, pasta, and wheat, produce gas as they are broken down in the large intestine. Rice is the only starch that does not cause gas.

Fiber

Many foods contain soluble and insoluble fiber. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Found in oat bran, beans, peas, and most fruits, soluble fiber is not broken down until it reaches the large intestine, where digestion causes gas.

Insoluble fiber, on the other hand, passes essentially unchanged through the intestines and produces little gas. Wheat bran and some vegetables contain this kind of fiber.

What are some symptoms and problems of gas?

The most common symptoms of gas are flatulence, abdominal bloating, abdominal pain, and belching. However, not everyone experiences these symptoms. The type and degree of symptoms probably depends on how much gas the body produces, how many fatty acids the body absorbs, and a person's sensitivity to gas in the large intestine.

1. Belching

An occasional belch during or after meals is normal and releases gas when the stomach is full of food. However, people who belch frequently may be swallowing too much air and releasing it before the air enters the stomach.

Sometimes a person with chronic belching may have an upper gastrointestinal (GI) disorder, such as peptic ulcer disease, gastroesophageal reflux disease (GERD), or gastroparesis, also called delayed gastric emptying.

Sometimes people believe that swallowing air and releasing it will relieve the discomfort of these disorders, and they may intentionally or unintentionally develop a habit of belching to relieve discomfort.

Gas-bloat syndrome may occur after fundoplication surgery to correct GERD. The surgery creates a one-way valve between the esophagus and stomach that allows food and gas to enter the stomach but often prevents normal belching and the ability to vomit. It occurs in about 10 percent of people who have this surgery but may improve with time.

2. Flatulence

Another common complaint is too much flatulence. However, most people do not realize that passing gas 14 to 23 times a day is normal. Too much gas may be the result of carbohydrate malabsorption.

3. Abdominal Bloating

Many people believe that too much gas causes abdominal bloating. However, people who complain of bloating from gas often have normal amounts and distribution of gas. They may just be unusually aware of gas in the digestive tract.

Doctors believe that bloating is usually the result of an intestinal disorder, such as irritable bowel syndrome (IBS). The cause of IBS is unknown but may involve abnormal movements and contractions of intestinal muscles and increased pain sensitivity in the intestines. These disorders may give a sensation of bloating because of increased sensitivity to gas.

Any disease that causes intestinal inflammation or obstruction, such as Crohn’s disease or colon cancer, may also cause abdominal bloating. In addition, people who have had many operations, internal hernias, or bands of internal scar tissue called adhesions may experience bloating or pain. Finally, eating a lot of fatty food can delay stomach emptying and cause bloating and discomfort, but not necessarily too much gas.

4. Abdominal Pain and Discomfort

Some people have pain when gas is present in the intestine. When pain is on the left side of the colon, it can be confused with heart disease, which sometimes causes abdominal pain. When the pain is on the right side of the colon, it may mimic gallstones or appendicitis.

What diagnostic tests are used to find the cause of gas?

Because gas symptoms may be caused by a serious disorder, those causes should be ruled out. Health professionals usually begin with a review of dietary habits and symptoms. The health professional may ask the patient to keep a diary of foods and beverages consumed for a specific time period.

If lactase deficiency is the suspected cause of gas, the health professional may suggest avoiding milk products for a period of time. A blood or breath test may be used to diagnose lactose intolerance.

In addition, to determine if someone produces too much gas in the colon or is unusually sensitive to the passage of normal gas volumes, the health professional may ask a patient to count the number of times he passes gas during the day and include this information in a diary.

Careful review of diet and the amount of gas passed may help relate specific foods to symptoms and determine the severity of the problem.

Because the symptoms that people may have are so variable, the health professional may order other types of diagnostic tests in addition to a physical exam, depending on the patient's symptoms and other factors.

How is gas treated?

Experience has shown that the most common ways to reduce the discomfort of gas are changing diet, taking medicines, and reducing the amount of air swallowed.

1. Diet

Health professionals may tell people to eat fewer foods that cause gas. However, for some people this may mean cutting out healthy foods, such as fruits and vegetables, whole grains, and milk products.

Health professionals may also suggest limiting high-fat foods to reduce bloating and discomfort. Less fat in the diet helps the stomach empty faster, allowing gases to move into the small intestine.

Unfortunately, the amount of gas caused by certain foods varies from person to person. Effective dietary changes depend on learning through trial and error how much of the offending foods one can handle.

2. Nonprescription Medicines

Digestive enzymes, available as over-the-counter supplements, help digest carbohydrates and may allow people to eat foods that normally cause gas.

The enzyme lactase, which aids with lactose digestion, is available in caplet and chewable tablet form without a prescription; Lactaid and Lactrase are two common brands. Taking lactase supplements just before eating helps digest foods that contain lactose. Also, lactose-reduced milk and other products, such as Lactaid and Dairy Ease, are available at many grocery stores.

Beano, an over-the-counter digestive aid, contains the sugar-digesting enzyme that the body lacks to digest the sugar in beans and many vegetables. The enzyme comes in liquid and tablet form. Five drops are added per serving or one tablet is swallowed just before eating to break down the gas-producing sugars. Beano has no effect on gas caused by lactose or fiber.

3. Prescription Medicines

Doctors may prescribe medicines to help reduce symptoms, especially for people with a disorder such as IBS. For more information about IBS, see the Irritable Bowel Syndrome fact sheet from the National Digestive Diseases Information Clearinghouse.

4. Reducing Swallowed Air

For those who have chronic belching, health professionals may suggest ways to reduce the amount of air swallowed. Two options are to avoid chewing gum and to avoid eating hard candy. Eating at a slow pace and checking with a dentist to make sure dentures fit properly should also help.

Points to Remember

Although gas may be uncomfortable and embarrassing, it is not life threatening. Understanding causes, ways to reduce symptoms, and treatment will help most people find some relief.

• Everyone has gas in the digestive tract.

• People often believe normal passage of gas to be excessive.

• Gas comes from two main sources: swallowed air and normal breakdown of certain foods by harmless bacteria naturally present in the large intestine.

• Many foods with carbohydrates can cause gas. Fats and proteins cause little gas.

• Foods that may cause gas include
• beans
• vegetables, such as broccoli, cabbage, brussels sprouts, onions, artichokes, and asparagus
• fruits, such as pears, apples, and peaches
• whole grains, such as whole wheat and bran
• soft drinks and fruit drinks
• milk and milk products, such as cheese and ice cream, and packaged foods prepared with lactose, such as bread, cereal, and salad dressing
• foods containing sorbitol, such as dietetic foods and sugar-free candies and gums



• The most common symptoms of gas are belching, flatulence, bloating, and abdominal pain. However, some of these symptoms may be caused by an intestinal disorder, such as IBS, rather than too much gas.

• The most common ways to reduce the discomfort of gas are changing one’s diet, taking digestive enzymes to help digest carbohydrates, and reducing the amount of air swallowed.

For More Information

American Dietetic Association
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606–6995
Internet: www.eatright.org (Click on "Find a Nutrition Professional")

Other site can be visited

Aerophagia remedies


Semoga maklumat di atas sedikit sebanyak membantu untuk mereka yang ada masalah ini memahami kenapa dan bagaimana mengatasinya.

Sebarang pertanyaan dan pembetulan dialu-alukan.

Wallahua'lam

Sebelum saya dinikahkan!

Semalam ada kes ‘realiti masyarakat’ masuk ke dewan bersalin. Kes incomplete miscarriage. Known case of thyrotoxicosis complicated by atrial fibrillation (AF) yang datang dengan history of retained placenta and ‘tumpah darah’ (heavy bleeding) at 22/52 weeks of gestation. She was referred from klinik kesihatan daerah to Hospital Seremban. Suasana kebiasaan dewan bersalin yang permai nian jadi agak hectic dek jeritan pesakit yang kesakitan dan MO yang sedang berusaha untuk mengeluarkan cebisan uri (placenta) yang masih tertinggal di dalam rahim. Muda lagi, sekitar akhir 30-an barangkali.

“Sakit doktor, tolong, sakit!” Terjerit-jerit si pesakit.

“Kita nak tolong awak ni, tolong bagi kerjasama. Jangan angkat punggung tu. Sikit lagi uri nak keluar ni” si doktor pula berusaha menenangkan sambil tangannya pantas menjalankan tugas. Agak susah.

Memang lain benar rupa uri yang sudah tidak sempurna. Tidak nampak bentuk langsuang. Entah berapa banyak darah yang dah ter‘tumpah’. Mujur pesakit masih kelihatan ‘steady’.

“Aduh, sakit doktor!” Jerit pesakit lagi. Tindakan refleksi pesakit, tangan seperti mahu menepis, tubuh mahu diangkat jauh-jauh.

“Tahan sikit, memang sakit. Kita nak tolong awak keluarkan uri ini kat sini, kalau tidak kena masuk dewan bedah lagi susah.”

Tambah lagi kabutnya apabila tiada rekod antenatal langsung dan seperti datang from nowhere secara emergency. Memang pusing kepala badan HO dan MO mencari maklumat. Sedikit laporan ringkas yang dibawa dari klinik kesihatan menulis patient adalah pesakit thyrotoxicosis complicated with atrial fibrillation. Ditambah lagi apabila soalan-soalan yang ditanya dijawab secara agak reluctant oleh pesakit.

“Sejak bila awak tahu ada sakit thyroid dengan jantung? Ubat apa ambil? Ada bawa tak?”

“Tahun lepas doktor. Ada kat rumah doktor, tak bawa..”

“Kenapa tak bawa sekali.” Soalan yang bernada pernyataan dijawab dengan heningan. Diam.

Alhamdulillah, cebisan uri berjaya juga dikeluarkan walaupun kepayahan. Tetapi MO masih kelihatan kurang puas hati. Firasat mengatakan masih terdapat sisa-sisa yang tertinggal di dalam. Ultrasound disorongkan untuk tujuan kepastian.

“Sebelum ini ada pernah mengandung atau gugur tak?”

Diam

“Puan, saya tanya ni ada pernah tak?” suaranya ditinggikan sedikit.

“Ni kali kedua doktor. Kali pertama gugur.” Jawab pesakit

“Kali pertama bila?” Dua kali soalan diulang. Dengan nada berbeza.

“Sebelum saya dinikahkan!”

Bila mendengar jawapan. Semua jadi senyap sebentar. Saya sendiri kurang pasti apa yang saya rasa tika itu. Tergamam, terkejut, sedih malah geli hati pun ada. Tergamam dan terkejut sebab kali pertama jumpa kes luar nikah depan mata. Geli hati juga sebab jawapan yang diberi bukanlah yang diharapkan. Tujuan bertanya untuk dipastikan tempoh gugur, mungkinkah setahun yang lepas atau beberapa tahun atau bulan barangkali. Sedih kerana mungkin dalam keadaan kesakitan, pesakit terjawab perkara yang membuka pekungnya sendiri di depan staf-staf dewan bersalin yang agak ramai pagi itu.

“Dekat mana gugurkan?” tanya doktor lagi

“Saya gugurkan di klinik dekat bandar doktor” jawabnya

....

Astaghfirullahal‘azim.. Illegal abortion for an unmarried woman? For a muslim woman? and it's Malaysia, my country and my nation and my people? Oh yeah, fantasy has no place here not even anywhere in this world. Please self, don't be surprised. and maybe there's more to come (hopefully. not)

It's actually something that we expected. Human is human and to err is human right? We are human, so others. We all make mistakes. Our country varies, our skin varies, our family varies, our knowledge and understanding also varies then shouldn't mistake varies too?

(Eh, do you know that world population are divided into 4 major races namely white/caucasian, mongoloid/asian, negroid/black and australoid? and approximately 5000 ethnics group according to a 1998 scientific study. I just knew it.lol.)

But when it occurs right in front of my eyes, yes, i am surprised. semi-surprised or quarter maybe. Poor me for lacking of experiences.

Memandangkan masih terdapat cebisan uri yang tidak dapat dikeluarkan secara PV – per vagina) a.k.a VE – vaginal examination), doktor memutuskan untuk pesakit dihantar ke dewan bedah bagi membolehkan prosedur D&C – dilatation & curettage) dilakukan. Hasil ‘soal siasat’ lanjut daripada pesakit tersebut, ubat yang diberikan ketika disahkan mempunyai sakit thyrotoxicosis dan AF tidak diambil secara teratur. Malah ubat warfarin yang diberikan untuk AF langsung diberhentikan secara sendirian berhad.

Bahayanya kak! Jerit saya dalam hati. Syukur ajalmu belum sampai. Jangan kerana kejahilan sendiri atau mungkin tiada kemampuan untuk membeli ubat, rohmu berjumpa Tuhan dengan PE sebagai asbab (PE = pulmonary embolism)

Prinsip perniagaan dalam perubatan

Bayangkan anda dihampiri agen insuran ataupun promoter jualan. Pasti tebal telinga menadah mendengar kelebihan (dan kekurangan) produk yang diniagakan. Jika berminat, pasti ada soalan yang akan anda lontarkan bagi memastikan produk yang dibeli tidak membawa bersama tambahan penyesalan. The end result is mutual understanding between two parties. Win-win situation kata orang.

Bukankah dalam isu kesihatan ia perlu lebih lagi dari perniagaan barangan? Kerana yang didagangkan adalah nyawa. Yang satu itulah, tiada dua mahupun tiga. Mungkinkah silap pada doktor yang menerangkan? Atau pada pesakit yang menadah ibarat masuk kiri keluar kanan? Atau mungkin faktor-faktor lain yang terlampau panjang untuk dihuraikan. Sebetulnya, ia prinsip perniagaan dengan nyawa.

‘Menggaru’ masa depan

Ber’rotasi’ di dewan bersalin bagi semua petugas kesihatan khususnya pegawai perubatan merupakan satu kelebihan juga kerugian. Lebihnya kita menjadi ‘penyambut kehidupan’ si kecil tanpa ayah dan pendamping buat ibu yang fragile keseorangan menanggung seksa dan perit. Tapi, melihatkan kesibukan yang tidak henti-henti di dewan bersalin, tergaru sendiri. Apa agaknya kaedah terbaik untuk menjadikan peluang sebagai salah satu asbab rahmat untuk mereka kembali ke pangkal jalan? Hendak diberikan ‘tazkirah online’, boleh jadi itulah seburuk-buruk cara yang mungkin bisa membuatkan mereka ‘hilang’. Seakan menghukum sebelum dibicarakan. Bikin panas hati saja, kan?

Semoga kuat hati untuk menyampaikan, semoga rahmat dan ampunan Allah sentiasa untuk kami dan mereka, amin… Ihdina subulana, waghfirlana zunubana wa tawwafana ma’al abrar

P.S #1 : Banyaknya tanda soal. Huhu provokasi, provokasi.

P.S #2 : Kisah lama semasa berpraktikal, tergantung dalam simpanan bila dugaan datang.

OSCE Medicine (Final rotation)

Berikut adalah soalan yang telah kami hadapi untuk exam OSCE semalam :)

MINI OSCE

1. Gambar X-ray tangan. Diagnosis? Rheumatoid Arthritis

2. A woman comes with heavy menses. Gambar Blood Film Microcytic Hypochromic RBC. Diagnosis? Iron Deficiency Anemia.

3. CSF Analysis. Diagnosis? Bacterial meningitis.
2 lines of treatment : Antibiotic and steroid.

4. Man, (tak ingat age berapa), coming with fever, rash. Blood Film disertakan. Diagnosis? AML

5. Gambar Yellowish sclera + Red urine. Diagnosis? Hemolytic Anemia.
Why red urine? Hemoglobinuria.

6. CXR - Mass in the lung + Serum Na= 118. Diagnosis? - SIADH. (Untuk soalan ini, mungkin ramai yang bubuh Lung CA.)

7. Addison Disease. (tak ingat apa soalannya. Tapi serum ACTH high + others lab result)

8. ECG : SVT. Treatment ? IV Adenosine.

9. ECG : Inferior MI

10. ECG : Hyperkalemia

11. PFT : Bronchial Asthma.

12. A patient comes with dyspnea post-colectomy. CXR- normal.
Diagnosis? Pulmonary embolism. Further investigation: Spiral CT.

13. A woman comes with nervousness, weight loss. Next investigation? Thyroid Function Test.


OSCE

1. Patient come with cough. Take a history. Diagnosis? Pneumonia/TB (depends on station. Ada juga yang jawab acute pericarditis.:))

2. Patient come with vomiting + blood. Diagnosis? PUD. Others differential? Esophageal Varices etc.

3. Physical examination : 3 pilihan.
a) Examine abdomen.
b) Examine precordium.
c) Examine patient with acromegaly.

Sekian, wish us luck!!

Yang Pertama dan Terakhir ....

Bismillah

Internal Medicine
Rotation pertama dan terakhir saya sebagai pelajar ijazah perubatan di sini.


Kehidupan saya di alam klinikal bermula dengan rotation ini di Princess Basma Hospital pada September 2007. Hari pertama yang sangat mengharukan. Pesakit pertama yang saya temui- seorang wanita penghidap IBD (Inflammatory Bowel Disease)- Ulcerative Colitis. 'History' patient, saya dan seorang lagi pelajar Malaysia bersama 2 orang pelajar Arab, yang masih amatur, kami ambil dengan lompong-lompong yang sangat banyak untuk diperbaiki. Mujur doktor tidak menyuruh kami membentangkan kes.


Hari pertama juga, saya ingat, di hospital yang sama saya bertemu dengan seorang doktor pakar yang juga tenaga pengajar- Doktor Iman, mengadu tentang kesukaran mengambil history patient ketika itu.

Doktor Iman sangat baik, tangan saya dipegangnya, lalu dia berikan kata-kata nasihat dan semangat untuk saya berusaha dan jangan mudah putus asa.


Dan semalam... 15 April 2010, yang terakhir dalam diari saya sebagai pelajar ijazah perubatan

Kata Faezza : "Hari ini hari terakhir kita ambil history patient dalam Bahasa Arab"

Farah pula : "Waaa.. hari terakhir dah... dari hari first kita, sekarang dah hari last..." Bersama wajahnya yang sukar untuk saya tafsirkan, seolah sedang mengimbau langkah-langkah awal kami di alam klinikal sehingga sekarang.

Saya :

"Nak nangis la....." Satu-satu kenangan datang menerpa.
"Faezza, jom nak before balik hari ni kita round jap kat floor tengok patients...." . Ada benda seperti tak dapat dilepaskan, ada perasaan yang berat untuk diungkapkan. Rindu sudaaaah....terutama pada doktor-doktor pensyarah yang amat mengagumkan.

Teringat kata-kata Puan Zayyani setahun lebih yang lepas di ruang legar hospital

"This is our playground for 1 more year". Pandangannya dilepaskan jauh ke tengah ruang legar yang dipenuhi pelawat-pelawat dan pesakit-pesakit yang berurusan dengan pihak pendaftaran

Our Playground.... saya suka ayatnya. Our playground, tempat kita jatuh dan bangun semula, tempat kita 'bermain' dan beri sepenuh tenaga dan usaha... Kini, playground ini yang akan kita tinggalkan sebelum terjun ke dunia sebenar alam perubatan.

Beberapa langkah sahaja lagi.....



Sebulan ini dan selamanya.. kami pohon diberi kekuatan, ingat kami dalam doa kalian

CLASS OF 2010

FINAL EXAMS

28 APRIL - 27 MEI 2010

INTERNAL MEDICINE - 28 April

SURGERY - 5 Mei

OBSTETRIC AND GYNAECOLOGY - 12 Mei

PAEDIATRIC - 19 Mei

ORAL EXAMS - 23 Mei - 27 Mei

Allah jua Pemudah segalanya, dan yang Maha Memakbulkan setiap impian hambaNya...
Semoga setiap langkah kita dituntunNya.. Ameeen

Wallahua'lam

Katanya : "Nobody graduates as a doctor"

Bismillah

Iklan : 21 hari lagi- Final,
12 hari lagi- OSCE Internal Medicine


Hari itu seperti biasa kami menghadiri kuliah sesi petang untuk rotation Internal Medicine, rotation terakhir kami sebelum menghadapi peperiksaan akhir ijazah perubatan.
Paginya, seperti biasa- 'bed side teaching' bersama doktor-doktor pakar yang dikagumi sentiasa.


Petang itu, kuliah atau lebih tepat saya katakan seminar dan sesi perbincangan (kerana doktor bukan hanya memberi, dan kami hanya mendengar, tetapi ia lebih kepada sesi diskusi dua hala pensyarah dan pelajar) menyentuh satu tajuk penting yang akan kami hadapi di wad-wad kecemasan mahupun klinik-klinik pesakit luar apabila bekerja sebagai doktor kelak- "An Approach To Upper GastroIntestinal Bleeding"


Doktor bermotivasi tinggi kami gelarkannya. Beliau memang sangat bermotivasi, dan suka memotivasikan pelajar-pelajar perubatannya. Satu yang unik, beliau sukakan ilmu falsafah dan sangat suka berfalsafah. Setiap kata-katanya, kalaupun tak semua, pasti ada mesej yang tersirat yang ingin disampaikan. Dialah Doktor Khaled Jadallah- doktor kegemaran majoriti pelajar perubatan tahun klinikal.


Perbincangan petang itu dikendalikannya. Saya menyediakan diri dengan membaca beberapa lampiran dalam buku berkenaan topik berkenaan.

Doktor tiba dengan muka yang ceria dan penuh semangat, seperti kebiasaannya. Kuliah dimulakan dengan pertanyaan khabar dan sembang bual yang santai...Beliau tahu ini adalah rotation terakhir kami sebelum final menjelma dan sebelum memegang gelaran doktor.


"So.. how is your preparation?"

"Are you ready to be a doctor?"

Banyak la jawapan yang diterima. Suasana bising seketika.

Ada yang menggeleng, ada pula kuat suaranya kedengaran di belakang kelas.. "YES!"

Amboi, semangatnya ! Detik hati saya.

Doktor kembali bersuara.

"The fact is, nobody graduates as a doctor. Nobody!"

Hmm.. apa ya maksudnya..?

"There is a lot more to learn, by time you will pick up one by one, and you will sharpen your skill day by day. Through the journey, you will know the feeling of a real doctor"

Saya mengangguk, tanda setuju. Doktor menyambung lagi.

"What more important is you graduate as someone who knows the rules of safety..."

Rules of safety...

Kali ini saya menggangguk lagi, lebih bersemangat, lebih bersetuju.

Rules of Safety..

Ya, apa yang membezakan kita dan mereka di luar sana, ketika kes-kes berkenaan perubatan berlaku, ialah kita TAHU rules of safety.

Apa yang membezakan kita dan mereka di luar sana ketika mengendalikan setiap langkah dalam pengurusan pesakit ialah rules of safety.

Dan kita diletakkan dalam 'high expectation' oleh mereka di luar sana, sebagai orang yang memegang rules of safety yang tidak mereka pelajari

Teringat pula kata-kata seorang doktor

"and the BASIC MEDICAL DEGREE is more like a license to start to really learn how to manage and treat patients"


Ijazah perubatan yang dimiliki sebenarnya hanyalah satu lesen untuk kita praktiskan RULES OF SAFETY kepada masyarakat luar yang memerlukan. Dalam erti kata lain, ia adalah satu amanah yang diletakkan ke atas kita, pengamal perubatan.

Daripada langkah awal kita mengambil 'history', melakukan 'physical examination', merangka satu-satu 'investigation' dan teliti setiap 'management' . Jangan pula sampai tersalah 'diagnosis', terlupa pantang larang dalam mem'prescribe' ubat-ubatan, atau tersalah 'management' yang diaturkan, kerana kita yang keluar dari sekolah perubatan sepatutnya menyemat rules of safety kemas-kemas dalam minda dan hati. Jangan menganiaya.

Juga ketika dalam kes-kes kecemasan, apa yang perlu dilakukan dalam waktu sesingkat cuma. Mereka di luar memerhatikan, kita doktor yang selamat atau yang membahayakan..
Saya ingin sentiasa menjadi doktor yang berusaha menghadirkan senyum di bibir pesakit, bukan air mata kesedihan kerana kehilangan. Tapi kita bukan Tuhan. Kalaupun saya tak mampu menyelamatkan nyawa, saya sangat bermohon agar kematian pesakit, asbabnya tidak disandarkan pada saya, atau dengan kata lain, pesakit yang meninggal kerana kesalahan doktor yang merawatnya. P.E.M.B.U.N.U.H ?? Nauzubillah. Sekali lagi RULES OF SAFETY yang perlu disemat dalam minda dan hati.



ARE YOU READY?

Teringat kata-kata seorang pakar perubatan di Malaysia, ketika saya dan 'Aqilah mengikut ward round di wad perempuan.

"You are almost ready!"

Saya tersenyum. Gembira mungkin.. Tetapi, sampai sekarang saya terfikir..

"Betulkah aku sudah bersedia?"

Dari segi ilmu, kemahiran berkomunikasi dan mencungkil cerita pesakit yang membawa kepada diagnosis penyakitnya, kemahiran memeriksa, kebijaksanaan memilih dengan tepat pilihan 'investigation' yang bersesuaian agar tidak berlaku pembaziran, serta ketepatan dari segi 'management' dan 'treatment' yang pesakit perlukan.

Ya, tiada siapa yang akan keluar dari sekolah perubatan sebagai doktor yang serba tahu, serba banyak pengalaman. Hanya 'title' sahaja dipegang sebagai lesen mengamalkan kemahiran-kemahiran yang dipelajari. Sifat dan hidup sebenar sebagai seorang doktor akan kita kutip sepanjang perjalanan dalam arena ini.

Tapi, apa yang lebih penting, kita PERLU keluar dari sekolah ini sebagai ahli yang TAHU dan MAHIR dengan RULES OF SAFETY dalam perubatan yang perlu dipraktikkan, kerana tiada ruang untuk kesilapan, apatah lagi kesilapan yang membawa natijah buruk kepada pesakit yang meletakkan harapan..... There's no room for error.. Ooowh.. sungguh menakutkan.

Doakan....


Wallahua'lam

p/s- bersemangat bila tengok kawan-kawan menghafal setiap step lembaran-lembaran berwarna merah buku OXFORD HANDBOOK of CLINICAL MEDICINE-Emergency cases and how to manage them.. jom!

Doctors Alert !- ..and that day is actually very near..

Bismillah

A friend of mine have recently forwarded an email regarding a sudden mushrooming of medical schools in Malaysia. Quality vs Quantity. Read until the very last word.


MARCH 26 - Malaysia, a country with about 26 million inhabitants, boasts of 24 medical schools now.

Just a few years ago, the number was less than 10. In fact, when my eldest son entered medical school 10 years back, I could count the medical schools with my fingers. Now even with my toes and my fingers, I can no longer. Some of the names are so new that I, as a doctor, did not even know they existed until I did some research for this article.


The list is below:

Public universities:

* University of Malaya, Faculty of Medicine

* Universiti Kebangsaan Malaysia, Faculty of Medicine

* Universiti Sains Malaysia, School of Medical Sciences

* Universiti Putra Malaysia, Faculty of Medicine and
Health Sciences

* Universiti Malaysia Sabah, School of Medicine

* Universiti Malaysia Sarawak, Faculty of Medicine and
Health Sciences

* International Islamic University Malaysia, Kulliyyah of
Medicine

* Universiti Teknologi Mara, Faculty of Medicine

* Universiti Sains Islam Malaysia, Faculty of Medicine &
Health Sciences

* Universiti Darul Iman, Faculty of Medicine



Private Universities and Colleges

* UCSI University, Faculty of Medical Sciences - School of
Medicine

* Monash University Malaysia, School of Medicine and
Health Sciences

* International Medical University, Faculty of Medicine

* AIMST University, Faculty of Medicine and Health
Sciences

* Allianze College Of Medical Sciences, Faculty of
Medicine

* Management and Science University, Faculty of Medicine

* Cyberjaya University College of Medical Sciences,
Faculty of Medicine

* Royal College of Medicine Perak, School of Medicine

* Melaka Manipal Medical College, School of Medicine

* Penang Medical College, School of Medicine

* MAHSA University College, Faculty of Medicine

* Newcastle University Medicine Malaysia (NuMED)

* Taylor's University College, School of Medicine

* Utar

These are the medical schools in Malaysia. These schools, when fully functional, will produce about 4,000 doctors a year. There will be thousands more Malaysian doctors being produced overseas, since many Malaysians are studying medicine in the UK, Australia, New Zealand, India, Indonesia, Russia, Taiwan and even Ukraine.


The sudden mushrooming of medical schools is apparently due to shortages of doctors in the public sectors. This is because most doctors in government service resign after their compulsory services and opt for the supposedly greener pasture in the private sector.


In most other countries, the logical thing to do to counter this brain drain of doctors to the private sector is to find out why doctors are resigning from government service, and then try to address the woes of the doctors, and hopefully, keep them in service. I call this common logic.


The Malaysian solution, like in many other instances, does not take common logic into account but rather uses the sledgehammer approach. After all, we do have Malaysian logic, which is different from common logic practised in most other countries. For example, if we cannot have spacecraft of our own, we can still produce astronauts by sending Malaysians into space, hitchhiking on other countries' spacecraft.


In most other countries, the common logic will be to try to improve the working conditions in public sector so that doctors will stay back. But Malaysian logic is sledgehammer logic, and is very different.

If the doctors do not want to stay in government service, then Malaysia shall flood the market with doctors, so goes the Malaysian logic. Never mind that setting up of medical schools and training doctors are expensive businesses. We have petroleum and huge amount of development funds.

By building more buildings and buying expensive medical equipment to equip these medical schools, billions will have to be spent and, of course, in the Malaysian context, everyone will be happy, down from the planners, the contractors, the parents and all others involved, since
the perception is that projects in Malaysia inevitably will have some leakages and wastages, and many people are very happy with these leakages and wastages.

Never mind that we may have the hardware but we may not have enough qualified people to man these medical schools.


MALAYSIAN LOGIC

The Malaysian logic seems to be like this: If enough doctors are produced, the market will be saturated with doctors, and thus, doctors will have nowhere to go but to stay in government service.

Well, the people may be clapping hands and rejoicing that, with more doctors than are needed, medical costs will come down.

Unfortunately, things do not function like this in medical education. Experience in some countries tells us that some doctors in private practice, when faced with too few patients, will charge higher and do more investigations, some of which may not be needed. So instead of medical cost going down, it will go up.


QUALIFIED VS INEXPERIENCED TEACHING STAFF

In any advanced nation, the setting up of a medical school requires a lot of planning and is not done on an ad hoc basis. Planning must include where to source for experienced and qualified teachers; where to build new or source for existing teaching hospitals, which are big enough for the placement of these medical students to do training.

Planning such as facilities, equipment, classrooms, curriculum. In the west, it takes many years of training for a medical school to be set up; whereas in Malaysia, we see more than 10 in the last five years.

In Malaysia, due to the sudden "exponential" increase in medical schools, we have medical schools pinching staff from each other, even the mediocre ones. With that number of qualified teachers only, it is unavoidable that many teachers may not have the experience and qualification to be medical lecturers.



TRAINING HOSPITALS

The early birds (medical schools) are more fortunate. Their students are placed in bigger hospitals like the General Hospitals of Kuala Lumpur or Penang. Now, some of the medical schools just opened have to send their students to smaller district hospitals to do their training. The smaller hospitals are often manned by more junior doctors who are not qualified to be medical teachers, and these hospitals have only very basic facilities and equipment.



IT'S JUST A BEGINNING

This is just the beginning of the problems. For a doctor, graduating from a medical school is the beginning of a life long journey, and the basic medical degree is more like a license to start to really learn how to manage and treat patients.

The most important year after a doctor graduates is the houseman-ship. If a doctor does not have proper houseman training, then he would face a lot of problems later on.

He or she may know all the medical knowledge in the world (just for argument's sake, since knowledge of medicine is so vast that no one can know everything), but without the proper houseman training, he or she will not get the hand-on experience so crucial and important to doctors.


DISASTER !!!

A doctor without proper houseman training is not unlike a person who has only ever raced in arcade games, suddenly being asked to race in a real life race. He would not have the hands on experience to do well. A doctor without proper houseman training would be like a person given a license to kill, and a disaster waiting to happen.

Now, with 4,000 doctors being produced in a year, where do we find so many houseman positions for these young doctors?


NO ENOUGH PATIENTS

Even now, with some of the medical schools just starting and not yet producing doctors, and the number of doctors being produced is much less than the 4,000, the wards in
some of the bigger hospitals are filled with so many housemen that, in some wards, there are not enough patients for these housemen to learn management skills.

About a year back, I was told, in HKL some of the units have more than 20 housemen. Recently one doctor told me that in some units, it may have even more than that. I was aghast. Since with that many housemen in a single unit, and so few senior officers to guide them and so few patients for them to learn from, how are they going to learn the skill of doctoring?

When there is not enough training for these housemen, what do you think our policy planners do? In the typical Malaysian style, they increase the length of houseman-ship from a year to 2, hoping that the longer time will help to give better exposure to these doctors.

Compared to Australia, New Zealand, and United Kingdom, houseman-ship is still one year only. By increasing the length of the houseman-ship, it is a tacit admission that our one-year houseman training is not as good as the above mentioned countries.

A poorly trained houseman will become a mediocre medical officer, and since now most of the specialists are trained internally, it will be a matter of time before future specialists may not be as well trained as presently.


Many parents do not know about the actual situation and still encourage their children to take up medicine. They are not told of the actual situation. The day will come when there are simply so many doctors that none are adequately trained. There will come a day when a doctor graduating from a medical school cannot even be placed in a houseman position.

And that day is actually very near.


Copied and pasted from here..- The Malaysian Insider


Wallahua'lam

Action speaks louder than words

Bismillah

ONG- Rotation week
ONG Outpatient Clinic, King Abdullah University Hospital
Ultrasound Room

A mid- or late-thirties housewife, G4 P3 (read: this is her 4th pregnancy, with 3 children) , on her 18-19 weeks of gestational age (more or less, couldn't remember), attending her regular monthly antenatal care. She complained of decrease fetal movement 2-3 weeks prior, but few days ago (or 1 week ago), she couldn't feel any of the fetal movement.


Doktor pakar memulakan pemeriksaan ultrasound. Sudah dapat dilihat pada skrin bentuk tubuh janin yang diperiksa. Doktor mengambil ukuran-ukuran yang sepatutnya (biparietal diameter, femur length, abdominal circumference). Ada tanda tidak menyedapkan hati.


Gambar hiasan


Ukuran yang sepatutnya menunjukkan umur kandungan dalam jangkaan 19 minggu ke 20 minggu, menunjukkan angka 17 minggu dengan ralat 'plus minus' beberapa hari. Eh, janin tidak membesar berbanding scan yang dibuat pada appointment antenatal care sebelum ini. Sepatutnya janin membesar berkadar terus dengan umur kandungan.

Doktor memeriksa lagi, kali ini mahu mencari denyutan jantungnya. Hmm.. betulkah ini? Cari lagi... hmm.. teliti lagi scan tu...

Lama juga ketika itu, saya tahu bukan doktor tidak terjumpa di mana jantung bayi, tapi ada perkara yang lebih besar yang doktor lihat- tiada denyutan jantung pada janin. Ketiga-tiga kami (the specialist, the resident, and the student) senyap. Dengan tiba-tiba doktor bersuara,

"We need someone to lie...."

Saya terkesima.. Adakah beliau tujukan ayat itu kepada saya..?

"Regarding the absence of fetal heart beat?"

"Definitely, that is our matter right now"

Saya tahu dia sedang bergurau ketika dia nyatakan yang kami harus menipu.

Selepas dialog itu, suasana kembali bisu. Kami bertiga memandang skrin ultrasound macam nak masuk ke dalam skrin (kami bertiga..? mungkin hanya saya yang kelihatan seperti mahu masuk ke dalam skrin, excited dan curious sangat). Senyap lagi beberapa ketika, mungkin masing-masing sedang merangka ayat untuk diberitahu pada si ibu.




Namun tiba-tiba si ibu bersuara....

"Anything wrong, doctor?"

Pertanyaan dalam wajah yang tidak tahu untuk saya gambarkan. Risau, dan ingin tahu bercampur dalam riak tenang wajah seorang ibu. Akhirnya, itu memudahkan kerja kami apabila si ibu sendiri yang dapat menghidu suatu yang tidak diingini. Kami hanya perlu menjelaskann sepenuhnya keadaan sebenar selepas ibu bertanya. Dia mungkin sudah bersedia mendengarnya.


ACTION SPEAKS LOUDER THAN WORDS

Kami tidak perlu memulakan bicara pada awalnya. Sikap kami yang menimbulkan tanda tanya
merupakan satu petanda. Doktor pakar yang selalunya tidak sampai 5 minit memeriksa perkembangan janin yang membesar dengan baik, mengapa kali ini mengambil masa labih lama? Mengapa pula si pelajar perubatan ini berkerut dahinya serta wajah doktor MO yang seolah sedang fokus melihat dan mancari sesuatu dalal skrin ultrasound itu.

Perbuatan kami seolah-olah satu pemberitahuan tanpa suara untuk si ibu cuba faham ada sesuatu yang tidak kena, dan cuba untuk bersedia.

Dia redha....


BREAKING BAD NEWS AND A WARNING SHOT

Seorang pakar Family Medicine, pernah sekali menerangkan kepada kumpulan kecil kami apabila ditanya oleh rakan sekumpulan tentang kaunseling dan "breaking bad news".

Give a warning shot....




Apa itu?

Tembakan amaran?

Tembakan amaran tanpa bunyi tanpa suara....


Dalam sesi kaunseling doktor dan pesakit yang diatur, satu cara memberi petanda kepada pesakit tentang berita buruk yang akan diterima tentang masalah kesihatannya dengan REMAIN SILENT....





Wujudkan satu suasana hening dan sunyi dalam bilik itu, duduk di atas kerusi anda dan pandang dengan penuh empati (bukan dengan muka melepek nak nangis, ye) sehingga pesakit sendiri dapat menghidu sendiri ada sesuatu yang tidak kena, dan dia harus bersedia. Kalu boleh tunggu sehingga pesakit yang memulakan bicara... tapi kalau dah lama sangat senyapnya, pandai-pandailah anda sebagai doktor yang bersuara...
Jika pesakit menangis, biarkan, biarkan selama mana dia mahu menenangkan diri. Anda perlu menjadi doktor yang penuh dengan empati...


Saya tidak pernah menghadapi situasi "breaking bad news" ini. Tapi cara doktor menjelaskan, membuatkan saya rasa, ia satu perkara yang berat untuk setiap doktor (dan pesakit sudah tentu) untuk menghadapinya. Susah juga....
Cara kita menjelaskan, cuba memahami perasaan pesakit, sedikit sebanyak membantu pesakit membina emosi yang positif dan bertindak dengan rasional serta tidak melulu (seperti bunuh diri atau sebagainya- memang ada kes macam ni...)

Saya mahu menjadi doktor yang penuh dengan empati (empati tidak bermaksud saya akan turut sama mengangis di hadapan pesakit).


BUKAN BIDANG PERUBATAN SAHAJA

Action speaks louder than words. Paling penting dalam hidup seharian, anda diperhatikan. Sama ada anda menjadi da'ie yang mengajak kepada kebaikan, atau menjadi contoh kepada keburukan. You choose....

Wallahua'lam

Medicine: A common and not so common sense

Bismillah

Everything needs explanation. Ironically, sometimes it's just too simple that it becomes too hard for people to reach the answer. The same goes for medicine...

Medicine.. ada sesiapa yang rasa senang? Tapi, tak semuanya susah, kan? Jangan terkejut, bukan sedikit penjelasan terhadap beberapa fenomena perubatan adalah berdasarkan ‘common sense’, senang sahaja untuk difikirkan… logik..

Tetapi hati-hati, banyak juga penjelasan terhadap sesuatu perkara dalam bidang ini yang bergantung kepada prinsip-prinsip dalam disiplin-disiplin perubatan yang kompleks (you name it- pathology, physiology, biochemistry, anatomy, pharmacology and so on..), yang tidak boleh diinterpretasikan sebagai ‘common sense’ (of course, you need KNOWLEDGE on it!)

OPENING STORY

Saya mulakan topik dengan satu cerita menarik yang saya petik daripada sebuah buku kegemaran saya "Life Is An Open Secret", lucu tetapi ada mesej penting yang ingin disampaikan.

Read on…

Fred and Mabel were both patients in a mental hospital. One day, as they both walked beside the swimming pool, Mabel jumped into the deep end and sank to the bottom. Without a thought for his own safety, Fred jumped in after her, brought her to the surface, hauled her out, and saved her.

The next day happened to be Fred’s annual review. He was brought before the hospital board, where the director told him,

“Fred, I have some good news and some bad news; the good news is that, in light of your heroic act yesterday, we consider you sane, and you can be released from this home back into society.

The bad news is, I’m afraid, that Mabel, the patient you saved, shortly afterwards hung herself in the bathroom with the belt from her bathrobe. I’m sorry, but she’s dead ”

“She didn’t hang herself, ” Fred replied, “I put her there to dry”.

~ Huh…??

Itulah dia si pesakit mental dan pendapat yang kuat dipegangnya...

COMMON SENSE

Situasi 1 : Oktober 2006, Bayt Raudhatus Saadah, Topik perbincangan- Carpal Tunnel Syndrome

Tengah-tengah bincang dengan seorang sahabat, dia bertanya..

"Kenapa ye carpal tunnel syndrome ni kebanyakannya kat tangan kanan"

Saya menjawab "Sebab orang kan ramai yang guna tangan kanan"

Kawan tergelak "Kesian patient Sarah nanti..." (mungkin sebab simple sangat jawapan)

Saya pun gelak sama..

Tapi tak lama lepas itu saya mendengar penerangan doktor, mengapa incidence carpal tunnel syndrome

kebanyakannya pada tangan kanan pesakit. Benar ! Doktor menjelaskan, manusia kebanyakannya menggunakan tangan kanan sebagai tangan dominan, maka ia lebih cenderung untuk bermasalah seperti masalah carpal tunnel syndrome ini. Tambahan, patient yang memang tangan kanan sebagai tangan dominan, berbanding tangan kiri yang kurang digunakan akan cepat perasan perubahan pada tangan yang selalu digunakannya..

Ooo.. COMMON SENSE

Situasi 2 : Blue hall, ONG rotation 2009, Malpresentation Seminar, subtopik-breech presentation (bayi songsang- presentation kepala di atas). Pastilah banyak sebab-sebabnya, tetapi...

Most common cause of breech presentation is PREMATURITY

Doktor bertanya "WHY..?"

Semua pun cuba la memerah otak cari dari sudut saintifik.. akhirnya doktor bersuara

Sebab bayi ketika belum cukup bulan (premature) kebanyakannya masih belum mengambil presentation yang sepatutnya iaitu kepala ke bawah, disebabkan pertumbuhan yangmasih belum sempurna sepenuhnya, dan jika dbiarkan ia matang (term), bayi yang sempurna pertumbuhannya akan mengambil presentation yang normal- kepala di bawah. Ini menjelaskan kebanyakan keadaan pra matang (premature), menjadi sebab paling utama bayi dilahirkan songsang..

Saya tersenyum, nak tergelak pun ada.

Situasi 3: Sambungan seminar di atas.

Presentation of breech fetus can be one of these : Frank breech, complete dan incomplete breech

But the commonest one is frank breech!

Doktor bertanya lagi.. "WHY..??"

Memang semua doktor pengajar suka, kan perkataan "WHY" ni?

Semua orang pun cuba la menggunakan kuasa minda

Cuba perhatikan keadaan bayi dalam presentation frank breech, dan bandingkan dengan bayi breech yang lain. Yang mana ada tendency untuk bergolek menjadi normal cephalic presentation? (kepala ke bawah).

Complete breech mempunyai highest tendency untuk berpusing menjadi normal presentation, incomplete pula walaupun tidaklah semudah complete masih mempunyai tendency berpusing menjadi normal presentation.

Bagaimana dengan frank breech? Bayangkan anda dalam satu kantung. Kaki pula melunjur ke atas. Boleh bergerak? Boleh berpusing? Samalah juga dengan bayi dalam keadaan frank breech. Tiada kemungkinan untuk berpusing mengambil tempat presentation yang normal. Maka bayi yang frank breech presentation, akan remain in breech presentation until delivery....

Ooo..

Situasi 4 : Blue Hall, ONG Rotation 2010, Congenital Anomalies Seminar, subtopik- Neural Tube Defects

(Bayi yang mengalami penyakit ini, selalunya- bukan selalunya, sememangnya akan membentuk satu posisi dipanggil extended neck di dalam rahim (kepala mendongak sedikit). Ketika lahir juga begitu,kerana ada kaitan dengan neural tube defect )- lihat gambar sebenar di atas (bayi atas ni bukan saja-saja nak mendongak ye.., tapi apepun posisi dia sangat cute!)

Doktor mengajukan pertanyaan

One of common intrauterine presentation of neural tube defect fetus is polyhydroamnions (air ketuban

banyak)

WHY...?

Ramai-ramai menjawab (macam lebah), seperti sepakat kami semua

"Because there is a defect in swallowing mechanism related to the defect of the nerve"

Doktor tidak terus mengiyakan atau menidakkan jawapan kami. Tetapi doktor menyuruh kami membuat

simulasi.

"Sekarang semua cuba extend kan kepala kamu",doktor memberi arahan.

Apa lagi, semua pun cuba la mendongak ke langit.

"Sekarang, cuba telan air liur kamu, susah, kan?"

(Cuba la buat..) Susah-susah-susah

Jadi, penyumbang kepada air ketuban yang banyak dalam rahim ibu (polyhydroamnions) yang disebabkan oleh bayi dalam rahim yang tidak mampu menelaan air ketuban (ini adalah physiological process- bayi akan menelan dan membuang air untuk memastikan komposisi air ketuban dalam kuantiti yang normal), disebabkan oleh extended neck menyukarkan proses 'swallowing' untuk berlaku.

Situasi 5 : ONG 2009 Group C OSCE. Taking History station- Genital prolapse.

Tengah berusaha bertanya segala yang boleh dalam history, doktor pun mencelah (me

mang banyak kali pun doktor mencelah)

"Do you think smoking can be one of the causes of genital prolapse"

"Yes!" Saya menjawab.

"WHY..?"

Semua orang pun boleh jawab dengan common sense...

"Chronic cough!" Tak payah susah-susah fikir dari sudut chemical apa yang bahaya dalam rokok yang boleh menyebabkan genital prolapse

Situasi 6 : ONG Clinic Hall- Seminar of approach to abnormal cervical smear, 2010

The incidence of cervical cancer increases in women using combined oral contraceptive pills (COCP)- pil pencegah kehamilan (mengandungi 2 hormon utama- estrogen dan progestogen)

Any explanation?

Tak payah susah-susah fikir- adakah di situ terdapat tindakbalas hormon estrogen yang meninggikan risiko kanser pangkal rahim (cervical cancer)sepertimana estrogen memainkan peranan penting dalam meninggikan risiko malignant breast disease dan hepatic adenoma?

Doktor beritahu...

Cervical cancer sebagaimana kata-kata doktor Fayez Jallad- merupakan kanser of sexual transmitted disease/sexual intercourse. Jadi wanita yang mengambil COCP sebagai pil pencegah kehamilan akan meninggikan tendency untuk melakukan sexual intercourse yang kerap, dan ini meninggikan risiko cervical cancer.

Situasi 7: Morning ward round, wad lelaki Medical Department, bersama seorang doktor yang hampir pakar (bukan Dr Kow), dan doktor-doktor MO yang lain.

Tiba di satu katil pesakit yang ada multiple disease (tak ingat pakcik tu sakit apa). Bila dah banyak sakitnya, banyak la pula ubatnya, kan..?

Doktor memulakan pertanyaan

Banyak ubat kita bagi. Tetapi kenapa kita kena beri warfarin pada pukul 7 malam setiap hari?

(Saya tidak mahu memberi jawapan, anda boleh fikir sendiri..) Bila fikir-fikir, ala.. doktor it does not make any difference if we give at 6 pm everyday, provided it is given in the evening.. but why must it be given in the evening..?

YANG BUKAN COMMON SENSE: hati-hati

Family Medicine 2009, Klinik Doktor Wael Markaz Sihhi- Topik: GERD and heartburn

Di tengah perbincangan, doktor mengajukan pertanyaan

"Why is a pregnant woman usually complaining of heartburn and regurgitation?"

Ooo.. cuba lah common sense

"Because the abdomen is enlarged, and it presses on the stomach and the gut"

Ramai yang jawab macam tu

"NO!"

"What kind of hormone increases in pregnancy?"

"Estrogen and progesterone"

"What are the effects of progesterone? Progesterone is known as a smooth muscle relaxant, and in case of heartburn and GERD in pregnancy, there is a lower esophageal sphincter relaxation as an effect of high progesterone"

Huhuhu... Mungkin anda ada yang berfikir begitu, tetapi ia langsung tidak terlintas dalam fikiran saya.

Yes, you need knowledge on it!

Untuk yang bukan common sense ini, pastilah sangat banyak contoh yang boleh dikemukakan. Untuk itu rujuk buku, sumber ilmu...

Kesimpulannya...

Jangan selalu sangat fikir common sense, takut-takut anda dikategorikan seperti pemuda dalam kisah di atas tadi, yang bergantung kepada common sensenya - benda basah.. kenalah keringkan, jemur..jadi gantungla...~

Tapi jangan pula lupa kadang-kadang jawapan kepada persoalan "WHY.. ?" dalam perubatan adakalanya semudah logik akal.

Dan berbalik kepada realiti kita sebagai hamba, Allah jadikan semua di alam ini bersama explanation untuk setiap soalan "WHY" yang timbul atas setiap penciptaan. Tinggal manusia sahaja yang mahu atau tidak untuk mencari, bertafakkur, dan berta'aqqul menghayati kebesaran ALLAH.

“Dan Kami tidak menciptakan langit dan bumi dan apa yang ada antara keduanya dengan bermain-main.”Ad-Dukhan [44]: 38

Wallahua'lam