Thursday, December 2, 2010

Husband & Wife

I'm really touched....tears almost drop from my eyes.

She is a known case of cervical cancer stage III, and now it's already spread to her acetabulum.Because of massive disruption of hip joint, walking without pain is almost impossible.Yet, she seems to be strong enough.She even can give me smiles..and what really touched me is her husband always gives her full supports,motivations, helping her in ambulation.CINTA TANPA SYARAT.

Sadly, nothing much we can do for her.Main treatment now is palliative care, no more curative.The survival chance is poor.I pray to Allah, may He bless them two husband and wife, and unite them in paradise,insyaAllah.


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Friday, October 22, 2010

7th Asia Pasific Meeting

Praise to Allah.

A journey to Kuantan on last few days was really meaningful.Attending international course - 7th Asia Pasific on Diabetic Limb Problem Meeting at UIA auditorium has brought in confidence to myself.

Me, myself the only doctor accompanied by one sister and two nurses were the representatives of wound team of HRPZII.The last minute plan ended up with a journey by bus.Never mind..as long as we reached there safely,it was good .Being in the new place, was quite challenging.It was hard to find proper comfortable room to stay in.Most of the rooms were already booked..preserved.We didn't expect that actually.Alhamdulillah, at last we got one.Shahzan Inn.RM 140 per night worth it enough.

Many speakers were invited.All of them were really expert in dealing with diabetic foot.We have those from Hong Kong, Australia, India, Singapore and Indonesia professors delivering a very fantastic presentation.The utmost attractive part was the workshop where we could learn directly from real life and situation, how to handle each patient with problematic diabetic limb including assessment of wound and the best choice of dressing need to be offered.

And now HONEY is officially approved internationally as one of the best material that can be used to manage diabetic foot.What Allah says, definitely TRUE !

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Saturday, September 4, 2010

Man or Woman

"Assalamu'alaikum Doctor, I'm Dr Redza, would like to refer to you one case of Brachial Plexus injury " She..actually he is........

" oh ya...sure.You may send him now."

That was the conversation between me and one of the medical officer in district hospital last week.When I heard the word 'brachial plexus injury' , I know already that I'll encounter an interesting and rare case for that day.Hmm...Alhamdulillah Allah wants to teach me something.

2 hours later, I got a call from A&E.

" Dr Hidayah, patient with brachial plexus injury already arrived here.Are you going to see him at casualty ? "

" yah...I'll go down now.Thank you."

At first glance, I thought the patient was a female, but suprisingly the name written in the card belonged to a male...ya it got bin, not binti.Huh..realy, it challenged me already.Now in my mind, suspicion came the first.

His neck was kept in left lateral position.He said he it was very painful to move his neck towards normal.He was unable to move his left upper limb and the sensation lost.Basically the neurology involved was from C5 to T1.

It sounds like he realy got some injury towards brachial plexus.Maybe the high velocity accident strecthed the nerve root which result with loss of motor and sensation around his unilateral upper limb.I need to consult bos now...

" Mr Aaron...Hidayah here,I need your opinion.Would like to show you a patient who suspected to have brachial plexus injury "

Mr Aaron is a very nice orthopaedic speacialist.He is generous and kind, always willing to help..and most of the time when we see him, he gives us smiles.

" well..Hidayah.I don't think he injured his brachial plexus.I think more of psychological.You see...when I passively flex his elbow, he actually can resist me.But never mind we'll see him again in 2 weeks time, see how he progress."

Hmm...my suspicion turned to be true anyway.Quite a number of patient have psycogenic component in their complaints.But as a doctor, we try not to put that as the first diagnosis.In this case, the apperance of a patient may give us a lot of clues,how a man could have lipstick on his lips, and he definitely was wearing a female cloth !

Subhanallah...




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Sunday, August 15, 2010

Fasting month

Beutiful Ramadhan.

Are you still nil by mouth ? your operation need to be delayed,sorry for that.

"No, Doctor.I just finished my last slice of bread just now."

OH...I thought you're still fasting, ya...in this beutiful Ramadhan.

"Doc...I feel like very ill today.I can't."

Ic.....


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Have a barokah day, uncle !

" ya doc, thanks a lot.

Uncle still fasting,right ?

" for sure doc, we're in ramadhan month.Either i will be called up for operation or not I'll still keep fasting "

Alhamdulillah....very good, uncle.Keep it.

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Two different occasions with two different patients that I encountered.Taking things for granted, sometimes we don't realize.Ya Allah....please do bless us.

Friday, July 23, 2010

Nice Experience

Last week was so wonderful.Alhamdulillah...Allah gives me chance to operate plating of femur for my first experience under senior guidance, Dr Anuar Ramadhan.Learning process needs hard work, patience and motivation.Belief to yourself, be confident insyaAllah He will lead you throughout the way.

To plate a femur, for a thin young man, usually not so difficult.We may begin with place our patient in lateral position, putting the fractured limb at the uppermost on the operation table.Locate his greater trochanter, and move superiorly to find tip of it.Then incise the skin in line with that mark, only do at the area that need to be exposed.The first that you will see after subcutaneous tissue is tensor facsia lata.Do another incision to this fascia until you find vastus lateralis muscle lying beneath.Split this musle by blunt incision until reach the bone.Once femur identified, use retractors to lift up the bone.Then you may now begin plating !

Sounds easy, but be careful with perforater vessels around.Ligate or coagulate them to control bleeding.Like what Dr Anuar told me, to do open reduction is the most difficult part in this operation.Imagine the fractured site as a jingsaw puzzle, then try to fix the bone as complete as possible to replace it back to the normal alignment.Once able to reduce, maintain with bone holder.Select your plate size and start making holes for the screws.Before closing, make sure tighten all the screws first to reduce risk of implant failure.

Lots of energy needed, indeed.So prepare yourself fisrt before entering operation theathre ! All the best.

# Thanks a lot to Dr Anuar Ramadhan for your kindness and supports.May Allah bless you all the while and helps you to become a good excellent orthopaedic consultant one day, insyaAllah.

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Friday, July 16, 2010

Appreciate your limbs !

It is hard to meet a day without MVA ( motor vehicle accident ).So it is almost impossible for me now to do oncalls without case.Sometimes the numbers reached up to total 25 cases only in one day !

But, Alhamdulillah Allah gives me strength.I like orthopaedics.I like dealing with bones, muscles, fresh blood, and even maggots in diabetic foot !
Really, Allah is merciful.I learn many things in this posting.How I'm feel very lucky to have complete four limbs while certain other people have to sacrifice their leg.Human only appreciate things when that things lost...na'uzubillah.

Be careful my brothers and sisters.Drive safely.I've already seen many cases here, don't follow them.Please pray before you drive, and keep zikrullah while you're driving.When your limbs get fractured, then it will create problems.Think about people around you, your mum, father who realy concern and care about you.Don't burden their life because once you fractured, you need somebody to help you moving and that's the time they have to sacrifice themselves for you.At least...

Last week, a man around 60 years of age, underwent above knee amputation.Pity on him, he actually still in denial state.He could not accept that he will lost his limb untill his son managed to counsell him.When I was in the operation theatre room, Dr Zubir's initial plan was just wound debridement even in the consent written KIV AKA.At last we found that the infection was very bad and spreaded up to above knee then AKA was proceed.We did in spinal anaesthesia, so the man actually knew that we were operating him in the OT during that time.He kept asking for cold drinks even before we put him on the table and continue mumbling until the time we cut his left limb into two.Alhamdulillah...the operation was successful.

Knowledge is wonderful.It is.

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Saturday, June 19, 2010

AAA

People keep coming.My watch showed 2.15 o’clock am.It was so cold that night, my coat still could not bear it.The chills that flow through the whole body made me sometimes dveloped rigors.

It was the time I just was to close up my eyes for a little while, then my ears cought a sound that stopped me to go into sleep.A man, around 60 years old, medium built was being pushed on a bed into yellow zone.He kept screaming in pain, as if trying to tell others that he realy need help.

He looked restless.I couldn’t get the proper history if he continued to be like that.My senior medical officer then told me to give him injection of Tramal (pain killer ) first.Until then, I managed to find out what is actually the reason that brought this patient to the hospital in that middle of night.

He was a 59 years old man, chronic active smoker with no known medical illness before.The main complaint was abdominal pain and left lower limb pain and weakness.He described the abdominal pain as a generalised, and the limb pain radiated from the loin area down to the thigh and calf.He couldn’t move even a little of his left lower limb.He looked very ill,restless,realy in poor perfusion, but not pale. The abdomen was so distended, generalised guarding and the left lower limb was colder and dusky in colour.There was hardly pulse palpable even left femoral artery. My senior didn’t feel good with his condition then he was immediately transfer into red zone -for critical ill patient.

FAST done.The liver is floating ! fluid accumulated in the Mourison’s pouch and splenorenal area.Aorta measured, and the diameter measured 5 cm.Now, condition looked worsening.My senior started thinking about aortic aneurysm.Blood pressure remained normal.Suprisingly, hemoglobin count came out as much as 20 ! This certainly made us confused.If leaking aneurysm was all about, the count should not be as high as that, it should be the other way around.

At this level, we could hardly think more to come towards diagnosis.Without hesitatation, specialist was called on the spot.Presenting all the progress, the only thing that could explain was still possibility of aneurysm.The dilatation of the aorta might be already spreading down to the Iliac vessels and this could interrupt the blood flow to the lower limb, either affecting one limb or both.Thus, his left lower limb now was in danger ! The vascular surgeon need to be consulted at once, if not, he might loss his limb in just few hours.

He was then be referred to the HUSM for further evaluation, KIV for angiogram.During passing over at 8 o’clock am on the same day, he was still in red zone.My duty on that day almost finished.However I felt quite guilty to leave him with this current condition.But my eyes could hardly opened anymore.I have to...

People always coming...and people always leaving.

Sunday, May 2, 2010

'Per vaginal bleeding'

Subhanallah...Maha suci Allah dari segala sifat kekurangan.

Hari ini post-call.

Satu malam yang indah berlalu.Keindahan yang punya makna tersirat.Malam yang hening dan agak sunyi berbanding malam-malam oncall sebelumnya.Penyaman udara yang sejuk mahu sahaja membuatkan diri terasa beku.Pesakit yang datang mendapatkan rawatan bermula jam 10 malam mungkin tidak sampai 50 orang.Bolehlah melelapkan mata buat seketika.

Lebih kurang jam 3 pagi, muncul seorang wanita ditolak dengan kerusi roda masuk ke zon kuning.saat beliau ditolak ke katil hujung , hati sudah dapat mengagak " tentu kes 'abortion' ".

Umurnya masih muda,tubuhnya juga kelihatan bertenaga.

" Akak kandungan ke berapa ini ya ? " soal ummu.

" kedua....akak tak ingat tarikh akhir haid ( last menstrual period ), jadi akak tak berapa pasti kandungan ini berapa minggu " balasnya.

" akak datang sebab pendarahan ya ? " soalan-soalan terus ditanya untuk mengetahui diagnosa pesakit.


" ya...hampir separuh kain sarung basah dengan darah,ada juga sakit perut sikit-sikit.Saya gugur ya doktor? " tanyanya penuh raut kerisauan.Dahinya sedikit berkerut.

" belum pasti lagi ya kak, kita scan dulu dan kita cek jalan ya ".Moga jawapan ummu boleh memberi sedikit harapan padanya.

Sewaktu perutnya discan dengan mesin ultrasound, ummu dah boleh mengagak beliau kemungkinan besar telah mengalami keguguran.Nadi jantung bayinya sudah tidak kelihatan.kantungnya juga sudah nampak abnormal.pemeriksaan diteruskan dengan memeriksa 'vagina.

" staff nurse tolong suluh lampu ya."

Saat ummu melakukan ujian 'perspeculum' ke atasnya, kelihatan fetus (bayi)sebesar jari kelingking keluar melalui speculum bersama darah merah.Justeru sahlah beliau telah gugur.kemudian terdengar staff nurse bersuara;

" doktor...itu apa? dia twin la...aha,betul.Tu..ada sorang lagi keluar "

Terkejut juga ummu .Disangka hanya seorang, single pregnancy, rupa-rupanya Allah mengujinya dengan dua janin.Subhanallah, kasihan melihatnya.Mujurlah ibunya tidak apa-apa bila melihat dua bayinya yang sudah cukup lengkap tangan dan kaki terkumpul dalam 'kidney dish' bersama darah.Tidak mengapa akak... Allah itu maha pemurah.Pohon lagi doa untuk zuriat akan datang.Umur masih muda.



Lihatlah betapa kerdilnya kita.Dulu kita hanya sebesar jari kelingking,kini Allah telah anugerakan tubuh badan yang sihat juga akal untuk berfikir.Amat tidak berhati perut kita jika perintaNya diabaikan,dan melakukan pula perkara-perkara yang mengundang kemurkaanNya.

Sedih hati ibu bila mengetahui anak keguguran...sedih lagi hati ummu saat merawat pesakit yang datang ke hospital kerana komplikasi menggugurkan anak secara sengaja tanpa ada apa-apa keuzuran syar'ie yang membenarkan 'pembunuhan' anak kecil dalam perutnya.Firman Allah s.w.t :

" Jangan sekali-kali kamu membunuh anak-anak kamu karana takutkan kemiskinan kerana kami yang memberi rezeki kepada mereka dan juga kepada kamu, sesungguhnya membunuh mereka adalah dosa kesalahan yang besar " { Al-Isra' : 31 }

Beranalah beramai-ramai kerana Nabi kita berbangga dan bergembira dengan jumlah ummatnya yang ramai di hari kiamat, seperti hadith riwayat Abu Dawud, Nasa'i dan Hakim ;

" Nikahilah perempuan yang mencintai lagi subur ( dengan nasab yang banyak melahirkan anak ) sebab aku bangga dengan banyaknya pengikut sebab kalian sebagai umat kelak di hari akhir "

Saturday, April 17, 2010

Muqaddimah

Assalamu'alaikum warahmatullah wahai pembaca budiman sekalian.

Setinggi-tinggi pujian untuk Allah kerana mengizinkan penubuhan rangkaian blog kedua ummu.Selawat dan salam atas junjungan besar rasulullah s.a.w serta para sahabat dan pengikut baginda sehingga hari kiamat.

Blog ini khusus diwujudkan untuk perbincangan dan perkongsian ilmu Allah di bidang perubatan dan kesihatan.Mengambil hikmah pengajaran dan perintah Allah untuk menyampaikan segala apa jua ilmuNya yang bermanfaat untuk disebar-sebarkan.Ummu doakan moga beroleh keberkatan.

Segala cadangan, perkongsian, pertanyaan yang bersangkut paut perihal 'Tibb' atau perubatan ini, ummu alu-alukan.Bersama kita selusuri khazanah Allah yang maha agung.Ma'rifatullah melalui keajaiban penciptaan manusia itu sendiri.

Selamat memeriahkan !