my blood

i went for check up last week, and i went to discuss the results just now.

my transferrin is quite high 3.2 ( normal is 1.7-3.0 )
its saturation is quite low 11 (normal is 15-50)
ferritin is very low - 12 (normal 20-350)

so i was prescribed with iron tablet.

the shocking news was that my testosterone is at the very high end of the normal range. the sex hormone binding protein is quite low. thus my free testosterone is 66.37 (normal is 3-37).. hahahh that explains all... but nothing to be worried abt.that's not sth bizarre altho not normal. it might be because of my extreme iron deficiency that signals to stop more blood loss. who knows. there's a lot more to be revealed in the world. Allah knows all.


~shiapa yg tahu akan sama hatimu dan hatiku~

Jangan Bilang Tidak

Ku pernah punya cinta namun kini ku sedang suka kamu

Cintaku dulu tlah kubuang jauh kini ku ingin kamu

Ku pernah menyendiri di sini ku akan terasa sepi

Walaupun bibir penuh gelak tawa namun hatiku sepi


Jangan bilang tidak bila kita belum mencoba

Siapa yang tahu akan sama hatimu dan juga hatiku

Banyak yang bercinta bertahun-tahun putus juga

Kuharapkan dengan dirimu walaupun singkat pendekatan

Cinta kita kan abadi

Ku pernah punya cinta namun kini ku sedang suka kamu

Cintaku dulu tlah kubuang jauh kini ku ingin kamu

Jangan bilang tidak bila kita belum mencoba

Siapa yang tahu akan sama hatimu dan juga hatiku

Banyak yang bercinta bertahun-tahun putus juga

Kuharapkan dengan dirimu walaupun singkat pendekatan

Jangan bilang tidak waktu dicium aku bingung

Namun dada ini bergetar

Makanya sungguh aku mohon

Jangan bilang tidak

2nd week

i'm all stressed out bcoz it's already sunday morning
and i havent spent more than 10mins on any pages of any book.
and right after this i'm going bbq,
then discussion will be until 8.30 but probably later than that.

~soo many things to do~~

brg2 spatutnye

i thought i saw the 'wedding cake knives' in quite a few places last yr, but when i actually want to buy it, it's nowhere to be found. i planned to buy 2 of them.one for me and one for mc ah.

so yesterday i went to one of the store on clayton rd which i dont even know the name but they are selling all the wedding and christening stuff. i 1stly picked just 1 'stacked cake plate' or whatever the name is, but then as i go around, i ended up picking another of the stacked plate, cake stand,porcelian tea set,and 2 square bowl. and everybody knows why i need them... huhuhuhu.. i'm all prepared~~

woke up late
missed subuh
tk sedap hati
need to go to the city


astarfighullah.

the longing

i'm finding 3rd yr quite fun so far.
or maybe it's too early to say that.
'penyapu baru' la katakan.

~sgt2la tak sbr menunggu sbulan lebey lg~
~hmmm.. sbrlah ye~

this longing is taking its toll on me

bofren saye jauh

the title doesnt have anything to do with what i'm thinking now.that was just the 'quote' that i used as an excuse when L asked whether i've got any cards for v day.

i was pretty busy today(which is a fun thing rather than wandering around having nothing to do other than staring at each other in the ward). started with ward round with nathalie and zoran, then went all around the hosp looking for pts,arranging things etc. i ALMOST got to do the IV bung on this 1 pt.we've prepared all the stuff(patho trolley etc).. but unluckily, she already had something/wire/tube into her chest/??.. so she didnt need the iv thing anymore :((

bilirubin etc

again, trying to organise my thoughts abt bilirubin excretion(just read it from guyton).

1st ly, the hemoglobin is split into heme and globin. the globin is the protein, broken down into amino acids and will be reused for protein synthesis. the heme ring --> iron and biliverdin.
biliverdin is rapidly reduced into free bilirubin,but then the free bilirubin will strongly bind to albumin .
in the liver, the bilirubin will be conjugated --> thus called conjugated bilirubin. they will be transported to the intestine and become urobilinogen. the urobilinogen is highly soluble.some of them are absorbed back into the blood. most of the urobilinogen from the blood will pass through liver and to the gut then into the feces. when oxidised bcome stercobilin. but the ones that didnt pass through the liver, they will be excreted by the kidney and into the urine, when oxidised bcome urobilin.

hmm.. still confusing..

trying to organise my thoughts for neuro hx.

firstly, never forget to introdeuce myself as a studentdoctor then ask her is it's ok for me to have a little chat with her.then ask her what she'd like me to call her and casually ask her age. then asked her what brought her to the hosp. i never failed to ask that but what i'm so not good at is exploring more abt the presenting symptoms. in ideal world we can ask all the WWQQAAB questions but in real world it's not that obvious. but i have to try to make sure that everyhting is covered somehow. then ask systems review(which i didnt really successfully ask any of my patient so far bcos i basically ask general med hx). but tomorrow i'll try as hard as i can to take a complete medical hx with(including the system review). and ask her what did she think might be the problem. i've always forget the rest of the hx taking when i started to ask abt what did the doctors do for Ix,and hwo did the doctors manage her at the time being.

so for systems review for neuro, i shud explore more abt any of such occurance before,any syncope,any seizures, incontinence,LOC,weakness or numbness somewhere,nausea,vomiting,dizziness.
not to forget cvs systems review(in case of infarction/stroke/embolus etc).
basically ask medical history.if she has any comorbidities ie:hypertension,diabetes,cardiac events etc.past surgery/hospitalisation. is she on any medications, does she have any allergies?

owh,family hx.ask her if any of her family members had the same condition before, or any of neurological condition, or any medical conditions at all.
also i've always forget to ask smoking and drinking hx. then try to ask her daily routines,with whom does she live, is she independent.. what does she feel?

i'll try to be as casual as possible so that she wont feel like being interrogated since she definitely are already tired with questions from med students.

hmm.. we'll see what happpen tomorrow! i hope we have new good historian patients.

~wish me luck~

7.30am: the moment we arrived at the 54S(or is it N???), we didnt really know what to do. there wasnt anybody at the counter and we didnt know who's the ward clerk. then we just grabbed eva's file,copied some medications to be searched on the MIMS(really plan to do k izza's suggestions). awkward moments last for nearly abt 10minutes,then only i decided to approach the ward clerk(after jun saw her nametag).she didnt really know if they have any patient with gait disorders(jun needed 1 for her pt pbl). there was this 1 'look-kind nurse' who brought us to the registrar. the registrar also had no idea of any pt with gait disorder. hmm.. it seems like it's a tough search ahead. but interestingly, she suggested us to see Mrs O since she had a mystery of left sided involuntary movements. mrs O was having her breakfast when we were there so we promised to come by later. we then tried 44N,tried yesterday's pt. she's under gen med unit.
damn!the interview was far from satisfactory level. i dont know why it's hard to organise ur thouhgts when it comes to the real patient.it's probably because their presenting complaints are not as well-written as in the case studies. but yeah, imperfections give rooms for improvements.

abt 9-ish : went to see Mrs O, jun interviewed her. the followed the registrar's ward round. it was just a brief round. Dr P suggested us to have a listen to her heart n report to him the findings. hahaha, kinda of funny trying to look like we know things when we actually didnt in front of the pt. but then i'm soo happy to actually hear the murmur.. the 'whoosh, whoosh' sound was soo cool. but then it wasnt cool enough of me to not knowing the parts of the valve.. i've alwasy take for granted which sides are all the A P T M areas. but at least there's sth to learn there. N taught us how to descrive the murmur. start with the character, is it systolic or diastolic( by checking the pulse at the same time).. then is it all the same thoroughout(pan) or is it ejection or late systolic? where is it loudest? radiation? manouvres? she also said sth abt the grading, but it's for the cardiologists.

11am: soooo rugi to miss the consultant's ward round. we thought ob and cl is going to join the round, but they actually didnt. !

12pm: cbt.. hmm... hahahah, penat dh nk cite.

now i know what's meant by being too overwhelmed with too much medical info.. in my case it's not info overload, it's too many systems to be covered at the same time.

clinical bedside tute needs me to cover on cardio xm (that'll includes the signs, symptomsm and of course the DDx)(everything!). not to mention that my history taking is still in bits n pieces all over the place.

patho class needs me to cover on gastro.obstructive jaundice.which is a topic that i didnt botehr to memorise last yr.yeah, ppl say that once u understood the mechanism u'll be fine,but the thing is that the mechanism need to be memorised.i'm still not sure abt which is the conjugated and unconjugated bilirubin. to be able to look for it's patho, i definitely have to know the normal one 1st right? hmmm..that' quite a lot of work to do.(luckily i still have a few days till friday patho teaching).

lastly, i am now attached to neuro unit. (no need to mention the complexity of diagnosing the mysteries neuro cases).

things to do

before i forgot them (yeah, i did write in my notebook but it's still kinda messy being 1st day)

gait : guyton's
mgt from the net
involvement of enlarged ventricular system

cbt nxt week : read talley - cardio
REALLY2 ORGANISE HISTORY TAKING TECHNIQUES (tabulate them!!)

ward : search the terms i jotted down (paget's disease etc)

they'r all urgent!!!

laugh at urself

i suddenly laughed at myself reading abt how comot i was when i really adore toknyang... hahaha, yeah i think adore is the most acceptable word for my infatuation towards him.. i really moved on!!!i even missed his harijadi minggu lps. yes2!!! that proves how i 'moved on' i am now..

back

i suddenly thought of updating my long lost blog.i tried to write last week after the overwhelmingly great nurse shift, but i cancelled the post since i dont really know how to put my thoughts into words, but come to think of it again, who cares?? nobody read it. this afternoon kemal went to see andrea(it's compulsory for all international students to have 15minutes meeting with her anytime within this week, mine will be tomorrow). i dont know what did kemal discussed with her but she advised kemal to have a diary..then only i remembered this blog.. so in case andrea suggest me to have one, i could just use this blog since i always felt like writing when i had great things happened (which is always abt a life of a survivng medical student).

we went to 54south ward at abt 9(act,we promised to be there at 0830 hihih).CL was already there, n he was reading the medical records.. wooah! that's impressive.. we were kind of scared n felt very inferior.. but then 'be kind top yourself'.. that's what andrea told kemal, dont compare urself with someone else..
i didnt follow the ward round coz we'll take turns (can u imagine 6medical students straying around the ward at the same time with the team of consultant,registrars,etc). then we headed to the lib. hmm.. as the 1st day enthusiastic 3rd yr meddies, i tried reading talley on neuro..hoped to finish up the whole chapter but failed.. eh no, i didnt fail, but havent succeed yet.. at abt 11, felt very wrong not seeing any patient for the day, so jun n me went to 44south. the nurse suggested 3 patients, but none oof them were at their bad at the time we went(hahah, just a lame excuse to not seeing patient).. to feel god abt ourselves, we promised ourselves to be at the ward 0730 tomorrow morning n see a few patients for history..
at 3 i' supposed to have an appointemnt with DR J. hmm.. he did everything that i cocerned abt, but there's no exact answer for my questions, so i'll leave it open and hope for the positve side of the coin.
oh btw, we went to clayton n had lunch at the bbq chicken.bought 500Gb external hard drive for $179. i'm not sure whether i really need it or not but i dont want not having it when needed. also went browsing for my bed. but no luck yet. tried to call the furnituregalore hotline but nobody answered.

**i'm supposed to be very busy now.. had to prepare for nxt 'patient pbl'**

hahaha, as usual, i'll only be writing here when things r going tough..i am SUDDENLY busy. i dont think i can have any gokusen tonight. all of a sudden spc n hpkm came. my suppose-to-be-free-tuesday will be packed. what about chairing the pcl, next week's anatomy, this thursday's clinical case to be constructed... n now i really need to practise the craig's stuff..mindfullness, prioritising n etc... this is the time i need to transform (a big word now) into a real nerd med student.. amiiin.. 1 2 3, transfooorm~~

al-furqaan

start ayat 63, menceritakan ttg sifat2 hambaNya yg mendapat kemuliaan..
...yg berjln di bumi dgn rendah hati dan mengucapkan kata2 baik bile org jahil menyapa mereka
...yg melalui mlm hari dgn bersujud dan berdiri untuk Tuhan mereka
...yg berkata 'Ya Tuhan kami, jauhkan azab Jahannam dr kami, sesungguhnya azabnya itu adalah kebinasaan yg kekal
...yg apabila membelanjakan harta tidak berlebih2an dan tidak pula kikir, dan perbelanjaan itu ditengah2 antara yg demikian
...org2 yg apabila diberi peringatan dgn ayat2 Allah, mereka tidaklah menghadapinya sbg org2 yg tuli dan buta
.. yg berkata 'Ya Tuhan kami, anugerahkanlah kepada kami isteri2 kami dan keturunan kami sbg penyenang hati dan jadikanlah kami imam bg org2 bertaqwa'

mereka itulah org yg dibalasi dgn martabat yg tinggi kerana kesabaran mereka dan mereka disambut dgn ucapan penghormatan dan ucapan selamat didalamnya.


p/s: not all points r included.

Menjemput Bidadari
Munsyid : Epicentrum

Bila yakin tlah tiba,
Teguh didalam jiwa
Kesabaran menjadi bunga

Sementara waktu berlalu
Penantian tak berarti sia sia
Saat perjalanan adalah pencarian diri
Laksana Zulaikha jalani hari
Sabar menanti Yusuf sang tambatan hati
Dipenantian mencari diri
Memohonkan ampunan dipertemukan
(Reff)
Segera kan kujemput engkau bidadari
Bila tiba waktu kutemukan aku
Ya Ilahi Robbi keras ku mencari diri sepenuh hati
Teguhkanlahku dilangkah ini
Dipencarian hakikat diri
Dan izinkan kujemput bidadari
Tuk bersama menuju Mu mengisi hari...
Kini yakin tlah tiba
Teguh didalam jiwa
Kesabaran adalah permata
Dan waktu terus berlalu
Penantian tak berarti sia sia
Saat perjalanan adalah pencarian diri
Laksana Adam dan Hawa
Turun kebumi terpisah jarak waktu
Dipenantian mencari diri
Memohonkan ampunan dipertemukan
Bidadari tlah menyentuh hati
Teguhkan nurani
Bidadari tlah menyapa jiwa
Memberikan makna...

pat & kumiko

pat saaaaangaaat la baik dan buat saye appreciate die. die bg saye japanese calendar.besar plak tuh. bukan calendar tuh yg jd ukuran, tp his thought tuh. untuuungnye kumiko jd gf die. mungkin saye bole juge bli sth utk die bile balik mesia.

And when we meet

Which I'm sure we will

All that was there

Will be there still

I'll let it pass

And hold my tongue

And you will think

That I've moved on....

essendon

last nite, essendon won over richmond by 8 points.it was at the MCG. but so far essendon won 5 games and lost 4.

that was sooo not me to report on sports. but it is ssooo me to report on footy ie: essendon. everybody knows why ^_^

hco3 reabsorption

okey, i've been reading the acid base regulation of kidney for a few times. i got it when i was readng it, but i cant really summarise them in my mind when i tried to. they just didnt flow well.

so i tot i'll try to write down what i knew about them.

here is i think one of the most important fact about hco3 reabsorption.
hco3 is impermeable at the membrane, so they cant cross the membrane by themselves.
sooo, they coombine with H+ to become h2co3 which then will dissociate to become water and co2.
co2 is the one who can cross the membrane into the tubular cells.
in the cells, co2 will combine with water.catalysed by carbonic anhydrase and become h2co3.
h2co3 will dissociate into H+ and hco3.
then only hco3 can get into the interstitial and then blood.
hco3 transport into the interstitial is coupled with cl-(exchange) and na+(cotransport).

so it's like for every h+ secreted into the tubule, one hco3 will appear in the cells.
for the h+ secretions, they r a bit different in the proximal tubule and distal tubules.

in proximal tubules, h+ is secreted by secondary active transport. coupled with na+ reabsorption. na+ moves down concentration gradient. so the energy released is used to take h+ out of the cells into the tubule.
but start from late distal tubules, h+ is secreted by primary active transport. in a specialised cells - intercalated cells. h+ is transported by hydrogen ATPase. that means the energy is from the breakdown of ATP.

okey, that's only the reabsorption part. that's the most handle-able ones.

p/s : yeeey..i've become a nerd as i wished for,bcos who else will post this stuff into their blog if for they arent nerdy2 ??

micturition

i guess i could use this blog wiser than i ever did( read as: other than bragging around about toknyang). i should try rephrase what i understood about what i just learned. isnt that a good idea?

okey.our bladder is lined with 2 layers. the outer is the detrusor muscle which is a smooth muscle. n the inner is epithelial layer. detrusor muscle is supplied by sensory mechanoreceptors that responds to stretch or tension. the motor supply is from parasympathetic motoneurones s2-s4. there's part where the detrusor muscle becomes internal sphincter.it opens when the muscle contracts. so when the bladder is full, the internal sphincter contracts n the urine flow out from the bladder. but at there's one more sphincter. external sphincter. which is striated muscle. it's always in a contraction state. nerve supply is pudendal nerve from s3 and s4. so for the urine to pass through, the neurone activities need to be inhibited so that external sphincter relaxes and opens the passage for urine. for us to be able to control micturition voluntarily, we need input from cortical micturition centre to inhibit the activity of pontine micturition centre.
incontinence can be caused by trauma/lesion to the frontal lobe.

there's a lot more in incontinence but i didnt bother to remember all. maybe i will one day.

so that's what i understood with micturition. i didnt refer to the notes while pouring out the stuff, so i need to recheck them. then only we could know whether we've grasp the topic or not. that's why we need to take the exams.lol~

xm

i moved on.i was in such a rage yesterday knowing that the xm is going to b postponed until after winter hol. that's a bad bad bad news.i've already planned my winter.(if lazying around is considered as a plan).i dont care anymore.it's all ruined.i moved on with a +ve mode.maybe it's time for me to really prepare for the xm. i'll still make my plan work, but maybe with a little bit of guilty deep inside. whatever it is,it's medicine.b prepared for more n more disastrous holiday.

i have a cold n congested nose.~

but i'm ssoooooo over the moon again.met his bro.dot.it's a great mood booster.

tasks for the xm

• buku kecik anat tuh
• grey's head & neck
• talley urinary system
• mnemonics
• guyton's renal

freaking

xm is in less than 1mth.13thjune.but havent really grasp urinary control of acid base yet.need to struggle more.less dramas.huhuhu.

awak comella

awak..comella awak lari dlm hujan td.

hihihi..it was raining quite heavily(in oz context), so i took a bus home from uni.before the bus moved from the bus loop, eh silap, kene ckp mlayu la.. takut kantoi..hahaha ..nampak toknyang berlari2 anak tgh hujan across the loop.btol2 blakng die adalah kwn cantik die... toknyang pakai baju hijau belang2 yg die slalu pakai tuh.. kwn cantik die kat blakang baju biru mude.. comel sgt diorg lari.dahla toknyang g skolah tak bwk beg ke buku ke ape2 pon...

my pretty boy

huhuhu..i just realised the lyrics..yep. i'm not that serious about my pretty boy.n he's not even mine. but m2m make it sounds sooo sweeet~

Pretty pretty boy of mine
Just tell me you love me too (tell me you love me too)
Oh my pretty pretty boy I need you
Oh my pretty pretty boy I do

one of the best day

i could say today is the one of the most fantastic day in the context of a medical student. started early. went to dandee hosp. was quite a good train ride bcoz we passed a few stations that're new to me. Megan was a great buddy. Showed us some interesting pathological signs that we've just heard about but never had the chance to really get the experience. Lung Crackles. Pleural Effusion. Atrial Fibrillation. Irregular Pulse. Fluid in the lung. Peripheral Oedema. Bronchial breath sound. 'sth' contracture. asbestosis. yeaaah, had a really grreat visit~ then get back to uni. the bus ride was even waaaay fantastic! i'll take one day soon just to take a bus to dandee, have a meal, shop in the market then get back on the bus. Had venapuncture.which was a veeery anxious one. but had quite a great time coz could find the vein n draw blood from it. than had a tachycardiaing chat with pat about japan~he was sooo sweeet to know soo much about her gf's country. wish them to be happy ever after ^_^

sarah, u've been avoiding me.. toknyang, i'm not!

mark this date,
4April2007.
from menzies to mannix.
a walk that'll never b forgotten~



i'm over the mooooooon~
xtremely eliated
hmmm..

i like toknyang's jeans!!
effah called me a stalker :p
no,i'm not.
i'm just an observer.

this is just a test

You're single because you don't want to get hurt

Ever heard the expression, "Once bitten, twice shy?" You can probably relate to this, can't you? Your last relationship may have left you a little raw in emotions, and the memories are likely still fresh in your mind. Fresher than you can sometimes believe. With a hurt like that, you're probably not so eager to enter the drama again — and we can't say that we blame you. You may be so afraid of getting hurt that you take things to heart big-time when you're involved with someone — after all, you've been hurt before, why can't it happen again? You also may be guilty of comparing potential mates to your ex who may still constantly loom large in your mind.But maybe, just maybe, it's time to check your baggage at the door and let a new person into your life with a clean slate. You have a lot to offer someone, but you can't do it when you have one foot firmly planted in the past.