Greetings From Ipoh

Cought a sight of this party taxi just as I was departing. There were plenty more balloon on the back seat! I wonder how much the fare is for them! Maybe tak pakai meter!Made it to Ipoh finally by 4pm, after the drama at the start - see my previous post and update.

I am here representing the UM Medical Faculty to the Perak Medical College. They will have the same exam as our UM boys and girls from tomorrow. Since my wife is from Perak, she decided to follow. So we rented an extra room, and both Idlan and Irfan were having a blast. We were at the pool for nearly an hour and a half. Ordered food for afternoon tea, which they gobbled down. We just got back form dinner, and they were running around like headless chicken in the lobby.

Casuarina Ipoh - now known as Impiana Casuarina - is one of those 80's hotel, old school style lobby, old furniture in the rooms. I remember staying here in the late 80s with my parents. It used to be more 'happening' then. It used to be buzzing with people, a place where who's who used to chill. I remember bumping into the previous Menteri Besar and his family while his children were playing in the pool. I bet it will not happen now as we can't even be sure who the Menteri Besar is here.

The Main Lobby at Impiana Casuarina tonightThe lobby was expansive but felt empty. There were nobody playing on the grand piano, there was no background music or chatter. The cafeteria was also pretty basic, although I was told that it was one of the best 'high tea' Ipoh has to offer. We had buffet there for our dinner. The spread was nothing fancy, the main dish being beriyani with a couple of sides. There was also some pasta, some basic salad with dressings. A disappointment really, at a place I used to look forward to visit when I was young. Maybe I was pampered too much with good food in Bangsar and around KLCC. 

The only thing that got the place going must be the swimming pool. We stayed here sometime last year when my wife's uncle died. The boys wanted to hit the pool but time was tight. They got their wish this time around.  The breakfast then was pretty OK. That is something to look forward to tomorrow morning.

As for my boys and girls in the final year at UM, they will have their Final MB coming up tomorrow. So all the best. Stay calm. I am sure I will have to call you with Dr as the prefix in a couple of weeks time. Good night and good luck. 

Good Luck You All!

Tried both tops but we still got beat. Must be the Tandoori, or the lack of it!

The amount of abuse I have to endure for United losing last night was unbelievable. As usual, as a true Devil, I remain confident that we will wrap the league up soon. Chelsea lost last night, and so will Liverpool tonight. Hence at the of the day, everything remains status quo, except for the ascendency of Villa who will beat Liverpool tonight. All the fuss will be about nothing.

As I mentioned on my previous post, I have superstitious about a our recent winning run. On the weekend games (obviously I can't get any Tandoori at 4am in midweek), I will don my ManYoo 2001 long-sleeved replica with number 4 Veron on the back - look at the pics, certainly has been over worn - , then I will go out to my local Mamak stall and order Mee Ladna, ABC, Tandoori chicken and a couple of naan bread. Last weekend during the Pool game, my Veron shirt was in the washer - courtesy of my maid which Alan is certain is a Liverpool fan - and we got soundly beat. I wore the Ronaldo top instead plus the Tandoori. Conclusion, no can do.

Last night, got my Veron top, but due to one thing or the other, no Tandoori. I SMS Alan, and he reckoned it was a bad omen. The rest is history. Next league game will be in a couple of fortnight. Enough time for me to sort everything out, and for sure United will win!

Just finished packing for my trip to Ipoh. The kids are in the shower. Will be there until Tuesday with the kids on tow. For my Final Year students, it has been a pleasure teaching all of you, and I hope that we will make good Doctors out of you guys and gals. Stay calm, trust what you know. There will not be any trick question I am sure. Got to go!

Update on Sunday, March 22, 2009 at 5:39PM by Haris Abdul Rahman

It was rather more adventurous than we thought. Reversed the car out of the driveway, put it back to drive. Parked it on the side, wanted to put it back into reverse but the gear wouldn't engage. Ooops! Only got the car serviced last week. Looks like it's going back to the garage. Had to use my father-in-laws CRV then. Made it to Ipoh smoothly though. Just got out of the pool with Irfan and Idlan.

Update on Friday, March 27, 2009 at 8:08AM by Haris Abdul Rahman

My C200 has been fixed on Wednesday. It was a minor wiring problem after the servicing the week before. No charge this time which is nice. The technician came to the house and got it fixed in no time. Drove into work today in it since my Kelisa is with my father-in-law.

You Don't Need Luck ... You Need A Miracle .... Part III

There was a major change of plan for the weekend as instead of going back to Penang, we will be heading to Ipoh tomorrow. Since I was kind of free in the afternoon, I took a stroll to the Orchid Garden in Taman Tasik. Weather was gorgeous. Took my camera out for a spin. I thought I post a couple of the picture on this update.

After some rest I thought I sit down and finish off my series of tips. We are now down to the short cases. This is a double-edged sword. It is easy to pass, it is also easy to fail if you are not careful. And if you are lucky and confident, you can breeze through it.

I will just comment in terms of Medical stations. The possible scenario will require you to be able to demonstrate ability to examine systems that can be listed as - Cardio, Respiratory, Abdominal, Cranial nerves, Neuro upper limbs, Neuro lower limbs and special system. The special systems include thyroid status, thyroid eye disease, common skin lesions (cellulitis, eczema, psoriasis), rheumatoid hands etc. The last group is basically a pot luck of cases!

Neurological cases are the most dreaded, maybe because lack of practice. It is very common to get neurological examination of the lower limbs, which all of you should score but in general are badly done in exam situations. If you take your time, even the cranial nerve examination can be taken in stride.

For the systems, you should have developed your routine by now. Remember the rules of first introducing yourself to your patient, then to ask if they are comfortable or in pain. You then explain that you need to examine them and expose them. You will then observe them from the edge of the bed. You then start with the patient's hands, unless it is the cranial nerves or lower limbs. In the special systems, if you are uncertain, always expose the patient, then start from the hands.

There is no substitute for practice unfortunately. If you are not prepared at this point, they is nothing much you can do but to practice your steps. Practice on your friends even though there are no pathology to be had. When I was a student, I printed all the steps in each of the examination procedures on a piece of paper and go through each one of them in sequence. I still have a copy of them when I was preparing for my MRCP. I gave the soft copies to your seniors. If you guys are interested, you can download it from this link. Not sure if it will make much difference. However at this hour, every little things help! Happy hunting!

Update on Sunday, March 22, 2009 at 1:10AM by Haris Abdul Rahman

Well, you win some, you lose some ..... well done Fulham!

Housekeeping ... Mousekeeping

Been surfing for half an hour or so in bed this morning before getting up ... trust me, there is nothing better than surfing in bed. I read through the number of hits I am getting for the last week. There were not bad considering how new I am with this client. Getting close to 200 hits per day. Many of the referrals seems to be from fellow bloggers. I spotted a pattern here, the best was to get hits is if you have a direct link from your fellow's page. What I need to do next is to set up a quick link section on my page. But first thing's first, need to figure out how it works on my system. A quicklink staring at them right on the blog page works better I think than having to be transferred to a new page full of link.

So, task for today, maybe tonight after I reach Penang would be to sort out a quicklink section on my page. I have also figured out that I can post an entry straight in through email via my E71. Maybe that's what I will try on the road. So watch this space

Update on Saturday, March 21, 2009 at 10:44AM by Haris Abdul Rahman

Oh dear, major change in plan. Since both Irfan and Idlan haave only just recovered from flu, we decided to just head out to Ipoh tomorrow. It will be a shorted journey plus less of a hassle driving against rather than with the traffic

You Don't Need Luck ... You Need A Miracle .... Part II

This book served me well over the years. Check out the vintage. I bought this before my Finals. Don't ask me when because I'm old!

Thanks so much for indulging me and more importantly, for being patient. I was updating my slides for a tutorial I am giving to Anaesthetics Masters students tomorrow. Took me some time but finally got it out of the way. Let's get down to business.

Long case. You need luck for this one. You need to pray that the solitary case that you are going to have is on a subject matter at least you have a clue on. Luckily when it comes to medical cases, there aren't very many. Let's go through the system. By the way, I am not involved in recruiting any cases, even for my unit. I am just going through these by experience, and in no way indicating they will be asked. It is just merely a checklist for your benefit.

Cardiology - chronic IHD, hypertension, rheumatic heart, mitral stenosis, chronic atrial fibrillation. These should be familiar to you by now. Respiratory - asthma/COPD, bronchiectasis, TB. Gastro - chronic liver disease, viral hepatitis, peptic ulcer disease, inflammatory bowel disease, irritable bowel (if you are unlucky).

We move on to Neurology - Parkinson's, spinocerebellar disorders, facial/Bell's palsy, carpal tunnel, diabetic peripheral neuropathy. Endocrine - thyroid with or without eye disease, hypo or hyper, diabetes (obviously), hypertension (essential or premature eg Conn's, pheochromocytoma), Cushing's, hypopituitary. Rheumatology - rheumatoid arthritis, OA, gout, ankylosing spondylosis, psoriatic arthropathy. Renal - nephrotic syndrome, polycystic kidney. Haematology - thalassemia, CML, myelofibrosis, AIHA. Dermatology - eczema, psoriasis. Did I miss any major subjects?If you think you want to add something, just put it in the comment section below so we can all share it. You can add them anonymously, so don't worry.

MAKE SURE YOU KNOW INSIDE OUT ON DIABETES AND HYPERTENSION. Make sure you present, ask all about the complications and all aspects of target organ damages. So in diabetes, ask about current and previous treatments, complications as in hypo or DKA. Any retinopathy, IHD, nephropathy, neuropathy and peripheral vascular complications. Ask about the cardiac risk factors without fail - the major 5 - BP, DM, high cholesterol, smoking and family history. 

So you have 1 hour to talk to your subject. The first 2 questions should be 1) what medications are you on, 2) when was your last clinic appointment and slyly ask them which clinic. You have the diagnosis in front of you by then and gear your questions towards it but during the systemic review, ask everything. Always ask your patient before you go to the examination part, "is there anything else you would like to tell me before I examine you?". The examiners wold like to hear you discuss about the family history and social background. What is the occupation, how much do they earn, what kind of house they live in. Take a thorough family history. Draw a family tree.

After you finish examining, do the urine dipstick, measure the BMI, measure the BP, measure the PEFR as applicable. There is a reason why the equipments were provided. In diabetics, make sure you open their shoes and check the foot for neuropathy and ulcers! During long case presentation, if a diabetic was still wearing their shoes it means that you have not been thorough. Tolak markah!

You must then formulate your main diagnosis and list of differentials. When you present your management plan, always consider them in terms of pharmacological and non-pharmacological. Diet change, exercise, physiotherapy are just as good as using drugs. This pointers are not exhaustive. Please add anything you think is relevant in the comment section so that we can all share them. We'll talk short case tomorrow hopefully. I will be driving up to Penang after my tutorial. I will be blogging from there. In the meantime, happy slogging and burn them midnight oil! Adios!