This patient was admitted with fever. This is her picture:
1. What are the abnormalities seen?
2. What could have caused this posture?
Mon, New Year’s Eve. 0700
Right about now you are probably on a much needed and deserved break in an exotic tropical island somewhere. I hope you brought Mrs Claus along!
I think you probably do not expect any letters from anyone since Christmas is over and I am sure you and your elves and trusted reindeers have done a good job distributing gifts to all the well-behaved children in the world.
I am writing to thank you for stopping by my home and leaving so many gifts under our tree! My kids were overjoyed with the toys they found there. Ryan was estatic with his Transformer BumbleBee Toy which actually transforms into a car! Darlene was delighted with her toy toaster!
I want to thank you for the Pierre Balmain shirt I received. It’s real nice and I think it made me look at least 20 years younger! I also like the L’Umo socks that has those bright red linings. You truly know my heart as I believe socks need not be just plain boring blue, black or brown. The hankerchieves were an extra bonus. You shouldn’t have because I already have about 30 of them at last count!
However, I feel I need to highlight some matters regarding the other gifts.
1. The nice and trendy t-shirt I got was about 2 sizes too big for me. Please remember, Santa, that not everyone is Santa-size in Malaysia.
2. The toaster toy broke within 30 minutes of play leading to unnecessary tears shedding. Ryan was to be blamed I guess. He must have thought the toaster was a toy hydraulic jack! Anyway, I have fixed it with some superglue. Next year I think it would be wise if you can advise your elves to get more hardy and durable toys when they go sourcing for toys in China.
3. The 500 pieces Winnie-the-Poo jigsaw puzzle my daughter received has ONE missing piece! I hardly think it is appropriate at such early years of her life to teach her that life indeed is not perfect! Withholding that vital piece from her is a tad sadistic of you, Santa.
Still, we had a wonderful Christmas. The stuffed roasted turkey was delicious and we had a good time with loved ones near and far over dinner. Laughter and mirth filled the air.
I hope you will remember my Christmas Wish List when you are preparing my gifts for next Christmas. I was a bit disappointed that I did not get the BMW 3 Series that I asked for (I don’t mind even if it’s in silver colour instead of black). I guess it was too short a notice. I am told that the ignition key of a BMW or Bently is ideal for eliciting the Babinski’s Sign. So, you see, getting the BMW is pertinent and vital to my work. In fact, I would be delighted if you could fast forward it a bit and let me have it by, say, Easter 2008!
Anyway, have a wonderful holiday and here’s wishing you a very Happy New Year!
PS: Please watch your cholesterol level and your BMI! Wouldn’t want you to have a coronary event before you deliver my BMW, would we?! ;P
Sat, 291207 @ 2005; blogging this with my Palm Treo 680 using Mo:blog while waiting for a friend to show (I have a feeling he won’t be showing!).
We took a trip to the Malacca Zoo 2 days ago. It was a fun-filled day and we really had a great time, despite the afternoon showers (it alway rains when we go to that zoo!). The entrance fee for an adult is RM 7 while for a child above 5 years old, its RM 2.
The zoo is located in Ayer Keroh and is the second largest zoo in Malaysia. It was established in 1963. The sprawling 54 acres zoo is home for more than 1500 animals from 200 different species.
I would like to share some pics that I took but don’t expect them to be conventional.
Conventional is boring.
That’s a pony’s…thing.
Bird’s eye view
All wrapped up…
Two amorous chimps…
One sleepy bear…
Apparently red striped nose and…
Blue fluorescent butts are in among the Mandrills.
You can’t tell where the legs end and the hands begin…
A bunch of flamingos…
Fellowship of the amputees..
And these are plain twisted.
We’re a horny bunch…
Errr….I am less horny
This is one of my favorites… Mother and baby giraffe
From the head…
To the tail, it’s perfectly symmetry.
One majestic animal. One glimpse of this fella and my son was totally satisfied. He wanted to see a tiger so badly.
Fri, 281207 @ 0700
My students helped saved a patient last week.
Well, they did, unintentionally!
Last week, I had to take a bedside teaching on my day-off! Why? Because some one alloted me 2 classes despite knowing it’s my day off. Anyway, I found out too late and so I went back to work.
Since I had no other obligations for the day, I decided to take the classes at a leisurely pace, meaning I was at liberty to have every single one of the students present the history of the patients they clerked and then went to see (with them) almost every single one of these patients.
There was one history that piqued my interest. He is a 24 year old Malay man who presented with 3 days history of jaundice and severe backache. There was no fever. He did not take illicit drugs, nor was he a intravenous drug abuser. He denied any sexual promiscuity and had no history of blood transfusion or consuming sea food.
We went to see him after the history presentation.
I took a look at his notes and saw that they (the ward doctors) were planning to discharge him that afternoon, with the working diagnosis of ‘acute viral hepatitis’. The viral serology were not back yet (it takes 2 weeks!) and the liver function test was consistent with viral hepatitis. The white count was not raised and he had no fever at all.
But he looked ill-at-ease and yellow. He kept complaining of his backache (a feature inconsistent with viral hepatitis).
My gut feeling told me something was not right.
I spoke to the MO in-charge and ordered an urgent ultrasound of the abdomen.
I left it at that and didn’t think of the patient anymore and we moved on to other patients.
Two days later, when I was back in the ward, I asked the MO what happened to that young man.
He said: “You are right, something was not right. The ultrasound showed a big pancreatic mass and the surgeons have taken over the case”.
Some call it “clinical acumen”, others call it “sixth sense” or “intuition”. I call it “gut feeling”. I think experience over many years has taught me (and no doubt, other senior doctors) to listen to our gut feeling when dealing with patients and to act upon it when we sense that something is not right. As in this patient.
Wed, 261207 @ 0700
For unto us a Child is born,
Unto us a Son is given;
And the government will be upon His shoulder.
And His name will be called
Wonderful, Counselor, Mighty God, Everlasting Father, Prince of Peace.
Of the increase of his government and peace
There will be no end,
Upon the throne of David
and over His kingdom,
To order it and establish it with judgment and justice
From that time forward, even forever.
The zeal of the LORD of hosts will perform this.
Isaiah 9: 6-7
Wishing all my loved ones, brothers and sisters in the faith, friends,
lovers (oops, typo there!), dear ones, colleagues, and students:
Have a Blessed Christmas and a Happy New Year!!!!
Tues, 251207 @ 1151; totally zonked from an all night caroling stint.
PS: Santa didn’t send me any of the stuff I asked for in my wish list ~ maybe next ya, Santa?
This week’s ‘Patient of the Week’ is contributed by CK, and he will reveal the answers on Thursday.
Others are welcomed to contribute, just email me your pics and a short scenario. Thanks.
This is a 55 year old man who presented with right hand pain. These are his pictures (a bit dark but you can make out the deformity). Both pulses and sensation are intact.
1. Describe the deformity seen.
2.What is your diagnosis?
Mon, Christmas Eve, 0700.
I am sitting opposite my dad at the char kueh teow shop near my place. Mum is at my friend’s clinic receiving an iv drip. She has mild dehydration from acute gastroenteritis.
We’ve had our food and dad is puffing away on his mandatory after-meal cigarette.
I’m browsing through the junk comments in the spam box of my blog. Strangely I’ve been getting a lot of ‘Hair Removal’ spam, which is rather ironic. I’m at an age where I’d rather keep my hair rather than have them removed. I still have a headful of hair, thanks to my dad’s genes I guess.
I think I should stop blogging and talk with my dad….
Sun, 231207 @ 1935; blogged using my palm treo 680 @ Mo:Blog
What Your Handwriting Says About You
You are balanced and grounded. You know how to get along well with others.
You need a bit of space in your life, but you’re not a recluse. You expect people to give you a small amount of privacy, and you respect their privacy as well.
You are conservative, old fashioned, and a little stubborn. You are resistant to change.
You are a decent communicator. You eventually get your point across, but sometimes you leave things a bit ambiguous.
I did this online quiz on my handwriting, flicked it from some one’s blog.
I must say I disagree with everything written there!
Sat, 221207 @ 0700