This elderly gentleman is a known case of acute leukemia. He presents with these spots which appeared almost overnight. His platelet count is single digit.
Here is a picture of his lesions:
Questions:
1. Describe the lesions.
2. Which leukemia (FAB classification) does he most likely have?
Mon, 310308 @ 0700
Jimbo is away on the 3rd day of his brief trip to the 8th largest city in the world (and probably freezing his hineys off)!!
At the tone, please leave a message/comment! Jimbo will get back to you asap. (tomorrow, in fact).
Sun, 300308 @ 0700
Jimbo once again went on a bit of a shopping spree the other day (the day the ‘gaji’ came out, which by now has been redistributed to all the Ah Longs waiting in line to collect their dues).
Anyway, just before they (the Ah Longs) managed to bleed me to death, I managed to buy 2 things:
1. A woolen cap from ‘SoxWorld’ at Terminal One. Right about now, I am probably wearing it in a very cold country up North.
2. The object of desire finally realised! A ‘High Sierra’ backpack with a 2-litre Hydration Pack. In case you are wondering what I am yabbering about, it’s a backpack, commonly used by serious cyclists (and amateur mountain climbers) which is light weight, and has an in-built water container complete with a hose and spout, just so one can continue to pedal/climb without stopping to dig out the water bottle to take a drink. You just sip as you go along. I’m not sure if I got the right size. The guy who sold it to me said they no longer make bags with capacity more than 2 litres (he sounded so genuine that I believed him). Anyway, I have a nagging feeling that the bag might be a tad too small for the big climb! There isn’t a lot of space left for anything else after filling it up with water!
So, please, if you know of a bigger capacity bag or a cheaper bag of better quality being sold elsewhere…
KEEP IT TO YOURSELF!
Let me enjoy my booty for a while ya. 
Sat, 290308 @ 0700
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No la, Jamie Oliver is not in town.
I took this pic at one of my favourite restaurant (the chee cheong fun is excellent and the ice-coffee, heavenly!).
I’m wondering if I could find a T-shirt with similar words and wear it to work! That would make me….
THE NAKED PHYSICIAN! LOL!
Ok, stop gagging already.
Fri, 280308 @ 0700
Last Saturday (22 Mac 2008), I went with a group of 20 medical students into the Orang Asli village which IMU has adopted. It marked the 3rd time we visited the village since the the village was adopted last July. Our aim was to provide basic health screening and education to the villagers there.
The last time we went in was in November last year when we provided similar health screenings.
After my climb 2 days prior to that, I really wasn’t really in the mood to go to the village but since there was no one else free to lead the students in, I had to go. Sigh!
In retrospect, I am glad I did. Sure, the stuff we did were the same old thing, but to the students; for a lot of them, it was their first experience providing health care in a rural setting. The seniors were teaching the juniors, just the way medicine should be taught.
Here are some pics I captured:
I still firmly believe that adult medicine is a whole lot easier than kids medicine (a.k.a pediatrics); for instance, the health screening form for adult is merely one page long while for the children, it was 4-5 pages long! It’s also harder to get children to sit still to be questioned and examined, especially when all they want to do is to ransack the toy-bag (yes we had a few bags of second-hand toys to be dished out) and eat all the grubs prepared (and indeed, they did, thus depriving another group of students who came back late from their house-to-house visit, their tea!).
Future pediatrician?
This is how you look for head lice! Almost 99% of the children there have head lice or their eggs! At the end of the day, a lot of us had ‘psychogenic’ itch in our scalps as well! EeeewwWWW!!! Personally, I washed my hair 3 times that night!
This is what they look like, up close!
I couldn’t sleep that night after the mobile clinic. In my dream (or nightmare), I was sleeping on a bed crawling with huge beastly head lice, eating away at my flesh and I was scratching like a lunatic. In the end, I got up and watched ‘Casino Royale’ for the 10th time and finally slept at 1 am! Somehow watching Vesper Lynd’s luscious lips had a sedative effect on me!
*purrrr* “C’mon, big boy, surely you aren’t scared of teeny-weeny head lice?”
Anyway, that’s the whole bunch of us (Jimbo’s missing as he is the one taking the shot!). It was a good outing, the best in fact as we managed to screen almost 90 adults and children which is a record so far. Right after this shot, we all had to run in the torrential rain to reach our transportation parked at the fringe of the village. Most of us were soaked (a few were smart enough to bring along their umbrella-ella-ella…)! We had to make a quick dash because had we waited some more, the estate road will become too muddy, slippery and flooded and that makes driving on it very dangerous indeed! Thank God, all of us made it out safely.
Well done guys! Please consider join us again this June 2008 in the next mobile clinic. (By then, I hope some one else will go in my place! Chronic periodic exposure to head lice is not good for my sanity).
Thursday, 270308 @ 0700
I saw her in my clinic last week. She is a lady of Indian descent and very young, in her mid-twenties.
Her story was like a fairy tale gone bad, really bad. About six or seven years ago, she married the man of her dreams and they have a child together. A couple of years down the road, the husband passed away, due to some unknown illness. She said, “he just wasted away”.
She probably gave thanks when another man came along and took her as his bride (I understand that it’s a bit of a taboo to marry a widow in the Indian culture, but correct me if I am wrong).
She got pregnant and from then on, her marriage turned into a nightmare.
She was tested HIV+ during a routine antenatal check-up!
Almost overnight, her husband’s family turned hostile. Every knew about her condition. The baby was eventually delivered and so far (now a year old) has tested HIV negative.
Her hubby got himself tested once and it was negative. Thereafter he has refused to get himself retested again.
He started accusing his wife of infidelity. He made her quit her job and made her follow him everywhere in his rounds at as a wireman. He gave her no money at all, even her lunch were bought by him. He dictates what she eats, where she goes, whom she meets, what she does. He would not allow her out of his sight.
Worst of all, he started beating her, almost on daily. She was punched and kicked repeatedly. When I saw her that day, she had bruises all over her body. Initially she didn’t want to tell me that she has been abused. Only after I convinced her that it’s alright to tell and she is safe in my clinic, would she open up.
She said her “hubby is waiting outside” and that whatever she said should not be repeated to her hubby (indeed, in the span of 20-30 minutes of that consultation, her hubby called 3 times to ask why she was taking such a long time to come out and her MIL called once to ask when will she be back to take care of her kids!).
She told me the last one year has been hell. She was beaten all the time. Her in-laws and relatives from his side of the family ostracized her. Her hubby didn’t care for her first child but loves the second child a lot. She ran away a few times, back to her parents’ home but her hubby managed to get her back each time. She made a police report once but they told her there was nothing they could do. After each beating, he would ask her for sex, to which she has to give in; if not he will beat her again.
Her hubby threatened to divorce her and take her kids. Her hubby reasoned that she will die soon anyway and is not fit to be a mother. Both her marriages were not registered. Both were ‘solemnized in an Indian temple. She is afraid she will lose her children. She wants to leave her hubby but unwilling to risk losing her kids to him. Her hubby even threatened to “sleep with other women”.
I felt more and more helpless as I listened to her story. I really didn’t know what to do!
Her CD4 count didn’t warrant starting any therapy yet, so clinically, I could have just told her to see me again in 4 months. But socially, this was a huge mess. I offered to refer her to the social welfare but she declined. I told her that since her marriage was not registered, legally, the man is not her lawful husband. I encouraged her to make another police report but she said it’s hard as she is constantly watched.
She wants to run away again. This time, she said, she is willing to leave the children behind! She said she could not endure the beatings anymore.
In the end, I had to let her off with an appointment for the next visit. I felt really bad.
I really feel very helpless. Any one has any idea what could be done? 
Wed, 260308 @ 0700
I wanted to put off buying these 2 items until a later date but seeing that I will be going to a place where the current average day time temperature is between 12-15 degrees, I thought I might as well get them (and there is a sale going on). I wouldn’t want to get frost-bite in my rear end in a foreign land, right?
So, here are my latest purchases, first to be tried out this weekend and then, next, when I go on the big climb in July.
1. A pair of ‘Inner Thermal Wear made of Modal Extra Fine 3 Layer Wool’. It costs me a week’s worth of groceries, so it had better keep me warm!
2. And a pair of water-proof ‘Thinsulate’ gloves by 3M. Costs me 3 days’ worth of food. Heh heh….
There are a few more things I need to get, such as a proper back pack and some real nice padded socks. Anyway, there is still time. It’s another 3 months plus before the climb.
Wed, 250308 @ 0700
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This 40-something-year-old man was admitted with sudden onset of breathlessness.
This is his chest radiograph.
Question:
Comment on the film.
Mon, 240308 @ 0700
I was reading the front page news of The Star today. The headline says ‘MB Standoff’. Apparently all the assembly men of a certain state in the East Coast do not agree with the Sultan’s choice of a political leader for the post of Menteri Besar and they plan to stage a ‘protest walk’ and boycott the swearing in ceremony.
Which got me thinking (and getting a bit angry). If they labelled an opposition leader who disagreed (and later apologised to the Sultan) with the Sultan’s choice of a person for the same post in another state, as ‘menghina Raja Melayu’, what would they call this then? An amicable solution? A peaceful protest?
Post election and we see more and more double standards being practiced. Shame on you, bigots!
Easter Sunday, 230308 @ 0840, thank God for the hope of resurrection for there is no hope to be found here. Happy Easter!
It’s terribly humiliating challenging climbing a mountain together with people who are younger than you. While they may claim to be as tired as you are, they seem to run on nuclear energy compared to yours truly, who is still on diesel power.
Which was what happened last Thursday (20 Mac 2008) when we summited Gunung Datuk. It was the 2nd time for me. There was a guy in our group who was climbing it for the 10th time! I bet he could do it blind folded! But for many in the group, it was their first experience.
There were 21 of us. The youngest is 10 years old while the oldest is 64! There were 3 children below 12. There were 8 IMU students with me as well. All 7 students (one was actually lagging behind, but I am told it’s due to him being online surfing the net the whole night prior to the climb) summited first, disappearing way ahead of us (I was a bit worried they would get lost ~ one of them even quipped that if they do get lost, they can have their own ‘LOST Season 1′)!
Let’s dispense with the statistics first. Time taken (for me) to reach the summit was 1 hour and 45 minutes (previously I reached15 minutes earlier; this time the delay was mainly because I stopped to wait for some of the slower climbers to catch up). Time taken to descend was 55 minutes (which was better than my previous record of 1 hour and 10 min). Water intake was about 1 litre (I brought 1.5 litres up but 400 ml was consumed by 2 children who were with me and didn’t have water on them. Their poor mum was carrying their backpacks way way way far behind!!!). Food consumed were 2 luncheon meat+egg sandwiches, 1 apple and a thermos of wonderful hot coffee!!!
As expected, I sweat like crazy, completely soaking my headband, a hand towel, my shirt and inner wear. Thankfully, the dri-fit shirt I wore kept me light and mobile. This time round, I wore my mountain climbing shoes which gave me a good grip even though the ground was wet from the heavy rain the night before (well worth the price I paid for it!). I also brought along my trekking pole which helped a lot in relieving the stress off my knees.
A few of the students told their stories of the climb in their blogs. For instance there was romance high up in the mountain!
Love is in the air!! (Dysmennorhoea + PCM search + high mountain = good love story plot)
You can read about it in YY’s blog!
Chee Koon took some really nice pics and CK wrote a good summary of the climb complete with pictures.
No one can deny that the last part of the climb was terrifying, especially to those who have a fear of height! Suffice to say all 7 male students wet their pants! Here are the evidences!
Students who wet their pants: (guess the wetters wearers)
I am told the wetness was due to profuse sweating (and not some organic waste product excreted due to fear) but we will never know, will we? 
I heard that at least one of them had a ‘minyak cap kapak leak’ contributing to the big damp patch and a very hot ‘southern region’. Ouch!!!! That’s the new meaning to the phrase ‘Fire in the loins’! LOL!!
Strangely, I wasn’t afraid of the last bit of the climb this time round! The 1st time, I was petrified! I think I’ve conquered my fear of height, at least on this mountain!
Just before we climbed the last part, we had a rest and had this picture taken. Let it be recorded for posterity that the 64 year old grandma who climbed with us made it to this plateau! Well done, auntie!!! And let it be recorded that all 3 children below 12 went on to reach the 2nd plateau just before the peak! Good job, kids!!
Somehow the sun got in my face again.
The view from the top was just as I remembered it, even though the it was a little misty.
No, wait! Wait! I don’t recall seeing this the last time:!!!!
The offending thing was revealed by the zoom function of my Canon Ixus 40 (ya, I know, it’s obsolete already but what to do, no money to buy new one) to be:
A tired looking ‘BN Flag’, probably hung there by some crazy over enthusiastic political party helper in the recently concluded general election! I mean, who are they trying to attract to vote for them? Monkeys? And who is going to take down this eye sore?
Anyway, victory was sweet as all 8 of my students made it to the top! I’m very proud of them. YY’s blog contains some reflections on this event as he drew parallels between the difficult task of summiting the mountain and life’s challenges. Very insightful indeed, you gotta read it!
Me and my students. Hmmm…the sun got in my face again…
I had another bout of visual hallucinations this time, much like the last time. I was deeply disappointed that I did not encounter those Bootylicious Amazon Babes again but my eyes sure saw some weird stuff on the way down as I breathed heavily, specs fogged by vapour, sweat pouring down my face and everywhere else, contributing to rapid dehydration and hence the optical illusions! These were some of the weird stuff that I thought I saw:
Genital warts on a tree branch??!!! *Gasps!!!*
Are those….nipples?! By George! They are! Nipples! Nipples! Loads of them! Bunches of them! Jimbo was in the Land of Merry Mammaries!
Nipples protruding out of tree trunks everywhere! Fui-yoh!!! The Amazon Babes must be near! Jimbo’s hands shook deliriously as he took this picture.
Thankfully before I went hysterically nuts, a bit of rapid rehydration back at the foothill (2 cans of cold 100 PLUS ~ the cold coconut water stall was closed! Darn!) saved me from any permanent psychiatric disorders!
Look out for the next climb (April 12th)!. Join us?
Sat, 220308 @ 0700
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