Third Kudos Count

As promised, a third kudos count has been done after the first in Mac 08 and the second in May 08.

For those who are ignorant, these kudos were awarded to those who participated in the weekly clinical cases published every Monday on this blog. The first to cross 20 kudos would be rewarded with a gift.

At the last count which was at Case # 37, the tally looked like this:

YY (20) CK (19) TFTD (13) peanut (10) FengY (9) nila (7) chiet (7) AM (6) vagus (6) Azman (5) yumei (5) dytia (5) edina (4) min (4) Jing (4) Syafiq (4)

OYY, being the first to cross the 20th spot received a gift.

Since then, another 17 clinical cases were published.

Here is the new tally:

OYY and CK share top spot at 28 kudos each (CK, you may come collect your gift!; OYY, aim for 40 for your next gift)
TFTD also crossed the 20th mark to stand at number 2 with 22 kudos (you may also come collect your gift)
Third spot goes to peanut at 19 kudos (just 1 more to go! But how to pass you the gift ya?)
FengY is just one less than peanut at 18 kudos.
dytia is fifth at 15 kudos
nila is sixth at 14 kudos
yumei is seventh at 11 kudos
New comer, w1, is eighth at 7 kudos (well done!)
Jing is ninth at 6 kudos (I have also added one extra for you since you claimed ‘_’ was you!)
Syafiq shares the ninth spot with Jing at 6 kudos
Chee Koon is tenth at 5 kudos, sharing the spot with farah

Some new comers have also gained some kudos:

lishun (4)
mbism1 (3)
kiwibird, pian pian, daun serai and aiesha (2)
mashc, lsy, little~by~little, Ronald (1)

The new tally (till Case #54) will be reflected in the side bar of this blog.
Well done guys.

Fri, 311008 @ 0700

Sicknesses and Deaths

It’s been a trying couple of weeks for Jimbo, as people around him either succumbed to sickness or death.

Three of his HIV patients passed away over the last 2 weeks. Two from infective endocarditis and one from cryptococcal meningitis. One of those who had infective endocarditis also had Hepatitis C and a nodule in his vocal cord which might be TB but the ENT people were reluctant to biopsy it. He did well for a while but eventually deteriorated and slowly slipped away. The other man with infective endocarditis simply refused an iv line which would have saved him and so we had no choice but to watch him slowly die. The man with cryptococcal meningitis presented too late and in too severe state of immunosuppression and succumbed to his illness within days despite being adequately treated.

And then Jimbo developed a bad flu where he produced cendol-like mucus by the buckets and took all of 10 days to get well. Then Mrs Jimbo came down with a viral fever and passed it to the daughter who then passed it to her brother who purged and vomited.

An old friend of Jimbo’s emailed him to tell him that another old friend has suffered a massive heart attack in Australia and collapsed.

Last Friday, Jimbo’s pastor’s newborn son passed away 1 hour after birth. He had Trisomy 18.

Jimbo’s dad fell through the roof of his house while cleaning the attic (Thankfully he managed to hold on to the support beam to break his fall).

Jimbo’s brother called to say his daughter is down with very high fever.

Jimbo’s aunt-in-law is down with dengue fever.

Mrs. Jimbo’s grand aunty passed away.

The wife of one of Jimbo and his wife’s friend also passed away from breast cancer.

Another friend of Jimbo sms him to tell him that his mother-in-law’s breast lump biopsy turned out to be malignant.

Yup, it’s been a bad bad bad few weeks.

Thurs, 301008 @ 0700

Fungus in the brain

Last week, Jimbo had the rare opportunity of popping down to the Microbiology lab and take a look at a slide under a microscope. The specimen was the cerebrospinal fluid from a patient with HIV who presented with seizures.

This was what he saw:

An indian ink stain of the CSF showing thick encapsulated fungus, a hall mark of Cryptococcus infection of the brain.

Here are some more pictures found on the internet:

Isn’t it a beauty?

So beautiful and yet so deadly….

The patient was immediately started on intravenous Amphotericin B. Let’s hope he pulls through.

After he is cured of this, there’s still the AIDS, Hepatitis B and Hepatitis C to deal with. Some blood tests are still pending. Let’s hope the rest will be negative. A human body can only take that much assault.

Wed, 291008 @ 0700

The proposal

Back when Jimbo was a medical officer, he once saw an elderly Chinese couple in the medical clinic. They were from Kuala Lipis and were under follow up for hypertension and diabetes. Jimbo was the only Chinese doctor around then and naturally, and not surprisingly, they were overjoyed to be seen by a doctor of the same ethnicity because they found it easier to converse in Chinese.

They must have been pretty impressed with Jimbo because 4 months down the road, they were once again sitting in Jimbo’s clinic. This time, they did not come empty handed. Instead, they brought along 2 large bags of fruits!

One bag was full of rambutans!

The other was full of mangosteens!

Apparently they owned an orchard in Kuala Lipis and they wanted to bring some fruits fo Jimbo as a token of appreciation.

They brought along one more item:

A photograph of their still-unmarried-daughter!

The father showed me her photo and then proceeded to sing the praises of their daughter. Apparently she was in her final year pursuing a degree in pharmacy and that she has a host of desirable virtues including being sweet, kind, gentle, can cook up a storm, etc, etc; you get the picture.

They were hoping that Jimbo would be interested enough to consider dating and eventually marrying their daughter-with-overflowing-virtues!

Alas! Jimbo had to gently break the news to them that, indeed, Jimbo was already married!

They must have been terribly disappointed and heart broken; but they were very nice about it and the father softly lamented the ‘missed opportunity’. LOL!!!

Hmmm… otherwise, Jimbo might have become an Orchard Boss by now. Heh heh…

Tues, 281008 @ 0700

Case #55: The teenager with the rash

This 16 year old teenager presented with fever of 5 days duration. He has no known medical illness. The fever is high grade associated with chills. There are some mild joint pains, in the large joints. He came because he developed rashes on his legs on the 3rd day of fever. He gives history of camping recently.

His white count was not elevated but have neutrophilia. The platelet count and the hemoglobin level are normal. His renal function is normal but his liver transaminases were both > 300 mmol/L. The INR is 1.6.

This is the picture of his rash:

Questions:

1. Describe the lesions.
2. What is the diagnosis?
3. How will you treat him?

Mon, 271008 @ 0700; Happy Diwali to all my Hindu readers!

Wife Crazy

A couple of weeks ago, Mrs Jimbo, for no reasons at all, bought Jimbo a book!

Not just any book, but a book entitled: CRAZY ABOUT MY WIFE.

It’s one of those books where they have a few sentences on one page like so:

And an illustration on the opposite page! Like so:

How could anyone not like such a book ~ the stuff inside are so, so , so true.

Crazy right?!

Sunday, 261008 @ 0700

Charity Walk

NOTE: This is a ‘sticky’ post which means it will be always on the front page of this blog until it is removed. To see other entries, please scroll down.

Jimbo wants to do promote a Charity Walk which will be held on 9 November 2008 at the IJM LAND Office in Seremban 2. The walk is organised to raise funds for MAKNA (Majlis Kanser Nasional), a non-profit organization with the objective of pooling and utilising all efforts, expertise and finance from all sectors of the society, to fight cancer and reduce related pain, morbidity and the suffering that cancer patients undergo.

The participation fee is RM 8 per person which will entitle you to a free T-shirt (the colour is so bright, you can be spotted from the moon!)

The time is 7.30 am and the distance is about 3.5 km.

If you are interested, please get the entry form from Jimbo.

PS; Jimbo is participating!

Sat, 251008 @ 2104

Superbug

Jimbo had to haul his lazy a*s off the carpet in the living room in order to blog this. Jimbo was actually having his afternoon slumber, dreaming of frolicking in the sand on an exotic Greek island with 10,000 nubile Greek princesses when he was rudely awoken by a series of sms-es! Sigh.

The first sms went like this:

“Hey, y u din blog tday? I need my daily laugh…”

Next the phone rang! Choosing to not to pick it up, Jimbo tried to get back to the waiting nubile Greek princesses who, just a few seconds ago, had their hunky Chinese Geek rudely snatched away! Unfortunately, Darlene, Jimbo’s still-refusing-to-take-an-afternoon-nap daughter thought she would do a good Samaritan and answered the darn phone.

Even more unfortunate was the fact that by the time she passed the phone to her sleepy Greek-princesses-desiring-dad, the other end has gone dead. Jimbo stared at the phone. He didn’t recognise the number on the ‘miss-call’. Placing the phone under his pillow, he made one last desperate attempt to return to that erotic exotic Greek island for the slumber was quickly fading from his befuddled mind.

Jimbo swears this was one of the Greek goddess on the island!

Tough luck, because just as he was about to take a buck naked plunge into the inviting deep blue sea of the Greek island with 5,000 bootylicious Greek goddesses (the other 5,000 got tired of waiting for Jimbo and went home), Jimbo’s phone went, “ding dong”, signaling a message.

Darn! Darn! Darn!

Here was the message:

“Dr. J, yesterday i clerked a suspected active TB case. I wore a mask. Later in da afternoon, i started 2 have flu with chills. Jz want to know if latent TB infection does actually present with flu? felt sum phlegm in my throat, no cough, no fever but i m worry still. Wat do u think?”

It was on impulse that Jimbo wanted to text something sarcastic back but stopped himself in time. That would not be nice. And so he replied:

“I do not think they are related”

One could almost feel the palpable relief somewhere in Malaysia as the person who sms Jimbo earlier replied:

“Okay, I feel a little more at ease. Alright, thanks n so sorry 4 bothering. Cya nxt week!”

Jimbo replied:

“See. already semi-cured by a sms. “

Sigh, if by merely clerking a TB patient, one could get TB and manifest the symptoms in a matter of hours, then we are in big trouble because we would have a superbug in our midst!

Double sigh….

Okay, blogging done for the day.

Another tele-consult done for the day.

Now, leave Jimbo alone.

Sat, 251008 @ 1526; Jimbo didn’t blog today because he was trying hard not to talk about the wake service he attended last night because it would be irreverent. He wanted to ‘hold his peace’

Hmm, how come people never wonders why Jimbo doesn’t dorn a mask even though he sees TB patients everyday??!!!

The Climb is On!

After a bit of uncertainty, the planned climb up Gunung Datuk next Monday (27 October 2008) is on! Unfortunately, this time, no IMU medical students will be coming along as those who have indicated their participation have withdrawn due to unforseen circumstances. No newbie climbers signed up, that’s also unfortunate.

Doesn’t matter.

The climb is still on! At last count there are 8 of us (including IMU Pharmacy students!).

Time to pray for fine weather on that day!

Fri, 241008 @ 1200

Globetrotters

Jimbo’s patients definitely travel more and farther than him.
Last week one of his patient brought back a little souvenir for him from Taiwan.

A can of Taiwan’s best tea, according to his patient!

Jimbo hasn’t tried it yet but he is sure it’s going to be nice (Jimbo’s a tea (and coffee) lover).

And inside the bag was a little something else ~ a miniature Eiffel Tower key chain.

Jimbo also has patients who would jet set from faraway countries like France, China or UK, or nearer places like Singapore, Indonesia or East Malaysia for followup and flying off again, almost immediately.

Actually, Jimbo can count on one hand the places overseas that he has been through:

1. India ~ to study medicine and one conference on erectile dysfunction.

2. Singapore ~ another erectile dysfunction meeting.

3. Vietnam ~ a cardiology conference.

4. China (Beijing and Shanghai) ~ company trips.

That’s about it!

Someone once told Jimbo that offers for overseas travel would come pouring in once he becomes a specialist. Well, that some one lied. So far, not even a trickle of an offer has come.

But Jimbo is happy ~ mainly because his patients are well enough to travel, just like anyone else.

They eat and sleep, just like anyone else.

They laugh and love, just like anyone else.

They enjoy life, just like anyone else.

And that is good enough for Jimbo, even if he doesn’t get to travel.

Friday, 241008 @ 0700; secretly praying that an ID conference will be held in Paris or Budapest or Egypt or Istanbul.