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Archive for May, 2009

The Lamp Post

May 30, 2009 5 comments

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Children are so gullible. Last Sunday, Jimbo told Ryan (his 5 year old kid) that the lamp post near the church is the very same one that will transport him to Narnia!

You should have seen his face when he heard it. It looked like he was just offered Bumble Bee (the car-robot in Transformers) as his toy! LOL!

When asked if he would like to go to Narnia, he initially looked doubtful and a little scared before nodding his head vigorously in consent! LOL!

Jimbo believes a little magic in a child’s life is essential. :)

Sat, 300509 @ 0700

Categories: Family

Being coy

May 29, 2009 3 comments

Spotted this in one of the toilets in UMMC.

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At the risk of sounding ignorant, can anyone explain what in the world is ’sampah coy’?!

Fri, 29509 @ 0700

Categories: Medical

Efavirenz dreams

May 28, 2009 7 comments

In 1998, the FDA approved a new drug for treatment of HIV/AIDS in combination with other anti-retroviral medications. The name of the drug is Efavirenz (Sustiva or Stocrin). It’s a wonderful and potent drug belonging to the non-nucleoside reverse transcriptase class (with Nevirapine and Delaverdine).

In Oct 2006, the Malaysian government declared that first line HIV medications would be given free to all HIV patients. Efavirenz was one of the drug declared free.

The drug is easy enough to take, one 600 mg tablet to be taken at night, on an empty stomach.

There is, however, one catch.

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It has a very intolerable central nervous system (CNS) side effect.

Here’s what the literature says:

Along with its desired effects, efavirenz can cause some unwanted effects. Serious side effects of efavirenz include abnormal thinking, confusion, depression, hallucinations, memory loss, paranoid thinking, and thoughts of suicide. Some individuals may develop a severe rash. Individuals should tell a doctor if they have any of these side effects.

Other side effects may not be serious and may lessen or disappear with continued use of the medicine. Less serious side effects of this medicine include nausea, diarrhea, sleep problems, abnormal dreams, headache, dizziness, impaired concentration, and changes in certain blood tests

Jimbo’s experience in prescribing this medication affirms the severe CNS side effects. Some patients experience such terrible giddiness or drowsiness or even horrific dreams that they stop taking their medications!

Ah, but there is a group of people, which Jimbo observed, who are rather immune to its bad effects! This is not validated of course, just anecdotal evidence from his day-to-day work.

The group in question are gay men! :)

Here are some experiences shared by them to Jimbo on commencing Efavirenz:

1. A few men simply had NO side effects whatsoever on taking Efavirenz! It’s as if they have never taken it at all! :)

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2. A gay man, on the first night after taking the drug, said he dreamed he was on the Star Cruise, sitting by the pool sunning himself in the glorious sun out at sea and then a drop dead gorgeous caucasian hunk came over to him and promptly seduced him! (this one is quoted ad verbatim)
The next night, he dreamed that he was the winner of Akademi Fantasia!

3. Another gay man dreamed of 4-digit numbers which came out as first prize! (And no, he did not buy the number…)

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4. Yet another, on taking the drug, dreamed that his best friend, who is a straight guy by the way, paraded on the cat walk in drag! LOL!

5. And many many other gay men claim that the drug gave them the best sleep ever.

Jimbo thinks this could be made into a research project: Effects of Efavirenz on gay and straight men. :)

Actually, when you think about it, if a straight guy has these dreams, they could be quite horrifying, really….

Thurs, 270509 @ 0700

Categories: Poz Peeps

How to deal with muscle cramps

May 27, 2009 8 comments

Last Saturday, during the Gunung Ledang climb, right after hauling themselves up the KFC (a.k.a Killer For Climbers) Rock, Jimbo and 2 of his fellow climbers were suddenly stricken by the beginning of muscle cramps!

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Jimbo going up the KFC while repeatedly mumbling: do not fart! do not fart!

And so, all 3 of them put down their bags and stretched the muscle that was threatening to go into painful spasms. The muscle in question were the vasti medialis. They flexed their knees and extended their backs. It’s a bit like 3 yogis practicing their craft high on the mountain.

They also took huge gulps of ORS or 100+ drinks, hoping the electrolytes would help ease the pain.

It worked for a while and the pain subsided only to come back with a vengeance just a few meters up the mountain!

By then, Jimbo was all alone again, the other 2 climbers were a little faster than him.

And then, suddenly, Jimbo heard a loud almost-unhuman commanding voice bellowing away, just a few meters from him, the source of the voice hidden was behind the thick foliage. He thought it was a banshee!

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“LACTIC ACID GO AWAY! GO AWAY!!!!!”

Apparently one of his fellow climbers was dealing with the muscle spasms in a new alternative way!

There are only 3 basic steps in this new therapy:

1. First, you make a firm fist with both your hands.
2. Then with murderous strength, you punch the parts of the body that are threatening to go into spasms. You gotta pummel them like there is no tomorrow.
3. At the same time, you must shout at the top of your voice and command: LACTIC ACID GO AWAY! GO AWAY!

It’s a bit like exorcism, really…

Jimbo tried it and it worked! (For a while anyway..)

Jimbo’s  going to try this alternative medicine on his next heart attack patient.

HEART ATTACK, GO AWAY! GO AWAY! ~ while thumping mercilessly on the poor patient’s chest! :)

Wed, 270509 @ 0700

Categories: Funnies, Mountain Tales

Case #81: The patient with recurrent pneumonia

May 26, 2009 8 comments

This patient has been bed bound for 2 years and has history of recurrent admissions for chest infections. Below is his abdominal Xray:

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Question:

1. Identify the object in the film above.

Tues, 260509 @ 0700

Categories: Patient of the Week

Gunung Ledang, for the 2nd time

May 25, 2009 27 comments

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Last Saturday, Jimbo joined a group of 35 other people to climb Gunung Ledang for the second time. It’s been more than 6 months since the last climb. In that time, he has forgotten how tough the climb was! :)

This time he did not take many photos and those that he took did not come out well (if you ever want to buy a new camera, buy the Canon, which was Jimbo’s old camera and not the Panasonic Lumix which is his current one).

Let’s dispense with the statistics first.

1. Time started ascend: 0810
2. Time reaching peak: 1300
3. Time to peak: 4 hours and 50 minutes (previous record 4 hours 30 min)
4. Time started descend: 1430
5. Time reaching base: 1730
6. Time to base: 3 hours
7. Total water consumed: 5 liters (inclusive of 2 sips of chlorine treated river water)
8. Food consumed: 1 energy bar, uncountable number of sweets, 6 bananas and half a pack of fried rice

This climb has a few ‘FIRSTS’.

1. It’s the first time Jimbo decided to wear a singlet instead of a T-shirt (the weather has been so hot!!!), which prompted some rather strange comments, like:
a. Do you sun tan a lot? (actually Jimbo swims a lot)
b. Doc! I see you are wearing bare-back today!
c. Bagi you, (the climb) ok-arr, sebab body you ’sedap’ (a comment from a fellow male climber from another team who was (Jimbo hope) trying to tell Jimbo that the climb is easy for Jimbo because he is fit). Jimbo hopes he did not imply in anyway that his body is ‘delicious’!!! *Sweat*

2. It’s the first time Jimbo climbed wearing Toric contact lenses, prompting some strange remarks as well, such as:
a. Doc, have we met some where before? (from a young climber who previously climbed with Jimbo in the Angsi climb!)
b. Doc, you look 10 years younger!

You judge for yourself, here is a pic below:

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3. It was the first time Jimbo saw a cockroach the size of his middle finger, about 3 inches long!

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4. It was the first time he forgot to bring his rain coat and in accordance to Murphy’s Law, it rained! No, actually it poured cats and dogs for 1/3 of the descend, rendering Jimbo (and everything else on him) soaking wet! The rain made the trail wet. slippery and dangerous. Quite a few climbers slipped and fell, but thankfully without much damage.

5. It was the first time he caught on camera one (of a few) people who blatantly vandalized the metal plaque at the peak of the mountain. This guy here below is but one of the few who used keys and other metallic stuff to leave their marks at the peak.

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I think what he wrote was, “I’m a blardy ass”

6. It was also the first time he encountered a bunch of obviously newbie climbers (from that tiny little red spot down south). Jimbo and company were descending the mountain at rapid speed until they were obstructed by a group of climbers walking slowly down the narrow trail in a single file. They were literally crawling down the mountain. Wondering what was holding up the team, Jimbo inquired and discovered that one of their fellow climber was injured with a sprained ankle and she was hobbling right at the front of the entire team, while the others just slowed to a crawl behind her.

When asked if we could overtake them (it was already past 3 pm at the time and at that speed, there’s no way Jimbo and team could make it back to base before night fall), the last guy of the other team turned around and said curtly, “Well, we have an injured friend and so you will just have to wait…at least until we come to a wider trail”!!!

Jimbo knew there will not be a ‘wider trail’ until at least an hour later. And so, he did a ‘first’ in his entire climbing career:

7. Jimbo mumbled lots of “excuse me, excuse me” and overtook the entire team from down south (Jimbo apologise to the lady whom he accidentally ‘pushed’ aside with his bag, if she happens to read this, he didn’t mean it; he was merely trying to get ahead to keep an eye on 3 young kids from his team who went ahead of him).

Jimbo reached the injured lady at the head of the human convoy and managed to ask how she is and offered her some pain-killers which she declined and so Jimbo and team moved on.

What the team leader of that team from down south should have done is to get 1 or 2 climbers to stay with the injured climber and allow them to descend at their own pace, while letting the others from the team (and other teams) to pass. At the same time, he should either inform the guide or get some of their fastest and fittest to rush ahead to base and get help. It was foolish and dangerous to slow the entire team (and other teams) down because any delay would result in descending in sheer darkness down the slippery and wet terrain and exposing everyone to dangers.

8. It was also the first time that Jimbo and team was delayed by an alleged ‘call of nature’ episode. A fellow climber (Jimbo can’t name names but she is one of his friend on Facebook!) had a sudden urge to do a ‘big’ one while at the peak. A similar episode has happened to her during the Nuang climb. In that climb, Jimbo was also producing ‘bio gas’ by the ton, so he could understand the feeling.

We were descending at good speed when the guide in front suddenly called us to a halt because, according to him, the lady wanted to “ease herself some where in front of the trail” and that she has requested for “some privacy”.

And so we halted.
And we waited.
5 min…10 min…15 min.

And then we got worried. I mean, no one can possibly ‘crap’ so long right?
And so we called out, “Are you ok?”
No answer.
“Are you there?”
No answer.
Then Jimbo dispatched a team of lady climbers to go ahead and so they went, calling the belatedly-wanting-to-do-big-business-lady-climber’s name aloud but they could not locate her!

And then Jimbo’s phone rang.
“I’m ok. I’m somewhere far down the trail. Near a river. I’m heading on first”, said the un-locate-able damsel in gastrointestinal distress.

And so we started the descend again, a good 15-20 minutes lost, with our eyes constantly scanning the trail in case we step on some freshly deposited human organic matter.

At the end of the climb, when met, the now-much-relieved-from-gastrointestinal-distress damsel swore that what she told the guide was that she wanted to run ahead and eventually reached base to ease herself. She swore she did not contaminate the mountain trail!

Oh well, it’s a case of ‘he-says-she-says’, so it will forever remain a mystery. Did she crap or did she not crap on the mountain?!!! LOL!!!!

9. It was also the first time that Jimbo hardly took any pictures on such a long trek. Here are a few of the nicer pics Jimbo took:

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The pillar has been painted and a new plaque fixed on it. It wasn’t there during the first climb.

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10. It was also the first time that Jimbo found crystals on his way up the mountain. A fellow climber commented that it’s a gift from the princess of the mountain. Jimbo stumbled upon these 2 rocks on the ground while navigating between CP6 and CP7. They were just there, shining away in the sunlight.

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Lovely, aren’t they? :)

Yup! All in all, it was a good and memorable climb.

Will Jimbo do it again?

Probably not. :)

Mon, 250509 @ 0700

Categories: Mountain Tales

Jimbo talks about H1N1

May 22, 2009 11 comments

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Today, Jimbo will give a talk on the Influenza A (H1N1) at the hospital CME. It took him all of one week to get the slides ready. :(

Wish him luck!!! (Because he knows H1N1 as much (or as little) as the guy next door).

If you miss it, you can download the power point here: H1N1 Lecture

Friday, 220509 @ 0700

Categories: Me, Medical

Protected: Exam Blooper # 33 (pw: first name of Dr. Grey is)

May 21, 2009 Enter your password to view comments

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Categories: Exam Bloopers, Medical

C.S.I. Report

May 20, 2009 2 comments

The body was found slumped behind the door of the staff meeting room in the ICU, at 0900 hours on Monday, 11th May 2009. No ID cards were found on the body but all signs point to the fact that the deceased was not well liked when alive.

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Rigor mortis and lividity indicate the body has been dead for more than 12 hours. There are no obvious external injuries seen. There are no sign of trauma or strangulation. The stiff limbs indicate that the deceased died violently, probably having pre-mortem seizures. We believe that the deceased put up quite a struggle before dying.

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The gender of the deceased could not be determined but it would appear that the deceased is male. There are no signs to suggest that the deceased was sexually assaulted antemortem. We have reasons to believe that the deceased was killed elsewhere and the body dumped here or perhaps in the dying moments, the deceased crawled to its final resting spot.

The cause of death at autopsy has been ascertained to be due to asphyxiation or to be put in layman’s term: the deceased was gassed to death.

Pinpointing the suspect would be difficult as the place is practically crawling with anaesthetists!!!

Our recommendation is to quietly dispose off the body and pretend nothing happened. What’s one cockroach in a population of a billion?!

Sigh….

Depends on how you look at it, the hospital can be the cleanest place on earth or the dirtiest!

:)

Wed, 200509 @ 0700

Categories: Funnies, Medical

Road Hoggers

May 19, 2009 8 comments

Driving to Kuala Lumpur two to three days a week from Seremban is terribly tiresome. The infamous KL jam is bad, especially on a Monday.

It’s made worst by heavy vehicles hogging up all lanes of the road:

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Three excavators and one bus!

Jimbo firmly believes that all vehicles that are bigger and slower than his car should be banned from the roads, especially at peak hours! The same goes for smaller vehicles with steering-hugging-drivers who cannot depress the accelerator faster than 40 km/hour.

Tues, 190509 @ 0700

Categories: Angst