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Archive for June 1, 2009

Bad bad dreams

June 1, 2009 8 comments

Jimbo had a fitful sleep last night. After watching CSI and CSI NY, he called it a night, being quite happy and contented that his wife and kids are back safely from their balik kampung trip.

But sleep would not come until way past midnight!

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When he finally fell asleep, he didn’t sleep long because he woke up sweating and shaking away! He dreamed that he was running from unseenĀ  foes in what appeared to be the vast unwelcoming grounds of an ancient castle, a bit like Hogwarts actually. The sky was dark and the wind was strong. As he ran, he suddenly heard a piercing scream to his left!

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He turned his head only to see a girl screaming away and in front of her was a boy of similar age convulsing violently on the ground. It was weird because when Jimbo got there, he saw that the boy has a grotesque facial expression with saliva drooling from his mouth. There were bruises covering his face. His body was contorted into a strange position, the upper limbs were twisted while the legs were twisted 180 degrees backwards! His spine was bent in an opistotonic arc!

The weirdest part was that despite his obvious agony, he was still very lucid. When questioned by Jimbo regarding his condition, the boy spoke in an unearthly voice but could answer all the ‘history taking’ while contorting away!

Now, here’s the weirdest part: Jimbo walked away and mumbled:

“Focal seizures with conversion to grand mal epilepsy”; differentials being “temporal lobe epilepsy”, “Malingering” and “Demon Possession”!

Good grief…. (I mean, how could one just witness that, make a clinical diagnosis and walk off?!!!)

Jimbo woke up, his heart palpitating away and his body covered in sweat! He looked at the clock, it was 1.45 am. He then went to switch off the air conditioning in his kids’ rooms and went back to sleep.

In the next dream, he read a comment on his blog, under the ‘Efavirenz Dreams’ article he published a few days ago.

Some one wrote:

“No thanks to you Jimbo, because of this article, I shall have to stop subscribing to WordPress! Because you have stooped so low as to solicit for business, trying to get patients via your website!”

Again, Jimbo woke up, feeling pretty disturbed and feeling like he is a pimp, soliciting for customers on his blog! He looked at the clock and it was 5.30 am. He actually made a mental note to quickly reply to the comment above, explaining that he had no intention of soliciting for any patients nor was he ridiculing any particular marginalized group in the community.

And then, suddenly, he realised that it was all a dream. The comment was not real!

Good grief!

Sigh….

A mental note to himself: NO MORE EATING NASI PULUT (GLUTINOUS RICE) BEFORE SLEEPING!!!! And no more watching 3 movies (Harold & Kumar – go to White Castle; Angels and Demons and Fast & Furious 4) over a weekend when home alone!

Mon, 010609 @ 1206

Categories: Me

Case #82: The man with recurrent pneumonia

June 1, 2009 10 comments

This elderly man has history of multiple admissions for recurrent pneumonia. He has been bed bound for almost 10 years due to an intracranial hemorrhage.

He has undergone an investigative procedure and this is his CXR.

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Questions:
1. What procedure did he undergo?

2. What is the diagnosis?

Mon, 010609 @ 0700