keeping track.

the exercise i’ve done this week, just for my personal reference.

Monday: 3km run + 500m swim
Wednesday: 1km swim
Saturday: 2.5km run + 750m swim

unfortunately, after checking last night, i realised that Monash Sport has closed its registration for the Standard Chartered Marathon. good in a way i guess, no more contemplating whether to run or not, because no way am i going to pay the $65.

on a side note, US Open is on, though the timing is pretty horrible, starting at 1am Aussie time and going on till 12pm or so the next day. go Nadal/Federer/Djokovic! (yes, i’m fickle-minded, i don’t know who to support)

the price to pay.

i can’t remember the last time i was actually at the hospital for 8.5 hours, so it was indeed a rather fruitful and hardworking day for me today. i learnt about drugs and hepatotoxicity at the gastro seminar; was taught all sorts of stuff by a really nice, pleasant and funny doctor at gastro clinic; was highly entertained by an awesome debate with the topic “Clinical Skills R.I.P.” at grand rounds; and saw colonoscopies and a gastroscopy being performed, where there were polyps and ulcers and even a squamous papilloma, amongst other strange and unknown lesions.

but all these new knowledge and exposure came at a price of $113. i was fined for exceeding my parking time for a mere 7 minutes. it wasn’t as if i was late on purpose; i was in the midst of a gastroscopy which was delayed because the patient needed an endotracheal tube (ETT) put in before the endoscope could go in, for reasons i’m not too sure of. due to such an unforeseen circumstance, i wasn’t able to leave on time and therefore was late. it wasn’t as if i was strolling to my car, hell, i was running even though my legs were still a bit sore from the 2 gym sessions i had had over the past 3 days and my feet were hurting because my shoes don’t have proper cushioning. and i actually saw the parking attendant taking a photo of my car as i was approaching it, so i hurried there in order to see if i could explain things to him and get out of the situation. however, before i could even open my mouth, he gave me a smile, hopped into his car, and promptly drove off.

RIGHT. can’t they be just a bit more sympathetic and understanding? it’s just 7 minutes for goodness sake, not 70. as what we like to say, cut some slack can or not?! seriously, would you like me to leave you or your family member opened up in theatre in future and run off because i have to move my car to avoid a fine?

GGGGGRRRRRRR. is this what i get for being hardworking and wanting to learn? how rewarding.

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anyway, on another note, here are 2 diseases that came up in conversation very randomly today. i found them interesting and have thus read up more about them.

Kuru
Kuru is a fatal neurologic disease that is restricted to the highlands of New Guinea, where it has infected the Fore, a tribe of remote highland natives. It is a type of prion disease and was spread by the endocannibalistic funeral practices of the Fore. Family members were ritualistically cooked and eaten following their death, with the closest female relatives and children usually consuming the brain, which was the most infectious organ.

Kuru patients of the Fore people. Picture from Dr. D. Carleton Gajdusek, who was awarded the Nobel Prize in Physiology and Medicine in 1976 for his work on kuru.

The prodromal symptoms of headache and joint pains are followed 6-12 weeks later by difficulty in walking and then a cerebellar tremor, hence the name, kuru, which means “trembling in fear” in the language of the Fore. This tremor disappears during sleep and is worsened in situations of stress and anxiety. Patients soon require assistance with walking, either using a stick or accepting support from family members. The tremor then becomes course, making an upright position difficult for patients to maintain, and they become bedridden. Eventually, patients can no longer swallow or eat, and progressive wasting results. Death follows a clinical course of 3 months to 2 years, with most patients dying within a year of symptom onset.

The disease may also be associated with progressive dementia, but this certainly is not always a prominent part of the illness, as is the case with classic CJD. Patients with kuru have a tendency to laugh or cry without apparent reason. Memory usually is relatively spared until the disease becomes advanced, when patients may not recognize their families.

Thankfully, the disease is almost nonexistent now.

Reference: http://www.emedicine.com/med/TOPIC1248.HTM

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Fatal Familial Insomnia (FFI)
i think Jeff had a link to this before in one of his previous blog entries, but anyway, today while we were on Uptodate reading about Kuru, this came up together with Gerstmann-Sträussler-Scheinker disease and Variant Creutzfeldt-Jakob disease. turns out that they are all prion-related diseases.

Fatal familial insomnia involves a specific mutation in codon 178 of the PrP gene. It is an autosomal dominant disease, predominantly affecting the thalamus, which influences sleep.

The age of onset is variable, ranging from 30 to 60, with an average of 50. However the disease tends to prominently occur in later years, primarily following child birth. Death usually occurs between 7 to 36 months from onset. The presentation of the disease varies considerably from person to person, even among patients from within the same family.

There are 4 stages of the disease before an individual’s life ends.
1. Progressive insomnia developing over approximately 4 months and includes a collection of psychiatric problems such as panic attacks and bizarre phobias.
2. Hallucinations, panic, agitation and sweating and lasts about 5 months.
3. Total insomnia with weight loss lasting about 3 months. The individual at this point looks much older and may experience incontinence.
4. Dementia, total insomnia and becoming mute over a period of 6 months. This is the final progression of the disease and the patient will subsequently die.

pretty horrible, isn’t it? sure is a disease i will not want to have. i honestly cannot imagine not being able to sleep at all for months. it certainly makes me treasure my sleep and rest time now.

Reference: http://www-personal.umd.umich.edu/~jcthomas/JCTHOMAS/1997%20Case%20Studies/AAkroush.html

finally, an update.

it’s really been a while since i last blogged. don’t know why, but don’t exactly feel like blogging much these days. the past couple of weeks or so have gone by pretty quickly i must say, one-third of this semester gone and another 12 weeks more to go.

i’m currently doing my renal/urology/gastroenterology/radiology rotation, which has been alright so far. i find renal medicine quite interesting, especially so when i have a role model to look up to :) it’s probably something that i might consider for the future. urology is quite a male-dominated specialty in my opinion, and having done my first rectal examination, it doesn’t seem like a very pleasant specialty to be in. we absolutely love our radiology tutor, she’s so cute and funny and never fails to brighten up our mornings. the next 2 weeks will be spent with the gastro unit, should be good.

my term at SAM as vice president came to an end on Friday. i’ll really miss the people, for i’ve gotten to know them better and grown closer to them over the past year. it had been fun hanging out together, be it at after-meeting dinners or during events. of course, i’ll always remember our Moomba Water Festival outing where we played carnival games to try to win a soft toy, watched the beautiful fireworks together, and shared yummy corn on a cob :) all the best to the new committee, i trust that you guys will do a good job!

in other news, i’m really happy that Singapore won its first Olympic medal in 48 years! thanks to the women table tennis team, we’ve now finally got another silver medal since 1960. luckily for SBS, i managed to catch that action on TV, though it was a little disappointing that Singapore lost fairly easily. well, i guess China is really too good to be defeated. Tao Li did well too, coming in 5th in the 100m butterfly. i think it’s the first time i’ve seen a Singaporean swimmer in the finals. pretty impressive eh, given that swimming has always been dominated by the big countries such as USA and Australia. speaking of swimming and the USA, Michael Phelps has indeed been phenomenal. i was blown away by how he won 8 gold medals, all within record time. that’s simply madness. haha. been watching the other sports too as well, such as athletics, soccer, basketball, the tennis final where Nadal beat Gonzalez, and whatever random stuff they show on TV. it’s all going to be over tmr, but the US Open is starting on Monday, so more sports to watch! though timings are quite crap, ie 1am in the morning =S

speaking on the subject of sports, i’m contemplating if i should take part in the Standard Chartered Marathon this year. not the full marathon, of course. a few of my girl friends are going to take part in the 10km run, which i’ve done in 2006. i don’t think there’s a point in doing a 10km again, yet i don’t know if i’ll be motivated enough to train for the half marathon. besides, i want company to do that run. i’ll ask my sis, but she’ll probably tell me she doesn’t have time to train because her A levels are coming. boohoo. i’ve been swimming at least 1km a week (though the past week i managed to find time to swim 3x of that, so yays), but the last time i ran was months ago. so i really don’t know if i should.

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photo time! i’ll just choose one each from the various events over the past few weeks.

St Kilda and Brighton Beach outing with Cheryl and Constance. i just remembered that Constance still owes me photos, she left a message on facebook when she got back to Singapore saying that she’ll send me photos soon, but i haven’t heard from her since then. haha. this is a pretty jump shot of the both of them. i had fun hanging out with these 2 lovely girls =)

Great Ocean Road with the boyfriend, Cheryl, Constance and Siao Hui. after being there for the 3rd time, i finally took a picture with me in it. lol :P

ski trip! much more proficient at snowboarding this year compared to last year. went on a few intermediate slopes, which were really fun! and by the end of the trip i could actually go down without falling at all, so proud of myself =) i wouldn’t call myself an expert as yet, but Renald and i decided to try one of the black slopes. we figured that it being very wide, we would only have to just snowboard straight down all the way; we wouldn’t have to navigate around turns or have any obstacles to crash into. the scary bit was the steep-ness, which was about 45 degrees, but we thought we could overcome that by braking and slowing down. so off we went! i had to make myself stop a couple of times cos i was going too fast, but other than that, it was an achievement indeed =)

Jeff, Terrence and i

we went to this bar called Silverski on the 2nd night to have some drinks and chit-chat

National Day celebrations. yummy good from Grand Tofu, and pity we didn’t manage to screen the parade. otherwise, a nice and cosy gathering for the SAM members. i love this photo of the committee :) i think i’ll really miss this bunch of people now that i’ve stepped down. boo.

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after debating over it for quite a while, i’ve just installed Windows XP on my MacBook via VMware fusion because i need to/want to run a particular radiology program. yes, i know some people will now go: see, still have to go back to Windows after all. to be honest, i think i’ve doing very well with my MacBook in terms of applications so far, but there wasn’t any other way to get around this one despite trying hard, so i figured since i had the software on hand, might as well. i remember ling asked me the other day if i was given the choice again would i choose a mac or a PC, i said mac without any hesitation. i love my MacBook!

on a final note, i’m cat-sitting for a friend for a few days because her dad is here for a visit and he’s allergic to cat fur. so i haz kitteh at mah houze now :P

no time + 不舒服

i know i haven’t updated in ages, i’ve been busy since semester began. i really do have quite a few stuff to write about, but i’m exhausted after the ski trip and i’m down with a very nasty cough/flu. the piriton i took is making me feel drowsy so i promise i will write a proper entry with photos when i feel better.

in summary (or rather, a reminder for myself):
start of semester: respiratory rotation, another CABG surgery
the boyfriend’s return from Sydney with 2 visiting friends
St Kilda & Brighton Beach
Great Ocean Road for the 3rd time
Multi-Cultural Festival (MCF)
The Dark Knight
ski trip
Complications: A Surgeon’s Notes on an Imperfect Science by Atul Gawande
banana cakes

winter break ‘08

the 4 weeks that we have are almost over. 4 weeks of fun, leisure reading, TV, movies, games and relaxation. 4 weeks to rest and recharge in order to prepare for the 18 weeks ahead. and now it’s almost time to start that engine running again.

well, i haven’t exactly done much this holidays, but i can’t say that i have done nothing either. the past 3 weeks post-Queensland, i worked twice a week and spent the rest of the time doing random stuff.

法政先锋 2 aka Forensic Heroes 2
got introduced to this HK drama because i saw it on the cable TV at work. couldn’t really watch it properly as i had to go serve customers whenever they came in (duhz). so thanks to the wonders of youtube, i completed all 30 episodes of it. i really liked the forensics in it, and the episode showing its production did mention that they put a lot of work into researching on the subject before filming, and the lab equipment that they used were all real. though i didn’t exactly understand some parts on chemistry and other scientific jargon since it was in canto and the subtitles in mandarin. otherwise, i’m looking forward to watching the 1st one when i get some free time.

Wimbledon 2008
caught some matches here and there, staying up till the wee hours of the night. the final between Federer and Nadal was indeed awesome to the max and worth staying up till 6+am for. my heart was pumping so fast and hard i thought i was going to have a heart attack. haha. very glad that Nadal won, cos he’s been playing well, though it would also have been nice if Federer had made a new record of 6-in-a-row. contradictory, aren’t i? anyhow, i’m quite excited to see what will happen in the US Open, and that’s coming our way in the next month or so.

lazing on the couch watching random cartoons, movies and documentaries
Spongebob Squarepants - yes i do enjoy watching that sometimes, i admit! ;)
The Pursuit of Happyness - fantastic father & son combination
I Now Pronounce You Chuck and Larry
Sympathy for Lady Vengeance
Ah Long Pte Ltd
Australia’s Hardest Prisons
Mythbusters

finally. some time for leisure reading!
The Bourne Ultimatum - loved the action and twists, but needed lots of concentration because of the numerous characters and conspiracies.
Marley and Me - nice little doggie book. very heartwarming, funny sometimes yet sad at others. would recommend it to all dog lovers :)

movies
Narnia: Prince Caspian and Farewell Joel - outing with the SAMmies and bidding goodbye to one of our team members. congratulations on graduating and all the best in your working life :)
Kung Fu Panda - a funny no-brainer which brightened up our day.

swimming
managed to fit some exercise into my lazy 3 weeks. headed to the gym for 1km swims once a week. hopefully can keep up with this routine when semester kicks in, or even better, go twice a week. i seriously need to make that gym membership worth its money :S

new Nintendo DS Lite
finally bought one after contemplating for so long, mainly cos Kmart was having an offer and it turns out to be the same as, if not less than, what it will cost in Singapore, and also cos i had a go at my cousin’s one when my family was here. got the crimson red/black one, and it came with Cooking Mama, which i’ve been having fun with. not that it’ll make me a better cook, haha :P got New Super Mari Bros as well, it’s a bit irritating cos you can only save after every few stages, so if you die at the one before you can save, you have to start from where you last saved and make your way till that point again. GRRS. on the other hand, there are about 20 mini games that you can play as well, which gives a bit extra to the game. got a M3DS Real card online, should be coming in the mail soon, and then i can do more things with the DS.

CO juniors in Melbourne
Geraldine, Gladys, Alex and Zhixuan were here in Melbourne for a week, with Zhi-xuan being their tour guide. ok, i know the names are confusing; we figured that there are a couple of HCCO people with same names eg zx, wx, Eugene, Andrew and i can’t remember if there are more. anyway, i joined them for dinner one night at the egg chiffon rice place in the city, and we headed to Philip Island last Sunday as well.

Pannys Chocolate Factory

along the Esplanade

grey furry ball spotted!

Amaze ‘n Things. it was a place full of puzzles, optical illusions and much fun! i’m glad we decided to go explore :)

my head, anyone? ;P

and finally, on a sad note, the death of a loved one
Faye’s dog, Tanna, passed away shortly after i was back from Queensland. he had been at the vet while i was away, as he had an operation to remove the pit of a fruit that he swallowed while out on a walk. somehow there were complications and he still did not recover after the op, but he went so suddenly that i didn’t even get to see him for the last time. i will always remember him as the one who would come up to me for pets and cuddles whenever i was over at their place, the one who would move about my lap finding a comfortable position to lie in since i’m quite skinny and can’t provide much cushioning, the one whom we all loved, and still love, dearly despite the bad breath. i trust that he’s in a better place now, and i’m glad that our paths once crossed. i’ll miss you, Tanna.

school starts tmr, and truth be told, i’ve slacked too much to be looking forward to anything academically-related. perhaps i need some interesting things to see tmr in order to spark that enthusiasm again.

and it’s going to be a lonely week or so, as the boyfriend/housemate will be heading up to Sydney tmr for the World Youth Day. wish i was going on a road trip too, how exciting, to be making a drive up, meeting old friends, and being in the same place as the Pope. i sure hope he enjoys himself =) and in the meantime, i shall find things to do while the “me” time lasts.

which specialty?

i think i’ve done the University of Virginia’s Medical Specialty Aptitude Test before back in year 1, but unfortunately i didn’t save a copy of the results. because i just saw it on Jeff’s blog, i thought i’ll give it another go, this time keeping a record of what came up, and perhaps we’ll see if things change in 2 years’ time.

Rank	Specialty	Score
1	pathology	40
2	rheumatology	40
3	hematology	40
4	endocrinology	39
5	nephrology	39
6	dermatology	39
7	neurology	39
8	occupational med	39
9	physical med & rehabilitation	39
10	pediatrics	39

ah-ha. note that no surgery came up in the top 10? lol. in fact, the first hint of surgery was plastic surgery which came in at 19th.

so, pathology eh. honestly i’ve always had an interest in forensics, probably further intrigued by TV dramas on the subject. yet i know it’s such a niche that it would be almost impossible to turn that into a career in Singapore. what murder cases, they perhaps only exist in TV dramas. i have had people telling me that working with dead people is morbid, and that i should be trying to save people from dying instead. however, i’ve always thought it amazing to be able to find out the time of death, the cause of death, etc etc; it’s as though the dead could, in a way, speak for themselves.

of course, there’s much more to pathology than just forensics. my path tutor has been a great inspiration - she is indeed one awesome lady. having seen her trying to come up with a provisional diagnosis while the patient was still in the OT with her head open made me realise how challenging pathology can be in urgent situations like these. but still, i can’t really imagine myself working alone in the labs, looking under microscopes, and having little, if not close to none, opportunity for patient contact.

rheumatology had been interesting. i quite enjoyed that rotation and i learnt more about it than i did in the past 2 pre-clinical years. neurology was good as well, where i got confused yet intrigued with the body’s complicated electrical system. i thought endocrinology was alright, while dermatology had been the most boring rotation to date. renal and haematology coming up later this semester, so we’ll see how i go with those. and paediatrics next year, i can hardly wait :))

at the end of the day, of course, there are still so many more rotations to go through in the remaining 2.5 years. i’m not ruling out anything yet. not even surgery. lol.

Queensland, June 2008.

a week with the family, a week of nice sunny weather, a week of fun and laughter, a week of endless entertainment by my dear cousin - what more could i have asked for?

sunset at Noosa.

finding our way through the rocks on Rainbow Beach to see the coloured sands.

the kids cooking a 3-course dinner for the adults :)

interesting craft shops in a small town.

the Giant Drop, Tower of Terror, Cyclone, Wipeout & Moto-Coaster at Dreamworld, and my lil sissy’s favourite Spongebob.

Batman, Catwoman, Flash, Green Lantern, Hawkgirl, Wonderwoman, the Looney Tunes characters, Shrek and Scooby Doo at Movieworld,

and my new favourite ride - Superman Escape.

Curtis Falls at Mount Tamborine.

another beauty of Mother Nature captured.

nice bridges and pretty city views in Brisbane.

i’m glad i got to see my family again so soon this year round. looking forward to going home at the end of the year and spending time with them again =)

Cardiothoracic Surgery

well, this is a backdated post because i was busy then, spending time with my family who came down to Melboune and then heading to Queensland for a week. i figured that i’ll complete this post first, before sorting out my photos and writing on the holiday.

so, reading what i wrote in my previous entry, i was really lucky indeed! despite the rarity of it, i got to see a heart transplant on my first day in the unit! though i had to miss the last PBL session with Trung (which i feel pretty bad about, yet i knew i could not have possibly missed the chance to see my first, and possibly last, heart transplant). it was really amazing to see a heart beating right in front of me, a heart that has been working non-stop since we were 5-week-old embryos. it’s fascinating how a small organ the size of our fist is so vital, without which there is no life. and to think that it will continue working until the day we die, not without complaints, of course, given that so many different factors can contribute to heart disease. well, i suppose this has prompted me to keep up a healthy regime with a balanced diet and adequate exercise, as well as sufficient sleep. better take good care of that vital organ before it’s too late!

other than that, i also saw a Coronary Artery Bypass Graft (CABG) surgery, and a tricuspid valve vegetations removal. all were as interesting, seeing how delicate those small vessels and valves were, all essential in ensuring the proper functioning of the heart. didn’t get any chance to scrub in, which was a pity because i was quite keen to get my hands dirty. nonetheless, just being there to observe, was in itself an eye-opener.

i would love to go back to theatre some day, not as a patient on the operating table of course, but to see more of these intriguing stuff that cardiothoracic surgeons do. and not to forget, part of the enjoyment that i had that week came from the team dynamics, which was pretty entertaining ;)