Saturday, October 31, 2009

They are brothers

3 MONTHS AGO, i blogged about Just To You to show my disappointment towards him.

Me : Hey, tmr can bring ah mah2 hkl for eye clinic first appointment? cos her first appointment is on 23rd June but she will be in Sabah that time. I tried to change the date to 11th june where i will be going back home but its full. If not, need to skip her first appoinment and follow up on 21st July.

One hour jo still no reply...
Me : Hey. can or cannot please reply.

A few mins later...

Him1 : I can't, i have work. I can't take leave... continue reading Just To You

RECENTLY i wrote an approximate 800 words email to another him. It has to be something very serious that i spent my time writing this long email to seek his opinion. 6 days has passed, i found out from my dad that he actually went back home last weekend so i text him to find out what actually happened.

Me : Hei bro. Did you receive my email on 23rd October?

Him2 : Yes, why?

Me : But u neva reply? i tot u didnt get it. So what do u think? 2day they all decided 2let ah gong hav beta diet already. cos nw getting much worst. lost of appetite n walk wit support bcos no energy.

Him2 : I went bk last wkend. i heard frm them that the chinese doc restricts all of the diet. let c wat happen after 1 month.

Me: Im not going 2wait anymore. i told them 2resume the last time diet already. nvm. i play game sin. ciao.

From now onwards, I gave up on this another him. Everything written above are true. I never add a single word from our conversation!

Oh by the way, Him1 is a different person from Him2. You will find out how they are related at the end of the post.

My ah gong is an ESRF (end stage renal failure patient). We were almost ready to bring him for dialysis last month. However, my family decided to try out TCM (traditional chinese medicine) before starting dialysis. So we went to a small town in perak (approximately 2 hours drive from KL) to see this chinese physician, came home with 30 packets of chinese herbal medicine after spending approximately RM 500.
2 weeks after the treatment, my ah gong lost 3 kg, lost of appetite very seriously (because of the completely ridiculous strict diet from the chinese physician) and feeling weak.

My email is as below :

"Hey uncle lee and andy bro,

Its gonna be long. So do continue reading only when you are really free. hehe.

I requested my dad to bring ah gong for renal profile test yesterday and the result came back today. Here is the comparison between 1st October and 21st October. Ah gong started on the 'magical' TCM on 6st October.

Electrolytes : 1st October vs 21st October (Ref range)

Urea : 19.8 vs 12.9 ( 1.7 - 8.3 )
Creatinine : 474 vs 454 (<150)>
GFR : 11 vs 11
Ca2+ : 2.03 vs 2.19 (2.12-2.52)
Phosphate : 1.42 vs 1.61 (0.64-1.48)
Uric Acid : 0.44 vs 0.34 (0.20-0.42)
Sodium : 132 vs 122 (137-150)
Potassium : 5 vs 5.4 (3.5-5.3)
Chloride : 103 vs 94 (95-100)
Weight :52kg vs49kg
Age = 81 years old
Haemoglobin???? Albumin??? (wasn't done this time, will request one during end of the month)
my Calculated Creatinine Clearance 7.96 ml/min VS 7.83ml/min

There is a major improvement in urea (what does it means?). The improvement in creatinine is almost negligible because looking at ah gong's trend, creatinine can go down or up even WITHOUT SUPER STRICT DIET CONTROL PLUS 'magical' TCM. BUT THERE IS A VERY MINOR DECLINE IN CREATININE CLEARANCE DESPITE THE SUPER STRICT DIET CONTROL.

The super strict diet - Is it necessary to obey completely???
I just spoken to my dad and he cant agreed with me regarding on letting loose ah gong's diet. Uncle billy and my dad stood firm to keep the strict diet for at least a month. I dont agree with that. Okay, i have spoken to the dietian (cik siti) in my hospital. I have told siti about ah gong's condition, progression except for the chinese medicine part. She concluded that it is neccessary to take some essential proteins such as meat/eggs (which provides high protein), mayb once a week, while bean provides low protein. I have observed the trend of renal failure patients in my hospital and found out that almost all of them are on calcium carbonate (phosphate binder), ferrous, iron, vit B complex. (will discuss about supplements with Dr Jeya, if the result by end of this month turn out to be good).

Next, ah gong called me last sunday to inform me about his bp trend. Then i called him today too. To all of our surprise, i think he is almost a doctor/pharmacist now. He stopped taking Amlodipine 5mg ON for the past 3 days already (without informing any of us, i guess), although i have reminded him to inform me regarding any changes in medication/sick/side effects for many times. His bp dropped tremendously throughout the 6 days. Something like this : sunday (116/74), monday ( 108/69), tuesday (118/70), wednesday (126/68), thursday (122/68). Normally his bp was at least 160/70 in the morning. all the values shown are taken morning (afternoon and night values are good : between 130-150/60-75). He said he felt giddy (almost fainted) upon waking up on Monday and Tuesday. He stopped taking Amlo 5mg Tuesday night. The bp was monitored for the following 3 days and the values are good. Why??? Could it be due to the chinese medicine? Why is it only start taking effect after 2 weeks?? I trust him in modifying his hypertension medication because he could still communicate rationally.

Next, big issue is up. Ah gong has lost 3kg in 2 weeks time. He complaint to me that he is feeling loss of appetite because of his SUPER strict diet. He is taking oats with milk every morning (no more bread or kon lou mee), only fried mee hun once in the past 2 weeks, then rice with 2 types of vege for lunch (almost tasteless, because no aginomoto, no soysauce, only little bit of salt), then the same or slightly different dishes for dinner. He wants more varieties! He finally complaint and i told him it was great to hear his complains.

i know the cooking part is mainly putting on fault on my mum or ah mu (they were ordered and i havent spoken to my mum regarding this yet), but the main thing that we must all agree first is on the diet modification. All of us should come to one same conclusion. we will have to let the family members accept what we want ah gong to take before ah gong himself, and ah mah(the biggest person in the family). I will email the BAN's and the CAN's from the chinese prescriber once i contacted my bro (it was written on my book at PJ).

and ah gong's renal function BEFORE and AFTER taking chinese medicine
any reason to explain why urea is dropping?? the rise in potasium could be due to the types of vege and the use of garlic in cooking for the past 2 weeks. my dad actually figured out that (so cool). SODIUM. it is dropping too!
There must be more issues/questions to raise after reading so much.

We need to think of a best diet modification plan for the cooker/carers/patient asap! Thank you very much!! Sorry to write u guys such a long email!


Some words for the 2 him.

1) If you cant care for your own grandparents, i doubt you will care for the patients (on your own initiative). Why the f*ck you want to follow up on one patient when you only see them in the ward (maybe once in your lifetime)?
2) If you cant spend time to examine your own grandparents, why did you examine other patient? You examine the patient every morning because you MO or specialist want you to do so? DAMN.
3) Drop your job. You are such an irresponsible grandson! I wont respect you at all. Doctor? Pharmacist?

Conclusion : They are brothers.

Wednesday, October 28, 2009

HSAJB news : Walao-eh

I received an email from jabatan farmasi, HSAJB today, the email is as follow :

weekend & pub hol :

a) beginning 31/10/09, Prp in tdm to work from 8am-1pm instead of 10am - 1pm..u need to follow-up d case in d morning.. HAR? WTF?? WHY WHY WHY???
b) as mentioned, tdm service is close at if any emergency (poisoning case) tdm sample come after 1pm, its d responsibility of the PF/PRP working at Farmasi a&e (8am-5pm) to do d tdm..

c) those working in ward, there r some regulation u need to follow:

sila catitkan kehadiran anda bertugas, masa sampai dan masa balik dalam buku rekod di farmasi satelit WTTTFFFF!!!
sila catitkan juga butiran bil borang cp1 - cp4 yang diisi & bil kaunseling dibuat sepanjang bertugas pada hari berkenaan dalam buku rekod item

sebelum pulang, bawa semua borang terbabit kepada peg farmasi di a&e (yg bertugas 8am-5pm) untuk dicounter sign.. WWWWTTTTTTFFFFFFFFFFF!!

anything tak faham, pls ask cik siti rosnah or myself..

d) prp working in tpn, after u finish prepare ur tpn bag, pls call & inform pharmacist at a&e to come n check your tpn bag (extension number 2290).. Must be the frp's idea... this one is acceptable!

My friends arh, why last time working on call for ward is considered one of the best on call, now become the worst already lur. Sobs! Sat A boss told me the rules will be effective from 1st Nov, my only ward on call is on this Saturday (31st October), mou diu only. WooooohoooooOOoo! :)

Monday, October 19, 2009

Tuesday, October 13, 2009

Frp posting

It was such a big shock when we heard about the posting for frp-to be in HSA last Thursday. Out of the 20 of them, only 3 stayed in Johor, and bear in mind, they were the 3 married Puan wang, Colyn and Zafeera. 3 unlucky one were thrown to Kelantan, 4 to Pahang, 2 got Sarawak and the other 8 to Sabah. We are almost ready to lose all 20 senior prps.

OMFG! EVERYBODY was talking about it so seriouly that day. I went to the office to enquire regarding transportation of cars to East Malaysia and the staffs in the office were all shocked!

5 of them (zhi yang, choon sen, yan jing, kim yen and shirlene) will be flying to Sabah tomorrow morning.

Tan zhi yang, the person who had dinner with me ALMOST every single night during the past 8 months will be going to Sabah tomorrow.

He said thank you to me in msn, for 3 times. Of course, i feel exactly the same. I want to thank him for accompanying me for dinner, gym, lending forensic books for me, sharing thoughts with me and many more!!! Thank you once again. Gambateh in Sabah! To the rest of you going to Sabah, Sarawak, Kelantan, Pahang and other places, I wish all of you success in your career and stay happy always!