"What do you mean you cannot drink milk??"

"It's because I have Lactose Intolerance (LI), ok? "

I got asked this a lot. And when I told them why, they automatically assume that I don't drink milk. Actually, it doesn't mean that I cannot take milk at all, in fact I love dairies, but consuming milk or any type of dairy products will eventually cause bloating, flatulence, abdominal cramps, and last but not least, acute diarrhea that could lead to dehydration if proper countermeasures are not taken.

Why me??
Well, thanks to the 1/8 chinese, and the remaining jawa part of me = Genetic predisposition, of course. And plus milk-drinking is never really a Malay culture, isn't it?

When will I have the symptoms??
Whenever I have appeased my cravings for something dairy i.e. milk, yoghurt, cheese, ice-cream.....YUMMM!!

How come??
Basically, we lack the enzyme lactase that breaks down lactose, a form of sugar found in milk & other dairy products. Lactose is a big-moleculed sugar and cannot be absorbed by the small intestinal (ileum) walls.
Therefore;
No lactase --> Lactose passes intact from ileum to colon --> Fermentation of lactose by the normal intestinal bacteria --> Production of a lot of gasses --------> Bloating, Flatulence, Cramps + Diarrhea (by lactose that attracts water into colon)

What to do??
Avoid dairy products (unless they are lactose-free), oral rehydration salt, water, water, water, water, water... + Oral enzyme substitution (never tried this before coz can't seem to get my hands on it yet)

Where??
Check out the prevalence of LI in the world population:

If you are still clueless and don't know what I'm talking about, go watch White Chicks the movie. Pay attention to what happens to one of the agents when he ate cheese. Oh yeah, I soooo know the feeling. Been there done that, sigh....

IMHO, being lactose intolerant ain't fun I tell ya. Especially for a person who loooooves dairy and can't live without them, like moi. And yes, different individuals have different levels and degrees of intolerance. But 'lucky' me, I got stuck with the one-glass-of-milk-will-make-you-have-diarrhea-the-whole-night type of LI. And imagine what would happen if I'd have 1 glass milk+1 slice cheese+1 stick ice-cream, in 1 day. Berkampung kat dalam bilik air ler jawabnya...

A lactose intolerant gal who loves lactose-full dairies. What a bummer, ain't it?

Paediatrics Surgery Test

.....is tomorrow. If we don't pass this test we won't be allowed to sit for the final exam.

Wish me luck!!

Nb: I love doing garda with our paeds surgery lecturer. He's a hoot, and the surgeries are pretty interesting. Will definitely join him again for the next garda.

Swine Flu - The H1N1 Influenza A Virus

With the outbreak of the H1N1 influenza viral infections in several countries, and also several reported deaths in Mexico and the US, are we going to be facing a global spread anytime soon? Will there be a phenomena like the Spanish flu pandemic in 1918? Is there a reason to panic?

Well, maybe not yet. Although it's not imprudent for us to take extra precaution to prevent further spread of the disease as announced by WHO. For now, we should practice good hygiene (i.e. hand washing, masks), cover your mouth and nose when sneezing/coughing, and avoid public places if you're down with flu to avoid infecting other people. And make sure that you have a healthy immune system, because our immune system plays a vital role in combating viral infections. And no, antibiotics DO NOT work against viral infections and flu. Unless you have a secondary bacterial infection, only then you should be taking antibiotics. This is important because if antibiotics are used too often generally then there will be a bacterial resistance phenomena, which we definitely do not want to happen.

What's interesting is it's the same etiological agent for both the Spanish flu back then and the swine flu now which is the H1N1 influenza virus. Moreover, there were six genes from American swine flu that have been identified; they are a mixture of swine flu, bird flu, and human flu viruses, and it is also a virulent strain. And because of this the WHO has increased their alertness level to level 4 (on a scale of 6) to prevent transmission and a possible pandemic situation.

Should we be scared and paranoid? I don't think so. But it doesn't hurt to err on the side of caution, don't you think?

Prevention is definitely better than cure in this case.

UPDATE: The WHO has advised against the use of the 'Swine flu' term and instead we should be referring it as H1N1 Influenza A Viral Infection.

My Mosaic, My Life

1. My first name
2. My favorite food
3. My high school
4. My favorite color
5. My celebrity crush
6. My favorite drink
7. My dream vacation
8. My favorite dessert
9. What I want to be when I grow up
10. What I love most in life
11. One word to describe me
12. My flickr name

Ehem!

Woke up this morning with a scratchy throat, and by mid-day there was definitely a sign of a throat irritation. Aiseymen.... this is the one thing that I have been trying to avoid, coz when I get the coughing fits they'll usually be accompanied with chest pains and insomnia and plus they'll last for at least a week or so. I hate it when this happens coz I could really bring the house down with the sound. Yup, that loud my coughs were.....

Already bought some lozenges from the pharmacy. Hope it'll help. Am keeping myself warm too, and definitely only warm water/drinks from now on.

Cepat lah sihat, penat ah sakit ni..... :((

Case Study Presentation

Yeah I know, this entry is kind of backdated. Had the presentation last week but was too busy and sick to write about it. Well, here's the gist of it...

As I've mentioned before, my group had the honour of making the first case presentation for the class. We are now in our Paediarics cycle and are currently assigned to the Paediatrics Cardiac Clinic. Our case study was about a female patient aged around 1++ years old with Tetralogy of Fallot. She was practically bluish due to her heart problems.

TETRALOGY OF FALLOT is a congenital heart defect that consists of 4 anomalies (hence the name -tetra):
1. Ventricular septal defect (VSD)
2. Pulmonary stenosis
3. Right ventricular hypertrophy
4. An aorta that overrides the septal defect

All these anomalies result in a right-to-left shunting of the blood, that leads to the cetral cyanosis. In addition to the cyanosis, she also has clubbing of the fingers and toes (Hippocratic fingers & toes), and poorly developed teeth and poor growth. She was also dyspnoeic during feeding (difficult to breath during drinking/eating), so the mother had to feed her slowly so that she could catch some breath in between swallowing. She could only sit/stand with support because her legs couldn't really support her body. Both the patient and the mother were very cooperative, and according to the mother the patient only cries when she's hungry and sleepy. Other than that, she's fuss free.

Clubbing of fingers and toes

She will be undergoing surgery to correct the defects. And she's also given Amoxycillin as a prophylaxis for endocarditis. Children with heart defects are also prone to get respiratory infections, and that's why she came to the hospital this time because she had pneumonia. She recovered from her pneumonia and was discharged on the day of our presentation while waiting for her surgery next month.

Our presentation was almost doomed from the get go. Apart from being notified last minute about it, we were supposed to present the case last two weeks, but due to unforeseen circumstances (n.b.kes terlupa bawak usb, lol) it was postponed to last week. And out of 9 people in my group only 6 of us were present during the presentation day because 1 was sick, 1 was taking care of someone sick and 1 went MIA. But all in all, it was a success and we really rocked! It was really satisfying to know that you've gone all out and gave your best. What we were happy about is that our supervisor was really proud of us that made it all worth it...

So, next case presentation for us will be after our Paediatrics Surgery cycle starting next week. Saw some really interesting cases recently and Dr.AL had hinted that one of them may be the subject for our case study. Oh well...

The peeps in the my group (minus Mr.MA who's taking this pic, and Mr.OAH who's forever MIA...)

Well, guys, congrats for a job well done and hope we'll rock again next time!

n/b: The patient was also recently diagnosed with an atrial septal defect. Thus she now has a pentalogy heart defect, sigh...

Flu-ish Weather

Demam
Selsema
Sakit kepala
Sakit badan

Yup, I've caught the bug that has been making people around me feverish, sneezing and coughing. Barely recovering from bout of stomach flu a week ago and now this, sigh...

Luckily the fever wasn't that bad though, only traces of blocked/runny nose remain. PCM, antihistamines and plenty of liquids were my salvation. Plenty of bed rest should also be in the list, but we have had full day classes all through the week so I still had to go. I missed only one day of classes when I really cannot tahan...

MC? Well, there's no such thing as MCs here. You are either present or absent, unless you have a really valid MC from the student's clinic (which is really far from my place) or you have managed to convince your lecturers that you are really unable to attend the classes. Kalau dah larat bangun nakgi amik MC kat klinik pelajar nun kat Copou sana, maknanya dah boleh bangun gi kelas jugak la kan? Baik gi je kelas tu, kalau dah tak larat sangat mintak ler balik awal, habih citer...

And the weather wasn't helping too. Nowadays it's been sunny/rainy in the day and cold at night. And just when we thought that spring is finally here, all hell broke loose yesterday and it actually snowed!! Well, it was snowing (with winds all) but because the temperature was above 0 degrees celcius the icicles turned into puddles of water when it reached the ground. Sejuk panas sejuk panas sejuk panas...sedangkan batu pun boleh terhakis inikan pulak kulit manusia, isy....

Ok folks, that's all for now. Need to go lie down coz my head is spinning.....

Stomach Flu et moi

Gastroenteritis, or commonly (and mistakenly) known as the stomach flu, is an inflammation of the lining of the stomach and small and large intestines. Most of the cases are infectious, although gastroenteritis may also follow ingestion of drugs and chemical toxins (eg, metals, plant substances).

Infectious gastroenteritis is commonly caused by viruses (Rotavirus, Norovirus, Astrovirus, Adenovirus, CMV), and less commonly by bacterias (Campylobacter, Salmonella, Shigella, E.coli O157:H7) and parasites (Giardia, Cryptosporidium).

Generally, there is a sudden onset of symptoms, with anorexia, nausea, vomiting, borborygmi, abdominal cramps, watery diarrhea (with or without blood and mucus), malaise, myalgias, and prostration. The abdomen may be distended and mildly tender; in severe cases, muscle guarding may be present. Gas-distended intestinal loops may be palpable. Borborygmi are present even without diarrhea. Persistent vomiting and diarrhea can result in intravascular fluid depletion with hypotension and tachycardia. In severe cases, shock, with vascular collapse and oliguric renal failure, occurs.

Treatment is symptomatic, although parasitic and some bacterial infections require specific anti-infective therapy. Gastroenteritis is usually uncomfortable but self-limited. Electrolyte and fluid loss is usually little more than an inconvenience to an otherwise healthy adult but can be grave for people who are very young elderly, or debilitated or who have serious concomitant illnesses.

(Source: The Merck Manual of Medical Information)

This was what I had last weekend. A rather bad case of gastroenteritis. First it was diarrhea. I thought it was just a plain case of lactose intolerance (had a glass of milk Friday afternoon) which usually would pass after a few hours, or at least food poisoning. But then the symptoms got worse; non-stop diarrhea, nausea, abdominal cramps, a pulsating frontal headache, back pain and muscle cramps. And come Saturday afternoon my temperature spiked! I was dehydrated from the diarrhea and had chills all over that I couldn't eat anything. All I could managed was sipping plain lukewarm water then and again, swallowing a couple of tabs of PCM, gulping down home-made ORS (oral rehydration salt) mix, wrapping up myself under the blankets, and slept and slept and slept...

Alhamdulillah, the next morning the fever, headache, cramps, nausea were all gone. Still had some mild diarrhea though. All I could manage was some dry toasts and soup. By nightfall I was almost normal, albeit a little bit weak. I was lucky that my recovery was speedy, I guess that my decision to rehydrate and control the fever worked in my favour. That and also the fact that although the urge to vomit was there I tried not to because I knew that if I do I'm gonna be more dehydrated. It may be bad to suppress the urge, but I do know my body well and how it reacts.

Until now I have been trying to figure out what had caused it. The only conclusion that I can come up with is that I may have had a viral gastroenteritis contracted from the hospital or from my colleagues. Why? Because apparently some of my classmates also fell ill with almost the exact same symptoms that I had on the very same day. It definitely wasn't food poisoning because we didn't eat the same food. Coincidence? I think not. Although, according to one of the doctors it could also be the fact that there was an epidemic of stomach flu at the time. And I think he could be right, because of this. Whatever it was, it affected my friends worse than me. Poor things. But as Ms MCL said there is an upside to it; she lost 5 pounds in less than a week! Good for her, but caution to all of you especially the bulimics: vomiting is NEVER the solution to weight loss, comprende?

It's been a long while since I was this sick. Thank goodness I keep some PCMs, aspirins, charcoal tablets, and paid attention during physiology class. Time and again the ORS mix proved to be useful when no pre-packed ORS are available on-hand. Thanks Prof. Ruby, you're a life saver!

n.b. I'm laying off rice for now. My stomach can't seem to stand it anymore, too starchy I guess. Might go vegetarian for a while. Wonder how long till I'll start craving for some meat...

Busy Bee

I'm wiped out. Tired of running around town for our classes in different hospitals scattered all over the place. Thank goodness the public transport here is quite efficient, although one do have to put up with bau-bauan yang kurang menyenangkan daripada orang-orang yang tak reti nak mandi, ada yang sanggup tak mandi berbulan-bulan sebab nak jimat air. Sheeeeshhhh....

We're having a case presentation tomorrow. It's about a patient in our pediatrics clinic with Tetralogy of Fallot. Interesting case, nice and very accomodating baby. My group has the honour of presenting first, so I would really hope that we'll do good. Will give an update later on how it goes.

Now need to get some zzzzzzzs before revising for tomorrow's presentation, got a killer headache residual from a very bad case of Gastroenteritis (stomach flu) over the weekend. If got time I'll blog about that too.

Oh, did I mention that I HATE public speaking?? Urghhhhhhh...

Battle of the Tests

This past few weeks have been HELL. Literary. Personal issues notwithstanding, we have been having class tests for almost each subject, and at least 2 tests every week. Crazy. And then there’s the class presentations. It’s like as if all of our lecturers are having a tug-of-war competition with our schedule. Unbelieveable. We were practically walking zombies in the campus (at least for the ones who studied)… With our packed morning to evening class schedule, it’s a wonder that I am still able to even remember to eat and chew my food, although more than often it’s on the run. Arghhh… I am slowly going nuts!!

WHAT IN THE WORLD AM I DOING HERE?!!

n.b. ECGs… People, I’m dreaming about ECGs nowadays, urghh… *facepalm*