Archive for the ‘medicine’ Category

Learning among a company of good people is unbelievably fun. I have almost forgotten how it felt after these kinds of activities became absence in my life while I engrossed myself in pressure of trying to pass every exam which is fueled more by coercion than passion. After been through a really tough year last two semesters, I really needed an injection of energy and I found it last Saturday.

When a friend of mine asked me to join a charity program in Baling last week, I was very reluctant to say yes. With no friend except him I was not sure I can survive the 6-day program unscathed. However, after a great persuasion by him, at last I agreed to join the other 34 medical students on the 4th day. The experience was so amazing and surely it was an opportunity not to be missed by everyone. I certainly welcomed the courage I had put in to brave myself to join this program.

On the 4th day of the program, they were conducting a free and some mobile clinics at one of the mosque in Baling (I kinda forgot the name of the kampong). Besides a free medical/dental check up, medicine and consultation from general practitioners, specialists, dentists and pharmacists, there were also blood donation campaign and free pap smear test.

As I was not really a participant of this program, I did not really have a major role at the free clinic and most of the time I went to Sara to learn something. Sara is an Irish who had volunteered to join the program too. She is a final year medical student in one of the university in Ireland but she knows almost everything like a real doctor. Besides she was so friendly and kind to me. She taught me so many things. For every patient that came to her to be examined, she will explain every single thing to me as if I was her student and she was my lecturer. She taught me how to diagnose the patient and let me perform the physical examination under her guidance.

There was a woman who came with red spots all over her extremities. I was about to ask Sara what rash was this and suddenly she said “look at the hemosiderin”. OK, the rash was hemosiderin and somehow I thought I was familiar with the word ‘hemosiderin’ but what on earth are the diseases that are associated with hemosiderin? I have no idea. Thus, patiently she explained everything to me from a to z.

After that I was busy calling the patient to see their doctors (which was my original duty) but suddenly Sara called me and handed me her stethoscope, insisting me on listening to an old lady’s heart. As I didn’t really remember the exact location where to listen to the heart’s sound, again without complaining anything, she taught me the locations. She even gave me an acronym on how to easily remember the locations of the 4 valves. OK, the reason why she called me was because she wanted me to listen to a murmur. The lady has been diagnosed bicuspid AV. So, the murmur can be easily heard and I swore it’s very loud.

Late in the morning, there was a woman who came just for a general medical check-up. She said she was healthy. Suddenly Sara asked me whether there was any difference in both arms and I realized the right arm was a bit swollen and then she asked me to press the edema and I thought she was going to ask me whether it was pitting or non-pitting but instead she asked me whether it’s due to vascular problem or lymph problem? Huh?! After that, she explained that the swollen arm was due to the accumulation of the lymph. The lady had a breast cancer which had metastasize to her lymph node and the doctors had removed the lymph nodes which had cause the accumulation of the lymph in the arm. I looked at the anamnesis paper (which was taken by someone else in previous station) and yes there’s a history of breast cancer. And obviously Sara asked nothing about the breast cancer or the lymph node to the patient because she couldn’t speak Malay.

What an experience!  There are a lot more to tell but I couldn’t write everything in here otherwise  it will end up being the longest post I ever write. I am really glad to have had the opportunity to be part of the medical camp. Thanks for inviting me and the never ending persuasion. After all, this is the thing I need the most.

After entering the university, my confidence markedly subsided as I lost the environment that nurtured me to fight for my dream. I only started to realize how low I felt one day in my room doing mediocre assignments that did not inspire me. Whether there should be an improvement from the university to make the assignment more interesting or not in order to make sure they will produce good young doctors later on, that is far less important because that would be entirely up to us, the student. Whether we like it or not, we are the one who determine our own path whether we want to become a good doctor or just a mere doctor who graduates from medical school but know nothing more than a layman.

In humble opinion, passing an exam is easy.

Yeah, call me snobbish or whatever.

But I think deep in you, you do agree with that statement too even though how ridiculous it may sound at first. Just do the pass year questions and understand the patterns and insyallah, you will pass it.

The hardest thing is whether by passing all the exams and was named to the dean’s list had ensure you of becoming a good doctor in the future as well?

I doubt that.

After witnessing a third year medical student came up with a diagnosis of sciatic nerve palsy yesterday, I think I really need to work harder after this.


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Just a wrap-up.

At long last, the day arrived. It was the end to the boring lectures, laboratory activities and mannequins. I am approaching my clinical years in which I’ll be spending my time at the hospital learning from the real patients. To come to think of it, if you ask me about this few decades ago, I never thought that would be possible because hospital has always been my least favorite place on earth as it’s the scariest and dirtiest.

Besides, I never dream of becoming a doctor. I fear I don’t have any ability or whatever it takes to become a healer. Healers are life saving noble folks whom people depend on so much. They heal people. They take away the suffering. For me, anyone can be a mere doctor but not everyone will become a healer as I do believe that there’s a significant distinction between a healer and a mere doctor.

This thought had led me to low self confidence.

Every time when there is an examination, I fear that the result may bring me farther down while I thought I was already at the bottom but recently an episode of Grey’s Anatomy had taught me that whatever happens, walk tall because no one knows how short you are except yourself. I try hard to take heed and gather pieces of myself with little hope but sometimes I still failed. That explains my idiosyncrasy. Some of my friends always chide me for having bipolar disease as me and violent mood swings are two inseparable items. I could be so full of confidence by being a maniac with unbelievable amount of enthusiasm in a few hours and a melancholic hermit feeling suicidal in the next. (Please take note that I don’t mean it literally). I admit that at times, I could feel that all those fear is overwhelming my rationality.

I don’t know how is my life at the hospital starting this mid September gonna be but so far my 4th year as a medical student has been the toughest. I am unsure why but this year has drained me emotionally. Perhaps it’s the thesis or the workload or the personal life or the goal that I had set during my freshman year that has driven me crazy.  I have no idea.

But I have made it this far. Shaken but I made it nonetheless.

I feel like it was just yesterday I rode the slow-freaking bus from Jakarta to Jatinangor with my other jpa mates and now soon enough we’ll be graduating.

Yes. Soon!

Because in Indonesia every medical student will experience two graduations in their bachelor program. The first graduation will mark the end of theoretical years in which after that you’ll be spending your next 2 years life as a medical student at the hospital, meeting real patients, maybe trying to diagnose and treat them in order to gain the experience. I am not sure whether it’s the same like an internship or not. And the second graduation is more like an oath-taking ceremony but I’m not sure too (believe it or not I’ve never been to any of these ceremonies) and I have no idea why they need two graduations either.

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Last few weeks, when we got a case about a patient who suffered from dental caries due to poor oral hygiene, everyone was like, “hey, I’m a future doctor not a future dentist. Did they give us the wrong paper?”. But actually we’re so wrong. Even a tooth infection can be life threatening if left untreated.

Dental caries is an infectious microbiologic disease of the teeth that results in localized dissolution and destruction of the calcified tissue. Treatments are by removing the infective caries, placing appropriate pulpal medications and restoring lesions in the most expedient manner and bear in mind that prognosis for this disease is actually good.

But, without a proper treatment as well as poor hygiene, for example like the patient in our case who neglected to come for follow up, the infection can spread into the deeper part of the teeth as well as the soft tissue of the mouth especially when the 2nd and 3rd molars are involved. At this point, the disease is known as Submandibular Space Infection or Ludwig’s angina.

Symptoms of Submandibular Space Infection include pain, dysphagia, drooling, trismus, stridor and potentially fatal airway obstruction. Treatment for early stages is IV antibiotics but advanced infections, however, require the airway to be secured and surgical drainage. Yet, without proper treatment, it can lead to death because this infection is rapidly spreading and can go as far as mediastinum to cause respiratory distress.

See, even a small thing like dental caries can actually cause death if we always take things for granted. Thus people don’t forget to go and see your dentist every 6 months as recommended. 🙂

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Acne? pimples?

This week I learned a new disease; acne. Yes, you read it correctly; acne! How many people out there really know that acne is actually a disease which requires a proper treatment from a certified doctor? I for myself, if I’m not a medical student, would be laughing out loud if I ever heard someone goes to a clinic because of acne. People always take things for granted or certain people have some stigmas like only rich people or beauty pigeons consult a doctor for acne problem.

Hey, the basic treatment for acne is an antibiotic whether in the form of tablet or cream. You don’t have to undergo all those expensive treatment such as the laser to cure the problem. Just opt for the basic because acne is actually due to the infection by the Propionibacterium Acne, a type of bacteria that colonizes our sebaceous gland. Everyone has this kind of bacteria on their skin but under certain condition, when it favors the growth of this bacteria, it can cause acne otherwise it is relatively harmless.

Yeah, there’s maybe other cause of acne such as high level of androgenic hormones ( testosterone + androgen ) which cause the overproduction of the sebum but that doesn’t mean you have to check your hormonal level which is quite expensive in order to diagnose your condition. Just a simple history taking and physical examination will be enough.

When looking at the epidemiology of acne, we can see it has a low incidence among Asian and African. But I think the low incidence is not due to less people having this condition in Asia but more to less people seeking medical advices.

ok, we always said we got acne but do we really know what actually an acne is? Acne is actually an inflammation of the pilosebaceous units in certain body areas that occurs most frequently in adolescence. Thus, it is an inflammation. Under certain circumstances such as during stress or before menstruation, our adrogenic hormones are very high. This will cause the overproduction of sebum produced by the sebaceous gland. Then, the P. Acne bacteria will act on the sebum and produce product that can cause inflammation to our skin and that cause the acne.

Here are some myths about acne :

    1. Women get acne because they don’t wash enough.(truth:Washing away surface oils doesn’t do much to prevent or cure acne because it’s formed under the skin)

    2. Eating chocolate or greasy food cause acne(truth:Experts have not found a link between the diet and acne)

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      It is now almost 3 weeks since I started my hectic life as a third year medical student. Last week we learned something about basal cell carcinoma which is the most common form of cancer worldwide. In the vast majority of cases, it is thought to be caused by a long exposure to the harmful UV rays of the sun. One of the basic Science that underlies this disease is the melanin production because our patient showed a hyper-pigmented skin and this disease often appears on sun-exposed areas of the body such as the face, scalp, ears and etc.

      One of my friends was presenting in the tutorial session about how important the melanin is in protecting our body. He said the melanin is actually produced to prevent the harmful UV rays from destroying the cells of the skin as it is a naturally protective substance that absorbs the sun’s rays. Thus, if we get tanned, please do not get worried because basically the melanin is protecting our body from the dangerous effects of the UV rays such as causing a cancer.

      But in my world today, or at least from the place I come, people adore fair skin so much. There are so many cosmetic products in the market nowadays that can help people to lighten their skin colour or make us become fairer. But we don’t actually realize that being fairer means the risk for us to develop skin cancer is getting higher… People with fair skin have less melanin and when exposed to the sun, our skin reacts by producing melanin as a way to protect itself from further damage. Instead of tanning, fair skinned individuals tend to burn when exposed to too much sun.

      That day I went back to my room and checked all my make-ups and the worst thing is my Loreal make-up contains Melano-block which regulates the production of the melanin so that my skin doesn’t go dark. Omg!

      So people, what will you choose? You wanna look fairer or you don’t mind being dark but have the less risk for developing cancer? The choice is in our hand.

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      i remembered someone said not to eat panadol with caffeine..dat’s so wrong.. in certain country there’s one type of panadol called panadol extra where one of the main ingredient besides paracetamol is caffeine…google it if u dun believe…

      and if i’m not mistaken, certain drug should be taken together with caffeine. =)

      i love caffiene… I don’t understand why certain people try to avoid caffeine as much as they can because for me caffeine is the one that kick my ass during my lazy day. =)

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