What's on TV?

*** These are all personal opinion. If you disagree, well, tough. My blog my say.***

i) It sucks that Clarke was eliminated last week from ANTM Cycle 11. Really. She's really stunning even though she behaves like a proper bitch at times. The week before she had this amazingly gorgeous eyes shoot that I totally swooned for. She won then, but I guess the arrogant nature of Clarke got the better of her. Joselyn is weird esp her laugh. Her features are not so striking and last week she performed badly doing the disaster-themed shoot, its a miracle that the judges chose her over Clarke. Then one of my flatmates raised a very important point that I had overlooked: ANTM's judges cant really kicked her out because otherwise the show wont have anymore black (or should I say- African American, no offense for the previous choice of word) people in it. Ooohh... I didnt realized that. Well- that's really unfair for Clarke- she really is gorgeous and I think Joselyn wont last long. Promise!

Tyra (to Joselyn): we are giving you another chance because of your personality.

p53 (to Tyra): personality- my ass- what a lot of rubbish.

ii) It was again another episode of nail-biting and nerve wrecking episode of X-FACTOR. Top three of each group were chosen, and to be honest I didnt care a shit about any group other than the girls. All bar one was damn good. Too bad that Cheryl Cole got the girls, they are better of under Simon. I really didnt expect Hannah to be that good. Today, she was nothing short of perfect. And after reviewing (read: you-tube watching) her previous performances, she had been really consistent all through out. Her voice has got this rocky-husky edge to it and she delivered. Man, I was so dissappointed that she didnt make it for the live-show. Laura White- got through: no surprised there; with voice like Amy Winehouse- I really wish her all the best in her coming songs choices. Diana Vickers is great. I absolutely love her performance (Hallelujah) in the bootcamp. A bit too disappointed that Amy Connoly's journey in XFactor ended now (over that alexandra girl). Ah.

iii) Chitty Chitty Bang Bang was on TV again. Again like for the 5th time since I've been in the UK. And yet there I was watching it and singing along (yes i know- guilty as charged- I have this penchant for musicals). Never notice this before: Baron Bomhurst's castle was actually NEUSCHWAN-freaking-TEIN. Been there!

Anyway... favourite song from the movie was: Doll on a music box . However today I fell for "truly scrumptious". And of course I was elated beyond words when those two songs were combined towards the end of the movie. Truly is soooo pretty. Ahhhhhh.

Eating Disorder

The other day I watched a very interesting documentary on Channel 4. It was about an 8 years old who is an anorexic. [Click here to watch it online] I was shocked to see such incident. 8 years old?!!! What's up with the kiddies these days. When I was a child of that age, all that I'm concern about is "will I miss the ice cream man if I take a quick nap". 

She's called Dana. Very beautiful girl. Pretty but thin (does this ring any bell??). (Editor's Note: p53 IS pretty and thin, but she is not in any way anorexic). It all started when she tried to eat healthily by giving up sweets and junk food. Then she became a vegetarian and not long after that she gave up food altogether.

It was shocking (to me, lest my sheer ignorance for the subject matter) to know that are more anorexic girls under the age of ten these days compared to previously. Obsession with body image has affected children of young age. Gosh- that's a disturbing thought. 

There I was- sitting in front of the TV gawking at it and making mental list of an anorexic's S+S. Dana ticked all the boxes.

• When she looks at mirror she sees a FAT girl (she is about 3 stone in weight)
• Extreme exercise (skipping all the time- mom took away her skipping rope, she then run up and down the stairs- mom detained her in her room, she then jumps on the same spot- dear God)
• Has a voice in her head that tells her thing and controls her LIFE.
• Calories counting. Even the older girls (in the rehab centre where she was at) was surprised to learn the fact that she knows the calories for everything.

[Click here for a review of this documetary]

The next day when I was in hospital I met a patient with ?Eating disorder. 80 odd. She refused to eat anything solid despite not having any dysphagia. Ensure (a type of nutritional drink/shakes) was delivered to her in small medicine cup- for which she happily drink away thinking that it was medicine. Ha! Of course the consultant was worried about her food intake, she's at high risk of not getting enough calories/nutrition. On further questioning (of her daughter) she has always been thin- all her life. 

Plus I noticed that she is very conscious about her appearance. Insisting of wearing matching coloured garment (pink nonetheless) from top to toe. At first I thought she's probably losing it (i.e. her mind- being old and all that), then when she really fiddle* with her hair while talking to my consultant or any other male doctors as a matter of fact, you know- with giggle and darting eyes. Body image issue anyone?

Numbers of elderly with eating disorder is underdiagnosed. The sad thing is when it is not detected(?) early enough, he/she will deteriorate fast or even die (many comorbidities and poor diet esp those living alone). 

My say: old also want to look pretty meh? Just enjoy life not that you have many of it left. 

*fiddle as in: brushing her hair away from forehead and tucking it behind her ears in a very teenage-like motion. difficult to explain, has to witness first hand.

Updates

Hi to all, 

How is everyone? Hope weekend brings only joy to everyone's life.

Okkkaaay...

I finished one month placement in a block called Student Selected Block (SSB).

Glad that I started with SSB first (i mean if say for example I were to start straight to hospital placement with a surgeon- which will definately crush my world and make me miserable). 

During SSB I had chance to laze around (like seriously) and eased myself in a very relax and slow-mo way into learning atmosphere (remember that by the time final year started I had NOT done any serious reading -on medicine and surgery- for at least 5 months: yeah- all due to short project, big project and summer holiday). so phew!

The essence of SSB is for students to do as much as (or as little as- like me- BAD!!!) they like to gain insights into the medical world. Sound cliche I know, but we are talking business here man! There were compulsory sessions to revise skills (which was an utter waste of time me thinks because we all fecking know already ALL the bloody skills). Then there were human simulation sessions (SIMs) that were exciting at times and got stressful at the others. In SIMs, students were asked to managed a dummy for various emergency situation. The SIMs can speak, blink his eyes, has circulating blood, receive IV drugs n fluids and for f*** sake has a cardiac arrest!!! 

On top of all that, we had to do compulsory sign-ups fo career taster (read: spend a day or half a day with a consultant asking them a lot of questions about their specialty and hopefully taste what the specialty can offer). I was personally frustrated that specialty like genetics and hematology are not included in the list. Instead we had this long list of rubbish. And due to compulsory nature of having to do at least one career taster per week, reluctantly I had to sign-up for the rubbish ones (you can choose, but the choices are very limited, and all the interesting ones- I know how roughly the specialty works as I had spent time in doing projects- like oncology etc). Neurophysiology- wtf? Plastic surgery. At least now I know for certain that I wont ever choose to specialize in either  of them. 

If there was one good thing that come out of the career taster rubbishness; it'll be spending a morning with a newly appointed, not to mention super cute, Anaesthetist. He is so charming, its untrue. Seriously, I swooned and drooled. So bad, p53. But hey ho, anaesthetics is again NOT an area of interest. Radiology, however, seem promising (never thought that it'll be!) so I will definately consider it in case of me being complacent and as lazy as I am right now comes 5 years time. 

So that's roughly an SSB block in smallcity's base hospital. I heard in other base hospitals, they hardly have anything (what? two weeks of nothingness?) and close to 200 students were placed at this tertiary cancer centre of excellence. Dont know which one is better, our SSB or theirs. I still choose our SSB despite its utter crappyness over complete nothingness that will only send me straight to depression-land. 

Ok guys, weather is nice. I'm gonna go out and soak some sun and probably hit on some guys. Whoops.

Ps: Eid celebration program is in place. Whoops whoops... I baked some cookies last nite and managed to find matching scarf and shoes for my eid dress the weekend before. And now, who should I pick to be my arm candy (read: date) for the big kick ass eid celebration party in BIGCITY?

HIV

I think somewhere previously I had mentioned that HIV is one of my favourite viruses (reason: its clever, living intracellularly crippling the immune system insiduously, yeay!). Actually world will be a better place without it, seriously we are better off without this dangerous retrovirus.

FACT: More than 30 million people worldwide are now infected with HIV. That's alot! -Considering that there are a lot more undiagnosed cases. 

Speaking of which, mom and dad are worried that I'll be going to Africa soon (for electives). I am not. Well, at least yet. 

PS: Finally, a medically related entry! Ha. You guys will be pleased to hear that revision has started for (poor?) me albeit very slowly (escargot or tortoise like speed) 

Eurotrip 2008 (Part 3)

OK, is anyone out there still reading this? (I mean really interested in reading the travel stories, Me myself grow tired of typing despite the stories being very exciting for me personally)

Recap: We had been to Budapest, Vienna, Krakow and now heading to Prague. As I hinted previously: Prague is where everything went wrong. Of course, time for yet another list:

WHY I DON'T LIKE PRAGUE:

i) I had my first big argument with my traveling partner. Mind you guys, I have been traveling with this particular girl since the last five years and had had many good times (nope, let me change that: many great times) trawling the narrow streets of venice, feeding the kangaroo in melbourne, awe-ing at the art of Muslim architecture in southern spain etc. Details are hard to recall but to cut the story short: I had lack of sleep while she didn't have her daily dose of coffee the morning we shouted at each other in the metro (and at its platform) in Prague. That was really a BADDDD experience, definitely something that I wish will never happen again.

ii) Prague is too crowded. Too many tourists. Blocking all the views, disturbing all photo opportunities, annoying me at every turn! 

iii) It rained. Every. Day. Boo. Me and Miss A again had disagreement: about the umbrella this time. Never thought that she was so sensitive about my usual frank comment, she was probably still geared up from the first fight (point no 1).

If there is one good thing that happened in Prague it would be going to string quartet performance in a converted church. They played crowd-pleaser renditions and I went ga-ga (as usual) over thing like this. Air (bach) and spring (Vivaldi) etc. 

From there we went to Munich on a night train (which a total killer as the journey sucked big time- 4 hours stop in an extremely cold train station)

Munich is, again, a city that excel well beyond my expectation. I could actually see myself living there. Why? I dont know. But I just like the laid back atmosphere there. We went to Deustches Museum (and was amazed with the size and number of exhibits), watched a concert of Germany famous artists (free in the town square), climbed a clock tower (and saw gorgoeus view of the whole city), ate Halal chicken sandwich (and delicious ciabatta....hhhmmm...mmm) and spoke to Munchen people (very friendly, I must add).

Then... then... then.... (ooo this is very exciting) ..

we went to a castle: Neuwschwantein Schloss. It was damn gorgoeus. This castle was used as the template for designing the Sleeping Beauty castle in Disneyland worldwide. I find it very difficult to describe the area without pictures, because it really was amazing. Even with pictures, the real thing is so much more magnificent. Info: This area is located about 2 hours away from Munich.

Then, the journey continued into Switzerland. Absolutely breathtaking. More story later. 

Ta, p53.

My Sincerest Thank

I would like to express my sincerest thank to my BIGPROJECT Tutor, Dr Supervisor, for his guidance and support throughout this project.

Haa.. what the hell was that?
That was the acknowledgment bit of my written report. Which could only mean one thing- yeah I finished my report- hell yeah!

But that was what I wrote on the acknowledgment bit. Actually what I wanted to do was to write a heartfelt letter for him.

It should go like this:-



Dear Dr Supervisor,

Thanks for being my supervisor.
THANKS (with such intonation- like whatever).
But no, thanks really.

First, thanks for having me as your student.
I'm one hell of a problem. Sure you didn't know that when you agreed to be my supervisor. Have you ever feel like backing out from being my supervisor? I wonder.

Thanks for putting up with me when I argued about basically about everything especially at the beginning of the project.

And putting up with my English. Written and spoken.

Thanks so much for proofreading my written report so many times. Grammar mistakes, spelling mistakes, syntax errors, presentation, formatting etc. Thanks supervisor. It was very helpful.

Thanks for allowing me to use your computer and printer. I printed so many things that I could have easily killed a tree myself.

It's amazing how our passwords are similar. I know, great minds think alike.

Thanks for fighting for/with me with the people downstairs. They are just lazy.

Right from the very beginning, it has always been a love and hate relationship between us.
You behave like Jekyll and Hyde, being nice and all then flipping quickly into something mean.
Its only fair as I behave like an unstable matter, being present at once and disappearing for the next (few?) days.

You was very demanding.
I told you, I was pretty laid back. So that's why I put down my feet when you asked me to do extra work.
All excuses about timing and logistics were purely lies. Sorry.
I have to live by my principle.

Sorry again for not telling you I went for a holiday. I just didn't want to make you feel sad to be left in rainy and soggy UK while I was enjoying myself in the sun. I guess it's ok now that you're going to some hot countries in the Middle East for holiday starting from tomorrow.

Sorry for the countless cursing that were direct or indirectly associated with you. I do curse. Like many others. When you saw smile on my face, half of the time I was thinking, it would be so nice if I could kill you. Sweet victory.

When you laughed at few things that I said or wrote, I thought, wow you have a very good English, but then when I thought again, your comments were not far from being pure sarcasm.

I wasn't bothered though. Which I guess must had been manifested clearly on my face. And yours turned red. Do you remember that? Ha.

Sorry. **silence for half a min here**

Sorry too for all the disappearing act that I had done in the last three months. The skill has somehow improved. hehe.

Do I enjoy working with you? I asked myself. Yes and no, yes on the good days, but no for the days that you almost killed me mentally.

Now let me ask you, do you enjoy working with me?

Will I do this again with you? No thanks.
Will I do a placement in cancer department again? Hmmm.. tough question.. I have always like cancer, but after doing this project I feel as if I don't want anything to do with oncology for the rest of my life. The bitter taste of my own medicine. Probably that was highly influenced by the fact that I had to do all the boring stuff. Reading case notes, doing statistics and writing report. These things weren't exactly patient centered. I do seriously miss patients' contact.

Why the hell that I chose you in the first place?
(come on readers are dying to know)
You're eccentric. As simple as that. I thought I'd rather work with someone eccentric than working with someone plain boring.
Eccentric in what way? That I cant really explain. Hardworking- crazy- funny- weird hybrid kind of person. Difficult to second guess. Difficult to get along with.

Extremely clever. Too clever even for some of my tricks. Tsk..tsk..tsk.

Cross my fingers that I'll be as clever but less as crazy as you.

Thanks now can you give me high mark please?
p53 xoxo

Afterthoughts

Last weekend was tough. I came very close to getting depressed. All because of this stupid BIG PROJECT that seems like its never gonna end. I wrote a very negative entry previously and I apologized to those who had (unluckily) read it. I deleted it as it didnt completely represent me and the nice person I am. Psst.. It was p35, an evil-ridden person in me that will come out when I'm feeling stressed out.

So yet again another weekend spent slaving to the need of completing project report. And what difficult task it was. It took me hours to figure out which statistical analysis is relevant the weekend before and this weekend more hours to figure out how to present them. However discussion section was by far the most difficult part for me.

Why oh why do we have to suffer like this?

Weather was not great. It was shit in fact. I can't wait until this Big Project finishes, then I can go to southern europe for my holiday. I'm counting days.

Due to this project and its demanding need (especially compulsory meetings with supervisor ACCORDING TO HIS FREE-TIME) I had missed few but very major things.
i) My best friend's graduation day in BIGCITY. ARRRGHHHH!
ii) I couldn't go to wave off my best friend's at the airport when she was leaving UK for good.
iii) A trip of a lifetime to Italy.

I absolutely hate this project now. Like I said, I'm counting days.

Repent

Repent! Repent! Repent!

Young girls and TOP

Well, it seems that I'll never drop this topic... might as well talk about it when its a hot topic under my radar.

The youngest person at the surgery that requested TOP was only 15 year 4 month. Almost half of the women that requested TOP in this particular surgery were younger than 20. In concordance with national statistics.

Taking us all back to why a large porportion of women asking for termination come from the under 20 age group. Some of them were simply too young. Some of them didnt even practice any contraception prior to falling pregnant. Was'nt that a big issue under public health that need looking into?

Sex in this cases might or might not be consensual [the latter which I wont discuss here]. Despite young women consenting to sex (read: not statutory rape even if illegal sex due to being under age) they should also practice safe sex. With accident (like split condoms etc) that lead to unwanted pregnancy hence TOP, the request in itself can be perceived as a good opportunity for patient education regarding reliable method of contraception.

A thorough discussion about this matter should be made compulsory during the pre-TOP counselling. Current guideline suggest that conraceptive should be prescribed before discharging these women following their abortion.

I rest my case.

Not again!

Do you guys remember me mentioning about a 10-y-o girl who self-harmed few days before? She's back in the ward again. I felt utterly disgusted to see her again in the Paeds ward, after only a day of being discharge out- this time around with another attempt of self harm (with knife on throat!!!) Disgusted is probably a harsh word to use. Probably not entirely ethically sound either. But hey, WHY ON EARTH?

I tried to think about possibly reason(s) of her committing the action of deliberate self-harm. Many times. And every single time I cant convince myself that her actions are justifiable. Not at all.

Physically: WELL.
Mentally: Distorted I guess. To think that childhood is the happiest time in life for most people (normal people thats it), its just inexplicable. What could have troubled her mind? Bear in mind she's in primary school. Pretty much normal family and pretty much normal social circumstances. Is there is anything bothering her so much in term of getting along with her parents/siblings at home or being bullied in school? NO. No mentioning of that in her file. Is she at risk of any kind of abuse (physical/sexual/emotional/neglect). NO. Bloody no!
Psychosocial issues: Come from an average middle class family. Few other siblings, very concerned parents. Patient reported argument with mum triggered her to kill herself. Like what???? Basically she doesnt get along well with mum, about everything and anything. I mean: come on, every one would have gone through the similar (or almost similar) situation, but we are fine with it. We all find ways to get around it, cope with it, distract ourself from this pathetic self-wallowing cycle. For goodness sake. 10 year old and thinking of ending her life? What the hell was she thinking? Is she harming herself to get attention? She certainly succeed then. But in a very wrong way. BAD!!! Still- her deliberate action is unjustifiable.
Body image issue: Possibly. But nay- dont think so, she's only 10 year old, but there's is nothing in her history suggest that. No body dysmorphism disorder noted, not under any apparent pressure to look at her best all the time. Still pre-pubertal, not associated witha ny normal teenage tantrums in the challenging growing to be an adult kind of story. Nope- none of that. She looks like any other 10 year old girls. No different at all.
Neurodevelopmental: No problem in this area either. No learning disabilities. No indication to say that she's struggling at school or struggling to fit in with her peers.

CAMHS (Child and Adolescence Mental Health Services) was called in (repeatedly) to assess her case. They can't get to the bottom of her DSH either. Clearly, it's better to keep her in hospital because the risk of another attempt is rather high if she is discharged. Tell me what other better way to care for this patient?

Pitching it down to patient's level

I haven't been doing Paeds long enough to be an expert on writing this kind of stuff, but suffice nevertheless for my standard; as far as I'm concerned. You know how in daily routine of a doctor who works in Child's Health Department, he/she has to interact and deal with people from all walks of life. A bit like in General Practice and A&E I supposed.

The mix varies tremendously; ranging from neonates (clearly cannot speak) to infant (incomprehensible babbling) to toddler (mismatch sentences) to young child (very curious lot) to adolescence (unique behaviour --> can't really generalized them) to of course lovely (not!) parents. And then we have parents of different educational background, social class and dynamic with their child. Then there are kiddies who are unlucky enough to have speech delay for any reason.

Some doctors really do portray an image of a good communicator with the children. Really pitching it down to the kiddies level. In a rather cute and super friendly way, not putting up a humiliating act. For example: "touch your nose, touch my nose" -directing a child in a sing-song voice while testing for cerebellar function. Some just can't be asked: which make me wonder why bother being a Paediatrician if you genuinely hate kids?

Addressing a child as a Fraser's competent being (talking/asking the child to explain rather than going straight to parent) is a good way of building up rapport with the child. Ok, possible not the non talking kiddies. That's fair enough. But for toddler who can understand what we mean, I would definitely advised approaching the child first as an autonomous being. Plus, it is much fun hearing a child trying to explain him/herself. "I had pain here... my mom gave me calpol. She said I have temperature. I dont think I have temperature".

It will make a big different I think if a child is treated as an autonomous person. A doctor can try to include the patient in the management. For example: "Do you think you can go to the loo 7 times a day?" Patient will feel that the doctor has put some degree of trust in her/him. "Yeah, I'll try, I'll let you know how it goes....next time I see you" (real case of management of daytime wetting in an 8-y-o girl).

Then while doing the physical examination, please don't medicalized the test. Alter it into a child-friendly step. I think the best way is to demonstrate it on ourself. Like this: I want you to blow into this paper like this (then proceed to show how). With the tendon hammer or the stestoscope, let the child touch it first. (real case of a child who cried upon seeing the tendon hammer as she was afraid that it gonna hurt her). Let them know that its not gonna hurt. Seriously. Sometimes we as an adult forgets.

Adolescence. Hmm... been there, so I perfectly understand what exactly they are going through. Of course every other doctors had gone through the same phase of life. So we all should know how difficult it is to be a normal teenager, let alone teenager with (embarrassing/chronic) medical condition. "My friends think I'm a freak show as I inject myself (with insulin) at school" (again real case). Personally I like to share a personal story/ experience when talking to teens. "I remember times when I was called a freak too. Just because I wore braces at that time". Its all about making the teenage patient comfortable in speaking to you.

Its a tough call I know and I wont stop improving myself. Promise.

Today a patient opened up to me and another medical student about her past history. She was raped (!!!!!!! I couldnt believe what I was hearing at that time; utterly shocked) 3 yr ago and the her Paediatrician doesnt even know about that (Presenting complaint: a year hx of unspecific abdominal pain, missing school and learning difficulties). Talk about shocking news!!! I guess she must have found it easier to tell us about her problem.

That was a really good eye opener.

?DVT

?DVT : Query Deep Vein Thrombosis

?Acute Nephritis
?Angina
?(insert medical term here)

Often I come across the ? phrase in medical notes (electronically and on papers). The queries range from rather vague symptoms/explanation (?constipation) to the more worrying ones like ?PE or ?Placental Abruption.

As a junior, it is very tempting to query just about anything. The easiest trap is to ?(insert common condition) on the basis of association. For example: ?Eczema for a non-specific rash for a patient with history of hay fever or asthma. Yeah, its true that they can co-present in a patient but there are a lot of other differentials for rashes.

If we think that what ever it is we are querying if worth mentioning, then surely it is worth investigating. Do not ever leave it just there.

Let me explain this by giving a scenario.

Say a 25y-o Caucasian man came to GP complaining of 3 months history of dry cough and weight loss. Patient mentioned about him working as a builder and does a lot of works outdoor- making him very tired at the end of the day and feeling unwell sometimes. No other complaint otherwise. Generally fit and well.

As the coughing was more of a nuisance for him (I'll be fine with some cough syrup- he said), I prescribed him a cough linctus. ?TB. I was certain he would be fine.

Few months afterwards he was admitted to hospital with haemoptysis. X-ray showed cannonball lesions in both lungs and massive multiple mediastinal lymphadenopathy. AFB test was positive and he was treated promptly with the TB regimen (4 meds).

Looking back at his medical notes, "?TB" flagged up. Everyone questioned why didn't I investigate that further then? Considering that it had already crossed my mind.

This unfortunate guy could have died! He certainly not gonna be happy about his doctor knowing that there was a possibility of TB (?TB) but not taking it any further.

You get what I meant now?
If its worth mentioning then its worth investigating. Anyone who is caught up in situation like that will have to put his feet in his mouth. No way out!

Remember:
i) Do not use ?X just for anything. There are implications
ii) Refer to your senior if in doubt. "?TB, spoken to Resp Consultant- he agreed to have this patient under his list- non urgent referral"
iii) Beware of patient's anxiety "?Diabetes- Patient: Do I have to inject insulin now/soon etc"

Week Recap

Fuh.. I managed to get through my first week in Paeds without missing anything. So far so good. Have not yet pinch any kids. Hahah, Not that I wish to do so ever so frequently. Reserve for naughty kids. A pinch can hardly do any harm, unless of course he/she has blood problem like haemophilia and the likes.

Few times when I woke up in the morning, I felt as if I dont want to leave the comfort of my duvet (or in fact my friend's duvet). Slept over at her place twice this week alone, as me, her and 2 other friends were busy preparing a booklet for a conference organized by medical students here in my base hospital.

Surrounded by perfectionists and being one myself, everything regarding the booklet will be cross-checked 4 times. Every minute details will be scrutinized. Front cover alone took us hours. (Editor's Note: The fact that p53 doesnt have a clue on how to use Adobe Photoshop made thing worse. She went ballistic when the Adobe kept on asking "Do you want to rasterize the layer?" --> Wtf is RASTERIZE- she asked.)

Conditions seen (and have to revise about):
Absence seizure, cerebral palsy, Asperger's syndrome, pilomatrixoma(!), aggressive behaviour following cakes ingestion(again !), the usual cough and colds in GP, Measles, Glandular Fever, ADHD, recurrent UTI, piles (errkk) and of course CONSTIPATION.

Never underestimate the proportion of kiddies experiencing constipation (almost a third of all OPD consultations). Poor diet consisting mainly junk food is the culprit. Lack of fluid too. Not liking vegetables' not helping. Some parents themselves dont normally have vege in their diet. I read somewhere that with prolonged constipation, the child will learn to avoid defecating (through conditioning) which only gonna make matter worse in long run.

Lactulose and Movicol. Remember. Increase dose, manage in primary care.

My Paeds consultant advised a 10y-o girl to exercise more and eat healthy diet. Walk to school, go swimming, eat more green and fruit, cut on sugary drink, and stop having snack after 8pm. The girl just nodded. She probably forget half of the things mentioned. Even if she remember them, the advices will be quite tricky to follow.

ME 1: What is happening in this world? Dietary advises and diet diary for a 10-y-o?
ME 2: Better to have all the advices now when she's much younger.
ME 1: But still, she only young. She should enjoy food.
ME 2: She'll thank the doctor later when she's a teenager, Hmm, a NOT FAT teen.
ME 1: Is the girl is to be blamed then if she is super dieting (to an anorexic level) then?
ME 2: Fine line there mate!

There are a lot more. Cant be bothered to type them out. Haha. I need to catch on sleep. Lack of sleep for the last few days had given me black eyes (not the iris, duh... black patch underneath the eyes). Not pretty. Eating pattern had also become ridiculous. Hope all will get better once I go further into this module.

PS: I slept for a complete 13 hours (Friday-Saturday)
PPS: American's Next Top Model Cycle 10 is now out! yeay.

Cars

I saw a Nissan 350Z on my way to hospital today. It was parked on the curb, looking majestic. Haa. I circled the car twice. AMAZING. I remember now WHY I fell in love with it the first time I saw it. (Brisbane-2006). The car is extremely beautiful, in every way. Trust me.

This car is also known as the "Fairlady". Yeah- indeed the fairest of them all. Its interior is absolutely smashing. Leather seat with one of the coolest looking dashboard. If I ever gonna have one, I'll have the perfect silver one! I wonder how much the one with basic specifications gonna cost. This pretty car will suit the pretty me just perfectly!

Then, I saw few Alfa Romeos (147 series and the classic ol' GT) passed by. Good engine and good built. Impressive interiors. However, Alfa Romeo logo right in the middle of the front bonnet just make the exterior looks asymmetry- as the plat no# has to be shifted to the right. (Pictured here is a very handsome looking Alfa Spider. Looks damn beautiful -but the minute the plat no# comes into picture- the pretty image is distorted) Boo. I want my things to be symmetry.

Editor's Note: (And hell yea- I'm my own editor!) To be honest, once you are inside the car, you cant see it. Who give a shit about the position of the plat no# anyways? All you have to do is drive, knowing that your car is all shiny and posh.

PS: I met MY (previous, i know) consultant in his Alfa Romeo Spider when I passed in front of the obs&gynae unit. Missing him already. Haha. His final words: when in doubt, wear heels!

PPS: or should I get the Roadster?

weekend whining

i) Whats the point of having a police-on-horse squad for? Nothing. They go slower than me walking. They go around and around in circle (in supposedly high risk area). Rather than providing amusement to little kids and chance to stride around town in style to the workforce, I think the whole squad is of no practical use.

ii) Seen at a local supermarket, a lady with trolley at the checkout counter with just a 50ml bottle of vitamin. The trolley can probably fit in 4 boxes of 30 cans of Cokes. Easily. Why bother having a trolley for just an item? Too weak? You will need more than just a bottle of vitamin to get stronger, my dear. (Pushing trolley i reckon will consume a lot more energy rather than carrying any single item in hands. With cumulative force downward + gravity, the energy needed will surely be more than carrying the item)

iii) Have a look at the TV listings for the usual 5 channels (BBC1, BBC2, ITV1, Channel 4 and FIVE) for Saturday afternoon. Boring boring boring.

**** notes added on Sunday****

iv) Seen on "Something for the Weekend" on BBC2, one of the guests prepared a cocktail at 10 in the morning! Cocktail with gin and vodka. This cant be right! Kids are watching. And is that normal for Britons to wake up to a glass of martini? No wonder the "E" in CAGE questionnaire will be taken rather lightly by the population. Whats up with calling the guest a "mixologist"? As in a specialist in mixing up stuff to make a great cocktail. Mixologist my ass!

v) Seen this morning at the park, a family (parents and a young child) walking their dog. My heart goes to the kid, he seems as being treated like the family dog in a sense that he is walking with a strap too. That shouldnt be happening.

vi) A lot of daffodils are seen blooming on the road sides. Yeay! Spring had sprung!