Monday, August 22, 2016

NAMIC 2016

               I was lucky to be able to attend the NAMIC (National Acute Myocardial Infarction Course) held in Grand Dorsett, Subang Jaya. It was organised by the Serdang Cardiology Department with the aid of drug company Boehringer. Thanks to my MO, i was introduced to this course which i had to self pay RM 250 for the course. While most of the participants were sponsored by the department, I had no qualms about forking out my own money for the wonderful course.



The grand ballroom of the Grand Dorsett Hotel, Subang Jaya. Ambience was nice.



The schedule of the course. As you can see, the lectures were quite packed. There was one German, Japanese and Indonesian speaker each.




Roti canai was served for breakfast




The reception and the exhibition booths. There were many companies showing their latest brands of stents and balloons. Too bad I wasn't trained in a centre with a catheterization lab (known as cath lab), it was quite difficult for me to figure out what those things were. All seem so alien to me haha.




Lunch was provided. As expected, it was not disappointing. Black pepper chicken drumstick with grilled saugage and potato wedges. It was served in the grand ballroom itself as the lunch symposium carried on. As expected, many people were busy munching their food  taking down notes from the talk. 



So what do you say about lunch on day 2. Amazing isn't it? Salmon with fried rice and steamed chicken pieces. The salmon was so juicy that I became too obsessed with the food. 



Dr Oliver is a consultant anaesthesiologist from Germany who gave the lecture regarding the reversal of oral anticoagulants. He spoke about the prothrombin complex concentrate, which is not widely available in Malaysia. Afterall, who is Malaysia compared to Germany? Hah...


So this was the card that every delegate was given. Obviously isn't it? There were almost 500 participants from all over Malaysia. I met a friend from Hospital Umum Sarawak Cardiology Department too! All the way from Sarawak. There were also people from the health side (even a family medicine specialist attended the course), from the cardiology centres and people like me who do not even standout in the crowd. There were registrars and specialists among the participants. 



My UKM senior all the way from Cardio Centre Sarawak =) Glad to catch up with each other!


So now for the academic part of the course. You might want to skip this part if you are not medically trained. These are the brief summaries and take home messages from the whole course.

On lipids
- Malaysia is still the fatest and  sweetest nation in Asia: Prevalence of Dyslipidaemia 40%, DM 30%
- Fenofibrate and Statins are the best combination for treating dyslipidaemia as they 
   = reduce LDL
   = increase HDL
   = reduce TG
- Fenofibrates are compatible with statins, unlike Gemfibrozil, which has to be taken separately with statins as they cause rhabdomyolysis

On PCI
- in PCI capable centres, door to balloon time (DTBT) is 90 mins
- in non-PCI capable centres, if u wish to send a patient to a PCI capable centre, DTBT is 120 mins
- in other words, door in door out time is 30 mins. Door in door out means timing starts when the patient enters you ED and being sent out to PCI capable centre. That includes triage, clerking, ECG, referral and preparation of transport.

On chest pain
- ST elevation (STE) is defined by new onset of ST elevation at J point for 2 or more contiguous leads
- significant STE is defined as
   = ≥ 0.1mV in all leads, except
   = for lead V2-3  , in males -- ≥ 40 y/o ≥ 0.2mV; 
                                                 < 40y/o ≥ 0.25mV
                               in females ≥ 0.15mV
- J point: point between the termination of the QRS complex and the start of ST segment
- STE in lead aVr is always sinister. Together with widespread ST depression, it signifies Left main coronary artery disease
- not all STE are MI! They can be 
   = early repolarisation
   = acute pericarditis
   = Brugada syndrome
   = Stress cardiomyopathy
   = LBBB
- in the event of STEMI, Dual antiplatelet therapy (DAPT) must be given for ≥ 12 months

On cardiac biomarkers
- Troponin is always elevated in renal patients. HD clears CKMB but not troponin
- Causes of non MI increased Trop T
   = ICB - esp SAH                                            = tachyarrhythmias
   = Pulmonary embolism                                  = myocarditis
   = Pulm HPT                                                   = aortic dissection     
   = SIRS/ sepsis/ septic shock                          = heart failure
   = hypothyroidism

On lytic therapy
- plasminogen is activated, activates plasmin which degrades the fibrin
- given within 12H onset of MI is best.
- give is unable to perform PCI within 90 mins, or delay in primary PCI > 120mins
- thrombolysis should be given with either UFH/ LMWH/ fondaparinux
- AHA recommends thrombolysis at INR ≤ 1.7. Any other interventions other than that is individual decision, with either trial of alternative e.g. aspirin or T/O tertiary centre. 

Post MI rehab
- Driving
   = 1/52 post PCI with EF >40%
   = 4/52 post MI with no operative intervention + stress test acceptable
   = 6/52 for large vehicles post MI with no operative intervention + stress test acceptable
- Return to work
   = not more than 3/12
   = not more than 6/12 if CABG/cardiac arrest
         (*too long a return will cause patient to be very reluctant to return to work. The aim of rehab is to get the patient to go back to work as a normal being and serve the country)


MI with heart block and LBBB
- complete heart block with
   = inferior involvement - temporary, allow 24-48H. Unlikely to be permanent, no intervention needed
   = anterior involvement - a/w massive infarct, temporary pacemaker till 1/52, then usually require permanent pacemaker
- normal LBBB: discordance (discordance is good, concordance is bad) 
- LBBB with concordance QRS and ST = bad. Use modified Sgarbossa's criteria
- Sgarbossa's criteria
   i) any leads concordant STE ≥ 1mV (5 marks)
   ii) leads V1,2 or 3 , ST depression ≥ 1mV (3 marks)
   iii) Any leads discordant ST ≥ 5mV (2 marks)
- A score of ≥3 is very specific for AMI (90%), but not very sensitive (20%) = if ≥ 3, it is very likely to be MI
(* please read here for more detailed explanation)

Cardiac rehab
- aerobic exercise is recommended
- prescribed exercise is more useful. E.g. say, walk 30 mins x 5 days, instead of saying, exercise lah, mayb can walk around lo, runing can also ah, mayb u swim everyday and see....
- 6 mins walk test is a good short test to gauge patient's ability - can walk at own pace
- For MI patients, aim 60% of max HR, 20-30mins, 3-5x/week
- For normal individuals, aim 85% max HR
(*max HR = 220 - age )

Do inform me if you find some of the information here misleading and I will try to verify it. Hope this gives everyone a small insight of what we usually miss out when dealing with patients in the crampy emergency department and the sweaty medical wards.

Overall, it was just so worth the RM250. I even got to catch some pokemon in the streets of selangor meet with my uncle and aunty for a small family gathering =)


Signing off
855pm

Saturday, October 25, 2014

房间的气息,
像我手中冷掉的可可。
最最叫人残念的,
总是未完成的另一半的歌...

Friday, September 19, 2014

Housemanship

     So I started my journey ( a very long journey) as a medical doctor 2 weeks ago. 

     I was given the medical posting to start off with. Hospital Seberang Jaya would be my 2nd home for the next two years to come. It is quite a nice place, not too busy and huge, but doesn't lack the facilities to train house officers. 




        How time flies and I'm off tag now, meaning that i have to only work according to shift systems in this posting. Work will be either from 7am (we usually have to come earlier) till 6pm (or later if our work doesn't finish by that time) or the night shift of 4pm-8am. 



       Things have been going quite smoothly except for a few bad patches here and there. There were tears of joy, touched, sadness and weakness throughout these 2 weeks. I can now look forward to more good things in the future. 

        Life has been kind to me, so has been my friends/colleagues and my dear, always so supportive of me. 



Fried noodles from dear's mum. How lovely!



Homemade bread by my dear <3



Nice pastries :)



Dear dear who always thinks of me. She even reserved a lunch box with me. 



The first time having breakfast with colleagues at tim sum house in Chai Leng park.


        4 more months to go in medical (3 1/2 months to be exact), medical posting will be the best posting ever in my housemanship life. 


yikping
1028pm

Monday, September 1, 2014

等一个人·咖啡



    这个世界上,每个人都在等一个人:伴侣,恋人,另一半,携手到老。也许,你等的那个人,曾与你擦肩而过,或者在茫茫人海里窜动。缘份的瞬间,犹如拉着红线的月下老,让我们能够碰面。世界上两个根本没有任何关系的人就这样认识了,为各自的生活书写崭新的故事,人生的旅程。

 


        渗入了对方的生活,慢慢地发现,其实对方没有你想象中的那么好,你会怎样做?继续等他,还是换杯咖啡?咖啡的香浓,是表面的,口感和味觉,只有品尝的人才了解。大家都会向往甜美的爱情,如童话故事般的完美,就如总人都会被咖啡的浓郁所吸引。若果你慢慢地品尝,慢慢的细嚼,每一杯咖啡,都是独特的。从咖啡豆的名字,到产生地,收割的季节,都会令看是模棱两可的咖啡产生不同的咖啡味。



       
        你在等他,她在等你。人往往都会好高骛远,把视野放到一个很高的台阶,期望过得比人家好,比人家幸福。我们会向往美好的,甚至遥不可及的,然后忽略了我们已经拥有的,上天已经在我们周围安排好给我们的事物。电影里的思萤,把心里的空位留给了辩论社团的泽与,成天都期待着奇迹的出现。与此同时,她却不知道最好的朋友阿拓也喜欢着她。直到了阿拓的离别,她才发现原来最喜欢的是阿拓。曾经的轰轰烈烈,赴汤蹈火,昨天的我爱你,转眼间有可能演变成今天的我恨你。没有谁有义务帮你自制咖啡,只有谁有义务诚恳地喝完你泡制的咖啡。失去,往往才会让人更加惦念。




        你就是你,我才能是我,彼此都是彼此的缺口。你期望,你等的那个人,可以弥补你的缺口。但,你等的那个人,是否也和你一样,在等着你,弥补他的缺口呢?





奕斌
1133am

Sunday, August 10, 2014

Bodyworks Gym and Fitness Centre

        I'm a gym guy. So this is the forth gym that I've joined since my long holidays started way back in April. It's very near to my previous gym (Orient fitness) which I had posted before


The notice board downstairs notifying about the operation hours. 



Warming up before entering the gym, perhaps?



Can you spot my previous gym opposite? The green building =)




        My first take on this gym was: Was I entering a gym museum? This is the lockers section. It was very small and looks dilapidated. The gym has a space of three shoplots combined at the third floor. The floor was rubber and the equipment were all over the place. 



View from the locker's area



Quite messy arrangement that I had to take some time to locate each machine



The weights section which has, sadly, only dumb bells. I was looking forward to at least a few barbells. Well, that's what you get for a cheap price of RM45/ month. Can't complain too much right?



The weights were not the best I would have wanted but at least they can still be useful at some point. 



Old old weights covered with rust. Seem like those things survived from the 90's.



Pictures around the gyms showing models which, hey, did you come from the 80's?



Ignore the television and just focus on the cardio machines. I bet you never saw such a thing before in you life, have you? It's a cycling machine that looks so....ancient.



There are some new ones actually, but they decided to keep the old ones here as well. For display purposes?



        If you are observant enough, you will notice that on the treadmills, a box is placed just below the monitor. I took a closer look only to discover that it is actually like a slot machine, in which you insert coins to get the thing moving. In other words, you have to pay for using the treadmills? I'm not too sure about that cause I do not usually use the treadmills in the gym.



        I wonder how long has this gym been operating.  The equipment look so old and some are rusty. The environment is not as good as the one in orient fitness but it's still better than nothing. Perhaps by time to come, I will be able to enjoy my workout time in this gym, going through the 'cultural shock' from a classy gym to an ordinary gym.


yikping
1120am

慈济大爱之夜

        为期一个星期,为募集慈济在马来西亚的建设基金,大爱之夜的活动,在槟城演艺术中心举行。每一场,都有三百多人来参与。前天被妈妈强逼有幸参与了慈济的大爱之夜。听说是有备受瞩目的vox玩声乐团, 英文称 Acapella,演出才让我比较有兴趣地去看看是怎么一回事。既然爸爸妈妈已经参与了前两场,那只有我和弟弟相伴出席。



Straits Quay的槟城演艺术中心



里头有各式的展览








礼堂并不很大,但是就会给人一种舒服的感觉。一入场,就有慈济的护士小姐带领我们到座位上。




趁节目还没有开始时,有录影片段让我们看看慈济最近的新闻和活动。



虽然入场时间为7时30分,8时正了还有观众陆陆续续进场。响应还蛮热烈的!



访问感恩户.  (注:感恩户,只在生活中突遭变故,而需暂时接受慈济济助的人)


        VOX 玩声乐团演绎了多种歌曲。从古典歌甜蜜蜜,何日君再来,龙的传人,到现代的菊花台以及欧式摇滚曲 Rolling in the deep. 六位歌手都只是以歌喉,把每首歌发挥得淋漓尽致。当中还能‘唱’出二胡,鼓等乐器的伴奏。






               VOX玩声乐团,是“A Cappella”(阿卡贝拉无伴奏合唱)人声乐团,也是流行音乐团体,成军于2012年,是由六个大男生所组成的纯人声演唱团体,喜欢在人声里分享单纯的感动,擅长演唱现代A Cappella,曲风为流行音乐摇滚风格。经常将流行音乐改编为A Cappella版本,并在YouTube上播送,也是台湾第一支以阿卡贝拉为职业演出的团体。由重量级音乐制作人“李寿全”老师带领的“VOX玩声乐团” 打造“VOX玩声乐团”尝试多元的演出的风格,让音乐玩得更火热!根据纯人声音乐跨国性整合平台--中华畅声亚洲音乐协会(Vocal Asia)纪载,VOX玩声乐团是目前台湾最活跃、也是最受瞩目的A Cappella 团队之一。 (摘自 wikipedia VOX玩声乐团 


                 表演10时正圆满结束。真希望大马也可以出现这种玩声乐团 =)


奕斌
1055am

Saturday, July 26, 2014

The Star Property Fair 2014

         The Star again successfully organized it's 12th property fair in G hotel and Gurney Plaza. I was looking forward towards the event as I thought it would develop much of my insight on new housing developments in Penang. However, it was more towards property for the investors as well as for the high end home seekers. Fortunately, there were many talks on various topics on property which really attracted my interest.




        I was fortunate to be able to learn about Green Architecture in Feng Shui presented by Master David Koh. The talk was about how to utilise space and live with nature while at the same time developing housing areas which are nature friendly. For instance, what are the best angles of the slope that a house can be built, how do we do town planning with regards to the river flow, how the wind direction determines the structure of a high rise buiding etc. In this picture above, he was illustrating about space and designs of a house. You could read more on green buildings here



The golden proportion on how to design one's house.




Application of the golden rule on the floor plan


        I also had to chance to learn about the effects of GST on property prices. The talk was delivered by accountant Richard Oon who spoke about the GST registered and non GST registered companies. 




The slide which portrays the simple concept of GST in business



        To sum it up, developers would have to increase the prices of the properties once GST is implemented since they cannot collect GST from the raw materials. As a result, the person at the end of the line, which would be the customer, has to absorb the increased cost of materials by paying more for the required property. (Raw materials would be taxed 5%). 

        As the fair progresses into it's third day today, I will be certainly looking forward to more of the talks that will surely benefit me in the future. The talks are FOC anyway, so why should I miss them =)

yikping
124pm