How far does the barrier stretch?

on and off our brains get fired with ideas and our fingers fly to the keyboard to pen them all down and share them with the world.

the zing of thought can be a creative spark of idea to do or create something, a new discovery or a life philosophy that struck you. or it can be emotionally driven and u long to lament ur sorrows or tell the world you're on cloud nine that particular time.

but as the world becomes more liberalised and we're granted more freedom, rights and means to pen down our thoughts and ideas, there is still an area of restriction to say everything you want to say.

what you say can affect just 1 person, your small circle of friends, or spark a nationwide propaganda, or impact a whole race. you do not know how far your words spread and bring up a reaction to how many ppl the moment u click publish and share your ideas in the stream of digital media.

that said, it comes down to 2 main aspects. of why our words need to be restricted. its either about yourself, or the readers. on your part, its protection. protection against physical or literal attacks from ppl who either disagree with you, or are unaffected by your words but can potentially use your words against you. sometimes u need to protect your thoughts and not appear to be too transparent for the whole world to see. its called private / personal space. every individual defines his personal space and how much he wants to reveal to others. our words translate our personality, mindset and ideology. words however can be misunderstood or mean different things to different ppl. all the more the reason to speak wisely esp when writing on the cyberspace becomes a form of documentation hence proof of whatever you say. its hard to track back or reverse damages done.

the other aspect is of what readers feel and think about your words. the advantage of reading rather than listening is that readers get to digest the material, analyse and ponder upon ideas b4 generating a full blown reaction. not always. but stil happens. the churning of more and more ideas on the net which are pro democratic or liberal ideas tends to shift the world to that end of the spectrum as well. it doesnt have to be so big scaled. happens within a community as well. whn ppl started going green, reading loads of articles and pro-environment perspectives got ppl to be more environmental friendly. vocal speakers / persuasive writers impact the world with their words. words are enough to generate peer pressure to be pro- say..purple! sth as small as that. the idea of restricting what you write is to avoid generating negative impacts in certain groups of ppl (imagines little mine fields blowing up whn being stepped on in random places).

heck why am i writing all these. it just started from me being apprehensive about me being sucked into another emotional whirpool of feeling down, worried and sad but not wanting to vent it all out on my blog bcz i need to protect my personal space, myself and contemplating its effects on others reading about it.

how much of yourself you want to reveal to the world (yes practically the world) lies in your hands.

Erupting Wisdom

i'm currently suffering from an ulcer due to impaction of my right upper wisdom tooth onto the gum in the lower jaw.
to my utter surprise during my visit to the dentist 2 days ago, ALL four of my wisdom teeth have already fully erupted. am i that blur or plain ignorant? *hits forehead

have been thinking for the blissful past 3 years that none of them have erupted yet. not that it matters.

i have been left with absolutely no choice but to undergo a surgery to remove that ulcer-inducing-culprit as soon as possible after finishing the dose of antibiotics that will magically kill the bugs of highest evil that have caused me to suffer from pain drg swallowing, tender lymph nodes, chewing on one side of my mouth, drinking water like thr's no tomorrow and not being able to talk properly, hence silencing me to a 200 word per day quota for the past 3 days.

either the surgery, or to suffer from recurrent ulcers and the above in days to come.


in conjunction with my future wisdom tooth removal, i've set up a survey on wisdom tooth removal lol. do participate. :D


and on wondering WHY the tooth deserved such name, i googled and this is what i found:


the tooth erupts around 18-21 years of age, the age whr we are deemed 'mature', given the badge to walk into adulthood. hence earning all the priviledges that come together w it.

it differs slightly in other places:

Turkish refers directly to the age at which wisdom teeth appear and calls it 20 yaş dişi (20th year tooth).

In Korean, its name is Sa-rang-nee (사랑니, love teeth) referring to the young age and the pain of the first love.

In Japanese, its name is Oyashirazu (親知らず), literally meaning "unknown to the parents," from the idea that they erupt after a child has moved away.

The Indonesian term gigi bungsu for the last teeth a person cuts refers to bungsu, meaning "youngest child", because the teeth erupt so much later than the others, implying that the teeth are "younger" than the rest.

In Thailand, the wisdom tooth is described fan-khut (ฟันคุด) "huddling tooth" due to its shortage of space.



painfully interesting indeed.

express plans

and today was the end of my 3rd year surgery posting.

i had a lot of fun, the doctors were nice, the wards and clinics were welcoming. i'm sure going to miss this posting in weeks to come.

the coming hols although 1 week, has been filled with a substantial amount of things to be done. planned at least haha.

- start reading up on O&G.
- research / lit review for eamsc paper / poster on adolescent's health.
- spend time with family.
- meet up with eugenie, tim, ang
- join cg
- cont to update myself on God's words
- think of ideas for esz

cant wait to get home :D

Are Msian Elderly Getting Enough?

when we first embarked upon the journey of a thousand miles looking for a suitable research topic to focus on for the coming AMSC 2010 themed Geriatric healthcare last march when the guidelines were out, all we knew about geriatric healthcare was (at least what I knew was hehe) palliative care for chronically ill elderly, elderly care in nursing homes or old folks homes and the fact that everyone knows it is best to care for ur parents urself when they age, not send them to nursing homes.

little did i noe that geriatric healthcare comprises of a whole broad range of aspects, from physical health to social support to socio economic security to problems like polypharmacy (taking multiple doses of the same drugs from diff clinics thus experiencing horrible side effects from them), the lack of specialised healthcare for elderly bcz of lack of geriatricians in the country, the rising need to attend to the concerns of the elderly esp their emotional well being bcz they're prone to depression due to their loss of active lifestyle and loneliness.

we consulted Prof Rahmah from the public health dept and she gave us input on carrying out a research. a questionnaire dubbed SF-36 was used to assess the QUALITY of LIFE of elderly. it has 36 questions that fit into 8 domains of quality of life: and the answers are subjective to what the elderly feels based on a Likert scale (1 to 4 or 1 to 6)

the 8 domains

1. General health perception : do u feel healthy?

2. Physical functioning: can u walk 500m, do vigorous activities etc.

3. Role limitation due to physical problems: do u need more time to achieve doing sth due to physical problems? etc.

4. Role limitation due to emotional problems: do u need more time / effort do do sth due to emotional problems?

5. Bodily pain: how often/ severity of bodily pain.

6. Social functioning: do you face problems that limit ur interaction w others?

7. Vitality: how often do u feel tired, worn out, full of energy etc

8. Mental health: how often do u feel happy / sad / down in dumps etc.

we carried out the survey in two gov old folks homes and in the Sabah community.

we compared the quality of life score for every domain in terms of

a) place of living : nursing home vs. community

Result: Quality of life is better in the community

Social functioning is worst in the community.

Vitality is worst in the old folks homes.

b) Gender:

Result: male elderly are more affected by physical problems, females more affected by emotional problems.

this suggest diff intervention methods in addressing the needs of male / female elderly. phps for males, creating opportunities for them to involve themselves in more physical based activities to decrease the sense of depression bcz of the drop in active lifestyle compared to their young age bcz of physical limitations. for females, phps more support grps to address emotional distress.

c) married elderly have better quality of life.

are we suppose to encourage elderly ppl to get married then? hehe.

phps more attention can be paid to those who are single / divorced / widowed.

d) Quality of life increases with higher education level.

e) Physical health correlates with emotional health.

despite our country having 15 gov nursing homes to care for the elderly etc, thr is still lack of workforce in these homes. the elderly to carer ratio is extremely high and the needs of the elderly cannot be met ideally. there are currently only 9 geriatricians for the 1.4 million elderly in the country.

any1 interested to specialize in geriatric healthcare? :P

as u walk around the wards in hospitals, u can gauge that 70% of the patients are elderly ppl. many express their wish to just perish bcz they cannot take the suffering from the illnesses they have any longer, they feel uncared for, they are depressed and feel they have no hope for recovery. it bcums normal that u will fall sick n suffer when u're old.

as much as the country advocates for the rights of the elderly thru the policies and NGOs like the NACSCOM and GeM and USIAMAS helping in uplifting the elderly in the country, the emphasis on elderly well being is still not enough. there is not enough awareness being pumped into the minds of the community, esp rural areas on active healthy lifestyle for the elderly, the importance of seeking treatment bcz illness is NOT a must in aging, and most importantly, dealing with the change in trend of more women working and a career centric society that cause the family support for elderly to drop tremendously.

in the end we find that the pool of elderly in the country are chucked into nursing homes or are mostly sick suffering depressed individuals.

with the advancement of medical technology leading to higher life expectancy and a growing aging population, the challenge in ensuring the well being of elderly in the country increases.

but as the challenge grows, it isnt a reason to back off. thr's more of a reason to look into the issue critically. bcz 1 day as well, we're going to be part of that aging community.

how can u play ur part? start understanding and show love to the elderly ppl ard you. :)

*a huge beam dedicated to Pei Sun for leading the AMSA academic team in completing and presenting this ppr in the conference and winning 3rd place. thank you Kevin Tan, Seng Wee, Grace, Chia Ying, Kevin Chin and everyone else who were directly or indirectly involved for making this achievement a success. :P huge thanks to Mr. Jaya Raman from the Jabatan Perancangan Pembangunan Negara for graciously helping us to speed up our proposal approval and the insight into the country's old folks homes given, all staff of Rumah seri Kenangan Cheng Melaka and N/Sembilan and everyone who helped us in the survey, and the support from the RC Hau wei, Chin Kimg. and the public health team for organizing an awesome geriatric health promotion. Yay! :D

extension of this morn's Ischemic Limb seminar

Found a pretty good powerpoint on Acute Limb Ischemia.

Google:

clinical features to assess severity of ischemia

and hit the 1st link on the search results. :)

This page offers good stuffs. Bookmark it :P

http://www.medicaleducationonline.org/index.php?option=com_docman

err

i find myself spiralling along the course of extreme emotions these few days. its pretty freaky.

its a mixture of hvg self confidence but thinking you're not good enough, standing tough but also being scared, filtering influences of emotions from those around you. its enough to make you go from being very happy to anxious to being lost to getting your senses stabilized again.

maybe its the whole stereotype painted picture by seniors or friends, all well meant to let u noe what u're getting into or what to expect. but it creates this destabilization and at some point you wonder whr your own opinion stand or should stand or how u shud be. lol.

i'm in my 6th wk of Surgery posting. its dubbed most easy going compared to the other 2. although i'm less blur, more confident, hv more knowledge compared to like 1st wk lol, i feel like i'm stil so inadequately equipped. stil lack of so much knowledge n skill, stil so incompetent. n probably not hardworking enough. am i hardworking enough? do i have a definition or std to compare myself to? i nvr reli savoured the thought of comparing myself w others. bt then again without a benchmark u can get lost. i dont have a schedule or target or i dunno, sth along that line. i woke up this morning feeling reli alarmed. just a sudden shock n feeling of fear that i'm in week 6 bt stil so far from being prepared to leave the posting soon. and fear, is not a nice feeling at all.

swinging along the lane. i've starved myself of feelings i don't even know what to feel right now.

its not entirely negative. its just, so swing-ish that u're knocked into a different spectrum b4 u know it.

its probably exam jitters thats affecting ev1's mood. the medicine n O&G ppl have short/long cases coming up n the nervousness is sucking into me as well.

lalallalalallalla

it started as an Obligation. thereafter,

when Jesus looked upon the crowd of thousands who had gathered in front of him to listen to his teachings for days, his heart was filled with compassion for the hungry people. and through the breaking of loaves and fish, he performed a miracle that fed all of them and additionally filled up 12 baskets of the fish and loaves from an original 5 loaves and 2 fishes.

now. compassion. love. obligation.

when we look at our purpose in doing things, some are done based on obligation. some based on compassion and love. some based on obligation at first, but as time passed, you developed compassion twds it.

sth simple for instance. u enter this new school as a stranger. u obey the rules, u dun throw rubbish ard its compounds, u greet the sch officers bcz its ur obligation as a student to do so. but after 3 years, u've come to become so familiar with the sch that u noe ur teacher's favourite parking spot, the menu at the canteen everyday, the distinct off-pitched keys of the piano played drg assembly and without realising it, u have grown to be so fond of ur sch. u no longer pick up rubbish bcz its an obligation but bcz u love ur sch and simply cannot stand the sight of some1 littering or abusing its facilities.

some institutions use community service as a way to penalize their members for failure to abide to the rules n regulations of the institution. whoever started this system is a genius. the punishment becomes a contribution. and from this form of retribution comes err what's the word.. repentance? not exactly repentance but the 'turning over a new leaf' with changed life perspective that sort of thing.

bcz the individual starts off by say, washing the sch toilet very very grudgingly (bcz no1 likes washing the toilet) and he is embarrassed by the fact that he is subjected to this form of punishment. the 'pain' is thr (the agony of a bunch of cute guys walking past n seeing this girl washing the sch longkang - no that has nvr happened to me hehe) n at the same time, the cleaning is done, and when this so called 'horrifying' job has been done a tad too often, the person hvg been in that institution for some time would probably be doing it voluntarily. maybe not washing clogged drains, maybe beautifying the environment, or some form of community service like helping out in old folks or charity homes etc.

i used to enter hospital wards thinking 'okay, so today i will clerk 1 patient at least and do physical examination on 1 patient at the wards'. i want it to be convenient and fast and i hoped for patients to give their cooperation. i complained to friends when patients say they're tired / sleeping / wave me away. a day with mostly unhappy tired sleeping patients would be a 'not so good' day.

1 day someone's words struck me. 'if i see any medical student taking history from a patient in a hurried manner, doing it for the sake of taking history and not being genuinely concerned for the patient, i'll fail that student.'

whoops.

that kinda stuck in my brain even days after.

last week i happened to have a so called very free morning, waiting for teaching in the ward or sth, and i sat down to take history from a patient. not reli to take history, but just chat with the aunty (cz dunno y i was so free that time). and as i let her talk about different aspects of her life, telling me her job, her life, concerns etc, i found out more about her background and stuff pertaining to her current conditions in a way that i definitely wouldnt be able to understand if i were to skip to short questions like 'what did u used to work as b4 this? *answer* 'where're u staying now?' *answer* etc. and after the long chat, in subsequent days, i felt not to say compelled, but genuinely interested to find out how she was doing and feeling. and she opened up to let me ask anything at all about her condition. and when she was going to be discharged, i felt very happy for her.

in reality it is of course not possible for doctors to build rapport to this level with every patient they hav in hospitals or else they would be treating just 5-10 patients a day with 50 more waiting in line.

but i captured a little essence in caring for a patient not bcz it was mere obligation but out of compassion.

yes it might make a difference in her life, but also importantly, it makes a difference in your life when you do so. the wards bcome more alive, in a way. =)

i got that person to thank for his words. lol.