a big thank you to all the people who asked about me, my family and last of all, my father.
Currently he is still warded in the SICU. His second operation to remove the surgical packing on the liver parenchyma did manage to achieve surgical haemostasis via omentum packing. However, it required additional access to the inferior vena cava from which was achieved by a further median sternotomy.
he is currently stabile but still in a critical condition. his vital parameters are much healthier - HR 90, BP 120/80, CVP 30, RR 13, O2 sat 97%, and does not look pale and cold anymore. He appears to be grossly edematous but its probably due to the massive amounts of infusion products he recieved. as such he is on continuous dialysis to remove the excess fluid volume as well as to remove the excess creatinine and urea.
He is also in acute renal failure, but with early intervention (dialysis) we are hopeful that he will escape this round without any long term renal failure. His significant comorbidities of hypertension and diabetes do however negatively affect his prognosis. however, conservative estimates are at 80% full recovery which sounds quite healthy.
With regards to his novoseven therapy, he appears to have managed to evade its side effects. However we do not know whether his microvasculature was affected. we will have to wait till he is conscious before we can access any neurological deficient. The surgeon did report that a quick test of neurological function before the 2nd op revealed that he was able to respond to the surgeons finger by grasping it on verbal command - this heralds a better prognosis.
currently he battles complications from: infection from two sites, the thorax and the abdomen, ARF, the possibilty of a microvascular stroke and end artery infarct of his kidneys.
infection is possibly the greatest risk at hand.
suddenly hospital precautions on managing infection seem so much more real and acute.
as for the lump that started this entire circus, we still do not know if its a benign or malignant lump. the pathology report will be out next week. i would really like to see those damn cells. *grin*
we are hopeful.
Friday, June 23, 2006
Yum!
this is a technically difficult shot. captured by judicious application of a bounced flash to the side which illuminated her other half of the face. this was done under direct fluorescent lighting. so i had to fight the downward shadows and the poor colour balance. :)
turned out yummy though.
Happy (X) birthday.
ladies should never reveal their age! and in anycase, my grandma will swear shes not a day over 60 - which in all honesty, is how she acts. which is really great! heh
Wednesday, June 21, 2006
Of surgical tragedies.
A quick update:
My dad is currently warded in the SGH surgical ICU for a simple liver right lobebectomy gone horribly wrong. Apparently the surgeon couldn't stop the bleeding from the liver parenchyma. This was unexpected and took us entirely by surprise. He had torrential bleeding which was unresolved after 3 applications of fibrin glue and 2 applications of surgical packing.
As a result, my dad subsequently went into haemorrhagic hypovolemic shock. Currently he is sedated and on a respirator, NG tube and IV adrenaline, dopamine, propanolol and insulin. His vital signs are stable with his BP hovering at 90/55, CVP 18 and HR 97. His O2 saturation is also over 90%. His recent ECG done did not show signs of recent ischaemic changes. He has already had 20 units of packed blood infusion. However, the blood bank is also apparently, very low in its stores. His 24hr urine output is 450mls which is still encouraging.
Due to the continued bleeding, he has electively taken a new trial drug, Novoseven in an attempt to stop the bleeding. The drug is a systemic procoagulant (recombinant factor VII) which has its own possible set of complications such as DVT, stroke, MI and microvascular lung failure. In two studies done, the drug did not appear to improve survival function.
see: link
The bleeding has, as of 1.00 am, stopped though chances of survival at this point are still touch and go (about 30% mortality at this point).
If he survives the night, he will still have to face a 2nd operation to remove the surgical packing left in his abdomen (to compress the liver), possible complications from acute renal failure and lastly the Novoseven therapy side effects.
all prayers are welcome.
thanks for all the concern guys.
im fine. hopefully - its all very sudden.
*pictured: my grandmother, just one day before this, who wanted to dress up to play Surgeon*
Monday, June 19, 2006
Living too long in Singapore makes you Cynical...
Just for fun, i decided to try a sample MCAT paper - to see if i would qualify for a place in the US medical system...the results to one of the questions scared me.. take a look. heh
Verbal Reasoning:
Read the following passage and answer the questions that follow:
There is no doubt that Americans today place a high priority on living a long and disease-free life. It is generally conceded that freedom from pain and debilitation ought to be looked upon as a natural right of all human beings. Achieving this goal is facilitated by the proper selection of health products and services.
Of all consumer goods and services, none is more essential to one's welfare than health care. There are several excellent consumer magazines distributed by product-testing agencies that may be helpful in choosing health care. Yet the array of products and medical facilities is huge, and the claims for the merits of each are confusing. Occasionally, we may visit a physician or dentist and receive specific care or advice, but few of us can afford professional counsel on all health matters.
Not only can we waste a great deal of money on ineffectual products and professionals, but our health, perhaps even our lives, may depend on getting proper treatment for disease and illness. There are times when self-treatment should not even be attempted. For example, some products—such as aspirin, laxatives, and antihistamines—are dangerous when used in excessive amounts, in the presence of certain physical disorders, or in combination with other medicines. In addition to the question of which products to select, there is always the question of whether any product should be selected without the consultation of a physician.
Obviously, people should not run to a physician for every little scrape, bruise, ache, or pain. If they did, our entire system of medical care would be swamped overnight and the doctors would be unable to take care of the more serious problems. How can we know then, which of the hundreds of different symptoms that can develop require the services of a physician? There are several circumstances under which a physician should always be consulted.
- Severe symptoms. Any type of attack in which the symptoms are severe or alarming—such as severe abdominal or chest pain, or bleeding—should obviously receive prompt medical attention
- Prolonged symptoms. Any symptoms—such as cough, headache, constipation, or fatigue—that persist day after day should be checked by a physician, even though the symptoms are minor. Serious chronic disorders are often revealed through persistent minor symptoms.
- Repeated symptoms. Symptoms, even though minor, that recur time after time should be reported to a physician because, like prolonged symptoms, they may indicate a serious problem
- Unusual symptoms. Any symptoms that seem to be unusual, such as unusual bleeding, mental changes, weight gain or loss, digestive changes, or fatigue, call for a visit to a physician
- If in doubt, the safest action is to see a physician. If there is a serious problem, it can be corrected in its early stages; if there is no problem, then you have paid a very small price for your piece of mind
1. The focus of this article is:
(A) the importance of selecting quality health care.
(B) determining when and when not to see a physician.
(C) holding down the cost of health care.
(D) maintaining consistency in quality of life.
In a Singaporean context, you simply have to be cynical enough to expect our health ministry (it sounded very health promotion boardish) to issue such a piece of text for only one purpose and one purpose alone: cost reduction! That must have subconsciously translated itself into my thought processes, especially since deal was sealed when i saw this statement: Obviously, people should not run to a physician for every little scrape, bruise, ache, or pain. If they did, our entire system of medical care would be swamped overnight and the doctors would be unable to take care of the more serious problems.
to me, it seemed pretty open and shut at that point... *snicker*
wrong.
lets see what the experts say:
1. The correct answer is (B). The author attempts to point out the symptoms that require a visit to the doctor and alludes to those that can be personally treated. Choice (A) is incorrect; while selecting quality health care is very important, there is no effort on the part of the author to deal with this subject. Choice (C) is incorrect; the author alludes to the importance of holding down the cost of health care, but focuses on care for the proper reasons. Choice (D) is incorrect; there is no mention of maintaining consistency in quality of life.
on post-analysis, i skipped ahead of the question, which was the regarding the focus of the article. .. instead, i answered the "purpose" and hence the "true focus" of the article... hai.
Sunday, June 18, 2006
Our mini 73 class gathering!
Pictured: left to right,
Front row: Kaiyan, Esther, Junie, Daniel, Rodney, Me
Back row: Jordan (pseudo 73), Chuan Tai, En En, unknown guy (extra)
its nice that we've stuck together. :) im all for junies idea of a massive get together for cycling and stuff...
Happy faces!
Pictured from left to right:
Front row: Joanne (or Kimberly, depending on the occasion and whether Christopher is around.. *wink*), Christopher, Susan, Janice.
Back row: Alvin, Ernest, Fuqiang
Claris having a bit too much to drink!
its the lovely tequila sunrise taking its *lovely* effect.... -ouch goes the pounding headache!!
anyway, heres my sympathies to a fellow probable sufferer from the dreaded asian flush syndrome. *sigh*
deep in a game of point of order
a game where the rules are made up! and the participants don't know the rules... its surprisingly fun heh!
En2 (the hyper queen) and me
boy was i glad and surprised to see En En down at Daniel's party.. its been such a long time since you left for elven shores in Australia m'dear! *pat pat!* its also nice to hear that lifes been good down under! also, regarding "miss tongs" hyperness... its still there so, no big surprises for everyone:
-med down under hasn't managed to suck the sugar high out of this sugary babe!
and yes, I think shes definitely grown prettier... so heres to all the desperate guys out there: shes still single you know! *wicked grin!*
the aftermath of daves party!
mhm.. good cooking mr ong! the nasi lemak was splendid! thanks for the invitation, i certainly had my fill!
and it was a real eye opener considering that it was my first visit to your place after you've been to mine for a couple of times... also, the after dinner entertainment of "point of order" was certainly hilarious, with jennheng (pictured center lower row) calling fouls every other second just for the sheer sake of it. very fun evening indeed. heh
Friday, June 09, 2006
Xiong!
-Quoted from the NEJM image of the week:
http://content.nejm.org/cgi/content/full/354/23/e24/F1
"A 68-year-old man was referred because of progressive dysphagia and regurgitation that had reached a stage at which he could no longer eat or drink without coughing and spluttering. He was receiving thyroxine-replacement therapy. Examination revealed undernourishment and myxedema. Blood tests confirmed the presence of hypothyroidism. Barium swallow demonstrated a large Zenker's diverticulum (Panel A). The patient was admitted for enteral feeding and thyroxine-replacement therapy administered through a nasogastric tube. After optimization of nutritional and thyroid states, he underwent an endoscopic diverticulotomy involving stapling.
Diagnosis?
During passage of the diverticuloscope to expose the tissue bar between the esophagus and diverticulum, a thyroxine tablet was found trapped in the diverticulum (Panel B). Both the procedure and the postoperative course were free of complications. The patient has subsequently been euthyroid and swallows without difficulty. Endoscopic diverticulotomy with stapling may be considered as a therapeutic option for the management of a Zenker's diverticulum."
talk about owning medicine!
i can only hope we won't be smoked this badly during our exams heh. can see just how it would go:
me: "ah mah, when did your thyroid symptoms start? have you been taking your thyroid medication? got checkup or not?"
ah mah: "oh,1 week ago lah, yah, ive been taking my medication, and i have got regular checkups...my specialist say very good control leh"
me:"oh oh, so tell me er... shit what other things can cause hypothyroid.. what should i ask...hmm... ok! tell me about your difficulty eating instead?"
after that its gg....
Thursday, June 08, 2006
me and rodney!
its been a good 4 years! and heh. nothings much has changed about either of us!
bays still happily munching away and im as psychotic as every - note the ever-present camera!
btw, bays slimmed alot! his new biking regime seems to be doing wonders! keep it up man. :0)
Wednesday, June 07, 2006
Esther & Judy.
some of the best friends on earth!
judy just came back from hongkong to do a radiography attachment at NUH. :)
Monday, June 05, 2006
the cat empire!
darn good music! was totally blown away... thanks natw for pointing me there, and rodney and daniel for dragging me there. :)
Sunday, June 04, 2006
susan
a little politically incorrect, but im having difficulty seperating the tones for susan's hair and face. its the darker coloured skin thats causing the lack of good toning. i need to improve my handling of the darker skinned subjects. *ponders*
all the western textbooks make no mention of this....heh
i must say however, susan still looks very good! :) as chris put it: "oh god, susan you've become ouyang's next pearlly." too true.
a very *happy* birthday to Huimin!
thanks girl for inviting me for the splendid dinner! it was so much fun!
best wishes in the years ahead yah? congrats! :)
Thursday, June 01, 2006
Friends / Da Vinci Code.
There are 3 types of friends:
friends you were close to
friends you are close to
and friends you'll always know you'll have.
friends you were close to
friends you are close to
and friends you'll always know you'll have.
its been a really interesting past few months. I've certainly learnt new things about friends - quite drastic new understandings in fact. thankfully both for the good and the bad. to the people to whom ive had a major increase in respect for, i think you know who you are and hopefully, my silent but heartfelt thanks will be enough. thanks for being there yah?
to the people who have unfortunately shown me that: as blind as i have chosen to be about your flaws, there has reached a point when i can no longer ignore them as they have become so devastatingly glaring that my mechanism of ignorance has been overwhelmed. that is not to say i cannot accept these flaws, it is just that i no longer fail to see them. which is really, quite a sad thing... still, the friendship takes a beating but im sure we'll settle it one day. i have faith in the goodness of mankind.
lastly, to the good friends who have always been with me, ie, sunder, lishang, jingxiang, nat, alex and weesoon, you guys (and girl), really deserve the best there is... god bless! -if you're a believer; have a good game of dota if you're not... have both if you like too. :)
P.S
Many thanks to good ol' sunder who took me out of my shell and showed me that an evening out at the movies (the da vinci code) without female company *ahem ahem!* would be so much fun! i'd be the first person to admit that ive been a "chee-honging little bastard..." and i apologize to all my male collegues for attempting a splungee into the gene pool without them.
sorry guys. hah.
long story short, ive nearly forgotten how it was like in the days of acsian yesteryear...where girls didn't matter.
still, its been great having a guys night out, if only to let out all those repressed homosexual tendencies. (just kidding!) hah. HAH!
btw, the movie was pretty cool with me. watch it if you're you a masochistic christian - it should rightfully offend your senses. *ducks for cover*
for all other demographics, i believe my attention was held mostly by audrey tatou's hot butt. in layman terms, if you didn't enjoy the plot: your loss wouldn't really come to much either. bet on the butt and you'll be fine. but *shrugs* to each his or her own. ciao.
to the people who have unfortunately shown me that: as blind as i have chosen to be about your flaws, there has reached a point when i can no longer ignore them as they have become so devastatingly glaring that my mechanism of ignorance has been overwhelmed. that is not to say i cannot accept these flaws, it is just that i no longer fail to see them. which is really, quite a sad thing... still, the friendship takes a beating but im sure we'll settle it one day. i have faith in the goodness of mankind.
lastly, to the good friends who have always been with me, ie, sunder, lishang, jingxiang, nat, alex and weesoon, you guys (and girl), really deserve the best there is... god bless! -if you're a believer; have a good game of dota if you're not... have both if you like too. :)
P.S
Many thanks to good ol' sunder who took me out of my shell and showed me that an evening out at the movies (the da vinci code) without female company *ahem ahem!* would be so much fun! i'd be the first person to admit that ive been a "chee-honging little bastard..." and i apologize to all my male collegues for attempting a splungee into the gene pool without them.
sorry guys. hah.
long story short, ive nearly forgotten how it was like in the days of acsian yesteryear...where girls didn't matter.
still, its been great having a guys night out, if only to let out all those repressed homosexual tendencies. (just kidding!) hah. HAH!
btw, the movie was pretty cool with me. watch it if you're you a masochistic christian - it should rightfully offend your senses. *ducks for cover*
for all other demographics, i believe my attention was held mostly by audrey tatou's hot butt. in layman terms, if you didn't enjoy the plot: your loss wouldn't really come to much either. bet on the butt and you'll be fine. but *shrugs* to each his or her own. ciao.
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