Monday, October 27, 2008



I have a busy and productive weekend.

Let's see what I've done on Saturday...It's a free day for me. So I've decided to go somewhere around Sydney. Something affordable for me. I've never wondering around or going for a trip alone back there in Malaysia. This experience only I can do it here. Relatively safe and nobody looking at you and think that you're wired. Everybody is thinking about themselve rather than think about you. It's a free world after all...and you can do whatever you want to do.

I went to Circular Quay again today...looking for any opportunity to follow any trip or cruise and I've decided to go for "Whale watching cruise". Something interesting, but of course I don't quite like sailing that much. It will make me nauseated and I'm prone to get seasick. But at the end I go for it and give a try. While waiting for my trip, I just walk around and infact now I realized that I don't have to take a bus to go to Sydney Opera, it is within a walking distance. It is quite nice, everywhere you go in Sydney, there is surely apark for you to relax youself and have a picnic if you want to. I walked around the Rock street and enter the museum of contemporary art. Nothing much I would say here, unless you really appreciate the art shown.

Cruise for whale watching, sound interesting. I was excited earlier, but the oil smell and the waves start making me nauseated (definitely my maxalon did not work for me this time). It's quite a nice journey I would say. It took us about 45 minutes to reach the whales area. At last I can see whales. Such a fascinating creature, they will come in pair ...mother and baby whales. This is seems the breeding season for whales here. However, I can't snap a good picture since we can see them only from far. I would enjoyed my cruise for seal watching when I had a trip in Cape Town last May. May be, I had not have seasick at that time and the journey is shorter that this. That was awsome. May be I should post some pictures while I was in South Africa later. That was a good journey.Oh ya, I can see Dolphin as well here as they came near our ship. On the way back, I was already tired and heading straight back to Randwick with still having giddiness from seasick.

Sunday...as planned, I have joined Dr Joshua for another hands on ultrasound practice. We drove to Kogarah to radiology department in St George. I thouhgt I'm really stupid to forget all the important anatomy landmark for msk us and the reason why ultrasound will be beneficial in certain rheumatology diseases. How forgetful I was. Anyway, I'm still learning. I had a practice on normal msk ultrasound and basically he's the specimen used. It seems to be clear now for me what to look for when we requested for ultrasound. I just need to practise further and to improve skill. I knew that....

Friday, October 24, 2008

Start my day with observing Dr Joshua Rheumato clinic today. I've to be an observer, no license to practice since I'll only will be here for only few weeks. One thing about working here is I feel comfortable and feel accepted. I think I'm more comfortable interact with the superior here rather than in Malaysia. It's easier to discuss things and they are more acceptable to critic or opinion. In fact it is something like sharing experience on how we practice in Malaysia compared to Australia experience. Discuss case of recurrent optic neuritis with no other feature of MS and later on developed peripheral neuropathy. Later diagnosed as Lupus in view of positive ANA marker. There are such condition I've seen but usually with other systemic involvement rather than solely optic neuritis. Such an interesting observation. That lady improve with steroid and methotrexate. He also discussed about a patient diagnosed as Sjogren's and presented with cerebellar lesion which was diagnosed by Prof Alan Sturges(an expert on Sjogren's and the one who found anti-SSA/ SSB). What a rare presentation.

Have an experience to attend their Rheumatology meeting again this week. Today it's in Kogarah. Met some of eminence Rheumatologists here; Prof John Edmond, Prof Alan Sturges, Jim Bertouch (Head of department in POWH) and other rheumatologists; Dr Paul Bird (expert in MRI and I've followed him for Biologic clinic yesterday in POWH),Dr Guilaine, Dr Ron, Dr Harry etc. I can't remember the whole lot. Oh ya, I've met Satgunan as well. He is doing his Rheumato attachment in St George Hospital. At last I met somebody I know.

It is quite relaxing, enjoyable and educational meeting. What's different from our meeting is, it is not too serious but of course I've definitely learnt something, and on top of it even those who're senior seem don't mind presenting. Totally different from Malaysian...usually we will try to push the junior most or trainee to do all the presentation. Amazing culture and they seem to enjoy doing so!! Trainees only listen.

What I've learnt today...
The first case is a case of elderly onset lupus who presented with feature of Steven Johnson's syndrome after taking PPI for H.Pylori. Diagnosis was then made following positive serology marker and presence of vasculitis. Later at some point developed palpitation with tachycardia with heart rate rose to 150bpm during one of the visit. Investigation then showed elevated Free T3(few occasions- baseline was normal)...Is it related or not, some argue may be lab result error. I remember seeing a case while in Selayang, also an elderly lady who presented with pancytopenia and feature of hypothyroidism and subsequently fit clinical feature of lupus...May be there's really a correlation between lupus and thyroid disease. Anyway both are autoimmune related disease.
The second case is suspicious SAPHO, but most of the audience not really convince with SAPHO feature may be more of Osteoarthritis with underlying infection. I notice they use a lot of bone scan imaging here to indicate the hot spot.
The third case is a asymptomatic mother diagnosed as lupus after baby born with neonatal lupus. Baby presented with rash occured 5 months after delivery. Prof Alan Sturge explain rash usually occurs late after precipitated by sunlight in a baby.
The fourth case is a haemochromatosis case with interesting hand Xray finding.
Interesting.

Ok enough for today...I'll have another u/s session with Dr Joshua on Sunday.

Thursday, October 23, 2008

Quite cold here in Sydney for the past few days. It has been forecasted to be on and off shower for another couple of days. May be difficult for me, I can't tolerate cold that much especially with not much fat to protect me from cold. Anyway, it's always an experience I need to go through.

Since most of the Ultrasound practice need to be done in St George, means that I have to do a lot of travelling from Randwick to Kogarah. It is easy earlier since Dr Joshua kindly gave me a ride and show me the way there. But, of course I can't depend on him for every single trip. So, I have to learn to get a public transport to come here. On the first day it cost me AUD 37 for one way trip from Randwick to Kogarah. I can't afford that if I'm going to have frequent trips here...I'm going to be broke. I have decided to get a train and bus to travel. I need to catch a correct bus to central station and from there get a train to Kogarah. Have to study the bus and train system here.The train system gives me no problem (almost the same as else where, but much more reliable than Malaysian train...have to comment on the bad public transport back in Malaysia), but I find difficulty in catching the correct bus and at the end I've to hop from one bus to another and was instructed to wait at the bus stand across. Gave me a good lesson and after 2-3 trips, I'm already an expert.

I have started my attachment in radiology department St George Hospital. Quite boring I would say, however it is still useful. Learnt some new things which I've never learned before while doing medicine. Learning about machine and how it helps in our daily management. I always thought it is not that important to know all these machine stuffs and leave it to the sonographer and radiologist to interpret every single thing about image...how wrong I am if I still think that way. Medicine has evolved so much and if you are not catch up with the new learning skill you are bound to left behind. Same thing here, I need to involve in new things and start learning, learning and learning even though it comes back to a basic medicine again.

Here in St George Hospital, most of the ultrasounds are done by sonographers rather than radiologist. The radiologist will confirm if neccessary or if any procedure or intervention need to be done. Quite slow progress noted on the second day there, since there was a change in management in the department. Better not get involve, since anyway I'm just an observer here. Overall the staff here are nice and very helpful. I was given a chance to have hands-on experience in performing ultrasound if there are msk cases. Thanks to Michael and Rohan.

Monday, October 20, 2008

Sunday, October 19, 2008


Had a chance to go around Sydney yesterday. Snapped some pictures at opera house and sydney bridge. Important landmark to make sure people know I'm really in Sydney. It's beutiful and I admirer the work of the architect who built it, a brilliant art.

Today, I have attended a private class on basic ultrasound usage especially concern rheumatology field. Unusual thing to do on Sunday in Sydney. However, I find it quite useful tips. Interesting but has to go back to basic physic. Dr Joshua was great in explaining, make things simpler than I thought (at least the physic part). I think there's a good future if I pursue and learn more on this field. Will consider this as my future specialty field in rheumatology. It's been great to do something that not many experts in this field yet in Malaysia. I hope I'll get the grasp of getting an experience in this....

I had a walk to Coogee beach in the afternoon. It is just within walking distance from my place. Full of people on the beach. The scenery was nice.


Friday, October 17, 2008

Quite a fruitful day today. Starting my day in POWH without any hassle. Plan has been organised for me for the next week program...seems to be in order.
3 cases has been brought up during rheumatology meeting. Quite interesting cases have been presented. First case was dermatomyositis complicated with peritonitis, second case was a patient with scurvy (quite rare to have found a scurvy patient, only found it in text book) and the last case psoriatic patient (?related to the introduction of lithium). Impressive presentation.

Wednesday, October 15, 2008

Rheumatology attachment in Sydney

Just reached Sydney 3 days ago. Still has nothing much to do. Able to secure place and start my attachment program in Prince Wales Hospital this coming Friday. Thought would raise some problem, luckily everything goes well.
Life a little bit difficult here,...not quite difficult actually. The only thing this is the first time I'm traveling alone and have no one to talk except for when I'm going to hospital.
Food seems to be not a big problem around here. Find a good Muslim Thai restaurant around the corner where I stay. Luckily I 'm small eater, so it does not cause a real problem to me.