Saturday, November 29, 2008

Back to work

It has been nearly 2 weeks since I last writing here.I'm being less active in writing in my blog after coming back to Malaysia, may be bussier now than when I was in Sydney.

I have given lecture on SLE in pregnancy for the 6th Pahang Medical Update last week and day to day work is just like before. Of course I feel more comfortable being in control rather than being as an observer. Here I have played active role and all the decision is made by me. I have started rheumatology journal club even only Hilmi and I have to alternate doing this...but I think it will be a good start. At least to keep myself busy and teach my specialist who has interest in doing rheumatology. I believe teaching others will make my work later much easier and make my knowledge grow.

I have started grumbling again to MOs as before...working with a group of majority Malay MOs here in HTAA is more difficult compared to work with a group of combination of other races. I used to work before with chinesse group...and I found they are more motivated than malays and they work harder to become physician as early as possible. I guess malay has the gene of lazinees in which malay needs to break that chain. Here I have to put the idea and push them so that they will work harder. Personally I don't think malays are stupid, but we need somebody to push us and motivate from time to time...as what Dr Mahathir once said "Melayu Mudah Lupa".So the way to make them do what you ask them to do is to keep on reminding them.I think may be the time of getting angry and shout to MO has gone, so I need to approach them with a better way so that it will be benefited to physician as well as to MOs.It will be challenging and I hope I can produce more malay physician under my care...That will be rewarding.

Since I just come back from my musculoskeletal ultrasound attachment, I have been given a task to give a talk during MSK US workshop in Selayang on 18 & 19 December. I take this as an opportunity for me to brush up again what I've learnt. Not to say that I'm good but I'll try my best to convince others that I'm really want to make this to be my area of interest. At least I'm quite convince that Fred knows I'm interested if I want to pursue further.

Tuesday, November 18, 2008

I am home

Return back from sydney yesterday. My flight (MH122)supposed to be departed at 3.40pm. However, due to unavoidable circumstances it was delayed for 4 hours. All the passengers had already boarded the aircraft and infact it was already started moving, however it stopped just few meters from where it was started and made a turn back. The pilot informed us there is a minor problem in the engine system which need to be checked by the engineer first before we proceed.

We were in the aircraft for 2 hours and had received several times refreshment, but the problem was not settle. Luckily I've in business class...not that bad. We have to disembark after 2 hours and hanged around at the terminal. Announcement made about an hour later, informed us everything ok. At the end, it departed at approximately 8.00pm. I've informed Abg Mi on this and I'll reach about 1am+.

I had a smooth journey anyway and I've enjoyed the food including satay..it's quite sometime I've not got malay food...and this is fantastic. Subsequent dish...I can't take anymore.

Ok, anyway I reached safely and now I'm already back to my house. Back to reality...tomorrow I've to work.

Saturday, November 15, 2008

Today is the last day in Prince of Wales Hospital

I have finished my short course ultrasound today. I've submitted the feedback letter and going to pack back soon. Still got 2 days to go and tomorrow may be to do last minute shopping (I've not bought anything yet so far)

Feel good in a way..I've got a congratulation letter from Fred stated that I've completed my Basic Musculoskeletal Ultrasound Course and entitle to consider joining advanced standing in Australian Rheumatology Association/ Australian Society for Ultrasound in Medicine: Foundations section of the Certificate in Clinician Performed Musculoskeletal Ultrasound. That's great..I can skip the basic part if I would like to join.

Anyway, I don't know yet how supportive it is from the Ministry of Health. Thinking about that, I'll come back to reality next week and I've line of patients waiting. I've opened Rheumatology clinic as soon as I come back. On top of that I've a lecture to be given next Saturday...everything ready. Not bad, since I've already presented the same topic before and just need to alter here and there to suit for the general physician, medical officer and paramedic understanding. At the end, I don't know how many of them will really appreciate it.

Last Monday and Tuesday were the last 2 days in Radiology department,St George Hospital. I managed to do ultrasound on Morton's neuroma patient..it appear hypoechoic lesion in interdigital region and no significant vascularity noted. Of course the patient I've seen also showed other feature of synovitis as well from her Sjogren's. Interesting finding. I've written separately in my other blog. The other case I've done was a case of tenosynovitis due to trigger finger. Say goodbye to Michael and Rohan.

I've joined Fred for ultrasound session on Thursday morning using portable ultrasound. I found it's not that good using portable machine after all...a little bit difficult to operate it compared to the real machine. It's ok to detect normal joint, but may be difficult to interpret when it comes to pathology as well as not that great for power doppler. May be later, I will try to get the proper machine to my rheumatology clinic. As for the loan ultrasound..will do it first till get the proper one. In the evening we drove to kogarah for update on current ACR meeting. Quite good content delivered here, however it was not a convenient place to hld a meeting because it was so noisy from the other side of restaurant.

Ok...tomorrow will do what ever appropriate for me to do. Hope I'll find something to bring back.

Sunday, November 9, 2008

Browsing some of youtube on Yusuf Islam today. Touch by his song and his journey of change to good muslim.



Saturday, November 8, 2008

Backpacker Safari tour from Sydney to Melbourne

4th November, 2008

My trip started here. I thought I’d prepared everything for tomorrow departure. I knew I had not got my insurance yet, in case anything happens…nauzubillah. I looked back at the itinerary posted to me earlier. Luckily I realized, it was going to be one way trip. So I had to get myself a place to stay once I reached Melbourne and to get a way back to Sydney. I googled for the affordable place to stay and booked a cheap air ticket back to Sydney. I had decided to stay in Melbourne for 2 nights…that would give me time to go around Melbourne at least for a day. The cheapest place to stay or air ticket here definitely is much more expensive than what’s the price offered in Malaysia. Don’t think you will get Air Asia price..don’t dream about it. So Malaysian, don’t complain so much…everything here I had to pay almost more than double than what I can get in Malaysia.

Thanks to this technology, I could still made an arrangement at last minute, provided my credit card was not reaching the credit limit yet. Thanks as well to this small Acer notebook I had bought just before I came to Sydney…it’s really useful and internet connection…of course I had to pay for it. Nothing in this world is free. I could bring it anywhere and would not cause shoulder pain to me, definitely it's easier for me to pack it. For this trip, surely I’ll bring it.

My next job is to find where the hell the Base Backpakers hostel is. I’d tried to make a survey last Sunday…but I could not find where the Kent Street was. This time I fail to read map properly. The tour agent had made an arrangement for me to stay a night in this hostel and the bus would come and picked me up in front of this hostel. After failed several attempt, at last I found it after got a direction and another map from of nearby hotel. Not bad… I survived this time. You have got to learn from the hard way. This hostel is located not far from Sydney Town Hall…hah..Now I knew how to come to Sydney Town Hall. Nothing great here …it's just looked like other historical English building with train subway located there and some shops.

The backpacker hostels…don’t dream it’ll be like 5 star hotel. It was a room with double-decker bed, a chair and a mirror. One of the walls is painted bright red with dark green curtain. It appeared ok when the light was on. Luckily I had asked for single upgrade. Sometimes you need to pay extra for your comfort. Here I had to use shared bathroom…I would expect the same for Melbourne accommodation. The accommodation offered through net…looked like better than this.I need to save some money, could not afford for 5 star hotel...botak kepala. I'd have few stops on the way and would have to sleep at different places.I'd bring this computer to help me to write what I’d experience along my journey.

Tomorrow I need to wake up early…the bus schedule at 6.45am and I need to be down there at least at 6.30am. Wish me luck!!

5th November, 2008

The bus waited just on time...The driver is Craig, he's the driver as well as the tourist guide. Very knowledgeable person and knew his stuff.I'd met a number of people from various countries and across the continent. 13 all together…: Grazia from Switzerland, David from USA, Laura from UK, Cathy from Canada, Alamara (don’t know whether I spell it correctly) from Spain, Jess and Charlotte from UK, Anlov (The spelling may be different) and her boyfriend from French ,Anita from Austria and Anne and her husband John (the eldest couple in the group) from Scotland. Of course, I'm from Malaysia…one of the weird among the rest. Craig made our tour interesting, rarely found one among the tour guide I'd met during previous tour especially those who accompany from Malaysia. He said to me “You are a real ‘Malaysian’ Malaysian”…and I told him “Yes, I’m. I'm a ‘Malay’ Malaysian”. I guess not many crazy malay Malaysian’s girl wearing tudung go around alone following a group of backpackers majority European for backpacking tour and obviously he never met one before.Chinese Malaysian...may be he had met. Anyway, I guess it would be interesting. The only thing, I had to consider myself as a vegetarian here. Difficult to explain what muslim diet is..they wouldn't understand, and I had to survive whatever chocolate left and may be some fruits.

It took about 2 hours from Sydney to Canberra. We stopped at one of the shop on the way to Canberra for breakfast. I just took doughnut and coffee. What I'd learnt from American or European going for tour they not really looking for luxurious food…not like Malaysian tour..good food is a must which I personally think it's a waste of money. Some of them had already spent few months visiting other countries with their big backpack. Of course my back pack is the smallest...proportionate to my small and thin body...my Malaysian Osteoporosis Society free bag. I wished I could do the same...but being a Muslim, that would be difficult. You need to think a lot of things..for short tour it is ok. I wished I would have a friend with same interest especially at this age.

Not much I would say about Canberra..it was more like administrative city for Australia (lebih kurang macam Putrajaya in Malaysia). We just passed the Parliament building and snapped some picture only from the bus. But as what the driver said..Canberra is famous with 5 Ps..Politician, Prestige, Pop, Porn and Prostitute. We went to National Museum after lunch. Just like other museum, but I guess Australian history is rather short since it was discovered later than most of the countries...in fact Malaysia had longer history.

We headed to Jindabyne, passed through Cooma (a small town). We went through highway and along which a lot of farms with cows, sheep and horses. It is interesting, there were reared in an open and large areas.
None you can see at the road side (like how cow were taken care in Malaysia). We reached Jindabyne nearly about 6pm and stayed in River Inn. Quite cold here...I had started to make friend with some...join more with Grazia and French couple. Nice people after you get to know them.





6th November, 2008

Craig had arranged for us to climb Mount Kosciuszko (the highest mountain in Ausralia). It would be cold up there, so everybody got prepared...weather forcast said it would be an okay day. We reached the foot of the mountain earlier than it supposed to be and took chair lift to go up half of the mountain.
It was considered a relatively easy climbed up with a track already there. However climbed up with the a strong wind blown against you, I think it is difficult especially hiking up. I was really breathless. May be due to lack of excercise as well.




I thought I was about to just stopped half way till the look out point. However, even Anne and John (the eldest among us ~ 60+) so energetic wanted to reach to the top, gave me the strength that I could also reached the top.


It was scenic and impressive. Some of the place were covered by snow..of course it definitely would be more in winter. We had to walk on the snow at some of the paths...and it was quite difficult especially when it was on a slope and windy. I was arfaid that I'd make an error and fell down on the side of the mountain. At the end of the hiking, I was among the last along with Jess and Charlotte.It took nearly 1 and half hours to reach up there. It was rewarding. Reaching the top was an exhilarating experience, it was the feeling of conquering and gave you the sense of confidence that you can do anything if you don't give up. All of us reached the top and we congratulate each others. Went down was much easier then since we had passed the first hurdle.

After lunch we headed to Australian Alpine track by bus. Craig told us about the bush fire which ocured in 2004 and destroyed most of the trees. Eucalyptus tress are like combuster and once it caught on fire the disaster might happen and this was what happened then.


It was not like rain forest like in Malaysia. It was interesting though and snapped some pictures of Blue River from far.We bought some food for preparation to bring for tomorrow lunch. We rested overnight at the coastal township of Lakes Entrance. Nice and spacious room with kitchen. Tomorrow we need to wake up early and start our journey at 7.00am.

7th November, 2008

This would be our last day journey..Craig drove us to the Wilson's Promontory National Park. It was predicted to be raining on and off today.

We hiked again this time, but this is nothing like yesterday...so it was easier. Smell of the natural fragrant from the wild flowers, it was such a great experience.
The scenery from up looking down at the beach and watched the southern ocean was spectacular.
I really enjoyed it. We went up to the top and then went down to the squeaky beach. It is called squeaky beach because when you walk on it, it gave a squeaky sound.
We had our lunch on the rock near the ocean, and because it was raining we had to hide under one of the rock.

After lunch we stopped to look for kangarroo in their own habitat.
We tried to see any wombat, but none was there. They are quite a shy type of animal and may be hiding in their hiding pit.

We drove then straight to Melbourne. Craig dropped David, Anita and I at the Victorian art cantre and I took a cab to City Centre Budget Hotel at Little Collin Street for 2 night stay here. The room is quite okay but I had to share bathroom again. There was a common bathroom and 2 bathrooms for female. Definitely not that comfortable but at least I survive..not that bad.

8th November, 2008

I was really hungry this morning. I really wish to get Halal Asian food today...really missed Nasi Lemak at this time. There are supposed to have few halal restaurant around this area...at least that was what I found on the net. But, I don't quite like the Indian or Labenese food. While trying to find for food, I just walked around the city centre to the Yarra river and Federation Square. Compared to Sydney, I would say Melbourne is nothing. Not much attractive places. They just had Melbourne cup last week. Apart from that it was just like other city..at some point it looked like Kuala Lumpur.

I had found one or two looked like Malaysian restaurant..."Sambal Kampung", but sadly to say it closed on Saturday and Sunday. People said it's easier to get Malaysian food in Melbourne...but it's not true in this city centre. I found at one corner, it was written there 'Little Malaysian"...again nothing there except for a chinese restaurant. For chinese, there's definitely no problem...they would always have chinese restaurant everywhere you go and even have China town. I just hope more Malays will open a restaurant here, so somebody like me will not suffer from hunger.Please those Malay businessmen or business women..take an opportunity to open a Malay restaurant here!!! So frustrated and it took me about 3 hours walked around and I've given up. I could choose any fish and chip restaurant...but today I have no appetite for such kind of food. At last I stopped at 7eleven and bought Maggie mee in cup. What a pathethic. I lost my way back to hotel and took right turn rather then left. It took me double the time that I should take if I took the left turn in which it was just around the corner from where I started.

I reached the hotel room with a feeling of disappointed, hungry and tired.I can be adventourous about journey but not food...I tend to be eat what suit me and sometime would stick to only one particular food if I like it. That's the reason why I still thin like this. I spent the rest of the day relaxing myself. Tomorrow will be back to Sydney andend my holiday.

Sunday, November 2, 2008

Darling Harbour and Sydney Wildlife

Sunday comes again today. I have to plan for something, or else I'll be bored the whole day. Looking back at local Sydney map and the bus route in which I need to take. It has been my habit now,to read map. This time I will take a tour to Darling Harbour and explore what I'll find there. Few interesting places I should go there...Sydney wildlife and acquarium. Seems to be both are situated next to each other.

I took bus 372 and stopped at the Railway Square...I guess this would be the nearest stop for me to get to Darling Harbour. From there I just walk, follow my instinct...I'm good at that. Not bad, I reach the Paddy Market and China Town and not far from there I found the way to Darling Harbour.

Today is a little bit cloudy in Sydney. I prefer this weather anyway since I won't easily get tired.
Sydney Wildlife and aquarium situated at the end of Darling Harbour. I have bought the combo ticket for both tours and it can be use up to 3 month.

Quite a number of creatures range from ants, insects, reptiles and other animals are here. Of course not to forget about koala bear and kangaroo. All behind glass, except for some. Since I don't have anything better than this...it seems to be an exciting thing to do to fill up my time.
Koala bear being so cute...and most of them are asleep except for one..wake up and eating. That's what they do...18-22 hours sleeping time and when they wake up, they will eat. It is really makan dan tidur

Kangaroo here...most of them are old. Not much in action. I like better those kangaroo last time I saw in Gold Coast..

I will continue for my aquarium tour on later day. By midday, I have already hungry. But the chips and calamari is not what I really like. Atleast it is halal. How I wish to have some nasi now. That's remind me, I have to get nasi lemak once I reach Malaysia. It is so easy here, you can just stop anywhere and have your take away lunch. After lunch, I just walk across to the 3D theatre...it seems to be interesting. So I bought a ticket and joined for 3D movie on "Fly to the moon". Who says you can't enjoy yourself if you travel alone.

Saturday, November 1, 2008

What else should I write this time....

Work...nothing much bothering me since I have all my time observing and may help by giving some opinion (don't know whether it is useful or not). Feels like coming back to medical student days. Sometime I miss the role of being incharge rather than just observe other people practice. Don't worry, it will be over in a few weeks and I'm on my toes again to start my real life back. At that time may be I'll regret not to take this opportunity to appreciate this wonderful time. Thinking back... I don't even start my lecture presentation for this up coming "East coast medical update in pregnancy". I have to prepare a topic on Lupus in pregnancy...just a week after the day I'm coming back. Ok..will do it later. Typical malay..last minute job and I have 3 more weeks to think about it.

This week I've learnt more...I feel more comfortable now (I think!!) in performing ultrasound. Spend my Monday and Teusday in Xray department and used the sonographer and radiographer student as my guinea pig. They are very coorporative and allowed me to scan every single joint I wanted to. Fred at last able to use portable ultrasound from Emergency Department in POWH to teach me and we did it for an Indonesian man with extensive psoriasis with MRSA...What a patient to do scan and we need to use protective apron, that's the only suitable patient we have. Anyway, I gained information how to adjust the "pulse repetitive frequency" button to reduce excessive power doppler colour. Abbot has promised during last MSR meeting to loan some portable ultrasound to some rheumatology centres ...I think it will roughly be almost the same as what we have here. It uses a laptop as a screen and you can either use the button like in the usual u/s or you can use function as in your computer. By adjusting the image, the quality is almost as perfect as the ordinary u/s...There where you need to know a little bit back ground physic. It has only 1 level of focal zone. Wow..now I can speak the machine language better, and I can at least tell my fellow rheumato colleague...hehehe.

Dr Paul Bird gave me a tutorial on MRI evaluation in RA...The physic part here, frankly I can't really understand eventhough I tried hard to impress him to show I understood every aspect what he was talking about. He's a PhD qualified for MRI usage in rheumatology (Seems that if you want to have a secure position in medical field especially university setting in Australia...you need to have PhD). Pathology part seems simple after explanation...T1 image is good to look for bone erosion which appear hypointense on the bright background bone, makes MRI is such a superior tools than ultrasound to detect erosion. T2 image is good to look for oedema..in which oedematous bone will appear bright. This is useful in predicting bony erosion in RA. Having said that, it can't differentiate oedema cause by other reversible condition like trauma which may have similar appearance. T1 with fat suppression is good to look for synovitis. However, synovitis is easier detect by ultrasound rather than MRI, so most ofthe time you don't really need MRI for this. Whether joint space progression can be assess by MRI, still no definite answer as yet.This is roughly how it looks like. Google it...but image c and e is CT image.


Friday meeting as usual...great presentations. I don't know how they can get those cases. First case is a tertiary syphilis presented with lancinating type of pain over right shouder and over the subscapular region, better on shouder abduction. Presented few months before with chest pain diagnosed as having aortic disection with presence of aortic regurgitation. Pulse were equal.Imaging of shoulder and neck were normal. Inflammatory markers were normal. Evaluation for VDRL/ TPHA were positive. Interesting!! The pain most likely due lhermitte's sign. Second case is a case of DISH due to Roaccutane treatment. I've never known that...seems too many things I don't know.

Next week I've arranged my tour to Melbourne...will write my exprience later. I'm looking forward for this trip. As usual, I'll travel alone. Interesting huh!!