Tuesday, August 11, 2015

My ReLEx SMILE story - Part One

It all started on a saturday afternoon.. I was oncall, and after my zuhr prayer, I accidentally stepped on my glasses and my lenses popped out of its frame. Luckily i managed to pop it back in and bertahan for the next two weeks with my out of shape glasses. I know this is a calling for me to get my eyes corrected, I can barely see anything without my glasses - I will not be able to function if this ever happen again - new glasses will take at least 3-4 days, and macam mana nak kerja or drive kalau tak ada cermin mata kan?

So, after massive research, I finally decided to go for it. On my last post call day, I went to Chew Eye Specialist in Ipoh, to get my eyes checked. The thing is, after I finish med school, I actually had my eyes screened and I was told conventional lasik is not for me - but I cannot recall for sure what was the reason and what was the alternative the ophtalmologist was going to offer me (looking back, I'm guessing he's offering relex smile as well). So, the staff from Prof Muhaya Eye & Lasik Centre told me, "Kalau kornea nipis, memang tak boleh buat Lasik or ReLEx smile, kalau you datang pun membazir je" as their thorough examination will cost RM600, not-refundable if you're not a suitable candidate. So, I got my eyes checked, and Dr. Chew told me, my pupil is large 7.1 mm, my cornea is thin, and I barely made the minimum requirement for Lasik. I may or may not get the outcome I desired from Lasik.

So, I got my readings, the cornea thickness, pupil size and my power and send them to PMELC, and she said, I can do ReLEx SMILE.


My appointment was supposed to be at 9 am... tapi sesat pulak 10 minit, and bertolak lambat dari IJN, so by 9.40 baru la sampai dekat PMELC. Tempatnya not so busy, parking space banyak dan very accessible. Sampai situ, kita pun register dan tunggu giliran untuk buat pemeriksaan mata. Untuk ReLEx SMILE ni boleh buat pada hari yang sama, kalau Lasik pulak mungkin kena buat temujanji selanjutnya untuk buat pembedahan. Macam ni lah algorithm di PMELC.

Selesai check topograpy, corneal thickness, etc(stage II), baru lah jumpa dengan optometrist. Suzanne namanya. Very friendly and explains a lot of things to me tentang ReLEx SMILE and what are my chances. Initially she's quite worried about my right eye as my prescription was 1000, tapi what I really need was only 850 (my glasses is over correcting my shortsightedness). My left eye was very promising, and my right eye... not really... Tapi lepas dah check she found out, my eyes can function well with the lower power pun.. I will not need to wear glasses after ReLEx SMILE inshaAllah...

Last sekali baru kita jumpa Prof Muhaya. So cute my mom was star-struck, she was so quiet despite prof being so friendly. My eyes are suitable for ReLEx SMILE, alhamdulillah.
"Okay, now I will show you your eyes... Let's test your ophtalmology, see if you studied well..." Dalam hati kita ni, I was going to spurt, "Err...Ophtal ni saya minor rotation je, belajar pun 2 minggu je..." hehe... But I did not. Luckily the question was just for me to identify my eyes' fundosopic image. "Macam mana you tahu that's your right eye?" Because optic disc is on the medial side! Thank you Dr. Rashid Joumard for teaching me this, I will never forget!

Lepas tu, masuk waktu Zuhur, semua patient dan keluarga dijemput solat berjemaah ...

Selesai solat, barulah uruskan payment dan masa untuk my surgery... Kata prof, yang paling sakit ialah masa letak speculum kat mata tu - which was, tak sakit pun, but for me, masa nak remove lenticule tu was a bit more uncomfortable.. Yang paling mencabar sekali untuk prosedur ni ialah nak maintain pandang lampu hijau dan make sure the light is centralized. You have to control your own eyes, and even though you've been briefed, bila lampu hijau tu menjauh just ignore it and make sure your eye doesn't move... Once lampu hijau tu menjauh, all you see is darkness and you pun tak tahu dah anak mata you bergerak ke tak... But Prof Muhaya was very helpful as she keeps talking to you, doakan you and says inshaAllah perfect vision, perfect correction for you...  I was so nervous!!!! Mata ni kalau ada kaki dah bertempiaran dah agaknya!

Alhamdulillah after 23 seconds for each eye, she removed the lenticule and told me to look at my parents behind the glass door... SubhanallTI can see it's them walaupun tak clear sangat lagi. I was so silly I asked"Err...tapi memang normal kan saya nampak blur-blur lagi ni". Nasib baik Prof tak cubit je kite atas ketaksabaran ini...  then she told me to look at my hands, and yes I can see my hands!

Lepas dah selesai, kita pun keluar, and I noticed I can read the writing on the mat, exit sign - which used to be a blob of colour je before this without my glasses.. Alhamdulillah.. After a while baru mata rasa pedih-pedih macam baru lepas potong bawang tu..

Selesai ambil ubat, jumpa prof balik.. This time abah pun masuk and Prof showed both my parents how my sight used to be and how well I can see now alhamdulillah.. "Sebelum ni, dunia dia dua kaki je..lain semua dia tak nampak...sekarang... semua ni dia boleh baca..Alhamdulillah.."

Lepas tu kita pun balik...on the way I was so excited about things i can now see, mashaAllah.. As for now, I'm still seeing some glowing effects, my vision is at least 75% of what I used to see with my glasses on... Masa ni memang very uncomfortable sebab kita rasa tak selesa tak sharp, tapi kalau pakai glassess lagi la kabur.. The night vision, mmg silau, but bear-able, macam pandangan bila lens dah berminyak kita malas nak lap je..

Ok macam tu lah kiranya cerita ReLEx smile kita ni...

Kesimpulannya : I would recommnd ReLEx smile ni kalau : power you tinggi, kornea nipis dan pupil you besar.. Also if you're pressed for time, sebab kita dari Ipoh macam mana nak ulang alik kan.. Cuti pulak begitu berharga... go for ReLEx smile.. Kalau so-so je, you can always do the Premium Lasik... no problem...

Okay untuk soalan-soalan cepumas.. nanti tengok dekat entry ni pulak...


Berapa kos untuk kedua belah mata? 

Lasik Premium : RM 8000 harga promosi RM 7200
ReLEX SMILE : RM12610 harga promosi RM 11700

Boleh bayar ansuran?

Boleh, dengan kad kredit Maybank, CIMB dan Bank Rakyat . Tempoh ansuran 18-24 bulan, kad kredit VISA dan Mastercard sahaja, AMEX tak boleh okay :-(

Apa beza Lasik dengan ReLEx SMILE?

Ini biar yang lebih arif jelas kan...

Apa kelebihan ReLEx SMILE?

Smaller cut on your cornea - faster recovery, less post-op complication inshaAllah, boleh buat hari yang sama.

Sakit tak?

Tak sakit langsung.

Terus nampak clear ke lepas surgery?

Nampak clear alhamdulillah, tapi bukan terus 100% sebab mata masih inflammed. Tapi basically you can see at least 70% of your vision with your glasses.
Takut tak?

Takut sangat! Tapi  bawak bertenang, ingat Allah... InshaAllah kheir...

Post-op care?

Guna antibiotics, steroid dan artificial tears secara istiqamah.. Jangan berenang untuk sebulan, berhati-hati bila ambil wuduk dan mandi jangan masuk air dalam mata dan jangan genyeh-genyeh mata... 

Follow up?

Yang termasuk dalam pakej - 3 kali follow up, tanpa expiry... Boleh datang bila-bila you nak, yang penting call dulu untuk buat appointment.

Persediaan untuk ke PMELC?

Bawak baju sejuk! pakai long-john kalau memang spesies tak tahan sejuk.. bawak jugak makanan, just in case kita punya turn tu lambat, boleh la makan-makan berkelah kan.. hehe,,

Okay ada soalan lagi? Drop a comment and I'll get back to you ;-)

Friday, July 3, 2015

My new white coat.

I remember when I first started clinical year. I was so excited about my white coat. My parents potong kain putih uniform misi and tempah dua pasang for me - which turned out to be disaster and unsalvageable - my mom tried to fix it but like I said, it was unsalvageable.

Then I started housemanship. I have one baggy, oversized, off-white coat from my days as a medical student and I bought another new pair. I don't even use them as in Paeds department, white coats are source of infection. Now that I'm in a new department, I were to wear white coats on daily basis, so I just alternately use those two pairs. I know my baggy, oversized white coat makes me look like a joke. But I just don't have the heart to buy another.

Or maybe, I just don't have the heart to continue.

I just don't.

Let's just say the happyhouseman is not so happy anymore. Months passed by. After further self-discovering thoughts and settling down in this new department, one day I figured, it's time for a new white coat.

It's not just a new white coat.

It's my newly-found determination to finish this journey.

I guess after this, when things seem impossible and weary ... 

... I'll just ...





.. buy a new white coat.

Thursday, March 5, 2015

Paeds 101 - For First Posters

How time flies...I'm already in my third month of pediatric rotation. Some said, I'm the happy houseman because I'm a first-poster - still very energetic, enthusiastic and smiles a lot. Well, truth is, the reason I renamed the blog was simply because I don't want to be a grumpy houseman along the way. I am aware that this journey might, one day, consume whatever is left in me. It serves as a reminder of what kind of houseman I want to be.

I have only two core advice for first posters in pediatric.

1. Never hesitate to ask question, but be careful of who you're asking. 

I really don't mind if people think I'm stupid for asking too many questions. Better than making any mistake that might jeopardize a child's safety. But, along the way, I have learnt to be a bit selective in addressing my questions. After a while you will recognize reliable and trust-worthy senior to refer to when in need. Usually this seniors are a bit more strict / garang but they will lead you to the right path. When someone tell you "Chillax la... don't worry... never mind one...." always seek a second opinion on the matter.

2. The Nurses is master of the master - if you don't know what to do, call for their help!

The nurses in pediatric are very skillful. They have post-basic or at least have been there longer than any of your senior houseman. Some of my nurses have been there since my specialist was a houseman, imagine! When you don't know what to do, you can also ask them , "Kak, selalunya... kalau macam ni, kita kena buat macam mana?" They sure know.. When they say something, take it into consideration because they definitely know better than you. Don't get offended when they correct you, they just want to save you from being scolded later.

So that's the fundamentals of survival. Let's move on to the more technical aspect.

Special Care Nursery - My favorite place to be :-)

Neonatal jaundice
  • How to clerk a NNJ case? Using a NNJ clerking sheet
  • Know when to start, off and continue photo
  • NNJ standard plan : Encourage BF, start/continue photo, Repeat LSB
  • Know when to repeat LSB, coming morning? 4 hours later? 6 hours later?
  • Know that heel prick SB (serum bilirubin) is not as accurate. Some might consider it as rubbish. I usually ask the mommies, ambil darah cucuk kaki atau ambil di tangan
  • Learn to use the the LSB photo chart 
obviously NNJ is your core business in NNJ. Other topics you should master includes

  1. Risk of MAS, MAS
  2. Risk of sepsis, Neonatal sepsis
  3. Hypoglycemia
  4. Prematurity - their problems, and screening that are necessary 
General Pediatric

Is not my forte. Basically you have to know how to clerk a pediatric case, don't forget the nutritional, vaccination, birth and developmental history. I used to use a list / template on my tagging days so I wouldn't miss  a thing. Common cases you will see:

  1. Dengue, dengue and dengue!!! 
  2. Febrile fit
  3. Afebrile fit
  4. Bronchiolitis
  5. AEBA
  6. Acute tonsilitis/pharyngitis with poor oral intake
  7. AGE
  8. AGN & Nephrotic syndrome 
Remember that for first poster, you will have end-of-tagging assessment. To pass this, I highly recommend the Ampang HO guide notes. You must be able to manage dengue shock, hypoglycemia, status epilepticus, life threatening asthma and master the fluid requirement and type of fluid we use in pediatric,

Going through previous admission clerking done by your senior colleague is a good way to learn. Read through the management as well, you will see the pattern. 

A senior once told me, the difference between a good, thinking houseman and a so-so houseman, is when you present your case and say "My plan is to bla bla bla bla..." Don't just wait for your MO plan, if your plan is wrong  you might kena marah, but at least you tried kan.

Attitude-wise.. I just would love to share how I deal with being scolded. Okay I made a mistake and deserved to be corrected - regardless how it was done. Then I move on and not repeat the same mistake la. Don't think too much about it, "MO must think I'm stupid" is not the kind of thinking you should have. At least don't let that paralyze you. If anybody wants to think I'm stupid, they have the right to do so, but I won't let what they think of me to define me. I'm a work in progress kan. Yang penting LEARN from your mistake and DO NOT REPEAT them.

Last but not least. You have to believe that everything is in HIS hand. It is easy to fall into the belief that your fate is now in another human's hand - given the assessment, multisource feedback form and what not... But, you have to get this right - nothing in this life happens without HIS permission. Everything is specifically designed to mould you into a better human being.

Please share your nasihat here as well :-)

Sunday, January 25, 2015

Housemanship, With LOVE

Finally... I decided to put it up on my blog. This post have been long overdue, I could say I'm too tired to post, too busy, I have better things to do and all other available reasons, but mainly because I don't know how and where to begin with. 

It has been 5 weeks for me in Pediatric department. How time flies! I tagged for 3 weeks, and have been a functional houseman for two weeks now. Long story short, within the first month, I have found myself considering quitting, offered permission to quit by my mother and decided not to quit, instead I now find myself considering Paeds as an option to be ventured further after finishing housemanship. I know what you're thinking; crazy right?

Housemanship, with love.

After a week of tagging, I was bestowed the opportunity to meet and greet our HOD, who turns out to be such a humble and inspiring person. 

Of all the wisdom he passed on to us on that evening, I am most affected when he said "God loves everybody". The discussion went on about how we should love those who hurt and wronged us too, because no matter what they did, God loves them and who are we to hate somebody whom God loves. 

He also told us that the best way to approach our colleagues who went MIA - missing in action - is to ajak them go for makan. Because food brings people together, helps people to open up a bit more to you. Amazingly, makan is also the way to build teamwork. So if you're a houseman, and reading this, you should initiate lah this makan-makan agenda.

Amazingly, after few weeks of struggle early on, I now can actually picture myself enjoying Paeds rotation. I even requested for a mentor to optimize my training process. I realized that you can choose what you want out of your training, whether you want to learn as much as possible to equip you to survive out there, or you can just follow what everybody is doing and pass the rotation and end up mismanaging your future patients.

I am not an excellent student in med school, so it is only natural that I have to work extra hard these days. My reference is Paeds protocol, and Mary Rudolph. I find the Mary Rudolph textbook very easy to understand and puts me at ease. You know lah, some  text book makes you pening-pening lalat and serabut kan... Mary Rudolph dengar nama pun macam ahhh soothing nya... Baca pun senang terlelap.. hihi.. 

Support System

I cannot stress more on the importance of having a good support system during housemanship. My support system involves the whole household. Abah is in-charge of my transportation for the first month until I have the confidence to drive to work recently. Mama provided me with the emotional support lah obviously, she would come along with abah to pick me up from work late at night during my tagging period and listening to all my jibber jabber and giving me advice. Every morning, I get to salam both my parents - which is something you would appreciate after being away from them for 7 years and tell them to make doa for me. I strong believed their doa is a huge portion of making this possible. I am thankful for each and every person- family, the significant other and my friends who showered me with their love and support through out the journey so far.

Toxic Working Environment?

The only thing I want to say regarding this matter is that sadly, it is the housemen themselves creating this toxic working environment. By thinking only about their asses, wanting to pass the rotation, and just that. Refusing to take responsibility because takut buat salah, kena marah and got extension. If everybody accepts that it is okay to make mistake and learn from it, working would be much better experience for everyone. The long working hours, workload is not so much of a problem. But rather the attitude of your co-worker is the one that kills your passion in medicine.

What makes a good houseman, good?

I owe this to a senior houseman.

" A good houseman is the one who thinks. Who offered his/her plan to the MO when they ask something, instead of just waiting for the MO's plan."

so now you know lah.

The day my mother told me it is okay for me to quit medicine was the day I realized I really am doing this for nobody but myself. I finally understood why some people decided to quit medicine - and they are not doing anything wrong. It is better for you to do something you love, for you and not for any other reason because housemanship is harder than med school definitely, and if you don't have a good "WHY" you may find it difficult to endure.

Ok lah. That's all for now. See you soon with my NNJ 101 project . :-)