~sudden realization~: COUNTDOWN: 19 weeks!!!

Today Prof Dr Shahril made me realized something: i have only 19 weeks more to Professional Exams. 19 WEEKS!!!!!! 19 weeks to Professional Examinations which will decide whether i shall grad med school or not... wow! time is running short.. have to buck up!! so much to revise in such little time...

Resolutions:
1. Will spend more time in the wards, practice long and short cases
2. Will spend less time fei-fei-ing, lepaking, onlining, sleeping, etc...
3. Will be more motivated to study
4. Will manage time effectively (hopefully)
5. Will pray really hard...
6. Will locked the laptop in the cupboard (if necessary) to overcome addiction!!

sorry, if i spend less time on my blog.. (not that i want to neglect you)..

Best Squid Noodles (Yau Yu Mai Fun)

Since everyone is interested in nice food in Seremban
(okay, maybe not everyone, but i like to think that people are interested)
so, today, i have for you, another famous delicacy from Seremban...

Have you ever heard of squid noodles
or 'yau yu mai fan' (cantonese)
or 'you yu mi fen'(mandarin)?
This is another famous noodles in Seremban.
In fact, it was one of the kind!
I could not find anything like it in any other parts in Malaysia.

Place: A stall at Blossom Food Court
Food : Best Squid Noodles in the world! (actually, it's the only place i tried, haha! no references for comparison)
Location : Blossom Garden Food Court ( Near Rasah Jaya)
Price : RM 3.50

The stall actually belonged to Boon Lee's Aunty,
She makes THE BEST squid bee hoon,
THE BEST!!

Smooth Squid Noodles in a special thick soup.
The warm gravy melts in your mouth,
The squid crunchy and meat tasty,
I think you would have to try it for yourself to describe it yourself...

Thanks Audrey, for belanja-ing me and my family, hehe... =)
Seremban has many nice food,
which also explains why am i picky with food..
haha!

Enjoy the Squid noodles!!

The Best Curry Laksa : Asia Laksa

Today, i would like to introduce one of the famous food in
Seremban, Negeri Sembilan - Asia Laksa

Place: Restaurant Asia
Food : Best Curry Laksa in the world!
Location : Rahang Garden, Seremban. (opposite Rahang Post Office)
Branch : Senawang
Price : RM 3.00 (s) RM 3.50 (m) RM 3.80 (b)

The other day, I went to Asia Laksa with my highschool zhi mui, Audrey and Boon Lee.
Just in case i forgotten to mention earlier, i came from Seremban.
I spend the second half of my childhood life here,
and grew up enjoying Asia Laksa.

Good service with a smile~ that's the friendly aunty waving at my friend, Boon Lee..

The Stall

Fair cleanliness and Fair price

Awaiting the best curry laksa in the world!!
(or at least that's what i think)
Audrey's father, Uncle Aloysius would usually bring his own personal
box of parsley leaves and onions when eating in Asia Laksa.

Finally!! 3 delicious bowls of curry laksa! =)
The laksa is served with :
eggs, chicken, shellfish, beancurd (tau hu pok).
The think coconut milk makes this laksa taste extra good,
together with its smooth texture,
aromatic curry smell.
The burst of curry taste with every 'tau hu pok',
I-R-R-I-S-I-S-T-A-B-L-E!!!
Makes me misses Seremban all over again!

**Ta-da!!**
*blink* *blink*

The next time you happened to head down to Seremban, do not forget to stop by Asia Laksa!

Stories from my childhood - Phagophobia

hp84 was asking me about the term for fear of swallowing pills, which reminded me of a childhood experience of mine... (yes, story time!)

Fear of swallowing pills = Phagophobia
(Phago = Swallowing) hence the term phagocytes,etc..
Phagophobia is a general term for fear of swallowing/eating
Fear of needles = Aichmophobia

So, when i was a little kid, (okay, maybe not so little) i had this fear of swallowing tablets. While other kids were showing off how they could swallow pills, some even without water, i would tolerate the syrup medication. And yes, the syrup medication tasted terrible (just like medicine!).

I remembered there was this one anti-pyretic medication (syrup paracetamol- for fever) which was pink in color. It smelled like strawberry but it tasted horrible! (i think, the pharmacist probably wanted to make it more acceptable to kids, unfortunately, it didn't work for me) It made me hated that smell, until now.. which explains why i do not drink strawberry-flavour products; eg: strawberry flavoured milk, strawberry-flavoured yogurt, strawberry-flavoured ais-cream, strawberry-flavoured what-eva... I am okay with the strawberry fruit though.. i mean the FRESH, REAL strawberries are good (especially when dipped and coated in melted cholocates)... it somehow tasted less artificial, i suppose... (great, now you think i am picky, to like strawberry fruit, but hated the strawberry-flavoured products)

Anyway, that's beside the point.. back to the story.... like i was saying, i had phagophobia. The pills just refused to go down my throat. Then, the pills melts, or regurgutates upwards, and i end up vomiting out the pill. Sis Benedict, the Philipino maid who babysit me back then, had this marvelous idea. She would asked me to open my mouth widely, and then, she would throw the pills right to the back of my throat, and make me drink a glass of water. The trick worked for a while. But, the problem arises when there is noone to throw that pill into my mouth. Occationally, the pill maybe missed aim, and get stucked at the sides of the mouth. Sometimes, the gag reflexes sets in, giving problems too!



So, today, now that i no longer have problems swallowing tablets, i shall share some tips with you on how to overcome this. This would come in handy if you have a younger bro/sis or a kid with this problem:

1. Phagophobia happens when someone is anxious about taking pills and tenses up. You can try relaxing by sucking on an ice-cube before swallowing, thus numbing your throat and reducing the sensitivity of gag reflexes.

2. RELAX before swallowing. Breathe in and out to calm yourself and reduce the tension.

3. Take a medium sip of water before attempt swollowing.

4. The RIGHT POSITION may help.Put the pill onto the centre of the tongue (yellow spot on picture) and take a big sip of water. Tilt your head slightly backwards, (not too far back) about 30 degrees, then swallow the whole thing down with a gulp.



5. If #4 failed, try tilting the head faster, like a jerk.

6. If #5 also failed, try to put the pill onto the tip of the tongue and take a small sip of water. Instead of tilting your head backwards, tilt your chin downwards towards the chest, eyes looking at your chest. The pill will naturally float upwards, towards the back of the mouth, and get swallowed naturally.

7. You can also try taking your pills with flavoured drinks like yogurt/ribena/fruit juice. It's like tricking your gag reflex to swallow them down.

8. Last but not least, PRACTICE, PRACTICE, PRACTICE!! You can practice swallowing by replacing the pills with small sweets easily available from the stores. Start with smaller sweets(eg: tic-tac), and slowly move on to bigger sweets.

9. If the child have phagophobia because of emotional reasons, counsel the child.

10. (open for suggestions)

*Note: a common practice of crushing the pills is NOT advisable.

All the best in overcoming your pills anxiety =)

Injections/blood taking DO NOT have to be a nightmare…

How to reduce pain in a patient when injecting /taking blood /inserting cannula? (for patients)

Aichmophobia- Fear of needles or pointed objects.

Injections/blood taking DO NOT have to be a nightmare…

I know the needle can be the scariest object in the world. It scares me too, sometimes, when I am at the receiving end. Honestly, I do have a very low threshold to pain. (which explains the way I abuse pain killers, but that’s another story).

There was once, i twisted my foot. The staff nurse inserted a cannula on my left hand. I was asked to get an xray of my foot at the radiology department. Upon arrival, i must have looked so in pain, that the radiologist thought i needed an x-ray of my arm (being surprised to see that the form requested for a right foot xray). I explained to him that it was the cannula. and yes, it was more painful that my sprained foot. So, since then, i developed some relaxation techniques to reduce pain during such procedures.

REMEMBER: Injections/blood taking DO NOT have to be a nightmare...

So, today, I shall blogged about how blood taking/injections can be less painful, or in simple words, how to overcome needlephobia (fear of needles):

1. RELAX. Tensed muscle makes it more difficult, especially the body naturally reacts by constricting the vessels.

2. TRUST your doctor. Fear and anxiety can amplify the pain intensity.

3. DO NOT LOOK at the needle / the syringe. Why choose to scare yourself?

4. DISTRACT YOURSELF. I like to talk to my doctor. I usually prefer my friend, Natalie to take blood for me. She’s very good at taking blood, almost minimal pain, I would say. She would distract me by asking what I did today, what I had for exams, etc...

5. Otherwise, THINK HAPPY THOUGHTS. Imagine yourself, in a garden, serene, surrounded by flowers. The breeze, cool and refreshing. The sun shining from above, reassuring. A butterfly flew down and lingers on your hand. It bit your hand, but it’s okay. You stared at its beautiful colorful wings, mesmerized by God’s creation.

6. Otherwise, try doing the minus 7 series… subtract 7 from 100 repeatedly (eg. 100-7 =93, 93-7 =86, 86-7 = 71, etc...) it’ll all be over even before you finish

7. Throughout the process, BREATHE IN AND OUT~ remain CALM at all time, find your ‘chi’...

8. NEVER WITHDRAW/PULL BACK your hand. NEVER!

9. At the end of everything, say ‘ Thank you, Doctor’. I know, this does not relieve the pain, but it feels good to hear that, hehe... =)

10. If all fails, there's always the lignocaine (local analgesia) patch for injections.. but i'm not sure about the price...

11. Other workable methods: hold a friend's hand, try ear piercings (the feeling is quite similar)

12. bet with your friend that you are not scare and stare at the needle while it sucks all the blood out (suggested by peanut)

13. try to ask for a lenglui/lengzai nurse/doctor if there is any! (suggested by peanut)

14. i tried LOOKING at my injection site when the doctor or the nurse poke or withdraw blood from me....then take few breaths, inhale and exhale slowly..my fear has gone! (suggested by chiiliyeow)

15. (open for any other suggestions)

I hope these tips would be useful to you, the next time you see your doctor for an injection / blood taking/ cannula insertion :) *all the best*

How to reduce pain in a patient when taking blood /inserting cannula? (for medical students)

I syringed 20cc blood from a patient last thursday. I did not realized how scary it was, until my friends stared at the size of the 20cc blood-filled syringe in shock. Thank God, the blood did not clot. The thing is, the patient, she just lie there like normal, relaxed... I wonder whether she was accustomed to blood taking, or did she not noticed the huge syringe, or was it really that painless?




*syringe sizes for comparison - 20cc is the most right*
p/s: mind you there are of course syringes even bigger in sizes, some even up to 50cc!

So, I figure, today i shall talk about a few tips on: How to reduce pain in a patient when taking blood/ inserting cannula (branula)? (for the benefit of the medical students)

1. Choose the site. Unless the patient has already a line/ has a AVF/etc, which you indefinitely need to take blood from the other hand, take time to choose the site.

2. If both hands have good veins, ask whether patient is a right-hander or left-hander. Use the non-dominant hand whenever possible.

3. Appear CONFIDENT. It is very important to maintain a professional outlook. Know what you are doing. Do NOT use words like : ‘I THINK I can take from here’ or ‘this is my first time’ or ‘my last line got bunked’ or ‘ I am a medical student’ etc...
I often introduced myself as a 'Trainee Doctor/ Doktor Pelatih', rather than ' Medical Student/Pelajar Perubatan'. I am not lying about myself... but words like that DO make a difference... patients would have more confidence in us... seriously, trust me...

4. Explain to the patient why this needs to be done. Start with a professional smile and a 'how are you today?'

5. Be prepared. Have everything readied in a kidney dish before doing it. (gloves, the alcohol swab, cotton, syringe+needle/ branula, the torniquet, etc) There was a study though, which concluded that using the alcohol swab does not offer any added benefits in terms of killing organism on the surface of the skin. We still practice it anyway, it is more hygiene, i suppose, it cleans the surface, and sort of 'shines' the skin, making the veins easier to be seen.

6. TALK to the patient. I have this habit of talking to patients whenever I do procedures or examine them. Usually demography data, like where do you live, how are your kids, how's your job, etc… somehow, distracting them makes it less pain.. it also helps allays anxiety..
(I do get into trouble when I do short cases in exams, though, and my supervisor/ examiner would comment: no talking to the patient in short cases. I find the silence when examining the patient being rather uncomfortable and tense)

7. Do it swiftly and smooth. Time does matter. But do not appear in a hurried manner.

8. Remember to take off the tourniquet as soon as blood is taken as it's uncomfortable to have it on the arm for long time (suggested by sine nomine)

9. Get help when necessary. I only allow myself a max of 2 attempts. Whenever failed, I get help. (don't fail too much also lar.... that's why it's important to practice, practice, practice!! you do not want to wait until you are the HO on-call and you'll have so much work to do, just trapped at a cannula insertion and there's noone to back you up... )

10. Last but not least, i would like to emphasize: WEAR gloves EVERYTIME you take blood/insert branula. BE EXTRA CAREFUL. DO NOT RECAP! The risk of needle-prick injury, it never worth it!

11. (will add on to the list if think of any, open for other tips/ suggestions)

One of the most frustrating words, in the wards, I guess was: line bunked!

*all the best in blood taking/ cannula insertion* =)