Feb 29, 2012

man in 2nd stage of labor

helping out in the quarter-yearly episiotomy workshop...

I wonder if episiotomy routinely should be offered in this case...

Feb 25, 2012

flash western delight !!

wifey's masterpiece for tonight.

To learn how to cook sumptuous seafood dishes, find online culinary classes at online universities.



explain a lot about my expanding truncal girth, doesn't it?

Feb 24, 2012

L.Y.N.A.S. Loathe Your Nuclear Ass Shit !!

after my short post on wearing green, i a feeling a soft tsunami of green ar0und the cyberworld and real.

I am joining them for sure and for the right reasons.

There is never try or try not, there's only do or do not, and it maybe a matter of life or death.

But our destiny with rare earth goes on.

Others' efforts:



Feb 23, 2012

being blue, wearing green

i wore blue today.
and i was truly blue today, for a good reason.

Besides the blanket bombing of referrals all over, I became the fall guy to get a proper placement of a pinballed patients between several disciplines. To others, it is about 'washing hands', out of the trouble, but for me, i believe patient should be given a ward where she can receive optimum care for her most active problem and the most back up in the event of an emergency.

As I spent most of my time camping in one of the air-conditioned first world areas of this hospy, I felt kinda suffocated although I was surrounded by lots of ventilator machines which is obviously leaking minute amount of oxygen each. Logically, the air should well saturated with oxygen.

I exited that ward, head held high, happily sorted out something and I was greeted by a middle-aged lady in green who rushed out from the airlock to the corridor. Previously she was standing among the visitors' crowd during lunch hour.

LIG (lady in green): Are you a doctor?
Me: Yeah.
She stretched her hand forward for an introductory handshake.
LIG: Well, you see, I am a Master in a lot of things.
Me: A lot of things?
LIG: Yeah, I am a Master in a lot of things.
Me: What do you mean a lot of things?
LIG: I am Master in numerology, astrology and a lot more.
Me: (Skeptical look) Er, okay...
LIG: You see, you must wear more green. because green brings general love. when you bring more general love to your patients, they will recover faster. You understand?
Me: Green?
LIG: Yes, you know like Chakra in our bodies... Green brings more love, and more health.
Me: How about blue? (refer to first line of this post)
LIG: Blue is not general, blue if what you're improving is the lung. (She held both hands to her neck, like how the lawyer in TBH's case trying to hypothesize how TBH strangle himself)
Me: Oh.. ok. I'll wear more green. (Trying to sound as much away from cynical as possible)

I ended this out-of-the-blue conversation with another handshake.

No wonder, Western people wear like the followings every day.
Lots of love and health all around.
Align Center

Feb 22, 2012


there's a whole book about it.
there's a whole course about it.
there's a whole world about it.

today, together with my colleague was dragged along by my specialist to attend a conjoint meeting with all other departments in the whole state of Penang and the CRC clinical research centre of my hospital.

apparently, the Ministry of Health came up with an instruction, order and command for any department with 3 or more specialists to come up with at least 2 research topics. Possibly, a knee jerk reflex upon discovering how much we're slacking in the matter of research.

To be frank, yes, to be really frank. The very word of research may even strike fear and pose rejection. Research to some people is just a pure of heavy load of work which lead to more confusion and despair.

Research is not just something that you must do, it must be something that you want to do. I believe research are not being done with a need to do it, but a strong desire and passion to do it.

Funding is important. At this point of time, we barely have enough dough to provide basic medical care and contemplating roping in the 1Care Scheme to compensate for our low national healthcare budget allocation, it would not be wise to push for research and add headache to the present migraine.

A simple analogy would be like asking a beggar who barely have food of the day to allocate more time from begging and do some experiment that may potentially improve the begging returns. potentially.

Research as a matter of passion should not be forced upon us or else we may just suffocate. There's no point if we just complete it for the sake of completion as such hasty work may just be shrouded with unaudited errors, omissions, falsified entries or worst, fabrication. It will just lead to an off-track clinical practice based on skewed clinical evidence.

Feb 21, 2012

MCQs and criticism

simple tips for MCQ that so blardy difficult to follow most of the times:


2) 'Absolute' statement is almost always false as rarely there are absolutes in Medicine.

And when someone blatantly blunt commented on me
"Hey, you know what's WRONG WITH YOU, you ALWAYS NEVER see your patients.".

In my heart answered silently: "False".

P.S. rarely, there will be so many capped letters in an MCQ statement, anyway, so definitely either really false or a misprint.

Feb 18, 2012

Thumbs down debate

The event: Debate between CSL vs LGE

My comment: Downright thumbs down

Just before the debate, someone close to me (not disclosing who, just in case, many people got upset and amok) commented:

So today, there will be a big debate between
a kam tan (ex-convict) and a ham sap lou (pervert).

Always a good sense of humor with this fella.

I didn't go all the way to watch in the big screen of live telecast, but I just sat down there beside my 12 years old radio and tuned in to 988 radio station. I hiked up the volume a bit, sitting there attentively, like how the downtrodden people in the movie waiting to hear the speech by John Connor.

If credits is to be given is for the both speakers who is English-educated to be speaking fluent Mandarin. Somehow such profile befits me and I was wondering whether I should consider dipping my toes into politics. Being in the clean field together with LGE and all.

Second thumb up would be for the moderator who is clearly unbias and moderates at his best.

The letdown of this debate would be some areas of unsubstantiated discussion by the both speakers. Both trying to run down each others with dramatic escalation of issues and both actively campaigning about their pledge. If you mentioned it once or twice, you're forgiven, but please don't keep repeating the bloody point.

If we want to know what is the past, we can search the internet. Thank you.
But what going through your mind, we may need Prof X Xavier, or this kind of debate.

Some major issues for the future like finances, business, industrial development, healthcare and education should be discussed in a more constructive way, instead of criticizing the past of this and that not being done and boasting about what the party had achieved previously.

The questions session by the public was the worst of all. It is not even questions.

And the people who asked them obviously require karyotyping for aberrant chromosomes to account for the subnormal mentality.

I believe the expert from both parties should screen through those questions before letting them out for the Speakers to answer. Karyotyping at that point may take too long.

Overall, I am disappointed by this debate for it's lack of substance but enjoy its value in entertainment.

P.S. By CSL's referendum: it's a debate between a 60 years old with a 3 1/2 years old. Like my father debating with my son. Interesting.

Feb 16, 2012

Condolences to Curtin U


Does Rosmah Deserve the Curtin Award?

By Kee Thuan Chye

It must be sad for the prime minister's wife, Rosmah Mansor, that for receiving an honorary doctorate from a foreign university, she got so much flak.

The university that awarded it, Curtin University of Western Australia, was hit with brickbats too, judging by the strongly-worded postings on its Facebook page after the award was announced. Curtin was probably astonished by the reception.

As one commentor wrote:

"Curtin dear, you didn't anticipate these at all, did you?"

The postings were so many and so fast and furious that Curtin removed some of them. And justified it thus:

"Thanks for your feedback around one of our recent awards. We are as always supportive of free expression but have removed some postings as they're repeats."

Why is there so much negative reaction to Rosmah's getting the honorary doctorate?

The answer to that might well lie in the answer to another question: Does she actually deserve the award?

According to the media release sent out by Curtin, it is to recognise her "for her dedication to education and the advancement of women".

It adds: "She has devoted herself to community life, becoming the driving force behind the Permata project, which focuses on early childhood education and care for Malaysian children aged under five."

Nowhere in the release, however, is there an example given of how she has contributed to "the advancement of women".

In any case, the university must have been misinformed or failed to understand the implications of Rosmah's involvement in Permata.

It's taxpayers' money

As the prime minister's wife, she needed a project to give her a high profile, so she's latched on to Permata.

But it has been the people's money that is giving her this boost. In the 2010 Budget, her husband, the prime minister, allocated RM100 million to Permata, which at the time seemed a huge amount, and bigger in comparison to some other allocations.

Then in the 2011 Budget, her husband increased the allocation to Permata to RM111 million, causing many to wonder if he hadn't abused his powers.

One commentor on the Curtin Facebook page rubbed it in: "With due respect, the money she is using is taxpayers' money, not from her own pocket. If she has done a service for ‘early childhood education', what about the half-dozen other unrecognised Malaysians who have done far more? Sorry, but this award absolutely stinks."

Another commentor invoked an apt comparison: "I am a Malaysian and I'm incensed by the award. Would any Australian be happy if a foreign university awarded [Australian prime minister] Julia Gillard's partner for creating day-care centres around Australia with taxpayers' money?"

The odd thing is, these criticisms are coming from ordinary Malaysians, so Rosmah can't say that they are politically motivated or generated by people who are jealous of her "achievements".

Odder still is the vitriol that accompanies many of these criticisms, which shows the level of respect -- or is it disrespect? -- the critics have for the prime minister's wife.

Numerous people wanted to know how much she paid for the award.

Understandably, the ones who felt most hard done by were alumni of the university. Some said they felt embarrassed. Some said they would not hang their Curtin certificate on the wall any more.


One alumnus lashed out: "Who is Rosmah? After all the three years of hardship I went through to earn a Bachelor of Commerce from CBS [presumably Curtin Business School], now she gets the award just like that? Disgusting Curtin. I will never send my children to Curtin although I graduated from there."

Another alumnus ran down Rosmah and lambasted his alma mater: "This honorary doctorate for Rosmah is a debacle. Shame on me for holding a Curtin degree. Shame on Curtin for ruining its reputation. As we Malaysians would say, 'jatuh standard'."

Someone wrote: "Pity all the hardworking PhDs of Curtin for being ranked with Rosmah now. How do you term it in the property market? ... Total market depreciation?"

Why such disrespect for PM's wife?

Why is Rosmah so lacking in respect? Why are people saying bad things about her?

Malaysians are not noted to say bad things about the wives of past prime ministers -- at least not in public. None of her predecessors have been bashed like this. So why Rosmah?

Is it because of her alleged spending sprees? Does Curtin know about the evidence Australian fashion journalist Patty Huntington has provided regarding Rosmah's alleged purchase of 61 dresses from Australian designer Carl Kapp?

Is it because of her alleged attempt to buy a RM24 million diamond ring last year? Is it because of the thousands of ringgit she allegedly spends buying her range of Hermes handbags?

Is it because of the advertisement that was placed in the New York Times on behalf of the Malaysian government when she and her husband visited the United States in 2010 in which she was congratulated for having won a little-known international award, an advertisement that allegedly cost about three quarters of a million ringgit?

Is it because of her being allegedly involved in government affairs, including allegedly having her own division in the Prime Minister's Office called FLOM (First Lady of Malaysia)?

And that she even attended the highly confidential meeting between the prime minister and his top aides in the Finance Ministry to discuss the final preparations for the 2012 Budget although she had no business being there?

Is it because of blogger Raja Petra Kamarudin's statutory declaration made in 2008 that he had been "reliably informed" that Rosmah was among a few people present when the Mongolian national Altantuya Shaariibuu's body was C4ed?

Is it more than all these?

Curtin defends the award

In any case, all these are irrelevant to Curtin. As the university has just clarified (on Feb 15) in a note put out on Facebook in defense of its award:

"In the case of the nomination of Datin Sri (sic) Rosmah, while the university became aware of some critical commentary in relation to the awardee, the allegations against her do not appear to have been substantiated.

"When the nomination was considered, her contribution to early childhood education and the advancement of women was considered worthy of recognition and so the award was approved."

It also spelt out how the awarding of honorary doctorates is decided.

The first response to that post -- from a Malaysian -- was: "What a load of crock! There are a lot more worthy candidates out there."

Others found the explanation vague, disappointing and unsubstantiated. Someone asked who the other candidates were and who nominated Rosmah as one.

So there! Curtin University doesn't mind awarding a doctorate to someone who might be dogged by negative controversy.

Well, that's its own business. Back home, Rosmah might want to ask herself why so many Malaysians have such a low opinion of her -- since these are the people who should matter more to her than any foreign university or organisation giving her awards.

She might want to be honest with herself when she evaluates comments such as these:

"If this lady was well-respected in the country, she would be receiving praise and perceived as deserving of the doctorate. As you can see, there is anger instead."

"They gave her a doctorate. LOL. Of all the people in Malaysia."

If she ever figures out why so many Malaysians have such a low opinion of her, she might want to do something to make herself better regarded.

Notice, however, that I did not say "loved". I did not even say "liked". And for her sake, I hope it's not already too late.

Thank you for your feedback around one of our recent awards. The information below is provided in response to several people requesting more information about the process of awarding a Curtin honorary doctorate.

Curtin University has a formal policy relating to how these awards are granted. A nomination may be submitted by any member of the University community, using a specific template. Nominations are assessed by the Honorary Awards Nomination Committee, comprising senior members of the academic and professional staff.

Nominations which are supported by this committee are forwarded to the Executive Committee of the University Council, and then finally to the C
ouncil itself. The Council is the governing body of the University, and comprises representatives of the community, staff and students. In the case of the nomination of Datin Sri Rosmah, while the University became aware of some critical commentary in relation to the awardee, the allegations against her do not appear to have been substantiated. When the nomination was considered her contribution to early childhood education and the advancement of women was considered worthy of recognition and so the award was approved.
I believe as an esteemed center of higher learning, the university's senior members of academic and professional staff and the Council, the governing body of University, still have pretty much to learn. Our allegations are at least at the level or lower with your recognition of her contribution to early childhood education and advancement of women, barely appear to be substantiated.

My condolences to the University's alumni.

Feb 14, 2012

No better gift than the gift of you!

This Google doodle vid melted my heart, mainly because my wife is as cute as the girl in the vid and she can do rope-skipping in thousands per session.

But the most wonderful message would be there is never a better Valentine's gift of love than the devotion, interest and respect of each others' world.

Love you so much , dear.

Pilo's 5 Types of V-Day On Call Doctor

At some point of time, I realized that to be using the term girl/boyfriend and husband loosely may not be politically-correct, especially at other part of the world where being married isn't synonymous to being together or vice versa. Thus, it would be appropriate to address our other half as partner.

I brought up and discussed this '5 types' of people last year with someone - a single and available Indian guy house officer with the sexiest voice. He was on call on last Valentine, simply because he was in the '5 Types'. And as I was wondering whether he's also on call today (not a good thing to be thinking of another guy during Valentine), I think not, because house officers no longer have on calls.

Here are the Pilo's 5 types of On Call doctors:

1. No partner
- no date, hate the cynical stare, making work as the love of his/her life.

2. Too many partners
- can't date all in one single day, better let work be the ultimate excuse.

3. Too loving/long term with partner
- either the steam had already iced down or the steam is hotter than ever everyday.

4. Partner also on call
- having the delusional idea of having lovely 'Valentine' on call.

5. Forced to be on call
- frequently happens, especially if you're at the lower hierarchy,
or all you're the only sacrifice as you're the only exception to the couple charade.
- or you refused to be SHO giving the excuse that you need more time to go for 'dating'.

Happy Valentine's Day...

Here's the perception on Doctors..


P.S. My dearest made the most wonderful V-Day cake for me.
I named it Dragon Valentine Grape-Mango, Lite Cheese, Fresh Cream Stripey Cake. Sei Mei!


Feb 13, 2012

Perimortem C-Section in maternal collapse

Read and learnt something new today.

Perimortem Caesarean Section should be undertaken for if gestation more than 20weeks with futile CPR for 4minutes, and to be performed by 5minutes of resuscitation. It should not be delayed by moving the woman, it should be performed where the resuscitation take place.

Before the C-Section procedure, if it can be done swiftly, a sonogram technician will conduct an ultrasound exam to evaluate the fetal growth and the site of the placenta. The result of the ultrasound exam will serve as a guide for the pediatric team and so that the surgery can be performed without any extra surprises.

Benefits of perimortem Caesarean Section includes
  • reduces oxygen consumption (no more oxygen consumption by fetoplacenta unit)
  • improves venous/cardiac output (no more aortocaval compression)
  • facilitates chest compression (allow heart compression through diaphragm*)
  • makes ventilation easier (no more diaphragmatic splinting, reduced progesterone: normalization of the increased tidal volume and minute respiration)
* After the delivery, place the hand behind the heart (with diaphragm closed) and compressing it against the posterior aspect of anterior chest wall. This improves cardiac output beyond that achieved with closed chest compressions.

this is the coolest - almost Matrix-like. watch 1:44 to 1:47, 2:45 to 2:48

Source: GTG56 Maternal collapse by RCOG, UK

Feb 12, 2012

RIP Whitney Houston

Whitney Houston
Whitney Houston has died aged 48

One of the most celebrated female singers of all time and my favorite singer.

Music classes at online universities will teach you why Whitney Houston is legendary and what her remarkable contributions are in the music industry.

2 songs of hers that I love the most are...

Her Obituary. Her life in pictures.

Feb 9, 2012

epic fail | religion

First, there was this confusion between race and religion... by an individual

Now, this epic confusion by a Department...

Feb 8, 2012

contraceptive 'failure'

Pimped this case from here.

27-year-old lady presented with persistent cough, sputum and fever for the preceding six months. Inspite of trials with antibiotics and anti-tuberculosis treatment for the preceeding four months, her symptoms did not improve.

A subsequent chest radiograph showed non-homogeneous collapse-consolidation of right upper lobe.

Videobronchoscopy revealed an inverted bag like structure in right upper lobe bronchus and rigid bronchoscopic removal with biopsy forceps confirmed

- the presence of a condom.

Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio.

Reference: Arya CL, Gupta R, Arora VK. Accidental condom inhalation. Indian J Chest Dis Allied Sci. 2004 Jan-Mar;46(1):55-8. [PMID: 14870871][PDF]

Hiding important part of history may just lead to higher morbidity or mortality and not to mention, wasted a whole shebang of clinical treatments.

In my real life encounter, if not for the timely intervention, the misleading lady may have died intraoperatively. Postoperatively, her life partner smiling away while correcting his part of history which had misled us, was classified as an educated jerk, even by my standard of tolerance for stupidity.

Honesty may not always be the best policy, but dishonesty may be fatal at times.

Full disclosure and honesty is recommended especially in the matter of life and death.

Feb 7, 2012

Male or female computer?

A Spanish teacher was explaining to her class that in Spanish, unlike English, nouns are designated as either masculine or feminine.

'House' for instance, is feminine: 'la casa.'

'Pencil,' however, is masculine: 'el lapiz.'

A student asked, 'What gender is 'computer'?'

Instead of giving the answer, the teacher split the class into two
groups, male and female, and asked them to decide for themselves whether 'computer' should be a masculine or a feminine noun. Each group was asked to give four reasons for its recommendation.

The men's group decided that 'computer' should definitely be of the feminine gender ('la computadora'), because:

1. No one but their creator understands their internal logic;

2 The native language they use to communicate with other computers is incomprehensible to everyone else;

3. Even the smallest mistakes are stored in long term memory for possible later retrieval; and

4. As soon as you make a commitment to one, you find yourself
spending half your paycheck on accessories for it.

The women's group, however, concluded that computers should be Masculine ('el computador'), because:

1. In order to do anything with them, you have to turn them on;

2. They have a lot of data but still can't think for themselves;

3. They are supposed to help you solve problems, but half the time they ARE the problem; and

4. As soon as you commit to one, you realise that if you had waited a little longer, you could have gotten a better model.

Feb 5, 2012

Bracht's vaginal breech delivery

Bracht’s simple, efficient, and effective method: the breech was allowed to deliver spontaneously to the umbilicus without push or pull. The knee-extended legs of the flexed breech were not brought down. The body and extended legs were then grasped in both hands, with the fingers around the lower back and the thumbs around the posterior aspect of the thighs, while the upward and anterior rotation of the body was maintained. When the anterior rotation was nearly complete the baby’s body was held, not pressed, against the mother’s symphysis using only a force equivalent to the weight of that portion of the baby already born. The mere maintenance of this position, added to the uterine contractions and, if necessary, gentle suprapubic pressure by an assistant, allowed the baby’s head to deliver spontaneously in full extension. They noted that a reasonable degree of cooperation and minimum use of anaesthesia were essential prerequisites.
  Figure 2

Too bad. No recent data on safety and complications.
Here's a teaching video of safe delivery of breech.

race or religion, dude?

Snippet from The Star.

OUR teacher was briefing us on how to fill the SPM registration form correctly. When she came to the part on religion, she said: “Put 1 for Islam and for all other religions, put 2”.

A group of students said aloud: “Racist! Racist!” The teacher’s face turned red at the statement. “How many times have I told you never to say that word! That word never existed.” Her firm statement silenced the class.

This incident shows that racism is still active, undermining the integration that we had built since Independence Day. When our Prime Minister launched a series of programmes targeted at Malaysians’ unity, it also shows...

Speechless, reading it in national paper. wtf.

Yesterday was 立春!!

Yesterday, from 640pm, we officially entered the year of the Dragon, through the first day of spring, or called as Li Chun. I didn't 咬春 and also failed at erecting any eggs on the floor. But I was wondering whether our testicles or ovaries will go more vertical yesterday as in 立春.

Below is a compilation of readings from various sources about 立春.
Spring season begins today on Chinese calendar, we call it 立春 or Li Chun, meaning the beginning of spring. On this day, people usually go outdoors, make paper-cuttings to decorate windows, and eat spring egg rolls filled with fresh vegetables inside, it’s called 咬春, meaning bite spring.

The real importance of this day resides on its agricultural implication – soon farmers will start to plow the soil preparing to seed. China has a long and well-developed agricultural history, people’s lives are very much involved with agriculture, and spring is considered a season for plantation (春耕) while summer is called growing season (夏长), autumn harvest time (秋收) and winter for reservation (冬藏).

Spring is so special, it always reminds us of life, renew and hope. So we celebrate it on its first day.


立春时节有游春、剪彩花、宴饮等习俗。另外,立春这天还要举行迎春的祭祀活动,天子率臣僚在东郊迎春。在清代,“立春日为春朝,士庶交相庆贺,谓之‘拜春'。” 民间有鞭打春牛、送小春牛、贴宜春贴、造“探春茧”(一种面食)、“咬春”、“演春”等习俗。

所 谓“咬春”,就是在立春这一天吃一些春天的新鲜蔬菜,既为防病,又有迎接新春的意味。有记载道:“立春日,食芦菔、春饼、生菜,号春 盘”, 还有:唐人于“立春日作春饼,以春蒿、黄韭、蓼芽包之”;到了南宋,宫廷中的春盘,除“春饼”外,还有“翠缕红丝、金鸡玉燕,备极精 巧,每盘值万钱”。杜甫的《立春》诗写道:“春日春盘细生菜,忽忆两京梅发时。”苏东坡的《送范德孺》诗写道:“渐觉东风料峭寒,青蒿黄韭试春盘。”都提 到“春盘”,指的就是立春这天吃的新鲜蔬菜。


source: http://my.opera.com/Aprilsnow/blog/the-first-day-of-spring
Another thing that is interesting is if direct translate the word “Li Chun” 立春, “Li” 立 means STAND. “Chun” 春 has a lots of meaning and one of it is represent egg. So, “Li Chun” 立春 means “Stand Egg”.

According to the saying, the egg should not be refrigerated and must use raw egg. I have tried to make a few eggs stand and the eggs continue to stand on till the next day. I am not sure whether the saying is correct as I never tried it on any other days. So I am not sure whether the egg will stand on any other days but it is indeed a good experience and knowledge. You could use this to impress or surprise your kids, family or friends in the next Chinese New Year. Perhaps you could make the egg stand together with your family members as a bonding activity. This is another fun activity during the Chinese New Year

source: http://swanthamsw.blogspot.com/2011/02/how-li-chun-relates-to-egg-standing.html

No physical influence of other celestial bodies on the egg can affect its balance to the extent required by the folk belief. Gravitational and electromagnetic forces, in particular, are considerably weaker and steadier than the disturbances created by the person's breathing and heartbeat.

In 1947, Japanese physicist Ukichiro Nakaya verified experimentally that eggs in fact can be balanced with ease at any time of the year. He noticed that the shell of an egg usually has many small bumps and dimples, so that, by turning the egg in different directions, it can be made to touch a flat surface on three points at once, in many ways. It is not hard to find an orientation such that the triangle spanned by the three contact points lies right under the egg's center of mass, which is the condition for balancing any object.[2] Of course, balancing an egg on a rough surface is easy too, for the same reason.

Martin Gardner also observed that "if you are convinced that an egg will balance more easily on a certain day you will try a little harder, be more patient, and use steadier hands. If you believe that eggs won't balance on other days, this belief is transmitted subconsciously to your hands", and compares the process to the "Ouija-board phenomenon".[1]

Source: http://en.wikipedia.org/wiki/Egg_of_Li_Chun


Awesome effort!!!