OUR PEJABAT PAKAR ..

If you pay a visit to the new Hospital Sultanah Bahiyah , as you walk on the lobby , you will see a glass window office-like area on the first floor.... which is better known as Pejabat Pakar. This is my desk actually.... well-equipped with a computer with high-speed internet, roster for specialist on call , district hospital covering and AIMST medical students teaching stick on to the board, files and papers, student's write-ups and my name stamp. Security card is needed to make an access to this place.



This is actually Medical department section. Head of departments have their own huge room. I never "lepak" here since abundant works need to be done as i sit on my confortable chair.. mmmm....like it never end ... but i am happy to be in this working environment

Singapore After Last 4 Years Visit

It has been years since my last visit to Singapore . I have many friends in this LION city that i can hop at their place anytime for accomodation purpose but yeah, the currency and the busy routine life there somehow ruin my intention to pay them a visit.


well...finally i ended up being here again for a TECOS meeting, a study trial to be conducted for a period of 5 years. Few centres in Malaysia are accepted including the hospital i am practising now. It was a good meet up and discussion between delegates from other Asian countries the the heading team from UK and US.


Singapore has change a lot but better. The road system is enhanced and the cleanliness of the city centre is superb. The people are well-groomed and the facilities are at their tip-top condition. I started to love this city again and hopefully i will come back for more.....i had some thinking about migrating here one day once i get myself established in my career profile..

SINGAPORE.....keep it up....you make neighbouring cities kinda jealous ! ha ha

A Modern Landmark In The Outskirt Of The Town

This is my new workplace... the new Sultanah Bahiyah Hospital, a huge landmark of Alor Setar. It is surrounded by paddy fields and the design impressed me the first time i came here to report to my Head Of Department, Dato' Dr Radzi , one of Malaysia best gastroenterologist. He never changed since i last left the department 4 years ago with no dato' title at that time.

I was given responsibilty to be incharged of 1st class (including royal wards) and 2nd class patients. At first , i was quite stunned as these wards usually being taken care by the senior specialists but yeah,, i am always up to the challenge and besides clinical skills, the interpersonal and communication skills are deemed important. In addition, i had to be incharged of neurology clinic since this hospital does not have any neurologist at the moment.

Lige goes on and i started to enjoy my life here, being away from KL , the soothing green environment, nice boss and helpful working colleagues.

To keep myself fit too, i have 2 gyms in town that i am still considering to join one of them. i will tell about them later...

To the readers, enjoy everything that comes your way, stay focus and leave the misery behind. Have a productive day ahead !!

Dobutamine Stress ECHO (We Call It DSE for short)

I may confuse all of you again with some of the medical terms in this entry but don't worry , i will make easy for you to understand....yeah and this entry is not about makan makan but an entry which requires skill and your experienced interpretation.

You probably read our Dr. Shah's blog regarding his Exercise Stress Test (EST) which requires one to walk in different stages and the ECG tracings will then show wether the test renders a positive or negative outcome. Similarly, DSE (Dobutamine) stress ECHO is a functional study whereby we resort it to people who has inconclusive EST or patients who basically cannot run for example they have knee problems or neurological problems and etc. Dobutamine infusion helps to increase your heart rate to mimic the exercise actually..and even we inject bolus of Atropine if the target heart rate is not achieved. In addition, during the test, we observe the ECG tracings and the Echocardiography (Heart Ultrasound) to see any wall proportionate augmentation. We need to take heart moving pictures during baseline, low dose, peak dose and resting/ recovery period and it usually takes about 30 to 45 minutes per patient. My interpretation has to be certified by my consultant first before i report it on paper.

DSE helps to diagnose/suggest coronary artery disease (yeah..angiogram still a golden method), viability study before deciding bypass is a good option in severe heart disease with poor heart contractily or either a vessel has added benefit for angioplasty (coronary stenting)

Picture above : i was doing DSE for a diagnostic purpose....CAN YOU GUESS THE MACHINE PRICE ????(clue : very expensive !! ha ha ha)

Talking about sub-cardiology specialties : we branch into ; EPS study , cardio imaging (eg . cardiac MRI, MSCT), Peripherals, non-interventional, heart failure and etc.... And insyaAllah...my interest will be in heart failure therapy whereby one has to deal with chronic heart failure management, ICD's, heart and lung transplant options ...etc ..and i think this field is very challenging and i love challenge but yeah..it is a long long way to go...

Hu Hu Cardio Team Out Again For Buka Puasa

Ampunkan gambar pertama yang blurrrrrr habis ni ! Sebab aku dalam gambar tu..jadi yang tukang ambilnya.. ntah sapa aku sambar tah !! Anyway, malam Jumaat lepas, sepasukan team Kardiologi HUKM buka puasa sama sama lagi... dibawakan oleh Boehringer... bertempat di San Francisco Steakhouse KLCC . Beza sikit dengan second gambar ni...padahal setting sama jer.

Sebab boleh bawa spouses dan anak-anak sekali dan maid jugak...so lebih meriah lahhh.. Bos pun hint supaya aku bawa teman istimewa... aku jadi puzzle sekejap....errrrr...he he. best jugak dapat outing macam ni .. menjadikan hubungan kerja tu lebih akrab ..kan ???

Panjangnya meja kami ..tu pun ada satu meja special untuk Prof Oteh sekeluarga. Aku dah kamcing dengan anak Dr. Faizan yang cute mute tu... eee geramnya uncle!!, anak Dr. Ika pulak bercakap tak habis habis.. in English u know !!! Few MO's tak dapat hadir sebab ada yang balik kampung. Semalam pun jumpa balik dengan Poh , Ai Ling, Tony, dan Angeline, Kelvin, Leong dan seorang lagi tu..aaa dah lupa pulak dari Astra Zeneca... dan yang bestnya all the bachelors gather at one side ... buka cerita lain...alamak kurang pahala puasa aku ... he he he.. IT WAS FUN !!!

Food as usual menu kat San Francisco... layanlah gambar makanan yang mengiurkan itu.. he he

Friday nite try la to avoid KLCC.....nak bayar autopay pun 30 minit tunggu..jammmmm..errrr. Thanks Boehringer !!

Cardiology Team Buaka Puasa Together...

Aaaaaa. an entry about food again. It was a treat from Astra Zeneca company to bring the whole cardiology team in HUKM for a " buaka puasa". It was my Head of unit choice to have it in Tupai tupai Restaurant, a very well-known Malay cuisine restaurant in Klang Valley. Thanks to Anna Ding and her boss from Astra for treating our get -together buaka puasa. We got to know each other better and we talked about anything apart from CARDIOLOGY that night... that was the rule !!! ha ha.

That was ME with my bosses and colleague : Dr Ting CK, Prof Oteh Maskon and Dr Samir (from Bangladesh)... errr and I was smiling.. who said i could not smile on pictures meh ???he he he

Anna Ding from Astra Zeneca who is covering Crestor, with my dedicated MO's : Dr Nik Razima, Dr Noorsharazat and my CCU MO : Dr Azrini.

Girl power in the team : Dr. Azrini, Dr Nik Razima and Dr Noorsharazat. Where was Dr Emma ?? Busy eating !!!!

The three among Malaysian's best cardiologists a.k.a my BOSSES : Dr.Noorfaizan, Dr. Ting CK (Calvin Klien ???..errrrr) and Prof. Oteh Maskon (Head of Cardiology unit).

Dr. Arif (my MO) was also there..

Who got the biggest biceps huh ??? He he he.......Dr. Noorfaizan's hyperkinetic son was also there and he is very cute....wanna cubit pipi dia !! Before leaving, we were given goodie bags from AstraZeneca .

The buffet price was RM 34 ++. The foods were plenty to choose from :

The restaurant was very FULL last night with Herbalife ...a weight reduction formula company threw an event there..errr...they sould hire me as their ambassador...he he..Thanks to Anna and the cardiology team !!

Let Me Pace Your Heart !! and Story About PhotoFrame and My Boss

This is how the entrance door look like to get into the pacing room. Yup we do emergency temporary pacing for heart block, symptomatic bradycardia with significant long pause on cardiac ECG, sick sinus syndrome . There are some reversible causes of heart block or bradycardia (low heart rate) that once corrected ..we can take off the temporary wire or else the patients have to be subjected to permanent pacemaker either single or dual chamber pacing .

We practice the ideal way of inserting a pace maker by flouroscopy guide and to establish the exact site for the pacemaker to generate its sensing.

I visited my boss today , Dr Ting CK in paedatric ward after his son had a surgery,, yup a minor one. I went there with Mee Kuan, drug reps from MSD when she dropped by HUKM to send this huge photo of the MSD course i have attended recently and it came with a photo frame..Thanks Mee Kuan. My boss took leave to accompany his son and i had the oppurtunity to meet his daughter and his wife. My boss did read my blog !!! Errr.. I never believe that he started up lifting weight again after reading my TRANSFORMATION entry.. ha ha but his wife had actually confirmed that.. NOW I BELIEVE that !! I never had any idea that i inspire people with my entry...feeling damn good to know that... Thanks to everyone who find my entry a motivational one... i am flattered.

To Dr Ting CK.. always miss your laugh when you are not around during ward round...you are not only i respect as a good boss but a good friend too... Hope your son has a speedy recovery..

Al Fatihah... Semoga Tenang Di Sana

Entry ni tanpa gambar... Aku masih lagi kat Langkawi semasa terima missed call dari satu nombor yang tak dikenali..Selalunya aku tak peduli..tetapi detak hati berkata ..REPLY IT...tut tut..rupanya panggilan dari bapa kepada Adik Ridzun, pesakit Acute Lymphoblastic Leukimia sewaktu aku buat posting haematologi dulu.

Berita yang memilukan sekejap hati aku. Adik Ridzun telah pergi buat selamanya-lamanya. Rasanya baru semalam Allahyarham adik Khairi Syafiq , juga pesakit ALL pergi meninggalkan dunia fana ni..Kedua dua pergi sebelum menerima pemindahan sum sum tulang. Kedua dua mereka antara pesakit yang istimewa dalam kamus hidup aku sebagai doktor.

Aku tak mengerti ... antara banyak banyak doktor dan konsultan yang merawat..aku yang dihubungi oleh kedua dua bapa untuk memaklumkan dan berkongsi kesedihan...terima kasih kerana memberitahu dan begitu mempercayai ...doktor hanya manusia..tak mampu untuk menghalang ketentuan yang Esa..

Adik Ridzun seorang yang cukup pintar..di saat dia menerima rawatan kemoterapi..dia masih mampu study untuk SPM dan mendapat result yang cemerlang sekali..cita-citanya mahu bergelar DOKTOR juga...Aku masih tak lupa..dia pernah berkata : nanti Dr Syukur jadi konsultan besar saya yer ....jawab aku..InsyaAllah .. Semangatnya cukup menjadi perangsang untuk aku jua..

Kepada keluarganya,, salam takziah..moga rohnya dicucuri rahmat dan tenang di sana. Tatkala aku menulis....sebak sungguh meruntun jiwa...Walaupun kami bergelar DOKTOR..tetapi kami insan biasa..punya jiwa..AL-FATIHAH

Duty On Call For Raya 2008

Bulan puasa pun belum datang lagi..ni kan pulak Raya... Terlupa initially ada meeting between all the registrars untuk DEBAT TERBUKA ???? pasal on call sempena Raya tahun ni. Awalnya ??? Mmmm ye lah masing masing nak balik kampung dan buat persiapan sempena Raya. Sebenarnya pagi ni berada dalam meeting Cardiology CME tepat 8 pagi..tiba tiba my colleague ,Ika call supaya attend meeting ni. Isunya seperti biasalah berebut TAK NAK on call. Lumrah..

Ada lah yang bertubi tubi cakap dia dah oncall tahun lepas lah dan tahun sebelumnya (macam la dia ajer yang berkorban besar ...ish ish ) padahal kalau rujuk roster tahun lepas rasanya ada ker nama dia ??? So adalah debat debat kecil . Aku paling TAK suka kalau suasana dah bertukar keruh macam ni dan aku tak faham macam mana pulak ada yang siap letak nama dia untuk oncall raya ke 5 dan ke atas dan 2 hari sbelum raya..itu tak payah volunteer ... semua org boleh buat.
Raya Eve dan Raya ke 3 jadi pertaruhan. sebab we have 2 non muslim to cover for first and second day of Raya .Tiba tiba pulak kes aku cuti emergency tahun lepas sebab Civic aku kena curi 4 hari sebelum raya tu dan kena belasah sikit tu pun dikira aku menikmati cuti yang panjang..tak pe lah if that counts.... i have no qualms.. The result : I give up with this heaty situation and I 'll be doing the Raya Eve dan Maujad will be doing the 3rd day Raya... That is something good about being a man : they talk less but ready for any responsibility (opsss sorry pedasss sikit but still i am not anti-feminisme yer... ha ha ha)

P/S : Menyanyi lagu Dari Jauh Ku Pohon Maaf ...atau Kepulangan yang di Nanti atau Dendang Perantau laaa aku malam tu... he he... please keep me company dan motivasi.. he he )

Dari KL Ke Bangkok

Rindu pulak dengan my blog ni....dah 3 hari sepi ... anyway..i am back in KL and to work. so entry minggu ni banyak pasal journey ke sana aje la.. Tajuk tu tiru ala ala filem indie Dari Jemapoh ke Manchestee ,,pernah dengar ?? Anyway..thanks for friends, colleagues dan bloggers juga readers yang lain terusan menghantar komen.. i am truly flattered.. thanks.

Tanggal 25 Julai lalu..jumpa Dr Norli kat KL Sentral ... lepas tu sama sama board KLIA Ekspress ke KLIA. Sampai kat sana ada pameran kat bawah ni oleh Malaysia Airports Bhd.. so snap a bit.



Gambar way out and keluar ni pun aku ambil jugak... sebab tunggu drug rep yang janji tu tak sampai lagi..

Anyway,, lepas jumpa Mr Poh, dari Boehringer yang uruskan semuanya..thanks Poh (mmm dah naik pangkat nampaknya) ..kami makan breakfast cum lunch tu dekat Eden Restaurant di KLIA.. sedapnya makan makanan Cina... waktu tu tak buka kamera pun sebab makan dengan semua nama nama pakar kat Malaysia ni... antaranya Dato' Azhari , senior consultant cardio di IJN juga famous endocrinologist dan nephrologist... nasib baik lepas itu datang Dr Mazidah, consultant endocrinologist dari SJMC yang becok mulut dia cakap PILAH... lepas tu baru rasa relaks sikit berborak dengan nama nama besar ni.. AKULAH TERMUDA SEKALI di kalangan mereka..hu hu...... KLIA memang cantik....

Pesawat MAS yang membawa kami ke sama.. kamu yang buatku terbang.... (aik berhantu betul lagu tu)
Sampai di BKK agensi tour dah siap tunggu. Dah nampak buruk benar Suvarnabhurmi Airport ni. Dulu mula mula datang cantik dan futuristik tetapi sekarang teruk maintanence dia. Kat bawah ni perkerja yang membaik pulih kat sana


Tol di BKK....mahal sangat.. minyak dia pun mahal... RM 4/seliter ..aaaa.

Bangkok views atas highway on the way to Sheraton Royal Orchid Hotel in Chankroung Road

Nilah antara delegasi Malaysia yang seramai 60 orang (35 dari KL) ke Conference tu..

Bumrungrad ni merupakan sebuah hospital swasta di sana... nanti kalau aku nak migrate ke Thai boleh hantar resume ke sini lah... he he tu pun once get my name established.

IABP .... To Save The Unfortunate..

I had received few phone calls from friends and colleagues encouraging me to update my blog...wow..i have no idea that they had visited mine so often. and enjoyed every single entry i've posted here .thanks again..I am honoured..

The reason .. yeah... i was quite busy the last 3 days.... seeing patient , clinics and so on and on. I am looking for the weekend to pamper myself, hit the gym again and hang out with friends. At least over the weekend, it is time to recharge myself and do something out from the medical world for a short while..

The pictures below were taken by my new Diamond HTC....3.2 megapixels....and the quality was surprisingly not bad at all. I took the pictures after finishing a procedure that i considered a life-saving for one of the unfortunate patient i had encountered last night.

Our Cath lab in HUKM are being upgraded..hence there will be no angiogram procedure done until we re-open probably in September. So far, IJN and Serdang Hospital (cardiology centre) accepted our ill patients for urgent angiogram and their co-operation was very much appreciated. Last night we tried to send to them for urgent angiogram which was a rescue to this unfortunate but IJN and Serdang had overflow of patient.

This procedure known as Intra-aortic balloon pump (IABP) help to restore the mean pressure from a failing heart secondary to massive heart attack.. I had the chance to insert this apparatus with the guidance from my consultant cardiologist. The team work was awesome.. i salute to my team..Similar cases like this ,,, we usually send straight to cath lab but we had to manage the best that we could at this situation.. The set is very expensive..up to a month of my salary...mmmmm

To all readers... love your heart... protect them starting from today.. eat healthy, stop smoking, ..

EMOTIONALLY ABUSED HEART probably better than PHYSICALLY ABUSED HEART...mmmmm.. Any comment ???

Rona Hidup Insan.....3 Kisah...

Karya Khabir Bhatia yang berbentuk penceritaan pelbagai kisah merangsang aku untuk menulis hari ini.. Sesungguhnya , sepanjang kerjaya aku sebagai doc... pesakit dan keluarganya merupakan kisah menarik untuk penceritaan dan ikhtibar semua insan. Rona hidup , susah payah, kasih sayang dan pengorbanan sememangkan tunjang kepada 3 kisah yang aku akan ceritakan serba ringkas yang terpahat dalam ingatan aku sentiasa .

Kisah # 1 :

Suami penghidap AIDS dan isterinya yang senantiasa di sisi...setiap masa tanpa jemu si isteri menemani. Hayatnya cukup kuat. Walaupun berbekal CD4 yang dua digit cuma dan pelbagai infeksi opputunistik..pesakit AIDS ni bertahan 2 bulan di wad...sesuatu yang diluar jangkaan prognosis... Mungkin cinta mereka menguatkan pesakit. Itulah cinta sejati..walaupun kecurangan suami, si isteri tetap setia . Tak pernah si isteri menghitung hari bila si suami akan menghadap Ilahi tetapi saban hari bertanya adakah si suami akan bangun berdiri...walaupun dia tahu kami hanya cuba mengubati..yang lain lain kuasa Ilahi. Mungkin ada yang jijik melihat si suami tetapi saban malam tangan mereka menggengam erat satu sama lain... Takdir Tuhan menjelma juga satu hari.. barangkali penderitaan harus dinoktahi. Raungan si isteri tatkala kami sahkan.. yang si suami pergi tak akan kembali. Si isteri akhirnya menjadi penghuni wad psikitri..adakah cinta dibawa ke mati ??????

Kisah #2 :

Kisah si ibu dan anak lelaki ... si ibu tenat di wad ICU.. pelbagai sakit dan infeksi... Si anak lelaki ni baru pulang dari luar negeri dengan tujuan sujud di kaki ibunda..memohon maaf dari kesalahan besar yang dilakukannya.. Kes ni miracle !!! Aku tak menduga si ibu bangkit diakhirnya.. Saban malam , siang si anak memegang tangan ibunda..memohon maanya yang terhingga..di saat air mata menggenangi gelodak jiwa. Ahhh anak kenapakah larangan ibunda juga yang dibuatnya sehingga menjadi kekesalan diri... Akhirnya satu hari.. berkata si anak muda kepada aku .... " doktor ..Tuhan itu Maha Mendengar... andaikata ibunda yang tak pernah berdosa digantikan tempatnya menghadap Yang Esa... izinkan saya galang gantinya..kerana rasa berdosa saya..tak bermakna tanpa mendengar lafaz ibu memaafkan saya. doktor ...doktor pernah salah pada ibu ???." Aku cukup kelu mendengar kata itu...Umpama pentas sandiwara.... si anak bertemu ajal dalam kemalangan jalan raya sewaktu pulang dari hospital satu hari... selang minggu..si ibu menampakkan perubahan yang ketara sehingga keluar dari sakitnya. Galang ganti ?? Mengetahui di sebalik cerita ..si ibu berkata " wahai anakku...aku sudah memaafkan kamu sejak dari mula....sambil hiba mengusai jiwanya..

Kisah # 3 :

Pesakit leukimia yang agak manja pada mulanya dan seorang bapa yang mahukan terbaik buat anak lelaki tunggalnya. Saban hari tanpa jemu..dia menemani anaknya ..harapan keluarga.Keakraban mereka sekeluarga buat aku yang merawat pun rasa sebak di dada. Asyik bertanya si bapa ``Doktor.........apa alternatifnya ??? tolonglah doktor...seluruh nyawa dan harta saya untuknya.....kasihnya bapa itu seolah olah mengundang aku sendiri umpama anak angkatnya... mm tak boleh aku harus professional.. Aku kagum melihat si bapa tak pernah minitiskan air mata di hadapan anaknya tetapi berjurai titisan air mata tatkala si anak dibuai lena... itulah kasih bapa...Aku terharu sebab kata aku sahaja yang didengarnya... Mereka ke Singapura ..kerana gagal untuk match donor transplant di dalam negara dan selepas itu kami jarang berjumpa cuma sesekali berbincang di telefon . Ajalnya datang juga..suatu hari bapa menjemput ke pengkebumian arwah... aku pasti luluh hati si bapa tetapi untuk meredhakan sesuatu ketentuan itu lah bukti kasih yang tak terhingga.

Di sebalik 3 kisah ini....sebagai pengamal perubatan...aku memahami setiap pesakit ada penceritaan mereka sendiri...dan kasih yang yang mengasihi......

I Won't Forget (Or Want To Forget !!)

The NHAM conference on interventional cardiology ended today by noon with the closing ceremony done by Dato' Dr. Robaayah from IJN. The 3 day course was an eye opener for me towards the challenging cardiology cases presented. Well done to all the speakers..!! I had time to meet my previous specialists,consultants, friends, colleagues from all over Malaysia.

The last presentation held in Ballroom A today left me with jaw-dropping experience. It was a session to illustrate few cases from 5 speakers from their daily work personal experiences. All of them delivered strong points and take home messages with the regards to the cases presented . The name of the session even high-lighted the momentum of the session ; Cases I Won't Forget (Or Want To Forget!!!).

Dr Teguh Santoso presented 3 cases of LMS (Left Main Stem) dissection in angiogram and how he dealt even without calling the surgeon in that crucial precious time. Excellant !!. Dr Rajesh from Penang Gleaneagles...threw us a case of young man with critical 2 vessel block with very very poor heart function and his heroic measures to save the critically ill patient at 2 am with him operating it alone with the staff. Wow !! . Dr. Shaiful, my senior from UKM now a consultant in IJN illustrated a case of a fractured stent in post percutaneous coronary intervention.

Medicine is definitely interesting... I wonder wether actually I chose to do medicine or the medicine itself chose me to be part of it... Anyway... glad i am in this health business..ha ha.