The heart.

Jametlene Reskp

Haha, I have really got to work on my consistency in blog posting!
Anyway, I have been struggling to study recently, trying to maximise my free time, which is the entire day!
You see, I tend to get caught up in mobile games and Youtube videos, I do tell myself that I am just taking a break but I never really stop once I start!
It's like studying are the breaks I take in between games and video watching! Ughhh!
So I've just read about unstable angina and NSTEMI.
We all do have some knowledge about heart attacks, don't we?
The heart attacks we commonly talk about is referred to as STEMI ( ST-segment Elevation Myocardial Infarction).
Usually once a patient with chest pain comes, the first thing we do is we get the ECG done, because if he/she were experiencing a heart attack, we will get a very peculiar finding which is pretty much diagnostic- the ST-segment will be elevated.

Back to the topic, then what are unstable angina and NSTEMI?
These 3 entities fall under a spectrum called Acute Coronary Syndrome.
Basically, the characteristics of this ACS are:

1. Chest pain - which is retrosternal, radiating to limbs/jaw etc
2. ECG changes - especially changes in the ST segment
3. Cardiac biomarkers release 

So what differentiates unstable angina from the usual angina/stable angina? 

UA = 

Exertional angina of recent onset (within 6 weeks) of class III severity

Angina at rest/minimal exertion, generally lasting for >20minutes

Angina of worsening severity - increased duration of pain, pain occurring on less exertion, increasing requirement of nitrates. 

Basically, it is worse and more frequent angina. 

And what differences do UA and NSTEMI have? 

In NSTEMI, there has been sustained myocardial damage, thus there will be an elevation in cardiac biomarkers, which is not seen in UA. 

To manage such cases, the patients have to be hospitalised first. 

Treatment given stat:

1. Crushed aspirin
2. GTN
3. Clopidogrel

Treatment subsequently given are:

1. Aspirin
2. Anticoagulants - LMW Heparin - enoxaparin sodium/fondaparinux sodium
3. Other antiplatelets - ticlopidine, ticagrelor, prasugrel
4. Oxygen administration
5. Statins to lower blood lipid levels
6. Other cardiovascular drugs as indicated - ACEis, ARBs, beta-blockers etc. 

On a lighter note, consume more tomatoes because they're good for the heart! 

Their cut section does look like a dual-chambered heart, don't you think? 

Till then! 

 

Waiting.

Johannes Plenio
I have been jobless for 5 months now.
I have remained stagnant in my career path ever since I last graduated from medical school.
Sure, I have been occupied with other aspects of life, trying to be a better Christian, better wife, better daughter etc.

What I have done so far:

1. Traveled to the USA, longest flight thus far. 
2. Experienced having my flight cancelled. 
3. Visited NYC, watched the longest showing Broadway show-Phantom of The Opera in FRONT MEZZANINE SEATS! 
4. Visited 2 church members I have not seen for a while. 
5. Experienced and witnessed snowstorms. 
6. Went to my first Disneyland in Florida!
7. Chewed on leaves given by my airbnb host who so happened to be a herbalist to soothe my throat. 
8. Visited Washington DC, Philadelphia and Hershey. 
9. Had a great time in Hershey Park alone :p
10. Read 13 books. 
11. Finished watching A Korean Odyssey.
12. Planned and had our wedding dinner! The planning was torturous, my sincere advice to all brides-to-be out there, it is impossible to please everyone, so just focus on what you want and what circumstance permits. 
13. Got hooked to The Sims 4 and forced myself into deaddiction. 
14. Prepare lunch for myself almost everyday.
15. Started keeping succulents.
16. Picked up brush pen lettering as a hobby ( you can find my works on Instagram @pandapens) 
17. Attended a calligraphy workshop. Never know art could be that exhausting and required that much focus!
18. Managed to attend the 3-day Annual Spiritual Nurture cum Evangelical Meeting which I have missed every year before that due to studies. 
19. Studied a bit, here and there. 
20. Drove friends and family around on many occasions to better my driving skill.
21. Restarted this blog. 

Right now, I cannot wait to work. 

I know I will probably regret saying this once I start but that is how I feel right now, in this moment. 

Had a long talk with my parents about getting a temporary job while waiting for my placement, but I am not willing to commit to anything since I do have some events to attend and I do not feel like giving up my freedom so soon >.< 

Dilemma, dilemma. 

Just to jog my memory a bit since I did do some reading just now on Rheumatoid arthritis.
Some interesting points to remember:
It usually involves small joints, in a symmetrical way, and it is a inflammatory polyarthritis.
Morning stiffness is characteristic of this disease, along with other classical digit deformities, such as Swan-neck deformity, Boutonniere deformity, spindling of fingers, ulnar deviation of MCP joint, Z deformity, boxing glove appearance etc.

Do not forget to look for extraarticular signs like pericarditis, pericardial/pleural effusion, scleritis, episcleritis, keratoconjunctivitis sicca...just to name a few.

Commonly prescribed drugs include -

• DMARDs ( Disease Modifying Antirheumatic Drugs)

Mnemonic- MEDICALS R Gold
M-Methotrexate
E-Etanercept
D-D-Penicillamine
I-Infliximab
C-Chloroquine
A-Anakinra, Abatacept
L-Leflunomide

R-Rituximab

Gold-oral=auranofin
        -parenteral=aurothioglucose, aurothiomalate

• NSAIDS
• Steroids

These 2 groups are given mainly for their antiinflammatory properties as they do not halt the progress of the disease.

I still remember a female patient I was fortunate to tend to, she was merely in her early 20s yet inflicted with RA. This observation trumped my misconception that this was a disease of the old age.
This skinny girl had digits which were entwined with each other, digits here being both fingers and toes.
It took me a while to take notice of her hands and feet. She always hid under her blanket, not sure because of the chilly weather, or if she felt embarassed due to her condition.
She was very cooperative, answering my questions although she was in pain most of the time.
Thanks to her, the findings have been etched in my mind.
I wish I could offer words of comfort properly, but I never did master the Marathi dialect.
Anyway, I will try to make the best of my free time (: 

Postgraduation.

Baim Hanif
Wow, this was taken by a fellow Malaysian (:

I studied in India for 5.5 years.
4.5 years actually, +1 year of internship where we got to work along doctors and consultants, acquired practical skills & let our theoretical knowledge slip away bit by bit, haha!
4.5 years of cramming vast volumes of medical textbooks, just to reproduce the facts onto our examination sheets. Just to recollect and prove that we do know what we know.
That we knew what was needed to know, and neglected other aspects of medicine that were good to know.
But who is to say what's important and what's not?
The syllabus, instead of the human body.
Then again, there's really too much to know that such categorisation helps a student stay sane.

Anyway, I graduated this year but did not attend my convocation.
I never wore the square cap, nor have I put on the gown.
I messed up and almost could not receive my certificate.
I chose to stay at home and missed reconciling with my friends.
Some with whom I might never cross paths with anymore.

Decisions, decisions.
I made my choice and stuck to it. Sacrificed but no regrets.
I believe that if one is able to live with the choices he/she makes and not dwell on what-ifs,
then he/she has made the right choice for himself/herself.
The right choice is right as long as the individual believes it is right.
No one else can decide for someone else because they are not the ones who are affected by the choices someone else makes.
Similarly, they should not be affected by someone else's choices.
Live your own life.
& don't try to control other people's. 

Start Again.

rawpixel
I am starting a new blog, all over again.
I have started a number of blogs in the past, 3-4 of them to be exact. 
My most recent one, I tried to make the content a bit more 'cohesive'? Tried to focus mainly on product reviews.
I thought that suited me the most, since I am a pretty compulsive albeit cheapskate shopaholic.
I thought I could use it as a platform to earn some side income, since I am currently unemployed.
However, I did not make the effort to post much, as I probably was not that into it from the start.
My longest lasting blog was the very first one, which I created to document my feelings and emotions, things I went through and had to go through as I grew up.
So here I am again, and I hope I can be as committed as I was when I was a teen.
Many have advised the younger generation to write more, thus I am here to improve in how I can express myself in words.

The entries will show who I am and how my life has shaped me to become, well, me.
I will write on
Christianity - been a Christian all my life and am grateful to be one.
Medicine - my choice of a career, which I managed to follow and achieve.
Married Life - Newlywed here! it's been more than 1.5 years already
...& miscellaneous happenings in life.
I will try to share photos from unsplash.com because I feel that the photographers are talented and deserve all the attention they can get.

Stay tuned, whoever you are out there!