The one and only SURGICAL blog carnival, SurgeXperiences is now up at The Sterile Eye.

What is SurgeXperiences?

It’s a blog carnival (registered with Blog Carnival) that collects blog entries every 2 weeks* on various surgical experiences. But we also accept articles on the news of surgical advances, etc. It is THE blog carnival for everything surgical and more! All are welcome to contribute.

Many thanks to Øystein Horgmo for hosting this edition with the theme of “Tools of the trade”. Link on to find out more the tools of the surgical trade. Very interesting read.

Next edition

The 22nd edition will be hosted by an Australia surgeon who calls himself Sheepish. His blog is over at The Paper Mask. His call for submissions is here.

Hosting

If you are interested in hosting future editions, kindly contact me. I have written some tips to host to made the process easier. We need hosts to keep this carnival going. If you enjoyed it, maybe you could do a part in helping it go on. Your efforts will not go unappreciated. You can submit your articles via the official submission form.

Here are all the issues of SurgeXperiences thus far:

Season 1

1. Surgexperiences 101: monash medical student
2. Surgexperiences 102:monash medical student
3. Surgexperiences 103: Unbounded Medicine
4. Surgexperiences 104: Other Things Amanzin
5. Surgexperiences 105: Suture for a Living
6. Surgexperiences 106: IntraopOrate
7. Surgexperiences 107: Vitum Medicinus
8. SurgeXperiences 108: Aggravated DocSurg
9. SurgeXperiences 109: monash medical student
10. SurgeXperiencs 110: Cut on the dotted line
11. SurgeXperiences 111: Buckeye Surgeon
12. SurgeXperiences 112: The Sterile Eye
13. SurgeXperiences 113: Counting Sheep
14. SurgeXperiences 114: Notes of an Anesthesioboist
15. SurgeXperiences 115: Made A Difference
16. SurgeXperiences 116: Other Things Amanzi
17. SurgeXperiences 117: Suture for a Living
18. SurgeXperiences 118: OpNotes
19. SurgeXperiences 119: Marianas Eye
20. SurgeXperiences 120: Surgeonsblog

*subject to change to 1 week upon popular request

one of my favourite bloggers had the honour of hosting Grand Rounds this week. check it out here.

her loose theme of introducing her state makes me wanna visit some day. maybe in year 5 when i do an elective in the States.

i was reading up on small bowel obstruction (SBO) again as i went through all the upper and lower GI surgical diseases (glad i’m finally done with them). then i was flipping through Bailey and Love’s Short Practice of Surgery when i caught sight of this picture that gave me the creeps.

pparently, one of the rare causes of SBO are worms… (disturbing picture ahead…)

Ascaris lumbricoides is the largest of the common nematode (roundworm) infections of man. The white or yellow adult is 15-35 cm long and lives 10-24 months in the jejunum and middle ileum of the intestine. Each female produces 240,000 eggs per day, which are fertilized by nearby male worms. A recent study from China showed that 45% of infected persons shed only fertilized eggs, 40% shed fertilized and unfertilized eggs, and 20% shed only unfertilized eggs. Unfertilized eggs accounted for only 6-9% of eggs shed. Fertilized eggs released into favorable soil may become infectious within 5-10 days. Eggs may remain viable in soil for up to 17 months. Infection occurs through soil contamination of hands or food, ingestion, and the subsequent hatching of eggs in the small intestine. (Source: Emedicine)

Ascariasis. The roundworm Ascaris lumbricoides causes ascariasis. Worms can reach 10-30 cm in length. Clinical disease results from effects of pulmonary larval migration, intestinal obstruction, or migration through the biliary tree.

Ultrasound of abdomen reveals a nasty find to be expected for the operation later.

Ok, that is the prize jewel (pictures credit). As can be seen, there is some ischaemia of the small intestine. I hope i don’t encounter many of these cases when i become a doctor/surgeon. Seriously, this is sick. Any one of you encountered these before? Bongi? Somewhat similar to your fettucini post i reckon.

“Lest we forget.”

All over the world, these 3 words are engraved in many memorial stones or monuments set up to remember the brave soldiers of ANZAC. Anzac Day marks the anniversary of the first major military action fought by Australian and New Zealand forces during the First World War. The acronym ANZAC stands for Australian and New Zealand Army Corps, whose soldiers were known as Anzacs. The pride they took in that name endures to this day, and Anzac Day remains one of the most important national occasions of both Australia and New Zealand. Thanks to the importance of these folks, we have a public holiday and as students, we gladly welcomed it. 3 of us decided to drive out to the country and do a little camping and hiking.

We conquered Cathedral Range National Park and Lake Eildon National Park in rural Victoria. It was scenic and refreshing…

We were on top of the tallest peak at Cathedral Range National Park. It is called The Cathedral. We got off the edge and tried to pose as rock climbers hanging off the cliff. Then apparently i faced some trouble getting up. So Elliot had to give me a hand.

The view from the top was amazing:

Scenery at Lake Eildon National Park:

I thought the view from the top was amazing, again. The hard climb was worth it:

Some other shots:

Overall i thought it was a great trip. We got to know each other better, had a good tour of the awesome works of wonder in Mother Nature in rural Victoria, had a tour of the Yarra Valley and some wineries, some wine tasting, etc etc. All thanks to ANZAC Day. Here’s to the valiant.

They went with songs to the battle, they were young.

Straight of limb, true of eyes, steady and aglow.

They were staunch to the end against odds uncounted,

They fell with their faces to the foe.

They shall grow not old, as we that are left grow old:

Age shall not weary them, nor the years condemn.

At the going down of the sun and in the morning,

We will remember them.

Lest we forget.

The “Ode of Remembrance” is an ode taken from Laurence Binyon’s “For the Fallen“, which was first published in The Times in September 1914. Binyon wrote it while sitting on The Rumps in Cornwall.

The one and only SURGICAL blog carnival, SurgeXperiences is now up at Surgeonsblog.

What is SurgeXperiences?

It’s a blog carnival (registered with Blog Carnival) that collects blog entries every 2 weeks* on various surgical experiences. But we also accept articles on the news of surgical advances, etc. It is THE blog carnival for everything surgical and more! All are welcome to contribute.

Many thanks to Dr Sidney Schwab, for hosting this edition with a poetic twist.

Next edition

The 21sth edition will be hosted by Norwegian medical videographer Øystein Horgmo at his blog The Sterile Eye.

Hosting

If you are interested in hosting future editions, kindly contact me. I have written some tips to host to made the process easier. We need hosts to keep this carnival going. If you enjoyed it, maybe you could do a part in helping it go on. Your efforts will not go unappreciated. You can submit your articles via the official submission form.

Here are all the issues of SurgeXperiences thus far:

Season 1

1. Surgexperiences 101: monash medical student
2. Surgexperiences 102:monash medical student
3. Surgexperiences 103: Unbounded Medicine
4. Surgexperiences 104: Other Things Amanzin
5. Surgexperiences 105: Suture for a Living
6. Surgexperiences 106: IntraopOrate
7. Surgexperiences 107: Vitum Medicinus
8. SurgeXperiences 108: Aggravated DocSurg
9. SurgeXperiences 109: monash medical student
10. SurgeXperiencs 110: Cut on the dotted line
11. SurgeXperiences 111: Buckeye Surgeon
12. SurgeXperiences 112: The Sterile Eye
13. SurgeXperiences 113: Counting Sheep
14. SurgeXperiences 114: Notes of an Anesthesioboist
15. SurgeXperiences 115: Made A Difference
16. SurgeXperiences 116: Other Things Amanzi
17. SurgeXperiences 117: Suture for a Living
18. SurgeXperiences 118: OpNotes
19. SurgeXperiences 119: Marianas Eye

*subject to change to 1 week upon popular request

Lots have been happening since i last updated my blog. Recently i have been trying to look for an additional source of income other than the gracious allowances my parents give me. I landed myself with a part-time job as a newspaper delivery man…

So this past week on Tues, Wed and Thurs i have been waking up at about 3:30am, drive my way down to the newspaper depot/warehouse where i utilize a machine that rolls up the newspaper and wraps it in a neat plastic. The first day i merely shadowed one of the guys, but the 2nd day i went solo on one of the rounds. I took a long 3hrs. The hard part of this job is knowing where to deliver the papers too. Its so early in the morning that light is obviously not in abundance. Street lamps are interspersed in the neighbourhood. Some houses don’t even have their house numbers on. You gotta get down and look at the house before/after to ascertain the unit number. It’s frustrating at times. Where to head next is also a challenge. It’s an entirely new territory i’m not familiar with, so thankfully i’ve got a GPS to help me out. That is the relatively steep learning curve i encountered with this new job. Hopefully i’ll be able to be competent pretty soon; to know the route and which houses to deliver which kind of newspaper to.

Speaking about learning curves, my time as a medical student have been packed full of them as well. I have just begun my general medicine rotation at a major metropolitan teaching hospital affiliated with Monash University. This will go on for the next 8 weeks or so during which we rotate through the major medical specialties like Haematology, Oncology, Gastroenterology, Neurology, Infectious Diseases, Cardiology, Respiratory, Renal/Endocrine. If we were to follow each service it’ll only be a short 1 week time. That’s just scratching the surface of experiencing the specialty and the service it provides to the community. Thankfully things are pretty flexible at my hospital. I might head up to the Operating Theatres if the day was boring. Somehow i doubt i’ll have time for that. I’ll try.

In Year 3 at Monash, we’re meant to be learning General Medicine and master our clinical examination and history taking skills. We’re also to become competent at knowing what investigations are appropriate to order and how to interpret test results. We’re not meant to become experts in a certain field of medicine over the course. Some students have this mistaken notion and delve so heavily into each specialty that they forget to master the basics, which is key. A strong foundation is necessary before further fortification. After this initial steep part of the learning curve is overcome, things get so much easier. I see no point getting your head stuffed with minutiae and not knowing the major important content.

My basis for doubting i have time to escape to the OTs is because we get lots of didactic and bedside tutorials by the various consultants. My group consists of some extremely motivated students who helped us organise these tutorials and we appreciate them very much. The consultants are all very nice and want to teach. For some reason, at bedside tutorials I have always been picked to be the first guy to examine the patient in front of our teaching group of about 8. This has been happening for the Respiratory, Neurology and Cardiology bedside tutorial. Gee. I must admit being put in the spotlight does force one to “up the game”. I reckon it’s fun Somehow, i thrive better and i seek to make sure i don’t forget those things i miss out the next time round. I think it’s inevitable to forget a thing or two under those kind of conditions. I’m human after all. But i think with more practice, it can be done.

With clinical examination, it’s really cool to start seeing those things we often see in Talley and O’Connor’s Clinical Examination textbook. In Year 1 and 2, we mainly examined one other. We got a good idea of “ranges of normal”. We have had appropriately aged (e.g. 70 year old man) patients for our OSCEs, but that was as close as we got. Now that we are in the hospitals, we get to see all the pathological signs that stick well in your memory. I don’t think its much to marvel about, but i for one finally got to see what wasting of the thenar and hypothenar muscles really look like. This guy also had severe ulnar deviation of his wrist consistent with his rheumatoid arthritis, which was sad for him but cool to see. The wasting looked something like this:

Also got to auscultate his chest and heard some basal inspiratory crackles. For one of my Cardiology bedside tutorial, i did the CVS physical examination pretty completely in less than 5minutes. Just need to brush up on the dynamic manoeuvres. It’s better to not talk as we go along the examination as i was directed by the Director of Cardiology. We are so used to doing so in an OSCE situation where we say, “I’m just doing a general inspection and i see no signs of cardiac cachexia and shortness of breath. The patient is on IV fluids and on NPO. His chest has no scars, deformities or bruising. Taking a look at his hands, i’m checking for clubbing, splinter haemmorhages, Janeway lesions, Osler nodes, palmary erythrema.” But leaving them for the end works well too.

We also got a log book that states about 10 or so procedural skills we’ve got to master by the end of the year. These are simple procedures like IV cannulation, venepuncture, cathetherisation, suturing, basic life support, oxygen therapy, etc. Its great to get a 5th year student who is your good friend. He let me place an IV in him and i let a fellow student put one in me. The next time i was on morning ward rounds with the Haematology registrar and resident, i jumped on an opportunity on a patient who had a IV that needed to be resited. So thats 2 in the bag, signed off. The next semester i’ll be rotated to another hospital where we do the same 8-week gen surg, 8-week gen med semester. During the general surgery rotation, i’ll make sure i’ll go for most operations and place the IV and catheter in.

So here’s to learning curves and those who dare to venture to the new, challenging, uncertain and unexplored territories, as the following photo depicts pretty well:

Into the unknown!

Ok, so i haven’t entirely been the most hardworking medical student of late…
Well, its not as if i’m neglecting my studies totally. I just haven’t been putting those extra hours of diligent study like a responsible student might do. I do the basics of attending rounds, going for the Problem-based Learning (PBL) tutorials i have each week, the lectures, and extra tutorials we get from arranged slots with consultants or registrars in various fields. I haven’t been roaming the wards looking for patients to interview or examine, or I have been busying myself with a newly discovered TV series called Friday Night Lights…

There’s quite a fair bit of drama going on, but watching it just reminds me of all the times i had with my canoeing team mates back in high school and i miss it. Back to the drama itself, notable storylines include how the main character Jason Street the star quarterback of the football team tackled someone down and “got a C7/T1 fracture and is paralysed waist down.” I might write more about that some day. He recovers in rehab, his girlfriend the hottest chick in the cheerleading team cheats with his best friend on the football team amidst all her support she has been giving him, visiting them everyday, he forgives her eventually, they want to get married, Jason tries to the USA quad rugby team, etc etc. It makes me wonder, what will i do with my life if i had been paralysed waist down. Will my loved ones still love me for who i am? What will by my purpose from then? Can i still be a surgeon or a doctor?

I realised, team camaraderie is exactly what i am missing right here in Melbourne. I need to join some sports team of sorts. Rowing? I’m too small. I’m only 1.68m, 70kg. Physically it is not ideal. But hey, i won the National Canoeing Championships 250m K1 sprint event, over the ~1.75 or so, 80kg, twice my size dude who was in the National Team. Was that against all odds? i would say so. i wouldnt have dreamed about it. No one expected it. But i did it in 2003 didnt i?

Kayaking here is not a big thing. There is some lake that is about 45min drive away i could go to get some kayaking action. I might one day. I miss the feeling of kayaking, and how the K1 cuts through the water, and how you sear forward with each powerful stroke, and the swift motions. It’s bliss i tell you. If you experienced it, you would fall in love with it.

Training for my marathon has been OK. I have been at the gym quite a bit, doing leg presses, extension and curls to strengthen them. I do 3 sets of 20 reps to build endurance power.. So when my blisters heal, ill be heading the roads again for more running. I gotta hit 30km soon.

Meanwhile, be safe and thanks for listening.

A landmark event in the history of surgical blogging, our blog carnival SurgeXperiences will hit its 20th edition next Sunday. It will be hosted by veteran surgeon blogger Dr Sidney Schwab who is behind his popular blog at Surgeonsblog.

He has called for submissions, so link on and see what he’s got in store for this 20th edition.

“SurgeXperiences is a blog carnival about surgically-related blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit. The next edition will be on April 27th. The deadline for submissions will be April 25th. Please submit your posts here.”

Claiming to have been tricked by yours truly, Dr Schwab is a first-time host of any blog carnival. Even long-lasting Grand Rounds has not had the honour of having him as the host. So SurgeXperiences is truly lucky. I guess persistence pays off. I have asked him to host on 2 or 3 previous occasions. He was the first i asked to help me host when SurgeXperiences took off.

And to downplay what the flattery i have served up to “trick” him into hosting, i shall cut and paste my invitation to him and you decide if its too flattering..

I would like to invite you to host the 20th edition of SurgeXperiences. This is a monumental time for our blog carnival and i would like to give you the honours of celebrating this achievement of 20 good editions that has gone by. I could not think of a better person than you to do it. People think of surgeons blogging and they straightaway think about Surgeonsblog by you. So i do hope you consider this once again and grant us the privilege of having you host.

I think i was just being honest. Who can disagree with the statement of people thinking of Surgeonsblog when we think about surgeons blogging? His blog is a prime example. Most medical bloggers will agree. What do you think? Was i being too much of a suck-up?

The kind folks over at OpNotes were there at the SAGES Scientific Session and have several articles.

SAGES Report: Hungry? How about swallowing this bag?

SAGES Report: Hands-on with the Surgiquest AnchorPort

i like this one most, on telepresence surgery: SAGES Report: The patient and you, miles apart

Hop on over to OpNotes.Com for more!

The one and only SURGICAL blog carnival, SurgeXperiences is now up at Marianas Eye.

What is SurgeXperiences?

It’s a blog carnival (registered with Blog Carnival) that collects blog entries every 2 weeks* on various surgical experiences. But we also accept articles on the news of surgical advances, etc. It is THE blog carnival for everything surgical and more! All are welcome to contribute.

Many thanks to Dr David Khorram, an ophthalmologist hailing from Saipan, for hosting this edition.

Next edition

The 20th edition will be hosted by Dr Sidney Schwab at Surgeonsblog.

If you are keen surgical reader, you should already know him. Otherwise, you should hop on over and check out his best posts in a “sampler” delight.

If you are interested in hosting future editions, kindly contact me. I have written some tips to host to made the process easier. We need hosts to keep this carnival going. If you enjoyed it, maybe you could do a part in helping it go on. Your efforts will not go unappreciated. You can submit your articles via the official submission form.

Here are all the issues of SurgeXperiences thus far:

Season 1

1. Surgexperiences 101: monash medical student
2. Surgexperiences 102:monash medical student
3. Surgexperiences 103: Unbounded Medicine
4. Surgexperiences 104: Other Things Amanzin
5. Surgexperiences 105: Suture for a Living
6. Surgexperiences 106: IntraopOrate
7. Surgexperiences 107: Vitum Medicinus
8. SurgeXperiences 108: Aggravated DocSurg
9. SurgeXperiences 109: monash medical student
10. SurgeXperiencs 110: Cut on the dotted line
11. SurgeXperiences 111: Buckeye Surgeon
12. SurgeXperiences 112: The Sterile Eye
13. SurgeXperiences 113: Counting Sheep
14. SurgeXperiences 114: Notes of an Anesthesioboist
15. SurgeXperiences 115: Made A Difference
16. SurgeXperiences 116: Other Things Amanzi
17. SurgeXperiences 117: Suture for a Living
18. SurgeXperiences 118: OpNotes

*subject to change to 1 week upon popular request

Here i am, proud of what my brother has accomplished once again. He traversed 250 kilometres in the driest place on Earth. Atalacama Crossing. Chile. The Atacama Desert has the most lunar-like landscape on Earth and is frequently used by NASA to test its Mars rover vehicles. The Atacama Desert is 15 million years old and 50 times more arid than California’s Death Valley. Some of the oldest mummies found on earth come from the Atacama, dating as far back as 9000 years.

And my brother did it. He came in ELEVENTH PLACE…! (pictures below)

There he is, Kah Shin Leow, 11th place. Cool. and yea, that’s right, super famous Dean Karnazes took part and duh, he won! Rob James is 2nd, and he’s some marketing manager for my favourite soccer team, Manchester United. Cool eh?

Isn’t he proud? Flying the Singapore flag high. They should really send a local newspaper, like the Straits Times, to report about his feat.

I think he’s sooo relieved he’s done. It’s his 2nd one. He is doing the June one in Gobi Desert with my sister and her finance. When’s my turn? When i graduate and earn some cash of my own. That’s when. Until then, i can only live in his glory.

Dr Wes hosts Grand Rounds with a cardiac slant. Excellently put together. I liked the following best:

• Reflections on Hospitalito Atitlan
• Pap smear … on a man?!
• Spine surgery - the real deal

Today is a day of landmarks.

For me, on a personal basis.

Last year, i tried to do the Great Ocean Road International Marathon (Half), which was 23km at the scenic GOR in Melbourne. That i wrote about here. Then, i struggled after i hit 18km. The last 5km were tortuous, painful and entirely due to my lack of training. I know i had ‘hit the wall’. I started walking when i passed the official half-marathon mark, and only started jogging toward the end. Though i completed, i considered that a failure. But i left hungry, hungry for more of such endurance events.

This year, i purposed myself to attempt the impossible. I would be attempting the full marathon. Well technically, anything more than the official 42.195km is an ULTRA-marathon. So the 45km this year will not only be my first marathon, but a first attempt at ULTRA-marathon-ing. As i think about this audacity of mine, it reminds me of my reading around the surgical blogosphere. It seems i’m not the only one skipping grades.

So, what have i done so far in preparation for this?

Well back to today, i did a 23.42km in 2hr 10 min 22 sec. That works out to be 5:33 min per km. Which i think is pretty good. My first half (11.71km) was done in 64min and the next in 66min. Which i’m personally pleased about because just on March 21, i did a 64:48min. I’ve not only shaved 48 precious seconds, but didn’t drop the pace that much. The weather today was perfect. After i did the first 3 rounds, i know i was onto something good. I actually felt i could go another 5.8km, but it turned out not to be so. There is work to do. My arms turned numb at the end of my 23km attempt. Good thing was, i didn’t stop. Well, not exactly… I stopped 3 times to drink. These were the simulated drink stations at my home, where i placed a bottle of Powerade for myself to take a sip each round.

The event is on May 18 Sunday, and i still got a bit to go. I want to do at least 2 35kms, before i go for the 45km. Wish me luck.

The next landmark is with regards to my personal life. It’s been a good 6 years since i started my r’ship with my significant other. This Sept will be the deadline of her scholarship application to a PhD program in Melbourne, so God willing, she will get it and be in Melbourne for the next 3 years. And hey, i still get to be a doctor before her. I have lined up some landmarks for proposal, marriage and kids, but i shall keep that a secret for now.

The 19th edition of SurgeXperiences will be hosted by Dr. David Khorram, an eye surgeon. You can read more about his profile at his practice’s site at Marianas Eye Institute.

He keeps a personal blog at Marianas Eye.

Blog synopsis: “A Saipan blog about life on a tropical island through the eyes of “not your average” eye surgeon. Here find island adventure, food, culture, humor, travel, medicine, and random thoughts about living a fulfilling life (along with an occasional gory eye picture thrown in, just to keep things fresh.)”

Dr. Khorram has also written a book entitled “World Peace, a Blind Wife, and Gecko Tails”

This coming Sunday on the 13th April, the 19th edition of SurgeXperiences will be hosted by Dr. Khorram and the theme will be “Funniest Operating Room Experiences”. Submit your posts via this form. Here is his CALL FOR SUBMISSIONS post.

Maintaining a blog carnival in an elite specialty is not easy. Finding a host is the toughest. Volunteers to host are hard to come by. I was considering if i should let it take a break when we hit edition 20. Let’s hear what the rest have to say.

Natural orifices. They can’t be that many. For males, you’ve got the anus, mouth, nostrils, and ears. For females, you’ve got the additional vagina, which comes in handy. Especially when U.S. surgeons have already removed an inflamed gallbladder through there before. That was way back in Sept 2007.

Surgeons at the University of California, San Diego Medical Center have performed the first clinical trial surgery in the Southwest to evaluate the safety and effectiveness of performing abdominal procedures through the body’s natural openings, virtually eliminating scarring. The UCSD Medical Center procedure involved removing the gallbladder through the patient’s vagina without traditional incisions through the skin. Only one small incision through the naval was required to help guide the surgeon…

Now, they have done one better. They removed the appendix.

There’s the famous team from UCSD Center for Future of Surgery.

So, if anyone will bother, trace the anatomical route from the orifice to the gall bladder and/or appendix.

I remember vaguely some obscure part in the perineum which was highlighted during my anatomy class which they lecturer mentioned surgeons made use of to gain access. But what and where is it?

The folks over at OpNotes talked to Dr Horgan who performed the NOTES appendectomy. Read about it here.

Its marvellous i would say. I think it will be probably within my lifetime that i can use NOTES technique to perform common surgeries like cholecystectomies, appdendectomies, GERD repairs (hiatal hernia), and obesity surgeries. General Surgery is definitely the way to go.

Ramona linked them all up.

So follow this link there to see all 7 parts of Grand Rounds!

My post on the runner’s high was featured in part 3.

Monash medical student tells us that the runner’s high is real after all…

Growing up in Singapore, blogger Jeffrey was doubtless deprived of his fair share of recreational pharmaceuticals. Now in Australia, he’s discovered runner’s high, 8 or 12 kilometers into his run. But don’t take my word for it when you can exult in his awe-inspiring use of the English language:

So get your running gear, which really isn’t much is it? Any tshirt and comfortable shorts will do. A decent running shoe will suffice. Add the music player for extra motivation. Does it really?

That says it all, does it not?

Monash med may have a bit of explaining to do upon his return to Changi. (Note to self, can you get runner’s high from rattan?)

Ok, i dont know if he’s trying to be funny about the rattan. Did you know that the students who attend Duke, which is apparently one of the best universities in the country, think everyone in Singapore gets caned once in their time? My friend doing biomedical engineering told me they actually thought that, so much so the Singaporean Society had to write a formal letter to explain how our punishment system for criminals convicted of crimes work! GeeeZZ!!

Anyway, glad to be featured, and hope u experience the runner’s high for yourself.

I was watching an episode of Grey’s Anatomy over dinner, and this one caught my attention and i decided to take some snapshots and write a little about it.

The episode is entitled “Enough is enough“. Link on to find out about the story. Anyway the part of the episode i wish to highlight is when Miranda deals with an unusual surgery of a man who has blocked bowels. He doesn’t say what caused the blockage. The surgical team highly suspect packs of drugs, which apparently is common with drug trafficking and all. But then highly observant Karev says, “Are you sure they are drugs?” And everyone takes a closer look at the films…

Can you make up whats in shown by the abdominal XR?

Let’s have a further look.

Get a shrink, this guy’s got a problem.

Causes of small bowel obstructions (SBOs): The leading cause of SBO in developed countries is postoperative adhesions (60%) followed by malignancy, Crohn disease, and hernias, although some studies have reported Crohn disease as a greater etiologic factor than neoplasia.

Several surgeries are closely associated with SBO. They are appendectomy, colorectal surgery, and gynecologic and upper gastrointestinal (GI) procedures.

Classification of SBOs: (1)partial or (2) complete, simple (ie, nonstrangulated) or (3) strangulated. Strangulated obstructions are surgical emergencies. If not diagnosed and properly treated, vascular compromise leads to bowel ischemia and further morbidity and mortality. Because as many as 40% of patients have strangulated obstructions, differentiating the characteristics and etiologies of obstruction is critical to proper patient treatment.

History: Abdo pain (often described as crampy and intermittent), nausea, vomiting, diarrhea (early finding), constipation (late finding), fever and tachycardia (suspect strangulation), previous abdo or pelvic surgery, history of malignancy

Examination: Abdo distension, hyperactive bowel sounds (early obstruction as GI contents are attempting to overcome obstruction), hypoactive bowel sounds (late), routine abdo exam to exclude hernia, DRE (gross or occult blood suggests late strangulation or possible malignancy), symptoms of GIT ischaemia (fever, tachycardia, peritoneal signs)

Best management option would be a laparotomy.

There it is in the small bowel.

Out it comes.

I think this is probably rare. Crazy guy swallows heads of Judy dolls. What for? I don’t know.

What is the weirdest thing you ever removed from someone’s bowels?

References:

• Emedicine - Small bowel obstruction
  
• Histopatho India - causes of SBO (picture credit)

ok now so previously my elder brother did the Sahara race last year which i wrote about.

having not had enough, now he is going to do the Atacama Crossing race in Chile starting today. here he is on the competitors list.

come June 08, he will take part in the Gobi March with my not-so-athletic sister and her fiance. my dad has decided NOT to sponsor me to go for this, citing that i should concentrate on my medical studies for now. he fears the whole excitement and buzz of the race will distract me from my core business - studying.

so too bad i will not feature in them until i graduate, God willing, in Dec 2010.

good luck to my bro. i’ll be sending him emails to encourage him the next few days and monitoring his progress. he should perform much better now that he has done it once before.

So i’m back from a family camp with Bethel BP Church. It was held at Norval Lodge at Halls Gap, in the locality of Grampians National Park. The spiritual food was plenteous with Rev Quek giving a series of messages on love. I was reaching out to Elliot too and i’m glad to see some progress. Prayerfully, God will work a mighty work in his heart and help him settle in Bethel.

The nature was great. Marveling at God’s creation could not have been better…On Wednesday, when we are making our way up to the Pinnacles where i was hoping to get a great shot of this below, something happened.

We overtook a little girl (probably about 8 or so) from our group. Elliot and I walked with her a bit and chatted. We were hoping to make it to the top nonetheless. However, we had to follow her pace and could not leave her alone in the bushes. It started to drizzle and it was getting cold. I immediately regretted not having my jacket which i left in the car before heading off because it was getting all sunny and warm. Darn! I touched my skin and it was ice cold! I seemed on the way to getting HYPOthermia but i kept jogging to keep myself warm. The cold winds did not help. However, it was the girl who impeded us. We headed back (so near the top!!) at 5pm because she wanted to. We had no choice. It was the right thing to do. On the way down, she started freaking out and crying. She was scared. We tried all our smooth talk and reassuring techniques. I even sang! Gee. That did not help. The only way was to keep walking and walking until we descended. Eventually when the end was near, she calmed down and got better.

I really relished the chance to have that view from the top of the Pinnacles. But situation calls and it was the right thing to do at that time. It was a pity.

For more pictures, check here and here.

It reminds of what the Apostle Paul wrote to the Romans in Chapter 1. “For the invisible things of him from the creation of the world are clearly seen, being understood by the things that are made, even his eternal power and Godhead; so that they are without excuse” (v.20)