GP Attachment in Newmarket Day 6

Assalamualaikum.

Diabetes

Update GP hari ke-6. Alhamdulillah. So, first of all today ada patient diabetes. Dia jumpa GP bawak ubat-ubatan dia untuk renew prescription. Bila dia dah keluar dari consultation room, my GP asked me, do you notice anything? Aku pun macam, err tak perasan apa-apa pun. Pastu GP tanya lagi, dont you smell anything? Gotcha! Makcik ni ada bau asap rokok. Phew~

GP kelihatan angin jugak laa. Sebab dia kata dah penah nasihat makcik tu untuk stop smoking. Dah la ada diabetes, pastu merokok, lagi lah increase risk of cardiovascular disease.

Researchers have long known that diabetes patients who smoke have higher blood sugar levels, making their disease more difficult to control and putting them at greater danger of developing complications such as blindness, nerve damage, kidney failure and heart problems. 

Parkinson's Disease

Makcik Parkinson ni datang dengan suami dia. Makcik ni bertongkat. So macam ada limping jugak. And tremor dia obvious la. But pakcik ni, OMG hahah sangat baik, seorang suami yang sangat penyayang. Ya Allah, saya nak suami penyayang, weehehe~ GP nak check kaki makcik ni sebab ada ulcer, pakcik ni la yang tolong bukakkan kasut, stoking, pastu pakaikan balik. And pakcik ni jugak, GP tak suruh pun tunjuk Parkinson Pump machine yang makcik tu pakai, tapi pakcik tu yang tunjukkan. Melting~ 

DUODOPA is a combination of levodopa and carbidopa in the form of a gel that is administered directly into the small intestine through a surgically placed tube. This treatment is for use in patients with advanced Parkinson's disease who do not have satisfactory control of severe, disabling motor symptoms when using available combinations of other medications for Parkinson's disease.

What are the advantages of DUODOPA over oral therapies?

By providing a continuous flow of medication directly to the intestines, where it is absorbed, DUODOPA can help maintain a constant level of levodopa in the blood. Maintaining a constant level of levodopa in the blood may decrease the number of times a patient alternates between stiffness and uncontrolled movements.

Cervical Smear 

So nurse ajak utuk tengok cervical smear. Makcik tu pun relax je tak kisah pun student ada dalam tu. Nurse pun tunjuk la cara-cara dia. 

Looks painful, tapi makcik tu macam chillax je, hoho.

Avascular necrosis

Ada seorang pakcik ni, GP suspek dia ada avascular necrosis sebab bila rasa kat area scaphoid macam sort of hanging. 

Multiple Sclerosis

Selalunya MS kena dekat patient perempuan yang muda, but patient ni makcik yang umur dia 40 jugak lah. So dia datang mengadu ada pain laa kat leg dia and akan later on menjalani hip replacement surgery sebab that's the only way untuk reduce the pain. So for now dia ambik painkiller je laa. Macamana dia tahu dia ada MS, lepas dia being referred untuk undergo MRI. 

Multiple sclerosis (MS), also known as disseminated sclerosis or encephalomyelitis disseminata, is an inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms, including physical, mental, and sometimes psychiatric problems.

Globus Phenomenon 

Globus pharyngis (also known as globus sensation, globus or, somewhat outdatedly, globus hystericus, commonly referred to as having a "lump in one's throat"), is the persistent sensation of having phlegm, a pill or some other sort of obstruction in the throat when there is none. Swallowing can be performed normally, so it is not a true case of dysphagia, but it can become quite irritating. One may also feel mild chest pain or even severe pain with a clicking sensation when swallowing.

Post Menoposal Bleeding 

There can be several reasons for bleeding after the menopause. The most common causes are:

• inflammation and thinning of the vaginal lining (atrophic vaginitis) or thinning of the womb lining (endometrial atrophy) caused by lower oestrogen levels
• cervical or womb polyps – these growths, which are usually non-cancerous, can form in the cervix (neck of the womb) or womb 
• a thickened womb lining (endometrial hyperplasia) caused by hormone replacement therapy 
• abnormalities of the cervix or the womb

So, untuk follow up makcik ni, GP refer dia untuk buat hysteroscopy sebab takut kalau endometrial cancer.

1. Scope
2. Pelvic bone
3. Bladder
4. Uterus
5. Anus

Cough + Weighloss = TB

Seorang patient ni dah ada cough quite lama juga, takde phlegm rasanya tak ingat pulak. And dia jugak ada 2 stones weightloss in 1 months which is abnormal kalau dia tak put effort untuk exercise or change in diet. So, for this patient, GP refer dia untuk buat X-Ray.

So, alhamdulillah, hari ni sangat wide range patients. Selain patient wanita yang umur 40, sekali GP suruh dia baring, uuucakkk! Perut dia besar, ingat ascites, sekali GP mease berapa minggu kandungan dia daaaaa. Hoho. And berjaya buat 2 phlebotomy (amek darah) hari ni. No more cuak-cuak, semakin hari semakin sayang. HAHA. If you got the right technique, mudah sahaja. Tapi tu lah, buat ngan GP, tak pakai glove apa bagai. Pheww~ 

Esok gonna be best sebab sebelah petang akan pergi community hospital and my job is to tengok berapa ramai patient yang ada sign of parkinson disease. So, moh study~

Sekian, wassalam..