GP Attachment in Newmarket Day 8

Assalamualaikum.

Hari ni tak banyak patients pun, haha tapi still balik lambat jugak. Sebelah pagi dengan nurse. Buat phlebotomy kat seorang makcik diabetes ni. Expert dah skang ambik darah haha. Partner tanya, do you manage to get the vein, aku pun jawab la yup yup. Aku tanya dia balik, rupanya masa dia dengan GP kat klinik kat lagi kampung dia tak dapat vein. Weehehe, bongkak di situ~ Lol! And then blood pressure. And then buat urinalysis. geli tak geli, buat je lah HAHA.

Aku buat urinalysis dipstick ni gaya tak hygieni langsung laa tak pakai glove bagai. Hatta buat phleb pun tak.

Hari ni banyak kali came across perkataan Lantus. Ingat pebenda lah, rupanya insulin glargine.

Lantus (insulin glargine) is a man-made form of a hormone that is produced in the body. It works by lowering levels of glucose (sugar) in the blood. Lantus is a long-acting form of insulin that is slightly different from other forms of insulin that are not man-made. Lantus is used to treat type 1 or type 2 diabetes.

Next ada patient nenek ni umur dia berapa entah, siap osteoporosis bagai. Sangat comel haha. Dia nampak aku macam tak nampak swelling ankle dia. So, dia sendiri bangun kat tempat aku duduk tunjuk ankle dia yang bengkak, pastu mengadu lutut dia pun sakit. Terus teringat arwah wan aku. Sobs. Tak tahu laa minggu ni memang minggu nostalgia sungguh.. 

And GP cakap lah GP akan bagi dia water tablet sebab nak kurangkan swelling. Pastu GP cakap dia kena buat CXR (Chest X Ray) petang tu. Makcik tu banyak tanya gak ar, dia tanya balik GP kenapa nak kena buat CXR, GP cakap lah kot kot kalau ada fluid kat chest dia. Bijak sungguh. Sebab jaranglah kalau elderly kat Malaysia nak question back soalan kat doktor.  

Next GP ada dapat call dari seorang anak pesakit dia yang macam sort of dying.. Kiranya macam takde harapan dah la nak hidup pun. GP tu cakap laa yang anak patient tu macam nak prolongedkan IV fluid camtu so then mak dia boleh "stay" longer camtu. Tapi dah memang keadaan teruk pun... GP kata itu macam buat lagi patient suffering lah. Sebab bila renal dia still proses fluid all that stuffs, patient akan berada dalam keadaan sedar lah... And sometime it better to let go...

Sebab tu rasanya ada je kan kes-kes, stop kan life support system sebab kesian orang tu menderita. Yes kita memang nak dia hidup, tapi kalau memang takde progress dan buat kan patient tu bertambah menderita, kita lepaskan lah dia agar menghabiskan hayat yang ada dengan tenang...

And then petang sikit, anak patient tu call GP, cakap setuju untuk stopkan IV fluid... 

Next ada budak laki omel baru nak masuk dua tahun ada epilepsy, last sekali kena bila entah tak perasan pulak. So, budak tu makan ubat Epilim. So ada side effect macam vomiting, and then susah tidur. So, sekarang kiranya nak mintak prescription midazolam. 

Amende epilim ni? Ianya ialah sodium valproate. Macam pernah belajar. HAHA. Lupa. 

Sodium valproate prevents epileptic fits by preventing the excessive electrical activity in the brain. It is thought to achieve this by increasing the activity of a neurotransmitter called GABA in the brain.

Next midazolam. Gapo dio? 

The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties.Midazolam has a fast recovery time and is the most commonly used benzodiazepine as a premedication for sedation; less commonly it is used for induction and maintenance of anesthesia.

And then ada seorang lelaki ni, dia ada idiopathic thrombocytopenia and juga splenectomy. Oleh yang demikian, patient ni memang kena jaga-jaga from infection. Sebab kalau dapat infection will make his health status lagi teruk. So, in order to ensure this, dia dah dapat macam-macam jenis vaccine.

Petang tadi jugak pergi dua rumah yang aku pergi macam last week. Enjoying the view of Meelin, the highest village in ireland, gituh~ Haha. Motif je aku guna cork accent masa sembang ngan atuk yang ada mitral valve regurg. Heh. 

Last sekali, tutorial about Diabetes. So macamana nak diagnose diabetes type 2? Blood screening and HbA1c. 

The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'.

By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months.

For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications. 

HbA1c is also referred to as haemoglobin A1c or simply A1c.

Targets for HbA1c are as follows:

For people without diabetes, the range is 20-41 mmol/mol 

(4-5.9%)

For people with diabetes, an HbA1c level of 48 mmol/mol 

(6.5%) is considered good control, although some people may prefer their numbers to be closer to that of non-diabetics

For people at greater risk of hypoglycemia (lower than normal blood sugar), a target HbA1c of 59 mmol/mol (7.5%) to reduce the risk of hypos

GP cakap, american sekarang ni memang towards untuk diagnosis using HbA1c instead of fasting blood glucose, gituh~

Okey lah people, itu sahaja... Sekian wassalam.