Boh's Tea Plantation (Cameron Highland)

Supposed to post this yesterday prior to the Bharat Tea Plantation but the photo blogger is down, and I couldn't upload the photos...

The trip to Cameron is not complete without visiting the famous tea plantations... We visited the Boh Tea Plantations in Habu and the Sg Palas Boh Tea Plantations in Brinchang. We stopped by the roadside to view the Bharat Tea Plantations as well (located between Ringlet and Tanah Rata)

Need to drive through the winding narrow road before we reached the sceneic tea plantation :)

I can't remember how far is it from the main road but what I remembeedr was that we had to drive through the narrow and winding 3 km pathways before we reach Boh Plantation and another 1.2 km before we reach the final destination, the Tea Factory. There's lotsa blind corners on the way. Need to horn everytime (as a warning sign of our approach) we reach the sharp corners, cos the road is very narrow and we can't see the car coming ahead..

The views were really breathtaking. Neat rows of tea shrubs lined the hill slopes, making a huge green horizon. .
Seeing the tea plantations reminds me of the HK TVB series 茶是故乡浓... The scenes from that HK drama series are taken from one of the tea plantations in GuangXi, China.


We visited the Tea Factory to see the process of tea production as well as the Tea shop. Previously, I didn't realise Boh produces so many types of tea products :D, and they produce coffee as well.. We bought one can of Boh Garden Teas Bukit Cheeding and one packet of Karamel Teacino (what a name :P) and another can of Boh Cinnamon tea for my sister in law.


We had our afternoon tea inside the tea estate as well, in the "Ummph Tea Shop" next to the Tea Factory..

It's nice sipping the hot Boh tea (Garden Teas, Bukit Cheeding) while enjoying the nice view and the nice scenery of the surrounding tea plantation. Very relaxing ;) Somehow, the hot tea turn cold pretty fast due to the cold weather; eating strawberry and lemon tart,

On the way down, we stopped by the tea plantation site, and walk through the tea plantation sites... The scenes are really beautiful... Of course the fresh tea leaves per se don't have any "nice" smell but the views are really breathtaking, especially in the late evening around 5 pm.


This is not the end of the tea plantations post yet.. I have another review on Sg Palas Boh Tea Plantation, which I will post some other time... :)

Strawberry Farm (Cameron Highland)

The strawberries in Cameron Highlands are cultivated using hydrophonic methods. The plants grow from plastic cocoons filled with water and essential nutrients. There are several strawberries farms in Cameron Highlands.


We visited KHM Strawberries Farm, located in Taman Sedia (a small village between Brinchang and Tanah Rata).

KHM Strawberries Farm has one small cafe located just beside the strawberry farm - with tables and chairs whereby one can enjoy eating/drinking the strawberries related products surrounded by the strawberry plants. There are strawberries ice cream, strawberries juice, strawberries milk shakes, strawberries cookies as well as fresh strawberries & strawberry jam etc etc.. They give generous servings of strawberries in packs as well, compared to other places.

Bharat Tea Plantation (Cameron Highlands)

I wanted to post on Boh Tea Plantation, but there's something wrong with photo blogger tonight.. Unable to upload most of the photos.. I planned to upload lotsa photos for Boh Tea Plantation. So I post on this Bharat Tea Plantation instead. Hope there won't be any problems with the photos uploading tomorrow..

The Bharat tea plantation is located between Ringlet and Tanah Rata. The "lovely" thing about this Bharat tea plantation is that the teashop is overlooking the hills - just like viewing an ocean of tea leaves. And furthermore, it is located at the road side.. which is easily accessible..

The factory is not open to public but one can take a walk through the plantation. I didn't do so as we just visited the Boh Tea Plantation, and the experience is something similar :)

Back from vacation

Just came back home this evening.. We really enjoyed our 4 days & 3 nights stay in Cameron Highlands( 金马仑高原). Cameron Highlands is indeed a very relaxing place for vacation with nice and cool refreshing atmosphere... We explored lotsa places in this highlands and have great fun over there :) We drove up via Simpang Pulai. Good drive, the road is much better than Tapah route.

We enjoyed the nice food over there as well.. Strawberries & related products, English tea & scones, herbal steamboat, steamed sweet corn & tasty sweet potatoes as well as the local cameron highland vegetables etc etc ...

And... I have taken lotsa photos as well during this trip ;) Will update on the Cameron Highlands trip with greater details together with photos later on...

Vacation...

So happy.. I'm on leave next week.. After the long wait and hard work for so long, finally I can take leaves liao.... Will be heading off to Cameron Highlands/ 金马仑高原 tomorrow for few days :) Haven't go there for years already, in fact, for a decade already.. Since the last time I go there was way back in 1995. Didn't go and explore any places also at that time, cos I went there for retreat.. I was one of the committees in the Christian Fellowship in the university at that time..

I just remembered that the road there is damn windy & "dangerous"... But with the new highway (exit via Simpang Pulai), it's much nearer and easier to go up there already compared to previously ;)

Have been browsing & surfing the net to search for which nice places to visit and what food to eat up there... Now I sort have one list already of places to visit and food to try ;) Have to pray for good weather and safe trip and journey there... Since I read from weather forecast, it will rain for the next few days...

Lunch with Wynnie & Darren

Raining heavily in Penang yesterday around 10 something in the morning, but luckily just for a short duration already..

Had "lunch appointment" together with my little sister, Wynnie and her sweetheart, Darren (who comes all the way from KL ;)) in Gurney Plaza... They arrived a bit later than the scheduled time cos there's heavy traffic jam on the road.. due to the heavy rain earlier on, as well as... the muslim guys going to the mosques for their friday prayer.

Went for lunch in Fish & Co in Gurney Plaza. We sat in one corner and took the set lunch treats over there.. There's 3 different set lunch treats available and we ordered different set for each one ;)

The set lunch treats consists of :-
1) soup of the day
2) one main course
3) beverages (kola tonic or passion fruit)
4) dessert

They ran out of stock for "soup of the day", so we were given "salad" instead. Wynnie said the salad sauce tasted like soya sauce only.. Hahha... I agreed as well, but since I was too hungry already, I don't care so much lah & I sapu everything ;)

The main course was served next... I took Fish & Chips.. Darren took Sweet & Sour Fish with Chips while Wynnie had Corriander Catch (grilled dory fishes marinated with coriander sauce) with Rice. We were chatting and eating at the same time.. Somehow Wynnie was very observance... She noticed the customers in the next table (sitting nearby us) ordered another set after they finished eating.. Well, either they had very good appetite or the food tasted really nice ??? At the end, we noticed it's one of the lady's birthday .. Cos the Fish & Co staffs brought out a small piece of birthday cake for her. They gathered around her; singing a birthday rap song for her :D

The lunch was very filling & we all felt very sleepy after lunch :D

*updated*
Photo uploaded upon request by my little sister ;) Her sweetheart is very cute & handsome, right? :)

On Call again..

Was doing EOD (every other day) on call... really tiring and exhausting ..
Nowadays I prefer quite and simple life instead of thrilling, exciting, nerve wracking and sweat drenching moments.. Frankly speaking, I feel very tired...

My friend LT just mentioned in his blog that he had a busy day during his last on call whereby he had lotsa laparatomy cases...

The moment I stepped into the Operating Theatre yesterday morning at 7:45 am, I was told that there was a post op case with bleeding problem for Re-thoractomy, and patient was on the way already to the OT.. Aiyk... What a case to start my day :( The patient was intubated with Double Lumen Tube (DLT). Intra-op, we transfused several pints of blood & Fresh Frozen Plasma as well as DIVC regime. Problem to maintain oxygenation when he was put on One Lung Ventilation (OLV) and have to resort to giving him 100% oxygen instead with PEEP.. Manage to maintain SpO2 97% with FiO2 1.0. Otherwise, his other vital signs are stable. The surgeon manage to find the bleeder and identify the source of bleeding.

The next case I did was a young girl with abscess in the pinna(ear) which developed after she pierced several holes at her ear not long ago.. for I&D.. All these results from unsteril & unhygienic instruments during the ear piercing process...

Then I continued my day with EVD insertion for 5 months old ex-prem baby with chronic hydrocephalus. When I called the case, the neurosurgical MO informed me that there's another case on the way from the other hospital with Extra Dural Haematoma (EDH) which might required craniotomy & evacuation of haematoma.

The patient with EDH finally arrived. She didn't require craniotomy cos the EDH was small but she had multiple deep laceration wound, including deep inverted Y shaped laceration wound on the scalp, and severely injured lips (being torn into pieces) & tongue (almost cut into two, causing massive bleeding... cos tongue is a very vascular organ) and multiple facial bone fractures as well... Another bleeding case... The surgeon managed to secure the bleeding after the identifying the bleeder.. Even though it's just Toilet & Suturing (T&S), the whole surgery took almost 5 hours cos it involved meticulous stitching & suturing ... Few pints of blood was transfused as well. The plastic surgeon really did very good and fantastic job.. Good cosmetic effect despite the severe injury..

I had many many other cases as well and I'm not going to list down each of the cases cos it will take me ages to do so ;) ...

Doing the last case of my day at 6 am in the early morning, which finished around 7:30 am..

Received a sms from Gasman while half way doing the last case..

Flower Crabs Curry

I haven't write any posts regarding food for the past few days :) It's time to write one .. This is what my hubby and I cooked few days ago.. the Flower Crabs Curry.

The crabs are still alive... While cleaning the crabs, we noticed one of the crabs is pretty much loaded with eggs !! I can't resist but to take few photos of this crab :)

The ingredients that we put in :- pineapples, tomatoes, lady fingers, lotsa small chillies, garlic, onion; salt and some other spices... and of course the flower crabs .. and not forgetting the important thing, the Alagappa's curry powder. I like this Alagappa's curry powder cos it's very hot.. I like hot and spicy food :)

This is the end result ... the delicious and tasty flower crabs curry.. We brought the curry over to my father in law's house and have dinner over there :)

On Call

I was on call yesterday. Another busy day.. Don't know why lately my on call are always busy :( Start my day at 8 am in the morning with a primigravida with cyanotic congenital heart disease, Tetralogy of Fallot (TOF) for Caesarean Section.

Tetralogy of Fallot (TOF) comprised of 4 seperate components, namely :
- Ventricular septal defect (VSD)
- Pulmonary Stenosis (PS)
- Right Ventricular Hypertrophy (RVH)
- Overriding Aorta (aorta lies directly over the ventricular septal defect).
Although it's very high risk surgery, luckily she doesn't has Eisenmenger Syndrome.

Clinically she is NYHA class 1 to 2 with central cyanosis. Her oxygen saturation under room air was 79 to 81%. With ventimask 60% oxygen, SpO2 was 89 to 91%. SBE prophylaxis given. I gave her epidural anaesthesia for the Caesarean Section with Intra Arterial Blood Pressure monitoring. It's very important to avoid any air bubbles inside the intravenous lines... Her haemodynamic was stable intra operatively. Surgery went on smoothly with minimal blood lost and she was sent to intensive care unit for post op close monitoring.

I have done few cases of Tetralogy of Fallot previously (with Eisenmenger Syndrome or pulmonary hypertension with Reversal of Shunt - Right to Left Shunt). Sad to say that most of them succumbed at the end.. This is indeed a very high risk condition with very high mortality rate. Pregnancy should be avoided in patients with Eisenmenger Syndrome because pregnancy carries very high mortality for these group of people, and death frequently occur during labour, or postpartum/post delivery.

Second case was a morbidly obese patient for elective Caesarean Section... She was too obese that we couldn't manage to get the subarachnoid space for Spinal Anaesthesia,even with the long spinal needle. Spinal Anaesthesia is the best choice for her cos she has very high risk for General Anaesthesia. Cos of the high possiblity of difficult intubation and high risk of aspiration of gastric content causing aspiration pneumonia. After several attempts by my consultant anaestesiologist and failed, we finally gave up trying spinal anaesthesia for her..

She was pre oxygenated adequately(obese people has reduced funtional residual capacity and tends to desaturate fast under anaesthesia) and induced with rapid sequence induction with cricoid pressure. No difficult intubation (Cormack & Lehane 1) but she desaturated pretty fast. Needed manual ambubagging for quite a while post intubation with 100% oxygen and PEEP to mantain her saturation. She also needed high PEEP intra operatively.

Subsequently I have another Chronic Rheumatic Heart Disease with Aortic Regurgitation for emergency Caesarean Section for prolonged second stage. Then followed by many other cases as well such as Fetal Distress, Pre eclampsia with macrosomia; Macrosomia/Big Baby in Labour etc etc.. I also can't remember how many cases I have done altogether...

Have another case with possible Post Dural Puncture Headache (PDPH).. post op Day 1 LSCS. She was quite distressed earlier on with severe headache aggravated by upright posture and relieved by lying down. Explanation given to her and she was asked to Rest In Bed. She was encouraged to take adequate fluid and caffeinated drinks as well.. Intravenous Drip also given to ensure adequate hydration. Pain relief with tablet mefenemic acid/ponstan was given as well.. With these conservative Management, her symptoms was relieved quite fast... I told her as well PDPH most of the time can be treated conservatively but if the headache persist or worsening, epidural blood patch need to be performed..

I'm on call again tomorrow.. Hope tomorrow will be a better day :)

DIVC (Disseminated intravascular coagulopathy)

Lately there are so many patients with Disseminated Intravascular Coagulopathy/DIVC inside ICU...

• 2 SLE patients with septic shock & acute on chronic renal failure in DIVC
• 2 DHF patients in DIVC
• Leptospirosis patient with liver impairment, renal impairment & septic shock in DIVC
• post lymphoma excision with recovering DIVC, but still having thrombocytopaenia.
  

Sounds like almost everyone is in DIVC :(

Was busy with one of the septic patient with very severe DIVC.. despite transfusing so many courses of DIVC regimes & blood products, her counts were still derranged and we still unable to correct her DIVC status.. She continued bleeding & oozing from many cavities and organs..

She had severe Adult Respiratory Distress Syndrome (ARDS) with pleural effusion with lung collapse as well and was on maximal ventilatory support (PCV 30, PEEP 15, FiO2 1.0 PS 20) but having very poor gas exchange and very severe metabolic acidosis. Blood pressure was low despite on high inotropic support. She also went into Acute Renal Failure (ARF). We attempted inserting femoral catheter for her for dialysis purpose but failed.. Unable to insert the guide wire further (resistance around 10 cm insertion depth) despite very good blood back flow.. We attempted several times at different sites but unsuccessful as well. .. likely due to her very distended and tense abdomen (with likely intra abdominal bleed as well from what we see from ultrasound abdomen).. However, she was not stable for dialysis as well since her BP becoming lower & lower despite on increasing inotropic support and she was not stable for any surgical intervention as well...

She also passed out massive blood clots per vaginally. We suspected she might had intra cranial bleed (ICB) as well since pupils are unequal.. She later went into arrythymia several times as well with unstable SVT (with heart rate 220 to 250 beats per minutes) which was unresponsive to iv adenosine. BP drop further later on and synchronised cardioversion done, but she was unresponsive as well. She remained critically ill despite the maximum medical supports given and her condition went downhill and finally we lost her :(

16th September - Hari Malaysia

I was on call last Friday on 16th September 2005 - Malaysia Day ... The day whereby Malaysia is formed (16th September 1963); but I wonder how many remember this day?? It's not celebrated over here in Peninsular Malaysia; Seems like not many realised or remembered about this meaningful day. Seems like it's just like another day only...... This day is celebrated in Sabah and Sarawak. I think we shouldn't put all the emphasize only on 31st August and forgetting about 16th September... Both dates are important..

Supposed to write on this earlier on, but due to time constraint, I only wrote about it today :P

And, I noticed few Sarawakians blogged on this... :)

• Fish Fish talked about this - Hornbill phew phew, and she flies the Malaysia & Sarawak flags on this day :)

• Grace talked about this as well.... Happy Birthday to Malaysia

• Fred, as well, writes a nice posting with the topic The Day we celebrate Malaysia..
  

• Another Sarawakian blogger, Matthew writes on this as well... Malaysia Day
  

• as well as lotsa others...

Happy Malaysia Day ...

Mid-Autumn festival (中秋节)/Lantern Festival/Mooncake Festival

Mid-Autumn festival (中秋节) orLantern Festival or Mooncake Festival is just around the corner.. two hours time, it will be the 15th day of the eight lunar month in chinese calendar already. (= 18th September 2005). Well, that day is my friend's birthday as well :)

This year, I will be "celebrating" this festival in Penang :D. For the past few years, I had been celebrating it else where... Last year (2004), I was in China (Yangtze River & the three gorges cruise, from Yichang to Chongqing); in year 2003, I was in Europe.. I was in Germany during the festival day; in year 2002, I was in Kelantan... further than that, I forget liao where am I ...

I still remember last year's Mid Autumn Festival. :) We board on the cruise around 7:45 pm on the night before Mid Autumn Festival. The fireworks display started sharp on 8 pm. We really enjoyed the fireworks from the cruise, and lasted for almost an hour.... Wow... very nice view. Shoot few photos as well. It's really an interesting tour & nice experience. The China mooncakes is different from the one in Malaysia. The China mooncakes are dry and not oily, and very sweet as well.. Not nice, might be I'm used to the locally produced mooncakes already :) In China, they have lotsa fruit flavoured mooncake, eg peach, orange, strawberry etc etc...

There's lotsa new mooncake varieties nowadays in the market. Besides the well known traditional lotus paste, red bean paste etc... there's pandan paste, red dates paste, coconut paste, durian paste, green tea paste, chocolate paste, cheese paste, jelly mooncake etc etc... I remember few years back, I even see Garfield mooncake as well, whereby the mooncake is made in the shape of Garfield...

The price of mooncake over here in Peninsular is much more expensive compared back to my hometown, Sarawak... Over there, I can get 4 lotus paste mooncakes at the price of around RM10 (it's cheaper for other flavour) whereby over here 1 mooncake already cost around RM10 already... The cheaper mooncakes in Sarawak is wrapped in the red paper type, no nice packaging or decoration or advertisement.. That's why can be sold at cheaper price :)

I still remember something interesting that CooknEngr, told few years ago.. From our previous conversation via emails few years back, he told me he bought some mooncakes for one of his ang moh friend. The friend loved the mooncakes but the way his friend ate it was rather "weird".. Whereby the Mat Salleh friend ate the mooncakes like eating a hamburger and wash it down with Coca Cola... :P

Yeap.. I take some photos just now... Doesn't turn out nice, but still okie lah. Can see the "Full Moon" ... :)


Something to share here as well, the hilarious mid autumn festival story by Dr Liew. Thumb up to Dr Liew ;) I really enjoy reading it :D

The Five Things I Miss From My Childhood

Alamak, I kena tagged again by BabeKL.. Second time already loh... First time being tagged was earlier on in June with the topic The Cook Next Door, something related to cooking and food :)

Have to scratch my head .... Feels like doing homework only.. kekkee.....
Before I started, let u have a look at my how cute am I previously :P

Btw, I changed the topic "FIVE Food I Missed From My Childhood " back to the original topic "The FIVE Things I Missed From My Childhood" as how it is started off by "the unrepentant individual", (with approval from BabeKL) cos I don't have much food choice when I was small time.... Nothing much I missed actually on food during childhood time, but if talking about childhood experience, then different story loh....

Mmmmmmm.....
Let me recall back those good old days.....
So long ago already :D more than 2 decades already...


(1) Enid Blyton story books
kekekeke.... I think most of those around my age group will know and read about Enid Blyton's story books during childhood days :) Read lotsa her books during my primary school days :) Eg. Famous Five, Secret Seven, Adventurous Four, Willow Farm, Noddy, Amelia Jane, Malory Towers, St Clare's, the mystery series, and lotsa other novels written by her. Enid Blyton story books accompany me as I grow up ;) Of course I read lotsa other story books and comics as well but hers, I have the deepest impressions.. Her books are still widely sold and available in the bookstores. In fact, I bought few for my nephews as well ...


(2) Catching fishes from drain..
Last time, when small time, we really enjoyed catching the little fishes from the drain/longkang near our houses together with my friends .. Sometimes we catch the tadpoles as well ;) (Initially, I thought how come the tadpoles looked so different from the other fishes.. hahahha... I don't know tadpoles are not fishes earlier on ..) We will go down the drain (I think the drain is less than 1 metre in height. We will "scoop" the fishes up with the "filter", I don't know what's the name of this filter; This filter is the apparatus that we used previously to filter coffee many years back. Nowadays I think people hardly use this sort of filter already :)

After we catch the little fishes, we will keep them inside the container and feed them with dry bread crumbs. It's indeed fun to see the fish swimming around and as the day goes... the fishes will multipy in numbers as well...

Hehehe.. I know it's dirty, but the activities is indeed fun and enjoyable .. I remember as well, when I was small time, around 3 or 4 years old, our housing area always get flooded whenever there's heavy rain... So we can even catch fish in our house :P. My family shifted to another house when I was 4 years old plus.. So no more flooding, and no more catching fish from the flood water inside the house as well =))


(3) Collecting duck eggs/Plucking fruits from fruit trees
When I was 10 years old time, I have a duck which I rear since ducklings time. .There are 2 ducklings altogether.. One is mine, and the other one belongs to my brother. The ducklings were kept inside the cage when they were small time. Later on when the ducks grew up, they were kept outdoors.. in the pen or "reban" in the backyard behind my house.

I feed the ducklings most of the time whenever I'm free till they grow up and lay eggs.. It's such an enjoyable activities getting up early every morning & go to the "reban" to collect eggs :P. I cleaned the reban as well; something like once a week or once in a fortnight :D

Next to the reban, we have lotsa fruit trees in the backyard as well... I still remember there are papaya trees, guava tree, ciku trees (this ciku tree never bear fruits... :( ), soursop tree, buah nona/custard apple/sugar apple tree, mango tree, lime tree etc etc...

The guava tree we have is the small guava, pink-fleshed & the flesh is sweet & juicy... Not the huge white coloured flesh guava. If we didnt pluck the fruits early, the birds will come and eat the fruits :(


(4) Food.....
I can still recall lotsa junk food I eat during childhood time.. Most of them are not available already nowadays... I particularly like the green coloured; small; round in shape keropok (corn flavoured)...and... there's free gift attached together with the keropok, something like the little small doraemon(known as xiao ding dang at that time) or E.T. figurine rubber toys... Sometimes I even buy the keropok just for the sack of the toys... hahhaha... (They really know how to trick or con innoncent little kids to buy their products) :P

Another keropok that I liked is Chickadees... mmmm.... now it's back to the market already, but I haven't go & buy one yet... I can still remember how it tasted like previously..

There are many other snacks that I eat previously but I don't know the name of the products :)


(5) Childhood friend(s)
Wonder how many of you all still keep in touch with your childhood friend(s)? I have few childhood friends, some I still keep in touch with till now (in fact, we are good friends as well.. but seldom/hardly meet each other already nowadays...since everyone working in different town/different states, but we still keep in touch through phone calls or sms). Some of my childhood friends, I don't know where on earth are they nowadays... whether Thin or Fat, Short or Tall? or .... No idea. Might be ... even if they stand if front of me, I can't recognise them even.. But I really wonder how they are nowadays... It's always nice to meet back and see how are things :) I wish I can meet back all my old friends...

And some "unbelieveable thing" happened early this year, during Chinese New Year time.... Whereby, I manage to meet back one of my really "long lost friend", someone whom i never expect to meet back again.. Well.. we are good friends during kids time and always played together.. and after kindergarten, in end of year 1979, his family migrated to another town, and since then, we lost contact.. From the time we finished our kindergarten till the day we met back again in Chinese New Year 2005 .. It's been 25 years already... How amazing!!! Something really unexpected... hahaha... It's long story how we manage to contact back & meet up.... Haha.. It's really something unbelievable.. I still have the photos taken together during kids time.. It's fun looking back at those photos....


Phew... Finally I have completed my homework.. I took so many days to write this.. hahaha... I save as draft earlier on and continue the next day or some other time whenever I'm free... Who should I pass this to?

(1) My dear friend, from Land of Hornbill, Grace
(2) My KSL Kenneth
(3) Evol
(4) Slenzie

Bleeding day...

Today is really the "bleeding" day...
Cos we used up so many blood products today...

First was the orthopod team next door... I don't want to comment about the surgeon or go into details what's happening intra operatively.... That patient had massive bleeding intra op and unstable... Massive blood transfusion given.. The patient was transfused total 30 pints of blood (packed cells) and 3 courses of DIVC regimes (1 course DIVC regime = 2 unit Fresh Frozen Plasma, 4 unit platelets, 6 unit cryoprecipitates). He was transfused another course of DIVC regime post op.. Counting how many pints of blood products given to this patient.. 78 pints till this moment, and the patient will still needs more blood products later on..

I'm doing a neurosurgical case, and my case needed blood transfusion as well.. 8 pints of blood and 1 course DIVC regime.. There was surge of massive bleeding in just a short period of time cos of sinus tear.. Patient went into hypotensive for a short period of time but I manage to bring up the blood pressure and stablise the haemodynamic status fast with rapid resuscitation with fluid(colloids) and blood products.

Another case next door is the uro case, nephrectomy with bleeding intra op as well.. needing something like 7 pints blood transfusion...

What a day !!! I can say that today is really a tiring day for everyone... Everyone was so tired by the end of the day...

Today, the blood bank was really "drained" by all these cases... Hope the blood bank won't "dry up" soon .. :(

Security Code

Have to key in the security code each time before one can gain access into the operating theatre (OT). The security code was changed every month, in the beginning of each month for security reason :) In other word, we have to memorise the new combinations every month. Aiyk....


This was just implemented not long ago (few months back) cos there's lotsa theft happening, and valuable belongings missing from the changing room in the Operating Theatre. Not only $$$ or valuable belongings missing, even the staffs' clothings disappeared as well, regardless of time.. it happened both in day time & night time as well..

I have colleagues who lost his trousers inside the male changing room. He was doing craniotomy and evacuation of blood clots for the severe head injury case in the middle of the night. By the time he finished the surgery and wanted to change back to his normal attire, he noticed his trousers was missing !!! I have few colleagues who lost their shoes as well..

And the most hilarious thing is that another colleague of mine even lost his pair of socks !!!! (His shoes were still around, but just that his socks were missing). And this occured during day time. My goodness, the "used smelly socks" also want to steal?? The person who steal the used socks is really a joker lah..

11th September

I was on call yesterday, on 11th September 2005 :) Nothing major happened over here... I just realised yesteday evening about "11th September" while one emergency Caesarean Section is in progress... And I forget to send birthday greetings to a friend of mine.. His birthday (as well as his brother's birthday) is on 11th September as well.. (they are not twins by the way.. but sharing birthday on the same day, but different year).

So fast, 4 years already.. since the terrorists attack... whereby two American Airlines planes were crashed into the World Trade Centre (WTC) towers on the on 11th September 2001 in New York, causing both WTC towers to collapse. So many people were killed.... :(

I came back home quite late that day (11th September 2001).. I was not on call that day, but there's one leaking/or ? ruptured Abdominal Aortic Aneurysm/AAA.. (I can't remember in details cos it's so long ago already..) for AAA repair in emergency theatre that evening.. So I helped out in the theatre. There are quite a number of us helping up that evening cos this is a major surgery.. The patient went into almost asystole on table during induction time and CPR performed... I can't remember how many ampoules of adrenaline & atrophine being given.. He went into ventricle fibrillation (VF) as well.. Defibrillation done... CPR commenced back again later on... we performed CPR for quite long time before we finally give up & pronounced death...

On call in Maternity Hospital

On call in Maternity Hospital yesterday. Early in the morning, before my on call started.. I received a call on my handphone while I was driving on my way to hospital.. The phone call was from my colleague who was on call the day before... Telling me to go to General Hospital straight, cause there is a case of Bleeding Placenta Praevia Major Type 3 Anterior, which will be done in GHOT. Mmmm... This doesn't sounds good. What a day to start with... Normally we prefer to do bleeding cases in GHOT(provided the patient is stable enough to be transfer over in the ambulance) cos in emergency bleeding cases, can get the blood products faster.. since the blood bank is over here.. and there are more staffs to help out as well if there is an red alert..) In MHOT, I am basically doing the "one-man show" cos I'm alone by myself.. and my GA nurse or assistant in MHOT is very very junior..

The patient hasn't arrive yet when I reached the hospital... Well, it's expected cos it takes time for the arrangement of ambulance & transferring the patient...I get my pager from my colleague before going up to the operating theatre. (I hate carrying pager... To me, pager is indeed a very annoying thing.. Hate the beeping sound.. I really prefer my colleagues to call me straight on my handphone...)

Regarding the case, this is her 3rd episodes of PV bleeding.. She was hospitalised for more than a month already. G3P2 at 36 weeks plus. (She was earlier on scheduled for elective LSCS next week). Her haemodynamic was stable but with only one green 18G branula :(. There's 6 pint blood in reserve. I set another two big bore branulas for her before starting the case. One good thing is that she doesn't has any previous scar.. The LSCS was done under General Anaesthesia. Rapid sequence induction with cricoid pressure. Cormack & Lehane 1. The Caesarean Section went smoothly without any complications. Blood loss around 500 ml. I have done quite a number of bleeding placenta praevia major cases previously and most of these cases are straight forward cases, but there are few cases which need to proceed to hysterectomy cos of placenta accreta, uterine atony.. etc etc with uncontrollable bleeding..

Have few more Caesarean Section cases later on in the day, but those are "minor" cases, all done under spinal anaesthesia.. One of the cases (fetal distress).. the patient is really "fantastic"... She can fall asleep to the extend of snoring, while the caeserean section is in progress... And I didn't give her any sedations or any sedative drugs at all!! Better still ... when the nurse bring in the baby to show her (We attempted to "wake" her up by calling her name, and shaking her shoulder... but somehow she is too "sleepy" and unarousable.. hahhaha) So we abandoned the idea of showing her the newborn baby :) She continued sleeping and snoring till the end of the surgery. She was still quite sleepy when we wake her up at the end of the surgery... Some people can really sleep very well, huh?!

Teluk Kumbar

Went to Teluk Kumbar this evening together with my hubby and friends for seafood dinner.... Teluk Kumbar is a small fishing village in Penang with nice seafood stalls. This is the first time I visit this place (Teluk Kumbar Seafood). My friends went there many times already for seafood. Hard to find this Teluk Kumbar Seafood place if we go by ourselves cos it's hidden.. Have to come here early cos this place is always full house. Sometimes the seafood are "sold out" already by 8 pm :) I really enjoyed the dinner tonight. Nice and tasty seafood, nice scenery and nice companionship :)

Since there's nice sea view scenery, I took some snapshots as well :)

Doggy's toy

My dog has a collection of toys as well.. The picture above is shows part of his toys.. He likes to play with soft toys as well as those rubber toys with squeaking sounds when pressed... He likes to bite his toys... So the toys won't last long.. The grey hippo is his favourite toy ;)

Everytime when he is given a new toy, he will play with the new toy for the next couple of days and left behind the old toys ... Hahha, his behaviour is exactly just like human :)

Hunting

I was surfing and reading blogs from few websites today and I came across one posting by Letti about dove hunting in US. This reminds me of an incident which occured many years back - in 1998 during my housemanship time. I was working in Orthopaedic Department in Sarawak General Hospital at that time. I had encountered quite a number of "interesting" cases during my posting there in Orthopaedic Department.

One particular incident that I won't forget is a young Iban guy, who was mistaken as "wild boar" by his friends.. They went hunting in one of the jungles in Sarawak. He was shot by his friend... Luckily - the bullet hitted his leg only and not any vital organs... He sustained fracture of femur from that gunshot injury, and was hospitalised. This Iban chap was the "bridegroom to be" in few days time :) Too bad, because of this, the wedding ceremony has to be postponed to a later date...

Another incident that I remember was an young Iban girl bitten by crocodile. There's lotsa crocodiles in some of the rivers in Sarawak. This lady was so unfortunate that she got bitten by the crocodile (but on the other hand, consider lucky as well cos she managed to escape and survived....)I can't recalled how the incidence occured but I can still remember the several deep crocodile bite marks on her legs (on her thigh as well as her calf).

Sometime, I feel scared as well thinking about the crocodiles when I take boat rides in the river in the rural areas in Sarawak...

Happy Birthday to my little nephew :)

My sister just called me up a couple of minutes ago... She just give birth to a cute baby boy less than an hour ago, via Caesarean Section, in Sarawak. Congrats to her :) Adding another boy to the family.. This is my third nephews :)

So, just one day difference between my birthday and my little nephew's birthday ;)

Birthday Dinner

This is my little birthday cake (ice cream cake) for this year :)

Have dinner tonight with my hubby, father in law and sister in law in Oriental Seafood as well (in Macalister Road). After thinking for a while of where to go for birthday dinner, finally the decision is back to this Seafood Restaurant as well.. :) For the next round of birthday dinner (my sister in law's birthday) we will go to some other place :)

Tonight, we didn't order any "special" dishes unlike what we ordered last time... (I still remember the horse shoe crab or king crab --> won't eat that again lah in the future... Enough already trying it once :) )

Deep fried Soft shell crabs... Quite well prepared.. The batter is crispy and the crab is juicy :)

Lala with ginger.

Steamed white pomfret with pickled plu, mushroom, tomato and salty vegetable.. Nice to eat when served hot..

Green broccoli with scallop, gingko and macadamia nuts.

Fried noodle.. Nowadays, instead of having "mee suah" for birthday, we have fried noodle with shrimps, taugeh, spring onions etc.. instead.. It's still "long" noodle anyway :P

Black pepper crabs. The forever "mouth watering" dishes... This is one of the popular dishes which we always order whenever we have dinner in Oriental Seafood. I like the hot & spicy taste... Very delicious and tasty. They always serve the crabs at the end... Cos most people eat crabs with fingers. Only a small number eat crabs with fork & spoon or chopsticks.. :)

Birthday Cakes

Went out together with a colleague cum good friend of mine this evening. Has evening hi tea with her in Coffee Bean in Island Plaza. Even we work in the same department, we hardly have time to talk to each other during working hours, most of the time only greetings each other "Hi" or "How are u" only at work. Well, we have long working hours and couldn't really manage to see each other often, not to mention having time to sit down and chit chat. The only time that we can talk to each other is after working hours. She called me out for hi tea and chit chat as well as celebrating my birthday.


Later on in the evening, my "little sister" Wynnie came to my apartment :) I bring down my little doggy to meet her. She carried and hugged my doggy as well.. My doggy is quite clever and understand lotsa English words. When she hugged my doggy the second time, she said something about wanting to bring my doggy back home, my little dog started to shiver. When she repeated the same thing again, my dog started to tremble more... Hahahaa... my dog was really afraid that she will really bring him back to her house :P

Btw, thanks a lot for the birthday cake & the nice birthday gift.. ;)

Have birthday dinner at night with my hubby and my in-laws, will blog about that tomorrow :)

On call

I was on call yesterday (1/9/05), and apparently there are quite a number of ill cases.. (3 ASA 4 cases come for operation). One of them is the 87 years old man, who was very dehydrated with low sodium 114 on admission with poor conscious level, with obstructed inguinal hernia and bronchopneumonia with sepsis and widespread T wave inversion on anterior leads in 12 lead ECG with liver impairment (raised bilirubin, liver enzymes and hypoalbuminaemia). With correction, the sodium raised to 125 and surgery was proceeded under epidural. If do under GA, sure cannot extubate the patient and the patient will be left intubated till the day he expired... and he needs inotropic support intra op..

I know already I have one POMR (peri operative mortality report) to write.. Not regarding the case mentioned above but on another case :(

Well.. not to mention too much about work.. Finish all my cases basically around 3 am in the morning. Receive quite a number of sms to greet me happy birthday after the clock strikes twelve. The first sms was arrived exactly at 12 am :)

Epidural ..

Epidural analgesia/anaesthesia is very effective for

• postoperative analgesia; to provide adequate pain relief and reduce post operative surgical incision pain,

• obstetric analgesia as well as anaesthesia; to reduce the labour pain for those undergoing vaginal delivery, or act as regional anaesthesia for the parturients who undergo Caesarean Section.. It is indicated in obstetric patients with high-risk labour, eg. pre eclampsia or patients with heart diseases.

• analgesia following chest/thoracic trauma; to provide adequate pain relief in those suffering several ribs fracture after Motor Vehicle Accident(MVA). This helps the patients to breathe adequately, cough and cooperate with chest physiotherapy, and improves the respiratory function.

• act as sole anaesthetic agent for Regional Anaesthesia .. especially for those patients with high risks to undergo General Anaesthesia. It is also performed for those undergoing knee and hips surgery eg. total knee replacement (TKR) or total hip replacement (THR), vascular reconstruction of the lower limbs,
  

• treatment for post dural puncture headache (PDPH) with epidural blood patch

Epidural is really a great "discovery", cos it's indeed a very effective method to reduce pain; If performed in parturients when they are in labour, it is really fantastic, it can reduce the labour pain to minimal, even up to the extend that the mums can have a "painless labour"... ;)

For those who are unfamiliar with the terminology epidural; it involves placement of Local Anaesthetic agent (LA) into the epidural space, aka extradural space.. It can be divided anatomically into Thoracic, Lumbar & Caudal epidural. This procedure needs expertise, and is performed by the experienced Anaesthetist.

It can be performed with the patient sitting or lying in lateral position, requiring full aseptic technique (including sterile surgical gown). The epidural needle is a "huge" needle.. Over here, we use the 18 G Tuohy needle. This Tuohy needle has a curved blunt tip to reduce the risk of dural punture and facilitates the catheter direction when the epidural catheter is inserted later on after correct placement of the Tuohy needle in the epidural space. There are few methods to identify the epidural space, I personally prefered using the "Loss Of Resistance" technique using air with the LOR syringe. The catheter is inserted to allow continuous infusion of the Local Anaesthetics for continuous & effective analgesic or pain control..

This picture shows the Tuohy needle (18G) used for epidural and the 26G spinocan needle used for spinal. The epidural needle (Tuohy needle) is a "huge" needle, 8cm in length with surface markings at 1 cm intervals, and has a blunt bevel with a 15-30 degree curve at the tip.

This is the closed-up picture of the epidural Tuohy 18G needle with the curved blunt tip.

However, all procedures also have their complications and side effects.. And epidural is not excluded. And not all patients are suitable candidates for epidural However the complications and side effects are minimised in those experienced hands..

Chang 棕子 breakfast/lunch

Went out together with hubby around 11 am for late breakfast cum lunch this morning after coming back from work.. Wanted to eat wantan mee earlier on but that particular shop we wanted to go to was closed today (they are "celebrating" merdeka day as well...). So we drove around and had a look what was available in town.
Finally we came to one of the streets in Chulia Street... The Chang (棕子) shop... Didn't know there was such shop earlier on.. specialising in selling 棕子 changs/zhong zhi/chung and few other changs.. They sell some other things like yam cake 芋头糕, red bean soup & desserts as well..
We ordered one huge bak chang (with double egg yolks, pork, mushroom etc fillings), one Cantonese bean chang and yam cake... Quite tasty and delicious.. And very filling as well.. We are full already before we finish eating :) The bill (plus coffee) is RM9 only :)

Talking about Chang (棕子) reminds me of something written by CooknEngr earlier on.. regarding the cooknengr's 霸王棕. Something special that he prepared during the 端午节 Duan Wu Jie :)