Life in an Incubator

It's just a norm! We human will not appreciate certain things around us when the things are aplenty. We take things for granted. Here I want to share 2 stories:
Last week I was posted into the Neonatal ICU, and I was taking care of this little life. He is just a premature boy born at 26 weeks (a normal pregnancy would go to 40 weeks, he is 14 weeks short!). Weighing just a little bit over 900 gram, he has a dark complexity and a body covered with fine hair (lanugo). He is slightly bigger than my palm. There was a respiratory machine hooked up with countless of continuous monitoring going on in him. This little soul was moving his tiny hand when I first saw him. Every breath he took seems so full of effort and every minute passed is a blessed moment that he is still alive. Although he had a number of complications from being very preterm, the will to survive is very strong.
On the contrary, I have a friend that had quited medical school just at the dawn of the final examination. Heard that medical life was not his thing and that he will never walk down this road again. It was a shock to all of us as a friend as the move he took was drastic. Everyone was screaming that this is a very big waste. Alas! The life is his. Whatever path that he chose to take in the future, I just wish him good luck and he will find his way someday.
Someone is letting go, yet someone is striving very hard to live. This is how contrary a life can be. Hope you found your way.

Hunter's Hunted

I write this post as a tribute to a young little soul that had laid to rest in peace earlier this week.

In paediatrics, students are trained to do a quick but thorough general examination as that yields the most findings and guide our further examination. Most of the time, we like to divide the patients into 'syndromic' facies and 'non-syndromic' facies. So one fine day in Teluk Intan, I came across this boy, with a typical 'syndromic' facies. I couldn't make out what syndrome he has, but generally, he looks too small for his age. There were abnormal movements as well. He loved to do 'scratching' activities, which is purposeless from my point of view.

The main reason that he came in was due to pneumonia. He had multiple episode of similar illnesses in the pass, according to his sister. As usual, when we as student do not understand certain things, we go straight to the case note. He had what we called a mucopolysaccaride metabolism disorder, leading to what we called as Hunter Syndrome. That raised further questions to me that night, as I never heard of this illness before.

Usually, Hunter Syndrome is a progressive illness with no successful therapy so far. The victims will live up to adolescent or late teens and usually die of the complication of the disease. This is one of the rare illness that we don't want to get. Maybe that is why he succumbed this time. I talked to the mother before, she was already in the stage of acceptance before the child passed away. She said it will do both of them good, as he doesn't need to suffer any longer and the parents can concentrate on the other siblings. So she opted not for intubation in case her child fails to breath by himself and refuses any artificial ventilatory support.

When the child was gone that day, the mother cried her heart out. The whole family cried for his loss. That makes me think again. No matter what the mother opted for, I will support her decision anyway. They were the one that faced him everyday. Sometimes, there were no right or wrong answers. There is only choice. With any choice made, we sacrifice certain things. What matters is how big the price we pay. when we earn something, we will give up something. Isn't that the way of life?

I just hope that this boy found his lasting peace. Sadhu.

Neglected Child

Last week I just came back from a district hospital in Perak. Nothing great about this hospital, just a small facilities to serve the local population. Doesn't even have a CT scan machine. I was posted to paediatrics in that hospital for a week.

The patient populations mainly from the lower socio-economic status. Mostly are children of estate workers, lorry drivers and fishermans. However, there was one little girl that caught my attention...

She was admitted on Tuesday. She was about 8 or 9. Short-haired, dirty ragged shirts and worn shorts; the first look give me the impression that she is a boy! She had a very red lips. Generally, she looks undernourished. There were multiple healed scars over the shins. She was crying frantically and the father threaten to throw her into the ditch. OMG. The father was a middle-aged man, dark skin and was having walking difficulties evidenced by his walking sticks. Mother was no where to be seen. A closer up with the father revealed nothing much except that this is his daughther. He didn't even know whether she was born full term or not, vaginally or through caesarian, and what illness that she is having. So I checked out the case note. She was a case of dengue fever. Not quite... Further down the page, there was a segment mentioned that she had a heart surgery done in Institut Jantung Negara (IJN). They were supposed to be followed up in IJN, but the parents did not able to make it due to extreme financial constraints.

This poor girl had a hole in the heart that requires a 2-stage surgery. Yet she had only completed first part and the second part was already long due. So I examined her. Heart was not only enlarged, there was also cardiac murmurs. She was in cardiac failure but not taking any anti-failure maedications. This is like a time bomb waiting for the moment to come... Furthermore, she had sacral agenesis, most likely due to mother having uncontrolled diabetes mellitus when she was pregnant. Subsequently, she is not toilet-trained till now. There was walking difficulty as well as both her limbs were stiff. In fact, she was not able to attend the elementary school for this reason, despite already 8 years old.

She had 4 other sibling, 2 already given out as adoption to some other family members because the parents weren't able to rear them. Now left with an elder brother at 13 years old. The brother loved the sister very much. They slept in the same cot together (despite not able to fit both of them together) and the sister seems much happier when the brother is around.

Father had accident a year ago, left him with weakness and was unable to work as fisherman. Instead, he is doing some odd job now. The income shrink from RM 1500 a month to RM 250. Mother is a housewife. They received a minimal monetary support from government for their daughther, for about RM 190 a month. How can a family live a decent life with just RM 440 a month? To add on to the problem list, the mother is also currently a diabetic which was not on any treatment.

I can't help myself thinking, what if she was borned in a different family, will she end up becoming like this? For the least, the parent can bring her for follow up, and she might not end up having a heart failure. I don't know how is her diet, but what seems clear was she was not eating enough and well. Just few hundred km away, a girl who was loved, cared so much but was being abducted by some sick paedophiles. The whole nation is on a lookout for this child. If this patient is lost one day, will her lost even be noticed by the parents? I doubt that a search party will be conducted to look for her as well. After all, she is just a poor child borned in a wrong place at a wrong time.

More Than a Cageful of Tears

Here I am again. My story never ends, or rather my agony never ends. That day, everything seems like a turning point for me. That day, one fine couple came and see me. Immediately they had fall in love with me. They were saying something like 'adopting' me. I was over the cloud nine. How I wish to have a family, to call 'papa' and 'mama' when I learn to speak one day. Some one would care for me, caress me, hug me and play with me.

Alas! Everything was like a dream.


Being born prematurely into this world, it has taken toll on my body. Some part of my system is imperfect. Few weeks back, I don't know what the 'big people' are talking about, but I overheard that they want to do something to my body. Something like 'surgery'. Something like putting me to sleep and then open me up. That idea sounds scary. What will happen to me then? But don't harm me, please!

That night, an angel came to me and spoke to me. She said the family supposed to adopt me changed their mind. This is because I am not perfect. She said I need to be brave. To endure what lays ahead. And I need to be strong! I cried that night. Knowing that the fragile dream is already broken to million pieces, I am back to square one. Again, I ponder this question. Being born like this, is it my mistake? Why I am subjected to so much of human cruelty? Why am I being so unwanted? The angel left. Again, I went to sleep with all the questions unanswered.

Obesity and Adiposity: Friend or Foe?

People are in denial, I am also in denial. Obesity... it is always a weighty issue. Whenever climb onto the weighing scale, the mood of day can change. If I indulge in something good previously, I will cautiously check the scale, fine-tune the '0' mark and then only weigh. If the weight just maintained, I would be very happy. On the contrary, if I add another precious kilos onto my already 'heavyweight' frame, the following days will be dreadful.

Why are people getting obese? As far as I understand, the body weight is maintained by a balance of input and output. Input is from what we take or drink. Output is the energy expenditure. Obesity occurs when the balance of input is more than output. Too much input occurs when we overeat. Too little output means we lead a sedentary life style, working 9 to 5 in front of computer and is a potato couch. Simple explanation, rite? Not so...

Our desire to eat is govern by a complex brain activities called the satiety centre and hunger centre. Long time ago a bunch of scientist did experiments onto mouse; first they destroy the part of the brain believed to be satiety centre, thus the mouse always in hunger and no end to eating. In the end, they produced a super-obese mouse (pity the mouse). Based on the concept, some slimming medications were created so to decrease our desire to eat, which are of amphetamine-based.

Genetically modified mouse that knows no satiety.

Furthermore, our eating habit is also governed by our mood. We overeat when we are happy. During festivals, we (over)eat to celebrate. When we are sad, eating sometimes help to calm the mood and sooth the nerves. When we are promoted, feast. When we are demoted, compulsive eating. Chinese New Year, bigger feast. Our life has been surrounded by this concept of live to eat instead of eat to live.

The simplest method to determine whether you are simply overweight or obese is using a body mass index (BMI) calculation. The formula is:

BMI = (Weight in kilogram)/(Height in meter x height in meter)

For Asians, the body fat is more compared to Caucasians in similar BMI value. So we adopted a lower cut-off point for BMI. Normal range would be between 18.5-22.9. Below that is underweight. Overweight is a general term to grade a BMI more than 23. For a range of 23 to 27.4 is considered pre-obese. 27.5 to 34.9 is Obese Type I which has moderate heart and diabetes risk. 35.0 to 39.9 is Obese Type II. More than 40 (Obese Type III), you are running into a very high risk for all the disease of the rich people.

Other method of measuring cardiovascular risk is by taking a waist circumference. For men, the risk is increased when WC is more than 85 cm whereas for women, it is more than 80 cm.

So, Now you know where you stand. How do we tackle the problem?

1. Determination. Do you feel like you want to have weight loss? What is your target weight? How much to lose in how long a period? What method to achieve weight loss? If you have no answer to all the questions above, you are not yet ready. Buckle up, my friends. Determination is the first step to success and to maintain weight loss.
   
2. Keep a food diary. Record what you have eaten over 24 hours. Include all the main meals and snacks. Be honest to yourself. This will ensure that you aware of what you are taking, and not to be excessive.
   
3. Regular exercise. No one can help with this except you. As mentioned above, you need to have good output, so to tip the scale to a negative balance. Exercise for about 30 minutes for most days in a week. Studies shown that exercise help to makes you feels better, not to mention healthier as well. Some mild degree of hypertension can actually be controlled by exercise alone.
4. Food intake. Although some fad diets claim to help achieve weight loss, I personally don't recommend them. Stick to what is easy to attain, cost-friendly and most importantly, palatable. Don't try out fancy fancy stuff that in the end you cannot stick to your plan and all equal to zero.
5. Drugs. There are various types of medication used, but I will only discuss a few. First type is Orlistat, which is able to decrease absorption of fat from alimentary tract. Next types are appetite suppressant such as Sibutramine and Phentermine. Sibutramine not only reduced the appetite, but also help in increasing the metabolic rate. However, the use of this medication in hypertensive person must be cautious. Phentermine is amphetamine-based medication which has side effect of increase blood pressure and insomnia. Otherwise, medications that was proven to be ineffective are cellulite treatment, dietary supplements such as chitosan, fibre capsule and herbal preparations. Laxatives like slimming tea should not be used because of ineffectiveness in treating obesity. Usage of amphetamine, dexamphetamine and thyroxine is dangerous, and should not be used at all. Please consult your doctor about the choice of treatments.
   
6. Surgery. It is reserved for severe and morbid obesity where reduction of 50 to 100kg is required. Type of surgery includes gastric reduction by doing a vertical banding of the stomach or inserts a constriction bands around the stomach. Other types includes gastric bypass, which is to shorten the gut and induced malabsorption. Liposuction is not for generalized obesity, but to help getting rid of local fat or for cosmetic reasons.
   

Always ask for help. Ask your doctor about options available. They should be able to help you. You are not alone.