Friday, 20 July 2018

Hydrocephalus, Kawasaki disease and Glycogen storage disease

I examined a child with Glycogen Storage Disease Type 1, he was a six year old child, at first he was a bit scared but then slowly I gained his confidence and it was an exciting moment for me. So in Glycogen Storage Disease Type 1 the body is unable to efficiently make glucose and thus the body makes another molecule which is glycogen, now the excess glycogen is stored in liver and kidneys which causes enlarged Liver.
He wasn't vaccinated for any of the infectious diseases, had a swollen belly, his skin was dry and coarse and he had dental caries. The dry skin was due to being malnourished.
I reached to the abdominal examination and for the first time I palpated an enlarged liver and spleen, then I practiced again for a few times till I gained some confidence that I was doing the examination properly. At first that chubby little kid wasn't comfortable but slowly he lost the anxiety and was very cooperative. That was the exciting part.
Then later on, we were in the Pediatric ICU where there was a case of Kawasaki disease, the patient was a 5 year old girl, she had a high grade fever, conjunctivitis, rash all over the body and cracked lips. That's all I could observe since it wasn't my case I didn't do the examination but since the child was very irritable it was very difficult to do it and I would have a very hard time trying to do it if I was presenting the case. After the case presentation was finished, there was another case in the ICU, the patient was a 6 month or a little older, I don't remember the exact age, this little kid was suffering from hydrocephalus, so here the head is enlarged due to excessive cerebrospinal fluid, the doctors had placed a shunt which would transfer the excess fluid from his brain to his abdomen,  now the child was going in distress. The mother was siting on a chair near the bed and she was crying, so much that you could feel the pain she was feeling, her husband and relatives were trying to comfort her but being a mother isn't easy and one can't understand the pain no matter how much one tries. This connection is magical and divine.
That's all for now.
Time to sleep now!

Wednesday, 18 July 2018


Concepts are the foundation on which you can build your dynasty, if the foundations are strong you can make renovations along as you please but if they are weak, you'd need to rethink about it and if you continue to renovate the dynasty without a solid foundation; everything will collapse.
When you are learning something, do not memorize but make concepts. Not every instructor focuses on making and strengthening concepts of their students, most of them never bother.
So you are left with sentences to memorize in order to clear the exams and once you're done with them, there's isn't anything retained in your memory.

Once concepts are made, different situations can be dealt with by placing the variables and assessing their consequences. for example, if you let this sink in that having stress in your life leads to different changes in your behavior, your personality and your interactions then you can focus on how and from where stress comes in your life. If you think in a uni-direction, you won't be able to comprehend what variables are bringing the change in life. For example, if you only think that work brings stress in life then you're not acknowledging the stress that's brought into life by your social life, your personal life, and your finances. If you think with a multi direction mindset and follow the concept that stress will bring changes in life then you get on a hunt, locate the stress promoting factors and work on them but if you just focus on a single variable for example if you consider that only work brings stress in your life then once you've sorted out your work stress, you'll find that oh something is not right the stress is still there; then you start working and find one more reason and again the cycle repeats. Your concepts weren't made and you had to start from scratch again and again.
Concepts are like independent variables, they effect the dependent variable but the dependent variable is not able to effect the independent variable. The actions you choose to take in your life are dependent variables. Taking another look, stress leads to changes in your personality, your behavior and your interactions, it is an independent variable, meaning it brings a change. Now that change is an action which you chose to take, meaning it is a dependent variable. It could be a positive change if your concept is strong that stress leads to change and if your concept about stress and its effects is weak then it will be a negative change. It's bend or break. Nothing else.
Drinking too much water in a short amount of time can be fatal.
Drinking water isn't bad but too much of it is bad.
Concepts are the key!

Tuesday, 17 July 2018

Learning styles, self confidence.

No interesting experience at Ward to talk about today but I thought of interesting ideas to write about

Two months or more ago there was lecture of medicine by a professor, in that lecture he talked about learning style.
Since every individual is different so their own learning style is also unique and it has a blend of varying proportions of different styles, for example I rely heavily on aural and visual aids for keeping a hold of something in my memory. If I don't follow that approach, the learning is very slow and tiring for me and there's no fun in that.
Divided a class into smaller batches let's the instructor manage an interactive session and lack of confidence was the main thing which held me back from participating in these session but with time I realized that this type of learning is more rewarding and it makes learning an absolute pleasure. As it allows you to think and gives you a chance to answer, it slowly helps you buildup the confidence.
Confidence is necessary for every step you take, if you're walking on very thin rope over a 10 storied building, you've made it half way through but suddenly doubt takes over and you lose your confidence and boom you're down to the ground.
I like to think of life just like that, so unless you find a way to undo that doubt which arises to grow powerful enough to take over your confidence, you will find yourself falling to the ground again and again; fall once, fall twice but don't make it a habit.
Know more about your own learning style, it is a very unique learning style, learn about it and then use it to your advantage and sometimes it's hard to focus on yourself when the efforts don't really repay in the short run but keep going on and you'll find the reward. that is what I keep telling myself, throwing a wrong answer in the interactive session is not a crime but not learning from those mistakes is a crime.
Evolve yourself, learn yourself, breathe in confidence and breathe out the doubts.

Monday, 16 July 2018

A Monday; Contraception and Spinal Muscle Atrophy

I made it to the lecture hall just in time for the Gynecology lecture, lucky me, things will make sense now. I was late for the first lecture so that one was a miss.
The topic of the talk was "Contraception"
This would be interesting as the topic is greatly important not only cause it's a FAQ in the exams but because it is a human need. Anyhow from the topic I remembered how much of an ambiguity surrounds this topic, when should it be used, how should it be used, when it shouldn't be used and why should it be used.
In the Pakistani setup, most of us never have "The Talk" given by our parents and the basics of human reproduction is usually revealed by a friend who has heard about it from someone else, perpetuating this cycle of "information" then slowly the "knowledge" expands. Even though from puberty to adulthood the journey has completed, still the "decency" of this society will never let the parents inform their children about what their body is going through during puberty and that this is a normal physiological process and talking about it considered a Taboo and in some families a sin.
So with that mindset almost all of us enter the med school, never actually focusing on how important this information is and how vital it is for the development of the society. Soon we are sitting in a lecture hall and this topic is being touched upon during a lecture hall, still most of us aren't serious enough, now I lay emphasis on the word "enough" cause most of us are interested in the topic but just for the sake of the final score on the exams. "That talk" is important cause if given by the parents it teaches you that it is a vital part of evolvement & development and whatever is concerned with it requires some action and thought. In short if parents break that Taboo and give their kids some information about it when they're growing up, it will yield a much positive mindset of the society. Contraception is a need now, look at the population growth rate and then at the resources, people need to practice it.
Then it was time for Paeds ward again, so back to the hospital. I did a cerebellar exam today, the mother of the child was telling of how much stress she has been recently, being at a hospital in another city as she was tending to her sick sister in law, she was away from her kids for almost a month or so. She said, I came back four days ago and both my kids were sick, so she brought them to the hospital and then she said she had barely slept more than 4 hours in these last 4 days. Mothers deserve credit but it's not only the children who should appreciate them, the husband should also appreciate his wife. After all, this isn't an easy job.
In the ICU there was an interesting case, a 6 month old child and she is a very beautiful child. Unfortunately she has a rare condition called Spinal Muscle Atrophy. This condition damages your motor neurons, you can say they are like electrical cables which supply the muscles of your body and without the proper electrical cable your muscles can't function, since they aren't supplied there is loss of muscle mass and it leads to an early death as they eventually lead to the damage of the respiratory muscle and the child isn't able to respire thus life ends there for that child. Overall, the life expectancy is 18 moths for the majority. It results from a genetic problem.
Her mother had a total of six children, two more of her children had this disease and they passed at 7 and 6 months of age, her other three children are perfectly fine. This woman was helpless, this condition has no cure, slowly the child is losing the strength in her muscles. Heartbreaking really. Every time I see something like this, it pains me a lot, may medical science progress far far and may we find cures for these life limiting and life threatening conditions.
I'd like to say that Appreciate the women in your life, your mother, your sister, your wife and your daughter whoever you have, appreciate them cause they are nothing less than magic.
Well that's it for the day.
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Sunday, 15 July 2018

Arranged marriage: A desi solution to all the troubles

You're living your life ordinarily and then suddenly you get to hear about people in your class getting married and this cycle then makes an appearance into the family and soon your eldest cousin is married and then its just a count down to your turn.
Being raised in the an Eastern family you have a set of rules and obligations, you choose what to study what your parents want and you become what your parents want, your own desires are mostly sidelined. For example, I had ZERO interest in becoming a doctor, I wanted to study economics but then I came into a med school and here I am in the final year and by this time next year I'll be done with almost two months of house job. I enjoy writing but still to this day I can't speak about my own interests in front of my family. But since I'm almost a doctor now, I figured I should be the best doc that my patients have ever had. That requires a decent knowledge, empathy, good clinical skills and excellent communication, working on those and will be much improved when I'm on the job. Luckily, I found some good hobbies to link my medical career with and the journey will never be boring and will always be full of rewards, satisfaction and happiness

So like your education, the choice of your significant other also falls under the decision of your parents. You can give your suggestions but the final judgement isn't yours. I have seen so many faces, which are unhappy, dissatisfied, lacking contentment yet trying to put up a fake smile. SO you're married to someone you may not like, who isn't compatible but you have to live like you're on a timetable, like a robot just to pass the time; cause of your family's respect. Satisfaction is never there. Then you reproduce and have so many kids, still your face lacks a genuine smile. There's this sorta cold war between the two of you, as your children grow this war deepens and soon your kids question is the whole purpose of life is to study, work, marry and reproduce. And then if your kid isn't into nice habits and hangs with the wrong crows, you think oh wait let's get him married and the responsibility will sort him out, well guess what. THE RESPONSIBILITY NEVER SORTS THEM OUT!
In the whole process of this arranged marriage, not one not two but multiple lives are involved and its a huge gamble, if it works good, you made the right decision but what if it doesn't work then what? Then the girl wasn't right, her family wasn't right and so many things you add. But you wouldn't realize that maybe just maybe it wasn't the right decision. Blame the girl for the easy way out.

I used to be fascinated by the concept of marriage and how it's supposed to bring you all the joy, lol that was some time ago, now I think this arranged marriage concept is literally killing contentment in the lives of so many people. I wouldn't want to put someone through that trouble and then end up deceiving her, have kids and then leave them stuck in between the cold war, no that's wrong on so many levels. You have one life, so you live it with contentment and let your marriage be the source of gratification and not of deception.
This is a general idea which I've observed and its a lot common than I thought, I don't know about the West but thats the way it works in the east. Arranged marriage the solution to everything. Sarcasm intended.

It's nice to sit and have a cup of tea, talk about something interesting, something productive with someone, someone who's the significant half, some day perhaps, not today.
Well wherever you are and whoever you are Miss, I hope those talks are as good as I think of them and may it be more of a conscience one rather than an arranged one. 
Don't settle for a proposal just cause your family pressurizes you, settle for someone who's compatible cause you have to spend that life not someone else.  Think wise and lastly marriage is not the solution to everything! Change your mindset, its not a single life, its multiple lives which will be effected by whatever good or bad you choose to do while in that relationship

Saturday, 14 July 2018

Accepting and Understanding rejection

Rejection in any form is like being caught between a rock and a hard place, so you're in a situation where you have to make a choice with both the possibilities being equally unpleasant.
The origin of this idiom is linked to Greek Mythology. In Homer's Odyssey, Odysseus must pass between two mythical sea monsters Charybdis, a whirlpool, and Scylla, a horrid man-eating, cliff-dwelling monster, both these sea monsters are within reach of another so if you're trying to steer away from Scylla you'll find yourself closer to Charybdis and vice versa. 

So your work got rejected, you got rejected from a job interview, you didn't get into that college or university you wanted to go to, someone you liked rejected you and so on; so you have two situations now either you just give up and go back or you can learn something from your efforts and give yourself another shot. Your work got rejected, okay now go and sit at a table, study it as critically as you can evaluate, look for any vagueness, any sentences which create confusion, any mistakes which might have played a part in getting it rejected and ask for a reason. There must be a reason that your work didn't get through, maybe you didn't clearly specify the methodology of your research paper or the results were not written properly or maybe your study design had some major flaws, get the reason and work on that. It's not easy to go back to the whiteboard again and work at it again but it's the only choice to improve. If you have spent a genuine effort, I would say don't give up on it, work on it and improve it, you spent time on it and it deserves to be appreciated and with the right amount of polishing you can get through. So, evaluate your own work critically, find out the mistakes and don't forget to ask for a reason. It wouldn't hurt anyone to give you a reason, if there is one. But if you're trying to submit a research paper on medicine to an electrical engineering journal, that is just not happening, it's like asking a fish to climb a tree. Wherever you submit your work, make sure it is the relevant authority, someone who teaches English Literature most probably wont have an understanding about the conduction system of human heart. 
Rejection by someone you like, well first off you need to understand this, you're not special for everyone who talks to you. Sure, we all like to think we are but we aren't special for everyone, most of us are special to people and the number of those people can be counted on your fingers. What you may be thinking, may not have even crossed the mind of the other person, its like sitting in a room blindfolded and you start to assume that there's a lot of food just cause you can smell that pizza, pasta, nihari, payee, spaghetti, burgers and what not, and when the lights are turned on, you see there's no food in your room just that the window was open and the people next door were having a party. The blindfold is what makes us think okay we are special, you're not. Take it off, look at the world then and you'll be a lot lot happier. Without the blindfold you won't be bothered with 99% of the rejections so you save yourself a ton of trouble. 

When you find yourself stuck between a rock and a hard place, you can either stay there or you can proceed ahead. To proceed ahead, you have to accept that rejection, accepting is the first part, then you sit down and evaluate where the mistake was, with a clear mind you plan and proceed. I like to relate accepting rejection and proceeding ahead to the rock cause you can climb a rock and staying stagnant is what I like to correlate with a hard place, the hard place won't become a soft and comfy mattress.

Friday, 13 July 2018

Inside the wondrous world of shopping for clothes

Thought I should put up a different type of post today, it's an experience which I always get to relive every time I accompany my mother on her shopping trips.
Whenever we enter the stores, the first thing which amazes me is the number of colors and the designs, like you have so many shades of blue, red, green, yellow and the list continue then the designs and the type of cloth. I need time just to digest the amount of colors and the variety they have there. All that glitters is not gold but lol they look so shiny and so nice, I could sit there and go through all the designs and at the end of the day still I wouldn't know which one to choose.
The salesman shows the unstitched clothes, so if it's a three piece there's the dupatta (worn over the shoulders or on the head), the kameez (shirt) and shalwar (trousers). Usually the fancier the suit is the more you can expect to find embroidery on there, different types of lace, designs printed on the kameez and the dupatta and usually the shalwar is plain. If it's a two piece suit either the shalwar is not there or the dupatta is not there or you can just get the kameez too.
These days they give you a picture of how the suit is supposed to look once you get it stitched and it's like if you can transform these three and some laces into that, it's just magic.
The transformation is absolutely magical, from just different pieces and parts to a whole suit but what is truly magical is when they finally make their mind up what to buy.
And to the sales dudes in those shops, you guys have some patience and stamina, rolling and unrolling all that cloth and then packing and repacking and placing all those colors in sight so every guy who is accompanying is lost in the colors and all that, confused and dazed. Thanks to you guys now I know a lot more about female clothing brands. Khaddi, Almirah, Elegance, Aroshi, Gul Ahmed, Maria B, Alkaram, Bareeze, Nishat and so on and so forth.