had pdp today, otherwise know as pretend-doctor-program. we were assigned ward 5-, where we met out prof, this nice, senior doc who gave us the introductory lecture on the program. he gave us three cases, a fifty plus odd-job laborer who had a history of lymphatic cancer and had come in for swelling in his hands and legs, a thirty-something working professional whose nerves to the right eye went haywire and lastly, a boy our age who came in after fainting in school.


the laborer had come in several days ago after downing two bottles of sour plum (suan mei) juice in two days. he claimed that the edema in his limbs had nothing to do with the cancer, for which he had already undergone thirty sessions of radiotherapy for, and told us never to drink sour plum juice at night. of course we knew better and later we discussed the fact that no one had told him that the edema was related to his cancer. in a way, witholding such info from a patient seems cruel, but then again, telling him, an uneducated, jobless man who's draining his family resources to pay the medical bills, that he just might not have much longer to live would be cruel too. we were left chewing over that.


the other guy, whom i got to interview, was a chatty but anxious man. thankfully he was forthcoming and he spoke english! i feared i would get a hokkien guy and i'd be standing there mutely and needing rodney or someone else to translate! his sixth cranial nerve had gone first, so he experienced headaches and double vision. subsequently his third nerve went, so now his right eye can barely open. the doctors told him that they have not the faintest idea what is wrong with him, so naturally he's worried, but he's optimistic about getting discharged soon after all the tests are over.


the last patient we saw was this boy who seemed to have some congentital spinal cord defect that left him with the occasional fit and fainting spell. in fact he was brought in yesterday after fainting in school. he told us his doctor had recommended him an overseas surgeon to operate on him, but that his dad doesn't trust them, so they rejected the offer. in the discussion later, we concluded that it was most probably because they couldn't afford it that they turned it down; his dad is a bus-driver and i can't remember what his mum does. medishield does not pay or subsidize such expenditure, which is sad, and only proves once again, that money does talk.


compare this to the second patient, who has a stable job and seems to have bought medical insurance. it's obvious how a little more cash in your pocket and a wee bit of planning can save you from burning a hole in your pocket.

ugh, what a day. prof naggy started off by announcing to the whole level that group one, amongst other groups, hadn't done our discussion. what rubbish! we've already posted stuff for all three questions, and she said we hadn't started moving yet?! she even asked who we were, and when no one raised their hand (obviously), she went," oh, so you all are too ashamed to say who you are?" aw shit, this is too much. i spent over an hour searching for stuff yesterday and she says we haven't done anything? give me a break. i shan't post anything soon.


orignally planned to see 2046 this afternoon, but the fish was sick and i think we're all in a mugging mood this week, so didn't go. i want to watch shark tale! it's been ages since i last saw a movie, that was the terminal, i think.


took the opportunity to get a pair of shoes for pdp. my other pair has heels that are too high, don't want to tire myself out with that extra height.


best of all, prof naggy hasn't uploaded tomorrow's notes. well done. on the brighter side, we're going for some weird respiratory prac tomorrow, so i end early.

sitting in front of the comp and trying to dredge the internet for info on the effects of dunking, thanks to prof naggy(as opposed to prof shaggy), who's been nagging at us every lecture to put up something on the forum, otherwise she won't help us with the tuts. i can't find anything on dunking people underwater, but i'm getting tons of pages on how to dunk your oreo cookies in milk. what the hell.


anyway, managed to find some stuff. at least i got to talk to zj.

will have to wake up at the usual time tomorrow cuz prof stand up comic wants to talk to us or something. ugh. why? i need the sleep. it was so nice to wake up to a sky that was already bright, instead of trudging to the station under a dark sky.


and the it department should standardize a way of uploading notes on mednet or ivle. it's ridiculous to have the assignments up one week after the lecture or to have us search high and low for our notes. if conducting experiments means following a strict protocol, why can't something as easy as uploading one miserable file be difficult? then again, it seems that many of the lecturers have 'slaves', ya know, people to help them set up their presentation even though the cpu and cd drives and switches are all labeled. hell, one prof even needed help scrolling down on a page. and they should print notes for us. one by one, our printers are beginning to give up the ghost. then my fondest memory of m1 shall be printing notes with dear printy.

had a weird dream the other night. dreamt that we went for surgery lectures and suddenly i was given a surgery to do. i was like, wha? me?! and the prof went, yes you. i didn't even know what the surgery was about, and who the patient was. so i entered the ot and made the first incision in the chest. when it came to the sternum i tried to crack it with two long wooden spoons tied together with twine. couldn't, so i asked a guy who was just hanging around to do it. he cracked it, and the next thing i remember, we're operating on him on a five-foot way in chinatown. the people walking past were staring at us, so we decided to move him back to the ot. but we didn't go back to the hospital we'd come from. instead we went to one whose ots have never been used before to finish it up. here's the exciting part. i went off, but later was called back cuz apparently, the patient had gone mad. i ducked behind a wooden panel to try and call my dad (wonder why) and was attempting to open my clamshell phone without the patient knowing. told my dad, then later tried to look for the patient. found him, then talked to him. don't remember what i said but after a while, he did calm down, and my dream ended. weird.

biochem fa tomorrow, and we were just informed of an anat fa next week. woo. we don't even know if it's on thorax and limbs or just thorax alone. what the heck, we're still going for 2046 or manchurian candidate right?!

a post from the med library. hoping to get some stuff about cardio physio straight, i'm just so tired. am camping out at the table under the stairs. interesting place. think i should go back to mugging.


and i'm kinda toying with the idea of staying at pgp next sem, but i don't have a laptop.

my printer's still screwed. i keep getting the dialog box that says the printer isn't responding. just feel like stranggling it.


had the second part of the heart development lecture today. as i listened to voon's description of the cephalocaudal (literally head-to-toe) folding of the cell layers, i couldn't help but be amazed, and it's times like that when you can truly feel, assuming you usually don't, that there's someone who's planning all this. it's so wonderful and complex, all the metabolic pathways and stuff. i know they're tough to memorize, but if i pause to think how marvellous the fact that all these mechanisms are going on in every cell of our body, i feel strangely honoured to have the chance to study it, to have a chance to understand the depths and intricacies of the human body, to behold the miracle that is life.

i've no idea what happened to my other blog.


the panic is arriving from the distance. as the CA comes closer and closer, there's this nagging question as to how much i really know. hmm. and i'm so jealous of the people who will get to go to o&g/surgery/pediatrics wards for pdp. my groups going to cofm. what's there at community,occupational and family medicine?! ok, i shouldn't jump the gun, after all i haven't started my rotations yet, and i still get to go to sgh for pbl. it'll be endocrine next. not really looking forward to that, cuz i gotta do a presentation on the relationship of extracellular fluid loss adn the effects on blood pressure and cardiac output. hmmm.

all the crazy medical, biochem, physio and anat terms are bouncing around in my head right now; the headache's getting worse.

failed to mention that i made several errors on the f.a. really stupid errors. for instance i said that the trapezius does not take part in the abduction of the arm. gawd, this is embarrassing. i don't know what went through my mind, all i saw was this image of the scapula and the arrow showing the action of the serratius anterior, but no arrow for the trapezius. -sigh-


some shocking news:

NEW YORK (Reuters) -- The arthritis drug Vioxx, used by millions of people around the world, is being pulled off the market after a study confirmed long-standing concerns that it raises the risk of heart attack and stroke, the manufacturer, Merck & Co., said today.

"Patients who are currently taking Vioxx should contact their health care providers to discuss discontinuing use of Vioxx and possible alternative treatments," Merck said.

The company said it was withdrawing the drug following a review of data from a three-year colon cancer trial.

"In this study, there was an increased relative risk for confirmed cardiovascular events, such as heart attack and stroke, beginning after 18 months of treatment in the patients taking Vioxx compared to those taking placebo," Merck said in a press release.

Worldwide sales of Vioxx totaled $2.55 billion last year. Since the introduction of the drug in 1999, 91 million Vioxx prescriptions have been written in the United States alone. The drug is sold in some countries under the name Ceoxx.

Merck shares plunged 15 percent in pre-market trading after the announcement. Shares of Pfizer Inc., which sells two rival arthritis drugs, rose 5 percent.

"It's a major blow for Merck," said Sena Lund, an analyst at Cathay Financial. "It was one of their five key drivers for future growth."

Vioxx sales have been flat in recent years amid safety concerns. Clinical trial data have shown the drug increased the incidence of blood clots tied to strokes and heart attacks.

A recent study by the U.S. Food and Drug Administration suggested patients taking Vioxx faced a 50 percent greater risk of heart attacks and sudden cardiac death than those taking Pfizer's Celebrex arthritis treatment.

Sales of the Pfizer arthritis drugs Celebrex and Bextra have steadily grown as doctors have turned to those drugs, which have not been linked to heart attack and stroke.

The colon cancer trial was designed to evaluate the effectiveness of the standard 25-milligram Vioxx dose in preventing recurrence of colon polyps. Such polyps sometimes become cancerous.

Vioxx was used in the colon cancer trial because some researchers theorize that inflammation, present in arthritis, may be linked to colon cancer.

Merck said the heart attacks and strokes were not spotted during the first 18 months of the trial but became apparent later.

"Given the availability of alternative therapies, and the questions raised by the data, we concluded that a voluntary withdrawal (of Vioxx) is the responsible course to take," Merck Chief Executive Officer Raymond Gilmartin said.

Vioxx and the two Pfizer drugs are designed to block inflammation and pain as effectively as standard nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen, while causing far fewer ulcers and gastrointestinal problems than the older treatments.

The newer medicines block a protein called Cox-2 that has been linked to inflammation.

Merck said it would continue to market Arcoxia, its newer Cox-2 treatment that is sold in 47 countries. Approval of Arcoxia in the United States has been delayed by concerns among U.S. regulators about whether it poses the same risk of heart attack and stroke as Vioxx.

it's scary cuz my dad used to be on vioxx.

finally the week is over, and i can take a breather. don't really know why, but the f.a. we had yesterday was really important to me. it was if it was a c.a., so the two days before i really mugged for it; i even gave up singapore idol. maybe it was because i saw people doing practice questions in the library on thursday morning and was spurred on to do more, to make sure i knew as much as i could. i guess i don't really regret it, especially since if you know how i fared on the biochem f.a. at least i've the comfort to know that details of the upper and lower limb are safely stored away in a dark, musty corner of my mind and i've the peace of mind to move on to thorax.


on the downside, i fell asleep during the biochem lecture yesterday. felt quite bad about it coz the lecture is this happy guy who seems to think that the urea cycle is the most exciting thing in the world; he even let us listen to a song about the cycle ( sing urea! sing urea! Which set the people free!) and kindly let us know that a certain disease would make urine look like maply syrup, and my appetite went out the door.


just finished downloading the notes for the week ahead. this weekly ritual of downloading and chalking up megabytes on my restricted broadband account and then sitting by the printer and feeding it continuously is mind-numbing. and ink-wasting. can't they just print the notes for us? after all the school collects tons of fees from us on top of tuition fees. i really wonder where the money goes to.