Heh. Some Random Thoughts.

1) WWDC starts in an hour. It's now 12.30 am. Damn it.

2) For good or bad, the fact that my wife and newly born kid are both in Melaka means that I'm able to train with a much higher frequency. I'm currently training every other day in between EOD calls. It might eventually be a stupid idea in retrospect but life is boring alone otherwise. And spending RM140 for training only at most 8 times per month (usually ends up at only 4 times per week there) is fucking expensive compared to when I was in Kuantan. Hell, if I trained at Bangi exclusively with the per entry rates it would be only RM80 per month!

3) 5/3/1 by Jim Wendler is probably the best training program ever for a general strength enthusiast. You can train 4 a week, 3 a week, and even 2 a week and still make progress. Let's just run the numbers:
Mid 2009 - My 1 rep maxes were:
Deadlift - 120 kg
Squat - never tested. 3RM front squat was 85-ish kg
Bench - 60 kg
Military press - 40 or 50 kg. I think. I didn't log my original 1RM.

Let's run the numbers now. Do note that I've not tested my 1RM's in more than a year. My best lifts are:
Deadlift - 145 kg for 6 reps
Bench - 75 kg for 10 reps. No spotters for racking/unracking.
Squat - 115 kg for 10 reps. No spotters for racking/unracking.
Military press - 57 kg for 6 reps.

And this progress is made even with on calls and real life stuff that make me lift only 2 times a week for the most part. Get the program here.

He doesn't even use the spotters in "just for fun" competition!

4) This is an extremely good read. From a man who's an accomplished powerlifter, head athletics coach, physical therapist, and a well of knowledge.

5) June 6 was the birthday of late Abah. Too bad he isn't around to see his grandson. Shit, not being able to see your father's last breath as you're stuck in your first on call as a junior doctor is a big blow. Sigh. No abuse from a consultant/specialist/medical officer can break my resolve in continuing as a doctor more than the circumstances and implications of Abah's death. Nothing can make you feel more like a failure. Al-Fatihah.

Valedictory Speech, Full Version

I've just finished my training session for the upcoming convocation with the IIUM Senate Committee. They said that it had good content and a good flow, but was far too long for the 10 minute limit. I'm posting it up, as I feel that the summarized version will never be as good. Note that I've not yet finished it, as the Arabicized stuff wasn't done yet, and the BM needs a lot of corrections. Done in like 2 hours before the training session, haha (!). We doctors do lack time you know (you know the typical doctor excuses).

Assalamualaikum and good afternoon to all.

It is a great pleasure and honor for me to speak in front of an accomplished audience. For today I am speaking not to an ordinary group of graduates; today I am speaking to a group whom can now be called professionals. I must take this opportunity to first thank my parents, my other family members and friends, my teachers of past and present, and as a doctor, my patients. Without all of them, I would not be as successful as I am today, nor selected to speak to address such a special group of graduates. For who I am today is a product of all those I mentioned above.

For you are a special kind of audience. You are an audience of whom standards are not just set by your teachers; the standards of your proficiency of practice is also set by your senior professionals, who have set high standards upon themselves. To graduate as a doctor, an allied health professional, or a lawyer means that there is no question regarding your qualification.

I still remember 7 years ago, when all of us were a group of students who had just finished the SPM examination, and were just about to begin a new phase as students in the Matriculation Center. At that moment many of the faces I saw were a mixture of excitement and anxiousness. We thought that SPM was hard. Would we survive the next 5-7 years of education? An education that is more specialized, yet harder. Nevertheless at the time there was always those moments of youthfulness. Late nights, last-minute studies, and of course the obligatory sleeping in class. This was the same regardless of the course undertaken by the students. Even Medicine.

Now fast forward to the moments right before the graduation. At that time you can also see the same mixture of excitement and anxiousness. But now it was for a different reason: We were preparing for the professional exams. An exam where you are judged not just by your regular teachers; but judged by professionals who are going to see you for the first time, and probably the last time. And this is what I mean to speak to a special group of graduates. You are graduates who are trusted not just by your own lecturers, but also by other professionals who have never met you before; who are convinced by your knowledge and skills the only time they saw you. You have achieved success, surely to be envied by others.

Kejayaan itu adalah sesuatu yang patut diraikan. Ini adalah kerana sesuatu kejayaan akan membawa kepada kejayaan yang seterusnya. Akan tetapi kejayaan kamu pada hari ini adalah hasil campuran pelbagai elemen. Ia bukan sahaja hasil daripada titik peluh usaha tuan-tuan dan puan-puan graduan. Kejayaan kamu pada hari ini juga adalah hasil daripada pengorbanan tenaga dan wang ibu bapa dan ahli keluarga kamu, daripada pengorbanan guru-guru, dorongan dan kerjasama rakan-rakan, sama ada rakan sepelajaran mahupun yang bukan, dan yang penting untuk diingati, para pesakit, pelanggan, dan sejarah atau pengalaman orang lain seperti kes-kes mahkamah yang terdahulu. Oleh itu, adalah penting buat diri saya bagi mengambil kesempatan ini bagi mengucapkan penghargaan terbesar bagi mendiang bapa saya sendiri di atas pentas ini, bagi Allahyharham Prof Madya Ayub bin Mohd Yatim yang meninggal ketika bulan Ramadhan al-Mubarak yang lepas.

It is only fitting to pay tribute to my father, who has given unlimited support in my endeavors to achieve excellence in IIUM. It was a rarity for him to ever say no to giving financial support for my efforts in buying all of However, my late father fell ill during my final year of studies with stroke, making life extremely hard for my family as a whole. He then was afflicted with a heart infection, which required heart surgery - on the day of my final professional exams. And yet my family and I persevered, and I passed my exams which I personally viewed as with flying colors considering the circumstances surrounding the end of my undergraduate life. But 1 month ago, ironically on the first day I was on call, my father passed away due to complications of his illnesses. It instantly had made the hardship of work, and the rigors of studying before that, pale in its emotional stress. The scolding of senior doctors and specialists, and the fatigue of long hours at work, felt tolerable with the death of my father.

The emotional burden of personal family illness, yet with the coincidence of becoming a successful graduate has taught me one thing, something that I wish to impress on you today: your success as a graduate today is to be cherished, but its elements are never to be forgotten. The success you achieve will thus protect you from arrogance, and keep you humbled.

And your humbleness in remembering your roots will keep our parents safe once they leave us, which they will. It is with this humbleness that we will remember to pray for them. To pray that they will be rewarded with Paradise, and saved from Hell. As the prophet once said, “One does not bring but 3 things to the Hereafter: beneficial knowledge, charity, and prayers of a good son.” But before we go further, I would like to remind everyone of a verse in the Qur’an”... I want to create a khalifah on earth...” To fulfill the principles mentioned in the above verse, we muslims must rediscover what it takes to become political and professional leaders. And the effort must be exemplified by none other than the IIUM graduates themselves.

It is important for IIUM graduates to not only be humble as I have mentioned above. IIUM graduates are bred in its system to be more than mere certification holders. We have to, and are educated to, to be more than followers. We have to be leaders. And the leadership displayed by IIUM graduates is not limited to our muslim ummah only, but also to the general public, or in terms of lofty standards befitting an IIUM graduate, leadership of present mankind itself. And better yet, the principles required to lead the ummah in the 21st century are easily derived from the Triple I-CE vision introduced by IIUM, that is internationalization, integration, islamicization and comprehensive excellence. By living the principles above, doctors, allied health professionals, and lawyers from IIUM will not be mere professionals; we will be professionals with leadership, who will unite the muslim populace and lead the world via the various avenues, whether it be academics, practice, or politics.

Internationalization is an important principle to be upheld if we are to achieve our ambition of being khalifah on earth. Muslims in the modern era are now segregated by nationalities and race. In the political sense, muslims are characterized by divisions, infighting, selfishness. And in the professional sense, muslim professionals are slow to not only develop, but to adapt new revised and better standards as regards to our professional development. Instead, we have left it to our Western colleagues, of whom the majority are non-muslim, to develop new ideas, practices, and guidelines which have increased the quality of the work of their profession.

In a different aspect, muslims now still stuck by sometimes questionable traditions. We have refused to see outside of our bubble, thinking that we are superior simply because of our religious faith as being muslim, or by misguided notions that some aspects of culture and tradition have their roots in religion when they are not.

Muslim professionals must be the spearhead of efforts to finally bring muslims to the forefront of the international arena. Muslim doctors, allied health professionals, and even lawyers must learn to be at the forefront of research and development, and to quickly explore new avenues of ideas that may help us improve the standard of healthcare care and legal systems. We should not hesitate to seek knowledge from non-muslims if it means improving ourselves. After all, best practice is best practice. And we must make example of muslim professionals who are among the leaders in their fields, but ply their trade in the western world, and thriving in it.

Muslims professionals from IIUM must also be at the forefront of efforts to educate the general public and modernize its thinking. The muslim professionals should make effort to educate the general public, to teach them than modern development does not have to, and should not lead astray from religious principles. Muslim professionals must teach the public to differentiate culture and religion; the latter is permanent, the former can and must change according to its suitability in modern practice. Muslim professionals from IIUM should be exactly that: excellent professionals, and faithful muslims. We must equal the accomplishments of the various muslim professionals of whom their names we keep on hearing as regards to the Islamic Golden Era.

To become a leader in the modern era, it is not enough to simply be a doctor, an allied health specialist, or a lawyer. The certificate that we have received today, despite of its significance, is not enough to allow us to lead the muslim world and the general ummah as a whole. We must seek out further knowledge, more than the knowledge of our practicing field. And all of this various knowledge needs to be united into one. Muslim professionals from IIUM must live the principle of integration.

A good example of this is seen in medical education. For clinicians of the modern era, it is not enough for them to simply be a highly qualified clinician in practice, or to simply be a Masters holder in a specialist field. Clinicians must now be proficient at research to become leaders of their field, that is to become research clinicians, to search for better practices and develop better technologies. To do so the clinicians must not just deepen the depth of their knowledge; these clinicians now have to broaden the scope of knowledge to the basic sciences of mathematics, the truly basic medical sciences: biology, chemistry and physics. But mastery of these fields is not sufficient; the knowledge must be turned into one, that is integrated.

Integration can also be seen in another light: that is integration of the general ummah. Muslims, exemplified by muslim professionals from IIUM, must be the example of integrating the ummah as a whole. In IIUM, we are blessed with a mixture of muslims originating from various countries. We even have non-muslims studying in this garden of knowledge and virtue. Our experiences and abilities to integrate with various peoples must be extrapolated to leading the muslim professionals and muslim populace as a whole, and then on to becoming political leaders of integration for the general mankind. Muslims professionals from IIUM must be at the forefront of education and goodwill to peoples of other faiths.

Muslim professionals from IIUM must not shun themselves and segregate into their own group. Instead, we must reach out to peoples of other faiths. We should provide service and education to muslims and non-muslims alike. And the responsibility is double-fold for us: to provide as a professional, and to provide as a muslim. During our practice is an excellent opportunity to preach regarding Islam to our clients and patients. And this preaching may not be direct; the character that we portray may sometimes be enough preaching in itself.

Integration and internationalization are interrelated with the next principle of Islamicization. IIUM graduates are ingrained with the principle that all worldly and religious knowledge is interrelated with each other. Secularization is the exact opposite of the what is taught in IIUM. Muslim professionals must change the current practice of their fields to reflect on basic Islamic principles. A good example of this is the field of shariah law, which combines the principles of modern law with basic Islamic rules and regulations into one field, which is already established by lawyers and led by IIUM. Other good examples are the halal food business and Islamic banking. And there are many avenues for muslim health care professionals to contribute to health care. The most obvious of this is medical ethics which I want to talk about.

Medical ethics is currently led by the Western world, based on mostly ethics based on human thinking, which can be wrong. And the western world is itself segmented, with those who believe and those who do not believe in divine concepts. This is where muslims have a great avenue to contribute. This is because Islamic principles of the world and law are based on permanent concepts: the revelation via the Holy Qur’an and teachings based on the Hadith of our beloved prophet Muhammad s.a.w. Because of this, medical ethics based on Islamic teachings would thus have more permanence and acceptance, as basic Islamic principles are true regardless of the passage of time. By improving our practice by integrating fields of professional practice with religious teachings, we will be following in the footsteps of the Golden Era researchers who pursued knowledge of Graeco-Roman origin and related it with Islamic principles to develop new fields of knowledge for which the muslims were the leaders and not mere followers.

To live by the previous 3 principles stated earlier, muslim professionals from IIUM would be living by another principle of IIUM needed to lead the muslim ummah and mankind in general for 21st century and beyond: comprehensive excellence. For to be leaders in an age with increasing populace, increasing political dynamics, increasing numbers of specialized academical and professional fields, and increasing technological advances, there is no other way other than to make effort to be the best: to be the best doctor, the best husband, the best father, the best son, the best neighbor and the best leader. This is because your deficiency in one area may ultimately hinder your role in another. And if you are deficient even slightly in a very competitive era, your leadership role will be taken by another. It sounds hard; no mission ever is easy.

But IIUM has taught you well. You have been taught to become excellent professionals in your field. You have been taught to become excellent muslims, who integrate knowledge of the islamic teachings and modern fields to develop knowledge more than the sum of its parts. You are taught to become one who integrates with the populace and others of your profession. You are taught to become one who seeks to be excellent in all aspects of life. You are a professional, an IIUM graduate.

Now go and make us proud.

Thank you. Assalamualaikum wbt.

Thoughts (July 24 2010)

1. It's back to reality pretty soon. But then again, the post exams was never a holiday for me. No honeymoon, no traveling, none of the stuff people do before starting work as a houseman. Every day, it was 4-7 hours of driving. If you think driving is not tiring by itself even though it burns no calories and chronically breaks people's backs, I'd love to have you as a personal driver.

I had to survive on pretty high doses of caffeine. There were several times when I had to just sleep in the car because of severe fatigue. Once my wife and I had dinner at 1.30 AM with work on the next day (I cooked of course, she was already fried from work and slept until food was ready). The day was spent helping my mother with errands/Abah's health issues. The only thing keeping me sane was the progress in the gym, which I could only go at night and ended up with coming home late, exacerbating my caffeine super-dependence. For references, to survive the induction I drank almost 6 cups/day of coffee/tea. That equaled 2 strong cups of coffee from Dunkin Donuts every day. I also kept my typically high levels of reading during the holidays, which at least kept my mind a little bit sharp. No studying though.

The recently ended induction program for housemen was supposed to be a holiday. But then I ended up as the participant leader. Luckily, other than an incident of a "lost" laptop and handling money-collecting duties, it wasn't too hard. But the chance for a mental break was lost. And housemanship starts next week.

I really envy the people who have been having fun during the holidays.

2. Next week I'll start work at HKL. Will it be that hard? I'm really not sure, after feeling exhausted already before starting work. Maybe it'll be the same level of tiring life as now, but in different ways. After all, I did say that the medical exams were harder and more stressful than the akad nikah (wedding vows).

What's really getting into me is the need to find a house. It's no longer feasible to go to KL every day from Bangi, especially if the aim is to reach there by 7 AM. The preferred places are Sentul/Ampang/Cheras as there are LRT stations there. A sleepy houseman is a dangerous houseman. But Sentul is super expensive, and the other two are jam centers on days that we drive. Other choices are Keramat & Gombak, but those options mean that driving is the only option to work. But as it stands, going to work from Bangi has been hell for both of us.

3. Will need to find another gym when I move. I'll make sure I get a lift, even during housemanship. But nothing will be as cheap as Kaki Gym/TLS/Try My Gym in KL. And it's utopian to get as many sessions as I could before, even during the peak of Abah's ills, when I did two a week, combing days into long sessions, sparing the weekends. Being strong has been quite useful and I don't want it to go away.

4. I'm a bit torn as regards to my future. My plan has been to go to a government clinic after housemanship, followed by pursuing studies in sports medicine. But there are several issues. With whom do I want to work? KKM, MSN, or MoHE? Do I want to be attached to a sport, or in a clinic setting? When the time comes, do I want to open what I have in mind: a comprehensive physical/sports rehab clinic, catering for sports and general public needs? I really would like answers.

But if all that fails, emergency medicine and internal medicine are fallbacks.

5. Lastly, Abah is back in the wards, this time for overwarfarinization, bleeding gums, INR of 8. Unsure of the cause though. Sigh.

Thoughts, Training (May 16, 2010)

Thoughts (It's been a while):

1) The LPT stretch from Gambang to Kuantan is dangerous in the presence of rain: T-Rex was skidding almost every 3-5 minutes.

2) An interesting quote from Harry Selkow to me:

"The quickest way to get strong is to be the weakest guy in the gym." I've learned to create my own ways to avoid a "jaguh kampung (big fish in a small pond)" mentality. For example, I always look at lift videos in the Internet, not really to humble me, but to motivate me.

MJ used to lie to the media that opponents smack talked with him, and admitted that he lied when he retired, with the intent of firing himself up.

3) An even more interesting quote from Michael Jordan when he was told to emphasize teamwork:

"There's no "I" in team, but there's an "I" in win."

4) People need to have a winning mentality. Standards must be individualized. You don't tell Federer to be grateful whenever he became second best to Nadal; hey at least he got into the finals. You don't tell the same to LeBron James when the Cavs just lost to the Celtics. When your potential is much more, why settle for less?

When I told Umi that I was close to getting a D for O&G, her response was to actually scold me (and my fiancee) for going back every weekend!

5) I've been feeling that I am very lax in preparing for the Professional Exam this Friday. Not spending much time studying, and more relaxing. No pressure for the most part.

This reminds me of SPM, a time in which Abah and I got into a very heated (understatement) argument, and a time in which I was even more hot-headed than I am now. Abah was pressuring me to study while I was home in between papers. I wanted to relax and take my time to read in the middle of a stressful exam period. The trigger was when he kept pestering me to come back after prayers while I was talking with friends. Hm...

6) Speaking of Abah, he and Umi are currently back to the general ward. Atrial fibrillation secondary to CAP. The neurologist said that there's probably new recent stroke(s), although there's no functional signs other than generalized lethargy. I guess the echo tomorrow is for that. Thanks for the wishes from everyone.

7) I'm finding that everyone loves my massaging skills. Maybe I should learn Active Release Technique (ART) or Graston (gasp!).

8) Hm, I can no longer borrow Abah's pants: my thighs have become too big.

9) I don't understand why casual gym goers waste their money with single joint, isolation exercises and getting no visible changes after even 1 year. Unless you can bench 100 kg (I can't), squat 140 kg (not tested yet), or deadlift 140 kg (yes), you have no idea imitating routines of people who spend at least 2 hours every day for 6 days a week with the help of assistance and are already fucking strong in the first place.

Sure, it's your choice, but money and time is precious for those of whom going to the gym isn't no 1 in their lives.

Training:

Since I'll be getting married soon (27 June, Bangi Golf resort - bookmark that date, invites will be sent out when they're ready), I'm going to start fat loss. It's time to dial in the diet 100%. I'm aiming for (generally) normal strength training via 5/3/1 3 days a week, with heavy conditioning on the same days + one. Every other day except 1 day per week will be filled in with general "light" conditioning, probably with Turkish get-ups.

Diet will be carb cycling. Previously I still took carbs on off days. Now it'll be carbs in morning and pre-training only on days with heavy conditioning, and no digestible carbs on off days. The aim is 1-2 kilos a week.

Soon I will also be going back to Bangi, with no lifting partners. At that time I'll have to reduce again my lifting maxes for the bench, which is my weakest lift relatively.

In the mean time, I did have a good deadlift session last week: 131 kg kg for 7 reps.

Thoughts, Training Log Until March 21 2010

I haven't written in a while; not enough time.

Thoughts:

1) Living in the fast lane, stress can either bounce off of you like a slab of concrete, or deliver blast through you, like a slab of concrete. Usually for me it was more of the former, but yesterday it as certainly like the latter, due to multiple stressors finally getting into me.

I need to keep my legendary temper in check: I think I punched the wall almost 10 times yesterday, hard enough to make people notice. The skin at my knuckles aren't hyperpigmented because of hemochromatosis, you know.

2) My aunt got operated for a "ruptured" appendicitis, but the operation was laparoscopic, so it shouldn't have been too bad. Get a good rest Umi Dah.

3) So far I'm finding that I need to do a lot more to get myself ready for Pro, especially now that the date has been pushed forward. And I can't enter the wards to boot. But with the current schedule and stress levels, I'm not sure how I'll manage to fill the hours in. With my current "intellectual abilities" I'm guessing that just 1 hour to study O&G and another to study for Pro consistently every day would suffice. Another would be to study 1 1/2 hours for Pro (which I've not started on my own yet, only group study), and depend 100% on bedside teachings and other "classes" (including on call sessions with 3rd years) to prepare for O&G (which was exactly what I did for internal medicine, and still got me no 2 in the group). We'll see which path I follow, which depends a lot on how well I cope with the stress.

But I want another distinction, for O&G and Pro. I want the money from the MMA award (though I haven't registered as an MMA member. 1K will help out a lot, especially with the internal drama in the family (not just Abah's illness).

4) Speaking of Abah, he has been talking a lot more, which is good. This morning he also started trying to regularly walk without his walking stick. But there's a lot more training required especially regarding his speech, and dealing with his upper limb spasms while doing ROM exercises are very difficult: too soft and you won't be able to extend the elbows & fingers at all, and too hard and Abah will be in pain. But he's laughing more, and interacting better with guests, who are still coming non-stop during the weekends.

Thanks for the support.

5) Next week is Naufal's wedding, the wedding of a person I can truly refer to as a best friend. Congratulations. Hopefully I'll be able to come over, unlike the so many I've missed lately.

6) Some people have it so easy: you'd God damned better be grateful.

Training (writer's block setting in):

The b-ball underground tourney is less than a month away, and what is hopefully going to be a special day is another 3 months away. It's probably time to reel in the diet, get a good more cardio in, and hopefully still increase if not maintain strength while shedding some fat. People don't care how healthy you actually are, just as long as you meet others' interpretations.

Videos are up on my Youtube page. But one thing is for certain: my pullup strength sucks, and I'm very unhappy about it.

Thoughts, Training Log Until Feb 19 2010

I'm typing this at R&R Maran, taking the opportunity to charge the laptop...(T-Rex has no radio, remember?)

Thoughts:

1) This is the first time in a few weeks in which I decided to drive back to Bangi, with the reason being that I've an A&E on-call this Sunday morning. I had a nice chuckle when Syafiq asked me if it would be tiring to go back today, and back to Kuantan on Saturday midnight.

But I finally have the opportunity again to listen to podcasts. I tend to doze off straight away taking the bus, and with the iPod gone, lonely drives like these are the only time to listen to them.

2) Abah has been recovering remarkably since being afflicted with the stroke. He can walk very independently, but with slower progress in his speech and slower still with his upper limb. This has made it very difficult for us to care for him, especially with his "depressive state". Imagine at 3 am he'd suddenly go from the lower floor bedroom to the living room, on his own, limping, without "telling us". And since he can't sleep, he'd also suddenly get up just as we'd doze in the living room to go back to the bedroom. And of course 1 family member needed to stay awake and keep an eye on him because of this. His walking ability is now so good that we went out to eat, with him walking. For all intents and purposes, the walking stick is probably the only assistance device we need.

As for the upper limb, only the hand is making progress, in which there's more finger movement but still no strength. The shoulder and elbow are still limp. This is not surprising as it's around that area of the motor cortex that is infarcted based on MRI. As for his speech, he can speak a few more words with coaching by my lil sis Sarah. But you can't expect good development when she coaches Abah to say "Sarah comel" (Sarah is cute). Drama queen.

But there has been a lot of improvement in less than 2 months from being completely dumb and hemiplegic.

Along with the experimental hyperbaric oxygen therapy (which hopefully can stimulate angiogenesis to the ischemic penumbra based on anecdotal evidence), let's see if intensive physio and speech coaching can show neuroplasticity in action. Each hyperbaric session costs RM 300 a session (for at least 10 total sessions). But if helps with Abah's recovery to the point that he can work again, the investment is more than worth it. I'm not too worried about him recovering independence at all.

3) Abah is now pretty sensitive to temperature, and the current hot weather isn't helping at all. Imagine this: we set the living room air conditioner to 26 degrees C with automatic fan speed, with all family members sleeping together. By morning, the A/C is still on full blast, as we can't reach even that temperature. Even the tap water is warm without the water heater.

4) I'm still coughing, though not as badly as 2 weeks ago. The bouts are still severe, but reduced in the frequency of episodes. But the crepitations (lower to mid zone anteriorly bilaterally, coarse) still persist. In a way, I'm still hopeful that it's just bronchitis with superimposed bacterial infection. But the fact that the CXR showed bilateral bronchiectatic changes is a bit depressing. If it is tuberculosis (unlikely due to the location of signs), I'm hoping that the sputum I sent for tests would show results straight away; I only sent AFB twice out of 3 times so far. Then I'll be able to get the whole ordeal dealt with straight away.

But at least other than the sometimes debilitating coughing, I'm doing very well. No fever, no shortness of breath, no loss of weight or appetite (okay, I lost 1 kg, but gained waist circumference, so that doesn't count). The RP showed slightly high creatinine (125), which was expected as I lifted the night before. Hyperuricemia was expected (strong paternal history of gout). LFT was normal. I'll trace the sputum results next week (ample time to have them all done).

Functionally, I'm so good that after lifting on Monday afternoon, I played futsal on that night as well, and felt relatively fine. I'm still aerobically fitter than the gasping sisters who chased after Dr Ng during his short case teaching (hehehe). Seriously though, it has been exercise that's kept my airways clear; I cough more (and it's drier) during the non-exercise days. After I work out, I cough less, but whenever I do, all of the phlegm comes out, making me feel better.

I'm a bit anxious to look at the HR CT when it's done on the 5th next month. But it's more because of the fact that the exact cause of the bronchiectasis is still unknown.

And I regret not taking the H1N1 vaccine when it was available. Oh well, when the 2nd wave erupts in Malaysia I'll have to start wearing a mask again.

5) I don't know why, but I like teaching juniors more than studying. Throughout this block, most of my revision comes from taking juniors during my on calls (yesterday I teached them for about an hour and a half) and doing short cases and discussions. I love teaching juniors (in my "mean sadistic" way, which many, especially sisters in the same batch, don't like). I really haven't touched the textbooks or CPG's yet, which is alarming as internal medicine is one field where you need to read a lot, a whole lot.

But with Abah sick and now me "sick", I really don't have the motivation to study; I'm just cruising through the motions. Meh. Sorry Dr Azarisman, but I don't think I can fulfill your request and earn another distinction.

6) Talking of the sick role, I'm still a bit confused as to how much of a sick role I should have. I mean, I have clinical signs of illness (my crepts are so clear that I could teach my mother to hear them; colleagues and juniors have been listening to them too). But I don't look sick; lay men wouldn't know it. I don't really "deserve" to be absolved of responsibilities. It's like a gray area.

Nevertheless, since Abah's illness, Fiza has taken over posting leader duties (I only handle the short cases, badly) and Iwan taken over full leadership of the AGD. And both have been doing well. Thanks.

7) I've also gotten more and more jealous of others lately. This has been especially since we had to postpone my engagement to another date. I hate seeing others having it so easy to get engaged and married. Hopefully the wedding itself won't be affected, as it's 4 months away. But Umi's dreams to have a "lavish" wedding for her first child has been shattered.

We've been in a relationship for almost 7 years now. And I'm seeing others in a relationship for less than that and are now married, or very soon to be. Yes I'm jealous. But at least my girlfriend is now very much a part of family. With approval of her family, she stayed with Umi at Bangi and helped out especially with sending Sarah to school, getting herself a red punchcard every time. She did this during the most critical time, at which Abah was still in the hospital. And she outstayed Tok and Tok Ki in helping out. Is there really any way to thank her?

8) I've always wondered about how we should respond to hearsay. Some people make conclusions straight away. Some wait until there's concrete evidence. Today was the first time I got burned big time for deciding not to act on it.

Confirming hearsay is time-consuming, and thus I tend to block it all out. I wonder how others deal with it and why.

9) One thing I don't like about TM Gym is the music played. Imagine yourself entering the gym and hearing:

Suck my d*ck

Suck my mother-fu*king d*ck

(Repeat x3)

Followed by bastardized Cascada songs..

But I really have to salute the cardio bunnies who continue to ignore the really offensive stuff played at the gym, loudly. These are the makciks and pakciks, including Dr Alik who has become a regular of the elliptical machine. The sight of him training really hard while "listening" to "Suck my d*ck..." is priceless. I can't warm up for a minute without laughing uncontrollably due to the "distracting" songs played at this gym.

Abe has suggested throwing away Abg Mat's (the manager) mix tapes. But then again, I don't want to go back to hearing Taylor Swift while benching or squatting. So keeping the gym only for those above 12 is a good idea.

10) Initially, doing this blog was just to write down thoughts to share with others. Never did I think that it'd turn more and more into a diary.

Training:

Nothing much, the wrist is better. Have resumed pullups, and hence almost back to normal training as pre-injury.

Monday:

Deadlifts - Up to 110 kg x 9

MP - Up to 40 kg x 9

Pullups - 5 sets of 3

Followed by an hour of futsal that night.

Wednesday. Based on the inverted rows, I need to get my core up to speed. Heavy core training will need to be done next week.

With the time constraints caused by Abah's illness, I really don't know how to prepare for the upcoming B-ball tourney in April. Conditioning targets may be barely achieved, but skill training is for all intents and purposes is impossible if I go back home every single week.

Thoughts, Training Log Up to Jan 24, 2010

And so the verbal reports are much exaggerated, and assessment by yourself is always better. On the bus back to Kuantan (I left my laptop charger at home, yikes!)..

1. Case report:

A 50 year old man, a known case of DM for 20 years, migraine, AAA, ureteric stones (I know it's irrelevant) and recent history of CVA (with no disability prior to the new admission) presented with reduced ability to speak and right upper limb weakness. CT brain at the A&E did not reveal any abnormalities. The patient was advised for rest in bed in the ward. On day 4 of admission the patient suddenly deteriorated, with Broca's aphasia (inability to speak but understands input) and right hemiplegia. Urgent CT scan revealed slight hypodensity at the left frontoparietal region. Subsequent MRI revealed a watershed infarct at the left frontoparietal region. CT with contrast revealed contrast flowing into most areas except for the hypodense area mentioned earlier. A subsequent CTA revealed a complete thrombosis of the left ICA just distal to the bifurcation of internal-external carotid arteries. The right ICA is atherosclerotic but not stenosed. The circle of Willis was normal, and evidence of flow from the right cerebral circulation to the left side was present. Previous lacunar infarcts were present but not enlarged.

This was with a picture of atherosclerotic right and left ICA via MRA 2 months earlier.

2. The good news is that Abah actually survived the incident. Had the thrombosis occurred much more acutely (and hence without the good collateral flow) death was certain. At the time of typing he is surviving with blood flow to the brain coming from the left ICA and vertebral vessels only. The right ICA is certainly pounding in character. I'ved told my mother to not allow the artery to be occluded, ever. The bad news is the current disabilities: he can mention few words when "forced" (Sarah, Allah). His improved power is 2-3/5 for the lower limbs, 2-4/5 (depending on motivation/desperation) for the shoulder-elbows, 2-3/5 for the fingers, 1/5 (twitching is at least there) for the wrist. He has improved quickly due to the intense therapy. A lot of the bad news I heard earlier about him were related to psychomotor retardation from frustration, and just not wearing glasses (so he can't recognize stuff better). Otherwise he is much much better than how I feared. What Abe and I said to myself (I don't really listen to myself) was true: do the assessment yourself first.

3. Since rehab is a lot about neuroplascity, Abah needs a lot of motivation to keep on trying. He seems to resist Umi's efforts to get him to move, and hence that's where I come in. With me there, we've forced him to stand with a walking stick, keep on moving the upper limbs, walk albeit slowly, and speak. Due to him lying around, he's been getting multiple episodes of reperfusion pain (think folding your legs for a long time, then getting the pins and needles when you stand up), so I'ved taught him to sit and hang his legs first, letting the pain go away, then stand. I've also told him to keep the legs moving (and have others help the right leg) to keep the blood flowing and prevent reperfusion in the first place. From no power, to at least walking-shuffling with help in a week: pretty good. Talking will need more motivation and mental focus, so...

I've given him homework while I'm gone: walk 5 times a day, start every upper limb activity with trying to use the right arm first (mimicking retstraint-induced therapy), speak 1 new word a day, breathing exercises, and reading the paper. He doesn't like it, but it's for him. I'm a sadist. The only problem is that there's no time for him, as he's so popular and liked by friends, family and students, so the room's almost always full.

4. Those who know me well know that's how I treat myself and teach others: I'm very mean. And the simple reason is that the human body and mind is a fucking amazing thing. The ability for learning, readaptation and compensation is pretty good. Hence why many hate it when they ask me for help/coaching: ask Coax how it feels like to be doing pushups to failure to rehab the shoulder, Abe when slacking off on doing those squats with a light load, or juniors when asking me q's (I ask them back to lead to the answer). But it works pretty good, as it teaches the man to fish and overcome his own mental barriers to success.

5. Behind the seriousness of the situation, there was some humor. I'm bad with diplomacy, and it required Umi's diplomacy to allow us access to the reports and scans. I told Umi that Abah is a good candidate for at least a short case (with laughter from the staff nurses as well). And I managed to teach Faiz probably 30% of all he needs to learn about radiology. Even in a situation where Abah is ill I can see him with "medical" glasses. But that's just how I am.

But that's the nature of medicine: what is bad/painful for the patient is amazing for the student.

6. I'm getting fatter (can't train as often, and diet is not adapting to it), although my weight remained the same; there must be some lean mass loss as well. So I compensated with my lack of conditioning (I focused on strength) by walking up the stairs to the ward, at level 7. I even ran up the stairs this morning. 4 rounds in all, I'll do it again next week. But not at HTAA; the staff ward at UKM is air-conditioned.

7. Thanks for all who came by to visit, especially family members who kept pressuring him to keep trying to move. Some think of it as military motivation. Think of it as doing what's best for the patient.

Training:

My wrist feels good, but no heavy rowing is possible still. I've been pushing the work, as heavy training beats the stress way. This is despite combining 4 training days into just 2.

Good mornings - up to 63 kg x 14(?)

Standing DB presses - up to 35 lb x 16

Back squats - up to 67 kg x 14 (?) (I'm damn demented)

Weighted pushups - up to BW + 20 kg plate x 13

Seated cable rows - up to 100 lb (full stack) x 5 x 8 (these were brutal by focusing on not using my torso to compensate)

Penlay rows - these were uncomfortable when with 100 lb at reps 6 and more. I might focus on keeping it less than 5 reps.

I'll try the heavier deadlift, BP, MP work next week and test out further my wrist.

Thoughts, Training Log Up to Jan 17, 2010

I'm typing this while Shahril drives the car...(Racing) Thoughts:

1) I'm just exhausted, and not even the 1 week break after psychiatry posting has been enough. So many things to do and think about, so little time, and even less cash. I'm weary of driving almost every week, arriving late at night/early morning. With fatigue from the gym, the tiredness is felt in the form of soreness. With mental fatigue/sleep deprivation the tiredness is felt in a sense of never having enough sleep, and an inability to think. It's worse. And it's really bad when not even caffeine can help you stay awake during the normal hours.

2) Abah got warded again, with possible Broca involvement; nevertheless the doc's said that there are no new lesions. The problem with his condition is that his symptoms fluctuate; one moment he's fine, another and he feels "blank" and can't speak, with right shoulder weakness (compared with predominantly lower limb involvement last time). He looks depressed at the times when he can't articulate complex things. He can still say simple sentences slowly when he enters "relapse". During brief "remission" periods, he's the same as premorbidly.

3) When you're a medical student, the fact that you can't look at the case notes is distressing. Appreciate the opportunity when you could look at it. At least I could ask for the figures in the investigations from the kind nurses at Wad Warga HUKM.

4) Due to the fact that Umi is caring for Abah, there's no one to take care of the younger siblings. Umi just asked my future wife to help out, bringing Sarah to school for at least the next 2 days, and might even have to sleep over at the house in Bangi. Talk about "kahwin sebelum nikah" ("married before solemnization"). At least she'll be able to use the car instead of the motorcycle.

5) Being the first son and grandchild (on my mother's side) to hopefully get married means that the "lavishness" of the plans is out of proportion to um, me. If it was up to me, I'd be wearing my old Camel shoes, without socks of course. I'm a simple man. And the hantaran would be books of course, my preference being historical non-fiction.

6) A rational discussion will beat rhetoric every time, but it will never win the votes.

Training:

My wrist feels good, Abe is stronger than ever, and Coax can actually paint his house without shoulder pain!

I'll still be using alternative exercises in place while I transition my training to that before I injured my wrists.

Monday - Good mornings, up to 60 kg x 8

Tuesday - Standing DB presses, up to 30 lb x 16

Thursday - Combined 2 sessions, in view of having to go back during the weekend. Squats up to 63 kg x 12, pushups up to bodyweight + 45 lb (plate) x 12. Had a hypoglycemic event afterwards.

Since my wrist is getting better, I'll start empty bar work so that I can hope to lift much heavier weights next month.

Not a Happy Person

Just as lifting was among the few good things that was good in the past few weeks, I got injured, enough said. Bilateral DRUJ strain, with the gym conditions being a factor; my training partners stopped early due to the extreme heat and humidity (no A/C at the free weights area). Hint: driving on day 2 of injury made me scream and cry in pain, relieved by copious amounts of ice. I'm much better, but in no shape for lifting.

Turns out that Abah had a lacunar stroke from bilateral ICA artherosclerosis (from the MRI/MRA). At least he's now back to almost previous activity, just some slow walking, but walking is not a problem.

I've been going back every week this whole posting due to Abah's condition earlier, my dental appointments and the intermedical school sports competition (more on that below). I'm chronically sleep deprived, my sleep cycle is completely screwed and led to caffeine dependence, which led to a vicious cycle. I'm slowly withdrawing.

I can't believe I drove all the way to Bangi to participate in 1 round of tug-of-war, as it's done playoff style. And we lost due to bad turf. More sleep deprivation.

My modem has given out on me, leading to a complete waste of money with Celcom 3G. And more money was just spent to return to being online.

I don't know shit about psychiatry, and exam is in 1 week.

The only thing good now is that I've an interesting new military history book to finish reading, and that I'm f*cking my enemies playing Rhye's and Fall of Civilization mod for Civilization IV.

Latest lifting stats:

Deadlift - 115 kg x 10

BP - 66 kg x 12

Front Squat - 77 kg x 12

MP - 45 kg x 9 (on day of injury, after resting briefly after the accident; thank adrenaline)

Thoughts, Training Log Up to Nov 28, 2009 (with video)

Thoughts:

1) Abah is doing well. His diagnosis has been changed from migraine paralysis to mild stroke. Edema was noted at the left region of the brain only on the second CT (at readmission), consistent with right hemiparesis. He's now at home, and can now walk at adequate strength but with some persistent tingling, is smiling again, and has an excellent chance of recovery provided he's diligent with the physical therapy. He was told by the neurologist that it was due to his chronic diabetes (microangiopathic I guess).

I'm still wondering if it's migraine stroke, as he still has headache at home as of now, although the neurological deficit has stabilized. We're planning to have the MRI/MRA at a private center as the queue for the MRI at HUKM is at 1 month, earliest.

2) I probably shouldn't question the knowledge of a professor in neurology, but I'm still wondering as to why he's been prescribed sumatriptan at a high dosage despite having his diagnosis as mild stroke, not migraine stroke. This is added with the fact that sumatriptan is contraindicated even in migraine paralysis, much less TIA/mild stroke. My worry has led me to withhold Abah from the sumatriptan even though he still has a headache, for now we're relieving him with PCM and Ponstan. So far, it's working enough.

The whole ordeal with Abah has reminded me of one thing. Those who have not entered family medicine will learn it, those who have passed it must not forget it: never ever forget to tell your patients the plan when discharged. Patients must know when to come back.

3) I've been very slow in learning psychiatry; too slow in fact. And still with no case for the write-up. I should be worried.

4) I've been rethinking the times when friends asked me whether I would be able to maintain my work on fitness when I become a houseman. Then, I answered, "I'll just go on maintenance to keep what I've achieved". What I should have added was, "If we're not going to start because we're afraid of having to stop in the future, we might as well stop living. It's rare that we get to do something from our youth all the way until our death. Probably 99% of things in life has a start and a stop. Just do it."

5) I've uploaded part 1 of the Raya Haji BBQ at my house, is uploading part 2, and will probably upload part 3 tomorrow. Not for the easily offended; you have been forewarned, hehehe. It's the last before I become a houseman, the last before Naufal gets married, and probably none will be organized next year as the Aussies won't be here and unsure of whether Hamzah will be back too.

Training:

Training went well, except for 1 thing: deadlifts, Penlay rows, and front squats+military presses on back-to-back-to-back days have annihilated my back, especially considering the "max" nature of last week. I'm currently having back spasms whenever I stand still. The last time this happened was during my basketball days (think the defensive position with poor posturing). Luckily next week is deload, and I'll get plenty of rest. Results:

Deadlift - 117 kg x 7 (11 kg PR from 5 weeks ago)

Bench Press - 71 kg x 7 (3 kg PR from last week)

Front Squat - 81 kg x 8 (+1 rep, 4 kg PR from last week)

Military Press - 44 kg x 7 (5 kg PR from 5 weeks ago)

All in all, very good. After the deload I'll shift to a 3-day per week schedule, so that deloading would fall right on break after exams. I have also bought a lifting belt for use with my top sets, I think I have earned the right to use one, considering that I'll be deadlifting 120 kg's for reps; when I started with 5/3/1 120 kg was my max.

As regards to the log,

Monday

Tuesday

Wednesday

Friday - Pistols (3 x 7), Paused pushups (3 x 12), Front plank with salutes (3 x 12)

Saturday

I can't get enough of this video. Have a happy week people!