Sudah lama tidak meluangkan masa bersama.Asyik terperuk di kerja dan pejabat aje.Muka dan minda sudah pun stress.Banyak beban tugas dan tanggungjawab yang telah dipikul.Begitu tidak seronok apabila menjadikan tekanan di fikiran.Sambil godek telefon,kami meneroka pelbagai tempat yang akan menjadi perhatian kami untuk di jelajahi pada masa akan datang nanti.Jadi pada kali ini kami bercadang untuk bercuti.Yes!!!percutian menarik….pulau atau luar negeri????
Memandangkan musim pandemik belum pon berakhir,kami merancang untuk bercuti hanya dalam daerah kami sahaja.Kerajaan juga sudah membenarkan rentas megeri bagi yang melengkapi dos kedua vaksin.
perjalanan pertama kami adalah sekitar kawasan daerah setiu.Banyak tempat menarik yang menjadi perhatian kami.
Tempat pertama yang kami redahi adalah
3.pantai rhu 10
zygomatic fracture,and right mandibular fracture for operation plan open reduction and intramaxillary fixation of right mandibular fracture via intraoral approach under general anaesthesia.
بِسْمِ اللَّهِ الرَّحْمَنِ الرَّحِيم…
Waiting for the presence of a small human being for many years is a hope for every couple who set up a household.
married on 22/08/2012 ,nad now almost 9years of waiting.
so,for the few years after married,me an my husband plan to do the sperm test on 2017 at pathalogy lab under private lab.
we decided to do after a married life for confirmation how the reproductive system both of us normal or in a bad condition.
after the result show,we need to refer to the specialist because we don't have sub speciality to translate it.
my husband was diagnose with azosperma(oligospematozoa).i don't tell him because don't want to make him sadness.so,we refered to the goverment specialist.the doctors tell us in medical term,so my husband don't understand but just follows the ordered as i am understand to the orders.
first step,we need to do the blood treatment for the blood investigation.blood examination of hepatitis B,and repeat sperm test for 2nd time.
the result just only 3mls of quantity of sperm liquid and no quality of the sperm show.
if i tell my husband now,maybe he is dissapointed.so i didn't tell him.
refers to the specialist,he need to taken profortil for 3months,30tbalet/months(rm350 cost)1tab per day.others medication is subectan/subecpro and healthy food to take is antioxidants.
for me,the doctor ordered to do papsmear examination eith inserted protoscope in lithohomy position,hepatits and syphilis test.medication is clomid tablet 50mg/day.the drug is blue in colour.taken D2-D7
taken D1 to D7 on menstrual date or to regulate the menstrual cycle because my period date irregular.
D2,-do the blood test LH/FSH for prolaktin (Luteinising hormon)
D21-to do menstrual blood investigation of progesteron.
folic acid each day for all of life till prengnant..
but 2017,we are defaulted for treatment.
We continue for ivf treatment.first of all we need to do sperm test again after long time not schedule for treatment.
Doctor prescribe pils duphaston.need taken D2 till D21 of menstrual period with folic acid.
CARA GUNA OPK
OPK hanya POSITIF bila Control Line lebih terang @ sama terang dengan Test Line (refer belakang pek OPK)
🌸Cd -cycle day
🌸Dpo-day past ovulation
Disarankan start opk pada cd 10 hingga jumpa hari ovulasi dan berhenti celup jika opk samar semula dan menjadi dpo1.
Step opk – puasa air 2 atau 3 jam dan test seawal jam 11pagi sehingga 8 malam sahaja.waktu hari tetap tak boleh berubah2 dan selain dari waktu tu tidak valid.
👉🏻Valid-11am -8 pm
👉🏻Tak valid- 8.01pm- 10.55
Cd tu bermaksud kitaran hari dari hari prtama period smpai la ke kitaran period akan datang.jika period datang semula..akan mnjadi cd1 smula bagi kitaran baru
Ovulasi adalah di hari mana betul2 subur dan telur dah get ready nak dilepaskan dari sarang menuju ke tiub.dan opk pula mendapat 2 line betul2 terang atau lbh trg dari biasa.. dlm sbln hanya ada 1 hari sahaja waktu proses pelepasan telur dari sarang telur wanita ke rahim.anda diminta bersama seawal 3 hari sebelum anda dapat mengesan opk positif dan selang seli sehari atau dua hari kerana sperm tahan 2 hingga 3 hari sekiranya dilepaskan didalam rahim.anda disarankan brsama seawal cd 11 sehingga cd 19 iaitu dpo6.
Dpo-day past ovulation👇
opk yang ditest pada esok nya akan jadi pudar semula tu bermaksud dpo1 terus stop celup opk…dan bersma sehingga dpo6 .dpo7 hingga seterusnya sila stop bersama sbb bimbang jika dah bersenyawa…janin yang telah disenyawa dan mulai terbentuk serta ingin menempel dalam rahim nnt jatuh atau bleeding kalau benar2 hamil.
Dpo 14 dah blh celup upt.sekiranya 2 line…anda hamil dan tahniah
- Period dan opk.
Cd9 -start opk
Cd17-opk dpo2 stop opk
Cd25- dpo10 upt samar
Cd26- dpo11 upt makin trg
Cd27- dpo12 upt trg lagi
Cd29- dpo14 upt kalau naik trg sgt mmg confirm
💥 digalakkan untuk celup 2x sehari jika OPK nampak semakin terang
💥 disarankan bersama sekerap mungkin apabila OPK menunjukkan hampir ke hari subur
👉 OPK 20 pcs
👉 UPT 5 pcs
After 3months taken,my period time was irregular and long menses.doctor diagnose with metrorhagia.so she prescribe others provera drug pils.
2nd times after 3months,the doctors ordered menstrual pils OCP (Oxyprogesteron and duphaston).Ocp 21pils /day start D3 of period.
Husband treatment plan is loss body weight with dietician refers,physilogy refer,and endocrine .need to reduce d/scan to 6.5mmol/L till 8mmol/L..glucose achieves with Hba1c results 6.5 mml for IvF.
Since pandemic covid19 happened,the tca cancelled over 2months.
It happened when Allah test us.
It happen since 23/8 till now..
Me,just taken vit c.vit E and folic acid.
Today.(11sept 1990) i got the phone call to continue with ivf plan
12/9/21 – 19/9/21 taken drug estradiol valerate 8am & 8pm (BD)
after taken this estrogen pills,i am period on same date.12/9.discused with specialist,taken medication as plan eventhough menstrual date.
15/9 taken blood investigation estradiol and progesteron.(d3 of period)
plan from othat day,i must taken a lot of vitamins and healthy food .research others experiences and survey the vitamin and mineral.using ig,fb,i joined the ttc group disscusion..
i do the research for opk test and ttc group guide.
20/9 tbs scan found polyp😔.on rt tube had 6 eggie,left tube 4eggies..condition ovary posterior to the back.21/9 gyneasvologist start wit gonal 250iu till 25/9.start injection/planner medication with cool box drug storage.
tapi 19/9 allah uji lagi..hso survaillance.alhamdulillah result kluar awl..ameen
26/9 or 27/9 repeat tvs scan x 2times and blood investigation for estradiol d6 stimulation
03/10 plan for taken embrio FET I (fertilize embrio taken/ivf start)
Myringotomy with mr easy
Such a name easy.. .my doctor today is dr izzi.
Troli and head light lay out.. camera head at the back of staff nurse.
Scrub kes myringotomy yang dah lama x buat kan. Nak recall balik
First at all we use set myringotomy.
The pt with diagnose i’m forgot, have a bilateral infectous at ear, moouth and tonsillitis. But not keen for tonsil as not consented with guardian.
First preparation of coz want system of telescope and cable..
When pt sedated, we make a ear myringotomy with myringotome.. Put grommet and suck the ear fluid… Take grommet with fine crocodile forcep. Sucker must have sucker tip with zoilner sucker..
For nose infection need fess set tubing and irrigation. Curve sinus blade and packing with morfat. 1adrenaline, 1cccocaine,and 8normal saline. Packed with 1inch ribbon gauze.
Mastoidectomy for study (my study case) 03/02/2020
On februari, my next aim for study more and more… For share more and more. If i’m wrong in writing, please nice to me…Kind to soft spoken. Okeyh!
Ent positioning.. Patient supine position.head Far away from ga machine. Microscope and burr machine at head.. Left side surgeon and marking, right side scrub nurse troli,left side sucker liner and diathermy. Also, celon probe or nerve stimulator machine,right side drip stand for irrigation and celon cable
pt came with 🔼 Left choleostomaPlan for op mastoidectomy and biopsy tissue
Beginning with preparing the instrument
1.set mastoidectomy, linen and proper lotion
2.midas rex (perforator and bur)
3.microscope tv monitoring
4.celon probe and nerve stimulator set
The first incision with local and next with incision site. After that surgeon will use diathermy for burn and cut. Surgeon need the periosteal elevator .. Then, surgeon take the perforator or burr…
Drip set for irrigation needed for larvage directly.
Burr till the antrum .
We can see the hole for antrum and need to use seeker oval or round seeker. I thing this instrument i got wrong. Remind me to writen back…use freer and seeker both.. Suck the drainage in same time. When the spesimen taken, surgeon need to use biopsy cup and taken with crocodile…
Surgeon also need swab cotton ball with adrenaline if bleeding ir secure with bone wax. Another option is packing. At the end with B.I.P.P PACKING. . 4/0 vestriyl for inner site and 3/0 vestryl for second layer. Skin with 3/0 dafilon.
Just enought time for me… I need to recharge energy booster and pray first. .
eat 7pm different from ussual scrubbing from 3pm till 7pm…i thought i’m fast learner today. ALHAMDULILLAH. enought!!
Today, my operating room has a few slightly problematic cases during the operation.
When called the patient,staff jurse ward called to inform patient blood pressure high,patient not consented,not have relative due to condition herself.Ongoing to intubation,ecg changes,bloodpressure highest.called for next case,patient not ready yet.refused for operative. So the surgery that usually takes about an hour is divided into two or three hours.
But,my team proceed and continue with major case surgery.
The last case was pushed to the operating room at 6.30pm. From the anesthesia process to drapping takes about 15min. Only then did the surgery begin.
The surgeons this afternoon were both women and one was pregnant with two. Can you imagine how committed the pregnant mother was to do her job -standing for a long time in the operating room. (The operating room this afternoon is dominated by women from surgeons, anesthetists, to nurses including radioghraphers. Except for one male ppk)
Surgery operation and prosedure is Open the abdominal cavity, look there. out all kinds of bowel content.Just understand how much energy needs to be used. Extra time now.
Azan resounded when OR was noisy with the sound of the instrument falling..surgeon asked for a suture..want to wash.where to swab.this time the plaque is breaking fast.
Even though the call to prayer has resounded, the operation is still going on. Well, the stomach hasn't closed yet. So to give way to a friend who scrubs in the surgical area. We fed the nurse and doctor friends with boiled water and dates (of course, the seeds were discarded. Kesian wanted to keep the dates until the case was over). Gamat operating room briefly. They were relieved because they had the opportunity to soak their throats and fill their stomachs with even a single date. Enough conditions for breaking the fast. And, without the slightest murmur, the operation continued.
The patient was happy when the surgery was performed even though he was initially upset when he saw the clock on the wall of the ward which was approaching 6 pm. Fear if the surgery is postponed to the next day ..
At the time of discharge, my patient said;
"kak,thank you. Say thank you all.maaf kerana saya,kamu semua tidak boleh berbuka puasa⁇
There is nothing happier than seeing a patient smiling happily greeting a family member during discharge to the ward.
A cholecystectomy is surgery to remove your gallbladder. The gallbladder is a small organ under your liver. It is on the upper right side of your belly or abdomen. The gallbladder stores a digestive juice called bile which is made in the liver.
Gallstones that cause biliary colic (acute pain in the abdomen caused by spasm or blockage of the cystic or bile duct) are the most common reason for a cholecystectomy.
A laparoscopic cholecystectomy—as called lap cholecystectomy—is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a laparoscopic cholecystectomy
After your surgery, you will likely feel weak and tired for several days after you return home. Your belly may be swollen. If you had laparoscopic surgery, you may also have pain in your shoulder for about 24 hours. You may have gas or need to burp a lot at first.
My writing started when a friend suggested that I write to recount my activities and work experiences on a daily basis. This was to make it easier for him to follow my progress as long as we were in touch as long -distance friends.
I welcome purchase suggestions because this is the way we connect in addition to filling my free time to tell stories in cyberspace.Embarking on the journey of this story may be the same or different from the readers but I took this approach to binding the memory of every story line of my life
The clock on the wall is ticking slowly as if waiting for the presence of a time and a moment when not a single pound cares about the travel of the needle ...15 january 2013......
I am a nurse. My job is to help doctors in administering treatment to patients. Nurses like me are different from others. Indeed, we are in a special area ... our group is not crowded and may be recognizable. Out there only our close -knit doctors and working families might recognize. Sometimes many are unaware of our presence. Not because of our physicality and nature .. But that is in terms of our socialization and work ethic. .my workplace is confined ... We work in our world only .. I mean, in a small room atmosphere .. Sometimes chatting pounds no time between us. We will only focus on work and rest when we are ‘freetime’ only. Our rest is unpredictable .. Sometimes we stand for a long time and eat when the task is finished ... sometimes fortunately we do not have time to finish the task is finished in a short time
2014 at selayang hospital..
amirul is a ma ortho department that cover local case anesthesia during the ot local with staff nurse.experience on him i had take a lot …pak salam,cleaner,old man..from indonesian.i am tried ate a bake ‘bepang nasi’ from her loving handmade with extra diet order from hospital .and the more collage are my friends till jannah..-“ameen.
pt came with left obstructed inguinosacral hernia for left hernioplasty,lower midline laparatomy,small bowel resection and primary anastomosis.
pt came agains with tro anastomosis leaking for exploratory relaparatomy proceed with small bowel resection and promary anastomosis and stoma
pt put in supine position under general aneasthesia.area of interest cleaned and draped.horizontal incision done overlying to left inguinal swelling.open in layer and sac identified and hold.noted direct inguinalscrotal hernia.sac open,noted samll bowel content mildly dilated which adhered to sac
unable to fully reduced small bowel content eventhough wound opened till deep ring.proceed with lower midline laparatomy laparatomy.small bowel content fully reduced after adhesionalysis.
proximally small bowel mildly dilated.decided for small bowel resection and promary anastomosis
left inguinal tunnel,repaired and meshed used and anchored prolene 2/0 suture.
complete left hernioplasty and wound closure.proceed small bowel resection using ligasure forcep..linear stapler 75 x 2,50cm small bowel resected.proceed primary anastomosis with hand sewn vicryl 3/o,double layered.leak test negative.peristalsis presence.good vascularity,mesenteric window closed with vicryl 3/o,small bowel remians 210cm.
wash with warn saline,haemostasis secured.portex drain 24ch x1 inserted with 5holes at RIFwith tip at left hypochondriac/near anastomosis.rectus closure with ethilon loop 1,and skin stappler stapler.dressing applied.
- direct inguinal hernia
- small howel content with interloop and sac adhesion upon opening sac
- haemorrhagic fluid within sac
- unable to fully reduced small howel content after adhesionalysis/extensionof wound till deep ring
lower midline laratomy
- minimal haemorrhagic fluid
- able to fully reduced small bowel content
- noted oedematous small bowel content with interloop dense adhesion
- proximally small bowel mildly dilated
- distally till colon not dilated ,normal
- no obvious perforation seen
i am hope that pt will speedy recovery because the patient to close with me.