The ALS (Amyotrophic Lateral Sclerosis) Ice Bucket Challenge has clearly gained a lot of social media attention. Every day I open my Facebook account to at least 3 new posts of friends completing the Ice Bucket Challenge. It is true that this seems to be a very effective way of gaining the public's attention regarding the condition known as ALS. And on that note, I am very happy that more and more people have come to realise how terrifying ALS can be to those affected by it. The Ice Bucket Challenge had certainly successfully promoted public awareness of the condition. 

Could it be when your world of sorrow and troubles become too overbearing like a tsunami wave threatening to crash upon the shores of life, you find the unrealised ability to build a tiny hut to store your most precious, in a hut made of wood, firm in its foundations, able to withstand the threatening wave. Nothing would be able to stop the wave - it is like the course of nature, an inevitable phenomenon. But as the dark waves crash upon the shores of life, destroying everything else, the small but sure hut remains. And after the chaos has ended, from that hut emerge a small ray of hope and continuity of building back everything on the shores of life.

That hut is the defence mechanism of every person out there. When all is lost, when everything has fallen into the deep chasm of chaos, we eventually find a single ray of hope that would eventually guide us back to the path of life. We bury that hope deep down somewhere in the depths of our subconsciousness, only to reveal it in desperate times. Sometimes, the destruction is so vast that the hut becomes unseen to our eyes and that hope gets buried so deep that we could only reach for it with the guidance of the people around us. And in times when your bitterness from the disaster has managed to isolate you from the world, leaving you completely on your own, you forget and you lose that ray of hope, and you continue your spiral down the depths of bitterness, loneliness and eventually self-destruction.

People come and go in our life. But the people who stay, who help you build that hut and find that hope, who help you regain normality, that you should never let go of.

Life is fragile. It is a fact not worth denying.
A moment of weakness, a shadow of doubt, an honest man's mistake, and life can come crashing down. Our bodies, they crumble. All it takes is just the protest of a single cell, or an alteration of a gene, to cause the world to shift, to cause a life or lives to be affected, broken, changed. Our bodies, they are weak. They last a lifetime, no more, no less. From the moment we are borne, to the moment we disappear feet below the ground, our bodies continue to be broken. Each day, every day, our bodies degenerate. True enough, we regenerate as well. Until it comes a time when the cycle slows and eventually stops, and only degeneration remains. That is the cruel fate of mankind.

And yet.

Man continues to thrive, to achieve far beyond imagination, to break beliefs and to set new sights. If life itself is so fragile, why should there be anything positive from life itself? Why not sit and wait for the final destiny of life to come along? Why not simply wait for death? It is an inevitable fate, so why deny it?

Because along with life, comes spirit. If there is one thing that man has, it is spirit. The will to live life to the fullest. We thrive because we have the will to thrive. We fight illness because we refuse to succumb to such fates. We refuse to be broken. We refuse to sit idly, awaiting death. We fall, we break, yet we pick ourselves up and keep on going, we keep on fighting.

Bodies break and disappear beneath our feet, long forgotten. Why fight a useless fight?

A pebble thrown to the ocean bears no significance. Yet it causes ripples that travel miles outwards.
Our actions bear no obvious significance. Yet it does. Because we often forget. That every one of our action affects one or perhaps, a million other people. If it takes a single cell to protest and break our bodies, then surely a single person standing up, refusing to succumb to the path laid out before him or her, can cause change. Because that one person's action can cause a ripple in the woven fabric of someone else's life, which could begin a continuous course of effects. The body dies, the spirit moves on, but the memory lives on. It may or may not be enough to be written into history, but it is enough to live on in the memories of those closest and dearest to you, or even a random stranger who's life has been touched by your memory and your spirit.

So scratch, claw and fight, and when the inevitable comes, embrace it with open arms, knowing with comfort and satisfaction, that it has been a good fight.

Because I irritate myself by not publishing this sooner BUT..

This is the mechanism as to why the pains experienced during appendicitis occurs...

Autonomic sensory neurones travel with sympathetic nerves in bowel and the visceral peritoneum. So the appendix receives its sympathetic nerve supply via the least splanchnic nerve which originates from sympathetic chain at T10 and T11. The sensation (pain) is interpreted as irritation occurring at the skin distribution of the spinal nerves of the spinal cord level (dermatome). In this case, T10 is the periumbilical region, thus pain is thought to be originating from the areas supplied by the somatic nerves entering the spinal cord at the same level as the nerves from the pain producing organ.
The pain may be described as dull in nature as it originates from the visceral peritoneum.

Continuous inflammation can cause the overlying parietal peritoneum to be irritated, thus causing a sharp pain. It is also more localised as the nerves involved are now somatic nerves.


Heh. Well, I'm not sure if I've explained this rightly/clearly haha.

Because I might as well make use of this blog to impart some knowledge to random readers...

Incidence: Most common surgical emergency (lifetime incidence = 6%)

Pathogenesis: lumen obstruction --> gut organisms invade --> oedema, ischaemic necrosis, perforation

Symptoms: Periumbilical (around the umbilicus) pain that radiates to RIF [ early inflammation --> irritates structure and walls of appendix --> colicky pain referred to mid abdomen/periumbilical --> continued inflammation --> irritation of parietal peritoneum --> somatic, lateralised pain settles @ McBurney's point (2/3 from umbilicus to right ASIS) ] anorexia, vomiting (rarely prominent), constipation, diarrhoea

O/E:

General signs: Tachycardia, Febrile, Furred tongue, Lying still (movement aggravates), Coughing hurts, shallow breaths, foetor.

Abdominal palpation: RIF - guarding, rebound tenderness, percussion tenderness

Special tests: Rovsing's sign (pain in RIF when LIF is pressed), Psoas sign (pain on extending hip if retrocaecal appendix), Cope sign (pain on flexion and internal rotation of right hip if appendix is close relation to obturator internus)

Investigations: FBC (check anaemia, WBC, CRP), USS, CT Abdo

Treatment: Appendicectomy. Start antibiotics (metronidazole 500mg/8hr + cefuroxime 1.5g/8hr, 1 to 3 doses IV starting 1 hour pre-op --> reduce wound infections)

Differential diagnoses: ectopic? UTI? mesenteric adenitis? cystitis? cholecystitis? diverticulitis? salpingitis/PID? dysmenorrhea? Crohn's? Perforated ulcer? food poisoning? meckel's diverticulum?

Complications: perforation, appendix mass --> inflamed appendix covered with omentum, appendix abscess --> appendix mass that fails to resolve

It's not that I have nothing better to do, it's just that I'm so caught up with everything else that I feel the need to do something different and definitely out of the norm.

Granted this blog is dead and CPR now would not help at all, even risk of hypoxic damage wouldn't be a problem, it's a corpse. But oh wells, consider this the blog going through reincarnation as we all have definitely gone on to a whole new chapter of Life.

So yes, I'm now in med school in Southampton, a teeny city in UK, and my co-blogger is still living life in Perth. Still being in third year, I have the perks of going through exams and boring university life. How much different is UK compared to Malaysia? For starters, the weather. Yes English people and their weather. And I now realise its for a good reason too. To have a bright sunny day is an absolute treasure to them. And me. I love the sun now. Just cause it makes the day slightly less gloomy and a little happier, giving the illusion that its going to be warmer even though its still absolutely freezing.

I never liked the whole idea of twinning, joining a bunch of people halfway through the year when bonds have been made and you just feel like an outsider because they do make you feel that way with their cliques and all. Not that I can blame them, its kinda like you've already established your clique, your friends, having a new person trying to fit into the group just doesn't work.

And speaking of work? How's the workload? It's there, having to learn their way of answering things, their syllabus is going to be one tough road. It's different yet the same in essence.

But I do still miss my loved ones, and most importantly, familiarity.

The hard cold reality of being in medical school really hits you when you reach semester 5. After being in medical school for 2 and a half years, you would think that we should be all prepared for all the stress and workload to come, turns out none of us were ever really that prepared for it.