Selamat Hari Raya

My sincere Hari Raya Aidilfitri wishes to all my Muslim brothers, sisters and friends.

It is truly a time for reflection, forgiveness and celebration. On the topic of reflection, I cant help but compare the death toll from Ops Sikap XX versus H1N1. There was so much hoo ha regarding the latter. Everyone (almost) was scared for a moment. Sadly, the public does not exercise the same level of alertness and diligence in combating road traffic accident related deaths.

On the topic of forgiveness, allow me to use this opportunity to seek forgiveness for all those unpleasant things I may have done over the past one year.

The celebration? Well, here's one story worth celebrating .....

A 48 year old lady conceives her first child spontaneously after 8 years of marriage. She is due only in mid-October. She came to the hospital just before midnight yesterday. Examination revealed that she was in labour but the fetus was underweight (<2.5kg) and slightly premature. The conditions were favourable for a normal delivery. My midwife was not too amused. " 48 years old, got pregnant after 8 years, better C-Section", she mumbled as I left the labour room. I didn't want to hear that negative remark anymore....

I took a walk outside the hospital, reflecting on all those evidence that says 'being mature' is not an indication for a C-Section. And deep in my heart, I wanted to give her the chance to deliver vaginally.

Half an hour later, the phone rang. "Dr! You kat mana?!", the voice cracked. I rushed back in and reached just in time as she began to bear down. Alas, the first "Raya" baby was born soon after. As I reviewed the mother this morning, I realized she had been cool and composed all along. A new meaning to the word 'mature' perhaps? He He

Waktu Rawatan Pakar Wanita Suria (Consultation Hours)

Ok, I'm sorry. Many people have been asking me this ....

9.00am - 2.00pm & 5.00pm-9.30pm everyday

EXCEPT:

Saturday: 9.00am - 3.00pm only.

We're closed on 3rd Sunday and certain Public Holidays.

Adoption

I received a phone call recently:

Caller: "Dr! I'm Mrs X's niece! Remember? You helped her deliver?"

Me: "Yes, go on."

Caller: "Well, we've given away the child for adoption. And the adoptive parents would like to meet you to make sure the child is completely ok"

Me: "What?!" (Not believing such people exist)

Caller: (Repeats the request)

Me: "Well, I suggest that they go see a Paediatrician"

Caller: "What?!" (Perhaps not believing that I would actually refuse)

Me: "Yes, you heard me right. Go see a paediatrician"

Well, there you are.... This is how some people view adoption - as if the baby is some 'commodity' that has to be checked for defects. Forgive me for lashing out but I suppose this is what happens when the biological parents and adoptive parents refuse to meet in person. And I sometimes doubt the sincerity of those who wish to take a child for adoption.

I have heard of couples paying thousands of ringgit to 'agents' to get a baby for adoption. And some have related how they got conned and returned home empty handed.

Hey!

You can't buy babies! You are BLESSED with them.

Even if they are not your own. Even if you pay.

Get it? Don't? I rest my case....

Back in Control .... He He

My computer got zapped by not one but two viruses: RVHost & Heap (std.txt).

They messed up my registry editor, disabling Task Manager, System Restore & REGEDIT.

For months, I kept seeing messages like "TASK MANAGER DISABLED BY ADMINSTRATOR" and multiple funny messages whenever I start up.

After some serious experimentation and internet search, I have found some links to help others to solve the same problem:

http://windowsxp.mvps.org/Taskmanager_error.htm

http://www.pchell.com/support/registryeditordisabled.shtml

http://forum.lowyat.net/topic/531132

Good luck!

PCOS (Polycystic Ovarian Syndrome)

PCOS atau Sindrom Ovari Polisistik adalah satu penyakit yang telah lama diketahui oleh pakar-pakar sakitpuan. Namun, hanya dalam seabad yang lepas, penyelidikan berkaitan PCOS makin bertambah dan mula mungungkit minat pelbagai pihak.

European Society for Human Reproduction and Embryology (ESHRE) dan the American Society for Reproductive Medicine (ASRM) adalah antara organisasi yang telah lama cuba menyeragamkan diagnosa dan cuba mewujudkan garispanduan dalam perawatan wanita yang menghidap sindrom ini. Usaha mereka akhirnya berhasil di satu sidang kemuncak PCOS di Rotterdam pada tahun 2004.

Menurut 'kriteria Rotterdam' tersebut, seseorang wanita harus memiliki sekurang-kurangnya DUA dari TIGA ciri-ciri am PCOS iaitu:
1. Haid tidak teratur atau haid sering lewat (absent)
2. Hiperandrogenisma (keadaan di mana berlaku peningkatan hormon androgen, sejenis hormon kaum lelaki)
3. Ovari polisistik, iaitu, sekurang-kurangnya satu ovari mempunyai minima 12 telur (follikel) atau saiz ovari telah membesar

Namun, PCOS masih merupakan satu sindrom dan dengan itu, diagnosa PCOS tidak TERIKAT semata-mata kepada tiga kriteria yang disebut di atas.

Berikut adalah antara masalah lazim yang saya kenalpasti di kalangan wanita yang disyakki menghidap PCOS:
1. Pertambahan berat badan yang mendadak (sekurang-kurangnya 5%) .... sering berlaku walaupun wanita-wanita ini tidak mengalami pertambahan nafsu makan
2. Ahli keluarga atau diri sendiri menghidap penyakit Diabetes (kencing manis)
3. Peningkatan pertumbuhan bulu roma yang tidak menyenangkan - roma makin menebal, hitam dan menjadi kerinting. Mula tumbuh di bahagian-bahagian 'sensitif' seolah-olah ada pertumbuhan misai halus atau janggut
4. Central obesity - kaki dan tangan tampak 'slim' tetapi lemak berkumpul di kawasan dada, abdomen dan punggung maenyebabkan wanita tersebut hilang 'shape' (maaf, saya bukan menghina kaum wanita...)
5. Kurang subur. Mengandung pun, mudah gugur.

Rawatan PCOS biasanya merangkumi strategi-strategi seperti berikut:
1. Mengurangkan berat badan
2. Ubatan seperti metformin (yang sebenarnya adalah ubat kencing manis) dan pil perancang. Pelbagai jenis pil perancang boleh diguna. Ada diantaranya yang mengandungi ubat anti-androgen (anti hormon lelaki) iaitu 'cyperoterone acetate'. Contohnya adalah Diane 35 (dipasarkan oleh syarikat farmaseutikal Schering) dan Estelle (maaf, saya tidak tahu nama syarikat)
3. Rawatan kesuburan bagi wanita yang mengingingkannya
4. Rawatan jangka panjang, terutamanya dari segi risiko kencing manis, kolestrol tinggi, darah tinggi, penyakit jantung & barah rahim
5. Rawatan kosmetik - juga untuk golongan wanita yang menginginkannya

Jenis dan cara rawatan adalah bergantung kepada kehendak pesakit, indikasi perubatan dan pendapat doktor yang merawat.

Dari segi rawatan kesuburan, tidak semua wanita yang perlu rawatan secara ubat. Ada wanita yang bijak mengurus berat badan dan ini dengan sendirinya merangsang kesuburan. Dari segi perubatan, bantuan boleh diberi dari segi:
1. Ubat metformin
2. Pil subur (clomiphene citrate) atau Suntikan harian hormon (FSH)
3. Suntikan hCG untuk menggalakkan ovulasi
4. Kaedah laparoskopik (ovarian drilling) - untuk memperbetul ketidakseimbangan hormon di dalam ovari

Ada juga doktor yang menggunakan kaedah tambahan seperti pemanian beradas (IUI) atau persenyawaan tabung uji (IVF).

Namun, kejayaan rawatan tidak boleh diukur dari segi kadar kehamilan sahaja. Ini adalah kerana kadar KELAHIRAN adalah kurang dari kadar KEHAMILAN. Bukan semua janin dapat bertahan sehingga tempoh matang. Ada yang gugur. Ada yang lahir terlalu pramatang. Ini adalah suatu kelemahan semulajadi dalam kes-kes rawatan kesuburan, apakan lagi kes PCOS di mana telur (ovum) yang terhasil kadangkala tidak sihat dan tidak stabil.

Semasa menjalan rawatan kesuburan, doktor biasanya akan memanggil wanita itu untuk datang pada hari ke 9 atau ke 10 untuk 'follicle tracking'. Ini adalah satu proses pengesanan tumbesaran telur (ovum) dengan bantuan alat skan melalui faraj. Skan ini terpaksa dilakukan berulang-kali (biasanya 3 hingga 4 kali) untuk memahami kadar tumbesaran ovum. Apabila ovum telah mencapai peringkat matang, satu suntikan penggalak ovulasi (hCG) akan diberi.

Tidak semua wanita yang memerlukan skan sehingga 3 atau 4 kali. Ada kes di mana telur matang dengan cepat.

Begitu juga dengan suntikan hCG: doktor kadangkala membuat keputusan untuk tidak memberi suntikan ini, terutamanya dalam kes respons terlalu lemah ATAU respons terlalu kuat (terlalu banyak telur yang matang sekaligus)

Kemaskini Sept 2009: Suatu kertas kerja jawatankuasa saintifik RCOG telah menyarankan bahawa metformin BUKANlah suatu rawatan 'first-line' yang disyorkan untuk PCOS. Sila ambil perhatian dan jangan ambil ubat ini tanpa arahan doktor. Untuk maklumat lanjut, layari: http://www.rcog.org.uk/files/rcog-corp/uploaded-files/SAC13metformin-minorrevision.pdf

Indications for MGTT

For the benefit of my students and those who seek knowledge:

Malaysia practices SELECTIVE screening for gestational diabetes. Not all women are screened for the disease. Here are a few indications:

1. Maternal obesity - em..... a bit tricky here.... i'm not sure whether we should follow BMI or maternal weight. Maternal weight > 80 is practical in the sense of a busy set-up such as Klinik Kesihatan. Can follow this simple rule of thumb so long you don't miss obese mothers who are short but weigh > 80 kgs

2. Excessive weight gain in pregnancy

3. Glycosuria on 2 or more occasions

4. Symptoms of frank diabetes

5. Recurrent infections, such as vulvovaginal candidiasis

6. Previous intrauterine death

7. Previous fetal anomaly

8. Previous macrosomia

9. Polyhydramnios

10. Underlying Polycystic Ovarian Disease

11. Family history of diabetes

12. GDM in previous pregnancy

I'm sure the above list is incomplete. If you think we should add more, leave me a note :-)

Biochemical Pregnancy

Have you heard of this term?

I didn't like it from the first time I heard. I mean, the term is both demeaning and confusing.

Demeaning because the affected woman feels like she's being treated like an experimental subject. Confusing because we are neither confirming or denying that she is pregnant.

Ok, background info. Decades ago, our grandmas realized they were pregnant when they began to experience 'morning sickness'. A doctor would then look for Hegar's sign and confirm the pregnancy. Then came in the urine pregnancy tests. Then, these tests became more sensitive. And we are now finally in an era where serum beta-hCG assay is easily available. To that, you add an anxious lady with fertility problems and an equally anxious doctor who wants to see the success of his/her fertility treatment.

And you get biochemical pregnancy.

These pregnancies are real, except when you have choriocarcinoma or hCG-secreting ovarian tumour. The more commoner culprit is hCG injections that are sometimes given to aid ovulation and / or provide hCG support for the early pregnancy.

If we take all the above factors away, then it has to be a pregnancy and nothing else (I stand corrected).

Most (up to 60%?) of pregnancies 'fade away' before most women realize them. These destined-to-fail pregnancies are being increasingly picked up due to heightened surveilance following fertility therapy.

For the benefit of students, a biochemical pregnancy is a pregnancy that fails before the beta-hCG levels enter the 'discriminatory zone'.

And you are what? No. 2 at home? Or is it No.3. Sure? Not 63?

I dedicate this article to all my biochemical brothers and sisters 'born' before me. :-)