18/08/2020

The wiggly tongue

Im supposed to be studying for my examination, but Ive got this memory in my head and I gotta write it down to ease my mind. It is kind of a funny story during GMGS year in dentistry whereby I had to attend the operating theatre for the ENT course. Entering the theatre is like a dream come true for me even though I did not do anything else except watch haha


Before going to the theatre, we changed into the purple scrub and black scarves. Then, we walked to the theatre and listen to the briefing (and warning obviously). So, the only interesting available case for that day was Pleomorphic Adenoma removal of a young man and tongue cancer removal of an elderly man.

For the young man, it was quite straightforward with the disinfection and isolation of the operating site. The patient was already anaesthesized beforehand. Then, marking of the operating area was done as a guide. The doctor also kept asking his master students some questions so that is where we gain some extra knowledge aside. 

After making the incision based on the marking made, they start to search for the ending (?) of the mass. This is also when they start to use this cool instrument to detect the nerve to avoid damaging it and cause problems. They also use this electrocautery instrument to seal the blood vessel and prevent some huge bloody mess during the surgery.

 There were also music being played on the speaker to lighten the situation which was kinda nice, I guess. It was supposed to be an easy surgery but the nerve and muscle makes it slightly difficult and it was so satisfying to see the whole mass being removed from the patient's cheek (?). I did not watch the whole surgery for a full three hours as I need to alternate with colleagues  which was a bummer haha

Oh, just an interesting fact, this benign pleomorphic adenoma mass if left untreated can lead to its cancerous form so he was definitely lucky to have his mass detected early as it might not be that obvious from the outside but the mass continues to grow on inside. Scary isnt it 

Then, for the next alternative patient that I watch (honestly Im beginning to think that this might not happen on the same day haha but whatever ). This elderly man had a huge tongue cancer and had to have almost half of his tongue removed for survival :(

one of the first tell tale sign of cancer especially if it last for more than 2 weeks
(the other picture as just to gory to be shared haha)


The surgery as usual requires the use electrocautery and the nerve detector. Oh, the tongue is also a muscular organ that can still move even if you have been anaesthesized. It wasnt easy to watch as the procedure happens in the mouth but it was also a lengthy procedure but it wasnt as long as the previous patient. There was also a time when there was a sudden spurt of blood as they accidentally cut the main blood vessel. I was so thankful that I stayed in the safe zone pheww but the doctors were only wearing goggles and mask, so just imagine guys. Wait, now Im not so sure whether this incident happen to this patient haha...aaa bencinya dah lupa

Once the resection finished, the doctor showed it to us with the tongue hanging from a piece of thread. Then, suddenly the thread slips from his hand and it fell onto the floor. Again, I thanked God the tongue is still quite far from me. The tongue does not wiggle obviously but it is still euww haha.. Suddenly, this nurse look at me into the eyes and said "why didnt you pick it up?" and I was like "what the hell? How am I supposed to pick it up? There isnt any glove and it is like a mass. You must be nut" (obviously this is silent monologue). 

She picked it up and put it into the specimen bottle and put it onto the shelves. I look at that mass and think the mass used to be someone else's tongue and I simply shivered by the thought of it haha. Then, I was reminded of my brother's brain tumor specimen. I was just searching for some medicine at a cupboard when I found this weird looking thing in some water. It seems like a trophy after a long battle, right? Because, my aunt also displays her kidney stone in her cupboard. 

All in all, watching a surgery is a memorable experience on its own and I love it (if and only if Im wearing a full PPE) and I cant wait to experience it again during my fifth year but in the dental field. However, I am definitely not looking forward for the missile of questions being thrown later haha... Thank you for reading my story till the end. I have many stories to be told but I still havent got the time and effort to rack my brain and write it 

04/05/2020

First Denture Issued

A denture story, huh? 

Honestly, I almost feel like I should write each of my denture stories because making one requires a lot of blood, sweat, and tears (we'll see about that). I had spent most of my free times perfecting it in the lab and to produce and present it to them is a bliss. I might be blessed with kind patient, but the skills developed throughout this journey was not easy to acquire. I have cried multiple times before when things doesn't go my way... a cry baby, ikr, but I enjoy every single one of it and I want to cherish the memories by writing in this blog.

I received my first denture patient after trying for three times (the first two patients had done their denture at a government clinic) and Alhamdulillah he was so compliant and nice and requires no pre prosthetic treatment. His favourite word was 'It is okay to make mistakes as you are still learning) and mine was 'Sorry for being so rough, sir'. The first case is a shared case whereby I'll do the lower arch while my partner do the upper arch. Generally, a denture has two types which are acylic and cobalt chrome and this case is a complete upper and lower acrylic denture.



cobalt chrome denture
acylic denture 


The examination and diagnosis part is very straightforward as he is fit and healthy and no other problems. Although we did have to take an OPG image to see if there is any retained root as his story is a bit suspicious and there were none found. Oh guess what, he had been edentulous (no teeth) for almost 30 years until he decided to make one with me yeayy. The first visit ended by taking the primary impression of his mouth by using alginate to prepare for the next step.

cast made from the first impression.

The second visit involves us trimming the special tray (made by using the previous impression). Once it is done, we use this sticky green wax stick to record the sulcus for better adaptation. You have to repeat this step until a suction sound can be heard when you remove the tray. Once that is done, you will use another material to record the secondary impression which is more accurate. Then, the cast prepared from this will be used to make the bite rims with wax. The function of these impression is to ensure a proper adaptation of the denture to avoid any dislodgement whenever the patient speak/ eat/ cough etc.

green stick molding and secondary impression of the mouth

Then, the third visit requires your patient cooperation and patients as it requires putting and removing the bite rims multiple time for adjustment. Wrong measurement can result in future unwanted problems for the patient. You also have to use your eyes to see the centre line, parallelism and aesthetic of the patient. My eyes were so strain by doing this haha and it took us two visit to make it right because you know it's our first time. Fortunately, our lecturers were willing to help us to make it right despite our multiple failing effort. 

adjustment and markings were done after necessary measurement were taken

Then, the important markings were made and recorded and the patient was asked to pick their desired tooth shade. I always hate it when they say 'you pick for me la, I trust you okey'. I mean like whyyyy and usually we would end up by picking the common shade. The markings made will guide you during the teeth setting. Once that is done, the acrylic teeth were chosen and requested and the painstaking journey of tooth setting begin. Among all of the procedure, this step is my least favourite huhu but the satisfaction you feel when you finish is just incredible hmmm. Plus, what is a denture without teeth, right haha

Once the setting was satisfied, we called him for our fifth visit (the third and fourth is solely for bite rims measurement) and adjustment of the teeth were made whenever necessary and it was kind of smooth sailing if memory serves me right. The patient has no comment regarding the arrangement of the teeth and tooth shade which we were so thankful of. Then, we went to the lab the prepare it for the next step.

teeth setting

After sealing and cleaning the required area, we put the denture in a flask with plaster of paris (POP) to get the negative copy the denture. I had made a mistake by not making the mixture slightly runnier for the top part, hence, there were holes in my flask which was so frustrating causing a breakdown. Luckily, it can be saved and the technician did something to it after I have clean the cast from wax with hot water. After that he also helped me to pack acrylic into the flask for the curing procedure. I prayed so hard for the technique work as I do not want to start from scratch. I was almost at the finishing line huhu.

puppy eyes trick to ask for help from the technician 

Miracles do happens as the technique works perfectly and there was no porosity seen on the denture. It looks beautiful even though it was ugly with the excess acrylic and stones attached to the denture. Then, a quick rough trimming of the denture was done. My fingers were on fire from the trimmed acrylic and my desk was full with dust (my suction doesn't work but whatever). It was almost like a magical scene with acrylic dust floating over you, even though in reality I look like a mess. 

Then, a finer trimming was done to make it look nicer before using the sand paper to make the surface smooth. Once this is done, the denture will undergo further refinement with pumice (remove minute irregularities) and whitening (make it shine bright like a diamond). It is always so satisfying to see the denture shine without any dull surface.

Later, the sixth visit was conducted and after a few trimming was done, the denture was safely issued to the patient and he was satisfied with it. We took some pictures with him and he also claims that he was a bit shy of wearing it because he was used to not having any teeth before. He thanked us and we sighed with relieve after seeing all the hard works being paid off.

the final product of our labour. Literally our pride and joy

The seventh visit is done a week later to tend to any complains. He has none, but we did adjust the biting a little bit and dismissed him once done. That was the last time we ever saw him and I'm glad he was happy with the denture issued. Then, we requested another denture case, but this time it was individual. This second complete edentulous patient of mine is an adventurous story on its own, so I'll tell you in another post. In conclusion, making a denture is not an easy process as it requires a lot of time and skills. Not to mention, the risk that each procedure carries.

27/04/2020

Losing Weight Part 2: Metabolism and Eating Less

For the second part, I am going to write on the tips to eat less (it is more of a mind trick kinda thing hehe) because it is always hard whenever you want to start something new like dieting. The key to every success is really dependent on your will and strength to resist those calling of high caloric food. You have a choice to decline or accept the call. Of course, it is okay to take it sometimes, but don't go overboard, instead know your limit every time you eat.

How to eat less?

1. smaller bowl 

see the difference it makes?? I bet you will feel more fuller with the left plate 

use a smaller bowl/ plate to trick your brain into eating smaller portion. When you have a big plate, you have a tendency to fill it with foods, hence causing over eating. Plus, seeing small portion of food on a big plate makes it harder for your brain to register that you are full. However, don’t cheat la by using a small plate yet piling your food like nobody’s business. Don’t pile and use smaller plate to reduce portion and calories. 

2. use contrast plate 


The use of contrast plating will allow your brain to assess the amount of food you have place onto your plate. And this will (hopefully) help you to realize about your portion and not go overboard. Use darker plate if you have lighter color meal and vice versa. 

3. use tall glass 

A tall glass usually have a slimmer figure (lesser volume) than short and fat (?) glass. Hence, this will make you drink lesser water (if you are craving for sweet drinks). Plus, a taller glass will give an illusion of more volume, even though it is not hence making it easier for you to feel satisfied.

4. buy small packs or divide into small servings

Having pre packed food will make you aware of the number of packages you have eaten. If you have a huge packet, then it is advisable to divide the food according to the serving size recommended to avoid your unaware self from emptying it. This is so me haha

5. drink water to fill you

Sometimes your stomach is grumbling for water, but you are feeding it with food. Then, the thirst is not satisfied hence making you binge unnecessarily and results in a weight gain. Water has zero calories so why not try to drink it first if you got hungry.

6. Keep food in place where you can’t see

The theory is you crave what you see. For example, you watch a mukbang and it triggers your appetite. Then, you end up making/ ordering the exact (maybe) food. Am I right? So, keep your food hidden and distract yourself from reaching for it. 

7. leave visual clue

Leaving the evidence to give you a hint of the amount of food you have take. For example, while you are eating some durian, don’t throw the seeds right away but keep them until you are done. It hurts to see the calories, but it works haha.. i mean one durian has about 100-200 kcal and I can eat 10 easily hmmm

7. Try to do plating of 1/2 vege/fruits, 1/4 protein and 1/4 carbs 

plating makes the dishes appear appetizing and ensure you get enough nutriets

Plating before you eat will help you get the necessary nutrition without adding extra calories in it. This will also helps you to control your food intake and avoid you from overeating. Remember, your feeling of satiety only surfaces 20 minutes starting from your first bite.

8.limit distraction


Don’t eat in front of the television or while talking to your friends. Have a mindful eating session and you will feel more full with lesser food. If you do not want to be a party bummer when hanging out with your friends or family, then drink plain water and eat some healthy snacks. 

Low metabolism?

you do agree that the higher the metabolic rate, the more calories will be burn, hence, the easier for you to lose weight. So, what factors affect your metabolism? It is affected by genetic, age, weight, diet, exercise, and lifestyle. So how to solve this?

*you can also calculate your BMR (energy needed to carry out metabolic process) from the internet. This will help you to determine the calories intake you requires daily.


1. Exercise

Even the simpsons exercise while watching a video

Do some exercises as one pound of muscle burns 14 calories per day while a pound of fat burns only 2-3 calories per day. Strength training burns 2-3 times more calories as compared to cardio. You can also do compound exercise (involves multiple muscles at once) as this is effective to build lean muscle and gain strength. Some examples are squats, planks, lunges etc

if you have a sedentary lifestyles, then try to walk more (at least 10000 steps per day). If you feel it is impossible, then try to watch netflix/ youtube while walking. And you will get your daily exercise while entertaining yourself. Problem solved.

2. HIIT

HIIT involves a quick workout with intense burst of energy, hence, your body will consume more oxygen resulting more energy burn. Plus, your calories will also continue to burn for the next few hours even during resting. 

3. Don't starve yourself

eat moderately and have fun dieting because you are changing your lifestyle for a better future

Starving will slow your metabolism as the body adapts to the lower calories intake. This is also not sustainable and your old weight will rebound once you start eating more. Instead, simply reduce your food intake and eat more healthily.

4. Eat more protein

increase your protein intake as protein causes the highest thermic effect of food (TEP) as it is harder to digest. Hence, this increases your metabolic rate by 15-30%. It will also makes you fuller for a longer time. High carbohydrate intake makes you feel sluggish once it metabolized. One of the food that makes me full for a longer time is milk and tempeh.

5. Increase water intake

drink more water as your body need water to metabolise the calories. Sometimes your body screams in hunger for water, but we tend to eat instead. If you don’t like to drink, then eat them by making soups. I always do this as I am always hungry and this makes me full for a longer time without having to binge eating.

6. Have enough rest

Lack of sleep causes alteration in your hormone making it harder to burn calories. Sleep is affected by hormones leptin (control feeling of fullness) and ghrelin (control feeling of hunger). The leptin production will be reduced while ghrelin production increased when sleep in inadequate. This causes your body to crave for more food and making you start binge eating


Please stop saying tomorrow every single day and start making your words a reality okey. Bye


26/04/2020

OS Emergency

Another throwback story for keepsake purposes hehe...
I've been wanting to write but I was too lazy to do it. Now, I almost forgot some tiny details and it kinda upsets me but there is nothing I can do about it.


It was my partner's turn for the clinical session and she brought an elderly man with multiple medical problems for extractions. He has angina, chronic kidney disease, and gout (there are others that I can't remember), so just imagine the amount of medications he is taking. He is very kind and friendly so it was nice talking to him. So, after taking all the necessary history from the patient, my partner began to prepare her 'presentation script'. In the meantime, I tried to entertain him by talking duhh

As we were talking, he suddenly told me that he also has a brain tumor and it hasn't been treated for he feels like he is already too old to live longer...mmmkayyy... then my mind reminds me of my brother who also happens to have a brain tumor and it is accompanied by epilepsy... so, I ask him,

 'have you ever had any seizure before?'
'yes, of course and it was a long time ago (i guess, can't really remember haha)'

Then, I rushed to my partner and told her about my discovery and rush to the nursing station to take the mouth prop phewww... then, we discussed further about the patient's medications and medical history and try to answer every possible questions that could be asked by the supervisor. Once we were done (well, more to we were running out of time haha), I called the supervisor and she presented her case.

As usual, there were a lot of questions being asked and I tried to help as much as I could. Luckily, our supervisor was being extra nice as she helps us whenever the answer wasn't satisfying enough. Once the discussion was over, it was time for 'business' and the supervisor began to check the teeth to be extracted. She lowers the chair and then the patient complaint of angina (chest pain) and said that his chair needs to be higher. Chair raised done.

Once the teeth was approved, my partner began her procedure by giving the injection to numb the area and anaesthesia was achieved. Then, she starts her extraction procedure. After a few moments, the supervisor came and tried to help by using coupland. The thing with coupland is it is advisable to slightly lower the chair so she reduces the chair height and the patient was okay with it. Then, the nightmare began....

literally me going everywhere around the clinic to get the items requested by the supervisor

A couple of minutes later, he began to feel another chest pain so the chair was adjusted again but the pain doesn't go away, so I was instructed to notify the staff nurse and bring the emergency cart and oxygen tank. Then, the staff nurse began to check the blood pressure and oxygen level, gives him the nitroglycerin pill and place the nasal cannula to supply the oxygen. There was also a crowd of our colleagues surrounding the cubicle.

the nasal cannula

Our heart were beating fast as we have never experienced this before. We kept looking at each other and try to assist whenever possible. Meanwhile, the supervisor kept asking the staff nurse questions with a worried look plastered on her face. There was nothing abnormal about his vital signs except for the chest pain.

Then, the supervisor asked the patient about the pain and he claims that it is slowly fading. So, she tried to persuade the patient to postpone the extraction, but the patient declines it. He pleads to have an extraction of at least one tooth. With a heavy heart, the supervisor agreed and she took over the case and extract the tooth.

The process was fast and easy, however, there was a root fracture when the socket was examined. She tried to remove it by using coupland without causing too much stress to the patient but it was too deep. Therefore, she called her colleague for some help and the fractured root managed to be removed after some manipulation. Once the bleeding stops, the patient was dismissed. Then, an evaluation of the situation was done with the supervisor to end the day.

20/04/2020

Losing Weight Part 1: Tips and Tricks

Writing this post based on my readings and binge watching some youtube videos. Hopefully this will help whoever in need and serve as my reference in the future hehe... So, how to lose weight?



I’m going to divide this into a few parts to avoid it from becoming too lengthy as I’m trying to crammed as much information as possible . So, before we start, let me tell you briefly about the three body type… no no it is not the pear, apple etc. This is a bit more specific. 

Importance? This may be helpful to guide you on your diet and exercise routine according to your body type. There are ectomorph, mesomorph and endomorph (usually it is a mix). This is determined by genetic, but lifestyles can help change it to another type.

ECTOMORPH

-naturally thin

-smaller bone structure and thinner limb

-hard to build muscle

-very little fat storage

-fastest metabolism 

usually their goal is to gain weight so they would need high carbs (50-55%), moderate protein (25-30%) and low fat (20%) intake. You should increase 750-1000 calories intake than your usual and try to eat every 2-4 hours

Exercise?
Minimize cardio and do more strength training and compound workout for a toned physique

MESOMORPH

-medium sized bone structure

-athletic body

-fast metabolism and easy to maintain healthy weight

-can put on and lose weight easily

-easy to gain lean muscle

Your goal should be to increase lean muscle, reduce body fat and maintain weight. Hence your diet should be of 40% carbs, 40% protein and 20% fats

exercise?
cardio and strength training

ENDOMORPH

-larger bone structure

-higher body mass and fat cell (esp lower body)

-soft body appearance and naturally curvy

-slower metabolism

The goal should be to reduce weight hence low carbs (20-30%), high protein (40-45%) and moderate fat (25-30%) since they have low tolerance to carbs

Exercise?
Low to medium intensity cardio with strength training to shed fat


Tips To Lose Those Extra Pounds




1. control food intake

This is important as food contributes the most to your body weight. According to the ‘rule’, losing weight requires 80% diet and 20% exercise. Logically speaking, it will be easier to burn calories if your calories intake is smaller. For example, an hour of running burns about 600 calories and an average lunch might be around 300-600 calories. So, if you eat lesser then you will be able to burn the extra calories including your lunch yeay

To start controlling might be hard at first, but once you do it consistently, then your appetite will get used to it. Don’t starve yourself because this will make your body adapted to it and slows your metabolism. Instead, try to eat healthier (more greens, less sugar etc). You always have a choice even though in Malaysia there’s nasi lemak,teh tarik and curry.

2. exercise

This will burn your calories and shapes your body by gaining muscle and burning fats. There are a lot of exercises available such as pilates, tabata, and HIIT. Choose whichever that suite your preference or you can switch it everyday. 

In addition, exercise also has a lot of health benefit. It can help to prevent obesity, reduce heart disease risk, prevent osteoporosis etc. If you are too lazy, then you can just walk to your destination or climb the stairs instead riding the elevator. Sometimes a simple changes can bring a huge impact in your life

3. drink water

Drink lots of plain water. You don’t have to buy those supplements or detox thingy as it is not necessary and you can’t be sure of the safety of the ingredients. If you have a hard time drinking than make some infused water. You can also make soups or eat watery fruits to increase your water consumption. Don’t limit yourself. Be creative. Be hydrated. Oh ya, when you are hydrated, you may also reduce wrinkles and appears younger (read that somewhere haha)



4. avoid fast foods, processed and junk foods 

These food contains a large amount of preservatives and sodium chloride aka salt. Having too many salt may lead to high blood pressure, plus the nutrition in these food might be lacking. Try to eat more real food or something that you make from scratch. Homemade food also means you know every ingredients you put into it and you can be sure of the cleanliness.

5. reduce sugar intake

sugar is like the biggest culprit in weight gain. It looks so innocent yet has a high impact. Too much sugar can lead to diabetes mellitus and obesity. Reduce your sugar intake or replace it with stevia or honey. Oh, sugar also appears to make you look older (this makes me reduce my sugar intake haha now I can’t take food that is too sweet). 

6. minimize stress

When you are stress, the fat usually portrays this by accumulating at the midsection. In addition, certain people tends to eat more when they are stress ( I eat lesser) as your brain thinks food can help to soothe some headache from the stress. Usually they would grab something sweet like ice cream or chocolates and this will lead to weight gain. Then, you got stress for those extra pounds and you end up eating again. Cut those vicious cycle by managing your stress by exercising hehe 

7. find your motivation

Find something or someone who inspires you and make it as your burner to lose weight. It can be anyone who fits your beauty definition. Motivation is important to make you determine throughout this process as it takes time and you may get tired along the way.

8. Stop obsessing over the scale
The numbers might increase slightly (muscle growth) or decrease slowly, but don't worry about that and focus more on the visual effect you see on your body. The numbers will get down eventually so don't worry much and focus on your workout and eating habit okey


That is all for today. Merci beaucoup and see you on the next topic