Resuscitation Trolley

AIM:
To enhance awareness among nurses the importance of continously maintaining efficiency of the resuscitation trolley in Paediatric Units

OBJECTIVE:

To determine compliance and non compliance among nurses in maintaining efficiency of resuscitation trolley.

STANDARD STATMENTS:
All nurses must be ensured that all the equipments and drugs are safe and ready to use.

Purpose:
It is the purpose of cardio pulmonary resuscitation and management of other emergencies in the Paediatric Unit.

All nurses:

1. Are required to be familiar with the location, contents and operation of equipments and supplies on the resuscitation trolley.
2. Will participate in checking the contents of the resuscitation trolley and ensuring daily checks of the resuscitation trolley.
3. Maintaining the cleanliness in the resuscitation trolley
4. Responsible for restocking after use as soon as possible
5. Ensure the placement of resuscitation trolley in the appropriate area
6. To ensure twice a day checks by staff who are assigned the defined task
7. To ensure all staffs awareness of the location and purpose of the resuscitation trolley.
   

What is the neonatal unit?
The neonatal unit provides expert, around-the-clock care for newborn babies who are ill or born prematurely.

NICU~Neonatal Intensive Care Unit (for the most seriously ill babies)

SCBU~Special Care Baby Unit (for babies who are not critically ill but still need complex care ie. catching up on growth and development after a premature birth, or those who are getting better after more complex treatment)

Why does my baby need to be here?
Like all newborns, premature babies have basic needs:
To be kept warm
To be given fluids and nourishment

Premature babies need extra help. For example, its harder for them to stay warm because their bodies aren't fully developed yet and they can't regulate their temperature. A special cot (an incubator) can help with this. Babies who are too small, weak or immature to feed can receive fluids and a special nutrition mixture through a drip. Or they might need a tube that carries milk into their stomachs ( through OGT- oral gastro tube feeding via syringes).

Premature babies also need extra monitoring, treatment and care because their bodies are not fully developed yet. They are vulnerable and can have serious health problems. Some of the common problems associated with premature birth are:

• Breathing problems/difficulties
• Bleeding in the brain
• Heart problems
• Gut and digestive disorder
• Eye problem ie ROP (Retinopathy of Prematurity)
• Neonatal jaundice
• Anaemia
• Infections

Who will care for my baby in the unit?

On the neonatal unit, a skilled team from different professions will care for your baby. Some of the people you may meet include:

• Staff and specialist neonatal nurses
• The senior nurse in charge of the unit (the sister or unit manager)
• Consultant paediatrician or neonatologist
• Other specialist doctors such as surgeons
• Physiotherapist
• Radiographers who take x-rays and scans
• Dieticians who advice on nutrition
• Pharmacists
• Nursery nurses
• A social worker to help you with family issues and support that might be needed after your babies goes home.

Last but not least, there's you, the parents. You know your baby best and are always her most important carers. The professionals will recognise this and treat you as part of the team. Neonatal units are open 24 hours a day for parents to visit. Others have more restricted visiting hours. Don't forget that if you're not at the hospital, you can call the neonatal unit anytime, day or night. Allways ask queations or talk to the staff about any worries you may have.

What are all those machines and tubes for?

It can be scary to see your baby attached to all sorts of machines. It can make you feel that you will never be close to her. Be reassured that as your baby gets stronger, she will need fewer machines and it will be easier for you to hold her and care for her. Some of these machines also have loud bleeping alarms and it can be frightening when they go off. Don't hesitate to ask the nurses if you don't know what an alarm means, and whether it's anything serious.

Here is some equipment you could see in a neonatal unit:

Baby warmers
Incubator: A special cot that keeps your baby warm and sometimes controls the moisture level (humidity) around her. Some incubators have lids, some don't. Some have overhead heaters.

Monitors
Vital signs monitors: Various machines might be used to keep tract of your baby's heart beat, breathing rate, blood pressure and temperature. Wires from the monitor are stuck to your baby's chest with pads (electrodes). The monitor alarms can sound off quite often.

Blood saturation monitor: This measures how much oxygen is in your baby's blood. It might be strapped to her foot or hand (sensor).

Help with breathing
Ventilator: If your baby is very premature or weak, she might need a ventilator to help her lungs do the work of breathing. This machine pushes air into the lungs, through a tube that has been passes into the windpipe.

CPAP (continous positive airway pressure): Some babies can breathe on their own with help from the CPAP machine. It gently inflates the lungs and helps keep them open. Air goes in through a mask or via tubes in your baby's nose (called a nasal cannula)

Tubes
Drips, lines and cathethers: Tubes are placed in your baby's veins to deliver fluids, medicines or nutrition. Tubes are placed in her arteries to test her blood pressure or oxygen levels (through radial line or umbilical arterial line/catheter)

Infusion pump: This machine makes sure that medicines and fluids are delivered into your baby's veins at the right rate and speed eg. 15 mls over 1 hour

Feeding (gastric) tube: Babies who are well enough to receive milk are fed through a tube into their stomach. The tube goes in through their mouth or nose.

Special lights
Phototherapy lights: Many newborns have jaundice. Their skin turns yellow because a substance called bilirubin builds up and cannot be excreted fast enough. A special light helps your baby to convert the bilirubin to a harmless substances until she can do this for herself. Your baby is placed under the lights and wears a mask to protect her eyes.

How can I help my baby while she is in the unit?

Your premature baby needs all the things that other babies need from their parents. Your touch, your voice and your presence all help a great deal. There are many things you can do to help your baby while she is in the neonatal unit:

Kangaroo care:
Once your baby is strong enough, one very good way to help her development is called kangaroo care. You simply hold your baby against your chest. Kangaroo care is soothing for your baby, and can improve her health and development.

Feed your baby:
As your baby gets stronger you can start feeding her, too. If you're keen to breastfeed let the nurses know and they should make every effort to help you with this. They should help you to express your milk in the early days before she is strong enough to breatfeed. The expressed milk will be stored and used to feed her when she is ready.
Giving your premature baby breast milk can stimulate her immune system and help her to fight illness. It's not always easy to breastfeed when your baby is premature, for all sorts of reasons, and especially when you are stressed and worried about your baby. So do make sure that you get lots of help and support.

Do the usual baby care tasks:
It may take some time, but as your baby gets stronger you can start doing all those ordinary things that most parents take for granted. like changing her nappy and giving her a bath.

Speak up for your baby:
Like all parents, sometimes you have to speak up for your child and be their advocate. If you think something is wrong, trust your instincts. Talk to the staff. Don't be afraid to ask questions, voice your worries or seek improvements.

Look after yourself:
The most important thing you can do for your baby is look after yourself. Get some sleep, eat healthy food, and take a break from it all. It's exhausting having a baby in the neonatal unit, especially if you have other children or if you're recovering from a difficult birth. It's natural to put your baby first but don't forget to be good to yourself, too.

When can my baby come home?

It's hard to say because all babies are different. It depends on their condition. Babies who are smaller and those born sooner tend to have more problems. Generally, a premature baby who is otherwise well usually stays in the neonatal unit until around the date she was due to be born (usually when the baby reached 1800 grams and the corrected age is 36 weeker). If your baby is feeding well and gaining weight with no other problems, she may be able to go home earlier than this.











Infusion

Weekend, macam kan santai saja padahal banyak kan wawa sasah n terikah baju di kulapis. Tadi bagas bawa Danish lepak sambil makan di wywy lambak ada access internet dsana. Pas tu otw balik kan kekulapis, singgah lagi ke library s'kurong, danish kan buat homework disana. Kan tanya jua siap kah sudah kad ahli wawa. Sampai sana jumpa ka kathy staff CDC...wah buat kraja clinic kah...Hmm rajin ka kathy. Rupanya mela call me several times kan bawa jalan jalan, tapi malas jua. Ntah masane malas nda mood kan jalan jalan wit frens, my good frens kan bawa jua last time, padahal kan show paper court yang ia tulung check kan....pun wawa malas. tapi kalau buka internet suka wawa, release tension. Kadang nda terasa jua bejam jam wawa dapan laptop ani. Rajin ke wywy s'kurong pasal last time kan masang broadband apa di kulapis...nda dapat access. Kan ke easiway s'kurong branch, nda tah jua ada access...boring tia jua. Adib pun sama suka melarat be facebook n begitar...biarkanlah maybe atu tah saja penghiburnya. Kadang bagi wawa sasak jua, kalau solat n study sanang jua hati wawa maliat. Wawa nda minat facebook, tapi sangat suka blogspot, jamu mata liat liat blogspot orang lain colorful n macam macam designnya....sungguh kreatif. Leka menaip, wawa cari dimana abang danish takut ia keluar....toleh danish asyik baca buku komik usulnya ...kumat kamit mulutnya tapi...oopps!..danish melimpang atas sofa library...Eeee!..danish ani baik jua nda kana tagur oleh librarian hehe. Masane wawa cuba try shopping online....siuk jua mencuci mata liat kadai kain, bakery etc. Lawa lawa sulaman n cupcake kiut miut....sampai dijadikan komersial...online shopping. Hahaha kalau baca buku Irfan Zikri pasal jutawan internet siuk jua......hmmm macam rasa kan cuba bisnes online....buang tension hehe. Kalau semua lah buat bisnes melalui online ane...alamat banyak tia tutup kadai n banyak penggangguran..adui!...dan lagi rumah pun jadi office. Bila bisnes sudah berkembang,...alahai macam durian runtuh n bernasib baik...sampai ada yang berhenti kerja, sanggup melapaskan jawatan tinggi semata mata kan fokus kapada bisnes yang jauh lebih menguntungkan. Alhamdulillah....

Hmmm biasalah namanya wad intensive care unit (NICU) plus special care baby unit (SCBU)....manang tangan, lapas satu, satu then ada lagi kraja yang teroverlap. Mesti buat yang "priority" dulu~ buat dulu yang urgent/stat. Palagi jadi nurse yang incharge stock n equipment ani awal awal pagi before 8am sudah mengorder routine wad list~ cek dulu dalam compartment setiap ubat ubat dalam trolley cukup kah inda tau jauh berkurangan. Hmmm let me recall my memory ingat ingat lupa jua tapi ubat intravenous yang selalu kana gunakan ie Calcium gluconate, potassium chloride, magnesium sulphate, dopamine, dobutamine masuk through intravenous (IV) line~ either peripheral line, long line atau umbilical venous line (UVL/UVC). Heparin goes to arterial line ataupun umbilical arterial line (UAL/UAC). kadang baby yang very ill need TPN (Total Perenteral Nutrition) usually goes through long line which is contain Lipid n Nutriflex. Common medication such antibiotics given like Netilmicin n BenzylPenicillin (crystapen). Others Aminophylline, Augmentin, Fortum, Zinacef, Flagyl, Metronidazole, Indomethiacine, Netilmicin, Phosphate sandoz, Ranitidine, Rocephine, Imipienam(Tienam), Unasyn, Atu baru treatment room, bilik untuk menyimpan ventilator n CPAP (Continous Peep Airway Pressure), ABG/CBG (arterial n capillary blood gases) machine lagi mesti di calibrate. Serum bilirubin machine lagi to analyse blood which is taken from jaundice baby yang need phototherapy. Segala pencuci n for dusting apa like hibitane n hibidil, chlorhexidine, cidex, methylated alcohol, povidone mesti jua dicek karang apa kan pencuci untuk our equipment such as ventilator/CPAP bagas bepakai, syringe pump/syringe driver, oxygen jar, ambubag, suction catheter, segala tubings, headbox, head shield, cot, incubator, resuscitaire etc. Lain lagi order sabun, lotion/cream tuk baby such as baby bath, dropolene, KY jelly, white paraffin ointment tuk moisturise baby skin yang kulitnya kering, zinc oxide cream tuk nappy rashes. Masa ani alhamdulillah, amah sudah dapat send sterilising equipment to CSSD macam inducer/airway, masks apa. Instrument yang bagas pakai like umbilical catheter set, sterile scissor, ventilator parts apa, all instruments send to MICU (Medical ICU). Daily order macam cotton, gauze, top n tail, orange stick, spatula, crepe paper, dressing pack, suture pack, suture removal set, hand towel etc pun mau jua. Eye pad mesti jua kan diantar ke Linen kan dijahit dijadikan kacamata hitam untuk menutup mata for jaundice baby kasian baby silau karang matanya masa baby on phototherapy treatment (lampu biru). Paling penting have to check every shift "Emergency Trolley" riuh karang...Masa ani emergency trolley mesti di audit supaya sentiasa always get ready beguna dimasa saat saat kecemasan. Lawa udah emergency trolley~colourful ceria jua our environment. Ada 5 drawer. Ist drawer tersimpan ubat ubat yang digunakan bila didalam keadaan critical macam Adrenaline, Metroclopromide, Heparin, Adenosine, Konakion (Vitamin K), Indomethiacine, Losec etc...Prostin disimpan dalam fridge. 2nd drawer,disimpan ETT (Endo Tracheal Tube) ada size 2, 2.5,3, 3.5, 4 according to age. Offcourse untuk premature (preterm babies) pakai size 2 or 2.5. 3th drawer tempat menyimpan laryngoscope with straight or curved blade size 0, 00 n 1, cek ada battery kah masih, plaster doudenum n white plaster to secure ETT position. Dalam drawer ani jua ada mask digunakan masa ambubagging, ada inducer/airway jua. 4th drawer, Bone marrow n Lumbar puncture (LP needle), umbilical catheter size 4 for umbilical arterial line (UAL) n size 6 for umbilical venous line or catheter (UVL). Ambubag with reservoir 600ml for preterm n 2600 for term/big baby. 5th drawer, ada disposable/sterilising gloves. hand rub, torch n scissor. Tempat nyimpan bottles 500mls line macam normal saline, heparinised saline, 50% Dextrose, water for injection etc. Ada satu trolley lagi sama jua macam emergency trolley tapi ani khas untuk drainage preparation, long line etc. Dalam fridge ada Survanta for baby yang pakai ventilator, Hapatitis vaccine, Hepatitis immunoglobulin, for eyedrops like Gentamycin eyedrop, Chloramphenicol eyedrop....eyefrop kan di apply ke mata baby prior to ROP screening macam mydriacyl n mimims. Dibilik linen, tempat menyimpan jaundice gown baby, baby blanket, Dr's sterilising gown n disposable gown apa. Pampers pakai buang, parents yang mengadakan. Tapi alhamdulillah, ada jua parents yang masani atau yang dulu anaknya di scbu mengunjuk pampers untuk baby yang ada pada masa ani...terima kasih. Pas tu masuk lagi kebilik store perkakas. Mun habis order ke medical store macam needles surflo, terumo, blades. plaster, 3 way tube, T-connector, medi swab, op-site, syringes, sterile gloves, mask, apron, suction catheter, umbilical catheter, tube feeding, ETT, ventilator set n tubings, humidifier, syring pumps n stand, trans swabs, bottle specimens, extension wire beguna banar kalau baby pakai 3 photo light banyak plug kan dipakai alum lagi masuk plug syringe pump apa. Asal keluar masuk barang saja, mesti tah dicatit dalam bin kad. Disini jua disimpan oxygen flow meter n apnoea monitor to detect any possible lung n heart problem especially in preterm babies due to immature developmental organ. Selalunya, we give them multivitamin, ferrum (iron) n folic acid even during discharge. That is why our preterm babies in paediatric still kana prescribe such medicines. As usual before discharge, baby back to mum in post natal wards or asal saja baby mencapai berat badan 1.8 kg, we give BCG immunisation (pelali), its not vaccination like flu or H1N1 vaccine. BCG selalunya ada scar because it is given sub-cutaneously (under the skin) besungkit way of injection. Atau dalam bahasa kami sampai "nampak bulan"...esok hariraya hehe. Injection given must be on the right arm side. Kalau baby begoyang tangannya, possibility site of injection kan lari, jadinya injection site temasuk kedalam, nda nampak bulan or vaccinenya tambus keluar. So that, good way in handling baby position n the correct way of injection technique is very important. Hampir 2 tahun meninggalkan scbu, wawa a bit confuse pasal dilution nya, walaupun sudah bekursus BCG tahun 2001. Bila kitani not sure, ada baiknya kitani belajar balik dari orang yang mahir dalam membagi immunisation ani. Baik jua ada geng midwife di post natal ward kan minta demo n lapas atu baru kitani membari sendiri. Palagi baibun tah tarus manainda jumpa geng. Baik jua wawa biasa banar dengan diorang ani since wawa stay dihostel masa time students. Dangan wawa bising makan sahur n liat TV sama sama. Diorang pun kadang minta tolong jua minta resite IV either untuk drip atau ubat antibiotics. Atutah sebenarnya keraja "teamwork" disini memainkan peranan. Kerjaya ani memerlukan kitani bekeraja bukan sorang tapi beramai. Apanya...muafakat membawa berkat hahaha....I like tho!

"Mengapa semua menangis?, padahal ku slalu tersenyum. Usap airmatamu, aku tak ingin ada kesedihan". Rangkap kata dalam lagu catatanku lagu melly/ba'im dalam versi mami/danish hehehe. Uh! touching banar lagu atu...mami nangis dangar lagu atu time danish inda ada. Kasih antara anak dan ibu sampai bila bila meski ada kecacatannya, ada timpangnya. Danish pernah bagitau mami supaya mami kawin sama timenya dangan danish kawin nanti. Pasal kata danish, danish ingau hati siapa dangan mami nanti kalau sudah danish kawin hahahaha cali!. Kalau danish kawin, mami sudah tua jua mana lagi ada jodoh. Sedangkan masa ani pun malas mami,...macam really really nda masa saja untuk atu.For me, satu perkara yang maha merumitkan iaitu soal hati. Alahai hati manusia boleh saja berubah dalam sekelip mata, sedangkan membinanya memerlukan masa, full commitment n.....money. Huh!, Hehe ani kan mikirkan hutang bank lagi kan disettlekan. Maybe, some other time tah, atu pun kalau ada really banar banar nice guy, insyaalah~~ Big Ooopps!!... Gunung akan ku daki, lautan kan ku seberangi...milik siapa kah hati ini??....siuk jua lah masane dangar lagu lagu jiwang melayu/inggeris tahun 80an n 90an....terkenang semasa dulu,...hatiku merasa rindu... I swear, by the moon n the sun n the star hehe. Kadang gali hati mami masa mami lagu frust tapi adib sambung lagu "bukakanlah hatimu....." hahahaha macam bercanggah saja liriknya. Alkisah last time wawa jumpa doktor tapi nurse nya tut....kisah dulu masa sekolah ugama. Mula mula malu jua tapi tepaksa jua beranikan diri pasal ia yang assess Dr. Sampat jua becerita as a fren, tanya berapa orang anak bla bla bla tapi im sure ia nda tau my situation rite now n nda mau cerita too personel. Yang wawa tekajut katanya ia masih simpan gambar sampai sekarang...Wow!!.. cayalah.. Wawa sempat tanya, baik nda ada yang berkecil hati?. Katanya dangannya pun suka maliat...buh dui!..maklum katanya gambar masa muda tapi ani berisi tia sudah hahaha!. Wawa respect orang camatu bukan macam ada yang sampai call (ntah dari mana ia tau), nda introduce siapa ia, konon misteri tah tu. Adui! zaman sekarang nda lagi camatu, atu skill lapuk, nda gentleman banar hahaha. Cukuplah setakat ani with my 2 awesome frens, bila datang uri n masalah we bincang sama sama. "sama sama gunung didaki, sama sama turun kelembah sepi, suka duka bersama dirasai...". Nah melarat tia lagi wawa ani eh,...atu lagu wawa masa kawin babu iju last month (masuk dalam carta tu!). Semalam, abang adib tanya wawa, camana boleh wawa lancar mengaji Quran?. Alhamdulillah kata wawa berkat asuhan mulah datu hjh aisyah (my beloved nini)... Datu mengajar mengaji al-Quran dikampung. Hampir semua kanak kanak dikampung atu datang kerumah belajar mengaji tiap malam sampai khatam quran...semoga rohnya dicucuri rahmat..amin. Sampai sekarang kalau tejumpa wawa, kana tagur "cucu nini aji". Alfatihah untuk nini. N now alhamdulillah ada cuzen cuzen yang aktif mengaji sampai keperingkat tinggi n mengajar mengaji jua....Fahmi (pak long) n Fikri (pak ngah). Iatah kadang bari galat rasanya kan beolah nda betantu, really love my family. Dimalam masa wawa kan bawa balik abang adib n abang danish balik kulapis dari lambak, malas wawa kan betudung pasal malam mana jua ada orang maliat. Tapi danish yang merasa kelainan, katanya "mami sudah siap kah? mami camatu saja kah inda pakai tudung?" hahaha padan muka wawa. Thanx danish, ingatkan mami..

Today first day wawa balik semula return back to scbu.Yeah, I know... ada yang tau, ada yang tekajut bagi surprise hehe...ok lah nice to hear them happy sampai nda pecaya hahahaha!....~ Yes, its me...Zur...Ka Zur!. Wah!...Teramat rindu suasana scbu nearly 2 years ninggalkan, nda yang berubah kecuali ada decoration sedikit didinding ada lampu warna warni apa. I know i love scbu very very much hati tetap pada yang satu ceewah!. Mula mula dangan college mandikan baby..hmmm rindulah pegang baby!...really love them..anugerah dan amanah tuhan yang tiada ternilainya. Ka zur,...disini kita??. Siapa itu?. Eeeh Amy anak ex-staf kami kajah nualam pun ada attachment disini. Waaah!..meriahnya scbu!. Au ah banar jua banyak my junior staf yang ampir hari menunggu hari saja lagi kan beranak hehe...macam be edar pas sorang sorang, alhamdulillah. Siuk cali liat diorang bejalan cool n pelahan saja sambil senyum senyum. Selalu jalan laju laju palagi masa time cbuk. Wah!..ada staf baru, coool!. Tibalah wawa kesuatu bilik tempat simpan ventilator machine...liat mesin ventilator/CPAP yang baru, tepaksa study dulu. Iatah yang kan wawa handle tu have to familiar wit semua equipment supaya senang macamana kan memasang tubing n humidifier nya. Mesin blood gases (ABG/CBG) n bilirubin meter brain wash lagi how to operate. Wawa soak n pasang tubing mesin SLE. Paling canggih mesin HPV yang high pressure especially for baby yang very ill. Sempat ambil barang di medical store...siuk jua kraja SE ani tapi ngaleh tejalan kesana kemari. Yup ngalih, kadang curi curi masa dangankan college buat kraja ie cucuk jelco, ready resuscitaire or cot, ambil photo light for baby kan admit dari labour room, OT labour room n some from postnatal wards. Hmmmm..kenangan dulu mengusik hati masa wawa taliat kain sarung bantal damit for sand bag yang wawa bawa suatu ketika dulu masih belum kabur warnanya. Jua bakul dikitchen tuk nyimpan piring cawan...rawan hati wawa..dulu wawa bawa didalamnya barang makanan minuman sedekah wawa selepas abang Danish lahir...sudah masuk 7 tahun tapi masih tahan!...Pas tu wawa kebilik linen atur cadar n blanket baby, lagi sekali hati wawa.... Aaaduuuh!..terlalu banyak kenangan disini. Kenangan wawa teantuk antuk bagi feeding baby masa keraja malam. Dimana wawa lepak sambil makan minum liat decorder sewaktu kerja malam wit Elo, hjh Amina, Laurie, Amy, Ajitha, Nomita n michele...really miss u all guys...Kajah nualam n ka dk salbiah (sudah pencen),yang banyak membantu semasa wawa mula mula karaja dulu. Paling wawa sebak masa wawa turun tangga dibelakang scbu, sempat wawa menoleh beranda dimana wawa senyum senyum menunduki kreta dibawah, gagas kan turun balik sewaktu dangar takbir hariraya dari masjid Omar Ali Saifuddin....OOhhh! sungguh indah kenangan atu..bilamana wawa disambut dengan senyuman ehem masa kan masuk kreta,..ah!..hilang rasa lelah wawa masa atu...abang Adib masih damit dalam kreta ketawa tawa liat wawa. Hati digamit bagai ingin sekali lagi mengulangi saat saat atu...kenangan terindah!!!. Walaumacamana pun, wawa inda kan lupa pengalaman bekerja di paediatric clinic....miss ka Teo, ka dk maidah, ka mas dangan wawa ambil barang barang...sampai ka Inah di scbu pun wawa tepanggil ka mas. kajah zainun...jangan berhenti menyanyi untuk ku hahaha.., ka sunah...thanx for ur support during my tough time hehe. Not forgetting siah,..dont cry daleng, see u some other time. We still warga RIPAS,..tak kemana, nanti jumpa jua...Kuatkan hati dan semangat..I know u can do it!. Rindu jua Dr hjh n others....tapi sempat ambil gambar gambar di paed for rememberance.

What u need is only B$380...No meeting! Need 2 downline saja then help ur downline to get another 2 downline through briefing regarding the process n the benifit in joining this helpful financial plan throughout ur life!!..

A year older, a year wiser. Hmmm...2 years before 40 (age is just a number)...Kalau sudah nanti 40 years old,....Life begins at 40...hahahaha betul..betul...betul. March 22nd, the day i'm waiting for... Kata orang "cintai dulu diri sendiri, baru dapat mencintai orang lain"..Iakah?..sounds macam selfish jua tapi ada jua banarnya. Bila kita menghormati diri sendiri, automatically orang akan menghormati kita, insyaallah. My birthday wish??....I wish...setiap yang di plan akan berjalan lancar, amin. Hopefully, before 40, masalah akan berkurangan dan mudahan mentari akan terus menyinar, insyaallah. Actually today nda kan wawa plan, cuma kan jalan-jalan sama adibdanish saja. Tapi tadi nini bini mau kami berkumpul bersama sama......patang makan ambuyat hehehe...Sibuk tadi dikulapis menyasah n menarikah n cuci-cuci. Datang lambak,...wah!!!..banyak sudah kreta parking. Hepy banar wawa maliat anak-anak buah wawa main main mandi dalam 2 kolam basar. Danish apalagi terus tukar baju seluar kan join mandi sama-sama. Didapur sibuk nini bini menyiapkan makanan. Baik jua ada bibi Eis sama bibi Adi mendangani nini. Mami dangani mengusai ngusai barang..iatah favourite mami tu suka mengusai ngusai tapi kalau bab memasak, hmmm refer tah ngangah imah..terror masak tu. Time makan, siuk tah becerita itu ini, baibun n menyakat hahaha. Hmmm, pendek kata soalannya, bila wawa kan ada 'dangan' lagi??. Hmm rasanya nda lah,..single n happy bah!..hahaha. Jara n fobia masih, may be jua. Not anti lah, becos not all of them beperangai buruk kan, yang penting nawaitu sorang sorang. Secret admirer saja,..cukup tah untuk jadi semangat hahaha. I dont think sampai kan serious. Takut pada commitment n risky jua. Nda tau lah dimasa akan datang...No Promises hehe. Yang penting, I have my family yang really supportive, memahami n mau menolong disaat wawa kesempitan baik dari segi masa dan kawangan. I really love U all...Asai n family, Ngangah Ina n family, Ngangah Imah n family, Ngangah Izul n Family, not forgeting Mamit n teman....Yo mamit!..Uda zaki n Amit padli n Usu...masing-masing wit teman. Semoga kitani semua dipeliharakan dan dilindungi Allah selalu,..Amin. Thanks for coming!!..We celebrate today tarus birthday Asai laki jua....Hepy birthday Bro!. Really love all my nieces n nephews....Abang Wazif, Kaka Zihah, wahidah,.Rizqa my Pooh, Damia....lawa rambut mia, wawa suka liat. Irfan today nda, ngangah zul karaja kali ia. Thanks nini, sibuk masak masak. Thanks to nini laki jua, the first person yang ucap happy birthday to wawa hehe. Pertengahan makan, wawa rindu abang Adib balum balik balik lagi. Ndapa baik saja ada Danish...Last last tekajut wawa liat ada kreta merah yang wawa familiar masuk diperkarangan rumah. Mungkin adib mau ambil baju seluarnya atau.....mau ambil Danish????...Nda lama, nampak Adib keluar dari kreta bawa bag laptop n gitarnya. Ahhh, alhamdulillah at last doa wawa dikabulkan...Adib balik dihari jadi wawa. Sempat jua TER lihat ia menoleh kanak kanak mandi dikolam. Danish pun masih bemain main siuk dengan abang wazif nya, nda ingau usulnya. Diorang dua ani bestfren bila bejumpa...hmmm....Yang wawa gali hati, Rizka marah liat ulah abang danish sama abang Wazif ..katanya kaka zihah bagus nda bising hahaha. Pooh..Pooh.... Hopefully, kitani akan lebih berbahagia di masa masa akan datang..., Amin!!.

Hati mami gelisah, tapi alhamdulillah tenang selepas solat... Adib nda disisi mami. Semoga adib sihat disana walau mami tau adib kadang nda happy...atu yang adib bagi tau mami. Mami nda boleh buat apa apa sayang...he's your dad. Nda pun pernah ada niat mami untuk misahkan antara keduanya walau hati mami disakiti. Seharian ani ingatan mami dikuasai akan kehilangan anak anak mami. Tapi mami mau anak-anak mami tau...nda lain dihati mami selain kalian. Nda pernah mami mensia siakan anak anak mami selama ani,...adib pun tau, danish pun sudah faham. Segala keperluan semampu mami adakan, walau sangat susah, sangat payah...meski tanpa ada bantuannya. Nda pernah pun adib danish belapar,....balik sekolah mami tanya, adib danish balikan apa duit mami bagi tadi?. Mami nda mau anak-anak mami belapar palagi disekolah yang memerlukan tenaga otak dan badan yang sihat. Mami nda mau adib simpan duit belanja makan minum sekolah tuk keperluan lain. keperluan lain biar mami yang mengadakannya nanti. Balik sekolah, anak anak mami dahaga lagi...."mami, karing leher adib",...."mami, danish kan bali minuman". Nda pernah mami sampai hati meniadakan walau duit syiling dalam kreta dalam bag mami kumpulkan. Maunya mami bawakan botol minuman yang sudah awal disediakan atau minuman kotak milo yang sudah disejukkan dlm esbok....jadinya save sikit belanja bayangkan kalau hari hari cmatu. ...."mami,...adib kan bali nasi siring kadai".....ehehe adib.....adib, padantah adib ani jadi badannya, kadang nda cukup mau jua 2 kotak. Danish lain sukanya green tea saja. Lain lagi lapas balik sekolah ugama..."mami,..adib kadai kajap mami". Eee anak anak mami ani sehari sudah berapa belanjanya, tapi kalau pasal makanan nda mami sampai hati, takut kepunan. Pasal makan minum nda pernah mami menyakat, tapi kalau kan bali dvd games saja palagi kalau balik balik bali cerita/game yang sama...kan membazir. Mami pernah liatkan adibdanish di Tv real story cmana kanak kanak lain nda tempat tinggal, nda cukup makan minum, nda cukup pakaian palagi pelajaran. Ada yang damit damit sudah keraja jaga adi adinya yang ramai....kasian kan??. Jadi jangan membazir. Adibdanish pernah liatkan ada kanak kanak memutik makanan dari sampah..."eee! kasian mami ah?..., karang sakit parutnya tu mami"...Adib pernah sendiri liat kan masa kitani dulu di hongkong sama di pilipin,..ada kanak kanak jual bunga banang, mainan yang nda seberapa tapi unik sampai adib ketawa.....hehehe. Adib marah mami bali bali saja tapi untuk apa. Mami saja kasian liat, yang mami suka kanak kanak atu bukan teminta minta tapi jual bunga apa untuk megalas parutnya.. Lapas atu mami nampak lagi ada bini bini jual barangnya sikit tapi anaknya banyak keliling pinggang kan?. "Eeeh mami ani singgah tia lagi membali padahal arah lain lagi lawa barangnya". Hehehe besungut lagi adib sama daddy masa atu. Bukan apa kasian mami liat banyak anaknya....yang anaknya satu atu macam sakit lagi usulnya. Mami pernah marahkan security dikadai supermarket landmark di pilipin. Adakah patut dimarahkannya kanak kanak yang jual-jual atu suruhnya lari jauh jauh. Apa salah kanak kanak atu, bukan jua mengacau orang, ganya menjual bunga dan mainan untuk membeli makanan mengisi kelaparan parut sendiri~daripada teminta minta. Dui, lamah bangun kanak kanak atu tapi nda menangis kana marahi. Semoga kanak kanak atu semua dilindungi dan dirahmati tuhan...amin. Mami selalu cakap "Hormati orang tua, kasihi kanak kanak". Danish kan masuk 7 tahun, macam biasa at this age banyak tia gigi dapan danish tumbang hehehe..."mami, karang danish inda ada gigi lagi, camana malu danish eeh!" hahahaha. Cali usul danish nda gigi dapan. AAhhhh....I really love my 2 kids whatever it takes!!. Kadang mami marah marah kalau adib belaptop saja, kalau nda ada homework pun baca buku dan sembahyang~belajar kalau dapat panuhkan 5 waktu. Kadang confuse mami bezakan jadikan kawan dan tegas arah adib. Adib sudah basar panjang, mami suka adib share cerita sama mami n alhamdulillah mami open minded jua. Mami pernah jadi remaja sama macam adib, tapi mami nda suka kalau adib leka dapan laptop dapan Tv sampai lalai pelajaran dan solat. Danish pun mami marahkan jua selalu liat malas malasan kan bangun mandi, nini bini pun taukan perangai danish ani. Mami marah ada sebabnya, I just want u all tau,..semuanya tuk kebaikan adibdanish jua. Selagi mami masih ada, insyaalah mami maukan, mami doakan yang terbaik untuk keduanya, amin. Sudah bertahun bersama mami, walau satu pihak sudah mengabaikan...anak anak mami umpama patah satu sayap. Fitrah manusia memang semua maukan kebahagiaan, masalahnya bila dikhianati dan berterusan disakiti siapa pun akan hilang kesabaran dan kehormatan terhadap seseorang.....Tapi Insyaallah, satu hari adib kan faham dan mengerti. Harta mami yang kekal dan paling berharga hanyalah "adibdanish". Masya allah, sungguh mempunyai hati yang busuk dan jahat akal orang yang ingin memisahkan. Cukuplah akad talaq,...tapi anak anak tidak sekali kali ku redha untuk melepaskan!!!......Apakah wajar setelah 5 tahun tanpanya, susah senang, sakit demam anak anak tiada dipeduli. And NOW!!,.....tanpa malu malu, ingin mengambil anak anak!?. Dimana dirinya sewaktu anak anak memerlukannya??, memerlukan perhatiannya??, memerlukan makanminum??, memerlukan perlindungannya??, memerlukan belas kasihnya???.....Hah!!...Ya Allah, peliharakanlah, lindungilah, kasihanilah, dan kurniakanlah kepada aku dan anak anakku rahmat dan keberkatan daripadamu jua...amin..

Antasid adalah kumpulan ubat-ubatan yang digunakan untuk merawat masalah penghadaman (indigestion), perut yang kurang selesa selepas makan makanan terlalu banyak, sakit atau pedih ulu hati (heartburn) dan penyakit ulser peptik. masalah tersebut adalah disebabkan oleh kandungan asid didalam perut yang terlalu tinggi. Antasid bertindak dengan mengurangkan atau menseimbangkan kandungan asid ini.

Jenis-jenis penyakit gastrik dan ulser yang sering didapati:

1. Pedih ulu hati (heartburn)
2. Refluks gastroesofagus (gastric Reflux)- kandungan asid yang mengalir balik dari perut ke bahagian bawah esofagus
3. Dispepsia (Dyspepsia)- ketidak selesaan bahagian perut selepas makan
4. Gastritis- keradangan (inflamasi) pada bahagian lapisan perut.

Ubat antasid boleh didapati dalam bentuk 'tablet' dan dalam bentuk cecair. kedua dua bentuk ubat ini mempunyai kesan yang sama. Ubat antasid cecair mungkin bertindak lebih cepat dalam melegakan simtom tetapi rasa kapor ubat berkenaan boleh menyebabkan ianya kurang digemari. Ubat tablet antasid pula perlu dihisap atau dikunyah dengan perlahan sebelun ditelan.

Jenis antasid yang terdapat difarmasi kerajaan,

1. Ubat "tablet' Antasid contoh Gaviscon tablet dan Hydrosil tablet.

Ubat ini diambil selepas makan dan sebelum tidur.

2. Ubat Antasid cecair contoh Gaviscon liquid, Polysilic iii liquid dan Eviline Forte

Ubat ini diambil selepas makan dan sebelum tidur
peringatan: Jangan berbaring serta merta selepas mengambil ubat ini.

Berbagai produk dengan berlainan jenama terdapat dipasaran. Dosnya adalah mengikut panduan atau arahan yang disarankan bagi produk berkenaan.

Kesan Sampingan:

Kadangkala ubat antasid boleh menyebabkan kesan sampingan seperti kekejangan perut (stomach cramp), rasa mual, muntah, sembelit dan cirit birit.

Peringatan dan Nasihat:

Sila jumpa doktor awda sekiranya simptom awda berlarutan lebih dari 2 minggu setelah mengambil ubat antasid.

Sila beritahu doktor awda sekiranya awda mempunyai penyakit buah pinggang.

Elakkan daripada mengambil ubat-ubatan seperti zat besi dan ubat Tetracycline sekurang kurangnya 2 jam sebelum dan selepas memakan antasid. Ini disebabkan antasid boleh mengurangkan keberkesanan ubat-ubatan tersebut.

Makan makanan yang seimbang 3 kali sehari (sarapan, tengahari dan malam) dan elakkan memakan makanan yang tidak berkhasiat.

Elakkan faktor-faktor yang menyumbang kepada masalah penghadaman dan pedih ulu hati seperti:

1. Makan terlalu banyak
2. Mengambil makanan berlemak, berempah dan pedas
3. Minum alkohol, kopi, minuman ringan bergas
4. Makan coklat
5. Buah-buahan sitrus dan jus atau produk tomato

Mendapatkan rehat yang mencukupi dan mengamalkan cara hidup yang sihat untuk mengelakkan daripada tekanan.

Last sunday, we attend forum di lecture theatre, RIPAS. Our guest from Paediatric Hospital KL (Paed Haemo-Oncology) iaitu DR Hisham Shah, Md Ibrahim.

First, apa yang kitani tau mengenai Penyakit Thalasaemia??
Its a commonest haematological problem in our community.
A medically debilitating disease,
Life-long blood transfusion,
Expensive medications,
8-10 hours injection daily for 5-6 days a week,
Multi organ complications.

Therefore, Public awareness of the disease is very important.

Types of Thalasaemia:

1. Thalasaemia carriers ada 2 jenis iaitu Thalasaemia Minor dan Thalasaemia Trait
2. Thalasaemia Major

Age at presentation:
<1 year - 62% -75%
1-2 year - 29%-35%
>2 year - 9% - 11%
(Modell & Berdoukas, 1984).

Sign & symptom:
Pallor
Easily tired
Loss of appetite
Disturbed sleep.

Treatment:

1. Supportive Therapy; Blood treatment, Iron chelation Therapy.
2. Curative Therapy; Stem cell transplantation.

Organ system susceptible to iron overload:

Pituitary - Impaired growth
Heart - Cardiomyopathy
Liver - Hepatic Cirrhosis

Desferal (Desferrioxamine) given via injection 5-6 days/week by injecting needle under the skin for the rest of their life....Life long...
Side-effects:
Local infection
Abscess formation
Erythema

Thalasaemia SET.....More expensive but safer than using butterfly needles.

Tablet (Desferasirox) taken once daily...but expensive.....

Haemo-Stem Cell Transplant:

1. The only curative option
2. A form of gene therapy
3. Replace defective hematopoietic system from healthy compatible donors

Cure VS Death:
Gene therapy ~ Ultimate goal to cure genetic diseases.

Can we prevent Thalasaemia???
In the West, they prevent further thalasaemia.
In our country?...By giving transfusion and offer chelation.

Thalasaemia prevention & control programme;

1. Screening
2. Detection
3. Counselling

Prevention programme - most successful in Med-countries.
In Cyprus:

1. Confidential premarital screening mandatory
2. 98% at risk couples detected prior to marriage proceed to marry
3. At risk couples having fewer children and utilise prenatal diagnosis
4. Screening also done in high school.

Antenatal diagnosis selective abortion: (8-9 weeks)
Amniocentesis
Chrionic Villus sampling
Cordocentesis.

PGD ~ Pre-implantation (retrieve several ovums)- genetic disease blastocyst by;
Induce ovulation
IVF
Biopsy 1-2 cells
Introduce healthy embryo/embrios.

Can we abort thalasaemia baby?
Ethically??
Religiously wrong??
Non-maleficence- first do no harm
Beneficience.

When does life begin?...After 120 days??

Ethical Issues..
Antenatal diagnosis
when does life begin
Abortion- In whose interest?, Life VS no life
Genetic Selection- designer babies, Eugenics.

Among couples...
Considered a social stigma
Relatives/ Illiterate
Wife blamed-menyalahkan pasangan masing masing.


FATWA on Termination~ Termination of pregnancy;

1. 1-40 days- MAKROH (not desirable)
2. Before 120 days- HARUS (permissible) if fetus affected AND life of mum at risk
3. >120 days- HARAM (not permissible)..unless life of mum at risk.
   

Kemarin sunday, March 14th ada wawa attend forum mengenai Thalasaemia. All about Thalasaemia~ Patients, Therapy, Adverse reactions, Its management n termasuklah fatwa mengenainya. Every thursday morning ada clinic khas for Thalasaemia patients. semasa berjumpa doktor, patients n parents ditanya akan hal keadaan pesakit atu. Kadang nampak dari warna kulit, kalau nampak pucat, selalunya turuntah 'Haemoglobin' (Hb) nya tu. Ani dikatahui dari result blood test PRE 'Full Blood Count' which is taken 3 days before appointment. ada yang memerlukan 'blood transfusion' as soon as possible kalau randah banar Hb nya n nampak pucat. Ada yang booking transfusion day awal awal lagi kadang via phone the day before. Booking days Thursday till Monday, 5 orang dalam sehari kadang ikut available katil jua. Mostly pesakit datang with other sibling kadang 3 of them jumpa same day, same time, see same doctor. Kasian jua kalau appointmentnya different day, balik balik parents membawa ke Hospital. Selain FBC, we have to monitor 'Ferritin level' jua every 3 months. kalau tinggi ferritin nya sampai >1,ooo atutah yang bahaya. Ani disebabkan Pesakit nda memakan ubat dengan secara teratur, which is kadang kadang 'Ter miss' tia apa. Banar pulang sakit yang menggunakan through machine pump, tapi ada jua makan ubat betalan. Mula mula doctor n nurses yang ajar cemana memasang, tapi lama kelamaan, parents n patients sudah terbiasa. kadang masalahnya syringe pump jua, tapi dapat dibawa kehospital tuk kan di komplen n repair. Blood transfusion given in wad 3. Wawa minat banar topic ani pasal ada tesangkut hal hal social dan hukum2. Apapun niat kitani untuk mengubati dan berubat. Bear in mind, penyakit ani bukan jenis penyakit yang dapat dicegah, kerana ia adalah penyakit keturunan yang didapati dari kedua ibu dan bapa. sebab atu penyakit ani kadang kadang sensitif isu.

Alhamdulillah, hampir semua kitani berada didalam kesejahteraan, tiada kacau bilau maupun kemiskinan. 'Average life'....kesederhanaan~ cool n practical. Tiada bebanan berat seperti yang dialami sebilangan manusia. Kerana terlalu lebih 'over' selalunya menjerumuskan kita kepada kekufuran dan akhirnya kefakiran...Naujubillahiminzalik...mohon dijauhkan Ya Allah. Sifat kesederhanaan sememangnya sudah dituntut oleh agama kitani yang mulia ini. Dari sifat kesederhanaan, menjadikan kitani lebih berhati hati, lebih menghargai dan lebih mensyukuri segala kurniaan dari Ilahi. Ibarat menaiki tangga, bila diri melangkah dengan sempurna, ada kesabaran dihati dan seimbang dunia dan akhirat...insyaallah kita akan menemui perjalanan. Jika diri sombong, takabbur dan lupa diri apalagi jika sampai membelakangi agama, ditambah pula tersilap langkah.....aduh!, kita akan jatuh ketanah jua....Masyaallah!..Barulah ingat dari mana asal usul, setelah kaki berpijak dibumi yang nyata.

Tadi telalai wawa maliat rancangan TV parabola dilambak yang menceritakan kisah dan teladan...Its life tentang rancah kehidupan yang dirakam secara tersembunyi dari seorang hamba Allah yang ingin mempelajari erti sebuah pengorbanan didalam mentadbir sebuah kehidupan. Sebak hati wawa maliat, hati seorang ibu mudah tersentuh, mudah sensitif!. Nda sadar menitik nitik aing mata maliat. Tapi ketawa wawa jua pasal malu adib sama Usu nampak wawa cry. Al-Kisah seorang ibu gigih (a) dan ibu yang berhati mulia (b)dari negara jiran. Semoga keduanya dirahmati tuhan, Amin. Ibu a yang mempunyai anak 5, yang terdesak ingin membelikan anaknya sepatu (kasut) sekolah kerana anaknya sudah sering diejek kerana mempunyai sepatu yang sudah koyak lagi buruk. Pekerjaannya adalah menjual makanan dijalanan hanya untuk mengumpulkan duit kerana manjanjikan untuk membelikan anaknya sepasang kasut sekolah. Sayangnya, dari pagi hingga kepetang nda ada yang mau membeli jualannya. Mungkin dugaan Tuhan, tetapi Ibu ani masih tidak berputus asa kerana janjinya pada anak yang tercinta. Wawa terharu dengan cara ibu a ani mendekati pelanggan, penuh ramah dan mesra menyapa lembut setiap orang yang lalu lalang sambil ditangannya membawa sebakul makanan untuk didagangkan. Pada satu saat, dagangannya dirampas oleh seorang perempuan jahat yang kurang siuman. Ibu ani tidak pun terdengar jeritannya terpekik terlolong meminta tolong tetapi berlari mengekori sambil berbicara lembut memohon supaya dikembalikan bakulnya. Masyaallah!,...sampai atukah derita yang terpaksa dilaluinya? ...hanya sekadar ingin membeli sepasang kasut sekolah untuk anaknya yang selalu diejek kawan-kawan??, Pipi wawa basah lagi, nda sanggup rasanya maliat cerita selanjutnya....Tekanang wawa kasut abang adib dan kasut danish yang banyak sudah sempit tetapi masih boleh dipakai rasa kan wawa unjuk rasanya tapi apakan daya jauh. Disambung cerita, berkat kesabarannya, bakul makanan jualannya didapatinya dengan pertolongan orang yang lalu dikawasan atu. Di suatu simpang, Ibu ani ditemukan dengan seorang ibu yang berhati sangat prihatin iaitu ibu b. Ibu a merayu supaya kali ani jualannya dibeli kerana sedari pagi hingga kepetang jualannya nda laku laku, tetapi butuh wang untuk membeli kasut anak. Nampak diwajah Ibu b ani sifat keibuan dan simpati dengan nasib malang ibu a tadi. Dengan hanya menjual cacing tanah untuk dijadikan umpan orang untuk memancing, berapa ada sangatlah pendapatan ibu b. Kesemua makanan dibeli dan wang yang ada diberi kepada ibu a dengan ikhlas, meski dirinya jua memerlukan untuk membayar biaya sekolah anak-anaknya. Walau tidak berapa mencukupi, ibu a menerima wang dengan penuh kesyukuran dan sebelum pergi, ibu a mendoakan semoga jualan cacing ibu b ani mudah-mudahan laku. Sebak melihat keikhlasannya, insan yang merakamkan tontonan cerita ani mengunjuk wang kepada ibu b sehingga ia terkejut tetapi berkeras tidak mahu menerima sehingga dipujuk berkali kali.

Niat ikhlas akan dibalas dengan seribu kebaikan,...Insyaalah.

Life is short, so...make it sweet!......Soo Sweet!,..

For me, dimana pun saja dan apapun jenis pekerjaan adalah sama asal kan halal dan ganjarannya mendapat berkah. Kalau bekerja didalam bidang yang sama, dimana mana pun sama jua theory dan practicenya ganya berlainan cabang. Ketahanan hati, kekuatan minda dan spiritual mau tau hehehe. Urat dawai tulang besi hahahaha........ waduh!..waduh!.. kok bisa mencabar gue sendiri gawat...gawat nih!. mata ngak bisa terpejam terpelik, tidur kekiri salah, kekanan jugak sa...lah!. Jadi apa ceritanya....bangsawan diudara errr atau bujang sigandam??..ngak jugak!...begawan solo?...ngak jugak!...laila majnun?...ngak jugak!...seribu satu malam?...ngak ah! ......lalu apa sih??!.

Sebenarnya siapa pun bisa termudah menjadi dirinya begitu sensitif ....aah!..Offended barangkali!...nda kira apa pun puncanya!. Masalah kadang ngak bisa diketerpikan, harusnya digendong gitu!.....kadang, bila kita nyembunyikan sesuatu, wah!..masing masing mau ingin tau banget!!. Tapi bila kita mau cerita sesuatu, semuanya angguk anguk aje, yang pasti dibelakang kita semuanya geleng-geleng ku capi hahaha. Jadi saya setuju banget deh ama lagu yang satu ini......"Kadang, suatu perkara...lebih baik didiamkan saja.....; Kadang mendiamkan diri.., lebih baik dari bersuara!...."

Tapinya lapas atu dituduh pulak marung!, nda mau nagur!,..apa jua kami ani!....Eeehhhhh!....JADI APA SIH MAUNYA???!!....
Nda mau bezakan diantara-antaranya,...waduh ama aja. Manusia kan sebentar bisa jadi malaikat dan bisa menjadi munafik silih berganti atas desakan sesuatu mungkin eyah!.. kalau mungkinnya ngak, ngomong aja ama diri sendiri.....gitu!...ehehehe..

Aduh sudahlah...lupakan aje!..relaks dong!... Apa gue masih bermimpi atau udah berpijak dibumi yang nyata lagi hakiki??... Cubit peha,....aduh sakit!!. Eyah, aku masih sadar nih....
A few weeks to go back to my previous unit..... Thanks to semuanya, banyak pengajaran dan pelajaran yang sudah dicetak!.... buruk dan baiknya harus ditelan...umph!!.. rasanya panadol juga rasa coklat, strawberry, vanilla, mint.... yummy!..yummy!...Tapi masih juga ada harga diri bila diri dimau, diperlu......ya eya lah!...insyaallah bisa buat yang terbaik selagi masih ada kecintaan terkadang masih juga di******** .......ooppps!!!....astaghfirullahul Azim, allahuakbar!!!

Kajap buang stress...

I love Maroon:
Melambangkan kekuatan, kemahuan atau cita cita, sifatnya agresif, eksentrik, berkemahuan keras, penuh ghairah, dominasi dan jantan.

I love Coklat:
Suka merebut, tidak suka memberi hati, kurang toleransi, pesimis terhadap kesejahteraan dan kebahagiaan masa depan.

I love Ungu:
Antara keintiman dan erotis atau menjurus pengertian yang mendalam dan peka. Sifatnya sedikit kurang teliti tetapi penuh harapan.

Hhmmm,....ada jua banarnya tapi ada jua yang nda pasti tapi kebanyakannya lurus hahaha!..
Ambil saja yang baiknya, yang kurang ditingkatkan...umph!..insyaallah.

Hmmm... sudah 3 hari fever on n off. Panadol n tamiflu masih on. Nafsu makan pun nda tantu maklum sakit menalan n telinga bangal n padas rasa lidah. Ehehe baik jua nda bedangan, mun nda nuhun ooppps senyum saja dari jauh jangan nda menghampakan paham paham saja. Glister amway malar wawa spray supaya menyamankan rasa mulut, segar rasanya bau mint. Danish alhamdulillah sekajap saja damam, now ok. Adib kuat antibodynya kadang tutup mulut ketawakan mami takut jangkit hehehe. Eeh jauh hati mami, ndalah viral fever saja. Liur damam ani tekanang menu menu kampung- lauk rabus, tahai tumis, ulam-ulam wow best tais liur wawa. Now lagi time adib coming first term exam year 7. Tadi minta ajarkan mami menghafal suruh al-zalzalah dari wikipedia internet, it works jua..sampai tetidur adib menghafal. Danish esuk macam biasa every saturday ada english n malay dictation test. Tadi ajar danish, semua ia tejawap..mudahan esok masih ingat, amin. Waaw nda dapat tidur, rasa kan minum susu dutch lady strawberry ummph!. Masa damam ani balik balik wawa mandi, nda wawa beguna heater tapi mau jua sejuk ntah mungkin pasal dalam badan panas. Baju pun balik balik betukar mungkin pasal mudah bepaluh. Masani allergic banar wawa kan habuk,kadang tepaksa pakai mask maklum mudah jadi batuk kalau sudah stat selesma. Tidur pun terganggu, tepaksa pakai bantal at least 2 tingkat hehehe teruk jua wawa ani eh kalau damam. Terhibur jua hati wawa tadi liat rizqa 'winnie the pooh' wawa. Sayang wawa anak buah wawa ani rajin menagurkan wawa, ada ada saja ceritanya ngam lah sama danish. Irfan,...wow macam lipas, nda teranah duduk ada ada saja kan dibuatnya. Sungguh camatu manja jua semana mana bepangku arah wawa, menyacah punggung saja lapas atu gauk tia balik. Damia pun ada hehehe makin pintar bekurapak tapi takutkan abang adib, liatnya abang adib panjang basar sudah, suara lagi sudah sangau. Next month adib sudah 12 tahun, muda sudah bujang sudah anak mami ani. Pendiam nda banyak cakap, maliat adib solat n study sudah sajuk hati mami, ganya susah banar hati mami kalau adib be facebook saja takut lalai. Danish, rasanya janganlah capat basar macam abang adib, karang mami nda kawan. Kata danish, mami kawinlah kalau danish sudah basar.....hahaha cali!. Danish suka buatkan mami minuman tea n milo, kadang buatkan abang adib nya minuman. Danish suka kedapur dangankan mami cuci piring, kadang maunya sendiri nda mau mami cucikan. Satu yang mami suka, danish prihatin n pengasian orangnya. ketara bila mami damam, danish selalu disiring mami perhatikan mami. kalau mami susah hati n menangis, danishlah orang pertama menakul mami sambil tanya...."kenapa mami nangis?....". Semoga segala pengorbanan mami akan selalu dihargai oleh anak anak mami, Amin...

Last sunday, sempurnalah majlis persandingan Iju, my cuzen dikulapis. Semoga berbahagia dan sejahtera selalu. Meriah lah jua rumah dikulapis, cuzen cuzen lain turut sama menumpang stay maklum iatah saja ni musimnya beramai ramai bekumpul. Ngaleh jua melayan orang datang but at the same time happy jua lagipun cuti memanjang friday to sunday. Wawa kana standby saja 23hb n 27hb, esuknya lagi beramai ramai iatah lalah terasa kan damam. Adib n Danish bukan main siuk lagi ada dangan bemain game dibliik masing masing. Auntie Wan dari singapore pun ada datang n wawa yang suruh nek wan stay dirumah. Bilik tuk auntie wan sudah ready hoping comfortable stay here. Rasa kan masak tiap masa tuk our guest tapi kesuntukan rasanya masa sebab kan kerumah nini uwa lagi liat persiapan n tolong mana mana yang patut. Habis berdikir dimalam berbedak, bekaraoke tia tuk hiburkan family. Wawa nda berapa suka bekaraoke, saja liat liat lagu mana berkenan tapi ahirnya menyanyi jua 3 lagu saja saja tuk hiburkan hati n family. Wah...pandaikan wawa nyanyi?...testing 1 2 3 chewah habis satu lagu nyanyat lagi kan belagu. Hehe ada tia jua cuzen ani tangkap gambar kan dimasukkan dalam facebook hahaha nyaya nyaya!....Rupanya lagu lagu yang wawa pilih ani lagu duet hehehe. Mula mula duet sama ntah saudara jua lah tapi orangnya malu malu tapi suara hmmm...bole tahan jua. Second time wit my uncle, amit n third wit my cuzen. wah...iakan, suara wawa mendayu dayu....oops!.. Maklum manyanyi dengan luahan hati hahaha. Now, alhamdulillah selesai sudah. Dua dua anak tua sudah kawin, nda lagi ada saudara rapat yang kawin dikulapis ani. Tapi ada jua yang mengusik ada lagi sorang kan dipengantinkan hahaha wawa said....impossible tapi nda tau kalau ada jodoh atu saja becos so far ntah ah.... auntie Wan dipanjangkan sehari stay dirumah auntie mina (our inspector) but pencen dah tapi.....badan cergas n maintain wah!...really admire her. Lusanya auntie wan baru balik singapore sebab she is teaching maths dimadrasah..... wah!,..'practice make perfect'!..Kadang siuk jua kalau mikirkan diri turut bujang, nda apa apa yang mengganggu fikiran... Tapi masing masing diberi bahagian oleh tuhan tuk menjalankan peranannya masing masing kan.. Now sunyi banar, malam nda kawan wawa lagi kan becerita sampai subuh hahaha.. Cerita pasal dulu dulu, pasal cinta dulu oopppsss!... kata auntie wan "Its better to be loved n lost rather than no love" hehehe.

Alhamdulillah, kemarin attend briefing lagi pasal our next vaccine ani. Vaccine yang mula mula namanya PANDEMRIX from Germany. Soalannya, apakah perbezaan diantara keduanya?. Sama saja kegunaannya dan kesannya. Cuma ada technique baru yang telahpun diDemo bertujuan untuk kebaikan (effectiveness) dalam penyediaan vaccine sebelum pemberian suntikan.

Aduh, matapun masih mengantuk. Manainda pukul 4.30 pagi sudah bangun, wawa kena standby n Adib pun ikut bebaris (1st time). Adib masih mengantuk, masih belum puas tidur pasal semalam tolak dari kulapis ke lambak akhir malam. Tepaksa jua tidur dilambak, takut akhir bangun. Kalau dikulapis, jam lagi lalu dijerudong..belum lagi highway. Habis bebaju, keluar stat engine kreta...hari masih gelap, tepaksa beranikan diri. Jam sudah 5.30 pagi, mula mula antar adib ke PGGMB secondary school naik bas kan menuju ke bandar. Lapas atu begagas lagi kan ke RIPAS, takut ketinggalan ambulan/van kan betolak pukul 6 pagi. Sampai mabohai, wah...banyaknya kreta/bas bas sudah besusun disana sini. Sampai di RIPAS Hospital, begagas lagi kan paking kreta hmm....baik jua masih ada transport, pikir tah ketinggalan tapi ada jua yang sudah lapas. Mula mula masuk di Emergency Unit didepan Paramedics, cari kan register nama dulu dinotice board to sign. Barang barang emergency temasuk emergency trolley, ubat ubatan, stretches, blankets, basins, towels sudah awal jalan bersama sama dengan Incharge barang kelengkapan. Makanan n minuman pun sudah ada. Hehe biasalah nasi berlauk ayam masak kurma kah tau kari kah tu usulnya n sayur. Pagi pagi cemani, dikem tah lagi nda wawa beliur kan makan tapi ada jua kawan kawan yang bawa kan tapau saja. Baik jua ada sandwich telor, atu tah yang wawa makan. Lagipun sudah kenyang, awal awal lagi babu masak mee dilambak, hmm nyaman tapi nda dapat banyak jua karang tekajut parut kan membuat proses penghadaman hehehe. Yang penting wawa minum 100 plus untuk restore energy dalam tubuh n kan tuk mencergaskan badan. First, check meja Dr sudah ready form triage, BP set, thermometer, stethoscope sudah ada dapan mata Dr. Cek box ubat ada panadol tablet, zantac, bascopan, gaviscon tuk yang sakit parut...maklum kanak kanak skulah ani kasian awal awal udah betolak dari rumah n begagas kesekolah takut nanti ketinggalan bas. Jadinya, terlupa tah kan mengisi parut sedangkan breakfast is very very important than lunch. Nah kan....ayung tia paning tia apa. Thanks god, baik jua pagi ani mendung n hujan renyai renyai, ganya nda berangin iatah bepaluh jua badan. Wawa dalam kem saja sambil menunggu cerita cerita sama gang yang lama dah nda jumpa. Kadang ingin jua rasa hati kan maliat perbarisan terutama kan maliat anak mami, adib ani barukan pernah bebaris. Bangga jua maliat anak kesayangan mami ani menyertai perbarisan, ingau jua hati mami takut adib ngalih n paning. Pertengahan acara stat tia ada yang tumbang n kena bawa ke kem pakai stretches. Masing masing tah dengan peranannya, ada yang isi borang triage, cek panas, cek tekanan darah, pulse, cek glukos dalam darah. Baik jua nda ada yang sampai cucuk jarum masuk ubat meaning nda yang teruk. Yang penting pernafasan cukup, jadi tepaksa buka tudung at least longgarkan sikit tudung kalau malu kan membuka. Lepas atu dibagitah secawan air yang sudahpun dicampur ORS salt. Gali jua hati maliat dangan prepare every sachet ORS masuk dalam setiap botol damit mineral water. Gunanya macam 100 plus jua tapi ani nda be gas...umph bagus pulang tu ah. Sandwich diunjuk bagi yang masih mampu makan pasal ada jua yang mutah nda tolerate pasal parut diorang andang kosong. Iatah karang mengajut parut kosong kan tarus di asak asak dengan makanan. Mostly students lah yang complain macamatu, kasian cigu cigu bisdia tepaksa menunggu sampai anak murid masing masing sudah ok. Ada jua orang dewasa yang paning, tapi kebanyakan mau kan duduk berehat saja, mungkin malu kan melimpang. Ada jua yang complain paning pasal baru tau ia pregnant, jadi katanya tepaksa jua diteruskan perbarisan tapi last last paning jua. Atutah macam macam kan diliat gelagat sorang sorang, tapi cukup nampak bersemangat tuk maraikan hari kecintaan pada negara ani. Next 27hb Feb ani hari maulud nabi (Hari Kecintaan pada Rasul), wawa pun kana standby jua. Nda apa selagi diri masih kuat, masih diperlukan...alhamdulillah disinilah kitani berkhidmat. Kerana dibumi ani tempat kelahiran, disini jua dimana anak-anakku dan keluargaku tercinta diami. Kasih pada anak-anak bangsa dan Sayang pada semuanya!....

Snoring may be a symptom of a spectrum of problems, including simple snoring without sleep disordered breathing, and snoring associated with obstructive sleep apnoea. Studies have shown that approximately 24% of the local population are loud habitual snorers. Obstructive sleep apnoea is a potentially serious disorder associated with snoring, in which one's breathing is interrupted during seep, causing the individual to awaken many times during the night and experience excessive daytime sleepiness.

What causes Snoring?

The sounds of snoring are caused by the vibration or flapping of the tissues lining the upper air passages. Snoring in most people is due to multiple factors, each playing some part in the snoring process. Relaxation of muscles causes the walls of the upper airway to fall together, causing them to vibrate. Swelling of the tissues in the wall (e.g. from anatomical or injury reasons) causes narrowing. The tongue may fall back into the throat when sleeping on the back and contribute to the snoring. Nasal blockage such as nasal allergy or deformities of the nasal septum (the cartilage partition between the two sides of the nose) can cause poor nasal airflow and set the soft tissues of the palate (roof of the mouth) and throat vibrating.

Whereas large tonsils are the most common cause of snoring and sleep apnoea in infants, they can also be the occasional cause of problems in adult, where nasal and soft palate problems are the more common causes of snoring. Other factors which can influence the snoring condition are obesity; aging and associated loss of general muscle tone, congestion of the throat due to reflux of stomach acid (heartburn); and the effects of alcohol or smoking.

where can I get help?
Consult your physician if you have loud snoring for a thorough evaluation of your problem.

what can be done to treat snoring?

Effective treatment is available for almost all patients. The treatment of snoring is divided into medical and surgical options. the therapeutic choice is individualised. a "staged" approach is often used, which involves medical therapy first, folowed by consideration of surgery.

Medical Treatment

As nasal obstruction increases the frequency of snoring and sleep disordered breathing, oral medications prescribed or recommended by your physician are available to help you breathe through your nose during sleep.

Nasal CPAP (Continous Positive Airway Pressure) can supply pressurised air into the upper airway via a nasal mask, keeping the upper airway open. CPAP is not usually prescribed for snoring unless there is associated apnoea.

Dental appliances that hold the jaw in a forward protrusive position during sleep have also been used to treat snoring.

Surgical Treatment

Surgical procedures for the treatment of snoring may include nasal, palatal, jaw, tongue and neck surgery. The surgical procedure will depend on the location of the tissues contributing to the snoring. Certain nasal conditions such as deviated nasal septum and very large tonsils can cause snoring and may require assessment by the Ear, Nose and Throat (ENT) surgeon. some patients have extra tissue in the throat, which when removed may help to alleviate snoring. this surgical procedure is called uvulopalatopharyngoplasty (UPPP). Excess tissues may also be removed using laser surgery. Radiofrequency thermal ablation of the soft palate (somnoplasty) is a procedure used for the treatment of snoring that works by stiffening and shrinking the tissues of the soft palate.

Some useful suggestions for Snorers:

1. Reduce weight if you are obese.
2. Avoid taking sleeping pills. Certain sleeping pills may cause the upper airway to relax, which leads to snoring.
3. Avoid consuming alcohol after 6pm. Alcohol causes relaxation of muscles and swelling of the tissues of the airway.
4. sleep on your side and avoid sleeping on the back. some people snore, or snore heavily only when sleeping on their back.
5. Quit smoking. smoking causes swelling of the tissues of the airway, which results in snoring.
6. Allow your bed partner to fall asleep before retiring to bed.
7. Provide ear plugs for your bed partner.

Singapore General hospital (Sing Health).
Website:www.sgh.com.sg

Sakit kepala ialah sakit pada bahagian didalam tengkorak. Sakit kepala adalah masalah yang biasa dialami oleh setiap orang.

Ianya disebabkan oleh:

1. Ketegangan pada otot-otot dibahagian kulit kepala, muka dan leher, atau
2. Perkembangan pada saluran darah dikepala atau
3. Tekanan yang meningkat didalam otak yang disebabkan oleh jangkitan kuman, luka atau barah,

Sakit kepala bukan berpunca daripada otak. Sakit kepala mempunyai berbagai sifat seperti pudar, denyutan yang berpanjangan atau tajam. Sakit kepala bukan selalunya bererti seseorang itu menghidap penyakit yang merbahaya, malahan kebanyakan sakit kepala disebabkan oleh rasa lapar, demam selsema, perubahan cuaca dan sebagainya. Ianya timbul sekejap dan hilang dengan sendiri tanpa rawatan. Ia boleh hilang selepas memakan ubat penahan sakit, jika perlu.

Walaubagaimanapun, ada sesetengah sakit kepala memerlukan rawatan dengan segera terutama sekali jika ia disertai dengan rasa loya, muntah-muntah, masalah penglihatan, kelalaian, hilang ingatan, hilang imbangan badan, pengsan atau koma.

JENIS SAKIT KEPALA

Sakit kepala yang SEDERHANA:

Sakit kepala ketika lapar
Sakit kepala akibat ketagihan kafein
Sakit kepala selepas bersetubuh
Sakit kepala disaat ketegangan atau stress
"Migraine"
Sakit kepala yang berkelompok
Sakit kepala ketika berada dikawasan bising
Sakit kepala ketika mengalami perubahan tahap hormon

Sakit kepala yang TERUK:

Sakit kepala selepas nkecederaan kepada kepala
Jangkitan kuman pada bahagian otak seperti meningitis
Radang pada bahagian lapisan otak
Barah otak
Pendarahan otak
Kenaikan tekanan dalam otak (mungkin disebabkan oleh tekanan darah tinggi)
Kenaikan tekanan dalam mata
Jangkitan kuman tropika seperti malaria.

Bagaimana cara untuk mengurangkan sakit kepala?

1. Baring didalam bilik yang tenang
2. Urut kepala
3. Makan ubat penahan sakit seperti paracetanol, aspirin
4. Letakkan beg atau tuala yang berisi ketulan ais pada dahi (untuk "migraine")
5. Mandi dengan air suam (untuk sakit kepala disaat ketegangan atau stres)

Bilakah awda perlu berjumpa doktor?

1. Jika sakit kepala melebihi daripada satu hari selepas memakan ubat penahan sakit
2. Jika sering mengalami sakit kepala
3. Jika berlainan dengan sakit kepala yang biasa dialami.

Bilakah awda perlu pergi ke bahagian kecemasan di rumah sakit?

1. Jika sakit kepala disertai dengan sawan
2. Jika sakit kepala disertai dengan panas badan yang tinggi dan ketegangan pada bahagian leher
3. Jika sakit kepala disertai dengan rasa kebas atau lumpuh pada anggota badan
4. Jika sakit kepala disertai dengan masalah penglihatan
5. Jika mengalami sakit kepala selepas kecederaan pada bahagian kepala.

Sila hubungi atau jumpa doktor di Pusat Kesihatan yang berdekatan untuk maklumat lebih lanjut.
Kem. Kes 2007.

Kitani sudah banyak mendangar ceramah yang melarang kitani supaya jangan teikut ikut menyambut hari kekasih yang biasa dipanggil valentine day. Bukan budaya orang kitani untuk membesarkan hari tersebut. Walaubagaimanapun, atu semua tertakluk kepada niat sorang sorang didalam hati. Kitani boleh meraikannya dengan niat untuk 'menghampirkan yang jauh dan merapatkan yang dekat'. Kitani saling memerlukan diantara satu dengan yang lain terutama keluarga dan kawan. Apa salahnya berkumpul beramai-ramai bergembira asal jangan berlebih lebihan sehingga membelakangi soal agama seperti minum arak dan pergaulan bebas. Sedangkan kitani memang dituntut supaya mempunyai keperibadian yang baik, menyayangi dan menghormati sesiapa saja. Adalah lebih bermanfaat lagi jika diselitkan dengan acara keugamaan seperti bertahlil, membaca doa selamat atau membaca surah yassin beramai ramai bersama keluarga. Alangkah sejuk dan damainya dihati...

Cakap pasal valentine ani teclick wawa masa dulu dulu hehe. Kalau dulu iatah ditunggu tunggu ne cali ada jua. Hati berbunga bila ada yang menyelitkan kad n bunga, masuk class saja atas meja ada complete package bunga, kad n chocolate....umph yummy!. Yang penting siapa sendernya ah? ada yang without name lagitu misteri jua ah...'secret admirer'. Tapi kalau ada yang usulnya senyum senyum ada makna, iatah orangnya kali tu. Ada jua yang bagi thru one of my fren yang maybe diorang trust. Pernah ada jua yang bagi novel bole lah untuk wawa baca sementara nunggu nini datang ambil wawa balik skulah. Ada yang berani datang kerumah bagi barang tapi yang receive dipintu ...my dad...Oops!..Yang siuknya ada jua yang tau my favourate bagi teddy bear.....wah!, boleh buat collections....Sayangnya sudah kawin, galak jua rasanya kan disimpan lagi semua barang barang atu karang hubby tersinggung apa nanti katanya hehe. Now siapa ah orang tersayang dihati ini??....hmm biar sendiri sendiri saja tau hahaha. Yang pasti my 2 young men~adib n danish, my adorable kids!. Adib sudah year 7, tinggi sudah dari mami. Pendiam orangnya compare to Danish. Suka berlaptop buka facebook. Kadang tepaksa mami tagur jua..yang penting siapkan homework. Mami suka liat adib solat, khusyuk sajuk mata hati mami. Danish, very cheerful n talkative. Manjanya over kadang tecangang alai irfan, damia sama alya liat abang danish hug n kiss mami saja. Pandai ambil hati mami, suka buatkan mami minuman tapi umph..manis rasanya. Tapi kalau main game batah, tepaksa mami tagur...nah sensitive tia lagi danish ani eh. Apa pun, mami love both of you!!...

An acronym for the word LOVE:

L-Listen
O-Overlook
V-Verbalize
E-Effort

Listen:
Listen beneath the words that people are saying. Try to hear what the person is saying.

Overlook:
We have to overlook some things, and not let them effect us. To overlook things does not mean that we are doormat. Being a doormat is a form of self hatred.

Verbalize:
Say the things that need being said. Don't let the sun go down before you tell someone you are sorry. Don't assume that people know that you love them- tell them. People need to hear that vthey are loved.

Effort:
we need to make an effort even if it is difficult. we want to be a person of peace.

What is Excessive daytime Sleepiness?

When sleepiness interferes with daily routines and activities, or reduces one's ability to function, it is considered excessive.

You mat have excessive daytime sleepiness if you:

1. Have difficulty paying attention or concentrating at work, school or at home
2. Have performance problems at work or school
3. Struggle to stay awake when inactive, such as when watching television or reading
4. Have difficulty remembering things
5. Must take naps on most days
6. Are often told by others that you are sleepy
7. Fall asleep while driving

What causes Excessive daytime Sleepiness?

Sleepiness can be due to the body's natural daily sleep-wake cycles, inadequate sleep, sleep disorders, or the effect of certain drugs or medications.

Sleep-wake cycle
There are two periods in the day when the body experiences a natural tendency towards sleepiness:
during the late night hours (generally between midnight and 7 a.m.) and again during the mid afternoon (generally between 1 p.m and 4 p.m). If a person is awake during these times, he has a higher chance of falling asleep unintentionally, especially if he has not been getting enough sleep.

Inadequate sleep
The amount of sleep needed each night varies amongst different people. Research has shown that when healthy adults are allowed to sleep unrestricted, the average time spent is 8 hours.

If a person does not get enough sleep even on a single night, a "sleep debt" begins to build and increase until sufficient sleep is obtained. Excessive daytime sleepiness occurs as the debt accumulates. Individuals who do not get enough sleep during the working week tend to sleep longer on the weekends or days off to reduce their sleep debt.

Sleep disorders
Sleep disorders such as sleep apnoea, Narcolepsy, Restless Legs Syndrome and insomnia can cause excessive daytime sleepiness.

Sleep Apnoea is a potentially serious disorder in which a person's breathing is interrupted during sleep, causing the individual to awake many times during the night and experience excessive daytime sleepiness.

People with narcolepsy have excessive sleepiness during the day, even after getting sufficient sleep at night. They may fall asleep at inappropriate times and places.

Restless Legs Syndrome (RLS) causes a person to experience unpleasant sensations in the legs often described as creeping, crawling, pulling, or painful. These sensations frequently occur in the evening, making it difficult for people with RLS to fall aslep, leading to excessive daytime sleepiness.

Insomnia is the perception of poor-quality sleep due to difficult falling asleep, waking up during the night with difficulty returning to sleep, waking up too eartly in the morning, or unrefreshing sleep.

Any of these sleep disorders can result in excessive daytime sleepiness.

Medical conditions and drugs
certain medical conditions and drugs, including prescription medications can also disrupt sleep and cause sleepiness. Some examples include:

1. Chronic illness such as asthma, heart failure, rheumatoid athritis, or any other chronically painful disorder.
2. some medications to treat high blood pressure or heart conditions, amd asthma medications such as theophylline.
3. Akcohol is a sedating drug that can, even in small amounts, make a sleepy person much more sleepy and at greater risk of car crashes and performance problems.
4. caffeine, which is consumed in coffee, tea, soft drinks or medications makes it harder for many people to fall asleep and stay asleep. Caffeine stays in the body for about 3 to 7 hours, so even when taken earlier in the day, it can cause problems at night.
5. nicotine from cigarettes or a skin patch is a stimulant and makes it hatder to fall asleep and stay asleep.

Shift Work & Problem Sleepiness
More shift workers get less sleep over 24 hours as compared to day workers. Sleep loss is greatest for night shift workers, those who work early morning shift, and female shift workers with children at home.

The humen sleep-wake system is designed to prepeare the body and mind for sleep at night and wakefulness during the day. These natural rhythyms make it difficult to sleep during daylight hours and to stay awake during the night hours, even in people who are well rested.

In addition to the sleep-wake system, environmental factors can influence sleepiness in shift workers. Shift workers whi try to sleep during the day are often interrupted by noise, light, telephones, family members and other distractions.

In shift workers, problem sleepiness may result in:

1. Decreased productivity due to poor night work performance
2. Increased risk of accidents and injuries at work
3. Decreased quality of life
4. Increased risk of automobile accidents

What you can do?
Getting Enough Sleep
Many prople do not set aside enough time for sleep on a regular basis. A first step may be to evaluate their daily activities and sleep-wake patterns to determine how much sleep is obtained. if a person is consistently getting lest than 8 hours of sleep per night, more sleep mey be needed. A good approach is to gradualy move to an earlier bedtime.

For example, if an extra hour of sleep is needed, try going to bed 15 minutes earlier each nught for four nights, then keep to the last bedtime. This method will increased the amount of time in bed without causing a sudden change in schedule. however, if work or family schedules do not permit the earlier bedtime, a 30 to 60 minute daily nap may help.

Tips for Shift Worker
The following may be helpful if you are working on shift:

1. reduce the amount of night work
2. Increase the total amount of sleep by adding naps and lengthening the amount of time alotted for sleep
3. Increased the intensity of light at work
4. Have a predictable schedule of night shifts
5. Eliminate sound and light in the bedroom during daytime sleep

Medications

In general, medications do not help problem sleepiness, and some may make it worst. Caffeine can help to reduce sleepiness and increase alertness, but only temporarily. It can also cause problem sleepiness to become worse by interrupting sleep.

Medications may be prescribed for patients in certain situations. Foe example, the short-tertm use of sleeping pills has been shown to be helpful in patients diagnosed with acute insomnia. Long-term use of sleep medication is recommended only for the treatment of specific sleep disorders.

While alcohol may shorten the time it takes to fall asleep, it can disrupt sleep later in the night, and therefore add to problem sleepiness.


Where can I get help?

If you think you are getting enough sleep but still feel sleepy during the day, consult your physician. Your physician may then refer you for a thorough evaluation of your problem.


Sleep Disorders Unit,
Singapore general hospital (Sing-Health).
Website:www.sgh.com.sg

Diabetes ialah sejenis penyakit kronik yang terjadi apabila organ pankreas tidak dapat menghasilkan insulin yang cukup atau apabila badan tidak dapat menggunakan insulin dengan berkesan. Ini menyebabkan paras glukos (gula) meningkat dalam darah. Insulin ialah sejenis hormon yang dihasilkan oleh pankreas yang membantu sel-sel dalam badan untuk mengambil glukos dari darah dan menggunakannya sebagai tenaga.