One Step At A Time- #3 EatHealthy

I thought we could start with food first before the physical exercise, because basically when you choose to loose weight, you choose to modify your lifestyle and a big part to it is your food selection.

To be honest, I'm not the best person to advice on diet, but these are the things I've tried, modified a bit from our consult in Endocrine clinic & tips from my trainer:

1. Most important and difficult- CUT ADDED SUGAR. If you take coffee in the morning, take it black or with skimmed/high calcium milk. The same goes with tea.

2. Breakfast
-try overnight oats. Use rolled oats, not instant as instant has higher GI (Glycaemic Index). Make 3-5 jars on Sunday, and just grab one every morning. I top up mine with lots of different nuts plus/minus apples, oranges, banana, peanut butter, dark chocolate, honey

//Overnight oats. And yes, that's Weet-bix at the back- love it!

//For this one, I cooked the oats instead. See the chocolate pieces?

-if bread, choose wholemeal or wholegrain. If you notice, Gardenia has GI value at the back, lower is better. I love mine toasted with butter & avocado as a spread, or peanut butter/strawberry jam/cheese spread

//GI value at the back of Gardenia's bread. White bread has higher GI, opt for a lower choice

//Lately I added Laughing Cow's cheespread to couple with my avocado toast

//Let me tell you that this is incidental but it's so yummy that I'd eat this every day if golden kiwifruit isn't expensive! Above is a mix of plain yogurt, (Green Hut) granola with roasted nuts and golden kiwifruit

//Smoothiiiiieeeessss!!

-cereal-wise, I chose granola-based, add a bit of cornflakes, sometimes topped with nuts or fruits
-add on above options with an apple or banana
-also tried a bit on smoothies- Pinterest has lots and lots of recipes!
-lately been trying salad + cheery tomato + Kewpie roasted sesame dressing, sometimes with toasts too. 😋

Roughly, 1 cup of rice = 2 pieces of bread = 4 pieces of plain cream crackers (in terms of calorie)

//Yup, packed these 2 (above and below) for breakfast combi. I added nuts and granola in my salad to give that 'crunchiness'

3. Main meals
Follow the recommendation from KKM- "Suku Suku Separuh", meaning of your plate, a quarter portion is wholegrain, a quarter portion is lean protein and another half portion is fruits/greens/vegetables.

Option: change white rice to brown rice, this is what we tell our diabetic patient, mainly because of the lower GI with brown rice. Some opted to avoid rice- not saying that it's bad, but I need my rice 🤣

4. Snacking- I don't because of no time. But if you choose to- fruits or nuts. Or carrot or cucumber.
Be aware that some fruits have high sugar content like grapes and durian
Fruits that contain less sugar we adviced our diabetic patients include the green ones- guava, green apple etc

5. IF- I don't do Intermittent Fasting, simply because I need my breakfast. The bulk of my job is in the morning so I need a good breakfast to sustain me till lunch hour at least.
If you want to do it, fasting for 16 hours or more will give you more benefit so for example, last dinner at 6 pm and next meal is after 10 am
If you want to fast, I suggest do puasa Isnin-Khamis instead 👍

This is mainly notes for myself.


Next post will be a little technical, but basically, it will make you understand how I choose the exercise regime.

One Step at A Time- #2 GetFriends

//Thursday's Les Mills Tone with serra_lin@IG; a killer session every time, but worth it!

Get acquainted. Get friends. Don't do this alone. I mean, get serious friend(s) who either get into the journey with you or someone to monitor your journey.

Reasons- you need someone to keep a tab on your progress & to keep on motivating you. And trust me, you will get tired and demotivated at times.

//Easy walk at KL Tower Eco Park

//Hiking @ Tabur East

//Picnic & walk at Frim, Kepong

//Coway Run this year

If you have the means (time and financial) invest in a gym membership. Gym places usually have classes- Les Mills (under FF), HIIT-like classes, zumba, yoga etc. You can go to these classes for a starter until you find what you like, your niche- we'll talk more about this in later entries.

Invest in a personal trainer (PT) if it's within your reach/budget- because they can tailor the workout for you and they can correct your forms to avoid injuries. And because at times when you feel like you cannot go on anymore, they will push you past your limit, and you will be thankful for that.
Ask around and talk to the trainers on what they can offer.

//Burn class under Fitness First

//The fun bunch @ FF!

//Another fun bunch (quorum x complete) at the gym

My working hour isn't as flexible and I sometimes ended up finishing late- I can't keep up with some of the classes hence getting a PT was my best option. And hey, like someone said, results don't lie. [Honorary mention : khairulmuzzamir@IG]

Alternative is you can always join programme like Jom Kurus 1Malaysia or Fat Loss Challange programme by Anytime Fitness. Point is, don't walk this journey alone.

We'll talk more about workouts, exercise, and trainers in later posts.

Share with me your experience.

One Step at A Time - #1 The Trigger

This is one post that I've been delaying for months and contemplated many times simply because one, my journey isn't as great compared to others; two, I was never a sports person; and three, I wasn't and still am not sure if I could maintain this (read: istiqamah). The 'what if?' kept coming back.

But as I got more questions on how, perhaps I can share a little bit based on what I know and have practiced. I'll break the journey into different parts with different themes. So we go with first step today:

If you want to lose weight, find your reason(s) / trigger(s) to shed that kilogram and anchor it with (a) goal(s)- must be measurable, do-able and realistic.

Mine? The trigger was patient's comment while I was running the obesity clinic (something that went along the line 'but you're also not as fit to give me this advice on how to lose weight' 😑)

I had many other reasons to start losing weight- I was easily feeling tired and the timing just fit. It was around the time where I no longer need to do weekends round and someone (read: cousin Ummi) was pestering me to join the gym- more excuses to lepak with cuzzies!

So first step: Find your absolute resolution. Write down your do-able goal(s)

Mine? To get to ideal body weight, normal BMI, meaning to shed off 10kg. The aim was ~1kg per month (that's what we advice in the obesity clinic- ~1kg per month in the first 6 months)

What's yours?

#wanizsnotes

#onestepatatime

Haematology, a humbling posting

//Above is a snapshot of an abnormal blood smear magnified under the microscope

I'm doing Haematology posting. To be honest, I have always though that Haematology as a world of its own, a foreign sub-specialty even though we learnt the basic stuff in medical school. The first day of my first weekend round in Haemato, Dad sent me to the hospital and asked which posting I am in currently. When I said Haemato he went, “About blood only right? It should be easy, yes?”. I almost went berserk at that statement XD

Blood composed of a lot of constituents which include red cells, white cells, plasma, coagulation factors, platelets etc. Your white cells further have different types i.e. your granulocytes (neutrophils, basophils, eosinophils), monocytes, lymphocytes (B-lymphoctyes, T-lymphocytes, NK-cells). Each of these red and white cells as well as platelets come from a common precursor/immature cells called haemapoeitic stem cell that later differentiate into different cell lineage. Amazing yes?

During the process of differentiation and maturation, at any step the process could go wrong and thus causing your haematological cancer (leukaemia, lymphoma, multiple myeloma), and there could also be structural defects or enzymatic / constituent defects for example in red blood cells (thalassaemia, sickle cell anaemia, iron defienciency anaemia, G6PD (enzyme defiency which cause your red cells to breakdown when exposed to certain agents), haemolytic anaemia where your red cells breakdown for different reasons e.g. infection, malignancy, immune mediated where your immune system attack the red cells), or deficiency in any of the other blood products (e.g. coagulation Factor VIII or IX deficiency in haemophilia or thrombocytopenia which is low platelet which can be due to different reasons) or too much production for example in polycythaemia rubra vera where red cells production is excessive. Not only that, your bone marrow i.e. the factory that produces blood can also have problems i.e. not producing enough blood like in aplastic anaemia, myelofibrosis or abnormal production e.g. myelodysplastic syndrome. I can go on and on and on and the list will just continue.

For us, once you recognize a problem or an issue, the next step is how to manage it.

Back in medical school, our Dean Prof Hatta, taught us a prayer that I still recite until now - "O Allah the Most Merciful, the Most Benevolent, please let us be the tool of your Mercy in serving the humanity regardless of race, creed and religion"

I currently have a few patients under my care who are around my age- One gentleman with a very rare refractory extranasal, extranodal NK-T cell lymphoma whose disease is far ahead of us and kept coming faster than the next cycle of chemotherapy and he would be in pain, because the cancer “grows” on his muscles and bones. If you want to look at it from the point of “fighting cancer”, we’re definitely at the loosing end. Patient and family however is still looking for a miraculous cure.

Another gentleman with progressive lymphoma, now affecting his central nervous system which made me learn about Omaya Shunt and intraventricular chemotherapy. His condition is complicated with many infections after infections which affect his chemotherapy schedule. He asked “why did I get (all) these (infections), Dr?” My reply, because he's immunocompromised, meaning his immune system is low hence he could easily catch any sort of infection. But beneath that question is, "Why me?"

Haematology for me is a very humbling posting- from dealing and learning from these patients, to learning from my consultants and specialists; amazed at the level of passion and care they have for their patients, and it made me realized again and again that the more I learn, the more I don't know...

"Which then of the bounties (favours, gifts) of your Lord will you deny?" 
[ar-Rahman 55:13]

Panda Run! I mean, Panda Rolls

 So yesterday I had my first fun run; after days being "badgered" by a colleague to do so (and she succeeded in pulling not only me, but another friend as well) I repeatedly said to them I can't run (which was true) and we would only walk. And since we're all on the same page, that was really the agreement.

Until I kinda.... walked slightly faster than them (>.<)
To be honest, I kinda surprised myself- at the little stamina that I had to sustain short run and fast-pace walk, and at how much I enjoyed it. Maybe those hours at the gym helped. Maybe my sister's advice on "try to go as fast as you can without compromising your breathing pattern". Maybe putting on upbeat songs while walking/jogging/running helped.

//Us, before starting

//And we finished!

//See how cute the finisher medal is!

So after run, we makan la kan? XD

Anyway, now entering 2nd year, we have a bit more time over the weekends if not doing on-calls. Supposedly that time is filled with studying, yeah I know... but one thing lead to another, we have yet to restart the engine of the study group. Past 2 semesters, we used the time after work to sit down and discuss questions, but now even after office hours we're still seeing referrals so there need for a dedicated time over the weekends for group discussion.

But 3rd sem is approaching the end fast and we're still yet to start the engine... Being into rotations with minimal people is also not helping. Ilham and I were having hard time adjusting to it; it's slightly better now but we're still agitated receiving referrals.

And I've added an extra activity into my already busy schedule- trying to keep up with 150 mins per week of physical activities. I guess there was a reason why I got into Endocrine as my first rotation this sem- giving advises like "cut down your sugar" and "you have to exercise at least 150 minutes per week, activities that make your heart rate goes up and you to sweat" are only believable when you're doing it yourself. At least now I can look into my patients' eyes and say these mantra without feeling guilt.

Working out for me also means venting out all those frustration and pent-up anger etc. You kinda literally feels lighter and satisfied after a good session, thanks to the endorpins and dopamine released. I think I have a better sleep and better energy at work too.

And those days I go to the gym, those are my happy-pill days because I got to spend time with my cousins! 

//Ok, this was when we went out for dinner, but these 2 girls are part of my support system for a long time :)

Now that I steadily scheduled exercise into my routine, the question is, how to fit in studying into the equation? Questioning myself this means that I'm entering a panic mode. Exam is only 3 semester down the road. (>,<)

Sticky Note 1-2018 : Madrasah Ramadhan (1)

//Sticky Note:

I am still somewhat green in this field, still learning the ropes and steps but sometimes when you’re working in this field, in general medicine especially, you’re sort of "immune" when you’re dealing with dying patients / death. Automatically there’s this invisible, protective barrier surrounding you, devoid of any emotions so that you can manage your next patient without having the recurrent thoughts of that particular patient looping in your mind.

I still remember the first time I encountered a patient that we (the team) issued “DNR” (read: not for active resuscitation, for best supportive care) in my second posting as a House Officer, I was shaken and I almost cried (read here). At the time, I kept asking myself if I did the right thing.
Nowadays, issuing DNR when indicated (i.e. when we postulate that the prognosis is poor) is something that is not as hard as before.

But my first referral in Resus during on-call last Monday, I lingered around longer than expected, trying to make sure the patient and family knows what was happening, what was bound to happen and how we planned to deal with it. A young gentleman with terminal metastatic cancer and we know that nothing much we can offer except for comfort care; to counsel him while he was still awake and aware, something struck my core.

He’s not much older than me, and he’s probably at the end of his life. I wonder how it feels to be in his shoes; not being able to do much and depending on others to care for him, with shortness of breathand his bloods showing multiple organ impairments… when I was counselling his sister, I myself almost tear up.

Another recent young death, Mr Ali Banat, also resonated in similar way- a young gentleman who passed away recently due to cancer, being able to contribute up to his last breath. These people were given chance by Allah, to prepare before they breathe their last breath.

But what about us?
Have we atone enough?
Have we seek for forgiveness from The Creator and other mankind whom we’ve wronged previously?
Have we settled all our debts?
Have we save enough merits for the hereafter?

“Ya Allah, iftah ‘alayya”

May 15th

//Zira, Mama and Me

This is my mom, the middle one.
Every year, there will be wishes of "Happy Mother's Day" in mid-May. We're lucky that Mama's birthday falls on May 15th, a couple of days after Mother's day. Mama is even happier that her first grandson's birthday is only a day before her birthday- when my SIL's EDD (expected date of delivery) was on 24th of May, she was praying it fell onto her birth date instead XD But Muhammad was born 1 day earlier. Nevertheless, it's like a double celebration.

Everywhere children wish their mothers Happy Mother's Day; some celebrate with special occasions, dinners or meals, some write on lengthy but beautiful speeches on social media, some forwarded gifs and wishes online and on whatsapp; anything to get the message across- Happy Mother's Day, thank you Mum(s). To most, their Moms are the best Mothers; well, logically they are right?

Mine's too.
She was working when we were growing up, but took early retirement because Dad was transferred to East-Coast. That was when I was 16. 2 years later, I went and studied abroad and one advice that stuck on to me even until now is- "whatever you do, let us (parents) know first before we find it out through other people (we have got spies all over)"- that was said to me when I was 15, while I was still in KL and I brought it with me even when I was in Perth :P
So she was the first one to listen to my ups and downs, my tales and wails, my adventures and sorrows when I was in Australia. She was a patient ear to my every phone call and I was glad I could tell her everything.

Only later on when I came home did I learn that she wasn't too keen of me pursuing my dream back then in studying medicine (abroad) but never once did she object it in front of my face, and I am glad she did not... In return, my sister and I decided to do our housemanship away from home, so she and Dad wouldn't see it firsthand how 'gruesome' the journey could be (okay, that was an exaggeration but not that far off.. the two years flew quite fast than expected).
Even so, she was there when I decided for a semi-impromptu day-trip back to KL to watch a movie (and accompanied me for breakfast and lunch in MidValley XD ; entry here) and joined ChocoMon's trip to USJ and Legoland (entry here) where she was sorta 'tricked' into getting onto the Revenge of the Mummy (sorry, Mama, really, I am!)

Then I came home to continue working as a medical officer in Putrajaya, commuting daily from KL; and she's still there, supporting me in every step- every littlest story that I have, to every non-spoken gestures I made, she's still here. Even when I decided to take that impromptu trip abroad before getting into Masters programme, she came with me...

No words can convey how thankful I am, how thankful we are to you, Mama.
Happy Birthday and Happy Mother's Day, for being awesome superwoman you are. May you always be blessed and be healthy always, Ameen.

Sky Blue

...Congratulations

幸せになってくれなきゃ困るぜ (Baby)

素晴らしい未来へ　愛を叫べ

...Congratulations

You've just gotta become happy, (Baby)

Shout this love to a wonderful future

愛を叫べ (Ai wo Sakebe), Arashi

(because One Love for wedding theme is overrated IMO... haha!)

I scrolled my journal and to my horror, there were only TWO entries for this year? O.o 

The lack of posts means either I'm under much stress that I couldn't even be bothered to write anything (because essentially writing is how I vent out previously), or I found better ways to de-stress. 

Or, I do no more traveling for whatever reasons. =( My last trip was to Korea last May and I foresee that there will probably be no more traveling next... 1 year. Or more. 

Anyway, it may be the combinations of all three factors mentioned above.

However, since today is a special day, I'll jot something here to bookmark the day.

//Arashians' gathering on Ija's wedding
.Picture courtesy of Annys and Zura.

Sometimes weddings are the only time and place to catch up with your friends, especially now when everyone's working different jobs and places and have different priorities etc. I haven't met these girls in ages!

//Zeti also matched our blue-coloured unoffical theme XD

First of all, CONGRATULATIONS to Ija and husband. May your life filled with barakah and happy memories, insyaAllah.

It's a bit difficult to explain how Ija and I knew each other, but it's also the (only) same answer I have if people asked how I knew the girls in the first picture- Arashi. And like the F4's, it started from Arashi Forum (which is no longer exist I must say)- so that dated back in.... 2009 - 2010... ? (because korek2 LJ, earliest mention of Ija was her birthday shoutout back in 2010).
Anyway, from fandom to lepak-ing buddies to coffee-mate after work and occassional trips / sleepovers domestically and overseas (Japan and Singapore je pon), I think Ija is one of the few who actually had witnessed my bimbo-moments, especially during driving -.-;
I guess now she doesn't have to see that anymore XD

After I've transferred to KL and started working in Putrajaya, I commuted by train and later we found the easiest way to catch up was at dinner and coffee after work, since she's also traveling via train. And since then, our regular catch-up / shopping / coffee session has became one of my ways of de-stressing (aka ranting) and keeping my sanity in check.

From the bottom of my heart, thank you for spending your time listening to my work-rant and about life in general, Ija =) The frequency to catch up probably won't be as many as before but I do hope that this friendship will last.

//F4 (missing Aimee) and Ijaji

//We need to fix a date for another of F4 meet up!

It was a good chance to catch up with Ai and Jules too; a tad short for Ai but Jules and I had coffee before going home and talked some more; yeah, that's the separation anxiety peeking up XP

//Also, thanks for the surprise! Ape la pulak pengantin bagi surprise present ni? XD

One Step

またひとつ夜が明けて　誰の胸にも眩しい光が　差し込めば
過ぎた日を思うより　新しい何か見つけたくて　歩いた

持ち合わせの言葉じゃ　育てた気持ち伝えること　出来ずに
不器用と言われても　自分に嘘をつけないから　顔上げた

涙を隠して　笑顔見せた
今も聞こえてくる　あの日のままの思いが

雨が上がり　また歩き出す　昨日と少し　違う気持ちで
Hey　全てに意味があるさ

Another dawn has come　When the bright light shines into someone's heart
Rather than thinking of the days long past, they'll want to find something new and walk forward

The words you have on hand weren't enough to describe the emotions that'd been growing inside
But though you might be told you're awkward, because you can't lie to yourself, you raised your head

Hiding my tears, I showed a smile
I can still hear the feelings from those days talking to me

The rain stops and we start walking again, feeling slightly different than yesterday
Hey　Everything has a meaning

One Step [The Digitalian, 2014], 嵐 Arashi

//The right watch was a birthday present my sister gave when I was in my first year of housemanship.

The watch on the left was a farewell gift from my previous department, which marked my new journey

One week plus
I'm still adapting. Changing places, new environment, new routine, new challenges... I'm never really good at quickly adapting, hence this may also take some time.
I still have palpitations going to work in the morning...
I still have worries when I go back home.
I still feel anxious knowing next few days would be my first day, my first weekend round, will be my first oncall and my first weekend call...
I still... have reservation towards everything and everyone at this point of time.

No matter if I've tried to prepare myself mentally for months, knowing it and actually facing it in reality are two different things.
This is yet another first step I'm taking
When you think that you've passed through one hurdle, another one seems higher and bigger.
When I was 16, I thought moving to Terengganu and changed school, left with no choice to take one particular subject I was trying to avoid was hard... It took me 6 months to adapt.
When I was 18, 1 month in Matriculation, living alone, making new friends despite the fact that I was introvert was hard... hence it was huge relief when I was accepted into pre-university foundation programme in Perth; the transition wasn't as difficult as it was in Matrics...
When I was 23 and had to repeat from Year 2 uni, I thought that was my biggest hurdle... it was, at that time that is. I didn't know there were more to come... towards end of our study years, our batch had some problems and it drove us past frustration but all was well afterwards and we finally were able to start work by August-September 2011

And there it was, at 27, working 300+ km away from home, I changed... became more reclusive, suddenly much less talking apart from at work to a point my housemates were worried about me. I was in a defence mechanism, which was actually part of my adaptation process. It was almost similar to when I was 16, when we moved to Terengganu. And it took me 6 months to finally being able to say "I'm comfortable working this job."

At 29/30, you think I've been accustomed to a new place, especially when it's closer to home... but nooooooo.... again, it took me more than 6 months to finally like my job, the new place and new environment.

So what makes me think that at this age, 33, it would be any different? Especially when it comes with heavier responsibilities with added title of a student?

I still have this penetrating cycle of thoughts that questioned my decision to take this path; of 'why did I choose a harder road?' 'why burden myself when there's an easier choice?' 'now you know why a lot of people quit this programme, right?' 'can you do it?' 'won't you quit already?' 'why did you have to go out of your comfort zone'.
Honestly, they are suffocating. And they make me nauseated, anxious and almost regret my decision.
Until I realize that's exactly what happened back when I first started working, comparing myself with my other friends whose had weekends and public holiday to rest and spend time with their families and I envy them... Hence I need to break that cycle of thoughts and find other ways of adapting.

I'm lucky that I still have my parents close with me and home to go back to as a place of solace. I'm fortunate my friends are around when I need them. Things may and will get harder from now on but I need to remind myself that لَا يُكَلِّفُ ٱللَّهُ نَفْسًا إِلَّا وُسْعَهَا (Quran, 2:286)
InsyaAllah...

//These 2 were with me when we set off as houseman, and they came to distract me from work a few days ago

Footprint

It's only April and I had taken 4 MCs within 2 weeks O.o I was down some URTI and fever 3 weeks ago then it escalated into bad sore throat that rendered me voiceless, like literally no voice at all that I had to take MCs! I even consulted the ENT team and they did a quick scope and I've never felt more relieved knowing my vocal cord is normal! Yup, not only singers and teachers need their voices to work okay, I had to take MC because I just can't communicate with the patients and had to be on voice-rest :(

My voice is coming back slowly , it's not as raspy as previously but it's still not normal yet. The cough still persists though... and I suspect it will last for another month or so, just as previously. 

I finally watched Shigatsu Kimi no Uso (Your Lie in April) live action and I LOVE it! Came across the soundtrack and insert songs and stumbled upon Seven's Orange (2nd Ending song for the anime version) and I absolutely love love LOVE them all! I have a feeling that I'd be playing the songs on loop for the next few days :)

Apart from that, we had a reunion- my classmates when I was in Standard 6 in Primary School! That's like.... 21 years ago okay! Someone actually went through all the troubles to initiate the group and surprisingly we've gotten everyone except for this one guy (and to be honest, I have no recollection of him ^^; ). So we decided a meet-up is a must and Saturday night was supposed to be the first official reunion but more than half of the class couldn't make it, so next time we'll plan it during school holiday, I guess since quite a number are actually teachers and some are living outside Klang Valley area.

On the other note... this cousin of mine will be leaving for Hong Kong at the end of this month :(  She'll be outstation for the next 6 to 8 months and I'd loose one ear to listen to all my whining , cries and stories...

It will be tough years coming ahead, if I'm accepted into the Masters programme... and that means more time and energy time spent for work and studying, more stress coming, less break and holidays (there goes my periodical must-have-holiday T_T), less time to join missions and to be honest I need all the support I could get in next 4 years... This is even more nerve-wrecking than when I first started working okay

To be honest... I'm scared. I don't know if I'm mentally and physically prepared. Past months had been tough enough and I was overworked to a point of getting sick... I also think that part of it is I've gotten too complacent at my current place, so I'm so scared now to a point of wishing that I'd not make the list...

This will probably be among the places where I rant...

I'm oncall tomorrow.... and the precall blues have started *sighs*