Hospice / palliative care

This term is quite new to all the people including even the doctor or health care worker. I myself heard that patient have misconception that hospice is hospital service. Since my friends and I were attached to KASIH HOSPICE during our elective, I have learned what the hospice really is.

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. It was founded by Dame Cicely Saunder (we are asked about this when we first met the doctor in charge)

In simple words, hospice or palliative care provide care to patient and family member holistically (biopsychosocial-spiritual or physical , mental, social and spiritual )so that patient have end stage of life with dignity and without suffering. Meantime, hospice helps family member to cope with loss of beloved till bereavement. In KASIH, Dr simplify this as 全人，全家，全程 (whole human being, whole family, whole journey in chinese)

Thus, as health care worker, we should NEVER NEVER tell patient that you have nothing to do to help him or her, leaving him unattended or disappointed. When we do not know how to handle this situation, please refer them to hospice unit. Click this link http://www.sabah.org.my/mhc/members.htm to see the location of the hospice centers in Malaysia. we went to KASIH HOSPICE CARE SOCIETY (KHC) which cover Rawang, Damansara, Sg Buloh.

Following is the detail of KHC

74, Jalan 14/29, Section 14
46100 Petaling Jaya, Selangor

Tel: (603) 7960 7424
Fax: (603) 7956 6442
E-mail: admin@kasih-hospice.org
Website: http://www.kasih-hospice.org/

President: Dr Goh Pik Pin

During the attachment, we really learned a lot and enjoyed it. If the day of birth is of so much significance, then it should be the same for the day of death (which is quoted by leong, I personally like this very much). So, my friend, be holistic and skillful while dealing with the terminally ill patient. Last but not least, see u guy and put effort in our final year.

Gout （痛风 or 尿酸)

Gout （痛风 or 尿酸 in Chinese term）

Gout is the joint disease where there is urate deposit ( specifically monosodium urate monohydrate crystal) in joint resulting in inflammation which cause all the symptoms ( pain , warmth and so on). It is more common in men ( 20:1)
Cause ( aetiology) are overproduction (excessive production) of urate and underexcretion ( reduced excretion) of urate.
Urate is breakdown product from the purine ( building block of DNA). The food rich with purine contribute to hyperuricemia and indirectly to gout. Thus, patient with gout should avoid these foods such as peanut product ( including taufu or beancurd), internal organ and red meat.
Doctor will confirm diagnosis of gout by increased urate ( hyperuricaemia , hyper- mean high )in lab test and most accurately by finding the birefingent ( green-coloured crystal ) in synovial fluid.
How to manage this illness?
Rest yout joint, take pain killer ( NSAID-non-steroidal anti-inflammatory agent). In severe case, doctor will prescribe colchine ( which will stop division of cell), uricosuric drug ( induce urate excretion in urine), allopurinol ( which stop or inhibit one enzyme ( xanthine oxidase) in the process of purine breakdown).

These uricosuric drug and allopurinol should be taken with NSAID during acute attack (sudden or short-lived attack) because it will precipitate or worsen the attack leading to more pain. In all disease, medicines just do a part in management of the disease. Thus, in this case, patient should lose weight ( weight really burden your joint, that’s why obese patient easily had joint pain), reduce or stop alcohol consumption ( which will reduce urate excretion), reduce or stop the diuretic ( the drug which cause urination to excrete water from our body, usually used in heart failure-inability of heart to pump blood efficiently, high blood pressure/hypertension, water in lung ( pulmonary edema) and so on)

Medicine is ever changing field so the information maybe no longer correct in the moment you are reading it. Furthermore, this is written by the medical student ( not a qualified doctor yet) when he encounter the people with that disease and there is possibility of mistake in this text. Consult your nearby doctor if there is any query.