Rabbit Park


Drove up to Bukit Tinggi yesterday. I think the drive was longer than our stay there :p
RM3 per entry for adults, toddlers above 2.

Rabbit = Bunny.

No wonder Arianna was confused when we kept saying rabbits.

She insists on choosing her own outfit. So if she wears seluar rumah yg comot, what can u say? Thank God the colour matches.

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Pop Goes The Weasel

'Round and 'round the cobbler's bench
The monkey chased the weasel,
The monkey thought 'twas all in fun
Pop! Goes the weasel.

A penny for a spool of thread
A penny for a needle,
That's the way the money goes,
Pop! Goes the weasel.

A half a pound of tupenny rice,
A half a pound of treacle.
Mix it up and make it nice,
Pop! Goes the weasel.

Up and down the London road,
In and out of the Eagle,
That's the way the money goes,
Pop! Goes the weasel.

I've no time to plead and pine,
I've no time to wheedle,
Kiss me quick and then I'm gone
Pop! Goes the weasel.

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Sing a Song of Sixpence

Sing a song of sixpence,
A pocket full of rye;
(Children in circle skip to the left while singing)

Four and twenty blackbirds
Baked in a pie!
(Children in circle skip to the right,
then stretch arms up toward center to form the pie.)

When the pie was opened,
The birds began to sing;
(Children in circle bring arms back down
to waist level, then children in center of ring
begin to 'chirp' and 'tweet')

Wasn't that a dainty dish
To set before the king?
(Children in circle skip to the left;
children in center flutter about like birds.)

The king was in his counting house,
Counting all the money;
(Children in circle walk backward
four steps then pretend to count money;
children in center keep fluttering like birds)

The queen was in the parlor,
Eating bread with honey
(Children in circle walk forward
four steps, kneel and pretend to eat;
children in center keep fluttering like birds)

The maid was in the garden,
Hanging out the clothes;
(Children in circle pretend to pick up clothes,
then turn outward and hang them up.)

When down came a blackbird
Who snapped off her nose!
(Children in center flutter to, and run around,
those in the circle, one bird to one child, each snapping
off a nose. Those in the circle kneel and the birds each
hold up one finger to represent the nose.)

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How To Teach Visual Spatial Learners

How To Teach Visual Spatial Learners

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outdoor: Bird Park

I think this entry is long overdue. Ummi Salsabila did ask... but I was kinda busy that time to dig out photos. Apart from shopping complexes, restaurants, Atok&Wan's place... she goes to the park. But it has been awhile since we went to the park ever since she's sleeping through the night (ie 11pm/12am till 9/10am).

Here's what we did yesterday- Bird Park, KL.

DH decided not to teach individual bird's species *phew, I suck at that*. All were birds haha. I didn't BW although I did have the Beco with me, just in case. She had run running around, with us chasing after her. Daddy carried her whenever she got tired... all 3 of us were pretty tired after 2 hours :)

Still no luck with stroller.
The last time we used a stroller, coz I had a backache (must be collecting dust now). Pic was back in December, in a nearby park.
This is Ray... we should have a playdate again.

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ILI- influenza like illness, it's not a new term... something doc's will write esp for monthly stats to JKN

Algorithm For Treatment of ILI In Adult Patients With Co-morbidities In An Outpatient Setting

Notes:

# Definition of Influenza-like Illness (ILI):

Sudden onset of fever with temperature > 38°C with cough and sore throat, in the absence of other diagnosis

* Treatment with influenza antivirals:

Treatment with the antiviral drugs should be administered as soon as possible after symptom onset. As the benefits are greatest when administered within 48 hours after symptom onset, clinicians should initiate treatment immediately and not wait for the results of laboratory tests.

While treatment within 48 hours of symptom onset brings the greatest benefits, later initiation of treatment may also be beneficial. This decision should be made on a case-by-case basis. If the symptoms are improving beyond the first 48 hours, treatment may not be necessary. Clinical benefits associated with oseltamivir treatment include a reduced risk of pneumonia (one of the most frequently reported causes of death in infected people) and a reduced need for hospitalization.

** Clinical assessment Tool:

Patients with ILI and any of the following parameters should be considered for admission to the of nearest hospital
Respiratory impairment: any of the following
  • Tachypnoea, respiratory rate > 24/min
  • Inability to complete sentence in one breath
  • Use of accessory muscles of respiration, supraclavicular recession
  • Oxygen saturation ≤ 92% on pulse oximetry
  • Decreased effort tolerance since onset of ILI
  • Respiratory exhaustion
  • Chest pains
Evidence of clinical dehydration or clinical shock
  • Systolic BP <>
  • Capillary refill time > 2 seconds, reduced skin turgor
Altered Conscious level (esp. in extremes of age)
  • New confusion, striking agitation or seizures
Other clinical concerns:
  • Rapidly progressive (esp. high fever > 3 days) or serious atypical illness
  • Severe & persistent vomiting

*** Home assessment Tool:

1.Respiratory Difficulties: Shortness of breath, rapid breathing or Purple or blue discoloration of lips
2.Coughing out blood or blood streaked sputum
3.Persistent chest pains
4.Persistent diarrhea and / or vomiting
5.Fever persisting beyond 3 days or recurring after 3 days
6.Abnormal behaviour , confusion, less responsive , convulsion
7.Dizziness when standing and/or reduced urine production

@ Co-morbidities / Risk factors:
Patients who are considered vulnerable to severe outcomes and should be a focus of early identification, assessment and treatment, include the following:

  • Chronic respiratory conditions, including asthma, COPD, Obstructive sleep apnoea
  • Pregnant women, esp. in second or third trimester
  • Obesity
  • Other possible predisposing conditions, such as chronic cardiac disease (not simple hypertension), and chronic illnesses including diabetes mellitus, renal failure, haemoglobinopathies, immunosuppression (including cancer, HIV/AIDS, chemotherapy, long term steroids).
  • Adults > 65 years of age esp. those with other chronic diseases

As more epidemiologic and clinical data become available, these risk groups might be revised.

Zanamivir
Zanamivir is not advised in patients with history of bronchospasm.

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for all moms/dads out there

Equip yourself with knowledge. Ministry of Healths' website is easy enough, but I was following WHO since the beginning (long before cases started in Malaysia).

Fact: Be more worried about local transmission rather than imported cases. Once local transmission starts, the airport screening etc isn't as important.

Fact: Quarantine works. Of course not adhered to. We got exposed to a UITM quarantined person...coughing away at a kenduri. Thank God it was open space, we were minimum 1 metre away.

Fact: Co morbid factors makes it worse...our common one is: OUR CHILDREN (okay I have 2 more: a healthcare worker, an asthmatic too)

Myth: Wearing a 3 ply mask doesn't help, we should get an N95 mask. H1N1 is spread via droplets...big drops which a 3 ply mask is adequate. If you're coughing, wear a mask, and stop the spread. Well, we wore mask coz public were coughing/sneezing right into our faces. Don't believe this? Go and ask the professor.

Me?
Probably have been exposed, but always watching for symptoms. That girl from kenduri (all 3 of us probably were at risk), 140+ UMMC staff, 1 suspected in my department.... and of course at one point or another the H1N1 patients definitely come to us for xray, CT scan.

Swab? Rapid test kit?
They can't cope with throat swabs honestly. IMR is swamped. Haven't been in touch with MKAK lab people if they're doing it as well. Rapid test kit... 60-70% accuracy.... so there might be false negatives too.

Antiviral, Tamiflu?
You wouldn't have to wait for positive throat swab to start it. But then again, it's not like candies which you can take just to prevent the disease, I know some patients love taking antibiotics and think doctors are idiots without prescribing antibiotics.
I prescribed antibiotics for those type of people, because psychologically they are not cured without antibiotics. Antibiotic resistance- well there are other types of antibiotics. Worse case scenario... you get top notch IV antibiotics in ICU.
Tamiflu resistance has been recorded. We don't have that many antivirals compared to antibiotics. Doctors really have to exercise care in prescribing.

Doctors in hospitals are working hard to fight this. Unfortunately people are not aware of how huge this is. Ignoring quarantine, not staying home when you're sick, coughing/sneezing without covering (that's just bad manners too), invading personal spaces (don't you feel like whacking people who just insist standing too close to you).

Public health, wake up! Local transmission is here to stay, forget about imported cases. Close the clusters. Don't just 'wait and see'. This is your moment for fame (only if you do it right in handling this.... Hello, we've been rehearsing that National Influenza Pandemic Preparedness Plan for years)

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high risk group and what to watch for

Siapakah yang berisiko tinggi akibat jangkitan Influenza A (H1N1)?
  1. Kanak-kanak berusia kurang 5 tahun
  2. Individu berusia 65 tahun dan ke atas
  3. Kanak-kanak dan remaja
  4. Wanita mengandung
  5. Dewasa dan kanak-kanak yang mempunyai penyakit asma, pulmonari kronik, kardiovaskular, hepatik, hematologikal, neurologik, neuromaskular atau penyakit metabolik seperti Diabetes
  6. Dewasa dan kanak-kanak yang mempunyai sistem imuniti yang rendah (immunosuppression)
  7. Individu yang menginap di rumah kebajikan dan institusi penjagaan yang lain
Panduan Menilai Tahap Kesihatan Diri Di Rumah
Secara amnya demam selesema boleh sembuh dengan sendiri. Namun begitu, anda perlu mendapatkan rawatan SEGERA di hospital jika anda mengalami mana-mana tanda dan gejala berikut
  • Masalah pernafasan : sesak nafas, semput, warna bibir bertukar menjadi biru/ungu
  • Batuk berdarah atau kahak berdarah
  • Sakit dada berterusan
  • Cirit-birit atau muntah yang kerap
  • Demam berterusan melebihi 3 hari ataupun demam berulang selepas tiga hari pulih
  • Berkelakuan tidak normal, keliru, kurang responsif kepada rangsangan atau sawan
  • Rasa pening apabila berdiri
  • Kurang kencing

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http://h1n1.moh.gov.my

Mencuci tangan adalah kaedah terbaik untuk mencegah kejadian jangkitan penyakit berjangkit.

7 Langkah Mencuci Tangan dengan Air dan Sabun

  1. Basahkan tangan anda dan ratakan sabun dengan sempurna
  2. Gosok kedua-dua tapak tangan
  3. Gosok setiap jari dan celah jari
  4. Gosok kuku di tapak tangan
  5. Gosok belakang tangan dan celah jari
  6. Cuci tangan dengan air bersih
  7. Keringkan tangan dengan kain bersih atau tisu

4 langkah Mencuci Tangan Dengan Bahan Pencuci Tangan Berasaskan Alkohol (Hand Sanitizer/Hand Rub)

  1. Tanggalkan barang kemas/balut bahagian luka
  2. Keringkan tangan dengan tisu/tuala bersih
  3. Letak bahan pencuci ke tapak tangan
  4. Gosok tangan dengan bahan pencuci selama 1 minit

Beri perhatian apabila menggosok belakang tangan, jari, kuku, hujung jari dan celah jari

Amalkan Mencuci Tangan:

  • Selepas bersin/batuk/menghembus hidung
  • Selepas menyentuh permukaan objek yang terdapat di tempat-tempat awam seperti kaunter tiket, kaunter pertanyaan, tombol pintu (door knob), rel tangga, pemegang tangan dalam pengangkutan awam (bas/keretapi/LRT)
  • Selepas berjabat tangan dengan individu yang mengalami gejala selesema
  • Bila-bila masa tangan anda kotor

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Influenza A(H1N1) - Kementerian Kesihatan Malaysia

Influenza A(H1N1) - Kementerian Kesihatan Malaysia

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breakfast anyone?

Carb: garlic bread
Protein: cute fishballs
Veggie: mixed vege
Fruits: watermelon, mango

It's a gap of 3-4 hours between me leaving for work, and her waking up. Daddy prepares breakfast most of the time. These days, most of it ends up in the trash...by evening I can scrutinise what she has, or rather hasn't eaten (in this case, just the cute fishballs were eaten).

Grandparents are also cracking their head to feed her.

Her current 'okay' food:
  • Nasi ayam
  • Sushi rice - with a dash of gravy
  • Pisang goreng
  • Cucur
  • Roti canai
  • Cake
  • Noodles

But it's always the same, NEVER EVER repeat it too often (more than once, twice). She got tired of:
  • Chocolate flavouring
  • Chocolate icecream
  • Soup
  • Meehoon

She had duku langsat yesterday. She really is cucu Tok Wan. They're both big fans of local fruits: durian, mango, duku langsat, banana. He's officially her fruit provider *LOL (she goes to Tok Wan asking for fruits, instructing him to cut the fruits haha)

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