skin talk

it's been a week since i started my dermatology ssc at hope hospital (or salford royal as they now call it) and i have to say, although i wasn't really looking forward prior to it, i'm actually liking it very much. not particularly loving and being passionate about dermatology but simply loving the fact that i'm in a different hospital and in a whole new environment altogether. i even enjoy commuting from manchester city centre all the way to salford each day, as crowded as the trams/buses are! the hospital is HUGE, it makes royal preston seem like a mouse hole. i envy the students based here because they have a newly-built education centre (opened by the mayo clinic i may add) which has 5 storeys and is very high-tech! i never really liked preston all this while but suddenly i am greatly resenting the fact that i was placed there. but it's something i cannot change and i have to make do, and at least i get to get out of it for awhile and experience being somewhere else for a change. besides, things back in preston were getting a bit... hmm... hostile. best i stay away for awhile. :p

i think it's unfair that many people don't regard dermatologists as doctors. just because they don't really deal with internal medicine (actually they do, especially those who work on the wards) doesn't mean they are not important in the field. i think we've been taking skin diseases for granted all this while; after all they're almost always the same old boring stuff like psoriasis, eczema and acne, but once you've seen the worst skin conditions you can ever imagine, your heart just goes out to the patients the same way it goes out to every other patient who's suffering from other diseases.

yesterday i met an inpatient who had erythrodermic eczema (called erythrodermic when more than 90% of the body is eczematous), and i immediately just wanted to shed tears for him. his whole body was literally red, perhaps a few spots of clear skin on his face but that was about it. he could only lie still on his bed because his whole body was itchy and painful, and just a little bit of friction would cause him to be in so much discomfort. his bed sheets were stained with fluids which were constantly leaking out from his tissues, and no matter how often he took a bath, he still smelled really bad. he was very depressed (who wouldn't be?) and clearly very embarrassed of his condition.

i also attended a 'clinical meeting' among dermatologists, where they gathered various odd cases from all over the region which conditions could not be diagnosed/treated. it was quite interesting - each patient was placed in a room and the consultants and registrars took turns to enter each room to talk to the patients one by one. i tagged along with a registrar and i felt as though we were all doing OSCE! must've been a bitch for the patients though, having to repeat their stories about 20 times to each doctor. :P after that the dermatologists gathered to discuss what they thought of each case and where to go from there. the differentials were all so weird and i was really lost, but it was an eye-opener to realise that there are people out there who are suffering from a whole new spectrum of diseases - those that we as NORMAL medical students/doctors would never ever think about.

the patients were from all age groups: children to the very elderly, and each of them are intensely affected by what they suffer from in so many different ways. there was a 14-year-old boy whose whole face was erythematous FOR 4 WHOLE YEARS. there were vesicles all over his face which never went away. at first they thought it was SLE because it did look a bit like a malar rash but they tested for it and it turned out negative. he has been all around the UK trying to get his problem solved but nobody seemed to know what it was. when we talked to him we found that he had so little confidence, very bad eye contact and seemed as though he was going to give up. i just felt so sad for him. he's 14. supposed to be enjoying school and life in general. but instead he has to shield himself from the world because he can't bring himself to face anyone with his condition.

and to think that we freak out when we have a random zit popping up on our faces once in awhile. or when we think we look "ugly" in pictures and beg our friends not to post them up on facebook. these people... the only pictures they're willing to take are those by medical photographers for research purposes.

other cases we had: a 16-year-old girl who had hirsutism which was more or less successfully treated by laser therapy, but then came with patches of hyperpigmentation all around her face and neck. they were NOT pleasant at all. she seemed very upset because, come on, she's 16! the age when we are exceptionally conscious of our looks. there was a middle-aged smart-looking lady who came in with a big indentation in her forehead which seemed to be growing (and by growing i mean getting deeper). just a random indentation! no trauma whatsoever. it was like she had a nail screwed deep into her skin and into her skull. can you imagine a hole right in the middle of your forehead? how weird is that? another middle-aged lady - a very sweet indian woman - came in with every single allergy possible. i swear. she's allergic to latex, flour, makeup, hair-dye, laundry detergent, seafood, dust... and i know, most of us are somewhat allergic to dust, but for HER, all she needs is to inhale a tiny speck of dust and she will start to wheeze and her whole body straightaway feels unwell.

there were many other strange cases that we saw but i will spare you the details. my point is that most of the time we think of skin diseases and simply assume they're all fungal infections or the common allergic reactions which could very easily be treated with antifungals or steroids, and that those who seek help for their skin problems aren't "as important" as those who walk into other clinics for, say, vomitting and diarrhoea. while i admit that most of the time skin conditions are hardly anything near deadly, a lot of them are chronic and cause a lot of distress to the people who suffer from them. they are affected physically, mentally, emotionally... it's just so draining to live life like that. i mean it's not like having heart problems where you can still walk around town without anyone knowing. if you have lesions all over your face and body, you step out of your own house only to worry about how people will think of you. it's just not nice!

i'm not saying that skin diseases are equivalent to the big killers like cancer and heart diseases and all that, but i just hope that people will gain a little more perspective into how serious some of the conditions can be. and by serious it doesn't just mean high rates of mortality (because mortality is obviously quite rare in dermatology), but also how it affects the quality of people's lives.

to be honest, i initially wasn't at all pleased to find out that i was going to do dermatology for my ssc project (5th choice somemore!), but i guess i should count myself lucky to be able to do it in one of the largest dermatology centres in the UK (28 consultant dermatologists, how is that not big enough?). i've learned quite a lot just this week itself, and i have 3 weeks to go. that said, i don't think i'm actually interested to pursue a career in dermatology - i'll leave that for those who are explicitly passionate about the skin :P, but it's good to learn a little bit about something totally different from what we're used to and at least know that there are so many people out there who are affected by these kind of diseases.

scotland!

but progress test right before that. sucks. and have to leave at 7:30 tomorrow morning for it too. sucks more!

i really did try to study on multiple attempts but to no avail each time. simply because they will test us on anything and everything under the medicine sky and when you see the amount of what you should be reading, you just lose the will to even start. so best thing is to not study and rely on memory! :D a very BRILLIANT technique indeed considering the last medical exam i did was exactly one year ago. *eyeroll*

(and also to just sit back and relax with youtube channel 4oD)

well but honestly i tried to cover NME (GI, renal & endocrine in non-manchestermedschool terms) because i just finished that module. hopefully i am sound enough in those three.

another good use for the oxford handbook: camwhore! and see whose display pic of being a nerd is nicer. obviously michelle's cos duh, she's the bigger nerd.


nah, some nerdy trivia for you in our conversation about guillain-barre syndrome. ahhaha.

can't wait for: coffee cream towers, greasy food, ben's cooking and SEAFOOD! and yala yala, to see you lah, retard.

paris, je t'aime

we hear so much about paris everywhere - from the people who have visited, movies, books, tv shows... we get really sick of it. well i did, anyway. i was minimally excited on going but i also decided to go with an open heart.

surely there's a reason for all the glorification. there's of course the eiffel tower, because that's what most tourists go to paris for (although i admit i am not one of them. was never particularly fond of the structure, even when i saw it right in front of me, i thought it was slightly overrated), world famous museums for the artsy-fartsies, designer fashion, high cuisine, music, theatre, parks, amazing architecture... there is no way paris will fail to enchant anyone.

having travelled to paris from rome, i wasn't really looking forward to it because i didn't want to leave the familiarity and comforts of rome. i was tempted to stay longer and fatten up with all that italian food, but i knew paris was beckoning from afar, so onto the train i hopped.

it wasn't until i arrived at the scene of the river seine when i was suddenly remarkably dazzled by paris in all its grandeur. it really was magical. bonjour paris! i was now drawn in.

nightview of the famous musee du louvre along the river seine.

the moulin rouge in the colourful district of montmartre.

pont alexandre III, i'd think the most beautiful of all the bridges spanning the seine.

relaxing stroll around the city on christmas day. beautiful weather, too. couldn't ask for a better way to spend christmas!

along the champs elysees.

arc de triomphe at the end of champs elysees.

tour de eiffel. magnificent, yes, but not something i can sit and look at the entire day.

eiffel at night.

the notre dame cathedral. loved the gothic architecture both on the outside and the inside. when we went in there was a mass going on with pipe organs playing.

the musee d'orsay. went all the way there on xmas eve only to find that it was closed early :| couldn't find time to go back again, so it'll be the first on my list to visit next time around.

me against the louvre, on the other side of the seine. enjoyed my whole day there - didn't realise i was actually that cultured!

pyramid of the da vinci code fame.

one of the great masterpieces at the louvre: the winged victory of samothrace.

most famous painting in the world: the mona lisa. i personally thought it was ugly and too small.

the breathtaking river seine again on a bright and sunny day.

the jardin du luxembourg. vast and beautiful gardens, even in the winter. i really cannot imagine it during spring.

lunch at the jardin. good thing the weather was fine enough to dine outdoors!

i was wearing the same jacket throughout my trip to both rome & paris because i travelled on a budget and there was no way i could fit another coat into my luggage. was very unfashionable during the trip, with sports shoes and all; while all the parisian little girls, ladies and even old ladies walked around wearing knee-high leather boots and Chanel coats. harhar.

gerard mullot french desserts. i can see you drooling.

typical parisian apartments. love the iron railings on the balconies.

our hotel daily breakfast. fresh croissants, breads, cheese, cereal, fruit, yoghurt, coffee, tea, juices... what a great way to start each day. we stayed at the nice contemporary hotel residence richemont at the olympiades area for 60% off! wouldn't have been able to afford it otherwise. thank you adrian for spotting it :P

paris paris paris. colourful, sophisticated, interesting, artistic and houses a nice blend of historical and modern day architecture. it is so regal that it can actually be intimidating at times. but there is no reason why i wouldn't go back time and again, and hopefully not on a budget so i can travel in style and do some shopping at least!

(i was so proud of myself for not even window-shopping while in either of the cities, not only because i couldn't afford it but also because stupid ryanair gave VERY limited baggage allowance. in fact the only purchases made besides food, transport and accommodation were a few magnets, shot glasses and a L'occitane mini christmas gift set for MYSELF. haha.)

now i am proud to say i have visited paris and i'm going to be one of those who spread the word about how worth visiting it is. the city is so posh and beautifully-maintained, no wonder it is dubbed one of the greatest cities in the world.

blah

i've been wanting to blog about paris for quite some time now, but words have been failing me everytime i attempt to write an entry.

so today i will just talk about the weather.

i woke up this morning to find that my neighbour's big fat black cat's pawprints in the blanket of snow in my backyard have finally disappeared after a few days. aww i miss those pawprints. but that also means that the snow is starting to melt! ahh bliss. i hope that the worst is over since the temperature has begun to rise slowly. it is now 0°C and i don't feel that cold! wowweee.

ok that's all about the weather, really.

i know this entry is very lame.

paris paris paris. soon.

oh the eternal city

i cannot decide if i prefer rome or paris. paris is of course grander and i dare say more breathtaking as a whole, but it can be really intimidating at times. rome - old, rustic, but so meticulously preserved - has a more comforting and inviting charm. so the answer is this: as a tourist, rome it is. but to live in: it has to be paris. once i learn french that is. haha.

i just love how easy it is to navigate around rome. everything is concentrated in the centre of the city that you can walk just about everywhere and anywhere you need to go to. weather-wise: obviously not as cold as here in england. very pleasant in fact, even in the winter. the people are so warm and friendly, and to my surprise, most of them actually speak english. the food? abundant, affordable, and most importantly, nothing like what you get at italian restaurants anywhere else in the world. and i mean in a very very good way.

oh rome. i could go back there again and again and let my troubles float away. i could go back to the trevi fountain and repeatedly be so much in awe of it, just like i was the first time. hold my breath and wonder, how anyone in the world could sculpt something so beautiful. i mean, is it even possible? this question actually comes up so many times while in rome: how is this possible?! from the trevi fountain to the colosseum to the terme di caracalla, all the way to st peter's basilica at the vatican- they keep your mind constantly boggled; how on earth have people from the past been able to construct these with such medieval technology, or even with their bare hands? i am simply amazed.

this is me atop the spanish steps, with the city of Rome in the background.

the colosseum. built 1st century AD. epitome of great roman architecture.

my beautiful fontana di trevi at nightfall, with a cone of gelato in hand. i can sit and watch this all day while i eat cone after cone of gelato!

the remains of the terme di caracalla (roman baths)- magnificently well-preserved and virtually untouched.

the pantheon. didn't think it was particularly great, but worth a visit anyway.

beautiful fountains and piazzas here, there and everywhere. one of the things i really like about rome.

sant eustachio. merv says they serve the best coffee in the world. i personally can't recall what's the best coffee i've tried, but this may actually be it. :)

st peter's square @ the vatican, with the basilica behind.

inside the basilica. if you are not blown away by this, you are made of wood.

in the vatican museum, where they play mind games with you before you actually get to enter the sistine chapel (which, honestly, was quite a letdown- perhaps it was the massive crowd and that they didn't allow us to take pictures in the chapel itself :P). oh well but it was great to finally get to see michaelangelo's creation of adam on the ceiling.

to be fair, i actually really enjoyed the museum despite the constant "Where the hell is the Sistine Chapel" whinings.

what is italy without its pizza. go into any pizza place and you are almost guaranteed a good meal.

and the pasta. ohmygod the pasta. this is the best - THE BEST - spaghetti carbonara i've ever tasted. i don't think i'll ever eat one with cream again.

grappa (italian brandy, 60% alcohol) is really yucky though.

ah, bella roma! i'll definitely make a trip back to rome again. venice, milan, and the italian outskirts await as well!

new decade

happy new year! i have to say, 2009 was possibly the best year of my entire life, having spent more than half of it at home doing absolutely nothing and being spoiled to the core. so i pray that my 2010 will be just as good or even better, and hopefully (actually, most certainly) much more productive!

my new year's eve was spent with my dearest friends who came all the way from dundee & nottingham. had dimsum for lunch and szechuan food for dinner (yes very cheena indeed), and shopping at the trafford centre in between. :) came back home, opened a bottle of kir and pseudo-toasted to the new year.

we later got hungry after midnight and ordered pizza and kebab. clearly we were thinking REALLY hard on what to eat =/

girls

boys

here's to our other friends whom we miss dearly. :)

blog about paris and rome another time.

have a blessed year ahead everyone.