The Pharmers' Connection

In response to constance's blog, and a grim reminder of pharmaco paper. Let no more brain cells die, no more meningeal arteries be vasodilated, let us never sit for any more pharmaco papers again.

Why are there so many notes for us pharmers
And all printed on both sides
Pharmers have visions, but they're just illusions
And pharmers have nothing to hide
So we've been told just choose to believe it
But I know they're wrong, wait and see
someday we'll find it
that pharmer's connection
the muggers, the dreamers and me

Is it that every word,
every line and answer
the page with the big, big star
somebody said "this will come out, believe it"
and look what its done so far
what's so amazing
that keeps us revising
what so we think we might glean
someday we'll find it
that pharmer's connection
the muggers, the dreamers and me

All of us under a spell,
we know this test's probably tragic...

Do you just want to sleep
and start hearing voices?
Saying don't write your name.
Is this the answer that will get you an A+?
Or leave you cowering in shame?
I've heard it too many times to ignore it.
It's something that just supposed to be.
Someday we'll find it, the pharmer connection,
the muggers, the dreamers and me.

Of all the time in the world...

... that i have, now, 48 hours left to the dreaded triple-battery PDP exams (Patho, DFD, Pharmaco),

i shouldn't be blogging.

Well....

Was talking about what to take next sem with nuan. She wasn't feeling too well just now, so i'd thought i'd cheer her up a bit. So we talked about this. Promised to take at least one module with her in NUS. Finding it a bit difficult, considering the fact that her break clashes with my lesson and vice versa this sem. Life is hard. Also, most of what i wanted to take (e.g. psychology), she had taken, and because of this, some modules are not available to me but available to her.

The only exception is marketing. Was deciding between mkt2401 and pr1301. however, pr1301 is not offered next sem (shucks). Checked the timetable for mkt2401, the prognosis is so far good, the tumor has not metastasized.

The only thing dragging me back is that mkt2401 is a very heavy module (although i've wanted to take it at some point in my uni life) and coupled with my four other not-so-interesting (esp. Pharmacotherapy I??? asking for death???) modules, you can cut my throat one sem in advance. Projects, assignments, research, etc etc.

The only good thing is that, mkt2401 is no-exam (according to this sem). Well, we'll have to hear the diagnosis from junice first.

***

And with that, made me think about what i wanna do in the future... there are at least three paths.
1) Retail / Hospital Pharmacist; sit in pharmacy, dispense drugs, advise people on ADR, look for drug interactions, "advise" doctors, get scolded, get intimidated by drug addicts, fawn rich people.

The pay isn't very good i heard, and there's CPE. But what comes with it is the relative job security (some pharmacists do get axed, esp. if they screw up big), the regular or fixed job hours it provides, and the satisfaction (well, almost) to see someone's illness get cured, partly due to your doing. When the day is over, go back and fetch the kids, help to prepare dinner, and be a good daddy.

I recently read the blog of a retail pharmacist, and it was quite inspiring - a very simple, quiet life, filled with anecdotes of the little charming things in and outside work. Sitting in the pharmacy and watching the days and customers go by while sipping a cuppa (in the back room), greeting customers with a smile, and seeing them leave with a smile. I met the guy once in person, although we never really talked, but one could see that he radiated an aura. Of calmness?

2) Throw away the license and go into business, manufacturing or regulatory, etc: seems even more remote. The range of pay is much larger than being a pharmacist (i think), but you're on your two hands, treading a tightrope day by day, at least that's how i would feel. But the dough you knead is good. All the people i met at the Pharmacy Congress - that's what they chose, and those who were there truly lived to tell fantastic tales of how they started from scratch to build their business empires. I am no born businessman, though. I wish money would fall from the skies, haha. $500 per day would be good.

3) Others: well, i haven't given much thought to this yet, since i have presented with no other talents and disciplines...

Hmm, i entered university without much of a thought of what i would become - and now, i am still lost.

Generalized (tonic-clonic) Seizures

From wikipedia.

[edit] Pathophysiology

The vast majority of generalised seizures are idiopathic. ^[1] However, some generalised seizures start as a smaller seizure such as a simple partial seizure or a complex partial seizure and then spread to both hemispheres of the brain. This is called a secondary generalisation. ^[2] In the case of idiopathic epilepsy, it is not certain what is the cause of the seizures. However, it is believed that factors could include chemical and neurotransmitter imbalances, and a genetically determined seizure threshold, which have both been implicated. The seizure threshold can be altered by fatigue, malnutrition, lack of sleep or rest, hypertension, stress, diabetes, the presence of neon or laser flashes or lights, rapid motion or flight, blood sugar imbalances, anxiety and other factors. ^[3]

In the case of symptomatic epilepsy, it is often determined by MRI or other neuroimaging techniques that there is some degree of damage to a large number of neurons.^[4] The lesions (scar tissue) caused by the loss of these neurons can result in groups of neurons episodically firing abnormally, creating a seizure.

Phases

The seizures are divided into two phases, the tonic phase and the clonic phase, hence the name of the seizure, though a tonic-clonic seizure will often be preceded by an aura.

• In the aura, the person may feel a sense of strong deja vu, lightheadedness and/or dizziness, unusual (and possibly inappropriate) emotions, altered vision and hearing (which may or may not include hallucinations), and sometimes other symptoms. This is actually a simple partial seizure. Sometimes, the person will lose complete awareness and start making odd or pointless movements (such as picking at clothes) towards the end of the aura, at which point the seizure has progressed to become a complex partial seizure. The aura stage is due to the fact that tonic-clonic seizures often start in an isolated area of the brain, and gradually progress to the whole brain, at which point it becomes a tonic-clonic seizure. An aura may last as little as a few seconds up to several minutes, depending on the person, and some people with epilepsy do not experience auras at all. It should also be noted that in many individuals, not all auras result in a tonic-clonic seizure.

• In the tonic phase, the person will fall unconscious, and the person's muscles will suddenly tense up, often causing the extremities to either be pulled towards the body or rigidly pushed away from it, which will cause the person to fall to the ground if they are standing. The tonic phase is usually the shortest part of the seizure, usually lasting only a few seconds. The person may also express vocalisations sounding like a loud moan during the tonic stage, though this is not always the case.

• In the clonic phase, the person's muscles will start to contract and relax rapidly, causing convulsions. These may range from exaggerated twitches of the arms and legs to violent shaking or vibrating of the stiffened extremities. The person may roll and stretch as the seizure spreads. The eyes typically roll back, the tongue is often bitten, and incontinence is seen in some cases. Post-ictal sleep invariably follows a tonic-clonic seizure. Confusion and amnesia upon awakening is usually experienced.

First aid

Many people who experience tonic-clonic seizures will be aware of an oncoming seizure for up to several minutes before the full seizure begins. This is called an aura and is typically a simple partial seizure or a complex partial seizure which has spread to the whole brain. However, many people who have epilepsy do not experience auras. If a person reports they believe they are about to have a seizure, their safety should be ensured. This can be done by laying them into the recovery position, and removing any objects which may pose a danger to the person during the seizure. If the person does not experience an aura, and goes directly into a seizure, they should be gently eased to the ground if possible.

Once the convulsions have begun, the seizure must simply run its course. No attempt to restrain the person should be made because this risks injury to either party, instead it should be ensured that they do not injure themselves by placing something soft under their head, and ensuring their limbs and body don't bump into walls or other objects. If the person vomits, the person's head should be placed to the side to allow the vomit to run out of the mouth without blocking the airway. Nothing should ever be placed into the person's mouth, as this can cause the person to bite their tongue or choke, (or injure the one placing the object into their mouth). Despite popular belief, it is not possible for someone having a seizure to swallow their tongue. The frenulum of the tongue prevents this.

Once the seizure ends, the person will stop convulsing, the limbs will go limp, and the person will be completely unconscious for a while. Once they start to come to, they will usually be tired, disoriented, and unaware they have had a seizure. A person having a seizure should never be left unattended until they are fully recovered.

If the person is known to have epilepsy, it is not usually necessary to call an ambulance. However, if the person is not known to have epilepsy, the seizure lasts four to five minutes or longer, the person has a second seizure before regaining consciousness, or the person injures themselves or stops breathing (apnea) during or after the seizure, medical attention is needed.

Photosensitive Epilepsy (PSE)

Finally found it... from Wikipedia.

***

Photosensitive epilepsy is a form of epilepsy in which seizures are triggered by visual stimuli that form patterns in time or space, such as flashing lights, bold, regular patterns, or regular moving patterns.

Symptoms

Persons with PSE experience epileptiform seizures upon exposure to certain visual stimuli. The exact nature of the stimulus or stimuli that triggers the seizures varies from one patient to another, as does the nature and severity of the resulting seizures (ranging from brief absence seizures to full tonic-clonic seizures). Many PSE patients experience an “aura” or feel odd sensations before the seizure occurs, and this can serve as a warning to a patient to move away from the trigger stimulus.

Treatment and prognosis

No cure is available for PSE, although the sensitivity of some patients may diminish over time. Medical treatment is available to reduce sensitivity, with sodium valproate being commonly prescribed. Patients can also learn to avoid situations in which they might be exposed to stimuli that trigger seizures and/or take steps to diminish their sensitivity (as by covering one eye) if they are unavoidably exposed. These actions together can reduce the risk of seizures to almost zero for many PSE patients.

Some PSE patients have trigger stimuli that are so specific that they are never likely to encounter them in real life. Their PSE may only be discovered by accident in an unusual situation or during examination for other complaints.

The visual trigger for a seizure is generally cyclic, forming a regular pattern in time or space. Flashing lights or rapidly changing or alternating images (as in clubs, around emergency vehicles, in action movies or television programs, etc.) are an example of patterns in time that can trigger seizures, and these are the most common triggers. Static spatial patterns such as stripes and squares may trigger seizures as well, even if they do not move. In some cases, the trigger must be both spatially and temporally cyclic, such as a certain moving pattern of bars.

Several characteristics are common in the trigger stimuli of many PSE patients. The patterns are usually high in luminance contrast (bright flashes of light alternating with darkness, or white bars against a black background). Contrasts in color alone (without changes in luminance) are rarely triggers for PSE. Some patients are more affected by patterns of certain colors than by patterns of other colors. The exact spacing of a pattern in time or space is important and varies from one individual to another: a patient may readily experience seizures when exposed to lights that flash seven times per second, but may be unaffected by lights that flash twice per second or twenty times per second. Stimuli that fill the entire visual field are more likely to cause seizures than those that appear in only a portion of the visual field. Stimuli perceived with both eyes are usually much more likely to cause seizures than stimuli seen with one eye only (which is why covering one eye may allow patients to avoid seizures when presented with visual challenges). Some patients are more sensitive with their eyes closed; others are more sensitive with their eyes open.

Sensitivity is increased by alcohol consumption, sleep deprivation, and other forms of stress.

Preparations

Finally, after eleven waves of attacks, like swarms of flying hornets, the tests are over.

I think i'm quite ok for pharmaco. Well, ok enough. Well, maybe not so. I guess i'm average.

Looking at the range of people from As to Fs outright, it can be seen, that some people hated this test. And well - what the heck - for an average score after studying like 3 days in advance and sacrificing my med chem (which was even harder!!) test the next day, i got this result.

Well, at least i didn't get much worse. Some justice there though.

No comments for the fallen. Everyone will despise his or her score anyway, myself included. Well, i guess i'm too tired to even care.

But yet... in the midst of them all, are people who scored As. Well, either they've been very hardworking, or God must have given them something extra. For this sem, i'm neither.

Back to anticlotting drugs. I'm worried for patho. It says "the whole syllabus". I wonder what that mean.

3 days of hell, 72 hours of pure cramming, deleting and cramming. Why do people who set the exam dates have no brain, to put 3 memory-laden exams one after another.

It's that time of the year again... (part 2)

Oh yes, the smses were great. Totally made my day.

Now i know why i feel so introverted this sem, like i'm in my own planet Zeus some 10 light-years away from here.

I forgot to tell everyone that i changed my handphone number!!! ARGH.

In fact, other than deardear and bx, no one said HB to me at 0000.. which is so sad... wondered why till today, when cons and jw said something about sending something to my old phone without getting a reply.

Just to say, for all the friends that send me the message, you made my day! (and made DFD notes more interesting!)

And to say, for all the friends who wondered why i was so dao, you have to endure this long explanation that my sim card spoilt in Sep, so i changed to a new one, then i was just either too busy to sms everyone with that message saying "Hi, I'm whyqueue, i just changed my number to ......."

And hence, everything you sent to me, was greeted with cold, utter, wasted, silence. Sincere apologies for that.

And i will probably send that changing of number message to everyone after exam.. a signal from Zeus to Earth. Hopefully someone will pick it up...

It's that time of the year again...

And cons, it's not christmas, no... haha

Yeah.. all i know is that, there's EIGHT freaking days to exam. 08 days to exam omg. and i've not touched anything.

Correction. i managed to sift through Kurup's notes. Not done yet though. Most of it is what i've revised for DFD2 test anyway.

2 days for DFD2, 3 days for pharmaco, 3 days for patho.
Objective: to average a B for all three subjects. Acutally, objective: to screw it and write all the shit i know at the point in time down, get it over and done with. Survive until 30th Nov.

Like the song said, "wake me up, when November ends." since i'm year 1, i've started singing it every year. Oh sorry. It's september, not november.

Then face the dreaded Med Chem (Target: no D+ and below).
Then study like mad for the last paper.
Then, after a short rendezvous with deardear, after the exam, spend the next three days in deep meditation with my team to India.
And then fly off.

Insomnia... again.

Can't get to sleep again.

After all this long while... i finally rebounded back to insomnia. Do i need a benzodiazepine??

The same complaints again: feeling sleepy, but somewhere in my mind i'm awake, not very alert though. When i close my eyes i don't enter deep sleep.

Instead, i think of all the things that happen to me during the day. and these things drift from missing 8am pharmaco lecture, screwing up 11am dfd2 presentation, missing 2pm patho lecture as a result of my insomnia.

When i try to relax, i think back of the horrible quarrel that i had about 12 hours ago, and all the things come back to me again. The anger felt, which led to an increase in adrenaline. What i should have done. What i should not have done. What if it turned out this way, what if it turned out the other way. One thousand possibilities, all playing out in my mind, like a non-stop cassette tape recording.

Then i drift off to other things like YEP, homework, how screwed i am for friday's test cos i'm going to spend most of thursday sleeping, and how to get my ass out of this mess. Each branches out to a thousand more different stories.

As a result, i never felt the decrease in sympathetic activity. Heart keeps beating like crazy, i can feel it bumping along the chest wall as i inhale. Wonder if i have cardiac myohypertrophy. Wonder i should take an ECG or something. Took some propanolol. Wonder if there'll be a drug interaction, or am i too sedated enough. Thinking of taking some cough mixture, scared of lapsing into a coma.

And to top it all off, i can't talk to any of my friends now, nor tomorrow, cos most of them are probably studying for test. And i can't talk to my girlfriend, and i don't talk to my parents.

Now the time is 4:27 AM. In half an hour's later, it will be 5AM, and the first train from the depot will rumble into Jurong East MRT station, bringing with it the hustle and bustle of the new day. And i will be worried, whether to carry on the new day without sleep, or to go home and rest halfway. Or to totally not come to school.

I really need a break. Someone just be merciful and put me to sleep.