UNCRAVED

Hello love

Couple with a cup of hot coffee on rainy day

One happy fatty kiddo

LOVE IS IN THE AIR HAHA

;) ;) ;)

Cik Dietitian's notes:

The basic ingredients of muffin are sugar, butter/oil, egg, and milk. They are refined sugar, saturated fat and cholesterol. Hence here are some tips to make it healthier:

1. Use vegetable oil such as canola oil, sunflower oil, corn oil, etc instead of palm oil. Those are polyunsaturated fatty acids (PUFA), or so called the 'good fat' that could benefits your cardiovascular health by reducing total cholesterol as well as LDL cholesterol (the bad guy cholesterol). Provided that it is taken as recommended -excessive is also not good. They are still fat thus there still calorie in them.

2. Use low fat/non fat buttermilk. Butter is also saturated fat that might raised the LDL cholesterol. If you use milk in your recipe, go for low fat milk.

3. Reduce the amount of sugar used. Simple sugar is also not good for your health, for the obvious reason (malas nak tulis dah sebenarnya =P)

4. Add fiber! You can add almonds (they are MUFA), oats or flaxseeds. You'll get not only crunchier muffin (yup i like the taste of something crunchy in my muffins), but also healthier one. 

Or if you dont have time like me (yeah i know lazy is the right word),  just have them once in a while when u are so craved for it. By once in a while I mean once in 2-3 month, and take 1 muffin per craving episode. Should be fine, no?

THE STORY OF MY DIETETIC COUNSELING -PART 2

Being a dietitian is not all about dietetic consultation. Sometimes its beyond that. Take today’s case as example. I was covering Kak Aishah in Klinik Sekilau. One of the patient today was a 50 yo Science teacher. She was the 8^th pt, the last pt before lunch hour, newly diagnosed with diabetes mellitus.

So same old same, I asked for her 24 hour diet recall, and the food frequency checklist. To cut the story short, she practices a very good, healthy, well and balanced diet (the one that I myself found it hard to do), all that you can find in the textbook. The portion size is very good, no refined sugar in the diet, lots of veggies (organic some more), healthy cooking methods, healthy lifestyle, exercise regularly, regular medical check up, and she also has an ideal body weight. She claimed that she has always been practicing healthy diet, and has become more conscious on diet ever since her husband was diagnosed with cancer in 2004. She knows all about the anti oxidants, omega 3, unsaturated fat and what not, as she claimed that she read about diet more than she study for her Masters. That’s how conscious she is. That being said, she has a strong family hx of DM, as her mother was diabetic.  

Her question is –what have I done wrong?

It’s a very difficult question. Because she asked that not because she didn’t know the answer, but she asked that out of despair, frustrated, and sad. I could sense that she was heartbroken. It is always easy to counsel diabetic pt based on the guidelines that we have –regular meal time, don’t skip meal, avoid refined sugar, carbohydrate counting, increase fiber and less fat. What if your pt already knows all these stuffs, and what more has been practicing it for long? Do I still nag about all these things? Of course I still did the usual diabetic counseling; despite she already knows most of it, but with justification. Each diabetic guideline that I mentioned to her, comes with the ‘why’. Well I hope that helps. But that’s not all.

Remember I mentioned before that diet consultation is very individual? So I told the pt, that diabetic, is hereditary. When your mother has diabetes, the chance that u might also get it is 25%. At the beginning of the discussion (I rather called it a discussion as she knows a lot) she was very skeptical about genetic issue (despite being a Science teacher she is). For her it is not fair, you know, to get the disease simply because your mother has it, because it is in your DNA.

I’ve learned Developmental Psychology during my first year of study. The Kubler-Ross grief cycle. There are 5 stages of grief, upon knowing bed news. They are Denial, Anger, Bargaining, Depression and Acceptance. I believed that the pt has been on the second stage –she she keeps questioning why, and how does she get diabetes, with all the healthy diet and lifestyle. She said that if it is not for the biochem result in her hand, and the repeating test, and the diagnosis by doctor, she will never believe it. And she is somewhat giving up on healthy lifestyle, as she mentioned that why bother when at the end of the day, she still sick. 

The Kubler-Ross Grief Cycle -image googled

At the end of the session, I did tell her something else –to bersabar, and having diabetes doesn’t mean the end of the world. She can always continue practicing healthy lifestyle, take control of the disease, don’t let it ruin you, physiologically and emotionally. And that was not me as a dietitian talking –that was me as a human being, trying to put myself in her shoes. Its difficult, really. I just hope that she will reach the end stage of the grieving process, which is the ACCEPTENCE phase, make peace with the disease, and yeah, control it.

Sometimes its hard to explain things with Science. As a Muslim, we have to have faith in Qada’ and Qadar. When Allah said kun, fayakun. No one can stop it from happening. And we must believe that there is always something in everything. Setiap perkara yang terjadi ada hikmahnya. La yukallifullahu nafsan illa wus’aha. May Allah grant us with good health, amin.

MY NEW ADDICTION

-image google-

Yeah I am addicted to this now, chocolate flavor. Twiggies Choc-A-Lot, 2 jejari span berinti krim coklat. 
Bought it almost everyday.
Memang gila.
I just could not resist the creamy chocolate taste melt in my mouth. Its the best feeling eva!

Right lets talk nutrition now.
1 packet contains 2 jejari span berinti coklat. 1 serving equals to 1 jejari span.

Each serving, weighed 40 g, contains 146 kcal energy, 5.6 g fat, 21.4 g carbohydrate (most of it comes from sugar), and 2.2 g protein. 

I can finish 2 servings (2 jejari coklat) in one go, which is equal to 292 kcal (not forgetting 11.2 g fat and 42.8 g CHO). Duhhh!!! No wonder I am fat now.

And how do I know most of the CHO comes from sugar? Besides the obvious (the sweet taste of course), the first ingrediens enlisted in the ingredient list is non other than SUGAR. That is a tip for u who didnt know -the first thing in the ingredient list is always the most abundant ingredient in the food. Note that.

One thing about being a dietitian is u will always be conscious on how much u take. Of course u cudnt resist the temptation. What left is the guilt u felt after u eat, and disappointment whenever u see the number on the scale. Hell yeah I am trying so hard to control the lust to buy Twiggies everyday. As a start, lets only buy it whenever I fill in the gas for my car. That is twice a week. Should be fine, no?

WORDLESS WEDNESDAY: DIET SHOP. LETS SHOPPING!

A friend of mine encounter this shop in Paris (if I'm not mistaken), and share it with me. I wonder whats inside.

CERITA KUCING, HIGH PROTEIN DIET, DAN ICU

assalamualaikum.
selamat berpuasa hari ke 6 to all. smg amalan kita diterima, insya allah.

a very cute story in a medical ward.

on thursday i went up to review a patient. septicemia case, with DM and HPT. he also has gastritis. Pt is LOA, but appetite is improving, and he is on soft diabetic diet. Has been losing wt for the past couple of months, and he appear wasted. high protein diet it is to the pt. i prescribe milk supplement to him before, but he could not tolerate the milk -nausea and vomiting. so i gave him modular protein supplement to be added to his porridge. Alhamdulillah he tolerate it well.

Well that is not the cute story i'm about to tell. so when i review this pt, the sister of the ward happened to be there as well. she is a very funny-cute-motherly lady. but she always forget my name. from perak she is, thus its easier for her to call me YONG (i believed it is a nama manja for girl in perak). so we discussed a lil bit about the pt's progress and high protein diet. and then suddenly she told me that her cat was once hospitalized, warded in icu, and given high protein diet. i was like huh???

yup, high protein diet for cat. ok lets call the cat lionel messi (bukan nama sebenar). poor messi has stunted growth. his brother has grown big but he is still small. he also developed diarrhea and vomiting. he has become so thin. so being a concern owner she is, the sister brought messi to the animal medical center in jalan tun razak (or is it jalan ipoh? x igt laa). he was warded in the cat icu, and given drip bcos he was dehydrated. and then he was given high protein diet (for catch up growth). well i heard of veterinar clinic before, but icu for cat? that was my 1st time. i forgot the name of the high protein foods for cat sorry.

nway messi was warded for several days (cost for cat icu is rm50, not including meds and foods, per day). the sister mentioned that his condition is improving. ever heard of a pet always know his owner? whenever the sister pay a visit to him, he will meow and cheer up. (but to a friend, who 'raised' fishes, aku x sure la pulak kan ikan kenal x owner dia ;) nway all d best to the new batch, dont worry nama mcm tough insya allah kekal la yg ni). well back to the story, messi was discharged after a few days of treatment. sister still continue his high protein diet for quite sometimes after that, and she said that messi's development has improved a lot since then. he grows bigger, the fur becomes shinier, and he becomes more active, portraying the name messi (though it is not his real name).

what i want to highlight here is right diet, appropriate to ur condition is very important. even animal shows significant changes when correct theraputic diet is implemented to him. dietetics has become one of the important treatment of a patient, because a pt's nutritional status as well as dietary intake pretty much affecting the prognosis of that particular diseases. 

funny part of the story is how the sister so enthusiastically tell me the story in the middle of the ward. the other staff nurse, overhearing the story, were smiling to us. she show me the picture of messi, from before warded, when in icu, and upon discharge. imagine she has like 600+ pictures in her phone's memory, so she has to scroll one by one to look for it. kite x sampai hati nak cakap x payah susah2, sbb die semangat sgt, so kite layan je la ;) then she realized she didnt have the latest pic of messi (who is perfectly healthy now), so she promised me to take one. fulfilling her promise, right after i counseled wt reduction diet to a pt yesterday (friday) she called me:

sister: yong, dah habis tgk pt ke?

me: dah counseling dah pt bed ** tu. ade refer lg ke sister?

sister: x de dah. nak turun dah ke? kejap. 

me: knp ade sample biskut raya ke (hehe)

sister: ni, awak (yes she called herself awak mcm usop wilcha tu) kan dah janji nak tunjuk gmbr messi yg terbaru. smlm awak dah amik gmbr die. jap eh.

*taking out her phone, scroll the pics, and show me a healthy, shiny, gorjes cat*

me: wow chumilnya..........bagus la diet die.

sister: tu la, die byk girlfriend tau skrg. 

monolog dalaman saya: hai tu pon nak cite ke sister??? haii laaa. 

well thats about it. cute kan cerita ni? baik cakap cute. kongkong nih. ;)

p/s dah selamat smpai umah pkl 9.30 mlm. teki-teki: kalau kite gembira kite cakap seronok kan? kalau gembira banyak kite cakap ape? jwpn: beronok-ronok!

THE STORY OF MY DIETETIC COUNSELING

It’s the world hepatitis day peringkat Hospital Selayang last Friday. And of course, they ask dietitians to open up a dietetic consultation booth. Its only been about 2 months I’ve been working in Selayang Hospital, and they have organized several events that involved diet consultation. Last month was for Hari Tanpa Tembakau.

me and cik elly diet consultation for hari tanpa tembakau hosp selayang June 2011 -pix taken from ben's fb

Personally, I did enjoy give diet consultation to people, for I always love community programme. Perhaps for some people it seems lame or boring or tiring, but from my point of view, it is one of the best ways to convey and disseminate the message to the public –healthy eating. Ever since study time, whenever there is health exhibition programme, diet booth always win –I mean it always has the longest queue, and the same happened here. Sorry pharmacy booth ;) And I love seeing how eager ppl are to learn about diet yeay! ;)

long queue for diet consultation. see counseling kat sorang, yang lain pon nak dgr -pix taken from ben's fb

Looking back to the first person I ever counseled, I think it was during Medex’07 (Medical and Allied Health Sciences Exhibition in conjunction of Convest 2007 at IIUM Gombak). That was our very first community programme. We were in our second year. At first I was avoiding myself from counseling work, only did screening part (measure weight ht body fat bla2). I was not yet ready to give diet consultation. But witnessing few of my friends who were very good at counseling did trigger me. So I tried one –and yup I like it! And Diet booth won the best booth for the programme. Yeay again!!

When we started our clinical year, my group was first posted at Klinik Kesihatan Bandar Kuantan Bukit Sekilau. Bukit Sekilau Kuantan is a Chinese community (I think so, because there are lots of Chinese pt there). Thing about Chinese ppl in Kuantan is most of them speak Cantonese, neither Malay nor English. Hence diet counseling there is quite challenging. You have to simplify ur words but at the same time not to forgo important part of ur counseling. Its always funny to see how enthusiastic we became to ensure pt understand what we are saying. One of my friend when counseled those type of pt, she will transformed into a kindergarten teacher, as in counseled the pt like he/she is a kid. And yes I have flaws too. When I happened to have Chinese pt who doesn’t really understand Malay or English, I always speak loudly. Yup it’s a habit. Haha. Funneyh because my friends said they can hear my voice across the hall, and excuse me Ija they don’t understand Malay not deaf ;) Well among the so many patients that we’ve seen there, there is this uncle that I still remember clearly. Here goes:

Me: Uncle, bile ade kencing manis, buah pon kena hati2 makan. Sbb buah pon ade gula. Kita sarankan makan buah 2 kali sehari, tapi kena ikut saiz hidangan (yadda yadda and tell d pt serving size of fruits)

Uncle: Ooo itu mcm ya. Itu buah cempelak pon boleh makan lorr?

Me: Cempelak??? (after few seconds I got it –CEMPEDAK!). Oh itu cempelak pon boleh makan uncle, tp kalau nak makan sekali makan boleh makan 4 ulas saje, x boleh lebih nanti gula darah naik.

Uncle: 4 kecik itu??? Itu lekat kat tekak saja mehhh!!! ~and then we both laugh~

Haha incident uncle cempelak will be a story that I’ll remember forever… 

at KKBK Bukit sekilau, Kuantan. tp ni gmbr grp community, bkn clinical. -pix taken from mazu's fb

Anyway, giving diet consultation gives us a mixed of feeling, depending on the patient. There are ppl who really eager to listen to our advice and ask question, hence will bring smile to our face. There are ppl who don’t even bother to listen, thus we’ll be demotivated (hey u don’t want to help urself in the 1^st place so why shud we bother?). Sometimes there is pt that share secrets and ask for opinion. Tough huh, kena jadi counselor pulak. There are also arrogant ppl, that  are so full of themselves, think that they know everything, and question our qualification  to advice. These ppl? Increase BP mehh (attn: pt kakzam ;)).. There are also flirtatious, funny, sad, problematic, etc. Ada yang bila kita buat public diet consultation, kite consult sorang, yg lain berkerumun nak dgr sekali. Ada jugak  yg nak jodohkan kita dgn anak dia (lol), and many many more. 

But regardless of what type of patient they are, we, as dietitian, will try our best to give diet consultation appropriate to their health condition. Diet consultation is very individual, thus there is no exact script that we can memorize. Of course the guidelines is there, but still we have to build rapport and make sure the dietary changes that we want them to implement suit their life, not just syok2 sendiri. Because we want the dietary changes to be implemented for life, not only for few weeks prior to counseling and boom, relapse! 

Well, to end this story, a funny story during diet consultation Hari Tanpa Tembakau last month:

Miss A: Dik, akak ni, ada problem ni tau. Bila akak ketawa je, akak rase mcm semput. Rasa nak putus urat. Ada diet yang sesuai x dik untuk elak putus urat?

Me: Huhhh???? (monolog dalaman: what the hell diet putus urat???)

kite ngn kak elly hari tanpa tembakau -pix taken from kak elly's fb

 So fellow dietitian friends, if u read this, ada diet untuk putus urat x? lol!

MAY THEY REST IN PEACE

Assalamualaikum.

One of my patient was dead over the weekend.

it sucks. not a good way to start a new week.

He had multiple problems and complications -ESRF, HPT, DM with micro/macrovascular complications, cancer, and CVA.  i planned an enteral regime for him with Nepro.

over the time i saw this pt, his children were always around. but this one son, probably 1 or 2 years younger than me, lets call him M, was the one who is always there most of the time.

in one of my follow up visit, his face was tight. the father keep on asking M to remove 'his shoes' because he felt numb. truth is there were no shoes. M told me that his dad has been requesting that since last night. and he keep on telling his father that there were no shoes. i cud sense that he is trying so hard to control his patience. the voice was slightly raised, but he keep on aswering to his father's request. i told M, his father might feel numb bcos of microvascular complications of DM, or probably bcos of the edema. and then he sighed. a long, tired, sad sigh. it was slow, but i cud hear him clearly. 'bawak byk2 bersabar'. i told him, slowly. he looked at me for several seconds, took a deep breath, turn to his father, look deeply at him, and slowly said 'abah tak pakai kasut. dari semalam lagi abah tak pakai kasut. takpe biar M picit ya' and then slowly he rubbed his father's feet. standing there, watching that very short father-son moment, i almost cried. i really cudnt stand situation like this. call me hati tisu. call me x professional. i dont care.

he was already in terminal care the last time i saw him on friday. the family members has gather around to recite Quran a few days back. he was pronounced dead on Saturday due to complications of esrf.

i reviewed this pt several times, and i am aware of his deteriorating condition. but i cudnt help myself from being emotionally drawn. it is not good, being attached to ur pt that way, i know...

Semoga rohnya dicucuri rahmat dan ditempatkan di kalangan orang beriman.

Al-Fatihah.

Al-fatihah juga utk allahyarhamah Dr Lo' Lo'. Smg rohnya dicucuri rahmat dan ditempatkan di kalangan orang beriman.

p/s Kullu nafsin dza iqatul maut. Setiap yang bernafas itu pasti akan mati. Peringatan untuk saya dan kita semua. 

DIABETIC MX WORKSHOP AT HKL

Assalamualaikum

Hello all.

Its been a gloomy week for me this week, not sure why. Maybe because am not feeling so good with the flu and cough and headache and homesick. Yeah maybe that. And for the past couple of week I’ve been sick –nausea and vomit after eat, could not finish up meal, LOA. Mazuin’s diagnosis? Stress related to just restart working. The only thing positive about it is I’ve shed a couple of kilos. Haha. Ya I know its not a good way of losing wt, but I did anyway lol!

Well I started this week with a diabetic management workshop in HKL. Went there with Cik Jun (housemate cum colleague).  Met great dietitians/teachers in HKL (I did my professional clinical attachment there) –Dr Romzi (yup she got her PHD now  ~so inspiring smpai rase goose bump), Datin Sharita, Pn Marlina, Pn Maryam, Pn Amilia etc. Also a few familiar faces, mazuin (a dear friend from uia, dietitian at pusrawi but soon to work in hukm p/s jgn marah aku reveal kat sini ek mazu nway ramai yg dah tau kan), alip (senior uia, dietitian serdang), khairil (or khairul, I always confused -ex besta dietitian now works in PPUM).

Nway back to the workshop, the 1^st talk was by Dr Ronald Ma, Assoc Prof Dept of Medicine & Theraputics Chinese University of Hong Kong. He talked about management of DM pt with obesity/overwt problem. The new generation drug for DM. But sorry I cudnt share much. I was pening2 lalat at that time (not well + hypo –skip breakfast), cudnt concentrate. Perhaps boleh tny Mazu she was busy jotting down notes (as expected from best student hehe). Tetapi di dalam kepeningan I got few ideas of what he’s talking –it’s important for obese diabetic pt to lose some wt, for it really contributes to help in glycemic control. I believed that is what we preached to our obese diabetic pt, but sometimes we (or at least me) tend to forget to emphasize on that sole fact to the pt, lebih focus pd diabetic diet mx je. Its true that if pt practice diabetic diet, it could help them to lose wt, but a little emphasis on the importance of wt loss to help control blood sugar, blood pressure and lipid profile wont do any harm no? 

After revitalized with morning tea, the session continues with a talk on MNT for DM by Miss Yeo, HKL dietitian. Well not much update, pretty much the same as the 2004 MNT. The discussion afterwards was on non-nutritive sweetener.  What is our stand on the recently popular stevia? As it is plant-based, it is safe to consume, including by diabetic pregnant woman. But more study should be done on stevia –long term effect, etc. Hey perhaps I could discuss this issue on next entry. Found a journal and review papers on this but x baca lg (biase la malas  *tampar muka sendiri laju2*). The last session was a case study presented by Ms Khalilah. Nothing much to share here, just the same diabetic mx as we always encounter in medical ward. 

Well the workshop ends with us (me mazu and jun) catching up with alip and kairil and get to know other new dietitian. And of course greeting HKL dietitians that have thought us a lot. Surprisingly ada antara mereka masih ingat kami yg hina ini hehe. Mazu sgt impressed dgn ke’dhobitan HKL dietitian. I pray that I can be great people like them one day. Mntk tlg amin ye.. macih.

us with hkl dietitian special unit posting

kami dgn tn hj ridzoni on our very last day there

p/s: on tuesday I cover kakzam for her endocrine clinic with ilman. 1^st pt adalah makcik yg sgt cute, 76 yo.

cikdietitian: makcik duk mane cik?

Makcik: duk batu kep (batu cave). Tp makcik org noghori (ilman kat dpn dah jeling2 dah), hari2 masak lomak nak oii, pakcik ko tanak makan bnd lain.

Alahaiii makcik, comel betol.. u really made my day ;)

p/s 2 hohoho balik kampongg!!