Tuesday, December 25, 2007


In 2nd week of December recently, I examined one patient, 25 years old foreign worker, who was brought to our hospital's Accident & Emergency (A&E) Department around 9:00 a.m. for having severe abdominal pain associated with vomiting after taking food.
 2 week earlier, he came to our A&E with  the same problem and was treated as outpatient as a case of acute gastritis. His symptoms was relieved after given treatment.
This time, his symptoms were really severe, described as crampy abdomen and generalised body weakness. Clinical examination however showed his abdomen was soft but the bowel sound was hyperactive. Vital signs was stable. *Later examination also found he has bluish discoloration line of his gum (Burton's line) which is the sign of plumbum poisoning.(See photo on the top).
Due to severity of his symptoms , he was advised for admission.
He came with a company driver  where he works for 2 years. The company main business is battery manufacturing.
Initially I suspected the patient has Acute Gasteroenteritis (AGE) but later included Acute Lead Poisoning as the diagnosis after obtained his occupational history. His blood was sent for Lead/Plumbum level as well as full blood investigations.
Mean while  he was investigated for other causes of acute abdomen including abdominal xray(AXR) and abdomen ultrasound(AUS) and blood amylase as ordered by Physician in-charge. AXR & AUS were suggestive of subacute abdominal obstruction, however his blood amylase was normal. His Full blood counts and picture showed a feature of iron defieciency anaemia.
5 days later, his blood lead result was ready with a reading of 212 microgram/dL which is more than 5 times of normal limit as allowed by  Factories & Machinery Act(FMA) 1967 (Lead Regulations 1984) and USECHH 2000 Regulation under OSHA 1994 ( less than 40 microgram/dL).
This case is very misleading and show the importance of occupational history in history taking of the patient to get a clue to diagnose  acute lead poisoning, otherwise the diagnosis can be missed or delayed.

Friday, December 07, 2007

Stress @ Work

Stress @ Work sometime started during your morning trip to office. If your route to office has traffic jammed and you are late, you started to have stress.
Stress can be identify through your feeling, behaviour, thinking and body reaction.
Too much stress or also called DISTRESS in long term can jeopardise your health, leading to some psychosomatic illness like High blood pressure, Gastritis etc and Mental ill-health.
So inorder to overcome the stress you must know its two components : Stressors and Response.
Stressor is a situation you are in which causes the STRESS, example : Traffic jammed as in above photo and you are late to attend a meeting at your office.
Response is how you cope with the stressors.
You need to change either Stressors or your Response in order to successfully live with stress. In  real life, you cannot expect stress-free life. Life is full of stress BUT too much stress and poor response to it will affect your health both physically and mentally.


On the 5th December, 2007 I was invited by NIOSH Sarawak to deliver a presentation on Stress @ Work at the above Seminar. This two days Seminar (4 & 5th December, 2007) was taking place at Merdeka Palace Hotel's Merdeka Hall at level 3. My presentation started from 1: 30 pm to 2:30 pm. Although a bit tired after coming back from KL holiday trip early morning the same day, but I accepted the invitation which was given to me on Friday 30 Nov. 2007
Over the weekend holiday at Bukit Fraser, Pahang I started to prepare my presentation slides.
My presentation was divided into 4 scopes :
1. Understanding Stress and Its Components
2. Causes of Stress at Workplace
3. The Effect of Stress on Organization
4. Basic Management of Stress
For the visitors of this blog who want the presentation material in pdf form, can request from me by providing  your email address.
About 120 participants from private and local government agencies attended the seminar.