Chronicles of Ellery Ivan MD

100daystooffload

Entry #41

It’s official. I’m closing the chapter on #100daystooffload.

While I really wanted to at least finish the task to create 100 posts in a year’s time, the sad reality is I simply was not able to or was not as committed enough to finish the job.

I skewed with the actual rules by extending the year and just opted to do 100 posts instead.

It seems and feels like an eternity.

So…

I decided to just skip it. And post as much as I can, when I can. And who knows this might even make me to write/journal more.

On a side note, I also realized that it would be also practical to note/count the actual number of post done. I decided just to convert my “Day X of #100daystooffload” to “Entry#X”.

Just finished answering 432 questions in 24 hours (time included all needs like sleep and eating); in preparation for a very vital exam. I tried to finish those questions to help me build my endurance and I think there is still room for improvement.

It still for needs for improvement to reach my desired score. Learning comes from feedback and rereading.

I’m writing this to commemorate a milestone. And a chance to relax my mind even for a few minutes.

Day 40 of #100DaysToOffload. Find out more about it here.

As it turns out, my favorite word is “chronicle”. This was according to a friend of mine. A fellow writer and a far superior weaver of words from ideas and imagination.

Thought-provoking indeed!

It just makes you think of the habits and bias one has. In any case, I do love chronicling from time to time.

Day 39 of #100DaysToOffload. Find out more about it here.

Achievement unlocked. Successfully changed the CMOS battery of a Gigabyte G41MTS2 model (yes, its an old old motherboard and it is still working).

Tools prepared:

  1. 1 small flat (straight) screwdriver

  2. 1 Lithium Battery CR 2032 (coin shaped)

Things to do: (this may vary per motherboard, please consult your motherboard manual)

  1. Turn off all peripheral devices connected to the computer.

  2. Disconnect the power cord from the AC power source.

  3. Remove the computer cover.

  4. Find the battery on the board.

  5. First note the orientation of the positive and negative terminal on the battery.

  6. Remove the battery. Using the screwdriver, gently pry the battery free from its connector.

  7. Wait at least a minute then replace the old battery with a new one. Note the correct orientation of the terminal. For this model the positive terminal is visible or is on top.

  8. Put the computer cover back on.

  9. Plug the computer and all devices back in.

  10. Power up your computer and set up the proper system date and time.

#DIY

Day 38 of #100DaysToOffload. Find out more about it here.

Last duty of the year, two patients in respiratory distress. One was intubated and the other one expired. I was swamped with patients at Emergency room. I realized it must be one of those last duty syndromes. Never the less, it was a good thing I had a breather and got to get a photo of the night.

It reminded me the tranquility and serenity of the night. I had the chance for a few minutes to look up, feel the fresh air, and thank God for the vastness of the universe and for the blessings and graces I received.

This is my 8th year as a physician; 1 year practicing as an Internist and despite all the difficulties and trials in 2023, I’m still thankful for the blessings I received this year. I am thankful for the patients who shared their lives with me. I have learned much from them and I hope I was able to heal their ailments. I am thankful for my mentors for their sharing life lessons with me, everything beyond the medicine life. I am thankful for the handful of friends who stayed in my life. We don't need much many friends, just a few trustworthy ones. I am thankful for my wife and small family. And I hope that in the next year it would grow some more.

I don’t know where I’m going next year, but I hope it will have elements of new beginnings, living well, laughing often and loving much. May God give me the courage to serve, the compassion of an emphatic physician and the competence of outstanding doctor.

Happy New Year Everyone.

Day 37 of #100DaysToOffload. Find out more about it here.

Today, I learned about the different species of genus Plasmodium.

When I was studying Nursing. I learned that there were four different species of Plasmodium.

This changed when I studied medicine, around 14 years ago. I learned about the fifth, Plasmodium Knowlesi. I learned about its history and how it was discovered. Even how it was named.

Today, I learned that are two morphologically identical sympathric species of P. ovale, curtisii and wallikeri.

It made me realize just how science and knowledge is expanding in Malaria.

And yes, doctors should always update and read.

Day 36 of #100DaysToOffload. Find out more about it here.

Today, I learned about the Chilaiditi sign.

Chilaiditi sign refers to the interposition of the bowel, usually colon, between the inferior surface of the right hemidiaphragm and the superior surface of the liver. It may be misinterpreted as a true pneumoperitoneum resulting in unnecessary further investigations and/or therapy (so-called pseudopneumoperitoneum).

In incidental finding in the chest and abdominal radiographs with an incidence of about 0.025 to 0.28%, with a male to female ratio of 4:1, where there is bowel, usually colon interposed between the liver and diaphragm.

The following criteria must be met before making the diagnosis of Chilaiditi sign:

  • elevation of the right hemidiaphragm
  • distended colonic loops between the right cupola and the liver
  • superior border of the liver inferior to the level of the left hemidiaphragm

This syndrome was first defined in 1910 by Demetrius Chilaiditi, a Greek radiologist, after he reported three cases of patients who were found to have intra-abdominal free air on radiological imaging caused by the interposition of the bowel between the right hemidiaphragm and liver.

Day 35 of #100DaysToOffload. Find out more about it here.

References:

  1. Chilaiditi sign. https://radiopaedia.org/cases/chilaiditi-sign-14?lang=us

  2. Chilaiditi sign. https://radiopaedia.org/articles/chilaiditi-sign

  3. Chilaiditi Syndrome. Kumar A, Mehta D. Chilaiditi Syndrome. [Updated 2022 Apr 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554565/

It is harder than it looks but heck its worth it if you want to save time.

You can change a PDF document into a PowerPoint presentation in a few different ways:

  1. Convert PDF to PowerPoint online: There are many online tools available that allow you to convert PDF to PowerPoint, such as SmallPDF, ZAMZAR, and CloudConvert. Simply upload your PDF file to the website, select the output format as PowerPoint, and download the converted file.

  2. Use Microsoft PowerPoint: If you have Microsoft PowerPoint installed on your computer, you can use it to convert your PDF to PowerPoint. Open Microsoft PowerPoint and select “Insert” from the top menu. Choose “PDF Printout” and select the PDF file you want to convert. The PDF content will be inserted into a new PowerPoint slide, which you can then edit and format as desired.

  3. Use Adobe Acrobat Pro: Adobe Acrobat Pro also has the capability to convert PDFs to PowerPoint. Simply open your PDF file in Adobe Acrobat Pro, select “Export PDF,” and choose “Microsoft PowerPoint” as the format. Adobe will convert your PDF into a PowerPoint presentation, which you can then edit and format.

Note that the quality of the converted document may depend on the complexity of the original PDF, and some information, such as images and graphics, may not convert accurately.

Day 34 of #100DaysToOffload. Find out more about it here.

This is an old feature of the PLDT phone system. To avoid bill shock from unwanted “long distance calls”, it may useful to use this feature.

I was curious if it is still working.

Instructions:

Your default PIN is “1234”

To change code: *85*Present Code*New Code# To lock: *54*Four digit code # To unlock: #54*Four digit code #

As of today, it still works.

Day 33 of #100DaysToOffload. Find out more about it here.

Around this time, four years ago, I recall being very stressed by my thoughts. So many what ifs and even detractors. I had just applied to a residency program. This was a new program and is most cases a tabula rasa. There was not even an actual date of the exact day to start. There was just a call for residents. There was much hope for it and much energy surrounding it. Certainly, we had birth pains. But I was confident with the people around me.

Right now, I’m probably just as stressed. Except this time with a different perspective to things. And nothing renews hope more than a fresh perspective.

During my residency, I've come to realize that the caliber of my medical dilemmas serves as a good gauge of the quality of my training as a resident. Because of this, whenever I encounter issues that are specifically mind boggling, I try to remember that this is a baptism, and I should call myself lucky to experience such matters. If they did not admit in Ciudad Medical Zamboanga I may not have the chance to learn and interact with them.

I've also learned how to apply this in my private life after learning that, in some ways, my difficulties led to my development. It gives me new inspiration to stick with things and persevere through both good and bad days. Looking back, it was indeed challenging phase during the first few months of the 2nd year. The overwhelming surges of covid-19, the uniquely challenging assimilation with the junior’s obnoxious expectations, the juggling of responsibilities both in work and real life, and the death of my mother. The last event made me really contemplate if there was really a point to all the hassles and struggles.

I am grateful for the leadership roles that fell on my lap, I hope it made me a better person in the process. It was indeed a great effort to balance every other person’s egos, wishes, requests, and personalities.

I now have more faith in the process and am more tolerant of my constructive criticism if there are any. I try to keep in mind that I'm not just going through this period. Each choice I've made has brought me closer to my goals. I believe that God's plan, whatever it may be, operates on a scale that is too great for human sight to fully comprehend. As such, the best we can expect and pray is some measure of grace that will allow us to play each moment and make sense of the cards that are dealt to us. And sometimes have the courage to mulligan.

I have become more trusting of the process, more accepting of my good problems. Reminding myself that my going through this phase is no accident. Every decision has led me to a good place. I suspect that God’s plan, whatever it is. works on a scale too large to fit our mortal eyes and the best we can do is to try to align ourselves with what we feel is right and construct some meaning out of our confusion, and hopefully we earn some grace to play at each moment and to make sense of the hand that we're dealt.

It feels just like yesterday when I first started my training. Today it is finished though unceremoniously. And so, like the other days, I have no reason to doubt that the dots in the bigger picture will align and coalesce.

So, I walk with the fervent hope that Providence will provide the direction that needs to be treaded upon. Walking in faith, sometimes with clarity, other times blindly, but every time with the assurance that there is guidance from above.

Day 32 of #100DaysToOffload. Find out more about it here.