Sick

Today, I came down with a slight case of 'tummy upset'. I was feeling entirely nauseous throughout the day coupled with 2 bouts pf diarrhoea and later after dinner, I puked up some of my meal (of pork ribs with peanuts and lotus root soup garnished with red dates and squid). I've been having a stomach problem for the past 2 months which cause still remains unsolved to this day (because I am a bit terrified of undergoing a gastroscopy/endocsopy as it is still categorised as an invasive procedure and you have to be mildly sedated) but I was prescribed some Losec (which is a proton pump inhibitor that reduces the stomach acidity that causes some of my reflux) and Motilium which is an antiemetic (makes you less nauseous and therefore less likely to throw up). It did help quite a fair bit and nowadays I am throwing up less (2 times a week only). I guess I could come up with the three likely provisional diagnosis for my case:

1) gastritis- I do suffer some epigastric discomfort but not to the extent of pain normally caused by Helicobacter pylori which can be detected by H. Pylori fecal antigen test of H. Pylori breath test. If this were the case, treatment is simple: triple therapy consisting of antibiotics (clarithromycin and amoxicillin) and omeprazole (proton pump inhibitor).

2) peptic ulcer disease- Yikes, I hope I don't have that. They are extremely painful and can lead to gastric cancer! But I do have to bear in mind that normally the pain is worse after meals such as in the case of gastric ulcer but duodenal ulcers are relieved by food. Also associated with vomiting, nausea, waterbrash, bloating etc.

3) gastro-esophageal reflux disease- I do sometimes get a bit of regurgitation of food but I don't have dysphagia (difficulty in swallowing) or heartburn.

4) Gastroenteritis- aka food poisoning. Quite likely due to the high probability of contaminated food and I do eat leftover food in the fridge which has adequate time for bacteria to grow but I've been having it for 2 months so maybe this is a case of chronic gastroenteritis? If this were the case, we just have to catch the bug that is causing it. Anyway 50% of these things are viral which means nothing can be done about it.

5>Don't think I could be having the other rarer causes such as cholecysitis, pancreatitis, inflamatory bowel disease. vascular disorders, tumours. Haha, or it could even be psychogenic abdominal pain or idopathic (no cause identified). I guess when I am finally a doctor, I have to come up with a more extensive list and gradually eliminate each according to the patients characteristics. If you watch House, I am always compelled and deeply awed as to how he can fathom the definite cause of the patient's problem in a heartbeat. Okay, so he's a fictional character who's head of a team of diagnosticians but I am sure there are medical geniuses out there that resemble him. Doctors are a lot like sleuths (Sherlock Holmes) who are a given a set of clues and must work their way backward to the original source. Its basically detective work and I guess a lot of doctors find this thrilling (well intially anyways). I guess it takes a lot of experience to tie these clues together and narrow them down to the more definite possibilities.

6>As for me, I recall I was absolutely clueless when it came to coming up with provisional diagnosis list back as a 2nd and 3rd year medical student. I remember I panicked during my OSCE examination in IMU Sem 5 when the doctor asked me to come up with a provisional diagnosis list for right iliac fossa pain. With time and more reading up of clinical textbooks (as compared to our blurry, font-too-small-too-read IMU notes), I improved slightly but I am definitely nowhere near as compatible as an intern.

7>Speaking of internship, we have to submit our hospital preferences by the middle of this year which is in fact FAIRLY SOON. I'm still so undecided yet as where to go...I would prefer doing it in Singapore as it is closer to home as I am not that fond of Sydney and a lot of people have already mentioned that Sydney is one of the top cities in Australia. If I were to do it in Sydney, I would have to do a 2 year prevocational training which is 'first two years of “on the job” postgraduate medical training which aims to further the personal and professional development of medical graduates' which is from the website http://www.imet.health.nsw.gov.au/www/472/1001127/home--default.asp. However, I'll have to pay an extra $440 since I'm a 'graduates from an Australian Medical School on a temporary resident Visa' unless I apply for Australian citizenship/permanent residency. But then if I work in Singapore and then suddenly choose to migrate to Australia due to some unforseen circumstances, I would have to pass the dreaded AMC (Australian Medical Council) Exam which I have participated before in POW hospital and it is exceedingly DIFFICULT to pass. Like the pass rate is less than 50%. Thinking about all these crucial matters is already giving me stress and I can feel a slight case of tachycardia and hyperventilation coming on right now. Sooner or later, I'll have to come up with a decision and hopefully I make the right one because its gonna affect MY CAREER AND MY LIFE. Things like these can easily be swept underneath a rug but then as it starts to accumulate dust and dirt and you try your hardest to supress it, one day you're going to end up with an upper respiratory tract infection or allergic rhinitis. Lets just hope it doesn't come back to haunt me later...