Mrs Wong a 32 year old school teacher has just been confirm to have breast cancer with metatases to the spine. She is married and lives in a 4 room HDB flat with her husband and one year old daughter. Discuss the psychosocial impact of this diagnosis on the patient and her family members.
discuss the community resources mrs wong and her family weould be likely to require in the course of her illness.

discuss the role of the primary care physician in the primary prevention of coronary heart disease.

describe the frequency distribution of blood pressures in an adualt population and indicate its main implication.
outline the risk factors for hypertension.

hypertension is considered to be both a risk factor and a disease. Discuss this statement.

briefly describe the strategies to control hypertension and the strengths and limitations of each.

Mr lim a 45 year old man has just been dischared after an AMI, He works as a taxi driver and lives wityh his wife an 2 school age children. He has smoked 20 cigarettes a day for the past 20 years and has type 2 DM for 10 years. has a bmi of 30 and hyperlipidaemia. as his doctor, discuss the management of this patient.

mr armugam is a 45 year old indian with type 2 dm. he works as a postman, He has just been discharged from hosp after 2 wks stay for trtment of cellulitis of the left foot.
outline ht continuing care that he will need.

publishing retrospectively

I am blogging with m thumb again. Feeling rather sleepy now. Which might have been expected for I woke at 10am and have barely slept a wink before waking up. Couldn't get to sleep before 6am nowadays. No football yesterday night. I wonder when are they going to show the african football. I get addicted easily. Anyway my daughter's name shall be chelsea. That's what I concluded after a hard soul searching.
Anyway I was having lunch alone at science canteen just now. Its abit lonely to be always eating on your own. I struggle to remember the last time I had lunch with any one at all. Bar yunnan. Which is why I always like going back. Cheap holiday aside, there is always company when you need it. And each year, the company just gets better. And of course, I get to do community service:)
And yah so I am a bit tight nowadays, not that my waist expanded by an inch or two. But my shrinking wallet is causing me to tighten up my purse strings. Not much income nowadays. But the tuitions are picking up. Getting a few calls every week already. Too bad this is a bad period with exams so near. I am still listening to offers so its going to be bad for my studies. But that's not the point. I was trying to say I am a pauper. I am using my phone to track my expenses, and hopefully it can curtail my reckless spending. So after spending twenty bucks on printing my pharm notes, I was left with a miserable 2.90. So I headed to the canteen, after heeding the rumbles of my stomach. There, I bought a plate of noodles for 2.70. And iwanted a drink as well. What can I buy witj 20 cents? Absolutely nothing, perhaps only tissue paper. But I wanted a drink. Left with no choice, I took out aaron's water bottle and went to the nearest water cooler. Its plain water for me. Good for my diet also. Somehow because of this highly commendable act, I felt quite holy. Or perhaps it was divine intervention, I made a claim: if someone brings a drink to me now,then I will be convinced God exists. If a pretty girl is the one to buy me the drink, I will convert instantaneously. Too bad Mr Almighty is too busy to help me out with my thirst, or maybe I was just too inane to realised somehow He has already satisfy my wish. Anyway at the end of my meal, I was none the wiser.
Well I was just being wishful in the first place. I am going home right now. The train I am on now has 5 more minutes before it departs harbourfront. I am in a semi comatose state and a part of me wants to keep typing. Divine intervention?recently I like to attribute some of my unexpainable or unreasonable behaviour to the supernatural. I am not psychotic yet. Usually I enter that hallucinational state while falling asleep.
I wish that there is some electrode which I can just plug into my head and all that I want to write or say will appear in microsoft word. That would really save me time and effort. The train is beginning to fill up. I hope no elderly or pregnant women gets up at dobby ghaut. I am rather comfortable in my curent state. My eyes half closed, looking no where but at m phone's screen. Indifferent to all that's happening around me.
Now I am heading home to catch the semi finals of the australian grand slam. Federer is playing and there is this 38th seed upcoming and rising youngster already in the final. Things might just get abit interesting. I am late for the start already. With such snail like bus services in singapore, how can anyone expect to be on time anytime? It took a full 20 mins or more before my 97 came in the morning. It just made me so late for every thing today. Waiting for a bus an certainly drive me homicidal. It did nothing to quench my deadly desires when I saw a female at the drivers' seat when the bus came. Maybe she never tried to beat any yellow lights. Or its just me and my time spent waiting for buses. Maybe god meant that as part of my trial and tribulations.
Tonight I shall be studying at some café outside. My parents are out and there is nothing for me to stay home. I think it is rather tiresome to get a gf. A friend of mine just broke up. After afew false alarms, I almost expected them to ride out the storm. It was not to be. Anyway, why must girls have friends? Maybe there should be a rule that says once girls get attached they should just belong to you.of course they should pretend to be busy when you are , but when you want them there, bingo! You have got her there. Some girls like to complain about not spending enough time together. And when you have the time, some bloody idiotic friend would want you to accomapny them to get birthday presents for another friend. Oh man, grow up. Mature people do not need birthday presents. I do not get many. And I am not complaining. I grew up with almost no present every year and it hasn't affected me one bit has it? My eccentricity is just an extraordinary manifestation of my genius streak. I wasn't talking about my friend and I haven't had the opportunity to find out more. Hopefully it will be soon. Why do people like to go to clubs and drink and chill out? I have never felt hotter than when ii am in zouk or chinablack or some other hippies joint. What's there to chill out? I can understand why guys go clubbing. Just ask anyone who has friends or sons killed in drink driving accidents. They are looking to get onto the expressway to heaven apparently. Then for those who bring their charges to a club, don't they find it shameful to be so intoxicated that their charges have to take care of them? Some imbeciles are under the impression that they have an incredible arsenal of oxidase an dehydrogenase and of course a rather big GI tract. Of course, it is possible but wouldn't that leave very little capacity for brain space? Of course there are the girls and the alcohol. Some girls who club are easy to pick up. Some and not all. But even if you can't pick them up, youu can make full use of the chaos and darkness to feel for all you like. Gyrating pelvis and thrusting hips. What a turn on. Then again there is the alcohol which absolutely removes your inhibition and you may start believing you are superman. Ironically that belief does not continue in bed because the confidence gained is at the expense of performance. I always think that confidence should come after a good performance and not the other way round. Of course I say that, I am a chelsea fan!
Anyway I am really not talking about anyone In particular. Any coincidence is erm coincidental unless it is deliberate in which case, it cannot be deemed as a coincidence. Anyway few and far people read this scrappy blog of mine. I shall just revel in this pitiful but enjoyable experience. After all, it more or less makes up for my occasional lack of interesting conversations. Or even the lack of any conversations at all. Even if deliberate attempts are made to elicit any mood symptoms in readers, I am factually inaccurate in most of my writings so I cannot be taken to task for anything that appears in this blog or any other blogs written or not written by me. In short I am an irresponsible person, which actually means I am living a carefree life.
Finally I reached home. Yi nan wang is showing on tv. I am reluctant to change channels!

for pandas

dear pandies, I am mugging my pharmaco at strbucks sengkang when I realized that its been a super long while since I posted anything here. I apologize for my absence. my comp has broken down due to its failure to withstand my badtempered kicks after I had lost a game while playing fifa08. in that moment of idiocy, I put a dent on the side of the chassis of my cpu and my computer stutter to a stop. in another attempt to revive it/wreck further damage, I aimed another kick on the other side. followed by a smck right on top of it. I realized by now, I probably would kill someone if I hd gotten into a fight and a few kicks or punches had connected. so right now I am restricted to using the internet on public computers or on my pda phone when there is wireless. I spent most of the chinese new year period in isolation. at starbucks trying my best to study. because of the lack of distractions, I finished most of the systems
. right now sitting right in front of me are two taiwanese babes doing their chinese homework. you would be right if you had guessed that I have spent abit of the laast ten mins observing and eavesdropping on them. but contrary to popular beliefs, its not their looks that caught my attention, it was their chinese. I had caught part of their heavily accented chinese before diverting my attention towards them. I made the mistake of assuming them to be from mainland china and cursed right under my breath. there just seems to be an influx of these lowly skilled labor to fill our vacancies of wantonmee stallholders. then again, the deap seated wisdom in me told me something ddoesnt fit. where would they get the money to buy drinks from starbucks, I bet they bring their own hot water and coffee powder out, heck they don't even add sugar! so how can two chinese nationals be sitting in front of me looking hotter and sweeter than the hot cocoa I am drinking? hence they must be the classier neighbors, they are taiwanese! it is probably a good thing since d I am reading my vasodilators. there is a fyi box somewhere containing informal about sildenafil. :)
tml I shall be studying at dobby ghaut I guess, hope ann wil be free to pass me the mochi she bought for me. colin and qt, want to join me at ps starbucks? or tampines if colin doesn't want to go.
thursday is vday! my 25th vday without a date. a quarter of a century already! not that I care.:p
should I ask ard to see who would not mind going out with me?dear pandies, I am mugging my pharmaco at strbucks sengkang when I realized that its been a super long while since I posted anything here. I apologize for my absence. my comp has broken down due to its failure to withstand my badtempered kicks after I had lost a game while playing fifa08. in that moment of idiocy, I put a dent on the side of the chassis of my cpu and my computer stutter to a stop. in another attempt to revive it/wreck further damage, I aimed another kick on the other side. followed by a smck right on top of it. I realized by now, I probably would kill someone if I hd gotten into a fight and a few kicks or punches had connected. so right now I am restricted to using the internet on public computers or on my pda phone when there is wireless. I spent most of the chinese new year period in isolation. at starbucks trying my best to study. because of the lack of distractions, I finished most of the systems
. right now sitting right in front of me are two taiwanese babes doing their chinese homework. you would be right if you had guessed that I have spent abit of the laast ten mins observing and eavesdropping on them. but contrary to popular beliefs, its not their looks that caught my attention, it was their chinese. I had caught part of their heavily accented chinese before diverting my attention towards them. I made the mistake of assuming them to be from mainland china and cursed right under my breath. there just seems to be an influx of these lowly skilled labor to fill our vacancies of wantonmee stallholders. then again, the deap seated wisdom in me told me something ddoesnt fit. where would they get the money to buy drinks from starbucks, I bet they bring their own hot water and coffee powder out, heck they don't even add sugar! so how can two chinese nationals be sitting in front of me looking hotter and sweeter than the hot cocoa I am drinking? hence they must be the classier neighbors, they are taiwanese! it is probably a good thing since d I am reading my vasodilators. there is a fyi box somewhere containing informal about sildenafil. :)
tml I shall be studying at dobby ghaut I guess, hope ann wil be free to pass me the mochi she bought for me. colin and qt, want to join me at ps starbucks? or tampines if colin doesn't want to go.
thursday is vday! my 25th vday without a date. a quarter of a century already! not that I care.:p
should I ask ard to see who would not mind going out with me? maybe a meal at bakerzin, a nice cheesecake, a small wooden box containing roses arranged in heart shape surrounded by chocolates , or a cactus inside a hourglass with some lovely messages hanging of the pins of the cactus and colorful pebbles to adorn the base..or just a romantic getaway with my beautiful cofm chick trying to figue out the allure of public health prevention and how to tug at the heartstrings of evidence based medicine. I guess the latter might be a safer bet. it is certainly not very cassanovic to be studying for pharmaco in march and april. the girls can wait then but not the books.
anyway I feel quite despondent now that the two babes left without a bye or at least an enquiry about my phone number or addres. so actually she is a chinese teacher marking her students' scripts. why was mine an old balding man? and to think students hate chinese nowadays?? oh comeon! with such a teacher, I am sure chinese is on the brink of a revival, like an old man who walks around with a limp and finally finds a tongkat ali! I am sure the results will be 'solid'!
haha enough of my yellow chatter. grace is planning and evil plot against caleb on vday! under my surreptitious influence. so keep your eyes glued to this blog for more updates!

on the first day of chinese new year

The first day of chinese lunar new year has passed. It should be the first time I did not go and visit relatives. My computer broke down, so I did not chat with anyone online. No one really msged me today also, except colin. He sent an mms of a panda movie which the pandas must go and watch. I spent my whole evening at starbucks studying: antihypertensives, anticoagulants, diuretics etc. Started on my cofm preventive medicine late at night. I felt abit lonely. Even though I went to watch cj7 with my mum at tampines mall in the late afternoon. It was a good show, abt a poor uneducated dad who wanted the best for his son. There is a good message embedded in the movie, you may be poor, but you don't steal or cheat or fight, you work hard to be a useful member of society. Just as I was feeling extra emo, I messaged a few good friends just to have some communication with the outside world. Then I went to switch on the tv, chelsea tv is on! Chelsea is trashing liverpool 4 nil on a replay. I hope sunday will be just as rewarding for the blues!
This is something so good that I have to write it down: reported in straitstimes
But on tuesday, law fearing netizens started spreading the new photos ( nudes of gillian, cecilia and so on) through email and msn. This came after the police said on monday that it is not illegal for friends to share x-rated articles privately.
What irony.

when i was in yunnan

I am actually feeling quite hot under the wraps of my blanket. I had woken up to darkness, I had only the faint light of the window visible to me. It was not much visibility because as I turned to put the window behind me, I couldn't see at all what is in front of me. It was as though I am blind and I for a moment thought I had woken up in an alternate universe where I was blind. I sat there frozen for a minute, trying to recall what I had known about this new dark universe of mine. Then it struck me that nothing has changed, I am just dazed from the sudden waking up in complete darkness. I fumbled about for my mp3 player, difficult because there were so many blankets and so much darkness. I found it after a while and used it to iluminate the front of the room. I just felt I needed my phone at that moment. I had a terrible nightmare. But it had ended nicely, with the savior in my dreams telling me that I can be a better healer than he is if only I put my heart to it. He had saved my parents in my dream. Sometimes I wonder about dreams, are they my subconscious reaching out through me in a world where we are clouded with impatience and blessed with the lack of time ? Maybe we have a sixth sense after all, this sense actually prevents our heart from talking directly to us, blur the voice of our subconscious and what is this sense? A sense of inadequacy..a sense of insufficient time to do everything we want... Because we are so busy to do everything we want, we forget in the end what we really want. Sometimes where you dream, the real desires of our heart surface with a tiny but impactful voice or in a hazy, but yet crystal picture. I am curently in the third day of my yunnan trip. It is around 6 am in the morning. Jianxiong and caleb are snoring to a cacophany around me. One has a nasal ,slightly drumming tone to his snoring , the type where your tonsils participates in the sending out of air from your throat.. While the other is like a incessant droning background noise. Just the sound of air flowing out of the nostril. Occasionally one of them chokes and the snoring ceases, but it will usually return with renewed vigour. Enough about the longitudinal assault of soundwaves from the either side of me. It is supposed to be the coldest part of the day, but I can't feel the effects of the low temperature. Instead I am hot and restless. I am sitting in the courtyard of the house.an elderly lady has already woken up and is seeing to te running of the house in her own quiet and eficient manner. She smiles at me and uttered something about sleeping abit more to me, the locals have some thick accent that we are slowly taking time to wade through. I smiled back politely and did my best to become invisible. In hope that she will not attempt any other form of communication while I am writing this.sometimes eye contact is what makes one obvious and loud.
I had a conversation with shawn, our guide for this trip. It was after visiting the temple and joining in the ceremonious beating of the drums with the folks here. They are a real friendly bunch, really good with the big ancient drum of the temple. Even the elder monk, I thought he was realy chubby, came out to show us abit of his skills. We had offered incense to the buddha, many of us knelt and prayed for something close to our heart. The only thing I pray for always is health, the gift of life, something I cannot buy with whatever or how much wealth I have. It is a bit funny how similar these two words are in english.
Jingjing, yuhan and helen appeared out of nowhere.I spent half an hour fraternizing with them. They were supposed to be going to the market to buy the animals and vegetables for breakfast. Apparently they will be cycling to the marketplace.
So shawn was telling me about his Lord jesus, about God and how He lives in each and everyone of us. There is a body of flesh and a spirit in everyone of us at first. But when eve and adam fell for the temptation, the original sin, we got separated and body and spirit became two. Only when jesus came, he led a life of godliness, without sin and eventually sacrificed himself for humanity were we reunited with our soul again. I do believe that each andeveryone of us are connected, maybe by a common spirit, a spirit that lives in everything ever created. Afterall aint we really similar down to the most basic levels, at the scale of the atomic and subatomic? God created the world because the world is so beautiful and marvelous and intricate. And god was just there forever and ever. How about this? God is not separate from us, each and everyone of us, plus the other living and non living things make up god. Precisely because everything in this world is so marvelous and beautiful. And everything has just existed since time immemorial. Why is there a need for a separate entity? Sometimes when certain aspects of religion caters nicely for human concerns, it seems only too perfect that it can only be man made.not the religion itself but that solutions that they offer. A logical and apt solution or even right solution doesn,t make it true. Almost all religion offers hope after death, while they may claim that human are so insignificant, they do not think that death and the eventual nothingness and emptiness is a suitable end to our insignificant existence. They offer hope and precisely that is what mankind needs. To know that we really matter. The best leaders know how to serve up these hopes to their followers, the best businessmen know how to play the right tune of hope and cheeriness. It is a human trait to proffer hope. And maybe also a human trait to be skeptical of hopes as well.

i am going to be a religious pastor!

You would most enjoy a career that allows you to meet new people. You would also be happiest in a career that allows you to be free and flexible, and allows you to be extremely creative. Some careers that would be perfect for you are:

Stockbroker

Secretary

Receptionist

Director

Recruitment Consultant

Politician

Marketing

Human Resources Manager

Religious Minister

Teacher

Lawyer

Advertising

Consultant

Financial Adviser

Financial Planner

GP

Physical Therapy

Occupational Therapy

Public Relations

Estate Agent

Travel Agent

Restauranteur

Hotel Manager

Events Organiser
You are a great leader. You genuinely enjoy being around other people. Your relationships with others are very important to you. You love talking and meeting new people. You are very enthusiastic about work and about all that you do and have in your life. You love being the focus of attention. You enjoy a fast pace. You are very socially oriented. Therefore, you are much happier being with others than you are alone. You crave interaction with others.


You are very spontaneous and often act before you think. You are always quick to answer when you are asked a question, even if you aren't sure of the answer. It is easier for you to improvise as you go along. You enjoy thinking out loud, and are most creative when brainstorming with friends or colleagues. You enjoy being involved in many activities.



You are very easy to read, and often wear your heart on your sleeve. You are never afraid to tell people what you think. You are very empathetic and genuine. You can sometimes be seen as over-emotional or too involved by others. But that is only because you tend to get so involved in the things you do that they become personal. You want to be adored, loved and appreciated. You like to please others and to make sure people are happy.



You trust your gut instincts. You are easily inspired and trust that inspiration. You are very innovative. You analyse things by looking at the big picture. You are concerned about how what you do affects others. You worry about your actions and the future. You tend to use a lot of metaphors and are very descriptive and colourful in your choice of language.



You are very creative, and get bored easily if you don't get to express yourself. You like to learn new things. You don't like the same old routine. You like to leave your options open.



Discover your email personality

hurt so bad

哭了才发现自己真的受伤了
你曾对我说你永远是我的
为了爱情我把自己的幸福都忘了
你快乐我就快乐

也许是我们彼此都太年轻了
就是特别容易沉溺在爱情里
每当我再次看到身边美丽的花火
你也离开我我还是想对你说

baby i love you so much
你走了我的心在淌血
baby you hurt me so bad
想要你回到我的世界

baby i love you so much
你给我的诺言已经瓦解
baby you hurt me so bad
只要我们都爱著无论多苦都值得

说好的你怎黱忘记了