It is more than a year i have not update any.huuuu...Tetiba rindu untuk menulis semula.hahaha..dah nak habis cuti baru nak rindu =p. Sorryla mydotss.com.There are so many dots that are not being reported.You have missed a lot!!
believe it or not...Mus'ab had become abg already!! yes =) Introducing my new hero...Iyas...He is 62 days old today. Alhamdulillah..Photos will be post later..insyaAllah..
What am I impressed to just now?
haaa..my writing! impressive!! wawawawa....angkat bakul sendiri=p
I love to write.ok `Atikah..let's restart!
Bismillahirrahmanirrahim.....
hoo yeah!! i'm bloging! lama betul blog ini dipinggirkan.....kesian..kesian...
my last entry was..hmmm.....bila entah...Ini semua angkara...ADAPTASI!
Baru-baru ini saya ditakdirkan untuk ber'oncall' bersama seorang PRP yang baru sangat bekerja. Kasihan pula rasanya.....
"Saya rasa hidup saya penuh kejutan je sekarang ni kak! Saya kahwin hari tu macam terkejut, pastu start keje. Terkejut lagi. Kerja bukan stay kat satu station. tukar-tukar! memang terkejut je la.Sekarang ni..dengan baby lagi! Saya dalam mode terkejut je!! Saya rasa macam berat sangat hati nak datang kerja. Memang saya salahkan kerjalah bila jadi apa-apa yang tak best!" luahan hatinya yang gundah gulana.
Terkesima sekejap. Aku pun pernah alami mode terkejut ni dulu mungkin sekarang pun ada juga. Faham sangat luahan hati beliau. 'TERKEJUT' bukan maksudnya tak redha mungkin kerana 'mind set' yang negatif tatkala itu.
Senyap sekejap sambil tangan terus membuat kerja sambil otak fikirkan ayat penenang yang terbaik.
"Itu semua normal sebab tahun PRP ni memang tahun kejutan! Siapa yang dapat cope cepat, memang rezeki dialah. Saya dulu pun pernah salahkan kerja. Sebab kerjalah rumah saya tunggang langgang, saya tak sempat nak masak untuk suami, baju berlonggok tak basuh, novel tak dapat nak baca, tak dapat nak jalan-jalan dengan member..hmm.... banyaklah....ni semua angkara minda yang negatif!
tapi...bila saya fikir-fikir balik, positifkan minda...kenapalah saya susah-susah salahkan kerja. Saya perlulah mencari kemanisan dalam kerja saya tu. Barulah saya dapat tenangkan hati walaupun saya tak dapat buat semua benda-benda tu, tapi saya dapat buat kerja saya dengan baik!"
Jangan dikejar mati mak ditelan mati ayah...ehhh..macam salah je...=p
Doa sangat penting. Kebergantungan pada-NYA. Saya pun sering kali lupa pasal benda ni. Frust sini, frust sana! lupa ALLAH kan ada.. doa banyak-banyak. Minta tolong permudahkan segalanya....
Memang tak dapat nak nafikan..situasi kita berbeza-beza..Allah kan tahu kekuatan dan kelemahan kita di mana..Allah takkan uji kita kalau kita tak mampu..Yakinlah...Yakinlah 'Atikah....
Bersyukur...ni lagi satu hal penting. Saya pun selalu lupa nak bersyukur. Bersyukur yang Allah dah pinjamkan saya banyak benda untuk permudahkan urusan saya..Alhamdulillah...
ok..mahu sidai baju..Semoga kita semua dapat lakukan yang terbaik dalam semua tanggungjawab kita tak kiralah sebagai seorang isteri ke ummi ke kawan ke pekerja ke....Jadikan setiap nafas kita penuh makna..penuh pahala.. InsyaAllah =)
Alhamdulillah.. today is Mus'ab's 53rd day...eh haahla.. it is not 2 months yet...but he is more than 5 kilos!
He is sleeping soundly for the moment!! huhuhuhu~ sempatla ummi membebel jap kat blog yang dah lama kusam-musam ni..
After 53 days became a mother...
I knew there are more challenges awaitings..but..I am happy! be optimist! =)) Walaupun pernah satu masa..Mus'ab menangis tak henti-henti..sampai Ummi dia pun nangis sama...wawawawa...Yela.. baru beberapa hari jadi mak..sikit-sikit call angah ke mak ke ..tanya itu dan ini.. terlalu banyak persoalan..too much experiments to be done! kesian betul Mus'ab..sokmo jadi spesimen..
Sekarang Mus'ab salalu muntah..lepas menyusu je mesti muntah..walaupun dah burp...kekadang tu sampai terpancut-pancut..euwwwwwww! apelah Mus'ab ni...=p
Sibuklah saya meng'google' pasal benda ni..mmg normal rupanya.. reflux...this is due to some reasons. The reasons could be as below:
1)The muscular valve at the end of the food pipe, which acts to keep food in the tummy, hasn't developed properly yet.
(in severe case..the baby will have poor feeding! Alhamdulillah.. Mus'ab ni sokmo la nak mwnyusu waima selepas muntah pun)
2)over feeding...klo dah terlebih-lebih susu memang tak sedar pun baby kita dah minum banyak ke tidak...
Benda ni sebenarnya normal je..As long as he grew accordingly...Mus'ab sebulan dulu memang naik satu kg..bagos! mengikut skala yang ditetapkan.. mintak-mintaklah tmbh lagi sekilo bila next check up..insyaAllah...
24 March : Hyatt, Teluk Cempedak...
"HAPPY BIRTHDAY AYAH!!Thanks for the treat!!" wawawawawaw..Alhamdulillah..we still got chance to be there..
"Mak tak yah lah datang this weekend.Tunggu next weekendla..Still no signs.Next Friday no matter what, i'll be induce.So klo mak datang..confirm da ade baby!" suggested...Tapi ayah masih berdegil..Nak juga datang..To celebrate his birthday at Kuantan..confuse jugakla..Tapi.....Inilah hikmahnya.......
"Abang da 2 kali dah kuar air macam terkencing neh..tapi rasanye bukan terkencing pon.." tenang..Habis basah katilku dibuatnya.
Atas nasihat mak dan ayah, kami tiba di Pusat Bersalin Risiko Rendah, HTAA..
"Abang..doakan sayang yee.." mulalah tak senang duduk.
Aku sudah mula merasakan perutku mengeras lain macam je. Mungkin juga sebab da mula takut. huhuhu...Tapi tatkala itu sakit perutku tidaklah kronik mana pun. Boleh tahan lagi la..Pain scale baru 3-4 kott..Kalau tak silap pernah lagi sakit dari itu.contraction started actually.
"Mengantuknye...! berpinar-pinar mataku dek bersengkang mata..Sabar je laa..Disebabkan ngantuk yang luar biasa itu..aku jadi tak lalu nak makan..Mungkin juga hasil mentedarah di Hyatt malam tadi..huhuhu..Kononnya masih kenyang.
"Sorry puan, we didn't found any leakage"terang HO itu.
"Habis tu air tu ape?..both of us were curious..
Disebabkan sudah 2 kalo aku mengalami keadaan itu( konon leaking tapi tak), sebagai langkah berjaga-jaga aku ditempatkan di wad melur untuk pengawasan. Lagipin contractionku masih lagi once in 10 minutes..
Seawal jam 8 pg aku ditemani Taufik untuk berjalan ke wad. Sempat pula "mesti sebab makan banyak sangat semalam neh.." kami melawak...
"Aiyoo..leakage coild be found anywhere. Not just here..She's in laborla" Dr Sundren mengajar HO sekalian..
Sakitku semakin kerap..Sakitnya..boleh tahanla..masih lg 3-4..tapi dekat-dekat nak pukul 11 pagi..sakitnya bertambah dahsyat dan semakin sakit!! Terus 5 dah dan contraction menjadi 4 in 10 minutes..
Rupa-rupanya sudah 3cm bukaan....Hebatkan..Patut sakit...
Tepat jam 12.30 tengahari..aku dihantar ke labor room..Kalau tak silap doktor telah memecahkan kantumg ketuban aku seawal bukaam baru 4 cm..it is good to induce labor.Setiap kali contraction datang...Ya rabbi...hanya Allah saja yang tahu..Dah 8-9 dah kot pain scale...
"Puan kalau ade rase nak teran bgtaw kami ye.." pesan doktor muda itu.
I was a bit frustrated with the procedure. In my oppinion..they should allow husbands to accompany theor wives starting at this moments..to ease the pain..I felt like giving up at that moment as the contraction became stronger and stronger but I habe nobody to console me..waaaaaaa!!
lailahaila anta subha naka inni kuntumminazzalimin.......diucapkan sentiasa..Terbayang wajah mak..memang wajarlah betapa tingginya darjat para ibu..
"Dr..saya rasa macam nak meneran dah ni!" jeritku kerana aku tahu semua di situ sedang sibuk menjalankan tugas masing-masing.
"Ya Allah..misi! tolong panggil suami puan neh sekarang juga!baby da nak keluar dah ni." maka besegeralah Taufik masuk...
Terngiang-ngiang lagi jeritan kata- kata semangat dari doktor, staff nurse, jururawat masyarakat..dan yang pqling penting sokongan suami...Alhamdulillah....
Tepat jam 2.44 petang..keluarlah Mus'ab Mohd Taufik seberat 3.41 kg..normal delivery but vacuum assisted.
Welcome to the world sayang......Ummi doakan Mus'ab akan menjadi anak yang soleh, pembela agama suatu hari nanti..Jadilah seperti Mus'ab bin Umayr....
Ameen...
"Abg..da pegi cek da kat A& E. Doktor kata bukan appendicitis." kataku tenang.
"Alhamdulillah. Abes tu?" he asked me curiously.
"I'm pregnant! UPT Positive bang.."aku menjawab terus terang. Sesungguhnya aku sendiri tak pasti apakah perasaan ketika itu...
Sunyi sepi...
"Abang dengar ke tak tadi?" confused...
Perasaan bercampur baur. Memanglah kan..da kahwin...mestila lepas tu UPT positive! huhuhuhu..
Macam-macamlah yang terlintas...baru sebulan kahwin..da melekat la pula..Tapi..isn't it part of the plan? The right timing! Tapi...we didn't expect this soon..ye keee...wawawaw..Tapi..mampukah aku? Macam mana nak beranak nanti..boleh ke?? Nak tukar lampin pon x tahu...dan yang paling merunsingkan..am i going to be a good mother? hmmm..
This is me...i love to think a lot....until no action can be taken! Dalam erti kata lain..Aku yang serabut! huhuhu..Ayah selalu pesan.."pikirla satu-satu..Lepas da setel satu, barula pikir yang lain pulak"..
"Alhamdulillah.."itulah perkataan pertama yang terkeluar dari mulut suamiku setelah beberapa minit diam beribu...
"Sayang da buat solat sunat syukur tadi.
Abang doakan kita sama-sama dapat get through everything ye.."
insyaAllah...
Anak itu amanah Allah..Ibubapalah yang mencorakkannya..Cantik lakarannya..cantiklah lukisan itu nanti..
Malam ni En Taufik ada program. Di situ nanti beliau perlu menceritakan tentang perang ini...Lantas, dia mengambil inisistif untuk menceritakan dahulu kepada saya selaku penyaring cerita merangkap penilai kepada tahap kemahiran bercerita En Taufik. Walaupun, mata saya menunjukkan tahap kemengantukkan yang tiada batasnya............
Saya gagahkan juga mata ini..dan sekarang, ingin saya kongsikan bersama..dah lama tak 'replenish' ilmu Sirah Nabi.Astaghfirullahal'azim...
Perang Badar ini berlaku dalam bulan Ramadhan tahun ke-2 hijrah. Alamaks, da tak ingat berapa haribulan..Nanti akan diupdate semula..Maaf yee..Perang ini berlaku di suatu tempat simpanan air yang berada diantara Mekah dan Madinah.Namanya lembah Badar. Tapi kalau tengok peta, dekat lagi jarak antara Badar dengan Madinah berbanding Mekah.
Tercetusnya Perang Badar ini adalah apabila kaum Muhajirin, mengenang nasib mereka yang semua harta yang ditinggalkan di Mekah semasa Hijrah dulu telah dirampas oleh kaum musrikin dan didagangkan. Tambahan pula, "Kafilah dagang Abu Suffian sedang dalam perjalanan pulang dari Syam ke Mekah Ya Rasulullah" terang seorang perisik....Masa yang sesuaikan?? Kiranya tujuan sebenarnya Perang Badar ini adalah untuk merampas barang dagangan kafilah Abu Suffian.
Sebelum menbuat keputusan......
"Saya akan tetap bersamamu, Ya Rasulullah", jawab Abu Bakar As-Siddiq...
"Kami juga akan tetap bersamamu, Ya Rasulullah", jawab wakil kaum Muhajirin dengan semangat.
Namun, Nabi saw masih resah, sehinggalah...
"Kami juga akan tetap di bersamamu, Ya Rasulullah. Walaupun kamu terjun ke dalam laut akan kami ikut", jawab wakil kaum Ansar.
Hebatkan? Cinta mereka terhadap Rasulullah. Plus, nilai persaudaraan yang tinggi antara Muhajirin dan Ansar..=)))) Suke 35 x!!
Abu Suffian pun cerdik juga. Mestilah ada 'informer'. Setahunya beliau akan rancangan Rasulullah dan muslim ntuk merampas barang dagangan beliau, beliau terus sahaja menghantar utusan ke Mekah."Tolong kami! Madinah ingin menyerang kabilah Abu Suffian!" kecohlah seluruh Mekah..
Orang kafir Quraisy pun apa lagi. Ambillah peluang ini untuk menghancurkan Islam. Maka boleh dikatakan kebanyakkan orang kafir Quraisy yang turut serta merupakan ketua-ketua puak dan bangsawan-bangsawan Mekah. Lebih 1000 orang kafir Quraisy rela hati ingin melihat kehancuran Madinah.Abu Jahal lah ketuanya..isk3x....
Pada masa yang sama, Abu Suffian pun mengambil inisiatif untuk menukar jalan rombongan beliau. Elakkan dari diserang...
Di medan perang...
to be continued...
"Atikah lunch jom! Makan mana?" Maya kelaparan.
"Tak pelah hari ni cam tak lapar pon. Lagi pun tadi dah makan heavy time breakfast." Aku terus menolak. mungkin kepala masih lagi berfikir tentang itu.....
Mataku terus menerus tumpu ke monitor.
Nak cek ke tak...nak cek ke tak...nak cek ke tak....haisyyyyyyyyyyyyy~ Benci pada situasi itu. Nak tahu tapi takutttttt.
Tanganku terus menaip nombor pendaftaranku di hospital. Dalam sekelip mata semua sejarah perubatanku di hospital itu keluar. Sejuk beku tanganku tatkala itu. Aku terus menerus 'scroll' tetikus ke bawah untuk menjejaki ujian yang telah ku lalui sebentar tadi.
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Sememangnya bermulalah satu lagi permulaan titik baru dalam liku-liku hidupku.
Malam itu kami cuba tidur awal untuk bangun seawal 4 pagi keesokkan paginya dan terus bergerak menuju ke LCCT. Aku perlu ke Tumpat untuk berinduksi. Taufik pula akan terus pulang ke Pekan.
"Abang macam sakit je perut ni", aduku.
"Meh abang sapu minyak" segeralah Taufik bertindak.
Malangnya keadaan semakin parah. 'Pain scale'ku bertambah dari 2 ke 7 secara mendadak! Aku cuba untuk mengherotkan badanku untuk mengurangkan kesakitan yang dialami.
"Ok tak nih??" tanya suamiku.
"Abang panggil mak boleh??". Entah kenapa walaupun suamiku ada di depan mata namun mak juga yang ingin ku jumpa.
"Mak, sakit sangat", kataku teresak-esak.
"Taufik, bawa tikah pergi klinik terus! Tak pernah pula mak tengok dia sakit perut macam ni. Nak kata period pain, tapi masih belum lagi kan? Lagi pun dia mana pernah senggugut before this," mak cuba mengaagak.
Betul kata mak. Pelik...Aku gagahkan diri untuk menapak ke kereta.
Di klinik...
"Doktor tolong cucuk saya dengan voren", rayuku agak aku perut segera kembali selesa.
Teruk betul.....Ini semua angkara kursus induksi yang akan berlangsung mulai esok itu. Tambahan pula tiket kapal terbang yang telah dibeli. Rugi laaa....
"Mungkin awak ni kena UTI. Kencing sakit tak?" tanya doktor.
"Tak pula,"jawabku lemah tapi lega setelah doktor mengikut sarananku.
Jam telah menunjukkan pukul 3 pagi. Aduyai...Banyak pula persoalannya. Namun, sebagai konklusi..
"Baiklah saya akan refer awak ke hospital. Kat hospital mreka akan kaji dengan lebih mendalam lagi sakit awak nih" mudah kan kerja doktor ni. Ish, ish, ish...Kami pulang ke rumah.Kalau ikutkan suamiku, teruslah kami ke hospital. Tapi, degilku menang, kami terus pulang ke rumah. Aku tetap bertegas untuk ke Tumpat. Astaghfirullah...Sian abang.....
Keadaanku sepanjang minggu di Tumpat baik. Sehinggakan aku terlupa akan sakit yang teramat yang telah kulalui.
"Kalau sakit sikit je, terus pergi hospital.Jangan tahan-tahan lagi.Balik dari induksi terus pergi jumpa doktor kat hospital. Suruh dia cek semua sekali" tegas suamiku. Risau dengan degilku.....
"Tikah da pergi jumpa doktor belum?" itulah soalan pertama Taufik pada hari Isnin setelah aku masuk kerja.
Alamaks......"Ye ye..tikah pergi kejap lagi..." itula...padan muka. Boleh pula aku lupa janjiku.
Alhamdulillah... Nasib baik di Ampang ini ada satu klinik khas untuk staf. Kalau sakit boleh terus jumpa doktor. Mungkin sebab itulah semua staf hospital ini akan kenal mesra dengan Dr Janz.Aku segera menunjukkan surat 'referral'ku kepada Dr. Janz.
"It has been a week! Ayoyo Atikah...Now, do you feel any pain?" ni semua Taufik punya pasal, siapa suruh paksa aku pergi jumpa doktor? huhuhuh
"Not at all, even for the last few days. i've just retuned from induction course last week. I experienced it the night before I off to Tumpat." kenalah bercerita panjang.
Macamana pun, sebagai seorang doktor yang berkaliber, Dr Janz terus melakukan PE keatas diriku.
"Wait a," pesan Doktor.
"They suspect that this patient is having appendicitis. Since you've just undergo appendisectomy last week why don't you double confirm what i've found." berbincanglah dua orang doktor itu.
"Eip..awak punya last period bila?" tanya dr Ayu.
"Patutnya 2 hari lepas saya punya due. Tapi tak peod lagi" jawabku selamba.
"Haa......pergi amek air kencing. Staff Nurse. UPT ye"arah Dr Ayu.
"Atikah you dah kawen kee?? Belum kan? Bila you kawen? Last time kita jumpa you belum kawenkan?" dengan mata-mata sekali Dr Janz bertanya.
wawawawa~ memangla, 'Last time' kita jumpa tu zaman bila dr oit....mula-mula lapor diri rasanya...
Aku pon sebenanrya terdiam..."Betul ke dr. nak buat UPT?" teragak-aak. "Baru 2 hari lambat. Memanglah selalunya period cycle saya tepat. Tapi, nak kena buat sekarang ke?"masih teragak-agak.
No choice...
"Nanti apa-apa contact saya ye at this extension XXXX." Aku terus menapak dalam kebisuan.
Macam-macam la kena fikir sekarang ni....ye la dah duduk rumah baru, teman serumah baru huhuhuuu, tempat kerja baru, jiran baru, kawan-kawan sekerja baru, jawatan baru, ape lagi yang baru?? hmm... Kereta masih sama=)) Alhamdulillah...
Alhamdulillah...walaupun banyak nak kena fikir...tapi macam semuanya dipermudahkan.There is always first time! Dah fikir kenalah try.Kalau tak try..mana nak tahu..kan??
Sekarang..dah jadi FRP ye..nama panjang Full Registered Pharmacist di Hospital Tengku Ampuan Afzan, Kuantan. Oleh itu, makin banyaklah tanggungjawab! Kalau dulu mana main dengan fail meja neh. Sekarang dah ada fail meja taw! Maka tersenarailah kerja hakiki anda sebagai FRP. Esok kena kerja lagi....perbaiki diri...Dulu kerja di Ampang..memang 'heaven'! mungkin sebab sistem IT yang wujud di situ. Sekarang dengan Sistem manual di HTAA....agak-agak lama-lama nanti boleh jadi 'heaven' tak?? =p Saya merasakan bahawasanya saya perlu berusaha lebih gigih lagi dengan sistem manual ini! =D
Sekarang dah memang diuji sebagai isteri solehah secara terus.wawawawa~ masak, basuh baju, iron baju, kemas rumah...dan bannyaaakkk lagi yang boleh dinilai. Yelah kan, suami dah ada depan mata. Kalau tak dulu weekend je. Itu pun kat rumah mak dan ayah atau kat rumah mak mertua. Boleh rileks lagi =))
Sebenarnya nak masukkan gambar rumah baru, tp.....nantilah dulu bila dah makeover baru letak! huhuhu~ bila ntah boleh makeovernye!! =p Neighbourhood di sini memang best! Adalah sekali jiran sambut hari jadi anak beliau. Semua jiran kat sini ramah tamah....Akibatnya, kena makan banyaksssssgt!!! =p Aduyai....
Standardlah kan? Semua orang kalau kena menghadapi sesuatu yang baru, memang banyak berfikir. " Camane kalau...". " Kalau dia cakap neh?"...banyaklaaaaaa~ betulkan? kan?
Apa yang membezakan seseorang individu dengan individu yang lain adalah berapa lama dia berfikir......Fikir punya fikir, punya fikir....sampai serabotttt!!! wawawawawa~ So, think once at a time.....Plan and take action....finally, TAWAKKAL...........Doa..Moga ALLAH permdahkan segalanya.....
First of all, let me clarify these are actually the things that are forbidden to do while you are travelling by bus. Especially for a LONGGGG distance journey. Clear??
=))) Rabu lepas genaplah 5 bulan perkahwinan 'Atikah Zahir dan Mohd Taufik Abdullah....
New York University’s Dr. Barry Reisberg outlines the seven major clinical stages of Alzheimer’s disease. Dr. Reisberg is the Clinical Director of New York University’s Aging and Dementia Research Center. As the principal investigator of studies conducted by the National Institutes of Health, Dr. Reisberg’s work has been pivotal in the development of two of the three current pharmaceutical treatment modalities for Alzheimer’s. He is developed the “Global Deterioration Scale” which is now used in many diagnoses and care settings as the rating scale.
Stage 1: Normal
At any age, persons may potentially be free of objective or subjective symptoms of cognition and functional decline and also free of associated behavioral and mood changes. We call these mentally healthy persons at any age, stage 1, or normal.
Stage 2: Normal aged forgetfulness
Half or more of the population of persons over the age of 65 experience subjective complaints of cognitive and/or functional difficulties. The nature of these subjective complaints is characteristic. Elderly persons with these symptoms believe they can no longer recall names as well as they could 5 or 10 years previously. They also frequently develop the conviction that they can no longer recall where they have placed things as well as previously. Subjectively experienced difficulties in concentration and in finding the correct word when speaking, are also common.
Various terms have been suggested for this condition, but normal aged forgetfulness is probably the most satisfactory terminology. These symptoms which, by definition, are not notable to intimates or other external observers of the person with normal aged forgetfulness, are generally benign. However, there is some recent evidence that persons with these symptoms do decline at greater rates than similarly aged persons and similarly healthy persons who are free of subjective complaints.
Stage 3: Mild cognitive impairment
Persons at this stage manifest deficits which are subtle, but which are noted by persons who are closely associated with the stage 3 subject. The subtle deficits may become manifest in diverse ways. For example, the person with mild cognitive impairment (MCl) may noticeably repeat queries. The capacity to perform executive functions also becomes compromised. Commonly, for persons who are still working, job performance may decline. For those who must master new job skills, decrements in these capacities may become evident. For example, the MCI subject may be unable to master new computer skills (Figure 3). MCI subjects who are not employed, but who plan complex social events, such as dinner parties, may manifest declines in their ability to organize such events.
Other MCI subjects may manifest concentration deficits. Many persons with these symptoms begin to experience anxiety, which may be overtly evident.
The prognosis for persons with these subtle symptoms of impairment is variable, even when a select subject group who are free of overt medical or psychological conditions which might account for, or contribute to, the impairments are studied. A substantial proportion of these persons will not decline, even when followed over the course of many years. However, in a majority of persons with stage 3 symptoms, overt decline will occur, and clear symptoms of dementia will become manifest over intervals of approximately 2 to 4 years. In persons who are not called upon to perform complex occupational and/or social tasks, symptoms in this stage may not become evident to family members or friends of the MCI patient. Even when symptoms do become noticeable, MCI subjects are commonly midway or near the end of this stage before concerns result in clinical consultation. Consequently, although progression to the next stage in MCI subjects commonly occurs in 2 to 3 years, the true duration of this stage, when it is a harbinger of subsequently manifest dementia, is probably approximately 7 years.
Management of persons in this stage includes counseling regarding the desirability of continuing in a complex and demanding occupational role. Sometimes, a ‘strategic withdrawal’ in the form of retirement, may alleviate psychological stress and reduce both subjective and overtly manifest anxiety.
Stage 4: Mild Alzheimer’s disease
The diagnosis of Alzheimer’s disease can be made with considerable accuracy in this stage. The most common functioning deficit in these patients is a decreased ability to manage instrumental (complex) activities of daily life. Examples of common deficits include decreased ability to manage finances, to prepare meals for guests, and to market for oneself and one’s family. The stage 4 patient shown has difficulty writing the correct date and the correct amount on the check. Consequently, her husband has to supervise this activity. The mean duration of this stage is 2 years.
Symptoms of impairment become evident in this stage. For example, seemingly major recent events, such as a recent holiday or a recent visit to a relative, may, or may not, be recalled. Similarly, overt mistakes in recalling the day of the week, month or season of the year may occur. Patients at this stage can still generally recall their correct current address. They can also generally correctly recall the weather conditions outside and very important current events, such as the name of a prominent head of state. Despite the overt deficits in cognition, persons at this stage can still potentially survive independently in community settings. However, functional capacities become compromised in the performance of instrumental (i.e. complex) activities of daily life. For example, there is a decreased capacity to manage personal finances. For the stage 4 patient who is living independently, this may become evident in the form of difficulties in paying rent and other bills. A spouse may note difficulties in writing the correct date and the correct amount in paying checks. The ability to independently market for food and groceries also becomes compromised in this stage. Persons who previously prepared meals for family members and/or guests begin to manifest decreased performance in these skills. Similarly, the ability to order food from a menu in a restaurant setting begins to be compromised. Frequently, his is manifest in the patient handing the menu to the spouse and saying ‘you order’.
The dominant mood at this stage is frequently what psychiatrists term a flattening of affect and withdrawal. In other words, the patient often seems less emotionally responsive than previously. This absence of emotional responsivity is probably intimately related to the patient’s denial of their deficit, which is often also notable at this stage. Although the patient is aware of their deficits, this awareness of decreased intellectual capacity is too painful for most persons and, hence, the psychological defense mechanism known as denial, whereby the patient seeks to hide their deficit, even from themselves where possible, becomes operative. In this context, the flattening of affect occurs because the patient is fearful of revealing their deficits. Consequently, the patient withdraws from participation in activities such as conversations.
In the absence of complicating medical pathology, the diagnosis of AD can be made with considerable certainty from the beginning of this stage, Studies indicate that the duration of this stage of mild AD is a mean of approximately 2 years.
Stage 5: Moderate Alzheimer’s disease
In this stage, deficits are of sufficient magnitude as to prevent catastrophe-free, independent community survival. The characteristic functional change in this stage is incipient deficits in basic activities of daily life. This is manifest in a decrement in the ability to choose proper clothing to wear for the weather conditions and/or for the daily circumstances (occasions). Some patients begin to wear the same clothing day after day unless reminded to change. The spouse or other caregiver begins to counsel regarding the choice of clothing. The mean duration of this stage is 1.5 years.
At this stage, deficits are of sufficient magnitude as to prevent independent, catastrophe-free, community survival. Patients can no longer manage on their own in the community. If they are ostensibly alone in the community then there is generally someone who is assisting in providing adequate and proper food, as well as assuring that the rent and utilities are paid and the patient’s finances are taken care of. For those who are not properly watched and/or supervised, predatory strangers may become a problem. Very common reactions for persons at this stage who are not given adequate support are behavioral problems such as anger and suspiciousness.
Cognitively, persons at this stage frequently cannot recall such major events and aspects of their current lives as the name of the current president, the weather conditions of the day, or their correct current address. Characteristically, some of these important aspects of current life are recalled, but not others. Also, the information is loosely held, so, for example, the patient may recall their correct address on certain occasions, but not others.
Remote memory also suffers to the extent that persons may not recall the names of some of the schools which they attended for many years, and from which they graduated. Orientation may be compromised to the extent that the correct year may not be recalled. Calculation deficits are of such magnitude that an educated person has difficulty counting backward from 20 by 2s.
Functionally, persons at this stage have incipient difficulties with basic activities of daily life. The characteristic deficit of this type is decreased ability to independently choose proper clothing. This stage lasts an average of approximately 1.5 years.
In this stage, deficits are of sufficient magnitude as to prevent catastrophe-free, independent community survival. The characteristic functional change in this stage is incipient deficits in basic activities of daily life. This is manifest in a decrement in the ability to choose proper clothing to wear for the weather conditions and/or for the daily circumstances (occasions). Some patients begin to wear the same clothing day after day unless reminded to change. The spouse or other caregiver begins to counsel regarding the choice of clothing (Figure 5). The mean duration of this stage is 1.5 years.
Stage 6: Moderately severe Alzheimer’s disease
At this stage, the ability to perform basic activities of daily life becomes compromised. Functionally, five successive substages are identifiable. Initially, in stage 6a, patients, in addition to having lost the ability to choose their clothing without assistance, begin to require assistance in putting on their clothing properly. Unless supervised, patients may put their clothing on backward, they may have difficulty putting their arm in the correct sleeve, or they may dress themselves in the wrong sequence.
In the stage of moderately severe Alzheimer’s disease, the cognitive deficits are of sufficient magnitude as to interfere with the ability to carry out basic activities of daily life. Generally, the earliest such deficit noted in this stage is decreased ability to put on clothing correctly without assistance. The total duration of the stage of moderately severe AD (stage 6a through 6e) is approximately 2.5 years.
For example, patients may put their street clothes on over their night clothes. At approximately the same point in the evolution of AD, but generally just a little later in the temporal sequence, patients lose the ability to bathe independently without assistance (stage 6b). Characteristically, the earliest and most common deficit in bathing is difficulty adjusting the temperature of the bath water. Initially, once the spouse adjusts the temperature of the bath water, the patient can still potentially otherwise bathe independently. Subsequently, as this stage evolves, additional deficits in bathing independently as well as in dressing independently occur. In this 6b substage, patients generally develop deficits in other modalities of daily hygiene such as properly brushing their teeth independently.
Requires assistance adjusting the temperature of the bath water. At approximately the same time as Alzheimer’s patients begin to lose the ability to put on their clothing properly without assistance, but generally just a little bit later in the disease course, patients begin to require assistance in handling the mechanics of bathing (Figure 7). Difficulty adjusting the temperature of the bath water is the classical earliest deficit in bathing capacity in Alzheimer’s disease.
Stages 6c, 6d, 6e
With the further evolution of AD, patients lose the ability to manage independently the mechanics of toileting correctly (stage 6c). Unless supervised, patients may place the toilet tissue in the wrong place. Many patients will forget to flush the toilet properly. As the disease evolves in this stage, patients subsequently become incontinent. Generally, urinary incontinence occurs first (stage 6d), then fecal incontinence occurs (stage 6e). The incontinence can be treated, or even initially prevented entirely in many cases, by frequent toileting. Subsequently, strategies for managing incontinence, including appropriate bedding, absorbent undergarments, etc., become necessary.
Requires assistance with cleanliness in toileting (Figure 8). After Alzheimer’s patients lose the ability to dress and bathe without assistance, they lose the ability to independently maintain cleanliness in toileting.
Requires assistance to maintain continence (Figure 9). After Alzheimer’s patients lose the ability to dress, bathe and toilet without assistance, they develop incontinence. Generally, urinary incontinence precedes fecal incontinence. Strategies to prevent episodes of incontinence include taking the patient to the restroom and supervision of toileting.
In this sixth stage cognitive deficits are generally so severe that persons will display little or no knowledge when queried regarding such major aspects of their current life circumstances as their current address or the weather conditions of the day.
In this stage the patient’s cognitive deficits are generally of such magnitude that the patient may at times confuse their wife with their mother or otherwise misidentify or be uncertain of the identity of close family members . At the end of this stage, speech ability overtly breaks down.
Recall of current events is generally deficient to the extent that the patient cannot name the current national head of state or other, similarly prominent newsworthy figures. Persons at this sixth stage will most often not be able to recall the names of any of the schools which they attended. They may, or may not, recall such basic life events as the names of their parents, their former occupation and the country in which they were born. They still have some knowledge of their own names; however, patients in this stage begin to confuse their spouse with their deceased parent and otherwise mistake the identity of persons, even close family members, in their own environment. Calculation ability is frequently so severely compromised at this stage that even well-educated patients had difficulty counting backward consecutively from 10 by 1s.
Emotional changes generally become most overt and disturbing in this sixth stage of AD. Although these emotional changes may, in part, have a neurochemical basis, they are also clearly related to the patient’s psychological reaction to their circumstances. For example, because of their cognitive deficits, patients can no longer channel their energies into productive activities. Consequently, unless appropriate direction is provided, patients begin to fidget, to pace, to move objects around and place items where they may not belong, or to manifest other forms of purposeless or inappropriate activities. Because of the patient’s fear, frustration and shame regarding their circumstances, as well as other factors, patients frequently develop verbal outbursts, and threatening, or even violent, behavior may occur. Because patients can no longer survive independently, they commonly develop a fear of being left alone. Treatment of these and other behavioral and psychological symptoms which occur at this stage, as well as at other stages of AD, involves counseling regarding appropriate activities and the psychological impact of the illness upon the patient, as well as pharmacological interventions.
The mean duration of this sixth stage of AD is approximately 2.3 years. As this stage comes to an end, the patient, who is doubly incontinent and needs assistance with dressing and bathing, begins to manifest overt breakdown in the ability to articulate speech. Stuttering (verbigeration), neologisms, and/or an increased paucity of speech, become manifest.
Stage 7: Severe Alzheimer’s disease
At this stage, AD patients require continuous assistance with basic activities of daily life for survival. Six consecutive functional substages can be identified over the course of this final seventh stage. Early in this stage, speech has become so circumscribed, as to be limited to approximately a half dozen intelligible words or fewer in the course of an intensive contact and attempt at an interview with numerous queries (stage 7a). As this stage progresses, speech becomes even more limited to, at most, a single intelligible word (stage 7b). Once speech is lost, the ability to ambulate independently (without assistance), is invariably lost (stage 7e, Figure 11). However, ambulatory ability is readily compromised at the end of the sixth stage and in the early portion of the seventh stage by concomitant physical disability, poor care, medication side-effects or other factors. Conversely, superb care provided in the early seventh stage, and particularly in stage 7b, can postpone the onset of loss of ambulation, potentially for many years. However, under ordinary circumstances, stage 7a has a mean duration of approximately 1 year, and stage 7b has a mean duration of approximately 1.5 years.
Early in the course of this final stage of AD speech ability is limited to only a few words. Later, all intelligible speech is essentially lost, with speech limited to at most, a single intelligible word. Subsequently, ambulatory ability is lost and the patient requires assistance in walking (Figure 11). Each substage of this final seventh stage lasts an average of 1-1.5 years.
In patients who remain alive, stage 7c lasts approximately 1 year, after which patients lose the ability not only to ambulate independently, but also to sit up independently (stage 7d), At this point in the evolution of AD, patients will fall over when seated unless there are arm rests to hold the patient up in the chair (Figure 12).
This 7d substage lasts approximately 1 year. Patients who survive subsequently lose the ability to smile (stage 7e). At this substage only grimacing facial movements are observed in place of smiles, This 7e substage lasts a mean of approximately 1.5 years. It is followed in survivors, by a final 7f substage, in which AD patients additionally lose the ability to hold up their head independently.
In the latter portion of the final stage of AD, patients become immobile co the extent that they require support to sit up without falling. With the advance of this stage, patients lose the ability to smile and, ultimately, to hold up their head without assistance, unless their neck becomes contracted and immobile. Patients can survive in this final 7f substage indefinitely; however, most patients succumb during the course of stage 7.
With appropriate care and life support, patients can survive in this final substage of AD for a period of years.
With the advent of the seventh stage of AD, certain physical and neurological changes become increasingly evident. One of these changes is physical rigidity. Evident rigidity upon examination of the passive range of motion of major joints, such as the elbow, is present in the great majority of patients, throughout the course of the seventh stage.
In the final stages of AD patients manifest increasing rigidity. Rigidity is evident to the examiner in the stage 7 patient upon passive range of motion of major joints such as the elbow.
In many patients, this rigidity appears to be a precursor to the appearance of overt physical deformities in the form of contractures. Contractures are irreversible deformities which prevent the passive or active range of motion of joints (Figure 14). In the early seventh stage (7a and 7b), approximately 40% of AD patients manifest these deformities. Later in the seventh stage, in immobile patients (from stage 7d to 7f), nearly all AD patients manifest contractures in multiple extremities and joints.
Contractures of the elbow, wrists and fingers. Development of joint deformities known as contractures is an increasing problem in the stage 7 Alzheimer’s disease. A contracture is a joint deformity which makes full range of movement of a joint impossible without producing severe pain. Approximately 40% of patients in stage 7a and 7b manifest these deformities to the extent that they cannot move a major joint more than half way. In the immobile Alzheimer’s patient (stages 7d to 7f). Approximately 95% of patients manifest these deformities which are usually present in many joints.
Neurological reflex changes also become evident in the stage 7 AD patient. Particularly notable is the emergence of so-called ‘infantile’, ‘primitive’ or ‘developmental’ reflexes which are present in the infant but which disappear in the toddler. These reflexes, including the grasp reflex, sucking reflex (Figure 15), and the Babinski plantar extensor reflex (Figure 16), generally begin to re-emerge in the latter part of the sixth stage and are usually present in the stage 7 AD patient. Because of the much greater physical size and strength of the AD patient in comparison with an infant, these reflexes can be very strong and can impact both positively and negatively on the care provided to the AD patient”. AD patients commonly die during the course of the seventh stage. The mean point of demise is when patients lose the ability to ambulate and to sit up independently (stages 7c and 7d).
Sucking reflex . ‘Primitive’ reflexes, also known as ‘infantile’ reflexes or ‘developmental’ reflexes, such as the sucking reflex, are evident in the stage 7 Alzheimer’s patient.
Babinski or plantar extensor reflex. Another infantile reflex seen in the stage 7 Alzheimer’s patient is the Babinski reflex. This abnormal response to stimulation of the sole of the foot is marked by dorsiflexion of the great toe and fanning of the other digits of the foot.
The most frequent proximate cause of death is pneumonia. Aspiration is one common cause of terminal pneumonia. Another common cause of demise in AD is infected decubital ulcerations. AD patients in the seventh stage appear to be more vulnerable to all of the common causes of mortality in the elderly including stroke, heart disease and cancer. Some patients in this final stage appear to succumb to no identifiable condition other than AD.
Hajat di hati nak buatkan short notes~~ tp it's not finish yet..once completed..i'll attach it then! =))..tp kalau sesiapa rajin nak tolong buatkan.....you are please to do so!!
“Janganlah kamu menghampiri zina sesungguhnya zina itu amat keji dan jalan yang sesat,”
Buat kakakku ‘Atikah. As-salam))) Oleh kerana munze x dapat bersama-sama dan membantu dalam penyediaan majlis pernikahan dan walimah kau. Ni je lah yang mampu munze buat untuk kau)) Kakakku ‘Atikah, “orang kampong” itulah panggilan yang aku berikan. Kadang-kadang telakar jugak aku memikirkannya)) Cara dia berpakaian, cara dia pilih barang-barang semuanya macam “kampong!!”. Bukan munze saje memberi gelaran tersebut, tapi memang pelik “style” dia nie. Kadang-kadang aku pernah rasa malu untuk berjalan bersama-sama dia))) macam jalan dengan erm.. erm.. cmne erk? Haha~ Kakakku ‘Atikah, “bibik” gelaran kedua)) rajin sangat mengemas! sapu sampah di depan rumah, basuh lantai luar rumah kalau ade taik kucing, basuh kereta, kemas bilik, kemas rumah, dan macam2 lagi la yang bibik buat!!)) Kakakku ‘Atikah, “pembuang barang” gelaran ketiga untuk dia. Semua barang akan di buang kalau dia rase menyemak di rumah kami. Kalau tetibe barang antara kami sekeluarga tidak dapat jumpa, dialah orang pertama akan dicari!! Haha~ kadang-kadang chumel memikirkanye,tapi sakit kalau betul barang itu hilang akibat si die nie buang! Kakakku ‘Atikah, “ATM” antara ATM machine di rumah untukku))) dia ni tak gemar akan shopping. Tapi kalau ade benda dia minat, memang itulah dia minat sampai dia beli walaupun barang tersebut macam bundle puye barang aje. Kakakku ‘Atikah, “Pharmacist dan penyimpan rahsia yang berajaya” . kalu tentang ubat.. Tanya je lah die.. insyaALLAH memang confirm dia dapat jawab.. tapi jangan sesekali tanya tentaang sakit perut ataupun cirit birit, nanti jawapan yang diberikan confirm2 sakit ati! PIL CHI KIT TECK AUN~itulah jawapannye!!!! Hahaha~ rahsie pula~ memang antara yang terbaek untuk di sharekan))) raseye lah~ )) Walaubagaimanapun, Semua ni baruku sedar semua kebaikkan yang ada pada kakakku ini. “Dan janganlah mereka menampakkan perhiasannya, kecuali yang (biasa) nampak darinya.” [TMQ An-Nur (24):31]. Dari maksud potongan ayat quran di atas, gelaran “kampong??” yang diberikan olehku padanya tidak menampakkan 1 pun kesalahan yang dia lakukan. Malah selama aku bersama kakakku ini, tak pernah aku lihat dia berhias melebih2 sampai menarik perhatian orang lain ketika kami berjalan bersama apatah lagi mendedahkan auratnya??. Setakat kemas dan bersih itulah dia. Memang inilah yang ditekankan dalam ayat ini. So aku memang out untuk berbahas dengan dia dalam bab ini)) Tentang “bibik”?? pengemas? Bersih? Memang itulah kerjanyakan? Bagaimana pula dengan ayat di bawah? "Bersih" adalah sifat yang sangat disukai oleh Allah SWT. ".... Dan Allah menyukai orang-orang yang "bersih". (Al-Qur'an Surat At Taubah Ayat 108). Nak buat cmne lagi? Memang sifat terpuji kut sifat bersih nie???!!!!! Huu~ aku kalah lagi(((((((( Buang barang @ letak barang di luar rumah supaya orang ambil??? Haa!!! Mungkin ini aku dapat lawan dia!!!!! ''Engkau tak akan mendapatkan kebaikan apa pun hingga kalian menyedekahkan sebagian harta yang paling kalian cintai. Ketahuilah, apa pun yang kalian infakkan, Allah pasti mengetahuinya.'' (Ali 'Imran: 92). Adekah ini niatye?? Haha~ ALLAH je yang tahu))) tapi kalau betullah ini niat dia~ memang aku angkat kedua tanganku! Surrender aku dibuatye~! Haa~ tentang ATM dan penyimpan rahsie yang berjaye~ aku amat salute sama kakakku atikah ini~ bukan yang laen tu tak boleh percaye or pape.. Tapi kali nak tulis tentang dia.. so.. puji je la dia nie)) hahaha)))) yang laen tunggu turn erk)))) Aku gemar akan cara kakakku yang ini bercinta)) susah sama sekali melihat die bergayut dengan mana2 lelaki~ ataupun cube mendampingi mana2 laki untuk menarik perhatian mereka?? Tup.. tup.. dapat si saudara taufik nie.. wic I neve heard sepanjang hidup munze sampailah satu ari kak tikah tanya aku untuk pendapat)).. alhamduliLLAH dari gaye bakal abang ipar aku yang kali ini memang ade care suami dan ayah yang soleh n cool~ jadi imam kut mase datang merisik dulu)))) hahaha~ tapi insyaALLAH walau apapun terjadi antara kak tkah n abg taufik.. munze akan sentiase susun sepuluh jari ini untuk berdoa kebahagian kalian dan dijauhi ujian yang hot2))~ Buat kak tkah.. semoga menjadi isteri yang solehah.. taat pada suami..))) yang laen.. kak tkah lbeyh tau kut))))) tapi nak share hadith ni untuk kak tkah))) semoga kak tkah dapat jadi yang terbaik sehingga ke tahap nie))))) Rasulullah SAW dalam hadisnya bermaksud, "Sebaik-baik wanita itu ialah apabila kamu memandangnya kamu akan senang hati (gembira), apabila kamu perintah, ia patuh kepadamu, apabila kamu pergi, ia akan menjaga dirinya dan menjaga hartamu." Dan buat bakal abg iparku taufik~))) munze pasti ilmu abang taufik jauh lbeyh tinggi dari munze.. tapi nak share la jugak~)) Rasulullah SAW dalam hadisnya bermaksud, "Takutlah kepada Allah, di dalam memimpin isteri-isterimu, kerana sesungguhnya mereka adalah amanah yang ada disampingmu, barangsiapa tidak memerintahkan agar isterinya mengerjakan solat, dan mengerjakan agama kepadanya, maka ia telah berkianat kepada Allah dan Rasul-Nya Menarikkan??? Nk share gak yg nie!!!! Dalam sebuah hadis yang diriwayatkan oleh Bukhari, Aisyah pernah ditanya apa yang dilakukan oleh Rasullulah SAW dalam rumahtangganya? Jawab Aisyah: Nabi SAW biasa membantu kepentingan keluarganya. Menyapu rumah, menjahit baju yang koyak, memperbaiki sepatu dan memerah susu kambing. Bila tiba waktu solat tiba baru baginda berhenti, kemudian menunaikan solat." Haaa~ bukan perempuan aje tau buat kerja rumah))))) dan akhir buat abang taufik~ Rasulullah SAW dalam hadisnya bermaksud, "Perbaikilah wanita, kerana sesungguhnya wanita itu diciptakan dari tulang rusuk. Paling bengkoknya tulang rusuk itu adalah di bahagian atasnya. Jika meluruskannya terlalu keras., maka ia akan pecah. Dan jika dibiarkan, maka ia akan tetap bengkok. Maka perbaikilah wanita itu dengan cara yang baik. Kalau ade yang kekurangan terhadap kakakku ini~ perbaiki lah dengan care yang lembut~ jangan garang2))) nanti patah!!! Heee~~~ Dan si sini~ ingin munze meminta maaf kerana tak dapat bersama kalian dalam majlis ni(((( semoga rumah tangga korang didirikan curahan hujan ribut ni’matye islam))) Sahabat2 seislam munze selalu katekan))) islam datang dengan asing.. dan pergi dengan asing juga))) sesungguhye beruntunglah sesiapa yang asing itu)))) Last but not least)))))) Semoga Allah memberkati kamu dan melimpahkan berkat kepada kamu dan menghimpunkan kedua kamu di dalam kebaikkan maksud dalam satu doa untuk pasangan mempelai)))))) waLLAHualam))).. proud to be part of Zahir and Robiah family)))) ALLAHuakbar! dari adikmu: MUNDZIR Dipetik dr NOTES MUNDZIR ZAHIR........
Nape tajuk entri kali ini macam itu??
"Ayyyyaaahhhhhhhhhhhhhhhhhhhhhh!!!!!!!!!!!!!!"
Tak tahu nak cakap macamana sekarang. Geram ke? Marah ke? Sedih ke? hmm...........Tapi lepas berfikir panjang....."Allah knows BEST! Of course we can do it!!" =D
Rasanya kalaulah kakiku ini boleh berkata-kata.......
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