Indecision in Life

                  In this world,there are only two thing thats matter.It is what a man can afford,and what a man can't afford. Still don't understand? Still disagree with me? Let me give you a few example...

A man can't afford to rob a bank, but a man can afford to borrow money from his mom.(like I always do)

A man can't afford to break a rule, but a man can afford to break a rule without getting caught.
A man can't afford car, but a man can afford to tag along in his freind's car.
A man can't afford a book, but a man can afford to borrow the book from the library.
A man can't afford to waste time, but a man can afford to waste time for 5 minute.

or in my case,

I can't afford a hooker, but I can afford to meet your mom.

I'm kidding. I'm kidding. Please forgive me. Although I am an insensitive jerk,i have a good heart (on  average 67 beats per minute)

Chill out.Thanks for reading todays episode of Apple Waffle. I'm Keough and you are awesome.


Side note
Do you notice that today's blog is really small and tiny (like my genital) ? Sorry guys (and beautiful girls) .I am really busy right now...and IMPORTANT ANNOUNCEMENT... I wont be blogging for a while.Huge exam coming on. Yeah,I'm gonna work my ass off or it will be the last thing I do.

If you see a handsome guy in this picture,that's me.

                       

Make Me Happy

               Presentation. Love it? Hate it? We all come through it at one point of our life,in one way or another.Most presentation sucks and damn boring! < High five  > Most of presenter I met,they are gay talk with monotonous tone. Last time I check,human have more than one tone.( Unless the presenter was fcuking alien or have throat cancer).Come on dude,don't make me bored. Don't complain if I fall asleep during your presentation.Blame it on yourself. (in my case,I blame it on the jews) Please make it more interesting so I don't fall asleep.I don't care what you do to make it interesting,put a picture of your gf (not-naked),cute kitten, porn (naked),whatever.I don't care..(or you can just put a fcuking coffee machine in the room)

Even  Saddam Hussein is bored by your presentation

              Don't you hate presenter who gave you a LONG TEXT but fail to stress the important point and fail to make make you understand the subject? The presenter don't give a damn whether you understand the subject or not.They just wanna complete their job with the most minimum of energy/commitment. Their half-baked effort in the presentation is laughable and not worthy of my precious time.I have a lot of mom to do with. I bet watching paint dry is more fun.(or reading Applewaffle blog/awesome-stuff)

Obama  face after he read my blog.

           Another thing that really bothers me is that the presenter talk so-damn- fast.How the fcuk am I gonna understand your presentation if your speech speed is 300km/h.What the fu.. fish?? Did someone replace your mouth with F1 car engine recently?? Are you trying catch a train? Slow down dude. Please give me a chance to understand whatever crap you gonna say. Next time someone present really fast to me,I'm gonna kick his ass (and balls) and scream"THIS IS BULLSHIT!! "

F1 mouth

Thanks for reading todays episode of  Apple Waffle. I'm Keough and you like Justin Bieber multiple orgasm.

Need More Sleep!

               It was any given weekdays.Early morning class. You hate early morning class? what are you? Snorlax? wake up sleepy-head, before I ask David Bechkam to kick your balls. If u don't have any ball,you are safe.There's me with my friend..Suddenly something really dumbstruck me. No,my teacher was not naked! If my teacher was naked, I will surely get severe vomiting,conjunctival hemorrhage and permanent brain damage.What I noticed was ............. 

ALL MY CLASSMATE HAVE EYE-BAG!!??
LOL what the fcuk fish? LMAO  (Laughing My Ass Off)

How come they all got eye-bag?? I hope they dont get eye-bag for the wrong reason such as:
a) play game in their laptop/psp
b) play with your mom hooker
c) watch  porn,anime/random korean drama/movie

Your favorite anime,Naruto

               I'm kidding.I'm kidding. All my classmate are good good people.They must have been studying all night long. I bet some of them even Qiyamullai......like me.Besides,I think eye-bag is sexy and cute.Those who disagree with me,go watch your porn korean drama.(note:don't trust a leng cai like me..i never Qiyamullai before =_='''')  A long time ago,I used to got eye-bag from FaceBook-ing. I blame it on the jews. Cis betul yahudi,apasal buat Fb seronok sangat!

This jews also like Naruto

  

Chill out.I'm Keough and your roommate like it in the ass.

Side note
By the way,a lot of you commented to me face to face,(yeah fcuk facebook!fcuk jews) that i use too much offensive word...
well to tell you the truth, what u read in my blog is the filtered version.The original version will contain 10x more F word.I really trying my best to limit the F word.Thanks for reading this,you all are awesome.
Check out my friend blog. (He blackmail me to promote his blog ) http://haruzato.blogspot.com/

Mark Zuckerberg,founder of FB.He is a jews.

Obnoxious Tale

You see,I just kambek from library.I was hungry,lunch time.Grab Rm10 from my wardrobe/bank,went to my apartment cafetaria.I intend to eat at my room so must use the polystyrene.I fill the polystyrene container with white rice until full.Suddenly,I notice there is a ..............

 
.........strand of HAIR on the back of the senduk nasi...

WHAT THE FCUK FISH??! Nasi beriani i know... but,nasi bulu?? Lancauuu,spoil my appetie already.

  

Since I work  part-time  CSI during form 5,(after watching 20 episode of CSI,u are certified forensic-person)I. analyze the unidentified hair/bulu..I concluded that it is not arm pit hair(bulu ketiak) nor nasal hair..coz very long,16 cm..so must be..................PUBIC HAIR?? Just kidding,of coz la normal human hair..unless big-foot cooked the rice.

I feel sorry for those who eat lunch at that kafetaria.


To celebrate my 5th day blogging,I give you special bonus.Mr Muthu,drum role pulisss...

< insert drum role here >

INFECTIVE ENDOCARDITIS NOTE!!! I know my classmate/lazy-ass-person dont read about Infective Endocarditis. They never read before class....Luckyly,Dr Keough is here to make you a good doctor like him ..
your welcome..your welcome...oh no..puliss don't kiss me,i dont want your STD..
by the way,It took me 2 hours to complete typing this note,my finger's bone is breaking alrerady,arghhhh!! *jump off the building* 

Chill out. I'm Keough  and your BF like suprise-butt-seks.

(ladies ,pls don't thow slippers at me )

INFECTIVE ENDOCARDITIS (IE)

Braunwald's Heart Disease. Saunders Elsenvier 2008

Introduction

characteristic: Vegetation

vegetation
variable size amorphous mass of platelet and fibrin with abundant enmeshed mircroorganim and moderate inflammtory cell.

site
heart valve -most common
on septal defect
chordae tendinae
mural endocardium


Acute IE                                                                        Subacute IE
Typically by Staphylococcus aureus                      typically by viridan streptococcus
mark toxicity                                                                   mild toxicity
days to week                                                                weeks to month
metastasize infection                                                       rarely metastasize


Epidemiology

more common in man    2:1
median age: 47-69
risk factor
IV drug user
degeneratve valve desease in elderly
intracardiac device
hemodialysis
helath care related(nosocomial infection,central venous line,catheters) 5-29% of IE cases


ETIOLOGICAL MICROORGANISM

Staphylococcus aureus-major cause in all population
Viridans Streptococci- 30-65% of IE related to IV drug abuser
                                    -normal flora of oropharynx
                                     -susceptible to penicillin..Kill it with penicillin+gentamycin

Streptococcus bovis-normal flora20-40% cases of native valve IE (native valve=non-prosthetic valve)
Enterococci- not common-kill with penicillin+gentamycin or streptomycin
Fungi  - Candida albicans

PATHOGENESIS
  

microorganism gain acces to the blood 

          |

adhere to valve surface 

|

proliferate to cause local damage and vegetation growth

|

disseminate hematogenous;y with or without emboli

#Bacteremia is a common thing but only not all develop IE.IE is rare because intact epithelium is resistant to infection.Platelet-fibrin deposit only at 

1.abnormal valve

2.injured/inflammed cardiac epithelium

the place platelet-fibrin deposited is called NBTE

(Non Bacterial Thrombotic Endocarditis)

NBTE is coz by: 1) endothelial injury

                      2) hyperocagulable state

Endothelial injury is cause by 

1..blod flow across narrow orrifice,

2..high velocity jet striking epithelium 

3..flow from high pressure chamber to low pressure chamber

NBTE become IE as a result of BACTEREMIA 

fibronectin    

produce by endothelial cell in response to injury

receptor of fibronectin is available in surface of S aureus ,viridans,streptococci,enterococci,S.pneumoniae,Candida albicans.(so can adhere to endothelium)

PATHOPHYSIOLOGY

clinical manifestation is cause by

(1)  local destruction effect of intracardiac infection

(2) embolization of bland or septic fragment of vegetation resulting infarction or infestion

(3)  hematogenous seeding of bacteremia 

(4)   deposition of immune complex

Effect of local destruction

1. destroy valve

2. distortion or perforation of valve

3.  rupture of chordae tendinae

4. fistula between major vessel or chambers (causing progressive Chronic Heart Failure )

5. Abcess-causing purulent pericarditis

6.distrupt electrocardiograph condution-causing arrhythmia  .

Large vegetaion can cause valvular stenosis.

CLINICAL MANIFESTATION

Symptom                                                 Sign

fever                                                       fever

chill                                                        murmur

sweat                                                   regurgitation murmur

rigor                                                    embolic event

Anorexia                                                spleenomegaly

Weight loss                                              clubbing                       

malaise                                                     splinter hemorrhage

dysopnea

Cough

Stroke

headache

nausea-vomitting

Chest pain

myalgia/athralgia

DIAGNOSIS

LAB TEST

-anemia,normochromic normocytic RBC (maybe absent in acute IE)

-low serum iron

-leucocyt   -subacue IE-normal

                 -acute IE-elevated

-ESR increase (except if patient have CHF,DIVC and renal failure)

-urinalysis: 50% cases of IE have protienuria and microsopic hematuria

TREATMENT

Two objective

• remove infection-antibiotic
• correct destruction in heart-surgical

 

 

Happy Love

I miss my first ex-gf.I swear to god she look just like Song Hye Kyo.That b*tch from korean drama Full House.

  

I'm a sucker for Full House.

We we're so happy together for three years.Until I decided to break our relationship.Yes,fcuk me.She was miserable for 6 month until she finally get over the big break up.Actually I never really stop liking her.But she already goin to get married next year.What a heartbreak.I ask myself," Do I want to remember my happy life with her or i want to remember the sad life with her?" I believe god want me to be happy so I will cherish the beautiful moment I have with her.The sad part can go away and join Pakatan Rakyat. I would like to quote a poem made by a friend-of-mine,her name is Daisy/future-Miss-Sabah :

But finally came kindness,

So warm and dear;
Never asking for anything,
Unconditionally clear.
And last there was love,
So warm and true;
A gift from God-
To me and you!

oh fcuk..I'm pathetic...I can't move the fcuk on.She will always be a part of me.So the moral here is don't be a sore loser like me.Go find another b*tch.

Remeber,b*tches,they come they go.

(all ladies in Malaysia throw slippers at Keough)

You now must be so boring oledy to hear my rant/random-crap..ok lar...here's a joke for you..

So you got a Commando,a Navy soldier and.............................  Mat Rempit from Puchong.

The General hand over each of them a gun and says "  Your spouses is seated next door (Mat Rempit oso can kahwin)  in a room on a chair.In order to pass this test you must go inside and kill them". Immediately the Commando says,

" No sir,I could never kill my wife,I  can't do it"

General look at him with a face of angry lion and says "You know what,You ain't got what it takes.Take your wife and go home.Navy soldier then head in, 5 minue later kambek(come back)-tears strolling down his face,

"I tried.I tried. I tried. I just can't do it.She look so beautiful in the chair.I can't do it"

General look at him with a stern face and say" You know what,you ain't got what it take"

Finally,the Mat Rempit from Puchong.Stroll into the room with a swagger.

BLAM!! BLAM!! BLAM!!

Shot rang out!There's banging.There's screaming.But suddenly,everything goes silent.

General say,"W-what the hell happened inside??? "

Mat rempit screams back, "The damn gun had peluru kapur in it,so I had to beat her to death with my BARE HAND!!"  (hahahaha XD)

Chill out.I'm Keough and you are awesome.

p/s:please check out Daisy blog: http://dcdaishie.blogspot.com/

Ah Pek go to Clinic

                Ah Pek is an old chinese man. manyak tua oledy.60-something.He is a known diabetic.Eveliday he drink teh tarik,confirm kena diabetic one.Summore he oso like eat sweet-sweet food.In the night,when his larling wife sleep,he diam-diam eat apollo and ice cream.

                 Ah Pek got appointment  for regular check up.He wake up early-early,wear pasar malam nike shoe and go to Dr Keough Family Clinic.Doctor Keough read Ah Pek past medical history beforehand,becoz he is a good doctor.(Not like you,so lazy,go to  Dr Ramzi's class not read before class).

wait wait,i show you my pic

The leng cai in black suit is me.Yes,evelibody say i look like Dr House if i remove my glasses.On my right is my girlfriend,Dr Cameron.The others is not doctor but medical student,notice I have one student from Nigeria.

Dr Keough     :  Uncle arr..lu ada kecing manis ar?
Ah Pek           : Saya kencing manis tak ada..tp darah manis ada..banyak gula
Dr Keough     :  =_='''''''

Ah Pek           :  Dr keough...dulu saya makan,satu mangkok mee sulah cukup...sikalang,selalu                 
                          mesti mau  mkn  2 mangkok,balu kinyang,apa pasal arr?
Dr Keough      :  Uncle,lu kena mkn untuk 2 org...itu pasal 2 mangkuk
Ah Pek           :  Saya talak mengandung,apa pasal 2 mangkok?
Dr Keough      :   satu mangkuk untuk Uncle....
                        satu mangkuk untuk........................ CACING
Ah Pek           :    =_='''''


 Chill out.I'm Keough and you are a lazy ass.

Where is the volume button?

My classmate and I  stand in a line.Why are we standing in a line? Are we trying to form a nasyid band?"

My classmate and I  are so afraid, much to even utter a single word,let alone a syllable.What are we so damn afraid off? ? Are we facing a firing squad?

Well my friend,if you answer Nasyid,you are wrong,I don't do nasyid,I only do pole-dancing.
If you answer a firing squad,again you are wrong.Well my friend,what we face is 10x more horrifying than a Justin Bieber multiple orgasm.We have a class with Prof Ghassan,everybody favorite lecturer . But let's call him "Your Father"

I rather face a firing squad then have class with your father

You see,Your Father come late for class.At the beginning of the class,he talk so soft.I couldn't fcuking understand what he is mumbling about.I can't decide whether he is half talking to himself or whispering to an invisible hooker.Why I suddenly feel the urge to smack his head repeatedly with a megaphone?Did I mentioned that Your Father is bald? I could almost see my reflection when I stand behind him.

Chill out.I'm Keough and you are awesome.

Adopted Bastard

       Everybody love fast food.(High five~ !! ) My friend/Sexy-lady work in a fast food restaurant, McDollah.Do you know that cashier at McDollah stand for 10 hours??What the Fcuk?I bet even soldiers in army didn't stand for 10 hours.I can barely stand for two hours. Those McDollah cashier must have titanium leg or something.Sexy-lady,I salute you,now give me Double Chesse Burger before I sell your damn-metal-leg to random metal dealer!!

        I met this guy who looks just like Orlando Bloom with mole, of Phua Chu Kang. Beforw you ladies go drooling over this guy Phua Chu Kang's mole..eh wait...am I the only one drool over Phua Chu Kang?you like Orlando Blooms?? Never mind.This bastard,let his senile 60years old-something mom....... 


STAND for an hour....

......while he sit on the only available chair.How can he let his own SENILE mom stand for an hour??I bet he must be  adopted,to have the heart to torture his mom likedat??.Ah Boy,what do you think??

Ah Boy : lanncauuu punya olang..

Thank you Ah Boy for your comment,teh tarik roti canai on me.I bet that senile-mom could get a job in McDollah coz she can stand for so long.LMAO

That bastard is Malaysian Orlando Bloom

During my class,my friend/pan yao  have to interact with this old man. Try to understand the situation

Pan yao age : 21
old man age  :  68

During the whole conversation between pan yao and old man,pan yao address this man as abang instead of PAK CIK.Dude,are you blind?That guy is fcuking 3x older than you.You called him abang?? What the Fish??Are you freaking married to him or something to call an old man "abang"?Seriously dude,if i were a gay,i pick more awesome partner,like Morgan Freeman.hell yeah,high five~~ ehh..??why you all,staring me likdat,who would not love Morgan Freenman meh..

Chill out.I'm keough,and your sister like to date me.





     



  

First Step

A chinese proverb once said,actually i know the guy,the guy is Conficius.Conficius/my uncle once said

"A journey of a thousand mile start with a single step"

So,this is my first step...towards blogging~~ Hurray!! <throw much confetti>

one of Apple Waffle Industry worker throwing confetti

        I got the idea to start blogging after i see my friend's blog.It was like,if she can write this crap,i could do better.Well,I'm not saying my English is good.I'm just saying i could do better than her/his blog.Besides,even my sister Fiera also blog.But she x blog interesting stuff,just her normal2 average life-thingy.(don't kill me Fiera).Yeah,like i can write interesting blog,i probably rant more than any other bloggers =_='''

         Right,moving on.When i register for a google account to start this blog,it say that i need to verify my account and they need my phone number to give the verification code.(if you don't know what i'm talking about,skip this paragraph.)I was like "there is no way google can send me a text msg".Then suddenly,i DID RECEIVE A TEXT MSG FROM GOOGLE.That really totally freak me out.I was like omgwtf? Technology these days,never stop to wonder us.Yes I was totally amaze by that.


       I did what you could not do in a million years.Yes,you.I'm talking to you.The person reading this blog/awesome-stuff.The following revelation might be disturbing with the general public.Viewer discretion advised.Im giving you 5 second to prepare yourself for the horror.


Ok? Ready?Aiya,still not leady meh? Don't care lor you ready or not.Mr Muthu,drum role puliss.

<Insert Drum role here>
..........................
...........................
.............................
I DELETED MY FB ACCOUNT

..and Im proud of it,I don't want my (fcuked-up) life to be control by FB no more.I'm free!!
I used to be FB-holic/FB-addict/very-handsome-person.But now i come to my senses (got 8 of those) and realize I COULD LIVE WITHOUT FB.But i sure miss this girl named......err...just let call her miss sex-slave/porn-star.

I sure hope my mom doesn't read my blog.

Chill out! Im Keough and i like to do it with your mom.