Late at Seven

Between Tiger Meat and Inhaler

2008-07-05T19:59:00.003+08:00

While I was doing my morning ward work one day, I overheard a visitor talking to the patient's mother:

" I think tiger meat is good for asthma. That what I heard from my friend."

" Yeah? But tiger meat is hard to get. You have to look hard for it, and I heard it is pricey too."

" Otherwise, my grandparents used to serve me crocodile meat when I had asthmatic during childhood. It does cure my asthma. Until now, I never had any attack."

Common cultural practice and medicine is inseparable. As a doctor, you can't stop the patient from practicing what they believe. You can only suggest, but you can't decide for them. Tiger meat, crocodile meat, squirrel meat, termites and even the human placenta are still being use as a treatment modality for bronchial asthma. Do they have a role? Certainly. Do they have efficacy? I am not sure.

Generally, the traditional medicines are cultural bound, passed on from generations to generations and believed to be effective in a way. They are not clinically tested to show their efficacy. The rarer the item, the more therapeutic it become. When does the traditional and modern medicine cross their path? Generally none. We can't force people to take our advice. We can treat a person unless the person want us to treat them. If they take only tiger meat for asthma and be cured of asthma, good for them. It they come in with asthma attack and request for treatment, we will still accepts them the same way.

Everyone has their choice, this I have to constantly remind myself, so not to impose my own value on them.

Doctor, how is my daughter?

2008-07-02T21:24:00.004+08:00

"Doctor, how is my father/mother/brother/son/daughter/neighbour's uncle's friends?"

This is the single most asked question I faced during ward rounds and especially visiting hours in the ward. And the most irritating one as well.

If you answer only once to the above question, it's perfectly well. However, when the second visitor come to take shift, they ask the same question again. And then come the third shift again, then they asked again, and again...

Generally, I would predict the worst for the family members. "Oh, your daughter, her condition looks grave. She might need surgery. But everything is 50:50. We can't guarantee her to be 100% perfect after the surgery. She might need Intensive Care support and ventilator after the surgery."

Why would doctors generally do so?

We were generally on a VERY TIGHT schedule. I wake up 5.30 am in the morning, reaching the ward by 6.30 am, start working until 7 pm. On on-call days, the working hours will be till the next day, non stop.
We are generally overworked and underpaid. On top of that, the ministry had slashed 50% of my Cost-of-Living Allowance (RM 100) and 100% of my Housing Allowance (RM 250)for a shared triple room per month. Others get a single room with nice and clean bathroom. Imagine, RM 1050 (350 x 3) for a room that is so horrible?
Patient conditions varies by day. No one will remain the same for the same period of time.
Some family member taking advantage by showing their filial piety by using doctors. Scolding doctors for not doing what they think is doctor's job or not doing fast enough.
There is no simple data to what the prognosis is. Everything is calculated based on 50% of the patients with the same illness. And there can be no same patient in this whole wide world.

What you can do to help the poor doctor:

Please keep your relatives informed about patient's general condition. We will help to bring updates, not to start storytelling one by one.
No BS in front of the doctors. We shall know who is the real and who is the fake.
Help doctors to help your love one. Let us do more important things to help your important persons in life.

We can't work alone as doctors. We need collaboration from all area. So please help us. Help me.

OCD: When Heart and Mind are not Functioning as One

2008-03-18T09:03:00.003+08:00

Have you ever have a feeling that you need to go and check the car, strong urge that it wasn't lock, only to find out later that it already was?

What about waking up in the middle of the night, fearing that you didn't shut the gas stove properly, and the thoughts keep on haunting you until you need to go and check it?

What about having all this symptoms, but en core over and over again, say, 10 times until you exhaust yourself? This is what an Obsessive-Compulsive Disorder person is going through.

Let me share a story:

Mr. Garry, 38 year old gentleman, assistant research personnel in a well known company, married for 15 years with 2 children. Since his teenager years, he started to experience excessive worrying whenever he is stressed out or under pressure. At times, the symptoms worsen until he felt like ' going to die'. With the attack, he heart beats faster, and he feels suffocated, out of breath as well. He tends to avoid crowded places whenever possible and seldom like to adress in front of his colleague. He is afraid of 'losing control of himself'. Generally speaking, his functions deteriorate with the symptoms. He smoked cannabis in the teenagers years but denied sharing habit now.

This persist until 8 years ago, his wife noted he starts to act strange. He would drive his wife to school everyday, but halfway through the journey, he would turn back to go and check the door again. This does not happen only once, but up to 7 to 8 times in a day. Halfway though work, he also can't fight the urge to go back and check on every electrical switch and gas stove. Subsequently, his wife is always late to school; the employer in his company aren't too happy for his absence from work. Despite knowing that the door is lock, there is repeated intrusive thoughts of not locking the door and internal urge to go and check again. This problem has worsen the relationship between he and his wife.

His problem came to medical attention when he went for a general practitioner, who subsequently referred him to a psychiatrist. Proper assessment of his problem was done and a diagnosis of OCD was made. He was given medications and behaviour therapy. His symptoms improved but there is still some degree of checking behaviour. So he device a method: using his phone, he took photos of the lock, the electrical switches and gas stove before he left. Whenever the thoughts came back, he would just check at the photos. Brilliant!

There are a few types of obsessional behaviours.

Obsessional (O.) thoughts is the repeated thoughts that intrudes the patient and patient will try to exclude them, labeling them as unreal. This differs from delusions, where patient entertains the thoughts and believe them as real. Furthermore, you can't change their false beliefs.

O. images are intrusive pictures, usually obscene and related to abnormal sex practices.

O. rumination is the internal debates that keeps on going on and on.

O. doubts is where patient have repeated doubts on locking the door or turning off the tap.

O. impulses is a form of urge to perform a violent act.

O. rituals are repeated senseless activity.

O. phobias is fear that one would loss control and harm someone else.

O. slowness is the recurrent thought that eventually leads to the slowness of the person.

The aetiology is believed to arise from genetic factor, organic factors and early childhood experience. Family members with history of OCD running among the members will have higher risk of getting OCD. Organic factors refers to lesion of the brain, medication or drugs used. and early experience that shape a person's personality is thought to be important to the development of OCD.

Treatment is by avoiding the rituals, medications and behaviour therapy. This disease is usually recurrent and requires long term treatment.

DA Blues

2008-02-03T13:08:00.000+08:00

Developmental assessment (DA) has always been a crucial part of learning in paediatrics. You will never be complete in paediatrics if you do not know about DA. It is single most frequent task to be asked during our short case examination. Even a post-graduate student can fail their final clinical exam when they fail this DA.

DA is easier said than done. It requires the full cooperation with the child. If the child mood is not good, you can imagine what will happen then. It is like a minefield waiting to be stepped on. If the child cries, we won't be able to finish the assessment, hence the examiner will penalized us.

This week, I was at home for my Chinese New Year break. Exam is scheduled to be next week, so there are a lot of things to practice. Naturally, my nephew is the good practice candidates. He is about 3 years old, very cute and active little chap. Now he loves scribbling and drawing and he kept a book for his drawings. Mostly were pointless scribbles, but there was a page that caught my attention...

At 3, he was drawing a man already! The features of his 'man' are a big round head,with 2 eyes, a nose and a mouth. The torso and limbs are sticks. What amused me is that he must add in a 'penis' in every man that he drew! The reason? The man need to pee!

Drawing a man is usually started at 5 years old. There is always give and take in assessing the developmental status. DA has four parts: Gross motor functions, fine motor functions, visual and speech and social behaviours. Some children has slower aspect of certain developmental status than others, but eventually most will catch up. Most importantly is adequate stimulations from the parents and caregivers.

At this point of time, he is able to speak 2 languages fluently, which is mandarin and malay, thanks to the maid. Stimulations from the start will ensure a good developmental status! Keep on stimulating, guys!

Life in an Incubator

2008-01-31T21:34:00.000+08:00

It's just a norm! We human will not appreciate certain things around us when the things are aplenty. We take things for granted. Here I want to share 2 stories:
Last week I was posted into the Neonatal ICU, and I was taking care of this little life. He is just a premature boy born at 26 weeks (a normal pregnancy would go to 40 weeks, he is 14 weeks short!). Weighing just a little bit over 900 gram, he has a dark complexity and a body covered with fine hair (lanugo). He is slightly bigger than my palm. There was a respiratory machine hooked up with countless of continuous monitoring going on in him. This little soul was moving his tiny hand when I first saw him. Every breath he took seems so full of effort and every minute passed is a blessed moment that he is still alive. Although he had a number of complications from being very preterm, the will to survive is very strong.
On the contrary, I have a friend that had quited medical school just at the dawn of the final examination. Heard that medical life was not his thing and that he will never walk down this road again. It was a shock to all of us as a friend as the move he took was drastic. Everyone was screaming that this is a very big waste. Alas! The life is his. Whatever path that he chose to take in the future, I just wish him good luck and he will find his way someday.
Someone is letting go, yet someone is striving very hard to live. This is how contrary a life can be. Hope you found your way.

Hunter's Hunted

2008-01-25T23:58:00.000+08:00

I write this post as a tribute to a young little soul that had laid to rest in peace earlier this week.

In paediatrics, students are trained to do a quick but thorough general examination as that yields the most findings and guide our further examination. Most of the time, we like to divide the patients into 'syndromic' facies and 'non-syndromic' facies. So one fine day in Teluk Intan, I came across this boy, with a typical 'syndromic' facies. I couldn't make out what syndrome he has, but generally, he looks too small for his age. There were abnormal movements as well. He loved to do 'scratching' activities, which is purposeless from my point of view.

The main reason that he came in was due to pneumonia. He had multiple episode of similar illnesses in the pass, according to his sister. As usual, when we as student do not understand certain things, we go straight to the case note. He had what we called a mucopolysaccaride metabolism disorder, leading to what we called as Hunter Syndrome. That raised further questions to me that night, as I never heard of this illness before.

Usually, Hunter Syndrome is a progressive illness with no successful therapy so far. The victims will live up to adolescent or late teens and usually die of the complication of the disease. This is one of the rare illness that we don't want to get. Maybe that is why he succumbed this time. I talked to the mother before, she was already in the stage of acceptance before the child passed away. She said it will do both of them good, as he doesn't need to suffer any longer and the parents can concentrate on the other siblings. So she opted not for intubation in case her child fails to breath by himself and refuses any artificial ventilatory support.

When the child was gone that day, the mother cried her heart out. The whole family cried for his loss. That makes me think again. No matter what the mother opted for, I will support her decision anyway. They were the one that faced him everyday. Sometimes, there were no right or wrong answers. There is only choice. With any choice made, we sacrifice certain things. What matters is how big the price we pay. when we earn something, we will give up something. Isn't that the way of life?

I just hope that this boy found his lasting peace. Sadhu.

Neglected Child

2008-01-19T15:48:00.000+08:00

Last week I just came back from a district hospital in Perak. Nothing great about this hospital, just a small facilities to serve the local population. Doesn't even have a CT scan machine. I was posted to paediatrics in that hospital for a week.

The patient populations mainly from the lower socio-economic status. Mostly are children of estate workers, lorry drivers and fishermans. However, there was one little girl that caught my attention...

She was admitted on Tuesday. She was about 8 or 9. Short-haired, dirty ragged shirts and worn shorts; the first look give me the impression that she is a boy! She had a very red lips. Generally, she looks undernourished. There were multiple healed scars over the shins. She was crying frantically and the father threaten to throw her into the ditch. OMG. The father was a middle-aged man, dark skin and was having walking difficulties evidenced by his walking sticks. Mother was no where to be seen. A closer up with the father revealed nothing much except that this is his daughther. He didn't even know whether she was born full term or not, vaginally or through caesarian, and what illness that she is having. So I checked out the case note. She was a case of dengue fever. Not quite... Further down the page, there was a segment mentioned that she had a heart surgery done in Institut Jantung Negara (IJN). They were supposed to be followed up in IJN, but the parents did not able to make it due to extreme financial constraints.

This poor girl had a hole in the heart that requires a 2-stage surgery. Yet she had only completed first part and the second part was already long due. So I examined her. Heart was not only enlarged, there was also cardiac murmurs. She was in cardiac failure but not taking any anti-failure maedications. This is like a time bomb waiting for the moment to come... Furthermore, she had sacral agenesis, most likely due to mother having uncontrolled diabetes mellitus when she was pregnant. Subsequently, she is not toilet-trained till now. There was walking difficulty as well as both her limbs were stiff. In fact, she was not able to attend the elementary school for this reason, despite already 8 years old.

She had 4 other sibling, 2 already given out as adoption to some other family members because the parents weren't able to rear them. Now left with an elder brother at 13 years old. The brother loved the sister very much. They slept in the same cot together (despite not able to fit both of them together) and the sister seems much happier when the brother is around.

Father had accident a year ago, left him with weakness and was unable to work as fisherman. Instead, he is doing some odd job now. The income shrink from RM 1500 a month to RM 250. Mother is a housewife. They received a minimal monetary support from government for their daughther, for about RM 190 a month. How can a family live a decent life with just RM 440 a month? To add on to the problem list, the mother is also currently a diabetic which was not on any treatment.

I can't help myself thinking, what if she was borned in a different family, will she end up becoming like this? For the least, the parent can bring her for follow up, and she might not end up having a heart failure. I don't know how is her diet, but what seems clear was she was not eating enough and well. Just few hundred km away, a girl who was loved, cared so much but was being abducted by some sick paedophiles. The whole nation is on a lookout for this child. If this patient is lost one day, will her lost even be noticed by the parents? I doubt that a search party will be conducted to look for her as well. After all, she is just a poor child borned in a wrong place at a wrong time.

More Than a Cageful of Tears

2008-01-09T21:08:00.000+08:00

Here I am again. My story never ends, or rather my agony never ends. That day, everything seems like a turning point for me. That day, one fine couple came and see me. Immediately they had fall in love with me. They were saying something like 'adopting' me. I was over the cloud nine. How I wish to have a family, to call 'papa' and 'mama' when I learn to speak one day. Some one would care for me, caress me, hug me and play with me.

Alas! Everything was like a dream.

Being born prematurely into this world, it has taken toll on my body. Some part of my system is imperfect. Few weeks back, I don't know what the 'big people' are talking about, but I overheard that they want to do something to my body. Something like 'surgery'. Something like putting me to sleep and then open me up. That idea sounds scary. What will happen to me then? But don't harm me, please!

That night, an angel came to me and spoke to me. She said the family supposed to adopt me changed their mind. This is because I am not perfect. She said I need to be brave. To endure what lays ahead. And I need to be strong! I cried that night. Knowing that the fragile dream is already broken to million pieces, I am back to square one. Again, I ponder this question. Being born like this, is it my mistake? Why I am subjected to so much of human cruelty? Why am I being so unwanted? The angel left. Again, I went to sleep with all the questions unanswered.

Obesity and Adiposity: Friend or Foe?

2008-01-03T21:44:00.000+08:00

People are in denial, I am also in denial. Obesity... it is always a weighty issue. Whenever climb onto the weighing scale, the mood of day can change. If I indulge in something good previously, I will cautiously check the scale, fine-tune the '0' mark and then only weigh. If the weight just maintained, I would be very happy. On the contrary, if I add another precious kilos onto my already 'heavyweight' frame, the following days will be dreadful.

Why are people getting obese? As far as I understand, the body weight is maintained by a balance of input and output. Input is from what we take or drink. Output is the energy expenditure. Obesity occurs when the balance of input is more than output. Too much input occurs when we overeat. Too little output means we lead a sedentary life style, working 9 to 5 in front of computer and is a potato couch. Simple explanation, rite? Not so...

Our desire to eat is govern by a complex brain activities called the satiety centre and hunger centre. Long time ago a bunch of scientist did experiments onto mouse; first they destroy the part of the brain believed to be satiety centre, thus the mouse always in hunger and no end to eating. In the end, they produced a super-obese mouse (pity the mouse). Based on the concept, some slimming medications were created so to decrease our desire to eat, which are of amphetamine-based.

Genetically modified mouse that knows no satiety.

Furthermore, our eating habit is also governed by our mood. We overeat when we are happy. During festivals, we (over)eat to celebrate. When we are sad, eating sometimes help to calm the mood and sooth the nerves. When we are promoted, feast. When we are demoted, compulsive eating. Chinese New Year, bigger feast. Our life has been surrounded by this concept of live to eat instead of eat to live.

The simplest method to determine whether you are simply overweight or obese is using a body mass index (BMI) calculation. The formula is:

BMI = (Weight in kilogram)/(Height in meter x height in meter)

For Asians, the body fat is more compared to Caucasians in similar BMI value. So we adopted a lower cut-off point for BMI. Normal range would be between 18.5-22.9. Below that is underweight. Overweight is a general term to grade a BMI more than 23. For a range of 23 to 27.4 is considered pre-obese. 27.5 to 34.9 is Obese Type I which has moderate heart and diabetes risk. 35.0 to 39.9 is Obese Type II. More than 40 (Obese Type III), you are running into a very high risk for all the disease of the rich people.

Other method of measuring cardiovascular risk is by taking a waist circumference. For men, the risk is increased when WC is more than 85 cm whereas for women, it is more than 80 cm.

So, Now you know where you stand. How do we tackle the problem?

Determination. Do you feel like you want to have weight loss? What is your target weight? How much to lose in how long a period? What method to achieve weight loss? If you have no answer to all the questions above, you are not yet ready. Buckle up, my friends. Determination is the first step to success and to maintain weight loss.
Keep a food diary. Record what you have eaten over 24 hours. Include all the main meals and snacks. Be honest to yourself. This will ensure that you aware of what you are taking, and not to be excessive.
Regular exercise. No one can help with this except you. As mentioned above, you need to have good output, so to tip the scale to a negative balance. Exercise for about 30 minutes for most days in a week. Studies shown that exercise help to makes you feels better, not to mention healthier as well. Some mild degree of hypertension can actually be controlled by exercise alone.
Food intake. Although some fad diets claim to help achieve weight loss, I personally don't recommend them. Stick to what is easy to attain, cost-friendly and most importantly, palatable. Don't try out fancy fancy stuff that in the end you cannot stick to your plan and all equal to zero.
Drugs. There are various types of medication used, but I will only discuss a few. First type is Orlistat, which is able to decrease absorption of fat from alimentary tract. Next types are appetite suppressant such as Sibutramine and Phentermine. Sibutramine not only reduced the appetite, but also help in increasing the metabolic rate. However, the use of this medication in hypertensive person must be cautious. Phentermine is amphetamine-based medication which has side effect of increase blood pressure and insomnia. Otherwise, medications that was proven to be ineffective are cellulite treatment, dietary supplements such as chitosan, fibre capsule and herbal preparations. Laxatives like slimming tea should not be used because of ineffectiveness in treating obesity. Usage of amphetamine, dexamphetamine and thyroxine is dangerous, and should not be used at all. Please consult your doctor about the choice of treatments.
Surgery. It is reserved for severe and morbid obesity where reduction of 50 to 100kg is required. Type of surgery includes gastric reduction by doing a vertical banding of the stomach or inserts a constriction bands around the stomach. Other types includes gastric bypass, which is to shorten the gut and induced malabsorption. Liposuction is not for generalized obesity, but to help getting rid of local fat or for cosmetic reasons.

Always ask for help. Ask your doctor about options available. They should be able to help you. You are not alone.

Doctor Shopping: How Good Is It?

2007-12-23T23:56:00.000+08:00

At the time of writing this post, Malaysia is having a Year End Sale. It's near Christmas holiday and now is school holiday. Every shops in town is throwing crazy deals to attract customers. I had to admit, Malaysians love shopping! If you go to any of the big shopping complexes now, you will face with huge crowd. Even parking your car also is becoming a problem. These kind of shopping promotes growth of economy, and help Malaysia building a stronger nation, but I am going to discuss about a kind of 'shopping' phenomena that will affect the nation. It is called 'Doctor Shopping'.

Basically, 'doctor shopping' does not mean doctors going out to shop. No. It means you and I, people that goes from one doctor to another doctor to get treatment. I will tell you how it cause negative consequences on you. Before that, I want to share a case:

I had a young patient about 4 months old, that came in with shortness of breath and fever for 1 week duration, which is worsening until she cannot feed. So naturally, the anxious mother brought her to the emergency department and the baby was then admitted. Upon history taking,I found out that prior to this, the mother had brought her daughter to a general practitioner, lets say Dr Ay, on day 2 of fever. Dr Ay had prescribed her some medications includes antibiotics type P and paracetamol. So the baby was on this set of medications for 3 days. The symptoms of fever and shortness of breath was not improving, but all the way worsen. The anxious mother became more anxious. Naturally, she thinks Dr Ay sucks, and the medication was not effective, thus losing faith in him. Since she had 'discharged' Dr Ay, and then seek for another Dr, let say, Dr Bee. Dr Bee, without having any knowledge that she already went to Dr Ay and received some medications there, manage this poor child with another set of medications that include antibiotic type Q and also some paracetamol. The mother gladly stopped the antibiotic P and starts taking antibiotic Q. 3 days down the line, the fever and shortness of breath not only worsen, now the baby can't even feed at all and had to be admitted to the ward.

This is what usually happens in Malaysia and I have to emphasis that it is not right! First of all, medicine starts with trial and errors. Even the best specialist also based on this concept, albeit with better percision and less hit-and-miss. No one knows a diagnosis of certain illness, we can only make our best guess aided with some examinations and investigations. However, if the first arrow miss the mark, we have to change the diagnosis. This will only happen if the patient have follow up and came back to us for progression. That is how things goes. In above example, the mother should bring he baby back to Dr Ay for follow up because Dr Ay knows her progress of illness and what to give subsequently. Instead, the mother brought the baby to Dr Bee, who had started the trial and error cycle again. Worse still, there were no knowledge of the child being partially treated with the medications.

Subsequently, it will lead to what we called as multidrug resistant strains. This is what happens: when one person is having an infection and was on antibiotic A, the antibiotic will react to kill the bacteria. However, antibiotic requires few days to reach its maximal actions, usually 5 to 7 days. Less than that, it will only partially kill the bugs. If we stop the antibiotic before its maximal activity, the bugs will react by creating new genes that is able to withstand the antibiotic, subsequently leads to failure of the antibiotics. Once it had fight through several types of antibiotic, a big problem starts. Currently, we have few antibiotics left to fight these 'superbugs' and there are more and more 'superbugs' emerging due to inadequacy of treating the infection. Once the bug is resistant to all antibiotic, there is no way to fight the infection.

Back to the baby, she had developed pneumonia. Since she is partially treated with antibiotic, so we have to hit with a stronger antibiotic, to prevent the emergent of the resistant strains. This leads to longer hospital stay, increased medical cost and disruption of family dynamics. 'Doctor Shopping' is a bad habit of Malaysians that requires change, for a better health care tomorrow.

Alternative Medicine: The Good, The Bad and The Ugly

2007-12-22T23:35:00.000+08:00

I am always a bit jittery when someone asked me:" What do you think of this product X? Is it good for my diabetes? Because I heard my diabetic medications will shrink my kidneys, is that true?" This sort of questions always pop up if I went back for Chinese New Year celebrations, where the uncles and aunts will start to pull out their supplements and ask me the benefit of it. Some of them are selling the products and sort of ask me to tell them whether it benefits them in certain medical conditions or not. If I started to say something, they will quote and make me reassure their product is safe and effective. This is like a free ads. So I choose not to comment.

But silence for too long is not good... Long before the emergence of modern medicine (or Western medicine), people use to seek healers in the past for all sorts of ailments. The principle of treatment includes chants, herbs and offerings to God. This kind of treatment had rooted deep into our Malaysian Society. Among the Malays, they will go and seek the bomoh for their ailment and Chinese will go to the Sing Seh. Sorry, I do not know about the Indians. It had been the basis of treatment until the arrival of modern medicine. So it is not uncommon to see a patient that went to a doctor as well as seeking advice from traditional healers.

Throughout evolution, the Western medicine improves in leaps and bounds. With the discovery of new investigation tools, new drugs, new antibiotic for treatment of bacterial infection, and new technique of treating illness, there is booming of modern medicine. But the core of the treatment remains the same. It is still evidence-based medicine.

Generally, we do not say no to patients who takes alternative medicine. Some supplements are good. We even prescribe supplements to patients such as ginko biloba for memory, vitamins and so forth. But I am sick of people making 'claims'. 'Taking this product and I guarantee you no need to take anymore medicines' ' Why taking the pills when you can have something natural to cure your illness?'

First of all, you must understand the illness you are having. How the disease affects your life and how to overcome the disease. If it is going to be long term, there is absolutely NO way to cure by just 1 dose. Understand how the medications given by the doctor work. Ask questions to your doctor. If someone promote you a product, ask them what medication is that, and how the medications can help you. Ask yourself, do you need to take it? Is there an indication for it? Are you able to pay for it? As most of the 'natural' stuff are expensive while it is readily available, do you really must take it? Ask them to show proof. Proof on how the medication works and what are the side effect of taking it. If the proof is based on an opinion, most likely the resource is unreliable. In modern medicine, we tested our medicine with randomized trials and continuous experiments. It is released to public only when it is found to be safe and effective. Even when released, if the drug found to cause certain side effects, it will be withdrawn.

What about those wonderdrugs that can cure all types of illnesses known to man? Whatever condition you have, just take the wonderdrug and you will get cure. Are you sure? Just think, if there are such a wonder drug, wouldn't the pharmaceutical company had already research it and used it to help mankind?

One piece of advice: Do consult your doctor before taking any medication outside the prescription if you are taking long term medications. Some drugs will interact with the other, causing the effect to be less, or become toxic. My professors used to tell us, they had done research on the raw tongkat ali (Eurycoma longifolia) roots found in the road-side stalls in Chow Kit Road. What they found was the content of steroid in the roots were exceptionally high. Steroids does help in symptoms but in the long run, it will damage the kidney, causing high blood pressure and many more side effects. As an end user, we have the rights to choose what is best for us and what is not, so be a wise one.

Tongkat Ali roots

Tiger penis - Traditional chinese medicine

A Cageful of Tears

2007-12-18T17:27:00.001+08:00

My little cage... This is where I live. This is where I know my world. No love. A small cage to call home, but large enough to notice what is missing in my life. I maybe small, I may not able to speak with words, but I can communicate through my eyes. I need love. Just like the other children. There are a lot of things I don't know, bit I know I am lack of love.

Where are you, Dad? Where are you when I need your hug the most? I don't even know how your face looked like. Are you tall? Are you warm? Are you a handsome guy? Are you a caring person? Where are you, Mom? There are times I cry myself to sleep, where are your warm hand to comfort my pain? I had no more tears, I have no love. All I have is the nurses that attend to my daily needs, feeds me, baths me and caress me. But they are not my mom. Do I have a brother? Or a sister, Mom? Are they with you in the family? Why I can't be with you? I want you, mom.

Every morning, I wake up to nurses that want to give me medications. It was bitter for sure. I don't want to take it. But who am I to object? All I can do is cry. To my left, there is another boy. I don't know who he is, what is his name, and where is he from. But for sure, there is no mom and dad around him. Does he suffers from the same fate as I am? I don't know. Does he need love as much as I do? Maybe.

I don't know why I am here. If I was so unwanted, why do you care to make me in the first place? Am I a mistake in your life? Am I a burden? Do I disrupt the way you live? I have no answer to all of the questions. If I could only speak, I wish to tell you, Mom, that I will be an obedient girl. I will not disturb you, I promised! But it's all too late. You had abandoned me. Here I am, with other 'brothers' and 'sisters' which I don't even know. They don't care for me like my real brothers and sisters. They don't want to play with me. At night, we slept together in a crowded bed. Sometimes I can't even breath. Sometimes I lost my belongings. But I can't blame them. There are simply too many of my brothers and sisters. That's why I was sick. Thats why 'they' bring me to my cage here.

My sad story had just began...

This is a tragic in real life. The message of the story is to practice contraception. Help reduce the number of unwanted child. You can make the difference.

Smoking: When TAK NAK! become NAK TAK?

2007-12-12T23:43:00.000+08:00

There is no need to emphasize how smoking can do to your health. But some would say: "My dad smoked, but he never died of lung cancer. And there are so many smokers out there, I wouldn't be the unlucky one." "If smoking is bad, the government should had ban the sales of cigarettes." "I am already hooked. If choosing between stop smoking and die, I would rather choose death."

EXCUSES~

There are things that you lose with smoking:

Your white, beautiful and strong teeth
Your breath - stinks with cigarettes
Your fertility - both men and women will suffer from subfertility
Your time with the loved ones as smoking shorten your life and well as the one around you
Your freedom as you can't go in certain public like cinema, petrol kiosk, bank and many more
Your enemy, if you smoke around them, they will die faster

TAK NAK! is a failure. Government spent millions in promoting public health awareness on stop smoking. On the other hand, cigarettes is so readily available, even the teens can get their hand on the cigarettes with ease. There are shopkeeper out there who only think of profit-making, think that they are above the law and sell the cigarettes to the young one. This is bad. At home, the parents smokes, setting examples for the children to follow.

Imagine, if a person is smoking a pack of cigarette (20's) a day, it will cost around RM 7 per day. In a month, he will use up RM 210 just for cigarettes. In 10 years time, if he stop smoking, he saved RM 25,200! This is enough to pay for a car or to save for children education fund. What more, this figure does not include the expenses spent on petrol to go to buy the cigarettes, the cost for getting chronic cough, and the time lost because of fallen ill.

Prevention is always the best way to be healthy. Nicotine found in the cigarettes is a substance that cause physical dependence as well as phychological dependence. There will be withdrawal symptoms if a chronic smoker suddenly stop smoking. Glad, there is treatment to reduced these symptoms. It is called nicotine replacement therapy(NRT). It is available in most government and private hospital and clinics. Basically, it is substitute for what is loss, and it can be in various forms. There are gums, patches and inhalers to help reduce withdrawal symptoms. Mind you, the cost of NRT can be high, but in view of the long term cost, it is still cost effective. Do consult your local clinic or hospital for this service. The following are the number to call for smoking cessation clinics:

and the website for a full list of smoking cessation clinics and some relevant web addresses:

http://www.infosihat.gov.my/Klinik%20Berhenti%20Merokok.html

http://www.infosihat.gov.my/TakNak.html

Some examples of nicotine replacement therapies

Coffee: Eye Opener or Brain Killer

2007-12-09T21:15:00.000+08:00

I have to admit, I am addicted to coffee. But 1 out of 2 of my friends are on coffee everyday. Be it a caramel machiato, nanyang memorably or a simple nescafe, I had to take 1 cup every morning to keep me alive. I can skip breakfast, but not this. Everyday, I took an average of 2 cups of coffee. It started to sound like cigarette already.

I started to drink coffee during my secondary school age. I remembered it was an Indocafe. The taste was very bitter but still nice. My favorite cup? 1 teaspoon of coffee + 3 teaspoon of Milo + sugar. Yummy! Now I still drink this way, only without sugar. They called it mocha, but I prefer to called it Neslo.

So does coffee do you any harm? We have to look at it at 2 angles: dependence and intoxication. Not surprisingly, coffee can cause dependence, but surprisingly, it causes only psychological dependence. There was once I was on Atkin's diet. They recommend the users to stop coffee. So I did. First of all, I know if I am off coffee, there will be severe, head crushing, brain-burning headache. I will be a total useless junk. So I pick a time where I don't need my brain: holiday. And next thing I need is lots of paracetamol. So, I went through hell for the first 2 days. gradually, on the 3rd day. the withdrawal became much better. On the 4th, I can function partially and the next day, I can do my usual things again! Furthermore, I felt much better, more alert when I am off coffee than when I am on. Unfortunately, when I had stress for exam, the coffee drinking habit comes again and I am hooked till now.

The other aspect is intoxication. Believe it or not, some of you all actually drink until you get light-headedness. This is part of the intoxication symptoms. Others are feeling your heartbeat beating too fast, sleepless, restless, increase the frequency to go to toilet and abdominal organ upsets. There is no specific intoxication level. Some can take 5 cups without symptoms but some will have symptoms even before reaching the bottom of the first cup. It is usually dependent on the age. Younger than 35 years (like me!) will usually not suffer from intoxication.

Do you need treatment for caffeine dependence? Personally, if it does not bothers you, why bothers? Seek help if you think it affects your function.

Suicide: It's not the end

2007-12-09T20:13:00.000+08:00

What an irony! My first post is all about the end. I have encountered a few case of suicide before, even been consulted by a counselor regarding a young school-going child that is suicidal. Just how common is suicide in our community? In Malaysia, it is highest among the Indian population, and the prevalence is 157 over 100,000 people (Maniam, 1988), which converts to about 3 in 2000 people that commit suicide. Not much, eh? Wait until you think of the burden of suicide to the family members, the society and the healthcare burden.

How wide is the scope of suicide? Do we only consider those who deliberately taking his/her life is suicidal? No. Not only that, those who pray to have their life ended also considered suicide. Those who has thought of death is also a potential suicidal. Thus, it is utmost important to take note of all these early signs before everything is too late.

How do we know if a person is suicidal? In another word, who are more at risk of committing suicide? First of all, if you noticed anyone that persistently complaining of sadness or simply look sad and down, these people needs attention and we must be cautious. It can occur despite having any obvious stressor or events. He or she might not enjoy what they usually do, e.g. watching television, shopping or walk the dog no longer a joy for them. The people around them will notice that he or she losing weight despite not on any form of diet. They will also not sleeping well at night, requiring sleeping pills at times. In short, those people that have major depressive disorder are at risk of suicide. If the person had committed suicide in the past, he or she is even at a higher risk than usual. Those who had lost their loved ones in recent time are also associated with increased risk of suicide.

Old folks that stay alone, jobless, and financially dependent are especially at higher risk compared to general population to commit suicide. Those who were diagnosed to have schizophrenia are also at risk. Schizophrenia can present in many forms, however the usual theme would be hearing voices, feeling that someone is inflicting harm onto themselves, that they have ‘special ability’ or misinterpret certain common things into unusual experience (the list is not exhaustive). Usually, a schizophrenic patient who will commit suicide are those guided by the voices, for example, hearing someone asking the person to take his/her own life or had underwent major stresses in life due to the disease.

Men or Women: Which Gender is More Lethal?

Men tend to choose the more lethal means of suicide. They are considered to be more impulse driven, straight forward and ‘I-mean-every-word-I-said’ kind of people. Women would choose more peaceful way, less deformity to the body and less pain way to die. Usually, they are more attention-seeking; harming themselves is a mean to attract attention to their current agony.

Treatment

How do we manage a potential suicidal patient? In the situation where a person are trying to take his or her life, we must ask ourselves: Can I help him or her? If the answer is no, then we need to get help from other people or the authorities. All suicidal case has to treated as a serious case. All of them requiring hospital management, the least to be seen by a medical personnel. There is always help available for those who looks for it. I personally do not reject alternative medication. In a multiracial community, the populations tend to attribute certain mental illness with supernatural experiences, thus seeking help from a traditional healers. However, one should not forget the need to treat his/her medical condition. If the person is left untreated for his/her depression, chances are the condition will get worse and the person might deteriorate and end up with suicide. Yet all these condition can be treated easily with medications. So do not deprive yourself from getting the appropriate treatment. Its okay to get other forms of help at the same time.

My mother is a social worker, mostly involved in counseling. She is a professional in doing her job. And most of the time, people can find help from her, emotionally, to unburden the mind and to find someone to talk to. The point is, always find someone to talk to regarding your problem. Find someone you can trust. Do not keep things to yourself too much until it became the last straw on the camel's back. There is always a professional person to help you sail through the troubled sea.

Next, a family members or friend must be supportive to the person. Blaming will only makes the matter worse. All they need is a little bit of love and a listening ears. Listen to their problem, openly discuss the matter. Have more family time together, sharing the joy and pain and the ups and downs.

In a Nut Shell...

I could not stress enough the importance of detecting a suicidal person early. Once detected, there is always a way to treat the problem. Don't be shy, get help. We are not alone in this world.

Late at 7: Its not too late

2007-12-06T10:53:00.000+08:00

Greetings to all!

Late at 7. This is my first time in blogging world. Why this title? It traces back a long way back to my background. I am a Malaysian. Truly a Malaysian. This country is located near the equator. So we have pretty fixed day time and night time. 7 PM. Its a transition time between the day and night. Its the time where day fades, the night comes. Its when the adult came back from work. Its the time when children reluctantly leave the playground because his or her mother calling them back home to bath and have dinner. Its the time when the Chinese serial movies start blaring away on the TV, where the family members will sit round the TV set anticipating for the show to begin.

So it started one day (few days back), I was rushing through the stuff online. Just registered an account in Blogger. Need to find a name for this blog. On the other hand, I had a group discussion which will start on 7 o'clock sharp. It was 6.54pm. Don't wanna be late, so there comes the name, Late at Seven.

In this blog, I wish to put up some info regarding health conditions, things that i experienced in my hospital, and things that usually people asked me about. Hope it helps you in some way. But one piece of advice: ALWAYS seek help from your local family doctor if you have any medical condition. They will served you best in regards of your condition. This blog does not serve to replace your normal follow up to doctor, nor it replace your medications.

Will write my first post on "Suicide" after my exam, which is today.