anaphylaxis

this is an adverse response to a substance, usually a foreign protein or a drug, that the body is hypersensitive to. most of us call this an allergy, like the breaking of "hives" with a bee sting or when some people take prawns. drugs commonly implicated in this reaction include antibiotics (eg. penicillin) & pain-killers (eg. aspirin).

most reactions are mild, like a rash or an itch, but some are severe enough to be life-threatening, eg. an asthma-like attack or a marked drop in blood pressure. sometimes, death results if medical treatment is delayed.

this 20-yr-old girl was involved in an accident & needed surgery. but on the operating table, before the procedure could commence, she developed a sudden & drastic drop in blood pressure. as this is common during an anaesthetic, she was given intravenous fluids & ephedrine, a drug that raises blood pressure. it was when she failed to respond after repeated doses & the appearance of a rash over her arms & chest, that we realised this was an anaphylactic reaction.

the treatment of choice in this instance would be adrenaline (ephinephrine in the US)...

...the same stuff the body pumps out when in fright, fight or flight. the same stuff one would give for cardiac arrest or severe asthma, except that in anaphylaxis, a smaller dose would have increased the blood pressure sufficiently. a wonder drug indeed - often reliable & effective when in dire straits.

this girl responded well after a few repeated doses of adrenaline & given the circumstances, the safest course of action would be to postpone the non-urgent surgery till she has fully recovered from the effects of this life-threatening event.

now, who said doctors in private practice are always out for a quick buck??

a little different penang

it was the usual year-end ritual - x'mas weekend in penang. things were much the same, yet a little different.

1st, traffic was unbelieveably smooth-flowing all the way up north - no bottleneck throughout, even on penang bridge.

2nd, instead of the usual rendezvous with the malls, we decided to pick up some history with a visit to...

...built shortly after Francis Light secured Penang for the British.

armed with cannons against potential enemies. a nearby lighthouse served also as a look-out.


3rd, instead of dining at a posh thai restaurant, we opted for some place more down-to-earth at sungai dua...

you can tell it's not 4-star by the cutlery...

but it did serve something unique...

would you believe deep-fried kangkong?

4th, they were re-surfacing penang road...

..& i can only imagine the chaos during the festive traffic volume.

5th, we did the hike up penang hill. after the steep climb...

it was a treat to be rewarded with hot green bean soup...


6th, there's a new hang-out place in town with a difference....

..young girls belt out canto-pop songs to drum up support.

appropriately 7th, like the prodigal son, i went back to the church that started it all for me...

..except that, instead of being greeted with a prepared feast.....

..the choir was singing christmas songs.

8th, we had morning dim sum at bali hai along gurney drive....

where it's always crowded....

& the fare was good.

9th, we also tried out corner club, also along gurney drive, for dinner.

no crowd on a friday nite, which seemed strange.....

...because the dishes were well-cooked & the price reasonable.

finally, the girl was ecstatic when we were at queensbay mall, not because there was a contest for...

..high school musical pretenders, but rather by chance, she met her idol in person...

that made her day!

the traffic going south was a little heavier with slight hold-ups at the juru & jelapang tolls, but the kids haven't the slightest worry in the world!

Aesop's Fables

Aesop's fables are famed throughout the world for their clarity & the moral behind each tale. i have a faint recollection of being told The Tortoise & The Hare, The Fox & the Grapes, The Lion & The Mouse, amongst others. so when Jim West's Puppets came to town, i thought it would be a good excuse for a family day-out.

Jim's props are all are self-made, mainly from painted card-boards & cut-out boxes. he's even thrown in a hand-shadow show for good measure. the fables are told in simple language, to the music of Scarlatti & Beethoven. after the 1-hr show, Jim obliged to a photo-shoot...


...and an autographed souvenir poster.


bangsar shopping centre also has a Times bookstore with a huge children section :

a boy's paradise....& i need to redeem a voucher as well.


next, it's off to 1-utama where the girl wanted to get her pair of skechers. i had feared i had to go round & round for a parking space, this being lunchtime on a weekend, when this nice lady indicated to me she was leaving. things are indeed looking up! except that the girl can't find a pair that she likes or has her size. so in the end she opted for a nike instead...

under normal circumstances, i wouldn't have consented to the purchase, but since she claimed to have done "quite well" in the year-end exams, i relented.

i had to admit that the xmas decorations were quite good.

CPR

it's been said that we can live 40 days without food (matt 4:2), 4 days without water & just 4 mins without oxygen, & some say, not even 4 secs without God. so, except if you collapse in a medical facility, you are unlikely to get medical assistance in 4 mins, unless this is witnessed by a bystander who knows basic life support (BLS) & who is prepared to administer it.

it's been a year since i taught BLS at church. with a new batch of students, i was once again given the honour to instruct in the art & science of cardiopulmonary resusctitation (CPR).

anyone can learn CPR - you just need strong lungs (for mouth-to-mouth) & arms (for cardiac massage) & some common sense (to remain calm & organised). a demonstrator mannikin called Resusci-Anne (or Little Anne, as our half-body version is called) would be useful to have.

CPR is really as simple as ABC:


A is for maintaining an open Airway


B is for Breathing, which means mouth-to-mouth breaths


C is for Circulation : both palms, one over the other, on the breastbone...


...external cardiac massage to assist blood flow.

if there are 2 rescuers,

1 will do mouth-to-mouth while the other, the cardiac massage.

CPR is performed till the unconscious person recovers & wakes up, or till the (para)medical team arrives & takes over.

lives are saved when ordinary folks are capable of providing BLS, & this "buys time" till definitive treatment is made available. further infomation on BLS/CPR can be found at these websites:

http://www.resus.org.uk/pages/bls.pdf
http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-12

Lazarus was raised from the dead without CPR but it was Elisha who may have performed the 1st on record:
Then he got on the bed and lay upon the boy, mouth to mouth, eyes to eyes, hands to hands. As he stretched himself out upon him, the boy's body grew warm. 2 Kings 4:34

windfall

ladies & gentlemen, i am a millionaire!!

well, sort of, as this email promised :

so, i'm about to receive a windfall equivalent to about MYR3.5m, thanks to the generosity of Mr Lewis's Lotto Awards. suddenly, i am smacking my lips, anticipating that LCD tv, dSLR & driving vacation in new zealand. & i can almost feel the dopod with GPS in my hands.
but, before i dream further, i remembered one thing - i have never participated in that sweepstakes, or any other for that matter. so, is this akin to the black money or magic stone scams we've read so much before in the papers? stories that keep emerging because it's fair game when there's a willing buyer & a willing seller? & of course, as dire straits sang years ago, who doesn't want money for nothing?? during this festive season of giving & receiving, let's not forget the Teacher'sadmonition : Then he said to them, "Watch out! Be on your guard against all kinds of greed; a man's life does not consist in the abundance of his possessions." luke 12:15 have a truly blessed christmas!!

Children's Xmas Do

you know it's year-end when the kindergartens have their open days & churches hold the Xmas functions. i've always harboured a soft spot for the children's program, held over 2 days recently.


the 1st, held in church, we had singing...


story-telling....


children participation....


lighting up candles.....


our version of the newborn King...


somehow, it always conclude with food & fellowship


the 2nd was held at a rubber estate as part of our outreach program. there was some excess funds which was used to purchase presents for children.





trying to get the correct-sized sandals for the kids.

after all, what is christmas without sharing??
blessed christmas one & all!

hanging by a thread

MZ is 52 & he has had end-stage renal failure (ESRF) for several years, which requires haemodialysis thrice weekly. this is achieved by connecting the dialysis machine to an arterio-venous fistula (AVF) which was created surgically, usually over the forearm.

after several years of use, the AVF has blocked up & a new one has to be created on the other forearm. meanwhile, MZ has dialysis via a temporary catheter inserted in his neck. he was scheduled to have a new AVF done on saturday, a day after the previous dialysis.

his chest xray in the morning was essentially normal.

(ok, the heart is a little large but this is expected as MZ also has hypertension)

as he was being prepared on the operating table at noon, he started coughing violently & complained of a little breathlessness. it was decided that another chest xray be done before proceeding with the AVF creation. lo & behold, there were new changes in this xray:

white patches had appeared on both lung fields & the heart outline had becomed blurred. it meant that his lungs had become congested with fluids, as a result of his deteriorating condition. he needed another dialysis before the procedure can take place.

it's a good thing the chest xray was repeated, because had the surgery taken place, MZ may have come off worse. the lives of patients with ESRF are already hanging by a thin thread. as medics, we should provide them every opportunity to alleviate their suffering.

note: MZ had uncontrolled diabetes & hypertension for many years, resulting in the severe kidney damage.

an overseas trip

i've always joked with the family - going to s'pore is an OVERSEAS trip because you need an international passport, foreign currency & roaming service on your handphone. so far, no one can prove otherwise.

so we went overseas last weekend. it was an impromptu decision - actually the kids have been looking forward to it, except that i couldn't pre-plan a date. it was a pleasant drive without getting stopped by traffic cops & going thru customs/immigration was a breeze.

after checking in, the family had a head-start at orchard road while i met up with an ex-colleague from my training days at the Sheffield Registrars' Rotation in UK. K has since joined private practice & we met at.....

now that's a name i've not heard for ages. years ago when i was at the Holland Village outlet, they served a most sinful blueberry cheesecake & milkshake, & as these were sadly not on the menu this time, i settled for the set lunch which turned out to be quite formidable:

full-flavoured home-made mushroom soup.....


a mean honey-glazed beef rib &.......


ben & jerry's cherry garcia ice-cream...mmmm!

caught up the good old times & i'm glad he's doing well. lunch was on him but he knows when he comes a-visiting, he'll be treated to a scrumptious ikan bakar meal, the likes of which s'pore can never hope to emulate.

caught up with the family at suntec city. i think shopping's a cinch for guys. i was at the sports shop & selected a pair of trainers for just SGD39.99 within 20mins, while the girl is still searching for that elusive pair of sketchers. now she said i must take her to 1-utama to get them.

it's really easy to figure out why tourists flock here. 1st, you just can't miss the visitors' centre along orchard rd.....


then they take you on a free tour......


on an open-top bus .....



to catch the x'mas trees, lights & decorations.....






needless to say, the street was teeming with people. some were out to make a quick buck like.....

the statue man....


the gimmick man....


musicians from china.....


& latin america.

guess what else was seen on tour? the beginnings of a new mall, right smack in the middle of orchard road..

the future Ion Shopping Complex.

sometimes the heart rules over the head. that's why the next morning we started out at

instead of the Science Centre, because the girl was still looking out for that dream pair of shoes. the boy didn't mind as long as he got his ride...


it helped that Vivo City is near Sentosa Island, because an LRT operates between the two..



included in the ticket price is a tram-ride around Sentosa...


& one reason why tourists feel safe here.....

is the obvious presence of tourist police patrol. just like orchard rd, it's never enough & there's evidence a new attraction is being constructed....


for all the attractions & distractions, amidst the vibrant yuletide activities, it's reassuring that the true spirit of christmas was not lost....


for me, the only pleasure i derived at vivo city was a brief sojourn at Ben & Jerry's....

so, how would a triple-header of cherry garcia, raspberry chocholate chunk &...

new york fudge chunk grab ya??

so, what's new about s'pore??
(1) when a local bank opened a new branch, they go all out...


(2) some of the bus-stops have display screens that indicate the ETA of the next bus...


(3) at the local toy store, monopoly now comes in electronic banking version....


and (4) despite its squeaky clean image, people still flout traffic rules...


i learn new things all the time.