Wednesday, June 30, 2010

life saver?

i saw this at a shopping mall in s'pore recently.
an AED is an automated external defibrillator. (read here) it's a crucial piece of equipment used in Cardio-Pulmonary Resuscitation, & in addition to being readily available at all medical facilities, the American Heart Association recommends that public places like office complexes, shopping malls & sports arenas be equipped with these devices.

although any man-on-the-street can perform CPR, the AED should only be used by those trained in CPR (read here) which explains the warning label & the key in the glass casing.

although this mall is to be applauded for installing AEDs for emergency use, the success of this operation is dependent on many interconnected processes, eg.
1) the public must be aware of its location;
2) it must be regularly serviced/maintained to preserve its function;
3) there must be a mass training in CPR for the public before the use of AEDs can be effective;
4) there must be an rapid-respond emergency team available within minutes of such an an emergency;
if all these procedures were in place, you'd wonder if the tragedy at a recent marathon could have been prevented. read Zewt's take here.
it's all academic now, but don't bet on such an incident NOT repeating in the near future.

PS. the AED in this post is located at the basement level of Wisma Atria & i'm told there are many like this positioned in offices/malls along orchard road. iPhone users in s'pore can download the free app "AED nearby" to locate the nearest device.

Monday, June 28, 2010


remember the advert where the toy powered by duracell battery continues to operate & outlasts toys using other brands of battery?

i have a colleague who seems to be powered by alkaline batteries. he'll run his clinic in the morning & work right through mid-afternoon before starting his operating list, which means his day will only be over in the late evening. this is his routine.

of late, he's been operating on non-emergency cases on weekends as well. which means, he's in hospital everyday of the week!

where does he get the energy for such a gruelling schedule, you ask? i don't know. maybe age is on his side. but what i do know is that he is made of flesh & blood, not mechanical parts. at this rate, someday something will give way & new batteries is not going to help.

i just hope he realises this before it's too late for him.

Saturday, June 26, 2010

hospital visit with a mission

my neighbour runs a roaring business. as they did not attain higher education, they took it upon themselves to ensure that their 3 boys studied in the best schools & are given the opportunity & support to enter the best universities. so all 3 are enrolled in private schools. the eldest just finished A-levels & has a firm offer from UCLA Berkeley for chemical engineering, which he will accept.

the 2nd boy will be doing A-levels next year & is still keeping his options open. unlike his elder brother who is fixated on doing chemistry, his mother is trying to persuade him to do medicine. she asked me if i could show him around the hospital, just to give him a feel of what to expect, even though he has no burning desire to take up medicine.

so, i took the boy around the other day. 1st, i asked my friend Dr L if he could demonstrate some communication etiquette with his patients in the clinic. the boy got more than he bargained for because Dr L also allowed him to watch a gastroscopy & colonoscopy done on 2 different patients.

then, in the afternoon, i took him into the OT & let him witness a couple of surgical procedures. at the same time, showed him some the of advanced equipment & ran through some of the precautions taken for patients undergoing anaesthesia.

i'd say it was an eye opener for him. should he eventually decide to do it, i can expect a big treat from his generous mother. unfortunately, there was a drawback. over lunch with a few of my colleagues, all of them were adamant that they won't encourage their kids to imitate their career choice, giving reasons like over-saturation of doctors & lack of specialist training opportunites.

even though the boy is matured enough to decide for himself, never underestimate the potency & influence of maternal persuasion!!

i'll let you know if i get that dinner invitation.

Sunday, June 20, 2010

fathers' day

the advertisers remind us...

the church celebrates it...

but this is all that matters to me.

Saturday, June 19, 2010

in her father's footsteps??

the girl has been home for 2 weeks for the term break. i have to admit i had been a bit busy at work during this time, so except for the occasional dining out, walks at the park & the one movie, i hadn't spent much time with her.

but today i finally had a couple of hours alone with her.

over an ice-blended at coffee bean.

that's when she dropped the bombshell - she may want to take up medicine.

i was surprised because she's never expressed such intention before (unlike the boy who enjoys following me to hospital when i do my clinical rounds on weekends).

and i was amused because she contemplated that as she can't imagine being anything else.

not law because not eloquent enough;
not engineering because her physics sucks (her own words);
not accountancy or actuarial science because doesn't like maths (although doesn't mind the money!);
not architecture because can't draw to save her life;
& not teaching because lacking in communication skills.

so, she chose medicine by a process of elimination.

that's why i'm amused. (muted ha! ha!)

Tuesday, June 15, 2010

end of the road?

it's confirmed.

mdm S (read here) has a recurrence of kidney cancer, aka renal cell carcinoma, in her right lung. last week, an attempt to remove the tumour completely was unsuccessful because part of it was adherent to a major blood vessel (superior vena cavae).

the most likely option left now, if she consents, is chemotherapy which itself is also fraught with side-effects, & some, other patients say, are worse than the disease itself!! whatever her decision, time is not on her side.

as i looked at mdm S's journey in retrospect, i couldn't help wondering if, at ANYTIME,  there was ANYTHING ANYONE of us could have done to have given her a better chance at survival.

doctors have been accused, rightly or wrongly, at playing God. seriously, having been in these shoes, heavy is the burden of responsibility on the shoulders of many who have to make difficult decisions, esp when these decisions profoundly affect the lives of others.

Friday, June 11, 2010

the devil & the deep blue sea

i recalled a statistic when i was a med student doing surgery ward rounds. the lecturer said 1 out of 14 women will eventually develop breast cancer.

1 in 14.

if there are 14 lottery tickets & 1 of them will hit the jackpot prize, don't you think the chances are high?

that's about 30 years ago. with a change (deterioration?) of lifestyle & diet, wouldn't the odds be terrifyingly higher now?

women above 40 have been advised to carry out monthly breast self-examination as well are regular mammograms for early detection of that dreaded disease (a term used in many insurance policies) & some studies have shown that these screening procedures have reduced significantly the mortality from breast cancer. check out the academy of medicine website  & read the Management of Breast cancer pdf.

but here's the twist...

there are recent reports that the annual mammograms themselves subject the women to a cumulative amount of radiation that MAY cause breast cancer!!

"Our work shows that radiation can change the microenvironment of breast cells, and this in turn can allow the growth of abnormal cells with a long-lived phenotype that have a much greater potential to be cancerous," says Paul Yaswen, a cell biologist in his report here. this is substantiated by a Cornell University report & a US National Centre for Biotechnology Information report.

so, where does that leave us? should the women continue with mammograms or not? it's down to risk-benefit issue again. is the benefit of early detection worth the possible risk of irradiation?

would you rather face the devil or the deep blue sea??

Tuesday, June 08, 2010

3 months

mdm S is 55 years & i'd say has more than her fair share of life's travails.

6 years ago, she had a kidney removed because it wasn't functioning. could be a result of hypertension, which she has had for several years.

last year, she developed a tumour in her remaining kidney. attempts were made to remove the tumour while preserving the rest of the kidney but that failed. on top of that, she bled a day after surgery & had to go for an emergency exploration to remove the bleeding kidney, ie. she underwent 2 surgeries in as many days. she survived & because both kidneys had been removed, is now dependent on haemodialysis 3 times a week.

today she came back, with yet another tumour - this time in one of her lungs. it could be a recurrence (called a secondary) from the previous kidney tumour. again she had major surgery - had her chest opened to remove the lump.

the surgery was fraught with difficulties from the word "go."  the pre-op preparation took almost 2 hours, the lung bled throughout, her blood pressure & oxygen saturation dropped. it was most unfortunate that, because the tumour was adherent to a major blood vessel, it couldn't be resected completely without damaging the blood vessel.

3 months.

no, that's not how much time she has - that's the extent i think my life has shortened today.

mdm S came out of surgery after 5 hours, very much alive. so perhaps, 3 months is a small price to pay.

Sunday, June 06, 2010


someone said very philosophically that the only thing that won't change is change itself.

it's so nice to remain in our comfort zone & dwell on what we are familiar with. but conform we must, to adapt to changes that invariably occur from time to time. for example, if things get expensive, we buy less or even stop buying altogether if possible. i remember the time not long ago when petrol costs RM2.80 a lit. we went on less outstation trips, & didn't travel when it was not necesssary. we even comtemplated installing a NGV tank in the car.

having been on the hypertensive pill coversyl for over a week, i developed a dry irritating cough, which sometimes happens. actually, i wasn't sure if the pill was the cause, or was it due to the sinus problem that was acting up again. that's when the secretions from the nose trickle backwards into the throat & irritate it, causing the cough.

anyway, discussed this with  my cardiology colleague & decided to stop coversyl & start on cozaar instead. this is a totally different class of anti-hypertensives called angiotensin receptor blockers, or ARBs for short.  so far, the cough has gotten less, but then my sinus problem has gotten better at the same time. so i still don't know for sure what the cause of the cough really was.

but i've also decided to have the recurrent sinus problem corrected surgically later this year, once & for all. is that a major (upcoming) change or what?

the other change in my life is the arrival of the altis. that's a toyota, by the way!

another round of adaptation here. with 50 horses LESS, 1-speed LESS, 4-airbags LESS & 4-CDs LESS in the changer compared to the old car, that's quite a bit of change to get used to. after having it for almost a week & having driven down to s'pore & back, i didn't miss the 50 horses, 4-airbags or less CDs in the changer one bit. but the 4-speed transmission did produce a constant grunt on the highway, something not noticeable with a 5-speed.

encountered 2 speed-traps on the way down. only time will tell if this reformed speed-demon has himself changed.

PS. did i also mention that my life is now also partially guided by GPS?? more about this later.