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.

duracell

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.

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.

fathers' day

the advertisers remind us...

the church celebrates it...

but this is all that matters to me.

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!)

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.

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??

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.

change

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.

hectic week

it had been a difficult week to get by.


i found out i have hypertension. had been feeling a little faint 2 weekends ago & i thought it was because of the sinus problem that started around that time. when i checked my blood pressure, the systolic pressure varied between 140 - 160 while the diastolic hovered around 90. that's definitely NOT normal under any circumstances & even after the sinus got better, the pressure remained high. that's when i decided i'd have to start treatment.


actually, i've been having borderline high pressure for sometime (135/85) & had been trying a non-drug approach to control it, eg. diet, exercise, but i suppose the job didn't help. so after asking around a few colleagues, i started myself on perindopril, an ACE inhibitor. after a week, the BP has stabilised at about 130/90. my target is 120/80 so there's still some way to go.

way before that, i had promised pastor that i would share a message last sunday. so, amidst the dizzy spells & blocked/running nose, i also needed to put together the message although i had searched & prepared the texts & illustrations some weeks ago.

but God, in His great mercy & compassion, saw me through the difficult week. He even impressed upon me the song of response which i selected. it was from psalms & it was appropriate, not only to emphasise the message, but also personally to me.

Return unto thy rest, O my soul;
for the LORD hath dealt bountifully with thee.
For thou hast delivered my soul from death,
mine eyes from tears,
and my feet from falling.
psalms 116:7,8 (KJV)

turning 8

the boy had his own birthday party recently & all his buddies were invited.

in a way, i'm envious of him - he has something i never had - a group of friends that he has known from birth, are classmates in primary school & growing up in sunday school.....  

it's must be reassuring to him that he is much loved. even the sister called him to wish him...

being such a stickler for tradition, he insisted on opening his presents on his actual birthday itself.

(or, will he develop OCD later in life, i wonder?)

and the new car will be a.......?

it's a toss-up between the civic, sylphy & altis.

it's NOT going to be a civic because there's a 3-mth waiting period & although it has a very sporty exterior, it has a spare tyre looks like it fell off a motor-cycle.

it was ALMOST a sylphy. i was going to sign up this afternoon when i got an sms from my mechanic friend. he had warned me earlier that its CVT transmission is still new in the market & if it's going to be like the CVT in the previous honda city model, then expect problems. i almost went ahead anyway because the sylphy dealer offered to trade-in my 9-year-old car for rm8,000 more than the civic or altis dealer. EIGHT THOUSAND BUCKS!!

in the end (i'd like to think) i listened to reason instead. unlike the sylphy, the altis has a reliable 4-speed gearbox, vehicle stability with traction control, steering wheel audio control, multi-information display, 16-inch wheels with rear disc brakes AND 10,000km service interval. besides, for this month, the altis comes with rm2000 discount plus a free garmin GPS.

with so many superior features, why did i even consider the sylphy? i think it was nearly a case of penny-wise & pound-foolish.

thanks, Roy, for the sms. the car will arrive in 2 weeks. 

not an ordinary day!

it's mothers' day......

in church, so we had the customary appreciation for all mothers. the guys prepared lunch including cooking rice & preparing the main course (roast duck) on site.

it's also a birthday.......

darling daughter turned sweet 16 today, & for the 1st time, we couldn't celebrate with her. the boy, on his own initiative, made a card for her, although he initially thought she's only 14.

it's also a brand new day.....

.....for 11 people in church when they took the plunge in the baptism pool. especially to C who made the decision to accept Christ as her personal saviour after i prayed for her, i bid all a warm welcome to the family of God.

what an awesome day this has been!!

playing safe!

it's like using a condom.

do you want to take the risk? are you prepared to suffer the consequences? i have been mulling over it since the issue came up last year & yesterday, i decided to play it safe.

i got 3 syringes of the H1N1 vaccine for the family.

i had strongly resisted the use of tamiflu last year as well as the newly manufactured H1N1-specific vaccine this year; the former because although it's effective against the common seasonal flu but doubtful against H1N1, while i hesitated over the vaccine because there's concern over it's long-term side effects, specifically to the nervous system.

besides, since H1N1 is reportedly to affect mainly those who are pregnant and people with underlying conditions like hypertension & diabetes, i figured the potential risk of the vaccine just about exceeded that of the flu itself.

that was until i read about a healthy 40yr old man who died from the flu. for me, that changes the scenario altogether. that's when i decided to play it safe.

like using a condom.

reunion

my varsity mates & i had our little reunion over the weekend. it was "little" because 15 people turned up (most with their spouses & kids) compared to about 40 at the last reunion in 2005. perhaps it was the location. previously, we had it at pan pacific at KLIA which was easier to access for those flying in, while this time, we had it at janda baik, just off the highway to kuantan.

why in janda baik, you might ask? this place is owned by our ex-medical lecturer from the varsity. she & her architect husband retired here & the organiser of the reunion, Dr L, is a  close associate of theirs.

as it turned out, because of the smaller numbers, i got to reaquaint myself more intimately better with the others compared to the last time. well, you know what reunions are like - we walk down memory lane & share stories about our current jobs. a few remained the extroverts they were before & frequently held court, while the others, like myself, were more content to just be the attentive audience.

i just figured out one reason why we still got on so well 26 years after graduation. none of us are  filthy rich extremely successful, neither was anyone found wanting. we could all associate with the common-man experiences we've gone thru.

the chap from penang, Dr C, has agreed to organise the next one there. coming from a military background, i'm certain he'll get the job done.

the other reason i was pleased with the event was that the wife got along well with the other spouses & the boy, despite not having kids of his own age group, kept himself occupied in his own child-like ways.

your money or your life - chapter closed.

the girl pulled through.

in fact, her recovery is just short of being labelled "miraculous." the kidneys started functioning like normal & no other organs failed despite the sepsis. she even started to eat normally today.

& how do i know the worst is over? she gave me the sweetest smile when i saw her yesterday. the only obvious evidence left of her life-threatening illness is a low-grade fever.

she should be going home soon & i am extremely happy for her and her mother. the latter's gamble may not pay off the next time.

& so ends another chapter of life's unexplained great escapes.

your money or your life?

it's strange how we misplace our priorities .

the lady came from indonesia with her 15-yr-old daughter who has had abdominal pain for several days. the ultrasound revealed a mass on the right side with fluid in the abdominal cavity, suggesting an infected appendix that had ruptured. despite the severity of the condition, the lady bargained & haggled over the price of surgery.

by the time the operation was performed after a day's delibration, pus had already contaminated the abdomen & the girl had developed early sepsis (generalised infection). her kidneys had begun to under-perform & who knows what else will fail in due time.

perhaps the mother shouldn't be faulted for the delay. after all, some doctors have been known to be scalpel-happy & eager to operate at the slightest hint.

for her & her daughter's sake, i hope all it wasn't all in vain.

honour your parents

spent the weekend in s'pore & stayed at my brother's place in yishun. there's a thai restaurant conveniently located just across the road. well, to be frank, it wasn't anything exceptional....

the pineapple rice looked ordinary...so did the claypot taufu & sotong kangkong....

as well as the honey chicken & garlic fish slices..........

but after a tedious drive & when you're having dinner at 8.30pm, everything looked sumptuous. what's remarkable was that with most tables occupied, the food came freshly prepared in 15mins. not to mention the bill for 5 dishes plus the rice came up to only $36. but this became secondary when cousins who stay apart get to play games together...
















the main reason we went down was to catch up with the girl. & bless her heart, she remembered the wife's birthday & even got her a gift...

surely she desires to fulfill the commandment, the one with a promise....

"Honor your father and your mother, so that you may live long in the land the LORD your God is giving you."

exodus 20:12

letting go...(sort of)

the girl has fended for herself for a period coming up to 4 months. yes, she had a really difficult time at the beginning, what with the new environment & people. the school work didn't make it any easier either.

but i believe she has weathered the storm & at the same time become mentally stronger. going thru an upheaval of this magnitude at an age not yet 16 is commendable - but perhaps that's a biased evaluation because i'm the father.

so when she asked me a few weeks ago if she could watch Chicago the musical at the Esplanade Theatre by herself, i couldn't really say no. she's been there with her classmates before & it was an afternoon matinee show that she had planned.

she said she needed a break & that's a good enough reason for me.

so when i spoke to her last nite, she was beaming with joy. she had enjoyed the musical thoroughly. i was glad i let her go - she may have been alone physically but her guardian angel was with her.

in military parlance, i think the commander would have said : the eagle has flown.

Even youths will become weak and tired,
and young men will fall in exhaustion.
But those who trust in the Lord will find new strength.
They will soar high on wings like eagles.
They will run and not grow weary.
They will walk and not faint.
isaiah 40:30,31

timing is everything!

my colleague really had a nice vacation in UK 2 weeks ago because....

1st, the british pound was at its lowest for ages;

2nd, the volcano in iceland has yet to erupt.

 
sometimes, we organise our holidays with military precision & scrutinise down to the minutest detail (i mean, who doesn't want total control?) but mother nature has a way of disrupting man-made plans.