Afternoon stop

Just finished my Jumaat prayers, so I thought I grab a quick bite before the afternoon chores. Got a couple of families I need to talk too, then off for some paperwork. Blogging certainly not as taxing as it was back in 1997 when I maintained my first website during the time I was UK UMNO Youth Chief .... I should have stayed in politics, likely I will make more money than just being a measly Haematologist. Back then, updating anything on the website took ages, due to combination of unintuitive interfaces and slow internet connection.

Nowaways, updating blogs can be done on the fly. For this blog, I use a client built into the website squarespace.com. I learned about it from listening to Leo Laporte's This Week in Tech podcast, getting a 10% discount I thought I might just as well utilise the 14 days free trial. I got hooked since. The interface is neat and I am sure anyone can afford the reasonable price structure - No, I am not being paid for this advert. I then took a step further and bought myself this domain name through nettica.com. If you are serious about blogging, find a decent tool, get yourself a decent domain and off you go!

Since uploading my update last night I have received request for more tips. I will try my best for later tonight. So talk to you again then.

You Don't Need Luck ... You Need A Miracle .... Part I

Saw this at MPH

Wow, the exam fever is effervescing in UMMC definitely. I felt the heat today when I offered to take a short case session and was politely declined. Everyone is clearly under stress. The usually calm boys and girls becoming kiasu big time. Everybody tak senang duduk! Received tons of SMS thanking me for what help I have offered but more importantly asking for forgiveness and blessings. Some asking for last minute tips and tricks etc. Rather than tell everyone individually, as a member of web 2.0 movement that I am, I decided to blog it. So, here we go.

There is NO substitute for a good solid base in physiology and pathology for answering the written paper. I am not going to lie to you guys, if you don't know your basics, you don't deserve to pass. Sorry to be blunt! But I am deluded. Nobody knows everything ... Dr Sangkar, my former colleague being the exception.  Written paper trick #1, what you can do at the last minute is to try out pass questions. People who knows the stuff, but doesn't know how to answer the question CAN fail. People who are not sure of their stuff, but knows how to answer USUALLY pass. A bit like the politicians la. Those who don't know their stuff still doesn't deserve to pass. So get hold of pass paper, try to answer them. If you don't have any, get a partner and practice asking and answering questions. But be certain and familiarise yourself with the format of the questions and what expected of the answers. After a while, you will manage to spot what's likely to come out and how to tackle them!

Written paper trick #2, highlight all the subjects you can think of, and then divide them into 3 groups - 1) MUST know, 2) HAVE to know and 3) 'if I got the time'. You will come up with around 60 big topics from all the specialties combined. OK, for the Medicine part, diabetes, asthma/COPD, hypertension and IHD etc should come under MUST know. Thalassemia, Parkinsons, Ca lung, nephrotic syndrome may come under HAVE to know. The others you will try to catch up with after the important ones have been sorted. If you don't know them, you may still pass the exam, but you will suffer from lack of confidence.

Written paper trick #3, make short notes on MUST know subjects. The notes should be on a single page of an A4 sheet. For best effect, you have to write it yourself though. In the panic of the exam, you will be able to remember each and every word on the A4 sheet verbatim if you it well enough. Trust your graphic memory. If you really struggle to do all that, find a group of friends, do it together, exchange notes etc. You don't have to do them in a boring room. Even Starbucks can do! This is the time when you will discover who your real friends are!

We will leave the tips for the long and short cases for later updates.

Have a good rest and eat well. It is easier said than done. I must confess that I learned more in the last five weeks in medical school than the previous 5 years. There are no perfect examination in life, and Final MB is certainly far from flawless. The subject scope of Medicine is huge. Passing this exam is a life-changing event, similar to having your first child. You will be under stress. But smart people will know how to handle it. From my observation, those that study in groups will do better. If it is not because they learn more together, they will certainly handle the pressure together as a clique. They will bounce off each other and pick each other up. There were times before exam that I felt like just giving it up. It was just too much stress. Luckily I have friends who helped me out. I also did my fair share of helping as well. Now they are all Neurosurgeons, cardiothoracic surgeons, Cardiologist, Paediatricians. That's who you all will be one day.

From an examiner's point of view, Final MB is not to be taken lightly. We are deciding the fate of the candidates, an we can't afford to be unfair at the same time. It is often difficult to weed out the good , the not-so-good and the awfully bad. Certainly not during the period of the exam, and worst still in the half an hour or so during the clinicals. The exam will never be fair. However, we also have a duty to the general public. I can't pass somebody that I don't trust to look after my grandmother to roam the ward as a doctor. It is a big responsibility. All I am looking for in the Final MB candidates is that they are safe, trustworthy and reliable! Do not lie to the examiners!

For the majority of you, the best of luck .... but for the few, you don't need luck, you need a miracle to make it through. For the Moslems amongst us, pray to Allah and He WILL answer your prayers. He can bless you in many ways, clear your head to study, have good health during the exam period (that is important), calmness in the exam hall and He may open the examiner's heart to be compassionate. They are all human beings, and Allah is the Almighty. Take advantage of tonight being malam Jumaat and perform Solat Hajat. I'm sure your parents would have done so!

Cuti-Cuti Malaysia

Irfan running around in front of the chalet at Bukit Merah ResortIt was another breeze driving into UMMC this morning despite the downpour. I wished that the school holiday is every week at this rate. Cut down my driving time from close to an hour to half of that, despite leaving home later. I'm certainly not complaining. This story about holidays brought back memories about my own previous breaks, not the freebies the pharmaceutical companies give for 'meetings', but the one I fork out money for with the family on tow.

There is a trend forming. I used to hate going for holidays in Malaysia as a Malay. The experiences certainly has not been kind. June 2006, during a quick break to Port Dickson, we stopped over for lunch at one of the five-star hotels. Drove the car into the driveway at the main entrance, stopped over to drop my two boys, my wife Anita and my mother-in-law. The two doormen just stood there while my mother-in-law clamber off, and my wife dragging down my boys. They did not even bat an eyelid. Another car pulled over behind us with a Mat Salleh couple in slippers. Usian Bolt would have cringed at the speed the two stooges raced to open their door. To add insult to injury, they even picked up the luggage and opened the door for them. My mother-in-law being a Mak Datin did not take it lightly. She was livid. We didn't bother staying, we promptly left for another joint.

There was another incident in a hotel in Penang, sponsored by a pharmaceutical company. I went to check in with the rest of the party, mainly Chinese doctors (my family was not with me). I noticed that they were eager to serve me first but probably changed their mind when I opened my mouth. They must have thought that I was a Middle Eastern type, until I started speaking in proper Penang accent!

By last year, it has gone a lot better. Maybe because the flock of foreigners with cash were thinning out. I have to mention two places that looked after us very well despite being Malaysians. I actually wrote on Kementerian website to give kudos to the two venues. They were Bukit Merah Resort and Eastern Pavillion in Cherating. The Gurney in Penang was also excellent. We were not asking for much, just to be treated fairly. Try this. Stand in front of the counter in a hotel lobby, next to a Mat Salleh. Who will person behind the counter serve first? I can bet RM50 that it's not going to be you, unless you happen to be a Leng Chai or something! If the Ministry want to make the Cuti-cuti Malaysia a success, they have to address these issues. It may appear small, but these are the things that can spoil a good holiday!

For those going cuti-cuti Malaysia, props to all of you. I might be heading to Putrajaya one of these weekends. The Pullman Hotel certainly look nice on the website.

Cherating

With Diet Like This, Who Needs Chemo?

My colleague, Dr Edmund with his dental students earlier today

Oh Dear! I thought I've missed it. Was rather late at updating tonight. Just returned from listening to my Boss talking about a not-so-new concept in cancer. It is termed 'epigenetics'. Not so new because it was talked about for the last 20 years or so, but only in the last few years it has gained mainstream medical acceptance.

Contrary to what my MO was trying to make everyone else believe, it is not the 'epidemiology of genetics'. That would be too easy wouldn't it. It is more to do about genes, and how when we were born we carry both genes from our mothers and fathers, but not all of them were expressed in us. Such as my uncles were mostly 6 footers, but yours truly is ... well, not quite that tall!

There is an in-built mechanism that tell our cells which gene to be switched on, and the pattern of the switch is epigenetics. Each turn of the switch bring different consequence, some good, some bad. We are trying to find out which switch were turned on in cancer, so that hopefully we have a way to switching it off, and cure the cancer. Sometimes without even using chemo!

What is curious is, the fact that our diet can play havoc with this switch. Certain food are bad. High fat stuff maybe. Certain chemicals added in food, colourings etc. Others may protect from the 'bad' switch being switched on or off, hence protecting us from some cancers. This is a simplification. Don't go around tomorrow drinking fruit juices or ginseng as they may protect from cancer. I am not saying that they don't but the dose that is needed may be thousand times our normal diet if we want to turn the switch. We are still not certain of the specifics. Diet that has been mooted to be protective were the ones containing ginseng, garlic, the list is endless. So far there are no scientific data to support their use in hospital settings. Don't come around to see me yet for prescriptions. You might get some chemo instead!

To be honest, when it comes to cancer care, there are no EXACT science. I cannot pretend that all my chemo will 100% work. They may in fact kill. It is all about balance. The science behind the use of drugs as chemotherapy are pretty solid. The checklist needed to go through in development including animal testing is complicated and thorough. They are still a lot to explore and each day, the armamentarium is expanding. We are now entering the era of targeted therapy, when the prescription of chemotherapy will be specific to the individuals cancer depending of which gene it expresses. Much like if you have a chest infection, the kind of antibiotics to be taken depends on the bug you carry.

The long and short of it ..... the 'penjual ubat' at your local pasar malam and the annoying salesperson trying to sell you supplements may have a point after all!

Never Trust a Fat Dietitian, Never Trust a Skinny Cook!

Irfan having his pizza at Marche - Does he need a dietitian?

I hate Mondays! Most of us do, unless their job include mingling around supermodels (the one without attitudes, rare ones) or their job have an obscenely huge amount of money as incentive, such as playing football for ManYoo. Driving in on Mondays to work usually put me in a right strop, but not today. It's school holidays week here. It usually takes me around an hour to get from Gombak to UMMC, setting off just after 6.30 am. If I am lucky, I may just arrive for my cup of Nescafe and some kuih just before 7.30. Driving in, I usually put on my usual Podcast to listen. It was 'The Chris Moyles Show', from the BBC this morning. I used to listen to him a lot while in the UK. I also contemplated what I did during the weekend. We had lunch at Marche yesterday. The picture at top is of Irfan muching away at his pizza. Before that, Idlan had his sports day on Saturday, and we had our brunch at Delicious, that was nice. Hmmmm ... a diet theme is forming.

Today, it was 7.05 when I pulled into the parking lot. The day is going to be ace.

One of my patient complained that she is losing weight. Not often that a SHE is concerned about weight loss, because it is usually the opposite. I asked her if she having problem with appetite etc. She said she was doing OK before when she stuck to the hospital dietitian plans, but lately, as she is getting healthier, she decided that the supplements were too yucky. She also had another complaint, "dia senang saja cakap sebab dia sudah kurus". (it's easy for her (the dietitian) to say as she is so skinny). Hmmm! An interesting observation. I remember reading an article some years back, in Reader's Digest of all places about a survey they did in Italy. Skinny cooks are never as good as their chubbier counterpart. Does that apply to fat dietitians as well?

Going back from memory, she is right. I can't remember a fat dietitian working with us. The one attached to my ward for example. I remember her being pregnant a couple of years back, and even with the baby I was sure she only weigh around 45kg. She was really skinny. She must have saved a fortune after delivery from not having to spend money in the gym. As for a cook, not terribly sure. So, my assignment for the semester, try to contact the dietitian school and see if they need a Haematologist to give them lectures. If so, I can see first hand if the theory is true or not. I will keep you guys updated!

The rest of the day was spend hearing the moaning from my Final Year Medical Students. They have their exam starting next week. A lot of them complaining about not getting much revision done .... in Facebook! So stop facebooking and get some reading done. To be honest, in the last week before my final exam, I was also having problem concentrating. I remembered watching a lot of TV. I don't think any last minute scrambling would have made much difference. The illusive distinction and book prizes would have still be beyond me! For the boys and girls, I wish them all the best. Yes, I will try to squeeze in another session of short case before the week ends. I must say that the current crop is pretty decent and I am sure they will do well. All the best you all! Now STOP FACEBOOKING!

Note to self - things to do, 1) enquire if the dietitian school need a lecture about chemotherapy, 2) try some of my patients food supplements ..... are they really yucky?

Irfan and Idlan outside Marche