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

Should we keep UMMC Astro-free?

It's Sunday, but since one of my colleague is away in Taiwan, I covered him for the weekend duties. I came in for my morning ward round and late morning, I met one of the Medical Officers in the Common Room. While waiting for her, I came across a piece of note on the wall. I snapped a picture of it on my mobile, but for some reason I can't transfer it to my laptop. It was a simple feedback form from the committee asking what they would like to have in the room for the future. One of the reply was to have Astro, the satellite TV company here in Malaysia. Some body wanted a subscription to include the sport channels. The request was promptly rejected and the reason being it may jeopardise patient's well being. Hmm... seems far fetched? Let me tell you my experience.

Wednesday, 7th June 2002. World Cup, Japan. England playing Argentina. I was working in Manchester then. Everyone was watching the match in the doctor's common room. It was just before 11 am due to the time difference. Score was nil-nil. 42 minutes gone in the first half. Every one was still glued in their seat. I can count there were about 50 of us in the small space.

It has been a tense game, mainly played in midfield, but in term of technique, the Argentinean were clearly superior. After 19 minutes, Owen Hargreaves was injured, and was replaced by Trevor Sinclair. England lost what ever left of their midfield superiority. A stray pass, and Owen got through towards goal, but took a heavy touch. From nowhere the keeper came in and upended him. Pierluigi Collina, the referree, has no choice but to point to the penalty spot. Beckham had the penalty duty, not only to score a goal, but to bury the memory of France 98 when he was sent off in the quarter finals for kicking Diego Simeone, an Argentinean midfielder. Everyone remember that infamous incident right?

The room was quiet. Becks put the ball on the spot. Took five steps back. It seemed an eternity. Suddenly all our bleeps went off in synchrony, "CARDIAC ARREST, CORONARY CARE UNIT; CARDIAC ARREST, CORONARY CARE UNIT". Argh! Luckily I was not on call. The anesthetist shouted, "whoever that is, he deserves to die!". Beckham scored seconds later.

Hmm! I wonder if you are watching such a tense match, with the bleep going off, what would you do? I suggest no Astro in the MO common room. The UMMC website should also say, "please come to UMMC, where the doctor will be on hand 24 hours a day and their common room is Astro-free!" Long live UMMC! Would you sent your relatives into a hospital with Astro installed?

Update on Monday, March 16, 2009 at 10:10PM by Haris Abdul Rahman

Managed to upload the said image

ManYoo 1 - Liverpool 4, and my pre-game rituals proven right ... ish

Oh dear! Vidic really got spooked tonight. Turned into an ordinary defender by Torres who had an excellent week, a stormer in the midweek game against Madrid the other night. I am optimistic still about winning the League. It is the consistency that counts over a period of many month. It is not about just having a good week, and getting beat later by the likes of Middlesborough.

Not only that I am a football fanatic, I am also born superstitious. I always put on my right shoe before the left. Enters a room with my right foot. Always stepping into a vehicle with my right peg, hence Malaysia being a right-hand drive country prove tricky when I enter into the driver's seat. Recently Manchester United has had a good run. Winning all and sundry, not always in style, but winning none the less. I would like to think I have put in my contribution in the winning streak. Every weekend game since Xmas, I always go out to a Mamak joint near my place and buy myself Mee Ladna, tandoori chicken and naan bread. I then don my 2001 long-sleeved home kit, with the number 4 and name 'Veron' printed on the back. ManYoo won every game, van der Sar went on to break the British record etc etc.

I was going through the ritual again today. But shock horror! My red replica shirt is in the washer! Therefore, I wore my 2003 shirt with 7 Ronaldo instead! At least that would be worth half the luck. Oh no! It's definitely not working. Or as Randy Jackson said it best' "I'm not feeling it, dawg!". I supposed it is only a game, but I am sure the phrase, "Sports is not about the winning, but about the taking part" was coined by a loser. I suppose if we were going to mess up, let's do it well and proper. Take it with the chin up. There are other games to be won, and I can bet Liverpool will lose their next league match. Watch this space.

But first things first. Have to call Alex Ferguson and apologise on behalf of my maid for not washing my shirt in time for the match.