The Decade that was... 2000 -2009

Many things happened in the decade which is fast drawing  its curtain. I am being selective here and mention only those which I feel significant . The tumultuous decade started off with the Y2K scare which, yes ,you guessed it, just a scare. Millions of dollars were spent to prepare us in Malaysia to face the possible computer havoc. Later some experts said "Damn if we do and damn if we don't". Anyway some IT-related companies laughed all the way to the bank!

Y2K compliant indeed!

The event which changed the world forever took place in 2001, the 9/11 which not only killed innocent people but was further used to justify killing more innocent people. It also saw the making of the worst American president in living memory and the attack on Iraq based on false intelligence as part of the war on terror.

The ensuing years, 2002 and 2003 saw many Arab tourists visiting Malaysia. I used to see many of them in London before 9/11, shopping in major shopping favourites like Harrods, Mark&Spencer, John Lewis and Selfridges. They even have hotels in Bayswater named in Arabic but last year I noticed those hotels have closed down. The trend of Arab tourists' arrivals to Malaysia has endured till today, so now you hear plane arrival/departure announcements in KLIA made in Arabic. Just this month I noticed about 80% of guests having breakfast at a five star hotel in KL were Arabs.You did not see this in the last decade before the new millennium.

On Boxing Day 2004, the great tsunami annihilated about 200,000 people mostly in Aceh, Indonesia and parts of Thailand, Sri Lanka and to a small extent Malaysia. The tsunami triggered by the earthquake on the 9.4 Richter scale off the coast of northern Sumatra. It brought a flurry of multi-million USD in international aids. The devastation was enormous and the tales of survivors were heart-wrenching. But we heard of wealthy celebrities like Formula One Schumacher and moviestars like Jackie Chan and famous singers like Ricky Martin coming forward to contribute some of their personal fortune to help rebuild the devastated areas.

                                                                                  Ricky Martin

The devastation in Bandar Aceh. Only the mosque was left standing.

Other major notable disasters were hurricane Katrina which pummeled New Orleans, Louisiana, in the US in 2006 killing 1800 people with damages estimated to be USD 81 billion, the costliest in American history. And the Szechuan Earthquake in May 2008 killing more than 10,000 people and making more than 500,000 homeless. In 2009, a series of typhoons and floods battering the Philippines causing much misery to its people. In 2009 also saw the deadliest Australian bushfire in South Australia killing more than 170 people and wreaking gargantuan damages to homes and properties. And as I write the volcano Mayon in the Philippines is spewing its lava and set to erupt.

In March 2008, the reigning party which had been governing Malaysia for over 50 years  suffered massive losses in the election. denying its usual comfortable two-third majority. Like the Liberal Democatic party (LDP) in Japan, that lost the election for the first time in 60 years. Somehow these losses planted the seeds of rejuvenation of the nations, just like the bushfires which destroy flora and fauna so that new lives would emerge completing the cycle of life.

It is noteworthy to mention the 2008 Olympics staged by China in August 2008. It was one of the most spectacular openings the world has ever seen on 080808. Though I remember well that the steel prices were at all time high as China was using a lot of it for construction works for the Olympics creating a temporary shortage but long enough for people like me who had to renovate my new house, having to pay almost four times the usual cost!

Then the subprime crisis in US evolving into financial crisis, credit crunch, economic melt-down and global financial disaster in October 2008 wiping out trillion of dollars, affecting people from all walks of life especially in US and Europe. We also felt the impact in Malaysia. I lost more than 20% of my stock market investment. Fortunately I managed to recover more than 10% since March 2009. It was a time of heartache for many people who lost their jobs as demands for goods and services plunged and inter-bank confidence retracted. Hard to believe that it happened as I remember in 2007 one of the advisers to NEAC (National Economic Advisory Commission) in Malaysia was saying that the world was flushed with trillions of dollars! Now we know it was just worthless  bubbles.

The Lehmann Brothers

One of the financial juggernauts which collapsed during the crisis 2008

The year 2009 saw the historic inauguration of the first African American, Barack Obama as the  44th president of America. It never crossed my mind  that I would see this in my lifetime. Thanks to the power of the internet, Obama was able to galvanize the nation fast into believing that CHANGE was what they needed after the disastrous unilateralism and policy on war on terror. The American people and the people of the world were already tired of the war President Bush.

                           President Obama- more articulate, charismatic and multi-lateralist.

Tomorrow is the start of a new day of the year 2010 and the first day of the Decade. Though the stock market has somewhat recovered as shown by the Wall St indices, concerns are still being expressed as to its sustainability. We saw the market short-lived panic last November on Dubai World debt problems as US and other European banks are major subscribers of the bonds issued by the Emirate. Indirectly some ripples would be felt in other parts of the world markets.

The Copenhagen Climate Change Summit (7 to 18 Dec 2009) has come and gone and the world is still divided on their share of carbon. Climate change is the politically correct reference to global warming thought to be have been contributed by carbon emission from various sources. There seems to be no urgency  for united global action as the impact is still on a fear-free scale.

Climate change causing ice in Antarctica to melt jeopardizing the native penguins and raising the sea level with its consequences

Just as the world is enjoying some kind of relative peace, we heard of a person who is bent on killing innocent people by taping explosive chemical on his body while on the plane on Christmas over Detroit US. When will these people ever stop? They make life difficult for genuine  air travellers. They make life uncomfortable for people of a certain religious persuasion.

I want to take one thing at a time. I want to enjoy and be grateful for each day, each week,each month and each year and forget the next Decade 2010-2019.... that reminds me, this is the decade before 2020! And what about the prophesied end of the world in December 2012?.... I must have that cup of coffee... sugarless thank you!

                                                Only a cup once in a while to perk me up

.....Am looking forward to South Africa 2010 WORLD CUP.... what an excitement!

MeRRy CHrisTMaS anD HaPpY NEw YEaR 2010

 
Good wishes and joy to everyone!

May the new Decade be better than the last

Let the spirit of world peace endure

Give us good world and local leaders

Bless us with bountiful harvest

Enable us to feed the world

Increase global efforts to address climate change

Save the endangered species

Eliminate poverty, famine and diseases

Create more sustainable global land use

 Preserve our environment too

Better international cooperation

Promote caring  and inculcate sharing

Stop wars, sectarian fighting and mindless terrorism

Spare us from the evil that men do

Let there be light in everyone's heart

Merry Christmas and Happy new Year.

Sinusitis Case and a Combination of Dehydration and Allergy.

Lily is relatively healthy for a 57 year old. Except for the blood pressure which is slowly creeping up due to her age, her baseline blood investigations are within normal limits. She is slightly obese though with a BMI of 30 (normal 23-25 for Malaysian). She needs to exercise to shed off her excess weight. On a positive note,she seldom suffers from any infection.

She travelled to Singapore last week and had a rather spicy dish the evening of her arrival for which she developed bouts of heavy diarrhoea early the next morning. She started to feel off color and the hotel air-conditioning was also not helpful as it made her throat dry. After feeling slightly better at midday, she went to a hair salon in a shopping mall and had her hair permed for almost four hours with only a glass of water.

                                     Lily's favourite hot and spicy "Mee Rebus" (noodle casserole)

On her visit to the restroom of the mall, she was inundated by the smell of cigarette's smoke but according to her she could not see anyone smoking. Now Lily is allergic to cigarette smoke and she could feel as if the smoke had gone through her nose and down to her throat. Her eyes and nose became watery and itchy and she coughed and sneezed incessantly . The shopping mall is,by the way, fully air-cond.

Then Lily, with her hair well couiffered, decided to visit her family friend and later they went for dinner. She remembered eating fried rice and drinking only tea. When she was about to leave, she was besieged by a discomfort in her throat as if the secretions had thickened in parts and was painful.

That was on 12 Dec 2009 and the next morning she somehow felt a bit better and only ate bland food. On the way back home on the plane, three days later, she started again to feel sick and her nose had become congested and secretion thick and yellowish-green and yet she did not feel feverish.By the fourth and fifth day of the initial throat pain, Lily had full-blown sinusitis, an inflammation of the nasal passages and throaty productive coughs signalling the start of her misery.

She was seen on 15 Dec and was started on a course of antibiotics when her condition did not improve the following day. The purulent secretions only receded and became clear on 19 Dec, after 72 hours of treatment. She was advised to continue the antibiotics for seven days. Throughout her ordeal, there was no fever.

Sinusitis, in this case was most probably initiated by the dehydration Lily suffered from the diarrhoea, the hotel air-conditioning, the mall and salon air-conditioning and the compressed cabin air of the aircraft. Then the allergic reaction due to the cigarette smoke. All these factors had altered the normal state of her sinus, rendering it more susceptible to secondary infection by micro-organisms prevalent in the nasal passages.

It is important to avoid getting dehydrated when you travel. it is also not smart to eat spicy foods on account of possible diarrhoea. Avoid prolonged stay in air-cond areas if you are already dehydrated or drink plenty of fluid. Fresh air is best.

For her indiscretion with food during travel and the unfortunate encounter with the smoke allergen in an enclosed area, Lily was off sick for three days, effectively lowering her work productivity. She had looked forward to a year without sick leave and she thought she was going to achieve it as there are only 19 days before 2009 ends.

Tricor is...... A Cold Cucumber

The best time for a long-term investor, apart from selling stocks at a high profit, is when the companies you are investing in are giving you dividends.  I really look forward to receiving these cheques in the specific months throughout the year. I also  check on-line when the payment date of the dividend is due and estimate the time I would receive it in the post.

I have had no problems all these while until one of these cheques did not arrive after about two weeks. This was the first time it happened to me. I knew I had to contact the share registrar to inform about  this but I did not know which one. So I tried one I found on line using the given telephone number.... there started my exasperated exercise. It took almost one and a half hour to finally talk to someone, before that you keep hearing this robotic voice telling you that all the customer agents were busy and try the extension ( how do I know what the extension was because the robot was not interactively human!).

I was disconnected so many times but I knew I had to be patient otherwise I would not get that dividend which I badly needed to top up my MAXIS shares. When at last I  heard a human voice, I told her the name of my stock, only to be told that they were not handling the company's services. I managed to ask the girl who else are the share registrars, then she mentioned Tricor and immediately I remember the name printed on the upper left hand corner of  dividend cheque envelope that I ever received. The girl was nice enough to give me the telephone contact.

This call to Tricor was not too bad as I got through after less than five minutes. The operator transferred me to the relevant section. The woman on the line did not have a warm voice ( I think everyone would know whether the person on the other end is friendly or not after the first few words). I explained to her about the "missing" dividend cheque. She told me to wait another week or so (Ghee!!) and she would send me a form to fill in  then I would have to pay to get the new cheque sent over. Then I informed her that I did not lose the cheque, I just did not receive it!  Why should I have to pay? She said that was just too bad and if I wanted the new cheque I just have to pay. She did not try to explain nicely at all. And that was my money she was talking about!  I would have understood... even if she said " Sorry, that is the  company's policy". Obviously she has not been trained on how to deal with clients. Her soft skills left much to be desired.

Honestly, If I were to choose my share registrar I would not choose this company!

I emailed my particulars and would you believe it? The reply was computer generated... "Dear valued investors.. blah..blah.". this was despite me using her personal company email address AND after we had talked on the phone. I was allergic to this kind of treatment and she called herself "The Manager"??.. I wonder how do her subordinates behave with a boss like that!

I was so relieved when POS Malaysia was able to trace the cheque! And the people there were so nice to talk to, congratulation POS Malaysia! .Your customer service is excellent.

The woman and the company would not exist without the investors... just like doctors , we would not be here if not for our patients so we treat them with respect.

Now, my next dividend cheque is from SIME, payment date is on 4 Dec 2009  and  Oh Blada! The same share registrar is handling it. Hope the cheque arrives safely.....

Are you for real, Cucumber?

                                                                                                                                                      AP photo

UEMLand Dives on Dubai Debt

 The tallest tower in the world
Burj Dubai.


Despite the assurances given, Malaysian investors are not taking chances against  stocks having exposure to the Dubai World which is currently freezing repayment on its massive loan. Properties in partneship with the Dubai conglomerate to develop the Iskandar region is hardest hit so far. A few weeks ago UEMLand was trading at 1.77, when last checked this afternoon  it was at 1.43 with a day low of 1.39.

According to newspaper reports Malaysian construction companies have limited exposure to Dubai financial activities but what is the quantum of the limitation? I suppose Dubai  World will eventually recover through restructuring of its loans and perhaps via a kind of bailout by its cash-rich brother emirate, Abu Dhabi. This then might be an opportune  time to buy UEMLand but how many  retail investors  want to try their luck? I for one, am not game. Moreover affected big western investors are issuing warning that they might not raise any more loans in the future for Dubai , particularly, should the company default on the repayment.

I am glad I disposed  this stock last September at a slight profit, not because I predicted the Dubai crisis but because I wanted to buy Maxis as the potential is more predictable. UEMLand was more speculative in nature and under current cash-strapped scenario, I do not think it is a good idea to hold on to this kind of stock.

I have more luck though with  the Sarawak-based construction company HSL whose shares  I bought at 0.89 and is now doing modestly well. Only government-linked companies, it seems to me,  would go all out for mega projects. Just look at the Dubai World, most people thought that it belonged or at least linked to the emirate that was why they invested happily (greedily?), now we know better. In time of boom  they share your good fortune, in time of bust, they keep a distance and call on investors to look at the fine prints! Who would want to invest in such a country?

People should visit Dubai World's website to check on the exposure of other Malaysian companies.

The Dubai Debacle

I have been monitoring some construction stocks  for some time particularly Gamuda seeing that the 10th Malaysia Plan is coming up in 2011 and some of these are in line for big jobs. I noticed a sudden drop in the price of Gamuda last Friday and concluded that some people were selling for reasons best known to themselves and maybe it was time for me to grab  the stock at a bargain. Only later did I find out that this stock has exposure in Dubai whose Emirate had announced on Wednesday 26 Nov for loan repayment freeze for up to six months. This means that the government-owned company cannot pay its loan and is  asking its creditors for a reprieve till at least May 2010!

The bad thing about the announcement was the timing. It was just before the long Eid Adha holiday  in the Emirate, which left a lot of investors across the world wondering what's next.Some comments included that the Dubai financial crisis would not affect the rest of the world, those affected are mostly banking stocks like the Royal Bank of Scotland , HSBC and Standard Chartered which provide loans to Dubai World an investment arm of the government of Dubai through Nakheel , its real estate conglomerate famous for building the artificial palm-shaped islands. Dubai has wanted to be the financial capital like London and New York but with the crisis, her dream may well remain a dream.

                                      A Stellar Nakheel Project-  Artificial Iconic Palm-shaped  Islands

 

                                    Building Boom with the World's tallest tower in the background

During the boom years Dubai went virtually berserk with constructions. They were trying to attract foreign investors to use Dubai as their destination. In fact many wealthy people including celebrities have bought properties there. However with the credit crunch and global financial crisis, many houses are not sold and projects half completed then abandoned with no adequate fund coming in. The problem was known for some time but the Sultan gave the impression  that this was no big deal.

Some analysts noted that in the past Dubai was always bailed out by its rich neighbor Abu Dhabi, after all the two emirates are related through marriage. If that is the case then, the debacle would only be temporary but it is strange  why this solution was not pursued earlier and avoid the market panic? Was it because Abu Dhabi is sick of bailing out  her high-spending brother? Whatever it is the Sultan had said that he took considerations of all these issues and effects on the financial world before making the announcement.

Night golfing with the Jumeirah Towers in the background- playground for the super wealthy

Affected investors are praying that Dubai would not default on the loans repayment , amounting to some USD 59 billion  so as to avoid the domino effect that might well cause the long-expected correction in markets around the world which have made gains well above the actual economic recovery on the ground. since March 2009. Obviously this debacle sent shivers to all the stock markets around the world. Investors will eagerly wait for more development on this by the Emirate and take it from there come this Monday 30 November.

                                                              Dubai Emirate Towers

Who would have thought this Emirate would face such a   financial crisis? Actually Dubai is the poorest among the seven emirates, it is compensating by taking out loans and creating services infrastructures and some of the projects are really way too pretentious, overambitious  (including the self-proclaimed the only seven-star hotel in the world!) and it did not factor in the world financial crisis in October 2008 as many of the  projects were started well before that.

Dubai Atlantis Hotel- like in DisneyWorld

However wealthy you are if you spend like there is no tomorrow, you will eventually  suffer from your extravagance. Unfortunately in this case, other people, the investors are also affected through loss of their investment either  in value or the whole lot.

It is interesting to note that the tagline in Dubai World website is  "Where the Sun Never Sets"... sounds too arrogant to me. And the German word schadenfreude comes to mind.

City of Brisbane.... Down Memory Lane

Brisbane Expressway

Got a new car and drove with my friend , now a Urologist at Ampang Putri Hospital KL, at 100 mph on this freeway, actually the speed limit was 100 kph ! No wonder the other drivers were left behind  and lucky we did not get a ticket!

City by  the Brisbane River

Brisbane city at night

I learnt to drive in Brisbane. The first time I was at the steering wheel, I hit the accelarator instead of the clutch (manual engine!) and nearly went into the Brisbane river!

My driving instructor was very good. He taught me how to do angle parking up a hill, In Brisbane there are many hilly roads. I remember his advice to always look in the rear view and side mirror, avoid tunnel vision, do not tailgate and drive fast when you are at the head of the traffic at the traffic light when the light turned green because he reasoned that everyone would want to catch that green light, so if you linger, less people can go through. To this day, when I am in that position, I follow his advice and  usually notice that I leave the others way behind.... eat my dust sort of  thing! Kind of hard to change my way...and  I do wonder about the Malaysian driving instructor... heard many first-hand story about them.

By the way, I passed the first time I took the driving test. I remember the tester was an old man, a bit amorous I must say.  After a short verbal test, we went together with me at the wheel and him guiding as to where to go. He jokingly said things like when I got the driving license I must take him for a ride..I had trouble concentrating with him yapping away and nearly went into a no-through road! ( talk about sexual harassment, you find it just about anywhere). But again no wanton  coffee money business here. I passed on account of my driving skill and understanding of local traffic laws. Things could be somewhat different in my country. Rather unfortunate but is being addressed now. Currently Malaysian driving license, unlike Singapore, is not recognised in the UK much to the chagrin of those who truly passed the test!

My only encounter with the traffic police officer was when I crossed the double line on my way back from  the Royal Brisbane Hospital, (RBH) on a Sunday! I then had only a few days before the end of my driving provisional period. I often noticed people crossing that double line and never got booked. So I thought no harm  if I were to do  the same after all  it was Sunday and there was hardly any traffics

Anyway this big burly policeman on an equally big motorbike flashed his light and stopped me. He came to the car door ready with a book and a ball pen, looking vicious. " What did you just do lady?" He barked... my heart ran faster than my thoughts. As he was about to write down on his book (there goes my driving license!), I unashamedly broke down and told him if he gave me the ticket, I would not be able to drive to the medical school and the hospital as I lived a distant away.. please. Ghee.. he actually stopped writing and closed his notebook and told me never to break the law again, and turned to his bike and rode off!! That was a close call. Till now when I see a double line, I recall that " Reasonable Brisbane traffic police officer".... no coffee money business like I used to hear in my own country.

The William Jolly Bridge

Jacaranda  blooming..... is Study time

Jacaranda starts to bloom about six week before our final exams. While the atmosphere went purple, we students knew the time to swot had come. It was and still is an annual natural calender in Queensland, the Sunshine State.

These photos are part of my journey down the memory lane. This is the city where I spent nearly  a decade  of my student's life. My university at St Lucia and later the Medical School at Herston and the Royal Brisbane Hospital where I once worked. And my friends... Allison, Elizabeth, Warren, John, Shaun, Janet, Richard, Lynnelle,David, Daryll who is now a prominent  Queensland Cardiologist and others.. those in my group work are best remembered as we studied and played together...they helped shaped some of my outlook on life. I was rather timid and took life seriously when I first set foot in Australia, was bullied silly by my  Aussie friends as I was the only foreign girl in that class.... And I almost forgot, this was where I met my husband, a chemistry of the opposites! No, no love at first sight.

I am feeling nostalgic because I happened to stumble upon a blog by a local TV personality whose daughter has been admitted to University of Queensland, my Alma Mater. For a close-up of the recent photos of the university , people can visit his blog at  http://aznilnawawi.blogspot.com/.

Kookaburra.... sits on the old gum tree, Merry merry king of the bush is he;

Laugh, kookaburra laugh, kookaburra gay as life can be... ( a sing-along)

   

Brisbane Botanic Garden

Brisbane Botanic Garden

Steps going down to the Brisbane river.

Stood on this very spot ... memories flooding in.. and that song by my favorite Diva, Barbra Streisand... "The way we were".

CHaNge aNd chAnGing ThINgS ArOuNd.

I like changing things around  once in a while. I think it is good to let people see refreshing change instead of the old appearance time and again. Some people change their cars every now and then and those who cannot afford will sometimes have their cars repainted a different colors. Change is a form of emotional release for individuals

   

                                                                    My favorite jacaranda blooms

Usually people do not change something they wish others to identify them with. For example you normally would not change the flag of your country as people have come to recognise it as a symbol of your nation.

I remember though some countries change their names to indicate their departure from colonialism for example Burma is now called Myanmar, Ceylon now Sri Lanka, South Rhodesia is now called Zimbabwe in fact many of the African countries have now been renamed. I was looking for Madras in India but it is now referred to as Chennai and Guangtzu in China is the old Canton.

Names of institutions are also frequently changed  such as  Malayan Banking is now known as Maybank, Hongkong and Shanghai Bank is now HSBC and Arab-Malaysian Bank has been renamed AmBank. And if you look at some of the logos of companies, you will notice that Telecom Malaysia has changed its logo the same goes to Shell whose shell has changes in shape.

Though we do not normally change our name, but you must have been familiar with western movie stars who change their names to more glamorous sounding ones such as Marlyn Monroe for Norma Jean. I think Nicholas Cage actually was born with an Italian name. Even our Tan Sri P Ramlee was actually Teuku Zakaria and Saloma was Salmah Ismail.

Have you noticed your local supermarket which keeps rearranging their stuff every now and then? You can also see this in hotels which keep on refurbishing their hotel rooms every seven years or so. I used to stay at the Kuala Lumpur Park Royal and the Seri Pacific and what a welcome change it was when they redecorate their rooms  from glum set to bright minimalist concept. It is like having a completely new experience.

Some people go to the extent of changing their life partner when they find that they are no longer compatible. I cannot imagine that scenario though sometimes it does cross my mind when I am angry :D.

As for me this time, I have just changed the color scheme of my blog.

Allergy...would you believe the offending agent?

For some months I used to blame house dusts and maybe the pipe water as the cause of my frequent multiple sneezes in the morning, afternoon and evening. It was really irritating and I was at a loss as to what triggers such an allergic reaction, complete with rhinorrhea (watery nose) and watery eyes. After a while I became kind of used to it rather grudgingly and I refused to take antihistamines.

Then I noticed recently that the sneezes had mysteriously gone in the morning and evening but I had it sometimes in the afternoon after lunch at my place of work. I was wondering how could it be. What has changed in my environment? Particularly in my house.

Then at the clinic, one afternoon after I cleaned my teeth, my violent sneeze came back! Then it dawned upon me that this happened right after teeth brushing. I subsequently realized that for a couple of weeks now I had used a toothpaste with a different brand at home but the one kept in my clinic was still the same brand which I had been using for a number of months as I like its taste and lemony smell.

It appears that I am allergic to one of the ingredients in the toothpaste! Unfortunately there are just so many ingredients in that toothpaste, there is no way I can guess which one is the culprit. The new brand of toothpaste only contains potassium citrate, zinc citrate and sodium monoflurophosphate as its active ingredients.

I am very glad that I am able to discover the offending agent that has been causing my misery all this while. Much as I like the toothpaste, I have to stop using it.




The ingredients of the offending toothpaste.
Just look at the chemicals that we put in our mouth!



In this day and age when we are subject to so many man-made stuff, we have to be aware of those which are detrimental to our health. I have seen patients who suffer allergic reactions from cosmetics, hairspray, nail polish and deodorants. We have to be vigilant to safeguard our health.

For those who have similar symptoms, check out your toothpaste!

Chronic Cough in Young Children

Sesame Street Gang... children just love them!

Courtesy: Philip diResta



Most primary care doctors (that I know of) who come across young children with cough will not look or let alone examine their chest. They would ask the mother/father a few short questions and immediately write out a prescription, usually consisting of decongestant (if above 2 years old), secretolytic ( decrease mucus thickness), antipyretic if there is fever and vitamin.

In most occasion, the children would recover not so much due to the medicine as to the self-limiting nature of the viral infection. There are however cases of children who continue to cough week after week and the mother would always return to the clinic on the basis that the medication has run out and they need a replenishment! Unfortunately in some instances, the children are again prescribed the same medication especially the cough mixtures. And they continue to cough causing great concern to the family.

Chronic cough here is defined as frequent daily cough for more than three weeks.

I have come across children like this. They keep coming to the clinic but never get better. One of these children was a five year old child whose mother had brought him to see a Paediatrician on two occasion and when the child still did not get better and instead became worse, the mother brought him to the clinic. I noted that his breathing was rather rapid as he walked in slowly. When I examined his chest, there was wheezy and coarse sound indicating an abnormal breathing. A chest Xray was immediately ordered and true enough, he had a pneumonia! I gave a course of antibiotic and a bronchodilator and after about one week the child came rushing in excitedly into my clinic. The mother was smiling broadly and was very grateful.

Last week another three year old male child was brought in with a similar history, cough for more than one month and had seen two different doctors. He however appeared more active and breathing rate was normal. According to the mother the child had been taking medicine but have had no effect. I asked her when did the cough get worse, was it in the evening or when he was actively running around. She replied the latter. And was there a wheezy sound? Yes, there was.

The child's chest examination revealed that wheezy sound (rhonchi in medical jargon). As he had been coughing for more than one month, I prescribed an antibiotic and a bronchodilator to reduce his bronchospasm (wheezy sound). I told the mother to stop all cough mixtures. In fact prolong use of cough mixture will worsen and prolong the cough!

Today the smiling mother and her child came for review and she reported that he no longer cough and the child was running around the clinic and not coughing. His chest was clear on auscultation.

This group of children usually starts off with a viral respiratory tract infection which somehow does not go away and is secondarily infected with bacteria progressing to irritation of their lung (bronchioles) causing spasm and coughs. The infection needs to be treated and the lung complication ameliorated. Most of these children would have a family history of asthma, either the father or mother or one of the siblings. It is important to manage them well so that they will not continue to be asthmatic in their adult life.

And as doctors, faced with this kind of cases, we need to take a good history and look for and hear those chest sounds!

MAXIS Listing on Bursa Malaysia on 19 Nov 2009

This evening a couple of my friends told me that their Maxis IPO applications have been successful and they are waiting with bated breaths to find out how much they are going to make out of their shares this coming Thursday Nov 19 I could sense their great excitement.

As for me, I chose not to apply for the IPO fearing that my money would be stuck in the early trading of the shares, should my application fail, and I must say that I kind of miss being in this realm of risk! But this situation I am in, can also be described as a form of discipline, an inner wish for order and of not wanting to be with the crowd. In a nutshell, unsavvy as I am as a small time investor, I am keeping close to my gut's feelings. So let us see how the long-awaited stock which, in a way, has been politically cajoled to be relisted , will perform on the first day of trading and the days, the weeks and months that follow.

As Dow Jones is doing well on Wall St this week, people can expect the shares to have a good upside. Come to think of it, I am also excited about the listing this Thursday.. and to my successful friends, here's wishing you all good luck!

In the meantime, I have instructed Charles, my hard-working remisier to keep a close watch for me... just in case, mind you.

Recalling Another Quiet Child.

Some years ago my domestic help was taken ill after returning from her country. She was purging and having diarrhoea. As cholera was prevalent then, I decided to take her to the hospital's emergency department for an examination and a rectal swab.

While waiting for her, I stood near the table where the doctor on duty sat and observed the goings-on. The casualty room was relatively busy and there was only one doctor on duty. I knew the officer as he had ever worked in my health program before. We had small chats. At the corner of my eye, I saw a man standing close to a bed with an infant lying quietly on it.

After writing some notes on a medical record, the doctor went over to the child and without so much as asking for the history, he proceeded to examine him/her. I noticed that he did not even look at the child. He was looking sideways when he put his stethoscope on the child's chest! Then he came over to the table and scribbled his "findings".

Then I heard an elderly nurse, in a bored, melodious tone, asking, " Whaaat are weeee dooooing with this child doctor?". And to my surprise the doctor replied, "Nothing wrong with him, send him home". My instincts told me something was not right, and having worked in a busy Children' s ward for two years , I could not help but stepped in.

I took one look at the child, about 12 months old, and noted that he was unusually QUIET, limbs hardly moving, eyes opened, nasal flaring and skin very dry (poor turgor). I felt for his fontanel (scalp suture above the forehead, normally remains open till about 18th month old) and noted that it was depressed. My God, the child was at least 10% dehydrated!

I told the doctor that the child needed an IV drip fast and that he should be admitted to the ward as the signs showed that he was severely dehydrated and should he be sent home, he would surely die.

I turned around and spoke to the man, the child's father who had tears in his eyes as he related to me that this was the third time he brought his child to the casualty and the last two times he was told to bring the child home. According to him the child had been having diarrhea and could not feed for some days.

The on-call pediatric medical officer was contacted and came down to the casualty and confirmed the findings and the child was promptly resuscitated and admitted to the ward.

I have never forgotten that quiet child. Should a nurse or anybody else tells me that a child is sick but is very quiet, I worry...... really worry.

The Quiet Child.... Indeed.

Last Friday 13 November 2009 as I was preparing to leave my clinic in the afternoon, my nurse came in and said there was an old lady with a small child who had just arrived and were waiting to be attended to. Seeing that I was getting ready for the weekend, she told me , "It's okay doctor, the child is just having a fever and rather quiet".

Silently I thought , regardless of the state of the patient, it was my duty to see him/her. The lady then came in holding the child close to her bosom. According to her, the child was already feverish four days ago before his mother, her daughter, took him for a holiday. The fever became worse when they returned the previous evening. She noted that the child had been vomiting and his lips had become blue.

I inquired into his birth, immunization, medical and hospitalization history, unfortunately she, the grandmother of this two -year old child, could not give specific and satisfactory information. When asked where the mother was , the old lady replied that she was at work!

I proceeded to examine the child, who was unusually quiet. His body temperature was 39.7 deg. C (normal body temperature is 36.8 deg. C). His lips were bluish, his skin was dry (dehydrated), his heart rate was very rapid and breathing was laboured underneath his T-shirt. His breath sounds were brassy and air entry was reduced on both lungs on auscultation. I could not really discern a heart murmur on account of the fast heart rate. I ordered for a chest-xray and noted opacity in his lung and the upper part of his heart (right and left atria) looked enlarged. I am waiting for the Diagnostic Image specialist to comment on the heart finding.

For all intents and purposes, the signs and symptoms suggested a pneumonia. I would have liked to determine his oxygen saturation but unfortunately we did not have the equipment (pulse oxymetry).

The quite child was, in actual fact, gravely ill! Not taking any chances and mindful of 2009 H1N1, I rang up the Pediatrician on call and informed him about the toddler's conditon. We set up a normal saline IV drip (20ml/kg), nasal oxygen (2L/min) and suppository paracetamol and packed him off to the hospital in an ambulance accompanied by our senior staff.

I ended up leaving the clinic rather late but I was pleased that the little boy was properly diagnosed and referred to the hospital for appropriate treatment instead of being sent home with a panadol syrup and perhaps an antibiotic, because he was... a nice and quiet child!

The Heart and Emotional Stress

I have read and heard , in layman's terms the effects of emotion, especially strong ones, on the heart which beats faster when in a state of anger, anxiety, fear and the like. Medical fraternity talk of the heart being stimulated by adrenaline (epinephrine), the hormone released as a result of symphathetic nerve actions during "fight or flight".

In a young person with a relatively normal heart, the resultant effect of extreme emotion on the heart is most likely an increase in heart rate. This is essential to increase oxygen in the tissues for higher production of energy required for "survival" actions. The rate will be faster but the appearance of the electrical configurations as seen in the electrocardiographic (ECG) tracings will remain the same as in a normal situation.

However in a person who is elderly or having a pre-existing heart condition such as ischaemic heart disease, where parts of the heart are suffering from lack of oxygen due to narrowed blood vessels, the heart response to severe emotion might be different as not only would there be a rapid heart rate but the appearance of electrical tracings would also be affected.

A 48 year old lady came in one day for follow-up of her hypertension. She looked anxious and uneasy and seemed to be in a hurry. When I felt for her pulse, it was rapid and irregular. I ordered for an ECG tracing and observed that her heart rate and electrical tracings were abnormal. She was otherwise not in any physical distress. She told me that she had to go to the airport to receive the body of her aunt who just went to the capital city by air the day before and collapsed and died on arrival and the remains was being taken back by the following day's flight home. It was such a shock to her that she could feel some chest discomfort.


Her ECG in Sept. 2009,
with an abnormal heart beat
( arrhythmia)

That was about two months back, and when she returned a few days ago, her pulse was normal, as confirmed by a repeat ECG. She had recovered emotionally and was looking so much better.


Her ECG in Nov. 2009,
with normal heart beats
(normal rhythm)


It is important to always remind ourself that emotion can be controlled mentally. Controlling emotion involves acceptance. Refusing to accept an event beyond our control, appears to stimulate further the nervous action , and burdening the heart. Of course this form of mental control would apply to certain situations only such as unreasonable anger and anxiety.

Seeing the heart response of the above patient convinced me that emotional stress could be deadly and we must somehow manage it without having to resort to medication unless really indicated.

Medical Error and Doctor-Patient Communication

This 51 year old railway worker has been on treatment for hypertension for a number of years but has only been on on my follow-up clinic for the last nine months or so. I noticed that his blood pressure readings were seldom consistent, some months were within normal limits, while others were high such as 160/100.

I suspect he has not been compliant in his medication. I informed him gently that unless he co-operates with the attending doctor, it would be a waste of time to come for regular visits to the clinic. As he was on a medication requiring him to take three times a day, I also cautioned him that he needed to take it at regular interval, every eight hours. I managed to explain in simple terms about drug concentration in blood and the concept of drug half-life and the effects on his blood pressure.

Well, he seemed to understand and started to take the medication according to instruction. His blood pressure seemed to stabilise within normal levels but then he started to complain of his heart "racing" every now and then at rest. As he was taking the drug regularly then , he began to experience its side-effects ( in some patients only), that is an increase in heart rate (nifedipine-induced tachycardia), brought about by this particular drug.

Under this circumstance, I told him I was going to change his medication to another class of anti-hypertensive to be taken once a day and for him to return to the clinic in a fortnight to see its effects on the blood pressure (BP).

He came today and his BP had gone up from 130/84 the last visit prior to the change of medication to 168/100 but his heart was no longer "racing. I asked him what had happened and whether he took the drug. And just to test him, I asked how many times he took the tablet in a day. He told me three times. I was aghast as the record showed once a day for the new drug. Then it dawned upon me that this patient could have been taking three times a day a medication which was supposed to be taken once a day!

I asked him to show me the tablets he was taking ( he had to return home to get them!), and sure enough my suspicion was confirmed.

The story was he took out the blister pack of the new drug and removed the plastic jacket on which the dosage and frequency were written. Then, according to him, he saw the old plastic jacket where three times a day was written and took the new drug according to that. Within a few days he started to feel uneasy, light-headed and his knee joints felt weak. He then stopped the medication on his own and so the high BP reading today! And those days that he had not been on medication.

Doctor and patient, especially one who is not well-educated, really need to communicate as the patient's understanding of medication is usually limited and this limitation can adversely affect their health. And in this case, a medical error had occurred due to the patient's lack of drug safety culture.

AXIATA....Am I glad I trusted my Gut's Feelings!

On Monday October 26, I was splitting my hairs whether to buy AXIATA stock which was being battered down or to keep my money and buy MAXIS on its "relisting" day 19 Nov 2009. I did not have any "firm" pointers as to MAXIS being a good or a bad investment.

I did ask around and received mixed opinions. My stockbroker told me to be careful as the IPO price, according to him was "fair value". If I were still to buy, he said, I should buy later in the day as there would be an initial morning frenzy but on the whole he said, I should be ready for the long haul.

My friend's ex-remisier said the MAXIS dividend yield might be low but dividend you would have as they had promised (subjects to those risks I read about in their prospectus, of course !) but for that share price you would want to look at other value stocks.

My gut's feeling was to go for AXIATA..... Gosh, that name sounds like some kind of Greek mythological GOD... so I moved some of my dormant plantation stocks and grabbed this battered down stock at 2.92. I went in when the crowd had left! Today, as they say, the rest is history.

Yesterday I visited Alex at Nexttrade and read his analysis on MAXIS relisting. I am glad at least I have some kind of opinion from another remisier who is neutral. Be that as it may, my instinct tells me to just buy some MAXIS shares for a fun ride on the roller-coaster and be ready with my tablets for possible dizziness.

Whatever happens, I am going for the long position on AXIATA , and I am set to be on the slow steady train ride which will be more pleasurable.

Amanah Saham 1 Malaysia (AS1M) is still my choice.

I went to ASNB branch office today to sell my ASN2 units to purchase some MAXIS shares. The unit price is right for me to sell as I bought them at 0.78 and 0.87 and now it is 1.0274, (slightly higher last week).

A few weeks ago I had wanted to acquire quite a number of MAXIS shares but somehow have scaled them down as the current market condition still remains volatile, much given to spurts of news rather than real sustainability. For me it is not fun to swim in this unknown waters much as I like risks but the current scenario kind of put me off.

I will still buy MAXIS shares at one-tenth of my intended purchase but where do I put the rest of my profit from ASN2? I spoke to a couple of ASNB officers regarding my concern about AS1M being benchmarked against a low yield five-year Malaysian Government Securities (MGS) and the possible negative effect on the dividend rate. Both of them told me that ASB is benchmarked against KLIBOR (Kuala Lumpur InterBank Offered Rates) which has a lower yield and yet look at ASB dividend rate! I have never compared it like that before.

Being the latest PNB fixed price product, you can expect the AS1M dividend to be quite attractive at least in the first year. You can now invest more than the permitted amount of 50K for those below 55 and at 100K for above 55. After mulling over for some time, I have decided to put my money into AS1M and lower my risks.

I will monitor MAXIS performance and may increase my shares later if the dividend yield is encouraging. At the moment, it looks like everybody is trying to get their hands on MAXIS shares so let me be one of the contrarians. Should I be proved wrong... Well, it is good to regret once in a while... that is life!

MAXIS Prospectus...I am reading the risks.

The relisting of Maxis will be on 19 November 2009 and what a month to launch it! It's the largest IPO in Asia Pacific so far for a number of years. My friend who is a post-paid Maxis customer has been offered 1000 shares at IPO price currently at 5.20. How lucky he is! He even got the prospectus for me to go through.

I am debating whether I should try my luck applying for the IPO online through my bank or to wait it out on the listing day and purchase the shares at market price. If I failed to secure the IPO, my money would be stuck for the next 10 days. As the number of shares offered to the public is only 9.4% of the total units, I am not hopeful that my application would be successful.

I have already in mind how many units I want to purchase before looking at the thick prospectus. I went straight to the section on investment risks. There are just so many risks ranging from highly competitive business, technological changes,new WiMAX /Broadband operators, dismantling of a number of existing base stations due to health and environmental concerns, socio-political changes, right to outbreaks of SARS, Avian flu and pandemics of Influenza A H1N1,that are likely to affect business operations and company profitability and ability to pay promised dividends.

Then I went through the section on positive stock outlook and am encouraged by the company's various achievements, strategies, business leverage and partnerships and human capital investment. They even have an Oxford university graduate in physics as one of their directors! I also noted that many of the top management staff have just joined the company in 2009.

So after weighing the risks, I am reducing my intended number of to be purchased shares as I am aware that previous stock performance should not be the measure that it will perform again. And yet no risk, no gain. Let the fun begins!

TA Dividend in Specie.... what is this?

My friend sent a text message yesterday and asked me to check for him why TA stock suddenly dropped drastically. The stock seemed to be doing well, from about 60 sen early this year to the highest of 1.48 just last Monday.

In fact he had bought this stock at a high price of about 2.02 last year well before the financial crash in October 2008 and was caught with his pants down so to speak. He lost a lot. So as a way of recouping some of his losses I advised him to buy more of this stock at the current low price (ringgit cost averaging). He finally did and bought some at 1.26 and sure enough it appreciated in a matter of a few weeks due to the recent "bullish" financial stocks.

Quietly, he sold his newly acquired shares at 1.47 and made a tidy sum. When I found out about this, I told him he was being impatient, he should have waited longer as I was sure he would gain more. He said something about not being greedy... well, what could I say?

Yesterday TA shares dropped to 0.78 and we actually missed the Bursa announcement on 15 Oct that the company would issue dividend in specie. Well what it means is that instead of issuing a cash dividend, this company, likely lacking in cash, has decided to give stock dividends instead, that is like for every five existing shares you hold they might give you an additional three shares, for example. Yes, he now has more shares but the whole value is much lower!

He was grinning cheek to cheek that he had made an earlier decision to sell the stock at 1.47 as , if he were to do it after this dividend in specie, he would have lost nearly 50% of his money. He was glad he did not ask for my "advise"...... well , after all didn't I say I was not trained in finance :D

Herpes Simplex - another disease through sharing

He came to do the rapid HIV test this morning. This man, 23 years of age, a security guard, came to the clinic about 10 days ago. He gave a history of abdominal pain and frequent diarrhoea for the last one year. He also noted loss of appetite and loss of weight. He looked thin with a greyish sunken cheeks. He voluntarily admitted that he did not look like that a year ago.

Having taken his medical history and examining him, I was thinking about an irritable bowel syndrome (IBS) in which a patient usually has a recurrent abdominal pain and bouts of diarrhoea. I ordered for all the basic and diagnostic blood tests which would be ready in two weeks. I treated him conservatively and asked him to come for follow-up after two weeks.

Immediately after this patient was a sweet single girl of 18 with an weak smile. I asked her what could I do for her. She said she had been coming to the clinic for intractable mouth ulcers and had been given oral cream to apply and even some antibiotics but to no avail. She has to take painkillers as the ulcers were painful and getting worse.

I asked her to open her mouth and shown a torchlight, and there were multiple ulcers behind the lips (I immediately use a mask and double glove my hands!) and held her lips as there were more sores in her gum and buccal mucosa (wall of mouth). It was florid! Yes, it was Herpes simplex type 1, a sexually-trasmitted viral disease (STD) without a grain of doubt. Not accustomed to beating around the bush, I asked her whether she practised oral sex. She looked stunned and then meekly admitted it.

I had some time to advise her on safe sex practices. She thought oral sex was safer as she would not get pregnant, being a single girl. I prescribed an anti-viral drug and OralAid cream for her ulcers and a mild painkiller. Before she got up, I told her to ask her boyfriend to seek treatment as well. Then my nurse blurted out that the previous patient was in fact her boyfriend! Ahah..... this rang a bell.

I asked my nurse to call in the man by himself and gently queried him about his sexual life. He is single and he has multiple sexual partners. I recalled the clinical features of "the slimming disease" observed in Africa years ago and planned an HIV test for him. I also treated him provisionally for Herpes simplex infection on account of his girlfriend's condition.

Does he know about safe sex? He looked lost as if the concept was foreign to him. Despite all the massive government spending on public health education on STDs prevention, this is the reality I am facing. I suddenly felt depressed.

Today he came for the test and when I enquired about his girlfriend, he said all the mouth sores were gone and as for himself, the abdominal pain and diarrhoea were also gone and he looked more cheerful.

After giving him a pre-test counselling, in my heart, I said " It'd better be ,man ,for your sake!".

An Avoidable Medical Error

The missed heartbeat
as seen on ECG

Today most of my patients are hypertensive and they come according to their respective appointments. They dutifully sit down in the waiting area for their names to be called. My nurse would search for their blood investigation results (if any) and attach them to their medical records. Due to the large number of cases, I would only know the patients by their faces and not by their names. Moreover I have always expected my nurse to be vigilant and ensure patient-record concordance.

A name was called after a few patients and a lady of 52 came in. I have of course seen this patient a few times but for the life of me I would not know what her blood pressure trend has been unless I looked at the record.

After the usual greetings and questions on her health, I proceeded to check her blood pressure(BP) and pulse rate (PR). I found the BP to be higher than the last visit two months ago and her PR was a lot slower than before as well. I checked the medications, it was not a beta blocker which could have slowed down her pulse rate. I then asked her whether she had been under a lot of stress lately since she had admitted earlier that she had been taking her medication regularly. She said yes, there was this issue with her husband that was making her stressful. Hmm..

I looked at the blood results, the parameters were excellent. The cholesterol and the fasting sugar level were perfect. I congratulated her. Wanting to know her lifestyle secrets, I asked her about her meals and what sorts of food items she liked and whether she exercised regularly. She said she hardly had time for regular brisk walking and that she liked drinking goat's milk, eating meat and fried foods and I was like wondering how she could produce such excellent biochemical blood indicators with such habits! Good genes?

I wrote out the prescriptions and told her to find ways to remove her stress which could have contributed to her higher blood pressure during this visit. I was still uneasy about this encounter and was rather reluctant to tell her to continue with her lifestyle.

The next patient was called in and as I was asking about her general health, someone knocked on the door and true enough she was the previous patient and she had been prescribed the wrong medication!! Her medical record was exchanged with the patient in front of me. What a blunder! This near mishap could have turned into an avoidable medical error.

A good system of record matching is already in place, it is the human error which needs to be addressed. A new young and inexperienced nurse does not help matters but she is learning fast. On my part, I need to trust my clinical judgement more the next time.

By the way, shouldn't I be greeting my patients by name ?

MAXIS or AXIATA? .... AXIATA or MAXIS?

Relaxing with Degas


I am at a dilemma. Since the announcement of the relisting of the telco giant MAXIS, I have been thinking hard about acquiring some of its shares. How would I fund this purchase? As most of my liquidity has gone into bonds and the likes, I was thinking of restructuring/readjusting my portfolio especially the plantation stocks which have been in the doldrums for over eighteen months!

I have been doing some homework on MAXIS which will be relisted before end of 2009. The latest that I heard the IPO would be between RM4.80-5.60, it is just a speculation based on the computation of other telcos' prices on the market as the book-building exercise is still going on. MAXIS will apparently pay 85% of its income as dividends, it has more than 40% share of mobile phone business in Malaysia, it is a well managed and innovative organisation on the negative side it will be relisted minus its more lucrative overseas operations. Notwithstanding the negative aspects, this stock, to me is going to perform like it did before the delisting about two years ago.

On the other hand AXIATA, formerly TM International is not to be outdone. It has a great deal of potential growth due to its significant interests in the mobile telecommunication business in India and Indonesia apart from other countries such as Sri Lanka, Singapore, Iran and Cambodia. At the moment there is a minor selloff going on at the market and the price which has been gradually appreciating over the last six months has currently reverted to that of last July 2009.

The price is very attractive at this point to me. I am not market savvy at all but it looks to me the disposal of a substantial amount of AXIATA shares by EPF, announced on 21 October might have something to do with this depreciation. EPF it seems is set to acquire MAXIS shares at RM5.60, as one of the anchor institutional investors. So do I follow the crowd or do I follow my gut's instinct of acquiring the battered down AXIATA stock? I am at the fork of a road.

The other alternative is just go headlong and get those AXIATA shares and sell off my ASN2 and buy those gold MAXIS units. ASN2 has been doing well lately due to the rising FBM KLCI . This way I will get both these bluechips.... otherwise I will have to toss a coin.