Cholesterol Lowering on Your Own Accord.

In my practice I come across many patients with high blood cholesterol (above the normal accepted limits) and as expected many of these people suffer from high blood pressure, diabetes,heart disease,gout, you name it, they are all there. While some are obese or overweight, others have "normal" weight based on the standard weight for height and the calculation of Body Mass Index (BMI).

Almost 95% of those who attend my practice presented with symptoms before they were diagnosed. These include recurrent headache, urine frequency,unquenchable thirst and single joint pains. About 5% came following routine screening of "healthy" subjects. Among those with symptoms, some can be considered as late presentations as they also complain of chest pain, blurring of vision and numbness in their legs, indicating their small blood vessels have been compromised.

The current trend among doctors is to prescribe cholesterol-lowering drug (statin) to their patients who have high blood cholesterol, one pill daily and that'll take care of the nuisance! The drug companies promote this "wonder drug" on a massive scale, so can we blame the doctor?

Granted that some patients may be genetically programmed towards high cholesterol and others just cannot change their lifestyle of rich foods, there are patients who are in need of a good diet advice that they would adhere to religiously. I have come across such "born-again" patients.

As I do not give medications unnecessarily, my usual questions for such patients are about their work,lifestyle habits and what kind of cooking oil they use at home. Then I let them know that cholesterol is important for our body, too low will make us slow, too high will block our blood vessels causing heart attack and brain attack (stroke). There are two types cholesterol in our body, the good (HDL -high density lipoprotein) and the bad (LDL-low density lipoprotein). Practice diet control, less fried foods, less fatty foods and more of complex carbohydrates, brown rice, wholemeal bread and plenty of fruits and vegetables.

Well, so far three of my patients who were tested high for cholesterol before the diet regime, have normalised their cholesterol level after six weeks. Did they do some exercise? Yes, the normal 30-minute brisk walking at least three times a week. See. no need to take that over-rated drug, statin with its possible side-effects on your muscles!

You can do it on your own accord.

One of these three proudly told me that he only ate boiled foods now, how boring !! So I advised him that having a plate of fried mee or an ice-cream once in a while would not instantly increase his cholesterol, it is all a matter of being disciplined.

Unfortunately, being disciplined is not many peoples' cup of tea.

Scabies..... Yes Mem, it can be treated.

Mite-causing Scabies


Last Friday, 18 Sept 2009, a rather exasperated mother brought in her two children, a girl of 10 and a boy of about 6. She said she had been to see two doctors for the last couple of weeks regarding her daughter's complaint of an itchy skin but the condition had not gone away despite the treatment given and according to her, was getting worse. I noticed that the child was vigorously scratching away.

I took one look at her hands and noted the small nodules in between the webs of her fingers and knew instantly that it was scabies, an itchy skin condition caused by a mite. The previous diagnoses were both recorded as "nonspecific skin problem" and an anti-itchy (calamine) lotion was prescribed on both occasions. This lotion does not kill the mites.

At the corner of my eyes, I saw the brother, standing behind his mother, also scratching his skin. I asked the mother whether the boy was coming for the same complaint as without looking I knew that he had been infected by his sister. The lady replied that yes, he just got it a few days back. He also had the tell-tale lesions of scabies.

I gave an anti-scabies prescription and had also advised the lady to do a spring cleaning of her house, get all those bedsheets and articles of clothing washed in hot water and dry them in the sun to kill all those mites causing scabies. And yes , if the anti-mite lotion is properly applied overnight and proper house cleaning done... the itchy skin condition will go away this time.

H1N1 (swine flu ) vaccine.... Hooray! At last is here.

The vaccine, after going through a trial in US, has now been approved by the Food and Drug Administration (FDA) on 15 Sept 2009, about six months after the pandemic was first reported.

FDA approval means that the US government has certified the vaccine is made properly and fulfils the specific manufacturing, safety and quality standards.

According to US and Australian researchers, just one dose of this new vaccine appears to be strong enough to protect adults and should take effects in 8 to 10 days following vaccination. Vaccine safety for children and pregnant women is still being studied. The vaccine is expected to be gradually available by mid October 2009.

The above Associated Press report brings great relief to Health authorities the world over especially those in the northern hemisphere which is entering the winter period when flu virus transmissions are much more efficient.

Countries that can afford the cost of the vaccines have, months ago placed orders. US have ordered 195 million doses, UK for almost 80% of its population and most likely the same percentage for other wealthy countries such as Germany and Australia. Whither the poor countries?

Due to the prohibitive cost, priorities have to be set so that those most at risk, children, pregnant women, those with medical conditions and frontline health workers will be protected.

There is no better protection against influenza A H1N1 than vaccine.

By the time the vaccine comes to Malaysia, we would have known its side-effects (if any) on a large population... an upside to the whole issue of this long-awaited vaccine... but, on reflection, any life loss due to the inability of the country to get the vaccine earlier is definitely a grim downside.

CIMB capital-protected structured products.. Is my capital really protected?

Early in 2008 I was looking to diversify my portfolios . During that period there were many financial products being introduced by the various banks and financial firms. I was particularly interested in the Islamic Sukkuk (bond) launched by CIMB and had gone the local branch to enquire about it.

The lady at the branch told me that they were not handling the instrument instead she talked me into buying another innovative product called capital-protected structured product, and the purchase deadline was only a couple of days away! I was made to understand that the return would be about 20% upon maturity at three years or more at five years. It was like a fixed deposit except that the returns would be much higher. The minimum deposit was 50K. And she told me that the attractive feature was I would get my capital investment back irrespective of the performance of the fund. In fact she tried hard to persuade me to double the investment and to put it there for five years! I wondered whether she would do that if it were her own money.

Now, this product is not listed/quoted as a normal trust fund. Instead it is only accessible after you go through layers of "windows" in the bank website. I was getting irritated due to difficulty in monitoring/opacity and had started to regret buying this product, Dynamic Market Ryder. Normally I would like to think that I was not that gullible, but the word capital-protected was indeed attractive.

A few days ago I came across a Singapore Law Watch article that reported Singapore would ban the use of the term "capital-protected" to describe investment products as many retail investors had misunderstood the term to mean that their capital would be protected upon maturity and apparently this was not the case. This came about following the global financial crisis especially the collapse of financial giants, for example, the Lehmann Brothers in US that issued such products,among others. A financial adviser based in the Lion City had explained that capital-protected was not the same as capital-guaranteed product. The latter is the one which would give you back your investment from day one regardless of the financial product's performance.

I went on the net to check out for myself this so -called capital-protected structured products. There were so many confusing definitions out there but I accept the one given by Barclay Bank UK which clearly stated that, upon maturity, you may not get back your capital if the fund did not perform.

I rang up the same lady at the CIMB bank asking her about this possibility of my capital being reduced but she insisted that I would get back my capital, upon maturity, even if the fund was not performing..... big deal! No wonder Singapore is coming up with the recommendation of not allowing bank staff to sell these financial products as they themselves are not really conversant with the product's profile, definition and risk implications.... the fine prints. They would usually promote rather than taking up an advisory and neutral role. An individual investor has indeed to be cautious.

I just hope that the fund performs that I would get back my capital plus the "expected" return in 2011 when the global financial crisis recovers? Currently this fund, related to property investment, is not performing, much to my dismay. This personal debacle is yet another lesson of financial naivety and the overrated word that is DIVERSIFICATION.

One should only diversify after the risk-reward ratio of a portfolio has been fully analyzed... I am still learning.

HaPpiNesS is BeiNg AppReciATed.

A bouquet of yellow flowers



This morning most of the patients I attended to suffered from chronic diseases such as hypertension and diabetes. some were newly-detected cases whereas others had been on my regular follow-up.

One of my regular patient is an obese Account Executive in her late forties. A very pleasant lady who is anxious to cooperate to stabilise her hypertension. she has been hypertensive for the last 10 years following her last pregnancy. The last blood test done showed that she is also suffering from high cholesterol, high uric acid, high triglyceride ( another form of lipid)... signs of a metabolic syndrome so typical of this type of patients.

Her blood pressure had been resistant to treatment so I decided to check her urine and found that she had high level of blood and protein (which should not be present if the kidneys are normal). Fearing that it could be stones in her kidneys, I ordered a KUB, an x-ray of the kidneys,urinary tract and bladder. There was no stone noted but her left kidney appeared shrunken. I repeated her urine test and the level of protein and blood remained the same.

The radiological and laboratory pictures indicate that she is suffering from renal nephropathy ( microscopic malfunction of the kidneys), no wonder her blood pressure had been recalcitrant! I immediately informed her that I would refer her to the Nephrologist ( kidney disease specialist) at the general hospital for specific management and follow-up. The condition can deteriorate to chronic renal failure.









This morning she came with a gift of yellow flowers for me, I was quite touched by her simple gesture of appreciation. It was nothing but the thought that counts. How I wished that the condition could be cured for her sake...but I know that it is just a wishful thinking.

I am happy to be appreciated, but really, I am just passionately doing my work.

Heart racing, Fingers trembling, Weight losing....

A 57 year old thin,attractive and agitated lady came in this afternoon complaining of restlessness for a number of months especially in hot weather. According to her, occasionally her heart seemed to beat faster. She had been told that these could be normal menopausal symptoms.....Hmmm, a rather prolonged one considering that she had stopped menstruating nine years back!

I decided to ask about her appetite and weight. Her appetite,according to her, had been good but she noticed that she had been losing weight. Ahah.... I looked at her neck there was no visible enlargement of her thyroid, there were, however, small palpable nodules in her thyroid gland. Asked to stretch her hands, I could discern a fine tremor which was amplified when I put a piece of paper on them. Feeling for her pulse, I counted it to be 116/minute and the ECG confirmed the rapid heart rate.

I ordered for a thyroid function test (TFT) and it was later confirmed that this lady, with the so-called prolonged menopausal symptoms, actually was suffering from the effects of a hyperactive thyroid!

I am doing a specific hormone studies to exclude any lesion in her brain. In the meantime she is given medications to control her heart rate and her thyroid hormone production and these will eliminate her annoying symptoms.

Amanah Saham 1 Malaysia...Have I got It Wrong?

Jumping on the Bandwagon
by Matt Hamm

Like many other eligible Malaysians, I happily acquired units from this PNB latest product, hoping to diversify my current capital- protected portfolio. However I have not been that excited lately as news of its low return has surfaced. As of Aug 25 only one fifth of the 10 billion units offered have been taken up forcing PNB to extend its offer deadline to one more month to September 30.

Have I bothered to read the prospectus before I acquired those units on Aug 5? A sheepish no! You know why? Because I was lazy to monitor my stock market portfolio, because I was getting risk-averse in the current market situation, because I listened to other people, because I trust PNB, because I was caught in the euphoria to ride on that bandwagon! So many unacceptable reasons. Now, the crux of my uncertainty is the following statement in the fund prospectus... read retrospectively of course:

The fund's returns will be benchmarked against the five-year Malaysian Government Securities (MGS).

The current yield of five-year MGS is about 3.7%, so the return is slightly higher than bank interest rates and, therefore, is not as attractive as previous Amanah Saham funds. The general feature of this equity income fund seems to be higher risk with low return so its risk reward ratio is not that favourable. The only upside is its high liquidity as there is no sales charge and it can be transacted at RM1 per unit.

Gee.... one always can be wise after the event... had I bought TM shares at 2.97 on Aug 5, the day I bought AS1M, I would have made a small fortune today as it has appreciated to 3.29! That would have been thrice the annual return for AS1M under the current rate... and what more, it is within a matter of six weeks! How can you lose with TM, the reliable blue chip. Still I cannot complain as I'd bought a sizeable TM shares at 2.62 out of investor's frustration and also as a form of dollar averaging, when the then price dropped drastically following TM's May capital repayment exercise... still could have made some more.... greed creeping in.



Roller-coaster ride

As for my AS1M investment, I will keep it there till after the dividends have been declared next year and take it from there, hopefully all the investment research houses are wrong and that the word "benchmarked" is only a rough guide such that the return could be higher, or at least comparable to other PNB fixed-price funds and alternatively MGS yield would have doubled by then?... But of course if the bull starts to awaken I might just get off the bandwagon ride and go on that roller-coaster ride instead... The thrill and the fun of it all...

Malaysia Airlines Values Customer Loyalty

As I was going to work this morning I saw an envelope laying on the table, addressed to me. It has an Enrich Gold logo at the back of it. My first thought was that the company was finally going to notify me that I am no longer eligible to be a member of the exclusive club as I have not been travelling extensively like I used to do. See, I have been enjoying the privileges of an Enrich Gold membership for more than 10 years, uninterrupted.

At first I was not keen to read the letter but somehow I quickly tore it open and out came a gold card! Gosh! There must have been some mistakes in the mileage calculation for as far as I know I do not have the re qualification points! Upon reading the letter by the General manager of corporate marketing and loyalty programme, I was pleasantly surprised that MAS has decided to continue my Enrich Gold membership. It is indeed a touching gesture on their part. It shows that the company is not robotic in their decision. There is the element of recognition for a loyal customer.

Though there is the other airline offering cheaper fares, I have yet to fly in it preferring MAS at any time. I am off to London again soon and the only way to travel is by MAS excellent business class. Thank you MAS, you really made my day!