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.

Small Caps Driving up the Market!

The current rally at the stock market pushing up FBM KLCI appears promising but when you look at the sectors, almost all of them are showing high volumes by small caps. To me it is too early to go into these stocks and my past experience has shown that it is not safe especially when you are buying stocks for a longer term!

While a few selected bluechips are doing well, many are not having the normal volumes seen about eight weeks ago. Are the institutional players taking a breather and retail investors are out in full force? The Dow Jones surpassed 10000 more than a week ago on US economic recovery sentiments but the weak greenback may have kept the foreign fund managers away.

To me, while the market is looking "bullish" and exciting, it is better not to be with this crowd instead it is now time to buy those value stocks and hold on to them and wait for the mutual fund managers window dressing their portfolio balance sheet!

Ectopic Pregnancy... my Good and Bad Experience

Some years ago I was woken up by my junior doctor who told me he had just treated a young single girl with a haemoglobin of 6.8g/dL ( normal: 12-15) at the casualty for anaemia. He then told me not to worry he would be admitting the girl to the female medical ward shortly. I said ok and was about to go back to sleep when an anxiety struck me. It seemed odd that the girl should present to the casualty in the early hours of the morning. Chronic anaemia would commonly come to the day outpatient clinic. I immediately dressed up and got into my car and drove to the hospital.

The girl was still in the casualty. She looked pale and was lying still .After examining her and excluding conditions such as an appendix, I did a simple "rocking vagina" test and she cringed with pain and immediately I knew she was having an ectopic pregnancy which had been bleeding into her abdomen and called my Obstetrics and Gynaecology colleague to come in and take over the case. Yes, she had an ectopic and was operated on first thing that morning.... I saved her life!

I could not blame my officer as he thought an ummarried female could not be pregnant!

Last year a married woman came to see me and complained that her period had been prolonged. I asked about her menstrual history and she told me that she had been on oral contraceptives for almost a year ( she got her supply direct from a pharmacist!). And she just stopped using it a few weeks ago so I thought this could have been an erratic bleeding following use of the contraceptive and usually a woman would experience a prologed period of no menses or sometimes heavy ones after they stop the contraception. I advised her along that line of thinking.

Apparently she continued to bleed and someone at the hospital did a pregnancy test and found that it was positive! Gosh the woman had an ectopic pregnancy, possibly a small one but ectopic pregnancy still the same and I had missed it. I take it as a good lesson and not to just stick to the history but to look out for possibility that the contraception could have failed and thus have a high index of suspicion on her pregnancy status.

We learn from our dear patients, they are our best teachers.

Hypertension, Urine Test and Kidney Mass

This 36 year old lady, a police officer, has been coming to the clinic for about six years now following a diagnosis of high blood pressure made during her last pregnancy. I thought she was rather young to have suffered from hypertension, yet pregnancy-induced hypertension is not unusual and many women continue having the condition well after their delivery.

When I first saw her she has been an "established hypertensive" with long-term prescription of drugs to keep her blood pressure within normal limits. I simply continued her treatment and kept her on my follow-up list. I normally make small talks with my patients on their health and she told me of being frequently tired which she attributed to her work. I also noted that in her earlier medical notes her blood pressure has not really been satisfactorily controlled despite high doses of drugs and her supposed compliance.

I thought of a possible deterioration of her kidneys due to prolonged hypertension which may not have been optimally controlled. I decided to order a simple test that was urine analysis. Her urine was found to have a significant presence of blood so microscopic that she has never complained about it. I repeated the test some time later, taking care that she was not in menses, and the same finding was reported.

Blood in the urine could mean a few things, an infection, a structural damage due to hypertension or autoimmune disease or a growth. I then proceeded with a KUB (xray of kidney/ureter/bladder) which showed nonspecific opacity above her left kidney and an ultrasound was later undertaken which confirmed a big mass sitting just above the kidney. Could it be an adrenal mass (adenoma) releasing excess hormone (aldosterone) causing high blood pressure? If this is so ,then by surgically removing the growth, her blood pressure should return to normal and there is no need for those cumbersome drugs! At this stage I referred her to see a kidney specialist (nephrologist) and a hormone specialist (endocrinologist).

Fancy what a simple urine test could do?

Fungal infection.... Been There for Years, Doc.

About six weeks ago a 26 year-old, thin and depressed-looking man came in with a complaint of being itchy all over his body including his face. When asked how long had he had the condition, he replied that it had been there for years! He volunteered the information about applying all sort of cream bought over the counter. The itch was relieved temporarily on occasions and came on again and again and now had affected his face.

I took his social history and found out that he worked as a security guard with night shifts and his meals were irregular and appeared to be not nutritious. He seldom changed his work uniform and had poor personal hygiene like irregular showers or bathing. He also kept many cats in his house.

There were numerous small flat lesions with central clearings and scaly borders indicating a fungal infection in his face, trunk, arms and thighs. It was quite formidable and I had a good mind to give him a course of oral anti-fungal medication for two weeks which could be toxic to his liver.

On second thought, I would try a simpler treatment first, so I prescribed an anti-fungal cream to be applied twice a day after a shower and a daily dose of vitamin C and advised him to improve his personal hygiene, eat nutritious foods which I listed for him and to get rid of those cats which are known to carry fungal agents if not properly looked after.

If these measures did not work after six weeks, I would definitely start him on medication by mouth. His liver status was assessed by a blood test as a pre-therapy requirement. I was sure he would need the oral treatment.

He finally returned to the clinic today and what a surprise it was! He looked clean and cheerful and his skin! Where were the lesions noted six weeks ago? All I could see were very light and small and clear depigmented areas and he said the itch had almost gone then.

He actually followed the advice to the letter and it had paid off. It is such a relief for me as I do not really like to institute a therapy which would cause harmful side effects for my patients.

A condition which has existed for "years" is now coming to an end with simultaneous improvement of his quality of life.

I recommended that he apply the anti-fungal cream for the next 10 days and always have regular nutritious meals and to forever practice good personal hygiene. And to watch out for those cats!

Hornets..My Painful Unprovoked Encounter

The culprit... the yellow belly


The tragic deaths of two young siblings stung by hornets in Sarawak, East Malaysia last week is truly saddening. They had no chance against a swarm of agitated and defensive hornets, the stings of which bring out an equally dramatic and overwhelming response by the human body. In their case, apparently one of them accidentally disturbed the hornets' nest.

I recall a painful encounter with these hornets in a public park where I did my walking exercise a few years ago. I was walking with my husband and some other avid walkers along the tracks and around the park were leafy trees some of which were flowering giving off sweet fragrance.

As I was feeling quite energetic, I broke off from the group and walked ahead by myself. Suddenly I felt a stinging sensation on my head, then there were whirring sounds like flies hovering over me and more painful, sharp stings landed on my face. In a split second, I was running and fending off, you guess, the hornets and they were chasing me. I ran and shouted and in my fright, I could still think that I should not run towards the group otherwise the hornets would also sting them. So I ran forward with my husband running after me and there I was shouting at the top of my lungs with my spectacles flung out and looking for a pool of water near the War Memorial. I was ready to jump in when I saw that there was no water in the pool! Of all days. I then ran to the open space away from the trees in a circle and I guessed the bees got tired of me and flew away.

Now why was I attacked? Why only me? I did not disturb any hornets' nest, I was minding my own business and hornets were the last thing on my mind. The other walkers were not affected at all though they were only a few steps behind me.

The pain was indescribable, kind of sharp and hot and soon enough, my face was swollen like an overweight pumpkin. And I was thinking before long my throat would swell and I would not be able to breathe. This is how bee sting victims die. There were nine bites on me and some friends said jokingly that I was lucky as those bites would have killed a buffalo.




You know why the hornets chose me that day? Yes, they chose me because they thought I was a source of honey... because I washed my hair the night before using honey shampoo. If you are going to walk outdoors with lots of trees, do not use honey shampoo to wash your hair. If you do not believe and want to experiment, do use a protective gear.

Two Weddings in One Week

She had been single for much of her working life. So had he in fact he was longer at living a life of a bachelor. She was 37 and he was 52 and they met in the organisation they were working for , he as the new boss and she as the company secretary. The families had been worried sick about their single status and at last, through mutual love, they had decided to end their single days.

A Centrepiece of Fresh Roses


Their wedding was held in the daytime at a multi-purpose hall, I would call this a reception, rather than a wedding proper as there were no sitting on the dais like couples in this ethnic group usually do (even though there was, I noticed, a wedding dais on the hall stage) but a relative whispered that the bridegroom refused to sit on it as he did not want the large number of guests, including some VIPs to have to gawk at them. The proud bride's mother had wanted it in the first place. Moreover, they had had such a ceremony at the bride's home attended by close friends and relatives a day earlier.

The hall was beautifully decorated and it was packed with about 500 guests, including several dignitaries The lunch was catered by a leading hotel. The foods were excellent and the company amiable. The wedding couple was resplendent in their matching traditional clothes of golden hue. They did not look their age!

My second wedding invitation was five days after. This one, an evening affair, was really grand and held at a leading five-star hotel. The bride and groom were in their twenties. There were about 1000 guests and all came in their fineries. The ballroom was magically transformed into a hall of light and flowers.

The wedding dais was shaped like a Roman throne complete with Grecian pillars and metres of sheer white organza surrounding them. The atmosphere was festive with many little girls all dressed up like little angels in white carrying baskets of flowers. The background music was joyous with local and overseas singers belting out wedding songs. A gamelan Group was also there. A short video of the couple on how they met was tastefully presented . The guests were the who's who of the city and they turned out in full force. There was a "blessing ceremony" where the VVIP guests were invited to sprinkle fragrant water on the hands of the couple and shake their hands.




Delectable Durian Cheesecake


The food was attractively presented and it was served individually at our table. But I prefer the taste of the food at the first reception though they were all placed at the centre of the table! So even if the venue is more expensive, it doesn't mean that the food is as flavoursome. Very much depend on the chefs, could it also depend on one's tastebuds?

It has been a tradition of this community that every wedding guest would be given a gift to take home. Usually a piece of cake, flowers, sweets, boiled eggs decoratively wrapped, scented dry flowers in cute colorful rattan basket or nicely painted vases, according to the affordability of the host. At the first reception, attractive gold wire baskets with scented pot-pourri were placed at each guest's seat. In the latter, girls came around to distribute colourful paper bags containing small things to each guest.



An Interesting Gift Bag


At the end of the reception, the host, the wedding couple , the in-laws and their close relatives would line up to thank the departing guests and that would then be the opportune time for the guests to surreptitiously hand in some money to the host. Normally we would estimate the cost of the food plus the gift for the couple and gave that amount. Indeed some wedding receptions are actually paid for by the guests!

For the first reception, we gave the money to the brother-in -law who invited us. For the second reception, the host is too wealthy and of such social standing that we opted not to give out of respect for his position in society. As far as I know, wedding guests in this community usually do not give the money to either the bride or groom. It is just not the done thing!

All things said, for me a wedding reception is always a good time to meet many friends and relatives and to wind down. It is always after the reception that one gets to meet up and talk about things that do not really matter. I enjoy attending weddings which usually signify a fresh start of a responsible partnership.