Flying with MAS and experience at Heathrow terminal 4

I was pleasantly surprised, as a gold card Enrich member, I was offered the use of the first class lounge. I had once used it in 2002 on my way to New Delhi on official duty. It is much quieter of course compared to the normal business class lounge and the food is served by waiters on white table cloth. It;s like a five star hotel and I had a couple of well-heeled Europeans for company.

The shower room is complete with WC facilities unlike in the business class which is separate. Yes the experience was welcoming prior to the long flight to London.

I had a good dinner in the lounge and opted not to have anything on board. Watched some videos and off to a good sleep. Woke up about five hours before arrival with a headache! Despite knowing the physiology of headache I decided to ask for a cup of MILO... ghee that made the headache worse I immediately requested for two cups of orange juice and within 10 minutes the headache had disappeared... thanks goodness, I was dehydrated... so no paracetamol please.

Breakfast was not so good as I made the wrong choice of "nasi lemak".... the rice was soggy and the condiments not so tasty. The attentive steward tried to replace it with omelette but I declined.

Yes my next seat companion was a lovely English lady who returned from Perth Australia after playing golf there. She was very stern at the beginning but we got talking a few hours before arrival as she had been going to and fro the toilet. I was glad I chose an aisle seat.

As I mentioned earlier we were given a card for premier lane immigration check. Very fast but too many people initially at the lane . I was served by a young British Pakistani officer  with a funny gelled hairstyle. Anyway as my passport was brand new as I just renewed it before this travel, he had his uneasiness and brought out a little gadget from his pocket to "scan" the passport!! He took some time triggering me to blurt out that he did this because it was a Malaysian passport which has been getting bad names around the world airport immigration check. I then took out my professional membership cards, my IC etc without him ever asking and he finally stamped the passport! By that time there was no one behind me. he was doing his work and yet why does a bona fide traveller always have to suffer this undue scrutiny? By the way the last time I was through this lane it was a breeze and the serving officer was a British English man with an unpleasant and sour face! This Pakistani officer at least had a nice smile and he even apologised for taking so long..... I forgave him.

After a long walk, luckily I had a bag on trolley, I arrived at the baggage reclaim carousel. It was cramped and like most space in London very narrow. I prefer Terminal 3 anytime. It is less vibrant and people crowd together. KLIA is 100% better.... ghee! How I miss my country with its warts and all.

We arrived at 5.10 am local time and I was out by about 6.20 am, would have been earlier if I had my old passport with me with all those international travels stamped on it... the young immigration officer would not have to apologise. Well a single lady travelling..... remember those mules? It makes me cringe.

Remember when you are travelling with a brand new passport just bring a long your old one. It saves you a lot of hassles.

Flying off to London with Malaysia Airlines

I am leaving for London in a few days. Actually I dread traveling long distant like this especially when you are alone as you do not know who is going to be sitting next to you for that "captive"12-hr  journey.

I am traveling business class with MAS, my favorite airline. The cabin staff usually make you feel pampered and at home so on that score, I am not worried. The seats, two in a row, are also ergonomic and you can have a restful sleep. I used to travel economy class when I was a student and I wonder now how I could have put up with such a crowded atmosphere and cramped leg room?  You can hardly move and watch out if you have a middle seat of five in a row and when your next door passenger is fast asleep and you cannot control that bladder of yours! I remember my body ached quite a bit on arrival.

When you travel business class they give you a form on board to go to Heathrow immigration through Premier lane so it will be a breeze as less people in a queue. Come to think of it, it might have been packaged into  the cost of your  ticket. Nothing is free in this world!

Thanks to the internet that I can check the weather and temperature on arrival so looks like I am going to have to acclimatize from 32  to -3 deg C! Have to look for all my warm clothing  from my last trip in 2008.. Gosh I have been so "busy " I hardly have time to pack! Zana please make sure you bring along those warm leggings when you fetch me! Yes, I must remember to print that  Terminal 4 map as not to feel lost. I have been to London many times and the earlier terminal was at number 3 which I am familiar with. This is the first time I am coming to T4.

I'd better start packing as I will be away for almost two weeks. And  I just hope the passenger sitting  next to me is not an obese gentleman who snores.....

Prolonged allergic reaction... currently alleviated

My second patient for today was a 53 year old lady whom I saw about three weeks ago complaining of itchy rashes in her arms of about  three weeks duration. She was not an asthmatic.

I remember she was quite distressed and was scratching away. And she said that, had she been fair, one could actually see the redness in her skin. She had an allergic dermatitis likely to be contact in nature. It was quite extensive and one would notice the thickening appearance of the skin with numerous scratch marks. She said she could hardly sleep due to the itchiness.

She had been to see three doctors and I was then the fourth. The first gave her antihistamines and calamine lotion, the second gave her an antihistamine injection as well and the third gave her a steroid cream which apparently worsened her itchiness so much so that she had to apply baby lotion to soothe the "burning skin". Obviously local treatment did not help neither were the usual oral and injectable anti-allergy agents. So I prescribed her a tapering oral dose of steroid and asked her to return after she had completed the therapy.

So she came today, smiling cheek to cheek and telling me that her condition had been "cured". In fact , according to her, the itchiness disappeared after two days of the medication. She thanked me profusely and showered me with praises and said she prayed for my good health and that of my nurse too! She apologised for not coming earlier as she had to travel outstation to see her sick old mother.

She also said she did go back to the first doctor for a cold medication and she told him that his medication did not cure her  itchy condition such that she had to seek other doctors to get relief. Apparently the private doctor  had inquired  who was the doctor who "cured" her and also asked to look at the prescription. 

She was indeed verbose with excitement and a kind of gratefulness. This patient made my day.

On a serious note, I advised her to keep away from the allergic agents/irritants as the condition will recur. Actually  I do not fancy giving oral steroid on a regular basis as it is against my training and ethical practice.

Recurrent skin allergy and persistent low-grade asthma with pain in the abdomen

A 17-year old schoolgirl came in early today complaining of itchiness in all her extremities for about three days. On general examination she appeared perfectly in good health. Both her forearms and lower legs were covered with raised coin-like rashes (in medical jargon they are described as maculo-papular lesions). She also complained of abdominal pain and at times her mouth would get swollen as well.

In a busy primary care clinic, a doctor would have been tempted to just ascribe the condition to some allergy caused by  the patient eating something that she was allergic to. In fact, she did mention that she was allergic to seafoods. An attending doctor would just prescribe an anti-histamine to reduce the skin reaction and alleviate the itchiness and send her away.

My instinct told me that something was not right. I therefore decided to engage her by asking for her history. She has been having these allergic reactions since 2004 ( when she was 11 years old) in fact she was hospitalised in the paediatric ward for one week for a severe allergic reaction around that age. She also said that she had asthma since childhood and that her mother suffered from the same condition , asthma and recurrent skin eruptions. Ahah.......

I asked her what she used for her asthma and she told me it was the blue metered dose inhaler (MDI) (ventoline) and she had been buying it  from the pharmacy on her own with no medical follow-up!! She said it was not that effective and that she had difficulty breathing almost everynight! Daytime was usually fine.

I decided to listen to her chest and yes I could discern the mild rhonchi (wheezy breath sounds) scattered on both sides of her chest. I gave her a questionnaire for asthma control test (ACT) and she scored 8 out of 25 revealing how poor her asthma control was.

The overall picture shows that the girl has an hereditary allergic condition which is not properly managed. What is affecting her lungs (respiratory system) and her skin is also affecting her gut (stomach and intestines) causing recurrent abdominal pain.

Her asthma is poorly controlled and she obviously needs a stabilising medication what we refer to as a "preventer"  on a daily basis along with what she is using now (as and when an asthmatic attack comes on)  referred to as  a "rescue medication".

I explained to her the need to come for a regular medical follow-up to assess her condition and perhaps for a specialist referral later on should the situation warrants it.

And to think that people self-medicate for this condition is really worrying to say the least.  Buying MDI ventoline without a doctor's prescription is also unthinkable in countries like UK, US, Canada or Australia.