Amanah Saham Nasional (ASN) units on "sale" and dividend in two months' time

This morning I went to the local ASNB (Amanah Saham Nasional Bhd)  branch to update my AS1M (Amanah Saham 1 Malaysia) book. It is always a good feeling to see your dividend in print! And by the way, as many of us know if you do not take out the dividend as it is annually credited to your account, you are actually unleashing the power of the "compounding principle". The accumulated amount is, however, subject to the annual rate of inflation which would affect the "value" of your money in the future so just be mindful.

Not withstanding,this mechanism of multiplying your money is excellent for young people who have many years of working before their retirement either in the private or public sector or anyone else (businessman)  for that matter. Saving for one's old age when one's capacity of income generating is greatly reduced is clearly a responsible practice.

Now for those who still want to make more money in a couple of months' time and are eligible to purchase the variably-priced PNB unit trust managed by ASNB, you can buy ASN whose price has come down slightly from 0.85 to 0.80 per unit and the dividend to be declared in about 10 weeks' time is expected to be more than 5 sen per unit thus giving you a better dividend yield compared to the fixed priced PNB unit trusts.

Transaction fee currently discounted by 2%

As it is variably priced, like ASN2 and ASN3, there is an up-front  transaction fee of 5% but for the period till end of this year, the fee has been discounted to 3%. The rate will revert to 5% in the new year (2012). It is a good way of "parking" your available money  for temporary investment. When you decide to sell after the dividend is declared, there is no more transaction fee. Of course, depending on the unit price after the declaration of the dividend, you will either have a major or minor gain but unlikely to lose.

I was made to understand that ASN unit price is benchmarked against the Bursa composite indices and if the current notable recovery on the stock market is any indication, one would expect the unit price to rise in the new year. The upcoming election is expected to momentarily excite the market despite the palpable external financial turmoil.

Honestly, I am envious of people who are eligible to  purchase this unit trust as there is a high probability that they will gain. A caution here though, any decision you make to buy this unit trust is entirely at your own risk. 

Benign Prostate Hypertrophy (BPH) and hypertension and......

My 52 year old patient RM has been on my hypertension clinic follow up for the last 12 months. Before that he was seeing other doctors. As he is a serial defaulter of his treatment, he keeps changing doctors earlier on to avoid, most probably, being rebuked by  some of them.

RM is an educated man holding quite an important senior position and he also travels outstations quite often. Besides having signs and symptoms of an enlarged prostate and a history of hypertension, he also suffers from chronic constipation and urinary retention, strangury, frequency and nocturia. All these symptoms are likely to be the effects of  his enlarged prostate.

I also observed that RM always looked depressed and not forthcoming about his condition especially with respect to his medications. I found out that he also defaults his urology clinic appointments (for the management of his prostate problems).

On his third visit I noticed his blood pressure to be rather low, 108/72. I asked him whether he was taking any other drug beside the blood pressure lowering drug that I have prescribed for him. He denied this. I was worried and after the consultation, told him to return any time he felt an unusual discomfort. He looked, as expected, rather depressed.

His following appointment was in August 2011 but he never turned up.

He came in early October with the complaint of  numbness on the left side of his body. He had defaulted for two months. He also failed to keep his urology appointment. At first I thought he was suffering from a mild stroke due to a high blood pressure as he admitted he had not taken anti-hypertensive drug for the last two months. But his blood pressure was strangely  within normal limits. I also could not elicit any signs of a weakened left side of his body. His  sensory and motor responses were normal so as his muscle tone and power and there was no other neurological deficits.

I was scratching my head as to what was going on with this "non-compliant" patient. I asked him again what other medication he was taking and he had better tell me if he wanted me to help him. After what seemed a long time, he admitted he was taking a drug to increase his urine flow. Then it dawned upon me that RM has been taking a drug called terazosin which also acts as  a blood pressure lowering drug.  That explained the low blood pressure recorded on his last visit. He was taking a double dose of "anti-hypertensive"!

It is therefore no wonder he experienced discomfort due to a low blood pressure whenever he was taking my prescribed drug. When he stopped the medication, he felt better and so he defaulted. I painstakingly explained the accidental blunder to him. I might not have continued the anti-hypertensive's prescription had I known he was on  terazosin.

On this non-scheduled visit, he admitted his urinary symptoms, accompanied by  back pain were getting worse. Wanting to be referred to the hospital , he came up with  the complaint of  left-sided body numbness which was, however, not verified by specific physical examination.

Giving him the benefit of the doubt, I referred him to the emergency department of the hospital for further evaluation and observation . Prior to that I took the opportunity  to advise him to always cooperate with the doctor so that his condition can be better managed.

And honestly, it takes  great patience not to dislike this kind of patient. Despite his reluctance to cooperate and his defaulting  twice on my clinic,  I have never admonished him, that is the reason he keeps returning but unfortunately he stretches it a bit too far and ends up not helping himself.

Urinary incontinence : An 11- year suffering

Last week a lady of 50 came to the clinic complaining of pain whenever she passes water (urinate) and this has been going on for many years. It has become worse for the last few years and whenever she goes to a private or government clinic in her home town, she is given the standard treatment for urinary tract infection, that is a course of antibiotics and bladder cleansing solution. But the condition keeps on recurring and she has lost track of how many similar treatments she has received.

She traveled a distance of about 130 km ( about two hours' drive) to come to the city to get another medical opinion.

I decided to engage her by asking about the history of her condition. She married in her early teens. Her problem started about 11 years ago since the birth of her last child, her twelfth (12th)! It was a home delivery and she suffered from a uterine inversion , she said "semua peranakan saya keluar" ( my uterus came out ) and had to be pushed back in at the hospital. She has been on an injectable contraceptive ever since then.

I probe on the nature of her urination. From the answers I summarize  the following; she feels a sense of heaviness as if something is coming down there (private part), she has urine dribbling, aching pain in her back and pelvic region, she has frequency (urinating many times a day ) and also urinating many times at nights (nocturia) and at the same time she feels she could not empty her bladder completely and urine keeps leaking and more so whenever she coughs (stress incontinence -loss of control of her bladder).

Her urine test showed the presence of a small amount of red blood cells but it was the physical examination of her genital area which confirmed my suspicion. There was an irreducible bulge coming down her vagina. The condition is referred to as pelvic organ prolapse most likely to be uterine. Prolapse of the uterus is the downward movement of the uterus due to weakened muscle of the pelvis likely as a result of injuries during childbirths.

The obstetrics history (twelve deliveries) of this poor lady testifies to her present predicament. No amount of antibiotics is going to help her unless her basic physical problem is treated. Her long suffering is due to poor diagnosis of her symptoms. A proper history taking could have avoided her unnecessary poor quality of life. As it is, none of the doctors who attended to her ever examine the genital area. Her gynecological problem requires to be managed at the secondary care level (by a hospital  gynaecologist) through referral which was what I promptly did.

Steve Jobs- Farewell to a Global iCon

I join the world today in mourning the passing of a great inventor and a computer genius, Steve Jobs on 06 October 2011. His accomplishments are legendary and his legacy will be remembered for generations to come. Macintosh, iPod,iTune,iPad and iPhone  are Apple products brought to us through the collaboration ,innovation, vision and efforts of  Steve Jobs.

Steve Jobs, Apple Products and Apple Shares

He changes the world of computing and makes it more delightful wherever we are.

I just like to re post some of selected net photos on Steve Jobs as memories on my blog.

The young multimillionaire

The Apple of the World's eye

Innovator and marketeer extraordinaire - iPod 2001

The world loves Apple

Turtle-neck sweater,Levi 501 jeans, trainers

iPhone launching 2007

Steve Jobs's  silhouette  on Apple logo- Tribute by Jonathan Mak (Hong Kong)

The outpourings of tributes the world over for Steve is just amazing. He is indeed the Apple of the world's eye.

 Quotable quote from:

Interview with Wall Street Journal, 1993

 

"Being the richest man in the cemetery doesn't matter to me… Going to bed at night saying we've done something wonderful… that's what matters to me."

What a remarkable man!

Thank you Steve, we will miss you. 

 

May you rest in peace

Life of Steve Jobs

• Born in San Francisco in Feb 1955 to students Joanne Schieble and Syrian-born Abdulfattah Jandali - adopted by a Californian working class couple
• Had a summer job at Hewlett-Packard while at school - later worked at Atari
• Dropped out of college after six months and went travelling in India, where he became a Buddhist
• Launched Apple with school friend Steve Wozniak in 1976 - first Apple computer sold the same year
• Left Apple amid disputes in 1985 but returned in 1996 and became CEO in 1997
• Bought Pixar animation company in 1986 for $10m
• Married in a Buddhist ceremony in 1991 - has three children with his wife and a daughter from a previous relationship
• Had a personal wealth estimated at $8.3bn (£5.4bn) in 2010
• Diagnosed with pancreatic cancer in 2003, and after three periods of sickness leave, resigns as Apple CEO in August 2011

Medicalisation of pre-Disease States

Have you heard of talks about preventing a chronic disease by using drugs? It sounds attractive if you could prevent diseases such as diabetes and hypertension (high blood pressure) by just taking drugs. It is of course highly attractive for drug makers (pharmaceutical companies) to expand their business to include a lot more people as to increase their already gargantuan profits for shareholders.

UnNatural Ways Only When Needed

Medicalisation of pre-disease states is virtually giving drugs (medicating) to healthy people with the objective of preventing chronic lifestyle diseases. It is not unlike immunising people against preventable diseases such as  diphtheria and measles but in this case the mode of prevention is through the stimulation of antibodies to fight against the disease agents such as viruses and they are not given everyday.

However studies done a few years back did not provide a conclusive evidence that an antidiabetic drug could prevent the disease, in fact modification of lifestyle like proper nutrition, maintenance of ideal weight and exercises, is noted to be just as effective.

Giving drugs to healthy people will make them feel like patients and could affect their quality of life especially if they suffer from adverse side-effects as often seen among patients on medications. At the same time there is the rise in costs to the society in terms of spending more on drugs with questionable outcomes and increasing use of health care (increased economic burden).

If you notice many people are taking vitamins in the belief that they would keep them healthy. The business of vitamins marketing is expansive. Healthy people who would get most of their vitamins through proper nutrition have opted to take the easy way out by ingesting these pills and then telling themselves that they are feeling better and healthier... a self-fulfilling prophesy. This vitamin intake also gives a false sense of security especially when it is unaccompanied by healthy lifestyle practices.

Suffice to say the medical fraternity is generally against prevention of diseases such as diabetes and  hypertension through the use of drugs as current evidence and health economic considerations do not justify their clinical use.