H1N1 (swine flu) is now sustained community spread in Malaysia

Anti - flu Kit

The last month or so has seen widespread community spread of H1N1 in Malaysia, a good two or three months after UK has achieved that status. Infection seems to cluster in schools and higher learning institutions where close interactions are common. As the virus relentlessly goes through its natural course, more at risk persons are being infected, resulting in some deaths. The first reported death was that of a student from a foreign country in late June 2009 and up to date, eight H1N1- confirmed deaths have been reported in the country and the number is going to climb.

Any death due to this novel virus is tragic . This is especially so in the case of a pregnant woman who had just delivered a live baby. Among our deaths are that of young children and this becomes a source of deep concern especially if there are no detectable risk factors like asthma, obesity or immune suppression.


Antiviral capsules

The decision to prescribe antivirals for those at risk with influenza symptoms at primary care level is wise. However, indiscriminate prescribing has the likelihood of the virus developing resistance and render the antiviral insensitive. It follows that an antiviral vigilance cannot be overemphasised.

On a lighter note, the fear of influenza A H1N1 virus is so irrational that some of the health personnel became depressed when they tested positive for the virus. One doctor was reported to break down in anguish when told she was positive. Ghee... this is not HIV for God's sake!

In most healthy people the infection is mild and it is better to be infected and develop antibodies against it and remain simultaneously and relatively symptom-free. When you test positive for the virus, practice self isolation and inform those around you to be extra-cautious till the danger period is over, about six to seven days from your onset of symptoms.

Finally, the anxiously- awaited vaccine specific for H1N1, is expected to alter the epidemiological course of this virus. Let's hope that it is both safe and effective.

What Patients Do that Frustrate Their Doctors

Here are some of the things patients do that drive their doctors crazy:

• Meddling Families in The Room

Some patients bring a companion, a spouse, adult child, parent or friend when they come to see a doctor. While many find that the comfort and support help them through their visit, the crowd can sometimes interfere with the doctor’s work or patient’s well-being with their unsolicited remarks.

• Answering Handphone During Consultation

Handphones have now become a necessity and answering calls tend to be automatic . Nothing is more frustrating when some patients do this in the middle of a consultation as it is likely that doctors can lose track of line of case history taking. Patients need to practice better mobile phone etiquette.

• Keeping Mum About Herbs

When it comes to herbal supplements, the medical community and the general public may, indeed, have a fragile consensus, namely that these remedies do not count as drugs. Doctors often discount the effectiveness of herbal supplements, and patients believe that the so-called natural origin of these preparations sets them apart from other medications.

Often they don’t tell their doctor what supplement they’re taking, it’s not until the point that they have a potentially serious reaction that the doctor knows they are taking one that might interfere with their other drugs.

• Quitting Medications Without Notice

Just as doctors would like to know all the medications, herbs and supplements patients start; they also like to know when patients stop taking their medicine.

One of some patients’ bad behaviors is when they discontinue medications because of adverse reactions but don’t let their doctors know about it until they come in with problems again.

• Change My Life Style? Must Be A Pill for That
  

Many doctors become frustrated with patient’s failure to see the common connection between their weight and their medical problems. Obesity can lead to diabetes, high blood pressure, heart disease and arthritis especially in the knees. The most frustrating thing for doctors is patients whose life style is making them miserable but they won’t change it.

Indeed frustrated doctors may end up having high blood pressure themselves... a real occupational hazard.

Swine Flu in the UK ... no longer in containment phase

The rising numbers of swine flu cases mean trying to contain the virus is no longer an option, the UK government says. The emergency response would now move to a new “treatment” phase across the UK as there may soon be 100,000 new cases a day as cases are currently doubling each week.

It means anti-flu drugs will no longer be given to the close contacts of those infected nor will lab testing be done to confirm cases. The move has been made to relieve the pressure on the health service.. The announcement, which comes into effect immediately, has long been expected. However, it does not mean that the virus is becoming more deadly, just that it can no longer be contained. Following this, the need for lab testing had been lifted in several hotspots , such as London and Glasgow.

Closure of schools will still be an option under the new phase, but shutdown will not be a routine.

WHAT DOES THE NEW PHASE MEAN?
• The so-called treatment phase is effectively an acknowledgement that the virus can no longer be contained.
• Many people reporting symptoms will no longer be tested to relieve the pressure on the health service.
• Instead, if they have uncomplicated symptoms drugs will be arranged for them and they will be told to stay at home.

The above BBC report is in line with the recommendation of the WHO that countries with rapidly rising numbers of cases should now shift from "containment" to "mitigation" strategy to avoid massive strain on health resources. Focus should now be placed on protecting the high risk segment of population, such as pregnant women and the very young and those with underlying medical conditions such as asthma, chronic lung diseases, and immunosuppression .

Malaysia is still in containment phase but it is a matter of time before we too have to progress to mitigation phase like Singapore, Hong Kong and the UK.

Understanding and Educating Patients

I saw a 44 year old lady civil servant this morning who came complaining of general body weakness and occasional breathing difficulties... rather unspecific complaints. I could not elicit any significant physical signs except for a visible small lump in her neck (would have escaped me had she worn the veritable headscarf!).

On further probing, I came to understand that this obese lady had been on a specialist follow-up clinic for some time now for goitre (enlarged thyroid gland in the neck) and according to her she had missed a few appointments and whenever she returned to the clinic, she would be chided and made to feel quite small. She missed her appointment again four months ago and was quite scared to return this time! Defaulting a clinic follow-up for a metabolic disease is not wise at all as uncontrolled disease-induced changes in the body may well be permanent.

I also recall a younger woman suffering from psoariasis ( a form of persistent skin disease) who had also stopped going to another specialist clinic on account of being scolded whenever she missed her appointment. She would rather go to a general clinic whenever her disease flared up and thus not getting the full benefit of optimum available treatment.

There is a need to understand this unfortunate state of affairs both from the patient and health staff perspectives. While patients need to be more responsible for their health, health staff too need to live up to their slogan "Kami Sedia Membantu" (We are ready to Assist) and translate their highly touted corporate culture values of "Caring, Professionalism and Teamwork" into tangible actions!

It is sad to see this kind of slip-up in our health care system where continuity of care is disrupted due to overbearing staff and uneducated patients. Uneducated here is defined as lack of knowledge about their intractable disease conditions.

TM is set to perform... didn't I tell you?

I had some TM shares before the capital repayment ex date on 27 May 2009. I was wondering whether to dispose or not when the price was above 3.80. Some people advised TM share holders to clear their positions, as earlier on generous dividends had already been paid out and that the price after capital repayment would definitely decline, but how low would it go? Nobody really knew.

As I am yet to be a more disciplined investor with planned exit strategies et cetera, I chose to take the risk of keeping my investment and excitedly prayed for the price to be reasonable after the capital repayment.... had regrets and heartache when the price plunged to as low as 2.60.... my instinct told me not to despair, buy more shares, so I bought additional shares at 2.62, such is my confidence in this company whose IPO some years ago had started me off to this exciting road of wealth creation!

Today, TM's closing price has gone up to 2.90! Dollar cost averaging, my friend, is indeed a fine concept. With the current share values plus the capital repayment... I have already made a sizable paper gain. Remember the edict, no risk, no gain... and I am not tooting my horn needlessly!

Wedding Anniversary July 1 2009

Roses for Enduring Love


To celebrate a wedding anniversary annually is, in fact, to be grateful and to increase awareness that your marriage has survived all the tribulations, perceived or otherwise, and all the challenges over the years. Marriage is a partnership founded on love, mutual trust and respect. Marriage is an understanding and a responsibility.

In most normal marriages a spectrum of emotion naturally exists. Joy, happiness, jubilation and laughter are interspersed with sadness, anger, disappointment and a sense of betrayal perhaps which is highly unacceptable to some people. Love will endure if you forgive each other and do not take rash actions and live to regret them. Sometimes the cause of a quarrel is so trivial that you forget it but you somehow would always remember the explosive emotion that accompanied it. Take time to also remember the good times shared and that everyday is a special day. It is important that you do not take each other for granted





Thank you Jeff for the man you are and for putting up with me for the woman I am. Happy Anniversary. Your bouquet of roses is truly lovely!

Madoff... the Fraudster Par Excellence.

Disgraced financier,
Bernard Madoff

The sentence to 150 years in jail of the American financier, Bernard Madoff last Monday 29 June 2009 brought some kind of closure to the many people who he defrauded. Many of these people have lost their lifetime savings and are about to retire. Just imagine what their lives would be like, penniless in the twilight of their years?

The Ponzi scheme created by Madoff was only discovered when the recession started in 2008. Investors were scared and they wanted to cash in their investments only to discover that there was no money to be paid to them. The earlier years were good as they received consistently "high return" because there were new investors, individual and institutional, who had provided the money through their investments! The "fund" just collapsed when investors, in large numbers, liquidate their investments and at the same time there was hardly any new investors to prop up the fund. Had the recession not set in, the scheme would have continued.

If you had your investment now with the Madoff's fund, you are not likely to get it back.

Madoff got away with this fraud because he had built around him an air of "trustworthiness". Operating right at the centre of the world financial hub, ex non-executive chairman of NASDAQ stock exchange, a philantropist and a respectable member of an elite club in Palm Beach, Florida. Who could have suspected the fraud that he was? His fund was investigated twice by the SCR (Security Commission Regulator) and "found" nothing irregular despite an independent investigator's report that Madoff's fund was actually a Ponzi scheme! SCR has failed in its duty to protect the investors and should be restructured to regain public confidence.

Madoff at 71, can look forward to spending the rest of his life in jail for causing massive financial problems to the people who trusted him. His wealth creation activities were both unlawful and morally wrong. They also have worldwide ramifications.