To Err is Human to Forget is.... Out of the Question

After a number of years and thanks to Facebook, I am able to re-connect with my class and schoolmates. Memories came rushing in as I see those faces aged by time but my mind could still see them when they were teenagers. Yes, I studied at a boarding school where our behaviours were shaped by the friends that we made. Six long years of happiness, loneliness,anger,disappointment, failure and success.

Find old friends  on FB and reminisce

Coming from a family of four boys and one girl (me), I found it hard to mix when I first joined the all-girl school located in the far south of the peninsular. I was awkward and tried hard to improve on the many areas that I found myself deficient and I learnt fast. I remember several teachers liked and trusted me. I was given responsibilities like carrying the girls' exercise books to the teacher's staff room and keeping the key to the school home science kitchen and assisting in the school library and chosen as a pack leader in the Girl Guide.

But somehow my relationship with my classmates was on a different plane. As a group, they would have found me as rather quiet and unsociable so they did not nominate me for any responsible task.To make matters worse I also suffered from anaemia which weakened me and stopped me from participating in more robust activities like sports though I excelled in class dramas usually acting as a male, must have been tomboyish!

Anyway to cut a long story short, it was when I was tasked with keeping the school kitchen's key that I came to trouble with the teachers because they stopped trusting me from then on and I was treated like a "pariah". You see, one day on a Saturday, after a school outing, my senior of two years, came to me to ask for the kitchen's key because she and her friends wanted to do some "unauthorised" cooking. Being my senior in the boarding school, I reluctantly gave it to her as it was a Saturday evening.

As luck would have it, as the girl and her friends were busy cooking,making the kitchen as if their own, Miss Pothucheary, the Home science teacher who entrusted me with the key,  came in probably because, as a duty teacher, she saw the light on and My God! I knew something was wrong when the girl failed to return the key to me for safe-keeping. Apparently the culprits got real tongue lashings from the woman.

The teacher called me first thing on Sunday morning ( years ago Sunday was not a holiday in that State) and without hearing my side of the story and explanations  she started to scream and scream at me and accused me of being irresponsible and undeserving of being trusted! I was only 14 years old! I had wished the earth would swallow me and I remember tears streaming down my cheeks. I was very furious and disappointed with that senior girl. Following the incident, I noticed the other teachers were also cool towards me. Imagine in a boarding school and I virtually had no one to really talk to for fear of further reprisals.

She screamed her heart out as I silently cried

After the unfortunate event, my grades started to fall. Initially, I came in second in the class of about 25 brightest girls coming from all over the country in the first year but slide in the next three years. I was depressed. I picked up myself in the last year somehow and managed to stay in the top five but bouts of depression and self-doubt still haunted me and my performance was really not consistent. I scored 96% , the  form's  highest, for Additional Mathematics during the MCE (Malaysian Certificate of Education) trial examination and became the toast of my maths teacher a man called Mr Chan but did not do as well in the real examination.

Getting a scholarship based on the results of the trial examination and going to Australia to study  was the best thing that could have happened to me. I wanted to show my teachers and my friends who I really am. There were five of us selected to study overseas and I am the only one who succeeded in completing my medical course. The others failed in their attempts or could not even enter Medicine after their matriculation. I was offered the prestigious Colombo Plan Scholarship to do Medicine at the University of Queensland. The period was the best in my life as I  regained my confidence away from small-mindedness. I made friends  and one of whom last to this day though he is in a different profession.

Now as you might have guessed it, I am looking at the face of the girl, now an old woman, who destroyed my life in that boarding school, on Facebook. The anger came back involuntarily as I cannot bring myself to forget what she did to me. I have to learn to forgive her but I could never learn to forget the consequence of her action on me. It was a long time ago but a teenager's terror and undue hatred has become entrenched. Even the name of the teacher I could not spell properly but her terrible raging face is fresh in my mind. I really pray no child has to undergo that kind of experience because it is just so unjust and unfair.

Yes, this is the feared  and despised Gorgon

Getting to where I am today, I always remember to treat my underlings fairly and refrain from them remembering me as a Gorgon... yes, the teacher became a Gorgon to a child of 14 on that fateful day and the child never forgets.

Facebook brings me joy but it also brings back bad memories.

ASB 2012 Dividend

Congratulation to all my Bumiputra colleagues and friends who invest in ASB (Amanah Saham Bumiputra), a fixed-priced unit trust exclusive for Bumi. This year dividend payout is 7.75 sen per unit compared to 7.65 sen last year. An apparent slight increase ( remember the general Election is just around the corner!). As for bonus, it is still the same as last year at 1.15.

PNB Chairman (L) and its CEO at the ASB 2012 dividend declaration

I have always advised my Bumi staff to invest in the unit trust as this particular product is the best among the unit trusts under the PNB (Permodalan Nasional Berhad) stable of  products. Many seem to take this exclusive opportunity to invest for granted and so miss out on the seemingly high annual returns. Many non-Bumi would do anything to get these units. As we have observed the non- Bumi portions of both ASM and AS1M have all been subscribed but there is still a large portion available to Bumis.

This is the best approach currently in preparing for your retirement coffer,  putting your money in this type of government-guaranteed scheme. And by the time you retire, you'd find that staying attached to this index-linked unit trust is the best way to create wealth over the long period. The failure of some people to save and invest diligently has led to their not being able to lead a comfortable life post-retirement. The reason could be due to inability to imagine their future as they tend to live and let live for today.

Happy Doomsday 211212 !

Today is the last day of the Mayan Long Count Calendar. For those who surf the internet a lot, you will certainly be familiar with the story of the apocalypse predicted on this day. In fact some people in Russia and America have taken to stocking up on supplies to prepare for this end of the world prompting experts like NASA to come out and tell the world that 21 December 2012 is just going to be like any other day.

Oooops, we've got the date wrong! (net image)

So it is today Friday 21 December 2012. When I got up this morning, the morning seemed bleak as it had been drizzling  last night. My compound looked wet. (Yesterday was bright and sunny).The traffic seemed to be just a wee bit light, perhaps some people have already gone on their Christmas holidays? I am trying to look for anything abnormal today as you can see.

The internet is full of articles on the fact that we are still here today. Someone from London tweeted asking "Australia, are you still there?" seeing that Australia and New Zealand would greet 21 December ahead of Europe. The whole thing has been turned into some kind of a circus show. This has upset some Mayan descendants who see today as a day of spiritual significance.

Well, I would say many people do not believe in the so-called prophecy of today being the end of the world. Parties are being held to celebrate the day and some go on tours of the few places said to be safe in the world. People seem to take it in their stride and as this “epic disaster” (set with all kinds of scenarios) would affect all of humanity, the fear seem to have diminished through its sharing.

In fact many people don’t even know about these  hullabaloos  and remain blissfully ignorant. I guess they won’t even know what hit them if the apocalypse materialises. That’s the best way to leave this world, provided everyone exits the same time!

But just hold on a sec, the day has not yet ended now they say the apocalypse will take place at 10.42 or 11.11  now where  in the world is that?

MAXIS - The final dividend for 2012

I just happened to check my dividend-paying portfolios and did not fail to notice that Maxis would be paying an 8 sen per unit dividend on 28 December. What a nice end to the year of 2012. All together Maxis has paid out 40 sen per unit for this year. It is substantial as far as I am concerned. At the same time its market price is rising steadily.

Whatever happens  I am going to keep this golden goose. I like the idea of getting dividend every three months. It kind of makes you feel your money is breeding right in front of you. I wish TM would do the same  as currently it is giving dividend every six months.

Maxis seems more robust in terms of its competitiveness. You notice that it has a number of innovative products to capture the broadband market. I think it still has some growth potential as it fights to get the migrant market share now being capitalised by DIGI.

About six weeks ago, Maxis share price was down due to profit taking activities of likely to be foreign fund managers and now they are coming back to lift up the stock price. As it has always been said, you can make money in a volatile market provided you have ready capital at hand. I had wanted to accumulate more shares       through the redemption of my recent ASIM dividend but instead I decided at a rather last minute to buy more AMB units as it was selling at a discount of 3% coupled with its low unit price which went down to below its issue price of 50 sen. Well, looking at the risk, it's better to be with an index rather than an individual stock especially during this uncertain financial times. I am a bit risk-averse here.

Having learnt certain lessons, I did not flinch this time around when Maxis share price went down to below the price I acquired it. The consistent dividend which makes me take the long position. It is like Warren Buffet and his golden Coca-Cola stock. Why do we need to ever dispose of it when the company is strong fundamentally and when communication will never be out of fashion?

So here's to Maxis.. a toast to our "partnership"

Loss of Appetite and the "Magical" Turmeric Paste

This 47 year-old lady of Javanese descent came to see me complaining of being constantly hungry but had no appetite to eat. She had lost some weight over one and a half year and now feeling quite agitated.  She also had gastric pain especially at nights. I ran a battery of tests on her but could not find anything major except for a low haemoglobin of 10.1 g/dL and a low BMI of 19 (underweight).

She spoke rapidly and appeared impatient. I looked for signs and symptoms of an active thyroid and did a blood test to assess her thyroid function.

Yellow-stained palm 

Something about her appearance intrigued me. Her face seemed to have a yellowish tint around the cheeks, nose and forehead. Then I noticed her hands were stained yellow. I asked her what she had been making and she said she made turmeric paste mixed with honey (Jamu Kunyit) as a health concoction. She has been making and taking this paste for the last two years to boost her health, strengthen her reproductive organ,pelvic muscle, make her slim and skin flawless! Now, this seemed to coincide with the start and the continuation of her anorexic ( no appetite) problem.

Yellow-tint facial skin

My nurse then related her own experience of taking this same paste during her confinement, apparently this turmeric paste is supposed to contract the uterus faster and strengthen the muscle around the pelvic region. She took it for a couple of months and found that she had lost her appetite and consequently her weight. She felt awful: nauseous and a strange taste in her mouth.  She stopped taking it upon realising the adverse effects. Such is the "magic" of the turmeric paste!

The following claims have been made on the use of turmeric:

Thirteen ways a 100% certified organic-based Turmeric can spice up your whole person:

Turmeric rhizomes and powder

1. Boosts your antioxidant protection against free radicals*
2. Helps promote your healthy skin*
3. Supports your overall eye health*
4. Provides you immune system support*
5. Aids your skeletal system and joint health*
6. Encourages your healthy liver function*
7. Helps you maintain healthy cells with support against free radicals*
8. Balances the health of your digestive system*
9. Aids you in support of healthy blood and your circulatory system*
10. Helps you maintain normal cholesterol levels to support your cardiovascular system*
11. Assists your neurological system's healthy response to stress*
12. Promotes a healthy female reproductive system*
13. Helps you maintain blood sugar levels already within the normal range

Source: Mercola.com

The pronounced benefits of turmeric seem wonderful  but where are the evidence to support its use by a large number of people? Moreover the processing of this herb may introduce other inorganic products which may be harmful to the liver and kidney when consumed on a regular basis. Can a manufacturer guarantee a 100% product purity? Is the dosage weight-dependent? what are its contraindications? What about adverse side-effects? What about the inclusion of other items such as honey, ginger and tamarind in a home-made paste (jamu)? Could the turmeric mixture become toxic to our excretory organs?

Despite all the alleged benefits, the home-made herb concoction has adversely affected my patient's appetite and the worst consequence is, she feels hungry but has no desire to eat: how paradoxical? I advised her to stop consuming the concoction and gave her multivitamins to promote her appetite and she has an appointment to see me later to review her condition.

Everyday I am learning new things from my patients some of whose practices never fail to fascinate me.

Skin disease... what in the world is this?

A nine -year old girl was brought in by her mother with the complaint of itchy lesion around her mouth  for about a week then later the right corner of the mouth became ulcerated. They have been to a clinic and the lesion had not improved.

Dry,ulcerated lips and corner of mouth of a 9-year old girl

The girl looked sullen, obviously unhappy with her appearance. On further questioning there appeared to be no systemic problems like loss of appetite, recent weight loss, fever or any other medical conditions. I asked about allergy history and it seemed no evidence of this. What about lipstick? The mother said the child had not started to use it. I did think of the girl being assaulted in the mouth but there was no evidence of a bruise.

Then my attending nurse asked the girl whether she had been sucking at pickled mangoes sold by street vendors. Then the mother recalled that the girl had eaten a lot of pickled mangoes and she noticed the mouth had swollen. The girl admitted of it being itchy and she kept rubbing at it ( and I guessed they must have applied some over-the- counter medications as well). She must have been allergic to the chemical used to pickle the mangoes, a kind of contact dermatitis. She was treated along that line.

Psoriasis....That's it

Flat, thickened coin-like and discoloured

This  48 year old lady patient  admitted she had been having treatment for her skin disease for several years in the private sector. From the history, I gathered that she had been shopping for doctors. When she first came to see me,  there was a patch of thickened,scaly and discoloured skin which looked like an allergic reaction which had been invaded by fungal infection on her left forearm. There were smaller coin-like lesions in her left foot, below the ankle and heel. They looked thickened and flat but scale-free with  darkened border.

Elevated,thickened with dark discolouration

She had come to the clinic and saw several doctors who prescribed an anti-allergic treatment, all of them had diagnosed it as an allergic dermatitis  and advised her not to take allergy-causing food such as egg, seafood and peanuts. Her condition, nevertheless, recurred unabated and persisted.

When she first came to see me, I also diagnosed it as an allergic skin condition mixed with a fungal infection and proceeded to treat her as such. she came back a month later and this time complained of intense itching and provided another information that the affected areas  were very  itchy especially after bathing.

Then she showed me newer crops of similar patches but this time on her right arm. She said that was how the big one started . I took one look at this newer lesion which was obviously not treated with all sorts of cream and oil like the earlier ones, meaning to say the appearance was in its natural state, it had not been altered by 'treatment' cream and the rest of the potion she had been applying all these years.

Newly erupted  red skin lesions with silvery scales

It was red and had silvery scales..yes, it was psoriasis, a chronic skin condition of unknown cause but seems to run in a family. When asked whether any other of her family members suffering from the same disorder, she denied.

Anyway, an appropriate treatment for psoriasis was initiated and she was advised that this skin disease was a persistent one, remitting and exacerbating. The treatment was only to relieve the symptoms, making her life more bearable with less itchiness. It may remit for a period, depending on an individual.

But for this kind of patient with low education, they find it hard to understand the concept of hereditary or chronic disease. Medically the disease requires continuous treatment. In this case, the use of emollient and specified solution known to reduce the eruptions and scaling of the upper layer of the skin. The characteristic of this lesion is that it can appear to heal for a long time and then it undergoes an  exacerbation. Unless a patient understand the nature of this skin condition, they will forever look for a cure and be stressed at the same time. Apparently stress  has been noted to worsen  the condition.

I asked her whether she had been overly stressed for the last few weeks ( to help explain for the newer lesions which I did not see four weeks earlier). Yes, she had been highly stressed having to look after her child who was hospitalised  for the last two weeks  following an accident.

As responsible doctors, we have to educate patient on the condition so that they are not bewildered by  its persistence. And that they would apply the standard treatment and not use hazardous cream and oil which could complicate  therapy.