Earache, Impaired Hearing and Antibiotic Misuse

A 47 year old lady came in last week complaining of her  left ear's worsening hearing problem. She said it started about five weeks before she came to see me and four weeks before that a doctor had prescribed some medications for her left earache.

Her problem has not settled instead it is getting worse. After asking some questions as per history, I proceeded to examine both her ears starting from the right which is supposed to be problem-free. I noticed that ear was very clean and the ear drum visibly normal.

On examination of the left ear I noted yellowish white fluid filling up the ear canal. At first I thought it was pus but the smell was not odorous. The ear drum was not visible of course. I made a comment about this to the patient and then she admitted that she had been using the antibiotic chloramphenicol ear drops prescribed a month ago on and off whenever she felt there was a watery discharge in the ear. No wonder she has problem with her hearing!

I was taken aback by her admission. Obviously this patient is ignorant on the use of antibiotic of this nature.And being English-illiterate she is not able to read the label which says "discard the bottle one week after opening".

One of the possible complications  is overgrowth of bacteria and maybe even fungus due to the prolonged use of the antibiotic in such a closed space.

I also note that people who have ear problem like pain and discharge tend to over clean their ears using cotton buds and when they feel itchy most likely due to dryness of the ear canal, they would poke the ear with all sorts of items. One man admitted he used his car key to scratch his itchy ear and of course ended up with ear pain  due to infection of the ear canal!

The need to educate patients on medication use cannot be overemphasised.

Happy New Year 2013- Another Year, Another Chance

Farewell 2012 and a Warm Welcome to 2013

Wishing all my blog readers a Happy New Year 2013 and may you all be blessed with good health,happiness and prosperity.

2013 New Year Celebration  on the River Thames London with Big Ben

The last word is manna to most people. Who wouldn't want money or more money for that matter? I am not referring to greed okay, because greed is one of the 10 great sins (for the religious).

2013 New Year Celebration at Putrajaya

We mark the end of 2012 with the beginning of a new hope and a new opportunity to do things right and these are represented by the new year 2013.

People around the world celebrate the new year with fireworks and lighting displays. It is a much anticipated event everywhere around the Globe.

When a new City Mayor failed to plan for an annual fireworks event to celebrate the new year, the people of the city  really cursed him silly. They felt betrayed, they felt let down. How could he, the old Scrooge!

City folks pay taxes and assessment rates not only to be provided with services like garbage collection and sewerage maintenance but for some form of entertainment as well.

Sydney Harbour Bridge
 spectacular 2013 New year Celebration

Big cities around the world celebrate the new year with fireworks where city folks come together in their hundred of  thousands to share the joy and express the common hope of a brighter year ahead.

I see this new year as another chance to improve myself and my relationship with people that matter. I also hope to comfort my patients more and increase my diagnostic skills and detect the causes of their malady earlier so that I can lessen their sufferings.

On the financial front, I hope this year will be just as great as 2012 if not better market-wise. Lessons learnt from last year have provided a compass for me to navigate the murky water of volatile markets which are expected to continue for some time yet.

While there is no gain without taking a risk, I hope I will temper my risk appetite with gratefulness of small gains, real gain not paper- high!

** All images are from FlicKr friends.

Market in 2012 and 2013- What the Fund Managers Say

I was reading a local paper a few days ago on the market outlook by fund managers particularly in Malaysia. All of them agreed that our market underperformed in 2012 compared to those of our neighbours, Singapore, Thailand and Indonesia. Our market is said to be defensive and has been bogged down by the uncertainties of the looming general election. Certain anxiety has been expressed regarding the anticipated upheaval should there be a change of government or if the present government is returned with a reduced majority.

While the concerns regarding the effects of the Fiscal Cliff in America are expected to be resolved, the sentiment is still cautious with the Eurozone debt crisis  still simmering. Economic data from China has shown some positive trend and the Country is expected to come out of its two-year economic low. Data on jobs and housing from America is also beginning to improve so according to these managers things are looking up in 2013.

Strategies,strategies, strategies

Some managers are still sticking to defensive stocks pending the political outcome following the general election to be called by March 2013. Some are avoiding cyclical performers in the oil and gas as well as construction industries and putting their eggs in finance,plantation and consumers stocks.

Others said they would buy on weakness (when FBM KLCI is below 1601) and sell on strength when the Index goes up to 1700. A good tip for me to also follow and make some money as I have trouble selling my stock, instead getting foolishly high on paper gain!

These big-shot fund managers certainly know what they are talking about as they are not only market-savvy but they also have a vast amount of data/information, economic researchers and stock analysts working for them and they deal with billion of fund so it is good to read about what they are saying.

Guilty pleasure

As I am managing my own little fund, I have to weigh in all the information and make my conclusions and buying and selling decisions which are also based on  readings and experience.

Actually my fund in equities is only 17% of my total portfolios. So delving into stock market is more like a little money-making hobby with ego being inflated and deflated along the way. For what is life without excitement,anticipation joy and slight depression? And now time for that coffee...

Baltic Cruise- Memories of St Petersburg

Summer palace garden

Romanov Winter Palace

As part of my 17-day Baltic Cruise to six Baltic countries  last September 2012 , I visited the city of  St Petersburg in Russia. Contrary to my preconceived ideas, the city is vibrant with traffic jams everywhere and on  bridges across the main river dissecting it. There are many architecturally beautiful buildings among the latest rather ugly simple box-like buildings.

Intricate façade of the Czar's Summer palace

Newer building-not as aesthetic but practical

 As our time was short, we merely spent most of our two day there visiting palaces built by the Romanov, famous among them are Catherine and Peter The Great. We also had time to visit a great museum-like place called the Hermitage where belongings of the Romanov are being displayed. many consist of paintings, sculptures, furnitures, cutleries,room furnishings,vases,clocks among others. We also spent some time visiting famous landmarks such as the Church of the Spilled Blood.

Church of the Spilled blood

The Church and its pretty minarets

Looking at the old aesthetically beautiful buildings , you could actually imagine the luxury,indulgence, wastefulness  and decadence enjoyed by the ruling class with their palaces,gardens, massive properties and retinue of servants. No wonder the suppressed peasants revolted (the Revolution) and finally toppling their elites and got what rightly belong to every hard-working citizen and Russia became a Republic.

Summer Palace Interior Garden

Part of interior of summer palace

Summer palace

St Petersburg's early morning traffic

Summer Palace furnishing

We visited the Summer and Winter Palaces and were only able to do some souvenir shopping. We managed to have our meals at restaurants and experience their culinary offerings.

One of the hundreds of palaces with
late afternoon traffic jam

Well-kept Summer palace garden

Winter  palace

Chic porcelain-one of many
different varieties on display 
at the Summer  palace

Compared to Berlin which we visited earlier, the paintings in St Petersburg were more refined and beautifully maintained. Their sculptures were more modest with less embarrassing exposures.

The palaces are maintained by the State unlike that in Germany which is by some charity foundation and you could see the difference in appearance of the palaces in the two countries.

Despite Russians being famous for vodka-drinking and rough behaviours (remember President Yelstin ) but the reality is far different, perhaps more like the current sedate President Putin whom I admire in spite of his tough reputation.

They are more polite and friendlier than the Germans, at least those manning the palaces. The tourist guide was excellent and she worked at the university and very proud of her heritage. Sandra was really funny and could laugh at her own shortcomings. A lovely sense of humour.

Potret of Queen Alexandra wife to the last Czar Nicholas
 and grand-daugther of  Queen Victoria of England

There was so much to see but we only managed to tour the tourists' attractions only. It would have been great to look at other aspects of the Russian life. They have such a long and rich culture beyond communism. It was hard to look at them as really different people professing an  ideology completely foreign to us.

I certainly would like to visit the city again and this time on a longer basis. It is best to visit around June as the weather would have been not too cold or hot, a pleasant time for walking.

The Prayer ...... Celine Dion - Andrea Bocelli

 A prayer is always soothing to the mind telling it that there is that Supreme Being looking over us especially when we are depressed or feel direction less in our pursuit in the business of living. There are times that we feel helpless and that we need that Power to help us find the right path and calm our nerves. 

 Having said that, we should also pray in times of joy to offer our thanks and gratefulness to our Creator whom we call by different names but mean the same thing. Yes, the faith in God will guide us towards positive living and true happiness.

I like this song as it portrays what a prayer should be, good lyrics, amazing voice and excellent harmony. It really touches the soul!

Pulmonary TB- a straight forward case with delayed detection

A 43 year old man came to the clinic complaining of recurrent blood-streaked sputum following bouts of coughs for three days. He looked healthy though on further questioning he admitted having a mild evening fever and that his weight had gone down recently.

When asked how long he had been coughing, he replied that it was more than three months but claimed the cough was mild and did not bother him. He had come to the clinic a couple of times for coughs and was treated with antibiotics. His coughs seemed to have settled till the recent bloody sputum that had caused great concern to him.

He is a smoker and works as a security guard. He denied any contact with a person suffering from tuberculosis.

Without wasting much time, I ordered sputum for Acid Fast Bacilli (AFB) on three  occasions and a chest X-ray which confirmed my suspicion. His sputum sample later was positive for TB bacilli. He was promptly put on a TB regime.

The cotton-wool lesions in the right middle and lower lung lobes  highly suggestive of tuberculosis prior to sputum AFB confirmation.

Really, his case could have been diagnosed earlier but somehow was not detected. Again here history taking is very important. Quite often patients are not going to volunteer information critical to diagnosis, unless probed. I always have to appear intrusive by asking questions to screen the signs and symptoms as to arrive at the right diagnosis. Early detection is vital in infectious disease control in the community.

Late diagnosis leads to greater transmission of the TB germs in the community and increase the risks of resistant TB as more patients are likely to default on the treatment causing TB control problems.

The patients' contacts are traced to ensure early treatment should any of them got infected.

Celebrating Christmas 2012

Relaxing at Marina Yacht Club

Christmas this year was not as exciting as last year when I went to Singapore to experience new sights and sounds of a metropolis. Stayed at the Hotel Michael in the Sentosa Resort World. Had a whale of time visiting the attractions of the resort including the Universal Studio. The whole place was vibrant and I must say there were more tourists than locals. After four days of fun and frolic, we moved to Mandarin  Oriental in Orchard Road right in the shopping heaven.

We were lucky to book our accommodation early as the hotels at the CBD were all fully taken up. Lightings in the streets of the city was truly magical with different colour themes for different years. The atmosphere was really infectious. People were on the streets enjoying the crowds late into the night, strolling,talking,laughing and eating.

Decorative part of a creative Christmas tree

So this year, with the end of the world prediction on 21 December 2012, we had really no appetite for travel though some of our close relatives have gone off to holiday in Paris and London, posting their status almost daily on Facebook. It was as if we were following in their journey by plane,train,car and cab! Such is the current social media penetration into our lives!

Looking at the pictures, we are tempted to also be there next year depending on my leave. So 2013 hopefully would be more exciting than this year.

Ubiquitous Poinsettia and Christmas is here

I went to have lunch with my friend  Doreen at her house. The company was excellent and foods were sumptuous (catered by a famous ex-hotel Chef!). We stayed there for quite some time catching up with other invited friends. Hugging was plentiful. Somehow it was time to express our emotion and cement our  friendships.

Just after four, we decided to drive to a place famous for local fruits, durians,manggis (mangosteen), duku,langsat and rambutan galore! Though the season was coming to an end, still there were good durians for the picking. The price was much cheaper than last year, something to be joyous about this Christmas.

In keeping with healthy foods, we cut down on cakes this year. Last year I gobbled on those delicious cakes and became guilty afterwards but this year, I am more disciplined and very relieved as a result. Having like-minded relatives and friends make it all the easier to stay away from those sweet stuffs and strive to stay healthy and strengthen the commitment for the new year 2013!

I hope you all had a Merry Christmas too!