My Melbourne Trip

A close relative is currently on official duty  to various parts of the world conducting specific training for High Commission/embassy staff. So far she has gone to New Delhi, Canberra and Melbourne. Her next trips will be Beijing, New York and Rome. Looking at the destinations, I decided to accompany her to Melbourne. I prefer the city because my familiarity with Australia and the fact that the people there speak English is comforting. I have never been to Melbourne despite spending eight years studying in Queensland, Australia.

And so I booked my ticket travelling business class to ensure comfortable travel. It was late evening when my MAS flight to Melbourne took off and reaching the Aussie airport at Tullamarine the next morning about 9 am local time ( three hours ahead of Malaysia). There is no need to show your visa as the immigration officer just key in your passport number and access it on the computer;  how convenient. And travelling business class also entitles you to an express immigration lane, lane used by aircrew but hold on tight to your invitation card as the immigration officer could be quite acidic if she thought you were trying to bypass the usual lane!

 I waited for Tasha to arrive from Canberra at about 11.30am. I have already studied the the airport map on the net and so it was easy to navigate my way in the big complex. It is easy to communicate nowadays as you have free WiFi at the airport.

The temperature was unbelievably hot at 30 deg C in middle of March and I was prepared for a cooler one at 14 deg C! Apparently Melbourne is dubbed as a city of Four Seasons. So be prepared as on any day the temperature could change from hot to cold!

A High Commission staff came to collect us to the hotel. We stayed at the Marriot right in Melbourne CBD. The hotel is fine except for the spring mattress which gave me backache! And the low support-less seat in the lounge is also not ergonomic. Five-star hotel with starless bed!

Melbourne is known as the culture capital of Australia. I could see why. They have many theatres and arts galleries and museums and other heritage attractions. Definitely different from Brisbane and Adelaide the other two cities I am familiar with.

There are so many places that you can go to and accessible by free transports! Yes, free. You must get the tourists' brochures at the hotel  and study the tram stations and locations where the bus shuttles pick up points for tourists are. Unfortunately I only came to know about these facilities on the second last day of my stay! Before that I was busy walking and taking the expensive cabs!

When Tasha was working I was shopping and visiting. I went to my favourite departmental stores of David Jones and Myer. I used to love window shopping at these two stores when I was studying in Brisbane.  Not much pocket money then. Every time I wanted to buy something heavy I was forever calculating the weight as my baggage allowance is only 45kg!

Melbourne is a city of trams

Part of City of Melbourne from Eureka Skydeck - highest point at 88th floor

Main entrance of the  famous Victoria Market

Seafoods galore at Victoria market

Flyways seem to be common outer city features

I managed to savour the city's scene by travelling with the free tram which  circle the city. There are various stops that you can take the tram from. It is number 30 with the name "City Circle" written on the front. The one I took was at Exhibition St stop just up the corner of Marriott Hotel. For further destinations I took a free air-cond shuttle from the Chinese Precinct just beyond the Commonwealth bank. It took me about 90 minutes without stopping to go around riding on that comfortable free bus. Stop 8 is just in front of the Victoria Market for those who want a free ride there. The free shuttle starts at 9.30am at the stop where I waited for it. Like the free tram it goes to the dockland at South Yarra . So the two modes of transport more or less wrapped up my short visit to Melbourne.

There is also a Malaysian small restaurant called Madame Kay on Lonsdale St near to our hotel, serving nasi lemak,nasi ayam and noodles cooked by Malaysians. That was my lunch stop everyday.

Victoria market, popular with tourists, is famous for fresh fruits and vegetables an at the same time there are are gift stalls selling cheap T-shirts and souvenirs. I noticed many Asian stall hands from Malaysia, Vietnam, Cambodia,Indonesia,Thailand and India. There was even an Arab lady selling fruits.

The trip was short but gave me an idea of the sort of city Melbourne is: busier than Brisbane and Adelaide and has that cultural vibes about it. The city is well planned and you cannot really get lost if you have a map with you.

On the way back at the Tullamarine airport, I was surprised to discover that you need to pay AUD4 for a baggage trolley! What if you do not have the coins as you are already on the way home? Lucky for me I had a change of AUD4 after paying a taxi costing me AUD56. I was of course unhappy about this small matter as our airport trolleys in Malaysia are free but thinking back, those free rides would have cost me more if they were not made available by the city for tourists like me. The only problem is nowhere does it warn the tourists on this payment.  I remember in Brisbane international airport, there was no charge for using the trolley.

Check the tax-free shopping procedures. You need to have more than AUD300 per receipt per shop. Unlike the UK requirement. You need to show your purchases at another level (quite inconvenient!) before you finally meet the officer after you check in, keying up the amount in the computer to be credited into your credit card. I had forgotten to have my purchases checked so the officer asked whether it was the first time I came to Melbourne and of course I replied "yes". He or she  could be difficult and refuse to give you the tourist privilege. Fortunately the custom officer was an understanding man.

The business class MAS lounge at Tullamarine Airport was pleasant with comfortable lighting and food servings were generous. A perfect end to a short, tiring  and enjoyable visit.

The trip soon came to an end and due to plane seating problem I had to leave 10 hours earlier than Tasha.But I found the day flight was better as I arrived home in the evening, showered and ready for bed and woke up refreshed the next morning.Tasha on the night flight arrived in the wee hour of the morning at KLIA and ended up suffering  from a jet lag!

The Liver, Herbal Use and Allergy

A 38 year old man was referred to me for running up an abnormal liver function test. The enzymes produced by liver cells were high indicating liver injury. And as often the case, the patient doesn't feel any pain or discomfort. Neither does he display any signs or symptoms like nausea,vomiting or jaundice. It is, by and large, an incidental finding on the part of the health-screening program. The test was done two weeks prior to his seeing me.

I also observe that when the hepatocellular enzymes are elevated so is blood cholesterol indicating the inability of the liver to process cholesterol within its metabolic cycle.

As per my practice, I go through with the patient on what he has been taking for the last few months. Among the usual agents causing liver injuries being drugs/medications (slimming pills, " traditional Chinese medicine"), alcohol and herbal preparations.

Yes, he admitted he started taking a herbal preparation early in the year (2013). And he told me an interesting story of being admitted to the hospital for observation on two occasions due to high fever and itchiness in his body about two weeks after the daily ingestion of the preparations. He was treated for allergy.   And according to him he has never had similar problems before. Feeling something amiss, he went for the screening program.

I advised him to stop immediately the herbal intake and put him on a two-month of liver treatment and will monitor his liver function after four months. He is also asked to monitor his incidents of allergy.

I have seen so many patients having this herbal induced liver injury. I just wonder whether the effects would just stop after one ceases herbal use or whether there is a threshold where there is a point of no return?

Imagine the liver is a big organ, minor injuries in parts of it would not have significant physical effects to the person. With continued ingestion, cumulative effects will result and would be too late already for someone to show the signs and symptoms of liver failure. It is well-known that the liver has a great capacity to compensate, meaning it can go on functioning while it is diseased  till it is too late. You can see these compensatory effects in alcoholic liver disease.

I have come across two cases of fatal liver failure due to spirulina ingestion in the hospital where I previously worked.

For those who take herbal preparations, do test your liver function before it is too late.

The European Horsemeat Scandal

It is a disgusting thought to eat something you think you know but actually it is something else. And so the horse meat scandal in Europe is a chance discovery which has shocked many people who have the least idea that they are not eating beef but horse meat. You can read the timeline of the exposed scandal here.

Beef or Horse meat - can you tell?

Besides the distaste, the main issue is eating horse meat that is tainted by pain killer phenylbutazone. This drug is known to cause blood problems namely aplastic anaemia. People are worried that it has entered the food chain and cause widespread effects. You can see the video on this rare but dangerous effects of the drug in the food chain. Drug residues perhaps, but over a long period of ingestion they could prove fatal.

It reminds me of the story of the disappearance of the vultures in Mumbai. These birds of prey were instrumental in "the burial" of dead bodies of people belonging to the Parsi faith in India at one time. The bodies are left for the birds to consume as per their religious tradition. But gradually these animals died away and it was found that  they perished en masse from kidney failure due to eating human meat tainted with the drug indomethacine ( nonsteroidal anti-inflammatory agents or NSAID) used to threat arthritis.

It is therefore very important that our food is not contaminated with such drugs which could compromise our health through its reactions with our body when taken on a long term basis.

The investigations are going on now as to establish and arrest possible criminal elements which produce  and profit from cheap contaminated  foods at the expense of public health.

Scabies and Medication Misuse

Last week a mother and her two teenage children came to the clinic complaining of intensely itchy skin. I took one look at the lesions especially in the interdigital areas of the hands and feet to quickly diagnose it as scabies, a skin disease caused by tiny mites burrowing into the skin.

The mother immediately said that the three of them came 10 days earlier and were told that it was kudis buta, a Malay word for scabies. They were prescribed with an emulsion to be applied to the body and one of the sons was also given an injection but the conditions have not subsided and in fact it worsened in one of her sons causing him intense discomfort and unable to sleep at night due to the itchiness.

The teenage patient's palms, note
the pus-filled blister

They looked exasperated and the mother said "Please give us injections and strong antibiotics to get rid of this skin problem!". I noticed that the son with the most lesions and purulent vesicles had a strange looking palms, dry and scaly and whitish  And when asked how the palms came to be in such an appearance, the mother related that the boy had been applying the emulsion everyday at least two, three times to get rid of the itchiness for the last 10 days!

Obviously this family has not been informed about this skin condition as to its cause and how to prevent its recurrence and the proper use of the emulsion (Benzyl Benzoic).

I told them about the mite and its disease history and even showed them the pictures of the mites on Google and stressed upon them the need to sterilise their clothes and beddings and keep their house clean to get rid of the mites . And the emulsion is not to be used for days, in fact it is only for 2 to 3 overnight  whole body applications. Chronic use of the emulsion can be poisonous or detrimental to health.

The mother looked perplexed and I had to explain to her several times that the condition would recur if she did not do anything to remove the mites in her house. The mites are not killed by antibiotics because they not bacteria ( the concept she found hard to understand in the first place).

After spending a good 15 minutes  talking about the skin condition, the mother at last said " I have never known about how the condition is caused and now we will do as you say". It is sad when doctors don't explain to patients properly resulting in so much morbidity and in this case the two children had not gone to school for more than a week as their conditions looked embarrassing beside difficulty holding a pen to write.

 Some doctors only know how to diagnose and prescribe but the prevention part is not explained. This happens due to perhaps their being too busy, failure to  think that it is important or taking things for granted. To me patient-doctor interaction should always be educational in order to have a greater impact on patient's health.

Happy New Year of the Snake 2013

Wishing all my friends and blog readers Gong Xi Fa Cai. May the new year bring us more prosperity and continued happiness.

Happy Chinese New Year of the Snake

To me this new year is not as lively as last year perhaps because of the lack of positive market activities on Bursa which is tamed by the uncertainty of the general election date and the thought of possible change of government. I have kept all my portfolios as they are, that is, not moving out of the market. The current market bearish outlook is a good opportunity to buy some beaten down stocks with good fundamentals.

For those of you who are interested to know some predictions (Feng Shui Index 2013) on the Year of the Snake, you can read them here.

Anyway, whatever it is, I am not going to let the current situation dampen my celebratory mood. The world is not going to end soon and politics is not going to cool down anytime now so why waste our precious time being anxious unnecessarily? Enjoy and be merry. That's the way to keep healthy, though I wouldn't binge on those foods and drinks.

A Thing of Beauty is a Joy Forever

Firecrackers have been released more than two hours ago and so we welcome the Snake with renewed hopes and a fresh zest for life.

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.