Saturday, July 29, 2006

Cosmetic Surgery

Has anyone noticed lately that roads are being repaved left, right & center?

Wonder if it has anything to do with the upcoming Big Meetings?


Sex (or the lack thereof)

Are Singaporeans ready for this?

Not many patients consult GP’s for sexual problems. I don’t mean sub-fertility or menstrual-related problems. I’m talking about actual problems with the physical act of intercourse. ED is probably the most common sexual problem for which males consult their GP’s since the advent of the little blue pill (Viagra, for those who have been living under a rock). Even then, most patients with ED feel more comfortable consulting male doctors.

I have had a few female patients come to me with the distressing problem of vaginismus. They were generally very embarrassed by their problem - so much so that one of them waited a whole year of non-consummation of her marriage before striking up the courage to talk to me about it! It can be extremely distressing for a couple faced with this situation, as they are often too embarrassed to talk to anyone about it. I believe this is just the tip of the iceberg; God knows how many people live with problems (emotional as well as physical) with their sex lives. And judging from responses from the patients who have approached me, they are unaware that there are specialists out there who can help with these problems.

In a conservative society like ours, sex, let alone sexual problems is a difficult topic to bring up for discussion over coffee or the dinner table. And, conservative or not, parents are probably the last people on earth one would want to discuss one’s sexual life with!

And it doesn’t help matters that sex education is so lacking in the local schools. I think the majority of teachers are ill-equipped to handle this sensitive subject. For crying out loud, many people (teachers included) can’t even utter the words “vagina” & penis” out loud without humming & hah-ing or sniggering! I remember going through my son’s Primary 5 health education book when he was still attending a local all boys school, & seeing a chapter on the human reproductive system. When I asked him if his teacher (a lady) had gone through that chapter yet, he said yes, but she skipped the bits on the female organs! I was quite astounded.

Judging from the very successful turnout of the first sex exhibition held in South-east Asia last year, I think Singaporeans are more than ready! Heck, I was surprised to find this on a government website! Yeah...I think we're ready...

Wednesday, July 26, 2006

A Doc's Life - More Memorable Moments (P.S. 5)

Subject: East is East and West is West?

In a society where a large proportion of the population still ascribes to traditional (or, in a more currently used term, alternative) medicine, I would get asked questions that, as a Western-trained doctor, I found difficult to answer.

A typical exchange:

Me: ”I’ll give you some medicine to help with your sore throat & phlegm. This is probably due to a viral infection, & you should get over it in a few days.”

Patient: ” Is it heatiness*? I ate a lot of chocolates yesterday.”

Me: “Er, I’m sorry, I really can’t say if it’s heaty or not, as I was not trained in Chinese medicine. This is probably a viral infection.”

I usually don’t brush it off as nonsense, as I like to keep an open mind. I occasionally even agree with the patient if I am too tired to explain, & the patient goes away happy that he/she has self-diagnosed the cause of his/her symptoms.

Another example involves a patient who is either recuperating from surgery or from an injury. He/she would ask me to confirm the “fact” that they should abstain from food like chicken & prawns as they are ”toxic”, & also from dark soya sauce as it would result in a hyperpigmented scar. I try to give them my opinion, but I usually don’t protest too violently, as I know that no matter what I say, these beliefs, which have been handed down through God knows how many generations, will persist; and they would abstain from those food items anyway.

*The concept of ”heatiness” & “coolness” is one held in Traditional Chinese Medicine to cause a variety of illnesses. Eg. Sore throat, phlegm, cough are attributed to one’s body being too “heaty”, often due to “heaty” foods like chocolates, anything fried, durians etc (the list goes on). Hence, “cooling” remedies like herbal teas are used to treat the symptoms.

Tuesday, July 25, 2006

A Doc's Life - More Memorable Moments (P.S. 4)

Scenario: GP Clinic; patient previously diagnosed with hypertension.

Again, this doesn't refer to one isolated case, but is a description of a commonly encountered situation involving hypertensive patients. Oftentimes, the patient comes in, not with the intention for follow-up of high blood pressure, but for another complaint, eg URTI, GE etc.

Me (after handling the presenting complaint): "By the way, I notice that you are on Drug XYZ for high blood pressure. Let's check your blood pressure & see how well controlled it is."

Patient:"I stopped taking the medicine already."

Me:" Why?"

At this point, there are two possible answers which illustrate misconceptions that patients have regarding the condition of hypertension:

a) Patient:"I finished the whole course already, so I thought I am cured."
b) Patient:"My friends told me that I shouldn't keep taking the medicine otherwise I will never be able to stop." (For some reason, some patients think that anti-hypertensives have some kind of addictive effect on their bodies).

I have lost count of the number of times where I have had to explain the chronicity of hypertension & the need for close follow-up & medication to keep BP under control. Yes, I have even resorted to expounding scary complications of uncontrolled hypertension like stroke, heart problems, kidney failure etc. to get the point across.

I don't know if this ignorance is a local phenomenon, or whether my overseas colleagues also encounter the same misconceptions.

Saturday, July 22, 2006

A Doc's Life - More Memorable Moments (P.S. 3)

Subject: Sex Ed for Dummies – I know it is impolite to call someone a dummy, but after you have read this encounter, you’ll know where I’m coming from…

Patient is a female of child-bearing age. This is not an isolated case but a fairly commonly encountered experience.

Patient: “ Dr, there’s something wrong with me; my menses is late. It was supposed to come 2 weeks ago. It’s usually very accurate.”

Me: “Are you married?”

Patient: “Yes,”

Me: ”Do you or your husband use any form of contraception?”

Patient: “Er, no.”

Me: “Do you have symptoms like breast tenderness, nausea, loss of appetite…?”

Patient: “Er, ya, actually my breasts have been feeling a bit tender & my appetite is not so good.”

Me: “Well, you may be pregnant. Let’s do a urine test to check, shall we?”

Patient: “But it cannot be! We just got married last month & we were not planning to have a baby till one or two years later!”

Me: “Err…you don’t use any contraception…?”

Patient: “No.”

Me (patiently): “OK, then you may be pregnant. We can confirm it with a urine test.”

Patient exits room with a doubtful expression on her face…

Pregnancy test comes back Positive.

Me: “Congratulations! You are pregnant!”

Patient: “How did this happen? We were not planning for a baby……..” etc. etc…

Sigh…I sometimes wished that I could have told these patients that mind-control & will power are usually not terribly effective methods of contraception....

Friday, July 21, 2006

A Doc's Life - More Memorable Moments (P.S. 2)

Scenario: ER in a small hospital on a Saturday evening. Patient is a Chinese gentleman in his 40’s, who came in with his hand wrapped in a bloodied handkerchief.

He had been trying to catch an iguana (to eat. The Chinese are notorious for having an appetite for any creature that crawls, walks, swims….basically anything under the sun that is not toxic to the system). I guess the iguana was not too keen on being a dish on the dinner table.

On examination, his hand had multiple (& I mean multiple!!!) smooth edged lacerations on both palmar & dorsal surfaces which looked like razor cuts.

Looking at the pattern of injury, it looks like what had happened was that as he reached out to try to grab the lizard, the creature clamped down on his hand (I honestly didn’t even know that lizards had such sharp teeth). And as he reflexively tried to withdraw, it refused to let go, hence resulting in said lacerations ranging in length from half an inch to 3 inches.

Fortunately, there weren’t any tendinous nor nerve injuries although most of the lacerations were deep enough to warrant stitches. Took me a good hour to suture him up (must have been about 15 to 20 lacerations in total).

Oh, and the lizard got away ☺ ….go lizard!

Thursday, July 20, 2006

A Doc's Life - More Memorable Moments (P.S. 1)

After completing my mini-series on “A Doc’s Life – Memorable Moments” last year, I have recently recalled further anecdotal tales of more similarly memorable moments. And since people, for some reason, seem to enjoy such stories, I’ve decided to add a post script to this series, named, quite unimaginatively: “A Doc’s Life – More Memorable Moments”.

Here is my first P.S.

Scenario: My first day of work in a GP clinic in the heart of town. Patient is a tall good-looking gentleman (his appearance is totally irrevelant to the topic at hand, I know, but what the heck, I am of the female persuasion, such things do leave a lasting impression - GRIN -), a backpacking tourist from somewhere in Europe.

The patient entered my room, carrying a backpack with him.

Me: “What can I do for you today, Mr. ____”

Patient: ”I think I have worms.”

Me: “Er, how do you know?”

Patient: ”I found it in the toilet after I did No. 2.”
(OK, OK, he may not have quite put it in exactly that way, but I figured it would be easier on the sensibilities of some of my readers if I paraphrased it).

Me (apprehensively): “Sure…”

He then proceeded to take out from his backpack a small plastic jar covered by a piece of (clean) toilet tissue secured by a rubber band, & placed it on my desk.

(Sidenote: I have a phobia of all things that creep & crawl; spiders, cockroaches, worms, lizards etc etc. I have debrided necrotic ulcers, helped remove ischemic bowels, amputated limbs, seen & handled partially amputated /crushed limbs, but I still CANNOT touch creepy-crawlies....such is the nature of phobias)

I stared at the bottle, half expecting the worm to spring out of the jar, through the tissue paper, and on to my person (hey, phobias are illogical fears. Note: ILLOGICAL).

The patient must have seen the look in my eyes & very kindly said: “It’s dead. Would you like me to remove the cover?”

I nodded & apologized & explained my phobia.

He then removed the cover, & true enough, there was a very dead worm of the Ascaris spp. (better known as the roundworm to laymen) about 6 inches long. The patient must have picked up the infestation during his backpacking journey through Thailand or Vietnam.

The last time I had seen the Ascaris was during our Parasitology module in Medical School (I think it was in 3rd year) & the ones we were shown had been preserved in formaldehyde for God knows how long. Doctors here (at least GP’s in town practices) hardly ever see such infestations, since Singapore, being the developed country that she is, has high standards of hygiene & sanitation. So this was the first time that I had actually seen a “fresh” specimen, & I called my colleagues into my room to view it as well. I think the patient must have thought we were a bunch of “swaku”* doctors for being so fascinated by a worm.

Anyway, I gave him a prescription to get anti-helminthics.

And, oh yeah, he very kindly threw away the jar & worm for me.

*Swaku = local slang to describe someone who is unaware of, or oblivious to, what would be considered common knowledge - quite hard to define, actually, if you are not Singaporean.

Tuesday, July 18, 2006

Laughter is the Best Medicine

I was trying to clear out some trash from my archives when I came across this little vignette I had received in one of those chain emails one receives from friends occasionally. It made me laugh so hard (I almost pee'd in my pants - pun intended) that I just had to share it with some of my girlfriends who were also ROFL when they read it.


The Real Restroom Story - author anonymous

My mother was a fanatic about public bathrooms. When I was a little girl, she'd take me into the stall, teach me to wad up toilet paper and wipe the seat. Then, she'd carefully lay strips of toilet paper to cover the seat. Finally, she'd instruct, "Never, NEVER sit on a public toilet seat."

Then she'd demonstrate "The Stance," which consisted of balancing over the toilet in a sitting position without actually letting any of your flesh make contact with the toilet seat.

By this time, I'd have wet down my leg and we'd have to go home to change my clothes.

That was a long time ago. Even now, in my more "mature years, "The Stance" is excruciatingly difficult to maintain, especially when one's bladder is full. When you have to "go" in a public bathroom, you usually find a line of women that makes you think there's a half-price sale on Nelly's underwear in there. So, you wait and smile politely at all the other ladies, who are also crossing their legs and smiling politely. You get closer and check for feet under the stall doors. Every one is occupied.

Finally, a door opens and you dash in, nearly knocking down the woman leaving the stall. You get in to find the door won't latch. It doesn't matter. The dispenser for the new fangled "seat covers" (invented by someone's Mom, no doubt) is handy, but empty. You would hang your purse on the door hook if there was one - but there isn't - so you carefully but quickly hang it around your neck.

Mom would turn over in her grave if you put it on the FLOOR; you yank down your pants, and assume "The Stance - Ahhhh, relief. But then your thighs begin to shake. You'd love to sit down but you certainly hadn't taken time to wipe the seat or lay toilet paper on it, so you hold "The Stance" as your thighs experience a quake that would register an eight on the Richter scale.

To take your mind off of your trembling thighs, you reach for what you discover to be the empty toilet paper dispenser. In your mind, you can hear your mother's voice saying, "Honey, if you would have tried to clean the seat, you would have KNOWN there was no toilet paper!"

Your thighs shake more. You remember the tiny tissue that you blew your nose on yesterday - the one that's still in your purse. That would have to do. You crumple it in the puffiest way possible. It is still smaller than your thumbnail.

Someone pushes open your stall door because the latch doesn't work. The door hits your purse, which is hanging around your neck in front of your chest, and you and your purse topple backward against the tank of the toilet.

"Occupied!" you scream, as you reach for the door, dropping your precious, tiny, crumpled tissue in a puddle, and sliding down, directly onto the insidious toilet seat. You bolt up quickly, knowing all too well that it's too late. Your bare bottom has made contact with every imaginable germ and life form on the uncovered seat because YOU never laid down toilet paper - not that there was any, even if you had taken time to try.

You know that your mother would be utterly ashamed of you if she knew, because you're certain that her bare bottom never touched a public toilet seat because, frankly, dear, "You just don't KNOW what kind of diseases you could get."

By this time, the automatic sensor on the back of the toilet is so confused that it flushes, sending up a stream of water akin to a fountain that suddenly sucks everything down with such force that you grab onto the toilet paper dispenser for fear of being dragged off to China. At that point, you give up. You're soaked by the splashing water. You're exhausted. You try to wipe with a gum wrapper you found in your pocket, and then slink out inconspicuously to the sinks.

You can't figure out how too operate the faucets with the automatic sensors, so you wipe your hands with spit and a dry paper towel and walk past a line of women, still waiting, cross-legged at this point, no longer able to smile politely.

One kind soul at the very end of the line points out that you are trailing a piece of toilet paper on your shoe as long as the Mississippi River! (Where was it when you NEEDED it??) You yank the paper from your shoe, plunk it the woman's hand and tell her warmly, "Here, you just might need this."

As you exit, you spot your hubby, who has since entered, used and exited the men's restroom and read a copy of War and Peace while waiting for you.

Annoyed, he asks, "What took you so long, and why is your purse hanging around your neck?"

This is dedicated to women everywhere who have ever had to deal with a public restroom (rest??? you've got to be kidding!!).

It finally explains to the men what really does take us so long. It also answers their other commonly asked question about why women go to the restroom in pairs. It's so the other woman can hold the door and also pass you a tissue.

Saturday, July 15, 2006

Pirates 2

Didn't quite fancy the sequel to the Pirates of the Caribbean: Curse of the Black Pearl. Found the story rather confusing, probably due to the oftentimes incomprehensible accents of the various characters (I wonder if all pirates speak with that strange brogue).

Why was Davey Jones after Jack Sparrow?

Why did Elizabeth Swann handcuff Capt Sparrow to the Black Pearl, guaranteeing him an almost certain death (note: ALMOST)? Especially after giving him a super-passionate kiss?

Why did they go back to that strange witch doctor lady with the incomprehensible accent?

Oh well, at least we managed to catch the teaser trailer from Spiderman 3! Venom aka Eddie Brock, played by Topher Grace of That 70's Show fame, is going to be one of the new villians!!! And we actually saw his trailer in NYC!!!

Mark your calendars: May 4, 2007

We've a Long Way to go

This article was in The New Paper:

Sick woman rushed to ambulance on ground floor. Ugly S'poreans squeeze in and make it stop on their floors
THE NEW PAPER, July 15, 2006

AN elderly woman, 60, collapses in a crowded shopping centre. She is seriously ill and needs to get to the hospital urgently.

Paramedics rush to the scene, place her on a stretcher, and get into a lift to take her downstairs to the ambulance.

But to the horror of the anxious family members, some shoppers refuse to give way. Instead, they decide to squeeze into the lift.

That's not all. They then press the buttons for all the other floors where they want to get off.

That's what Singapore Civil Defence Force (SCDF) paramedic Carolyn Low, 28, encountered recently at an Orchard Road shopping centre when trying to transport an unconscious cancer victim down from the fifth storey.


She said: 'The lift ended up stopping at every floor. One of the relatives was so upset, she shouted at everyone in the lift.'

The incident highlights a new breed of inconsiderate people who think nothing of blocking the work of rescue personnel despite years of public education.

As SCDF personnel attend to more emergency cases in highrise buildings, they recall having brushes with a new breed of ugly Singaporean: The lift-hoggers.

While the SCDF says that most Singaporeans are helpful and considerate toward emergency personnel (see report on facing page), some are just too selfish and insensitive.

Given the serious consequences that could arise from a lift hog's actions, even one delay could be one delay too many.

Ms Low, who has been with the SCDF for seven years, recounted another incident in a HDB block in Serangoon last year.

She was trying to transport a woman in her 70s, who had a heart attack, to the ambulance downstairs.

She was trying to give the woman CPR inside the lift, but that didn't stop some 'uncles and aunties' who 'die die' wanted to squeeze into the lift. Not only did they get in her way, they also delayed the transfer to the hospital.

Mr Muhd Milhan Shah, 23, a medic and NSF, encountered another group of ugly Singaporeans last month.

Together with a paramedic and ambulance driver, they responded to a 995 call at a second storey HDB flat in Toa Payoh just past 7am.

Because the patient, a man in his 20s, was suffering from back pain and had to be immobilised flat on his back, the paramedic and driver had to carry him down the stairs using a special device.

Mr Milhan was left to transport the regular stretcher, the 10kg automated external defibrillator used to shock patients, and a large 'trauma bag' containing medical supplies, by himself.

But when the lift arrived, there were four people already inside.

Said Mr Milhan: 'I asked them, 'Can you let me through, you can use the staircase, it's only the second floor.''

But one women in her 50s said instead: 'No no, I'm late for work.' Then she tried to close the lift door.

Shocked, Mr Milhan pressed the lift door open and asked again - this time stressing that he was with the ambulance service and there was a patient downstairs waiting for him.

But he was turned down again.

In the end, Mr Milhan pushed open the door, and squeezed himself and all the equipment into the lift.

He said wryly: 'They nagged at me a bit, but I just kept quiet.'

Besides lift hoggers, emergency personnel also have to deal with the ubiquitous Singaporean kaypohs.

Said Ms Low: 'Sometimes they crowd around to kaypoh, see what we are doing. But when we need help, like carrying the patient, they don't offer.'

There's also the bochap shoppers: 'We are in shopping centres, trying to get access to the patient. But they don't give way until you shout, 'Excuse me, excuse me!' ' she said.

Singaporeans can also be inconsiderate in indirect ways.

Said Mr Milhan: 'Sometimes when I push the stretcher down the corridor, there are a lot of big vases (flower pots) obstructing our way. Slippers - we can still kick aside. But vases, bicycles, we have to carry aside one by one - especially early in the morning when they (the owners) are still sleeping.'

Anyone who voluntarily obstructs any public servant in the discharge of his public functions can be jailed up to three months, fined up to $500 or both.

Cpt Siti Afzan, assistant director of the SCDF Medical Department (emergency medical service), said: 'During emergencies, our paramedics are trying to assist those in distress and quickly rush them to the hospital. Help from the public, such as giving way to responding ambulances and giving priority to paramedics using the lift, can help us in our life-saving mission.'"

Smile Singapore 2006 indeed.

Friday, July 14, 2006

Singapore Idol...NOT!

Don't get me wrong.

I had hoped with all my heart that we would see come credible talent on SI.

But after the dismal showing on the first show, these hopes have come to nought. These were the top 12 out of the thousands who auditioned??? I shudder to think what the others who didn't make it were like.

Apart from a couple of potentials like Paul & Mathilda, I watched the other performances with a grimace of pain on my face (note: this was an involuntary reaction to the sight & sound; my son bore a similar expression). This was the first time that I was watching the entire top 12 in action.

"Give them a chance, why not?" I thought. I had missed the first 3 episodes cos I was away then. Then I saw the wildcard show - grimace of pain there too.

Then I thought: "Maybe the top 12 will be better."

High hopes.

I really don't know how the judges can bear it; at least Ken Lim has some substance in his comments. As for Ja...err...most of the time I wonder what the heck is she trying to say...

I am all for supporting local talent...if you can find it.

I think I will watch Rockstar: Supernova instead.

Wednesday, July 12, 2006

A Little Book with a Big Heart

I read "The Secret Life of Bees" by Sue Monk Kidd in just one day. I just couldn't put it down.

It's a story set in the South (of the USA) during the fledgling days of the Civil Rights Act, when racism was rampant against the African-Americans. It tells of a motherless girl, Lily, who discovers that family ties can transcend man-made barriers like differences in skin color, and can form even between non-related individuals. She discovers the strength of the human spirit through trinkets of advice from black beekeeper August Boatwright.

Here are some excerpts:

"Well, one time Big Mama told me she went out to the hives on Christmas Eve and heard the bees singing the words of the Christmas story right out of the gospel of Luke...

...What I mean is that the bees weren't really singing the works from Luke, but still, if you have the right kind of ears, you can listen to a hive and hear the Christmas story somewhere inside yourself. You can hear silent things on the other side of the everyday world that nobody else can...."

"You know, some things don't matter that much, Lily. Like the color of a house. How big is that in overall scheme of life? But lifting a person't heart - now, that matters. The whole problem with people is-"
"They don't know what matters and what doesn't," I said, filling her sentence and feeling proud of myself for doing so.
"I was gonna say, The problem is they know what matters, but they don't choose it..."

Cynics may find it cliched...but I found it inspirational.

Tuesday, July 11, 2006

Soul searching

Been feeling kinda restless lately. Not that I don't enjoy my free time & being, somewhat, a 'lady of leisure', as some might put it. But perhaps its the guilt complex in me, or the work ethic that's been drilled into me from school days, through med school & internship & through my working life that in order to be a productive citizen of society, one has to work & contribute to the economy.

I thought that I had gotten over it last year in the first few months of non-working life. But I guess I haven't. This feels slightly different, though. I know that there has to be more to life than lounging by the pool, reading novels, having foot massages/facials, watching matinees in a non-crowded theatre or going to The Sale Worth Waiting For at Robinson's at off-peak hours. There are probably tai-tai's out there who would disagree, but I'm not one of them. (I do appreciate the luxury of being able to linger over a leisurely lunch with a friend without having to worry about rushing back to the clinic to clear the post-lunch crowd.)

However, the thought of going back to clinical practice is still quite abhorrent to me. In fact it evokes a rather unpleasant fluttery feeling in my stomach just thinking about it. I'm just not ready yet. I need to find something to do other than Practise Medicine. What that something is, I have yet to discover.

Friday, July 07, 2006


I was quite confuzzled by an editorial in today's Straits Times "S'pore health system 80% fine but fix the 20%" by Ms Chua Mui Hoong. In it, she highlights what is right about the local healthcare system but emphasises that we should not ignore what needs improvement. She gives as examples of the latter, cases in which miscommunication between patients & healthcare providers resulted in death of the patients.

She says:
"A punitive culture where everyone fears making decisions in case a mistake is made is paralysing and counter-productive."

A promising attitude, I thought.

Then she proceeds to say in following paragraphs:
"The system must be exacting enough, and the auditors or senior doctors stern enough, for those down the line to fear the consquences of making a mistake sufficiently to keep them on their toes."

A bit of a contradiction, eh what? Isn't she advocating a punitive culture here?

I wonder what message she is trying to bring across in this article.

Wednesday, July 05, 2006

Ladies Night Out

Actually, it was more like a "Ladies Weekend Away".

I just returned from a long weekend in Hong Kong with two of my oldest & best friends - no kids, no husbands, no stress!

The relationship between girlfriends is a unique & special one. When we are together we can talk about things we would never discuss with our husbands/children/parents. There is a comfort about being with someone whom you have grown up with, through the angst of adolescence, through the teenage crushes, through shared experiences of school/university/relationships.

So this time away was a much appreciated one by all three of us. Not just the shopping or the eating, but more so, the company one was with.

Sidenote: Singapore needs to take notes from Hong Kong as far as customer service is concerned. HK has come a long way from as recent as 5 years ago. The sales persons at the retail stores are incredibly helpful. Even if you walk out without buying anything, they say a cheerful "Have a nice day" as you exit.
Oh, and one more thing: for the best "dou hua" (bean curd dessert) in the world, go to Sweet won't regret it. I am still thinking about the tub of dou hua we ordered....yum...