Thursday, November 30, 2006

A chocolate a day keeps the doctor away

Good news for fellow chocolate lovers out there!

This article from Medscape shows promising results that eating chocolate may have the same effect as taking an aspirin a day!

"Chocolate Has Antithrombotic Effects Similar to Aspirin"
Martha Kerr

November 17, 2006 (Chicago) — Subjects enrolled in the Genetic Study of Aspirin Responsiveness (GeneSTAR) inadvertently helped Johns Hopkins University researchers measure chocolate's inhibition of platelet function and show that eating chocolate slows clotting time. The findings may explain how chocolate and cocoa-containing foods exert a cardioprotective effect.

A group of 139 healthy individuals did not eliminate chocolate from their diet.

Senior investigator Nauder Faraday, MD, associate professor of anesthesia and critical care medicine at Johns Hopkins University in Baltimore, Maryland, told Medscape that "chocolate was just one of those things this group couldn't give up."

The subjects were ejected from GeneSTAR proper and were not randomized in the aspirin assessment phase of the study. But Dr. Faraday and colleagues took advantage of the subjects' noncompliance to assess chocolate's previously demonstrated role in cardiovascular risk reduction, using the same platelet function analyzer test employed in the GeneSTAR study.

The investigators measured agonist-induced platelet activation in the presence of shear and calculated time to closure in the system by a platelet plug. Platelet activation was also assessed on urinary excretion.

Chocolate consumption caused a significant increase in time to closure, but remained within the normal range, the investigators announced here this week at the American Heart Association 2006 Scientific Sessions.

"Chocolate, even in small amounts, was an independent factor in inhibition of platelet activation," Dr. Naraday said. It extended closure time, regardless of age, sex, smoking status, body mass index, systolic blood pressure, total cholesterol level, fibrinogen levels, or von Willebrand factor.

"The magnitude of the effect was quite small," Dr. Naraday emphasized. Chocolate had the same type of effect as aspirin, but by a factor of 5 to 10 times less, according to the assay used in the GeneSTAR study, he said.

Elliott Antman, MD, professor of medicine at Harvard University in Cambridge, Masssachusetts, told Medscape that he found the results intriguing. "It might help explain the tremendous variability among patients to platelet inhibition, particularly as seen in response to aspirin."

Dr. Naraday pointed out that "any time you shift the balance away from thrombosis, you set up a situation with the potential for increased bleeding time and other risks, but I don't think this is a big problem with eating chocolate!"

Dr. Faraday's study is funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. Dr. Antman reports no relevant financial relationships.

AHA Scientific Sessions 2006: Abstract 4101. Presented November 14, 2006.

On Mediation Again

I wrote an entry about Mediation May 25th this year titled On Mediation. I was very skeptical about the workability of such a process here at that point of time.

In today's Today Online, this process is outlined & will come into effect next year. I think it is a good first step to take in trying to tackle the increasing numbers of complaints lodged against medical practitioners & healthcare institutions.

Now doctors can say 'sorry'
A freer, less painful approach to medical negligence cases

Loh Chee Kong
EARLY last year, Mr Surender Singh's wife died after she donated one of her kidneys to him. He still doesn't know why. He hasn't heard an explanation or an apology from the doctors concerned. The hospital is being fronted only by its lawyers — and for good reason.
When something goes wrong, doctors worry that anything they say might be used against them in court, said lawyer Amolat Singh, who represents Mr Surender Singh.
Starting next year, an initiative by Chief Justice Chan Sek Keong could change the complexion of medical negligence cases. All parties can meet before a case begins; patients or their relatives can find out exactly what happened; and, if necessary, doctors can say sorry.
More importantly, everyone can speak freely, because the information exchanged cannot be used in court.
In fact, experts said that if the move takes off, there could be less need to go to court at all. The air of mistrust can be cleared, and if an honest mistake has been made, the matter can be settled without relying on expensive litigation.
Under this new protocol, once someone has paid a fee of between $75 and $100 for his medical documents, he should get a response from the hospitals and doctors within six weeks.
After that, a face-to-face meeting can be arranged within two months.
An average of nine medical negligence suits have been filed here each year since 1998. Most get settled at the Subordinate Courts' Primary Dispute Resolution Centre without going to trial.
The new "open disclosure" policy could ease the pain further. Eventually, said Subordinate Courts Registrar Toh Han Li, it might even be applied to cases in the High Court, which hears civil suits involving claims of more than $250,000.
Both doctors and patients could gain. More understanding — and fewer cases going to court — could bring down premiums on insurance policies for doctors and lower medical costs.
Patients also know how hard it is to prove outright medical negligence. One of the last notable cases where a patient sued successfully was in 2001, when a botched operation shrank an American national's testicles to the size of a child's.
Some patients get unnerved by high legal fees, while others find it difficult to find a medical expert to testify against his peers, said lawyer Peter Low.
Doctors, caught in a legal tangle, get equally frustrated.
Said Dr Chong Yeh Woei, a general practitioner: "When you get involved in a legal process, the first thing you do is to consult your lawyers and do what they tell you to.
"You might want to say sorry — and sometimes, it's all the other party wants. But by saying sorry, you are admitting liability and guilt."
Or, as Dr Melanie Billings-Yun, a consultant in conflict resolution, put it in her February lecture to a roomful of Subordinate Courts officials: "The adversarial system is based on faults. But in 80 to 85 per cent of malpractice cases, there is no fault to be found.
"If doctors are forced by their lawyers or insurance companies to treat every adverse outcome as a dirty secret, is a patient or his family being unreasonable to imagine that fault must indeed lie behind a stone wall of silence?
"With an open disclosure policy, doctors and nurses will no longer be made to hide as if they were criminals ... more importantly, they will find that their words have the power to heal their own wounds."

However, I am still skeptical as to how long it will take for the mindset of doctors & patients to change from one of blame & shame to one of openess & mutual understanding. As doctors, we have been so afraid of being open to admitting to mistakes because of the fear of litigation that I wonder how long it will take for us to embrace this new process.

And in addition, within our own community, this punitive culture is still prevalent enough to prevent most of us from owning up to honest mistakes. How many of us have, as junior doctors, been made to feel absolutely fearful & ashamed by our seniors when they belittle us for our lack of knowledge or skill?

Yup, this is a good first step. But I still see a rather long flight of stairs ahead of us...


Been getting really strange dreams this past week or so, possibly due to my subconscious mind reacting to the stress of the impending move.

Last week, I dreamt that my sister was married to Hugh Jackman! Not withstanding the fact that Hugh "Hottie" Jackman is already married, I really really really REALLY cannot imagine my sister falling for him. I do admit that in my dream, I was a trifle jealous (married woman that I am, I confess to a little crush on this hunk of a dude). The fact that I watched "Happy Feet" (in which HJ did the voice of Memphis, & was the first time I had heard him singing - lovely voice - wish I could have caught him on Broadway doing "The Boy From Oz"...but now I digress) last week probably contributed to the generation of this dream.

Then last night, I dreamt that I (Mary Jane Parker) went on some kind of weird vacation with Peter Parker (aka you-know-who) at this dumpy little motel located in what felt like a really bad part of LA. Every corner we went, there were these Hispanic gangs eyeing us, looking like they were about to attack us any minute....and dear old Peter refused to use his Spidey powers to intimidate these people!!! And I was quite upset by that. Bizarre. I think I have Spiderman on my mind after watching the latest trailer for Spiderman 3, which looks to be superb.

Maybe I am subconsciously calling for help from my superhero idols - Wolvie & Spidey - to help me pack & move house!!! Especially since my husband will be away for 2 weeks preceding the pack out, on a business trip & only arriving back here THE DAY BEFORE THE MOVERS COME!!!

Maybe tonight I'll dream of the whole X-Men team...

Saturday, November 25, 2006

Organs For Sale?

There were two articles recently about kidney transplants.

The first was a heartwarming one about a 5 way swop of kidneys so that 5 needy patients with 5 willing but otherwise non-compatible donors, would be able to receive suitable kidneys. With the shortage of donors, this unconventional method of transplanting kidneys was a great success. Although it must have been a logistical nightmare, all came together with a resulting happy ending.

The second is about the legalisation of sales of kidneys in Iran. This is undeniably controversial. The question of ethics comes up. But if you were the patient, & had the means to pay for such a procedure, would you do so? Having said that, would this mean that only those who can afford it will get the kidneys they need while the poorer patients will have to wait till an available donor comes up, or till they die?

As doctors, our first response to such commercialisation of organ transplantation would most likely be that of disapproval. The idea of selling organs for money is a distasteful one. Whenever money comes into play, there is always the chance that eventually, the bottom line will become more important than the patient's health (IMHO, this is already happening - look at how aesthetic medicine is booming & how MHC's have affected the way medicine is practised).

But as humans, how do we condemn someone who only wants to live to see his/her children grow up & grow old with the one they love?

This is a complicated issue indeed, & something that we need to step back & look at from different easy answer to it.

Friday, November 24, 2006

Separation Anxiety

I think emotionally, I haven’t yet come to terms with the fact that we will be leaving Singapore in just over a month. I’ve been so busy taking care of the practical side of things like arranging moving dates, selling stuff etc. that I really haven’t had time to ruminate over what this move will mean.

This will not be the first time that I am moving away. Fourteen years ago, we left this island with an infant in tow. I was too excited about living in a new place & meeting new people to really be overcome with any kind of sadness over leaving. Definitely I missed my family & friends. But I was too busy with having to take care of a young child, & settling down to wallow in any form of misery (not that I am the wallowing kind in the first place!)

This time around, both my kids are more independent & don’t need round the clock care like 14 years ago (!!!). I will have more time to myself, since domestic help is readily available in China. I certainly don’t plan to immerse myself in self-pity. I hear that expats there make friends more easily than here in Singapore, for some reason. Hopefully that will prove to be true, as I find that the older I get, the harder it is to establish firm friendships like the kind that endures since childhood or college. That kind of comfort level where you can meet each other & feel immediately at home even though you have been apart for a number of years…that is the kind of intimacy that close & old friends share that is hard to capture in new friendships.

I know for sure that I will miss being able to visit with my parents/siblings/best friends when I feel like it. And I will miss the fluid efficiency of the way things are run here (despite our frequent complaining!), not to mention local hawker fare.

But with technology, Mom/Dad/Sis/Bro are just a phone or Skype call away, we can even use the webcam to have face-to-face conversations without having to worry about long distance phone bills. And a six hour flight is not that far away for one to visit or be visited by family.

Monday, November 20, 2006

busy, busy, busy

please excuse my absence. it's been a busy week, including a rockappella concert, and a short trip up to kl to attend a wedding of the son of an old friend of my mom's. talk about lifestyles of the rich & famous...this wedding was the wedding of the year in malaysia (imho). even the agung (king of malaysia, for the uninformed) attended. blessing ceremony by the lakeside; goody bags with amazing pressies for all the guests; carnival-like entertainment with magician, jugglers, pretty girls with pythons draped around their necks & parrot/parakeet on their fingers; hired band from singapore; beautifully made videos of the couple's love story (this beats, hands down, the usual slideshows played to cheesy romantic love songs that one sees at the "normal" wedding dinners) including the proposal video involving a mini had to see it to believe it.

of course, no trip to kl is complete without the ritual rounds of yummy hawker food (wantan mee, char kuay teow, mee yoke, chee cheong fun, hokkien mee all cooked in ways unique to kl)...i think my arteries are semi clogged from all the cholesterol i ingested over 3 days!!!

now that i am back, it's back to the overwhelming task of preparing for the move. add to the list of things to do(refer previous entry):
  1. choose furniture for housing (not easily done with pictures sent via email)
  2. get influenza shots for family (hep a & typhoid already done; don't think we are at risk for jap encephalitis nor rabies so will pass on that for now...will have to warn kids to stay away from stray animals & rabid looking humans!)
  3. get vital medical checkups done before leaving (ladies above 40, don't forget your annual mammograms!)
  4. sell furniture that we are not bringing with us (almost done - surprisingly, lots of takers for 2nd hand stuff)
  5. finish christmas shopping
add to this the 2 final locum sessions that i had earlier committed too, & you have one pretty busy lady. i didn't want to call the hiring doctor to say that i can't do the sessions, knowing that it's the school hols now & locums are in demand (especially lady ones)...ah well....i'll survive.

note: no caps in this entry - quite liberating. maybe i should try no punctuations one day, but then it would probably be too hard to read. :)

Saturday, November 11, 2006

Aliendoc's Things To Do Before We Move

1. Sell home - check
2. Sell car
3. Decide what belongings to ship to new home
4. Decide what belongings to sell
5. Decide what to put in storage
6. Buy winter clothing for kids (IMPORTANT!)
7. Forward mail to either mother or sister’s address
8. Change address of credit cards/banks etc
9. Terminate some credit card accounts
10. Inform SMC of move - check

As can be seen only 2 out of the top 10 things to do before we move have been checked off. Which means that I STILL HAVE A LOT TO TAKE CARE OFF!!!


Wednesday, November 08, 2006

On Being Parents

A couple of days ago, a toddler’s big toe was ripped off when it got caught on the side of an escalator. She was wearing rubber clogs (you know, the one that is damn ugly but damn comfortable). It was highlighted that these clogs are very pliable & hence would get caught & pulled into the gap between the side of the escalator & the step.

Hopefully, the clogs won’t be made the scapegoat of this kind of accidents. If you think about it reasonably, it would be quite difficult to edge your foot to the side of the escalator so that it would get caught. But knowing children, they have a propensity to stick things where they don’t belong. I have had to, on many occasions during my A & E posting, extract a variety of foreign objects from various orifices in the head of a number of children.

My point is this: an adult (usually the parent) is supposed to supervise the behavior of children, especially those under the age of 5. They are supposed to teach them that certain actions are dangerous, and that certain kinds of behavior are unacceptable in civilized society. They are supposed to teach them how to do certain things like crossing the road, going up & down stairs, going up & down escalators. Obviously, we don’t expect the kids to pick up on the safe way of doing these things immediately. You would expect the adult to hold the child’s hand, for example, while crossing the street (I still try to do that to my 12 year old, to his chagrin ☺). You would expect the adult to watch the child & admonish him if necessary, if the kid starts misbehaving on an escalator (like trying to stick his/her foot into the crevice between the step & the side…I don’t know if this actually happened in the above mentioned case, but it could have).

Parenthood is a full-time job. You need vigilance, care, and attention on top of TLC. It’s easy to love a child (especially your own☺!) but it is hard to keep them safe 24/7.

When my kids were little, I had child-proof locks on all my kitchen cabinets/drawers; child-proof covers on the knobs of the stove; a plastic shield attached to the front of my stove to prevent inquisitive fingers from reaching up & pulling a pot of boiling liquid on top of his head; child-proof gates preventing the kids from getting into the kitchen while Mommy was cooking (no maid while living in the US – I survived ☺); child-proof gates on the bottom AND top of the staircase, bumpers on the corners of my coffee table to prevent accidental bumps & scalp lacerations.

Whenever we ate out, I automatically would move breakable crockery or glasses full of liquid or hot dishes out of reach of grasping hands…I still do this if I happen to be dining in the company of small children!

Locally, many children are being looked after by domestic helpers. I think many parents become very lackadaisical when the time comes that they have to take care of their own child (eg. on the maid’s day off). They need to wake up, step up to the plate & take responsibility, not only for keeping their children safe, but also in teaching them how not to behave like hooligans.

Tuesday, November 07, 2006

“I yam what I yam!” (from Popeye the sailorman)

I read a report in the newspaper today about a 16 year old boy, D., who was convicted of robbery & given a 5 year jail sentence with 24 strokes of the cane (which is the maximum allowable). He had previously been sent to a juvenile facility for “reformative training”. D. himself shouted at the judge during his trial, threatening him & saying that this training was useless & that he should be sent to jail instead.

At first glance, the picture of this boy shows a typical face of a teenager. But look closely at his eyes & you see the vacuous expression, almost bereft of emotion. Who was it that said, “The eyes are windows into the soul”? How true.

This boy (yes, I consider him a child) is only 2 years older than my elder son. He started off in life with less than desirable circumstances - parents divorced, with dad apparently abandoning the family when he was just an infant. He is supposedly of below average intelligence as well – he has been faced with so many disadvantages in life already, I guess we shouldn’t be surprised with the outcome.

We are the result of our life experiences. As individual beings, we start off as a mass of organic material, with certain genetically pre-determined qualities. However, how these “lumps of clay” are shaped & what the end result is, is due to a complex interplay of factors including parental influence, family relationships, environmental push & shove and to a small degree, sheer luck.

Many of our neuroses stem from these factors. Whether we have been nurtured or battered by these childhood experiences & familial relationships, will determine whether that lump of clay will turn out to be a work of art, or just a rock to be hidden out of sight. I believe that all of us have, to varying degrees, dysfunctional families. If severe, this would express itself as neuroses. I would be the first to admit that I have issues to work out, all stemming from the factors listed above. However, I don’t think I am neurotic (yet…although it is probably matter of opinion, depending on whom you ask!).

It is sad that D. ended up where he is now in his short life. The African proverb “It takes a village to raise a child”, made famous by Hilary Clinton, is so true.

I guess D.’s village failed him.