Thursday, October 25, 2007

Plantar Fasciitis

Boy, what a pain this is.

I just read this article from Medscape about Plantar Fasciitis.

I am sure GPs will agree with me that this is one of the most common foot problems seen in their clinics. And treatment can be difficult as well as it tends to drag on or become a recurrent condition in some patients.

The article mentions most of the modalities of treatment we would generally use (although now, I tend to discourage patients from getting steroid injections into the affected area....damn painful, & also not advisable) but seems to have left out NSAID’s for symptomatic relief.

Oh, and I think they could have mentioned CROCS as well…. :)

Monday, October 22, 2007

Tough Calls

How does one make such a decision?

Oct 22, 2007

Weigh options when saving premature baby

I REFER to the article, 'Saving tiny tickers' (ST, Oct 11).

It is indeed heartening that medical advances allow the babies mentioned to enjoy a new lease of life.

Infant mortality has been reduced drastically because of the excellent medical care and services provided by Singapore's health-care workers.

However, we should not use the plain vanilla number of initial infant survivals as the basis of a job well done by health-care professionals.

This holds true, especially for extremely premature babies.

With advances in medical treatment, younger and younger 'premmies' are able to survive.

However, some will have disabilities, from minor to major, because of their early arrival and subsequent damage to their brain and under-developed organs.

If a baby is severely brain-damaged, where his quality of life in future is likely to be almost non-existent, should the doctor go all out to save the baby, just so he is alive for another painful day?

Or should the doctor let the baby die with dignity, through compassionate inaction?

Who should be the one to make such an important judgment call on the treatment (intensive, moderate and just enough to prolong the life, letting go) for the tiny patient?

For parents, this dilemma can be very much be like that of the relatives of a brain-dead patient.

It is therefore important that a clear standard set of rules and guiding principles be provided and adopted for extreme premmies' treatment, as this is a sensitive and grey area where emotions, and personal and religious morals and convictions play a big part.

It is important that the parents have a say in the premmie's treatment and can make informed decisions.

This is because, as parents, their decisions will be based on what is best for the baby.

Doctors should not be biased against their young patients' parents, even when the parents' views and opinions differ greatly from theirs.

Doctors should also respect parents' decision on treatments offered to the baby, even if they disagree with the parents' decision.

At the end of the day, it is the parents, not the doctors, who will have to care for the disabled child.

Thus, treatment options should be scaled towards what the informed parents want.

As a resident working in the NICU, I grappled with such dilemnae almost daily. Why save the premature, especially the severely premature, when the child eventually develops disabling conditions like cerebral palsy, bronchopulmonary dysplasia, ROP, all requiring long term medical care, with questionable quality of life. And the caregivers, having had to deal with the heartbreaking situation, are now saddled with a huge hospital bill, & look forward to a life time of probably repeated hospital stays & visits & seeing their child suffer.

But as a resident, one sworn to save lives, we pretty much did our damnedest to save even the most premature of babies until we knew that there was nothing much else we could do for him. I don't remember any one of the parents trying to stop us from doing so. I sometimes wondered why.

But then I became a parent. I then realized that the love one has for one's child, even unborn, is undescribably all-encompassing. I understand now, why these parents would want the doctors to try their damnedest, no matter how disabled or how much suffering their child might end up with. In a way, it's a selfish kind of love.

In any case, it's a tough call to make. To save or not to save. You tell me.

Sunday, October 21, 2007

Impressions from China - Blocked

And the blockages continue. First it was Blogspot then Flickr and now You Tube.

It's annoying.

Appreciate your freedom, people out there.

Thursday, October 11, 2007

Mountains & Molehills

A case of who knew too much about Clooney

By Gina Piccalo, Los Angeles Times Staff Writer October 11, 2007

A New Jersey hospital is at the center of a storm over its suspension of 27 staffers. The action, over viewing of the actor's file, seems 'a little harsh,' his publicist says.

George Clooney's medical records and the hospital staff who may or may not have leaked them to reporters have caused quite a dust-up at a North Bergen, N.J., hospital this week, leading to a month's suspension of 27 staffers without pay and thrusting Palisades Medical Center into the rigorous churn of the worldwide celebrity news cycle.

The story was bested this morning only by Lindsay Lohan's whereabouts since rehab, and naturally hundreds of bloggers debated the hospital's actions. Camera crews flocked to the Palisades Medical Center, and reporters flooded the phone lines of the hospital and the union representing some of the suspended staffers.

"It is just sickening," said one hospital receptionist of the newshounds. "There's more important things going on in the world."

Indeed. But -- spoiler alert! -- those things won't be covered here.

Clooney and his girlfriend, Sarah Larson, took a spill while riding the actor's motorcycle in northern New Jersey on the afternoon of Sept. 21. Clooney suffered road rash and a cracked rib, and Larson injured her foot. They were treated and released from the hospital the same day.But news of the incident ricocheted around the Internet and made headlines around the world (as did subsequent footage of Clooney escorting his paramour as she teetered along on crutches).

Palisades Medical Center found itself at the heart of the news story and launched an investigation into staff access to Clooney's records. So far the hospital hasn't accused its staff of leaking the information to the press, but the investigation revealed that as many as 40 hospital staff members accessed the actor's personal medical records in apparent violation of federal law that bars staff members who are not directly connected to a patient's treatment from consulting a patient's medical records.

Since then the story has gained momentum, leaving the hospital struggling to go about its daily work while at the eye of a celebrity news story. The 27 staffers were suspended on Friday. The hospital released a statement today, emphasizing that its staff "adheres to a strong code of ethics that respects the privacy and confidentiality of all of our patients.

"Eurice Rojas, the hospital's vice president of external affairs, could not be reached for further comment.

A spokeswoman for the Health Professionals and Allied Employees union, which represents seven of the suspended workers, has publicly criticized the suspensions as premature until the hospital's investigation is complete. Some suspended employees may have been legally permitted to view the records, said union spokeswoman Jeanne Otersen.

"I'm looking at the Web and seeing how widespread [this story] is," she said. "Whether you are John Doe or George Clooney, you have the same rights to privacy. The same goes for the staff. They have rights too. Now you have a tenfold violation of his privacy. . . . I think there's a different way to handle it so that you both protect patients and educate workers and make sure that, while people are held accountable, there's due process."

For his part, Clooney -- known for his lively debates with the media on its treatment of celebrities -- has taken this latest security breach in stride.

On Tuesday afternoon, he issued a statement in defense of the staffers and emphasized that he had nothing to do with the investigation of the alleged leak.

"This is the first I've heard of it," Clooney said, referring to the suspensions. "And while I very much believe in a patient's right to privacy, I would hope that this could be settled without suspending medical workers."

"This is not our issue," Clooney's publicist Stan Rosenfield added today. "This is between the hospital and their employees . . . . This was not anything we instigated. We felt that perhaps suspending medical workers was a little harsh."

Yes, patient confidentiality is important & is well understood by health care workers.

But suspending 27 hospital staff for one month with no pay??? That's a bit much, isn't it?

I wonder if the same punitive action would have been imposed if the patient happened to be John Smith, plumber instead of George Clooney, movie star?

Monday, October 08, 2007

Impressions from China - Blue

Yesterday we saw blue skies. An unusual occurrence here in Beijing where a grey haze has become what we are accustomed to & a PSI of 90 is called "Good" day. The clear air was a result of a full day of slow drizzling rain, washing away the fumes & pollution coming from the kazillion vehicles, factories & what-have-yous.

It was wonderful seeing the Blue again, with white flurries of clouds interspersed amidst the cumuli nimbus, & breathing in clean air without the smell of exhaust or chemicals. We could even see the mountain ranges north of us - a rare & beautiful sight, indeed.

I wonder how long it will last. Today looks promisingly Blue still. The day is still crisp, with sunlight brightening up this fall day.

Mmmm….nice…I'd better go outside today & & enjoy it whilst I can, before the muck builds up again, which should take, oh, another 12 hours or so, I would think.


We’ve been offline for almost 3 whole days now. THREE WHOLE DAYS.

It’s sad how reliant we’ve (at least our family) become on our Internet connection. It feels like losing the use of my left thumb. (I don’t mean to belittle the importance of the opposable digit, but on the contrary, emphasize on the importance of keeping connected with the cyberworld.)

Email, Facebook, Blogging, Google…all a means of keeping connected with family, friends, & the community at large. For work, or for school, or just plain daily living, we’ve felt lost without it. Hubby needs it to access his email from home; kids need it to research school work, do homework & just for keeping in touch with friends in far away places.

By the time you read this, we obviously would be back online.


Wednesday, October 03, 2007

Impressions from China - Corn, anyone?

In the past month or so, this has become a familiar site. The end of summer marks corn harvest time, & I have to say the Chinese are resourceful in using what is available to them.

Our neighborhood is built amidst villages. A lot of the land has been taken over by sprawling expat compounds. Previously mostly farmland, there are still large areas where various crops are grown, depending on the season.

When the corn was ready for harvest, all those ears were stacked on the neighborhood streets, for lack of available space, in hundreds of piles, exposed to the elements, road gravel, passing vehicle exhaust & the occasional wandering stray dog or animal (I shudder to think what else these dogs may have done besides sniff at these piles of corn!). After a week or two of drying, the villagers put these ears of corn through machines which de-kernelize(is there such a word?) the corn, after which the kernels of corn are again left on the roadside to air before subsequently being ground into cornmeal.

I really, really wonder if there is further cleansing or sterilizing of the end product before it is sold as a consumable product. Maybe it's meant for the pigs?

Who knows? This is China.

Tuesday, October 02, 2007

Aliens in America

This looks like a promising new series that addresses our differences (as well as our similarities) head on, without the double-talk & hypocrisy that is so rampant nowadays in the guise of political correctness.

Crossing my fingers that it will reach our shores (or at least, our satellite waves!) eventually!