Monday, November 23, 2015

A Hypogonadism Consult

I had an interesting consult the other  day. Again, one of the many, hordes in fact, of men coming in for a testosterone prescription. And I admit I'm jaded and I've begun the stereotype. This was the classical young man, meathead type with biceps bigger than a treetrunk. He could have been a body double for the incredible hulk. Proud that he bench presses 200 lbs.
And yet, feels that he needs to be on testosterone. Admits he 'juices' up frequently too (a word I learnt not too long ago) with crazy shit he was getting from his gym- androgens, to which they often add aromatase inhibitors to prevent gynecomastia, and HCG to prevent the resultant testicular shrinkage. What a crazy world.
Anyway, like many before him, this chap refuses to accept that his blood test showed his testosterone to be normal. And so he was here for  some 'medical testosterone'.
"I'm young. I should be on the higher range of normal!".
They all say that. Never mind that the total T was in the 600s already.
And he was most convinced of this for two reasons. That he has peaked with his weightlifting. And that he has 'erectile dysfunction'.
As an endocrinologist, I do go into a bit of detail when taking a history of ED. So I asked him what that meant to him. He was very concerned because a few years ago he could have sex about 5 times. And now it's only about twice.

Talk about feeling inferior. This chap's definition of normal was having sexual intercourse 5 times a day. And he is concerned that he is now only interested or able to do it 2 times a day.

I wasn't sure if I should laugh, cry, hit my head on the wall, or go on my knees and kowtow to him. 5 times a day??? Teach this padawan, O Master.

I was professional and held my composure. And did all I could to explain to him the normal endocrine physiology of the reproductive system, the risks of unnecessary testosterone use and the medical guidelines. I'm pretty sure he left unconvinced.

In the meantime, I feel like I need to go to the gym more.

Tuesday, November 17, 2015

The Nonbelievers

I have to admit, I have an inherent bias.
And how it came to this I don't know. After all, I hated Evidence-Based Medicine (EBM) in medical school. I had a bully of a mentor, a lab-based cardiac physiologist with minimal people skills, who bluntly told me, "Your question was so stupid I'm not even going to try to answer it...." (digression: I'm not a model teacher- but I swore I would never speak to a student/resident like that ever. Words do scar). Anyway, I spent all of medical school fearing the word 'research', and hating everything EBM.
I went into residency with the same sentiments, feeling stupid, ignorant and inferior when you are in the company of the world's medical greats. The world-famous researcher clinicians whom patients travel the world over to see. Classmates who compare not only how many publications you have but what impact factor the journal that accepted your manuscript carried.
Research. Ugh.
And then something kinda slowly happened. After all, you do get brainwashed training at the same institution for six years. And not that I consider myself a brilliant researcher, but at least I learnt some of the ropes. I learnt what it takes to write a paper, analyze a study, even perform experiments (I got to play with human orbital fibroblasts, yay!). And I popped my publication cherry. And became a scientist. I still consider myself one- after all, a doctor is a person of science, and as dynamic as science can be, we too need to evolve and learn, don't we? And so, it's interesting how I went from that hater of EBM in 1999, to one who looks at The Evidence, to guide his clinical judgments. Not only the conclusions of the study, but also to try to pick apart the study to see if he agrees with the findings. After all, the goal of an author is to get the study published, and one often learns to present the data in the most compelling way; so you can't always take things at face value. And so, yes, I'm a believer of EBM, I think we all should be.
That being said, I've realize that the world doesn't see things that way. For some, EBM remains a bad word, one that is controlled by Big Pharma who makes things up to fool doctors and ultimately patients, all in the name of making money. And I've realized that once a person chooses to not believe, there is no amount of data you present that will be accepted, that they always will view things with a generous serving of skepticism. That big pharma bought you/CDC/FDA over- never mind that the basic concept of EBM is that you learn to critically appraise and make your own decisions.
This is perhaps more worrisome when the person you're trying to convince is a medical professional. I ran into this situation when discussing a case with a surgeon, when he (in my opinion) was over treating a patient with an unjustified therapy based on an unproven diagnostic test (which incidentally enough, is something he owns too).
And so sometimes, there is only so much you can do. And sometimes, you just have to take a step back, and agree to disagree. But secretly you hope the patient takes your side, because the data really doesn't show that that treatment is necessary.

Sunday, November 01, 2015

Patient Satisfaction

There is much talk about the importance of patient satisfaction. Of how some hospitals and physicians are reimbursed in part based on how satisfied patients are, the much-hated Press-Ganey surveys. After all, we do want our patients satisfied, don't we?
Do we?
Proponents say, patients are clients, customers. Keeping them happy should be a priority.
But is this truly the relationship physicians and patients should have? After all, in situations like this, the 'customer' isn't always right; the patient doesn't have the background knowledge to know that's best for him or her. Studies have shown that higher patient satisfaction is associated with more adverse outcomes.
I'm sure this is a struggle all physicians across all specialties face. I hear this coming from ER and primary care colleagues of how patients leave disappointed if they are not prescribed antibiotics for a viral syndrome, or opiates for pain.
This week alone I encountered three situations myself where patients left obviously disappointed and upset.
Two patients with no background of thyroid problems who were upset because I would not prescribe thyroid hormone treatment for their fatigue and inability to lose weight despite claiming to be on a diet and exercising. One already had a TSH that was undetectable while on exogenous Levothyroxine, refusing to discontinue treatment.
Another patient, a woman, who left upset because I would not prescribe Testosterone treatment for her dry skin! Because according to her extensive research (on Google) skin dryness if from Testosterone deficiency; after all if a person makes too much, you get oily skin, acne, right?
I have to say, a part of me blames the referring physician. It gets my blood boiling, wondering where how the heck these people got their medical degrees. It's not surprising that a patient leaves unhappily, when your GP promises that this hormone specialist will fix your problems, and gives you the impression that your troubles are indeed from a hormonal imbalance. And then you wait 2 months to see this person, who then says no to treatment but bills you for the visit.
So, no. I do wish to try to satisfy my patients, but my view is a patient is not a customer in the classic sense; he/she does not have the medical background to really know what's best for his or her health.
As how my patient ominously ended my session with her after I counselled her on the risks of unnecessary hormonal treatment: "I'd rather have a stroke than continue to be fat..."
Is this going to be the future of healthcare?

Sunday, October 11, 2015

Farewell, my Malaysia

My flight out departs in a few hours. And truth be told, I miss my wife and kids terribly, and a large part of me can't wait to see them.
Another part will miss what will always be one of my homes- Malaysia.
And I find myself doing what I usually do in the days preceding my departure. I try to capture as much as I can, to bring the memories back with me. This usually means my shooting of random pictures.

Such as the beautiful chaos of the pasar malam. 

Or how motorcycles snake in and out of traffic, often carrying little kids, or sometimes even 3!

I'll miss the KL skyline. Even if it was haze and smog-covered this trip. But thankfully, this night when I was up there for dinner, it cleared up enough for me to snap this picture.

My mom found it amusing when she saw me take this picture. It was just a reminder of simpler times. And it was something I wanted to show my family- they are so used to getting coconut milk from packs that one never wonders about how we get the milk. The girls have never seen a machine like this.

Yes, it's all random stuff. But it's the weird, simple, random stuff that makes Malaysia truly Malaysia. I've had a busy week- giving lectures to 3 groups in 3 different states (all pro bono, mind you). The last group I met with were medical students early in their careers. Asking me the age-old question- should I go overseas to study/specialize?
Well, it's a difficult, subjective question to answer. There will be goods and bads. But the one bad will be, you will be leaving a culture, a people, a language, a cuisine, a climate that is so familiar and near and dear to you, to live in a foreign land. No doubt with time, that land becomes home as it has for me, but some things will always remain foreign. And so, you will make sacrifices, and when it's your time, you may find yourself doing as I do- taking pictures of quaint coconut graters because it reminds you of your childhood.
Farewell, Malaysia. You have not lost your charm, though many of us abroad worry about your future. Here's to hoping that the Rakyat will rise up above the disease and rot emanating from her politicians and bigots, and bring her glory days of peace and harmony and muhibbah back.

Friday, October 09, 2015

T -1.5 days

I imagine all Malaysian expats do this.
When you get home, you have a checklist.
It may be places to visit. Or stuff to do. People you wanna see. Which applies to me. However my List A, the one I consider priority, is the food list.
Ie. Foods you'd like to consume devour before your flight takes you away from Tanahair again and you are in some place with foods that do not compare. I'd pick Nasi Lemak any day over US$50 filet mignon any day.
And so my list:
Nasi Lemak (x 4)
Ipoh kuey teow
Mah kiok
Bak Kut Teh
Seremban beef noodle
Seremban siew pau
Curry mee
Chicken rice
Chee cheong fun
Banana leaf rice
Curry puff
Tomyum fried rice
Goreng pisang

I leave Monday. Which gives me another ~6-8 opportunities to hit the remaining ones. However, having been abroad so long, my stomach can't contain as much as it used to. And with my Fitbit sending my exercise information directly to my health coach aka wifey, I need to balance things.

Ah hell. I won't be back for another 2+ years. Eat up.

Tuesday, October 06, 2015

The Reunion

We had a swell weekend!
The boys and I met up at Sunway Resort Hotel. Some backed out for medical/family reasons but there was still enough of a quorum for us to just almost get into trouble.
It has been years (probably at least 5) since I visited Sunway (aside from driving through it). After all, when I was in Taylors, we frequently this area regularly. And for those ancient enough (ahem) to remember it, we did attend the Salem Beach Blast and Kent Fresh Freakout at Sunway Lagoon many moons ago.
Anyway, I didn't recognize much of this. Undoubtedly the haze played a role- I couldn't see anything! And it gave you the false impression that you were in the cool mist of Genting. Until you step out of your car and realize you're in a sauna. With special aromatherapy ala haze.
The resort was huge, with a cavernous lobby and pretty fancy decor.
We had a junior suite to ourselves, which also gave us access to the VIP lounge on the 20th floor which provides tidbits and refreshments. Until 5:30PM at which they would serve nonalcoholic and alcoholic beverages. And so we hung out there for most of the early evening, eating small samosas and pakoras while drinking wine and beer. When the lounge closed, we adjourned and staggered to a restaurant in Sunway Pyramid for more drinks and food.
It was great to catch up with the boys. Yes, we do have good friends near where we live in the US. However, there is a difference between good friends, and childhood good friends. These are the guys I grew up with, some having known me even before kindergarten. These are the guys who know your deepest darkest secrets. The guys you'd want carrying your casket at your funeral, and delivering your eulogy. 
So, much of the night was about reminiscing, laughing over events decades old. Like how one buddy crapped in his pants (literally) in standard 1 because he was too afraid to use the filthy primary school toilet. About first girlfriends, first kisses, first heartbreaks. The what-ifs.The customary dirty jokes- something all-boys-school students know too well. Memories of camping, the prefectorial board. And strangely enough, a testament to the fact that we graduated from secondary school over 20 years ago- we also talked about our spouses and kids, and what our families were up to.
We laughed. A lot. The beer, wine, mojito and scotch probably made the jokes funnier than they really were. There was no filter; we didn't have to watch our language because of kids. We made stupid, politically incorrect, self-demeaning jokes. But I made sure I soaked in years' worth of my pals- pals I haven't seen for years and probably won't see for another few.
Yes, spiritually, I feel recharged, and I have my wife to thank for that for suggesting I make this trip. She knew more than I did how much I missed my pals.

Sunday, October 04, 2015


Speaking purely as someone who is neutral (ie I do not own stock nor do I sell these things), I am sometimes impressed by how technology evolves so quickly. In this particular context, the CGM systems, or continuous glucose monitoring systems or 'sensors'.
These nifty (but often restrictively expensive) devices allow one to better keep track of their glucose levels without needing to stick themselves in the finger more (but it isn't mean to replace glucometer testing. Yet). You wear a transmitter which measures interstitial glucose every few minutes, and transmits the data to a receiver.
Particularly helpful to allow one to see real-time effects of activities or meals on blood glucose. Most importantly it can warn the user of severe glycemic excursions, especially hypoglycemia in a person with limited hypoglycemia awareness. It certainly isn't yet the replacement for fingerstick testing, but we hope to get there someday.
Having used this in countless patients, I decided to include this in my lectures in Malaysia so I got in touch with some of the device reps and obtained several loaner devices. I thought it would provide credibility and make it more fun if I actually wore it for the lecture. And since I was going to be eating Malaysia, thought it would be interesting to see what food would do.
So this is me in the midafternoon.

This is me, 45 minutes after eating 1 Seremban Siew Pau, and kuih lapis. 
I guess I should be reassured. Even after a huge rice dinner, I can't make it go higher than 150 mg/dL. So I suppose I should be safe, for now. But I should have worn this this morning before that belly-ripping buffet breakfast.
Though I'm still unimpressed by the cost of these things, I am thankful that they are available for those who need to be extra vigilant. And certainly wearing one of these devices gives one a different perspective on things, and helps me understand what my patients have to go through.

Monday, September 28, 2015

And it begins

My 30 hour trek to Malaysia.
Except this time, it was kinda different.
You see, usually there is a lot of sadness when I'm LEAVING Malaysia. Not much when I'm leaving the USA.
This time, it was interesting. I left the US feeling sad. Torn. Something I kinda was expecting but still unprepared. Leaving the wife, and my two girls behind. Having the darlings bawl at the airport, yelling "Daddy, daddy", as I'm trying to walk up to the security screening with my composure.
I have much to look forward to: seeing mom and dad again. Seeing my brother and sister after a lapse of two years (how time flies). Seeing and catching up with high school buddies- people I haven't seen for ages, and even then, the last reunion only lasted about an hour because of the jetlagged kids, and they weren't on their best behaviour when we were out at dinner. Eating the Malaysian food- this time with no wife or kids nagging about the smell of belacan.
That all being said, I'm kinda surprised by how difficult it was to leave my family behind. How I'd miss everything, from how they spell or kiss or hug or giggle, even to how they throw tantrums. Laying beside the wife in the bed, hearing her breathing. Seeing her smile.
It does certainly make me admire the people who travel a lot routinely without their family. Especially those in the armed forces, having to do stints overseas. Leaving loved ones behind certainly does more than tug at your heartstrings- it's not easy.
I promised Kristin I will have a good time in Malaysia. I'm sure I will. But truth be told, there will be a huge part of me that will be miserable as well until I am with my wife and girls again.

Friday, September 18, 2015


Thanks to the most wonderful wife in the world, I will be making a trip back to Malaysia in a week. This time, without the family. I had some extra vacation time, and since I had minimal time with buddies the last time- always difficult when you are travelling with jetlagged and cranky kids- she suggested months ago I should make a solo trip.
I hesitated.
For about a millisecond.
And booked my ticket on Qatar Air. This will be my first time flying with them. And because I will be giving a series of lectures to Malaysian docs too, I'm able to use some of my CME funds for the trip and opted to go business class.
I'm psyched; after all, it's been 2 years since my last trip to Malaysia, or since I saw my sis or older brother. Many many years since I saw my school mates.
Many years since I made out with Ms. Satay, Nasi Lemak, Chow Kuey Teow and other seductresses.

But admittedly, part of me is not too excited about this trip. I'm disgusted and heartbroken reading about all that fucked up mess going on in Malaysia. From the alleged corruption charges of politicians, to the free falling Ringgit (yes, it is to my advantage coming in with US Dollars.... but still....). But most of all, saddened that despite our claims and boasting of how far Malaysia has come, that we almost 60 years from Merdeka, that the racial tensions now are worse than it's ever been. That many young Malays still hurl insults at the pendatangs, never mind that they might be 3rd or 4th generation Malaysian and was born there and pay the same taxes everyone else does. That any stupid problem is blamed on the Indians, Chinese, Jews, Lim Kit Siang or whoever. That there is still a paranoia that other races have ulterior motives or some grand conspiracy to take over the country. That DAP is a 'Chinese' party. That Bersih was an anti-Malay movement. That it's perfectly OK to put up flyers threatening bodily harm, of a man yielding a keris, with blood splatter all over another man who is kneeling and bound. That it's fine to say Shut up, or be reminded of the massacre of May 13. Or to call the Chinese pigs. And to have the Deputy PM stand behind these statements, saying it's important for the Malays to protect their rights.

What do we have to show for the 50+ years of Independence? It certainly does not seem that we are progressing as a society- racial intolerance seems worse than ever. And groups do not seem to be thinking for the betterment of the country or society, but only in terms of each racial group's interest.

I miss Malaysia. I'll always call her home- and though I've spent half my life overseas, this place still in many ways feels foreign to me. However, I thank my lucky stars that my parents had the strength, and the foresight, to tell their kids: Go, spread your wings and go where they may take you- but leave and don't come back. For the future for us minorities in Malaysia does not seem all that bright.  And sadly, I've been much more warmly welcomed here, never mind my skin color- than in my native Malaysia where I'm still considered a pendatang.

Monday, August 24, 2015

Of having girls

I saw Mr. T the other day for follow up of his thyroid cancer.
He excitedly shared with me that his wife is pregnant, into her 2nd trimester. They are expecting their first,a girl.
In jest (he knew I have two), he asked if I had any advice.
Ah, what would I say?
With girls, you would be sentenced to a life of:
  • A life full of pink, in varying shades, so much so that it begins to become your favorite color
  • Dora, Barbie, Sofia, Cinderella, Ariel, Rapunzel, Belle. You'd learn the words of the themes songs of all the princessy shows
  • Braiding and nail painting (which I secretly enjoy doing now- good bonding time when they're actually sitting with you and listening)
  • Drama. Not the kind I remember growing up with boys. Not of that physical wrestling, punching. But a lot of "mommy, XX said this...."
  • Your wife having natural allies, more than you appreciate. "But DADDY, mom said you shouldn't do/eat that...."
  • Perfumes and make-ups
  • Little hugs and kisses (I'm going to miss these when they hit their teens and stop giving daddy kisses)
  • Tiaras and gowns
  • Unlimited and unconditional love. Even after you've punished them for being naughty

Yes, these are generalizations, but at least for me this is what I have to deal with. And I wouldn't have it any other way (ask me again when they are teenagers).

But no, I didn't give him too much details. All I told him was "You'll love every moment of it".

Thursday, August 20, 2015

Hunting for a school bag

We took Alli schoolbag shopping the other day. And I have to say, it brought some warm memories back to me. Except this was a variant of what I did when I was a child.
I remember being excited as mom and dad took us to get our schoolbags. Back then, it seemed that the popular ones were the bright yellow 3M backpacks that every kid in school had. You know, the one that was big and yellow and waterproof, with a metal clasp to hold the flap in place? That feeling of pride, when you carry your brand-spanking-new bag for the first time, loaded with freshly sharpened pencils and a new eraser, in a shiny pencil case?
Except this time, it was me taking my child out to pick her own backpack. We took her to the store and she was so excited looking at the racks and racks of back packs. Checking each out carefully. And instead of getting something boyish with superheroes or robots or planes or cars, she picks a pretty purple-pink princess bag. With Cinderella, Rapunzel, Ariel, and Belle on it.
And this time, instead of excitement (well, I guess I am a bit excited), it was a lot of other emotions. My wife and I had our moments when we looked at each other and tried not to tear up. Our girl's growing so fast.
Come Monday when she starts school, I'm pretty sure we will be a mess. Wish us luck!

Tuesday, August 11, 2015

New Toy

OK, I'll admit, part of me feels a bit guilty.

After all, a person in healthcare should not take pleasure in killing living things, should he? Isn't that a sign of antisocial personality issues?

But man, this has been one of my more fun purchases from Amazon:

All fathers will attest to this I'm sure; kids just somehow can't learn to turn off lights, fans, or close the screen doors. And because of the latter, we have flies infiltrating our house on a daily basis in the summer. And so I recently decided to get this electric fly zapper from Amazon. Something my wife hadn't heard of before, but pretty commonplace in Malaysia.

Well, let's just say I've probably already killing a generation of flies. At least 30- I kid you not- in the last couple of weeks. And there's some gleeful pleasure in hearing that "pop" when you finally catch that sucker in the wires (sadistic, I know. Maybe I should have become a pathologist). And yes, I use this only on flies.

Sunday, August 02, 2015

Little Lies

My fear is someday my girls will follow my footsteps, and go into medical school and become doctors. 
And then one day, after they have learnt real physiology, they will confront me and angrily say:
"Dad, eating broccoli does NOT prevent armpit hair", or "Eating peas does not make me grow taller!". 
Or, Alli: "Daddy, why are you putting deodorant on your armpits?". Me: "To help the hair grow". Alli: o_O

Please tell me I'm not being a bad dad and telling these little white lies. It's almost too easy now, especially when their daddy is a doctor and knows everything.

After all I remember the ones I was told:
Eating chicken feet will give you bad squiggly handwriting
Not eating all your rice will give your future wife a lot of acne
Eating too much Maggi mee will make you bald (or maybe this explains a lot for me...)

Ah, the joys of fatherhood.

Monday, July 27, 2015

A Gift from a Patient

I received the most unusual gift from the patient the other day.
Over the years, I've gotten some thoughtful things from the people I treat. And no, it's certainly not a requirement or expectation, but it certainly brings some warmth, and a smile, knowing you're appreciated. 
Let's see. Giftcards. An angel ornament. Books. CDs. A mug. T-shirt. Bookmark. Brooch. Cookies. Cake.
And now, fish.
Yup, fish. As in fish a patient caught during a fishing trip. Which he then skinned and filleted himself, then packaged and flash-froze it himself.
He handed it to me when I saw him recently.
It probably isn't worth much. But then again, it was worth everything. This was something he did himself, and of all the people, he thought about his endocrinologist during his fishing trip.
I was very much flattered, and grateful. He gave me some tips on what to do with it. And I think the first batch I cooked turned out pretty good. I cooked it on a grilling plank in my gas grill.
Maybe Portuguese fish curry the next time.

Thursday, July 16, 2015

Faith and Medication

I'll start by saying this: faith is a GOOD thing. So please don't misunderstand my intentions.
However, with faith, one also needs to have some common sense.
I saw a woman the other day in the ICU. Presented with florid diabetic ketoacidosis, sick like stink and was intubated for airway protection. She was pretty acidotic, with her gap being 27.
She had type 1 diabetes, diagnosed in childhood for which she took insulin for survival. Very devoted mother and she homeschools her 7 kids. She was also very devout in her religion. And so, unclear to me why, after a period of very intense prayer and meditation, she was convinced God has cured her of her disease. Somehow resurrected the long-apoptosed pancreatic islets, and that she was again capable of producing endogenous insulin.
And so, she stopped her life-sustaining medication. And stopped testing her blood glucose.
It didn't take her long to go into DKA.
Remember, kids- you cannot control sugars by eating less alone- in insulin-deficient individuals, survival without insulin, even when one is fasting, is not possible. It's 2nd year physiology.
It's the 2nd case of DKA induced by religious fervor that I've seen here.
With the excellent care she is receiving in the ICU, I'm optimistic she will recover. And we'll have to reinforce that she will need to stay on insulin for life (unless she chooses to have a pancreas transplant).
However, it's important to remember that while faith is important, it's also important not to disregard medical advice.

Sunday, July 12, 2015

7 years

I had to renew my hospital ID the other day. And perhaps I just forgot about it, or was in denial, but I was kinda taken aback by the new photo ID on the left.
This, compared to the photo I took when I first started to work. Heh, I even had my braces on in the earlier picture.
My first reaction was, KNNCCB, WTF??!?
It looked like I've aged 20 years in the last 7. I'm still not sure what was to blame- genetics (after all, I remember dad's old pictures- long flowy hair until his early 40s when boom, it was suddenly gone), being married (heh, I don't think my wife reads my blog anymore), the kids, or just work.
And so, I'm still sometimes tickled by patients who ask to see an endocrinologist for premature balding, because they thought it was hormonal in nature (probably partially, but it's not something I treat)- and then I walk in the room and they take a look at my head and go "maybe I'm not seeing the right doctor...".
One of these days, when I'm gutsy enough, I'm just going to shave it all off.  

Sunday, June 21, 2015

Happy Father's Day

Happy Father's Day, guys! To all the dads, grand-dads and great-grand-dads. To those here, and to those who have left us.
Being a father myself now, I realize more than ever how vital a role dads play. After all, as they say, a dad is a boy's first superhero, and a girl's first love. No matter how we complain about our parents as kids, you realize that your parents are indeed your first role models and the mold into which you grow as you find your place in life.
It's scary during those moments when you utter the words you swore you'd never use, the very words that your mom and dad said. It's scary when you look in the mirror early in the morning when you're half asleep, and realize you're looking at your younger dad.
I'm never going to claim that I'm the best dad in the world- I realize there is much I do wrong and there is much I have yet to learn. But I try, and I understand the roles dads and moms play (not that this cannot be interchanged), and that in our household, I'm the fixer, the problem solver, and also the disciplinarian. The girls know when I'm on scene, they're in trouble. I'm also the worker- which partly saddens me as I hate being away at work- and though mom works just as hard, it seems that I'm the one with more meetings, coming home later and leaving earlier, and working weekends. It reminds me of the sacrifices dad made to provide for our family. And for that I shall forever be indebted to my parents for all that I've achieved.
Happy Father's Day, dad! We love you!
(Disclaimer: I know I should have made a Mother's day post too last month- but I got lazy- this is not meant to say dads do everything. The reality is the moms do more than us. But at least one day a year, I get to feel like a superhero!)

Sunday, June 14, 2015

Missing the boat

One of my partners was asked to see a hyperthyroidism consult in the hospital the other day. A 30-something year old woman with Graves' disease, who was admitted with a large left hemispheric stroke.
I was horrified and deeply saddened when I heard about her. Because she was so young. Because her life which was so full of potential, has drastically changed probably forever. She could not walk (perhaps with therapy, might recover some degree of ambulation in the future), could not move her right arm, and had marked aphasia (speech). Mother of 2 young kids. And because the stroke could have been prevented.
Turns out, I had seen her in clinic 6 years ago, and made the diagnosis of Graves' disease. The biochemistry, clinical picture and the I123 scan were classic. I started her on antithyroid therapy. At follow up 2 months later, her labs actually looked worse- she had not been compliant with her medications because like many others, she did not want to gain weight as we corrected her thyroid and slowed her metabolism back to a normal level. I never saw her again- she subsequently no-showed visits and was lost to follow up. And while this was a rare, severe complication of untreated hyperthyroidism, unfortunately it happened.
Was the stroke caused by the hyperthyroidism? Probably- she was young with no other risk factors. She was in a-fib when she presented, with FT4 levels 8 times where it should have been. It was clear this was a causative factor.
She promised to be compliant with treatment this time; but a huge part of me was saddened to think of how things could have been if that was the approach 6 years ago, and while it'll be helpful to be on medications now, the truth is we've already missed the boat and the damage has been done.
I only hope that with her youth, physical therapy is able to help her recover some meaningful use of the right side of her body.

Thursday, June 04, 2015

In a Blink of the Eye

In a blink of the eye, and they gone.
Mom and dad left today after a month-long visit. Can't believe the time just flew by- it didn't seem that long ago when the girls and I picked them up at the airport.
And today, we sent them off. They are somewhere over the Eastern seaboard as we speak, enroute to KLIA and home.
It's been a wonderful month- having my parents around, having mom's homecooked recipes, conversing in Chinese, seeing them interact with my girls. And Kris has been most patient, putting up with our idiosyncrasies and obsession with white rice.
But truth be told, a part of me cried a little, coming to terms with our reality- one that any expatriate Malaysian with children will likely encounter. You realize that you may consider yourself Malaysian, and remember your smalltown boy roots fondly, this will not be the same for your children. Because of the distance, they will never be as attached to your family as you are; that in all likelihood they will be much more attached to their families here, and would have trouble understanding some of the cultures, language and traditions you may share with your parents and siblings.
And so, it was heartwarming to watch the girls interact with their Ah Kong and Ah Ma, I was a bit saddened to see that they were more attached and familiar to/with their maternal grandparents. That they had their moments too especially when they were tired when they just didn't want anything to do with my parents. Like how Alli had to be coaxed to even give a goodbye hug at the airport, because she just woke up from their nap.
My parents being as patient as they are understood. And I'm sure this was something they knew would come- sending their son overseas and having him start a family there. This is to be expected, that despite the phone calls and Skype sessions, that the distance will always be there and so the girls will grow up not having them here all the time. Sending them off had a profound effect on me- and I left the airport feeling somewhat lonely, realizing that the girls were not as saddened as I was, and that there would be no one on this continent that would feel the way I do about my parents.
But yet, another part of me was humbled and in awe too of their sacrifices. Being a father now, I realize how it is really possible to love your child that much. How crushing it is to leave your child. And yet, because they saw a better future for me away from Malaysia, they had the strength and love to encourage and let their kids spread their wings and fly and go to where life takes them. And in my case, half the world away.
Have a good flight, mom and dad. We enjoyed your visit and will miss you...

Wednesday, May 27, 2015

9 years

Oh, how time flies.
We made a short Midwest road trip last week. Visited friends in WI and MN. And amongst the stops we made, we stopped at our alma mater- it brought back floods of memories checking out our old hang out places, even drove past my old rental home of 5 years.
Anyway, we also made a stop the the Minnesota Science Center. This was special for several reasons, the main reason being this was where Kristin and I went on our 2nd date 9 years ago, almost to the day! They had a Bodyworlds exhibit then, and so we checked it out. We also walked about the center, and took a picture sitting on the erythrocyte-modelled chair.
Then and now- (sighhhh)

My wife has threatened me with bodily harm should I post any then and now pictures of her- and because I value my family jewels I shall not do so.
But boy- it did make us realize how time flew by. Our first date in 2006, engaged in 2007, married in 2008. And now here with two beautiful girls who act like crazed monkeys. Professionally, it also reminded us of how we grew. From my first day at my alma mater in 2002, then fellowship in 2005 and graduation and practising as a consultant in 2008. It was a bonus too that it so happened that a fellow graduate and good friend from Singapore was making a 2 week visit for a clinical observership- and when he saw on my Facebook page we were there, he texted me and we were able to meet up and reminisce about the old times and the crazy things we did.
Life now is at a different pace. Work, family, all the grownup things like taxes, bills, mortgages and life insurance. But once in a while, it's nice to visit those earlier years in my dreams.