Winds of Change?

And so a new era begins.
Good or bad, it's too early to tell. The way these things go, it'll be good for the next 2 years, at least, before the bubble pops, if at all.
Exubera.
The world's first inhaled insulin. A revolutionary step in a revolutionary new direction. Insulin has been injectable since it was first introduced to the market after its discovery in 1922. No doubt, many new formulations have been created since, including the new ultra-long and short-acting analogues. But the dream was always to create a more convenient method of administration.

Researchers weren't able to overcome the issue of gastric acidity to develop ingested insulin. So this was the next logical step. Studies have shown this to be at least as efficacious as NPH insulin in type 1 and 2 diabetes. However, although the safety profile appeared to be similar, many like myself are nervous about how airway disease affects systemic absorption and how the aerosol may affect the respiratory tract in the longterm. Also, because inhaled insulin delivers such a high concentration of insulin into the body, many endocrinologists are nervous about the body may react to this after chronic exposure. Indeed, earlier studies have shown a much greater insulin antibody percent binding, 29% compared to 3% in subcutaneous insulin although the original article in Diabetes Care November 2004 stated:

"... was not associated with any clinically significant findings..."

But that's what they all say. Inadequate time for side effects to be obvious.

I'm sure my patients will start asking me about this soon. I'm not sure if I'll be starting anyone on this though, at least not in the first 6 months. Also, one thing people don't realize is that this just takes the place of their short-acting insulin, and not the basal.

But damn, maybe I should have bought stock in those companies producing it.

Year of the Dog

Happy Chinese New Year!

May the Year of the Dog bring everyone prosperity, health, and lots & lots of moo-lah.
We had a blast at our CNY party, with our usual feast (including yee sang, minus the yee), a gambling den, and believe it or not, our very own lion dance!

Still, I miss our cardiac surgeon friend, who returned to Singapore to practice last month. Though I bet he's having a more fun CNY.

Disclaimer: This has been a busy week, and I've been ill the last couple of day. So let me enjoy my mood swing and fantasize a bit. Yea, I admit I've been blessed with a lot of things. And I am supremely thankful. But that's not what this blog is about. Ever wished you had more? More than what you currently have? Even for a fleeting fantasy moment?

• I wonder how it feels to be the kind of suave guy who does and says all the right things, in the right, confident way. No fumbling. No stammering. No doubt. No mistaking names. The kind who'll have any father want to give their daughters to you.
• Or how it would be to be beautiful. Not ugly. Not even okay-looking. But the kinda person who would turn heads when you walked into a room (and not because you left your fly open and your schlong hangin' out). Members of the opposite sex throwing themselves at you, having catfights amongst themselves while trying to impress you. Wanting to have YOUR baby. (I know, it's shallow, but I bet YOU've fantasized that before. Come on...)
• To be filthy rich. To be able to walk into a car showroom, testdrive a car, and, just to spite the snobbish salesman who thought you couldn't possibly afford his XKR, ask to speak to his colleague and write him a cheque on the spot. After all, what's one hundred G's to someone like me? Sheesh.
• I'd love to be a total asshole for a week (people I know might actually say that I already am). Not considerate, nor kind, nor thoughtful. But just a total asshole. Because it doesn't really pay to be nice. No one remembers you. So that if you had a crazy patient come in, you could just fire him. I saw a physician do that once in Arizona (it was a county hospital): "Dude, you're already lucky I'm giving you 20 oxycontins. Now get out of my sight before I call the cops on you!" Wish I had the balls to do that.

Wah. Kembang. Article in The Star.
They forgot to include my phone number though.

It can be a challenge though, as my colleagues pointed out in that article; to have the freedom of speech to blog, but at the same time, to protect the sanctity of the physician-patient privilege and not divulge too much identifiable information.

But I'm glad that many of us in this field share this interest.

Some people I know made me do this online survey. Apparently, I'm not as bad as others...

You Are 158% Weird

Normal enough to know that you're weird... But too damn weird to do anything about it! Then again, not as weird as Coolcat or Paulos!

How Weird Are You?

Residency Talk

Ok, I'll be returning for a 2 week vacation in February. There was some interest in the talk I once presented to IMU students on the process of getting into a US training program. So, this will be a short, shameless ad:
If there are students out there who are keen (phase I or II), just drop me a line, and make arrangements for a lecture hall for an hour, and I'll be more than happy to give the talk, whether Bkt. Jalil or Seremban. I still have the powerpoint file.

Admission free, but donations for beer and Xbox games welcome. Heh heh, kidding, I'm kidding.

Sorry if I haven't been updating my blog in a while. It's been a trying week- busy at work, and then my secretary's husband was killed in a car crash. Was in a foul mood when I received this email via the Global Malaysians Network:
Dear Dr XXX, Pleasant to introduce my product for global market. Currently my circumcision device Sunathrone is available for surgeon's training in Malaysia. We are in the process to commercially produce in March to May 2006. For your information I was responsible in the realization of smart klamp (www.fuckingidiotcantspeakenglish.com ) project and surgeon's training worldwide.We welcome any interested medical professional to arrange appointment with me ( 603 5633645X ) to review the procedures and having hands on surgical training in Malaysia. Due to marketing strategy arrangement we are not allowed to post any sample or pictures until such time are met. Please bear with us for the exciting news and Sunathrone Worldwide Happening.Anyway we welcome any interested party to have proper arrangement to distribute Sunathrone worldwide.


To which I replied:
I am not interested in your product, and would appreciate it if you do not misuse the directory to sell your trade.You might want to consider improving your English before you try to interest any potential buyers.


Farking idiot. Firstly I'm an endocrinologist, not a rogue sausage-chopping family physician (not referring to the other non-sausage-obsessed family docs). I have no need for a circumcision device. Secondly, learn proper English before you try to farking sell me your crap. Nothing wrong not having good English, but for gawd's sake if you want to bloody send spam-mails, and are soliciting 'worldwide distributors', have some class. And this email was signed by a 'doctor'.

But, I must say I felt better after sending off that email. I included my full signature in my email, with my degree and rank and institution, in all its glory. Bet I'll never hear from that moron again.

(Can you tell I'm in a foul mood?)

Sifu V's Forecast

I consulted my trusty Crystal Ball to see what might be in store for us in 2006. My predictions for the year?

• Our national car carrier attempts to break into the washing machine industry. Fierce competition with Hitachi causes it to go bankrupt
• A controversial ex-President appears in a leading American publication
• Malaysia's first submarine runs aground off the coast of Port Dickson; the crew is saved by illegal Indonesian immigrants who are then granted citizenship for their heroic efforts
• In an unexpected twist, the police reveal that the controversial video clip was in fact a scene from the HQ gymnasium of one of the prospective athletes for the coming olympics; the policewoman featured was in fact the gym coach
• Malaysia gains worldwide recognition for draping the world's biggest batik on the Statue of Liberty; a mere RM1.2 million will be spent. This historic event will be marred by the death of one of the expedition members after falling off Lady Liberty's nose
• Our country launches a chemical attack on Australia in retaliation for comments that Proton was 'a pile of junk'. Our chemical weapons consisting of durian warheads wreck havoc on the continent, but strangely enough, immigrant Malaysians are unaffected

2006!

Gosh. Can't believe the year's gone. 2006, huh? Can't believe I started medical school 10 freaking years ago, and am still not done with my training yet. Seems strange that not too long ago people were talking about the millenium, and Y2k. And now, 6 years have passed! So, looking back at 2005, what were the big moments for me?

Graduating from my specialty. Becoming a fellow. The Katrina & tsunami disasters, which made one realize how we belong to a greater community of man. Seeing my nephew for the first time. Meeting some new friends, including some fellow bloggers.So what are my resolutions for the new year? Well, guess I don't believe in these things. Kinda feel that if something's worth doing, it's worth doing now, not with a new year. Having said that, am hopeful that particular one aspect of my life will change this year. We shall see.

Happy New Year, folks! Hope everyone was as blessed as I was to be in the company of good friends during our countdown dinner and party.