My review of the Porsche 987

"So, how's the car?"
I get asked this frequently. Often, it's with a snigger as my colleagues are expecting me to get stuck in the snow one of these days. The Porsche 987 Boxster is a magnificent car. Though I drive only the base model, and not the S, I couldn't be more pleased.
It is a 2.7 liter, flat-6, mid-engined car with a manual transmission. I haven't verified this myself, but the 0-100 kmh time is supposed to be just over 6 seconds, with 228 bhp.
It's a great feeling, having reserve power under the slightest tap of your right foot. And one my nicest surprises- the mileage isn't that bad either. 20 mpg city and 29 mpg highway; better than Kristin's CRV.
Many people living in this part of the country drive something more practical during the winter months, keeping the Porsche in the garage away from the gravel and salt and snow. I'v read that some, however, do drive their cars all year round, and because I can't afford a 2nd car now, I'm left with that. With a set of 18" Blizzak LM25 tires and a 25 lb bag of rice (yes, I know people usually use sand, but I AM Asian, after all!) in the trunk for traction I have to say it's been pretty roadworthy. Only 2 days have I been fearful of taking my car out so far, and those have been horrific freezing rain conditions; that aside the car has done pretty well with the occasional oversteering on the snow. I know the winter is still young, but I'm much less reserved now about winter driving using the Boxster. So if you're considering a Porsche and are worried about using it on the snow, I'd say go right ahead.
The options I really like: the bi-xenon lights, the Bose surround sound system (they say the base audio sucks- can't verify that myself) which is pretty necessary with the top down at 100 kmh. Even with the top up, because of the midengined design you DO still get significant engine sound. And it's really really handy having the optional hardtop- it does dull the cabin noise significantly, and is a blessing to have during the winter. The plexiglass wind deflector (Porsche Windstop), well, that's a given; you definitely need that if you're planning to do a lot of top-down driving.
Though Boxster owners get a lot of grief about how the Boxster is the 'cheapest Porsche' or the 'poor man's 911', really, it is a well-built car with plenty of power, looks great and handles extremely well. And that it drops its softtop in 12 seconds; offering a breathtaking driving experience with the wind blowing in your hair on a sunny day. I miss the summer days when I would be itching to be done with work just so I could drive the car home. Sigh- only 5 more months...
The things I miss- the convenience of an automatic transmission; I feel this most when I'm oncall and get paged and need to return calls while driving. I also miss having easy access to music. In this regard, it's too bad Porsche had been skimping on convenience features like MP3/Ipod integration, bluetooth connectivity and steering wheel audio controls, things I believe will be offered as options for the 2009 Boxster. Maybe I should have gotten the 6-CD changer or the PCM (Porsche Communication Management) though for my model didn't have bluetooth yet. And a minor issue, but I do miss the many cupholders that I had on my old Accord, though the hidden pop-out dual cupholder in the Boxster works pretty well.
Overall, it was a tough choice between the Mercedez-Benz SLK 300 and the Porsche Boxster, I think I'm pretty happy with my decision. It offers unparalled roadhandling, predictable driving, and even without the added horsepower of the Boxster S, has more than enough vroom for most drivers.

Merry Christmas

(Gone to Milwaukee. Back in a few days!)

Dear Santa

It's 3 days to Christmas.

What would I ask for on my wish list for Santa?

A new computer?

A nifty ultrasound for work?

A new cellphone?

Strangely, as I was thinking about what I would list on my blog, I came up with this conclusion: Nothing.

I'm married to a beautiful young lady, who despite my rapidly thinning hair and short legs, loves me for who I am. I have a stable job despite the bad economic times that pays decently, and though we're up to our eyeballs in mortgages and loans, we're holding up. My family and I are healthy. I have a wonderful family, and the bonus this year is that we'll be together this Christmas (though Dad's coming only next month).

So, I'm realizing that aside from the childish "I want a space shuttle", really, I'm content. I thank God for all that He has blessed me with.

And so Santa, and God, this year I 'm going to pass on giving you my Christmas wish list. Instead, I'm going to wish for peace in the world, kindness amongst men, and health and happiness in my patients.

(okay, and perhaps a really quiet call-week over New Year's).

Merry Christmas, everyone. And have a Blessed New Year.

RM70mil to retrain jobless grads
SHAH ALAM: The Government has approved a RM70mil grant to retrain 10,000 unemployed graduates, said Human Resources Minister Datuk Dr S. Subramaniam.
He said the grant would be used to train them in skills like communication, language and creative thinking.
“Some have good qualifications but their hurdle is language. So, we want to train them in English,” he said.

I read this in the Star the other day.

That's RM 70,000,000 of your tax dollars, ladies and gentlemen.

You can't undo what your school and social systems have done in a decade, in a short retraining course (short being relative; in this context even a year is short, me says).

In the meantime, groups are now still debating whether science and math should be taught in English, or some other language.

Let science be taught in the language of science, me says. English. The universally used medium, the language in which scientific journals are published.

Unfortunately, I think the poor standard of English is the result of politicians playing the nationalism and patriotism game while trying to make their mark, coming up with the simple conclusion that anything non-BM is bad. And now, a generation down the road they're trying to backpaddle their way probably aware that they're too far downstream for any simple solutions.

To Bx or not to Bx? That is the question...

I got a phone call at work yesterday.

"Are you sitting down?", Dr. F, a surgeon friend of mine asked over the phone.

"Err, yup. Shoot." I tell him. Probably wants to refer some thyroid nodule patient to me, I'm thinking. Though usually I'm the one referring patients to him and not the other way round.

"Can you see a patient for me? A man with (get this) a BIOPSY-PROVEN pheochromocytoma!"

I cringe. I can tell he's cringing as well.

We both understand the gravity of the situation. Some smart aleck physician sees an adrenal mass on this patient's CT, and before any biochemical testing, sticks a needle into it. He must have turned a few shades of white when he got the pathology report, and quickly sent this patient to my surgeon friend.

The truth is, this patient could have died from the biopsy.

Take home message: Never, ever, biopsy an adrenal mass before you rule out pheochromocytoma. These things can turn ugly real fast. I recall that 45 year old woman I saw last year who crumped after the biopsy, had a myocardial infarct, stroked and was airlifted to us with an LVAD.

And so I'll be seeing this patient Monday to ensure he's blocked adequately before he goes under the knife.

"...see no touch..."

Sometimes you're fucked if you do, and you're fucked if you don't.
I give up.

The Interview Trail

My kid sister is on the interview trail, looking at getting into a US residency for internal medicine. Kinda like where I was 7 years ago. Which brings back many unpleasant memories.

You see, coming from Malaysia to the US for the interviews, you tend to still be thinking in Malaysian currency. At that time it was US$ 1 to RM 4 or something like that. And although I had been saving my salary for the past 4 months it does drain your bank pretty damn fast.

To save, LP and I travelled together most of the time. He was my buddy from KL who went to Calgary with me. And so we actually interviewed at pretty much the same hospitals; we overlapped probably 75% of them.

Which led to several interesting situations. For one, we didn't realize how it must have looked to have to Malaysian guys travelling together and staying in the same hotel room. Until 2 of our programs asked if we were going to 'couple's match'. Which is the most legal way they could ask if we were gay.

We took the bus pretty much everywhere. From Pennsylvania to Ohio to Illinois to Wisconsin and to Minnesota. 10-hour bus rides, napping on the benches at 4 am at Greyhound stations. When hospitals didn't pay for our hotels (half of them did) we stayed at the cheapest of hotels. I remember my room in Chicago had bugs scurrying around on the floor. And the worst thing, being so perpetually hungry. Just that deep, gnawing feeling in your epigastrium. We were miserable. Being in the -10C winter cold didn't help either.

I'm not kidding. You'd think that 2 doctors (we had already graduated) wouldn't feel like they were homeless and would actually be able to afford proper food.

Any guesses as to which city this was?

I remember that by the end of our 4-week journey, we were broke and had 2 more interviews to do in Minnesota. It was February by then. LP in HCMC and I at Mayo. We were so broke that we were eating instant noodles for most of our meals. And because we had no other way of cooking, we took turns using the coffee machine in the hotel rooms to half-boil the noodles, taking turns to eat directly out of the pot. Finally one day we were so miserable I got permission from my dad to use the credit card he gave me for emergencies just to have a meal of Vietnamese food. I've never tasted such a good bowl of $5 phò (it was my choice really, to be as self-reliant as possible. A matter of pride, as a new doctor I didn't think it was right to be asking for money from dad).

Mayo was my very last interview, and because I was so homesick by then I was close to just cancelling things, thinking there was no way they would take me anyway. But Nick, a buddy who was there, convinced me to go on.

Funny how things turn out, don't they? And so, with a sense of pride and hope, I watch my sister go through the same process (though she has it a lot easier, says me ).

Case of the week

A 57 year old woman was referred to me for asymptomatic hypercalcemia, Ca 10.8. This was discovered incidentally during her routine physical.

Her family history is noteworthy for hyperparathyroidism in her mother, who underwent 3 1/2 parathyroidectomy many years ago.

Laboratory testing reveals:

Ca 10.8, PTH 45 pg/mL (normal 15-65), Phosphorus 2.3 mg/dL (normal 2.5-4.5), Creatinine 0.54 mg/dL.

How would you proceed?

Answer:

The 'inappropriate normal' PTH in the context of hypercalcemia suggests this to be a parathyroid issue. Therefore the next step should be to obtain 24-hour urine calcium (and creatinine) to determine the extent of hypercalciuria, and to calculate the fractional excretion of Calcium to rule out familial hypocalciuric hypercalcemia.

In this case, the patient's fractional excretion of Calcium was only 0.3%. The parathyroid imaging was negative for parathyroid adenoma, suggesting this to be a case of FHH.

This autosomal dominant condition is usually benign and leads to no problems usually associated with primary hyperparathyroidism. However the patient, family and their physicians need to be made aware of this as FHH can sometimes be diagnosed as primary hyperparathyroidism, putting patients through an unnecessary noncurative surgery, which is what I suspect happened to her mother.

Mutations of the Calcium Sensing Receptor (CaSR) can also be performed, but probably would not add anything to the case. I've only tested this once in a patient who was convinced she needed surgery to have her parathyroids removed; the positive test allowed me to convince her she did not need surgery.

Thanks for the comments!

Happy Birthday, honey! (picture of her birthday 2 years ago)

Yup, that's me, with the white shirt. Way back in 1993, with the 'Tommy Page' hairstyle and aviator glasses. Gawd. *cringe*

(I bet you Americans never even heard of him, have you? He was supposed to be the biggest thing out of the US since Elvis; he sang only soppy love songs. Strangely enough, he was only popular in Asia; no one here has ever heard of him).

Someone posted that picture of me on Facebook. Ah, the wonders of modern technology. People are able to find your old, embarassing pictures and post them for the world to see.

But anyways. This relates to my earlier posting about about being a nerd.

My wife happens to think I'm a big time nerd. I had reminisced to her about how I missed my high school buddies, and our good ole days.

I was in the school prefectorial board. I became the head prefect before I left for college. Basically, we enforced the strict school rules and were universally hated. We would cite students for having long hair, or write them up if they forgot their name tag. We'd even force them to cut their nails if they were long, in public. Gawd, we loved the code we adhered to.
I was also in the St. John Ambulance Brigade, something akin to the Red Cross. Over the years I rose to the rank of Cadet Leader, and was the vice-chairman of my division. I proudly wore the stripes on my right shoulder.

I also founded the Astronomy Society. And was involved in a few other clubs.

We even had our own 'gang'. We called ourselves 'Now & Forever' (I'm still pretty close to many of them, though).

Then, I thought I was cool. I thought I was admired. That the juniors wanted to be like me. Though I always wondered why the cute girls never paid any attention to me.

That is, until my dear wife gently put me in my place. After hearing all my exciting stories of high school, she giggled and said, "I knew it, I married a nerd. I've always had a thing for nerds!"

That figures.

Excitement

I got all excited yesterday.

I was reviewing consultation notes and lab test results when I realized the lady had undiagnosed nonclassic congenital adrenal hyperplasia!

I must have seen just a couple in fellowship, but nothing that I had diagnosed personally. And so I was pretty excited when the lab test results made it clear to me.

I shot an email to my wife:

Wheee!!! I'm so excited. I'll be seeing a patient with congenital adrenal hyperplasia!!

And then the second realization hits me the moment I send off that email:

I'm such a nerd.

Snowday!

We had a snowday over the weekend. Not a lot, only about 6 inches. But boy, it was good quality, heavy, wet snow. Just perfect for making snowballs, snowmen, and for my neighbour's kids, snow forts and a snowball fight. There's something magical about a nice fluffy dump of snow that makes grown people regress into childhood. Kristin and I ran around with Chloe in the backyard having a lobbing snowballs at each other.

Even my mom had fun sledding down the slope in our yard!

Chloe seemed confused though... she wasn't quite sure how to take a poop with all that white stuff lying around.