Seeking Advice

I'm throwing this out to all you physicians in Malaysia as I haven't a clue to the answer.

Someone I know was diagnosed with sleep apnea and was told he needed to be on CPAP (continuous positive airway pressure), which is pretty standard treatment here.

Except he was quoted a price of RM 10,000.

And when he wanted his polysomnogram report, he was told it was "confidential information" and he cannot be given a copy.

My questions:

1) Does anyone know what these devices may cost (they cost about US$700 to 1200 here I believe) in Malaysia? I'm surprise by the cost quoted (public hospital, too!)

2) Isn't a patient's "confidential" medical records the property of the patient?? Here, we are not even legally allowed to refuse to share a patient's file with him if requested.

Would appreciate any info, thanks!

Instinct?

Animals, humans included, have such amazing inborn instintcts. Things that these organisms do, without anyone actually teaching them.

Like, how eagles learn to fly. Or how the geese migrate south in winter.

Or, how a toddler learns to pick her nose, and gingerly pops her booger into her mouth like it was a raison.

Yup, that's our pride and joy. And we caught her doing that the other day. Mom shouted in shock, I laughed.

Where DO they learn these things?

I found this hilarious posting on howtobeadad.com. Apparently they contain Vitamin C

Gongxi!

Happy Chinese New Year!

It's the year of the Dragon- woo hoo. Or rather, sighhh. Because it means my age is now a multiple of 12 (whether it's 24, 36, 48 or 60 I'll let you decide, but I'll tell you that story sometime this week).

Anyway, if you're a Malaysian expatriate like me living outside of Asia, you know it can get pretty damn boring, and it gets pretty homesick too. After all, for many of us we grew up having CNY as the BIGGEST event of the year, one that's filled with all kinds of smells, sights, tastes and traditions. But if you're living in the northern hemisphere, it's cold and white and pretty much nothing else that reminds you of the festival.

And so, we're determined to have Alli experience some of this. We dressed her up in a cheongsam her uncle and aunt bought her, and put on her gold necklace Ah Kong and Ah Ma gave her, and took her to a Chinese festival in one of the local colleges. She got to see her first lion dance (good effort though it was weird to see 4 Caucasian women perform it)(wait, then again I'd bet many Malaysian men would PAY to see that).

And though she was too young to understand it, I told her of some of the traditions and things we'd do. Like:

• Having a family dinner on the eve of CNY, then going out to the relatives' for our first angpow hits of the year
• Going to the temple for prayers early in the morning, then coming home and getting dressed in our new New Year clothes
• As kids, after the open-house crowds had died down (ie I had seen the girls I had crushes on), I'd head out on my BMX with my neighbourhood buddies looking for trouble. We'd have a bag of fireworks, and would look for things to blow up. One of our favourites- freshly made cow-dung. Yes, we have a fierce-looking Sikh guy who'd walk his herd of cows from one area to the other, and inevitably they'd leave a trail of dung. And so, we'd dare each other into sticking a single firecracker into it, and lit the fuse. We never ran fast enough to come home totally clean. There was always some green/black splatter on us, or our bikes. It's a wonder none of us died of E.coli poisoning!
• After all that work, we'd be famished and head to each others' houses for snacks, drinks and the all-important gambling sessions. Yes, even parents allowed this, once a year. We'd be playing Blackjack or Cho-tai-tee, with 10-20 cents a wager. It made me feel like a cardshark. But alas, every year I lost. Even to my little brother. The lucky red Superman underwear never worked.
• I miss the fireworks! My favourite was the dinky little Moon Travellers; mom and dad would get use a carton and my brothers and I would preciously divvy them up. They were small little things, with only a minimal pop, nothing like the Thunderclaps people eventually used. I loved the smell of the burnt gunpowder at Chinese New Year time.
• And of course, the food. Mom and dad always had an open house, and they always catered Malay food (yes, race wasn't as big a deal then, unlike what the idiot politicians are making it to be these days). And always, we'd have rendang which was my favourite even now (despite it one year pretty damn near killing me; remind me, there's another story to be told someday), dumped on a serving of fried beehoon.

Yes, wonderful memories. My buddies and I were just reminiscing that on Whatsapp the other day. The 11 of us, spread over numerous continents and most with kids now. But those were wonderful times. Someday, I hope to show Kris and Alli what CNY is like. And someday, I'm going to show my little girl how to blow up a fresh cow dung!

Manuscripts

My resident approached me the other day asking for advice on how to write up a case report. It was somewhat timely as my sister had seeked a similar advice recently. I can't claim to be an expert in publishing materials as at my alma mater, the real experts had over 300 first-author papers each, though I've had my hand in this several times. This is what I told him:

• Use a cover letter. Even if the author instructions lists this as optional. Take the trouble to find out who the Editor-in-Chief for the journal is, and address it to him/her appropriately. Make it succinct, but explain in one or two lines what your manuscript adds to medical knowledge, or why the case/study is special. Otherwise, a manuscript simply entitled "Chordoid glioma of the third ventricle" gives the reviewers little insight and makes it easy to disregard. Thank the Editor for considering your paper.
• Identify potential journals. Not all journals take all types of manuscripts; not all journals take case reports, or medical images, or unsolicited review papers. Do your homework
• Know the format. Once you identify your target journals, use the appropriate format. Double-spacing is a given, but know how they like their references cited, or tables and diagrams labelled. If they lists a word-limit, do not exceed it.
• Use the proper lingo. Obviously, don't mess up the English. That being said, there is a certain type of lingo that is expected in a scientific publication. Informal language should not be used. No DON'Ts, CAN'Ts, WON'Ts, HE'S. My style is to follow reinforcing statements with INDEED, THUS, FURTHERMORE, rather than SO, OF COURSE.
• Don't over-abbreviate. While abbreviations can be used, always start with the full syndrome names and follow this with abbreviations. But do not overdo it. Ie. A 50-yo man with DM 2 presented with SOBOE and ACS...
• Do it now! It's true, the passion and motivation for any case or study will fizzle. So, if you are enthusiastic about writing up something and submitting it, do it now! Because if you don't the weeks become months, and then years. Though I'm pretty satisfied with what I've done, I do have manuscripts that ended up in my dusty to-do folder that will never see the light of day. Including that (sigh) 20-page (double-spaced mar)/80-reference review of thyroid nodules that is now 5 years old and is stale and no longer up-to-date. And I'm too lazy to update this. So, do it while you are keen. Otherwise life gets busy and you make excuses.
• Use reference formatting software. Do not manually type out your references! That is a lot of work, and you need to modify it to the journal you submit it to. And, if you manually type things out, but decide to add a new reference between Number 3 and 4, you're left with manually relabelling references 4-20! There are numerous programs out there that do the formatting for you. I used Endnote back in my day. It was neat, as from Medline or Pubmed you could directly save the citation (even the .pdf) and keep it in a folder, and then just label it when you work on your Word document.
• Don't give up. About two-thirds of my manuscripts were rejected initially. Sometimes it's just a matter of shopping for the right target journal, whose reviewers feel your paper is well-suited to their readership. So, if one journal rejects your paper, look for another. Start with more ambitious ones, the ones with a higher impact factor, and then work down. A mentor once told me, "All manuscripts can be published, if you look long enough for the right journal". (Almost true, though I had one manuscript that in retrospect sucked bad enough that I probably shouldn't have bothered even trying! Ah, that was when I was still a publication virgin).

It's a lot of work. My most hard-earned papers spanned 2 years of my personal work (and 5 years of data). But to get that email, "Congratulations Dr. Vagus, your manuscript entitled X has been accepted for publication...", and then to see your paper in print, is a very rewarding feeling. So, if you are inclined to do research and write papers, it's well worth the effort.

Contraband!

No, not the movie.
Even better.

Look what I found in the pantry over the weekend. I had the case of the munchies, and went in on my usual exploratory searches. And on one of the shelves, I hit jackpot.

Though I hadn't realized it until a month after they left, mom and dad must have 'imported' this from Malaysia when they visited. I haven't had these in well over 10 years. Not one of those things that would come to mind when I visited Malaysia and went out on a food-hunt. But definitely one of those things I missed.

Ah, the memories of my childhood that each bite brought back. It's a good thing Kristin wasn't a fan; I didn't have to share a crumb of this with her.

Thanks, mom and dad!

Ugh

Ugh. I feel like throwing up. And so, I have my barfbag beside me right now, in case something comes up the wrong way.

Though we've been together 5 years now, the wife and I can think so differently sometimes. I blame it on my Malaysian heritage.

I made rendang, briyani (from the packs) and roti canai for dinner just now. I made A LOT of it. And much of it we probably could keep for another day, but I didn't think the roti would thaw well. And here's where we digress.

Kristin: Just throw it away, or give it to the dogs. You can always make more.

Me: You want me to throw away my precious Roti Canai*? Never! Here, I'll find some room for it in my stomach.

In the end, guess whose suggestion was the better one? Ugh. I'm gonna need some Tums.

*May replace with (expired) curry paste/ayam masak merah/sambal belacan/etc. Yes, we've had this conversation many times before. Somehow I never learn.

And yet, ask any Malaysian expatriate. Spices and foodstuff from Malaysia are more precious than gold.

After 9 years.

That's almost a decade. But after 9 years of being in this country, I finally received my green card the other day. It's been a long convoluted road, from a J then H visa and now this.

Though it's a huge relief, and will make travelling with my family much easier, and not having to worry about 'secondary' screens (which is still much better these days compared to the post 9/11 days), getting this was almost a bittersweet moment.

Probably more psychological, since I've called this place home for the last 9 years. Including medical school, I've lived in North America since 1998.

But, becoming a Permanent Resident, also makes it pretty clear (if it wasn't already): This, here, is now home. Here.

No longer Malaysia. No longer the place I was born. The place I grew up with, the place that holds so many precious memories, and still holds so many family and friends still so dear to me.

Though this was not what I foresaw when I started my career here, this was but to be expected when Kristin and I got married and started our family. And though I do consider it a privilege to receive this card, I am somewhat saddened to think about the factors that led me here. The same factors that have led 5 of the 10 other close friends of mine from highschool to seek permanent residence elsewhere, outside of Malaysia. To cause the massive brain drain from Malaysia, the loss of so many young talents. The same issue that comes up over and over again, in a country that found her independence almost 55 years ago: If you are of a different skin color, then you'll always be an immigrant. You'll never have the same rights.

So ultimately, for my family, for my daughter's future, like many of my friends who think about their children's futures, we seek greener pastures. Though this place is far from perfect, this is now home.