Thursday, February 28, 2013

Miracle Oil

Speaking as a Malaysian Chinese raising an American daughter with a Caucasian wife, I have to say it makes me immensely proud to see my little munchkin reaching for my good ole' Minyak Angin Cap Kapak whenever she complains of a tummy ache.
There are many things my little girl will never understand or know. Things of my heritage. But she seems to have picked this up on her own (as mom absolutely abhors the smell).
Ah, the minyak angin (literally 'wind oil', or camphorated oil) is something every Chinese household would never be without.
We've used it for migraines, gastroenteritis, nausea, sprains.
Heck, I bet it'd even work for my diabetes or thyroid patients!
It's like the miracle oil. I've even seen people ingest this when they're ill (I wonder if that high school friend who routinely did that is still alive?)
It reminds me of Toula's father's obsession with using Windex, in My Big Fat Greek Wedding.
Now, I wonder if there are published randomized controlled trials out there?

Monday, February 25, 2013

Self Check-in Kiosks

I saw this in one of my rounding hospitals the other day when I went in to see a consult. Self Check-in Kiosks?!!
I was so curious I just had to ask the receptionist who was nearby. Apparently, it's a newly launched program, mainly for elective procedures and things like that.
Outpatient surgery, endoscopies.
Obviously, this won't work for the patients who have to be admitted for some unexpected illness.
But these apparently have been adopted by numerous medical institutions to make things (supposedly) more seamless and quicker. And it has the ability to scan personal ID.
And though there wasn't any takers for these when I was there (the lines were for only the manned reception), I have to say I left fascinated by the prospect.
What will they think of next?
(Drive-though colonoscopies?)

Saturday, February 23, 2013

Email from a reader

I got this email from a reader some time ago:

Thank you so much for sharing your experience in your blog. I came across your blog regarding training in US, just like how many others did.
My plan is to apply for the coming match in 2013 September. However, as I made this decision of pursuing post graduate training in US rather late, I did not do my elective in the states when I was a medical student. Thus, I think it puts me at slight disadvantage compared to others candidate in terms of letter of recommendation and also the part on US clinical experience, even though we may have the same scores. I am actually looking at internal medicine programs, which may be considered the least competitive compared to other programs. But I am interested in university affiliated hospitals so that I can have more research opportunities in the future, which is rather tough for international medical graduate. But either way, I am happy if I can secure a spot in any hospital.
I have tried sending emails to a few university affiliated hospitals for externship experience, but most of them only offers clinical elective to medical students, which I am not already. Some offers observership, but I think it would not be considered as part of USCE in the residency application. I also came across a few websites eg FMG portal which offers help to seek for externship spots at a sky high price - but from the list they gave me, there are only categorised to specialty and areas, but not the name of the hospitals, so I am not sure how reliable it is.
1) Should I apply to the FMG portal?
2) Should I wait for the observership from the universities hospital, which I can only apply after I am ECFMG certified, after passing my Step one in April? ( then I may not be on time for this year's application in september, since it takes time to process the certificate , then the letter of recommendation.)
3) Or should I go ahead with the application in September without any USCE and letter of recommendation from US?
4) Do you know any hospital in particular which offer such elective spot to IMG?
5) What are your experience with other students/IMG ? ( I mean how many actually manage to secure a spot, in particular the internal medicine?)
The truth is, I'm feeling more and more rusty with the application process since I did this 12 (gulp) years ago. And so things undoubtedly have changed much.
However, if any of you readers find yourself in a similar situation, I have this to say. And I humbly acknowledge that I am not directly involved in any residency selection processes (so I can't speak from firsthand experience) though am on faculty in 3 residency programs and a medical school here.
It might be 'ideal' to do a US elective. Especially in the specialty you seek, and in the hospital to which you hope to apply. And to get a letter of reference from a US physician.
However, just because you don't have the above, is not the end of the world. Ideal is one thing, but there are many things to consider too.
I know of quite a few IMGs who got into residency programs here without the above. I for one didn't do any US electives when I was a student (though granted, Canadian hospitals are probably seen in a similar light). And I am of the opinion that almost everyone can potentially secure a spot. The question will always be, how flexible are you?
If you are worried that your credentials might not be strong, to consider less-competitive specialties. And to apply to less popular programs/locations. At the very least, have a few of these backups.
Also, I know of some foreign-trainees whose US-elective plans backfired- I met numerous students who wanted to apply to work at the 2nd-ranked top hospital in the country (ahem)- but their performance in that month was less than satisfactory which gave them not-too-good letters. And firsthand feedback to the program director that they were not suitable candidates. So, a US elective isn't always a plus.
While it might be true that letters from overseas physicians might not carry as much weight, I'm sure these do account for something. And I'm not sure the letters I've written for students here, would be seen much more differently from letters coming from elsewhere, since the program directors probably know as much about me, as they do about some Dr. X in Malaysia. Hence I doubt I have any more credibility than anyone else.
I do feel strongly though, that a clinical observership carries very little weight. Do it if you're curious about how things are done in a different country. But don't do it to try to get your application any stronger. As an observer, for medicolegal reasons, the hospitals cannot allow you to directly involved in patient care. So your mentor would not be able to make an assessment and write you a good letter with this.
So, whoever you might be, and wherever you are, getting a spot certainly is possible. Don't lose faith!

Thursday, February 21, 2013


Sent from my iPhone

Just when you were foolish enough to think that perhaps winter is coming to an end, we get another dump of snow!
This was the Doppler radar map of the precipitation. Lots of it.
Most of my afternoon patients cancelled today. So all there was left to do was to come home early and relax under a warm blanket with a glass of rum. Ahhh

Sunday, February 17, 2013

The white badge of parenthood

I imagine most parents would know what I'm talking about. It was chilly and so I looked for a sweater to wear. Strangely enough, ALL my sweaters had weird white stains on the right shoulder.
Any guesses as to what this it?

Saturday, February 09, 2013

Happy Chinese New Year!

Happy Chinese New Year, folks!
Wherever it may be that you're celebrating, hope you are with loved ones and friends. May the Year of the Snake brings you prosperity and happiness.

Thursday, February 07, 2013

New Year Blues

Sigh. I always get the blues this time of the year. More so that during Christmas or any other holiday. Simply because growing up, Chinese New Year was THE celebration of the year for my family. And so, being a gazillion miles away, in a place with no littlest feel of the festivities, in the freakishly cold, does make one feel quite homesick.
Especially when many other friends are gloating on Facebook that they are travelling back for CNY. Sonsofbitches.
Someday, I keep telling myself. Someday, I'd like to bring my girls, ALL my girls (Kris, Alli and Ava) back to Malaysia during Chinese New Year. I'd love to show them the sights and sounds and smells. The high-pitched warbling of the CNY songs. The smell of the incense. The unescapable redness everywhere. When nightfalls, the popping of the fireworks, accompanied by the laughter of kids.
The glorious, glorious food.
Sigh, I'm making myself cry.
Perhaps in a few years when they are old enough to absorp it all in. I've love to show the girls what their daddy grew up with. What his "Christmases" were like. Someday, but not this year.
This year, we're saving most of our trip time and budget for my sister's wedding in November. We'll see if I survive the flight.
In the meantime, hope the rest of you are enjoying prepping your homes for CNY. And stuffing the Angpows with cash. Just do yourself a favor; don't spread bad luck by using the wrong red packets.

Monday, February 04, 2013


Just when you thought it was safe to think perhaps the days would get warmer, WHAM, we get another dump of snow.
This was the 2nd major snowstorm we got. Fortunately, it was my day off and I didn't have to drive in to work.
But it got me thinking how things compare to Malaysia. Our winter routines.
For one, instead of getting the torrential rains, we get snow blizzards. The good thing is you stay relatively dry. The bad thing is driving becomes a nightmare- thankfully we have AWD in our cars. Well, except THAT one. I did drive the Porsche in our first winter here; with winter tires I have to say the car did surprisingly well. I did get stuck only once when we had a 1cm layer of ice. I had to park the car 50 m from home and stumbled back.
The other interesting comparison is the snowblower. My dad had fun with this the last time he was here. Instead of the lawnmower, we have a gas-powered machine to clear the snow. It's just as noisy as a lawnmower, a bit more fun because you get to shoot the snow in whatever direction you want. Except your fingers risk falling off because of the cold. Or if you're dumb enough to stick your hand into the chute to clear the snow; I remember that one year when Vince from Singapore did a ortho-hand rotation here and he told us how many cases of these he was seeing. Apparently, even if the engine's dead from the compacted snow, there is still a lot of torque built up so once you clear enough snow it spins and rips your fingers off. Ouch.
That aside, snow's definitely a lot of fun. You get to make snowmen, have snowball fights. I'm still trying to teach Alli how to make snow angels by laying down on the snow and waving your arms and legs- however after our last incident with dog poop, she doesn't seem too keen now (yes, I know, I need to do a better job scooping up doggy do).
Anyhow, it's stopped snowing. I'm going to clear my driveway. If you don't see any more entries from me, it probably means I was dumb enough to stick my hand into my snowblower.

Sunday, February 03, 2013

Halo 4

So, I decided to give myself a treat. I bought Halo 4 finally. And because I deserve only the best, I allowed myself to buy only a 2nd hand game off eBay (and saved myself 13 bucks!).
The gameplay has been amazing so far, and the clarity seen on the 47" HDTV is unreal. I've only completed the first level, and just started Requiem when Ava starting bawling and I had to stop, but I've been enjoying it immensely.
One thing seems to be missing though. I miss having my wingman.
Yes, there was a time we were crazy about Halo. And yes, that is indeed a picture of Buddy and I playing Halo in the backyard of our rental in 2005- it was such a beautiful day that we felt it was wrong to stay indoors. Our compromise: take the damn TV and Xbox outside! And we've had Sundays when we would start playing at 8AM and finish at 11PM.
Sigh; those were the days

Friday, February 01, 2013

The New Generation

I saw Mr. R yesterday for our regular diabetes follow up. He was a 69 year old farmer with severe insulin resistance. He came with his daughter and grandson and were making a daytrip out of his visit to the city to see me. His grandson gleefully said they just came from McDonald's.
No surprise that his hemoglobin a1c was 9.7. Also no surprise that his triglycerides were 612 mg/dL. What unnerves me professionally, isn't that he has diabetes. Rather, it is the degree of diabetes we see these days. Admittedly I have not been in practice for long. I've had my MD only 12 years, and I've been in endocrinology only 7. But I seem to remember a time when using over 200 units of insulin a day was extreme.
Mr. R however, was using in excess of 800 units of insulin a day. Almost 150 units of prandial insulin per meal!
And while he probably wins the prize of being the most insulin-resistant patient I have, he isn't alone. These days many endos are seeing this phenomenon of patients being on massive doses.
Why is that? It's both a complex and simple answer. Lifestyle. Or rather, how lifestyles have changed.
The modern conveniences often result in less physical activity. Escalators, elevators, cellphones, cars. And if you're deemed medically disabled from obesity, you get to park nearer to your destination (a socially responsible step, but perhaps not the most logical medically). The most convenient or cheapest foods are often the unhealthies. And our perceptions have changed too. What was obese, is all too common now that we consider it normal.
When I asked him about exercise, he was adamant that he works out 5 times a week, at least an hour each. When I asked him what he did, his response was "Pool".
Not swimming, mind you. As in playing pool. Plays with his retired buddies in his basement. Often while having beer and nachos.
Sadly, he isn't the only one. His daughter's BMI was probably in excess of 40 herself. Her pre-teen son was himself visibly obese, on his iPad when I was talking to the patient.
And this isn't a problem affecting only the USA. It's a worldwide epidemic. And so, the solution's going to be difficult. Not because it's complex. Rather it will require a huge momentum, a major paradigm shift, in how we view our bodies and responsible habits. And I'll be the first to admit I myself will have a lot to change, too.