Conversing with Life

REAL load off my mind

Just finished the men's open of the New Balance REAL run this morning. It was a 10km race, transversing across 3 terrains: road (6km), sand (1.6km) and trail (2.4km).

This is the second time I signed up. I had to forgo the race last year due to a very bad and unforgettable gastroenteritis. I felt sick, nauseated and vomited at least 7 times over saturday night. I couldn't eat or drink and had diarrhoea as well. Finally saw the doctor at 0030hrs, for which he charged me over $120 for night fees. Thus I could only watch my friends finish the race last year. So memorable right?

This year, I was glad I finally finished this. I was praying hard not to fall sick because I had felt the initial symptoms of sore throat and runny nose just on Thursday and Friday.

It was a tough race, especially on the sand. As it was my first time, I was slipping on the sand mounds made by the previous runners. As we had to run through 3 beaches, I learnt fast and ran nearer the sea where the sand was more compacted. It was so much more easier.

I started off quickly, cutting here and there. Overstretched myself and after the sandy beaches, I was almost gone. I had thoughts of why I paid money to torture myself on Sunday and also that I'll give this run a miss next year.

But when I crossed the finish line, I was relieved and all those thoughts disappeared and was replaced by thoughts of, "let's do this again next year" and "I want to improve my timing next year".

Came across something interesting there. At the lucky draw, my friends and I were sitting around hoping to win something. They announced the numbers as they picked them up from the box. But alas those announced had left. They probably called like 5-6 numbers before anyone claimed the prize. Finally due to time constraints, they decided to only call 1 number. And the prizes will be donated to charity if no one claimed the prize. A particular elderly uncle was very agitated and shouted out to the stage with comments like "Not fair!", "How can you when we are sitting here!", "Donate to NKF is it?!". For a moment I thought he was going to scold vulgarities. I guess if you are meant to get it, you will. If you aren't, you won't. He didn't win anything.

Wei Qiang converses @ 18:37 0 buzzes

Of noise and distractions

I'm constantly distracted. I constantly feel like I'm concentrating on too many things, and these things are often not useful or meaningful.

In case you may think I'm hearing or seeing things, don't worry. I'm not hallucinating.

There's always noise around me. Sounds, images, and events that happen around me. Although I'm not involved, I seem to get distracted by them easily.

I wish I could only focus on one thing now. That is my studies. However, almost always the case, something or someone would distract me.

How can I avoid these distractions? Short of running into an uninhibited area and becoming a hermit (which i used to fantasise about doing), I think my present environment isn't very helpful. Maybe I just have to curb myself, strengthen my mental strength. It's tough and I don't have much time.

I think I'm going to have a panic attack now.

Wei Qiang converses @ 20:44 1 buzzes

ECG case

A 49-year-old man presents to the emergency department with fatigue and palpitations over the last 24 hours.

His family states that he has also been drowsy and fatigued for the past 2-3 days. They state that, when he is awake, he appears to be somewhat confused. The patient denies having a fever or chills, shortness of breath, chest pain, or abdominal pain. He does not have a headache and has not vomited or had diarrhea.

His medical history includes chronic hepatitis C, cirrhosis, chronic renal failure, and hypertension. His current medications are lamivudine, nadolol, lactulose, and spironolactone.

On physical examination, the patient is awake but somnolent. His temperature is 98.2°F, his heart rate is 96 bpm, and his blood pressure is 114/72 mm Hg. His oxygen saturation is 94% on room air. Findings on pulmonary and cardiac examination are unremarkable, but his abdomen is slightly distended. Trace peripheral edema is observed. Findings on neurologic examination are nonfocal. The patient does not know the date, though he can state his name and knows that he is in an emergency department.

The patient is attached to a cardiac monitor and given oxygen. A full set of laboratory investigations and 12-lead ECG are ordered (see Image 1). Soon after the initial ECG is obtained, the nurse calls you into the room to examine the patient, who has become diaphoretic. His heart rate is now about 40 bpm. He appears ashen and uncomfortable. Repeat ECG is performed (see Image 2).

What finding on the repeat ECG indicates the need for immediate therapy?

Tag me for the answer.

Wei Qiang converses @ 20:13 1 buzzes

Ten points in a derm history

(1) Duration
(2) Primary site and spread
(3) Morphology and evolution
(4) Associated symptoms (itch, pain, anaesthesia)
(5) Aggravating (heat, cold, sunlight) and relieving factors
(6) Previous medical history and treatment (esp past skin disorders, atopy)
(7) Contact history
(8) Family history
(9) Occupational history
(10) Social history (including hobbies, pets)

Wei Qiang converses @ 19:42

Athletes and drugs

The French sports daily newspaper "L'Equipe" ran reports suggesting that Lance Armstrong took performance enhancing drugs during his first Tour de France win.

Now, Armstrong happens to be one of the most legendary athletes ever. Battling testicular cancer and coming back to win the Tour de France for a record 7 times.

The tests were done with samples taken during that year. During that time, EPO could not be detected but they kept the samples to conduct experiments to devise a way to detect that performance enhancing substance (EPO). The samples were not labeled with names but with serial numbers. And some how the newspaper reported that they have credible proof that the tainted sample belonged to Armstrong.

Armstrong wrote on his website. "I will simply restate what I have said many times: I have never taken performance-enhancing drugs."

I believe Armstrong.

No test is perfect. I'm sure there's always some degree of inaccuracy. Now instead of jumping to such conclusions, the lab should be absolutely certain. Anyway since the samples were not labeled properly and the fact the samples were taken 6-7 years ago, man-made errors are bound to be present. This sounds like French sour grapes, attacking the American who has dominated the French event for years.

Drug allegations are very serious, especially for athletes. It's almost like a litigation of malpractice for a doctor. Both are career breaking allegations. No test is perfect, there's bound to be errors. How can labs ensure that the margin of error is minimal?

It's easy to say the test is positive, but without considering the possibility of lab error, the damage to the athlete is huge. Just take Marion Jones for example. She's been hit by drug allegations but never tested positive before. Now her career has taken a serious blow.

So I believe Armstrong. I believe in the integrity of a man who has managed to show the world that determination can create miracles.

"To all the cynics, I'm sorry for you. I'm sorry you can't believe in miracles." -Lance Armstrong-

Wei Qiang converses @ 14:06 0 buzzes

Keeping tabs on your health

Here's some good advice: If you are above 45 years old, do go for a health screening.
Do the basics: blood pressure, blood glucose, lipids.

My dad just had his. Results came back, dyslipidemia (hypercholesterolemia type IIa). It wasn't unexpected, afterall my dad enjoys food (especially pig's trotter, laksa, char kway teow). But it was a reality jolt.

The high cholesterol values on the report were like a firm reminder that something is wrong and not that something may be wrong. Made my dad see the doctor immediately, he's on simvastatin now. He's going to do some major changes to his lifestyle, good changes. Hopefully we'll see good results in a few months.

But it made me realise something about screening.

Firstly, people don't want to screen because they are afraid of finding out that they are ill. But just because you don't know it, doesn't mean it's not there.

Secondly, the disease doesn't always go away in a jiffy. After knowing the disease is present, doing some extra walking and eating less doesn't cure the disease. The disease is a chronic cumulative one, and is the result of many years of insult. Similarly, you would expect many years of correcting the lifestyle to right the illness.

Unfortunately, we don't have the luxury of so much time. That's why drugs help. Even then, expect years of treatment before you see any benefit.

So if you are above 45 years old, go for that screening. If you get a clean bill of health, that's great. If you don't, take heart that you have detected it and are going to do something about it.

If you are younger, examine your lifestyle. Treat your body with respect, it'll last you longer and better.

Wei Qiang converses @ 21:00 0 buzzes

Singapore's most wanted

Dim Sum Dollies tickets. It's for their final show on Saturday. Being a poor student (and potentially even poorer when I have to pay my study loan back), I had to get the cheapest tickets. Was hoping to get those in circle 2 but ended up with circle 3 seats.

I didn't realise how high the theatre in esplanade was. I mean, I was looking at the stage from like a height equivalent to a 5 storey flat. The dim sum dollies looked like miniature xiao long baos.

The show was hilarious. It was totally worth the ticket price. Laughed till I had stiches.

As it was the last show, they gave away a car. Or do they give away a car every show? (will those who've seen the show enlighten me?)

They had a game show segment like "The price is right" and invited 2 contestants to guess the price of the Singapore Dream. The closest to the actual amount without going over will win the car. The items in the Dream are the car, an Indonesian maid, a Chinese tuition teacher, make up kits, shoes and a condo unit at the Carribean. And I must say the condo at the Carribean is really a dream. It's the most ideal condo and I would buy it if I had the moolah. 1.8 million dollars. I'll put it on my wish list, hopefully someone will grant my wish. Anyway the Dream is worth 2.8 million dollars.

Although they had quite a few quips at the local political scene, it was amazingly patriotic at the end with lots of national day songs.

I came away with the impression that even though we complain about Singapore and the government, it doesn't mean we don't love Singapore. In fact, it shows that we care enough to want to take an interest in it.

And as Zhang Ziyi would say in English, "The soup is too salty!"

Wei Qiang converses @ 21:01 1 buzzes

Keep the romance alive

Being in a long term relationship, one question will inevitably pop up.

"Do you still love me?"

I think that doubtful thought can and will surface anytime, especially after all the drama and heart-pumping adrenaline of initial romance wanes away.

Some people say love is like a roller coaster. The heart must be pumping, palms sweaty, head dizzy when you see your love. That's true, in the initial phase. Afterall, having prolonged tachycardia may bring on cardiac failure.

The adrenaline rush will dampened somewhat. Soon it'll become a more chubby and comfortable kind of feeling. You'll feel relaxed in the company of your love, and your heart only gets pumping when you get into one of those lover's tiff.

So it'll perfectly logical to think, "Are we still in love?"

Granted you may not feel the rush of the initial romance all the time, but I feel one must make the effort to re-create the romance. Afterall that's why anniversaries are invented. The 1 month anniversary, the critical 3 month anniversary that says we really like each other, the 1 year anniversary that says we are steady, the 5 year anniversary that says we love each other very much, and the 10 year anniversary that says 'are you going to marry me?'.

So make the effort to show how much you love your partner. Re-create that heady feeling of yesterday. Buy her a gift, bring her out to dinner at a posh restaurant, go for those romantic walks at botanical gardens, kiss her like you did when you first experienced her soft lips. A little reassurance goes a long way.

Afterall, it says, "I love you very much dear, much more than when I first met you."

Wei Qiang converses @ 18:49 2 buzzes

Coagulation cascade

NB. Before coagulation can occur, Virchow's triad must be present. Circulatory stasis, endothelial injury, hypercoagulable state.

There are 2 pathways in the coagulative cascade:

(1) Extrinsic (measured by the pro-thrombin time)
Clotting factors involved are 10, 5, 2, 1 and 7. 7 is the only factor unique to the extrinsic pathway.

(2) Intrinsic (measured by activated partial thromboplastin time)
Clotting factors involved are 10, 5, 2, 1 (which is similar to extrinsic) and 12, 11, 9, 8.
Factors 8 and 9 are implicated in hemophillia A and B respectively.

NB. Vitamin K dependent factors are 10, 9, 7, 2. Which involves both the extrinsic (7) and intrinsic (9) pathways.

NB. factor 1 is fibrinogen, factor 2 is prothrombin.

Wei Qiang converses @ 17:23 0 buzzes

Pimple cream

I put some pimple cream on my big red pimple just at the side of my right nostril, hoping it'll shrink the ugly bump.

My mom saw me and said,"qiang ah? how come you got mucus dripping out of your nose!?"

"mom! it's pimple cream!"

The last time I put on the cream, my dad said,"you got rice on your face."

Man...

Wei Qiang converses @ 16:33 2 buzzes

Overmedicating

My grandma's sick. She had chills and was febrile, indictating something infective was at work. The source? Some questioning in Hokkien revealed only a sore throat, non-productive cough and generalised malaise. Typical symptoms of early-onset flu. That's good, at least it wasn't anything serious, like a urinary tract infection or pneumonia.

Poor grandma. She was really ill, dizzy and all. There's been this flu bug going around. In fact I just recovered from one. So we helped her to the clinic and let her doctor take a look.
The diagnosis: flu, as expected.

But the doctor gave her 9 medications! 9!!! Okay, 3 were for her knee pain. But 6 meds for flu?

The 6 were: cough syrup, anticongestants, antibiotics, NSAIDs, antipyretics and H2antagonists.
Overkill? I think so.

Wei Qiang converses @ 21:39 0 buzzes

You don't know me

How many times have we heard the phrase, "You don't know me." in a romantic movie or drama serial. The phrase has been used thousands of times, especially in the heat of an argument.

How many times have we used it in our lives? Who have we said this phrase to? Spouses, parents, siblings, friends.

Why do we expect people to know us well? And when we expect that from someone, how sure are we that we understand them?

And if we don't even understand ourselves, how can we expect others to do so?

It hurts when you realise you don't understand someone. Even after knowing the person for years.

It hurts even more when you realise you don't even understand yourself, and yet expect the other person to understand you.

How can we know ourselves better? How can we know other people better?

Wei Qiang converses @ 16:36 1 buzzes

The ten aspects of PAIN

Site
Character
Duration
Onset
Progression
Relieving factors
Aggravating factors
Radiation
Referral
Severity

Wei Qiang converses @ 00:30

Hydration

I've been jogging for 3 years. I started in year 2 med sch for health reasons. At that time, after being disrupted from army, I rejoiced in the decadent lifestyle of eating and sleeping as and when I wanted. Weight gain was inevitable, especially since I think I am quite endomorphic.

Jogging presented a cheap, accessible and easy to pick-up way to lose the flab. I got addicted and things have gone on from there.

Now, 2 half marathons and several shorter races later, I have embraced jogging as my primary activity of keeping my cardiovascular fitness up.

Prior to this point, I was never a believer of hydration during a run. Let me clarify that point. I never saw the need for me to hydrate myself during my training runs. Of course I would drink during marathons and long distance races. I couldn't possibly last 3 hours without replenishing the water I lost through sweat, respiration and other sources. But I've never saw the need to drink during my training runs that last about an hour. I believed that one can always drink AFTER the run. Besides drinking during runs may bring on stitches and also break the concentration.

But one fine day, I brought along my small 350ml evian water bottle for a run. I'm not sure why I did it. Maybe the weather was hot, or maybe I was feeling very thirsty that day. I took sips along the run and somehow the run seem much more comfortable than usual.

That did put the thought of drinking during runs in my head but I was still convinced I could run without hydrating, becasue the hassle of carrying a bottle in my hand is simply too much.

Then came the runs in the hot morning sun. I could feel myself melting, my energy sapping away rapidly. Is it because of the dehydration? I took along a water bottle the next time, and the run had seem easier.

Okay, so intermittent hydration may prolong my energy levels but carrying a water bottle will simply waste more energy unless I'm wearing it.

So here comes this beauty.

Looks good, doesn't it? I hope this doesn't bounce around like those horrible waist pouches. From the picture it seems like a snug fit. It's also less restraining on the upper body, unlike the camel hydration packs. I still remember that I used it once for a run and the rough seams ruined my adidas singlet.

Haven't seen this hydration packs around. Maybe I should search the Nike shops more thoroughly.

This may help me push my running to a new level or it may simply be another white elephant. Guess I won't know until I try it out.

Wei Qiang converses @ 19:55 2 buzzes

Duh...

I was at the NUSS Guild house off Adam road today having dinner when I saw the weirdest toilet layout.

The toilet bowl was not separated from the urinals by any wall or partition. That means if you were taking a crap, anybody could walk in and see you.

I wonder how anyone can survive the embarrassment. I'll probably cover my face with toilet paper.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Anyway I've fully recovered. Finally I can get back to studying full steam. It's near impossible to study with a runny nose, I keep trying to stop mucus from wetting my expensive textbooks.

1 and a half weeks to go. Keeping plugging.

Wei Qiang converses @ 00:14 2 buzzes

Sleepless Night

What troubles you my dear?
Please share it with me.
Spare me from hours of agonizing fear,
Wondering if it was me.

Wei Qiang converses @ 02:15 0 buzzes

Are you playing me?

I had an eventful saturday lined up at first.

My YEC asked me to attend a National day dinner at today during the meeting last week. Then they gave all the invitations to the vice-president, thus freeing me from the task.

I then accepted an invitation by my JC OG for a dinner on the same evening. Then on Thursday the YEC called me up and asked me to go to the National day dinner. I said I had already arranged to have dinner with my friends and so declined them.

Then the OG dinner was cancelled as the response wasn't good. So then suddenly I was free and I thought I'll spend more time with Audrey.

Then I developed flu over friday night and was really sick. I decided not to spread the bug and stayed at home the whole day.

Then I got an sms from my OG friend asking if I want to have dinner with a smaller group of them.

Being sick, of course I had to refuse them.

My God, are you playing me?

Wei Qiang converses @ 12:54 3 buzzes

Full Blown Flu

I'm ill. Down with flu. Had some pro-dromal symptoms like sore throat a few days ago but the actual flu-like symptoms came on over the last night.

The running nose cancelled my running.

Wei Qiang converses @ 08:43 0 buzzes

The sun is a reciprocal of my running speed

I melt in the sun, at least while running. Started jogging with Kwang How at 10am after my end-of-posting test (psychomed). Original plan was to run the whole stretch of the ulu pandan canal, but by the time we reached the clementi stretch (3.8km), we were bushed.

Maybe my sore throat played a part. Maybe we were mentally tired after the test. In anyway, I think the sun played a major part in zapping our energy.

Since we couldn't do much jogging, we decided to make up for the lack of distance with intensity. We did speed runs back to school, much like fartlek.

Will jog again tomorrow, before the 10am sun is up.

Wei Qiang converses @ 18:04 0 buzzes

Rounded Individual

I've always been a believer that a student should be well-rounded. One should be able to manage studies, hobbies like sports,arts or music, friends, families and even relationships well. It would be very sad, if one were to excel solely in one field and neglect the others. A sense of loss or unfulfilled will be felt.

Recently I signed up for the Standard Chartered run in December. After I signed up, Kwang How reminded me that 4 December would be right smack in the midst of my medicine SIP (student internship programme). In simple words, I would be very very busy in the hospital during that time.

Hit by that realisation, I began to doubt if I could go for the run. Then I thought again and decided that if I couldn't even spend half a day away from hospital work / studies, I would be very sad. Afterall I've lived by my principle of roundedness.

And if you've noticed my little introductory paragraph at the top, I'm supposed to juggle studies, sports, friends and family.

I'm only a university student once. With this course, I'm already not living the typical life of a uni student. Let me enjoy doing my interests without the shackles of the rigid schedule imposed upon us.

Am I making a mistake? Will there be any consequences? Following my heart, I know I want to do this now.

Wei Qiang converses @ 19:00 1 buzzes

Focus

What is your priority in life right now?
What do you hope to achieve in the future?
What should you do now to achieve those aims?
What is stopping you from doing it?
Can you resolve those issues?

Although there's always a tomorrow, why don't you start today?

Wei Qiang converses @ 21:28 0 buzzes