Monthly Archives: September, 2008

Move Over,Road Rage – Here Comes Desk Rage!

Stress: many don't leave home without it

You have heard about road rage. Now, its time to face desk rage, as stress problems in the office boil over and cause abusive and violent behaviour. According to a recent REUTERS article, workplace violence is on the rise. And to find the reason why, one need look no further than the world economy. Job cutbacks, home foreclosures and high food and fuel prices are putting a strain on families. Unfortunately, that strain is not staying in the home. It’s traveling to work with many employees right into the office.

Desk rage is a sign of stress: on-the-job anger that increasingly is triggered by the pressures and tensions of the workplace. Furthermore, electronic devices like laptops, PDAs, mobile phones, and e-mail have created an ever-widening gap between the amount of information people are expected to keep up with and the amount they can reasonably process, and this adds on to the stress. No one is spared, including doctors, as in the case of a cardiac surgeon who was sued by his staff for ‘workplace bullying’.

Anger in the workplace – employees who are grumpy, cynical, hostile, short-tempered or insulting – may lead to extreme abusive behaviour, as seen in this video:

Are you stressed and at risk of a ‘burnout’? Take this quick test taken from MSNBC website. Click here.

So what can you do if you are put in a situation with a boss or a colleague who’s ranting and raving at you? Here are some pointers:

1. Do not react. Count to 10, take a few deep breaths and tell yourself the rage is about him, not you. Note your own emotion but do not let it control you. So, keep cool, calm and collected.

2. Listen and keep listening till he’s finished, before you talk.

3. Seek to understand the situation and provide empathy. There is a difference between undertanding and agreeing.

4. If that doesn’t work, you can quote Harry Truman, “If you can’t stand the heat, get out of the kitchen!”.  But be prepared to be shown the door if its your boss… 😦

Need to know more? See 7 Tips for Combating Desk Rage or my earlier post on Managing Anger.

“This is Your Captain Sleeping” – OSA affects Pilots,too!

Dreamy Hawaiian islands..enough to make you sleepy, even without OSA

Two commercial airline pilots, who fell asleep while on duty in February this year, have been reinstated as pilots after they were confirmed to have been diagnosed as suffering from Obstructive Sleep Apnoea (OSA). See here.

The two, who were commandeering a 45 min commercial flight operated by Go! Airlines from Honolulu to Hilo on February 13 carrying 40 passengers, overflew their destination at 21,000 feet and alarmed air traffic controllers when they received no response. Finally, when contact was established after one of them woke up, the plane  landed safely.

The US Federal Aviation Authority (FAA) suspended them for up to 60 days for careless and reckless operation of an aircraft and for failing to maintain radio communications but allowed them to resume duties from 9 September, presumably because they had received treatment for OSA and certified fit.

This incident highlights a rather newly-recognised medical condition which causes people to snore and stop breathing repeatedly in their sleep, causing them to feel extremely drowsy the next day. I have even encountered cases of chauffeurs presenting with chest-pain due to chest injury , the result of them falling asleep at the wheel and crashing their cars! Please see my earlier post to know more about OSA, the medical version.

Cutting Healthcare Costs Without Cutting Corners (Part 3) – Seek Treatment Overseas

Sun, Sea, Scalpels - the Lure of Combining Surgery with a Vacation Abroad (courtesy TIME)

As recession threatens to throw the world economy into a deep slump, many consumers are cutting back on their expenses; but when it comes to healthcare, do expect the unexpected and when illness strikes, be prepared. In a front-page story, the Wall Street Journal (9/22, A1, subscription required) reports, “As the credit crunch threatens to throw the economy into a deep slump, Americans are already cutting back on healthcare, a sector once thought to be invulnerable to recession.”

In earlier posts, two ways of cutting costs were covered: the use of generic drugs and taking up an adequate health insurance. For those in high-cost areas where insurance may not provide adequate cover, seeking treatment in good affordable medical centres located overseas is a viable option, the so-called medical tourism initiative.

The media is littered with articles and promos of how Mr X was in despair about the long waiting-list for his planned surgery at home-base and how he decided to fly off to some faraway country to successfully get it done at a fraction of the cost with hardly any waiting time. There’s a lot of truth in this and I have written about it here (Malaysia – one of the top 5 health tourism spots in the World) as well as being interviewed by Time some years ago.

Forbes magazine last month wrote about how Americans (45 million remain without medical insurance today) can get substantial discounts by travelling abroad for surgery. A knee replacement surgery costs $4500 compared to $16,000 in the US. See below:

Soon, to minimise the bursting health budget, governments may give the green light and pay for such surgeries overseas. A paper in the Patients Rights Bill in the UK proposes that the NHS pay for treatment abroad when NHS hospitals miss waiting time targets. More details here.

Medical tourists must do their homework before jumping on the plane. Some of the things to look out for:

  1. Check the doctor’s qualifications with a professional body; and the hospital’s standards with an accreditation body.
  2. Check on the contracts and costs and what it doesn’t cover.
  3. Ensure that the surgery is covered by the health insurance policy- get their OK in advance.
  4. Arrange for follow-up care when back home by establishing communication with the health providers.
  5. Should things do go wrong, have an alternative plan ready.

Health Alert (4) : Mixing Melamine and Milk

If you think that only milk and milk products with only Chinese names are contaminated with melamine, the results released by the Center For Food Safety of Hong Kong as reported by China Daily yesterday raised the possibility that the practice may be more widespread.

Of 65 different brands tested, one contained melamine at a level of 1.4 ppm(parts per million), the safety limit being 6.3 mg per kg body weight per day. While the level detected is below the safety limit, it was enough for the authorities to have it removed from the shelves. However, to allay concerns, this product, named as Nestle Dairy Farm Pure Milk (Catering Use Only), was actually manufactured on the Chinese mainland.

The recent outbreak in mainland China was reported widely in the media the last 2 weeks and to date, 53,000 babies are affected, 13,000 hospitalised and 4 have died , and counting..

Melamine - the high content of nitrogen(blue dots) are similar to that of amino-acids which make up protein

Melamine is used in making plastics and is loaded with nitrogen molecules. Because of the high nitrogen content, this makes milk products appear to have a higher protein count as the current methods of measuring protein are based on measuring the nitrogen content alone.  Health experts say that ingesting small amounts does no harm, but sustained use especially in babies and children can cause kidney stones and renal failure, as melamine is insoluble in the human body and tends to deposit itself in the kidneys which cannot remove it from the system via the urine.

But why add melamine in the first place? This allows milk to be diluted with water by the unscrupulous and the greedy to give more volume.  The ‘protein’ levels are then built up back by adding the protein substitute (melamine).

A burning issue is that, while the NZ government raised this issue as early as March this year, no action was taken by the Chinese government. One of the reasons quoted by some newspapers was that the Chinese government had issued a 21-point plan to all journalists covering the Olympics to avoid taboo subjects, including food safety issues (point 8). A sort of news censorship to put the Beijing Olympics in a spotless stage.  I guess I should add the melamine issue as an addition to my series of earlier posts on “Beijing Olympics Face Major Health Issues”…. 😦

Update(26/9/08): From milk to sweets: The popular White Rabbit candy, which is distributed worldwide, was tested positive for melamine in Singapore. The manufacturers Guanshengyuan have now halted export of this sweet.

Update (02/10/2008): The Melamine Milk Mess – Other Foods Have Been Banned,too

Update (08/10/2008): Not enough: Despite assurances of  new melamine-free milk from the Chinese authorities and a clamp-down on guilty parties, Thailand’s FDA today still found melamine in newly imported milk. See here.

Update (13/10/2008): China’s watchdog on quality GAQSIQ today reported that no traces of melamine have been detected in the 4th round of tests since the outbreak. Sofar,1209 batches have been tested since Sep 14 and none contained melamine, it added. See here.

Update (16/10/08): Switzerland yesterday withdrew S&P Milk Cookies which were made in Thailand. This would be the first food source outside of China to contain significant melamine content, although it is still unclear if the milk used was originally from China. See here. Another startling revelation today is that Thailand’s FDA has detected high melamine in condensed skimmed milk  (Mali Brand) whose manufacturers claim they sourced milk from countries other than China. See here and here.

Update (21/10/08): It looks like melamine has found its way into foods other than milk. A raising agent used in making cookies (called ammonium carbonate) has been found spiked with melamine in Taiwan and Malaysia. Nowadays, ammonium carbonate has been replaced by baking soda in most cookie factories, but some still retain the former due to its inexpensiveness.

Update (24/10/08): Consumer confidence regarding drug & food safety watchdogs appeared further shaken with the news that the European Union has banned a popular recently-introduced slimming pill Acomplia. See my post here.

Update (26/10/08): Singapore today banned some more biscuits and cookies originating from China and Malaysia. Get more details here.

Update (27/10/08): Its now eggs.. China has discovered hen’s eggs to  be contaminated with twice the permitted levels of melamine. The implication here is that chicken too may be affected as the suspicion is that melamine has been added to animal feed. See here.

Update (1/11/08): The Chinese state-run media yesterday published a report saying the illegal practice of mixing melamine into animal feed to boost its apparent protein levels was an “open secret” in the food industry. This has spurred a series of law-suits by affected families. See here.

Update (4/11/08): The tainting of milk with melamine has been an open secret in China for many years, except that users were told it was ‘protein powder’ instead. An excellent overview by the Wall Street Journal is found here.

Update (6/11/08): Another brand of cream crackers made in Malaysia has been found to contain more than the acceptable amount of melamine, the Food and Drug Administration (FDA) of Thailand said yesterday.See here.

Update (7/11/08): China hits back… as its health authorities released a list of foreign food products which were imported into China and banned for not meeting its health standards. This includes milk products from Australia! See here.

Update (14/11/08): The United States has prevented the entry of a broad range of foods from China which have been implicated to contain melamine, a move which is unprecedented. Read here.

Update (16/11/08): Find out how China has disposed off the thousands of tons of melamine-tainted milk in my new posting.

Update (25/11/08): Well, what do you know! Traces of melamine were found in infant formula milk in the USA which were not originating from China. Expect to hear more. Meanwhile, see here.

Update (28/11/08): Two brands of milk made in USA have been named by FDA: Mead Johnson’s Infant Formula Powder and Enfamil LIPIL. And calls for a national recall of infant formula milk in the US are now spreading. Read here.

Update (30/11/08): In the face of mounting criticism, the US FDA has revised their guidelines on what constitutes safe levels by declaring melamine levels at below 1 ppm to be safe for infants. See here.

Update (02/12/08): For the first time since the outbreak, China has released the latest figures: a total of 294,000 (!) have been taken ill, 51,900 required hospital treatment and 6 have died. Click here.

Update (03/12/08): Saudi Arabia has now joined the list of affected countries. Read my posting here.

Update (06/12/08): Finally! WHO issued safety limits for melamine levels in food.  The so-called Tolerable Daily Intake (TDI) has been fixed at 0.2 mg per kilogramme of body weight. See here.

Update (10/12/08): To date, Australia has withdrawn 11 food products from its shelves. See the list here.

Update (17/12/08): China has listed 17 harmful food additives to be banned. See the main ones here.

Update (23/12/08): The U.S. Food and Drug Administration (FDA) just announced another recall of a another food product over melamine contamination.See here.

Update (29/12/08): 22 dairy producers in China have been asked by the Chinese government to come up with compensation totalling close to US 2 billion. Families who lost babies will get US$30,000 while those who were hospitalised will get US$4,500. Read more.

Update (03/01/09): In a surprising turnaround of events, parents of children affected by the milk scandal were detained by Chinese authorities. Read more.

Update (10/01/09): FDA melanine guideline levels are unsafe, say US consumer group. See here.

Update(14/01/09): The final toll? A total of 296,000 babies fell sick. 52,898 infants needed to be hospitalized with 52,582 of the babies being cured and at least six dying. 6 had already died. See here.

Update(23/01/09): A few days before the Chinese New Year, Chinese courts have sentenced 2 to death and the former head of Sanlu milk company to life. But the affected parents remain unhappy. Read here.

Update(02/02/09): While the former head of Sanlu is appealing her life sentence, New Zealand’s Prime Minister has said that the Chinese milk scandal has damaged NZ’s image.

Update (11/02/09) : Its payback time and China goes on the offensive. See my latest blog article here.

For Those Studying Medicine..(3)

Hippocrates, the Father of Medicine

“To cure sometimes, to relieve often, to comfort always”

-ascribed to Hippocrates (Greek physician, 460-370 BC)


As a medical student this message would have been drummed in countless times; and, as a young doctor, one will realise that permanent eradication of illness is not always possible and that many diseases cannot be cured.   One needs to not just administer pain-killers but also to devote time to understand the patient’s agenda despite a busy work schedule, offer empathy and, most important, seeing the patient as a human being, not just an object to operate on or to inject drugs in.

When treatment has failed to cure and patients are about to die, many doctors and nurses feel they have failed and give up their hands in despair.  Don’t forget that that the dying patient still requires another form of treatment  –  palliative care.

Smokers’ Graveyard

Full marks to the artist that drew this ceiling mural in a smokers’ lounge located in a hospital. I am reproducing this from an earlier post “Identifying Kids Who Will Smoke” as I cannot help but feel impressed with the message it imparts, as you can see by the expression of the guy on the left. Thanks to DAB.

Spare Parts For Your Body

Arnold Schwarzenegger,61 - now a Cyborg with a hip-joint and two heart-valves replaced into his aging body

Millions are walking around with artificial body-parts to replace their own, be it from wear-and-tear,  nonfunctioning components, or, for cosmetic reasons even.  Ranging from hair and heart transplants to  hip-joint and heart-valve replacements, the reasons they have been done boil down to a merger of high-tech innovations and man’s desire to live longer, better and comfortably.

These devices are expensive – hip-joint replacements can cost US$25,000, so do implantable heart defibrillators; a cochlear implant  can set you back US$40,000. Again, technological advances in medicine have outstripped economic ability. Not many can afford these devices. Even in the US, Medicare will only partially subsidise the cost of fixing these devices – it pays for only 60% of hip-joint replacements. For those who cannot afford, should we consign them to permanent disability and leave them to die? This is an issue governments must face and decide, and its not an easy one.

Another problem is that these devices don’t always work and may require replacement after some time. The complaints can be minor, like a squeaky hip-joint (you can’t actually oil them!) ; or relatively major with lethal complications, like a faulty implantable heart defibrillator which will need repeat surgery. In fact, the usage of  heart defibrillators have actually decreased in recent years due to numerous problems related to the device.(see here)

There was a time when, as we age, our body-parts wear out, leading to immobility,morbidity and death.  Now, we can replace them and sing “Papa’s Got a Brand New Hip”(with apologies of course to James Brown and his 1965 hit “Papa’s Got a Brand New Bag”- listen to it here!)

Popular Diets a Health Threat – or Not?

Popular slimming programmes using special diets were recently praised by researchers to be effective and ‘carried no health threats’. This was reported in a recent issue of Nutrition Journal which showed that people not only lost weight  but also received adequate nutrients.

Four commercial diet-plans were studied – Slim Fast, Atkins, WeightWatchers and Rosemary Conley’s Eat Yourself Slim diet.They praised the “effectiveness and nutritional adequacy in weight management for the general public.” Take a look at the results:

Average weight loss after eight weeks

Atkins: High protein, low carbohydrate: 11.4lb (5.17kg)
WeightWatchers: A points system to count calories: 10.36lb (4.7kg)
Rosemary Conley: Low fat, low sugar: 8.8lb (4kg)
Slim Fast: Low-fat shakes replacing b’fast and lunch: 8.1lb (3.67kg)
Initially, the weight-loss appears impressive but, on a closer look, a few things raise concern:

Fad Diet - Beyonce Knowles created a craze for maple syrup which she took to reduce 22 lbs for "Showgirls"

  1. The study was over 8 weeks only. Can these diets be maintained long-term? Its known that once off the diet, weight-gain  is the norm.
  2. Concern has been raised on the long-term unwanted effects of these diets, esp Atkins, South Beach, which promote a high-protein,low carb diet that causes acidicity leading to osteoporosis and kidney failure in susceptible individuals. Read more here.
  3. There is a risk of shortage of certain nutrients if these diets are for long-term. For instance, Atkins have been known to cause a shortage of iron, niacin and fibre, due to the lesser  intake of cereals, flour and fibre-rich foods. Most diets do not recommend enough fruits and vegetables.
So why are these fad diets popular anyway?
  • Role models like Beyonce create a band of star-struck followers who are prepared to die to diet!
  • These diets tell people in black-and-white simple instructions what to do; and many can identify with that.
  • The promoters only highlight the positive studies and conveniently downplay the bad news.
Finally, if you want to be on a healthy diet, then I would suggest trying the Mediterranean diet, which comprises mainly of vegetables, whole grains, fish, legumes, fruit, and, for those inclined, moderate red wine. The main cooking fat is olive oil. A recent study showed lower incidence of heart disease, cancer and Alzheimer’s in those on a strict diet of this type. See “Accolades for Mediterranean Diet”.
Added 17 Sep 2008:  Lately, there’s a new trend towards eating : Instead of Eating to Diet, They’re Eating to Enjoy.

When The Latest May Not Be The Best..

When it comes to healthcare, using the latest piece of equipment or taking the latest medications may not always be the best thing for you to do..

Take a look at the following examples:

  • The anticholesterol medication Vytorin was introduced with great fanfare 5 years ago, touting to be the most efficient way of reducing cholesterol in the blood. Vytorin is actually two drugs in one: simvastatin (Zocor) and ezetimibe ( Zetia , Ezetrol). It works in two ways – preventing cholesterol from being absorbed in the intestines as well as cutting the production of cholesterol in the liver. It claimed to be superior to the other existing anticholesterol drugs in the market.  Now, a series of studies have shown, among other things, that Vytorin may not be better than the existing drugs (ENHANCE study) in thinning the walls of arteries. Worse, last month it hit the medical headlines when it was shown (SEAS study) that those taking Vytorin had a higher chance of getting cancer, although this needs to be proven conclusively. So don’t stop taking it yet pending further proof as further studies are being done.
  • Diabetic patients with heart problems were told in recent years to control their blood sugar on a stricter basis (the ADVANCE study) so much so many doctors, including the writer, were seeing patients suffering from the unwanted effects of low blood sugar due to the stringent control. Then, another study (ACCORD) showed that these patients had a higher chance of getting fatal heart attacks! So, doctors are now advising controlling diabetes as usual pending further studies.
  • Heart-scans, (also known as 64-slice CT scans, cardiac CT scans, MSCT heart-scans, CT coronary angiograms), were the rage when they were first introduced; to the extent that they were offered (even at present) by some centers as part of a medical check-up for otherwise healthy individuals. Radiation danger aside (see my earlier post), such scans have not been found effective in screening for heart disease in healthy people despite the exhortations of those who own these machines. Often, they have led on to more unnecessary expensive tests and have caused needless anxiety. To find out who needs these scans, see here.

    Heart-scans: beautiful images but at what cost?

Unlike the latest electronic gizmos, in healthcare the latest devices or medications may not be the best.  After all, the art of medicine is really an imprecise science applied to an even more imprecise subject -the human body. Sometimes it may be better to stay on the older time-tested pills than to reach out for the new ones!

The decision whether you need to take a particular medication or to do a test requires a thorough discussion with your doctor. All medications carry side-effects of varying importance and taking them is on the premise that the pros outweigh the cons. After all, the ancient Roman poet Ovid said, Medicine sometimes snatches away health, sometimes gives it.

For Those Studying Medicine… (2)

Sir William Osler : Canadian-born and regarded as the most influential physician in history

“When a doctor treats himself, he has a fool for a patient”

Sir William Osler (1849-1919)


Came across this statement by a doctor writing about her personal experiences, and its worth remembering for those who are studying medicine.  They will teach you in medical schools not to treat your own relatives, but not many will also say flatly that doctors should not treat themselves.

The reasons are manifold : professional objectivity is compromised, proper history and physical examination is difficult( try looking into your ear canals!), diagnostic reasoning may be faulty and emotional feelings like denial may come into play.

Emergency treatment and minor problems aside, it is best to consult a professional colleague. Doctors ask patients  to seek medical care from doctors, so doctors are no different. Practise what you preach!

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