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The Doctor's Consultation: Self-monitoring
or personal neglect?
by Dr. Iain Corness
After many years in the primary health care business, I
realized that many patients self-select into two very different groups. There
are those who worry with every symptom they ever get, and those who ignore
their body’s telling them of things that are amiss.
It is between these two sides that the field of
self-monitoring lies. With some patients, they will just not do these simple
procedures, but for others, they will slavishly carry out examination and
recording far more than their disease process would require.
It is important here to state that I am discussing long
term monitoring of chronic ailments, such as hypertension, diabetes or asthma.
I am not asking patients to become doctors and make their own diagnoses.
Sometimes it is hard enough for experienced doctors to do that!
This whole business of self monitoring is something that
gets much space in the medical literature, and the medical profession itself
is also quite divided over this issue. Here I will try to provide the
‘middle ground’, which itself is not without certain problems.
Let’s take blood pressure problems first. In actual fact
it is quite difficult to get accurate blood pressure readings. Blood pressure
is a dynamic factor in the body. Step off the kerb and be narrowly missed by a
speeding motorcycle going the wrong way up a one way street and your blood
pressure will rise immediately. If it doesn’t, it probably means that he hit
you and you are already dead. There is also a well documented type of high
blood pressure reading called ‘White Coat Hypertension’, which is where
the BP goes up as the white coated doctor gets closer.
So what is your ‘real’ blood pressure reading? For me,
one isolated raised reading does not mean you have hypertension. All that the
one reading means is at that particular time, for any number of reasons, your
BP was elevated. It could be down again tomorrow. Only by taking serial
readings will you (and your doctor) know.
Let us now imagine that a definitive diagnosis of
hypertension has been made. This is where self monitoring can be very good.
You can return to your doctor and give him serial readings, taken at home, and
these will probably be closer to the ‘real’ numbers than ones taken in the
sterile and sometimes frightening doctor’s office. Mind you, this does
depend upon accurate home measurement, using accurate equipment.
However, the physicians with the care of diabetic patients
are not so enamoured of glucose self monitoring as the cardiologists are with
BP readings. There is little evidence that home blood glucose monitoring
improves outcomes in Type 2 diabetic patients. There may even be negative
effects associated with it, including increased distress and worry. Regular
haemoglobin A1c levels may be more appropriate than daily finger pricks. Since
the Hb A1c levels show the overall diabetic control over the previous three
months, it is actually a more consistent monitor, but that test is not
available as an easy home testing kit. It’s back to lining up to see your
diabetic specialist on a regular basis, I’m afraid.
And so to asthma. The respiratory physicians seem to be
more in agreement with home monitoring for this chronic condition. Serial lung
function testing with simple hand-held devices can show the asthma sufferer
the trends of decreasing or increasing respiratory function. At predetermined
levels, the patient can be instructed to initiate different therapies to stop
them going into a full-blown asthma attack. This is self monitoring towards a
preventive end. The main aim in asthma treatment.
Agony Column
The following note was in a parcel containing an
expensive bottle of French champagne and a box of Belgian chocolates, left
at the editorial offices:
Dear Hillary,
Enjoy! Promise kept!
Man looking for an honest car dealer
Dear Man looking for an honest car dealer,
You have restored not just mine, but everyone’s faith in human nature.
For those who cannot remember, a few weeks ago this gentleman wrote in,
“Just to let you know the Belgium chocs (liqueurs) and champagne will be
with you shortly as promised.” He certainly did keep his promise, and
even delivered the parcel personally. I shall also personally raise a
glass to you, in thanks. I do hope that you will find that honest car
dealer! Have a great new year, Petal, you deserve it! And to Mistersingha,
the world’s greatest ingrate, I blow you a raspberry,
“Thrrrrrrrrrrrrpppppppppp!”
Dear Hillary,
I write to protest strongly that you saw fit to publish the letter from
two old codgers criticizing adorable young men like myself. I have to make
a stand for my lovely self, and if I had my way, all men over age 35 would
be taken from the streets of Pattaya to some island colony where tourists
could throw stones at them from passing boats, leaving the ladies to us
more desirable creatures.
It is nature’s way that us sexy young studs give our charms (no charge)
to these eager young damsels who prostrate themselves at our David Beckham
feet, while the old wrinklies sit reminiscing in their allotment pigeon
lofts. And No! We will not age as they have. Cosmetic surgery will see to
that. I intend to keep my chiselled features, and the ladies will forever
be calling out, “Hello handsome man”.
I am not totally problem free though. I do have some lonely nights due to
staring for hours into the mirror while preparing to give some lucky girl
the pleasure of my delightful self, and then not being able to tear myself
away from such a gorgeous reflection.
No my dear Hillary. No chocolates and champagne for you for publishing
such a hurtful letter. Instead I will spend the money on yet another
tattoo to adorn my Adonis-like physique. Perhaps complete the snake that
entwines my muscle-rippling torso. The tattooist had no vision as to where
it might terminate, to complete and embellish such perfection, for the
pleasure of my countless admirers.
To redeem yourself, I demand that you come up with an idea as to where the
tattooist might conclude the serpent. You always come up with something.
Nairod Remraf
Dear Nairod,
It is indeed a pleasure to receive such an adulatory letter. It must be
very satisfying for you to be able to go to bed every night holding
yourself and your serpent so tightly. You are just so perfect! Why would
you ever want to have someone else to share your bed with you? The thought
defies all logic.
However, by holding your letter up to the mirror, your true identity was
revealed. “Muscle-rippling torso” indeed! And that’s no
“serpent” tattoo either! Judging by the size, I would call it more of
an “asp” than a proper-sized snake, irrespective of whether it is
covered by your shirt or your trousers.
David Beckham indeed! I saw a movie called “Bend it like Beckham” and
that is probably the only connection between the famous footy player and
yourself. A severe attack of the ‘bends’. However, they tell me that
Vitamin V fixes the problem, and you don’t end up playing 90 minutes
with a limp.
Now you want me to “redeem” myself? My dear “Nairod”, I didn’t
know I had even been pawned! I hope I got a good price for me.
But to show my good faith, I have thought long and hard about you and your
snake problem. Cleopatra was bitten on her right-sided 34B (by the snake,
not Marc Anthony), but that would not be appropriate for you. I think your
snake should entwine itself around your perfect body and disappear between
your cheeky protuberances. Like the biblical eye for an eye, this would be
more like an asp for an ass! Thank you for your amusing letter, though I
did have to shorten it. That part of you, if nothing else, was too long.
Dear Hillary,
Why do the Thai girls all wear those moulded plastic and rubber bras that
look like two dumplings attached to the front of their chests? It is
obvious that the lumps don’t belong to them, but come from their bra
manufacturer. I’m like a lot of guys and like a nice pair on a girl, but
real ones, not rubber ones, please.
Tim the T-man
Dear Tim the T-man,
I presume you mean Tim the Toyman, you naughty little Petal! I must admit
that I have never heard the girls in the lingerie shops asking if madam
would like one lump or two, as I have heard in some five star restaurants
over coffee. Perhaps something swinging is going on behind the kitchen
swinging doors, that Hillary is unaware of. Dearie me! Since Thai girls
were standing behind the door when the chests were given out (the Russian
ladies made it to the front row), we have to do something to catch the eye
of Toymen like you, Tim. So you have discovered our secret. Don’t tell
everyone, that’s a good boy.
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Camera Class: Buying a digital point and shoot
by Harry Flashman
Having read my own advice of a few weeks ago, I decided that
it was time for the family to go digital, even if I would still be faithful to
film. The camera that the new digital would replace was a very ancient compact
point and shooter that was now giving variable results, and it really was time
to consign it to the bin.
Buying any type of camera in this country is an exercise
worse than buying a new set of spectacles. Anyone who has been dragged into an
optometrist’s by a bevy of immaculately dressed young ladies, and then pounced
upon by a white coated technician who wants to give you a computerized eye test,
while the aforementioned bevy is weighing up your wallet, will know what I mean.
We ventured into one of the large shopping centres and began
the window shop overview, to be attacked by a bevy of young hopefuls, obviously
on their day off from the eye glasses department. In no time at all, we were
shepherded inside the shop and the sales pitch began in earnest. Features were
thrown at us like confetti at a western wedding. The mountain of carefully
unwrapped cameras also began to grow like Mt. Everest. Despite my wife now in a
state of total confusion she saved the day by telling the eager sales people
that we were going to walk around and discuss it.
Unfortunately, the next camera shop was right next door, and
having seen that their neighbour had failed, pounced with an even greater
intensity. Once again we were shown a myriad of cameras, all of which seemed to
do the same job when we thought about it! We were starting to become informed
customers, a dangerous breed of animal!
One feature that my wife liked in these point and shoot
digital cameras was the ability to take short video clips. Now being smarter
than we were before we asked if these video clips could be played back on the
family TV set. When we were told yes, we then asked to see this demonstrated. If
you also think this would be a great feature, then think again. In the more
budget end of the digital point and shooters, the video end result is poor to
mediocre (at best). The images look like the pixilated photographs on the front
page of Thai newspapers, thinly disguising dead bodies at traffic accident
scenes. The more we investigated, the more it became obvious that digital point
and shoot cameras are really only still image instruments. You are not going to
get ‘movie’ and still capabilities at this level. Like the microwave oven
that has a clock, you will never be able to use it as a wrist watch! It is an
oven that can tell the time, not a clock that cooks food!
And so we went on to another shopping centre, to more eager
sales personnel, but by this stage we knew what we wanted. We needed a camera
with good optical qualities and a good sized memory card. An optical zoom makes
sense at this level - much more important than digital zoom, but a most
important feature is the viewing screen, known as an LCD monitor in digital
terminology. Get the biggest you can. There is an enormous difference between
looking at a two inch screen, compared to a one and a half inch screen, believe
me.
Another factor that we considered important was physical
size. Size does matter! But this time we were looking for small dimensions.
Since digital technology allows miniaturization, this means a woman can pop the
camera easily in her handbag, or a man into his shirt pocket. Why continue with
the relatively large film cameras when all you want is point and shoot
capabilities?
So that was how we made our choice of digital point and shoot
compact. Small overall size, large viewing screen (oops, LCD monitor), easily
operated controls and from a known quality manufacturer.
What did we end up with? Our choice was the Canon Digital Ixus 40. So far we
have not been disappointed.
Psychological Perspectives: Caring for others at a price
Disaster relief workers at risk
Asian University presents:
by Michael Catalanello, Ph.D.
I was recently talking to two
students who happened to be vacationing on Koh Phi Phi on the fateful day
that the tsunamis hit the small island resort. Fortunately, they were on a
portion of the island that was not badly affected. Not having immediate
access to the media and unable to leave the island for several days
following the event, these students learned of the tragedy firsthand, as
they encountered local scenes of death, personal injury, and widespread
destruction of property. They saw people rushing about frantically, many
tearfully searching through ruins for missing loved ones. Now, about a
month later, these students admitted to experiencing difficulty readjusting
to an academic routine of attending classes, and concentrating on their
studies.
It is not necessary to have been present on Phi Phi or
Phuket to be emotionally affected by this tragedy. A stoic British
colleague of mine was commenting that he had trouble understanding the
strong emotional reactions of those in his native England, to the loss of
life brought on by this disaster. Such extreme reactions, in his view, were
usually reserved for those suffering the loss of someone they know
personally, such as a close friend or family member.
Many, like myself, who learned of the event only through
the news media, were, nevertheless, deeply moved by what we saw. Television
news displayed graphic video footage of rising waters engulfing
vacationers, people desperately clinging to any stationary object, those
unable to resist the powerful waves, being swept away from their loved
ones. In the aftermath of the floods, haunting looks of disorientation and
utter disbelief on the faces of survivors is hard to forget, even for those
of us who watched and listened from a safe distance, in the comfort of our
living rooms.
The experience of strong emotions is considered normal,
particularly immediately after witnessing an event involving death, serious
injury, or the threat of death or severe injury. If certain characteristic
symptoms persist for more than a month following a person’s exposure to
trauma, he may be suffering from post-traumatic stress disorder (PTSD). One
hallmark of PTSD is the persistent re-experiencing of the traumatic event,
such as through recurring disturbing nightmares, thoughts, or
recollections.
In the aftermath of a natural disaster like the Asian
tsunamis, those most directly affected are at greatest risk for
experiencing severe and prolonged emotional distress as a result. Others
less directly impacted, however, may also experience such reactions. One
group of people at particular risk for experiencing unpleasant or
disturbing emotional reactions to a natural disaster is that of relief
workers.
Although a diverse group of people, relief workers share
certain characteristics that may increase their risk of experiencing
persistent disturbing emotions following a disaster. They are likely to be
very dedicated, caring and compassionate individuals, somewhat
perfectionistic, maintaining high personal and professional standards for
their lives and work. As such, they may be prone to pushing themselves
beyond their own personal limits in order to meet the virtually endless
needs of disaster victims.
Following a disaster many relief workers are called upon
to work long hours under difficult conditions. They come face to face with
those whose losses are greatest, children who have lost parents, parents
who have lost children, entire families wiped out. Confronted by a level of
need that is impossible to satisfy, these workers may begin feeling
ineffective and dissatisfied by their perceived inability to make a
significant difference.
The American Red Cross offers the following advice
to help relief workers cope with the aftermath of a natural disaster:
- Understand and appreciate the intensity of your
emotions and talk to others about your feelings.
- Understand how stress may be affecting you, and make
every effort to deal with it;
- Engage in stress-relieving activities, like walking,
talking to others, or using deep-breathing exercises;
- Eat nutritional foods, avoid consuming excessive
amounts of caffeine or alcohol, get plenty of rest and as much sleep as
possible;
- Feel free to make a request of your supervisor to
allow you time off or a change in assignment, if you need it, to rest or
recharge.
This, no doubt, seems pretty good advice for all of us,
whether we happen to be disaster victims, relief workers, or simply normal
people, with a healthy sensitivity to the suffering of others.
Dr. Catalanello is a licensed psychologist in his
home State of Louisiana, USA, and a member of the Faculty of Liberal Arts
at Asian University, Chonburi. You may address comments and questions to
him at mscat@asianust.ac.th
Money Matters: Do pigs have wings?
Part 2
Alan Hall
MBMG International Ltd.
Our main takes are still
the same (continued):
4) A while ago we viewed tangible assets such as gold and
other hard commodities as being undervalued, looking for gold to double in
price over 3-5 years. Since then we’ve seen a gain of 11% to the end of
the year, although this year has started with a fall back on profit-taking.
We remain happy to buy and hold and look for longer term targets.
What if we’re wrong? How far can gold fall in the
current market? A real gold bear market would see a max fall in the region
of 30% over a drawn out period of time. Compare to equities – they could
fall at least 40% (some analysts say 70%) and don’t appear to offer 100% +
upside over 3-5 years. In other words, gold offers a much better upside in
return for much less downside. To us, that’s the epitome of a relatively
efficient investment strategy.
5) In November we stated that the US dollar (USD) was in
a bear market due to the need to devalue, the need to print dollars, the
unattractive interest rates, the rate differentials going forwards, the
reduction in capital inflows from Asia, the American monetary policy, the
American fiscal policy etc., etc., etc., etc., etc. The dollar promptly fell
by almost 10% against our preferred currencies. The thin trading conditions
of the holiday season were, however, prime breeding ground for a dollar
rally. This, though, may well be over within a very short period of time and
the downtrend set to continue. The Australian dollar (AUD) and sterling both
looked attractive at that stage because of high interest rates but the
crumbling property markets in both countries suggests that both currencies
may have achieved a short term peak. The Euro, which is not without
problems, and, to a far greater extent, the Swiss franc (CHF) look like the
best bets. The euro is fairly valued but has some political risk due to the
various referenda, new additions to the euro and if there is a major
downturn has no status as a safe haven currency. Eurozone economic
conditions are also a cause for concern – the strength of the currency
being now almost recessionary. The CHF is attractive relative to the euro
because of absence of political risk and because it is a safe haven. With
low volatility strategies currency gains really jack up the returns and
currency losses wipe them out totally – currency risk must be avoided,
currency potential needs to be exploited. We bought some dollars in the last
few weeks, but we’re looking for jumping off points, and we’d rather CHF
and euro to Stg and AUD.
What if we’re wrong? Despite our firm convictions
we’re not going out on a limb here; we are even holding some Asian
currencies (notably yen) to further diversify. We’re really trying to play
safe but just squeeze out a bit more from what we have without running any
extra risk.
Specific funds
- PPBs
Core (50-70%)
Optimal Coreharbour - This is the new more flexibly managed
version of PSG Global Dynamic (see below) which is available currently in
USD, Stg and euro. Additional currencies will be added in the near future.
Satellite (30-50%)
Man (CHF & AUD)
Forsyth Diversity Euro
Orbis Japan EUR/Optimal and Leveraged EUR
ML Gold and General
GAIM 2012 Note CHF/Long Short EUR
- Generali:
Core (85-100%)
PSG Global Dynamic is a fund for all seasons – aims for double
digits annualised in all investment conditions because it accesses all asset
classes - unlike other balanced or managed funds that tend to take a static
70/30 equity/bond position. In good times it will under-perform aggressive
managed funds (e.g. New Star) but will achieve greater consistency and
capital preservations. Underlying funds (PSG Global Growth and PSG Global
Balanced are 1 & 2 respectively in their S&P sector over 5 year and
6 years – both launched just under 7 years ago) and Global Growth is
‘Lipper Leader’ (i.e. top 20% of all funds for capital preservation and
consistent returns). Currency managed for optimal performance. No rocket
science, just making use of all 5 asset classes impartially – i.e. not
infatuated with any particular asset class and applying top class
independent analysis. As a fund of funds, it uses best quality underlying
funds. It is hoped to add sterling and euro classes.
Satellite (0-15%)
Fidelity Japan/Fidelity Jap Smlr
GAM Diversity Euro
GAM Multi Arbitrage EUR
ML Gold & General
Thames River Warrior EUR
- Friends Provident International (Isle of Man):
Core (50-60%)
Collins Stewart Balanced Stg
Satellite (40-50%)
Thames River Mainstay Stg
ML Gold & General
GAM Japan
Eur Balance Yield
- FPI Guernsey:
Core (0%):
None available
Satellite (100%):
International Bond
With Profit
Open Managed Portfolio
- Zurich:
Core (75%)
HSBC Euro Hedge
Zurich In-house managed funds
Satellite (25%)
HSBC Global Hedge
Zurich In-house managed funds
- Royal Skandia:
Core (50-60%)
Forsyth Wealthbuilder Stg
Satellite (40-50%)
Momentum All Weather Liquidity EUR
ML Gold & General
Fidelity Japan
Invesco GT Bond Stg
- Scottish Provident International:
Core (75%)
Forsyth Wealthbuilder (sadly only available in US$)
Satellite (25%)
European Bond
Japan Growth.
Hansard:
Core (60-80%)
Honeyguide
Pathfinder
Forsyth Wealthbuilder Balanced
Satellite (20-40%)
Invesco GT Nippon Enterprise
Investec European High Income Bond
SLI:
Core (100%)
Japan
Multi Index with Bonus
Satellite (0%)
OMI:
Core (100%)
Fixed Interest
Satellite (0%)
The above data and research was compiled from sources
believed to be reliable. However, neither MBMG International Ltd nor its
officers can accept any liability for any errors or omissions in the above
article nor bear any responsibility for any losses achieved as a result of
any actions taken or not taken as a consequence of reading the above
article. For more information please contact Alan Hall on
alan@mbmg-international.com
Mrs. DoLittle’s Corner: Hugging an elephant
It was reported in the press that elephants were being used
to pull decomposed bodies from the debris left by the tsunami. Mrs. DoLittle
can assure you, elephants would hate to do that job, as well as any human.
 Don’t
forget they have extra long noses and would have to smell it for a lot longer.
Also their feet are very sensitive and they should not be made to walk in areas
where they could get hurt. They have to be forced to do such a job with a
little extra jabbing by the hook that their mahouts use to handle them. In fact
everything that elephant’s do that we witness at the camps, they do against
their own will. They are very bored carrying tourists about all day without
enough time to forage for food and tend to their young.
Since it takes many years to bring a baby up to the point
where it can earn money, many operators consider it too big an expense. New
born babies struggle to keep up with their mothers on trail rides. These facts
about elephants never reach the tourists. Most people think it’s normal to
see elephants in chains performing tasks for people, but actually I believe
it’s exploitation. The elephants lead miserable lives and are used till they
drop dead from exhaustion.
Elephants are very intelligent creatures and if they were
let loose in a sanctuary, free from chains and hooks, just as many people would
come to see them act naturally. Many tourists are now objecting to the use of
elephants for rides.
Elephants that roam free at the handicapped elephant centre
in Mae Taeng and at Mae Sai Elephant Centre look a lot healthier than their
counterparts at other camps. For a start they are totally round without their
spines sticking out along their backs. They have time to eat the 200 kilos of
food they need per day to stay healthy. They also make many sounds that camp
elephants do not, because they are afraid to talk to each other. The free
roaming elephants chatter all day. After seeing this you will realize the camp
elephants are suppressed.
One elephant that was certainly not suppressed but allowed
to express herself to the fullest was Mai, the orphan that Mrs. DoLittle cared
for until she was five. The minute she heard me coming she’d be screaming,
hooting and hollering, jumping up and down, just like any kid. Everyone could
hear it a mile away and knew I had arrived at the zoo. As soon as she saw me,
she’d run to grasp me in her arms. You have no idea what a thrill it is to
get an elephant hug. Lots of people who visited us at that time were able to go
home and say, “I was hugged by an elephant!” Wouldn’t this be a better
tourist attraction for Thailand? Hugging elephants!
The moral of this story is: You can catch more flies with sugar than with
vinegar!
Life in the Laugh Lane: Email to Barbara
by Scott Jones
Barbara,
It’s great to hear about all the donations you’re
getting in America as you prepare to come to perform at the FERC 6th Annual
Benefit Gala here in Chiang Mai! I just came home from the board meeting at
Baan Wongmalee, the gala site. Besides the joy of everyone working together, I
witnessed a wonderful testimony of what these people are all about.
 Grammy
Award winner and singer/songwriter Barbara Bailey Hutchison (www.bbhsings.com)
will be performing with many other artists at FERC’s (Foundation for the
Education of Rural Children) 6th Annual Give and Live Benefit Gala on 19
February 2005 at Baan Wongmalee just north of Chiang Mai near the Ping River.
More info is online at www.giveandlive.org. Tickets may be purchased here at
Chiangmai Mail 053-278-515.
We’d set the ticket price a bit higher this year since it
hadn’t changed in six years: 1,500 baht = $37 went to 1700 and 1900 at the
door. Concern arose because that’s a steep ticket price for Thailand.
(Consider that here you can buy 50 stems of beautiful orchids for 50 baht =
$1.25. In America those same orchids would cost $250.) The dance band + sound +
lights cost 18,000 baht = $400 and although some wine was donated, we still
needed another 70 bottles. Lance says, “Okay, I’ll pay for the band.” Jo
says, “Okay, I’ll put in 10,000 = $250 for the wine.” Becky says, “I’m
in for 10,000, too.” Warren, not on board but just attending his second
meeting, great friend, singer, guitar player from Liverpool who used to hang out
with the Beatles during the Mesozoic Era says, “Cheers. 10,000 from me.” So
just within our little group, we raised 48,000 baht = $1,100. Ticket price back
down to 1500 baht! Beautiful.
48,000 baht from the people who put on the event, one that
won’t even be here to attend, folks that get no compensation for all their
hard work ... AND each of these people will buy their own ticket for another
1,500 baht! This is the kind of organization that gets what people give, gives
more and then gives it right to the people who really need it. When FERC board
member Frank went to the Nampu Thai School (one of the schools that will receive
the proceeds from the event) to help them with some grim sex traffic issues, he
was moved to hear about the kids who had lost their families to AIDS and
couldn’t afford to attend the school. He gave them 3000 baht = $75 out of his
pocket. When we went back to take photos, find more about their needs and tell
them about our event, he was thanked in a formal presentation by five students
who could attend school for a year with the pocket money he gave.
You’re part of a grand energy that translates into tangible giving, helping
and loving. Thanks for coming. You’re helping us rise to a new level. I’ll
do everything I can to convince you and Chris to live here, now, forever, even
if that involves bamboo cages, vats of delicious Thai food and large amounts of
duct tape. See you soon. Can’t wait to see your smile and hear your voice!
Love, SJ
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