The Doctor's Consultation:Anaphylaxis. Will it kill you?
by Dr. Iain Corness
Anaphylaxis is something that all doctors dread. Or I
should be more accurate and say ‘anaphylactic shock’. That difficult
sounding name of Anaphylaxis is just a fancy word for the most severe form of
allergic reaction you can experience. Those people who have lived through this
will attest to just how frightening it can be. And they have good reason to be
frightened - it is classed as a medical emergency as people can die from this
reaction. It is also much more common than you would imagine. The figures
quoted from America are that Anaphylaxis occurs at an annual rate of 30 per
Unfortunately the causes are multiple and include food
allergy, penicillin, cephalosporin and sulfur drugs, intravenous contrast
medium (used in some special X-Rays), aspirin and Non-steroidal
anti-inflammatory drugs (NSAID’s), walnuts, cashews and pistachios and
insect stings. The commonest food allergy is peanuts and again going by the
American figures, peanuts cause 30,000 documented cases of Anaphylaxis every
year and 200 deaths within that figure. (And you never thought that those nuts
on the bar were killers, did you?)
The symptoms include a very sudden and very severe
breathing problem (bronchospasm - the basis of asthma), itching around the
mouth, flushing of the skin with large swellings plus swelling of the face,
tongue and mouth, some gut pains and sometimes nausea and vomiting and finally
a lowering of blood pressure and increasing difficulty in breathing.
Although Anaphylaxis does mimic an asthmatic attack, the
difference is in the speed of the attack and the rapid progression of the
bronchospasm, plus the skin effects that come with it.
With Anaphylaxis, the patient should be hospitalised, even
if they appear to have recovered from the acute symptoms as there is something
we call the “biphasic reaction” which sees a recurrence of the symptoms a
couple of hours later. This can be even more severe than the initial attack,
so we recommend that patients be kept in hospital under observation for 12
hours, in case there is a biphasic reaction.
The treatment of the acute phase emergency includes
injection of Adrenaline 1/1000 strength, oxygen by mask or by tube if the
swelling is producing too much of an obstruction, intravenous saline to boost
the blood pressure plus intravenous steroids and even some antihistamines. Not
the sort of things you keep at home in the cupboard above the drug cupboard,
is it! And you do have a drug cupboard, locked and high enough up that small
children cannot reach it, don’t you.
The management of the condition from the long term point of
view goes into trying to find out and eliminate the allergen causing the
problem. With the food allergies this is very difficult, and involves
withdrawing each “perhaps a problem” food from the diet, one at a time.
But start with peanuts, if peanuts are something commonly eaten, and something
that was eaten on the day of the last attack. Do not suppose that the
triggering item is bananas if you didn’t have a banana before the last
episode of Anaphylaxis.
So what should you do if you are a person who suffers from
these acute allergic responses? Well, if it were me, I would alert those
around me to the dangers and advise them on what to do - mainly to get you to
the hospital as soon as possible - remember that this is a medical emergency.
I would also be looking at keeping a supply of 1/1000 Adrenaline injectable
for immediate use. But most of all, I would be letting family and friends know
to take you to hospital at the first signs of a problem.
This is a very embarrassing problem, so you will forgive me if I
don’t attach my real name. I have suffered from wind for many years. My
mother even tells me I had it when a child. Living on my own it is not too
much of a problem as I can let one rip whenever I like, but I have
recently taken up with a lovely young lady and it is obvious that she
would be willing to spend some nocturnal quality time with me. I don’t
want her to hear the Charge of the Light Brigade and be put off by the
musical items that my bottom can produce, so what do you suggest?
You have my sympathies, as opposed to my symphonies. You have several
choices, however, Flatulent. You can opt to remain celibate and join the
clergy, but your flatulent fits might be misunderstood as music to some
cleric’s ears. You could train yourself to be able to play the Charge of
the Light Brigade, and make money from your musical bottom. A French
entertainer did just that. Called Le Petomaine he could musically
extinguish a candle at one metre. You can have a look at your diet and
avoid milk products and green beans and see if that helps. Finally, you
can always get the young lady concerned to ‘burp’ you before settling
down for the night. That is what your mother would have done.
Every day I see these Thai girls sitting sideways on the rear of some
motorcycle and wonder where did this custom come from? China adopted
bicycles, but Thailand seems to have adopted the motorcycle. Do you know
why this is so, and also when did the Thai girls start to ride pillion in
this strange way? I must say I have never seen one fall off, but I suppose
they must. Any answers are appreciated.
Dear Pillion Pete,
An interesting observation. China, I believe, adopted the pedal power
because of financial reasons, while the more affluent Thais adopted the
gasoline engine for boats, cars, trucks and personal transport
(motorcycles). The Thailand infrastructure was such that the itinerant
motorcyclist could always find a gas station to get fuel. Well, up till
now anyway, as you may find your local gas station closed at night to save
the country’s fuel and put the pump jockeys out of work. However, the
art of riding sideways came long before the nasty two strokes from Japan
(smelly motorcycles and karaoke bars were Japan’s revenge after the war,
I am sure) as Thai women have always been very aware of their femininity.
Figure hugging sarongs and skirts are not new. They were wearing them over
100 years ago, and try slinging your leg over a buffalo in a tight skirt,
Pillion Pete my Petal. No, you can’t, so they sat side-saddle on the
buffaloes. Sitting side-saddle on a motorcycle was a very natural
progression, otherwise the skirt would have to be hoisted around the waist
to get on. Something you men wouldn’t mind, but something the naturally
shy Thai woman would not countenance. “Do they fall off?” the simple
answer is yes they do, but not because they lost their balance. They only
fall off when the rider (or the person nominally in control of the
machine) loses balance, and down they go, including the two girls sitting
opposite each other, but still side-saddle!
You hear that farangs should not learn Thai, because you will learn
too much. This is the situation I am in now. I do frequent the bar scene
and know many of the mamasans and know where they have been and what bar
they’re off to next. I also know the real ‘professional’ girls who
stay in the oldest profession because they can make big money out of it,
by playing the suckers. Some of these girls are milking three or four
farangs, all sending cash to their sweet adorable faithful darling! But
that is their problem, not mine, but that’s not quite the case. Because
I can speak Thai (Esarn really), many of these guys are asking me to relay
messages to their girls and I have got to the stage that I don’t want to
know any more. How do I tell them that they are being scammed, but at the
same time be able to go back to the bars and just sit and chat to the
girls, something I enjoy too? Should I just come clean and lose the farang
friends and my Thai ones, or what?
Dear Poot Esarn,
You certainly do have a problem, don’t you! But it isn’t all that
impossible to fathom. I think you’ve got too close to the problem to be
able to see the big picture. If someone asks you a direct question about
someone else, the answer is surely to tell that person to go and ask the
question themselves. Stay out of it. You are not going to do much for
anyone by giving unsolicited advice. Your farang ‘friends’ won’t
thank you, and neither will your bar girl ‘friends’. I really think
that what is happening is that you have grown out of the bar scene. Start
looking for real friends, away from the ‘entertainment’ industry.
Camera Class: Time exposure for beginners!
by Harry Flashman
Talk time exposure and most photographers will run away. How many times have
you used the “time exposure” facility on your camera for example? How about
“never”! That’s the usual response to that question. And the reason?
“Looks too complicated or too hard to work out the exposure.”
courtesy of Mercure Hotel, time-exposure of hotel building.
Let’s address the “too technical” aspect first. A
camera is purely a device that lets a certain amount of light fall onto
sensitized film for a predetermined amount of time. This is the old “f8 at
1/60th” sort of routine. The number of the “f” stop (the aperture) tells
you how large the hole is that lets the light in, and the 1/60th denotes how
long the hole was left open. Sounds technical - but it’s not!
Way back, when photography was in its infancy, the film
material was so insensitive that the exposure times were nowhere near as
“short” as today. 1/60th was unheard of - it was more like a three weeks at
f4 in those days! With today’s super-sensitive film materials and printing
papers you can get away with “short” time exposures and you don’t even
need to be accurate any more. Near enough is good enough!
What do you need for Time Exposure photography? Well, a
camera is a good start, but it has to be one with “T” or “B” settings.
The “T” setting stands for Time Exposure - one “click” opens the
shutter, the second “click” closes it. “B” originally stood for
“bulb” and the way that works is by holding the shutter release down keeps
the shutter open until you take your finger off, which closes it. Why two
settings? Simple, use “B” for time exposures up to a minute and “T” for
longer ones (mainly because your finger will go numb holding the button down for
Film stock? The new 400 ASA is fine (but you can use
anything, I generally just use the standard 200 ASA film in the camera.)
Those of you who have read books and magazines will have read
about ‘reciprocity failure’ with long time exposures. Forget everything you
have read! It’s photo industry techo-speak and won’t stop you getting good
pictures, it just changes the colours a bit. In fact, pro photographers will use
this to their advantage to produce a different atmosphere to a shot.
The last thing you need is a tripod, unless you are good at
standing motionless for twenty seconds or so. You should have one by now anyway.
And a strong sturdy one, not one of those lightweight skinny aluminium models
that will blow over in the breeze. However, if you have not got a tripod, it is
not the end of the world, but you will have to find some way to keep the camera
steady. I have taken 30 second time exposure with the camera sitting on a table,
or the roof of a car.
The important point to grasp, is that all Time Exposure
photography is “hit and miss”. There’s no real way anyone can tell you
exactly “f8 and 24 seconds”. The camera’s exposure meter doesn’t help
here either. There’s too many variables, but all you have to do is to take the
same scene or picture with several different exposure times - one of them will
be right. Believe me! This is what the pro’s call ‘bracketing’. In other
words, at least one shot will come out!
Here’s the rough guides. In all of these the aperture (f
stop) is set on f8. Now to take a street scene at night, try 2 seconds, 4
seconds and 8 seconds. For the interior of a room, lit with ordinary light
bulbs, try 5 seconds, 10 seconds and 20 seconds. To take a picture, just before
dawn try 5, 10 and 20 seconds. Now, for a completely dark, night landscape (or
seascape) try 30 seconds, 1 minute and 2 minutes.
Make a note of the order your time exposures were shot in, and jot down the
“best” result after you get your films back. Sure, the colours will be
strangely different - but if you wanted a “normal” shot you’d have taken
it in daylight, wouldn’t you?
Dr Byte's Computer Conundrums
by Dr Byte, Citec Asia
In the last column we had a look at Google’s Desktop Search
Engine and answered a couple of reader’s questions. This week I think its time
to look at notebook computers. Notebooks have become more affordable than ever
and are fast becoming serious contenders with the desktop and tower computers.
Because of the range of features and good performance they are taking a large
bite out of the desktop PC market.
It is now estimated that the notebook market has grown to 30
to 40 percent of the total PC market and it is predicted that by the end of
2006, more than 65 percent of the PC market will be a notebook of one kind or
another. Like desktop PCs, notebooks fall into a range of categories and each
caters to a specialised set of needs.
Multi-media addicts, gamers and developers are probably the
most power-hungry group and the gaming/multimedia category should fill their
demanding requirements. These have super-fast processors (3GHz or better),
discrete graphics chips and large screens (preferably with widescreen aspect).
The downside is they take a heavy toll on battery life.
If you are a member of the group that needs to frequently
cart a notebook around the world, it’s best to go for an ultra-portable model.
The emphasis is on being small and light. The trade-off is that they’re
generally slower than larger notebooks and have significantly fewer features and
If you’re looking for a powerful notebook that will spend
the majority of its time perched in your home or office, a desktop replacement
will do the trick. Finally, the budget category will suite those after simpler
and more basic models and more importantly many now include lots of nice
Identifying which of these categories suits your needs means
you won’t be paying for extras that you don’t need.
Build quality is also very important when you consider that a
notebook usually suffers the rigours of life on the road, not to mention the
murky depths of travel bags. If your main use is going to be in the great
outdoors, special rugged models are available which can handle a thorough
beating. However, this is overkill for the rest of us. A little bit like a Range
Rover when 99% of your driving is in town.
A growing technology that goes hand in hand with mobile
computing is the growth of wireless networking (Wi-Fi). Although “hotspots”
that deliver wireless internet access are still relatively sparse, it will
eventually be possible to travel from home to town centre without ever leaving
the coverage of a wireless network. Bear in mind that Wi-Fi does not have the
same capacity as a cable network and if there’s a few of you wanting to
connect up, it will not be as speedy as you want. If that’s the case, go for
the 802.11g Wi-Fi standard for speedier access.
Anyone’s pre-purchase checklist should include some of
Battery life - A notebook that spends most of its time
indoors doesn’t need extra-long battery life. Even if the notebook is going to
be carted around to various offices for demonstrations, power saving features
and excellent battery life aren’t crucial because mains electricity is usually
easily available. However, if the notebook is going to be used on the road and
outside a building, battery life can be the deciding factor. Aim for a battery
life of at least four hours, which can even extend to six hours for less
intensive applications such as word processing. Sometimes, even this lengthy
amount of battery life isn’t enough, so it could be necessary to purchase
Screen size - If you’re going to be using the notebook to
show information in a group environment, and don’t have the convenience of a
projector, a large screen (15-inch or larger) can make all the difference. A
wider viewing angle is also preferable in this situation, so pan side-to-side to
determine if the screen can be clearly seen by onlookers. Gamers and multimedia
viewers will also prefer a larger display, with widescreen being a must for
movie lovers. Higher native resolutions deliver a much clearer image.
Weight - It’s amazing how heavy 3.9kg can feel if you’ve
been carting your notebook around all day. If you need to take your computer
everywhere, the weight can make a big difference in comfort, so try to get a
total package weighing less than 2kg (including battery). Obviously there’s a
trade-off to be made to allow for the added convenience of a lightweight design
and these ultra-mobile notebooks tend to be less powerful and much more
expensive. They are also not quite as feature-packed as the cost of
miniaturising components leads to a higher retail price.
Chipset - For the ultimate in battery life, Intel’s new
Sonoma chipset offers excellent performance. If the ability to handle demanding
tasks such as video editing, multimedia or gaming is more important than battery
life, it’s possible to have a notebook based around a desktop CPU. But
you’ll be lucky to squeeze two hours out of the battery in these powerful
notebooks. Most notebooks use an integrated graphics processor but this won’t
cut it for the gaming crowd. It’s wise to go for a notebook with a discrete
graphics chipset and its own dedicated memory. If the notebook is fitted with a
new MXM module, it’s possible to upgrade the graphics as more powerful
graphics chips are developed.
In the next column, I have a few more Questions and Answers
to share with you. Don’t forget to keep your preferred Anti-virus and Spy
sweepers up to date. Do a full hard disc scan and sweep at least once a week.
Don’t open e-mails with funny attachments if your not expecting them and last
but not least, make sure your firewall is on. Dr Byte appears in Chiangmai Mail
every 2 weeks and if you have any questions or suggestions you would like to
make, you can contact me at Dr Byte, Chiangmai Mail.
Money Matters: The Investment Regulations (Part 2)
MBMG International Ltd.
There is also a view that the general
market needs protecting from individual interest. Short selling is always
emotive because it’s clearly a case of a few benefiting when the majority
suffer. If the market goes down why should someone be able to profit from
that just because they’ve been smarter? That’s both ironic and
rhetorical by the way!
Interestingly though, the Commodity and Futures Trading
Commission (CFTC) believes that the presence of Commodity Trading Advisor
hedge funds in the market has stabilised the price of oil during the recent
turmoil and not made it more volatile - having short selling in the armoury
can actually be for the general good.
Admittedly there is still a great deal of confusion about
which strategies do what and how. Without understanding how the risks and
the returns are generated you should avoid any investment. Many people
invest in shares without understanding the work that Eugene Fama has done in
quantifying the risks of equity investing, but somehow that’s okay with
the regulators. A less risky, more efficient investment might be available
but if the regulator doesn’t fully understand it then he’s not going to
stick his neck out.
That’s not to say that we’re opposed to regulation -
we’ve been at the forefront of attempts to regulate the offshore industry
in Thailand and we believe that one of the biggest disasters waiting to
happen could have been avoided with better regulation. Greenspan and the Fed
have long held the view that derivatives provide balance and checks to the
market and are a welcome alternative method of risk control.
The problem is that the industry has now grown so large
(roughly 7 years worth of US GDP currently outstanding on contracts, 10% of
US GDP traded in such contracts every day and a further year’s worth of US
GDP out on debt securitisation contracts too!) that Warren Buffet is waiting
for the accident to happen. The potential damage if a major counter-party
fails in these contracts is unparalleled and yet this situation has been
allowed to develop almost entirely without regulation. Regulating the
parties here rather than preventing individual investors getting access to
more efficient strategies would have been a better use of Fed time.
There are winds of change blowing though - in the UK, the
Financial Services Authority will this month publish a discussion paper,
prompting a debate on whether the ฃ275bn retail fund management
industry should be able to engage in the sort strategies used by hedge
Hedge funds, once seen as dangerous, high-risk and exotic
investments on the fringe of the investment community, are becoming
mainstream with more than ฃ1,000bn in assets and 8,000 funds
worldwide. However, most private investors in the UK are prevented by
regulators from investing directly in hedge funds. Fund managers report
pent-up investor demand for the products, which can offer double-digit
returns but can also be high-risk.
The FSA will publish two discussion papers to launch a
debate about the range of investments open to individuals. Regulators
worldwide are looking at the same issue. The UK asset management industry is
pressing for change amid fears that it is losing out to financial centres
such as Germany and Ireland that have relaxed the rules on retail investment
into hedge funds.
Keith Jones, chief executive of Morley Fund Management, a
subsidiary of Aviva, said: “Most asset management firms would welcome the
opportunity to look at distributing hedge funds in the retail market. There
is no logical reason for not allowing retail investors to buy hedge
Industry chiefs who have had meetings with the FSA on
this issue claim that the regulator appeared “supportive” of change. One
said, “They seem open to change.” The FSA’s discussion papers will
cover retail investment and the wholesale market.
The Investment Management Association said, “The FSA is
looking at extending the range of products available to investors, including
hedge fund strategies.”
Let’s just hope there are no attempts to link this to CAT standards -
financial methodologies of the highest sophistication in the hands of
mediocrity would be a scary thought - a bit like seeing a Ferrari Enzo with
‘L’ plates in the hands of a pimply 17 year old.
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
Life in the Laugh Lane: Fatter Than Ever
by Scott Jones
The day I arrived in San Francisco, the
newspaper headline read “Fatter Than Ever.” I stole it. And I just had to
look around to know that it was too true: Michelin men munching on mammoth 100
baht muffins, sucking down sodas from gallon jugs with a handle on the side and
a hose on top, feeding on super-sized fast food fried in fat. The 300 million
people in America weigh more than the billion people in China. No wonder the
world tips to one side.
On a road trip to Nashville, we decided to stop at the next
Taco Bell for a quick, low-fat lunch. As we walked from the car, Mr. and Mrs.
O. Bese struggled out of theirs and waddled in behind us. The counter helpers
were enormous. The cook was gigantic. The patrons, from the Rotunderson and
Jumboman clans, were engaged in a serious mastication marathon, silently eating
their weight in burritos. We felt like tiny stickmen from another planet,
surrounded by a foreign species large enough to influence the tides. We had
landed in Yomamaville where the jokes are facts of life. “Yo mama so fat when
she dances at a concert the whole band skips. Yo mama so fat she got baptized
at Sea World. Yo mama so fat when she walks her butt looks like two pigs
wrestling in a blanket.”
Stories from my surgeon stepfather came to mind. “You know
that slimy fat you cut off a chicken? Just imagine a foot of it under your
skin. I have trouble finding the organs I’m trying to fix and it’s hard to
hold onto a scalpel covered with grease. One obese woman came into the clinic
complaining about a pain in her side. After examining her, we found the
half-eaten bag of Oreo cookies she’d lost in the folds of her flesh.” Those
tasty sandwich cookies were never the same after thinking of them sandwiched
between two slabs of flab.
At an airport in Detroit, two mountain-shaped men were
travelling together. Even my photo of them weighed 10 kilos. Cell phone resting
on his chest, one had a built-in desk to hold his mobile office equipment. They
stood up, pushed their wheelchairs to the check-in stand, sat down in them and
waited to be carted onto the plane. The pictures on their driver’s license
said “Continued on other side.” Both crammed into the three-chair airline
seat with arm rests removed, I wanted to point out a perfect item designed for
them advertised in Sky Mall catalogue: the XL Talking Scale by My Weigh. (If
one stepped on the scale, it would probably say “One at a time, please.”)
The ad read: “Ideal for anyone with poor eyesight” (or anyone who hasn’t
seen their feet for several years). “Available in extra large 250 kilo
capacity, readability to .09 kilos, the XL uses strain gauge technology to be
incredibly accurate and precise.” (When you weigh 250 kilos, it’s helpful
to know you lost .09 kilos on Tuesday and, at that rate, will only take 1111
days to get down to a petite 100 kilos.) What do you say to encourage them
during their weight loss program? “Lookin’ good, Hugh G. Normousman. You
lost 50 kilos! Do you still have to use one scale for each foot?”
Ah, America the Beautiful, be you till full, where “world
hunger” means “stuff your face until you’re shaped like the earth.”