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The Doctor's Consultation

Agony Column

Camera Class by Snapshot

Money Matters

Life in the Laugh Lane

The Doctor's Consultation: Rectal bleeding and frog’s bottoms

by Dr. Iain Corness

Little Johnny was overheard by his teacher, describing to his classmates, how to insert a firework in a frog, saying, “You slip it up its ass.” The teacher immediately said, “Rectum, Johnny, rectum.” “Wrecked ‘em? Blew ‘em to bits, more likely!” replied Johnny!

So after that irreverent (but not totally irrelevant) beginning let’s look at rectal bleeding, without using a mirror. The rectum is the last portion of the large bowel that ends just before the anus. Bleeding from this area can be a herald sign of a mild or life-threatening matter, which is why all episodes of rectal bleeding must be investigated.

Depending upon how high up in the gastro-intestinal tract is the cause of the bleeding, it may be seen as black, tarry stools, maroon stools; bright red blood on or in the stool, blood on the toilet tissue, or blood staining the water in the toilet bowl bright red. Treatment can range from relief of symptoms and let Mother Nature do the rest, to antibiotics, blood transfusion, or even surgery. It all depends on the cause.

There are many potential causes, including Hemorrhoids (piles) which are swollen rectal veins in the anal and rectal area. They can cause burning, painful discomfort, as well as bleeding. External hemorrhoids are small swellings that are easy to see (with the mirror) and quite painful, however internal hemorrhoids are usually painless. A feeling of incomplete emptying may be noted with bowel movements. Treatment focuses on relieving these symptoms with the use of stool bulking agents and softeners, and if necessary, ligation of the bleeding piles.

Rectal fissure is another. This is a tear in the lining of the rectum caused by the passage of hard stools, which can lead to mild rectal bleeding of bright red blood. Exposed nerves and vessels result in moderate to severe pain.

Diverticulosis, I dealt with a few weeks ago, and these little pockets on the bowel wall can also bleed. The stools are dark red or maroon. Pain is usually absent but surgery is required in up to 25 percent of these patients.

Bloody diarrhea is often seen in Bacterial dysentery, which we have all had to a greater or lesser degree. Responsible organisms include Campylobacter jejuni, Salmonella, Shigella, Escherichia coli, and Clostridium difficile. A most unsavory bunch! The treatment depends upon the organism, but generally intravenous fluid replacement and an anti-spasmodic and broad spectrum antibiotic will bring this under control.

Another common cause of rectal bleeding is Inflammatory bowel disease especially in young adults — typically those younger than 50 years of age. Bleeding occurs in small to moderate amounts of bright red blood in the rectum, usually mixed in with stool and mucus. Associated symptoms include fever and abdominal cramps. This condition generally settles with steroids.

The list does not stop there, as there are also conditions like Angiodysplasia, which is a vascular problem that involves enlarged veins and capillaries in the wall of the right colon. In the elderly, these areas become fragile and can bleed.

Of course, the one that everyone worries about is bowel cancer. We lump these together under the general heading of Tumors and polyps. Polyps bulge out from the lining of the colon. Bleeding occurs when large polyps develop. They can be hereditary, and are usually harmless, but some types can be precancerous.

Both benign and malignant tumors are frequently found in the colon and rectum. Those people older than 50 years are most affected, however, tumors can be found in younger people. It should also be noted that less than 20 percent of people with tumor or polyps will have rectal bleeding. However, when bleeding does occur, it is usually slow, chronic, and minimal. Diagnosis requires careful evaluation with colonoscopy.

Rectal bleeding from a traumatic cause is always a critical concern. Rectal damage from a gunshot wound or foreign body insertion can result in extensive infection or rapid and fatal blood loss.

And yes, there’s more! A common source of bleeding is hemorrhage from the stomach or duodenum. This can occur after someone has swallowed a foreign body that causes injury to the stomach lining or bleeding stomach ulcers.

The list does go on, but these conditions are rare, however the message is that rectal bleeding must always be investigated, unless Little Johnny is the culprit.

Agony Column

Camera Class:  Cats and kids – Irving Penn – the B&W Master

by Harry Flashman

While Irving Penn is one of the best photographers America has produced and handled all media, formats and films, for me, his Black and White work stands out as some of the most spectacular photographs of his era. He had an eye for photo and design that was unique, so it is worthwhile spending a little time to look at this great man and his works.

He was born in 1917 in Plainfield, New Jersey. Realizing early that his talents lay somewhere in the artistic world, he enrolled at the age of 17 in a four year course at the Philadelphia Museum School of Industrial Art, where he trained for a career as an art director. At this stage he had no thoughts of becoming a photographer.

His first art work experience was as an office boy and apprentice artist for Harper’s Bazaar magazine drawing shoes.

After graduation he had positions as an art director, but he was not happy or convinced that this was all that life was going to offer him, so he went to Mexico for a year to devote himself to painting.

One year was enough to convince Penn that he was not going to make it as a painter and he returned to New York and took a job with Vogue magazine as a junior art director. His work was noticed by the senior art director, but the staff photographers could not deliver the pictures that Penn saw in his mind, which encouraged him to take the photographs himself.

This was the start to a great career. He continued with Vogue, with just a small break for the war effort, and his first exhibition of magazine covers was held in 1947 at the Metropolitan Museum of Art in New York.

For me, his work is unique because of his use of light and other devices to isolate his subject from the background. One example of this was his series, taken against a totally plain background, of workers in their working clothes with their tools of trade being the main item to lead the viewer to the industry concerned.

He is also the master of side lighting to produce a dramatic atmosphere to his photographs. Look at the shot of Picasso for example. The pose, the close up aspect, the one dramatic eye fixing you, the Spanish hat as the clue – all these items are true art director material – but Irving Penn was an art director who could take the photograph as well.

His use of photographic equipment was also very varied. Since he would envisage a shot before he took it, he would then work out what he felt would be the best equipment to use to produce the shot. His formats were also varied, from 35 mm Leica and Nikon, through to medium format (6x6) Rolleiflex or Hasselblad and then all the way through to giant 8x10 Deardorff plate cameras.

His talents have not gone un-noticed. He was voted as one of the top ten photographers in the world in 1958 and has had his work exhibited internationally as well as some sell-out shows in his native America. Included in these are those in the Museum of Modem Art, the Metropolitan Museum of Art, the Addison Gallery of American Art, the Baltimore Museum of Art and at the Museum of Modern Art in New York (1975) and at the Metropolitan Museum (1977). Published boks include ‘Moments Preserved’ (1960), ‘Worlds in a Small Room’ (1974) and ‘Flowers’ (1980).

Irving Penn and his extraordinary capacity for work, versatility, inventiveness, and imagination in a number of fields including editorial illustration, advertising, photojournalism, portraits, still life, travel, and television is someone who truly is a “Master Photographer” and studying his work one wet afternoon will go a long way towards improving our own photography.

Money Matters:  A look at Thai baht

Alan Hall
MBMG International Ltd.

We recently researched the recent history of Thai baht exchange rates and this is what we uncovered - Thailand adopted a floating exchange rate regime (similar to now) prior to 1963. However, this regime was ended on 20 October 1963 and Baht was linked to U.S. dollar at a rate B20.80 per U.S. dollar. Prior to this Baht had included a gold standard but to allow the Bank of Thailand to retain the pegged exchange rate, the gold content of Thai Baht had to be reduced for several times. This process basically prevented volatility in Baht value against the US$ but, especially when the Nixon administration caused the depreciation of the US$ in 1971 which in turn caused the deprecation of the Baht, it added to Baht volatility against other currencies and also caused reduction of the country’s gold reserves. To avoid further reduction of gold reserves, the BOT introduced a band of up to 4.5% fluctuation range in May 1972 and then up-valued the official rate to B20.00 per U.S. dollar in July 1973.

In March 1978, the Baht’s link to U.S. Dollar was broken as the exchange rate regime was changed from one that was pegged to the U.S. dollar to a system pegged to a weighted basket currency of Thailand’s major trading partners (which is what China claims to be doing currently). Initially the basket comprised of US$, West German mark, Swiss Franc and Japanese Yen. Again, the Effective Rate was allowed to float within a limited range (Controlled Floating Rate). In 1979, the Vietnamese invasion of Cambodia and subsequent Chinese retaliation caused a flight of capital from Thailand. In attempt to ease this liquidity crunch, the interest rate of Non-resident Foreign Currency Accounts was permitted to float, the interest rates on Baht accounts were also boosted and a number of currency controls were relaxed. By 1981 the then soaring US$ had increased the costs of imports while depressing the receipts of exports. In response Thailand twice devalued the Baht initially by 1.08% to B21.00 per US$ and then in July that year by 8.7% to B23.00. Between the years 1984 and 1990, the basket of currencies was revised twice ultimately being composed of 10 currencies of Thailand’s major trading partners. In addition to the original components Sterling, Malaysian Ringgit, Hong Kong Dollar, Singapore Dollar, Brunei Dollars, Indonesian Rupiah and Philippine Pesos. In November 1984 Thai Baht underwent the biggest devaluation that it had experienced changing from B23.00 to B27.15 per U.S. dollar, representing devaluation by 14.8%. During the period of 1984-1997, the Exchange Equalization Fund (EEF) defended the Baht value against the U.S. Dollar by using some monetary and financial measures in line with the pegged exchange rate regime. These interventions by the Central Bank were intended to assist exports and stop capital outflow. A “managed float” was used to control the currency, but market forces led to the collapse of this system amid the Asian currency crisis in 1997.

Since 2 July 1997, Thai Baht has been freely floated with value of the Baht determined by market forces. The Bank of Thailand intervenes in the market only when necessary, in order to prevent excessive volatilities and achieve economic policy targets. Part of the attraction of the floating regime is the enhanced flexibility and efficiency in monetary policy implementation. This allows Thailand to operate within the terms of the free markets and is intended to increase confidence of both domestic and international investors. Initially, to protect the domestic economy against speculating. a two-tier currency market was created to separate exchange rates for investors who bought Baht in domestic and overseas markets, although by January the following year this had been unified, creating a genuine traded value for Thai Baht at any given time.

From 1979 until the free-float was implemented Baht exch rates were as follows -

31 December 1979 20.425
31 December 1980 20.630
31 December 1981 23.000
31 December 1982 23.000
31 December 1983 23.000
31 December 1984 27.150
30 December 1985 26.650
31 December 1986 26.130
30 December 1987 25.070
30 December 1988 25.240
29 December 1989 25.690
28 December 1990 25.265
30 December 1991 25.255
30 December 1992 25.520
30 December 1993 25.540
30 December 1994 25.090
29 December 1995 25.190
31 December 1996 25.550

That’s the past, going forwards we expect the Baht to continue to ply a gradually depreciating mid-path between the currency performance of Thailand’s major trading partners, most notably US$ and Euro, but not forgetting Yen. Therefore the clues to Baht’s performance this year come from its own economic performance and from that of the US, Japan and the Eurozone. In the course of this research we also tried to evaluate the accuracy of published forecasts for THB rates over the last 10 years. In general the performance of forecasters has been poor. Few people have accurately forecast what has happened, i.e. the strengthening of Baht during the two years following Baht bottoming out, the weakening of Baht again once it had touched 36, and the couple of bouts of strengthening and one bout of further weakening since then. We expect the current short term strength to follow its course but then once Baht has become clearly overbought expect a further bout of weakness.

By 2015 capital flows mean that we should expect a Baht that looks 10% weaker against its weighted basket than today. This is potentially interesting for investors - but only if you can pick a currency with a clearly weaker prognosis than Baht (such as US$) and only if your borrowing requirements match the term of that prognosis (say 2 years) and only if you can afford the risks of currency markets behaving as irrationally as they always have in the past, should you even contemplate buying Baht assets with anything other than Baht liabilities. Buying Thai property with loans in, e.g. Singapore Dollar, could prove to be much more expensive than many borrowers might realize. Caveat Emptor!

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

Life in the Laugh Lane: ESL: Engrish as a Sekund Langridge

by Scott Jones

with this

FTP (Faulty Thought Process) #19: “I’m trying to sell stuff to English-speaking people so I translate Thai with my incredible language skills learned 20 years ago in grammar school that I haven’t used since then.” FTP #273: “My brother Nit writes for me. He says his English is perfect.” In this age of hurry up, zip, zap, snap impressions are all you get, you’d better get it right the first time. It’s not hard to find help: a college student, the internet or the gaggle of Farangs lounging on every corner who’d probably take a minute to check over your translations for free. (NOTE: Beware of the aging, chopstick-thin backpacker on a 17-year World Drug Tour, with only eleven remaining brain cells and long, slimy hair which may actually be his head unraveling. He probably uses the “Sliming Herb.”)

Faulty Thought Processes are also widespread in America with people struggling to communicate in EFL: Englitch as a Furst Langwudg. Noticing the expensive, neon sign saying RESTARAUNT, I casually mentioned to the owner that restaurant was spelled incorrectly and he replied, “Who cares? Everyone knows what it means.” Right. If he can’t even spell his own business, how do you know he won’t mix up the cans of turmeric and arsenic?

Try to figure out this one, written using every word in his/her/its vocabulary including several randomly chosen words from other labels, “A ten soft-headed from shows the characteristic that was superior in with sporting equipment such as medical business or sports shoes as an artificial heart muscle. I show fitting nature and a support power surely in orderwrap stress in order to be superior in flexibility and let a shock disperse from the characteristic that is going to catch a sudden shock with a respect instantly, to be adversely sticky that let, in addition, you do deformiry and seen to be crowded, and to re-construct it.” (It’s very difficult to write this column since my spelling and grammar checker keeps crashing.)

LET ME BE VERY CLEAR ABOUT THIS: I do not want these people to change their ways. I love them. Some of the best entertainment in town is attempting to decipher menus and labels. Thailand would be less fun without businesses run by the Wit brothers: Nit, Dim and Half.

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