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The Doctor's Consultation: I think I’ll have a blood test
by Dr. Iain Corness
Very often, when discussing blood tests with a patient, I
will be asked, “What were my AIDS results?” or “What is my blood
group?” or similar. In most instances I have to disappoint them, because
unless the specific test for HIV antibodies, or blood group, was requested,
there will be no record of it, even though the initial test was called a
“complete blood count”.
The reason for this is simple. There are so many tests that can be done, that
testing would go on for weeks if you wanted “everything” checked. For
example, the Australian Royal College of Pathologist’s Manual of Use and
Interpretation of Pathology Tests that sits on my desk lists 150 pages of
tests that can be carried out. These include such items as a Reptilase Time,
something I have never requested in 40 years of practice, or a red cell
Galactokinase, ditto.
No, when we send you off for a blood test, we have to try and be reasonably
specific, and often give the pathologists a clue as to where we are heading,
and be guided by them as to some specific testing.
However, many times we are just casting a ‘wide net’ to see what
abnormalities we can turn up to use to find the definitive diagnosis. One of
the commonest is the “Complete Blood Count”, usually called a CBC, since
we medico’s love acronyms, but remember this testing is in reality very far
from “complete”.
The CBC does provide important information about the kinds and numbers of
cells in the blood: red blood cells, white blood cells, and platelets. A CBC
can help us evaluate symptoms such as weakness, fatigue, or bruising and even
directly diagnose conditions such as anemia, infection, and many other
disorders.
The CBC test usually includes the white blood cell (WBC) count as these cells
protect the body against infection. If an infection develops, white blood
cells attack and destroy the bacteria, virus, or other organism causing it.
White blood cells are bigger than red blood cells and normally fewer in
number. When a person has a bacterial infection, the number of white cells can
increase dramatically. There are five major kinds of white blood cells:
neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The numbers
of each one of these types of white blood cells give important information
about the immune system. An increase or decrease in the numbers of the
different types of white blood cells can help identify infection, an allergic
or toxic reaction to certain medications or chemicals, and many conditions
(such as leukemia).
The red blood cell (RBC) count is also part of the CBC. Red blood cells carry
oxygen from the lungs to the rest of the body. They also help carry carbon
dioxide back to the lungs. If the RBC count is low, the body may not be
getting the oxygen it needs. If the count is too high (a condition called
polycythemia), there is a risk that the red blood cells will clump together
and block blood vessels (thrombosis).
Another test is Hematocrit. This test measures the amount of space (volume)
the red blood cells occupy in the blood. The value is given as a percentage of
red blood cells in a volume of blood. For example, a hematocrit of 38 means
that 38 percent of the blood’s volume is composed of red cells.
Hemoglobin (Hb) is the substance in a red blood cell that carries the oxygen.
The hemoglobin level is a good indication of the blood’s ability to carry
oxygen throughout the body.
There is also the platelet (thrombocyte) count, which is an important part of
the CBC. Platelets are the smallest type of blood cell and play a major role
in blood clotting. If there are too few platelets, uncontrolled bleeding may
be a problem, such as occurs in Dengue Hemorrhagic Fever.
So even though the CBC does test for many factors, there are still another 149
pages of tests that can be done! If you want to know your blood group, or your
HIV status, you have to ask!
Agony Column
Dear Hillary,
You get so many letters from foreigners complaining about being cheated
here in Thailand, that even you cannot ignore them surely. There is a
saying there’s no smoke without fire, and I believe that is what the
situation is here. The letters you get are the smoke and the fire is
behind it. Not everyone is a dummy, so these people who cheat are real,
just like the people who get cheated. You should remember this.
The Fireman
Dear Fireman,
I think that the smoke got in your eyes, my Petal. When have I ever
ignored the claims of foreigners who say they have been cheated here in
Thailand? I faithfully print their letters, just like I have printed
yours, but by publishing the letters does not mean that I necessarily
agree with them, or fully accept a one-sided story. Undoubtedly there are
confidence tricksters out there, masquerading as innocent young ladies who
just happen to be resting on a bar stool while somebody else shouted
“Hello sexy man, come in please!” However, the number of innocent
young ladies resting momentarily on bar stools is very small, compared to
those not-so-innocents who use bar stools as their workplace. There is an
old Chinese proverb which says, “If you want to find apples, you don’t
look in an orange orchard.” What I have said for many years is that if
you are seeking a fresh young lady, you don’t look for them in beer
bars, but in places of more regular employment. It is not impossible to
find an apple in an orange orchard, but they are very rare. Make that
very, very rare. There are books and books and books written on this
subject, all warning the visitors to this country of the dangers of
falling in love with the first lady they meet. It is this group of people
who end up writing angry letters, but the anger they express they should
turn on themselves. They were the ones who went to the orange orchard,
didn’t they?
Dear Hillary,
One of the women in my office has a problem with body odor. She does not
seem to realize this, but it is now getting to the stage that nobody wants
to sit downwind from her, and she always turns the fan on which is at the
top of the office. Have you any suggestions Hillary that can help us
through this difficult problem. The woman in question is also higher in
the company than we are, so there is another problem, as you can imagine.
Odoriferous
Dear Odoriferous,
Tread very softly my Petal. This is a very difficult situation. Whichever
course of action you take, you could end up in a confrontation situation
very easily, and you would be the one to lose. If everyone agrees that
there is a problem, get everyone in the office to have a small incense
burner going on their desk. When she is the only person without one, she
might ask you why, which is the time when you have to wriggle around a
little and tell her that someone in the office has bad body odor, but
nobody is sure who it is, so you are masking the smell. Then retire
gracefully stage left. By the way, you began your letter by saying, “One
of the women in my office has a problem with body odor”, but that is not
strictly correct. One of the women in your office has body odor, which you
find a problem. Subtle difference. Hope you still have a job on Monday!
Dear Hillary,
My wife tells me every night that she is going to divorce me. There are
too many, and very numerous reasons stretching back over a long time (five
years or more), none of which can’t be gotten over, but my problem is
not the thought of impending divorce, it is the fact that she never gets
any further than saying it is going to happen. How can I get her to either
stop the threats, or just go ahead and do it? There must be other things
that husbands and wives talk about, not just threatening divorce. Or is
this “martial” bliss after all? What is your advice, wise Hillary?
Tired of it all
Dear Tired of it all,
A few weeks ago, one writer was asking about communication and I wrote
that for some people they think that the art of good communication is to
shout louder. I think one of you needs to shout louder as there is
something awry here with your relationship (if you haven’t guessed by
now). Have you thought that it really is time to talk? Not only really
time, but long overdue at five years. Perhaps you could try talking to her
next time when she threatens divorce, and say, “Right then, let’s see
what the reasons for the divorce will be when we go to the courts.” If
she won’t rise to that bait and opportunity to begin dialogue, then as
per the art of good communication, shout louder and tell her to either get
on with it or give up talking about it. If that doesn’t work, you can
always get divorce papers drawn up and the next time when she threatens
divorce, whip out the papers and say, “Sign here!” Lots of luck my
Petal, I think you’re going to need it.
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Camera Class: Photo project can be communal fun
by Harry Flashman
 One
of my Miss Piggy “bus art” shots
I have written before about personal photo projects as a way
to improve your photographic techniques. Once you start to look at how you can
present a subject photographically, you are on your way to thinking like a photo
pro, and not someone who is just snapping pictures.
I was reminded of this the other day when a chap I only know (Mac) through an
email connection sent me a photo of a bus he had taken in Thailand. He also said
how difficult it was to take the shot while the bus was moving, and getting this
large object to fit in the viewing screen.
Now, I have always loved Thai busses. Wonderfully painted, gaudy bucolic beasts
that roar along the highways almost blowing small vehicles from their paths as
they thunder through. I had even started a small photo project of my own, to
record some of the incredible paintings on the sides and tails of these busses.
100,000 baht busses with million baht paintwork.
 1/5th
of a bus
So I replied by sending him one of my Miss Piggy “bus
art” shots, never imagining what might happen next. Mac had in turn sent my
photograph to his email circle, and this started a deluge, and we all started to
be bombarded by shots taken all over the world, of weird and wonderful busses
and cars. (So it is with thanks that I have included some of their shots here,
as well as my own this week.)
In addition, the various respondents began to enumerate their difficulties in
getting their shots, but the common thread was that there were plenty of photo
opportunities; however, you had to have a camera with you and ready. This has
also been one of the subjects I have covered before, calling it “Be
Prepared” (with apologies to the Boy Scouts Association).
Mac even writing in his email, “I’m going to start carrying my camera a
little bit more handily so I can catch some of these. I can tell from the 1/5th
(bus) I’ve got to do better driving one handed with camera and view finder in
the other hand while milling along with the traffic going my way, and the odds
and ends of drivers going the opposite way on my side of the road!”
The results of this emailed photo project exercise was something I had not
thought of before. Photo projects, as I have said previously, are a good idea to
stimulate your creative self, but by then expanding this project to include
friends, relatives and acquaintances, you can pool thoughts and techniques to
improve your own results. Thanks Mac!
Money Matters: Gold - Onwards and Upwards - Part 2
Alan Hall
MBMG International Ltd.
The most important thing that affects gold
in terms of interest rates is real interest rates, or rates adjusted for
inflation. Even though interest rates have risen, real interest rates remain
close to zero, or are negative.
John Williams, an economist, has an interesting Website called
Shadowstats.com. He looks at the CPI and what level it would be at were it
not for all the adjustments in the past 30 years. If the CPI were still
calculated today as it was in the 1970s, the inflation rate would be about
8%.
Depending on how you measure inflation, real interest rates are no better
than zero and probably are negative. That is very inflationary. What will be
negative for gold is when real interest rates go to 4% or 5%. It took Paul
Volcker bringing real interest rates up to 6%, 7%, 8% in a short period of
time before the market was convinced he was going to save the dollar and it
was time to move out of tangible assets into financial assets.
The main problem lies in the fact that the US Government is trying to
produce a rabbit out of a hat by trying to fund the federal budget deficits
without destroying the dollar, and trying to raise interest rates to save
the dollar without destroying the economy. This is basically impossible. The
dollar will continue to lose purchasing power.
Gold stocks are still relatively cheap. In the past several months, even as
the gold price has gone up, the stocks have been reluctantly following
rather than leading, which is contrary to what normally happens. If the
price of gold eventually goes to four digits, the earnings of gold companies
will be significantly higher. As a consequence, gold stocks are still cheap.
Another problem for the markets is the new chairman of the Fed. Bernanke is
very different. Greenspan clearly understood gold, and in his Fed testimony
he used to talk about the “automaticity” of the gold standard. If you go
back to Greenspan’s testimonies, you will see him using that word from
time to time. Bernanke doesn’t have the deep understanding that Greenspan
had about gold and perhaps about markets in general.
Greenspan came up from the business world, Bernanke came up through
academics. That makes a difference in terms of one’s outlook and levels of
experiences. Bernanke just does not appreciate the value - in every sense of
the word - of gold. This can be seen from what he has written in the past
and what he said prior to his appointment as Fed chairman. He has been
pretty cautious. He has only been chairman for a short while but he seems to
be focused on the deflation in the 1930s, and this is quite alarming.
What we don’t need today is a greater supply of dollars. What we need is a
greater demand for dollars. The way you improve demand for dollars is to
take those steps that will give people confidence in the dollar and its
purchasing power for a long period of time. This can be done by raising
interest rates, just as Volcker did, at a pace that is not measured, but
rapid. This will be painful, but it is a cure, almost everything else will
be terminal.
America has to recognise that it has far exceeded its ability to live at the
level at which the country has been living for the past couple of decades.
There is going to be some pain and adjustment. But if the dollar’s
purchasing power is destroyed, as a consequence of not taking strong action,
the pain is going to be much greater.
When Volcker raised interest rates, the US had a severe recession, but
eventually the adjustments led to a period of economic growth, and the
country continued to create new wealth from economic activity. When you
create too many dollars in an environment where the demand for the dollar is
declining, it could lead to a situation similar to Argentina a few years ago
or to one that resembles Weimar Germany - one deflationary and one
inflationary.
In Argentina, the supply of pesos declined by one-third from peak to trough,
but the purchasing power of the peso lost 50%. In Germany, demand for the
Reichsmark was falling and the central bank tried to offset that by putting
more Reichsmarks into circulation. Both situations ended badly, and the net
result was severe economic dislocations.
The problem is the dollar is the world’s reserve currency. What happens
when you have a flight from the world’s reserve currency? This is the
point of Turk’s book, The Coming Collapse of the Dollar. The flight from
the dollar is going to accelerate. The dollar has only 5% of the purchasing
power it did maybe 50 years ago.
Oil is interesting because there are two dynamics. The oil producers
seemingly are less and less willing to take dollars, because dollars are
being depreciated. The Russians are questioning the dollar’s role as the
reserve currency. And in Venezuela, when President Hugo Chavez takes a swipe
at the U.S., he is taking a swipe at America’s ability to create dollars
out of thin air.
The second dynamic is Matt Simmon’s argument that we are running out of
easy-to-produce light, sweet crude. If the supply of easily refinable crude
oil is diminishing, all the more reason for the price of crude oil to rise.
So, we have a weakening dollar and a declining supply of the best-quality
crude which could translate into USD100-a-barrel crude oil before too long.
There is a close historical relationship between crude oil and gold.
Throughout the last sixty years, the price of crude in grams has, basically,
remained unchanged. The USD price of crude has broken out of a 30 year
range. Normally it takes about 2.2 grams of gold to buy one barrel of crude
oil. Now it takes about 3.4 grams to purchase one barrel of crude oil.
Either oil is relatively overvalued at the moment or gold is very
undervalued. Most believe that gold is undervalued and that oil is properly
valued. So as oil goes higher in dollar terms, gold is going to continue to
go higher as well.
One other question on people’s lips at the moment is what value
Exchange-Traded Funds are for gold. They are positive in the sense that
people are looking at gold and coming up with new products. But I do not
recommend people buy the ETF. If you want to speculate on the gold price,
the ETF is one way to do that. Futures contracts are another way. But owning
the physical metal in your own name is something entirely different. There
are too many parties between you and the gold in the ETF. And they don’t
audit the gold to prove it really exists. This is the only type of fund the
SEC has ever approved for the retail level that isn’t required to audit
the assets supposedly backing the fund. It is a great way to speculate on
gold’s spot price, just as futures contracts are a great way to speculate
on gold’s future price. But neither should be viewed as an alternative to
owning the physical metal. If your garage is a bit small for this then you
can always look at bullion funds.
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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
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Life in the Laugh Lane: The Klutz Klub: Part 2
by Scott Jones
My friends marvel at how my fingers can be so
deft on the keyboard and so daft at other times. At a university in Indiana, I
play a glissando down the entire keyboard of the piano. I generally execute
this move with my forefinger, but I’d seen another artist use his thumbnail
and decide to try it. Someone must have sharpened the keys, because shards of
my thumb soon litter the keyboard. I continue playing until there is too much
blood on the piano and the audience is gagging. “What’s black and white and
red all over?” A newspaper, a sun-burned zebra, a nun with a harpoon through
her head, and the grand piano in Terre Haute, Indiana. The audience can’t
forget that concert, no matter how hard they try.
My feet are the same way. Over the years they’ve become skilled at opening
doors when my hands are full, a useful talent that backfired in Wisconsin.
Early in my musical career, I have an engagement at the Howard Johnson’s
Motel for $100 for the weekend. After my last set, I walk out carrying guitars
in both hands and open the glass door with my foot. The door remains closed
while the glass and my foot go outside. They send me a bill for $100. I may
have played for free that weekend, but whenever you’re passing through Eau
Claire, you can visit The Scott Jones Memorial Door that I bought them. (They
could at least put up a plaque or something.)
People blame me for accidents just because I’m in the immediate vicinity.
I’ve begun to believe them since the fateful day in Spokane, Washington when
my guitar tried to commit suicide. It is a normal, everyday noon concert in the
cafeteria at a community college. I sit at the piano, calmly telling a story.
Out of the corner of my eye, I notice movement and turn into stone as my
expensive, handmade guitar lurches out of its stand, bounces on the stage and
falls four feet towards the cement floor. Time slows to single frames as I
watch a daring woman in the front row lunge from her chair and slide across the
floor on her chest with outstretched arms. It is a replay of that rug shampoo
commercial where the woman flies through the crowd only to miss the piece of
pie that smashes onto the carpet. Somehow this woman actually catches my
guitar. I offer to marry her, but she only wants the guitar.
The president of the Klutz Klub is a temporary office, held by the member who
has performed the latest extraordinary mishap. I became president after an
incident in the dead of winter in North Dakota. I ask my aunt if I can use her
car and she says, “Okay, but make sure you unplug it from the garage.”
(Fargo folks have electric heaters in their engines so they’ll start when the
temperature is several hundred degrees below zero.) I get the keys and put on
my jacket. She reminds me, “Now, make sure you unplug it from the garage.”
I tell her not to worry and walk outside chanting, “Unplug the car, unplug
the car.” I enter the garage, unplug the heater, start the car and back out.
Unfortunately, I had neglected to open the garage door. Hey, she never said
anything about a garage door!
My presidential title was secure for several years after a house concert deep
in the woods of northern Minnesota. It is 37 degrees below zero the night of
the show. I had spent the previous night with my hosts and built a fire under
the engine of my van to get it started in the morning. One guest remarks as he
walks in the door, after a mile trip through the forest in a four-wheel drive
truck, “This guy better be good, because I risked my life getting here.” A
half-hour before the show, I’m on my way to the bathroom when two old friends
come in the front door. There are two doors right next to each other labeled
“Men” and “Women.” As I take a step through the men’s doorway, I turn
to wave at my friends. The women’s room is on the main floor, but the men’s
room door leads to the stairs to the basement bathroom. I fly backward and
downward, bounce once on the wooden staircase and land on the cement floor
about a week later. I am hot, cold, nauseous, dry, sweaty and in shock all at
once. A disco beat of pain throbs through my left thumb. Now I am even with the
guy who had risked his life to get there. Earlier in the day, my host had asked
me, “What do you do before a show? Relax? Meditate?” I didn’t have the
heart to tell him I like to fling myself backwards down a long flight of
stairs. He might not have let me do it.
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