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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: 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.

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.

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 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.

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 [email protected]

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.