The Doctor's Consultation: Learn to ‘drive’ your own diseases
by Dr. Iain Corness
The secret of living a long and healthy life is learning to
control your own innate disease problems. This goes in particular for such
conditions as hypertension and diabetes. Both of these are amenable to
treatment, and both of them can be monitored by yourself. Whilst it is
necessary for a doctor to oversee your treatment, your doctor can do this much
more efficiently with a little help from you.
Taking blood pressure monitoring first, there are many automatic,
self-inflating cuff instruments that will give you a digital read-out of your
systolic (the high reading) and diastolic (the low reading). For these home
readings to have even more significance, you need to have a small notebook
recording time and date. After many days you will be able to show a strong
pattern so that your doctor can really tailor the medication to keep your BP
in ‘safe’ limits, and avoid side effects from the medication.
By doing this, you can give yourself upwards of another 10 years of healthy
living. That has to be worth it, surely!
The other condition that lends itself to home monitoring is diabetes. We know
that uncontrolled diabetes is life threatening. We also know that poorly
controlled diabetes will shorten your life and lower the quality of life.
However, well controlled diabetes need not be a bar to a good and happy long
However, how do you know if your diabetes is well controlled? The blood test
you have once a month, both blood sugar and glycated hemoglobin, can give your
doctor a ‘snapshot’ of what is going on, but at best, it is only a rough
indicator. Something more exact is much better, and that something is under
your control! This is home blood sugar monitoring.
If you wish to lead an independent and active life, learning to test blood
sugar levels by yourself is essential. The results from the home monitoring
provide information about how meal intake and timing, medication, exercise and
stress affect your blood sugar levels. All important factors both your doctor
and you need to know to be able to correctly balance your blood sugar levels
with diet and medication.
There are many different monitors for checking blood sugar and your doctor or
diabetes team can advise you on makes and models suitable for your condition.
Just like blood pressure monitoring, keeping a log book is a very important
part of the monitoring. Random blood sugars are very inaccurate methods trying
to get in control.
However, unlike blood pressure monitoring there are certain precautions you
have to take to get the required accuracy. Note that you need to make sure
The meter is clean;
The meter has the correct code that matches the strip you are using;
Wash your hands with warm water,
Shake your hands below your waist.
Squeeze or milk your finger a few times gently. Excessive milking is
discouraged as results obtained may be inaccurate, but do make sure you have a
good-sized drop of blood.
Now you need to know how often you should test. This is where you must follow
the recommendations from your doctor, as your doctor will want levels at
different times of the day to get an idea of how well your treatment program
is working for you.
Generally, the best times to check are before breakfast, before lunch, before
dinner and before bedtime snack. Sometimes it is also useful to check blood
sugar two hours after a meal to see the effect of the food on your blood sugar
levels. You should also test your levels more frequently during periods of
stress, illness, or surgery, when you are pregnant, or when low blood sugar is
suspected or when there are changes made in your treatment program, such as a
change in medication dose, meal plan or activity.
You should also know your own target range. This depends on your age, which
type of diabetes you have and the duration of the diabetes. Your doctor will
help you with targets, and an ‘action plan’ for when your home monitoring
shows levels above or below the targets.
Learn to drive your own diseases and live happily ever after (or until you are
I am an avid reader of your Agony Column, which is always very
informative and showing great insight. Due to unfortunate circumstances, I
also am in need of your wise counsel.
You indicated some time ago that, if there is no emotional connection, a
relationship has no depth and is unstable. I fully agree with this and
infer that such a relationship is in danger, sooner or later, to come to
grief, unless emotional closeness can again be achieved.
The question is, what can a loving partner do who is trying very hard to
improve the relationship emotionally, when he is confronted with a
seemingly unending grudge and a total lack of any love, forgiveness and
compassion? What indeed?
I feel for you, my Petal, I really do. The saying “Between a rock and a
hard place” sort of describes what you are currently going through.
Human romantic relationships do require emotional commitment, which as you
correctly imply, must come from both sides of the relationship.
Unfortunately, no one person can make another return affection. It has to
be freely given. I take it from your letter that there has been some event
which has soured the relationship, one that requires forgiveness and
compassion. To achieve this forgiveness, you have to look at what your
partner found attractive in you from the beginning. If you were the strong
silent one, then by becoming a cringing, hand-wringing, please-forgive-me
type, you cannot expect to renew the fire in the relationship. You almost
have to pretend that the schism has not happened, and try to be the man
you once were. This may or may not work, but this is giving it your best
shot. If it doesn’t, then all you can fall back on is ‘time’, the
great healer. Best of luck, my Petal. I feel you may need it.
I was doing some spring cleaning in my computer at work and found all
this porno stuff on it. I am supposed to be the only person in my office
to use this machine, but it isn’t passworded or anything, and sometimes
other staff members work late too. What should I do about it? I am worried
that if I make a noise about it, then others will think I’m just
covering my ass. Don’t get me wrong, I’m as red-blooded as the next
bloke, but I wouldn’t like some of the girls in the office to see this
stuff. It’s pretty graphic. Any ideas Hillary?
You are worried that you will become known as “Porno Pete” I suppose,
but I have to say I find it a trifle unbelievable that you never go
looking for the odd bit of fancy photography, which in turn leaves its
grubby pawprints inside your computer. There’s only several million
sites on offer, despite the Thought Police’s Department of Naughty Bits
trying to block it all the time. One of the guys in the office told me you
only have to click again if the site is blocked and you get through the
second time. Try it next time. I don’t think there is much to be gained
by having a witch hunt in the office, just quietly delete it and check the
comp daily until you find the culprit. You never know your luck, it might
be one of the office girls!
My Thai girlfriend and I want to buy some land upcountry where she
comes from near Nong Khai. The price is quite reasonable and in a few
years I would be happy to retire in that place. The other day she went up
country and rang me to say that we could buy some land OK, but it would
take two months for the deeds to be transferred into my company’s name.
If she were to buy it in her name then the deeds could be transferred in
two days. This doesn’t seem right to me, Hillary. Do you think I am
being taken for a ride here?
First off, James my Petal, is to decide whether it is “my Thai
girlfriend and I” who want this land, or is it your Thai girlfriend? I
must say I do not know too many farangs who have successfully retired to
Nakhon Nowhere, approximately 20 kilometers this side of the Laos border.
Since you want the title deeds in your company name, I take it that you
want to retain control over it. Buying it in someone else’s name does
not fit in with that does it? Go and talk to a lawyer.
Every time I go to get a hair cut the man or woman barber always want
to bend me over in the chair half way through the cut and start thumping
my back as some sort of massage. The best the other day was when the man
approached me with some sort of vibrating electric motor strapped on his
hand and began to try and massage my legs! All I want is a haircut. Where,
Oh Hillary, where do I go?
Dear Hirsute Harry,
Lucky you! What was the address of that shop?
Camera Class: Man beats machine - Over-ride the electronics
by Harry Flashman
With the newer and more sophisticated cameras that can
apparently do everything, making the photographer almost redundant, it was very
heartening to receive an email from one photographer who had found that perhaps
the electronic brain did not know everything.
Regular readers will know that I often advocate turning the camera off the
‘auto’ mode and going on to full manual. I also suggest turning off the
inbuilt flash for many night shots. Why? Because only you know exactly what you
want to get on film. The electronic brain inside your camera does not!
Now this goes for all types of cameras that have manual settings, be that film
or digital. The concept is the same for both and the rules remain true. A camera
is merely a black box that lets light on to a sensitized layer, be that film or
magic pixels. No difference.
Now my friend had emailed me after he had tried to photograph the moon with his
new digital SLR, but had fitted his old lenses, from the same manufacturer. The
details were a new Pentax DSLR with a 40 plus year old Pentax Super Takumar F2.5
135 mm lens. However, he also tried letting the new digital camera do its best,
and by comparison he did his best and the difference was quite spectacular.
There are actually only two rules to be followed in taking lunar pictures
(unless you are going up there, courtesy of NASA):
Rule Number 1 – Do not use any autoexposure modes (program, aperture, or
shutter priority) - switch to full manual.
And Rule Number 2 - follow rule number 1.
There are two reasons behind these simple rules. First, the
camera’s metering circuitry will average the exposure over the night sky (most
of the frame) and the bright Moon in the center, in its design which is to
produce 18 percent grey. This will result in a hopelessly overexposed frame.
Even if you have a spot-metering mode in your camera, you’ll not avoid this,
unless you are using a 400 mm or greater focal length.
So how do you get the right exposure to keep the night sky black and still some
detail on the moon’s surface? You can actually use the “sunny 16” rule
here: with the aperture of f16, set the shutter speed to one over the ISO speed
of your film (or its digital equivalent). So that would be (with 100 ASA) f16 at
1/125th. That will get you in the ball park, but is not necessarily the exact
correct exposure. For that you have to ‘bracket’ since exposure times given
by formulas are approximate, varying according to the exact phase of the moon,
atmospheric conditions, etc. To be safe, bracket at one and preferably two stops
on both sides of the exposure suggested by the formula.
There are other factors to be taken into account with lunar photography, and
first is the tripod. Always use it! And a cable release if you have one. If you
are using a digital camera, also use the highest resolution setting.
Photos of the full moon are flat and featureless. For more interesting pictures,
photograph the moon at crescent or quarter phases when the mountains and craters
are illuminated from the side and cast shadows.
Another factor not to be overlooked is that the moon is moving, and so is the
earth you are standing on. Because of the earth’s rotation, the moon appears
to move approximately half its diameter in one minute, so long exposures are
best avoided. The longest acceptable exposure time is somewhat arbitrary, and
depends on the amount of enlargement, but most guidelines recommend an exposure
no longer than one minute.
For the good shot here, the photographer used the new Pentax DSLR on full,
manual mode (100 ASA) at 1/125th at f16. Just as the formula suggested!
Try some moonscapes today, or rather, tonight!
Life in the Laugh Lane: Plastic Baggage
by Scott Jones
In America, you might find these things in a
plastic bag: severed pig snouts, miscellaneous worms, an excrement-brown
casserole of sinister gooey stuff containing vaguely familiar shapes that, upon
closer inspection, you realize are chicken feet. That bag would be a black
garbage bag. Here in Thailand, you can take these splendid items home
separately from the market in clear-plastic doggy bags. Anything is available
in plastic bags of all sizes, including miniscule ones that hold a quarter
teaspoon of fish sauce. Although the unofficial symbol of Thailand is the
elephant, it should be the plastic bag. (If you look closely at the symbol, the
elephant is actually in a plastic bag.)
with customized plastic baggage.
When I first arrived here, I ordered a Coke and received it, with ice, in a bag
with a straw. This was new to me, since American marketing slogans never
mentioned “Coke is it! Pick up a refreshing bag today!” It worked okay, but
I couldn’t really sit down and set it on a table. I had to finish it before
tackling my next novel activity, trying to decide which insects to eat, which
was quite simple - none. I had yet to learn that I could buy 150 bagged Cokes,
75 sacks of complete meals, plus an unlimited amount of random brooms, stuffed
animals, and used car or squid parts, hang them all over my motorbike and sell
them in the streets.
After three years in Thailand, I still haven’t mastered the art of removing
the steel-belted rubber bands used to close the bags with a complex series of
mystical twists and knots, a slight-of-hand trick deftly performed in one
second by vendors. I need knives, scissors or sharp keys to puncture these
bulging, pressurized bags, which invariably sends instant-staining chili sauce
spurting onto the whitest part of my shirt (this taught me to dress in black or
multi-colored clothing, soon crusty with dried food, but at least you can’t
see it.) I want to master this remarkable binding maneuver, so I can quickly
bag the head of the rooster that wakes me every morning at 2:30 a.m. or perhaps
the next motorcycle mechanic who returns my bike disassembled in a bag.
Recycling is approaching official religious status in America, but I was
indoctrinated decades ago by my grandmother, who carefully washed and reused
the few bags that appeared in our home. With my marginal Thai skills, I
politely try to convince the salesperson that I don’t need another bag for
the bag of peanuts that are already in a bag, thank you very much, I can just
put this bag in my handbag. They look at me as though I’m insane, as if the
sale isn’t complete without the final, redundant bag and they have failed in
their job. They put the peanut bag in another bag anyway, which I remove from
their bag and hand back to them, which they promptly throw away, foiling my
useless attempt at saving the environment. Three cheers for Rimping Market and
their new program: for every bag you do not request, or use, or something,
they’ll give a charity 50 satang, a mythical denomination of Thai currency -
nothing costs 50 satang; you only get it as change. Unfortunately, the clerks
haven’t read the signs explaining this at the checkout, and look at you like
you’re insane, as if the sale isn’t complete, etcetera.
My modest recycling efforts in America helped the world a bit, but ruined my
reputation in the neighborhood. By separating my garbage, I got a break on my
collection bill. Colored glass bottles, clear glass bottles, plastic bottles,
newspapers, cardboard, Styrofoam boxes with unintelligible classification
symbols printed somewhere: all had to be divided into individual bins behind my
garage. The apartment building across the alley had no program, just one huge
dumpster. A few concerned tenants clandestinely dropped their hodge-podge of
garbage onto my segregated trash, including enough liquor and beer bottles to
host a block party. To no avail, I posted signs requesting them to stop, so I
accepted my duty to a higher cause. I systematically combined their garbage
with mine, on Sunday night at 30 below zero, amongst the snowdrifts. Whatever.
They’re trying; I’ll help. Years later, while chatting in the alley with my
neighbor, I asked if she ever got bags of trash from the void. She did not, so
I described my plight. She said, “Well, that’s good to know, because every
Sunday night I’d wonder about your massive piles of liquor bottles. I knew
you liked to party, but never saw any major bashes. You went to work everyday
and lead a reasonably normal life, but I could not believe how much alcohol you
put away every week!”
I’ll continue my mini-quest for the Thai environment. So far, I may be
responsible for contributing 50 satang to a charity, which should provide
someone with a microscopic bag of fish sauce, one dried squid tentacle or six
Language Matters : Words, Words, Words: The Direct Approach to Teaching Vocabulary
You are studying a foreign language, you want to learn
ten new words every day, and the mental task of managing your growing word
list seems formidable. To put the job into context, consider the following
from linguist Stephen Pinker.
“Children begin to learn words before their first birthday,” he says,
“and by their second they hoover them up at a rate of one every two hours.
By the time they enter school children command 13,000 words, and then the
pace picks up, because new words rain down on them from both speech and
print. A typical high-school graduate knows about 60,000 words; a literate
adult, perhaps twice that number.” (*1)
Smaller than a toddler’s daily intake, your ten-word vocabulary list
suddenly seems like a pauper in a palace. And the problem of properly
learning vocabulary involves much more than remembering words. In the
classroom, only a few words and a small part of what the learner needs to
know about a word can be dealt with at any one time. For the common words,
which often have multiple meanings and complex nuances, you can only teach a
bit at a time. The more information you present, the more likely your
learners are to misunderstand.
For both teacher and learner, vocabulary is a huge challenge. But help is at
hand from vocabulary researcher Paul Nation, whose magisterial 480-page
tome, Learning Vocabulary in Another Language, offers endless insights into
the science and practice of teaching and learning vocabulary. (*2) He calls
his preferred method of vocabulary teaching the direct approach.
Nation describes vocabulary learning as a “meeting” between the learner
and the word, and he stresses that it only makes sense to have close
encounters with common, useful words. Most teachers emphasize the most
common 2000 English words. The most widely accepted list is available on the
Internet by googling Michael West’s General Service List.
“Useful vocabulary needs to be met again and again to ensure it is
learned,” Nation says. “In the early stages of learning the meetings
need to be reasonably close together, preferably within a few days, so that
too much forgetting does not occur. Later meetings can be very widely spaced
with several weeks between each meeting.” (*3)
There are essentially four ways to learn and teach high-frequency words.
* One is direct teaching, mentioned earlier. For the language teacher,
explaining vocabulary is a critical part of classroom duties.
* Also, encourage your students to participate in direct learning, which
involves study from word cards and dictionary use.
* A third method, incidental learning, can involve guessing from context in
extensive reading or through word use in communicative activities.
* The fourth method Nation calls “planned encounters.” These encounters
include vocabulary exercises and graded reading - that is, using reading
materials like shortened novels with reduced vocabulary for language
Graded readers are available in many language teaching bookstores. In Chiang
Mai, the best source is DK Books, on the second floor.
Nation’s direct approach to vocabulary teaching is built upon three main
ideas. First, vocabulary teaching should focus on high-frequency words that
will be of continuing importance for the learners. As a teacher, you have a
duty to pass over low-frequency words completely or with little comment.
Also, you have to make sure the learners come back to the word frequently,
to diminish the power of forgetfulness.
Also, when you teach a word you should focus on its “learning burden” -
that is, the features of the word that actually need to be taught. These can
differ quite dramatically from word to word. Take the word “think.” You
need to explain that it is an irregular verb; that it includes the irregular
spelling “thought”; and that “thought” can also be a noun.
Finally, direct teaching should be clear and simple. To learn a word in all
its complexity, learners need to meet it many times. Don’t try to teach a
complex word - for example, the many meanings of the word “right” - in
one sitting. That kind of intensive vocabulary teaching takes place in
boring classrooms, and it frequently leads to perplexed students.
Peter McKenzie-Brown teaches TEFL at Chiang Mai University’s Language
*1 Stephen Pinker, Words and Rules: The Ingredients of Language, p. 3.
*2 Paul Nation, Learning Vocabulary in Another Language (Cambridge,
Cambridge University Press) 2001.
*3 This article relies heavily on ideas from Paul Nation, “Teaching
Vocabulary,” Asian EFL Journal. Accessed online, May 25, 2006.
*4 Nation, 2001, p. 16.