The Doctor's Consultation: by Dr. Iain Corness
Sliced and diced for the over-50’s
This week I was asked by a
gentleman in his 50’s about the 64-Slice CT examination. Since he was unsure
of what it was, I suspect many others of you may be in the same boat, so I
thought I should demystify it.
If you are over 50, and particularly between 50 and 60, coronary heart
disease is one of the most likely causes of your being struck down, other
than a blow from a rampant song taew baht bus (of course, if you get through
the dangerous decade and get to be 61 you are automatically 10 foot tall and
Coronary heart disease refers to the gradual build up of ‘plaque’ (and it is
not the dental kind) in the inside of the coronary arteries, the arteries
that ‘feed’ the heart muscle.
What is often not realized is that the heart muscle does not get its
oxygenation from the blood inside its chambers, but through separate
arteries that run around the heart and supply the heart muscle directly.
These are called the coronary arteries. If the inside diameter of the
coronary arteries is reduced by 50 percent, it means that the oxygen
required cannot be supplied in enough quantities to keep the heart muscle
alive when it is called to perform extra work, such as running to (or out of
the way of) a baht bus, for example. Viagorous exercise could also come
under this heading. Constriction greater than 50 percent means that the
heart muscle ‘starves’ of oxygen even more quickly.
We know these days that the ‘plaque’ build-up is made of cholesterol and
calcium, and that the likelihood of deposits depends on many factors,
including diabetes, high blood pressure, high cholesterol levels, stress and
cigarette smoking. This is why we advocate regular testing for those
physical factors, and strongly advise you to give up smoking! We actually do
want you to live a little longer, with a good quality of life.
To diagnose coronary artery disease, we will evaluate a patient’s risk
factors and perform some tests and then divide the patients suspected to be
at risk into the two groups; high and low risk. After that, there are two
main diagnostic procedures that will usually be performed, conventional
coronary angiography (CAG) or the 64-Slice CT.
However, whilst CAG might be the gold standard, it is also expensive (like
gold) and time consuming, as it requires a stay in hospital of four to six
hours. Being a direct intervention, with cardiac catheters, there can also
be a risk of hemorrhage, though this is not usually the case. But it can
The alternative is the 64-Slice CT. This is the latest variation of CT
scanning, with the original known as 16-slice CT. This was fine for
assessing organs which did not move, but was not as accurate in
demonstrating coronary artery problems, because the heart is moving and
beating inside the chest (unless, of course, if you have died already and
please advise the technician beforehand). However today, with the advent of
the most advanced form of this imaging, the multi-slice detectors and high
powered computer programs called the 64-Slice CT, we can efficiently get
information on the coronary arteries in as few beats as possible, in around
4 seconds. And this comes with 90 percent accuracy.
The 64-Slice CT has many advantages. First off, nobody is actually slicing
you open to insert cardiac catheters into your arteries. The 64 ‘virtual’
slices are done of your cardiac image and the coronary arteries by the
computer program, not physically. Each slice is 0.625 mm, so will be able to
pinpoint calcium deposits. It is a quick and painless procedure. You do not
have to wait around in hospital afterwards, other than perhaps wait for the
radiologist’s report. A boon for the busy 50-60 year old businessman (the
group most at risk). And finally, it is much cheaper than having a coronary
If you have no risk factors, other than being over 50, I would seriously
consider the 64-Slice CT.
Heart to Heart
I read the letter from the chap up north about his local monk who makes
petrodiesel. Is this not bio-diesel? And how can he make petrol and LPG
from one kilo of plastic? We should all be wanting to save the planet,
but I don’t think the young abbot of Wat Doi Noi in Ban Jambon in
Lamphun can really do all this without the technology training to do it.
The Chemical Engineer
Dear Chemical Engineer,
The letter you are referring to was from a long-time reader, Delboy. He
is not prone to exaggeration and seems to have his feet well and truly
on the ground (other than when he is riding his motorcycle). It is not
only Buddhism that teaches that if you really want to do something, you
can do it if you apply yourself properly. I would agree with Delboy that
Khru Bah Noi is an amazing man, he has so much energy, and puts it all
into helping the local people of his district. Perhaps you should go and
visit him before commenting further, my Petal.
Regarding your “Very Tempted” 40 year old with the hots for the waitress
who wrote in a couple of weeks ago. Does she think that just because the
waitress is a woman this makes it more difficult before “planning the
next move”? I’m just glad I’m a bloke and I don’t have these hang-ups,
or I hope I don’t get them when I’m 40. All she has to do is go back
there one night without her husband and she’ll soon know, that’s for
sure. If she’s too scared, then I’m happy to help her out!
Who is it you want to help out, Petal? The 40 year old or the waitress?
Or perhaps at your age, you’re ready for both? You will find out, Jack
my young lad, that personal relationships become a difficult and
personal matter when you get older. The ‘bull in the china shop’
approach will not stand you in good stead all your life, Jack. Read your
response again in another 20 years and see if you still feel the same
As I am thinking about retiring here, I was hoping you could advise me
on a couple of points. It has always been one of my ambitions to have my
own little pub (I’ve spent a fair deal of time in little pubs and bars
after work). There seems to be a few very successful bars for sale and
they only want about 600,000 baht for most of them. Since I will be
getting a nice tidy sum for my retirement, I thought I might invest in
one by buying a half share or something. It would be nice to make money
at a bar, rather than spending money at a bar, don’t you reckon,
Hillary! My only worry is that I have heard that foreigners have been
ripped off and I am hoping you can advise me on what to watch for.
With apologies to the Charge of the Light Brigade - “Into the valley of
death rode the six hundred” (thousand baht). Geordie, Geordie! For a
start, there are very few successful bar owners who learned the trade
from propping up the outside of the bar. Even with half shares for sale,
have you stopped to think why the owner of such a successful
establishment would want to give half of it away? Things to watch for?
There is always the third or fourth 50 percent share that gets sold.
Unfortunately, with the economic downturn, tourist cancellations etc.,
etc., etc., the bar will pay no dividend this year and the regretful
owner will buy your 50 percent share back for 100,000 baht. Yes, there
are quick profits to be made in the bar bizz - for the seller, not the
purchaser. Mind you, if you can get a half share in Jameson’s for
600,000 baht, count Hillary in too!
For the last two years I have been based here but I have taken another
off-shore posting to go to Malaysia for the next year. Should I keep the
lease going on the condominium and keep my girlfriend in it, or just
tell her that I will let the lease run out (there is another four months
to go) and she will have to go back to live with her mother till I come
back. I don’t want her to go back to the bar. What do you think I should
Your question is appalling, Petal. Surely you know by now whether this
is the girl for you. Stop dithering and make a decision. How much does
this girl mean to you? Not much it seems. From the kindness of your
heart you will let her stay on at the condo you have signed a tenancy
agreement on for the next four months - so you have got to pay anyway!
After that she can do anything except go back to the bar (where you got
her from) for the next eight months. Sounds to me as if she should go
back there right now and hope that someone who thinks more about her,
rather than himself, comes along.
by Harry Flashman
f8 and be there
The photojournalist’s creed used to be “f8 and be there” and
that still is relevant today. Even with today’s auto-everything
cameras, when you don’t have to set the f8 side of things, or
even the focus, you still have to “be there”.
I was reminded of this the other day when I was touring the UK.
I had spotted a rainbow and was chasing it, hoping to get a
great shot. Rainbows are not easy to get, as when you get the
exposure right for the actual rainbow, it is generally not
enough light for the foreground or background. Try it yourself
Anyway, I was getting increasingly frustrated with the rainbow,
but suddenly there was a break in the trees and I told my driver
to stop and I leapt out. A bracket of three shots was done, but
when I checked the exposures on the LCD monitor, I was again
disappointed. I turned back towards the car and suddenly, there
was an absolutely surreal image which had been behind me. The
birch forest in the late winter’s afternoon frosty light was the
shot of a lifetime. The three shot bracket produced the photo I
have used with the column this week. It was certainly a case of
“being there” to get that photo.
We traveled further and came across a wind farm. These are quite
fantastic, almost science fiction when you get up close. Again I
was “there” and it was just a case of getting close enough, but
yet far enough to try and show the height of these things. The
blades rotate very slowly, so a fast shutter speed is not
necessary, but I again did my customary three shot bracket. When
shooting something against the sky, it can be difficult to get
the best exposure, so try f8 and be there.
So what I am suggesting now is just “be there” to get good
shots. It also helps if you have a theme. This is true
“editorial” photography, where you, the photographer are
illustrating a story.
Try for example, “Early Morning at the Beach”. Firstly because
there is great light at that time and secondly because beaches
are a wonderful hive of activity as people get ready for the new
The following subjects are all there for you to shoot and you
should try and get them all. There are monks doing their morning
rounds. You will find the local people offering the monks their
food for the day. Get two shots here - one of the woman giving
the food to him and another of the monk in his robes walking
slowly down the street with his alms bowl.
Next subject should be the beach vendors, preparing their area,
raking and collecting rubbish, putting up the umbrellas and
placing the deck chairs. Try to make sure you have the man or
woman in the overall shot. Human interest always appeals. In the
early morning, the sunlight is with you, not against you, so
there is no tricky exposure compensations to be done.
More workers - the beach boys and the speedboats. There are
several shots here. Firstly take the line of boats and water
scooters being towed slowly to the boat ramps. Again a rear shot
of them going away from you is best, especially if they have the
young boys sitting on them, holding them down! Looking down the
road, as the second last trailer in the string goes past, pop
the shutter. That will be a good shot - guaranteed!
Mount them all together, and you have “Early Morning at the
Money Matters: Paul Gambles
MBMG International Ltd.
Water - 21st Century’s Oil
We have written on this subject before. Please check previous
articles in the Pattaya Mail for further information. However, this is a
subject worth reviewing again.
The Western world is consuming water like never before. This is at a time when
we have never had so little of it. On top of this, the method of distribution,
in many cases, is still in the 19th Century and not even the twentieth. This
means that there is also a lot of wastage. As president Lyndon B Johnson said in
1968, “A nation that fails to plan intelligently for the development and
protection of its precious waters will be condemned to wither because of its
short-sightedness. The hard lessons of history are clear, written on the
deserted sands and ruins of once proud civilizations.”
A well known study last year gave a doom and gloom forecast of what would happen
if there was a collapse in infrastructure around the world. The costing of a
total updating of what was needed came to over USD40 trillion. This is at a time
when the world’s population is growing faster than ever before. That figure
alone is worrying enough. The really bad news is that over half of it relates to
water infrastructure. If we just look at America, then you will start to
understand the problem.
There are over 700,000 miles of water pipelines in the USA. If you then add the
sewage system to that then there are nearly 1,500,000 miles. That fact is
stunning in itself but what if it was admitted that if things were to carry on
as they are now then it would take almost a millennium to replace everything
there is now? Well, this is what is happening and the fact has been confirmed.
As the citizens of London know only too well from experience, water systems for
both drinking and waste should be replaced at least every one hundred years -
preferably less than this. Most countries in the west take at least twice this
time to do this. This is why they are losing between 15%-45% of potable water.
So far we have just talked about the problems in the western world. Many cities
elsewhere still rely on something that was built well over a century ago. If you
look at places like New Delhi in India then they actually lose four fifths of
their drinking water due to poor infrastructure. This is because very little has
been done to update things since the 1950s.
Hong Kong is not as bad but still loses over a third of what is available as
does Sydney in Australia. To put this into perspective, even places like
California can lose a quarter of what runs through its pipes and this is meant
to be one of the most sophisticated places in the world. Everywhere in the world
is losing water unnecessarily and people turn a blind eye even though it costs
them a fortune.
However, times are a-changing. Due to global warming, politicians now realize
there are votes to be had due to environmental issues. Even the Chinese have got
onto the bandwagon. When China was awarded the Olympic Games for 2008, the
country realized that it needed to supply good quality drinking water for all
the visitors. Thus, it built a canal from the south of the country to the north
as the latter has no real water facilities itself. This cost USD60 billion or
twice as much as the Three Gorges Dam.
The problems go on, as an anonymous Jordanian said a few years ago in the
Washington Post, “(If) you think we have bad fights over oil. Just wait until we
start fighting over water. It’s predicted in the Koran.”
This is not surprising if you consider the Middle East itself. Many politicians
in this area agree with the above quote; for example, Palestine has to get its
water from Israel. This leads us back to infrastructure as water cannot be
transported via vehicles, it is just not financially viable. It is a lot easier
to go to war over who owns what. Being cynical, this will also reduce the amount
of people who will be around to drink what has been won.
Another important factor is that water and energy are becoming more and more
interlinked. It takes an enormous amount of water to create energy and vice
versa. The power industry needs three things:
1. A fuel source
2. A transmission line
3. A water source
Going back to America, nearly half of the water taken from rivers goes to
cooling power generation as you cannot have electricity power stations without
The situation is close to getting out of hand. It is not just the Third World
that is suffering but also the so called developed world. Big changes are going
to be needed in the near future but will they come?
Again, the cynical hat comes on, by investing in water and water related
infrastructure projects, there is good money to be made.
Let the last word be from Ismial Serageldin, World Band vice president for
environmental affairs, quoted in Marq de Villiers’ Water, 2000 - “The wars of
the twenty-first century will be fought over water.”
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 Paul Gambles on
Life in Chiang Mai:
by Mark Whitman
Facing up to bullies – Burmese and Thai
My thanks to the reader of last week’s piece about the
ongoing – and deteriorating – situation in Burma, for reminding me of an
oft-quoted but important saying by Edmund Burke: ‘All that is needed for
evil is that decent human beings do nothing.’ It’s another version of a more
modern suggestion – if you’re not against something then you are for it.
The saddest news since the incarceration of more political opponents to that
vile regime (some for up to 65 years) is that the UN, under the so-called
stewardship of Ban Ki-moon, decided not to present the petition asking for
the release of political prisoners to the Burmese generals. This letter
signed by well over 100 of the world’s most prominent people (including
three former Prime Ministers of the UK and two former US Presidents and
others of comparable distinction) was an echo of a letter signed by 60 or so
people last year, following the crackdown on the peaceful monks who had
dared to march against their oppressors.
Ban felt – with some justification, I suppose – that the generals would
ignore the petition. This follows the humiliation suffered by his envoy
there who has achieved nothing after several visits. In order to avoid such
a rebuff he seems to have decided not to make his planned official visit to
Burma in December. In other words, he is a decent person ‘doing nothing.’ My
argument against ignoring the letter from 122 important people is that at
least they are trying to do something and if – or when – they are ignored,
it is one more assault on the regime, which might serve to affect other
people and prompt them into action. Current leaders instead of past ones and
possibly the ASEAN conference, which has so sadly been a casualty to Chiang
Mai following the bully boy tactics of the PAD in Bangkok.
These bullies are not in the world class league of those across the border,
but they have certainly done incalculable harm to both the economy and the
image of the Kingdom. And harmed themselves in the process, especially by
employing people to sit in at the airports alongside the genuine – if
misguided – PAD supporters.
Their actions at Government House were deplorable and should have been
brought to an end long before early December. Equally their actions at
Suvarnabhumi and Don Mueang should never have been allowed to happen and
should certainly have been curtailed with all necessary force. They were
described nationally and internationally as terrorists and now their money
men face prosecution. Too late to undo the horrendous damage, which will be
a financial disaster in terms of tourism to rank with that of the tsunami.
The effect on travel to and from Bangkok and then beyond affected hundreds
of thousands of people, but resonated with many more. Some countries took it
worse than others, it appears. I received a frantic mail from a New
Zealander asking whether I was safe in Chiang Mai (ditto from family but
less frantic). And a friend who lives on North Island during our unpleasant
British winter sent me a somewhat humorous mail, which has an underlying
message that the actions at the airports were viewed very seriously abroad
and reflected very badly on Thailand. He wrote, “The ‘plight’ of the handful
of NZ tourists who did not get on planes before the shutdown has been
filling the press and the TV news for days. You would think that, rather
than being delayed and inconvenienced, they had been used as human shields
by a latter day Saddam Hussein from the reaction here. Very insular in their
thinking….” Sounds funny, but there is sure to be a sting in the tail. Sad,
when the world economy is bringing tourism into freefall, that these people
should give it a push in the wrong direction. Of course it will be the
ordinary working people who will suffer most, not the Bangkok middle
Let's Go To The Movies: :
Now playing in Chiang Mai
The Day the Earth Stood Still: US Drama/ Sci-Fi/ Thriller – I
enjoyed this! If you like sci-fi thrillers, you should too. Of course, you
have to be willing to accept a lot of the “aliens invade Earth”
conventions. I did, and found it a lot of fun. And as for Keanu Reeves,
he’s perfect for the part of the alien. Absolutely perfect, because he
really is an alien himself! I think all of us have always known that.
Think about him in any movie he’s ever been in. He is not human. He’s
truly an alien himself, a little spooky, but accessible, and lovable.
This is a remake of the landmark film of 1951 with Michael Rennie, Patricia
Neal, and Sam Jaffe, directed by Robert Wise. This time Keanu Reeves plays
Klaatu, a mysterious alien who travels to Earth with a simple mission: to
save the planet. He lands his vast space ship in Central Park, New York,
and tries without success to announce his plans to the world via a speech at
the United Nations. He’s taken into custody instead. Thus rebuffed, to
goes to his backup plan: He will destroy everything on earth, then
re-populate our planet with clones of the current species. All, that is,
except humans who he feels are responsible for Earth’s destruction and must
be permanently eradicated. He unleashes swarms of dust size robots who
sweep through New York and the surrounding area dissolving everything in
their path. As mankind fights to survive, one female scientist tries to
convince Klaatu to stop the earth’s destruction and give us all a second
Transporter 3: France Action/ Crime – I’ve seen it, and I can attest
that it’s an action movie – meaning that there are a lot of explosions, car
crashes, and men being violent and assertive. And it’s all quite
brilliantly done, and seasoned with just the slightest bit of plot and
humor. If that’s what you like, this is for you. It stars Jason Statham,
returning again as Frank Martin, a former British Special Forces soldier
turned mercenary, whose specialty is delivering risky items in a timely
fashion. In this third installment, Frank, just relocated to Paris, awakes
to find a bomb strapped to his wrist which threatens to blow up should he
try to remove it. Mixed or average reviews.
Ong-Bak 2: Thai Action/ Adventure – With Tony Jaa, who also directed.
I’m not sure what your reaction will be to this film, for it’s rather
difficult and really not too much fun to watch. It’s quite dark, and
exceptionally violent. Not for children! But it’s extraordinary in many
respects, and approaches almost every aspect of an action film in a new
way. And it seems a terribly personal film for Tony Jaa, in which he
apparently is trying to exorcise some inner demons. A fascinating attempt.
Traitor: US Drama/Thriller – With Don Cheadle. At Vista only, and
probably in its last days. See it while you can. Another serious look at
the world of moral uncertainty amid the war on terror. I am very fond of
this movie, but only mixed or average reviews.
Twilight: US Vampire love – It’s quite well done overall, and I rather
enjoyed it. Robert Pattinson is indeed a handsome, smoldering devil as the
vampire. It’s a complex story, in three volumes so far and more to come.
Mixed or average reviews. Vista has a Thai-dubbed version only, with no
English subtitles. Airport Plaza has it in the original English, with Thai
Beverly Hills Chihuahua: US Comedy/ Adventure/ Family – In this Disney
talking-animal comedy (not an animated movie), a pampered Beverly Hills
Chihuahua finds herself accidentally lost in the mean streets of Mexico.
Overall, mixed or average reviews. I found it amusing with some parts quite
a lot of fun.
007 – Quantum of Solace: UK/US Action/ Adventure/ Thriller – A
continuation of the 2006 Casino Royale, which was a reinvention of
the James Bond film series for present-day audiences. Here, with a
different director, I found the undertaking greatly diminished in charm and
style and elegance, with the action sequences more mindless and muddled, the
plot more convoluted and confusing, but with much to still like if you’re a
fan of Bond films. Generally favorable reviews.
The House Bunny: US Comedy – About the travails of an ex-Playboy Bunny.
Appallingly nauseous. Mixed or average reviews.
Scheduled for Dec 18
Happy Birthday: Thai Drama/ Romance – Starring Ananda
Everingham. Looks like a real weepy love story. This time Ananda is a
travel photographer who travels around Thailand with his guide/girlfriend,
until she has a terrible car accident and ends up in a hospital in a coma,
while Ananda waits endlessly at her bedside for her to wake up. From the
previews, I have to say it looks perfectly tedious, despite the fact that
I’m a fan of Ananda.
Bridge in Paradise :
by Neil Robinson
Last week’s column was about defence, and so is this week’s. When I read
about this hand (reported by Andrew Robson), it struck me as an example of
good defence – nothing spectacular, just good solid partnership play to take
advantage of declarer’s stumble. The hand occurred four boards from the end
of a long match. But this was not just any match – it was the final of the
Women’s Bridge World Championship held in Beijing recently. The English team
was playing the Chinese team. The overall match was eventually won by a
margin of just one IMP – the equivalent of a single overtrick. This board
was worth five IMPs to the eventual winners, so it turned out to be critical
to the championship.
At the table where the English team sat NS, they bid 2H and made 3H, for an
overtrick.. Now watch what happened at the table where the Chinese team were
sitting NS. The bidding is shown below. The Chinese South made a try for
game by bidding 3H. North declined the invitation and 3H was the eventual
South West North
South, all vulnerable
S: 10832 S: Q765
H: 83 H: AJ4
D: A975 D: 43
C: K32 C: A1086
West led the two of spades.
Dummy played low and declarer beat East’s queen with the king. Now, declarer
led a low trump. If she had put in dummy’s queen, she would have made the
contract. However, she played the ten and East won the jack. It still looks
like declarer only has four losers, two trump tricks, the ace of diamonds
and one club (since she only has a singleton club) and therefore she will
make the contract. So can you see how the defence could score the critical
fifth trick to get the contract down? The English pair at the table did.
East switched to the four of
diamonds. West won the ace and returned the diamond five – her lowest card,
asking for a club lead. Declarer won and led a second trump to the queen and
East’s ace. Now East, trusting her partner, made the key play. She underled
her ace of clubs. West won the king and led a third diamond. East ruffed,
taking the contract down one and showing the power of good communications in
effective defence. Four hands later, the English team were holding the gold
Please send me your interesting hands at: [email protected]