Dentist charged $7 for Consumables

I was walking past a dentist in a mall when I did a double take.

There was a notice on the door that said that from a certain date onwards, the dental clinic would charge an extra $7 for consumables used per visit.

Consumables are those disposal dental stuff/products that dentists used during consultation.

That's inflation talking. Prices are going up. Now even dental clinics are charging for consumables.
I heard of some clinics charging about $2-4 for such consumables but $7?

Why can't they incorporate that in their usual fee?

Personally, in order to slash expenses, I have changed my dentist from that of a private clinic to a dental clinic in a public hospital. And my savings have been quite significant.

For patients to really accept $7 extra in dental consumables, that dentist had better be freakingly good! Otherwise patients would just like me migrate to other dental clinics with cheaper fees and zero charge for consumables.

New rules for Beauty

Everyone wants to look beautiful. Beauty comes with a price and now new rules.

I suppose that these rules are created to protect the consumers. I have personally underwent a few aesthetic treatments for my skin.

I have done chemical peels, micro-needling, sub-ablative laser etc

The doctors I went to are aesthetic doctors or doctors who practise aesthetic treatments full time. They dun do other forms of medical practices, in other words, they dun see patients for other ailments like cold, fever, flu etc.

I have known people who underwent aesthetic treatments under GPs who also has a family practice. Treatments are definitely cheaper, but the the quality of treatments is not really there. The doctors are always busy in between treatments, seeing other patients for other common ailments.

Obviously such GPs are in it for the money. A common medical consultation cost about $20 to $30 per patient per session. An aesthetic treatment cost anything from $100 for a single session of chemical peel to $300-$500 for IPL or laser treatments. Do your maths.

Frankly, the best aesthetic doctor I have seen is Dr Yeak. She was formerly from Raffles Medical Group. She is now with Singapore Aesthetic Center in Novena, #08-12. She is warm, very friendly and not pushy!

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The Straits Times
25 July 2008

Doctors face tighter rules on aesthetic treatments

Such procedures to be offered only as a last resort from Nov 1

By Jessica Jaganathan

THE days of the 'cowboy practice' are numbered. From Nov 1, doctors will have to get permission before they can offer a range of controversial aesthetic treatments.

The Singapore Medical Council's (SMC) newly established Aesthetic Practice Oversight Committee will decide who will be allowed to offer these treatments that are not backed by strong scientific evidence.

Promising weight loss and fairer skin among other results, they should be offered only as a last resort, after all conventional methods have been exhausted. No advertisements of these treatments are allowed too.

Doctors will be also have to get written consent from patients and record every detail of the treatment and the results, just as in a clinical trial for a new drug. This regime will apply to seven aesthetic treatments, including fat-busting mesotherapy, where drugs are injected into the body.

Aesthetic treatments have been the subject of much debate over the last three months, after the health authorities raised concerns about the number of doctors branching out into lucrative beauty treatments, some of which are banned in other countries.

Yesterday, details were released about how the profession plans to regulate some 30 aesthetic procedures, within a week of the Health Ministry coming out with stricter rules for liposuction.

Professor Ho Lai Yun from the Academy of Medicine said: 'At the moment, it's a cowboy type of practice.' With the guidelines, he added: 'Patients will know who they can go to, what are the procedures available to them, what they can expect...So, to a greater extent, they are protected.'

For instance, filler injections to plump up lips can be done by plastic surgeons and GPs in a clinic. More invasive procedures, like breast enhancement surgery, can only be done by a plastic surgeon in an operating theatre.

Although general practitioners are allowed to do most of the less invasive aesthetic procedures, they will need proper credentials - they must attend an accredited course recognised by SMC and attain a certificate of competence.

Doctors who flout these guidelines may be referred to the SMC for disciplinary hearing, where, depending on the case, they could be fined or even suspended.

The profession's watchdog is already investigating the aesthetic medicine practices of six doctors, including a specialist.

Madam Halimah Yacob, chairman of the Government Parliamentary Committee for Health, said the guidelines were a good start to enhance patient safety but cautioned that consumers may be driven to beauty salons instead. She said: 'These treatments if not done properly can lead to serious complications...it does not make sense to insist that only doctors be subject to these guidelines while beauty salons are free to operate without any rules even for invasive procedures.'

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The Straits Times
25 July 2008

AESTHETIC TREATMENTS CARRIED OUT BY GPs

New rules' impact merely skin-deep?

New guidelines still being debated but most GPs taking them in their stride

By Jessica Jaganathan

THERE is unlikely to be any major shake-up in the aesthetic treatment business because of the new rules released by the profession and the Ministry of Health (MOH), say doctors.

The guidelines covering about 30 aesthetic treatments give both the specialist and the general practitioner (GP) sufficient room to continue to make a living.

Some signboards will have to be changed, though - as doctors were reminded yesterday that they cannot refer to themselves as 'aesthetic' doctors or surgeons, as it is not a recognised specialty.

There will also be clear benefits for patients with the new guidelines. They can be confident that the doctor is properly trained to offer the treatment if it has been tried and tested. And if it is experimental, then the doctor will be watched closely and the results monitored as well, regardless of whether he is a specialist or a GP.

The two camps have, for the most part, been on opposite ends of the aesthetic treatment debate for the past three months.

Some plastic surgeons were portrayed as viewing regulation as a way to protect their turf, while GPs were said to prefer minimal oversight so that they could muscle in on the lucrative $200-million-a-year market.

With the new guidelines out yesterday, plastic surgeons are happy that most invasive treatments must be carried out in an operation theatre, a requirement which would effectively rule out GPs.

Dr Colin Tham, honorary secretary of the Singapore Association of Plastic Surgeons, welcomed the restriction on GPs doing invasive procedures, and said the impact of the new guidelines on plastic surgeons was minimal. He did speak up on behalf of GPs, questioning the need for a certificate of competence for GPs to perform some of the non-invasive procedures, describing the requirement as being 'over the top'.

But other plastic surgeons did caution that the institutions awarding the certificates should be scrutinised carefully.

GPs who have been offering some of the less scientifically proven treatments such as mesotherapy and carboxytherapy said they would have to study the clinical trial requirements closely before deciding if they will apply to offer these treatments after Nov 1, when the new guidelines kick in.

The Society of Aesthetic Medicine, which comprises mainly GPs, plans to write in to MOH to appeal against requiring seven 'controversial' treatments to be offered only as a clinical trial. The society's spokesman, Dr Benjamin Yim, a GP who has been offering endermologie for four years, said patients might be more sceptical of the treatment when told that it is experimental, and this might drive them away. Endermologie is a non-invasive technique for reducing the appearance of cellulite

As a clinical trial, doctors have to document in detail patient results and, usually, a large pool of patients is needed - typically about 200.

Associate Professor Goh Lee Gan, president of the College of Family Physicians, said the cumbersome process might discourage some doctors from doing them. 'Research will show us if the treatment is useful or not for the patients,' said Prof Goh.

However, Dr Roy Chio, a GP who offers endermologie and micro-needling, said there already exists evidence that these treatments work and they are well-documented in medical journals overseas.

A marketing executive, who wanted to be known only as Cynthia, said having proper guidelines now will make it easier for patients like her to know what is allowed and what is not. But the 26-year-old, who had micro-needling treatment about five months ago, said it had been effective in reducing her acne marks.

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Treatments that need clinical trials

Fat reduction

# Mesotherapy: A drug cocktail is injected into the skin. It is believed to melt fat.

# Carboxytherapy: A non-surgical procedure like mesotherapy, in which carbon dioxide is shot through a needle to 'kill' fat cells and stimulate blood flow.

# Mechanised massage: This is a non-invasive deep-tissue massage performed with a machine to reduce cellulite.

Skin treatments

# Microneedling dermaroller: This device uses a series of pins on a hand-held roller to make microscopic punctures in the skin. It supposedly encourages collagen to form and reduces scars and wrinkles.

# Stem-cell activator proteins: Patients consume a protein extract that 'regenerates ageing tissue' by using protein or chemical messengers to send signals to cells to 'teach' them to regenerate.

# Skin-whitening injections: These jabs are supposed to reduce blemishes such as acne and chicken pox scars and wrinkles.

Miscellaneous treatments

# Negative pressure procedures: In vacustyler sessions, for example, a patient's lower body is placed in a chamber where a machine stimulates the lymphatic system. This is believed to improve circulation in the lower body.

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THEATRE WORKS
With the new guidelines out yesterday, plastic surgeons are happy that most invasive treatments must be carried out in an operation theatre, a requirement which would effectively rule out GPs.

APPEAL PLAN
The Society of Aesthetic Medicine, which comprises mainly GPs, plans to write in to MOH to appeal against requiring seven 'controversial' treatments to be offered only as a clinical trial.

Skin patch to reduce paranoid

I did a double take as I read this news article. Is this real? Has medical technology advanced to such a state that only a skin patch is used to treat paranoid?

Maybe I should get one for my mother? She has been paranoid for years!

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The New Paper
25 July 2008

Skin patch helps reduce woman's affair paranoia

The Exelon Patch improves mental functions such as memory and thinking in Alzheimer's patients

By Ng Wan Ching

THE 80-year-old woman was severely paranoid that her husband was having an affair. So much so that her husband made sure all the caregivers in their household in Jakarta were men.

Paranoia can be a symptom of Alzheimer's disease, which was what she was suffering from. Her condition was progressively getting worse. It was also a challenge to get her to take her medicine - she was paranoid that people were poisoning her, so she refused all oral medication.

A few months ago, the elderly woman came to Singapore to see Dr Sitoh Yih Yiow, consultant geriatrician from Age-Link Specialist Clinic for Older Persons.

He prescribed a medicated patch (Exelon Patch), the only skin patch approved for the treatment of mild to moderately severe Alzheimer's dementia here. Dr Sitoh said: 'This mode of delivery of the medication helps both patient and caregiver by providing an easier way to manage their therapy.'

He told the woman's husband to put a patch on her lower back once a day. The drug on the patch is absorbed into her body through the skin. Two months later, when the doctor assessed her, she had improved a little. She was no longer as agitated and paranoid and was a little more amenable to being treated medically.

The patch that Dr Sitoh prescribed is the world's first skin patch to be used in treating Alzheimer's.

The medication (rivastigmine) is not new. It has been available in capsule and liquid formulations since 1997. It improves mental function (such as memory and thinking) by increasing the amount of a certain natural substance in the brain. It also improves the patient's ability to perform everyday activities.

It is the delivery method that is new. Researchers found that the once-daily skin patch provides smoother and more continuous delivery of the drug over a 24-hour period compared to pills. A study of 1,200 patients from 21 countries who were given the patch daily showed that the patch was as effective as the capsules. The study also showed that the side effects were three times less than those for the pills.

One in four patients reported the side effect of nausea with the pill, while one in 14 reported nausea with the patch. Other side effects include vomiting and diarrhoea.

There was also a study done with the caregivers. It showed that 70 per cent preferred the patch because of ease of use and an easy-to-follow schedule.

Dr Sitoh cited another patient who was a good candidate for the patch. The man, an 83-year-old Singaporean, suffers from Lewy Body disease, which is a cause of dementia very similar to Alzheimer's disease. He had difficulty swallowing. He also suffers from diabetes and high blood pressure. His family were resistant to having him take more medication.

'Earlier this year, I suggested the patch. He's now more alert,' Dr Sitoh said.

The patch was approved for use here by the Health Sciences Authority in April. Dr Sitoh has prescribed the patch to five patients. In Singapore, there are about 200 patients using it.

Dr Ang Guan Lee, medical head of Novartis (Singapore), manufacturers of the patch, said: 'The cost of similar drugs used to treat Alzheimer's disease here is between $210 and $280 a month.'

The patch will cost a patient about $250 a month.

Lipo new rules

I am intend to undergo liposuction in the future to remove some stubborn areas of fat.

But a GP? Frankly, the option is not that attractive when only one litre of fat can be removed per session.

I would rather pay a few hundred bucks more to consult with a licensed plastic surgeon and have a few more litres of fat pumped out.

I have consulted with a aesthetic doctor who is not a plastic surgeon. He charges $2500 - $3500 per area.

The tummy area is NOT considered one area. It is the middle section, the right abdomen and the left abdomen. So that is 3 areas! But then there is also the top abdomen and the bottom abdomen.

The range of prices for each area of lipo cost between $2,000 to $5000, depending on how experienced and famous is the doctor. Some doctors may even charge more.

Frankly, I would not advise anyone to see a plastic surgeon unless one is prepared to spend at least $10k -$30k!

Lipo can be a simple surgery of just pumping out the fats from parts of the body, but dun forget, complications can happen!

Can a GP handle all these complications of excessive bleedings, infections, nerve injury? Are they trained to do so?

Frankly, I am not that afraid of death, but I have seen pictures of lipo gone wrong. Gaping wounds, sagging skins, organs failure due to infections etc. And these sort of after effects of lipo are not really worth it!

Get a reputable doctor, preferably a plastic surgeon!

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The Straits Times
23 July 2008

Most GPs able to perform liposuction under new rules

Majority would clear key hurdle - a year's surgical training - when rules kick in

By Lim Wei Chean & Jermyn Chow

IT WILL likely be business as usual for most doctors who do liposuction when rules governing the now-unregulated surgery kick in this November. Most GPs would clear what many see as the main new hurdle - having one year of surgical training in fields ranging from urology to paediatric surgery.

Professor Foo Chee Liam, who is chairman of a new committee that will licence the surgery, said 'initial data' show that most GPs satisfy that requirement.

It was one of several rules unveiled over the weekend designed to regulate liposuction, which has led to deaths in other countries, but not here.

In November, doctors will also be required to have nurses on hand to monitor sedated patients. They are allowed to remove less than one litre of fat per session. Doctors who want to be accredited will also be assessed on their track record for liposuction.

The Society of Aesthetic Medicine, formed mainly by GPs, hailed the rules, which allow doctors to continue performing the procedure in their clinics.

Dr Benjamin Yim, a spokesman for the society, said the move requiring GPs to be accredited for liposuction by the new committee will benefit patients. The regulations will see the procedure performed in a safer and more professional manner, he added.

Doctors estimate that thousands of people have liposuction annually. A single session can cost $2,000 or more.

Some plastic surgeons, who for months had criticised the rules as being too lax, voiced their disappointment again on Monday. 'How is one year of surgical training in urology relevant to liposuction?' said Dr Colin Tham, spokesman for the Singapore Association of Plastic Surgeons. He said the new rules could sidetrack Singapore's goal of becoming a centre for medical excellence.

But others hailed the new rules as a move in the right direction.

'At least it will no longer be a cowboy industry where anyone can just buy the machine, watch a few DVDs and do the procedure,' said Dr J.J. Chua, a plastic surgeon. 'The onus lies on all doctors, including plastic surgeons, to show the authorities that everything they do is above board,' said the 42-year-old, who runs his own practice at Mount Elizabeth Hospital.

Madam Halimah Yacob, chairman of the Government Parliamentary Committee for Health, said the new rules will help protect the safety of patients. But she cautioned that liposuction should not be considered the only way to lose weight. 'Exercising regularly and maintaining a balanced diet are still the best ways to look good,' she said.

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What you need to know about the procedure

What is liposuction?

It is an invasive surgical procedure in which solid fats are sucked out of the body. Performed under general anaesthesia, it typically takes a few hours and costs at $2,000 or more. Recovery follows in one to three weeks. Less invasive ways to remove fat include laser- or ultrasound-assisted liposuction.

How widely done is the procedure?

One of Singapore's most popular vanity procedures, liposuction is done here thousands of times every year, doctors say. No exact figures are available, though.

What can go wrong?

Botched jobs can result in infections, bleeding, skin ulcerations and nerve injury.

Who can perform liposuction now?

For now, liposuction is performed by a range of doctors - from plastic surgeons to general practitioners (GPs) in operating theatres or their clinics.

From Nov 1, however, only plastic surgeons and accredited GPs will be allowed to perform it.

To be accredited, GPs need to have spent at least a year in surgery, and they must acquire some training. They need to observe at least five such procedures being done by qualified medical practitioners and perform at least five procedures themselves under the supervision of these qualified practitioners.

Where can it be done?

From Nov 1, operations to remove more than a litre of fat have to be done in a hospital or surgical centre. Procedures involving less than this amount can be done in approved premises.

How is this procedure regulated overseas?

In Malaysia, private GPs have been barred from performing liposuction since last November, along with breast implants and laser- and light-based therapies. They also cannot use unapproved agents or inject products unsupported by evidence, such as growth hormones.

Britain, Australia and Canada have no specific regulations on cosmetic procedures. The British government encourages self-regulation, and independent bodies in Britain set recommended standards.

Doctors there are not required to undergo special training in aesthetic medicine, and no register of specialists in the field is kept.

Medical clinics in Canada are regulated, and they are required to administer anaesthesia.

France has a 15-day 'cooling-off' period, which forestalls liposuction practitioners who are hard-selling the procedure to their patients.

What price Altruism?

The New Paper
23 July 2008

What price Altruism?

Should there be financial compensation for organ trading?

By Low Ching Ling

IT is an issue that has divided patients, their families, doctors, lawmakers, ethicists and just about anyone who feels strongly about it.

Supporters of legalising organ trading say it is a no-brainer: Why not do it if it can save more lives?

Please, get real, no one is going to give a stranger his or her kidney for free, they argue.

Critics decry organ trading as unethical. They insist donors should do it out of the goodness of their heart.

Which way should Singapore go?

But does it always have to be narrowed to a zero-sum game - either pure altruism or financial reward?

Perhaps not, Health Minister Khaw Boon Wan revealed in Parliament yesterday. He said he would sometimes get requests from charities and religious bodies who want to offer 'some compensation, in kind and in cash' to organ donors and their families to 'acknowledge their altruistic act'.

But the organisations would worry that their gestures might be seen as organ trading.

Mr Khaw said: 'My view is that we should encourage third parties, especially those from the charity and religious sector, to help promote altruistic organ donations, and that we should consider how they can be allowed to provide some financial compensation to the donors and their families after the transplants have taken place.'

Yes, push altruistic organ donations to their 'maximum potential', and let living-related kidney donations and those done under the Human Organ Transplant Act to still be the 'predominant sources' of kidney transplants.

But don't rule out organ trading, Mr Khaw added.

'If altruistic organ donations cannot fully meet the demand, we should continue to search for good complementary solutions,' he said.

'We should not reject any idea just because it is radical or controversial.'

Can legalising organ trading be the answer to our kidney donation woes?

Mr Khaw said: 'By forcing ourselves to think about unconventional approaches, we may be able to find an acceptable way to allow a meaningful compensation for some living-unrelated kidney donors, without breaching ethical principles and hurting the sensitivities of others.'

And perhaps it is time we get real, he said. After all, there are desperate patients out there who want to live, and also desperately poor people willing to exchange a kidney for a better life. 'This is the reality and the human dilemma confronted by many in such desperate situations,' Mr Khaw said.

'Criminalising organ trading does not eliminate it. But it merely breeds a black market with the middle man creaming off the bulk of the compensation which the grateful patient is willing to offer the donor.'

WHAT PRICE ALTRUISM?

So, will putting a price on altruism work in Singapore?

It may still take some time before the Government reaches a decision. For now, the Health Ministry will push to amend some other existing laws on organ transplants.

First, by removing the age limit of 60 years old on cadaveric donors.

Mr Khaw said: 'Many countries, including Spain, do not set such an age limit. The suitability of the organ depends on its condition, rather than the age of the donor.'

Second, by allowing pair-matched donations here.

This means that if patient A's donor does not match A and patient B's donor does not match B, they can switch donors if there is a match that way. A live donor registry will be set up to facilitate this.

With the two initiatives, Singapore can aim to raise its kidney sufficiency level from 50 to 70 per cent in the medium term.

What about those who have broken the law?

Mr Khaw said: 'Even as we take action against those involved in illicit organ trading and unscrupulously exploiting the desperate and the vulnerable, we will take a sympathetic approach to the plight of the exploited donors and the basic instinct of kidney failure patients to try to live.'

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The New Paper
23 July 2008

Want fairness? Let kidney bank handle it

By Ng Wan Ching

THROWING money at donors is not the solution to the kidney shortage facing kidney failure patients here. If it is, then those who need money the most will be the first to give. And those who have the most money will be the first to get.

That situation, as so many have pointed out, will exploit the poorest among us and it will favour the richest. The amount of money given, directly or indirectly, to the donor, will influence who might donate a kidney.

At $20,000 to $50,000 a kidney, perhaps the lowest earning segment of society will feel compelled to give.

For up to $300,000, perhaps the next higher segment of society will feel the push.

For up to $500,000, perhaps even well-heeled professionals might be induced to donate.

The amount has to be carefully calibrated so as to be meaningful and yet not glaringly so that it becomes a rare consumer item.

Idealistic as this sounds, there should still be room for altruism, albeit not so pure. (None of this prevents those who want to give for nothing in return.)

So how can the sums paid to donors be regulated?

The money could come from a common pool managed by a governing body rather than individuals paying for their donor organ in a free market. On top of managing the money, the governing body overseeing the kidney bank will have to come up with policies that address various issues.

Such as, what will happen to their family members if they happen to need a kidney in the future? Once someone has given up one of their kidneys, they won't be able to help their loved ones in their time of need.

One solution is to put kidney donors' family members at the top of the transplant list if they do need a transplant. And while money might encourage more people to give, there will still be those who baulk because of health considerations.

Many US hospitals say donation does not increase a donor's risk for kidney failure or put him at more risk for future health complications.

But the 'what if's' linger.

Studies have been done to show that donors are at no more increased risk of heart attacks. Further study is needed to determine whether the apparent increase in the risk of high blood pressure is truly an effect of living kidney donation.

The long-term monitoring of donors' health calls for more research.

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The New Paper
23 July 2008

Allow organ trading, says Noble Prize laureate

Attitudes towards compensating kidney donors are changing. Health Minister Khaw Boon Wan spoke about a recent article by Dr Gary Becker, of the Hoover Institution, who won the 1992 Nobel Prize in Economics.

In an article titled 'Should the purchase and sale of organs for transplant surgery be permitted?', Dr Becker used economic principles to argue for organ trading. Here are some excerpts.

AN ECONOMIST'S PERSPECTIVE

'To an economist, the major reason for the imbalance between demand and supply of organs is that the US and practically all other countries forbid the purchase and sale of organs.'

WON'T REDUCE NUMBER OF DONORS

'Some critics simply dismiss organ markets as immoral 'commodification' of body parts. More thoughtful critics suggest that allowing organs to be bought and sold might actually reduce the total number of organs available for transplants because they claim it would sufficiently lower the number of organs donated from altruistic motives to dominate the increase due to those sold commercially.

'That scenario, however, is extremely unlikely since presently only a small fraction of potentially useable organs are available for transplants.'

LIMITS TO OPT-OUT SYSTEM

'A PhD thesis in progress by Sebastien Gay at Chicago shows that opt-out systems may yield somewhat more organs for transplants than the opt-in systems used by the US and many other nations, but they do not eliminate the long queues for transplants.'

CHARITY NOT ENOUGH

'If altruism were sufficiently powerful, the supply of organs would be large enough to satisfy demand, and there would be no need to change the present system.'

EQUILIBRIUM PRICE

'In a paper on the potential of markets for live organ donations, Julio Elias of the University of Buffalo and I estimate that the going price for live transplants would be about US$15,000 ($20,280) for kidneys and about US$35,000 for livers.'

Current costs for transplants in the US are in the range of US$100,000 for kidney and US$175,000 for liver.

POOR NOT EXPLOITED

'... why would poor donors be better off if this option (of selling their organs) was taken away from them?

'... Many of the organs used for liver or kidney transplants are still likely to be supplied by relatives. In addition, many middle class persons would be willing to have their organs sold after they died if the proceeds went to children, parents, and other relatives.'

DETERRING IMPULSIVE SELLERS LOOKING FOR SHORT-TERM GAIN

'(We can have) a month or longer cooling-off waiting period between the time someone agrees to supply an organ and the time it can be used.

'They would be allowed to change their mind during the interim.'

My dying love

Gin, the love of my life, my beloved terrier is dying. She is about 15 years old this year, a grand dame in doggy years. I had her since she was a few weeks old and she had been with me for most of these years. Except for the few years I moved away from home. But once I had my own place, I moved her back to stay with me.

She has always been a loving, patient little doggie. My previous dog, a Pomeranian lived only to about 10 years of age. So 15 years has been a blessing.

Since the beginning of the year, Gin has been showing signs of her age. There were a few occasions she collapsed after coughing. Her coughing has been getting worse. We had a heart ray done and the vet said she had a heart problem and that her windpipes were narrowing. All these are signs of aging. Other than giving her anti-biotic to help relaxed her pipes and cough syrup to sooth her throat, the vet said nothing can be done.

Frankly, I dun quite expect her to live beyond the year. Everyday, I live in fear of the moment that she would breathe her last.

Just this evening, as I was bringing her for a walk, she staggered and I had to carry her. She went all limp and soft, her energy all gone. But back home, she managed to recover.

She has been panting and smiling at me these few nights and it bloody hell scared me and freaked me out. And it broke my heart to see her this way.

Just a few days ago, on a walk, she just collapsed on the floor and gave a blood curdling cry that can be heard for miles. Frankly, I thought, that's it, finally and it really scared me to hell and back.

One of my worse nightmares was that I have lost her. There were several nightmares I had where she gone all missing and I cannot find her. I always woke up in tears and sweating and the first time I did was check she is still around and not missing.

Gin had a good life. If I am a dog, I want to be her. She was loved, had good food, good company, and a great life. I just dread the day that she would be taken from me and go to doggie heaven.

I am going for a blood test this friday and I did consider taking her to the vet since we lease a car for the day. But can the vet do anything? She is already at her end of her years. 15 years is really quite an old ripe age for canine.

I was also thinking of bringing her to the groomer after the vet, but I am so afraid that she would collapse and just drop dead at the groomer.

SO refuses to let me take her to the vet on Friday cos I have a medical appointment on Saturday. It is the day the doctor would test my blood level to access if my liver condition has worsen. SO is afraid that if she dies at the vet or groomer, I would not turn up for the medical appointment.

My heart is heavy. Gin is the love of my life, she is my sister, best friend and daughter, Frankly, I do not know what to do without her around.

Going numb and blind

Today I had two scheduled medical tests at AH. I had complained to the doctor on my previous visit 2 weeks back that my last three little fingers on my left hand were numb. I also told her about the grey black spots that appeared in my vision under bright sunlight.

We arrived bright and early at AH's Clinical Measurement Unit for my nerve tests. There were a few people sitting around waiting their turn. I had arrived earlier than my scheduled appointment and was surprised that when the actual appointment time came, I was shown into a room punctually.

I was greeted by this rather petite lady, whom I later found out to be a medical technologist. Her duties was to perform a series of electrode tests on all my fingers on both my hands to test their nerve functions.

The technologist was quite friendly but eh...there was a certain smell about her. At first, I thought she had body odour, but then later, I realised the smell was coming from her shirt. It was a sourish sweat smell, which took me a while to get used to.

Frankly, I did considered telling her about the smell but I did not cos I really dun know her and she might constitute such frankness as rudeness. Besides, she might feel embarrassed and that could maybe spoilt her day.

If it was someone I know, yeah, I would tell them about their sweat smell or BO or certain smell, so that they could take note and do something about it.

I remembered when I was working as a temp many years back. There was this young girl in the accounts department who had really bad BO. I really hated entering the accounts room cos the room reeked of her sour BO. I asked around why no one told her and how they could have worked in such an environment. The accounts people said that they were used to it and they thought it was rude to tell her she got BO. So no one did. They just held their breath until they got used to it. That was so kind and yet so stupid!

People with BO could not smell their own foul smell. Someone need to tell them so that they are aware of their problem and do something about it. If I have BO, I want to know, so I can do whatever to treat it. So yeah, I will tell most people tactfully, unless I think they cannot handle knowing. Maybe then, I would drop heavy hints.

I am digressing. Anyway, the nerve test took about 3o mins. The medical technologists attached electrodes to each finger and test the nerve reactions as she ran a minor electrical current through them.

I asked her if the results were normal. She said most of my fingers nerves were normal except for the last 2-3 fingers on my left hand. She repeated certain tests on those fingers to verify her results. She told me she could not give me a detailed report. She would submit her findings and her superior would generate a report, which a doctor would explain to me on my next medical appointment.

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My next appointment was at the Ophthalmology and visual science clinic for my eye test. This clinic was crowded and most of the patients were old folks in their 50s. I felt out of place. Had my eye condition gone so bad that it is similar to those of senior citizens? Am I going blind?

After registering and waiting for 15 mins or so, they called my name for an eye test. There I was lead to a darkened room, where a nurse checked my eye sight. There was a series of rows of numbers a certain distance away, and she made me read certain rows to check my eye sight. She checked the right eye first and then the left eye. And then she repeat the test with this dotted glasses. With the dotted glass, some of the rows which I could not read initially, I could see. I ought to get myself a pair of these glasses, which I know is available in some pharmacy.

Then she led me to this eye examine machine where she asked me to look into. The inner of the machine was this bright photographic picture of a long straight road with blue skies on both sides of the road. She then told me she is going to spray something into my eyes and asked me to focus looking into the machine.

After the eye test was completed, I was next asked to wait outside for a eye doctor.

After waiting for what seemed to be ages, a young doctor came out of his room to call my name.
He introduced himself as Dr EC and sat me down. Dr EC was this stocky hairy fellow with short hair and bouncy butt. His voice was rather high pitch whiny tone but not feminine.

He then started to ask me a series of questions like when i noticed the dark spots in my vision, if I had any eye trauma or fall or whatever etc. Then he asked me to stare and focus into his machine lenses as he examined my eyes. He directed me to look right, look left and look straight.

Frankly, it has been a long time since another man except SO stared so intently into my eyes.
Gosh, he must be staring for more than 15 mins.

Maybe cos due to his age....late 20s?, I dun really think he was that experienced. Frankly, I wondered if he found the real cause about my eye condition? All he could said was it did not seemed to be retina detachment. And these dark spots also sometimes known as floaters and flashers are signs of aging. He said that people just have to live with it cos it is not something that can be treated with medication, eye drops or surgery.

Sigh...I was a bit depressed on hearing this. I had read up all on floaters and flashes before this, but this verbal confirmation of my eyes made me realised that my eyes are failing. I always had perfect eyesight. While a lot of my classmates were struggling with glasses, I have always been glasses free and now I am young and my vision are showing these signs of aging. By a certain age, I would probably go blind!

While checking my eye sight, our thighs and knees were pressed against each other. And yeah, as I told SO later (who called me a slut!, that bitch), it has has a long time since I pressed my knees against another man's thighs or had my thighs pressed against by someone's knee.

Gosh, I sounded so desperate and deprived. Ha! It was a certain intimate moment that was mostly corny and very awkward.

Anyway, Dr EC told me to wait a while and that he would get a senior doctor to confirm his diagnosis. Sigh...that shows that he is as inexperienced as I thought he was.

The senior doctor, Dr S arrived and directed me to look into the lens of the machine as he examined my eyes. He was quick in his diagnosis. He was able to detect in less than 5 mins that I have floaters and that I also have the beginning of cataracts in my left eye. He explained that that would account for the bright flashes as I watched TV.

This was something that the young Dr EC could not detect despite staring at my eyeballs for ages. Anyway, Dr EC told me that I have to check into the hospital immediately should my vision worsen drastically in a short time. He gave me a follow up appointment in one month time.

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Frankly, eye sight is the most important to me. I would rather go deaf or mute than be blind. I got this great fear of darkness. I would rather die than live a life in darkness. I can survive without hearing, without speaking but seriously I dun think I can function without seeing.

Let's see how this goes in one month time.

Turning yellow

Fingers still numb!

My fingers are still numb. The numbing sensation is less and I am also getting quite used to it.
The first two days were the worst. I was so conscious of the numbness that my fingers felt so uncomfortable.

Now, they are still numb but I can block out some of the feeling. They are constantly numb, not numb in flashes. Could the fever burn out some nerves to cause such numbness? Are they temporary, semi-permanent or permanent?

Frankly, before they were numb, I was not so conscious of my fingers. They were my fingers and just there. Now the tingling numbing sensation is a constant reminder of the existence of my fingers.

SO wanted to bring me to the doctor nearby. But what can they do? Do they have the necessary equipment to run tests or would they just refer me to the hospital or specialist? I refused to go. I told SO I would rather wait for my medical appointment at AH on 24th May.

This AH medical appointment is my regular medical appointments which I have been doing for years. Every three months, I had a series of blood tests to test my uric acid, blood pressure, blood sugar, cholesterols, liver and kidney functions. And each session, I paid about less than $100 for blood test and medication. And if I have additional medical problem, I just have to tell the doctor and they would referred me to a specialist within their hospital clinics. Just like the time, I had bloody stools and was referred to a doctor who checked my colon and gave me a colonscopy. He found out I had piles and I had a minor day surgery to cut off my those protruding blood vessels.

SO agreed reluctantly but wanted me to go see a doctor or hospital, should the numbing spreads or become worse.

Fingers Numb!

I had just recovered from my high fever over the weekend and was watching TV last night when I realised that my three last fingers on the left hand going numb. There was a sharp tingling and numbing sensation. Frankly, I thought I was having a heart attack or having a stroke. I really thought that my fever yesterday had triggered a stroke.

SO was sleeping as usual but I did not wake him, though I was close to panicking. But rather than checking in the hospital and staging a false alarm, I surfed the net and googled for numb fingers. I was not having any heart palpitations, nor was i having difficulty breathing just that my fingers were numb.

I found out online that for a stroke to happen, your left side would be totally numb, that means including the whole arm, and maybe the face. Since my was only 3 fingers, the cause could be neurological caused by the high fever, or pinched nerve or carpal tunnel syndrome.

Such conditions are quite common and reading these lessen my fears to a great extent.

I did told SO the condition as I was preparing for bed. He told me that if the numbness persisted longer, he would accompanied me to a doctor the next day.

High Fever!

SO and I came down with high fevers over the weekend. It started as a slight sore throat on Friday afternoon on my side and by evening, my throat was cracked and raspy.

SO as usual had went home to his mother's place to spent the night. When I sms him on Sat morning as he was returning home, that I was sick with fever, sore throat and cough, he told me he had the same symptoms.

By the time he returned home in the late morning with breakfast, I was down in bed with fever. After breakfast, both of us went to bed, feverish.

Frankly, the next 2 days were in a daze. I remembered just sleeping and sleeping. We simply have no energy nor strength to wake up. We were just lying there, weak and faint. I was feeling hot and cold and having all these nasty nightmares of being in a hospital ward. It was a nightmare that repeated itself. For two whole days, I dreamed of being in a hospital ward, lying in bed, turning and tossing.

I seriously thought I was going to die. I asked SO if he thought it was dengue fever but he simply just refused to accept the notion. Being the one always at home, while he's always about running about for work, chances are that he brought back whatever virus, sickness and spread it to me. That bitch simply denied it. He claimed it was airborned and that I had spread it to him.

Anyway, after sleeping for 2 days and having 2 panadols every 8 hours, we recovered. Well, at least SO recovered enough to go to work on Monday, while I slept the whole day until he returned from work.