A patient of mine with past history of epilepsy presented with sudden change in behaviour recently.
She went for a trip to a holiday beach resort with her friends, and started to develop strange behaviour a few days later. She first complained of her right hand being "jammed" and was unable to play piano, then developed difficulties in expressive herself coherently, and started to have panic spells with insomnia/pacing in-out of the room ... these culminated eventually to spells with arching of the trunk backwards when she lay supine on the bed (making a reverse C-shaped), with head and legs pressed against the bed. Her mouth would be wide opened, neck flexed backwards, tongue rolled back, struggling hard to shout but no sounds appeared. She might thrash her legs involuntarily in the midst of the attacks at time. These episodes occurred intermittently, several times per day, lasting 5-20 minutes each. They persisted despite the use of high dose of sedative medicines. At times, at the end of the spells, she would uttered "help me" in exhausted voice. These paroxysmal spells were rather reminiscent of scenes from "The Exorcist". It was no surprise to me when some of the nurses surreptitiously asked me "Doc, could she be "possessed"?".
Traditional cultural / spiritual beliefs are very strong among residents of South East Asia. Many of us , particularly those staying in rural areas, grew up in society where folk tales about black magics, pontianak, spirits abound. Even those who stay in urban areas are not spared from the horror movies depicting evil spirits with Eastern flavour. When faced with things beyond reasonable scientific / logical explanations, people will resort to traditional spiritual realms for answers.
And back to my patient, I don't think she is "possessed". There is a neurological basis for the bizarre contorted postures she adopted. They are typical manifestation of frontal lobe seizures - with arching of trunk, thrashing of limbs and unresponsiveness. To the untrained eyes, these are too bizarre to be pure disturbance of brain activities. It is a real challenge to sort out the underlying cause of her seizures. Various tests to date (MRI, spinal tap, blood tests) have yielded negative results. A brain biopsy has just been performed (her family members finally consented) to help in identifying the exact diagnosis, so that the appropriate treatment and hopefully cure can be administered. My strong suspicion is she most likely has some form of inflammation of blood vessels of her brain (so called CNS vasculitis). The biopsy results should be available in a few days' time ... lets wait and see!
It is not easy to deal with the mental challenge of having to come out with various options to treat the ongoing seizures, let alone explaining to the family members the futility of our efforts to date. Kudos to the family members for being patient and understanding to me to date.
Saturday 28 July 2012
Wednesday 18 July 2012
Kind of busy lately ...
I have been rather busy over the past 2 weeks, having to work through off days and forgoing the regular keep fit schedules.
Suddenly, there is a "deluge" of patients being admitted for neurological disorders over the past 2 weeks. One of them was particularly quite severe and challenging - she present with acute deterioration of her seizures, the underlying cause of which is still a mystery.
It is a real "torture" when treating ill patients who continue to deteriorate clinically despite the best of my treatment plan. And this is exactly my current predicament. I am managing an adolescent girl with refractory seizures despite the use of high dose anti-epileptic medicines. I have proposed a brain biopsy for definitive diagnosis of the underlying cause of her seizures. The caregivers were understandably apprehensive and reluctant to pursue that route. And I could certainly empathize with them - who wants an operation to be done on the BRAIN!
I have been managing many children with acute neurological disorders for over 10 years. It is less tormenting when I was working as part of a team in public hospital; the burden of managing the patients was shared among all parties involved.
However, in private practice, the onus of taking care of the patients falls squarely on me alone. I have encountered sleepless nights on several occasions, cracking my head thinking of all possible options (in treating a sick patient) and being woken up several times in the wee hours of the days (answering calls from worried nurses attending the patients). Sometimes I just feel that I should just "let go" and send the patients off to public hospital. However, it is the trust and appreciation of the patients' family members that tend to spur me on...
Suddenly, there is a "deluge" of patients being admitted for neurological disorders over the past 2 weeks. One of them was particularly quite severe and challenging - she present with acute deterioration of her seizures, the underlying cause of which is still a mystery.
It is a real "torture" when treating ill patients who continue to deteriorate clinically despite the best of my treatment plan. And this is exactly my current predicament. I am managing an adolescent girl with refractory seizures despite the use of high dose anti-epileptic medicines. I have proposed a brain biopsy for definitive diagnosis of the underlying cause of her seizures. The caregivers were understandably apprehensive and reluctant to pursue that route. And I could certainly empathize with them - who wants an operation to be done on the BRAIN!
I have been managing many children with acute neurological disorders for over 10 years. It is less tormenting when I was working as part of a team in public hospital; the burden of managing the patients was shared among all parties involved.
However, in private practice, the onus of taking care of the patients falls squarely on me alone. I have encountered sleepless nights on several occasions, cracking my head thinking of all possible options (in treating a sick patient) and being woken up several times in the wee hours of the days (answering calls from worried nurses attending the patients). Sometimes I just feel that I should just "let go" and send the patients off to public hospital. However, it is the trust and appreciation of the patients' family members that tend to spur me on...
Tuesday 10 July 2012
Horfun 炒河粉Horfun
Our entire family went for a wild boar hunt two nights ago.
By the time we completed our search for wild boar along Lower Pierce Rd and Old Thomson Rd (leading to Upper Pierce Reservoir), followed by the trip to Geylang to buy durians, it was already 1 a.m.. We were quite hungry by then, and decided to dine at Han's 24 Hours restaurant in Upper Thomson Rd.
Both Cheng Kai and I ordered Horfun, while Cheng Yee and Cheng Jie ordered Sweet and Sour Pork (with rice) and Fried Beef with Green Pepper (with rice) respectively.
Horfun has always been my favourite supper. It always reminds me of my late father, who served the best Horfun that I have ever tasted.
My father was a hawker. He was the youngest son in the family of 6 brothers and one elder sister. He used to peddle bicycle in the neighbourhood, looking for customers to order noodles. My grandparents subsequently rented a place in "public avenue" 公市, and set up three stalls selling drinks / fruits, coffee/tea (old coffee shop) and noodles/ZhiCha煮炒小吃respectively. These stalls were run by my paternal 3rd uncle, 4th uncle and my father respectively.
My father's specialty was in ZhiCha 煮炒; dishing out various types of cooked meats, vegetables, soups, in addition to the usual fried noodles/kway teow 炒面／粿条. In addition, he also had a helper to sell Hokkien Noodles (Cantonese style) 广东式福建面, dried noodles (Kong Lou Mein 干捞面), kway teow soup 粿条汤 etc. My mother entered into the scene later (when I was studying in Primary School), setting up a stall selling Chicken Rice.
Because the food was delicious and yet cheap, the business was thriving quite successful. Many locals throng the place during lunch and afternoon tea time, with long queue forming during those peak hours. I used to help out in the stall during my secondary school years (during school holidays), and could see people waiting for over half an hour for their food at times.
One of my favourite dishes is Fried Horfun, particular the one with the sauce laced with eggs. I never failed to ask my father to make one special dish of Fried Horfun for me, whenever I helped out in the stall. My father never failed to put in additional meat/prawns for me; and needless to stay, the portion was bigger than usual.
Whenever I returned home from Singapore during school holiday or vacation, my father never failed to bring home a big packet of Fried Horfun for my consumption in the evening.
Undeniably, my father's culinary skills were superb. His fried Horfun was mouth watering; but what made it insurpassable is the love that permeated the dishes. I could never get it from any place in the world. And yes, I missed my father ....
By the time we completed our search for wild boar along Lower Pierce Rd and Old Thomson Rd (leading to Upper Pierce Reservoir), followed by the trip to Geylang to buy durians, it was already 1 a.m.. We were quite hungry by then, and decided to dine at Han's 24 Hours restaurant in Upper Thomson Rd.
Both Cheng Kai and I ordered Horfun, while Cheng Yee and Cheng Jie ordered Sweet and Sour Pork (with rice) and Fried Beef with Green Pepper (with rice) respectively.
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| Fried Horfun |
Horfun has always been my favourite supper. It always reminds me of my late father, who served the best Horfun that I have ever tasted.
My father was a hawker. He was the youngest son in the family of 6 brothers and one elder sister. He used to peddle bicycle in the neighbourhood, looking for customers to order noodles. My grandparents subsequently rented a place in "public avenue" 公市, and set up three stalls selling drinks / fruits, coffee/tea (old coffee shop) and noodles/ZhiCha煮炒小吃respectively. These stalls were run by my paternal 3rd uncle, 4th uncle and my father respectively.
My father's specialty was in ZhiCha 煮炒; dishing out various types of cooked meats, vegetables, soups, in addition to the usual fried noodles/kway teow 炒面／粿条. In addition, he also had a helper to sell Hokkien Noodles (Cantonese style) 广东式福建面, dried noodles (Kong Lou Mein 干捞面), kway teow soup 粿条汤 etc. My mother entered into the scene later (when I was studying in Primary School), setting up a stall selling Chicken Rice.
Because the food was delicious and yet cheap, the business was thriving quite successful. Many locals throng the place during lunch and afternoon tea time, with long queue forming during those peak hours. I used to help out in the stall during my secondary school years (during school holidays), and could see people waiting for over half an hour for their food at times.
One of my favourite dishes is Fried Horfun, particular the one with the sauce laced with eggs. I never failed to ask my father to make one special dish of Fried Horfun for me, whenever I helped out in the stall. My father never failed to put in additional meat/prawns for me; and needless to stay, the portion was bigger than usual.
Whenever I returned home from Singapore during school holiday or vacation, my father never failed to bring home a big packet of Fried Horfun for my consumption in the evening.
Undeniably, my father's culinary skills were superb. His fried Horfun was mouth watering; but what made it insurpassable is the love that permeated the dishes. I could never get it from any place in the world. And yes, I missed my father ....
Sunday 8 July 2012
探寻野猪 In search of wild boars
最近报章大篇章报道野猪在汤申区国家公园及淡滨尼一带出没，引起公众的关注。
昨晚，我们举家大小漏夜驾车到汤申区碧尔斯上下段公路取探寻野猪的踪迹、佷幸运的成功目睹一群野猪分别在碧尔斯上下两段公路旁游荡、低下头啃咬细草；过后，我们再绕道去芽笼买榴槤。
完成了这两项任务后，已经是凌晨一点多，大家都觉得饿了。于是便再驱车回汤申路上段的24小时韩士(HANS)餐厅吃夜宵！
捕捉野猪的踪迹
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| 路边的野猪 |
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| 钻回丛林的野猪 |
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| 等待夜宵的到来 |
Getting rid of the "Snake"
My wife came down with shingles, the colloquial "snake" coiling around the body recently.
She had been experiencing some discomfort at her left posterior lumbar region (area just above her waist) for a few days, before appearance of non-specific red rashes in that area. I thought it was some allergic rashes initially, until some vesicles began to surface the next day. It then dawned on me that it was shingles (herpes zoster infection)!
The infection coincided with our impending family holidays to Australia in 2 days' time. I hurried to local Guardian pharmacy at Yew Tee Point to purchase Acyclovir (antiviral agent to treat herpes zoster infection). Anticipating that the vesicles would develop into blisters and might bursts in the midst of our holiday, I had also purchased antiseptic cleansing solution, antiseptic cream/ antiviral cream (acyclovir cream), gauze; and specific analgesic (neurontin) for possible post-herpetic neuralgia which could be quite debilitating at times.
True enough, she had several blisters which erupted in the midst of our holiday. I helped her with daily cleansing of the wound. Fortunately, my wife handled the infection quite well despite the pain and discomfort.
It was only upon our return to Singapore that she started to experience excruciating neuralgic pain (burning, tender to light touch, and at time intense itch). I had to resort to Morphine + Lyrica (as Neurontin seemed to be ineffective), in addition to amitriytiline to help in pain relief. The excruciating pain was quite unbearable still despite the above medicines. Hence we had to resort to traditional remedies: she consulted Chinese physician to "catch the snake", applied some herbal solution (which supposedly might help to relieve the pain from shingles), and last but not least, I had to make a trip to the one and only hot spring in Singapore (at Sembawang Camp) to collect the hotspring water. Supposedly the sulphur content of hotspring could help to get rid of the "snakes".
Traditionally, it has been a myth in local Chinese community that a person may die from shingles if the rashes managed to "coiled" completely around the trunk of the infected person (as if being asphyxiated by the tight squeeze of python). The truth is the rashes merely spread according to the distribution pattern of sensory nerves, which happens to be wrapping around the trunk of a person. It is the neuralgic pain that can be so unnerving and relentless, that potentially may drive one to suicides.
Even though I am a medical doctor, my philosophy is that as long as the traditional remedies do not cause any harm, and may help to alleviate psychological torments, why not ?
She had been experiencing some discomfort at her left posterior lumbar region (area just above her waist) for a few days, before appearance of non-specific red rashes in that area. I thought it was some allergic rashes initially, until some vesicles began to surface the next day. It then dawned on me that it was shingles (herpes zoster infection)!
The infection coincided with our impending family holidays to Australia in 2 days' time. I hurried to local Guardian pharmacy at Yew Tee Point to purchase Acyclovir (antiviral agent to treat herpes zoster infection). Anticipating that the vesicles would develop into blisters and might bursts in the midst of our holiday, I had also purchased antiseptic cleansing solution, antiseptic cream/ antiviral cream (acyclovir cream), gauze; and specific analgesic (neurontin) for possible post-herpetic neuralgia which could be quite debilitating at times.
True enough, she had several blisters which erupted in the midst of our holiday. I helped her with daily cleansing of the wound. Fortunately, my wife handled the infection quite well despite the pain and discomfort.
It was only upon our return to Singapore that she started to experience excruciating neuralgic pain (burning, tender to light touch, and at time intense itch). I had to resort to Morphine + Lyrica (as Neurontin seemed to be ineffective), in addition to amitriytiline to help in pain relief. The excruciating pain was quite unbearable still despite the above medicines. Hence we had to resort to traditional remedies: she consulted Chinese physician to "catch the snake", applied some herbal solution (which supposedly might help to relieve the pain from shingles), and last but not least, I had to make a trip to the one and only hot spring in Singapore (at Sembawang Camp) to collect the hotspring water. Supposedly the sulphur content of hotspring could help to get rid of the "snakes".
Traditionally, it has been a myth in local Chinese community that a person may die from shingles if the rashes managed to "coiled" completely around the trunk of the infected person (as if being asphyxiated by the tight squeeze of python). The truth is the rashes merely spread according to the distribution pattern of sensory nerves, which happens to be wrapping around the trunk of a person. It is the neuralgic pain that can be so unnerving and relentless, that potentially may drive one to suicides.
Even though I am a medical doctor, my philosophy is that as long as the traditional remedies do not cause any harm, and may help to alleviate psychological torments, why not ?
ON THE TRAIL TO HOTSPRING
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| Walking towards the Hotspring |
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| Piped hot sprinng... the pungent smell permeates the air |
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| Collecting the water ... it is quite hot! |
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| An elderly person cleansing himself with the hotspring water |
And what was the outcome? My wife's still had some residual pain over the dermatomal distribution of the shingles infection, but it was not as bad as last week. Considering that it is only second week that she experienced the pain, I must say the improvement was quite encouraging.
Which remedies had helped? I leave it for you to decide ....
Sunday 1 July 2012
Family Holiday in Australia (Day 10 - 11): Clayton, Melbourne Airport, Hume Highway to Sydney (stopover at Yaas)
Day 10: Rest day in Clayton: Miscellaneous
We were anticipating ongoing rain from the night before. Hence, we had cancelled the original plan of visiting Phillip Island. The rest of the day was spend on doing miscellaneous shopping in the town, while the two boys were left in Cheng Yee's hostel (playing computer games), and also giving time for Cheng Yee to pack her things (she was scheduled to fly back to Singapore on Qantas the next day).
We bought a heater blanket, some more honey, multigrain bread, fruits (apples and kiwis) etc. Almost bought rice cooker and shoe rack for Cheng Yee, but decided otherwise in the last minutes.
Day 11: Drove Cheng Yee to Melbourne Airport, then long drive on Hume Highway to Yaas (towards Sydney International Airport)
Day 12: Boarded Scoot Airline --> Back to Singapore
Finally reached home ~ 10pm. Home Sweet Home....
We were anticipating ongoing rain from the night before. Hence, we had cancelled the original plan of visiting Phillip Island. The rest of the day was spend on doing miscellaneous shopping in the town, while the two boys were left in Cheng Yee's hostel (playing computer games), and also giving time for Cheng Yee to pack her things (she was scheduled to fly back to Singapore on Qantas the next day).
We bought a heater blanket, some more honey, multigrain bread, fruits (apples and kiwis) etc. Almost bought rice cooker and shoe rack for Cheng Yee, but decided otherwise in the last minutes.
Day 11: Drove Cheng Yee to Melbourne Airport, then long drive on Hume Highway to Yaas (towards Sydney International Airport)
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| Driving along Hume Highway |
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| Overnight at Motel in Yaas (3 hours drive from Sydney) ...very very cold... |
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| Packing up --- leaving for Sydney Airport |
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| Entrance to the Motel |
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| At Sydney Airport, waiting to board Scoot airline |
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| Waiting to board Scoot |
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| On the Scoot airline |
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| Leaving Sydney Airport |
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| Sydney Airport |
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| Glimpse of the City |
Day 12: Boarded Scoot Airline --> Back to Singapore
Finally reached home ~ 10pm. Home Sweet Home....
Family Holiday in Australia (Day 9): Wilson Promontory
Day 9: Sale --> Foster --> Wilson Promontory --> Clayton
Cheng Kai has specifically requested for a trip to Wilson Promontory. He had read from the internet that the PROM is a beautiful place not to be missed!
The weather had been quite kind to us till now - it started to rain continuous. We heard from the news that a cold front had moved in from the west, carrying with it strong wind and torrential rains. Reportedly, a few shallow areas in Victoria had been flooded...
It was still raining when we reached Wilson Promontory. Hence, we could only make a quick stop at selected look-out points/beaches.
There was no restaurant in Wilson Promontory. We traveled back to Foster for a quick lunch (Fish and Chips... again). As it was still raining heavily after we finished our lunch, we decided to forego our original plan of visiting Phillip Island. Instead we drove back to Clayton, and spend the night in Clayton (at Sandown Motel)....
Cheng Kai has specifically requested for a trip to Wilson Promontory. He had read from the internet that the PROM is a beautiful place not to be missed!
The weather had been quite kind to us till now - it started to rain continuous. We heard from the news that a cold front had moved in from the west, carrying with it strong wind and torrential rains. Reportedly, a few shallow areas in Victoria had been flooded...
It was still raining when we reached Wilson Promontory. Hence, we could only make a quick stop at selected look-out points/beaches.
A short detour before driving to the PROM --- a view of old jetty
Entered Wilson Promontory National Park, on the way to Tidal River
Beach at Tidal River
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| Cheng Kai and Cheng Jie, braving the rain |
Another corner of the beach .. a bay which is shielded from the strong wind
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| Cheng Jie |
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| Cheng Kai |
Another hot spot in the PROM: walking towards Squeaky Beach
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| Squaeky Beach |
Animals in the wild: Emu and Kangaroos
There was no restaurant in Wilson Promontory. We traveled back to Foster for a quick lunch (Fish and Chips... again). As it was still raining heavily after we finished our lunch, we decided to forego our original plan of visiting Phillip Island. Instead we drove back to Clayton, and spend the night in Clayton (at Sandown Motel)....
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