青黄不接

 

前几天步行运动，不期然的看到靠近泊油路边的草地，铺上了密密的落叶，让我联想起“青黄不接” 的景象。刚好那时有一位脚踏车骑士，身着橙红色的衣服，拖着红色的四方形布袋，奔驰而过；点缀了整个场景，感觉还蛮不错！

花，草，树，木 Plants and vegetations

花

草

树木

落花，野草

花草树木，属于植物。虽然是有生命气息，也经历生老病死，但却因为人类听不到它们的呐喊呼叫声，而成为“不杀生”者的盘中餐。

素食，也许并没有想象中那么‘仁慈’！

Why is it that we never thought of eating greens as something atrocious?

Are plants and vegetations truly devoid of Life and Emotion, as we think all animals have?

Plants have phloem and xylem, akin to vascular system in animals

Plants grow, move towards sunlight, wither and age, and eventually die, just like any living beings. 

Just because we could not hear them screaming in protest, or murmuring in distress, we assumed they could be trampled relentlessly.

How cruel can we be?

节俭，吝啬 thrifty or stingy?

节俭与吝啬，有时只是一线之差。

我向来没有到豪华餐馆吃大餐，或住宿高档旅店的习惯。穿着也相当老土，多数服饰都是等到购物商场举行大减价时才采购。

有幸出入高档酒店或餐馆，都得托工作的福。到外用餐，多选择在小贩中心去。

大手笔花钱，只限于买屋，买车，支付孩子们到国外求学的学费，生活费。

这种习惯，也许该“归功” 于本身原出生于家境一般的环境下。上中学时，是寄宿在槟城的亲戚家；过后上高中与大学时，便远赴他乡到新加坡，寄宿于学生宿舍。为环境所趋，得小心自理钱财。

不过说来也怪，在看戏这方面，我却从来没有手软过；学生时代 （尤其是上大学时），几乎每一两周便会到电影院捧场！

幸好我的另一半，对钱财开销，也持有同样的态度。可想而知，我们的孩子，也潜移默化的受到类似的影响。

When we went for family trips oversea, we never stayed in luxury and/or expensive hotels. We opted for one that offerred reasonable rate /relative comfort for overnight stays in our travel.

For meals, we either prepared our own breakfast, bought some fast food (burgers, fish and chips), and if time permit, cooked our own dinner. Of course, we did eat out in some restaurants, but not those fancy / expensive ones.

At home, the most fancy restaurants we frequented are Ding Tai Feng (in recent years), Jack's Place (when the kids were young), and of course MacDonald. Occasionally, we would eat at Swensons. Hawker Centres are out popular eating places. 

We don't spend much on our clothes. In fact, I have been wearing "selected same" shirts for work for decades!

Am I being thrifty or stingy???

调皮，淘气 Mischievous

 

偶尔放松心情，扮个鬼脸，调皮淘气一会儿，是需要的！

生活上的种种挑战，使我们的神经，紧绷的几乎喘不过气来！若不适时的放松一下，可能下一秒身心会坍塌跨下，到时可能已回魂乏术。

Life is full of stresses and challenges.

It is vital to be mischievous at times. We need to let off some steam, and "loosen" up!

It takes time to reach definitive diagnosis...

As the old saying goes, it is easy to look back into history and have a better understanding the whole situation.

However, sometimes, when seeing a patient, time is a luxury that a doctor does not have. 

Sometimes, things evolve rapidly eg. a patient may look well just a few minutes ago, but suddenly become very sick beyond salvation after that... This is a nightmare scenerio that most doctors fear!

Cases in point ...

Case #1:

I recently saw a young child with isolated right facial nerve palsy of 2 weeks' duration. She was otherwise well. Hence, I shared my thoughts with her parents - that isolated facial nerve palsy has excellent prognosis, with spontaneous recovery in almost all children in 1-3 months. On rare occasions where there is no significant improvement by 1 month, a neuroimaging study may be warranted to exclude sinister causes (e.g. nerve compression by tumour). 

The child came back one week later with decreasaed hearing on right side. MRI head done 2 days later showed the presence of brainstem tumour (which carries grave prognosis).

Her gait became wobbly the following day. 

Subsequently, she was referred to neuro-oncology team in KK Hospital for advise on further treatment plan. 

The question often arises in such situation is should a scan be done earlier? From evidence based medicine, neuroimaging for isolated facial nerve palsy in otherwise healthy child is not necessary. However, if there are other associated with abnormal neurological findings such as impaired hearing, focal weakness or unsteady gait - then neuroimaging study is necessary. 

Case #2:

 A 9 year-old boy with new onset obsessive compulsive behaviour, agitation, impulsivity, learning difficulties - these evolved gradually over a few months. 

He was thought to have attention deficit hyperactivity disorder (ADHD) initially, and then possible Autism Spectrum Disorder...

I ran a few tests - MRI head, lab tests to exclude immune encephalitis / lupus --> they were all normal. But his EEG (brain wave test) showed some abnormal discharges in right temporal region.

The possible diagnosis of PANS (paediatric acute neuropsychiatric syndrome) was considered - he was given a short course of steroid; his behaviour improved with steroid medicine, but relapsed once steroid was weaned off. 

After much deliberation, his parents finally agreed for more comprehensive evaluation (spinal tap, repeat EEG) and treatment with immuno-modulatory treatment (IV steroid and IVIG) last week.

He is due for review in a week -> I am cautiously optimistic that his condition will improve with the medical intervention. Keep fingers crossed. 

Case #3:

8-year-old boy with low grade fever x 1 week, followed by nausea x 1 month, and only fed white rice together with some gravy. Developed generalized swelling (edema), leg weakness, double vision, and had a seizure secondary to hyponatremia (low sodium level). Clinically, he had generalized edema, horizontal nystagmus, lower limb weakness with areflexia (indicative of neuropathy). He had difficulty in voiding urine (needs indwelling urinary catheter) 2 days before admission to hospital.

Evacuated to Singapore - MRI head showed abnormal signal in bilateral thamus - this changes can be seen in Thiamine Deficiency.

Looking back, all his signs and symptoms can be attributed to Thiamine Deficiency - he was treated with thiamine -- his condition gradually improved over the following week. 

Indeed, some medical condition can be diagnosed after reviewing the history and performing clinical examination, but some more complex cases need time for physician to unravel the mystery to come to a definitive diagnosis.

Advising affected individuals that we need time to reach a diagnosis may sound cruel, but it is inevitable sometime!

行人天桥与梯级 Overhead bridges and staircases

回想起来，新加坡可能是设有楼梯最多的国家之一。

由于马路之阔及车辆之多，为了方便路人过马路，还要顾及能否让双层巴士通行，行人桥横阔马路需要有一定的高度。这就苦了过路人，需爬上斜倾的梯级，方能抵达桥的顶端。

随着国家人口年龄老化，过路的年长人士越来越多，要爬上梯级，不是一件易事。因此，多数的行人天桥都得翻新，加建电梯。那些没有电梯设备的天桥，便只好增添没有梯级的斜面人行道，以方便老者或残缺人士行动。

As I grow older and attain "senior citizen" status, I start to realize that climbing up the steps to use the overhead bridge to cross major roads can be quite challenging at times.

If one has a pair of bad knees, or poor exercise intolerance, climbing up the stairs is going to be quite a chore. 

Some overhead bridges are upgraded with lift for the elderly and handicapped. But this does not apply to all. 

The moral of the story - be healthy with good exercise tolerance and a good pair of knees/hip joints as we grow old!

累了，歇一歇 Take a break

 

在烈日下劳动，是件苦差。

君不见近年来，在东南亚发达中国家，在建筑工程劳动的均是外劳，本土人屈指可数。若没有他们的付出，建筑业会崩溃。

累了，歇一歇，无可厚非。尤其他们并非在树荫下休息，而是在烈日下席地而坐。

It is tough to work under the heat.

The younger generation of our time is too pampered. Not many of them fancy working under the hot sun. Instead, the gig job of food delivery or being a private hired driver seems to be the darling of our young workers.

Hence, don't begrudge the labourer who takes a break in between their job!

井水不犯河水，两不相干 Man-made division

 

就因为那人为的物障，原本同属一类的河水被无情的隔离。一边泛起碧绿涟漪，另一边则心如止水，彼此井水不犯河水，两不相干！

这好比原本应该相安无事的家人，在外来人的从中作梗下，忽然反目成仇，不相往来。

Man-made division can caused unforseen calamity.

Just like the conflict between Palestinians and Israelis. The arbitrary division of Palestinian "holy land" into enclave of Palestinians and Israelis has created an humanitarian disaster and conflict that defies arbitration.

Important lesson to learn: never, never interfere with others emotion and/or possession. One can advise, but never act on others behalf...

电影/视频剧情的真伪

长时间沉迷于电影或视频短剧，思绪渐渐的被潜移默化，在日常生活里，在看到某些情况时，电影或视频里的情节会莫名的浮现出来， 比如每个丈母娘都是见钱眼开的势力者，两个男人在一起谈天关系必定不寻常等等。

想来是应该自律，减少全看视频的次数。

It is indeed difficult to distinguish reality from fantasy depicted in movies after a while. 

The short video clips depicted in TikTok or Instagram can be rather addictive. Time flies unknowingly as one scrolls through the various video clips. Somehow, tha video clips of similar themes keep on appearing once the apps are opened for viewing (thanks to the serendity work of the "wonderful" algorithm of the apps). 

Even adults can be drawn and trapped in the "reel" world unknowingly, let alone young children/adolescents. Hence, the importance of vigilance!!!

启航，降陆 A tale of two different budget airlines...

在樟宜机场登机，飞往槟城。

第一次乘搭萤火虫航空飞机，还以为是旧式旋螺浆运作的飞机，其实不然。

虽是廉价航空班机，但起飞时很意外的尽然有分发花生及饼干各一包，以及矿泉水一小瓶，蛮贴心。座位也蛮寛，有足够的伸脚空间。

起飞前，于樟宜机场

飞行中，略见云海

      回程是乘搭亚航。没有免费零食。航程只有一小时，无所谓。

                                   

降落于槟城机场。从亚航班机内座，往外拍照。

Took a flight in Firefly budget airline from Changi to Penang. Was pleasantly surprised when the stewardess served packets of peanuts and cookies (free of charge) and a small bottle of mineral water. This gesture is unheard of in other budget airlines. Kudos to Firefly!!!

The flight was smooth. The leg room was spacious! It departed on time. It was a wonderful flight.

Flew in AirAsia for my return trip. It was business as usual. No freebies. 

The return trip cost me slightly below S$100. Indeed, it was a difficult fare to get nowadays! No complaint!

Chinatown Midautumn Light Decor 牛车水灯饰2023

今年的牛车水亮灯，主角不是嫦娥，有点意外！

往年的嫦娥，因为外型设计的偏差，有环肥的，阳刚的，不符合常人对嫦娥所抱有的形象，而导致恶评如潮。

全家福

这回，没有嫦娥，只摆出“全家福”，感觉气氛有点不对，反觉得在迎春节似的！

不过，市人终于摆脱了疫情的阴影，一峰窝的在商业小巷步行，消费；也有俩批年长者，分别聚在不同角落，唱歌跳舞， 不亦乐乎！

一群年长者，聚在一起，唱歌，玩乐器。

所幸玉兔还在。。。

合家团员。。。今年的主题。

ChangEr, the moon fairy is missing in this year's Chinatown Light Decor. Without her, the light decor lacks some "authencity" - it looks mundane, not much different from the light decor in Lunar New Year

Fortunately, her faithful companion, the Jade Rabbit is still present.

But the crowd is definitely back, after 2 years of tepid response during COVID pandemic.

Hiking... and mishap! 爬山，意外！

During my brief stay in Nibong Tebal last week, my sister (LS) and I went for an exploratory hike at TM Bukit Sungai Kechil Trailhead in Bandar Baru.

We tried to hike up the hill several months back, but the trip was interrupted by torrential rain.

This time, the weather was fairly good - cloudy in fact - this provided a much needed shed when we descent from the hill at later part of the morning. 

It was rated as an easy hike - suitable for all ages.

We left our house around 6.45am - parked our car at the road side near the paved entrance to the hiking trail. Only 2 other cars were parked there (probably other fellow hikers).

Hiked up a fairly steep paved road for the first 1km or so... panting along the way (no stamina)..

view from the hut

As we ascent, we noticed the sun was rising on our left hand side.

Walked further up... view of TM tower #2 (the hike supposed to cover 5 TM towers, if I am not mistaken).

The surrouding scenery was quite interesting...

colorful leaves of the palm trees

Rubber plantation

But alas, as we were near the peak (I think), I slipped while walking on the uneven road paved with some sands... sustained abrasion on my left knee and right palm.

Decided it was time to turn back home!

As we descended from the hill, my sister slipped while walking down a slope, and landed with a heavy thud on her bums.... luckily no fractures! We managed to hike down and returned home safely!

上周末会老家探访病卧在床母亲。趁机在周日早上，到附近的小山去看看。网络上有人分享，此山老少咸宜，若碰上好天气，还可以观赏到云海！

爬上此山，开始步上陡峭的斜坡时，有点吃力，过后便没有那么辛苦。

接近山顶时，有几个分岔路，但没有明确的指示牌，得走些冤枉路才能步上“正轨”。

再接近山顶时，在铺满沙粒的黄泥路上滑倒，刮伤了左膝与右掌；最终得打道回府，无法前行。

还会有下次吗？应该没有了！

附上他人的视频与你分享。

Visiting my elderly and bedridden mother

Flew back to Nibong Tebal over the weekend (30 Sep - 2 October) to visit my mother.

My mother is 24 years my senior. She has been troubled by Parkinsonism secondary to cerebral small vessel disease for over one decade. She was still able to ambulate a few steps with the help of walking stick/rollator initially, but her strenght gradually deteriorated over the years. 

She was looked after by a domestic helper all these years. 

She became bedridden / non-ambulant since early this year. We discovered she had hugh bedsores over sacral/gluteal region when I was back home for QingMing in April 2023. Rushed her to local district hospital in Butterworth that night itself, but she was discharged home for outpatient treatment after waiting for several hours in the Accident and Emergency Department. It seemed that local district outpatient clinic was unable to manage her condition satisfactorily, hence, she was admitted to private hospital in Butterworth for about one week - given IV antibiotics and wound debridement. After that, she was sent home, and attended by GP daily for wound debridement and cleansing. Fortunately, the bedsores were healing - now only left a fairly deep ulcer at sacral region.

Along the way (over the past one month or so), she developed abscess with sinus underneath the skin at left groin region - now on regular dressing. 

Because of her neurological disorder, she has fairly severe spasticity of limbs, with both hands held in fisted posture. The fingers with flexed so "stiff" and painful when passively stretched, with the finger nails "biting" the palmar surface of the hands, causing some wound. 

Despite her immobility, she was still able to recognise people and converse in a very soft voice when needed. And fortunately, she is still able to swallow food orally. 

Being far away from my mother, my siblings in Nibong Tebal are the ones looking after her all this years. I could only contribute monetary support for her daily needs / medical care.

We were quite appalled with the care provided by our domestic helper. She probably sensed our displeasure, and asked to go home (on the pretext that her parents were sick). We promptly agreed, and sourced any domestic helper to take care of our mother.

So far, the new domestic helper has been consistent in turning my mother regular on the bed (to prevent bedsores) and feeding her meals at dedicated times. Hopefully, things will be better along the way.

Sigh, it is no joke to be incapacitated at old age...