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!