Addictions and life

You know you have an addiction when you can't stop thinking about it. Your mind continuously ponders over it and you lie in bed, reliving the addiction over and over in your head. And when the morning comes, your body, mind and soul feels unrested and unrejuvenated. Yet all you can think of now is to go ahead and feed your addiction.

All of us human beings have addictions. So what is an addiction? It is merely an obsession, compulsion, or excessive physical or psychological dependence such as: drug addiction, video games, crime, alcoholism, compulsive overeating, computer, pornography, etc. Often it is viewed negatively because over time our body relies on it for normal functioning and after awhile we develop a physical dependance or withdrawal symptoms when that drug or substance is removed from our presence. It is basically a recurring compulsion by an individual to engage in an activity despite harmful consequences to the individual's health, mental state or social life.

Not all addictions are entirely that bad. Often they start off innocently. Take for example dieting. The main goal of dieting is to lose weight in the prospect of better physical health such as a more ideal weight, lowers triglyceride and blood glucose levels and to decrease the chances of cardiovascular disease. This is more appropiate for an older individual but in a young person, dieting could be targeted at a better figure in the hopes of becoming more attractive/desirable to the opposite gender or just for self-vanity or a boost to one's own self-esteem. At first the individual is successful and he/she becomes pleased with the results which is greatly reinforced by other's praises and compliments. And so the individual concludes that he/she had made the right decision for change. This may stop and come to an abrupt halt or the individual decides to take it one step further. And another step further. Soon the dieting addiction no longer becomes a hobby or pleasurable, it consumes the individual like a parasite leeching the very life force out of the individual. The person becomes obsessed with food, weight, numbers on the scale, exercise and not a day passes by when he/she is not free from this bitter battle that rages on his/her mind. He/she shuns out his social life, family members, career/education in the pursuit of fueling his addiction/obsession. Why? Because he/she is no longer in control, the addiction now controls him/her. What started out as something so seductive and enluring has evolved into something so sinister, enpowering and most of all inescapable. It has developed into an eating disorder. There are only 2 options to conclude this bitter tragedy; 1)the individual may be in denial and try at all costs to protect his/her addiction and therefore the addiction grows even stronger and the individual weaker, 2) the individual finally stops and realises that the addiction he once held onto like a trusted companion or a safety net as wicked and evil and decides to stand up and fight against it to save himself from drowning in its clutches. That's where medical care comes in. A doctor once asked me what is the difference between someone drowning and depression/addiction? The feelings are exactly the same except that you can't see it in the individual with depression/addiction. And I asked the doctor, 'So where do antidepressants come into play?' He replied that 'Antidepressants are the safety line that holds up the individual preventing him/her from sinking. Without them, what's the benefit/point of utilising a psychological approach?' Haha, no wonder Prozac is the best-selling antidepressant world-wide since 1987 and psychiatrists are filthy rich (The annual salary for psychiatrists ranges from US $173,800 to $265,000).

Note: This post is just a random one, I am not in any way affliated with it.

Reflections

Right now in the comfort and luxury of my home, I can sit back and reminsce the days when I was a half petrified half, half excited first year medical student. I recall the first day of orientation at IMU, where approximately 220 eager, enthusiastic, fresh faced medical students stood in front of the stage that faced the luminous auditorium and posed for a class photo. I gurantee that on that day, a lot of thoughts and emotions were racing through our minds; some filled with pessimism and dread of a new course that has been notoriously known to involve endless hours of labourious self-study, discipline, perserverance and the never-ending quest for medical knowledge. Others were more optimistic and perhaps some were already envisioning themselves as full-fledged doctors. Nevertheless, we were basically thrown into the UNKNOWN.

Soon, the months started to fly by as swiftly as the sands of time and we became bombarded with a tremendous amount of information to absorb that consisted of anatomy, physiology, pathology, pharmacology and microbiology. We were cracking under the pressure and this was easily demonstrated on our sleep derived places, jittery hands due to the high intake of caffeine from countless cups of coffee during the midnight study sessions and constant irratability. If this was just the pre-clinical years, how can we possibly fare during the clinical years? Some of us were already having second thoughts about this course and were contemplating of switching to an easier and less demanding one. We faced our first exam with our hearts pounding in anticipation and crossed our fingers and prayed for the best. When the results were finally released, the majority of were delighted...WE HAD PASSED! Unfortunately there were a small batch of us who were not so 'truimphant and victorious' and either dropped out, fell a year behind or thankfully passed the second time round.

This continued on for the next 5 years and examinations became second nature to us. These continuous assessments seemed to increase in level of difficulty as each year progressed as well as required constant revising of earlier topics that were long forgotten. I think our minds became OVERSATURATED with the humongous amount of 'neccessary' information that needed to be read, revised and regurgitated. Furthermore, the clinical years were entirely more challenging and brought about a new and different perspective in the field of medicine for us. Not only did we have to decipher what was in the textbooks and lectures, we had to apply our knowledge to each individual patient. We soon learnt that not everything that appears in the textbooks was so adequately demonstrated in 'real life' and we were constantly puzzled by the overlapping diseases in the same patient. The majority of our consultants and lecturers provided guidance to help us decode our 'medical mysteries' but a large part still waned heavily on us. We needed the motivation, the desire and the dilligence to slave away hours at home revising the new material learnt or at the hospital chasing after keen consultants willing to lend a hand. We sacrificed much of our own personal time that included friend's and family's gatherings, leisure activities and possibly even our own vital needs and we became (and still are) physically and mentally exhausted. MORE LATER...

Soup fetish

Lately, I've grown a liking to the taste of soup. Basically a soup is defined as 'a nourishing food that is made by combining ingredients such as meat and vegetables in stock or hot/boiling water, until the flavor is extracted, forming a broth' according to wikipedia, the free encyclopedia. It can be home-made or bought at a local grocery store but the former definitely has more benefits. The time, labour and effort put into concoting a steaming bowl of 'home-made soup' makes the meal even more enticing. These are a number of benefits derived from soup that I have researched on:

1) It has been scientifically proven to combat infection and cold due to its anti-inflammatory effects and can help warm you up especially during the cold season when colds and flus are most prevalent.

2)It has been an ancient and time honoured technique practiced by the Chinese to brew soup such as those containing ginseng to improve circulation memory and thinking, those with spinach and ginger to promote digestion and winter melon to help cool down the body.

2) They help restore the necessary water balance, which in turn helps keep our blood pressure (and salt content) under control.

3) They are economical and convenient as you can basically just add anything to soup. Those left-over meat and chicken bones from a Sunday lunch can fill your home with a wonderful aroma and lower your food costs in terms of whipping up something that involves more time, preparation and ingredients. Plus, you can later freeze the soup and at a later date just defrost and reheat it. This will give you a head start on next week's meals. And what better convenience for a College/University student on a low budget than popping open a can of soup that can be microwaved, freezed or dehydrated and costing anywhere from 50 cents to $2?

4) They are versatile as one day you could thicken your soup with elbow macaroni, the next day diced potatoes, then rice, barley bread and additional protein.

5) They are great for sick people and those who have trouble chewing, digesting and swallowing.

6) It is an excellent way to add healthy vegetables and protein to your meals. Vegetables without doubt are famous for their anti-oxidant properties which can lower the risk of cancer and heart disease.

7) The protein in hearty soups helps satisfy hunger, and the nutrient rich liquid is digested rapidly which signals your brain that you're full.

8) Miso soup and other soups made with soy can help lower the risk of breast cancer. In fact, a recent Japanese study showed that their level of breast cancer is about 10times lower than in the West. Miso soup is also said to help regulate the hormone oestrogen in women, a hormone that can cause tumors to develop. Miso soup is also rich with antioxidants and protective fatty acids, and a healthy dose of Vitamin E. It also boasts protein and Vitamin B12, and a nice selection of minerals to help boost the strength of your immune system.


9)Unlike what happens during stewing and frying, vegetables, mushrooms, meat and poultry cooked directly in soups conserve much more of their natural nutrients, vitamins and general essence which makes them nutritious and filling.

10)Many soups in groceries now come in lower sodium, saturated fat and cholesterol alternatives which makes it ideal for those watching their intake.

11) Can be great for kids too if you add macaroni which kids simply adore so this pleases them and ensures that they get the proper nutrients.

So all in all, drink up to a hearty bowl of nourishing home-made soup!

Boredom put to use

Tonight, I had a brief discussion with my parents on my internship application. Sigh, conversations like these can be short but they leave a lasting impact and you find that later during the day, your thoughts often dwell heavily on the words spoken and topics highlighted. I am grateful that I am given the upper hand in choosing where I want to apply for my internship (and most probably residency) year. Found a couple of useful websites for medical internship in other parts of Australia (interesting to note is the basic intern salary):

1) South Australia (Adelaide)- http://www.health.sa.gov.au/MEDICALOFFICER/Default.aspx?tabid=22
salary as for 14 April 2009 is $56,925 (GPSS) pa plus shift penalities (afternoon, night and weekends), overtime and the ability to salary sacrifice and 6 hospitals to choose from.

2) Victoria (Melbourne)- PMCV (Postgraduate Medical Council of Victoria) conducts an intern computer matching service to allocate all intern positions to 14 Victorian
hospitals, http://computermatching.pmcv.com.au/public/hospitaldirectory/intern_index.cfm
Selection is made by the hospital/health service, taking into account three (3) PMCV online referee reports and any other hospital/health service specific application requirements (e.g. academic history, interview, CV, covering letter etc). Salary ranges from $44,559-51,527.

3)Western Australia (Perth)- Salary is $53,500 and 3 hospitals.

Other places in the world:

1)Singapore-http://www.smc.gov.sg/html/1150880211414.html
PGY2 is S$3500 sinaporean dollars per month and then additional S$750 per month accomodation allowance and various other variable rate bonuses.

Singapore PGY2 total salary per year before tax S$51000
tax S$2008
=$48992*
* For residents of singapore. Foreigners would have to pay $7650 in tax for a total $43350 total (15% flat rate tax for foreigners)

Living in Sydney vs Kuala Lumpur

After living in Sydney for approximately 2 years, there is a considerably marked difference between the two in terms of culture and lifestyle. One of the striking few examples would be the unpredictable weather in Sydney which can be extremely annoying eg: rainy cold weather with winds at the speed capable of destroying your umbrella and putting you at high risk of being blown away (hence it is advised that umbrellas are utterly useless in Sydney and one should opt for a more handy raincoat) in the morning which suddenly evolves to a clear, bright sunny afternoon. Another would be that shops close by 5pm except on Thursdays when they do open until 10-11pm which is another big nuisance especially if you suddenly have to do a crucial errand such as retrieving a parcel from the post office. However, thankfully Coles supermarket open until 12am daily which is a big relief for office people and students who finish late in the evening and are ravenous from a hard day's of work/study and would just like to whip up something simple for a meal. A lot of my friends initially survived on instant noodles, bread, jam, cereal as restaurant/cafe food is darn expensive (1 bowl of noodles costs approximately

AUS $ 8.00) so in reality, it is a lot more cost effective and less straining on living expenses if you know how to cook. Plus Coles, Woolworths and the infamous ALDI (which is by far the cheapest supermarket) constantly have grocery items that are marked down or discounted. You can save a lot if you are a good cook and have adequate culinary skills eg: ALDI sells 1kg chicken drumsticks for $3.49. However, the portion sizes of food in restaurants/delis/cafes are at least 2 times larger than in KL so you can imagine the flabberghasted look (and possibly delighted) on a newcomer in Sydney when he steps in a Chinese restaurant and orders a plate of fried rice to find a humongous plate of Hong Kong fried rice immersed in chunks of chicken, peas, carrots, corn, garlic piled the height of a mini Egyptian pyramid. The choice of food in Sydney is quite commendable as there is a variety of food available ranging from Japanese, Vietnamese, Thai, Lebanese, Asian, Indian, Western, Mongolian, Middle Eastern etc. But if you are Chinese and have lived in Malaysia nearly all your life and often crave for foods similar to the one back in your hometown, you would have to become accustomed to mainly Hong Kong Chinese food, Indonesian and Northern Indian food. Note for a fact one of my friends actually thinks Sydney food is better than back home (he is extremely fond of Kingsford sweet and sour fish and chicken hor fun from Honeywok restaurant and butter chicken and rice from any Northern Indian restaurant/cafe and Mcdonalds double quarter pounder which caused him to complain later in the year of his undesirable weight gain). Speaking of food, the main diet of an Australian consists of bread, bread and more bread. Oh and definitely throw in a couple of steaks/ribs/veal/lamb chops although not many Sydney-ians like pork. That's why bakeries such as Baker's delight and Brumby's do exceptionally well and I must admit, their buns/pastries/pizzas/muffins are by far a world of a difference as compared to the miserably, hollow and often sparse meat filling buns back in KL. They are tastier and definitely leave you feeling full longer including the white or wholemeal bread available from supermarkets. It is considered the NORM to see someone passing you on the street taking a bite from a 6 inch Subway sandwich or anything bun-like. Also, in Sydney you get a more extensive range of health/diet foods which is a pro if you're BMI is considered overweight or you're suffering from hypertension, hypercholesterolemia, diabetes and other chronic illnesses that need modifications to your diet. I mean, just step into Coles and you'll be amazed to see that every food item in the supermarket has nutritional packaging on it including fat, carbohydrate, sodium content etc and a wide range of non fat, low fat, 99% fat free, extra light items. Even Mcdonalds and other fast food restaurants offer healthier alternatives such as lean deli sandwiches, salads, yoghurt. It just goes to show that Sydney people are a lot more health conscious. I'm not just saying in terms of diet but even exercise; a lot of people subscribe to gyms, fitness centers and even wake up at 5:00am to go for an early morning jog. Oh and do try the dairy products in Sydney, they are really yummy especially the chocolates, ice-cream, milk and biscuits which is one of the reasons why there are still a lot of overweight people in Sydney and it's the occasional treat for an average person to indulge so often in a pint of Ben and Jerry's Chunky Munky/Chocolate Fudge Brownie ice cream which I've heard many of my friends claim that its by far the best ice-cream on the planet.

In terms of culture and lifestyle, people in Sydney eat their dinners by 6pm and go to bed by 9pm to wake up the next morning at 6am. This would be considered abnormal for a Malaysian who is used to mamak-ing until 3am. However, a wonderful aspect of people in Sydney is that they are more hospitable, considerate, polite and helpful (well the majority except for a few racists). The handicapped and elderly people living in Sydney will benefit a lot from the hosptilality expressed by the people in Sydney and that includes the average pedestrian crossing the road. In KL, one has to duck and avoid the traffic for fear of being knocked down by an unforseen vehicle (even when there is a pedestrian crossing road/lane). Also, the health system network in Sydney is superior compared to KL and hospitals/clinics/health centers offer the best available medical treatment that is up to date and highly specialised. In KL, you only get paediatricians or obstetricians/gynecologists but in Sydney you can find paedetricians specialising in endocrinology or O&Gs specialising in infertility or highly intensive care obstetrics. I also find most GPs in Sydney to display a more caring attitude towards their patients (as opposed to the 5-10 minute consultation with our local Malaysian GP who just simply nods every now and then and prescribes the neccessary medication). They not only spend at least 45 minutes with their patients, it is vital that they are allied with a team of health professionals for every patient which can consist of a dietitian, occupational therapist, social worker, podiatrist, psychologist etc. During my GP term, I could really admire the good rapport and trust built between my GP and his patients which is why many of the patients are more compliant with treatment and are more willing to discuss other issues that are affecting their lives which can be non-medical.

In terms of entertainment and recreation, a lot of Sydney folks prefer outdoor activities. In KL, a normal Malaysian would spend their Sunday strolling away happily in a shopping center where he or she will shop. eat lunch, catch a movie, take tea, shop and have dinner. That is why shopping centers in KL are like mini-cities; you can practically live inside them and be completely not starved of food, shops and entertainment. Sydney-ians love their beaches on the other hand which is why beaches are packed everyday with surfer dudes, teenagers, tourists and even veterans. (Hint: Bondi Beach). I find a lot of youths in Sydney also partake in a wide range of sporting activities and to name a popular few would be footie, hockey and tennis. They're a lot more competitive in nature as well which is why a lot of international students are very malu when they are asked by a local to have a game of tennis for fear they will not live up to their standards. They take their sports quite seriously unlike the Malaysian who just wants to kill time whacking a few shuttlecocks in the hopes of fullfilling their once a week exercise regime to compensate for the daily morning roti canai's and nasi lemak's.

Also, if you are living in Sydney or any part of Australia for awhile, you might have to become accustomed to their strange accent or slang. Like almost everyone in Sydney even a random outsider will greet you as 'G'day mate'. And after staying for another month or so, you'll realise that some words such as 'How's it going?' is another form of greeting and that is common for anyone to use the phrase 'No worries'. Females are also addressed as 'darl' which I guess is short for 'darling'. Beware that people in Sydney are also more verbally expressive and it is not extraordinary to witness a stranger on the street cursing or swearing like a madman and then a few minutes later reverting to his/her normal calm self. In Malaysia, this person would be be dubbed as having a psychiatric illness or just emerged from Tanjung Rambutan as Malaysians tend to be more introverted. It does have its pros though and I find that a lot of patients are able to express their symptoms well with good descriptive phrases and give a more thorough history. For example, if you were to ask 'Where is the pain and could you describe the pain in your forehead for me?' to a Malaysian patient, their reply would be just 'sakit kepala'. Its advantegous for a clincian and for an inadequate medical student such as me to better arrive at a clinical diagnosis as an Australian would even go to the lengths of describing the pain as 'sharp/stabbing, radiates to the left eye, severity of 8/10' etc.


I guess to elaborate further on the differenes between Sydney and KL will probably take another post but these are just the main ones that I feel I have come across and has affected me in some way or another. To sum it up, if I were to choose between living in Sydney and KL (not taking into account the higher living expenses in Sydney) I would have to vote for KL as it has been my home for the past 21 years of my life. I always find comfort and solitude when I am back home in a familiar environment (I am quite a homely person) and around the people I grew up with which are basically my parents. I often get homesick for a week or so if I fly back to Sydney alone. After all, 'home is where the heart is' and if you have always loved your home and wake up each morning enjoying even the aroma of your bedroom, then that is the place where you should spend your entire life at.

Sick

Today, I came down with a slight case of 'tummy upset'. I was feeling entirely nauseous throughout the day coupled with 2 bouts pf diarrhoea and later after dinner, I puked up some of my meal (of pork ribs with peanuts and lotus root soup garnished with red dates and squid). I've been having a stomach problem for the past 2 months which cause still remains unsolved to this day (because I am a bit terrified of undergoing a gastroscopy/endocsopy as it is still categorised as an invasive procedure and you have to be mildly sedated) but I was prescribed some Losec (which is a proton pump inhibitor that reduces the stomach acidity that causes some of my reflux) and Motilium which is an antiemetic (makes you less nauseous and therefore less likely to throw up). It did help quite a fair bit and nowadays I am throwing up less (2 times a week only). I guess I could come up with the three likely provisional diagnosis for my case:

1) gastritis- I do suffer some epigastric discomfort but not to the extent of pain normally caused by Helicobacter pylori which can be detected by H. Pylori fecal antigen test of H. Pylori breath test. If this were the case, treatment is simple: triple therapy consisting of antibiotics (clarithromycin and amoxicillin) and omeprazole (proton pump inhibitor).

2) peptic ulcer disease- Yikes, I hope I don't have that. They are extremely painful and can lead to gastric cancer! But I do have to bear in mind that normally the pain is worse after meals such as in the case of gastric ulcer but duodenal ulcers are relieved by food. Also associated with vomiting, nausea, waterbrash, bloating etc.

3) gastro-esophageal reflux disease- I do sometimes get a bit of regurgitation of food but I don't have dysphagia (difficulty in swallowing) or heartburn.

4) Gastroenteritis- aka food poisoning. Quite likely due to the high probability of contaminated food and I do eat leftover food in the fridge which has adequate time for bacteria to grow but I've been having it for 2 months so maybe this is a case of chronic gastroenteritis? If this were the case, we just have to catch the bug that is causing it. Anyway 50% of these things are viral which means nothing can be done about it.

5>Don't think I could be having the other rarer causes such as cholecysitis, pancreatitis, inflamatory bowel disease. vascular disorders, tumours. Haha, or it could even be psychogenic abdominal pain or idopathic (no cause identified). I guess when I am finally a doctor, I have to come up with a more extensive list and gradually eliminate each according to the patients characteristics. If you watch House, I am always compelled and deeply awed as to how he can fathom the definite cause of the patient's problem in a heartbeat. Okay, so he's a fictional character who's head of a team of diagnosticians but I am sure there are medical geniuses out there that resemble him. Doctors are a lot like sleuths (Sherlock Holmes) who are a given a set of clues and must work their way backward to the original source. Its basically detective work and I guess a lot of doctors find this thrilling (well intially anyways). I guess it takes a lot of experience to tie these clues together and narrow them down to the more definite possibilities.

6>As for me, I recall I was absolutely clueless when it came to coming up with provisional diagnosis list back as a 2nd and 3rd year medical student. I remember I panicked during my OSCE examination in IMU Sem 5 when the doctor asked me to come up with a provisional diagnosis list for right iliac fossa pain. With time and more reading up of clinical textbooks (as compared to our blurry, font-too-small-too-read IMU notes), I improved slightly but I am definitely nowhere near as compatible as an intern.

7>Speaking of internship, we have to submit our hospital preferences by the middle of this year which is in fact FAIRLY SOON. I'm still so undecided yet as where to go...I would prefer doing it in Singapore as it is closer to home as I am not that fond of Sydney and a lot of people have already mentioned that Sydney is one of the top cities in Australia. If I were to do it in Sydney, I would have to do a 2 year prevocational training which is 'first two years of “on the job” postgraduate medical training which aims to further the personal and professional development of medical graduates' which is from the website http://www.imet.health.nsw.gov.au/www/472/1001127/home--default.asp. However, I'll have to pay an extra $440 since I'm a 'graduates from an Australian Medical School on a temporary resident Visa' unless I apply for Australian citizenship/permanent residency. But then if I work in Singapore and then suddenly choose to migrate to Australia due to some unforseen circumstances, I would have to pass the dreaded AMC (Australian Medical Council) Exam which I have participated before in POW hospital and it is exceedingly DIFFICULT to pass. Like the pass rate is less than 50%. Thinking about all these crucial matters is already giving me stress and I can feel a slight case of tachycardia and hyperventilation coming on right now. Sooner or later, I'll have to come up with a decision and hopefully I make the right one because its gonna affect MY CAREER AND MY LIFE. Things like these can easily be swept underneath a rug but then as it starts to accumulate dust and dirt and you try your hardest to supress it, one day you're going to end up with an upper respiratory tract infection or allergic rhinitis. Lets just hope it doesn't come back to haunt me later...

Friends

Due to a huge abundance of time (I have exactly a month left of holiday), I've decided to reflect and reminsce on some joyful memories within my circle of friends. It is true that as a medical student we have to put our top priorities first which means sacrificing outings with friends to spend agonising hours trying to devour heaps of information from the dreaded Kumar and Clarke medical textbook. Nevertheless, we as human beings cannot function as solitary creatures and there will eventually come a time when we seek comfort in the company of others.

This topic will be delved further into another time...

First entry

Hey,

I've decided to start a blog to record my journey through life; its ups and downs; its miracles and failures and simply just to express my emotions, thoughts and opinions on life's trivial matters. Just a short introduction on myself; a 23 year old female who is a final year medical student at the UNSW embarking on a quest of medical knowledge who stresses very easily especially during examinations but somehow has miraculously pulled through in the past(thankfully) by God's Will. Basically a simple girl who enjoys life's simple pleasures such as curling up with a good novel or downloading music (when not bustling through the hospital's corridors during clinic hours). Not exactly the typical girl who goes crazy over mega sales in shopping centers but would much rather prefer an hour's workout in the gym or a game of tennis. Enjoys socialising with friends but not into clubbing or heavy drinking although I wouldn't dispute that the endorphins and adrenaline released from a night out of booze and dancing does combat stress from the workplace. I must admit, I am a pessimistic person by nature which often leads to endless hours pondering over minor mistakes and fretting over them.

Nevertheless, a normal person does have a few good traits although we often focus more on the negative aspects (as such as my case). We have to put our positive assets to full use and either forget our flaws or draw them to a bare minimum. Anyway, I shall stop now on introducing myself; after all only time will reveal my inner personality as isn't this what a blog is for?

As for now, signing off,
Lil.