Hong Kong 26 - 30 Nov 2013

My last visit to Hong Kong was 2 years ago. I remember blogging about the trip - if I don't recall wrongly we had spent a considerable amount of time eating and shopping.

Not sure why my family chose to go back. But 2 years later we are back for more. Maybe we have an insatiable appetite for eating and shopping.

The Hong Kong Skyline taken during a stroll about Victoria Peak

Interesting sign. Also found on Victoria Peak.

A stroll at Victoria park in the morning led us to this pleasant surprise. I am pretty sure that is not an owl.

Me looking downright silly while celebrating our find of cifan. It has turned into an obsession but tastes pretty nice actually. Basically glutinous rice with pork floss, salted vegetables and You Tiao. I took a similar picture 2 years ago, and I believe this is the same stall - The Shanghai Hong Kong Noodle shop.

Took a ferry from Wan Chai to Tsim Sha Tsui and was rewarded with this view at 3pm in the afternoon. Great weather - sunny with cool temperatures, a rare find back home.

No we did not eat this in Hong Kong. The queue was way too long. This photo was taken from our hometown at Plaza Singapura, Singapore.

Ningbo-shanghai trip

I havent blogged for ages.

There's no particular reason except that my last posting was a particularly good one.
One that I hope i will remember for life.
A quick recap on events thus far:
- completed 3 months rai posting
- passed mrcp part 1
- went for shanghai holiday
- started accident and emergency posting
- and made lots of good friends along the way :)

How to differentiate between renal tubular acidosis, gittelman syndrome, bartter syndrome and liddle syndrome.

Acidosis! Hyperchloremia!

Renal tubular acidosis type I = Distal RTA = Decreased distal acidification. Urine pH > 5.3. Low to normal k. Nephrocalcinosis and renal stones due to hypercalciuria. Sjögren's syndrome, amphotericin. Give bicarbonate.

Type II = Proximal RTA = Decreased proximal bicarbonate absorption. Urine pH variable. Low to normal k. Rickets, osteomalacia, fanconi's syndrome = hypophosphatemia, hyperuricosuria, glycosuria. Multiple myeloma, acetazolamide, heavy metal poisoning. Treat cause, restrict sodium.

Type III = mixed type I and II 

Type IV = Aldosterone deficiency or resistance. Urine pH < 5.3. Hyperkalemia. Diabetes, primary adrenal insufficiency, spironolactone, amiloride, triamterine, tmp, pentamidine. Sodium restriction, frusemide.

Alkalosis! Hypokalemia! 

Bartter syndrome = hypokalemia, high urine calcium, act like loop diuretic (impaired sodium, k chloride reabsorption in TAL) Replace potassium, give amiloride, indomethacin. 

Gittelman syndrome = hypokalemia, low urine calcium, acts like thiazides diuretic (sodium chloride cotransporter). Hypomagnesemia ? Mechanism. Replace potassium, magnesium. K sparing diuretic.

Liddle syndrome = hypokalemia , metabolic alkalosis, hypertension. Hypoaldosteronism secondary to constitutive activation of sodium channel. Triamterine , amiloride . 

Six things I'm thankful for, and four more I wish could be better

1. Amazing colleagues who lend a listening ear and who never shy away from lending a helping hand

2. Supportive and understanding senior staff

3. Best family support one can ever wish for

4. Finding time to have breakfast and exercise with family

5. Best sister anyone can have. Even if she's overseas.

6. Relatively peaceful national day call. And the joy of not having any more calls for the rest of the month!

1. Sleep regularity. 

2. Work and study efficiency

3. Physical fitness (groan)

4. Work life balance (the elusive goal)

Changeover

Post night float, I am physically and mentally exhausted.
Even forgot to collect my change for breakfast this morning.
Fortunately, I was allowed to go post call by my new consultant.
The last 14 months has been eventful, by any standard.
I am not sure what to expect for the next 3,6,9 months and so on.
But every rotation makes me see things from a different perspective.
It has been enjoyable though perhaps bittersweet journey thus far.
Better start reading up on rheumatology.
Better start practising for MRCP part 1.
Better submit the application form for the ITE.
And to quote my consultant this morning, better drink lots of water and stay healthy!

Don't hate me for being an idiot

Don't hate me for being an idiot

I dislike being rushed
But the pressures of working life make me very rushed indeed
Sometimes I don't even know what I am doing
Then I turn into a robot
Eeee! Bump! Whee!
Until 5pm or exit time
I sit down and relax
Do my discharge summaries
Update families
Make a date for people

I play
Tiny tower
Robots and the mountain of doom
The black rabbit of inle
Neopets
People

I eat
Anything and everything
Except Dogs And Cats

Testing, testing

Left with a long vacation (1 week is long by medical standards), I made my beginner's foray into tablets.
I spent the whole morning researching on the pros (fun factor, medical apps) and cons (cost, time investment) of buying a tablet. The clincher between android vs apple was Nejm - it had no android app to speak of!
Basically I went ahead and bought the cheapest iPad like thing I could find - which was the iPad mini. I know that the specs are subpar compared to other mini tablets. But I didn't mind as long as it did the job - which it did.
Battery life seems pretty good so far although I have only tried reading ebooks and medical apps. And the range of applications (medical or otherwise) really betters android by a mile. I am not sure what they mean by android catching up.
Hopefully this vacation turns out to be fruitful one!

Ignore this post

I haven't ran in so long that my legs are aching after jogging less than 2.4km
The effects reach a maximum day 2 post jogging
But I feel the effects already
Sedentary lifestyle = decreased effort tolerance
Irregular meal timings = increased irritability
Increased irritability + decreased effort tolerance = very pek chek

Notable articles of the week

Something slightly more academic than my usual rants.

Diagnosis and management of carotid atherosclerosis: BMJ 2013;346:f1485; doi: 10.1136/bmj.f1485 - Refer symptomatic patients with 50-99% stenosis or asymptomatic patients with 70-99% stenosis for surgical revascularization. Medical therapy for symptomatic patients using plavix (CAPRIE trial), BP control, statins, smoking cessation, 2.5 of moderate intensity exercise per week. Medical therapy for asymptomatic patients? Not mentioned.

Use of caffeinated substances and risk of crashes in long distance drivers of commercial vehicles: case-control study: BMJ 2013;346:f1140; doi: 10.1136/bmj.f1140 > suggests that consuming caffeine for the purpose of staying awake can reduce the risk of an accident. But results subject to bias (state regulations for work and fatigue and reporter bias).


Use of high potency statins and rates of admission for acute kidney injury: multicenter, retrospective observational analysis of administrative databases: BMJ 2013;346:f880 doi: 10.1136/bmj.f880 > suggests that current users of high potency statins (defined at rosuva 10mg, atorva 20mg, simvastatin 40mg) are 34% more likely than users of low potency statins to be hospitalized for AKI within 120 days of starting treatment.

Nearing the end of the beginning

It has been almost a full 10 months since I graduated and turned into a house officer.
I still remember the nervousness and unease that came towards the end of my final year in medical school. Then, there was a lot of uncertainty over 1. residency 2. exams 3. HOship yada-yada.
Well, that hurdle was overcome.
I went through 4 months of orthopedics (one of my favourite subjects) before plunging into internal medicine - working under endocrine consultants for 5 months! - before jumping into renal medicine for a short 1 month.
My brain is undergoing a constant stress every day I go to work, but I am not sure if my number of brain cells is increasing - I know for a fact that brain cells don't multiply after a certain age.
So I buy lots of supplements for my brain in the form of textbooks which I don't read, exam questions which I don't do, journals which I barely read. Possibly an overt expression of insecurity and maladaptation.

Anyway.
The year of the snake has just begun. Lots of opportunities for self improvement. My advice to self remains: enjoy this year while it lasts. After all, I only get to be a houseman once.