it’s raining outside

It’s 2 AM and it’s raining heavily outside, so apologies in advance if any of the above factors affect the mood of this post. I’m sitting on my bed hammering this post out (so much for proper sleep hygiene, the bed is reserved for only sleep and sex right?), and it’s all over the place so bear with me.

There are conversations, and then there are the 6 am conversations that happen just because, and make you really THINK.

There are conversations, and then there are the 6 AM conversations that happen just because, and make you really THINK.

This blog is always about what I’m thinking about, and what interests me today is a stark realization of the huge difference between KNOWING, and DOING.

In all aspects of life.

It’s very easy to know things; all you have to do is read! In our generation, with the Internet at our disposal, reading up about something just simply requires you to have the interest, have access to Google, and have the attention to read what comes up.

You can actually read about anything: pharmacy, medicine, love, relationships, how to change tires, how to tie a tie, do cats really always fall on their feet (yes, but only if they fallen from at least a certain height!), what is loose leaf tea (I’ve read so much about tea…XD), how to lead a more fulfilling life, how to be happy, who’s a good fantasy basketball pick up, what REALLY happened with the Malaysian flight, who is Taylor Swift singing about now, how to shoot a jump shot, how to cross-over defenders, actually ANYTHING!

Patrick Beverly – I’ve actually been reading a lot about playing good defence lately, and I’m hoping to incorporate it into my game ASAP. Let’s go PharmaBeasts, next semester is our last chance to win a championship!

I read a lot – anyone that knows me knows this. I’m also quite indiscriminate about what I read too, so I read a lot of random things – so overtime, things stick. Yet, I’ve found that I am not very good at translating what I read into actual practice. I mean, this seems obvious, but upon closer introspection, I realize how hard it actually is.

I mean, gosh, if I could translate even 5% of what I read into practice, I’d be a basketball star with the knowledge of journals at my fingertips, and also know how to tie at least 5 different types of knots while effortlessly (and stylishly) wearing my scarf in over 35 different ways.

SCARVES! Please come back winter =(

I’ve read a couple of pretty insightful things recently, and they’ve made me think a lot.

First up is an article about asking the right questionshttp://www.huffingtonpost.com/glennon-melton/the-questions-that-will-save-your-relationships_b_4618254.html.

I always ask people how was your day, or what’s new, or update me on your life. But if you really care, or you really want to know someone, then we need to ask them better questions and then really listen to their answers. If you don’t want throwaway answers, then you really can’t ask throwaway questions. I don’t want people to think I’m just asking them questions because I have to or because it’s polite; it’s because I actually want to talk to you, because I care about what you have to say and how that makes you feel.

So after reading this article, I decided to put it into practice. For about a week or so, I carefully watched the questions I asked, and tried to live this philosophy. I got a couple of weird stares, someone asked me why I was asking weird questions, and so a week later I abandoned this one. But the thing is, I truly believe in it – and yet despite reading all about it and reading it several times, I couldn’t put it into practice.

And another one I read, and this one is a HUGE article, absolutely amazing, insightful and bookmarked for ages to come – an article on relationships and life partners:

Part 1: http://waitbutwhy.com/2014/02/pick-life-partner.html

Part 2: http://waitbutwhy.com/2014/02/pick-life-partner-part-2.html

Please, if I ever tell you anything and you ever decide to follow through, let it be my recommendation for you to read these 2 amazing pieces.

PWETTY PWEASEEEEEE

One thing in these articles that just struck me – I mean it’s pretty obvious, but it’s one of those things people don’t think about usually so that when you read it, it just strikes you so strongly because it’s so true:

A good relationship isn’t about the epic love story or the poetic romanticism or the grand gestures and the cliche lines. It isn’t about the flowers or the amazing trips or the butterflies or the awesome social excursions…

It’s about having lunch together for the 1047th time, it’s about that quiet Sunday night where she watched TV and you read a book, but you were together, on the couch. It’s about getting stuck in a traffic jam on the 401, about the routine good morning texts you both send and receive.

A good relationship is 20,000 Forgettable Wednesdays, together

There is just so much in these 2 articles, and I absolutely find myself agreeing with their bottom-lines. Yet, even though I KNOW these fallacies, I still find myself unable to get out of them. Why is that?

Even in pharmacy and medicine, I see this disconnect between literature and practice. So there’s a drug, metformin, which is basically the best drug for diabetics, PERIOD.

Who’s a good drug, yes you are!

One of the rare side-effects that pharmacists always counsel on or mention is lactic acidosis (long story short, its basically a build up of lactic acid in the body and it’s pretty bad for your health, you might even die).

Yet, we have learnt that from a meta-analysis on the topic (what is the incidence of lactic acidosis in metformin users) that compared to placebo, metformin actually does not statistically significantly increase your risk of lactic acidosis. That this myth is actually perpetuated by the fact that metformin’s precursor (phenformin) was the one that was actually associated with lactic acidosis, and was pulled off the shelves.

So even though we know this, why do we – as practitioners of evidence-based medicine – continue to remind people of lactic acidosis?

One reason that comes to mind is that it’s the safe thing to do – I mean, what harm is there in adding on an extra complication to our monitoring plan? Or counselling patients on it? Isn’t it better to be safe than sorry?

I have no easy answer for this, but again this is another example of where it’s easy to know what you read, but hard to put it into practice.

I guess the whole point of this post is that I recently read something else that really resonated, and something I also want to put into practice. But at this point, I have these doubts as to whether I can really do it.

Courtesy of reddit:

You are in control of your own happiness. Stop for a second when you feel offended or hurt and ask yourself these questions:

1. Why does this bother me?

2. Was it intentional?

3. Is there a solution?

4. Do I really want to be mad about this?

Then make a CHOICE to ALLOW it to bother you or not, it’s up to you. But don’t waste sweet precious moments of your life. Forgive and forget and you will absolutely be happier.

All we can do is try. 

Alfred to Batman: Why do we fall, sir? So we can learn to pick ourselves up.

Music time:

I’ve been moving away from EDM lately – and maybe even trance – and into music like this kind of genre. I’m not exactly sure what genre it is (I think colloquially it’s been referred to as chillstep?), but all I know is the things uploaded by Fluidified – Best Serve Chilled has been just amazing for me, and I can’t stop listening to it.

pz out for now.

perspective

In my head, this was supposed to be a Valentine’s Day post. Looking back at 3 years worth of posts, it seems like my Valentine’s Day posts tended to be quite popular.

Forever alone.

Forever alone.

However, I actually wanted to blog about something a bit more important and a bit deeper than your usual attraction/relationship/melodramatic blog that I tend to churn out on Singles Awareness Day (LOL). With that said, I can’t simply not blog about Valentine’s though, so in a compromise, here’s a short bitty on it.

First, you gotta watch this video:

This is a very new video, and it’s by a brand new group on Youtube – so I’m not sure whether you guys have seen this or not. It is very reminiscent of WongFu production’s earlier material (see Strangers Again). I personally really like this video, and I think it is quite nice that it came out on Valentine’s Day.

(COINCIDENCE? I THINK NOT!)

A plan so intricate that I can't even follow

A plan so intricate that I can’t even follow

The theme underlying this video is very similar to my own personal philosophy, which is something I’ve blogged about previously. To recap, I would rather live a life of ‘oh wells’ than a life of ‘what ifs’. Everything in life is an opportunity – wouldn’t you rather have tried and failed (laugh about it later, and take that experience away as a learning one), than to not even try at all and wonder what could have been?

Opportunity is knockin' at your door // But you never left a welcome mat // it doesn't matter anymore...

Opportunity is knockin’ at your door // But you never left a welcome mat // it doesn’t matter anymore…

Of course, this is a philosophy that can and should be applied to every aspect of life. Whereas this video romanticizes the concept and applies it merely to approaching a girl. With that said, however, there are some nice lines in this video: “But you let doubt consume you. And those perfect moments can only be mere thoughts, and not memories.”

So what is the issue I have with this video? The problem with this video is that it subtly implies being single is bad. Near the latter end of the video, they show clips of what the guy’s life is like since he missed his chance – lonely, the lighting is gloomy, and he subsists on a diet of beer and pizza.

Really?

Now, I do understand the artistic direction here – parallelism contrasting what could have been, to what is; all because the guy doubted himself (or as pick-up artists would call it, approach anxiety :P). However, the message is tainted because it basically tells viewers that to be happy, you have to be in a relationship.

However, the reality is that until you are capable of finding happiness with yourself on your own, how can you expect to be in a relationship and keep somebody else happy?

So next topic:

Perspective.

Specifically, I want to blog about an oft-overlooked perspective that we healthcare professional students often miss.

Sometimes, being a pharmacy student feels a little bit like acting. We have lines to memorize: we say hypertension instead of high blood pressure, or salbutamol instead of your blue inhaler. Then there are the props: we learn how to use stethoscopes, attempt to interpret a patient’s lab tests, and wear white coats.

professional

professional

The first “patients” we see are, in fact, professional actors, trained to mimic a specific constellation of symptoms depending on what the subject of the day is (uncontrolled COPD? newly diagnosed heart failure?). After all, it makes sense that novice healthcare practitioners can’t expect to be working on real patients without some practice first.

Pictured: the solution to heart failure

Pictured: the pathophys of heart failure

So I was eager to move on to the real thing. The first time I ever took a full medical and medication history was doing a medication reconciliation with a patient in the emergency department. He had been hospitalized because his legs were very swollen (full of fluid) due to his uncontrolled heart failure (it’s called edema for all you keeners) – and he was a real patient. But the fact that I was no longer playing a part didn’t hit me until later.

“What brings you here today?” I ask. Legs swollen to twice their normal size, he said. He attributes it to overeating during the holidays (the holiday salt). We share a chuckle at that. I think to myself: building rapport with patient, check.

Running through a mnemonic in my head, I walked the man through the major questions necessary to flesh out their best possible medication history – I like to use HAMS (thank you nardine) as my mnemonic (History of medical conditions, Allergies, Medications, Social history). I didn’t interrupt the patient; I spent time with him; we share some chuckles. I listened to what he said and wrote it down.

With the help of the pharmacist, I reconcile the patient’s medications and identify some drug therapy problems, and leave some recommendations for the physician in charge. As for the interview, I had, the pharmacist said later, “done great.”

A few hours later, I left work on something similar to a post-workout adrenaline rush. Pulling out my phone, I text some close friends telling them I officially worked up my first real patient in real life. I practically dance down the street.

victory dance

victory dance

Only when I got back to my room and change into comfy clothing did it sink in: the old man I’d met today was not an actor. He was not one of my classmates, pretending to be a patient and rattling off symptoms so that I could practice patient interviewing. He was real. He is the kind of person that I will be able to take care of, years of study and post-grad education from now, when I am a real practitioner.

Just then, the patient might have been sleeping in his hospital bed, happy for a reason completely different from mine: he was going to be ok. This was the true joy of the day. And for a few moments neither of us will ever forget, I got to share in it.

Anyways, this brings me to the end of this post. Although this experience happened last year, I didn’t really find the words to express it until more recently.

Music Mondays!

So I am going to see Zedd live in a couple of weeks. Obviously, this music monday is gonna feature one of the top songs by this guy:

I absolutely cannot wait for it to happen. SO EXCITED! enjoy =)

pz out for now

stuck on me

I knew I wanted to blog today, but I wasn’t sure on what. I pretty much sat here after dinner, staring at my laptop screen and thinking. I figured I might as well just start writing, and see what comes out of my mind.

"the mansion of your mind // just an oversized cell"Props to anyone who recognizes these lyrics.

“the mansion of your mind // just an oversized cell”
Props to anyone who recognizes these lyrics.

So this past weekend I went on a snowboarding trip up at Blue Mountain. I think it marked my 4th visit to BM this season. Last year, due to a variety of ankle and knee booboos and the lack of snow, I only went snowboarding twice. So clearly, I had to make up for it this season.

forum or against em

forum or against em

I’m not sure exactly what it is about snowboarding that gets me so addicted. There’s definitely that adrenaline thrill as you carve down a steep mountain. Then there’s also that surge of happiness you get when you successfully land a move (buttering? frontside 180? backside 180? faceplant?). All I know is I can spend 10 hours snowboarding by myself as long as I have my music with me – there aren’t many activities I know of where I can go 10 hours without talking to another person and feel perfectly content about it. And they call me an extrovert…

And then there are those tasks where I most definitely cannot go 10 hours straight – like studying or tedious working. I find that I am most efficient in the morning. There are times where I get more studying/work done between 7 AM and 2 PM than from 10 PM onwards. Part of this comes from taking breaks – I can chug it straight in the mornings with barely any breaks, but come evening, I find myself taking random breaks every 45 minutes or so (facebook? youtube? NBA? food runs?).

What determines when I decide I need to take a break, and when I have the gusto to chug it through?

too pro

too pro

So I did some quick research (or procrastination, depending on how you see it :P)

There is actual research looking at how people decide when to keep going and when to take a break. What they conclude is that this crucial decision apparently hinges on a specific neural signal that at its peak (e.g. when your muscles are screaming that you can’t do another rep) prompts you to quit. And when you’ve rested up a bit, the signal quiets down and gets out of your way.

"Man I regret going to the gym" said no one ever.

“Man I regret going to the gym” said no one ever.

However, the peaks and valleys that trigger these decisions are not pre-set; they’re influenced by how much effort you’re expending and how big a reward you expect from the work. The bigger the reward and the smaller the effort required, the more likely you are to keep going. As you work, your brain continuously calibrates your breaking point in relation to your expectations of gain.

The studies also suggest that situational factors such as music, stress or the presence of an attractive potential mate (holla!) also affects how much pain is seen as tolerable. That probably explains why people tend to study/work better when they’re listening to their favorite music. Or when cute girls are nearby 😉.

Makes me wonder just how packed the Hogwarts library  must have been....:P

Makes me wonder just how packed the Hogwarts library must have been….:P

The authors hypothesize that the pain regions of the brain are adjusted depending on expectations. Essentially, it is the pain region sensitivity that is altered – great expectations tend to desensitize the pain region, allowing you to push yourself through the pain then when you expect great gains.

So what’s the bottom-line?

For that last bit of motivation to finish the last rep/bit of studying/work task, think of your big picture gains and that should help you push through the pain. Or just listen to good music 😛

Speaking of music, I guess it’s time for Music Mondays.

This one is a nice ballad-style song by Youtube sensation David Choi. If you look at the comments, everyone is calling it the friendzone anthem. Take a look at the video, and I’m sure you’ll see why it’s basically the ultimate friendzone song.

Anyways, pz out for now!

end of another era

Finally done exams. FREEDOM!!!

LOL. There's actually a funny story about this quote.

LOL. There’s actually a funny story about this quote…

Funny story: even though we know marks don’t really matter where we’re going, for some reason, we love to calculate our marks and try to figure out exactly what mark we need to get on the final to pass the course/get 80% overall average. During one of these discussions, I remember telling a friend: “Don’t aim to just pass the course! Shoot for the moon, because even if you miss, you’ll still land amongst the stars!”. Haha I guess this image puts that into perspective 😛

So as always – reflections: 

This semester, we learnt all about diabetes and cardiology, amongst other topics. It made me realize something: for some of these topics, ALL we’re expected to know as true professionals, we’re learning now. For example, we’ve covered diabetes exhaustively – and for the rest of our education, we won’t be going back into it in depth.

Diabetes master! Aka recommend metformin :P

Diabetes master! Aka recommend metformin 😛

That says a lot to me. It tells me that I need to retain this knowledge, that if I want to be the kind of professional I want to be, I need to work on making sure I remember and can recall this knowledge.

It also tells me that since I’m a third year student now, that I’m basically half-way to being a professional. To be perfectly honest, that scares me a bit because sometimes I don’t feel like I’m ready. There’s so much that I expect from myself, and sometimes I don’t deliver to my own standards, and then I feel like I’m disappointing myself.

But.

Who I am now is not who I’ll always be, and far from who I’ve been. It may be an indicator of who I will be, but that is always subject to change. This is just the beginning of the journey.

Some day, when I’m a legit professional (the awesome kind), I want to be able to look back on this post and think: Man, 3rd year Victor was stressing over nothinggggggggggg :P.

Anyways.

Related food for thought:

TRUTH. Depressing though.

TRUTH. Depressing though.

So what’s the bottom line? Simply graduating as whatever profession you’re in may not garner the respect, the responsibilities and the satisfaction that you feel you deserve. And god knows how deserved we feel, what with our generation brought up to feel entitled. At the end of the day, it’s all about how well you express yourself, and how well you demonstrate your capability. If you can do that well, and you are legitly good at what you do, then you will be successful.

Simple equation? – I hope. Otherwise, all that I’ve worked for will be in vain! Haha.

Unless your definition of success is dating one of these girls. In which case: good luck.

Unless your definition of success is dating one of these girls. In which case: good luck.

Anyways, Music Mondays aka what music did I loop while studying:

Good-sounding vocals. Also, kinda interesting premise for the song/MV. Essentially, the song is about how sometimes, when you meet someone and you feel like you would be great together, it may only take 60 seconds to find out if you really would be great together :P. Doesn’t make sense entirely (but it’s basically a Korean drama-in-a-song, it doesn’t have to make sense).

BEST ANIME MOVIE I have ever watched :P. Keep in mind I was probably 12 or 14 when I first watched this, and I’ve seen this movie maybe 20 times now? So I may be biased. Plus, I grew up watching Gundams haha. Simply put, the music, the premise and the depth behind Gundam Wing Endless Waltz, Gundam 00 and Gundam Seed are all pretty awesome.

For those who are interested, the song is Last Impression by Two-Mix. Great song.

Anyways, time to catch some much-needed snoozles.

pz out for now!

constant maelstorm

Time really flies by – just a while back, I was on co-op, and now I’m halfway done another semester! I haven’t added a blog post in a while, although I did write a short blurb on cool breathing exercises, which is in the Health and Wellness section of my blog.

time flies but don’t forget that you’re the pilot

The title of this blog is maelstorm, which is eerily appropriate as I have just come out of 2 months of whirling midterms and projects, and the weather outside right now as I am writing this post is stormy rain. Of course, the next day after a storm is always beautiful, and this applies to more than just nature’s storms; I feel life is pretty balanced right now, even though the craziness restarts again in a week (#IPFClife).

Over the past two months, I’ve accumulated a ton of cool things I wanted to share on my blog, so this blog post is just gonna be a red carpet roll of things with narration? 😛

story of my love life? 😛

Sometimes I meet people that I get along tremendously with, but life often has different ideas and we drift apart as time goes by/people relocate as per career/life. It’s sad, but sometimes I think it’s better to be the perpendicular lines than the parallel lines because even if it’s only meeting once, every person we meet has some indelible effect on our life. Whether it’s positive or negative, it’s still an experience.

So when you ask me whether I would rather ‘have loved and have lost’, than ‘to never love at all’, I would pick the former.

Speaking of love (and neurotransmitters), I found this awesome sketch:

if our IPFC slides were cute like this, I think I would study better 😛

As I’ve blogged previously, I’m a member of the camp that believes love is an emotional state triggered by a unique mix of neurotransmitters and associated chemical impulses. Different types of love (romantic, friendship, familial) are triggered by different permutations/combinations of the same neurotransmitters.

So when you ask me if I believe in the concept of soulmates, I would have to say no. Because once the environment is right and the timing is good, then odds are there will be more than one person who can trigger that unique mixture of neurotransmitters in you. The probability lies in meeting those people when all the other factors align. #foreveralone

Switching topics: compared to my undergrad experience (FYI I was in microbiology and immunology at McGill aka I majored in partying with a minor in slacking off), I find pharmacy school more difficult than undergrad (#understatement-of-the-century?).

HYPER CHARGING STARRRRR

Part of this definitely stems from the fact that our curriculum is extremely clinically-based, with our modules centered around disease states and how to use drugs to treat them rather than just the drugs themselves.

I like that.

But it definitely does not prepare us for the PEBCs. Because the PEBCs just want pharmacists who memorize drugs and nothing else. Pathetic.

I think even though our curriculum may not prepare us adequately for the PEBCs (which have barely changed their testing strategies in the past 10 years despite the profession’s niche changing drastically), it helps us become better clinicians.

Because at the end of the day, passing the PEBCs just gains us a piece of paper (and the certificate looks so amateur too, something out of a low quality laser printer). But becoming a better cliniciana more complete practitionera true professional – that’s something that you EARN.

YOUR knowledge.

And you don’t need a goddamn paper to tell you that.

There’s a layer of proud ownership over everything you possess that wasn’t merely given to you.

Of course, getting there requires hard work. No one said that being exceptional was easy. I believe that hard work goes a long way, because at the end of the day, hard work trumps natural talent. Lots of people are talented.

But not everyone has the discipline to delay gratification and put in those hours of hard work.

Looking at this from an outcomes-based point of view (the Naggs would approve), being talented and not optimizing it leads to the same result as not having that talent at all.

You are lucky enough to be blessed with something. Now what are you going to do with it?

articulating your own limits is powerful.

As soon as you say it, you’re that much closer to making it true.

I guess this is a call-to-action to myself, on my blog, to work harder.

Anotha day anotha dolla :P.

Wow I love these graphs.

For those who have noticed, I’ve really gotten into this whole hashtagging thing – I just think it’s so fun. And that’s because I’ve JUST started a twitter account – get at me at ‘t3_victor’.

Music Mondays (man when’s the last time I actually blogged on a monday?):

Augustana – Last Mistake. I just started getting their discography again, it’s good stuff.

pz out for now.

 

of bad doctors

I am going to warn you right now – this post isn’t going to be pretty. I’m not going to spare anyone’s sensibilities, and I am not going to sugar-coat anything. After all, this is my blog. Although today’s post is more of a rant than anything else, I do very much welcome feedback (especially if it contradicts my own thoughts, since the only way for me to really learn is to let go of what I think I already know), so feel free to comment publicly or message me privately.

FLAME ON!

So someone close to me was travelling around in Asia, and happened to be chillin’ in HK when he caught a bad case of SOMETHING. The symptoms were stomach-ache, vomiting, diarrhea, fever, malaise, and dizziness. He goes to a clinic in HK and sees the doctor, who takes his blood pressure and it comes back 96/60 – a bit on the low side. When my friend described this to me, the first thing I thought of was traveller’s diarrhea or some strain of stomach flu (as certain strains of the flu cause GI symptoms). My next thought was that the loss of water from the vomiting, diarrhea and sweating from the fever resulted in low blood pressure, which explains the dizziness.

My recommendation would be to stay hydrated, try some Gatorade/Powerade (Pedialyte if you’re really looking for it) to replenish electrolytes, and get some rest to let your body fight off the infection by itself. And as always, acetaminophen as needed for headache, pain and fever. Of course, this is all since my friend is a healthy young adult with no comorbid conditions, no allergies and no significant past medical history.

So what did the MD do? He said the problem here was the low blood pressure, and prescribed prednisolone high-dose once a day for three days.

Now when my friend first described this, I was quite skeptical – when was the last time you heard prednisolone prescribed for low blood pressure? And this was high-dose too, albeit for 3 days duration only. Also, why prednisolone and not prednisone? From my understanding of ER/ICU medicine, you would give prednisolone over prednisone when the patient has hepatic failure, since prednisone is hepatically processed to form the active metabolite prednisolone. But my friend’s liver is totally fine…

But as always, I tell myself that my experience is limited (several community pharmacies, and hospital ER and ICU) and well, this is a MD we’re talking about. These guys are the big guns, the smart ones. Knowing my friend, he wouldn’t visit some shady-ass crap clinic in HK; this would definitely be a more proper, middle-class-based clinic. So after seeing the MD and picking up his drugs, my friend asks me: Hey Victor, should I take this medication? What should I do about this illness I seem to be struck with?

Right off the bat, I talked about what I mentioned above with regards to possible stomach flu/traveller’s diarrhea, and staying hydrated and replenishing electrolytes. But on the subject of the MD’s prescription and whether I should tell my friend to ignore it or take it, well I had to do some research first.

Now for all my readers who aren’t familiar with this drug, let me break down my thought process for you.

1.) Prednisolone is a corticosteroid, and while increased blood pressure is a potential side-effect, I’ve never heard it being prescribed simply for low blood pressure. But that doesn’t mean it’s not possible!

2.) High-dose corticosteroids aren’t to be taken lightly – they have a wide range of undesirable side-effects, and are often reserved for high-risk scenarios (i.e. acute asthma exacerbation, AECOPD, inflammatory diseases such as Crohn’s, etc…)

Cushing’s syndrome and adrenal suppression are the more serious effects, though they are usually a result of chronic use.

3.) Going into Lexicomp and Micromedex, I find out that prednisolone is a corticosteroid with high glucocorticoid and low mineralcorticoid activity. Which is interesting since the mineralcorticoid activity is what increases blood pressure. The mechanism of action is that the mineralcorticoid increases salt resorption, and since the water follows the salt osmotically, you reclaim more water and hence your blood pressure goes up. But here we have a drug that isn’t known for its mineralcorticoid activity being prescribed to increase blood pressure…..sketchy.

4.) I went to work and asked the hospital pharmacists about this issue, and they hadn’t heard of prednisolone being prescribed to increase blood pressure.

So I told my friend to ignore the prescription, since the benefits will be minimal (healthy young man will easily recover from a bout with stomach flu/traveller’s diarrhea and hypotension) while the potential adverse effects are numerous and simply not worth it (especially when you are prone to acne). Furthermore, a corticosteroid would suppress his immune function, making it HARDER for his body to fight off the infection…

So why did the MD prescribe this? Could it be he’s stupid? I don’t think so. I think it is the greed that permeates the healthcare system, facilitating a culture that makes this kind of practice commonplace, especially in HK. Let’s talk about the healthcare system there.

Firstly, there are no pharmacists basically. The doctors in HK hold awesome power: they prescribe, AND dispense. In the same office. At the same time. Can you see why I think this system is broken? They make money for diagnosing you and telling you what you need, and then they give you what you need and charge you for it! So when you are a patient that needs the diagnosis but doesn’t really need any medication, the system is set up so that it is in the MD’s best interest to give you some crap just so they can charge you for it. I mean, even if my friend took the prednisolone, he’d probably get better anyways without any really bad side-effects, since he’s a healthy young adult. And the MD makes an extra buck (for the record, it was an extra 100$ HKD so roughly 12-13$ CAN) and no one was harmed (except my friend missing out on $100 HKD). So it’s not so bad right?

No.

It is simply irresponsible to prescribe drug therapy when none is needed. It’s actually one of the drug-related problems we learn to identify – inappropriate drug therapy. Sadly, this kind of practice is rampant and widespread in HK – other people have mentioned this before, but it never really hit home to me until someone close to me actually asked me for my advice and I realized that this kind of corruption ACTUALLY HAPPENS. The lack of pharmacists in HK is another problem – a couple of months ago, there were a series of scandals where prominent famous people were harmed due to misprescribing by the MDs (no pharmacist to check appropriateness and interactions).

you signed the hippocratic oath dude.

Now let’s switch gears and talk about walk-in clinics in Canada. I went into a walk-in clinic recently to see the MD for something. I saw about 7 people ahead of me in the waiting room, so I figured 7 people x 10 minutes each with the MD = roughly 70 minute wait. To my surprise, I was called in about 45 minutes later, and sent to sit inside a clinic room. There were 4 clinic rooms, each with a different patient inside, and the MD was non-stop going through the rooms, about 2-5 minutes per room. It was like a factory – as soon as the room was vacated, the secretary already had the next person lined up to enter the room. That way, all 4 rooms were always occupied and the MD just kept rotating through them. So his patient output (and billable hours) is INSANE.

So I’m sitting there and the MD walks in. He doesn’t even sit down with mehe’s standing at the doorway with a clipboard and a prescription pad. He asks me what I want. I explain to him my symptoms and why I’m here today. Without actually looking at my problem (he was standing at the goddamn door, didn’t come to physically inspect my issue and definitely too far away to see anything), he tells me he’s going to write me a prescription for Drug A.

He doesn’t ask me about my allergies (I mean yes, he has my profile. From a year ago. And just because I didn’t have allergies then doesn’t mean I don’t have allergies. Especially drug allergies).

He doesn’t INSPECT MY PROBLEM.

He doesn’t ask me WHAT I’VE TRIED. God this makes me angry. This is so important – it gives you an indication of what the patient has tried, and how effective they have been. It guides you in empiric drug prescribing – especially for antibiotics! (for my MD friends – antimicrobial stewardship hospital policy advises not to give someone an antibiotic that they’ve had in the past 3 months, because of potential drug resistance).

Luckily for him, I know what problem I have and I’ve done the appropriate research, and I actually know what drug I want (scoured PubMed for randomized controlled trials, as well as checked out the Health Canada submission that made this drug marketable in Canada). And so I get that drug and I’m happy with that.

Still, I find it ridiculous. My god, doing OTC recommendations with my peers lasts longer and is more effective than seeing the MD today. Honestly. So this is his secret to seeing 7 patients in 45 minutes – not give a shit. What if I had been a patient with actual comorbid conditions? Holy shit, I shudder to think what could have gone wrong. No wonder our hospitals ER waits are so long – cleaning up the fucking mess that doctors like these make.

I suppose the reason I’m so upset is because my illusions have been shattered. Like society, I’ve always kind of put MDs on a bit of a pedestal. They go through so much school, go through such a rigorous selection process, that I can’t help but expect them all to be great. But its unrealistic to expect all of them to be great, and it really just takes several real-life examples to break down your illusions.

*FLAME OFF*.

Anyways, this was a long rant – here’s some nice soothing deadmau5 to calm the blood:

pz out for now.

mental economics

First of all, you’ll notice that I changed the layout of my blog! The colour scheme is quite similar to the old one (I do love my purples and blacks after all), but the overall configuration and navigation has been improved! Edges are slicker, corners are neater, options to share are available, and the whole site is just smoother in general. Of course, this sudden update to the layout of my blog (which took 2 hours mind you) came in the midst of final exams week (I can only sit still and study for so long).

YOU SHALL NOT PASS.

As well, if you look at the top right, you’ll see a new section (Health and Wellness). I often read about random things, and I find that the most useful stuff are the health-related ones because I can apply them to myself. So this is a database-styled page that I am going to be updating periodically as I read about new things that are interesting and applicable! For example, the first post is one on the Thessaly test, which is a test that doctors use to assess if you’ve torn your meniscus or not (like Jeremy Lin). This came as a result of when I decided to start running long distances (10 km when I used to only run 3), and ran too far for too long and ended up with consistent pain associated with movement in my left knee. I decided to self-diagnose using the Thessaly test instead of waiting in line at a walk-in clinic, and everything’s worked out since then. So this new page is going to be a repository of random knowledge like that.

Like Mike? or Like Lin :P?

So what’s new? It’s that time of the year again, where another semester is over and we’re starting co-op now. After an amazing post-exam trip to Montreal (mad shout-outs), I have to settle in and gear up for my placement. Good thing there is a 24 hr Goodlife Fitness near where I’m working – now I have absolutely NO EXCUSE to not hit the gym after work no matter what the time.

I admit it – I’m a bit of a calorie counter. But only because your diet counts so much more than your exercise! (though both are required, in terms of impact, diet > exercise)

Today, I wanted to bring to light the phenom of how utterly inadequate human mental economics are. As I’ve elucidated in a previous post, our brains are logical simply because they are emotional (long story short, our brains assign every decision we consider with varying amounts of emotion, and so our seemingly logical decisions are actually based on emotions). Mental economics refers to how humans comprehend and analyse numbers, and it is related to our emotions-based logical decision-making.

heh heh heh oh cats. they have the emotional range of a Bella Swan

Let me start by posing this hypothetical question to you:

1) You want to go watch a movie which costs $10. You buy a ticket at the door, but somehow lose it before getting into the theatre. Do you want to go back to the door and buy a second ticket?

2) You want to go watch a movie which costs $10. You have not bought a ticket yet. While standing in line at the door, you discover that you’ve lost a $10, dropped on the floor a while ago. Do you leave the movie and go home, or do you continue and purchase a ticket and watch the movie?

Even though taken from a coldly numerical standpoint, both situations represent the EXACT SAME LOSS (a loss of $10). Yet, when given this scenario, most people will choose option 2. Why? It is because in option 1, it feels like you end up paying $20 for the same movie, while in option 2, the loss of the $10 seems to occur independently of the movie ticket and so it’s ok to watch the movie.

Mental economics occurs because of human’s need to lump things together – after all, with all the input through our 5 senses, we must process a significant amount of information all the time, and so it is not surprising that we’ve developed this habit of lumping things together during analysis. In option 1, we’ve lumped in the $10 loss into the original movie ticket, which is why we feel like it’s not worth $20 for the movie. In option 2, the loss of the $10 bill occurred separately of the movie, so our minds have not lumped them together, and so it is OK to watch the movie even though we lost $10.

Yet either way, we finish that day $20 lighter.

of course, if you had enough money, you wouldn’t have to waste time thinking about decisions like these. JUST SPEND IT ALL!

The bottom-line is that while our brains are amazing pieces of machinery, they are not perfect when it comes to categorizing and lumping things together for analyses. This is true not only for numerical situations (i.e. mental economics), but also for non-quantifiable things like emotions and relationships; it just becomes painfully revealed when we put numbers into the equation and see how flawed the result of our emotionally-charged logical decisions can be.

like MAKE-UP. the liesss that girls can cake onto their faces 😛 jk jk

So what does mental economics mean to me? I guess it just means that next time I feel like making a snap decision, I should stop and empirically weigh everything out – because sometimes even though my gut instinct is great for memorizing and flash memory, I need the slow, brainpower-consuming process of cold logic behind my decisions.

’nuff said.

Before I end things off, here’s an awesome series of songs:

I hate to say it, but I am a fan of their old sound much more than their new. This song is great because it’s getting back to their roots (Mike rapping, Chester some screaming/singing, nice background beats, etc…)

I like the sample from Michael Jackon’s song. Overall, I like their sound.

pz out for now!