Thursday, July 29, 2010


  • Thank God...we are getting better now.I never expected a common flu can cause so much of problems until I personally experienced it.

    Actually,Influenza is a common cause of serious illness and death. About 5% of adults and 20% of children develop symptomatic influenza infection each year.

  • The typical symptoms include:
    -Dry cough
    -Muscle pains
    -Sore throat
    -Temperature between 38°C and 39°C
    -Runny nose
    -Feeling weak and tired.
    Symptoms typically last about three days.
  • Complications include:
    -Bacterial pneumonia
    -Primary influenza pneumonia
    -Worsening of pre-existing diseases, such as cardiac failure.

After going through the difficult part of the illness,I decided to vaccinate my whole family against seasonal flu using the seasonal trivalent influenza vaccine 2010 which also contains the H1N1 pandemic strain.

How effective is the influenza vaccine?
  • Children
    In two studies, vaccination was about 80% effective at preventing influenza in children.4 5 The studies looked at patients with symptomatic infections, which were confirmed in the laboratory.
  • Adults of working age
    In two studies vaccination was 77% effective at preventing influenza in adults of working age.6 7 Again, the studies looked at patients with symptomatic infections, which were confirmed in the laboratory.
  • Older people
    Vaccination is less effective in older people. It is about 50% effective at preventing episodes of influenza (which were confirmed in the laboratory) in older people.It reduced
    the number of influenza-like episodes by 35% and hospital admission for pneumonia and influenza-like illnesses by 47%.

Current influenza vaccines aren't as effective as they could be for several reasons.

  • It's often because the person being vaccinated doesn't mount an adequate immune response. This may be because of old age, or diseases or drugs that cause immunocompromise. But older people and people with a compromised immune system are the groups that are most at risk of the complications of influenza.

  • Even when there is an adequate immune response to the vaccine, there may be poor concordance between the viral antigens in the vaccine and those that are causing infections in the community. This is because it isn't possible to predict the antigenic nature of the viruses that will be circulating during the coming winter.

Despite the easy availability of the vaccines,many are still reluctant to have this jab.There are many excuses for not having this injections.I was also sceptical to have the H1N1 written in my blog few months ago.

  • An old man says he had the vaccine last year and still got "flu." Why?

He may not have had influenza. There are many respiratory pathogens circulating during the influenza season that also lead to flu-like symptoms, such as rhinovirus, which has more that 100 serotypes. Influenza vaccination won't prevent infections with other respiratory viruses. Such viruses can cause an influenza-like illness. But the illness isn't usually as severe as influenza, and it isn't life threatening.

  • A 76 year old woman says she had the influenza vaccine two years ago and it gave her "flu." She says she never wants to have it again. What should you say to her?

Influenza vaccine can't cause influenza because it is an inactivated vaccine. The vaccine is inactivated and can't cause influenza.
It's likely that she had some other respiratory virus. But it's possible that she could have been exposed to influenza just after vaccination, at a time when she had not yet mounted an immune response. The delay between vaccination and effective protection is about two weeks. The best time to be vaccinated is therefore at the very beginning of the influenza season.

  • A 68 year old woman comes to see you the day after having the influenza vaccine. She says she felt feverish and developed a headache about nine hours after receiving it. She wonders what the problem is. What should you say to her?

Fever, headache, and malaise can occur after having the influenza vaccine. But these symptoms occur in only a minority of patients. They typically start six hours to 12 hours after exposure to the vaccine. But they are usually mild and settle down after one or two days. So you should reassure her.

  • A 78 year old man wonders why he should have the influenza vaccine. He has never been seriously ill and he has never been in hospital. What should you say to him?

Influenza can be a serious illness. Primary influenza pneumonia is rare, but it has a high death rate.
The overall death rate for influenza is 0.5 per 1000 patients to 1 per 1000 patients
The hospitalisation rate for influenza is 2 per 1000 persons older than 65
About 90% of influenza associated deaths are among people older than 65
In winters when the incidence of influenza is low, about 4000 people die from influenza. But there were 29 000 deaths in 1989.
So you should still urge him to have the vaccine.

  • A 66 year old man with a history of stroke has read about the influenza vaccine. He read that the vaccine can cause strange neurological illnesses. What should you say to him?

Influenza vaccination does not cause strokes, so you can reassure him on that count. He may have read about Guillain-Barre syndrome. But this is exceedingly rare. The link between the vaccine and Guillain-Barre syndrome has not been definitively proved. It occurs at a rate of about one additional case per million people vaccinated.

  • What about someone who forgot to have the influenza vaccine and now there is an outbreak of influenza. What should you advise her?

She can still have the vaccine. But antibody levels take 10 to 14 days to rise after vaccination. If she has been exposed to the influenza virus and the exposure has been in the past 48 hours, you could give her oseltamivir(Tamilflu) to prevent her getting influenza.

  • If influenza A or influenza B is circulating in the community, you should consider oseltamivir(Tamilflu) for the post-exposure prophylaxis of influenza in people who:

-Have been exposed to someone with an influenza-like illness in the past 48 hours
-Are at risk of complications of influenza
-Are not adequately protected by vaccination.

You should consider people not to be adequately protected by vaccination if:
-They haven't received the vaccine
-The vaccine has yet to take effect
-The vaccine and the circulating strain of influenza are not well matched.

So guys...don't be afraid.Go ahead and have the jab!!

Sunday, July 25, 2010

How B cause havoc in my family.

  • The past 2 weeks was a terrible time for my family because of B.Who is B?

B was actually a virus...the influenza B virus.My children got symptoms of flu 2 weeks ago and probably got infected from school.Thinking it was just a common cough and cold which will recover in few days,I did not take it seriously.

  • However their cough and fever became severe despite on medications.With the help of my friend Francis,he did a nasal swab which confirmed presence of Influenza B.Their chest xray showed both of my children has pneumonia!What a shocking news to me.

Both of them was immediately started on Tamilflu and antibiotics.They were away from school for a week.Two days later my youngest child developed fever and without taking any risk,I started her on Tamilflu immediately.

  • Then it was my father's turn of catching the virus.He started to have severe cough and also developed pneumonia!Currently he is still on intravenous antibiotics.His recovery is a bit slow probably due to his age and weaker body condition.

My wife and I were also infected and both of us are recovering without those "high fly"anti virus or antibiotics.

  • Two weeks of nightmare...worrying about the children conditions.Have to deal with "groggy"sick children 24 hours a day.
  • Two weeks of no running.Not even a simple exercise!Probably my legs forgot how to run by now..
  • Two weeks of physical and mental exhaustion from daily stress.

Hopefully today is the beginning of a fresh and cheerful week ahead.I pray that all the illness and disease will be struck off from my family.Pray that everyone will recover fully.

Sunday, July 18, 2010

Government PR at work.

Few days ago the government decided to raise the prices of some essential items by cutting the subsidies.

  • This round of price increase was nicely orchestrate in order not to annoy the public.The wasn't much negative comments on the price increase in our local media.Most of the comments were positive ones and in favour of the price increase.

Govt's bold move will have minimal impact on people,says PM

PM:Govt will not burden people

Cuts not expected to drive up inflation

Many M'sians agree with gradual subsidy programme

  • Where is the logic??Normal persons wouldn't want price increase or buy expensive essential products.Why there were no negative comments from the rakyat being published?

I found out the reasons behind this...

  • The media have been instructed to praise and support the government moves to increase price of some essential goods.

However some statements don't really sound the report in The Star:

Health issue a factor in sugar price increase

  • PETALING JAYA: Sugar suffered the highest cut in subsidies and the reasons are obvious – to counter diseases due to “over-use” of the commodity.
    A statement from the Prime Minister’s Office pointed out that 40% of Malaysians were overweight or obese.
    “Incidents of diabetes are rising quickly. Statistics show that the percentage of Malaysians with diabetes now exceeds that in the United States.
    “We must, as a matter of urgency, take every step available to tackle what is clearly a public health issue for our nation. Reducing sugar consumption, among our children in particular, is a step in the right direction,” it said

  • By increasing the price of sugar doesn't mean the consumption of sugar will decreased.I am sure the public will continue to consume sugar as usual.The same goes to price of cigarettes.Even the government increase the price,rate of smoking cigarette did not come down.So is rate of lung diseases.

  • There are many risk factors that predispose an individual or population to developing
    diabetes. Besides genetic, there is ample evidence to show that the main factor
    influencing the explosion of diabetes in modern times is lifestyle related changes.

  • Longstanding positive behavioural adaptation and lifestyle modification will provide the answers to the fight against the impending epidemic of type 2 Diabetes but not by increasing the price of sugar.!! the government going to do a study to prove that by increasing the price of sugar will bring down the rate of diabetes in Malaysia??

Sunday, July 11, 2010

Seremban Half Marathon 2010

Seremban Half Marathon,one of my favourite event because it is in Seremban,my hometown.This year is my second year of running the half marathon.I started running by taking part in the 10km run in 2008 and have been running since then.

**It was still early when I arrived at the Padang.Not many runners have arrived.The sponsors were setting up their booths.

  1. Although the starting point is near to my home,I decided to go to the Seremban Padang early in order to get a parking space near to the race site.Seremban is not very big and one can park anyway in Seremban town and able to walk to the Padang within few minutes.

  1. The race was slightly delay.I think the race started at 6.50am according to my watch.I started with Lau,Wun,Steve,Tay and Yee.Francis,as usual started in front since he is a fast .

**Pictures taken after the race.Only managed to meet with few of the Seremban group.The rest were "scattered" all over the Padang and I was unable to locate them.Francis went home immediately after the race...probably feeling too bored waiting for the rest of us who is relatively slow.Ha..ha..ha...

  1. The route is the same as last year.We encountered our first up slope from Jalan Rahang leading toward Carrefour and Forrest Height. Yee overtook me at the Forrest Height and I followed him from behind until the second water station which was near to the Taman Warisan Puteri.There I overtook him and encountered the second up slope which was much steeper but for only a short distance of probably 500metres.

**The special tent for runners to collect prizes if they have the red coupons which came together with the finishing certificate.It was randomly given to runners immediately when they cross the finishing line.This year,I wasn't so prizes.Not a big deal though.

  1. I did not noticed Wun have been following me throughout the run until I heard an angry voice of someone scolding a race official.That was at Jalan Ujung Pasir.Wun was angry because he claimed there was not enough of water stations along the route.Wun claimed there should be 4 water stations instead of 3.

**As usual...lots of school children taking part in this event.Most of them were not running but taking it as a Sunday morning leisure stroll.Can't blamed them since they were not interested in running but been "forced" to take part by their school.

  1. Running for the second time along the same route seemed to be easier to me.I know when to conserve and when to speed up as I was familiar with the route.I knew the last 1.5km would be congested..."blocked" by massive group of school children.

  1. The last up slope was at the Seremban Lake Garden.I have to run at the middle of the road in order to avoid running into the walking group school children and I also need to be careful of cars coming from the back.

**The finishing lines...many lanes for different categories of runners,from 21km,10km to VIPS and OKUs(Orang Kurang Upaya)

  1. The last portion of the run was the was a down slope and one can increased the pace immediately after the water fountain at the roundabout.The finishing line was just 500metres ahead.

**Drum performance by Chan Wa school.Last year,I think there was a lion dance performance.

  1. I finished with a position of 37 for my category of Men Veteran (above 40 years of age) and time of 1h 54m own watch timing.There were no timing chips provided in this race.I am happy with this result since it is also my best half marathon result.My previous best half marathon was the SCSM 2008 half marathon time of 1h 55m 30s.

However I found out the distance might not be 21km as some runners with GPS claimed it was 20.5km.

**The VIPs tent..watching performance while waiting for the right time to give out prizes to the winners.I went home immediately after taking this picture since I have to attend my usual Sunday church service at 10.00am.

  1. The results from the Seremban group:

1)Francis 1h37m-position 19 in Men Senior

2)Myself 1h 54m 37s-position 37 in Men Veteran

3)Wun 1h 55m

4)Yee 2h 01m

5)Steve 2h 16m

Lau-DNF...he gave up after 5km.Reasons?

Tay,Heng and others...can't remember their timing.Need to ask them again.Ha..ha..ha..

  1. Personally I think this event is starting to attract more serious runners.I saw many runners from Klang Valley today compared to last year.

  1. In the future....

extra water stations will be appreciated

better traffic control especially at the last portion of the route near the Lake Garden.

different ending route for school children and those taking part in 21km will be better.

Monday, July 5, 2010

Procedural Skills Workshop

Spent the whole weekend attending an updating course on first aid and emergency treatment in a hotel in Kuala Lumpur.

It was quite fun but tiring as we spent the whole day practising on doing procedures.

Inserting a nasogastric tube for feeding purpose,lavage or administration of activated charcoal in poisoning cases.
Nowadays we can practice on a mannequin but when I was in the university many years ago,we don't have these models for us to practice on.So we try it on the real patients in the wards!!

They even have mannequin arm which look so real and can even produced red colour fluid(supposed to be blood)if we can mange to hit a vein during blood taking or setting intravenous drip.

Model for us to practice on choking in an adult.The person standing behind is one of our programme facilitator.

This is an AED machine-Automated External Defibrillator which is easy to use and an important machine to have during resuscitation of a collapsed person.It is easy to use even by layman as the machine will tell the user what to do but one has to recognise how it look like.

Learning how to turn over a victim

Learning how to do cervical in line immobilisation before applying the cervical collar -to prevent further injury to cervical spine

Learning different types of heart rhythm found in a collapsed patients.Not all cases are suitable for defribrillation and CPR is important for cases where 'shocks' can't be delivered.

Learning the effective and proper ways to do CPR.Incorrect ways will not help the victim and can even cause more harm.

Learning how to intubate a 'victim'.It is easier now to learn on a mannequin.I used to learn this on real dead bodies.

Learning how to do bandaging and applying different types of slings for different part of the body
Personally I manage to learn quite a number of new skills in this workshop and also to refresh my "rusty"skills.Definitely worth my time and money spent on both days.However missed out on the usual Sunday morning run with my Seremban group.
Well...running can wait but important life saving skills can't wait.