Friday, October 31, 2008

Master Close-up Magician

Jean-Pierre Vallarino, one of the greatest world-class close-up magicians, with his famous routine. His elegant way of handling the cards are definitely the smoothest of all that I've seen. Enjoy the clip of his classical act!;)

This is a clip that I filmed in 2005, during my first ever major show, the KENT event. That last part when I did my card revelations, it's actually a combination of what I learnt from Jean Pierre, plus some of my own ideas. I really wish I can do as smooth as he does one day..keep on practising!=)

Wednesday, October 29, 2008

Doctors - The Most Difficult Patients?

I'm wondering if you agree with this statement? Well, through what I've seen or heard, I think I now do agree with it. I've encountered:

A doc who smokes and with cigarette's smell whenever he speaks. And he tells, "You know, it's very difficult to quit this. Easier said than done."

A doc who's diagnosed leukemia and get frustrated and refused all chemoradiotherapy. Finally he said, "You know, honestly, I never believed in all these treatment."

A pregnant doc who's admitted for acute pulmonary edema secondary to severe pre-eclampsia. Being asked about why BP was so uncontrolled, she said, "I just don't feel like taking the medications..."

A doc who has been having intermittent per rectal bleeding but has never sought any investigation or treatment simply because, "You don't have to counsel me. I won't go and check...I'm afraid to know the diagnosis."

A child with G6PD deficiency presented with acute hemolysis, after taken Fava beans from his parents, who's surprisingly medical personnel. The reason was given as, "I have no choice..child kept on crying and nagging, and so I gave him a little bit..just a little bit only..."

A young doc who's been having progressively worsening ankle swelling, and diagnosed thyrotoxic cardiomyopathy, admitted that he actually had the onset of hyperthyroid symptoms 6 months earlier. His explanation to the delay for seeking treatment, "My work is so hectic. Where to find time to really check?"

A middle-aged doc came with slighly high BP (160/90), and by himself he took 3 tabs of Nifedipine 10mg (a dangerously high stat dose which may lead to rapid BP drop and subsequent stroke). When being asked to justify what he did, "I have been practising for more than 20 years. I know what I'm doing!" said by him impatiently.

I'm sure there are many more stories.

So, are doctors the most difficult patients?
I think you find it not easy to deny the statement now.

Friday, October 24, 2008

Project Magic - Therapeutic Magic

David Copperfield, the greatest man in the magic history. I look up to him not only because of his astounding achievement in magic, but he has such a great mind to develop the use of magic in a therapeutic way, which is what I'm going to share about today.

"Project Magic" is a program designed by David Copperfield, to give the gift of magic to people with various physical, psycho-social and developmental disabilities. It is beneficial to those with a variety of diagnoses, such as arthritis, spinal cord injury, brain injury, drug and alcohol abuse and learning disabilities.

Project Magic assists individuals to achieve new skill levels and also the achievement-orientated behaviour, which is necessary for the disabled individuals to successfully re-enter the outside community. Combining the talents of professionals in the entertainment field and those in medical field, it provides a quality of therapeutic training far in advance of traditional rehabilitative programs and techniques.

"Project Magic" is used in over 1,000 hospitals worldwide. It achieved not only physical success, but showed remarkable improvements in patients' cognitive function, speech, self-esteem and social skills.

"Learning magic can help them to learn a variety of skills," says Copperfield. "It's fun and challenging."

Pics from daylife

"To date, through Project Magic, David has spiritually and physically enriched multitudes of patients across the globe over the 25 years. He has enabled them to break out of the poverty of imagination, and to enter the world of dreams."

How inspiring. I've long been captivated by this thought that, magic combined with medicine, and how it can do good to the patients. Copperfield has really made a giant step beyond "magic as entertainment" to a whole new realm of "magic as a form of therapy" which truly works.

I'm wondering, what about "Project Magic" in M'sia? Mission possible or otherwise?;)
I have some thoughts and would like to see what you all think about it. Feel free to put in your thoughts!;)

Wednesday, October 22, 2008

Signs of Anemia?

A group of medical students are having a bedside teaching session with Prof. (MO and HO just happened to be doing work at the table nearby)

Prof: "In a patient that we suspect to have anemia, what clinical signs do we look for?"
A: "Cyanosis."
Prof: "Very good (sarcastically) can get out from the ward now. Make sure you prepare adequately before you come to my class again."
B: "(shivering voice) Capillary refilling time..."
Prof: "(shakes his head) Why you look at CRT in anemic case? You all ah..(sigh) Tell me, in what cases do you need to look at CRT?"
C: "Heart failure..."
D: "Ischemic heart disease..."
E: "Hyperthyroidism..."
F: "Uncontrolled Hypertension..."
G: "Cerebrovascular accident..." (Prof's head shaking non-stop)
H: "Finger clubbing?" (MO: Wow...)
I: "Rheumatoid arthritis?" (HO: What?)

Finally a distinction-looking student said out confidently, "Takayasu's arteritis!" (MO & HO: Woww...)

Prof: "ENOUGH! ALL GO BACK AND READ AGAIN!" Then walked off the ward leaving the frightened group of students.

What happened to the medical students (quite senior batch) ler.
CRT is to access hydration and circulation status. Simple as that.
High-5 diagnoses do not mean they're correct, and most of the time, to quote a famous saying in medical school, you're digging your own grave by saying things that you don't know!

Moral of the story: "Think and answer smartly!" and, "Make sure you master the basics, before aiming for higher level!" ;)

Wednesday, October 15, 2008

Couple Jokes (2)

Wife: "Dear, tonight I feel like sleeping with the light on. Is it ok?"
Husband: "Oh..hmm can but..."
Wife: "But what? You'll be uncomfortable with it?"
Husband: "Well it should be fine, as long as you keep your make-up on..."

Wife standing in front of the mirror.
Wife: "Oh dear, I think I look old, fat and ugly. Can you just give me some compliments?"
Husband: "Oh sure. Well, at least your eyesight is still perfect."
Wife: "......"

Husband is playing with a cat.
Wife came and shouted angrily, "I've been looking for you! Why are you playing with a pig?"
Husband was confused, "Huh? I thought it's obviously a cat that I'm playing with?"
Wife: "Don't interrupt! I was talking to the cat..."

Husband came back home and told his wife,
"You know what, I went to apply for pension allowance just now. I didn't bring my IC so I showed them my silvery chest hair and they believed my age."
Wife: "Oh I see. Then you should have dropped your pants, and you'll get the disability allowance, too."

Related post:
Couple Jokes (1)

Monday, October 13, 2008

Magic Medicine Formula (3)

3rd part: Time for microbiology!
Always confused by various types of bacteria & viruses? Well, not anymore!=)

You only need some codes..

Gram Positive cocci - SSE
S - Staphylococci
S - Streptococci
E - Enterococci

Gram Negative cocci - MN
M - Moraxella
N - Neisseria (N.meningitidis & N.gonorrhea)

Gram Positive baccilli (rods) - ABCD.LN
A - Actinomyces
B - Bacillus anthracis
C - Clostridium group
D - Corynebacterium diphtheriae
L - Listeria
N - Nocardia

Obligate intracellular bacteria - R.CML
R - Rickettsia
C - Chlamydia & Coxiella
M - Mycoplasma pneumoniae
L - Legionella pneumophilia

Spirochaetes - BTL
B - Borrelia
T - Treponema
L - Leptospira

And the rest are (very much mostly) Gram Negative bacilli!

And trust me, with these simple codes, you're just gonna tell the types of bacteria almost instantly!=)

As for the viruses, a few rules can help:

1. DNA-containing viruses are the HHAPPP(Y) viruses (Herpes, Hepadna, Adeno, Papova, Pox, Parvo); and the rest are RNA-containing viruses.

2. All DNA viruses are double-stranded except Parvoviruses.
3. All RNA viruses are single-stranded except reovirus.

Again, hope it helps!
Ok my dear friends, I've shared with you my (season 1) magic medicine studying tips;)

Hopefully I'll come up with more in the near future, and most importantly, pls let me know if they really help in your study and I'll be glad to hear it!=)

Friday, October 10, 2008

Magic Medicine Formula (2) we come to the 2nd part. Well, MRCP really likes to ask about genetic diseases and mode of inheritance. It'll be a waste if you do not master this part, but to memorize all that is obviously not an easy task.

A general rule is, Autosomal dominant conditions are mostly with "structural/ phenotypical" abnormalities; whereas autosomal recessive conditions are with "metabolic" disorders.

A list of major genetic diseases with which genes they are linked to:

Chromosome 1: Gaucher disease
Ch 2: Gilbert's syndrome
Ch 3: Von Hippel-Lindau syndrome
Ch 4: Huntington's, adult polycystic kidney disease (APKD 1)
Ch 5: Familial adenomatous polyposis (FAP)
Ch 6: Hemochromatosis
Ch 7: Cystic Fibrosis
Ch 8: Hereditary spherocytosis
Ch 10: MEN II
Ch 11: MEN I
Ch 12: Von Willebrand's disease
Ch 13: Wilson disease
Ch 14: HOCM
Ch 15: Marfan's syndrome
Ch 16: APKD 2
Ch 17: Neurofibromatosis Type I (von Recklinghausen's disease)
Ch 21: Autoimmune polyendocrine syndrome (APS) Type I
Ch 22: Neurofibromatosis Type II

Long and boring list? Any simplifying method? Ok here we go:

"Von Hippel-Lindau" = 3 words = Ch 3
"Huntington" = "Hunt 4 food" = Ch 4
"FAP" = "polyp has 5 alphabets" = Ch 5
"Hemochromatosis" = "HemochromatoSIX" = Ch 6
"Cystic Fibrosis" = "Think F is a mirror image of 7" = Ch 7
"Spherocytosis" = "Think 8 has double spheroids" = Ch 8
"Wilson" = "WIlson looks like 13 if you rotate the W a bit?" = Ch 13
"Marfan" = "Marfan's syndrome has 15 alphabets" = Ch 15
"APKD" = "APKD has 4 alphabets, polycystic kidney has 16 alphabets" = Ch 4 & 16!
"Neurofibromatosis Type I" = "von Recklinghausen has exactly 17 alphabets!" = Ch 17
"Neurofibromatosis Type II" = "Type 2 = 22" = Ch 22

Easier? After I found these linking methods, I think I'm just not gonna forget them for life!

Hope it helps!=)
And in the next post, I'll share about how I remember bacteria family!

Magic Medicine Formula (1)

Thursday, October 09, 2008

Magic Medicine Formula (1)

Hi dear friends, time to share my studying tips. Well, to relate magic with medicine, hmm I would say that learning magic has definitely improved my memory. However, I think to study medicine, such a profound and broad field with countless facts and terminology involved, mere memory might not be adequate. Then I found a very useful tool, it's definitely not something new, which are "mnemonics". Quote from English artist William Wolcott, "Nothing is ordinary if you know how to use it." You might think mnemonics are nothing special, but if you know how to use it, my personal experience is, it's purely magical.

Mnemonics help to memorize facts in a quick, organized and (far) painless way. But take note that, the quality of mnemonics are extremely important, as the bad ones, will not only waste your memory space, it may fail you! For example, let's take a look at this (found this in snowy's blog but not by him, just for eg purpose, no offence):

SAM Suka Fry Ayam Peha - Classification for ischaemic heart disease.

S - sudden cardiac death
A - angina
M - MI
S - silent IHD
F- failure of heart (heart failure)
A- arrhythmia
P- postinfarctional cardiosclerosis

A few things to point out:
1. Poorly organized, and most importantly, do we need a mnemonics for classification of IHD?
2. Facts are not entirely true, e.g. arrhythmia is not a "type" of IHD?
3. Do you think "SAM Suka Fry Ayam Peha" is an easy-to-remember phrase?
4. Facts not "concrete" enough. To improve the quality, try use more professional terminology (so that you can impress your examiners).

An example of good one:
Wilson's disease : ABCD

A - Asterixis
B - Basal ganglia degeneration
C - Copper accumulation with reduced Ceruloplasmin level, causing Cornea deposits (Kayser-Fleischer rings), Choreiform movements, psyChiatric abnormalities, liver Cirrhosis and treatment is with Chelation.
D - Dementia

See the difference? So much essential facts in just 4 alphabets.

And to further improve it, sometimes the mnemonics are purposely made "naughty", and some will find it even easier to memorize! (Of corz, this is subjected to personal preference)

For example, adverse effects of Amiodarone: BITCH

B - Bradycardia
I - Interstitial lung fibrosis
T - Thyroid dysfunction
C - Corneal microdeposits
H - Hypersensitivity/ Hepatitis

I'm sure you're gonna remember it for life? Effortlessly?=)

Or one more way is, try to create a "funny" relation between the facts.

E.g. 1: Have you heard of "Argyll Robertson pupil" is like a prostitute? Because it accommodates but does not respond! (to light)

E.g. 2: 3 zones of adrenal cortex: GFR - glomerulosa, fasciculata and reticularis, which mainly regulate balance of salt (mineralocorticoids), sugar (glucocorticoids) and sex (androgens).
So the mnemonics for this: The deeper you go, the sweeter it gets. =)

And lastly, when you get familiar with the system, you can always create mnemonics of your own! First, look for the facts that you find it very hard to remember. E.g. from my own experience, I'm always confused with the terms of signs for aortic regurgitation, until I found a way to remember it!

(Darren's mnemonic) "In the MCQ about AR, the answer D is True!"
So from head to toe,
M - de Musset's sign (head nodding)
C - Corrigan's sign (carotic pulsation)
Q - Quincke's sign (nail bed capillary pulsation)
D - Duroziez's sign (femoral murmur)
T - Traube's sign ('pistol shot' in femoral artery)

Piece of cake now?=)

Ok so in conclusion, what I have shared are the principles of mnemonics and how they can help you to study. Obviously it's not possible for me to show all the mnemonics that I know (my blog will get out of space!). But if you have any problem remembering certain group of facts, feel free to tell and probably I can share the related mnemonics to help.

Finally, thanks for reading.
In the next post, I'll share about how I remember genetics and chromosomes!=)

Friday, October 03, 2008

Preparing for MRCP?

Ok since there are quite some questions on how did I prepare for my Part 1, hmm probably I'll just show you what have I got for my preparation:

The top and the bottom form the essentials. Many seniors told me that the minimum requirement is to finish Oxford handbook and K&C Clinical Medicine..cover to cover. To be honest, it's true. Painstaking and time-consuming but, this is what MRCP is about!

And the rest of the books that I displayed, are the supplementary. (Disclaimer: I'm not the best person to recommend which books to get, I'm just sharing my opinions) After the exam, I would now sort the books by their "usefulness" like this:

1. "Best of Five" - The questions' format are quite close to the exam's, hence a good practise book.

2. "An Aid to the MRCP" - Fantastic mnemonics! Though the facts provided are quite limited, but the mnemonics are helpful for quick revision.

3. "Update for the MRCP" - I think this is a should-get. Up-to-date information is essential when you sit for the exam, which you'll be tested on the latest facts!

4. "Basic Medical Sciences for MRCP" - This book I'm planning to sell it. Anyone's interested? (oops I hope the author is not reading this). Well, my humble opinion is, maybe the facts are somewhat inadequate and contents are not focused enough on Part 1=)

Beside books, I do have somemore things to share.

From USMLE Step 1, to Step 2 then now Part 1, I have to confess that, yes, I did use magic in my exams. HEHE. They're called "Darren's magic medicine formulas".
I'll share about the "formulas" in my next posts. Hope you all will find it useful!=)

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