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!=)

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:

#1
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."

#2
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."

#3
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..."

#4
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."

#5
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..."

#6
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?"

#7
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.

Randomz (3)

I think "Randomz" is becoming a series. Hehe.

Went to Chay & SY's wedding on 24th in Kuala Kangsar. Since KK is just 30 min away from Taiping, so obviously the whole "Taiping gang" went..and we had such a good surprise that Wei Siong & Han Hua also came down from Sarawak to attend it. Had a really good catch up.

Our group pics are with WS now as to quote what he said, he's now half Darren (magician) plus half Shawn (photographer)..hehe. So still awaiting him to send us his professional shots. Just to show this pic that I took with my phone, I noticed that the cameraman had a socket at his waist! Amazing? Don't play play..;)

Come back to my work. I saw another mad referral the other day which I must share it here:

"To whom it may consent,

Thank you for seeing this 13 yr-old boy, who complains of having difficulty in swallowing foot..."

Ya, of course it's a typo of "food". If not, who can actually have no difficulty in swallowing a foot? XD

See more Mad Referrals.

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!;)

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)..you 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!" ;)

Frank's Sign

I think once you know this sign, you'll love looking for it.

Frank's sign is a diagonal crease in the lobule of the auricle, as shown in the pic, which was a patient that I came across yesterday. (To be more specific, it's Grade 2a Frank's sign)

"The sensitivity of Frank's sign reaches 75%, its specificity 57.5% and its positive predicting value 80.3%. The prevalence of Frank's sign increases progressively with age: 42% in the 30-39 age group and 75.8% in the 60-69 age group.

Frank's sign is considered as a marker of the coronary disease, independent of risk factors but frequently associated with them. If its absence does not permit in any way to exclude the diagnosis of coronary disease, its presence corresponds in three quarters of the cases to an established coronary disease within a symptomatic population."

- Extracted from Ann Cardiol Angeiol (Paris), Vol. 36, No. 1.

"Jonahness" is Appreciated

I think I really enjoy working in this (extra) new place, started about 1 month ago. We just had its official opening today. Just wanna share some pics and working experiences over here.

Media and the guests. Response was really good. Guess my "patients load" are going to further shoot up after this opening;)

One thing interesting here is, to those who're "jonah", well you'll find yourselves finally "appreciated" here. (If you're not sure what is 'jonah', it was explained and elaborated before). An example is that day during my duty, due to my (dunno wanted or unwanted) "jonahness", the ER was full of patients and not only that, the cases ranged from mild ones like URTI/AGE, to MI, decompensated CCF, CRF with fluid overload, severe pneumonia, and I even got one ectopic pregnancy for the O&G side.

The Medical director there found it amazing, "Darren, it's been so far the busiest day we have here. What's happening?"
Me: "Hmm how should I say..I've been this "jonah" during most of my calls..."
Medical director: "Oh I see. Then, we've made such a right choice of hiring you!"
Huh? What a different perspective on "jonahness" ha.

I suddenly got an idea. Maybe "jonahness" is something you can put in your resume next time?
Imagine during your interview, your interviewer look at your resume and say,

"I've looked through your resume. Wow, you're just notoriously Jonah...

We can't wait to hire you." Quite true isn't it?=)

And one more good thing is Sushi King is just next to my hospital. And this is what happened when two "sushi pigs" went to the Bonanza. It's considered acceptable right..still in the process to evolve to "sushi monsters" hehe. Can't wait for the next Bonanza=)

Couple Jokes (2)

#1
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..."

#2
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: "......"

#3
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..."

#4
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)

Randomz (2)

Well..just a post of random stuffs again;)

Got my MRCP formal result today, attached with the analysis of answered items by specialty. To my good surprise, the best fields I did are cardiology (future dream..), endocrinology (ok..) and geriatric medicine (quite surprised), which are scored 100% correct. Followed by clinical science (so my magic medicine formula can work?), nephrology and rheumatology. But of course there are some fields were not so good also, e.g. clinical oncology and ophthalmology. Here I must leave a msg to elaine, my opthal housemate who has been my private tutor on eye subjects, "Sorry for disappointing you, I'll study harder de. Hehe=p"

Then I got this funny sms from my good psychologist friend Gabriel,
"Hey dude. Heard that you passed your Part 1. Congrats!"
"Oh thanks thanks.."
"Was it the exam you sat for is MRCM?"
"MRC..M? What's that?"
"Membership of Royal College of Magicians la..lolz"
"......"

That's a good one ha. But come to think it, what happened to my magic life? In fact throughout the past few months I did get invitations for golf club dinner event, corporate dinner, a few birthday parties or even some children's day celebration in schools..but the timing just not too right, clashing with my working schedule. Kinda miss my performing days=) But that's one seems to be a quite probable one, it's a christmas party by G2. Think I'll plan my leave for that;)

And maybe it's time for some magic posts to be up! Just give me some times..

And last but not least, life has been really good lately. I'm sure you know why.^^

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!=)

Magic Medicine Formula (2)

Ok..now 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)

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!=)

Back From Penang..

Back from my 2-day Penang trip. Went with family..had some really good times. And guess what, I've become a 100% Buddhist ha, finally! I went to a renown temple, visited the "Si Fu" and went through some formal procedures. I was even given a Buddhist name=)

Just to share that the "G Hotel" is really nice to stay in.


I really like the "arrive in style" concept. The atrium lobby is stunning. Love the contemporary design and stylish comfort.

One of many restaurants in the hotel. Buffet there is really good.

And one of the "remarkable" things that happened in the past 2 days, well, there goes my shirt! While examining a patient with bleeding head wound, gosh the blood just shot out when the clots were removed! Thank god I was wearing mask..but my shirt..sigh. The extra price in work! Ha.

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!=)

How Sick Can One's Mind Be?

Today's the first day of Hari Raya.
The workload's almost doubled. Taiping town is flooded with so many ppl who come back to hometown. Most common cases? Congestive cardiac failure who drank too much fluid, uncontrolled diabetes, road traffic accidents etc.

But one case was really really unexpected.

A rape case. A 6 year-old girl went to her neighbour's open house. She was brought by her neighbour who's a 60 year-old man into a room, and raped.

She's severely mentally traumatized. Her father, could not control the anger and grief, cried in front of us.

How sick can one's mind be?

YEAH I Passed!

Dear all,

I'd really like to share a good news with you that my MRCP Part 1 result was just released. I PASSED! *jumping up & down*

MRCP (Membership of the Royal College of Physicians) exams are the 3-part exams to get specialized in Internal Medicine. Well, I'm just one step nearer to my dream now=)

Big thanks to everyone who has wished me, all your wishes really, really encouraged me a lot!

What a great moment. Yay!