Sunday, April 29, 2018

Flat Earth & Miracles: Professor! Professor! 3 month? !



   It is not my intention, either as an individual or as a scientist, to express an opinion on religious visions and miracles. Science has generally failed to understand these phenomena and many religions on the whole have tended to ignore scientific explanations.
        For the religious amongst us, a close study of the history of religion would have seen deliberate attempts a couple of millennia ago to trick people into believing certain things supernatural. In a recent visit to Ephesus, we heard tales of how early “Christians” were duped and “cured”.
        When the Western World was in the tight grip of the Catholic Church, the Jesuits were generally regarded as the greatest scholars. They brought Western culture and religion to the East. They must have had a glimpse of the Chinese understanding of the universe and the world. Yet for so long the religious view of Flat Earth held true. Did the Jesuit scholars know the truth or did they pretend not to in order to avoid persecution and possible death? We shall never know.
        Many “visions” have proved to be the work of errant brain waves due either to epilepsy or brain tumours. Yet the Church continued to celebrate these phenomena.


© 2012 Am Ang Zhang
  

From my book The Cockroach Catcher Chapter 15: Miracles:

First Miracle
         When Professor MacFadzean first arrived in Hong Kong many years ago, he was consulted on a middle-aged Chinese man, a fisherman who had a huge lymph node under his left arm pit. Investigations showed that it was a secondary from a primary in the lung.
         The man asked him, “How long?”
         “Three months. Maximum six.”
         Two year later as the Professor was crossing the harbour on Star Ferry, a man came up to him.  It was not difficult to spot him anywhere in Hong Kong as he was at least a head taller than most, with a bright red face that Scots seem to acquire in Hong Kong.
         “Professor. Professor. Remember me?”
         The man pointed to his armpit.
         No mass.
         “Three months.  Remember?”
         It turned out the man sought the advice of his fortune teller in Shatin on the third day of Chinese New Year, and he had a good “fortune” telling him about an illness disappearing.
         “Now it has disappeared!”
         What a miracle! Fortune telling has been a major growth industry in Hong Kong.  Recently, the richest Chinese business woman left all to her fortune teller.
         “Never be definite about prognosis, especially if it is a bad one. Spontaneous cures have been recorded regularly, especially with lung cancer.”
         To the patient, it was old ways triumphing over modern medicine. It was his “miracle”.


To remember our eminent yet formidable Professor of Medicine, Professor MacFadzean: One Patient One Disease.
I would like to pay tribute to our eminent yet formidable Professor of Medicine, Professor MacFadzean, 'Old Mac' as he was 'affectionately' known by us. He taught us two important things right from the start:

First - One patient, one disease. It is useful to assume that a patient is suffering from a single disease, and that the different manifestations all spring from the same basic disease.

Second - Never say never. One must never be too definitive in matters of prognosis. What if one is wrong?


Flat Earth & Miracles: Duping & Human Kindness!





Saturday, April 28, 2018

Flat Earth & Miracles: He will never learn to speak!

It is reassuring that there are still people that were kind enough to risk everything in order to help others in desperate need. It became more upsetting when you realised that the kind-hearted person has been duped. But then even government has been duped into paying millions of our money to so called charitable organizations we can hardly blame any individual except of course the individual is not losing other people’s money but their own.


Photoshop Miracle:

Black Currant Miracles © 2012 Am Ang Zhang


        It is not my intention, either as an individual or as a scientist, to express an opinion on religious visions and miracles. Science has generally failed to understand these phenomena and many religions on the whole have tended to ignore scientific explanations.
        For the religious amongst us, a close study of the history of religion would have seen deliberate attempts a couple of millennia ago to trick people into believing certain things supernatural. In a recent visit to Ephesus, we heard tales of how early “Christians” were duped and “cured”.
        When the Western World was in the tight grip of the Catholic Church, the Jesuits were generally regarded as the greatest scholars. They brought Western culture and religion to the East. They must have had a glimpse of the Chinese understanding of the universe and the world. Yet for so long the religious view of Flat Earth held true. Did the Jesuit scholars know the truth or did they pretend not to in order to avoid persecution and possible death? We shall never know.
        Many “visions” have proved to be the work of errant brain waves due either to epilepsy or brain tumours. Yet the Church continued to celebrate these phenomena.
The first picture is the original: the rest miracles!


From my book The Cockroach Catcher Chapter 15: Miracles:

Second Miracle
         The second “miracle” I am going to recount was again not experienced by myself but occurred none other than where most miracles happened.
         Jerusalem.
         And in the 20th Century.
         I heard about it at a World Congress on Infant Psychiatry held in Chicago.
         Generally the big plenary sessions at nine in the morning were reserved for the big presentations. Given that it was an Infant Psychiatry Congress, one was surprised to be having a presentation of a case of an older child.
         Yet this was a presentation by one of the most respected professorial units in Jerusalem. The hall was packed and word must have got out that this was going to be good.
         The professor was himself on stage. He was already rather old, but when he spoke he did so with authority and a certain air of natural arrogance. It was the kind of arrogance that came as a matter of course to one who had made a discovery of some kind that none of us in the hall, except his team, had heard of. Perhaps pride is a better word to describe it, but no matter.  Something big.
         His presentation involved the showing of some film clips, one of which was from the BBC archives.
         This boy suffered from severe epilepsy from a very early age and was on four different medications. He never acquired speech, ever.
         He had a younger brother, bright and very advanced, who was reading well before the age of three, not unusual for Jewish boys you might say, but unusual given his brother could not speak.
         His mother sought help for him over the years, and by the time he was twelve, most specialists she consulted told her there was a critical period after which a child would never acquire speech.
         She had said her fair share of prayers at the Synagogue.
         One day, unbeknownst to her, her genius toddler took an overdose of his brother’s medications. He was found in time and his life was not threatened. For four full days after he came out of intensive care, he stopped talking altogether.
         It suddenly occurred to her that it could be the medication that was holding her son back.
         She immediately secured a consultation at a top hospital and the consultant said that it was possible to use other methods to control the epilepsy.
         But it would be drastic, as it involved removing nearly half of his brain.
         “Without medication would he learn to speak?”
         Now this was where the BBC film cut to a big picture of the lady consultant who said, “Never. He is beyond the critical age. He will never learn to speak. Never ever.”
         The Professor in a very solemn voice said from the podium, “She is not one of ours.”
         The boy had the operation. He was now free from epilepsy and free from any medication.
         Mother decided to emigrate to Israel and seek help in the Promised Land.
         “What a wise move.” The Professor interjected again.
         The boy now came under the Professor’s care, and a big team of different therapists started working on him.
         And mother’s prayers were at last answered.
         The boy now spoke fluent Hebrew and reasonable English. Not one but two languages.
         I remembered what one Rabbi said to me at our friend’s son’s Bar Mitzvah, “You know our God will give, but we must work hard.”
         And Old Mac:  Never say never.


Flat Earth & Miracles: Duping & Human Kindness!


To remember our eminent yet formidable Professor of Medicine, Professor MacFadzean: One Patient One Disease.
I would like to pay tribute to our eminent yet formidable Professor of Medicine, Professor MacFadzean, 'Old Mac' as he was 'affectionately' known by us. He taught us two important things right from the start:

First - One patient, one disease. It is useful to assume that a patient is suffering from a single disease, and that the different manifestations all spring from the same basic disease.

Second - Never say never. One must never be too definitive in matters of prognosis. What if one is wrong?



Friday, April 27, 2018

Wednesday, April 25, 2018

From Tampopo to Sideways: Merlot at last.

After this post first came out in 2008 when I started blogging, The Cockroach Catcher has at last had a chance to taste a most amazing Merlot. 

It is amazing how easy it is to influence modern day consumers with nothing other than a well made film. As far as wine is concerned the film Sideways has more or less changed the wine landscape of California if not elsewhere. This is because of two simple lines from the film. The wine snob character Miles tells friend Jack before a double-date dinner:

“If anyone orders Merlot, I'm leaving. I am not drinking any……Merlot.”

All of a sudden, it is no longer cool to order Merlot, and Pinot Noir becomes the new Merlot.
The fact that the same snob Miles’ most treasured wine Cheval Blanc
is 45% Merlot is lost to the vast majority. In fact if Petrus had not refused permission, Miles would have drunk Petrus in the film, and that, one of the most expensive wines in the world, is 95% Merlot. Towards the end of the film, he was being comforted by a bottle of Cheval Blanc, 1961 no less and arguably best of the post war ones.

Ours is more recent, 2000 but what a wine. 

Many blogger thought it was a Hollywood goof. To me it is one of the smartest irony: for the Merlot hater to be raving about a Merlot (with Cabernet Franc) is deliberate as it was originally going to be the Petrus. Merlot sale unfortunately suffered, but only the Californian variety.
In the animated hit Ratatouille, feared critic Anton Ego visits Gusteau's, the restaurant in which the movie is set, and orders a bottle of 1947 Ch√Ęteau Cheval Blanc to go with his meal. The '47 Cheval Blanc is probably the most celebrated wine of the 20th century. However, there has been no rush to buy cases of this as you are unlikely to find them except in top merchants and private cellars.
I have my own suspicion about some lesser known films that may have influenced wine drinking habits in the Far East.
In 1985 the film Tampopo came out of Japan. This comedy features a truck driver who helps a young widow named Tampopo improve her noodle restaurant, and draws attention to the power of food.
There is a beautiful wine tasting scene, by a group of hobos following the lead of a professor. The professor realises that life as a hobo is much freer, with no one above him telling him what he should do, no targets to meet, and no paperwork.

The wine tasting is not at a winery or a restaurant. It is in a park by the back door of a restaurant. The wine is that little bit left at the bottom of a bottle. There is not enough to go round; so the hobos allow the professor to do the tasting and are content to just listen to his analysis. (In the Cockroach Catcher, I wrote that a blind case presentation at Queen Square was a bit like wine tasting.)

It is one of the most enjoyable scenes for wine lovers and if you are not a wine lover you will become one.

The wine?

Chateau Pichon Longueville Comtesse de Lalande,” announced the professor in perfect French.
This wine has since become a favourite of the Far East.
Chateau Pichon Lalande is not as expensive as the First Growths but is fast catching up. Fortnum and Mason of London used to have a house Pauillac made by Chateau Pichon Lalande. I was tipped off to get the last few bottles some years ago. Now the supplier of their house Pauillac is Chateau Haut Bages Averous, a vineyard next to the new rising star of Bordeaux: Chateaux Lynch-Bages.
The best year in recent vintages has to be 1989, a great year for most of Bordeaux and rumour has it that it will become drinkable in 2009. Hurrah. The 2000 is superb too but recent vintages have all been great and if you can store them buy them now.
The biggest wine influence worldwide came from a documentary. In 1991, after the airing of 60 Minutes on CBS, wine sales went up 44% in the next four weeks in the U.S. It was about the French Paradox: the incidence of coronary heart disease in France being 40% percent lower than in the U.S.
Health sells.
Once upon a time in Hong Kong, when people made money they drank the most expensive Cognac and Scotch, with Hennesy XO and Dimple being the “Gold Standards”, partly because of their highly recognisable bottles. To have such a bottle on your dining table was a sure sign that you had arrived. Now, the status symbol is the most expensive red wine, and it is often taken with just about any dish that is served.
But then the French perhaps always knew; including its own most famous psychoanalyst Jean Laplanche (born 1924). His book The Language of Psychoanalysis was first published in 1967 and translated into English in 1973. All of us training at the Tavistock had a copy and it is to this day one of the best reference books on the subject. He has co-authored a number of other books in psychoanalysis.
What is not so widely known is that Laplanche was for many years the owner of Chateau de Pommard, a Burgundy vineyard, and actively involved with the wine-making processes. He sold the vineyard in 2003 but continues to live on the estate with his wife and to act in the capacity of a consultant to the new owners on wine making matters.

Wine Posts:

Saturday, April 21, 2018

London Marathon: Hyponatraemia & Rehydration


There is little doubt that overhydration is now the biggest threat to the runners. Most fatality is due to hyponatraemia and as far as my searches go, no one has died from dehydration during the various Marathons. 

Despite what you may have read: DEHYDRATION is not the problem. Low SODIUM is!

Elite Marathon runners in the past rarely drank much during races. Mike Gratton, when he won the London Marathon in 1983, apparently drank nothing.

It has been said that even doctors may overlook the role of low sodium in rescues especially as there are sports drinks in abundance. 


Marathon runners who drink too much water are at risk of a deadly condition
Every couple of miles, the 30,000 or so runners competing in the 36th Marine Corps Marathon on Sunday will pass stations stocked with water and sports drinks. Most, hopefully, won’t stop unless thirsty. Some, however, following outdated advice, will drink according to a preset schedule — even downing all they can hold — increasing their risk, doctors say, of a potentially fatal medical condition.
The condition, called exercise-associated hyponatremia, killed Hilary Bellamy of Bethesda two days after she competed in the 2002 Marine Corps Marathon.



© 2016Am Ang Zhang
As runners from around the world prepared themselves for the London Marathon. I will publish my take from an earlier post.


It is amazing to hear of advice on drinking plenty of water in any heat wave both here and in the US.

Marathons:
Marathons are often sponsored by bottled water companies and their main aim is to let the public get he image of runners with bottles of their water.


Of 766 runners enrolled, 488 runners (64 percent) provided a usable blood sample at the finish line. Thirteen percent had hyponatremia (a serum sodium concentration of 135 mmol per liter or less); 0.6 percent had critical hyponatremia (120 mmol per liter or less). On univariate analyses,hyponatremia was associated with substantial weight gain, consumption of more than 3 liters of fluids during the race, consumption of fluids every mile, a racing time of >4:00 hours, female sex, and low body-mass index. 

Modern marathon advice is to up the intake of salty food in the pre-race preparation. When dehydrated taking salt and water alone will not work: see below. 

Watermelon:


When I was growing up in the tropics, one of the fruits we were given after a long walk was watermelon with salt sprinkled on it. This was long before the current understanding of Oral Rehydration. My parents were careful to warn us then that just drinking water is no good. Why? They did not know!

Now I do but watermelon is still my favourite and in the tropics you can buy fresh water melon juice in the summer.

Chinese farm workers:
It has to be said that the diet of many Chinese farm workers was generally higher in sodium, from dried salted fish and vegetables. It is likely that the serum sodium of many such workers would have been at the high end of the normal range. Modern advice on cutting down sodium often does not take account of sweating in hot countries. A friend of mine with hypertension had an epileptic seizure when he went to work in Singapore. Luckily the medical services there were alert to the problem and he survived. He was on a low sodium diet and on diuretics amongst other medications.

Free water:
I also remember one very hot August day when we hiked down Grand Canyon to Angel Point. There were warnings everywhere of the risks and even fatalities on such walks. The National Park did have clean drinking water taps along the way and one particular girl overdid the drinking. She had a narrow escape, as the Ranger fortunately knew a thing or two about rehydration. He put some salt in a can of Sprite and reverted a potentially serious situation.

Thailand:
The first time we went to Thailand the most amazing dip was simply a bowl of sugar that has been mixed with salt and some chopped chilies for good measure. This dip was used for serving unripe mangoes, papayas, guavas and other local fruits, and gave me a taste sensation that was unforgettable. Same principle as ORT.

In Thailand, workers in rice fields, fruit orchards and vegetable patches manage to survive temperatures of over 100°F.

Golf:
The Cockroach Catcher plays golf in his holiday home in the tropics and he uses his own mix of diluted Pomegranate juice and a pinch of salt for Oral rehydration. I would never drink plain water alone.  This is one time where a bit of sugar helped the body to absorb salt and fruit juice is higher in potassium.

When the first public golf course was opened on the beautiful island of Kau Sai Chau in Hong Kong, drinking water was provided along the course. One player drank so much that he nearly died of water intoxication (result of drinking excessive amounts of plain water which causes a low concentration of sodium in the blood leading to amongst other problems: ‘brain’ swelling---cerebral oedema).


Cocktails:
It seems wrong to recommend alcohol but has anyone worked out why cocktails from hot countries would be served with the rim of the glass covered in salt!!!

Drowning:
I remember one of my professors telling us: the body survives dehydration much better than drowning. How right he was, as water intoxication is in a sense a kind of drowning.

Cholera:
I well remember Hong Kong’s cholera epidemic in 1961 and the major cause of death was the rapid loss of fluid due to a specific secretive action of the cholera germ. Patients could die in a matter of hours. The medical profession has long been of the strong belief that Intravenous Fluid (IV Fluid) is the only answer. In that situation, the patient is in shock and to find a vein means a cut-down: literally cutting through the skin to find one. It is a messy business as the patient is violently pumping out fluid in the most horrendous fashion.

Johns Hopkins established a centre in Calcutta in the 1960s to study precisely a better way to replenish the fluid. IV fluids were expensive to manufacture and required medical personnel to administer. Their Clinicians sought help from basic physiology and carried out the first carefully controlled study which showed that intestinal perfusion of cholera patients with saline solutions containing glucose strikingly reduced fluid loss. Put simply, the patients could just drink a glucose and salt solution and the glucose would allow the salt to be piggy backed and absorbed, thus sparing the need to use IV fluids.

“……These compelling findings, however, did not convince the medical establishment, who remained sceptical that such a simple therapy could substitute for traditional intravenous fluid replacement in severely stricken patients under epidemic conditions in the field.”
The World had to wait for a war, this time in Pakistan, when Bangladesh fought for its independence in 1971 and 9 million refugees poured into India and with them cholera. When IV saline treatment was exhausted, Dr Mahalanabis, who had worked at the Johns Hopkins Centre in Calcutta, took the gamble and decided to prescribe a simple solution of glucose and salt in the right proportion for the friends and relatives of the cholera patients, thus saving at least 3.5 million people.  Since that time it was estimated that such a simple and cheap remedy saved at least 40 million more lives.
No wonder The Lancet hailed the development of oral rehydration therapy (ORT) as "the most important medical discovery of the 20th century".
The scientists at Johns Hopkins and Dr Mahalanabis received the Pollin Prize of $100,000 in 2002.


“Ideas without precedent are generally looked upon with disfavor and men are shocked if their conceptions of an orderly world are challenged.” 

Bretz, J Harlen 1928. 

Thursday, April 19, 2018

Osthmanthus & Guava: An older and more sedate time!



Guava fruit and the beautiful trunk.


                                        Osthmanthus fragrans©Am Ang Zhang 2011

In The Cockroach Catcher:


The examinations were finally over and I was back home in the village that I had more or less abandoned for the most of the last five years.  I could not remember skies as bright and temperature as high, but it was a nice interlude from the mad preparations and the nerve-wracking examinations.
         We had an unusually dry May. The worst of the 1966 rains seemed like a distant memory and the crisp blue skies somehow made the heat tolerable. Even back then we seemed to be complaining of the ever rising temperatures in Hong Kong. The way we had been complaining about the rise every year, the temperature should really have reached 110 or more by now. The air-conditioning of offices, followed by that of private homes, necessarily led to the feeling of higher ambient temperatures in the streets.
         The garden was filled with the fragrance of the white tropical jasmines.  That fragrance is only second to that of the Osmanthus (Gui Hua)[1], the flowers of which are tiny and appear more towards winter. We used to collect the Osmanthus flowers, dry them and use them to flavour our best teas.  Jasmine is more a late spring and summer flower and we had a big bush. By nightfall the cooling hill breeze brought with it occasional whiffs that made you want summer to last forever.
         It was a peculiar time for those of us who had lived in or around the university for the past five years.  We left home as school children and now we were back, and with any luck the majority of us would in a few weeks become fully fledged doctors ready to apply our skills.
         We had changed and the rest of the family probably not as much; and yet it was a time to savour – the last of the old before embarking on the new and brave.
         It was good to be reminded of the fine cooking back home, of an older and more sedate time when shopping was done twice a day for fresh ingredients.  This practice of course still continues in some parts of the world.

.........The guavas were not quite ready but our own giant papaya tree seemed capable of fruiting through the year. These were yellow fleshed and delicious though without the special fragrance associated with the red variety. Bananas too grew wild and bunches were cut when ready and suspended from a tripod for indoor ripening. It was too risky to let them ripe on the tree as various animals and birds would have had first claim.


[1] Osmanthus (Gui Hua) - Osmanthus fragrans is a flower native to China that is valued for its delicate fruity-floral apricot aroma. It is especially valued as an additive for tea and other beverages in the Far East.



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