A shot in the arm

I had been dilly-dallying for years, but finally decided to go for my pneumonia jab yesterday. I first became aware of the pneumonia vaccine during the Covid-19 pandemic. At the time, I was encouraging my friends to get their annual influenza jabs. While the flu vaccine doesn't protect against Covid-19 itself, I felt that keeping the body's defences up against one infectious disease couldn't be a bad thing when dealing with another.

That's when one of my friends brought up the pneumonia vaccine, pointing out that it was just as important, especially for older people. He reminded me that pneumonia is one of the leading causes of hospitalisation among senior citizens and can be particularly dangerous for those with chronic conditions such as diabetes, heart disease and lung disease. Although the vaccine doesn't prevent every case of pneumonia, it greatly reduces the risk of severe illness and serious complications.

It certainly sounded like something worth having. Unfortunately, the price at the time was rather steep, so I shelved the idea. As often happens, one year became two, and before I knew it, several years had slipped by. Then about a week ago, something just clicked. I realised I had procrastinated long enough. We insure our homes, service our cars and go for regular medical check-ups, yet we sometimes hesitate over a vaccination that could help keep us out of hospital. The older we get, the less sense it makes to keep putting these things off.

So yesterday, Saw See and I, together with two other friends, kept appointments with a doctor friend who had kindly arranged for our vaccinations at cost price. I won't mention who he is or where we had the injections, just to respect everyone's privacy.

The vaccine we received was Prevnar 20, one of the newer pneumococcal vaccines that protects against 20 strains of the bacteria responsible for pneumonia and other serious infections. Unlike the influenza vaccine, which needs to be taken every year, this is generally a one-off vaccination for most older adults.

The whole thing was over in a matter of minutes. Just a tiny prick in the arm and a much lighter wallet, but also the comforting feeling that I'd finally crossed another important item off my health checklist. Come to think of it, the hardest part wasn't the injection at all. It was taking so many years to make up my mind.

SG Lim's run for cancer

There was a huge charity event at Penang Free School yesterday and, much as I would have liked to be there, I had to give it a regrettable miss. Not through any lack of interest, but because several weeks earlier, long before details of the event had been finalised, my brother-in-law from Singapore had already arranged to return home with his family for a visit. Family took priority as rare reunions, like this particular one, are not something I can postpone lightly.

Still, I followed developments from afar because this was no ordinary event. It marked the conclusion of Old Free Lim Shyang Guey's remarkable Run for Gold journey, which was a 2,200-kilometre run (actual distance covered was 2,390 kilometres) across Peninsular Malaysia to raise awareness and funds for children battling cancer.

Better known now as SG Lim, the Class of 1975 (Form Five) alumnus began his journey on the 28th of March from the National Cancer Society Malaysia's Home of Hope in Penang. Over the next 86 days, he ran north to Perlis, crossed to Kelantan, travelled down the east coast to Johor and then turned north again along the west coast before returning home to Penang.

The final stage took him on an 82-kilometre route around the island, passing through Teluk Bahang, Balik Pulau, Batu Maung, Jelutong and George Town before he crossed the finish line at his alma mater, Penang Free School, one day before his 67th birthday.

There was something fitting about that ending. The journey had begun in Penang and it ended where another journey had started many years earlier at the school that helped shape him.

More than 150 teachers and present pupils of the school were among the several hundreds gathered to welcome him home, alongside family members, former schoolmates, supporters, volunteers and well-wishers that included Penang Chief Minister Chow Kon Yeow and Penang Island City Council Mayor Rajendran P Anthony. Standing before the crowd at the finish line, SG Lim looked skyward and spoke words that had carried him through the entire journey. "Firstly, my darling, we made it." 

The tribute was to his late wife, Goh Joo Lee, who passed away from gallbladder cancer in August 2024 at the age of 63. The couple had once dreamed of travelling around Peninsular Malaysia together on foot after retirement. After losing her, Lim transformed that shared dream into a mission with a different purpose.

"We had wanted to walk around Malaysia together, every state," he said. "But I did not get to do it with my wife. She was there all along with me. Yes, we made it."

At its heart, Run for Gold was never really about running. The name itself comes from the gold ribbon, the international symbol of childhood cancer awareness. As Lim explained, "It's for the children. Children with cancer. That's why it's Run for Gold. I am running for the children. I don't need any more gold." 

Along the way, he covered between 25 and 35 kilometres a day, staying mostly in homestays and shared accommodation, meeting families affected by cancer and listening to their stories. The journey also formed part of the torch relay for Relay for Life Malaysia 2026 which carried a message of hope and solidarity from community to community.

The campaign had initially aimed to raise RM600,000 for the National Cancer Society Malaysia. By the time he crossed the finish line, donations had already exceeded RM775,000, with funds earmarked for childhood cancer support services, including the Home of Hope programme, psychosocial care and survivorship initiatives.

Penang Chief Minister Chow Kon Yeow, who welcomed SG Lim home at Penang Free School and announced a further RM50,000 contribution from the state government, perhaps summed up the significance of the occasion best.

"SG Lim's 2,200km Run for Gold journey across Peninsular Malaysia is far more than an extraordinary feat of endurance; it is a powerful story of love, resilience and hope. Every step he took carried a message of encouragement for children battling cancer and their families, inspiring Malaysians from all walks of life to come together for a meaningful cause."

The Chief Minister also spoke movingly of the personal sacrifice behind the journey. "Dedicated to the memory of his late wife, Joo Lee, SG Lim transformed grief into hope, raising more than RM700,000 for the National Cancer Society Malaysia and proving that one person can make a profound difference."

What SG Lim accomplished over those 86 days was not measured simply in kilometres covered or funds raised. It was measured in something less tangible but perhaps more important: one person's determination and compassion that brought people together.

As Old Frees, we often speak about the values our school tries to instil: service, perseverance and concern for others. SG Lim embodied all of these qualities. In recognition of his remarkable achievement and service to the community, he was presented with Life Memberships of the The Old Frees' Association and the Old Frees' Association Kuala Lumpur & Selangor.

And there is something more. While grief has a way of turning people inward, here was a man who chose to transform personal loss into an act of generosity that will help children and families facing challenges far greater than his own.

Staircase danger

A recent unfortunate incident brought back a memory that I had not thought about for quite some time. Four years ago, I had a close call falling down. I was standing on a collapsible ladder, only on the first step, when the whole thing suddenly slid backwards. It happened so quickly that there was no time to react. Fortunately, as the steps shot away beneath me, I fell sideways onto my right rather than backwards. The only injury was a bruise on my thigh. Over the next few days it grew impressively black and blue, spreading much further than I would have imagined, before gradually fading away and healing completely. At the time, I regarded it as an unpleasant but ultimately minor incident. After all, nothing was broken and life went on as normal.

Recently, however, I learnt of a far more tragic accident involving someone I was acquainted with. He fell down the staircase at his home and never recovered from the injuries. The news affected me more than I expected. Perhaps it was because the circumstances sounded so ordinary. Stairs are among the most familiar features of any house. We climb them and descend them every day without giving them a second thought. Yet a staircase can become dangerous when something goes wrong.

As we grow older, we become more vulnerable. When we are young, a fall often results in embarrassment, a few bruises and perhaps a story to tell later. Age changes everything. Bones become more fragile. Reflexes slow down. Balance is no longer quite what it once was. A fall that a younger person might shrug off can become a life-changing event for an older adult.

Medical studies have shown that the direction of a fall can make a tremendous difference. Falling backwards is often especially dangerous because there is little opportunity to protect oneself. A person may strike the back of the head, neck or spine with considerable force. Falling forwards is not necessarily safer. The instinctive attempt to break the fall can result in fractured wrists, broken shoulders or facial injuries.

Then there is the question of height. One might assume that only a tumble from the top of a staircase is dangerous, but even a fall from the bottom few steps can have devastating consequences. A sideways landing can fracture a hip. For many elderly people, a broken hip becomes the beginning of a long and difficult decline involving surgery, rehabilitation and a loss of mobility.

What is particularly sobering is that the danger does not end with the initial injury. A serious fall can trigger a chain of consequences. Reduced mobility leads to muscle loss. Confidence disappears. Some people become fearful of moving about independently lest they fall again. Ironically, that reduced activity can weaken the body further and increase the likelihood of another fall.

As I thought about my acquaintance's passing, I found myself thinking not only about the fragility of the human body but also about how Buddhism approaches impermanence. We often associate impermanence with grand events: aging, illness and death. Yet there's also impermanence in the smallest moments. A misplaced step. A stumble from uneven floors of even one millimetre apart. A momentary loss of balance. An ordinary staircase climbed a thousand times before without incident.

We tend to imagine that major changes in life arrive with warning signs and dramatic announcements. More often, they arrive unexpectedly. One moment everything is normal. The next, circumstances have changed completely.

When I look back on my own accident, I realise how fortunate I was. Had I fallen differently, the outcome might have been very different. It was a reminder, one that I perhaps did not fully appreciate at the time, that we should never take safety for granted. These days when I climb a staircase, I find myself paying more attention. When I step onto a ladder, I ask someone to hold it. Not out of fear, but out of respect for the simple fact that our bodies are not indestructible. The older we become, the more we learn that life often hangs on small things: a secure handrail, a dry floor, a firm footing and perhaps a little good fortune. The loss of my acquaintance is a sad reminder of that truth. May he rest in peace.

Cataract landmark

Another landmark reached today in my cataract journey. It’s been a calendar month since the operation. I’m only due to see my surgeon for the final follow-up next Wednesday, and I expect he’ll take me off the eye drops then. I’ve been on a steady routine of Nevanac, Maxidex and Vigamox, each with its own timing and purpose, so the day has been punctuated by little reminders on my mobile phone to tilt the head back and squeeze in a drop or two. Not a moment too soon, as one of them contains a steroid, which isn’t meant for long-term use.

I suppose the one lesson I’ve taken away from all this is how important it is to diligently follow the doctor’s instructions on the eye drops. They’re prescribed for a reason. In the past, keeping to such a schedule might have been a bit of a challenge, but with the timer function on the mobile phone, it has been quite straightforward. I’ve had no real difficulty keeping to the schedule once the alarms go off.

Cataract routine

It’s been almost two weeks since the cataract operation on my left eye. I’ve already gone back twice for follow-up sessions with the surgeon and, according to him, everything is progressing well. So far, I haven’t experienced any of the warning signs he mentioned earlier, no pain, no discharge, nothing out of the ordinary, so that in itself is already something to be thankful for. There’s one more follow-up scheduled towards the end of next month, just to make sure everything continues on track.

So how do I feel with this artificial lens sitting inside the eye? From the very first day, the difference was quite striking. Vision suddenly became very bright and very clear. Almost too clear, if that makes sense. The best way I can describe it is with the Penang Hokkien expression, Cheng Beng. It's the same term used for this time of the year when we Chinese make our way to the cemeteries to spring clean the graves of our ancestors and especially, to remember and fulfil our duties to those that came before us. Cheng and Beng, clear and bright. That same sense of clarity in the air, as if everything has been washed clean. That’s exactly how things look now. Colours appear more vivid, whites look whiter and there’s a certain crispness to everything that I don’t remember having for quite some time.

But of course, it’s not all perfectly balanced yet. The left eye is now long-sighted, while the right eye is still short-sighted. So when I look at something, the left eye sees it sharp and clear, while the right eye comes in slightly behind, blurred and struggling to catch up. It’s a strange sensation, like the two eyes are not quite in agreement with each other. At times I find myself unconsciously favouring the left eye, letting it take the lead.

I suppose this is part of the adjustment period. The brain probably needs time to sort things out and decide how to combine the two different images into something workable. For now, I just carry on as usual, reading, moving about, letting the eyes and the mind slowly get used to this new arrangement. How long that will take, I really don’t know. But at least for now, things are heading in the right direction, and that’s good enough for me. 

Of course, there are all the little routines that now come with it. Whenever I’m outdoors in the daytime, I have to wear sunglasses. “Protect your eyes from the ultraviolet light,” the surgeon warned. For how long, I asked. “As long as necessary,” he said. I suppose that means quite indefinitely.

At night, I have to put on an eye shield before going to bed. It’s quite a ritual, sticking it on with surgical tape. For afternoon naps, it’s much simpler, just the sunglasses will do. Both are really there to stop me from accidentally touching or rubbing the eye when I’m not fully aware of what I’m doing.

Then there are the eye drops. Three different types, several times a day. And this, not counting my glaucoma eyedrops too! By now I’ve more or less settled into the routine. Life goes on. I’ve even resumed driving, although with the difference in vision between the two eyes, I do have to be more careful and alert. Night driving I’ve not attempted yet, leaving that to my wife for the time being.

On the hygiene side, showering is not a problem, although I’ve avoided shampooing my hair these past two weeks. Instead, I give the scalp a good wipe with a damp cloth. Surprisingly refreshing. The eyelid too gets a daily clean with damp cotton puffs, just to remove any accumulated dirt. But that’s as far as I go when it comes to getting water near the eye.

As for food, the surgeon more or less dismissed any need for restrictions. But my wife, after listening to various well-meaning friends, has taken a different view. So for now, anything involving prawns, shrimp, hehbee or belachan is off the menu. Pantang for three weeks, she decided. Thus, no Hokkien mee, no char koay teow. She is the "She Who Must Be Obeyed", as the character Rumpole in Rumpole of the Bailey would say of his wife. Woe is me.

As a postscript, perhaps I should say that inevitably, in the longer term, I shall need another operation on the right eye to balance up my vision. That is something for another day. For now, I’ll just let things settle and take it as it comes.

#chengbeng

Cataract done

So I had my cataract procedure done on my left eye yesterday and I got through it okay. Many thanks to my doctor, Teoh Hian Jin, from Bagan Specialist Centre in Butterworth. I must admit that before the procedure I was mighty anxious and nervous because he had warned me that my iris was rather small and that he might have to use some alternatives to get it to open wider. And true enough, despite several attempts to dilate the eye, he eventually had to use hooks.

I probably wasn’t the perfect patient either. Several times he had to remind me to relax and unclench my jaw and turn my head slightly towards him. In the end, I attempted some basic techniques to calm myself down. 

Maybe I should also explain why I chose to go to him in the first place. I discovered that he is also an Old Free but seven years my junior at Penang Free School, although he isn’t a member of The Old Frees’ Association. Still, that information was good enough for me. I would trust an Old Free any time and in this case my trust certainly wasn’t misplaced. Hian Jin did an exemplary job on me. Now I just have to wait for the world to look a little brighter through that eye!

Cataract

Today's the day. Left eye. Wish me well.

Ultra-processed

Yesterday, I wrote about having attended a health talk on aflatoxins—those invisible toxins that can grow on grains, nuts and spices when they’re improperly stored in humid conditions—and food safety, and it left me thinking about what really goes into our daily meals. It’s quite concerning how some of the things we eat, which we think are okay for us, can turn out to be more complicated than they appear.  For example, the dangers that come from consuming deep-fried food too often. It was eye-opening to learn how burnt food could quietly damage the liver or, over time, lead to serious diseases.

But what caught my attention even more was something closer to home: the food products that line supermarket shelves and health stores, all neatly labelled “nutritional,” “balanced” or “scientifically formulated.” Products like Glucerna and Nutren, for example. They’re popular among older folks and people with diabetes, and they’re certainly convenient. Just flip open the lid, mix the powder in warm water and drink. But convenience often hides complexity.

I learned that these so-called meal replacements fall under what nutrition experts now call “ultra-processed foods.” They’re made from refined carbohydrates, isolated proteins, sweeteners, vegetable oils and a cocktail of stabilisers and artificial flavours: all carefully engineered to provide complete nutrition. In theory, they contain everything the body needs. But in practice, they’re still industrial formulations, far removed from the natural foods we grew up eating.

There’s nothing immediately dangerous about them, of course. Used sensibly, they can be a helpful supplement. The problem begins when they start to replace real meals altogether. They lack the living texture of food, such as fibre, the subtle nutrients and the natural balance that fresh ingredients bring. Over time, the body feels the difference, even if blood tests don’t show it right away.

I suppose this is one of the ironies of modern living. We’ve made great progress in medicine and nutrition, yet we’ve drifted farther from the simplicity of natural food. I’ve often thought back to how our parents and grandparents cooked with patience, simple ingredients and little waste. They didn’t have to read labels or worry about emulsifiers and trans fats.

So perhaps the lesson is not to be fearful, but to be aware. There’s no harm in occasionally reaching for a bottle of Glucerna or Nutren, especially when health or appetite falters. But they should stay as the exception, not the rule. Nothing replaces the goodness of a meal that’s cooked, shared and enjoyed fresh. And if we can manage that most days, I think our bodies will thank us in ways that no supplement ever could.

Aflatoxin

We attended a talk earlier this month that left quite an impression on me. It was about the food we eat every day. The speaker, Dr Steve Kuan, spoke about two hidden dangers that most of us probably don’t think about: aflatoxins and the harmful compounds that form when food is deep-fried, especially with reused oil. I must admit, I’d heard of food contamination before, but never realised how quietly these things creep into our lives.

Aflatoxins, we were told, are among the most potent natural toxins known. They come from certain types of mould, Aspergillus flavus and Aspergillus parasiticus, that grow easily in warm, humid places like ours. Once they infect crops such as peanuts, corn, rice, chillies, sesame or even spices, they produce an invisible toxin that stays behind even when the food looks and smells fine. It’s not just a minor health issue; long-term exposure can damage the liver, and in severe cases, lead to liver cancer. The talk mentioned that aflatoxin B1 is classified as a Group 1 carcinogen by the World Health Organization, meaning it’s a confirmed cause of cancer in humans. Children, too, are especially vulnerable; chronic exposure has been linked to stunted growth and developmental problems.

Listening to all this, I found myself thinking about the simple things we take for granted, for example, a jar of ground peanuts, a bag of rice or a packet of spices from the market. So much depends on how these foods are dried, stored and transported. Moisture and warmth can turn a harvest into a hazard, yet the problem remains invisible until it’s too late.

The second part of the talk turned to something far more familiar: deep-fried food. That one hit home instantly. Who among us doesn’t love something fried: a crispy snack at tea-time, a plate of char koay teow or fried fritters from a roadside stall? Yet frying at high heat, especially when the same oil is reused, can produce toxic compounds called Advanced Glycation End Products (AGEs) and trans fats. They may sound harmless enough, but these compounds quietly promote inflammation, harden our blood vessels and raise the risks of diabetes and heart disease.

It made me think of all those times I’ve seen stalls with oil that’s clearly been used over and over again. The golden crispness comes at a price we don’t see right away. It’s not about avoiding fried food altogether, but being mindful of how it’s prepared, and perhaps choosing steaming, boiling or poaching a little more often. I was also surprised to learn that a splash of lemon juice or vinegar in cooking can reduce the formation of those harmful AGEs. Small things, really, but they make a difference.

What stayed with me after the talk was how fragile our food chain really is, from the fields where crops are harvested to the kitchens where we cook our meals. Clean storage, careful cooking and a bit of knowledge can make all the difference. It’s not about becoming fearful or fussy, but about being a little more aware of what goes into our food. Most of the time, the danger isn’t what we can see but the quiet, invisible things that build up over time. If we can make small changes here and there, whether it’s drying our grains properly, choosing fresher oil or going easy on the deep-fried treats, then perhaps we’re already doing enough to keep ourselves and our families safe.

Health perils

It’s that time of year again. Another journey completed around the sun. My 71st. And now I’m looking forward to the 72nd, hoping it’ll be a steady, uneventful ride. Wish me luck; I think I’ll need it. The trouble with growing older is that the body starts sending reminders of everything you’ve put it through.

I’ve lived with diabetes for quite some time now, a quarter of a century, kept in check with metformin and gliclazide. But even before that, back in my late 30s, I had my first real taste of pain from uric acid stones in the kidney. I still remember that morning: waking up to an excruciating pain in the back that spread down to a dull ache in the groin. That episode taught me that good health isn’t something to take for granted.

For many years, I used to be a regular blood donor, proud of doing my small part. Then one day, the hospital turned me down because my blood pressure was high. That marked the end of those donation days. Soon after, I was started on cholesterol medication too. Just to be safe, the doctor said, because diabetes, hypertension and cholesterol often travel together. Later, when my cholesterol numbers stabilised, the pills were stopped. But by then, aspirin had entered the picture “to thin the blood,” they told me. That little tablet would come back to haunt me years later when I was hospitalised for two weeks with diverticular bleeding. The blood had thinned a bit too much, and once the vessels broke, there was no stopping it. It was a frightening time, but I recovered, and life went on.

My eyesight began to falter about a decade ago. Glaucoma, the doctor said. Since then, I’ve been on long-term eye drops to slow it down. Lately, though, my vision seem a little mistier as if a thin film has settled across both eyes. The legs have also started to complain. Cramps in the calves and feet, but some good massage therapy has helped ease them. My left knee, however, is another story. The natural lubricant is drying up, and the doctor’s been recommending injections to keep it going. Then there’s the drier skin and eczema. It’s a constant irritation, but what really worries me is the thought of it turning into psoriasis, which my father suffered from. Thankfully, that hasn’t happened.

And finally, the latest in this long list: an enlarged prostate and elevated PSA levels. That discovery on my birthday last year was an anxious one. The tests and scans made me fear the worst, but with treatment and time, the numbers have come down. Still, it’s a reminder that age doesn’t come quietly; it makes its presence felt in all sorts of ways.

So here I am, a man full of prescribed drugs and quiet gratitude. Whether my ailments are typical of a 71-year-old, I can’t say for sure. But I do know that I’ve been lucky that every scare so far has found its resolution, lucky that I can still walk, still see, still write these thoughts down. As I step into my 72nd year, I carry all these stories in my body, each a little scar of survival. May there be more good days than bad ones ahead, and may I have the grace to take them all in stride.

Important hygiene factors

Together with friends from the Nandaka Vihara, we shall be embarking on a Buddhist Trail to Nepal and India later this month, and I thought it might be useful to share a few general tips on hygiene expectations—especially for the India sector, which, if we believe the horror stories from past travellers, could be quite an experience.

Our route this November and December will take us through familiar names from the Buddha’s life: beginning at Lumbini, his birthplace, and crossing the Nepal-India border to Shravasti. We shall travel on to Vaishali and Kushinagar, sites of his final teachings and Mahaparinirvana; to Rajgir and Nalanda, those ancient centres of learning; then to Bodhgaya, where enlightenment came under the Bodhi Tree; and finally to Varanasi and Sarnath, where he preached his first sermon. Ideally, we should visit these sacred places in the order of the Buddha’s life, but travel logistics seldom allow such perfection. There will also be stops in Agra, Jaipur and Delhi, each with its own rhythm and pace. Some towns are bustling, others half-asleep, and it’s in this mix of the urban and the rural that we shall learn to adapt.

The Buddhist Trail in northern India is more than just a string of holy sites. It’s a slow, sometimes dusty, always fascinating journey through places where history and belief still live side by side. Hygiene standards, though, can vary widely from one stop to another, and a bit of common sense goes a long way towards keeping us healthy and comfortable throughout the trip.

Good hygiene starts with simple habits. We’ll keep a small bottle of hand sanitiser handy and wash before meals or after using public toilets, especially at roadside stops. We’ll drink only bottled or filtered water (even for brushing our teeth) and remember that ice can be risky. We’ll eat freshly cooked food whenever possible and save the raw salads and street snacks for when we’re feeling both adventurous and confident about the stall’s cleanliness, which I don't think is possible under any circumstances. Above all, no fish dishes if they’re caught from the Ganges or other rivers where the dead are cremated and their ashes scattered in the waters! Public toilets can range from acceptable to best-forgotten, so it’s wise to carry a bit of tissue paper, wet wipes and hand sanitiser.

Most hotels along the route provide decent bathing facilities. The water in urban areas such as Varanasi and Bodhgaya is treated and generally safe for showering. We just take care not to swallow it. In smaller towns, the supply might come from wells or storage tanks; fine for bathing, but not for drinking or brushing teeth. A quick-dry towel, a bar of travel soap and a pair of shower sandals will make life easier. As mornings can be chilly, a warm layer and a good cup of tea become small blessings.

It’s also sensible to carry a few medical basics. Vaccinations against Hepatitis A, Typhoid and Influenza are worth updating before we go. We should bring along a simple first-aid kit of antiseptic wipes, plasters anti-diarrhoeal tablets and oral rehydration salts are usually all we’ll need. Travel insurance that covers medical emergencies provides peace of mind, even if we never have to use it.

Cleanliness, of course, isn’t just about staying free of germs. The Buddha himself spoke of personal hygiene as part of spiritual discipline: an act of mindfulness and respect for the body that sustains our practice. To wash, shave or brush our teeth regularly was to honour both the teaching and the self. Seen this way, the daily routines of travel - bathing, keeping our clothes tidy, washing our hands - become small meditations in themselves.

The weather during November and December is one of the blessings of the journey: cool, dry, and pleasant. The only nuisance is the dust that hangs over some parts of Bihar and Uttar Pradesh, so those with sensitive lungs might find a face mask useful.

In short, we should travel light, travel clean and travel with patience. The Buddhist Trail may test our comfort levels at times but will reward us with moments of deep peace and wonder. The rest is simply part of the journey.

Don't fall for it

A message came through one of my health chat groups on WhatsApp yesterday, this one from Dr Dicky Ng, the occupational health and lifestyle medicine doctor at Penang Adventist Hospital. He was sounding a warning about some of the devices being sold on various online shopping platforms, particularly those making exaggerated claims. His message was clear: don’t fall for flashy marketing or promises of miraculous results — especially when it comes to health gadgets that claim too much with too little science behind them. 

He had written: "Saw this on a social media platform, I would like to share with you all that any company which claims its blood sugar (test kit), whether prick blood, or wear on skin or just shining thru finger, if it claims such accuracy, you've got to be Highly SUSPICIOUS -  all medical equipment, unlike counting money or engineering measurements, CAN'T reach such Accuracy yet, at least not that I know of.  Please share with your family, friends, and associates." and adding later another message: "Good rating, time limited offer with Buy Now button, are all good ways to pull your emotion to click the...prominent button.  You will gain more health by donating that amount of money to charity. Even current gold standard CGM AKA F Libre, carry a 5 min lagging time.  Real time Blood Glucose Monitor, it is definitely an OVERCLAIM."

Calf cramp

I was hit by a nasty calf cramp this morning. Turned my half-sleepiness into fully awakened mode. Maybe I was stretching myself a wee bit too much, but suddenly my left leg seized up in a bolt of pain. It caught me in the calf and left me frozen in pain on the bed. The sharp pain didn't subside for quite a while and the muscle stayed sore despite all my efforts to reduce the pain. Two hours later, I can still feel a dull, lingering ache in the same spot.

Some of my efforts to ease the discomfort included flexing my foot upward so that my toes pointed back toward me. That helped loosen the tightness a bit. Definitely, I also massaged the sore area with my fingers, working slowly to ease the knot that had formed. It wasn’t instant relief at all.

Then came the heat application. At first, I wanted to apply one of those menthol "deep heat" cream rubs on the cramp area but then my wife suggested that I try applying an oily ointment which someone gave us in Bangkok recently. I tried that, applying a few drops on the calf and then rubbing them in. For a short while, nothing registered but then gradually a tingling sensation passed over the calf. In spite of me having taken a warm bath soon after, I can still feel the warmth effects of the ointment. The dull ache has gotten better.

I suppose that I shall also have to make it a point to drink more water than usual. Cramps can sometimes be linked to dehydration, or low levels of minerals like magnesium or potassium. Maybe I should search for some nuts too. Cashew nuts, maybe? I have some in the house.

Thinking back, it’s probably time I did a bit more to prevent these cramps from happening again—especially as I’m not getting any younger. Simple calf stretches before going to bed or first thing in the morning might help. Nothing complicated, just a few minutes of gently loosening the muscles before lying down or jumping into the day. Staying hydrated is important too, especially in our hot climate. I should also probably watch what I eat—make sure I’m getting enough magnesium and potassium. I’ve read that leafy greens, bananas, avocados and even yoghurt can help.

And of course, I’ll have to remind myself not to stretch too forcefully when waking up. That half-conscious stretch we all do in bed. I might need to be a bit more mindful of that from now on.

Brain tumour symptoms

How coincidental it was for me to discover this image on facebook some days ago! 

Although it is part of a series of sponsored information from a leading private hospital in Penang, the message is important enough for me to share around. 

In recent weeks, I've a close friend - we've known one another since our primary school days - who had undergone a risky operation to remove a tumour in his brain. 

Some of his symptoms were identical to those shown: headaches and visual disturbances. He underwent an MRI scan that confirmed the tumour and necessitated an immediate removal. My friend is now in rehabilitation and undergoing therapy.

Corner kick

So much have happened to my wife and I in the last two and a half weeks or so. I'm actually having some difficulty deciding how to begin this narrative. But I think the best is to start from the very beginning. 

Anyway, in the morning of the 29th of November, my wife stubbed her little right toe against the corner of our bed. It was quite loud, or at least, I thought that it was quite loud. She was in the bedroom and I was outside at my computer when I heard a loud crack from the room. Rushed in to find my wife clutching at her little toe. We had stubbed our feet many times against the bed and we thought this time would not be any different. But it was not. 

By the afternoon, she complained of a nagging pain that wouldn't go away. The doctor's X-ray confirmed that there was indeed a hairline fracture. The following day, we consulted an orthopaedic surgeon at the private hospital and her toes were immediately bandaged up. It would take about six weeks for the fracture to heal partially, the specialist said, and three months for it to heal totally. Our hearts sank. We had planned for an overseas holiday and now, it was completely shattered by this little bad luck of a freak accident. Worse was that we had already paid for the holidays and it was impossible for us to get all of our money back. The stumbling block were the airline tickets. Cancelling the tickets would come with a hefty loss as obviously, the full amount won't be reimbursed. We made a frantic search for our replacements and luckily, we did find two persons to go in our place. Still, it was a monetary loss to us.

My wife had a follow-up appointment with the surgeon two days ago and luckily, the good news was that her toe was healing well. The bandages have come off and she can now put her weight on the whole foot. There'll still be a final check-up in another three weeks' time.

Leaving us

This is a very short post I make today. I just want to get it off my chest. I still can't get over the matter that in the course of the last two or three months, several persons whom I know have been affected by deaths in their families. Of course, my own father-in-law had himself passed away on the 13th of July but about a month earlier, the mother of one of my Quah Kongsi committee members had died from old age. My wife told me that the father of one of the committee members at the Nandaka Vihara had similarly died and it had happened about four months after the death of this same committee member's mother. Then I had a neighbour staying four houses away from me who passed away. In Kuala Lumpur, a friend's mother passed away. Recently, two chess friends told me that their respective grandmother and father had died. And only last week, I had the wife of my former dentist informing me that her husband had passed away. So all in, I can count easily eight deaths in the last three months connected to people I know. I have also observed that this period can also be a crucial time when older people tend to fall seriously ill. There are at least two cases among people I know. So while calamities like these do happen at rather short intervals, I wonder whether there is any co-relation with the run-up to the Chinese seventh lunar month or the month itself which began on 29 July this year? The logical mind in me says no but who knows better? There are so many things that still cannot be explained logically. (Note: To the uninitiated, the Chinese seventh lunar month is also known as the Hungry Ghosts month or festival when the gates of the underworld are open for the hungry spirits to wander in this plane of existence. People usually don't like to go out till late at night during the 29 or 30 days of this month, and there's still a week to go before the gates are shut again. Superstitions and stories abound that contribute to Chinese folklore about this festival.)  

Something on dementia

Dementia is a health bummer that can strike at anybody. Lately, I've been hearing stories from friends and relatives about how dementia had struck at their elderly family members. I don't have to look far myself. Prior to his passing, my father-in-law was already suffering from it mildly. And yesterday, I had visited my old dentist at his home - he retired some years back and his business has been sold - and saw how his wife was coping with his condition. "The forgetfulness comes and goes," she told me, "but he doesn't like to talk now." Today, this three-part video on dementia came to my attention. Very helpful information there; it explains a lot. Worth a look.

Plus or minus?

Ever since the 1990s, my doctor had recommended that I take Enervon-C to supplement my daily diet. This, I've been doing faithfully without fail even after I had retired. Every few months, I would scour the pharmacies in Penang in search of this supplement but since about three or years ago, I discovered that it was far more convenient for me to purchase a bottle through the online portals like Shopee or Lazada.

The combination of Vitamins C and B-complex in this product is supposed to promote the body immune system and provide more energy to the user. For a long time, I've known that essentially, it contains 500mg of Vitamin C. At the height of the Covid-19 pandemic, I embraced this product even more because of this high Vitamin C content and even added to it by consuming another 500mg of normal Vitamin C some 12 hours later, thus bringing my daily Vitamin C consumption to 1000mg. I still think to this day that this high daily amount of Vitamin C in my system has helped in warding off infections.

The bottles of Enervon-C that I buy were imported from the manufacturers in Manila. A look at the formulation reveals that apart from the Vitamin C content, each tablet also includes 50mg of Vitamin B1, 20mg of Vitamin B2, 5mg of Vitamin B6, 5mcg of Vitamin B12, 50mg of Niacinamide and 20mg of Calcium Pantothenate.

My latest online purchase of Enervon-C came in strip packs of four pills per pack. Locally produced. There's a slight change as the name is now Evervon-C Plus. I thought what this Plus thing was all about. Would there be something extra on top of my regular Enervon-C in a bottle? The pills looked similar but I noticed that the formulation was slightly different. For one, there's only 40.53mg of Vitamin B1 instead of 50mg. For a second thing, the Calcium Pantothenate is now removed. So it is quite puzzling, isn't it, for this supplementary to have the word Plus affixed to its name when the formulation is reduced? What the heck, it might as well be called Enervon-C Minus.

The case against ivermectin

This is the transcript of the reply by Noor Hisham bin Abdullah, Director-General of Health, Malaysia, to a burning question why ivermectin has not been approved for use in the country to treat people affected by Covid-19. This question came at the end of Noor Hisham's public lecture which was organised by The Dr Wu Lien-Teh Society in Penang last Saturday. 

When we look into the data, there is conflicting evidence and there is no consistency among the available data to suggest ivermectin. And remember when this started, we also used hydroxychloroquine, a malarial drug, and we had a clinical trial by WHO, they call it a Solidarity trial, and it was proven that hydroxychloroquine had no effect at all and likewise we used [Note: several names were mentioned very quickly which I was unable to catch] HIV drugs, and they also had no impact to manage Covid-19. Last year even in Parliament this ivermectin issue also was raised. The public raised ivermectin and I actually was also a board member of the DNDi. In fact, two or three years ago when we explored a new compound in the DNDi to treat dengue, ivermectin was raised again in terms of using it to manage and treat dengue. 

Ivermectin is an old drug used for parasitic infection but there is actually an antiviral effect. We know that. The question is the consistency. To use the antiviral effect, you need to have a very high dose of ivermectin and we did a clinical trial for dengue… ivermectin for dengue in Thailand. They did a study. But you need a very high dose and you need close monitoring of ivermectin dosage because otherwise complication of diarrhea, renal toxicity, etc, will be there. They did the trial but halfway through the trial they had to abandon because of the high side effect. This is from Thailand. 

Dr PP Shah asking the "tough" question on ivermectin

What we did last year, and then when the pressure for the Ministry of Health to use ivermectin, we approved ivermectin for clinical trial, exactly what WHO had highlighted. You can use ivermectin but on a clinical trial basis. We started to do the ITEC trial, recruiting patients from both sides on a randomised control study of Covid-19. We had about 500 patients recruited, and then we monitored their progress. They were given ivermectin and whether they deteriorated to Category 4 or 5, more severe forms of Covid-19 and initially there was a lot of pressure on us. We said that we give (approval) in terms of clinical trial. Those enrolled in the clinical trial can use ivermectin. 

We have now completed our clinical trial. In fact, that paper has been published in the Journal of American Medical Association. JAMA journal, one of the peer review journals, a global peer review journal, accepted and it was actually one of the top references for ivermectin study, and that study showed that there was no improvement, no whatsoever benefit in terms of to stop the progression to a severe form. That was the conclusion of the paper. We have another clinical trial ongoing under the Institute of Clinical Research looking into ivermectin as prophylaxis, whether we can use it as a prophylaxis. Again, this trial has not been concluded yet so we cannot comment on that. 

Likewise last year when in Parliament they were asking us to register ivermectin but we needed evidence. Like I said, we follow science, facts and data. This evidence today, when we published the paper in JAMA in America, not only the issues of ivermectin but it shows that our clinical trial in Malaysia is able to penetrate (an) international journal which means the quality and standard of our trial is very high. The data has shown clearly that there is no benefit whatsoever. If you recover with ivermectin, if you don’t take ivermectin you also will recover. This is the thing that we have shown and proved in our clinical trial. We go on that and today this paper, we call it the ITEC paper, is the centre of referral for the global community using ivermectin in Covid-19. 

Public health award

It was a good outing this afternoon. Went to Penang Institute for the sixth Dr Wu Lien-Teh Society annual public lecture. Several weeks ago when the invited speaker was revealed as the Director-General of Health Malaysia, Dr Noor Hisham bin Abdullah, the news had caused quite a stir in Penang. Imagine, the DG himself would be turning up in Penang to honour a true Malaysian hero! 

As expected, the Press turned up in full force at the venue to listen to Noor Hisham's updates on the coronavirus situation in the country. Although the Society might have felt a little sidelined by the presence of the DG, my impression was that the occasion had also brought Dr Wu Lien-Teh back into the limelight. Not too late nor too much!

Together with the public lecture, we also held a little ceremony to receive two paintings of Wu Lien-Teh from a lady artist, Lim Guat Eng. She told me later that prior to several months ago, she had never heard of the doctor but after she did, she was inspired enough to interpret Wu Lien-Teh in two paintings. The first one was completed in two weeks but the second one was more complimented and took her about a month to paint. In any case, she decided to give both paintings to the Society. 

In the last few weeks, the paintings had been sent for framing. I had visited the frame maker about a fortnight ago to take pictures of the paintings before they were mounted as I knew that once framed, reflection would be unavoidable if anyone tried to photograph them. But I was only half successful as one of them was already framed. Ah, well....

Anyway, back to the public lecture, we had the Chief Executive of Penang Institute, Ooi Kee Beng, give his welcome address before Anwar Fazal, the President of the Dr Wu Lien-Teh Society, took to the floor to enthrall everyone with his customary informative address. Noor Hisham then spent about an hour on the lecturn to give everyone in the room, as well as those who had tuned in on YouTube and facebook, on a journey of the last 27 or 28 months from the time that the Covid-19 virus had surfaced in Wuhan in November 2019 till the present moment. There was also a more interesting Question And Answer session with the inevitable question of Ivermectin cropping up. More of that in a later posting!

Noor Hisham bin Abdullah receiving The Dr Wu Lien-Teh Society Leadership in Public Health Award from Anwar Fazal

The committee members of The Dr Wu Lien-Teh Society with the Director-General of Health and CEO of Penang Institute: (left to right) Cheah Cheng Chua, Ronald Quay, Ooi Geok Ling, myself, Hor Chee Peng, Anwar Fazal, Noor Hisham bin Abdullah, Ooi Kee Beng, Clement Liang, Alison Chong and Chin Poh Chin

The unveiling of the two paintings by Anwar Fazal and Noor Hisham with the artist, Lim Guat Eng (far left) and Ooi Kee Beng (far right) looking on. The two paintings will be on display at the Dr Wu Lien-Teh Room in the Penang Institute building.

Ooi Kee Beng (CEO, Penang Institute), Anwar Fazal (President, The Dr Wu Lien-Teh Society) and Noor Hisham bin Abdullah (Director-General of Health, Malaysia)