Had a really cuckoo day at school today.

1) MCQ/OSCE didn't go too bad, got a respectable mark for OSCE and with a bit of luck, I'd pass my MCQ. Lovely lunch with old groupmates, and HypoC started on his weird malady-paranoia by proclaiming once again his ankylosing spondylitis.
2) Skipped the ethics lecture (EW blew me and Dopey off!! She ran off to the lecture despite not wanting to. I know HS's got something to do with this, he's been actively promoting medical ethics the entire day.) We ended up mugging in the library, both fell asleep at one point or another (erm .. I actually drooled onto the table I think, urgh) and we practiced our physical examination in a most innovative way. Used 4 pens to simulate the femurs and tibias of a pair of legs and went ahead with the examination. Way to go! Hahaha ... desperation. Finally, we retreated to the Quiet Room on Lvl 6 and discovered it's actually a prayer room. A lovely place to study, actually.
3) Psychomotor assessment. Go green on this, guys! Haha ... Dr. Hui actually pretended to be a patient, and it became a tutorial instead. Just on hand examination. Grrr ... and I spent the entire ****ing night fretting away and cramming bits and pieces of info.

As expected, I'm a walking zombie now. Skived off night duty (hmm .. and N&R actually didn't try to contact me regarding my absence. Does make one wonder eh?) and taking a full night off orthopaedics. For some reason I keep thinking of opening my Apley to read. Addiction ...

Asian culture and the woes of orthopaedic surgeons

Was at Clementi in the evening when I watched 2 different ladies walking past. Both well past their 50s, first one was walking with an antalgic gait. The other lady had genu varum at about 20-30 degrees, and she was hobbling away. Good for spot-diagnosis eh? Which makes one think ... why didn't/don't they seek medical attention?

Perhaps it's the culture of traditional sinsehs. All the things about "wind" and whatnot, and the general idea that osteoarthritis is a natural process of aging and nothing can be done for it. And sinsehs are smart - their "medications" and "plasters" are laced with prednisolone and all sorts of steroids, which well .. decreases the pain and gives the impression of apparent amelioration, but there's no avoiding the continuous wear and tear, is there? And woohoo .. they end up with lovely cases of Cushing's syndrome for medical students to see. To be fair, what we offer medically isn't very much better - NSAIDs, with all sorts of risks like gastric ulcers. But still ... maybe it's a lack of education in general, and public awareness. On the other end of the spectrum, there are those who have consulted a GP and perhaps given NSAIDs, salicylate creams or glucosamine/chondroitin supplements, gave up on treatment and went running back to sinsehs. Perhaps a lack of communication and education, that glucosamine may or may not work for different people. And the locals, in general, like miracle drugs; things that give instant relief and visible improvement. Kind of an irony really, given the fact that they go running to the docs for the most minor of ailments like the common cold which, in most cases, resolve on their own. Over-worried and over-treated for some, under-treated for many others. Loads of treatment options out there, from Synvisc injections to laparoscopic debridement to high tibial osteotomies to total knee replacements. Not all are effective in the long run and some truly are expensive, but at least IMO these really beat hobbling around bearing the pain, with a reduced range of motion to boot.

And frankly, it's seeing all these osteoarthritis cases that really made me decide - it's time to lose a lot of weight. Mr. Ye, care to share some secrets about your crazy metab rate?