Posts

medicine (2) : 死 - 2 resuscitate the dead

Image
Prologue   Can you measure my blood pressue? *Reading ~170/120* Are you currently on any medication? Yes *shows Amlodipine 5mg, 1 daily, dispensed 6 months ago* Is that your current box? Yes.  ... Can you give me another box? please? said softly  Are you really a professional 早幾日serve 咗一個中國客,佢拎咗兩樽唔同牌子嘅supplements 畀我睇叫我找不同。 一樽就 Lysine 1000mg, Zinc 50mg, Vitaminc 250mg, 而另一樽就得Lysine 1000mg. Treasure hunt 呢類野唔駛讀大學都做到,但難到我嘅佢問我 邊隻防到cold sore? Supplement 呢類野唔理有冇效食你唔死就reg. 到ARTG. 最火滾嘅係我同佢講supplement好少evidence 佢話自己有睇電視有教,are you really a profession? 係Hippocratic writings本書有講過,就連當時生活嘅人醫自己都係根據自己個experience, 今次treat完係recover度,到下次翻發(symptomatic)嘅時候都可以用返同一招;甚至身邊見到嘅人都monkey see monkey do. 既生電視可生我? Consumerism 就係層出不窮,vitamin C包裝下成唔同牌子,加埋濕鳩channels 教學,最後變成一個抗疫神藥,得出黎嘅效果就係架上嘅products成日都係空曬 (e.g. 掃嘅數量夠食十幾年…).  食黎為乜?個個都想活過2020,個個都想延長自己條命。 講到死又有幾多個人接受到? Stage of grief  雖然話stage of grief 係theory, 講到好經典嘅5個experience,  Dr. Elizabeth Kübler-Ross's five stages of grief: denial, ange...

DSE 放榜

Image
第三 part 有心情先講 就黎放榜,你而家嘅心情係緊張,定係既來之則安之?如果TL;DR,聽我講句,衫再貴都好,型男著乜都係咁型。 當年高登張舊圖,Edison 著乜都型。 當年冇溫書,成績差到冇得揀。人生係港台之間漂泊,最後都係去咗澳洲讀pharm。 可能你覺得好癡線,會考5分都冇問點去讀medic/pharm。得來嘅答案好多都係「就算畀你讀到啊,你都係唔好返香港喇。」 香港商業社會,究竟讀醫療專科,讀法律,讀搵錢科定係自己有興趣嘅乞食科? 種種問題,如果呢個世界係咁formalised, 咁仲讀書為乜? 非常老套講句公開試係人生一個轉捩點,conclude 唔到成個人生將來嘅走向,尤其而家大學生通街都係,入學又唔剩係得JUPAS一條路,20-60歲讀year 1都大有人在。不如問下你自己將來究竟想做啲乜仲好, 畢竟一個人個嘅mentality 係勁嘅,大撚把機會啦 。雖然唔係去encourage你,但係身不由己,想搵錢又冇料嘅人而走去做警察身邊都有唔少。 如果你真係想做HCP幫人,我可以同你講: 可能我同醫生做嘅野唔同,不過有一樣相近嘅係,大家都食好多antidepressant。O.D. minaserin 有,Max sertraline fluoxetine, escitalopram都唔少。 相信唔剩止得HCP, 其他professions真心想係幫人為主我諗佢地呢世掂嘅邋遢野唔會少過我地。但無可否認,如果你主要想靠幫人途中搵銀,咁都冇問題嘅,一樣,呢個世界大撚把獸醫獸pharm.,多你一個唔多。 最後冇得同返嗰陣吋鳩我條友講,但就算冇國安法,我都冇打算返香港幫你班冚家剷。

medicine (2) : 死 - 2 QALY

Image
Va'esse deireádh aep eigean, va'esse eigh faidh'ar 上篇留底咗兩個 key notes QALY - Quality-Adjusted-Life-Years //對於死,到底你有乜野睇法?上面講嘅只係肉體嘅死,另一種departure嘅表達。// 如果你唔係讀health science, 可能會對QALY有啲陌生。 QALYs are calculated by multiplying length of time spent in a given health state by the utility associated with state. QALY 嘅ideoloy  https://www.researchgate.net/publication/302485082_The_Limitations_of_QALY_A_Literature_Review   簡而言之,做人慘過做狗,個QALY就會低。 咁點解QALY咁重要?我舉個例子,香港買樓冇四五百萬唔駛諗,所以畀完首期之後接落黎嗰幾十年就係用黎供樓。當你供完層樓之後,你會發現到幾樣野 你唔再候生 你身邊嘅朋友唔係走曬就係死咗 周身病痛 e.g. hypertension, hypercholestrolaemia, glaucoma, cognitive declination, depression, diabetes, occupational injuries (e.g. plantar fasciitis), anxiety, insomnia ...etc from google 當然呢個例子好撚pessimistic,但換個角度睇,好多野都會受到physical 嘅局限而發揮唔到。亦都因為咁,我唔介意你係到包拗頸: 識新朋友 改變自己諗法 etc 林林總總嘅說法都係非常之stoic, 但係你會想老咗之後過住經常改變嘅環境,定係咁個地方抖下就算?可能候生有動力嗰陣唔介意去再適應,去experience新嘅野。但係到老嗰陣乜撚野動力都冇曬,到時點樣再去adopt 新嘅環境?(所以係呢度我好撚同情時下被稱為廢老嘅人 i.e. 低學歷,patriotic, 低socio-economic status ...etc。s...

medicine (2) : 死

Image
Waverley Cemetery有Epitaph咁寫 Remembrance   When I die Will you be sad that I have gone, Sad that our friendship has ended, That our talking is over, That we have parted? Remember me. When I die Will you be glad that I lived, Glad that we met, Glad that we enjoyed so much? Remember me. When I die I leave you love and the sea, Friendship and all the loveliness of the world. I bequeath to you, the living, All joy and all sorrow. Have courage always, And sometimes, sometimes, Remember me. 呢排有少少難過,可能fluoxetine 40mg 開始唔夠做,可能效果太好可以帶返我上正軌,諗嘅野又好弔詭地搞到我好難過。雖然話想每日都出到一篇文,但係心情唔好就唔想打字,起碼講少好過講多。 事發幾日之前見到個熟客執藥。Serve佢嘅人唔係我,但係執完藥佢有走埋黎同我嗲兩嘴。 「今日之後我應該唔會再黎。出咗啲事而家唔方便講。睇下半年之後返到黎先再同你講」…「我好慶幸自己養到個仔大,又同媳婦相處得好。一把年紀,都係時候要退落黎。」 出咗乜野事,其實唔一定要睇實驗報告。如果你用心/眼同個人傾計,都會知唔少情報。 講到死,有兩樣嘢讀書嘅時候聽lecturer/professor講過 (thermodynamics, kinetic) 人體好難達到equilibrium, 唯一達到嘅時候就係死嗰陣 (palliative care)做呢行經常都會掂到死嘅topic   Fact 呢類野,嘈黎都係曬時間。不過講到遇死人/就黎死嘅人,當然可以包拋頸到話只係執藥,有幾可會遇到就死嘅人?不過如果你熟藥同diagnosis, 其實同個history就多少都會知道佢剩底幾耐。不過冇再配藥係咪不在人...

想自我增值,take 野增強性能力

Image
藥劑師呢個身份可謂cogito ergo sum。你唔明等我舉個例子 某個客拎部電話show 偉哥張圖問有冇得買 中學生乜野食乜可以令到細佬更勁 熟客問我Cialis, Viagra 有咩分別 煙臭,流曬汗嘅人問我有冇Durogesic 100mcg/hr 賣 有個客帶住個發緊燒,成身又震嘅小朋友問可以食咩藥 有個大隻燥燥地嘅人問邊間分店有Pregnyl 賣 甚至亦都有人問綠色gel capsule 入面係啲乜嘢成份 https://funnyjunk.com/funny_pictures/3329779/What+pharmacists+actually+do/ 呢個世界好多問題,但係冇問題我地亦都冇存在價值。如果你問我做retail 會唔會好悶,好似做麥記咁你嗌我地pack乜,但手腳要快過薯條師。我可以話你知,身邊已經好多個都已經做到好撚麻目,大腦外判咗畀部電腦。 好似 morning after pill/ plan B, 當然你可以話上網睇相關資訊,幾時食得幾時唔食得。但問題係現實都有好多考慮:時間唔允許,又冇private area去傾,變相個問題唔係在於個pharm.想唔想做,而係個環境做唔到好完美嘅counselling,傾就breach privacy, 唔傾就唔competent, 加埋冇時間去傾,可以點?久而久之冇咗個心做嘢,返工等收錢。 上面都只係講緊老嗰批,新嗰批就更加不堪入目。雖然話就與時並進,活係capitalism 下識得用social media去promote自己,但就算係KOL, 都喜歡報喜不報憂,畀咗片面嘅資訊去吸引讀者,究竟係以病人利益為先,定係為自己銀包為先。Well, 一直好強調,有病睇醫生,唔單止因為人地真係professional, 仲有出錢你都可以搵到佢覆卓。 活生生嘅example, 有客show個死人app問我可唔可以買,你話呢? 係連登我都鬧過唔好亂教人食isotretinoin (A酸),但鬧完一排就有另一波討論熱潮,同李小龍vs.泰臣邊個會贏嘅post一樣,永遠都討論唔完。有責任嘅大人/ Healthcare professionals當然會入去屌鳩班友開心share/ 唔同source入藥。不過你期望連登多大人,不會dum多啲期望落波膽仲好。 人類總是重複同樣的錯誤 最後連登好多中醫同怪醫秦博士,加埋豬閪...

Medicine?

Image
尋晚發咗個夢,又見返F字頭個朋友: 返到公司黎咗個新intern,原來佢讀緊medicine,要黎呢度學retail pharmacy點run。  平時黎講,有新intern/placement學生我都會講" I have nothing to teach you, you'll have to explore yourself."因為所有野都唔係飯來張口,茶來伸手,如果呢個世界冇trial and error, 我諗我今日都冇機會打呢篇野。 奇怪嘅係,係夢入面我肯主動教曬佢我識嘅野,其中一樣就係感情。如果只係一部「打打字機」,呢個世界唔需要藥劑師;但係人類就算會think logically, 有時都會被其他野影響到個decision。   (來得快走得更快。 https://www.bbc.com/news/av/health-10959457/how-the-prescription-drug-vending-machines-work ) 所以我返工對客好少帶感情,唔係想hea班客,因為個決定錯影響到嘅隨時唔係一個人。   (有啲藥就係咁受歡迎。google. ) 而另一個原因,好耐以前我係facebook同你地講過我有PTSD, MDD 食緊duloxetine 120mg daily. 或者係根本個psychologist 呢幾年都冇幫唔到我,所以久而久之對好多嘢都desensitised, depersonalised. (我唔怪個psychologist, 冇佢我諗上年隊完樽vodka absolut 就咁走咗。之但係,let's say, 如果係physical lost, 再幾專業都好難幫得到手。)   Generic duloxetine, 兩年前仲有食, 而家食緊Prozac. 由打scripts,接客到decision making 全部教曬佢,as if 個情景大家一樣歲數,但係我兩隻腳已經企曬係棺材。薪火相傳,甚至係想俾曬我有嘅野佢。 雖然只係一個夢,不過就有好多思考空間,尤其係我知佢返緊嘅工涉及therapeutic , i.e. 音樂治療。我唔會否認任何approach 真係幫到手 e.g. 用針灸醫背痛,用中藥去醫dermatitis,甚至香爐灰去醫胃痛都好,你覺得岩駛嘅咪用囉。畢竟evide...