Escapades in Dentistry

New Year's Heave

2010-01-02T22:53:00.002+08:00

yeah, so this is actually on D+1. but heck lah, an update is an update!

looks like im the DO I/C for Singhealth Poly Dental now. the realisation only hit me during a meeting last week, when the exact shitty state of our manpower and leave hit me. i now have to run herd over 10 other DOs of varying experiences and attitudes and aptitudes. and all this in a tight period where even getting leave is hard... part of me is excited about the challenge. part of me wants to run off and do post-grad...

三個心願 - F.I.R.

Boxes

2009-11-23T17:54:00.002+08:00

this blog has probably gained as much metaphysical dust as the possessions i now pack into cardboard boxes to prepare to move to my new house. many things have happened since i last wrote. the housing has been arranged, we'll be occupying my granny's place which will be next to the new flat my parents have. yay en-bloc redevelopment! renovation's halfway through, and through the cloud of dust and random bits of wood being joined together i can see a home taking shape. it wont be a home in the proper sense until we're back from honeymoon tho!

there are some things i hope i can do after everything has been worked out. as with every single list i've ever posted, it never happens that way but it's a fun exercise nonetheless...

1) read every single book on marriage in the family bookshelf before May 1st

2) increase my (negligible) piano skills/flute skills/guitar skills

3) assemble, paint poor little VF-1S model kit that has been gathering dust for years half-completed

4) assemble, paint the massive collection of incomplete minis:

- WOB MD 42nd SD

- Clan Nova Cat Xi Galaxy

- 3025 minis in 4th Ed box set scheme

5) read that implant book that's been sitting on my shelf for the longest time

6) re-read my perio texts

7) start little potted plant eco-garden-in-a-jar thing for my study room window sill

8) sew curtains

um yeah. right. place your bets how much of this is going to happen. i'm prioritising number 1 tho.

Bitter Heart - Zee Avi

Compressions

2009-07-26T22:12:00.000+08:00

time has come for me to wipe the dust off this blog! for those of you who actually bother to read this darn thing and don't have me on FB/meet me in real life, i would like to broadcast the following:

on 170709 i became engaged to the love of my life. we intend to marry in the middle of next year. and a week after the proposal, i'm still feeling pretty high!

Dental Reflections 015

2009-05-13T10:25:00.002+08:00

the patient came in complaining of a dislocated jaw a few hours ago. the occlusal disturbance and head of condyle bulging out of position were obvious to see. after some sweating and straining and cursing i managed to stuff it back in.

not 5 minutes later, as i begin to treat the next patient, the patient comes knocking on my jaw saying he's popped his freaking joint out again.

by this time, my thumbs are hurting like heck, and as i attempt to stuff it back in i find myself struggling to find the strength to do so.

in the end i have to scream for help and Raymond stuffs it back in within a 10-second attempt. we then bandaged his head to keep the darn thing closed.

i wonder if he'll be back? sian...

Dental Reflections 014

2009-04-25T22:40:00.004+08:00

i guess wall-of-text posts can be quite dry. here's something a bit different.

just the other day we had a walk-in. c/o pain q2. there was some pretty extensive FP work in place, with #16-#25 as 2 bridges. #26 was unrestored, and what i tentatively labelled as #27 had the weirdest prosthodontic restoration; it looked for all the world like a pre-fab temp crown and yet had been left as a permanent restoration for 20+ years. it was in fact older than the rest of her FP work, although it was done at the same clinic. as it was tender to percussion and the patient wasn't too keen to dis-ass it and kiv RCT, i took it out there and then. sorry, no clinical pictures. what i have for you is a series based on what i did the next day during lunch time.

*note: the pics i uploaded are too damn big, please click to see until i can fix them*

quite a sight, isnt it? i actually asked the patient which village in china she did it in. apparently its called 'bukit timah'...

here's the buccal view. i support my claim that this was a pre-fab item made in tin or aluminium by the fact that my claw forceps could put that dent into it that you see at the gingival margin.

it even has a seam line!

a root view to let you see once again the magnificent overhangs. and just imagine, they were equigingival clinically... that weird lump of meat near the palatal root is some granulation tissue.

the suspected caries were just away from the forceps, at the distopalatal...

so i proceeded to put a bur to it...

the soft, cheap-ass metal yielded easily enough. the luting agent underneath was impressively thick, and still mostly white.

i continued to hack around the temp crown...

after prying the sucker off with a combination of ultrasonic scalers and violence, here's what it looked like. i was at first thinking that the cement may have been ZOE but it was hard as heck. might have been ZnPO4.

here's another view

i found big-ass root caries, which was probably what led to the endodontic infection

much easier to appreciate when dry.

at this point the smell was really getting to me and i chucked all the stuff. the one thing which i forgot to show about this? there was no evidence of caries or restoration of the coronal structure under all the cement!

so... why the heck did the dentist do what he did and leave it that way? i think the only possible answer is that this was in fact #28, with the #27 extracted and drifted forward. the temp crown may have been placed simply to fill the interdental space. with all that ZnPO4 within the confines of the temp crown and locking into the natural coronal bulbosities, the temp would have stayed in for all those years, while the overhangs made it impossible to do any form of proper hygiene maintenance...

Bob Lennon - Urasawa Naoki

Dental Reflections 013

2009-04-07T22:18:00.003+08:00

i guess it's a reflection of the current state of the economy that i should be talking a bit about how the government funds its dental services. from the complaints lodged in the papers, it would seem that the people expect the Ministry to be something like Santa Claus, giving away good, cheap stuff and quickly too. i'd also like to clarify that while i am on a Ministry bond, i consider myself a healthcare practitioner and not a civil servant in the usual sense.

most people know that i despise the assumption that one can get cheap fast and good in one package. this is no different.

the way i understand things work, the government gives the polyclinics a certain allotment of money to fund their activities. whatever fees the polyclinics charge goes into supplementing this yearly budget to fund their operations, manpower and logistics costing.

polyclinic dental services are no different. grant costs must fit with takings to keep the dental service in the green, despite the higher materials cost and slower consult times that dental management requires. manpower and supporting infrastructure is also much less.

where does that leave us? a recent spate of letters to the forum sections has been bemoaning the long queue times that are needed to get a dental appointment. now, here's a thought. why are we so fully booked? i believe a lot of it has to do with our fantastically low prices. where else can you get an enthusiastic idealistic young DO to do a SAP for $25.60 that's worth $70 in the private? and if these people can't wait, why not head out to the private? are the dental polyclinics so saturated?

imagine another scenario. every single one of my appointment slots for 6 months is booked solid with the patients i have seen before, returning for 6/12 hygiene reviews. thats... 2000 patients (a nice round number for illustration). we have 10 chairs in SHP. that means we can theoratically saturate at 20000 patients in the whole of the south to east side of singapore. lets throw NHG into the mix. imagine... they have 20 chairs (illustrative, i havent collected the stats) which means they can see, what, another 40000 patients? this brings us to a total of 60k patients. one can appreciate that this represents less than 2% of our 4mil singapore population. even considering our huge database of defaulters and one-off attendees, we'll never be able to cater to more that 5% of the people of Singapore at once.

so now how, you ask. oh great rich and prosperous Santa Claus Zheng Hu, what will you do for us? to increase our dental staffing means a need for personnel, infrastructure and logistics. this all costs money. dentists dont grow on trees, neither do dental chairs. so... where can we get this cash from? there is only one place where governments primarily fund their activities. this is tax. how much do you want to raise the income tax and the GST to give us this supposed cheap treatment? GST at 15%? sky-high income tax? is this fair to tax the general populace just to pander to the whims of the few? and when the tax rises to an unfair level, wont the rich people and the businesses run off and take their money elsewhere, leaving us poor slobs to die for our selfishness?

what is the other way to make the queues shorter then? if money can't be touched, what can we sacrifice next? quality. its very simple. shorten the appointment times, or double-book the slots. so what if you force the DOs into situations where they have to do incomplete scalings or crap-ass ugly CRs? the patients are being seen! oh joy! never mind if they come back with dropped fillings or periodontitis because we missed the calculus or had no time to give OHI. they wont know the difference.

bollocks.

someone needs to stand tall and decide what they want out of our polyclinic dental services. do you want us to truly care for our patients? then restrict who can see us so that we can truly serve them. do you want to cast your net wide and still have short queues? be prepared for complaints about shoddy quality. you cant have all 3 factors, you cant have your cake and eat it.

School Ties

2009-03-01T22:27:00.003+08:00

i did something a bit unusual for a sunday morning today. i put on a white shirt and work pants instead of the usual jeans and polo shirt. and before i stepped out of the house i put on a school tie.

why in the world, at my age, having left school for so many years, would i still want to remember Founder's Day? i've talked at length in this blog before about what i owe this school in terms of opportunities, education and friendship. in terms of learning not only about the things in books but of life and how to live it. in terms of how to conduct myself as a scholar, officer and gentleman. this is nothing new.

no, i wear my tie lest i forget the goodness of my God to me through my school. without this school, founded 123 years ago, i would not be where i am today. and without my God, my school would not have been able to shape me in the way it did.

God save our land and heaven bless our ACS forever!

The Anthem - H.M. Hoisington

Getting Away With It...

2009-02-07T23:30:00.003+08:00

its been a while since i've posted on non-dental matters. after today's lunch i felt it in the public interest to blog once again about food.

as one grows older and perhaps more financially carefree, ones ability to eat at fancy schmantzy restaurants also increases. i had previously discovered the joys of really good raw fish at Sushi Yoshida and Tatsuya, and also found a pretty decent quality and volume mix in Wasabi Tei. this also led me to stop eating at Sakae Sushi (pronounced suck-ka-ey btw), because there are some things you just don't do to nigirizushi... like put cheap-ass fish on it and send it for a long trip around the konbeya beruto until some poor sap picks it off, dips it in overly-hot wasabi stirred vigorously into his shoyu and eats it without an appreciation of true flavour, feeling so happy to eat weakly-flavoured fish with its taste deficiency covered by a strong sauce mixed in a way that actually causes its main ingredient to spoil.

this lunchtime we went to Sushi Tei at Ngee Ann City. we were hoping for at least decent food at reasonable prices. for mains i went with the Yakitori Bento and Peijun ordered a Sashimi Salad. we also threw on a double serving of Salmon Belly Aburi Sushi, and a Hotate thingy-with-cheese.

my Yakitori Bento arrived first. competent but unexciting, the chicken was tender and flavoured by a sauce and sliced onions. i was in fact counting on this to be a filler so that i could cheap out instead of having to stuff myself up on sushi. and unfortunately this was the most successful dish of the lot, in my eyes. Peijun rejected her salad because the lettuce bits were a most suspicious looking brown. and we witnessed a kitchen staffer take over the rejected plate, pick some pieces of fish and leaf off and chuck them, then glad-wrap the remaining salad and put it in a fridge. please tell me you like Sushi Tei now... the Aburi Sushi was cold and not terribly good (whats the point of turning a flamer on your sushi if you can't get the contrast of cold rice and warm fish right). the Scallop? an unbalanced overly-strong cheese on inconsisted shellfish (one piece was soft, one was hard).

i think i'll save my money and spend it at Tatsuya. rare but treasured meals are more worthwhile than cheap and unsatisfactory ones. fare thee well, Sushi Tei, your old standards have fallen.

Seishun no Tobira - Ikimonogakari

Sunny Side Up

2009-01-28T12:26:00.002+08:00

xin nian dao! and with it new blessings and problems... from crisis comes development and strengthening. and from crabs come tomalley!

on the way back from lunch we were discussing the concept of sick leave. please note that the thoughts recorded herein are mine and may not reflect the actual prevailing legal or ethical standards of employment in my country...

1) Sick Leave is a Privilege and not a Right;

2) Whereas Annual Leave is a Right provided for in the Contract of Employment allowing for the Employee to take leave of absence from his work place (subject to certain conditions as laid out within said Contract),

3) Sick Leave is contingent upon the Employee having taken ill or requiring a procedure

3a) to a degree at which a licensed Medical Practitioner or Dental Practitioner deems the Employee incapacitated and unfit for work

4) This does not happen every day, or at the whim and fancy of the Employee!

5) Furthermore, if there was no difference between Sick Leave and Annual leave, why would HR go to all the trouble to separate and differentiate the two? Sick Leave and Annual Leave would thus have been combined under a single administrative umbrella.

6) In conclusion, Sick Leave is a Privelege awarded to the Employee to provide for rest and recovery during periods of convalescence, while allowing him to take the same amount of entitled Annual Leave as other employees.

6a) It is NOT for extending your holidays!

CrushCrushCrush - Paramore

Dental Reflections 012

2009-01-08T13:42:00.003+08:00

i really think this is something i dont update enough. inertia and ennui get in the way of me sitting down to type out things, reflect on actions and improve my approaches.

today i saw the results of questionable management. it was a situation which, when presented to me, was something that i found myself unable to cope with and had to urgently refer. and it is because that situation may have been preventable that i want to blog this out, to settle mind and emotions.

the patient first presented to us on 070109, c/o pain q3. NRMH, NKDA. in addition to the poor oral hygiene status, assorted caries and a root stump, #37 was deemed to be non-vital with an acute suppurative apical periodontitis. due to the buccal swelling, the practitioner who saw the case decided to prescribe antibiotics and painkillers and gave a 2/52 return visit.

the patient returned the next day, with the pain unrelieved and the swelling even bigger despite the prescribed medication having been eaten.

o/e: L buccal swelling, of a doughy consistency and extremely tender to palpation. there was trismus, preventing insertion of 2 finger-breadths. intraorally, the sulcus adjacent to #37 appeared raised and hyperaemic. #37 was impressively carious, the entire buccal aspect was missing to a subgingival level.

my approach was to attempt an extraction kiv i&d. the patient was progressively wedged open with a rubber mouth prop (no gag-prop available to crank him open unfortunately) and periodontal infiltration was delivered to the tooth, followed by an attempt at an IDN block, which was not successful. anaesthesia was however sufficient to attempt extraction, and despite the remaining lingual coronal structure shearing off the tooth was elevated and delivered in pieces, completely.

this is where things didnt run the way i wanted them to. there was no drainage from the socket, even after curettage. there was no obvious fluctuant point in the sulcus despite the apparent raising, and so for a shot in the dark i went for an incision at the buccal of #37. no pus, no joy. the patient was then referred to a nearby hospital with oral surgical facilities for immediate management of the abscess.

what is the surgical lesson to be gained here? our professors and texts left us with 2 excellent principles. firstly, the surgeon's best antibiotic is his scalpel. secondly, do not let the sun go down on undrained pus! i believe that both these principles were breached in giving antibiotics and a 2/52 return date. extractions can and should be carried out in the presence of swellings. these prevent a dento-alveolar abscess from turning into a facial abscess and a dental emergency from turning into a possible medical emergency. while it is not entirely clear that, given that i could not achieve drainage today, drainage may have been achieved yesterday, it sure as heck would not be raising questions in my mind if the tooth had been removed yesterday while the swelling was still small. it may well have saved the patient a trip to the hospital...

Dental Reflections 011

2008-12-13T17:02:00.000+08:00

now for a little ramble on everybody's favourite dental hard tissue lesion, the non-carious cervical lesion!

scourge of all honest dentists, NCCLs of varying shapes and sizes can be found in just about every mouth. NCCLs as a lesion also have various aetiologies and thus serve as diagnostic indicators for complex problems in the mouth. a lesion is after all part of a complete disease process...

the NCCL can be generated by factitious means (overbrushing) as well as from occlusal overloading (bruxism), while their appearance can be modified by acid erosion. the key is to be able to identify each possible cause, and to link them up into a total treatment plan.

the NCCL of overbrushing is by far the most common type of NCCL. sheer chronic traumatic brushing force will over time cause gingival recession. the denuded root surface is then worn away by the same chronic brushing force, creating smooth-surfaced depressions in the root dentine. enamel may also be lost due to an undermining effect, but will have a smooth surface.

the NCCL of bruxism is a rarer lesion. current theories point to loss of the enamel and later dentine at the CEJ region due to flexion of the tooth under parafunctional loads. the lesion will have a well-defined wedge shape, and the coronal margin at the enamel will have a sharp edge. this lesion, seen early enough, will actually be bounded by enamel, unlike the overbrushing NCCL which begins in dentine. later lesions will, due to increase in size in an apical direction, have their gingival margins in dentine, but will once again have the classic sharp edge to the enamel border.

Acid erosion modifies the shape of the NCCL by eating away at its borders. the coronal edge is more affected, possibly due to the higher mineral content of the enamel. the effect is a dramatically wide lesion with reference to its coronal-apical dimensions, with an enamel involvement often 3mm or more in height. the surface is smooth and gives the restorative dentist headaches in trying to figure out how to place a bevel for his composite.

in the whole scheme of things, aetiology will lead to diagnosis, diagnosis will lead to treatment planning, and then on into review and a re-planning if necessary. it goes without saying that all 3 conditions identified should be dealt with.

overbrushing can be dealt with, first by education and then by devising a monitoring system. education for me would consist of actually getting the patient to stick out his hand so you can demonstrate on his skin/thumbnail what adequate brushing pressure truly means. once the patient has been told about soft toothbrushes, he is also informed that he can self-monitor; he will still be overbrushing if his toothbrushes spoil rapidly or his new restorations have been rubbed away by his brushing. this also incentivises the patient by empowering him to take care of his own condition.

bruxism is of course a much more tricky proposition to deal with. splints and such are by no means simple things to manage, and given the complex, multifactorical nature of the bruxism syndrome, referral is always a viable option.

acid erosion will require a careful review of dietary intake. acid erosion from dietary sources tends to lead to NCCL aggravation, whereas acid reflux from GERD or bulimia will lead to erosion of the palatal surfaces of the teeth, especially the upper anteriors and first premolars, and the 2 problems could of course also come superimposed. it is also a given that what the dentist considers acidic and detrimental to dental health a patient may consider a normal part of his diet, for example an orange every day as an afternoon snack or grapefruit juice with the breakfast. modifying of behaviour as opposed to banning may be more effective in the long run, as a patient may be more willing to listen if you tell him to rinse with water and apply Recaldent as opposed to being faced with a bleak future containing no lime juice after his lunches.

once the aetiologic cause has been at least initially addressed, the dentist can consider the question of restoration. i personally take a conservative approach to restoring the NCCL. if the lesion's cause has been dealt with, they will of course not get deeper, and restoration becomes option if the lesion does not trouble the patient aesthetically or via sensitivity.

most of us have been at least cursorily trained to deal with NCCL lesions using direct restorative materials, including the whole tooth-coloured restorative spectrum of composite resins and glass ionomer resins. other options, although now out of vogue, include amalgam and direct gold. a further consideration of an indirect restoration, for example CAD-CAM ceramics or even an indirect composite resin, were mooted over dinner with some friends but i have yet to try these or even heard of these being issued to a patient as of yet.

direct restoration of the NCCL faces a few challenges. the first is crevicular fluid, possibly compounded by blood in the case of the gingivitis patient. the second is aesthetic considerations with colour and contour, having to match the colour of both the coronal enamel as well as the root dentine. the last are the mechanical and chemical challenges faced by the restoration with respect to the aetiologic factors which created the NCCL in the first place.

crevicular fluid, flowing freely from the sulcus of an inflamed patient, is the bane of the restorative dentist. either the material must be able to handle the presence of fluid and its challenges to the material as well as its bond to tooth structure, or the dentist must be able to practically, if not absolutely, eliminate the crevicular fluid. for the first option, glass ionomer is the usual favourite option. while the material handles crevicular fluid a whole lot better than its other tooth-coloured alternatives, bathing it in crevicular ooze or blood is an invitation to failure. it may in fact be best to scale the patient, institute OHI and chemical adjunctives such as antibacterial mouthwash, and return to the problem in a few weeks when the gingiva is more willing to behave. this is cold comfort for the dentist faced with impatient patients or long intra-visit times which he can do nothing about. a second option mentioned by a colleague was an on-the-spot laser gingivectomy; laser ablation of inflamed and overhanging tissue, with its attendant cauterisation, would help greatly in terms of relative isolation of the lesion.

how does one choose shade for an NCCL? match to the coronal enamel, match to the root dentine, choose a happy medium, do a 2-colour build-up? there is no safe answer for this, as every aesthetic situation varies. this will become a major pitfall if root dentine colour varies greatly from coronal enamel colour, especially if there is exposed root on adjacent teeth which is not to be restored. long bevels on the coronal enamel are a great help when trying to achieve a colour match in an unfavourable situation, or if the edge of the NCCL has been back-stained by dietary content, when using a composite resin; the opacity of glass ionomer generally provides much more colour masking at the risk of an opaque and obvious restoration if colour match is sub-optimal. contour is also critical; a flat restoration is un-natural and may trap food. over-contoured restorations, on the other hand, will stick out and look 'pregnant' and unaesthetic. adequate contour helps to hide the restoration as well as provide a more 'self-cleansing' shape that will aid hygiene. good fine diamonds are critical for this.

finally, not every material is suitable to every NCCL. glass ionomer beats composite resin flat in terms of flex resistance, which will be critical in the stress-fracture NCCL of the bruxer. conversely, in acid environment or when faced with mechanical trauma from overbrushing, composite resins will perform better. when conditions with varying requirements coexist ot create an NCCL of multifactorial aetiology, simplify your problem by eliminating one cause first and restoring in a manner to suit the more intractable problem.

once the NCCLs have been restored, the dentist must be able to evaluate success. the restoration now becomes a diagnostic indicator of the success in eliminating aetiology. if, despite your best efforts in restoring, you notice the restorations disappearing in months, obviously something is wrong. perhaps your overbrusher has not taken your OHI to heart. perhaps your bruxer hates his splint. perhaps your dietary acid patient has fallen back on his usual comfort food without the hygiene behaviour modifications that you prescribed for him. in such a situation, reevaluate the causes, your aetiological control measures, and then re-restore the patient so that your monitoring devices are back in place!

The Little Flowers By The Roadside

2008-12-02T08:49:00.002+08:00

i think that as a nation, we don't stop and stare often enough. there are times when we rush through life and fail to see the gradual changes around us. the blooming of the wild orchids in the trees on the way to the bus stop. the lizard scurrying on its way to the next tree. the pigeon squashed on the street. the neighbourhood kids who have grown up and gone to university. the way the wanton mee uncle flicks his scoop. sometimes one need to find time in the whole rush of life to breathe a bit.

here's a little poem:

"What is this life if, full of care,
We have no time to stand and stare.
No time to stand beneath the boughs
And stare as long as sheep or cows.
No time to see, when woods we pass,
Where squirrels hide their nuts in grass.
No time to see, in broad daylight,
Streams full of stars, like skies at night.
No time to turn at Beauty's glance,
And watch her feet, how they can dance.
No time to wait till her mouth can
Enrich that smile her eyes began.
A poor life this is if, full of care,
We have no time to stand and stare."

W.H. Davies

*note: this whole entry does not apply to accidents on expressways! please drive on!*

Quando, Quando, Quando, Quandary

2008-11-27T09:36:00.002+08:00

its kind of surreal when bits of your ancient past show up in unexpected ways in the present. today a patient came in for 6/12 carrying a book by Benoit Mandelbrot. i never actually knew that he was doing stuff on markets, although his chaos theory expertise makes so much sense given the unpredictability of stock markets. and if Mandelbrot-sama is writing on such a topic, it makes it more than obvious that market behaviour will truly be impossible to predict with any accuracy over any significant stretch of time...

*for those of you i lost along the way, here!*

http://en.wikipedia.org/wiki/Benoit_mandelbrot

http://en.wikipedia.org/wiki/Mandelbrot_set

Dental Reflections 010

2008-11-04T14:56:00.002+08:00

the fine art of examining a scientific paper was emphasised to us during an excellent paper review yesterday. the topic of the OS Journal Club session was guided bone regeneration and membranes, focussing on the PhD paper of a particular oral surgeon in his quest to understand the importance of membranes in guided bone regeneration. one of the salient points brought up was that the PhD student's research was done on rats, whereby he had to hack up a whole bunch of rat mandibles. time consuming surgery for sure, especially in such a tiny, fiddly, smelly animal model. his conclusion was that for block grafts, at least, while the placement of membranes did not give a significantly better result in terms of graft outcome, the smaller confidence intervals for the membrane group once he plotted his stats indicated that he would still like to put in his Gore-Tex for his grafts.

this was picked up on by members of the floor; Gore-Tex has its own little problems. while much more able to hold its shape that the equivalent collagen membrane, once a Gore-Tex membrane gets exposed infection (and loss of the whole chunk of graft) happens very rapidly. post-op infections seem to correlate to size; the bigger the graft area, the bigger the Gore-Tex, the larger the area of flap which will not benefit from vascularisation of the graft region (due to the interposed Gore-Tex barrier) and hence the higher the chance of failure. this was practically eliminated in the 5mm diameter defect and graft sites in the rats. the differing immune and wound healing physiologies were also mentioned as significant, with a pithy quote from Prof Henk Tideman to sum it all up. questioning the over-reliance on animal experimental models, he said

'...you can put poop in a dog and it will still heal'

indeed...

The Old Man And The Sashimi

2008-10-08T10:14:00.003+08:00

food review! the eatery du jour is Wasabi-Tei, a little (and i do mean little) japanese diner on the 5th floor of Far East Plaza. once again a surprise find from HungryGoWhere.com, we decided to head over to get some japanese food for comfort purposes.

Wasabi-Tei has a reputation for being run by a tyrant of a chef, who has a peculiar way of taking orders, but who creates amazing food which generates quite a crush of people. with this in mind, we arrived about 15min before opening time (1715hrs) and were first at the head of a queue which slighly overflowed the eatery's roughly 20-seat capacity by the time the doors opened. the excess people were left quietly sitting outside.

layout of the eatery corresponds to that of your average sushi shop. the chef's main work area is in the centre of the floor, with a bench all round. once customers are seated he is effectively locked in, much like an Elizabethan thrust-type stage. from here he and his wife command the floor. orders of food are taken first, from left to right, then drink orders. there is a strict rule of ordering everything at first instance, else a fee of 20% of cost is levied on the 2nd order. drinks are factored into a $2 'occupancy' charge, unless you want booze. Ocha is of course free-flow, and very hot.

a standard-issue starter of stewed chicken and wakame was plonked down in front of the whole eatery. while some food reviewers were over the moon with the starter, i found it pleasant enough but nothing to write home or scream oiishi about. a rather homely flavour which relaxes you as opposed to a knock-your-socks-off overture kind of starter.

next up was an Una-maki. here our opinions divided. the una-maki was cut in to 4 big, chunky sections with the unagi spilling out the terminal ends for visual effect, then piled on a small dish with a bit of pickled ginger and wasabi before special-secret-keroppi sauce was dribbled on (for those who understand the reference, a pat on the head for you!). i liked it. big-ass pieces of unagi, soft and tender with a sauce to modulate the potentially overpowering fishyness that unagi occasionally suffers from. minus points for incompletely slicing the nori between my pieces, requiring me to tear my makizushi apart. a ruptured maki is a tragedy... PJ found the sauce too sweet, and was not terribly impressed with the way he plonked the unagi pieces on the dish before getting the rice ready for rolling.

next up was a teriyaki salmon set. a slab of salmon, accompanied with shredded cabbage and salad dressing, pickled cucumber and a good old bowl of miso soup on the side. huge serving. and i say it again, it was big! i liked the done-ness of the salmon, altho the skin was a bit charred, resulting in PJ removing it from circulation.

the last item ordered was a Gyu-jyu. beef on rice in a laquered square box. honestly, while the beef-and-garlic concept was a good change from the usual beef-and-sauce type of gyu-don/jyu thingy, it was a little bit on the stringy side. anathema to she-of-the-active-ortho. i got a glimpse of the chirashi-don as i was eating this. similar box, intimidating mound of fish. i so want that the next time i go.

and so... in summary:

Jon - yesyesyes! want sushi in servings big enough to hurt when thrown! wantwantwant! surly service and small seats are a small price to pay!

PJ - nothing to write home about

Changin' - Stephanie

Senseless

2008-10-02T21:17:00.003+08:00

there are times when the impetus to put finger to keyboard just strikes, inexhorable and irresistable. sometimes this is in the face of great tragedy. other times great joy. other times the understated simplicity of a flower in bloom or the smile on a patient's face will create the stirring in ones heart to write. and for me, it was rediscovering a Koda Kumi song on JPopAsia.com...

people ask me why i listen to music in a language i don't understand. it's usually surprising enough for them when they find out my preferred channel is 93.3, and when they find out it's because im actually hoping for the occasional JPop song to hit the airwaves, the mystery deepens.

my greatest moments in music have been as a musician. i believe in the power of the melody, the communion of the chord progression, the rage of the rhythm. to me, what are words next to the sheer depth of emotion that music, unfettered by the speech of man, can evoke? an encumberment at best. listen to Holst's Planets and Rach II. words? words fail us, as they often do in everyday usage. best to sit back and let the music hit you, soak deep into your being and speak directly to your spirit.

and that is why i like JPop. the chords speak to me too. they call out to me in ways the white man's songs, or that crap which people term as R&B, never will. the melodies speak of a world of ways strange and familiar, and its rhythms seem to lift my feet forward.

JPop. it just is.

Moon Crying - Koda Kumi

3

2008-09-25T11:02:00.004+08:00

its really been 3 years! 5 of knowing her, 3 of love, and many more to come. despite all the difficulties i have grown to love her more and more, her little idiosyncrasies and peculiarities adding charm and humanity to a wonderful person.

and with that background, here's a food review for the anniversary dinner!

Dozo is located in Valley Point Shopping Centre, away from the orchard crowd somewhere in the River Valley area. i got to know about it from the ever-useful hungrygowhere.com portal, where it had garnered 16 straight positive reviews on the strength of its service.

they really weren't kidding. my reservation was for 6.30 but by 5.30 me and PJ were already starving, so we toddled down from Orchard after doing some essential shopping. arriving 15min early, we inquired as to whether we could occupy early. the staffer immediately ushered us in. the restaurant's culture is one whereby all the waiters and waitresses are warm, friendly and joke with the guests, be in when introducing menu items or serving the food. they also aim to give best service. when i made the booking, the person taking the call asked if it was a special occasion. the resulting exchange of information yielded a little cake with a candle on the house. high marks for service, these guys are deliberately aiming to deliver.

the dinner (which is after all the point of the whole exercise, ja?) is organised as a set menu costing $58+++ for a dinner or $38+++ for lunch, sans the starter. diners get to choose the appetiser (starter is fixed), soup, entree, main, dessert and drink. the menu choices are also rotated every 3 months to keep things new and exciting.

the starter dish was 3 very small, chic-looking bite-sized things which were honestly very tasty but i'm not quite sure what they were. i do recall a grilled scallop with a sprig of asparagus and what seemed to be foie gras on a piece of toast.

for appetisers, i had escargot and PJ had her a foie gras chawanmushi. the escargot was acceptable, i guess. the concept was to subvert the usual garlic butter paradigm by making it a teensy bit like an oyster mornay, ie drowning it in cheese. i like cheese more than i like oysters, to be honest. more cheese for the escargots would have been nice. PJ's chawanmushi was a source of unexpected amusement. it actually, in all honesty, smelled like wet dog. not unpleasantly so, it was more like a small happy dog which had been caught in the rain while on walkies rather than a Hound of the Baskervilles type of smell, but still wet dog. and it tasted like... chawanmushi with bird liver in it. tasty, but nothing to make faces like a japanese food vlog.

soup was a cream of mushroom with black truffles and a seafood bisque. i dont know whether its my philistine tastes, but the seafood didnt quite agree with me. too much of the crustacean-type umami, and perhaps a little too much grog thrown into the soup stock. more cream might have modulated the flavour well. the mushroom was however good. coarse-blend mushroom bits for extra goodness. not quite sure why truffles are so hyped tho...

next up was a beef carpaccio for me and a crab salad for PJ. the carpaccio was a bigger hit with me than it was for her. the external surface of the beef appeared to have been lightly cooked before being thinly sliced and went well with the flaked parmesan and crepe. i think i would actually have been pretty happy to eat something like that (in 3x the quantity) for a light lunch. the crab salad was however a bit of a hassle; while the claw had been cracked and a section removed for access, it still required some dissection.

i had the beef steak for a main. consisting of medium-rare sliced beef on a very very hot granite stone, this seemed to be the best item of the night. one could cook each individual slice to preference on the hot stone, protected by a leaf, and few things make me happier than beef. Peijun's cod was decent enough, but by this time she was beginning to feel stuffed, and eating the cod became a bit more of an exercise. the pairing of cod with some filo pastry did assist in lightening the usually heavy flavour of the fish.

dessert was a hot chocolate cake with ice cream, and a green tea creme brulee. both competent, but nothing to write home about. and of course, the surprise little cake to end the evening!

so to sum up, excellent service, okay food. nice ambience, although going early means its quite quiet. it seems more like a girls night out kind of place, where the waiters can be cheeky and the small serves will fill up petite young ladies...

Lion - May'n, Megumi Nakajima

The Fine Art Of Annoying Your Dental Practitioner

2008-09-12T17:04:00.003+08:00

or: how to piss me off.

its actually quite strange how patients can find new and inventive ways to piss off the dentist. its not the cleverest thing to do really, to antagonise the person who will be placing sharp objects into your head in an effort to fix things gone wrong in your mouth.

1) say the word 'cheap' more than 2 times in 20min
-yes, i really do like being reminded of how amazingly low i charge in the government service, and how good that makes me feel about the quality of work vs its monetary value
1a) say the word 'expensive' more than 2 times in 20min when i try to refer you, or in reference to the last dentist you saw
-see above

2) address your dentist as 'Mr' instead of 'Dr'
-especially when i specifically introduce myself as Dr Ee. are you deaf, rude or inattentive? we've been 'Dr' since the 1980s in these parts, mind...

3) inordinate squeamishness towards dental treatment
-grow up. please. the days of low-TLC dentistry ended with the last generation. we treat patients well... until they anger us.

4) strange noises during treatment
-some describe the noises as sounding constipated. some describe them as tortured. i really don't want to hear things when im trying to deliver an injection, clear your decay or clean the crud out of your gums.

5) keeping quiet during treatment and then filing complaints with the Clinic Exec after
-why not just tell me before i do things and save us the trouble? if you don't want something, opening your mouth and keeping still is in fact implied consent. so yes, please... don't be an idiot.

6) show a lack of attentiveness when the dentist explains treatment/brushing technique
-these days we work on a basis of information and trust. you must must must must understand what it is that we do. we are only legally empowered to advise, not to dictate. for goodness sake, pay bloody attention when i talk to you. and 'you decide lah' is not an acceptable answer, it reeks of a lack of responsibility.

7) knock on the dentist's door or barge in demanding to be seen when it isn't your turn
-if you can't do this in an ATM queue when drawing money or at HDB HQ when applying for a flat, what makes you think it's acceptable here? and do you really want to piss off the person who will be putting sharp objects into your mouth?

8) act as if subsidised dental treatment is a birthright and not a privilege
-really, if you can wear good clothes, nice shoes and a decent watch and carry a leather wallet with money in it and a credit card and yet complain that $60 2 times a year for scaling in the private is too expensive, what are you actually telling me? thats less than 50 cents a day across the year, for your information...
8a) act as if getting fast appointments is a birthright and not a privelege
-yes, we really are booked up for 3 months solid. welcome to government service! no amount of whining or threatening the Clinic Exec will change this fact, or our desire to honour the appointments of those who came before you.

so yes, 8 ways to piss of your dentist. this is of course not exhaustive. feel free to drop me suggestions so that i may add to this list.

Dental Reflections 009

2008-09-02T09:43:00.004+08:00

so heres one which is a teensy bit off the clinical and more into the philosophical.

what exactly is the relationship of the practitioner to the patient? what is it that patients expect from us, and we from them?

this was sparked after lunchtime discussions with Boss K about our ever-beloved FON patients and their weird ways. the main point here being, why in the world would a patient want to kick up a big fuss and aggravate the very people who they expect to treat their illnesses? we've all seen them in various forms wherever we practise... the Geylang Door-Knockers, the people who get the NDC patient-service 'bomb-squad' down on practically every visit, the nasty parents at HPB. and yet, these people come back again and again and again to our clinics despite having made their unhappiness very unclear. lets be honest; we're not the only dental practice in town. there is an abundance of dental treatment available to the population, from the back-lorongs of Geylang to the high towers of Orchard Road. some even go across the causeway on occasion. but yet the problematic people still return like homing pigeons. is it the excellent (for its cost) service we provide? the ability to break a young ego and spoil his day? or is it the fact that we're inexpensive?

i think that something should be done about this. we should be able to perform our services, get thanked for it at the end of the day and not have to worry about verbal abuse or getting stalked or complaints being forwarded to the boss for doing treatment in a manner consistent with modern standard of care. we should not have to have patients complain about rising costs of dental work when they live in condominiums and have nice watches and gold jewellery. we should not have people barge into our rooms demanding to be seen as walk-ins for loose teeth when the periodontal damage was already done 10 years ago. and we most certainly should be appreciated for heroically scaling the severe periodontitis cases instead of getting scolded or complained about because they feel sensitive when their great walls are being broken down. we should be allowed to blacklist nasty patients from our clinics, and to share this information with the other polyclinics if necessary. people who abuse us and want to play the system for all its worth do not deserve to benefit from healthcare in the public sector; their selfish interference in fact decreases efficiency and drives up running costs. i already suspect that healthcare bleeds a huge chunk out of the government budget. people should pay for their dental work so that more money can be turned to education and general medicine for the terminally ill.

and as an aside, i hate it when people call my treatment cheap. it makes me feel cheap. i do the best work humanly possible under the conditions. but the public thinks dental work is like buying refrigerators or cars; compare the price tag and buy something cheap. how clean they end up after a scaling is not important so long as it's 'gentle'. they'll never see the subgingival wall, anyway, and all that matters to them is that the black spots have been removed...

Cast Iron

2008-08-11T21:00:00.003+08:00

i think i must be getting a touch of the emo, if things like this can hit me harder than they should. after 2 weeks of faithful support, hearing unsavoury and inaccurate things about myself is a slap in the face. but then again, what's there to expect. i went to do a dirty job, to be the enforcer/bad cop/hatchetman that noone was willing or wanted to do. what more can one expect than misinformation and malice?

the news came to me as such: a certain classmate of mine was conversing with a junior on All Night Long. and in the course of discourse with this year 2 she was told by said junior that there was this year 5 called Jon who kept coming down every night, and made the juniors sing and sing and sing the anthem until 11pm.

[rant] half-truths are the nastiest lies. yes, i was there every night. i think that the year 2s in general deserve some support. its not like the old days when things were convenient to make visits, now that they've been plonked in the parking lot far away from a faculty which, due to the unthinking and misguided actions of a few successive years of infantile iconoclasts, has been unable to show the level of support that they could in the old days. now, only a few seniors pop by for fly-bys and don't really stay to get to know the new colleagues-in-the-making. frankly, its easier to talk to the year 2s than the year 1s, which is what i've mostly been doing. the Ballman, FOC head, various dance ICs... either getting to know them a little bit better, or even in one case having a deep discussion that i think did both our souls some good. but to imply that to kick the asses of dysphonic juniors was my only activity or reason for coming boggles the mind. its tiring, dammit! its tiring to show up every night without rest, to stay back and talk to people and find out how they're doing and craft words of encouragement for each and every one of them personally. i could well have not given a rat's posterior about orientation. lets face it, who does these days? who cares about the company of dirty children playing at construction worker in the parking lot far away from one's immediate area? the sponsors for sure, and they have every right to be there. but respect also those who give, not of money but their time. by not understanding the heart of the people who show up for you, you spit on their charity, the precious time which they have given which you cannot return to them. and in so doing, you show your lack of manners. it is this same paradigm shift in attitude which drives your seniors away from visiting you, it reeks of a foul egotism which cannot be allowed so early in your career.

by exaggeration, you also show either a poor memory or a lack of integrity. i did not make them sing every night, although the singing was... *searches for a kind word* sub-par. i wish i could have done so, but it was not meant to be. and to say that i held them back from going home on time, up until 11pm every night? you bare-faced liar! they were dispersed far and wide before eleven, possibly an good half hour earlier on most nights, and i only pushed the song, what, 3 of the 8 nights before All Night Long. glue for sticking bits onto the float must have addled your brain...

and finally, i'm a Year 6, you fool. remember that. [/rant]

and to end with a little quote, here's something i found while reading a bit of fiction...

'Not all of me is dust. Within my song, safe from the worm, my spirit will survive'
- Alexander Pushkin

what kind of song, what kind of legacy will i leave? hopefully one that resounds richer and louder than that which that damn fool of a junior dares to think of me...

Dental Reflections 008

2008-07-29T09:47:00.003+08:00

seems like i've been doing a lot of big-ass CRs here. the irony being of course the absence of such basics as primer and B-shades... have kinda developed a technique for doing massive CR direct inlay-onlay work to restore occlusal surfaces or even VD...

1) caries free and any cavity prep necessary or possible. in the absence of decent dentine bonding systems, fling Vitrebond with abandon at all visible dentine.

2) place matrix system of choice (or lack of choice *coughcough*) and get 3/4 of the occlusal height needed. cure, check for clearance

3) vaseline the opposing tooth

4) re-etch the tooth if needed. splooge a generous dollop of CR onto the tooth, shape it roughly to look sort of like a tooth.

5) bite and grind! beware the patient with weird bite/posturing.

6) cure. check occlusion. curse under your breath if the patient has only just revealed said wierd bite.

Dental Reflections 007

2008-07-21T23:02:00.003+08:00

been a couple of things ive wanted to write about but never got round to, so here i am with an urge to write and some time to kill!

1) the nefedipine hyperplasia patient

uncle Carranza tells me that a good 1 in 5 of these patients will have some form of gingival hyperplasia. at the least, this makes SAP into a messy affair as they will bleed like animals in a slaughterhouse. at worst... a week or 2 ago, i saw a patient who had nifedipine hyperplasia superimposed on severe generalised chronic periodontitis. his papillae were swollen to the point where they were actually touching his CEJ. in 20min i could only root plane half his mouth...

considering that the hyperplasia is actually a fibrotic overgrowth of tissue that will not go away by itself even after OH improves or nefedipine is substituted (the only improvement being reduction in oedema) there really should be a lot of business for gingivoplasty via either the gingivectomy or modified Widman technique...

2) the periodontal abscess patient

with no Graceys, can there be adequate debridement? since im not exactly equipped with the funkiest of root planing ultrasonics, it usually means some form of hand-instrumented root planing will be needed. and when the fall-back is a set of single-ended 2L+2R... gyaaaa!

Conquering New Territory

2008-07-02T09:29:00.002+08:00

Queenstown. not exactly terribly awe-inspiring when one rolls the name around the inside of ones head. but here i am. the sun is shining wanly through my room window and the nurse has gone on tea-break. and i think i'm pretty happy, all things considered.

of course, it stands to reason that i miss my old place. the availability of company is a greatly important thing. and the availability of a PA machine as well... it really is turning out that our work is being hindered by the simple inability to do PAs. not to say that diagnoses of simple conditions are impossible, but when one wants to advise on prognoses of teeth with either cuspal coverage or perio issues...

on the bright side, the scalers rock. the machines are just 6 months old, and both an inbuild chair unit and a trolley-mounted cheong-Cavitron are available for me to rape calculus at my leisure. you have to love it when the Cavitron-clone has a Turbo button, the usage of which will make patients shriek with sensitivity! rocking!

Triangler - Gabriela Robin

Dental Reflections 006

2008-06-12T22:01:00.002+08:00

how many factors can you think of that will mess with good matrix band placement and hence hinder the interproximal contour of a Class II restoration? here's a short and by no means exhaustive list...

1) insufficient tooth structure to band securely and still touch the adjacent tooth/teeth
2) weird concavities in the root surface that prevent the band from adapting well despite attempts at wedging
3) unusual coronal morphology/the cusp of Carabelli
4) long-standing cavitation into which the abutting tooth has drifted
5) a diastema whereby even furious burnishing will not stretch the band far enough to allow a contour that prevents food trapping

and how to overcome them?
1) euuhhh... work in CR. freehand yourself some buccal and mesial structure, then band from there.
2) with crappy wooden wedges, not a lot a man can do. prepare to stuff a fine diamond or an EVA into the interprox region...
3) this is actually, strangely enough, not too bad if you work in CR. you can shape the tooth bit by bit and respect the original structure. if you work in amalgam... fat hope
4) enamel mod *hack up coughcough* the offending neighbour!
5) this is counterintuitive... leave the gap big enough so that any food which makes its way in comes out easily. and teach the patient the joys of the interprox brush.

Prisoner of Love - Utada Hikaru

Under A Warm Sky

2008-06-08T20:03:00.002+08:00

just when i was least expecting it, an email plopped itself into my mailbox, and now i know that i have my marching orders. to Queenstown it is then. i guess this isnt the place to dissect exactly why i've been sent there, but i dont feel too much of a wrench. after all,
1) am i not the most junior employee, and a maggot amongst the maggots? if i got everything i wanted and word was sweet and easy, it would be called fantasy and not a job.
2) wherever i go, God has a plan.

went to Cedele with Peijun for lunch. now, i think my views on priorities in food are well known. flavour and quantity are the 2 pillars of a good meal, in my opinion. secondary considerations include service, ambience (whereby i mean good seats and lighting and decent music) and costing. Cedele was established on the principles of providing alternative food choices. to whit, they concoct egg-free desserts and gluten-free mains. all very noble, of course, but how does it all match up? after all, the proof of the pudding is in the eating...

Cedele did not get off to a good start with its surly front-door dude. but we persevered (on the uncomfortable front-door purgatory seats, no less) and were rewarded with a table near the window. within a few seconds it became apparent that the outlet (apparently the Wheelock branch is newly opened) was having staffing problems. a full house, and many staff running around like headless (but stylish, mind) chickens, bussing tables, pouring water and doing every damn thing but actually taking orders. finally a nice young man *yay* came to our aid and took the orders for our mains, as well as our drink orders. while our mains did arrive, the drink orders fell through the cracks. i mean... one warm water and one iced water, and a reminder is needed? severe work flow problems. and down to the mains...

Peijun ordered what basically amounted to a mushroom and bacon fettucine carbonara. i felt adventurous and had some fusion-sounding thing that basically said steak and pasta. firstly there really wasn't much to say about Peijun's food. it was competent but... meh. if you can screw up a pasta with cream and cheese and bacon in it, you should be hung from the nearest crossbeam available. my food... was weird. firstly, if the menu promises medium-rare pieces of beef, i most certainly do not expect the pieces well-done in the style of a boot sole. and squeezing lime juice on it most certainly does not help things. damn tree hugger chefs. disappointment was written on my face, enough for my dearest lunch partner to see.

so after that fiasco we had a quick look over the dessert menu. they were offering a free scoop of icecream for orders totalling over $25 *handily achieved*. the Honey Nut was rather good, a base flavour of vanilla given life by a hint of honey and some nice bits of nuts. we also ordered a Cranberry Scone, enticed by the purported hot scones and cranberry jam. alas, this was not to be. half an hour of waiting later, we politely called for the bill and cancelled the scones. not 2 minutes later, the prodigal scones finally arrived. we stuck our ground and the scones were taken away and we caught a glimpse of them being binned... *tragedy in freefall*

so yeah... Cedele. not going back there in hopes of a good square meal. this is the kind of place girl gangs go to gossip over cakes and coffee. lime my beef steak? *unmentionable* you!

Back Again

2008-06-06T21:09:00.002+08:00

so i return to stick my head into the grind once again. i really hope that all i've gained over the week will not fade from me as sunsets collect. its been a rare and precious experience, something to be treasured for a lifetime.

so there i was, a new church camp looming on the horizon. school had precluded any attempts at attending for the last four years, and i was really wondering what this camp would turn out to be like. it didnt help expectations to have, as its theme and song, 'A Passion for Thee'. i have to confess, i truly cannot stand that song. hearing makes me feel as if heat-plasticised treacle is being poured into my head via a hole trephined by a squad of upset monkeys. nothing to do with the words, guys, its the tune and chord work. if the tune gives me the musical equivalent of an MSG headache, i will have trouble liking it. but that's just me...

getting there and starting to do stuff, this camp exceeded all expectations. it was good to be playing again. even despite all the difficulties of an ad-hoc gang of noisemakers which were often-times difficult to round up. i was also blessed to have as a discussion group a fellowship of people who could open and talk about the things of life. it wouldn't have been the same without them. people to laugh with, cry with, and do nonsense with. valuable beyond belief.

at this point i'd also like to make a shout-out to Debbie and Norman, Tapir-boy and Angel-girl, dynamic duo, partners-in-crime and life and soul of our gang. they've been a literal blessing to ACTS (and i say blessing because every other word is inadequate) and the camp really wouldn't have been the same without them.

and finally i'd like to remember the camp speaker. Pastor Richards delivered the Word simply and truly. i just wish more people could have had the chance to hear him *brandishes sermon VCDs* best. camp. messages. ever.

back into the real world, i'll be waiting to see what's on my plate for monday. going to be reorganising my life a bit to give me more prayer and bible time. hope that all i've seen and heard doesn't get swept away in the rush of life...

Heart of Worship - Matt Redman

Dental Reflections 005

2008-05-21T21:20:00.003+08:00

amongst my experiences in NDC i can now add the WWF Pulpect. i have performed WWF SAP before, whereby when i really need to get a patient cleaned up in a hurry (think pack-a-day smoker, never been cleaned in his life and radiotherapy looming in a month) i will head-lock the patient in the crook of my left arm and get the job done. not my favourite maneuvre, but i do seem to be using it a lot more than i would like to have to. but today, i had to use the same headlock to do a pulpectomy...

pt was scheduled for CAP #47(d).

hx of an impacted #48, causing the caries for which i was scheduled to spend a leisurely hour digging out. NRMH, NKDA

and so there i was, with the patient in the chair. EPT -ve but cold ++ve, non-lingering. this was probably a sign of trouble to come, but as i was checking the tooth over it didn't seem terribly out of the ordinary. 2 carts into the IDN and some initial caries free later, i was greeted by the sight of a mass of hyperplastic, hyperaemic strawberry-red tissue bursting out of the distal cavity. and IDN be buggered, it was sensitive to manipulation.

one quick scream to Dr Lui and some prodding later, and it seemed that my only option would be for the patient to grin and bear it while de-roofing the pulp chamber to allow for a good intrapulpal. the sheer irony of of hyperplastic pulp is that the tissue that you want desperately to anaesthetise is blocking the line of sight for you to get your needle into position to do the intrapulpal. damn. and so i had to headlock the patient and rip a diamond bur across the occlusal, and then stuff in a big-head round bur to slash out the pulp from the chamber, all the while apologising profusely and sweating in the deficient air-conditioning. to compound matters, when i sent the patient in for a PA to make sure i was digging in the right direction, and not to china, the radio auntie didn't have the faintest idea how to handle a PA for a patient with dam on! gwaaaaaaaaargh... ended up grabbing an EndoRay from Dr Kuah and aiming it meself.

upon returning from the PA queue, the pulp stumps were still gushing fantastic amounts of blood (hyperaemia ftl) and so another shoutout to Dr Lui later i was witnessing my first live demo in the use of Ledermix. Dr Lui qualified that Ledermix is not a good thing to use in infected cases in general, but due to the sheer amount of inflammation in this case, closing up after splorking Ledermix onto the pulp stumps would prove helpful and allow me to finish up the case in 1-2 weeks with much less bleeding.

hope it all works out...

Dental Reflections 004 and some spleen

2008-05-05T23:12:00.005+08:00

so there i was, with an upset patient in my chair...

pt c/o swelling R face for 7/7:
on 290408 i did a PSA block for cons purposes. after that the patient noted swelling and ecchymosis.

o/e: R lower cheek area presented with ecchymosis, tender on palpation of the bruised region. posterior to the ecchymosis was a region of inflamed skin. pt reported using a muscle ointment on the bruise to cope with the pain. no abnormalities intraorally; buccal sulcus normal. adjacent teeth nttp/pp and vital except for the one with the prior RCT. stetson's duct was patent, with clear fluid expressed.

everything basically pointed towards me having nicked a vessel or something. blood then tracked down the fascia and pooled in the lower end of the buccal space. so what's to be done? AB cover and review, plus some Piriton for the skin irritation that seemed to be connected to usage of an oil of wintergreen-containing ointment. pretty standard stuff, management is basically to make sure that the dead space is taken care of using antibiotics to minimise risk of ending up with a cellulitis.

now at this point the blog will leave didactics and move into full-blown rant mode...

for this patient there is also an incidental finding of acute malignant shit-for-brains. the patient was remarkably ungracious about the whole incident. yes, youre upset because you have a big-ass bruise on your face. yes, you acknowledge it's your bloody fault that when i bent over backwards to give you a fast review you didnt show up because you thought it was getting better, and couldnt be arsed to come down and grace my chair with your presence. but for goodness sake, checking you up one more time costs money too! x-rays don't come free! and medications certainly don't come free either. if you don't want to eat medications and still want to be seen, what do you want me to do? we already bent over backwards to waive all the clinical stuff and x-ray fees, now be a good hippopotamus and eat your medication! no point coming up with stupid excuses about 'i fear medications' (this doesn't translate well from the mandarin) or 'antihistamines make me sleepy'. how do you expect things to happen if you don't eat medications? and when you casually mention the fact that a dentist in your church told you it was just a nicked vessel and not to worry, it identifies you as a person of the book and destroys testimony, not to mention the snide remarks about God blessing you with a haematoma. shit for brains! truly shit for brains...

and i have to review her again on thursday. i am so looking forward to this...

Dental Reflections 003 + some other stuff

2008-05-01T23:31:00.004+08:00

when a patient has hope, he always does better than the patient who doesnt have hope. the patient who believes what you say and acts on it will also perform better in the long run.

so what do you do with the patient who
1) has a Hx of NPC with all the problems of
1a) xerostomia
1b) a 1 3/4 finger opening of DOOOOOOM!
2) doesnt use his F- gel
3) is still ACTIVELY SMOKING ~20/day?

doing his CAPs felt like an exercise in self-punishment. there was smoker's breath, exposed dentine blackened, not by foodstuff and caries, but by the assortment of noxious chemicals from the ciggies, bad-ass caries (ever seen distal upper 7 look as if a rat has chewed it?). amazing. hope my little preventive talk got into his thick head...

Kenneth managed to get me hooked on another anime series. Macross Frontier tells the story of a colony fleet, its inhabitants, a group of civilian military contractors who defend said fleet and in particular one particular, well, for want of a better description, reluctant bishonen. i think my general tastes in anime tend towards exploding things and series which have fun and don't take themselves too seriously, notable exceptions being Monster and Gunslinger Girl. this series kinda fits the mould, and they know that they have rabid fanboys amongst the viewers! expect frog abuse, micronisation errors and the ever-loved Macross Missile Massacre(tm) a-plenty!

My Boyfriend's A Pilot - Ling Minmei

Dental Reflections 002

2008-04-30T00:42:00.002+08:00

got to review a case today after a pulpect, thought this one was worth writing up.

pt walk-in c/o lingering sensitivity on #12

o/e: #12 barrel morphology, AR (o) intact (and yes the barrel was that big), nttp/pp and perio normal but lingering to cold, EPT positive

dx: #12 irreversible pulpitis, normal periapex

so there i was with a pulpect of a #12 in a tooth with an old AR which i suspected to be a dens invaginatus. hacking out the AR yielded.... no pulp chamber or canal. gentle exploration at the base of the invagination yielded nothing either. and so, one consult later, my answer appeared in front of me... the canal, by very very careful staring at the PA, was in fact mesial to the dens invaggie chamber, and had i gone on a quixotic dig-to-china spree on the base of the chamber i may well have done a mid-root perf. heng ah!

lesson learned... in the dens invaginatus the pulp chamber proper may not lie in the middle of the tooth!

Dental Reflections 001

2008-04-26T22:25:00.006+08:00

what i learned this week:

1) fear is a very powerful motivator and must be managed well. or else patients will go and do stupid things and make stupid choices.

2) the people who have dental anxiety tend to have heightened gag reflexes and strong circumoral and tongue muscle tone. truly trouble never comes singly.

3) never underestimate the trouble in matrix banding a lone-standing tooth and trying to get good contour from the outset. it's not going to happen.

4) the person who smokes a pack a day is smoking just over $10 bucks of noxious chemicals every day. this means that the SAP visit he claims is too expensive could be afforded by, oh, say, stopping smoking for 5 or 6 days. the single unit chrome partial by not smoking for, oh, 2 months. and then imagine the patient who smokes 2 packs a day...

4a) truly, smoking is a great social evil that keeps the poor poorer. and yet it is a self-inflicted poverty that strikes in 2 phases; the first when the person spends his hard-earned Yusof Ishaks on smokes, and second when he lands his posterior on the NCC treatment list...

Luminosity Is Levity/ And Levity, Luminosity

2008-04-22T09:50:00.005+08:00

its been a very long time since i put finger to keyboard for this blog. far too long. but i guess after recent turns of events one should take the time to put ones mind to the written word as an exercise in focus. sorry boss; there ain't not patients present on worklist or in-tray...

it finally happened on sunday. ibu myra decided to postpone the orthognathics for PJ because of a persistent, nasty, phlegmy URTI. in a dispassionate way, one could well reflect that it was for the best. who wants to do elective ops on a patient who isn't ASA 1? and in a way that allows one to be gripped in emotion, this has been something that she's quite literally been waiting for; and end point to her ortho tx. and this has taken four whole years, probably twice the duration of your average pt. but all in, long term management of a disappointment situation must be one whereby disappointment gives way to acceptance and a willingness to move forward. failure to recognise a closed door and an acceptance of a new path will only need to unhappiness and depression.

so what's my take on the whole thing?

- the good Lord closes doors according to his will and timing, and it is definitely not in the christian's best interests to either whine at the door which he closes, or to try to breach the door.

- at the same time, the door which he will surely open instead of the closed door will be a door that will prove beneficial compared to the closed door.

- true peace comes from acceptance of guidance when one's will is subordinate to, and guided by, the divine hand.

so yeah... time to apply leave for the 12th of may!

a second thing ive been wanting to do is start a series of blog entries on what i've learnt at work so far. i'd hate to forget any of the lessons that i've learnt while i've been here, and there are so many of them...

as a closing note, watch Bamboo Blade. a recent work of anime, this short series focusses on a high school kendo club and its members. and thats probably all i can say without blowing the plot, after all its classic slice-of-life genre stuff. the brilliance lies in how this series has fun, advances plot and yet doesn't take itself too seriously. there's emotional development, yet not too treacly and emo, great shinai-work, and they even created a whole faux Super Sentai show for the lead character to idolise! enough blurb! get thee to Veoh!

Star Rise - Bamboo Blade Seiyuu

And Now, For Your Entertainment And Vilification Pleasure...

2008-02-27T10:05:00.004+08:00

this over the class mailing list: a debate in the country-over-the-bridge re implants. anyone who's known me for a while is probably familiar with my opinion of the state of politics there. sadly, showboating and unsubstantiated rhetoric seems to extend to the helathcare sector as well. on with the show:

*****

Wednesday February 13, 2008

Dental visits a pain in the pocket

ACCORDING to statistics, about 10% of people who are 55 years and older will begin to lose their teeth. Whatever the cause attributed to each individual, age is the single biggest factor. Because of our ageing population, the number of people who would become edentulous would be a substantial number. The market is huge.
Many old folks are at the mercy of dental surgeons, especially the ones who now describe themselves as implantologists.
Many of them wear doctor’s coats, carry stethoscopes and insist on being called doctors. They charge by the tooth for every implant. Current prices range from RM7,000 to RM9,000 for the implantation of a tooth. This does not include the cost of the replacement parts, surgery, X-rays, etc.
Hence, for about four to five teeth to be implanted in the average elderly person, the price can come up to RM45,000. This is more than the cost of a complex angioplasty, bypass operation, or a hip replacement.
There seems to be no regulation to control these prices. It is a free market, with dentists, specialists, as well as GPs competing and charging whatever the market can take.
Most older people are poor and have to depend on their relatives. And few family members want to pay these exorbitant charges.
Government specialists, curiously, do not provide teeth implants for most of these unfortunate victims. If they do, it is to learn the technique before leaving government service.
While the cost of private medical care is now regulated and there are guidelines provided by the MMA, implantology is a wide open field with no control. Even the Malaysian Dental council has not tried to exert any control.
The patients who cannot afford implants are given cheap dentures or a mix of implant and a bridge (if they can afford the latter).
Having watched the implantation procedure, I think this is really a simple procedure, most of the time done under direct vision. There are no special tools required.
Most surgically trained medical GPs should be able to learn this procedure very quickly. There will, of course, be some difficult cases which can be left to the specialists.
Dental surgeons, whether specialists or GPs, work in a very narrow field of the human body. From experience, I have learnt that they know little or nothing about the wider spectrum of medicine.
The number of antibiotics they are familiar with is very few.They ask for a history of diseases that the patient may have but do not know how to assess how bad these diseases are or how they should be treated.
They have no idea about emergencies that may occur with surgery or with drugs.
They do not know anything about cardiopulmonary resuscitation.
Because of these weaknesses, I would suggest the following remedial actions:
> The Malaysian Dental Council should investigate and control prices in this dog-eat-dog business. They must impose some discipline to care for poor old people.
> The dental surgeon who calls himself an implantologist should give a written bill to the patient before he starts treatment. He should list all his immediate charges as well as charges for subsequent visits.
> It should be possible to train technicians to do single implants. These technicians should be licensed and also given guidelines on charges. Prices would come down in a free market once you increase the supply.
> Medical emergencies during a dental implant are rare but can happen. Hence it should be mandated that an anaesthetist should be on standby during any implant or surgical procedure done by a dentist.
> The dentist should buy and place in his clinic emergency equipment. This would include a defibrillator, a heart monitor, a pulse oxymetre and an ECG machine.
> The implantologist should be certified, which means going before a panel of peers who will verify if he has the knowledge and skills to perform large volume implantation.

MEDICAL DOCTOR,
Kuala Lumpur.

Thursday February 14, 2008

Get your facts right, doc

MEDICAL Doctor in his letter “Dental visits a pain in the pocket” (The Star, Feb 13) does not even know the duties of a dental surgeon and a dental technician.A dental surgeon graduates with a “Bachelor of Dental Surgery” degree and is conferred with the title Doctor while a dental student studies anatomy, physiology, biochemistry, dental materials, pathology, microbiology, pharmacology, medicine, surgery and all other dental subjects in a dental college.The RM7,000 to RM9,000 fee is still cheap for a single dental implant. The cost to set up a dental surgery with implantology varies from RM500,000 to RM1mil or more. The material costs and laboratory charges are equally high.The procedure for doing a dental implant is not simple. It is a high precision procedure and needs lots of training before the dental surgeon can provide such treatment. It is not just a case of cut and fix.All dental surgeons providing dental implant treatment have undergone intensive training and attended courses and meetings like the latest Osstem Meeting 2007 at KLCC on Nov 25 last year.

Here are my replies to some of the suggestions raised in the letter:

> The Malaysian Dental Council together with the Health Ministry have set the range of dental charges for basic dental treatment under the Private Healthcare Facilities and Services Act. Dental specialist charges have not as yet been imposed.

> All dental surgeons providing dental implants and any other dental treatment quote the treatment charges prior to starting the treatment and patients are forewarned of any other charges that may occur during the procedure should any deviation of treatment arise.

> Technicians are not surgeons. They only fabricate the implants, crowns, bridges, dentures and splints in their laboratories.

> All dental surgeons doing dental implants are fully aware of any medical emergencies that may arise and are well prepared for it. So far, not a single emergency has occurred for a dental surgeon to require a defibrillator, a heart monitor, a pulse oxymeter or an ECG machine.

> Should such a need arise, the dental surgeon will either call for medical help or take the patient himself to the nearest medical centre.

> A dental surgeon providing dental implant treatment has attended courses and is proficient in his expertise. Not all dental surgeons provide dental implant treatment.Medical Doctor should get his facts correct before alarming the public unnecessarily. If you cannot afford an expensive car, you should buy a cheaper car according to your budget.The Malaysian dental surgeons are doing a very good service to the public.

DR JASPALL SINGH,

Vice-President, Malaysian Private Dental Practitioners Association,

Kuala Lumpur.

Saturday February 16, 2008

What a dentist can do only a dentist can do

I REFER to the letter ‘Dental visits a pain in the pocket’ (The Star, Feb 13). The dental treatment charges in Malaysia are well regulated by the Medical Practice Division, of the Health Ministry under the Private HealthCare Facilities and Services Act 1998 (Act 586).This act is well supported by Malaysian Private Dental Practitioners’ Association and Malaysian Dental Association.Dental practitioners’ in the private sector whether they are GPs or Specialists are well trained in this aspect and are supposed to adhere and practise dentistry according to these guidelines.The healthcare clients (new terminology for patients) have their own rights. Under the Act, they have all the rights to know about the charges and treatment procedures.If they do not feel satisfied with the dentist, there is the “Grievances Mechanism” in clinics to address the issue under the Act.The writer also said that the dental surgeons were not well versed in drugs.The second year of dental course covers pharmacology.In fact, dental surgeons can treat Upper Respiratory Tract Infection (sore throat) that is a common disease treated by medical practitioners.The third year covers subjects of general surgery and general medicine.The syllabus clearly shows that dental surgeons are on par with their medical counterparts.Another accusation by the writer is that implantologists are not well trained and medical GPs can place implants.This is a joke!My sincere advice to him is, please look at your backyard.There are a lot of illegal and incompetent medical practitioners. Try to rectify that.We have our own professional body to regulate competency.In conclusion, I feel the writer was wrong in all his statements and figures.He was too emotional in expressing his opinion and created an increase in dental phobia among dental patients.One important phenomenon that everyone must realise is that: “What a dentist can do only a dentist can do.”

Dr NEDUNCHELIAN VENGU,

President, Malaysian Private Dental Practitioners’ Association.

Monday February 18, 2008Cheaper to do dental implants here AS A practising oral implantologist, I read with alarm and concern the polemic “Dental visits a pain in the pocket” (The Star, Feb 13).
To clarify matters and to set the record straight, I would like to address certain inaccuracies that were unfortunately passed off as facts:
> To qualify as an oral implantologist requires vigorous practical and theoretical grounding on par with medical doctors: a five-year basic degree in addition to a further two to four years of specialisation.
During the course of the training, many modules are identical to those undertaken by medical students, including management of medical emergencies and performance of cardio-pulmonary resuscitation (CPR).
> The current prices of implants in Malaysia range from RM5,000 to RM9,000, which is substantially lower than those in other countries. For example, implants in Singapore easily cost in excess of S$6,000 (RM13,662); in the UK, more than £2,500 (RM15,788); in the US, more than US$2,500 (RM8,050).
In fact, many foreign patients of mine have performed multiple dental implants in Malaysia specifically due to the equivalent level of professional competence but at a fraction of the price back home.
> Implants are not necessarily the final word in tooth restoration (even though the procedure ranks as the best among the options available in terms of comfort, function and aesthetics).
In the interest of cost, cheaper options such as dentures and bridges are available. On this note, no right-minded dental practitioner will force a patient to have implants done if affordability is an issue.
> The Malaysian Dental Association does provide a list of recommended fees for dental implants. However, as the writer pointed out, it is a free market; therefore each patient has the right to find the practitioner that he is most comfortable with.
> Government specialists have been providing dental implant services for some time now at lower rates compared with private fees. The writer seems to be ignorant of this fact.
> The implantation procedure is not as simple, nor as straightforward, as claimed by the writer.
As stated in the foregoing points, an oral implantologist has to undergo lengthy clinical and hands-on training to become an expert in the field.
There are many serious complications and adverse effects that can arise should the procedure be done incorrectly: for example in the case of guided bone regeneration procedure, sinus lift and bone harvesting.
I hope I have clarified some of the misconceptions that the writer has generated in his letter.
AN ORAL IMPLANTOLOGIST,
Petaling Jaya, Selangor.

> Sunday February 24, 2008>

> Dental implants have the best bite

> THE ideal standard of care for replacing teeth is not a denture or even a bridge anymore, but dental implants. >

> Dental implants are now used to replace missing teeth, stabilise loose dentures, straighten teeth and rehabilitate patients who have lost parts of their jaw and face due to cancer or accidents.

> We refer to the letter “Dental visits a pain in the pocket” (The Star, Feb 13) and wish to express our sadness over the misconceptions of a colleague whose profession we highly respect and admire.

> Dentists or dental surgeons are part and parcel of the healthcare providing medical profession and work hand in hand for the betterment of our patients.

> We do empathise with his concern for the older members of the population who due to inadequate dental care in the past now require dental implants.

> However, the main cause of teeth loss in older people is not aging as stated by medical doctor, but gum disease.

> This means that a healthy adult who takes proper care of their teeth and gums will enjoy a full set of teeth for life.

> Hardly 10% of dentists practice implantology and also because implants are all imported and costly, the cost of providing the service is still relatively expensive.

> Research and development of dental implantology took a lot of time, effort and expenditure on the part of university researchers and implant manufacturers.

> The cost of training is still very high because it involves highly trained lecturers, logistics and material costs.

> Implantology is not as simple as it looks.

> Such treatment can range between simple to highly complex procedures that involve bone grafting, gum grafting, specialised imaging, detailed planning and a thorough understanding of occlusion which may take years of experience to understand and successfully manage.

> Special dedicated tools, equipment and materials are needed in implantology.

> Dental implantology usually does not incur any more trauma than an ordinary extraction of a tooth, and therefore does not require any extra safety measures that are not already in place in all dental clinics.

> Dental implants have helped countless people around the world to enjoy their food again. They are the best replacement for lost teeth.

> Though expensive currently, the price will keep coming down due to free market forces.

> Like in all professions, some dentists charge more and some less. Find one you can afford.

> After all, dentists here in Malaysia are highly trained and yet are still among the most affordable in the world.

> The cost for dental implants in Malaysia is one of the lowest in Asean.

> This has led many from overseas like Australia, Europe, America and Japan coming to Malaysia to enjoy the benefits of dental implantology at international standards and yet at half the price or less in their home countries.

> Dental implantology has placed Malaysia on the map as a major destination for health tourism in this region.

> DR FIRDAUS HANAPIAH & DR CHOW KAI FOO,

> President and Honorary Secretary,

> Malaysian Oral Implant Association (MOIA).

*had enough? more to come*

Saturday February 23, 2008

Implants cost too much

I REFER to the letter Cheaper to do dental implants here in The Star, Feb 18. Implants in Malaysia costs between RM5,000 and RM9,000. Let us say it is RM7,000 on the average, which is the equivalent to 7,000 cups of coffee or three months' pay of a government medical officer’s salary here.
In Britain, it is £2,500 which is about 1,500 cups of coffee there or less than a month's salary of a government medical officer.
In the United States, it is US$2,500, which is about 1000 cups of coffee there or much less than a month's salary of a government medical officer. In Singapore, it is S$6,000, which is about 2000 cups of coffee there or less than a month's salary of government medical officer.
A baby delivery by Caeserean section here - which includes general anaesthesia and few days stay in a private hospital - would cost less than a tooth implant in Malaysia.
So dental implants here are among the most expensive in the world.
Suggesting other alternatives like dentures and bridges is like telling a patient with a bone fracture not to have nailing and plating and just to have plaster casts, as it will heal anyway.
Just as there is government control over food items and other products, there must be a price control over dental procedures. Dental health must be available and affordable to the rakyat of Malaysia.
As can be seen from above, a reasonable charge for an implant would be around 1,500 cups of coffee or RM1,500 by comparing the different prices of several countries. A root canal should not cost more than RM300 and crowns not more than RM300.
Technicians here should be taught to perform implants as there are other more difficult procedures that are also done by technicians. For example, there are midwives doing a good job with examinations, investigations and the delivery of babies.
Ultrasound and echo (for heart patients) are done by technicians, medical assistants are doing examinations, investigatings and treating patients while dental nurses are doing fillings and extractions. In addition, anaesthetic assistants are giving general anaethesia in rural areas.
Medical doctors should be taught to do implants as they have basically learnt all that the dentists have learned such as oral anatomy, physiology, pathology, bone regeneration, bone harvesting etc.
In my rural posting I was taught to extract teeth and do fillings. Implants have now become a common part of dental procedures, just as root canal treatment.
If there is a shortage of oral implantologists then we should recruit medical doctors. I am sure doctors here will fulfil their Hippocratic Oath to serve the public.
Dentists are also bound by Hippocratic oath to serve the public.
*
ANOTHER DOCTOR,
Kuala Lumpur.

Monday February 25, 2008Dental implants an expert’s job WE REFER to the ongoing discussion on dental, medical and healthcare costs in Malaysia. In Implants cost too much (The Star, Feb 23) oral implants were likened to treatment for bone fractures.
Comparing the cost of dental implants to the local price of a cup of coffee does not make sense. This is because a major cost of a dental implant is the cost of the imported prosthesis itself.
More than just the cost of materials, oral implantology is a multi-stage multi-disciplinary treatment procedure. The surgical component (i.e. the placement of the implant within the bone) is performed by the implantologist/ oral surgeon.
In fact, we invite interested medical surgeons to equip themselves with the proper training and accreditation that enable them to perform this surgical procedure.
The demand for oral implants is far higher than what dentists in this country can cope with. Having well-trained medical surgeons to help out in the surgical process will be a welcome bonus.
The next step involves designing an artificial tooth over the implant. When a patient requests an implant, this tooth component is the one he or she will see and use every day.
Therefore, this stage is best carried out by a dentist properly trained in treatment planning, dental occlusion, function and aesthetics.
Based on the dentist’s exact specifications and detailed instructions, the prosthesis (tooth) is custom-made in the laboratory by a dental technician. Finally, this prosthesis is precisely attached to the implant.
Function and cosmetics are examined clinically. This multi-stage, multi-disciplinary approach is important to ensure that each stage is done by an expert in that field, to ascertain the best possible treatment outcome.
The dental implant of today is by no means the ultimate replacement for missing teeth. Further research and development (R&D) is required.
Currently, essential/basic dental treatment like extraction, pain relief, fillings, scaling, and infection management are already affordably priced. These procedures are cheaper than most medical surgical treatment.
We are working towards a time when dental implants are no longer an optional luxury but a common affordable treatment alternative, just as cars were once exclusive to the rich but are now commonplace.
We can achieve all this and more only with the understanding and cooperation of our medical colleagues and the public.
Who knows, with support from all parties and sufficient funds for R&D, the option of replacing a missing tooth with a new one grown from stem cells may soon be available.

DR FOO CHI CHEAN, President – Malaysian Academy of Cosmetic Dentistry.
DR MELISSA FOO SUYIN, Oral & Maxillofacial Surgery Department, Hospital Sungai Buloh.

*****

really, to sum up, it does look like a bad case of doctors with itchy backsides and a poor understanding of what other people do. it doesn't mean that a well-rehearsed procedure is effortless just because it looks to be so. also, healthcare should be based on needs, not wants.

Now I Know

2008-02-08T15:05:00.000+08:00

i finally understand the fuss about tuna-based sushi. this is a bit of an overdue blog, but anyway me and PJ went out over last weekend to celebrate her birthday. it involved going for a play and then a good dinner.

Chesty Nutty Bang Bang: The Hairspray of the Phoenix was quite literally 2+ hours of cheap shots. very good ones too, mind. the comedy crew opened up mercilessly spoofing the now-infamous MDA rap (youtube for it, you lazy buggers!), followed by skewering such subjects as Ribena ads, Beauty World, Heroes, 881... excellent. you have not lived until you have heard people sing Umbrella in hokkien. catch the next one when they get back on the stage! also ran into Lor, long-unseen JC class rep. good catchin up w her, wonder when our gang will next assemble...

the evening's laughter was followed up by a meal at Sushi Yoshida. we always passed by the place on the walk from Cine to PJ's place, and saw head chef Yoshida-san standing with the valet parking dude of the bar next door watching the world pass by every time. this reached the point where we dubbed the place 'Valet Sushi'. original plan was to check out a restaurant up the hill for dinner, but a great urging for a dinner of the raw fish variety struck PJ. i thought to myself, what the heck? expensive raw fish, here we come!

Sushi Yoshida is located in a small corner next to Bar Stop on Devonshire Rd, they possess a common entrance so dont walk past wondering where it is. ambience is cosy, slightly darkish in terms of lighting for my taste but alright otherwise. serving staff are generally friendly but still rough around the edges. the sushi, however, is excellent. this will be remembered as the place where i had my first Chu Toro Nigiri. its not just any old Magurozushi, mind you. a completely different animal, and another excellent proof that without fat of some kind food has less flavour. it tasted like fish in a good way, darker than salmon. it literally made me wish i had another hundred bucks to splurge on O-Toro. i must admit PJ was less blown away than i was, but now if i can get good tuna cuts i'll get some over the more generic local favourite salmon. in japan noone eats shake-sashimi anyhow...

Umbrella - Mandy Moore

O Muse! Sing in me, and through me tell the story...

2008-01-27T19:57:00.001+08:00

after having discovered the wonders of the disc borrowing service at Gramophone, there are a couple of movies that we've watched that warrant a mention. in particular, go check out 'O Brother, Where Art Thou?' by the Coen brothers. in terms of comedy, this is one fun movie! 3 men escape from a chain gang to go get some treasure, and the rest would be spoiling the movie i guess. definitely worth the rental fee!

I Am The Man Of Constant Sorrow - The Soggy Bottom Boys

How To Fly A Kite

2008-01-09T09:12:00.000+08:00

or... the life of a DO after 4 and a half working days. seems as if the old saying about sheer boredom punctuated by moments of abject terror really is true. i've had irritating pulpectomies, angry patients, and a panic-attack-in-the-chair from a heart patient. ive scaled, root planed, done TDs, CRs ARs, and too much GIC to count. but i still need to be faster. and learn how not to irritate the consultants. bleah.

Deconstruction

2007-12-21T01:34:00.000+08:00

seems like i havent had terribly much time to write, but its a damn good procrastination tool. right now i need a few moments to regather my thoughts before i head off back to do some work.

i've been meaning to write for the longest time about the concept of the boyfriend corner. every boutique should have a boyfriend corner. this is a little space where the tired boyfriend may rest a moment while his girlfriend sacks the racks, looking for that elusive new buy. while shops must consider their merchandise, advertising and product layout, the presence of a boyfriend corner shows how much a shop cares, in a very literal way. improvised boyfriend corners are couches or benches commandeered away from their original use as places to perch while slipping on new shoes. poor boyfriend corners are those made up of stools stuck in a corner next to the winter coats that will never sell well in our sunny island. better boyfriend corners have adequate seating for the weary multitude of boyfriends/batmen who are on duty during sale time. excellent boyfriend corners have a commanding view of the changing room entrance to facilitate our giving useful comments on apparel that is being tried on by the girlfriend. and to this end, i have to say that the best boyfriend corner i have seen to date is located in the Giordanos in the basement of Takashimaya. it has 2 spacious couches, next to the atrium leading to the changing room. more storekeepers should take note...

The Night Santa Went Crazy - Weird Al Yankovic

Please Hold

2007-12-14T14:52:00.000+08:00

so the Registrar's Office cocked up my bloody transcript. don't you love wild goose chases of an administrative nature? there are a whole bunch of things i could be doing right now that would be a more intelligent use of time, such as cutting my toenails or watching glue dry...

bloody hell.

Finally

2007-12-13T12:40:00.000+08:00

just like to take the opportunity to congratulate my brother who will be having his graduation ceremony this evening. here's to the late bloomers of the Ee family!

Heartbreak Hotel

2007-12-10T23:34:00.000+08:00

"Love is patient; love is kind; love is not envious or boastful or arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice in wrongdoing, but rejoices in the truth. It bears all things, believes all things, hopes all things, endures all things."

-1st Corinthians 13

as i take stock of the way things have been and turn out, i see my shortcomings shouting back at me. God give me the grace to improve...

Peons In The Mist

2007-12-05T16:19:00.000+08:00

sitting in the Engineering Canteen, an empty cup of joe next to me and a slight jiggle in my extremeties as i type up a long-overdue blog. having taken up this part-time job, i find spare time to do personal things even more fleeting and precious. after work and picking Peijun up to send her home, i just want to get horizontal and let the tension ease from my body. not so easy when there's so much to do.

been just over a week of part-time work. i think organising Prof Foong's research stuff was a major success, measuring virtual OVD on Lit Teen's projections was pretty decent. but tracing MRIs makes me want to run screaming for my bed to lose consciousness. should have discovered Engin coffee earlier, though, it tastes pretty good and seems to be loaded full of caffeine goodness. just can't wait for it to be all over. its a cold-lonely lab in Engin, with no company. occasionally, 2 girls from VJC are in my area to do their colaboration with Prof Foong and Hsiao Piau. theyre about as friendly as rotting tree stumps, and ignore my presence except when i open the door for them after they go for pee breaks. assholes... where i come from being polite enough to say hi is required!

on the Anime front, Arts Central's latest import, Monster, seems to be really good stuff. not the usual blow-stuff-up shonen adventure, Monster deals with horror and moral dilemmas, centred around a killer with no morals who was saved by a doctor years before. and i guess thats all i can throw up without utterly spoilerising it.

seems like the little plans Peijun and me had to take a small regional break may not be happening, too short notice, not enough resource. but there's always next year, when we have more coin in the pocket, and the op is over.

one round of practice achieved for Terence and Lishan's wedding. even though this time only half of us will be Ejects and Rejects (or voluntary withdrawals) but the music looks like it'll be good. the small but acoustically decent venue will also help immensely. auditoriums suck! and because the runway is so short, whatever we play of Canon in D will not have a chance to hit the funky bit. plus point or minus point, take it as you wish...

Selfish Love - Miyavi

I Get To Hear Their Delightful Screams Again Today

2007-11-16T14:49:00.000+08:00

so there i was, quite literally looking for something to do while waiting for epoxy to cure. my new anime entertainment is Sayonara Zetsubō Sensei, which may be the most freaking funny, twisted series ever! basically about a teacher with a pessimistic view on life, who tries to commit suicide at least once an episode, and his weird class, this has to be seen to be believed.

i wonder if the epoxy is done...

絶世美人 - Ai Nonaka, Marina Inoue, Yū Kobayashi, and Ryōko Shintani

A Gamer's Perspective

2007-11-14T00:10:00.000+08:00

so there i was, killing time talking to Darren in PI this afternoon, reminiscing about the wonders of big stompy robots and blowing stuff up. one of his friends popped by, being a bit early for a gathering to organise the gameplay for a huge WH$40k promo in the store. this lead to a little discussion about perceptions of the gamer by friends, family and prospective life partners. in essence, this was sparked off by him asking what game i played. after finding out i'm a CBT player, he made a remark about not having the resources to dive into more minis-based games, and since he started with $40k he's been essentially married to it. this lead on to how he has a honking great collection of minis (GW huge army lists ftw), and how people (= girlfriends) react when they pop by his house. essentially, once the girl gets over the shock of how much plastic and metal she is seeing (think big-ass glass-fronted display cabinet), variations of a few standard questions will come out...
1) don't you have a life?
2) wah! you love me more or those figurines more?
3) once we get married will you sell them?
question 1 is an ignorant bigoted narrow-minded attempt at passing a comment via a rhetorical question. of course we have a life. it's just different from yours. while you choose to spend your time doing things to relax and switch off such as shopping or cycling or watching a movie, every so often we like to engage our brains. stops the atrophy from setting in.
question 2... quite succinctly answered by Darren's friend. 'wait... this is the 3rd time we're meeting up, i hardly know you and you're asking me this?' why does it turn into a me-or-them thing? its ridiculous. what kind of insecure females are we breeding to feel threatened by minis...
and the 3rd question... to the non-gamer, it seems as if games are things that one discards as one ages so as to move on to more 'matured' things. what if we like it this way? what if our little escape provides us the much-needed stress relief from the mature lifestyle you happen to be touting? why is gaming considered childish anyway? because we imagine? ban the fantasy stock market then! ban Rowling, Tolkien and Gaiman! ban singing in the shower even!
in short, give gamers a break. i truly hate feeling marginalised because i carry dice and am proud of it. because i chose to use my brain in my free time instead of vegetating. because i chose to let little fantasies of big stompy robots seep out of my head and onto the table from time to time.
but then again, the people who most need to re-think their attitude towards their gamer friends, family and loved ones will never read this, because they simply dont care, being an apathetic majority secure in their 'normalness' and 'conventional social behaviour'. they live out their white-bread lives, happy to trudge the same paths and so ready to criticise the harmless variations from their comfortable middle road.
disgusting.

Do Not Read This If You Value Productivity...

2007-11-14T00:06:00.001+08:00

best flash game ever!

Boxhead 2play Rooms

simple polygons, yet so much fun! shoot zombies and run around to survive, how long can you last?

Lebensraum

2007-11-08T23:06:00.000+08:00

so it's confirmed. i am now fully qualified, unlicensed and unemployed. a big thank you to all the guys who offered advice and support during the exam period! glad it's over, looks like i passed despite the irregularities in question phrasing and the odd stuff that came out during the clinicals. and apparently one can indeed complete the entire Final Pro BDS using the ink in 1 Pilot G-Tec C4 pen.

sent in an entry for the church 20th anniversary songwriting competition. first time i ever tried this kind of thing, was kind of fun, both spazzing out the tune in the space of an hour or so while trying to coordinate the lyrics, and using the entry-level WinXP sound recorder software to cut-n-paste a demo recording together with my brother. see how that one goes, i have a statistical 1/4 chance of winning!

Lust, Caution really does need the extra cockles. after last night's movie session with the class, i can confidently state that the NC16 version should be boycotted! so much significant plot progression was lopped off, the humless version was effectively neutered! do not watch the monkey-version if you value artistic integrity!

Prof Foong offered me a job with the faculty doing some kind of admin stuff. its for a few hours in the day, apparently pays okay, so i should have time for myself. meeting him tomorrow, see how this goes!

Transition

2007-11-04T10:01:00.000+08:00

it feels kinda good. although nothing official's on the board, i find myself more able to let myself go and relax. to think of what the heck to do ahead. lets face it... im broke and have too much time now. so many opportunities present themselves nonetheless. i need to learn how to drive. find some income. have some fun. prepare for work. think towards getting a new computer cos this one's dying!

peijun's been sick for practically 2 weeks now with various stuff coming and going in a stream of illnesses, just hope it'll all clear up cos its making her miserable. and the delivery boy is pretty wiped out too! someone should level the bloody hill at river valley, i swear!

when i get my posting, i'm going to change the title of my blog.

Half Past

2007-10-29T13:20:00.000+08:00

it was really quite a surreal feeling. there i was, in SM2B starting to write my supposedly erudite opinions on scaling and root planing, when a song rose unbidden into my head and stayed there, rocking away through pretty much the whole paper. a rousing work of rock, possessing a tune full of hope and some truly righteous axe work, that kept my pen driving across the paper for the whole 3 hours.

i present:

Lost My Music - ENOZ feat. SOS-dan
.
Hoshizora miage Watashi dake no hikari oshiete
Anata wa ima doko de Dare to iru no deshou?
.
Tanoshikushiteru koto omou to Samishiku natte
Issho ni mita shinema hitorikiri de nagasu
.
Daisuki na hito ga tooi
Toosugite nakitaku naru no
Ashita me ga sametara
Hora kibou ga umareru kamo Good night!
.
I still I still I love you!
I’m waiting waiting forever
I still I still I love you!
Tomaranai no yo Hi!!
.
Nemuri no fuchi de Yume ga kureru omoide no One day
Anata no kotoba ni wa Sukoshi uso ga atta
.
Hanasanai yo to kimi dake da to
Dakishimeta no ni
Yakusoku ga fuwari to kurai yoru ni kieta
.
Daisuki na hito yo itsumo
Itsu made mo sagashite shimau
Kitto me ga samete mo
Mada maboroshi o kanjitai Morning
.
I lost I lost I lost you!
You’re making making my music!
I lost I lost I lost you!
Mou aenai no? No!
.
Daisuki na hito ga tooi
Toosugite nakitaku naru no
Ashita me ga sametara
Hora kibou ga umareru kamo Good night!
.
Daisuki na hito ga tooi
Toosugite nakitaku naru no
Kitto me ga samete mo
Mada maboroshi o kanjitai Morning
.
I still I still I love you!
I’m waiting waiting forever
I still I still I love you!
Tomaranai no yo
I still I still I love you!
I’m waiting waiting forever
I still I still I love you!
Mou aeru yo ne? Ne!!

and for the jap-impaired people:

Look up at the starry sky and tell me about my own light
Where are you now? And who are you with?

If I think about enjoying things, I feel sad
I weep all by myself at the movie that we saw together

The person who I love is faraway
Too faraway and I feel like crying
When I wake up tomorrow
Look, hope just might be born, Good night!

I still I still I love you!
I’m waiting waiting forever
I still I still I love you!
I won’t stop, Hi!!

In the depths of my slumber, my dream gives my memories a ‘One day’
And there were some lies in your words

Even though you embraced me
Saying, “I won’t let go” and “I’m only yours”
The promise softly disappeared in the dark night

I’m forever searching for
The person who I love
I’m sure that even when I wake up
I’ll still want to feel the illusion, Morning!

I lost I lost I lost you!
You’re making making my music
I lost I lost I lost you!
Can’t we meet anymore? No!

The person who I love is faraway
Too faraway and I feel like crying
When I wake up tomorrow
Look, hope just might be born, Good night!

I’m forever searching for
The person who I love
I’m sure that even when I wake up
I’ll still want to feel the illusion, Morning

I still I still I love you!
I’m waiting waiting forever
I still I still I love you!
I won’t stop
I still I still I love you!
I’m waiting waiting forever
I still I still I love you!
We can meet again, right? Right!!

Lost my music - ENOZ feat. SOS-dan

Suspense

2007-10-12T21:01:00.000+08:00

here i am, still hanging in limbo. while technically i should be free and on the way to my exams, the truth is that unless i see my name on the board saying im eligible, i wont have any peace of mind. and at the same time im too inert to haul my ass out of the house and go to school. this studying sucks. dont know why but its even more shitty than all the other years where ive had to study for finals. i feel drained, immobile, in need of instant noodles, irrationally tired, and very bored.

i want this over with quick!

Hurt - Johnny Cash

To Be With You

2007-10-09T21:14:00.000+08:00

this was a song i came across only during army time, due to intense sua koo-ness. Mr Big was a band that combined radio-friendly choruses and excellent guitar work. this song stuck in my head because it simply sounded real good! at this time, i wanted to dig the lyrics out and just refresh everyone's memory.

Peijun, the first 4 lines of the 2nd stanza might reflect a bit of your current situation...

To Be With You
*
Hold on little girl
Show me what he's done to you
Stand up little girl
A broken heart can't be that bad
When it's through, it's through
Fate will twist the both of you
So come on baby come on over
Let me be the one to show you
*
I'm the one who wants to be with you
Deep inside I hope you feel it too
Waited on a line of greens and blues
Just to be the next to be with you
*
Build up your confidence
So you can be on top for once
Wake up who cares about
Little boys that talk too much
I seen it all go down
Your game of love was all rained out
So come on baby, come on over
Let me be the one to hold you
*
I'm the one who wants to be with you
Deep inside I hope you feel it too
Waited on a line of greens and blues
Just to be the next to be with you
*
Why be alone when we can be together baby
You can make my life worthwhile
And I can make you start to smile
*
When it's through, it's through
Fate will twist the both of you
So come on baby come on over
Let me be the one to show you
*
I'm the one who wants to be with you
Deep inside I hope you feel it too
Waited on a line of greens and blues
Just to be the next to be with you
*
I'm the one who wants to be with you
Deep inside I hope you feel it too
Waited on a line of greens and blues
Just to be the next to be with you
*
Just to be the next to be with you

To Be With You - Mr. Big

Chicken Wings

2007-10-04T18:37:00.000+08:00

i could do with chicken wings now. chicken wings have played a pretty major role in my dental life as convenient comfort food. the quality of the wings varied from day to day but they were generally both decently edible and fairly cheap. then, a price hike kicked in, and my card got spoilt. chicken wings have not featured in my school life for the past 2 terms or so. its been kind of weird without them. hope there are good chicken wings somewhere near NDC.

on an un-related note about deep fried food, i was wondering if it would be possible to make intrinsically spicy french fries and wedges. kind of like rolling the suckers in tabasco and pepper before throwing them into the fryer. it would make a nice change from the standard issue french fry, and the spices would play off the plain-ness of the potato well, especially if the usual un-thinking Singapore staple of chilli sauce was swapped out for japanese mayonnaise.

Geng Feng? return the deep fryer!

Speed-Waxing

2007-09-27T21:55:00.000+08:00

i think i've developed the fastest way to set teeth to conform to an opposing prosthetic dentition! this example assumes a f/p situation...

1) wax up upper arch to ideal setup.
2) grind contacts, adjust for inter-arch alignment issues
3) take first lower molar of desired side, put a column of utility wax underneath. place in region where tooth will eventually lie. close articulator and make fine adjustments.
4) holding articulator closed to maintain position, add wax to cover utility wax, stabilising the molar.
5) add subsequent teeth until all desired teeth are placed. interproximal grinding may be needed to adapt mesial-most tooth against abutment/framework.

this method allows one to get achieve fast positioning of the lower arch teeth without messing around with heating and reheating wax. it also eliminates wax shrinkage and tooth slip as the wax holding the tooth in place cools down. the wax which comes free with the rack of teeth is actually pretty decent, havent tried with the standard-issue rope wax yet.

Logic vs Evidence

2007-09-26T14:50:00.000+08:00

logic is never enough, there must always be evidence. for while logic is a valuable decision-making tool, sometimes logic is faulty, or does not factor in every possibility.

On an unrelated note, i hate Fuji I. i mean, yeah... it sticks stuff okay, but it also clings to mucosa. at least i'm getting a lot of experience with it cos of all the bloody FP i've been luting with it. seems like ive stuck down as many units with ZnPO4 as i have with Fuji I. now it better hold well...

729

2007-09-22T15:18:00.000+08:00

in all the chaos that swirls around my life, im glad that i have Peijun. she's been the greatest comfort to me during the days at school when she was around, and then in the days when she wasnt. guess it wasnt the easiest thing when i was left behind and she had to move on to work. but im glad to have her, even if i cant see her as often (by quite a drastic margin i might add). im glad for all the times we spend together, the laughing, the crying, the happiness, the sadness, everything. it seems so alive with her around, much better than being a drone in the lab and clinic with no aim but to discharge, no joy but to close up for the day. sure, things havent been easy due to all the stresses from school, home, NDC now and other sources, but i'd rather have lived this with her than not have had the chance to be with her at all. because its been the greatest happiness in my short little life. and i hope for much more happiness for the 2 of us in the years ahead, as we walk the road of life hand in hand, stopping to peer at the little flowers along the way.

Peijun, you're my little Gunslinger Girl.

The Light Before We Land - The Delgados

Gunslinger Girl

2007-09-19T20:09:00.000+08:00

i think i've found my latest favourite anime. Gunslinger Girl features an Italian black ops group composed of cybernetically-enhanced girls and their handlers, and the trials, fights and emotional upheavals that they go through. its dark, contemplative, its got good soundtrack, and you just feel for the girls who have been plucked out of the dire straits they were in only to be put in another set of trials. unfortunately, i surmise it may never reach Arts Central. angsty pre-teen girl assassins with big-ass guns, especially after Dave Teo? more's the pity...

Dopo il Sogno ～夢のあとに～ - Yoshitaka Kitanami

Thunderbolt

2007-09-13T21:23:00.000+08:00

seems like my life is a life of upheaval. just when you think things are working out, events come along to shake your world and prove you wrong. and thats when you have to get on your knees and pray, and then rush off to save that world from collapsing, with only great faith to guide you. if Job could say 'Though He slay, me, yet will I trust in Him', can't we? even when it seems like failure will make life unbearable...

Let's Fighting Love - Trey Parker

A Story

2007-09-12T11:37:00.000+08:00

heres something lol-worthy i read on CBT.com:

"Once along time ago after pining over a girl for several months I was at a bar, still pining, when my best friend put his hand on my shoulder and said, "Dude, just rest your head on the table." Feeling so low and sorry for myself over a girl I put my head on the table with a big sigh, knowing that my best friend was about to fill me with his sage wisdom. And he did. He smacked the back of my head so hard it bounced back of the table and blurred my vision, made my eyes water and gave me a headache so blinding I thought I'd pass out. i looked at him and said "WTF did you do that for you ******. That hurt! You just about busted me skull open!" He just smiled at me and said "Head hurts doesn't it" to which I replied "Goddamn it hurts I just told you that. I think im gonna pass out. I'm gonna have a bruise on my head. You're an ass" He smiled at me again and said "Your not pining over your poor little broken heart anymore are you, because now you have a fractured skull to complain about"

七色の明日 ~Brand New Beat~ - BoA

The Coming

2007-09-05T14:43:00.000+08:00

the CBT box set is out in PI now, along with Tech Manual and Starterbook: Sword and Dragon! and i have to receive the news online while casually perusing the PI website... dammit! want want want! im stuck here in the frigid science library (while, funny enough, its damn hot outside) and my box set is lying alone in the PI back room waiting for me to pick it up and open it lovingly and play with it. oh when shall that happy day be?

Pieces - L'Arc en Ciel

Lizard In The Fridge

2007-09-04T10:50:00.000+08:00

holidays are here again, an im spending them in the beloved science library. i miss the medical library. its probably a matter of familiarity, seeing old faces around, having a favourite corner next to the dental shelves, being able to yell out to the guys to go for lunch/beg the guys to bloody hell listen to the call of the stomach and go for lunch. guys, i miss you all! this is a unisex designation btw...

i guess it kind of hit home during Buffet Night. sure its an annual affair, the same old damn thing year after year, with D1 skits sinking to new lows in terms of off-colour jokes and banana placement. but amidst all of that, i miss sitting round with the class and talking with them, hearing the guys crack jokes. i wish i could have taken a walk on the pier with Peijun (im sorry Geng, you just dont look, feel or sound the same) to feel the sea breeze in our hair. but this is the reality of life i guess. and to the D3 and D4 juniors who were at the dinner, thanks for inviting and old man to join in your photo shoots. it means something to me.

watched Ratatouille (damn that was a challenge) on Sunday. this movie is good. id say that it could stand proudly beside The Incredibles. it was american animation which was intelligent, had a story and a message, was not afraid to show characters with real flaws. in short, marketing potential for toys aside, this show is more than just kiddy faire. watch this movie.

SNOW KISS - NIRGILIS

Boot To The Head

2007-08-29T14:31:00.000+08:00

why does it seem like the world is getting colder? not exactly in the most literal sense, but the air conditioning in clinic 3, which for years has lagged behind that of clinic 2 in terms of sheer cooling power, seems to have been fixed/upgraded/pimped out. coupled with the cold weather, sometimes its actively bloody freezing! the science library is also more frigid than, urm, a fridge i guess.

i think the guys are changing. they look the same, yet different. more confident. happier. in some cases, more prosperous. changes in circumstances, fortunes and mindsets. i want some of that!

single crown competency mounted and ready to send down. endo competency to be stuffed up tomorrow. whats left for me to take care of?

One Half - Wu Jiahui

Things I Learned Today

2007-08-15T19:35:00.001+08:00

i found out the key to feeling lymph nodes on the cervical region today during an OS tutorial. press against the nearest firm structure, they say, and we futilely grope away. for the submandibular and submental glands, the nearest hard structure is the body of mandible. and for the neck, the next best thing to bone for the superficial nodes is a tensed sternocleidomastoid...

i cannot lose the will to press on. fatigue is setting in, the pressure doesnt want to go away... sleeping for 10 hours or so the day before yesterday helped immensely, but theres so much to see and do.

一色 - 中島美嘉

Barometer

2007-08-12T20:46:00.000+08:00

pressure? frankly it sucks. to be pressured from so many directions while being told to be focussed is hard. especially when you cant just tell the sources of pressure to please take a queue number and wait for the recep to call them in. there have been times when i wished that i could sprout wings, flown out the window and lived on love and fresh air for the rest of my life. not going to happen. i find myself more and more tired, wishing i could find a nice corner to curl up and sleep. somewhere safe and warm where i can leave the world behind for half a day or two and surrender to the obliviousness of unconsciousness.

Debra the Violin Girl is back from america! seems like the longest time since i saw her around. unfortunately, no time to catch up. as an aside, wonder if i can scrape up the funds to buy the Mika Namashika CD going for ten bucks at Du Yi. looks worth it, even tho these days ive been listening to my radio so much.

think friday was my best endo session ever! restored my faith in the discipline somewhat. working under TLC is damn fun! showed us how to nuke voids, and even let me play with using chloroform to make a custom cone. hope i get that competency settled quick, not much time left.

我可以 - 蔡旻佑

Song of Truth

2007-08-05T22:02:00.000+08:00

the world is a messy place, especially as the YouTube generation grows up. im not going to repost the long letter i sent out to my class, that remains in Dental circulation. suffice to say, its stupid to think that what you mail around or sent to the national papers will have no repercussions. to the freshies, i'd say im sorry your intro to the world of the faculty had to be so rough. normally its a time where you bond by the sweat of your brow, sharing fun and frustrations. the petty machinations and inconsiderate actions of others have marred this experience. and to the Taleban 3, please go find a quiet corner and commit seppuku. you can form a little triangle and second each other if you so wish.

真実の詩 - Do As Infinity

Under The Covers

2007-07-27T18:03:00.000+08:00

right now, i'd really like to be asleep. warm blanket. aircon, not to cold. bolster. clean sheets. good pillow. absolute darkness. it has occurred to me that drinking Red Bull and doing labwork after midnight is like living on borrowed time. sure, the energy drink at 9.30pm will give you one hell of a boost in about 15min that lasts for almost 3 hours, but the next morning? you're buggered. so yeah... drink Red Bull responsibly.

have finally finished off the f/f patient. not in an amicable way, and i hope he doesnt come back to haunt me, but at least HT has signed that clown off as completed, and unsuitable for UG Tx, with reasons. its really quite something to be told by a patient that his denture is uglier than the last one, that people will laugh at him, that the other operators were better, and why do the instructors keep changing? the sheer stupidity of it all is phenomenal. and to top it off he refuses specialist care, saying that student treatment is better (with the notable exception of this operator). ass.

i find myself becoming more and more attached to my Nokia earpiece. i think having 93.3 playing semi-permanently has a kind of calming effect on me when i have to do work. it is weird, however, taking phone calls have having people look at me like i belong in ward 12...

Zhao Long lent me a patient for S&RP competency next week on thursday under MT. lets hope this goes well! apparently he took the easier quadrants for his own competency. then again, what one really needs is sharp curettes and a good ultrasonic, not a simple patient. if i pass because my patient is easy, am i truly competent? its a question running through my head more of late. i hope i graduate well and dont screw things up outside...

深い森 - Do As Infinity

MP3, not for listening to

2007-07-23T16:49:00.000+08:00

school has tottered into week 4. what have i gotten done?! *panic* at least i got some of the staff looking out for me. Prof Foong sent me a pair of brothers to do up, even specified which one was competency and which one was for requirement. got HN to see the my dearest darling f/f for 1st recall, hope he doesnt pull stunts. and im freaking gonna take my single crown under the most sympathetic staff i can find!

in other news, pre-order for the new CBT Box set is now open at PI! got your copy now! bask in plastech goodness!

watched Paprika at the Picturehouse this weekend. for the people tired of Hollywood formula shows and lame edits to HP:OOP, watch this please. sure, its a teensy bit confusing, but when part of the plot is centred on mentally disturbed people it all makes sense! the fish and the frog swim in a storm of confetti! government spending in the year of the radish will increase!

Runner - Susumu Hirasawa

The Word Of Jon

2007-07-16T15:31:00.000+08:00

1: and after RDTPS, jon sat in contemplation for a minute, and then spake:
2: consider the squid, my brother, and be wise
3: for the squid, when it is confronted, doth squirt a cloud of ink and flail its arms. and when the ink hath dissipated, behold, the squid is not there.
4: but when the squid is surrounded on all sides, and hath emptied its ink pouch, then is the squid found in plain sight, and there shall be no escape for it.
5: verily, i say unto you, the squid is truly buggered, and fit for dinner.

Parodontitis Gravis et Complicata

2007-07-09T12:40:00.000+08:00

got me a complex perio e&d case! looks like a GAP too! been a good chance to learn about the diagnosis and treatment planning for an aggressive case, hope this all works out well. hope it works out for the patient too cos we'll be throwing away at least 2 teeth.

2 movie reviews! first up we have Transformers. contrary to popular fanboy expectations, this movie wasn't slaughtered. for some reason, the way this movie was shot made me more charitable to the artistic liberties they took with the storyline. so yeah, Bumblebee has transmogrified from an VW Beetle into a Chevrolet Camaro. Megatron is a plane! Ironhide isn't a van! Shockwave looks like a little freak! but is had big stompy robots, and that warms me to the core of my being. guess im easy to please that way.

Hooked on you was the girlfriend-friendly alternative to Die Hard 4.0, and after watching it i'll recommend this one. good plot, good character, and a strange Hong Kong sense of humour in a careflu, not-over-the-top-Stephen-Chow way. it captures the zeitgeist of the people of Hong Kong going through a hard point in their history, and the lives of 2 people in particular. watch this movie!

Project Little Plastic Locust is finished. Click here.

Difference

2007-07-01T20:43:00.000+08:00

operation Little Plastic Locust is under way! a much-overdue project, i have decided to take the time to repair a 3rd ed plastic LCT-1V from the Settlers Katong shoe box, and record my progress in photos to be made into a little guide. blame Inrepose if you want, that Archer paint guide was t3h r0x. so what do i have to do?

i have on hand:

-1 3rd ed plastic LCT-1V missing both arms
-1 right arm loaned from JT, with a request to make a new left arm for his LCT in addition to the 2 new arms i will be making.

both the locust itself as well as the detachable arm have some pretty impressive flash problems.

predicted steps to be taken:

1) de-flash the parts using
a: burrs
b: scalpel

2) clean up the parts with soap for good bonding

3) sculpt a greenstuff spacer between the left leg and the body to make up the 1mm discrepancy in thickness

4) create a reusable mould system so that i can make 3 of the bloody arm things in decent order, with options for left or right arm usage. deep thought on the bus home has lead me in the direction of a 2-part mould, with a 'male' die-stone member and a 'female' suck-down thermoplastic member. sprues may be required to minimise void formation. damn this is going to be fun!

5) cast the arms in plastic material. plan A is to use clear Orthacryl because of its original fluid state and lack of colour that could interfere with painting. plan B is TBR. plan C is greenstuff, far too stiff for what i want to do.

6) clean-up of the casted pieces, and dry-fitting to the dis-armed LCT mini

so yeah, lets see how this goes!

Go West - Eldissa

Life Is Peaceful There

2007-06-28T13:34:00.000+08:00

patients booked, cephs traced, table tidied. what more could i want for the new term? besides Bill Gates dropping 60 million greenbacks in my lap in a big paper bag...

Peijun will be starting up work in NDC on the 2nd level. im still here in NUH on the third level. wish i was in NDC, even if it wasn't the 2nd level. dont want to lose the interest in what i do...

2 weddings to play for in a week! i guess i must be getting old, i find myself starting to take note of the way the weddings are organised to gain a better understanding of how i want mine to be conducted. at the very least, i want one that goes according to plan! no little kids-who-toss-petals freaking out or swallowing the ring or whatever. no unexpected catering problems. no screwed-up music.

Staying Alive - Eldissa

Every Time

2007-06-24T23:10:00.000+08:00

council gathering at Suat's place yesterday night. guess ive probably detailed in earlier posts why i feel so strongly about my school and why i joined council. and now, so many years on, people i served with have turned into old friends with whom i can reminisce and play Munchkin with. people to relive the good old days with while we eat ice cream and brownies. people whom we can needle with old jokes as we lead into new jokes. people who im proud to call my friends.

Casa della Suat has some amazing stuff. a Wii as well as an XBox 360. and so i got to try out 2 consoles of which i have only been able to see in ads and on VGCats. the Wii is a fascinating thing. is it meant to be pronounced the japanese way as Wi-i or ang-moh style as Wee or what? and waving ones hands! how novel! now i understand all the crude rude mean nasty things from VGCats. they were absolutely spot on. played Gears of War with Meng as the rest indulged in a spot of bridge. the game sure isn't Halo, for one thing the interface is one heck of a complex. for another thing, i couldnt find a way to alter the sensitivity. running and shooting felt like trying to fight while drunk. slightly slow and disorienting. on the other hand, i guess the felon-soldiers of Delta Squad arent exactly as agile as Spartans. nonetheless, the puzzle elements of the game made it feel at least a bit harder than the usual point-shoot kind of fps or 3rd-person game. but will i ever get a Wii or a 360? yeah, dream on. maybe if the damn school decides to pay me for the help i give the juniors *broad hint!*

Winter Love - BoA

Taimu Reapu

2007-06-22T23:26:00.000+08:00

please watch The Girl Who Leapt Through Time. its the freaking best movie all bloody holidays. its got solid plot, character development, spectacular director vision, and good soundtrack. support good movies. bollocks to Pirates 3: At Wit's End and Shrek The Turd. put your money where the quality lies.

Streptococcus

2007-06-16T22:56:00.000+08:00

one week of holidays gone by. what have i achieved? what great leaps forward? what riotous fun?

watched Fantasic 4 with Peijun on wednesday. having not watched any of the previous instalments, i come to this series with a clean slate. and let me put it to you that this movie didnt seem to be worth the ticket money. a poorly-fleshed major character. a greater-evil type character as a mess of rocks. and ridiculous plot development. awful awful awful!

seems like i wont be getting my cluster allocation letters like the rest. Peijun got her email from SingHealth, but i'll have to wait until i come out before i found out what cluster i belong to....

went with Peijun to Settlers Katong to meet Pinfen, Siewping and John, and played Saboteur! looks like this really was a great christmas gift, even tho i havent had the chance to take my set for a spin. its the kind of game which can quite literally occupy you for 4 hours straight! decently fun because of the inbuilt hook of deceptive play, and it doesnt get stale because rounds are short. but of course it doesnt match up to my first gaming love of CBT. my dice still call to me in the darkness....

Nobody Knows - 伊藤由奈

Under The Moon

2007-06-11T23:13:00.001+08:00

one day of holidays over, and for the first time since ive come to FoD, i'm struck by how little holiday we actually have. the date is already into 2 digits, and at the end of the month i'm back into the grind, and PJ is going to work. the transcience of life's little pleasures is at once a warning to treasure what we have, and also a warning to expect all good things to end at some point.

its kinda sinking in that i am now attached to a Dr Chia. and she'll have to move ahead of me in life as i complete my unfinished business in school. i guess the good thing is that anything that i experience when i go to work wont be entirely a surprise, since i have a 6-month early 2nd-person preview. at the same time i'll be having to support her during the adjustment phase. oh well, maybe better one than both at once.

bought Yuna Ito's CD. good shit! having heard it on YouTube doesnt take away from the fact that its good songwriting and good singing. just wish DAI were still together...

what to do with the rest of my holiday? what to do?

Precious - 伊藤由奈

Poco Voce

2007-06-11T01:23:00.000+08:00

so my lungs have shrunk. got another month to grow them back before i play for Matt and Cheryl's wedding. need to regain my sightreading skills too. just feels like its been too damn long since i picked up my flute. if only there was some way to get in regular quality playing time... especially with a school schedule. and no, the Worship Team does not count as quality playing time...

what to do with the holidays?
1) regrow lungs
2) go and swim
3) organise for next term
4) do up patients' cephs
5) play excessive CBT!

really want some of item 5! my dice call to me to sieze them, ride forth and lay waste!

Stupidity is never more daunting

2007-06-06T21:00:00.000+08:00

as when it is systemic. why do we do the things we do? multiple steps to nowhere? break our hopes and pray that they reassemble? and why am i here in the middle of the night blogging in the lab, a can of Red Bull sitting in front of me, when there is work to do?

sometimes doing the right thing just doesnt feel rewarding. i finally got round to bringing in a patient i havent seen in a million years. literally. i dont need any of this guy's requirements, but on the other hand it isnt honest to let him sit and rot. so i update his xrays, TD his caries, chart his resto, perio and even his recession. and suddenly noone wants a backup exam case. noooooo! 3 crowns to go, anyone? please? im even preparing provisionals in case the ones i put in screw up!

finally getting in an ortho patient. prescreened by the boss himself, no worries about a screwy indication. hope i can work fast tomorrow.

damn i wish i could be overseas...

Unchained - Love Psychedelico

Leaf On The Wind

2007-06-04T13:11:00.001+08:00

seems like sometimes the world changes around us, and we're left standing wondering what happened to all that we found familiar. my lab is now populated by the incoming D3s, and while theyre a nice bunch, they sure arent my old class. half the class is overseas, and the rest are in the process of going. and me and ZX are left here pottering around in the lab chasing the dream of leaving NUS to spread our wings and fly off to some distant polyclinic where we can caries free in peace.

what is my role in life now?
1) i need to graduate. stat. the work i do, the things i study, must lead towards this eventuality. i must improve my hands and my mind to write well in my papers and stand tall during clinical dentistry.
2) i want to help my juniors not to end up like me. will this end up at odds with (1)? how much time can i afford?

擱淺 - 周杰倫

Left To Dessicate

2007-05-31T23:49:00.000+08:00

after a bit of nudging from wanwah, i've decided to blog again. dont know how often i can do this, or whether i'll find it as therapeutic as i used to, but worth a try i guess...

im stuck in school for a while longer. guess me posting it on the net wont answer all the people who ask me about it in real life, this is more for me to vent. i didnt give up on my schedule at the end, i was having trouble early on and didnt recognise it. wish i did. but for now, i just want to focus on getting out of this place. 4 years is plenty long, and if its been predestined for me to hang about a bit longer, so be it, but i'm going as soon as i can. in the meantime, i want to learn what i can, do what i can, and help people onto a path that doesnt involve time extension. now that i walk this path, i know exactly how much it sucks, and i dont want my juniors to have to follow in my footsteps.

finally passed my p/p. happy as heck. but the fly in the ointment of my prosthetic career is my f/f patient. guess ive vented about him in real life so many times, but every visit is a new trial, a new frustration, a new aggravation. i have learnt so much about him, about myself, and about the little private hell a patient can create for an operator. i shall take these lessons and treasure them, because they were hard earned. and having discussed with my instructor, once this royal ass is issued his f/f of doom we shall be writing in the notes that he is unsuitable for UG Tx. so shall it be until all have fallen...

the other good thing is that Lady Boss appears to have passed her exams, we're 99% certain and just waiting for the results to seal the deal. now for my turn...

Endless Story - Yuna Ito

The Angels Are Singing Again

2007-01-03T11:07:00.000+08:00

seems like i haven't had anything good to write about in a damn long time, but finally i have something to be well and truly publicly thankful for. Peijun is now a child of God! havent been this happy since, possibly, the day i was born!

Unfavourable

2006-08-23T21:43:00.000+08:00

its been just over 5 months since i last posted. and i am tired!

just the other day Stan and me were talking about depression. i suspect every person in the class may be clinically depressed. people are starting to crack up under the stress. i know im not coping as well as i would like. delayed dentures, skipped slots, and now a pharyngitis. bugger this. i want holiday and i want it now! but not before i pass those 2 competencies on friday. pulling that off might just make me go down in history for most crazy competency stunt attempted ever, but all i want to do is get some of that junk out of the way.

contemplating a spare exam case. looks like it has a bit of a history, though. talked to the last operator, and not only does the patient speak only mandarin, he also started to find excuses not to see her just as exam time was drawing near. but in itself, the case is damn simple. so tempting...

http://singapore-btechers.blogspot.com/

JT has made up a blog to let us get the news on CBT and official events. so if you love battletech and need some action, get the hell over and check it out already!

浪漫手機 - 周杰倫

My Modus Operandi Is Amalgam

2006-05-22T21:43:00.000+08:00

its been way too long since i last posted. too many things have happened in my life to recount, its just a big mess. and yet i find myself writing again. i hope i still find it therapeutic.

finally got round to watching the 4 episodes of Samurai Champloo that Debra the Violin Girl passed to me. it certainly lives up to the hype she placed on it, the standard of animation, the action, the themes are all excellent. its weird and wonderful. people get dismembered to the flashing of blades. got to get more...

its just so weird when not half an hour after you get your special tray looked at, you are informed that the patient for which you prepared it has departed this mortal coil. it seems like now i can rub shoulders with those who were among the legendary suay people of old. it just seems so surreal... the patient only sat in my chair once, and never had any time to make an impression on my psyche. and now he's gone, leaving a legacy of a ratty yellow file, a set of primarys and 2 special trays with no more purpose. a life, just gone like that.

they say knowledge is power, but to be able to use it wisely, that's another thing. on saturday on a crowded bus towards Clementi, i noticed a woman with a lesion on the left side of her upper lip. 2 cm by 1 cm, surface varied from a mole-like raised black to an ulcer on its inferior border. surrounding skin normal. my spot differentials include BCC and malignant melanoma. and what does one do with the information? is it proper for me to go up to a person and advise a consult, just like that? the 70ish woman had a companion, a 40-ish woman. was she her daughter? should i inform her? would that be inerference? i had no time to resolve my dilemma, they got off one stop after i noticed the lesion. we always say we're in it for the patients, to improve people's lives. do we have the power? do we have the courage?

i finally got off my ass and got myself an FP allocation for Mr Cho. to Prof Chew, no less. looks like major ass-kicking for me. thank you Dr Joanne. and damn...

Battlecry - Shing02

So We Hear/ He's Just Coming Back/ From Half A Year Of Withdrawal

2006-04-09T21:25:00.000+08:00

my holidays end in 2 hours... but it was good! possibly the best one holiday since i stepped into the faculty. watched movies, painted again, got to sun my ass even. and now the summer days fade away as clinics come round again.

Rent is an amazing movie. please watch it. disregard the Today review. they wouldnt be able to tell good movie material if they'd had it waved in front of their faces. as a musical, the point IS the music! but yet it's done in a way that doesnt break the pacing. Rent is energetic, harmonious, touching, spectacular even. the singing is tight, the acting tighter. and the plot is touching. please, go and watch this. on the big screen. with the surround sound. and a big barrel of popcorn, and someone who appreciates that good things don't need explosions or CGI to work.

Ice Age 2 was viewed with much lower expectations. it wasnt as lame as the newspapers projected, but then again all i was looking for was brainless laughts, which i found plenty of. torturing a flexible and dim-witted furry creature for amusement is fair game in animation! the animation standard is fair, good in the gross concepts but losing out slightly in fine textures light hair quality and ripples. but then again, how realistic do you want talking mammoths?

Tristan and Isolde, was by comparison, somewhat of a letdown. hunky men for the women? not really. hawt chicks for the men? not really. arresting plot? not so... i think Tristan's facial expressions just didnt quite carry it. and Isolde... lets not get started. a forgettable movie , while not bad per se it can only be mediocre at best.

i'm kind of wondering how this term will turn out. after the Great Scheduling Session, Shafiq, Adrian and yours truly ended up in the BK at Suntec having an amazing bitching session. it is most unfortunate that our class, as with any class, has started to show flaws during clinical years. i hope that this term will pass without incident. because i'd hate to be the peacemaker or arbitrator for a dispute in Yr4. there's simply too much at stake here, but by being selfish one merely gambles short-term personal gain against real bad karma. i hope that if anyone tries to play loopholes in the system the class will have the sense of solidarity to not let things stand and make the person see the error of his ways. it will be a sad day for the profession if the graduating class of 2007 come out into the word from a background of backstabbing and cheating.

楽園 - Do As Infinity

Neutral Red

2006-03-27T12:06:00.000+08:00

FYP is almost done! its been a royal pain in the hindquarters, doing mathematics, trying to get SPSS (hence SPAZZ) to work and hunting for non-existant things on google.com. had so many ups and downs in the course of 2 days that it's been absoultely draining...

2 overdue movie reviews! the first is V for Vendetta. i'd first like to state that i think Natalie Portman looks better with hair. now with that out of the way, on to the movie itself. i've always been a sucker for good music usage, and Vendetta makes liberal usage of a popular piece of classical music, giving it significance. 1812 overture as a backdrop for the demolition of some of London's great landmarks was an excellent concept. the characterisation was well done as well, with the enigmatic V gradually becoming humanised, and Natalie Portman's Evie gaining some backbone. other minor characters, such as the comedy programme host and the little girl with the pink t-shirt added depth to the plot. visuals were excellent. considering that this movie is more thriller than action (please do not ever compare this to spiderman) there is much less fighting and exploding. but when it comes, it doesn't disappoint. V's showdown deserves to be ranked up within the best fight scenes ever. and if you've been paying attention to everything, it just gets better because you feel for the character by this time.

our second review is Failure To Launch. this might be considered chick flick central, but it does indeed have a story to it. it could have been developed more, especially concerning Trip's prior life, and his 'nephew', but this did not present any jarring loopholes at time of viewing. characters looked comfortable and believable in their roles, and watching animals bite Trip was always fun. the scene where ACE gives CPR to a mockingbird stole the show.

a few days ago i made the discovery that PJ can paint. and well too. dragged my poor neglected painting gear and some minis to her place, intending to give a painting tutorial. my student truly has natural talent. pictures to follow!

Pictures At An Exhibition - Modest Petrovitch Mussorgsky

Chaconne

2006-03-09T01:10:00.000+08:00

in a few days the continuing saga of our class will reach another exciting climax. so why do i feel so apathetic about the exams? i think i'm just tired of the whole study routine. people keep saying i should be on the dean's list but i don't know anything! and the lack of DotA is driving me nuts. cant wait to get my computer repaired so i can enjoy the simple joys in life like non-laggy web page loading and fuss-free boot cycles. and yeah... its probably going to cost. far as i can tell the on-board chip is dead. Soh says its as good as 'hello new motherboard' which is so nice to know... that also means byebye to quite a few Yusof Ishaks. damnit...

went to the ACJC/ACS(I) concert today. amidst all the memories and inevitable comparisons of playing standard, i just wonder what it would have been like if i'd stayed current with my playing skills. like, say, if i'd been an ordinary science student with enough time to devote an evening a week or so to go down and play. it's one thing to spot the flaws in people's playing and another to realise that if it was me playing i dont think i could produce the same standard, or even that which i used to be able to put out. and for the record, i miss the days when they used to play the school anthem before band concerts. its a school concert, of course it should have the anthem. some things dont change, driven rhythm makes ACS players sound miraculously better.

need battletech... need to roll dice and blow stuff up...

Cao Cao - JJ Lin

Radeon

2006-03-03T16:29:00.000+08:00

have just been wrestling with my computer for the better part of a day. yesterday morning, c/o laptop interrupted boot cycle w/BSOD re: ati2dvag.dll creating an infinite loop. presented to the IBM care centre, at which point my stupid laptop didnt wanna reproduce the problem; a desperate roll-back was (temporarily) successful. in the afternoon the infernal machine proceeded to die on me repeatedly, and rollbacks were instituted repeatedly to no avail. this morning, searched whole damn room to look for original windows discs so as to format C: and get on with life. com then revived itself again and i tried to reinstall drivers. discovered to my horror that ATI no longer supports my little on-board chip. bastards... reinstalled the IBM driver (4 years old, btw) from website. com proceeded to BSOD me again. finally, as of 30min ago, have used a 3rd-party fix that allows the more updated ATI drivers to run for my little, now officially-old, laptop. i'm tired now. and theres still the matter of the broken M key and the possible huge repair bill for fixing that. assholes... hope my laptop can last out until i can at least find my discs. i have a really bad feeling that this might be a hardware problem.

Move This Mountain - Sophie Ellis-Bextor

Beyond The Plane Of My Imagination

2006-02-27T14:39:00.000+08:00

exams are up in 2 weeks. besides this marking the end of 1 year in clinics, and my utter lack of attempted competencies, the exams this year seem rather ominous. lets face it, the internal med and surgery admin don't seem to love us very much. lecturers not showing up, screwy ward round timings that mess with the doctors' work schedules... hope we all can pass this one. there's got to be more to this than looking for clubbing and splinter haemorrhages.

CBT looks like my latest greatest escape mechanism. my disciple's love of light mechs and maneuvre play seems to be developing quite nicely. in campaign, Warrick's Warriors have hit 2 lances and look all set to grow even more.

yesterday, Pastor Choo spoke of chicken curry. to paraphrase:
'chicken curry has an essential core which makes it a chicken curry. it must have chicken. it must have curry powder. but how each curry turns out depends on the values your family embraces. if your mum is health-conscious, your chicken curry will have no oil, and little salt. the chicken will have no skin. my mum wasn't a health freak. we were a Baba family, and the most important thing to us was that the curry be tasty...'
which sums up my feelings about food...

공중정원 (Garden In The Air) - BoA

Not My Cause

2006-02-22T20:58:00.000+08:00

even with a rather wasted session Dr Yap still amazes me with new techniques and words of wisdom. i wonder if we really do make our patient's problems into our own, i usually try not to but this patient had a filling done which may not need to be there because it's indicated for RCT later. and even when i wanted to hold payment Dr Yap advised charging ayway. but i believe i have to be accountable, the patient is claiming from her company. on the one hand, another endo case is still manageable, but on the other hand if her tooth miraculously recovers i'll be happy too.

just over 2 weeks to exams and i can't find the motivation to study. the books are dry, and i need some nice coloured pens. this sucks.

Joanne has been in the hospital for about 3 weeks, absolutely record-breaking. amidst all her fears of TPN, as well as conversations with the patient today about pain, really emphasise how much of a patient's behaviour is influenced by fears of pain. which leads us to ask, can we confidently indicate RCTs, crown lengthening, double jaw surgery confidently if we're too scared to do it ourselves, and can't rationalise it out within ourselves to have it done. hope her GI gets back on track, cos she's basically been starving for 3 weeks. although not quite as damaging as a post-op catablic state, 8kg and counting of weight loss is quite powerful.

Para Machuchar Meu Coracao - Antonio Carlos Jobim

Who Needs Summer Days?

2006-02-10T01:34:00.000+08:00

finally started proper work on my molar endo. working lengths determined for 3 of the 4 canals, and it feels good! TPH is my endo idol now, cos he taught us how to use a ZX and gave us a bit of rationale into obturation technique. hope that this endo turns out ok...

was reading some stuff online and found out that the song Summer Days by Do As Infinity is actually written in english. now because of Van Tomoko's garbled pronunciation, this wasnt apparent to me immediately. and so, i got hold of the lyrics and listened to the song again. it was freaking hilarious!

Summer Days


CHORUS
Summer days, I can't stand the summer days
Frozen cocktails and night fireworks
What's so great about them anyway?
Summer day, let it be some other day
Seaside motels and sex on the beach
Don't be thinking I went all the way

I hate summer days!

Rushing down the traffic, to the beach,
That's jammed for blocks and blocks
They ain't getting nowhere,
Still miles and miles left to go
Strutting down the street, the girls,
they try to impress their boyfriend to be
I give up and don't try
Every day is a bad hair day
Guys, they come up with lame pick-up lines,
Desperate to just get laid
Damn, give me a freaking break!

CHORUS

Goddamn summer days!

Kate was the one, who said that life was made to be enjoyed
Stop crinkling your face
Everything will turn out okay
Serving table to table up and down the isle
Had on a face I'd never seen
Whatever happened to her?
Who has stolen your smiles away?
Who said that summer can brighten the mood of fate?
Nothing is going to change
Damn, give me a freaking break!

CHORUS

Who needs summer days!

Summer days, they have never been the same
Once you left and were out of my sight
Leaving no trace behind
Summer day, why oh why on a summer day?
You were gone without saying goodbye
Taking it all away
No more summer days!

Summer Days - Do As Infinity

Who Am I?

2006-02-02T18:28:00.000+08:00

why do i feel like life in school is becoming purposeless? was suddenly struck by a sense of melancholy while doing suction boy and having a generally bad session. my grades are crap. i have no will to do anything about it. my health is spiralling down the drain. i make mistakes in clinic that are totally avoidable. my romantic life has enough landmines in it to stop an armoured battalion. i need a holiday bad. and a secretary. and 6 million bucks. and a big hug.

Creeping, Insidious, Slow Onset, Inescapable

2006-01-17T22:31:00.000+08:00

i guess its a sign of age when people who are your contemporaries start to pass away. although i didnt get to attend the wake service of Dr Alvin Tan, i'll still treasure the few reflective moments i had at his coffin-side. i hope that when its my turn to be the grey thing in the box, people will be able to remember that he was so much more than the sum total of the present contents of the box. that he lived, loved, fought, prevailed, created, healed, taught, made his impression in the world and cast something good out of it. will people miss me when i die?

OS posting week got off to a good start. got an assistantship and a LA exo done in a patient who wanted a 4-by-8 clearance. first time using a Warwick James too. and after that got to see Prof Yeo do an IMF on a patient with a left mandibular condyle fracture. arch bars with 0.5mm wire, heavy elastics and a little bit of magic, and you can really see the fracture reduce before your eyes! cool stuff...

Love and Honesty - BoA

Cardio-Pulmonary Resuscitation

2006-01-16T09:37:00.000+08:00

here i am resuscitating the old blog. time flies, and so do stress levels. even a lack of work is stressful, its highly weird having no labwork to do because my patients aren't ready for prosthetics. blame it on my E&D i guess... and thats the bloody last time i do E&D under an instructor who doesnt give a shit. 3 extra cavities undetected! blows the mind...

watched Memoirs of a Geisha on saturday. its kinda weird with chinese people doing japanese characters. and Mameha is a bloody hilarious name! apart from that... well, nice visuals. okay plot, even though the ending was like so obvious as to be visible a mile off. and Gong Li has like a 1 unit right upper midline shift! very disturbing when she smiles...

Soh dug up a voice comms program to enhance our DotA playing experience. now i have an excuse to use the pre-packaged telemarketer-style headset i have. and the rest of the guys have been urged to pick one up for ourcombined gaming pleasure. Operation Jue Dui DotA-Star in progress!

心の手紙 - BoA

Salvage Rights

2006-01-04T00:59:00.000+08:00

school isnt getting any easier, i really hope that i can keep pace. the work load is pretty crazy cos of how sessions do, or dont, line up so as to facilitate our work.

had an amazing perio session, got to finish a class IV in one hour flat! it looks tolerable despite the lack of assistance, and while i think it could have been better aesthetically with an assistant to help micro-manage, the patient is happy. contours have been rebuilt. occlusion has been checked. and i can be confident of filling this kind of cavity.

the new battletech campaign is looking up. placed an open bid to sell off a salvaged JR7-D at 70% of cost, hope someone buys. need more firepower, and a VND-1R fits the bill. but need to ditch the unwanted mech to save on pilots. the unit really is picking up nicely, with a mix of mobility, speed and firepower in the medium weight class.

A Sea Of Blinding Light

2006-01-01T20:14:00.000+08:00

new year is the time of year where we binge-eat and feel sorry after! after like 2 large dinners in 3 days i feel the bulge coming back with a vengeance. wont be long before all the musical stress weight loss is counteracted.

met up with the 24ths at Hui's place on friday night. pretty well attended with the right people to keep things lively. and none of the obnoxious people who would make things awkward. there was almost exactly enough food, and we played some amazing polar bear! i think im a real sucker for RPGs...

the post-production party at Turtle's place was pretty good too! more amazing food and a lot of fun. its just a pity that parties have to end and that i tend to run out of steam around midnight. and this time there was enough food to really make me bloat. wonder what happened to all the excess...

Red Wall

2005-12-30T00:27:00.000+08:00

PJ complained my blog entries are getting more boring. i think the internal filter must be working overtime, because if ya really think about it the days that go by cannot be completely boring. but i also wonder if every little wonder or petty disagreement or chicken wing consumed makes for good reading.

played a round with Stan and some random outsiders. lost the match but i got an offer to join clan RoTK. like... wow. the players i've seen in game arent too bad, above average actually. and he wanted me to join for competition purposes. his play was... ok though. the presence of an SA always turns a match into a gem party. had to do a lot of gem repo rounds. and i declined the offer. to have a BDS in my match account nick is all the clan i need.

My Vampire Heart - Tom McRae

Shady Crimbo Afternoon

2005-12-25T20:23:00.000+08:00

so how did this holidays go for me? as the holidays evaporate away into nothingness, i can say that have not accomplished much. played enough, gone out enough. rested well. eaten good stuff. seen nice movies. but was it worth it? i hope so! im finally done with the musical. and i think it did leave its mark out there. but next year, im gonna be an usher. for sure.

Under The Old Raintree

2005-12-20T11:36:00.000+08:00

another long overdue entry in a dying blog... seems like all the blogs that my class writes are dying by apathy. perhaps we're sick of seeing each ohter rant about our closed lives. or how tired we are in the face of all the nonsense that school flings at us. i know i could do with another holiday. spent on the beach with an enthusiastic puppy and a frisbee or sth.

its almost over, it really is. i guess this is gonna be the last pre-production entry about the musical. its been too damn long in its inception, and the labour of making it was troubled. its gonna be over soon and frankly it doesnt look to bad at all. hope that people dont fall apart on us as we hit the stage on the nights. hope that the cold air in the auditorium doesnt kill off my voice. hope i dont get winded moving and singing. hope Ben doesnt screw up her solo. hope the people i invited come!

went down to do an E-case yesterday. i swear... provis will be the death of me. broken provi, he said. and it was actually the metal of the stainless steel crown form coming apart. haiz... after smoothing that off and recementing, i decided to redo the adjacent provi that had awful overhangs what were contributing to gingival inflammation. at 4.30 i figured that i was dying and had to go to the DC for help. at 6.00 the patient was discharged. i now have a new idol in Dr Lim Boon Kuan, who is like amazingly fast and efficient as she works. one day i will be bloody fast like her. such economy of movement... and i still hate doing provis in live drooling patients.

翼の計画（花王ラビナスＣＭソング） - Do As Infinity

Songs Of The Future, Lyrics Of The Past

2005-12-15T17:48:00.000+08:00

i must be going through some bad-ass down-period if i simply don't feel like writing for long periods of time, especially if writing has always been so therapeutic. but somehow in the life that ive been leading for the last month or so i simply can' find anything nice to write about. and the bad stuff has been axed by my internal privacy filter. i wish it wasn't this way. but thats life. there are times when there will be problems but you just can't scream them into the north wind, or in this case the Net, because there is just too much at stake. you never know who's down south. and i have so much to learn, so much to do, and so much to grow into.

infections suck. this pharyngitis just doesnt want to bugger off and i wake up every morning with bits of phlegm waiting to be coughed up. as an aside, the Nokia dictionary doesnt have the word phlegm. and i fell a bit sick every day but not sick enough to go to the doctor. this is just annoying.

just ripped a CD off of Anqi. this is the first Jay Chou CD to actually make it to my hard drive, and it doesnt disappoint. good melodies, though i cant comment on the lyrics. wish i could just have the time to lie down somewhere and fall asleep with my music collection playing in my ears softly. bugger this...

夜曲 - 周杰倫

A Little Bit Late For That

2005-11-29T13:23:00.000+08:00

why in the world would Do As Infinity disband? i'd say their career was still going strong, and their songs were always good to listen to. maybe they got bored and wanted to start with something new and unprecedented. wonder how Van Tomoko will sound as a solo singer? they will be sorely missed...

watched Harry Potter and i've got to say that the thicker these books get the more time they'll need to cover all the points in the book. i mean, for goodness sake, kids may have short attention spans but the movie felt so... rushed! Krum didn't quite look they way i expected, the Triwizard challenges felt so short and Voldemort didn't look threatening enough. it was really just an okay movie, watched for completeness.

Under The Moon - Do As Infinity

Dessication

2005-11-08T23:14:00.000+08:00

who the heck has my Jack Johnson CD? i'm supposed to lend it to Debra the violin girl, and i can't find it anywhere!

finally fitted and issued my F/P, and im so happy its out of my hands and into his mouth! all those evenings spent a-grinding and a-cussing, and now i get to see my little plastic labour make it into a mouth. we'll see how it does at the 1-week review, hope it isnt covered with muck and gross stuff. still have his old one in a plastic bag, goldfish-style, in my cupboard as a failsafe...

dance practice for the musical has finally started. woke up on the morning after hurting in the arm cos of heaving the lead actor around. like... hey! he's supposed to be lighter than me... the absence of some of my chorus is disturbing, because they will have a lot of catching up to do, being able to sightread is one thing, but dance cannot be sight-read.

so is OKC really a neoplastic entity?

牙關 - 五月天

Alpha Strike!

2005-11-05T23:50:00.000+08:00

its been way too long since i blogged. what things have passed since my last entry that would have been worth mentioning? what have i done with my life?

today i taught 4 people how to play CBT. its amazing how long its been since i played, i couldnt even find my dice and record sheets. had an early morning heart attack searching my room for my damn stuff, thankfully they were just safely boxed away by my mum. but i managed to get the box set, shitloads of dice and the RS out the door by the time i had to go for orchestra. and then off to Shafiq's for the Great Hari Raya CBT initiation. players: Mao, PJ, Clement and Shafiq. they all got random mechs and set right to it. it was a bit rough-going, because i was rusty, and we couldn't finish the game due to time constraints, but everyone had fun! and that's ultimately what is important. and at least they had guidance instead of my baptisms of fire jumping straight into L2 rules. mebbe some day we'll play again....

Catch The Sun - Jamie Cullum

Only Sadness

2005-10-26T19:41:00.000+08:00

i have no idea why but James Blunt has become the singer of the season. he sings melancholic, slightly gay songs which grab your brain and refuse to let go. frankly im afraid of overplaying his stuff but nothing else seems to do anything for the moods ive been in the last week.

im seriously starting to wonder if another half year extra is in the works for me. i feel so damn inadequate in the face of the great work that is my profession-to-be. and the prostho stuff is not coming up fast enough. and the way my out-of-school life is going, i'm enough of a wreck now for 2 men.

No Bravery - James Blunt

There Would Still Be Music Left To Write

2005-10-15T12:49:00.000+08:00

somehow havent had the incentive to blog for a long time. my life lately has been a mess of burring and flaming, and tempers have risen and fallen in a steady synchronity with how my patient's teeth are lining up. its frustrating when work slows because of lack of the proper items, and uncertainty about how to proceed. i need to find Mohammad stst on monday morning cos the teeth i've been issued for my Yellow File Ah Pek are too tiny. and setting him up with 3 or 4 anterior diastemata is just gross.

latest hot topic in the local sections of the paper has been aggressive proselytising of patients by the Christian members of teaching and healthcare professions. our nation has been miraculously glued together despite its diverse creeds and cultures, and religion has always been a touchy thing. a disturbing factor is that by nature, Christianity is made to be spread. its methods seem agressive next to the other religions where the usual mode of entry is birth. there is, and i will categorically state this, no such thing as a person born into Christianity. we gain our converts via, you guessed it, conversion. decisions made as conscious, convicted, consenting individuals. so the question is, should doctors be allowed to practice and preach? should they care for the soul of the patient as well as his body? should the dentist have a tract rack in the waiting room and bible verses on the wall where the patient can see as he's stuck in the chair, captive and rubber-dammed? when are lines crossed? where are the lines? how can a healthcare professional be so insensitive? i think amongst all of these the Christian healthcare worker should be sensitive to the call of God. ask nicely before proceeding, and back off if the patient is in pain, just like any other procedure. no preaching during venipuncture, definitely.

How Many Hearts - Travis