Nepal Earthquake Experience - a life changing experience.

It has been a month since I left Kathmandu, Nepal. Coming back, my life was in such a chaos handling the work that I had left for 8 days. Exhaustion was merely an understatement as I sought the balance between my children, my work, my patients and many more decisions that required immediate attention. 1 month is perhaps a short time to resolve most issues in view of how big they were, but I am not planning to talk about all those. I want to tell you about Nepal.

My first interest in Nepal was when I was a young girl and we use to play a detective game called "Carmen Sandiago" (Yes, I am not that young anymore) - one of the cities that the thief would travel to was Kathmandu in Nepal. Nepal also hosted the highest range of mountains i.e. the Himalayas and Mount Everest. It has been a lifelong dream to see the Himalayas with my own eyes and to experience its magnificience. It is also home of many artistic cultures of Hinduism with beautiful temples and architecture marked as UNESCO heritage sites. The lovely paintings, cashmere products, beautiful literature and unique history is enough to pique my curiosity enough to agree volunteering myself for a medical relief team despite my crazy schedule.

A massive earthquake had occurred in Nepal which caused a lot of death and destruction on April 25th 2015. It was recorded at 7.8 or at peak 8.1 Richter scale Magnitude. Gorkha was hit the worst and it was estimated 8000 people died, 23,000 people injured. It was the first earthquake in more than 80 years according to the locals. Reading about it in Malaysia, I did ask my team whether are we going or not? 

So after 2 weeks they decided to send the first team and we left on the 9th of May 2015. My team consisted of 5 people with Papa Joe being the logistics coordinator, me as team leader, another male doctor and two nurses. As usual we brought medication along which luckily we had clearance from the Malaysian Nepal Embassy to bring in so there were no hiccups. It was a 4 hour flight from Kuala Lumpur but we lost 2 hours due to time zone differences. We arrived late night and by the time we went throught the visa and customs and collecting our baggage, we were out at midnight. Luckily we were welcomed by the Islamic Sangh Nepal group who facilitiated our whole stay and mission. Checking into the budget hotel provided, I was thankful that at least it had a clean bed and a proper toilet. We brought our sleeping bags just in case we need to evacuate and sleep outside.

The rendezvous point for our team was the mosque in Kathmandu. We were amongst the fourteenth or fifteenth team sent there for medical help so most of the relief works have been done. In fact most of the teams were already leaving, but it was okay. There will always be some area requiring assistance and medical attention. In my 10 years of experience vounteering for medical relief efforts, this was one of the most well coordinated effort I have ever seen. We were astounded at the amount of funds and volunteers who came in, and the amount of food and basic necessities distributed like tents and blankets. 

I spent the first day doing the official stuffs like informing the Malaysian embassy of our arrival, visiting WHO command center and getting maps to plan out our activities. We visited the health office to inform of our presence whilst my other team members followed the Pakistan group to conduct medical health checks. So I had a good look around.

Kathmandu was a beautiful city with a mix of old and new architecture. There were purple flowers growing on trees as the mark of early summer and the weather was sunny around 25 degrees day time. However, the whole city was so dusty that it was impossible to walk around without a mask. Initially I thought that it was due to the earthquake, but then I realized that they had a dry and hot weather that causes dust particles to suspend in the air longer. Coupled with on-going pollution, construction and not-so-hygienic practices it had turned this beautiful city into a dirty one. Our food choices were limited due to our own dietary restrictions but it was good enough. The mosque provides food for 500 people a day each meal time, and there were 2 shops selling Muslim food. The spices used were very different than in Malaysia, and I realized I was putting on too much weight from the lovely Biryani dishes. Another interesting dish was Momo which was something like a boiled meat dumpling and fried meatballs.

The second day we were sent to a remote area northwest of Kathmandu at the Tamang area inside district Nuwakot. Tamang are the rural folk of Nepal who live in mountains and valleys. We literally crossed 3 huge mountains, crossed a river and travelled 3 hours in a car that occasionally required us to get off and push it out of a ditch or mud. Yes, it was fun. The people were happy to see us. I met one of the UNICEF photography groups who were stationed there for a week. Pity I forgot to take their contact information. It would be nice to see their work. On the way back, it rained and thunder was clashing as we went down the mountain back to our hotel.

The third day, we were stationed nearby at a place called Sitapaila. Sita is the goddess Sita (Hindu beliefs) who was thought to be the daughter of the goddess of earth, Bhumi. She is the central female character in the Hindu epic Ramayana and was married to Rama. She is revered as the epitome for all Hindu women and is known for her devotion, self-sacrifice, courage and purity. Paila in Nepal means slipper or shoe. The village is about 10km from Kathmandu. Being in the outskirts portray more of the womenfolk who tends to the wheat fields. Whilst in the city, I could not help but notice the more male to female ratio of people walking around.

We were about to start our mobile clinic when we heard a commotion. I turned around and everyone had left the building we were in, and I heard someone shout, "Run, run, quick". We ran outside to realize an earthquake had just occurred lasting for maybe a few seconds or minutes. (I was disorientated at that time because it was my first experience).The ground shook and then it stopped. Everyone was quiet. Then in the distance I saw one building collapse, then another one, and another one. I sucked in a deep breath and said a prayer. Subsequently there were a few aftershocks not as strong as the first but no one dared go indoors. My colleague suggested we do a quick scout survey of the area to see if anyone was injured, so with 2 motorcycles we were pillions checking on the schools, and surrounding area. Luckily none were severly injured, just a few cuts and bruises. After that, we continued the clinic and we only returned to base in the evening. It was only then did we realize the magnitude of the quake. It was a 7.3 richter arising from Sindhulpalchowk in the northeast side, extending through Kathmandu, with an aftershock of 6.8 richter occurring minutes after the first (Yes, I felt both). A building in Thamel district collapsed to rubble and a few buildings cracked. At least 117 people died and 2500 people injured this time. They were more prepared due to the first episode of quake, and most people have only started to return to their homes. Subsequently, there were a few more quakes occuring on the next days we were there.

Perhaps the worst was the one that occurred at night when we were sleeping. The whole building shook and I jumped out of bed to run downstairs. It was 2 am local time. Just as we went back to our rooms, another one occurred, less strong but significant enough to make everyone hang around outside. In the morning we were informed that the quake was 6.8 richter and that Japan had an eathquake too soon after what we felt. I couldn't sleep after the quakes. I was thinking about my babies back home. How would they survive without me? I count my blessings every day that I am alive. The subsequent days we were sent nearby to Bhaktapur (south) and the last one was at Nagarkot located east of Kathmandu. Nagarkot was at a mountain district that allowed you to see the Himalayas on good days. We were lucky, we managed to see the Himalayas although Mount Everest was covered by clouds.

Experiencing the quakes was really life changing. Some people would chide that it was just tremors, but then again, what if a building toppled on top of you or you didn't realize because you were asleep? What if the tremors were signs of bigger ones to come? The Earth is changing and we are seeing more and more disasters happening. Maybe the level of pollution and ravage that we humans have done has reached a point where the Earth needs to evolve again to cope. Maybe it is the start of the end of the world.

To the people of Nepal, I enjoyed your hospitality. They were very receptive and welcoming the help we were giving. My only qualm is the cleanliness, which I hope they will improve on after this. Regardless, I will definitely come back and hopefully in much better times as a tourist, to embass in the beauty of the old city and its treasures.

Tribute to MH 17 ...... May your souls rest in Peace.

It is definitely a sad Ramadhan for Malaysians. The ending of the football World Cup series marked the start of the Zionist bombing and massacre of Gaza. Many children and women died overnight whilst the whole world was focused on the semi-finals. It is definitely horrific news. Religion aside, which part of humanity allows such mass homicide is beyond understanding. In the midst of all the protests towards the violence in Gaza, Malaysians were shocked by yet another news.

We lost another plane. MH 17 was traveling from Amsterdam heading back to Kuala Lumpur was shot down in Ukraine skies and there were no survivors. Everyone was flabbergasted. Everyone was shocked. I guess the whole nation seemed to have been silenced by disbelief. That was only a few days ago. 17/7/2014 marked the lost of our plane with 293 passengers and crew. May God keep the souls in a better place. The major question now is why?

There were many theories. The Ukraine government says that it was their rebels, some say it was the Russians, some say Ukraine government. Some believe that some other countries were behind it. It is still an on-going investigation. Our Prime Minister looked so miserable. I could not imagine how I would feel or what I would do if I was in his shoes. He deported our people to help investigate and bring back the bodies. 2 planes in one year is highly stressful. The only thing we can go as a nation is to stick together. No point pointing fingers and blaming each other. It is a time of grief, but we also need to get to the bottom of this. Emotions aside, we have to be as professional as possible in handling this situation as there are many parties involved, and perhaps nation ties may be severed if any wrong remarks are made. Mr Prime Minister, keep your head straight, chin up. Remember that God will not befall on to you something you could not handle. Pray for guidance and Insya Allah if you are true to your people and is sincere to lead, God will help you, regardless.

To the families who have lost their loved ones, my condolences to all of you. My sister's friends were on that plane and my dad knew a family who were related to some of his closest friends. The thought of 100 AIDs researchers, scientist and motivators lost in the flight is a major pang to the scientific and medical community. Dr Lange was one of the most active activist for AIDS, who was also the pioneer and former president for the International Aids Society. His untimely death is a great loss to the AIDS community. Some even believe they had the cure for AIDS on that plane. So many people were affected by this tragedy. 

We lost another good pilot and another good crew. Its just too sad and at the same time scary. Air travel now seems to be so dangerous with all these unanticipated disasters happening. I salute the air crew who still continue working despite 2 tragedies in a year. For a lot of people, air travel has become a source of anxiety. Still, emotion aside, let's look at the facts. With 2 tragedies a year means that Malaysia Airlines and our government has to fork out millions to overcome the disaster and reimburse the families. MAS will be in a fragile state as the money deficit increases. With the lost of confidence of the airline due to these disasters, it will cause the revenue to plummet down more. Other airlines will benefit, and there may come a point where MAS will be taken over by another party. But remember, MAS belongs to the people. It is a nation asset. Losing MAS is a tragedy and as Malaysians we should not let this happen. We should be strong together, MAS needs the nation support, and we should support our local airline. Perhaps reorganisation of the Company for a more efficient performance during this stressful time is needed to survive. As Malaysians, we should do our part to support them. MAS hospitality has always been the best so far. They carry our image as Malaysia.

My prayers are to the souls that were lost in the flight and to the families who have to bear the lost. May God give them peace, and God give you strength. Let's pray the bodies can be brought back as soon as possible for a proper burial. Let's hope we are able to find out the true story behind the incident and those responsible are brought to justice. It is a sad time for all Malaysians, yet we must stand together and be strong. Despite our differences, we must unite as a whole nation. I think all of us feel it, the need to be united. Somehow rather with all the events occurring in this short span of time makes us feel like we are being attack by some unnamed force. Let's hope I'm just being paranoid.

Eid is just around the corner. Usually by now the radio will start blaring the Eid songs of fun, laughter and going back to the home town. We are still in mourning. Let's pray for the best together. Hopefully Gaza will also be able to celebrate Eid in peace. 

By the way, the clinic will still receive appointments till Saturday. I'll be celebrating in KL again, so we'll be open on Wednesday for patients by appointment only. Do call us at 014-2233268 or email to faceworksclinic@gmail.com for appointments. 

Tried & Tested for this season..... Lalala......

It has been a very dramatic weekend in Malaysia as the 13th General elections took place and for the first time in history the turn up of voters were estimated around 10 million people which is the most so far. And most people were parading for change. So with the announcement of BN still remaining as the federal government, there were a lot of grouses and dissatisfaction from the voters. Especially since they are calling foul play as to be the reason for the current party to retain its victory. Despite the results are out, there is possibility of a rematch, or change in power in view the opposition leaders are determined to get justice. Many Malaysians wore black as a sign of protest as to how the election results were finalized, with many who were on duty confused as to how the amount written on the Form 14 and mutually agreed upon suddenly became a different number when announced by the election committee. Some were even more confused with the sudden black outs during the finalizing of vote counts, and TNB (the national electric company) claims they have nothing to do with it which made more people suspect foul play. Not to mention the appearances of ballot boxes that may have possibly fallen from the sky to side more on the ruling government. 

Since the election fever has not really subsided, I finally have some time to review some products that I have been trying out.

1. Rejuve TruWhite & Black Magic Whitening Soaps.

These are 2 whitening soaps from the same company. Black Magic has glutathione with papaya extract to help reduce inflammation. It is mainly for acne prone skin. Personally I haven't tried this one since I do not really have acne much except for the occasional hormonal spike break outs but based on what I gather from those who have tried, it does help to a certain extent especially for acne on the back and very oily skin on the face. I have been using TruWhite for the past month since I came back from Penang. It is a 100gm bar soap. Normally I am not a fan of bar soaps as the usual commercial ones give me break outs. Out of curiosity, I decided to give this a try. The soap has a very nice fragrance and on application makes the skin feel very clean. Its active ingredients are glutathione and sheep placenta extracts. It is slightly drying for those with dryer skin. After a week of using this soap, my skin does feel a little bit softer. In terms of whitening, I did notice an improvement of tan (I was really tan from Langkawi, Penang and Singapore). Fairer than I usually am? Perhaps not, but what could you expect from just a soap. Still, it does give me a softer feel, a more evener skin tone and it is very safe, even for children. Aina loves it. The retail price for this soap is roughly RM 35 +/- only, and is worth trying out. 

2. Age Defy Crystal Tomato

This is a new product in town which I found during my conference in Singapore. Crystal Tomato is a 100% vegetal extract from a special type of tomato grown in a controlled environment. The colourless caratenoid has been found to be a very potent skin whitening agent and through research and technology, they have managed to extract it into an oral form taken once daily. To make these tablets more effective, they have also included L-Cysteine which is a precursor for glutathione production in the liver to give you a more anti-oxidant effect.

Crystal Tomato™ has been scientifically proven to offer the following benefits:

1. Serves as a natural sunscreen against UVA and UVB rays to protect against UV damage, photo-oxidation and sunburn.
2. Acts as anti-oxidants to protect against free radical damage caused by environmental aggressors.
3. Contains anti-inflammatory properties against wounds and UV damage.
4. Inhibits melanin synthesis to prevent pigmentation spots from forming.
5. Reduces the melanin present in the cells including dark acne scars, freckles, dark underarms and age spots for an anti-ageing and anti-photo ageing effect.
6. Prevents DNA damage.
7. Promotes even skin tone and radiant complexion.
8. Protects and enhances the efficacy of other active ingredients and their activity.

Personally, I have been consuming this product religiously every morning and now entering my second week. The most striking difference I can see is the radiance that emits from my skin even without having to wear make-up. My skin tone seems to even out more, but pigmentations still remain. According to the literature study, it is suppose to help with pigmentation as well as it also affects the eumelanin pathway. I also notice that I do not tan as much as compared to before even without applying sunblock and this could be the sun protective effect that they mentioned about. But its only 2 weeks, I'll have to finish the box and write another review later with more explanation about the science. This product's retail price should be around RM 450 a box of 30 capsules, single tablet a day. The tablet is pretty big, but you can chew on it, it has a tomato taste actually. The product is still undergoing registration process in Malaysia. It is already registered in Singapore since last year. 

3. SRS e-Co2 Gel Mask

This is not a new product in the market. I have been using this mask on my patients for the past 4 years. as a rescue mask after doing procedures. One of the most significant case was a patient who was allergic to arbutin and developed redness and swelling over the face. She was allergic to a lot of other stuffs as well and her birthday was in 2 days. We tried the mask on her, and it help reduce the redness by 50% on the 1st application. I gave her another one to use at home and by the second day, only a slight redness that is concealable by make-up. Not only the redness disappeared, but her skin became softer and more radiant afterwards. So why does it work so well? Carbon dioxide has been known to cause blood vessels to dilate if present in a concentrated amount. When applied into the mask, the CO2 granules create a relative gradient of higher concentration of Co2, hence increases blood circulation to the area of application (usually face). It also increases local tissue metabolism and enhances the separation of oxygen from haemoglobin thus increasing tissue oxygenation. This in turn improves tissue healing and thus, the almost instant result. 

I tried out this mask last night after having a chemical peel and arbutin iontophoresis done to the face. It had a warm prickly sensation which was not uncomfortable. After the 30 minutes, we took it off and I can feel that my face felt tighter and my pores appeared smaller. Even pimples seem to have shrunk. Immediately, my skin felt very soft and smooth. Today when I woke up, my face still felt smooth and soft. The whitening effect of arbutin kicked in, hence my face did appear brighter so I can't really say it was an attribute of the mask. However, for the past couple of days, I noticed my face to be very oily when I wake up in the morning that I require Turnover to reduce the oil. This morning, my face was not  oily and I only washed it with water before sending my kids to school and chilling out in KLCC for breakfast. Even without any make up or sunblock my skin looked healthy. This mask is sold at RM 250 a piece if you would like to bring it home. If you like to try the effects yourself, you can opt for one of our rescue facials - I have taken the liberty to include this mask into some of our treatments since it has shown to be very effective.

Interested in any of the above products, feel free to contact us at  Faceworks Clinic : 03-21440080 / 014-2233236 or email your enquiries to faceworksclinic@gmail.com. For facials, please book prior appointment. Thanks.

Sweat Sweat here... sweat sweat there........

It has been a super hectic month. With Fashion Week started end of September in New York, so a lot of the boutiques were having their fall/winter collection show. Fashion is a personal interest even though I am not really a shopper. I love seeing the designs and colour themes that come out which are distinct from years before. 

The fall and winter collections are very interesting although perhaps not the best suited for Malaysia's climate. Malaysia so hot and humid, so it's almost impossible to wear tweed or fur or long coats. Besides, we do not have snow here. Its sunny year round. Because of this sort of hot humid weather..... the major problem everyone have is sweat. A quick stroll between shopping malls and you will start sweating. If the sun shines a little bit more, everyone will start sweating.

But some people sweat more than others due to hyperactive sweat glands. The term for this is hyperhidrosis. According to PubMed, "Hyperhidrosis is a medical condition in which a person sweats excessively and unpredictably. People with hyperhidrosis may sweat even when the temperature is cool or when they are at rest."

The causes can be primary or secondary to other medical illnesses. For primary hyperhidrosis, it is usually limited to a few areas of the body commonly arm pits, hands, face and back. It affects 2-4% of the world population and seem to run in families. It is a simple problem, but it can be pretty annoying to those who have it. Especially in social functions in a hot country like this, you'll be needing to bring a hanky and wear sleeveless. 

There is no permanent cure for this problem. Yes, some surgeons say you can do ETS (Endoscopic thoracic sympathectomy) but its like a double edge sword. Despite solving 85-90% of primary hyperhidrosis in palms, there is a compensatory sweating risk that occurs in 20-80% (Notice the wide range means that it is different for each individual). Not to mention the other risks which can be minimized in very careful hands but still, it is hard to say since you will be tampering with your sympathetic nerves. Plus, the procedure costs a bomb between RM 10-15K depending on center.

The over the counter aluminium chloride preparations to help inhibit sweating does work to a certain extent and is much more affordable. However, this is only for mild cases and the concentration of this compound has to be more to have a more visible effect. The common side effects would be skin irritation and later leads to darkening of the skin (note how using certain deodorants the armpit area becomes darkened?)

So the next modality of treatment that comes into my field of interest is the use of botulinum toxins (Botox/Dysport/BonTa) to help control symptoms. In the past, we learn about the use of botulinum toxins to relax muscles causing dynamic wrinkles. Then it extended to skin tightening, pore closure (yes, it can do these too if you are willing to fork out the cost) and now sweat glands. How did this came about? Well, it was observed during the early usage of BonTa on the forehead and the patient would complain of less acne or sweating. So, they studied it more and found that it does help to stop overproduction of sweat by sweat glands by making them inactive for a certain period of time. Usually, we will dilute the toxin more compared to what we use on the face as our aim is more for the sweat glands and so lower doses at a more distributed area is ideal. In fact, recently FDA of America has approved the usage for underarm sweating.

The procedure involves multiple superficial injections aiming at the subcutaneous of diluted botulinum toxin. The pain is tolerable although now with advancement of more potent pain relief, it can be minimized. It takes about an hour to complete since it involves a few things. There would be some local swelling, but usually subsides in a couple of hours. Results can be observed between 1-2 weeks after injection and lasts 4-9 months on average depending on how severe the hyperhidrosis was to begin with. Complications? Less sweating at the area of injection and dilution but for palms, there may be some muscle weakness of the palms. Cost wise - depending on the area and the technique used can be between RM 2-5K per session. Regardless, comfort is valuable and not being shy due to wet armpits and sweaty palms is makes a huge difference to your life.

For more inquires or appointments, please email to info@faceworksclinic.com or call the clinic at 03-21440080

Sexy Lips......... In 15 minutes...

Lips... Lips... Lips..... Everyone is so obsessed with lips. Which is why cosmetic companies make so much creating lipstick and lip conditioners from various types to various colours. When a person looks into your face, the 1st thing that catches their attention would be eyes than lips, hence it is normal for us to want to have perfect lips. But lipsticks can only play with colours and some enhancement which is gone by the end of the day. And as we age, our lips start losing its shape, colour and more wrinkles are seen, especially if we smoke. So what can we do? Fillers of course. But which one?

Lip filling with fillers is not really something new. It has been around from years and was especially rampant in the United States. But in the past, most people used silicone or collagen lip fillers and the idea of enhancement was to have bigger lips. But bigger did not always meant better.

(Borrowed From Top 10 Worst Celebrity Jobs)

Looking at the celebrity botch jobs makes people feel scared to even think to try, but we all know that when it comes to tabloid, everything is blown big out of proportions. The other issue when dealing with lips is pain as the lip receives multiple nerve supplies in the face hence explain why the lips is a very sensitive organ. The saying before Beauty is pain. I personally do not believe that.

Which is why when Juvederm came out with their XC brand, I was excited. So what is Juvederm? Juvederm is a brand of hyaluronic acid filler which claims to be the number 1 brand in the world. Now they have preparations with lignocaine premixed in the syringe to reduce pain and inflammation. I have been using Juvederm for years, and it is my filler of choice when it comes to dealing with lips because of less problems when it comes to lumpiness. (Yes, fillers can get lumpy at times). Plus it softens within 2 weeks and now with lignocaine in it makes it less painful. Prior to this, I would need to give a complete nerve block around the lips which would involve additional 7 injections to get a good block - but with this, I have an option to reduce the block injections or not use blocks at all. (For first timers, I'd rather use blocks)

Furthermore, since it is a very soft and smooth product we can inject with a small 30G needle to allow better control and shaping. It is FDA approved to last 12 months, so for a non-permanent filler, this is ideal. Yay, great - now we have no pain and temporary. What else to consider?

Before you want to get your lips done, you need to have a clear idea what you want or at least discuss it with your doctor. From my observation, most young ladies prefer to increase the size, and more matured ladies prefer to return their original shape. Having a non-permanent filler the first time round is good, as you will have a look and feel of how it will be in case you do not like the change. I would normally advise, less is more. Its never good to look done, the more natural it appears makes a lot of diference. How many syringes? Usually for lip defining and contouring takes only 1, but if you are thinking of adding up volume then maybe 2 or more. How much is it? Well in US roughly around $600++. In Malaysia, the price starts RM 1500 onwards for the XC range. In proper hands, you can get marvelous results.

 

2 syringes of JUVÉDERM^® Ultra 1 week after treatment

Interested? Please call 03-21440080 for consultation and appointments. Especially for our Mother's Day Open House on this coming 5th of May, we will be having a Juvederm XC lips demonstration and will be selling RM 1200 coupons for Juvederm lips only on that day. This coupon can be used any other time till 1st Jan next year. See you there.