Empathetic Understanding

1. She is just 14. Feeling dejected, sensitive to criticism, need to be loved, wistfulness formed part of her personality. Dad is ill with multiple chronic ailments. Mum, a rubber-tapper has to work hard on a piece of rented land. She aspires to become a doctor one day but her achievement is just minimal.

2. She knows she got to read books until the sun comes below the ridge line and dusk had a full grip on the sky. Dad hollered out a warning warily. The slogan is for her to study hard and help them change the family financial situation for the better.

3. Every time she thinks about it her head pulses. Headaches become a psychosomatic symptom. She had just plain stressed out from this anguish and its aggravations.

4. Depression, of course, has to be ruled out.

5. Empathetic understanding by entering her private ‘world’ so as she could communicate her feeling regarding all her dilemma without hesitation is necessary.

6. She has to understand her attributes and learn to modify some of her attributes.

7. My advice is for her to be realistic about her aspiration to some achievable goals.

8. Lastly, learn to express the latent conflict.

9. The family role has never been underestimated. Who else, is the best to show empathetic understanding, if not the parent?

What the Guidelines Say About Hormone Replacement Therapy?

Women in general need to be educated on Hormone Replacement Therapy.

Indications for the use of Hormone Therapy include the following situations related to menopause:

– relief of vasomotor symptoms (hot flushes, sweating)

– relief of joint and muscle aches and pains+

– relief of sleeplessness and other sleep disturbances+

– relief of depressed mood

– relief of urogenital symptoms (vaginal dryness)

– relief of sexual dysfunction, such as decrease libido

– maintaining and improvement of quality of life.

(+ commonest complaints in Asian postmenopausal  women)

– As a prevention for bone loss and fractures in postmenopausal  women

Contraindications to Hormone Therapy include:

– history of breast cancer

– history of thromboembolism and stroke

– undiagnosed uterine bleeding

– significant cardiovascular disease

– hypersensitivity to oestrogen


Best start between 50-59 years or within 10 years of menopause


Lowest effective dose of estrogen with corresponding low dose of progestogen.

(Source: Clinical Practice Guidelines AMM, MOH + CO&GM)

Abuse: Predict Long-Term Consequences?

1. It’s hard to predict what would be the consequence of sexual activity inflicted on a 6-year old child. Adult perception is develop based on early images, meaning, and perception. Fantasy play as early as 4 years old is known to affect the child’s view of sex-typed behavior.

2. Children at this age can’t differentiate between play or abuse. They may appear explicitly normal but years later when they started to understand the meaning of their experiences, feeling of shame and guilt may appear.

3. Adult’s coping with unfavorable experience ranges from repression, suppression, denial and displacement.

4. Women with a history of childhood sexual abuse show greater evidence of sexual disturbance, homosexual experiences, depression, and are more likely to be revictimized. Anxiety-depression and suicidal ideas have been associated with a history of childhood sexual abuse too (1).

5. Reconstructing and strengthening of perceptions of self and the meaning of events as well as helping to strengthen coping mechanism help to achieve positive outcomes in the adult. Exploring new possibilities, relating to others, personal strength, spiritual change, and appreciation of life would lead to optimism and extraversion in later life.

Absent Father

1. Everyday he whimpers upon reaching the classroom. Teachers are sick with him. We are puzzled by this behavior. Mum stands by him.

2. Probing into the history suggests a significant finding. Abandon by the father is believed to be significant to cause regressive behavior.

3. The hypothesis needs to be tested. The lab is a special rehabilitation class for children with special need. Teacher F moderates this client. He is a foster father, so to speak. In fact, the client doesn’t need to be in this class. The target is to get him back to the normal class as his IQ is sufficient enough for ordinary teaching in a normal classroom.

4. Feeling of loss and lack of love leads to the feeling of inferiority and low self-esteem. Social relationship is affected. He has no friend and doesn’t like to stay in the classroom. Added to the insult, is his small for age appearance and anxious emotional feeling.

5. When he shows too much attention-seeking behavior, teacher F ignores him. He comes back and reported of being ignored.

6. Father undoubtedly plays important role in the family. In those days, ‘ahem’ would just mean ‘don’t do that’. Father set and enforce a limit. Absence father figure has resulted in emotional difficulties in this child.

7. My advice: Making him understand by giving reassurance on how much mum and dad love him. If he feels loved, he can be helped to have well-adjusted life and grow up into a strong adult. Listen to him, let him talk and make him feel validated.

8. My final say: don’t give up!

+ + + + + + + + + + +
Update (21/3/12)

1. With perseverance, he is attending cognitive rehabilitation (CBT) class weekly and put back into the normal class.

2. Educational progress is monitored by continuous contact with teachers and the mother.

Ree and his Habit-forming Behaviour

1. Ree wants to perform Umrah finally but he worries he couldn’t bring methadone to the Holy Land. At last, he got the conscience to stop hooking on drugs. A friend of him even try to wean off methadone before going to Umrah but upon coming home he got even worst. What the chance Ree has?

2. The chance is Methadone hydrochloride produces subjective changes similar to those produced by heroin. It is about one and the half as potent when administered orally. Chronically administered methadone produces sedation, lethargic, apathy, reduction in sexual interest and activity, hemodilution, and edema.

3. Even when patients were receiving and tolerant to 100 mg/day, drug-seeking behavior was seen. Methadone hydrochloride in dose level of 100 mg orally produces physical dependence similar to that produced by morphine, except that onset of the abstinence syndrome is slower.

4. All I can reassure Ree is while on maintenance substitution therapy, you can have a better quality of life (QOL), a productive life as a human being but perhaps not so much on habit-forming long-lasting behavior.

5. Again another encounter of interesting human character..

You Are Superb

1. Her dialect had changed to baku-ish slang after the injury which landed her in ICU for days. Friends were bemused and they teased her: ‘ganas mu..’

2. Today she has headaches and couldn’t go to school. She had just come back from the nearest government health clinic when we arrived. Reporters had ceased visiting her since she is more or less not to be pursued for prime news anymore.

3. She welcomed us with a timorous smile. Mum was in school attending adik’s Hari Kecemerlangan Akademik. We opened up our kit and started testing her cognitive abilities.

4. What astonishes me is how she now needs to work with some effort to speak the slang that she used to converse before with unpretentious free and easy.

5. She has now transformed into a renaissance girl, obedient and well-behaved daughter.

6. We all burst into laughter as we are convinced she is now ‘ganas‘ (superb!)