媽媽敷臉照顧綠植、小孩趕作業的早晨
😆😆😆😆

今早預約了最早的COVID-19 檢測
去確定一下我們全家有沒有中標
學區並沒有規定返校要有陰性證明啦～
是我跟榮先生覺得還是驗一下比較安心
雙恩也因此賺到兩天的假期

現在LA還是有很多免費檢驗的單位
今天預約的是跟二月回台灣的時一樣的單位Curative （https://curative.com)
但是已經沒有口腔檢測了
都要戳鼻子，然後等24-48小時才有結果
所以可能明天也得繼續請假😅

不過雙恩這兩天也沒辦法閒著
因為請假這九天學校將他們列為independent study
所以作業完全比照在學校學習的進度，超多～～
度假時候只要求他們每天寫兩頁～
接下來這個禮拜都要全力追趕進度了😅😅
好在他們兩個都還蠻怕老師的，滿認命寫作業的

媽媽我就有很多閒暇時間囉～～
跟大家報告我的兩株綠植活下來了！
青蘋果有幾片尖端焦了，龜背芋很好
只是有一些灰塵
等一下幫他們除塵擦身體是雙恩的工作
事實證明～龜背芋比較適合我們😅

旅行回來就想好好來整理一下家裡、後院
讓在家也有度假的感覺
我相信榮先生看到這幾句話又會下樓來關心我一下
不是擔心我太累
是關心我什麼時候要執行（很期待這樣）😆😆😆

—
想看愛馬仕開箱的可以看昨晚直播喔
昨晚有臨時直播睡前保養
小曝光了一下 ☺️
https://www.facebook.com/ptcarepipe/videos/387508843044813

講CUHK單嘢都講到口臭，今日想講下現代醫學急速發展，科學醫學基因學一日千里後對醫學院學生同初級醫生嘅影響

拿，頭盔，我唔係故意要同senior們作對，而係有d好重要嘅概念我覺得一路都無人address過。而醫學界仍然有股好重嘅「當年都係咁捱咁讀，點解你咁多意見」嘅風氣

的確，當年前輩們嘅非人on call生活、要去library睇文獻睇書而唔係方便地用Microsoft surface神速打筆記、開uptodate、開pubmed/medline等等。

無可否認，上個年前代嘅醫生們要增進知識要靠嘅自動波去睇論文去溫書，甚至要自己去R導師做臨床教學等等。無人否認當年環境無咁豐富，上堂無精美PowerPoint、臨床教學今時今日已經好structured，分哂history session, examination session, skills session，有像真度極高嘅假人俾你練習，呢d係上代無嘅luxuries

No one is denying this fact

但上一代都一樣無嘅係咩，大家有無諗過？

就係千千萬萬種過去20年發展出來嘅科學醫學理論同治療方法。

O&G 幾十年前都未知道preeclampsia嘅實際原因係乜，原來可以early pregnancy low dose aspirin prevent or delay onset of preeclampsia。廿年前都無HPV疫苗, 都無話原來screen HPV virology比Pap smears更有效發現子宮頸病變，廿年前無人需要知道呢d

Rheumatology幾十年都無一堆biologics, TNFa, IL inhibitor 。原來autoimmune inflammatory arthritis failed NSAID/MTX可以轉infliximab, adalimumab。psoriatic可以用secukinumab但如果有IBD/enteropathic features要小心IL-17 inhibitor，廿前年無人需要知道呢d

Immunology/ID，幾十年前HIV邊有咁多種antiretroviral？今時今日ART多到就算你de novo resistance都可以換藥換到U=U，廿年前都係得舊式治療，無人需要知種種嘅新式療法。immunology仲多咗幾十種唔同嘅complement, complement inhibitor etc etc嘅investigation

Respiratory醫ILD或pulmonary HTN幾十年前個療法來來去去都係得幾種。今時今日IPF有nintedanib，Pul HTN有成堆endothelin antagonist、PDE5 inhibitor同prostacyclin類嘅藥要知。asthma當年來來去去都係ventolin+inhaled/oral steroid，今時今日分埋IgE asthma, eosinophilic asthma，有成堆唔同嘅SABA-LABA, SAMA-LAMA, IgE monoclonal antibodies, IL-5, IL-4 and IL-13，到底eosinophil要幾多先會大機會有response，用緊steroid嘅eosinophil個cutoff係幾多。

Hematology/oncology幾十年前都未有monoclonal antibodies，無rituximab、nivolumab、targeted therapy等等，幾十年來個發現多咗好多唔同gene mutation同targeted site，EGFR, VEGFR, CTLA-4, PD-1，PD-L1、BRAF，HER-2, you name it you got it。以前癌症病人你大多只要beware of neutropenic fever/infection，今時今日你要screen埋immune checkpoint inhibitor autoimmune hepatitis, pneumonitis, thyroditis, colitis，你要知埋有個病人用緊nivolumab時突然變黃，你要screen咩autoimmune，落咩藥，high dose steroid定點，之後仲可唔可以rechallenge。乳癌病人HER-2依加唔止用herceptin，仲有埋pertuzumab，你仲要screen埋cardiomyopathy，echo drop幾多可以接受，係唔係reversible，可唔可以rechallenge

Endocrine幾十年前糖尿病來來去去都係metformin, gliclazide, insulin今時今日T2DM有GLP-1, SGLT-2, gliptin等等，有埋continuous glucose monitoring device又有bump又有唔同林林總總嘅治療。唔止T1/T2DM，今時今日仲有埋LADA，你要知埋個autoimmune panel screen咩。骨質疏鬆當年玩來玩去都係bisphosphonate，今時今日有denusumab有teriparatide，仲有更多新藥。

Gastroenterology幾十年前IBD來來去去都係steroid/steroid sparing agent 5-ASA/aza，今時今日有TNFa blocker有a4b7 inhibitor vedolizumab。當年hepC得幾種antiviral今時今日有sofosbuvir, velpatasvir, glecaprevir等等，仲變成curative。

Neurology MS幾十年前邊有natalizumab，今時今日如果MS on natalizumab with rapid neurological decline，你要諗埋會唔會可能係JC virus reactivation。GBM以前都係只靠surgical resection，今時今日可以用avastin, temozolomide仲要screen埋MGMT hypermethylation去決定有無得用chemo

呢啲改變同發展只係佔各system嘅一小部分，只係我細小嘅腦袋突然諗到嘅小部分內容。世界不斷發展，學海無涯，我們有愈來愈多嘅知識要學，呢一點無人懷疑過。

醫生擁有比一般人更多嘅權力同地位，就自然需要更大嘅責任。

但係，值得大家反思嘅係，當個knowledge base不斷擴大嘅時候，考試仍然要期望你記埋某張slide嘅角落嘅minute details時，呢個係唔係一個合理嘅期望？

當一個basic trainee去考PACES/long case嘅時候，到底係唔係同以前一樣要知得咁深入？當深度一樣，而個base不斷widen broaden時，新世代嘅醫生應該如何應對？

而考試嘅範圍似乎未有被address過，呢點好值得我地一齊諗諗

I’ve nominated MAKNA to receive the donation items. Helping those who work hard to mobilize resources to provide curative, preventive, research and support services to cancer patients and their families, high-risk groups and the general public, in Malaysia and the world. Join us to spread the love with @thefaceshopmalaysia for the #RelayBersamaJiayou campaign and share your nomination with us too! Just spend as low as RM50 & nominate a beneficiary of your choice!

檢測時記得帶上photo id哦～
Stay safe and healthy!

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01:23 4家免費的新冠核酸檢測檢測機構預約申請，建議提前2-3天預約
05:57 核酸檢測當天以及檢測前注意事項
12:48 如何獲得核酸檢測結果
13:25 得到核酸檢測報告｜pre-travel testing final report
13:42 核酸檢測報告要求
13:45 核酸檢測報告樣式
14:44 順利登機

*記得帶上photo id！！！！ ｜covid-19 testing for free.👇🏼

1.Santa Clara Country PUBLIC HEALTH（also for Hawaii）
https://www.sccgov.org/sites/covid19/Pages/covid19-testing.aspx
Or call 888-334-1000 提供語言翻譯 ｜ 408-885-5000

2. Project Baseline
https://www.projectbaseline.com

3. CURATIVE
https://curative.com
Or call 888-702-9042
（更新於1/20/2020 Palo Alto檢測點不能drive thu，需要下車檢測）

4. Stanford HEALTH CARE | APP
https://stanfordhealthcare.org
Or call 408-426-4900

5. Or call 4-1-1 提供多種語言

*免費流感疫苗（不需要健保，3歲以上）www.sccphd.org/flu or call 2-1-1

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Creative Commons — Attribution bit.ly/free-range-download
Bumps by the lake (mini tape) - Aixion

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World's best motorcycle pants are RHOK (search Ebay for them) "More than three million Chinese drink their own urine in the belief it is good for their health, according to the official Xinhua news agency."

"In Roman times, there was a tradition among the Gauls to use urine to whiten teeth."

"In Hinduism a religious Sanskrit text called the Damar Tantra contains 107 stanzas on the benefits of one's own urine."

"In China, the urine of young boys has been regarded as a curative. In southern China, babies' faces are washed with the urine of other young boys as a skin protectant.

The French customarily soaked stockings in urine and wrapped them around their necks in order to cure strep throat.

Aristocratic French women in the 17th century reportedly bathed in urine to beautify their skin.

In Sierra Madre, Mexico, farmers prepare poultices for broken bones by having a child urinate into a bowl of powdered charred corn. The mixture is made into a paste and applied to the skin. "