Stir Fried Green Beans

1) Get some fresh green beans from grocery store.
2) The label like this

3) Heat pan on high and use 2 table spoon cooking oil and stir fry the chopped onion, garlic and gingers with salt about 2-4 minutes.

4) Add cleaned and cut green beans to the cooking pan.

5) Add soy sauce and 5 specie powder to the cooking pan.

6) Stir fry them all together for about 10 to 15 minutes.

7) Put in a plat and serve with steamed rice and Sweet Sour Stir Fried Potato Julienne.

Sweet Sour Stir Fried Potato Julienne

1) Get couple potato, and clean them

2) peel out the skin

3) Clean them like this

4) At first cut the skinless potato as slice

5) Cut the slice potato as Julienne

6) Put the Julienne to a big bowl of cold water to wash off the starch

7) Clean some hot peppers

8) Cut the clean peppers like Julienne

9) Get some garlic

10) Clean and cut them as small peaces

11) Get a ginger, clean and cut it as small peaces and also Clean and cut some onions as small peaces

12) Drain the potato Julienne

13) Heat a fry pan at high, Add two table spoon cooking oil, Put the prepared onion, garlic and ginger in to the hot oil and stir fry them with one table spoon salt

15) When you smelled the aroma, Add the potato Julienne

16) Add two table spoon of vinegar

17) Add one table spoon of five spice powder

18) Add one table spoon of sugar

19) Stir fry them all together for 10 minutes

20) Add the hot pepper Julienne and stir them well about 2 minutes

21) The stir fried potato Julienne is ready to serve!

How to make Steamed Chinese Buns

A friend of mine who once tried my Chinese steam buns and asked me to write a instruction of how to make it. I am trying here. I hope the instruction I put here would help. If you have any questions, please leave me a comment and I will try my best to answer it.

The step to make the Chinese steam buns like this:

Make a yeast dough ® make the stuffing ® make flat bread dough ® put the stuffing in the flat dough ® wait for water in steamer boiling ® put the buns into steamer ® close the steamer ® keep steamer on oven at high heating 30 minutes ® turn off the oven and open the steamer, buns are ready to serve!

1) To make yeast dough

• 
  Using a big salver (container) which can keep at least 1.5 gallon of water. Put 2 table spoon of yeast in the container

• Put about 500ml (or 1/8 gallon) of warm water (40 degree centigrade or as your hand can tolerate) in to the container
• Add 3-5 cups of all purpose flour in to the container and using a fork to stir the flour in to the water until they look like porridge ( thicker or thinner are all OK), we call it the beginner dough
• Let the container sits in someplace warm: not too cold, not too warm ( too keep the correct temperature to be able to wake the yeast up) for half hour or more
• Once you see the porridge like beginner dough have some bubbles raise, you may put more flour (4-5 cups or more) in to the container and start to make a dough
• The dough should be soft and the shape is easily changed by hands
• Put the dough in a warm place like before and let it sitting there for another hour or more
• Once the dough raises as twice as its original site, it is ready to use.

2) Use cooking spry on the steamer so it will not be sticky


3) To make the stuffing

• 
  Get one onion, one clove of garlic, one table spoon size of ginger and 2 jalepeno hot pepper as you desired and clean them up
• Get all above in to food processor and chop them to small pieces and put in a plat to be used
• Clean some vegetables (like one zucchini, couple carrots and 3 celery sticks) you like and ground them to small pieces and put aside to be used
• Fry 4-6 eggs or one box of tofu and then chop them as small pieces if you are vegetarian
• Ground half pound of meat as your choice if you like to eat meat

• Mix all the grounded mean or eggs or tofu with the vegetables and the grounded onion, garlic, ginger and poppers together, add 2tsp salt, 1tsp 5 specie powders and any other flavors you like, Add ¼ cup of soy sauce as you desired to make the stuffing smells good. Mix them well, add 1tsp sesame oil in to it, and stir them again.
• When the stuffing smells good, it is ready to be used.
  

4) To make the Buns

• Cut the yeast dough as small pieces like Ping-Pong balls

. Use roller to roll the Ping-Pong ball dough to a round flat bread

Pick up the flat bread and put 1 table spoon of the stuffing in to it

Close the flat bread with stuffing from edge to center and the bun is ready

Keep going and make as many as your dough can

5) Boil half pan of water for your steamer

6) Put the buns to the steamer

7) Put the steamer on the boiling water and keep the oven on high, let it steam for 30 minutes

8) Open the steamer and take the buns out and serve!

9) Enjoy!!

Chinese doctor in Zambia

The Chinese doctors started to help people in Zambia since 1970s. This year, one of my friend went to there and worked hard in Livingstone Genaral hospital as a gynecoligist. Here are couple of pictures she sent to me.

A lovely picture

Use amplitude of vibration method to calculate ECG Axis

Use amplitude of vibration method to calculate ECG Axis:

1) Calculate lead I and III’s QRS amplitude algebraic sum.
To measure R wave, 0.1mv = +1, 0.2mv=+2, and so on.
To measure q or s waves, 0.1=-1, 0.2= -2, and so on.
2) After got the algebraic sum, find the point on the lead axis I and III and make a perpendicularity line to Axis.
3) These two line will joint at some point “A”.
4) The “OA” line’s direction will be the Axis’s direction.
5) Measure the angle formed by line “OA” and Lead I, the degree is the mean Axis, clock-wise is positive and counter-clock wise is negative.

Using this rule, the above ECG example is:
I: +4
III: +9-1 = +8
Find the point +4 on lead I and the point +8 on Lead III, Make a perpendicularity line from the point to both of the leads.
The joint point of these two lines are the “A” point.
Make a line from “O” to “A”, that is the mean Axis.
Measure the angle formed by line “OA” and lead I. It is approximately +70o.

So in this example, the mean electrical axis is approximately +70o .

The mean electrical axis for the heart normally lies between -30 and +90o. (Some textbooks say the normal range is 0 to +90o.) Less than -30o (or less than 0o) is termed a left axis deviation and greater than +90o is termed a right axis deviation.







By Dreamer
Saturday, September 22, 2007

Pneumothorax

One day, I came on duty. That was an afternoon shift. There were rules that for shift exchange. For stable patients, the off going shift may only give oral and writing report, but for unstable patient who were in the pediatric intensive care room, there were always the needs to go to the bedside to give report to up coming shift.

The morning shift doctor was Dr. Li. She went to the pediatric intensive care room with me and introduced a little boy to me: “This 1 year old boy admitted with Pneumonia yesterday. He was in room 7 before transferred to the intensive care room. His heart had stopped beating for few times and every time he was brought back with CPR. I do not know why and what is happening to him. Therefore, I transferred him to this room so we can keep a closer eye on him.”

I started to exam the boy while listening her report: he was well nourished and on 1L oxygen delivered by nasal cannula, with moderated respiration distress. I listened to his lungs, there were dismissed breath sound in his left side of the lung, and then I performed palpation and percussion of the chest, there were decreased voice vibration and tympani noise on percussion at the left side.

“ Did we do any x-ray exam on his chest today?” I asked. “Yes. The X-ray film showed pneumonia. It was Dr. Wang in radiology gave the report.” “Is there any sign of Pneumothorax?” “Not I can tell.” Dr. Li replied. “OK. I want to borrow the film to take a look.” I said. “Why not we go together and take a look there?” Dr. Li suggested. “Sure.”

Dr. Li and I followed by four medical students, we went to the radiology department and found Dr. Wang, the chief radiologist in the hospital. Dr. Wang got the film out, put on the negatoscope, and explained to us: “Look, here, the white spots are the increases of density of the lungs showing us there is pneumonia on this film.” I look at the film; I saw the left side of chest showing a fine line around the lung, and between the line and the chest wall, there was a clear black area. I pointed the black area: “Dr. Wang, is this possible there is pneumothorax exist here?” Dr. Wang exam the film again and said: “Yes. You are right. It is a pneumothorax.” “Ok. Thank you. That is all I want to know.”

I went back to the unit, wrote an order for a thorax surgeon consolation, and later on we transferred the boy to their unit to get chest tube put in. The boy was recovered and discharged a week later.

In China, it is not required to be able to read X-ray film for every clinical practitioner even they do have classes in medical school for X-ray. There are radiologists who read the X-ray and give report. As a clinical doctor, we only read the report but the film itself. In addition, the radiologist sometimes lack of clinical experiences, and sometimes the clinician did not provide enough information of the patient’s history on the order of X-ray, it could be difficult for the radiologist to give the exactitude report. That really is the gap of clinical practice and accessory examination.

I can see the pneumothorax does not mean I was better then the radiologist. In fact, I was just learning. The only benefit I had was I did exam the patient, I did the basic physical examination as a doctor should do and I knew the patient‘s history better than the radiologist. Based on these, I already knew there were air in his chest. That was what I was looking for. That is why I got it right away.

It is the doctor’s preference to learn how to read X-ray film at that time. Doctors are very busy in China. They do not even have a personal life. Their house doors are opened to all patients. They even have prescription pad and lab order forms at home to serve the patients who may come and knock their doors. In addition, the pay was very little. My first years pay as a resident was 45 Chinese Yuan per month and after served the hospital for 15 years, my salary was 500 Yuan per months. They are very busy workers. There is very little time left after work. That is why many doctors decide not to learn more than they have to. Reading X-ray film is one of the knowledge that they do not have to learn.

I learned this when I was doing my graduate study in Tianjing Children’s hospital. There I spent a month to listen to the radiologist and read all different kind of children’s chest films. It really helped me a lot. I always appreciate the class they offered there. I appreciate the knowledge of reading X-ray films I got from there.

It is true that if I did not learn the skill, the baby boy would still get the correct treatment probably one or two days later. However, it certainly helpful having that skill so that I can help my patients to get less time suffering and cost less for curing.





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The first Lumbar puncture

Friday, August 17, 2007 10:29 AM

Suddenly, I am thinking about to write done my experiences as a pediatrician in China. It is true I worked as a pediatrician in China for 18 years even I did not have any work pictures and work dairy. But when I think back, there is lot of in memory and I want to write done it and share with others. I am not a very good English writer, but I certainly want to try. It also will be a good practice in writing for me anyway.

The first Lumbar puncture of my life


I stayed in the doctor’s break room and crying. I cried so hard that not only my tears but also my nose were running. “ The little boy has been through so much and we did so much work to get his permission to do the lumbar puncture, but I failed. I am so sorry and feel so guilty about it. I hate myself!” I was complaining of myself did not make my first lumbar puncture success.

It was in 1982, I first graduated from medical school in my hometown. I was sent to a pediatric department in the city’s hospital working as a resident. My attending doctor was Dr. Yang Xiu Mei.

As a resident, I basically act like a doctor independently for two years. But at the first three months, there was an attending doctor to work and watch me. I was still within the three months period.

Wang Dong was the patient. He was 5 years old with tuberculosis meningitis. We were using the intravenous and intrathecal anti-tuberculosis therapy to treat his disease. He was doing well. But before we discharge him, we need to do a last check of his cerebral spinal fluid to see if his meningitis was recovered.

As a 5 years old boy, he had been through lot. From the beginning of the therapy which require lumber puncture every other day for couple weeks and then once a week, and plus the use of steroids. His puncture area became thick and hard, it was very difficult to do the puncture. And the boy hate the puncture. Dr. Yong, me and the boy’s father, we work together to persuade the boy to agree of the last one and he finally nodded his head. It was my job to perform the operation.

The boy side lying on the operation table with the father and dr. Young’s help. I opened the sterile lumbar puncture kit and put on my sterile gloves, using a syringe get some lidocaine out of an ample. Put the sterile clothe around the puncture area. Applied local anesthesia and using the lumbar puncture needle to perform the puncture. It went well, but I could not get the CSF out. I checked the depth and the site, everything was correct but the cerebral spinal fluid did not come out. I had to give up …

Since the boy’s medications were weared down to oral and everything was normal except the CSF test was not done. He was discharged from the hospital and come visit as out patient. We performed the lumbar puncture again in put patient area at his first visit as an out patient. It was normal.

As for tuberculosis meningitis, the treatment plan at that time was after the CSF test was normal, it still was requiring additional two years anti-tuberculosis therapy and periodically check of the blood and CSF tests to be considered full recover. If there were any abnormal of the tests, the patient had to be hospitalized again to start the full treatment again. Dong went back to be hospitalized for few times since his first discharge due to incompliance of his medication. But finally at his 10 years old age, he was completely off of all medication and fully recovered.

With the time of my practice, I realized that not every attempt has to be successful since we are dealing with the deferent human bodies and deferent disease process. It requires practice, skills and the operator’s confidence. But I certainly appreciate the tears for my first lumbar puncture as newly graduated medical student. It stays in my memory forever and reminds me to improve my knowledge from time to time.