Been There, Done That

Much of what I know about medicine are rarely taught in medical school. For example, most medical students do not know that:

• If a baby refuses to take a certain prescription liquid medication that has a nasty, pepperminty taste, there is a common over-the-counter chewable alternative that can be cut up, crushed and given with food, and that it has a nice fruit flavor.
• A particular medication is quite expensive at most drug stores, but can be purchased at bargain prices at Costco.
• Taking mineral oil as a laxative may result in mild embarrassment from the oil seeping into the underwear and giving the sensation of having Vaseline smeared on the rear end.
• Glycerin suppositories and enemas can cause stomachaches, butt cramps and passage of mucus.
• It is a good idea to blow your nose first before someone tries to stick a tube into your nostrils to pump your stomach, otherwise the sensation of snot being pushed down the throat can be pretty disgusting.
• Some infant formulas don't taste too bad, but have a distinct aftertaste and odor that reminds one of rotten fish.

The reason that I learned the above is because I have actually sampled several of my patients' medications, given myself laxatives (including the ones that go “up” the other way), perused the pharmacy aisles and checked prices, shoved a nasogastric tube down my own throat, and drank several cans of expired formula with my nose pinched. These extra measures that I took taught me how it is like to be a patient, and likely made me a better doctor when I counsel my patients and their parents. When they get nervous about certain treatments and procedures, it is reassuring for them to know that I have already tried them myself, and that I managed to live and tell about them.

Been there, done that.

However, what I have put myself through is nothing compared to the earthly experiences of the incarnate Jesus, who not only came to die for our sins, but to also live as we live in this world. He ate, drank, hungered, thirsted, wept, got angry, suffered pain, experienced rejection, and bled. He also faced temptation in far greater measures than what we have encountered daily. Jesus knows our struggles...he's been in our shoes before. This is Jesus,

“Who, being in very nature God,

did not consider equality with God

something to be grasped,

but made himself nothing,

taking the very nature of a servant,

being made in human likeness.

And being found in appearance as a man,

he humbled himself

and became obedient to death –

even death on a cross!

Therefore God exalted him to the highest place

and gave him the name that is above every name,

that at the name of Jesus every knee should bow,

in heaven and on earth and under the earth,

and every tongue confess that Jesus Christ is Lord,

to the glory of God the Father."

(Philippians 2:6-11)

Been there, done that.

Thanks be to God for the personal touch!

Walking With Eyes Closed

I tend to take my sense of vision for granted unless I encounter those who suffer from severe visual impairment or blindness. I marvel at how the blind are able to carry out common tasks, read braille, play the piano, walk down the sidewalk and cross the street without assistance, even running in road races, and I occasionally wonder how it feels to not see. I would sometimes practice the exercise of closing my eyes as I walk down the street to see whether I could walk without straying off the path, akin to when one lets go of the steering wheel while driving to check the car's wheel alignment. Invariably, I would start confidently with the initial steps, but eventually my steps would become increasingly tentative, and I would open my eyes after only a few seconds for fear of tripping or crashing into a fence.

Just as I depend on my vision to walk a straight path, I also need my eyesight to maintain balance. I can easily stand balanced on one foot for over two minutes at a time; however, I usually can barely remain upright in that posture for a few seconds with my eyes closed.

Without light, my body becomes disoriented, and I stumble easily. On the other hand, when my surroundings are illuminated and my eyes are open, I walk, run, and jump confidently without fear. Although the visually impaired and the blind can run marathons, they can only do so with the aid of personal guides who direct their every step. In the same way, God's word is like a guiding light that gives me a sense of direction. It guides me to act according to His will and allows me to steer clear of potholes, traps and stumbling blocks that the devil scatters before me in my everyday decisions.

I have hidden your word in my heart

that I might not sin against you (Psalm 119:11)

Your word is a lamp to my feet

and a light for my path (Psalm 119:105)

May I walk this day with my eyes open as God's word chases away the darkness.

Irritable Bowel Syndrome, Cats, Raccoons and Christians

Some medical conditions are much easier to diagnose than others. To determine whether one is pregnant, one simply needs to start with a testing kit and an urine sample. On the other hand, it takes a bit more experience and skill to diagnose irritable bowel syndrome (IBS). IBS affects tens of millions of Americans, with symptoms of crampy abdominal pain and abnormal bowel movements. As a pediatric gastroenterologist, I have seen thousands of children and teens with IBS, most of whom being referred to me after various combinations of negative laboratory tests, X-rays, ultrasounds and CT scans. The problem with diagnosing IBS is that this condition cannot be detected by routine tests, but only by asking the right questions, recognizing specific characteristics of reported symptoms, complaints and examination findings, and having sufficient information to confidently rule out other potentially serious disease. Most young physicians are quite nervous when confronted with the diagnosis of IBS, and they order many expensive tests for fear of missing cases of bowel obstruction, appendicitis, serious infection, or cancer. Seasoned doctors (at least those who have not been sued often), on the other hand, tend to order fewer tests as their abilities to positively recognize IBS are honed by years of practice and experience.

In addition to my ability to spot IBS in youngsters, I have also been sharpening my ability to identify unleashed animals in the dark, pre-dawn hours. While training for marathons, I often run around my neighborhood before sunrise, when most of the road traffic consist of stray cats and leashed dogs taking their owners for their morning walks. I soon learned to distinguish between a cat and an unleashed dog in dim light from a distance, using clues of their dark silhouettes and gait characteristics alone. If I see a cat, I need not alter my running in any way, as the cat will get out of my way. A dog without an owner, on the other hand, needs to be approached with caution, and I make sure that I maintain a safe distance from it while avoiding eye contact, lest I invite an awkward confrontation. Occasionally I would see a couple of cat-sized creatures that walk neither like cats nor dogs, and I take special care not to disturb them. They often turn out to be raccoons or opossums.

We often identify things by comparing them to certain profiles in our minds. As a physician, I evaluate patients and compare my findings with profiles of irritable bowel syndrome and various other conditions. When I run outside, I check my surroundings with profiles of cats, dogs, raccoons, potholes, and reckless drivers. In the same way, the Bible indicates that there is also a profile of what a Christian is like. The apostle John wrote,

Dear friends, let us love one another, for love comes from God. Everyone who loves has been born of God and knows God. Whoever does not love does not know God, because God is love. (1 John 4:7-8)

The greatest joy that I experience at work is not from patients and families telling me that I'm a good doctor, from diagnosing a rare disease, or even from praise by colleagues. It is from a few of my patients or their parents spontaneously declaring that I must be a Christian because they can tell by some manner of my speech, action or demeanor.

As ambassadors for Christ on earth, we are constantly having our profiles checked out by those around us. Do we fit the profile of the Christian in our daily lives?

The Perils of Being Too Flexible

I recently witnessed an amazing acrobatic performance by three young Asian women at a televised talent competition. They were quite a flexible bunch as their synchronized contortions resulted in body parts appearing to be in, uh, disturbing relationships to each other. Is it possible to be too flexible? Maybe I'm just jealous, but I think if you are able to bend backwards and literally sit on top of your head, the answer has to be yes.

Musculoskeletal flexibility has never been my strong suit. I'm pretty sure that I was able to stand and touch my toes at one point in my life, but since I can't really remember anything prior to my preschool days, memories of me accomplishing such a feat are at best fuzzy. On the other hand, recollections of hamstring pain as I try to touch my...shins, abound. A serious back injury that resulted in surgery 15 years ago stiffened me up even more, so that I can no longer stand and reach much farther beneath my kneecaps without feeling something tighten up. As an avid runner, I learned that flexibility may help improve running speed, so I've often tried various stretching exercises, to little avail.

Despite my longstanding history of back and hamstring stiffness, I also learned that not every part of my body is equally inflexible. While practicing a Haydn concerto on my oboe, I encountered a particularly challenging passage, during which my right pinky finger would make clunking noises and cause pain whenever I tried to play a certain note that required me to reach for a key with that finger. It turned out that whenever I tried to play that note, one of my right pinky joints was too flexible, and would hyperextend, i.e., bend backwards, causing my finger to get trapped like a cocked trigger. I have been trying to adjust my hand position to ameliorate the problem, but the ultimate solution may be to wear a small finger splint to restrict my joint's motion. In other words, I lament about my back and hamstrings being too tight, while simultaneously wishing that one of my fingers is not as flexible.

Just as one's flexibility or lack thereof sets limits on a person's range of motion, God's law also sets limits on what one can or cannot do. If you violate limits on a joint's range of motion, you may end up with a sprain, a dislocation, a fracture or other injury. Violating God's law also has serious consequences, as Adam and Eve disobeyed God, and their descendants are still reaping the consequences of sin. Nevertheless, there is great freedom when one is conscious of the boundaries, for he can move within them without fear. We usually think of law as being restrictive rather than liberating, yet the writer of Psalm 19 clearly saw delight in God's law:

The law of the LORD is perfect,
reviving the soul;
the testimony of the LORD is sure,
making wise the simple;
the precepts of the LORD are right,
rejoicing the heart;
the commandment of the LORD is pure,
enlightening the eyes;
the fear of the LORD is clean,
enduring forever;
the rules of the LORD are true,
and righteous altogether.
More to be desired are they than gold,
even much fine gold;
sweeter also than honey
and drippings of the honeycomb.
Moreover, by them is your servant warned;
in keeping them there is great reward.  (Psalm 19:7-11)

If the boundaries of law actually are liberating and protective, what about my stiff back and hammies? There is an ongoing debate among runners and sports medicine experts on how much stretching is beneficial, as studies indicate that while too little flexibility is bad, too much flexibility may actually be associated with greater risk of injury. Despite my stiffness, I have logged over 20,000 miles of running and 20 marathons during the past 7 years, and never experienced a serious running-related injury. While my restricted range of motion made me slower, it also protected me.

May we run long and far as we abide by God's law in our lives.

The Bucket List

The clinic corridor was buzzing with curiosity as a small crowd gathered around two doctors who just returned from a three-week vacation to South Africa. The doctors, a pediatric cardiologist and a pediatric oncologist, decided to take a once-in-a-lifetime trip together, during which they spent many hours in the various wildlife preserves, saw innumerable large mammals, and tracked down the “big five”, i.e., the elephant, the lion, the leopard, the rhinoceros, and the Cape buffalo, with their guide in open-air Land Rovers. The excitement reached a climax as they recounted how they got dangerously close to a rhinoceros that nearly charged at them, and a voice in the group chided the surviving travelers for putting the clinic at risk of losing two doctors on the same day. Another pediatrician, who also took a similar vacation a few years ago, exclaimed that every person needs to take this trip at least once in his or her lifetime, and the returning adventurers heartily agreed. In other words, an African safari is on their “bucket list”.

Bucket lists, that is, lists of items to check off before one dies (kicks the bucket), have become quite popular nowadays. There are books on places to visit before you die, restaurants to eat at before you die, and in a recent issue of an endurance sports magazine, I even saw a bucket list of events for hardcore runners...let's see how many I can check off:

Boston Marathon – check...did it in 2007

Comrades Marathon in South Africa – 56 miles...probably doable if I don't get too old...maybe in a few years?

Western States Endurance Run – 100 miles in the mountains? I'm not good with directions, so it will probably turn into 150 miles...forget it....

Seriously, you can't always take these lists too seriously.

Do I have a “bucket” list? Well, not exactly, but I do hope to someday see Alaska, be on a cruise, go to Europe, have grandchildren, and finish a triathlon. However, experiencing the awesome, majestic presence of the holy God would be on the short list if I have one. It was certainly highly endorsed by king David long ago:

One thing I ask of the LORD,

this is what I seek:

that I may dwell in the house of the LORD

all the days of my life,

to gaze upon the beauty of the LORD

and to seek him in his temple

(Psalm 27:4)

Better is one day in your courts

than a thousand elsewhere;

I would rather be a doorkeeper in the house of my God

than dwell in the tents of the wicked.

(Psalm 84:10)

Would I rather be in the house of the LORD, or be charged by an angry rhino in South Africa? One experience is bound to be life-changing, while the other is potentially life-ending. There is no comparison.

Updates, Uploads, Links, Posts, Tweets...But No God

Facebook has brought me back in touch with friends, classmates and colleagues that I have not seen for many years, and has given me glimpses into their lives. Status updates, web links and uploaded photos indicate our personalities, passions and priorities as we each stand in an individual corner in cyberspace and clamor for attention. Through Facebook, I discovered that one of my high school classmates openly lives an “alternative” lifestyle, many of my old friends are obese, most are passionately bragging about their kids, several have taken up running, cycling and hiking as hobbies, one was teaching his children to scuba dive, some changed jobs, others lost jobs, and some seem to spend endless hours playing online games. I also get to know one's political and religious views, as well as favorite movies, songs, books, and quotes, and can generally synthesize a crude idea of the person, or at least the image that he/she wishes to portray. As an example, my Facebook page indicates that I'm a geezer who is married with kids, is a Christian, listens to classical music, runs marathons, works as a pediatric gastroenterologist, and shares similar political views with his wife. It's not a complete picture, but it's not necessarily an inaccurate one.

Oftentimes, what one does not post on Facebook also speaks volumes about the person. Imagine a married man not mentioning anything about his wife and declares that he is seeking “friendship”, or parents being mum about their children while waxing eloquently about their work and hobbies – these would be “red flags” that suggest the possibility of serious relational problems. Fortunately, such glaring omissions are rare among my friends with well-maintained Facebook pages. Nevertheless, as I curiously perused the profiles of friends who had the greatest impact in my life, i.e, those whose lives, words and actions led me to become a Christian many years ago, I became quite distressed by what I did not see.

I had several Christian friends in high school who invited me to church meetings and services, and through their witness and friendship eventually received Jesus as my personal Lord and Savior during the summer after my junior year in high school. I have not seen many of them over the years, but was quite excited to find most of them via Facebook, and wanted to know what the Lord has been doing in their lives. Not surprisingly, most are married with children after more than 27 years, one became a missionary, some others are also living abroad, and others have been leading interesting lives as well. However, among those who had the most instrumental roles in my becoming a Christian, there was no mention of their faith, their participation in the body of Christ, or of God. It seems that their career pursuits, hobbies and sundry interests have received ample attention, but there was nothing in their Facebook postings that remotely suggested a Christian worldview. It was as if they never knew God.

What happened to my friends? Is it possible to become a Christian and then not become one? Did the Holy Spirit actually regenerate their hearts and redeem them? Were they never saved in the first place? I am afraid to find out.

Whoever acknowledges me before men, I will also acknowledge him before my Father in heaven. But whoever disowns me before men, I will disown him before my Father in heaven.

(Matthew 10:32-33)

If Christ is real, and if I claim that He reigns in my heart, I cannot help but put Him first in my thoughts, words and actions. As a husband and proud father of two children, it does not take long before my wife and kids are mentioned in any conversation. Will I acknowledge Christ before men with equal ease and fervor?

Undiagnosed Celiac Disease

Celiac disease was once considered a relatively rare condition when I was in medical school.    Those who live with celiac disease have to be on a strict gluten-free diet, because gluten (a protein that is found in wheat, rye and barley) in the diet somehow confuses their immune systems to cause damage to the intestines.  Symptoms of celiac disease include stunting of growth, diarrhea, abdominal pain, weight loss, and skin problems, and my early mental image of celiac disease was that of a bald, scrawny toddler with tiny bones, virtually no muscle in the arms and legs, and a bloated belly.  If I ever see a child who has such an appearance, I certainly will need to rule out celiac disease.  However, most other doctors who see such a child would also recognize that something is seriously wrong, and chances are that screening tests for celiac disease would have been done before I ever lay eyes on the child as a pediatric gastroenterologist.

As understanding of this condition and diagnostic tools improved over time, it is now relatively easy to diagnose celiac disease in individuals who are clinically not as ill, and even in those who appear essentially normal.  While previous estimates suggested a prevalence of one in a few thousand people, it is now believed that celiac disease may actually be present in one out of every 100-200 persons.  Many who have the condition (based on laboratory test results and abnormal findings on biopsies of the small intestine) appeared to have no symptoms, and were quite surprised by the diagnosis.  However, some of them, like Mr. James (not his real name), the shock came only a few weeks later.

Mr. James brought his son to see me to rule out celiac disease.  He explained that he himself always had stomach trouble as a child, but neither he nor his family paid much attention to it, and dismissed it as being “regular” stomachaches.  Over time, Mr. James became accustomed to his frequent discomfort and disregarded it until years later, when, for unrelated reasons, he underwent an upper gastrointestinal endoscopy, and was incidentally diagnosed with celiac disease.  He started himself on a gluten-free diet, and within a few weeks began to feel dramatically better than at any previous point in his life.  The sense of well being was accompanied by a weight gain of twenty pounds, and as I spoke with Mr. James he appeared muscular and fit.  He marveled that he never knew that it was possible for him to feel as good as he did after his condition was properly diagnosed and treated, and he wished that he could have known about this many years beforehand.

Mr. James' experience reminds me of my own spiritual condition before I became a Christian at seventeen years of age.  I was born of hard-working, responsible parents, and was grateful for their sacrifice in bringing my brother and me from Taiwan to the U.S. to have a better education.  I studied hard, somehow managed to get straight As in high school within one semester of being immersed in a new culture and language, and rapidly became popular among my friends in the school band because I played a mean saxophone.  While life was often difficult as I rarely saw my father, who mostly remained in Taiwan to support the family, and I suffered many bouts of loneliness despite being surrounded by classmates but few friends, I thought that things were going quite well overall, and had no desire or room in my heart for God.  I thought that working hard, achieving success and contributing to society were the chief goals in life, that science was the answer to everything, and that God was an invention of weak minds.  It was only after Jesus, the Good Shepherd, claimed me as His own that I realized that there is such greater joy and meaning to my existence when God takes the center of my life.  As I come to understand and experience His creativity, righteousness, holiness, love, mercy and grace over the years, the spiritual poverty that I was living in without God has become appalling to me, and I believe that God will never allow me to ever live life in denial of Him again.  Jesus gave me this assurance:

And this is the will of him who sent me, that I shall lose none of all that he gas given me, but raise them up at the last day.  (John 6:39)

Somehow, I have this feeling that Mr. James will never stray from his gluten-free diet.

Texas Thumpin', A Near-Maulin' and Satan's Schemes

I have always enjoyed the drama of college football. Some games pit nationally ranked powerhouses against teams that have nary a fighting chance, and they predictably end up as blowouts where the outcomes appear certain from the outset. Other games are advertised as evenly-matched rivalries that promise to be nail-biters until their very ends. However, some of the most interesting stories in college football are the big upsets, where unranked underdogs somehow manage to dish out spectacular efforts and come up with unlikely victories. As it turned out, the UCLA vs. University of Texas game a couple of weeks ago was predicted as a mismatched blowout that turned into a resounding upset.

UCLA's football team seemed to be headed in the wrong direction from the very beginning this season, as it started with two losses, including a 35-0 thrashing by Stanford, before finally notching its first win against Houston. Texas, on the other hand, was undefeated after three games, was highly ranked, and was the home team of the contest. The entire town of Austin, Texas showed up dressed in school colors in support, expecting a one-sided slaughter. The Texas players were relaxed and confident as they finished their warm-ups and entered the field. Meanwhile, the UCLA athletes arrived knowing that they were not expected to win, and that a loss would practically spell doom for their season.

The game was not close. UCLA was the dominant team, and won handily, 34-12.

During the ensuing week, the UCLA coaching staff cautioned against a letdown as they prepared for the upcoming home game against the lowly Cougars of Washington State University, whose football program was widely regarded as being among the worst of all Division I schools in the country. Could the roles be reversed this time, and that UCLA be ripe for a major upset in the hands of the Washington State Cougars? It nearly happened, as UCLA trailed by 8 points late in the third quarter of the contest, before the team finally buckled down late in the game to secure a 42-28 win, and a collective sigh of relief.

It seems human nature for us to let down our guards immediately after we experience a great deal of blessing, victory or success. This is certainly the case in sports, and it is exceedingly uncommon to see even the most spectacular team of athletes compete for an entire season undefeated. The same is true in the spiritual realm, as Satan knows that we are weakest right after experiences of success and victory, because that is when we let our guards down. In the Bible, king David's most serious sins of adultery with Bathsheba and murder of her husband occurred when he was at the height of his powers, and the nation of Israel seemed secure.

An epic account of glorious victory and subsequent letdown involved the prophet Elijah, who faced off against 450 prophets of Baal and 400 prophets of Asherah at Mount Carmel. By the power of God he gained a great victory, resulting in God being glorified and the prophets of the false gods utterly destroyed (1 Kings 18). However, shortly afterward queen Jezebel threatened to kill Elijah, and this mighty prophet of God, who barely finished praying for fire to strike from heaven upon the altar, became unsettled in his moment of weakness. In fact, the Bible recorded that,

“Elijah was afraid and ran for his life....” (1 Kings 19:3)

We are most vulnerable when we feel invincible, and need to be especially wary of Satan's attacks. These are times when we do not cling to God as tightly, thinking that we alone are able to fight the battle without His protection and direction. Remember, if God is with us and we cling to Him, there should be no upsets.

As for UCLA, they will be the underdogs again this Saturday.

Running Unhindered

Runners tend to be a competitive lot. They want to outrun their friends, outrun their training partners, outrun their adversaries, and hopefully set PRs, or personal records, i.e., the fastest times ever for themselves at a particular distance. As I prepare for my 21^st marathon in a couple of weeks, I recognize that my PR days for the 26.2 mile distance (actually, 26.21875 miles, but who's counting?) are essentially over, as I am gradually getting slower with age, and that it takes many hours of training each week simply to maintain my current level of fitness. However, I continue to seek every possible advantage on race day to hopefully shave a few minutes or seconds off my time. I try to stay well hydrated during the days leading up to the race, watch what I eat, try my best not to get sick by washing my hands extra diligently, and get extra sleep. Most of all, I try to run as light as possible.

Studies have shown that most people will run noticeably faster if they lose excess weight, at least up to a certain point. If you don't believe this, try and run around the block with a couple of 10-pound dumbbells in your hands, and you will definitely not run as fast. I am about 5 ft 7 inches in height, and I normally will try to wake up on race morning weighing in at about 135 pounds, fully hydrated and carbo-loaded. This is my ideal racing weight based on experience, since excess weight will slow me down, and any further weight loss likely will mean that I am dehydrated and/or depleted.

Not only do I avoid carrying excess weight inside my love handles, I also try to carry as little weight as possible on me during races. I wear a quick-drying, lightweight polyester singlet (kind of like a tank top), the shortest, thinnest pair of shorts that doesn't get me arrested for lewdness, no-show socks, the lightest pair of running shoes that I can wear without causing injury, and my car key. I may not be fast, but I at least try to look the part. On the other hand, you can always spot the back-of-the-pack participants who plan to walk their 26.2 miles. They dress in layers, carry large bottles of sports drinks, pin several packages of energy gels and bars to their waists, are armed with cell phones and cameras, and are busy eating bananas and bagels to fortify themselves for the journey. Many carry backpacks. It is hard to be fast while collapsing under all that weight.

Similarly, our spiritual journey is often compared to a race, and in our pursuit of God's plans for our lives, we often weigh ourselves down with cares that hinder us. These may be material possessions (a larger house equals a bigger mortgage payment), misdirected passions (as an extreme example, there is a man whose sole purpose in life is to visit every Starbucks Coffee store), anxieties (oh, no, the Dodgers missed the playoffs), and fear. Each of us carry unnecessary burdens, and will feel relief by casting away some of these cares. In my case, I have discovered that this journey through life has become considerably less hectic after I intentionally neglect to check Facebook updates, receive live e-mail inbox notifications, follow up-to-the-minute stock market reports, and keep up with all the celebrities who are in drug rehab, and I only bother to check up on my beloved UCLA Bruins football team AFTER the games (they are playing lowly Washington State as I am typing this...if the Bruins lose I'll having something else to write about). The resulting freedom is quite liberating.

Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles, and let us run with perseverance the race marked out for us. (Hebrews 12:1)