‘The Greatest Showman’: A Most Sensational Show

‘The Greatest Showman’: A Most Sensational Show - The Greatest Showman showcases a stellar ensemble cast alongside vibrant musical numbers that sweep you through the flow as ecstatically as a stage-diver carried aloft by the crowd.

This Broadway-style musical biopic, set mainly in mid-19th century United States, depicts the story of the legendary Phineas Taylor “P.T.” Barnum (Hugh Jackman) – the founder of the Ringling Bros. and Barnum & Bailey Circus and of the showbusiness in general. We see his rise and struggle from poverty and shaming when he was young, to becoming the first and “greatest showman”.

It sets up Jackman’s Barnum as the once-unprivileged outcast, shown kindness by the rejects of society, and who then becomes a saint of sorts (not a perfect one, as the film goes on to rightly reveal) to these social outcasts and offers them a chance at stardom – no matter the obligatory perception of fraudulence and fakery on Barnum’s part.

Passionate, warm and bold in every sense, the film starts off with explosive, pulse-pounding music right from the opening, transitioning immediately (and dramatically) when its silent film format turns into a colourful vibrant musical number. This sets the stage for circus excitement that gets you in the mood for a vivaciously swinging spectacle.

It’s almost like a Broadway production brought directly to life on screen.

The rest plays out effortlessly, never seeming to lose its fast pace, even at the most poignant moments.

Most evidently illustrated in the film are its many dominant themes. Among them are acceptance, tolerance, 19th century discrimination, conservatism, being unafraid of who you are, not judging a book by its cover and being fearless to dream with an unfettered imagination for self and others.

These are powerful messages that will make you ponder each unique individual’s purpose in this world.

There is also the underlying idea here that the circus is not really a place for the misfits and “freaks” of society, as typified by the condescending crowd, but rather a sanctuary of talent and belonging.

Although veteran thespian Jackman steals the limelight, almost all the actors and actresses (even some of the minor ones) are standouts in their own right. Even Zac Efron shows off his performing skills, proving his High School Musical years have not been lost.

The music, songs, singing, dancing, storytelling and even costuming are almost straight out of a Broadway musical, a telling sign of how well the film was put together.

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'Lexi' Rule Dominates Golf Chatter In 2017

'Lexi' Rule Dominates Golf Chatter In 2017 - A rules violation prompted an overhaul of the controversial trial-by-television rule in 2017, and the ascendancy of youth continued unabated, all the while played against a backdrop of a certain 14-times major champion whose occasional health updates kept his fans hopeful that a comeback awaits.

The California desert was where Lexi Thompson took an inch and changed the game a mile when she replaced her ball in the wrong spot after marking it on a green during the third round of the ANA Inspiration women’s major on April Fools' Day.

The final round was already well underway when rules officials were informed by a viewer, who still has not been publicly identified, of the infraction, which meant Thompson incurred a two stroke penalty for the violation itself, and another two shots for having signed an incorrect scorecard after the previous round.

That led to the bizarre situation of an official informing Thompson of the penalty as she walked from the 12th green to the 13th tee.

Starting on Jan. 1, armchair referees will mostly be a thing of the past, as will retrospective penalties for a player having signed an incorrect scorecard when he or she was unaware of a violation.

Instead, on the major tours a rules official will monitor telecasts for infractions.

The changes are a forerunner to Jan. 1 of 2019, when a major overhaul of the rules will go into effect in an effort to make them simpler, fairer and more practical.

On the course, 2017 saw three of the four men’s majors won by players in their 20s – 27-year-old Brooks Koepka (U.S. Open), 23-year-old Jordan Spieth (British Open) and 24-year-old Justin Thomas (PGA Championship).

Only 37-year-old Sergio Garcia, who finally won a major when he beat Justin Rose in a playoff at the Masters, was the exception to the trend, but how different the entire major season might have been if not for a stair mishap by Dustin Johnson.

Johnson arrived at Augusta the kind of prohibitive favourite not seen since the halcyon days of Tiger Woods, coming off three consecutive victories and an ascent to the world number one ranking.

But when he slipped down some stairs on tournament eve and badly bruised his back it not only knocked him out of the Masters, but also changed the entire complexion of the majors, because he did not regain his erstwhile form until the majors were done and dusted.

Lurking in the background meanwhile, Tiger Woods issued occasional updates on the condition of his surgically repaired back, and finally returned to action in December at the Hero World Challenge in the Bahamas, where he swung with apparent freedom and played competently, suggesting 2018 might be the first year since 2013 that he will be able to play a full schedule.

Woods turns 42 on Friday, but with apologies to the youth movement he is still the man, at least when it comes to television ratings and fan interest.

SHOT OF THE YEAR: Jordan Spieth’s three-iron from the practice range at Royal Birkdale at the 13th hole during the final round of the British Open, which allowed him to save bogey and buoyed his spirits en route to a sizzling charge to victory. Just as impressive was his cool decision-making under pressure, realizing that the range was the best place to drop after he had taken a penalty from an unplayable lie, even though he had to move nearly 100 yards further away from the pin.

ROUND OF THE YEAR: Branden Grace, in third round of British Open, becomes first player to shoot 62 in a major.

QUOTE OF THE YEAR: “No one really asked me if I was married, so I didn’t have to answer that question,” Hideki Matsuyama, revealing that he was married, in a press release to Japanese media, who interview him interminably after every round, but seemingly never ask him about his off-course life.

LEST WE FORGET: Former Masters chairman Hootie Johnson, aged 86; 1967 British Open champion Roberto de Vicenzo, aged 94; 1994 U.S. Senior Open champion Simon Hobday, aged 76.

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The Beautiful, Natural Sights Of Iceland

The Beautiful, Natural Sights Of Iceland - What spurred me to visit the land of fire and ice this year were stunning pictures of Iceland on Facebook that a friend had posted.

I wanted to go during the summer, so I started planning for the journey in March after collating all the information I could get from the Internet.

Since there was no direct flight from Kuala Lumpur to Reykjavik, the capital of Iceland, I made a stop in London first. I then took a three-hour flight to Reykjavik on British Airways.

Once I arrived at Keflavik Airport, I got on the shuttle bus I had booked two weeks earlier. If you’re planning a trip to Iceland, I suggest you do this, too, as there is not much to choose from in terms of public transportation.

My return ticket for the shuttle bus (airport to town) cost me around RM230, but a private car hire would probably cost much more than that.

There are many types of lodging available at Reykjavik to fit most budgets. However, do be wary of websites or accommodations that post misleading pictures of their rooms online. I checked into a guesthouse that’s further away from Laugavegur, the main tourist district, for three nights and paid almost RM750 a night (twin sharing). At that price, one might expect a hotel with five-star facilities but what I actually got was a tiny room with cobwebs, a broken shower curtain and dim lighting!

Chasing waterfalls

I booked a six-day ground tour online via Viator.com for US$2,030 (RM8,275) which included accommodation, some meals, sight-seeing tours, transportation and a tour guide-cum-driver. The tour might seem expensive but I think it is a value for money offer as things in Iceland in general are very expensive.

The country is sparsely populated and many people live in the capital city. The main industries are tourism, fishing, geothermal power and hydropower. Icelandic is the official language but English is widely spoken, especially in popular tourist areas.

Iceland is blessed with breathtaking landscapes ranging from active volcanoes to towering waterfalls and what I witnessed during my sojourn was only the tip of the iceberg. It appears that there are countless amazing foss (waterfall in Icelandic) in Iceland like the cascading Gullfoss and thundering Dettifoss.

However, in order to get close to the waterfalls, one needs to be reasonably fit as some of the mountain treks are physically challenging.

Hot and cold

Water and fire don’t mix, but these elements uniquely co-exist in Iceland. One of the most prominent geothermal areas is the Great Geysir which can spurt hot water as high as 70m. The Great Geysir erupts every seven to eight minutes.

In the summer, you can enjoy activities like kayaking, cycling, hiking and rock climbing. I chose to go whale watching at the Eyjafjörður fjord near Akureyriin in the north. The first half hour of the journey was uninteresting but once we spotted the first humpback whale splashing from a distance everyone perked up.

We started cheering as we got closer – it was a sight to behold. Some passengers also saw a pair of adorable white-beaked dolphins frolicking nearby.

If you’re not into any of these activities, then maybe glacier walking is for you. I joined a three-hour glacier hike expedition on one of the Vatnajökull outlet glaciers in Skaftafell. The expedition was led by a skilled female guide from Britain. It was a cloudy day with occasional drizzles during the hike, making it more challenging but it didn’t dampen my spirits.

To me, feeling the glacier beneath my feet was a once-in-a-lifetime experience.

After the hike, we went to Jökulsárlón glacier lagoon. The place was so beautiful I felt like I was hypnotised by the view. I saw snow-capped mountains, glaciers, floating icebergs and sparkling waters from the lagoon, and it was breathtaking.

Small towns, big charm

There are many quaint towns in Iceland, mainly near the coastlines. One of those small towns I enjoyed the most was Siglufjörður which has a population of about 1,000 people. I could hardly find any modern retail shops or trendy cafes and bars in this small fishing town but it seemed that everyone knew each other by name. What an ideal choice for retirement!

After spending six days experiencing Mother Nature at its most beautiful in Iceland, it was time to head home but not before exploring Reykjavik. I yearned for a cup of freshly brewed coffee, and Reykjavik did not disappoint. The city centre is small and walkable, and unless you are a history freak, there is really not much else to do than to soak up the local culture and atmosphere.

I spent two days there checking out the charming street art. As a result of the government’s decision to overturn its ban on street art, many walls and lanes in the city are now covered in interesting works of art.

Some people may be mesmerised by the hypnotic dance of the aurora borealis in Iceland but for me the “midnight sun experience” during the summer months was equally rewarding and enthralling. If you ever find yourself in Iceland, try to say “Eyjafjallajökull” when you’re in front of the camera!

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Taming The ‘Monkey Mind’ With Meditation

Taming The ‘Monkey Mind’ With Meditation - Meditators often tell you that meditation means emptying your thoughts, which will eventually lead you to happiness.

But is it possible to think of nothing when your mind is constantly busy pondering, strategising, analysing and whatever else?

Of course not.

The mind acts like a crazy monkey and causes plenty of destruction – if you allow the monkey to rule.

“I call it the monkey mind,” says renowned monk and meditation teacher Yongey Mingyur Rinpoche.

“Monkey mind says do this and do that, and if we listen, it causes problems and we can become crazy.

“If we fight the monkey mind, it becomes the enemy, so make friends with it.

“How? Keep giving it jobs that it’s happy doing.

“Now, instead of it being the boss, you are the boss. Meditation is like giving it a purpose so it has no reason to wander.”

Basically, meditation is a precise technique for resting the mind and attaining a state of consciousness that is totally different from the normal waking state.

“Many people think meditation is about freeing the mind, concentrating, daydreaming, focusing on one object, emptying the brain, etc…

brain, etc… all these are misunderstood.

“Meditation is what we call awareness; if you know you understand, then that is awareness; if you don’t understand and you know you don’t understand, that is also awareness; if you know you’re confused, that’s also awareness,” says the author of the best-selling book, The Joy of Living: Unlocking the Secret and Science of Happiness, which debuted on the New York Times bestseller list in 2009 and has been translated into over 20 languages.

The thoughts that pass through your mind are responsible for everything that happens in your life.

Your predominant thoughts influence your behaviour and attitude, and control your actions and reactions.

There are numerous ways to meditate and different personalities require different techniques. There is no one-size-fits-all. The most important thing is to keep the spine straight and relax your muscles.

Two types of meditation

According to Mingyur Rinpoche, there are two styles of meditation – formal and informal.

In the formal method, practitioners either sit on the chair and touch the feet to the ground or sit on the floor with the legs folded and crossed, remove all distractions (no gadgets), and watch their breath.

“In the beginning, if the mind is very restless, just spend five minutes to watch your breath. Bit by bit, extend the time.

“Watching the breath is very boring. People always ask me how this can relate to happiness.

“‘I’m looking for happiness and you ask me to watch my breath!’ they tell me,” relates Mingyur Rinpoche.

“But you’re actually getting freedom from the monkey mind and using it the right way so that it doesn’t create problems.

“It’s not easy, so you have to build up a habit slowly… take baby steps and don’t be too ambitious or you’ll be back to square one.

“If you do something for 20 to 30 days, then it will become a habit.

“Sometimes you fail, but that is good because failure is the mother of success.”

In an informal setting, meditation can be anywhere, any time, under any circumstances – while walking, on the phone, playing the stock market, etc.

Mingyur Rinpoche says, “If you need to think, focus on the breath and ideas will become clearer and more creative.

“If you’re thinking without breathing, the creativity becomes lower.

“Everyone has the potential to meditate as long as you’re willing and you comprehend the technique.”

He teaches throughout the world, and his candid, often humorous accounts of his own personal difficulties have endeared him to thousands of students across five continents.

He was in town recently for a retreat and a series of talks.

Happiest person alive

Born in 1975 in the Himalayan border regions between Tibet and Nepal, Mingyur Rinpoche was drawn to a life of contemplation from a young age.

He spent many years of his childhood in strict retreat.

At the age of 17, he was invited to be a teacher at his monastery’s three-year retreat, a position rarely held by such a young lama.

In addition to extensive training in the meditative and philosophical traditions of Tibetan Buddhism, Mingyur Rinpoche has also had a lifelong interest in Western science and psychology.

At an early age, he began a series of informal discussions with the famed neuroscientist Francisco Varela, who came to Nepal to learn meditation from his father, Tulku Urgyen Rinpoche, a meditation master.

In 2002, Mingyur Rinpoche and a handful of other long-term meditators were invited to the Waisman Laboratory for Brain Imaging and Behaviour at the University of Wisconsin-Madison, United States, where scientists examined the effects of meditation on the brains of these advanced meditators.

The left prefrontal area of their brains showed a significantly higher degree of activation, a pattern often associated with the feeling of being “positively engaged, goal-directed, enthusiastic, and energetic”.

What was deemed instrumental was the length of meditation practice in one’s lifetime, which underlined that, as with any worldly or spiritual endeavour, practice matters.

The results of this ground-breaking research was reported in National Geographic and Time, and Mingyur Rinpoche has often been referred as one of the “happiest persons alive”.

The animated Mingyur Rinpoche brushes all of it aside.

The abbot jokes, “I did some kind of brain ‘competition’ with 10 other meditators to see who was the happiest and I won!

“Happiness cannot be measured like that, but the reporter has the freedom to write whatever he wants, so I just let it be.

“For me, happiness is a sense of joy, contentment that comes from within and not necessarily from outside circumstances.”

With just a toothbrush

By 35, Mingyur Rinpoche was enjoying a high profile career as a globe-trotting meditation teacher in the Kagyu tradition of Tibetan Buddhism, had a bestselling book to his name, a monastery in India, and Tergar, an international organisation based in the US with branches worldwide.

Yet something was amiss and he decided to go on a wandering retreat to improve his meditation skills and learn about life.

Armed with only a toothbrush, he left a note to say he was away on a retreat and disappeared from the monastery for four-and-a-half years. No one could trace him during that period.

“I was born to a nice family and was recognised as a Rinpoche. I had many good friends and students.

“I was a Dharma prince, so I never went out and I never stayed on the street for more than an hour.

“My solitary retreat led me to big discoveries. I was naïve. It was like a karmic suicide mission: no money, no house, no friends, no support, nothing. Just me, alone,” he says of his experience.

He fell sick numerous times, almost died, but survived to tell his tale.

He finally returned to Nepal after discovering it was struck by a devastating earthquake, which left more than 9,000 dead, in 2015.

For someone who suffered panic attacks as a child, Mingyur Rinpoche has come far.

“I was fearful of strangers, fireworks, cars, thunderstorms, etc, but didn’t know the cause.

“One day, I went to a cave near my house and pretended to meditate, so I recited the mantra in my mind.

“I didn’t know it was meditation, but I felt good, so I asked my father to teach me.

“It took almost five years before I could get rid of my panic attacks.

“Yes, like anyone, I’m also lazy. I like the idea of meditation, but I didn’t like to practise much then!

“Now I try to do an hour daily. The timing depends on your personality.

“My mission is to make everybody recognise what I call basic innate goodness, which means  everyone has this wisdom, awareness and compassion that is within us to make us happy,” he shares.

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No Proof Kaesong Cash Funded North Korea Arms Programs - South Korea Expert Panel

No Proof Kaesong Cash Funded North Korea Arms Programs - South Korea Expert Panel - There was no evidence that North Korea had diverted wages paid to its workers by South Korean companies operating in a now-closed industrial park on their border to bankroll its weapons programs, an expert panel appointed by Seoul's Ministry of Unification said on Thursday.

South Korea pulled out of the industrial park on the North Korean side of the border, where South Korean factories employed North Korean workers, after the North launched a long-range missile last year.

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Oil Refiners Continue To Trend Higher On Bursa

Oil Refiners Continue To Trend Higher On Bursa - The FBM KCI got off to a slow start, slipping back 0.44 points to 1,771.32 points 10 minutes into the opening bell after putting in a strong performance in the previous session.

Turnover was 264.5 million shares with a value of RM109.87mil. There were 184 advancers to 106 decliners and 198 counters unchanged.

Asian shares rose to a one-month high, on track for their best annual performance since 2009, Reuters reported.

MSCI's broadest index of Asia-Pacific shares outside Japan was up 0.1 percent at 563.86 points, a level last visited in late November.

Back home, the local benchmark index saw some declines in banking heavyweights following the previous day's rally. Maybank slipped bank two sen to RM9.53 and CIMB dipped one sen to RM6.49.

Petronas Chemicals also fell one sen to RM7.79.

Some advancers included Tenaga Nasional, rising four sen to RM15.16, Public Bank, gaining two sen to RM20.72 and Sime Darby Plantation, adding one sen to RM5.48.

On the broader market, refiner Hengyuan continued to put on gains, rising 60 sen to RM17.10. Petron Malaysia also rose 46 sen to RM14.32.

Glovemaker Top Glove again saw upward movement, rising seven sen to RM7.89.

Among decliners, Westports shaved off nine sen to RM3.64, Pelikan lost six sen to 82 sen and Edgenta slipped back three sen to RM2.50.

Oil markets stayed steady after some profit-taking yesterday, following a price surge on Tuesday night due to the attack on a Libyan pipeline.

US light crude rose one cent to US$59.65 a barrel while Brent crude dipped one cent US$66.43 a barrel.

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Producers On The Decision To Cut Kevin Spacey From ‘All The Money In The World’

Producers On The Decision To Cut Kevin Spacey From ‘All The Money In The World’ - A month after All The Money In The World was supposed to premiere at the AFI Fest, the Academy of Motion Picture Arts and Sciences hosted the event on a chilly Monday night.

The premiere was dominated by warm praise for the efforts of director Ridley Scott, who managed to revamp the thriller in six weeks, completely cutting star Kevin Spacey from the film following sexual harassment and assault allegations waged against the actor. He persuaded Christopher Plummer to replace Spacey as J. Paul Getty in the story of the 1973 kidnapping of John Paul Getty III.

Tom Rothman, chairman of Sony Pictures Entertainment’s Motion Picture Group, introduced Scott, who turned 80 during the re-shoots, by noting that few filmmakers could have pulled off the feat in such a short period of time. “He’s a young filmmaker with a promising career ahead of him,” Rothman quipped.

The exec also singled out producers Dan Friedkin and Bradley Thomas for financing the re-shoots and enthusiastically backing the idea. “I’m not sure I’ve ever seen a gutsier producing effort,” he added.

Friedkin and Thomas admitted they were seriously fatigued, but pleased. “My daughter told me today that I looked tired,” Thomas said.“There was such a determination on the part of everyone to do what it took and it seemed like the right thing to do,” Friedkin said.

The re-shoots required actors Mark Wahlberg, Michelle Williams, and Timothy Hutton to give up part of their Thanksgivings.“It was an amazing situation and we all did it for Ridley,” Hutton said. “It’s something that was necessary to keep the movie a movie and not a lightning rod.”

Wahlberg said: “Ridley made the decision out of respect for the sensitivities of the victims. I wanted to support Ridley in any way I could.”

Screenwriter David Scarpa said the willingness of the actors to return meant that he did not need to rewrite the script.“I saw the Kevin Spacey version, which was good,” Scarpa said. “But I think Plummer brings something special to it. I think we’re coming out ahead.” Scarpa is in the midst of writing the screenplay for Scott’s next movie, The Cartel, based on Don Winslow’s novel.

Scott did single out Scarpa’s script when he introduced the movie, calling it one of the best three screenplays that had ever landed on his desk.

“I’m not going tell you what the other two are,” he added. – Reuters/Dave McNary

All The Money In The World opens in cinemas on Dec 28. Catch this movie at Golden Screen Cinemas nationwide. Follow GSC on Facebook, Twitter and Instagram.

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England Bowl Australia Out For 327

England Bowl Australia Out For 327 - England bowled Australia out for 327 in their first innings after lunch on day two of the fourth Ashes test on Wednesday.

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Travel To These Countries For Cheap Surfing Lessons

Travel To These Countries For Cheap Surfing Lessons - Heads up wannabe surfers! If you want to learn how to ride the waves without wiping out your bank account, a new ranking suggests heading to Ecuador, which offers the most affordable surfing lessons in the world.

According to The Surf Lesson Price Index, Ecuador is the cheapest destination for amateur surfers wanting to amp up their game on the cheap, with the average surf lesson clocking in at US$22 (RM94.10).

At the other end of the spectrum, with a price difference of more than US$100 (RM428), is Norway, where the average surf lesson will cost students an eye-watering US$128 (RM547).

Elsewhere on the ranking, Australia, an undisputed capital of surfing, landed in 19th spot for averaging US$49 (RM210) a lesson, while another surfing capital, the US, came in second to last at US$85 (RM364) a lesson.

For the index, tech travel company Surfholidays.com analysed surf lesson booking data from 1,250 surf schools around the world. The list ranks 30 destinations.

Predictably, the cheapest destinations are found in less developed seaside countries such as India, the Philippines, Peru, Jamaica, and Sri Lanka, which all cracked the top 10 list.

Top 10 affordable countries for surf lessons

1. Ecuador US$22 (RM94)

2. South Africa US$23 (RM98)

3. India US$24 (RM102)

4. Argentina US$25 (RM107)

5. Philippines US$26 (RM111)

6. Peru US$29 (RM124)

7. Jamaica US$31 (RM132)

8. Chile US$34 (RM145)

9. Ireland US$37 (RM158)

10. Sri Lanka US$38 (RM162)

Top 5 most expensive destinations

1. Norway US$128 (RM547)

2. US US$85 (RM363)

3. Puerto Rico US$80 (RM342)

4. Barbados US$77 (RM329)

5. China US$72 (RM308)

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This Bone Marrow Cancer Causes Your Plasma Cells To Go Crazy

This Bone Marrow Cancer Causes Your Plasma Cells To Go Crazy - When there is an infection, the body responds with its plasma cells producing antibodies (immunoglobulins) to combat the microorganisms. These cells are produced in the bone marrow, a spongy tissue in the centre of some bones like the hip and thigh bones.

Plasma cells are normally produced in a controlled manner. However, large numbers of abnormal plasma cells are produced in the malignant condition known as multiple myeloma.

These cancer cells fill up the bone marrow and interfere with the production of other healthy cells, i.e. red and white blood cells, and platelets.

Multiple myeloma involves many bones, including the spine, pelvis, ribs and spine.

The exact cause of this blood cancer is unknown. However, it has a close association with monoclonal gammopathy of unknown significance (MGUS), a condition in which there are excess numbers of immunoglobulins.

About one in every 100 persons with MGUS develops multiple myeloma annually.

Other risk factors include increased age and being male.

Features in multiple myeloma

There may be no symptoms in the early stages, which may be diagnosed on routine blood or urine examination.

Multiple myeloma presents in several ways.

There may be anaemia due to decreased production of red blood cells. The features of anaemia include tiredness and breathlessness. Anaemia can also occur because of treatment.

Infections may occur repeatedly and/or may be prolonged because of interference with the body’s immune system.

Interference with platelet production leads to bruising and bleeding from the nose and gums, and heavy periods for women.

There may be pain in the affected bones – usually the back, hips or ribs – with a persistent dull ache that may be aggravated by movement. The weakened bones, usually the back and ribs, may fracture.

Spinal fractures cause collapse of the spine and/or compression of the spinal cord.

The former causes pain, and the latter, pins-and-needles sensation, numbness, weakness in the lower limbs, and sometimes, affects bladder and/or bowel control.

The release of excess calcium from the affected bones raises blood calcium levels (hypercalcaemia), which leads to increased thirst, passing urine often, constipation, confusion and drowsiness.

The kidneys can be damaged by the abnormal cells, hypercalcaemia or medicines used in treatment. Ultimately, kidney failure will result and its features include swollen ankles, feet or hands; tiredness; poor appetite; weight loss; itchiness; and breathlessness.

Sometimes, the blood may become thick (hyperviscosity), which leads to headaches, blurred vision, bleeding from the nose or gums, and breathlessness.

Investigating multiple myeloma

It is not easy to diagnose multiple myeloma because there are no symptoms in the early stages.

After taking a history and performing a physical examination, investigations will help in its diagnosis. Some of these tests may be done initially by the family doctor, but at some stage, a referral will be made to a general physician or a specialist in blood conditions (haematologist).

The blood tests include a full blood count, erythrocyte sedimentation rate, plasma viscosity, blood calcium measurement, liver and kidney function tests, and measurement of the proteins produced by the abnormal plasma cells.

The abnormal proteins, called Bence Jones proteins, are collected over a 24-hour period to measure its quantity and to assess kidney function.

X-rays of the bones of the limbs, skull, spine and pelvis will be done to assess any damage.

Computerized tomography (CT) scans and magnetic resonance imaging (MRI) may also be done.

The diagnosis of multiple myeloma is confirmed by a bone marrow biopsy in which a marrow sample is obtained by inserting a needle into a bone, usually the pelvis, under local anaesthesia.

A microscopic examination of the sample is then carried out.

Management of multiple myeloma

Multiple myeloma usually cannot be cured, i.e. further treatment is needed when it recurs (relapse).

Treatment is usually managed by a team of specialists led by a haematologist or general physician. The objectives of management are to control the condition, and to prevent and treat its complications.

Treatment may not be prescribed in the early stages, but there will be monitoring to detect when problems arise.

The initial treatment may be intensive or non-intensive.

The former is more toxic and is usually prescribed for younger and fitter patients. It involves higher doses and is followed by stem cell transplant.

Both treatments involve consuming anti-myeloma medicines.

These usually include a chemotherapeutic medicine, steroids, and either bortezomib or thalidomide (or its analogue, lenalidomide).

Chemotherapeutic medicines destroy the myeloma cells. Oral melphalan and cyclophosphamide are commonly prescribed.

They are usually well tolerated with mild side effects, e.g. nausea, vomiting, increased infections and hair loss.

Steroids increase the effectiveness of the chemotherapy and help destroy the myeloma cells. Oral prednisolone and dexamethasone are commonly prescribed.

Their side effects include indigestion, increased appetite and mood changes.

Bortezomib destroys the myeloma cells by causing protein to increase in the cells. It is administered by injection.

The side effects include nausea, tiredness, diarrhoea, and numbness or tingling sensations in the hands and feet.

Thalidomide destroys the myeloma cells. It is taken orally and the side effects include constipation, rashes and numbness, tingling sensation in the hands and feet, increased risk of infection and blood clot formation (blood-thinning medicines may be given to prevent this). It cannot be prescribed in pregnant women as it can cause birth defects.

Lenalidomide has similar effects.

Patients on intensive treatment will be prescribed a higher dose of chemotherapy as an in-patient, to potentially destroy larger number of myeloma cells with the objective of achieving a longer period when the condition is inactive.

As the high doses also affect healthy bone marrow, a stem cell transplant will be needed for recovery of the bone marrow after the treatment.

The stem cells are usually taken from the patient prior to treatment; sometimes, they are taken from a sibling or an unrelated donor.

The choice of treatment is influenced by disease factors like type of myeloma, extent of the condition, complications of the condition and recurrence, and individual factors like health status, fitness, expectations and lifestyle.

It would be useful to discuss these matters, and the pros and cons of particular treatments with the doctors before commencing treatment.

Having a list of questions for clarification would be helpful.

A recurrence is treated in a similar manner as initial treatment.

In general, non-intensive treatment is preferred and additional medicines may be prescribed.

The complications and symptoms are treated with various modalities, i.e. painkillers, and even radiotherapy for pain relief; blood transfusions or erythropoietin to increase the haemoglobin; bisphosphonates to prevent bone damage; dialysis for kidney failure; surgery to repair damaged bones or treat spinal cord compression; and plasma exchange for hyperviscosity.

There may be offers of participation in clinical trials that compare new treatments with existing ones.

It is crucial to remember with such offers that there is no guarantee that new treatments are more effective than existing ones.

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Medical Evacuations Begin From Syria's Eastern Ghouta - ICRC

Medical Evacuations Begin From Syria's Eastern Ghouta - ICRC- Medical evacuations have begun from the Syrian rebel-held enclave of Eastern Ghouta to Damascus, the International Committee of the Red Cross in Syria said early on Wednesday.

Almost 400,000 people in Eastern Ghouta are besieged by forces loyal to President Bashar al-Assad, and the United Nations has pleaded for his government to allow evacuation of around 500 patients, including children with cancer.

The Syrian American Medical Society (SAMS) said four patients were taken to hospitals in Damascus, the first of 29 critical cases approved for medical evacuation, and the remainder would be evacuated over the coming days.

SAMS advocacy manager Mohamad Katoub said in a tweet that five had been approved for the first group of evacuations, part of a deal on an exchange of detainees between Assad's government and rebel group Jaish al-Islam. It was not clear why only four of the five had left.

On Sunday, Turkish President Tayyip Erdogan said Turkey was working with Russia, Assad's ally, on the evacuations.

Last week Jan Egeland, the United Nations humanitarian adviser for Syria, said 494 people were on the priority list for medical evacuations.

"That number is going down, not because we are evacuating people but because they are dying," he said. "We have tried now every single week for many months to get medical evacuations out, and food and other supplies in."

The United Nations has been waiting for months for the Syrian authorities to provide "facilitation letters" to allow the aid operation to get under way.

Forces loyal to Assad have carried out air raids on Eastern Ghouta, while besieged rebels have fired mortars into neighbouring Damascus.

"That has nothing to do with the right of evacuating, and obligation to evacuate civilians (and) wounded," Egeland said.

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Japan Government To Promote Fugu Exports To Asia

Japan Government To Promote Fugu Exports To Asia - The government plans to promote exports of fugu, a traditional luxury food item in Japan, targeting wealthy people in China and other Asian nations, according to sources.

Fugu, or puffer fish, are rarely seen in overseas marketplaces because of the poison they contain, but the government is aiming to make the product a big seller among the country’s agricultural and marine exports.

The government has set a goal to raise the value of agricultural, forestry and fishery products exported overseas to ¥1tril (RM36bil) by the end of 2019. It hopes to attain the goal by promoting fugu as a new “Japanese brand” foodstuff.

Fugu has poison in various parts of the body, such as its skin and testis, depending on the species.

According to the Fisheries Agency, many countries prohibit imports and domestic sales of fugu. Currently, the United States, Russia, Malaysia and Singapore import fugu from Japan.

Some countries limit the kind of fugu species that are eligible for import to torafugu tiger puffer. Others have regulations allowing imports of fugu “meat” only after the skin, internal organs and other poisonous parts have been removed.

Annual combined domestic production of natural and artificial fugu was 8,470 tons in 2016, but within that figure, exports were “very small,” according to a senior official of the Agriculture, Forestry and Fisheries Ministry.

A government source said that tasty Japanese food is very popular among wealthy people in foreign countries and great demand for fugu is expected. Based on this judgment, the government is considering promoting sales of fugu as a foodstuff along with cooking methods for the fish, such as removing the poison.

With Japanese food becoming popular recently in China, local Japanese restaurants have started serving fugu dishes.

China officially approved the domestic distribution of fugu last year, but has yet to approve imports of the fish.

To export fugu to China from Japan, the government needs to negotiate with China’s food sanitation authorities to have them recognize the safety of the fish and other elements.

The government plans to accelerate efforts to negotiate with China for that purpose.

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