Monday, August 24, 2015

Of having girls

I saw Mr. T the other day for follow up of his thyroid cancer.
He excitedly shared with me that his wife is pregnant, into her 2nd trimester. They are expecting their first,a girl.
In jest (he knew I have two), he asked if I had any advice.
Ah, what would I say?
With girls, you would be sentenced to a life of:
  • A life full of pink, in varying shades, so much so that it begins to become your favorite color
  • Dora, Barbie, Sofia, Cinderella, Ariel, Rapunzel, Belle. You'd learn the words of the themes songs of all the princessy shows
  • Braiding and nail painting (which I secretly enjoy doing now- good bonding time when they're actually sitting with you and listening)
  • Drama. Not the kind I remember growing up with boys. Not of that physical wrestling, punching. But a lot of "mommy, XX said this...."
  • Your wife having natural allies, more than you appreciate. "But DADDY, mom said you shouldn't do/eat that...."
  • Perfumes and make-ups
  • Little hugs and kisses (I'm going to miss these when they hit their teens and stop giving daddy kisses)
  • Tiaras and gowns
  • Unlimited and unconditional love. Even after you've punished them for being naughty

Yes, these are generalizations, but at least for me this is what I have to deal with. And I wouldn't have it any other way (ask me again when they are teenagers).

But no, I didn't give him too much details. All I told him was "You'll love every moment of it".

Thursday, August 20, 2015

Hunting for a school bag

We took Alli schoolbag shopping the other day. And I have to say, it brought some warm memories back to me. Except this was a variant of what I did when I was a child.
I remember being excited as mom and dad took us to get our schoolbags. Back then, it seemed that the popular ones were the bright yellow 3M backpacks that every kid in school had. You know, the one that was big and yellow and waterproof, with a metal clasp to hold the flap in place? That feeling of pride, when you carry your brand-spanking-new bag for the first time, loaded with freshly sharpened pencils and a new eraser, in a shiny pencil case?
Except this time, it was me taking my child out to pick her own backpack. We took her to the store and she was so excited looking at the racks and racks of back packs. Checking each out carefully. And instead of getting something boyish with superheroes or robots or planes or cars, she picks a pretty purple-pink princess bag. With Cinderella, Rapunzel, Ariel, and Belle on it.
And this time, instead of excitement (well, I guess I am a bit excited), it was a lot of other emotions. My wife and I had our moments when we looked at each other and tried not to tear up. Our girl's growing so fast.
Come Monday when she starts school, I'm pretty sure we will be a mess. Wish us luck!

Tuesday, August 11, 2015

New Toy

OK, I'll admit, part of me feels a bit guilty.

After all, a person in healthcare should not take pleasure in killing living things, should he? Isn't that a sign of antisocial personality issues?

But man, this has been one of my more fun purchases from Amazon:

All fathers will attest to this I'm sure; kids just somehow can't learn to turn off lights, fans, or close the screen doors. And because of the latter, we have flies infiltrating our house on a daily basis in the summer. And so I recently decided to get this electric fly zapper from Amazon. Something my wife hadn't heard of before, but pretty commonplace in Malaysia.

Well, let's just say I've probably already killing a generation of flies. At least 30- I kid you not- in the last couple of weeks. And there's some gleeful pleasure in hearing that "pop" when you finally catch that sucker in the wires (sadistic, I know. Maybe I should have become a pathologist). And yes, I use this only on flies.

Sunday, August 02, 2015

Little Lies

My fear is someday my girls will follow my footsteps, and go into medical school and become doctors. 
And then one day, after they have learnt real physiology, they will confront me and angrily say:
"Dad, eating broccoli does NOT prevent armpit hair", or "Eating peas does not make me grow taller!". 
Or, Alli: "Daddy, why are you putting deodorant on your armpits?". Me: "To help the hair grow". Alli: o_O

Please tell me I'm not being a bad dad and telling these little white lies. It's almost too easy now, especially when their daddy is a doctor and knows everything.

After all I remember the ones I was told:
Eating chicken feet will give you bad squiggly handwriting
Not eating all your rice will give your future wife a lot of acne
Eating too much Maggi mee will make you bald (or maybe this explains a lot for me...)

Ah, the joys of fatherhood.

Monday, July 27, 2015

A Gift from a Patient

I received the most unusual gift from the patient the other day.
Over the years, I've gotten some thoughtful things from the people I treat. And no, it's certainly not a requirement or expectation, but it certainly brings some warmth, and a smile, knowing you're appreciated. 
Let's see. Giftcards. An angel ornament. Books. CDs. A mug. T-shirt. Bookmark. Brooch. Cookies. Cake.
And now, fish.
Fish?
Yup, fish. As in fish a patient caught during a fishing trip. Which he then skinned and filleted himself, then packaged and flash-froze it himself.
He handed it to me when I saw him recently.
It probably isn't worth much. But then again, it was worth everything. This was something he did himself, and of all the people, he thought about his endocrinologist during his fishing trip.
I was very much flattered, and grateful. He gave me some tips on what to do with it. And I think the first batch I cooked turned out pretty good. I cooked it on a grilling plank in my gas grill.
Maybe Portuguese fish curry the next time.

Thursday, July 16, 2015

Faith and Medication

I'll start by saying this: faith is a GOOD thing. So please don't misunderstand my intentions.
However, with faith, one also needs to have some common sense.
I saw a woman the other day in the ICU. Presented with florid diabetic ketoacidosis, sick like stink and was intubated for airway protection. She was pretty acidotic, with her gap being 27.
She had type 1 diabetes, diagnosed in childhood for which she took insulin for survival. Very devoted mother and she homeschools her 7 kids. She was also very devout in her religion. And so, unclear to me why, after a period of very intense prayer and meditation, she was convinced God has cured her of her disease. Somehow resurrected the long-apoptosed pancreatic islets, and that she was again capable of producing endogenous insulin.
And so, she stopped her life-sustaining medication. And stopped testing her blood glucose.
It didn't take her long to go into DKA.
Remember, kids- you cannot control sugars by eating less alone- in insulin-deficient individuals, survival without insulin, even when one is fasting, is not possible. It's 2nd year physiology.
It's the 2nd case of DKA induced by religious fervor that I've seen here.
With the excellent care she is receiving in the ICU, I'm optimistic she will recover. And we'll have to reinforce that she will need to stay on insulin for life (unless she chooses to have a pancreas transplant).
However, it's important to remember that while faith is important, it's also important not to disregard medical advice.

Sunday, July 12, 2015

7 years


I had to renew my hospital ID the other day. And perhaps I just forgot about it, or was in denial, but I was kinda taken aback by the new photo ID on the left.
This, compared to the photo I took when I first started to work. Heh, I even had my braces on in the earlier picture.
My first reaction was, KNNCCB, WTF??!?
It looked like I've aged 20 years in the last 7. I'm still not sure what was to blame- genetics (after all, I remember dad's old pictures- long flowy hair until his early 40s when boom, it was suddenly gone), being married (heh, I don't think my wife reads my blog anymore), the kids, or just work.
And so, I'm still sometimes tickled by patients who ask to see an endocrinologist for premature balding, because they thought it was hormonal in nature (probably partially, but it's not something I treat)- and then I walk in the room and they take a look at my head and go "maybe I'm not seeing the right doctor...".
One of these days, when I'm gutsy enough, I'm just going to shave it all off.  
Someday.

Sunday, June 21, 2015

Happy Father's Day

Happy Father's Day, guys! To all the dads, grand-dads and great-grand-dads. To those here, and to those who have left us.
Being a father myself now, I realize more than ever how vital a role dads play. After all, as they say, a dad is a boy's first superhero, and a girl's first love. No matter how we complain about our parents as kids, you realize that your parents are indeed your first role models and the mold into which you grow as you find your place in life.
It's scary during those moments when you utter the words you swore you'd never use, the very words that your mom and dad said. It's scary when you look in the mirror early in the morning when you're half asleep, and realize you're looking at your younger dad.
I'm never going to claim that I'm the best dad in the world- I realize there is much I do wrong and there is much I have yet to learn. But I try, and I understand the roles dads and moms play (not that this cannot be interchanged), and that in our household, I'm the fixer, the problem solver, and also the disciplinarian. The girls know when I'm on scene, they're in trouble. I'm also the worker- which partly saddens me as I hate being away at work- and though mom works just as hard, it seems that I'm the one with more meetings, coming home later and leaving earlier, and working weekends. It reminds me of the sacrifices dad made to provide for our family. And for that I shall forever be indebted to my parents for all that I've achieved.
Happy Father's Day, dad! We love you!
 
 
(Disclaimer: I know I should have made a Mother's day post too last month- but I got lazy- this is not meant to say dads do everything. The reality is the moms do more than us. But at least one day a year, I get to feel like a superhero!)

Sunday, June 14, 2015

Missing the boat

One of my partners was asked to see a hyperthyroidism consult in the hospital the other day. A 30-something year old woman with Graves' disease, who was admitted with a large left hemispheric stroke.
I was horrified and deeply saddened when I heard about her. Because she was so young. Because her life which was so full of potential, has drastically changed probably forever. She could not walk (perhaps with therapy, might recover some degree of ambulation in the future), could not move her right arm, and had marked aphasia (speech). Mother of 2 young kids. And because the stroke could have been prevented.
Turns out, I had seen her in clinic 6 years ago, and made the diagnosis of Graves' disease. The biochemistry, clinical picture and the I123 scan were classic. I started her on antithyroid therapy. At follow up 2 months later, her labs actually looked worse- she had not been compliant with her medications because like many others, she did not want to gain weight as we corrected her thyroid and slowed her metabolism back to a normal level. I never saw her again- she subsequently no-showed visits and was lost to follow up. And while this was a rare, severe complication of untreated hyperthyroidism, unfortunately it happened.
Was the stroke caused by the hyperthyroidism? Probably- she was young with no other risk factors. She was in a-fib when she presented, with FT4 levels 8 times where it should have been. It was clear this was a causative factor.
She promised to be compliant with treatment this time; but a huge part of me was saddened to think of how things could have been if that was the approach 6 years ago, and while it'll be helpful to be on medications now, the truth is we've already missed the boat and the damage has been done.
I only hope that with her youth, physical therapy is able to help her recover some meaningful use of the right side of her body.

Thursday, June 04, 2015

In a Blink of the Eye

In a blink of the eye, and they gone.
Mom and dad left today after a month-long visit. Can't believe the time just flew by- it didn't seem that long ago when the girls and I picked them up at the airport.
And today, we sent them off. They are somewhere over the Eastern seaboard as we speak, enroute to KLIA and home.
It's been a wonderful month- having my parents around, having mom's homecooked recipes, conversing in Chinese, seeing them interact with my girls. And Kris has been most patient, putting up with our idiosyncrasies and obsession with white rice.
But truth be told, a part of me cried a little, coming to terms with our reality- one that any expatriate Malaysian with children will likely encounter. You realize that you may consider yourself Malaysian, and remember your smalltown boy roots fondly, this will not be the same for your children. Because of the distance, they will never be as attached to your family as you are; that in all likelihood they will be much more attached to their families here, and would have trouble understanding some of the cultures, language and traditions you may share with your parents and siblings.
And so, it was heartwarming to watch the girls interact with their Ah Kong and Ah Ma, I was a bit saddened to see that they were more attached and familiar to/with their maternal grandparents. That they had their moments too especially when they were tired when they just didn't want anything to do with my parents. Like how Alli had to be coaxed to even give a goodbye hug at the airport, because she just woke up from their nap.
My parents being as patient as they are understood. And I'm sure this was something they knew would come- sending their son overseas and having him start a family there. This is to be expected, that despite the phone calls and Skype sessions, that the distance will always be there and so the girls will grow up not having them here all the time. Sending them off had a profound effect on me- and I left the airport feeling somewhat lonely, realizing that the girls were not as saddened as I was, and that there would be no one on this continent that would feel the way I do about my parents.
But yet, another part of me was humbled and in awe too of their sacrifices. Being a father now, I realize how it is really possible to love your child that much. How crushing it is to leave your child. And yet, because they saw a better future for me away from Malaysia, they had the strength and love to encourage and let their kids spread their wings and fly and go to where life takes them. And in my case, half the world away.
Have a good flight, mom and dad. We enjoyed your visit and will miss you...
 

Wednesday, May 27, 2015

9 years

Oh, how time flies.
We made a short Midwest road trip last week. Visited friends in WI and MN. And amongst the stops we made, we stopped at our alma mater- it brought back floods of memories checking out our old hang out places, even drove past my old rental home of 5 years.
Anyway, we also made a stop the the Minnesota Science Center. This was special for several reasons, the main reason being this was where Kristin and I went on our 2nd date 9 years ago, almost to the day! They had a Bodyworlds exhibit then, and so we checked it out. We also walked about the center, and took a picture sitting on the erythrocyte-modelled chair.
Then and now- (sighhhh)
 

 
My wife has threatened me with bodily harm should I post any then and now pictures of her- and because I value my family jewels I shall not do so.
But boy- it did make us realize how time flew by. Our first date in 2006, engaged in 2007, married in 2008. And now here with two beautiful girls who act like crazed monkeys. Professionally, it also reminded us of how we grew. From my first day at my alma mater in 2002, then fellowship in 2005 and graduation and practising as a consultant in 2008. It was a bonus too that it so happened that a fellow graduate and good friend from Singapore was making a 2 week visit for a clinical observership- and when he saw on my Facebook page we were there, he texted me and we were able to meet up and reminisce about the old times and the crazy things we did.
Life now is at a different pace. Work, family, all the grownup things like taxes, bills, mortgages and life insurance. But once in a while, it's nice to visit those earlier years in my dreams.

Sunday, May 17, 2015

Disney Dream

We're back. And boy, was it a blast.
We took the 3 night cruise from Port Canaveral to the Bahamas on the Disney Dream. Best of all we got to go with my and Kristin's parents, taking up 3 cabins.
This was my 2nd cruise, but the first on a Disney ship. And boy, it was all I imagined, and more. The people on the ship were just so friendly, and the vessel was obviously geared towards to the kids with numerous activities for them. In fact, for the 3-11 year olds, the Oceaneer's Lab and Oceaneer's Club were play areas where you could drop your child off for free. They had all kinds of playthings and activities that even I was kinda envious of. They also had rooms for the tweens and teens, and a childcare service for kids under 3.
Best of all, thoguh the ship was extremely child-friendly, the adults would have plenty to do themselves. With the numerous pools, some adult-only, and the Aquaduck water coaster which actually loops you over the ocean at a point, Broadway-quality shows and great restaurants- there was plenty to keep us occupied.
The rooms were well-appointed- we got a cabin with a balcony which was well-worth it. With a queen sized bed, but two additional pull outs- but what was neat was they had two separate stalls for the toilet, and the shower; so you could have two people using the facilities at the same time.
The ship made stops in Nassau and Disney's own island- Castaway Key. Nassau was expectedly quite touristy- but I had a blast on the island paradise of Castaway. In fact, the kids spent 5 hours there! Beautiful beaches with calm waters, two waterslides and water activities. We rented a stand-up paddle boat and tried it out for the first time.
After the cruise, we spent a few more days at a rental condo at Cocoa Beach- also made a visit to NASA. After a week's vacation, we're back home.
Definitely would recommend a Disney Cruise to anyone- this was a wonderful experience and a bonus that the girls got to go with both sets of grandparents. Hope we'll get to do it again someday.
 

Saturday, May 09, 2015

Grandparents!

Finally, after a long wait, they're here. My parents; Alli and Ava's Ah Kong and Ah Ma. They got in Sunday night- their last visit was several years ago, so we were excited to have them visit. The girls even made a banner for the wait at the airport. This was how the looked, before they got bored and tired after waiting for awhile. Eventually Alli just sat and moped while Ava fell half asleep >_<
They'll be with us for a month. Not as long as I'd wish, but long enough for the girls to spend some quality time with them. After all, the huge sacrifice living here is that they will grow up far away from their Malaysian roots. Skype helps, but there is much to be yearned.
Anyway, it's almost tradition; so much so that Kris cleared up the dining table in anticipation of this. Mom and dad never fail to bring loads and loads of contraband, aka Malaysian food. You will notice the 5 cups of kaya, in addition to the two jars of homemade kaya! And it's fun to see the kids take a liking to some of the kuihs.
They're here also for our much-anticipated trip; we will be taking a Disney cruise with my parents and in-laws. So 3 cabins side by side, to the Bahamas. This will be the girls' firsrt cruise, and our first on Disney, so we're really excited. 
I'll admit- I'M REALLY EXCITED.
Anyway, we depart Monday. Wish us luck!

Saturday, April 25, 2015

Malaysia 2015

Woo hoo!
I bought my tickets for Malaysia. Yes, after a lapse of 2 years, I'm making a journey back, this time sans kids and wife.
It'll be in September so I'll have plenty of time to wait. But Kris and I were talking, and my thoughtful wife shared that it's been a long time since my last trip back, and that time because the kids were jetlagged and cranky, I had minimal time with my buddies. Some of whom I met up with only for 2 hours, to catch up on 3 years. Since I have a few weeks of vacation time to kill, she suggested I make a solo trip.
After much pondering, I finally bought the tickets.
Will be back for 2 weeks in September to October. And have committed to giving a couple of lectures to doctors/students in Seremban, and if time permitting, may do more in the Bukit Jalil campus. Aside from that, this will be mainly a trip to be with family and friends.
More to follow, but in the meantime I have 5 months to work out and lose some weight in preparation for the gastronomic expedition I'll be sure to undertake.

Saturday, April 18, 2015

The Mysterious World of Kids

So here I am, sipping coffee at 609AM on a weekend. Hoping the kids won't wake up for a bit so that I get some peace and quiet in the house. But inevitably they will get up early, because it's the weekend. If you're a parent I'm sure you know. Which gets me wondering about this and other questions.
  • Like why is it that you have to drag kids out of bed on weekdays when they have to go to preschool, but on weekends they miraculously wake up by 630 all energized?
  • How after wolfing down two bowls of rice and saying they're full, but only after a mere 30 minutes later they can say "I'm hungry?"?
  • How a 4 year old learns the spelling for Ice Cream before Apple?
  • Why it is possibly for a toddler that small, to make a poo that large in her diaper?
  • How kids can magically make a freshly laundered shirt dirty again within 0.2 milliseconds of putting it on?
  • They can't hear you when you're asking them to clean up 3 feet away, but have superhuman hearing when you're sneaking a sweet dessert in the pantry 30 feet away?
  • How they never get sick of watching the same cartoon over and over again? Alli and Ava have seen 'Frozen' about a trillion times by now.
  • Or how toddlers seem to get more food on their face than into their mouth?
Not that I'm complaining. But maybe someday I should study this and get this published in some scientific journal. And prophetically, I hear commotion from the kids room.... someone's awake. Uh oh. 

Sunday, April 05, 2015

When the cat is away...

... the mice comes out to make prawn noodle!
Yes sad as that may sound, I have to resort to doing this secretively.
For some men, when the wife is gone for the weekend, they may have other wilder stories to share. Alcohol. Women. Smoking. Fast cars etc.
For me, it's food.

If you are married to an AngMoh, you may understand. Certain smells do not agree with Kris and the kids. Particularly shrimpy and fishy smells.

You should have seen her reaction when we were dating, the first time I used belacan. From the other side of the house, I hear "What the hell is that???" and her running outside, thinking it was some chemical spill (and they say Malaysia doesn't have biochemical weapons? The silly Westerners obviously have not encountered belacan and durian).


Anyway, this was my lunch(es). I had a pack of prawn noodle paste. One that I had hiding in the deep corner of my pantry, only because I didn't want my wife to leave me and Child Protection Services to come and take my kids away- so I have not used this. For years. Hence the baik sebelum date of April 2013. But then again I've been away from Malaysia too long, and I don't read Bahasa Malaysia anymore and so those words meant nothing. Probably date of manufacture, huh?

Out I went to the store to buy some spaghetti (it's a decent substitute), veggies and shrimp. And gleefully put it together. And I made a potful that it lasted me for two heavenly meals.

It's been 8 hours since my last bowl. My gut is still behaving normally, so I take it this means I'm in the clear and won't die of food poisoning (but if this is my last blog ever, you know what happened).


The wife and kids get back from Wisconsin (visited the in-laws for the Easter weekend- I have to work tomorrow so could not join)- I pray the smell dissipates out of the house by then. Otherwise I'm going to be in trouble.

Saturday, March 28, 2015

LKY

A few days late, but I wanted to leave some thoughts on this.
Being so far away, and ironically being a Malaysian, I still did feel a sense of loss over the recent passing of Lee Kuan Yew. Indeed, part of me was envious that I couldn't be there to pay my respects, reading about this on my Singaporean friends' FB posts. And certainly the huge envy most Malaysians would have, thinking about what a great man and leader Mr. Lee Kuan Yew was, and how things might be/have been if only Malaysia had leaders such as him.
It's pretty damn amazing reading about Singapore's development from a small island settlement to a what it is today. And how it rapidly advanced after its separation from Malaysia, leaving us in its dust while we still, almost 60 years later, struggle with bickering, corruption, racial disharmony. Mention Malaysia here and I'm usually faced with "where is that?" or "Isn't that where they have terrorists?/Is it safe?/That's the country with the plane crashes!".
Mention Singapore, and everyone here knows about it.
Singapore truly has come a long way, and though she isn't without her issues, it's pretty evident that much of her progress can be attributed to LKY. Even if you don't agree with his ways, you can't argue with his success.
RIP, Mr. Lee. You have worked so hard- it is time to rest knowing you have raised a country well.

Tuesday, March 10, 2015

Passport Renewal

So last week the wife and I made a trip to NYC to a date-trip (in-laws offered to watch the kids as we flew out), and to renew my Malaysian passport.
Yes, I admit, though I could probably apply for US citizenship now, part of me is too damn proud to give up my Malaysian identity. I still take pride telling people here I'm Malaysian.
Which is probably why I put up with the tidak-apa crap everyone else does. Which was well illustrated when I was last in Malaysian in November 2013. I knew my passport expired in late 2015 and didn't think I'd make another trip back in the meantime, and tried to get my document renewed.
The Jabatan Imigresen opens I think at 8AM. I was there by 845AM; to my chagrin there was already a long line there. I took a number to wait for my turn to submit my papers.
And waited.
And waited.
In that humid, packed room.
And after 2 hours and having seen the numbers advance only a few digits, I decided to come back. Especially since one of the officers told one of the Ah Pek's off and told him to come back in the afternoon.
When I popped in again at 1PM, it was still nowhere close to my turn.
And so I told them to go to hell, and decided to do it here instead.
Fast forward to now. 
When I emailed the Consulate General of Malaysia at NYC, my emails were answered in a most unMalaysian way- within a few hours. I asked about what documents I needed, and what preparations I needed to undertake.
As it turns out, all I needed were:
1) To complete the Registration of Malaysian Citizens in USA form
2) Passport
3) Malaysian IC (best to have the new MyKad- you'd get a 5 year renewal, versus a 2 year) and a copy 
4) Malaysian BC and a copy
5) US Green Card (not listed on their website, but they asked me to bring mine)
6) US$70

The embassy was located in the east side of midtown Manhattan, walkable from Times Square if you're adventurous. They open at 9AM; we arrived at 930AM and took a number and were attended to within 45 mins. They took my photo on the spot, and my new passport was ready in less than 2 hours.
And best of all, people were FRIENDLY! For one, the Malaysian camaraderie in the waiting room, "Eh which part of Malaysian are you from?" etc. But best of all the consulate officers were actually friendly, efficient, and quick! 
Such a difference from my experience in Seremban in 2013.
Syabas, guys! This is the way to do it. 
If you're looking for info, they are located at 313 East 43rd St, New York 10017 NY
Email: iminych@yahoo.com 

Wednesday, February 25, 2015

Signs Your Kids Are Growing Up

  • Your girl is able to brush her own teeth and doesn't need any help
  • Being able to get herself dressed on her own
  • Telling me she doesn't need me to wave goodbye to her anymore as I drive away from daycare, as she'll have her friends to play with
  • At one time, you stand in the restroom with your daughter as she goes potty to make sure she doesn't fall into the bowl. Now, she goes "Daddy, I need some privacy please"
  • Going from singing lullabies at bedtime (I swear I've probably sung Twinkle Twinkle Little Star over two thousand times in the last 4 years) to reading bedtime stories, to now watching a video on the iPhone of One Direction and having the girls swoon and go "Oooo He's so Cute" at bedtime
  • Being able to tell me the name of a song when she hears it on the radio (when I've never even heard of it before. I guess this is how our dads must have felt hearing New Kids on the Block for the first time)
I'm reminded of the song Butterfly Kisses. To perfume and make-up from ribbons and curls. Trying her wings out in a great big world.
 
Don't grow up too quick, kids. Because someday I'm going to be giving you away at your wedding. And THIS dad is definitely going to cry.


Saturday, February 14, 2015

Another Phaeo

Phrase that sends shivers up an endocrinologist's spine:
"Biopsy-proven phaeochromocytoma..."
 
Saw my 2nd case of this recently, to my chagrin.
I've seen perhaps 20 cases in my career so far of catecholamine secreting neuroendocrine tumors. But theses should be diagnosed based on clinical suspicion, appropriate biochemistry and radiologic findings.
Never (usually- but will come back to it*) is it justified to diagnose this from a biopsy, as this usually means the physician/surgeon evaluating a patient with an adrenal mass was not considering a phaeo in the differential diagnosis. Or that he/she made the fatal assumption that asymptomatic rules out a phaeo and that lab testing isn't needed- just stick a needle into it.
My first referral was 7 years ago- that patient had a hypertensive crisis in the radiologic suite immediately following the adrenal biopsy. I think the radiologist shat in his scrubs when it happened and it must immediately have dawned on him what the mass actually was.
The second, this patient, had adrenal hemorrhage that required invasive intervention.
 
What I tell residents is this: The classic features of a phaeo isn't that classic after all. All adrenal masses need a biochemical workup, especially before you stick a needle into it.
 
Most phaeos are asymptomatic. And of the symptomatic ones, the most common is hypertension; what looks to be plain old simple essential hypertension. So never assume.
 
(*perhaps the one situation in which I would not blame this on shoddy work is a paraganglioma/extraadrenal phaeo in a weird location- which would be unfair to expect one to consider a phaeo in the differential diagnosis)