Calcium Metabolism Disorders

I have recently wrote this for meducation.net. Enjoy!

http://upload.wikimedia.org/wikipedia/commons/a/a3/Illu_thyroid_parathyroid.jpg

Calcium Metabolism Disorders

author: Chan En Ze, MBBS

date: 13 October 2013

What are the functions of calcium in our body?

Calcium has numerous functions in our body and can broadly divide into two:

1) The first role is calcium act as structural support in the form of bone. A bone is composed of 35% organic matrix (mostly proteins in the form of Collagen) and 65% inorganic calcium hydroxyapatite (hy·droxy·ap·a·tite). When you put a bone under a flame, the organic part will be all burnt up, and what remains is the inorganic calcium hydroxyapatite, which gives the white chalky texture. The Calcium Hydroxyapatite has the biochemical formula Ca5(PO4)3(OH) which shows that it composed of both calcium (Ca) and phosphate (PO4), thus regulation and metabolism of Calcium in our body is closely related to the regulation and metabolism of Phosphate. It is interesting to note that some orthopedic prosthetic implants are coated with Calcium Hydroxapatite to promote osseointegration.

2) The second role is it maintains normal cellular function: neuromuscular signalling,hormone release, cardiac contractility, and blood coagulation. That is why, the calcium concentration in our blood is maintained within a narrow range (2.2-2.7mmol/l) because any small disturbance of the concentration will greatly affect the muscle, nervous system, endocrine, heart and blood coagulation. The details of these mechanism is beyond the scope of this chapter.

How calcium regulation take place in our body?

The four main organs which tightly regulate calcium in our body are the intestine, bone, kidney and parathyroid glands. For simplicity sake, think of the intestine takes in all the calcium into our body, bone act as a huge store room for calcium, kidney as calcium disposer, and the parathyroid that secretes parathyroid hormone (PTH) maintains the blood calcium concentration.

There are 2 main hormones which tightly regulate calcium concentration:

1) The parathyroid hormone(PTH) secreted by parathyroid gland which regulate blood calcium concentration minute by minute. Increase of PTH will increase calcium concentration and vice versa. The only way to get calcium supply in this short amount of time is to get it from the bone and to immediately decrease kidney secretion of calcium ion. You can’t count on the intestine to wait for supply of calcium in the next meal! That is why after a total thyroidectomy done, a surgeon will measure the corrected serum calcium the following day after the surgery. If the parathyroid is affected, there will be a quick decrease in serum calcium concentration the following day. I say “corrected” because calcium is bounded to albumin in plasma, hence we need to take albumin concentration into account.

2) Unlike the PTH, the Vitamin D has a more long term role on calcium regulation. It has the major role on calcium absorption in the intestine and lesser role on the bone and kidney. With the help of Vitamin D, these absorbed calcium is then stored in the bone. Another way of thinking the Vitamin D is it act as “bone builder”, it increases calcium and phosphate absorption to the bone and decrease excretion of calcium and phosphate in the kidney. This is contrast to PTH which breakdown the bone by releasing calcium and phosphate into the blood, decrease calcium excretion in the kidney but increase phosphate excretion.

The Vitamin D is obtained from diet and synthesis in the skin by the action of sunlight. It is serially activated to 25-hydroxylation in the liver and 1-hydroxylation in the kidney. That is why decrease in sunlight exposure, liver and kidney failure will affect Vitamin D concentration.

In the “mind” of the hormones	Parathyroid hormone	Vitamin D
My Goals	My goal is to regulate serum calcium concentration minute by minute by increase serum calcium in a very short time.	My goal is to build strong bones and long term calcium regulation.
How I do it?	Breakdown bone, increase calcium and phosphate release into the blood. Increase decrease excretion of calcium in the kidney but increase phosphate excretion in the kidney	Activate the intestine to absorb dietary calcium. Build bone by increase calcium and phosphate absorption in the bones. It also need increase supply of both calcium and phosphate by decrease excretion of both ions in the kidney.

The other hormone is the Calcitonin (produced by the C-cell of the thyroid) act exactly opposite to the PTH, but has less physiologic importance.

What are the causes of too much calcium in our blood (hypercalcemia)?

The causes of hypercalcemia are increase calcium intake, increase calcium release from the bone, and other causes.

Increase calcium intake:

1) Excessive ingestion of OTC medicine Calcium Carbonate to treat dyspepsia. This is known as Milk-Alkali Syndrome. This is more markedly in pregnancy when there is increase absorption of calcium in the guts.

2) Total parenteral nutrition

3) Vitamin D intoxication

4) Excessive Vitamin D production in granulomatous disease like sarcoidosis, tuberculosis, and silicosis. In these lesions, there are excessive macrophages which produce Vitamin D, which in turn activate the gut to absorb calcium.

Increase calcium release from the bone:

1) One most important cause is hyperparathyroidism. Primary hyperparathyroidism is when there is single or multiple parathyroid adenomas or hyperplasia causing increase secretion of PTH inspite of already high calcium concentration in the blood. In normal condition when serum calcium is high, the feedback mechanism causes decrease secretion of PTH. However, in primary hyperparathyroidism, there is increase in serum calcium and normal or high, PTH level. There is also increase urinary calcium, decrease in serum phosphate due to its action on the kidney. Because of the action of PTH, there is increase bone resorption, activation of osteoblast and osteoclast which results in high alkaline phosphatase level, resorption cavities in the bones (known as osteatitis fibrosa cystica) and bone marrow fibrosis. Treatment for this condition is to surgically remove the parathyroid gland. In familial cases, hyperparathyroidism is associated with MEN type 1, a neoplastic lesion of pituitary, parathyroid, and pancreas.

2) Parathyroid carcinoma can results in increase PTH production and hence, hypercalcemia.

3) In renal failure, there is decrease production of activated Vitamin D which cause prolonged hypocalcemia state. This cause compensatory hypertrophy of the parathyroid gland. In this case, the PTH level is high, but the calcium level remains low or normal. This is known as the Secondary hyperparathyroidism. In long setting of this condition where there is parathyroid hyperplasia, eventually blood calcium level is raised. This condition is known as tertiary hyperparathyroidism.

4)  Lytic skeletal metastases in malignancies such breast cancer and myeloma

5) Many solid tumours like squamous cell carcinoma of lung secrete Parathyroid Hormone-related Protein (PTHrP) which behaves like PTH and causes hypercalcemia. This may be the first sign of malignancy and is consider a paraneoplastic syndrome.

6) Hyperthyroidism can cause hypercalcemia but the exact mechanism is not understood. Thyroid hormone is known to stimulate osteoclast differentiation and hence increase bone resorption causing hypercalcemia.

7) Like wise, prolonged immobilisation increase bone resorption causing hypercalcemia.

Other causes:

1) In the parathyroid gland, there are calcium sensor receptor (CaSR) which sense the calcium concentration level and in return the parathyroid gland will secrete the appropriate amount of PTH. Mutations that reduce the activity of this receptor can result in higher concentration of  calcium and PTH. THis condition is known as Familial hypocalciuric hypercalcaemia.

2) Lithium therapy also can affect the function of CaSR and causing hypercalcemia.

3) Endocrine disorder such as Addison’s disease, Pheochromocytoma, VIPoma

4) Medication such as thiazides, Vitamin A toxicity,, Theophylline toxicity.

What are the causes of too little calcium in our blood (hypocalcemia)?

The cause of hypocalcemia can be divided into two categories: hypocalcemia with low serum PTH level (hypoparathyroidism) and hypocalcemia with high serum PTH level (secondary hyperparathyroidism).

Low Parathyroid Hormone Levels. This is due to defective in the parathyroid gland itself. Failure of PTH production cause decrease serum calcium level. The causes are of low PTH hypocalcemia are the following:

1)Parathyroid destruction can be spontaneous due to autoimmune causes. Autoimmune hypoparathyroidism can be associated with autoimmune polyglandular syndrome type 1 (mucocutaneous candidiasis, adrenal, gonadal, thyroid failure)

2) Post radiation, post surgery like parathyroidectomy and thyroidectomy, infiltration by metastases or systemic disease; all these can cause low PTH

3) Hypomagnesemia can impaired synthesis and secretion of PTH. Hypomagnesemia is always associate with hypocalcemia and hypokalemia.

4) Previously, we mention CaSR. Mutation that reduce the activity of CaSR can cause hypercalcemia in case of familial hypocalciuric hypercalcaemia; in contrast, mutation that increase the activity of CaSR can cause hypocalcemia and this condition is called autosomal dominant hypocalcaemia with hypercalciuria.

5) Parathyroid agenesis like DiGeorge syndrome (mnemonic CATCH-22: cardiac anomaly, abnormal facies, thymic aplasia, cleft palate, hypoparathyroidism - Chromosome 22 abnormality)

High Parathyroid Hormone Levels. The parathyroid gland is fine, but there are other factor which cause hypocalcemia. Hence, to compensate, there is overactivity of parathyroid gland. The causes of high PTH hypocalcemia are the following:

1) Vitamin D deficiency can occurs in malabsorption, dietary deficiencies, lack of sunlight..Vitamin D resistance including receptor defects (vitamin D dependent rickets type ii) can cause hypocalcemia. In chronic renal failure, there is impaired production of activated vitamin D and hence causes hypocalcemia.

2) Also, in chronic renal failure, there is hyperphosphataemia. When phosphate level is high, it will precipitate ionising calcium and cause serum hypocalcemia. This is why hyperphosphataemia will cause ectopic deposition of calcium in tissues. The other causes of hyperphosphataemia besides chronic renal failure are acute rhabdomyolysis, tumour lysis syndrome, phosphate administration.

3) Deposition of calciums also can occurs in pancreatitis, hungry bone syndrome following parathyroidectomy.

4) Pseudo-hypoparathyroidism is when the parathyroid gland and secretion of PTH is normal but there is PTH resistance. Pseudo-hypoparathyroidism is due to G protein mutations with a characteristic of short stature, short metacarpals, and intellectual impairments.

4) Drugs can cause hypocalcemia by precipitate serum calcium are like EDTA. Some drugs like bisphosphonate inhibits bone resorption causes hypocalcemia. Phenytoin and ketoconazole can altered vitamin D metabolism which causes hypocalcemia.

What happen if there is too much Calcium in our blood?

We know that calcium is important in the signalling process in nervous system and neuro-muscular junction. Hence patients with hypercalcemia will experience, neuropsychiatric symptoms like depression, decrease concentration, personality changes, lethargy, confusion and muscle weakness. Calcium is also important in cardiac contractility, hence in hypercalcemia especially in acute hypercalcemia, there will be bradycardia, AV block, short QT interval. That is why administering calcium intravenously is done slowly and in diluted form (rules of 10: 10ml Calcium gluconate dilute 10ml of 10% Dextrose given in 10 minutes) and with monitor attached on the patient.  Hypercalcemia also can cause gastrointestinal symptoms like nausea, anorexia, constipation. It also can cause pancreatitis. Hypercalcemia can increase gastrin production and causes peptic ulcer disease. Hypercalcemia decreases renal concentration ability which cause nephrogenic diabetes insipidus where there is polyuria and polydipsia. Hypercalcemia which cause hypercalciuria also can cause renal stones (nephrolithiasis). Hypercalcemia due to long standing elevated PTH can cause bone pain. The easy way to remember all these symptoms of hypercalcemia is to remember this mnemonic: "stones, bones, abdominal groans and psychiatric moans"

The treatment for acute hypercalcemia is adequate hydration, intravenous disphosphonates and identify the underlying cause and treat appropriately.

What happen if there is too little Calcium in our blood?

Calcium ion is important signalling process in nervous system and neuro-muscular junction and in hypocalcemia, there will be neuromuscular disturbance like muscle spasm, tetany, seizure, confusions, neuropsychiatric and myelopathy. Signs in hypocalcemia including on tapping the facial nerve causes twitching of the facial muscle (Chvostek’s Sign) and sphygmomanometer-induce ischaemia causing carpopedal spasm (Trousseau’s sign). Hypocalcemia can affect cardiac contractility which cause prolonged QT syndrome. Chronic hypocalcemia can affects bones growth like rickets and osteomalacia. It also can impair dental growth. There will be dry skin, brittle nails, and hair loss. It also known to cause cataracts in chronic hypocalcemia.

Treatment for hypocalcemia including calcium replacement: intravenous calcium gluconate infusion if severe hypocalcemia or oral calcium supplements if less severe. Vitamin D supplement for Vitamin D deficiency, renal failure, and hypoparathyroidism. Thiazide diurectics and low salt diet can increase calcium level. Recombinant human 1-34PTH is available but the cost is prohibitive.

References:

1) Harvey R et al (2010) Biochemistry (Lippincott's Illustrated Reviews Series), Chapter 28 Vitamins

2) Khosla S (2008) Harrison's Principles of Internal Medicine, 17th Edition Vol 1 , Chapter 47 Hypercalcemia and Hypocalcemia

3) Kalra P (2009) Essential Revision Notes for MRCP Third Edition, Chapter 13.5 Disorders of bone, mineral metabolism and inorganic ions.

MRCP part 1

I was so elated that I recently passed my MRCP part 1 paper. I started prepared during mid-internship in CMC. Really thank God for His goodness.

1) To register, use the official website: http://www.mrcpuk.org/

2) Look out for the exam dates, venue, application opening date. Check out the requirement too.

3) I used Essential Revision Notes for MRCP, Second Edition by Philip A. Kalra as my reading material. I haven't manage to complete the book. I just completed 18 out of 21 chapters.

4) Onexamination.com has one of the best question bank. I just complete all its question and revise it over and over again until I am familiar with the question-answer style. The MRCP question pattern is pretty predictable once you are familiar with their style and the style of onexamination.com is very identical to the MRCP question pattern.

5) Get a study partner, or visit http://www.rxpgonline.com/forum11.htm for support group.

6) Use a tablet computer to revise your question bank when you wait for your registrar or consultant to come for rounds. I use Samsung Galaxy Tablet 10.1 to study in the ward while waiting for my consultant or during minor posting.

7) I used Evernote to make a checklist on each question I complete. I make sure I complete 50 questions daily. During busy days, I will just do less than 10 questions.

8) I used Timesheet app to make sure I am not distracted when I use my tablet and study.

9) This maybe very useful for you to consolidate what you learnt: 100 commonly tested facts for MRCP Part 1

10) A little hard work, a little confidence, discipline and being consistent, with God's blessing, you may do well. The preparation is rewarding. The knowledge acquired is tremendous. Passing the paper is just a bonus.

Design Website: designlifg.blogspot.com

http://designlifg.blogspot.com/

I recently uploaded most of my design portfolio online. Most were done in India when I was in Medical School. I use Adobe Photoshop, Adobe Illustrator, and Dreamweaver for website design.

Visiting Aenon healthcare for 1 month

After completion of Internship in CMC, I wrote to Dr Lee, the doctor in charged in Aenon Health Farm at Tampin, and he is kind to allow me to stay in Aenon for 1 month to learn, interact and observe.

I must say my 1 month stay is rewarding and mind blowing.

1) Aenon was divided into 3 sections:

• The School - where they train post SPM student who are interested in becoming a Medical Missionary/Audio Visual Ministry. The school is accredited by Taiwan Adventist College in which it is possible to transfer your credit to TAC after completion of 2 years course in Aenon should you want to obtain a degree in TAC. The other college which accredited Aenon is Hartland College in USA.
• The Media section known as the Loud Voice Media. They do graphic design, video shooting and editing, script writing, composing and arranging music, studio recording. They have fully equiped studios, cutting edge equiptment and software. The work they do can blow your mind away!
• Finally, the health centre where sick patients comes for treatment and recuperation. 
• One more thing, there is this backyard organic farm plantation where they plants organically grown herbs, vegetables, and fruits: all staffed by Aenon students and staff from the previously mention 3 sections.

2) My reason of visiting Aenon is I am fascinated by Lifestyle Medicine which made famous by Dean Ornish, Colin Campbell, Hans Diehl and of course by the Seventh-Day Adventist Church. here and here. The old thinking is that if you live healthy, you can prevent disease. Hence it is known as the Preventive Medicine. Now, however, many realized that living a healthy lifestyle not only can prevent but can bring healing and reverse disease. Aenon is one center in Malaysia which specialized in Lifestyle Medicine. It is a non for profit organization and it is a Christian organization.

3) Patients normally comes with multiple co morbid illness like diabetes, hypertension, obesity. Dr Lee will access and examine them, and a based line blood test was done.

4) Patients will be subjected with strict healthy regime like exercise, vegetarian healthy diet, juicing, fasting, relaxation and devotional program, health talk, educational seminar, cooking class, Q&A, counseling, group support, singing and other leisure activities. They also will undergo physiotherapy treatment, hydrotherapy, infrared and fever bath.

5) Unlike many of the conventional medical center, where treatment is mainly on the physical aspect; Aenon focus also on the Social, Spiritual, Emotional and Mental dimension. Which means Aenon is more holistic in its treatment.

6) The Aenon health center archive on their patients medical records and progresses. I went through the records and I saw, cholesterol comes down, blood sugar under control, BMI comes down, blood pressure comes down,  patient off medication. It was amazing.

Multiple Choice Question: How to be an evil examiner?

How to be an evil examiner:

You must set your MCQ question this manner:

MCQ answer options :

A)Obviously wrong answer at first glance, but it is actually the correct answer.
B)Obviously right answer but it is actually the wrong answer.
C)99% about the information in this answer is right but 1% wrong
D)This is the right answer, but when compared to option A, option A is the better correct answer.
E)Controversy answer, if you read widely, some authorities said this is the correct answer, however general consensus disagree. So, wrong answer.

http://sports.bluesombrero.com/Portals/4938/Images/Little%20Guy%20QA.jpg

Sometimes, knowledgeable students perform poorly in an Examination, you wonder why.

Fact: Your answer is based on your personality, not knowledge.

Reason why you choose these answers on the previous MCQ question:

A) You are a Perfectionist. You might get this answer right, but you failed your exam because you spent too much time on one question and run out of time to complete your paper. Your work appraisal is poor. Your boss don't like your because you unable to meet your dateline, and your subordinates hated you because you always pick on their mistakes.

B) You are a Go-Getter. You hate spending plenty of time on one small decisions. You follow your instincts instead of hard facts. You generally succeed but, you made plenty of mistakes in the past but you just don't care.

C) You are a Big-Picture person. You make generalization and you tend to be stereotypical. Small details doesn't matter to you. You tend to sum up every information learnt. You learnt your concepts well but you hate memorizing facts.

D) You are a Diplo. People love you because you always agree with them. You are liberal and open minded. In your eyes, everything is relatively right. You however,often fail to make a stand and stick to your own opinion.

E) You are a Left Wing person. You often support the underdogs, vote for opposition and believer of every conspiracy theory. When you hear an opinion, you will google for the counter argument to that opinion.

The lesson is, my friend, stop studying and LEARN YOUR QUESTION BANK!

This post is dedicated to those who write exam and those who are preparing for an exam! Do well!

MOHH Singapore Application for Medical Officer Post

MOH Holdings Singapore is the agency which recruits all junior doctors to serve in Singapore Public Hospital. If you are interested in working in Singapore as a junior doctor, you might want to apply through MOHH.

The following is the 'How to':

1) Make sure your medical degree is recognized by the Singapore Medical Council. You can check it here.
2) Print out the application form and send it to  
Director,
Clinical Manpower Division
MOH Holdings Pte Ltd
1 Maritime Square #11-25
HarbourFront Centre
Singapore 099253

3) Wait for them to contact you. It takes 1 months for me. If you are kancheong, you can call them up and follow up. I applied from India, and hence, they hook me up with a recruitment agency in India, Global Placement Centre. Mrs Geetha from GPC called me up and fixed a date for interview. They will intimate you what document is required. Bring the photocopy copy along with the originals.

4) The interview in 2013 was in Chennai, The Taj Club House. Arrived there at 7:30am in suit, tie, shoes. It is pretty straight forward, filling up forms and choose which specialty you are interested. I choose Internal Medicine

5) Few minutes later they called you in, there are 2 interviewer and one of them is a doctor. All questions were medical related. The doctor asked me on Diabetic Ketoacidosis, ECG (only limb lead one) which shows inferior wall MI and management related to that and complication to look out for inferior wall MI. Clopidogrel and Aspirin vs Aspirin alone. They asked the anatomy and vasculature of the heart. Internship experience in CMC really helpful in answering all these questions. Thank God, the 1 week CME on Diabetic by CMC Endocrine Dept by Dr Nihal Thomas helped me to somewhat impressed the interviewer. I must say I really enjoyed the interview because the doctor interviewer actually teaches me. I went home that day and read so much cardiology which made so sense after the interview.

6) They will let you know if you passed the interview immediately. Many passed, few were unsuccessful.

7) Then those successful, stayed back, and there was a brief lecture which promotes Singapore, working there and its benefit. Low tax, low crime, high pay, good postgraduation training and career track.

8) Offer letter comes couple of weeks later. Submit all pertinent documents for Singapore Medical Council registration. We were required to pay SG 1200 for the deposit, employment pass fee and medical registration fee which is all refundable when you work in Singapore.

Obstetrics Presentation

One of my presentation during my obstetrics posting. A complete rip off of Williams Obstetrics 22th Edition of carbohydrate metabolism in pregnancy.

What to do when we got proposed unexpectedly

I am surely not as lucky as many of my friends who receive proposals to be their boyfriends. Yes, I am very much jealous. But what interest me is how the proposed person reacts to such un-cunningly-planned proposals.

It often when A developed a volcano-erupting-crushes on B. And A simply tells B that she like him. Out of the blue, point blank. You see, B and A were classmates. Both were hardworking, mission minded and from a spiritual sense, they are God-fearing. But A just don’t usually talk to B. However B’s personality is admirable, charming and handsome. He carries himself well. That just melts A’s hearts. When B speaks, A goes bonkers. So rather than keeping to herself and suffers silently, A decided to just tell B that she loves him.

If you were B, and you don’t like A, (or perhaps, you don’t see her ‘in that way’), how would you react?

1) Don’t give any answer? Acting as if you got an absence seizure?

2) A big, blunt but clear NO! and hope that A don’t jump from the top of ASHA building.

3) Or just say yes... and being that MR nice guy but secretly hated A. And run in to the risk of playing with A’s heart? God forbid.

4) But most of the case is, avoiding that person, disconnecting and terminating all friendship. Being overly suspicious when A is being nice. Stop talking to A and not allowing friendship to develop at all!

There is no easy answer for it.

How can we react to such away:

1) To minimize hurt and embarrassment, even though is inevitable.

2) Maintaining pre-existing friendship and allow it to develop as normal and closer friends instead of cutting off and avoiding her.

3) And at the same time being completely honest with her and ourselves?

If think, firstly, we have to understand that it is completely NORMAL to develop crushes and like someone. In fact, it is OKAY to be crazy and super desperate. To like and to be liked is part of how human related to each other.

With that in mind, I guess we need to know that, someone will invariably likes you or develops chronic crushes on you. Even though we are aware or not.

The only different is that the person (you may not like) is heroic enough to gather all her guts and just confesses her feelings towards you. In fact, one needs to risk her ego, being disappointed and shame to just confess. That takes an entire length of the guts. That is why I always admire people who make the first move and confess their feelings.

Yes, she may be a little too brash and a little not in her right mind, but isn’t that normal when we are crazy at somebody?

I think mature reaction to all this is, to acknowledge her feeling towards you and tell her that it is completely normal to have such feelings. And thank her for being honest to you. That will probably minimise her embarrassment. Tell her she has a lot of potential and talented. And reaffirm that she has been a good friend. But be completely honest with her that you didn’t see her “that way” and she will be her friends always.

Not sure if these suggestions will work. Didn’t try it out myself though. Or did I even have the chance to try it out? :)

AY talk on Music: Reverence or Relevance

Loving a girl/boy enough?

Loving a girl/boy enough?

I am really honoured and really privileged to have few friends who are honest and willing to open their heart and feelings to me. They are really good, honest, driven, responsible, and good looking. But their stories were similar; they saw a really good and pretty girl (or good and handsome boy), they fall in love and they told their girl (boy) that they love her (him), and not surprisingly the girl (boy) say a big NO on their face and eventually avoiding him/her. And this did not end in a day or week. This painfully usually goes on for months or even years. Plus, they have been praying hard to God about it before proposing.

I really wish to help but I just don’t know how. But I do thought about this problem for a long time.

I think the question is do I love the girl enough to say ‘Actually, I love you’. Love her enough means:

Know about her family:

                Are you closer to your dad or mum? Your parents fight at home? Your parents kiss in front of kids? Who makes the decision on...? Who usually control the money? Are you closer to your siblings or friends? Who is sick at home? What is your parents expectation at you? Who usually do the whacking at home? How they punished you when you were small? Family problems?

Know about her dream:

                Why she choose this profession? What’s her ambition? What PG? What’s her dream work place like? Dream family?

Know about her friends:

                Who is she closest too? Childhood friend? Boy friends? Girl friends? What kind of friends she is attracted to? Her crushes? Her ex?

Know about her values and spirituality:

                One common mistake is, “I am going to married an Christian/Protestant/Catholic,” and were too lazy to find out more about his/her spirituality. Equally yoke does not mean going to the same church. Equally yoke means the spiritual growth and direction is the same. What is God to her? She really interested in knowing the truth or just follows religious tradition? Eg.  Ask simple question like why do you think baptism is really necessary?

Well the list is endless. What I am trying to say is that if we love somebody, we will find more about her/him.

Pro 31:10  Who can find a virtuous woman? for her price is far above rubies.

The bible wants you to FIND! That means a lot of homework and searching to be done.

Heard of this awesome example:

Boy and Girl working in the same office. Boy doesn’t know much about the girl except the usually business stuff and work. But the girl’s personality attracted the boy.

Boy: Erm, we been friends for many years, working in the same office. I think we need to explore the possibilities of “more than friends.”

Girl: *blur*

Boy: I meant consider being my girlfriends/ marriage?

Girl: erm.. *felt weird, she don’t even usually talk to him* Actually, I don’t think it is the right time.

Boy: but why?

Girl: both of my parents is old and sick, I need to take care of them. I can’t think of relationship now. So, NO THANKS!

Boy: *ouch* [walk away felt hurt]

Well the boy has been just loving himself more than the girl in a sense that he is more concerning of getting the girl FOR HIMSELF. If he really LOVE the girl, he should has been really concern and ask:

Boy: oh, I am really sorry to hear that. What happen to your parents? What do you actually do to help them? Must be tiring for you...etc...

You get what I meant?

When we find out more about her, if you see that she is responding to your concern, and after much prayer, and then only tell her about your feelings towards her.

“Actually, I love you”

Weather to tell or not to tell. To tell means, that letting out and ending the torture of secret crush towards someone. But it also can make you at risk to seal a relationship goodbye; for good or for bad.

Make friends

1Ti 5:2  The elder women as mothers; the younger as sisters, with all purity.

I love this bible text. It is a really good guiding principle on interacting with opposite gender.

The problem with many of us is that we view every opposite gender as “potential girl friend/wife.” Hence, eventually, some choose not to talk to ANY girls, becoming a male chauvinist or to another extreme, our interaction with other’s become very flawed.

I see this problem everywhere, even in church and classroom. I guess I am blaming Bollywood.

I guess, we need to learn to be just friends with an opposite gender. With as many as possible. By talking. Helping. Exalting. Encouraging. Just like what normal macha do. It’s okay to have close females friends.

How do we treat our sister?

We love them, but we don’t see them as ‘potential wife.’ Yeah, I know, yucks! That is God want us to treat the all opposite gender.

That means, I am not afraid to talk deep stuff with a girl, (just like I talk to my sister), maybe sharing some secret, or really getting to know about her. But I will not use terminology which I will reserve to my wife/girlfriend like: “dear”, “darling”, “I will be there for you.” I will not be too touchy with her, playing her hairs, too close physical proximity, gave any physical signal.