Globalisation doesn't come without a price .....
Tuesday, December 30, 2008
Globalisation doesn't come without a price .....
He was lucky; this is a benign disease, not a cancer. If this were cancerous, then he would be in deep trouble !
SUSAH SANGATKAH NAK DATANG AWAL ???(Is it difficult to come for treatment early ??)
Tuesday, November 18, 2008
However, she was also noted to have a fungating
tumour in her left breast. (picture below)
Biopsy (core-needle biopsy) showed that it was an infiltrating ductal carcinoma; meaning this was a confirmed breast cancer.
The CT-scan film showing the primary cancer of the left breast
Further examination also revealed a tumour in her right thyroid lobe.
Biopsy (Fine needle aspiration cytology - FNAC) showed that it was a follicular lesion.
A follicular thyroid swelling can be either benign or cancerous, but looking at the tumour clinically and on CT-scan, I was almost certain that it was a follicular cancer.
She underwent a surgery for the breast cancer (left mastectomy with axillary clearance ), a palliative by-pass of the pancreatic head cancer (gastro-jejunostomy, hepatico-jejunostomy - biopsy confirmed adenocarcinoma of the pancreas)
So, what am I trying to say ?
I am saying that this lady had three (3) primary cancers. This is extremely rare (I am waiting for my report to be published in a peer journal). But this is not my point to you. What I want to highlight here is how 'fantastic' our patient can be. Should she presented much earlier, she could have been saved. She succumbed to her diseases not long after the surgery.
By the way, it was reported in most news today, that the country is in need of more oncologists (cancer specialists) - "We need more than 200 oncologists but the country has only 39" - say the Health Minister. But with this attitude of not seeking treatment until it is too late, I dont see the urgency. The ministry of health has to come out with a policy / campaign / or what so ever to get cancer patients to the hospital, and to do so early !
Sunday, June 15, 2008
Tuesday, June 3, 2008
Saturday, May 31, 2008
A long midline incision; the usual ceaserian section is through a pfnenstiel or bikini incision
Thursday, May 29, 2008
Akhir tahun lepas, seorang kena potong 'kepala'nya, terkulai. Ini baru yang datang kepada saya, tapi masih ramai lagi pakarbedah yang dapat kes semacam ini. Moga-moga cerita ini menyedarkan ibubapa. Janganlah kerana seringgit dua, naya anak tu. Tapi orang kita memang macam ini, duit beli rokok habis beratus ringgit sebulan, tapi untuk kesihatan atau pelajaran berkira macam nak mati.
Monday, May 26, 2008
Immediately after completion of surgery
From the web !
Sunday, May 25, 2008
Friday, May 23, 2008
7.30 pm; it was getting dark, alone, 28-km from the nearest civilization
Finally out by 8.40 pm, intact to continue the challenge of a life of a surgeon !
Monday, May 19, 2008
I could not imaging how these people get on with their life, having to carry huge things in between their thighs. How did they hide this from other peoples? Once I saw a man in a 'kenduri' who had to adjust something in his sarong in order to sit down and eat; and the way he did that, it must be a huge thing.
Almost the whole bowel, from the jejunum to the sigmoid colon were in the hernia. X-rays taken before operation showed bowel shadows lie near the knee joints.
Is there a way to make patients come early?
Probably the goverment (Ministry of Health) should start putting billboards on the highways with a picture like the above with a caption " JANGAN TUNGGU SAMPAI MACAM INI" or "MACAM MANA NAK BUAT KERJA KALAU INI MACAM!"
Saturday, May 10, 2008
I have been asking this question to my patients and to myself regularly in an attempt to understand their attitude towards this deadly disease. Some of them found the question insulting, others didn't mind sharing.
1. In Bahasa Melayu, cancer is 'barah', breast cancer is 'barah payudara' . In Kelantanese dialect, there is something called 'barah susu'. This is not breast cancer, but it is used to describe lactating breast abscess. If you ask a patient whether she has a family history of barah, she might say yes, you ask what happen to the patient, you will get: 'OK sembuh dah, tak payah buat operation pun!" and this is misleading. When I was working in Penang, a friend of mine told a Chinese patient that he had a barah, the man jumped off the then newly-built Penang bridge. He knew exactly that he had a grave disease that he took his own life prematurely. Now I never use the word barah when communicating with my patients, I use 'kanser'. Tak faham juga, I said; penyakit yang membunuh our ex-No.1 lady. Ohh... baru faham. Bagus juga if some well-known peoples get certain diseases, boleh buat contoh. Anyway, I used Kylie Minogue's name to explain breast conservative surgery.
2. Even if the lady understands that she has a breast cancer, and she knows that she needs to remove the breast in order to save her life, she may not in a position to decide on that. You might laugh on this, but I have seen cases after cases where the ladies said no because the bloody husbands said no to mastectomy. In 1998, a man told his wife(my patient); if you consent to the surgery I am going to divorce you! Somehow she agreed to the mastectomy which I did. When a nurse asked me where to put the specimen, I told her to send it to the man so that he could do whatever...(He divorced the poor lady a as soon as she went home after the operation) Of course not all husbands are the same; there was man who told his wife; I love you with or without your breasts!
3. BOMOH - This is an irritating element in the society. They offer to treat all sorts of diseases, usually without surgery. Of course the poor patients fall to their trick, and in the end the patients come to seek your help with a locally-advanced or metastatic disease.
This experience has thought me to offer breast reconstruction to patients undergoing mastectomy surgery; either immediate or late reconstruction. And whenever possible, I will always offer them breast conservative surgery.
Mastectomy - surgery where the whole breast is removed
Metastasis - cancer that has spread to distant organs
Wednesday, May 7, 2008
They prefer to go anywhere else, but not to the doctors. For example , this 25 year old well-educated girl seek treatment from a 'bomoh who operates" for her breast lump."Picture DELETED"
After undergoing 'surgery' and acquiring disfiguring scars, the lump was still there. She came to me for a' second opinion'. Luckily it was a breast mouse; a fibroadenoma, a non-cancerous or benign condition.Whooi, what's this?
During my 20 years of surgical practice, I have seen 5 such cases. The first one was 15 years ago in Mentakab, the woman walked into my clinic with a towel over her shoulder and her arm was supporting something underneath the towel. It was a FIFA-standard-football size lesion. This lady in the picture came last year. The last patient came last week, all the way from Penang. This lesion is called Phylloides tumour (giant fibroadenoma - but ours are really giants!) The point is, why our ladies presented with this huge lesion? Why so late? Why don't you come early and get treated with a small lumpectomy. This tumour changes to cancer after sometime. When it does, it becomes a sarcoma; a cancer with even worth prognosis compare to that of the usual breast cancers.
When I decided to start this blog, all I have is this in mind... To get rid of this third world mentality out of our mind. We have first class medical facilities ! I am not talking about KL or Penang, but in most major towns and cities in Malaysia. Probably before we start talking about medical tourism, we should get our people to recognised our hospitals as a place to come for medical treatment !
In the last 5 years of my private practice, many women came to me to seek treatment for their disease (breast cancers). Unfortunately many of them came with advanced diseases. They were not old ‘makcik’ from far-away ‘kampongs’, but they were women with good education, wealthy background or wives of ‘somebody’. The usual story is that they were diagnosed to have breast cancers one or two years’ earlier, advised treatment but defaulted. They then seek ‘treatment’ from bomoh or singseh, spend thousands of ringgits, went overseas as far as Turkey or Egypt, not to see surgeons or oncologists, but the bomoh-equivalents of course. When the cancers ulcerated, infested with maggots and they themselves couldn’t bear the smell, they came to me; ‘Doktor, tolonglah, buatlah apa saja, saya terimalah !’ At that stage, the most I could offer is palliative treatments. In two circumstances, the only thing I did was to chase-away the maggots with turpentine, before they succumbed to their disease; ‘peacefully’- maggot-free !
This was one of the cases.
When I was working in the university, after seeing many of these ladies dying in this miserable way, I hope not to see this again. Now, after so much publicity on the cancer and the government efforts in preventing advanced diseases, campaign on free mammogram; things are not changing. What has happened to Malaysian women?
Is this is part of the famous ‘tunggu saat-saat akhir’ attitude of Malaysians? Wait till the last minute to renew your licence – fair, but this cancer, you lost your life.
I will try to discuss the causes of this in my next posting. Before I stop, see this….
This is mat saleh,….. minah saleh to be exact, from a textbook.
Bukan Pak Pandir sorang yang mati anak !