Sunday, October 18, 2009

1 Malaysia

In Malaysia, 1Malaysia (ONEMALAYSIA) is now the most spoken word on TV. Most corporate advertisements are circling around this theme.

This morning, while doing my round in the ward, my phone rang. A patient who has recently been discharged from the hospital called to enquire about his wound (he had an abdominal surgery few days ago; bowel perforation from a motorvehicle accident). He is an ethnic Chinese asking about 'begho' around his wound, in Bahasa Melayu of Kelantanese dialect. Not understanding what 'begho' means, I asked the patient in front of me, who is an ethnic Siamese. (maksudnya; orang Cina cakap Melayu kepada orang Melayu, Melayu tak faham, tanya orang Siam, orang Siam explain istilah Melayu kepada orang Melayu.....baru kawe faham). 'Begho' tu lebam-lebam le doktor!.
Point-nya : In Kelantan, 1Malaysia is not a 'propaganda', it is 'darahdaging' !!!
Anyway, I am not a pure Kelantanese, only S.K.M.K - Sudah Kahwin Mek Kelate !
(Sorry for 'out of the topic' writing - just to start blogging again after the long raya holiday).

Monday, September 14, 2009

Seronoknya Beraya Di Kampung

Musim raya datang lagi. Alangkah seronoknya anak-anak. Ibu bapa pun tak kesah apa yang anak-anak buat, maklumlah minggu terakhir ramadhan.

Mercun; budaya entah dari mana sudah jadi darah daging. Bila malam menjelma, meletup bagai nak rak. Nak solat terawih pun jadi tak kusyuk. Mak bapa pulak tu yang beli. Mercun yang kecil-kecil, mak belikan di pasar ramadhan. Yang besar-besar, bapak belikan dari 'polis' (bad cops atau agen penyeludup) yang jual 'mercun rampasan'. Anak pun apa lagi. Dalam seronok-seronak tu, adalah jari-jari yang putus dan ada mata yang buta. Yang susah doktor jugak yang kena jahit.

Biasalah tu. Terutama di Kelantan dan Terengganu. Kalau tak ada jari yang putus akibat main mercun, tak raya lah kita. Modus operandinya sama. Beli mercun, buka pembalutnya, ambil belerang dan sumbat dalam besi paip. Kalau meletup baru uummmp. Tahun ini Terengganu dah pecah rekod. Kalau berterusan macam ni, lama-lama boleh panggil Terengganu Darul Kudung.

Apa nak jadi ayahwang?

Ini pulak lain. Anak orang bandar (KL le tu!) bila balik kampung, jumpa basikal buruk, terus naik. Tak sempat nak periksa, pelana (seat) ada ke tidak.

Akibatnya burung kena sembelih. Kan dah susah. Nasib baik kulit saja yang terlapah. Kalau putus habis, masuk Harian Metro (akhbar sensasi). Kalau silap hari, tok nikah mu sapai ke tuo.

Mak ayah tu, tengoklah anak-anak. Doktor pun nak raya juga!

Maaf. Cuma nak lepaskan geram dengan orang kita yang tak serik-serik.


Sunday, August 30, 2009

DEMI HARIRAYA.... (If Not for the Hariraya..)

Hariraya (Eidulfitri) is a very important and significant day in our life; for that matter, the lives of all Muslims throughout the world. Just like Christmas to the Christians. We prepare for the big day that comes at the end of Ramadhan (the fasting month). For Malaysians, we decorate our homes, buy new clothes for our childrens, bake some cookies and prepare for the balik-kampung. In the morning of Hariraya, we take bath (mandi sunat raya), put on our best clothes, springkle perfumes and walk to the nearest mosque for solat raya.

But what if you have an ulcerating, foul-smelling breast cancer like this.
Your close friends wouldn't come near you, your childrens try to avoid you. Your last Hariraya becomes your worst Hariraya.
This is exactly what this lady was expecting. So she came to me 5 days ago. She knew what she was having; CANCER. She hopped from one bomoh to another during the two years she had the lesion. When I saw her, she was anemic (pale) with Hb 5.0 gm%. The left breast busuk dan meloyakan, and bleeding noted from the edges. The underlying pectoralis muscle was involved. The axillary nodes were massive and fixed.
Her request (or probably instruction) to me was simple : I want to celebrate the Hariraya, I don't want my friends and relatives to avoid me. . . . (with a please! at the end).
So I offered her Toilet Mastectomy. Meaning removing the ulcerating cancer with palliative surgical intention. Surgeries for cancer can be either curative or palliative. In this case, it means to make her remaining days better without the foul-smelling and bleeding cancer. She agreed, so I transfused her with some blood and proceeded with the toilet mastectomy. (Toilet ini bukan jamban tapi maksud serupa; to ease and clean). Lucky that I managed to close the wound gap. Today she is going home, and beeming with smile on her face. Before I let her go, I explained to her the treatment that she should undergo after this Hariraya. That's include a chemotherapy, radiotherapy and even hormonal therapy. I even warned her that the cancer would come back in no time should she defaults treatment.
With the smile on her face, I reallyI hope she understands what I mean and takes my advice seriously. With proper treatment this Hariraya Eidulfitri 1430 H shouldn't be her last. WalLahu 'aklam. As for me, this is one occasion that I am bersyukur that God has made me a surgeon; giving hope to the 'hopeless' and cheer them for the Hariraya.

Saturday, August 15, 2009

Immediate Breast Reconstruction - Is this the Solution ?

Running away from proper medical treatment for breast cancer especially surgery resulting in late presentation. This in turn manifested in poor prognosis and untimely death. But for most Malaysians women, that is not the problem. Biar mati berkopek asal jangan .....whatever!. The irony is that, if they have a small benign goitre (thyroid swelling) in the neck or a ganglion in the wrist joint, they rush to us for removal. Maklumlah tak comel dipandang mata.

Tak boleh juga nak salahkan orang perempuan, yang jantan juga utamakan yang tu .... macam si tua ini.

So, if surgeons can offer our breast-cancer-striken women a 'replacement' after mastectomy, probably more will come for proper treatment, instead of going to the bomoh.

I personally believe that mastectomy is a body mutilating procedure. But what option do we have? We have to get rid of the cancers and save the women.

If I ask you to choose between A (post mastectomy and cured of cancer) and B (maggot-infested cancer and imminent death), many of you will choose A.

No, not for many Malaysian women that I have seen. That is why I have a collection of them - gambar le ! They rather die a 'whole woman' rather than live an 'incomplete women'.

Thus if surgeons can reconstruct that 'thing' to make them 'complete' again, then we can probably save more women. Those who came to me are always given options for reconstruction either immediate or late. Immediate reconstruction is done together with the mastectomy. Meaning, if they go to the operation theatre with the cancerous breast, they wake up from the surgery with a new breast free of cancer. Whereas late reconstruction is done later after they are cured of the cancer, usually after completion of chemotherapy or even later, when dia terasa nak comel semula.

Late reconstruction (the woman A)

Immediate reconstruction :

The nipple can be reconstructed later upon request.

Saya tidak berniat untuk menyinggung perasaan sesiapa yang mendapati gambar-gambar ini offensive atau memalukan. Niat saya untuk mendidik. Saya pohon maaf sekiranya anda berasa demikian.

Monday, August 10, 2009


Last week, a 56 year old lady presented with lethargy and poor appetite. Her hemoglobin was 8.6 gm/dL and her Liver Function Test showed low albumin/protein. CT-scan of the abdomen revealed multiple liver metastases (cancers spread to the liver). She was a very 'strong' lady; despites her incurable cancer, she smiled and told me her story which I personally knew part of it.
In July. 2007, she came to my clinic with a 1-cm lump in her left breast. Ultrasound and a mammogram done showed the lesion was most likely a cancer. I explained to her what a cancer means and adviced her to have a biopsy and the subsequent treatments including surgery. Unfortunately she disappeared after that. Apparently the lump rapidly increased in size till it started to ulcerate in Feb. 2008. On the coersion of her children, she agreed for a mastectomy which was done in a hospital in KL. Again she refused adjuvant treatments. Now, she comes with the cancer spreading to her liver and is killing her slowly..... yet she is smiling happily.
Her story: In early 2007, she and her husband were planning to establish a 'tahfiz school'. Unfortunately he passed away leaving her with hundreds of thousand in 'infaq' or donated money. When she was told to have the breast cancer, she 'knew' that she would soon follow her husband. So she decided 'not to waste' whatever short time she had, for the cancer treatment. She started to work on the 'tahfiz' until it was completed and started to enrolled local girls. Now, the tahfiz school is running well. And she is now ready to join her husband ! Beliau bersyukur kerana Allah telah memanjangkan hayat beliau sehinggalah siapnya sekolah tahfiz beliau. Moga-moga Allah mengangkat beliau sebaris para syuhadaNya - Amin.
In Malaysia, there are now many organisations either established by the government or the NGOs to help cancer patients and cancer survivors. Cancer survivor is a term used for a person who had cancer and survives the disease for five years or more. Unfortunately, I believe not many Malaysians know about these organisations. Hence, once a person is diagnosed of having a cancer, he or she feels hopeless. They turn to all sorts of people, conmen and some even end their life prematurely. When I was a Medical Officer in Penang (1986-7), Penang bridge was a favourite place for some of the desperate patients to find a shortcut to 'heaven' (saya rasa neraka).
In Kota Bharu, there is a volunteer organisation called KAWAN which give supports and advices (and probably where you can buy a breast prosthesis - after mastectomy). I was invited to participate in one of their workshop once - where a man said to his wife (a nurse who had a mastectomy for left breast cancer) ' I love you with or without your breast!'
As a muslim, I believe that God determines everything, and He says He does so with reasons. It is up to us to find the reasons. If we wants to be cured of a cancer, we find the reasons. And as a scientist, I believe a proper medical treatment is the reason. Off course, in the end He determines whether we are cured or not. It is His prerogative.
When a patient comes to me with breast cancer, I always tell them about 'living examples'. And this is my favourite living example. Australian singer, Kylie Minogue.
Diagnosed to have a 1 cm breast cancer many years ago. Underwent a local excision, followed by a course of radiotherapy and a regime on chemotherapy. Now cured and kicking well; back to her singing stages.
On the other hand; we have our 'equivalence', an actress who hid her breast cancer till it fungated and smelly. Now begging for mercy; asking donations for her chemotherapy.
God is Great; He gives to whoever strives for His Mercy. He helps those who help themselves !
As for the lady in my story; deep down in my heart, I believe if she had decided to receive a proper treatment when she came with a centimetre lesion, she might not only able seeing her tahfiz kicked off, but be with it till many years to come. Wallahu 'aklam

Thursday, July 23, 2009

Tropical Fruit Season

Fruit season is a very much awaited time of the year in the rural areas of Malaysia. Plenty of delicious fruits are available freely (for those who have the trees) or cheaply (if you need to buy it from the mushrooming roadside fruit stalls) .

For some rural folks and the orang asli (the aboriginies) - those who kais pagi makan pagi, they don't need to go to work, they just stay home and eat. They just need to pluck the fruits and eat. So they eat and eat and eat.

Sometime you see complications... especially if they swallowed the seeds. Tropical fruits are not like apples; thick 'flesh' and small seeds. Furthermore, some fruits you have to swallow the seeds, otherwise no 'uumph'. Mangosteen and rambai are examples of this type of fruits.

Last night a senile elderly lady, was brought in to the hospital with constipation and severe anal pain. Abdominal X-ray showed dilated colon packed with hundreds of 'seeds. I spread-opened her buttock, and I could see those seeds impacting the anal canal. I had to manually evacuated the seeds. Memanglah sakit tapi lepas tu lega. They are manggosteen seeds, and that suprised me. A mangosteen usually has six fleshs; only one or the most two have seeds. That means she really ate plenty of those fruits probably more then a hundred in several days.

When I was a medical officer in Mentakab, an orang asli girl presented with abdominal colic caused by similar problems.... and I had to dig out hundreds of 'setol' seeds. She literally picked up the fruits from the floor of the jungle and ate them. I had to sedate her with Ketamine and removed the seeds with my finger till clear.

A fellow physician once told me; The most honorable thing a surgeon does is to digitally relieve a patient with an impacted rectum !

Hard objects impacted in the colon cause ulcers in the colonic mucosa by pressure necrosis. These ulcers are called stercoral ulcers. Not uncommon, the ulcers perforate through and caused peritonitis. Few years ago when I was in the university, an old lady presented with peritonitis. I took her to OT and opened her abdomen. To my astonishment; I found hundreds of rambai seed in the peritoneal cavity. What happened was she ate the rambai and swallowed the seeds; her colon was packed with the seeds resulting in the colonic perforation. I had to pick up all the seeds, washed the peritoneal cavity and exteriorised the colonic perforation as a loop colostomy. Later when she was well, I closed the colostomy.

This picture showed ripe rambai fruits. Each fruit contains three glistening, usually sweet and sour flesh with a seed in the middle. You don't need to chew them, just put in your mouth and swallow them.
The lesson is: If you really like these fruits, eat them by all means. But please don't swallow the seeds. Otherwise someone has to stick his finger into your arse.

Saturday, July 11, 2009

Tired and Betrayed

Last Thursday was a busy day for me, I had several surgeries and some endoscopies. As I was about to settle down just before midnight (malam Jumaat beb), a lady was brought in with difficulty in breathing. She was pale as a sheet, her hemoglobin was 3.2 gm/dL(normal > 11). As I was asking where and what could be the source of her chronic blood loss, I smelled something bad from her body; smell of necrotic tissues.

After much persuation and explanation including by her sister (whom I thought I've seen before)she reluctantly showed me this;
The usual thing . . . . . . . . . . . . . . . . . . !
Advanced ulcerating cancer of the right breast with chronic bleeding from the ulcers.
If you observe the surrounding skin, there were multiple nodules. There are cancerous metastases called stellite nodules. The other breast were also involved, with peau d'orange (skin lymphatic infiltration)
She forewarned me not to do anything to the tumour as she was at present on treatment; homeophatic medicine and after this is going to another bomoh in Melaka. All she wanted was the treatment for the breathlessness.
The breathlessness was caused by severe anemia. So I transfused her with 4 unit of concentrated blood (packed cells). When she felt better, she insisted on going home. I asked her who was doing the dressing all the while, the answer; my sister. I turned to her sister; have we met before? Yes, I was a head-nurse in xxxxx department when you were in the university.
Oh Tuhan, apa dah jadi ni? (O God, help me!)
I put much efforts to make Malaysian ladies seeking proper treatment for their cancers, to avoid unnecessary deaths and morbidity. I gave lectures to nurses and women groups. Promoting breast-self-examination and mammogram screening. But now I have a senior nurse who I knew personally, yet is 'encouraging' her own sister to go to the bomoh. No wonder, there are bomoh bragging that doctors and nurses are among their patients. Once I had a patient (hernia surgery) who is a bomoh patah(he treats fractures) himself, he boasted that many doctors went to him for their fractures.
Common chaps, if you don't believe in what you practice (modern medicine), then stop practising. Don' t misled others. Go out and do something else !
As for the lady, she chooses to end her life in a miserable way with other people avoiding her due to the foul-smelling cancer on her body.
As for me, I am tired and feel betrayed by my own colleagues . . . .

Monday, June 22, 2009

PILES, So What .......?

Buasir je, tak payah susah-susah lah.....

Not everything that comes out of the anus is faeces
Not everything that protrudes out of it is hemorrhoids

An old man came to the hospital with severe anal pain and faecal incontinence (tak boleh kontrol berak le tu). He was dehydrated and emaciated and this thing (picture) was seen in the anus.

It was a fungating anal cancer which was later confirmed by a biopsy. So I told him the diagnosis. Buasir je... saya telah jumpa doktor panel banyak tahun, dia kata buasir, tak bahaya pun!
So this is the problem; "patients come with rectal bleeding and prolapsing anal mass - hemorrhoids until proven otherwise" No examination done, given some medications and sent home. Subsequent visits - same medications. No reassessment or referral to the appropriate specialists.
This is what happened to this unfortunate old man. Deadly cancer treated as a common disease; piles. The biopsy was reported as malignant melanoma; a rare but deadly cancer. On top of that, his chest X-ray revealed multiple metastases (cancer spread) . . . . . . . . . . . . . . . . . and the old man's days now are numbered .... KKM-DKP.
Ironically, this is not just 'a case I saw', I have seen many cases including referrals treated for months as hemorrhoids / piles / buasir / ti cheng / zhi chang or what ever you like to call it - but actually are anal or rectal cancers. Once I attended an surgical workshop on PPH (new technique of treating hemorrhoids); the patient was already put to sleep and when the legs were lifted, poop.. out came an anal cancer. That case was pre-selected by a surgeon for the demonstration! . See, hemorrhoids are probably not just a simple disease to diagnose.
If you are primary care doctors, think of a differential diagnosis beside your provisionals.
And if you are a patient, always ask for an explanation especially when things are not as expected.
and TABIB BUASIR is not part of the solution.
Any way, KKM-DKP stands for kubur kata mari, dunia kata pergi ..............

Saturday, June 6, 2009


Today, my PA put five Cancer Notification forms on my table. The MOH requires medical practitioners to notify The National Cancer Registry all new cases of cancer they diagnosed. 5 new cases a week is common in a big goverment hospital surgical depatment. But for a single surgeon like me in a 100-bed private hospital, this is a record. In the last one week I encountered 2 breast cancers, one skin cancer (BCC), one stomach cancer and an occult cancer with liver metastases.
This is unfortunately not a suprise. The incidence of cancer generally is on the rise. Although different cancers have different causes, the upward trend is usually associated with the rampant use of chemicals that induce normal cells to change to cancer cells. These chemicals are called carcinogens.

Carcinogens are found in industries, drugs/medicines, clothings and most disturbing our foodstuff. Almost all factory-made food items contained some sorts of carcinogen. Some in traces, others full of them.
One day, my young son bought a coloured, flavoured drink in a plastic container in the shape of 'ultraman'. There was a small note: Ingredients: Air, Pemanis, Pewarna, Perisa dan Penstabil yang dibenarkan. Basically it contains water, and four chemicals to change it colour and taste. In another words, it contains water and most probably four carcinogens to shorten our lives. In Kelantan, if you look for the traditional nasi kerabu hitam which is stained purple by daun mengkudu, you would never find it. Insteads you will get a nasi kerabu stained blue by a dye usually used to colour tikar mengkuang and this is highly carcinogenic. Your mee goreng or mee latna are usually added a big spoonful of Thailand's ajinomoto (which is also used as additive to farmer's racun lalang to make sure the lalang dies sampai ke akar).
See my point: Nak makan sedap, you may risk shortening your life.
That is my bad news for the week. BUT the good thing is : Hari ini every junction from Kota Bharu to Kubang Kerian along Jalan Bayam is beautified with bunga manggar. Maklumlah, cuti umum Agong' Birthday bertindih dengan cuti sekolah. Ramai ambil kesempatan buat kenduri kahwin. Baguslah tu, kurang peluang syaitan nak suruh orang buat maksiat. Yang sebelumnya haram dah jadi halal, dapat pahala pulak tu!. Dalam pada tu, malam tadi ada yang datang ke hospital melahirkan anak dengan jari yang masih penuh berinai. Bila kahwin dik?. dua hari lepas doktor....
AstaghfirLah hal azim...apa nak jadi dengan orang mim lamalif ya waw................................

Monday, June 1, 2009

Young Malay Ladies

Forget about this picture, I am not writing about it. I am using it only to beautify my posting.
(Anyway it is a picture of a myomectomy operation - removing a uterine fibroid - done by a gynecologist friend of mine; Dr. Ang Koh Seng)
Last week I attended our Annual Scientific Meeting & AGM, College of Surgeon, Academy of Medicine of Malaysia in Langkawi.
College of Surgeon bukannya sebuah kolej tetapi lebih kepada kesatuan profesional (seperti Bar Council) yang dianggotai oleh pakar-pakar bedah seluruh Malaysia.
A lot of important things presented and discussed; new technologies demonstrated and things that had happened reviewed and learned.
One thing that is relevent to this blog is a presentation from University Malaya Medical Centre (UMMC) on breast cancer survival. They presented a paper: The Impact of Defaulting Breast Cancer Treatment; Halving The Survival Time For 1466 Breast Cancer Patients.
They studied the outcome of all their breast cancer patients from 1993 to 2002. Out of those, about 100 defaulted treatment. What they found was;
1. These defaulters succumbed to their cancers much earlier; their 5-year survival rate was only 47 %. Maknanya selepas 5 tahun hanya tinggal 47%, yang lainnya telah berpindah ke alam barzakh
2. Majority of the defaulters were Malays
3. Many of these poeples were younger than 40 years old.
Their findings and the messages are easy to understand. Pertama: You ada kanser payudara, tak rawat you mati (of-course semua orang mati, tapi you mati menderita kanser). Kedua: Orang Melayu, kita ada bomoh yang memang kita tak percaya pun, tapi bila kita kena kanser bomoh inilah yang kita cari. Ketiga: Yang ini yang saya tak faham; kenapa yang muda banyak yang jadi defaulter.
I have seen young, well educated, some are extremely rich and of course yang berpangkat ladies when told about about the cancer, they say thank you, I am off to my bomoh. In my personal experience, teachers are the worst. If you have a Malay teacher with breast cancer; I can bet; she presents early (kena paksa oleh kawan-kawan), when I told her it is cancer, she disappears, and a months or two before she dies, she comes back to you crying as if you are the Archangel Izrael. I tak cakaplah off you go, but at that stage nothing much could I do.
I hope my message is loud and clear .................................

Monday, May 11, 2009

Hanya Jauhari Yang Kenal Maknikam

Yesterday, a lady with advanced breast cancer came to me requesting breast cancer surgery. All the while she didn't bother to see a doctor because there was no pain, but lately the cancer became painful (usually indicating the cancer is penetrating through the skin, soon it is going to ulcerate). She and her family knew very well that it was cancer, and the chance to have a proper curative treatment was wide open to her right from the begining. One of her anakbuah is a doctor working in a hospital designated for breast cancer treatment; the Putrajaya Hospital. Instead she opted for the mercy of a bomoh .

Bomoh bukan sebarang bomoh
Bomoh bergelar dari Keraton


Barah dirawat dengan surgeri
Sakit tidak berdarah pun tidak
Bahkan dirakam kamera VCD
RM 7000 dibayar pengeras diberi

The bomoh 'operated' on her. He 'performed surgery' to treat her cancer !

When I saw her, the cancer was huge, axillary nodes are massive and fixed, there chest wall was involved. Basically it was non-operable. There was no evidence of any surgery or intervention what so ever. The bomoh had done nothing but had taken her for a ride. What she needs now are chemotherapy and radiotherapy. Surgery can be considered later if the cancer managed to be down-sized by the chemo.

Back to the bomoh thing, out of inquisitiveness I searched the web for the center. They have a nice homepage, even daringly posted few of their 'surgeries' for us to see.

One thing I believe; you should know your limits. Once your cross the line, you are exposed. There was a bogus doc way back in 1985 in HKL. A failed year 3 medical student impersonating a doctor (teringin sangat lah tu!). He managed to work 'undetected' for more than a month in a medical ward. But on the day he went to OT to assist a surgery (he crossed the line), his identity was exposed.
I tell you a story. A friend of mine sent his Mercedes to a mechanic. The next day the mechanic told him that he had changed the alternator and showed him the one that he had 'removed'. This friend took the rosak alternator home. Another mechanic saw the thing and said; ini bukan mercedes punya, ini Wira punya dah !
You need a mechanic to know what a mechanic does .......... !
I saw a video of a 'bare-hand' surgery from Philipines, the 'bomoh' put his hand on the victim's tummy and pulled out a 30 cm of intestine (claimed colon cancer). That thing was so small for a human intestine. That must be usus ayam (chicken intestine). I know exactly how colon or intestine look like. Any medical student or doctor knows it. To some non-medical peoples; wow, hebatnya, boleh bawak keluar usus dengan tangan kosong..... memanglah kalau usus ayam !
You need a surgeon to know what a surgeon does ........... !
I am going to blow up the cover of this bloody con man with big tittles hiding behind verses of quran and Islamic medicine.
So back to this bomoh Keraton; he put his hand into a patient chest, pulled out a very small heart, too small for a human heart. My bet is that was jantung kambing! Maklumlah susah nak cari jantung yang sama saiznya dengan jantung manusia. Jantung lembu terlalu besar.But sir, if you want a jantung that of the size of a human heart, ambillah jantung BABI. Jangan kena influenza H1N1 sudahlah.
That's not all. What about the technical aspects of the surgery, physiology, infection, blood and etc. My adviced to this bomoh, if you want to help, do what a bomoh does. If you decide to operate, then you have crossed the line. Your wickedness would be uncovered. Kalau nak tipu pun biarlah orang tak tahu. Dahlah menipu orang yang susah, yang sakit dan yang amat mengharapkan, guna pula nama Islam. Memalukan ugama dan bangsa.
Malangnya bilakah orang kita nak sedar....
Yang nak kaya, ambil jalan mudah; skim cepat kaya,
Yang nak nama, bayar ejen untuk dapat Dato'
Yang nak jawatan, bayar rasuah
Yang nak rebut DUN pun , panggil bomoh, puh sana, puh sini
Alahai .

Tuesday, May 5, 2009


Rent To Kill

Yesterday was a historical day for me. I was hired to remove pests; unfortunately a 'friendly' ones. At 3.00 am in the morning, a lady came screaming to the A & E unit; '......takutnya, tolonglah takutnya........' jumping up and down. Some creatures creaping out of her breast !

This is what the breast looks like

And these are the scarry chaps.....

Friendly larvae trying to clean the necrotic cancer tissues away.

Berbuih mulut trying to explain to her and her family about proper cancer treatments. Although already a locally advanced disease, her quality of life might improved with palliative 'toilet' mastectomy, radiotherapy or even chemotherapy. But she insisted on getting rid of the good little fellas and went home to continue with her own treatment using some expensive 'DNA milk' or what ever.

By the way, live maggots are flushed out of the dead tissues using turpentine (minyak gas). Get some turpentine from a hardware shop (not pharmacy), and pour it onto the tissues. The maggots would crawl out of the necrotic tissues. If you use some other chemicals, they might get killed and left rotting in the tissues.

Anyway... just before she left for home, I told her....."You don't need a surgeon to do this, next time just call RENTOKIL .
..............................................................RENTOKIL provides pest-control service in Malaysia

Wednesday, April 22, 2009

BOMOH - In All Strata Of The Society

Look at these 2 CT-scan films

The first was taken on 17/02/2009, and the second was taken on 20/04/2009 They are 2 months apart. Name deleted.

This CT-scan film belongs to is a 50 year old lady (not a commoner) who presented two month ago with lower abdominal pain. She was diagnosed to have ovarian cancer and was adviced (by the gynaecologist) for surgery and chemotherapy.

She went off AOR (at own risk), refused the treatment and opted for the bomoh 'therapy'.

Bomohs are usually more friendly than doctors, but their 'treatments' are cheaper. Wrong ! some charge much more than what I charge for a laparoscopic cholecystectomy for a single consultation.

Back to this lady, she came back to me 2 months later with intestinal obstruction. The intestine was blocked completely by the cancer. She could not eat or drink, vomitted her stomach out. She now agreed for anything, belahlah, colostomy pun tak apa !

But everything was too late. The tumour was not resectable; anyway I did I could do to help her. And she now is counting her days.

Kadang-kadang terfikir juga, apa salahku? Mungkinkah aku tak tahu nak explain apa dia kanser. Mungkinkah aku kena cakap ...Makcik, kalau tak rawat ini, makcik mati dua bulan lagi.

In Kelantan, this bomoh things are killing more people than what the Mat Rempits do on the road. Nak salahkan siapa ?

Ada orang kata ............ ini budaya kita.

Ada juga yang kata ..... ini mentaliti dunia ketiga

Janganlah kata.............. Melayu mudah lupa

I saw TV9's Tanyalah Ustaz 3 days ago. Ustaz Amran Kasimin answering questions, very interesting.

Tuesday, April 7, 2009

Radiologist blues


When I was a lecturer in the university, I got very irritated when my students demonstrated 'lack of common sense'.

Medical students are unique creatures; there are usually intelligent, capable of memmorising many things, giving 1001 rare differential diagnoses, but (now I begin to realise that) they are actually lack of common sense.

I used to think of that long time ago, but I kept pushing that idea to a deep corner of my head. Maklumlah, they are top scorers in their schools and colleges. But more often than not, when you asked them simple straight forward things, they could not give you the answer. They think that you simple questions are tricky, and give you around-the-corner answers. If I do post-grad teaching, it is usually highly 'technical' (or rather surgical), but if I take year IV medical students, it becomes philosophical. This is because I want to inculcate 'common sense' into their brains.
With teaching and training, they 'come back to their sense'. Many of them become good doctors after graduating, but some of them maintain this bad attitute in their professional life.
This is demostrated in this particular case.

This CT-scan film belongs to a 52 year old lady who came to me two days ago. She complained of a severe upper abdominal pain and a progressively enlarging mass in the area. Associated with that she had occasional fever, poor appetite and a weight loss of 16 kg in the past 6 weeks. The pain was so severe that it was only temporarily relieved by pethidine.
She was seen in three hospitals in the last 6 weeks, the last was on 26/03/09 on which a CT-scan was done. She was asked come back for the CT scan report on 26/05/2009 (The radiologist wrote TCA - 2 months, the nurse gave appointment on 26/05/09).
The scan above (taken in my hospital) shows a huge multicentric liver cancer, which is about to rupture (the severe pain is due to liver capsular stretching). I bet on 26/05/2009, she is already 6 feet underground. In the hospital her pain was only controlled with i/v Fentanyl PCA (patient control analgesia), Oxycontin and amytriptyline. Yet the 'good-thinking chap' requested 2 months to report a CT-scan of a terminally ill, dying mother of 5 children presented with an impending rupture of liver cancer.
Inilah yang dikatakan "ada akai tapi tak pakai" atau NO COMMON SENSE !

Sunday, March 8, 2009

Outright Bluffer

Yesterday I was visited by a 49 year old lady who later turned out to be my ex-MU college mate (78-79) asking my opinion regarding her newly diagnosed breast cancer. She is a very educated lady; knows her disease pretty well, but 'caught in between her scientific knowledge and traditional belief'. She is scheduled for a mastectomy and axillary clearance (surgery for the breast cancer) sometimes next week in KL. She came back to Kelantan before her surgery to visit her parents.
Offering to help, her mother invited a bomoh to 'treat her' and later 'certified cured' by the man. Not to offend her mother she came to me to be re-investigated to see whether the cancer is still there or not. Of course, it is there !
You see, even a very educated person can be swayed by this so-called faith healer, what more ordinary kampung folks. What I don't understand is the bomoh themselves.... They don't even know what cancer is all about, yet claim 'can treat and certified cured' a cancer patient. To me, these are not faith-healers or traditional medicine men, they are outright bluffers !
Ada bomoh-bomoh yang jujur dan mampu merawat penyakit-penyakit tertentu (yang boleh dibomohkan), tapi bagi penyakit yang bukan bidang mereka, tak payahlah menyusahkan orang. Ini ada sampai ada yang tertipu dan akhirnya mati dengan keadaan yang menyedihkan.
P/s The picture above has nothing to do with the lady in this article. It is a picture of the breast cancer of a lady (deceased) who came to me last year with lung metastases after months of intensive treatment by various bomoh.

Sunday, February 15, 2009

Dancing With Dr Death

New Straits Times: Tuesday, Feb 10, 2009
Bungling US doctor charged in Australia.
When I read this news in NST and later read the event from major Australian online newpapers - I found some similarities with what happened here about 20 years back.
In the late 80th and early 90th, there used to be many expatriate (foreign) doctors in Malaysian hospitals employed by the goverment to overcome shortage of specialists in this country. Many of these people came here from countries which were generally 'poorer' than Malaysia. You can't expect doctors from UK or Australia to come here since their income in their home country is much higher than here. Since the salary we paid them was relatively low, we couldn't expect to get first class specialists. Bak kata pepatah: You give peanuts, you get monkeys ! Jadi ramailah yang datang ke sini buat-buat pandai, ada yang datang dengan 'blown-up CVs'. Ada seorang tu, dalam CV pernah buat lebih 1000 endoscopy, tapi bila pegang OGDScope, nampak sangat tak tahu!. Every thyroid operation, blood loss would be more than a litre. I still remember very well; few medical officers 'diverting' cases to other surgeons whom they believed were more competent. I have assisted a surgeon doing esophagectomy - after the surgery I thanked him for allowing me assisting him although I was not in his team; I said "thanks sir, this is my first esophagectomy", he said "thanks to you, this is also my first, I choose you because I saw you opened a chest before". Laa, patutlah dia sungguh-sungguh suruh aku belah dada kawan tu!
I believe those era has long gone; we are now having many capable doctors. Some of our hospitals are the best in the region; for example the IJN. But recently the cycle might have come back. With prosperity, more private hospitals were opened. More specialists moved from the public to the private sector, leaving the public hospitals short of senior doctors. Again the vacancies are filled with foreigners.
Janganlah pisang berbuah dua kali...... The goverment mungkin perlu ingat .... you give peanuts, you get monkeys. Sorry !

Monday, February 2, 2009

Hirschsprung Disease

Hirschsprung disease is a disease seen in neonates where congenital absence of special nerve cells in the rectum called ganglion cells resulting in the failure of the that segment of large intestine fails to function. Newborns fail to pass meconeum, and they are diagnosed and operated by paediatric surgeon as soon as possible to save them. A very small percentage of children born with this disease might survive with chronic constipation. This is usually when the affected intestine is very short; short segment Hirschsprung disease. Rarely they live beyond that and into adulthood untreated. This is what I am highlighting today.

In the last 20 years of my practise, I have seen many such patients, 16 to be exact. These people was never brought to seek treatment by their parents when they were small kids. Some was forced by their teachers and friends to seek help because they were smelly with overflow incontinence - cursed busuk, tak tau basuh punggung ke?

This is an intra-operative picture of a segment of a large intestine (rectum) in a 33 year old policeman with Hirschsprung disease. (I once joked to a colleague; I removed a cat that accidentally went into the man's rectum while he pleasured himself with the animal ! )
He had a laparotomy and colostomy done in a nearby hospital when his colon perforated. He was then referred to me for the definitive surgery called Duhamel operation, and later closure of the colostomy.
The point is - our peoples wait till the last minute to seek treatment. If they had done so earlier; they would have led a normal life. But they rather wait and suffer the consequences; in this disease - chronic constipation, abdominal distention, overflow incontinence (ke mana pergi busuk bau taik) and if unlucky enterocolitis and death.
Ini sebut je operation, tak payah lah. Tunggu besar lah; bila besar yang senang dah jadi susah. Apa nak jadi !!!

Saturday, January 24, 2009

Sorry, I need to talk to BOMOH first

This CT scan image belongs to a middle-age man who came to the hospital for prolonged fever and multiple lymphnode enlargement. He was found to have generalised lymphadenopathy involving those in the neck, abdomen, inguinals and in the chest. CT-scan diagnosis was Non-Hodgkins Lymphoma stage IV, and the managing physician advised him to have a biopsy of one of the nodes. This was when I came to the picture.

I explained to him that the biopsy will involve making a small incision in the neck or in the inguinal, and taking out a lymphnode for the pathologist to study. All he said was ..."Sorry, I need to talk to my BOMOH first". With that, he discharged himself from the hospital despite many attempts to make him understand what a lymphoma or a cancer means.
I am speechless ! Whoi !

Last week I joined my gynaecologist operating on this patient; inserting bilateral ureteric stents and assisted him in his surgery. The patient was an elderly lady with advanced ovarian cancer. She had earlier seek treatment for a progressively enlarging abdominal mass and lower abdominal pain in a nearby public hospital. She went to the gynae clinic there; saw one MO (medical Officer - ? trainee gynecologist) who did an ultrasound scanning. Detecting the mass, he requested for a CT-scan examination. During the next visit, CT was done and she was seen by another MO and was asked to come at a later date to see the gynecologist in-charge. On the given date, she came but this time she was seen by another MO and no decision was made. She was then given another date. The time interval from the first to the last visit was four and half months. Upset with the long wait, her childrens later decided to bring her to our hospital; saw our gynaecologist on one day, admitted her and got the CT-scan and IVU done on the next day, TAHBSO surgery on the day after. Now, she is awaiting her chemotherapy.

Look, I am neither comparing (the efficiency or what) nor advertising; but to highlight the attitude of some of our doctors in dealing with cancer patients. When you suspected a cancer, you should put high priority in the case, deal with it 'urgently' . You are not dealing with a reducible inguinal hernia or a lipoma where you can take your sweet time and schedule the surgery electively at the end of your long elective surgery list.

No wonder we are seeing advanced diseases with poor prognosis !

Kalaulah orang lain buat benda macam ini pada kita atau orang kesayangan kita, tentu kita marah. Jadi rawatlah pesakit kita sebagaimana kita mahu dilayani atau dirawati.