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 .................................