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.

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Your close friends wouldn't come near you, your childrens try to avoid you. Your last Hariraya becomes your worst Hariraya.

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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.

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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).

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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.

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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.

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SELAMAT HARI RAYA, MAAF ZAHIR BATIN untuk semua pembaca !

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.

CANCER SURVIVOR - A DIFFERENT PERSPECTIVE

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.

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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.

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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.

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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).

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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!'

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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.

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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.

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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.

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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.

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God is Great; He gives to whoever strives for His Mercy. He helps those who help themselves !

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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