tag:blogger.com,1999:blog-38854231097593470332024-02-20T22:29:18.351+08:00PakarBedahAndaPakarBedahAnda or Your-General-Surgeon is my blog in which I highlight common surgical problems faced by Malaysians. In the last 20 years of my practice, many of my patients presented with advanced diseases in which treatments were more complicated, and if they were cancers then the prognosis were poor. This is also my personal 'fight' against late presentation of surgical diseases particularly cancers.Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.comBlogger55125tag:blogger.com,1999:blog-3885423109759347033.post-42334289071262242162013-06-09T12:46:00.002+08:002013-06-09T12:49:01.016+08:00WOI ......Assalamu'alaikum<br />
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Lama sungguh saya tak menulis di blog ini.... Sebenarnya saya 'dah lupa' pasal blog ini - maklumlah zaman twitter dan facebook sekarang ini. Sehinggalah saya dikejutkan beberapa email yang menanyakan tentang beberapa perkara yang saya tulis dalam blog ini. Begitu jugalah dengan beberapa kes yang really 'mencabar' ego yang InsyaAllah akan saya nukilkan dalam beberapa penulisan yang akan datang. Kes-kes ini menuntut saya terus menulis - orang Malaysia masih tak faham penyakit kanser.Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-2404251706621759452011-08-27T15:24:00.005+08:002011-08-27T17:04:56.657+08:00Peutz-Jegher Syndrome<em>Sometimes, when you see something. you just could not forget it . . .</em>
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<br /><div align="justify">Way back during the earlier years of my career, there was a little girl admitted to my ward with intestinal obstruction. She was found to have multiple polyps in the small and large intestines. She was operated and got well. While in the hospital (<em>biasalah</em> - university hospital - batches of medical students came to see her because she had distinctive pigmentations on her lips - <em>malangnya</em> her father who also had the same pigmentations listened to the medical students' discussion. <em>Dia rasa bersalah kerana menurunkan baka penyakit itu kepada anaknya. Apa yang</em> medical students <em>tu cakap tak tahulah... hinggakan satu pagi dia dijumpai mati setelah terjun bangunan hospital lapan tingkat.</em> Commit suicide !</div>
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<br /><div align="justify">So, when this man came to me with abdominal pain, I knew the diagnosis straight away... because of the distinctive lip pigmentations.</div>
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<br /><div align="justify">The dots or circum-oral pigmentations on the lip, or freckling of the mouth is a feature of a hereditary condition call Peutz-Jegher Syndrome.</div>
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<br /><div align="justify">I knew straight away that the abdominal pain was most probably due to intestinal polyps. X-ray showed feature of small intestinal obstruction. I took him to the operation room, and this was what I found !</div>
<br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvSUgv6SJ8odzyth_AxRqPeyzvnS8oX0UxDJ89W7iikvv2rBlcP1nMHa42I2nAknYnx-26IIiiQSevo1-l9wSrcznReDAjEy0VMMR6QIIerY24qQesMNIPWa5ORetetzDgu0iFQ3-GSkI/s1600/27102009+004.jpg"><img id="BLOGGER_PHOTO_ID_5645453579460572354" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 239px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvSUgv6SJ8odzyth_AxRqPeyzvnS8oX0UxDJ89W7iikvv2rBlcP1nMHa42I2nAknYnx-26IIiiQSevo1-l9wSrcznReDAjEy0VMMR6QIIerY24qQesMNIPWa5ORetetzDgu0iFQ3-GSkI/s320/27102009+004.jpg" border="0" /></a>
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<br /><div align="justify">Intestinal polyps causing intussusception (invagination of the intestine onto itself)</div>
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<br /><div align="justify">What is Peutz-Jegher Syndrome?</div>
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<br /><div align="justify">Peutz-Jeghers syndrome (PJS) is an inherited condition that puts people at an increased risk for developing hamartomatous polyps in the digestive tract, as well as <a href="http://www.cancer.net/vgn-ext-templating/v/index.jsp?vgnextoid=c532ea97a56d9010VgnVCM100000f2730ad1RCRD">breast</a>, <a href="http://www.cancer.net/vgn-ext-templating/v/index.jsp?vgnextoid=4762ea97a56d9010VgnVCM100000f2730ad1RCRD">colorectal</a>, and other types of cancer. A hamartoma is a growth of normal-appearing tissue that builds up into a non-cancerous tumor. However, the growth can transform into cancer over time. Cancer begins when normal cells begin to change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (non-cancerous) or malignant (cancerous, meaning it can spread to other parts of the body).</div>
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<br />The lifetime risk of cancer in people with PJS is around 93%. People with PJS also tend to develop dark blue or dark brown freckling, especially around the mouth and on the lips, fingers, or toes. Freckles generally appear in childhood and may fade with age.
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<br /><div align="justify">The proposed criteria for a diagnosis of PJS are:
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<br /><div align="justify">Diagnosis of one or more hamartomatous polyps in the digestive tract, and at least two of the following: </div>
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<br />1. Polyps in the small intestine
<br />2. Characteristic freckling of the mouth, lips, fingers, or toes</div>
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<br /><div align="justify">3. At least one relative diagnosed with PJS </div>
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<br /><div align="justify"><em>Apa maksudnya semua ini bagi pesakit tersebut? Ini bermaksud kemungkinan beliau untuk mendapat kanser (terutamanya kanser usus adalah tinggi) dan beliau mestilah menjalani satu skima pemeriksaan perubatan secara berkala untuk mengesan kanser sebelum ianya parah.</em></div>
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<br /><div align="justify"><em>Bagi pesakit ini, beliau perlu menjalani pemeriksaan kolonoskopi dan ultrasound setiap 2 tahun.</em></div>
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<br /><div align="justify"><em>Tak semua yang ganjil di kulit kita itu tanda lahir, ada antaranya tanda-tanda kanser.</em></div>
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<br /><div align="justify"><em>Bertanyalah pada yang tahu. Setiap yang Allah jadikan itu ada sebabnya !</em></div>
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<br />Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com1tag:blogger.com,1999:blog-3885423109759347033.post-32420443676275016012011-03-01T21:16:00.005+08:002011-03-01T21:57:30.589+08:00NEGERIKU DILANGGAR TODAKTake a break . . . . .this is not about cancer !<div><br /></div><div style="text-align: justify;">A 30 year old man was rushed to the hospital with a chest injury. He was swimming in the sea near Perhentian Island at about 9.30 pm one night. Suddenly he was hit on the chest by a sharp object; and he found a long 'ikan todak' stuck to his chest. He was rushed to a nearby district hospital where he was noted to have pneumothorax <i>(paru-paru bocor</i>) and a chest tube was inserted. He was then transferred to me for further management.</div><div><br /></div><div><div><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6ydAmLumd380L-EjNn7JkVShc8ar0ckFs8FATgYUWys2VHL5uSGg-HurhZMqvoiMHIqEWanyPUJjW10nmKYpbA0JkR5lHRsepgRKfzRcfmK8Gisbm-3jPwnJNVCJxwgsypupiz-L91-M/s320/todak.jpg" style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 239px;" border="0" alt="" id="BLOGGER_PHOTO_ID_5579100225617480402" /></div><div style="text-align: justify;">In this era of digital technology, the culprit was easily captured; of course, on camera.</div><div><br /></div><div>This is it . . . . .</div><div><br /></div><div>IKAN TODAK</div><div><br /></div><div>or</div><div><br /></div><div>Needlefish or Swordfish or Garfish</div><div><br /></div><div>or</div><div><br /></div><div><i>Tylosurus Crocodilus</i></div><div><i><br /></i></div><div>To the contrary of the famous Malay epic; <b>Temasik Dilanggar Todak</b> (<i>heronya budak botak bernama Hang Nadim</i>), ikan todak is usually not dangerous</div><div><br /></div><div>Wrote Susan Scott in <a href="http://www.aloha.com/~lifeguards/needle.html">http://www.aloha.com/~lifeguards/needle.html</a></div><div><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">As their name suggests, needlefish are long, narrow and silvery. The smaller common species reach about 15 inches long; the larger ones can grow to more than 3 feet. In all species, the fishes' needlelike beaks, filled with sharp teeth, merge with their bodies to form sleek, living spears.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">Needlefish have two long jaws, good for catching fish. A needlefish strikes at passing prey with a sideways movement of the head, then swallows it whole.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">Like their other close relatives, the flyingfish (malolo), needlefish can leap from the water at up to 38 miles an hour, skimming the surface before falling back to the water. This is where needlefish and people can clash.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">At night, lights sometimes attract and excite these fish, causing them to jump at speed. Needlefish beaks have penetrated the wooden hulls of outrigger canoes.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">Tragically, one also penetrated the eye of a 10-year-old Kauai boy while he was night fishing in a small boat with his father. The fish beak penetrated the boy's brain, killing him.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">In other parts of the Pacific, needlefish have punctured people in the chest, abdomen, arms, legs, head and neck.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">People at greatest risk of needlefish punctures are night reef fishermen carrying lights in low boats. For many village fishermen in the Pacific, needlefish are a greater occupational hazard than sharks.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">Although it's rare, swimmers and divers have been seriously injured by needlefish in Japan, New Zealand and the Red Sea.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">No such injuries have been reported in Hawaii, but it's a possibility. To prevent such an incident, night divers should leave lights off until well submerged. Fishermen in small boats should be aware of the potential danger of carrying lights at night.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">Millions of people, including me, have snorkeled near, dived around and paddled into schools of needlefish countless times without any trouble at all.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">These lovely, interesting fish aren't out to get you and injuries are indeed rare.</p><p style="text-align: justify;-webkit-border-horizontal-spacing: 2px; -webkit-border-vertical-spacing: 2px; font-family: 'Times New Roman'; font-size: medium; ">Still, it's good to know the facts. Now, when someone asks me if those skinny, silvery fish can hurt you, I won't say never. I'll say, almost never.</p></div><div><br /></div><div><br /></div><div style="text-align: justify;">Jadi, sekiranya anda atau seseorang dilanggar todak, ia bukanlah satu serangan tapi satu kemalangan.</div></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Sebaliknya</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">Jika sekiranya anda atau seseorang dilanggar kereta, ia bukanlah satu kemalangan tapi satu kecelakaan.</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">. . . . . fikir fikirkanlah !</div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-4847179861105013812011-02-27T22:25:00.009+08:002011-02-27T23:11:20.516+08:00LAGI-LAGI TUNGGU<div style="text-align: justify;">A 30 year old teacher presented with a progressive abdominal distension. It was painless, thus she waited until she could not hide it anymore in her loose outfit (<i>jubah</i>). She just smiled broadly when her colleagues <i>tegur; anak keberapa tu? </i>knowing very well that she was not pregnant.</div><div style="text-align: justify;"><br /></div><div style="text-align: justify;">She came to the gynecologist. This is one of the CT-scan pictures: large ovarian cyst with features of cancer.</div><div><div><br /></div><div><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTWF2c4xWrlbppqPZiZhAz5lJlVrE-GpauSy3LWltNcqdRio4uyO2M-2SsMrje4Yn2nxCb-Vg64yfFQREAScrr_hfCw_uiq_qh1mZ6L_zHlrsCEXAIddkzV-QneBQXqu8d65nCJRMPxM0/s320/ovarian+cancer.jpg" style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 240px;" border="0" alt="" id="BLOGGER_PHOTO_ID_5578378667535290050" /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div>This is the removed specimen; well encapsulated tumour but with features of cancer on CT - Oophrectomy (removal of the ovary) was done by the gynae. I came in the clear the omentum and the appendix; the organs that are usually affected by cancer seedlings.</div><div><br /></div><div><img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiI6jf-g_Tg5LAs6hwJiwG0Lsy6KlPyZQNObRUKVD9dW3EfstVY4KW-mLb70ls_jdP7eTTGWoBbkwzl0q82-2uXDVy105-Wo5YsEtm06lhzlzCcePQUcI5Ek_GR79nN4Vy5XqkoDsPpoC8/s320/kanser+ovari.jpg" style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 320px; height: 240px;" border="0" alt="" id="BLOGGER_PHOTO_ID_5578376732644141474" /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div>And now she is waiting for her chemotherapy.</div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><i>Kalaulah dia datang lebih awal . . . . .malangnya kalau, kalau, . . . . . . . . . . . .kalau !</i></div><div><i><br /></i></div><div><i><br /></i></div><div><i>Mungkin ini dah jadi budaya kita? </i></div><div><i>seperti yang terjadi padaku siang tadi; </i></div><div><i>bersesak-sesak bayar saman lalulintas tertunggak </i></div><div><i>di saat-saat akhir.</i></div><div><br /></div></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com1tag:blogger.com,1999:blog-3885423109759347033.post-61163969474246036052011-02-26T22:18:00.002+08:002011-02-26T23:26:20.381+08:00Kelate oh Kelate ku ......Dalam seminggu dua ni kita dikejutkankan dengan beberapa berita kematian. Mula dengan kematian seorang bekas pemain bolasepak, kemudian seorang VIP.<div><br /></div><div>Yang berbezanya; </div><div><br /></div><div>Seorang lelaki, seorang perempuan,</div><div>Seorang akibat kanser tekak (nasopharynx -NPC), seorang kanser payu-makdara</div><div><br /></div><div>Persamaannya;</div><div><br /></div><div>Dua-duanya bukan 'oghe kapung duduk dale rok'</div><div>Tapi 'anak Kelate hok ado namo'</div><div>Malangnya dalam kedua-dua kes ini, perubatan moden dianaktirikan, tok bomoh diutamakan</div><div><br /></div><div><br /></div><div>Bahkan dalam yang satu tu, sampai ke akhir hayatnya santau disalahkan</div><div><br /></div><div><br /></div><div>Inilah bahana yang melanda anak negeriku..</div><div><br /></div><div>Kanser ni gapo ?</div><div><br /></div><div>Ironinya di kampung saya (sebelah Hospital USM) ramai penduduknya dapat manafaat dari kanser. Apa tidaknya, oghe luar (orang dari luar Kelantan) sewa rumah/bilik ketika datang rawatan kemoterapi atau radioterapi di HUSM. Unit Onkologi HUSM adalah salah satu pusat rujukan rawatan kanser negara. Homestay tumbuh macam cendawan di sekeliling HUSM, disewa oleh keluarga pesakit kanser.</div><div><br /></div><div>Kita ada macam-macam kemudahan, tapi kita tak caro nak guno.</div><div><br /></div><div>Mungkin kita boleh reka slogan baru : </div><div>1 Kelantan, kanser diberitahu, Tok Bomoh didahulukan</div><div><br /></div><div><br /></div><div><br /></div><div><div><br /></div></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-30484260769441626972011-02-26T22:13:00.003+08:002011-02-26T22:18:21.805+08:00GAYA HIDUP SIHAT<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwqV3a0CN6elJWm2HC6HVPjQq9lWazbeiBY9Owb9eT3L89rgn1asGEaQDyqOWuNkz5QDWvKua9hhYknqyG3DzdlglV_aoDr18XAocvzqH9-23BoiH4FTDaHoyYuT0En293LKTP3uX6wpo/s1600/longer+life.jpg"><img style="text-align: center;float: left; margin-top: 0px; margin-right: 10px; margin-bottom: 10px; margin-left: 0px; cursor: pointer; width: 320px; height: 294px; " src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwqV3a0CN6elJWm2HC6HVPjQq9lWazbeiBY9Owb9eT3L89rgn1asGEaQDyqOWuNkz5QDWvKua9hhYknqyG3DzdlglV_aoDr18XAocvzqH9-23BoiH4FTDaHoyYuT0En293LKTP3uX6wpo/s320/longer+life.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5578001653210771842" /></a><div style="text-align: center;"><br /></div><div style="text-align: center;"><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div><br /></div><div>Betul jugak ....... inilah ironinya kehidupan !</div><div style="text-align: center;"><br /></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-25925966902360974792011-01-09T13:38:00.010+08:002011-01-09T16:26:53.020+08:00Penangan TOK BOMOH<div align="justify">A 64 year old lady presented to the hospital with severe abdominal pain and high fever after <em>balik berurut</em> with a <em>bomoh.</em> She has been visiting this <em>bomoh</em> for a left sided abdominal mass since 6 months ago. According to her children, the mass was initially small in size but lately has grown much bigger. She had been adviced to seek treatment in hospital which she boldly refused. </div><br /><br /><div align="justify">When I saw her, she was in severe pain with signs of septicemia. There was a huge abscess (<em>bisul yang nak pecah)</em> in the abdomen with an underlying tumour.<br /></div><div align="justify">CT-scan done showed a large sigmoid colon cancer with an overlying abscess cavity filled with pus and gas (or fecal matter)</div><br /><br /><div align="justify"></div><p><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKu1g1ACWlwWBLCiZro0CI5wWltEEc-YjecYRFbt41KhEPFxlsZ2vqm4f73DTaKJRzIeOaNGuP8wXZ5-utR904VK2Gz8V7t2JVQO3RePcfpyORa1pCNzz4CnaghH3MOKQXX9zMWviySfE/s1600/Sigmoid+Cancer+perforation.jpg"><img id="BLOGGER_PHOTO_ID_5560064501349403618" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 336px; CURSOR: hand; HEIGHT: 215px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKu1g1ACWlwWBLCiZro0CI5wWltEEc-YjecYRFbt41KhEPFxlsZ2vqm4f73DTaKJRzIeOaNGuP8wXZ5-utR904VK2Gz8V7t2JVQO3RePcfpyORa1pCNzz4CnaghH3MOKQXX9zMWviySfE/s320/Sigmoid+Cancer+perforation.jpg" border="0" /></a><br /><br />abscess cavity<br /><br />the colon cancer<br /></p><p></p><p></p><p><em></em></p><p><em></em></p><p><em></em></p><p><em></em></p><p><em></em></p><p><em>.</em></p><p><em>.</em></p><p><em>.</em></p><p><em>.</em></p><p><em>Apa yang telah berlaku ?</em></p><p align="justify">Basically she has a neglected / untreated colonic cancer, now it has perforated through the abdominal wall (<strong><em>kena uli tok bomoh sampai pecah</em></strong>) . Soon, it would be coming out through the skin (<em>itu pun</em> if she survives the septicemia).</p><p align="justify">What needs to be done is to drain the abscess and feces through the skin and treat the infection. Once her condition improves, go and remove the cancer. But that was not in her mind. She wanted to go back to the bomoh. What could I do?. Furthermore she had the full support of her children. So be it.</p><p align="justify"></p><p align="justify">This is it ........ <strong>CANCER and Kelantanese don't click !</strong> </p><p align="justify"></p><p align="justify">I hope this is not the end of my struggle. I believe there are many more non-Kelantanese that would benefit from my writings.</p>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com2tag:blogger.com,1999:blog-3885423109759347033.post-88476539503470409052010-10-25T14:57:00.006+08:002010-10-25T15:18:55.477+08:00KANSER BUAH PINGGANGA 40 year old man came with <em>'letih-letih'</em> and not feeling well for the past one month. Ultrasound examination done by a general practitioner showed a tumour on the left kidney. CT-scan done revealed a large tumour arising from the upper pole of the left kidney.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhP9Pr0B5kekGlhqCwdlIEYE_UJjrjfhMfbHry77ai3BKR2K6jK0J3Q-D7GUrQ07r4zqEwA5-Skd9dgPtU-vD6hoxrJ6icSOANhhbigPchxNanQMaHgsiGBWXZz2v3BDNqi46ebfz2ZOmk/s1600/RCC1.JPG"><img id="BLOGGER_PHOTO_ID_5531874985192922514" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 314px; CURSOR: hand; HEIGHT: 320px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhP9Pr0B5kekGlhqCwdlIEYE_UJjrjfhMfbHry77ai3BKR2K6jK0J3Q-D7GUrQ07r4zqEwA5-Skd9dgPtU-vD6hoxrJ6icSOANhhbigPchxNanQMaHgsiGBWXZz2v3BDNqi46ebfz2ZOmk/s320/RCC1.JPG" border="0" /></a> <div><div><br /><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4Jio5SstI04OplzhZvm4YgOhdqE6XCimdIBuebr7ZiC4RJPDYGPEcjU-9Ly5vcCuPxMQ-mWGdfn0G2uGSG_sfOPRky2LDk-wgHfVraHEqM4_qshlOZ7C1AsZACPao2lqgLK9SiFechnE/s1600/RCC1.JPG"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-6QQxBW9ePf9cYp4jVXItxN01uAfDMR4Fk4LVGL2UCFo3NuHBAVmEQKqvFzkHGokf_V-1R-8RADXECZLD9cMNqkZTexGJdacFxlLXmXN161-fSSqEyioo5tGhgrVVTNBkTOglX6E1QBs/s1600/rcc3.JPG"></a>This is one of his CT-scan films; it showed a large tumour involving the left kidney. This is most probably a Renal Cell Carcinoma (RCC) - <em>kanser buah pinggang. </em></div><div><br /></div><div align="justify"><br />He was told of the diagnosis, treatment and the prognosis with and without treatment. </div><div align="justify"><em>Prognosis tu maksudnya apa akan jadi dengannya selepas ini termasuk mati. </em></div><div><br /><br /><br /></div><div align="justify"></div><div align="justify">He was offered surgery; as the cancer is still resectable and most probably curable.<br />And the expected happened; the <strong>Kelantanese syndrome</strong>. He disappeared, I hope temporarily.<br /></div><div align="justify"><br />5 years ago, I operated on a 33 year old man with similar cancer; he survived. Now happily married and last week called me to inform me that he just got a baby girl. </div><div align="justify"></div><div align="justify"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRmLkikoa3V1lGtv6E76M_FhvepAUVALXu1dAuQbNzgPWuh1z7PMu4r47EpFFEzGdYIzNDjQpu8bKXPFPw2x3IgRPev_LqWeyyaisw7WGG0_1819WorDRzMGDQufVz8hbyEzQ8dItTvRI/s1600/rcc5.JPG"><img id="BLOGGER_PHOTO_ID_5531875806332235730" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 239px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRmLkikoa3V1lGtv6E76M_FhvepAUVALXu1dAuQbNzgPWuh1z7PMu4r47EpFFEzGdYIzNDjQpu8bKXPFPw2x3IgRPev_LqWeyyaisw7WGG0_1819WorDRzMGDQufVz8hbyEzQ8dItTvRI/s320/rcc5.JPG" border="0" /></a></div><div align="justify">This is the picture of his cancer. </div><div><br /><br /><br /></div><div align="justify"></div><div align="justify"><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmxadK8lsHNrB4VN7O8bBa40GvP0zfEplIsKizfH4Dw8S6QBOd3LM5OTJNWM-_X2fAFs2r5xJunBaXzGhsKU7SNB3qPCBDIhJlpau05fZR5vCXYbeNgJ2yT1drugVitQDfeef_zGRGiCY/s1600/rcc5.JPG"></a>The cancer was well-encapsulated, the capsule wasn't breached by the cancer. No chemotherapy was given.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjW_xzLOWpXiucHtseyMSrr5dptY8jo8nKPZF-wfq9tPAzWAAmhgh2-ICx8N5YliTfJ_tq6mwPdpjj4FvQCSD6h3aSRh9n20J0lOX9x-n5SIdPy8ejLzYxWCGUPJIWfwWmQHhoDONW5k7A/s1600-h/Renal+Cell+Carcinoma.JPG"></a></div><div><br /><br /></div><div align="justify"></div><div><br /></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div><br /><br /></div><div align="justify"></div><div><br />And these are CT-scan picture of other patient with similar cancer on the right side (see how huge it is) and the picture of the removed specimen.<br /></div><div align="justify"></div><div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKwemPQ6dd6-IlKGce-Gbw0HnUb7qUWJnueYn3woIlNTC4LEjZbApdRpYy2LY81P6M2r_JDtHv6B47tASIeBxpFJvfBcJy5YlS8pbeaDIClAFGXM4mZwm_PvdpL3WCBOb1Ks_ftSQ5X4k/s1600/rcc4.JPG"><img id="BLOGGER_PHOTO_ID_5531876672835835602" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 282px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKwemPQ6dd6-IlKGce-Gbw0HnUb7qUWJnueYn3woIlNTC4LEjZbApdRpYy2LY81P6M2r_JDtHv6B47tASIeBxpFJvfBcJy5YlS8pbeaDIClAFGXM4mZwm_PvdpL3WCBOb1Ks_ftSQ5X4k/s320/rcc4.JPG" border="0" /></a><br /><br /></div><div align="justify"></div><div><br /><br /></div><div align="justify"></div><div><br /><br /></div><div align="justify"></div><div><br /><br /></div><div align="justify"></div><div><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKwemPQ6dd6-IlKGce-Gbw0HnUb7qUWJnueYn3woIlNTC4LEjZbApdRpYy2LY81P6M2r_JDtHv6B47tASIeBxpFJvfBcJy5YlS8pbeaDIClAFGXM4mZwm_PvdpL3WCBOb1Ks_ftSQ5X4k/s1600/rcc4.JPG"></a></div><div><br /></div><div align="justify"></div><div><br /><br /></div><div align="justify"></div><div align="justify"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIIb8BmKEr994ZbCobXsaEBBtsQogYxcDjGbj-4Ee3h5tyLPjBd08IkmCHKzDKkReVMRZ0dWYiTH6Qb-hIQVzw5vzuA_TiowXFdNJMr6KyhXloiuvQA22z4fgU13c6t6umXxoX4f942Pk/s1600/rcc3.JPG"><img id="BLOGGER_PHOTO_ID_5531876431144104034" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 239px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIIb8BmKEr994ZbCobXsaEBBtsQogYxcDjGbj-4Ee3h5tyLPjBd08IkmCHKzDKkReVMRZ0dWYiTH6Qb-hIQVzw5vzuA_TiowXFdNJMr6KyhXloiuvQA22z4fgU13c6t6umXxoX4f942Pk/s320/rcc3.JPG" border="0" /></a></div><div align="justify">She waited for three months before agreeing to the surgery. </div><div align="justify"></div><div align="justify"><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjspb1FLPpdP-BcFUuA3VCpSDTHVjGwf-Oo8_Ch_M8PKD-t3el8SrkaMZicRH-TDIhniDR4HcJ4x5c9UgCbvYevDUFd-5kI5zcb3VpKHqnFEGFwTHTFKpfj20xsdNjB1IrXTQy04HyZ2fQ/s1600-h/Renal+Cell+Carcinoma.JPG"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-6QQxBW9ePf9cYp4jVXItxN01uAfDMR4Fk4LVGL2UCFo3NuHBAVmEQKqvFzkHGokf_V-1R-8RADXECZLD9cMNqkZTexGJdacFxlLXmXN161-fSSqEyioo5tGhgrVVTNBkTOglX6E1QBs/s1600/rcc3.JPG"></a>See, the cancer had breached the capsule, she was given chemotherapy. Two and a half years later, she came back with bone and brain secondaries <em>(kanser merebak ke otak dan tulang)</em> and died soon after. </div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"><br /><em>Kadang-kadang, saya tak faham dengan orang kita. Bila doktor kata <strong>kanser</strong>, dia mungkin dengar <strong>risa</strong>; buang tak apa, tak buang pun tak apa. </em></div><div align="justify"><br />In Kelantan, <em>risa</em> (pronounced <strong>reeso</strong>) is a benign tumour of the skin or subcutaneous structures; it could be a lipoma, sebaceous cyst, ganglion, etc.</div></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com2tag:blogger.com,1999:blog-3885423109759347033.post-46291822815823179182010-10-18T15:52:00.004+08:002010-10-18T16:45:47.321+08:00SUDAH MUNTAH TAHI BARU NAK KOREK LUBANG..<strong>Pepatah Melayu : </strong><br /><br /><strong><em>Sudah terantuk baru tengadah</em></strong><br /><strong><em>Hendak terberak baru nak gali lubang.</em></strong><br /><br /><em>Inilah yang jadi kalau susah sangat nak faham</em><br /><br /><div align="justify">A 59 year old man, had fecal incontinence (<em>tak boleh kontrol berak</em>) two years ago. He went to a private hospital, told to have cancer of the rectum (<em>usus besar dekat dubur</em>) and adviced surgery. Refused, went to HUSM and told the same thing. <em>Tak puas hati</em>, went to Kota Bharu Hospital (HRPZII). Tak mahu faham juga.</div><br /><div align="justify">He has cancer of the rectum, very close to the anus resulting in fecal incontinence (meaning the cancer has already involved the sphincter muscles). The surgery to the remove the cancer would also remove the sphincters. thus he would need a permanent colostomy.</div><br /><div align="justify"><em>Sebabkan tak mahukan colostomy, langsung tak mahu rawatan</em>. Obviously, <em>Tok Bomoh kata kolostomi tak perlu.</em></div><em></em><br /><div align="justify">Two years <em>sengsara pakai</em> diapers. Now the cancer has totally oblitrated the rectum causing intestinal obstruction. <em>Apa lagi, perut jadi kembung, tak boleh berak. Makanan masuk ikut mulut, tahi pun keluar ikut jalan yang sama.</em></div><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqXJ0Oe0HbNZho1s4drVQOyIRuEmBh_uKbSoWPP54vnU_KFkIyp9xZCyYwt7NZLw4ZD6nRLau1Jyn3e4BNfGoICu9lbF_Y_pzeaUtzf8k4x0kRBywYYfccRqLPm1nKyej3zb1htNtrbm8/s1600/27102009+009.jpg"><img id="BLOGGER_PHOTO_ID_5529292002559405618" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 239px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgqXJ0Oe0HbNZho1s4drVQOyIRuEmBh_uKbSoWPP54vnU_KFkIyp9xZCyYwt7NZLw4ZD6nRLau1Jyn3e4BNfGoICu9lbF_Y_pzeaUtzf8k4x0kRBywYYfccRqLPm1nKyej3zb1htNtrbm8/s320/27102009+009.jpg" border="0" /></a><br /><br /><br /><em>Gambar X-ray usus besar kembung tiga kali ganda</em><br /><em></em><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><div align="justify"><em>Terpaksalah buat</em> emergency operation. <em>Sekarang bukannya nak buang kanser yang telah merebak</em> (inoperable), <em>tapi nak selamatkan nyawa, supaya boleh makan.</em></div><em></em><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzG6jjW7YBl9x_U1BCy7hW8vczEgOGD_6LKhrwcOIKjULJlxT4sgZ_Rtnzpv9_utyPwnu2i1-TElrXO4Qh5NGyf8EFjFstN9WZHGyVgNKQ_ZA5K1P1S5GmKSuJ9227HyXikbRUCeh95no/s1600/27102009+010.jpg"><img id="BLOGGER_PHOTO_ID_5529292459125870818" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 239px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzG6jjW7YBl9x_U1BCy7hW8vczEgOGD_6LKhrwcOIKjULJlxT4sgZ_Rtnzpv9_utyPwnu2i1-TElrXO4Qh5NGyf8EFjFstN9WZHGyVgNKQ_ZA5K1P1S5GmKSuJ9227HyXikbRUCeh95no/s320/27102009+010.jpg" border="0" /></a><br />Grossly distended large intestine.<br /><br /><br /><br /><br /><div></div><div></div><div></div><div></div><div></div><div></div><div></div><div></div><div><em></em> </div><div><em></em> </div><div><em></em> </div><div><em></em> </div><div><em></em> </div><div><em></em> </div><div><em></em> </div><div><em></em> </div><div><em>Akhirnya kena buat juga kolostomi juga.</em> Now <em>dah</em> <em>selamat; dah boleh makan dan berak melalui kolostomi.</em></div><div><em>.</em></div><div>Tapi kansernya tetap di situ. </div><div>.</div><div><em>AlhamdulilLah sekarang baru nak kemoterapi dan radioterapi. Tapi apakan daya !!!</em></div><div><em>.</em></div><div><em>.</em></div><div><em></em></div><div><em>Inilah cerita 'oghe kelate' ku.......</em></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-51818514712826349332010-10-18T15:34:00.004+08:002010-10-18T15:52:01.591+08:00BARAH PAYU-JANTAN<div align="left">KOTA BARU: Three cases of breast cancer involving men were reported at Hospital Universiti Sains Malaysia (HUSM) in Kubang Kerian, here last year with one patient succumbing to the disease.<br />Coordinator of HUSM's breast cancer information centre, Dr Nik Munirah Nik Mahdi, said according to the last national cancer registry in 2006, six men in Kelantan had died of breast cancer."Breast cancer is seen more as a disease that affects women but it is not necessarily so. That is why it is important for people from both sexes to be well informed about it," she said after the launch of the information centre's blog and a workshop on women's health yesterday by the chairman of USM board of directors, Prof Emeritus Datuk Dr M. Zawawi Ismail. Read more: <a style="COLOR: #003399" href="http://www.nst.com.my/nst/articles/20brest/Article#ixzz12kjXZy27">6 Kelantan men die of breast cancer</a> <a style="COLOR: #003399" href="http://www.nst.com.my/nst/articles/20brest/Article#ixzz12kjXZy27">http://www.nst.com.my/nst/articles/20brest/Article#ixzz12kjXZy27</a></div><br /><div align="justify"><em>Jadi jangan sangka barah payudara</em> (breast cancer) <em>hanya terkena pada wanita, yang jantan juga boleh kena</em>. Unfortunately breast cancer in men tends to be more aggressive. I have seen a man with breast cancer presented with brain secondaries. <em>Maksudnya datang dengan tanda-tanda barah otak, setelah disiasat didapati puncanya adalah barah payudara (dalam kes ini payu-jantan). </em></div><div align="justify">.</div><div align="justify">.</div><div align="justify">.</div><div align="justify"></div><div align="justify"><em></em></div><div align="justify"><em></em></div><div align="justify"><em>Jadi abang-abang tu jangan asyik nak buat BSE (breast self examination) pada isterinya saje, sendiri juga mesti rasa .......</em></div><div align="justify"><em></em></div><div align="justify"></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-41791549257492324272010-10-11T13:46:00.003+08:002010-10-11T14:37:56.140+08:00PRK DUN GALAS<div align="justify"> </div><div align="justify"> </div><div align="justify"> </div><div align="justify">Lunch time: I was joined by a radiographer (juru-Xray) asking me <em>'kenapa dah lama tak</em> update <em>blog doktor</em>?' <em>Tiba-tiba saya teringat.... dah lama tak buka blog ni ! mungkin sibuk dengan</em> <em>'kegilaan' baru di</em> facebook. So I said; <em>OK saya pergi update sekarang jugak</em>.</div><div align="justify"> </div><div align="justify">Just before the lunch hour, I was in the A & E Department; attending to a patient presented with cough and breathlessness. She was a 35 year old teacher, has been coughing since 2 months ago, went to Kuala Krai hospital yesterday and claimed the doctor there refused to give her any medication. When I came closer to her bed, I smelled something familiar; <em>'bila lagi dah ada penyakit ini?' 'Baru 2 bulan batuk-batuk ni'. 'Bukan batuk,</em> your breast cancer?' <em>'Mana doktor tahu saya ada kanser?</em>' ' I can smell it !</div><div align="justify"> </div><div align="justify">Reluctantly she exposed her self; and there you were... large left breast cancer with involvement of the contralateral breast. <em>Jarang jumpa ni, kanser payudara kiri dan kanan serentak. </em>I examined the lungs, and I told her that most probably the cancer has infiltrated her lungs as well. Suprisingly she suggested; <em>mungkin</em> infection <em>doktor, TB ke.. beri saya ubat antibiotik je</em>!</div><div align="justify"> </div><div align="justify">Unbelievable....<em> inilah sikap orang kita (oghe kelate kito)</em> the big <strong>C</strong> is nothing<em>.</em> So, to made her understand the serious situation she is in, I told her ; <em> Kalaulah cikgu ni Tok Wakil, selepas PRK Galas ni, kita pergi mengundi kawasan DUN awak pulak ........</em></div><div align="justify"><em></em> </div><div align="justify"><em>Saya harap dia faham, </em>her days are numbered !!</div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-59407168792196808372010-08-22T11:31:00.005+08:002010-08-22T12:47:15.951+08:00JUMPA DOKTOR HANYA SETELAH HILANG 60 kg<div align="justify">A 50 year old man came to see a physician with severe anemia and difficulty in swallowing. He had these symptoms for the last five months. Associated with that he also noted that his stools were dark (malenic - meaning there is blood in it). And he gradually loss his weight; from an astounding 130 kg to less than 70 kg during these 5 months. He could not take anything solid.</div><br /><div align="justify">His friends including a doctor neighbor had adviced him to seek treatment. He went to his usual <em>bomoh</em> and <em>tukang urut</em> and once to a homeopathic practitioner. Last week, he could not swallow anything and only then he saw the physician.<br /><br />On examinaton he was grossly wasted and dehydrated, and <em>pucat lesi</em> (Hb 5.4 gm%). After transfusing him with 4 units of blood, the physician referred him to me for scope (OGDS). He initially refused (couldn't imaging having a camera being pushed down his throat!), but after convincing him that there wouldn't be any pain, I managed to do the procedure. There was an obstructing tumour in his esophagus. Biopsy showed a well-differentiated adenocarcinoma and the CT-scan showed :<br /><br /></div><div align="justify"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhm2HBkIWOe6bwRxroMU94aBsboXGciq7XYIG1ererIqVvYydjvKfv7GToRyYjPwvtvnQdIqvfOTVkhatNULq6NmARM3GL4bTFKJCWdf9M_iAO0y820hq1i9Hl6Lqn74J0af4CJil4pd4/s1600/OGJ+tumour.jpg"><img id="BLOGGER_PHOTO_ID_5508084720145087922" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 257px; CURSOR: hand; HEIGHT: 194px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhm2HBkIWOe6bwRxroMU94aBsboXGciq7XYIG1ererIqVvYydjvKfv7GToRyYjPwvtvnQdIqvfOTVkhatNULq6NmARM3GL4bTFKJCWdf9M_iAO0y820hq1i9Hl6Lqn74J0af4CJil4pd4/s320/OGJ+tumour.jpg" border="0" /></a><br /></div><p align="justify"></p><div align="justify">A huge cancer in the lower end of the esophagus extending into the stomach ( or vice-versa) with metastatic nodes. There is a trickle of contrast going into the stomach.</div><div align="justify"></div><div align="justify">So, now with an massive cancer (adenocarcinoma) in the esophago-gastric junction, 'inoperable'; he is left with not many options. </div><div align="justify"> </div><div align="justify">This type of cancer does not respond to radiotherapy, poor results with chemotherapy and surgery has high morbidity and mortality. As a palliative measure, a stent could be placed so that he would be able to take something orally. </div><div align="justify">And of course his days are numbered.</div><div align="justify"></div><div align="justify">.</div><div align="justify">To make the thing worst; after talking to him many times, he didn't seem to understanding ......<br />.</div><div align="justify">.</div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"><em>Kelantan, oh Kelantan ku</em></div><div align="justify"></div><div align="justify">or rather</div><div align="justify"></div><div align="justify"><em>oghe kelate, oghe kelate....gapo nak jadi ni?</em></div><p align="justify"></p>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-67649354821959219612010-08-10T23:00:00.004+08:002010-08-10T23:42:04.526+08:00BUASIR LAGI . . . .<div align="justify"><br />A 55 year old man came to me for treatment of 'piles (<em>buasir</em>)'. He complained of passing out blood and mucus (<em>lendir</em>) during defecation, and lately the feeling of incomplete defecation (<em>rasa berak tak puas). </em>He had been seeing several doctors in his hometown for these symptoms, and all of them treated him with hemorrhoidal medications. None of them did a rectal examination.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9p-kXvgWP5Ntju2V0LvPcFJg3YK_YX4lpx9ezrt5qW2g2RH-wXfpJxAFxUCBpPT7NJZiUQUJXTjAZKi67-t4XSWPhVw9cH_CHwcpw9Erwdp-YQvuxEIPag4UJYna23JvjCMadtpsYzng/s1600/27102009+018.jpg"><img id="BLOGGER_PHOTO_ID_5503797084732913538" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 239px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh9p-kXvgWP5Ntju2V0LvPcFJg3YK_YX4lpx9ezrt5qW2g2RH-wXfpJxAFxUCBpPT7NJZiUQUJXTjAZKi67-t4XSWPhVw9cH_CHwcpw9Erwdp-YQvuxEIPag4UJYna23JvjCMadtpsYzng/s320/27102009+018.jpg" border="0" /></a></div><div align="justify"><em></em></div><div align="justify"> </div><div align="justify"> </div><div align="justify">When I examined him, there was an ulcerating tumour in the lower third of the rectum extending into the anal canal. </div><div align="justify"> </div><div align="justify">This is how it looks from the inside of the rectum (on colonoscopy). Anybody could have feel it if he sticks his finger into the rectum, but nobody did it. And the cancer was missed !</div><div align="justify"></div><div align="justify"> </div><div align="justify"> </div><div align="justify">Anyway, after confirming the diagnosis with a tissue biopsy, I proceeded with surgery to remove the rectum (including the anus) and constructed him a permanent colostomy. This is the picture of the resected specimen.</div><div align="justify"></div><div align="justify"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYm85zUDsAk74ldpDIVmK6bJ_-bGIckwDdU_TrLuQzy3YYt9TDJRt0FvYnUcHcfOBa-WukQMmxexpiKBrkRnayLP4mybKegKV3jkWmInyyUeoEk5DvzLy2YHI9Lwj055c8zdQ821ZaAzg/s1600/27102009+010.jpg"><img id="BLOGGER_PHOTO_ID_5503796755273618114" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 239px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYm85zUDsAk74ldpDIVmK6bJ_-bGIckwDdU_TrLuQzy3YYt9TDJRt0FvYnUcHcfOBa-WukQMmxexpiKBrkRnayLP4mybKegKV3jkWmInyyUeoEk5DvzLy2YHI9Lwj055c8zdQ821ZaAzg/s320/27102009+010.jpg" border="0" /></a><br /></div><div align="justify">The cancer can be seen very close to the anal skin.</div><br /><br /><br /><br /><div align="justify">This is the problem. A patient comes with very obvious symptoms, no proper assessment or examination done, yet, oh, you have <em>buasir</em> ! and a cancer is missed again until it's too late.</div><br /><br /><br /><em>Susah sangatkah nak buat</em> rectal examination ?Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com1tag:blogger.com,1999:blog-3885423109759347033.post-42102940829829614112010-08-10T10:51:00.005+08:002010-08-10T22:13:55.363+08:00TERMENGANDUNG . . . . Apa nak buat ?<div align="justify"><strong><em>Termengandung</em></strong> - literally 'accidentally gets pregnant' - but I am not talking about unplanned pregnancy. </div><div align="justify"></div><div align="justify">This is about a woman who was adviced NOT to get pregnant but somehow found herseft pregnant. Cancer patients undergoing chemotherapy or hormonal therapy are not suppose to get pregnant.</div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">This women came to me with right breast cancer, and had a breast conservative surgery done. What it means is - only the cancer and the surrounding breast tissues were excised, and she still has the breast. For that she was referred to an oncologist for chemotherapy. She went around in KL and Penang (with my referral letter) meeting several oncologists to find one who would agree with her not to have the chemotherapy. Unfortunately she found none! All the oncologists she met insisted that she should have the chemo. Finally she accepted it; and the chemotherapy was started 4 months ago. After 3 months (3 cycles of chemotherapy) she found herself pregnant. <em>Tiga bulan baru tahu dah mengandung, susahlah kawe nak explain, hok ni kena tanya orang pompuanlah ! </em>The oncologist referred her to an obstetrician for abortion. She called me yesterday for advice as both her physicians are non-muslims and she needs to know whether the abortion (in this circumstance) is permitted in Islam.</div><div align="justify"></div><div align="justify">I am not an expert in Fiqh (Islamic jurisprudence) but I told her what I undertand and adviced her to seek the advice of <em>Tok-tok Guru</em> or <em>Ustaz</em> and <em>'alim-ulamak'</em>.</div><div align="justify"></div><div align="justify">.</div><div align="justify">As a doctor, I explained to her why she was adviced not to get pregnant when she went for chemotherapy.</div><div align="justify"></div><div align="justify">.</div><div align="justify">Chemotherapy is a form of cancer treatment using drugs / medicines (chemotherapeutic agents). The drugs 'kill' the cancer cells. <em>Kalau awak ada cacing, makan ubat cacing. Maka cacing mati dan awak jadi sihat.</em> If you have TB germs in your lungs, you take TB medicines' <em>kuman TB mati dan </em>you<em> jadi sihat!.</em> Cancer is different... the cancer cells are parts of your bady, they are not germs or <em>cacing</em>. So a drug that kill cancer cells also kill normal cells. Then, how to kill cancer cells without killing the patient? Cancer cells are fast dividing cells, thus chemotherapeutic agents (ubat chemo) are designed to target cells that divide fast; <em>yang cepat tumbuh</em>. <em>Malangnya dalam badan kita, bukan sel-sel kanser saja yang tumbuh dengan cepat; ada juga anggota badan yang tumbuh cepat; misalnya rambut, kuku, sel-sel darah dan sebagainya. Sebab itu bila kena kemo, rambut habis gugur, kuku jadi hitam, sel darah merah berkurangan (</em>anaemia<em>) dan sel darah putih rendah (mudah kena jangkitan dan kadang-kadang pesakit kanser perlu</em> reverse isolation).</div><div align="justify"></div><div align="justify">.</div><div align="justify">Just imaging if you were pregnant ! The budding foetus and the fast dividing cells within it are killed by the chemo drugs. <em>Samada janin tu mati (anda keguguran) atau kalau dia hidup, dia cacat dengan teruk sekali.</em> So, in the case of this particular patient, I told her that the pregnancy might aborts spontanenously or if it manages to mature, she might give birth to a severely deformed baby - <em>tapi Allah lah yang menentukannya dan Dia Maha Mengetahui dan Maha Menyayangi !</em></div><div align="justify"></div><div align="justify"><em>.</em></div><div align="justify"><em>Bagi doktor-doktor, dan adik-adik yang belajar perubatan; berilah penerangan yang jelas setiap kali anda menerangkan sesusatu kepada pesakit. Jangan anggap semua orang mudah faham sesuatu seperti anda. Ada di antara pesakit kita (sorry to say) 'slow' sungguh !. </em></div><div align="justify"><em></em></div><div align="justify">.</div><div align="justify">I'll tell you my experience last week<em>. Ada satu orang yang saya buat </em>operation<em> membuang sebahagian ususnya kerana kanser usus. Hari pertama selepas pembedahan, saya benarkan dia minum air kosong, hari kedua saya benarkan minum milo. Sebelah malamnya dia bertanya jururawat; "Misi, bolehkah saya campur gula dalam milo saya, tawar sangatlah! ... Bagi kita bila sebut milo, maksudnya tentulah ada air, milo, gula atau susu. Tapi tak semua orang begitu.</em></div><div align="justify"><em></em></div><div align="justify"><em>.</em></div><div align="justify"><em>Jadi berilah penjelasan yang sejelas-jelasnya ...... sebelum terlambat atau pecah perut kerananya !</em></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-62105936746087514612010-03-13T14:37:00.007+08:002010-03-21T12:38:47.829+08:00Air Tujuh Kolah<div align="justify">Gallstones (<em>Batukarang hempedu</em>) is a common disease. It presents with upper abdominal pain and usually the symptoms mimic that of peptic ulcer disease (<em>sakit gastrik</em>). Treatment of uncomplicated gallstone is easy and straight forward; remove the gallbladder. The operation is called cholecystectomy. Previously, cholecystectomy is done through an incision in the abdomen just beneath the right costal margin. Now it is done laparoscopicaly (minimal invasive surgery - keyhole surgery). It can be done as a daycase surgery, and with minimal pain.</div><div align="justify"></div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeFVbpDsBdj2jBb79g4RgmlM9I5gXUJ97vDoiSxb1Y7V95FgCOFDEvXhIU2MOoJSk7eswTBjLihaPOxYhcOdguVpNBjAT1ZGi9EwPlNS95u2xo0iOAFZeQ6yVOlYBiX2kMR4Ip3lO2_Qc/s1600-h/27102009+055.jpg"><img id="BLOGGER_PHOTO_ID_5448321932638126450" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 240px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeFVbpDsBdj2jBb79g4RgmlM9I5gXUJ97vDoiSxb1Y7V95FgCOFDEvXhIU2MOoJSk7eswTBjLihaPOxYhcOdguVpNBjAT1ZGi9EwPlNS95u2xo0iOAFZeQ6yVOlYBiX2kMR4Ip3lO2_Qc/s320/27102009+055.jpg" border="0" /></a><br /><p align="justify">In Kelantan, most patients describe it as <em>pembedahan laser</em> (which is literally wrong). Despite the advanced technique and all its advantages, many Kelantanese still prefer to go somewhere else before coming to their surgeon.</p><br /><p align="justify">Last week I did a laparoscopic cholecystectomy on a 42-year old teacher. Ultrasound examination done two weeks earlier showed multiple gallstones. However on the day of the operation, she insisted that I repeat the ultrasound before the surgery. Her reason : She had seen a bomoh who prescribed her with "<em>air kolah tujuh buah masjid</em>" - drank unboiled. </p><br /><p align="justify"><em>Saya percaya Allah berikan ilmu kepada sesiapa saja yang dikehendakiNya, dan ilmuNya begitu luas. Saya yakin ada di sana seseorang yang Allah berikan ilmu untuk merawat sesuatu penyakit dengan cara yang berlainan. Tetapi masaalahnya, bomoh-bomoh yang kita ketahui kebanyakannya tidak jujur dengan perbuatannya. Ada seorang insan di Jelawat Kelantan yang 'menyedut' batukarang hempedu dengan pelepah betik sebelum diludahkan dari mulutya. Ada pesakit yang bawa batu itu kepada saya. Yang saya lihat hanyalah batu kerikil sungai atau yang dikutip di tepi jalan. Yang bomoh tu tak tahu ialah batu karang hempedu diperbuat dari kolesterol (hard but smooth, multifaceted and shiny) atau pigmen hempedu (black, soft and dirty). Tentunya kalau di'scan' semula masih terdapat batu yang sama walau pun telah 'disedut' keluar oleh tokmoh. </em></p><br /><p align="justify"><em>Pastinya bomoh itu tahu yang dia menipu, dia lakukan juga untuk cari makan. Malangnya orang kita mudah sangat percaya. Hujah mereka IKHTIAR. Memanglah Allah suruh kita ihktiar, tapi Dia juga beri kita otak. Dan Dia suruh kita gunakannya untuk berikhtiar.</em></p><br /><p align="justify"><em>Tok moh, tok moh ...........................</em></p>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com1tag:blogger.com,1999:blog-3885423109759347033.post-29238082950596021012010-03-01T16:44:00.008+08:002010-03-06T15:10:39.623+08:00KITA MINUM DULU ....<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTrM5ifM0Heb0r2e9diof83lAJxQyK1Ubun49CSUsqC4-yq8k5QGFkEODDf6FYoohl1U473Unx-9ZRXDVfQAR-ljq_TgDHVvRgNvUPabtpEeCwjvmqgmvwm31xzWQ7-bpAumj4DFZlsZ4/s1600-h/Shukery+Hashim.jpg"><img id="BLOGGER_PHOTO_ID_5445411660265213250" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 172px; CURSOR: hand; HEIGHT: 285px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjTrM5ifM0Heb0r2e9diof83lAJxQyK1Ubun49CSUsqC4-yq8k5QGFkEODDf6FYoohl1U473Unx-9ZRXDVfQAR-ljq_TgDHVvRgNvUPabtpEeCwjvmqgmvwm31xzWQ7-bpAumj4DFZlsZ4/s320/Shukery+Hashim.jpg" border="0" /></a><br /><div><div>Masihkah kita ingat pelakon ini?<br /><br /><br /><br /></div><div align="justify">Allahyarham Shukery Hashim, 55 tahun, menghembuskan nafas terakhir jam 1.45 petang 10/06/2009.</div><div><br /><br /></div><div align="justify">(ataupun ada yang menyangka bahawa beliau masih hidup, kerana melihat drama lakonan beliau yang masih baru di kaca TV hampir setiap minggu?)</div><div><br /><br /></div><div align="justify">Beliau meninggal dunia 3 bulan setelah disahkan mengidap kanser pankreas.</div><div><br /><br /></div><div align="justify">Kanser pankreas biasanya dikesan lewat, dan pengidapnya mengalami sakit perut yang teruk (<em>body & tail of pancreas</em>) atau jaundis (<em>head of pancreas</em>). Prognosis biasanya teruk, maksudnya jangka hayat pesakit adalah pendek. <em>My longest surviving patient after surgery (Whipple's operation) lasted only two years.</em> Yang lainnya hidup 6 bulan ke setahun. Tanpa pembedahan, <em>none lasted more than 6 months</em>.</div><div align="justify">.</div><div align="justify"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc55aUCEu0x32aBppG-CL3757bhSU5UqVi7nudrP9t3S3KnwlXgzzv6qNGIh5qCedYgsL6SyOH4W6WwWSpRQXbdMYZ_KNqhlL9EVjT2tftr34ga1p5kyaeOw5VcfGGe8cY_JlwBB7adWA/s1600-h/Pancreatic+cancer.JPG"><img id="BLOGGER_PHOTO_ID_5445411148251874962" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 214px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc55aUCEu0x32aBppG-CL3757bhSU5UqVi7nudrP9t3S3KnwlXgzzv6qNGIh5qCedYgsL6SyOH4W6WwWSpRQXbdMYZ_KNqhlL9EVjT2tftr34ga1p5kyaeOw5VcfGGe8cY_JlwBB7adWA/s320/Pancreatic+cancer.JPG" border="0" /></a> <em>Picture: Advanced cancer pancreas with intra-peritoneal disseminations </em><em>(carcinomatosis peritoneii)</em><br /></div><div align="justify">Pesakit dalam gambar ini datang dengan ketumbuhan dalam perut, busung (ascites) dan disahkan mengidap kanser pankreas. Hanya biopsi yang dapat dilakukan. Beliau kembali ke rahmatulLah 4 bulan kemudian<br /></div><div align="justify"> </div><div align="justify"> </div><div align="justify"> </div><div align="justify">Kajian terbaru tentang kanser ini amat mengejutkan saya: </div><div align="justify"><strong><em>Soft Drink Consumption Linked to Pancreatic Cancer.</em></strong> February 2010: <strong><em>Cancer Epidemiology, Biomarkers & Prevention</em></strong>. Kajian selama 14 tahun ini dijalankan di Singapore dikalangan penduduknya yang berbangsa China (Singapore Chinese Health Study (n = 60,524). Mereka mendapati <em>those consuming 2 or more soft drinks per week experienced a statistically significant increased risk for pancreatic cancer (hazard ratio [HR], 1.87; 95% confidence interval [CI], 1.10 - 3.15). The results of the new study found that individuals who consumed 2 or more soft drinks per week had an 87% increased risk for pancreatic cancer, compared with those who did not. </em>Satu serving soft drink adalah satu tin kecil yang biasa kita beli dengan harga RM1.50</div><div>.<br />.</div><div align="justify">Maksudnya kebiasaan kita dan anak-anak kita yang minum minuman bergas hampir setiap hari akan mendedahkan kita kepada kanser pankreas. Ingatlah, dalam minuman itu yang ada hanya air, yang lainnya adalah kimia; pemanis, perasa, perisa, pewarna, pengawet dan penstabil (biasanya ditambah perkataan <em>yang dibenarkan. </em>Pernahkah kita bertanya: siapa yang benarkan?)</div><div>.</div><div>.</div><div align="justify">Oleh itu berhati-hatilah.</div><div>.<br /></div><div align="justify">"Mamak, air kosong satu" - adalah satu pilihan bijak, <em>and</em> <em>no longer an indication of poor financial planning !</em></div><div><em>.</em></div><div> </div><div align="justify"><em>Tepuk dada, tanya selera !!</em></div></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com1tag:blogger.com,1999:blog-3885423109759347033.post-75349366462371498302010-02-09T15:39:00.005+08:002010-02-10T15:43:40.745+08:00Nak Fikir Dulu Doktor, Nanti Saya Telefon Kalau jadi....09/02/2009<br /><br /><div align="justify">A 37 year-old teacher, single - referred by a General Practitioner for a left breast lump. On examination, there was a 2X2 cm lump in the left breast. Ultrasound examination showed features suggestive of a probable cancer. Adviced biopsy.</div><br /><em>Nak fikir dulu doktor, nanti saya telefon kalau jadi.......</em><br /><br />26/06/2009<br /><br /><div align="justify">Came with a much larger lump, this time with her newly-wed husband, <em>kami baru kahwin 40 hari.</em> On examination, the lump was 8X8 cm with areolar skin involved. Due to the rapid progression of the lesion, I told her that it was most probably a cancer. She needed proper treatment: surgery KIV chemo and radiotherapy.</div><br /><br /><div align="justify"><em>OKlah doktor, buang butir saja, kalau pun kanser, kami tak mahu buang semua (mastectomy) . kami kan baru kahwin....</em></div><em></em><br /><br /><div align="justify">Excision done and the histology report came back as expected - CANCER - infiltrating ductal carcinoma. <em>Gikgu...</em> you need a proper cancer treatment!</div><div align="justify"><br /><em>Nak fikir dulu doktor, nanti saya telefon kalau jadi.......</em><br /><em></em><br />September - December 2009: contacted patient several times. Please, you need proper treatment. Each time, the answer was :<br /><br /><em>Nak fikir dulu doktor, nanti saya telefon kalau jadi......</em><br /><br /></div><div align="justify">(09/02/2010)<br />Today she came without an earlier appointment, <em>AlhamdulilLah terbuka hatinya untuk mendapat rawatan!</em></div><em></em><br /><br /><div align="justify"><em>Saya datang ni nak minta surat pengesahan doktor yang saya ada kanser untuk saya diberi pengecualian dari menghadiri kursus! </em></div><em></em><br /><br /><div align="justify">Can I see you first? Now the cancer has come back; 6X6 cm with skin and axillary nodal involvement. </div><div align="justify"></div><div align="justify"><em>.</em></div><div align="justify"><em>Memang saya nakkan rawatan, tapi ginilah doktor:</em> </div><div align="justify"><em>Nak fikir dulu doktor, nanti saya telefon kalau jadi........</em></div><div align="justify"><em></em></div><div align="justify"><em>.</em></div><div align="justify"><em>Inilah</em> my well-educated patient<em>; Nak fikir dulu, nanti saya telefon kalau jadi.........</em></div><div align="justify"><em></em></div><div align="justify">She came with a curable 2X2 cm lesion, and the concerned surgeon is just a phone-call away, yet she chose to end her life in a miserable way.</div><div align="justify"><em></em></div><div align="justify">.</div><div align="justify">Probably, in the future if someone says<em> ; </em></div><div align="justify"><em></em></div><div align="justify"><em>Nak fikir dulu doktor, nanti saya telefon kalau jadi,</em> </div><div align="justify">I would say;</div><div align="justify"><em></em></div><div align="justify"><em>.</em></div><div align="justify"><em>Ikut mu lah.....</em></div><div align="justify"></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com2tag:blogger.com,1999:blog-3885423109759347033.post-24070641775357660502010-02-06T12:22:00.002+08:002010-02-06T12:33:33.907+08:00Breast Cancer in NST<a href="http://www.nst.com.my/Current_News/NST/articles/19afn/Article/index_html">http://www.nst.com.my/Current_News/NST/articles/19afn/Article/index_html</a><br /><br /><br /><br /><em>Breast Cancer: Many come when it is too late</em><br /><em></em><br /><em></em><br /><div align="justify"><em>At least 40 per cent of Malay women who came to the department were diagnosed with either third or fourth stage of breast cancer.The percentage among Chinese and Indians was lower.</em></div><em></em><br /><br /><div align="justify">In my practice, probably more than 70 percent of Kelantanese women with breast cancer presented with stage 3 or 4 disease (Locally advanced or metastatic)</div><br /><br /><em>Moga-moga tahun 2010 ini memberi perubahan yang positif bagi wanita Kelantan !</em>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-64696471889684563792010-01-25T15:12:00.009+08:002010-01-26T09:41:34.997+08:00I lost a patient with umbilical hernia<div align="justify">Umbilical hernia is hardly a fatal disease. In most cases, umbilical hernia is a congenital condition. To Kelantanese, it is known as <em>pusat bujil </em>or <em>uluran; </em>and is usually seen in neonates and premature babies. Strap a 50 cent coin there or apply a <em>'barut perut'</em> - settle the problem in most infants. Those who still have the hernia after the age of one year, would most probably need surgery to repair it.</div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">This is how an umbilcal hernia looks like:</div><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNRUS_M3VqH0u1EbUmiFwH6xXMEeEtFFZkSpZvyzwo95NyhUAdnr4bKtw3bTyfRQZmGL5U7nZRQR9D0pI4SWNGwgUwDIhI9nGJf8yNlh4xPnaEj1_PTL9M6Pr0lK2jYHuPVpU1IvZJrZY/s1600-h/hernia179.jpg"><img id="BLOGGER_PHOTO_ID_5430574286750404866" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 277px; CURSOR: hand; HEIGHT: 196px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNRUS_M3VqH0u1EbUmiFwH6xXMEeEtFFZkSpZvyzwo95NyhUAdnr4bKtw3bTyfRQZmGL5U7nZRQR9D0pI4SWNGwgUwDIhI9nGJf8yNlh4xPnaEj1_PTL9M6Pr0lK2jYHuPVpU1IvZJrZY/s320/hernia179.jpg" border="0" /></a><br /><br /><br /><div align="justify">In children, the content is usually a loop of small intestine. If the umbilical hernia occurs in adult, more often than not it contains omental fat (<em>lemak dari dalam perut</em>). </div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">Complications come in the form of obstruction; a loop of intestine herniates or protrudes out (into the hernial sac) and could not go back inside (into the abdominal cavity). Thus the hernia could not be reduced or pushed in. <em>Sakitlah jadinya ! </em>Reducible hernia is usually painless.<em> </em>On top of that, when the intestine gets blocked; <em>perut jadi buncit, tak boleh makan dan muntah-muntah.</em> It may get worse, if the blood supply to the obtructed intestinal loop is cut off by the pressure of the swollen bowel to the hernial ring. This is now called strangulated hernia. If not relieved immediately, the intestinal loop would become gangrenous (<em>mapuh le tu!).</em></div><p align="justify">This is a picture of a gangrenous bowel loop in a stranguled hernia:<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFqzEZjyi7R06TB5bgK-dJqyb_5W3GTIw1kAG7o7Dry4urVNvgvqq9p1B2B-UmZXmKtZQAxn2EP-crfKWK0nX2tkh_SMnUACFdR8du_pGRRHy_kZsauu3hdtIGh_K5FAcQgIRy32NA1Fo/s1600-h/strang_hernia2.jpg"><img id="BLOGGER_PHOTO_ID_5430572355366504578" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 265px; CURSOR: hand; HEIGHT: 215px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFqzEZjyi7R06TB5bgK-dJqyb_5W3GTIw1kAG7o7Dry4urVNvgvqq9p1B2B-UmZXmKtZQAxn2EP-crfKWK0nX2tkh_SMnUACFdR8du_pGRRHy_kZsauu3hdtIGh_K5FAcQgIRy32NA1Fo/s320/strang_hernia2.jpg" border="0" /></a><br /></p><p align="justify"></p><p align="justify"></p><p align="justify"></p><p align="justify">For many Malaysians (<em>biasalah, selagi tak sakit, selagi itu tak buat apa-apa)</em> they come for treatment when the hernia got obstructed. Since the last Hariraya I operated on two patients with strangulated inguinal hernia and one with strangulated umbilical hernia. The first two were operated immediately; loops of vascular-compomised intestine resected, hernioplasty done and the patients went home after few days.</p><div align="justify">The third patient came seriously ill, she came with septicemia (very ill with overwhelming infection and multiple organ failure). She was resuscitated, blood pressure stabilised and taken to the operation theatre. Her condition was made worse by her uncontrolled diabetes.<br /></div><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJV8kd1WSx2f0QTjkbacaK_LnpSpv4us2ycEVKLZXQOM4ZQ-sCiBNMgbLunAuyLpGokrTkp0qSVIDdvFVF1l5p09OjSu4lfITWf66C3nbmM25vb3NOnrduC-vpvJYtLFm6zoRlSX9faOA/s1600-h/Incarcerated+umbilical+hernia.JPG"><img id="BLOGGER_PHOTO_ID_5430572230772173826" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 288px; CURSOR: hand; HEIGHT: 179px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJV8kd1WSx2f0QTjkbacaK_LnpSpv4us2ycEVKLZXQOM4ZQ-sCiBNMgbLunAuyLpGokrTkp0qSVIDdvFVF1l5p09OjSu4lfITWf66C3nbmM25vb3NOnrduC-vpvJYtLFm6zoRlSX9faOA/s320/Incarcerated+umbilical+hernia.JPG" border="0" /></a><br /><div align="justify">This is how her tummy looked like. <em>This picture was taken after I had painted the abdomen with iodine solution to sterilise it for the surgery (before draping).</em></div><br /><div align="justify">Once I opened the abdomen, I noted the bowel was gangrenous and feaces (<em>tahi) </em>all over the abdominal cavity and in the hernial sac. I had a difficult job; resecting the dead and necrotic large bowel, cleaning all the spilled-over <em>tahi</em> and at the same time try not to breath in too much air through my surgical mask. </div><br /><div align="justify">Post-operatively she was pushed to the ICU and ventilated. Despite of a very aggresive management she did not recover from her septicemia and finally succumbed to her illness.</div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">This time I did not need to put a 'sympathetic face' and say to the family ; sorry, we lost your dearest one ! Insteads, they came to me apologitically "<em>apa nak buat, kami dah puas pujuk, suruh dia buat </em>operation<em> lama dulu, tapi dia yang degil</em>"</div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"><em>.</em></div><div align="justify"><em>.</em></div><div align="justify"><em>Inilah orang kita, selagi tak nampak bayangan malaikat maut, tak mahu berubat.</em></div><div align="justify"><em>Nak tidur baru nak cari bantal, nak berak baru nak korek lubang !!</em></div><div align="justify"><em></em></div><div align="justify"><em></em></div><div align="justify"></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-61706394312234098912010-01-11T12:56:00.011+08:002010-08-21T12:12:49.715+08:00Start blogging again ....... The usual Kelantanese stuff !<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSlGX9RXN7JJsDaCTXu7rUB5I-03CEqXcTBVUhqLJCVZd69kv-pv8SkTWld2QlK1m_UIV0pT6WPqy-zXq_hC2fsmXudK5PJ6abwgxTq0-MPEgoedciy68w-w-biQTkp6PYJDLo44OUc2g/s1600-h/Buasir+berdarah.JPG"></a><div></div><div align="justify">A 43 year old 'well-educated' gentleman presented to me last July with symptomatic anemia i.e. he complained of tiredness and breathlessness. On examination, he was pale (Hb 4.0 gm/dL), his blood pressure was normal but his heart rate was a bit faster than it should be. His lungs, heart and the abdomen were essentially normal.</div><br /><p align="justify">On enquiry as what could be the source of his chronic blood loss, he admitted to have some bleeding piles for many years. On examination, this is what it looked like: a bleeding and prolapsed piles.</p><p align="justify">"<em>Picture DELETED"</em></p><p align="justify">Piles or hemorrhoids (for treatment purposes) are classified as first, second, third or forth degree, in term of severity. First degree piles are those situated in the anal canal and they stay there. Second degree piles come out when you strain but goes back inside spontaneously when you stand up. A third degree piles needs to be pushed inside, and a forth degree could not be reduced at all.</p><p align="justify">What he need was blood transfusion to correct the anemia and a hemorrhoidectomy surgery to treat the third degree piles. He accepted the blood but refused the surgery. Fair. Many people are scared of surgical proceedures. So he was transfused with several pints of blood, given medications to treat the piles and was discharged from the hospital.</p><p align="justify">Last night, he came back(after 5 months). Again with breathlessness and severe anemia. His Hb was 4.3 gm/dL. The piles were still the same; bleeding and prolapsed. And he still refused definitive treatment. The reason is : "<em>ada orang kata kita boleh mati ketika buat operation</em>". I gave him a lecture on risk-management: what ever we do, there are risks involved. The important thing is how we face and manage the risks. <em>Tak faham ju</em>ga. So I told him; <em>nanti keluar hospital jangan guna lift, kalau lift terjatuh boleh mati. Balik rumah jangan naik kereta atau motor, nanti accident, boleh mati. Jangan jalan tepi jalanraya (pedestrian), kena langgar kereta terus mati.</em></p><p align="justify"><em>"Doktor, you bagi I darah cukuplah, I tak mau dengar itu semua"</em> So he got it. But before I transfuse him with the blood, I asked him to sign the 'Blood Transfusion Consent Form'. For your information, the MOH has implemented this policy after facing few cases of medical litigation following complications of blood transfusion, mainly transfusion of HIV-infected blood.</p><p align="justify">"<em>Masuk darah pun kena sain ke?"</em> I told him: The chance of you dying from the blood transfusion is higher than that of dying from a hemorrhoidectomy surgery.</p><p align="justify"><em>Itulah orang kita......</em>to be exact<em>....oghe kelate kito !</em></p><p align="justify"></p>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com1tag:blogger.com,1999:blog-3885423109759347033.post-42337949943654288652009-10-18T15:28:00.005+08:002010-02-23T15:19:59.928+08:001 Malaysia<div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify">In Malaysia, <strong>1Malaysia</strong> (ONEMALAYSIA) is now the most spoken word on TV. Most corporate advertisements are circling around this theme.</div><p><br /></p><div align="justify">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 '<em>begho</em>' around his wound, in Bahasa Melayu of Kelantanese dialect. Not understanding what '<em>begho'</em> means, I asked the patient in front of me, who is an ethnic Siamese. (<em>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!.</em></div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">.</div><div align="justify">Point-<em>nya </em>: In Kelantan, <strong>1Malaysia</strong> is not a 'propaganda', it is '<em>darahdaging'</em> !!!</div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">.</div><div align="justify">.</div><div align="justify">.</div><div align="justify">Anyway, I am not a pure Kelantanese, only S.K.M.K - <em>Sudah Kahwin Mek Kelate</em> !</div><div align="justify"></div><div align="justify">(Sorry for 'out of the topic' writing - just to start blogging again after the long <em>raya</em> holiday).</div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-34276073007686586382009-09-14T14:32:00.006+08:002009-09-15T09:52:20.365+08:00Seronoknya Beraya Di Kampung<div align="justify">Musim raya datang lagi. Alangkah seronoknya anak-anak. Ibu bapa pun tak kesah apa yang anak-anak buat, maklumlah minggu terakhir ramadhan.</div><br /><br /><div align="justify">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.</div><br /><br /><div align="justify">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.</div><br /><br />Apa nak jadi ayahwang?<br /><br /><br /><div align="justify">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. </div><br /><div align="justify"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhC-fw0f2f0EkAAcfwShj-GTFICIzkCuOYv49j2b6aocQ2pfJM1lk1t5QuReedHNPXP97KbOvD-jGXh4qo5H1ORbEN4yIJ1GjnqmXSRtGSNk-dXF-qM3gW7aLfg1RI6CF-unvVseqLXCp8/s1600-h/Beraya+Di+Rumah+Tok.jpg"><img id="BLOGGER_PHOTO_ID_5381213378958410978" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 244px; CURSOR: hand; HEIGHT: 176px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhC-fw0f2f0EkAAcfwShj-GTFICIzkCuOYv49j2b6aocQ2pfJM1lk1t5QuReedHNPXP97KbOvD-jGXh4qo5H1ORbEN4yIJ1GjnqmXSRtGSNk-dXF-qM3gW7aLfg1RI6CF-unvVseqLXCp8/s320/Beraya+Di+Rumah+Tok.jpg" border="0" /></a>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.<br /></div><p align="justify"><br /><br /><br />Mak ayah tu, tengoklah anak-anak. Doktor pun nak raya juga!<br /><br /><br /><br />Maaf. Cuma nak lepaskan geram dengan orang kita yang tak serik-serik.<br /><br />SELAMAT HARI RAYA MAAF ZAHIR BATIN. </p>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-81155336474787525382009-08-30T11:47:00.011+08:002009-09-02T12:10:54.698+08:00DEMI HARIRAYA.... (If Not for the Hariraya..)<div align="justify">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 (<em>mandi sunat raya</em>), put on our best clothes, springkle perfumes and walk to the nearest mosque for <em>solat raya</em>. </div><br /><div align="justify"></div><br /><div align="justify">But what if you have an ulcerating, foul-smelling breast cancer like this. </div><div align="justify"></div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKGqLv6g9FQI9xa3uDOClaLCRxrEJ4QSgwajkxiacWDiyR-usTWJ0nW0XUkokk5cL3125IOTsaq3TW0xOc3ZrKc2hHdk-dBuoUGelvcx0X0XKP8PYWYQuOX9DOKyWWfoKH3HJlsaci7MA/s1600-h/advanced+breast+cancer.jpg"><img id="BLOGGER_PHOTO_ID_5375611974035368882" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 274px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKGqLv6g9FQI9xa3uDOClaLCRxrEJ4QSgwajkxiacWDiyR-usTWJ0nW0XUkokk5cL3125IOTsaq3TW0xOc3ZrKc2hHdk-dBuoUGelvcx0X0XKP8PYWYQuOX9DOKyWWfoKH3HJlsaci7MA/s320/advanced+breast+cancer.jpg" border="0" /></a> <div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">Your close friends wouldn't come near you, your childrens try to avoid you. Your <strong>last</strong> Hariraya becomes your <strong>worst</strong> Hariraya.</div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">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 <em>bomoh</em> 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 <em>busuk dan meloyakan</em>, and bleeding noted from the edges. The underlying pectoralis muscle was involved. The axillary nodes were massive and fixed.</div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">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 <em>please!</em> at the end).</div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">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<em> ini bukan jamban tapi maksud serupa</em>; 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.</div><div align="justify">.</div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify">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 <em>bersyukur</em> that God has made me a surgeon; giving hope to the 'hopeless' and cheer them for the Hariraya.</div><div align="justify">.</div><div align="justify">.</div><div align="justify">SELAMAT HARI RAYA, MAAF ZAHIR BATIN untuk semua pembaca !</div><div align="justify"></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-66146709268459669502009-08-15T22:39:00.013+08:002009-08-17T17:49:13.040+08:00Immediate Breast Reconstruction - Is this the Solution ?<div align="justify">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. <em>Biar mati berkopek asal jangan</em> .....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. <em>Maklumlah tak comel dipandang mata. </em><br /><br /></div><br /><br /><div align="justify"><em>Tak boleh juga nak salahkan orang perempuan, yang jantan juga utamakan yang tu .... macam si tua ini.</em></div><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDCLlaI9YEPYasYAOA532ZBTgG5ipRKc6dYNIBzslvExwEZZ0Hh016zNz7ZL2RgBSjCBZjfTlzMww1iYbVsxdYzAQUHvzmZkhwYLIMHOzat8YBv0BxJvJTBna8HuCFKlXPHk-BQGiZxT4/s1600-h/gatal.jpg"><img id="BLOGGER_PHOTO_ID_5370207214354840498" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 197px; CURSOR: hand; HEIGHT: 209px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgDCLlaI9YEPYasYAOA532ZBTgG5ipRKc6dYNIBzslvExwEZZ0Hh016zNz7ZL2RgBSjCBZjfTlzMww1iYbVsxdYzAQUHvzmZkhwYLIMHOzat8YBv0BxJvJTBna8HuCFKlXPHk-BQGiZxT4/s320/gatal.jpg" border="0" /></a><br /><br /><div align="justify"></div><br /><div align="justify"></div><br /><div align="justify"></div><br /><div align="justify">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.</div><br /><div align="justify"><br />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. </div><br /><br /><br />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.<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfakFuZzJId3UmOQFOEKWy9jwWP3xloaHINYG-1cE2dsSv2QHq0-Tuc7bOpBObIcU_B-djmcCR59vc3fVxrlThLp26_lru-U2b8f-rn9N5vCy9GKPsKIneSHztnOX_LHu3nZyXU1agf9s/s1600-h/before.jpg"><img id="BLOGGER_PHOTO_ID_5370215270985918754" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 216px; CURSOR: hand; HEIGHT: 134px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgfakFuZzJId3UmOQFOEKWy9jwWP3xloaHINYG-1cE2dsSv2QHq0-Tuc7bOpBObIcU_B-djmcCR59vc3fVxrlThLp26_lru-U2b8f-rn9N5vCy9GKPsKIneSHztnOX_LHu3nZyXU1agf9s/s320/before.jpg" border="0" /></a><br /><br /><br /><br /><br /><br /><br /><br /><br /><div align="justify"></div><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTJetKO0UO3x75X4tzHHD6ZRiCaexz_zfb6MUKttz0nkXH2tC8DM38-zSDy5mek1AQZwdptqlgj3vdSO7harKC_njdXJq3aDakEjpli3DeiAXBmny9EdR1otf4CCIN38Jaf36kbTLGhsg/s1600-h/P1010016.JPG"><img id="BLOGGER_PHOTO_ID_5370215562287192770" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 220px; CURSOR: hand; HEIGHT: 146px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTJetKO0UO3x75X4tzHHD6ZRiCaexz_zfb6MUKttz0nkXH2tC8DM38-zSDy5mek1AQZwdptqlgj3vdSO7harKC_njdXJq3aDakEjpli3DeiAXBmny9EdR1otf4CCIN38Jaf36kbTLGhsg/s320/P1010016.JPG" border="0" /></a><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhw_gn0KAmImxZOEKJ22_6kCS-yOB7P-2jgN1BT7TPcfpr3wBB9u9rCjnw1jMWb-hd8_VqLveFn0rDRmMgC-41Wd4vXdpF2CggPU9vogCMDHaF4pCRL1UFHGxKAHWdsC6Fa4CyZRgEpUGI/s1600-h/before.jpg"></a><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><div align="justify">No, not for many Malaysian women that I have seen. That is why I have a collection of them - <em>gambar le !</em> They rather die a 'whole woman' rather than live an 'incomplete women'. </div><br /><br /><div align="justify">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 <em>dia terasa nak comel semula.</em><br /></div><br />Late reconstruction (the woman A) <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi47NfN5GohrvuXQYHu2eRf35vF72ZI-dTQRHOi9O_EzvNiFnxgWfbDlr4tX2xjgP8WEK7PnrqwG3cUHnFoKnmsCWKZX0yjFww3ENH5QhS2tHcBkcOhd4nuhS1jrU1eAQTvix0ynts-JKk/s1600-h/after.jpg"><img id="BLOGGER_PHOTO_ID_5370220154763678610" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 214px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi47NfN5GohrvuXQYHu2eRf35vF72ZI-dTQRHOi9O_EzvNiFnxgWfbDlr4tX2xjgP8WEK7PnrqwG3cUHnFoKnmsCWKZX0yjFww3ENH5QhS2tHcBkcOhd4nuhS1jrU1eAQTvix0ynts-JKk/s320/after.jpg" border="0" /></a><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />Immediate reconstruction :<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsKH3T2MXrp3zdFQfwxoBSEmCvVRgQ6TTE9L8jVE4MUeidi5aN0IX74F-tPbOlmmJVOpa-xZrOEY5VPfT5JxTwNvhyphenhyphenZ76F9293wxCkswHASJb31o0yBpQwdggWK-6c0HPnHwEtDkp3WWc/s1600-h/Picture2.jpg"><img id="BLOGGER_PHOTO_ID_5370222109419137938" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 214px; CURSOR: hand; HEIGHT: 320px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsKH3T2MXrp3zdFQfwxoBSEmCvVRgQ6TTE9L8jVE4MUeidi5aN0IX74F-tPbOlmmJVOpa-xZrOEY5VPfT5JxTwNvhyphenhyphenZ76F9293wxCkswHASJb31o0yBpQwdggWK-6c0HPnHwEtDkp3WWc/s320/Picture2.jpg" border="0" /></a><br /><br /><br /><br /><br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzTJSiGzNO8jzJ9CLzuySuiHyzNA65PSR20TQ46GqKG75tWvWS6MypmPaQ-Aipw7uA2ynkg3FrsrrI18RLqzEgNUg6y41Wllg_S4pKAtla5VVQdxAkBHMaev9uWStOzYzPsRPjaZ8UO5w/s1600-h/Picture3.jpg"><img id="BLOGGER_PHOTO_ID_5370220928265989170" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 320px; CURSOR: hand; HEIGHT: 214px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzTJSiGzNO8jzJ9CLzuySuiHyzNA65PSR20TQ46GqKG75tWvWS6MypmPaQ-Aipw7uA2ynkg3FrsrrI18RLqzEgNUg6y41Wllg_S4pKAtla5VVQdxAkBHMaev9uWStOzYzPsRPjaZ8UO5w/s320/Picture3.jpg" border="0" /></a><br /><br /><br /><br /><br /><div align="justify"><br /></div><p align="justify"><br /><br /><br /><br /><br /><br /><br /><br />The nipple can be reconstructed later upon request.<br /><em></em><br /><em></em><br /><em></em><br /><em></em><br /><em>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.<br /><br /></p></em><em></em>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0tag:blogger.com,1999:blog-3885423109759347033.post-70664730941246994522009-08-10T21:17:00.008+08:002009-08-11T09:53:21.840+08:00CANCER SURVIVOR - A DIFFERENT PERSPECTIVE<div align="justify">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.</div><div align="justify">.</div><div align="justify"></div><div align="justify">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.</div><div align="justify">.</div><div align="justify"></div><div align="justify">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 ! <em>Beliau bersyukur kerana Allah telah memanjangkan hayat beliau sehinggalah siapnya sekolah tahfiz beliau. Moga-moga Allah mengangkat beliau sebaris para syuhadaNya - Amin.</em></div><div align="justify">.</div><div align="justify"></div><div align="justify">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' <em>(saya rasa neraka). </em></div><div align="justify"><em>.</em></div><div align="justify"><em></em></div><div align="justify">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!'</div><div align="justify">.</div><div align="justify"></div><div align="justify">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.</div><div align="justify">.</div><div align="justify"></div><div align="justify">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. </div><div align="justify">.</div><div align="justify">.</div><div align="justify"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_OmSP7HBJv1zrIvKTZwTyfWXQIEiVMz7IE2MpXmaEnBPhr2PDtwCBUUMVDprxEsHLezmGeD4G41DM8onp05gu76qiFO5jblCVob42EUlWzDJG0mXBzMOx_aklv-8uSx3R3ADUxWqvzkM/s1600-h/KylieMinogue.jpg"><img id="BLOGGER_PHOTO_ID_5368324370105881266" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 166px; CURSOR: hand; HEIGHT: 123px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_OmSP7HBJv1zrIvKTZwTyfWXQIEiVMz7IE2MpXmaEnBPhr2PDtwCBUUMVDprxEsHLezmGeD4G41DM8onp05gu76qiFO5jblCVob42EUlWzDJG0mXBzMOx_aklv-8uSx3R3ADUxWqvzkM/s320/KylieMinogue.jpg" border="0" /></a>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.</div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">On the other hand; we have our '<em>equivalence</em>', an actress who hid her breast cancer till it fungated and smelly. Now begging for mercy; asking donations for her chemotherapy.</div><div align="justify"></div><div align="justify"></div><div align="justify"></div><div align="justify">.</div><div align="justify">God is Great; He gives to whoever strives for His Mercy. He helps those who help themselves !</div><div align="justify">.</div><div align="justify"></div><div align="justify">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. <em>Wallahu 'aklam</em></div>Dr. A Zahari Zakariahttp://www.blogger.com/profile/15519714556987924342noreply@blogger.com0