KITA MINUM DULU ....

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Allahyarham Shukery Hashim, 55 tahun, menghembuskan nafas terakhir jam 1.45 petang 10/06/2009.

(ataupun ada yang menyangka bahawa beliau masih hidup, kerana melihat drama lakonan beliau yang masih baru di kaca TV hampir setiap minggu?)

Beliau meninggal dunia 3 bulan setelah disahkan mengidap kanser pankreas.

Kanser pankreas biasanya dikesan lewat, dan pengidapnya mengalami sakit perut yang teruk (body & tail of pancreas) atau jaundis (head of pancreas). Prognosis biasanya teruk, maksudnya jangka hayat pesakit adalah pendek. My longest surviving patient after surgery (Whipple's operation) lasted only two years. Yang lainnya hidup 6 bulan ke setahun. Tanpa pembedahan, none lasted more than 6 months.

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Picture: Advanced cancer pancreas with intra-peritoneal disseminations (carcinomatosis peritoneii)

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

Kajian terbaru tentang kanser ini amat mengejutkan saya:

Soft Drink Consumption Linked to Pancreatic Cancer. February 2010: Cancer Epidemiology, Biomarkers & Prevention. Kajian selama 14 tahun ini dijalankan di Singapore dikalangan penduduknya yang berbangsa China (Singapore Chinese Health Study (n = 60,524). Mereka mendapati 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. Satu serving soft drink adalah satu tin kecil yang biasa kita beli dengan harga RM1.50

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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 yang dibenarkan. Pernahkah kita bertanya: siapa yang benarkan?)

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Oleh itu berhati-hatilah.

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"Mamak, air kosong satu" - adalah satu pilihan bijak, and no longer an indication of poor financial planning !

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Tepuk dada, tanya selera !!

Nak Fikir Dulu Doktor, Nanti Saya Telefon Kalau jadi....

09/02/2009

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.

Nak fikir dulu doktor, nanti saya telefon kalau jadi.......

26/06/2009

Came with a much larger lump, this time with her newly-wed husband, kami baru kahwin 40 hari. 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.

OKlah doktor, buang butir saja, kalau pun kanser, kami tak mahu buang semua (mastectomy) . kami kan baru kahwin....

Excision done and the histology report came back as expected - CANCER - infiltrating ductal carcinoma. Gikgu... you need a proper cancer treatment!

Nak fikir dulu doktor, nanti saya telefon kalau jadi.......

September - December 2009: contacted patient several times. Please, you need proper treatment. Each time, the answer was :

Nak fikir dulu doktor, nanti saya telefon kalau jadi......

(09/02/2010)
Today she came without an earlier appointment, AlhamdulilLah terbuka hatinya untuk mendapat rawatan!

Saya datang ni nak minta surat pengesahan doktor yang saya ada kanser untuk saya diberi pengecualian dari menghadiri kursus!

Can I see you first? Now the cancer has come back; 6X6 cm with skin and axillary nodal involvement.

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Memang saya nakkan rawatan, tapi ginilah doktor:

Nak fikir dulu doktor, nanti saya telefon kalau jadi........

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Inilah my well-educated patient; Nak fikir dulu, nanti saya telefon kalau jadi.........

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.

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Probably, in the future if someone says ;

Nak fikir dulu doktor, nanti saya telefon kalau jadi,

I would say;

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Ikut mu lah.....

Breast Cancer in NST

http://www.nst.com.my/Current_News/NST/articles/19afn/Article/index_html



Breast Cancer: Many come when it is too late

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.

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)

Moga-moga tahun 2010 ini memberi perubahan yang positif bagi wanita Kelantan !

I lost a patient with umbilical hernia

Umbilical hernia is hardly a fatal disease. In most cases, umbilical hernia is a congenital condition. To Kelantanese, it is known as pusat bujil or uluran; and is usually seen in neonates and premature babies. Strap a 50 cent coin there or apply a 'barut perut' - 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.

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This is how an umbilcal hernia looks like:

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 (lemak dari dalam perut).

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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. Sakitlah jadinya ! Reducible hernia is usually painless. On top of that, when the intestine gets blocked; perut jadi buncit, tak boleh makan dan muntah-muntah. 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 (mapuh le tu!).

This is a picture of a gangrenous bowel loop in a stranguled hernia:

For many Malaysians (biasalah, selagi tak sakit, selagi itu tak buat apa-apa) 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.

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.

This is how her tummy looked like. This picture was taken after I had painted the abdomen with iodine solution to sterilise it for the surgery (before draping).

Once I opened the abdomen, I noted the bowel was gangrenous and feaces (tahi) 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 tahi and at the same time try not to breath in too much air through my surgical mask.

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.

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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 "apa nak buat, kami dah puas pujuk, suruh dia buat operation lama dulu, tapi dia yang degil"

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Inilah orang kita, selagi tak nampak bayangan malaikat maut, tak mahu berubat.

Nak tidur baru nak cari bantal, nak berak baru nak korek lubang !!

Start blogging again ....... The usual Kelantanese stuff !

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.

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.

"Picture DELETED"

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.

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.

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 : "ada orang kata kita boleh mati ketika buat operation". 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. Tak faham juga. So I told him; 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.

"Doktor, you bagi I darah cukuplah, I tak mau dengar itu semua" 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.

"Masuk darah pun kena sain ke?" I told him: The chance of you dying from the blood transfusion is higher than that of dying from a hemorrhoidectomy surgery.

Itulah orang kita......to be exact....oghe kelate kito !

1 Malaysia

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

This morning, while doing my round in the ward, my phone rang. A patient who has recently been discharged from the hospital called to enquire about his wound (he had an abdominal surgery few days ago; bowel perforation from a motorvehicle accident). He is an ethnic Chinese asking about 'begho' around his wound, in Bahasa Melayu of Kelantanese dialect. Not understanding what 'begho' means, I asked the patient in front of me, who is an ethnic Siamese. (maksudnya; orang Cina cakap Melayu kepada orang Melayu, Melayu tak faham, tanya orang Siam, orang Siam explain istilah Melayu kepada orang Melayu.....baru kawe faham). 'Begho' tu lebam-lebam le doktor!.

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Point-nya : In Kelantan, 1Malaysia is not a 'propaganda', it is 'darahdaging' !!!

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Anyway, I am not a pure Kelantanese, only S.K.M.K - Sudah Kahwin Mek Kelate !

(Sorry for 'out of the topic' writing - just to start blogging again after the long raya holiday).

Seronoknya Beraya Di Kampung

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

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

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

Apa nak jadi ayahwang?

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

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

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



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

SELAMAT HARI RAYA MAAF ZAHIR BATIN.