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.

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

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

But what if you have an ulcerating, foul-smelling breast cancer like this.

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

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This is exactly what this lady was expecting. So she came to me 5 days ago. She knew what she was having; CANCER. She hopped from one bomoh to another during the two years she had the lesion. When I saw her, she was anemic (pale) with Hb 5.0 gm%. The left breast busuk dan meloyakan, and bleeding noted from the edges. The underlying pectoralis muscle was involved. The axillary nodes were massive and fixed.

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Her request (or probably instruction) to me was simple : I want to celebrate the Hariraya, I don't want my friends and relatives to avoid me. . . . (with a please! at the end).

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So I offered her Toilet Mastectomy. Meaning removing the ulcerating cancer with palliative surgical intention. Surgeries for cancer can be either curative or palliative. In this case, it means to make her remaining days better without the foul-smelling and bleeding cancer. She agreed, so I transfused her with some blood and proceeded with the toilet mastectomy. (Toilet ini bukan jamban tapi maksud serupa; to ease and clean). Lucky that I managed to close the wound gap. Today she is going home, and beeming with smile on her face. Before I let her go, I explained to her the treatment that she should undergo after this Hariraya. That's include a chemotherapy, radiotherapy and even hormonal therapy. I even warned her that the cancer would come back in no time should she defaults treatment.

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With the smile on her face, I reallyI hope she understands what I mean and takes my advice seriously. With proper treatment this Hariraya Eidulfitri 1430 H shouldn't be her last. WalLahu 'aklam. As for me, this is one occasion that I am bersyukur that God has made me a surgeon; giving hope to the 'hopeless' and cheer them for the Hariraya.

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SELAMAT HARI RAYA, MAAF ZAHIR BATIN untuk semua pembaca !

Immediate Breast Reconstruction - Is this the Solution ?

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

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

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

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

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

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

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

Late reconstruction (the woman A)
















Immediate reconstruction :

The nipple can be reconstructed later upon request.




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

CANCER SURVIVOR - A DIFFERENT PERSPECTIVE

Last week, a 56 year old lady presented with lethargy and poor appetite. Her hemoglobin was 8.6 gm/dL and her Liver Function Test showed low albumin/protein. CT-scan of the abdomen revealed multiple liver metastases (cancers spread to the liver). She was a very 'strong' lady; despites her incurable cancer, she smiled and told me her story which I personally knew part of it.

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In July. 2007, she came to my clinic with a 1-cm lump in her left breast. Ultrasound and a mammogram done showed the lesion was most likely a cancer. I explained to her what a cancer means and adviced her to have a biopsy and the subsequent treatments including surgery. Unfortunately she disappeared after that. Apparently the lump rapidly increased in size till it started to ulcerate in Feb. 2008. On the coersion of her children, she agreed for a mastectomy which was done in a hospital in KL. Again she refused adjuvant treatments. Now, she comes with the cancer spreading to her liver and is killing her slowly..... yet she is smiling happily.

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Her story: In early 2007, she and her husband were planning to establish a 'tahfiz school'. Unfortunately he passed away leaving her with hundreds of thousand in 'infaq' or donated money. When she was told to have the breast cancer, she 'knew' that she would soon follow her husband. So she decided 'not to waste' whatever short time she had, for the cancer treatment. She started to work on the 'tahfiz' until it was completed and started to enrolled local girls. Now, the tahfiz school is running well. And she is now ready to join her husband ! Beliau bersyukur kerana Allah telah memanjangkan hayat beliau sehinggalah siapnya sekolah tahfiz beliau. Moga-moga Allah mengangkat beliau sebaris para syuhadaNya - Amin.

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In Malaysia, there are now many organisations either established by the government or the NGOs to help cancer patients and cancer survivors. Cancer survivor is a term used for a person who had cancer and survives the disease for five years or more. Unfortunately, I believe not many Malaysians know about these organisations. Hence, once a person is diagnosed of having a cancer, he or she feels hopeless. They turn to all sorts of people, conmen and some even end their life prematurely. When I was a Medical Officer in Penang (1986-7), Penang bridge was a favourite place for some of the desperate patients to find a shortcut to 'heaven' (saya rasa neraka).

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In Kota Bharu, there is a volunteer organisation called KAWAN which give supports and advices (and probably where you can buy a breast prosthesis - after mastectomy). I was invited to participate in one of their workshop once - where a man said to his wife (a nurse who had a mastectomy for left breast cancer) ' I love you with or without your breast!'

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As a muslim, I believe that God determines everything, and He says He does so with reasons. It is up to us to find the reasons. If we wants to be cured of a cancer, we find the reasons. And as a scientist, I believe a proper medical treatment is the reason. Off course, in the end He determines whether we are cured or not. It is His prerogative.

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When a patient comes to me with breast cancer, I always tell them about 'living examples'. And this is my favourite living example. Australian singer, Kylie Minogue.

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Diagnosed to have a 1 cm breast cancer many years ago. Underwent a local excision, followed by a course of radiotherapy and a regime on chemotherapy. Now cured and kicking well; back to her singing stages.

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On the other hand; we have our 'equivalence', an actress who hid her breast cancer till it fungated and smelly. Now begging for mercy; asking donations for her chemotherapy.

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

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As for the lady in my story; deep down in my heart, I believe if she had decided to receive a proper treatment when she came with a centimetre lesion, she might not only able seeing her tahfiz kicked off, but be with it till many years to come. Wallahu 'aklam

Tropical Fruit Season

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

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

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

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

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

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

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

This picture showed ripe rambai fruits. Each fruit contains three glistening, usually sweet and sour flesh with a seed in the middle. You don't need to chew them, just put in your mouth and swallow them.

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The lesson is: If you really like these fruits, eat them by all means. But please don't swallow the seeds. Otherwise someone has to stick his finger into your arse.

Tired and Betrayed

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

After much persuation and explanation including by her sister (whom I thought I've seen before)she reluctantly showed me this;

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The usual thing . . . . . . . . . . . . . . . . . . !

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Advanced ulcerating cancer of the right breast with chronic bleeding from the ulcers.

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If you observe the surrounding skin, there were multiple nodules. There are cancerous metastases called stellite nodules. The other breast were also involved, with peau d'orange (skin lymphatic infiltration)

She forewarned me not to do anything to the tumour as she was at present on treatment; homeophatic medicine and after this is going to another bomoh in Melaka. All she wanted was the treatment for the breathlessness.

The breathlessness was caused by severe anemia. So I transfused her with 4 unit of concentrated blood (packed cells). When she felt better, she insisted on going home. I asked her who was doing the dressing all the while, the answer; my sister. I turned to her sister; have we met before? Yes, I was a head-nurse in xxxxx department when you were in the university.

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Oh Tuhan, apa dah jadi ni? (O God, help me!)

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I put much efforts to make Malaysian ladies seeking proper treatment for their cancers, to avoid unnecessary deaths and morbidity. I gave lectures to nurses and women groups. Promoting breast-self-examination and mammogram screening. But now I have a senior nurse who I knew personally, yet is 'encouraging' her own sister to go to the bomoh. No wonder, there are bomoh bragging that doctors and nurses are among their patients. Once I had a patient (hernia surgery) who is a bomoh patah(he treats fractures) himself, he boasted that many doctors went to him for their fractures.

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Common chaps, if you don't believe in what you practice (modern medicine), then stop practising. Don' t misled others. Go out and do something else !

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As for the lady, she chooses to end her life in a miserable way with other people avoiding her due to the foul-smelling cancer on her body.

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As for me, I am tired and feel betrayed by my own colleagues . . . .