NEGERIKU DILANGGAR TODAK

Take a break . . . . .this is not about cancer !

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 (paru-paru bocor) and a chest tube was inserted. He was then transferred to me for further management.

In this era of digital technology, the culprit was easily captured; of course, on camera.

This is it . . . . .

IKAN TODAK

or

Needlefish or Swordfish or Garfish

or

Tylosurus Crocodilus

To the contrary of the famous Malay epic; Temasik Dilanggar Todak (heronya budak botak bernama Hang Nadim), ikan todak is usually not dangerous

Wrote Susan Scott in http://www.aloha.com/~lifeguards/needle.html

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.

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.

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.

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.

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.

In other parts of the Pacific, needlefish have punctured people in the chest, abdomen, arms, legs, head and neck.

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.

Although it's rare, swimmers and divers have been seriously injured by needlefish in Japan, New Zealand and the Red Sea.

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.

Millions of people, including me, have snorkeled near, dived around and paddled into schools of needlefish countless times without any trouble at all.

These lovely, interesting fish aren't out to get you and injuries are indeed rare.

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.

Jadi, sekiranya anda atau seseorang dilanggar todak, ia bukanlah satu serangan tapi satu kemalangan.

Sebaliknya

Jika sekiranya anda atau seseorang dilanggar kereta, ia bukanlah satu kemalangan tapi satu kecelakaan.

. . . . . fikir fikirkanlah !

LAGI-LAGI TUNGGU

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 (jubah). She just smiled broadly when her colleagues tegur; anak keberapa tu? knowing very well that she was not pregnant.

She came to the gynecologist. This is one of the CT-scan pictures: large ovarian cyst with features of cancer.

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.

And now she is waiting for her chemotherapy.

Kalaulah dia datang lebih awal . . . . .malangnya kalau, kalau, . . . . . . . . . . . .kalau !

Mungkin ini dah jadi budaya kita?

seperti yang terjadi padaku siang tadi;

bersesak-sesak bayar saman lalulintas tertunggak

di saat-saat akhir.

Kelate oh Kelate ku ......

Dalam seminggu dua ni kita dikejutkankan dengan beberapa berita kematian. Mula dengan kematian seorang bekas pemain bolasepak, kemudian seorang VIP.

Yang berbezanya;

Seorang lelaki, seorang perempuan,

Seorang akibat kanser tekak (nasopharynx -NPC), seorang kanser payu-makdara

Persamaannya;

Dua-duanya bukan 'oghe kapung duduk dale rok'

Tapi 'anak Kelate hok ado namo'

Malangnya dalam kedua-dua kes ini, perubatan moden dianaktirikan, tok bomoh diutamakan

Bahkan dalam yang satu tu, sampai ke akhir hayatnya santau disalahkan

Inilah bahana yang melanda anak negeriku..

Kanser ni gapo ?

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.

Kita ada macam-macam kemudahan, tapi kita tak caro nak guno.

Mungkin kita boleh reka slogan baru :

1 Kelantan, kanser diberitahu, Tok Bomoh didahulukan

GAYA HIDUP SIHAT

Betul jugak ....... inilah ironinya kehidupan !

Penangan TOK BOMOH

A 64 year old lady presented to the hospital with severe abdominal pain and high fever after balik berurut with a bomoh. She has been visiting this bomoh 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.

When I saw her, she was in severe pain with signs of septicemia. There was a huge abscess (bisul yang nak pecah) in the abdomen with an underlying tumour.

CT-scan done showed a large sigmoid colon cancer with an overlying abscess cavity filled with pus and gas (or fecal matter)

abscess cavity

the colon cancer

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.

.

.

Apa yang telah berlaku ?

Basically she has a neglected / untreated colonic cancer, now it has perforated through the abdominal wall (kena uli tok bomoh sampai pecah) . Soon, it would be coming out through the skin (itu pun if she survives the septicemia).

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.

This is it ........ CANCER and Kelantanese don't click !

I hope this is not the end of my struggle. I believe there are many more non-Kelantanese that would benefit from my writings.

KANSER BUAH PINGGANG

A 40 year old man came with 'letih-letih' 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.

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) - kanser buah pinggang.

He was told of the diagnosis, treatment and the prognosis with and without treatment.

Prognosis tu maksudnya apa akan jadi dengannya selepas ini termasuk mati.

He was offered surgery; as the cancer is still resectable and most probably curable.
And the expected happened; the Kelantanese syndrome. He disappeared, I hope temporarily.

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.

This is the picture of his cancer.

The cancer was well-encapsulated, the capsule wasn't breached by the cancer. No chemotherapy was given.

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.

She waited for three months before agreeing to the surgery.

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 (kanser merebak ke otak dan tulang) and died soon after.

Kadang-kadang, saya tak faham dengan orang kita. Bila doktor kata kanser, dia mungkin dengar risa; buang tak apa, tak buang pun tak apa.

In Kelantan, risa (pronounced reeso) is a benign tumour of the skin or subcutaneous structures; it could be a lipoma, sebaceous cyst, ganglion, etc.

SUDAH MUNTAH TAHI BARU NAK KOREK LUBANG..

Pepatah Melayu :

Sudah terantuk baru tengadah
Hendak terberak baru nak gali lubang.

Inilah yang jadi kalau susah sangat nak faham

A 59 year old man, had fecal incontinence (tak boleh kontrol berak) two years ago. He went to a private hospital, told to have cancer of the rectum (usus besar dekat dubur) and adviced surgery. Refused, went to HUSM and told the same thing. Tak puas hati, went to Kota Bharu Hospital (HRPZII). Tak mahu faham juga.

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.

Sebabkan tak mahukan colostomy, langsung tak mahu rawatan. Obviously, Tok Bomoh kata kolostomi tak perlu.

Two years sengsara pakai diapers. Now the cancer has totally oblitrated the rectum causing intestinal obstruction. Apa lagi, perut jadi kembung, tak boleh berak. Makanan masuk ikut mulut, tahi pun keluar ikut jalan yang sama.

Gambar X-ray usus besar kembung tiga kali ganda

Terpaksalah buat emergency operation. Sekarang bukannya nak buang kanser yang telah merebak (inoperable), tapi nak selamatkan nyawa, supaya boleh makan.

Grossly distended large intestine.

Akhirnya kena buat juga kolostomi juga. Now dah selamat; dah boleh makan dan berak melalui kolostomi.

.

Tapi kansernya tetap di situ.

.

AlhamdulilLah sekarang baru nak kemoterapi dan radioterapi. Tapi apakan daya !!!

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Inilah cerita 'oghe kelate' ku.......