Thursday, December 8, 2016

UMRAH.......reminiscence of 'old time' and our time for renewal




Labbaik Allah humma labbaik
Labbaik la sharika laka labbaik
Innal hamda
Wan-ni'mata
Laka walmulk
Laa sharika lah.

O my Lord, here I am at Your service, here I am.
There is no partner with You,
here I am.
Truly the praise
and the provisions are Yours,
and so is the dominion and sovereignty.

There is no partner with You.




nadzru, johan, nina , shasha and yazman,


children,

we are coming to the penultimate week before our umrah.
i hope you guys are polishing up yourselves spiritually so that you would not just end up as  'tourists'.
we want to be 'travelers' not tourist....'travelers on the path to allah'
the late ustaz dr harun din once told papa in the eighties before haj and umrah that, 'haj and umrah are essentially a rehearsal of death'.
he was echoing the fact that in a haj mabrur a traveler 'dies to the duniya and lives for the akhirat' after that.

the good shaykh, shaykh ninowy here talks of attachment and detachment. 
papa could remember some years back, being an 'old kaki' at umrah and haj, when doing tawaf and papa could feel like acres of space, while some years, when papa was 'sergabuk' and unfocussed, it felt so crowded.
iman , like everything else , waxes and wane, even in the best of circumstances and place, for all of us mere mortals! 

life is a mind game.
the relative 'success' or 'failure' in life is determined largely by the paradigm or shift of paradigm that each individual make up there in his cerebral cortex.
and your 'cerebral cortex' is just a servant of  your 'heart'
the 'heart' of a believer is malleable.
it is 'moldable', but require a lot of serious work.

it is our choice, to be ok or not ok, to be a good abdal of allah or to be 'always in a state of 'irrational' anger with HIM throughout life.
there are so many example for you guys to see around, people perpetually 'angry with allah'

if you can achieve that detachment, alhamdullillah, if not continue to work on it.
it will come to you, insyaallah.
it is 'dowable' insyaallah.
and  in papa's estimation, 'umrah' is a 'great  open university' for such game plan to change towards the better.
an expensive one no doubt but you guys are fairly lucky lot since papa is very much an addict to this 'open university'!

but this is not free guys!
you guys have to some work on your own.
in the equestrian parlance, one can bring the horse to the water but one cannot force it to drink!


to achieve this end it is important in this last week to brush up on the following :

1 . prayers ie sunnat prayers around the compulsory prayers.

2.  solatul jenazah
there is jenazah prayer all the time in the haram and masjid nabi

3. solatul tasbeeh



this is papa's favourite prayer. some months ago  papa used to do it daily and in ramadan almost twice a day. 
now at least twice a week. children, iman and fervour waxes and wane. your dad is no exception.
' why solatul tasbeeh, i heard the hadith is dhaif? ', you asked.

' sons!, forget about dhaif, hasan or soheeh! you are not there 1470 years ago ! if imam al ghazali [circa 300 to 325 year, post nabi ] or al qushairi [ circa 350, post nabi ] did it, i dont care that  muhammad ibnu abdul wahab [ circa 1102 to 1192, post nabi ] did not think ibnu abbas' tradition is strong. 

just do it. 

papa's point is this: if you are al ghazali or imam qushairy, your tok gurus were at least tabi-tabi'in or at worst, tabi-tabi-tabi'in. hadiths and memories , especially in the arabian context, were still fresh. if the 'salafis' now whose substantive tok gurus was at least 11 centuries after nabi, what basis of claim can they make that their version, and only their versions are correct , the rest are maudhu' or suspect.

in solatul tasbeeh, papa agree with the minority view . 
children!,do it  daily in the haram for size.

and when you are safely back home in KL , go do tasbeeh daily for 6 months. 
then come back tell me whether you think it is dhaif,  soheeh, hasan or maudhu'. !
we can discuss further.

chances are, you will  find solatul tasbeeh bringing in  so much solace and pleasure to you, that you would feel embarassed to discuss dhaif, hasan or soheeh anymore!
those who feel happy going  thru life wearing blinkers, go ahead.
we have no querrel with these 'blinkered'  guys!

' is'nt it  time for those who believe in the zikr of allah to taste the sweetness of iman? '

'experiential islam ' is more important than a load of hadiths and theory.
the hadith is not dhaif, the iman is dhaif.

4.night prayer [ tahajjud ]
in the haram, one don't sleep my sons!
https://www.youtube.com/watch?v=CDyF_JaiFKw [ mufti menk short take on night prayer ]


5.sembahyang israk and dhuha

6. zikr

any of those 30 or so zikr,  or more.
these are papa's favourites.
they are short and the ma'ana are quite obvious and easy.
we are not 'schooled' in the ugama, so just try do what we know best.

7. and please polish up on the rudiments  and doa involved in an 'umrah'.
if you guys find the doa during tawaf and saei too tedious, do a thousand 'kul huwalah' instead.
some 15 years back, papa did the big tawaf, around the kaabah, early morning after sahur and the crowd was too big! the big circle on haram's 1st floor is around 1.2 km or so and that equates to 750 kul huwallah each round!

in the haram, children, do your things.
on that day papa thought papa did very well well until papa met a young somalian teacher, and mashaallah the conversation went on like this:

'assala mualaikum young brother , where are you from'
'somalia...', said he, he carried one sling bag, and later i found out that was his only luggage.
'where are you staying in makkah?'
' i eat, sleep in the haram....i wash and have bath in the public rest room outside sir'
...and papa had a five star hotel room to go back to after the ordeal of the sunat tawaf!!!!


7. solawat to the nabi.
the little time we spend in madinah, try to be in continous solawat to the nabi [ pbuh ].
visit his grave every prayer if you can, otherwise everyday.
read his seerah before our journey to know him better.
martin ling's seerah of the nabi [ pbuh ] in papa's estimation is one of the best.
it is collecting dust on papa's bookshelf for over 40 years!
none of you read it, so occupied you guys with whathapp, misshaps etc etc and etc!
t o love THE BELOVED you must 1st love HIS prophet numero uno.
https://www.youtube.com/watch?v=kw7u6_DZyAI


at the end of the day guys, ' what is  the heck papa, are these all about!!?? ', you may ask.

it is all about getting closer to HIM.
when HE is your friend, the rest of the world can go and fly kites.

that young somalian teacher had very little.
but papa thought his haj and umrah was 'more mabrur' than papa's.
on the day when nothing else matter, that is the difference between the night and the day.

i am not asking you to be an average worker or citizen.
for from that.
if you are just a bandaraya worker, be the best , honest bandaraya worker.
if you are a shopkeeper in downtown pj, be the best and honest one.
does not matter you earn million rm or just a mussel here, and a mussel there.
if you are a govt doctor in shah alam, be the best medical officer.

likewise, if you are ceo of malaysia incorporated, please, please, don't be like that shameless numbskull, that clown , that badut, now sleeping and shitting in putrajaya, totally oblivious of what the whole wide world thought of him!

islam is about good intention [ niya'], good thoughts, good deeds and above all good character. islam is about excellence.
certainly it is  not about this kind of utter nonsense!
..... and being quiet on this tantamount to 'subahat'.

where are all the shakers and movers of society!!!??
are  we justa nation of 'cari makan' with no 'core' values?
no maruah and no accountability?

papa.




Friday, November 25, 2016

...All Of Us Can Fly.......



friends, dato and tansri,

we are all fellow travelers on this planet earth.
this short sojourn in this duniya is just like a transient stop under a tree before our forward journey
our next stop is alam barzark.
a relatively very short stop compared to the next
it is just a 'small' station.

the final stop is beyond the atlantic, beyond the pacific.
it is back to our paradisal origin...the alam akhirat.
alam akhirah, just after the sirat, bifurcates into two....al jannah and al jaheem.
there is no return ticket
there is no side station
al jannah and al jaheem are for eternity.

[ oops! correction: there is a small sub station, on a plateau called al a'raf  where those with 'equal weightage on the 'al mizan' get assessed and reassessed for a couple of hundred thousand earth years , allahualam, before their on-toward final respective destination ]

here, we have a 'potpourri' of related lectures, old and current, by shaykh ninowy of duluth, usa, to invigorate us into the journey.
i count shaykh ninowy as one of my tok guru

we start in a rather inverted way, we start with the 'top end', three khutbah on the 'awliyas'.
their 'karamah etc and etc
then we go back to the nitty gritty of cleansing the 'heart', the tazkiah an naf tazkiah al qulub ,the real hard work......

shaykh abdal qadir isa, [ circa 1920-1991 ], a syrian mujaddid  and doyen of ilm tasawuf from aleppo, ,  in his magnum opus, ' haqa' iq an at-tashawwuf ', realities of sufism, opined , that the journey starts with taubatan nasuha as the first station.

the next station is muhasabah, or introspection.
the third and the fourth stations, khauf [ fear ] and raja' [ hope ], come together.
the  careful traveler goes through life till death with both fear and hope.

then the subsequent stations, shidiq, ikhlas, sabr, wara', zuhud, ridha, tawakal, and shukr..........

the fruit of all these is closeness to allah, mahabbatullah

in a tradition from umar al khatab known as hadith al jibril, ' worship allah as if you are seeing HIM and if you can't , be assured that HE is seeing you! '.

all of us want to be people of ihsan.
all of us can fly.
we just need to re-orientate our paradigm.
we  just have to re-calibrate our hearts and minds in congruence with the qur'an and sunnah






   awliya allah 1

    awliya allah 2

    awliya allah 3




   on shukr




   on piety



    tazkiah , 4th nov.





    ibnu athaillah al iskandari's hikam, part 1
https://www.youtube.com/watch?v=VGPLC0MUNQw

[ starts after 26.05 ]





    ibnu athaillah al iskandari's hikam, part 2
https://www.youtube.com/watch?v=IIg7A0nxSl0




    on zikr






  on detachment & attachment
https://www.youtube.com/watch?v=nK8UeZBU32s
[ a lot of us live in a spiritual winter ]





   on death, dying and the living dead...





   from rituals to spiritual





.....and now, dato and tansri, are we ready to re-testify?
https://www.youtube.com/watch?v=E9ewZ6uk_98











Thursday, October 13, 2016

Shaykh Ninowy......an interview






friends, dato and tansri,

for muslims around the globe now, especially in muslim minority countries, holding on to their 'ugama' is like  clenching  'a burning coal ' in the palm of a believer.

muslims are despised everywhere they go.
minimum, we are looked with suspicion and in some place with derision.
masjid and surau got burned; having a qur'an in some airport may end up with you missing or being ejected from a flight etc an etc.

yet, there was a time less than a century ago when even the news of a muslim woman getting raped in belgrade would have launched massive troops movement at the austrian-bosnian border.

now we are 1.6 billions and growing.
but we are like 'foams being pushed around by the ocean'.

what ails us? 

listen to one of my  current tok gurus and shaykh , shyakh ninowy, for a possible answer and solution to this current ennuie and malaise affecting the ummah

Sunday, September 25, 2016

Shaykh Mukhtar al Marghroui.... 'from spiritual vacuum to al hamdulillah...'



friends, dato and tansri,

i count shyakh mukhtar al marghroui as one of my virtual tok guru, along with shaykh muhammad ninowy of atlanta; shaykh al yacoubi formerly of damascus, syria: the late tok guru nik aziz of pulai melaka, kota bharu; the late prof hamka of indonesia; shaykh hamza yusuf of california usa; and tj winter aka abdal hakim murad of cambridge.

our common denominator was of course abu hamid al ghazali of tus.
abu hamid al ghazali's tok gurus dated back  finally to rasullallah, sayyidina muhamad ibnu abdullah [pbuh] of makkah/madinah.

that is the nature of ilm in 'traditional islam'. from one tok guru to another to another , to another and to another, and finally to the murid. 
in the twentieth century, the subsequent anak murid could read from books or via the electronic media....this later day 'innovation' cannot replace 'one to one' teaching, but at least it is better than 'nothing'.

one cannot claim, as many  young punks are doing now: ' i subscribe to the salaf of the nabi ' and the sunnah' and only my tok guru has the monopoly of knowledge!'....

one  young upstart mufti from wang kelian, up north, has also joined this 'band wagon'  of thinking, unfortunately.

when one's claim to such fame is that one's tok guru is 8th century or 11 century after the nabi, and only they are the significant 'reformists of the ugama!
only these two have the monopoly of true hadithic knowledge.
the rest of the scholars and ulama' can go and fly kites!

this is bloody nonsense and bullshit!.

'shafei, ahmad hambal and imama malik can go and fly kites because they oftentimes did not follow muslim or bukhari to the T!' , they opined. unfortuntely revealing their utter ignorance about transfer of knowledge and wisdom in our 'ugama'.

these clowns, these intellectual midgets, [ and that is how i feel about some of them, young punks going around rubbishing centuries of scholarship and age-old traditions ],in their haste , forgot that these ulama par excellence predate both bukhari and muslim, some by at least a half century!


this is  bloody nonsense by people who should know better.......

ok i have said my piece, let us now get down to business.

here, marghroui, a double phd in physics and electronic engineering and originally from algeria, discusses on the need to fill that spiritual vacuum in our souls.
he wraps up with the sublime meaning and intoxication of tasbih, tahmid and tahlil.

enjoy him.




[   http://almadinainstitute.org/teachers/mokhtar-maghraoui/   ]






Monday, September 19, 2016

islam but no muslim......[ a preamble to surah al ahzab ]







friends, dato ansd tansri,

al junayd al baghdadi, al sultan al awliya, [ circa 835- 910 ce ], was reputed to have  been asked by one of his disciples,
'sir, how do you reach the level you are now?'
"by staying under that staircase  over there, for over 30 years"

so much for the symbolism of the 'staircase', signifying humility; self reflection and introspection; stoicism; muraqaba; zuhudness; sabr in zikrullah and remembrance and plain hard work , work and work.

in zen buddhism, in old japan, they also have such things.....between the exquisitely divine beautiful ginkakuji temple and chion-in temple in downtown kyoto there is a beautiful path along a small river that weave and meander. they name this 3 km path,the philosophers path.

i could imagine the monks and enthusiast walking this path between two temples, slowly, slowly giving them time to introspect and reflect on the mysteries of life and the universe, centuries back.

as soon as i arrived back at my airbnb bivouac near kinkakuji temple in the higashiyama mountain, i asked my host  koji as to what makes a japanese tick,

'koji, the whole world never failed to be amazed by you guys....i mean you guys can still queue in the face of calamities as happened during the tsunami nuclear meltdown in fukushima. elsewhere even in america, and especially in america, a one night total blackout would cause riot and pandemonium..'

koji did not understand what i was drawing at and i don't blame him. apart from running three jobs at the same time, a conceirge by morning, a fairly successful airbnb business in between recess and an avid gardener, in his free evening

the complex interplay of centuries of warring shoganates; geographical isolation from original source china; the stoicism of having to face the world during world war two and the subsequent demoralizing defeat; and in the background all the time with shintoism and zen buddhism rubbing on the psyche and humanity of the japanese collective souls....this cauldron of heat and fire that mould a nation's philosophical psyche were too complicated for koji to comprehend.

i put it to him in simpler term,
'what is it koji, shintoism, taoism or zen buddhism that drive the japanese people?'

' no sir, almost 100 % of japanese do not subscribe to any religion. only when we die we get buried under shinto or taiost culture and ways...'

alas, now japan has islam but no muslims, and  a great  number of us, majority muslim countries, have got so-called muslims but no islam.

we do not have to go very far.......just visit putrajaya's sri perdana!
the mother of all evil....gross chronic cronyism, out of the world nepotism; unbridled corruption ; shameless avarice and irreligiosity.
there is no more words or adjective to describe this irreverence to such traditional values held in high esteem both in the muslim world as well as the malay world!  

elsewhere the scholars and brilliant; the shakers and the movers of society sleep well.
this resounding silence from these 'zombies', these living dead, is deafening!
shame on you guys.
what  have we done or not done  to deserve this monumental 'bala', i wonder?
and i can assure you we have not reach the trough yet, mind you.
worse is to come.


'apadah jadi'......reminded me of the croner, the late sm salim

let us once again drown our collective sorrow in the opening gambit of surah al ahzab.
we come to the business part of the qur'an, since surah al ahzab is a madani surah, dealing with the limits and hudud of living..
the early ayat in this important surah discuss the nitty gritty issues of adoption, inheritance etc and etc.

enjoy mufti waseem khan.
i like him for his clarity and preciseness.

dr nik
mountain retreat 2,
higashiyama mountains,
eastern kyoto,


https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=ginkakuji%20temple%20photos


https://www.jtbgenesis.com/pic/tour/141231tenryuji.jpg


...............................................................




From: Azmi Wa Sent: Tuesday, September 20, 2016 5:59 PM
To: Nik Isahak Wan Abdullah
Cc: jublintan65@yahoogrou
Subject: Re: pariah status......


nikhowk,  the only way to live with the reality of external and internal perception, is to reject the conscious and subconscious sense of a relationship to a leadership family/clique/gang/party that you feel only embarassment/humiliation/abhorrence for. push away the subliminal notion that as citizens you have to feel responsible or accountable for those that you find governing you. if they do not subject themselves to some level of accountability to us for the things they do, why should you and i feel a need to feel answerable for the unspeakable things they do? when they appear on the tv screen, change channel; when they pass by you, turn the other way, when they make a speech, get up and leave the hall for the toilet. nothing much you can do, but these little tyrants hate been ignored. eventually, being given the silent censure may just make them disappear up their own arseholes, like pink panther and his vacuum cleaner. 

as things stand, it is still legal to do this. it is satyagraha lite, but appropriate for we malays and malaysians are the meekest of God's creatures! peace, my friend!


.........................................




Nik Isahak Wan Abdullah

|
Today, 7:50 PM

Azmi Wan Hamzah (azmiwah@terangbulang.com;

jublintan65@yahoogroup+15 more
You replied on 9/20/2016 10:10 PM.
brilliant answer ts, plausibly brilliant.
just only plausibly.

but i put  it to you that if we, right from the outset, make millions of 'animal noise' on our own, in our own ways special ways, accordingly to our god given talent,collectively, on the street, in the cyberwave, in papers in the airwaves etc etc etc....i dare say these 'animals' that is  'tak ada hati perut dan tak ada malu dan segan', will disappear faster.

instead we have insipid journalists, insipid ulama and complete silence from senior corporate citizens, senior government servants, g25, academicians, and others etc  and etc.
our parliementarians, government and opposition are mostly a bunch of brain dead people warming their benches
[  http://drnikisahak.blogspot.my/2011/07/bersihbersihbersihbersihbersihbersihber_11.html  ]
this seem to be a special malaysian malady....'cari makan', most important than everything else.

but as windstedt observed some 100 years back we malays are truly feudal to the core and probably the meekest animals to walk the earth!
that is our bala.
just look at the pathetic malay hero of old ....hang tuah

we, collectively cannot separate the trees from the forest.
we cannot think straight.
we all are a whole load of 'cari makan ' people.
we are just bloody pathetic...all of us.
i am sorry if by saying so i have  pricked your collective conscience.
frankly, we all have not done enough to get better governance.

what need to be said , need to be said.
i am sorry.

dr nik howk




Thursday, September 8, 2016

spiritual discourse in cyberspace....on ' a soft heart ' and ' God's gst '





mufti waseem khan of trinidad/tobago wraps up surah as sajdah in this slot.

the ending of surah as sajdah reminded me of a question posed by a dato recently:

" doc nik, if islam is truly god's revealed religion, why are the muslims downtrodden and at the bottom of the league table, everywhere around the world?"
he is 75, highly schooled....a self confessed secular humanist
his question sounds cheeky  and naughty, for someone who professed to be secular and muslim at the same time.

[ i do not know whether in god's book it is acceptable to be such 'animal', but that would entail writing a book, perhaps the likes of prof tariq ramadan would, in future....rather than waste his time trying to reinterpret the qur'an. he neither have the zuhudness nor the humility and wisdom to embark on this project, with due respect and my apology. ]

i walk away, allowing his question, unanswered.
very sensitive question, especially in the context of malaysia now.
we have a whole cabinet here, mostly so-called muslims, suppporting a chap who, the whole world said, rightly or wrongly,  had 'songlap' billions from the state coffers.
if i answer the dato's question, in the local context, it would mean rubbishing the ugama of the whole cabinet, and even the ulama' and scholars, who stay back in the background 'macam 'lembu lembu kenyang'.

dr nik

......................................................................................



From: Dato Rahim Kamil Sulaiman <rahimkamil@
Sent: Wednesday, September 7, 2016 6:14 AM
To: Nik Isahak Wan Abdullah
Subject: Re: let us get back to basic....surah as sajdah; epilogue



That's the answer, Doc Nik!

Sent from my iPhone

............................................................................




On 7 Sep 2016 7:45 a.m., "Nik Isahak Wan Abdullah" <drnikisahak@hotmail.com> wrote:

   dato Rahim,

the fact i am still walking free is phenomenal.
these ..stards, dato , lack ugama!
    they think they have ugama 

cabinet, scholars and all.
tansri abu jahals and d ato seri abu lahabs abound
all 'cari makan'

   their hearts are hardened
   only allah can sodten their hearts! 
   in equestrian linggo, one can bring a horse to water, but one cannot force it ti drink...

  dr nik 
[   https://www.youtube.com/watch?v=GWuPdcaZJuA  ]
shaykh mukctar ash shinqitii on 'softening the hearts'












Saturday, September 3, 2016

Progress in Endoluminal Treatment of Coronary Artery Blockages.....from balloon to disappearing magnesium stents...40 years of progress in cardiology



Dr Andreas Grunzig, a German physician-radiologist, in 1974 performed the first ground breaking balloon angioplasty in an awake human patient, in a Zurich hospital. In Germany, then, he would have lost his medical practising license due to great inertia from fellow colleagues  and seniors who thought this kind of procedure was only for experimentation in pigs and cattle.
[  https://www.youtube.com/watch?v=v5FFTZTvTiQ  ]


I was a cardiological research registrar in the cardiology department at St Bartholomews Hospital in central/east  London, the business and high finance side of London, way back in 1981. 

Even at that time, some 7 years after Grunzig's ground breaking case,my bosses at St Barts were 'tip-toeing' like pirates operating under duress,, doing their cases under the watchful  and prying eyes of the 'demigods' at the hospital: the all powerful cardiothoracic surgeons. The surgeons insisted that we get ready all our patients for potential emergency surgery, if situation arise. 

Way back in London in 1981, it would mean taking patients' consent for both balloon angioplasty and emergency CABG [ coronary artery bypass graft op ], a medicolegal requirement.....and getting ready five pints of grouped cross-matched blood ready for 'possible open heart surgery if plan A failed'!
.....and having all patients thoroughly shaved from the neck below, as if they are going for open heart surgery!


'These bastards are cavalier and crazy!', must be the silent common swear words from the surgeons at Barts in those dizzying days of the early eighties!

I was not involved in the actual 'crime'  scene at that since I was only a research registrar , a gurkha actually, attach to another branch of cardiology, probing electrodes in the hearts, investigating patients with 'electrical' and rhythm problem. My direct boss, Prof John Camm,  was , and still is in 2016 , one of the biggest names in Cardiac Electrophysiology, another growing point in cardiology.


Then, by 1986, along with the balloon, came the metallic stent, to give better result and less 'restenosis' [ re-narrowing ], from 40 % to something around 20 % and afforded the cardiologist to be more work perfect at opening arteries and more adventurous. Before the advent of 'stent', in the early days of just plain balloon angioplasty, the 1st 24 hours post procedure used to be stressful period for the interventionists as 'opened up arteries' are known to collapse and close back acutely. In lay man's term, the stent is like a scaffolding, holding back the arterial wall from closure, while it has time for self repair.
[   https://www.youtube.com/watch?v=cdSf5GOyJdw   ]

With the advent of STENTS, interventionist cardiologists get braver and much much safer.
Surgical pre-consent  and surgical coverage became a thing of the past.


Technique-wise the early stents were inundated still by high 're-stenosis' rate.
The expanded lesions after stenting has it's natural 'repair' process, a necessary physiological activity of the living vessel wall and a necessary one indeed.
But in 20 % of cases, this repair process did not 'know' when to stop thus 'over-repair' cause lost in the luminal gain initially achieved by the earlier procedure.

But guide wires, balloon and stent technology improve by leaps and bound over the years.
By the early 90's, DES [ drug eluting stents ] were introduced.

Growth impeding drugs such as SIROLIMUS or PACLITAXEL was impregnated into the stent. This drug, on successful implantation of the stent in the coronaries, diffuse  slowly for days and weeks into the vessel wall, effecting to control cell regeneration at a more reduced level, thus reducing  RESTENOSIS ie. reducing lumen loss due to excessive tissue repair.

[  https://www.youtube.com/watch?v=JeH4zPzQgRc   ]


Just eight years back, another milestone was breached. Drug eluting balloon was introduced. This is a niche piece of equipment to treat increasing incidence of 'In Stent Restenosis' in patients who developed repeat narrowing within their implanted drug eluting stents.


By then angioplasty and stenting has already far outstripped in term of numbers CABG. Only the rare patients are sent for surgery.

Since people with coronary problem nowadays generally survive longer and longer due to improvement in treatment modalities as well as the massive effect of statins [ LIPITOR, ZOCOR, CRESTOR ]on lipid control, it is fairly common to see  patients who developed coronary problem when they were in their early 40, having had 6 to 8 stents when they reach their mid 60's or 70's..


I myself has a lady patient of mine whom I referred for bypass surgery 15 years back, who 'chickened out' at the last minute, had 6 stents implanted then. I was earlier managing her husband whom I sent for bypass surgery 5 years earlier.

Now, 15 years later, and several episodes of 'acute coronary syndrome' and hospital admission later, she is a bionic lady with a total of 10 stents implanted by myself over the years. 

This seventy five year old 'Datin' is currently still active playing and tending to her 'cucus' in a famous tea plantation in Cameron Highland. Her son is one of the senior manager there.

If you ask the 'Datin' why she opted out of her surgery and pleaded for me to do 'angioplasty, in the wee hours of 5 am , that fateful morning , her reply was simple :
" I saw how Dato' suffered during his bypass surgery and much after....Please do not force me to go thru that, Doc ! "

But to be fair to CABG, both endoluminal technique and CABG are complimentary.
The only thing that work against CABG is that while the surgeons only have their pairs of hand, over the last 40 years, the cardiologists have the whole gamut of industries helping them: the engineers, the metallugists, the whole range of bio-genetic scientists. 

It is an unfair advantage!

But from my  perspective , some of our patients would finally need CABG one day later in their life, only that I would like to postpone that day to as late as possible because all current techniques have their 'shelf life', and CABG is the final pathway in the life of a patient with coronary problem. It is ideally not to be repeated due to high mortality risk in repeat  CABG surgery. If I can, I want to exercise other options first for my patients before the final option of CABG.

To us interventional cardiologists, coronary problem is  a chronic , relentless disease. We try as hard as possible to keep all our patients from going under the surgeon's knife. Personally to me it is like  playing 'gin rummy', and if you are familiar with 'gin rummy', we try to not use our precious 'jokers' early in the game. CABG is the all important JOKER! But at the same time, when we need to send our already aging patients under the surgeon's knife, we want our surgeons to be able to do his 'bypasses' at the right place. If our patient's heart are full of 'metal jackets' [ stents ], there may not  be any more place for the poor surgeons to bypass.

So when BIORESORBABLE SCAFFOLD, or 'plastic stent' came into the picture about 4 years ago, most  people like me  cannot help but get excited. I implanted about 10 of them in my younger patients. It is a relief of sort for me since my youngest patient so far is just 22 years old. Imagine how many metal stents he would have before he reaches even 40!
These 'plastic stents' as I called them should self dissolve into carbon dioxide and water by three years. Theoretically I could re-vascularize these involved arteries and allow them to be regenerate back to normal after three years. 

[    http://drnikisahak.blogspot.my/2013/08/absorb-new-absorbable-plastic-stent.html  ].

This toy has now improved with the recent advent of a more durable, disappearing metallic stent, the MAGMARIS . And the possibility of  'metallic' foreign body disappearing in one year and allowing for regeneration and normal vasomotion of vessel back to its original state.....nice thought.

Now in 2016, MAGMARIS, the new magnesium stent, has just got it's CE mark. It is now open for general use and validation.. The obvious advantage over the 'plastic stent' is its relative strenght.

So far around 200 Magmaris stent have been implanted world wide, 10 of which come from Malaysia, with nine implanted by the 'boys' in IJN and one recently  by me at my hospital, SJMC. 

My patient is a 49 year old engineer, who developed troublesome angina on mild exertion.
Coronary angiogram done last week showed 90 % narrowing in the proximal section of the Right Coronary Artery. I implanted the Magmaris stent rightaway.

[   https://www.youtube.com/watch?v=OjwPrOgdtgQ   ]


"When are you retiring Nik...and joining us for golf?.', a paediatric consultant colleague of mine who just recently retired from teaching in UH asked recently.
" I am not sure Peng, there are new 'toys' to play around with all the time....."

I am certainly living in interesting times....








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