Friends ,
The recent by-election result from Kuala Terengganu was no surprise to me .You ask any Malays now below 35 whether they would vote for UMNO in any election and almost 100 % of them would say they would vote a frog instead !You ask those Malays with tertiary degrees ,indirect product of UMNO's affirmative policy ,a great majority will vote the opposition ,except those few who live on lucrative government contracts and handout and the Pemuda's and Puteri's looking for easy life as government's hangers on .
This is a sad state of affair .A party that once was so proud of it's election record and always the bastion of the Malaysian government now having to swallow humble pie and continue to whistle in the dark .Still impervious to change and insensitive to criticism ,with built in mechanism that tend to promote the unashamedly corrupt ,the inept and the political missfits.With all these UMNO is like that robot they sent together with the astronauts in the film Red Planet: It has been switched on a self destruct 'military mode' !
With Najib Tun Razak definitely taking over at the helm in March the scenario for self destruct would almost be complete and beyond 'reconfiguration' .With the Altantuya baggage on his shoulder and his wife's previous excesses ,in these years and age of information, his would be an uphill task
Let us look at the other side of the equation :Anuar Ibrahim .Anuar's achilles tendon at least to the Malays [ and no one gets to power in Malaysia without overwhelming Malay support ]is that his Party Keadilan lacks Malay content .Look more HINDRAF if anything else .The marriage of convenience between PAS and DAP in Pakatan is neccesary and make no mistake about it ,both Lim Kit Siang and that old man Karpal can make all the animal noise they want about hudud but PAS is the senior partner in Anuar's Pakatan .Without PAS ,Anuar might as well be the President for HINDRAFF .Lim Kit Siang knows fully well that the Chinese ,as represented by DAP ,would never be in a position to share some semblance of power in a 100 years without piggy bagging on Anuar 's Pakatan ,and Anuar know without PAS he might as well get back to the relative safety of having free lunch for the rest of his life in the vicinity of Sungei Buloh .
Look at it this way : If Dr M did not offer that parachute jump for Anuar some 20 years back where would Anuar be ?My guess is that he would probably join PAS but since he was a young man in a hurry and PAS then was all 'kopiah and no content',UMNO became his obvious choice .
What would I do if I am one of the think tank for PAS now that 'UMNO is in its death throes and there would be a vacumn soon enough .I would advice PAS to get a 1st class PR firm specializing in massive 're-branding exercise' .Islam from time immemorial stood for excellence in this 'duniya' and excellence in the 'akhirat': when Florence ,Madrid and Rome were still bathed in darkness ,ignorance and plague ,Cordoba was a city of light and centre of knowledge and the arts .Now these former 'barbarians' have the audacity to want to teach the Muslims all over the world how to live and govern .
PAS should get away from the present stigmata of just being seen as champions only for the meek and the mediocre .PAS ,like Islam ,must aim and 'sell' itself as a party that stand for 'universality' of man and should not be weighted down for being 'Malay' .Islam is about the 'Universal man ' with excellence in thought ,actions and word .PAS should go for more 'Erdogans' amongst it's fold .
In 2009 ,NEP and Nationalism are outmoded concepts .Equality ,egality and fraternity are in . They are also the rallying cry in Islam .They just need to be repackaged !Malay dilemma is no longer a relevant issue .This vacumn in leadership is a Malaysian dilemma ,and all issues must be looked from an overall Malaysian perspective ,not Malay ,Chinese or Indian .In the eye of God ,all of us are equal except for our level of piety .
Enough of the bullshits ,I better go to sleep !
Monday, January 19, 2009
Saturday, January 17, 2009
Pearls & Gem : Redza
Friends ,
Redza .Simple word but has deep philosophical meaning .In English ,acceptance of one's fate ,actually for want of better words .
It is easy to 'redza' a loss in the monetary sense but when it involved a lost of a beloved life ,'redza' can be very difficult even though one can outwardly say "I redza the death of my son in that fatal accident " but in actual sense the interpersonal tension existing between say the parents and the prolonged melancholia and depression that followed speak of hearts not yet fully 'redza' of this unfortunate event .
My long time patient ,had his bypass op some 16 years ago , today came to my outpatient clinic with 'heart' pain requesting for the reassurance of a normal stress electrocardiogram to which I did and as expected was reassuringly normal .I know from his history this time that the pain was not his heart but his 'soul'.He just lost his beloved 11 year old daughter from a spontaneous intra-cerebral bleed of a congenital arterio-venous malformation in the brain which was diagnosed at my hospital a few months earlier following complaint of frequent headache by the child .
My patient[ friend ]and his wife must have been told that an endoluminal technique akin to angioplasty [ except in this case the small feeder vessel in the brain ,instead of being blown and stented ,would be 'stuffed' and closed by overloading it with coils to prevent further enlargement and future bleed ].The parents wanted a 2nd opinion but probably sat on it too long .The bleed occured and the child died .
Interpersonal tension between spouses ensued ."If' this and 'if' that followed .The blame game .Depression .The main issue is when loss of life is involved 'redza' is difficult .Our iman and depth of religious knowledge and wisdom or relative lack or shallowness of them all , showed .Depression sets in .Can be very long ,insiduous and chronic .I told him about my personal story of my own inability to really actually 'redza' even when at the verbal level I said 'I redza' ..
A painful one ,and despite my present apparent 'scholarly' approach to life , it was only just a few years ago that I managed to 'wean' the 'internal sadness' off .That was when I 'revealed' my internal conflict to my eldest brother who had nothing much in term of 'formal schooling' compared to me but I reckoned had many scale higher wisdom than me .Probably through the rough education of 'idongotoyou' university and also having to deal with a lot of young upstarts bosses like me who think we 'know all that need to know' about life .
He just told me I did not yet 'redza 'enough .I understood what he meant and by God ,decades of pain just evaporated .
My 'internal sadness' started when I was a 1st year medical officer then working in the academic department of medicine UKM based in GHKL .Was on call ,manning a very busy Coronary Care Unit at GHKL .A madhouse in 1979 and even now .Much madder then because of under-staffing and lack of hospital CCU beds in KL .A call came from my younger sister's friend by the name of Mustapha from Telecom Hq :" Doc ,Your sis Wan Maziah is in coma in Kuantan GH Casualty Dept from motor vehicle accident in Beserah ".Her husband of 5 days sustained some fracture in the leg .They were driving from KB towards KL to start work after a short brief honeymoon in KT .
I took time off work and attended their wedding just 5 days earlier .Wan Maziah Wan Abdullah ,a bubbly 23 year old economics grad ,bright future ,,University of Malaya Kesuma cultural dancer ,loads of peminat and boy friends,could have chosen any one of them as life partner but as fate had it that she chose one quiet ,nondescript Ahmad bin Zakaria [ young girls those days thought they would be 'andartu' if they are not yet married by 25 !] and 5 days later had a fatal accident !
My God ! I was very busy looking after 4 freshly 'infarcted' patients in CCU that morning .Calls were coming from ER to review another 2 potential 'Acute Infarcts'.The ward round in 1st class ward was pending .Patients' relatives thugging at my shoulder for explanations and reassurances .It was a day when you had to be at 3 places at one time .A typical busy day for a young up and coming MO going for higher things in life .A hundred and one thing a junior medical officer had to deal in the course of a morning's work plus the burden of being the 'On Call MO'- .I needed to find replacement for someone to do my call etc etc .I was numbed .It was only 3 hours latter that I could sit down and 'reorganise' my thought and emotion for my sister presumably lying in coma in a corner somewhere in the casualty ward at Kuantan GH .
By the time I arrived at Kuantan GH in the evening ,my sister was just pronounced dead !Very fresh .Her body still warm .A limited PM done that very night .Cause of death :brain death due to mounting pressure as a result of neglected subdural haematoma .
In lay man's term ,she just had a small bleed under the skull and her death was due to the bleed getting larger and larger over the 8 or so hours of 'callous' and inactive observation in the casualty department .In medical parlance :totally unacceptable .
A simple small burr hole by the 'stupid' demigod surgeon on call would have solved the problem of pressure build up on the brain .As simple as that.The surgeon knew it and on meeting me he knew that I knew it ,but thank God my grieving family members did not know that implication otherwise the 'redza' part of the event would involve more people ,unnecessary anger and more complex .
[A deviation here... Litigations on the care givers in the main are reflections of a 'non redza' state of mind ,from a 'sufic' viewpoint.Ignorance oftentimes is a blessing .I am not saying or stating a position here ,just an observation ,a profound one no doubt .Any remedy then ?Well if you have to have an accident ,try arrange one near Sime Darby Medical Centre with state of the art MRI and CT scan and consultants on 24 hour call .If you plan to have a massive heart attack ,just do it within the lobby of IJN !Try to talk and cajole God about it ,if it can be arranged .Of course if you are in that enviable position you would not have bothered about it in the first place .]
In my mind then there were so many if's .What if I have the presence of mind to make a few intelligent phone calls earlier on to the consultant surgeon in Kuantan ?What if I could have used my family contact who knew the Pahang MB then for a mercy airlift by RMAF to GHKL where medical knowledge and expertise were more 'decent' .If ,if and If .All the 'iblis' If's
I 'redza' that part of the medical officer and surgeon on duty not doing their expected 'bit'[ otherwise they would not be in Kuantan ,I told myself ]but I could not come to term for decades of my inability to act 'proactively' .That was the right setting for future prolonged intermittent melancholia and depression .In actual fact ,on looking back with hindsight , I have been very unfair to myself for having so high an expectation .I was only 27 then .This 'too high expectation of oneself lead to protracted ,really unnecessary and painful ,'internal sadness' and mourning without end .
My other brothers and sister and even parents were fast to 'redza' and after a short period of mourning ,life went on as usual for them ,alhamdullillah .I had fits of depression and lounging for years to come .I was ,in a way too engrossed with the concept of Plan ,Plan ,Plan and plan ,disregarding that Allah has a bigger plan than us mere mortals :forgetting that in the real realms of things ,it should be redza ,redza and redza !The IMMOVABLE will remain IMMOVABLE and what are MOVABLE are MOVABLE only because of HIM .That was my level of 'kufrness .I had to pay with years of depression and lounging s .Lounging for a beloved one that was gone to join the Realm of Reality .
That is 'redza' ,a simple word but deep in meaning and connotation .Shaikh Abdul Qadir al Jilani in a short discourse put Islam as "Following what are prescribed for you by The One and Only ,enjoying what is halal and avoiding what is haram ,and lastly Redza to what is thrown in your way " .One does not have to have an IQ like Einstein to enjoy our faith .
My friend ,'redza' and 'redza' earlier ,than later .Your 11 year old is already in the 'cradle of love' ,while we are still being tested and if we do not 'redza' ,we fail the big test !
Redza .Simple word but has deep philosophical meaning .In English ,acceptance of one's fate ,actually for want of better words .
It is easy to 'redza' a loss in the monetary sense but when it involved a lost of a beloved life ,'redza' can be very difficult even though one can outwardly say "I redza the death of my son in that fatal accident " but in actual sense the interpersonal tension existing between say the parents and the prolonged melancholia and depression that followed speak of hearts not yet fully 'redza' of this unfortunate event .
My long time patient ,had his bypass op some 16 years ago , today came to my outpatient clinic with 'heart' pain requesting for the reassurance of a normal stress electrocardiogram to which I did and as expected was reassuringly normal .I know from his history this time that the pain was not his heart but his 'soul'.He just lost his beloved 11 year old daughter from a spontaneous intra-cerebral bleed of a congenital arterio-venous malformation in the brain which was diagnosed at my hospital a few months earlier following complaint of frequent headache by the child .
My patient[ friend ]and his wife must have been told that an endoluminal technique akin to angioplasty [ except in this case the small feeder vessel in the brain ,instead of being blown and stented ,would be 'stuffed' and closed by overloading it with coils to prevent further enlargement and future bleed ].The parents wanted a 2nd opinion but probably sat on it too long .The bleed occured and the child died .
Interpersonal tension between spouses ensued ."If' this and 'if' that followed .The blame game .Depression .The main issue is when loss of life is involved 'redza' is difficult .Our iman and depth of religious knowledge and wisdom or relative lack or shallowness of them all , showed .Depression sets in .Can be very long ,insiduous and chronic .I told him about my personal story of my own inability to really actually 'redza' even when at the verbal level I said 'I redza' ..
A painful one ,and despite my present apparent 'scholarly' approach to life , it was only just a few years ago that I managed to 'wean' the 'internal sadness' off .That was when I 'revealed' my internal conflict to my eldest brother who had nothing much in term of 'formal schooling' compared to me but I reckoned had many scale higher wisdom than me .Probably through the rough education of 'idongotoyou' university and also having to deal with a lot of young upstarts bosses like me who think we 'know all that need to know' about life .
He just told me I did not yet 'redza 'enough .I understood what he meant and by God ,decades of pain just evaporated .
My 'internal sadness' started when I was a 1st year medical officer then working in the academic department of medicine UKM based in GHKL .Was on call ,manning a very busy Coronary Care Unit at GHKL .A madhouse in 1979 and even now .Much madder then because of under-staffing and lack of hospital CCU beds in KL .A call came from my younger sister's friend by the name of Mustapha from Telecom Hq :" Doc ,Your sis Wan Maziah is in coma in Kuantan GH Casualty Dept from motor vehicle accident in Beserah ".Her husband of 5 days sustained some fracture in the leg .They were driving from KB towards KL to start work after a short brief honeymoon in KT .
I took time off work and attended their wedding just 5 days earlier .Wan Maziah Wan Abdullah ,a bubbly 23 year old economics grad ,bright future ,,University of Malaya Kesuma cultural dancer ,loads of peminat and boy friends,could have chosen any one of them as life partner but as fate had it that she chose one quiet ,nondescript Ahmad bin Zakaria [ young girls those days thought they would be 'andartu' if they are not yet married by 25 !] and 5 days later had a fatal accident !
My God ! I was very busy looking after 4 freshly 'infarcted' patients in CCU that morning .Calls were coming from ER to review another 2 potential 'Acute Infarcts'.The ward round in 1st class ward was pending .Patients' relatives thugging at my shoulder for explanations and reassurances .It was a day when you had to be at 3 places at one time .A typical busy day for a young up and coming MO going for higher things in life .A hundred and one thing a junior medical officer had to deal in the course of a morning's work plus the burden of being the 'On Call MO'- .I needed to find replacement for someone to do my call etc etc .I was numbed .It was only 3 hours latter that I could sit down and 'reorganise' my thought and emotion for my sister presumably lying in coma in a corner somewhere in the casualty ward at Kuantan GH .
By the time I arrived at Kuantan GH in the evening ,my sister was just pronounced dead !Very fresh .Her body still warm .A limited PM done that very night .Cause of death :brain death due to mounting pressure as a result of neglected subdural haematoma .
In lay man's term ,she just had a small bleed under the skull and her death was due to the bleed getting larger and larger over the 8 or so hours of 'callous' and inactive observation in the casualty department .In medical parlance :totally unacceptable .
A simple small burr hole by the 'stupid' demigod surgeon on call would have solved the problem of pressure build up on the brain .As simple as that.The surgeon knew it and on meeting me he knew that I knew it ,but thank God my grieving family members did not know that implication otherwise the 'redza' part of the event would involve more people ,unnecessary anger and more complex .
[A deviation here... Litigations on the care givers in the main are reflections of a 'non redza' state of mind ,from a 'sufic' viewpoint.Ignorance oftentimes is a blessing .I am not saying or stating a position here ,just an observation ,a profound one no doubt .Any remedy then ?Well if you have to have an accident ,try arrange one near Sime Darby Medical Centre with state of the art MRI and CT scan and consultants on 24 hour call .If you plan to have a massive heart attack ,just do it within the lobby of IJN !Try to talk and cajole God about it ,if it can be arranged .Of course if you are in that enviable position you would not have bothered about it in the first place .]
In my mind then there were so many if's .What if I have the presence of mind to make a few intelligent phone calls earlier on to the consultant surgeon in Kuantan ?What if I could have used my family contact who knew the Pahang MB then for a mercy airlift by RMAF to GHKL where medical knowledge and expertise were more 'decent' .If ,if and If .All the 'iblis' If's
I 'redza' that part of the medical officer and surgeon on duty not doing their expected 'bit'[ otherwise they would not be in Kuantan ,I told myself ]but I could not come to term for decades of my inability to act 'proactively' .That was the right setting for future prolonged intermittent melancholia and depression .In actual fact ,on looking back with hindsight , I have been very unfair to myself for having so high an expectation .I was only 27 then .This 'too high expectation of oneself lead to protracted ,really unnecessary and painful ,'internal sadness' and mourning without end .
My other brothers and sister and even parents were fast to 'redza' and after a short period of mourning ,life went on as usual for them ,alhamdullillah .I had fits of depression and lounging for years to come .I was ,in a way too engrossed with the concept of Plan ,Plan ,Plan and plan ,disregarding that Allah has a bigger plan than us mere mortals :forgetting that in the real realms of things ,it should be redza ,redza and redza !The IMMOVABLE will remain IMMOVABLE and what are MOVABLE are MOVABLE only because of HIM .That was my level of 'kufrness .I had to pay with years of depression and lounging s .Lounging for a beloved one that was gone to join the Realm of Reality .
That is 'redza' ,a simple word but deep in meaning and connotation .Shaikh Abdul Qadir al Jilani in a short discourse put Islam as "Following what are prescribed for you by The One and Only ,enjoying what is halal and avoiding what is haram ,and lastly Redza to what is thrown in your way " .One does not have to have an IQ like Einstein to enjoy our faith .
My friend ,'redza' and 'redza' earlier ,than later .Your 11 year old is already in the 'cradle of love' ,while we are still being tested and if we do not 'redza' ,we fail the big test !
Friday, January 16, 2009
Pearls & Gem : Cancer !
Back to my mother in law who was diagnosed to have advance adenocarcinoma of the lung with metastasis [..'spread'] to the heart and heart sac [..pericardium ].Well ,she was on state of the art medication Tarceva which costs a bomb monthly .Ideal candidate for Tarceva :women ,adenocarcinoma in histopathology,non smoker .
Alhamdullillah ,six months now ,and the chest X ray done yesterday showed complete resolution of the cancer effect on the heart which was double in size earlier on due to accumulation of malignant fluid between the heart and its sac .The 'golf ball' size tumour in the lung has shrunked to just residual scarring .Masahallah !The wonder of modern medicine .
"If the seven seas are ink and all the trees in the world forest, pens ,even that could not touch the immensity of My knowledge " ,so goes one of the ayat in Lord's Divine Speech to mankind .Roughly so ,quoted off the cuff , I have forgotten the Letter and the Ayat index .Mortal men in their quest for knowledge ,like the scientist and researchers who stumbled on things like Tarceva ,are just scratching the periphery and surface of Divine knowledge .
Likewise ,I am an interventional cardiologist ,a glorified plumber .A man with just a hammer .
Najib Razak ,our next PM [ oh my God ! how is it like to be under Najib and madame Rusma for the next 20 years !Please help us ]is a professional politician who probably has not just a hammer but also a chain saw ,a bulldozer and a pickup truck .
...and worst still, he has a wife who can drive pick up!
An accountant is a guy who count [..and in our Malaysian setting induced to occasionally, miscount and creative accounting ] and a KL taxi driver ,drives .The more 'tools' you are endowed with ,the more you can do for society ,and the more damage as well if not done well !
The single most important element that all four of us share in common is our accountability to Him and definitely one of these days we are going to meet Him and have to explain what we do with our 'Time ,Wealth and our Youth '.Najib ,the accountant ,the taxi driver and yours truly ,all of us know this but all of us are in our state of varying degree of 'kufrness' to Him .Allahualam !
Back to my mother in law ,she has been given at the most another six months of reprieve to think ,ponder and do whatever appropriate about that important meeting .She ,I guess ,is in a better position than most of us who generally will be caught with our 'pants down' at the wrong time in the wrong place .
There is grace and mercy even in so called adversity ,if we just care to look beyond the realm of 'ordinariness' !
As I reminded my 28 year old son this morning over breakfast in front of his grandma ,as the Malay saying goes ,"even the young coconuts also oftentimes fall earlier than the supposedly old ones" .
Alhamdullillah ,six months now ,and the chest X ray done yesterday showed complete resolution of the cancer effect on the heart which was double in size earlier on due to accumulation of malignant fluid between the heart and its sac .The 'golf ball' size tumour in the lung has shrunked to just residual scarring .Masahallah !The wonder of modern medicine .
"If the seven seas are ink and all the trees in the world forest, pens ,even that could not touch the immensity of My knowledge " ,so goes one of the ayat in Lord's Divine Speech to mankind .Roughly so ,quoted off the cuff , I have forgotten the Letter and the Ayat index .Mortal men in their quest for knowledge ,like the scientist and researchers who stumbled on things like Tarceva ,are just scratching the periphery and surface of Divine knowledge .
Likewise ,I am an interventional cardiologist ,a glorified plumber .A man with just a hammer .
Najib Razak ,our next PM [ oh my God ! how is it like to be under Najib and madame Rusma for the next 20 years !Please help us ]is a professional politician who probably has not just a hammer but also a chain saw ,a bulldozer and a pickup truck .
...and worst still, he has a wife who can drive pick up!
An accountant is a guy who count [..and in our Malaysian setting induced to occasionally, miscount and creative accounting ] and a KL taxi driver ,drives .The more 'tools' you are endowed with ,the more you can do for society ,and the more damage as well if not done well !
The single most important element that all four of us share in common is our accountability to Him and definitely one of these days we are going to meet Him and have to explain what we do with our 'Time ,Wealth and our Youth '.Najib ,the accountant ,the taxi driver and yours truly ,all of us know this but all of us are in our state of varying degree of 'kufrness' to Him .Allahualam !
Back to my mother in law ,she has been given at the most another six months of reprieve to think ,ponder and do whatever appropriate about that important meeting .She ,I guess ,is in a better position than most of us who generally will be caught with our 'pants down' at the wrong time in the wrong place .
There is grace and mercy even in so called adversity ,if we just care to look beyond the realm of 'ordinariness' !
As I reminded my 28 year old son this morning over breakfast in front of his grandma ,as the Malay saying goes ,"even the young coconuts also oftentimes fall earlier than the supposedly old ones" .
Wednesday, January 14, 2009
Pearls & Gem :Shaykh Abu al-Hasan al-Shadhili
" If you must plan ,and how can you not plan ,then plan to only not plan !".
He was of course pointing to the fact that as life is just a measure of numbered breaths ,not even one for one moment determined by us ,the abdals ,how can we possibly plan ?Of course one has to plan but always add that conditional "insyaallah" to your plan .
He was of course pointing to the fact that as life is just a measure of numbered breaths ,not even one for one moment determined by us ,the abdals ,how can we possibly plan ?Of course one has to plan but always add that conditional "insyaallah" to your plan .
Sunday, January 11, 2009
Pearls & Gem : Shaykh Abdul Qadir al-Jilani
" My brothers and sisters ,I did not arrive in union with God by staying awake all night in worship ,by staying aware all day fasting ,or by staying engrossed learning knowledge !Rather ,I arrived at union with God by generosity and humility and letting my breast be at peace ".
Thursday, January 8, 2009
Pearls & Gem : Hoarding
You are obsessed by greed for more and more
Until you go down to your graves
Nay ,but you will come to know.
Nay ,but you will come to know !
Nay ,if you but only knew it with the knowledge of certainty
You would indeed see the hell that you are in .
In time ,indeed you will see it with the eye of certainty .
On that day you will be asked what you have done with the boon of life .
The Glorious Quran on the issue of 'Hoarding' .
Surah 102
Leopold Weiss was travelling with his wife ,Elsa ,in September 1926 ,in a Berlin subway when he noted a well dressed business man ,with a beautiful suitcase on his knees and a large diamond ring on his hand .It was an upper-class compartment .
" But when I looked at his face ,I did not seem to be looking at a happy face .He appeared to be worried :but not merely worried but acutely unhappy ,with eyes staring vacantly in space and the corners of his mouth drawn in as if in pain -but not in bodily pain...Then I began to look around at all the other faces in the compartment-faces belonging without exception to well dressed ,well fed people :and in almost every one of them I could discern an expression of hidden suffering ,so hidden that the owner of the face seemed to be quite unaware of it "
Shocked by the transformation of a routine train ride into a moral vision ,he shared this experience with his wife ,Elsa .She also looked around with new eyes ,and said ," You are right .They all look as though they were suffering torments of hell...I wonder ,do they know themselves what is going on in them ?".When Leopold returned home ,he chanced upon his copy of The Glorious Quran which has fallen open on the 102nd chapter .The rest was history .
Leopold Weiss went on to become Europe's most famous convert to Islam ,Muhammad Asad .He found in the Quran a voice that addressed the particular obsession of his age [ which is still our age ,despite our intellectuals' pretension to be not just 'post modern' but also 'post contemporary'].
Monday, January 5, 2009
Pearls & Gem :The Four Jokers
Friends ,
If you are 'gin rummy hantus' you will definitely know what having four jokers amongst your deck of cards mean :Instant 'gin' and double penalty points for all you opponents .
Having 'four jokers' in cardiovascular disease ,[ I use this term 'loosely' to mean both combined coronary ,cerebrobrovascular and renovascular ie renal as for kidney ],mean also almost the same thing :you are living with a 'short fuse'.Just waiting for that inevitable stroke ,heart attack or kidney failure looming in the horizon .
The four jokers are :
1 .Hypertension or High blood pressure .Pressure generally above 140/90 on 2 or more occasions .Our BP is variable with time ,place and occasion .When new patients come to see for the 1st time for other problems I normally do not give heed if their 'pressures' are a wee bit highish since these are stressful situation for them .This we practitioners all know and term it "white coat hypertension" . Does not even help even as nowadays that I dress to work rather 'casually' .Of course 150/100 is definitely high and 180/110 is a no no and most doctors will start treatment and full 'blood' investigation rightaway .Hypertension is a common problem and all your family physicians are capable of handling this situation .See them .
2 .High Cholesterol .A reading of below 5 mmol is ideal .Very rare in Malaysians to find such values .Our Malay and Mamak food are soo very rich .Our Chinese 'warong food' are always loaded with lard .Our 'makan places' opens 24 hours .It is not in the culture of we Malays to exercise and burn away the excess 'fats' etc and etc .[ see my blog on longevity ].6 to 6.5 mmol is no man's land .Some doctors treat some dont .7 mmol ,we are getting interested .At 8 mmol ,even if you wake me up at 2 am I will say shut up ,go take medication indefinitely ,or if you are reluctant what whatever irrational reason [ God ! I am getting tired of hearing 'Doc ,I am afraid of the side effect so i stopped the medication !] ,'change you religion': go veggies ,come back see me in 6 weeks ,repeat your cholesterol test !At 8 mmol ,even veggies only and all the diet in the world will still need some help from the statins ,the most effective anti cholestrol drug .
3 .Smoking .I do not have to add anything here .You all already know but must insist you do continue .The funny thing is whenever one has to spend 1 or 2 nights in the CCU in the context of having an 'acute coronary syndrome' or a heart attack ,seeing and feeling the nearness of 'Izra'il' at your jugular ,the smoking just stop easily mostly for years to come .No 'gian' even on day 1 ,whatsoever .Friends ,I hope you would not have to wait for that .It is a wee bit too late .Of all the 4 jokers ,smoking is the easiest joker to eradicate :you either stop 100 % or you continue .Prevention is better than cure ,and mind you there is no cure for established cardiovascular disease .
4 .Diabetes .It is such a big problem now with increasing obesity and affluence and increasing 'sedentariness' in our daily life . I would write on this specifically in future .Around half of all my angioplasty and stented patients are diabetic .On any one day my outpatient clinic follow up is consisted of 30 % diabetic .My wife is an insulin dependent diabetic and I can see my 2 overweight, under exercised ,internet addicted sons could well be diabetic in a cuople of years time .[ Would rather give them a kick on their backsides but that don't seem to be fashionable these days and age !]It is Makan ,Makan ,and more Makan !And no exercise .
How do these 'four jokers' effect their way on our body ?To be simplistic ,through our arteries ,big ,small and medium .Look at it this way ,the arteries are our main 'roads ,highways and lorongs' for nutrient ,oxygen and toxins transport and redistribution .When 'they 'collectively ' age prematurely our 'end organs [ brain ,kidney ,heart and in men ,even the 'lowly' penis ]suffer .ED problem in the main is not a urological problem ,it is a symptom of 'clogged arteries and clogged arteries are usually also present elsewhere ,unless proven otherwise .If you have ED ,go see your cardiologist ,he will check your heart .You do not 'die' of ED but you can die of a 'heart attack ' .So your doctor will do a stress test 1st ,and only then talk about your ED .
Blocked roads in Puchong could well be also blocked roads in Damansara Heights ,as I always jokingly tell my patients !ED is usually an early manifestation of heart problem .The 'PWD people', when they are not efficient, you get bad roads with potholes in Puchong ,Damansara Heights and TTDI as well.Need to look at all of them .Especially Damansara Heights as they cause more damage !
Dr Nik Howk
If you are 'gin rummy hantus' you will definitely know what having four jokers amongst your deck of cards mean :Instant 'gin' and double penalty points for all you opponents .
Having 'four jokers' in cardiovascular disease ,[ I use this term 'loosely' to mean both combined coronary ,cerebrobrovascular and renovascular ie renal as for kidney ],mean also almost the same thing :you are living with a 'short fuse'.Just waiting for that inevitable stroke ,heart attack or kidney failure looming in the horizon .
The four jokers are :
1 .Hypertension or High blood pressure .Pressure generally above 140/90 on 2 or more occasions .Our BP is variable with time ,place and occasion .When new patients come to see for the 1st time for other problems I normally do not give heed if their 'pressures' are a wee bit highish since these are stressful situation for them .This we practitioners all know and term it "white coat hypertension" . Does not even help even as nowadays that I dress to work rather 'casually' .Of course 150/100 is definitely high and 180/110 is a no no and most doctors will start treatment and full 'blood' investigation rightaway .Hypertension is a common problem and all your family physicians are capable of handling this situation .See them .
2 .High Cholesterol .A reading of below 5 mmol is ideal .Very rare in Malaysians to find such values .Our Malay and Mamak food are soo very rich .Our Chinese 'warong food' are always loaded with lard .Our 'makan places' opens 24 hours .It is not in the culture of we Malays to exercise and burn away the excess 'fats' etc and etc .[ see my blog on longevity ].6 to 6.5 mmol is no man's land .Some doctors treat some dont .7 mmol ,we are getting interested .At 8 mmol ,even if you wake me up at 2 am I will say shut up ,go take medication indefinitely ,or if you are reluctant what whatever irrational reason [ God ! I am getting tired of hearing 'Doc ,I am afraid of the side effect so i stopped the medication !] ,'change you religion': go veggies ,come back see me in 6 weeks ,repeat your cholesterol test !At 8 mmol ,even veggies only and all the diet in the world will still need some help from the statins ,the most effective anti cholestrol drug .
3 .Smoking .I do not have to add anything here .You all already know but must insist you do continue .The funny thing is whenever one has to spend 1 or 2 nights in the CCU in the context of having an 'acute coronary syndrome' or a heart attack ,seeing and feeling the nearness of 'Izra'il' at your jugular ,the smoking just stop easily mostly for years to come .No 'gian' even on day 1 ,whatsoever .Friends ,I hope you would not have to wait for that .It is a wee bit too late .Of all the 4 jokers ,smoking is the easiest joker to eradicate :you either stop 100 % or you continue .Prevention is better than cure ,and mind you there is no cure for established cardiovascular disease .
4 .Diabetes .It is such a big problem now with increasing obesity and affluence and increasing 'sedentariness' in our daily life . I would write on this specifically in future .Around half of all my angioplasty and stented patients are diabetic .On any one day my outpatient clinic follow up is consisted of 30 % diabetic .My wife is an insulin dependent diabetic and I can see my 2 overweight, under exercised ,internet addicted sons could well be diabetic in a cuople of years time .[ Would rather give them a kick on their backsides but that don't seem to be fashionable these days and age !]It is Makan ,Makan ,and more Makan !And no exercise .
How do these 'four jokers' effect their way on our body ?To be simplistic ,through our arteries ,big ,small and medium .Look at it this way ,the arteries are our main 'roads ,highways and lorongs' for nutrient ,oxygen and toxins transport and redistribution .When 'they 'collectively ' age prematurely our 'end organs [ brain ,kidney ,heart and in men ,even the 'lowly' penis ]suffer .ED problem in the main is not a urological problem ,it is a symptom of 'clogged arteries and clogged arteries are usually also present elsewhere ,unless proven otherwise .If you have ED ,go see your cardiologist ,he will check your heart .You do not 'die' of ED but you can die of a 'heart attack ' .So your doctor will do a stress test 1st ,and only then talk about your ED .
Blocked roads in Puchong could well be also blocked roads in Damansara Heights ,as I always jokingly tell my patients !ED is usually an early manifestation of heart problem .The 'PWD people', when they are not efficient, you get bad roads with potholes in Puchong ,Damansara Heights and TTDI as well.Need to look at all of them .Especially Damansara Heights as they cause more damage !
Dr Nik Howk
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