4 AM.Still tossing and moving in bed. Too much adrenaline. Could not sleep tonight.Just visited a long time friend earlier in the evening, who just came back from the USA. He went to a 'centre of excellence' in 'neurovascular intervention' in Minnesota, USA, seeking for an 'endoluminal' treatment[cerebral angioplasty and carotid artery stenting] to his blocked arteries in his brain.Thirty days later, and nearly 2 million RM poorer,he came back no better.Almost lost his life during the procedure.
Lesson? No issues involved here, and no 'moral of the story' from my view point. Complications do occur even in the best of places. When it does,drives the 'shit out' of your patients[he could have died!] and the doctors.If it happened in the best centre in the US be prepared to cough out 50k RM a day for a CCU bed!And we Malaysians go berserk when a fully ventilated patient on megadoses of antibiotics and multiple cathethers going in and out of the body,a typical 'bad case' in private intensive care, do creep up to 2k RM per day!Intensive critical care medicine is very expensive standard everywhere with spiraling cost and high techs.[ We do not use stents or antibiotic made from Jinjang or Kepong! All US or Europe].In the US of A, just time it by a multiplier of 20, though.
We discussed 'Stem Cell research and progress' over dinner.It is bludgeoning everywhere.Especially in Asia, namely China.StemCellChina.com is selling it as if it is already established clinical practice.Elsewhere around the world, people are more cautious. It is still 'experimental' and 'research' and we have to wait and see.Exciting no doubt but give it some time before the 'clouds of anecdotal claims settle a bit and the real result comes out'.Too early and too many issues that need to be solved and settled!Malignancy issues,selection issues,and most importantly 'is there evidence it really work' issues.....Too early days to say.Anecdotal evidence in modern medicine is not good enough....Trials ,trials and more trials.Don't you be a guinea pig for the moment.
One or two 'doctors' even in Malaysia have already join the bandwagon, not wanting to be left out as the early birds." Early birds catches the worms ",leaving behind ethical and moral considerations.Stroke patients and patients with 'bad hearts' with thick wallets and unlimited cheque-book queue for treatment.['more money' than brain: just look at that KT fellow! Sorry folks ,this is unrelated except I cannot help being political here. It may help his party's cause in gaining respect and looking at new directions if 'leaders' like him just can disappear from the scene!Can someone tell him that!] .Exercise care in your decisions, there are charlattans even amongst doctors.99.9 per cent of us who practice evidence based medicine would rather wait.
Earlier at 5 pm, my cousin[ just 60+ ] visited me, with a coterie of 'husbands and sisters', at the clinic, to consult about her neuropathic pain in the fingers and feet. She is a diabetic of 40 years standing.I just knew that she had a malignant breat lump removed at PPUM 6 months earlier.People,even relatives,don't discuss cancer.Refused chemotherapy after prior consultation with a handful of 'armchair' experts.She missed that 'window'of opportunity now.I told her that the surgical removal of the lump is just like a German panzer division coming to whack down a Belgium town, you would still need the commandoes and the foot soldiers[chemotherapy] to sweep and mop-up the carpet and finnish off whatever remaining Allied soldiers left here and there.Otherwise the win is not secured.Possibility of recurrence is that much higher....In some cancers , we have effective ' cell specific immune, 'targeted' therapy but that is not yet available for many cancers apart from lung and kidney.For lung,specific to woman,non smoker ,of the 'adecarcinoma histological variety. My M.I.L. one and half year on is on Tarceva,and Alhamdullillah still hale and hearty! And that is marvellous, alhamdullillah, as far as cancer of the lung goes, stage 4 at initiation of therapy.
No ! My cousin would rather have no chemotherapy !Her armchair 'specialist' friends had a greater sway.If I were to meet her doctor in UH 6 months ago I would give him a good'whacking' on his backside for not educating her enough!When you are 'clever' you have to work extra hard to convince your patients to get the right treatment. Even to the extent of threatening to send the 'police' to bring her back from 'cloud nine'. I usually use this 'gambit' to convey to my patients I mean it.If that fails,then I am satisfied I have tried my best!
[ Now I remembered giving a Datuk patient of mine 2 months ago a verbal 'whacking' for allowing his dear sister who had a 'tiny winny' of a lump[ ?breast cancer,only seen on a routine mammogram], too much democracy...She wallowed in self pity and ignorant self indulgence for 12 months,opting for 'air yasin',bomoh and kiai,this and that, by the time I heard of her predicament from a another friend a year latter, and able to 'prised' her out of her self imposed 'self pity', the tiny growth has progressed to a size bigger than a golf ball..So much for our blatant misunderstanding of Qada' and Qadar.I always maintain Qada' and Qadar are Allah's domain, we mere mortals we do our best , with our best understanding of the sciences and current 'state of the art' and then we PRAY. That to me is the right humanly approach to Qada' and Qadar....And I am from the old school, a firm believer in Sukarno's Guided Democracy...Guided democracy for the relatively ignorant...I hope you can understand my anger with the brother. That young lady probably could have had a 'cure', now she stand to 'lose' 15 to 20 years of her future life , the difference between 'cure' and palliation can be tremendous!.Even with surgical removal now and the best chemotherapy money can buy, a golf ball in your breast is a golf ball in the breast!Seeding in the lungs and/or brain might have occured. Maybe, may not be, but why play dice with your life].....
So much for digression, let us get back to my cousin:
Her alternative megadoses of B17, B19 and B20 and B21[ I did not know there were so many B's] cost her 'a whacking 2k' a month! So much for vitamins!I would rather go to her house and collect her pee from the drain and still could make a couple of hundred bucks a month by opening a factory for recycled vitamins! Her 'source' is a lady somewhere in town.The lady had had her hands full.Packed with customers.All had to go through a 'computerised' assessment with blinking light and all, telling whether cancer cells are still there or dissapearing.The source just died acouple of months back also of cancer! Great business!My cousin was worried about her neuropathic pain, I was worried about those few 'American soldiers still left in town'.
These are what that keep me awake.2009 but still too much ozone therapy,colonic washouts,'Air Yasin',unproven alternative therapy,faith healing 'multiorgan transplantations', in town!We guys like short cuts.Malays and Muslims mostly.Why? Why? Why?...And Islam is supposed to show us the way out of ignorance and superstition to Truth.It is supposed to move 'mountains'!
5.30 AM now.Almost Suboh. I hate to go around knocking my children's rooms [and wife].I will be relieved if they wake up, I will be damned if they don't. Not a nice feeling....Actually at this stage in my life ,a sinking feeling....
"I put it to you Sir, that you have been neglectfull and 'callous' in the upbringing and 'education' of your 'flock'".......arggghhh! arghhh!
That come to my recurring thought and theme:How do we motivate ourselves and family towards Ihsan,Iman and Amal?
I think most of us[myself included]modern parents, staying in KL especially ,got it wrong.We leave this too much to the schools: There is the ugama lessons etc etc etc, there is the ustaz 'mengaji' coming to the house...
Even with ugama lessons, the Mak and Mek Rempits are 100% Malay, Muslim boys and girls.The 'hantu dadah' are 99.9% Malays.Our children[and ourselves of course] still in the main do 'Suboh gajah' or not at all! Despite all the 'mengaji' and the ugama lessons.
I was 'struck' and schocked when I heard over CNN some one year ago that Hamid Karzai[he was a California based 'Oil adviser' before he become Mr President] wanted the UN[mind you bugger! The UN] to ban the ubiquitous madrasahs, all the world over! He was echoing what Bush had politely and quietly proposed earlier on.Even Bush dare not mention it. And we have one very stupid Muslim 'Head of State' coming out with the magic formulla for world peace: Do away with the Message! Now, what do young boys do in the madrasah, you may ask? They learn the Qur'an.
Yes! That is the answer. We have to start teaching ourselves and our children the Qur'an.Certainly not in the traditional way of pure recitation in front of a 'guru mengaji' and be finnished with it once you reach juz 30.We have to start all over again,read and understand.....daily ,little by little.
Can be very costly you may say:"Guru mengaji" is already 100 to 200 RM per month.A 'guru' with tafsir background will cost more.
Children spend hours on the internet. Use the internet Qur'an. Be there with them initially, then leave them alone...In a year they will be able to teach you one or two ayats if you are not carefull!
The Glorious Qur'an is self empowering, that is why Harmid Karzai and Bush et al are so worried! JMHO
I will start with my 12 year-old rightaway tomorrow! Social engineering...Together ,father and daughter, we are going to move 'mountains'! Never mind the 'pahala'.I know one get 'pahala' just by mere recitation. Our joint project this time is to just move 'mountains'! The 'pahala' will come when the'mountains' are moved anyway.More sustainable.We will not be there for them all the time......
I can go to sleep now.