On Exercise and Longevity: You don't Have To Be A Marathoner..

Longevity and Exercise are inter-related but you need not be a marathoner to achieve good, prolong health. In fact, excessive, intense exercise has been shown in most studies to be detrimental to health in the long run. It increases morbidity and mortality.

Listen to Dr O 'Keefe on this issue:

....my own personal addition to this is from the Islamic perspective.
Don't just exercise...do something to your mind while you are burning all those calories and moving all those muscles !

Read on.......
http://drnikisahak.blogspot.com/2009/03/exercise-mixing-profane-and-sublime.html

Case History : Left Main Stem...

I must count myself 'lucky' or unlucky, depending from which perspective I look at it, this last two weeks. I have the opportunity to manage  directly four 'left main cases' ! Coronary artery disease is my bread and butter as an interventional cardiologist but even after more than 20 years in practice as one, 'left main' remains a rarity. If I get to see and manage directly one case in 6 months, that is already being on the 'cutting edge'. Until this two weeks when I am faced with four cases...It is like a sledgehammer.
[  http://drnikisahak.blogspot.com/2012/05/procedures-in-medicine-coronary.html ]

Man has two coronary arteries.  Both branch out straight from the Aorta, as the great blood vessel emerge from the stem of the heart.One on the right side known as the Right Coronary Artery, supplying blood on the right side of the heart namely the right atrium and the right ventricle. The Left Coronary Artery, comes out on the left of the aorta  and is known as 'The Left Main Stem' as it runs for a few centimetres, [ 1 to 4 cm ], before  branching off into two main branch, the Left Anterior Descending artery which runs forward supplying blood to to the left ventricle. The other branch of the left main is known as the Circumflex Artery and it curve backward supplying blood to the back part of the left ventricle and the left atrium. Of the two branches, losing the LAD would be more 'major' or catastrophic than losing the Circumflex, since it covers more territory. Suffice to say, in any one branch, be it on the right or the left, having a 100 % blockage or occlusion at the more proximal part of the vessel  confers more damage than having an occlusion more distally. Common sense. [ A traffic jam at PJ Hilton of the Federal Highway would cause more problem than one also on the Federal Highway near Port Kelang !]
Along the same reasoning, an acute occlusion of the Left Main would invariably cause almost 100 % death in a patient since 60 % of the beating heart is deprived suddenly of it's blood supply.

I had 4 of these over the last forthnight!

The first one was a young  45 year old Chinese male who came in the context of a major anterior myocardial infarction seen at ER. We push him straight to OT from ER to do Primary Infarct Angioplasty. It turn out to be a Left Main! We could not cross the blockade and open up his artery in time . He died on the table despite 'heroic' cardiac resuscitation. No way that he could have survived, looking back , more wise, after the benefit of a 'retroscope'. We appear always wise 'looking back'. More wiser, looking and commenting from an 'armchair' over coffee or in court of law !

Case 2, involve a young Malay man , 38, five feet six , obese plus plus at 99 kg.  Familial hypercholestrolamia of 9.5 mmol !! Routine coronary angiogram following a positive stress test done after he complains of slight chest discomfort on waliking up staircases at his office. At angio, noted 70 % diameter narrowing in the distal Left Main. I have scheduled him to see my cardiothoracic colleague in a week's time. He need bypass surgery. A low risk straight forward case for my surgical colleague. A tough decision for me though to send young chaps like him to go under the surgeon's knife, but a left main is a left main.
It would have been just a half hour job for me if I were to proceed from the angiogram and do an ad hoc angioplsty and stenting procedure. Just need to cross his narrowing with my guidewire at angioplasty and ballooning and subsequently putting a drug eluting stent across it.

Easy.

But I am not going to expose this young man to that 0.5 to 1 % chance of possibility of 'sudden cardiac death' [ SCD as a euphemism] due to 'subacute stent thrombosis' [ SST], post-procedure for the next one year or so, despite optimal  dual anti thrombotic therapy with plavix and aspirin. On any other patient cohort, a 0.5 to 1 % risk of  SST would be OK by any standard as the result would just be a small infarct or an unstable situation we cardiologists term as 'Acute Coronary Syndrome'.  We could as easily bring them back to the cath lab as they present themselves to us in the clinic or Er as a case of sudden onset 'angina' and cross the clot build-up with a guidewire then balloon and stent. But  in the 'left main' cohort of patients , the possibility of instant death at presentation is real. This is not acceptable

Case 3, a 50 year old young lady, 20 years diabetic, HRM manger some GLC company, recently insulin dependent,with a wee bit of heart failure.
At angio, a tight Left Main Stem narrowing with severe triple vessel disease in the Left Anterior descending artery, Circumflex a s well as her Right Coronary artery. Good surgical candidate but my Cardiothoracic colleague will curse me while operating. Diffuse disease, small vessels, many lesions, these are typical hallmarks of neglected, long-term diabetes. I pity the surgeon. We are giving them difficult cases to do nowadays !

Case 4, the chap is still in CCU, second day post infacrt.
68 year old Malay chap, looking his age. Already had two stents to his coronaries done at IJN in 2000. Bad neglected diabetic mainly on self medication, buying his drugs from pharmacies mainly. Chronic renal failure on haemodialysis over 10 years as well. Sudden onset low grade chest pain after hemodialysis at the hospital in the evening. Called to see patient in the ward at one in the morning as pain persist. Angiogram at 2 am showed, OMG!, a very tight Left Main lesion [ the culprit aretery causing the chest pain ] and diffuse three vessel disease worse than Case 3. He survived the infacrt because there was partial  spontaneous recanalization. Not a staraight forward case otherwise I would have ballooned and staented him.

Todate, still hanging on in CCU. Left Ventricular function on echo  assessment, moderately poor which make mortality risk during intervention higher. 
Other option? Leave him alone on medical therapy....not quite acceptable in 2012.

I have to find himone very brave Cardiothoracic surgeon and a superb anaesthetist... still searching.
[ ....this week, reminded me of the fleeting and transientness of this earthly existence, it brought me back to the three ,central and pivotal elements in each individual muslim's life : ILM , IMAN & AMAL ]

                                                                         Part 1

Part 2:-  

                                         

                                                                         Part 3 :

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

Fresh Catch from "Tafseerkoran.blogspot.com"/For Those Who Think:-
http://tafseerkoran.blogspot.com/2012/11/surah-al-hijr-5prologue.html

Case History : A Young Man with PPH....

Ali  Johar, [ not his real name of course ],27 year old junior technician working with a port authority in Pasir Gudang , Johore, walked into my clinic two days ago complaining of 'progressive shortness of breath' over two months duration. He told me he needed to stop twice for breath walking from the underground car park to the hospital lobby. Coming from a 'vital' 26 year old , I was immediately all 'ears'.
Examination was remarkably normal apart from a 'pursed' lip while breathing. He appeared fairly breathless just sitting there on the couch. This is not good. Not good at all. No overt evidence of heart failure.

ECG and Echocardiogram done at the same visit 'shocked' me. Routine chest x-ray was normal except for  an over-prominent pulmonary arterial shadow. That clinched the instant diagnosis of Primary Pulmonary Hypertension, a  very rare ailment.

CT  of the chest  and doppler echo studies of the leg veins done in the same evening, more or less confirmed the diagnosis and exclude the possibility of another cause for his 'breathing difficuly, a  relatively common diagnosis in camparision with PPH  ie ' chronic pulmonary embolism... a condition where you get continued, chronic,  'plugging of the lung circulation by minute blood clots ,over time, coming from the deep veins in the legs and pelvic region.'

His ECG showed obvious 'right heart strain' and in the echo, the right heart [ right ventrical and right atrium ] are both enlarged! His PA systolic pressure [ pressure in the lung circulation, normally less than 20 mmHg ]on echo assessment is 115 mmHg , as high as his systemic pressure on the left. This is bad, prognostically- speaking.


PPH video:-

What is my specific plan for this unfortunate young man?

I  am referring him to my  former student and junior colleague in IJN who 'subspecialise' on this disease and is currently the  director of  their 'heart and lung' transplantation programme. Six months to two years down the lane, my gut-feeling is that, this young man would need a heart and lung transplant, judging by his markedly raised PA systolic pressure now.  Whether he would get one is another matter I would not want to ponder about. Waiting list  is long 'plus plus', and hearts and lung from 'donors' very in very short supply. Only 'accident cases' in  'brain dead'  circumstances qualifies.  Even then, family consent is difficult to get by. This is the real world...

Even if he gets one,  one year down the 'lane', there is the incessant  problem of host versus graft disease; graft versus host disease; and myriads of other issues; and last but by no mean the least,  is cost.

In the interim period, IV prostacycline infusion initially,  and the new oral ones recently introduced may tide him over. Very expensive treatment , a couple thousand RM a  month! Oral viagra or cialis , which help lower the pulmonary circulation pressure have been helpful in some, giving a new hope of better symptom control in many at less cost.

How do one tell  all these to a previously bubbly 26 year old, younger even than even my sons and daughter;recently married young chap; with a  young innocent wife and a six month baby in tow?!  Just three months ago he  was still playing 'futsal' with his work colleagues in JB......
That in practical terms, his life will be  drastically 'truncated'.
.
I am reminded of an old professor of medicine at Massachusett General, Prof  Sir William Osler, doyen of American medical fraternity at the turn of the previous century, who used to say: " The science of medicine is long and arduous, the art is even longer.."
How very true. I am still learning......

Inna lillah hiwainna ilaihirojiun.
From Him we come , to Him we return.

Case History : The Good, The Bad and The Ugly..Scene 2

What a day today. I am on call for the hospital covering all cardiological admissions  'after office hours' till 8 am tomorrow., meaning all cardiological emergencies and referrals..... Still very high on adrenaline at 2 am especially after the last ' primary infarct angioplasty case which I had just now, I could not sleep......

Started the day very well at 6am after 'fajar' prayer, did a short surf on the internet just lurking around and reading my mails etc  and etc. Came across a wonderful  already 'dated' utube  'article' from Down Under. Very happy to note that my  fellow endurance competitor Meg Wade, four time Tom Quilty champion, and several consistent top ten's at world level, recovering very well from her near-fatal equestrian  brain-injury sustained  after a fall in mid 2009 in a local 160 km ride in Australia.
[  http://www.abc.net.au/news/2011-11-20/back-in-the-saddle/3682640?section=sa ]. 

Indeed Meg Wade up to the time of the 'spurious fall', [ that can happen to anyone actually competing at any level in that 'crazy' but self enduring sport ], the top rider in the world, following  and replacing the footstep of the legendary,aging Ms Valary Kanavy of USA, the undisputed endurance queen of the early  and mid 2000's. They share the same common denominators: They 'eat, sleep and breath equine'. Kanavy is born into 'old money' in Vermont, USA with acres and acres of  farmland ideal for endurance. Meg Wade used to fly her own helicopter to keep track of her farmland herds in northern Victoria, Down Under.

We went a long way together even though we do not know each other personally.I first competed with her in the World Equestrian 160 km Championship  in Dubai in 1998, myself riding and ex-race Thoroughbred, Boss, very much a 'rookie' at that time.  Then, at Canberra Open FEI 120 km in 2002,  where she was a very fast 1st and myself just completed at 9th position. Another event locally in Putrajaya over 80 km in 2012, a small event for her presumably. Again in the World Equestrian Games at Jerez, Spain in 2003.  I think she was top ten at that Game. I was around number 40 in a field of two hundred horses, when my mount , Floyd , a leased horse from  France, collapsed at the penultimate round of a total of seven rounds/phases of riding . Exhaustion plus plus, camouflaged by massive herbal antidote given by my French handlers.  I had on board a heart rate monitor on Floyd and he was looking good all the time 'cardiovascular-wise'. I was too polite to tell the FEI people about the 'herbal thing' given to Floyd at every rest stop, and thus was made to be a 'pariah' in the international endurance scene, for prusumably 'pushing the horse to far'. Horse death in the sport, especially at this level of competition, is taboo despite everyone wanting to do their best. A paradox.  I was exonerated a year later by the Secretary General of FEI himself, Mr Michael Stone. The French Equestrian people,  of course went ballastic  and their 'press' had a field day on  me for weeks after the event. Lucky I don't read French! But looking back, it is all worth it. I lost face for a year, at the most two. The lady owner  and her husband lost her horse for her  own 'naivity' and mistaken belief that 'things herbal are OK and cause no harm! . My disclosure at that time would have cost her more 'pain'.  I can handle my 'pain' but was not sure it is fair that she should have a share of it, at that point in time. Time is a great healer anyway.

By morning outpatient clinic I was into the 'thicks of things'. Saw  a young Malay chap, just 34, obese plus plus, who came in with classic 'angina', with a total cholesterol of 9.3 mmol !! Stress test  is positive. He need admission rightaway for a  coronary angiogram, to get a road map of his coronaries, plus minus angioplasty plus minus ad-hoc 'stenting' 
http://drnikisahak.blogspot.com/2012/05/procedures-in-medicine-coronary.html

At angiogram, was found to have a 'left main stem' lesion. We , plumbers' , whenever, we see a LMS lesion on the screen would say a little prayer of: " My God, let me finish this study without mishap ". If a LMS blocked 100 % acutely, it would mean instant death for any individual. And an occasional LMS do get disrupted occasionally during even an angiogram study.
 http://www.medicalnewstoday.com/releases/81412.php 


This young man, in my book, will be scheduled  for 'bypass surgery' soon. It is not often now that we sent our patients for CABG [ 'bypass surgery'] given that stents and equipments for angioplasty are becoming better and better with time and techniques have improved by leaps and bound, making cardiac surgery in most cases almost unnecessary. Cardiac surgery , from the standpoint of bypass surgery, is fast becoming a 'sunset profession' the world over. Only valves operation remain their last bastion and even that is going the 'endoluminal' way as cardiologists are invading into their turf with new valves. I emphaties with my surgical  colleagues but the problem facing  cardiac surgeons all over the world is monumental and fundamental at the same time: While in cardiac surgery especially, they basically have only their pairs of excellent hands and skills to depend on, we cardiologists have  a myriad of people and new 'tools ' to play with: bioengineers, geneticists, new science, the whole gamut of the fast moving pharmaceutical industries and free enterprise , are all behind us.  It is not a level playing field certainly.

Having said that, LMS is still in 2012 , at least in my book,  a 'surgical animal' in most countries except Japan and Korea. I will refer patients for surgery , even at 34, without having to think long and hard about it. I belong to the 'conservative' very 'British school of thinking'.

My patients oftentimes ask me why we Malaysian cardiologists do not follow the Japanese or the Korean way and do more 'Left Main Stem' cases, apart from the occasional ones during dire emergencies. I  always have to tell them my favorite story:
In Japan, if a patient dies on 'the 'table' after a difficult procedure, The 'professor' can be assured that the next day the late patient's  son of daughter would be queueing  dutifully in the professor's outpatient clinic or office with a bouquet of flower for him and some form of 'profuse' apology to the effect, ' Sir, I am sorry my late dad gave you a lot of trouble etc etc and etc..'.

Elsewhere in the world , including ours, we may be lucky to escape with a very 'hot' lawyers letter fishing for details and what not! Time has change.

At 10.30 pm I get called to see a 43 year old Chinese gentleman with sudden onset central chest pain and profuse sweating plus plus. He was drenched in sweat when I saw him. EKG showing an acute phase of an oncoming 'massive anterior infarct' [ heart attack affecting the front part of the heart due to 100 % blockade  arising from a plaque rupture]. An ST-T EKG changes of 5 mm depression in all anterior leads....very 'angry looking and threatening EKG' indeed!
No time to waste. His lungs were getting 'wet' by the minutes. Every minute and second counts. He was brought straight to the cath lab and our emergency team alerted for a 'salvage, emergency procedure. We must get a 'road-map of his blocked arteries and 'start from there.  Surgery is out of question, there are 'slow animals' as far as we are concerned. At angio,  I nearly 'died'.I found out he had an acute LMS  total occlusion.. My God!!...seconds count now.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029447/

I could not cross his acute occlusion with my 'guide wire'.
Pulmonary oedema sets in very fast,  breathing difficulty,then slow heart rythmn [ 'bradycardia' ], followed very fast by no rythmn, then, ventricular fibrillation [ cardiac arrest ].
When things like these happen , they happen very fast. No time to stand and stare.
Patient succumbed on the table at around 1 am, despite more than one hour of resuscitation..

'Innalillah hiwainna ilaihirojiun'
From Him we come to Him we return.
Post Script :................ Now in 2021, Left Main Stem with Multivessel angioplasty and stenting are very common place. The Park brothers of Korea have for the past 3 decades, shown the world that it is safely "dowable", with conparable results. The West, Americans, French, Europeans and British, were initially slow to catch , up but now, Left Main Stem stenting and angioplasty are acceptable everywhere......... From my personal perspective, more than 50 % of the cases that I send for bypass surgery in the past, by present " dowability ' and good results status, I would angioplasty and put in stents......... Such is progress in stents and stent delivery. That 34 year in 2012 that I sent to bypass surgery in 2021, I would have in 2021, easily stented , with equally good long term result.

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


A Current Article from " For Those Who Think ":-

1. Key To The Garden : In Pursuit Of Happiness
http://tafseerkoran.blogspot.com/2012/11/key-to-garden-in-pursuit-of-happiness.html

2. Key To The Garden : 'Caravan of Illumination'
http://tafseerkoran.blogspot.com/2012/11/mokhtar-al-maghraoui-algerian-in.html

Case History : The Good, The Bad, The Ugly.....

What a week !

First I have Ananda Arumugam [ not his real name  ]walking into my clinic after an absence of 6 years. A post infarct patient who lost his job because his boss thought he could no 'longer deliver'. Now a 'boss' himself with twenty or so people depending on him.

Then there is CML, a young Chinese engineer,  just turned 32 year old and just married,  with advance lung cancer complicated by disemminated neoplasm to his pleural cavity [ sac  covering the lung ] resulting in fluid accumulation and partial collapse of both lungs; acute  blockade of his pulmonary circulation [ pulmonary embolism ] due to increased clotting activity [ increased thrombogenicity ]arising from the cancer situation; and if this is already not enough, a very tense and 'compressed heart' due to malignant fluid accumulation in between the heart and it's sac. We termed this 'pericardial effusion leading' to a 'tamponade.
This young man has advance cancer [ stage 4, ie disseminated ] and in real deep 'shit'.

I had to do an emergency evacuation of the malignant accumulated fluid by doing a pericardiocentisis [ pericardial tap] ...[ http://www.nejm.org/doi/full/10.1056/NEJMvcm0907841 ]
That was just the beginning of things to come. He needed top notch specialist oncological treatment with the latest chemotherapy regime available. Two days after the pericardial tap, he went into respiratory failure due to the  dual additive effect of pulmonary embolism and his  lung's encroachment by disseminated  cancer. Needed to be actively ventilated to tide over the acute situation while the chemotherapy take its slow effect.
Prognosis ? G. O. K
Statistically speaking,probably two years at best, in the best of centres[ http://drnikisahak.blogspot.com/2012/08/on-death-and-dying-expiry-date.html ]. Not great ! But this is the reality of life when you happened to be in a 'deep shit' like this.

Madam GkL, 61  year old Chinese lady arrived at our ER in 'extemis'. She was pulseless and not breathing. The ER Medical Officer noted 'ventricular fibrillaiton' on the EKG meaning she has a 'cardiac arrest'. [ http://www.youtube.com/watch?v=nxpYuVr53zQ&feature=related ] The ER  in my hospital is one of the best place to have a cardiac arrest in the whole of KL and PJ! The staff  there are all superb at bringing back people 'who are actually ready to go to the other side' and pull back to 'this side of the realm'. After half an hour of active resuscitation and ventilation, GKL' heart comes back to sinus rthym. She was by now on artificail ventilation and my anaesthetist colleague was in charge of the 'breathing'.

"Sir, you wife has massive acute myocardial infarction and I am bringing her straight to the cath lab now to do an angiogram to look at the blockages and open them up with  balloons and then tacked them up with metal  wire-mesh  which would act as scarfolding, called 'stents'. We have no choice and time is of the essense...it is early days now for us to tell the effect of the cardiac arrest on the brain...that we have to assess later.............". One hour later in the wee hours of the morning she came out of the cardiovascular cath  lab with all her blockages opened  and three 'stents' implanted. That took care of the heart. [ http://www.youtube.com/watch?v=CGwiJjiASEY&feature=related ]..The effect of 'hypoxia' [ lack of blood flow, or no flow due to cardiac arrest ] on the brain need to be assessed the next day. Need to give her sometime

On the 3rd hospital day, she is still fully ventilated, brain function assessed by EEG showed minimal activities. Outlook is grim: a long term vegetative state as a possibility was on the card, 99.9 % probability. She has global 'hypoxic encephalopathy', the period of no 'oxygen and no blood flow to the brain' while arriving to hospital was too long. [ http://en.wikipedia.org/wiki/Cerebral_hypoxia ]

I had a long discussion with her husband. He does not foresee a' vegetative' situation as something that his wife would have liked.

" Doc, you are Muslim and I am also People of the Book. Both of us believe in Him in our very own ways. What do you think I should do?............."

" We have done our utmost best, me as a doctor and you as her husband.....As a Muslim I entirely agree with your plan to bring her home and let God decide...but Sir, things will happen very quickly the moment we wound down her treatment and especially the active ventilation. At the moment she has no ability to breath by herself, the 'signals from the brain are not there' , so to speak..whatever we decide, let your Canada -based son and daughter  arrive at KLIA first tonight and see their mother still alive, after that I will unwind everything....I am not playing God of course..it is just the small things that He allow us to play around with....you know what I mean..it would be kinder for your children, in the long run...and I would do that, if you  and your children could come to an agreement all round....".

That is the Good, The Bad and The Ugly  handed to me on my plate this week.

At this juncture in my private and professional life, I wish I could  be involved more in all  my patients' spiritual life due to this feeling of 'mahabbah' for my fellow humans  but societal, medico-ethical considerations and political correctness, does not allow that 'boundary' to be traversed. A pity.....

Innalillah hiwainna ilai hirojiun....From Him we come, to Him we return.

Case History : Young Man With An Attitude...

Ananda s/o Arumugam [ not his real name , of course ] was only 32 when he had his 'heart attack' some six years back. I could still remember the medical officer on duty at ER calling me at 3 AM  at home saying that he had a young Indian chap who was wokened up  an hour earlier with gripping  chest pain radiating to his jaw and back in between his shoulders associated with dripping cold sweat. 
I told the ER doctor to summon our emergency cath lab team for a 'primary infarct angioplasty and stenting' rightaway. Time is MUSCLE LOSS in this situation. 

 http://drnikisahak.blogspot.com/2012/05/procedures-in-medicine-coronary.html ,    
 http://www.youtube.com/watch?v=TS0Je1m9Q8A&feature=related
   
One hour later , with two, cobalt-chromium, drug eluting stents in his initially occluded Left Anterior Descending artery [ I always fondly called this, the' Federal Highway'] and  one long  38 mm stent in his Right Coronary artery, Ananda was breathing better in CCU. He had a full blown massive anterior infarct just one half hour in the making and TIME IS OF THE ESSENSE. His saving grace was that he arrived early, otherwise , there would have been more  'unsalvageable ' muscle loss leading to impaired LV function, weeks,months and years 'down the lane '. Discharged well on the 4th hospital day and given one full month MC since he needed a lot of rest for recuperation : he was a 'two-tonne'  small time lorry driver to a small ' Chinaman ' outfit. Despite this he had the right attitude. He took the right health insurance cover despite his meagre income.

On the first outpatient follow up Ananda dropped me a bombshell: Ah Kow, his boss, has asked him to stop work, on day one when he reported back for duty, since he thought Ananda would be a liability in the long run. With cash running low, three hungry young mouths and a wife to feed, and no decent job on sight in the near future Ananda requested me to refer him to Serdang Hospital for further outpatient follow up. I consented.

" Ananda, don't despair. Go back and do a lot of thinking . This is an opportunity for young man like you to 'fly'.... God is merciful and compassionate. He will look after people like you, insyaallah !....etc etc and etc "

Today, 6 years later, Ananda suddenly showed up at my busy outpatient clinic for a check up on a niggling 'chest pain '. I was happy to see him again, looking well and prosperous........
Stress test OK, Hbaic not bad meaning his diabetic control is almost optimal, Echo showed normal LV function.....Great news.
" Ananda, you are fine..your ECG does not not indicate any evidence of 'heart scarring'  at all and your echo showed excellent  heart muscle contraction. It is as if you never had that heart attack six years back. Disregard this pain, it is just muscular ", I retorted , reassuring him. " What have you been doing this six years since your dismissal?"

" Doc, I took your advise...now I have 20 people working for me collecting plastic and bottles..I have three lorries and I pay 30k a month to my people in salaries ".

It is 'basic' people like Ananda that keep me going and plodding on...he made my day today.

utube rage...............

We Muslims , as an ummah, should not be overly concerned over the recent utube misrepresentation of our Prophet. These clowns in the West do not have a future that we all have. Instead we should  feel sorry and pity them for being lost sheep.

We are like a huge supertanker, moving on and on, albeit a wee bit slow about changing direction, but the  'captain'  is still very much in charge, and his 'compass' is  in good working order.

We still have our 'BOOK' [   http://tafseerkoran.blogspot.com/  ]   and the  SOP's are still there very much intact while the rest of the world are already in their 'dinghies' and 'safety boats'  rolling about in the sea without 'directions'.

We Muslims are enjoined, along with  the rest of humanity, to 'read' the two great Books of Revelation and Creation. We still have the first Book, 100 % fully intact, while the rest of humanity have had theirs pretty much adulterated and manipulated several times over, beyond recognition. Early Muslims from the 7th century to the 14th  gained much ground because they followed the precepts of the Book of Revelation and they were  in the forefront 'reading' the Book of Creation. We present day Muslims need to reassert our confidence in  the former and find our way back with the latter. A monumental task but something 'dowable'  with the proviso we stop aping the West and follow their dictates .

PR-wise, we  may think we are losing ground because we do not have CNN, BBC, CNBC, Aljazira, Hollywood and all that jazz. But by Allah we have  the internet, utube etc and etc ! With a wee bit of luck, in due process,  we may even be able to bring back those very  lost souls and clowns back  to 'fitrah'.

Just look at the Arab Spring ! Despite very heavy European and American involvement, things are not going in  the direction they would like it to be. 
' Cest Dieu Qui Direct ' ,  it is human to plan, Allah Direct.

This is the age of connectivity and globalization, and we better make full use of it. 
Allah, insyaallah, is behind us !

This seem  rather a simplistic way of my looking at things. 
TJ Winter and Yahya Rhodus look at the issue at a higher scholastic level  and plane :

TJ Winter aka Abdal Hakim Murad,
"Rida and Acceptance "
Part 1 : http://www.youtube.com/watch?v=kMuMS0dgNrI
Part 2 : http://www.youtube.com/watch?v=phdKJihf_hE&feature=relmfu
Part 3 : http://www.youtube.com/watch?v=lcun57cKSsc&feature=relmfu
Part 4 : http://www.youtube.com/watch?v=Zt8VmlFV_ew&feature=relmfu
Part 5 : http://www.youtube.com/watch?v=zl81VIIwH2U&feature=relmfu


Shaykh Yahya Rhodus,
" The Science of The End "
Part 1 : http://www.youtube.com/watch?v=dcQeu1v4KFQ&feature=related
Part 2 :  http://www.youtube.com/watch?v=areFiCkWZ1Q&feature=relmfu
Part 3 :  http://www.youtube.com/watch?v=PrxaTF_njeo&feature=relmfu
Part 4 :  http://www.youtube.com/watch?v=1UotEXTa3tA&feature=relmfu
Part 5 :  http://www.youtube.com/watch?v=LE0e76hj1dE&feature=relmfu
Part 6 :  http://www.youtube.com/watch?v=OZFVaSxRtXI&feature=relmfu

For Those Who Think : tafseerkoran.blogspot.com

Was in Alor Setar over the weekend attending to a medical school classmate's son's wedding [ Dato' Dr Zahari Che Dan].

Across the  table, one neurologist, 3 general surgeons, 3 family practioners, one timbalan naib chansellor and a lone plumber.

All talking of old days  'exploits' some 35-40 years back. 

I recollected borrowing Zahari's brand new sport bike to 'tayang' to a girlfriend in SecondCollege, MU.

It was an uphill climb.

On coming down the  steep Second College hill I could not understand the brake.

Whizzed across the road at 60 kph into the belukar !!

I am still alive today, mashaallah !

Could not sleep that night.

Life too short.

All of us, across the table, in our varying frailties and not 'young' anymore....

Never like this kind of meeting but this is a necessary  social 'evil' in our daily fabric of life....

A new website is born..............................

We will start with probably Menk's tafseer of al Fatihah, perhaps too elementary..

Dr Israr's would probably be more comprehensive...............

Utube is still not around when Mawdudi was here  otherwise he would be interesting........

Syed Qutb is more radical

Interesting possibilities, combination and permutation

http://tafseerkoran.blogspot.com/2012/09/the-quran-for-those-who-think.html

Conversation on Islam : Philosophia Perennis

Dear  Mazeni,

Young man, you seem to be everywhere !

I was rummaging through Kapar, Klang yesterday [ my afternoon off from the hospital ], looking at some cool sheep called the Mulberry sheep of Barbados. They are sheep but look like goats, with little hairs ! It seemed they are resilient for our climate and I intended to get a stud or two for my 'hobby' farm, to cross with the local Malin breed...I stumbled upon a man, with a taliban-like janggut, a mafia in the local lembu business, forgot his name..he said he know you and you have a significant 'lembu presence' in  Kapar , near his. Mashaallah ! One of the best and safest pair of hands on this side of the southern hemisphere and the numero uno paediatric cardiology brain in the country, dabbling in lembu ! The agric people should have given you the NFC grant rather than to the husband of that MP from Menglembu. You would have been more substantive  and definitely not an embarassment all round to the government of the day !

Today, I was as usual, after Friday prayer, surfing thru the net for more info regarding the triad of  Martin Lings, Rene Guenon and Fridjouf Schuon plus minus  Seyyed Hoessin Nasr and lo and behold  I came across your most wonderfully written passage on Titus Burckchardt,  aka Shaykh Ibrahim, the noted sufi scholar.

OK, let me go straight to the jugular since both of us are busy people:

Years back when I was in 'communication term' with Prof Wan Mohd , I used to asked him about Martin Lings, who probably wrote one of the best , if not the most readable  Sirah on the Prophet. He just died at that time. The good prof said, " insyaalah, may god help him, he is a perinealist !".....the good prof sounded negative to me. Now the good prof does not dare come near me...[.I am an academic pariah probably, or he would suffer drastic pay cut, writing in my column !]

Later,reading about them, on the superficial level, with all that jazz about 'transcendance of religion' , at the superficial level.....it sounds  more negative.

I am a fan of Prof  SeyyedHoessin Nasr and spent hours going through his utube  lectures , and reading about him elswhere. I find that if we  do  allow ourselves to get beyond our superficialities , and our inherrent need to isolate and to compartmentalise these rarefied individuals into narrow confines, our view of them will not fall  into the narrow perspective as the madrasah's ustaz........you certainly know what I mean , I cannot put it into words....

WHAT IS YOUR  PERSONAL TAKE ON THIS perennialist issue?

Let me rephrase the question :
I want to 'bersangka baik' in the main.

From my limited understanding my take on them is that, what these people are actually saying  was ,secularism and materialism are the cause of man's heedlessness in modern time;

this heedlessness is not bringing us any where  except a path of universal specie self-destruct from the moral as well as material sense....let alone from the spiritual sense.

It is time that humanity go back to the great religions of the past [ traditions] that share many common threads.

That is the gist of their argument or position.

It is hard to belief that at their rarefied level that they are ignorant.
'Political correctness' maybe, given that Schuon, Lings and Rene , all share a Judeo-Christian perspective, before becoming Muslims. As for Nasr, my only guess would only  be 'intellectual arrogance' combined with trying to pander to a Western audience who only want to listen what is sweet music to them. Or otherwise lack of intellectual honesty in calling 'a spade a spade'.

In this perspective, I am sad that Tariq Ramadan seems to be following the same trajectory, though in a different landscape.....I pray not. 
We do not want to lose him, but we would be losing him if he carries on with his hare- brained project of 're-interpretation of the Quran.' ! 
[  http://drnikisahak.blogspot.com/2012/08/muddle-and-puddle-within-islam.html ]

......Of course some imaginative dissenting people, ulama'  and scholars included,are saying that these triad et al are saying the great religion of the world are all the same in essense.

there lies our problem  with the periennial philosophers......
then you have the bandwagon of clowns  and pseudo intellectuals from our local  nusantara breed, such as MM,  Kairi et al  etc and etc saying 'ah, all religions are the same, at the highest level' !!
Very suave politically correct position ! Good for election and getting votes...
Indonesia, our neighbour, seem to be a  very fertile breeding ground for this kind of pseudo intellectualism.

I think, and I hope that  we misread or overead these triad's objective. Or I may be wrong.

YOUR ESTEEMED  COMMENT PLEASE.

Nik Howk

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

Dear Nik,

Salam aidil fitri. I apologize for this late response to your e-mail. I do not access e-mails at home and it happened that yours came during the long hari raya break. When I first read it on coming back to office, I thought I need to digest a bit before responding, ya lah, not the usual kind of e-mail.

1)Like you and many others, I have learned a lot from the perennialist in terms of understanding our religion(and the need for one in general) from the philosophical and intellectual angle. Not that this is a necessity, the simple folks and the unlettered often have stronger iman than us, but why not. I find Schuon’s “understanding Islam” exceptionally brilliant, although I had to read and re-read a few times over, from medical school to MO and even bila dah jadi cardiologist. SH Nasr is also brilliant when he critiques modernity and the loss of spirituality, and is brilliant when he argues in defence of Islam, as well as his writings on Islamic art. I also agree that Martin Lings’ biography of the Prophet(SAW) though written in seemingly simple language, is very eloquent and inspiring. I also like biography on Shaykh Al Alawi, though it was written as an academic dissertation. As for Burckhardt, I think he is brilliant when he writes about Islamic sacred art, architecture and traditional communities. In his 20s as a young man he lived in Fez, morocco and learned Arabic and Islam from the great shaykhs of morocco, and a small book of his that I really loved is his translation of some letters Shaykh darqawi wrote to his pupils(letters of a sufi master, I think). In the 80s followers of shaykh ab qadir as sufi in the UK made a full translation of the rasail, but the language does not match burckhardt’s. So much so that I visited morocco twice esp the city of Fez in the 2 years I was in the UK.

To cut it short, I have a great esteem and admiration for the perennialists. I think they are intellectually gifted individuals and have a very important message to the modern man.

About philosophia perennis –I have a bit of misgiving of it. To bersangka baik , I assume that it is tawhid seen from  the western intellectual understanding of the concept although one can sense at times that this is treading on slippery ground. But it is definitely not the crude religious pluralism as preached by some, and worse, for political expediency. Even if we may ,think these gentlemen say that all “authentic spiritual traditions”( a term nasr likes to use) can lead to salvation – and this include  Hinduism and buddhism –but  I am also baffled that they chose the “shariat “of islam, and making themselves known to their readers as muslims.

2) In the early 90s, if I’m not mistaken, I read an article by an ex-follower of Schuon denouncing the deviationist teachings and practices of the sufi order he founded in Minnesota, tariqat maryammiyyah( as of Maryam , the virgin mother of Isa AS).

The practices allegedly include zikr sessions with men and women in the nude, and there is even a photo of schuon from the waist upward unclothed. Also weird drawings by schuon..Seemed like how modern day Sufism commonly end e.g al arqam, the darqawi followers in the UK,becoming pseudo-sufism around a highly charismatic cult figure. I did not investigate this further, but I heard nasr, being a faithful disciple of schuon, is also into this. You might want to check this out with Prof Osman bakar.  

If that is what actually happened to schuon in the twilight of his years, it is really sad. But No one can take away the brilliance of his works written nearly half a century earlier. 50 years is a long time and we change, sometimes for the better, somes the opposite. I do not hear of this about Burckhardt or Lings,and I hope I will not. At least Burckhardt, from some insight that nasr gave us, is a more of a contemplative and discreet gentleman, not someone who draws people towards him.

3)Yes, Kapar is where my kampong is, near puchak alam & saujana utama,and that is where I have my lembu and kambing. Am slowly developing the place so that by the time I retire it becomes a viable business operation that provides a few jobs and preserves part of my kampong from the fast encroaching urbanization. Farming, like many life skills, is something that even kampong kids today do not have. This is one aspect of “the crisis of modern man” that perhaps nasr should write about.

May I know your take on these too Nik?

mazeni

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

Dear Mazeni,

I am quite confused because these are not ordinary people.   They are creme de la creme of ultimate scholarship. It can be said that their 'road to Makkah' are highly esteemed, and by Allah , I pray that souls like Martin Lings, may find special place amongst the beloved.  Like you I 'bersangka baik'. But listening to this short Martin Lings interview down here, unsettled me a lot..........
[ it is still possible to miss the last  junction  on our' long road to Makkah 'and end up in  Mina  instead!  That is the fine work of 4 star General al Iblees. No one is immuned to him, at all levels, even at the level of a Tok Guru or Shaykh ! ]

http://www.youtube.com/watch?v=k2IOKeTg3G0&feature=related

Of course as Muslims we are urged to go back to the sunnah and ultimately the Quran to settle issues and in this respect I did not have to go very far.

Al Baqarah, 2 : 41, make my heart rest in peace . It is part of several ayat addressed to the Bani Israil of Prophet' time :

O Children of Israel! Remember My favour wherewith I favoured you, and fulfil your (part of the) covenant, I shall fulfil My (part of the) covenant, and fear Me. (40) And believe in that which I reveal, confirming that which ye possess already (of the Scripture), and be not first to disbelieve therein, and part not with My revelations for a trifling price, and keep your duty unto Me. (41) Confound not truth with falsehood, nor knowingly conceal the truth. (42) Establish worship, pay the poor-due, and bow your heads with those who bow (in worship). (43) Enjoin ye righteousness upon mankind while ye yourselves forget (to practise it)? And ye are readers of the Scripture! Have ye then no sense? (44) 

[ al baqarah, 40- 44, pickthal's translation ]

My understanding from the above ayat  , cross referencing with my tok gurus, Hamka, Asad and Ibnu Kathir, is :

"Hey, you guys of Bani Quraizah , Qunanu, Nadhir etc and etc [ those Jews community fringing  Madinah in 600+ CE ], Muhammad is MY new messenger. Listen to him ! His message is universal.  He confirmed your Taurat given to your ancestors in earlier time, if it still remain intact. Trouble is your rabbis and doctors of letter have already sold them, and 'doctored' them for pittance, centuries back !"

Of course this goes without saying that the flocks following Nabi Isa were already lost sheep with their bible by 600+ CE. The Council of Nicea called by Emperor Augustine, sometime in 200+ CE, only recognized  the Concept of Trinity as the foundation of  Christianity. The rest were heretical

Our Muslim position on this should be very simple and unequivocal :

If you guys can go  back to your original biblical source, Bible or Taurat, you guys are safe from HIS perspective.

If you can't and definitely you guys can't, 
then be practical and play safe:  ...Follow the way of Muhammad.

Failing to do so run you the risk of being HIS 'fuel and firewood for Hell'.
This is not my description or imagination. This is HIS promise , peppered everywhere in the Quran...for eternity, my friends....
and please do not say that you are not being forewarned.

Definitely there is no such thing as Philosophia Perennis in my book.
These highly educated and well meaning individuals are unfortunately misguided.
But then again , this is a free world, it is their choice......to be misguided or to be enlightened.
Huwallahualam.

Nik Howk

Surah al Baqarah : The Opening Gambit....

Surah Al-Baqara
In the name of Allah, the Beneficent, the Merciful

Alif. Lam. Mim. (1) This is the Scripture whereof there is no doubt, a guidance unto those who ward off (evil). (2)

Who believe in the Unseen, and establish worship, and spend of that We have bestowed upon them; (3)

And who believe in that which is revealed unto thee (Muhammad) and that which was revealed before thee, and are certain of the Hereafter. (4)

These depend on guidance from their Lord. These are the successful. (5) As for the Disbelievers, Whether thou warn

them or thou warn them not it is all one for them; they believe not. (6) Allah hath sealed their hearing and their hearts,

and on their eyes there is a covering. Theirs will be an awful doom. (7) And of mankind are some who say: We believe in Allah

and the Last Day, when they believe not. (8) They think to beguile Allah and those who believe, and they beguile none save themselves; but they perceive not. (9)

In their hearts is a disease, and Allah increaseth their disease. A painful doom is theirs because they lie. (10)

And when it is said unto them: Make not mischief in the earth, they say: We are peacemakers only. (11)

Are not they indeed the mischief-makers ? But they perceive not. (12)

And when it is said unto them: believe as the people believe, they say: Shall we believe as the foolish believe?

Beware! They indeed are the foolish? But they know not. (13)

And when they fall in with those who believe, they say: We believe; but when they go apart to their devils

they declare: Lo! we are with you; verily we did but mock. (14)

Allah (Himself) doth mock them, leaving them to wander blindly on in their contumacy. (15)

These are they who purchase error at the price of guidance, so their commerce doth not prosper, neither are they guided. (16)

Their likeness is as the likeness of one who kindleth fire, and when it sheddeth its light around

him Allah taketh away their light and leaveth them in darkness, where they cannot see, (17)

Deaf, dumb and blind; and they return not. (18)

Pickthal's tranlation of Surah al Baqarah, 2 : 1- 18

I love Surah al Baqarah

One of the many reasons is that :

 its opening gambit in its 1st 18 ayat always frightened the hell out of me,

the ayatul kursi [ 254] come very useful when I am alone in the forest , before I sleep, or when I feel I need the 'al Ghaiba' protection.

The last three ayat of the surah , [ 284-286 ] ,I read it most times in my solat, my favourite in fact,  because it always reminded me  and sums up  my unequal relationship

with HIM, a fairly balanced combination of fear, awe and everlasting hope...

It is however the 1st 18 ayat that make me lose a lot of sleep.

2 ayat on believers, 2 on the outright kuffar and omg !, something like 12 on people like most of us... Many will take exception of the word 'most of us' that I used here.

'The neither here nor there' people, of what George W Bush [ he is probably drunk most time on his Texas farm now ] put famously as, 'ARE YOU WITH ME OR ARE YOU AGAINST ME.

Yes, are you with HIM, or are you not with HIM ?....God may ask

The top guns amongst us wheel and deal 100 % of the time on riba.

The rest of us mere mortals have our car, housing and whatever loans on interest.

we think  full time material and secular thought.

Our visions and aspirations are mostly secular.

When we have disputes we have them settled by man-made laws.

We cannot think beyond Reid, at least in Malaysia.

It has even become ' pariah 'and uncivilised to even wonder about hudud or the sharia.

This political correctness has even crept in the local Muslim minds.

In some places in the world, one may even get 'droned', nuked or a UN resolution passed for outright  invasion, if one think sharia !

Just yesterday someone brought up a case in our courts that cross dressing is indeed a human right

Homosexuality and lesbianism are ok !

To not want to accept now is no longer tenable in the public sphere

Zikr, fikr, solat, alms and doa are now dinausaurs in our day to day lives

And if we do, there are obvious lack of presence

Our children, blinded by 24 hours of astro and video games, we do not know what go on in their tiny weeny brains.

Right now seem to be inordinately wrong, and wrong become obviously right.

Deaf, dumb and blind; and they return not.........

remember that in a time before time, this conversation took place :

'alastu biRabbikum?'..am I not your lord ?

'balaa shahidna'....yes! of course You are....!

and now sadly, Deaf, dumb and blind; and we return not.........

Nik Howk

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

 Date: Fri, 31 Aug 2012 12:23:01 +0800
From: kdin63@yahoo.com
Subject: Re: al baqarah...opening gambit.
To: drnikisahak@hotmail.com

a friend made a comment why the word gambit was used for  surah al-baqarah..he associated the word to a chess game...

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

But why not ?

I was  a chess player in my younger Malay College days and I liked to start most games defensively by adopting moves known in the business as 'Sicilian Defence'.

Not an aggressive way to start a game certainly, defence moves made all  around the 'King' in place right from the beginning.

Allah chose to start al baqarah right away touching the jugular: the al munafikuns !!!!  

Allah could open up His Divine Letters to us in any way He likes...He could discuss apples and orange, night and day,seasons of the year etc and etc

But He chose to address the issue of believers, unbelievers and al munafukuns rightaway at the opening surah 2 !

foretelling us that at the end of time almunafikuns will form the great majority of us, Muslims......

of course  the great majority of us are believers !........but 'separuh, separuh'.

One prof even sees it fit to want to reinterpret the quran so that it can brought in line with the  current western philosophical thots and practice.
[ Tariq Ramadan, http://drnikisahak.blogspot.com/2012/08/muddle-and-puddle-within-islam.html ]

Nik Howk

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


Subject: Re: al baqarah...opening gambit.
From: aisyalam@hotmail.com
Date: Fri, 31 Aug 2012 19:41:18 +0800
To: drnikisahak@hotmail.com

Who believe in the Unseen---Muhammad Asad's tafsir has it as---Who believe in the realm of that which is beyond human comprehension---so much wider in meaning and necessarilly refers to the limitations of the human intellect---something that Prof. and others like him should take heed of in wanting to re-interprete the Holy Qur'an---according to their desires. Has not Allah swt told us that of knowledge He has given us just a little bit?

Adam

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



Adam,

What kept me awake and frighten the hell out of me all day whenever i approach surah al baqarah is the fact that in nabi's time the issue of al munafikun only arose at the time of the occasional ' roll-call ' to the war-front, defending against the invading kuffar army of Makkah. Then the likes of Abdullah bin Ubays et al came to the  fore,with their excuse, their misgivings, and  notably,their MC's !!

Otherwise things are pretty cool in downtown Medina : the Jews keeping to themselves on the fringe, the Ansars and the Muhajirins going about their daily 'cari makan' business peacefully, and the souks, I would imagine , as busy as could  be, like Chow Kit Road  in  KL in 2012. Al Munafikun remained inside the 'hearts' not something that could be seen. All joined nabi in prayers......

Now, in our time  jihad is no longer fashionable. In fact I would not be surprised that in a few years time UN would even  literally ban the word from our daily active vocab.

Rohinghas can die by thousands in Burma,

Chechens could still continue to be slaughtered by Putin for decades,

Palestinians can continue to be treated worse than dogs,

and NATO and America can go in and out of any 'Muslim' country at every opportunity for a variety of rhyme and reasons,

and we the ummah unwittingly enjoy the show on Aljazera, CNN, CNBC and BBC and continue to think it is OK. ' We are the problem that need to be solved' !

From another perspective, I just wonder in my heart of heart whether our flip flopping and dragging the legs on hudud and sharia in our muslim majority country;

our inability to rid from our lives the complete stranglehold of riba, capitalism and secularism;

our utter lack of presence in our daily prayers, solat, fikr and zikr;

our scholars and ulama's insipid and inconsequencial presence on the scene;

whether all of the above constitute 'treasonable' acts big enough to constitute the title of 'al munafikun'.....or worse ?

All these kept me awake all night, thinking......

I am scared.
I am scared that  I will not be counted as one of those who will  be allowed to go back to our original paradisal state.

Even the late dr israr, the great Pakistani thinker of our time, after Iqbal,[ utube below] was avoiding this rather sensitive issues I brought up above in his short  3-hour discourse on the opening gambit on al Baqarah.

nik howk

part 1  :  http://www.youtube.com/watch?v=drTC6BV0vrc

part 2  :  http://www.youtube.com/watch?v=QpWhfYEVfUQ&feature=relmfu

part 3  :  http://www.youtube.com/watch?v=21EXoE7FLMA&feature=relmfu

PS : 
Guest Editorial : Letter to Tony Blair
http://www.intifada-palestine.com/2010/09/an-al-quds-day-letter-to-tony-blair-from-lauren-booth-in-iran/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+intifada-palestine%2FyTiY+%28Intifada+Palestine%29

Mishary Rashid al Afashy : [ surah 41 : 19- 36 ]
https://www.youtube.com/watch?v=qcqFWr6h4qc&feature=player_embedded