Subacute Stent Thrombosis in a 28 Year-Old : Use Of Export Aspiration Catheter

28 year old, Ghazali al Ghazali [ not his real name of course ! ], long-haired, pony-tailed, a messenger with the local DHL, chronic smoker with familial hypercholesterolamia [ meaning 'high lipid level' largely due to genetic component ], had had a drug eluting stent implanted in Damansara Specialist Hospital just four months ago for a longish 90 % narrowing in his dominant right coronary artery. His left coronary was no better but stent implantation on the left side, I assume, was not possible or ideal as his left was grotty looking with diffuse disease both in the Left Anterior Descending branch as well as the Circumflex branch. The left coronary, if considered singly , is only good for optimization of medical therapy. His right culprit artery is dominant plus plus. And there lies the interventionalist's problem and potential nightmare.  He  has very  little leeway to play around due to very little cardiac reserve. In 'interventionalist' parlance... a distinct case of 'no insurance policy' to fall back on if things do not go the way he plans.

Oh dear ! When you have this kind of 'coronary tree' at 28, your future is not too bright.....
His cardiologist put him on a high dose ' statin ' to bring down his lipid level. and DAPT [ dual anti platelet therapy] ie Plavix and aspirin to give adequate 'thinning' of his blood. He ran out of medication for two weeks and this wee hours of the morning at 1 am,  landed at our doorstep at ER, SDMC with what appear as an acute inferior myocardial infarct. My provisional diagnosis is an acute Myocardial Infarction [ heart attack ] due to subacute stent thrombosis meaning, an MI arising from blood clot formation in the stent. He was in pain plus plus, clutching his chest and despite double dose of IV morphine, still no abatement of pain.  Not a good sign, the territory and the vessel involve must be massive. Time is the essence.

We immediately brought him to the Cath lab and perform an emergency coronary angiogram.
[ http://www.youtube.com/watch?v=kY5gKdFWT3k&feature=related ] . At angiogram, I noted that my provisional diagnosis and suspicion was right . There was total occlusion prior to the stent in the right coronary artery. I could easily pass a 14/1000 inch guide wire across the occlusion. This guide wire act like a life giving railway line across the occluded artery providing a base for me to pass a balloon or stent across.
If one cannot get the guide wire across, one cannot perform balloon angioplasty or stenting. For us in the 'business', getting the guidewire across the occlusion is the 1st single most important step to a  successful procedure. [ https://www.youtube.com/watch?v=ApJvxgjUOjc ]. No wire across, no work done

In Ghazali's case, since the initial angio film showed a chokerblock full of blood clots, I did not pass a balloon to open up the lesion. I change my technique to using the Export Aspiration Cathether, passing it to the blocked portion of the artery, by sliding it along the guidewire. 
[ http://www.youtube.com/watch?v=_bUMm8E0w6s ]. I made altogether three complete 'passes' across the blocked artery and suck out almost all of  the clot.

In the final angio film the artery looked fairly respectable with only some tiny clots left here and there. The stent that was implanted four months ago look very well deployed by my colleague in Damansara, so putting another stent across the old one, in Ghazali's case , in my opinion would not be necessary, and in fact would be counterproductive. Instead I gave a shot of an anti thrombolytic agent[ Rheopro ]  directly into the coronary.

Ghazali was a bundle of nerve plus plus when we started the procedure despite two initial boluses of morphine IV. Missing two weeks of plavix and cardiprin was his undoing
I managed to cool him down by divine help.
" Ghazali, I want you to concentrate on your zikrullah or kul huwallah all the time while iIconcentrate on my work ". It did wonders. I find it always help to have a 'Third Person' helping you in cases like this !

In Ghazali's case now, a young man  of 28 with two heart attacks already under his belt, with a left ejection fraction of only 30 - 40 % [ normal being 60 to 80 % ], in future,  I could see that I have to address the issue of his 'soul '.
And this is the difficult and touchy part. I have to thread carefully here.
Him, being Muslim make my job easier.

" No more' korner' baring please... !  and be friendly with the local mosque..."




Nik Howk



Related Articles in the blog :

Prayer of the Righteous
http://tafseerkoran.blogspot.com/2012/12/key-to-garden-prayer-of-righteous.html


Young Deaths...
http://drnikisahak.blogspot.com/2012/07/case-history-young-deaths.html


'Jangan Korner Baring' : Unto Him Is The Journeying
http://drnikisahak.blogspot.com/2011/02/unto-him-is-journeying.html

Just Visiting.........

After a very busy Saturday morning clinic, I went back to the ward to visit a dear friend of mine. A Malay College old boy network, senior to me by a good 10 years, we did Haj together in the mid 80's. He, dying slowly but definitely of cancer, squamous cell carcinoma of the lung, his left lung riddled with tumour masses and inflammatory fluid, his right lung still cancer free from the look of chest X-ray. Myself, a week earlier I thought I was also dying. Funny, how 'little illnesses 'can change one's perspective  to life, and  once healthy, back in the grove, you think the world is yours ! Today, I am still groogy and feeling fuzzy in the head with a tinge of that 'pregnant feeling', but already  on the verge of thinking the world is mine.

Mashaallah, this heedlessness , this'ghaflah' ! Astagfirullah hal azim.

" Doc, Dr Ashoka has not put up any referral yet for you to see Yang Mulia Sutan Kahar Budiman ...", the ward sister muttered politely reminding me I have no business here
" No. I am  an old friend of Yang Mulia. Just visiting....."

Sutan Kahar Budiman [ not his real name of course ] in his days could have done better than Sammy Davies Junior and  Matt Munro put together. A karaoake expert. A livewire at dinner gatherings. When I went into his room he was standing, looking breathless plus plus, plus supported by his children and wife on both side. He was a shadow of his old self, half the size. His hands and feet are cold and he appeared ashened. Fear sketched on his face.

I reorganized his bed, made it more upright and reconfigured it into a trendelenburgh position to prevent body slippage, and with the help of his son, got him back to bed. Standing and getting more anxious would not help his poor oxygenation in the lung.

"My friend , I know this difficult time for you... it is difficult breathing for you but you have to reallywork on your mind to take away your anxiety and ease this real breathing difficulty.  This may work if you try hard enough and sabr. Concentrate on ...ya Salam, ya Salam ya Salam....or ya Latif. Think Astagfurullah, Astagfirullah,... and  do a lot of 'Selawat on the Nabi'.....This will help you immensely." I am being diplomatic for want of something to say. He needed to be ventilated, but for what ?? To prolong his agony and give his family a false sense of something being done!? His time is up......I can see the futility of it all.

I know the score. In a few days time at the most or even tonight, Sutan Budiman may go into coma due to respiratory failure. May need to be  ventilated artificially. But as long as concious level is still intact, it is critical at this time to be in continuous remembrance. It eases the pain and the fear.....

Success is a mind game as the cliche goes. I would venture further from this. From my perspective, Life[ and  for that matter even in death ] is a mind game. If we are in continuous remembrance of Him throughout our lives,  insyaallah, even near death , we could still remember Him. And the difference is tremendous. It could well be 'husnul khatimah' and not  'suul khatimah' !

Remember the 'evil whisperer' at work.

As I sadly walked away from his room towards the cafetaria  for a late late lunch my memory was drawn to another near death incidence, some six years back. Then, I had a small piece of TOL land in Cyberjaya. I gave permission for Wak Karman from Indonesia to stay FOC on the land while he and his wife worked on a nearby farm owned by a Chinese farmer.

He must have been about half my age but hardship made him looked older. Wak Karman , being ambitious , I think, must have borrowed some money from the infamous Acheh triad to organize his own farm on some abandoned land in nearby Putrajaya. The long and short of it was that his business venture did not work. His farm was Ok but he could not sell his produce fast enough. His Chinese towkey friend, who now considered him their rival, just pulled the carpet from under him. Vegetables aplenty but no market. Wak Karman was a dead duck in a week! Figuratively and literally. His Acheh connection did not take too kindly to unfulfilled promise......

One morning the village was rifed with the news that Wak Karman was found paralyzed from neck downward, sustained after a presumed fall from a rambutan tree. The tree was at the most part, only 8 feet tall ! In Serdang Hospital he was diagnosed to have a clearcut, precise  fracture at the C4 C5 vertebrae and the CT showed clean trans-section of the spinal cord. From my perspective a nice place to wack someone really hard from the back with a long wooden thing. It was clearcut homicide, if he dies, and surely he was going to die. His breathing was laboured, his abdomen was distended from retained urine and inability to move his bowel. His young wife knew it and there was already 'desus desas' amongst the small  ' illegal Indon 'community in Kampong Meranti about potential candidates taking over 'the vacuum' with his impending demise.

The 'desus desas' was not on just generalities. There was already 'open 'discussion' on the 'specifics', whether the new suitor should wait for the three month 'eddah' or whether that was not necessary since it was common knowledge in the kampong that the couple was having a hard ' patch ' for over 4 months already and has ' not been together' . Such is justice and the nature of things operating at this level of 'illegal communites' here which not many people knew. They are basic people coming here to earn a morsel here and a morsel there, no time for superficialities and facetiousness of the upperclass!

Wak Karman was brought home to his kampong Meranti house to die and his friends expected him to die 'fast'. Many working days already 'wasted' with them milling around his house. Yasin were read, and prayers and prayers had been organized, and he was still there in bed, unmoving but muttering loudly,

" Apa ini Tuhan, apa ini Yasin !...Mana ada Tuhan !!?? "
And now a different kind  and round of prayers needed to be organized again. This must be the local 'jembalang' that has gone into him.  Wak Karman was on the whole not religious, as most of them are anyway, but this cannot be him, they surmised rather collectively.Several kiyai came. And they failed. His friends were getting anxious and exasperated. The Indons illegals are a superstitious lot, I must say, but they are a close community, helping each other in time of needs.

One night , I took time off from my call and decided to just pay him a visit.
His small hut was full of friends, some milling outside, some reading the yasin and most staring into space in despondence. The was an air of total despair that I could sense in that small, house, dimly lit by a 'pelita' powered by old used cooking  palm oil.

" Wak ! I want you to repeat after me, 'la ila haillallah muhammadarasullah' "
"La ila haillallah Muhammadarasullallah! ", he shouted
Then we read the al ikhlas together.
After that, without my guide, he did the Azan!
Mashaallah !
Everything suddenly became so much brighter.....

I walked out into the night and according to my younger brother, who stayed back for the night virgil, the 'illegals' unanimously voted and conferred me an automatic 'honourary kiyaiship'. I did not have to pay any entrance or membership fee !

The next evening Wak Karman died.
During his burial, the local police decided to pay a visit at the local cemetery, and all his friends  fled, including all the grave diggers, only leaving  the poor  imam to read the 'talkin'.
May Wak Karman's soul be amongst the blessed........


Ya mukalibal qulub, thabit qalbi ala kaa di nik
Ya mukalibal qulub, thabit qalbi ala kaa taatik
[ oh the One who changes hearts, firm my heart on your religion
  oh the One who changes hearts, firm my heart in Your obedience ]




Nik Howk




Similar Articles in the blog:

1. Cancer
http://drnikisahak.blogspot.com/2009/01/pearld-gem-cancer.html

2. Unto Him is the journeying
http://drnikisahak.blogspot.com/2011/02/unto-him-is-journeying.html

3. Book : Purification of the Heart
http://drnikisahak.blogspot.com/2012/03/books-purification-of-heart.html

[   http://www.youtube.com/watch?v=rNfQxnRoPHo  ]

Case History : Dilated Cardiomyopathy

http://www.youtube.com/watch?v=RYe-l-mP89k


In my clinical practice I do 'collect' one to two cases of congestive dilated cardiomyopathy  a month, not that rare, but my statistic is skewed because as a cardiologist, this kind of problem do land up on my 'table' .

Notable amongst them is a Malay male,  lorry driver, 45 year old who saw me some 13 years ago with a big ,globular heart on chest x-ray, coming to my outpatient clinic with complaint of shortness of breath on mild exertion. Echocardiogram examination revealed reduced heart pumping action [ contraction, LVEF ] of about 25 %  [ normal LVEF  is between 55 to 80 % ]. He is now 55, has three daughters who are now doctors, one of them in a specialist training program at the UITM hospital in Selayang. Every time I see him in my clinic, I tell him that he is the 'most successful lorry driver in the whole wide world !' His LVEF has climbed up to a decent 48%. Eddy Warman, that is his real name. With success, one do not need to use a pseudonym.
" Would you like me to refer you to Sungai Buluh ,Eddy, because there is nothing spectacular with your medications. All simple and all freely available for free in the government hospital ?"
"...Biarlah doktor. Disini ada barakah. Saya boleh bayar.. "
This 'biarlah doktor' has been going on for 13 years.
It is simple people like Eddy that keep me going all these years.


Which reminded me of a  patient I saw yesterday. And this is a digression from the subject. Not my patient actually. He came in for an 'executive profile' full examination and a stress test by me was one of the 'profile'. I was busy upstairs with my regular patients. I was late for 20 minutes.
" Doc, You guys treat us like animals!!....blah blah blah blah blah blah ", he stood on the threadmill  with arms akimbo, ready to fight. I read him well.
" I am very sorry Mr Ding, this is  totally unavoidable" , I am sorry.. ". 
We do  meet such characters in our daily practice once in a few years.
After nearly 33 years of practice, I thought of giving such young punk just a tight slap on the face , but he was lucky , I have a bad cold and was in no mood for confrontation.
They are usually lawyers. The lawyer-doctor alchemy is a bad alchemy I must say.
Lawyers somehow feel life is always confrontational.

Three ladies with congestive cardiomyopathy on my follow-up over the last 5 years did extremely well. One is an insurance banker, in her mid 40's, who came shortly after losing her baby at delivery and presented with heart failure [ peripartum congestive cardiomyopathy; cardiomyopathy realted with pregnancy ]. To make matters worst and cloud the issue further, she had dengue fever near delivery with platelet level around 12 thousand !

LVEF 12 % ! I had to ask a nurse to follow her whenever she went to the  loo. At 12 %, you can get cardiac arrest anytime or a bad fall in the toilet. Two months down the lane, she was fully active in her job and follow up echo six month later, was normal. Al hamdullillah!

The other two ladies in their 40's had 'tachycardia -induced' [ untreated fast heart beat ] dilated cardiomyopathy. The diagnosis was not apparent initially but much  later in their clinic follow up they came back with fast rythm [ supraventricular tachycardia ]which clinched the diagnosis. I referred both of them to my junior colleauge who did a 'radiofrequency ablation' of accessory pathways in their hearts. In layman's term these two ladies have an extra 'electrical circuits' in their hearts 'electrical cable system' that get  'switched on' for long period of time.
They are doing very well now and their LVEF are low normal.

...and there are young deaths as well. Mr Rodrigo, presented at age 41, a long haul tour bus driver plying Penang KL route, with a heart as big as a football, LVEF 18 %. Lasted for a long 5 years. Miraculously driving until his sudden premature demise at home from a cardiac arrest two months ago. In the UK I would be duty bound to have his license taken off by informing DLVC but in the UK they have good social security as safety net. I knew what was coming, thus advised him early on to co-opt his son to start taking over the business from him.

What is the role of heart transplantation in dilated cardiomyopathy, one may ask? It has a definite role and IJN is the place for it but one or two heart a year with a few hundred or thousands on the waiting list does not make a programme....Cadavaric heart donor is still a rarity in Malaysia.
So in my group of patients I prepare them  and their families early for possible premature demise, and do not put false hope in the horizon.

My 'champion' of course is  Mr LK Lee,a 40 year old dog-trainer, a bachelor, who spent 8 years of his life training dogs for the Saudi Police. I saw him 10 years back, walking into my outpatient clinic with bloated abdomen plus plus and bloated arms and bloated legs due to fluid retention. The bloated legs were so bad , that I could see fluid oozing out from its pores! His LVEF was in single digit and his heart was bloated and hardly pumping as seen on the echocardiogram.

Just last week I saw him on his three monthly follow up visit, looking very good.
"Lee, I did not tell you this but when I saw you 10 years back, I mentally gave you only a  month at the most to live.....", myself ,trying hard to bring the question of mortality on the table...
"Doc, this Tuhan-Allah has been kind to me . I am still able to train some dogs for a living, otherwise how I can pay your bill? "...[ Lee is still 'in this world' and not ready just yet, I thought to myself ]
" My God..Lee, you make me feel guilty. Your drugs cost peanuts compared to those guys who  had stents and angioplasty.."....
For Lee, 10 years is a long long time. Perhaps it is time I address his other 'heart' but political correctness and medical decorum does not allow me that leeway. And he is obviously not ready yet.

This is the 'stuff' that keeps me awake at night pondering, whether I have done enough.
Political correctness versus 'marhabah' for a fellow man.
It is not easy. You feel you have the alchemy and the secret to happiness in this life and the hereafter but you are not willing to share the secret  with the rest.
It is a responsibility we Muslims have to answer.






Nik Howk


ps : 
26/ 12/2013 [ one day post christmass ]

 just saw lee this morning at clinic
" kai fahal Lee? " [ how are you?]
" insyaallah doctor, alhamdullillah "
still the cheerful lee that i come to know 10 years back when he was just 47
he is 57 now, still training his german shepherds for some friends
" bila mahu masuk islam Lee,arab sudah pandai", i said half jokingly, half serious
"..belum ready, doc.."
i have a feeling of 'marhabah' for Lee after all these years
he is my favourite patient and why not: a 'left ventricular ejection fraction of only 8 %
and still around after 10 long years....a world record of sort!!!!







Other articles in the blog :

http://drnikisahak.blogspot.com/2013/01/case-history-takotsubo-cardiomyopathy.html

http://drnikisahak.blogspot.com/2011/12/case-history-most-successful-lorry.html

Purification of the Heart : " Matharat al Qulub'
http://www.youtube.com/watch?v=_ges5k0LTjI

....By Time [ demi masa ]

by time,
verily! man is in a state of loss
except those who believe, and do good deeds,
and recommend one another to truth and recommend one another to patience

surah al-asr





To a believer, in a day, one third of the night past midnight has special significance.
The skies are 'filled' with 'people of the higher circles' [ alam malaikut ] looking out hard to register any prayer and doa to be 'percolated upward.'.

In the days of the week, Friday has it's significance. The time leading to the Friday noon prayer is a feast for believers.

Amongst the months, Ramadan carries it's very special weightage, and in a year , the last ten days of Zulhijjah are very heavy and  pregnant with meanings and worth.. Of the last ten days, Wukuf day [ the day of Arafah ], is the best day of all. 

Of that day, the period between the Zohor and the Asar prayer at Arafah is the most precious time of all time for the whole year. And within that the day, there exist a short window period,
between Zohor and Asar [ Arafah local time ## ] when all the '  skies in seven heavens ' open up and the veils between the ' abdals and the Master ' just exist within the hearts of men [ or women ].
The best time for prayer, doa and supplication.

In Malaysia, that time this year would be on 14th  day, this month,Monday, between 5 pm and 8 pm. The day and time when there is ' no veil between the slaves and the Master ', unless of course our hearts are hardened to spiritual meanings and eyes dry to things of the 'al-ghaiba' !

Where would you be at that time on that auspicious day, my friend?
..and will you be thinking of Him and your days ahead of now, or still too engrossed in 'collecting the garbages of this ' al- dunya ' ?

May I humbly suggest you, for a short moment at least, to drop all things of this 'al dunya ', and  be on your 'sajdah' , praying and supplicating, do whatever, even crying, and if your eyes are too dry......just pretend.  If we ' pretend ' hard enough and frequently and long enough, insyaallah, even that heart that has become rock-hard like stone could soften.
....and when it melt, mashaallah ! You could be one of  Rasullallah's guests at 'al-Kauthar'.
Have a good weekend.


dr nik howk






Other similar articles in the  web....

my journey thru the qur'an : surah al asr
http://drnikisahak.blogspot.com/2012/01/my-journey-thru-quran-surah-al-asr.html

gunong stong revisited
http://drnikisahak.blogspot.com/2011/04/gunong-stong-revisited-prayers-of.html

prayer of the righteous
http://tafseerkoran.blogspot.com/2012/12/key-to-garden-prayer-of-righteous.html






footnote : [ ## ]

I was sitting beside Prof Dato Dr Mohd Zambri Zainuddin, astrophysicist at UM, at a marriage do of a friend in Kelana Jaya yesterday. He intimated that several time in the past several decades, the Saudis ' played god ' with time. The Saudis authorities hate to have wukuf falling on Friday since they will have difficulty managing the sudden influx of humanity flooding from the middle east diaspora and also, politically, by tradition they will have to free all their prisoners, political and otherwise, to commemorate the Haj Akbar.

What they normally do would be to  push the wukuf time forward or backward by a day, by in corporating the now seldom used hadith that the 'new moon' can be heralded when ' one or two bedoiun reports its sighting '. In simple language, they played ' stupid ', and this is allowed within the ' traditions '. Sighting the 'moon' is not archaic but picking and choose so that it will not be Friday is 'below the belt.  Mashaallah !!

Never mind modern day technology and astro physics that can calculate right up to the second, if it fits your scheme of things, let us use whatever archaic hadith there is available !!

So my friends why are we soo dissapointed that they are now centrally and deeply involved in yet another dismemberment of another  militarily strong and great Arab nation? It is in the gene inherrent in the Nejd desert.

The Passing Of Bulldog Drummond.......

Last night I was at a  wedding reception and my handphone was on a  ' meeting ' mode.
I did not notice the sms from my dear wife that..... " Pak Mae from Setia Kasih 9, just passed away in IJN ", until this morning. He died around 6 hours after an emergency admission to IJN  [ National Heart Institute ] of a massive myocardial infacrtion [ ' heart attack ].  A known diabetic for over 30 years, 5 years now on  subcutaneous  insulin injection, twice a day. 14 years post bypass surgery.


Abdul Rahman  bin Yaacub, from Chetok, Pasir Mas, Kelantan, 68, the local kampong boy, made good via education. A government retiree, His last post was deputy KSU in the Ministry of Home Affairs, having served under luminaries such as King Ghaz and Hussien Onn during their heydays of catching big time opposition politicians and writing and sprucing  up 'research paper' on them prior to his political bosses consideration,  for ISA consideration ...tough job for the senior 'neutral' civil servants at that level.

We, the Wan Abdullah clans, from the Rao family, remember Abdul Rahman  Yaacub differently. He is my third cousin. In the 60's , he and his two other elder brothers[ and their wives ]grew up in our meagre household at Jalan Teliput, Kota Bharu, the ' Damansara Height ' of KB in the 60's.
[ Two of the only three  general practitioners in Kelantan in  the late 50's, Dr Ezanee Merican and Dr Aziz, build their houses along  the prestigious Jalan Teliput. The Old British Advisor's residence'is'  a few houses away from our wooden pondok, now refurbished as an official residence for the present sultan. Dr Aru stayed in ? Jalan Kebun Sultan. Dr Aziz, to recall correctly had two houses in Jalan Teliput, a bigger one for his 1st wife an 'orang luar' , meaning non-Kelantanese , and  down the road, near ours for his 2nd, a local lady.  All the three of them, Dr Aru, Dr Aziz and Dr Ezaneee are 'orang luar'  and wealthy plus plus plus.  Just three Gp's for the whole of Kelantan! ]. 

My late father was just a chief clerk but the 60's in Kelantan at that time was a great time of sharing. We relatives ,all share in poverty and in 'relative' wealth . My late father [ who died at  the ripe old age of 41 ! ] drove a Ford Prefect in the late 50's.  By the early 60's he graduated to an Opel with a special number, T7000. No mean feat. That made him an elite!

Abdul Rahman's  school friends called him by the Kelantanese eponym,' Budok Derg'omae ', .but my elder brother, who is the same age as him and went to Sultan Ismail College with him, was more imaginative and diplomatic. He fondly called him 'Bulldog Drummond' after a fictional British pilot/hero/spy in the 1st World War. And that  endearing 'private' name stick amongst us, the senior Wan Abdullah brothers. Mr Bond, James Bond double '0' seven was not yet created, otherwise we would have named him as such. Such was our fondness.

'Bulldog Drummond' must have lead a very clean and pious life throughout, in my estimation, for Allah was with him at the time of his demise. I gather that he must have been in severe pulmonary oedema [' wet lung' ], for otherwise in a facilityb such as IJN, the obvious choice would have been to proceed to primary infarct angioplast there and then but  I gather from his son's description of  the terminal events, he was in bad heart failure which negate the 1st approach  in some instances.  

He was intubated and given artificial ventilation  shortly after to help in his breathing. He was still conscious and able to say .." Allah, Allah, Allah...". In his dying throes he asked his sons for a piece of paper. On it he  weakly scribbled,
"..read Yasin for me please.."

I told his sons at their home in Setia Kasih just now,
" Your dad died in good circumstances. Don't be sad.  I want to teach you one ilm which I              got direct from one of the Imam in Masjidil Haram some 30 years ago. Read this very short doa,..'  Rabbir Firli Waliwa Lidayya wal Mukmini wal Mukminat '..In your sujud, in your rukuk and in your remembrance of him. Insyaallah, he will be in good Hand "                      

Innalillah hiwainna ilai hiro jiun [ from Him we come, to Him we return ]
Bismillah Himajreha Wamursaha Inna Rabbi laGhaffur rurRahim
[ In the name of Allah, He is our anchor and journeying. He is al Ghaffur and al Rahim ]


nik howk

Post Script :
Just now at 230 am, I was wokened up to see a 42 year old young Malay gentleman at our ER who came with central chest discomfort and feeling short of breath. He has been having the sypmtom since after his dinner at 8 pm, but waited and his sypmtom was getting worse.

ECG and troponin T [ blood test ] were both normal, but our casualty MO was not happy by the way he look, thus he called me. I have nothing substantive to go by either but my gut feeling was that he look like an ' acute coronary event'. he was beginning to cough and the chest Xray was showing a 'wee bit ' of congestion in the upper region. In my mind if we were to wait another hour or so for the ECG or the blood test to be 'more positive', we may lose the window of oppoertunity to save a lot of 'cardiac muscle' from cardiac muscle death and with 'wet lung that usually follows in a massive heart attack,, I will have a 'wayang kulit' in no time. The window period for muscle salvage is critical, and it is short.

He was wheeled to the theartre and lo and behold, the coronary angiogram showed total occlusion in the left anterior descending artery, just 0.5 centimetre away from the Left Main  [ the 'widow-maker's junction ]. The occlusion was duly crossed with a guide wire and ballooned and stented.
Insyaallah he will be out of the hospital by Monday or Tuesday.

Oftentimes, when the presenting ECG and the initial blood test are  normal, we 'plumbers' have to rely on our gut feeling and clinical acumen. Time is of the essence.
We 'plumbers' often live dangerously. 
[  http://www.youtube.com/watch?v=3Z2DaU0GBAE&feature=related ]









Other articles on ' Death & Dying '  in the blog :

http://drnikisahak.blogspot.com/2008/05/not-so-pearls-gem-nik-isahak.html

http://drnikisahak.blogspot.com/2008/11/death-eternal-life-after-death.html

http://drnikisahak.blogspot.com/2011/02/unto-him-is-journeying.html

http://drnikisahak.blogspot.com/2009/01/pearls-gem-redza.html

http://drnikisahak.blogspot.com/2012/07/case-history-young-deaths.html

.....monologue on egypt

Doc Azman,

You are a graduate of the Egyptian education system

I know you go to their medical school in Cairo in the 70's  and not to the famous brother university, the al Azhar but by your silence on this Egyptian debacle, I hold you fait accompli in this mass slaughter of Muslims by  socalled 'Muslims'.

I would love to call these 'socalled muslims'  and  the 'people  sewaktu dengan mereka' as hypocrites but I am not a scholar, I do not have the prequalicationa as such, so I will stick to that term instead.

I know you are at all not  related to the butcher from Assisi but your resounding silence is deafening!

 Why????

As way back as early July, the reknowned jurist, Shaykh Yusuf Qardhawi has already given his advice and fatwa on the possible ouster of Morsi

[   http://english.alarabiya.net/en/News/middle-east/2013/07/06/Leading-Sunni-cleric-says-in-fatwa-Egyptians-should-back-Mursi.html ]

WE, the Muslim ummah , have always looked up to his fatwa on whatever subject  before, but why now the sudden global  inertia and selective myopia.

Had guys like you and thousands others from the al Azhari alumni joined in the bandwagon making ' 'animal noise' against it, this subsequent bloodbath could have been avoided. Where is the OIC [ oh i see ] ?

Your 'cik gu' in al azhar, the sheikhul al azhar, was so quiet like a poodle, no fatwa, no advisory, nothing..........

until the infamous photo shoot with the general and the 'imam' of the coptic church. He certainly know which side to butter the bread ! So sad for an ulama of his calibre and office. It is a shame really.

[ when  does a 10 % become more important than a 90 %....my god ! what kind of equation is this! ]

After the bloodbath , he conveniently disappeared from the radar screen!

Frankly, the office of shaikhul al Azhar has lost its meaning , we should not bother about them anymore, as  a source of rujukan

Our collective silence is a crime in islam, my friend.

nik howk

http://drnikisahak.blogspot.com/2013/07/egypt-oh-egypt.html

ps: now i can conprehend why nabi used to say, at the bottomomost of the heap  in' an nar' are scholars and scholars ! scholars who are just there for the 'cari makan'




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


28th August



http://www.aljazeera.com/news/middleeast/2013/08/20138285655559615.html

a patient of mine who has an office in cairo told me today he is harbouring one of his egyptian consultant in kuala lumpur.

otherwise this chap would be hunted and killed by the egyption secret police. such is the ferocity of the egyptian security apparatus on their search and 'kill' operation.. true to expectation, the secret police went to his house in a cairo suburb, and confronted his wife and family.

. how long assisi and his gangsters are going to persue this path we do not know. this is pure madness.

the fatwa has been out. assisi  and the current egyptian government is illegal morally and from the syariah perspective...this is qardhawi's not from al  a zhar.

sheikul al azhar is quiet as a poodle. we should all stop looking to al azhar as an institution famous for its juristic direction.

al azhar as an institution of fatwa has all but lost their moral and religious high ground. their reputation in tatters.

even shaykh qardawi is not safe from this group of gangsters!!

this is the position of islam today.

the real muslims become terrorists and the munafikuns rule the day......this is dunia akhirzaman.

nik howk

ps : ...and doc azman, mbbs cairo u , why are you sooo quiet? you can say your piece you know...

A Young Man Who Came In Smelling Like A Fish.....

Uraemia, [ end stage kidney failure,classic type ] presenting in the clinic smelling ' like a fish' usually now belong to the realm of old classic medical text book of medicine.  One such case walk into my Saturday morning clinic yesterday.
Mr AbdulRazak Aipojo, [ not his real name of course ],a 28 year Nigerian student attach to Taylor's came to see me with a complaint of easy fatiguability and frequent vomitting of two weeks duration. He has a sallow, pale complexion and smelt like a fish . Blood pressure was 220 / 130 !! [ normal for guys his age around 120 / 80 ].

' Young man, you need to be admitted..You BP is sky high and if we delay treatment, you will have a burst artery in the brain or you will have breathing difficulty plus plus..."

Always very difficult to persuade a young man of just 28 who thinks he has another 40, 50 years of life ahead of him. Adipojo is a candidate for sudden death which can come from a sudden cardiac arrest arising from a grossly disturbed electrolyte/ metabolic disturbance following impaired kidney function, a sudden stroke, or acute heart failure due to high bp and fluid accumulation in the lung.

His renal function test [ kidney function ] showed a serum creatinine of 2300 micromol/litre [ normal less than 115 ], an elevated blood urea of 55 [ normal up to 5 only ], and a potasium level of 6.1 [ normal up to 5 only, this elevated potasium level is the one that predisposes to cardiac arrest ]

Uraemia is not my speciality. On admission, he was handed over to a nephrological colleague, who will institute urgent haemodialysis on a daily basis at first for a week or so. His bp need my urgent attention, of course.

This young man need to be on  long term kidney dialysis programme.

Life will never be the same for him, having to be hooked to a dialysis machine, 4 to 5 hours, 3 days a week 

End stage renal disease, oftentimes are quiet , insiduous disease than can surprise seemingly healthy looking people. Commonest cause is autoimmune inflammation of the kidney itself [ parenchymal kidney disease: glomerulonephritis, second commonest, due to choric untreated hypertension ]. In this young man, I think he had insiduous glomerulonehritis. The gross raised bp in him , in my opinion , is a sign of of his inherrent kidney dysfunction, rather than the primary cause. 

At the end of the 

'executive summary', old hands like me, in this 'business of  looking after the sick and infirmed, will write : Adipojo has rather a short fuse!

William Shakespeare, four centiruies ago, opined about this tragicomedy called LIFE, "

the world is a stage, we, men and women are merely players. We have our entrance and exit...... ", or something to that effect.

This is rather sad, at 28 !

From my vantage point, that is the nature life, thrown to us, from the 'Great Beyond The Beyond the Blue Yonder'.

Which somehow reminded me of death all the time
And I am not complaining. I consider this  frequent  reminder of the 'fragility of life', a priveledge.

Inna lillah hiwainna ilaihirojiun








articles in a previous blog :

http://drnikisahak.blogspot.com/2012/08/on-death-and-dying-expiry-date.html

http://drnikisahak.blogspot.com/2011/02/unto-him-is-journeying.html

ABSORB, The New Bioresorbable Drug-Eluting Vascular Scaffold

Just came back from the hospital just now  after reviewing Encik K [ not Datuk Siti Norhaliza's Datuk K of course ]. Encik K , 58, recently retired Oil and Gas man from Petronas and Shell, currently doing some 'oil trading'  on his own told me his lifestyle is " nothing stressful doc" .

His crime? Sub-optimally controlled diabetese over 6 years and smoker, 20 sticks a day, 30 pack-years and carrying excess baggage of 30 kilogram. He weighs 100 kg , but only 170 cm in height. On top of these, he has hypertension over 10 years. All, 'push' factors for early coronary tree aging.

What is interesting in Encik K is that he is my first patient walking around from today with SDMC's first bioresorbable 'plastic-polymer' scaffold.

K presented to me last week just on a routine check up insisted by his wife. HBaic  blood result of 7.8 % told me that for the last 4 months or so his diabetic control was 'moderately sub-optimal'. A routine threadmill stress ECG nearly gave me a 'heart attack' !  He had a long spell of dysarrythmia, we called 'ventricular tachycardia', a precursor to a cardiac arrest, just shortly at the beginning of Bruce Stage 2 exercise protocol. I stopped his exercise test immediately and advice him to have a fairly  immediate coronary angiogram study to get a definitive road-map of his coronaries.

Today, just now at 5 pm, coronary angiogram showed critical 95 % stenosis [ 'narrowing' ] at the proximal Left Anterior Descending Artery near the Left Main Stem [ 'widow maker's junction', we cardiologists lovingly called it ].

After discussion with him [ on the table ], and his anxious wife, waiting outside the theatre, I opted to use the new resorbable 'plastic' stent instead of the now  aging ' 10 year-old  drug-eluting'metallic cage stents' [ stainless steel, cobalt chromium, or platinum coated ].

Vessel preparation and predilatation  and stent implantation technique are almost similar to the traditional metallic cage stenting. Cost-wise though,the new bioresorbalbe 'scaffold'  presently come with a hefty  40 %  increase in price com pared to the present work horse, the metalllic drug eluting stents, but 'insyaallah', with new players coming in, the cost will find its own level, hopefully much lower in future. Currently only Abbot Vascular Laborataries of America are the sole manufacturer of this  stent. It would not be long before others  join in the bandwagon. Siemen from Germany is already waiting in the wing to join the competition


From the cardiological perspective, this 'bioresorbable vascular scaffold' offers us more complete potential for 'restructuring and reconstruction' of diseased arterial tree.  The realities of Ischaemic heart disease it is both a  chronic and unrelenting disease. With the negative effect of affluence, sedentary lifestyle,  obesity, hypertension, and early diabetes,  we cardiologists are increasingly faced with  a new subset of younger and younger patients needing arterial construction. 

From my vantage point as a cardiologist, managing people with coronary artery disease is both an art and science of postponing the inevitable. It is my job to keep my patients from the inevitable ie that is surgery.  The downside to this  philosophy is that when it is time for 'my average patient' to have to undergone the 'final pathway', it is not uncommon now to see a patient in their  late  50's or 60's having  had 5 to 8 stents implanted, over the progress of time, all over the place in the coronary arterial tree. They present to our poor  cardiovascular surgical colleagues, a daunting task since their arterial tree are full of metallic cages.

It is hoped that with the bioresorbable stents increasing usage [ drug-eluting metallic stents still have a big role to play ], our surgeon can still do CABG on these individuals after postponing decades of  disease progression. But cardiac surgery at present is a 'sunset' profession as the cardiological tools and weapons attain more sophistication with the years. This is inevitable as coronary stenting is a multi billion dollars industry backed by engineering, bioengineering , genetics and allied sciences  all galvanized together by multinational devices companies of America and Europe.

At the end of the day,  we, the cardiologists have the best of  both  'soft as well as the hard' sciences', backing us, and a bludgeoning  devices companies competing to outdo each other to produce better and better 'devices'. For the poor cardiothoracic surgeons, they only have their 'bare hands'. 

This constitute 'unfair competition'. But what is unfair to the cardiothoracic surgeons can only be good  to all patients globally. Across the board in the field of medicine, the whole world is moving towards minimally invasive endoluminal techniques and away from having your chests, pelvis , brain or abdomen ripped open. If need be, it would have to be our last choice.


Nik Howk
1.30 am, Tuesday, Ramadan
Subang Jaya

ABSORB :
http://www.youtube.com/watch?v=ccLwmZ6Gwdc



1st Absorb Procedure in Dubai
http://www.youtube.com/watch?v=u91MOZSzhYs



They Are Getting Younger and Younger...
http://drnikisahak.blogspot.com/2013/07/they-are-getting-younger-and-younger.html



It Is Diabetes, Diabetes and Diabetes.........
http://www.youtube.com/watch?v=C30C5dthslc
[ editor's comment : if you are muslim, when he talk on deep breathing etc and etc, think about zikr..
this is a panacea of most ills ]

.....they are getting younger and younger : Primary Myocardial Infarct Angioplasty and Stenting

Zain S A, 33 , KLIA limo driver [ not his real name of course ]
Smokes 2 packs a day, recently diagnosed insulin dependent diabetic on Novo-rapid subcutaneous insulin, 3 times a day and  a long acting insulin, Novomix  12 unit at bedtime. 
Diabetic control seem quite optimal.

11.30 pm just now had sudden onset gripping chest pain while watching TV at home. Wife, who is a nurse brought him to our ER at 1 am just now.

" Doc Nik, we have a young diabetic with an acute inferior infarct for you...", my medical officer in ER woke me up with a start at 0130 hours.
I used to curse quietly under my breath before in my younger days at this kind of  'rude' interruption to my 'dream', but now at 61, I  have somewhat mellowed a wee bit. I now consider this kind of calls  in the wee hours of the morning as a very polite and welcomed 'wake  up call to tahajjud'. 

Patients are getting younger and younger. It used to be ' I am younger than my patients' some 25 years ago, now they are about my eldest son's age! Time certainly waits for no man.

By 2.15am the emergency team were all ready for action in the thearte  and Zain S A already on the table. In 'Manhattan Fish Market' linggo, 'it cannot get any fresher than this !'

Angiogram showed he has a totally occluded right dominant coronary artery. An inferior infact from the right coronary artery occlusion is usually smaller than a left coronary infarct and but a dominant right coronary artery is a 'different cattle of fish'. Patients with these type of occlusion behave badly if not opened fast enough. It is geographical. It supplies more myocardial muscle, therefore its occlusion impacts more. They will be more muscle loss and heart muscle death.

We did not have much time to work on him as his pulse rate was already going 'bradycardic' [ 36 beat per minute ], which duly responded to an intravenous atropine, for the time being. His right coronary artery, being dominant  supplies blood to his SINOATRIAL NODE, the 'natural' pacemaker  of the heart, and ' bradycardia' is it's  way of 'complaining' that it is getting 'suffocated due to no blood flow' and if 'you guys are too slow, I have to call it a day! '. 

Asystole  and cardiac arrest may follow extreme bradycardia..if that happened, we would have a 'wayang kulit' on the table and possibility of instant death , much, much higher, even though it remian that the cardiac thearte table must be about 'the safest place for any cardiac arrest in the whole hospital'!

" Dont get too excited Zain, you just concentrate on your Kul Huwallah, and insyaallah, you will be OK soon......", and I say mine as well. Divine blessing and help is a bonus in this kind of  dicey, life threatening situation.

We ballooned up the artery in no time with a 20mm by 2.5mm balloon, and then duly stented it with a  drug eluting XIENCE stent ,3.0mm by 28mm at 18 atmospheres pressure, x 2

By 3.30 am patient was dozing deeply in CCU helped by the initial dose of morphine given at ER and in the cardiovascular lab for pain management.

This morning at nine he is already asking me when he could be discharged.



What Is A Heart Attack
https://www.youtube.com/watch?v=n8P3n6GKBSY

Coronary Angioplasty and Stenting [ cartoon ]:
https://www.youtube.com/watch?v=S9AqBd4RExk



How A Heart Attack Is Treated
https://www.youtube.com/watch?v=ApJvxgjUOjc



Angioplasty and Stenting of Occluded Left Anterior Descending Artery:
https://www.youtube.com/watch?v=3Z2DaU0GBAE&feature=related

' .....show me the straight path '

'Show me the straight path', 

Reminded me some 20 years ago when myself and the late Ibrahim Promet found ourselves lost in the myriad of small lanes in downtown Makkah, going in circles.

We saw an elderly Arab man and approach him, " Ya shyakh !..ihdinassirotolmustakim  ila makkah hotel!? "

The old man understood us and kindly lead the way.

Admittedly, the path to  hotel makkah was neither straight nor short.

Shyakh Ninowy here talks about  "ihdinassirotolmustakim"

In essence, it is not a straight path.     

It is not easy either. 

In fact it is tough. Oftentimes you lose friends as well  

It  is the path one takes after fully immersing oneself in 'Allah's' colouring'

not 50 %, not 60 %.....it has to be 100 %

If it is  just 50 %, 60 % , you get what you get with those clowns in Tahrim Square right now.

And they are Muslims! Almost all of them.

They  think 'ihdinassirotol mustakim' is a continued free lunch from Uncle Sam.

http://www.youtube.com/watch?v=pHoeXZlW1Tk

Egypt, Oh Egypt....

oh my lord,

your esteemed messenger once told us

if there are blatant injustice to your creatures, to raise an army

if we cant, then do personal jihad

and  if we still  cant on the basis of being weak , puny and feeble minded,

to raise our voice

and if we still cant,

to feel  the pain in our hearts and soul and pray.....

oh my lord, i am both feeble , weak and puny
in body, mind and soul

hunger,jihad and death are too much beyond me

but i do feel the pain and the anger....

do accept this as my objection and place me along those who believe

register this soul as the one in pain,

pain at the injustice being done in the name of modernity and progress

oh my lord 
i pray let there be a thousand more morsi to replace morsi
and a thousand more martyrs to replace those who have given their lives for You 

oh my lord,
bless me with a heart able to separate  truth from falsehood
bless me  with an eye to view this world through Your prism

ya mukallibal qulub thabit qalbi ala ka taatik

ya mukallibal qulub thabit qalbi ala ka di nik

oh the One who changes hearts, firm my heart in your obedience

oh the One who changes hearts, firm my heart on Your Din

From Ikram Mokhtar, somewhere in Dubai :

Nik,

4 July 02:58

after reading the events of Edward Snowden disclosure and the follow up actions by the USA, the Gay marriage law approval and many other things I cannot help concluding that America is the Great Satan as Imam Khomeini said long time ago .I think the US government is Dajjal as it has all the characteristics as described.

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

Ikram,

we disagree on many issues Ikram but on this I am in full agreement with you.

And why not

I was senior registrar in a Central London  teaching hospital during the dizzying days leading to the 1st gulf war in the late 1980's

I could sense the general mood there: Islam against the 'rest of us' feeling.

If America is the dajjal , Britain is its able bulldog

We Muslims should by now know who our friends and foes are...

Just look at Morsi, barely 1 year in his tenure and the secularists  and the small minority coptics are already after his blood, not helped a little by cnn, aljazira and bbc

Just look at Ghadafi and Saddam, the former had a bullet in his head and the latter stretched by his neck. Their crime:  not wanting to sell their oil in US dollars! I know, you may say the are not perfect Muslims themselves. So what? Who are in this topsy turvy world.

Just look at Erdogan, 15 years at the helm, raising nTurkey's GNP and standard of living many times over, and when he  chose to close the pubs at 10 pm, Turkey is on fire.

And just look at us here, 50 years 'menerajui kerajaan', we even have difficulties passing the 'underage laws for conversion'. and why not?
we still have clowns in the government like nadzri  apakahnamadiadah who thinks he is clever and playing to the gallery. every time he opens his mouth , he reveals his utter ignorance

We Muslims must know who our real enemies are and start using the ballot box to the max.

They want democracy, ok we can have democracy.

We are 1.6 billion going on to 2 billion..let us have democracy

Let us play their ballgame..but 1st let us know our enemies!

Nik Howk

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

Dear Nik Hawk,

I have not been to the Middle East for a quite while and I have no view to offer other than repeating what the Press and the Media is already covering.

I will be there next month, so I will have some 'ground ' coverage to share.

Wassalaam

Nadzru Azhari
In Jakarta

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

Nadzru dear,

There is a new twist to democracy nadzru..which our leaders here should take note

It is not a blank cheque.

and  to make matters worse,if you have an Islamic bent in Egypt, beware, alBaradei and his band of secularist gangsters can get you in jail within a year.

In my 'not too humble' opinion , is that if we leave Islam to the bloody secular Arabs in 2013, we better say good bye.

I wonder how albaradey and prof fahmy would answer HIM in their  graves in the not to distant future,

" Sir, I put it to you that you have nipped Islam in the bud when it was ripe to be a rose! "

and back home..." as the substantive pm for the last 22 years or so , what have you done to bring MY sovereignty to the  land"

Sri rum is not there to turn and twist.

We now almost forget that we finally all are answerable to HIM

ya mukalibal qulub, thabit qalbi ala kaa di nik

[ oh the One who changes hearts, firm my heart on your Din ]

Nik Howk

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

Dear Nik Hawk,

For the lack of ground knowledge and my 'long 'absence from the 'arab street', I can offer you opinions based on the same cliches perhaps with less 'religious'content in it. Please don't get bored. First, if the crowds can cause the removal of Husni Mubarak+Co , then call for elections and Morsi +Co wins by a simple majority,with the Army standing by voluntarily and not losing an iota of its power and privilege; so can a similar crowd be raised and a demand for socio-political correction be cobbled together and Morsi be antiseptically removed. Just like Husni Mubarak was removed. Democratically elected? So was brother Husni,he won by a'99%' of the votes! The methodology is predictable and must be made aware of at all times. It is the same old wine ( in deference to our arab brethren unto whom wine is an inseparable part of their social culture, piety and repentance notwithstanding) ) in a new bottle. Here, Thailand can offer our Morsi +Co a reprieve and solution. When PM Thaksin Shinawatra was removed by an army coup d'etat , in response to a 'crowd'and 'popular demand that he be removed, parliament suspended and an interim Government led by a nominee of no less than the Royal Privy Council and an ' general election' was conducted and the Opposition Front won and formed a new government to last the rest of the season. Then feeling confident, army in full backing, privy council in tacit approval , the time for the new season of the democratic process came, new general election was held . Against the strong army support, privy council approval and the 'popular' support as seen in the 'red shirt' demonstrators all over Thailand, 'humbled' ( not humble) Mr Thaksin Shinawatra won the general election with an even bigger margin! The army sheepishly returned to the barracks, the privy council went on their normal duties of fixing the honorifiques due to be handed out at the next birthday celebrations and the buddhist waisak day and Mr Shinawatra rules well and good , even when he has to run his administration from office in Dubai, as the decree on his 'persona non grata' still holds. That's is one hope that Morsi+ Co can hold on to,win again, win handsomely. Not marginally, win handsomely beyond reproach from the 'people' of Egypt.

For this our Brother Anwar Ibrahim+Co have to very careful, for he can be Al-Barada'i + Co and instead Najib + Co can be Morsi +Co ! Whereas our Brother Anwar a Morsi he much a wanteth to be and Al-Barada'i he like a plague avoideth to be!

Talking about Egypt and its political intrigues, it is not uninteresting. It is one of the main reasons why I put a son in college there in Cairo. I want him to have the best socio-political education and Egypt is offering him the best. ' Religious education' as it is popularly understand here, is not my intention. I recall the biography of Gur Dur a former President of the Republic of Indonesia and that of Malek Bennabi a socio-political activist from French Algeria,that,' Cairo offers the best 'street' and 'popular' education and socio-religious +political consciousness! Gus Dur and Bennabi hated the rote and stulthifying Al-Azhar education and both picked up the best of arabic language education and Islam in its socio-political challenge from the 'streets' , Opera house, the movies + theatre, the libraries and publication houses of Cairo. So that is still Cairo right at this moment of time!

Do not ask from Cairo and the Egyptians what they since post-Ottoman times, cannot give, not able to give and will continue not to be able to give. Let us rejoice with Egypt and Egyptians in what they are giving us now. We learn from them and become far better then them. They are destined to be our 'laboratoires' and such is their lot.

Wassalaam

Nadzru

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

nadzru,

very good sum up from an arabist par excellence.

sorry about my religious bent, cannot help it nowadays. the more i spend listening to the likes of hamza yusuf, shyakh ninowy et al , 

the more skewed i get. my apology.

look like i have to change my 'glass'

just that egypt to me is a deja vu' of algeria some 15,20 years or so back

for morsi and his muslim brotherhood though, to sum up what doc rosli of pas wrote to me some years back, 'the nawaitu is there,they have tried their level best, the result is immaterial, it is beyond them'.

in the final court of law they can stand up with their chins turn upward and say, 'my lord, we have tried our best, the world is just not '...cking' ready for YOU"

....and perhaps the late asri,haji fathil,tgna, tuan guru hadi et al can also join them in this rarefied group as well, consisting of luminaries such as sayyid qutub, mawdudi and a few others. even though in the secular sense of the world, they are failures.....

can we, nadru? can we ?

nik howk

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

Nik Howk,

I beg to differ Dr Nik as they may not be failures in the eyes of Allah Swt, In Shaa Allah as we have the comfort of knowing half of those in Shurga will be ummah Mohammad though we are trying very hard to be one of those so permitted by Allah Swt.

Sent from my iPhone

Nadimah Nik Adeeb

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

Nadimah,

 in the secular sense of the world, they are failures....

this is just a metaphorical expression

i do agree with you.

they are the successful ones, placed alongside the ambiya and the shuhada, insyaallah......allahualam

we, where are we??

always looking at things from the secular perspective, reading situations forever with cynicism and disdain.

always looking from the perspective of the'stomach' rather than the spirit.......

we, where are we heading to??

people like prof khalid fahmy, who sold his religion for a few penny, who think the syaria is outmoded and that the muslim brotherhood should disband themselves,

people who one time ago lamented that kelantan would be inundated by 'sup tangan'

we, where are heading....?

as muslims, if we have no confidence in the syaria, we should just keep our mouth shut and be damned....this is no small matter...it is aqidah...if we want to remain muslim. and if you are pm and you have to open your big mouth, reexamine your soul 1st before you become pm, is it worth it??

we open it, and we have to explain later.......

who wants to be pm still??

or mrs pm??

that is a lot of baggage....

nik howk

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

Dear Nik Hawk,

I have a litlle bit of a problem if I have to divide my opinion in the cliche of religious bent, of the pious and the unpious ,as a lot of men and women of piety are with Al-Barada'i and among the officer class of the Egyptian Army. The rank and file of the Egyptian army is the biggest employment destination of egyptians who graduated from the Al-Azhar campuses in Cairo, Tanta and Zagazig. The most prominent corner of the Army Officers Club in the Gezira, is the club mosque! So is the Police Club there and the Air Force officers club in Heliopolis! So good are the lectures by visiting al-Azhar scholars at the club auditoriums, so attentive and solemn are the good brother officers! The General that got promoted to the Chief of Staff was vetted by Morsi's own corp of religious advisors! And that Brother General was ever so happy to antiseptic ally extricate Morsi with a knife and scalpel away from the Presidential Palace. I attended a wedding of Suzanne Mubarak's niece at one of those clubs in 2011 and I can tell you it does not lack the 'religious observances' of any pious rich Islamist NGO activist in Kuala Lumpur. There was a sea of elegant ladies in headscarves and foulards! Morsi's and Al-Barada'i flock is not a divide of islamists and secularists, the Egyptians are too steep in islamic roots to be so divided into good cheese and bad chalk.

The Egyptians do not have our history of civil obedience and obeisance to law and order when that is enacted among themselves for themselves, when that was done by the colonialists on them, they were the best obeisant and servile types on earth.For all our weaknesses the ASEAN society ( olde Malaya is too small for me to talk as a base case) is an enviable one in terms of civil order and respect for 'democracy' if ever that can be a base case, since religiosity is not my forte. Save a bad spell of Khmer Rouge Cambodia and authoritarian Myanmar, we are admirable in the way we take to the culture of electoral campaigns, ballot boxes and respecting the outcome, give or take a period of stadium demonstrations. We have Presidents and PMs that actually retire, though belated at times , save HE Thaksin Shinawatra who was surgically removed like that done for HE Morsi.

Let us be fair to the Egyptians by not giving their current political noise a 'religious' content. There are manifestos and political party mission statements and they are all good, they have to be. I believe it is the inability to accept Morsi's electoral victory and that he is indeed by popular count the 'people's choice that prompted those that got defeated by popular count to dismantle the elected government before the tenure is over and they had discovered that the 'demo at tahrir square' is a very effective tool. Why do egyptians behave this way? Because they are egyptians! If we know that and accept it as is where is, I believe we will be less fatigued following their events. Take it as our distant learning in socio-political intrigue and manipulation education, give or take a few deaths on the streets.

We can go on with the cliches of ' foreign intervention', the 'israeli hidden agenda at work' done on the egyptians. Let us not dwell on that, just stick to looking at the folly of our Egyptian brothers and sisters and learn what to do and not to do. Let us not put too heavy a weight and measure of Heaven and Hell for them.

Wassalaam

Nadzru B Azhari

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i am used to   tall stories  in my everyday work nadzru, but you version is too tall.

but you are the arabist. me, i am just a dreamer.

anyway, time is on morsi 's  and the muslim brotherhood's side

come next 'erection' they will win hands down, insyaallah

unless they ban ikhwan just as they tried to prevent him from becoming president by putting a clause about being 100 % egyptian in the 1st place

certainly the muslim world are disappointed with what is happening in egypt, 

but islam is an idea that is long overdue....it will prevail, even in the land of the pharaoh

as for albaradai, he once was a stooge for the west with respect to sadam's alledge nuclear ambition, by being less definitive and wishy washy on iraq's nuclear capability, thus giving a leeway  and window of opportunity for bush and blair to act.

now what....

leopards do not change their skins.

nik howk

ps: 

and by the way morsi is not your ordinary kopiah wearing islamist carrying banners around. he is an active  post doctoral fellow with several research thesis to his name, and used to works for nasa. his research papers ,even the heading i cannot comprehend.

in egypt it is possible to be a 'nik aziz' in term of spirit but has a phd in engineering and research and be a consultant engineer as well.

'muslim brotherhood' is his other call-card, and that my friend, negates him from the high office of the land of the pharaoh.

" the whole world my lord is not ready yet for YOU ".

i am not alone nadzru,

http://www.islam21c.com/video/viewvideo/257/current-affairs/egypt

but of course , islam is not fashionable

and even sheikhul al azhar can be bought as most ulama are

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from Ikram Mokhtar in Dubai,

Another Syria in the making? I wouldn't bet on the impossibility MB vows non-stop protests in Egypt www.presstv.ir Egypt's Muslim Brotherhood vows non-stop protests until Morsi returns to presidential palace.

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Ikram,

frankly speaking when i see the sheikhul al azhar alongside the general and the head of coptic church and albaradei on tv yesterday, i almost vomitted.
my only consolation was that i was not alone with this sentiment.
tok guru nik aziz also must have felt the same.
we obviously are in the minority but it does not matter
as long as the 'people in the higher plane know it and register it', that is all that matters.

egypt, oh egypt.


nik howk