Thursday, February 4, 2016

Of Cycling Tales; Allahyarham Ahmad Ramli Zakaria in Memorium and Long Haul Air Travellers' Dilemma...

From: Nik Isahak Wan Abdullah <>
Sent: Tuesday, February 2, 2016 8:19 AM

Friends Dato and TanSri,
I came home from a short sojourn at my  holiday pondok, al Qalwa,  Pantai Telaga Papan ,Teganung Darul Runtuh, to be told by my wife that i just lost a long time  good friend since University days, allahyarham Ahmad Ramli Zakaria, ex RMC, ex Malayan Banking, ex gm Saujana Golf, avid international long distance cyclist, a 'budok Tumpat original from Kelantan'...all thrown into one.

Li, as I fondly call him, was as fit as a fiddle, cycles 80 to 100 km a day on his many international forays.
I am supposed to cycle with him in New Zealand  in the not too distant future, as and when I retire and have the time to take up the hobby, I told Li, some years back. 

He was just back from a ten day cycling trip to Kerala, India, when, as the story goes, he noted some non painful swelling in both ankles. On day six after returning back, while doing some window shopping in  a mall in Shah Alam, he 
developed sudden shortness of breath, and was admitted to a nearby medical facility.
He succumbed to his short illness in the hospital.

With the eye of a 'medical detective' and the wisdom of hindsight , I think my good friend and confidante died of what we call 'massive pulmonary embolism'  ie  blood clots coming from the deep veins mainly in the calves and both lower limbs, clogging up the two major arteries of the lung, right and left. Deep vein thrombosis [ DVT ], is a well known sequalae of long distance air travel. It is about 'relative immobility' in a confined space, especially in prolonged sitting position.
           This to me is the long distance air traveller's dilemma commonly known as the 'economy                  class' synfrome. Now with the ease of long distance travel and the 'everyone can fly' 
            regime, I will coin a new term here, ' Air Asia class' travel.
All travellers flying at whatever class are prone to this.
But my gut feeling is that 1st class travellers probably less prone than business, and businesss less prone than air asia class...but this is just a personal gut feeling, not supported by any double blind study. Difficult to study and have double blind randomised study anyway in a situation like this.

In Li's position i think his problem is compounded by the long period of riding in India, which would have contributed to a position of 'relative dehydration'.
This, with relative immobility in the Air Asia class  could well exacerbate DVT.[  Li took an Air Asia flight, ....TS Tony Fernandez, also ex RMC, may not like this, but this is just generalization tan sri, ] 

'What do we do then Doc? you may ask...'
At our age and in this age of 'everyone can fly' ,no travelling is not an option!
I myself  almost always travel economy class or worse still Air Asia class! 
         Cramped like sardines!!!!!

I will always try to get an aisle seat
If i travel with my wife , she will always occupy the seat near the window [ I am naughty, I must admit... ]
I pace the floor every  30 to 45 minutes from one end of the plane to the Club class.

Thanks also to my 'prostate' problem which requires and give me the need to go to the loo often. While sitting, I try periods of isometric exercise in volving my calves and legs muscles...period of contraction and relaxation, contraction and relaxation....
I dont take 13, 14 hours flight nowadays. I try to split my journey. Dubai is a convenient place to stop. So is Jeddah and Makkah!
It is rather too late for all of us to be PM or Ringgit Malaysia who can of course travel on executive private jet!

Of course there is an escape clause in any advisory.
Kalau DIA nak ambil you, ko' mana mana pun DIA ambil you juga'.

May Allah place my good friend and confidante amongst those HE bless
Al Fatihah.

dr nik



innalillahhiwainna ilai hirojiun.
takziah to you, your brothers and sisters and  your mum on the 'untimely ' demise of your dad..
uncle nik was in teganung when he died and only come to know about his demise on tuesday
your late father , as i recall is as fit as a fiddle. 
cannot be a heart attack. unlikely..

i remember seeing your dad some three years ago , just after a ride and an oversea trip , with similar complaint of  ANKLE SWELLING.
we looked hard for telltale sign of dvt in the calves via an ultrasound sound doppler examination. it was not there  then.
on hindsight we are probably looking at the tail end of things at that time which did not progress, or was self limiting. 

innalillah hiwainna ilaihirojiun.
uncle always share this with your dad in conversation as well as in emails the rather morbid [ to some ] perception that
that we, clever muslims , always live in two worlds, one foot in the here and the other foot in the afterworld. it is not at all a morbid perception, it is a healthy one .

insyaallah, your dad will be amongst the blessed.
al fatihah

uncle nik


         From: Rqim
Sent: Wednesday, February 3, 2016 2:44 PM
To: Nik Isahak Wan Abdullah

Subject: Re: innalillah hiwainna ilaihirojiun......ahmad ramli zakaria,ex rmc

Salam DR Nik, 

Thank you for your kind words and the in depth explanation on his DVT condition. The cause of death in papers released by demc is unknown and i think your explanation below made alot of sense to me.

My late father suffered shortness of breath and was sweating for a short while before he passed on and by his side was my mother- the love of his life. I am forever greateful for he did not suffer a long illness and our memory of him will always be of someone healthy and always in good spirit. Syukur for that

I would also like to thank you for having been a great friend to my late father and even my late grand mother. You will always be his to go to person when it comes to medical questions.He will be missed and not forgotten. InsyAllah

May Allah grant him Jannah and ease the pain of those he left behind.

My regards to cikgu, Nadzru and the rest

Raqim & family


My friend Li was a health nut.
He introduced me to scuba diving some 20 years back.
When I moved on to long distance competitive equestrian, Li took on Big Biking until he and mrs had a near fatal accident somewhere in Negori Sembilan darul Khinzir area. I  still can remember him telling me he and his mrs were transported to a nearby hospital bundled up at the back of lorry full of al khinzir by a good samaritan farmer. 
This nasty experience having to share the same transport with a load of al khinzir changed him from a big biker to the relative safety of cycling......

cycling tales are all about his riding exploits and oftentimes deep philosophical but simple approach to the big picture itself

 We, all his friends will sorely miss him.

The French saying, 
Cest du Qui Direct....It is human to plan, God Directs!

PS :

Thinking about Li's case brought me back 4 years ago to allahyarham Shamim, Senior GM of Malaysia Airline, a superb marketing man, another friend and patient of mine.
Unknown to me he had planned to have a knee op at Pantai Medical. Just three days before the op, he flew to London, flying 1st class to watch MU- Chelsea Final . Flew back on the next flight to KL, and 'into bed' for the prolonged immobilization , as usual that follow any post knee op.
The next thing I came to know was news in NST of his demise, just on the day he was about to be discharged from Pantai.

I was very sure he had DVT, followed by massive pulmonary embolism.
Not a heart attack.

Another question you may ask...''Is there any preventative medication to take before  and during a flight? "
The answer would be apolitical one..yes and no.
Firstly NO.
Secondly YES, if your doctor is willing to use the new blood thinning medications like PRADAXA or Xarelto, on an 'off label' basis. No actual study yet but just an extrapolation of their current usage in almost similar situations.
The risk? possible bleeding from the gastrointestinal tract or brain....... quite remote since one take only for 2 days, but possible.

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