Progress in Endoluminal Treatment of Coronary Artery Blockages.....from balloon to disappearing magnesium stents...40 years of progress in cardiology

Dr Andreas Grunzig, a German physician-radiologist, in 1974 performed the first ground breaking balloon angioplasty in an awake human patient, in a Zurich hospital. In Germany, then, he would have lost his medical practising license due to great inertia from fellow colleagues  and seniors who thought this kind of procedure was only for experimentation in pigs and cattle.
[  https://www.youtube.com/watch?v=v5FFTZTvTiQ  ]


I was a cardiological research registrar in the cardiology department at St Bartholomews Hospital in central/east  London, the business and high finance side of London, way back in 1981. 

Even at that time, some 7 years after Grunzig's ground breaking case,my bosses at St Barts were 'tip-toeing' like pirates operating under duress,, doing their cases under the watchful  and prying eyes of the 'demigods' at the hospital: the all powerful cardiothoracic surgeons. The surgeons insisted that we get ready all our patients for potential emergency surgery, if situation arise. 

Way back in London in 1981, it would mean taking patients' consent for both balloon angioplasty and emergency CABG [ coronary artery bypass graft op ], a medicolegal requirement.....and getting ready five pints of grouped cross-matched blood ready for 'possible open heart surgery if plan A failed'!
.....and having all patients thoroughly shaved from the neck below, as if they are going for open heart surgery!


'These bastards are cavalier and crazy!', must be the silent common swear words from the surgeons at Barts in those dizzying days of the early eighties!

I was not involved in the actual 'crime'  scene at that since I was only a research registrar , a gurkha actually, attach to another branch of cardiology, probing electrodes in the hearts, investigating patients with 'electrical' and rhythm problem. My direct boss, Prof John Camm,  was , and still is in 2016 , one of the biggest names in Cardiac Electrophysiology, another growing point in cardiology.


Then, by 1986, along with the balloon, came the metallic stent, to give better result and less 'restenosis' [ re-narrowing ], from 40 % to something around 20 % and afforded the cardiologist to be more work perfect at opening arteries and more adventurous. Before the advent of 'stent', in the early days of just plain balloon angioplasty, the 1st 24 hours post procedure used to be stressful period for the interventionists as 'opened up arteries' are known to collapse and close back acutely. In lay man's term, the stent is like a scaffolding, holding back the arterial wall from closure, while it has time for self repair.
[   https://www.youtube.com/watch?v=cdSf5GOyJdw   ]

With the advent of STENTS, interventionist cardiologists get braver and much much safer.
Surgical pre-consent  and surgical coverage became a thing of the past.


Technique-wise the early stents were inundated still by high 're-stenosis' rate.
The expanded lesions after stenting has it's natural 'repair' process, a necessary physiological activity of the living vessel wall and a necessary one indeed.
But in 20 % of cases, this repair process did not 'know' when to stop thus 'over-repair' cause lost in the luminal gain initially achieved by the earlier procedure.

But guide wires, balloon and stent technology improve by leaps and bound over the years.
By the early 90's, DES [ drug eluting stents ] were introduced.

Growth impeding drugs such as SIROLIMUS or PACLITAXEL was impregnated into the stent. This drug, on successful implantation of the stent in the coronaries, diffuse  slowly for days and weeks into the vessel wall, effecting to control cell regeneration at a more reduced level, thus reducing  RESTENOSIS ie. reducing lumen loss due to excessive tissue repair.

[  https://www.youtube.com/watch?v=JeH4zPzQgRc   ]


Just eight years back, another milestone was breached. Drug eluting balloon was introduced. This is a niche piece of equipment to treat increasing incidence of 'In Stent Restenosis' in patients who developed repeat narrowing within their implanted drug eluting stents.

By then angioplasty and stenting has already far outstripped in term of numbers CABG. Only the rare patients are sent for surgery.

Since people with coronary problem nowadays generally survive longer and longer due to improvement in treatment modalities as well as the massive effect of statins [ LIPITOR, ZOCOR, CRESTOR ]on lipid control, it is fairly common to see  patients who developed coronary problem when they were in their early 40, having had 6 to 8 stents when they reach their mid 60's or 70's..

I myself has a lady patient of mine whom I referred for bypass surgery 15 years back, who 'chickened out' at the last minute, had 6 stents implanted then. I was earlier managing her husband whom I sent for bypass surgery 5 years earlier.

Now, 15 years later, and several episodes of 'acute coronary syndrome' and hospital admission later, she is a bionic lady with a total of 10 stents implanted by myself over the years. 

This seventy five year old 'Datin' is currently still active playing and tending to her 'cucus' in a famous tea plantation in Cameron Highland. Her son is one of the senior manager there.

If you ask the 'Datin' why she opted out of her surgery and pleaded for me to do 'angioplasty, in the wee hours of 5 am , that fateful morning , her reply was simple :
" I saw how Dato' suffered during his bypass surgery and much after....Please do not force me to go thru that, Doc ! "

But to be fair to CABG, both endoluminal technique and CABG are complimentary.
The only thing that work against CABG is that while the surgeons only have their pairs of hand, over the last 40 years, the cardiologists have the whole gamut of industries helping them: the engineers, the metallugists, the whole range of bio-genetic scientists. 

It is an unfair advantage!

But from my  perspective , some of our patients would finally need CABG one day later in their life, only that I would like to postpone that day to as late as possible because all current techniques have their 'shelf life', and CABG is the final pathway in the life of a patient with coronary problem. It is ideally not to be repeated due to high mortality risk in repeat  CABG surgery. If I can, I want to exercise other options first for my patients before the final option of CABG.

To us interventional cardiologists, coronary problem is  a chronic , relentless disease. We try as hard as possible to keep all our patients from going under the surgeon's knife. Personally to me it is like  playing 'gin rummy', and if you are familiar with 'gin rummy', we try to not use our precious 'jokers' early in the game. CABG is the all important JOKER! But at the same time, when we need to send our already aging patients under the surgeon's knife, we want our surgeons to be able to do his 'bypasses' at the right place. If our patient's heart are full of 'metal jackets' [ stents ], there may not  be any more place for the poor surgeons to bypass.

So when BIORESORBABLE SCAFFOLD, or 'plastic stent' came into the picture about 4 years ago, most  people like me  cannot help but get excited. I implanted about 10 of them in my younger patients. It is a relief of sort for me since my youngest patient so far is just 22 years old. Imagine how many metal stents he would have before he reaches even 40!
These 'plastic stents' as I called them should self dissolve into carbon dioxide and water by three years. Theoretically I could re-vascularize these involved arteries and allow them to be regenerate back to normal after three years. 

[    http://drnikisahak.blogspot.my/2013/08/absorb-new-absorbable-plastic-stent.html  ].

This toy has now improved with the recent advent of a more durable, disappearing metallic stent, the MAGMARIS . And the possibility of  'metallic' foreign body disappearing in one year and allowing for regeneration and normal vasomotion of vessel back to its original state.....nice thought.

Now in 2016, MAGMARIS, the new magnesium stent, has just got it's CE mark. It is now open for general use and validation.. The obvious advantage over the 'plastic stent' is its relative strenght.

So far around 200 Magmaris stent have been implanted world wide, 10 of which come from Malaysia, with nine implanted by the 'boys' in IJN and one recently  by me at my hospital, SJMC. 

My patient is a 49 year old engineer, who developed troublesome angina on mild exertion.
Coronary angiogram done last week showed 90 % narrowing in the proximal section of the Right Coronary Artery. I implanted the Magmaris stent rightaway.

[   https://www.youtube.com/watch?v=OjwPrOgdtgQ   ]

"When are you retiring Nik...and joining us for golf?.', a paediatric consultant colleague of mine who just recently retired from teaching in UH asked recently.
" I am not sure Peng, there are new 'toys' to play around with all the time....."

I am certainly living in interesting times....








[  

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

From: Nik Isahak Wan Abdullah <drnikisahak@hotmail.com>

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

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


          qim,

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 ...life.

 We, all his friends will sorely miss him.

http://www.cyclingtales.blogspot.my/


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.

Truncated Lives....

Prof,

We met just now in the evening along the hospital corridor.

You told me your cancer has recurred. You must have been in a state of shock at 1st impact, I am sure.

One hour earlier I visited a friend of mine with severe dilated congestive cardiomyopathy,  a serious heart failure condition. He, at best only have  'X' days to live, in my estimation, only on statistical ground.

All of us only have 'X' days   to live technically speaking, only that most of us take for granted that that 'X' days  is automatically translated as being, 15 to 20 years!!

Which bring me to an anecdote which i can recall in my clinic the other day. A mak chik in her late 70's asked me for sleeping pills to cure her insomnia. I retorted, much to the happiness of he accompanying son, that, " Mak Haji, at your age and mine, not being able to sleep is a blessing!.....we have been sleeping much too long all our lives! Do the tahajjud, the hajat and the tasbeeh......and if you dont find pleasure in this , watch cnn or aljazira...".

Life is, just at best, a number of measured, already actuated, already accounted for, and precalculated, number of breaths. If you are apportioned a total of 'Z' breaths in your lifetime and you have reached your sixth decades and three and used already 'Y' number of breath, you have only ' Z - Y ' breaths left!

Simple arithmetic we all choose to forget.

I was woken up at 2 am  just now still thinking what practical advice I could offer both of you guys apart from advising both of you to get the best technological and medical treatment that 2015 has to offer. 

Actually off the cuff, I would have blurted it out right away in the hospital corridor to you but political correctness and politeness prevented me from doing so.

I find myself still stuck to a famous tabi'in, Hasan al Basri's advisory on life, his trilogy of :

1. Solat [ in your situation, 'extreme situation' requires 'extreme measures',throw in  daily Tahajjud, Tasbeeh , Taubat , Israq and Dhuha as well....they are therapeutic. And if you want to add a wee bit of stevia, daily hajat prayer will not harm you. That is DOA, also another form of Zikrullah ]

2. Daily dose of Qu'ran [ with some understanding, would be infinitely better ]. The accent is on daily. Does not matter the size of the dose. Like low dose aspirin, which is in vogue nowadays, daily dose of Qur'an, even in small quantity, is effective. The smaller the dose, the bigger the reflection.

3. And thirdly,Zikr [ lots and lots of it ]

Especially Zikr. 24 hours of Zikr would not make one mad. It is the antidote and panacea of all ills.

And one more thing, and I am not trying to be better than Hasan here.

Lots of taubatan nasuha.

Taubatan nasuha is part of Zikr thus Hasan al Basri sticked to his trilogy.

Just sleep on this thot:

Allah promised the new Muslim revert to erase all his sins if he says ' laila haillallah...' and if that revert dies that day, he is promised automatic Jannah!

And here we are , 50, 60 years being nominal Muslims, with our occasional solat, zikr and all......

You have your Solat, and your Qu'ran and your Zikr and lots  and lots of Taubat.....albeit quite late in life.

So what?

You are OK.

Insyaallah.

Dr Nik

https://www.youtube.com/watch?v=VPMhVwM7Ovs

[ Shaykh Hamza Yusuf Hanson on Zikr ]

https://www.youtube.com/watch?v=jmKBf3kGbbg

[ Shaykh Muhammad al Yacoubi ]

https://www.youtube.com/watch?v=blJ8neV3wYU

[ Shaykh Muhammad al Ninowy.....Levels of Zikr ]


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



Date: Sat, 31 Oct 2015 03:14:32 +0800
Subject: Re: truncated lives.......
From: nj@gmail.com
To: drnikisahak@hotmail.com

Dear Dr Nik

Thank you for the guidance to preparing myself to face the inevitable reality. My meeting with you that Wednesday was part of His Grand plan. I have been going to the hospital for consultations with the oncologist many times but never have i crossed path with you before. But that very day when I received my blood results of the cancer marker God had willed it for me to meet you for a purpose. 

When you  personally emailed your thoughts and advice to me,  it made me reflect further the purpose of that meeting. Every word you said aptly describe  the state of my soul and my health condition. Your  response to my disappointment(which may be more obvious to you than anybody else) is reflected further in your email. Such a response is just what I needed and which I didnt even realise. Most friends who knew abt my recent progress would give me  standard responses such as "take care of yourself" and "have faith in the Almighty." Masha Allah I shouldn't complain for those are encouraging phrases to keep one strong in the face of life's trials. I thank God for such friends. But your response contains the message which I have been thinking about a lot lately.  

The time given to me by God is measured. No one knows when Allah SWT will call us back from this world. My illness is actually an opportunity, not an end. I ask: Have I completed my mission in life? Have I done my best to please God? But you are certainly right--- move on, give yourself a chance by preparing for the inevitable. Dont waste anymore time. The time is measured.

 What is important--act fast before the time comes. Thank you Dr Nik. I have shared your writing with close friends. They said masha Allah it is a reminder for those who forget and need to be reminded of the measured life by God and of the Day that we will all face, that is, to answer for all our deeds. I'm most grateful to Allah SWT for giving me the chance to  meet you on that day. May Allah continue to have mercy on us.

With respect
Nj

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


On 5 Nov 2015 07:53, "Nik Isahak Wan Abdullah" <drnikisahak@hotmail.com> wrote:

Prof,

tq and I hope you don't mind if i publish your response under a pseudonym of course, for general 'kebaikan bersama' .

But if you have any reservation i would not.

There are ways and ways to occupying  oneself in HIS remembrance.

Science based individuals like you and myself will put it as 'unlimited permutations and combinations'.

But here is just one way on how you might want to start your day, if you may allow me to bore you.

Hopefully it would just serve as a guide and you may want to personalize it to your favourite one, adding here and 'minusing' there, as you get better and better in your remembrance , as you go along the path.

[     https://www.youtube.com/watch?v=MvEf5l2cuoo  ]

I assume here you are still having your work and career to content with, but this suggestion is still  very 'dowable ', even if you are working fulltime. You just need to make some adjustment to how you go about in your waking hours day .

Try to keep your night in remembrance and this require some change in your sleeping pattern ie sleep early, say after isyak and wake up at 3 or 4 am, 1 to 2 hours before subuh daily.

This is the best hours. Having a short nap post Zohor would certainly help.

Start your qiam with astagfirullah , say 30, 40, of your favourite ones, short one will do.   
[ https://www.youtube.com/watch?v=8xSoO0OCRHk  ].  
Then do a cycle or two or three of tahajjud.

Another 30 to 40 astagfirullah, followed by a cycle of tasbeeh prayer of 4 rakaats. This is specially illuminating.

Punctuated again by another cycle of astagfirullah.

Followed by a cycle or two cycles hajat prayers.

My favourite is, when I have the time, to do 2 cycles of two rakaat each, with 99 kulhuawallah total, 9 in the 1st rakaat, 20 in the second. 30 in the 1st rakaat of the second cycle followed by 40 in the second rakaat. 99 kulhuallah in all. Don't ask me where I learn it. It was years back from a 'Tok guru', I have forgotten his name.

Purists may have 'some ' reservations about both hajat and tasbeeh prayers but we do not want to go into debates on this. There are scholars who strongly recommend it and there are cynics who say, NO! Nabi did not do it. [ as if they were there during Nabi's time! ]. If they want to remain at their level  and feel at home with it, well and good. This is a free country.

After the tahajjud, the lenghty tasbih and the 99 kulhuallah hajat, it is now ' ripe  to open your heart's content to HIM and ask. Ask forgiveness....long life..health..and most importantly, husnul khatimah.

Remember you are in the realm of  the Sultan of the sultans! 

Do your two rakaat taubat prayer. More doa yet again while in sajadah position. Cry if you have too!....it would be good for you.

Polish off with your witr.

It  may be possible that you would be just in time for your subuh prayer.

otherwise 'wax and polish' all these prayers and doa with a hundred selawat on the nabi and then followed by subuh.

Post subuh, do your usual tahmid and tasbih.

Followed by fatihah 7x, an nas 7x, al falah 7x, kulhuwallah 7x, kulia 7x, kursi 7x, and the last 3 ayats of al baqarah 7x.

That would bring you to solat israq.

During the rest of the day do your tasbih, tahlil and tasmid as and when you feel your are 'witnessing' events around you unfolding right in front of your mind's eyes.

and lots of ' laila haillah huwah dahu lasyari kallah lahul mulku walahul hamdu wahuwa ala kulli syaiin qadir'

They say  your abode in jannah is a'vast empty  plain for miles and miles as far as the eyes can see' and for the owner to fill it with 'trees, garden  and a palatial home', the above two  forms of zikr will do the job!

Allahualam.

Have a wonderful journey experimenting  and 'enjoying' with your zikr.

Prof, 

Very rarely we find ourselves  sandwiched  in between the lion and the deep blue sea and unable to change the 'parameters' on the ground. You are in that rare position now.

I always believe that , even if one cannot change the paradigm  and the parameters on the ground, insyaallah, with the right attitude and focus, one can change the paradigm in one's qalb.
And in the final analysis, that is all that matters!

Since when we go to meet HIM, it is all at HIS pleasure and grace, not what we do. HE is after all al Rahman and al Rahim.

Yours sincerely,

dr nik

ps : I have omitted the use of HIS 99 beautiful names. These are for the ' specialists from amongst us 'and require a tok guru to guide you. I am just a novice. But from what I heard and read, reciting 'ya Salam, ya Salam...' or ' ya Latiff, ya Latiff...' any number of time would be good for you.

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

from Nj :

Not at all Doc. 

Go ahead (even with my name on it). I'm accountable for what I wrote. You certainly woke me up and many others who I shared your writing with. I am admitted in hospital now but I doing fine alhamdullilah. 

Thank you  so much Dr Nik. May Allah SWT include you among those He is please with and reward you with Jannatul Firdauz Aamiin.

Wassalam
Nj

Similar articles in the blog :

1. http://drnikisahak.blogspot.my/2014/12/on-death-dyingthe-friend-revisited.html 

2.   http://drnikisahak.blogspot.my/2014/12/a-long-prescription-for-friend.html 

3.  http://drnikisahak.blogspot.my/2013/11/just-visiting.html

Of Red Wine, 'Halal Pork' and The Way of Muhammad.....

Date: Thu, 15 Oct 2015 09:07:38 +0800
Subject: Re: Study shows a glass of red wine at dinner good for diabetics
From: hamzah@cempaka
To: drnikisahak@hotmail.com

This is a scientific finding. A glass, just one glass, of red wine is good for diabetics anf heart patients. Reduces their blood sugar, and LDL levels, and raises their HDL levels.
As a cardiologist, how would you advise your patients?

AFP-Relaxnews  :.

""Between too much and not enough, the right amount for type 2 diabetics is one glass of red wine, just one. — Reuters picNEGEV, Oct 14 — One glass of red wine at dinner was found to help sufferers of type 2 diabetes sleep better, improve their metabolism and increase levels of “good cholesterol” to protect against cardiovascular disease, according to an international study.
Between too much and not enough, the right amount is one glass of red wine, just one, if possible taken at dinner. That is the conclusion of an international study published in the 13 October edition of the journal Annals of Internal Medicine.
The researchers, most of who were from the Ben Gurion University of the Negev in Israel, studied type 2 diabetes patients controlled by drugs. The researchers said that these patients were chosen because they are more likely to develop cardiovascular disease, have a lower level of “good” cholesterol and are also less inclined to drink a lot because of their condition.
Their aim, via this study, was to examine the impact, in safety and efficacy terms, of moderate intake of wine on health on this group of patients.
The team chose 224 people with type 2 diabetes who drank moderate levels of alcohol. During their evening meal, the volunteers had to drink the equivalent of 5 ounces (142 ml) of one of the following drinks: mineral water, dry white wine or dry red wine.
With a dietician’s guidance, the participants also followed a Mediterranean diet without calorific restriction for a two-year period.
Each participant had to fill in a questionnaire and undertook blood tests to identify various biological markers including glucose, lipids and markers associated with various liver functions.
Their findings indicate that the group of participants who chose to drink red wine had a greater amount of “good” cholesterol (HDL cholesterol), as well as better cholesterol ratio compared to the participants who drank water.
The researchers also noted that with the volunteers who drank wine, there was a significant reduction in the number of components of the metabolic syndrome (the presence of a combination of signs which increase the risk of acquiring diabetes, cardiac conditions and strokes, editor’s note).
The researchers found that drinking red or white wine was also associated with improved sleep.The researchers concluded that this long term study suggests that combining a healthy diet with moderate wine intake, especially red wine, helps to lower cardio-metabolic risks. "" — AFP-Relaxnews 

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tq dato,

I know you are being 'naughty' here, but I will answer you.

As what all good muslim doctors  would do.......I will look at the red wine advisory from a  more global perspective. This red wine study is certainly very good for the world red wine industry. It is great for them but this is not new This news is already 40 years old!. It keep surfacing as if it is new information. That is the nature of industries. The benefit conferred to risk reduction and protection is very minimal compared to the classical advice of :

DONT SMOKE, 
Keep your weight to your precollege days weigh IDEAL 
EXERCISE EXERCISE AND EXERCISE AND exercise.
Look after your cholestrol etc etc .
Control of hypertension if you have one
And above all , avoid and prevent the onset of diabetes

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

Date: Thu, 15 Oct 2015 17:30:16 +0800
Subject: RE: Study shows a glass of red wine at dinner good for diabetics
From: hamzah@cempaka
To: drnikisahak@hotmail.com

Cuit, cuit, sahaja Doc!

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

On 16 Oct 2015 8:10 am, "Nik Isahak Wan Abdullah" <drnikisahak@hotmail.com> wrote:

            I know
            This red wine thing has been there over 40 years already dato.

I think it act via anti oxidant and another pathway, but the benefit is very minimal compared to dieting, low cholesterol. exercise , control of hypertension and diabetes, no smoking et c etcetc.

In fact if one were to make an objective study on the effect of life of piety [ ie; zikrullah, solat etc etc ], on the lifespan of people already proven to have heart problem, the prolongation to life would be more significant.

But piety is not an easily quantifiable 'variable' and there is no 'industry driven' motivation to spend millions on such study.

But having said that, I always advice my non muslim patients who take alcohol to change their beer drinking habit to just a touch of 'red wine'.

For  Muslims, my accent is on walking that extra kilometre to their nearest surau for their isha and subuh prayer and 'NO CORNER BARING'.

[  http://drnikisahak.blogspot.my/2011/02/unto-him-is-journeying.html ]

A footnote and disclaimer though need to be inserted here.

Despite what we cardiologists do, that sword of Damocle is always on the head for guys already proven to have coronary disease.

Some degree of uncertainty is always there, therefore when you ask me about the miniscule effect of red wine, I consider it quite peripheral...

              Consider this hypothetical scenario :

One fine morning , when you go to your school for an important board meeting,  your chairman of the board fired you summarily for no apparent reason. That same  morning CIMB Damansara phoned in to say they are foreclosing your bungalows in TTDI, Damansara Height and your London  and San marino apartments, because your massive business loan has been withdrawned , due to your apparently lack of show of public support to 'Ringgit Malaysia' in her time of need. Coming home your dear wife of 50 over years asked for an instant divorce. My God ! ..and she has always been very loving.She wants to go on in life and lives on with your business partner! Your must have not been performing, one can presume!

Your BP suddenly shot up to 240/140 . That paper-thin vessel , the circle of Willis, that all important roundabout up in the center of your brain remained intact and does not burst. Lucky you!  But this sudden burst of high pressure was too much for your coronary tree. The undiagnosed , subclinical, unimportant, 20 % narrowing  plaque in your Left Main Stem coronary artery ruptured and become suddenly 100 % block. You had it even before you can say,'abradacabra...' Not even enough time to say the shahadah.

              The news in NST the next day emblazoned on page 2:
          'Former DG Tourism, vibrant entreprenuer, educator par    excellence of Cempaka, found dead on kitchen table at his palatial Damansara Height home...foul play excluded'

          A life of piety, a zikr  and solat laden life.
          This is not easily quantifiable by any study.
          But I put it to you that it is far better than your  glass
          of red wine daily! It can help 'modulate' and 'cushion out'
          all the rough edges and uncertainties related to living this 
          transient and superficial life of ours on this earth.
       
          It is better a 1000 times than your RED WINE!

Life from my perspective is pretty fragile.

It is human to plan, but GOD directs!

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





Date: Fri, 16 Oct 2015 10:44:28 +0800
Subject: RE: Study shows a glass of red wine at dinner good for diabetics
From: hamzah@cempaka.edu.my
To: drnikisahak@hotmail.com

I agree with what you say doc, to which l add the benefits of clean, unpolluted air. A study was done on a small, remote village on the Tibetan side of the Himalayan range. A statistically significant percentage of the Buddhist village elders there live actively to well over 100 years, many over 110!

They were lean and wiry, and lived on a simple diet of yogourt, unleavened bread, tofu, vegetables, nuts, tea, and occasional meat. No sugar. Basic in calories quantum. But they a do a lot of walking and climbing in the open CLEAN AIR. The air quality was very good.

The researchers monitored their bloods and found the LDL and triglycerides low, HDL high, liver and kidney functions good.

The scientists attribibuted the longivity mainly to the walks in the great open spaces, very clean air, and a simple, low calorie diet, and absence of sugar.

I am sure you would have come across this study.

H.

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To: Nik Isahak Wan Abdullah, hamzah@cempaka.edu.my

yes i do dato.

i wrote a  3-article series on ' longevity 101 ' in  my 'mutiara dan zamrud' blog [ pearls & gem ] some 7 years back.

[      https://bay182.mail.live.com/?tid=cmnR5Oc1l05RG6dgAiZMFUZg2&fid=flinbox  ]

you are welcomed to read it.

we have to be, lean, hungry and moving, and lead spiritually simple life.

easier said than done now of course in our highly geared , high level-consumerist, the more the better, economy, that is expounded everywhere today.

in the 3rd article, 'longevity and the way of rasullallah', i posed the view that at 1450 years ago rasullallah's 6 decades and three was probably equivalent to a hundred now.

he had nine wives and never failed to visit all of them in the course of a day's work; ran the affairs of  the  state and fight many  wars in the name of defence of a fledgling nation state, surrounded in the north by a belligerent super-power, the roman empire, to the west,  the  indomitable persians, in the south,  the musrikuns of mekkah and worse off, peripherally on the edge of madinah by the jews of najran and internally within madinah, the al munafikuns.; sell things in the market place for his own and family sustanence right after subuh prayer up to zohor; eat little and stopped before reaching satiety; slept immediately after isha and and do qiam around 2 or 3 in the wee hours of the morning and had a light nap after zohor, etc and etc  and etc.

and no red wine of course!

red wine is a peripheral issue.

the porcine protein [ pork ] has the lowest antigenicity to human protein and in medicine, can be beneficial.

but halal is halal. haram is haram.

in 10 years if they come up with pork that live in lab and feed on corn, and rid of dangerous parasite, and some studies show it is excellent for universal consumption, you may pose to me another questionaire.....

haram is still haramdato, i would write.
halal is halal.
God in HIS infinite wisdom,KNOWS all and HE is just testing our faith.

HE throw in 'some spanners in the engine' and see whether we 'blink or not'

same with Riba , futures trading, etc, etc etc and etc.