.....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

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

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

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



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.

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


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

Arab Class....

...at a time before time, in the 'alam ruh', on the day of the Primordial Covenant, this conversation took place:

Alastu biRabikum? [ Am I not your Lord? ]
Qaloo, bala shahidna  [ Yea, verily. We testify. ]



"Am I not your Lord? They said: Yea, verily. We testify. (That was) lest ye should say at the Day of Resurrection: Lo! of this we were unaware; "( al-A'raf : 172)

On 25/02/2013, at 8:15, Nik Isahak Wan Abdullah <drnikisahak@hotmail.com> wrote:

At the opening session of our Sunday night arab class in USJ last week our Algerian born tutor, Mr Bahaeedine Muhammad who is English and French-speaking tutor said this:

"Consider this as a 'fardu' of sort since your learning Arabic is part of your ' religious duty

and since you are Muslim, Arabic is your language, you are coming home!"......

This is my third class after prematurely dropping out from the last two in a period of 10 years.

Insyaallah I will stick this time. I am learning 'my language'.

Additionally at 60, it will help keep my trillions of brain neurons together.

It is easy for  neurons to just disappear from lack of usage at this age.In medical parlance we call it 'disuse atrophy'. CT scan of people above 70 generally show  smaller brains due to'cerebral shrinkage'. Exercise them, say by learning new skills like picking up a new language. This is akin to 'cerebral gymnastic'.

           Remember: there are more than 200 ways of describing a lion in Arabic!

 nik howk

 ps : nadzru my 'arab' friend , i can almost hear him chuckling in the background.

 this chap can sell sand to the libyans....that is how good his Arabic is !

           He feels people should take up Arabic for the 'culture'  etc and etc. Taking up Arabic for     
          
           the religion is plain " pathetic".
       
          I am not at all surprised....he can sell sand to the Libyans..that is how good he is!

 



From Tasnim, who wrote in,

Assalamualaykum,

Whoever u r..thanks for this short inspiring notes..it has surely drive me to attend this class..hope its not too late as missing the fist few basic ones is definitely a loss....anyway..insha'allah to attend the next one..

Thanks shima and also Dr Nik Isahak..

Sent from my iPad

Puan Husna  of Ampang wrote in:

Salam Shima,

The Arab language can be very difficult to learn, as what I saw at last night's class.  But the fact that we all learned to read the quran early in life probably put us all in a better stead.  I do hope the teacher will not go totally Arabic during class as he promised to because like many people, I think in English, I would be totally lost.

I hope experienced Arab language students like yourself can give some tips on how you mastered  it, every now and then.

On Mon, Feb 25, 2013 at 11:47 PM, Shima Derus <shimaderus@yahoo.co.uk> wrote:

wa'alaikum salam w.w. dear sis

Arabic language is not easy but it's not impossible to learn it, either! It hits me very hard post-911, within a very short span of time, watching scores of non-Muslim journalists from CNN, BBC , et al, interviewing Arabs!! 

They can read & converse in the language that I recite everyday in my solat, (without understanding what I was reciting)?!!

Then in 2002, when I was in Masjid Nabawwi I met a college girl who asked me if I speak Arabic, since I was then reciting the Qur'an. She was baffled when I said No cos how can read the Qur'an then, without understanding it??!! BUt as usual, being a busy corporate woman then, didn't do anything afterwards.. It was until after I quitted my job in 2005 I strated to learn Islam, tajweed and then the urge to learn Arabic was revived again..  like Dr Nik, I attended 1 semester night classes at UiTM. No Semester 2 cos not enough students... Then I organised a class at the masjid but this time the teacher (the same UiTM lecturer) dropped out!!  He was too busy juggling between his lectures, meetings that we had to reschedule our classes many times. Then I joined yet another class at a friend's place. Also lasted several months - too technical. About 2 years ago I got acquainted with a native Arab speaker, Ustaz Mo'az. Gathered my 3 children and a few mualafs fr Philippines we started another class. Dr Nik also joined in then, for a while...The mualafs' (all  reverted less than 5 years) determination drives me to continue the class. Then Ustaz Mo'az passed on the class to his friend Ustaz Bahae, as the former stays in Gombak whereas the latter in USJ.

So, it was a very2 slow journey for me to come to stage I am now, which is still elementary, actually! But they as they say, Winners never Quit!!! InshaaAllah one day I will win the battle!!! So can you! Sit at the front row; then you can be more attentive. Ask questions; take down notes (bring a note book). read them again (at least once, before you come to the next class!). The next time you read the Qur'an, read the meaning. Then you'll start to get familiar with words that we learn in the class. We are lucky that there are many BM words that are derived from Arabic.

InshaaAllah I will try to share the little knowledge with you. Together we can make it!

Ma'as salaamah wa ilal liqo', inshaa Allah.

(Goodbye and see u again, inshaaAllah)

Wasalam,

Shima Derus

From Nadzru Azahari, 'The Arabist', who wrote in:


Dear Nik Hawk, friends, Romans and countrymen;

I wish you all the best in your arabic language class and I hope you are enjoying it very much.

Very soon Nik Hawk will be saying, ' as-sakt ad-damghi min ajl ad-dakh dam al-aali al-mu'aqata - stroke due to momentary high blood pressure. He will also remark, ' aj-jaltan amama al-mafraq ghaira saaleh bish-shurayyan AVM' - a clot before a poor AVM junction. Then he will repeat the usage in a different context, ' al-hukuma al-mu'aqata qabla al-istifta' ' - a temporary goverment before a referendum. Then he will say, ' al-wadh'iya fi mafraq al- nadzariyat as-siyasiya' - the position before a junction separating political thoughts. The word ' sharayan' to Nik Hawk can refer to a vascular system or a political consensus building access network.

At that time we will confer him with a 'Kelas Dewasa' KEMAS certificate in arabic!

All the best and May Allah bless you all. I am very proud indeed of your efforts.

Nadzru Azhari





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



Basic Quranic Arabic can be accessed on this site:

http://drnikisahak.blogspot.com/2011/05/basic-quranic-arabic.html

Case History : Two Contrasting Cases...A Day in the Clinic

Yesterday I had two contrasting 'cases' in one morning at my outpatient clinic session.

Case 1 :

Young Malay man, hardly 30, accountant, just married with one child.
Had a major ' anterior myocardial infarct ' [ heart attack ] about a year ago and seen early in Kajang District Hospital. Duly given streptokinase [ agent that 'breaks blood clots', we call them 'thombolytics' ]by admitting physician. The right thing to do in a small hospital where primary infarct angioplasty needing a cardiac catheter lab with 24 hours cardiological specialist coverage is not available. Was referred to me three days later when an angiogram was done and balloon angioplasty and stenting to culprit artery instituted. A late damage limitation exercise I would say, as 'primary infarct angioplasty and stenting' at the earliest possible time is the gold standard therapy for the last 15 years now, without doubt. He has missed the boat, but better late than never. Left ventricular ejection fraction [ LVEF ] then was 40 %. Not great when you are just turning 30, normal being between 55 to 80 %. There was a lot of muscle loss at the point of the 'infarct'.

Yesterday was a disturbing finding. His follow up echo showed only LVEF was only 25 %.
?? Progression of disease despite his lipid and cholesterol already on the 'floor' and ideally very low.
?? Occluded stent, despite no chest pain and normal stress ECG.
Will bring him in and reangio  after these festive CNY season to reassess and get a new coronary road map...kiv stenting, I made a mental note.
Whatever the finding, the news is not great......
The chance this nice young man celebrating his 55th birthday, 'on statistical ' ground, is truncated..an automatic thought.
Unless 'heart transplantation' become epidemic and organ donation acceptable then [ highly unlikely ],
Or 'Yamaha heart' or 'Suzuki heart' is easily accessible in 2030??..most unlikely.
Got to work on his 'soul'...he look like a good practising, committed Muslim  and can take the 'bad' news....have to be extremely careful here...not many people wants to know the score....just another mental note. [ kiv]




Case 2 :

Abdal Hakim Murab [ not his real name of course ], 65,a Norwegian sailor, a convert par excellence, domiciled in JB. I am seeing his wife regularly in outpatient for a ' moderately leaking mitral valve'.
Hakim had a full  annual employment medical check up in Sinapo and the Sinapo doctor wrote "adviced not to exert himself". This small advisory note in his report, according to Hakim, is going to affect his employability in Norway where he works as chief steward on a ' mining ocean going ship' off  the North Sea, a very well paid job with great vacation periods in between. He plans to work till 72.

I know Hakim very well. He does weight training in the gym four times a week, followed by cardio, the whole session lasting two solid hours. Three times a week he does 'interval training' on the beach or runs up a small hill at the back of his house in JB. OMG, this man embarassed me. I thought my one kilometer swim at lunch time , three time a week is already exemplary!

Hakim is 172cm tall and weighs 65 kg, ideal body weight. I have a simple formulla for calculating ideal body weight. Height in centimetres minus 100. That is your ideal body weight! Anything less is an added bonus.
He is almost all muscles.

I did a threadmill on him that day. He completed Bruce Protocol stage 5, at a workload of 15.5 MET!
A year earlier I did threadmill tests for all the Sime Darby footballers aged between 20 and 25 and none of them could complete stage 5.

" Hakim, I have bad news for your wife! You are a 64 year old man in a 16 year old body...."

Exercise , to me, is the perfect elixir of youth.







Previous articles of similar vein:

1. 'You Don't Have To Be A Marathoner'
     http://drnikisahak.blogspot.com/2012/12/on-exercise-and-longevity-you-dont-have.html


2. 'Letter To Rifqi'
    http://drnikisahak.blogspot.com/2011/05/on-obesitymodified-cambridge-dietand.html


3. 'Mixing The Profane & The Sublime'
    http://drnikisahak.blogspot.com/2009/03/exercise-mixing-profane-and-sublime.html


4. 'Some Random Thots On Death'
    http://drnikisahak.blogspot.com/2008/05/some-more-random-thots-on-death.html



5. 'Unto HIM is the Journeying'
    http://drnikisahak.blogspot.com/2011/02/unto-him-is-journeying.html
   


6. 'Longevity: A Muslim's Perspective'
    http://drnikisahak.blogspot.com/2008/07/longevity-muslims-perspective.html
 

Case History : Takotsubo Cardiomyopathy

I was in Singapore the last 3 days, attending the now world famous annual affair, The Singapore PCR-Live, a regional meeting of like minded  interventional cardiologists all over the world to discuss current  advances in techniques in coronary angioplasty and stenting.

My usual problem in Singapore is always over 'makan'. It is probably easier to find 'halal' food in Beijing or London than in Singapore. So over the short ' in between lecture' lunch break I  find myself rummaging at the buffet table for anything 'halal'. Cauliflower soup does not look palatable but probably is 'halal'. So be it.

"Is this sea food?", asked a tall Middle-Eastern looking man behind me.
" No it is not but it is 'halal ", I retorted , with a smile [ OMG, I am not alone in this crowd ], with some relief.
" You are Muslim, where are you from?"
" Kuala Lumpur, just 400 kilometres up north from here!, Are you from Iraq or Iran?", I retorted, excited.

It turned out he is Kurdish from Iraq, now domiciled in Sweden over 20 years. He is in Singapore to present his series of patients and study on Takotsubo cardiomyopathy, or what we term commonly as the 'broken heart syndrome'. Quite a rare occurrence. I have seen probably only once in my 30 years or so of clinical practice.

"By the way Doc, I take pork. I am just allergic to sea food. I am non-practising Muslim for sometime now", he announced to me rather with some pride.
Now it is my turn to be 'broken hearted'.
In the midst of hundreds of like minded individuals at the brand new Marina Bay Sand Convention Centre, I find myself 'alone again in the crowd'.

We are are just like ships passing  by in the night.
We lead our own lives and at the end  of our 'time'  go to that 'hole in the ground'.
Whether you are an 'unbeliever' or a 'believer' or increasingly nowadays,' a non-practising Muslim' like this Kurdish cardiologist, you will meet with your Maker and will be made to account for whatever you do in this life.
HIS opening gambit , asked via HIS angels, Nukal and Nakil, would be: 
Man Rabbuka ? [ who is your Lord? ].
 [  http://drnikisahak.blogspot.com/2010/11/ma-rabbukawho-is-your-lord.html ]


No, I was not really 'broken hearted'. 
I was just feeling sad for him. In his intelligence, he cannot fathom his 'loss' !
He just cannot appreciate the chaff from the grain.
That meeting of like minded people in Sinapo discussing the  intricacies of forms in its various minutiae, but missing out on the substance....

No! I was not broken-hearted, just feeling  yet  again 'alone in a crowd'.
A privilege feeling.....some degree of sadness combined with a feeling of 'marhabah'.

Next time a Muslim-like face ask "is this sea-food?", I need to put my  best 'political correctness jacket' on  and say, "No. Sir, this is just a vegetable soup! ". 





1.  http://en.wikipedia.org/wiki/Takotsubo_cardiomyopathy

2.  http://www.huffingtonpost.com/2012/12/26/broken-heart-syndrome-heartbreak-physical-effects_n_2325732.html

2. A personal encounter with " Takotsubo Cardiomyopathy "

Some 10 years back I was called to ER at 2 am to attend to  Mr R E, a third cousin of mine, some 3 years my senior in his late forties presenting with sudden onset chest pain and breathing difficulty. His presenting EKG suggest an acute massive anterior wall infarct [ 'heart attack' ]. He was admitted to CCU. Emergency Primary Infarct Angioplasty, meaning pushing patients straight to the cath lab and opening up the blocked arteries there and then, was not 'in vogue' yet at that time in Kuala Lumpur and at my hospital. He was given streptokinase, a blood clotting thrombolysis  agent, intravenously to break down his "?? blood clot ". Nonetheless he was behaving rather atypically in CCU, since despite thrombolysis and full medical therapy, his pain and breathlessness remained persistent and in fact increased a little and the EKG did not show improvement at all.

At angiogram the next morning, I was surprised to see that all his coronary vessels are patent perfectly. It could still be a heart attack with transient 100 % blockade , successfully reopened by the intravenous Streptokinase, but this is highly unlikely as there was no evidence of  residual.narrowing at all in his 'supposedly' diseased vessel.

R E has had a very stormy relationship with his wife over the past few months and at the point in time of this  hospital presentation, on the verge of a  difficult 'divorce'. This is his second marriage.
I have no doubt that , R E must have been my first brush with 'Takatsubo cardiomyopathy".

Unlike most cases of Takatsubo cardiomyopathy, R E was unlucky. His heart took  so much severe damage during the attack, the function did not recover due to much muscle loss, and his left ventricular function was permanently depressed to an 'ejection fraction  just slightly over  30 %. [ normal is 55 - 80 % ]. He has to be given anti heart failure oral medication the rest of his remaining life.

He remarried 2 years later to a new partner but his 'broken heart' did not recover.
Sadly, he died of worsening heart failure just 3 years ago.

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

Philosophical Quarrel with God.........

June,

I saw your beloved  Fred, 3 days ago. His heart is ok. But when we discuss' politics', after the threadmill session, and when the subject somehow veered-off to Islam, it dawn upon me that, obviously like a 'sore thumb' sticking out,  Fred has some nagging philosophical difficulties with God himself, which need some fine tuning.

He reminded me of  our mutual colleague Doc ZZ 'who is angry with God because the current Islamic worldview,according to him, could not take in the concept of evolution'

Fred's problem with God is not as chronic as ZZ's, but nonetheless,even not on the same scale, is almost as bad, if not resolved. 

I am poorly equipped to confront these two eminently educated gentlemen on their intellectual differences with God but  I believe if they read in between the lines the 'khutabahs' in the 'Reflection' and 'Key to the Garden' series in my collection of  'utube articles', this would make my job easier when we do meet later over tea-tarik. I am certainly  looking forward to several tea-tarik session with Fred in future, just for him to name which 'mamak' shop. Turning him around would be an interesting academic challenge, with your tacit agreement , of course.. No venture no gain.....

Nik

http://tafseerkoran.blogspot.com/2013/01/index-2-for-year-2012.html

http://drnikisahak.blogspot.com/2010/11/z-i-feel-humbled-by-your-frank.html

http://tafseerkoran.blogspot.com/2012/12/key-to-garden-free-will.html

http://drnikisahak.blogspot.com/2011/12/christopher-hitchens-anwar-al-awlaki.html



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


   Nik

Let him simmer in his anger, he will be guided in this issue, insya Allah. 

June

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