The enemy within

One fine day, your GP tells you that your persistent cough with blood may indicate you have lung cancer. And a second opinion from Dr Dunhill Marlboro concurred with it. So your GP refers you to the most respected respiratory unit in the Klang Valley (which I happen to work with currently ehem ehem).

The task is now how do we look for it? Let's assume your respiratory physician works for the CIA, and your cancer's name is Osama.

Chest xray:

The CIA can use satellites to take aerial photograph of Afghanistan (your lungs) hoping to see some shadows that resemble Osama. With some luck they may see some suspicious looking shadows wearing turban holding machine guns (lung nodules/lesion). Which may be Osama (harmful malignant nodule) or it could be just innocent small kids with toy gun (harmless benign nodule). To confirm it we need to extract that bugger out for confirmation. We need to biopsy it!


Biopsy via bronchoscope:

What they need now is to grab some of the lesion. Imagine your airways is like a network of caves. Now, if the lesion sits near the big airways a favourite option is to do insert a fexible endoscope via your nostrils/mouth into the airways and biopsy that lesion (send some agents into the caves and grab Osama to be sent to Guantanamo Bay for interogation. Trust me - doing the bronchoscope is really look like one is exploring a cave network.




CT scan-guided biopsy:

Boy! The CIA didn't realise that Osama doesn't play hoola hoop near the cave opening to be captured. He is hiding deep underneath the ground. So forget the caves onslaught. The CIA now has to drill the ground and send a covert team to kidnap Osama guided by special satellite image (CT scan).



Pleuroscopy:

Or if there is pleural effusion AKA 'abnormal fluid collection in the pleural cavity'. We can puncture the side of your chest and insert a flexible scope into the pleural cavity and suck the fluid out and biospy your pleural wall from inside... hmm something like the CIA can examine a river next to the cave plus some take some soil sample, hoping to find Osama's waste in the river which means he's there all along.

Oh all right that is a crap anology! So i'm gonna skip it and you guys just have to wait for Discovery channel.

Disclaimer:

The above anology is just for fun. If the CIA happen to read my blog. I'm neither working for Osama nor that I know where he is.

PS: Btw the CIA/Bush and Co. are bunch of moron who wouldn't know it even if Osama sleep in the White house over Thanksgiving.

Let's nuke the bastard

There is no certainty in life, you make plans and hope for the best.

At 40 years old, you could either be married or stay single... with a bit of luck you might live long and dance the funky chicken at your 70th birthday party.

Or you could also be diagnosed with cancer at the tender age 30 years old. I've seen lot of fatalities to these malady. It knows neither mercy nor boundary. Any of the human organs is a potential target, from prostate to ovaries... from brain to bone marrow. In most cases you can't cure them.


Sure we can kill the sonoffa with chemo or radiotherapy but not without caveat emptor. Take chemo for instant we have reliable cocktail on our shelf. But the side effect can be nasty to the other healthy living cells. Not to mention the nausea and puking your guts out. In the end the cancer cells might return and haunt us back like Stallone in Rambo 4 (he should know when to quit).

Performing pleural biopsy on a patient with pleural effusion, suspected to have lung cancer.

This unlucky pakcik smoked 1 pack per day for 15
years.

Cut that sucker out you say. Sure if it is Stage 1 NSCLC (non-small cell lung cancer)... why not? But what if we diagnosed Ahmad's cancer a bit too late. Think of it like PS2 game - Stage 4 is a more difficult level where surgical resection is rendered useless because your Damansara cancer has taken the LRT to Port Klang and married a second wife there. What did you say?? That LRT route doesn't exist? Oh sue me then and later take it to Ong Tee Keat.

Not to mention the issue of 'no-fly zone' or no man's land where if Muthu's cancer cells have an office on the 52nd floor of Petronas tower. The surgeon surely can't take it out without chopping away the first 50 floors. Hint: Most brainstem gliomas are deemed inoperable due to its close proximity with certain vital part of the brain required by Muthu to breath, shit or copulate.

I would not be far wrong in that to own your own cancer cells are likened to the top 3 real estate pearls:

1. Location


2. Location
   
3. Location.

Persoanal probe-lem

I watched Dark Knight last night and phew! As far as comic superheroes on silver screen goes, this would rank as one of the believable one.

You see, batman is just a normal dude who train himself to be at peak human physical performance. And being obscenely rich he fund himself with lotta cool toys to fight the bandits of Gotham.

Perhaps if I'm that rich I could even transform myself being a superhero. Why not? Then all I need to work on is a slick superhero name... hmm I wonder if these would cut it:

1. the stethoscope


2. the spatula man


3. the syringe
   
4. .... the scalpel-man?

The next step is to find a tailor to change my whitecoat into a tight white spandex. I'm sure Jln Masjid India has some extra material that I could use... not too mention a 'bling bling' add-on would be nice too!

Then I would need a supervillain to beat the shit-out in order to show my heroism prowess to the PJ-folks. He would definely has a cool name too like ''the cholera' or even better 'the chlamydia'! Which of course would be the alter ego of some prick from the BN frontrunners who have evil hidden agenda like lying to the Malaysian public about fuel hike etc.

Hey who knows it could be Khairy or Hishamuddin whom of course would be armed with his longgg keris to compensate for something else. If I'm lucky maybe the Keadilan would field me as its candidate in the next General election.

Oh crap then I better not get any persoanal (pun intended) aide or else the BN would pin me down with some wild sexual allegation!

... "Look! It's a bird.. no it's a plane.. no! It's the Proctoscope-man!!"

Think again

There are number of the do's and don't that you should adhere to when you visiting your relatives in hospital.

In random orders:

1. Do not shake doctor's / nurses' hands

They spend their waking hours (sleeping hours too) touching patients from head to toes and yeah including sticking their right index finger into anus (patient's not their own) checking for bleeding or enlarged prostate.

Often enough, patients have all kind of germ and nasty bug, some would be resistant to even powerful antibiotic - among the popular ones are MRSA and ESBL. Being tired mortals & all, these doctors sometime forgot to wash their hands.

2. Using the utensils in canteen

You would probably don't mind sharing the utensils with the general public at restaurants. Think again when ill patients find out that ward meals aren't that tasty and they decide to visit the hospital canteen. Some of them even have oral candidiasis (fungal infection inside the mouth). Ooh yes the kitchen staff really clean those forks & spoons thoroughly like you do at home.

3. Don't stand near mobile Xray

Frequent enough we call mobile xrays to ward if patients are too ill (boley blah xray). You will see hospital staff move away from the xray machine, at least 6 meters away, even hiding in the next room. I suggest you do the same. Coz you don't want to be exposed unnecessarily to the radioactive ray.

4. Bring regular medications

If you send your love ones to hospital for treatment. Please la bring their medications as well. Our records are usually not available after office hours. The last thing we want is for you to describe them " alaa dokteerr ubat yang panjang warna coklat tuuuu".

5. Bring previous letters/appointment/previous discharge summaries.
E'nuf said.

C4 satuu!

It seems like Malaysians are tired of our current politicians' shenanigan and tomfoolery acts. I tried to stay away from blogging about these people - frankly speaking I'm tired of hearing their childish remarks to each other. Not to mention their condescending attitude towards certain quarters of general public. They think we're fool!

Their bickering routine on papers started to sound like an episode in Dynasty or Knots Landing.. yes I'm that old.

To digress, one of our national's shocking news from last year that has lost its way to page 10 in Malaysian papers is the infamous case of Attantuya Shaariibuu murder. After the homocide, her lifeless body was exploded with C4 bomb...

Phew! I tell you C4 is one nasty bugger. You don't want to get near any of that yellow stuff within 2km radius.

It is so wicked that it got itself into hollywood culture:

1. Blows up Nakatomi building and John McClane's ass out of the sky in Die Hard.

2. Strapped to the bank hostages in Hancock

PS: The moral of the story is do not date politician. Period.

These days

Life felt different these days. Breathing has become a conscious effort at some point of most days, which made me afraid to go to bed at night. Just in case I forgot to breath while I'm sleeping. Paranoia loves company.

Last sunday I bought my 1st ever notebook ASUS Z99 SR - a Centrino powered 2.2 GHz, 2 RAM, 250 hard disc with 128 dedicated graphic card. Anyhow I spent half day in Low Yatt which by 8pm I found myself hurried along Bukit Bintang shoplots with empty tummy. A chinese girl in a Komono suit handed me what look like a dinner menu leaflet.

Slightly excited and without looking at the leaflet I asked her.

"Halal ke?"

She threw me a confused look.

I looked at the leaflet and to my embarassment it said:

"FISH SPA for RM29 per 1/2 hour - let them massage your feet"

Someone had forgotten the drum roll.

Losing a friend

I first met him when he got admitted last November. A 35 year old man hailed from Terengganu. In many respect, he was one tough man inside. Never had I came across a person with a long list of medical problems. He had asthma, diabetes, burnt out-acromegaly, AIHA with evans syndrome, cardiomyopathy, hypothyroidism and left leg filariasis (untut). He was even allergic to penicillin which once nearly killed him.

He was single and being morbidly obese with those list of illness. Perhaps it was hard for him to meet up a girl for a meaningful relationship, although he was a gentle, good man with a chirpy character.

That November he was admitted for severe left leg cellulitis which compounded the filariasis. We became good friends after a while, he addressed me just by my name - no more doctor which didn't bother me at all. It took him 1.5 month to get well enough to be discharged back to Terengganu.

Two weeks ago while I was on call. A nurse told me a new patient just got admitted. She said "He's big doc... very big and there is something about his left leg which doesn't look right". I knew right away my friend had come back.

He looked like he had lost a couple of pound. Flabby arms and shrunken face. He was ill. This time none of his pre-existing diseases could explain his current problem. He had fever, breathlessness, weight loss for the past 1 month. Over the few days we treated him for congestive cardiac failure secondary to pneumonia.

The full blood picture however showed presence of blast cell (immature blood cells produced too early by damaged bone marrows). We immediately knew he had leaukaemia.

It was me who had to do the first bone marrow aspiration and considering his weight of 110kg, the task was not easy. It hurt me to see him in pain during that procedure despite the 100mg of IV pethidine and the 10mg midazolam which didn't sedate him either. We then proceeded with chemotherapy after identifying which type of leaukaemia we're dealing with.

He fought his last days with courage and patience. Never had I see him broke down in fear, one time he asked me why was he being so unlucky. I replied perhaps God was testing him.

I last saw him one morning in the high dependency ward. He looked tired, lost all his hair from the side effects of chemotherapy. His lips were swollen and bruised and he could barely speak which required him to communicate with pen and paper. I held his hand and tried to comfort him. He knew his time would come soon, so I stayed beside him for a while.

The next morning when I went to see him again. His bed was empty. A crisp clean sheet covered the bed. It took a while for me to realise that he had gone forever.

Rest well my friend, you had fought a good battle.