Breast Cancer Q&A

"I don't know how to start to ask my mum to check her breast. I just feel weird to ask that.

Anyway, for guys do I need to go for medical check up for my breast? I don't think they examine my breast during my last medical check up."

That is a good question. How do you ask someone to get a private part checked especially when you are the opposite sex because it feels weird.

It does feel awkward to do so since you are the son but because of your good intention and your concern towards your mother's well being then you very much have to raise the topic to her. Here is an easy way to hint her about breast cancer and breast examination. First you look up for a newspaper article or a brochure about breast cancer and ask her to read. Then maybe you can casually ask her if she has gone for breast examination anytime of her life before. Most Malaysian women are too shy to go for it. And then you point out to her that she can do it at home on her own. It helps if you can remind her of someone she knows or someone in the family who have or had breast cancer since that is a high risk factor and she doesn't want to be diagnosed late.

Men are also at risk of having breast cancer. Even though it is quite rare but it is important to examine yourself too. The self examination doesn't take long and it is very easy. So you should encourage yourself to do it once in a while.

Thanks for posting some good questions so other readers can benefit from these too. :) Enjoy reading.

Suicide? Think Again!

I'm so beat today. I am now posted in Emergency Department. Today is my 7th day here. It's quite fun to be working here because us in the emergency department is the first line of people taking care of cases that comes in.

Today, it's sad to see a few people who came in with poisoning. They tried to become suicidal by consuming poison and excessive paracetamol (panadol). I hope none of you will ever fall into these category of patients. You see, people who attempted suicide really do not care about their life anymore as to have decided to drink up pesticide or do something stupid, like stab themselves. But us in the hospital try so hard to help them come back to life.

When I saw a girl who came in today unconscious after drinking pesticide, I was so angry. I don't really know why I was angry at her, maybe because of what she did to herself. And we tried so hard to bring her back. We did so much to revive her, but it felt ironic and I felt stupid too. I can't really explain how I felt that time. I do understand that as a doctor I have to try my level best to counter her condition, but I was mad at the same time because she did something really stupid.

If you think that drinking poison and try to kill yourself is an easy job, you are wrong. In fact, it can be the most painful thing to do ever. You won't just get knocked out instantaneously like how you see in movies or TV shows. When you consume poison, depending on the nature of the poison, you can ulcerate your mouth all the way down to your stomach, or you might get the most painful burning sensation and you start throwing up in a very painful way. And because you start throwing up, you might even aspirate (the vomit might enter your lungs) the vomit and poison and then you will start having difficulty in breathing, that you are gasping for air but your lungs are burning and the airways constricting disabling you to breathe. We definitely don't want that do we?

So choose to seek help rather than attempting suicide. There are many ways you can try to let your heart and emotions out. Get someone to talk to. Get anyone, you can even talk to a pet if you want to. As long as you don't decide on doing something stupid. And know this, people do care about you. Somethings in your life may not go the way you want it to be but there are people who want you to continue your life's journey and strive in any challenges you may face.

Take Good Care of Your Teeth

Many of us do not bother much to go for yearly dental check up. But I do hope you do take good care of your teeth. Some of us might not give much attention to how our teeth look like, if it has started to get black with caries or some even start to decay.

We should all start looking into the mirror and get a closer look at your teeth inside and out and in between. It is important to take good care of your teeth because not only it makes your smile more impressive but also it helps to prevent heart diseases.

Any teeth with caries or those which are decaying are good site for infection to sets in. And as we all know, if there is infection present, that means there are bad micro organism around. So these micro organism can travel inside your teeth and gets into the blood and at the end the blood will be carried into your heart. When the micro organism gets into your blood it can cause some dangerous heart diseases and damages your heart. It will slowly and silently causes you problems and you might not even be aware of it until your heart and your body cannot decompensate(correct) whatever that have been going on with your heart.

So start brushing and flossing and gargling. Do not brush too hard till u bleed, because that is wrong. Just brush lightly and make sure you don't miss out any areas especially at the back and in between the roots and hopefully we all can be proud of our teeth and smile from ear to ear everyday! :)

Touching the Void

Until now I have never understood why people would even enjoy climbing humongous cold icy and rocky mountains for days and as I and most of us see it, we would swear never to set foot in that kind of place because it is hauntingly dangerous. Today I watched a very real documentary film about 2 friends, Joe Simpson and Simon Yates. They were 2 very ambitious mountaineers whose aim was to conquer an unclimbed West face of a notorious 21,000 feet peak called 'Siula Grande' in Peru in 1985. And something went really really really wrong.

The movie started off by showing the beautiful scenery God created of the mountains. When I saw the scene where there was nothing else but whites of the snow and the thick clouds, and the blue sky together with strong sound of wind blowing every now and then, it was gorgeous. I was telling myself I would love to experience that, just to stand in front of it and enjoy the view.

The movie went on with the 2 of them climbing to the top of the mountain. Simon was the leading guy and Joe follows about 100 feet behind him. They were connected with a rope and the rule is, if one of them fall,the other will have the same fate. They took 3 days to just get on top of the mountain. Everything seemed to be going on well. Until they were on their way down.

Joe happened to be the unlucky one in this expedition because he broke his right leg on the way down and he fell off a deep hole inside the mountain that made Simon thought he was dead. So Simon continued his journey back and left Joe in the mountain.

Joe's determination and courage was tested on how he would survive to get out of the inside of a mountain with a broken leg. At this point I was thinking to myself. What is it that I would do given the same situation as Joe had. But I think it is too easy to plan now that I'm watching it in a movie. Something is now swirling in my thought. What would I do now to survive in my own world. The world I'm living in. The daily life I have now and tomorrow's. Joe never gave up in spite of having a broken leg, probably shattered into pieces, alone, cold, with no food or water and most of all, he was getting nowhere. With his condition and his state of mind, he formulated a strategy. Pure survivor instinct. He made his aims little by little, and he gave some time to accomplish his aim. He pushed himself to gain what he aimed for, what he craved for, his safety. He crawled, he hoped with his good leg and fell every time he hopped but even with his excruciating pain he still went on, and on, and on. Until he reached his goal he refused to stop. He gained his strength, for what ever was left, to keep going. It touched me deeply. For one person to be able to help himself to win his own challenges and never stops until he gains more and more, to me that feeling is overwhelming. I want to be able to do that. I want to be able to challenge myself to see how far I can go.

Being alone doesn't mean you are weaker. It means you are stronger. Because being alone means you are independent and that you are ready to commit to life's great challenges without other's help or sympathy. Being hurt doesn't mean you are a loser. It means you are a winner. Because you achieve when others think you would falter. When Joe was alone, he thought of 2 things, either he would die from pathetically waiting for someone to come and get him when nobody knew where he was or he could die on his way out trying to survive. And he decided he would rather die trying. But as he was on his way to get out of the mountain, he realized he was stronger and smarter than he thought he was. So now I feel good about being alone. It makes me feel impressed with myself that for all this time I have won my life because I am independent.

I am looking forward to be able to experience new things in life and I am excited to get to know what is waiting for me in the future. And I hope in every challenges I am to face, I can make it through and come out stronger every time. To be able to do that, and perhaps if I became successful one day, I would be more than pleased to tell my life's story might have been sparked after watching this beautiful true story based movie called 'Touching the Void'

Diabetes

It rained the whole day today. Feeling quite cold but rather cozy because i get to enjoy hot soup and hot tea. I hope it rains tonight too so i can sleep like a baby kitten (as I always do) :P

Today in the hospital I met a patient who is in her 60 who have been a diabetic and hypertensive for over 25 years. She came because of palpitation (her own awareness of the feeling that the heart is beating fast and hard) and breathlessness.

I won't blog about heart condition today, instead I'll talk about Diabetes. Diabetes is defined as high blood glucose (sugar) level in the blood.

Diabetes affects over 1.5 million people in Malaysia alone. It is one of the most dangerous disease because it creates multiple complications(bad outcome) to those who are suffering from diabetes. There are 2 types of diabetes. The type 1 affect children or younger age people because there is a defect in producing a substance called insulin to take up glucose while type 2 affects the adult due to their bad eating habits.

Some people might say "so what if I have diabetes? It's just high sugar in my blood. It won't harm my health at all."

Diabetes is frightening in spite of just high blood glucose level. Because of this high glucose level in the blood it creates many complications that can affect your entire body from your brain and down to your feet. Due to high glucose level in the blood, your body tissues are more prone to infections. The bacterias love to be around tissues and environment rich with glucose. And once infection sets in it is very difficult to treat unless if the person can control their blood glucose level. That is why some of you might have seen your elderly who have been having diabetes for a long time who had infection of their feet which did not improved and at the end had to go for an operation to amputate(operate and remove) some part of their leg.

Diabetics are also at risk in developing kidney failure. These patients undergo a complication called nephropathy which means that the kidneys are dying. Hence they need a treatment to replace their kidneys either by kidney transplant or hemodialysis. A transplant sounds easy but how many people do you know now who are willing to donate their organs for others? Hemodialysis is a good substitute because it works as an artificial kidney but it is expensive. One cycle of treatment of 3 times a week can cost up to RM300 and these people need to go for hemodialysis for the rest of their lives.

Other complications can be blindness, loss of sensation and hence you wont even feel that your feet are badly cut and that becomes a good source of infection. Uncontrolled diabetics can also develop heart failure, coma and stroke.

So don't give excuses not to care about your blood glucose level. You can get your blood glucose level checked in a clinic or if your diabetic parents have got a device called 'glucometer' like the picture up there you can test your glucose level yourself at home.

STOP SMOKING

Hello everyone. It has been a very long time since I last blogged (I think I've said that too many times too). But it was for a good reason (I think). I've been busy with studies and also elective programme where I was working with my dad.

I have quite a lot of things I want to share with you but today I've decided to talk a bit on smoking.

I know some of you smokers might roll up your eyes and ignore this but I'm still going to pin out to you the effects of smoking you are creating not only to yourself but also people around you, especially your loved ones.

Lets see how much of harm have you caused to your lungs since your lungs act as your air filters. Most of the smokers will have occasional cough which may be severe and may prolong and worsen as time past by. Still they refuse to quit smoking because they have an excuse by saying that others who don't smoke gets cough too. That is true but people who doesn't smoke gets cough due to infection that spread from one person to another by air. In case of chronic smokers, they develop cough because of their lungs have undergone desruction and abnormality hence you are more succeptible to infection and other diseases.

Few of the most diseases that affect chronic smokers are : Chronic Obstructive Airway Disease (where the patient frequently gets attacks of breathlessness), Lung cancer, Bronchiectasis. These conditions are most grieved because they are the difficult illnesses to be treated and chances to return to normal is very minimal.

The smokers might even deny that they smoke a lot of cigarettes a day and claim that they only smoke occasionally so they think that they are safe from dangerous illnesses but hear me out, once you have smoked, it takes 6 years to clear your lungs from the harmful toxins you have inhaled and only afterwards your lungs can be healthy again.

The harm done isn't contained only in your lungs, your bad habit also affects your heart and your blood vessels. Your poor over worked heart muscle gets weaken and since you have also caused damage to your heart's artery bringing the blood supply, your heart gets weaker and weaker and it might undergone a disease called 'coronary artery stenosis'. Stenosis means the artery (a vessel bringing blood supply) gets smaller. Coronary artery is the name of the artery bringing blood supply to your heart muscle. When this happen your heart muscle can die and you get something called as Myocardial Infarction or Myocardial Ischemia. These 2 are Malaysian 2nd cause of death compared to other morbid illnesses that kill our population.

So lets do our parts to either stop smoking (to those who smoke) and to those who don't smoke you should play your role by advising people to stop smoking.

There are ways on how you can stop smoking. You can seek medical help where you may be prescibed with nicotine patch, or counseling session but most importantly you should believe in our own ability to make yourself stop smoking. Do not hesitate to seek help or other's supports. And as far as possible, try to stop in just one day and don't try to reduce is because usually you fail to totally quit smoking if you think you should first reduce the number of cigarettes you smoke daily.

VARICOSE VEIN

It has been a tiring week. Though I think it has also been a boring one too. I didn't go to hospital the whole week because the final year students were having their exams in the hospital so other students are banned to enter the hospital, unless if you are sick of course :P

Today I was called by the lecturer to talk on Deep Vein Thrombosis(DVT) but before I can tell you what it is I have to write about VARICOSE VEINS first then maybe next time if at all I remember I'll write about DVT.

Varicose veins are actually quite common. It actually means that there is presence of abnormal vein anywhere in the body that is more elongated,tortuous and dilated. It can occur anywhere in the body but the one that concerns doctors more is the one affecting the legs. Usually patient will not complaint much on pain as they are usually dull type. But it might not be acceptable to the patients cosmetically.

Normally, there are valves in the veins of the legs that help the veins to bring back blood towards our heart. But what happens here in varicos veins, the valves will be damaged and then it causes blood to pool in the legs and causes the veins to be dilated and tortuous. And if patients don't seek medical help then it might progresses and he or she can develop complications, such as an ulcer or bleeding from the varicose vein.

There are certain risk factors as to why it develops, like smoking, standing for a long time-like policeman or guards or surgeon too(my dad has one too),and it can also happen in pregnancy. But there are also ways how you can prevent this from happening. You should exercise regularly,STOP SMOKING!,and learn to stretch your legs and contract the calf muscle every now and then even if you are sitting down.

If you have developed a varicose vein(or someone you know has varicose vein) you should seek medical help and the doctors can try to deal with your problem. Certain varicosity need only conservative treatment but the later stages, you might need to undergo operations to remove the diseased veins. Usually the doctors will give you a compression bandage like the picture I posted up there. At home, whenever you are sitting down you should put your feet on another chair or when you are sleeping you should elevate your legs over 2pillows. This will help the blood to stop pooling in the veins and can be circulated back to the heart.

Friday 20/04/07

I had a terrible morning today. As soon as I got back into my room I sat on the chair and was admiring my new fish. Then I scrolled my phone picture gallery and found some old pictures of my pets. I've lost my dearest cat Tom and only got to know about it few months after that since my family kept it a secret from me until I came back home and was calling his name but he never showed up. So today I'll show you my dearest cuddly best friends and I'm missing them dearly. I wish I get to see them again one day :(

PEPTIC ULCER

It was a long long week for me this week. I was in so much stress that my body and brain refused to do anything I was supposed to do. I just couldn't be bothered with what was happening around me and my room was a big mess. Nowadays every time I get down from the bus from Muar I came back to my room to shower and I left it just how it was in the morning and went out till 10 and got back to knock myself out till the next morning. That was what happened the whole week and nothing else.

I had my surgery end of posting examination on Monday. It was a terrible one for me because I had a case which I had never seen and discussed before. I had a case of Hemorrhoid or also known as Piles. In Malay it is called Buasir.

But I don't feel like talking about Hemorrhoid today. I'm thinking of writing about Peptic Ulcer. Patients always term this illness as 'gastric'. I'm sure you have probably had one yourself or someone else you know have one.

This is actually an ulceration of the food tract, that is the stomach and small intestine. This condition is quite commonly seen among Malaysian. Usually when asked, the patients will tell us that they love consuming carbonated drinks especially Coke. And they love spicy food and also they love asam ( a kind of preserved snack ) which I love too :(

As to why the ulceration happens, there's a lot of theories and reasons why. A major causative agent is microorganism called H Pylori. This bad microorganism have the ability to make our stomach release excessive gastric acid. Normally we all do secrete gastric acid to digest food but in excessive amount, the acid can erode the food tract and then cause pain to the patients.

Patient always complaint of pain in the area close to the centre of rib cage. The pain may be of gripping or burning in nature. And is usually associated to food. Some may vomit after taking food due to this pain but some may experiance the pain when he or she is hungry. This depends on the site on which the ulcer develop because our stomach and small intestine is about 41 feet! Some worse or acute condition, patient may have vomiting of blood or they tell the doctor that they are passing tarry black,sticky stool (feces).

Gastritis is usually well treated with medicine and if the patient can try to reduce or stop their habit of drinking carbonated drinks,spicy food and asam.
In some patients, Gastric Cancer can occur too. Because due to the acid irritation, the lining cells transform themselves into canceros cells. This is what worries all. So do try your level best to stop your carbonated drinks and etc.

I had a 40years old patient last week who was diagnosed to have gastric cancer. He came with a hard lump in his abdomen which was painless. He had gastric ulcer when he was younger. He was offered to get the lump removed by surgery 3 months ago but he refused it and seeked treatment from a local bomoh. And when he came back last week to the hospital his cancer growth has spread to his liver. He died a few days after that. It was really sad to have lost a young patient of that age and it was very sad too that he was not being followed up even though he had refused his treatment.

So I do beg you to please be more alert of whats happening in your body. The problem with patients are that they only come when they cannot tolerate pain. And cancer growth is painless.
Maybe on my next blog i'll talk about cancer. Since it is just too commonly seen and misunderstood by most people.

Oh and yes, today I bought 5 guppies and put them in a lovely long vase. I'm admiring their beautiful colours and how they keep swimming. I wanted to take their pictures but they just can't stop swimming! But they are gorgeous :)

BREAST CANCER

Again, I've forgotten about my blog. Well, actually I didn't forget. Only that I just couldn't find the time to sit down and blog about what I saw in the wards.

I just got to know that quite a number of people have been reading my blog. I didn't really expect that. And thank you for your support. From now on I will try to blog a little more often and blog on the more interesting cases I saw in the hospitals.

I'm now in the final year of my M.B.B.S course and hopefuly in another 1 and 1/2 year I will graduate and start working then. I am now posted in one of the specialist hospital in Muar, Johor. It's quite a busy hospital but work hasn't been at it's hectic peak yet. I've gained few good experiances here by seeing more cases now that I'm in surgery ward.

Almost everyday there are new cases of breast cancer patients need to be admitted in the hospital to undergo treatments. Sadly, most of these women seek medical help too late. Few of these women have a huge cancerous lump in their breast and a number of them have developed ulcers on the breast skin too.

I got to talk to the patients and asked them what was the reason that they came too late to the hospital. Some told me that they wanted to try for alternative medicine and some had seek help from a medicine man. Sadly but true, some of them have went to see a doctor in some private clinics and these unfortunate ladies were just treated with antibiotics and panadol! For a simple yet unforgiveable reason that these doctors didn't examine their breasts and didn't even have a suspicion of something dangerous even though breast cancer is at rise in Malaysia. I hope I will never forget this and will never ever do the same to my patients once I start practicing.

There are a few simple steps of how women can examine their own breasts at home and if at all they have felt any abnormality in their breasts they should immediately come to the doctors to be checked. Here is a good link to have a look at on how to do Breast Self Examination. Click on it.

Oh and yes, breast cancer although occur mostly in women, men are still in danger of it too. There are a number of causes as to why it develops. The strongest causative factor is the inherited gene called BRCA1. In those families where there have been a member who have been diagnosed with breast cancer before, you should be more cautious and should be more alert of any changes in your breast since you are at a high risk of developing it.

For men out there, do encourage your loved ones (not forgetting your dearest mother) to do breast self examination and push them if at all they hesitate to get their breasts checked by doctors. Though previously this disease attack the aged women, nowadays there have been cases reported among women who are as young as 30 years old.