Stories around ayah's death are still hovering our house.. people come in and about to visit mak and give words of encouragement..

We re-arranged the house back to its old form. The multi-functional surgical bed we bought ayah was put in the room.

Ayah has left us..

Before any of the cytotron therapy ever discussed, ayah telah dipanggil ke dakapan Penciptanya Yang Maha Mulia...


Kullu nafsin zaiiqatul maut.. and every living soul will (surely) experience death..



Mak called ummiwaled to inform that ayah was terminally illed last night. At around 9.30pm i received call from ummi at locum clinic that ayah has already gone. Ayah dah meninggal dunia at around 7.20pm ystrday, right before iftar in a very calm way (according to mak).

Tapi mak pesan jangan cakap berita ayah dah meninggal pada abang who's still driving back from Tganu. Mak risau abang akan sedih and will not concentrate on the driving. This makes me think hard camne nak keep this as a secret ( susah nak control my mimics and facial expression) sepanjang nak balik dengan abang ke ipoh nanti. Camnelah nk jadi se'strong' ummu sulaim yang dapat sembunyikan kisah anaknya mati daripada abu talhah. Mujahadah.

Elok2 kul 10pm he called me and said.."ayah dah takde..dari kul 7.30 dah tadi' in a calm manner.

Ehm, camne leh tahu. (controlling my voice)

Sorang sepupu called and tanya " bila nak kebumi?"

O my.. so he act received the news from an unexpected caller.

I was saying something to sooth him, and leave him all to ALLAH... Be strong !




Mak said that day ayah was holding his head, refusing to eat nor drink, looks very weak. Mak asked one of the nearest GP to come over and check ayah..

Then is when the GP said its better for people to start 'reading' something to console the soul..

Mak tak nak cakap direct that its time for all the sons to gather together and come home.. so when my husband rang Ateh..tanya betul2 .. then ateh (full with her ex-matron's instict on dying people) recommend abang and adik to come home.

Ayah actually dies on the 21st of Ramadhan ..no more suffering (from the brain ca) dear ayah.. Jzk for those who have come to the funeral..

We buried ayah among his other relatives in Talang Hulu. about 30mins journey from ipoh.

Moga ruh ayah ditempatkan di kalangan para solehen dan mendapat keampunan dariMu ya Rabb..





Deeply loved, greatly missed from us (that are still awaiting..)
Syifa' Al Hayah, u_syifa' & a_syifa'
Mak & adik
ummiwaled

New hope for ayah?

Cancer is one of leading illness on a global scale and is increasing every year. Cancer cells multiply uncontrollably and often rapidly. Worse, sometimes they spread to nearby tissues and wreck havoc in the body. Cytotron Therapy for cancer is based on triggering the self-death (apoptosis) of the cancer cells, thereby arresting the growth and ultimately the disintegration of cancer cells

New hope for Ayah?

CYTOTRON - non invasive , non surgical , non radioactive treatment for cancer?

http://www.care-nexus.com/home.html





we'll go for second opinion next week iA..

Ayah is becoming weaker..

My husband found this:

--------------------------------------------------------------------------------
Title : USM beri harapan baru kepada pesakit barah otak
News : Oleh WAN ZULKIFLI WAN YAACOB

KOTA BHARU 11 April – Pesakit barah otak di negara ini berkemungkinan mempunyai harapan baru untuk sembuh sepenuhnya daripada penyakit itu tanpa perlu melalui proses pembedahan dan rawatan kemoterapi pada masa akan datang.

Penyelidikan oleh Jabatan Neurosains Universiti Sains Malaysia (USM) sejak 2003 dengan menggunakan virus sampar ayam sebagai rawatan alternatif, didapati berjaya melawan dan memusnahkan sel barah.

Ketua jabatan itu, Prof. Dr. Jafri Malin memberitahu Utusan Malaysia, hasil ujian itu memperlihatkan virus pembunuh ayam itu tidak merosakkan sel-sel normal dalam badan dan hanya memberikan kesan sampingan yang minimum.

Beliau yakin, perkembangan positif itu akhirnya dapat mengubah persepsi bahawa barah otak mustahil disembuhkan dan dicegah serta menjadikan USM sebagai peneraju dalam mengaplikasikan teknologi rawatan berasaskan kejuruteraan virus.

‘‘Kita telah menjalankan kajian termasuk menggunakan tikus bogel iaitu sejenis tikus termutasi yang tidak mempunyai antibodi dan tidak mampu membuang sel barah otak manusia yang disuntik dan berkembang dalam badannya,” ujarnya di sini hari ini

Menurut beliau, dalam tempoh sepuluh hari selepas virus sampar ayam yang telah dibiakkan itu dimasukkan, haiwan tersebut kembali pulih sepenuhnya dan proses ujian ke atas manusia dijangka dapat dimulakan tidak lama lagi.

‘‘Kita menggunakan virus tempatan AF2240 dan V4UPM hasil penemuan Universiti Putra Malaysia (UPM) yang dihasilkan bagi mengatasi penyakit sampar ayam.

‘‘Ciri-cirinya telah dipatenkan dan kita berharap pada masa depan, kita dapat turut menghasilkan vaksin pelalian tempatan bagi mencegah penyakit barah,” ujar beliau.

Katanya, penyelidikan dijalankan dengan kerjasama UPM dan Majlis Kanser Negara (Makna) yang memperuntukkan dana hampir RM750,00 bagi tujuan itu.

Menurut beliau, penyelidikan yang diketuainya melibatkan sekumpulan penyelidik iaitu Prof. Aini Ideris (kini Dekan Fakulti Pengajian Siswazah UPM), Prof. Manaf Ali (kini Dekan Bioteknologi dan Pertanian Universiti Darul Iman), Dr. Hasnan Jaafar dan Dr. Zulkifli Mustafa.

Hasil penyelidikan peringkat awal telah dibentangkan di Kongres Persatuan Neuro-Onkologi Eropah ke-7 di Vienna pada Oktober 2006 oleh Dr. Zulkifli.

Katanya, virus sampar ayam didapati hanya menyerang sel barah dan merangsang kematian sel itu secara terus atau merangsangnya untuk membunuh diri.

Source : Utusan Malaysia, Khamis 12/4/2007 - Dalam Negeri (m/s 5)
Date Source: 12/04/2007

------------------------------------------------------------------------------

So i called up Prof Jafri Malin, asking about my father in- law's condition.

Whether there's any hope for cure..

Any of this vaccine available in the market now?

He's a nice guy with very strong Penang accent. he..

Prof kata skrang research ni hanya pada peringkat rodents (tikus) lagi.. belum ada ujian keberkesanan pada human..

Siap dok kata lagi " Tan Sri Merican hang la tak approve lagi result research ni. Kena test pada non-rodents (bukan tikus) dulu baru boleh kata boleh work on human. skrang kami tengah dok continue research ni pada beruk. Beruk paling dekat dengan human so kena tengok result vaccine ni pada beruk dulu.

O ok..

So camne prof, ada tak apa2 lagi yang kita boleh try and work up for my father?

Tumor dia kat ne? Kat pons ke?

O tak prof. Tumor dia kat corpus callosum..

O dah jadi butterfly pattern ke?

A'ah..

If that's so, prognosis mmg bad. Kat US ada buat dendritic therapy. Target pada end nerve tu utk bunuh cancer cells tu. Tapi GBM kalau dah jadi butterfly pattern mmg prognosis bad regardless of any therapy available skrang..

O ok..

Butterfly pattern is still a challenge for neurosurgeon...

Hm.. not much for ayah.. only TLC.. and TLC..

May ALLAH strengthened ayah's faith ( and us ), sekuat mereka yang berjuang di Badr Al-Kubra hari ini.. 17th of ramadhan..

May ALLAH purified ayah ( and us ) sesuci lebaran Al-Quran yang diturunkan hari ini.. 17th of Ramadhan..

drfatiha

Setelah 4 hari di GH, ayah still tak dapat slot utk MRI. So we've slotted ayah into Hosp Fatimah's MRI.

I've discussed thoroughly with the radiologist, Dr Muhammad.

It's actually a GLIOBLASTOMA MULTIFORME, or grade 4 astrocytoma - a form of vulgar brain cancer...

Radiologically, it appears in a butterfly pattern. It originates from the corpus callosum , tempat white matter of the brain atau nak senang nak fahamnya, tempat all the fibres crossing each other. Seperti yang kita tahu, brain kita ni ada Grey matter and White matter. Grey matter ni tempat all kepala neurons terletak,, manakala white matter ni tempat all fibres /ekor neurons tu terletak. Dalam white matter ni ada beberapa glial cells yang fungsinya utk bagi makanan pada sel saraf / neurons. Maka if ada satu dua cells di white matter ni jadi cancerous ( multiply without stopping) dia akan terus menerus multiply tanpa ada had sempadan. Sbb itu kalau nak diikutkan most likely cancer ayah ni develop within this year. .. the most deadliest form of brain cancer.

Cancer ni developed dari CORPUS CALLOSUM and dah involve both of the PARIETAL LOBES...

Treatment wise, sebenarnya pada chemotherapy and radiotherapy.

Tapi utk pastikan chemotherapy dengan radiotherapy ni berkesan, it was recommended for ayah to undergo surgery.

Belah otak and debulk the tumor.

We've discussed with Mr Cheung, HOD neurosurgery GH ipoh, diorang akan approach from the vertex / hujung atas kepala. Make a craniotomy window about 5x3cm di kepala, and they will enter the brain and will try to debulk the tumor.

Debulk to maksudnya dia akan cuba keluarkan tumor semaksima mungkin..

He promised us that ayah will be discharge 3days after the surgery.. dan ayah will be at least the same atau a bit better from his condition now..

itupun if takde complications during the surgery...

for a 78 year old man, with chronic kidney disease, tak sure ayah boleh lepas pre-med dengan anaesthethist ( pakar bius).

Takut his heart and lungs are not fit enough to undergo surgery..

Imagine during operation, we have to take over patient's breathing with a ventilation tube, tambahan lagi ini adalah pembedahan kepala. NO room for mistakes. IF silap sj, boleh dapat massive bleeding. Brain adalah salah satu organ yang paling banyak salur darah / vascular.

Mr Cheung discussed about possibility utk ayah ke ICU after surgery.

ICU Ipoh skrang ada 1 kematian H1N1.

If ayah settle down di ICU, dengan keadaan ayah yang immunocompromised sbb baru lepas surgery, there is surely risk utk ayah dapat H1N1...

And possibility that he wont recover from the surgery.. terus menerus depend on ventilation tube..

And itu baru sebut pasal operation. After operation ayah kena buat chemotherapy dengn this drug named temozolamide and radiotherapy. Temozolamide will help the cancer cells to be more responsive pada radiotherapy nanti.

Chu An tanya if buat operation tapi tak nak buat chemo and radio boleh tak.

If tak nak buat chemo and radio, might as well tak yah buat operation.
Because operation alone doesn't cure the cancer. The definite treatment is with chemotherapy and radiotherapy.

Dalam keadaan ayah nanti utk berulang alik pergi chemo and radiotherapy..i'm not sure whether ayah can cope.

But we can try..

Thinking of these possibilities, mak sangat sedih and affected..
If ayah tak buat surgery, maybe ayah boleh balik dengan keadaan ayah sekarang.. he will deteriorate sooon, but not now.. maybe skrang we can give him among the best moments.. make him happy..

After all, we are talking about QUALITY OF LIFE Vs LIFE.

After all umur ayah dah 78 tahun, mean age male kat malaysia ni 73. Ayah dah hidup far beyond the life expectancy. Ayah dah hidup dengan 5years bonus years.

Rasulullah pun hidup 63years old...


I asked if kita boleh buat radio-surgery, a form of non invasive treatment. Shine kan radiotherapy wave ke tumor bulk to and kill the cancer cells.. Dengan cara tu kita tak payah open up the skull. Tapi rupanya this kind of surgery only available di GHKL. Under Mr Safari.
So I called up Mr Safari, he said he needs to look at the MRI images first.
Tapi he said gamma knife tu cuma boleh matikan cell yang less than 3cm.
Ayah punya tumor dah 5x4x3cm from the MRI images..
Mr Safari offered me that he can take a look.. Boleh cuba tengok for second opinion.



Hence we discussed again in the masjid, apa keputusan yang akan dibuat..

at last we decided to take ayah home.. to rest at home..
play with syifa'.. eat food that only my mom makes..
enjoy life to the fullest..
give back his smiles..
lots and lots of TLC ..(tender loving care)
and opted for complementary medicine..

reflexology, massage..acupuncture.. hemopathy..

Ateh recommend ayah minum mangosteen juice .. banyak antioxidant.. boleh serap free radicals dari badan..

Hemopathy wise, elakkan ayah makan benda bakar2 ..sbb takut carsinogenic..

Air syifa' with daun bidara to ?shrink the tumor..

In the mean time probably i can shoot some MRI images to Mr Safari..

Hence we took ayah home last Thursday..

Ayah was crying bila kami papah beramai2 menuju ke katil yang kami dah bawa keluar dari bilik dan letakkan di living room..

Lepas mandi, mak dudukkan syifa' dekat ayah.. syifa' was entertaining aki to gain back his smiles and strength...

Pagi esoknya, zaujiy ateh me and syifa' shop around for a surgical bed, urinal, commote, wheel chair...

Agak limited options utk cari multifunctional bed like the one in the hospital but we finally manage to find one.

Alhamdulillah..

May ALLAH give strength to all of us.. and make all these as kaffarah to all the past sins we've done.. and take us back in the purest form.. husnul khatimah..amen..

Tok Aki is not well..

salam..

sekarang berada di kampung mertua di Buntong, Ipoh. Memang menjadi kebiasaan setiap kali zaujiy habiby balik, kami akan pulang menjenguk mertua ana di sana. Baru 2 ini emak kata ayah macam letih2, tak larat bangun,,macam kaki tu sakit..cakap berulang ulang..bila bawa kereta tak ingat jalan...ayah jadi kerap tidur.. temper..suka marah2 tak tentu pasal.. masuk rumah tapi terlupa buka selipar..Mak suspect kidney ayah..kadang2 ayah boleh lemah bila buah pinggang dia semakin rosak. Tapi mak kata ayah takde bau mulut payau ( uremic fetor ) atau kencing kurang atau pengsan, spt sebelum ni... ana jadi terharu mendengar cerita ayah ana.. lagi2 memikirkan mak sorang yang akan menjaga ayah if jadi begini..

Sudah 2kali mak call utk tanya pendapat tentang ayah. Ana tidak dapat mengenal pasti kenapa ayah lemah kali ini. Seperti biasa ayah baru saja selesai mengambil darah utk usual check up for his kidney pada 28/7.Bila ayah jadi begini 2-3 hari yang lalu, mak terus minta tolong kawan mak yang keja di lab utk check kan result darah ayah. Kesemua uric acid, urea, creatinine menurun. Mak ingat chronic kidney disease ayah stabil.

Tapi ayah still lemah utk bangun. Maka bila mak call lagi kata ayah tiba2 jatuh toilet masa mak papahkan dia utk buang air kecil, ana terus desak mak bawa ayah ke emergency hosp. Nasib baik Mak teh ada dekat utk tolong bawa ayah. Di sana mak kata mrk repeat semula darah ayah n xray pelvic ayah.Tp result xray tak direview lagi.Mrk beri appoinment ke orthopaedic clinic isnin minggu depannya. Ana rasa tak puas hati sbb kenapa mrk tak nak rule out stroke. Bg a 78 y.o man yang ada chronic renal failure with mild hypertension, stroke is sometimes inevitable.

Bila zaujiy habiby bawa ana balik jumpa ayah, i reassess his symptoms. BP is normal, 116/73. PR pun regular, to suggest arrhythmias ke- can sometimes a prove of ACS- acute coronary syndrome )heart block ke arrhythmias ke. CVS dual rhythm no murmur. Respiratory clear.

Neurologically sebelah kiri ayah nampak weak sikit compare to right side. Bila suruh ayah angkat kaki ( active movement) ayah akan angkat kaki kiri bersama tangan kiri sekali. Bila pin down ayah punya tangan kiri tu ayah akan terhoyong hayang nak angkat kaki kiri, Tone normal. Reflex equivocal kat kiri, normal sblh kanan. xde clonus. pupils reactive..so tak nampak cam stroke...signs and symptoms mixing...banyak run diagnosis dalam kepala ana..maybe ayah early onset Alzheimer's? parkinson? depression? mild stroke? takkanlah.. erm.....hi kena buat cr brain ni..if just the ct machine is mine....

Ayah kata dia xde rasa pening kepala ke nak muntah ke. Makan ok, BO/PU normal. Takde susut badan..makan je la kurang. So ana discuss dengan zaujiy, ikut je la appointment ortho tu esok. Tengok apa mereka nak kata. Perhaps if mrk dapat rule out fracture, baru mrk nak suspect stroke. Baru la nak terfikir utk ct kepala ayah kut..

Isnin tu adik pegi dengan zaujiy bawa ayah ke hospital. Ingatkan mrk bawa ke GH. Tup2 dapat call mereka kata ayah di PSMH ( perak specialist medical hospital) -dulu hospital chinese maternity. Mrk terus bawa ayah ke private sbb takut lama nak beratur di GH. Bila ke sana, PSMH tahan ayah dalam ward utk buat CT scan brain. Tapi lepas buat plain ct scan,mrk suspect benda lain pula. Terus buat Ctscan brain with contrast. Ana masa first2 dengar tu terfikir apa lah yang mereka nak tengok dgn contrast...takkanlah ..erm... better find something from the contrast ct..dah la ayah ada kidney problem. Kang tak pasal2 kena dialysis sbb kidney tu jam nak secrete contrast nanti.

Ayah was admitted under Dr Loo CK, nephrologist merangkap physician di PSMH. Petang tu dia kata nak jumpa with the family, nak discuss pasal ayah.

Dia ada beritahu pada mak pasal result ct scan ayah. Nampak macam ada tumor dalam kepala ayah. Ana terkejut bila mak bagitau begini. Di rumah, ana bincang dengan zaujiy, if this tumor slow progressive ana rasa its time to let go ayah. Dalam keadaan ayah begini, memang chances utk survive operation tipis. Kalau ayah survive pun, mungkin ayah akan paralyse, makan pakai tiub feeding, slowly looses his bowel motion and unable to pass urine.. isk.. hati ana sebak coz i've seen these abang.. its dreadful.. so better kita fikirkan cara nak jaga ayah if kuar hospital without operation..

Bila dia show ct scan pada kami, i was shock. Dalam diam i agree. Mmg obvious ada huge tumor at the right parietal lobe, beneath the cerebrum ( boleh kata huge sbb eventho measures around 2x3 cm, skull kita ni sempit,tak leh dah nak bagi ruang pada 'tetamu' yang tak di undang tu. Tumor tu cam arise dari centrum ovalae and was compressing the right lateral ventricle. Ada sikit midline shift to the left. Tapi dia tak exactly measure, so tak sure bape banyak shift tu.

Usual tumor boleh menyebabkan pressure dalam otak tinggi ( increase intracerebral pressure, ICP) dan boleh menyebabkan part of brain herniate atau termasuk ke dalam saraf tunjang (coning). Kalau jadi begini patient akan mati sbb part yang control respiratory center akan terhimpit. Pupils ( anak mata ) akan jadi dilated. BP akan lowish..heart stop pumping...

Tapi the thing with ayah is that the 'tumor' ni macam reactive. It causes the surrounding brain matter oedematous. My Lord, tumor tu dah menyebabkan ayah ada cerebral oedema. (bengkak otak). THIS is EMERGENCY. Dalam keadaan begini, operation is a MUST to remove the pressure. Bukan optional lagi.

If tak operate, keadaan ayah akan critical. Kemungkinan besar ayah kena intubate for cerebral resus-= ayah akan bernafas pakai tube and machine utk control fungsi otak utk terus hidup. If operate, it just to stabilkan pressure dalam ayah. Mrk mungkin tak akan remove the primary tumor tu lagi. Normalise the pressure and treat the cerebral oedema. If ayah survive ayah mungkin akan paralyse. Sukar utk ceritakan apa keadaan ayah selepas operation sbb semua tu bergantung pada operation. Worst ayah mungkin 'die on table'- mati masa operate. Ana pernah 2-3 kali dapat patient die on table. Mmg horror tengah buka perut dia and jahit usus, tiba2 cardiac monitor tu asystole ( jantung berhenti). Terus kami CPR patient dengan keadaan perut dia terbuka. Ana kena tahan usus dan tali perut dia daripada terkeluar setiap kali Mr George push thorax dia utk CPR. Akhirnya we lost the patient. Mengingatkan ini ana sedih sekali.

So the dr gave us options. Rupanya PSMH doesnt have any specialty dalam neurosurgery ( otak/saraf). Kena refer either GH atau ke mana2 private center lain. Discuss lagii with the whole family, we agree to transfer ayah to GH sbb neurosurgeon lebih ramai. Berbanding private, kadang2 neurosurgeon tu sorang la yang akan buat semua benda. Takut he will not judge the best. Dalam situasi ni i agree that public hospitals are better than private. Ada certain things yang private best, tapi ada certain things juga yang public hospitals are terrific at doing.

Ayah di bawa dengan ambulance ke GH. Dimasukkan ke ward neuro 2A. Adik teman ayah malam tu di 3rd class. Tak dapat tidur sbb patient ramai yang bising, mengeluh sakit la and etc. Maka remove kan ayah ke 2nd class. Dlm keadaan gini, ana memang recommend ayah stay either 2nd atau 3rd class. Better tak gi 1st class. Bukan apa, patient first class di tempatkan di blok lain. Kalau jadi apa2 emergency, biasanya respond lambat sbb bukan berada di tempat yang ramai orang. Lagipun ward 1st classs biasanya patient bercampur campur. Semua specialty ada di sana. Jadi takde staff nurses / doctors yang exactly menjaga patient neuro di sana.

Esoknya mak kata Mr Jamie datang round. Explain pada mak yang mrk akan tahan ayah di ward dulu utk stabilkan kidneys and hypertension. Tapi sebelum decide utk operate, mrk kena buat MRI ( magnetic resonance imaging) dulu. Its like a ct scan but dia guna magnet to capture the pictures. MRI is good at looking at soft tissue. After that baru mrk akan decide whether to operate or not. Paling lewat this Tuesday operate if ayah fit for operation. MRI ayah maybe Thursday ni. Doakanlah yang terbaik utk ayah...

i finally manage to read the actual ct report.. its actually a glioma, high grade astrocytoma with central necrosis.........................


drfatiha