Changed from HAS'S PSYCHO-SPIRITUAL CABINET for fear of being a spiritual braggart. THIS IS JUST MY PERSONAL SELF-HEALING BLOG; DEFINITELY NOT PROFESSIONAL MEDICAL OR PSYCHIATRIC OPINION OR ADVICE FROM THE AUTHOR. This blog cannot and must not replace hands-on medical care or the specific advice of your own doctor. Penulisan hanyalah pengalaman dan pendapat peribadi penulis blog dan tidak boleh mengantikan nasihat dan penjagaan perubatan daripada doktor anda.


Thursday, May 31, 2007


The doctor was doing the colonoscopy. DH’s colon was so clean; the mucosal lining was reddish as what mucosal lining should be. The doctor navigated further, and then he stopped and focused to take pictures. I heard Duke's C and D being mentioned. That was the time I got up from my seat and whispered to the doctor. “Which part is that?” “Ascending colon, about 5 cm involvement, probably stage II, needs a staging workout,” was his reply.

Forgive me my Dear Husband for taking away the popular phases of accepting bad news. I don’t know whether DH is fortunate or unfortunate; he woke up to hear the diagnosis and plan from his wife and psychiatrist. This episode, he did not ask for another psychiatrist.

In the ward, the oncology counselor and sisters came to see him. They, as my surgeon friend in Penang, were saying the same thing, as the same rumination that was on my mind over the last one week. If a person can’t avoid having cancer, but God is kind enough to offer him/her a choice, then go for either thyroid or colon cancer. Of course to a patient who had just known his cancer diagnosis, that is not much a consolation.

When we reach home yesterday DH said; “Yang, I am so very sorry. I can't bear to see you burdened by my illness” I told DH, “Don’t, I am embracing your illness with such peace in my heart and could feel the blessing from God, for being patient, for caring you even if I need to carry you and for standing strong by you. All you need is to be strong and PATIENT. Being ill needs a lot of patience! Don’t be sad for I am blessed with so much intangible rewards, don’t be afraid for I am by your side and don’t feel lonely for I am in this together with you, as you have been together with me.

Maybe my cancer was supposed to be so bad last time, but because of your prayer to God so that I am spared of severity and complication, some of the suffering got displaced to you, for maybe you have prayed that way. Thus, my dear, your suffering, now or later, is probably part of taking off that pain from me. Don’t you think, we were matched by some great design?”

What is Duke?


Tuesday, May 29, 2007

My Herbs this season

Selom; Sambung-Nyawa, Sambung-Nyawa, Kemangi, Sambung-Nyawa dan Sambung-Nyawa.


Nama Tempatan:Kemangi
Nama Saintifik:Ocimum sanctum Linn
Nama Lain:Cemangi
Famili:Lamiaceae /Labiatae
Lokasi dijumpai:Tumbuhan liar


Kemangi merupakan sejenis tumbuhan yang banyak digunakan dalam masakan terutamanya masakan indonesia.Ia merupakan sejenis tumbuhan beraroma da baunya seakan-akan bau serai. Ia tumbuh rimbun dan mempunyai cabang yang banyak.Daunnya tersusun dalam bentuk pasangan yang bertentangan dan tersusun dari arah atas dan bawah. Batangnya pula berbentuk empat segi dan mempunyai bulu-bula halus. Bunga kemangi Tersusun pada tangkai bunga yang berbentuk menegak. Bunganya dari jenis hemafrodit (dua jantina), berwarna putih dan berbau sedikit wangi.Bunga ini akan menghasilkan biji benih kemangi yang banyak dan kecil. Ia boleh membiak melalui biji benih dan keratan batang.


Air rebusan daun kemangi diminum untuk menangani masalah pernafasan, batuk dan bronkitis yang kronik. Kaedah yang sama juga digunakan untuk merawat masalah gastrik. Untuk asma pula jus dari daunnya diminum.


Nama Tempatan:Selom
Nama Saintifik:Oenanthe javanica(Blume)
Nama Lain:Java dropwort,seri, silom, water parsley,water celery,pampung, shui qin
Lokasi dijumpai:tumbuhan liar/ulam
Asal:tumbuhan tempatan


Selom biasa dimakan sebagai ulam kerana baunya yang wangi dan kerangupannya. Ia biasa dijumpai tumbuh liar di kawasan yang agak berair terutamanya di kawasan lereng bukit yang berpaya


Berfungsi untuk membersihkan darah dengan mencuci toksik didalam badan

Thursday, May 24, 2007





0800 - 0830 Pendaftaran peserta
0830 - 0930 Majlis perasmian

0930 - 1030
Penceramah 1
: Cadangan: Pakar bedah dalam bidang endoskopi
dan kanser berkaitan

1030 - 1045 Persegaran

1115 - 1200
Penceramah 2
Ms. Ranjit Kaur
Kekuatan Dalaman Untuk Melawan Penyakit Kanser

1200 - 1245
Penceramah 3

Prof Madya Dr. Siti Amrah Sulaiman
Unsur-unsur Tradisional Yang Membawa Kepada Penyembuhan Dan Pemakanan Yang Baik Dari Sudut Kesihatan

1245 - 1430 Jamuan Makan Tengahhari/Rehat/Solat

1430 - 1515
Penceramah 4

Prof Madya Dr. Nik Zaki Nik Mahmood
Meningkatkan Kualiti Kehidupan Di kalangan Pesakit Yang Telah Sembuh Dari Penyakit Kanser Dari Sudut Kewanitaan

1515 - 1600
Penceramah 5

Prof Madya Dr. Hasanah Che Ismail
Mengatasi Masalah Sakit Dan Keletihan Di kalangan Pesakit Kanser Setelah Menjalani Rawatan

1600 - 1630 Majlis Penutup

1630 Jamuan Teh/Bersurai

Pertanyaan lanjut:
Jabatan Perubatan Nuklear, Radioterapi dan Onkologi:
Tel: 60-9-1663000 / Fax: 60-9-07663370

Tuesday, May 22, 2007


When the wife was fighting the big C, the husband mustered all strength to lend support to her. Then the wife sailed outside the danger zone. The husband remained strong physically but his body probably got depressed in a certain way while witnessing his wife’s suffering or while worrying about her. The wife eventhough a medial doctor, was unaware that her husband was not well. It was rediculous to have such suspicion because he was his usual active and energetic self. With haemoglobin level halved that of healthy person, his vitality was like a person halved his age.

Now, my mind is preoccupied with a working diagnosis. When I got preoccupied, I tend to get loud. Fortunately, the case remained strong in his own ways; wanting his own pace.. He wanted to take his time, investigating along the line of suspicion and not be pressured by the wife’s and her medical friends’ clinical impatience.

It is easier to handle my own medical crisis than watching and participating in the medical crisis of loved one. As much as God’s mercy and blessing to those who are ill and at the same time being patient, I hope for the same compassionate rewards to the significant others who are patient. Also, to significant others who reminded the ill one. Reminding of the limitless rewards to the one who is patient in facing adversities in life.

20/05/07 – Hb 6.8 – Iron deficiency anameia

21/05/07 – Gastroscopy – Normal; Transfused blood two pints

27/05/07 - Ultrasound of abdomen: Liver, pancreas, kidneys, bladder, prostate and the nodes that can be seen all appeared normal.

30/05/07 - Colonoscopy


Thursday, May 17, 2007

The treasures from the wilderness of my garden

Petai Belalang or Leucaena leucocephala

Scientific name:Leucaena leucocephala Other names:Leucaena glauca, Lead tree, Acacia palida, Aroma blanka, Campeche, Cowbush, White popinac,ipil-ipil Famili:Leguminosae/Fabaceae

This emeraldic seeds of fruits gathered from my wild garden. DH showed me how to peel it and collect the seeds. It looks easy, thus I picked a bunch. I thought that the young fruit is eaten raw with the jacket while it is still young and crunchy. I also knew that the leaves are eaten as ulam, or mixed with other herbs for the nasi ulam or nasi kerabu.

Since, DH himself made an effort to show me the fruits and how best to eat it, I assumed that he don’t mind my breath or our toilet being scented with the smell. I ate one of the young fruit while still under the tree, by the pond. Then the task of peeling and collecting the seeds, thought of making sambal udang or ikan bilis with it. In the meantime, had to go and deliver the talk for the breast cancer workshop.

Well, for the rest of the day, I felt uncomfortable. The taste on eating the petai belalang was great. I am sure, more so if cooked with sambal ikan bilis or udang. However the lingering taste and smell of the petai after that was not acceptable to me, not to mention if my spouse gets the odor while kissing me. I think eating petai is simply outside the ettiquette of kissing. Let just say, however good for health, I’ll just leave it to the neighbours or the neighbours’ cow. Apparently the leaves are good as suppliment for cows.

For more information go to:


Next to the petai tree, we also have Jering tree. That is worse; I mean the smell. Though we don’t eat jering, the tree is left to shade the area as well as to hold the pond’s bank from erosion.

In the ponds, there are also abundant lotus root. I gave up dipping for the rhizomes as the only way to get them is by going down the water and grope for them in the muddy bed.

Well, nature is not short of pink, beautiful and healthy products. These bunga kantan is simply delightful, in its natural environment or as décor inside your house. Of course it is best mixed with other herbs for nasi kerabu and laksa, or put in masak asam or singang ikan or simply as ulam.

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Monday, May 14, 2007

Lagi-lagi soalan tentang suami yang tak guna

Last Friday, we anticipated the crowd in the vicinity of Raudah Hotel. We parked our car a distant away and walked into the crowd. The Quran recital from the speakers greeted us and the air was scented with attar perfume. There were tents for people to sit in to listen to Tok Guru and along the roads, small traders and hawkers were taking advantage of the weekly event. The people, the traders, the sound and the scent awakened a state dependent feeling and emotion that brought tears to my eyes. I felt DH holding my hand. He was probably feeling it too. The feeling and memories while in Madinah and Mecca.

Slowly, we walked to Hover Restaurant, to kill time, to eat satay and nasi dagang. As we walked, we met quite a number of Chinese, shopping. We walked into Hover; the Chinese owner welcomed us into a restaurant, already full-house with Malays, attired in Jubah or Baju Melayu/Baju Kurung, the men with skullcaps and the ladies with tudung labuh. What a blessed state and people.

The Workshop was officiated by YB Dr. Nik Mazian bin Nik Mohamed, Ahli Dewan Undangan Kerajaan, Negeri Kelantan. YB was a surgeon in Koto Bharu General Hospital and had done his share of mastectomy. He knew the problem related to breast cancer, the stigma, the delay in treatment and the poor support from husbands. Yes, he did say, “What is wrong with you men?” and his speech was too good to let it just decay from my memory.

He said that men should realized, mastectomy is not the end of their relationship – marital or sexual -with their wives. God is great, He took a part away and he gave much better substitution. Only ignorant men or fools can’t see or understand. So special are women that God dedicated a special Sura, An Nisaa’, to them. He recited the first few verses of An Nisaa, and then gave the translation. Also, he voiced out his frustration that the so-called religious and pious people do not come in enough force in voluntary organizations.

My respect for his brilliant opening speech, wholistic and holistic, supporting conventional modern as well as complimentary treatment. Never, have I heard before, the one officiating an event said in the same way; “…….maka marilah kita sama-sama merasmikan ……..”

I was requested to give another talk on the next day - Saturday - an hour talk, as the time left for me to speak during the forum was too short.

The number one question was: “What to do if the husband does not allow the wife to proceed with treatment for breast cancer? What if he threatens to divorce the wife if she insists on surgery, chemotherapy and radiotherapy?”

My answer is simple. Of course we try to counsel both and individually but those husbands who pose resistance or hindrance actually wanted to do away with their wives. They just don’t have the courage to do so before. As simple as that!.

Just look and hear around. Chances, there is at least one example in your kampung or office: the husband wanting to send his wife packing, for the simple reason that he is bored with her: whatever excuse he may have given. The wife doesn’t have to have breast cancer. She probably is pretty still and serving as a wife and as a loyal servant, i.e. in spite of having a job, she cooked his meals, hand washed his clothing, spent her own money before taking his and tried hard to please him in bed. Yes, if you ask me, it is too good to be true – like 2 in 1, a wife and servant in one woman. We are not talking about bad or evil wives here. We are talking about good wives – even I can’t measure up to them – who are almost too good to be true. So it didn’t take a breast cancer for men to be heartless and inhumane. I rephrased the description of the problem as in “Marriage has become a sad sham” in Dear Thelma in The Star on 13th May. Yes, I am borrowing Thelma’s description of the husband being inhumane.

My approach with that kind of husband is to take the wife aside and try to give insight to her. She got no time, and there is no point lowering her immune functions for that kind of a husband. I’ll tell her to go and get the treatment. For all you know, her husband will learn a very expensive lesson with whoever he think more deserving of his love. If he fits the picture of being inhumane, then there will not just be him who will be learning.

Women should be clear. In dealing with breast cancer, waiting and weakening oneself is proportionately reducing the length of survival from breast cancer.

So, women, be strong and be empowered. Too bad, sometime your own kind plays a part in distressing you.

Sunday, May 13, 2007

The invasion of Gynura procumbens in my living room

Actually there many species of Gynura: For further info:


Interesting reading:

Family medicine between west and east

Rustamadji MDa, E-mail The Corresponding Author
aRancho Indah Estate, JI Tanjung 10, Blok B-2, Tanjung Barat, Jakarta 12530, Indonesia

Available online 12 November 2004.

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Rustamadji graduated from the Free University, Faculty of Medicine, Amsterdam in 1983. He worked as hospital doctor in Bethesda, Yogyakarta, central Java and is now a general practitioner and family doctor with interest in herbal medicine in Jakarta.

As a family doctor, I work in the front line of the medical services within my community.

Working in a developing country, I am confronted daily with the local culture, difficulties in understanding the illness, and lack of modern pharmaceutical drugs. Patients usually end up consulting a traditional healer or a local “wise man” who they believe possesses supernatural spiritual powers to cure them. In his hands, they often feel more at home than with doctors who practise modern medicine. The traditional healer or practitioner seeks to re-establish harmony and equilibrium for each individual within his or her unique personal environment.

Since the financial crisis hit Indonesia 4 years ago, traditional healing has increasingly become a preferred method of medical treatment and has been adopted widely throughout the community.

In modern medicine, it is commonly accepted that a fee should be charged for treatment. Traditional healing, however, is seen as a charitable or divine act, a gift from God provided through a human being. Therefore compensation may not be asked for, and any fee should be given voluntarily by the patient.

An example from my practice might help. About 6 months ago, the parents of Irzan, a boy just 2 years old, discovered a red spot on his nasal bridge and thought it was a big mosquito bite. In 4 months, this “mosquito bite” was as big as a peanut. I advised the parents to consult an ear, nose, and throat surgeon, who in turn advised a computed tomographic scan. The result was a benign softtissue tumour, probably of dermoid origin. Surgical intervention was recommended.

Irzan's parents, shocked after hearing the result and the surgeon's planned treatment, consulted me, not understanding the medical terminology being used. They were also worried about the likely hospital expenses. The parents, therefore, turned to alternative medicine. Irzan is now undergoing combined herbal and food therapy. Every day he drinks freshly made herbal juices, containing among other ingredients Merremia mammosa (bidara upas), Gynura procumbens (daun dewa), and honey. After 3 months, his general health is improving, his rhinitis is cured, he can play, and he happily mixes with the rest of the family again.

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Indonesian students being trained in herbal medicine Panos Pictures

As a family doctor, I have to balance western scientific and eastern traditional medicine when giving medical assistance and educating families about preventing illnesses. I often treat my patients with pure (not derived from animal parts) herbs and plants. With this therapy, I try to re-establish the harmony and equilibrium in their body. The diagnostic interview is essentially the same as in western medicine. After the initial diagnosis, a treatment programme is discussed with the patient, because he or she must be motivated and fully committed to undergo and to continue this way of healing until the desired result is reached.

The basic herbal formula may change with the changing therapeutic needs of the patient. I also explain how to prepare the plants and how to ingest them. The need for certain plants is now so high that it is sometimes hard to find them. I look for these herbs and plants myself to be sure that I get the right type. In addition, I am currently setting up a project with local people, whereby we are growing medicinal plants and herbs in a neglected field close to my practice.

Traditional healing is widely accepted in the Indonesian community and sometimes even preferred above modern medicine. Modern medicine however, does not always fully accept this way of healing. Traditional healers are occasionally regarded as quacksalvers and are much looked down upon. I feel that a well-balanced and appropriate combination of both methods is the ideal approach in serving my patients.

Indonesian cultural philosophy and spiritual beliefs go back a long way, and go hand-in-hand with traditional healing. In Indonesia, we have a huge quantity of medicinal herbs and plants. Many of them have already been assessed by scientific research. But traditional knowledge handed down from generation to generation is also commonly relied upon.

This way of healing is work-intensive and requires a great deal of energy. I sometimes spend a long time in one session with a patient.

Some of my western colleagues may be sceptical about my approach, but it can be useful to look at health care from a different perspective. Once familiar with these more traditional methods, the outcome can be fulfilling and rewarding.

Wednesday, May 09, 2007

Hempedu Bumi dan Kanser Payudara

Cut and paste from:


Brief history: Andrographis paniculata has a long history of reported successful use in various Asian cultures - (see Traditional Andrographis Use Table). It is found through Chinese medicinal literature, modern and ancient; it is prominently listed in the Indian Pharmacopoeia. A member of the Acanthaceae plant family, it is also widely used in Scandinavian countries to treat and even prevent common colds.

Andrographis Chemical Components & Their Effects: We know that Andrographis contains compounds that are analgesic (kills pain), antithrombotic (prevents blood clots), thrombolytic (breaks up blood clots), hypoglycemic (reduces blood sugar), and antipyretic (reduces fever). So, most of Andrographis' traditional uses have a scientific basis. Its most significant physiological effect is that of a "signal transducer," that is, it stops the unregulated cell growth caused by viruses (which may be why HIV sufferers are reported to show improvement with its regular use). Its most active component is andrographolide (see empirical formula at left), a colorless, bitter crystalline compound. Termed a "diterpene lactone" to describe its ringlike structure, this substance accumulates primarily in the brain, spleen, heart, and lungs. It is absorbed and excreted from the body quickly: 80% is removed within eight hours; 90%, within forty-eight hours.
Effects on Cancer: Andrographis is a potent stimulator of immune response through two mechanisms: (1) antigen-specific response, that is, where antibodies are made to counteract an invading microorganism, and (2) nonspecific immune response, where the body's macrophage cells scavenge and destroy intruders. These mechanisms make Andrographis effective against a variety of infectious and cancer-causing agents. So extensive are the studies on the medicinal benefits of Andrographis that we have a separate In-Depth Review page to cover its well-established characteristics.

Further info:


Tuesday, May 08, 2007

Regional Training Workshop For Service Providers For Women’s Health

Breast Health & Breast Cancer

11-13 May 2007

Target group: Male members of NGO and health caregivers.


Kelantan Family Planning Association (KFPA)

National Council of Women’s Organization (NCWO)

Women’s Health Development Unit, USM (UPKW)

Supported by Pfizer Malaysia

Sokongan Emosi/Kesihatan Mental Dalam Rawatan Kanser Payudara

Prof. Madya Dr. Hasanah Che Ismail

Apabila seseorang wanita mengalami kanser payudara, dia mungkin akan teringatkan kes kanser payudara yang pernah diketahuinya. Begitu juga suami dan keluarganya. Apa yang telah pernah didengar dan dilihat tidak semestinya sama dengan yang dialami sendiri. Walaupun kansernya bersifat sama, akibatnya berbeza dan bergantung kepada pertahanan atau sistem imuniti badan seseorang. Faktor penentu yang paling jelas sudah tentunya rawatan optima yang dijalani secepat mungkin. Walaupun begitu, kestabilan emosi dan semangat yang tinggi juga menentukan kejayaan melawan kanser.

Sokongan dari pasangan dan keluarga membantu pesakit ke arah rawatan awal yang optima. Kanser payudara melibatkan seksualiti pesakit dan kualiti perhubungan dan kemesraan pasangan sebelum isteri mengidap kanser payudara adalah penentu penting kepada sokongan berterusan semasa dan selepas menjalani rawatan. Jika kualiti sokongan adalah baik pada pengamatan pesakit, nilai diri dan semangatnya melawan kansernya adalah juga tinggi. Oleh itu gangguan emosi seperti anxieti dan kemurungan tidak akan melanda diri pesakit. Kemurungan yang berpanjangan pasti akan menekan daya pertahanan seseorang pesakit dan dalam keadaan sebegini, agak senang dirinya ditakluki oleh sel-sel kanser yang mengganas.

Bagi pesakit kanser kehidupan dilalui mengikut musim berikut:

- Fasa rawatan

- Fasa kembali ke kehidupan normal

- Fasa penyesuaian jangka masa panjang

Dalam ketiga-tiga fasa kehidupan ini, pesakit kanser payudara akan mendapat banyak kebaikan dari sokongan yang diberikan oleh pasangan dan keluarga. Walaupun begitu cabaran kepada perhubungan perkahwinan dan kekeluargaan mungkin boleh membawa kepada kehancuran jika tidak ditangani dengan baik.

Ramai yang menyangka fasa rawatan memberi cabaran yang paling getir dan sokongan emosi dari pasangan dan keluarga mungkin lebih senang diperolehi. Sebenarnya cabaran dalam fasa kedua dan ketiga, berbentuk kurang nyata dan boleh bersarang dalam bentuk kronik dan membahayakan perhubungan, terutamanya dengan pasangan. Dalam tidak disedari pasangan juga mengalami beban tekanan yang tinggi dalam memberi sokongan kepada pesakit dan apabila fasa rawatan telah berlalu dia mungkin terus tertekan tanpa dapat meluahkan perasaannya. Bagi pesakit adalah mudah untuk mendapat simpati apabila meluahkan perasaannya, sebaliknya pasangan mungkin merasakan dia tiada hak untuk mendapat simpati yang sama.

Selain dari itu, rawatan kanser payudara melibatkan kemerosotan tahap hormon wanita dan menyebabkan berbagai-bagai kesan sampingan atau komplikasi. Salah satunya melibatkan hubungan seksual dengan pasangan. Ramai pasangan yang mengalami masalah seksual mengelak dari menyelesaikannya dengan cara intim dan menyokong di antara satu sama lain.

Faktor lain yang amat memerlukan sokongan adalah krisis kewangan yang timbul akibat rawatan kanser payudara. Kadang-kadang, mempercayai propaganda produk jualan yang berbentuk suplimen juga boleh mengakibatkan kos yang tinggi. Rawatan kanser payudara sebenarnya telah jauh maju di negara membangun dan hanya dapat diperolehi oleh pesakit di negara ini dengan mengeluarkan belanja sendiri yang tinggi. Pesakit akan mengalami dilema dalam hal ini kerana walaupun dia mampu; kemungkinannya dia berasa seperti mementingkan diri sendiri, kerana wang simpanan dibelanjakan untuk rawatan dirinya dan tidak akan dapat digunakkan untuk perbelanjaan pelajaran anak-anak atau keperluan pasangan. Adakalanya, walaupun dia membuat pengorbanan dengan tidak mengeluarkan perbelanjaan yang lebih untuk rawatan yang lebih baik, dia tetap – mungkin tanpa disedarinya – merasa kecewa. Natijahnya, dia mudah terganggu emosinya dan cepat terasa hati dalam perhubungan.

Pesakit dan pasangan atau keluarga yang menghadapi konflik akibat dari kanser payudara tentunya akan mendapat manfaat jika berjumpa dengan kaunselor atau pakar psikologi.

Untuk matlumat lanjut: Persatuan Perancangan Keluarga Kelantan

Tel: 09-7483323/7432407 – Ms Wong


Thursday, May 03, 2007

Breast Ca survival up

This is my letter to Editor of Medical Tribune. One of the great things about having a blog is to publish something that is not selected for publication elsewhere. However I really hope my letter is published. Climbing Everest won't move treatment for breast cancer forward; but a tinge of sarcasm may prime the right people into action. I hope.

Dear Editor,

The article in the issue 15-30 April 2007 only commented on switching from tamoxifen to exemestane. Probably it is fair to mention that similar switching, but to other types of aromatase inhibitors had also yield similar result. In fact the company sponsoring an earlier study that involved switching to letrozole elected to stop the study prematurely because of significant benefit.

Treatment of breast cancer had far advanced and yet breast cancer patients in our population are limited to treatment options that are only found in the hospitals’ pharmacies. As a practicing psychiatrist who practices psycho-oncology as well as a breast cancer survivor: I think patients with schizophrenia are more fortunate in getting more variety of novel anti-psychotic - that are equally if not more expensive than the aromatase inhibitor -into the blue book or as standard item in the hospital.

Maybe, the oncologists needed to be reminded that the unavailability of aromatase inhibitors should not stopped one from explaining their benefits to patients. Aromatase inhibitor blocks estrogen production and so has fewer effects on the uterine lining than does tamoxifen. Also the theory that tamoxifen acts more like estrogen when estrogen total body levels are low; stimulating rather than suppressing hormone sensitive cancer. In addition, women who are both estrogen receptor positive and Her-2/neu overexpressing may be resistant to tamoxifen but sensitive to aromatase inhibitors or ovarian ablation.

Probably, poor level of education pose difficulty to patients in grasping the different histopatholgical and immunological traits of breast cancer . However, too often, educated patients were also uninformed. Many also happened to be, not just educated but young, attractive, productive and mothers to dependent children. If the hospitals could not provide the drug, they should be counseled to buy it. Patients could get the annual tax relief of RM5, 000 for personal medical expenses.

Thus, breast cancer survival up not just with exemestane but with optimum information and treatment. Sometime, I do wonder whether the stigma of cancer reduced the reasons for being more informative and facilitative in the way forward for treatment of breast cancer in our population.

Assoc. Prof. Dr. Hasanah Che Ismail