Angin and Cancer

Sunday June 29, 2008

The age of reason

By Dr ALBERT LIM KOK HOOI

Blowing hot and cold in the cancer clinic – the downside of traditional and complementary medicine.

THE patient with nasopharyngeal cancer (NPC) related the history of her illness.

A year ago, she had a nosebleed. She could feel that her neck glands were hard and swollen. She sought help from a traditional Chinese sinseh.

She was told it was all due to “heatiness”. She was happy as her world view was reinforced. She was given some herbal concoction to “cool” her down.

Things waned and waxed for some time but eventually she got worse. The nosebleed persisted and soon her hearing was affected. Being “politically and culturally correct”, she then sought the help of a traditional Malay medicine man. He told her that her problems were due to “wind” (angin). More herbs were prescribed and duly ingested.

Nine months on and the “heat” and “wind” did not seem to go away. In addition to the progressively swollen neck glands and the worsening nosebleed, she developed double vision.

Last month she decided to give “Western” medicine a try (the term “Western” is one I strongly object to, but more of that later) after some cajoling by her office colleagues.

The first “Western” doctor she saw was a basket case. He never suspected cancer. He prescribed antibiotics in the hope that all will be well. The unfortunate, pathetic, culturally-imbued, ignorant patient got worse.

It would have been a comedy of errors if not for this tale being such a sad one. She was finally seen by a doctor who was clued in to NPC, a common cancer in Malaysia.

He referred her for further investigations to exclude NPC. A colleague of mine, an Ear, Nose & Throat surgeon, examined her. The patient had a large NPC, which had eroded the base of her skull. We performed a whole body CT scan on her.

It showed that the tumour had infiltrated the bony part of her skull and the sixth cranial nerve (one of the nerves that controls eye movement). Fortunately, the tumour had not spread to other parts of the body e.g. the lungs, liver or bones.

As you read this, the patient is halfway through her chemotherapy/radiotherapy programme and she is doing well. Her neck nodes are smaller. Her vision has improved.

This week I shall discuss two potentially harmful concepts Malaysians harbour in their approach to science and medicine. One is the dichotomy between Chinese medicine and Western medicine. Science, technology, medicine and oncology are neither East nor West.

Every culture, every race, every ethnic group has contributed to science and medicine at some time or other. Think of the Chinese during 800 to 1000 A.D. and the Arabs during their golden age of mathematics and learning.

The Europeans were then still grappling with “evil air” and “bad stars”. It is true that the West (Europe, North America and “Western civilisation”) has been in the forefront of science and technology in the last 200 years but the pendulum may swing to China and India in the next 100 years.

Science, technology and oncology are firmly rooted in mathematics, physics and statistics. It is not culture-bound, race-bound or geography determined.

The second sensitive issue I wish to address is political correctness a la Malaysia. We speak ill against traditional and complementary medicine (TCM) at our own peril. We must be “holistic”, “respectful” and “all-embracing” of all cultures and traditions when it comes to cancer treatment.

TCM purports to complement and not replace mainstream scientific medicine. If only that were true. Very often, patients practise TCM exclusively and completely. They shun the four modalities of cancer treatment: surgery, radiotherapy, chemotherapy and molecularly targeted therapy.

Worse still, TCM is not only about treatment but also about how the human body works and malfunctions. The “heatiness” and “angin” explanations have wrought unthinkable harm on so many Malaysians who postpone proper diagnosis for their ailments including cancer. Stage 1 cancer progresses to Stage IV cancer because victims thought it was all due to “heatiness” and “angin” for too long.

The point I want to make and make strongly and assertively is this. A nosebleed could be a clue to one of many causes: it could be bleeding from Little’s Area (inherent weakness of blood vessels in the roof of the nasal cavity).

Inflammation could be another cause. Trauma (nose-diggers, beware!) is another. Sometimes our platelet counts are low (as in dengue hemorrhagic fever or leukaemia) and our blood clotting mechanism cannot function normally.

Sadly, a nosebleed can also be due to cancer. “Heatiness” and “angin” are too vague and encompassing a concept. It can be dangerous, as illustrated here.

“Heatiness” and “angin” are harmless concepts as long as the illness is a minor throat infection (“heatiness”) or a minor muscle sprain (“wind”). But how can we be sure? It may be cancer or something equally sinister.

The Age of Reason and the Age of Enlightenment have been with us for already 200 years.

Malaysians, welcome aboard!

Dr Albert Lim Kok Hooi is a consultant oncologist.