Cervarix -The Medical Revolution

Why am I so aggresive in effort to create awareness?

2011-10-21T01:52:00.000-07:00

I may have written about this in a post long time ago, but I completely understand if new readers are reluctant in reading every post that I wrote. It gets bored after a while.
Today, creating awareness among women on the availability of cancer prevention has become more of a personal crusade rather than merely a doctor's responsibility. Even if I am able to reach out to a single person, it's a personal achievement for me.
It all started back in 2006 when the first vaccine, Gardasil came into the market. I didn't pay much attention to it. All I knew back then was that the vaccine is to prevent cervical cancer,and it's way too expensive. It cost RM800+ per jab. It was a challenge to explain to parents of young girls as the public perceptions on cervical cancer back then is associated with sexual promiscuity, which later i found out it's not true. The mere suggestion of prevention of "cervical cancer" angered many parents who storm out of the clinic, which obviously left me flabbergasted.
After a while, I gave up promoting Gardasil(I am glad to think about it now).
Then 2008, when Cervarix came into the market, it was comparatively cheaper, yet it's still expensive. Though it's about RM400 per jab, but how many working class people can afford to take the jab, and considering the public awareness about cervical cancer is so low not only among the public but the doctors as well.
I didn't take it so seriously initially, until one day when a man came for treatment of his sorethroat. Somehow I can't remember how our conversation ended talking about his wife. His eyes turned red and tears trickled down his cheeks. His wife just passed away merely 3 months ago due to cervical cancer, despite her Pap Smear report stated everything was normal. He doesn't know who to blame and I doubt she would ever have a closure as her wife did her annual Pap smear religiously. He started to cry right in front of me. Claiming that the world is unfair to him. Why was his wife taken away from him and his two young children. She was just 43 years old.
I felt for him. It affected me, badly. When he left, I was sitting on the chair, contemplating on what he mentioned to me. A full grown man, crying in front of me. His statement about how unfair God was to him for taking his wife away despite the medical report stated everything was normal. How was it possible?
This wasn't the first case. 2 months later, I had 2 similar cases where sister of the deceased questioned me who to blame? Similar case. Normal Pap Smear report, but 6 months later, passed away due to cervical cancer.
Since then, I begin to do my own research online. Contacting the pharmaceutical company requesting for data on death due to cervical cancer. I was shocked to find out that cancer is rated as the second highest among the causes of death in women, and cervical cancer was rated number 2 after breast cancer.
Then I realized how significant the discovery of cervical cancer prevention vaccine is. It's revolutionary, life saving, and marks a milestone in the field of medicine. Progress has been gradual throughout the years, but with the discovery of such vaccine, it marked the progress by leaps and bounds. Perhaps in future, the other progress that carries similar significance and importance in its impact on human is perhaps the discovery of cure for AIDS.
I may not have felt fully the pain, but I do understand its degree, and it's effect not only on the patient but also the caretaker and family member as well.
Last year, my aunt who was 52 years old came to me with jaundice. Immediately my heart sank as I mentioned to her the most probable cause of jaundice at her age. Pancreatic cancer was the top of the list. I referred her to Selayang Hospital for a CT Scan to confirm my diagnosis. I prayed and hoped I was wrong. I prayed hard that I was merely overzealous and over did on my diagnosis. 2 weeks later, the report came out. The thing that I dreaded the most came out to be true. She had a pancreatic tumour that blocked her hepatic duct, and it has spread to the adjacent blood vessel, hence surgery is out of the question. When I saw her for the first time, she was a hefty 83kg lady, but 9 months later when she passed away, she was merely 35kg.
It was the painful 9 months of seeing her dying day by day. She comes to my clinic nearly every week for IV infusion as she constantly gets dehydrated. She was constantly in pain, couldn't sleep, every position she sits was uncomfortable. Her remaining life was miserable.
I was there by her deathbed. She passed away as 2.45am. The impact on my uncle was tremendous.
He was psychologically, mentally, and emotionally in a wreck. He would burst out into tears whenever he's alone, suffered from insomnia, often woke up hourly drenched in sweat, talks to his deceased wife's photograph, visits her grave on a daily basis. He was hospitalized 3 times for not eating and ended up with bleeding ulcers.
I saw the way my uncle suffered. I made a decision to create an awareness and promote prevention of cervical cancer a personal crusade. I believe a person is already dead on the inside the moment they've been told to have cancer.
I offered the cheapest price for cervical vaccination in KL, or even perhaps the nation. I don't intend to make a profit out of this life saving vaccine. I created a blog purely for women to read and gain more knowledge from the comfort of their own home as I understand how reluctant they can be when approaching a male doctor.
Then the worst case scenario happened to me personally. My father was diagnosed with lung cancer 8 months ago. he is undergoing chemotherapy. I was depressed. I became a different person. I became withdrawn, often cry alone in the clinic. I lost my faith on God. My father is a God loving man, he does tremendous amount of charity work, donated a dialysis machine, and drive for 1 1/2 hours every week to a spastic centre where the resident would be covered with feces and urine, and my dad would wash and clean them up, bathe them, feed them, and dressed them up. He has been doing that without fail for the past 12 years. Prior to that, twice weekly for 20 years, both my parents would go to the hospital just to spend time talking to patients, to cheer them up. He doesn't smoke, nor drink. There's isn't anyone in the family who has cancer. My dad was the first. I questioned God. After three decades for being such a humble servant, WHY MUST THIS HAPPEN TO HIS????
I was depressed that i shut myself up. I don't communicate with my wife or children after work. My mind was in dark, evil, and tempting places do so silly things. There were days where 4-5 days would pass by without taking a single meal. I ignored the hunger. I lost 20kg within 3 months.
Time heals everything. But my life was hell then. I was about to trash the prayer's alter at home. I was in the prayers room, hand was tightened into a fist, was about to smash everything up, until my three year old came into the room. Sensing something wrong, she innocently asked me," What's wrong,daddy?" I was in tears. She immediately hugged my leg. I gave her a tight hug while crying my heart out. Immediately, I calmed down.
I knew then I needed help, badly. I opened up to my wife, my parents, and I am not ashamed to admit that I was seeing a therapist to talk about my depression.
I bought a punching mannequin where I would punch till my hands bleed despite covering my hands with multiple layers of crepe bandages and wore a MMA approved glove. I was still angry. With each punch I would ask myself WHY! WHY! Even with a loaded gun wouldn't solve my problem.I can't
But the moment i opened up to my wife and my parents, they started to understand the reason for my changed behaviour and mood swings. I was emotional, and my mind was constantly filled with filth.
I accepted the fact that my dad has cancer today. And the best thing that I can do right now is to spend more quality time. Live life day by day. The past is the past and there ain't nothing you can do about it, the future is unpredictable. The only thing that we can truly call our own is the present.
I started to see things differently from a different perspective. I am a happy person, genuinely happy.
I started appreciating the vivid colours of the flowers outside of my house, the early chirps of birds seem to greet me in the morning while walking towards my car, and the branches of trees seem to wave hi to me.
I've been to hell and back. Nobody would believe I lost 20kg within 3 months, except for my parents and wife. Everyone thought I was on diet or on some diet pills. But do you think dieting and diet pills would not make you lose weight so fast.
What I am trying to convey to fellow readers is that there are illnesses that exist today that doesn't have cure. But when you have a preventive measure available, please make use of it. It would be a crying shame to be diagnosed with cervical cancer when there are methods to prevent and detect it at an early stage.
Please do not be ignorant. Ignorant ain't bliss in such matters. Cervical cancer though today is ranked third as the cause of death, nevertheless there are over 5 million new cases in ASIA pacific alone... ANNUALLY.
Please ladies, get your vaccination today. Don't procrastinate anymore. There are many cancers that affect humans, but when it's ranked 3rd and there is a method to prevent it, prevent it then.

Phone service restored

2011-04-27T22:09:00.000-07:00

Dear reader. On behalf of Management of Klinik Wan Dan Keluarga, we are pleased to inform you that our phone service has been restored. You may call in at 03-62722678 for information regarding this clinic and it's service provided. Thank you.

Yours sincerely,
Dr Wan Chee Hung

Phone are down..

2011-04-27T19:36:00.000-07:00

On behalf of management of Klinik Wan Dan Keluarga, we would like to inform you that our key phone system is temporarily down pending repair. Any attempt to contact the doctor would need to be either through email of directly to my cell phone at 0122917360. Sorry the inconvenience caused.

My source of passion.....

2011-04-20T09:35:00.000-07:00

My in depth passion to educate the public stemmed from deep down within my heart where I genuinely concerned over misinterpretation, wrong knowledge, wrong impression on these wonderful vaccine. I sincerely doubt anyone sees the significance of the discovery of such vaccine which marks a milestone in the history of medicine and mankind.
It all started at around 2006, where the first vaccine, Gardasil was launched. I didn't pay much attention to it. Well of course back then I have not started studying in depth regarding how rampant cervical cancer is. All that I knew back then was 2 things. First, it's an extremely expensive vaccine, and I doubt the community would accept it with open arms. As a matter of fact, I angered a few parents when I merely suggested the vaccine, to my dismay soon I realized the parents whom I spoke to had the impression that I view their daughters to be potentially promiscuous, hence my recommendation for the vaccine.

After several attempts to talk to parents, I knew I failed judging from the reaction from them.
I remember very well, a couple actually condemned me for suggesting it and stormed out from the clinic.
Since then, I stopped promoting the vaccine.
Back then, Cervical Cancer is almost always associated with unhealthy sexual behaviour, which today after studying in details on it, it's not.

One may contract the disease even with only one single partner.

With price exceeding RM800 per jab, I knew for sure it will receive poor response. I gave up then.
Tlhen GSK launched Cervarix at 2008. The price then was around RM400+. Back then I wasn't paying much attention to it. After several month, GSK slashed the price by 60%,hence making it more affordable for the public.

Now how I developed the passion was an interesting tale. 2009, I had three patients, a man and 2 ladies. I can't recall for what reason they came, but I treat all my patient with genuine and whole hearted. Some how the conversation revolves cervical cancer. The gentleman's eyes started tearing up the moment he mentioned about his deceased with from Cervical Cancer. He claimed that his wife never missed her Pap Smear, and the result was reported normal. However 6 months later, the wife died from cervical cancer. From the conversation we had, I can tell this gentleman will never get a closure to the wife's tragic death. He literally cried, and questioned how was it possible the Pap Smear reported normal, yet she passed away from cervical cancer. I doubt this poor gentleman will ever have a closure and will never except the reality that the wife is no longer around. Who to blame? The test? the doctor?
I felt an overwhelming sadness and how I wished I could comfort the man, but i know its impossible.
The story from the two ladies similarly resembles when their sibling died despite yearly Pap smear stated normal finding. Its unfair, and I felt the pain when they tell their stories. I was overwhelmed and told myself I will study the faults for the false positive result that cost lives.
The more I delve into finding the faults of conventional Pap Smear, I realized there must be a more accurate screening method to counter the faults of conventional Pap Smear.
Then I found out a more accurate method called Thin Prep Pap Smear which was made available since 1996.
I started promoting TPPS in my blog, but the response was poor.
2009 was the year my aunt was diagnosed to have Pancreatic cancer. Every month, she would come to my clinic for check up. The first time I diagnosed her, she was a hefty 86kg lady. Her 9 months ordeal was the most depressing experience in my career as a doctor. I see her getting emaciated, the tumour was eating her as time goes by. Until the last visit, she weighs 35kg.
I accompany her to the hospital and was there by her deathbed... I was there when she blew her last breathe.
My uncle was devastated, he lost his appetite,was hospitalized twice, and whenever he's alone at home, he would talk to late wife;s photo,the wife's favourite dog. Out of the sudden he would burst into tears, having difficulty sleeping, having to wake up every two hours drenched with sweat.
I was there witnessed the psychological and mental damage it has one my uncle. Once a week, he would visit my aunt's grave.
Witnessing all these, I was determined that with a vaccine so revolutionary, I try my best, I dedicate this blog purely to educate the public, that now they have a choice to say no to cervical cancer, the number 2 killer among women. I tried hard, and even if I managed to reach out to a single lady to agree to vaccinate,I feel contented. This crusade, to reach out to the masses has become personal to me. I do not want ANYONE to go through what my aunt faced. Even when she's gone, the damage is still felt my the family member.
That is why I don't mind spending hours explaining to patients about this vaccine for free. There are 500,000 new cases everyone, out of which 270,000 is from Asia Pacific.
Patients asked me why am I relentlessly promote this vaccination. After reading this, I hope you'll understand why. I am not making profit from this vaccination, and the price that I offer is the cheapest in the entire nation. Its not fame that I am after, but I want to make this vaccine affordable to all walks of life.

New site of injection

2011-04-12T23:45:00.000-07:00

95% of patient who received the injections would complained of pain to almost right off the pain chart, however, I am glad to inform you that alternatively we can inject at the thigh which I had done for a number patients already. They had claimed the new injection site is far lesser pain.
However, the injection is not recommended through the gluteal(buttocks) as the pad of fats prevents the vaccine from being delivered into the muscle as its supposed to. Unless of course you don't mind me using a larger bore needle!

MUST READ!

2011-03-29T02:15:00.000-07:00

Many "syabas" and "tahniah" to our Malaysian Medical Association for kick starting a year long program where the cost for Cervical Cancer vaccination is partially subsidized by them. For this particular

campaign, I salute to the policy maker, to whom who had to pull strings to make this happen.
For this

Ribuan Tahniah dan ucapan Syabas.
Current market price for a dose of Cervarix ranges from RM300+ to RM180++. With this campaign specifically targeted at girls of age 14-19 years old will benefit as the cost of vaccination would be subsidized by MMA(why not MOH??)
The total cost for vaccination is RM466 under such program.

So why wait, don't procrastinate any longer, register with the nearest clinic near you that took part in such program to enjoy the price cut. I hope I don't sound much like a salesperson, but merely reaching out to the public to take advantage of this.

1st Dose
Remember to bring the ID of the recepient
and RM 233
2nd dose
- RM 233
3rd dose
FREE!!!

My Email Reply to an inquiry

2011-01-25T23:05:00.000-08:00

Dear respected Miss ****,
First of all, I would like to apologize for my seemingly short reply,hence giving you the impression that "I don't care" or "it doesn't matter to me" kinda impression. As you many have noticed, I was replying through my IPhone, hence the limitation .
Now,my uttermost passion for cervical cancer prevention stemmed from three patient of mine, who came to me. I prefer the term socializing rather than consultation. I had a man, who lost his wife a few months back due to cervical cancer despite her wife being doing her Pap smear annually. The Pap Smear report was normal. However, 6 month later, she succumbed to cervical cancer.
He started to sob as he speak, and I somehow could feel the pain and torment the gentlemen is experiencing. He started questioning the doctor who performed the test, questioning God, he simply couldn't accept the fact.
I doubt if he will ever have a closure in such matter. Unless if he openly admit that he has accept the fact that his wife is no longer with him. He has 2 daughters and 1 son.
Then I encountered three similar cases.
Then the desire started to build within me to get myself well versed with cervical cancer, and my desire was reaffirmed with the death of my aunt due to pancreatic cancer. UNLESS you have a family member or friend who is close to you who had died from cancer, one wouldn't understand the psychological,emotional, and mental trauma both the patient and family member experienced.
I was the one who diagnosed my auntie's cancer, and I see through her 9 months battle with pancreatic cancer was the most painful thing. I was there by her deathbed when she died.
Cervical cancer is the 3rd commonest cancer in Asia Pacific. The discovery of the vaccine is revolutionary and marked a milestone in medical history and perhaps even changed the course of history of mankind. It's the second cancer where you have the power to chose NOT TO HAVE instead of merely living healthily and HOPE that one wouldn't get it.
Among the two vaccine, Cervarix is a a better choice by hundred of folds. You may visit www.cervarix.blogspot.com to know more about it.
I sincerely believe a good health care is a basic human right, hence I charge a very low price to enable more group of people to get themselves protected against this dead disease.
I hope I have answered your questions. Please drop mail if you want to know more about this vaccine.Thank you.

Yours sincerely,

Dr Wan Chee Hung(MBBS,Man)
Family Practice, Aesthetic and Anti-Aging Medicine
Klinik Wan Dan Keluarga.(Map)

Battling cancer

2011-01-21T22:42:00.000-08:00

I just got to know that January is cancer prevention week. After talking to three family member who's spouse or siblings succumbed to cervical cancer, and seeing my own auntie battling cancer for 9 months,I remember vividly standing by her deathbed, her breathing was shallow, she became unresponsive to calls, her stare was blank, despite knowing the inevitable, my uncle kept on urging my aunt to fight, never to give up, but with the machines attached to her to read her vitals kept on beeping, she was long gone, and that the breathing and the heartbeat were self regulated despite brain dead.As long as her brainstem still works, her heart will continue to beat, breathing is purely automated. I couldn't find the heart to tell my uncle who was constantly cuddling her, saying sweet loving words to her.
I was determined then. Nobody should die like this. This is painful death. Her death doesn't stop the grieving family, the psychological, mental,and emotional scar is indescribable. Only one who goes through this knows the impact cancer has upon ones family.
And with the discovery of cervical cancer vaccine, it marked a milestone in medicine, changed the course of mankind forever.
But the sad new remained, ignorant doctors, ignorant public,. I bet those very few cancer survivors would wish the vaccine were discovered much earlier.
Often times, I felt like fighting a battalion of ignorant army all alone. How great would it be if I have brothers or sisters in arms and together we take the challenge of educating the public one by one. If the ignorant are challenging enough, what about the skeptics, those who write books and had them published, poisoning the minds of people by feeding them lies like these diseases aren't as rampant or serious as it's being told, but merely a ploy by pharmaceutical companies to earn their money, where the share holders would laugh away as the public sees the emergence of such vaccine is a "miracle" in medicine.
Ladies, it is a miracle. I may have said this a million times, but I will say it again. The next big thing in medicine where it's significance is at par with the discovery of cancer vaccine would probably be the discovery for the cure for AIDS.

Since the masses are rather ignorant, and probably being deluded with the thoughts that they aren't so unlucky to get cancer, well, please think again. Do you know that the charts, figures, and graphs that represents mortality were once human with family like you and me.
Don't let doubts creeps into your mind. I have been sitting in front of the computer the whole day writing proposal to human resource departments of giant companies like Maxis,Digi,Berjaya Group, and Shell.

I am offering RM165 per dose, probably one of the lowest price in the nation,well probably the lowest...
Love your siblings, wife,cousins,?Spread the news to them. The threat of cervical cancer is very real.
The least you could do is to spent some time at another site which I dedicate entirely on cervical cancer. Click here to be directed there.See your doctor today.

Message from a Cervical Cancer survivor.

2010-10-29T02:49:00.000-07:00

Since I can't manage to get a real survivor from cervical cancer, I searched in the internet and stumbled on this two videos.
Imagine the angst, psychological,and emotional trauma one can avoid with a simple vaccination. Please ladies, wait no more..

So ladies, do no hesitate or procrastinate any longer. It can happen to you. Do you know that the 13 minutes spent on watching these videos, 6 women died of cervical cancer.
Talk to your doctor today.

Why I chose Cervarix...

2010-10-25T03:50:00.000-07:00

At present, there are 2 vaccine against Cervical Cancer. Cervarix, by GSK, and Gardasil by MSD.
Now, one claims to be a tetravalent vaccine,which means it provide protection against 4 genotype of HPV(Human Papilloma Virus) that is responsible in triggering cellular changes that leads to cervical cancer.

Or....

One thing that is rather misleading is the claim that Gardasil being emphasized upon as a tetravalent vaccine in protecting against Cervical cancer. This is such a misleading statement. Indeed while Gardasil being a tetravalent vaccine by it's own rights does not mean it provide more protection compared to Cervarix.
Tetra- 4, the subtypes are 6,11,16,and 18

Subtype 6 and 11 causes only genital warts, and does not lead to Cervical cancer per se.
While on the other hand, Cervarix, was designed to protect against subtype 16, and 18, it however, have shown to provide cross protection against subtype 31,33, and 45.
Subtype 16,18,31,33,45 are the top 5 serotype that causes cervical cancer.

Cervarix was designed with ASO4 as an adjuvant, acting as "turbocharger" that leads to high level of antibody titre and for prolonged period of time. Mathematical formulation ha estimated that Cervarix gives protection for at least 20 years, while antibody level of Gardasil would dwindle after the 5th year after vaccination.
One of the criteria for one to develop cervical cancer would be persistent infection with HPV.
What happens then for those who was vaccinated with Gardasil after 5 years. Nobody today can tell whether the need of a booster. Though the blood antibody titre may be low, or even absent, but the B-memory cell would trigger the production of these antibodies. True. But it fails to serve its purpose as it takes 2 days for these antibodies to be produced, while it takes only 2 hours for HPV in blood circulation embed themselves at the basal membrane, isolating them from the circulating antibodies.
It got on my nerves when I got to know that there are doctors who told the patient to chose the vaccine of their liking. Doctors are humans with their fair share of doubts. I personally emailed Dr Diane Harper, the principal researcher in both vaccines, and a committee member in WHO,
her reply is this:-

For a virus that stays dormant in the body for decades, one needs a vaccine that last much longer than the virus for which the vaccine is designed to protect against.

New promotion on Cervical cancer vaccination.

2010-10-12T03:42:00.001-07:00

Don't be shy for Pap Smears if done by Male doctors.

2010-09-25T02:16:00.000-07:00

In view at the fact that Pap Smear has saved million of lives worldwide, to my personal opinion, one shouldn't feel shy about getting your Pap Smear done by a male doctor.

In Klinik Wan & Keluarga, we conduct Pap Smear by using the Thin Prep Pap Smear only, as conventional Pap Smears yield a significant number of false negative in it's result due to poor sampling collection and deposition of samples onto the slides.
In case if you are shy about the doctors being a male, and that the examination seemed "violating", well, to the doctor who sees both the male and female genitalia day in and out, it's nothing sexual.
Personally, its no difference from looking beneath the hood of my car to see what's wrong with it.

Seriously! I am not trying to be funny here. I am genuinely concern for your well being because you meant a lot to someone, either your parents, boyfriends, husbands,children, and my aunt was to my uncle. And I see the trauma that my uncle bears up til today, though it's been seven months since her passing due to pancreatic cancer.
Normal price for Thin Prep Pap Smear is RM90, but at Klinik Wan & Keluarga, we charge at only RM60, believing that access to proper health care it a basic human right.
Don't take chances.. Talk to your doctor today.

Successful campaign..

2010-09-23T23:19:00.000-07:00

First public vaccination campaign-- success..
Hitler managed to convince a crowd of 2 million that their Aryan background is superior, that led to the elimination of 2 million Jewish during the Holocaust.
This man, the greatest orator of all time.....

drove his people to commit this

Genocide to the Jewish.
While Anthony Robbins, the great sort after self improvement speaker,

..Convinced his attendees to practice "Mind over matter" exercises by walking on burning hot charcoal.

While me....tried and succeeded in getting people to protect themselves against cervical cancer by a painful vaccination.

That's the number of emptied vaccine syringe.
This is very encouraging, and as the effort that I put in creating awareness begins to sap away, this rejuvenates me and justifies and reaffirms my worthwhile effort.

All prepared for mass vaccination in IBM.

2010-09-20T00:57:00.000-07:00

I am all stocked up now for the first mass vaccination.
At last, the effort and my aspirations materialized. To provide patient with proper health care with an affordable price.
I am considering lowering the price even more, specifically targeted at the lower income group of people.
I am looking at at somewhere around RM150 per dose.
I simply hoped that more people will be aware of the impact cervical cancer has on our society. Unless you know someone who had died of cancer of suffering from cancer, onl then would you able to understand how it felt like.
Death is inevitable, but the question is, whether or not one dies with their dignity intact.
Trust me, there is no glory nor dignified in dying from cancer.

Are you sure you are telling the truth or out to sabotage?(some photos may be graphical. Viewer's discretion is adviced)

2010-07-16T02:49:00.000-07:00

It took me 4 days of writing and then erase my write ups as each time I feel there is so much better ways to convey my message?
To begin this long winded post, let's talk about human psychology. (at this point, I sincerely doubt if anyone is reading this post as it's boring to most) a peculiar feature than makes a man, is self interest. What seemed important to them, they would go all out to get it,but it, hunt for it, study for it, etc.... but to what seem trivial not to mention potentially harmful to them, we will go all the way dispel them off, even against Government. Whether the Government is corrupted or not is another issue altogether.
Now, lets get back to the point here. It's been reported that increasing number of adverse effect leaning towards Gardasil is being reported, and that cases due to Cervarix is gaining.
What the the adverse effect?
Guillen Barre Syndrome,seizure, convulsion,anaphylactic shock, paralysis, chronic fatigue, autoimmune diseases, blood clots, urticarial rashes, shock, pancreatitis, transverse myelitis, and many more.
Now this is the point where each time I erase the whole write up and rewrite them all over again..
There are often times when i actually contemplated to video blog rather than to write it due to it's lenght.
Some goes all out to say that the figures in charts and graph are all made up to create a hype in the need to find a solution for such condition such as cervical cancer.
I've checked with Makna that back in 2006, cervical cancer was ranked 3rd among all mortality due to malignancies. Why would Makna(an NGO) want to do anything as such.Cervarix wasn't even out to the market at 2006.
I sincerely think the our western counterparts have exaggerated this a little bit. For any products that is classified as medical product are obligated to list down the possible side effect, no matter how remote it maybe. Whether it's 100% or 0.00001%,the possible side effect must be listed down.
By now, everyone should know the westerns are well known for their views on personal/liberty rights.They are the first to stand in front of a legislative building with sign boards, shouting slogans on human rights , social injustice,racism,etc..
I am not at all surprised when they decided to go all out against state legislature on making cervical cancer vaccination compulsory for school going children as the public perception on cervical cancer is totally different from Asia Pacific region. Cervical cancer being ranked 15th or 16th in UK and US with mortality of less than 1% obviously would not be seen as national threat!
99% of the reported side effects came from the western world. UK and US in particular. Just because the mortality rate is low due to cervical cancer in their country, it NOT necessarily means it;s not important nor it being any less revolutionary.
As a physician coming from Asia Pacific region where Cervical Cancer has plaque women in our countries for years, the discovery of such vaccine is the closest thing short of a miracle.In my humble opinion, it marks as a milestone in the progress in health and science.Progress has been constant and gradual all these years, but it is incidences as such that marks it;s progress by leaps and bounce. This belong to the same group in terms of significance as the discovery for Polio vaccine, the discovery for Malaria drugs, TB vaccination, and in future, the only thing that is in par with such discovery is the cure for AIDS.
Complications, convulsions, development of Guillen Barre Syndrome, urticarial rashes.. these are not discoveries, but its well documented as possible adverse effect in the leaflets within each and EVERY VACCINES, and not only in cervical cancer vaccines only.
Vaccines don't cause a urticarial rash, convulsions, or Guillen Barre Syndrome. They merely triggers off these already present condition. One don't contract epilepsy. Anything under the sun, stress,heat, fear, pain may triggers off a convulsion, but that doesn't make a person epileptic.

The same goes for Guillen Barre Syndrome, a rare autoimmune disease that normally manifest itself in middle age. If it's not being triggered off by the vaccine, it will triggered off by something, somewhere. If it happened spontaneously, who are you to blame? Bloody Helios?
As I had mentioned earlier, all form of medical products whether it's vaccine, contraception, antibiotics, painkillers, etc... carries a leaflet stating all their possible side effects, no matter how remote it may be.
At least its better than some products that doesn't state them, and if anything were to happen, the consumer were to be blamed or a pat on the shoulder saying sorry, it happened to you.
Just like any medical product, Cervarix carries its leaflet stating all effects, both possible and remotely.

I simply couldn't understand why come party says pain at the side of injection is an "adverse effect". I though when you're poke through with any sharp object, that's the reaction, a normal reaction. Not a side effect.

Some party claimed the possibility of contracting cervical cancer is enhanced with the vaccination! Based on what?? Did these independent body of investigators conduct their own studies or do they simply come out with a number as how is it possible when the vaccine is engineered by producing it's vaccine by means of production of it's plasmids(the protein /capsule that does not contains the viral DNA that cause the actual damage to the body. Yup, you got me right. What makes up the vaccine is nothing but an empty capsid for the body immune system to form an immunity against the actual harmful virus. By that, how is it possible that someone came out with the statistic that the percentage of increased possibility of post vaccination cancer is more than 40%.

The listed adverse reactions are listed in the leaflets, ranging from pain at the site of injection, to numbness, headache, nausea, to urticarial rash. These are listed and known possible side effects, not something new yet to be reported.

Other possible side effects is so rarely seen, that it's categorized under "possible side effects".
The possible complication of urticarial rash is clearly stated in the leaflets. Please don't ever complain that it is a side effect!.
As I've mentioned earlier, these effects aren't only seen in Cervical cancer vaccine, but in all other vaccines and medicines as well.

Take for example hepatitis B vaccine.

The leaflet for Engerix B, Hepatits B vaccine which comes along with each units of vaccines.

Observe the listed undesirable effect which is classified under common, uncommon, and remotely common.

Can't see clearly???

What is written right at the middle of the leaflet? Guillen Barre Syndrome!
But how come I don't see any reports by parents from anywhere who rejects this vaccine? Why no voice of opposition despite the similar percentage of side effect?

There, enlarged. Can you see it now? Why with the discrepancy? Why is it that there was absolutely no opposition nor anyone wrote anything against Hepatitis B vaccine but majority of complaints from the western "developed" countries are taken so seriously, that there are dedicated blogs, organizations formed against Cervical cancer vaccination?
Before I come out with my personal conclusion, let me reaffirm the bias the westerners have on this vaccine.

What about vaccine against Pneumococcal infection. If anyone were so sure that i am affiliated directly or indirectly to GSK, there, Prevenar is NOT FROM GSK.

Now, let's look at the leaflet on Prevenar and it's content.

Let's see now.. oh, see! Seizure! Convulsions! Irritability, Urticarial rash!

Oh, my!!Dyspnea, bronchospasm!!
Anaphylactic shock! Isn't that life threatening?! Of course! In such conditions, if no active and immediate intervention,death is imminent.
But, my... why have I not heard any complaints from anyone?? Despite the warning??? Is it because the risk associated with pneumococcal infection and hepatitis b infection vaccines is "more acceptable"? Is death due to hepatitis B /pneumococcal infection is less "severe" than cervical cancer? Come on.. Which moron would ever come out with such idiotic and moronic conclusion? Yet, ask ourselves, how come no opposition for other vaccines but only on cervical cancer vaccine??
Still not convince on the discrepancy?

The box says inactive hepatitis A and rDNA hepatitis B vaccine, which means they are actually injection the ACTUAL VIRUS, but just being attenuated. Compared to VLP (Virus like particle) which is molecularly engineered, wouldn't live attenuated vaccine which still contains the DNA is more dangerous than VLP which have the structure of the virus but devoid of the DNA? But why no complains on Twinrix???

Check out the possible adverse effect! Anaphylactic shock, paraesthesia, syncopal attacks. Goodness! Doesn't it's risk is in par with cervical cancer vaccine??

YIKES!!! URTICARIA!!!!

Look!Convulsion! Syncopal attacks!

Ooh.. Now that's an eye catcher. Guillen-Barre syndrome! But more! Encephalopathy! That's inflammation of the brain! Isn't that how Bruce Lee died??
My,oh,my. Look at these adverse effects? How?
If everyone were to form opinion based upon individual ideas and experiences, there would be multiple organizations who are against ANY VACCINES! No BCG, No MMR,No Polio, No Hep A & B, No nothing!! The whole TB, measles, mumps, rubella, hepatitis a and B are nothing but man-made diseases simply for :-
a. Population control - which moron came out with idea as such?
b. Monetary gains through sales of vaccines!!! Yeah! That's the most popular rationale.

All these diseases must be part of some worldwide conspiracy. Ideally no doctors exist, and everyone lives till 500 years old!
But wait, not only are these vaccines part of some widespread conspiracy, but antibiotics too!

Ideally there shouldn't be microorganisms like pneumococcal, staphylococcus, streptococcus..

All these are man made, simply created by mankind to cheat mankind!(do you see how dumb that sounds?) Why?..Once you get the infection, there's always the possibility of dying without treatment, and of course all possibilities of dying due to "adverse effect" of these antibiotics too!!

SIDE EFFECTS!!!!???

Anaphylaxis!!!??? Or die from the disease??? Let me think...???

Steven Johnson Syndrome!!!!?????
Now that's life threatening!
If you are wondering how Steven Johnson syndrome looks like and what is it,...
Well, basically it's a exaggerated and life threatening form of skin allergy towards any medication of unknown reason.

(Picture taken from Wikipedia)

ANY MEDICATION MAY LEAD TO STEVEN JOHNSON'S SYNDROME! ANY!!
So, as you are reading this post, how old are you today, and how many times have you visited the doctors, how many times were you prescribed antibiotics? How many times did you ended up being like what these poor individuals had?

Hmm.. What about Augmentin? A high end antibiotic that belonged to Penicillin group of antibiotic.. Since nearly 80% of antibiotic are Penicillin based or structurally similar to penicillin, how safe is it??

Oh,no!!! risk of anaphylaxis, again???

Oh!!! Goodness! Even Augmentin may put you at risk of developing Steven Johnson's Syndrome!!!????!!!
Which one may die in hours or days...... or...

...or die in minute from convulsion!

The point that I am trying to highlight is that any medicine... ANY medicine may have side effects, depending upon individuals.
If the benefits of a medicine far outweighs the "possible" side effects, then reason for consumption is validated. However, if the region where you're living in isn't plagued with disease such as Cervical cancer in Asia Pacific, I sincerely hope your opposition towards this "unnecessary vaccine" or the ingenious theory that cervical cancer is a hoax is expressed with discretion. Just because NHI of UK and FDA of US had devised a more aggressive and comprehensive method in detecting early stages of precancerous lesions, hence intervened early to prevent death, it isn't so in our region.
Have some respect for your fellow man who discovered the pathology and vaccine of this deadly disease.
Publishing books and blogs to discredit such revolutionary vaccines/medicines NEVER HELPS! Unless you've got the disease, I doubt those who are against this vaccine will ever come close to comprehend the significance of such vaccine.

It;'s me against the world.

2010-07-14T19:35:00.000-07:00

"Its me against the world"
It a strong word for a title but nevertheless that's how I feel.Lately, I am beginning to attract the spotlight, problem is it's negative.
This is just an introductory post for a longer post to come. Hence be talking about way Cervarix and Gardarsil caused death in overseas, it;s, adverse effects, if does more than than good, right??
I think on this matter alone, it will talk at least 4-5 post to rationalizes what they got to ...

As a start I will present the e mail that the author emailed me

Dr. Wan -

Christina England - forwarded your email on to me.

I am from Colorado in the United States.

Please be aware that there is a growing body of parents, daughters, researchers, educators, and politicians who are concerned over the safety and efficacy of the

HPV vaccines.

I am well aware that cervical cancer rates in Malaysia post a threat for the female population.

However, there are risks associated with the vaccines causing life threatening illnesses and death.

First of all let me clarify by saying that I have been involved in this issue since Gardasil hit the market in 2006.

I belong to a network of women and men from Spain, New Zealand, Finland, UK, Netherlands, India, Australia Germany, France, Sweden, Ireland, and throughout

the United States.

I was one of 6 women invited to share our research and data on HPV vaccine dangers to the FDA in March of this year.

I will be addressing the British Society of Ecological Medicine about HPV vaccine dangers in March 2011 in London.

To date there have been over 18,600 adverse reactions to the HPV vaccines - mostly Gardasil - since Cervarix is quietly making its debut in the U.S.

There have been 75 deaths - 3 from Cervarix.

According to the National Vaccine Information Center only 1 to 10% of the population is reporting.

Adverse effects associated with Gardasil (from PDR) are Guillain-Barre syndrome, lupus, seizures, anaphylactic shock, chronic fatigue, paralysis, blood clots, brain inflammation, blurred vision, and blindness. Furthermore, the following events have been reported after vaccination from Gardasil: blood and lymphatic system disorders, autoimmune hemolytic anemia, idiopathic thrombotic purpura, lymphadenopathy, pulmonary embolis, pancreatitis, vomiting, asthenia, chills, death, fatigue, malaise, endocrine disruption, fertility, autoimmune diseases, bronchospasm, urticaria (hives), arthralgia, myalgia (muscle pains), and transverse myelitis (inflamed spinal cord).

According to Diane Harper, lead researcher for the Gardasil vaccine - who has since pulled away from Merck pharmaceutical "There are now more adverse reactions than there are cases of cervical cancer."

The adverse reactions just starting to be reported from Cervarix - are even more unsettling and severe than Gardasil.

I have posted hundreds of articles on my blog about the HPV vaccine trails.

Cervarix/HPV Vaccines

There are also plenty of research papers available on this topic:

Global Concerns about Gardasil

Letter to Commissioner Margaret Hamburg - FDA

Source and References

What you need to be aware of is that is the FDA has acknowledged that if a woman has already been exposed to HPV vaccines (and they are transmitted vertically - through breast milk, under finger tips, via the birth canal etc. AND she received the vaccine - her chances of developing cervical lesions increased by 44.6% for Gardasil and 32 plus % for Cervarix. The FDA already acknowledged in a September 2008 Closing Statement on Gardasil that 73.3% of girls getting the vaccine will develop "new medical conditions." According to the US CDC, (Center for Disease Control) on 1/3 of the girls in the US have completed the vaccine series. We know of too many girls who experienced severe side effects after the 1st injection and quite the series. The stats back it up.

Treatise on Gardasil from the United States

US Concern for Europe regarding Cervarix

There are already 278 abnormal post vaccination (up to 2 years) pap smears reported to VAERS.

If I may be of further service to provide more information please let me know.

I am sure that this may all be unsettling for you - as it is for others who are coming to understand the potential health risks the vaccines impose.

I do hope that Malaysia has a solid vaccine adverse event reporting system - and that women are aware of the importance of posting side effects.

Most Sincerely,

Leslie Carol Botha

Leslie Carol Botha, Health Educator, Broadcast Journalist
Internationally Recognized Expert on Women’s Hormone Cycles
Holy Hormones Honey -The Greatest Story Never Told!
http://holyhormones.com/
http://truthaboutgardasil.org

Now this is the first part of my crusade to dispel the fear these group of people creates among the public who considers getting vaccinated.

to Mr/Mrs/Ms De

2010-07-06T08:28:00.000-07:00

I posted your comments which I felt it's a debate for public and for your good self to witness. Unfortunately, somehow, you're the second person who's comment failed to appear on the blog when I press "post".
I respect your point of view, and I will not even try to attempt to convince your belief on what these "cervical cancer vaccine does" and on your statement about the vaccine kills more than the disease itself.
However, I am unsure on the source which you're derived from that draw such conclusion, but from personal experience, it's been in our statistics for years before the launch of the vaccine that shows that cervical cancer is ranked second among cancers that inflicts women in Asia Pacific. I sincerely
respect your opinion about such vaccine which you think does more harm than good, since in the western countries such as US and UK, where the public screening program is so good and well funded, and the level of health conscious among women is in your country is nothing less than exemplary for women in our region to follow.
It's due to the thorough health conscious individuals in developing countries such as yours would be the main reason for the low mortality rate in due to cervical cancer. (US mortality rate is only 4% compared to Malaysia which is 60%)and perhaps cervical cancer being relatively non life threatening in your country, hence ranked 15th among all cancers. That would be one of the reason why most public outcry and voices against national vaccination program has is "more" from your country.
But the scenario is totally different in Asia Pacific. Hence strong opposition from you against my blog in advocating cervical cancer vaccination is not perceived negatively, but instead I felt the sincere need to explain to you the rationale for me to be such an advocate for cervical cancer vaccination.
I hope you would understand my rationale for being so vocal in creating awareness concerning cervical cancer among the public, not limited only to Malaysians but to countries within our region.
I sincerely hope this post is not perceived as a personal attack but rather, a dialogue.

Especially to you!

2010-07-03T03:52:00.000-07:00

GSK has been doing so much to create awareness despite the limitations imposed by the Government on advertising a product.
In my rather humble opinion, Cervarix isn't a product.. it's a answer to killer disease. Despite several parties/bloggers who does nothing but criticizes miraculous discoveries by scientist and doctors,(to you who is scrutinizing my blog, you know I AM TALKING ABOUT YOU!) despite been awarded Noble Prize, unfortunately there are bloggers who doesn't have cervix thinks all your effort is part of a multinational conspiracy for "population control"..(now, isn't that the most ridiculous thing you've ever read?)YOU! Who forms opinions without thorough knowledge on what cancer does should consider what you write about. Perhaps no one within your family has cancer, but there are million other who does, including mine. To include my name as "A******Rfing for GSK is uncalled for. You seriously have to consider what you write. Please get your facts right. Do you have any form of evidence that I advocate Cervarix in return for any form of remuneration?
Sure, any multinational company, including pharmaceutical companies considers financial returns in running their business. But while doing so, millions of lives are saved. Have you ever put any thoughts towards the company that produces Sildenafil ( since you are gifted in scrutinizing blogs and squeezing bits of information and twist it around to serve your purpose filled with paranoia, I am sure you have no problem finding out what Sildenafil is or by what name its been traded.) any idea how many individuals using it ended up with heart attacks? Why don't you dedicate an entire blog on it,instead?
And of course during H1N1 epidemic, there are only two antiviral drugs that is capable to treating or preventing one from contracting H1N1.
Oseltamivir(sure you know what it is given your level of intellect, or am I wrong to assume?) and
Zanamivir( You know the trade name, hope you know what is it then, wouldn't want to appear like a fool for not knowing what you're writing about).
Why do I chose Zanamivir? Click here.Check out the "Possible side effect" column.

Unsupported criticism never helps, friend. Especially when you post your photo on your blog with nonsense as your content for the whole world to witness. It's so obvious you're all out to attack the pharmaceutical company, but when you include another person who advocates their product with much sincerity, you've crossed the line.
Please stop before making yourself looking like an

Is it all worth it?

2010-06-23T23:25:00.000-07:00

Listening to the story on how a patient of mine who's wife faced the ordeal of a downhill battle against cervical cancer, and experienced it myself seeing my aunt whom I attended to during her 9 months battle with pancreatic cancer, my heart tells me that nobody deserves to die from cancer.
I believed a person have died on the inside the moment they've been diagnosed to have cancer.
The memories of my aunt's weary stare each time she walked into my consultation room,the look on her face, her reluctant smile that greets each time she sees me, all those memories still lingers at the back of my head, still remain vivid as ever.

Though she isn't my mother, but her warmth, comfort, soft an genuine self was motherly. So much so that though I called her auntie, I held her hand and sat by her side while the drip was running. I was the one who administered the IV drip as she often gets dehydration. but it felt so naturally being more than just a nephew to her. Someone much closer. Someone that warms your heart. Her passing, till today remained unsettled within me. I can't believe she's no longer around.
From the bottom of my heart, I sincerely do not wish anyone would have to go though what she went through from the day I told her of her diagnosis last June until her passing last March.
Out of sincerity, I hoped to create a public awareness by going through all measures, by lowering the cost of vaccination, creating a blog purely for those who genuinely seeking out information regarding cervical cancer, organizing awareness and prevention campaigns.
To be frank, I was feeling rather hopeful until reality hits me.
For the past 1 week has been, bad. I felt being taken advantage of, being made a fool of, being condemned, like for what purpose am I doing this if no is taking this seriously?
I had a middle age lady who came with her daughter last week for the vaccination and Thin prep Pap Smear, which both I have reduced the price. Yet, the mother was reluctant and tries to negotiate for a lower price! She claimed she didn't bring enough money, and that they are poor, all the crap she told me about blood investigation being so expensive, that I should charge her lower price, yet, when she flipped her wallet, i noticed she owns a gold credit card!

I felt cheated, and being taken advantage of.
Another lady who knew about the Cervical Cancer Prevention Weekend, were I purposely reduced the price of Thin Prep Pap Smear from RM90 to RM45. The price promotion lasted only during the week.

RM45 is the cost price which the lab charges the doctor.

Not only am I not making any profit out of this, but i am bearing the cost of the disposable speculum used, the electricity to run the refrigerator where I store the vaccines,etc. Even after the campaign, i only kept the cost for Thin Prep at RM60 instead of RM90.
I don't think she can't afford to pay RM60! In fact, she claimed I agreed to charge her RM45 even after the campaign. I've checked through the mail and there wasn't any that i ever mentioned to her about RM45.
The the worst thing I got to know is that some other blogger who hold grudges against GSK blogged about my content, and totally twisted and turned the entire fact,mentioned my name, took photos from my blog despite the copyright as per written in the disclaimer.
To that particular blogger who claimed I advertised GSK's product within my clinic when I'm not supposed to, but I sincerely think he's making a fool out of himself for not getting his facts right about medical law in Malaysia. You CAN advertise anything within the vicinity of your clinic. To the blogger who condemned what I do,(google dr wan cervarix, it will lead to his blog) maybe you don't have a woman with cervical cancer, and I doubt you got the entire facts on Cervarix. What are the odds of you knowing more than world renown gynecologist in Asia Pacific region regarding this vaccine?
I got to know people who really wanted to get themselves protected, even at RM165, the price is still a little steep for them. They've had to save up to get themselves vaccinated. I've confided to one of my family members, that perhaps I could lower down the price for them, but the answer that i got was rather discouraging. "Perhaps if one day you're as rich as Bono or Bill Gates, then you can do charity." .... i think that is something I don't deserve to hear when I know I am not rich, nor have i even made my money yet, but that was the reason why I chose to be a doctor to begin with, not for the $.
I felt rather depressed over these incidences. There is a significant percentage of people who live within poverty standard. Why can't the government allot some funds towards them? Why are the politicians getting richer, driving RM1 million Cayenne, making a mockery in the Parliament, living a lifestyle way above their pay grades, yet they claim to represent the people, who's social and economic status hasn't changed for decades.
I am just mad. This is such an unjust world. I realized I cannot make a difference. Not at all. All the stories about about changes, or revolutions that begun with a single idea remained stories, something inspirational, only for idealist, not realist.
For those who intends to negotiate to lower the price, please don't bother coming at all.

Revised price for Thin Prep Pap Smear

2010-06-16T22:13:00.000-07:00

While getting ready to work yesterday, i thought to myself what else can be done reach out to more people concerning Cervical Cancer awareness.
Recently I found out Tzu Chi Buddhist group foundation jabs their followers with Cervarix at RM130+. Wow!
There are only two way one could get such a good price. Someone must have purchased it in a large lot with the best bonus.Unfortunately, it's only for Tzu Chi members.
I am not running a charity clinic,yet I want to give something back to the society as I felt compelled to do so.

The price for Cervarix will remain competitively low.
Unless of course GSK is willing to further bring down the price. Then I will definitely reduce the price further.
Then it struck me, perhaps there are two other things which I can still try to do(irrespective of the result, more importantly is the attempt) to enable people of the lower income group to get themselves protected.
Out of the available methods of Pap Smear today, Thin Prep Pap Smear still be a choice for a more thorough and accurate sampling, hence accurate result.
I took some time and thought of several possibilities:-
1. to lower the price for Thin Prep Pap Smear from RM90 to RM60, and each test were done using sterile gloves and disposable speculum.

Normal price of Thin Prep Pap Smear will be reduced from RM90 to RM60.

Sample are collected using the prepacked sterile brush for Thin Prep Pap Smear.

For hygienic purposes, only once only disposable speculum are used.

Hence, the whole package will cost RM60 instead of RM90, which has just begun yesterday.
My sincere plea to all readers to inquire more knowledge on Cervical Cancer, as it is the one of two cancers that we are given a choice whether to be willfully protected, rather than leaving to chances. It would be a crying shame when this revolutionary vaccine that is available in the market, yet there are few hundreds of new cases and at 2 deaths everyday due to Cervical Cancer in Malaysia.
Ladies and gentlemen, is has never and will ever be a stigma to get yourselves or your daughter or wife examined.

As a matter of fact, it is probably be one of the most important decision you've made in your life.
To demonstrate to you how rampant Cervical Cancer is in Malaysia, recently I've conducted a Cervical Cancer Prevention week, where I performed Thin Prep Pap Smear only on 4 individuals, out of which one of the four's test result came back as such.

...and when I proceeded with HPV DNA test where the samples are sent to Australia to identify presence of HPV virus and it's subtype.... it reads,

HPV subtype 16,18,31,33,45 are ranked top five that causes Cervical Cancer.
I sincerely ask the public please take care of your health.Please make use of the available "tools" today to detect and prevent this deadly disease before it fully develops.
This reaffirms my belief that one shouldn't have the attitude where disease as such won't happened to them.
It happened to my aunt, it happened to my mother in law. Do you think if ever given a choice, would they want it???
2.Income base/age base
Based upon the income of an individual, where patient would require to bring their pay slip. Monthly income below a certain amount would be charged much lower than proposed price. This will be implemented soon, but yet to ascertain the cut off income point and the price offered.
3.Organize outreach program
90-95% of individuals who have heard of cervical cancer vaccine are urbanite, yet those who stepped forward for the vaccine is rather discouraging and insignificant. Perhaps to organize a talk in the rural area would be a good idea. It has never been tried for this vaccine, which doesn't mean it won't be receptive.
Ladies,please approach your doctor and ask regarding Cervical Cancer.With the availability of this vaccine, there is no one else to blame if one day your doctor informs that you've got cervical cancer.

Eh?? Excuse me?

2010-06-07T09:05:00.000-07:00

Last Saturday, I had a lady who came along with her friends to my clinic to inquire on Cervarix. From a question and answer session it slowly turned into a dialogue.
I've explained I was perpetually surprised to know that many women are still hesitant about getting themselves vaccinated despite the lowered price. One of the factor was that these women have the impression that prior to vaccination, they need to get a Pap Smear performed. Naturally, being male doctor, it's natural to feel shy from being examined by a male doctor. Hey, if I've got a "male" problem, I'll think twice about seeing a female doctor.
But what I found from the conversation got me stunned. For a fleeting moment, I was left speechless. Honestly, my mind went blank from the question that was thrown at me. I tend not to be judgmental, not at all. But this time, I simply can't help it.
I've accepted the fact that most people are ignorant about Cervical Cancer Vaccination. I've even accepted the fact that not all doctors are offering accurate counselling on Cervical Cancer. Some women actually stated their rationale for not getting vaccinated was that they've experienced intercourse before, and since the vaccine don't render 100% protection, why would they bother getting vaccinated? The saying "common sense isn't very common doesn't apply in this situation as there are people who genuinely unaware of the availability of these vaccines in the market.
I sincerely do not mind have to repeat myself over and over again like a broken record just to get the right message across, because more than anything else within the spectrum of priority, education should be listed right on the top. With knowledge, an inquisitive minds follows, and that would lead to the right information,counselling, and ultimately decision making. To have the will for self preservation and health care is essential, which unfortunately many of us take it for granted. It's almost disheartening to know that most of us would never realize the extent of damage, emotionally, psychologically, and mentally, for any cancer patients bears. One would never realize the fact that non of us are naturally immune to cancer. "What are the chances to get cancer?" often the thought that pops in the mind of an average Joe. The answer would simply be, "More often than you think. You could be next."

That's the main reason why this blog is created in the first place. For those who feels uncomfortable to meet a doctor face to face, this would be a perfect platform for finding out the facts. You can write to me, and stay anonymous, or even perhaps want me to write a post on a given topic (I am more than happy to answer your questions in a post)with your identity remained anonymous.
Ok, back to the question that caught me off guard... this lady and her friends came over the moment they sat down, they actually told me they just wanted to ask, and not come for the injection itself.. I told them it's absolutely fine. I don't charge a single cent for counselling on Cervical Cancer.The first lady broke the silence by introducing herself."Doctor, before taking the injection, no need to do Pap Smear one,hor?" Of course!
I added that in fact, I told them that need not feel obliged to be followed under me simply because they got vaccinated by me.
"ooohhh...like that.." That's why, no need to feel shy, you can just come alone only for the injection."...
"then coming for the injection also shy,mah?"
I was surprised! Injection.Just an injection. What's so shy about that. I almost fell off my chair when I was asked,"Doctor, you mean this cccCervaarix is not injected into the private part,ah?

Huh!!!

NO!!! Of course not! It is injected in the muscle either through the deltoids or the thigh.

Boy! I found out something new today. No wonder these ladies were hesitant about the injection, first has to do with me being a man, and second, I felt like I was in the Twilight Zone when she asked me whether wasn't the injection meant to be given at the "private part"I forgot to ask her how did she come with such funny conclusion?

Cervical Cancer Symposium at Shangri La hotel 29.5.2010

2010-05-31T03:57:00.000-07:00

I have been looking forward for this Cervical Cancer symposium. Partly due to the fact unlike other symposium where the speaker would spill out medical jargon in the form of charts, diagrams, and graphs, this symposium would discuss the more practical method of approaching patients, which I feel is far more important than mere data and charts.
The speakers for this symposium are specialist from their respective backgrounds. First we have
Dr Anna Ong Lim-Pediatric Infectious Disease specialist from the Philippines,the renown gynaeoncologist Dr Quek Swee Chong, from Singapore, Dr Maria Julieta Germar, who is a associate professor in obstetrics and gynaecologist university of Philippines, Manila, and Dr Cecelia Lavae, Clinical Gynae oncologist attached to Phillipines General Hospital.

Everything was so well organized that day. They printed name of participants of the symposium on files, and on the name tags along with the country of origin. .

Doctors from Vietnam, Thailand, Taiwan, and Indonesia attended this seminar.

One thing that is a little discouraging for me to attend CME or symposiums as such is the thought of being left out, as those who attends are mostly from mid age and above. Having said that, I don't mean to imply that I am young, don't get me wrong, it's just that our wavelength simply don't resonate with one another.
I wanted to ahem..ahem... cancel my attendance, however I got to know that GSK actually sponsored the attendees, which cost USD100 per head!

The facts are figures that was presented on that day was alarmingly worrying. Now, what do I mean by that?

Charts like this makes me worry.
There are doctors who thought cervical cancer is hereditary!... and due to bacterial infection??? Yikes!!! Now I know why 16% of doctors aren't particular about which brand among the 2 vaccine available in the market, and 8% are strongly against the idea of vaccinating young adolescent!.. ( I am sweating now!!)

A word of advice. Please ran away as fast as you can if your doctor say this:-
1."Ini miny miny mo! Oh,ok... I think I shall use ******** today!!!"
2."Which one bettter,ahh?? Ok, now.. lets see.... you got a coin??"
3."Aiyah!! So obvious,lah! Those who cannot decide are simply blind or ignorant! One is bivalent, one is quadrivalent. You tell me.. Which one is worth it??? Count,lah!!"
4. Hmmm... you think good quality product BP lab can offer 3 doses for RM500,ah?

Indeed at the end of the day I've learned a lot of things, especially on the practical side. This is what I've been hoping for in any symposium, where the practical issues are discussed in details rather than spurting out data in the form of charts and graphs which doesn't help me in my practice in creating an awareness at all!

I started to feel as if at any given time I will explode if the presenter continues to show graphs as such!This is the result of questionnaire given to doctor on their perception of those who are relatively more vulnerable to get cervical cancer. It's nauseating when you've been told 52% of doctors thinks only promiscuous women are prone to get it, a mind boggling 34% thinks it's related to personal hygiene, and I almost fainted when 28% of doctors thinks it's hereditary!!!!
That goes to show how ignorant doctors in general are about cervical cancer.
It's a sin when a lifesaving and revolutionary vaccine that had changed the course of history in mankind is available, yet, they chose not to update their knowledge on this disease. If it's ranked 10-15th among reason for mortality, then I don't blame them for not paying much attention, but it's number 2!
I love the question and answer sessions, where the panel speakers had answered in detail, yet comprehensive manner to all the practical questions. I find the Phillipines and Indonesian doctors are inquisitive and more proactive in creating awareness about cervical cancer in their countries.
I am particularly impressed with Dr Cecelia from Phillipines who spearhead not 1 not 2, but a few NGOs and campaigns to create awareness among the public.
Cervical cancer vaccine has been in the market for 4 years now, yet, most Malaysians chose to ignore it, with the false sense of security that they aren't that unlucky to contract cervical cancer. Is that truly something you want to leave it to chance?

These panel of experts seemed to answer the questions thrown at them so effortlessly. This is what i call knowledge at the tips of the finger. It doesn't matter how silly these questions were, but I realized only the Indonesian doctors asked questions. No Malaysians!

For those who reads my blog, I had previously mentioned that 10-15% of all Cervical cancers are adenocarcinoma. But Dr Quek's own data revealed a more alarming number... up to 25%!

I like the style of the presenter of this slide, she presented the meaning of lost in a more emotional, humane manner, rather than mere graphs and statistics, because each and our lives by any means is worth living to its' fullest, rather than just become a number, a part of statistics presented in conferences.
Another fact worth noting, that if in between doses, one found to be pregnant, she can actually delay the next dose until the termination of pregnancy before proceed with the subsequent dose.
And Cervarix is safe to be given during breastfeeding.
i would like to congratulate GSK for arranging such a mind engaging symposium, which unfortunately, before the end of the session, half of the attendees were already missing. Strange.
Symposiums as such only happens once a while, and how often do you get to attend talks by a group of intellectuals who are experts in their respective field, and collectively constitute a whole and integrated lot. You need not surf the net, buy text books, or read journals. All you need is to have interest, the passion, and believe me, if you have that, understanding comes naturally as every details quenches the inquisitive mind.
It is not a task if you do it wholeheartedly. It's almost effortless to learn new things if you have genuine passion. Passion stemmed from the humanity expect, the desire not only to preservation of life, but improvement as well. Desire comes when we put a little bit of emotion to what we do, when we listen to pleas from patients, be genuine and exhibit a little emotion in responding to patient. It doesn't make you an emotional doctor, but instead, it makes you a healer, as 50% of patient's pain get alleviated simply by giving them a good listening ear.
As my previous unforgettable experience with Dr Christopher Lee that taught me it's ok to show a little emotion to what we do. Take a few step back when our response become mechanical, to enable us to see from a far, a clearer view of the entire forest, rather than standing inches away from the bark of the tree.
Being a doctor doesn't mean you're living in a higher society nor being any more important then anyone else. As a matter of fact, we are given more responsibility... as a servant to society.

"We've got to learn to kneel in order to reach out for the sky"
--Dr. Wan C Hung--

Hope this will work.

2010-05-27T02:11:00.001-07:00

I've created a blog, sending out flyers, organizing awareness campaigns, and the cost of vaccination that my clinic offers possibly be one of the lowest in the country, has yet to see much response from the public. Though the campaign held last week was a good start for many more campaigns to come, i sincerely hope the message that I am trying to convey gets across to the mind of the general public.
Prior to the first campaign, after we had sealed off the envelope that is sent to the people of Bandar Sri Damansara, I totally forgot to write the URL for the blog on Cervarix, it's indication, how it benefits women, why should women get themselves vaccinated, at www.cervarix.blogspot.com .
No matter how hard I try to send out the message across, there is always room for improvement.
My sincere reason for being so proactive in promoting Cervarix stemmed from my experience with patients and my own family member who had died of cancer. There are certain parties who actually doubted whether the vaccine that I use is genuine or not.
Last year when BP lab organized a campaign where vaccination with Cervarix only cost RM500 for the total three doses. Due to the drastic drop below market price, there are a lot of doctors who actually complained as the move made by BP lab jeopardizes their market.
I am absolutely stunned upon knowing the reaction of the doctors. Is there a necessity for these doctors to react at such manner? Shouldn't they be happy that more people from all walks of life have better access to health care?
Even though the market price today may range between RM230-RM300 per dose, there are a significant number of population who belong to the lower income group who can't afford to get themselves protected against this deadly disease even if they want to.
The mere reaction of such doctors towards the price offered by BP lab is totally uncalled for and unjustified. This goes to show that these doctors prioritize monetary gains rather than providing proper health care which patients pay from their hard earned money.
But what shocked me the most was when the patients asked their doctor's how was it possible that BP lab charges so low compared to them. The doctor simply answered, "those are fake ones".. These doctors in my personal opinion do not possess the quality and character to be a medical practitioner. When you start to accused the competitor by telling the patients lies, they are nothing but scums.
Why can't these doctors who are already well established, would want to tell lies to the public?
These group of people should have their practice license revoked. When another doctor, or medical centre offers a lowered price, it is because they are community orientated. That's the essence of medicine. By simply telling the public that the vaccine they used were fake, all the effort in lowering the price with the noble intention to provide better access to health care is ruined.
Just a few days ago, a friend of mine who came with his wife was curious as to why the price that I offered is SO MUCH LOWERED! They actually asked me to show them the vaccine that i use.
I am totally baffled with certain parties, who always have the impression that the quality of a product is always in direct proportion to the price.
???????
Then why on earth would I want to write a post on how to know whether the product is genuine or not?(click here)
Has society today is so negative minded that when someone comes up with a noble idea, it is never accepted without skeptics?Or the public view him as having a hidden agenda behind the so called " too good to be true" offer?
To be frank, is RM165 per dose is so unbelievably low? To the extent where some international medical journalist actually send me this mail.

Is there always a hidden agenda whenever a person wants to be a good samaritan?
Anyway, I went to a local bookstore located within my housing area to get a stamp made.

I collected the stamp just a few hours ago.

Yup, to use it to stamp the URL of the blog specially designed for those who are reluctant to check out this vaccine simply because the doctor in charge is a male.

Now, you don't a reason not to be ignorant with all the various ways to create awareness.

Today is a good day...

2010-05-24T03:51:00.000-07:00

Today was the day of the presentation for the Cervical Cancer prevention weekend.

Though the crowd wasn't large, nevertheless, it was worthwhile as it has the personal touch.

In a way, its good to have a small crowd as the interaction would be more personal. I started off the presentation by telling the crowd not to consider this as a talk, but rather a talk, and they are allowed to stop and question me at any time.

I forgot to shave that particular morning, as I just completed the slides for the presentation at 6.30am, which gave me hardly 3 hours to sleep before the presentation. I tried not making this presentation too "medically orientated", hence making it more public orientated. No graphs, no dates, no charts in my presentation which is typical of any medical forum which bores not only the general public, but to me as well..
I didn't have time to practice my presentation, so everything that i presented was spontaneous.
When you are telling your genuine experience, as to why I developed the desire to educate the public, I told them my personal account with with cancer, it sounds genuine, because it is!

One of the featured slide was this, a true photo of my aunt while receiving her drips during her last visit to my clinic before being admitted to the hospital for the very last time. The computer screen was the true file on her during her visit on 16th June 2009, the time when she came with jaundice.
I guess what captured the audiences attention was the true life account that I've experienced, hence making the presentation more heartfelt and genuine.
For a while, while describing the last few hours of my aunt's ordeal, i started to stammer a little, as I felt a little emotional while recollecting those memories that will always stay at the back of my mind. I've emphasized that I sincerely do not want anyone else to experience the same ordeal as my aunt and uncle did. There in fact, isn't a reason to as Cervarix offers women the choice, the option to decide whether or not you want to be protected, rather than merely leading a healthy lifestyle, and hope you would be have cancer.

The most appealing part was I got to know there are people out there who are aware of such vaccine, and willing to step forward to get themselves protected from this deadly disease.
Perhaps, getting oneself vaccinated with this revolutionary vaccine would probably be one of the most important decision you've made in your life.

No one else can decide on the course of our lives. The discovery of a vaccine that protects us from Cervical Cancer has got to be one of the most highlighted and monumental significance in the history of medicine and mankind.

I ended the presentation is a short poem.

At the end of the day, with the amount of specimens collected by Thin Prep Pap Smear is the most rewarding result that I hoped for, though I don't earn anything at the end.
I am already looking forward for the next campaign.

Thin Prep Pap Smear

2010-05-19T21:07:00.000-07:00

Designed and patented since 1996, Thin Prep Pap Smear is the answer to the flaws in Conventional Pap Smear. Today, over 90% of Pap Smear done in US is by Thin Prep Pap Smear.
It has it's advantages over conventional Pap Smear in many ways.

In Thin Prep Pap Smear, it's advantage begin with the use of a specially designed sampling brush, to enable a more thorough collection of both ecto and endo cervix.

The central longer bristles and the shorter adjacent ones fits snugly onto the ectocervix, and samples are collected by rotatory movements while in contact with the surface of the cervix.

Compared to Conventional Pap Smear that was designed back in WWII, no doubt it has saved thousands if not millions of lives.

With the conventional Pap Smear, early non malignant changes can be detected early for intervention before it turns malignant.
Though 85% of cervical cancers are squamous cell carcinoma, the other 15% are adenocarcinoma, which most of the time arises from the endocervix, the inner part of cervix that faces the uterus.Due to the design of the wooden spatula, though it is able to collect a good sample from the ectocervix, but not the endocervix.

The flaw of the conventional Pap Smear arises from the sampling as well as the deposition of the samples collected onto the slides.

Smearing of the sample collected onto the glass.

Fixing the sample onto the slide with a cytofix chemical. Unfortunately, the possibilities of a false negative(early signs of pre-malignant changes has occurred but unable to be detected) is as high as 50%.This is due to as the deposition of smear takes place, only 20% of the sample actually gets deposited onto the slide, while 80% of sample remained on the wooden spatula.

of which often gets tossed into the bin...

Besides the poor sampling method, Thin Prep Pap Smear goes through two level of screening, where the samples are initially screened by an imaging device. Upon detection of abnormal cells, the samples is then reconfirmed by a pathologist.
While conventional Pap Smear is normally screened by a pathologist, where the report is based upon the experience of the person doing the screening.
Upon detection of abnormal cells, the existing sample collected through Thin Prep Pap Smear can be sent for HPV DNA, while another separate sample is needed for conventional Pap Smear.

So, ladies, insist upon Thin Prep Pap Smear from your doctor. Unfortunately, not many general practitioner are aware of the availability of such test.

During the Cervical Cancer Prevention Week, Klinik Wan & Keluarga will be conducting Thin Prep Pap Smear at a lowered price at RM45. Normal price for this price is RM90.
You need not worry about hygiene as the speculum used to collect samples are disposable ones.

Protect yourself against cancer today.
A note that i feel compelled to say. With the availability of this vaccine today, in addition to the campaign which is regularly held, it would be a crying shame if you procrastinate upon getting vaccinated, and unlucky enough on day to be diagnosed to have cervical cancer.
Cervical cancer is not limited to those who have multiple partners,but to you as well. There is always a possibility of contracting cancer in every woman. The possibility wouldn't be as remote as you thought to be considering it being ranked number 2 among mortality secondary to cancer.

Preparation for Cervical Cancer Prevention Weekend

2010-05-19T00:14:00.000-07:00

This post is written based upon the author's own initiative, and not being influenced in any way, nor being given any form of remuneration by the pharmaceutical company of which the product is highlighted.
The much anticipated Cervical Cancer Prevention week begun yesterday. Over 700+ flyers were mailed, however yet to receive any response. I am optimistic this campaign, being the first of many more to come throughout the year will reach the public. I don't expect many to turn up for the talk this coming Saturday, but for every project, initiation by taking the first step irrespective on the size of the crowd is what counts. It's easy for any medical practitioner to routinely come to clinic, treat the sick, then go home once the clinical hours is up.
However, deep down, I sincerely believe the nature of the medical profession goes beyond treating the sick, but to reach out to create an awareness among the public.
Cervical cancer is merely a word to many, but to those who was diagnosed to have it, their life revolves around it.
Unless a celebrity, an icon, a personality known to many who is diagnosed with this deadly disease is made public, otherwise, it's most disheartening to know most people are still ignorant about this disease.
This is the reason why it's important to reach out to the public, to educate the masses that such a diseases is now avoidable by choice. I guess one wouldn't realize the degree of trauma one has to go through upon being diagnosed by this disease, getting test done to know the stage, whether are they salvageable or be told that their days would be numbered, the morale that has died the moment being told their treatment is purely palliative. Why? Why would anyone in the right frame of mind would want to risk all that when a revolutionary vaccine is available today to avoid all those inconveniences?
For those who follows this blog would understand why am I being so driven in creating an awareness.
First of all, on behalf of Klinik Wan & Keluarga, we would like to personally thank Miss Wendy from GSK who has been so helpful in furnishing me with updates concerning this vaccine. Her help in providing materials in this campaign has been monumental and instrumental. If it isn't for her help, the campaign wouldn't have materialized.

The eye catching posters being provided for by GSK. One should note that no clinic is allowed to advertise the products available, however, this poster did not mention the world Cervarix, merely an eye opener for the public.
One is placed inside the clinic, while another being placed outside,along the walkway outside the clinic.

Noticed the multiple posters pasted on the glass, indicating Klinik Wan & Keluarga's commitment in creating an awareness for the public. The counseling conducted is free. Anyone irrespective of age and sex can walk in to inquire about cervical cancer and vaccine available. For those who is planning to get themselves vaccinated, please note that you need not do a Pap Smear prior to vaccination, nor the need to feel obliged to be followed by Klinik Wan & Keluarga.
In preparation for the Cervical Cancer prevention week, GSK has furnished us with several goodies, which includes:-

Word puzzles or patients while waiting for their turn for counseling or vaccination.

Leaflets as such in all four corners of the clinic for patients to read, and ask the doctors if unsure of what is written or for a more thorough explanation if needed.

The campaign shouldn't be something to be taken so "seriously".. Hence balloons to create a more "light hearted or happier" ambient.

A questionnaire to determine whether do you fall within the high risk group that warrants vaccination.

A button tag for the staff...

A goody bag for attendees for Saturday's talk on "How to prevent cervical cancer".. which contains

A leaflet, tissue, questionnaire, and a pen, courtesy of GSK...

In fact, i was given a door notice to inform the public of my presence, unfortunately...

It can't be used in my clinic as there isn't a door knob on the door into my consultation room.

GSK has gone all the way to support medical practitioners like me to create awareness among the patients and public by providing tissues with messages printed on the cover.

Even they have printed plastic bags with messages on it. As you are aware, this isn't a advertising ploy, as they don't mention anything on their product, but merely emphasizing on the disease per say.

Even though cervical cancer vaccine was first introduced to the public since 2006 in the form of Gardasil, it is still considered new, as a considerable number of people aren't aware of the availability of such vaccine.Even if the public knew about the presence of such vaccine, how many actually know the the extent of problem cervical cancer has on us?

With the availability of different vaccines, now the public has a choice. Which is the better

vaccine? Which is superior compared to the other? How to decide when one doesn't have knowledge on the properties of the vaccine?

Hence, it's important to educate the public on it, and it takes times. But cervical cancer don't wait for the "ideal" time to strike.

Cervical cancer do not recognize race, religion, social status, and age. We've come across patient as young as early 30s who was diagnosed to have cervical cancer.

One thing that i like about GSK is their commitment towards providing medical practitioners up to date knowledge with diseases and findings of ongoing medical studies by providing medical journals.

...and regularly organizing CME(Continuous medical education) and symposiums by inviting world renowned doctors and scientist from their respective fields of expertise.

The next CME will be on the 29th May in Shangri-La, with Dr Quek from Singapore, who is a renowned Gynecologist who came for a symposium held last year.

In conjuction to Mother's Day celebration, we took this opportunity to kick start our all year long campaign, and personally, I am excited about it.

The clinic before this was "normal"....

How plain the clinic was previously compared to .......NOW!

This is the "Pink Corner" where chart, pamphlets, and leaflets are placed for the patient to read and explore while waiting for their consultation.

That's Miss Wendy, a gentle and petite lady, who blew most of these balloons.

Whoever miss seeing the notice hung from the chandelier must be blind or simply ignorant.

Would I simply hang a notice tied to thousand dollars chandelier if it's not important?

That's Miss Wendy hanging the balloons...

Ta...dah!!!!! But wait!!!

More balloons!!....

Now the clinic look more "cheerful and a happier" place, even to those who come to seek treatment for cough and cold, hopefully coming to Klinik Wan dan Keluarga wouldn't be a glum experience, as normally clinics are associated with.

It ain't no Disneyland either,though..

Just do not want coming to Klinik Wan & Keluarga to be an ordeal, but rather, an experience..

Klinik Wan & Keluarga isn't just a clinic for the sick, but rather a health centre.

Forward the URL to your love ones, friends, wife,sisters,mother,cousin,colleagues,etc...

Cervical Cancer Prevention Week.

2010-05-15T00:55:00.000-07:00

I've was asked whether the lowered price for Cervarix is only for the duration of Cervical Cancer Prevention Week.
No, this is not an offer. This is the price Klinik Wan & Keluarga charges for those who plans to get themselves vaccinated here, and we do not intend to raise the price for each dose whole year long in the effort to make Cervarix affordable to all walks of life.

The only difference is the charge for Thin Prep Pap Smear, where we will revert back to the original charge after the campaign.
For those who couldn't make it, Klinik Wan dan Keluarga will organize campaigns as such from time to time.
In future, once we establish a larger crowd, we will invite guess of honour during our campaign, to give their presentation to the public.

Who else do we have in mind other than cervical cancer survivors? They are the people who experienced first hand the kind of traumatic experience, psychologically, mentally, and emotionally. Perhaps the public would understand the such pain cancer patients have to endure.
Whether being a survivor or not, they would definitely urge the public to get themselves protected against such a deadly disease.

Being a doctor who has attended several symposiums and CME(continuous medical education) organized by pharmaceutical companies, presentations in the form of charts, percentages, and graphs to me are simply numbers. Whether we acknowledge it or not, it may appear like a group of intellectuals gathering to discuss "latest findings, latest data collected, or new discoveries"
but to be frank, i find it rather boring. Being a doctor is about sacrifice, dedication, and putting someone else welfare before ours. The essence would be the emotional aspect which is often lost among those who is still practicing today. Whether like it or not, medicine isn't a profession anymore. It has become too commercialized for it be be called a noble profession.
From time to time, my fellow doctors need to be reminded they aren't treating diseases, but people and family members.
One of my unforgettable lesson I've picked up from Dr Christopher Lee, the head of Infectious disease team in Sungai Buloh Hospital, was while doing rounds in the ward, he suddenly stopped and asked me "what" am I dealing with. I answered confidently the diagnosis of the patient for which he was warded for. "Wrong answer! I Expect more from you,Wan!" Initially I thought I gave the wrong diagnosis, but he insisted I was wrong. What he told me that day would be one of the most memorable day that I will always remember. He told me when I walk from bed to bed, to look at the files, and discuss among fellow colleagues only on the "case", that's when I lose the essence of being a medical practitioner. Take a few steps back, you'll see a person. Then take a few steps more towards the back, only then would I able to see the entire picture clearly. I'll see the patient, along with the wife, his parents, his children, and other family members.
Strictly speaking, you aren't treating only the patient, but also alleviate the worries the caregiver has to bear. What I initially see was this:-

But after that day, he taught me to see things like this:-

Likewise, Klinik Wan & Keluarga believes in treating every single individual as people, we lend a listening ear to listen and understand, instead of merely to hearing and forget, our responsibilities goes beyond the office hours, the nature of our work isn't limited to only treating the sick, but to educate the public. We would like to run our clinic as what a real medical clinic should be. Klinik Wan & Keluarga isn't running a business, but we are running a health care centre, with dignity, accountability, and sincerity. We never call a person who walks in for treatment as patients, but address him/her by the name.

We sincerely hoped the campaign aimed at creating awareness towards the public will be well received.

Ladies. Do you know the best time to get a Pap Smear?

2010-05-11T10:08:00.001-07:00

In the effort to reduce the incidence and mortality due to cervical cancer, it's only so much a person can do. But deep within me, I believed if I stay persistent, i would be able to reach out to the public. It would just a matter of time before one decides to get themselves vaccinated.
Organizing campaigns, talks, providing free counseling, lowering the price for the vaccines, making it more affordable, and to convince fella Malaysian ladies to be regular in their Pap Smear ( which I strongly recommend Thin Prep Pap Smear) will take time.
But i felt the sense of urgency as I sincerely do not want anyone to go through what my uncle and aunt did.
Now for those who already had their vaccination done, please note that after vaccination, one still needs to perform their annual Pap Smear, except for country like United States where HPV DNA test is integrated as their screening test too.
And if you are doing your Pap Smear, please request for Thin Prep Pap Smear.
Do you know that to get an optimum and accurate result, there are several criteria that enable a better sampling?

Conventional Pap Smear- which has a "false negative" rate of 50%

Thin Prep Pap Smear- the better alternatives by several folds.

The best criteria to get your Pap Smear done would be:-

1. Avoid sexual intercourse for 48 hours from the scheduled date for Pap Smear.

2. The best time for Pap Smear would be 10-20 days after the beginning of the previous menses.

Just to inform ladies out there before going to your doctor for it.

Is it real?

2010-05-10T00:11:00.000-07:00

RMXXX per dose may raise some eyebrow, one of my patient told me. Since market price per dose of Cervarix is between RM230-RM300, patient would begin to wonder why am I offering RMXXX? One would definitely begin to question whether the product is genuine, and if it is, whether is it expired?
Klinik Wan & Keluarga can guarantee the vaccine that we use is genuine and still far from being expired.
Since you are paying for the vaccines, it is your right to insist upon the doctor to open the box containing Cervarix right in front of you. What are the things you look for to ensure it's the genuine product?

1. There would be holographic prints all over the box that can be seen under fluorescent light.

Then when the doctor opens the box, you'll see a prefilled 0.5ml syringe with 2 needles of different size, sealed in a plastic container.

The plastic contained is sealed with a thin layer of plastic sheet.

Then notice the 2 needles of different sizes.

A bigger blue 23gauge needle and a ..

a smaller 25gauge needle.
And the vaccine in the syringe is slightly murky in colour.

And at last, to confirm that you are receiving a genuine vaccine, Cervarix hurt a little more than other vaccines you had taken prior.
Please do not feel hesitate to give us a call to inquire on the price of Cervarix at 03-62722678

The inevitable truth.

2010-05-07T03:55:00.000-07:00

This post is written purely base upon the author's initiative. The author's choice of vaccine is based upon his/her own decision, and NOT being paid or given remunerations in any form by the pharmaceutical company.
Another day had passed, as I was driving back, the faces of patients that I've attended to still fresh in my mind. Perhaps it's my attitude towards work.My working hours isn't limited to the time in the clinic. But patients have access to my cell phone, as I believe if they needed help, or in case of emergencies, they could get hold of me.
As I reached the gate of my house, I could see both Isabelle and Natalie running towards the front door, excited to see me. Nothing beats this feeling of warmth and love that awaits your arrival. I am lucky I have a home, instead of merely a house to return to at the end of the day.
The loving hugs, jumps of joy, and heartfelt laughter by my two daughters is the best moments in my everyday life. Stress and worries of work that I bear on a daily basis seeps away the moment seeing this two angels calling out "daddy" is comforting to the ears and soothing to the heart.
I'll shower right after dinner, then it's family time. There is so much joy at home. Isabelle excitingly telling my wife and I how her day was, and Natalie never seem tired from all her running, and jumping. This little angel never cease to amuse both my wife and I with her spontaneous,unpretentious, adorable expressions. Leonidas's eyes would brighten up and coos happily upon seeing both his elder sisters.

The struggle that one needs to go through in life, the ups and downs, joy and jubilation, it's all part of being human. Many believes if we do good, there will be a place reserved for us in Heaven. But why want to wait till then? The happiness and joy we experience within our family is heavenly. It is my "heaven" on earth.
Suddenly my cellphone rang. I answered the call made by my uncle. Over the other end of the line, the situation is a direct opposite of mine. He told me he wasn't feeling too well, that he is feeling nauseous, similarly a few weeks ago he had experienced the same thing. He was brought to the hospital by my cousin. But this time, he was all alone at home.
While talking to my uncle and advising him through the phone what to do, as i listened to him, I sensed loneliness, depression, hopelessness, and sadness.
As far as I have known my uncle, this is the first time him being so expressive. He yearned for someones to talk to.
To him, the fact that my aunt had passed away hasn't sunk into his mind. There is no closure for him. He will forever wonder why was it that there wasn't any indication, early symptoms, or signs to suggest and to prompt them to go for further test?
The first time my aunt was brought to me was June last year, what transpired on that particular day is still fresh in my mind.

16th June 2009, was not a good day for me,my uncle,and my aunt.

She came with jaundice for the past 2 weeks, with tea coloured urine and clay coloured stool. At the age of 61, a person who comes with such clinical picture, one has to think of the worst case scenario.

With a heavy heart and filled with reluctance, how i wished I was wrong in my diagnosis. Somehow, truth need to be told. So, carefully, i explained to them the worst possible reason that could result in such clinical manifestation.

I referred her to Hospital Selayang for radiological investigation to confirm my diagnosis. I remembered hoping I was wrong, that perhaps I was just being overcautious. After CT Scan abdomen was done, the report came back:-

That's it. The whole world crumbled, knowing that her days are numbered. Less than 2% of patient survived more than 5 years upon diagnosis.
Unable to accept the grim fact, since then, I saw the change in my uncle. He was desperate for a solution. Knowing that western medicine aren't able to help, he started searching the net for alternatives or holistic approach. Suddenly, their 38 years of marriage seemed like a fleeting moment. Simply too short a time for any couple to be together. Too soon for death to set them apart.
A sense of helplessness, an endless plea, a cry of sorrow and the endless question as to why it happened to them was simple overwhelming. Cancer, do not recognize race, age, social status, or religion.
Death seemed more difficult when the disease slowly eats you up, emaciates, weakens, turns you into a frail lifeless body. Witnessing the change for the worse was indeed a heart wrenching experience. There is this disturbing possibility with each hospitalization could be the last. Unknowing whether with each admission, would she be discharged alive....
Throughout the while 9 months of battle with cancer, her spirit seemed to die off by the bits.
Her physique deteriorates, as well as her morale.
No matter how my uncle encouraged her to give a good fight, and be positive, that they will go through this battle together, but the fact is, at the back of his mind,the inevitable will happen. My aunt is dying with each passing day.
The last time she came to my clinic was 16 March, she was feverish, dehydrated, and desperately in need of IV fluids and get her blood cultured to identify the bacteria which doesn't seemed to respond to a prescribed broad spectrum antibiotic.
I infused her with 4 pints of normal saline, and immediately sent her to Selayang Hospital. Unknowingly to her, this admission would be her last.
The first time I saw her 9 months ago, she was a hefty 86kg lady, and just before she got admitted to hospital the last time, she was merely 35kg, severely anaemic, lethargic, and frail.
I can't help shedding tears as I was writing a referral to the hospital while she was in the procedure room next door with IV fluids being infused into her.
I wondered what was going on in her, my uncle, as well as her daughter's mind. Words simply couldn't justify the feelings that she had then. Somehow, a few days after she passed away, my cousin told me that my aunt knew this would be her last admission.She mentioned that her mum was particularly sad when she left home while coming to my clinic, as if she knew it would be the last time she step out from her home alive. She seemed sentimental, caressing her favourite pet dog Bo Bo goodbye, and seemed reluctant to leave the house. She knew she won't be coming back again. I remembered 10 days prior, she developed high grade fever which I insisted her to get hospitalized. The medical officer in charge of the outpatient department just discharged her with a broad spectrum antibiotic.

10 days had gone, yet her fever persisted. I did a urgent blood test just to rule out viral infection, however the result was suggestive of bacterial infection. I was stumped as to why the fever didn't subside even being hit hard with such a strong antibiotic. Immunocompromised patients may present an uncommon symptoms even when infected by common infection.
It hurts to see her then, so frail that she could barely walk. Both her daughters supported her by holding both her arms. She looked pale, dehydrated, almost lifeless...Her stare was blank and unfocused. She could hardly speak.
She was so weak, that she can't take food or liquid orally. It struck me then..... I believe my aunt will always have the thought of why this happened to her? Imagine if you knew you're days are numbered, what would you do?

Once inserted the IV lines and while receiving the drips, I called my uncle and cousins to my consultation room and had a chat with them. Through my experience, I've seen enough deaths, and as I looked at her, I knew she had just a few days left.

My aunt is was a gentle lady. She has never lost her temper. She was a motherly figure to both her siblings and to me.
As my uncle and cousin went out for their meal, I was left alone in the clinic with her. I sat next to her, asking whether was the air conditioner was too cold, how was she feeling, asking her to be strong. I gently held her hands, and she gave me a weak , yet reaffirming squeeze.
Upon completing 4 pints of normal saline, her blood pressure picked up, and I wrote a referral letter to Selayang Hospital.

Her admission on the 16th June would be the last one.....
10 days had passed, and I had not received any phone calls from my uncle. On the 27th, I called my uncle up,he sounded tired, exhausted, and depressed. I remembered him telling me, "She's not doing well"... I don't know why, but the sorrow was simply overwhelming. After the conversation, I sat silently with both my eyes shut. The inevitable is near.

I went straight to the hospital the next day right after my clinic... As I walked towards the ward, I can't help but to wonder how many times have I walked through this corridor since my aunt's first admission.

She was on bed no. 3. The beeping of the cardiac monitor reminded me of ICU in Kuala Lumpur general hospital. She had difficulty breathing. That is the first sign of the inevitable. I knew her time will end soon, but not this soon.
She was breathing with the aid from an oxygen mask. Despite that, her oxygen saturation was merely 86-90%.
We was weak. I spoke to the staff nurse in charge. She mentioned the order from the consultant was "No Active Resuscitation" if my aunt collapses.
I sat on the bed, held her hand, giving her support to fight on. Though her breathing was laboured, her weary eyes lightened up when someone talks to her, encouraging her to stay strong. But somehow, she knows she wouldn't last long. Before I left, I whispered to her ears,asking her to pray to Lord for His guidance and protection. She reached out her hands and gave me a hug, thanking me for all that I've done for her. I refused to accept it as within family members, no thanks is needed. I haven't done much, in fact, I did not manage to alleviate her problem, not even a bit.
As I left,I signaled to my cousin to step outside to have a word with her. I asked her to inform her uncle and aunts(they weren't aware that my auntie was warded...and dying.)to visit her as I doubt she's would last more than a day or two the most. I briefly explained to them what are the different phases that her mother would go through so as they would be prepared for the worst.
First, she would become disorientated, she wouldn't able to recognize place, person, or time, then would worsen when she become unresponsive. Only the basic reflexes would be present. Her blood pressure would plummet, then brain dead, though her heart may be beating, and she would appear to be breathing, but these two functions are controlled by their respective centres within the brainstem.Her basic reflexes would be absent by then, then her breathing becomes shallow, heart beat slows down to a complete stop.My cousin cried upon hearing my explanation. The eldest among three daughter who is same age as me, who is jovial by nature, a person who always wears a smile, was so overwhelmed with the idea of losing her mother, cried bitterly.
As I walked towards the parking lot, it was already 10.30pm, and I felt like crap.
During the morning while I was in the clinic, i called up my cousin, seemed like everyone, including the my other aunts and uncles, cousins, friends, my grandmother, all of them visited her during the morning. She was still orientated, but in pain. She thanked them all for visiting her. By the time I reached the hospital after my clinic, she was already disorientated.
My uncle sat beside her, hugging her the whole time, kissing her forehead, whispering tender words to her, hoping she would able to hear. My aunt's stare was blank, expressionless, a sight that brought tears to my uncle. My aunt was still able to mutter some incomprehensible sound, much to my uncle's dismay, not knowing what my aunt was trying to convey.
By 12.30am, my aunt's blood pressure plummeted to 70+/40+, so low that the blood could hardly reach the vital organs.Her oxygen saturation was 60+%. Her stare was blank. Her eyelids were half shut. Her skin was cold and clammy, I could hardly feel her pulse. She was already brain dead. But I kept it to myself as I couldn't bear telling my uncle who keep on kissing her forehead, and spoke gentle words to her.
By 2.20am, her breathing seemed to have stopped. I called upon the staff nurse on duty that particular night to attach her to the cardiac monitor to ascertain a flat line. The cardiac monitor was beeping, however her pulse was not palpable. What appeared on the cardiac monitor were merely the electrical impulse that continues to discharge within the heart.
At 2.35am, she flat lined.....
By the time i left the hospital, it was 5 minutes to 4am.
It's been slightly more than a month since the passing of my aunt. The entire 9 months ordeal of seeing my aunt being eaten and emaciates with each passing day, her final hours, her funeral rituals, all of these had traumatized my uncle so much that he neglected his health, often times he found himself talking to the picture of my aunt. Occasionally he breaks into tears while in a midst of doing something.
He has difficulties falling asleep. Claimed to wake up every hour or two, and often finds himself crying while asleep. His world is void, the absence of his wife whom he was married to for 38 years made him felt lifeless, that he is merely existing, not living. He seemed to have lost his purpose of life. He was grieving, and still is.
I wrote to Hospice Malaysia hoping they have counseling for adjustment disorders, someone who is experienced in saying the right things to those who grieves, hoping to alleviate the pain they have.
The reply that i received was this:-

My uncle seemed to have symptoms listed in 1,2,3,4,5,6,7,9,10, and I am not sure of 8.
He expressed his regrets for not living life to it's fullest while her wife was still healthy.
Fellow readers, dying from cancer is far from being a dignified death. You start dying on the day you're diagnosed to have cancer. Initially you have a sense of loss in purpose of life since majority of cancer upon its first symptom usually manifests only in advanced stage.Particularly ovarian and cervical cancer.
Indeed death is inevitable for all of us. Irrespective of race, religion, caste, or status, we all die.
But dying from cancer is the worse. Knowing the end is near, and the the final journey is filled with emotional and psychological turmoil not only to the patient, but to the rest of the family members.
Most cancer survivors would vouch and convinced that they were given a new leash of life, a second chance. But not all of us are that lucky.
One of the reason why I put in so much effort in creating an awareness among the public is I do not wish anyone to experience what my uncle and aunt went through. The psychological, mental, and emotional trauma will scar my uncle for the rest of his life. Whenever he is alone, he wished
his wife is still around, instead of forsaking him all alone to go through the rest of his life.
Friends, I sincerely pray and wish non of you would have to face what both of my aunt and uncle went through. We are supposed to grow old gracefully, and enjoy the Golden Years of life. That we are able to sit back and reflect upon the bittersweet memories of our lives. We are supposed to look at our partner's eyes, telling each other how we appreciate their presence, how they complete our life.
All of these is taken away the moment you're diagnosed to have cancer. There's is no more sweet memories, unable to recall even if there was any.
Friends, cancer is ranked 2nd as the cause of mortality in our society, and among malignancies, cervical cancer is ranked 2nd in women.
With the revolutionary discovery of Cervical Cancer Vaccine, it has and will change the course of thousands of lives.

Now we are given the "choice" whether to protect ourselves or our love ones from contracting these killer disease that has a 60% mortality rate. Other form of cancer, we may decrease the possibility by our lifestyle, but that does not guarantee we won't get it. However, with the vaccine, we can CHOOSE not to get it.

Never think it won't happen to us. Because it possibly will. And being ranked no 2. with 4700 new cases every year, it's a serious issue not to be taken lightly.
Those who are in the late stages of cervical cancer would definitely tell you not to take chances. Be wise, get yourselves protected.

I've seen first hand the degree of psychological trauma it inflicts the patient as well as the caretakers. Day and night isn't a routine, it's a ticking clock, a countdown to your demise.

...This is lifesaving. 3 doses within 6 months is a small price to pay in exchange for growing old gracefully.
Show that you care for yourself and your love ones. Share this with your mother, daughter, sisters, cousins, friends,etc... do it now.

In conjuction with Mother's Day celebration, Klinik Wan & Keluarga with the help from GSK, will be organizing a Cervical Cancer Prevention Week from the 18th May until 25th May 2010.

Feel free to inquire about this vaccine from the doctor in charge of Klinik Wan & Keluarga, and all counseling is free of charge. It is a policy of Klinik Wan & Keluarga to provide the most comprehensive and thorough health care, as well as creating an awareness among the public as there are a lot of misconception and misunderstanding concerning this vaccine. Media often sensationalize controversial issues which creates unnecessary fear among the public.I personally think it's rather irresponsible for the media to report of death and attribute the cause directly or indirectly linked to the vaccine.
In late September 2009, the death of Natalie Morton, a 14 year old girl who died 2 hours after being administered with Cervarix, was later reported that her death is due to malignancy of the chest involving the lungs and heart.
Clinical trials that was conducted in India using both Cervarix from GSK, and Gardasil from Merck,
where 6 death was reported after the vaccination.
However, an official report released stating that the 2 deaths in the state of Gujerat is due to Malaria and snake bite. While the other four that happened in the state of Andhra Pradesh, was linked to poisoning, pyrexia of unknown origin, and drowning. Click here to read about it.

Indeed the best gift anyone could present to their mother is the gift of access to health. After the counseling, no one is by any means obligated to get themselves vaccinated, but I strongly recommend to as Cervical Cancer is significantly high and contribute to 12.7% of all mortality rate.

Our clinic will organize awareness campaign, with the help from GSK in order to reach out to the public and to provide an accurate facts and data on this vaccine.

As I had mentioned earlier, Cervarix give you the opportunity to decide whether you want to be protected or not. I simply can't describe my overzealous desire to reach out to the masses. I don't want anyone to go through what my aunt went through.
As a matter of fact, when my mother in law was diagnosed to have stage 3 ovarian cancer, it was a shock to me, and i didn't know how to break the news to my wife, who just gave birth to our son. She mentioned that she couldn't accept the fact that her mother was fated to walk along the same path as my aunt did.

No appointment is necessary. But we will be organizing a talk on Saturday, 22nd May, on " How to prevent Cervical Cancer" at 10.30am. For those who are interested, please RSVP before the 18th of May by sending a mail stating number of person who will be attending as well as name of those who wish to attend.

The price offered is for the vaccination is the most affordable one in the nation. (except for public school)
The vaccine that we will use is Cervarix, from GSK.

Why the cheap price? Klinik Wan & Keluarga felt it's only right to make health care accessible to the general public, and not only to the rich and well to do. Klinik Wan & Keluarga's choice of vaccine is based entirely upon consideration of the doctor in charge, and found to be more superior than the other available vaccine.

...and no, Klinik Wan dan Keluarga do not receive any form of remuneration by GSK. Payment can be made using credit card as well, without any extra charges.

You have the choice to either pay individually, or three doses at the same time and save RM15.
Within that week Klinik Wan dan Keluarga offers a reduced price for Thin Prep Pap Smear.
Normal price for Thin Prep Pap Smear is approximately RM90 ringgit, however, Klinik Wan & Keluarga offers at RM45.
However, do know that one need not do a Pap Smear prior to the vaccination, nor need to be followed up by the doctor of Klinik Wan dan Keluarga.
However, one thing I would like to emphasize upon is for your to request for Thin Prep Pap Smear instead of the Conventional Pap smear that has a high percentage of false negative.

This method is far more accurate to detect pre cancerous changes. Instead of using a wooden spatula used in Conventional Pap Smear,

This wooden spatula has faulty sampling collection methodology, as well as deposition of samples onto the glass slides as only 20% is deposited, while the other 80% goes into the waste bin, as it remained on the surface of the spatula.
Instead, Thin Prep Pap Smear uses a cyto brush.

So friends, my sincere intention of spreading to your friends and family regarding this campaign.

"With Cervarix, you are given the liberty to get yourselves protected....my choice.

Always remember, cancer does not recognize caste, religion, nor social status. Protect yourself and your love ones today.

Cervical Cancer Prevention Week..

2010-04-26T01:59:00.000-07:00

As part of the effort to create an awareness and making the cervical cancer vaccine more accessible to all walks of life, Klinik Wan dan Keluarga, along with GSK will organized a Cervical Cancer Prevention Week starting from 18th May to the 25nd May.

We provide free counselling in regards to Cervical cancer, the vaccine, prevention method, and screening methods.
On that particular week, we offer Thin Prep Pap Smear with only half the actual price.
The cost of vaccination will be the same, much lower than the current market price, and would further enjoy more discounts if the price of three doses are paid in full.

Already lower than current market price...
........................OR............................

or enjoy further discounts is three jabs are paid in full.
And we accept payment by credit card, with no extra charges.

In addition to this, Thin Prep Pap Smear which usually cost RM90, will be reduced to RM45.

RM 45 (from 18 May to 25 May)

Please note

1.You need not do Pap Smear prior to vaccination.

2.You do not need to be followed up by the doctor in charge of Klinik Wan & Keluarga after vaccination.

3. Insist on Thin Prep Pap Smear by your respective doctor.

4. Price of vaccination will remain the same after the Cervical Cancer Prevention Week.

5. Klinik Wan & Keluarga provides free counselling all year long.

6. The Vaccine that is available in Klinik Wan & Keluarga is Cervarix.

7. You need not set an appointment for the vaccination.

If you have difficulties finding the clinic, click here for map and directions.

We will be organizing a talk on "Measures to prevent Cervical Cancer" on the 22.5.2010.
So, bring along your friends and family members.
Remember, Cervical cancer is now preventable BY CHOICE.Grow up and grow old healthily and gracefully, instead of becoming a "number in statistics" for others to study upon.
Please call us at 03-62722678 to inquire on price that is guaranteed the lowest in the country

Now that I am vaccinated, then what?...

2010-04-21T01:48:00.000-07:00

The expressed opinion in this post are made entirely based upon the author's own impression and knowledge. They are not influenced in any way, nor the author being given remunerations in any form by any party.
In the effort to reduce the incidence of Cervical Cancer, multiple awareness campaigns held by pharmaceutical company isn't suffice. It may serve the purpose to remind the public the presence of this disease, and that the vaccine against it is available. But I doubt the public knows the degree of seriousness this disease and it's impact upon the lives of patients and caretakers.
Personally, as a medical practitioner, I felt the need to be more proactive and reach out to the public since the community is unaware of the impact cervical cancer has.
Public perception is the single most important factor in the effort to lower the prevalence of cancer.
No doubt, cervical cancer vaccine receives its share of bad reputation from media. Those 12,000 reported adverse effects are mainly against Gardasil, not Cervarix.
Naturally, first and foremost important task to achieve is to educate the public and to make available the true facts to dispel the negative impression the public had perceived.
Through campaigns, seminars, talks, public forums, internet, etc.. any form of mass media that enable to reach out the facts on this vaccine. However, the facts shouldn't be biased, and to reveal possible side effects, right from the trivial to the serious side effects.

My preference for GSK's Cervarix is based upon it's quality which I determine by :-

1. The spectrum of protection it provides

2. The duration of immunity the vaccine provides.

As the law states, any products which is of pharmaceutical grade is required to list it's possible side effect, even if its remote and rare.
GSK does just that in their brochure which is handed to the public.

Possible side effects are divided into very common,common, and rare

These brochures are distributed by the nurses to the patients, or displayed in strategic areas in clinics for patients to to read while awaiting their turn to consult the doctor.

For patient's convenience, these brochures come with a follow up card with columns to write the dates for vaccination.

This goes to show that GSK goes all the way not only to encourage, promote, but to remind patients of their date of the subsequent doses.

Does completion of vaccination prevents cervical cancer altogether? Absolutely not. Individuals who have had intercourse prior to vaccination are required to continue with their annual Pap smear.Cervical Cancer Vaccination DOES NOT replace annual Pap Smear for screening for pre malignant changes.

Pap Smear was discovered during World War II. Since then, it has reduced the mortality due to Cervical Cancer drastically by early detection of pre-malignant changes. If Cervical Cancer is diagnosed upon the first symptom, often the malignancy would have been in the advance stage.

It's a easy clinical procedure to collect sample from the cervix. Procedure is done with patient lying on their back.

A wooden spatula is used to collect sample from the surface of the cervix.

When the spatula is in contact with the cervix, it is then rotated 360 degrees to obtain the lining epithelium of the cervix.

The sample is then smeared on a glass slide, which is then chemically fixed with a cytofix.

As shown in the picture above, the sample is fixed onto the slide with the cytospray. It is then examined by histologist/cytologist to detect changes of the cellular make up.

Despite the drastic reduction of mortality rate in cervical cancer , the incidence of "false negative" reports in Pap Smear is relatively high. (False negative is failure to detect early pre malignant changes,hence the sample is reported as normal) this gives the patient a false sense of security.
Pap smear is an effective way of screening for cancer, however, it's not diagnostic. Even when considered effective, there is still possibility of a false negative report. The percentage of false negatives ranges between 5%-50%, out of which 80% are true false negative, and the rest are due to mistakes done in the laboratory.
To date, there is yet to exist a "perfect" test to detect and diagnose cancer in terms of cost effectiveness and accuracy.

Even though our government provide free Pap Smear screening program at government hospital, sadly percentage of woman who actually did the test remains low. To my opinion, this is due to the attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms.
Pap smear coverage in the country was a dismal figure of less than 2% in 1992, 3.5% in 1995 and 6.2% in 1996.Most woman have a wrong perception of Pap Smear.Many believe it to be diagnostic rather than screening, hence do not see the necessity to get it done, until the presence of symptoms that prompts them to do so.

Other main reasons for not doing the screening included lack of awareness of Pap smear indications and benefits, perceived low susceptibility to cervical cancer, and embarrassment. Other reasons for not being screened were related to fear of pain, misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own health needs versus those of the family.

These are some of the many reason behind the drawbacks of Pap smear. As I had mentioned earlier, public perception and an awareness of the nature of disease is of utmost importance in the effort to decrease of its occurrence.

Say ,somehow we managed to change the mindset of society towards annual screening, the next question would be the accuracy of Pap Smear.

It's rather unfortunately that I've encountered quite a number of patient who's family member who previously goes for their annual Pap Smear religiously, was reported to be normal, but 5-6 months later, succumbed... due to Cervical cancer. With total disbelieve, those family members would never have a closure to what has happened.

The inaccuracy of Pap Smear could be due to sampling where inadequate samples are collected. Based on head of histology and cytology department, Gribbles Laboratory(Malaysia), upon smearing the sample onto the surface of the glass slide, only 20% of the samples are deposited, while the other 80% are discarded along with the wooden spatula.

.....which is of course naturally discarded into the waste bin.

....... Such a small and trivial avoidable mistake that cost someone's life....

All it takes for a more thorough screen is all still on the surface of this spatula...
While Conventional Pap Smear is a good method to detect squamous cell carcinoma(85% of cervical cancer that arises from the ectocervix)......

...Ectocervix is part of the cervix that faces the vagina, while 15% of cervical malignancy is due to adenocarcinoma which often arise from the endocevix...

...Endocervix is the part of cervi that faces the uterus. Hence conventional Pap Smear is unable to detect adenocarcinoma.

...advance stage of Cervical cancer....
Though conventional Pap Smear reduced the number of mortality significantly, nevertheless, for those unlucky undetectable "adenocarcinoma" type, 15%,30%, or 50% doesn't mean anything to them. It simply doesn't make any difference.
Since 1996, an improvised version to counter the problem in sampling by Conventional Pap Smear was found.
Thin Prep Pap Smear.

This process differs and possesses several advantages over conventional Pap Smear.

Most importantly, the brush which is used to collect the sample is designed in such a way to enable a thorough sampling from both ecto and endo cervix.

As you can see, the design of the brush is such a way that the centre bristles are longer than the surrounding ones. The longer bristles is able to reach deep into the endocervix, and collection of sample is done by rotating the the brush once it's inserted on the right place.

The sample taken from the brush has both endo and ecto cervix.

The brush is then rinsed by pushing the brush into the bottom of the sampling vial several times, forcing the bristles apart. Lastly, the brush is then swirled vigorously to further release the sample.

The name and the ID number of the patient is written of the surface of the container, and send to the lab for investigation.

The second advantage being that the sample are screen twice compared to only once in conventional Pap Smear, which then depends on the experience of the pathologist who writes the report.
While in Thin Prep, the first stage is screen by a computerized imaging device that screens and detects abnormal cellular picture, which then proceeds to the second stage where the abnormality is confirmed by the pathologist.
If at all there are presence of abnormal findings in the Thin Prep, the same sample can be sent for HPV DNA testing to determined the subtype of HPV, in addition to STDs, while in conventional Pap Smear would require a second sample to be taken.
Today, 90% of cervical cancer screening in the US is done via Thin Prep Pap Smear. The high sensitivity and specificity of this test is significantly more accurate than conventional Pap Smear.

It's rather alarming to know that not many general practitioners are aware of the availability of such test. Out of all the Pap Smear samples received by Gribbles Lab( Malaysia) only 30% are Thin Prep Pap Smear, and out of that, only 20% are sent by general practitioners.
Considering the awareness, or rather ignorance among doctor on the availability of such investigation, the public aren't the one to be blamed. How would the public know if it's not being brought up by the doctor?

It's in the book. Just in case if my fellow doctor aren't aware on where to look for it, it's here...

Yes.. It's on page 13.

I would encourage my fellow doctors to constantly update ourselves through the internet or medical journal in regards to latest advancement, new regime of treatment, latest method of investigations..etc.. because decisions made by us determines the outcome of lives of others.
So, fellow, readers, after reading this particular post, the thing to remember is:-
1. Get vaccinated NOW!

You would be deluded to even consider contracting cervical cancer is being far fetched.
2.DO NOT DEFAULT in your vaccination.

3. Upon completion of vaccination, it doesn't mean you need not do your annual Pap Smear.

4.Request for Thin Prep Pap Smear instead of conventional Pap Smear.

5.Spread the news around. Discuss with your doctor today about Cervical Cancer. Inform your friends and ask them to come along if you feel hesitant on seeing the doctor by yourself.

Cervical cancer is the second cancer which is preventable by choice. So chose not to have cervical cancer. Get vaccinated at the clinic near you today!

Effort to reduce Prevelance of Cervical Cancer in Malaysia

2010-04-18T10:48:00.001-07:00

GlaxoSmithKline, the pharmaceutical giant that manufactures Cervarix, is organizing another symposium to update and share ideas among doctors in the endless dedicated effort to lower the incidence of Cervical Cancer. GSK indeed is a pharmaceutical company with an unquestionable ethics, that produce excellent cutting edge and high quality health products in keeping up with global demands.
The lowered cost of Cervarix to enable accessibility by community from all walks of life, regular conventions,symposiums, and talks by world renowned experts to share and update on the latest development of their product, aggressive health campaigns to create public awareness, and round table discussion with experts who spearheads in their respective fields in the move to minimize the incidence of cervical cancer. While the incidence of Cervical cancer has drastically reduced with the discovery of Pap Smear during World War II, the genetically engineered vaccine totally revolutionize the approach to cancer by prevention. With Cervarix, the field of medicine has progressed by leaps and bounds with gargantuan significance that is forever immortalized in the history of mankind. Today, this is the second among so many form of cancers, that is preventable by man. The other being liver cancer.
It is rather disheartening to know the effort put into the research and finally the discovery of this near miraculous vaccine isn't just not being well accepted, but being opposed by certain groups of people who do not fully comprehend, nor open minded enough to even try to understand the benefits of this vaccine.

Ignorance is the main hindrance to progress of mankind. However being ignorant due to lack of information available is excusable, but expressing dissatisfaction and opposition by posting "warnings,'you vaccinate-you die' kind of articles, videos on YouTube, etc" without the fully understanding the facts about this vaccine is simply wrong. It is understandable that prior to subjecting yourself to a "controversial" vaccine, there are questions and doubts lingering in your mind.

I do encourage the public to inquire from the doctor the full facts on this vaccine. Unfortunately, it is sad to admit that not all doctors are well versed in cervical cancer or the vaccine. Naturally, if you find the doctor's explanation isn't convincing enough, you'll search for information from the internet. That's when misinterpretation and misunderstanding of this vaccine begins. Most of the videos posted in YouTube are by individual who's opinion is formed from an inadequate knowledge.

I am really amazed at some individuals who actually thought this vaccine is a part of some government conspiracy to sterilize woman, and how these vaccines were related to freemasons. Click here to have a good laugh. I sincerely cannot imagine the things that was going on in their mind while writing that. I had my share of good laugh after reading such post that is so ridiculous to a point where it becomes an entertainment.

US's FDA and UK's NHS do not approve a drug unless they had passed a set of criteria upon which only would their safety be established. US's FDA not only approved of it, but actually recommends it to protect girls and young woman from developing Cervical Cancer later in life. Click here for reference.
The death of a 14 year old Natalie Morton in UK on the 29 September 2009, hours after being vaccinated was found not to be caused by Cervarix, but instead was due to a undiagnosed huge malignant tumour in the lung and heart. Click here for reference.
As stated on the disclaimer on this blog, my choice of vaccine between the two available ones in the market is not being influenced by any party nor being given remunerations in any form by the pharmaceutical company that manufactures the vaccine.
So far, there are over 12000 reports of complications upon administration of HPV vaccine. As I had explained in detail about the validity of the reported side effects, and how the media play the role in amplifying the degree of "adverse effects", one should note that these reports weren't made against Cervarix. Click here to verify.

In the scientific and medical community, the unwritten rule is US FDA is being regarded as the Gold Standard for many other countries to refer to. I am not sure whether my fellow Malaysians are aware at the fact that Malaysia do not posses a lab of our own to conduct scientific studies prior to approval of drugs. I am not sure what are the set of criteria our local "FDA" is based upon to establish it's safety.
However, one can be assured of the quality of drugs and its safety upon approval by FDA as it possess the reputation for protecting public health and consumer safety.
The response towards cervical cancer vaccination is still very low, despite GSK's effort in multitude ways to create awareness campaigns, public forums, regular symposiums by inviting world renowned experts in various fields to update and share the latest information and development of new drugs, all this being done bearing society as the beneficiary. Unlike some company that I've come across, especially in the field of cosmetology, doctors need to pay,often amounting to thousands to attend courses and often as a token of "qualifications" upon completion of the course, these doctors are issued "certificates of attendance" that is hung on the wall of their consultation room, very often giving patients a false sense of confidence towards the doctor.Who benefits from this?
Base upon the regular visits from company representations, this unquestionably proves GSK's commitment in supporting health care provider.

It was less than 3 weeks ago since the last symposium held in Le Meridien Hotel, Kuala Lumpur. Just a few days ago, the friendly company representative invited me to attend another symposium on this coming 20th April, in Hilton Hotel.

The topic for the symposium is Broadening The Protection Against Oncogenic HPV Types.
I am looking forward for this symposium as the guest speaker would be a leading European Virologist, Professor Tino F. Schwarz, Head of Virology Laboratory at Foundation Jusliusspital,Wurzburg,Germany. He has 19 publications in various field concerning vaccines, virology, pandemics, etc.

Looking at his resume, he is the best person to talk to when comes to issues such as safety profile of HPV vaccines. But most of his research are based on Cervarix, which has the least if not non adverse effect compared to the other available vaccine in the market. A leading virologist in Europe who has traveled all around the globe to speak in symposiums attended by many well known doctors in various fields. It would be quite an experience to
have the opportunity to meet him.

This goes to show the degree of commitment of GSK in it's contribution in public health and consumer safety by regularly organizing symposiums as such, in addition to the regular visitation by the company representation to doctors to share the results of the latest studies.
I was excited and looking forward to attend the symposium on the 20th, but I was ESTATIC when I received this!

A round table discussion with Professor Tino himself. This invitation is limited to only 30 doctors all over Malaysia. I felt honoured, yet nervous since it's only limited to only 30 doctors, obviously, those 30 doctors would be intellectuals, professors from various teaching hospitals, researchers, consultants Gynaecologist with fancy titles like Datuk, then it dawned upon me, GOSH! How is it possible that I got invited in this event?

Out of curiosity, I requested for the list of doctor who are invited to attend the event.
Thank God there's no Datuk, nor anyone in the list who is a professor, but out of the 40 names listed, only 3, including me, are general practitioners, while the rest are gynaecologist.

I was having a mix feelings of excitement and nervousness at the same time.

The round table discussion will be held on the 19th April, at One World Hotel. That's tomorrow!Yikes! I was all excited and REALLY looking forward for the RTD, until I received a SMS from the pharmaceutical company representative,

Arrrrggghhhhh!!!!!!!!!!!

The cheapest cost for Cervarix in Malaysia?

2010-04-16T10:05:00.000-07:00

Guaranteed the lowest price of Cervarix in Malaysia. Call now to inquire on it's price at 62722678

My rationale for vaccination vrs against those who opposed of it...

2010-04-16T03:50:00.000-07:00

Simply go to Youtube, and key in the word "side effects of cervical cancer vaccine", the page that appears is full of videos clips of claims of its hazardous side effect, death, complication, whether or not a person should be vaccinated or not.. it's just simply overwhelming.

I thought to myself for a while, and I guess the best way to change the mindset of public perception on this vaccine would be to publish a mail which I've received today, and the reply that I wrote.

I am from India and am 42yrs old.
I had my daughter of 18yrs vaccinated with the first course of Gardacil on 10th April 2010.

I was very worried when i read articles is the local newspapers doubting the efficacy of the vaccine and its side-effects. I was in mental torture after watching the youtube videos against the HPV vaccine.

Please kindly advice about the side-effects and dangerous risks(infertillity, blood clots etc) associated with the vaccine as mentioned online in reports.

Thank You very much,

Your help in the matter will be sincerely appreciated.

************

After reading his mail, I thought his worries are totally unnecessary. But who wouldn't after so much hype the public created? So, my reply was this:-

Dear respected Mr ***,
First and foremost, I would like to express my sincere thanks and appreciation for writing in to inquire regarding HPV vaccine. The sole purpose of me writing a blog on HPV vaccine is to reach out to the public, local or foreign to educate and to create an awareness regarding this vaccine.
I understand completely the psychological trauma you are bearing at the moment. With each YouTube video that you watch, it felt like the worries you already have kept on piling up. I am sure at a given time, you had wondered why isn't there any video on the positive side of these vaccine? I am a father to 2 daughters, and I can imagine being in your shoes. You are not alone,Mr*** . I am glad you write in to inquire concerning the efficacy and potential side effects of this vaccine. I sincerely wish more people would be as inquisitive as you,Mr ***.
First and foremost, Mr ***, i would like you to know that as a medical practitioner, I personally feel the duty of a doctor is beyond treating the sick.In addition to that, we are responsible to create an awareness and to dispel any form of misinterpretation and misunderstandings on a certain disease or drugs stemming from rumours, friends, personal experiences, etc. I will speak to you as friend, rather than a doctor-patient relationship.
I sincerely hope you will be assured and have a better understanding about this vaccine after reading this mail.
Since the launch of the first anti cervical cancer vaccine, Gardasil in 2006, it was was received with much controversies. Some believed that this vaccine gives the false sense of security and encourage sexual promiscuity among the recipients. Personally, I felt this is a unjustified and unwarranted, as it is entirely depends upon the upbringing of the individual, and not the vaccine. A well brought up individual would know for themselves the impact and consequences of health and morality issues on promiscuous sex, irrespective of being vaccinated or not.
The total amount of reported "side effects" that was more than 12,000 cases so far is rather far fetched and exaggerated.
The side effects such as pain, muscle weakness, fitting episodes, convulsions,epilepsy, Bell's palsy, lost of sight, dizziness, blood clots, infertility, auto immune diseases, etc are being highlighted and repeatedly being portrayed as "definitely hazardous" by many.
But Mr ***, as in other given vaccines that provide protection against viral diseases, it acts by stimulating our immune system, thus creating antibody against the disease. I am sure you are aware on the fact that in our lifetime, we never get flu from the same virus twice.
Initially when our body is being infiltrated by pathogens,eg bacteria and virus.. our immediate immune response would be non specific characterized by fever, nasal congestion, running nose, basically the feature that you see when you fall sick.
To understand that these claims of so called "dangers" or "hazards", you would need to understand a little about immune response.
Initial body response to infiltration of pathogens would be a non specific response to deter the propagation of the pathogen. What at the features? Lets look at them one by one.
1.Fever. Mechanism of Fever and why?
Our normal body temperature is 37.4 degree Celsius. Incidentally, it happens to be the optimum temperature of which bacteria and virus flourish. So, as a pre programed immediate response, our temperature control centre located in the brain would reprogram itself to increase the norm from 37.4 to a higher temperature, say 38.5C. So now, 38.5C is perceived as normal in sick patients.
2.Running nose, sorethroat,
This are due to inflammation of the mucosa of the lining epithelium(the cellular layer than lines that inner surface of body) and vasodilatation(widening of blood vessel to increase blood flow to the effected area).
The inflammation response is a result of cascade of chemical reactions characterized by increased local temperature, redness, tenderness, swelling. This in fact do increase the blood flow to the infected or affected area as white blood cell(our body defense "soldier" that defends against bacteria) contained in the blood would be channeled to the site.
All these response are non specific and does not last. They are pre- programed with the intention of providing an initial defense before a more specific response takes place. Remember that I mentioned that early non specific response is mainly inflammation as a result of cascades of chemicals being released into the blood circulations particularly histamine,bradykinin, serotonin, leukotreines, and prostaglandins.
These non specific defense response takes place before a more specific target orientated long term response develops, upon completion which renders the patient having the long term protection against the same pathogen in future, by which the patient becomes immune toward a second attack from the same pathogen,.
As the initial response is non specific, it involves the entire body system. Some exaggerated immune response would result in allergies. Similar to asthma.
It is this non specific inflammatory response that attribute to the so called complication upon administration of vaccine into an individual. As these vaccines are made up of protein from the capsid of the virus, is doesn't contain virus DNA hence IT DOESN'T CAUSE HPV INFECTION. So by this, it dispels the argument that the vaccine is the cause of HPV infection as highlighted in this YouTube presentation.
The report of patient develop epilepsy, seizures, convulsions upon the administration of HPV vaccine, to my humble opinion isn't valid. No one "develops" epilepsy. It's not a disease that one contracts. It's either a person is born with abnormality is the brain's electrical pathway, E.g damaged pathway in Cerebral Palsy, head injury involving the brain, tumour.etc. Judging from the way these articles are written, one can easily identify the author as non medical background. Fitting, seizure, convulsion. These terms describes the same condition. It it written in such a manner that is easily misinterpreted by the public as if these three words are different entities altogether. One may develop seizure, but not necessarily be an epileptic, but all epileptics have seizures.
Epilepsy is the condition, while seizure is the clinical presentation.
One needs to remember that a person who is epileptic may get a seizure which can be triggered by various factors, including flashes of bright lights, not enough sleep, restlessness, anxiety, stress, missed medication, etc. Whether or not these reported seizure post vaccination were epileptic to begin with isn't being reported, as while awaiting for their turn for vaccination and pain induced by the intramuscular injection may trigger it off. Hence, by that, one cannot attribute the seizure as the result of the vaccine.
Non specific inflammation response towards introduction of pathogen or any particle that is recognized as being foreign is a pre programed response developed within the physiology of the human body as a result of million of years of evolution that involves a gradual slow process of adaptation towards becoming a perfect being within the surrounding environment. As the definite, long term, and specific defense mechanism(immunity) which is a characteristic of creature of higher level of evolution takes time, hence the immediate response towards detection of pathogen would be generalized and often systemic. As I had mentioned earlier, inflammatory response is a main feature in a non specific response.
When inflammation involves the nervous systems, where it interferes with the transmission of electrical signal along the nerve, the motor and sensory response would obviously be affected. Hence this accounts for the reported cases of Bell's Palsy,hemiparesis, numbness or hypersensitivity of the extremities, muscle weakness, temporary loss of sight, temporary paralysis, transient loss of hearing.
As for autoimmune disease, I believe the susceptibility of a person to develop autoimmune disease is pre determined by gene. Very often viral infection or vaccines that triggers an immune respond may trigger an acute episode in these individuals, which can be controlled by steroids. However, the report of vaccine causing an auto immune disease has not been reported. It may trigger an acute attack on patient who are known and already being diagnosed earlier, or may trigger a first clinical attack on genetically susceptible individuals. However, one should understand that this is being observed on various auto immune disease like Systemic Lupus Erythematosus, Guillain -Barre Syndrome, Multiple Sclerosis, myopaties, vasculitis, rheumatoid arthritis,etc.. where its been observed that vaccine have a different spectrum of susceptibility in triggering attacks on each of the listed auto immune disease. Some are not related, while some may trigger the attack but the degree of correlation between vaccine triggering attacks is inconsistent to be listed as a contraindication. In cases of Guillain Barre Syndrome, one needs to be careful and observe for an acute attack, but not in any way, a contraindication. Click here for reference. Instead of jumping into the bandwagon in the effort to protest against vaccination for HPV, these correlations of "complications" post vaccination doesn't apply to HPV vaccine alone, but also for Hepatitis B, Hepatitis A, and the various Influenza vaccines in the market.
The process of manufacturing and mechanism in development of immunity is the same for all these vaccines, but it doesn't make sense as to why is HPV being a topic or a much heated argument and controversies?
Very often, Mr ****, man by nature are psychologically creature of convenience. What seemed acceptable to them despite all the risk involved is received without much debate, while another with similar risk, when an opinion has been formed in the minds of people, every trivial temporary effects will be highlighted.
In the beginning when Gardasil was first launch, besides being expensive, medical practitioners have difficulties to even introduce the vaccine to parents of potential recipients, as cervical carcinoma is often being associated with multiple sex partners. Patient often felt offended when a doctor suggest this vaccine to them as they have the impression that they are thought to sexually promiscuous.
The protest against vaccination as it gives a false sense of security and promotes sexual promiscuity is an excuse, rather than a reason. What has promiscuity got to do with medicine? It's psychological rather than a medical condition. The following are based upon my own observation, and not in any given time have I claim to be an expert in psychology. My opinion are not to be taken as facts, but rather perceived as an opinion from an individual.
I observed that 90-95% of the so called reported side effects comes from developed countries such as US, UK, and certain European countries. The epidemiology of cervical cancer indicated that its occurrence is significantly higher in developing and third world countries.
Once, a well known Consultant gynaecologist and obstetrician, Professor Dr B.K Lim, quoted in a symposium held by a giant pharmaceutical company, that the incidence of cervical cancer is so low in UK that training hospitals for future Gynaecologist have a hard time obtaining cases for training purposes. I would rationalized that since it has such a low incidence rate, the community do not see the degree of importance and significance of these vaccines to them compared to us who are from developing countries where cervical cancer is ranked top three among death due to malignancy, where the benefits of the vaccine far outweighs the potential side effect.
In the US, the incidence back in 2009 was just over 11,000 with mortality just over 4000 cases, compared to Asian countries where more than half of the overall global cases are from us.
The low incidence of cervical cancer in UK and US is attributed to the availability of an advance screening method, where more than 90% of screening done in US today is through Thin Prep Pap Smear.
Why only HPV vaccine be the much heated and controversial subject today? Why not Influenza Vaccine be the topic of debate when the method of manufacturing these vaccines are the same? While some says that efficacy of HPV vaccine is "questionable" as it hasn't been through the test of time.
Then, for the same reason, H1N1 vaccine was developed and it wasn't being subjected to the similar "test of time" nor its long term complications is known, but everyone is rushing to the nearest clinic to get themselves vaccinated? As a matter of fact, H1N1 vaccine was developed urgently and has not being subjected to sufficient test to established it's safety, but why wasn't it being debated upon? Why the discrimination?
It's because H1N1 that originated from Mexico City spread at an exponential rate to countries irrespective of whether it's developed, developing, or third world. Then, the UK and US general public demanded the vaccine despite it being at its infancy. News reports with photos showing people queuing up all the way out of the hospital premises still remain fresh in my mind. Why weren't there any debate? Because to them, the benefits far outweighs the potential side effects.
Based on this Mr ***, I see an element of discrimination and bias over the report and controversies involving this vaccine. The potential side effects are exaggerated and repeatedly highlighted.
Suddenly so called "experts" started popping out everywhere voicing their "human rights NOT to subject their children to unnecessary life threatening risk" which I find it rather hypocritical just because they don't face the same degree of incidence as other countries.
In my opinion, the so called side effects of this vaccine seemed more high risk simply because of media and public perception. Most of the doctors who have a bad impression of these vaccines are individual opinion.
FDA of US and UK's NHS will not approved these vaccine if the safety aren't being established. If the vaccine is at all that hazardous as it is being portrayed, then why would the health authority of these countries approved of it then? These countries are:-
Australia,Brazil,Canada,Denmark,Finland,France,Hungary,Germany,Iceland,Ireland,Italy,Japan,Korea,Luxembourg,Norway,New Zealand, Sweden,Switzerland,UK,US,Uruguay,India, Malaysia.....the list goes on.
I hope this would give you some assurance, Mr ****. Have a good day.

Warmest regards,
So, guys, now you tell me, what is your opinion on this vaccine now?

Cervarix.What else can be done?

2010-04-12T09:43:00.000-07:00

With the amount of effort I've put in creating awareness among woman in Malaysia concerning Cervical Cancer, I wouldn't say I am at all passive about it.
Right from decreasing the price to the extent where some people begin to doubt the genuineness of the vaccine(yes, I know doctors who started injecting normal saline when their vaccine ran out of stock)

...to placing pamphlet on Cervical Cancer awareness on every corner of my clinic...

like this placed right on the drug collection and payment counter, NOBODY could miss it. And if that's not enough, i got this piece of huge sticker pasted on the counter itself...

There.. wait, there's some more!..

This is placed right at the registration counter. Well, all these are placed in the clinic, what about outside the clinic where people walk by?

First I've got this pasted on the glass entrance of the clinic, in addition to this...

Well, after all of these, if it still couldn't draw the patient's attention, I think I would be right to assume that they simply don't care.
There are times when I felt what's the point of all this effort when they chose not to respond? You could prepare a mouth watering meal, but it takes the person to reach out, grab the food, and place them into their mouth.
After a while, it came to my senses that perhaps the crowd aren't paying the due attention as they simply aren't aware of the degree of the disease and how it affects not only the patient, but the caretaker as well.
So, i begin to write post on cervical cancer, it's discovery, the significance and importance of getting vaccinated, to inform the general public on the more accurate method of screening for early signs of cervical cancer in this blog. So, a lot of those who sent me mail to inquire on the vaccine would someone get to know me on a personal level, which can be both good and bad.

Later i realized that letting the public know too much on my personal side isn't always a good thing. So, I created another blog purely to post write ups on cervical cancer vaccine of my choice.

The URL of this blog is www.cervarix.blogspot.com. All my previous post are transferred from my personal blog to this new blog site.

Well, I received quite an encouraging number of people writing in to inquire on the whereabouts of my clinic. However, hardly anyone turn up.
Again, for a while, I thought to myself, that's how far I'm able to go.But after a short period of time, my inner self told me "don't falter, you need to get off the boat to walk on water."
Don't get why I am trying to say? Well, that's what happens when you listen to too much of U2. It means not to be discouraged. Put more effort, take some risk, you wouldn't know what would the result be in the end which could lead to something unexpected.
So, last week, I thought my old poster wasn't attracting any attention as it's written in monochrome.The new one is this

It's written the price for each dose, along with a logo of a camera for passerby to snap the URL in case feeling reluctant on seeing me. And to convince that I am using the genuine product, I even pasted a photo of the product. My previous post tells you ways to make sure the doctor whom you are seeing is giving you the genuine stuff.
I pasted two of this, one on each side of door.
As I was watching the CCTV from my consultation room, i was feeling despair seeing this!

Notice the screen on the upper right?

In case if you fail to notice the picture, non of these people who walked past the poster even stopped to give a look at it!
I went out to take a picture of the poster when I spot 2 ladies who walked by....

Sorry, photo is blur as I had not time to focus. Yup, like the rest, didn't stop to look at the poster at all.
This reaffirms my belief that generally,people here are rather ignorant when comes to health.
Sincerely, I don't know what else can i do.

Preventing Premature Death

2010-04-10T03:57:00.001-07:00

This write up on the particular product is based upon the author's own initiative, and not being influence in any way or given any remuneration in any form or manner by the manufacturer of the product. The views given are based upon medical journals conducted and information written here are from medical articles found by the author's effort and had not being helped in any way by the manufacturer.

Mankind and disease has come a long way and through out the course of history, humans had faced multiple diseases which were pandemic and had claimed millions of lives. Some of these deadly disease were so wide spread and claimed a biblical amount of lives worldwide that some faith believe it was the wrath of God. These deadly disease includes The Black Death, poliomyelitis,malaria,smallpox,cholera,Ebola,Bubonic plaque,The Spanish Flu, Influenza, and AIDS. History is marked with significant achievements that is forever immortalized as highlights in the course of science and medicine with discovery of vaccines that protects and prevents, and medicine to cure and control some of these deadly diseases that inflicts mankind. While most of the diseases I've mentioned can be prevented, while some has totally been eradicated, unfortunately there are those that its treatment or prevention are yet to be discovered. I believe it's just a matter of time before it's discovery. A promising fact is the nature of these diseases is known, and while medicine for cure and prevention is yet to be found, its methods of prevention is known.

At present the three most feared diseases with no known cure if influenza, AIDS, and cancer.

While there are antiviral drugs and vaccines that were developed for previous influenza attacks, yet new mutated strains emerges from time to time. The latest being H1N1, and not too long ago SARS. While HAART(highly active antiretroviral treatment) regime prolongs and increases the quality of life, it's not curative. The quest for its vaccine is currently under research with it's recently published human trial on HIV type B and E, conducted in Thailand indicated 26% drop in infection rate. A promising number, yet far from being deemed an effective one.

Advancement in the field of medicine has come a long way with its progress forges on in steps.It's progress occasionally occurs by leaps and bounds with discoveries of vaccines and medicine that cures. One of the most significant moments as such by the turn of the century is the discovery of vaccine for cancer.

(there are currently 2 brands available in the market for Cervical Cancer Vaccine, Gardasil by MSD, and Cervarix by GSK)

Perhaps(in my opinion) the fact that mortality rate and statistics presented in figures, percentages,and charts in medical conventions or symposium to highlight the impact of the disease on us fails to convey to doctors that cancer is a disease that affect the patient as well as the family members psychologically, financially, and emotionally,and not just merely numbers and figures.

From time to time, pharmaceutical company organizes symposiums and medical conventions for the purpose of sharing new data on latest studies conducted, it's efficacy, latest figures in mortality for a given year.

Most presentation are on facts and figures, presented in the form of charts and graphs. These symposiums automatically becomes "logistically" orientated, instead of "patient" orientated.

Personally(As this is purely a personal blog, contents of this write up is based on facts and figures presented are from the pharmaceutical company as well as independent health organizations. However opinion deducted is entirely based on the author's own personal opinion) I feel these presentations ought to be more patient orientated. Instead of showing slides with charts and graphs, which I doubt interests majority of doctors present, they should perhaps consider showing this instead:-

Why can't medical conventions highlight upon the humanity side of the patient? Very often doctors forget the essence of medicine, their role in society, the impact they have on the patient and their family members, that certain decision which was made with much cavalier actually at times determines the outcome of patient's life.

(Again, I would like to remind fellow readers that this post is written based on my personal point of view,ideas, and opinion. It may not be applicable for general public whether sharing the same profession or not. THIS IS A PERSONAL BLOG)

Perhaps one wouldn't understand why am i being so excessive in this matter. I wouldn't view it as being excessive. I think it's my deep rooted passion on this revolutionary discovery . Come on! This is cancer we're talking about. The disease that kills more than half a million woman worldwide out of which more than 270,000 is from Asia. A disease that potentially occurs on every woman irrespective of race, social status, religion, and age. Its a disease that reportedly affect approximately 4700 woman annually.

Don't the public realize the impact this discovery has? It's advancement in medicine by leaps and bounds, it's a milestone in human history. My previous post, I mentioned that it's significance is in par with the landing of the first man on moon. I would like to rephrase that. It's more important than the landing of the first man on moon. Did Neil Armstrong "one step of man, giant step for mankind" save any live?? NO!!

I remember back in early 2006, when the first cervical cancer vaccine, Gardasil was launched. Not many doctors(mostly GPs) was keen on promoting this product for several factors. First, the doctors themselves aren't well versed to provide counselling to potential recipients, being the first of its kind- the price was most of the time unaffordable by middle class income group, even those who can afford it had to think twice as it cost between RM1600-RM2400 for complete vaccination, and last but not least, it's difficult to even begin introducing the vaccine to patients as they perceived that the doctor have the impression that they lead a sexual promiscuous life.

Personally,I felt the pharmaceutical company who manufactured this product which IS revolutionary that marked man's first step in the effort to have control over cancer, a disease that one shudders and dreaded upon being diagnosed to have and totally change the perspective of one's view towards life, shouldn't have put such an unaffordable price tag.

There's nothing wrong being financially orientated. Hey, which stake holders wouldn't want that? I wasn't forming any opinion in my head when Viagra was launched in 1998. No one dies as a result of erectile dysfunction. They can charge a few hundred dollars a tablet for all I care, but when it comes to life saving drugs, I felt there is a moral obligation one needs to consider. Cancer accounts for 14% of causes of death worldwide. Cardiovascular disease ranked 1st in the cause of death for many years, but it is primarily a disease that stems

from the lifestyle, which is within one's ability to control. Right from the beginning I felt it's morally wrong to commercialize such product, making it into a drug of exclusivity.

A significantly huge percentage of people cannot afford this vaccine, even if they genuinely longed for it. But it's a fact of life. Only the rich and financially capable group enjoys better health care. Why is that so? Just because one is poor, does it mean they aren't as humane as the upper class people? This is absolutely ridiculous!

There are many opportunity to earn a good financial return, but to my opinion, by simply hike up the price since there is no competitor is a simple act of exploitation.

I was most delighted when another well respected pharmaceutical giant came out with their own vaccine,Cervarix.

Right in the early phase after the launch of Cervarix, the manufacturer announced their intention to lower the cost price, with the intention of making this vaccine affordable to the masses.Cheers to this company! This company is known to produce superior quality medical products. Another product from this company that I endorse in the midst of H1N1 pandemic would be Relenza. This product is far superior than the alternative Tamiflu. Why?

Why not you google or read on Tamiflu's side effect in Wikipedia? You wouldn't even want it even if it's being given free to you!

the fact that the company decides to lower the cost price shows that being a pharmaceutical company where their products contributes to health care, they uphold their integrity and nobility, when their version of cancer vaccine is far superior than the previous in so many expects, could have easily raise the price a higher, but they chose not to.

Immediately, I knew without doubt this product would definitely be my choice. Right from it's pricing, awareness campaign, continuous support provided towards doctors, the multiple symposiums to keep health care workers up to date with the latest data on the product, their efficacy,degree, and duration of immunity,etc... are by far more superior to the previous.......by many folds i might add!

Good patient information pamphlet.

Excellent support to doctors.

Regular symposium organized for latest updates.

its superior quality acknowledged and approved by renown leaders in Gynaeoncology...

Regular updates by the medical representatives that supports the doctors....

Though being advertised as a bivalent vaccine, it gives protection against the 5 most high risk cancer causing subtypes of Human Papilloma Virus.(HPV).. while the previous provides immunity to only 2 subtypes.

It's unique formulation in making this vaccine that is by integrating aluminium hydroxide that acts as an adjuvant to boost up and maintain body's immunity for at least 20 years... I say again, AT LEAST 20 YEARS! The use of aluminium hydroxide is the first of its kind in Malaysia. The only other vaccine that uses the similar adjuvant is vaccine for Hepatitis B in Europe that is designed for immunocompromised patients.

Now tell me which among the two would you chose?

Why am I being so passionate about this matter? Why am I so concerned about this issue?

Perhaps my direct encounter with family members of patients who had succumbed to cervical cancer, despite Pap Smear reported negative/normal. I felt their sense of frustration as to how is it possible when they undergo annual Pap Smear religiously. The question kept on lingering in the mind of family members as to why and how it happened so suddenly?

How was it possible when the report came back normal? When there's no history of cancer within the family? It was apparently clear to me the distress and psychological trauma they had gone through seeing their helpless sister,wife,daughter, or wife dying. They just simply couldn't accept the fact. That they must be some mistake. There was no and will never be a closure for them.

At the same time, maybe perhaps due to the fact that I had experienced first hand how it felt like to have your own family member being diagnosed to have cancer and the traumatic one sided battle that dampens your spirit, leaving behind psychological and mental scars seeing your love ones dying as time passes by. The repeated hospitalization, the regrets that you have not lived a fulfilling life with them, and now being too late.

My aunt recently passed away from pancreatic tumour. I diagnosed her with possible pancreatic tumour when she came to me with post hepatic jaundice.

I remember praying hard that I made the wrong diagnosis. Sadly, it was confirmed to be carcinoma of head and body of pancreas after CT Scan of abdomen being done in Selayang Hospital.

It was heart wrenching to see my aunt getting emaciated each time she sees me from time to time. I stood by her deathbed during those final hours of her life. I see how the pre mature passing of her has affected my uncle whom I was with just last week and told me he has difficulties sleeping at night. No matter how hard he tries to hide his feelings, its rather obvious that he's traumatized by her passing. My cousin told me he would suddenly break into tears. No medication, sleeping aid, anti depressant, or anti anxiety can relieve the pain he is experiencing.

I do not wish anyone else whether I know or don't to experience the same thing as any cancer patient and their family members endured.

Right from the beginning, my inner consciousness tells me it's the right thing to do to make this vaccine affordable to all walks of life.

It doesn't matter if I do not profit from this vaccine. What else is more satisfying and gratifying than knowing that you are living in an era that witnessed the discovery of a vaccine against a disease that previously deemed incurable and certain death for those who were diagnosed to have? Not only am I privileged enough to be living in this era, but to be given the opportunity to contribute to create awareness among the community on the importance of prevention of this killer disease. It's history in the making, and being part of it is certainly an opportunity not to be missed.

When I announced that I am charging RM165 per dose, i received mixed reactions almost immediately.

I was sort of frustrated as despite the lowered price, not many people are interested to even inquire about it!

Perhaps maybe the community do not realize how rampant the incidence of cervical cancer is. Maybe perhaps they weren't aware as they weren't informed by their doctors? Maybe it's the common attitude that ignorance is bliss and the delusional belief that it would not happen to them. Having such thoughts is akin to playing Russian Roulette! No kidding! It's like holding a revolver to your head hoping each time you pull the trigger, it would be an empty chamber.

I have written numerous post in my blog, repeatedly emphasizing the importance of vaccination. It doesn't matter if I had to post repeatedly, as long as I am able to reach out to the public, I knew I had contributed to decreasing cervical cancer morbidity and mortality, even by an insignificant amount.

The challenge of creating awareness among the public and to educate them became personal to me. Don't ask me why. Soon I begin to realized why am I not able to reach out to public.

First of all, significant number of those who are considering the vaccination thought they would need to perform a Pap Smear prior to vaccination. -- NO YOU DON'T HAVE TO!!

Second factor being, they feel obliged to be followed up by me since they got vaccinated here!--NO YOU DON'T HAVE TO!

I insist that they can continue to be follow up with their regular doctors and not at all need to feel obliged to be follow up by me. However I always insist that they should ask for a Thin Prep pap Smear instead of conventional Pap Smear as it is significantly more accurate in detecting adenocarcinoma.

Reason being conventional Pap Smear is not reliable in detecting adenocarcinoma as the sampling method is faulty. Thin Prep Pap Smear is an improvised version of Pap Smear.

Notice the ectocervix and the endocervix? Adenocarcinoma is tumour that mostly arises from the inner part of the cervix, the endocervix, where conventional Pap Smear is unable to get a good sample.

Wooden spatula used in conventional Pap Smear that fails to get a good sample from the endocervix and while smearing the sample onto the slides, only 20% of the collected samples are deposited, while the other 80% is left on the spatula.

The answer to the false negative from conventional Pap Smear.

The brush used in Thin Prep Pap Smear is designed for a more effective sample collection. I know what is in your mind now.THE ANSWER IS NO, ITS NOT ANY MORE PAINFUL THAN CONVENTIONAL PAP SMEAR.

So,please next time insist on Thin Prep Pap Smear. The fact is, not many doctors especially general practitioners are aware of the availability of such test.

According to head of Cytology and Histology Department, Gribbles Lab(Malaysia), out of the samples they received, only 30% are Thin Prep Pap smear, out of which only 20% out of those Thin Prep Pap Smear samples are from General practitioner.

Its an alarming fact that indicates the depth on knowledge general practitioners have on Cervical Cancer and it's screening.

What is more alarming is the fact that 8% of the doctors who attended a symposium on Cervical Cancer held at Le Meridien Hotel recently were strongly against vaccination of girls age between 10-15 years old! Aiikk!! that is the best time to vaccinate, before their first intercourse.

Determined to be more pro active, I thought perhaps woman who were contemplating the vaccination but holding back at the fact that it's being done by a male doctor, hence shy away.

I've made a new poster announcing that our clinic provides free counselling, and if you feel hesitant on seeing me, you could always check out the URL written in blue.

I've also prepared a notice informing passerby to snap a picture with their handphone in case they can't remember the UR

Another reason for the low reception was the fact that the price I offered was so low that some actually question whether do I use the "real product"! No. That's a sensible, reasonable doubt to have considering my unreasonably low price! You SHOULD HAVE DOUBTS!

One way to ensure you are receiving the genuine product is to insist on the doctor to open the box containing the prefilled syringe right in front of you.

Inside the box, the prefilled syringe comes along with 2 needles.Please take notice of the colour or the needle. One Blue and One Orange. Both the needles and the syringe is sealed with another layer of plastic. Make sure the doctor peel out the plastic IN FRONT OF YOU!

Don't feel awkward in insisting to inspect the syringe and its content. The vaccine is not entirely clear and transparent. It's a has a little murky look.

The moment you decide to get the vaccination, you have already taken a huge step in preventing cervical cancer. Now that you are sitting in the consultation room, made sure that the doctor opened the box, peel the plastic, connect the needle, and had inspected the colour of the vaccine, you are 95% sure that it is the genuine stuff. But to be 100% sure, well, I know its silly but out of so many times you've received vaccination which was administered through intramuscular injection, I would assure you that you had received the original stuff when you notice this vaccination is OUCH!! more painful compared to others, due to its formulation, aluminium hydroxide.

This is as far as I can think of in my effort to reach out to the public to create awareness in the importance of getting vaccinated.

GO TO YOUR NEAREST CLINIC THAT OFFERS VACCINATION FOR CERVICAL CANCER TODAY!

How accurate is the conventional method of screening for Cervical Cancer?

2010-03-20T22:18:00.000-07:00

This post is written based upon the observation and personal experience of the author, and not influenced by means of payment or any other form of remuneration by any pharmaceutical companies or parties.
With the discovery of Pap smear more than 50 years ago, death due to cervical cancer has been reduce significantly throughout the years worldwide. With the production of first ever Cancer vaccine back in February 27,2006, it marked a milestone in the history of medicine where personally I felt its significance is in par with the landing of the first man on moon.
With the second vaccine produced by pharmaceutical giant, GSK, it added on to the arsenal at our disposal in the fight against cervical cancer. However, despite these development over the years, even with the marked reduction of mortality, it makes no difference to the family member and patients who was diagnosed with this killer disease.
Somehow, with the presence of these vaccines, some individuals developed this false sense of security that their immunity against cervical cancer last forever, in actual fact false. These vaccines prevent future infection of HPV(Human Papilloma Virus), but does not cure the already existing HPV.
Though vaccinated, one still needs to be screened annually. Last year alone, I had three patients who has sisters who never missed any of their annual Pap Smear, and each time was told to be normal, unfortunately, 5-6 month later, died of cervical cancer.
Despite the marked reduction of occurrence over the years, it makes no difference to these family members and victims who had succumbed to this killer disease which is currently ranked number 2 as the cause of death among women.
In my previous post, I had wrote on why Cervarix is far superior to Gardasil.

Deciding on getting the vaccination done is by far one of the best decision made in a woman's life. If you have decided to totally avoid from contracting this killer disease, vaccination MUST be followed up with annual Pap smear.
Unfortunately, the conventional Pap smear which most clinics perform have a high incidence of false negative. (when a patient have an early changes in the endocervix, which conventional Pap smear fails to detect, and hence its reports comes back as normal)
Such error is tragic to the victim and their family member.

Error occurs especially when cervical carcinoma arises from the inner part of the cervix, where conventional Pap smear's methodology of sampling is relatively poor, hence yields an inaccurate result, which gives a false sense of security to the unfortunate patient. This form of cervical carcinoma is called cervical adenocarcinoma.

While sampling from carcinoma that arises from the ectocervix as illustrated on the diagram above, cancer arising from the endocervix is not easily detectable.

A conventional Pap Smear kit.

The sampling is done using a wooden spatula which is then smeared on a glass slide, which then "fixed" with a chemical called cytospray which then is then looked at under a light microscope by a pathologist.
This method is proved to have high incidence of false negative due to several factors:-
1.majority of cells not collected
2.Non- representative transfer
3.Clumping and overlapping of cells
4.Obscuring materials
Hence since 1996, an improvised version that lessen the false negatives up to 30% was introduced. It is called Thin Prep Pap Smear.

The Thin Prep Pap Test is a liquid-based pap test that employs a fluid transport medium to preserve cells and an automated process to eliminate debris and distribute a representative portion of cells on a slide in a uniform, even layer. A Thin Prep Pap Test slide is clearer, easier to read, and minimizes obscuring blood, mucus, and non-diagnostic debris, enabling increased accuracy for both manual assessment and computerized assessment of the cells. The Thin Prep Pap Test process improves the quality of the sample, preparing a slide that is more appropriate for diagnostic review.

The additional advantage of Thin Prep Pap Smear is that if there exist any abnormality in the cytology report, the same sample can be sent for HPV DNA testing to determine the subtype of HPV(Human Papilloma Virus), or for further test for sexual transmitted diseases.

Hence ladies, with the availability of an improvised Pap Smear, insist upon it to your doctor that you want this method instead of the conventional Pap smear.

Cervical Cancer Vaccine...

2010-03-19T22:20:00.000-07:00

I have written several post on Cervical Cancer in my blog as I felt the need to create an awareness among the public on how rampant it is, being ranked number 2 killer among causes of mortality among women in Malaysia.
However, I felt the level of awareness is still very limited, and despite our effort of lowering the price down to RM165 per dose(there are some clinics that charge RM500 per dose), very few number of women showed interest.
With the availability of Cervarix, which personally I think is far superior compared to Gardasil, women now have a choice, on which to chose from. Unlike several years ago when Gardasil was first launch, being the only cancer vaccine available, the price wasn't affordable to the masses. Unfortunately, despite such drastic price reduction purely for the purpose of providing an excess towards a more affordable health care, many women still remain ignorant.

Cervarix even though being advertised as being a bivalent vaccine, (provides immunity to two subtypes of HPV that causes Cervical cancer), latest date shown that it provides cross protection against three other subtypes,hence making it actually a pentavalent vaccine!)

Initially being advertised that it provides protection against HPV type 16, and type 18, now data shown that it provides additional 3 subtypes, that are type 31, 33, and 45. (the top 5 most oncogenic types)
Unlike Gardasil, it uses an adjuvant in its formulation, AsO4, which gives a rapid and a prolonged immunity against these viruses.

As you can see, cervical cancer being ranked second amongst all cancer as well as overall that affects women.

It's prevalence is the most between the age group of 30-60 years old. Note that quite a significant figure is from the age group of 70s and more.

Hence, since the recommended period of injection for Cervarix is between the age of 10-45, I would still recommend injection amongst the age group exceeding 45 years old.

Cancer does not recognized age of its victim. It spreads and kills irrespective of age.

In Klinik Wan dan Keluarga, we council patient's on importance of getting vaccinated.

Do not procrastinate anymore. While being a revolutionary drug that made a mark in the milestone in the field of medicine, it still receives poor response, unfortunately.

So,ladies, get your jab right away. Never think that it can never happen to you.

I bet Anita Mui and Farrah Fawcett never thought they would contract cervical cancer, until when it's too late.