To Die Now or Later? Revisiting the worldly life…


The traffic gets heavier. Streams of vehicle rushing through the three-lane system, tailgating in a long que. He strode through the congestion, moving in between other big vehicles, efficiently overtaking each one with ease. It has been his daily routine since the last 2 months, leaving his Keramat home at 7.35 and reached the hospital at 5 minutes before 8. The brand new Yamaha XJ had radically changed his commuting life, no more headache from traffic jam. Be it peak hours or otherwise, it does not matter. It only matters when it rains. Or of course, when he has to travel outstation as part of his work, when riding on the motor is not a very practical option – especially because navigating by GPS system is not possible while riding.

However, this morning he felt a little awkward. Was it because he got a touch of flue, or due to work stress lately, he wasn’t sure. First of all, he missed the morning prayer at the surau, one of the daily routines which he rarely keeps these days, it therefore has not become a routine, rather an exception. As he only managed to get in bed at 1am, he felt a little drowsy when he woke up. People say that as you get older, you need less sleep, however in his case, it looks like he is needing more. 5 and a half hour seems too little for him, as he could hardly open his eyes at the repetitive whispering of his dear wife. ‘Bang, wake up, say goodbye to your daughter’. For the last 2 days, he had returned home late, when all the children were already asleep. Commitments with the national societies, and long hours at the Operation Room was his excuse. Due to this, he has not met the children for two days, and his wife was good enough to ensure that at least he wakes up to say goodbye to his eldest daughter who leaves for school at 6.30am.

‘Bye ayah…aw you look so awful, I can’t wait for another holiday, you need it so badly!’ grinned Liyana. ‘Come here’ he summoned his daughter close, gives her a hug and a kissed her on the cheek ‘hmmm I really missed you’. Not infrequently he overheard Liyana’s disgruntled, as she ‘rarely sees anyone’ when she wakes up and leaves for school. He was deeply aware of this, but just could not help it himself. Coming home late, and yet he still got loads of works to do, ended up going to bed past midnight. He just felt that his physical strength is diminishing. Erratic meal times, lack of exercise, long working hours plus frequent outstations, all have been his routine – is he getting burnt out syndrome? Sometimes he could not help it but put the blame on other people, for lack of understanding of his overwhelming commitment, or is that the case with everyone else? Despite all that, he rarely complains, and he still enjoys working – well perhaps because many of his close friends are still around, furthermore his private practice has just received a boost, when his income has tripled since last year.

After having a quick shower, he put on his clothes and walked to the lounge. The two boys sat quietly in wait – Zaid, who goes to evening school, and Azam who has morning session primary school, should be leaving home shortly after. As he stepped closer, the two boys stood up and greeted him; then Zaid called the iqamah for the morning prayer. He lead the two rakaah Subuh prayer and recited the Quran fluently. He could well have got Zaid – who recently committed the entire Quran into memory, to lead the prayer – obviously a more deserving ‘imam’, however, as the father he maintains the leadership role. Wife followed behind. Liyana had done hers, on her own, just before the school minibus fetched her for school.

He still felt drowsy, and felt like going back to sleep. Ahh he just cant afford to do that, his morning private clinic session starts at 8am, so he had to keep moving. By now Rina his wife, Adam, Fisha their 5 year old daughter and Iyad, their little baby boy, all are ready to leave. Rina is a head mistress at the preschool, she is on duty this morning so has to be at school by 7.30am. She has to drop Adam to his school, then leave Iyad at the nursery, then drive to her school with Fisha with her. Fisha goes to the preschool year 1 at the same school she is teaching.

Rina started the X5 engine, ushered Adam and Fisha in and carries Iyad in her hands to be seated at the child seat in the middle row. He usually helps little, more so when needed, this makes him guilty in retrospect, leaving his wife managing most of the childcare. Most of the time his wife does the shopping with the children’s help, she does her own cooking proudly even though they have their own maid. After work, she sends Liyana and Adam to tuition, later in the evening just before sunset she would go to Zaid’s school to fetch him – an act that she rarely asks her husband to help, knowing his business. She will also attends the parents meeting, send their cars to the garage by herself whenever services are due. She even takes care of all their pets, that includes taking their cats to the vets, something that is needed almost monthly. Excepting the many bills that he conveniently paid online, his wife does the rest – that includes renewing the car insurance, settling the children school fees and related etc. He happily gave his wife his bankard which she can draw as much money needed for the home maintenance.

Often, he wonders, what’s his role at home, apart from being the bread winner – of which he’s proud of, as he is earning 30 times as much as his wife. But money can’t buy everything, and with so little time left for the family, his wife rather have him spend quality time with her and children, than doing any of the house chore. How kind, he thought. He promised himself that Rina is the only woman in his life, though as Muslim, he is allowed another 3, he had never given that a thought. There are many beautiful and intelligent women he frequently meets or get acquainted to, seductive and charming – but he is fully aware that those women are good to look at, but in his home, there is a room just for one, and he is content with that.

‘Screecheeeeeeed, a hasty Wira driver behind him pulled his emergency break, as the car in front changed lane suddenly therefore blocking its passage. A Nissan Vannette van who tailgated behind made a swift move to the fast lane, almost crashing to the Kancil car in front. The Wira driver was obviously enraged. He floored the accelerator and swayed his passage to the left lane, charging at projectile speed. The sudden move was obviously against his favour, as he suddenly realised that there were a group of motorists riding by the lane, three or four of them. Salem was positioned second behind the Kawasaki, he was riding at 90km/h. The XJ body was just slightly protruding towards the middle of the lane as he was ready to overtake the Kawasaki. This put the Wira driver in dilemma, as to his right there was a long trailer, making it impossible for him to pull right. His right foot pumped the break pedal, trying to cool the speeding car down. This did him no good, as the Wira suddenly swerved leftward, almost touching the XJ. He manourvered right a bit, but he was too close to the trailer. He sounded the horn, but it was too late. Just as the critical procession has now reached the top of Shamelin bridge, there was a big thunder.

Salem’s helmet suddenly popped out of his head – his head now exposed bare. His body was thrown mid-air, his XJ was plunged to the middle of the highway, landed just right in front of the slow moving trailer. And the next thing, he saw darkness.

From 'M3 multivehicle

At 7.46am, at Shamelin bridge along the Middle Ring Road II, there was a harrowing scene of a multivehicle accident. A Wira car crushed under a trailer and the driver was trapped under the wheel axle. The back of the trailer had swayed to the fast lane, rammed by a Vannetta van, and an E class Mercedes crumpled to the rear of the van. Crushed under the bonnet of the trailer, was a Yamaha XJ, without its rider. There was a commotion. The already congested three lane traffic now had come to a halt. Several drivers have parked their vehicles along the hard shoulders, trying to assess the scene or offer any help. And the immediate thing they saw was a Wira car burning under the trailer. About ten metres ahead, on the left lane, the body of a young man lied on the ground, motionless. His head was covered in blood.

‘O my God, O my God, Hell, help, its disaster, Mayday!’ cried a woman who just came out of her 3 series bimmer.

Crowd of spectators started to gather. Some move around, trying to do what they think is appropriate. The police, ambulance service, and the fire brigade had been called, it will take at least 30 minutes before help arrived, in this dense jungle of traffic. Meanwhile it is all left to the good Samaritans to help the victims of the accident. Not the Wira driver anyway, left burning under the body of the trailer, there was little can be done, in fact the whole crowd are now keeping well away from it, in case its going to explode. The driver of the van and the Mercedes escaped unhurt, and speedily ran away from the scene, leaving behind their vehicles and all its content which has meant nothing more than their own lives now. The trailer driver also was unhurt, however, his door was jammed. He would not try escaping from the other door, as the trailer now has tilted slightly, leaving the passenger door facing the open air.

What a tragedy, most harrowing. Suddenly there was explosion, and a huge fire went off, ripping the middle body of the trailer. The truck driver was frantic, he still could not escape. He tried breaking the window but it proved stronger than his hands which are partly injured. He jumped up and down in the hope of drawing help. But no one dare to come closer, with the flame threatening to kill, no wise person will attempt a heroic deed now. All they can do is try to salvage the motor rider who is lying unconscious, that is, if he is still alive.

The truck driver now started to feel breathless. His legs were trapped under the seat, his both arms injured, he lost all might to fight the impending doom. He shouted unwavering voice, which only himself can hear. ‘Cut me, cut my leg, just break the door, get me out!!’ if only any person could hear his desperate scream.

Some of the spectators have turned their faces away and tried to move away further – perhaps did not have the strength to witness the driver burned alive, or perhaps afraid if the fire could suddenly turn wild and throw shrapnel or arson at them. The driver of the bimmer, the van driver who survived the accident, and another two people who were motorists riding behind the RX, were the only people trying to help now. They have wisely decided to avoid the truck and the Wira, now they marched to Salem. “Too much blood” commented the woman. She was right, as the van driver bravely touched Salem’s head and tried to turn it aside, they saw a huge laceration on his cheek extending all the way to the scalp. He was lying on his back, and the back of his head was heavily bleeding, in fact the skull frame felt flattened now. No motion, no eye opening, speechless, just occasional breath. CPR? Sure one of them knew, either the bimmer driver, or one of the motorists but perhaps not the van driver, who did not even complete his primary six. Uneducated be he, but kind hearted enough, leaving all those others supposedly more intelligent and capable spectators doing nothing, not even witnessing the event due to fear. He just shrugged his shoulder and shook his head, as if implying that they are dealing with hopeless situation.

Finally he stood up, firm. ‘Look’, he said firmly, ‘the police or ambulance are not here, and they may not reach here for another 20 minutes. Every minutes count for this young man. I don’t know whether he is still alive or not, but I must take him to the hospital myself!’ Then he remembers that he did not even have a vehicle to drive. His van is lying there, stuck to the trailer’s body, perhaps awaiting the fire to engulf it.

The van driver’s act had brought consciousness to the woman bimmer driver. She quickly gather her thought, and without hesitation, blurted out: “You got no car right…I will take him, you just need to help me get him into the car, then we drive him to Ampang Hospital, the nearest place we can get to.” Without second thought the van driver waved at the two motorists signalling them to help lifting the lifeless body to the car. Several spectators who have now learned about small deeds, moved in to help. The woman drove her car slowly, closing on the body. This time the spectators were again made speechless, as they saw, a young Chinese woman, driving a brand new, all singing all dancing 3 series BMW, volunteered to help a Malay motorist who had become a victim of a horrific crash. Little did she hesitated to have her brand new car littered with the blood of a stranger. And moreover, a stranger whom they know have little or no chance to survive, judging by the severity of the injury sustained. So now, the BMW is moving away, driven by a young Chinese woman, helped by an Indian Van driver and a young Malay student, on their journey to save the life of an unfortunate young Malay man – what a true 1Malaysia spirit. After all, they are all human, servants of God. An act of kindness on this bright Friday morning, may pave their way to the future heaven.


A young girl is playing outside the house. She clumsily tries to climb the scooter, gives it a push and rides on, not for long, before it stops and she fumbles. ‘Alaaa…’ she sounded frustrated everytime she fumbles. Not giving up, she keeps trying. All around it looks so quiet. No one can be seen around the neighbourhood. The girl has got all the compound to herself. It’s getting sunnier now, she still keeps practising her scooter. Then she takes a new move. She started to move a little away from the house compound, out of the gate. The road is uneven, and leading away from the house, it takes a downhill course. Salem always reminded his kids to be careful when cycling down the lane, as the slope is drastic and had caused a few serious falls. But for Fisha, today is her first time trying the downhill slope, on her own. Whatever happens with her other brothers and sister, may be they are busy with homeworks, or are they getting engrossed with browsing the net, or watching favourite TV programs.

The road is dry and no obvious obstacle or dangerous objects along the way. Fisha in her casual style, started riding, bit by bit. Suddenly she lost control, just as she strides along with both legs on the scooter, it sharply glided fast, and faster. She held on tight to the handle, but could not think of what else to do. Now the scooter has glided about 30 meters away from the house gate, passing several neighbours front gates. Still no signs of people around. Fisha felt nervous, and surge of cold blood tracks up her throat, she panicked. Now the scooter hit a bumper, and the small wheel was too unstable to climb over the big bumper, as a result, it jolted and spinned sideways. Fisha scream, and the next thing, she fell on the ground, face down.

“Fisha! Fisha!” Salem called. Poor little girl. Her nose was bleeding, she bleeds from the lip as a result of accidental bite from her upper teeth, during the sudden fall. She cried louder, but no one heard. “Oh, Fisha, you poor little girl” Salem came close, stretched his hand out, tries to help her daughter get up. But no hand can be seen, and no voice can be heard by the girl. She continues to cry, and once she was able to get up, she ran straight to the house.

Salem moved closer to the house, his house, which he now does not belong to. The single storey bungalow is a handsome building, brightly painted, surrounded by a well maintained garden which grows a variety of flowers and shrubs. There is a small fish pond at the left inner side of the entrance gate. There is a spacious driveway lined with marbles, facing the verandah, that can easily accommodate 4 large cars. The 3 series bimmer is parked, and he thought it must have not been used much. The X5 which is his wife favourite car, is not there, means Rani must have been out somewhere, leaving the kids at home to look after themselves. The Audi TT is parked closest to the house entrance, which it has always been. The hot hatch which they brought home from London, is rarely driven and despite its age appears immaculate and plushed. The grass which grows around the pond shows sign of recently being cut. Salem carefully moves closer to the door, which is ajar, left open by Fish when she rushed in. He spotted the house number, of course he knows it well and he does not need permission. After all no one will be aware of his presence. In a flash of wind he is already in at the lounge. Now he can clearly hear Fisha’s voice talking to the brothers, who are sitting in their rooms. He peeked inside.

QIL Winter sadness website

The two boys were busy playing Playstation – Tekken 5 game. The console is kept in their room, so they could spend all day there playing. Liyana’s room is vacant, Salem scan around the house but she could not be seen anywhere. Rina and the baby neither, perhaps she went out for a meeting. Rina holds several key posts in the national NGOs as well as community organisation. She also conducts weekly circles with the students from the Technology Institute. Even when Salem is around, and occasionally had free weekends, he found his wife was busier than him, having at least one long meeting every weekend. 2 or three evenings of her weekdays filled with either meetings or student circles. Even at home, she spends time designing the school planning or online meeting with people in or outside the country. She still does her own cooking though, and that fact alone never fails to leave impact on Salem’s mind. No doubt she is a good wife, despite her busy commitment, she never neglected the children.

However, today was a bit different. Salem wonders how she is now, managing without a husband? Life must be different, he could not wait to see her face, what signs is she showing, of frustration, unending grief, or is she holding strong?

Fisha sits at the lounge, alone, still crying. She had gone in to her brothers, who kept on playing despite hearing her cries. Her eyes swells with tears. No one to talk to, she sobbed “I want dad…where is dad…dad, when are you coming home”. Salem could not hold his emotion, draws himself close and tries to give her a hug. It’s all vacant. He can’t feel or touch her, and she can’t see or hear him. Now Fisha moves towards the computer, and still sobbing, said to herself “I wanna see Upin dan Ipin”. Upin dan Ipin is her favourite TV series, she has watched all the series numerous times, but it never bored her. Now she had the CD on her hand, she press the button but nothing happens. Obviously the DVD player is turned off, and the cable not connected. It really pities him seeing his daughter cries and not getting what she wants, just simple thing like watching her favourite DVD. Maybe, this is what has been happening all this while, but he never realised it, due to his business at work. Only now he has the luxury of time seeing his children in action, which before he has not seen – like what are the kids doing when both their parents are away. But now, it’s too late, nothing that he can do. Not even helping his daughter turning the DVD on, let alone calm her down when she is crying from the fall.

Fisha went to her brothers again and demanded their help. “Fisha! Just press the button, the thing will pop up, there, you just slide in the CD!” shouted Adam. She left the room sobbing even harder. “Come dear, I’ll help you” Salem whispers. Oh, what a pain, he sees everything, he hears everything and yet he can do nothing. Fisha threw herself on the sofa, and sobbed again “ayah….ayah…nak ayah…(dad…I want dad…)”.

“This is not fair!” Salem jerked, and went to his sons’ room. “Zaid, Adam, help your sister…please” suddenly it took him by surprise. A Deja Vu? How so familiar, yes he always uttered the same sentence, all the time, not long ago. Sitting in his sofa, busy tapping his laptops keyboard, writing scientific articles, or reading his students’ case reports or research proposal, he could not be bothered by his kids behaviour. And each time Fisha demands something from him, he will just summon one of the other kids to attend to her request. What’s the difference now? You such a hypocrite, Salem scowl at himself. If he WAS alive now, and sitting at the sofa, busy with his works, will he have attended to his daughter’s request promptly? Not, judging from his past behaviour. No other greater regret than having to blame oneself for neglecting such small deeds could make a difference to a kid’s happiness.

The sobbing had eased off, but she is clearly in pain, her nose and lips were bleeding, and smears of blood can be seen on the leather sofa. Poor Fisha having to bear all these torment herself. Finally she regained her energy, got up, walked to the corner of the lounge, where her school bag is kept. She unzips the bag and took a drawing pad and her pencil case. She began drawing. She is drawing something peculiar. At first it did not seem to make sense, but as she continues sketching, now it became clear what she is drawing. Figure of a man, crooked, jagged here and there, but a near perfect drawing for a 5 year old. Beside, she drew another figure, much smaller, a girl, with pony tail, then she drew her face, smiling face, and her right hand, reaching her father’s. How symbolic. Then she wrote under the figure – ayah, I love you. Does she understand where her father is? Did she know what happened? What does death mean, to a 5 year old? It’s a real pity, at her age, she is perhaps the most unfortunate of the family member to have lost her father, Salem thought. She is too young to understand, and yet she is big enough to remember her father and of course to keep wondering of his whereabout. The baby, is still too small, it makes no big difference to him, since at this age, he is fully dependent on the mother. As to his older kids, they would have understood, and by now, 2 months since the incident, they must have recovered. Or, have they forgotten their father? Are they still praying for him?

Fisha wipes the blood on her lips with her sleeve. Then she stood up, reached for a tissue, and pressed it on her face. Next, she walked towards the kitchen. Her gait is steady, as if she has forgotten all that has happened a few minutes ago. At the kitchen, she took a stool, climbed on it in order to reach the top cabinet and got hold of a plastic cup. Then she went to the fridge, again took the stool with her, climbed up, opened the fridge door and poured a few ice cubes from the freezer compartment. Next she walked to the dinner table, where a jug of plain water is to be found. Slowly Fisha reached for the jug that is full with water, grabbed it and tilted it sideways, towards the plastic cup that is now half filled with ice cubes. The jug felt heavy on her hand, and as it tilted further, it just slipped of her hand and gushed out its content on the table. Fisha quickly caught the nearly empty jug, now she held it tighter, that it had lost most of its content, she could easily handled it and poured the water into her cup. Finally, after a long struggle, she manages to enjoy a cup of chilled water. Just as she made the first few steps away from the table, her right foot landed on the wet floor, that had been sprayed with water from the falling jug. The wet marbled floor was too slippery to hold her feet and she slipped to her right side, banged her head on the table edge and fell under the table. Salem could only watched in horror. How much more accident his little girl has to suffer, and he could only watched in silence, helpless.

Strangely, the table accident did not seem to affect her, and Fisha swiftly got up and walked again. Now she looked so tired that she reached for the sofa and lied face down, probably trying to sleep. In less than ten minutes, she fell asleep.

The whole house seems so quiet. The boys now have stopped playing, they stepped out of the room, and Zaid suggested to his brother to play badminton. Adam went to the storeroom and took out a pair of badminton rackets and a box of shuttlecocks. “Look, I got ayah’s racket, Im going to use it today, I know ayah loved playing badminton…if only he is around now” Adam remarked. “What are you talking about?” Zaid was a little hurt. They ran outside, put on their shoes and began playing. They started long rally of play, both are getting good with the game now. “Aaah it so boring, just the two of us…if ayah…” Adam could not continue his sentence. “Adam, stop it…you can’t bring ayah back, you know that” Zaid tried to live up to reality. They played for another 15 minutes, now both are exhausted. They stepped inside and walked to the kitchen. “Zaid, look, this must be Fisha, she drop the jug and the whole floor is wet, I could have fallen” Adam was quick to point his finger on his sister. As if realising their own fault of neglecting their sister, both were now quiet. Zaid took the mop and dried the floor with it.

They both went back to the room to watch TV. The biggest looser is on and it is one of their favourite series. They have been playing the game all morning, and now they are going to watch TV, up to the evening? What a waste. Salem knew he could do nothing, not that he would have done anything before either. There were time when he sat at home, engaged with various office paperworks, and the children were let alone to do whatever they want. If the mother was at home, she will impose a schedule on them. Salem tended to be a liberalist, or perhaps due to preoccupation with his works, he just could not be bothered. Rather he just let them do what they want. How spoilt are they, now that they have made TV and internet as their main routine. Everyday has to be filled with at least 2 hours or more of watching their favourite programs – from the Biggest Looser, Wipe out, football etc, the list goes endless. If nothing too exciting, they just flip the remote control button from one channel to another until they come across something worth watching.

The whole house is quite again except the murmur from the television set in the boys room can be occasionally heard. The silence of the scene is so engaging, this is interspersed with the ticking from the cuckoo clock that Salem had bought from Geneva last year. The hallway looked so gloomy without the light on. Now he has the opportunity of entering his room, which now does not belong to him. The room has been cleaned, the bedsheet has just been changed. Everything is in order. Salem noticed a huge chandelier hanging from the ceiling. Was it there before, he could not quite recall, but it looks so beautiful, Salem wonders how it looks when the lights is on. He scanned the other corner of the room, there sits the office table. What used to be his table. The mahogany furniture purchased from Mid Valley shopping centre has been his working desk since ever. His wife never work on a desk anyway, though at times she has a lot of writing and typing to do. She just sit on the sofa, or rather works from her bed. That is, when he is not around. When he is home, she just prefer to sit by him, watching TV or just getting huddled quietly, while watching him does his work. To her, the husband must spend a quality time, that is with his wife and children.

The bathroom door is left ajar, fresh smell of air freshener can still be detected. A strange feeling awakes him, there is no sign that the bathroom has been used. The floor is dry, the sink looks untouched. All the toiletries are put in such order as if they have not been disturbed for so long. Has the wife not been using this room since? He has no idea, and suddenly there is this urge to know. Then he moves out to the hallway again, down the kitchen. The rear room which used to be the maid’s room, is also empty, Perhaps they have not had a maid since he left. Salem had a peek anyway, and he could clearly see, the wardrobe, which is half open, contains a few piece of his wife’s dress. And the dressing table too, is lined with a few simple make up set, all belongs to his wife. Salem knew instantly now, that his wife has now taken up this small room. How about the baby? He still was not sure.

…to be continued…

Panduan Menghadapi Jerebu

Jerebu terhasil dari pencemaran udara yang menggabungkan berbagai gas seperti ozone, carbon monoksida, sulfur dan partikel (habuk) kecil. Ia berpunca dari pembakaran terbuka, kilang, asap kenderaan dan lain-lain bentuk pencemaran udara. Ianya menyebabkan halangan pada sinaran matahari yang menyebabkan pudar pandangan.

Partikel kecil ini bila disedut dalam udara melalui pernafasan akan memasuki paru-paru lalu menghasilkan berbagai kesan tidak baik samada jangka pendek maupun jangka panjang. Kadangkala partikel halus (berukuran kurang dari 2.5micron) ini yang paling berbahaya kerana boleh menyerap masuk ke dalam sel paru-paru ataupun aliran darah.

Apakah kesan-kesan buruk jerebu

Kesan langsung pada paru-paru – sesak nafas, sakit dada, batuk, radang paru-paru, memburukkan penyakit paru-paru kronik, serangan asthma, bronkitis atau jangkitan kuman pada paru-paru.

Jantung – mengganggu pesakit jantung kronik, lemah jantung, aritmia dan boleh menyebabkan serangan jantung

Mata berair dan pedih

Hidung berair atau kerap bersin

Tekak kering dan pedih

Kulit terasa gatal/pedih, terutamanya untuk pengidap penyakit kulit seperi eczema

Kesan jangka panjang – selain kesan-kesan serta merta di atas, seseorang yang terdedah kepada jerebu pada tahap tidak sihat secara berterusan boleh membawa kepada penyakit jantung kronik, penyakit paru-paru kronik, kanser, mengurangkan jangka hayat, gangguan terhadap janin atau ibu mengandung.

Jelasnya jerebu ini boleh memberi kesan buruk kepada orang yang sihat, apalagi kepada yang berisiko. Golongan warga emas, OKU, kanak-kanak, pesakit-pesakit jantung dan paru-paru, ibu mengandung adalah contoh golongan yang berisiko dan perlu lebih berhati-hati terhadap gejala jerebu ini. Selain itu, perokok atau mereka yang bekerja di lapangan juga lebih berisiko dari orang biasa.


Langkah-langkah menangani jerebu

  1. Jika anda mengalami batuk, sesak nafas atau sakit dada berterusan, atau penyakit kronik seperti asthma, bronkitis terasa bertambah teruk, dapatkan pemeriksaan/rawatan doktor dengan segera.
  2. Tutup pintu dan tingkap rumah rapat-rapat untuk menghalang jerebu masuk terutamanya bila tahap IPU melebihi 100 (kadar tidak sihat)
  3. Bila memandu pastikan tingkap tertutup rapat. Penghawa dingin boleh digunaka. Set kitaran udara kereta anda tertutup (untuk halang udara luar masuk).
  4. Buat penunggang motosikal/basikal, sebaiknya elakkan perjalanan jarak jauh atau lama, dan pakai penutup muka (mask) contohnya N95 serta helmet yang lengkap menutup keseluruhan muka (penunggang motorsikal).
  5. Pesakit-pesakit yang berisiko seperti disebut di atas, hendaklah mengurangkan keluar rumah, dan bila tahap IPU melebihi 100 elakan keluar rumah seboleh mungkin. Sekiranya perlu keluar rumah pastikan anda memakai penutup muka (mask) contohnya N95.
  6. Penggunaan penutup muka – N95 adalah yang paling elok dan dapat membantu menghalang partikel kecil dari disedut masuk. Jenis-jenis penutup muka lain (surgical mask dll) boleh digunakan tetapi mungkin kurang berkesan. N95 tidak digalakkan untuk anak-anak kecil (tiada saranan boleh dipakai untuk usia kecil) oleh itu lebih baik hindarkan mereka keluar rumah.
  7. Banyakkan pengambilan air minum (2 liter sehari), elakkan alkohol dan rokok atau kopi yang berlebihan.

Ketahui IPU Di Kawasan Anda

Apa itu IPU? IPU ialah indeks pencemaran udara, satu ukuran tahap pencemaran berdasarkan kandungan gas-gas dan partikel kecil (dalam bahasa Inggeris API – Air pollutant index atau PSI – Pollutant standards index). Lebih tinggi bacaan IPU, lebih serious lagi tahap pencemaran udara, menurut kategori seperti dalam jadual. Tindakan perlu diambil, bergantung kepada risiko seseorang.

Julat Bacaan IPU Status Orang yang sihat (1) Orang tua, mengandung atau kanak-kanak kecil (2) Orang berpenyakit paru-paru kronik, sakit jantung (3)
0-50 Sihat Aktiviti seperti biasa Aktiviti seperti biasa Aktiviti seperti biasa
51-100 Sederhana Aktiviti seperti biasa Aktiviti seperti biasa Aktiviti seperti biasa
101-200* Tidak sihat Kurangkan aktiviti luar yang berlebihan atau berpanjangan Minimakan (jika perlu sahaja) aktiviti luar berlebihan atau berpanjangan.

Anak-anak kecil dinasihatkan tidak bermain di luar rumah

Elakkan (jika perlu sahaja) aktiviti luar berlebihan atau berpanjangan
201-300** Sangat tidak sihat Elakkan (jika perlu sahaja) aktiviti luar berlebihan atau berpanjangan Minimakan sebarang bentuk aktiviti luar Elakkan aktiviti luar
Lebih 300 Merbahaya Minimakan sebarang bentuk aktiviti luar Elakkan aktiviti luar Elakkan aktiviti luar
  • * Pemakaian tutup muka spt N95 diperlukan untuk golongan berisiko (2 & 3) pada tahap IPU ini
  • ** Pemakaian tutup muka spt N95 diperlukan untuk semua pada tahap IPU ini

Di Masa Jerebu Lebihkan Masa Di Dalam

Bila tahap IPU mencecah 101 ke atas, lebih baik kurangkan aktiviti luar yang kurang perlu. Walaupun beriadah dan bersukan adalah aktiviti sihat, tetapi bila tahap jerebu meningkat (lebih 100 untuk yang kurang sihat, atau lebih 200 untuk yang sihat), adalah lebih baik minimakan aktiviti tersebut, atau buat secara dalaman (indoor).

Inilah ketika untuk lebihkan masa di rumah atau di dalam bangunan, ruangkan waktu ini bersama keluarga/sanak saudara/rakan, banyak aktiviti produktif yang boleh dikongsikan seperti membaca, mengemas rumah beramai-ramai atau apa-apa aktiviti untuk menambahkan ilmu dan merapatkan silaturrahim. Semoga kita semua terpelihara dari kesan pencemaran jerebu.

Inilah ketika untuk lebihkan masa di rumah atau di dalam bangunan, ruangkan waktu ini bersama keluarga/sanak saudara/rakan, banyak aktiviti produktif yang boleh dikongsikan seperti membaca, mengemas rumah beramai-ramai atau apa-apa aktiviti untuk menambahkan ilmu dan merapatkan silaturrahim. Semoga kita semua terpelihara dari kesan pencemaran jerebu.

What I have learned from ESC London 2015

esc-congressFinally ESC (European Society of Cardiology)  Congress London 2015 that took place at Excel London, came to a close today, after a full 5 days of lectures, symposiums, debates, exhibitions and abstract presentations and other varieties of fulfiling showcases of today and tomorrow’s cardiology. 32,000 over delegates from all over the world, making this congress one of the largest, if not the largest gathering of Cardilogists in the world.
‘Environment and the Heart’ was chosen as this year’s theme. 5 new ESC guidelines were launched namely on Non-ST Elevation Acute Coronary Syndrome, Pulmonary Arterial Hypertension, Pericarditis, Endocarditis and Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.
All of these presentations can be followed or downloaded from the website.
Many things have been highlighted. From my perspective the most important highlights are one the new treatment of hyperlipidaemia (PCSK 9 antibodies) where both of the new agents have recently received approval, a new biomarkers protocol to further improve the diagnostic accuracy of acute coronary syndrome, and rejevenation of potassium sparing diuretic/s in the treatment of resistant hypertension.
From my impression, the many so called late breaking trials or discoveries that had been ‘promised’ in the opening of the Congress were unfortunately disappointing, due to mostly neutral or negative result. Nevertheless, in fairness one would be more interested with the quality of the studies rather than the positive result since, a well conducted study will bring equally important clinical implication whether positive or negative! In this regard the Congress certainly can pride itself for maintaining the tradition by presenting a wealth of researches that come from all corners of the world.
Highlight of each subspecialities of cardiology are presented here briefly.



Data on the long term efficacy of catheter based treatment of atrial fibrillation was presented. In general AF ablation is effective while addition of short medical therapy with antiarrhythmic did not influence the long term result in patients who had the ablation (no difference in arrhythmia recurrence).
Interestingly, a small study had found weight loss as an effective way of maintaining sinus rhythm. Another study suggested that LAA isolation in addition to PV isolation during the AF ablation therapy will improve the long term success rate.
Leadless pacing with St. Jude’s nanostim was proven to be safe and effective, as the result of LEADLESS II had shown. 6 month safety & efficacy of the procedure were examined in non-randomised series of 300 patientsn – 96% success rates of implant, freedom from serious adverse event due to implant (SADE) 93%, it showed good pacing performance, with battery longevity of 15years. Bear in mind the current system is single chamber VVIR only.
A study looking at Environmental effects of patients on PPM & ICDs were presented, which found that exposure to cellphone is safe as long as it is held at 15cm away. Household security system is safe, however with Electronic security patients are advised not to linger for too long. Ear phones used are to be kept at 3cm distance, therefore the general rule is keep calm, keep distance!
CRTP or CRTD implantation in patients having the indication for CRTP?
It was postulated that CRTP patients would benefit from CRTD as well due to its benefit in preventing fatal arrhythmia. The study involved 535 patients undergoing CRTP, 1170 CRTD by French doctors. Surprisingly the SCD mortality were identical in both groups.
As more patients are undergoing pacemaker implant, there are cases when lead extraction is required. ELECTRa study looked 12 months result of patients undergoing lead extraction which found it to be safe with low 12m mortality at 6.7%. In addition, among these patients, after 1yr 1/5 of them did not get new lead implant!

In the PROMPT trial presented by G. Stone post ACS patients were assigned with the implantation of LV pacing or control. It was hypothesised as perinfarct pacing in narrow QRS (120ms QRS) to reduce the LV remodelling. There were a total of 126 patients post STEMI who underwent the implantation of LV pacing however, 18m followup failed to show benefit comparing to control.

In the ALBATROSS study – among patients with AMI (STEMI/NSTEMI) who were randomised within the first 72 hours to receive intravenous K canrenoate then spironolactone prior to undergoing PCI. The objective was to determine whether treatment with aldosterone antagonist could reduce remodelling due to the infarct in this group of patients. At the study end, no difference was observed between treated subjects and placebo, though there was trend towards benefit among the STEMI group.
A new Mineralocorticoid antagonist Finerenone was tested head to head against eplerenone in the ARTS-HF trial among patients worsening HF, the result indicated that finerenone was non-inferior to eplerenone.
Sleep disordered breathing has been thought to be a common detrimental factors among patients with heart failure due to systolic dysfunction. The SERVE-HF study examined the role of assisted mechanical breathing among subjects with Central Sleep Apnoea. However, the result did not show any significant benefit, indeed there were excess death among the subjects receiving the intervention.

One of the major highlights this time was on the advances in diagnosis of ACS assisted by the highly sensitive Troponin. As shown in SWEDE HEART the new test resulted increased in improved diagnostic accuracy. The BACC study compared 1 hour strategy with hsTNI versus 3 hours. The bottom line is using new cut off value of 6ng/L rather than the 99 percentile (used for the 3 hours). The one hour rule out protocol has resulted in higher patients survival, overal the 0/1 hour rule-in/rule-out strategies better than 0/3 hour. This is reassuring given Roche hsTNT has also been shown to provide higher accuracy in the TRAPID study. One caveat though, you must check which or who is your hsTN source, as there are differences between different manufacturers, therefore you need to establish your own lab value!
Now we are back talking about REPERFUSION INJURIES. Researches in the CIRCUS study tested the hypothesis that Cyclosporin could prevent reperfusion injury among AMI patients undergoing PCI, as had been shown in a previous study. Patients presenting up to 12 hours were given ciclomulsion (cyclosporin) (or matching placebo) prior to undergoing emergent PCI. Unfortunately the result was neutral at one year, no reduction in infarct size was observed.
Dual antiplatelet therapy in ACS is still topical particularly regarding ideal treatment duration. An analysis of the PEGASUS study, among stable patients with history of MI one to 3 years with additional risk factors were included, randomised to ticagrelor 60mg or 90mg BD, or placebo (receiving aspirin only). There was overall benefit observed in both ticagrelor treated groups (albeit increased bleeding), though researchers concluded that the benefit was confined to those patients that stopped the DAPT within 30 days of AMI. For those who have been on aspirin monotherapy for more than a year, no benefit was observed.

Not solely confined to ACS, in the interventional cardiology world the issue of DAPT treatment duration seems to remain topical. The OPTIDUAL study compared DAPT duration of 48m or 12m (clopidogrel/aspirin) among subjects undergoing PCI with DES. Unfortunately the study had to be terminated early due to problem with resources, resulting in failure to recruit targeted number of subjects. At the end of the study, there was no significant difference in term of thrombotic complications between the two arms.
The MATRIX study comparing transradial vs trans femoral access for NSTEMI/STEMI is still ongoing, however they presented the antithrombotic arm in which patients were randomised between bivaluridin (bolus and extended treatment) vs heparin, there were no difference in the primary endpoint between the two treatment strategies.
As for stenting strategy, the ABSORB STEMI TROFI II looked at Healing score (using OCT) among subjects undergoing PCI with the bioabsorbable Absorb BVS vs EES. The Absorb was non inferior in term of healing compared to EES, with trend to superiority
Further to this, the ABSORB JAPAN examined the long term outcome between subjects treated with BVS vs Cobalt Chromium EES, there was no difference in late loss or target lesion failure, no stent thrombosis.
A study looking at the differences between new generation vs older generation DES was presented, dissecting the result among 6000 plus patients in total with 2 years follow up. There was clear superiority favouring the new generation DES in term of CV death, MI and stent thrombosis.
The Transradial British Columbia Canada study that incorporated 83,659 patients proved that radial strategy should be the preferred access in PCI, showing 30d mortality, blood transfusion favouring radial (0.8, 0.49)
FAME FFR STRATEGY 5YR FOLLOW UP showed the difference favouring FFR strategy remain, though it’s no longer statistically significant, convergent in the MACE between the two strategies were observed at 3 years.
There was a study called PRESERVATION: looking at the effect of injecting bioabsorbable cardiac matrix during PCI among AMI subjects, which failed to show any benefit.
A Japanese study analysing result of emergency advanced resuscitation among cardiac arrest patients suggested that the optimal timing to observe benefit among these patients was at 35 minutes, ie there is no or minimal benefit for subjects who were revived beyond this time.

On the subject of BP control among hypertensive, the registry study showed that among the Europeans, barely within 35% which therefore exposing majority of hypertensive patients to all sort of long term consequence from uncontrolled hypertension. New treatment strategies in resistant hypertension? The answer might had been around the corner for long, till more and more convincing data come to surface now.
The PATHWAY 2 showed that Spironolactone is better than bisoprolol or doxazosin whether singly or combined in reducing blood pressure. If all resistant hypertension were treated with this regime, only 15 out of the 300 resistant hypertension subjects would need intervention with renal denervation. Monitoring K+ is a must though as this complication is observed more frequently comparing to other regimes.
Another study, PATHWAY 3 tested the three different diuretic regime Amiloride vs Amilo+hctz vs hctz in hypertensives with uncontrolled BP & one component of metabolic syndrome, with value of OGTT as primary endpoint. The findings confirmed treatement with HCTZ raise OGTT value most, compared to combination or amiloride alone. As regard BP reduction, the combination of amiloride/HCTZ gives the best BP reduction. It also showed that high dose of amiloride was as effective as HCTZ in reducing BP. The combination treatment result in neutral potassium changes.
Meanwhile, LCZ, which was pronounced as blockbuster drug discovery in heart failure last year, came up in another study on hypertensive subjects, called PARAMETER – in this study, ARNI resulted in Central pressure & pulse pressure reduction compared to olmesartan. 24hour ABPM – also proved the superiority of LCZ (mainly reduction in nocturnal BP). The study also showed reduced ntProBNP greater with LCZ, as well as urinary cGMP


VALVULAR DISEASES & Pulmonary Arterial Hypertension (PAH)
The GRIPHON TRIAL on Selexipag – a new prostacyclin receptor agonist in PAH treatment had been presented elsewhere however this time it was presented as a poster, which received the best poster presentation award. It looked at the effect of the drug in naive, or patients already on 1 or 2 treatment for PAH. The result showed consistent reduction of endpoint of death/morbidity up to 40% among all the subgroups. Therefore this is going to be a promising future for patients with PAH.
RAAS BLOCKADE in Aortic Stenosis? A retrospective study involving 23120 patients diagnosed with aortic stenosis, a nationwide propensity score matched study in Denmark, divided those receiving either drug, or those who were not on either, showed consistently lower mortality among patients treated with ARB or ACEI. The result was consistent encompassing all cause mortality, CV mortality and AVR. ARBs were found to be more effective in reducing mortality comparing to ACEI.
Doing MRI in Aortic stenosis subjects may help detect myocardial fibrosis (infarct pattern or midwall fibrosis), which may predict higher mortality in this group of patients, as shown in one study. However, it could not ascertain confounding factors like the effect or early surgery on these patients.
BICUSPID AoValve morphology – bicuspid without raphe – associated with eft dominance coronary and hence more prevalent CAD in this group. Regarding effect of gender, it showed that men with bicuspid valve tended to have higher event rate
A study on Acute onset Infective Endocarditis showed deferred surgery may lead to higher mortality, therefore an urgent surgery in this group considered to be a better strategy. Less pronounced effect among those with non-acute onset.
As more centres are performing percutaneous aortic valve implant (TAVI), now a study that looked at procedures performed under local anaesthetic, among those with balloon expandable vs self expandable, 570 patients received local anaesthetic, only 0.7% needed GA, another 3.7% deep sedatio, the study also showed both Corevalve and Edward Sapien were comparable.
UK TAVI REGISTRY compared various access in performing TAVI, when femoral approach was not possible – Transapical vs direct aortic vs subclavian, it showed that Subclavian access was next best to femoral in term of safety and success.
Atrial fibrillation onset post TAVI may be associated with adverse outcome. 13795 patients underoing TAVI were studied in a meta analysis which showed new AF predicted CVA in short term with hazard ratio (HR) of 2.86. It also affected long term mortality with 1.68 HR
Transcatheter mitral valve implant in high risk pts w degenerated bioprosthesis or ring annuloplasty – 37 pts underwent this procedure – 30m overal survival 60%, 6 month survival was 92%. Therefore this herald a good future for percutaneous mitral valve intervention.
Howe about Native Mitral valve replacement percutaneously? (ie when surgery deemed very high risk or unsuitable) – This could be fought with heavily calcified annulus as the main culprit. In a series of 13 patients undergoing such procedures, the 30 days outcome was promising, with 1 death and 11 of them had improvement of symptoms and NYHA, 1 patient had stroke, and another required PPM.
Functional MR w reduced EF has been successfully treated with mitral clip intervention. In one study 25/56 subjects ie 45% improved following the treatment. The registr of Mitraclip (TRAMI) showed 30 day survival of 95%, and one year of almost 80%. Predictors of event – severe symptoms, anaemia, prev AV intervention, PAD, EF <30%
Cardioband is a study looking at percutaneous annuloplasty for MV repair, result is awaited.

FFR CT (PLATFORM trial) CT FFR vs INVASIVE ICA & FFR could improve the referral rate for invasive coronary angiography among those subjects that have significant CAD.
Perfusable tissue index may predict LV function recovery after AMI
EchoCRT – persistent LV dyssynchrony among subjects with narrow QRS was related with worse prognosis, (albeit, previous study had failed to prove any benefit of CRT among these subjects).
LGE MRI / MIBG SPECT – intergration of myocardial scar and innervation imaging could refine risk stratification among heart failure patients.
Lastly there is a growing research in fusion imaging and 3D printing of valve anatomy.

EUROASPIRE III, IV showed over 80% prevalence of obestiy or overweight among the CV subjects at risk. Rate of obesity was 44%, BP control 45% and appalingly, lipid 18%! This goes to show that CV risk factors not adequately managed in primary care and hence need more effort
With the proliferation of DPP4 inhibitors as one of the new treatment of type II DM, question lingers on safety, previous study with Saxagliptin raised concern with increased heart failure event. TECOS (trial evaluating CV outcome with Sitagliptin) result was presented. This was a study involving more than 14000 subjects treated with either Sitagliptin or placebo. There was similar CV outcome between the two arms at the end of 2 years followup, and no increase in heart failure or hospitalisation for HF was observed among patients treated with Sitagliptin.
A re-analysis of IMPROVE -IT study on the efficacy of Simvastatin/Ezetimibe among ACS subjects was presented. The study that showed an absolute reduction of 2% in primary endpoint favouring the combination. Now the study examined the incidence of new onset DM among these subjects, and concluded that there was no increase among those receiving the treatment. Additional finding showed that higher events occurred among DM subjects, which was further reduced by Vytorin. Therefore DM subjects are the special group that need more aggressive lipid lowering.
Finally WHICH trial that studied 1226 patients compared standard vs nurse led multidisciplinary home based treatment among patients with CVD. It was concluded that home based intervention give better survival & all cause mortality by 44% but more so in patients with high clinical complexity score, hence home based therapy particularly beneficial in high risk patients

Lost again? Think of the unthinkable…

As I had written previously in my posting entitled A Tale of Lost and Found (link here) is fascinating that in life, of the off chance to recover what you have lost or misplaced.

Sadly, the handphone, belonged to Ajwad that was temporarily lost, which I found myself, was later lost forever, when he accidentally left it in the bus. Yes, some lost would be almost impossible to recover, and you just have to accept.

Worse still, my third child, Harith who lost his iPhone just about 3 months after it was purchased. That morning he followed me to the mosque for the Subuh prayer, on my bike. Everything was fine till we arrived back home when he yelled that he has lost his phone. We quickly went back to the mosque, frantically searched everywhere along the road, asked the Imam of the mosque and checked every inch of the prayer hall, to our frustration. It rang when I called, with noone answering, and towards the end of the day, the ringing tone was gone forever. That was a lost.

Now it was fair and square, the first child Widad, had also lost her old iPhone in a nearly similar way, except, I managed to track the phone using iCloud, knew where it was, but still unsure what to do. Report to police? Do you think they will be kind enough to go in search of your lost phone, keep hoping!

So today we had a lost again. Ajwad had lost his car key. It so happened that the Proton Satria, when I purchased had only one set of key (remote controlled) which up to these days we had never bothered duplicating. The boy was left alone at home, coming back from meeting friend. Slept overnight, only when we returned home he broke the news about the lost. Of course he went on search all over the place, the whole house was left unspared. In fact the search was so thorough that he began recovering items that previously was decided as permanent lost, such as Harith’s expensive spectacles! That was good, at leas the exercise has given a positive result if not in finding the key, but some other useful (and potentially more expensive) item.

As usual I took a bit of history. The boy came back late at night. Parked the car, turned of the ignition, walked out. He has this habit of leaving the car unlocked, so I guessed this time he did the same. Took out the house key and went inside, did a few things before retiring to bed. I asked him of what attire he wore, in case he had left the key sitting in his pant’s pocket. He said he was wearing a sarong, so one can imagine what way he would be holding the keys then.

A day nearly passed and the boy was frustrated, sat there or laid down all day thinking and doing nothing. Now he begged us to call the Proton garage to send a foreman to install new set of ignition key/alarm. We inisisted on trying or at least give another 24 hours, for what I wasn’t sure. There seemed to be nothing much we could think of. He had searched the shoe box, the settee, his room and his brother’s room, and everywhere like tables, boxes that he could have possibly dropped the key. Negative.

I went through the routine check around the house again, checked his trousers in case. then the bed, the settee again, but everytime I tried the wife kept saying that he had covered those areas nothing else left! For the final straw I tried to imagine his movement again right from the time he turned of the engine.

Engine off, key out, went to the shoe rack to pick something….then inside the house. At what point he dropped or misplaced the car key? Now I checked the car thoroughly, inside out, areas around it. Nothing. Finally I tried to think of something funny. Yes he went to pick up something at the shoerack. And he was wearing sarong, so maybe when he picked the stuff at the shoerack, he had to place his car key, which he was holding on his hand, somewhere. Bingo, he put down the car key, picked the item he supposed to take from the shoerack and went into the house, that’s it!

So I quickly rushed to the shoe rack, examined every inch of it, looked at all the shoes. Nothing. Huh…wait, another shoe rack. But all the shoes looked untouched, except my riding boots, one of which is sitting at the top rack, the other fell on the floor. I picked it and checked to find nothing. Next to it pair of my old office shoes which I have not worn for years, and no one has touched it. I shone the torch on it and yes! I saw the car key sitting quitely inside one of the shoes! Found, thank God

More lost, more found…
Trying to think the sequence of event – the last moment before the lost, does help. But sometimes you have to think of the unthinkable. Lastly, have the believe that the solution is simple, and never give up. Keep searching. This applies particularly with things lost at home, because you know more than likely it is hidden somewhere safe. But if the items are lost elsewhere than home, it would be much less likely to be found, since the chance that someone, or an opportunist to tamper with it would be anyone’s guess.
How can you reduce such a nuisance like losing keys, cheques or documents? I always think, the best way is to have a system to organise your storage. Filing for papers, hooks or special hangers for keys etc, though you will have to develop the good habit and force yourself to follow the system. Like the boy, who rarely keeps his keys in the tray specially made to keep our keys safe.

As an extended exercise, today, I have learned how to discover (again) a misplaced bike’s keys, an important document folder and a cheque. The cheque…I had been looking for it for ages, it’s from a company who paid me for consultation, I remember the amount was RM500, not huge but substantial enough that I can’t afford losing. So, here was the simple exercise.

Bike’s keys – the Triumph Bonneville. It’s almost always kept in the keys tray, but today I could not find it. So I traced the sequence of event again, I could hardly recall the last moment I used the bike. Definitely on Friday night when I came back to work. The trouble is I was not utterly sure whether I did use it again after that! Trousers pocket is the most common place, but there was nothing. Hold on, the riding jacket? negative. Bags – sling bag or backpack could be a possiblity, or could have left them in the car, during a rush to drive the family away. Nothing yielded the result and after exhausting almost everything, short of asking my family members whether or not they saw the keys, or even helped to locate them, I tried for the last time. Association – maybe I have kept the keys with another set of keys, like office keys? I have the habit of keeping the office keys in a bookshelf, one of the documents wallet. So off I went to check, and there I found it!

Back to the cheque – since I also lost the document that I kept along with other riding accessories like helmet and gloves, I knew my wife had been sorting them out and today we bought a shelf for stroing the helmets. Looks nice but where is my document folder? I asked her, and she pointed out to a large bag whereby she kept mixtures of documents, old and new letters some of which unopened. Going through the papers one after another, not long after I found the document folder, and next a few letters and bills that needed attention (poor me…), and finally the cheque – yes, found it! and guess what, it was dated in January 2015…luckily it has one year expiry date therefore I got sometime to cash it.

Bad enough for not organising our life
That’s the whole point. But, no matter how organised you are, someday you will be faced with a loss, or maybe your loved one therefore trying this formula may help.

Triumph Street Triple Endurance Test – for the bike or the rider…?

I had said it many times how good the Street is, however, I must admit that it takes the arrival of another bike in order to fully appreciate the value of one you already have! As mentioned above there was this reluctance to take the Street for a long ride, for the fear of excessive back pain as result of forward leaning position.

Though I have ridden more than 15000 km, not till now I begin to appreciate this machine more and more

Though I have ridden more than 15000 km, not till now I begin to appreciate this machine more and more

Since having the Bonnie, I had already undertaken a two series of long ride to the North on it(read the review here). It was fine with the exception that the Bonnie is ‘happier’ to be ridden rather gently, and best to stay at or below 160km/hr. You can push it to 170/180 (its not that I do it regularly you know…) but it would be a hard struggle and impossible to keep even at 160km/hr for too long. Another is it’s slightly less agile due to the rigid suspension, sometimes you loose that feeling of harmony with the bike, when the rear tire feels sort of waning a bit once you do an extreme manouver like switching lane aggressively. When you need that performance ride and the extra umphh then the Street is the definite choice.

I was right, and once I made up my mind to take it for a long ride to Trengganu – I was fully satisfied, indeed the STreet gave more than I expected.

Taking the Challenge
I was set to accompany two friends to Kota Bharu, as part of their journey across the border with the rest of MIB team. I did not join the trip due to local commitment. They were the two riders who could not join the team who have left earlier in the morning. Then, as we met at the RV point at BHP Gombak, we found out that the other guy, KZ had to cancel due to pouring rain in his area at Shah Alam. Initially we were quite taken aback, but thinking about it, then I thought there is no way we can force people to ride (despite the weather), we can force someone NOT to ride, and not the other way. So, I was left with no choice, have I not gone ahead to accompany R, there would be a strong possiblity he will back off, and I could be the guilty party then.

I had a meeting early morning the following day. The wife just left with two kids to the camp, means, my other two kids are left at home overnight without big adult…means, I have to come back home by hook or by crook. Thinking about the prospect of riding over 400km and then turn back home, alone, made me almost sweat…knowing the brothers in MIB, they will most likely advise against doing it for safety. So I was torn in between.
So I made a deal with R, I will not be able to ride all the way to KB, but I shall accompany him to a point he feels comfortable to proceed. And to him, its Kuala Berang, near his home town, where he will have the opportunity to rest there, or proceed to KB if we arrive early enough. And Kuala Berang is just over 400km away!

We began the journey around 3.30pm after a cool lunch and refuelling. I was riding the Street and R his Sym Evo 250i, what a missmatch you may think. Knowing R, he is such an efficient rider, at open highway he will ride at constant speed of 130km/h plus, but thrown into a traffic congestion he is the king, and will not waste a second to project himself ahead of others. However today, for some reason I initially did not know, he decided to keep himself at a lower speed below 130. That was pain (oops).

Huh….as the Street began its cruise along the Karak highway, I kept at 4th gear, anticipating series of corners ahead, I started to feel restless. Not a few seconds pass and R was nowhere can be seen behind. Never mind I thought, he will catch up when I got to those tight bends – since I am quite hopeless with them. Suddenly just as we approached Genting Sempah, I saw vehicles slowing down as a long que started to build up. I had just begun enjoying the corners with this ‘new’ approach when the traffic came to a halt. I was caught once when I tried follow the emergency lane (gravels and soils on the road, waited clearance to join the first lane gap, and R quickly launched ahead leaving me struggling with lane splitting behind.

Not long after the congestion started to ease off. I must say the STreet is well capable of tackling those tight gaps, but I am talking about tackling it at high speed, of course a no no when met with mixtures of tailgating plus tight corners, no choice but I had to take it easy. Once I was clear, I began squeezing the throttle fast, the machine just complied with no sign of stress at all. Now comparing with the Bonnie, it was a breeze to enjoy streaming at 160-170 or 180plus (occasionally) smoothly. Yup, its such a muscular machine, and I felt comfortable despite the foward leaning position. In fact the position is ideal for dealing with wind and high speed riding. In no time I caught up with R and took the lead again.

At one point I was overtaken by this Z1000x I thought, I quickly caught up just to remain closely behind the rider, maybe he realised he was being followed. When it came to tight gaps, I felt I could do better and once freed, I squeezed the throttle hard almost to full, very close but I decided not to overtake him, I know he owns a more powerful machine! no wonder the guy is riding a litre bike which is no match to my Street, though almost! (Well I supposed, the game would have been entirely his when we come to corners huhu).

How does it compare to my Bonnie T214?
Most amazing, comparing to the Bonnie, both being naked bikes, the STreet did far better at higher speed. At 140 cruising is a doodle, you hardly feel the wind resistance (keeping in mind my Bonneville has no windshield yet). Even stepping up to 160, 180 is a gem, and the humming sound when you get beyond 150km/h is seductive. In contrast to Bonnie (quite viby at high speed), steady ride at 160 is a pleasure, I could squeeze to 170 and beyond without feeeling any vibration or instability, yes a confidence steady ride at such a speed, as long as I am on a stright line. On a high speed corner, it is possible to maintain a 150 plus without any trouble. Ooops, I forgot about my friend, now I definitely could not trace his shadow…so I had to practically stop on the roadside and wait. That was good, coz i could take the time to stretch out, walk back and forth straighten my back and exercise my neck. 160km on, I stll felt good.

Two Triumph bikes side by side....well it poses a dilemma when I want to start the journey as to which machine should I take?

Two Triumph bikes side by side….well it poses a dilemma when I want to start the journey as to which machine should I take?

We took two stops, one at Gambang, and another … not another. From Gambang it was a straight long, almost boring ride. R said we could go all the way pass Kuantan, but I almost made mistake at the Kuantan Tol booth when R came behind signalling me to make a U turn which took us back to the LPT (I was slow enough then R could see me). From then on, straight ride till we reached the Kuala Berang exit. My fuel reserve indicator had long come up but I managed to keep going and the reading was 220+ when I reached the refuel station.

Home with happy mileage…
We stopped for maghrib prayers and then made a U turn and ate at a nearby restaurant – simple menu (that took a while to arrive!) consisted of fish Tomyam and Kailan ikan masin. Due to the long waiting, it took us a total of 90 minutes or more rest before started riding again. By now R had decided that he is ok to go alone, indeed he was near his house, but proceeded straight to Kota Baru, which was just over 180km. I headed back to KL which was another 400km plus, alone.
Now this is the most challenging part of the ride. Riding at night, a long straight ride, and it began to rain. God knows how nervous I felt in the beginning. One of the MIB members asked on the Whatsapp group how I plan to spend the night. I left the question unanswered.

Bidding farewell...after riding together for more than 400km, we were ready to bid farewell, each proceeding to own destination...and my ST awaits happily to take me home

Bidding farewell…after riding together for more than 400km, we were ready to bid farewell, each proceeding to own destination…and my ST awaits happily to take me home

Riding gears on, I started the bike, ahead of R, we both headed the same direction till the beginning of the highway that separated us according to the direction. I bid farewell to R & prayed to God for his safety. Just as I about to enter the highway, there were a number of young guys riding RXZ acting suspicious as if they are going to rempit. I speed away and did not see any sign of them again. Now onto the highway, I felt warm and my confidence grew. Amazingly I did not feel tired, even after that long ride. My back felt normal, though my neck hurt a bit. I built up the speed, 140, 160 plus…and the bike kept going nicely. Then came to the unlit part of the highway, I suspiciously slowed down a bit, when the ran began to pour quite heavy. I had to take it easy this time indeed quite a number of time I just kept it at 120-130km/hr. Being a naked sport, its not easy to keep a constant speed, and despite the rain I could not avoid passing the 130 mark. In total I travelled under the rain for almost one hour, covering over 100km of highway, when the weather began to get clear. Now I was on to the better part of the highway, though most part were still unlit – which I despised this shortfall. My aim was to reach Gambang, distance in total about 220km. Now I kept to a constant speed between 140plus to 160, or more sometimes especially when coming to a well lit area I could squeez more juice out. The road was rather quite in most part, that was not very desirable, since I had no clue what it was like, except that I had to rely on my own vision. My eyes fully focused on the road and surroundings, watching for any signs of puddle or any unusual objects. It is known that sometimes animals like monkeys or foxes could cross the road at this time, and I am definitely not going for the kill or else I would be the one troubled.

Off to Gambang, there was jubilation and excitement, knowing I only had less than 200km to go. I rested a bit, drank coffee, refuel and check tyre pressure before resuming my journey.
Gambang KL was much more civilised with the traffic began to build up once I passed Karak tol. The worst part was tackling the curves in total darkness, I almost gave up, slowed down a lot and only picked up my pace when the lighting got better. I kept wondering how the authority have the heart of leaving such dangerous bendy road unlit, in fairness it is not very safe even for cars and other vehicles. All I could do was slow down and refuse the temptation to follow other, more experience or daring riders. Passing Bentong there were better lighting and I felt more confident going at speed. The rest of the journey was smooth and thank God, I arrived after spending in total about 3 hours 40 minutes (including stops) of return journey.

Arriving home, it was all for a happy ending after breaking the record of doing over 800km ride within a day!

Triumph Street Triple ABS One Year Experience – Life in the fast lane continues…

14 months ago, celebrating the arrival of Triumph Street Triple ABS
After a long research I came to a conclusion that the best and most practical bike for my daily use is a naked bike and I chose the best, if not one of the best naked bike that was Triumph Street Triple ABS. I decided to go for the ‘ordinary’ Street without ‘R’ to keep thing simple and cheap. The result: 14 months of fabulous and rewarding ride with over 15,000kms completed.
Though Triumph brand is popular across the globe, in Malaysia people especially from the older generation remember it by the existence of the old classic. Truely the brand have only been revived in the country since the last 5 years or so. Then came Fastbike promoting all range of the bikes to Malaysian customers. The three most popular got to be the Street (naked), Bonneville (classic) and Tiger (touring).
When I first entered the world of riding, I only knew one thing, that is any big bike is a superbike. Anything with the capacity of over 250cc or so will be regarded as a superbike. So when I decided to pursue riding hobby and upgrade my KTM Duke 200, I started looking for a ‘mid-range’ bike. This means any bike with the capacity of 250cc to 800cc. Not a litre bike, that belongs to different league. A mid-range would be the most suitable next step, allowing me more grunt aka power to move around, faster acceleration and higher speed, or even better safety features such as ABS. That was meant to give me more comfortable ride to work and further, short to medium distance rides.
20150211_115516The Street is agile, quick and ‘muscular’. Though not as aggressive as the like of Kawa Z8, Ducati Monster or Yamaha R6 its 105bhp is enough to propel me from 0 to 100 in less than 6 secs, and keep upshifting the gears, I could reach 160-170 in no time, on a clear road of course. This is not a speeding manouver per se, but it certainly is a necessary capability of the bike especially in dealing with certain circumstances. I like the smooth engine, I could crawl quietly with 1st or second letting the clutch released freely – a manouver that I frequently adopt when approaching home along the quiet neirbourhood, or at the basement parking at work. In fact, so smooth that someone said you could trod along the street all day with the 1st gear! At higher gears, I could reach well above 120km/hr remaining in 3rd, and with 4th. will take me up to 140-150 when the engine roaring becomes excessive. The 5th. could easily bring me up to 180, when engine strain can be felt. To accelerate beyond 180, at 6th. of course, will happen at special occassion only as the windblast becomes unbearable. But yes, when the time is right you could take it beyond 200 with no complaint (best to keep it short…), and there is yet more power left to be exploited. But I will never be a speed maniac on this machine, no. If I were to speed beyond 200, I will take my Golf GTi which I could do it with more confidence, but again, these days, I don’t really get excited with this prospect anymore, it is enough if you have done it once…and hence can claim the accolade, oh yeah, I had done it before!
As a capable street bike its three-in-line engine is smooth allowing filtering through the city traffic an enjoyable task. Its tyres strong grip can be appreciated when manouvering corners and bend – I am a hopeless rider with corners and most of the time I will lose out to other quicker riders, however as times goes by I begin enjoying the lean and countersteering manouver more and more, now the wife, who joins as pillion from time to time started complaining of my new excessive ‘leaning’ habit…

Precision is the word…
I remember my first day experience. It only took me a few minutes to feel at home with the bike and there I was happily cruising along the busy traffic of PJ and Federal highway, no fuss. I could filter the traffic congestion with confidence, despite it was first time riding (I did not test drive the machine before buying it!). On to a clear road, the temptation is so strong to blast the wind and top the speed, just knowing that I had to take it easy during the run in period that slowed me down a bit. With this beautiful street bike, nothing stopped me.
Its precise, sharp acceleration, sharp breaking, confident handling and beautiful engine note is a joy to own and ride. A truly capable machine having plenty of juice to satisfy everyday need and beyond. Sneaking between traffic feels solid and you could almost pass any gap as long as you have the gut to. Flexible side mirrors (folds inward allowing the mere width of handlebar to pass narrow gaps) helps the sleek manouver. I felt I was good, and in full control even in tight traffic, till one day my confidence shattered – following the accident with the KTM Duke 200. Since then, I had to tone down, to regain my confidence. Seems like things could never be the same, at least you know that you do not have the luxury to make second mistake! Nevertheless, the machine complies with your riding style, its all up to you. Best move would be keeping to 3rd or 4th gear, when you still have strong engine braking, while having that umph to accelerate briskly, when the engine roars aloud, producing awesome noise. Plenty of muscle yes, its all down to your own bravity as to how much you are willing to push it to the limit.
I had that few occassions when I really needed the power and precision. I had 15 minutes from home to the hospital in a dire emergency. The machine happily delivered me on time, it smoothly took on the road filtering the night time modestly busy traffic without fail. On this occassion I kept to 4th gear mostly which gave a perfect balance between punchy ride and precise breaking that was greatly aided by the engine.
Indeed it is a bike to be enjoyed at any speed. For a good while its engine smoothness became an addiction, when I feel like sitting on the bike all day to enjoy that fabulous sweet engine note.

Daily Ride
A bike should be good to ride as well as easy to handle, during motion and stationary. Thats what this machine is about. With its fairly light body – just around170kg, pushing the bike is not a problem. To turn the bike while parked, I could simply spin the body using the stand as the pivot, tilting the bike to the side – mostly left side – a trick I learned from season bikers. Therefore not much space needed for turning, but tilting the bike will need a bit of confidence and experience or else you end up dropping it.
Pushing the bike back or forth, while sitting on it is not that easy, and never do it on a slope!. I used to be able to do it better when it was lowered (usiing the lowering kit), but later I decided to undo the lowering kit, therfore the bike felt taller and more difficult to steer in some way. When the bike was fitted with lowering kit, I got another problem, that was, the stand was almost vertical when opened, therefore there was a feeling of instability when the bike is parked. I made a mistake once, of pushing the bike backward, while the stand was opened, due to its almost vertical nature (making it stick out longer than the base clearance of the bike…), it caught a grilled drain cover and I was caught unprepared. The bike jolted to the right with extrem tilt, and I ended dropping it on the ground. No major damage though, apart from the indicator light on the right hand side which later need replacing.
That was the learning period, the experience dropping the bike was an expensive one, and I never repeated the same mistake ever. There was only once near fall moment while coming to a stop, this time with a pillion passenger at the back. It was a rainy day, I decided to pull over for a shelter under the bridge, the hard shoulders were lined with gravels, hence it felt unsteady and as I came to a stop, the bike tilted to the right, I used all my might to hold the bike from falling, using my right leg. The wife managed to get off and the situation was under control.
The main use of the bike is for work. That’s it. And it suits this purpose very well. Not so big profile, brisk acceleration, smooth engine allows comfortable ride all day no matter how good or bad the traffic condition. Even when it rains, I know the ABS works well and the great handling, plus full complement of rain gears allowed me to continue riding in most rainy occassions.

The joy can be shared with a pillion too...though may not be the most comfortable way for a long ride!

The joy can be shared with a pillion too…though may not be the most comfortable way for a long ride!

There is still a teething problem with storage. I settled with the tank bag (complement of free voucher from Triumph Fast Bike).
Right from the first day, I took the bike daily to escape the traffic congestion along MRR2. Lane splitting is an art, and one will do it without fail, God willing, once you observe several basic rules. You just need to be good in controlling the bike physically, and your ownselves. And never get intimidated by erratic kapchai riders or other hasty superbikers who treat the road like a racing track. Honestly, on daily commuting experience, I rarely see crazy superbikers, though I see those hasty kapchai riders everywhere.
ST smooth engine, beautiful exhaust note, superb handling all makes it one of the best bike to ride through heavy traffic. Slightly inclined posture could make you tired when dealing with extremely tight congestion, but most of the time it is still manageable, as long as you keep yourself cool.

Long Ride
Unfortunately there was none (not till early this month – see The Street put to test of endurance). If you consider long ride means anything beyond 500km, then I had not done it. The most was approximately 400km return trip Ampang(KL)- Merlimau Malacca-Shah Alam- Ampang on the same day. Another was a return trip to Batu Pahat Johor (return the following day). Few other journeys including convoys can be considered rather short rides – average of 200-300km returns. Shame, yes I have not truly tested the machine for long journey. The thought is, being a naked bike, its too taxing to subject it for a long ride. Unfortunately I have not tested it, so how did I know?
I have made a rule, when riding to stop at every 1 hour. Lately I had done longer, a distance up to 190km, with the Bonneville. With this Street, after a full one hour ride, you definitely need a break, at least to stretch out and straighten the back. The return journey to Malacca was quite a taxing one, I felt like, with this naked machine, 400-500km is perhaps the longest that I could cover in a day.
The good thing, the bike is agile, punchy and feels very stable even at high speed, making it such a pleasant companion. Right from the moment I flicked the first gear and go, it takes no time to launch to a ecstatic speed of 140km/hr, and keep revving, in no time you already reach 180, that I consider my top speed which I will only consider reaching on a clear road. Beyond 180 it takes a little longer and you need to shift to the highest gear. But even with 6th., I can still comfortably overtake without downshifting, provided I keep my speed above 110km/hr or so.

Convoy ride is one way I learn the art of riding from the more experienced friends

Convoy ride is one way I learn the art of riding from the more experienced friends

For a comfortable long ride, a speed between 130km/hr to 160km/hr is very sensible and fun. These days it may not be very easy to maintain this speed due to high traffic volume. I would drop my speed to between 120-130km/hr to pass between vehicles when lane splitting on the highway.
Regarding fuel consumption, average full tank will cover 250km/hr. Fuel light will come once you touch 200 mark, a little more when riding on highway, that depends on your speed.
The riding position is a little forward incline, therefore, long journey can be tiring, one will need to get used to. But this is perhaps the best riding position, balancing between comfortable posture a sense of urgency as one would feel when riding a naked bike – that sort of ‘unsettled’ feeling – as one rarely feels good to stay at a particular speed. Rev a little more, and you already pass the 160-170km/hr, when windblast is too strong you won’t last too long at this speed. But chopping the acceleration a bit, there isn’t hardly any speed by which you feel you can maintain to a happy end. It seems like, being a naked street bike, it is made to go faster and faster as you progress, its that feeling that you always have to vary your speed, slower when things look tight, or you get tired, and faster when you want more fun or get challenged by those occasional erratic drivers or other riders (huhu, I don’t do that often, you know).
The bike’s quick pace is a very useful ‘safety’ features when maneuvering tight traffic on the highway, this is where the machine feels so solid and strong, fantastic handling that will not fail you. Why I said so, you definitely need that strong torque when passing another vehicle at high speed (talking about 160km/hr or above), and also when trying to escape from danger such as some lunatic who tried to tailgate behind you. I have rarely failed to keep ahead of any cars, except a very few occasions, when one or two crazy prestige car drivers decide to floor their accelerator to a speed beyond 200km/hr. I backed off, sorry I don’t participate in road race.
What more, it takes corners willingly, you just have to learn the art of cornering. I admit this is one of my weakest link, I rather slow down and take it easy. But lately I am enjoying corners more and leaning and controlling the machine on corners has been fun. Long or double or even triple corners, still a big challenge that I need to refine my skill further.

Read my other post Endurance Test – for the bike or the rider…? my real long ride experience with the Street Triple that has changed my riding perspective. The bike delivered, and beyond, awesome

Problems? Not really.
Once I failed to start the bike. I have kept the gears neutral, undo the stand, pull the clutch as usual, tap the ignition and nothing happen. There I did it again and again and it refused. I checked, there was still a good amount of petrol in reserve. So I left the bike cold for one hour, went out to sip coffee with friend, came back later with a bucket of petrol and topped up the tank, just in case it was fuel problem. This time I managed to start the bike no problem – it never happened again, and the guys at Fastbike had no clue of what whent wrong when I told them the story.
I still get annoyed with the failure to strike the gear from neutral, it happened quite a number of times, especially when I flicked the gear gently. If I snap it hard, it worked all the time. But who knows, it all depend on the mood, and it is annoying or even embarassing when what you use to do everytime to engage the gear, suddenly fail – not once but many times. Again, no help from Fastbike despite my bitter complain.
As regards fuel consumption, generally satisfactory, though I could be happy with more. 200km is standard for a tank, I have ridden beyond 220km and fuel indicator estimated 30km plus left. However, the fuel reserve indicator tends to light up rather early sometimes, especially on long rides, indeed it started to lit at 170km plus! I kept riding and managed to reach the next refule at 220km with no problem. In fact at this point I could only top up about 13-14 litres, means there is still plenty of reserve left. Therefore, a good practice is to top up once you reach 200km, in order to avoid the shock of running empty tank.
Others, hmm no really, I could have not asked for more I guess, it is such a fantastic bike and I felt very lucky to own it. I wish I am an inch taller that I could handle it better at stationary, and I do need a bit more of lesson in cornering.
Windblast is a certain problem, just with any naked bike. I got the short flyscreen, which is not too protective I think. Despite this I can still push the bike to 160/170km/hr and feel steady most of the time. Wearing the right gear and keeping yourself light (no heavy luggages etc) will help.

Verdict: One year (or more) experience with Triumph Street Triple ABS
Satisfaction: 4.5/5
Met expectation?: 4.5/5
Build quality & look: 4/5
Will recommend to others: 5/5

Playing with statistics in medicine…

Finally the therapeutic dilemma came to an end…
There was this young ex-pat patient came to my clinic with new onset atrial fibrillation (irregular heart), as she has hypertension we recommended blood thinning medication (anticoagulation) called warfarin on her. Soon after, another doctor prescribed a new novel anticoagulant A, which costs >100 times more. When she came to my clinic she told me that she has not started the medication, as she was not sure whether it was good or not..
Apparently there was some lack of communication. So I went through a brief counselling till she asked, which one is better? I told her comparing the two, the new one, drug A is of course far better, as has been proven in clinical trials. However, taking warfarin strictly with good INR (a way to check your blood thinning index) is likely going to give you similar protection, with overall higher risk of bleeding – the cost however is the main obstacle.
Now the patient said: I trust your decision, doctor. And I am willing to spend the money….
Knowing she has a very young daughter diagnosed with SLE, I really pity her, and this put me in serious dilemma having to recommend a treatment costing over RM400 (or higher cost for her as foreigner) – and yet there is no sure way to tell her she will benefit more compare to her current treatment – its all about statistic – if the ‘number needed to treat’ is below 30 – then it is something very compelling – but in this case it is far more (167 for efficacy & 67 for serious bleeding)…of course there are other benefits like less interaction with food, drugs, and no need for blood test (INR clinic).
Sighed….in the end I advised her give it a try and see how she tolerates the new medication…today, she came back telling me that the new medication had caused her to have pain, cough and shortness of breath. She happened to suffer from flu as well. Well, not a direct adverse event from the medication, however, to remove the doubt, and due to her reluctance I advised her to revert to warfarin.
The lesson here, decision making in medicine may not be very straight forward especially when cost effectiveness is concerned. Patient counselling is an important part of management, do make the patient aware and understand the benefits and risk of the treatment, as well as potential cost effectiveness.