THANK YOU… 

Dear husband, 
Calm down! This is not a rant. I’m not here to complain about anything. This is a letter of appreciation. I just want to say THANK YOU… 

Thank you for loving me. Thank you for being my Godsent protector and sustainer. Thank you for crowning me as the Queen of your heart. Thank you for trusting me enough to make me the manager of your home. Thank you for believing in my dreams and helping me achieve them. 



Thank you for the basic provisions and the bonuses. Thank you for hustling in the midday sun while I bask in my air-conditioned room. Thank you for going through the bustles of the city to bring me food and clothing. Thank you for risking your life so that I can enjoy mine. 

Thank you for putting up with my mood swings and periodic nagging. Thank you for your understanding during the times I was weak or sick. 
Thank you for the little things you didn’t even remember you did – like fixing the light bulbs and replacing the clock batteries! 

Thank you for the things I didn’t expect you to do but you did anyway. Thank you for the surprise gifts and occasional treats. 
Thank you for your kindness towards my parents and siblings.

Thank you for assisting me to keep my duties towards Allaah. Thank you for waking me up for tahajjud and enjoining me to pray on time. Thank you for reminding me to recite the Qur’an and daily adhkaar.

Thank you for everything I forgot to thank you for. Thank you for the little things I didn’t notice. Thank you in advance for the good things you’re planning to do. Thank you for the things you intend to do but you don’t have the means yet. 

JazaakaLlaah khairan! 

Signed

A grateful wife. 

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“70 WAYS TO LOVE YOUR SPOUSE”

The first five years were the bomb.  The intimacy was great. The food was always ready in time. Behaviour was top notch. Looks were flawless. Everything was on point. The best word to describe this phase is: PARADISE. 
By the end of that phase, the theme begins to change. The fertile couple starts experiencing the reality of parenthood while the subfertile ones become extremely tense.  There is a paradigm shift from “my husband/wife” to “my children’s father/mother”. Show of affection becomes a seasonal affair. The bedroom becomes just a place to sleep and snore. Communication is reduced to “please buy diapers on your way home, thanks”…. 
Oops! Sorry, wrong title! I’m not here to give you a list of ways to love your spouse. You will have to find out by yourself. As a general guide, find out what works for you and stick to it. What works for couple A might not work for couple B. What are the things you used to do during the honeymoon that you’re no longer doing? Which of those things can you start doing again? What do you need to do differently now? These are the questions you need to discuss with your spouse over and over, and work out the answers, together. 
No one can teach you how to love your spouse better than your spouse. Ask them what they want and how they want it; however, be realistic and reasonable. Pay attention to the fine details. From time to time, arrange dates and outings; away from the interruptions and tantrums of the kids. 
Monotony kills love in marriage. Up your game! Update your wardrobe according to your means. Upgrade your bedmatic skills. Try out new recipes. Read books to sharpen your mind. Mix with older couples and learn from their success strories (but avoid comparing; each couple is unique). 
Most importantly, search within yourself and strive to bring out a better version of you. You will have to make a lot of sacrifices, but these things pay off eventually. Patience is an essential ingredient; it breeds love, happiness and peace of mind.

​RAMADAN LIFE OF A MUSLIM DOCTOR

 

Switching from pre-Ramadan to Ramadan mode can be very challenging for those of us in the “special duties squad”… Health care professionals, security personnel, etc. It’s much better when you’re working in a place where there are other muslims to identify with. Otherwise, you have to contend with people eating, drinking and gossiping around you while you’re fasting. 
The painful part is having to (occasionally) eat suhoor and iftar in the hospital, away from your family. Sometimes, it becomes inevitable to skip suhoor when you’re in the middle of an emergency which doesn’t get resolved until fajr. Sometimes you miss the taraweeh in jama’ah and have to make do with witr plus/minus 2 or 4 raka’at whenever you’re free. You plan to finish 2 rounds of tilaawah, but you end up struggling with one… All the same, AlhamduliLlaah! 
When work gets busy, time runs fast.  Before you say Jack Robinson, it’s time for iftar. The excitement of serving humanity and saving lives makes you forget about hunger and thirst. The sight of patients in pain and suffering makes you see the home-cooked iftar as a non-issue. The constant reminder that sickness and death doesn’t respect age or status, makes you more humble and thankful. 
Personally, Ramadan makes me more patient with patients. I’m more calm when talking to them. I can listen more attentively. I’m able to show more empathy. I don’t mind if you’re malingering, I’ll hear you out and offer you soothing counselling after your rant. I feel how it is to be hungry, so I understand how a patient on “nil by mouth” feels… 
Ramadan is such a blessing and a period full of lessons. If Ramadan doesn’t make you more pious, I wonder what will. 

O Allaah, open our hearts to receive the blessings and open our eyes to see the lessons. Aameen. 
“O you who believe! Observing As-Saum (the fasting) is prescribed for you as it was prescribed for those before you, that you may become Al-Muttaqun (the pious) – Qur’an chapter 2 verse 183. 

BREAST CANCER 

Breast cancer occurs when there is abnormal, uncontrollable growth of cells in the breast. These cells grow beyond the normal confines of the breast tissue and can spread into adjacent structures and distant organs. It is the most common malignancy affecting females in the western world (second commonest in developing countries – after cervical cancer). In England and Wales, over 40,000 new cases are diagnosed each year with over 20,000 deaths. Men can also be affected by breast cancer but it is more rare (cf. 260 cases, 68 deaths). Mortality from breast cancer remains high in developing countries due to inadequate screening programmes. 

RISK FACTORS 

There is no known single cause for breast cancer but there are numerous risk factors. The common denominator for these risk factors is prolonged exposure to excessive oestrogen (the female hormone that promotes the growth of breast cells). 

These risk factors include:

*Early menarche (less than 11 years at onset of menses) and late menopause (more than 52 years before cessation of menses) 

*Advanced age (mean age of breast cancer was found to be 49years in a Nigerian study) 

*Family history (breast, ovarian or colonic cancer in first degree relatives – mother or sister) 

*History of breast cancer in a male relative 

*History of breast cancer in contralateral breast, especially if there is genetic mutation in genes BRCA1 and BRCA2.

*Late pregnancy (>30years before the first pregnancy carried to term) or no pregnancy at all. 

*Use of oral contraceptive 

*Use of hormone replacement therapy 

*Unhealthy lifestyles such as increased weight gain, sedentary lifestyle, alcohol intake, tobacco smoking etc. 

SIGNS AND SYMPTOMS 

Most cases of breast cancer remain asymptomatic until they become advanced. A lump usually becomes palpable in the breast at a late stage. However, NOT ALL BREAST LUMPS ARE CANCEROUS. A breast lump can be suspected to be cancerous if it feels hard or irregular, contains solid nodular components or is fixed to the skin or underlying muscle. 

Most lumps are painless. Pain occurs in only 5% of cases. Other possible signs of breast cancer include:
*Unusual changes in breast size and shape 

*Dimples on the breast skin (orange peal appearance) 

*Retraction or inversion of the nipples 

*Abnormal nipple discharge – purulent or bloody

*Axillary lump (swelling in the armpit) 

*Dilated veins on the breast 

*Tethering or ulceration of the breast skin

*Symptoms of spread to other organs, such as lungs (cough, bloody sputum), brain (neurological deficits like stroke, seizures, etc.)  or bones (fractures) 

SCREENING TESTS 

Because of its insidious onset, the best way to curb the menace of this deadly disease is through effective screening programmes. This will help to detect it at the early stages, whereby successful treatment can be achieved. 
What are the screening modalities available? 

-Self breast examination (SBE) : all women in the reproductive age group should learn how to check their breasts at least once every month (just after the menses)
-Clinical breast examination : once in a while (depending on age, presence of risk factors and result of previous examinations) women should have their breasts examined by a physician. Any sign or symptom detected during the SBE should be reported promptly for double-check. 
-Radiological tests : includes Ultrasound, Mammography, Magnetic Resonance Imagine, or a combination of these as indicated, depending on the density of the breast tissue and individual risk factor assessment. 

DIAGNOSIS 

A definitive diagnosis is made through biopsy. This could be done through a needle with radiological guidance, to obtain a sample from the lump and send to the laboratory for confirmation. Excisional biopsy can also be done – a surgical procedure whereby the entire lump is removed and sent for laboratory (histological) examination. Other investigations needed to rule out, or confirm metastases, as well as prepare patients for treatment include:

Chest xray

Brain imaging

Abdominal scan

Bone scan

Full blood work up 

Renal and liver function tests, etc. 

MANAGEMENT

The first level of management is to “stage” the disease. This “staging” provides an idea of how advanced the malignancy is. It also gives us the prognostic indices such as likelihood of cure, remission and recurrence. The popular TNM classification is used to categorise the diseases into stages 0 to IV, where 0 is the earliest stage and IV is the most advanced stage. TNM stands for: 

T-clinical staging of breast lump

N-lymph node involvement 

M-presence and type of metastasis (local or distant spread) 

Treatment depends on the stage. This can either be curative or palliative. There are 3 broad modalities of treatment : Surgery, 

Chemotherapy and Radiotherapy. Other classes of treatment are:

*Hormonal therapy 

*Genetic modulators

*Immunotherapy 

A combination of these modalities are often employed. Palliative measures used in advanced cancer include:

-Pain relief 

-Treatment of metastatic disease 

-Psychological support

-Hospice care

-Home care and end of life support 

CONCLUSION 

Breast cancer is a disease of public health importance. Thanks to the aggressive campaign for active screening and early detection, mortality rate has been decreasing steadily in the developed world but this can not be said of the developing countries. We need to do more of public enlightenment and advocacy programmes to augment the effort of the government in preventing and curing this disease. 

References:

-NICE guidance, UK, 2016 update

-Medscape reference, Breast Cancer, 2017 update. 

​FASTING AND PREGNANCY

 


Pregnancy is not a disease in itself but there are significant physiological and anatomical changes that may pose some discomfort to the pregnant woman. According to the scholars, pregnant women can be categorised into 2 as far as fasting is concerned:

1. The one who is healthy and fit, who is able to fast without any jeopardy on herself and her baby. 
2. The one who is sick and weak, who is unable to fast because of perceived harm on her and her baby. 

For pregnant women in category 1, fasting is waajib. The same ruling applies to breastfeeding mothers (after 40 days of postnatal bleeding). 

As for those in category 2, they are expected to stop fasting and repay the missed days after childbirth and before the next Ramadan. They fall in the same ruling as the sick or traveller. The evidence for this concession is in a hadith reported by Imaam Ahmad from Anas bin Maalik Al Ka’abi: “Allaah has relieved the traveller of fasting and half of the prayer as He relieved the pregnant and breastfeeding women of fasting” (hasan) 

Pregnant women can fall into category 2 due to conditions such as:

*Severe hyperemesis gravidarum (nausea and vomiting with metabolic derangement and marked weight loss) 

*Infections like Malaria, respiratory or urinary tract infections etc. 

*Pre existing medical conditions with worsening during pregnancy, eg. Sickle cell anaemia, diabetes, hypertension, epilepsy, etc. 

*Longstanding infertility or recurrent miscarriages in the past or bleeding in the present pregnancy (fear that fasting may lead to pregnancy loss) 

*Any other condition necessitating hospital admission and aggressive treatment. 

Dear mothers, study yourself but do not assume. Discuss with a qualified doctor who also knows some basic fiqh of fasting and let him advise you on which category you fall into. 

“… and whoever is ill or on a journey, the same number [of days which one did not observe Saum (fasts) must be made up] from other days. Allah intends for you ease, and He does not want to make things difficult for you… ” (Qur’an chapter 2 verse 185)

​BETWEEN THE QUR’AN AND MUSIC… 

Last year, I posted a write-up – “9 bad habits you can drop in Ramadan”. I think the list was incomplete. I  need to add one more thing – Music. Majority of the people will argue that music isn’t bad; that it is, in fact, a healing balm. I’m not going into that line of argument because there are overwhelming authentic evidence to show that music is a form of idle talk and musical instruments are tools of shaytan. (See Qur’an chapter 31 verse 6 and its exegesis by Ibn Katheer, Qurtubi, Tobraani and others) 

I had plenty of music in my head from childhood, but when I got to secondary school, it became much more. By JSS2, I could chant hundreds of musical lyrics from my memory. I bought the book of lyrics (with my meagre pocket money). I bought audio and video cassettes. I crammed every hit album as they drop. Yeah, I was that girl…

AlhamduliLlaah for Islaam. A brain that has memorized the Qur’an has no business enjoying music anymore. Music stinks when the Qur’an is being recited. The Qur’an lifts your soul in a way music can never come close to… 

The feelgood effect of music is indisputable. But is that our purpose in life? To come and feel good and die? No. We are here to worship Allaah and Allaah alone. Feeling good is not a sin, but the “feelgood experience” that doesn’t take you closer to Allaah; that even makes you disobedient to Him; is that one a feelgood?!  

How do we avoid music in a world that is full of it? Well, that’s where your intention comes it. Try your best and leave the part you have no control over. When the neighbours loud their music, loud your Qur’an. When the bus driver starts the music, put on your earpiece and listen to the Qur’an from the comfort of your mobile phone. 

Dear brethren, promise yourself to discard what is left of music in your life today. Start this Ramadan and don’t look back. It may be difficult, but it’s doable.

​PREPARING YOUR BODY AND MIND FOR RAMADAN

 


Think of Ramadan as a fresh bridegroom and you, the new bride. Imagine how the new bride prepares for the D-day… She undergoes a total beauty makeover. She goes for a medical check up to rule out any infectious or genetic disease. She buys the best of dresses, the finest of perfumes and jewelries of gold and silver to adorn herself for her groom. She also studies a lot about marriage and how to be a good wife from the first night and beyond…. 
This is how a muslim should welcome Ramadan. Begin to simulate the things you would be doing when Ramadan finally arrives (more nawafil, more qiyamul-layl, more recitations, etc). The best way to prepare for Ramadan is by fasting.  The Prophet (saw) used to fast more in the month of Sha’baan than in any other month of the year (Hadith). Fasting helps to prepare your system so that the 29/30 consecutive days  will not come as a shock to your body.
You also need to understand the physiology of fasting. Fasting is one act of worship in which EVERY part of your body participates. Fasting is a potent detoxifier. When you begin to feel the pangs of hunger, the stomach sends a signal to your brain and your brain transmits a “low time” alarm to the rest of your body. So, you tend to be less aggressive, less distracted, albeit spiritually motivated. No wonder fasting was prescribed as a way of curbing sexual urge… 
Visit a clinic and do basic health check for yourself and your family. If you have any chronic medical condition or you’re taking some medications routinely, discuss with your physician to see if you can fast and if you can adjust the dose to suit the timing of fasting. The ruling of fasting by the sick is clear. If fasting would harm you or aggravate your sickness, skip it and pay later. (Qur’an chapter 2 verse 184-185)