Not so mysterious
By Dr ALBERT LIM KOK HOOI
Trust in science to come up with logical explanations for 'mysterious'
events.
A FOUR-month-old baby girl from Seremban was diagnosed to have a giant
cavernous haemangioma of her left lower limb. This was reported in one
of our local English dailies last week.
A cavernous haemangioma is an abnormal growth of blood vessels. The poor
infant's lower limb (thigh, leg, foot) has swollen up to four to five
times the size of the right. These things happen and it is unfortunate.
I hope the parents, Mr and Mrs Chong, will get the best medical advice
and treatment possible for their child.
What caught my eye in this news clip was that the parents of the unfortunate
child were "appealing for help from doctors and even practitioners
of traditional medicine to diagnose the mysterious (my italics) illness
afflicting their four month old daughter."
A cavernous haemangioma (from the photograph, it most probably is one)
is uncommon but certainly not mysterious. Neither is any other disease
or abnormality that afflicts us.
I was working in the Middlesex Hospital, London, in the early 1980s.
The first few patients with AIDS were brought in dead to our hospital.
It was then a "mysterious illness" and none of us was willing
to perform a post-mortem on the patients. We knew it was a deadly disease
but we did not know the mode of spread. AIDS is no longer the mystery
it was.
Diseases are no longer "mysterious". The Black Death in Europe
in the 14-15th century resulted in 50 million deaths. No one knew the
cause. It was attributed to miasma ("bad air") or to witchcraft.
Some thought mankind incurred the wrath of God. We now know it was caused
by Yersinia pestis, a deadly bacteria transmitted by rats.
No disease should be classified as "mysterious". My field is
oncology i.e. the study and treatment of cancer. Some cancers such as
breast cancer are common and we know a lot about it.
Knowing a lot about a disease gives us confidence when we advise patients
about treatment. It does not mean we have all the answers. But we can
make fairly good predictions.
Early breast cancer can be divided into about 10 subsets. Women who belong
to the most favourable subset (small tumour, low grade, no armpit nodes
involved, hormone receptor positive, HER2 oncogene negative) do very well.
Only 1 to 2% will recur.
Women in the worst subset (large tumour, high grade, many armpit nodes
involved, hormone receptor negative, HER2 oncogene positive) do badly
and need a lot of treatment. Science and statistics take the mystery out
of breast cancer.
Even for a rare cancer there is no mystery. Take esthesioneuroblastoma.
This is a rare tumour of the upper part of the nasal cavity. It may affect
smell and vision. Treatment is by surgery and radiotherapy.
We need to learn more about this tumour but we are hampered in our efforts
because there are few cases for us to study. Nevertheless we counsel patients
about the most appropriate treatment but with less confidence than we
do with breast cancer patients.
Again, there is no mystery.
Every phenomenon, be it a disease, a meteorological phenomenon (seeing
gurus and deities in cloud formations) or a rock formation (vulvas in
Thailand, Twelve Apostles in Australia) is not mysterious. It is a phenomenon
to be studied. It has a natural explanation.
We may not know every thing about it. But there is no reason at all to
attribute supernatural explanations to phenomenon we don't fully understand.
Even the word "supernatural" is a contradiction in terms. If
something happens or exists, it is a part of nature. Science seeks to
explain nature. The more we don't understand about the workings of nature,
the more PhD programmes this will throw up.
E.L Doctorow likened science to a searchlight. We cast our light upon
the dark unknown. With each year, each decade, each century, we learn
more of nature and physical phenomena. The circumference of our lit circle
also grows and more unknowns are brought into focus for our study. Science
is a never-ending quest.
The word mysterious when applied to physical phenomenon (like a large
thigh and leg due to cavernous haemangioma) is insidious. It leads to
mantras, chants, jampis and a wild goose chase. Shamans and charlatans
may offer supernatural explanations and cures for a condition we can easily
treat in a rational scientific way.
Mr and Mrs Chong, take heart. Most haemangiomas go through three stages
of development and decay. A haemangioma grows quickly for about twelve
months (the"proliferative stage"). In the "rest stage",
there is very little change in the size of the tumour and this will last
until your child is one to two years old.
In the "involution stage", a haemangioma finally begins to
diminish in size. About 50% of these tumours will have disappeared by
age five and the vast majority gone by puberty.
In the meantime, all little Shun Jing needs is tender loving care and
a doctor who will approach the problem with mostly masterly inactivity.
Oral steroids may be all your child needs. Do not fall prey to the quick-fix,
snake oil doctor who promises a cure.
If the word supernatural is a contradiction in terms, so is the word
"mysterious". To me, mysterious only serves to fascinate, provoke
and stimulate me to search for answers.
It is not time yet to settle for the easy "supernatural" explanation.
# Dr Albert Lim Kok Hooi is a consultant oncologist. For further information,
e-mail starhealth@thestar.com.my. The views expressed are those of the
writer and readers are advised to always consult expert advice before
undertaking any changes to their lifestyles. The Star does not give any
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