Heath Ledger and Brokebock Mountain are names that ring a hell for many people

His legacy
One to be remembered: Father of Angiogenesis, Dr Judah Folkman -1933 to 2008.

HEATH Ledger and Brokebock Mountain are names that ring a hell for many people who have been following the recent entertainment news.

Few would recognise, much less have heard of, Dr Judah Folkman.

Though both men died in the same month (January 2008) each event received a different level of publicity.

Quite often, for people who work hard behind the scenes, it takes a substantial amount of effort to be reeognised. Dr Folkman, a cancer treatment revolutionist, was one that contributed his greatest to mankind but remains unfamiliar to the majority of the six billion people on earth.

Dr Folkman was the founder and director of the vascular biology programme at the Children's Hospital in Boston and a professor of paediattic surgery and cell biology at Harvard Medical School, also in Boston.

He was very passionate about his work and many have said they were not surprised to hear that Folkman, 74, was working till the very end. He collapsed at the Denver International Airport on his way to a speaking engagement in Vancouver.

His departure is indeed a great lost not only to his family, but the world at large. Dr Folkman is sur-vived by his wife, Paula, with whom he lived in Brookline, Massachusetts, two daughters and a granddaughter (Hannah).

The early days
Born in Cleveland in 1933, Moses judah Folkman was the son of a rabbi. He had a brother and a sister and, as a boy, started making house calls to the sick with his father.
He began his medical career in high school in Bexley, Ohio, volunteering in a hospital laboratory at Ohio State University. This early calling led Dr Folkman to Ohio State University, where, by the end of his freshman year, he was performing surgery on dogs under the mentorship of Dr Robert Zollinger, then president of the American College of Surgeons.
The young Dr Folkman even designed a device to cool the liver during surgery without causing organ damage and then, he became coauthor on his first academic paper.
With this extraordinary achievement, he was accepted into Harvard Medical School at the age of 19. After graduating in 1957, Dr Folkman began his surgical residency at the Massachusetts General Hospital and served as chief resi-dent in surgery from 1964 to 1965.

Discovery of Angiogenesis Theory
In the midst of his residency at Massachusetts General Hospital, Dr Folkman was suddenly drafted into the Navy, assigned to do research on artificial blood at a facility in Bethesda, Maryland.
The assigned work was finished far earlier than expected, so Dr Folkman and a colleague, pathologist Fred Becker, had free time in the laboratory and decided to study tumour cells growiug in a special apparatus.
Dr Folkman saw something unusual when their black melanoma cells only grew briefly. All the little tumours were exactly
the same size. He knew that this wasn't natural and something must have halted their growth at a maximum size.
That initial observation led to years of experimenting, thinking, arguing, and exploring until he concluded that the tumours had all stopped growing because they couldn't get enough blood.
As this research continued, Dr Folkman returned to his internship at Massachusetts General Hospital, and then began work at Boston City Hospital as a young surgeon.
In 1967, when he was only 34, Dr Folkman was recruited to become chief of surgery at Children's Hospital. While serving as chief of surgery, he continued pursuing his research, believing that "angiogenesis" was the factor that made tumours grows larger.

A lonely voice and a breakthrough
In the 1970s, Dr Folkman's team applied for their first grant based on the hypothesis of angiogenesis and its role in tumour development and growth.
However, the reviewers at the National Cancer Institute turned them down. Dr Folkman never gave up pursuing his research. In subsequent years, as a result of a huge number of experiments, failures, breakthroughs, and insights, Dr Folkman and his colleagues were able to prove four major points:
1. Tumours do require blood to grow;
2. Turnouts do recruit the blood vessel systems that bring in fresh blood;
3. The recruiting mechanism involves hormone-like growth factors emitted by the tumour;
4. The body makes natural factors that can shut down abnormal blood vessel growth; a phenomenon that Dr Folkman named "anti-angiogenesis".
The journey of discovering a new agent which could stop angiogenesis was not smooth sailing. The media troubled him with over-whelming publicity on his research. His innovative ideas drew attention, especially from reporters covering science and medicine.
As a result, news stories often proclaimed his successes, and desperate patients quickly besieged their doctors seeking a new "cure" that didn't exist.
The publicity problem became most extreme in May of 1998, when a New York Times reporter quoted Nobel-winning biologist James Watson as saying "Judah's going to cure cancer in two years."
This placed tremendous pressure on Dr Folkman and his colleagues, especially when some of their antiangiogenic agents failed to deliver the exoected results.
The turning point came about five years ago, in 2003, when San Francisco's Geneutech lnc reported success with a drug they ca]led bevacizumab, an anti-angiogenesis agent which blocked the action of the stimulators of blood vessel growth.
Clinical trials showed that infusing regular doses of bevacizumab actually extended the lives of patients with colorectal cancer.
Since then, bevacizumab has been approved worldwide for use ir such patients. It has also been approved for breast cancer patients in the U5 and Europe, and is showing promising results against various solid tumour cancers.
Dr Folkman's tenacity and determination culminated it the breakthrough discovery that has changed the entire landscape of solid tumour cancer treatments.
His efforts have helped thousand', afflicted with cancer and remain one of the most promising approaches in future cancer treatment development and management.
His passion for results and his determination in pursuing the seemingly impossible have touched the lives of many colleagues and patients alike and earned the highest level of respect and reverence.
"A bright light has dimmed at Children's Hospital and for the cancer-research world. May that light shine again and guide the way as others are inspired to continue Dr. Folkman's vision and research for a cure for cancer. This is truly what he would want," adds Jo-Ann Rose RN.
"To honour his memory we should all follow his example - pursue your dreams, never give up. and believe in yourself. May his memory be eternal."

Coming to terms with size and self

For more than six decades, Michael Berman has lived as a fat person. At 5 feet 9 inches, he has weighed as much as 207.5kg. He has been known to eat three racks of ribs at one sitting, or a 40-ounce steak, or a whole box of saltines. In 1986, after dropping a few pounds, he spent US$2,100(RM7,770) on three custom-made, pinstripe suits. By the time the suits were ready, 10 weeks later, they no longer fit. Eleven years after that he gave them away, having never worn them.

A highly successful political campaigner and Washington lobbyist, Berman, 66, doesn't deny the dangers of fatness or the urgency of encouraging people to exercise and eat healthier. He acknowledges that with 60% of the US population overweight or obese, being fat has serious consequences for the health of individuals and the economy. He'd like to see resources used for a public education campaign similar to that for smoking and seatbelt use.

But forget the notion that fat people can become slim, he says in a new book that is part memoir, part self-help book. They can and should, manage their weight. They can, and should, find an exercise programme they can stick with. But fat adults will always be fat. They are in the grips of a disease over which, in the end, they do not have complete control.

“The idea that you can slim doen by willpower is a bunch of horse manure,” he says. If “nonfat” people could be convinced of this, perhaps they'd start relating better to fat people.”

He is comfortable with being different, now. But he has suffered through countless weight swings, 20 diet programmes, a kidney infection and knee surgery. It has taken eight years of counselling, the careful attention of a personal trainer/nutritionist, and his wife's sustained support to get to that place.

Berman first realised he was not just husky but really fat when, at 13 about 170 pounds, he was in the shower of the boy's locker room after gym. A boy grabbed his chest, saying he wanted to know what it felt like to touch a girl's breast, Berman recalls in Living Large:A Big Man's ideas on Weight, Success and Acceptance, written with Laurence Shams. That was just one of thousands of indignities he would encounter or bring upon himself.

One afternoon in law school, reading in a wooden armchair, he started to get up only to realise he was stuck. “My hips were captured; my bottom stayed glued to the chair and the whole thing lifted up with me as i tried to stand,” he writes. “ I felt all eyes on me,” and decided to play the clown. “Still crouched over, taking small, constricted steps, I carried (the chair) across the room, somewhat like a turtle with its shell, and sat down once again.

Today he winces at all the times he played the jolly fat man: leading college cheerleaders onto the football field by pedalling a miniature girl's bike, playing Santa Claus at White House Christmas parties. Perhaps such experiences were why he could ignore the advice of a friend who tried to steer him away from writing a book about his fatness, saying it would be “undignified”.

As a teen, Berman realised that to be taken seriously and make something of his life, he would have to develop talents. His parents taught him ballroom dancing-the first thing, he writes, that his rotund body was good at. He managed his first political campaign in junior high for a girl running for student council president. She lost, but he learned he could succeed in politics behind the scenes. He didn't need to be cute, just hardworking, shrewd and resourceful.

Life together with his wife Carol has been good, although Carol had to make a couple of what she Calls”accommodations”. The hardest for her was being unable to have children. A fertility specialist told the couple that his sperm count might be a factor; fat men tend to haver a lower number.

In 1998, he started jotting down thoughts and memories about being fat with the idea of writing a book someday. The exercise became an obsession. He read scientific reports and researched cultures of the past in which fatness was considered a symbol of wisdom, serenity and wealth.
He read that for some people, fatness is genetic. But that wasn't true for him, so he began to develop his own theory.

The easy answer, of course, is that fat people take in more calories than they burn. Then it gets more complicated, he writes. Each person's metabolism is different. He , his sister and his parents all ate a lot of his mother's delicious cooking and none exercised much. But he was the only one who got fat.

Emotions play a role, too. From age four, he sneaked food into his bedroom. “Something was driving me,” he writes, “something that was beyond the reach of willpower, outside the realm of reason.”

he and his psychologist came to believe his compulsion started partly as a reaction to his mother. She showed her affection by cooking rich meals and he showed his affection by eating lots of it. As he got heftier in early adolescence, she started withholding food and he ate as a way of asserting his emerging will.

Eventually he had to admit that he was an addict. But unlike alcoholics or drug users, he couldn't go cold turkey: “The most difficult thing about a food addiction is that you can't give up food.”

he pulls out a tiny notebook in which he records his daily food intake and exercise. On one day, suddenly: 4,465 calories.

What happened that day? He couldn't resist the chocolate cake at a dinner party. “I ate probably eight ounces of chocolate,” he admitted. “But i don't beat myself up anymore. I knew I'd be heavier the next morning so the next couple of days I'd be careful.”

a couple of years ago, he wouldn't have been so sanguine. But if there was one thing he had learned in writing his book, it was this : “Managing fatness means accepting ourselves as who we are....in short, learning to live a full and satisfying life at whatever weight and size we happen to be.”

Stopped having periods.

Whos's at risk?


What causes abnormal vaginal bleeding and who is at risk? Abnormal vaginal bleeding may occur between the normal menstrual bleeds (intermenstrual bleeding)or it may take the form of unusually heavy menstrual bleeding (menorrhagia). In postmenopausal women, it may develop after a number of years without any vaginal bleeding.



It's inportant to understand exactly what is causing the bleeding and where it's coming from (uterus, vagina, or some other organ or tissue) and to make decisions about how to control or stop the bleeding.



A wide range of "normal" menstrual periods Periods differ from woman to woman and from month to month. A period can last from three to 10 days, and occur every three to six weeks. This pattern can vary with age, stress, diet, exercise and inherited factors. The flow can also vary. Around 40ml (two tablespoons) of fluid is lost, which the body quickly replaces.
It is common for women to suffer some cramping pain with their period. This is felt just below the navel and may spread ito the legs or lower back. It can be felt as a dull ache or sharp twinge. During a period, it is also common to feel bloated and heavy, get more pimples, feel tense and emotional, and have sore breasts and greasier hair.



What gynaecologic conditions are associated with irregular vaginal bleeding?Irregular vaginal bleeding is a possible sign or symptom of a range of causes. For others, the cause depends on their age and the site of bleeding. Once pregnancy has been ruled out, some of the known causes include:

• Dysfunctional uterine bleeding


• Contraception-such as the pill, injection or IUD (intrauterine device)


• Vaginal infections


• Tumours, polyps or fibroids of the vagina, cervix, uterus or fallopian tubes


• Cervical disorders-such as cervical ectropion, a condition common among younger women, especially young women taking birth control pills-in which the cervical tissue becomes more susceptible to abrasion, often associated with bleeding after sexual intercourse


• Cancer of the uterus, cervix, vagina or vulva


• Some sexually transmitted diseases, such as chlamydia, gonorrhea or genital warts


• Vaginal injury from trauma or sexual abuse


• Some medications such as anticoagulants or anti-epilepsy drugs


• Underlying health problems such as bleeding or thyroid disorders.Dysfunctional uterine bleedingIn more than half the women with

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