Sunday, April 19, 2009

light at the end of the nostril

It was ENT time. I was late 12ish and the appointment was for 10. Hope no-one complained. When I went to the waiting room the nurse ecognise me and said the docs out for lunch, come back at 2pm. Not much I can do, just have to hang around and accept the 'punishment'.

2pm comes by and in I went. He managed a 'how are you' I said good, after all no CSF leak. His office was more quiet now and he seems to have more time. In went the 'anaesthetic' the cocaine. I took a sniff, wonder if it 'helps'. Don't feel any 'happier'.

Then up went the scope. I see that there is flesh from the left wall connected to the right wall. The passage now seems blocked by growth, there was 3 small openings. One seemed to go to a dead end, one to the base skull and the other I don't know. Looking at this it appears that there is no way a feeding tube can go up there. He then zoomed in to the central opening. It was dark but there seems to be a bubble like thing at the end. It was also throbbing. He says 'that's your brain throbbing'. I'm actually looking at my brain! The throbbing coincides with my heart beat so it looks like the blood rush from the my heart is showing through the hole in the base skull. I think to myself, this looks bad, the central opening goes straight to my brain. If I go into a coma hospital staff may insert a feeding tube throught the nose. If they put it through the right nostril then it will go straight to and possibly through my brain.

The white stuff that I thought was some kind of gel was still visible. This time he said he was going to remove it with tweezers. Ok. I look on as he pinches the thing and pull it out. It bled a little. It was a small thing. I thought it was bigger. Under it seems growth. Permanent growth that blocks my nostril. There was now no way anything can go through there anymore.

The doc says I'll see you in a few days. He asks if I'm gonna get radiotherapy or chemo. I said I'll see the neuro on monday, I'll find out then and let you know on tuesday.

I ask him about a medic alert badge to inform medics I cannot have tubes entering the right nostril. He said he didn't know. I voice my concern about the nostril he said he can right a memo and put it in my wallet. I said ok, maybe I can write something obvious and attention grabbing so someone can read the memo.

Sunday, April 12, 2009

the postman always knock twice

I get to go home, fantastic. I didn't have to see my daughter walk home waving googdbye. I get to take her home this time.

Dr Shan does the paperwork but said I would not get any medication. I didn't feel confident. I needed the devil's brew, not for a week but a few days would do. I was worried especially with the surgeon saying I will get 'IT'. He says no, its got bad side effects especially kidney stones (so he knows about this, thats good) but I still wasn't getting any, even for a few days worth. Dr Thinnesh walked by. Says how I was. I said I was back to by 'normal' self. I was hoping the good appetite would stick but that went with the steroids. Oh well, nothing lost but the tumor. I ask if there was anything to get my 'good appetite' back, he said vitamins. He also said he'll give a weeks supply of acetazolamide. Thank god. I feel better already as the medication stopped the leak but for only 3 days wasn't good enough to instil confidence in me as I know its character, it was gonna leak if I didn't get it for a few more days. When he said that I was ecstatic. I didn't even have to ask. What a relief. Now I'm happy. I was waiting around and the nurse came. She says you going yet. I said I'm waiting for the paperwork. I ask if I can have the poison as it's lolly time. She says ok, do you want the antibiotic as well? Yeah, if it came in a drip. She says OK. Great a pill and a drip to fill the rest of the day. I feel better already. I went to pay the bills the medical assistants statrted to wish good luck but I said I'll be back after paying the bills and getting my medicine from the pharmacy (which takes ages due to the number of people that gets treated here, it's the main hospital in the state). When I got back they were out for lunch, I was a bit disapointed as I wanted to say goodbye and thanks for the smiles. But too late. I ask the staff nurse whether I needed to see the ENT again, she checked and said yes. and gave me the appointment cards for the ENT and neurosurgery clinics. She also said that if it started leaking again to go to emergency and gave me a paper with my medical summary to show the medics. Man hope that was not going to happen, then I say my goodbyes and left. I felt a little sad after being here so long.

It was good to be home. The next day I did what I didn't have to do for 2 weeks, put out the garbage. This and that, then in the afternoon, I had a funny feeling in my right nostril. Yes it leaked. One drops worth. Damn. I wasn't keen on going back. I was only out yesterday for gods sake. I said to myself I wasn't going to go back. So I say ok lets see what happens tomorrow.

The next day I was worried, morning toothbrush time was when it was going to leak, this is when it usually leaked the most. It didn't. Phew. But later that afternoon it leaked! Half a drops worth. I was stubborn, I didn't want to go back. So lets see tomorrow.

The next day the anxiety was there, morning toothbrush session passed, no leak. The afternoon I took the day off, no activity. I just laid on my back and watched tv. Of course it didn't leak. Man thank god.

The following days I took it easy, no strenuous activity. Keep the nose high, no bending forward. Thank god for the drug otherwise I would've had to go back. Wouldn't that be funny, a day out, discharged, then back the next day. No way.

I had a followup appointment with the ENT and neuro after 2 weeks of freedom. But the drug was only for one week. I then started to cut the tablets in halves then quarters to to get it to fill 2 weeks. It worked, no leaks.

a deal with the devil

9 days of observation and no improvement. The surgeon was itching to drill my head. I know it. Then they say that I will get a drug to see if it will work, acetazolamide, twice a day to reduce CSF. I said ok, beats surgery. After looking it up on the internet I see that it is not a user friendly drug. Used by mountain climbers this thing is like poison. It increases the risk of kidney stones. So I avoid surgery up the top but may get surgery in the middle. Great, if I was not lucky I get both. One patient had CSF leaked from the stitches on his stomach from his vp shunt. I needed this drug to work. After 2 days it still leaked. Then I get it 4 times a day. For 2 days I laid on my back, this makes the CSF settle on the back of my head and where the pressure is the least at the hole. I had to make sure my nose was as high as possible. Sure enough, it stopped leaking. For 2 days it stopped. Woohoo. It was working. Mr/ Cheang didn't need words when he saw me, just a finger jester to the nose. I said nope. Third strike lucky, the doc Dr/Mr Cheang asked if I wanted to go home. You betcha. Didn't need to tell me twice. I said I can't wait to get 'proper' food again. He said ok get outa here. Woohoo, he wasn't evil, but added if it leaked again I was gonna get 'IT'. I said ok as long as I get to get some 'real' food, I would die happy.

boring

After a week in hospital, I was getting bored. Bored as hell. All I see is what I saw yesterday and the day before. Sometimes the 'victims' change but everything else is the same. No entertainment, no nothing, only the window serves as a point of interest.

There was this patient. An old guy with tatooes on parts of his body. Man he looks like a hitman. I felt a little uncomfortable with him in the bed in front of me. He is the person someone carries around when they want their money back. Even a staff or two gave him a slightly different service than usual. It may be skin deep as this talkative guy on the bed to my left talks to him and he seems ok. But I never saw him smile. Never. A man of few words, like Clint Eastwood but without the appeal. Maybe there was a magnum in his drawer. Then I noticed his head was missing some skull ie soft tissue only. After his surgery he gets a new skull, metal maybe, a new round head. He had a lot of bleeding in the left nostril. Some rough treatment maybe. A day or two later he was gone. Man he scared me.

I then moved beds. Then another guy got admitted in the bed in front of me. This guy seems friendly but the bastard liked to smoke. In the ward! Only thinking of himself. One night there was no wind, only the ceiling fan. Initially the smoke went out the window but when in started to come back in I couldn't stand it, I couldn't breath. I can't stand second hand smoke. I told him enough. Luckily he stopped otherwise I would've had to threaten him. He was admitted with fainting spells and needed an MRI scan but the nurses said that it may take a month or two as the machine was well overbooked. It is the only public hospital MRI scanner in the state! His question was whether he had to stay for that amount of time. For a fidgity bugger like him who cannot stay put, this would be hell. Another patient mentioned that a private hospital offered MRI scans at RM300. This was an option. He took it. He went out and got scanned a day or two later but was charged RM1K. This was how much I paid at another place. Knew it was too cheap. I found out later that he had growth up there in the brain. The doctors offered to operate 4 days from now, a tuesday. But he didn't want it. He wanted to go home against doctors wishes. After getting angry he was allowed to go but without any medication. He was on steroids and anti gastric (histac) medication. Something I was on. So he left, the self centered bugger. I wonder what happened to him.

Today I had to see the ENT again. But since I saw him last week did I need to see him today? Last week I asked the ENT staff whether they need to see me today, they said we'll check. So today I ask this guy that guy, they all say I will get back. They never did. The nurse then came to take me to the ENT, the staff nurse complained that I should have informed them earlier because the apointment time had passed. ??? I was still leaking CSF that day. The funny thing was that when I went into his office, it stopped. The ENT doc scoped and said it stopped. But when I left, it started to leak again. Unpredictable this thing. I remember staying on my back a few days to stop the leak which it did but every morning when I brushed my teeth it leaked, this was when it was the most likely time for leakage. After 2 off days it leaked again. Then the doctors said, huh, because the ENT doc wrote no CSF leak on the diary. What to do, it had a mind of its own. I'm just another sim to a higher being.

On one of the days I noticed this guy get carted in from surgery. He had some spilled blood near his throat and had his head wrapped up like a mummy. An accident victim I thought. At the end of the day this guy comes in with the buffet cart ie a corpses cart. I turned to see the bed where the accident victim went was closed. I knew he didn't make it and so did another guy. He didn't last long. Such a fragile thing life, so easily taken away. So unapreciated when we have it.

After a week I was really bored. The food was repeats of repeats. I had to force feed myself to eat it. I started to try my hand at soduku out of boredom. After a few hours I finished it. Success. While I was doing soduku CSF dripped from my nose to the newspaper below me. I didn't care anymore, I had already told the doctors I was leaking anyway so it wouldn't make any difference. It just kept dripping like a slow leaky fawecet. A few days later I finished my second soduku puzzle. I wonder how they put the puzzle together because there is a solution to it but its time consuming (for me) and almost a single path. I think I can write a perl script to solve it. Along the way this guy pestered me, he said throw this number here, there. I said no, it has to be unique, after a while he understood the complexity.

His father was diagonally to my left. He always winges about the pain. The annoying thing was that when he said it hurts I felt my IV hurt. It was annoying. After a while I didn't notice anymore and he went to sleep. Later the nurse came for his shots and he said it hurts, etc. Then he slept. I asked his son what happened. He said a motobike accident (I think), he bumped his head. He said the doctors wasn't too quick on the diagnosis. I said if it was complicated, the solution may take a while. What I didn't know was that he wasn't even scanned yet. He said maybe today, maybe. Sometimes they have to change his diapers. Man it smells. Imagine doing that for a living, poor staff. He was in and out of sleep state for a while until one day he didn't respond to the morning blood pressure test. The trainee called the staff nurse. She slapped him around for a while (only joking) but also no response. She then checked his iris for autonamous response also nothing. Then she looked concerned and called the doctor. The nurse called for a heart monitor. The doctor started to poke needles and doing stuff, and closed the curtains. Then they moved him closer to the nurses desk. The next time I passed him he was on a breathing aperatus and IV everywhere, neck, thighs, etc. This is bad. When his relatives come in they were crying, one fainted. His curtains were drawn. Then I knew. He was conscious, went into a coma, then the end. A fate that could have happened to me if I didn't fortunately got scanned. Dr Muin mentioned this as what would happen if I did not get my tumor removed. I was disapointed that the sole MRI machine (for the state) was so overworked that this guy died before they could see what could have saved his life. Couldn't a CT scan helped? Such that one has to wait months to get scanned, those that can afford it had no choice but to do it privately.

After 2 weeks I was bored and frustrated. I was so BORED with the food. I wanted to take the tray and throw it at the window, and kick the tray holder. But then I would've gotten an injection and sent to the funny farm. I couldn't eat anymore but I forced myself to swallow the 'lauk'.

One day, after getting a drip I asked the medical assistant to remove the drip. He removed it, then looked around for the stopper (to plug the end of the IV), I pointed to one on the shelf behind me. After a while I wondered whether this was mine. I tried to ask around for the MA that put the drip whether he placed the stopper where I found it. I was a little worried, as it could belong to someone else , one with a contagious disease, hepatitas, whatever. I walked to check which hand the guy I shared the shelf with, the guy behind me, had the IV on the left or the right hand. It was the left, it could be his! His bed tag didn't have any contagious notes on it. But I still was not comfortable. Eventually after raising some concerns and getting more attention than I wanted, I found the MA that put the drip. I ask him where he placed the stopper. He said he couldn't remember. Then another MA said change it, I agreed, change it. So he changed it. That eased my mind but hope I didn't get anything. Up to god I guess.

After 2 weeks of hospital food and boredom I could not take it anymore. I was going insane. We all know how cows go mad (mad cows desease). It's the food (literally).

On the 15th day the medical assistant came and took the morning blood pressure. 75/48. This was LOW, very low, very very low. The medical assistant took several readings just to make sure. He said he'll try it 2 hours later to see if it improves. I said ok ,let me go for a walk. Of course this would give false readings. 1 and a half hour later he came back. Liar. I didn't get a chance to 'improve' the readings. Yep the readings are the same. "Doctor". The doctor came and looked at the readings. I asked what are you going to do? She said fix it. Injections was what was going through my mind but I didn't ask. She asks whether I have been eating, I said no, I couldn't not stand the food anymore. She said "eat lah". I thought to myself, I better eat before they start giving me injections.

Saturday, April 11, 2009

Dr Frankenstein I presume?

Days come and go, the nurse ask the same questions as the doctor, "still leaking?". I say yes, regardless of how much came out. What can I same it's true. If I say its getting less it gets more, when I say it stopped it restarts, it's as if there was someone with a remote control, turturing me. So I just it's leaking.

Several days later Dr/Mr Cheang makes a visit. He says will if the leak don't stop they'll have to make a vp shunt. A vice president shunt? Later I check on the internet that it is a ventriculo peritoneal shunt ie a vent to the peritoneal (stomach). This is a vent at the back of the head to drain the CSF ie surgery. This make the lumbar drain look more attractive seeing as it's not permanent. I thought the vp shunt was temporary and will require surgery to remove it. But no, it's to stay, a very long time. I don't like the idea of this tube to the stomach and very long time in one sentence. So I say no handstands, thinking it may go from the stomach back into the brain. He says it has a pressure valve , so only at a certain pressure does it drain and the valve prevents the fluid from going back into the brain. But the risk is that there may be infection. Great more things that can go wrong. I ask about the lumbar drain. He says that that was not going to happen.

A possible bad case is if the flesh covering the hole in my skull base breaks in which case I will get another major surgery. This time a piece of my stomach is removed, my nose cracked open and the flesh from the stomach shoved into the hole, once and for all. A 20 hour surgery!

I think he should've placed a torch under his chin and shone it upwards and rubbed his hands at the same time.

Man it's getting bad to worst.

bigbrother

The 3rd day Dr Shan comes in to see me. Finally I get to be told what's happening. He asks if it is still leaking. I say you betcha. He says you will be here under observation for 10 days and be given antibiotics. Great. This will mean at least 3 IV changes. Bad. But at least I know what's happening. Will I get the lumbar drain?

up your nose with a rubber hose

The next day, day 2 I was told to see the ENT doctor. Sure why not. So I was called into the office. I noticed something different. The hussle and bussle was gone. Previously his office was like rush hour and the doctor will die of stress before I die of cancer. Everyone was after his attention. But this time it was nice and serene. He even managed a hello, how are you. Well what can you say when one is leaking brain fluid? He says "come, sit". So I do and he squirts his happy juice into my nose. What to do it was anaesthetic. I needed to wait a moment for it to work. As usual I look around, looking for interesting medical tidbits. Then I notice the label on the anaesthetic. C-o-c-a-i-n-e. Huh?. Happy juice? You gots to be kidding, cocaine! Man I needed to see this doctor more often. Can't let him have all the fun. No wonder it's always empty.

So up went the scope (a camera at the end of a stick). I see this white thing, some hardened booger on it and thats about it. But he can see more, he mentioned throbbing then he says, yes it was leaking CSF. I have no idea what he was looking at (maybe he took too much happy juice). I thought the white thing was some kind of gel to hold against the removed growth to prevent bleeding. He tried to remove the booger using a sucker. He was trying to get at it while at the same time it was like he was trying to remove my nose like Mr Potato. It was not going to come off, man it hurts. Hello, it hurts. But then he gave up his attempt to suck that stubborn booger. Man my nostril ached bad. He said he didn't want to disturb it. Better leave it alone for now, else it would bleed. Good idea. I will see you in a week. Ok.

Disclaimer: This entry is all in jest only. The cocaine is real but the implications are just for fun. No-one is inappropriately taking the juice, as far as I know anyways.