February 9, 2014

The Battle with Graves' Disease Prologue: The Thyroid Menace

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I was young, I was idealistic and I was making a killing in the stock market. That was in 2004 when a silent menace crept up and cast a shadow over the next 9 years.

It started when I was getting insomnia for a couple of weeks.

Initially, I attributed that the stress and demand of trading the US Options market.

The options trading platform I uses
Fresh out of attending Atul Sharma Options course, I was making a good 10-15% returns every month writing call and put options. The only problem is that, I often stayed up late, way past midnight, to perform additional analysis and scouring the net for fresh investment ideas. The stress got worse when there are major Fed events or during earning seasons, when the prices of stock can swing from one direction, to the other, all in a span of a few moments.

I tried a couple of methods to solve my insomnia problem.

I tried mediation

I tried aromatheraphy

I bought a "Sleep Well" CD which plays smoothing music and there is some chant in the background, which was supposed to "talk" to your inner conscious and smooth a person to sleep. BTW, the CD also comes in different variety, that promises success, wealth and health.

None of the methods work.

Trying hard to solve my insomnia problem. Aromatheraphy
 Meanwhile,after the initial beginner's luck, I started to take bigger and higher risk bets on the options, and I started to lose money. I was even more stressed out by the events in US as the stakes get higher and I gave up sleep all together and often stayed up late glued to CNBC.

One fine afternoon, I was having lunch with my sis, drinking soup from a bowl and spoon. My hands was shaking real badly as I was scooping the contents of the bowl to my mouth, losing half of the spoon's contents by the time it reached its destination.

My sister saw that, and commented, "Wow, your hand is really shaking badly. Maybe you have hyperthyroid like me also. Go and see the doctor."

I was like: No no no! Cannot be! It's just stress!

But the seed of doubt has already been planted into my mind.

A few days later, I visited my General Practitioner (GP) and he ran a battery of tests on me.

Sure enough, my thyroid level is through the roof!

My GP assured me "No worries, Hyperthyroid is a very common disease in Singapore. You will be cured by taking medication consistently for the next year or two."

Well, that was assuring. However, the price of the tests and medications was not assuring. The blood test cost around $300 and 1 month medication for $40. On top of that, there is the consultation fee of $20 per visit.

After starting on the medication, my symptoms did disappear. However, after one year, the cost of treatment is starting to take a toll on me.

As I was complaining to the cost of the medication to one of my friends, he commented, "Why don't you get referred to a specialist in a hospital via polyclinic? You get an expert treating you and at the same time, the government pays a part of the bill for you."

Sound like great advice!

At that point of time, I had a doctor friend who recommended his friend who is working at CGH who specializes in endocrine.  When I consulted with the doctor at the polyclinic, he insisted that I do not need to seek specialist treatment, as hyperthyroid is a common problem in Singapore. I persisted on my part that I wanted to be treated by a specialist, and he relented, writing me a recommendation letter. However, when I asked if I could name the Doctor, he told me that I will be paying the unsubsidized rate if I chose to go down that route. Doesn't make much sense since I wanted to get a subsidized rate in the first place, so I decided to go with the flow and let CGH assign me a specialist.

Over the next few years, my condition progressively gotten worse and a higher and higher dosage of the medication is needed, to control my hyperactive thyroid gland. Along the way, mild illnesses such as viral attacks and stomach flu, developed complications as a result of the Graves' disease.

There was one particular attack of stomach flu which I still remembered vividly. Typically, we will have vomiting or diarrhea intermittently, but this attack, was so bad, that I cannot literally control my bowels. I will actually loosen my bowels while on the bed and asleep! The flu bug persisted long than usual and I had to go back to my GP two more times over the span of 3 weeks, as I ran out of medication. My endocrine specialist later told me that it was probably due to the complication from my Graves. Many small illnesses will be amplified making it worse than it usually is.     

Another time, I was attacked by a virus similar to dengue. The symptoms are pretty strange: I will have a high fever every afternoon after 2pm and my knee and elbow joints hurt so much that I had to let my 87 years go grandma, go up the stairs first, in my 2 stories apartment. In short, the pain is so bad that I am literally walking like an old man. The persistent fever went on for 3 months, and despite many blood tests, no distinctive virus was discovered. However, all the specialists I talked to agreed that my thyroid condition complicated my condition and the virus attack was more severe than it normally should be. Only time and my immune system can battle this virus. By the end of 3 months, I was so used to the evening fevers and daily paracetamol intake, that I decided to go for my Japan trip in the face of the illness. The first few days in Japan were agony. I was cursing at every flight of stair case and had to stay in the hotel room in evenings while my friends went out to enjoy the Nippon nightlife. Luckily, the Japanese air agreed with me and strangely, my conditions went away near the end of my Japan trip.

I was running a 38 degrees fever at that time
 I became much more sympathic to my grandma who is suffering from rheumatism after this episode.

By the end of the 6th year of my Graves', I was on the heaviest dosage of medication and yet, my thyroxine readings were still out of range. By than, I have adopted a healthier life style by stopping all alcoholic beverages and trying out traditional Chinese medicine. Nothing worked.

In fact, one very respected Chinese Physician told me that my problem is at the genetic level and not even Chinese Medicine can cure a DNA malfunction. He even encouraged me to go for surgery or RAI to remove the thyroid gland

My Chinese Medicine and Western Medicine
My specialist had been encouraging me to go for the radioactive iodine treatment (RAI) and I had pushed it back for years to try out alternative medicines. By now, I was desperate enough to "nuclear bomb" my system with radioactive materials and hoped that this treatment will solve my problems once and for all.....

*Sorry that I wrote the prologue way after I finished the climatic final battle of the Battle with Graves' Disease. But I thought that something is missing, so here is the real prologue!

February 6, 2014

The Battle with Graves' Disease Part V: Going Under the Knife

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My private ward at CGH
Now that the surgery is good to go, the next problem will be dealing with the ward and the cost of hospitalization.

For those who missed out on the earlier parts, here are the links:


The cost of the surgery is of great concern for me, because the hospitalization expenses can build up quickly over the years with a chronic disease. On top of that, I didn't manage to get a comprehensive enough hospitalization coverage as I contracted this condition 8 years ago, shortly I came out to work. All the insurance policies which I applied for after my diagnosis of Graves' were piled with layers and layers of high loading and exclusions. Fortunately, AVIVA came up with the MyShield program, which I signed up for, just before I was diagnosis with Graves'. The AVIVA MyShield program was revolutionary at that point of time, as it removes the claimable cap on all the procedures, making it the first inflation proof hospitalization plan at that point of time. However, AVIVA did not design a rider at that point of time, to remove the deductible and co-insurance and we have to use another plan, AXA premier care, to plug the co-payment hole. The $100 daily room and board limit of AXA premier care, was more than sufficient at that point of time to pay for the deductible and co-insurance component of the AVIVA Myshield Plan. However, move forward 8 years later, this amount barely cover the co-pay component, after a rapid rise in medical inflation. I also regretted that I did not opt for the Plan 1, which covers private hospital.

Oh well, when you are young, healthy and hopeful, you never think that you will fall prey to illness.

My current outpatient treatment is heavily subsidized by the government when I switched from the very extremely expensive GP treatment to the hospital specialist treatment referred via polyclinic. Every 3 months, I will need to pay for blood test ($100-$150), specialist consultation fee ($90) and medication ($50). The total works out to be almost $400 every quarterly and with the heavy government subsidies, I only need to pay $250 on average. However, the problem with our healthcare system, is that if for one reason or another, you opt to go for private treatment or a "A" ward treatment, you will lose the subsidies. For a one off surgical procedure, this ain't so bad, but it is devastating for a person who need to go for expensive outpatient treatment every few months, for life!

I have also stayed in different hospital wards over the course of my short life, and I can tell you, even for a 4 person shared aircon B1 ward, you won't get much rest. 

The number one enemy of shared ward: SNORING!

Tolerating snoring during army days when you are dead tired every evening is one thing, but tolerating snoring when you are in pain, getting roused by the nurse every few hours in the middle of the night to do a battery of tests makes it difficult to catch any sleep at night. In the day, when your room mates stopped snoring, you are disturbed by a steady stream of well-intended friends, and your room mates' friends and relatives, who kept asking redundant questions such as,"Are you in pain?" (Yes, I am in f**king pain!). "Is the food good?" (No! It obviously sucks!). "When are you going to discharge?" (No idea. Until the Doc says so??). So with a stream of visitors in the day and snoring at night, a patient rarely gets any rest in a shared ward.

This is why I made it a point to visit my friends only after they have discharged from the hospital, after being in their same shoes.

While pondering which ward I should go for, the good nurse at the financial counseling center gave me some good advice. She told me to go for A ward (Since my insurance covers most of it) and maintain my appointments with my current endocrine specialist under the subsidized scheme. As long as I do not get referred to my specialists as a result of the surgery under the private scheme, I should still be able to maintain my subsidized rate for my future outpatient treatment. Considering that this is a major op and I would probably need all the rest I can get, I opted for the "A" ward.

20th Jan 2014

After fasting for the last 12 hrs, I packed lightly (iPad, iPhone, Charger) and reached Changi General Hospital at 730am. Changed into the surgical grown, got wheeled into the surgical room and got knocked out by the anesthesia.

I woke up at 11am later in my hospital room, with the procedure completed.

Still groggy from the anesthesia, I wriggled my fingers and toes. Okie.. still there.

Try to hum a few note. Okie.. Voice still there.

Went back to sleep...

By the time I woke up again, it was 4pm. I took some time to examine the tubes around me. The usual drip tube. Check! What's this 2 tube poking out from my neck? I fingered the tubes and it lead to 2 huge balls of blood. The blood plugs, are meant to drain the excess blood post ops, so that they do not cause excessive internal bleeding. 

It does feel strange to have 2 balls dangling from your neck. 

Feeling a bit stronger, I reached for my iPhone and took my first post surgery shot.

First Post Op Selfie!

My Right "Ball"

That looks painful!(Yes it is!)
 Not before long, my sis and my colleague came bounding in 2 hours later, while I was feebly trying to scope the porridge into my mouth with trembling hands. Groan... they have flaunted my no visitors rules! 

The first thing they did, was to take pictures of the slit on the throat and my balls. I was asked to make an appropriate expression in order to add "Drama" to the pictures. (My sister claims that her blog visitors reached record high, after posting her blog. Blood and gore do sell papers!) 

Post surgery, the doctors were most worried about my calcium level and I was made to do a blood test everyday. Luckily, the calcium level stayed normal throughout my stay in the hospital. Meanwhile, the nurses were worried about my ability to pass urine and motion, and they threatened to use a machine to suck my urine out if I don't pass any by end of day 2. Even though I feebly protested that I don't feel any urge (a common post GA symptom), they adamantly insisted that I do it in front of her.

Fish Porridge. Love This!

Fish Mee Sua. Too bland for my taste
Vegetable noodle. Too bland!
I was very very impressed by the menu!

Toiletries included

Get Well Doll! Cuteee!!!

First class toilet!
Everything turned out well by the end of my hospital stay and I was discharged 3 days later. I was given 2 weeks of Medical Leave which I flaunted by the end of the first week and went back to work. Why? Because, I sensed that the stock market is on the brink of crashing and I absolutely have to get my clients money out before something bad really happens. The market did tumble shortly and I was relief that I got almost everyone out in time.

The most worrisome issues post-op, are my calcium and thyroid level, as my body adapted to a new environment, which it had grown accustomed to in the past 8 years. The other issue, is of course, the hospital bill....  

Accolades

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