February 6, 2014

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

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....  

January 22, 2014

The Battle with Graves' Disease Part IV: Chickening Out....

The waiting area for all my endocrine specialist appointment at Changi General Hospital
After deciding to go for a total thyroidectomy to deal with my troublesome thyroid gland once and for all, I made an appointment to see my Surgeon, who will explain the surgical risks to me. If you have missed out on the previous postings, here are the links:

  Even though I have decided to go for the surgery, I did not inform my family, as I am not quite sure whether I want to go through with the procedure yet. Intensive research ensued.

First, let's find out more about the Surgeon.

There are many horror stories on the internet how a thyroidectomy procedure went terribly wrong and all of them agreed on one common thing. An experience surgeon will lower the risks of any complications. Armed with the my Surgeon's name, I Googled.

Hmmm, He is an adjunct assistant professor with an established medical school.

Aha! Facebook! 

Hmmm. Married, with 3 kids. Looks like a serious man in his late 40s. Good good, not a young chap who will accidentally slit my throat.

Looks like my Surgeon has all the makings of a good Doctor!

On appointment day, the Surgeon looks exactly like the person I googled online. That sets my heart at ease a bit. 

Than we got down to the business of examining all the possible implications:

1) I will be on Hypothyroidism and has to be on hormone replacement medication for the rest of my life. I was well aware of that even before the surgery.

2) 1% chance of Laryngeal nerve injury. Might be higher since my thyroid gland is so big. This will lead to a change in voice, and I might not be able to speak in a loud manner. This is a pretty big concern to me since I give talks and workshop, and is insanely proud of my loud voice.

3) 1-4% chance of Hypoparathyroidism .There are another 4 glands that are attached to the thyroid gland that regulate  the calcium in the blood. Side effects of this conditions include cramping of muscles or tingling sensations in the toes and fingers. Long side effects include increased risk of kidney problems. Calcium replacement hormones may be needed on top of the thyroid hormone. This is the biggest risk my both my doctors are concerned about.

4) The usual general anesthesia, excessive bleeding risks that comes along with any major surgery.

Estimated hospitalization days: 3 days. With complications: 7 days

After explaining all the risks and potential complications, I have to decide whether to move forward with the surgery date. So as usual, the Doc assure me that I can cancel my surgery anytime as long as it is one week before the surgery. He is also going for a month long leave during December. 

Oh well, might as well plan the date and I can back out later if I want to. After considering, I decided on 20th Jan 2014. Why? Because a it is one week before Chinese New Year and in case there is any complications, I will have more time to recover. Most people don't work or want to meet me during CNY anyway and the stock market shouldn't bother me too much as it has been going up during Capricorn/CNY period for the past 5 years (I was wrong on this. The stock market crashed during CNY)

So all the wheels were set in motion for the surgery and I will have to meet my endocrine specialist, decide in my hospitalization ward class and do a pre ops checkup. 

It's time to break the news of the surgery to my family and friends.

And I was rewarded with a storm of conflicting information, advice and stories of friend of friends/ aunt/ distance relatives who were cured of thyroid through a myriad of means without needing to go through the major surgery. 

After 8 years of battling with Graves', I think I am a semi expert on this topic by now, but I must still thank my friends and relatives who took the effort and  tried to find out other alternatives to cure my condition, even though I know deep down, that many of the suggestions most probably will not work. 

In any case, the advice that made me wavier came from my sister, whom spent a longer period of time battling Graves' disease, but abate a much milder form of the condition. She had her own struggles as her pregnancies were made complicated by Graves

She said," If you were feeling great and healthy now, why do you want to take this unecessary risk? Perhaps with a healthy lifestyle, and the right kind if diet over a long period of time, might reduce the problem?" 

Her solution was indeed tempting. However, I know that her advice was based on her own condition which is not as genetically advance and mutated (anti-drug/anti-radioactive) as mine, but still, the idea was tempting for me to give it a try for a few more years.

During my next appt with my endocrine doctor, I told him.

"Doc, I feel like pulling out from the ops and observe another year or two. What do you think?"

Than I told him my idea.

He replied, "Yes, you can continue in this condition, perhaps for life, but you have had this condition for many many years, way longer than most average patients with thyroid conditions. I am sure that you have already tried many methods to try to cure yourself of this condition. If you do not do anything about it when you are younger and healthier, you will have much more problems dealing with it when you are older. On top of that, you will have a much higher chance of getting a heart condition or stroke when you are older. Having heart disease is not too bad, but stroke! That's the worst way to die! I have seen people dying due to different conditions, but trust me, I will rather die due to other disease than due to stroke. Think about it!"

After a few minutes of thinking how miserable it is to die of stroke, and having a similar experience when I was paralyzed for 3 days prior to this discuss, I can understand what he meant. 

 Steeling a my heart, I told my Doc

"Heck! Let's go ahead with the surgery. Get this over and done with!"

January 21, 2014

The Battle with Graves' Disease III: The Thyroid Strikes Back!

I am sure many of my dear readers know about my 8 years battle with Graves' Disease and I have posted a couple of posts on this issue and my visits to the hospital.

In case you have forgotten, here are the links:

Part I:  Five Stitches, Two Weeks Running Ban: The Prologue to my Running Hobby.A Life changing Experience 

Part II: The Adventure of being poked and probbed at Changi General Hospital

My medical took a new turn on 20th Jan 2014 as I was pushed into the surgical room for a total thyroidectomy. Many asked me why did I choose to undergo such a major surgery and have I considered other alternatives. I will have to elaborate what happened since the radioactive iodine treatment...

Changing into the surgical gown
 After my near death experience with Thyrotoxicosis as a result of an overactive thyroid gland due to the radioactive iodine treatment (RAI), I was put under observation for 2 years to monitor the aftereffect of the RAI. There has been cases whereby the thyroid cells take up to one year to die off as a result of the radiation, and the docs were hoping that there was the case. As the end of the day, there is only a marginal improvement in my condition. Prior to the RAI, I am taking the maximum dosage of 30mg of carbimazole and yet, the hormone levels, indicated by T4 and TSH remained out of the healthy range. After the RAI, the blood count level came down successfully to the normal zone, with a dosage of 25mg of carbimazole on weekdays and 30mg on weekends. It means that only a small portion of my thyroid gland was destroyed by the RAI and any tweaking of this formula downwards, will lead to a spike in the thyroid levels again. In order to check the condition of my thyroid gland post RAI, the doc ordered an ultra-scan on the thyroid gland sometime on the 4Q of 2013. 

As usual, more complications arised.

The ultra scan revealed a nodule, which has the potential to grow cancerous if left unchecked. For now, the doc diagnosed that it should be benign, but to be sure, a biopsy should be performed. However, the RAI which I have underwent previously had scrambled the cellular structure, that the biopsy may not have any conclusive results, which might lead to a surgery which they need to cut me open to take a look at the lump. I was given these options:

1) Continue with the current condition and pray that no other complications kick in.

2) Do a RAI again. However, due to my resistance to RAI the last time round, the Doc is not confident that the procedure will kill off all the thyroid gland. If the RAI fails again, the celluar structure will be even more messed up and they may really need a surgery to take a look at the lump.

3) Perform a partial thyroidectomy. Given how powerful and unpredictable my thyroid gland is, the reminding thyroid cells may still produce enough hormones to put me back at a hyperthyroid condition again. A second surgery or RAI to remove the thyroid will have much higher risk.

4) Perform a full thyroidectomy. Takes away all the thyroid problem once and for all, but accompanying that, a new set of problem and lifelong medication.

It was a very difficult choice to make! I was tempted to maintain my current condition as I feel pretty good and healthy after all these years but the stupid lump is complicating matters. So, as a consultant myself, I asked the all important question that all clients should ask:

"If you were in my shoes, which option will you choose?"

Doc hesitated for a while and replied, "I will go for the full thyroidectomy."

 I considered for a while.. Heck! This stupid gland has been bothering me for the longest time, disrupting much of my life. Let's go with what the good Doc says!

"In any case, just book an appointment with the Surgeon and let him explain to you the surgical complications. You can cancel the procedure anytime within these few months."

Sounds like a good deal! I booked an appointment with the surgeon and began researching on life after a total thyroidectomy.
   

January 4, 2014

Farewell ECP! - A visit to the dysfunctional expressway (4km)


Good Morning! ECP!
The biggest news in Singapore this week. The closure of a segment of the most scenic section of the East Coast Parkway Expressway and the 2 hours jam at the newly opened Marina Coastal Expressway (MCE) which is an expensive, undersea and boring expressway which will replace the ECP. The former ECP cuts through some of the most scenic and expensive real estate in Singapore and after pleads from one of the richest man in the world, Sidney Adelson, owner of Sand Casino and the Marina Bay Sands, that he needs more space to expand the integrated resort, the government decided to reroute the expressway. (Baseless allegations. Pure speculations on my part. Adelson did appeal for more space though!)

December 28, 2013

December 15, 2013

Tanjong Pagar Run - Short Run to Test Recovery of Knee

Staycation at Amara Hotel
Ever since my knee injury, I have been testing the recovery level of my knee with short distance runs to gauge how much it has recovered. I tried 1 km before the pain came back a 3 months back, worsen the injury due to me pushing myself during a run in Europe and since 2 weeks ago, I can advance 1.5km before the pain starts kicking in. Today, I am going to test my knee again.

December 5, 2013

Stanchart Half-Marathon: Short Interruption to my Running Career

The last few weeks, have been quite a depressing affair for my running career. First, I injured my knee during one of my routine Sat run during the end of Sept. I thought resting for a 2 weeks before my Europe trip will give it time for my knee to recover. I tried a short run just before my Europe trip but my knee starting throbbing after 1km. Than I forced a run at Amsterdam doing about 2km. Knee hurts but not that bad. During the next run at Dusseldorf Germany, I forced an even further run of 5km. My knee gave way at 3km. I hobbled my way from Hamburg to Berlin to Paris for the rest of the trip, cursing at every European staircase that confronted me.

After I got back from my Europe trip at the end of Oct, I thought that a good one month rest should be enough for my knee to recovery for the Stanchart Half Marathon. A week before the race, I strapped on my shoes and tried to run. My knee started to throb after hitting the 1km mark. I started to feel pain after 1.5km. I have little choice but to abandon the Standchart Half Marathon.

This is depressing. I wonder when my knee will heal...

A few days after the Stanchart Half Marathon, I came upon this piece of news whereby an unknown Singaporean runner who won the local title for Stanchart, was disqualified. He ran for 6km, felt a pain in the knee, probably went somewhere to drink some coffee before walking back to the finish point and "accidently" clinched the first place. He also revealed that he cheated not only once, but thrice, just because he wanted the finisher T-shirt and the medal.




October 21, 2013

Berlin, Germany - Guest Appearance by Big Boned Guy (BBG)

The early morning view from our apartment
Everyday, I cursed my stupid decision to push my injured so hard during my run in Dusseldorf. The pain doesn't seem to go away and I spent my days hobbling along with the old people in Germany, thinking whether to buy a German made walking stick to go along with the appearances.

October 16, 2013

Dusseldorf, Germany - Across the River Rhine and Back Again

The River Promenade at Dusseldorf
After being rained on for the last 4 days at Amsterdam, we were hoping that the weather at Dusseldorf will be better, but no! The rain clouds seem to be following us a everywhere. Before I carry on with my rant with on the weather, most Singaporeans will be scratching their heads and wondering where and what is this place called Dusseldorf. Personally, I was one of those ignorant Singaporeans who haven't heard of this place before I set foot on it

October 14, 2013

Canals of Amsterdam, Netherlands - Of Canals & Gay Kinos

The canals of Amsterdam
It has been raining non-stop since Day 1 when we arrived at Europe 4 days ago. Sometimes it pours, sometimes it drizzles and sometimes, it is a mix of everything. Throw in a below 10 degrees temperature and cold bitter winds, it made walking along the beautiful streets and canals of Amsterdam a dreary affair. 

Accolades

Powered by Blogger.