March 30, 2014

March 18, 2014

Bedok Reservoir Night Run - Recovery Run 2

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When it rains, it pours...

And it has been raining literally non stop for the past 2 days. Seems like heavens have been storing a lot of rain water over the last 2 months of drought in Singapore.

The rain finally let up this evening and I took the opportunity to go for a short run.

Since my last run 5 days ago, I was having quite a bad muscle ache at my calf muscles and the ache has mostly gone away today. A short 2km run and I am having such a terrible muscle ache. Looks like the road to recovery going to be a long one....

Reminding myself to take it slow, I decide to do a slow jog of 2km to build up my muscles again. I am also concern about the condition of my knee, which might act up again.

Miraculously, my knee doesn't hurt at the end of the 2km run. Good sign!

I saw a new installation where the old Berlin Wall used to be . Initially, I thought it was a piece of advertising for one of the many condominium projects that are sprouting all around the reservoir. On a close look, it is actually a form of marketing material for the new Eco project being implemented at the nearby Temasek Polytechnic. They even have shops and outlet marketing environmental friendly goods. I wondered if Temasek Poly paid the government any money to market their Eco Project at such a strategic spot. In any case, this is better than a piece of empty glass exhibit with only bugs trying to build a nest within it.

The nearby bistro Wawawa is having a pretty decent crowd, with diners digging in, while enjoying the evening breeze. This is definitely a good place to chill out in the evening, but not a good place to hunt for a drink after a run. Based on my last experience, it is either expensive booze, or expensive soft drinks and sparkling water. I don't blame them as they do need to pay for their rental.

March 13, 2014

Bedok Reservoir Night Run - First Post Surgery Run

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Night at Bedok Reservoir. Doesn't look Hazy
It has been 2 months since my last run.

I have been wanting to stretch my legs for the past few days but lo and behold, the haze from Indonesia started their assault on Singapore. This evening, the air seems to be fresher without the usual burning smell. I decide to risk a run.

As I was heading out, my mum yelled at me, "The PSI is 84! Where are you going?!?"

"Mum, out for a run. No worries."

"The PSI is higher today than yesterday! Yesterday is only at 64!"

"But the air smells okie. Besides, I need to work out a bit!"

Without waiting for any more protest from my overly concern mother, I dashed out of the door.

Well, the air smells alright and the sky looks clear!

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March 2, 2014

The Battle With Graves' Disease Part VII: The Horrors of Medical Bills.

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I have been grounded from any exercise or workout for a month since my last consultation visit to my specialist during February. I gazed at my Vibram Five-Toes longingly but orders are orders... I am not about to split my neck open while tripping over a rock while out jogging.

Meanwhile, my thyroid hormones are on the low side and my hormone dosage has just been increased by 25%. No wonder I am feeling chilly these days, while walking through the air-conditioned shopping malls of Singapore. I have to resort to carrying a windbreaker everywhere I go. Sigh.
Hormone Replace Pills

My medical bills from my recent surgery started to stream in. Although the big bomb comes from the recent surgery and hospital stay, I am also beginning to feel the bite of the smaller outpatient bills. A few hundreds here and there and before you know it, the bill just grows and grows.

Feeling curious on how much I spent on medical bill since the start of my saga (Hospitalization due to Thyroid Poisoning) in 2011, I dug out all my receipts and compile them into an excel spreadsheet.

The current tally is at: $13,124.41.

Ouch!
Hospital Bills Over the Years

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....  

January 22, 2014

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

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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!

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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)

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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!)

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December 28, 2013

Accolades

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