Respiratory Disorder - Episode 14

When I went back to the hospital at 2pm, there was an unusual crowd waiting to see my doctor. I have to wait for about an hour before I was called.

She told me that there was not much changes to the x-ray. It was also hard for me to tell because the x-ray was not very clear for a layman to see. The doctor believed that the radiologist did not use enough radiation to penetrate my body. So, the image was not that visible compared to the one I took last month. But at least the radiologist and the doctor are able to interpret it.



The doctor then prescribed me an anti-fungal drug - fluconazole since she suspected that I have a fungal infection in my lungs. Also, my phlegm is positive for Candida which is a type of fungus. However, probably that was not the fungus that causes my cough because candida is a fungus that is commonly found in anyone's mouth.

Again, I have to undergo some medication of swallowing big big capsules which I don't fancy at all. What I'm undergoing now is some sort of a trial and error treatment because the doctor has yet to know exactly what causes my cough. We still have to wait for the full result of the bronchoscopy. The lung biopsy which I have yet to do would be somewhat a much faster and accurate diagnosis.

If the fluconazole could not cure me, then I have to go for the lung biopsy to find out what's wrong. Oh, Jesus, please help me.

It looks unlikely that I could avoid the lung biopsy. I do really hope that this fluconazole would cure everything. I just do not want to do the lung biopsy. My next appointment is about another two weeks time.

Respiratory Disorder - Episode 13

It has been two weeks since the scary bronchoscopy. I think the whole experience has left me traumatised.

It is 21st September and it is time to see the doctor again to find out some preliminary results from the bronchoscopy.

I reached there at 11am.

I waited for about 10 minutes and I was called in to the doctor's room. Quick enough, she told me that my phlegm is negative for TB. What a relief!

But then she said my phlegm is positive for Candida, a type of fungus. But she doesn't think that's the cause of the cough. I've read about Candida and it could appear if you are on some antibiotic medication. Yes, I was on antibiotic medication when I went for the bronchoscopy. So probably that's how the Candida came about.

So that means we still do not know what is causing the cough. I will have to wait for a few more weeks for my phlegm culture to grow completely in the lab. The doctor then asked to go for an x-ray to see if there are any changes since my last x-ray.

The reception for the x-ray section

I was surprised to find a waiting area just outside the x-ray room with a TV for you to watch.

I didn't notice there's a container floating in the air when I took this picture. Well, nothing surprising since it's a hospital anyway....you know what I mean.

Taking the x-ray was quick and simple unlike the CT scan where you have to be injected with a radiopaque dye.

It was over in less than 5 minutes and I was asked by the doctor to come back to see her at 2pm. So I went home for lunch and worrying whether the image on the x-ray has turned out better or worse?

Some basic facts of lung cancer

It is a well known fact that smokers make up 90% of lung cancer cases. So why do smokers still smoke, just like my neighbour Ah Beng who smokes like a chimney 24/7? Beats me. Maybe they didn't know the perils of lung cancer, yet.

One good news for smokers is that only 10-20% of smokers will eventually develop lung cancer in their lifetime. Researchers are still finding out the reasons why some smokers could end up with lung cancer and why some did not. Luck, perhaps? Definitely not. Researchers blame it on the genes. Well, if smokers do not end up with lung cancer, then they will eventually end up with COPD (Chronic Obstructive Pulmonary Disease), Buerger's disease, bronchiolitis, oral cancer, Crohn's disease, peptic ulcer, ulcerative colitis, bla bla bla bla............

The sad thing is that non smokers are not completely safe from developing lung cancer. The remaining 10% of lung cancer cases are due to exposure to asbestos, radiation, arsenic, radon gas, mustard gas, air pollution and the list goes on.

The symptoms of lung cancer are similar to any other lung infection such as coughing. So, that makes the diagnosis difficult. Often by the time the patients found that they have it, it is already too late because the tumour grows very fast and painlessly unbeknown to you.

Compared to other types of cancer, lung cancer has a very poor prognosis. The survival rate is only 13% even with treatment. Furthermore, the treatment is not cheap. The cost of the treatment can already buy you one nice imported Japanese car in Malaysia.

Where do I get my sources from? The Merck Manual and two close confidant who had personally known two lung cancer patients. The said patients were non smokers and they did not survive.

Want to live longer? Just go to Bama county in Guangxi Province of China. The residents in Bama seem to live over some 100 years and some of them reported that they have never been to hospitals. Go read some news from The Star.
http://thestar.com.my/lifestyle/story.asp?file=/2010/8/16/lifefocus/6683534&sec=lifefocus

Last reminder....don't smoke!

Lung Infection - Part 9

Finally, the dreadful day has arrived. 6th September 2010. I have to fast for at least 4 hours before the bronchoscopy procedure. So my last meal should be by 7am. I woke up early just to take my meal by 7am.

I reached the hospital at about 11.30am. I have to search for the bronchoscopy section on the 1st floor. And here I am. Strangely, the signboard indicated it is the endoscopy section.

I went inside and asked the nurse about the bronchoscopy procedure and she said 'Yes, this is the place'.

The nurse took my blood pressure and asked me to change my clothes and to wear their hospital gown.


Next, they asked me to lie down on a bed and soon they brought a set of syringe. As I expected, they are going to give me an injection. The doctor has already said that this injection will be like the vaccination that I had in school. An injection to the muscle. Argggh..

As soon as the nurse injected me on my left arm, I groaned loudly 'ARGHHHH' Seriously! That was the most painful injection I ever had since BCG. You can feel the needle puncturing your muscle. Now I began to realise the injection for the blood test is 'nothing' compared to this painful injection to the muscle. This injection was needed to reduce my mucus production in my throat.

Soon, another injection came. This time they need to insert a tube on my hand near the fingers. Sigh...another painful injection. I groaned again...'ARGHHH'. LoL, I'm serious!

I was so worried for the next procedure. The bronchoscopy! The clock was ticking just right in front of my bed. The time was 12pm. I waited and waited until 12.30pm when the nurses pushed me into the scope room nearby.

I was so anxious and maybe a little excited when I was in the scope room. I could see all the medical equipment in there, just like in an operation theatre. Again, I waited and waited anxiously for the doctor to arrive.


Finally I saw her walking towards the room. It was about time....

Lung Infection - Part 8

On 1st September, when I was about to take the ANCA blood test. The doctor called me and said she wanted to talk with me. I do not have to take the blood test for now. Wooohooo. So I went to see the doctor again on 1st September.

She has spoken with the professor in KL and she advised me to do the lung biopsy.

What is a lung biopsy? I asked

She explained that a needle will be inserted into the lungs to collect some tissues from there. From there, they will inspect the tissue to identify whether it is a tumour or it is some fungal or bacterial infection. Also, I need to be hospitalised overnight after the lung biopsy so that I can be monitored in case anything happened.

She said that there is a risk of air leaking from the lungs after the lung biopsy if the cells failed to close after the insertion of the needle. Yikess!!! She said that a tube has to be inserted into the lungs in case that happened and I might be hospitalised for a few days. Oh my...

Yikes!!!, I began to squirm...

She also advised me to do the bronchoscopy.

Now it is a matter of decision to do the lung biopsy first or to do the bronchoscopy first.

Now I feel that doing the bronchoscopy is so much easier than doing the lung biopsy.

I look at her quizzically and she looked at me smiling.

Sighhhhhhhhhhhhhhhhhhhhhhhhhhhh

Why do I have to go through all these procedures?

Lung biopsy? Yikes!! It's a bloody and painful procedure. Just imagine you are awake and you could see a long needle being inserted into your lungs right in front of your eyes. Ewwww!

The same with bronchoscopy. Ewwww!

Finally after a long sighhh, I told the doctor I will do the bronchoscopy on 6th September.
As I am writing this, I'm so worried about tomorrow - 6th September, the day I will do the bronchoscopy.
Sighhh.

Lung Infection - Part 7

Oooh, I can't wait to know the results of my blood test and the CT scan result on 30th August.

I was breathing heavily while waiting to see the doctor on that day. Finally, the nurse called my name and I entered the door.

She said my blood is ok. Most of it are negative and most importantly, HIV is negative. Pheww!
Then she showed my CT scan result and said that it matched the lesion on the chest x-ray. Most importantly, there are no new lesions in my lung.

Okayyy, then what?

She can't still diagnose from the CT scan whether it is a tumour or it is an infection. She said that there are three possibilities.
1. A bacterial or fungal infection
2. Tumour/Lung cancer
3. Wegener granulomatosis

She told me she will seek advice from a professor in KL before proceeding to the next step. Meanwhile, she advised me to take an ANCA blood test to determine if I have that so called Wegener thingy. What is this Wegener granulomatosis? It is some rare disease and I will explain it next time.

So I decided to take the blood test on some other day because I'm in a daze at that time. I just want to go home and sleep.

Lung Infection - Part 6

To undergo the blood test on 28th August, I was required to fast for at least 8 hours before the blood was drawn. From 10pm onwards on 27th August, I have to stop eating. Drinking is ok. This was a slight torment because I'm also suffering from gastric all the while and I need to take small meals from time to time. I have to endure this and fortunately there was no serious gastric attack.

I woke up to a hungry and nauseating stomach due to my gastric condition. I managed to calm down to avoid from vomiting and I reached the laboratory in Island Hospital 'safely' at 8.15am.

There were already a couple of people waiting at the laboratory at Level 5 of the hospital at that time hoping to end their fasting as soon as possible, just like me.

I have to endure the waiting because the laboratory has yet to open. Thankfully, there is a nice view overlooking a rooftop garden from the waiting area.

Rooftop garden in Island Hospital Penang

Finally, the nurses opened the laboratory door at exactly 8.30am. Everyone rushed in and gave their cards/slips to the nurse at the counter.

After waiting for about 5 minutes, my name was called and I was asked to give my urine sample. After doing that, I waited for another 5 minutes and I was finally called for the blood test. As usual, I always feel anxious whenever I have to undergo a blood test. I hate it.

The doctor injected my left forearm and this time the injection lasted for about a looooong one minute because the doctor needed to draw out enough blood for a full blood test. The blood test is called a full Profile D plus HIV. It is check for basically everything. During that time, so much blood was drawn to the extent that my left hand turned numb and tingling. It was so uncomfortable.

As soon as it is over, I quickly headed down to the hospital's cafeteria to take some quick bites to avoid any fainting spells. Again, I ate some fried bee hoon. The fried bee hoon has indeed saved me from fainting.

The bill came to about ~ RM400. $$$ fly away....

I have to wait until Monday August 30th to know the results of the blood test.

Again, I waited anxiously for two days to know my results. Is my liver functioning properly? Is my kidney functioning properly? How high is my sugar level? How is my white blood cell count? Most importantly, am I HIV positive? That is the most scariest. I will also know the CT scan results on Monday August 30th.

So, ladies and gentlemen, a little advice. Don't do drugs! Practise safe and protected sex! And beware of blood transfusion to avoid the risk of HIV infection. If you are a health care worker dealing with blood, be extra careful as well. I read that there are rare cases of health care workers being infected with HIV accidentally due to their daily exposure to tainted blood.

It is unfortunate that scientists still can't find any cure for the HIV infection until today. TB was similar to HIV in the olden days. If you have TB during those times, you are 'gone'. There was no cure and you will be left to die. The cure for TB was only found in the 1940s.

I will continue on Part 7 soon.

Lung Infection - Part 5

The day was 26th August. I walked into the doctor's room. Doctor L greeted me and I greeted her. She talked a bit and finally she said my QuantiFERON TB Gold blood test was NEGATIVE.

Okkayy, I said. Inside me, I hope it is not a false-negative result. There is always a risk of false-negative. She has already said it earlier that having a negative result does not mean that you don't have TB, it might be a false negative.

But let's get this straight. My sputum/phlegm tests were all negative for TB, tuberculin skin test was negative and now the QuantiFERON TB Gold blood test was negative. Can I safely say I don't have TB for now? Maybe.

Like the nurse in the Sungai Dua government clinic (where I sent my phlegm for testing) I talked to the other day, she advised me to think of some other thing instead of just TB. It could be something else. Something else like what, I wonder.

Cancer??

There's always the probability.

So on that same day on 26th August, Doctor L advised me to a CT scan to rule out tumour/cancer. A CT scan? What is that? I thought it is something simple like going for an x-ray. Just pose yourself for a scan shot like I how I always scan papers in my office and the files go directly to my PC. Noooo...not that simple.

CT Scan

It looks scary when I entered the room and indeed the whole procedure was scary enough! It ain't the same as an x-ray procedure. When I was in the room, the nurse took out some equipment. And in that tray, I saw a syringe. A syringggeee!!!

It looks sharp!

Yikes! I hate it. I hate an injection. The nurse told me ...Yes there will be an injection.

Oh noo! I think I'm going to have some fainting spells soon.

I laid down on the bed or the board or whatever you call it and she injected my hand with something and I don't know what was that. I remember seeing a tube being inserted into my hand the place where I was injected. Yep...just like how you always see those tube inserted into someone's hand or arms in the movies.

I went home and read about CT scan and I learnt that what they inject you during a CT scan is a radiopague dye. Oh my...some radiation thingy being injected into my bloodstream. Isn't that dangerous? Strangely, I still don't have any radiation powers like Spiderman after that day.

Ok. Back to the CT scan room. I was told to listen to some instructions later. So I was pushed into that 'tunnel' and the instructions came from some voice box above.

Breathe in, breathe out....

Breathe in deep and hold it.

And immediately I could hear some pictures being snapped....lol.

After a few seconds...the instruction came again. Breathe as normal.

I had some weird feeling when I was pushed through under the tunnel. I don't know how to describe it but it was certainly a new experience for me. An experience that one should avoid! The radiation from a CT scan is 500 times the radiation dose of an x-ray. So try to avoid a CT scan if possible unless you are really sick.

Anyway, I was shivering throughout the whole procedure because the room was cold! It was still very cold even the nurse had placed a thick blanket over me.

Guess what! The cost of the CT scan is RM650! Not cheap!

I had to come back to the hospital on 28th August again for another blood test. This time they wanted to do a full blood test including HIV! No joke! She wanted to test my liver function, kidney function, sugar level....bla bla bla.

The doctor needs to rule out as many diseases as possible to find out what is infecting my lungs.

Another injection again.... :-(

Lung Infection - Part 4

I took the blood test for the Quantiferon TB Gold on 24th August. Thankfully I did not black out after my blood was drawn as the previous times. I took the very first blood test in February 2008 for some other cause and I almost black out about 15 minutes after the doctor drew my blood out from my arms. As I could still remember, my vision became blurred, my entire body was tingling and I felt nauseous for about 5 minutes.

Ouch...painful!

The same thing happened again on 12th August 2010 when I took a blood test in General Hospital. Fortunately, I have reached home by then and I was untying my shoelaces when it suddenly happened. 30 minutes after the blood test, my vision was blurred, my body was tingling, I felt nauseous, I turned white as if I have seen a ghost, and I was sweating profusely as if someone has sprayed water on my entire body. I quickly took a bite of a bun that I have in my bag and I tried to chew and to swallow what I have put into my mouth but I could not. The bun remained in my mouth and I couldn't do anything. At that time, I felt like my entire body has shut down. I was sitting by the door and I couldn't move at all. This time the incident lasted for about 10 long minutes.

The lesson learnt was that I should have eaten something before or immediately after the blood test. On 24th August, I ate some Bee Hoon before I left for Island Hospital. I took the blood test and I went home and nothing happened. Phew! Thankfully!

On 26th August, I came back to the hospital to see the doctor for the results. There are crowds in Island Hospital but it is not as bad as General Hospital where you might have to wait for hours before the doctor sees you. Of course, in Island Hospital, you still have to wait for a couple of minutes before you can see the doctor because the business is good over there.

So I was waiting anxiously to find out whether the blood test result is positive or negative. And finally the nurse called my name to come in. It is time.

The Tuberculosis Journey Part 2

I went to see the doctor yesterday (19th August). This time they gave me a female doctor, a different doctor from my first visit. What's wrong with General Hospital???

On my first visit on 12th August, they seem to be provide a very nice service. An intern was assigned to me to diagnose me. I told her my entire story about my coughing and she wrote it down in a piece of paper and she later presented the diagnosis to her boss, a male doctor. He is the head of the respiratory department of GH. The intern told me that he is the best chest specialist in Penang. Hmm...not bad.

On my second visit yesterday, I got a different doctor instead, unfortunately. She checked my chest x-ray, listen to my story, measure my weight, and checked my blood test results. The blood test I took last week was just a general blood test, not to check for TB. She told me nothing is wrong with my blood. Everything seems ok. She then asked me whether I'm keen on bronchoscopy. Bronchoscopy!!! Yikes!!!!!!!

What is bronchoscopy? It is a medical procedure where a doctor will insert a tube down your throat through your nostrils. The purpose is to check for those stuff in your lungs. Yikes!!!!! It is one effective way to check what has infected my lungs. But it will be uncomfortable and irritating. That was what the doctor said. Yikes!!!

Doctor V: Are you keen on doing a bronchoscopy?
Gabriel: Noooooooooooooo
Doctor V: I will set an appointment next month
Gabriel: Next week?
Doctor V: No, next month. It will be on 30th September.
Gabriel: (WTF...next month!!! 30th September!!! I might die by then....) Of course I just said it in my head.
Doctor V: We will monitor your culture of your sputum meanwhile.
Gabriel: (Still mumbling in the head.......WTF...Next month!!!!!!!)
Gabriel: Oh...ok. I will see you next month.

I'm going to a private hospital next week to do the QuantiFERON TB Gold blood test. I don't understand why this blood test is not provided by GH. I need to do this blood test to check whether I have TB or not. Alternatively, I can do the bronchoscopy to check for TB....yikes!!!! No no no no noooooooooooooo.

Before I leave GH, I asked the nurse in GH whether I can take out my chest x-ray to bring it home.

Gabriel: Boleh saya ambil x-ray pergi private hospital for second opinion
Nurse: Eh...tak boleh. Ini government....tak boleh ambil pi private.
Gabriel: (Bodoh!!!&#@@#@ GH)

Okaaayyy, looks like I have to take the chest x-ray again in a private hospital. That's not good. Taking too many chest x-ray will expose you to radiation. It is certainly no good. Stupid GH.

That's my experience yesterday at the respiratory department in GH.
QuantiFERON TB Gold blood test, here I come.....

The Tuberculosis Journey Part 1

I've not written anything here for a very long time. I have been hit by a writer's block, perhaps.So let's start writing. This shall be the start of the Tuberculosis (TB) journey.

I have been coughing since (if I could remember exactly) I would say 22nd May. It started as a dry cough. The dry cough went on for about two weeks and suddenly I started to cough out phlegm on the third week on 6th June. That was good. Having the phlegm was good because a dry cough is just irritating. It was a terrible week because I was having an exam that week!!

On the fourth week, the cough went violent and I began to have barking cough. Yea, barking like a dog while I'm coughing. What am I suffering from, I wonder.

This went on until 8th July when the cough began to subside, strangely. But the cough came back on 14th July, strangely again. So, the cough continues until today.

Starting August, my phlegm turns yellow and bloody, and I started to get slight fever now and then. This is the typical symptoms of TB. The one common symptom that I don't have is night sweats, where you will sweat profusely while you are sleeping to the extent that the bedsheet will be soaked with your sweat. Thankfully I don't suffer from that.

I went to see a general practitioner on 4th August and doctor told me it could be TB based on the chest x-ray I took. My heart sank...blooob. TB is an incurable disease until the 1940s when scientists discovered some antibiotics which could kill the TB bacteria.

I took the Tuberculin skin test on 6th August and the result was negative. I don't know why. My sputum samples were negative as well. Perhaps, the samples were weak.

I was referred to a specialist to the General Hospital and I went to see him on 12th August. He also suspected it is TB. I took the blood test on that day and I hate blood test very much! It is painful!....even though for 20 seconds.

So now I'm waiting for the results of the blood test. I hope it is positive so that I can start taking the medicines and get it done with this TB.

If it is negative....sigh...what could it be then? Then I have to take more test and that certainly sucks.

I hope I could get well again or I risk my gf running away from me because I keep falling sick.
I felt bad too that I couldn't celebrate her birthday because I'm not feeling well to hang out with her. I also get worried so much not for myself but for her, whether I have infected her.

I hope by this Thursday, the blood results will be out. I will wait.

Part 2 coming soon...