At about 5am on Jan 25, I woke up because of a vivid dream.
I had dreamt that I had signed up for a commando course. To get to the place where the course was being conducted, I had to climb down an almost vertical cliff with no proper path or steps. I stared down the cliff and wondered how others who had signed up for the course would get down safely. At that point, I woke up and found myself in Singapore General Hospital. My ileostomy bag was almost full.
An ileostomy is an opening in the abdominal wall, from which the contents of the small intestine can trickle or pour out unpredictably. The intestinal content is faecal-like. Hence the need for an ileostomy bag.
Fortunately I had not turned to lie on my left, my preferred sleeping position but also where my ileostomy was. Hence the semi-fluid, smelly contents of the ileostomy bag had not leaked. I changed the bag and pressed the bell to get the nurse to clear away the mess.
The preceding day, I was not so lucky. There was a leakage.�I have highly skilled nurses looking after me in SGH. They took meticulous care in changing the wafer. The wafer is the base to which the ileostomy bag is attached. Changing the wafer is a tedious process that can take up to 30 minutes. Despite the excellent care of the nurses, the wafer often caused severe itching.
The background to my surgical problems in January was that I had a small perforation in my ileum or small intestine, where it joined the colon. Intestinal content contaminated my peritoneal cavity, or the space lined by peritoneum inside the abdomen. I had an operation to repair the perforation and clean up the peritoneal cavity. It was necessary to bring my small intestine out through the abdominal wall as an ileostomy, while we waited for the swelling and inflammation of my gut and any scar tissue to settle before joining the ileum and colon.
Most of my dreams are illogical and not related to my real life. But this particular nightmare may indeed have been symbolic of what I knew I was in for. The probable scenarios were not pleasant, but I intended to treat whatever happens as a commando course - a challenge.
On April 14, I had the surgery to reconnect my ileum to my colon, and close the ileostomy. As my condition was not a straightforward one, the procedure was performed by a team of excellent senior surgeons as well as experienced anaesthetists. My personal physician was also in the operating theatre.
The surgery went well. The post-operative discomfort lasted a mere few days. I am still recovering and will take a few more weeks to recover fully.
In theory, I can then go back to normal life. But I have had so many medical and surgical complications before that I prefer to visualise the worst case scenario and hope for the best.
The potential problems that I may encounter in the future include intermittent intestinal obstruction with abdominal pain and vomiting which may evolve into perforation or gangrene of the gut. I may need further surgery, more of my gut may need to be resected. I may not have enough gut left to sustain my nutrition by eating and I may need to be fed through the vein. I may also end up needing a permanent ileostomy. There are several other rarer but no less unpleasant scenarios which may follow the present surgical adventure.
None of the above complications was within my surgeons' control when they operated on my already battle-scarred abdomen.�As I described my nightmare in my journal at 5am on Jan 25, I reminded myself that no one promised me life would be fair or devoid of suffering.
I stopped seeing patients during the period of my illness because of the potential social embarrassment which might occur with ileostomies. I continued with my administrative duties from my hospital room. I got to know many of the nurses personally and one day I will write a column about this group of dedicated, skilled and caring women. A short mention does not do them justice.
Fast-forward to this moment: It is three in the morning as I write, having been awoken because of coughing which caused pain at the site where the ileostomy had been closed. The operation had gone well, but I have a premonition that my troubles are not over yet.
But life must carry on. Worrying about potential complications which may occur a few months or many years down the road is a waste of energy. After all, no one knows tomorrow; no one even knows the next moment.
Granted, my next moment is more unpredictable than for most; I personally think that that is an advantage. It helps put life in perspective for me. What should be done and can be done now, I always try to do immediately. My game plan is to try to do my best within the constraints I live under.
Using boxing as an analogy, there will be times when I am knocked out, the referee counts to 10 and I cannot get up. I will crawl to the ringside, lick my wounds, haul myself up, recuperate and return to the ring another day. At some point, after a severe knockout, I will no longer be able to enter the ring again. But until then, I will keep trying until I have completed my duties, or at least as many of them as I can.
For now, I am looking forward to the end of the present ordeal. It has been an interesting though not particularly pleasant experience since Jan 8. But as my friend Gino once told me, 'what does not kill you will make you stronger'.
I think I have emerged psychologically more resilient just as I hope the present poor economy and the threat of a flu pandemic will force Generation Y to become tougher.
http://isalutesingapore.blogspot.com/2010/03/live-to-fight-another-day.html
I started having ARU (acute retention of urine) more than 13 years ago. It is the inability to voluntarily pass urine. This condition happens suddenly, gets worse quickly, and lasts a short time.
It may be the most common urologic emergency but it is a very rare problem in women as the distance between bladder outlet and the outside of the body is short with no chance of obstruction in between.
I was treated at the Singapore General Hospital (SGH) by then head of urology Christopher Cheng, who did a urodynamic study and on the basis of no bladder contraction, he diagnosed me as psychogenic ARU.
Often, in the absence of biological evidence of an underlying disease, doctors assume that the illness must have a psychological cause, -- even if the patient shows no signs of being under stress or of having a psychological or psychiatric disorder.
I admit to being psychologically unusual but not abnormal. The last thing I would want to do is draw attention to myself by being unable to pee. It was not until my friend, who is a neurosurgeon, examined the muscle power of my lower limbs that it became apparent. He had found a pattern of weaknesses suggesting tethered cord, a condition in which the spinal cord is being stretched, causing unexplained back or leg pain and sometimes urinary problems.
Surgical resection of the filum terminale, a delicate strand of fibrous tissue about 20 cm in length, then followed and there was by clinical improvement as residual urine dropped to 0 from over 300ml. But my recovery was impeded by zoster vaccination against shingles. A fever and red flush of my skin followed, and I suffered ARU for an entire week. My bladder never went back to normal after that and the frequent ARUs resulted in my needing catheterisation, which my helper, an intelligent and capable Indonesian maid, aided in administering. By then, I had given up hope of normal bladder function.
There was one occasion when I was in a public toilet at Fort Canning Park, unable to pee because my bladder would not contract for 30 minutes. I cursed and swore at my bad luck of being seen by a urological surgeon who was more proactive with his hands rather than his brain.
The 13-year delay had robbed me of a chance of complete recovery. Now I am dependent on Ubretid, a drug that inhibits the breakdown of acetylcholine, chemicals used to transmit signals from one cell to another, leaving enough at the nerve endings in the bladder to cause bladder contraction.
I believe in living dangerously and intend to hike the Swiss Alps alone. The bladder problem will be taken care of by increasing the dose of Ubretid from two tablets at night and one in the morning to two tablets twice a day. It is impractical if not impossible to catheterise aseptically given the lack of clean water on the Swiss Alps.
The other alternative is to abandon the idea of hiking the Swiss Alps, but the Lonely Planet guide to walking in Switzerland states that the very natural beauty of the Swiss Alps is threatened by modern technology, acid rain that contains nitrous oxide, reducing the area of the Swiss forest. I rather take my risk and enjoy the natural beauty whilst it is still available for my enjoyment.
Bad luck hits everyone randomly. I have had more than my fair share of good luck and will not allow this little bad luck to hold me back. Better to take risks, enjoy the scenery than whine and moan about my misfortune
I have been diagnosed with progressive supranuclear palsy.
It is a rather nasty brain disease which starts with a Parkinson’s-like illness that slows physical movements, impairs fast eye movements and balance, resulting in a tendency to fall. This is followed by difficulty swallowing, choking aspiration, pneumonia and death – for the fortunate.
Further progression of the disease will lead to dementia with prominent behavioural changes such as disinhibition and impulsivity.
My immediate reaction to the news was “忍”(ren), or endure in Chinese, of which the traditional character has a knife above a heart. I have been practicing “忍” since I was in Chinese school, recognising that life has many unpleasant, unavoidable situations.
It would be nice if this entire episode turns out to be a nightmare and that I will wake up. But it is getting increasingly real and inescapable every day.
My movements are slow and hesitant and I have difficulty getting up from my futon (yes, I upgraded from sleeping on two exercise mats, one on top of the other, to a comfortable futon on top of the exercise mats).
The futon was what my brother Hsien Yang’s kids would use when they had friends sleep over. It gives more cushioning than just exercise mats and the surface is made of woven bamboo strips, making it cool and easy to slide on.
The next question is “Why me?" but I did not ask it because the obvious answer was “Why not?". I have had it good for too long.
I was born into a middle class family with sensible parents that did not want their children brought up as rich and privileged. My father was Prime Minister of Singapore and we could have stayed in a huge bungalow in the Istana grounds. But he did not want us growing up with the wrong idea of our importance and entitlement. He did not like the idea that if we threw a ball, a butler would run to get it. So we lived in our old pre-war home at Oxley Road.
We played with the butler’s children as equals and watched their little television set in their sitting room as their equals. This relationship was maintained through the years and even now, if we happen to cross paths, we greet each other as childhood friends and on first name basis. Over the years I have seen Flora and Stella when their children were admitted to the hospital, usually for asthmatic attacks. John and Aloysius, I have not seen for a long time.
I enjoyed school — both academically and socially — I even represented Raffles Institution in athletics and swimming. After my “A” level exams, I did well enough to earn a President’s scholarship and was admitted to medical school. Again I did well academically and topped my cohort.
My first taste of failure was at the MRCP (Membership of the Royal Colleges of Physicians) exams. A day after the results were announced, almost all Singapore doctors knew I failed and cheered. That was an important lesson in resilience. I took the exams again and passed it this time.
I chose to specialise in paediatrics because I had initially wanted to do veterinary medicine but was dissuaded by my parents. The challenges of paediatrics and veterinary medicine is similar — in the two, doctors deal with with patients who cannot convey their problems clearly and concisely, and in both, patients may be uncooperative without deliberately being nasty. I then chose to subspecialise in paediatric neurology and was awarded a Health Ministry scholarship for 3 years, training at Massachusetts General Hospital a famous hospital in Boston.
On my return, I served my 13-year bond. Unfortunately, I was not really wanted at the paediatric department and was transferred to the neurology department at Tan Tock Seng Hospital. I was the only paediatric neurologist amongst a group of adultneurologists.
As epilepsy is the only neurological condition that was treatable at that time, I delved into paediatric epilepsy, which has a wider range of manifestation than adult epilepsy and I became competent as a paediatric and adult epileptologist. I was subsequently given another Health Ministry scholarship and spent one year at the Toronto Hospital for sick children and a few months at the Mayo Clinic and Cleveland Clinic. Each scholarship came with a bond and I served a total of between 15 and 17 years.
All in all, I enjoyed my years as a neurologist and epileptologist.
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KNN in the event if she leelee need to feed by the vein my uncle confirmed with chop he can take care of all the needs and passive care at a quote of sgd 15 to 20k KNN as usual no pun and Soon par if my uncle cannot leeleever his lanjiao will rot KNN @lwl pm my uncle if you are leeading this KNN
