Monday, July 31, 2006

Day +26

My Blood Count Today:
Red Blood Count (RBC) = 95(Normal 130-180)
Platelet = 46(Normal 150-50)
White Blood Count (WBC) = 1.8(Normal 4 - 11)
Potassium = 3.6(Normal 3.5 - 5.2)
Magnesium = 0.47(Normal 0.65 - 1.05)

I am well today, with magnesium deficiency. The red blood and white blood count drops further but there is some improvement in platelet count. The potassium level is also improved but the magnesium level is still low.

The doctors decided not to discharge me today.

My friend who visited me yesterday teached me a lot of "secret recipes" pertaining to health. One of the "secret recipes" to prevent cancer is to drink a cup of water immediately after we wake up each morning. No matter how rush we are, we have to drink the water slowly with great patience, dividing it into one hundred sips(swallowing very small quantity each time). The reason behind this one hundred sips is to allow more saliva from the mouth to be swallowed together with the water to the stomarch. After finishing this cup of water slowly and patiently, we have to stay there motionless for the burp(to bring out gas from the stomarch) to come, else our great effort in sipping the water will be wasted.

So next time, please don't get too worried if you see me sitting there motionless for hours. I am most probably waiting for the burp to come:-)

See you next post.

Sunday, July 30, 2006

Day +25

My Blood Count Today:
Red Blood Count (RBC) 103(Normal 130-180)
Platelet 41(Normal 150-50)
White Blood Count (WBC) = 1.9(Normal 4 - 11)

I am fine today, with potassium and magnesium deficiency. The count for all blood components drops a little bit but I believe they will start to pick up again very soon.

One of my friends came to visit me this afternoon. He is my house mate when we studied in UPM long time ago and he is also a nice and interesting guy. He said that he tried very hard to access my blog at but still unable to gain access to it. In order to convince me that he keyed in the correct blog adress, he showed me the blog address recorded on his handphone memo and I found that the address was precisely recorded. After some discussion with him, he finally said: "I have tried both google and msn, but still could not access your blog." With this, I only realize that he actually mistakenly type the blog address in the google and msn search field to try to gain access to my blog.

So if you try to access my blog using the same approach as him, please stop doing so. Just type in my blog address in the address field of the browser and I am sure that you will be able to reach here:-)

See you next post.

Saturday, July 29, 2006

Day +24

My Blood Count Today:
Red Blood Count (RBC) 107(Normal 130-180)
Platelet 47(Normal 150-50)
White Blood Count (WBC) = 2.2 (Normal 4 - 11)

I am well today. The white blood count drops sharply from 5.2 to 2.2, but don't worry, it will pick up very soon. There is a good increment in red blood count, from 96 to 107. The platelet count remains almost the same.

I experience potassium and magnesium deficiency everyday even with oral supplement. So these two minerals have to be further supplemented through infusion, that is the only time when my hand get "wired" to the stand again. Hopefully, my body can overcomes these deficiency very soon.

I appreciate many of you out there who support me through prayer and encouragement. One day, I received a short SMS "Jesus is Love" . Since the message is not signed and the sender number is not on my phone book, so I had totally no idea of who the sender was. In order to find out who the sender was, I replied "Your number is not on my phone book, may I know who are you?"

I got the reply, "Matthew x-x-x", where x is some number. I really couldn't figure out who is this Matthew. I asked my wife if she know anyone called Matthew but she also don't remember who this Matthew is.

No long later, I received another SMS, "John x-x-x", then "Luke x-x-x", then "James x-x-x". How come this person keep on changing his name? From Matthew, to John, to Luke and James... Finally, I called the number and based on the voice, I realize that he is one of our church members. He was actually sending Bible verses to me.

Everyday, I received at least three very short SMS from him. Example of the messages:
"Jesus is King"
"Holy Spirit let us understand"
"Timothy x-x-x"

Why don't he put all the messages in a single SMS to reduce the telephone charges? I don't know, but I do know he is remembering and supporting me everyday!

See you next post :-)

Friday, July 28, 2006

Day +23

My Blood Count Today:
Red Blood Count (RBC) 96(Normal 130-180)
Platelet 49(Normal 150-50)
White Blood Count (WBC) = 5.2 (Normal 4 - 11)

I am fine today. The white blood count is now 5.2, it might drops later because I am no longer given "growth factor". The sharp increment of platelet is mainly due to the platelet transfusion yesterday. I received two single donor platelet transfusion yesterday, one in the morning and one at night. The red blood count drops a little bit, hopefully it will pick up tomorrow.

The BMA result is very positive. The doctor said that there are many blood cells engrafted and there are zero blast cells (cancer cells). We would assume for now that the new cells are produced from my sister stem cells. This will be confirmed by cytogenetics analysis which is a study of the chromosome structure from the bone marrow samples. If the blood cells are produced from my sister stem cells, then the last pair (pair 23) of the chromosomes should be XX (female) instead of XY(male). So you can imagine this transplant results in a male carrying female blood. However, you don't have to worry I would then become a girl because this involves the blood cells only. The cells from other part of my body are still carrying XY(male) chromosome. So at the end I am still a male:-) The cytogenetics analysis result will be ready about six weeks from now.

Yesterday, after the dinner, I noticed heavy bleeding at the wound due to the BMA. The nurse gave me another transfusion of single donor platelet. She then called the doctor in at midnight to stitch the wound. The bleeding stopped after 3 stitches. This is the first time that the BMA wound needs to be stitched to stop bleeding. I think the bleeding is due to low platelet count. Most of the previous BMA was done with higher platelet count.

If everything goes on smoothly, I should be dischargable from the hospital next Monday.

See you next post.

Thursday, July 27, 2006

Day +22

My Blood Count Today:
Red Blood Count (RBC) 100(Normal 130-180)
Platelet 19(Normal 150-50)
White Blood Count (WBC) = 5.0 (Normal 4 - 11)

I am well today. The white blood count reaches 5.0, a very good increase. The doctor stops to give "growth factor " injection to me. The red blood and platelet count also increase a little bit.

I am given another transfusion of single donor platelet today due to the BMA.

BMA was done this morning smoothly. But the wound bleeds a lot just now, the nurse asked me to lie down. So I cannot continue my writing.

See you next post:-)

Wednesday, July 26, 2006

Day +21

My Blood Count Today:
Red Blood Count (RBC) 96(Normal 130-180)
Platelet 16(Normal 150-50)
White Blood Count (WBC) = 3.0 (Normal 4 - 11)

I am well today. The white blood count reaches 3.0, a very good increase. The red blood and platelet count drop a bit but I believe they will pick up very soon.

The bone marrow aspiration is postponed to tomorrow due to unforeseen circumstances.

I have also completed the current course of intravenous antibiotic. The doctor also stops to administer normal saline(Sodium Chloride solution) to me since I can drink and eat without problem. With this, I can move freely in the room as my hand is no longer "wired" to anything now.

I would like to thank Dawn for sharing the followng bible verse with me through the comment for my post yesterday.

"It's useless to rise early and go to bed late, and work your worried fingers to the bone. Don't you know he enjoys giving rest to those he loves?" Psalms 127:2

"你们清晨早起,夜晚安歇,吃劳碌得来的饭,本是枉然;惟有耶和华所亲爱的,必叫他安然睡觉。" 诗篇 127:2

The phrase "giving rest" in chinese translation simply means "sleep peacefully or sleep well".

The ability to sleep well is a gift from God and I thank God for blessing me with this precious gift. I have to wake up many times at night in the hospital to go to toilet due to heavy water intake. After waking up, I would be able to continue sleep without problem. Before I was diagnosed with Leukaemia, I always wake up together with my wife at 5:30am as she needs to go to teach in school at about 6:30am. While my wife preparing herself to go to school, I went for jogging for about 25 minutes, completing a distance of about 3.7km. After sending off my wife to school, I would continue to enjoy my sleep for another hour.

Since I can sleep very well and my wife always has difficulty to continue her sleep after waking up, I always volunteered myself to bottle-feed the babies at night if they cried for milk. However, it would be impossible for me to help her if the babies are still under breast-feeding because there is no way for me to produce milk for the baby.

Apart from able to continue sleep after some interruptions, I am also able to sleep with the light turn on, people moving around, noisy environment, without mattress and pillow:-)

But one of my brother-in-laws can sleeps better than me. He always turns on the light, the television and radio together, and then sit down on the sofa to enjoy himself. I was greatly puzzled by this funny behaviour - how can he watches television and listen to the radio at the same time? His loud and noisy snoring will soon tells you that he is actually enjoying sleeping there with everything turned on. However, if you think that he is wasting electricity and try to help him to turn off either the television or radio, he will wake up immediately and question: "Who turn it off?" It looks like he is able to enjoy both the television and radio program at the same time while sleeping. With him possessing this extraordinary ability, I have to admit that he can sleep a lot better than me:-)

See you next post and happy sleeping:-)

Tuesday, July 25, 2006

Day +20

My Blood Count Today:
Red Blood Count (RBC) 99(Normal 130-180)
Platelet 18(Normal 150-50)
White Blood Count (WBC) =1.8 (Normal 4 - 11)

I am fine today. The white blood count increase by 0.5 to 1.8. This is the best increase so far. Hopefully, it will be more than 2.0 by tomorrow. The platelet also increase from 15 to 18, an increase without platelet transfusion first time ever. Meanwhile, the red blood count also increased from 95 to 99.

The doctor will do a Bone Marrow Aspiration(BMA) for me tomorrow. This is my 7th BMA. A needle will be inserted into the back of one of my hipbones to draw a liquid sample of the bone marrow for analysis. I always requested the doctor to put me to sleep before the procedure or else it will be very painful.

I sleep most of the day because I am too sleepy. I am afraid I started to be like my sister who donated the stem cells to me. She is very hardworking but also always very sleepy. We used to do homework and revision on the same table while we were schooling long time ago. I always like to sit at her opposite side, facing her. She would start to become very busy after sitting down - not busy doing the revision but busy "mengantuk"(continuous bowed down her head due to sleepiness) with a book wide open in front of her. Since bowing is a sign of respect, so I enjoyed her continuous respect while I was studying or doing my homework. We advised her to go sleep but because she was so hardworking, she always refused to go to sleep. She would like to continue to study and at the end she ended up with her continuous act of respecting me for hours. So you can see how respectable am I :-)

But now I am as sleepy as her. If we sit opposite to each other, you will be amazed how much this pair of brother and sister respecting each other by bowing their head to each other continuously :-)

See you next post:-)

Monday, July 24, 2006

Day +19

My Blood Count Today:
Red Blood Count (RBC) 95(Normal 130-180)
Platelet 15(Normal 150-50)
White Blood Count (WBC) =1.3 (Normal 4 - 11)

I am fine today. The white blood count continue to increase to 1.3. The doctor said that my white blood count is increasing quite slowly compared to other patient, but as long as it is increasing, it should not be an issue. There is slight increase in red blood count and the platelet. No platelet transfusion is done today.

With the constant increase of white blood count, we can conclude that the stem cells from the donor are able to engraft. The next thing that we need to pray hard is that no severe GVHD will occurs.

The nurse "uninstalls" the triple lumen catherter at my neck. The reason for the removal is that this type of catherter is prone to infection and it is normally used for two weeks only. I have been using it for almost one month, so "untunglah saya"(I gains) :-)

The doctor also change the intravenous anti-GVHD drug Cyclosporin to oral tablet form, taken twice a day. With this change, the flow control machine is no longer needed which means I can move more freely now - without the need to bring the heavy flow control machine and multiple power extension cords with me. However, now the intravenous drug such as antibiotic, potassium, magnesium and normal saline have to be administered through the catherters on my right hand. This will affect the movement of my right hand. I don't know if I can still play the guitar with those plastic tubes connected from my right hand's "socket" to the mobile stand.

That's all for today, see you next post :-)

Sunday, July 23, 2006

Day +18

My Blood Count Today:
Red Blood Count (RBC) 92(Normal 130-180)
Platelet 11(Normal 150-50)
White Blood Count (WBC) =1.1 (Normal 4 - 11)

I am fine today. The white blood count increased by 0.3 to 1.1, which is considered to be a good increase. However, the platelet is still dropping even with transfusion yesterday. The doctor said the Platelet recovery will normally lack behind 5 to 10 days compared to white blood cells.
Given this low Platelet count 11, I receive another transfusion of single donor platelet today.

The cough get a little bit more severe today. So I started to take cough syrup. It makes me feel sleepy. The mucositis condition improved a lot.

Back to the daily examination check lists I mentioned yesterday, after asking the question:"How are you today?", the next step is to examine the mouth and throat with the help of a torch light. As a "family doctor", instead of looking for mucositis, I should check whether their mouth is clean- make sure that they brush the teeth, no left-over sweets in the mouth and the teeth are sparkling white.

The next examination is to see if the the lung is clear. I will put the stethoscope on the chest and back (lung area of the body) and then ask the family member to breath in and out to see if the lung is clear or not. Frankly speaking, when doctor said:"Good, the lung is clear", I don't know what does the word "clear" means because I never has a chance to listen to my lung. The word "clear" can means the lung generates some sound which is very "clear" - something like 24-bit mastered Dolby Surround AC-3 Digital classical music. It can means the lung is "clear" of some sound - for example those noisy heavy metal music. It can also means the lung is "clear" of all sound - totally quiet. I need to do further research on this.

The next examination is to listen to the heart using the stethoscope to see whether "heart murmur" can be heard. But I also don't know what does this "heart murmur" actually sounds like. One afternoon during my 4th cycle of chemotherapy in April this year, four doctors suddendly appeared at my bed side and asked permission to examine me. One of the thing that they wanted to find out was whether I had this "heart murmur". So the four doctors take turn to examine me. This means that I had to go through the same examinations for four times. At the end I only realized that this examination formed part of their exam - they probably had to write report to conclude what they heard. Even doctors have to be tested on how to listen to this "heart murmur" correctly, I guess it is not easy for me to find one.

But nevertheless, I find the word "murmur" in Longman dictionary as "to compain to friends and people you work with, but not officially". With this, the "heart murmur" can be interpreted as "complain from within the heart". So with this examination I should be able to hear if their heart murmurs against me. If so, I think I would also be able to hear through the stethoscope the complains and dissastifactions in detail so that necessary actions can be taken :-) Anyway, this is just a joke, if you want to find out what "heart murmur" actually is, you can read something from here.

The next exmination is to press at various position of the abdominal area to see if there is any pain. If there is no pain, then everything should be fine. If there is pain? I also don't know what to do because I pass this examinations everytime doctor examine me. I think the best solution is to send them to see a medical doctor if they failed this exmination.

The next one is to exmine the eyes. This one is a little bit tricky for children. I have to ask them to look at left first, then right, then up and then down or east-west-north-south, while keeping their head stationary. If the children having difficulty to do this, then I have to ask my wife to hold their head so that I can examine their eyes with full concentration. If the eyes are red, I have to investigate why they are crying.

Lastly, I have to examine their skin. The children are so active that it is very easy for them to injure themselves. If I found any bruises on their body, just cover them with handiplast. A pretty easy task to do :-)

I believe with this exmination, the family members would be more healthy, both physcially and psychologically.

See you tomorrow:-)

Saturday, July 22, 2006

Day +17

My Blood Count Today:
Red Blood Count (RBC) 95(Normal 130-180)
Platelet 13(Normal 150-50)
White Blood Count (WBC) =0.8 (Normal 4 - 11)

I am well today. The white blood count increased by 0.1 only, less than what I have expected. However, this small increase of 0.1 is still considered to be very precious to me and I hope that the count would reach 1.0 or more by tomorrow. The Platelet count remains 13, even with the transfusion of a single donor platelet yesterday.

I am given transfusion of another single donor platelet this afternoon.

The body is losing magnesium and potassium almost everday. These two minerals are added into the normal saline to be administered to the body. Apart from this, my blood pressure is also high, it can reach 160/100. This is one of the side effect of taking anti-GVHD drug Cyclosporin. Today I start to take medicine to control the blood pressure and also taking oral potassium supplement.

The patient in this VIP Room 1 is very precious to the doctors. Sometimes, I will be examined 3 times by 3 different doctors at different times of the day. Whenever the doctor comes in to the room, she or he will do the following:
1. Ask the question "How are you today?".
2. Look at the mouth and throat to see the level of mucositis. The doctor will always shoot the torch light to my mouth and ask me to say "Ah!".
3. Listen to the breadth sounds using a stethoscope - chest region and back. The doctor will ask me to breath in and out while they are listening. Then most of the time they would say: "The lung is clear."
4. Listen to the heart sounds by placing the stethoscope on the left chest. The result is most likely "clear" also.
5. Press the abdominal area to see if there is pain caused by applying pressure to the area. I will be asked to breath in and out also.
6. Examine the eye.
7. Examine the skin on the body.

I believe the above examination is very useful and meaningful to be performed not only on patient in hospital but on my family members also . Since I have plenty of torch lights at home, the only equipment that I lack of now is the stethoscope.

So, instead of shaking, begging, advising and finally commanding the two elders boy to wake up at 9:00am in the morning, I should take a more professional approach - just imagine myself a "family doctor". I shall no longer raise my voice and issue the command: "Boys, listen carefully, this is a command, now I start to count down from 10, those who wake up, brush the teeth, wash the face, change the pyjamas and then be in the dining room to take breakfast before I count to 0 will get 2 points of reward! 10, 9, 8, ..." This command will almost immediately responded by complain: "Why you don't issue advice first before giving command?","Why you count so fast?" and "Why...?"

Now with the "family doctor" examination check lists. The first question I should ask is "How are you today?" One of the possible response from my eldest son Daniel would be as follow.

"Let me stretch my body first." then he will stretch his body on the bed for one minute before start to talk.

"Baba, can you buy me two large Domino Pizzas, ALOHA CHICKEN flavor for breakfast?" He likes to eat Pizzas so much that I have to sign up as a Domino Millennium Gold Card member, so that whenever I buy a large Pizza, I also get a second large Pizza free of charge. If you need to buy Pizza from Domino, I can lend the card to you - it is transferrable.

"Daniel, you just eat Pizza two days ago. You know Pizza is not a healthy food" I responded.

"Why all the delicious foods are not healthy and all the healthy foods are not delicious?" He will ask.

"..." This is a tough question. I am also finding answer to this question. Could it be because the delicious foods are too delicious that make people over-eaten them which then cause diet imbalance - unhealthy? If we give the Pizzas, KFCs, Big Mac Burgers to the hunger strike mulnutrition Africa's children, would the foods still be considered unhealthy?

Then it comes to talking to my second boy Joseph who is studying in primary one: "How are you today, Joseph?"

"Baba, what day is today?" He will ask


"Oo... I don't want to go to school, I don't want to go to school." He will start to cry.

"Joseph, tell me, why you don't want to go to school?"

"Oo... I don't want to go to school, I don't want to go to school." He just have the conclusion, but not the reason.

Then I should ask Adriel, my 2 years old girl. "How are you today, Adriel?"

"Go, go Baba go, go to garden!" She will force me to bring her to play in the garden.

Lastly, I should never forget to ask my cute beautiful wife Angela. "How are you today, Honey?"

"Tell me, why you look at the beautiful young lady yesterday?" She will start to question.

"Honey, it is completely necessary to look at her."

"You see, you admit it yourself, colour wolf..."

"Honey, if I didn't look at her crossing the road and adjusted our car speed accordingly, we would simply knocked her down." Of course she will not be satisfied with this simple answer and start to argue with me. In order to prevent this type of unnecessary misunderstanding and argument, I will definately has to put "auto-pilot" as one of the top most feature when purchasing our next car. With this feature, when I see a lady crossing the road, I can quickly put the car on "auto-pilot" then close my eye immediately and tell my wife "You see, I see nothing now." If the "auto-pilot" feature is too expensive, the "auto-brake" feature will also serve the purpose.

The youngest 3 months old boy Aaron should be easiest to handle. I just hold him in my arm and ask :"How are you today, Aaron?" Amost everytime he will respond with smiles to show that he is happy - no complain, no dissastifaction, no request.

I believe the life of a "family doctor" is more challenging than the medical doctor in the hospital. This is because it is impossible for the "family doctor" to limit the scope of the answer for the question "How are you today?", while in the hospital the patient would normally answer the question within the scope of their sickness only.

I think I should continue this tomorrow for other form of examination.

See you next post!

Friday, July 21, 2006

Day +16

My Blood Count Today:
Red Blood Count (RBC) 99(Normal 130-180)
Platelet 13(Normal 150-50)
White Blood Count (WBC) =0.7 (Normal 4 - 11)

I am well today. The throat pain problem is getting better. I have stopped taking Morphine Syrup and Panadol Soluble.

The white blood count increased from 0.4 to 0.7 and there is a also a slight increase of red blood cell, from 96 to 99. There is a small drop of platelet, which consider to be alright since I did not received platelet transfusion yesterday. The body will gain some immunity once the white cell count reach 1.0 and above. Hopefully, the white cell count will be more than 1.0 tomorrow.

Thursday, July 20, 2006

Day +15

My Blood Count Today:
Red Blood Count (RBC) 96(Normal 130-180)
Platelet 14(Normal 150-50)
White Blood Count (WBC) =0.4 (Normal 4 - 11)

I am well with reduced cough and flu, still with sore throat. There is a very significant increase of white blood count - from 0.2 to 0.4. If white blood count can increase steadily everyday until 2.0, then I can be discharged. The increase in white blood count also implies the recovery of other components such as platelet and red blood cell.

In fact, the nurses suggested many times to put me on Total Parenteral Nutritient (TPN) due to my mucositis problem. TPN is a method that transfer the necessary nutritient that a body needs through the vein. In my case, it can be done through one of the catherters that I have. With TPN, the patient can stop eating but still acquire the necessary nutritient. However, I am very reluctant to do this because I can still swallow, of course with some bearable pain.

Some nurses and doctors advised me "Don't try to be a superman!" - they thought that I force myself to swallow even though it is very painful. But I never try to be superman because the pain is tolerable to me especially with Morhpine Syrup and the Panadol Soluble. If I want to be superman, I shall be jumping here and there in the room to learn how to fly instead of trying to swallow food! With God grace, I am able to take soft food like oat meal, poridge, barley etc.. In the morning, I have two packs of "3 in 1 cereal oat drink" in about 400ml of hot water. It is very delicious and soothing to the painful throat.

Yesterday was a sleepy day, when I try to write something late at night, one of my cartherters experience back-flow problem. What is a back-flow? A back-flow happens when blood from the body flow out to the plastic tube that connect the catherter and the drug solution pack. Normally, the drug solution pack is hanged on the stand higher than the patient, therefore the drug always flow towards the body through the plastic tube. However, when the patient stand out and there is not much drug solution left in the drug pack, the blood pressure in the body can becomes higher than that of the tube which would then force the blood to flow into the tube. If this happens, one has to lie down quickly to allow the blood to flow back to the body.

Yesterday morning, I managed to solve one Sudoku puzzle, from Monday Sin Chiew's Newspaper (10 July 2006), in about an hour time. Without the Morphine Syrup, I should performance better :-)

Wednesday, July 19, 2006

Day +14

My Blood Count Today:
Red Blood Count (RBC) 102(Normal 130-180)
Platelet 24(Normal 150-50)
White Blood Count (WBC) =0.2 (Normal 4 - 11)

I am well, but with sore throat. The white blood count remains 0.2. The platelet count is 24, but after a single donor platelet transfusion this morning.

I need to stop now, because one of catherter experiences back-flow problem, the nurse asked me to lie down.

Tuesday, July 18, 2006

Day +13

My Blood Count Today:
Red Blood Count (RBC) 105 (Normal 130-180)
Platelet 14 (Normal 150-50)
White Blood Count (WBC) =0.2 (Normal 4 - 11)

I am well but with severe sore throat. The white blood count dropped by 0.1, quite a big drop.

I am given another transfusion of single donor platelet today.

The nurse started to give Morphine syrup to me, with 5ml each dose 6 hourly. It is a very good pain killer but it also make me very sleepy. This morning, I was playing my guitar while the nurse gave Morhine syrup for me to drink. I have to quickly pack my guitar after 10 minutes of drinking it, else I will definately fall asleep on top of my guitar.

Monday, July 17, 2006

Day +12

My Blood Count Today:
Red Blood Count (RBC) 119 (Normal 130-180)
Platelet 11 (Normal 150-50)
White Blood Count (WBC) =0.3 (Normal 4 - 11)

I am well except with quite severe sore throat. The white blood count increased from 0.1 to 0.3, a very good increment. However, the platelet drops from 26 to 11.

I am given transfusion of another 4 units of platelet this morning.

After the chief haematologist (blood specialist) examined my mouth and throat to determine the extent of mucositis (mouth, throat, digestive tract ulcers) that I have, she decided that I am fit for the last dose of Methotrexate. The nurse then administered it to me at 2:00pm today.

I am taking Panadol soluble in the form of effervescent tablet to reduce the throat pain. The dissolving process of this Panadol tablets in a glass of water is amazing. The tablet creates so much small white bubbles in the cup in such a short time while disintegrating itself. It looks like the cup of water is boiling suddenly . It is really like magic show! After looking at the show, the Panadol solution tasted better to me :-) So if your children refuse to take Panadol when they are sick, get this type of Panadol for them. Let them dissolve the Panadol themselves. I am sure after looking at the magical effect of dissolving the Panadol, they couldn't wait to swallow the cup fo Panadol solution. However, please remember to lock the remaining Panadol soluble tablets in a safe place, else the children will consume all of them at once when you are not around.

The nurses suggested to me a couple of times to take "morphine syrup" to ease the pain, but I refused because the pain is bearable. The Panadol is more than enough to for me to control the throat pain.

The pain is experienced only when I swallow something such as saliva, food and drink. If I don't swallow anything, then I won't experience any pain at all. With this throat problem, I should be able to count how much saliva that I swallow within an hour more accurately than you because each of my swallow equal to "one pain". A healthy person will surely miss a lot of swallow count because he/she always swallow unconsciously - don't even notice he/she is swallowing. God abundant grace is actually embracing our whole body - making it works wonderfully, but because so many actions that we perform are completed unconsciously, we becomes ignorance of God's abundant grace upon our body. So, if you have nothing to thank God in your next prayer, thank Him for giving you a body that can swallow so well - so pain free, so smooth and so automatic!

Sunday, July 16, 2006

Day +11

My Blood Count Today:
Red Blood Count (RBC) 100 (Normal 130-180)
Platelet 26 (Normal 150-50)
White Blood Count (WBC) =0.1 (Normal 4 - 11)

I have developed sore throat since early morning today, otherwise I am well. Because of this, I have to take soft food. The white blood count remains to be 0.1 and the platelet increased from 18 to 26, the best increment after transfusion :-)

The doctor cancelled the last dose of Methotrexate that suppose to be given by today, due to the throat pain and mouth ulcers.

Every morning, the nurse will take my weight. I weighted 63.4kg this morning, a 3.4kg increment compared to when I was admitted. You would be suprised that my weight is not dropping but increasing. It is definately not due to the luxurious life in this VIP room where I have eaten too much delicious meals. It is because there are too much water left in the body - a situation which also called fluid retention. Apart from the weight comparison, the doctor will look at the fluid input-output (IO) balance. It is simply the total fluild input minus the total fluid output. If there is too much positive balance, then fluid rentention occurs. With this IO balance calculation, I have to record all the fuild intake and all the fuild that I pass out (urine volume). It might seems too tedious for you to do this, but it is perfectly alright for me to do this as I have a lot of spare time in this small room. The only problem is my "short-term memory loss" problem, where I forgot the volume of urine that I passed before I got a chance to record it down after coming out from the toilet. The third approach to judge if one has fluid rentention is to examine the body especially the face, stomarch and the limbs to see if they swell. If they swell then fluid rention occurs. Please be warned that numerous other problems might cause the above conditions, consult a medical doctor if you counter any of the symptoms above is my best advice.

I amost get all the symptoms everyday. In order to discharge the excess fuild in my body, the doctor always administers a drug called Lasix (Furosemide) through injection, luckily not through a needle poking into my body, but through one of the catherters. Then the next one hour or more, I will be busy going to toilet and doing recording.

If you went to a clinic and the doctor decided he needs to administer this drug to you, never insist that you need an injection instead of taking an oral form of the drug. While many peope are afraid of injection, one of my friends will always force doctor to give him injection. I believe he has not so much confident on oral medicine or he is a hot tempered guy who want instant result. If you get an Lasix injection and try to drive home immediately, you would most likely to have a "game-over" in your car as the injection works incredibly fast, normally within 10 to 15 minutes.

That's all for today and see you next post :-)

Saturday, July 15, 2006

Day +10

My Blood Count Today:
Red Blood Count (RBC) 106 (Normal 130-180)
Platelet 18 (Normal 150-50)
White Blood Count (WBC) =0.1 (Normal 4 - 11)

I am well today. The appeptite remains good. The WBC increased from less than 0.1 to 0.1. Even though the increment looks small but it is a very signification improvement. Prayerfully, it would increase to about 0.2 or further tomorrow. The platelet count drops by 1 even with transfusion yesterday.

I received transfusions of another 6 units of platelet today. Each unit of platelet is separated from the full blood from a single donor. So, 6 units of platelet have to be from 6 different donors. The earlier platelet transfusions were all from a single donor who just donated their plalelets through a filter machine while the rest of the blood components were return to the donor body. Single donor platelet is of higher quality compared to multiple units of platelets from different donor.

The iv drugs that I am still receiving are cyclosporin for GVHD, antibiotic Tazocin, 4 litres of normal saline, potassium and magnesium. The oral drugs are sleeping pill called Lorazepam , Antiviral drug called Acyclovir and Antifungal drug called Itraconazole. In addition, the Neupogen is given by injection to stimulate the bone marrow to produce white blood cells.

Normally, after the nurse "unwired" me in the morning, I have about an hour of precious freedom moment to move around in the room and to take bath. Before taking bath, I would do about 5 to 10 minutes of cycling. Since my platelet count dropped below 20, the nurse no longer allowed me to cycle to prevent bleeding.

Now, I changed my morning exercise to playing the two sport cars as shown in the picture. I purchased the toys for the children the night before I was admitted to hospital for transplant. The sport cars are made in China, 6 units cost about RM8.00 only. Even though they are cheap, they are incredibly fun to play. I saw the children playing, but did not have time to join them as it was too late. I need to prepare for the admission. I asked my wife to borrow two of the sport cars from the children for me to play in the WAD. The nurse won't bother to play with me, so I have to play alone :-(

The sport cars are equipped with good spring, you just press them against the floor and push backward quickly and then release, they will run forward with a very high speed. The right one shown in the picture will even make a beautiful turn for you before it speeds off. They can run very far and my room is really too small to play them. So they always end up colliding the wall, of course without getting damaged :-) I would spend about 10 minutes chasing after these two sport cars until I almost sweat before I go to take bath.

One idea to play the sport car is to place a chair at one end of the room and speed off the car from the other end of the wall, aiming the car to the chair, estimating whatever turn that the car might make. If the car goes through between any two legs of the chair, then it is considered a "goal". Please be warned that if you use a single legged chair, no matter how smart you are, you would never strike a goal. Another idea is to place more than one chairs from one end of the room to the other, the more chairs the car passes through the more point one gets. To make the game more interesting to play, the room has to be very big and vacant. With this, you can enjoy "Family-Cup" everyday with your children :-)

If you want to know where to get the sport cars, just let me know, I will tell you where they are available.

See you next post.

Friday, July 14, 2006

Day +9

My Blood Count Today:
Red Blood Count (RBC) 101 (Normal 130-180)
Platelet 19 (Normal 150-50)
White Blood Count (WBC) < 0.1 (Normal 4 - 11)

It looks like the bone marrow is producing the white blood cells since it is increased from 0 to <0.1. Hopefully, the amount will be increased further tomorrow.

I fell well today and the appetite to eat returned. I also received another notebook equipped with WIFI from the office this afternoon. So after replying the emails I started to catch up in writing.

I am given transfusion of another single donor pack of platelet in the morning. Hopefully, this should further increase the Platelet count to over 20 tomorrow.

It is rather late now, I need to go to sleep.

See you next post and God bless you :-)

Day +8 13-July-06(Thurs)

My Blood Count Today:
Red Blood Count (RBC) 83 (Normal 130-180)
Platelet 15 (Normal 150-50)
White Blood Count (WBC) =0 (Normal 4 - 11)

So the WBC dropped to zero.

I was given transfusion of another one pack of single donor platelet and 2 packs of red blood cells.

I was feeling better but still tired most of the day.

The notebook computer was sent for repair. I got a replacement from the office, but without WIFI, so I am unable to go online to update anything.

In the afternoon, two BMT (Bone Mrrow Transplant) nurses came to me and started to examine my left arm. They keep on praising my arm and said "cantiknya! cantiknya! (beautiful!, beautiful!)". Nobody would say that my arms which are full of "tahi lalat (moles)" beautiful. While I was puzzling what did that mean, I was having a big shock to see them pulling out a needle from a tray and poked into my arm to draw blood. I only realized that they mean I have beatiful veins on the arm. A vein is beautiful when it is big and slightly raised from the surface of the arm. It is very easy to draw blood from this type of vein, that is why the nurse called it beautiful.

My beautiful vein on the arm is attributed to my poor childhood life in the kampung (village). My brothers and sisters used to do heavy work in the plantation such as tapping rubber trees, planting and harvesting pepper and oranges. After the hand go through heavy exercises, the veins became big and raised slightly which makes it very easy to locate. So if you would like to have beautiful veins on your arms, please start to let them do heavy work. If you really don't have heavy work to do, just come to my house to help carry my babies, then your veins will sure look beautiful :-)

Day +7 12-July-06(Wed)

My Blood Count Today:
Red Blood Count (RBC) 93 (Normal 130-180)
Platelet 12 (Normal 150-50)
White Blood Count (WBC) < 0.1 (Normal 4 - 11)

Sorry for the "Siaran Tergendala...(Broadcast Interrupted...)".

While I was in the midst of red blood cells transfusion, I started to shiver at about 12:00am. The nurse suspected it might be due to the reaction to blood transfusion, but I have no history of such reaction due to blood transfusion. I personally know that I am getting fever. The shivering lasted for about 6 hours. I am not allowed to take panadol as it will affect the accuracy of body temperature measurement.

Whenever I started to shiver, I dictated Psalm 23 and Psalm 121, which stopped the shiver miraculously. However, when I rise to pass urine and then lie down, the shivering started again, and I started to dictate the two Psalm chapters again and the shivering stopped. These was repeated many times until about 6:00am, the shivering stopped. I really thankful to the night duty nurse who took great care of me during the difficult time. At 5:00am, the temperature went up to 38.8°C, they called this a "spike".

The normal procedure initiated, the doctor in charge was called in to take blood samples from the 3 catherters from the neck and from one of the arms. No blood samples were taken from the 2 catherters lumen from the right arm. May be because they are not in use.' After the blood samples ware taken, the nurse started to administer iv antibiotics called Tazocin to me. Chest X-Ray also be taken. Then later of the day another iv antibiotics called Vancomycin, which was redrawn the next day when it was confirmed that some types of bacteria were not found in the blood culture. Therefore, I am now receiving Tazocin only. The antifungal, most probably Cancidas will be used only after second "spike". Hopefully this second "spike" would never happen. I was given another single donor pack of platelet.

I was weak and bedridden throughout the day. No appetite to eat. My sister and my wife prepared some home cooked barley drink for me.

At night, I gained some strength which I thought should be enough for me to blog something. When I turned on the notebook computer, I notice that it was also down with some kind of "fever" which make it unable to boot up successfully. It is suffering from "perpetual-booting" syndrome which means, it try to boot up, when the Windows XP logo appeared, it then showed me a blue screen with a lot of description in less than one second and then started to boot again. How could we human read such a lot of information in less than one second? Microsoft must be joking! At least leave the message longer enough for us humand to read or let us pause the message by pressing "break" or "space" or "p" keyboard button. But I tried so many buttons it still just flashed the message to me and then go into its business of next cycle booting.

It is really like playing a reaction game. I have to stare at the screen and once the blue screen appeared, I quickly hit "break" button and only found out that this "break" button does not work. Then I waited again, try many other possible buttons including the space bar - because that is normally used to shoot in computer game, but it does not work as well. It is really frustrating, if there is a "reformatting" button, I would definately press that one to end the story. I guess the engineer who design the boot process must mistakenly thought that the message is for machine to read. But the common sense is, if it is for the machine to read, why show it to us :-( However, the engineer must not be blamed, it must be my ignorance of handling this situation.

The next big question is how to stop this "perpetual-booting" syndrome. I press the "Power" button, it did not work. I disconnected the notebook from external power supply, the notebook carried on its booting business happily. I thought I would just leave it until the rechargable battery get exhausted, then it would stop. But when I thought of this notebook doing this crazy thing, I could not sleep. The next thing that I could do was to pull out the battery and it would sure stop. If it still continue doing the crazy thing when the battery was pulled out, then it would not be frustrating anymore, it would be a big discovery, a discovery of a "Perpetual Machine" - a machine that could generates energy from no where. Anyway, this type of machine had been proven impossible to construct long time ago.

I suddently remembered that if I needed to shutdown the running notebook by force, I should press the "Power" button long enough until it shut down. And you know, it worked and I went to sleep peacefully.

Tuesday, July 11, 2006

Day +6

My Blood Count Today:
Red Blood Count (RBC) 79 (Normal 130-180)
Platelet 11 (Normal 150-50)
White Blood Count (WBC) < 0.1 (Normal 4 - 11)

I am still considered fine, even with mild throat pain, mild flu and cough. The appetite is still good.

I received my 3rd doses of Methotrexate this afternoon at four o'clock. Only one more dose left to be given on day +11.

I am now immuneless with WBC less than 0.1. This situation will last for about 2 weeks, even with the administration of Neupogen. We pray that there would be no serious infections within this waiting period. Infections is marked by fever where body temperature increased to or more than 38%C from normal 36%C. Once this happen, the doctors have to investigate the causes of infections. Chest X-Ray will be taken to see if the lungs are healthy. At the same time, the blood samples will be taken from different parts of the body for culture to determine whether they are infected with virus, bacteria or fungus. If I were not mistaken, in my case, the blood sample has to be taken from all the 5 catherters (lumens) , 2 from the arm, 3 from the neck. As mentioned earlier, catherters are similar to electrical sockets installed on the body but are used to administer drug through the vein, draw and transfuse blood. Another blood sample have to be taken from one of the arms. Taking blood sample from any of the catherters is not painful at all, but drawing blood directly from the arm is painful. Without waiting for the blood culture result, the doctor will administer intravenous(iv) antibiotic immediately.

In my case an iv antifungal drug which is called Amphoterisin B will also be given. The Amphoterisin B is needed because I was infected with a fungus called aspergillus during my second cycle of chemotherapy. Not like iv antibiotic which can be administered within 1 hour per dose without much reaction, the administration of Amphoterisin B is very tedious. First the patient has to be put to sleep using two iv drugs called Pethidine and Phenergan. These drugs acts like morphin , it sooth the patient in order to reduce reaction from the Amphoterisin B. Then the Amphoterisin is administer intravenously through a flow control machine. The flow rate (ml per hour) is depending on the tolerancy of the patient towards the drug. The highest flow rate used so far is 100ml per hour. Therefore for a dose of Amphoterisin B diluted in a normal saline of 500ml would take at least 5 hours to deliver.

One thing I need to mention is that the drugs Pethidine and Phenergan are addictive, once you have it, you would long to have it the next day. They will make me so relax and peaceful and go to sleep before I am able to count to 10. If you cannot sleep at night, these drug might be helpful :-), but never say that I recommend them to you.

Despite the relaxation and soothing effect with Pethidine and Phenergan, my experience with Amphoterisin B is terrible. Frankly speaking, no one would like this drug, some patient still cannot tolerate it even with the help of Pethidine and Phenergan. Instead of going to sleep, they are shivering there even the Amphoterisin B is administered very slowly, say 30ml per hour. I experienced kidney impairement after 19 doses of Amphoterisin B, a dose each day. The impairment was marked by a very high level of the creatinine in the blood, 1.6 mg/dl compared to normal range of 0.6-1.2mg/dl. But the treatment of fungus has to continue, therefore, the doctor changed to a better iv drug called Cancidas. This drug is administered like antibiotic, without much effect, either on reaction while receiving the drug or organ function impairments. The only undesirable effect is that the price is very high, a dose would costs RM735. The first dosage is called loading dose with a higher volume than the following dose. It costs me more than RM1000 for the loading dose. Therefore I paid about RM5700 for 6 doses only. Hopefully, I would be able to claim this amount back from somewhere else. After this, I never stop taking oral antifungal drug Itraconazole (Sporanox) from middle of March this year until now. You can see how tedious is to handle the fungus infection. But please don't worry, for normal person like you with functional immune system, the likelihood of fungus infection would be very slim.

Apart from low WBC, my platelet count is also extremely low. As you know, platelet take parts in blood clot, low platelet count makes one very prone to bleeding. On the other hand, the red blood cells are helping in carrying oxygen to the tissues and organs of the body. A low level of red blood cells makes one get tired easily.

The nurse transfused a single donor pack of platelet to me in the evening. I will be receiving two packs of red blood cells tonight. Transfusion of platelet take less than one hour, but transfusion of red blood cells take about 3 hours per pack. So tonight until tomorrow morning I will be busy receiving red blood cells. All the transfusion has to go through a leukocytes (white blood cell) filter to remove the donor white blood cell. This is important to minimize the risk of transmission of diseases such as CMV, to reduce GVHD to the recipient. Non-transplant patient does not need this filter for blood transfusion.

I have too much stories to tell you, but I think I have to stop now. See you next post :-)

Monday, July 10, 2006

Day +5

My Blood Count Today:
Red Blood Count (RBC) 82 (Normal 130-180)
Platelet 18 (Normal 150-50)
White Blood Count (WBC) 0.2 (Normal 4 - 11)

Now the WBC is extremely slow, the nurse started to inject G-CSF (Granulocyte Colony Simulating Factors) which commonaly referred to by its brand name Neupogen. Its purpose is to stimulates the bone marrow to produce white blood cells to reduce the period of low immunity. This has to be done everyday until the white cell count reach 2.0 on two occasions. It will take about two weeks to reach to this level.

Fortunately, the injection is done subcutaneously, it is administered not far beneath the skin on the upper arms or stomarch. So the needle used is short and small and thus it is not so painful to receive this injection. After the drug is deposited under the skin, it will slowly be absorbed by the body. Whenever the nurse would like to carryout the injection, she always asked me to take a deep breath, then she will poke the needle into my arm or stomarch, after that she will push the piston of the syringe slowly to release the drug into the body. If she pushes the piston too fast, then it would be more painful. Some nurse cares about me very much by saying "If you feel pain, just jeritlah (cry of pain)". But no matter how painful it is I never dare to jerit, because if I jerit suddenly she might get shocked and pushes the piston of the syringe instanly until its end, then pengsanlah saya (fainted me).

Today, they stopped the adminstration of a drug called clexane, a "blood thinner" to me. The rule of thumb is when my platelet drops below 20, then stops this drug. The reason may be that the blood is already thin enough with this low platelet. This drug was administered to me subcutaneously also starting from day -8 until now. So with the Neupogen, the "cucuk" (poking) continue :-(

The X-Ray was taken this morning. Urine and blood sample also taken to check for the Cytomegalovirus (CMV). The earlier administration of the antiviral drug Ganciclovir from day -8 to -1 is to prevent complications due to CMV. The CMV test costs RM25.

Everyday, I wake up at about 7:30am. The nurse then comes "unwired" me. After that they draw blood, check my weight, body temperature, blood pressure, oxygen level and then they tidyup my bed. I will do exercise by cycling in the room.

My room has a bicycle, no matter how fast I cycle, it stays there without moving a single inch. Everyday, I cycled and cycled but at the end it still go no where. What a waste of energy! I believe I am not the only one who do this, there are a lot of people out there paying money to do this in the gynasium or recreation club. Why not just fixed a motor onto the bicycle and let our cycling drives the motor to generate electricity? We can then supply this electricity to Tenaga Nasional. In this way, the gynasium or recreation club has to pay us because we generate electricity for them instead of we paying them. More importantly, I will be also able to earn some money while doing exercise each morning :-)

After the cycling, I will have to take bath, take the breakfast provided by the hospital. Then I will wait for the doctor to come for examination...

I think I need to continue this tomorrow as it is time for me to play guitar...

Good night and have a nice sleep!

Sunday, July 09, 2006

Day +4

My Blood Count Today:
Red Blood Count (RBC) 89 (Normal 130-180)
Platelet 32 (Normal 150-50)
White Blood Count (WBC) 0.4 (Normal 4 - 11)

So the white cell drops to 0.4 today. I fell well except with very mild cough and flu. They will take my chest X-Ray tomorrow. The staff from radiology department will shift the mobile X-Ray machine to the room to take my X-Ray. This is to make sure that I do not break the "isolation" rule :-(

I mentioned in yesterday blog that I am actually wired to the wall, but please don't feel sorry for me. You know why?

David's Body <--> Wall
David's Spirit <--> God and Heaven

So even though my physical body is restricted but my spirit is filled with freedom from our God in Heaven!

One of my old university mate, Amarat came to visit me yesterday afternoon. She waited outside my VIP room for more than half an hour, seeing me dreaming on my bed. The nurse wanted to wake me up but she insisted to let me continue dreaming. Fortunately, I have this "toilet-going" syndrome - need to visit toilet almost once an hour, so no matter how sweet is the dream, it also have to be interrupted for a while to allow me to fulfill the syndrome. After I returned from the toilet I was suprised to see her waiting there .

So if you come to visit me and discover that I am dreaming on the bed, just knock at the partitioning glass. But of course don't knock too hard until you make a hole on the glass, if this happen my room will not longer be isolated. If I am sleeping, I will be quick to response to your knock, but if I am "sickleeping", you might need to ask the nurse if I can wake up to talk to you :-)

One question you might wonder, after I have a blood system borrowed from my sister, would my characters, mind or talent be changed to be like her. In order to verify this, the very next day after the transplant, that is day +1, I tried to solve the Monday's Sin Chew's Chinese Newspaper Sudoku (A number placement logic puzzle). Surprisingly, no matter how hard I try, I could not solve the puzzle. I am still cracking my head until today to solve that particular puzzle, but still to no avail. Funnily, before the transplant, I can solve all the Sudoku published by the Sin Chew. This is worrying me! Do you know why? The reason is that my sister is not as smart as me academically. So after the transplant, I am worried I will not be as smart as before academically:-(. But nevertheless, after careful consideration, it is completely not a bad idea to be like her. She know how to earn money at lot more smarter than me. If the above verification is correct, then I should be rich after the transplant :-)

Anyway, don't believe with the above verification method. That particular Sudoku could be too difficult for me to solve for now, but I am completely sure that it can be solved. This is because my handheld PDA - Palm solve the puzzle in less than 30 seconds. I will keep on trying, until I solve the "Monday" puzzle.

Saturday, July 08, 2006

Day +3

"The LORD will keep you from all harm—he will watch over your life; the LORD will watch over your coming and going both now and forevermore." Psalm 121:7-8

My Blood Count Today:
Red Blood Count (RBC) 90 (Normal 130-180)
Platelet 37 (Normal 150-50)
White Blood Count (WBC) 0.9 (Normal 4 - 11)

I am feeling well today. There is a significant drop in WBC, from 1.5 yesterday to 0.9 today. In about 2 to 3 days time, the WBC will drops to zero. In order to reduce the immuneless period, a growth factor will be injected under the skin on hand or stomarch on day +5 onwards. This will stimulates the bone marrow to produce white blood cells faster . When the new WBC grows from the donor(my sister) stem cells, these cells will start to attack my body organs. This is called GVHD as we mentioned earlier. A mild GVHD is necessary as it shows that the new immune cells are attacking the cancer cells as well, but severe GVHD is very dangerous. Total absense of GVHD is not very good either as it shows that the new immune cells are not clearing cancerous cells in my body.

I will be receiving second dose of Methotrexate (MTX) today at 4pm today. This is the same that I received on day +1. It is used to killed cancer cells and at the same time to prevent GVHD. I don't like this drug (in fact, I don't like all the drugs), it will cause mouth and throat ulcers. But praise God, the first dose does not give me this ulcers problem. There are two more MTX administration on day +6 and +11.

I want to share with you my mobility (how free I can move around in my room) as a "VIP" in the WAD. Frankly speaking, I am quite heavily "wired". Do you still remember that my body are installed with 5 lumens, 3 on the neck and 2 on the right hand, these lumens are just like electrical sockets on the wall. When necessary, the nurse will plug in a plastic tube to the lumen to infuse drug into my body. Unfortunately, most of the drug have to be infused slowly into the body. Therefore, at least two lumens are always connected to the drugs. These drugs are in turn hanged on a mobile stand - with 5 wheels. In addition to this, for some drug, they have to control very precisely the amount of drug that can infuse into my body in hour. In order to do this, they fix a flow control machine on the mobile stand where the plastic tube passes through and of course this machine has to have electricity supply. So the machine is connected to the electrical socket on the wall through multiple power extension cords so that it is long enough for me to reach everywhere in the room, including the toilet. The summary of my connectivities:


The conclusion is DAVD<-->WALL: so I am always connected to the wall :-(

So you can imagine how much things I need to carry each time I move around. The worse thing is when I need to visit toilet urgently - always happens due to the drug Lasix. Still remember what it is? It is used to discharge surplus of fluild in my body. With this drug I always need to rush to toilet, and you know in a rush, the electrical wire always get entangled together, the plastic tubes get entangled to the stand and the wheels of the stands get stucked with the electrical wire, which result the mobile stand becomes static stand. Therefore, quite often the urgency is over before I manage to reach the toilet. This is really embrassing but can't be help. The only solution is to stay in the toilet all the time, but who want to do this :-(

I am too hungry to write now, waiting for Richard to bring lunch for me ...

See you next post and May God Bless you all.

Friday, July 07, 2006

Day +2

I have no reason to fear,
For Jesus my Savior is near;
I'll trust the Lord and His power
To save and to keep me each hour. -Hess

My Blood Count Today:
Red Blood Count (RBC) 90 (Normal 130-180)
Platelet 46 (Normal 150-50)
White Blood Count (WBC) 1.5 (Normal 4 - 11)

The platelet and WBC are dropping, however the RBC seems to increase a little bit. With WBC of 1.5, I still have immunity against infections.

Thank God that no mouth or throat ulcers have been developed so far. But appetite is a little low today. It could be due to the drug MTX that was given today. I slept most of the morning. However, My brother Richard brought again chicken soup "Mee Sua" as my dinner, that really boost my appetite. Unfortunately "Foo Chow" red wine is not allowed, if it is allowed, then {Check Soup "Mee Sua" + "Foo Chow" red wine = HEAVEN!}

One thing I praise God is that the blocked PICC lumen on my right hand is now thoroughly unblocked, it can even be used to draw blood now.

Someone asked if they could pay me a visit. The answer is definately a Yes! But read on...

In fact I am isolated in ROOM 1 in University Hospital, the best room in the haematology wad. So I always see myself as "VIP", but this poor VIP is not allowed to go a single step out of the room apart to the big luxurious toilet. "Security" is very tight. With the exception of the hospital staffs, no one, including my little cute beautiful wife, is allowed to enter the room. Visitors have to shout over the glass of ROOM 1 to talk or pray for me. Therefore, if you plan to visit and talk to me, the very first thing you need is to train your vocal, that is to learn how to "shout", as loud as possible, so that I can hear you. And after this you should be accepted into the church choir without any question :-)

Richard just brought me my precious Spanish Handmade Classical Guitar. I couldn't wait to play it now...

See you next post. May God Bless You!

Thursday, July 06, 2006

Day +1

My Today Blood Count:
Red Blood Count (RBC) 84 (Normal 130-180)
Platelet 57 (Normal 150-50)
White Blood Count (WBC) 2.2 (Normal 4 - 11)

I am well today, managed to sleep a few hours in the afternoon. But of course not continuous sleep, I have to wake up many times to pass urine. "Why so much urine to pass?." In fact they infuse (transfers through the lumen that I mentioned earlier) 6 litres of solution into my body each day. The solution contains water plus 0.9% Sodium Chloride and 5% Glucose. The hospital sometime also add potassium and magnesium, but definately not GOLD into the solution due to the deficiency of these mineral in my blood. In addition to what I drink, my total water intake is about 9 to 10 litre per day. I gains 2 kg this morning due to fluid retention, the nurse injected a drug called Lasix to make me pass urine almost every 15 minutes initially :-(

The next 21 days or more will be very crucial. It is the waiting period for the new stem cells to engraft. During this period my white blood count will drops until zero rendering myself without immunity at all. Another component of blood are red blood cells which are used to carry oxygen to the organs and tissues of the body. The third component is called platelet. It helps blood to clot. All of these blood components will drop as well. However, the red blood cell and platelet are easier to handle. They can be transfused if the level drops to an unacceptable level. There is no way to transfuse white blood cell. We can only wait for the body to grows. A drug called growth factor might be able to speed up the white cells formation. It will be given daily to me from day +5, 10 July onwards until my white cell count increase to 2.

Apart of Cyclosporin to reduce the GVHD, today they added a drug called Methotrexate (MTX). This drug is a chemo drug but they give me in small dosage. The purpose is also to reduce GVHD in this case. However, this drug will cause severe mouth ulcer. Luckily, it does not have to be given daily. We pray that severe mouth ulcer will not occurs.

I also notice my face turned darker each day. It should be due to chemo effect. Please don't blame me to be too serious next time you meet me. The face turned dark by itself, not by me:-)

Wednesday, July 05, 2006

Great Day 0 - My New Immune System's Foundation Laid

First of all, I am very touched and encouraged to receive so much encouraging comments within such as short time. I know many of you out there are very concerned about my situation and some of you even fasted to pray for me. I feel the joy of God with me.

Pastor Andrew came very early this morning to the ward to pray for me. He gave me this bible verses. "Therefore, behold, I will allure her, and bring her into the wilderness, and speak comfortably unto her. And I will give her her vineyards from thence, and the valley of Achor for a door of hope: and she shall sing there, as in the days of her youth, and as in the day when she came up out of the land of Egypt." Hosea 2:14-15

The transplant process started at about 9:10am and end at 9:35am today at the ward. The blood bank staff defrosted the stem cells which is packed in a small square like plastic packet to a room temperature. Then the nurse injected a drug to make me sleep. Following this, the stem cells from the packet was dripped into my vein through one of the triple lumens on the neck. But I was awake during the infusion of the stem cells. After that, I slept for almost whole day due to the sleeping drug.

My body do not get any special feeling (reaction) during the infusion? But my heart praise God for his wonderful creation that makes the body works so amazingly.

I praise God that no clotting or technical problem happens during the infusion. The nurse later also unblocked the blocked PICC lumen.

I missed the lunch because I am too sleepy, but my sister and brother-in-law brought good dinner for me which I consumed in less than 10 minutes as my appepite is good now.

The challenges of the next 21 days will be waiting the stem cells to engraft. The blood count will drops due to chemotherapy and I will be very prone to infections. Normally, the GVHD (or rejection) will develops 2 weeks from now or even months later.

But God is my Shepherd, I shall not want and I will be casting all my care upon God, for He careth for me.

God bless you all!

Tuesday, July 04, 2006

From Day -8 to Day -1 (Today)

  • Day - 8, 26 June (Mon) : Admission to hospital
  • Day - 9, 27 June (Tues) : Insert a triple lumen catherter near the neck, it is a tube with three smaller tube inside. This is for the administration of drugs and draws blood. Start to take antiviral, antibacterial, antifungus drug, "blood thinner" drug, drug to reduce uric acid, injection of Vit B12 (quite painful, like stinged by bee, luckily need to do it only for one day while the rest of the drug has to take until day -1 or day +21). They also give me some kind of pill to control my anxiety or "to keep me happy". But I think after taking the medicine, I got "short term memory lost", just like that Dori fish in the movie "Finding Nemo". It is a "law" to record the volume of urine that we pass out each visit to the toilet. I always forgot how much the volume immediately I emerge from the toilet.
  • Day -7 to Day -4, 28 June (Wed) to 1 July (Saturday) : Start taking chemotherapy pills, 4 times a day, each time 30 pills. In addition to pills from day -8, I need to swallow more than 100 pills a day. Luckily they are small, with my big throat, consume 30 over pills with a single swallow is definately not a problem. You know, this big throat is a blessing of my poor childhood. When my parent brought home some nice foods home, I always swallowed them lightning fast because they are too delicious. Slowly, my throat becomes big enough to swallow so many pills with ease :-)
  • Day -3 to Day -2, 2 July (Sun) to 3 July (Mon) : Stop the chemotherapy pills, switched to intravenous (iv) chemo drug, plus another drug to protect the bladder from the chemo drug. The iv chemo drug make me feel to vomit until today (4 July). But luckily it was not too bad, only experience one vomitting.
  • Day -1 , 4 July (Tues) : All chemo drug completed, started iv cyclosporin drug to reduce the GVHD. This is considered a rest day. My appetite recovered during the dinner. Thanks to Richard's chicken soup "Mee Sua - 长寿面".

Thanks God and your prayer that until now everything goes quite smoothly. One thing to pray for me is that one of my PICC lumen (one of the double lumen catherters that are installed through my arm) seems to be blocked. Hopefully the nurse would have patience and wisdom to unblock it.

Tomorrow, Day 0, 5 July (Wed) is a BIG DAY for me as the stem cell from my sister will be transplanted (infused) into my blood circulation system. They will defrost it first to body temperature before the infusion. Ocassional clot might happen. Please pray that it would be smooth. They will put me to sleep for the process. It is just like a normal blood transfusion.

I have to go to sleep now. Will let you know the progress if I am well enough to write. Just come back to check often.

You can post comments in turn of prayer, encouragement, whatever in response to my blog. Click on the comment at the lower left corner, choose other as your identity and write your name so that I know who are you.

God bless you all.

What is involved in a Bone Marrow Transplant?

When one's blood factory goes out of order, we called he or she has blood disease. One of these disease is called Leukaemia or blood cancer. They are various types of Leaukaemia. One way to control this cancer is to go through chemotherapies. After the chemotherapy, the cancer cells might be kept to an acceptable level. We call this situation that the patient has entered complete remission (CR). This is still not equivalent to a cure, we can only say that the cancer is now under control. However, for some cases of Leukaemia, there is a high chance that the cancer will come back again (relapse). The best way to reduce a relapse is to do a bone marrow transplant BMT) or stem cell transplant (SCT). BMT and SCT are quite similar except that in SCT the stem cells from the donor are harvested from the donor's peripheral blood while in BMT, they are harvested from bone marrow.

I am fortunate to have matching stem cell from one of my sisters. Her stem cells are harvested and stored in the hospital blood bank in May, 2006. This type of transplant which involve sibling (brothers or sisters) donor is called allogeneic transplant.

It is quite amazing to most people that bone marrow transplant does not involve a surgery operation like other kinds of transplant. It is definately not cutting off a portion of bone marrow (spongy material in the bone) from the donor and then insert it into the host (recepient) bone.

The general procedure for a bone marrow transplant is as follow:

  1. Harvest donor stem cell
  2. Donor goes through a few days of very strong chemotherapy - taking either oral or itravenous chemotherapy drug for a few days, to destroy the function of the host blood factory. After this the host could not produce blood anymore.
  3. After that, the donor stem cells are transfused through the vein to the host blood circulation system.
  4. The stem cells will then be able to find it ways into the host bone marrow and starts to generate the blood of the donor type, a process which we called engraft. If the donor has a different blood group than the host's, the host blood group will change to the donor's blood group. We also can say that the host is now to have same immune system with the donor, a blood system which is free of cancer cell.

The risks involved in the transplant:

  1. Organ failure due to chemo drug.
  2. Infections especially while waiting for the donor stem cell to engraft. At this period the white cell count will be almost none, which means that the body lost its immune system compeletely.
  3. Graft-versus-host disease (GVHD) , the immune cell of the donor attack the host organs. Someone also call this rejection - which is not very true. A mild GVHD is good to indicate that the transplant is successful. Some drugs such as cyclosporin or methotrexate are used to control GVHD. They are immunosuppresive agent which will also cause the host to have low immune system and prone to infections.
  4. The infused donor stem cell fail to generate blood or to engraft.

We trust our Lord Jesus to lead me and protect me from all these and other unforeseen risks. I will take his promise fully, "I shall not die, but live, and declare the works of the LORD." Psalm 118:7