Day +2534 : Follow-up at ophthalmology clinic

I am fine today.

I went to the ophthalmology clinic at UH for my eyes follow-up. The last follow-up was six months ago. After examination, the ophthalmologist confirmed again that my eyes are extremely dry. He advised me continue to use the artificial tears (Tears Natural Free). Since there is not much can be done, he scheduled my next appointment one year later.

The appointment for this morning was at 9:00am but I reached the clinic at 10:00am and I managed to see the ophthalmologist before 11:00am :-) This is certainly a record! I hope the clinic can maintain this kind of service level when I come for the next follow-up next year.

See you next post :-)

Day +2530 : Follow-up at BMT Clinic

I am fine today.

I went for a post bone marrow transplant follow-up in BMT Clinic at UH this afternoon. All post bone marrow transplant patients are required to do their follow-up in this clinic. The haematologist put me on annual follow-up since last visit.

I reached the clinic at 2:00pm. The nurse drew my blood for blood count test almost immediately after I registered. And the haemalogists came quite early today. I was on my way back before 3:00pm. This is the fastest follow-up that I ever experienced :-)

The blood counts are normal and my next follow-up is scheduled one year later.

See you next post :-)

Day +2353 : Follow up at ophthalmology clinic

I am fine today.

I have more holiday photos and stories to post but I would like to take a break to post something that is more important; that is my follow-up at ophthalmology (eye) clinic at UH today.

The appointment today is scheduled at 10am but since I have to attend a church planning camp in Port Dickson this afternoon, I reached UH as early as 7:10am. I was number 16 in the queue which is not too bad. We have to get a second 4 digits queue number through the counter. I waited at a corner for my turn.

Not long after, I heard the number running and patients were called into a room to do a general eye checking - something we had to do first before seeing a eye specialist later. I looked at the queue board on the wall and didn't see any 2-digit numbers. All the number shown was 4-digit. I wondered why the number didn't start at 2-digit and despite that, I waited there patiently for the 2-digit number to appear.

I felt that something was not right after quite sometime and went to check in the counter where we normally got our second 4-digit queue number. The counter staff gave me a 4-digit queue number and I only realised by then that I was looking at the wrong queue board. There was a 2-digit queue board placed on the column in front of the counter for the first queue number. I totally forgot about that :-(

Both my eyes were still in good condition despite the fact that my tear glands failed to produce tears for the eyes. The specialist introduced to me a few other brands of artificial tears; she even gave me one sample to try.

My next appointment was scheduled 6 months later.

See you next post :-)

Day +2167 : Follow-up at BMT Clinic

I am fine today.

I went for a routine post bone marrow transplant check-up in UH today. As usual, the full blood count result was perfect :-)

The haematologist (blood specialist) asked me how long did I live after bone barrow transplant. I told him almost 6 years. He then scheduled my next follow-up one year later. The longest interval between check-ups were 4 months previously. One year is another breakthrough for me :-)

I shall give thanks to God for the steadfast love of Him never ceases, and his mercies never come to an end.

See you next post :-)

Day +2164 : Follow up at ophthalmology clinic

I am fine today.

I went for a follow-up at ophthalmology clinic, UH this morning. The eye specialist checked my eyes and found that they are in good condition :-)

See you next post :-)

Day +2034 : Follow-up at BMT Clinic

I am fine today

I went to UH for a regular post bone marrow transplant follow-up this afternoon. All the blood counts are normal. I also did a lipid profile test but the result was not out when I saw the doctor. I will check the result next follow-up which is scheduled on 21 May.

I noticed one of the panel doctors of the clinic was having a name almost the same as me - Dr. S.K Ting. My name is Ting Sie Kiew, and its short form is S.K. Ting. I am quite proud to have my name on the board and also to have my title elevated to Dr. :-)

Take note of Dr. S.K Ting - last one in the list

See you next post :-)

Day +1915 : Post transplant follow-up

I am fine today.

I went to UH to have my post bone marrow transplant follow-up this afternoon. I am glad to know that everything is in order :-)

The next follow-up will be four months later, that is after the Chinese New Year.

See you next post :-)

Day +1804 : Follow-up at BMT clinic

I am fine today.

I went to UH yesterday afternoon for post bone marrow transplant follow-up. The appointment was initially scheduled on 15 May, but I was busy with my study at that time, so I requested the clinic to postpone it. This makes the appointment yesterday 5 months after the previous one, achieving the longest interval between follow-ups :-) This is the first record of the day.

The appointment was scheduled at 2pm and normally the haematologists came late. However, it was a surprise that came on time yesterday, and finished seeing all the patients at about 2:30pm. That was incredibly fast. Another record was broken! With the assumption that the haematologists won't come so soon based on my previous experience, I went to buy drinking water after registration. When I came back, I noticed that the haematologists were looking for me. This was for the first time ever that a doctor had to wait for me; a very good feeling indeed :-)

My blood test result was not out when the haematologist saw me, but I was informed that if there is anything wrong with the result, I will be informed.

My next appointment will be four months later. That will be 3 months after I crossed the 5 years mark since the bone marrow transplant.

See you next post :-)

Day +1663 : Follow-up at BMT Clinic

I am fine today.

I had my post bone marrow transplant follow-up at UH this afternoon. The haematologist, Dr. Bee, said that I am getting thinner but in fact, I am gaining weight :-) He didn't know that once my weight dropped to 53kg and now it increased to 62kg, almost the weight while I was diagnosed with Leukaemia.

The doctor saw me first before the blood test result was ready, so I didn't keep a record of the blood count this time. However, the doctor said later that all counts are normal :-)

On the way back from UH, I dropped by a Christian bookshop called Sufes at Petaling Jaya to buy some text books for my study but only to find out that it was closed for stock check :-( However, it doesn't really matter much as the bookshop will be selling books in the Bible college sometime this week.

My next follow-up will be four months later.

See you next post :-)

Day +1646 : Follow up at ophthalmology clinic

I am fine today.

I went to ophthalmology clinic for eye follow-up this morning. The appointment was supposed to be on 3 December 2010 but I was not feeling well at that time, so I have to postpone the appointment.

As I mentioned in my post Day +1597 : Follow up at ophthalmology clinic, the eye specialist was trying to improve my dry eye condition in two ways: blocking the duct that connect the eyes and the throat, and change the brand of the artificial tears from Tears Naturale Free to Vismed. Unfortunately, both didn’t work, so there is no point to plug the duct permanently and on the other hand, I have to settle with Tears Naturale Free. In fact, a few attempt to change to different brand of artificial tears all failed.

I am also glad that UH has approved my claim on the expenses of artificial tears. The claim is under my wife’s welfare as a government servant. She has to pass the approved claim form to the school to further process the claim. The school insisted that we have to submit a memo from doctor that certifies that I have eye problem and need the medication but unfortunately, unlike the haematologist, the doctor in the eye clinic was reluctant to write even a simple note on this. I approached the medical record unit of the hospital I the end and apply for a proper medical report which cost me RM80 :-( Hopefully, the medical report is acceptable.

My next eye appointment will be 8 months later.

See you next post :-)

Day +1597 : Follow up at ophthalmology clinic

I am fine today.

I went to UH for eye care follow-up this morning. I prayed that I would see a young and kind eye specialist. One year ago, while examining my eyes, he encouraged me to claim the artificial tears expenses from the government. I didn't do that before as I was told that the artificial tears was not in the list that I can claim.

I compiled the bill and completed the form today. The total bill over the years is more than RM4,500. And the amount could be more as many of the receipts for purchasing the artificial tears in 2008 was submitted to claim for another medicine as they were printed together on the same receipt. Since I didn't have the original receipt, I am unable to claim those artificial tears expenses in 2008 which exceed RM2000 easily :-(

The eye specialist wanted to do something to improve my eyes and after discussing with his colleague, they decided to see if blocking the duct that connect the eyes to the throat would improve my eyes condition. The procedure will prevent the tears to be drained through the duct so theoretically, keeping my eyes moist for a longer period of time before applying the artificial tears again.

However, there is no guarantee that it will work and the cost of putting the permanent plug (punctal plug) cost RM200 per eye. Instead of punctal plug, they blocked the ducts using surgery stitch - two ducts per eye. The procedure took about 15 minutes and there was no pain experienced at all but I could feel something in the eyes after that. Hopefully, I will get use to the feeling. The stitch will be dissolved in two weeks and I have to monitor my eyes condition. I will go for permanent plug if it works.

Apart from the procedure, doctor also suggested me to try another eye drops called Vismed (preservative free). I will only start Vismed next week as I need to isolate the changes in treatment else I wouldn't know which one is effective later. So change one thing at a time :-)

Hopefully, the new effort will be fruitful, at least to certain extent.

See you next post :-)

Day +1538 : Follow-up at BMT clinic

My Blood Count Today: - Readings in square bracket [] are result from previous test.
Red Blood Count (HB) = 154[155] (Normal 130-180)
Platelet = 207[192] (Normal 150-450)
White Blood Count (WBC) = 8.4[9.7] (Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 3.612 (Normal 1.5 - 8.0)

I am fine today.

I went for a post bone marrow transplant follow-up at UH this afternoon. Again, the blood count results were all within normal range.

Dr. Haris checked my lung and let me listened to the sound from the lung through the stethoscope. I heard hissing sound :-( Doctor explained that it is due to pulmonary fibrosis or “scarring of the lung” which was a result of previous lung infection. And unfortunately, the problem is not reversible.

In fact, I could hear the hissing sound even without the stethoscope, especially when I was having flu.

Such a lung condition is prompt to infection. Doctor advised me to go for an influenza vaccination. However, I have to wait for the vaccine being updated to the “latest version” – the one that is effective for the coming flu season. And that will only happen November this year. Perhaps, I should just wait until the next follow-up, which is 4 months from now.

I am now free from all medicines including the antibiotic – Penicillin - which I was once told that I have to take it lifelong.

See you next post :-)

Day +1426 : Follow-up at BMT clinic

My Blood Count Today: - Readings in square bracket [] are result from previous test.

Red Blood Count (HB) = 155[150] (Normal 130-180)

Platelet = 192[183] (Normal 150-450)

White Blood Count (WBC) = 9.7[6.9] (Normal 4 - 11)

I am fine today.

I went to UH this afternoon for a post bone marrow transplant follow-up. The blood counts today were good and I was told that the liver function test result for the last follow-up (3 months ago) was in good order as well. For your information, the liver function test result for the blood sample taken this afternoon was not out at the moment I saw the doctor.

I asked the doctor about the necessity of having H1N1 vaccination as I am considered to be under the high risk group. The doctor advised me to have trivalent influenza vaccine which covers the pandemic H1N1 strain and also the seasonal A and B influenza viruses. In other words, the vaccine has a wider coverage than the monovalent vaccine which covers the H1N1 only.

But the problem is that UH is starting to roll out trivalent vaccination and the priority now is to give this vaccination to the staffs, not the patients. I was advised to go to the government clinic for trivalent vaccination. I will try Puchong clinic one of these days.

The doctor also told me that most people who received trivalent vaccination would have fever as the side effect :-(

Doctor also commented that I have more post transplant side effects than most patients but my condition now is generally good, so he scheduled my next follow-up 4 months later. This is the first time ever I got to enjoy such as long interval between follow-ups :-)

See you next post :-)

Day +1342 : Follow-up at BMT Clinic

My Blood Count Today: - Readings in square bracket [] are result from previous test.
Red Blood Count (HB) = 150[148] (Normal 130-180)
Platelet = 183[200] (Normal 150-450)
White Blood Count (WBC) = 6.9[7.5] (Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 2.277[2.625] (Normal 1.5 - 8.0)

I am fine today.

I went for a follow-up at BTM Clinic in UH this afternoon. The blood counts are in order; all readings are within the normal range.

I met a lot of post transplant friends in the clinic and I am very glad to know that all of them are doing very well :-) One of them will be opening a lighting shop near TESCO Puchong and the shop is expected to open for business in April. If you have any lighting requirement and would like to support my friend, please let me know.

My next follow-up will be three months later.

See you next post :-)

Day +1318 : Follow-up at Eye Clinic

I am fine today.

I went to Ophthalmology Clinic in UH for an eye checkup appointment this morning. I was glad to be told that my eye condition is good. No damage had been observed despite the serve dryness problem that plagued me for almost three years.

I have to rely on the artificial tears – Tears Naturale – all the time. In other words, I can’t survive without it. I have to bring it along wherever I go. I have to get it by all means should I forget to bring one; else I have problem to open my eyes.

I have to spend about RM240 for the artificial tears each month and I was told that I am not eligible to claim this expenses from the government. However, after discussing with doctors this morning, they agreed that I submit the claim document next visit to the clinic. If the claim is successful, I might be able to claim back as much as RM5000 that was spent over the last three years.

My next appointment will be 9 months from now.

Life still goes on as usual without the tears. I always tell people that I am living a normal and happy life; a life more normal and happier than many who are tearful :-)

See you next post :-)

Day +1279 : Follow-up – a blood test only

My Blood Count Today: - Readings in square bracket [] are result from previous test.
Red Blood Count (HB) = 148[146] (Normal 130-180)
Platelet = 200[265] (Normal 150-450)
White Blood Count (WBC) = 7.5[10.6] (Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 2.625[5.406] (Normal 1.5 - 8.0)

I am fine today.

I experience stinging needle pain all over the body for the past few days. Besides that, I am getting tired very easily.

In order to make sure that my blood is in order, I went to Columbia Asia Hospital for a blood test this morning. The result showed that my blood counts are normal :-)

In fact I planned to do the test yesterday but when I requested Dr. Koh to refer me to Columbia Asia for a full blood count, he warned me that there would be an extra charge of RM30 for any test that was done off office hour. So I waited until today.

“Why you need a full blood count?” he asked.

“Just to rule out a relapse,” I told him after explaining the pain that I experienced.

He checked my body temperature and said that it was very unlikely that there was a relapse, which I agreed. A Leukaemia patient might experience pain in bone or joints but in my case the pain was more on the skin.

Anyway, I just want to rule out the relapse totally or in other words – to spend a little bit of money to have peace of mind :-)

Now the total cost of the test– RM10 (Dr. Koh’s reference note) + RM22.5 (Lab charge) = RM32.5. Not too expensive, isn’t it?

See you next post :-)

Day +1258 : Follow-up at BMT Clinic

My Blood Count Today: - Readings in square bracket [] are result from previous test.
Red Blood Count (HB) = 146[145] (Normal 130-180)
Platelet = 265[185] (Normal 150-450)
White Blood Count (WBC) = 10.6[10] (Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 5.406[5.3] (Normal 1.5 - 8.0)

I am fine today.

Instead of going to UH twice, I went to UH once today. Usually, I went there very early in the morning to draw blood and then returned again in the afternoon to see the haematologist. This is to make sure that the blood result is available when I see the haematologist in the afternoon.

Those who finish the follow-up in a single trip will take blood in the early afternoon and then wait for the result before seeing the haematologist. However, there is no guarantee that all test result will be available. In this follow-up, my liver function and lipid profile test result are not available.

My blood counts today are normal. Even though I experience mild breathlessness due to flu attack last week, doctor said that my lung is clear, so no further examination is needed. My blood pressure is normal too. So I am doing quite well generally.

My next appointment will be 12 weeks later. This is a record :-)

I purchased 15 boxes of Tears Naturale Free, paying RM480. Hopefully, this amount of tears can last for 12 weeks.

See you next post :-)

Day +1195 : Follow-up at BMT Clinic

My Blood Count Today: - Readings in square bracket [] are result from previous test.

Red Blood Count (HB) = 145[141] (Normal 130-180)
Platelet = 185[205] (Normal 150-450)
White Blood Count (WBC) = 10[7.3] (Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 5.3[2.263] (Normal 1.5 - 8.0)

I am fine today.

The blood count results today are within normal range. The elevated white blood count might be due to mild flu that started yesterday. Hopefully, the flu won't develop as bad as before. I asked doctor if there is anything that we can do to prevent the flu from getting worse, he just ignored it :-(

Doctor reviewed the result of my respiratory function test done earlier. He didn’t see any problem with the result. Indeed, he commented that one of the result indicated that my lung is less obstructed than before :-)

Since the doctor didn’t order liver function test during my last visit, I didn’t visit UH twice for this follow-up. I went to UH at 12:30pm and took blood in the BMT clinic at about 1:30pm.

The doctors only came very late today. They supposed to start seeing patients at 2:00pm but they managed to come at 3:30pm only.

When the nurse didn’t see any doctor coming, she started to become impatient and called one of the doctors, saying that the patients were impatient. In fact, I was very patient. Though I wish the doctors come early, it is definitely not a problem to wait a little bit longer. I believed they were busy attending patients in the ward.

“Comparing to living in the hospital for more than 160 days throughout the treatment, this amount of waiting time means nothing to me,” I always tell myself while waiting. And with this thinking, I am very happy :-)

There were many patients in the hospital today. I waited for another one and half hour to get the medicine.

I reached home at 6:00pm.This is one of the longest follow-up that I experienced so far :-( Hopefully, the situation will be better next follow-up.

Doctor scheduled the next follow-up 8 weeks later but the date clashes with my trip to Sarawak. I requested to postpone it a week later.

See you next post :-)

Day +1185 : Respiratory Function Test (RFT)

I am fine today.

I suffered mild breathlessness for quite some time already. Doctor suspected that this might be a result of graft-versus-host disease. However, it is not easy to confirm this.

The possible treatment in this case is to take Prednisolon (steroid), but I am not keen to do this. This is because the breathlessness that I experience does not come to a scale that impairs my daily activities. Taking Prednisolon for an extended period of time certainly is not good for the body.

In order to monitor my lung condition, doctor arranged a RFT for me half yearly. If the lung condition worsens, then I have no choice but to start taking Prednisolon.

The last RFT was done in April this year, and I did another one yesterday. I don’t have much knowledge in interpreting the RFT result. Fortunately, there is some explanation about the test on Wikipedia under the entry of Spirometry.

The readings of primary concern for a RFT are as follow:

• FVC (Forced Vital Capacity) - the volume of air that can forcibly be blown out after full inspiration, measured in liters.
• FEV1 - maximum volume of air that can forcibly blow out in the first second during the FVC manoeuvre, measured in liters.
• FEV1/FVC - ratio of FEV1 to FVC. In healthy adults this should be approximately 75–80%.

For yesterday’s test:

1. FVC = 4.66 Liters
2. FEV1 = 3.61 Liters
3. FEV1/FVC = 77% (within the normal range)

I don’t have the April result, but I managed to retrieve the one that was done on 30/6/08.

1. FVC = 4.80 Liters
2. FEV1 = 3.72 Liters
3. FEV1/FVC = 77%

There is a very small degradation of lung function over the past 15 months, and I believe the degradation is negligible. However, only doctor can confirm whether this is the case.

I would show the result to my hematologist during my next BMT clinic appointment.

The RFT result - click to have a larger view


See you next post :-)

Day +1146 : Follow-up at BMT Clinic

My Blood Count Today: - Readings in square bracket [] are result from previous test.
Red Blood Count (HB) = 14[151] (Normal 130-180)
Platelet = 205[256] (Normal 150-450)
White Blood Count (WBC) = 7.3[9.2] (Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 2.263[4.876] (Normal 1.5 - 8.0)
ALT = 51[66] (Normal 30 – 65)
AST = 33[37] (Normal 15-37)
GGT = 52[68] (Normal 15-85)

I am fine today.

Both blood count and liver function test results are well within the normal range. Dr. Gan said that there is no need to monitor the liver function test so closely from next follow-up onwards. So she didn’t order the liver function test for the next follow-up. This indicates that she is confident that there will be no issue on the liver since the enzyme levels have been stable for a long time :-)

I also informed Dr. Gan that I was discharged from the lung (asthma) clinic because the lung specialist thought that my lung is well. However, both she and I think otherwise. She said that she will refer me back to the lung clinic if necessary in future.

I will have to take steroid again if my lung condition worsens. I didn’t feel that it is worsening; the problem of shortness of breath and chest restriction remains status quo for quite some time. We will see the result of next respiratory function test before deciding next course of action.

Dr. Gan also prescribed me Ventolin Evohaler, a type of inhaler that is used to relieve asthma symptom. Hopefully, with this inhaler, I can breath more smoothly when doing more vigorous work such climbing staircase.

“Hospital is not a good place,” doctor commented in view of the widespread of A (H1N1). And she arranged my next follow-up 8 weeks later.

See you next post :-)