Please visit my other blog for updates - Musings on Life. I had a minor operation recently to remove nasal adhesions that were due to my two previous transphenoidal surgeries. The technical term of the procedure was "release of synechiae." You can visit my story here.
Monday, August 5, 2013
Thursday, October 1, 2009
Getting There—to the End of My Journey—This Time Around
Day 0, Tuesday, 15 Sep
Armed with the guarantee of payment from my insurance, I got myself admitted to Mount Elizabeth Hospital. A friendly Filipino, named Rod, seated me, asked for my passport, and checked the room reservations list. He said a single room was booked for me by my doctor’s clinic. He looked up my file and then went away for a while. Coming back, he had his own copy of the letter from my company’s insurance and a one-pager estimate of the hospitalization costs, excluding doctors’ fees, as he pointed out. I glossed it over, I was sure it was going to be taken care of by the insurance, except for lodger fees which were on top of the cost of a single room.
In a short while, we were escorted to Ward 6. Two nurses helped me settle in, one of whom was Irene, a Filipina. My husband, Let, and I marveled at the room appointments. It was huge, carpeted, with a new-looking Hill-Rom hospital bed and a huge sofa bed. The room was one grade lower than what I was entitled to, making us wonder what the single deluxe room looked like.
After settling in, a pathology staff came and took 4 tabs of blood. Afterwards, I went for the pre-surgery tests such as chest X-Ray and ECG.
Day One, Wednesday, 16 Sep
I was offered a sleeping pill the night before the surgery in case I was too tensed to sleep. But I did manage to doze off without taking the drug. It was a repeat surgery after all, and the operation, as explained by the neurosurgeon, would be simpler than the first one I had—no cut on the inner mouth would be done as he would only access the pituitary gland through my nostrils.
The operation was set for 9:30am. By three quarters past 8, an Indian lady fetched me from my room. When she came in, I asked why it was rather early, but she dismissed my question and asked me to change into the hospital gown. I did so, taking my time as I reluctantly got into the oversized blue gown which ties at the back. By this time, I was feeling a bit nervous. Good thing there was no chance to drum up my anxiety as I was fetched early. I got into the wheelchair, and glanced up to Let. Now, he was the one looking more worried as all he could muster was “Bye.” and “Kita na lang.” (See you.), as I was being wheeled out of the room.
I was then made to wait beside another patient in a stretcher in the waiting room near the Operating Theater, OT, (that’s how they call the OR). An Indian nurse came over with my folder and asked the usual pre-operation questions. Like the other Indian nurses who attended to me while I was in the ward, this one also appeared aggressive as she stood at the foot of the stretcher, leaning over my feet quite heavily and jotting down my responses.
Five minutes to 9:30, I was fetched by the anesthetist, a lady doctor in her fifties but with an air of youth around her, and was wheeled into the OT. She helped curb my tension as she tried to strike up a small chat asking me of what I do in the Philippines, and what the political situation was back home. I smiled at her when she asked me whether I was rooting for Aquino (Noynoy). “There is so much possibility to do good,” she said. I agreed. This exchange happened as she was inserting the drip. In the meantime, my neurosurgeon had all the scans up on the white screen and the big machine fixed on me. Then, in a snap I went out.
Four and a half hours later, I woke up to a headache inside the Critical Care Unit (CCU or ICU as it’s more commonly called). I was still very drowsy but managed to listen to the anesthetist as she relayed me the good news that they saw the tumor and Dr. Ho, the neurosurgeon, was able to remove it. I said, “Thank you.” I was still feeling heady from the drugs—anaesthesia and morphine. I have a faint memory of talking briefly to Dr. Ho, hearing him tell me that he believed that he had cured me. And then I sensed Dr. Peter Eng, my endocrinologist, hovering around me, giving instructions to the nurse. The nurse then inserted a catheter.
I again drowsed off, and woke up half past 5pm looking for my husband. The nurse called him in from the waiting area. I was already fully awake. Let came in, grasped my right hand, and gently kissed it. It was a beautiful moment. I felt God’s hand over us. It was too good, too beautiful to awaken to a loved one whose eyes showed so much gratefulness. I was happy. It was my birthday. And I was truly happy notwithstanding the physical pain from the surgery.
After a while, Dr. Ho entered the room to officially break to us the good news. He said that the operation was successful but it took more than 4 hours, as it took him 2 hours to get in and locate where my pituitary gland was. He explained that the scar from the previous operation modified how my pituitary anatomy looked, making it difficult to say which was which. According to him, he almost gave up and would have abandoned the operation if he still was not able decipher on which part the tumor was excised.
After 2 hours, he finally located the scar from a very small opening through which my first neurosurgeon accessed the gland. Once inside, he related that he then found a yellowish tissue on the right distinct from the normal gland which had a pinkish hue. Further, there was a suspicious-looking mass on the left side, which he also removed.
Dr. Ho has done quite a number of transphenoidal surgeries. He explained to me, during my first consult at his clinic, that he chooses to be more aggressive in his methods as he would rather excise a part of the normal gland than risk having a residual tumor missing his curettes. Apart from the normal procedure of scraping the tumor, he uses 100% alcohol to ensure that he kills all the undesirable tissue around the gland—a procedure not done by other neurosurgeons, but which, he said, works well for his patients based on his observation.
Dr. Ho is already in his 60s. But, to me, he looks much younger than his age, appearing still in the prime of health. He has a very good command of English, and is able to explain in great detail the procedure, mentioning his experience with patients with the same case. He mentioned that he had a patient, who happened to be a medical doctor as well, who was diagnosed with acromegaly based solely on his blood chemistry as there was no evident tumor that could be found on his MRI scans. The second time that he performed the operation on this doctor-patient of his, he was also at a loss in identifying which was the pituitary gland, and rather than create more damage, he closed him up, and abandoned the operation. He had to be aided by an MRI imaging the third time around. Needless to say, the operation was successful and the doctor, he said, so far is doing well in remission.
Day Two, Thursday, 17 Sep
Thanks to the morphine drip, I managed to get some sleep in the CCU. I had Leonie, a Filipina nurse attend to me from 10 pm to 8 am. She closely monitored my BP as the machine would frequently alarm when it dipped to around 85/45.
At 8am, Leonie endorsed my case to Furong, an equally competent and caring Chinese nurse. Furong offered me fish congee, Milo, and orange juice for breakfast. The doctor said I could eat anything. But I had no appetite. The surgery had temporarily affected my sense of smell, hence, making even the most delicious foods taste bland.
Dr. Eng, my endocrinologist, came and looked at my stats. I asked if my BP was alright. He said it was okay as my BP had always been on the low end, and the surgery had caused it to drop a bit. He ordered for hydrocortisone (cortisol/steroid) injections explaining that it is commonly given after a pituitary surgery to aid the body in recovering. I was also given Panadol (Paracetamol). He ordered for the morphine drip to be stopped. I was okay, the headache I had was mild.
Furong then arranged for my transfer to the ward. After securing a room, she removed my catheter, unhooked me from the monitors, put me in a wheel chair, and brought me to Ward 10 (Royal/Exec. Suites). I was surprised to learn that all single deluxe rooms were housed amongst the suites which accommodate the royalty and big personalities. I also did not realize that this would later on put me in a battle with the hospital’s billing dept. which would refuse to be convinced that my insurance was going to cover my “deluxe” accommodation.
Day Three, Friday, 18 Sep
Dr. Ho came early, and without any ado, motioned for the nurse to assist him as he pulled out the nasal packing. Out it went in a snap! Some blood dripped. The nurse plastered on some gauze to my nose to catch the dripping blood. I thought I’d be able to finally breathe through my nose again! But alas, my nose was heavy with mucous. I could somehow breathe from the left opening but the right side was totally blocked.
During the night, sleep would not come. The sleeplessness I would experience in the next days had then started. I could not doze off without a sleeping tablet. No matter what position I took, no matter how tired and drowsy I felt I was, I just could not completely snooze!
Day Four, Saturday, 19 Sep
I was feeling better except for the blocked nose. I was no longer getting a headache. And I was enjoying the food being served by the butler although I could hardly taste it. Yep, the room accommodation made for a royal hospital stay. There was a butler on call!
Drs. Ho and Eng visited me twice everyday, once in the morning and again in the afternoon. I felt I was feeling good enough to be discharged. But, they noticed that I was peeing more. The nurses had been keeping count of my fluid input and output as diabetes insipidus, manifested by uncontrolled urination, was a common complication secondary to a pituitary surgery.
Dr. Ho was going away for the long weekend. It was going to be a public holiday Monday, 21 September, in Singapore to celebrate the end of Ramadan. He said that from his point of view, there was not going to be any more major complication. He ruled out any CSF (cerebrospinal fluid) leak. He said that he thought I was okay for discharge, but just to be sure, he recommended that I consume the 7-day guaranteed confinement issued by my insurance. He then said that he would leave my case to his neurosurgeon colleague, Dr. Alvin Hong. I thanked Dr. Ho, remarking that he had been great and agreed to see him at his clinic after I was discharged.
Day 5, Sunday, 20 Sep
I was walking about by this time and spending less time in bed. I was trying to tire myself hoping I could sleep unaided by the tablet.
I was starting to dread the nightfall as I imagined hours of turning in bed, finding no position that would make me get a full rest.
I was also peeing more, but Dr. Hong, the reliever, said that I was still okay and they wanted my brain to adjust naturally, hence, they were not giving me any medicine.
Day 6, Monday, 21 Sep
The day passed pretty much the same as the last one. Things had become a routine by this time. Let and I would Skype to see our kids online. I ached to go home.
Day 7, Tuesday, 22 Sep
The pathology staff came by 8am, and hourly afterwards until 10am to take blood samples for the hormone and liver function tests. I was given the glucose drink at 0 hour to check for growth hormone suppression.
At last I was going to be discharged! Dr. Eng gave me some take-home meds—Panadol for headache ad Imovaine for sleeplessness.
I was excited. I was still kind of weak, my nose was as blocked as it was from day 2, but I felt I was ready to get out of the hospital.
Let and I checked in to 2-star hotel. Hotel rates had doubled because of the Formula 1 (Grand Prix) event happening in SG on 24-26 Sep.
Day 8, Wednesday, 23 Sep
We went to see Drs. Eng and Ho at their clinics. Dr. Ho showed us the lab results. Gist of which was that we had attained the targeted growth hormone suppression level of less than 1 mIU/L. And although still rather early, my insulin growth factor (IGF 1) level was down from 352 to 212 ug/L. All other hormones (e.g., FSH, LH, and cortisol) remained within the normal ranges, meaning I had no need for any hormone replacement therapy. Thanks to Dr. Ho who did the job so cleanly yet thoroughly.
My growth hormone results (mIU/L) were:
Pre-surgery, 15 Sep:
• 4.29
Post-surgery:
• Random, 0 hr: 0.70
• 1 hr: 0.23
• 2 hr: 0.96
Dr. Eng was sure that Dr. Ho would be happy to also see the results of the hormone tests. He said that IGF-1 test could be repeated after 2 months to get a more stable and accurate result. But, as for growth hormone, he is confident that we attained the clinically acceptable results for ascertaining that “cure” has been achieved. Symptomatically, soft tissue swelling around my fingers and toes has receded. It could also be that the water I previously retained was lost after my growth hormone levels went down.
Dr. Ho, for his part, showed us the histopathology report confirming that the tissues removed consisted of pituitary adenoma (tumor) which was growth-hormone secreting. He showed us a picture of the specimen. Dr. Ho was happy with the results. He repeated what he told me at the CCU that he thinks that he has cured me. He explained again how the operation went, and patiently answered our questions. We thanked him immensely and arranged to stay in contact by email for my next consultation.
After the consults with Drs. Eng and Ho, Let and I visited a high school friend of mine at their place in Choa Chu Kang, near East Jurong. We had dinner. I was full.
We were back at the hotel past 10pm. I was tired but again I could not sleep. I got up around 1am feeling nauseous. Then I started vomiting heavily. Afterwards, I took the sleeping pill to get some rest.
Day 9, Thursday, 24 Sep
I felt worse in the morning. I vomited again although I had practically nothing to throw up except water. I felt so weak that I asked Let to get me quickly to the hospital. Let phoned Dr. Ho and was instructed to bring me to the ER.
Dr. Ho came shortly after we arrived. My blood sample was taken for analysis. He confirmed with me first that what I was only vomiting, and that there was no fluid leaking from my nose. He then called Dr. Eng. I overheard him telling Dr. Eng that I could be having Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Seeing how weak I was, Dr. Ho decided to have me re-admitted. I was again back at the ward.
I felt terrible, lethargic, spinning. The nurse injected something into the hep-lock for the dizziness. Dr. Eng came with the lab result. My sodium was at 120 mmol/l, normal is from 135-150 mmol/l. It was normal upon my discharge at 139, but suddenly dropped after 1 day causing the vomiting and dizziness.
He ordered me to restrict my fluid intake to a maximum of 800 ml per 24 hours. He also instructed treatment with i/v 3% saline 150 ml over 6 hours.
Day 10, Friday, 25 Sep
I felt that this time around was even more difficult. The saline drip was quite painful. The nurse had to reinsert the i/v line twice, making me have 4 insertions in total!
I realized that headache is far more pleasant than dizziness. I felt out of control whenever I was feeling dizzy.
Dr. Eng explained that I had a bit of diabetes insipedus (DI) 3 days after the operation. I then went on to have SIADH. My pituitary had been damaged a bit causing it to produce less ADH during the DI phase and then more ADH afterwards.
My brain, according to Dr. Ho, got a bit confused. The good thing was that it meant that ADH was not in short supply. And for a time, it was signaling my body to conserve water, resulting in salt dilution.
Day 11, Saturday, 26 Sep
We were scheduled to fly back to Manila at 5:40 pm. I was still nauseous upon waking up. I vomited again. But I resolved to be discharged. I managed to take a shower despite feeling giddy. I wanted to go home badly by now.
I was counting on the assurance of Dr. Eng that my sodium level would definitely come up so long as I was restricting my fluid intake.
Dr. Eng came early, and shortly after, Dr. Ho also arrived. They discussed my case and agreed that they expected nothing else to crop up. Because if there was any other complication, it would have manifested itself by this time, i.e., 10 days post-operation. They were confident that I was okay for discharge even if the sodium level had not yet normalized. It somehow stabilized at 119 mmol/l. Dr. Eng again assured me that it would normalize in 2 days.
By 1pm, we were off to Changi Airport. We were still rather early for our flight to Manila with ETD of 1740. Typhoon Ketsana, with local name “Ondoy,” was then inundating Manila. I was kept updated by posts made on Facebook. Rains had been non-stop since last night and floods were fast engulfing low-lying areas in Manila including our place, Taytay. Our Cebu Pacific flight was delayed as the aircraft was stalled by bad weather conditions in Manila. We finally boarded past 10pm, after long hours of waiting.
Day 12, Sunday, 27 Sep
We arrived NAIA half hour past 1am. I was feeling nauseous again so I asked for a wheelchair. We got out of the airport 2:30am and reached Ortigas by 3am. All roads to Cainta and Taytay were inaccessible. Trucks blocked the highway. Some parts of Ortigas Extension were flooded waist-deep. We were stranded!
It had been a very long wait at the airport. Now, there was nothing we could do but wait again until the floods subside and the roads clear. I had to spend the night in a hotel. Let had to leave me alone to fly to Cebu that night and report for work the following day. Good thing that my sister, who works in Laguna, was near the area as she was also stranded. She came to the hotel to accompany me. I was still feeling weak. It was likely that my sodium level was still low.
It was an ordeal alright. But I could not complain. I had no right to complain after seeing the devastation brought on by the typhoon to the victims. The flooding was a nightmare! It made for good fiction. But seeing it claim lives and destroy so many homes was too much, making my recent experience pale in comparison to the kind of trial Ondoy suddenly brought to many Filipinos.
I am awed with gratitude. Our place, though right between Cainta and Taytay which were two of the most badly hit municipalities by Ondoy, was spared. I finally reached home the following day, 28 Sep, straight into the arms of my two children. I was home safe and cured. I have everything to thank God for.
with Dr. Ho Kee Hang - neurosurgeon
with Dr. Peter Eng - endocrinologist
with a Filipina nurse at Ward 10
taken at the lobby of Mount Elizabeth Hospital during my first discharge, 22 Sep 2009
Armed with the guarantee of payment from my insurance, I got myself admitted to Mount Elizabeth Hospital. A friendly Filipino, named Rod, seated me, asked for my passport, and checked the room reservations list. He said a single room was booked for me by my doctor’s clinic. He looked up my file and then went away for a while. Coming back, he had his own copy of the letter from my company’s insurance and a one-pager estimate of the hospitalization costs, excluding doctors’ fees, as he pointed out. I glossed it over, I was sure it was going to be taken care of by the insurance, except for lodger fees which were on top of the cost of a single room.
In a short while, we were escorted to Ward 6. Two nurses helped me settle in, one of whom was Irene, a Filipina. My husband, Let, and I marveled at the room appointments. It was huge, carpeted, with a new-looking Hill-Rom hospital bed and a huge sofa bed. The room was one grade lower than what I was entitled to, making us wonder what the single deluxe room looked like.
After settling in, a pathology staff came and took 4 tabs of blood. Afterwards, I went for the pre-surgery tests such as chest X-Ray and ECG.
Day One, Wednesday, 16 Sep
I was offered a sleeping pill the night before the surgery in case I was too tensed to sleep. But I did manage to doze off without taking the drug. It was a repeat surgery after all, and the operation, as explained by the neurosurgeon, would be simpler than the first one I had—no cut on the inner mouth would be done as he would only access the pituitary gland through my nostrils.
The operation was set for 9:30am. By three quarters past 8, an Indian lady fetched me from my room. When she came in, I asked why it was rather early, but she dismissed my question and asked me to change into the hospital gown. I did so, taking my time as I reluctantly got into the oversized blue gown which ties at the back. By this time, I was feeling a bit nervous. Good thing there was no chance to drum up my anxiety as I was fetched early. I got into the wheelchair, and glanced up to Let. Now, he was the one looking more worried as all he could muster was “Bye.” and “Kita na lang.” (See you.), as I was being wheeled out of the room.
I was then made to wait beside another patient in a stretcher in the waiting room near the Operating Theater, OT, (that’s how they call the OR). An Indian nurse came over with my folder and asked the usual pre-operation questions. Like the other Indian nurses who attended to me while I was in the ward, this one also appeared aggressive as she stood at the foot of the stretcher, leaning over my feet quite heavily and jotting down my responses.
Five minutes to 9:30, I was fetched by the anesthetist, a lady doctor in her fifties but with an air of youth around her, and was wheeled into the OT. She helped curb my tension as she tried to strike up a small chat asking me of what I do in the Philippines, and what the political situation was back home. I smiled at her when she asked me whether I was rooting for Aquino (Noynoy). “There is so much possibility to do good,” she said. I agreed. This exchange happened as she was inserting the drip. In the meantime, my neurosurgeon had all the scans up on the white screen and the big machine fixed on me. Then, in a snap I went out.
Four and a half hours later, I woke up to a headache inside the Critical Care Unit (CCU or ICU as it’s more commonly called). I was still very drowsy but managed to listen to the anesthetist as she relayed me the good news that they saw the tumor and Dr. Ho, the neurosurgeon, was able to remove it. I said, “Thank you.” I was still feeling heady from the drugs—anaesthesia and morphine. I have a faint memory of talking briefly to Dr. Ho, hearing him tell me that he believed that he had cured me. And then I sensed Dr. Peter Eng, my endocrinologist, hovering around me, giving instructions to the nurse. The nurse then inserted a catheter.
I again drowsed off, and woke up half past 5pm looking for my husband. The nurse called him in from the waiting area. I was already fully awake. Let came in, grasped my right hand, and gently kissed it. It was a beautiful moment. I felt God’s hand over us. It was too good, too beautiful to awaken to a loved one whose eyes showed so much gratefulness. I was happy. It was my birthday. And I was truly happy notwithstanding the physical pain from the surgery.
After a while, Dr. Ho entered the room to officially break to us the good news. He said that the operation was successful but it took more than 4 hours, as it took him 2 hours to get in and locate where my pituitary gland was. He explained that the scar from the previous operation modified how my pituitary anatomy looked, making it difficult to say which was which. According to him, he almost gave up and would have abandoned the operation if he still was not able decipher on which part the tumor was excised.
After 2 hours, he finally located the scar from a very small opening through which my first neurosurgeon accessed the gland. Once inside, he related that he then found a yellowish tissue on the right distinct from the normal gland which had a pinkish hue. Further, there was a suspicious-looking mass on the left side, which he also removed.
Dr. Ho has done quite a number of transphenoidal surgeries. He explained to me, during my first consult at his clinic, that he chooses to be more aggressive in his methods as he would rather excise a part of the normal gland than risk having a residual tumor missing his curettes. Apart from the normal procedure of scraping the tumor, he uses 100% alcohol to ensure that he kills all the undesirable tissue around the gland—a procedure not done by other neurosurgeons, but which, he said, works well for his patients based on his observation.
Dr. Ho is already in his 60s. But, to me, he looks much younger than his age, appearing still in the prime of health. He has a very good command of English, and is able to explain in great detail the procedure, mentioning his experience with patients with the same case. He mentioned that he had a patient, who happened to be a medical doctor as well, who was diagnosed with acromegaly based solely on his blood chemistry as there was no evident tumor that could be found on his MRI scans. The second time that he performed the operation on this doctor-patient of his, he was also at a loss in identifying which was the pituitary gland, and rather than create more damage, he closed him up, and abandoned the operation. He had to be aided by an MRI imaging the third time around. Needless to say, the operation was successful and the doctor, he said, so far is doing well in remission.
Day Two, Thursday, 17 Sep
Thanks to the morphine drip, I managed to get some sleep in the CCU. I had Leonie, a Filipina nurse attend to me from 10 pm to 8 am. She closely monitored my BP as the machine would frequently alarm when it dipped to around 85/45.
At 8am, Leonie endorsed my case to Furong, an equally competent and caring Chinese nurse. Furong offered me fish congee, Milo, and orange juice for breakfast. The doctor said I could eat anything. But I had no appetite. The surgery had temporarily affected my sense of smell, hence, making even the most delicious foods taste bland.
Dr. Eng, my endocrinologist, came and looked at my stats. I asked if my BP was alright. He said it was okay as my BP had always been on the low end, and the surgery had caused it to drop a bit. He ordered for hydrocortisone (cortisol/steroid) injections explaining that it is commonly given after a pituitary surgery to aid the body in recovering. I was also given Panadol (Paracetamol). He ordered for the morphine drip to be stopped. I was okay, the headache I had was mild.
Furong then arranged for my transfer to the ward. After securing a room, she removed my catheter, unhooked me from the monitors, put me in a wheel chair, and brought me to Ward 10 (Royal/Exec. Suites). I was surprised to learn that all single deluxe rooms were housed amongst the suites which accommodate the royalty and big personalities. I also did not realize that this would later on put me in a battle with the hospital’s billing dept. which would refuse to be convinced that my insurance was going to cover my “deluxe” accommodation.
Day Three, Friday, 18 Sep
Dr. Ho came early, and without any ado, motioned for the nurse to assist him as he pulled out the nasal packing. Out it went in a snap! Some blood dripped. The nurse plastered on some gauze to my nose to catch the dripping blood. I thought I’d be able to finally breathe through my nose again! But alas, my nose was heavy with mucous. I could somehow breathe from the left opening but the right side was totally blocked.
During the night, sleep would not come. The sleeplessness I would experience in the next days had then started. I could not doze off without a sleeping tablet. No matter what position I took, no matter how tired and drowsy I felt I was, I just could not completely snooze!
Day Four, Saturday, 19 Sep
I was feeling better except for the blocked nose. I was no longer getting a headache. And I was enjoying the food being served by the butler although I could hardly taste it. Yep, the room accommodation made for a royal hospital stay. There was a butler on call!
Drs. Ho and Eng visited me twice everyday, once in the morning and again in the afternoon. I felt I was feeling good enough to be discharged. But, they noticed that I was peeing more. The nurses had been keeping count of my fluid input and output as diabetes insipidus, manifested by uncontrolled urination, was a common complication secondary to a pituitary surgery.
Dr. Ho was going away for the long weekend. It was going to be a public holiday Monday, 21 September, in Singapore to celebrate the end of Ramadan. He said that from his point of view, there was not going to be any more major complication. He ruled out any CSF (cerebrospinal fluid) leak. He said that he thought I was okay for discharge, but just to be sure, he recommended that I consume the 7-day guaranteed confinement issued by my insurance. He then said that he would leave my case to his neurosurgeon colleague, Dr. Alvin Hong. I thanked Dr. Ho, remarking that he had been great and agreed to see him at his clinic after I was discharged.
Day 5, Sunday, 20 Sep
I was walking about by this time and spending less time in bed. I was trying to tire myself hoping I could sleep unaided by the tablet.
I was starting to dread the nightfall as I imagined hours of turning in bed, finding no position that would make me get a full rest.
I was also peeing more, but Dr. Hong, the reliever, said that I was still okay and they wanted my brain to adjust naturally, hence, they were not giving me any medicine.
Day 6, Monday, 21 Sep
The day passed pretty much the same as the last one. Things had become a routine by this time. Let and I would Skype to see our kids online. I ached to go home.
Day 7, Tuesday, 22 Sep
The pathology staff came by 8am, and hourly afterwards until 10am to take blood samples for the hormone and liver function tests. I was given the glucose drink at 0 hour to check for growth hormone suppression.
At last I was going to be discharged! Dr. Eng gave me some take-home meds—Panadol for headache ad Imovaine for sleeplessness.
I was excited. I was still kind of weak, my nose was as blocked as it was from day 2, but I felt I was ready to get out of the hospital.
Let and I checked in to 2-star hotel. Hotel rates had doubled because of the Formula 1 (Grand Prix) event happening in SG on 24-26 Sep.
Day 8, Wednesday, 23 Sep
We went to see Drs. Eng and Ho at their clinics. Dr. Ho showed us the lab results. Gist of which was that we had attained the targeted growth hormone suppression level of less than 1 mIU/L. And although still rather early, my insulin growth factor (IGF 1) level was down from 352 to 212 ug/L. All other hormones (e.g., FSH, LH, and cortisol) remained within the normal ranges, meaning I had no need for any hormone replacement therapy. Thanks to Dr. Ho who did the job so cleanly yet thoroughly.
My growth hormone results (mIU/L) were:
Pre-surgery, 15 Sep:
• 4.29
Post-surgery:
• Random, 0 hr: 0.70
• 1 hr: 0.23
• 2 hr: 0.96
Dr. Eng was sure that Dr. Ho would be happy to also see the results of the hormone tests. He said that IGF-1 test could be repeated after 2 months to get a more stable and accurate result. But, as for growth hormone, he is confident that we attained the clinically acceptable results for ascertaining that “cure” has been achieved. Symptomatically, soft tissue swelling around my fingers and toes has receded. It could also be that the water I previously retained was lost after my growth hormone levels went down.
Dr. Ho, for his part, showed us the histopathology report confirming that the tissues removed consisted of pituitary adenoma (tumor) which was growth-hormone secreting. He showed us a picture of the specimen. Dr. Ho was happy with the results. He repeated what he told me at the CCU that he thinks that he has cured me. He explained again how the operation went, and patiently answered our questions. We thanked him immensely and arranged to stay in contact by email for my next consultation.
After the consults with Drs. Eng and Ho, Let and I visited a high school friend of mine at their place in Choa Chu Kang, near East Jurong. We had dinner. I was full.
We were back at the hotel past 10pm. I was tired but again I could not sleep. I got up around 1am feeling nauseous. Then I started vomiting heavily. Afterwards, I took the sleeping pill to get some rest.
Day 9, Thursday, 24 Sep
I felt worse in the morning. I vomited again although I had practically nothing to throw up except water. I felt so weak that I asked Let to get me quickly to the hospital. Let phoned Dr. Ho and was instructed to bring me to the ER.
Dr. Ho came shortly after we arrived. My blood sample was taken for analysis. He confirmed with me first that what I was only vomiting, and that there was no fluid leaking from my nose. He then called Dr. Eng. I overheard him telling Dr. Eng that I could be having Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Seeing how weak I was, Dr. Ho decided to have me re-admitted. I was again back at the ward.
I felt terrible, lethargic, spinning. The nurse injected something into the hep-lock for the dizziness. Dr. Eng came with the lab result. My sodium was at 120 mmol/l, normal is from 135-150 mmol/l. It was normal upon my discharge at 139, but suddenly dropped after 1 day causing the vomiting and dizziness.
He ordered me to restrict my fluid intake to a maximum of 800 ml per 24 hours. He also instructed treatment with i/v 3% saline 150 ml over 6 hours.
Day 10, Friday, 25 Sep
I felt that this time around was even more difficult. The saline drip was quite painful. The nurse had to reinsert the i/v line twice, making me have 4 insertions in total!
I realized that headache is far more pleasant than dizziness. I felt out of control whenever I was feeling dizzy.
Dr. Eng explained that I had a bit of diabetes insipedus (DI) 3 days after the operation. I then went on to have SIADH. My pituitary had been damaged a bit causing it to produce less ADH during the DI phase and then more ADH afterwards.
My brain, according to Dr. Ho, got a bit confused. The good thing was that it meant that ADH was not in short supply. And for a time, it was signaling my body to conserve water, resulting in salt dilution.
Day 11, Saturday, 26 Sep
We were scheduled to fly back to Manila at 5:40 pm. I was still nauseous upon waking up. I vomited again. But I resolved to be discharged. I managed to take a shower despite feeling giddy. I wanted to go home badly by now.
I was counting on the assurance of Dr. Eng that my sodium level would definitely come up so long as I was restricting my fluid intake.
Dr. Eng came early, and shortly after, Dr. Ho also arrived. They discussed my case and agreed that they expected nothing else to crop up. Because if there was any other complication, it would have manifested itself by this time, i.e., 10 days post-operation. They were confident that I was okay for discharge even if the sodium level had not yet normalized. It somehow stabilized at 119 mmol/l. Dr. Eng again assured me that it would normalize in 2 days.
By 1pm, we were off to Changi Airport. We were still rather early for our flight to Manila with ETD of 1740. Typhoon Ketsana, with local name “Ondoy,” was then inundating Manila. I was kept updated by posts made on Facebook. Rains had been non-stop since last night and floods were fast engulfing low-lying areas in Manila including our place, Taytay. Our Cebu Pacific flight was delayed as the aircraft was stalled by bad weather conditions in Manila. We finally boarded past 10pm, after long hours of waiting.
Day 12, Sunday, 27 Sep
We arrived NAIA half hour past 1am. I was feeling nauseous again so I asked for a wheelchair. We got out of the airport 2:30am and reached Ortigas by 3am. All roads to Cainta and Taytay were inaccessible. Trucks blocked the highway. Some parts of Ortigas Extension were flooded waist-deep. We were stranded!
It had been a very long wait at the airport. Now, there was nothing we could do but wait again until the floods subside and the roads clear. I had to spend the night in a hotel. Let had to leave me alone to fly to Cebu that night and report for work the following day. Good thing that my sister, who works in Laguna, was near the area as she was also stranded. She came to the hotel to accompany me. I was still feeling weak. It was likely that my sodium level was still low.
It was an ordeal alright. But I could not complain. I had no right to complain after seeing the devastation brought on by the typhoon to the victims. The flooding was a nightmare! It made for good fiction. But seeing it claim lives and destroy so many homes was too much, making my recent experience pale in comparison to the kind of trial Ondoy suddenly brought to many Filipinos.
I am awed with gratitude. Our place, though right between Cainta and Taytay which were two of the most badly hit municipalities by Ondoy, was spared. I finally reached home the following day, 28 Sep, straight into the arms of my two children. I was home safe and cured. I have everything to thank God for.
with Dr. Ho Kee Hang - neurosurgeon
with Dr. Peter Eng - endocrinologist
with a Filipina nurse at Ward 10
taken at the lobby of Mount Elizabeth Hospital during my first discharge, 22 Sep 2009
Sunday, September 20, 2009
Winner in God's Amazing Grace
Acromegaly is a rare medical condition. I’m one case in 3-4 of a million cases happening per year. Yep, that rare! Maybe because in most cases the disease is left undiagnosed until it manifests major complicating conditions, like diabetes and cardiovascular problems, which are then treated as the primary ailments.
Wikipedia better explains this rare disease:
Most pituitary tumors arise spontaneously and are not genetically inherited. Many pituitary tumors arise from a genetic alteration in a single pituitary cell which leads to increased cell division and tumor formation. This genetic change, or mutation, is not present at birth, but is acquired during life. The mutation occurs in a gene that regulates the transmission of chemical signals within pituitary cells; it permanently switches on the signal that tells the cell to divide and secrete growth hormones. The events within the cell that cause disordered pituitary cell growth and growth hormone oversecretion currently are the subject of intensive research.
I faced it head-on 1 Feb 2007 when I went in for surgery in Manila. The tumor that showed in my first MRI scans measured around 7mm. This was reduced post operation to a subtle 3mm. Between that time and last 16th of Sep, that subtle residual tumor had been insidiously affecting my life on the whole. I know I was not yet cured. I know the battle had not ended. And I know that there was still something that could be done. Something within my reach. Something that just needed me to will it to happen.
And on 16 Sep 2009, with one of the best neurosurgeons in Singapore, something amazing happened. I went under the knife (again) with a faith enough to ride any tide. It was an extraordinary day. For one, it was my 34th birthday. It was the 2nd time I was taking my chances of battling it out with an unheard of disease amongst my circles of family and friends. A post on Facebook before midnight immediately drew attention to my status, and all through the next day, messages poured in. The prayers whispered to God by family, relatives and friends from all around were truly amazing. Not only did they make me feel loved, they made me come out of the surgery cured. Yes, I have the gut feel, and the faith that I have defeated acromegaly finally. I have a whole life, maybe another 34 years, may be even more to look forward to. I can now happily picture myself in Gabee’s 18th birthday, Garrett’s college graduation, in both their weddings, and in many happy family occasions yet to happen.
Friday, September 5, 2008
Not so much a brain tumor
Fingers crossed, but just in case you, or someone close to you, ever need to have an MRI done, I'd strongly suggest that you go to Cardinal Santos MRI Center. It is highly recommended by my neurosurgeon, Eric Legaspi. Dr Legaspi, btw, graduated summa cum laude from UPLB for his pre-med and topped (read: First) the medical board the year he took it. I chose him after asking around and doing some research on the best neurosurgeons available.
Cardinal Santos MRI Center
I had my third MRI (of the sella/pituitary) last 25 August. My first was done in 2007 at Medical City
My first MRI revealed a 7mm tumor in my pituitary gland. Just for reference, the pituitary gland is about the size of a pea (very small!) located at the base of the brain. Calling it a brain tumor may not be technically accurate, but it's also not totally incorrect to name it as such, as it is still lodged in the brain area!
So there, I had a brain tumor! I had it removed Feb 07. It was producing excessive growth hormones (GH). If you had read my previous posts you would have come across the word "acromegaly." That's the condition that I have. A very rare disease in that only three to four out of every million people develop acromegaly each year and about 60 out of every million people suffer from the disease at any time. Now, don't you think that having this disease kind of makes me extraordinary!!! Some consolation! (Please click on the hyperlink to learn more about acromegaly.)
But I have good news! The tumor’s now reduced to approximately 1-2mm. Dr Ison gave this impression:
"Interval decrease in the size of the tiny hypoenhancing lesion immediately superior to the right cavernous internal carotid artery. Imaging finding likely relate to resolving post-operative granulation changes. No definite residual or recurrent adenoma is identified. Nevertheless, continued follow-up is recommended."
Whew! Yes, we’re quite relieved. As you would probably know, I just had my second pregnancy; I gave birth last 24 June. I was apprehensive that the pregnancy could trigger a tumor regrowth. Good thing that it looks like I’m still ok post-op. The blood tests did not turn up very ideal results but so far my symptoms have been kept at bay. Will have a repeat of the blood work after 4 months as my endocrinologist said that my hormones might still be affected by the pregnancy. I’m keeping my fingers crossed… 
Saturday, August 30, 2008
Back to work
My 12-week maternity leave is up. Huhu! 
I’m back to work also because I need to be so. We could have chosen to live within my husband’s earnings but since we wanted our own house and to be able to send our kids to a good school, I need to help earn the dough. Who would not want of course to live comfortably? Somehow, it’s not enough to earn “just enough.”
The first morning when I left my little baby, Gabee, to go to work, she was already awake, flashing me with her smile and cooing. It was heart-breaking, I almost cried. It was difficult yet I was also quite excited about resuming work after doing almost nothing the last 2 months except caring for Gabee. She had developed an attachment to me since I'd been nursing her. When I get home, she’d cry when she hears my voice. She’d want to be carried and would turn her head from side wanting to be nursed. I still breastfeed her during the night and plan to continue nursing her as long as I can.
At times my conscience pricks me as I am now so completely dependent on the yaya. I’m thankful that Gabee’s yaya seems to care genuinely for her. I just run home after work to again take my rightful place as Gabee’s mother.
Sunday, July 1, 2007
My GH Levels
Below are my GH levels. Presurgery, my random GH was 22.8 and after a 75g glucose load, it remained fairly the same at 20.85.
Postsurgery, on the three tests made on different dates, my GH could still not be suppressed to <1 be="" br="" considered="" ideal="" in="" is="" level="" ml="" ng="" remission.="" the="" to="" which="">
Note: Surgery was done on 1 Feb 2007.
My IGF levels:
Presurgery = 214 ng/ml (normal)
Postsurgery = 370 ng/ml (normal range for 31-35 yrs female is 115-307)
Ironically, it was normal presurgery but increased quite significantly postsurgery.
Histopath findings: + GH and + Prolactin
All other hormones (prolactin, cortisol, FSH, LH, T4 and TSH) were normal before and after surgery.
Postsurgery, on the three tests made on different dates, my GH could still not be suppressed to <1 be="" br="" considered="" ideal="" in="" is="" level="" ml="" ng="" remission.="" the="" to="" which="">
Note: Surgery was done on 1 Feb 2007.
My IGF levels:
Presurgery = 214 ng/ml (normal)
Postsurgery = 370 ng/ml (normal range for 31-35 yrs female is 115-307)
Ironically, it was normal presurgery but increased quite significantly postsurgery.
Histopath findings: + GH and + Prolactin
All other hormones (prolactin, cortisol, FSH, LH, T4 and TSH) were normal before and after surgery.
Saturday, June 30, 2007
Diagnosed as Acromegalic
It was Christmas. We went to visit my grandmother and cousins in the province to give our gifts. I was alright. I was not feeling sick at all. My husband and I just decided that it was time that we have our second child as our firstborn was already four years old. I just withdrew from contraceptives two months back.
When I alighted from the car, I was greeted by two old friends/neighbors from my home place. It was one happy, curious inquiry that would lead to succeeding life-changing episodes... I was simply asked if I were pregnant--to which my simple retort was why did they think I was.... Then came the innocent comment that my nose was as big as it was when I had my first pregnancy. That was it!
Such innocent comment, unknowing to the one who gave it, confirmed my growing dislike of how I looked, especially in the recent pictures taken during an office Christmas lunch-out. I looked different--ugly, in fact, to my eyes! Not that my nose was perfect or small before but certainly it was not so big as to make me shun from having my pictures taken. And my eyes seemed to have become smaller, appearing puffy as if I had just cried.
Apprehensive and very much affected by the honest criticism on my appearance, I went right away to see any available doctor in a nearby clinic. Most doctors were out on their Christmas break. The doctor I chanced upon specializes in internal medicine; she had to call her OB-GYN professor to seek for advice on my case as she could not place where the swelling was coming from, i.e., other than being pregnant. She ordered a pregnancy test and asked me to stop any medication I was taking (I was taking antibiotics prescribed by my dermatologist then), and advised me to see an OB-GYN.
When office resumed in January, I immediately set an appointment with our company's OB-GYN consultant, who, just like the first doctor I saw, seemed to be out of wits in being able to diagnose my condition. She said that it was very unlikely for the swelling to be caused by an early pregnancy stage. She had some blood tests done and referred me to another doctor. The third doctor that I saw had more blood work done plus a liver ultrasound. Everything came back normal except for the thyroid tests which gave slightly indicative abnormal findings. That made her refer me to an endocrinologist. Finally, I was with the right doctor.
At my first consult, all I could tell my endocrinologist was that people in the province whom I saw last Christmas after almost a year noticed that I looked as if I was pregnant again. I told her that I dismissed my condition as just something that could be related to my abrupt withdrawal from the pill which I had been taking for almost 4 years. She queried if my shoe and ring size had increased over the years. I was size 6.5 just right after college, became 7 after giving birth, and four years after, I was even size 8.5 at times! My engagement and wedding rings used to easily fall off with a little soap when I wore them on my left ring finger, but recently, they had become so tight on the left, leaving etched circle marks on my finger when removed, and would not fit on my right ring finger.
That first consult with my endo was to be succeeded by several visits that eventually led to an MRI exam, results of which confirmed my endo's first impression, that it was indeed acromegaly!!! She said that she had approached my case systematically before reaching her diagnosis. On one of my visits, she assured me and my husband that she would not refer me for surgery were she not 100% sure!
Acceptance of my condition came not as hard for me as it did for Let, my husband. Not a few times did he say that increased shoe and ring size could not be accepted as symptoms as these are experienced by all people who gain weight. His point was that how could I be easily diagnosed with acromegaly when I was not manifesting symptoms other than aging appearance and increased shoe and ring size. He would say that my nose was really big right from the start, especially when all my hormones came back normal after the blood tests. All except for my growth hormone, which was barely suppressed after a glucose load. While Let was still in a "denial" stage, so to speak, I would search the web, trying to make sense of the repetitive medical stuff about acromegaly on google. I felt that I had most of the symptoms of acromegaly: swelling of nose, fingers and feet; excessive sweating; oily skin; snoring; fatigue.
With some bitterness, I accepted my circumstances, sought for healing and gave it all up to God. This could not be as hard as cancer--such was the thought that made me accept my condition easier. In fact, God knew I had it, and even before it was discovered, he was preparing me for it. He first made me move to a new job with an organization that has a comprehensive medical insurance. The diagnosis coincided with my appointment confirmation (on my first year anniversary). The surgery was then scheduled posthaste. Had I still been with the government institution I was before, the sickness I have would have cost all of my husband's savings and more. Rare as the disease is, curing and managing it is very expensive. I might had been worried sick of our finances on top of being worried of excessive growth hormone in my body. God has a reason for this. He chose not to give it to anyone, he chose me among the few that He knew could survive it.
1 February 2007 was a day in my life that could have been my last if there were surgical complications. But, it came to pass! Before the surgery, my feeling was that I was prepared for anything but the possibility that I could be leaving behind a four-year old kid without a mommy. I believe that that was the single thing I was most afraid about. I could not hold back my tears as I was fetched from my room and wheeled into the operating room. One nurse whispered before she wheeled me inside the OR, "God bless, ma'am." That had me crying even more. My son was all I could think of. I was seeking God's grace for forgiveness of my sins and praying for my life, for my son...
Through the ordeal of the surgery, not once did my husband leave me. He was my anchor, a reminder that my life was precious, that I was still needed. My family stood by me as well, helping as much as they could to make the ordeal seemed just like another confinement.
Life is too precious indeed to be claimed by acromegaly. Five months after the surgery, my postoperative MRI is indicative of a subtle residual tumor measuring 3 mm. But, there's hope. I'd bet that acromegaly could only make me look less beautiful but it could never claim my life. My battle goes on, with only God knowing how and in which way it will go...
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