Thursday, January 3, 2013

Back On The Treadmill

It has been more than four months since my last post and it has been much longer since I last used the treadmill. I have no good reason to lay off any of them other than laziness. I have promised several people including my son Azuan that I will continue to blog and post new stories but nothing came out of it. Unlike the days of old, making a new post seems to be quite a mental effort. The enthusiasms of old seems to be vanishing all the more so with the popularity of Facebook which seems to be the new preoccupation of even the most ardent of bloggers. Only a few hardcore bloggers most of whom a political bloggers seem to survive.
With the coming of 2013 I guess it is time for me to make a new resolve and continue to blog. There is so much to share and perhaps the sharing may help others and may even save their lives. "Is it that serious?" you may ask. Yes! It is that serious.
As a start for the new year I did a slow walk on the treadmill beginning with a speed of 2 kph at 0 degrees inclination and peaking at 6 kph at 2 degrees inclination and slowing down to 3 kph at 0 inclination for 30 minutes covering a distance of 2 kilometers. 70 calories of energy was expended. All the while I kept a close watch on my pulse rate so as not to exceed 125 beats per minute though the threshold for my age is 150 beeps per minute. Good enough for a start as anything more could be exerting too much strain on a certain section of my vital organ
Prior to this wet season gardening was the way for me to sweat it out. Unfortunately tough physical job is taboo to me now. The balmy wet weather is not the reason that I have to be on the treadmill to exercise. The reason is the incidental finding of me to be suffering from Abdominal Aortic Aneurysm, AAA for short or Triple A as is often referred to by doctors. The gist of this disease is the swelling of the aorta, the major artery exiting the heart. In my case it occurred in two places along the same artery with the one at the upper arch as most serious as it is more than 3 times the normal size. Intervention is usually recommended if the aneurysm exceeds 5.5 cm in size. In my case it far exceeded that threshold level.
This Triple A condition wouldn't have been detected if I hadn't suffered from a thyroid disorder. It was sometime in October 2012 that I had discovered a lump the size of a halved egg on my throat. It was diagnosed as hypo thyroid disorder when a thyroid function test was carried out on my blood sample. Fortunately for me a Dr. Andy Zulqarnaen of Hospital University Sains Malaysia had taken up my case and he suggested that the thyroid be removed after a further investigation to determine the malignancy of the tumor.
The Fine Needle Aspiration Cytology (FNAC) procedure was carried but the result was later found to be negative. We reached consensus after a discussion with Dr. Andee that an operation to remove both lobes of my thyroid even though the FNAC result was benign tumor. The sample used to determine the result via FNAC was too minute and I could risk a cancerous tumor as an Ultrasound Scan later showed a widespread coverage of the nodes reaching the collar bones on the lower side and the jugular vein on the left side of my neck. If the tumor is indeed cancerous, I may have to undergo a second operation of the other lobe if only the enlarged right lobe was removed.
I was admitted to Ward Dua Intan at HUSM on 21st November 2012. An X ray was taken the night before the operation. The total thyroidectomy for papillary thyroid carcinoma was  performed the next day by a team of doctors led by Consultant Endocrinologist Miss Maya Mazuin. Dr. Azlina was the anesthetist. Other surgeons assisting Dr. Maya were Mr. Mizwan, Miss Galpalam and Miss Athirah. Dr. Andee was in the operating theater even though he wasn't performing the operation. It was a marathon operation which started at 10.00 AM and ended at 4.00 PM. To all these people and many others in Wad 2 Intan, from the bottom of my heart, I beg to offer you a BIG thank you.
To recuperate, I had to be warded further. Two drainage tubes were attached to my body leading to two bottles to receive the discharge from the sutured incision. The bottles were marked as A and B and the amount of discharge was monitored. They will be removed after the level of discharge was reduced. I will be only discharged from the hospital once the drainage tubes are removed.
One of the tubes was removed on the 25th of November and  the other one was removed the next day. On the 26th morning the head of Specialist Outpatient Department (SOPD) came with a group of doctors including the doctors who operated on me. They decided that I was ready for discharge and Dr, Maya Mazuin was given the honor to remove the tape that covered the incision on my neck. That afternoon, I returned home after 5 days in the hospital ward.
Meanwhile the removed thyroid tissues were sent to the laboratory for further analysis.
The X-ray done on the night prior to the operation showed an enlarged aorta and the surgeons were notified of the finding by the radiologist. This finding was conveyed to me during my recuperation in the ward. A Computer Tomography (CT Scan) is necessary to really determine the extent of the enlargement. The CT Scan was done on 13th December 2013 and I was scheduled to meet a doctor at SOPD on 30th December 2013.
Dr. Lee Say Bob showed me the images of the CT Scan on the computer. There were two sections of the enlargement and the one of importance is the upper arch of the aorta as the enlargement far exceeded the threshold level of 5.5 cm diameter where intervention is necessary. Mine was measured at 6.7 cm! The one on the lower section is smaller and could probably be dealt with by inserting a stent. Another finding from the CT Scan is that of cysts in my kidneys.
Dr. Bob confirmed that the findings of the pathology laboratory on the thyroid tissues were of malignant tumor. The total removal of my thyroid was the right thing to do.
After a lengthy explanation by Dr. Bob of the dangers involved as a rupture may lead to fatality, in the presence of my wife, I agreed for an intervention surgery to be performed. It could be done in the General Hospital Kota Bharu but the earliest date that I could have an appointment with the Cardiologist is 14th March 2013 which is months away. Anything could happen to me within that period.
My other alternative is to have the intervention surgery done at Institiut Jantung Negara in Kuala Lumpur. For that I will have to meet Professor Madya Dr. Ziyadi at the Cardio Unit HUSM on 9th Jan for a reference to IJN. Hopefully after that I will be able to secure an earlier date for the intervention surgery at IJN.
All these while I have been oblivious to my ailment as the Electrocardiography (ECG) done at the local clinic has not shown any sign of the problem. It is not that the disease has been totally asymptomatic which I have been telling the doctors at HUSM that examine me, but I did not relate the mild chest pains that I have been suffering as well as the many other tell tale sign that are the symptoms of such an ailment medically known as fusiform thoracic aneurysm. Other notable symptoms are the pain in the lower back, the swelling of the leg which is known as edema and when pressed with a fingger, it is clearly a pitting edema. Most of the time I have been telling myself that the tough physical work that i have been doing was the cause of the muscular pain in the upper left chest.
To all my friends in the age bracket of 50 and above a CT scan of the thorax, abdomen and pelvic area is a good thing to do just to be sure. HUSM Kubang Kerian Kota Bharu charges RM300 - RM550 for a CT Scan. My scan for a thorax and abdomen should cost me RM550 but as a government retiree, I got it done for free. If you have any chest pain however mild, pain in the lower back or pain in the kidney, get a CT scan done, the sooner the better.
For the moment I will be working on my treadmill to improve my overall health so that I will be able to face another arduous operation under at IJN. A serious regime of dieting to reduce my cholesterol level and control my hypertension is also of paramount importance.

Any doctors out there who may notice any mistake in this post, please do not hesitate to correct me as I am only a humble farmer trying to warn others who may have been suffering the same problem without realizing it.