School Immunization Programme

Ouch!

Ian got his DT (Double Antigen), OPV (Oral Polio) and MMR (Measles, Mumps, Rubella) booster vaccination at his school yesterday. The service was provided free of charge under the School Immunization Programme by the Ministry of Health.

Before sending him off to school yesterday, I got him mentally prepared and reassured him that the level of pain would just be as mild as getting bitten by ants when the jab is administered. Not that he was worried or freak out about it, just that I thought he should be made clear what lied ahead of him.

He shared his jab experience with me soon after. He told me the feeling was slightly more painful than gotten bitten by ants. Mommy, you know, it was more like my two arms (yes, a jab each on both arms) got stung by bees!! But never mind larrr. I can take it (take the pain). Hahaha.... What a brave little young man I have here.O.O.

Under The Weather

Our Lunch

Both Ian and myself are under the weather with flu, blocked nose and chesty cough. I did not cook today but instead ordered Domino's as our lunch. Ian wiped off half of the regular aloha chicken pizza and some garlic twists I ordered! I am glad he still maintains his usual appetite.

I did not take him to the doctor as most doctors would only prescribe antibiotics even for viral infections. We went to the nearby pharmacy and the pharmacist prescribed Cetrizine for flu and Carbocisteine, both liquid and flavoured, to loosen up pleghm. I did not get myself any medications though as I believe what I needed was to drink lots and lots of water and a good rest without my laptop!

Ian's Daily Supplements

These are Ian's daily supplements and he will be fed with a tablespoonful of Cod Liver Oil and

one tab of Vitamin C and Multivitamin each every morning after breakfast.

Health Screening Report Out

This is an outdated post.

The physician, Dr Kwan called and informed me that the Health Screening Report was ready on the 4th day after the examination. We went back to Tung Shin Hospital the next day to collect our report.

My result

Mild Hypertension (needs monitoring)
Mild raised cholesterol level
Other blood and urine tests unremarkable
Ultrasound Abdomen showed uterine fibroids
Normal Chest X-ray, Ultrasound Breasts and ECG
Pap Smear normal

I have expected my hypertension to return as I had Gestational hypertension during my pregnancy 7 years ago but never did it cross my mind that it had to be this soon! Yes, I am almost always stressed, whether it be about anything and everything!

My only concern would have to be several fibroids noted within my uterus (uterine fibroids). The largest is noted in the posterior wall measuring 5.8 x 5.5 x 5.8cm. The largest in the anterior wall measures 1.o x 1.1 x 0.9cm. Dr Kwan's interpretation: Nothing to be concerned about. Most women have them and very rarely the fibroids will turn maglinant (cancerous). Advised to have ultrasound scan every year to monitor any growth.

The left ovary measures 3.6 x 2.4cm with a dominant follicle seen within, measuring 0.6cm in diameter. The right ovary is not visualised. No Free fluid noted in the P.O.D.

Dad's Result

Hypertension - Advised long term medication
Mild raised LDL Cholesterol
Mild raised PSA - needs monitoring
Other blood and urine tests unremarkable
Ultrasound Abdomen showed liver cysts
Normal Chest X-ray, Lung Function Test, ECG and Stress Test

Dad is now on amlodipine 5mg (anti-hypertensive drug) once daily. He stopped taking it two years ago since the GP told him his BP level was normal then. Well, it could be the herbs that he took that had worked wonders. He has stopped taking the herbs since coming to KL to be with mom. Well, no one could ever tell if this was indeed the reason.

His PSA (Prostate-Specific Antigen) test showed a slightly elevated result which needs monitoring and another test to be done in 3 months' time as advised by Dr Kwan.

Several simple cysts were noted in dad's liver though the size was too small to cause concern as commented by Dr Kwan.

Gestational Hypertension

Gestational hypertension: Some women just get high blood pressure near the end of pregnancy. They don't have any other associated symptoms. This condition does not cause any problems for you or your baby, but it can increase the risk that you will develop high blood pressure later in life. Gestational hypertension can also turn into PIH.

This condition doesn't need any treatment. But it can be hard to tell this condition from early or mild preeclampsia, so your doctor will monitor you very closely to make sure your high blood pressure does not turn into PIH. Your blood pressure will go back to normal within a few weeks after you have your baby, but you are more likely to develop chronic high blood pressure later in life.

Uterine Fibroids

What are fibroids?Fibroids are muscular tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is "leiomyoma" (leye-oh-meye-OH-muh) or just "myoma". Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.

Why should women know about fibroids?
About 20 percent to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.

Who gets fibroids?
There are factors that can increase a woman's risk of developing fibroids.
Age. Fibroids become more common as women age, especially during the 30s and 40s through menopause. After menopause, fibroids usually shrink.
Family history. Having a family member with fibroids increases your risk. If a woman's mother had fibroids, her risk of having them is about three times higher than average.
Ethnic origin. African-American women are more likely to develop fibroids than white women.
Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
Eating habits. Eating a lot of red meat (e.g., beef) and ham is linked with a higher risk of fibroids. Eating plenty of green vegetables seems to protect women from developing fibroids.

Where can fibroids grow?
Most fibroids grow in the wall of the uterus. Doctors put them into three groups based on where they grow:
Submucosal (sub-myoo-KOH-zuhl) fibroids grow into the uterine cavity.
Intramural (ihn-truh-MYOOR-uhl) fibroids grow within the wall of the uterus.
Subserosal (sub-suh-ROH-zuhl) fibroids grow on the outside of the uterus.
Some fibroids grow on stalks that grow out from the surface of the uterus or into the cavity of the uterus. They might look like mushrooms. These are called pedunculated (pih-DUHN-kyoo-lay-ted) fibroids.

What are the symptoms of fibroids?
Most fibroids do not cause any symptoms, but some women with fibroids can have:
heavy bleeding (which can be heavy enough to cause anemia or painful periods
feeling of fullness in the pelvic area (lower stomach area)
enlargement of the lower abdomen
frequent urination
pain during sex
lower back pain
complications during pregnancy and labor, including a six-time greater risk of cesarean section
reproductive problems, such as infertility, which is very rare.

What causes fibroids?No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors could be:
hormonal (affected by estrogen and progesterone levels)
genetic (runs in families)
Because no one knows for sure what causes fibroids, we also don't know what causes them to grow or shrink. We do know that they are under hormonal control—both estrogen and progesterone. They grow rapidly during pregnancy, when hormone levels are high. They shrink when anti-hormone medication is used. They also stop growing or shrink once a woman reaches menopause.

Can fibroids turn into cancer?
Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma (leye-oh-meye-oh-sar-KOH-muh). Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus.

What if I become pregnant and have fibroids?Women who have fibroids are more likely to have problems during pregnancy and delivery. This doesn't mean there will be problems. Most women with fibroids have normal pregnancies. The most common problems seen in women with fibroids are:
Cesarean section. The risk of needing a c-section is six times greater for women with fibroids.
Baby is breech. The baby is not positioned well for vaginal delivery.
Labor fails to progress.
Placental abruption. The placenta breaks away from the wall of the uterus before delivery. When this happens, the fetus does not get enough oxygen.
Preterm delivery.Talk to your obstetrician if you have fibroids and become pregnant. All obstetricians have experience dealing with fibroids and pregnancy. Most women who have fibroids and become pregnant do not need to see an OB who deals with high-risk pregnancies.

How do I know for sure that I have fibroids?Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your uterus, ovaries, and vagina. The doctor can feel the fibroid with her or his fingers during an ordinary pelvic exam, as a (usually painless) lump or mass on the uterus. Often, a doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 16 weeks pregnant. Or the fibroid might be compared to fruits, nuts, or a ball, such as a grape or an orange, an acorn or a walnut, or a golf ball or a volleyball.

Your doctor can do imaging tests to confirm that you have fibroids. These are tests that create a "picture" of the inside of your body without surgery. These tests might include:
Ultrasound - uses sound waves to produce the picture. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to make the picture.
Magnetic Resonance Imaging (MRI) - uses magnets and radio waves to produce the picture
X-rays - uses a form of radiation to see into the body and produce the picture
Cat Scan (CT) - takes many X-ray pictures of the body from different angles for a more complete image
Hysterosalpingogram (hiss-tur-oh-sal-PIN-juh-gram) (HSG) or sonohysterogram (soh-noh-HISS-tur-oh-gram)—An HSG involves injecting x-ray dye into the uterus and taking x-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures.

You might also need surgery to know for sure if you have fibroids. There are two types of surgery to do this:
Laparoscopy (lap-ar-OSS-koh-pee) - The doctor inserts a long, thin scope into a tiny incision made in or near the navel. The scope has a bright light and a camera. This allows the doctor to view the uterus and other organs on a monitor during the procedure. Pictures also can be made.
Hysteroscopy (hiss-tur-OSS-koh-pee) - The doctor passes a long, thin scope with a light through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for fibroids and other problems, such as polyps. A camera also can be used with the scope.

What questions should I ask my doctor if I have fibroids?
How many fibroids do I have?
What size is my fibroid(s)?
Where is my fibroid(s) located (outer surface, inner surface, or in the wall of the uterus)?
Can I expect the fibroid(s) to grow larger?
How rapidly have they grown (if they were known about already)?
How will I know if the fibroid(s) is growing larger?
What problems can the fibroid(s) cause?
What tests or imaging studies are best for keeping track of the growth of my fibroids?
What are my treatment options if my fibroid(s) becomes a problem?
What are your views on treating fibroids with a hysterectomy versus other types of treatments?
A second opinion is always a good idea if your doctor has not answered your questions completely or does not seem to be meeting your needs.

How are fibroids treated?Most women with fibroids do not have any symptoms. For women who do have symptoms, there are treatments that can help. Talk with your doctor about the best way to treat your fibroids. She or he will consider many things before helping you choose a treatment. Some of these things include:
whether or not you are having symptoms from the fibroids
if you might want to become pregnant in the future
the size of the fibroids
the location of the fibroids
your age and how close to menopause you might be

If you have fibroids but do not have any symptoms, you may not need treatment. Your doctor

will check during your regular exams to see if they have grown.

Medications

If you have fibroids and have mild symptoms, your doctor may suggest taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.

Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Low-dose birth control pills do not make fibroids grow and can help control heavy bleeding. The same is true of progesterone-like injections (e.g., Depo-Provera®). An IUD (intrauterine device) called Mirena® contains a small amount of progesterone-like medication, which can be used to control heavy bleeding as well as for birth control.

Other drugs used to treat fibroids are "gonadotropin releasing hormone agonists" (GnRHa). The one most commonly used is Lupron®. These drugs, given by injection, nasal spray, or implanted, can shrink your fibroids. Sometimes they are used before surgery to make fibroids easier to remove. Side effects of GnRHas can include hot flashes, depression, not being able to sleep, decreased sex drive, and joint pain. Most women tolerate GnRHas quite well. Most women do not get a period when taking GnRHas. This can be a big relief to women who have heavy bleeding. It also allows women with anemia to recover to a normal blood count. GnRHas can cause bone thinning, so their use is generally limited to six months or less. These drugs also are very expensive, and some insurance companies will cover only some or none of the cost. GnRHas offer temporary relief from the symptoms of fibroids; once you stop taking the drugs, the fibroids often grow back quickly.

Surgery

If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
Myomectomy (meye-oh-MEK-tuh-mee) - surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver. Myomectomy can be performed in many ways. It can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy.

The type of surgery that can be done depends on the type, size, and location of the fibroids. After myomectomy new fibroids can grow and cause trouble later. All of the possible risks of surgery are true for myomectomy. The risks depend on how extensive the surgery is.

Hysterectomy (hiss-tur-EK-tuh-mee) - surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. Fibroids are the most common reason that hysterectomy is performed. This surgery is used when a woman's fibroids are large, if she has heavy bleeding, is either near or past menopause, or does not want children. If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the doctor may be able to reach the uterus through the vagina, instead of making a cut in the abdomen. In some cases hysterectomy can be performed through the laparoscope. Removal of the ovaries and the cervix at the time of hysterectomy is usually optional. Women whose ovaries are not removed do not go into menopause at the time of hysterectomy. Hysterectomy is a major surgery. Although hysterectomy is usually quite safe, it does carry a significant risk of complications. Recovery from hysterectomy usually takes several weeks.

Endometrial Ablation (en-doh-MEE-tree-uhl uh-BLAY-shuhn) - the lining of the uterus is removed or destroyed to control very heavy bleeding. This can be done with laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. This procedure usually is considered minor surgery. It can be done on an outpatient basis or even in a doctor's office. Complications can occur, but are uncommon with most of the methods. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About three in 10 women have much lighter bleeding. But, a woman cannot have children after this surgery.

Myolysis (meye-OL-uh-siss) - A needle is inserted into the fibroids, usually guided by laparoscopy, and electric current or freezing is used to destroy the fibroids.
Uterine Fibroid Embolization (UFE), or Uterine Artery Embolization (UAE) - A thin tube is thread into the blood vessels that supply blood to the fibroid. Then, tiny plastic or gel particles are injected into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. UFE can be an outpatient or inpatient procedure. Complications, including early menopause, are uncommon but can occur. Studies suggest fibroids are not likely to grow back after UFE, but more long-term research is needed. Not all fibroids can be treated with UFE. The best candidates for UFE are women who:
have fibroids that are causing heavy bleeding
have fibroids that are causing pain or pressing on the bladder or rectum
don't want to have a hysterectomy
don't want to have children in the future

Are other treatments being developed for uterine fibroids?Yes. Researchers are looking into other ways to treat uterine fibroids. The following methods are not yet standard treatments; so your doctor may not offer them or health insurance may not cover them.

MRI-guided ultrasound surgery shrinks fibroids using a high-intensity ultrasound beam. The MRI scanner helps the doctor locate the fibroid, and the ultrasound sends out very hot sound waves to destroy the fibroid. The ExAblate® 2000 System is a medical device that uses this method to destroy uterine fibroids.

Some health care providers use lasers to remove a fibroid or to cut off the blood supply to the fibroid, making it shrink.

Mifepristone®, and other anti-hormonal drugs being developed, could provide symptom relief without bone-thinning side effects. These are promising treatments, but none are yet available or FDA approved. Other medications are being studied for treatment of fibroids.

Dominant Follicle in Ovaries

Roughly a week before the midpoint of the menstrual cycle the dominant follicle develops in one of the two ovaries. This grows faster than the other tertiary follicles and prepares itself for ovulation. It reaches a diameter of up to 25 mm and is also known then as the graafian follicle.

A dominant follicle just means that it is not quite big enough to call it a cyst. You can have a dominant follicle if you are still in the reproductive ages. A lot of women have these on their ovaries.

Health Screening at Tung Shin Hospital

After having done some price comparison and research on the type of health screening available at private hospitals, I have finally chosen Tung Shin Hospital in Jalan Pudu, Kuala Lumpur.

Comparison with other private hospitals
Tung Shin Hospital - Comprehensive Health Screening Package

Physical Examination by physician Hearing & eyesight test/ Resting ECG / Chest X-ray / Ultrasound Abdomen & Pelvis / Stress test / Lung function test / lab profile 44 tests:(Haematology Profile / Fasting Blood Sugar / Renal Profile / Liver Function Test / Lipid Profile / Diabetic / Thyroid / Hepatitis B Screening / Urine Analysis / Blood Grouping / Venereal Disease (STD) / Tumor Markers for CEA & AFP) / Medical Report / report interpretation by specialist

Cost: RM630 (senior citizen), RM665 (public)
Sunway Hospital - Platinum PackageSame as above with additional diet counselling but minus the stress test and 2 tumour markers

Cost: RM799 (all)

I called the specialist clinic to make an appointment a day before going. We were then advised to fast at least 10 hours before the health screening process.

The next morning, after dropping off Ian at his kindy, off we went to Tung Shin Hospital. We reached the hospital around 9am and I took the Intermediate package with breast ultrasound and pap smear added in (total cost) while Papa took the comprehensive package with a PSA test added (total cost).

A friendly Malay nurse brought us to a room where our weight and height were taken and we were then asked to lie on the bed with all wires were hooked up to our chest for ECG.

We then went to see the physician, Dr Kwan Eng Keong for physical examination, we had our eyesight tested and Dr Kwan checked my blood pressure and found that my bp was a bit on the high side, same with papa. We were then asked to lie on the bed to check on our sensivity toward the hammer knocked on our knee and ankles. I was sent down to the X-Ray Department to have my chest x-ray and ultrasound on my breast, abdomen and pelvic while papa was having his stress test on the 1st floor. I was asked to change into a blue loose gown to facilitate the chest x-ray scan and was given a basket for keeping of my blouse and belongings. I was then sent to a dim lit room with the ultrasound machine just next to the bed, I lied on the bed while waiting for the radiologist, Datin Dr Ranjit Kaur to do the scan. A transparent gel was applied over my breasts down to the pelvic area and Dr Ranjit tole me there was no lumps found on both my breasts and they appeared normal.

My liver, spleen, gallbladder, blader were all normal except she found 5 fibroids in my uterus, especially the one at my posterial wall, it was as big as an orange. She assured me there was nothing to be concerned about as very rarely the fibroids would turn maglinant and most of them would disappear after menopausal. She advise me to have a pelvic scan at least once a year to monitor if there is a growth in size of the fibroids.

I then went to 6th floor to get my blood and urine samples done. I was a breeze and painless when the nurse took my blood. I would have to go back to 1st floor for Pap Smear to complete the whole health screening process.

It took a while before I was attended by a lady Indian doctor as they had an emergency case prior to that. It took a mere 5 minutes for the doctor to take some sample out from my vagina for the test.

Not long after I have completed, papa walked out from the X-ray department and he told me that the radiologist, Dr Kaur told him that there was some water trapped inside the stomach. I was doubtful though not very sure if an ultrasound could ever get through any gas or air let alone the stomach. Papa was very concerned about stomach as he has been having stomach discomfort ever since he can remember.

It was 12.45pm when we completed the whole process. We then looked for the canteen in the hospital and had mixed rice there. We paid RM11.00 for two plates of mixed rice and two cups of hot drinks, reasonably priced I would say that.