Wednesday 22 June 2016

A Family Medical Emergency

You realise just how fragile life is when a loved one who just a week ago seemed healthy and full of life is suddenly in ICU having just undergone an Aneursym Embolisation procedure. In simple terms, an "Interventional Radiologist guides a long tube called a catheter through a small incision in the groin up to the location of the aneurysm. Through the catheter, the radiologist places many soft platinum coils into the aneurysm. The coils are extremely small and soft. The body develops a blood clot around the coils. The packed coils and the blood clot effectively prevent blood from entering the aneurysm, essentially eliminating the risk of the aneurysm rupturing." (This is an excerpt from http://www.riainvision.com/)


A picture of what endovascular coiling looks like. Taken from www.brainaneurysm.com 


Yeah, my sister has a brain aneurysm! I kind of know what it is but really don't know exactly what it is. I knew that it had something to do with vessels in the brain and the horrors stories of people dying within minutes of a ruptured aneurysms came to mind. Since then I felt the driving need to really understand what it is and how my sister could come out of it alive and well.

Typing "aneurysm" into Google yielded 9.2 million hits. I just clicked on the first hit which was WebMd and they had a topic overview that was very helpful for a non-medical person like me. Copying a small the excerpt from the article:-

What is a brain aneurysm?

brain (cerebral) aneurysm is a bulging, weak area in the wall of an artery that supplies blood to the brain. In most cases, a brain aneurysmcauses no symptoms and goes unnoticed. In rare cases, the brain aneurysm ruptures, releasing blood into the skull and causing a stroke.
When a brain aneurysm ruptures, the result is called a subarachnoid hemorrhage. Depending on the severity of the hemorrhage, brain damage or death may result.

You can read the full Topic Overview here.

This just happened last Thursday, my sister was on a scuba diving holiday with her family in Redang Island. For as long as I can remember she always had incidences of bad migraines causing her to become nauseous and vomit. But she would always feel better after some vomiting, downing some pain medication and going off to sleep. Little did we know that it was an indication of bigger things happening in her brain. Two days prior she was experiencing excruciating migraines that would not go away and caused her extreme discomfort and nausea. They were actually due to come home to KL that day but my brother-in-law found her slumped in the toilet. She had blacked out and on the way down she must have fell face first on her right side, as she had a terrible black eye, swelling and bruises on her face and all along her cheeks and chin. She also had petechiae all over her face and neck.

They then quickly called the doctor from the neighbouring resort and he immediately recommended that she be transferred to the Kuala Terrenganu Hospital as soon as possible. A speedboat was then arranged to transport her to the mainland and then by ambulance to the hospital. They did some test and found that there is bleeding in the subarachnoid space and most probably would require surgery. They did a CT scan and a angiogram. They found the aneurysm but thankfully it was not actively bleeding. However, the risk of a potential rupture was imminent. As with all aneurysms, it is a ticking time bomb that could go off at anytime causing irreversible damage!!

A cerebral angiogram was needed but they didn't have the necessary equipment in Kuala Terengganu. Hence, the doctor wrote out the transfer to KL General Hospital at about 4 in the afternoon. Unfortunately my brother in law was then informed that they would only be able to do the transfer at 8 pm due to the fact it was the fasting month and they had to break their fast at 7 something in the evening. It was really a shock and inconceivable that a life of a person was worth less than someone breaking their fast and getting something to eat. It really begs the question, could they not break their fast on the way? Surely our newly built fantastic and equipped highway could provide a place and food for them to appropriately break their fast during this holy month of Ramadan. Ironically, the virtues were just not seen at all...They waited from 4 pm till 8 pm and when nothing happened my brother-in-law had to go once again to ask if the transfer was happening and he was then told, that the people still had not completed their meal and would be back soon. The possible rescheduled timing was 9 pm. Once again more delays and what was worse, they could not even be bothered to inform anyone about the change of time. You could just be sitting there waiting for nothing! At 9 pm, my brother-in-law had to once again ask the nurses whether the transfer was happening or not only to receive the answer yes, BUT there are some paperwork that they had to completed before they go. The level of harebrained kooky competency was just staggering! This could have been done well before the transfer time! As it is, the transfer was already delay by one hour from the initial 8 pm timing. They could have asked for all this to be done when my brother-in-law first approached them at 8 pm! Of course this caused a further 45 minutes delay and it was about 9.45 pm when they left Kuala Terengganu. Can you imagine? First of all, the patient just sitting through 5.5 hours of pain and the unknown...just waiting..waiting...the anxiety and dread of every minute that passed for family members praying that the aneurysm not rupture...watching helplessly as she suffer the increasing pain in her head and neck due to the increasing pressure in her brain...It is incredible how some human beings can have so little compassion and empathy for another human being who is suffering and so much selfishness of "wanting to eat"...

The ambulance reached Kuala Lumpur at around 3 am and went straight to the ER. Once again in the usual crap of Malaysia hospital bureaucracy and the seemingly "tidak apa" (can't be bothered) attitude of "I have already seen so many people in worse conditions or dead" my sister was made to wait a mere 2 hours just to get a short of pain meds to help with the increasing pain that she was experiencing. What was worse, the people in the ER didn't see it fit to inform the receiving doctor that the patient had arrived. It was really frustrating and its making us angry. Another 11 hours later, they then wheeled her in to get the much needed cerebral angiogram. As my brother-in-law and sister are both physicians, we were very fortunate that they knew fellow doctors and surgeons at all levels to help speak to the appropriate people and discuss possible options.


This is a snapshot of her aneurysm

In our desperation, we started to look at options in private healthcare particularly in Subang Jaya Medical Centre (SJMC) as someone had recommended a good Interventional Radiologist who is practicing there.  We hit another road block, do you know that is next to impossible to get the medical records, results of tests and whatever scans or x-rays that you have taken? We went on a bootless errand trying to procure the images and CD for a 2nd opinion, only to be told finally that we had to go to the medical records department to fill in a form, pay a sum of money and WAIT! I nearly strangled the doctor I was talking to and snapped back at him saying...wait for her aneurysm to burst? I then calmed down a little and ask where is the location of the medical records department so that I could apply to get the things that I needed? Take a guess what his answer was....of course! The famous "I DON'T KNOW." We needed the CT scan and angiogram CD for the consult.

But God is always in control and has the best plan for us. The short of the long story was that the doctors in the private sector had to assemble their own teams. In this case apart from the Interventional Radiologist, there was also the Neuro Surgery team (in case anything went wrong) and it would take some more time that we didn't have. So we decided to stay on in KLGH and wait for Dr Lau who was coming back from a convention in Singapore who could do the procedure. Lo and behold, he was actually her classmate back in medical school! The surgery was scheduled for Saturday afternoon. She was wheeled in at about 2 pm and it was successfully completed at 2.45 pm. 7 coils were inserted.

He is such a wonderful doctor as he treats all of his patients like his family. He was an extremely humble and down to earth person. Can you imagine that after the procedure he actually went to my brother-in-law and said "thank you for the opportunity to serve you and your family" What an incredible person! People like him really restores your faith in government healthcare!

At this time of writing, I am glad to say that she spent about 3 days in ICU and now been transferred to the ward to recuperate. She is able to walk and move about albeit slowly and carefully. The pain in her head has also reduced significantly.

We are so grateful for God's mercy and love shown to us through so many people who prayed in vigil with us for her healing and recovery. It was indeed a miracle how she condition did not deteriorate into something worse. The aneurysm was on one of the main arteries in her brain and God preserved her life. It was also a miracle how fast all the arrangements were made for her surgery.




I pray a blessing on Dr Lau and his family. Thank you for restoring our faith in the public health care system and thank you for saving my family. 

My last thoughts was of course on how much this procedure would have cost my sister if it happened to her in the US. I also thought about the potential cost we would have incurred had we transferred to SJMC. The indications of it going into the hundred thousands of dollars was actually not a far off estimation. I am so thankful that we were saved from huge medical bills which would have made life that much more strenuous.

I am very thankful that we have public healthcare in Malaysia. It may not be perfect, but when it works, it really works. The other thing that I have come to appreciate is insurance. Medical and travel insurance is definitely a must! Anything can happen at anytime, This incident has really lit a bulb and I am now going to re-look at our coverage for our family.

Thank you once again everyone who prayed in vigil with us, helped in so many ways and made thing just a little easier.


Have you or any of your family member gone through the same thing? Do share your stories, I would love to connect with you. My sister has some way to go to complete recovery.


Tuesday 7 June 2016

My Confinement Stay Review (Part 2) - Location & Facilities

DISCLAIMER: Please do note that this is my personal experience. I understand that everyone has different expectations and therefore different experiences. Please do ensure that you do your own due diligence. Please visit the center and ask the questions which are important to you. I am happy to share if anyone has specific questions. Please do connect with me on themummynotebook@gmail.com



This is my second installment in sharing about my stay at Yuan Yuan Confinement Retreat Centre for my one month confinement after the birth of our little Murtabak. I decided to break this review down to bite size posts so that I could cover my stay in different parts as I have been getting requests/emails and comments from my blog readers on specific areas.

Location

One of the biggest push factor for us when we decided to confirm on Yuan Yuan was the proximity to our home. When I was in confinement with Chapati at my parents home, the traveling really wore Hubby out. Mind you my parents home is really not that far away and it was still difficult. The incredible ease of  getting to and fro our home and the confinement centre was just such a huge plus point!

  1. Less tiring for Hubby who was working as he didn't need to travel out of his way to come and visit me everyday. The confinement centre is in between our home and our parent's place. So early in the morning, he could literally drop by to say hello before continuing on to drop Chapati off for the day and same for evening when it's time to take Chapati home.
  2. I could go home for the KKIA home visits and not have to go through the hassle of registering in another KKIA. This is because when you get health services from them, it based on your location. I would have had to register again at a different KKIA if I wanted them to visit me at the centre.
  3. I could visit home at anytime that I felt homesick! 
  4. I could also visit our other "kids" namely Kape, Skippy & Christmas and Hubby could also ensure that they get fed and loved in a timely manner.
  5. It was easily eaccessible to our parents who wanted to visit their precious grandson!

Facilities

Ground Floor

The center itself is relatively new, well kept, neat and tidy. when you first enter, it open up to a spacious living room with ample sofa seating, a TV and a PC. You can entertain your guest here of if you choose to spend some time out of your room, you can watch TV/Astro or surf the internet here. Just after the living area is a simple dining area that you can also meet with your visitors or eat your meals if you prefer communal dining with other mummies.  Beyond that is the kitchen and the baby nursery.

The kitchen is generally off limits for parents and guests whilst only the parents could go into the nursery . This is quite understandable as the staff would need to be able to work and cook freely without outside people getting in the way. As for the nursery I thought that it was a good policy because new born babies are very delicate and sensitive . It is important to limit their contact with outside people as your never know if the person is unwell and might just pass on a bug to your baby. Anyway the staff on duty were more than happy to carry out baby to Mummy or our guests. The nursery has an attached bathroom for the staff to bathe and clean the baby everyday.

I only wished that the flooring could be less slippery. Whilst the tiles were beautiful, it wasn't very practical. It got even worse when they mopped the floor and the water made it really slippery. Half the time I thought that I was going to fall down at anytime and the other half was worrying about the staff falling down whilst carrying my baby! They were very considerate in providing mothers with a pair of slippers to navigate the slippery floors better.



As you can see ample seating space for lots of people. That's my little murtabak!



Chapati is always glued to the computer when he comes over because they always have youtube playing children's programs. That's Isaiah the owner's son (cute little fella) 




I would sometimes eat downstairs when I want a change of scenery. It was fun because I got to talk to other people rather than just eat on my own.

The kitchen is pretty spacious.


The nursery overview. They had special baby cot beds like in the hospital. Very safe and practical


The Good: 
Spacious living area  
Computer for internet surfing 
Alternate dining area 
Full facility nursery
They provide slippers to mummies

The Bad: 
 Extremely slippery floor.

Tip:
Bring your own slippers if you want to be more comfortable.
Don't wear socks or go barefooted without slippers

First Floor

All the rooms for the Mummies to stay are on the 1st Floor. I had the opportunity to experience both the sharing room and the single room.

Sharing Room

This was the room that I had initially booked and when I checked into the center 5 days after coming out from hospital, it was really pleasant, bright, airy and spacious. It had floor to ceiling windows facing an open field and a lot of natural lighting.  I literally didn't need to leave the room at all because it had a TV with Astro channels, a dining table with chairs where you could eat all your meals and a large attached bathroom. This was so ideal for me because after my delivery, I experience very severe lower back pain and pain in my legs radiating all the way done to my foot. I could hardly walk so I didn't leave the room for 5 whole days.

However when I stayed in the sharing room there was only one other mummy there. If it was full house, I think it might not be as comfortable as the room is supposed to fit 4 mummies. You could see that three beds were properly planned whilst the 4th one was just a bed that was pushed in at the last minute. They also had curtains separating the 3 beds except for the 4th one which is at the other end of the room. That bed is the worst as people coming through the door would see that bed first.


My bed when I first checked in. A nice side table with drawers to put your personal things



Attached toilet and shower, dining table with chairs and a central laundry basket



It was great that there was space to entertain visitors and we even managed to celebrate Chapati's birthday with a little cake for him. His birthday only 6 days away from his baby brother!

The Good:
Spacious open area with dining table 
A lot of natural lighting during the day (you don't even need to turn on the room lights)
Flat screen TV with lots of ASTRO channels
 
The Bad:
Not enough privacy screens - only 2 available whilst there are 4 beds.
The 4th bed on the other side of the room has no privacy at all. They really need to either buy more privacy screens or put up a curtain like the other beds. 
Shared laundry basket - If you are particular about your clothes then this might be an issue
The staff don't know whose laundry belongs to whom so you have to check and make sure that all your clothes are there. I saw a lot of laundry that were left behind by other mummies who forgot what clothes they have brought with them.
I personally left my beautiful mickey mouse laundry net that was given to me as a gift from a friend who went to Tokyo Disneyland. Sniff... :( 
No specific laundry system, ie. where they put the washed laundry for people to check. Sometimes they put it upstairs, some times downstairs...etc.

Tip:
Bring your own laundry basket and washing nets for intimate items or other delicate items. 
Check all the places that they put the washed laundry to ensure that you don't leave anything behind


Single VIP Room

After about one week , I had the opportunity to stay in the VIP room. There are two VIP rooms and one Deluxe room in the center. The VIP rooms have a window and an attached toilet, whilst the Deluxe room shares the Sharing Room toilets.

Honestly comparing the Sharing Room and the Single room I felt that the Sharing Room seemed more comfortable because of the size and natural lighting. 

However after a day or two of staying in the single room, I could really appreciate the larger bed size (Queen) and the added privacy. My hubby and Chapati could some over at any time and if they were tired could also sleep there as the bed was a queen size.

Eating in there was a bit depressing as they had a small table facing the window which looked out to the house behind. So I choose to eat in the Shared room dining table or downstairs dining table. I would only eat my tea or supper in there. 

The Good:
A lot of cupboard space to organise your things
There is a comfortable armchair in the room for breastfeeding or if you felt like watching TV but not sit on the bed.
Private toilet and shower (No worries if you decide to walk around naked! :) 
Flat screen TV with ASTRO channels

The Bad:
 A small desk/table facing the back of the house behind to eat your meals at.


The Toilets and Shower

In general the toilets were pretty good with basic facilities and had a shower area, toilet and sink. The provide you with toilet paper but all other toiletries you will have to bring your own which I felt was ok because everyone has their own preference for soap, toothpaste...etc.

However, there was one thing that was very strange, they provide salt and hot water for a Sitz Bath for mummies who went through a normal vaginal delivery but don't have a plastic container for you to actually take a Sitz Bath???!! Yes very strange indeed, so I had to ask my mother to bring me a shallow round container for me to use whilst I was there. Probably a hygiene issue? 

If you are interested in preparing one for yourself at home, you can read up all about Sitz Bath through this link here at Healthline.

Watch out for my 3rd and 4th posting which will be about the food and how they care for the mummies and babies there!



Update: 30th December 2016

The center has been rebranded to Culture Romance Confinement Retreat Center. You can reach them on their Facebook page at @cultureromance