Me and My Wegener Granulomatosis Continue Part 2, Into 2010 and beyond !

Me and My Wegener Granulomatosis Continue Part 2,

 Into 2010 and beyond !

The purpose of the below story is to tell our friends in the medical world of

 This is also the continuation of the real life happening, the below 2 chapters were from the first story,

Is this that I am born with Wegener?  

            I am also very kiasu since young. I am hyper active so I am very poor in my study. So since I left school, I had a fear of failure, because I failed all over the schooling years. So I began to challenge each time something that people are struggling to do. So from 1976, after I left the army without an occupation, unlike the rest of my friends, I set my mind that if you can do, I will be better. So since the mid 70’s I cannot fail in what I set to do, this became my life motto. Then eventually, I was working for a top multi national, and of the 30 plus years with this single company, I did not miss a single target until the day I left.   Is this that Wegener is cultivated?

            The origin of this Wegener Granulomatosis is relatively unknown, so is the relapse. I hope to post this up so that medical student is aware of this disease and can take a more cautious approach. Hopefully with the current technology, Singapore can run the c ANCA and PR3 twice a week instead of once a week. Also liberate this test. I find testing will be at least a thousand times cheaper to test for the WG than having an infusion to repair the damage it caused. Dentist, ENT and Urology guys will also have to watch out for signs. We can dig some more of such patient out from those that might have WG hiding somewhere. I to now still very strongly believed that there are sure more people with WG that we can think of. The only thing is not many can or lucky enough to last to tell a story. They may just be waiting for a flare up. He or she might just go away to another world after being diagnosed for some thing else. By the way, actually are there any existing patients in Singapore now?

Ending so far.. Dec18 2009

Now , Let continue  into the year 2010

Dec 2009

Steroid : 60mg

CRP : 16.4

Days come days go without one that do not have headache. I am still on Steroid of 60mg, look like this coming half year, I will be mentioning more of the usage of steroid. Now is Dec 19 2009, and blood is still found in the nose, though smell does improves. The high dose of steroid is also causing blood in stool, and it was pretty bad. The pain in the bladder is subsiding, though I am still waking up every 1.5 hours to relieve, it is due to the damaged bladder. Now I have to take 100mg of Cytophosamate, which is far lesser than required of 200 mg per day. This is real poison, it does knocked me out suddenly in the afternoon, iinstant knock in the beginning two weeks of taking the cytophosamate..

The headache is still pretty bad, it started at around 3.30 am, and will last till 8.30 am. Unless I find something strenuous to do, the pain can last till noon, when the morning intake of steroid take stronger into effect. The nerve that was affected in the last relapse in November, does not seems to heal, till now, the left leg, left face and left hand is still numb, as well as the right tigh. As for the steroid, which help to subsidise me to the producing of Cortisol, is a very taxing drug. It will destroy my muscle and bones too. However, If I do not have the steroid, I would definitely go into another relapse.

Jan 2010

Steroid: 45mg

CRP : 0.8

January, headache is still bad, starting  from 3am, my worry is whether this could become a  permanent nature. This month is a visitor month. On Jan 07, Mr. Eric Chow, the great grand old man visited me. I met him in Yoke Hotel, and we had breakfast at the hotel. He seems grown old after a year we did not meet. I also found that my false teeth cannot fit at all, due to the disappearance of my gum, I had to make a new set , however it was pretty cheap, the upper and lower cost me $320 only. This came from a no brand maker at Ghim Moh. Now, I began to have more exercise, basically to take off my headache, usually starting off at 5.15 am. Then on Jan 13, Ivan came from Britain, we had coffee at his hotel in Parkway.

For a week now, there is no blood found in the nose, as the exercise proceeded, I found that I had the speed, but does not have the power. I can jog pretty fast, but up slope, I just have a lot of difficulties. Came Jan 15^th, Harry, Khiang, Hock Joo, Siem and Huang, we visited Pengerrang again. This time on returning, I was knocked out and slept the whole day on 17^th.

On Jan 20^th, after visiting the doctor, this time, steroid from 60 reduced to 45mg per day. Though there was no blood in the nose, my tongue is whitish in colour. Next day Ganesan from JIT India came for a visited as requested by me. We normally find a way to reward our guys in whatever form. I brought him and his friend to lunch, and the zoo. We also went to the Merlion the following day.  Now my running has improved to 1000 meter per day, and I do not find the tiredness at all. It is only at three to four days later that I will be suddenly knocked out again. Jan 25^th is also the second month out of hospital for the relapse and my headache is beginning to improve. So on Jan 30^th , I have the mood to make some Chinese New Year biscuit, Lotus Biscuit.

Feb 2010

Steriod :45mg

CRP: 15.3

PR3 : NEGATIVE !!!!

The month of Chinese New Year! On Feb 3^rd, I had the mood to make some Achara for the new year. Today, my steroid intake is now reduced to 40mg. I do not know why, but once the steroid is going downwards, on Feb 7 to 8^th, I had another total breakdown, so tired that I had to sleep the whole three days. Feb 6, I went to Toa Payoh to meet Bernard Loh at Burger king, we had coffee. There. Bernard also visited me on 17^th  with his wife, this time round his visit was longer than usual. After 8^th, I only to woke up on the 9^th that I find that I had piles. I believed that this is the side effect that I expected during my November relapse. Luckily, I asked Ricky for help, and he gave me his medicine, which was both expensive and effective. After several doses I was cured. It was during the pre relapse time when the urinating agony that put a lot of pressure on the whole body system, which caused the piles. Then , I also feared the pressure could even forced the whole rectum out of the body, no joke.  Feb 10^th, I went to NanAn temple to pray to Granny and Grandpa for the coming new year. Unlike other year, we used to pray in the eve of new year, but this year, we did it earlier, basically due to the time constrain on each new year eve.

As New Year approaches, most of the people working oversea began to return, so on Feb 11, I went to Hougang Street 91 , and had coffee with Steven Lim and Royce. After coffee, I went to ride my bike back, unfortunately, the back wheel rode up against a loose stone, and the whole bike fell. I was shell shocked, pulling my leg away, fearing that if ever the bike fall on my left leg, I think it would be like biscuit being crush by a motar. Luckily, I can up from the fall with some bruises on my left wrist. I was not able to lift up the bike, too weak to, only waiting for a few minutes to ask a passer by rider to help me.

            The next day on Feb 13, I meet Danny, Sebastian and Ricky for dinner of simple noodle soup at Holland village. What a surprise, the next day, Asiah Abdullah and her husband visit me without notice. I was really very happy, the last time we saw each other was in 1994, while working in Toa Payoh. She brought me some special peanut biscuit with stralberrry jelly coating cake and a lot of fruits. Feb 14^th, today is Chinese New Year, after visiting mother in law, I went to Ponggol, and from then I stayed home the whole of next two days till Feb 17, after my blood test, I meet Steven Lim for coffee again in Whampo. When I returned, Fandi and Sumini called.  The next day I went with Ricky for Mee Rebus lunch. I returned to give a call to Fausiah.

            On Feb 19, Ravindran and his family visited me, sure he was shock to see me in such a state. Then the next day, to my biggest surprise, a huge group of ex Getaper Malay colleague visited me. For this I call KC, and he and his family came too. They were Fausiah, Sumini, Halimah, Siti and Ranjit, all organized by Asiah They brought along a lot of biscuit, fruit juice and fruits. All of  them look the same as 15 to 20 years ago, but added some weight. The one with the most change was Ranjit Kuar, who had changed from a conservative girl to a modern girl. We had almost two over hours of happy getting together chit chat. On that night, Edward Chia of Qualitek came to visit, only to leave at almost mid night. This was one of the few months that so many visitors came in a week.

            On Feb 21, I went to Harry house, I did not feel that good, only to return and slept for the next three days. It is just weak and tired. Come Feb 24, I went TTSH to see doctor again, This time, there is a piece of good news for the past one year. The PR3 test indicated that it is below 20, which means it is in remittance. Imagine, I do not have active Wegener now! So under doctor advice, my steroid was to drop to 35mg the next day onwards.

            Feb 28, the last day of the month, was also the last day of Chinese New Year. I woke up finding myself being very moody. After waking up, I went 205F Ponggol and had almost nothing to do except pruning the guava tree. I decided to go for a tea break, and had fried dough. Then I bought a packet of glutinious rice flour and made a whole pot of rice balls. So I pack a packet of it thinking of going back to 205F to give to Florence. Too bad, I had no good memory now, this morning, I left my bike on with headlight on, and now the battery is flat. For today is Yuan Xiao, the last day of gathering so I contacted Edmund, and he said he is busy with his office, while Elena said it is ok to go out for dinner together..

            So the dinner was in Hougang Mall, The Soup restuarant. Her friend Tong Guan was with us, and in the midst of the dinner, I saw her arguing over the phone with Edmund, this upset me, only a brother and sister each and arguing all the while. I told her, why she was arguing and for the last month, she did not do a few things I request form her. For a while my mood turn so bad that I banged down the chopstick . I went off, not completing a supposed to be nice dinner together. I was supposed to get them together as I had a few words for them, but did not make it. I left and walked all the way home, rode my bike out and return around 8.pm. 8.45pm, Edmund came, with his mother advise, they took the rice ball soup and left quietly. Today is also the day I reduced my steroid by 3.5 mg to 32.5 mg. I was trying to see if I can forgo the night steroid intake. I noticed that once I reduced the steroid input, it affected and changes both my mood and health.   

Mar 2010

Steriod : 35mg

CRP : 2.0

        Pain in the chest is now on the subside, to 4am from the usual 3am, a little improvement. Now  I suspected chest pain due to over stress in chopping guava tree. I called doctor Tan about the pain, he told me wait another week to monitor. Mar05, I caught a bird with mouse trap, the trap was placed 2-3 day ago. The nice part was that a cat was waiting anxiously beside the cage for a free lunch. In the afternoon I went to Elena birthday party at the yoke Hotel Simple party, with all the cousins. It is good to see them together..

On Mar 09, steroid was further reduced to 30mg per day. Each day passed I became more and more restless, so on Mar 13rd, I went to Sungei Buroh, got lost and walk like hell for almost 3 hours.  I knew I was weak, but I had to struggle through as a form of exercise. Mar15th , I went Pubin, I met Khim, his sister and Ah Hoot, this is the beginning of my more frequent trip there. I went there another 2 times this month, each time, I rent a van at $10 per trip, very expensive for the 20 minutes journey if I can ride by bicycle. However, I was not familiar with the route, as well as I do not have the strength to do so too. For the next trip onwards, I stay overnight and return on the next day. By March 29^th, steroid was dropped to 20 mg per day, and cytophosamite intake is now increased to 100 mg except Tuesday and Thursday which is 50mg per day.

Apr 2010

Steriod : 20mg

CRP : As March

        Today, I am in Pulau Ubin, and the steroid is now at 20mg, this night I went fishing with Khim. We had 3 nets, two made by me and one by him. Surprisingly, I still make net as fast as they can, and ended with better catch as compared with theirs.  With us was also his friend Boon How. We caught few fishes only. That night, chest pain was pretty bad, just like a tonne of rock place on the upper lung. The next day, I returned early, and went to pray to mum and dad. Again on April 5^th, I had bad chest pain again. Is dropping from 30 to 20 mg of steroid by 33% too fast a drop? Only later that is proven to be. Next day, chest pain started at 2.30 am. I was in Ubin then, and the next morning I quickly return earlier, also to meet KC. I gave him a few crabs, caught by Khim, After coffee, I quickly return home to sleep. April 11, I had to go back to 25 mg on steroid, and I called Doctor Tan about it that I  really cannot bear with 20mg for now.

        April 14^th, I arrived at Steven Lim house at 2.30 am. He fetched me from airport and we had porridge at Mei Ling. The temperature was very cool and dry at 22 degree C, I felt like my nose is cracking inside. Next day, I sleep the whole day, till evening, Hu came and we went Happy Valley to have our dinner of pizza and dessert in the next shop. That night, as I slept, I began to have chest pain as early as 3am. And I had to take 2.5mg of steroid to press the pain down. This is very tough, the pain is like either out of breath, and the top muscle of the lung constricted to give a strong pull, this is very painful to wake a sleeping log. This kind of pain reaction is like a dieing man struggling for breath. The pain also scared Hu stiff.  On April 16, the temperature dropped to 16 degree, and I began to see blood in the nose. I went to office. The following day, the humidity reading goes below 60%, and with the coldness, I had difficulties in breathing. I cannot sleep properly, and was also hungry through the day. Even on one night, when there was a black out, I had to go down to buy some food at 1 am.

On April 18^th, we had dinner at the vegetarian restaurant in Shen Zhen with the old Thomson people, together were Betty, Spring and family, Jess and family and Neil and family.  Now the temperature is raising, but nose is still bleeding. On 21^st, I went to work, and on 22^nd, under heavy rain, I went to Steven Office and met him for lunch. The following day, I went to Bao An, and had meals with Peter and Qui. I stay for the night and left China on the 24^th. Next day, I went to Aljunid to have coffee with KC, and there I cough out quite a big patch of blood. Apr 28, I went to swim,  and in between this day, blood and headache returns, and but it now begins at around 6am.

May 2010

Steriod : 10mg

CRP: 14.1

        Labour Day, got hold of  Patricia and  Florence and went to try out dinner at Choong Seng at Hougang Ave 1, it was a bad dinner for taste. However, after dinner, I went to the barber. Looking at the mirror, I twig my right cheek, surprise to me, it move. This is the first time it move, very small movement but, it made me so happy. Now I drop the steroid to 15mg, and the head began to get heavy, and on May 5^th, I had to take pain killer to be able to sleep. On May 8, steroid was dropped to 12.5mg per day, and this day, I had a total lost of smell. Blood volume grew, and now it is about a peanut size per nose per 24 hours. On May 09, which I cannot remember the occasion, we had dinner at Tai Seng, I did not feel good, when I slept the whole day. The next day, I lost both smell and taste, which I found it was the worst lost since the first day in 2008.

May 11, I went to Changi, but returned for lunch with Patricia and Florence at Ah Seah. After lunch I rush back to sleep, I was so tired. That evening, Choo brought me to TTSH Emergency to see a doctor. There I met Her Ee, ( Fishball), who is there for asthma. The Filippino doctor prescribed some anti biotic for me.The next day I felt better, and there I reduce the dosage of steroid to 10 mg, a week ahead of my doctor advice.  

On 14^th, my health improved, and I took bus 147 to the other terminal in Clementi. On the return, I passed by town and pray to Kuan Imm the goddess of mercy. As you are sick and an had nothing to do, places of worship visit seems to be the in thing. Peacefulness of those praying houses gave you a lot of serenity and solace, never mind which god is sitting there, just enter and pray the way you like. Those understanding gods should know you mean no harm, and is just asking for health and peace of mind. Come May 21st, I had coffee with BC Teo at Tampenis White Sand, and after that went to Toa Payoh and spend a few hours at the library followed by the next day I went to visit Doctor Lee with Ricky Chng. May 24^th .we arranged and visited Electroly factory in Johore,  Pasir Gudang. Alan and Shuan of Electroly brough us a very good sea food lunch, though I do not have taste. It was at the seaside just exactly opposite our Sembawang Jetty.. The next day, I brought Quynn to visit the Merlion. Ricky cannot make it as he was struck with bad gout, I believe he is heavily over weight. We went to MRT from Tampenis to City Hall, and walked all the way, till Sogo, I think almost 3-4 km of walking, which tired me flat

        Next day, I want to Genting Highland. This place is cooling, and as I was there, I bought a packet of cigarette, a cup of coffee, and sat outside the hotel and pretend to enjoy myself, though I do not have taste and smell. I did.  I also won a few hundred Ringgit playing roulette. On the second night, May 27, Choo called and told me that my mother in law passed away. She was the best woman I knew, work or slot throughout her live, once she stopped working, sickness befell on  her. Her diabetes caused her two legs to be amputated. She was on the wheel chair for almost 10 years, dreaming and crying away.  I felt very sad for her. She had never enjoyed any fruit of labour, and her life time is born to suffer.  This was her fate. When I returned from Genting, I went straight to the wake, and she was then creamated on May 31^st. 

Jun 2010

Steriod :10mg

CRP : 51.1

        June1^st, though I do not have headache, blood is still found in the nose. I am getting pretty tired, I think due to the dizzling rain at the funeral. Smell is also unreliable, on and off. On the 3^rd, I visited ENT, the doctor just give me antibiotic, and she said there is nothing she can do, and also told me that with my sickness, my nose should continue to bleed, of course I do not believe her at all. I found that the RAI, Eye, ENT doctors, the ENT lady doctor is the worst and most irresponsible of them all. On 6^th, we went to pray to mum on her death anniversary. Before the prayer, we gather for coffee, but on the way I was drench head to toe in heavy rains as I rode my bike there. From then I had flu till 10^th, on Thursday. I begin to realize that with a little bit of rain, I will be sick. Physically I am now very weak, in the past, I can be in the rain from morning to night but now with a few minutes of being in the rain, I will sure to be sick.

        June 9^th, went for medical check up, it was found that I have Osteopaenia -1, this is a drop of one grade of bone deteroration. Though it still does not need medical attention, according to the doctor, it is too early for my age to have this osteropaenia. However, this is the cause of steroid. The doctor also noticed that my CRP kept raising, which is bad sign for my Wegener. On June 17, I went Pulau Ubin, this time, I rent a bicycle at $4 for two days. On the 19^th, I brought Harry there, we went with Khim for a bicycle ride and crabbing. Later we went to our floating platform and after lunch, he found the place too boring, so he went back to Singapore at around 3pm with $40 worth of nice crabs.

       On the 21^st, I woke up in Ubin, and began to read newspaper, after reading a while, I begin to look for my spectacle, only then I found I was reading without a pair of spectacle ! My eyesight changed. I had been wearing reading glass after a few months in the Philippines.  During that time, on the 3^rd trip back to Singapore, while I was eating, I told Choo, why she cook the rice into a huge lump. Actually it was my eyesight that was falling, and I am not able to see clearly up close. I recalled a few months back, I was telling Tony Yeo why he needed glass when typing at the computer, now it is my turn. After wearing the reading glass since 1994, so 16 years down the road, after the Wegener and steroid, reading glass is no more needed. I wonder what will come next, as the whole body metabolism is still changing. I believe I should have aged accordingly. But due to my super immue system, most deteroration in the body was held back, then when Wegener struck,  within 1.5 years, what should had aged, just comes, so I am now being aged to the norm.  

        On July 24th, it will be my first  time, that I took my grand daughter for a bus ride. She was very inquisitive, just looking around all the time. She does not cry, but through out the ride, she just observed other passengers.  Then on 25^th, I went P Ubin again, but return on the 26 to watch Teochew opera at KuChai Pa. The opera came from Guang Zhou 2^nd troupe.  June 28, Richard arrived from New York.  I drove to fetch them. One happy moment, for a brother who last visit was 3-4 years ago. On 30^th,  Florence , Richard family and myself went to Sungei Buroh and the War cemetery. Later that evening, we went Serangoon Garden for dinner.

July 2010

Steriod : 10mg

CRP: 77.7

        July started without smell and taste. Except nose bleeding which is increasing in volume, there is no more headache or chest pain. So on the 5^th, I found time and went watch Teochew opera again. I had to pay $10 for a plastic chair, and was still give a sit in far away corner. However, the show was good, with a lot of professionalism shown. On July 11, Thomas gave a treat at a Teochew restaurant in Boon Keng. It is a get together as well as to celebrate their 25^th wedding ceremony, and we were to pass the crystal ware to them. This crystal ware is a pass down from our parent 25 year wedding memory. We decided who got into 25^th   wedding anniversary shall old the beautiful oblong crystal ware till the next one comes.  The dinner was good. I told Richard that Una had something she will never forget, that is picking durian in P Ubin at night, for a New Yorker, he agreed and told me they saw a group of wild boars during the durian picking. I joked back saying is it that they saw my two sisters instead of the wild boar. Surprisingly, this upset Huang, which I definitely did no offence and did not know at all. It was only after dinner when I ask Pat is Huang sick?,  that she told me she was angry with my statement of her being wild boar. This really shocked me. I had been happily joking to get into this. Who say we need to be young to be but we are old yet childish!.  

        Time past fast,  on July 17^th, Richard return to US. In the afternoon, KC and myself went lunch in Toa Payoh with CH Yeo Ronnie, followed by Ricky joining later. The morning I was feeling good,, but suddenly I begin to feel tired, went home to rest. Next day there was a celebration for my grand daughter 1^st year birthday, and I did went, it was raining. At the place, I was knocked out, did some sleep at the place, and before the party begin, I told Elena to fetch me home, I could not take it. I went home and sleep straight away, Even the day after, I could not go to pray to granny for her death anniversary. I just lay home sleeping.

        On the 20^th, I went ENT check up I told the doctor there is too much blood in the nose, she just shrugged me off and told me Wegener should be like this agin. I was pissed off., but like in the past, what can I do, not many people know Wegener, and as Doctor Mahes said to me that these doctors should not play god. I believe something bad is happening, falling sick frequently and blood volume is increasing and taste lost. After blood test and ENT, I quickly return home to sleep. Now even the rashes in my face is appearing not to accept any drug. In the past, this is a bad sign of Wegener relapsing.

Next day  the 22nd, I want RAI for check up, the blood result shows that the CRP now shoot up to 77.7 points, which is the highest this year. The last highest was last year March at 199.2 points, this was when after the Wegener was full blown when I entered hospital for the nose operation. There was no record taken before that.  As for the last relapse in November 2009 the reading was at 55.3 points. The doctor was stunned with the 7.7 reading, and as he aynalsed, the blood in nose and the severe lost of smell, he slumped to his chair, gave a long thought and told me to up my steroid to 20mg per day. I told him I am now putting myself on 12.5, for a week already, and the reason being I just cannot stop the blood in the nose. The last time at 20mg was April 25 th.

Another problem was I cannot continue with any cytophosamate, because by right I should not dosed with more than three months, and for me it is almost six months. So the drug to use now is the older version of Myfortic, which is called Celcept, Mycophenolate Mofetil. This is going to multiply my medical bill, from $200 plus to $800 per month.

The past few days, I heard Mr.Balan was not in good health, so on July 23^rd, I went with Ricky to Penang to visit him. The day I went, he was in Taiping doing is last prayer for the sickness. The next day, Ricky and myself went to visit the Kok Lok Si Temple. After lunch, we went to Balan house, he was waiting for me. He look better than I expected, and told me the prayers he had works. I was very happy to see him in pretty good health. Like the past he was scolding me for not staying in his house, which I said we were supposed to come with KC, as such it would be inconvenient and our stay will also be only 2 nights.  I later found that the last trip here was exactly a year ago. On the 25^th we returned.

On the 27^th, I took a bus to airport, going to Hanoi. On the way around 1.30 pm, my smell return, just a sense of it. I was very happy. At he bus stop I happened to call Hu and  I told about this. This is just 5 day after steroid increased! Hanoi is hot like hell ! After staying in Ricky house for a day, the next evening, we took an overnight train form Hanoi to Lao Cai. When we reached Lao Cai, another hour plus by van, we went to SAPA, a resort like place in North Vietnem near to the border of Yunnan China. This place is a valley surrounded by hills, and the aborigines that are a plenty. The place is very beautiful, however, to take a journey there alone, is not worth it, as it is too far away.  The weather is cooling, and on the third day, we crossed into China border called HeKou. The immigration on both side are backward, where computer do not seems to work. The tour guy brought us for lunch in one of the Chinese restaurant. We had 7 course lunch for three of us. . Quynn was with us to, and the main purpose was also a working tour for her. We spend a lot of time talking about work and the who what why when how to do. I believe it was a good training for her.

On our return to Hanoi, it was Sunday, so I booked a hotel to stay. The weather is too hot for me. Monday and Tuesday, we had few meetings, and trainings. During this stay, my smell was also improving. I felt better than the last trip here on March which I found I was still weak. At the hotel  I bought a packet of cigarette to test my smell. It was low but did improve by the day.

Aug2010

Steriod :20mg

CRP: 4.1

        On August 4^th I returned to Singapore. Actually, was supposed to return from Hanoi on the 9^th,  but August 6^th, had to visit RAI  for my medical check up, because Doctor Tan will be on leave after the 6^th. This time round, the CRP dropped to 4.1 points, both of us are happier now. So he decided that steroid should remain at 20mg, however, I told him I prefer 22.5 mg, for a while first. I still recalled on April I told him that my trash hold should be roughly at 25mg .When I returned, I followed his advice and went to take 20 mg for the next 3 days. At the same time, I began to develop sore throat. On the evening of August 8^th, I begin to smell like never before, and on Aug 9^th, all the sense of smell was totally gone, and I decided to go back to 22.5mg, but this time round, I split out 5 mg to be taken in the evening hoping to reduce the blood in the nose, which is reducing but still there. This time, my sore throat got worse and I quickly took some bitter gourd juice, for 2 days. I think I over stuff during the Vietnam trip, which cause this sickness. On 11 Aug, I went to Hougang Central to see a doctor, for $20, I got some panadol like pills, useless. I will never see him again, this is the second time, the previous time I saw him was during November before the last major relapse when my eyes was affected.

        Aug 12, I went to the wrong hospital to visit Danny. I went to Mt. Elizabeth  instead of Mt. Alvernia. It was only after several call to Victor, Danny brother that I got it right. His operation was done, and he was well resting. The next day, had nothing to do, so on my bike, I went to Simon road and pray to Hua Tao, the god of medicine. My eyesight falls very fast, that night I went to visit Peke, and found that I had great difficulty riding. I am seeing sparkling light instead of the normal traffic light. Today is also the first day I decided not to take breakfast. I had grown to 68 kg , which is the highest ever on me. I am still smell less. Aug 15th, I went to make a pair of spectacle. I just cannot believe that 3 months ago, I need reading glass, then I do not need for a while, and now I am short sighted ! At this rate, I dare not imaging how my eyesight will be in a year time. In the afternoon, I went to Holland Village to meet Roland and Danny, but today, sense of smell is returning

        As day passed on 18^th, I brought grand daughter to People Park to look for a tour. Next day, I rode to Changi to buy meat Bun, and gave Danny a few, this time, he looked very normal, like before.  On 21^st, I went P Ubin again returning on the next day with 10 kg of fishes given by Khim’s sister. We went fishing and caught a 1.5 kilogram sea bass, but tore one net away. That night, sleep was difficult, I believe it was bed bugs from Khim  On the 2nd, I brought a few fishes to 205F, forgetting to bring key, I climbed over the gate, planted some chilli and brinjal, then I placed the fishes on the table and return. But 11 am, I found from Patricia that Florence was not home, she went to Taiwan, so I had no choice but to return to collect the fishes and got some other goodies and gave it to Patricia with some log bean I cut from the garden.

        24^th August, today mark the first day my nose do not have blood for a long long time, and smell was returning very fast, roughly half n hour after waking up. This is very good progress. At least I am able to smell people burning joss stick.

        During this half of the year, you may see that I am mentioning more of steroid, versus headache and chest pain. It is happening. Yes, the doctor agreed with me that I am very reactive with steroid. This was mentioned by Doctor Eugene Lim on last year September too. Each time when I reduce steroid, few things can happen. Firstly, my headache will return or get bad. Secondly, there will be chest pain, like being put on heavy pressure. Thirdly, there will be blood in the nose. Fourthly, smell will get weaker or disappear. Then lastly, the rashes in the face, will not accept application of any medical cream, however strong, These are the order of sequence of another relapse of this Wegener. As I tracked my data, I observed that when the steroid reduces the CRP points increased. 

.       As for the other auto immune drug, like Celcept, no one know how my body react. There is no data that can directly show, so I just have to keep on eating those expensive pills. According to advice, reaction of such drug may take at least 3-6 months. Now my medical cost increased considerably, due to the taking of this Celcept.  Let us see

Today I will be flying off to Shen Zhen. Throughout the year, I will still be busy visiting doctors, My next doctor appointment will be September 17^th, for the RAI,  Eye doctor on 9^th, and ENT on 14^th. Until the next round of report , bye.

Andrew Lim

2 years old.

August 25 2010

Going to 3 years old.

The first st9ry

            The purpose of the below story is to tell our friends in the medical world of

 Wegener Granulomatosis (WG)

Is not just a theory or by the book sickness for us Asian. I believed that this is a strange disease that is hidden in many people, whom in the end my just expire due to the fact that WG is a disease that do not appear by itself. I hope that this can enlighten many people to get to this disease through more careful analysis and use modern technology of blood test. I also hope that we can study the relapse of this disease, or just what a doctor should know before the next knife stroke you cut.  According to Dr. Foo, striking WG is much more difficult than striking Toto first and full prize! Yes based on my situation it look like 4 million to one, however, there should be a lot out there, hidden!

My story of Wegener Granulomatosis (WG).

One day, in August 2006, I was looking at the mirror and saw a sore on my lower right jaw’s gum. As per normal, I used my finger nail to dig it, it split open and did not grow back. I remembered that the part of my gum was a little darker than normal then, anyway it is ok. I just feel a little heaty in the body, so be it. I always say heaty, to us Chinese, heatiness is a term when the internal organ heat up, especially the liver, due to taking certain types of food, like fried food, or excessive food that the body cannot consume through normal metabolism. Next day, I took to the mirror again, wow, it does not heal, and what I dug split open and since then it never heal back. A month or two later, it happened to the lower left jaw. Though I felt strange that it something in me does not heal, I just forget over time.

Jan 2008, I was in Japan and the temperature was just one or two degree Celsius, I was standing on the road side smoking away. Victor Ong came to me and said I am mad, wearing only a long sleeve shirt smoking away, without a jacket or wind breaker. He wondered if I was cold, but I showed him I still have some sweat on my forehead, and it did not come to my mind of anything wrong, as I was all those years fearless of cold. Normally, I do not need even of a long sleeve if the temperature was above 10 degree C.  My friend use to say I am different, those words just passes by.

            May 2008, it was almost summer time in China, and I began to feel heaty, though the weather was still fine, I mean around 25 – 27 degree. This time I began to start to drink cooling tea. I travel on some weekend to my friend, Hu’s place. When I reached there, I just drink some cooling tea and sleep over the week end. Hu told me that I seems to like to sleep for the past one year or so, and I said that I am getting more lazy, not knowing that it was a fact that I get worn out pretty fast nowadays. I was thinking I am getting old, not knowing that actually the body is asking for something, rest and repair.  Since this time, I began to feel that my nose was a little blocked, so the more I continue to drink cooling tea. I wanted to see a doctor to have some medicine, but I hate to see doctor, I found an excuse in July not to see one blaming my traveling schedule. I cannot remember seeing a doctor for normal sickness, as I had not been sick with flu or something like that before. This was beginning to disturb my sleep.

           Nov 2008 was another chance for me to see a doctor for my congested nose during my son Edmund wedding. But then as I rode my motorcycle by the Hougang Polyclinic, there was some renovation going on, so again I need not see a doctor. After the wedding I return to China to work, as days passed the blockage get tighter and breathing get tougher.  Soon a lot of our colleague began to take note of my blocked nose. Sky Liu brought me many bottle of herbal drink (Silver Flower drink), Jackie brought me other herbal soup, and they were heartrendingly concern for me, One day, at the beginning of December, one of our sales engineer Chuang Cheng came and told me that there is a nasal clearing spray which is extremely effective for nasal blockage. I wanted to buy from Singapore but forgotten, that night I immediately bought a set, which cost me RMY86/-, called U Bi. On that night, I applied, and what a relieved for me then. Immediately the swelling in the nose was reduced and I began to breathe freely. That night, I slept well, but I woke up at 3 am, the nose blockage got worst. The second night, the application pattern was the same, now I woke up at 2 am, thing got worse, this time real bad. With a led light, I saw the left nose was not totally blocked, while the right was blocking halfway through. I even saw a crack on the surface, as if the internal of the nose wall is breaking into pieces. The next day, I had to use a cotton wood, pushed into the nose to allow some breathing.  

 Soon, I could not stand it and went to BaoAi Hospital to see a doctor on Dec 12^th. Dr. Yao attended to me, and sends me to the ENT specialist. I was also taken to do the MRI and scanning. A picture of the internal of the nose was also taken. The doctor was shocked to see such swelling and brought long his superior to have a look. As he took a cotton but and touch the inner nose, it just bleed. It was the first time I ever have a bleeding nose. Then he diagnose as normal sinus, a little more serious of course. Looking at him and what he said, I think he had never seen such swelling before. I was given some medicine to take and was told to return when the swelling is gone. This should take 4-5 days. I was also given eye cream, which according to him will be used as antiseptic, to be applied into the nose!

            He told me that with a simple operation of 5-6,000 RMY, and 5-6 days everything will be OK. In my mind, he is just plain over confident, while I had little in him. When I went back I began to ask around like Hu, Mr. Balan and Bernard about this surgery. All advised me to return to Singapore for the operation. Further more, it was winter in China, and even if the operation is successful, I may not be able to take the cold and dryness in the weather then.   On the 14^th I called Elena to book a doctor for me and I immediately book a ticket back on December 17th morning.

Dec 2008, 17^th 3pm was my appointment with Dr. Foo at Mt Alvenia Hospital; he reviewed the picture and the scan I took from China. He then look at my nose, and told me I should let the swell subside and gave me an injection to help to speed down the swelling. I will be back the next day, to be warded for the surgery. I was very happy and anxious that I should have free breathing in a few days time.

So Dec 2008, 18^th  was the surgery day, everything went fine, and the next day I was bandaged at the nose and on the 19, I was out of the hospital to be resting at home. Prior to being out of the hospital, I told Dr. Foo that my right saliva gland is aching and part of my lower tongue had been cut. What Dr. Foo told me was this was pretty normal for ENT, but in my heart, I still think something is wrong. On 22^nd I was review by Foo again.

Though I was home, my nose bleed, little by little daily, but more and more too. On the 28^th I was having coffee in the morning with Hock Joo, but that night, at 4.30 am, the bleeding just flow out. I was sleeping on the sitting position on the sofa, when suddenly blood just oozed out at a very high rate. Within minutes, the whole roll of kitchen sanitary paper was wetted with blood, and it just does not stop. By 5.20 am Choo was awake for work and I think I lost enough blood to weaken me .She brought me to the hospital again. At the emergency the doctor put a plug into my nose to stop the bleeding. I was hospitalized for the second time now, for 2 days.

  Jan 2009 arrives, and now my body seem to be boiling internally daily.  I found strange ulcer which is not ulcer, the gum just began to swell. Jan 2^nd was drizzling, and the rain was heavy with a darken sky, but I went to TCM Ng Whye Teck, I told him about my operation, got some herbal drink which was very effective to cool down the body a little. I also had some powder for the gum. When I return home, I applied the power on the gum. Strangely, the gum is now much darker towards purple colour, and turned porous. As I touch it, blood came out to my finger. The powder is no more effective, where I applied it, where the blood will come out. But there is no pain at all.

Jan 3^RD, both the upper and lower gum gets darker and it was swelling, and just look like rotting bit by bit. I went to see Doc Koh/Liew. He was my regular dentist. Though he saw me without appointment, he refuse to go further, saying he had never see such thing before, and gave me a referral letter to see SGH the next day. I was so pissed off that my dentist reject me, and just went home paying some money. Next day, a Sunday, I visited TCM Doc Lee for some cooling medicine too, I told him of my operation, so he need to give me a medicine that can cool me down but not cause bleeding. This was a tough one for him, and this to condition does contradict in Chinese medicine too. He did give me, and that evening, I had to drink a few glass of sugar cane juice to cool me down, as the medicine though very strong still cannot cool me down.

Jan 5^th, my gum worsen, I went to my mum dentist, old Dr. Cheong, just begged him to take a look. Yes, I scared shit out of the old fellow, who shake his head and told me he cannot help me. But he reviewed me twice, not believing himself, and gave me one of his good medicine. I was terribly sad, as no one know how to help me. Gone case I think. As I stared on the floor of Serangoon Road, my hand phone rang, it was Elena. She just wanted me to meet Dr. Singh. After some argument I agreed. At Mt. Elizabeth, they look at my gum, but have no idea what is it; they call it the straw berry effect, which by dentist standard is a simple problem. As discussion goes, we end up taking about the pain and growth of my saliva gland. They gave me a CT scan and FBT (full blood test). Good Dr. Singh and Dheng called Dr. Foo to inject Fragl (ant-biotic) into my vein to bring down the pain and swell of the growth in the saliva gland.  The next day Dr. Foo wanted to do the injection but I did not pay attention as the pain was terrible and the gum was beginning to rot, and rejected it. No my focus is not only the pain from the swollen gland but the rotting gum.

Then for the 3rd time, on Jan 8^th to Jan 16^th, I was hospitalized again. This time was because of the gum and the pain of the swell of the saliva gland was causing and the nose is bleeding daily too. On the 9^th, was the fist time I saw Dr. Eugene, a friend of Dr. Singh. He looks at me strangely and told me, holding my medical record and said  “I think you have Wegener Gautaumatosis”, I was not shock and asked him to explain in layman term, and he said, “you got a disease with no cure, but can be suppressed” Ooops, I missed the name of WG. He then arranged another doctor to review me if I have leukemia or others like, and have a bone marrow test tomorrow to confirm.   So I got WG, Wegener Gautaumatosis now eh! Hey, by the way, no one was interested of my rotting gum. Each morning, I took a tooth brush with tooth paste, stared at the mirror, I just cannot brush, it is too painful to brush your gum away. I had seen a lot of horror ghost story, and this it that is in me now. As I brush, I brushed away my gum! As I said, no one bothered. Am I possessed?

I am now filled with all kind of pain daily. Blood from the nose is now dripping when it like. One night, I almost stop breathing. At around nine, the swollen gland was so painful, and the nurse injected painkiller on me. It did not help to relieve the pain, but as the nose blood hardened, I began to have problem breathing. By midnight, the nose was totally shut, and I had to breathe through the mouth, but soon the mouth dried up, and got painful too. I continue to use the cotton but to open the nostril. Only until around 6 am did I manage to open up around 1-2 mm opening which allowed me to breathe. Between midnight to 6 am, I was in fact grasping for breath, at around 5.15 am, it almost stopped. I just cannot recall why I did not even call for the nurses to help? Lucky for me, I was a good diver before and was able to control breathing, if not; it was a gone case for me. I was so close to breathing stoppage. KC visited me that morning on Jan 13^th, and I was telling KC, I almost stop breathing last night as all my nose were block with blood flowing and hardening, and I was almost giving up, as gum was rotting at a fast rate now, the pain killer they are injecting into me is no more effective, and for the last two nights I did not sleep a quarter of an hour. He gave me a scolding and told me to hold on, and I am too young to go!  After he left, a doctor told me I need not go for the bone marrow test, and I should be fine. This brightened me a little, though the WG alone is scary enough. Dr. Eugene began to prepare for my WG medication. After a lot of Fragl was pump into me, my saliva gland swell subside a little and I was discharged on 16^th.   

Jan 26^th was Lunar New year. These few days were wonderful. I do not know why but my sense of taste return, maybe 30-40 %, I had three good days. But on the third day, all the senses were gone again. Till today, I am puzzle why the ‘recess’ time to have the sense just for Chinese New Year. However, I end up cooking several dishes for my sibling a few days later. According to them, all my cooking flavours were intact.

On Feb 16^th to 17^th I will be hospitalize to infuse 300 mg of Infliximan, 500 ,g of mehtylprenisolones for 3 consecutive days, 2 doses of Ritumaximab, once I am out I will have oral of Mycophenolate(myfortic) about 720 X 2 per day and 60 mg of prednisolone, and calcium. According to Eugene, these drug he was pumping into me will only react or take effect at least six months later. They are dammed expensive, in fact in the end that occupies about 40% of my total cost to date. However, when the steroid was reduced to 40, my right parotid glands (saliva gland) swell, if I go 60 mg of steroid, I will be over dose!! Look like my body was reacting to my steroid intake.

On 23 Feb, I clocked the 5^th time to be staying in the hospital in 2 months. I had been sleeping for the past 4 days after the infusion and, and when Huang visited me at around lunch time, I was still sleeping. I told her it was very nice to be able to sleep like this and I told her then that having chemo was like that. She thought other wise. Actually I was too weak to wake up. I am so tired and continue to have minor headache. She got me to the hospital where I was ‘locked’ in.  I was having some infection. Again, much medicine was injected into me again. I left the hospital on 26^th, but went back on 27^th to see Doc. HH Tan as I am having problem urinating. I was sent to all sort of tests and nothing was found. I though it was a wasted visit, as I began to realize that I am now well controlled by the amount of steroid in me. Or this was in me a sign of the Wegener being very active.

After being review by Eugene on the 5^th of March, 9^th I was stayed in the hospital for the second infusion. Thing goes well and I brought my first hearing aids with Yang and Hock Joo for $120 instead of $270. However, since then I did not use frequently. I thought it would be wise not to rely on it, or I could easily be dependent on it.  On March 19^th, I changed the Endoxan to Myfortic, as I had begun to have foam in my mouth in the evening, when I was on Endoxan. On this day, the nose still bleeds. On 21st, Florence, Huang and Patricia, we went to Pengarrang. Had a good, but very short trip. I brought back the memory of Lou Han Island when I passed by in Mr. Tan’s boat on the way to Sedeli way back1972-73.

On 23rd, my steroid was reduced, by another 5mg per day, but that night my nose bleed again. Was it due to the consistent headache? Next day was a tough day, as my saliva gland area began to ache, it was a pretty painful day, and I just slept through the whole day. Next day Huang brought me to Nee Soon and the Sinseh prescribe 5 bags full of herbs. On 27^th I was bathing at around 2pm, and the nose just bleed full stream again, I began to panic. I remember I tore a piece of flesh out from deep in the nose.  The dog was barking, while I bleed, I knew there is a visitor, but after a few minutes, the blood stop. Victor was the visitor.

On the March 29^th, the fungus in my mouth was turning real bad. Look like there is no space in the mouth that is not yellow with ulcer. The tongue is colored with greenish blue rings. There was no pain, but look terrible. Next day Huang brought me to Grandeagles hospital to see Eugene. He stopped my oral steroid intake and injected a 10 days steroid for me. I was skeptical of the injection, but the ulcer or the mouth condition was very bad that I had no choice. I also was prescribed medicine to cool down the fungus in the mouth, Diflucan, wow $25 per piece, 3 pieces per day. It was effective then. Eugene told us that he would like the saliva grand out, so he can understand the extend of WG behaving in my body. He thought the swell is causing me great pain and discomfort. But Foo knew the consequences of such operation which will cause drooping face, tried to object or delay. He did tell me that if he operates, he need to cut off 3-4 of the five facial nerves, and should cause a facial disorder and even a floating eye ball.

I went home and slept 2 days, and this time, I just cannot urine again. I work up on April 1^st at 9am and text a birthday wish to Yang. When I went to toilet, I found my face swollen. My eye balls look like popping out, like a goldfish. This time though I cannot urine, I felt no pain, which means my bladder is empty, and my kidneys are not working! I slept another hour and as I took up my phone again, my vision was blurred. I texted to Huang about my condition and asked her to come and fetch me to the hospital. She came quickly, as two days before, both of us did though I might have problem with the steroid injection.  So for the 7^th time, I was warded in into Mt Alvernia hospital. I was immediately put on the catheter when I reach the hospital, and for the next 2-3 hours, nothing happened. It was only until the evening that urine began to flow out. This flow, till the next morning, at least 5-6 litres of urine came out.  I get better the next day, but the saliva gland pain kept increasing, so was the swell. Like a duck egg sticking out of the chin. As per normal, I was given plenty of anti biotic. I recalled Peke visited me on April 5^th. He looked at the ulcer was shock, immediately went out and bought three bottle of bird nest for me. I did take two, it also helps.

On 6^th, the swell of the saliva got worse, and Eugene and Foo arranged me for the CT scan and withdrawal of abscess in the growth for analysis. The result was that I go have a growth, and the reviewing doctor advised I had to be operated. The pain was so bad from the swell, it was quite indescribable. The pain not only came from the swell but also lingers between the scalp and the skull, so every hair I touched my headache appears. Each night the nurse injected pain killer, and it was just no use, the pain just continue. Recalling, I think though these few months the Wegener just continue to attack the right parotid gland. Then the doctor fed me with steroid to solve the pain, and antibiotic to ease the swell, of which both were contradictory. One up and the other down and vise versa .But at this time, some senses returns and so it was the first time in many months that smell was returning, and the first I smell was Pandan cake! So Doc Foo has to operate me against his wishes. He briefed me about the consequence of this operation after math. A drooping face but worse case, my right eye might not be able to shut or even my eyeball could be floating upwards permanently.

April 11^th, the operation taken by Doctor Foo began, and I was wheeled in at 2pm. I waited till 4pm to have the tranquilizer injected as Doc Foo had an emergency operation with him.  I was wheeled out to my ward at around 11 pm. I remember some warm hands of Pat, Florence, Huang and many more grasping me. I know it was terribly cold, I was shivering like hell, and tens of hand grasp me, and I recalled the first word I was mumbling “did the 4D XXXX came out.” All I had was a reply the system it did came out but not the exact number. I remembered all the people, including Helen and Yang etc.  In a short while I got my fifth blanket that I began to warm up, but I was so weak that I just knock off, cold and tired. The whole spectator leaves one by one.

The following night, I had a chance to read Dr. Foo report on the operation.  It was quite scary then he wrote that the nerve beside the ear is ‘black colour’, and the part he cut out was supposed to be cancerous. In fact this was what he told my family when the operation was finished, based on his years of experience. On April 14^th, Foo came. This was the third day from the operation. He was smiling gleefully and asked me, ‘are you a Christian?” I wondered why? He said I just went through what should be a miracle. As based on his experience, I should be preparing for my exit from this world, because the parotid gland look cancerous to him, while all the nerve around had all turn black. He had cut out all the ‘bad’ nerve up to almost the top of the ear, and he could not go further as it could damage the brain. He then took out the blood drainage can from the operation. Next day he gave me a bottle MedNeil for washing my nose, it was real good, more a miracle bottle, almost everything can be cleaned of the nasal cavity. Soon I began to have some effect of the steroid, which means insomnia. By now April 17^th, I dropped to 54.5 kg. Foo also took out some switches. Today is also in four months that I have proper bowel, it is also the fifth month of my first operation and hospitalization entry.  I was discharged from the hospital again.  This seems to be the end of my second chapter of this Wegener.

 

Relapse or insufficient suppression, I am with WG

April 18^th was a Saturday, and spends the time teaching Florence how to cook chicken rice, good day spent. There was still bleeding of the right nose, and the next day, I spent breakfast with Patricia, and Hock Joo at Hougang Plaza.  I had a tough time walking there. I am quite weak and even have difficulty breathing. I had my pulse rate going around 100 per minute. This time, I dropped another 5 mg of steroid. I began to be hungrier, high pulse rate and slight fever nightly. On the 21^st, I went to KC temple, had a good talk over the phone with Balan, who told me about his Japan visit. By 2pm, I was so tired, and kept sweating though the wind was strong and cooling. KC sent me back home. The next day, I was shacked and tired, laying down the whole day, resting away. 

April 23^rd, I visit Eugene and Foo. I gave a small gift to Dr. Foo, and in return he gave me some strength building Prosure and Ensure milk powder. This milk powder had been good breakfast for me since. Between now and the next few days, nothing in my body was stable. Pulse, headache all went up and down. As my steroid is reduced to 10 in the morning and 5mg in the evening, my pulse rate began to slow down. On April 26^th, I thought Florence how to cook braise duck. She done it well and it turned out very good.

Soon the pain of the surgery began to subside, but it was very difficult to sleep on one side, as the right side was not fully healed yet, still on the healing stage.  April 30^th comes, was a good day, but my hearing get dumber. Eugene wanted to give me the Cyclophosphamide injection but I did not agree as I felt very uncomfortable with consolidated injection, I already had a phobia on this injection that so called will last for a long period. (Reflecting back, this could be a big mistake of me, I presumed) However I switched back to the very expensive Myfortic. My doctor just does not agree that steroid is controlling my body water level, which I insisted. Well that was his theory with my practical. Eugene show the blood test, it was bad, C Reactive protein was 146, and except a 3-4 items, every other indicator was negative.

On May 6^th, I visited Foo, and he did not charge me again. My smell and hearing was returning back little by little. The next day, I visited Eugene, returning home to cook fish porridge with Huang.  Each day comes without any good activity, and the weather was hot.
On 11^th, I went to Changi Fairy Point and did some crabbing. Though it was the first time I walk unaided, it was extremely tiring. Is the WG still so strong in me or the steroid? Or was it just I myself that is very weak from all the stay in the hospital and those infusions. Yes I did catch a couple of crabs and file fishes. The next day, my chest pain, heart pain and breathing was tough. I think I over exerted myself. Still I went around visiting temples. I went to pray to Hua Tao, the god of medicine. I also went to the Tao Temple. On May 13, I had coffee with KC, but by afternoon, I felt that the Changi fishing trip backlash was coming at me, I began to have headache, heart pain, breathing problem and muscle of my thigh aching, and I just went back to sleep in the afternoon.. May 14^th was a knock out day. I reduced steroid to 12.5 mg per day as instructed.  I was already a month away from the operation, but the body was still so unstable. Huang told me to be patience. Well, am I dropping steroids too fast to keep WG at bay?

Between 15 to May 19^{th, I} traveled here and there by bus, even to Chinatown just for lunch showed that I am still too restless. Though tired, but this was the only way to pass time. On 20^th, I went with Patricia and Huang crabbing again. I just slept away while the two do the crabbing. I actually did not have the energy or strength to do the crabbing.  The next day at Eugene, he does not want to drop the steroid for this time.  After Eugene, I went to Bt Batok, Huang friends place to get some Chinese medicine for the liver and stomach. Pretty good medicine I got. It also clam my pluses. Time passed with me sleeping most of the days, seems to be pretty tired, but it is also laziness. On May 28^th, I received a text form Huang that my PR3 went from 170 to 101, good news to me as I will be flying to Shenzhen to visit my friends there. Why fly now was because I do not want to cross a six months barrier of sickness. 

 May 29^th, I reached Shenzhen, though most things are well, I still found strain of blood in the mucus, could it be permanent, or I am still bringing the WG along.  Altitude does play a part, and I turn pretty deaf on the plane, and I cannot hear well till the next day at 5 pm, before some hearing return. I went straight to Tang Xia very tired. For the next few days, there was blood from the nose. On June 1^st, I went to JinXiu JiangNan. Here Neil visited me. Next day, I had headache, took 2 Panadol and went to office. I gave Bernard a shock. He visited me before my April’s operation, now, while I do not know, to him, I look like a very sick man now.  Looking around, everyone was shocked. Some like Eric Zhu do not even recognize me. Till June 3rd, I had headache every morning, so had Panadol daily.  June 4^th, I went with Hu to BaoAi Hospital to visit Doc Yao, she was shocked but happy to see me. I told her I just come to visit her to let her know my condition. She was taken aback as she though I wanted to see her for my slanted mouth. I recalled she said that she can heal my heart condition which was still good, but not your crumbled face.

Next day, I want to Shenzhen Vegetarian Restaurant to meet Jess, Spring, Betty, Neil and wife. Ms. Lam CL was sick while Lucy was occupied with work. We had a good dinner and talk till 9.30 pm, when they wanted me back home to rest. All of them tried to offer me financial help. Jess was asking if I treat here as a daughter, if so why I do not want her help, and all claimed that if am too thin skinned to obtain their help. The fact was that they are still so young and had a family to take care. You would be surprise of the huge amount they offered. Almost all their saving!  Well, Ricky, Balan, Danny, Richard from US, and almost everyone I knew were offering financial aid to me too! On the 7^th, KC and I went for lunch, and after lunch, I moved to Long Hua. This morning, my temperature went to 39 degree Celsius. On 8^th, I went to office, and that evening Steven Lim, Weber and Jonathan treated me dinner, at a roadside Teochew food stall. Next day, I woke up with fever again, but ended up in Tang Xia. On June 11^th, I flew back to Singapore, with Hu sending me to the airport. I began to believe that with the constant fever arriving, I should be very unstable, other than what my mind said otherwise.

Between now and end of June, I went to Pulau Ubin, taking buses here and there, visited sinseh to get medicine for cooling the liver. We also went to Botanical garden with HJ, Patricia, Huang, Florence and Adeline, where I dropped my phone into the pond, and was unable to retrieve it myself. I was still very weak physically, and I still do not notice it. I was still not able to hop a three inches high step! By 18^th, I already dropped steroid to 10mg, at Eugene advice of course. Though I can move around freely, I do not have the strength or power as before, far from normal, properly 40% of my pre-sick days. Thinking to myself, I was playing squash with Richard Wu, Neil and Simon before this happened and non can win me, but now!  I was not able to out walk a post-stroke guy two day ago when I went to Hougang Mall.

July 1^st, I went to Ubin again, this time was to stay a few days there at the end of the durian season. I had my first swim since long ago, on the 2^nd day. There were plenty of durians, and I did tried some, with some flavour. The stay was very pleasant and peaceful, thanks to Florence, Huang and Patricia. After returning to Singapore on 3^rd, I spent almost daily swimming, actually dipping, at Ponggol daily till 6^th.

July 7^th, I flew to Penang. I was strolling happily in the street when Bossing Balan called and told me I have to check out and stayed with him. Finally I agreed and the next morning he came to fetch me. He was shocked looking at me, even though he was mentally prepared, as Ms. Siew Lay had already told him. We went around the north east coast of Penang for a tour. That day I had the first nasi lemak at an Indian stall. We spend a lot of time chit chat, like before. His house was spacious and beautiful semi detached. On the second night, I felt pretty uncomfortable, and had a slight fever. When I woke up in the morning, blood was not flowing well throughout my body, my leg was swollen, very tight muscle, which I found blood is not flowing. I tried walking around the garden, which does help to relieve. In fact there was also blood stain from the nose that morning. That afternoon, after lunch, Mr. Balan brought me for another driving tour with Dr. Mahesh, Mr. Balan son. As the tour went; my body heat began to rise. We went to all the beautiful hill side sceneries, and to where the Penang riches stayed. I already not had been to Penang since 1993 or 94. The place is now so built up, which once was so peacefully serene. As my body heat up, I requested for him to stop at the Botanical Garden and I quickly drank a coconut and pack another one back home. It was a prompt cooler for me. Finally on the 11^th, I returned to Singapore. The stay was good, but was spoiled by my health condition.

Between 12^th to 16^th, I had a lot of exercise in Ponggol Park. I had began to jog, Starting with a hundred metres and incremental of 100 metre per day. I also swim half to an hour per day between 4 pm to 5 pm. By 16^th, my steroid dose come down to 7.5mg per day, but at the same time, my liver AST and ALT goes up to 222 and 462 respectively. Normal should be 40 below.  I was already jogging at 400 meter then.  July 18^th, I visited Dr. Singh. He tried to do something to my teeth, but as I had no more gum, it was so sensitive that he gave up and told me to return a month later, which I did not. On 21^st, I went to the eye hospital, which I had an appointment from Hougang Polyclinic on the 17^th, but the cream they gave me was not suitable. Well, a lot of money was wasted.

Ricky was back in Singapore, on 23^rd, we both went Ubin, just for a cup of tea, not to mentioned that he fall down an got a bad bruise on his knee cap. The morning spent there was so peaceful, both of us like those peaceful environment very much.  When I came back by bus, I got a call from Eugene. He wanted me to be back for another blood test as my liver AST and ALT goes up to 451 and 739 respectively! He sounded puzzled, kept asking if I drank any Chinese medicine, which I denied. On 27^th July, I had another liver scan and on the 30^th, blood test. I was told to stop all medicine, except Fumiciul. On 25^th, Florence told me of a good fruit juice drink from Taiwan. A mixture of apple, orange, bitter gourd plus Yakult all in one. It was a fun drink, as she brought a set of the fruit for me. Huang brought over to me with Adeline juice machine. I not only tried but it soon became my good medicine. For me I found that bitter gourd and apple juice can bring down AST and ALT. Eventually, I am also able to control ulcer of the mouth when I am high on steroid and cycto.   

On August 4^th, Eugene called, and told me that there was some improvement from the blood test. My AST and ALT inches down to 304 and 599 respectively.  I am consuming back the entire medicine and increase steroid to 10mg… Should I tell him the bitter gourd theory? I also founded that I still cannot do a single sit-up at all. The muscle in my body was badly deteriorating and almost gone.  Prior to my sickness, I am doing 28 per minute. It was only till August 11^th, few weeks of trying, that this day, I did 2 sit-ups. Hurray for me.  13^th, I visited Eugene again, and now my AST and ALT dropped to 20 and 27 respectively, and my weight was 57.7. Kg. Personally, I know bitter gourd was the key, reason being that when I drank, I felt less heaty by the day. The next day, I found Danny was here, so I brought him to Hougang for dinner. After sleeping the whole day on the 15^th, next day I spent half a day in Holland with Danny. On 17^th, we went to Changi Village to have lunch at his sister restaurant. After, I dropped him at the 3^rd terminal airport. Incidentally, I also fetch Elena to airport the next day to Bangkok.

September 3^rd, had a review with Eugene and most blood parameter are pretty good. Huang, Patricia and I also went to Hong to discuss the possibility of my facial recovery. My facial feature is now like that of a guy down with stroke and a little worse. The top eye lid received little command, and will close only if I forced it. The lower eye lids slacken downward, as there is no nerve signaling for a pull. The right chin just drops down and slides downwards. The doctor said that have to do fast to ensure good recovery chance, on the first of his few proposals. This was to connect the right side with the left command nerve through the face below the nose, and the nerve may come from one of the limbs. If there is delay, then the right nerve will not be activating. To me, this is out because I do not think my WG will allow this operation as yet. To him, even if he found the nerve, the connection might not work. The Second was to borrow some muscle from the thigh and connect to the lower chin and lift it up. This will only make me look better, and the right face still will not move. He also talked about putting a gold weight on the upper eye lid to close it better. Such operation will cost S$18,000/-. A good lesson learnt from him, but not for me now, as physical and financial does not permit. As of now, the right ear still does not hear well, something like 30% poorer than the left, but is improving. Sense of taste is poor too, as half the tongue is not ‘functioning’. Smell is even worst, still cannot smell anything, unless thing are as close to touching the nose. Even so, not much thing smells the same, as some nodes of smell were gone.

September 9^th, once again I end up in China. The purpose of this trip was to see if I can take the change of weather from summer to autumn, which will take place during this time frame. The weather will get dryer and if weather my nose can take it. Secondly, of course was to meet my friends there and then thirdly to see if I will have problem working again.  On the flight there, I began to find my urinating problem coming back, which actually was lingering around me for a month or so ago. I recalled I told Eugene, but he said “Again, is it? ‘And smile with me returning his smile. I told KC about it, but took no notice. Few days later, I told Danny that other than urine problem, other things seems fine with me, but  he said do not worry, but I knew something tough is coming again.

            Situation get worse by the day, and now the call of urinating was about an hour, and it is getting more and more painful. I just cannot control at all. Once the bladder gave a call to go toilet, I just get in, the body will have automatic push but the valve is shutting tighter by the day. On the third day of arrival, I called Huang and she prescribed some herbs with barley, I drank daily, but it did not work. On Sept 20^th I went to BaoAi hospital. After scanning and bacteria test, they found minor inflammation of the prostrate gland and small amount of bacterial or white blood cells in the urine. The doctor to him, it was a small matter, and gave me some pills to take. I will also have to go to the clinic for some cleansing of bacterial through a heating machine. The medicine did help but only for the first and second day, and from then on, the pain grew, the valve shut smaller, and it was like laying a durian during urinating. Now normal medicine again cannot work, I began to suspect the Wegener is now closer with me! .I told myself, if it does come, I will return to have my hair cut to the shortest, at my 14 years old length ( yes, I did , and today I am wearing this short cut).

            I tried to bear with the pain; the worst was that now I cannot even sleep at all, as the bladder call had now reduced to between 30 to 45 minutes. I had a lot of trouble having dinner with any one, because I have to be seating beside a toilet, and pop, suddenly I will be going to toilet. By 27^th, I began to feel pretty helpless, because I do not know what to do, and I tried for four days taking 10mg of steroid per day. I do not have the stock or guts, I think if I did continue to increase the steroid, I think things could improve.

Sebastian brought me to a local hospital on this Saturday, but it was so crowded that we went back immediately after paying 1 RMY fee. It was only the next day I visited BoaAi again. Another doctor saw me, and he prescribed almost similar medicine as the first one, Cardura and now with Ciprogloxacin Hydrochloride, both are controlled release tablets for the prostrate problem. They also added some herbal tablet, which was anti bacterial for the bladder. In fact the doctors there are pretty good and sharp. It was just that I cannot tolerate their style and behavior. By the way, they are not cheap too. They charged me a total of around 3K RMY which is about S$500 for both.

            As time goes, it got worst. I called Balan, whom I knew is going with the prostrate medicine and he told me to drink a lot of water if I do have prostrate problem. So now Bossing Balan gave me another problematic idea. If I drink a lot of water, urinating frequency will increase, as the bladder seems getting smaller, if I do not drink more, under prostrate problem, the urethra may dry up and get smaller, I got to chose. Simply every norm does not work. When the bladder calls for me to urine, I just go to the urine. I have no control over the urinating process. Then the back muscle will compress. The body will exert pressure around the kidney region. Soon the strength of the pressure will rise to the head area, and then to the eyes, as if it is going to squeeze out the eyes. Eventually the pressure will reach the nose. This will be one full cycle, but nothing comes out, or I would say at most some drips. The more I cannot urine, the more the frequency increased. On the last two days prior to my flight back, I was practically staying the whole night in the toilet. It caused a lot of pain at the backbone area, and after a trip to toilet, I get so tired like running a few kilometers, panting for breath. I began to be shaken out. At the same time, my nose bleeding increased a little, by now almost have a drip of blood per night and I began to lose the sense of smell by almost a third of what I preciously had.  

            I continue to take the medicine, and two days later, situation just continued to deteriorate. I began to find a way to change my flight back. Sebastian helped, and I manage to get the flight on 8^th. KC was talking to me over the phone, and he had to rush back earlier than me, as his father was critically ill. I told him I may be able to take the delay. I began to call Huang to help me book an urologist, she did, on the 9^th for me, just nice, but to me it would be better every minute, which mean morning instead of afternoon. This time it is Dr, Tan Kok Peng.

 So on 8^th of Oct, I flew back to Singapore, into another twilight zone episode of Wegener.

            The flight back was tough for me; I occupied one of the two Silk Air toilets through out the flight. Now the frequency to toilet is half and hour, while I still need to spend 15 minutes in it. I just did not sleep well for the past few days, just cat nap throughout the period. That night, I tried to take sleeping pill to sleep. But it got worst, when the bladder called, and the prostrate just shut. That night, it was so painful that I had a whole toilet roll torn into pieces with my bare hand. Again, I did not sleep, and the next day I went to see Dr. Tan. Huang showed him the scan from China. He tried understanding it while Huang explained the Chinese document I brought from Chinese to English. He prescribed some medicine for me, and he put the catheter. I was pretty happy at least I had some relieve. After waiting at the lobby for about 10 minutes, suddenly, I began to feel the pain rushing at me at the lower abdomen. It was quite bad, I began to have cold sweat, Dr. Tan quickly brought me into his room again and took out the catheter, and the pain still grew. He quickly took out a pain killer and insert into the anus, and I was rolling around with pain. It took another 10 minutes for the pain to subside, and he stared at me. Then everything was normal again, and it seems nothing had happened at all before this! So we just went home with the medicine. I go a feeling that the whole urinary channel is not swollen or inflamed. 

            So going home was going back to square one. Again, I cannot urine once I reached home. That next night again I cannot take it, and Choo brought me to the hospital again. The A&E doctor put back the catheter for me again. On 15^th, I went back to relieve the catheter in the morning at Dr. Tan place. In the afternoon, KC brought me back to Tan to check urine, I did passed out around 110 cc, but had a residue of more that 100 cc in the bladder upon scanning. To the urologist, this retention volume is still too high. As such Dr. Tan put back another and told me it will be for at least 2 weeks. He told me that I am having so much stress that I cannot urine. He does not think I have other problem at all, even a urine problem. On Oct 29^th, the catheter was taken out in the morning. Later we visited Eugene, he told me the blood parameter was a little out, and could be due to my urine problem( actually is the other way round), but he said he would like to monitor for another month when I get better with the urine issue. After lunch I went back for bladder residue check with Dr. Tan. Passed out 200, residue below 100 milliliter, I passed and return home. But urinating was still a painful work, and the volume was still small with frequency improving very little. We are supposed to meet a month later.

            Oct 30^th, I just wanted the morning to come faster than it was. I waited till around 8am, and got my self dressed, and went to take a taxi to the hospital. I wanted him to put the catheter back!! I did not sleep last night at all. Who said Singapore taxi is not making money.  For one and a half hour I just cannot stop one, I even do service call, but could not get a reply even. I knew most of the drivers were hanging around coffee shop. By the time I got one, it was already around 11 am.  Choo was there before me, and Doc. Tan quickly put a tube in to withdraw the urine content. Now the pain is no more at the bladder but the channel below the bladder, the feeling of the whole duct swollen. Dr. Tan told Choo that in his mind, I am too sensitive and too stressed, that physiologically I cannot piss. He kept telling me to whistle while pissing. To me, I am thinking I had been urinating since year one, why this problem now. I thought it would be easier if he cut out my prostrate. He thought otherwise, Lucky me, I had Dr. Tan, he did not knife me. Come to think of it, most professional do not like to do surgery as they are well aware of the damages it causes.

            Now, for the 8^th time, I am warded again, as Dr Tan had seen me and decided I should not be going home. I was fixed with catheter again for the next few days. There was no medicine except some relaxant and anti-biotic. Three days later, they found the urine I had dose have a Pseudo bacteria, called Pseudomas aeruginosa, 100,000 per ml!

 So Dr. Tan immediately changed the anti biotic for me. I got well very fast with the new antibiotic. On the second night, HJ and Edmund visited me, and I was complaining that the air was dry, Edmund went out to get me a bottle of plain Vaseline, I applied, within 2 minutes, I began to sneeze, and droplets of water came out of the nose, and that night, after a few sneezes, my nose bleed, about a tea spoonful of blood. Here it comes. As I knew, WG is very sensitive to anything except water, applied into the nostril. The next 3 days, the catheter was taken out and I was able to urine myself, but at slow and still painful paste. My residue of bladder content was measured and Dr. Tan found I was well enough, and on Nov 4^th, I was sent home, with the same medicine.

            I knew I had already damaged my bladder, or even the whole urinary channel. So were my eyes, kidney, nose etc.  It was still not easy, but I had to try, as the impression from my sister with the influence from Tan, or they also had in their mind, still thought I am full of stress, which is the main cause of my trouble. To me, I think it should be at least 50/50, 50 stress, from where I do not know, and 50 from real sickness. So I spent another week of poor sleep, again the call of bladder is now an hour or less throughout day and night. Strangely, as night passes, my nose began to drip blood around midnight to 2 am, each night, more and more. On Nov 10^th, I was shocked when I woke up and found that my left lower eye lid, half the nose, half the left upper lip and upper left jawbone were numb! The feeling was like going for a tooth extraction and after the doctor injected the anesthesia, the dumbness refuse to go away. I also felt that the left eye becomes very red and dry. Huang acupunctured me, but there was no relieve. Each day it got worse, and on Friday, I had no choice but I went to Hougang Polyclinic to see a doctor. The nice young Malay doctor was so patience with me as now my hearing was deteriorating. He tested me for stroke. I was found to be normal but he still arranged me an appointment at TTSH Neurology to test my facial numbness, on 16^th Nov, the coming Monday. I was also given some eye drops and vitamin E pill for my numbness and I returned home. By now my eye white is turning very red.  I was so happy and relieved that I really seen a doctor myself and for the doctor to arrange for me to visit the neurology, of which I can be there to see what else the neurology can help to expose my WG which I had been suspecting all the while, but dare not voice out. .

            Now the bleeding of the nose gets pretty consistent, nightly, with incremental volume. We visited Dr. Foo on Nov 12^th. We had a nice conversation of the to and fro of my traveling. He scoped the nasal cavity for me. He found some blood, and unsuspecting of any undoing of my previous illness, he told me I should be OK, and then he prescribe me with a week of anti biotic pill, Enchanic, and Encodine, to clear the internal cavities. (Coincidentally, the first visit to MT. Alvernia was Dec 17 2008, and the last to Mt. Alvernia was Nov 12^th Dec 2009, the first and last)

                        The night was tough for me, urine problem grew, and the eyes was giving another problem, the numbness of the face another one, the next morning Nov 14^th , I went to Cheah Family clinic to see the doctor again for my eye. What Polyclinic gave was just eye drop. In Cheah, which I did visited him once for sore eyes, and his medicine works. This time round, he gave me eye drops, but it did not work. My eye white had turned blood red by now, the nigh I was just waiting for the morning to come fast. Then come Monday, I went to TTSH. Attending to me was Dr. Sim Siew Hung. Since I had WG, nowadays, I had to spend some time explaining to her I had WG. She was very attentive, and also asked why my eye was so red, but I wanted her to help to arrange to let me see an eye doctor soonest possible. She then checked me for stroke again, and found nothing wrong with me. She then had me go for a full blood test, with ANCA c and PR3, C reactive protein, ESR and FBT …etc, most of the WG critical parameters. I think she does know quickly a lot about WG. She then help and arranged for me to see an eye doctor the next day, while I have to return to see her on Thursday. What a great relieve for me when I saw what she wanted in the blood test requirement.

                        The next day, I return to see the eye doctor. Again I had to explain about my Wegener. Dr. Ho Su Ling listened patiently. The checking of the eye took pretty long. Next I was given anti-biotic eye drop and steroid eye drop too. So, now I had to be with steroid on whatever sickness I had. I was told that there were little white patches of bacteria in the eye ball. She told me to be back on Nov 19^th.  I was also arranged for MRI, this will be able to find out any problem with my nerve for the numbness and my sever headache. While I was returning home, I got a call from TTSH Neurology. They wanted me to return the next day instead of Thursday. Well, I think something was not right at the brewing.  

                        The next day, 18^th Nov, my eyes got better, and but I visited Neurology Dr. Sim again. Here after some discussion, especially my headache, she blamed it on my ‘sinus’ problem as shown in the MRI report. But I insisted that my headache was well before… To me, the nostril cavity was filled with blood. The volume of blood from the past few nights was around two to three table spoonful per night, and was getting worse. I knew this blood flow is not a simple nose bleeding issue.  To them as long as it is seen in the MRI, it will be so.  The blood test result was not good, I cannot recall but the ESR and C protein was bad. I kept asking for PR3 and c ANCA. But the result was not out, and through these two months, this was only what I was interested.  As far as Eugene told me in the whole of Singapore there is only one analyzer for PR3 and c ANCA, which will run on every Thursday, and today is only Wednesday.  After a while, Dr. Sim decided to ward me in to the 9^th hospitalization for me! She felt that I am in a serious state enough that I could be required to return every other day for various test. So I was sent to Ward 9D, bed 127. I was also arranged to meet the ENT for my block nose too. She may transfer me to the charge of the Immunology Department.

Enter the Relapse of Wegener Granulomatosis (WG)

Nov 18th night, I was in the ward, not knowing what next. The amah even refuses to give me water, because there was no indicator on my bed. . I was not having medicine except those I brought from home from Eugene.  The following day, I began to have a lot of visitors, especially from Neurology final year student of Doctor Long. They were very interested in my post surgery face features. They need to know what will happen if the nerve is gone. Then met Dr. Tan Teck Choong of the Immunology department. We talked over more than half and hour, with few other doctors around. The few Neurology doctor began to review my numbness problem, trying to establish if I have stroke. But by now, my condition continued to worsen. My nose began to bleed more. Each time if it bleeds, I will sneeze, and it will flow out of my nose, or the other way round.  Some rashes on my face began to grow, and refuse to work with the normal drugs any more, even Dermovate, which is low steroid based, and I was using for at least 8-9 years. My face began to swell and turn reddish. Many joints, like my ankle or wrist began to ache. It is just like everything was falling apart in the body. The worst was a headache that was 24 hours bumping non stop. I remembered two weeks ago Patricia asked me if the headache was similar to those I had before, she sounded like she was trying to relate something. At first I said no, till few days later, did I remember it was the same. The severity, frequency and timing, all the same. 

On Friday morning Nov 20th, Dr. Justina and team visited me very early. They checked my derexity again, and while she was recording on the computer we discussed and she told me that my PR3 result came out and was way out at 150 now. Wow, this was bad. She began to prepare me for infusion of medicine for this WG. That afternoon I was wheel chaired to the ENT. The Doctor, SW Ng was very joyful, and he was wondering why I was there, as I told him he was to, but I will clean up my nasal cavity myself. He gave me a nasal spray, which I will not use. By evening, the infusion began. I was infused with 800 mg of cyto-toxin, IV cyclophosphamide, and 3 days of 60 mg of Prednislone of and a day of IV Methylpred 500 mg OM.  The following day, I was already put on oral steroid of 60 my and anti-biotic, followed by cyclophosphamide of 50mg too.

            On Saturday evening, another doctor from Neurology came to extract spinal fluid. They want to check if I had any bacteria attacking my brain or nervous system, that could cause those sever headache. The extrusion at the lower spinal cord was supposed to be very painful. The whole thing lasted less that 20 minutes, and the doctor was surprised that I did not move with the pain. But I told her that my headache was much worst, so I did not feel any pain at all. By Sunday, some pain were gone, rashes subside, swollen face no more. Yes, the drugs work, it means the Wegener did return as I feared and sensed in the middle of September. On Monday, I was visited by Dr Bernard Thong the senior consultant for the immunology department, and the team though has very little experience with people having WG (or may not have), they are very systematic and professional. Each move was well measured and taken. I was to be discharge on Tuesday, but now I was arranged to Neurology to be screened again on Tues, so I will be out by Wednesday. At the neurology, I was fixed with a couple of wires, and about an hour of test, nothing wrong was found in me. As I returned, alike any other day, another batch of final year medical student arrived. They asked question, work on my face. It was fun way of occupying me then.

Just the next day, Nov 26^th, I was in the coffee shop at Block 309 Hougang already. Recovery had been fast up and down. Ricky was with me and Choo, followed by KC. This time round, I found that my taste had improve at least 10 %, and I drank my first coffee black from months of abstains ion due to poor taste. With this stay, I found I am much more mentally ready, though physically weaker. I was also happy that the cost was now much lower too. Now I had higher confidence, such like another few guys know WG as compared to my fear before.  I was also very happy with every one there, from clerk to consultant, all of them are very helpful, caring and nice.

 On Dec 1^st, I returned to TTSH to be reviewed by Dr. Tan Teck Choong. My C Reactive Protein was 9.9 as compared to normal person of 5, was the best since blood test of such was taken this January. ESR was 39, compared to normal of 30.  Other blood parameters were relatively good. I showed him the pimples coming out of my back, and immediately Dr. Bernard the senior consultant reduced my steroid from 60mg per day to 50 per day. I also advised them that my stool has a lot of blood, all due to steroid. Most of what I mention was recorded, and look like to them, all are relatively new. I also request him to give me a c ANCA and PR3 test every 2 months, of which we finally agree to 3 months.  I will be returning on Dec 23 for review.

 Dec 3^rd, I went for review with the Eye doctor and same, the result was good, but Dr. Alvin Lim told me I cannot stop the steroid immediately but just had to step down like 4 drops per day to 3 to 2 to 1 drop per day, within a month. This is the problem with steroid. With Dr. Alvin and Ho, we had a good talk on the WG. Look like Dr. Alvin is pretty studied on WG too. He was mentioning about cycto infusion during my second visit.  I am to review with them in two months time.  Going over to the ENT doctor, I told him why I did not use any of the drug he prescribed, he was smiling, accept my idea and told me patient know best. Again we discuss a little about the WG, and I had to review with him in 3 months time.

Aftermaths

After a week of steroid, my weight went up to 58.5 kg, and is still going up, as appetite is terrible good, even though the stomach was full. Today is Dec 18, and after a month of this WG suppression at the Tan Tock Seng Hospital, I think I am handling this WG sickness much better. Today is also a year since I had my nose operation, ending one year of agony and pain.  Today I will give my sisters and family a treat. Sorry I cannot give a treat to everyone for their care. Physiologically I am now more prepared, and I do not think I want to fight with the quantity of medicine prescribed like before. 

For now, each day, I will have headache from around 2 am to 10 am, this is when the steroid has lesser power. I took my steroid at 7 am every morning. I will be seeing blood in the stool daily till steroid reduced to below 20mg per day, and I do not know when this time round, will the doctor reduce the volume of Prenisolone. I can ask, but will not insist a reduction like before. Between 1 pm to 5 pm, I will be very tired and panting for breath as the cyclophosphamide began to work. I will have insomnia and every square inch of my back, now spreading to the front belly is filled with pimples. This will only disappear when steroid drop below 5mg per day. I will be eating non stop till steroid goes below 20mg per day, and now my face will be round and my belly will be like a pear. I will also find my skin and the body not sticking together. I can peel the skin out exactly like a cook potato skin.

WG is not a local, then why I have it?  I think it is more common than many doctor thinks. Each time I talked to a doctor about WG, they say it is a theory sickness for us Asian. I got a feeling that not many can survive to tell a story to help out any future victim. If I did not meet Dr. Eugene, or Dr. Foo, there will be no story today. Or if I did not go to TTSH, this story would be half way, but not sent out. Based on the way it destroyed my gum, it could just take 10 days or so to destroy any kidney or liver, ending up with doctors diagnosing as other sickness.

By the way, do take a lot of calcium; for steroid just dissolves your bone and muscle at a speed you actually can feel it. Then, ensure you do a lot of exercise. You will tend to be very lazy due to the mental torture of this sickness with physical slackening during a long stay at the hospital, and unless you do a lot of moving and walking, your insomnia is going to disturb you a lot too. So exercising helps to build you up and tired you down to have some proper sleep. Also as there will be a lot of medicine in you, it weakened you very fast. Like my April stay of 17 day, ended me almost not able to walk when I was discharged.  

An advice for Doctors pertaining to WG.

To me, a few front line doctors that is crucial to this disease, the dentist and the ENT doctor and for me the Urologist too. Watch for the gum, when it does not heal. Watch for the nose, when it bleeds without stop. Watch for the urinary problem when it does not react to medicine. For ENT doctor, do not operate if swelling does not subside!  For the dentist, if the gum does not heal, For the Urologist, not to operate if medicine is not helping. Even for a normal doctor if you have a guy the seldom or never sick at all with normal flu, watch out. He might have an immune system too strong.  Please arrange patient for the ESR, C Reactive Protein, c ANCA and PR3 blood test. It may delay a few days and cost a few dollars more, but is sure going to help, like wise, I am alive today. 

Living to tell this story is not easy. Imaging having headache throughout the year, and all your love one from near and far worried, rushing to hospital to see you, and try to make you happy while you just cannot concentrate on their jokes. All the people following you around to doctors, visiting you in the hospital, and everyone busy on you. Financially you will be torn down. Physically, you only have the mind and the bones standing. Today, I am retuning to square one on my treatment, of course hoping the WG would not make any more relapse for a long long time to come. I just do not know how to thanks the so many people with me, but thanks.

My next appointment will be Dec 23^rd, by then I should know better what the next thing I have to do is. As Florence mentioned, “what cause a relapse”. If the origin is yet to be known, I believe relapse as puzzling. I feel the WG is already with me, so it occupied 30%, another 30% could be environmental, including stress, work and weather. When the weather change, my nose have problem. The other 30-40% of a relapse if any should be from our intake of food. My life time experience of ‘heatiness’ means food does cause problem, significantly to the liver, AST and ALT. I will spend some time to study this and let you know. I do have an idea to study it. I think Dr. Tan TC will help by letting me have the blood result monthly.

Until Dec 23^rd 2009 to update, that all for now.

END

Sign that you may have WG in you.

Gum that swell, change to darker colour and does not heal

Not scared of cold weather

Nose is block or congested for a long duration

Heatiness that does not cool

Anti oxidant is useless

When normal medicine just do not work

When you normally do not fall sick when other are sneezing away,

When your nose start to bleed more and more volume at higher frequency.

When it comes or Return.

So now I know that when the WG comes, it will hide behind something else. Well published document, easily obtained from the records is the nose. Like me, with a congested nose, looking like a normal sinus problem even through the eyes of many specialists, but once operated on, the WG lid just blew up. Nose will also bleed when the seriousness increased, and volume of blood drip out will increase with the severity. Secondly is the gum, it rots away like shown in the horror movie. Dentist may find the purple gum too scary to look at, like a rotten strawberry, but is it also a sign of WG coming. But now that my operated nose is bigger, it is not going to be noticed if it hides behind the nose.
            At times some nerves or nodes will be painful at almost the same time too. One other symptom is the strange ever lasting headache. Dr. Tan PK told me I had migraine. The pain is every corner of the head, and the position of pain shift as days goes by, starting at the inner left lope to the back then the front and eventually in between the scalp and the skull, will also be the last position, where till you touch a hair and have a severe headache.

I had bladder or urinary problem 3 times, and each time WG was with me, at a high PR3. Each time medicine does not work and it just will one day disappear, when Steroid or Cyto began to work. Only now after months of bladder and urinary problem that my bladder began not to hurt! I hope it heal fast, as cyctophoshamite one serious side effect is cancer of the bladder, oops, got to be fast to have the strength to sustain the onslaught of those drugs. Certain time, joints can be painful, those cold shoulder, old sprain points that was ‘cured’ 20 years ago will suddenly appear over night. Rashes will also not react to the normal medicine.

Advise to Surgeon/ doctors again:

Do not operate if any swelling does not subside.

Persistent and difficult to describe headache for weeks.

Body refuses to react to normal drug.

Body refuses to react to anti-oxidant.

For nose, when it swell when react to any nasal spray, except pure saline.

Please send patient for a c ANCA test and PR3 blood test, you just need to wait for a few more days to confirm. Basically, once the WG attacked, it is only a matter of 7-10 days when you just expire. As I mentioned, the WG will caused the operated part not to merge, or heal. If will open up the wound after a few days as and when it like, without warning.

Sign of Relapse:

Urinating: It can hide in the urinating system. I had three times with it come hidden in a form of urinating problem. Either you cannot urinate, or it stops the kidney from generating urine. This can last for around 2 months. The last I had come in late August and till it comes in full blown in November. Thus it means this Wegener comes pretty slow and does give a lot of signal that it is coming back. Maybe I was still on a daily dose of 5mg of Predinsolone and Myfortic. However, if the urologist is not experience, and operate upon your complain of block and pain, you could die in the operation where I assume the bleeding will not stop as the wound will not heal due to the Wegener !

Rashes grow: those rashes that you ever use steroid to heal will return and it gets wider by the day. In the past you may just wash, apply some cream and it is ok, but this time round, it reappear every other day, and cannot subside. Also those rashes, they called butterfly, around the nose, look swollen as compared to just redden patches as per normal.

Sever headache: The headache comes pretty terrifying. The pain for me started in the left lope at the back of the head, then it move to the real back, then to the front in between the eyes. Eventually it traveled to the temple. There is just in a matter of a week or two. Soon it goes back to the back of the head.   Finally, it ended up stranger, in between the skull and the scalp of the head. This means if you touch your hair, just one there is severe headache. This pain arrives periodically though the whole day, and worst for me is after around 6-7pm, and will last till 3-4 am but most of the time , though out the 24 hours, more or less. 

Certain places of body get numb: there will be patches of the body that numbness will come. As it comes, today may be the first three fingers of the left hand, but tomorrow could be the toes. This time it activated me to see a doctor is I was woke up to find a facial numbness (L V2-3 x 1/52), without pain, supposed to be control by the 5^th nerve. . As I knew, if it strikes the area, in the future, the numbness could reduce, but will stay, it does not fully heal, I think the nerve there will be gone.  For how long I do not know, but till now, most had been with me ever since. So if this WG strike you a few times, you can expect many area of you body to be numb forever, so as big an area as 5 square inches.

Pain comes from every corner and cannot subside: Beside numbness, pain. I found that as the WG get worst in term of PR3 figure, maybe 150 RU/ml, those in the joints pain that occur to me 15 to 20 years ago will suddenly return over night. For example those gout and cold shoulder can suddenly return over night, and then disappear in a day or two. This terrible as you woke up and found pain all over.

Heatiness that cannot cool down: Well as Asian, heatiness. I for one had not ever seen a doctor for flu, but I do see doctor for heatiness. Which means my body is burning up internally due to taking fried food too frequently or having excessive food than my body required. The breathing get tight and the nose get blocked. What we normally do is to get some cooling tea or herbs (I think western doctor call anti-oxidant). The more bitter the better. In a day or two the body will cool down and I get better again. However, as the WG PR3 rise or relapse, how much cooling tea is no more useful. I first experience, I drank all sort of bitter cooling tea for 4-5 months non stop, and it just do not cool me down, till I went for my nose operation.  Come to think of it, for a normal person, he would be over cool and cannot even walk, as the knee should be soften too much by the tea.

Nose bleed: this is the last and final signal WG gave. As the urgent and most crucial signal comes, about 3 weeks prior to “dangerous/serious (D/S)’, the nose which mine was operated, the one year old wound began to bleed. Three weeks before D/S, we find spec of blood in our flam. Soon it just get bigger or more, and about 10 days before D/S, I get 3-4 drips of blood. Just a week before, I can say if began to flow out by the spoonful. Most flow happen in the middle of the night. I sense the head ache began to grow, and suddenly the blood will ooze out of the nose, by now about a table spoonful, and it will just stop as it come suddenly. Once this pattern comes, it will be almost uncontrollable. Maybe the end of you.

Medication and Monitoring and Suppression

This could be because I am still on daily 5mg of steroid maintenance. Looking at it unless we suppressed the Wegener, till the PR3 reading goes closer to 60 as compared to below 20 as with normal people, 5mg could be too little too fast as maintenance. I started 60mg on February, but by July 25^th I was already on 5mg. All the while I wanted the steroid to be reduced as soon as possible. This could be a failure for me. I am not at ease with drug, so when doctor prescribed me with drug, I just resist. By now, I also know when I can move around freely. My best guess is my PR3 should be around 60 or 50 if I want to travel freely. Last I moved was when my PR3 was 101, and C Protein was above 30 (normal is 5 and below). Recalling I did not have a two weeks of comfort range, having up and down through out the whole year. In all it means all this while, the WG was hanging in me, floating up and down depending on my stress, environment and food to allow it crossing the limit.  So relapse may not be the word, but insufficient suppression should be the real thing happening to me.

Today I even do not have full hearing, but is improving. Shampoo does not smell like shampoo, but some new smell to me. But is improving. Taste, there are considerable amount of taste butt lost, but is improving too. Everything is improving.

Cyclophosphamide is one of the drug cocktails I had to live with. According to Dr. Eugene, 50 mg for me is not sufficient, on the other hand 100mg seem too much for me. However, this slow reactive drug does cause me some trouble. The first time I had taken it, I used to foam like a washing machine in the evening. This is the reason I switch to Myfotic. Dr. Eugene told me to be very careful of the liver AST/ALT when I am on this drug.

Steroid Prednisolone is a destroyer but a saver to me. Once you are on, you cannot get away. There is no immediate withdraw but just stepping down. The side effect is many and difficult to deal with. Upon over dose, the whole mouth could be flooded with ulcer. I was lucky second time. There will be a lot of blood in the stool. One should ensure to take calcium when you are on this steroid. On the first one two weeks of taking Prednisolone, you can start to feel or hear your bone joints cracking up. You can hear many part of the body making noise as it dissolves your bone pretty fast. 

Bitter gourd, orange and apple juice is the concoction I used to suppress such ulcer coming up. In the past Nystatin(Mycostatin) was used to suppress the ulcer. This time I will use 2 apples, one orange and 150-200 grams of bitter gourd, juice it and drink. So far since the relapse I do not have ulcer coming up, thank to Florence idea from her tour of Taiwan. For every 10 days, I will need to concord three days of it.  Once a while the throat may ache, and this is when the juice comes in and I might use the Nystatin at nigh before I sleep, but this time round, much lesser frequency, about 1/10 lesser.

Blood test :  I suggest that blood test for the below few parameters should be taken at least once every 2-3 months instead of every six month as prescribe in the book .Yes, it was six month, but then technology was low, but I think it is too long. c ANCA and PR3 is a new test, but by my experience, it is a key indicator of any WG relapse or measurement, so please 2-3 month. Moreover, it is not expensive if taken together with other test.

            They are c ANCA, PR3, ESR, C reactive protein.

Very Special Thanks to:

Patricia, Huang, Florence, Choo

 

 

Special Thanks to:

Dr. Foo Toon Hiong, ENT Mt.Alvernia

Dr. Eugene Lim, Immunology, Mt. Alvenia

Dr. Tan Peng Kok, Urology, Mt. Alvernia

D. Abdul of Hougang Polyclinic

Dr. Sim Siew Hung TTSH Neuro

Dr. Tan Teck Choong TTSH RAI

Dr, Justina Tan  RAI

Dr. Bernard Thong RAI

Dr. Ho TTSH Eye

Dr. Alvin Lim Wee Tiak TTSH Eye

Dr. NG  SW, TTSH ENT

Nurses of Mt. Alvernia

Nurses of TTSH W9D

Andrew Lim

The Writer

            Andrew Lim, born August 1955 at 793-G Florence Road, which became 6C, Lorong Tombong. On 1970, moved to 205F Ponggol 17^th Avenue, then to Blk 5 Lorong Buang Kok and at last now to Hougang, listed as Pasir Ris, Bedok, but actually some where on the old Ponggol Rd, we called 7 ½ milestone . The last time I remember I was sick, was in Primary 4 or 5, when my mother carried me on a bicycle to Serangoon Clinic for a fever injection. I was not sick for flu, but heatiness. Each time my metabolic was not able to burn the amount of food I take or over eating of heaty food, I will find myself burn to ‘sickness’, never hit by flu.  So since I can remember, I had not been to see a doctor for flu. Yes, I did go for oncology, cutting of growth like corn, but never flu. I even had once with a kidney stone, the crystallite type, which after few weeks of pain passed it out myself, as x-ray cannot detect. I do not easily eat any medicine, normally I see a doctor, returning home not satisfied, will immediately throw all medicines away. In fact it was my claim of my flu-less well being that had partially led Dr. Eugene to diagnose me with this disease before the blood test result was out.  My best medicine had been all sorts of cooling tea. Rarely western medicine, not even Panadol.  Is this that I am born with Wegener?   

            I am also very kiasu since young. I am hyper active so I am very poor in my study. So since I left school, I had a fear of failure, because I failed all over the schooling years. So I began to challenge each time something that people are struggling to do. So from 1976, after I left the army without an occupation, unlike the rest of my friends, I set my mind that if you can do, I will be better. So since the mid 70’s I cannot fail in what I set to do, this became my life motto. Then eventually, I was working for a top multi national, and of the 30 plus years with this single company, I did not miss a single target until the day I left.   Is this that Wegener is cultivated?

            The origin of this Wegener Granulomatosis is relatively unknown, so is the relapse. I hope to post this up so that medical student is aware of this disease and can take a more cautious approach. Hopefully with the current technology, Singapore can run the c ANCA and PR3 twice a week instead of once a week. Also liberate this test. I find testing will be at least a thousand times cheaper to test for the WG than having an infusion to repair the damage it caused. Dentist, ENT and Urology guys will also have to watch out for signs. We can dig some more of such patient out from those that might have WG hiding somewhere. I to now still very strongly believed that there are sure more people with WG that we can think of. The only thing is not many can or lucky enough to last to tell a story. They may just be waiting for a flare up. He or she might just go away to another world after being diagnosed for some thing else. By the way, actually are there any existing patients in Singapore now?

My Blood Test Records

 

Andrew Lim
																	TTSH
			22-Jan	12-Feb	25-Feb	23-Apr	30-Apr	21-May	18-Jun	16-Jul	23-Jul	30-Jul	13-Aug	3-Sep	15-Oct		30-Nov	####
BIOCHEMISTRY
																TTSH
GENERAL CHEMISTRY	Reference	Unit	Result	Result	Result	Result	Result	Result	Result	Result	Result	Result	Result	Result	Result	Refer:	Result	Result
Creatinine	53-115	umol/L	60	61	82	53	50	66	65	70		69	70	82	74	60-110	75
Uric Acid	212-435	umol/L				278
Alk Phosphatases	35-120	U/L				237
Blood Glucose	3.6 – 6	mmol/L	3.6	na								5.1
SGOT/AST ( liver)	0-40	U/L	95	28	29	47	39	35	51	222	451	304	20	16	15	15-41	22
SGPT/ALT (liver)	3-40	U/L	345	78	79	111	112	56	77	462	739	599	27	12	11	17-63	40
Cholesterol	<4.1	mmol/L	7.45f									9.07
Triglycerides	<2.3	mmol/L	2.67									1.5
HDL – Chol	>1.0	mmol/L	2.24									2.59
LDL – Chol	<2.6	mmol/L	4									5.8
Cho/HDL Ratio	0- 4.5		3.3									3.5
SEROLOGY
C- Reactive Prot	0-10	mg/L	<5			199	147	97.5	49.9	14.9		24.2		23.4	55.3	0.0-5.0	9.9
HEAMATOLOGY
BLOOD COUNT
Heamoglobin	13.5-18	g/dL	14.5	13.9	12.7	11.2	11.3	11.1	12.2	13.2	13.5	13.7	13.8	13.5	12.8	13 – 17	14.1
PCV	40-54	%	na	na	40
RBC	4.5-6.3	mil/uL	4.62	4.41	4.25	3.58	3.63	3.59	4.05	4.32	4.54	4.45	4.48	4.34	4.16	4.4 – 5.7	4.55
Heamatocit	38-52	%	42.3	40.6		33.3	33.7	33.9	36.9	40.1	41.9	41.8	40.2	39.1	37.5	41-51	33
MCV	76-97	fL	91.4	92.2	93	93.2	93	94.4	91.1	92.8	92.4	94	89.6	90.1	90	82-98	94
MCH	26-32	pg	31.3	31.5	30	31.4	31.2	30.8	30.2	30.7	29.7	30.8	30.7	31.1	30.8	27-33	31
MCHC	31-36	g/dl	34.2	34.2	32	33.7	33.5	32.6	33.2	33	32.2	32.8	34.2	34.5	34.2	32-34	33
RDW	11-15.6	%	14.2	15.1		16.9	16.8	16.8	16.6	16.2	16.3	16.7	16.2	15.6	14.4	11-15	6.4
Platelet	140-460	ths/ul	754	381	367	493	717	733	626	503	517	522	569	439	540	170-420	632
WBC	4-11	ths/ul	25.14	14.22	12.5	16.96	13.67	13.99	11.64	10.25	9.29	9.62	10.08	9.97	12.18	3.6-9.3	15.7
DIFFERENTIAL COUNT
Neutrophil	40-75	%	92	92	90	91	84	89	82	76	75	72	85	81	82	1.4-5.9	15.38
Lymphocyte	20-45	%	5	4	6	4	6	1	8	13	13	13	9	9	8	0.9- 3.3	0.26
Monocyte	3-11	%	3	4	3	3	8	5	5	5	5	8	4	5	4	0.1	0.2 – 0.7
Eosinophil	0-6	%	0	0	1	0	0	4	3	5	7	6	2	5	6	0.0 – 0.7	0
Basophil	0-1	%	na	0	0	0	0	0	0	1	0	1	0	0	0	0.0 – 0.1	0
N Myelocyte						2	2	1	2
BLOOD BIOCHEMISTRY
Liver function Test A
Total Bilirubin	3-24	umol/L	na	na	18						21
	0.2-1.4	mg/dl	na	na	1.1
Total Protien	60-80	g/L	na	na	60
Albumin	37-52	g/L	na	na	34
Globulin	25-39	g/L	na	na	27
A/G Ratio	1-2		na	na	1.3
Alk Phosphatase	35-120	U/L	na	na	226						192
Gamma GT	Nov-50	u/L	na	na	356
RENAL FUNCTION A
Sodium	135-150	mmol/L	na	na	125
Potassium	3.3-4.9	mmol/L	na	na	3.6
Choride	95-108	mmol/L	na	na	86
Bicarbonate	20-32	mmol/L	na	na	26
Urea	1.7-8.3	mmol/L	na	na	2.1
	10.2-49.8	mg/dl	na	na	12.6
	0.9	mg/dl	na	na	0.9
SPECIAL HEAMATOLOGY
ESR	2-30	mm/hr	20	30		111		114	79	15		17	22	29	50	1-10	35
URINALYSIS
MACROSCOPIC ANALYSIS
Ph			5.5	7	7	7		7	7					7
Sg			<1.005	<1.005	1.010	1.010		1.010	1.010					1.005
Protien			Neg	Neg	Neg	Trace		Neg	Neg					Neg			Neg
Glucose			Neg	Neg	Neg	Neg		Neg	Neg					Neg			Neg
Ketones			Neg	Neg	Trace	Trace		Neg	Neg					Neg
Bilirubin			Neg	Neg	Neg	Neg		Neg	Neg					Neg
Blood			Neg	Neg	Trace	Trace		Neg	Neg					Neg
Nitrite			Neg	Neg	Neg	Neg		Neg	Neg					Neg
Urobilinogen			Normal	Normal	Normal	Normal		Normal	Normal					Normal
MICROSCOPIC ANALYSIS
RBC/hpf		0-3	Nil	Nil	3	Nil		Nil	Nil					Nil		1-13	8
WBC/hpf		0-6	0-2	0-2	5	5-8		0-2	0-2					0-2		0-6	9
Epith Cells/ hpf			0-2	0-2	0	2-3		2-3	0-2					0-2			3
Organism					Nil
CASTS
Casts			Nil	Nil	Nil	Nil		Nil	Nil					Nil			Neg
CRYSTALS
Crystals			Nil	Nil	Nil	Nil		Nil	Nil					Nil			Neg
PR3		>20	171					101									150
																	Nov 18th

       

Reviewing the above, there are three crucial points to look for other than the c ANCA which is not indicated here. To me these four parameters are the most crucial when monitoring the WG strength.  First is the C-Reactive Protein. The best was on Dec 1^st 2009. Other than that the other lowest was 14.9 on 16^th July. The norm is below 5. Second was ESR, on the same date, was 15 at the best against the norm of 30 below. . Then the third was PR3 at 101, around the timing region, versus the norm of below 20. Was the period of end July to mid August my best time? I recalled it should be. I recalled by the end of August I began to find places that were closer to toilet, as I began to feel somewhat irritating. What is puzzling was that period was also when my ALT and AST at their worst. So as per most doctor advises, the cocktail of drugs for the Wegener have very slow delay effect. Which means it is not the WYSIWYG, it is going to come earlier or later then result shows. It can be said that it can be like chasing after a shadow.

We may be easily distracted by the falsehood of these WG, where it hides in other aspect of health, and appear at the last minutes, significantly appearing when my nose started to bleed!  I for one, would try not to let this WG relapse again. It was a full year of pain for me. Pain is descriptive, not measurable, but equating a toothache, I prefer to take a few toothaches at a time, rather than the pain caused by this Wegener Granulomatosis for a day.

Ending so far.. Dec18 2009

WEGENER BLOOD TEST 3

 

Andrew Lim
		TTSH	TTSH	TTSH	TTSH	TTSH	TTSH	TTSH	TTSH	TTSH
		30-Nov	23-Dec	19-Jan	17-Feb	24-Mar	5-May	9-Jun	19-Jul	5-Aug
BIOCHEMISTRY				2010	2010	2010	2010	2010	2010	2010
	TTSH
GENERAL CHEMISTRY	Refer:	Result	Result	Result	Result	Result	Result	Result	Result	Result
Creatinine(kidney function)	60-110	75	93	87	94	95	83	85	76
Uric Acid
Alk Phosphatases
Blood Glucose								5.3
SGOT/AST ( liver)	15-41	22								24
SGPT/ALT (liver)	17-63	40	24	30	31	39	28	22	20	20
Cholesterol	Below 6.2					7.2
Triglycerides	1.7 ~2.2					1.2
HDL – Chol	B 1.6					2.8
LDL – Chol	B 4					3.9
Cho/HDL Ratio
SEROLOGY
C- Reactive Prot	0.0-5.0	9.9	16.4	0.8	15.3	2	14.1	51.1	77.7	4.1
Creatine kinase	50 – 250								49
HEAMATOLOGY
BLOOD COUNT
Heamoglobin	13 – 17	14.1	14.1	14.5	14.1	13.8	13.2	13.3	13.2	13.5
PCV
RBC	4.4 – 5.7	4.55	4.59	4.58	4.24	4.07	3.73	3.77	3.77	3.98
Heamatocit	41-51	33	44	43.9	42	41.5	38.4	38.5	38.6	40.4
MCV	82-98	94	96	96	99	102	103	102	102	102
MCH	27-33	31	31	32	33	34	35	35	35	34
MCHC	32-34	33	32	33	34	33	34		34	33
MPV	7-10						6	5.8	5.9	6
RDW	11-15	6.4	18	18.9	18.9	17.8	16.1	15.4	15.2	15.6
Platelet	170-420	632	404	324	368	330	356	416	449	431
WBC	3.6-9.3	15.7	19.1	10.3	12.7	8.9	9.8	7.8	8.5	9.1
DIFFERENTIAL COUNT
Neutrophil	1.4-5.9	15.38	18.52	9.07	11.43	7.47	8.32	6.13	7.27	7.43
Lymphocyte	0.9- 3.3	0.26	0.53	0.7	0.73	0.81	0.66	0.81	0.56	0.87
Monocyte	0.2 – .70		0.08	0.5	0.49	0.62	0.73	0.66	0.51	,73
Eosinophil	0.0 – 0.7	0	0.02	0.02	0.01	0.02	0.1	0.2	0.16	0.1
Basophil	0.0 – 0.1	0	0	0	0	0.01	0.01	0.03	0.03	0.02
N Myelocyte
BLOOD BIOCHEMISTRY
Liver function Test A
Total Bilirubin
Total Protien	63-81						60
Albumin	35-48						34			37
Globulin
A/G Ratio
Alk Phosphatase
Gamma GT
IgG	8.5-19.5						7.3
IgA	1.5 – 4.5						1.7
Igm	.4 – 2.8						0.3
RENAL FUNCTION A
Sodium
Potassium
Choride
Bicarbonate
Urea
SPECIAL HEAMATOLOGY
ESR	1-10	35
URINALYSIS
MACROSCOPIC ANALYSIS
Ph
sg
Protien		Neg		Neg	Neg	Neg			neg
Glucose		Neg		Neg	Neg	Neg		Neg	neg
Ketones
Bilirubin
Blood
Nitrite
Urobilinogen
MICROSCOPIC ANALYSIS
RBC/hpf	1-13	8	0	1	0	5	1	0	6
WBC/hpf	0-6	9	3	16	1	9	2	8	5
Epith Cells/ hpf		3	0	17	1	7	1	6	7
Organism			Neg	Neg	Neg	Neg		Neg
CASTS
Casts		Neg	Neg	Neg	Neg	Neg	Neg	Neg	neg
CRYSTALS
Crystals		Neg	Neg	Neg	Neg	Neg	Neg	Neg	neg
PR3		150			<20
		Nov 18th			Negative
Folate	8 – 30						25
Vitamin 12	133 – 675						219
Thyrixine, Free	8 – 21						12
TSH	.34 – 5.6						1.3
What the fish, I nearly got into a relapes again. Look at row 21, CRP, it raises from March at 2points, raising to July at 77.7 points, where rashes began not to accept drug, and my nose, began to bleed again. Luckily my doctore increased my dosage of Steriod from 10mg per day to 20.mg per day. Now I am taking 22.5 mg per day, which I believe my trashold for steriod should be 25mg per day.

Coconut

                   LAST TIME COCONUT John was about half the school age elder than me. He was not the angel type (I saw him last week, Jan 18th 2010, near Hougang Blk 309), and Lucifer would had called him brother. He is the eldest son of our neighbour Aunt Pek Huang. I was then, only in primary one, and it was our first semester vacation. On morning, at around 8 am, I was wasting my time near to Ah Ter provision shop, doing nothing. John came to me asking “ Hey, you want to drink some coconut water” “ Where to find ” I replied “ Come follow me” he said and I did.

                     Both of us walked to the charcoal producer, near to Ark Bor (mother duck) estate. Beside the road stood, a small pond, and at the edge, stood a lone coconut tree, maybe six to seven years old. Young tree as compared to most in our village. The moment we reached the place, John pointing to some fruits up the palm tree said, “ There, the three coconuts up there, those are very sweet, and the flesh is tender too. want to try.?” Looking up, “ How? So tall, no stick long enough to bring them down” I said.“ Aiyah, you climb up lah, not too tall what” John said. “ I don’t know how to climb, and what happen if I fell down” I replied. John interjected. “ Don’t have to worry, if you dropped, you will drop into the pond, and there is water, you will only get minor injury, no big deal”

                     Kind of a logical deduction. So I got close to the coconut palm, kicked off my pair of red clogs that I was wearing, and started towards the first step by hugging the trunk of the palm. John watch, but quite a few steps away fearing that I might dropped on to him. He was too smart as compared to all of us. 

                   The diameter of the trunk was very big for me considering my arm length it seemed, so the next step was to lift up my legs. I did it. Full hug for the trunk. Like a Panda on the bamboo stalk, how to move the next step was a big puzzle, I do not have the panda crawl sto work with. So, I look towards John, and he just waved the up signal that was all. So, heave, I move my hands up with a smack sound. The whole body on the trunk. It seems to be hours when I finally in the motion of an overweight caterpillar, managed to inched up to the end of the palm. 

                    “ Now, what next ?” I asked John. “ Stretch your right hand and twist any of the three coconut one by one “ I did what was told. These fruit was big and after twisting a few rounds, I was tired, and looked down towards John, yelled “ Hey, John , my hand is very tired” “ Why, you do not know how to change hand ?” John replied, making me look stupid. Changed hand so did I, till one of the coconut dropped. The second fruit was easy. But the last was tough. I was already shacked, and the third fruit was standing alone, as you twisted it, it recoiled back, and just keep on repeating. I tried pulling it, and it did not work, as it was too tough and by then I have already no strength. I gave up. Looked down, and called “John , how to come down ? “ John was busy looking for the two coconut on the ground lying in the tall grass, looked up and yelled “I am not too sure, maybe just slide down” “ What, I cannot hear you. ?” I barked back. “ Aiyah, slide down lah.” John yelled again. 

                           There was no way I can inch down as I had no more strength to griped tight to allow my legs to be free to inch downward, so I must slide down. “ John was right, and very smart”, came to my mind The trunk was still with the morning dew and was pretty slippery, so sliding down was not so difficult but painful that was all. When I stood on the ground my legs was trembling, looked at my chest, blood was oozing all over, tree trunk against human flesh. I am in trouble now. John, took a fruit, smashed it against the tree trunk and as the nut cracked, started to drink from it, passed me some, and as the frest fruit juice flowed onto my chest, boy, was it more painful. “ Ouch. ouch” I exclaimed. “ I am going to be in trouble when my mother see this” I said. John, took a look and said “ No problem, just wear a singlet when you reached home” Good idea, but I seldom wear a shirt unless I am sick, so chances will be that I will still be in trouble.

                     Other than thinking of the problem to come, I was pleased to have conquered the first coconut palm, further more, it was true that the coconut water from this palm was sweet and the flesh was tender, as John claim, so I turned to him and asked, “ How do you know the quality of this palm fruit, did you pluck from here before” John replied “ What ? I never climbed a coconut before, and someone told me this palm fruit was sweet” At least I learnt three lessons, one was that this is a good palm tree, and second, never to trust John, and third, do not climb a palm tree with such big trunk diameter.

                             Not many people can climb coconut palm. I did not get into trouble when I went home that day, nobody wants to take notice of me anyway. A few days later, I called Botak, and we want to the Lower Payoh( swamp) and showed him how to climb one. This time, it was a very tall one, almost treble the height of the previous one, and as I climbed, he watched me and keep on yelling “ Hey, be careful, Hey, be careful” I was touched as compared to my outing with John, at least he cared. From then on, coconut dessert was no more difficult to get. Can be obtained anywhere and when I want. This time round, I will not be clinging to the trunk to twist the fruit, now, I would go up and sat on the leaves near the shoot and stamped down as many as I want. I was also able to choose between the age of the fruits by the look, whether was it old or young tastier ones..

                      Soon enough, the stupid school reopened again, and as I went up the primary education ladder, my climbing skill improved further in height. Soon, I was earning pocket money from plucking dried coconuts for sale to Mr. Arrh (the laksa seller) for ten cents each. At times, climbing a tall trunk could means just only one fruit, of ten cents that was all. But ten cents allowed me to buy back a bowl of laksa noodle. On some days, I was able to climb as many as eight to ten palms. This beats looking for one on the ground, as most were collected by people living nearby. Eventually, even to find one palm to pluck becomes scare, as these fruits took months from flowering unitl ripen, and to make matter worse, young ones was already harvested by us for drinks. 

                        Over the Tua Long Kow( Big river) currently the one beside Hougang Stadium, was Mr. Tua Jiak(Big size) duck farm, where coconut palm was plentiful. That became our next hunting ground for sellable coconuts. Whenever it rains, few of us would be scouting in the estate for the nuts. A good harvest could means as many as six to seven. Here the palm was younger, and the fruit bigger, which could fetch fifteen cents each from Mr. Arr. It was hard dangerous work. Mr. Tua Jiak would sometimes weld his short gun chasing at us for taking away his fruits. 

                    Soon, I had been forced into the secondary school for the passing of the primary education, and this time, almost once a week I would be climbing palms for drinks. Selling dried fruit was getting no where, as it was getting lesser profitable, considering the long journey I had to take to look for coconut, or the scarcity if I were to climb for one. One day, Madam Ma Chai ( the noodle soup seller‘s, one eyed wife) use to sent coconut oil to his children in China as medicine. She was paying as much as six to seven dollars per half litter bottle. This was a huge sum in the sixties. So I was wondering what could I do to benefit from the situation, I went back and asked granny how coconut oil came about. That was it , so simple.

                 I began to collect coconuts again, this time, I care less whether it has a shoot sticking out, which signify too old, where Mr. Arr would not want it, or the husk was greenish, which was too young. Every types would be all right to me now. I do not want anything else except the oil. First, dehusk all the coconut I had, grind the coconut against a jagged metal plate, and got all the fine bits of coconut. Then squeeze the juice out. Pour the juice into a heated wok. Add some water to the coconut again, and churn the coconut bits, squeeze the coconut again. This was repeated till there was obviously there was no more juice to be squeezed out , throw them away.

                      On the other side, the wok, with fire heating underneath. The coconut was kept boiling, then as it began to dry, pearl drops of oil began to appear. The aroma was very strong and nice. There it was, my first bottle of home made coconut oil, 100% pure. Twelve coconuts to make a full bottle of concentrated oil. Three bottles were sold to Mdm. Ma Chai, at four dollars each, and she wanted more.

                       Now, where to find so many coconuts. In business, I must make sure that I must be able to ensure constant supply. That evening, I asked mum “ how much is a bottle of groundnut cooking oil” She shot back “ Why ? a dollar and twenty” I left the kitchen, and the next day, I began to make coconut oil of 75% purity, the rest diluted with cooking oil taken from our kitchen. Though these new formula smelled some peanut flavour, was similarly sold for four dollars each. Soon business was dead, Mdm. Ma Chai decided not to sent any more oil to China, because most of them she said was confiscated by the corrupt communist custom official, as coconut oil was highly priced in Mainland China. Unfortunately, I had two bottles left, so a bottle was given to mum, who kept then till the mid seventies when she threw it away, and the other for granny, who applied it on her hair.

          Other businesses of coconut was to make ‘kueh’. Sold for five cents per two pieces, was not good business either. Too much work to do. Had to grind rice powder, prepare the coconut , steam the ‘kueh’ Not many will buy, as most of my customers, Ah Khiang, Ah Noi, Ah Boo Soo, were poorer than me. Botak and Jepun had them free. From then on, goes my whole nutty business. LAST TIME COCONUT John was about half the school age elder than me. He was not the angel type (I saw him last week, Jan 18th 2010, near Hougang Blk 309), and Lucifer would had called him brother. He is the eldest son of our neighbour Aunt Pek Huang. I was then, only in primary one, and it was our first semester vacation. On morning, at around 8 am, I was wasting my time near to Ah Ter provision shop, doing nothing. John came to me asking “ Hey, you want to drink some coconut water” “ Where to find ” I replied “ Come follow me” he said and I did. Both of us walked to the charcoal producer, near to Ark Bor (mother duck) estate. Beside the road stood, a small pond, and at the edge, stood a lone coconut tree, maybe six to seven years old. Young tree as compared to most in our village. The moment we reached the place, John pointing to some fruits up the palm tree said, “ There, the three coconuts up there, those are very sweet, and the flesh is tender too. want to try.?” Looking up, “ How? So tall, no stick long enough to bring them down” I said.“ Aiyah, you climb up lah, not too tall what” John said. “ I don’t know how to climb, and what happen if I fell down” I replied. John interjected. “ Don’t have to worry, if you dropped, you will drop into the pond, and there is water, you will only get minor injury, no big deal” Kind of a logical deduction. So I got close to the coconut palm, kicked off my pair of red clogs that I was wearing, and started towards the first step by hugging the trunk of the palm. John watch, but quite a few steps away fearing that I might dropped on to him. He was too smart as compared to all of us. The diameter of the trunk was very big for me considering my arm length it seemed, so the next step was to lift up my legs. I did it. Full hug for the trunk. Like a Panda on the bamboo stalk, how to move the next step was a big puzzle, I do not have the panda crawl sto work with. So, I look towards John, and he just waved the up signal that was all. So, heave, I move my hands up with a smack sound. The whole body on the trunk. It seems to be hours when I finally in the motion of an overweight caterpillar, managed to inched up to the end of the palm. “ Now, what next ?” I asked John. “ Stretch your right hand and twist any of the three coconut one by one “ I did what was told. These fruit was big and after twisting a few rounds, I was tired, and looked down towards John, yelled “ Hey, John , my hand is very tired” “ Why, you do not know how to change hand ?” John replied, making me look stupid. Changed hand so did I, till one of the coconut dropped. The second fruit was easy. But the last was tough. I was already shacked, and the third fruit was standing alone, as you twisted it, it recoiled back, and just keep on repeating. I tried pulling it, and it did not work, as it was too tough and by then I have already no strength. I gave up. Looked down, and called “John , how to come down ? “ John was busy looking for the two coconut on the ground lying in the tall grass, looked up and yelled “I am not too sure, maybe just slide down” “ What, I cannot hear you. ?” I barked back. “ Aiyah, slide down lah.” John yelled again. There was no way I can inch down as I had no more strength to griped tight to allow my legs to be free to inch downward, so I must slide down. “ John was right, and very smart”, came to my mind The trunk was still with the morning dew and was pretty slippery, so sliding down was not so difficult but painful that was all. When I stood on the ground my legs was trembling, looked at my chest, blood was oozing all over, tree trunk against human flesh. I am in trouble now. John, took a fruit, smashed it against the tree trunk and as the nut cracked, started to drink from it, passed me some, and as the frest fruit juice flowed onto my chest, boy, was it more painful. “ Ouch. ouch” I exclaimed. “ I am going to be in trouble when my mother see this” I said. John, took a look and said “ No problem, just wear a singlet when you reached home” Good idea, but I seldom wear a shirt unless I am sick, so chances will be that I will still be in trouble. Other than thinking of the problem to come, I was pleased to have conquered the first coconut palm, further more, it was true that the coconut water from this palm was sweet and the flesh was tender, as John claim, so I turned to him and asked, “ How do you know the quality of this palm fruit, did you pluck from here before” John replied “ What ? I never climbed a coconut before, and someone told me this palm fruit was sweet” At least I learnt three lessons, one was that this is a good palm tree, and second, never to trust John, and third, do not climb a palm tree with such big trunk diameter. Not many people can climb coconut palm. I did not get into trouble when I went home that day, nobody wants to take notice of me anyway. A few days later, I called Botak, and we want to the Lower Payoh( swamp) and showed him how to climb one. This time, it was a very tall one, almost treble the height of the previous one, and as I climbed, he watched me and keep on yelling “ Hey, be careful, Hey, be careful” I was touched as compared to my outing with John, at least he cared. From then on, coconut dessert was no more difficult to get. Can be obtained anywhere and when I want. This time round, I will not be clinging to the trunk to twist the fruit, now, I would go up and sat on the leaves near the shoot and stamped down as many as I want. I was also able to choose between the age of the fruits by the look, whether was it old or young tastier ones.. Soon enough, the stupid school reopened again, and as I went up the primary education ladder, my climbing skill improved further in height. Soon, I was earning pocket money from plucking dried coconuts for sale to Mr. Arrh (the laksa seller) for ten cents each. At times, climbing a tall trunk could means just only one fruit, of ten cents that was all. But ten cents allowed me to buy back a bowl of laksa noodle. On some days, I was able to climb as many as eight to ten palms. This beats looking for one on the ground, as most were collected by people living nearby. Eventually, even to find one palm to pluck becomes scare, as these fruits took months from flowering unitl ripen, and to make matter worse, young ones was already harvested by us for drinks. Over the Tua Long Kow( Big river) currently the one beside Hougang Stadium, was Mr. Tua Jiak(Big size) duck farm, where coconut palm was plentiful. That became our next hunting ground for sellable coconuts. Whenever it rains, few of us would be scouting in the estate for the nuts. A good harvest could means as many as six to seven. Here the palm was younger, and the fruit bigger, which could fetch fifteen cents each from Mr. Arr. It was hard dangerous work. Mr. Tua Jiak would sometimes weld his short gun chasing at us for taking away his fruits. Soon, I had been forced into the secondary school for the passing of the primary education, and this time, almost once a week I would be climbing palms for drinks. Selling dried fruit was getting no where, as it was getting lesser profitable, considering the long journey I had to take to look for coconut, or the scarcity if I were to climb for one. One day, Madam Ma Chai ( the noodle soup seller‘s, one eyed wife) use to sent coconut oil to his children in China as medicine. She was paying as much as six to seven dollars per half litter bottle. This was a huge sum in the sixties. So I was wondering what could I do to benefit from the situation, I went back and asked granny how coconut oil came about. That was it , so simple. I began to collect coconuts again, this time, I care less whether it has a shoot sticking out, which signify too old, where Mr. Arr would not want it, or the husk was greenish, which was too young. Every types would be all right to me now. I do not want anything else except the oil. First, dehusk all the coconut I had, grind the coconut against a jagged metal plate, and got all the fine bits of coconut. Then squeeze the juice out. Pour the juice into a heated wok. Add some water to the coconut again, and churn the coconut bits, squeeze the coconut again. This was repeated till there was obviously there was no more juice to be squeezed out , throw them away. On the other side, the wok, with fire heating underneath. The coconut was kept boiling, then as it began to dry, pearl drops of oil began to appear. The aroma was very strong and nice. There it was, my first bottle of home made coconut oil, 100% pure. Twelve coconuts to make a full bottle of concentrated oil. Three bottles were sold to Mdm. Ma Chai, at four dollars each, and she wanted more. Now, where to find so many coconuts. In business, I must make sure that I must be able to ensure constant supply. That evening, I asked mum “ how much is a bottle of groundnut cooking oil” She shot back “ Why ? a dollar and twenty” I left the kitchen, and the next day, I began to make coconut oil of 75% purity, the rest diluted with cooking oil taken from our kitchen. Though these new formula smelled some peanut flavour, was similarly sold for four dollars each. Soon business was dead, Mdm. Ma Chai decided not to sent any more oil to China, because most of them she said was confiscated by the corrupt communist custom official, as coconut oil was highly priced in Mainland China. Unfortunately, I had two bottles left, so a bottle was given to mum, who kept then till the mid seventies when she threw it away, and the other for granny, who applied it on her hair. Other businesses of coconut was to make ‘kueh’. Sold for five cents per two pieces, was not good business either. Too much work to do. Had to grind rice powder, prepare the coconut , steam the ‘kueh’ Not many will buy, as most of my customers, Ah Khiang, Ah Noi, Ah Boo Soo, were poorer than me. Botak and Jepun had them free. From then on, goes my whole nutty business.

Wegener Blood Test Result 2

Andrew Lim							WEGENER BLOOD TEST VERSION 2
																			TTSH	TTSH	TTSH	TTSH
				22-Jan	12-Feb	25-Feb	23-Apr	30-Apr	21-May	18-Jun	16-Jul	23-Jul	30-Jul	13-Aug	3-Sep	15-Oct			30-Nov	23-Dec	19-Jan	17-Feb
BIOCHEMISTRY																					2010	2010
																		TTSH
GENERAL CHEMISTRY	Reference	Unit		Result	Result	Result	Result	Result	Result	Result	Result	Result	Result	Result	Result	Result		Refer:	Result	Result	Result	Result
Creatinine(kidney function)	53-115	umol/L		60	61	82	53	50	66	65	70		69	70	82	74		60-110	75	93	87	94
Uric Acid	212-435	umol/L					278
Alk Phosphatases	35-120	U/L					237
Blood Glucose	3.6 – 6	mmol/L		3.6	na								5.1
SGOT/AST ( liver)	0-40	U/L		95	28	29	47	39	35	51	222	451	304	20	16	15		15-41	22
SGPT/ALT (liver)	3-40	U/L		345	78	79	111	112	56	77	462	739	599	27	12	11		17-63	40	24	30	31
Cholesterol	<4.1	mmol/L		7.45f									9.07
Triglycerides	<2.3	mmol/L		2.67									1.5
HDL – Chol	>1.0	mmol/L		2.24									2.59
LDL – Chol	<2.6	mmol/L		4									5.8
Cho/HDL Ratio	0- 4.5			3.3									3.5
SEROLOGY
C- Reactive Prot	0-10	mg/L		<5			199	147	97.5	49.9	14.9		24.2		23.4	55.3		0.0-5.0	9.9	16.4	0.8	15.3
HEAMATOLOGY
BLOOD COUNT
Heamoglobin	13.5-18	g/dL		14.5	13.9	12.7	11.2	11.3	11.1	12.2	13.2	13.5	13.7	13.8	13.5	12.8		13 – 17	14.1	14.1	14.5	14.1
PCV	40-54	%		na	na	40
RBC	4.5-6.3	mil/uL		4.62	4.41	4.25	3.58	3.63	3.59	4.05	4.32	4.54	4.45	4.48	4.34	4.16		4.4 – 5.7	4.55	4.59	4.58	4.24
Heamatocit	38-52	%		42.3	40.6		33.3	33.7	33.9	36.9	40.1	41.9	41.8	40.2	39.1	37.5		41-51	33	44	43.9	42
MCV	76-97	fL		91.4	92.2	93	93.2	93	94.4	91.1	92.8	92.4	94	89.6	90.1	90		82-98	94	96	96	99
MCH	26-32	pg		31.3	31.5	30	31.4	31.2	30.8	30.2	30.7	29.7	30.8	30.7	31.1	30.8		27-33	31	31	32	33
MCHC	31-36	g/dl		34.2	34.2	32	33.7	33.5	32.6	33.2	33	32.2	32.8	34.2	34.5	34.2		32-34	33	32	33	34
RDW	11-15.6	%		14.2	15.1		16.9	16.8	16.8	16.6	16.2	16.3	16.7	16.2	15.6	14.4		11-15	6.4	18	18.9	18.9
Platelet	140-460	ths/ul		754	381	367	493	717	733	626	503	517	522	569	439	540		170-420	632	404	324	368
WBC	4-11	ths/ul		25.1	14.2	12.5	17	13.7	14	11.6	10.3	9.29	9.62	10.1	9.97	12.2		3.6-9.3	15.7	19.1	10.3	12.7
DIFFERENTIAL COUNT
Neutrophil	40-75	%		92	92	90	91	84	89	82	76	75	72	85	81	82		1.4-5.9	15.4	18.5	9.07	11.4
Lymphocyte	20-45	%		5	4	6	4	6	1	8	13	13	13	9	9	8		0.9- 3.3	0.26	0.53	0.7	0.73
Monocyte	3-11	%		3	4	3	3	8	5	5	5	5	8	4	5	4		0.1	0.2 – 0.7	0.08	0.5	0.49
Eosinophil	0-6	%		0	0	1	0	0	4	3	5	7	6	2	5	6		0.0 – 0.7	0	0.02	0.02	0.01
Basophil	0-1	%		na	0	0	0	0	0	0	1	0	1	0	0	0		0.0 – 0.1	0	0	0	0
N Myelocyte							2	2	1	2
BLOOD BIOCHEMISTRY
Liver function Test A
Total Bilirubin	3-24	umol/L		na	na	18						21
	0.2-1.4	mg/dl		na	na	1.1
Total Protien	60-80	g/L		na	na	60
Albumin	37-52	g/L		na	na	34
Globulin	25-39	g/L		na	na	27
A/G Ratio	1-2			na	na	1.3
Alk Phosphatase	35-120	U/L		na	na	226						192
Gamma GT	Nov-50	u/L		na	na	356
RENAL FUNCTION A
Sodium	135-150	mmol/L		na	na	125
Potassium	3.3-4.9	mmol/L		na	na	3.6
Choride	95-108	mmol/L		na	na	86
Bicarbonate	20-32	mmol/L		na	na	26
Urea	1.7-8.3	mmol/L		na	na	2.1
	10.2-49.8	mg/dl		na	na	12.6
	0.9	mg/dl		na	na	0.9
SPECIAL HEAMATOLOGY
ESR	2-30	mm/hr		20	30		111		114	79	15		17	22	29	50		1-10	35
URINALYSIS
MACROSCOPIC ANALYSIS
Ph				5.5	7	7	7		7	7					7
sg				<1.005	<1.005	1.010	1.010		1.010	1.010					1.01
Protien				Neg	Neg	Neg	Trace		Neg	Neg					Neg				Neg		Neg	Neg
Glucose				Neg	Neg	Neg	Neg		Neg	Neg					Neg				Neg		Neg	Neg
Ketones				Neg	Neg	Trace	Trace		Neg	Neg					Neg
Bilirubin				Neg	Neg	Neg	Neg		Neg	Neg					Neg
Blood				Neg	Neg	Trace	Trace		Neg	Neg					Neg
Nitrite				Neg	Neg	Neg	Neg		Neg	Neg					Neg
Urobilinogen				Normal	Normal	Normal	Normal		Normal	Normal					Normal
MICROSCOPIC ANALYSIS
RBC/hpf		0-3		Nil	Nil	3	Nil		Nil	Nil					Nil			1-13	8	0	1	0
WBC/hpf		0-6		0-2	0-2	5	5-8		0-2	0-2					0-2			0-6	9	3	16	1
Epith Cells/ hpf				0-2	0-2	0	2-3		2-3	0-2					0-2				3	0	17	1
Organism						Nil														Neg	Neg	Neg
CASTS
Casts				Nil	Nil	Nil	Nil		Nil	Nil					Nil				Neg	Neg	Neg	Neg
CRYSTALS
Crystals				Nil	Nil	Nil	Nil		Nil	Nil					Nil				Neg	Neg	Neg	Neg
PR3		>20		171					101										150			<20
																			Nov 18th			Negative

Ang Hoon (Tobacco)

LAST TIME

ANG HOON

                It was so very long ago, probably 1960. Third aunt had inconvenience of moving around due to her long ago, handicapped leg. So long that even left or right one I could not remember. She was a smoker. Once a while, I had to piggy drag her to where she wanted to go, to save time, as moving from one destination to another would had took her a long time.

            However, at times, she would had forgotten to bring along her tobacco – Ang Hoon. Seeing her smoking was a puzzling view for a five years old like me, where nothing was sucked in, but smoke comes out. How wonderful. One day, as I recalled, I was under the huge star fruit tree, she called me to bring her the tobacco. To me, bringing her the tobacco will be the norm, nothing exciting, so this time I decided to prepare one for her.

            Into her room, where three of us sleep, granny, herself, and me. On top of the dressing table in front of the room entrance, laid a plate, with the tobacco, some fine paper and a box of match stick. Tenderly, I took out a piece of cigarette paper, laid down flatly on the table, added onto it some tobacco, and started to roll. Shit, it was not pleasant looking at all, it was flat. Yak, throw it away then, and redo. Only by the third  or forth attempt, that it was successful, but look a little small as compared to normal.

            Well, just bring it to her. But I should light it for her, to save the journey of bringing back the match. Lighting it was simple, just struck a match and that was it. The taste was not good at all, just cannot imaging what the taste is equivalent to. With the lighted cigarette, I rushed to her. When I reached her, almost two third was gone. She was looking at me trying to suck the air into the cigarette to ensure the cigarette light do not die off. “ Hey, do not do that again , your mom will kill you”  she exclaimed. “ What have you done, nothing left for me” she continued.

            Happily, I offered to redo the whole process again, and I did again and again, it was fun.  It was so simple, and I am now able to blow smoke like she could. So, the next time when my dad wanted a Pigeon cigarettes, I will be doing likewise, without the trouble of rolling tobacco, where skill was required, just light the prefabricated stick, puff a few mouthful of smoke out, run to him, past the stick to him, that was it.

            As one grew to be just a little older, responsibility changed. Now dad began to have some interest of smoking cigar instead of cigarette. Maybe it was because of cost saving, Seventy cents for a packet of twenty Pigeon cigarettes, which will finished in no time, twenty cents of three cigar, lasted much longer. Sunday was his time to smoke cigar while he meddle with the construction of chicken coops.  I am not sure whether it was victimisation, but it always must be me. Ali, no way, he most likely  would have disappeared with Uncle William . Ah Woo, no way too, he would be studying, mom said so.

            “ Ah Mak, go to the shelf , take twenty cents and buy for me three chooloot(cigar)” Shit , that MaMa shop was at least a mile away, in Sixth Mile Market, what to do, just go and buy, no comment, no argument, no opinion . It was frequent affair to walk to buy chooloot. Better time will be evening, where the weather was more kind, not so hot. Kind of a boring to lone that distance, so ideas had to be created, and ideas came.

            Again “ Ah Mak, go to the shelf, take twenty cents and buy for me three chooloot”  “ O K”  I replied. This time, I went to granny “ Granny, can you give me five cents”  “What for” she said “ Nothing, you won the Four Colour yesterday right ?” “ How do you know” “ I knew” I returned.

“ Ok, here is your five cents. don’t tell anyone” she dug into her three inch wide green money belt and tugged the five cents coin  into my right hand , and I sped off.

            My whole body  full of sweat, was oily, as I approached the MaMa.   “ Four chooloot ”  He gave me four pieces, and said thirty cents. Dammed I only had twenty five. “ Hey, yesterday you said four for twenty five cents” “ OK lah, OK  lah” I took the four stick, and off I go. By the time I walked past the market, out from my pocket, I took a packet of match I had brought along, lighted one of the cigar. Puffed away the smoke, and that was it. Trying to imagine what I look like. A four foot plus boy, wearing a dark blue short with a pocket on the right side and three chooloot sticking out, shirtless, and nothing else, not even a pair of slipper.

            There was no fun smoking cigar, by the time I reached the corner of the Serangoon Secondary School, now an army camp, I was already dizzy. I managed to hold myself and sat down by the roadside. Blame the weather, it must be the weather, too hot. Took another few puff. Too bitter, needed some rest. So I sat close to the huge Angsana tree (the tree is still there). A little cooler, but did not helped at all. Shit I better throw away the chooloot. I think this should be the cause of the dizziness, so I did, and took a longer rest. I think it could be more than half and hour before my mind came back to my head. Oh, I had been too long out, better run back, which I did.   No matter how long or how short I took my time to do things, dad, as usual “ What took you so long to buy two miserable cigars ?” Well , as usual, no reply was needed, just another ordinary exclaimation mark from him.

            So soon, I was in primary one, my third aunt passed away, and I use to feel very sad for quite a long period. Was it that I missed her Ang Hoon ? No, I missed her as a protector. Not long later, I continues the Ang Hoon production for granny at a cost of five or ten cents per day.  Ang Hoon was too mild, Pigeon  was too thick, and chooloot made you dizzy, I need to come out with something better.

            Got it ! One day, as I was doing my bowel clearing in the toilet, staring out of the room, there stood a papaya tree belonging to our neighbour.  “There must be some use, if not it should not be standing there.”  Stood by my opinion.  So, I took some cigarettes paper, pluck a dried branch of papaya leave, into the toilet, and start the experiment. Firstly, as usual, lay the paper on a piece of newspaper, because the toilet is dammed dirty, usually with worms wiggling in it, then crushed the driest part of the papaya leave, until it was so fine like Lipton tea leaves, rolled the new product, and Bingo!, a papaya cigarette – manufactured in the toilet.

            I lighted it, being the first papaya cigarettes in the world, and due to lack of skill, I did not close the small end properly, sucked all the leaves into the mouth, “ phooooy !”  Re do every thing again, just second try I got it. Complete disappointment. Tasted like Lucky Strike or may be Pigeon, too thick,   perform like chooloot, made you very dizzy. Never says die, right ?. Further innovation did not produce any better result. Banana leaves, cannot be crushed, needed to be finely cut, the texture was spongy, and need newspaper as wrapper, ending up as a huge cigar almost one inch in diameter. While trying, the toilet always look like a Red Indian smoke signal room, so no fun with Banana leaves as, it tasted waxy too. 

            For the next period, I went around pinching dried leaves of every kind I past, to get a feel of each specie texture, squeezed it. I just could not find anything better than those of the papaya leaves. Some that I found, I dare not try, as they look poisonous. So, what to do? , just gave up. No not smoking, just the other kinds of tobacco!

Fish Collection

LAST TIME

FISH COLLECTION

                I front of our house,  793-G Florence Road, stood five huge concrete enclosures about fifteen by fifteen feet and three feet high.These were my dad fish breeding tanks. By the time I knew, only one had some angel fishes remain, and a few tortoises in another. There was also a round one with some lotus in it. Some nights, dad would carry a torch light, went to one of the tanks, and watch the angel fish and gold fishes laying eggs on fresh water weeds. So since young, I had already been cultivated for the liking of fishes. Eerrr, I mean catching them.

            The first time I reared fishes was before my school days. Simply washed a Byecream hair cream bottle, put some water in it, went over to dad fish tank, caught two white Angel fishes, and squeezed them into the bottle. The difference was that they were not as graceful as in the tanks, because they cannot move. In fact their dorsal fins were sticking out above the water level of the little bottle. Place was on top a chicken coop near to the Buah Dong Dong tree. For hours, I would be watching how these two will be turning around, which was actually impossible.

            Then came evening, Uncle William saw me, and he said why was I wasting time there, I should be making the fishes grow fast instead of just watching. He said that with a little bit of washing powder, these fishes will grow very fast. Why not, I thought. So I went to the washing area, took a teaspoonful of washing powder, put into my fish “tank”. So, I began monitoring. These fishes were making bubbles. Strange, I walked to Uncle William, and he smiled at me and told me to cover the bottle with dried banana leaves and see it how it comes alive the next day, which I did, but the fishes was not coming to life as he described.

            Next day came, and very early, I lifted up the leave, to see that the fishes was in fact bigger, but dead, decomposed , thus swollen in size. Uncle gave the same smile, and told me that I had put too much of the powder, so, again I caught two more fishes, repeated the process, but this time, a quarter spoonful. By afternoon, same thing happened, two more died. Well, I think I will be successful after few experiments, and repeated it with lesser powder. It was only till the fourth try, that dad was voicing up on his disappearance of fishes that I stop. Luckily, Uncle William did not spoke a word about it. What would Dad think?

            As time passed, going to Lower Payoh to catch Rainbow Guppy became an obsession. We called them Jepun because near the tail thereis a round isigna which is similar to the Japanese war plane. They were called the big stomach fish, as they can keep on breeding non stop. Usually we started off early in the morning where the drain water was cleaner. Sometimes if it was too late, we need to brush off floating debris and excreta to get to the fishes we want. One good thing then was there was not many or no plastic bags then, they were expensive and some model was not being invented then. After we shifted the kitchen to the new place, when Uncle William moves to Toa Payoh Block 2, the old kitchen’s water storage tank became our fish tank. By now, collecting Guppies became obsolete, since the tank was big, we needed bigger fishes. 

            So now I have to work day and night to fill the tank of about 1.5 times 1 meter width and about 3 feet deep. So when there was rain, heavy rain, the next morning, I will rush to Lower Payoh which is now Hougang Sport Stadium, bringing along a ‘pun kee’, which is a soil carrying basket. There will be a lot of fishes that were drain down from various places and ponds. I might return with cat fish, snake heads, eels or Sampankua. One day I even had around ten to fifteen of them. Put them in my new tank, fantastic. Watch them, and what to do next?

            One day I came to know that in Joo Chiat, Geylang People’s Emporium, they sell syringe, so took a bus and bought a set with three types of needle. I recalled it cost me around fifteen cents per piece.  When I returned, I took fish by fish and injected them with plain water. At least I did like a doctor for once. Those fishes still swim normally. , I used ‘ang eng nee’ those dye used for ‘ang ku kuay’, to inject, which did not cause harm at all, though they turned reddish. When I used ‘blue colour medicine’ with this, the fishes swim akwardly, so not so good, soya source was not good too, and vinegar will make them dead.  However, the biggest fish was only less than five inches in length, so I believed I need one or a few bigger fishes.

The only place I can get bigger ones would be from ponds, not drain or stream. I remember Yong Tau Hu ponds do have huge fish like Jepun and snake head.  At least two snakes heads which could be 5 to six kilogram’s in size. So that night, I took a torch light to do a survey. The water was only 3 feet and around four feet deep at the deepest, and at night the water was crystal clear, as you cannot see a thing in the day. I saw cat fish, tilapia, and sure there were three to four huge snake head. Though I had a hand net, could not do a thing, so I returned home, with my mind full. Next day, I look for Botak, our uncle, who is two years younger than me, he was also eager, I asked from him to get some of his father old unwanted fishing net. With the rotten net, we make a good net out, with the sinker of stone and float make of tapioca stem (will float).

            That night I put the net which was about 2 plus meter long and around 2 feet high, into the pond, and the next morning, I went to collect and the net was stuck with five cat fishes, most already dead of exhaustion. I did not want them, because I was dreaming of the impossible, catching the snake heads with the net of 2.5 inches mesh. So when night falls again, I went out to the pond with a bigger hand net and stronger batteries with brighter light. At the far end of the pond, I saw a huge Toiman, quickly, I not daring to disturb the fish, switched off the flash light, and rush nearer, as I move toward the pig sty,  “ kwanggggg”, a noise of my knee kicking on something, one of the barricade of a pig sty made of strong metal used for road bedding during the second world war. The one that is about 1.5 feet wide and full of hole in it.  I hit it straight, just two inches below the knee cap. Suddenly I found I was not being able to move at all, as the pain rush over my whole body, so I just rush back. When I was beside the window, Ali saw me and I just told him what happened, so he just said ‘alamak’ and walk away. I saw the opening of the hit was about half inches wide, and there you see your bone! The bleeding was very bad with the whole leg  red in colour.  I was not able to walk freely for almost a week, although I applied the “Pek Chao You” daily.  This stopped me fishing there for quite a while. Until the next time I went there, the pond was almost dried up due to the dry season in the middle of the year.

The next area of interest was another pond, just exactly beside this one. This pond belongs to Cha Cheng Thui, who makes weighting weight for weighing machine. It also served as a cooling pond for electricity generator. Then electricity was generator by them and he collected a monthly fee from each they supply. The pond was shallow but you can see a lot of fishes hidden at its edges, where tree roots and water weeds was. This time round, I will not use nets, but fishing hook, or fishing! It was impossible to steal dad hooks, they were huge, for deep sea fishing. The smallest could even be bigger then the biggest fish mouth from that pond. Thus I have to make my own hook. First was to use galvanize wire from the chicken coop, burn it, dip it in oil or water, which ever can harden it, will be used. This method was used to harden our ‘gorlie’ or marble which
I used to be champion. Though it did not work well too, it could be for my hooks. Well, it too did not work too after tens of tries.  The wire was as soft as before.

 Next was to use nails, we had lot and lots of them, same from the tool box of dad chicken coop.  Each of them was carefully grind with bare hands on grinding stones. Then it will be bended and it look exactly like a fish hook. I took the number 8 string and tie one by one. With some earth worms, off I went. I used a tapioca stick as a fishing rod. It was still early, around 6.30 am, I began squatting beside the bamboo patch and started to fish. Sure enough, there are a lot of big fishes. I had a lot of bite, and each time, it just escaped. Dammed it, all my hook does not have the reverse tail, so all will escape! There goes another of my fishing idea.

I have to give up dreaming of big fishes. Once I had my leg heal, I began roaming around again. I began to realize that beside Yong Tau Hu house and at the back of Bean Curd house, there was another with a lot of short little chicken and those chickens were running around several fish pond! As I observed, there were so many types of exotic fishes, both colour, sizes and species. One I really like was the one that was looking like Jepun but so beautifully blue. One night I went out for it. I carried an Ovaltine can. It was so dark, I cannot see a thing, I began to get worried, not because of someone catching me in his small cement pond of four by four feet area with about a foot deep, but because of not being able to catch anything back. At last I had an idea. So I just took out all the water weeds, with just the fish and water. Then I began to stir the water in circular motion. Soon, I can see under the little moonlight, the fishes were in the centre of the whirlpool… With the kilogram size Ovaltine size can, I just scoop the center of the churning water, and all the fishes were in it. With the catch, I ran home, so happy. When I woke up the next morning, I found the there were few fished left alive, most were dead due to the vigorous stirring of the water last night. With the precious few left, I had to go back to use the Byecream bottle again. Those few left were graciously swimming in it till the next interest I had, lizard catching.

Durian

LAST TIME

 DURIAN COLLECTION

                Firstly, there must be some expert advice and lesson. The master happened to be my cousin, Muay Hiah, from Jurong, had been staying with us, was my second aunt eldest son. There must also be some associate, Ali, my elder brother. How about an indirect supporter, yes, granny, who like other granny, could be proud of grandchildren mischieves. Lastly, the source, yes we had the source.

            Beside our house, reside Lau Kow (old dog), the only Hokkien family in our kampong ‘ Xing Lai Hng. The head of the house was an artist, supplying huge poster drawings to the cinemas. Their piece of land was about 60 by 250 feet in size. On the far side fence, stood a rambutan tree and two durian trees lined up nicely. Where as the other fence dividing our compound and theirs, stood a lonely durian tree. At time, it blooms once and at times twice per year. Usually, when bloom times came, we would gather on our side of the fence and stared at the flowers. Durian has white coloured blooms. I am still puzzled what the other two guys was admiring at, but to me, I was already imagining the ripening fruits to be.

            Since village life was very well occupied, very soon the fruits were matured, ready to drop any moment. Durian watching was not difficult at all. Daily, we had to feed the chicken in the morning, pick up eggs in the afternoon, and feed them again in the evening. So we watched every moment. Convenient to the tree was just over the fence. Time passed, at last the first fruit fell. Based on experience, the next fruit should drop the next morning unless there was rain before.

            Time to do some work, so the next morning three of us would be waking up abnormally just a little before day break. Firstly, we would rush to the scene to look for any fruit lying on the ground that was within fifteen feet range. The moment there was, at times three or four fruits, we would quickly  get ourselves armed. Our tools were simple, a rubber band, a long clothing bamboo stick, and a long Guni rope( rope made of jute), about three millimeter in diameter, and a small piece of stone. 

            The first step was to wait till 7.35 am, five minutes after dad left for work. Next was to have one among us to do a watch out, on both end, one for anyone from Lau Kow, and the other on our end. Then the rope would be tied with a stone, and throw over the eight or nine foot fence. Once over, the stone would be slowly pulled towards us, then, a loop knot would be tied to from a lasso, and lightly tied to the bamboo stick with the rubber band. Then the bamboo stick with the lasso would be pushed towards the stalk of the fruit, hooked to it, gave a jerk, and the loop would be locked onto the stalk. Pull back the bamboo stick, keep it properly along the chicken coop.

            Now, three of us would squad down to avoid being seen, and start pulling the fruit. Gently does it, and when it reached the fence, pulled it up, and it became ours. Best harvest could be four pieces. Next was to find granny to share the fruits of labour, she would say “ When your dad see you all, you will die” Usual statement.

                        Eventually we found that this form of harvest was slow and very likely to get caught, so one night Ali and myself decided to do a faster one. So both of us climbed over the fence, up the tree and started plucking. When I was up on the tree, the fragrant smell was all over, and I had no choice but to pluck every one within reach. Tud, Tud , the fruit drop one by one, Lau Kow hearing fruits dropping, came for their pick. By now Ali had already thrown some over to our side of the fence. Nicely, Lau Kow called for mum, and told her that her durian strangely dropped over to our side, and well stacked too. Mum was mad. I was still on top of the tree. So, mum pick the fruit, one by one threw back over the fence and apologised to the other lady. I was not sure where the hell was Ali, but the moment the lady passed the tree towards her house, I dashed passed her and escape through her main gate. The consequences we faced later were worst then being hit by a basket of durians.

            Not long later, Low Kow realised that their durian was always missing. They were genius too, so they laid zinc sheets around the tree, and when a durian dropped, Bang, this will alarm them to pick up the fruit. To us, it was also an alarm too. In fact our reaction was so fast, that most of the fruit were gathered by us. This made them to be more attentive, and they reacted fast too. Now we lose out. Since there was no fruit for us, most of the time, for the fun of it, every once a while, we would be throwing a stone, half a brick or a coconut . Well, that irritated them, but worn us out too.  

            That period, Low Kow business expanded fast, and part of his land, he constructed a workshop to cater for his art business. So some branches of that durian tree were hived off, and the tree was also damaged by the construction. No more near durian. However, the two trees over the other end of the fence, continued to bear fruits, for us, it was good to see only.

Temptation. This time, we need to be more adventurous, we started claiming over the fence.

            Every day I need to be up very early to wash the drinking bowl of our chicken farm. So, when durian season times came,  I would climb over the fence, moved towards the other end, and pick, as many durian as I want. The other two trees usually had higher yield. I would carry them and threw over to our side near the mango tree. But this posed another problem, storage. So, on the other end of our compound  was an area planted with banana.

In the middle of the banana plot, I dug a hole, placed wooden box in it, covered with damp banana leaves. No one is able to smell any thing at all in the humid atmosphere of the banana plantation and the damp leaves. As I camouflage the area, at times I have to ‘find’ it too, as it was very well concealed. This was my secret storage place.Even if one stood beside or on top of it, one would not realize anything different. It had a capacity to store up to seven fruits. When there was stock, I would bring out two or three pieces, and Botak and myself would enjoy our afternoon tea break when mum will be asleep. Every now and then, granny would have one, but none knew where they came from. The stock would be replenished when it diminished up.

            These adventure continued, though we were usually being supplied with dad’s purchased of basketful of such fruits. Only till 1970, that we stop such accumulation of fruits from over the fence. I found it not practical anymore. Because we moved to Ponggol, too far away to return for the practice.

            But Ponggol have many many more durian. I had to wait till
Poo grows up before the next durian adventure begins. This time I will be more professional, better skill, but of course it was less interesting because Granny is gone, and we need good transport to travel the vast area durian spread all over Ponggol. But the variety were more, the volume were higher.        At places, even ghost were added to the fun.

Rambutan

LAST TIME

RAMBUTAN

                         During the sixties, there was no Macdonald, even if there was, we would not have the money. There were many types of biscuits and candies to see, but not to buy, without money we cannot buy anything. So if there was an opportunity to have something to eat or chew, it would be wonderful, and well cherish. It was found that to enjoy a piece of candy in the longest time was to put it in your mouth and go to sleep. By morning this piece of candy would still be around, eight to nine hours per candy. Fruit like guava and rambutan was favourite, as it could be easily found in the wild though seasonal.

                     At home, there was only a lone rambutan beside our house near granny room. About thirty feet tall, it straight trunk was very close to the roof. It was my favourite practice to climb up, and midway, stunted myself to the roof and sat there. During the rambutan season, this tree would be out performing other in flowering. However, in time to bear fruits, it did nothing. Accordingly, it was call the male tree. For as long as I know, it did bear only three fruits, till it was hacked down. In fact, the mango tree beside had been influenced not to bear fruit too.

                      During mid year school vacation, second aunt place at Jurong, would be the best place to lived in as far as fruits is concern. The whole surrounding area was a big producer of these fruits, while almost a third of aunt’s estate were filled with rambutan trees. Aunt place had many types, unfortunately, most of poor quality, as her focus was on producing star fruits. 

                        Other than a few good ones, most were of the soft and sweet type, or the sour type. Lucky for us, her husband was a fruit distributor. So, part of our stay included following our cousins, going around to other estates to collect huge baskets after baskets full of rambutans by bicycle. At times the distance could be very far, but to us was well worth the trouble, because we will be eating all sorts of varieties throughout our journey.

                     Normally Chua Hiah (Lee Chua) or Lee Cheong would be the one I followed. Their skill on the loaded bicycle was superb. However, on steep slope like the one on the opposite of Meng Heng provision shop, I would need to get down the pillion and help to push if the bicycle was fully loaded. One evening,, I was the one riding the bike, and during up slope, Chua Hiah thought that I was riding all right and did not bother to push for me. I ended flat on the floor with red rambutan spreading all over the ground.

                       Near to our own home, there was not many rambutan trees around. In Lower Payoh, there was one. One day, I spotted some fruits on it. The tree had huge trunk. I managed to climb up after much struggle. I managed to pluck only fifty odd pieces of fruits. It was not the best type, but it was rambutan after all. Strangely, for many seasons later, the fruit bearing of the tree was fantastic, I was able to collect big basketful of fruits.

                Number 52, Lim Ah Pin Road , lived classmate Joseph . Their house had the most crunchy fruit. To my observation, children who are good in studies usually dislike rambutan, so the tree in Joseph were usually left untouched. What a waste. So, every morning, on the way to school, I would casually walked into their compound and pluck a few branches of fruit, and enjoyed myself. There was also a need to take note that too much rambutan in the empty stomach, at too early in the morning , caused bad stomach ache.

                   Along Florence Road, there were many of such trees. During on kite flying season, everyone was busy flying their kites. Since Botak and me could not fly a kite, we suggested plucking some fruits from a nearby tree. It was a good suggestion, so he climbed up a slope towards the fence separating us and the fruit, stretching his hand over a barb wire fence to get the fruits. When he managed to grip a few fruits, I shouted at him “ Hey, your sister is coming” He immediately withdrew his hand and pretend innocence. But the barb wire had left a four inch cut below his arm. We found that it was not worth while to get so few fruit and so much risk. In comparison, facing us there were four to five trees fully loaded with fruits, and there was no fencing. But there was a minor problem, the trees were very tall.

                          So that night, Jepun, Botak, Ali and myself deployed ourselves there. Two person to go up, and to be below to gather the harvest. Botak and me being the better climber went up. It was very dark. When we were on top, the below were whispering, “ Hey , faster “ “I can’t see a thing, and shut up” It was not easy to climb a tree at night, as one could not even see a branch, not to say the fruits. I could had been easier if rambutan are white in colour. After so many bites from ants, at last we reached the fruits.

                       On this tree, the fruits were very big, then branch after branch began to go down. All we heard was OooH! oooh!. For sure it was from Ali. He was skinny, and the impact for the every pound or two of fruits dropping on him was not easy to take. On that trip, we managed a few hundred fruits. Though I normally do not consume many rambutan, the fun was there. It was the first and last time that I climbed that tree.

                      Tua Jiak ( Big Size), of Lower Payoh, had the best fruit of all the trees I knew. His was the most crunchy and sweet, of yellow skinned type. The most difficult to get too. Although there was no fence and the tree was quite far from his house, the escape route was separated by a river about twelve feet wide. On normal day, no one would dare to try, because of fierce Tua Chiak.

                      One heavily raining day, Botak and me was ‘gathering’ some pineapple far behind Xin Ming school, about two miles from our house. We already had six pieces, but we found that it was to obvious and heavy to carry them home. Since the fruits was not fully ripe, the best way was to throw them in the rushing water of the river. These fruit would be floating, we would follow them till the nearest convenient point where we would collect them. Then, both of us would be running along the river at the pace of the rain water rushing down the river, yet keeping sight of the fruits.              

             By the time we reached Lower Payoh, I went down the navel deep water in the river, we had only three fruits to collect in the murky water. “Probably the riper ones were slow” I said . Botak suggested “ We rest a while and wait for the rest to come” Good idea, we put our pineapple near to our soaked body, sat on the concrete edge and keep peering. Few minutes past, nothing arrive, except floating dead leaves, rubbish and excreta. 

                     The rain was still pouring. Looking up, in front of us, stood a rambutan tree, full of tasty looking fruits, yellow in colour. “ Hey, Botak, shall we go over” I suggested. “ Sure, why not. We leave the pineapple here and let’s go over” Like magic, both of us were already on top of the tree. We sat on the branches and continued eating to our fill. Once full, we began to collect for our take home. While busy, we heard “ Hey you, %$#& , who you think you are to be on my tree” The coarse and loud voice be from Tau Jiak ( this place is now the edge of Hougang Stadium).

                          Immediately we jumped down from the tree, tried to accumulate some branches of fruits. Then, Bang, Tua Jiak fired his hunting short gun into the air. Botak panic and jumped to the river, crossed it, grabbing a few branches of leaves. Yes, leaves only. I managed to leap across the river. Surprisingly, my arm was able to reach the other side of the twelve foot river. By the time I climbed up the edge of the river, Tua Jiak was already by the other side of the river. I bent down, grabbed a pineapple, and sped off, with Botak in front of me.

                  Luckily he did not want to pursue us. Even if he did, I doubt we could be caught. Both of us sped across the thick undergrowth straight towards Arr Bor (mother duck) estate like Speedy Gonzales . Soon, we depleted our energy, squad together panting at the corner of the estate only to realise that we had only three rambutans and an unripe pineapple left. Disappointed, ate the rambutan, took a bath from the public tap, and went home to share our pineapple.

Swimming

LAST TIME

SWIMMING

                        How I began to like water was not yet understood. Like most village children, it was normal to be either wet or muddy. Most likely the interest began with the huge cement tanks where dad bred fishes. When ever he need to change the water, we would be swimming in it while cleaning away the mosses. Here swimming meant there would be five to six inches of water for few of us to be in the huge tank to move around.

                        Before the easy availability of tap water. there were many common washing areas around our village. These were enclosure of about 12 feet by 12 feet dug into the ground, about five feet deep. In the middle of the enclosure was a pool, further dug in of about four feet cube. Just above this pool, would be a concrete pipe supplying never ending water from underground stream. The use of these pools were free. Most of them were around Xin Min school because that place had a lower ground level. In the morning, it served as a washing area where all the forty something ladies talk non stop while doing their laundry. Water from here also provided all other household needs. In the afternoon, these became our swimming pools. A few of us would dug our head up and down from the water level, which was our swimming standard then.

                     During that time, watching diving film on television ‘Sea Hunt’ was popular. To me, it was harmful. One day, trying to emulate, I took a large plastic bag, went with Jepun and Botak to one of the pool, and tried diving. Scoop a bagfull of air, covered my head twisted the opening of the bag to create a ballon with my head in it, and squad down. The actor had a tank full of air, while I had a bag full. I dip down a few times, but Botak, watching from the top, said there was no bubble coming out, so it did not look real. So, I loosen the knot on my neck and making sure there was a hole for the bubble to come out.

                  When I went down again, some bubbles did came out. Jepun and Botak was happy, they siad it look like real. Then I dip lower, the water pressure grew, and when I need the first inhale for air, the plastic slapped on to my face, sealing my face, thus ability to breath. In panic, I began to rip the plastic bag off, scratching my face all over. There were finger nail lines of scratches on my face for both the spectators to laugh at.

                          The first taste of deep swimming was when one Saturday afternoon, John, and his brother Michael, and a few others met me and suggested we go to a place called No Fishing. Sound tempting, and I agreed. It was a deep pond of about 150 feet in length and breath, but few miles walk from our house The water was brownish colour, about four to five feet deep on uneven ground. As long as my body was in the water, it was swimming to me. But the guys that I went along with did not swim at all.

                      Their purpose was to catch fishes. On the floor of the pond was filled with coconuts that have their top chopped off. For every coconut they lifted up, sure there will be a tilapia or two in it. The catches were good. I just followed, due to my height, leaping all the way at the edge of the pond was tiring. Few times, I leaped into deeper parts, where John being much taller than me, had to fish me up time and again. It was good experience, but there was no fun, as I ended with many mouthful of stinking water in my stomach. By the time I went home, it was already 5.30 PM, dad was waiting for my return, the rest ceremonies of the welcoming of me home, should not be elaborated, for the fear of child abuse could be charged on him. 

                          My trip with the same group to Mt Emily swimming pool a few months later was not well recieved at home too. However, as I could not swim then, I tried diving. Simple, go to the four feet deep side of the pool , placed two hands in prayer position, semi squad down, lift up the body and jump at the same time, make sure the body was perpendicular to the water surface, in you go. Tud !. That was the sound of your head hitting the tiled flooring. Groop ! This was the sound of water entering the oesophagus due to the impact of the hit. I was not sure how I returned to breathe air. When we returned by around evening, incidentally also on a Saturday afternoon ( dad would be home by around 1.30 PM. from work, where the first thing he did was to roll call everyone ), the iodine from the water redden the eyes. As in the pool, shirt wearing was not allowed, so I was tanned. He saw me coming home !.                                  

                        Since swimming was a endeared interest, two outings proved that it could be dangerous. After Uncle William move his house, the old kitchen was left vacant. So, the water storage pool about four feet by five feet by three feet deep was use as our personnel swimming pool. But I was not allowed to turn on the tap there for water, so I need to fill the tank with water drawn from the well, about a hundred away. When it was almost, full, I would be in there , sometimes with Ali, and started dipping ourselves in the water.

                             More unquie was swimming in a vertical swimming pool. Our drinking well. Never on Saturday or Sunday, preferably around eight, when no one would be moving around, vertical swimming would start. First take a wooden ladder, about eighteen long,, lift it up, shaft it into the well, climb up the edge of the well, step on the ladder, climb downwards, slowly dipped into the water and stay there. Get yourself soak for as long as you like, maybe paddle with one hand, while the other holding to the ladder (never two hands, I still do not know how to float on water). Pretend you were a good swimmer, that’s all. Extremely save, you would be all the while at home. I can swim as many times as I like each day.

                                                   During year end school vacation, there will be more opportunity. Especially so if we were to stay at second aunt house in Jurong. Being November or December , the rainy season brought plenty of rain water, so those ponds which cultivated water hyacinth for pig rearing would had more water than the mid year period. The biggest problem while swimming in one of the three pools was that you must be able to digest red coloured clay, as the water and clay would be well churned and mixed, after five to six boys stirring in it. At times the after swim effect, especially on sunny days could be terrible, with mud drying up all over the body, plus the process of the mud cracking all over before your turn to bath. Second aunt did not quite like us swimming there because the ponds were infested with painful stinging cat fish. Further more, we were visitors, anything happening to us ( non of us a swimmer) would be a big burden to her. Few times she had chased us out of the pond in the midst of our swim. Once a while, granny would come to chase us out too.

                                     It was no good to be caught many times for the forbidden swim in those ponds, but this did not stop our entering into water. The main reason that pond swimming was not enjoyable was because of the mud, furthermore, water was also warm. At times, we took to swimming in the well near to the pig sty. It was all right to swim in it because there were many tree roots on the edge of the well to hold on to. But, four guys would not be able to go in at the same time, so no fun. 

                               One of the best places to swim was to blockade by damming the stream in front of aunt’s house. The eight feet wide stream run clear water, at times. The water was very cool, as throughout the path of the stream, was shaded by fruit trees. It was not advisable to do so if rain got too heavy, as most pig sewerage storage pond would be flooded, and all the excreta would be over flowed into that stream. Though it was only about thirty meters away from the house, the view was blocked by the many star fruits trees in between. So once a while, Ah Hian, Choeng, Ali, myself and even little Ah Kwang would be helping out to dam the stream. We would take chankols or spades and start to build up mount of soil, blocking the flow of the stream just right below a Jambo tree. We could build up to three feet high, making a good swimming arena. This was the most enjoyable place. The elders also did not like us to be there not only because of water, also it was too dirty when excreta of all kinds would flowed by. Of course, granny would be mad when she found out that we were there swimming. In fact swimming for us was always a taboo to the elders. 

                        Second aunt was always busy with her work. She had to do washing, cook for pig, and we all too. As such, she seldom had time to watch us. Granny was different, she had the time, but would normally wake up late. One cool morning, prior to lunch time, our whole clique decided dam building again. This time the building of dam was fast. But to be save, and not to be caught with wet clothing which we will get a lot of scolding, we put our pants on a branch of a star fruit tree standing in between the house and our swimming area and we swam naked.

                        That morning the water was very clear and cool due to the rain the night before. In the midst of our swim, we saw granny, hand carrying a cane, walking speedily towards us. Suddenly all of us quite down and squad at the edge of the stream, and peeped at granny movement. Instead of coming to us, she went straight to the star fruit tree, pick up the pants, and moved to the hut where aunt used for cooking pig food, and brooding of chickens, threw them onto a basket, and returned to the house. All of us were stunted. Non of us had pants on! 

                         Each of us pluck a yam leave, and turned to be Adam, stoop low, walk along the stream, dashed up the hill behind our house, and gathered behind some low rambutan trees, and began to scratch the itch all over the body caused by the sap of the yam leave. Held a conference of what next. We then run over to a permanent wayang stage which was way out of our estate, hide in the covered enclosure underneath the wayang stage straight in front of a Chinese temple. At last, we appointed Ah Kwang to steal the pants back. Since he was the youngest, not much problem for him to run around naked, and he did so. 

                          Soon, all of us were proudly walking back to our house wiht our head high, as if nothing had happened. Granny saw us returning, she smiled, and said that next time round, she would be keeping the pants some where else. Not long later, dad, who had vast interest of the sea, became more frequent in bringing us to the sea in Ponggol, so to steal a swim became an obsolete obsession. In time to come, we move to Ponggol, and the sea was just a hundred meters in front of our house. We do swim, once a while. Now, with the abundance of opportunities, what so good about swimming ?

Ghost

LAST TIME

GHOST

 We must always do something that have some trills. While staying in First Aunt house, her neighbour Ngak Song Pek would be telling many of his experiences on ghost, saying what his Yin Yang eyes ( eyes that can see ghost) saw. Most of them were eriee. These stories did give us periodical interest, whereby going around to ask for more. Being living in the village, lacking the brightness at night, the fear of ghost would not be strange, whether true or not. 

            One day, Muai Hiah, Ali, and myself decided to play some tricks. The identified the victim will be Anne. The most gutless girl around. It was also that every night, very punctual, she would go to our house to see Ah Khiang at eight sharp. That morning, we picked some betel nuts, about the size of an egg, loosen the husk on one side, shave clean away the husk on the other, and painted a white face on each of them. Together there were six pieces. On top each of then, we tied a galvanized wire loop. On the pathway entering our compound the left was our toilet, while on the right were many banana palms. A Number 8( 0.8mm) string was then tied to a banana palm, about three feet from the ground, while the other , across the path, loosely tied to the toilet. All three of us would be hiding in the toilet. Once Anne walk by, we would place the “hairy head” one by one on the string, which they would slide down the string in the dark. Then, these would scare Annie to hell. Every thing was ready, just had to wait for poor skinny Anne to cross our ghost string. As watching Anne was our prime focal, the wait was long, we stood down from the wall of the toilet. Suddenly, out of our notice, there was a pull on the string. I though we got her, so three of us rushed up the wall but we actually caught Kang Song Pek neck, coming home late on his bicycle. 

    Luckily no “ghost” was on the string yet. He was a cool man, in TeoYeo dialect, he mumbled why in the world would some people put a string across” Well, it was our luck that the string did not catch any other person. But he did indirectly helped us, he showed us that the string was too high. We lowered the string and waited again. Good , this time it was really Anne walking in. Muai Hiah quickly lower the hairy head one by one. So well prepared, the head slide down gently along the string, which Ali was waving. Now Anne had already touched the string, but there was no reaction. The head and the face was too small. The place was so dark that these ‘heads‘ could be recognised to be scary. She pushed the string till Muai Hia let go of it, and just walked towards our house as usual . Nothing happened.!!! One whole day of preparation and anticipation, and nothing happened ? No, we were not satisfied. This time we must, by hook or by crook scare her. In the toilet, we waited, she must return home. I went to our huse to wait for her return.When she was about to do so, I quickly rushed back to the toilet and kept out group imformed. 

          Now Anne was casually returning. As she got past us, three of us simultaneously jump out and in good timing loudly shouted “ Hoi !! Arr, Aaaaaa, kui ah, kui ah” (ghost, ghost). It worked. That really scared her to crazy. She was stunned, panic, run like a headless chicken, in a S shaped path, head on collided with a coconut stump in the middle of an open ground. Zoom, three of us disappeared. Boy, that was fun, right ? Wrong. In a short moment, Aunt Pek Huang dragged along Anne still crying and with bleeding lips entered our house by our back door, went direct to granny. Mum and dad was not around then, boy were we lucky. Granny was seating comfortably in front of her room entrance. Pointing to Anne’s swollen and bleeding lips, spat out “ Ah Mm ( auntie ).. … .my Anne…. …..bad….” As normal, she spoke so fast that the full sentence could never be recorded. In a few words it meant “ bad boys victimised Anne, need punishment” Granny apologised profusely, and when they returned, granny took a long cane and tickled us. 

          Few weeks later, I met my repercussion. Every night between ten thirty to eleven, by the main road a hawker selling prawn noodles would pass by. One night, Mum called me to take a pot to buy some noodle soup for her. I was a dark moonless night. As I passed by the path near the toilet, I could imaging ghost all over. I walked as fast as I could. By the main road, after a fifteen minutes wait, the mobile hawker came. I bought fifty cents of noodle soup, and returned home. Again I had to get by the path. Just ten feet from the toilet, in front of Aunt Pek Huang house, I began to think of ghost again. For the moment, a huge dark shadow came out to my path, face without contour, hand stretched, trying to prevent me from passing. Suddenly I was very scared, my legs soften and trembled, yelled “ Kui ah, kui ah “, threw the soup away, sped home, panting. Mum came to me to ask for the noodle soup, but I was flabblegested and could talk for a while. Mum gave me a cup of water, and when I came around to talk minutes later, I told mum what I saw. She did not believe a word, scolded me, insist that it was my imagination. She was not bothered any more.

                    We had the most banana palms in our village, most were about twenty feet tall. We used to listen to stories of banana spirit with long green teeth sticking out, residing in huge banana plam that had yet to bear fruit, and how some people hard up for lottery numbers would force the spirit to provide a set of lucky numbers to punt . So, Ali who usually had some great ideas, discussed with me to try one of the methods. Being much more braver than him ( the previous incident had already evaporated away from my mind) will be the one to communicate with the spirit when it appear. We waited anxiously for the night to come, while in the meantime, we took a roll of red string and placed in the kitchen. Beside the washing area stood a tallest banana palm that was yet to bear fruit. Yes, this would be the one. The long waited darkness arrived. I would be lying on the bed and Ali will go to that chosen banana tree, tied the red string a few rounds around it tightly, then laid the sting all along till it reached me on my bed. This end of the string will be tied to my right little toe. All done. Every procedures were followed as per the story we heard. The expectation was that a banana tree that cannot bear fruit had an angry spirit in it. From our tying of the red string, it would come out of the palm, traced the red string to the other end, me, to beg for mercy to let go of it from the spiritual squeezing by the string. This would allow me to be asking for whatever I want, when it agree, then I would untie the string around the palm. Good move, next was to wait patiently for the right time when the spirit would appear for mercy. After a while the wait, seem quite long and got boring. Ali could not be around to talk to me for the fear of scaring away the ‘approaching’ spirit.

                Suddenly, I felt there was a jerk on my tied toe, the feeling was like that of a fish biting a hook. Now I felt a little scared, closed me eyes tightly, curled a little closer, and wait. The moment of truth was about to come. Whip!, I felt a stinging pain on my buttock. This spirit must be angry and fierce, I thought. Again it happened, the pain was familiar. Continuos quick strokes followed, made me jumped up of the bed in pain. Dammed, it was the canning from my dad.

                              This stupid Ali had laid the red string on the path, where dad tripped over it, and that was how he found out. It took me few days to recover from the damages done by the caning. The action of dad could had scared the spirit back to the banana palm by the way of the red string. Till now, I had yet see how the banana spirit look like, and also yet to decide what would I be asking for when it appear before me.