The Famous and Infamous Kacang Parang

The popular bean is known by a few names, among them kacang parang, fava bean, broad bean, sword bean, field bean, bell bean and 蚕豆 (chan dou in Mandarin)".    Today, I would like to share something about this famous as well as infamous bean.

Common local snack.  Satay-flavoured kacang parang sold at the 'kedai koperasi' of my workplace.

This picture gives a better idea as to what the bean looks like.  Kacang parang with shell... In its original state, the beans are contained in pods similar to "petai"/
Source: http://ms.wikipedia.org/wiki/Fail:YosriKacangParang.jpg

Almost wherever I go, I frequently come across them being sold as snacks at various shops as well as "kacang putih" stalls, be it at supermarkets, sundry shops, bus stops, as well as the shop at my workplace.  There must be a high number of kacang parang lovers around or else what explains its sale at large scale throughout the country...

Kacang parang and I...
I used to buy 'kacang putih' - an assorted crispy snack with comprising various "kacang", and it contains kacang parang.  The snack is famously sold around Ipoh by Indian peddlars on motorcycles. 

For strange reasons, I would automatically pick out and get rid of all kacang parang before I settle to eat.  This had been the phenomena since I was very young.  Perhaps I found the shells a nuisance, perhaps I disliked its appearance.  It wasn't in my wildest imagination I'd one day discover that I am related to G6PD deficiency, suspectedly from my mother's side of family... oh God, why am I created as a carrier of two X-linked conditions from both parents....  Either way, I am doomed especially when I only have sons, looks like it's either this or that and there's NWO (no way out).

What's it about the bean?
Favism refers to reaction towards fava bean - hemolysis.  Or simply-called, the breakdown of red cells.  Of course not everyone who eats kacang parang will get it, but individuals with G6PD deficiency have to be careful not to consume the bean.

The philosopher Pythagoras used to forbid his followers from eating fava beans, in fact also all other beans.  Relating this to our knowledge today, this probably has something to do with the occurrence of favism upon its consumption. 

Which in turn brings us to the following topic:

G6PD Deficiency (or 蚕豆症 in Chinese)
The infographic below illustrates what is G6PD deficiency:

 Source: http://www.medcomic.com/050414.html

I am not a medical doctor but merely a layperson whose life is related to the condition.  So the purpose of my writing here is to share my humble knowledge on this topic, and *hopefully* also to increase our awareness on the condition.  Among my sources of information are the handout I took from hospital, the website of the G6PD Deficiency Association at www.g6pd.org as well as my good cousin who is a hematologist.  Ultimately, please consult an expert for advice / clarification.

Here we go...

1) G6PD stands for Glucose-6-Phosphate Dehydrogenase.  It is a type of enzyme in our red blood cells.  G6PD protects red cells from breaking down. 

2) G6PD deficiency is more prevalent among people from the Mediterranean, Africa, and South East Asia.  These areas also happen to be malaria-prone places.  G6PD deficiency itself offers a degree of protection against malaria.

World map distribution of G6PD deficiency.  Source: The Lancet

3) In our country nowadays, the screening for G6PD deficiency is performed upon newborns on their respective cord blood.  I am not sure when did this practice start, but I am sure that during the era when my brother and I were born, the screening wasn't a routine.  Over here, G6PD deficient newborns will have to remain in ward for observation for 5 days.

4) G6PD deficiency is X-linked i.e. carried via the X chromosome. 

5) Among the signs and symptoms of hemolysis are anemia (paleness, exhaustion, dizziness), rapid heartbeat, chest / back pain, jaundice, dark/tea-coloured urine.

6) G6PD deficiency is lifelong.  But G6PD deficient persons should be able to live healthily just like any other normal persons provided they take care and not expose themselves to factors/substances that may trigger hemolysis, as shown in the following table:

The list is subject to revision from time to time, so it is not exhaustive. 

7) More dos-and don't:

- The consumption of fava bean / broad bean / kacang parang is strictly prohibited for a G6PD deficient person;
- Please beware of the hidden content of kacang parang / fava beans in popular dishes, e.g. ful medames (an Egyptian breakfast dish) or kacang pool in Malaysia (most famous in Johor), dou ban jiang (豆瓣酱)  - a famous spicy and salty paste from Sichuan, China - common ingredient in the famous "ma po dou fu" (麻婆豆腐)dish and a spicy sauce called ma la jiang (麻辣酱) from Sichuan, and zha jiang mian (炸酱面) from northern China.  Since it's impossible to know the recipe of all dishes from around the world, caution is thus advised before consuming dishes containing beans;
- Contact through ingestion, touching or inhalation of moth balls ("ubat gegat") shall be avoided due to the content of Naphthalene in most of them;
- Medication-wise, to avoid using those stated in the list above;
- Certain traditional medicines are unsafe for G6PD deficient people, so to be safe, please refrain from consuming them on your own.  A reputable local Chinese traditional medicine manufacturer even print warnings on some of its products like bao ying dan and pearl powder, that are known/believed to be unsuitable for G6PD deficient persons;
- Some suggest that it may be a good idea to wear a Medic Alert pendant/wristband which states "G6PD deficient" so that medical personnel who treat such person in an emergency will be aware of the condition.  

Conclusion
Sometimes I am just a little concerned when I see kacang parang being sold abundantly at so many places, when so many of us (e.g. my generation and earlier) have never had our G6PD status tested.

If someone, be it adult or child, were to come over and I were to serve them snacks,  I'll serve almost anything except kacang parang.  I am afraid what if someone who is unknowingly G6PD deficient termakan the forbidden bean.  At ward 2B HUKM - my home for 2 months, the nursing sister told that one of her nephews was admitted to ICU and had to be given blood transfusion after unknowingly consumed a dish that contained kacang parang at his friend's house.

"Friendly frontliners needed at KLIA". Would like to share my experience too.

A throwback
About a month back (why did I take so long to finally complete the draft of this note before posting...), I came across a letter entitled "Friendly frontliners needed at KLIA" sent to the Editor of The Star by reader G.K. Gill.

I concur with what Mrs Gill had written.  Likewise, I shared a similar experience some nine years ago.

My intention to share my personal experience is not to defame any party, but just to share a fact that took place quite some time ago. 

First class infrastructure does not guarantee first class service

"I am first-timer"
My pioneer international trip took place in June 2005.  Being a first time user of KLIA, I was excited.  Please don't get me wrong, as being an ordinary person (I am not a wealthy person), I only travel very very occasionally.

Everything started off pleasantly until I was about to go to the queue to board into the plane.  An officer was there checking the passports of passengers.  Passengers boarding that flight comprised mostly Japanese, followed by a handful of others including Malaysians.

Politeness is selective
Mister Immigration Officer on-duty appeared very polite to the majority of passengers. He greeted each one of them "good morning" before taking a glance at their respective passports without asking questions.

When I gave him my passport, the demeanor of his face transformed from smiley to stern. There was no greeting whatsoever.  Fine, I understand perfectly well the mantra of "mandatory politeness to foreign nationals, but politeness is optional or selective once it comes to your country folk".

It is a fact that in the past, some Malaysians used to go to where I was traveling to under the pretext of being visitors, complete with valid travel documents and return tickets, but ended up remaining there longer than allowed to work illegally.  Maybe it's a phenomenon of "nila setitik, rosak susu sebelanga" - a Malay proverb which literally says 'a drop of ultramarine spoils the whole barrel of milk'.

But still, even if you have grounds to suspect  (note: suspect, not confirm) someone for possibly being hanky-panky, do you have to show a tight face to that person even before you confirm your speculation? 


Mr Immigration officer: "Ni frst time punya passport ke?"
Me: "Ye encik" 
(He then took about 5 minutes flipping through every page of my mostly empty passport, still with a stern facial expression)
Mr Immigration officer:"Visa ni you buat kat mana?"
Me: Penang
Mr Immigration officer: "Berapa you bayar untuk buat ni?"
Me: Tak kena bayar... free.
(Mr Immigration officer then returned my passport and left without a word)

While I understand he is merely performing his duty, I wonder about the necessity of having to show an expression that is borderline-hostile, if not truly hostile.  If I had been hostile to him first, then I can see why he had to treat me like that.  But I was never one, never been arrogant to any public servant whom I have came across all my life. 


My visa was genuine alright.  Rather than to go through the hassle of going to the embassy to apply for one, I had mine done through a travel agent.   My trip was not under any tour group, so I had paid a commission to the agent to have it done.

Those were the days when a visa was mandatory for Malaysians to visit Japan, but it is no longer applicable today.  I knew that the visa was issued free-of-charge, or else, I might kena kantoi at the stage of Mr Immigration officer's interrogation.  Imagine if I had mistaken the commission paid to the agent as payment to obtain a visa... then Mr Immigration officer would have thought I had "bought" a fake visa.

Conclusion
During the days when my mood was still boiling, I thought of not using KLIA anymore because I hated the rude encounter I came across.  First time kan, sure traumatizing.  Fortunately the immigration and customs people whom I encountered during my return to KLIA were nice.

The Alammi Spa

Just in case if you're wondering what happened to Tanamera Wellness Spa at Sooka Sentral and Concorde Hotel Shah Alam, the spa is now known as Alammi Spa.

View from the main waiting area

The good news about Alammi is that it is run by the same team of people as before, still exclusively using  Tanamera products and retaining the same range of spa treatments - traditional Malay spa within a modern setup. 

The spa had undergone extensive renovation.  The one at Sooka is currently occupying two lots on the third floor instead of just one previously.

 Sample of Tanamera natural oils and body scrub to help you choose your favourite oil and scrub

 Bath tub... for flower bath ;)

Cup of ginger tea, mildly-sweetened, pre and post-session 

 Spa bed in one of the many rooms

I was in for a pleasant surprise when I went to the spa for a very brief session recently after being away for a very long time.  I find the newly-transformed Alammi spa better than ever, being much cozier and more spacious now.

Packages at discounted prices are available and recommended for anyone who intends to become regular patrons.

Peak Day, Peak Hours
As Alammi at Sooka is surrounded by various office blocks, a number of its patrons are thus comprise mostly people who work around the area.

The spa is usually fully-booked (by appointment) on Friday afternoons from between 12.30 - 2.30 pm, in view of the longer lunch break adopted by a few organisations based near KL Sentral.  So for those who would like to spend the Friday noon break for a facial, hair treatment, massage, bath, etc, it's best to call (03-27851815) or walk-in a few days earlier to secure an appointment.

Alammi Sooka opens on Saturdays too, but for shorter hours. It closes on Sundays and public holidays (while Alammi at Concorde Hotel Shah Alam opens on Sundays too, but closes on Mondays).

P/S (added on 07.09.2015) : The Alammi Spa is currently only at Concorde Shah Alam.  Its branch at Sooka Sentral had ceased operation since 30.08.2015 after MRCB, the owner of Sooka Sentral had sold the building, and the tenants of Sooka are supposed to move out by a certain date in September.

Part 3: Hello Brother of Alvin

Introduction
Due to constrain of time, this post is almost half a year overdue by now.  Instead of discussing on my 2-months experience as a patient of ward 2B, today I would like to jump into Part 3 first - my delivery experience at HUKM, the arrival of Alvin's brother:

Removal of cerclage
For first-timers who wonder how does the removal of cerclage feels like, it is painless, done without having to go to OT, and takes only a few minutes (note: speaking of cerclage done via the " v ", not abdominal cerclage). 

A cerclage is normally removed from the 36th week onwards.  In typical cases where contraction is absent or when the os is otherwise still closed, these patients will be discharged... and will only return when it's time to deliver.

On Monday, 31/3/2014 at 9 am, I was sent from ward 2B to the labour room - Room No. 1 (LR) for removal of cerclage, and possibly delivery on the same day.  Prior to that, I was told not to eat after breakfast - a precaution just in case if a c-section is required... you'll never know until the time comes.  And prior to the removal, a CTG was done in the LR.

 Labour Room no. 1, 1st floor, HUKM

But I was in the middle of nowhere...
In Part 1, I had mentioned about an opening of 2 cm prior to admission into the HDU where I was tocolysed before undergoing an emergency cerclage.

Upon removal of cerclage, the os was already 4 cm.   However, there was no contraction at all. To induce, or to return to the ward and risk everyone getting "kelam-kabut" if suddenly I felt like delivering?

Epidural vs. no epidural
At HUKM, the doctor readily asked if I would like to have epidural.  Cost-wise, I did not see it being included in my bill - I wonder if it's free, or only at a very minimal charge? :)

My initial principle was to have everything as natural as possible with minimal intervention (I later betrayed that so-called principle but arguably it's for good).  The devil in me suddenly changed my mind when I heard someone screaming in pain from a neighboring room .  Thinking of it now, my fear might not be unfounded for after all, I was already distressed by the long stay in ward, and did not want to aggravate what's already there by undergoing tremendous pain... One may or may not agree with this, so it's entirely a personal and subjective decision.


"Hot soup" and epidural is not 100% pain-free
Induction of labour:  This is my first experience going through an induction.  The membrane was first artificially broken.  I felt a gush of warm fluid slowly flowing out.  It felt so much like hot soup.  From the CTG, I could see a rise in fetal heart rate, which went back to normal 15 minutes later.  Adik must have been irritated by the sudden 'disturbance'.. haha.  The pitocin drip was administered 30 minutes later.

Epidural analgesia: A little similar to spinal anaesthesia, but they are not the same.  With epidural analgesia, contraction, VE and suturing were all pain-free... but not when the baby started crowning where sakit bersalin tetap ada...  despite having it.

A brand new experience
With epidural on and half a pint of pitocin left, I was relaxing myself when I suddenly felt a very sharp pain as if something was poking my pelvic real-hard.

I'm by nature a person who does not scream easily, yet it wasn't easy restraining myself from uttering some "uhh" and "ahh" every now and then.  This was definitely nothing like what I went through with Alvin... this was a totally new experience for me.

I called the nurse, and 2 of them came in.  One of them did a VE and told me "wah, cepatnya sudah 7 cm.... awak akan bersalin ni".  The nurses had helpfully guided me until the baby came out.  The whole process didn't take long.

If I remember correctly, the baby took 5 minutes from when I began to push to be out.  The reason why it's fast is not because I'm strong, but an incompetent cervix probably makes it easy to get the baby out.

Deep breath in, hold the breath, push... then breath out.  I do not remember how many times I repeated that, but beneath the pain, I was filled with gratitude for the brand new opportunity to share similar experience as what typical mothers who carry their pregnancies up to 9 months go through.  If a baby of 2.51 kg is enough to give rise to so much pain, imagine moms of truly full-term babies whose little ones are 3 kg and above.

The first touching moment was when I heard adik's first cry...  It was very loud, very loud indeed (to me as one who delivered a near-term baby for the first time ever).
NB:  It's still fresh in my mind that I all heard of Alvin at Hospital Ampang some 22 months ago was some faint "weeeee"-sounding cry, which is expected in the case of a very preterm baby due to immature lungs.

Another moment that felt touching to me was when the nurse put adik onto my body for about 10 minutes before cleaning him up.  All these, were my first experience although I was by no means a new mother when adik came along. 

As soon as the epidural was off, I felt a little dizzy and had no appetite to eat the sandwiches served at the labour room.  Gosh, while I felt generally well with spinal anaesthesia except for urticaria on both legs, I felt sick after the epidural was off.  Fortunately I did not eat anything in between meals, or else imagine the possibility of puking... something which I fear very much. 

The 1st few days post-delivery
Due to an unforeseen reason, both adik and I did not get to go home on the next day although moms of typical SVD cases are usually discharged the next day.

Conclusion
I was advised that if I get pregnant in the future, I must come in for early booking.  An elective cerclage will be necessary, and should be done early at 16 weeks.  Which means a cerclage is a must each time I am pregnant.  And hopefully will not have to be on long stay in ward.  If God lets both Alvin and Aaron grow up smoothly, I should preferably not be pregnant anymore in view of some realities that seriously require me to stop playing with risk.

Although unplanned, I am nevertheless grateful for the arrival of Aaron despite the close age gap with Alvin. It will be an uphill task upon the family to simultaneously take care of 2 very young children at home but I believe there is a reason behind everything that occurs in life, why at this time and so on.

The next challenge will be a test upon my skill and patience in maintaining a balance between my existing routine, caring for and teaching them what they ought to learn... oh God, please guide me to the correct path in order to carry out my responsibilities with strength, fairness and patience towards them both.  Right now I am still far from doing enough for the brothers, let alone feeling like a good parent. 

P/S:
I appreciate and would like to express my gratitude to the following persons, including those whom I saw earlier before going to HUKM:

- My first ob-gyn Dr Norshida of Columbia Asia Cheras who did my antenatal check-ups during my first and early second trimesters;
 - Prof Jamil who did all the detailed scan and very thorough check-ups during my second trimester;
 - The good doctor and nurses at KKIA SK... I've gone there a couple of times for the sake of  getting the 'buku merah';
 - Dr Aqmar Suraya for promptly referring me for admission into ward 2B and doing my difficult cerclage which in turn had saved Aaron from being born at 29 weeks;
- The soft-spoken Prof Azurah for giving me the green light to go for the emergency cerclage;
 - The registrar and all the medical officer whom I've met either at the ward or HDU ... I was under "team hijau"; 
 - All the good HO and kind nurses who had worked very hard in monitoring and providing care... am thankful to the nurses for their patience in guiding and encouraging me when breastfeeding was initially a major headache + heartache - Despite frequent latching, I had zero milk for the first 3 days (will talk about that topic one day);
 - The medical students, nonetheless. All of them were very professional and in my heart I wish them the best;
- My ward-mates cum friends.  We had great times together, and I was happy to join a recent reunion with them at Iera's home recently; and
 - My husband for coming in every evening after work, my parents-in-law and sister-in-law for coming over whenever they're free although Seri Kembangan is not very near to HUKM... cousin Vernon for texting in to ask how I was doing, and friends who either came in physically to visit or gave me words of encouragements online.... Thank you Azies and family, Paul, Moganah & husband, Lidia, Maliz, Aimi, Fahmi and Ahmad for coming over to HUKM for a visit / my home /delivering the gift to me at home.  Thank you to my dear colleagues for the cute hamper from Chomel Store.  :)      

Ouch... again.

Speaking of allergy, for reasons unknown to me, I suddenly got into plenty of allergic reactions lately.  The best Malay proverb to describe the feeling now is "sudah jatuh ditimpa tangga".

Night cough please go away...
For more than 2 weeks, I was coughing like mad almost every dawn.  It's called post-nasal drip.  It results from allergic rhinitis.  Before I started coughing, I was sneezing quite badly.  But I knew it's not infection because apart from sneezing, my throat was perfectly fine (not sore, not red), there was no fever, and I felt okay when not coughing.

This reminds me of what took place back in 2007 when I was suffering from allergic rhinitis for about 2 months.  So bad, I even lost weight.  An episode of fever coupled with very tiny red rashes all over my arms, and my doctor ordered a full blood test, which confirmed that I was indeed suffering from an allergy.

I didn't, and still don't know exactly what I'm allergic to although I used to suspect it's cat's dander, dust mite, and perfumes. 

Fine, and I no longer suffered from anything as bad as that until very recently.  Since I'm no longer exposed to cats now, perhaps I may rule out cat's dander as an allergen.

Loratadine did quite a good job although not 100% perfect in alleviating my symptoms of allergic rhinitis, likewise dexchlorphenyramine although I don't quite fancy the slight drowsiness caused by the latter because that would mean missing on one milk expression session.  The ideal is of course not to go on any medication when breastfeeding.  But sometimes I just can't help not taking medication as long as they are generally safe (only very small amount passes into milk).

Later on, my doctor prescribed Clarinase (a combination of loratadine and pseudoephedrine), and budesonide spray.  The latter is steroidal, but after weighing the pros and cons, I have decided to use a little of the spray for a only few days. As for the use of Clarinase during breastfeeding, its pseudoephedrine content may reduce milk production a little, so I hardly take it for fear of losing milk like during Alvin's time.

Note: Fortunately, this occurred after I have donated my extra EBM, so my milk-children are not exposed.  Although these are safe for breastfeeding, I think most parents will be uncomfortable about it... so better not.

Complaint no. 2
Now that the symptoms of allergic rhinitis are beginning to disappear (fingers-crossed... touch wood), I am faced with a new sort of nuisance - urticaria!  Or simply known as hives.  Actually it's not all-new because I had slight hives during my sneezing and coughing days which I managed to suppress well due to the antihistamines I was consuming.  All-in-all, it's been on and off for more than 2 weeks by now.

 On my left hand

I remember complaining about hives once in this blog back in 2011.  Dishearteningly however, the hives now are much worse than that.

My complaint centers on two main reasons - looks and discomfort.

If I were to wear short sleeve and skirt, observant folks would have spotted the redness right away.  I'm not vain by fearing others seeing it, but I'm worried if people who do not know it think it's some sort of contagious skin disease and thus want to get away from me for fear of getting "infected".

The discomfort?  Needless to say, I spend a lot of time scratching despite knowing that scratching not only doesn't help, but is bad for the skin because I apply strong friction onto it.

Doctor after doctor...
Red spots above my lips.  Red spots around my throat.  And red-looking hives on my legs, still.

As it was public holiday for Aidilfitri, I could only see a doctor the next day to confirm what's on my throat.  I was worried about spots on the throat because other than a weird sensation when swallowing fluid, there wasn't any feeling of soreness.

I didn't visit the regular doctor whom I used to see because his clinic was closed for the week.  So I visited another doctor whose clinic is located in a neighboring block near my workplace in the morning.

Of course whenever I see different doctors (although I will try my best to avoid it) I will tell them my history... what happened earlier, when, what medication I took, etc.  

Then the doctor checked my throat and skin on my legs.  She told me it's a throat infection and that I need antibiotic.  She told me she'd prescribe amoxycillin, to which I replied 'ok'.  I've taken amoxycillin before and tolerated it well, no allergic reaction. 

Despite having consumed loratadine earlier, the itch didn't go away.  In fact, the swarm of hives only got larger and red.  And so I went to the doctor (again!) near my home in the evening.  My doctor-phobia Alvinvin would have screamed out loud doing that, and I happily went from doctor to doctor.  But of course I always reveal my full story each time I visit a doctor, be it the same doctor or another.

At the end of the troublesome punya consultation, I was give an additional prescription - levocetirizine.

So far I have only consumed levocetirizine once, this morning.  So far, I notice my itch had subsided very minimally, and the red patches are still there.

Conclusion
Allergy oh allergy.....   I have never really been comfortable so far.  If only i know what I'm allergic to, but I don't. 

I did not eat or use anything new. I was not on any medication prior to this.  The budesonide nasal spray may not be the culprit for I've used it before back in 2007.  Also, I'm not on any pill, injection or Implanon.  So what's the culprit?  Or is it due to any hormonal imbalance?

This year is by far the worst ~ in hospital for 2 months for bed rest, and now chronic allergic reaction, gosh!

Oh God, please let me complete at least 6 months of giving my baby exclusive BM this time (if not 1 year as I wish it to be).  I do not want Ken-ken to be allergy-stricken like me, although I could see a risk of him becoming the same as me, because I see he has sensitive skin around his face. 

Part 1: Eventful 3rd Trimester at HUKM

Hello to all my dear readers,

It was indeed a long hiatus, being away from updating for the past 6 months.  How time flies and we're already in the third quarter of 2014.  I was in HUKM for a total of 2 months, plus another 3 months of maternity leave.

Aaron is Alvin's brother, and he's slightly more than 3 months old now.  I personally prefer calling adik Ken-ken (it's part of his Chinese name) so that Alvin may learn to call his brother sooner because it's easier to say "ken-ken".   

Introduction
My journey this time began almost the same way as previously - antenatal check-ups at Columbia Asia Cheras during my first trimester, KKIA in the second trimester, and subsequently went on to HUKM (to UKMSC first, later referred to the public wing).  Don't know what suddenly drove me to HUKM this time instead returning to Hospital Ampang as initially planned, or to Hospital Serdang as it's the nearest to my home, but I just had a strange feeling that HUKM would be the right place.

Before it All Began.....
Prior to admission to HUKM, I had received 2 doses of IM Dexamethasone at 28 weeks.  This was how I spent the 2nd day of Chinese New Year - a journey back-and-forth HUKM once in the morning and another at night.  These steroid injections were given in view of the risk of a recurrent premature labour, to help speed up fetal lungs maturity.

Also, in view of the complaint of "heaviness" on my lower abdomen during my first pregnancy from the 25th week onwards, I also did TVS this time on top of the usual scans during my antenatal check-ups, to monitor my cervical length.  That's because such "heaviness"sounds a lot like shortening of cervix, which in the past, I didn't realise was a red flag until a year later.  

Source: NICHD

So, to all pregnant mothers, should you feel pelvic pressure / persistent heaviness on your lower abdomen when you're only in your second or early third trimester, please seek your doctor to check your cervical length because it's not normal to feel heavy so early.  Cervical incompetence is very rare, but it happens and for unknown reasons, I just happen to be among the minority. 

 Treatment room of Ward 2B

The Arabin Pessary
My cervical length appeared normal until the 28th week.  The first line of treatment offered to me was the Arabin pessary.

Source: www.dr-arabin.de

The Arabin is a "ring" that is made of silicon.  It serves to prevent further shortening of the cervix. It's painless, non-invasive, and can be inserted within minutes.

That Fateful Night when History Almost Repeated Itself
I was still in the ward for observation a day after the Arabin was in.

On history almost repeating itself...  It was all too familiar that I did not even panic, but instead I calmly finished my (super-plain) dinner before calling the nurse.

 The meals served at HUKM are very plain... mostly boiled, and it's difficult to describe what the taste is like.  I'm neither a fussy eater nor someone who likes to comment about food, but I have to say that the caterer who's awarded with the tender could have done better.  This comes from my experience of eating the food provided for 2 months and I actually lost weight there although I was supposed to gain some.

Back to the threatened premature labour, I saw blood coming out the same way as previously, but didn't feel any pain.  There was contraction, as shown by the CTG, but I did not feel anything. More dreadfully, the internal os was already 2 cm opened and the bag of membrane was visible.

The CTG... number in red is fetal heart rate while the one in green is contraction.  At the time when this is captured, contraction was only very mild.

Although I looked calm and kept quiet, I was already into "Oh no, I've caused a blunder... another one into the NICU... I'm losing the battle despite being super careful." 

That Saturday night itself, I had consumed don't-know-how-many nifedipine tablets - that oh-so-familiar pill!  I had lost count.  Note: Nifedipine is an antihypertensive drug, but is used off-label as tocolytic agent to stop uterine contraction.

Three Days in HDU
The O&G HDU of HUKM is located on the 1st floor.  Just opposite the OT.  It's blasting-cold, very quiet, and isolated.  

I was on nifedipine for a total of 5 days - 3 days pre-cerclage and 2 days post-cerlage.  BP and pulse rate were closely monitored (nifedipine may cause low BP for a non-hypertensive person). It's feels "rimas"i.e. highly-uncomfortable to be hooked on multiple wires.  I believe such discomfort is not even a fraction of what my first-born Alvin felt in the NICU and I have to salute him for his strength even though he's only so small (1.16 kg). 

As I was prohibited from standing up and walking (including no toilet visit), I was on CBD, which was highly uncomfortable each time I tossed myself. As for eating, I was only allowed to sit 45 degrees.

The Mother of all discomforts?  Bed on Trendelenburg position = legs up, head down.  The reason for such position is in order to minimise exerting pressure onto the cervix.

Buttons of "my bed"... just a finger away to adjust the bed position.   Sometimes I 'curi-curi' reduced the slant of my bed in order to gain greater comfort, but at the expense of doing myself a disfavour actually.

Compression Stocking and blood clot
A person who's bed-bound is at higher risk for blood clot.  As "simple" as it may sound, it's not something to be taken lightly.  

Compression stocking, or TED stocking is available at the pharmacy of HUKM for RM80 per pair.  It's cheaper in comparison to pharmacies outside.  The stocking is long and very tight, serves to prevent blood clot in the legs.  

The reason why a blood clot is dangerous is that the clot is capable of moving upwards.  If it goes to the lungs, then it will cause pulmonary embolism.  May be fatal if not careful.  So,this is the reason why doctors always emphasised on wearing the stocking at all times during the bed-bound period. 

The Cerclage Experience
That's right... 29 weeks. 

A cerclage (pronounced as "ser-klaj") is usually done at around the 16th week.  In simple words, it's placement of stitch onto the cervix to prevent preterm delivery.

Just like any other surgery, whether major or minor, it comes with some risks.  The outcome is normally good when it's done early.

I was initially not feeling optimistic because my pregnancy was already at an advance stage.   But for a while, I felt on top of the world when Prof Azurah told me I could go for cerclage. 

D-Day
It was February 11, 2014.  I was really hungry because I was required to fast.  The sight and smell of yummy food from neighbouring cubicles were tempting yet irritating.  Irritating because it challenged my patience even further.

 This cup is great for drinking while lying down... provided at the HDU.  In moments of hunger and thirst, I took a few sips of water when no one's looking.  I am not as obedient as people think...

The Spinal Anaesthesia Experience
The cerclage was done under spinal anaesthesia (sitting down hugging a pillow, 3x injections on the back).  I find spinal anaesthesia very "pleasant", my legs felt hot at first, followed by a loss of sensation within minutes.  I felt extremely relaxed and sleepy.  I didn't expect spinal anaes to make me as sleepy as this.  There's no nauseousness, but my legs were full of hives post-op.  The antihistamine Piriton had aggravated my sleepiness and I ended up sound asleep for 4 hours straight post-op.  This is only spinal, if it's GA, I cannot imagine how long will the sleep last.

Back to cerclage, it was 2.30 pm by the time I was taken to be OT.  Dr Suraya did mine.  This is the first time I went for an op. 

My comment about the procedure?  It's painless during as well as post-op.   I was relieved that it's finally done... Prof had initially set a "target" of 32 weeks for me, followed by 34 weeks (another round of IM Dexa b.d.), and finally 36 weeks (successful treatment, thanks to the great doctors and nurses at HUKM, yayyy!). 

After cerclage, I spent a total of another 2 months in ward where  I continued with bed rest in Trendelenburg position and weekly Proluton injections.

Coming up next... in Part 2, or Part 3:
1) Out of HDU and how I spent the remaining of my days in HUKM, meeting friends, living a life of Sleeping Beauty (what beauty is there in me?);

2) How I find it at HUKM.  The people, the food, the environment, medical students, and other stuff;

3) The day of cerclage removal;

4) The arrival of Aaron; 

5) What lies ahead should I become "p2 g3", which I pray hard that I will not need to go through.

6) Another few days in ward. I was very stressed at first, but later thought it's probably a blessing in disguise in some ways. 

Happy New Year... and 1st update

Happy new year everyone.  :)

http://www.techblogstop.com/wp-content/uploads/2013/12/Beautiful-Happy-New-Year-2014-HD-Wallpapers-by-techblogstop-23.jpg

As usual, always speaking of time flies... There are so many things to share as well as rant about, but the chase for time is ever present.  Juggling between two (one an elderly person, one a toddler), and soon (maybe...) three persons will surely be no joke.

Let's begin my first update for the year with.....

The unborn baby...

I am thankful that "adik" Alvin is still with me.  Based on the EDD calculation, today is the 24th week in gestation.  Let's not divulge into the baby's sex yet although it's already clearly visible (yes, I saw!), mainly because to me, whether boy or girl, what's most important is the baby's overall health and well-being. And no use fearing about what I used to fear... because once conceived, a child's fate is thus already written, though not entirely.

I also pray hard that I won't deliver anytime soon, because if adik Alvin were to follow Alvin's footstep, then "it" will be born in a month from now.  And just because we escaped danger once, does not mean the same will necessarily occur, bearing in mind the long list of risks that all extreme preterm babies face.  "My dear child, please be patient and wait for your New Year ang pow to come next year instead of now!".

I was a little relieved after yesterday's check-up with Prof.  Don't know whether it's psychological or for real, but I immediately saw a semblance between adik Alvin and Alvin over the screen during the 4D ultrasound scan.  They both have the same habit of touching their faces. 

At least I am still able to continue with my usual work for another month.  And what's next?  To continue with my Duphaston (even though >20 weeks), IM Dexamethasone later on to help speed up fetal lungs development for just in case I deliver early, and to rest from week xx to 34 (I don't want to tell when because I don't want my superior(s) to know) . 

On the issue of cervical polyps, there's one pretty big growth located quite high up (and thus removal is not done at this stage).  Last month's pap smear result looked normal. And GBS negative.  I also had blood drawn for a test yesterday, after I told Prof of the persistent presence of rashes all over my hands and feet every night for the past 1 week or so.  Itch coming from these rashes are really a nuisance because my sleep is greatly affected.  It could be simply due to hormonal factors or allergy... or something more serious (gulp!). 

Actually, the fear of MC is one of the reasons why I worked triply hard in December to make sure that I don't carry forward "old work" to January, for just in case I have to be put on rest.  Old work stemmed mainly from the days when I was least productive during the 1st trimester when I was frequently tired, sleepy, as if my head was spinning all afternoon, and of course medical leave when there were incidents of PV bleeding.

Right now, I find it difficult to imagine "34 weeks", let alone the full 40 weeks, or even early term at 37 weeks.  Although most mothers have no problem with that, with me, it will feel like some sort of record-breaking personal achievement.

I shall not decide where to deliver adik Alvin, but will leave it to convenience when the time comes.  I have shortlisted 3 places so far.

Anyway, we don't really get to choose 100% where to be born because while humans can only plan, there's a power above us that will finally decide whether things occur according to what we plan or otherwise.

Since Alvin is still so young, I am sure he still does not appreciate anything about the expected arrival of another baby just like Alvin-vin (if God permits things to run smoothly).  At most, he may be wondering why's his mom's belly getting bigger and bigger, and why's mom not carrying him for a duration as long as last time. 

Conclusion
Last but not least, wherever you may be... my dear friends and readers, may the year 2014 bring you abundant blessings and good health!  :)