Back Home... In Ipoh

On day 1 of the Hari Raya public holiday, we made a trip to Ipoh... a place called my hometown because there's where I was born.

But apart from being my place of birth and where my former family home was in, I'm otherwise pretty estranged from this city of delicacies, as I spent my entire life-in-school-and-beyond outside Ipoh, and hence had minimal experience being an "Ipoh girl".

Memories of my mom's humble garden at my former home

Anyway, I'm happy that I still have family members living in Ipoh, namely my aunts and my cousin. So, whenever I happen to be there, I'll pay them a visit them.

After the demise of my paternal grandmother in 2011, gone are the days when family members of all ages and from various locations used to come over and gather for lunch on Chinese New Year.

How time flies!  It's been 5 years since I had a home in Ipoh.  During this trip, I saw a number new developments, mostly comprising hotels, luxurious residences and some shopping malls... among them is AEON Station 18 which is ten minutes away from my former home by car.

My former home with new occupants today

Apart from all that, Ipoh appears largely the same as before, as I'm still able to get around without major hassles.

On a cloudy Wednesday evening...

Left: Ipoh Parade and Main Convent.

Right: Sam Tet School and the famous Tong Sui Kai (or dessert street, which opens at night) by the side, with new development called The Octagon (mixture of serviced apartment and retail outlets).

I felt a sense of proximity to my mother when I was Ipoh, because I spent a lot of my time with my mom in Ipoh after her retirement, and perhaps also because there's where her final resting place is.

On the positive side, fortunately Alvin did not suffer from car sickness this time, unlike last year. Both kids slept well and adapted generally fine as "Ipoh boys" throughout the stay.

If time permits and given a similar opportunity in the near future, I'd like to revisit more places in town, as well as meet up with more folks whom I've not met for very long in Ipoh, as well as in BG which is only 20 minutes away.  Let's look at the schedule and see how then.

We're Sick! The Mycoplasma Attack :(

It all began with an innocent-looking cough and a mild fever on a Friday evening.  "Nothing unusual about it, as common infections are widespread at kindergartens and nurseries ", we thought to ourselves.

A twist of event leading to a twist of outcome

Due to a certain unfavourable reason that day and being obliging, we ended up at another clinic and not the clinic that we usually go to.  

Unfortunately, Alvin's cough became worse a day after.  Went back to the same clinic the 1 1/2 day later. This time, another dr attended to us (it's a partnership clinic).  Received a neb, followed by a change of antibiotic from cephalexin to amoxycillin. That night, Alvin's cough seemed a little relieved, but returned to its violent form by the next day.

In total, it's 4 days down the line, but Alvin's cough and fever still persisted.  The cough turned so bad that Alvin continued to wheeze even after nebulization, and when he coughed, it could run for 10 minutes straight in a row.  His sleep and appetite suffered - he refused all food, and drank very little.

Went back to the same clinic, the dr referred for admission on the same day.  

A little thought as to which hospital to go to came momentarily.  Cost vs convenience, familiarity vs uncertainty.  Finally, we decided to go to where we're already quite familiar with, which is also one of the nearest from where we are.

The process of admission
The emergency department at Columbia Asia Cheras on that Monday night (near 9 pm) was surprisingly crowded for its size.  The waiting time was considered ok, the medical officer on-duty (I didn't get his name) was quite prompt in attending to us. But the waiting time to go to the ward was long, it's past 1 am on the following day.

First, the dr checked Alvin's breathing. After that,  Alvin was given a neb, followed by chest x-ray and blood test.  It's typical of children to scream when blood is drawn, likewise Alvin. 

About an hour later, pediatrician Dr Hew came, checked and asked a few questions about Alvin.  He later proceeded with branula insertion because Alvin will need IV fluid (he wasn't eating and drinking properly) and IV antibiotic.  We've seen Dr Hew a few times before, starting with Aaron about 2 years ago when he was admitted for phototherapy, and for a few vaccinations after that.  Dr Hew is a very soft-spoken doctor and explains things in pretty great details. 

I wish but I couldn't
In most cases when a young child is warded, the mother is the one who'd stay to take care of her child.  I wish I could do it, but alas!  As I am currently in my first month of employment at a new place, I am generally not allocated with  leave.

But compassionate leave, which includes hospitalisation of family members, is available.  However, I don't feel good taking it although my superior is very understanding... unless for critical causes (touch wood, I pray that nothing as bad will happen in my life anymore after one incident back in 2011 at Ipoh GH, which unfortunately had a negative outcome and I ended up utilizing my compassionate leave).

On weekdays, my mother-in-law helps out by staying with Alvin in ward every night, while my husband and my father-in-law accompany Alvin during from noon until the evening.  I only get to see Alvin after finishing work, and room-in during the weekend. 

The culprit, and oh no wonder
Yesterday was a bit fortunate as Dr Hew was around when I went to see Alvin in the late evening. Dr Hew explained a few things, inter alia that blood test shows Alvin is infected by the bacteria called Mycoplasma, or specifically Mycoplasma pneumoniae.  Oh, that's why the antibiotics he took a few days earlier from the clinic did not work at all! 

Alvin's present treatment comprises 4-hourly neb, oral medications for fever and cough, IV Zithromax and chest physio.  Hospitalisation may take between 5 to 7 days, depending on his recovery.  As of yesterday (Day 3 in ward?), he still coughed a lot, although with slightly improved appetite.  :(

Maybe Alvin is going to miss school for 2 weeks.  OMG, this is only the 2nd month in pre-school and he's already like this, I can't imagine how's it going to be like for one whole year.  I like the fact that pre-school helped him a lot in terms of development, like learning to talk and be more independent.  Yet I can't deny how fearful I am if similar illnesses were to recur, because what is ordinary URTI to many other kids, may not be the same for him.  It's likely because very preterm babies are physically not exactly the same as their full-term counterparts.

We too, are invaded by it
As M. pneumoniae easily spreads through cough droplets, it is thus very difficult to avoid getting infected especially when living within the same house and same room.

Aaron is sick now, although not to Alvin's extent (fingers-crossed).

Likewise, I couldn't escape either.  I had a fever (high, at 39 deg C) starting from Wednesday. My chest feels slightly tight when I breathe in.  So when I saw my doctor, I told him that one of my kids is currently in ward due to mycoplasma pneumonia.

Today is my 3rd day with presumed Mycoplasma infection... looking at the way I "progress" i.e. negligible improvement, maybe I shouldn't call it presumed anymore. Appetite-wise, I don't seem to get hungry, don't know why... although I still do eat. Yes, with this particular bacteria, recovery is expected to be longer  In the meantime, I think I'm heading back to the clinic when I'm free later.

Conclusion
I used to think it will be better to cut-short the number of hours that Alvin spends in school.  So that he will get more rest, and cut down a bit of exposure to what he's still not able to cope well with. Like now, his pre-school is from 8 - 12, followed by day nursery until the evening.  The only hindering factor is that no one is able to pick him back in the noon.  I also realised that once he gets used to the back-home-by-noon routine, it will be difficult to go back to the earlier route.

Lastly... Don't succumb to hearsay or nasihat tak bertauliah.  Stick to what is only known to be right, or supported by facts.   This is not insinuating that being stubborn is good, but exception is justifiable under special circumstances.  In order to be tactful, just nod yes, but sit adamantly about the execution part.

The New Year Post: Lessons from the Past, My Simple Chinese New Year, and the Brothers

Without much hype, I left the job that I've been doing for more than 6 years.  Six years can be considered a quite a long time nowadays, but of course not in the context of my parents' work lives where loyalty service of more than 20 years was a norm.

New year, new job - My resolution, theoretically-speaking

A change of job does not necessarily have to stem from negative reasons, although boredom may fall under the negative category.  Between getting comfortable and continuous professional challenge, it's crucial for both to be balanced.

Today marks my second week of work at a new place away from KL.  It's a mixture of familiarity as well as strange feelings. A long way lies ahead for me to learn before I can call it "mission accomplished".

My mission is very simple, yet not necessarily easy to attain - I would like to be better-rounded; not just being a parent to A & A, but at the same time, a balance between work and personal commitments equally.  Also to always try not to let personal challenges, if any, distract me from delivering.

Being an ordinary person means my life comprises ups and downs, and hence some moments of imperfection, although they're only minor ones, thankfully.  The 5 months of being away from work in 2014 due to a long stay at HUKM (a case of cervical incompetence and thus a high risk of recurrent premature delivery if not careful), and maternity leave thereafter, came at a cost as I seemed a little lost upon my return to work after that.

The awaited moment when someone opens his mouth
Alvin is coming to 4 years old this May.  One of the biggest gifts of the early months of 2016 that I am most grateful for is to hear Alvin talk meaningfully for the first time at the age of 3+.  We used to worry a lot about this issue - despite having normal hearing, he was still not verbal as at December 2015.

Although his pronunciation isn't 100% perfect, at least it provides answer our anxiety as to whether he will talk or not one day.  He speaks mostly Mandarin, with a mixture of English.

I don't know if it's speech therapy or pre-school that made Alvin open his mouth to talk, maybe it's a combination of both.

However, also as in the case of me, Alvin has a long way ahead for improvements, although for different aspects. Certain parts of his behaviour still needs improvement - he has a highly fiery temper (not appropriate for his age!) when his wishes aren't fulfilled.  For instance, his unfulfilled requests for not-so-good stuff such as tidbits, which severely affects his appetite for proper meals.

From where did he learn about the yummy taste of tidbits, I do not know as I don't take/buy snacks. Maybe it's through sampling the food of others, which in reality is not anyone's fault, because folks normally mean well when they offer tidbits to young children.

The only prudent thing to do is to make Alvin realise what's good and what's not as he grows up, which is easier said than done.

The brother
As for Alvin's brother, Aaron, he's small and may be mistaken for a 1 year plus baby when in fact he's a toddler closer to 2 years, unless you see his mouthful of huge teeth. Poor Aaron frequently get pushed or knocked head-to-head by Alvin when they fight, which is not unusual due to their close age gap.  How to make Alvin understand "sayang adik"?  Aaron enjoys climbing, eating, playing with blocks and flipping through photo albums - a different personality from his brother although they look similar.

The Chinese New Year
As I am still new in my present employment, I am not allocated with annual leave this month. No problem, I'm ok with that.

I celebrated the new year modestly at home in Seri Kembangan.  I've been away from home long enough, hence homesickness is no longer an issue although at all times, I still regard the various authentic food of Ipoh (my place of birth) and Taiping (my mother's hometown) as the best.

Unlike the previous years, I did not get to go back to Ipoh to visit my relatives due to limited time factor this new year. Maybe I will go there some other days when I have the chance to do so.

Conclusion
There are still many rooms for self-improvement, and that will be my biggest challenge this year.
Any shortcoming committed once or twice may be forgiven, be will surely become my nightmare if they persist - you will know what I mean without further elaboration here!

   

Year of the Goat. Happy New Year.

Today is the last day of the Chinese New Year celebration, popularly known as chap goh meh which stands for 15th night in Hokkien.  Happy New Year of the Goat...

(1) What lies ahead for the festive season
Prior to the long break as CNY fell on a Thursday and Friday this year, among the FAQs received were "When will you be on leave?", "Only 2 days, such a short break, is that enough?", "Where's your hometown and when are you going back?", etc.

(a) Flashback to a year ago...
As any other ordinary person, I can only plan.  But what ultimately transpires is sometimes beyond contemplation.  Last year for instance, it was totally outside my imagination that I was to spend most of the CNY "celebration" at HUKM.  Ended up spending my entire third trimester at ward 2B for 2 months, which felt a lot like living in a dormitory, with shared bathrooms, makan ramai-ramai, the purple uniform, and a fixed daily routine.

Anyway, despite the dread and boredom at first, it was overall a pleasant experience after getting to know some new friends.   Lots of time to rest and sleep, but couldn't help missing the little guy at home.  While others enjoy yee sang and an array of festive dishes out there, I was only confined to bland hospital food.

It was the 9th day of CNY when threatened preterm labour occured (also at 29 weeks) and I was transferred to the HDU for tocolysis before undergoing the emergency cerclage.  Thankfully everything turned out well and Ken-ken did not come out during the CNY period.  "Be patient baby... the angpows can wait until next year..." I thought. 

(b) Cuti-cuti New Year
I only took a day off on CNY eve and another a day off post-CNY weekend.  After skipping Ipoh last year, we went there on the 3rd day this year to the home of my cousins+aunts in Bercham.

Scene along the PLUS highway.  

(This is an old picture taken a few years earlier... not during the recent trip)

Alvin was in a rebellious mood.  The rebellion was probably further aggravated by a previously-unknown fact that he's car sick, as he had never puked in car prior to this.  Puking can be traumatising to a young child, and worse when it occurs in a strange place.

Speaking of Alvin and some of his behavorial/sensory issues...  It's NOT TRUE that Alvin's rebellion is due to seldom going out, as what a few concerned relatives said to my parents-in-laws.  He was seldom exposed to crowds before he turned one due to low immunity as a very preterm baby... but after that, he started going out, unless he's having flu or something like that.  I swear that he had been to more places than me at the age of 1+ compared to when I was 5 (i.e. visits to local attractions, not overseas). But then this is my fear... how to bring him to people's house without his  resistence?  Tak bawak kang unfair to him...

Maybe this is related to prematurity as very preterm babies are born with immature brains.  Or maybe it's not.  If by God's will, things works out successfully, I shall try to share them here for the benefit of those under the same shoe.   Issues may not end upon discharge from the NICU, no matter how positive things appear to be at first.  The longer your baby stays inside your womb, the better it is... even by a week.  I don't know whether to be happy or otherwise, but I have probably been chosen to walk a path that differs from the majority... and parenting an ex-prem baby may or may not be the same as for other children.

Despite being a brief, simple and impromptu one, the one-day trip to Ipoh was memorable indeed.  From meeting up with family members whom I've not seen for a long time to passing through places that was once a part of me, I cherished them a lot despite already not feeling well a few days earlier... oh my sorethroat!

(2) The voiceless CNY
On 1st day of CNY, swallowing felt painful to me.  Body temperature was up at 38 deg C by evening.  All clinics around my place, including non-Chinese doctors, were closed for public holiday.  The only safe home remedy available?  PCM and Difflam lozenges.  Tahanlah dulu....

The same thing persisted on the following few days, coupled with cough later on.  I lost my voice completely on Sunday (Day 4), a day after the visit to Ipoh.

On Day 5, when the panel clinic resumed operation, I went to see my regular dr.  I had no voice at all, thus wrote everything on a piece of paper and showed it to the dr.  Fever was still on after so many days... although just very mild.  A medical leave of 2 days after the CNY break was a lil against conscience, as if taking advantage to sambung cuti.  But, commit no fault and hence fear nothing...

Remaining silent, especially when in front of the kids was very odd esp when they are too young to understand why you're suddenly all-quiet with them.  Then they'd frown in front of you, as if wondering why, when they hear your strange voice.

(3) Conclusion
Today, on the 15th day of CNY, my voice still has not fully-recovered although improvement is starting to be more visible now.   :p

Fortunately the voice came back early this week or else I might have to miss the sponsored CNY luncheon again at my workplace.   It's very thoughtful of the management to organise such an event for its (minority) Chinese employees, so how could I have the heart to skip it... unless I genuinely couldn't be present, as in last year?

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.  :)      

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.