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 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.