TGUH di SFO: Apr 22, 2012

Ruang menunggu Klinik Kardiovaskular penuh dengan adik-beradik kami sahaja.8 orang duduk meneman seorang pesakit ! Segerabak keretapi sinaran pagi.Bayangkan kalau ada 10 pesakit dengan peneman sebanyak itu, mau pening misi dan kaunter memikirkan tempat duduk yang kepenuhan.Riuhnya toksah cakaplah..Berapa kali kena tegur dengan TGUH.

Segerabak keretapi sinaran pagi...atau senandung malam....atau apa-apa yamg sewaktu dengannya.

Dr. Alan Yeung- seperti biasa,tiba tepat pada masa yang dijanjikan- 11 pagi

Homework untuk diselesaikan sebelum pemeriksaan fizikal

Sessi pemeriksaan dan penerangan berjalan panjang,.....biarlah Wacheda pendekkan......(atau katikkan... Boleh ke Abu Nasih pakai perkataan ni..katikkan?)

Katik kata......

Medical Review by Dr. Alan Yeung- TGUH is still not physically ‘fit to fly’.

Senang sikit kalau speseles yang dah keluar verdict, kang kalau Wacheda yang cakap, ramai pulak yang serang..” Eh !!! tengok gambar...OK..... jeeer...dah jenjalan taman punn....” Ramai jugak yang hantar sms ,pm,pesbuk Wacheda “Bila nak balik”...”Macam tak nak balikkk jerr”...” Eh..belum boleh balik lagi kerr..” Mintak maaplah Wacheda tak balas pun...letih nak menaip satu-satu, lagipun laporan dalam blog memang teramat terperinci.Wacheda pun segan nak mengeluarkan ‘profesional judgement’ takut dituduh sengaja mengada-adakan situasi.Let it come from someone else..easier for me to convey,walaupun Wacheda ada lesen MD dan valid APC.(dengan izin – Inggeris).

Klinik Dr.Alan Yeung

Tuan-tuan adik beradik yang dirahmati Allah sekelian.. TGUH yang kita kenal, memanglah seperti itu.Nilaian fizikal secara medikal kadang-kadang tersasar dengan semangat yang ditunjukkannya.

Buat masa ini kekuatan fizikal jantung masih belum mampan menanggung perjalanan yang sebegitu jauh. Long haul flight may induce respiratory changes similar to ventilatory acclimatisation to altitude.Recent X- ray shows bilateral pleural effusion .Air travel may worsen respiratory symptoms as they are exposed to a reduced air pressure in the aircraft.

According to regulations, commercial aircraft fly at cruising altitudes ranging up to 41,000 feet above sea level, but are pressurised to a cabin altitude of 8,000 ft (2,438 m), meaning that the aircraft environment has a reduced pressure of oxygen, equivalent to that at 2,438 metres above sea level. The reduced alveolar oxygen partial pressure at this altitude equates to breathing air with an oxygen concentration (FIO2) of 15% oxygen (rather than the normal 21%) and lowers the Pa,O2 of a healthy passenger to 7.0–8.5 kPa (53–64 mmHg).

Healthy people tolerate the reduced amount of oxygen available but heart and lung disease patients may need extra oxygen to help them breathe normally. Many heart and lung disease patients already have low levels of oxygen in their blood compared with healthy subjects, so an increase in altitude is likely to further reduce the amount of oxygen available, aggravating their symptoms. Even the slightest effort, such as going to the toilet, may further reduce arterial oxygen concentration in lung patients as natural compensatory mechanisms fail.

TGUH also falls under the high risk group for developing Thromboembolism.Why high risk??..Post surgery- injury which damages veins, or surgery can slow down the flow of blood, thus raising the chances of blood clots. General anesthetics can dilate the veins, which makes it more likely that blood pools and clots form. DVT (Deep vein Thrombosis)-refers to the formation of thrombus(blood clot) in a deep vein in the leg.This is medical emergency!!!!! If the thrombus breaks off, it is known as an embolus - a piece of blood clot - and can make its way to the lung, resulting in a pulmonary embolism. And this Pulmonary Embolism my dear brother and sister has no mercy at all...

Besides pleural effusion as apparent on Chest X-ray,crepitus is audible on auscultation up to mid zone of lungs bilaterally. TGUH also has bilateral pitting pedal oedema up to the knee.Started on Lasix by Mr Robert Robbin on previous appointment,and tapered up as oedema is still at that level .Shortness of breath is still bothersome aggravated by lying flat and activity.

With 8pt of blood tranfused ‘on the table’ plus in ICU, we can imagine that TGUH Hb(hemoglobin) must have drown in the drain. And that reqiures time....replenishing the store that has been overly depleted.Our normal capacity is only 1gm% in 28 days !!

Not forgetiing all the scars for vein harvesting- Right thigh and Left Thigh- all along., plus the wound from IABP at the Left groin- still requiring daily dressing and packing.

“ A beautiful smile that hide the pain”.....

Paralytic ileus is also an issue post surgically. Let me refresh ourselves ..it was 10 and half hours(usual CABG 5-6 hours) of surgical intervention. 8days in ICU, 4 days under ventilation. Usually patient got extubated 6 hours post CABG, monitored 1-2 days in ICU the moved on to CCU or IICU. Paralytic ileus is the occurrence of intestinal blockage in the absence of an actual physical obstruction. This type of blockage is caused by a malfunction in the nerves and muscles in the intestine that impairs digestive movement.TGUH has ileus ... Can we imagine the sense of bloatedness, nauseous all the while, reduced appetite. Vommitted twice in the apartment....

This time 4 more medication were added to his long list.

Setiap minggu kami perlu memenuhi jadual temujanji yang telah ditetapkan.

Setakat ini , temujanji yang perlu dilayan sehingga ke tarikh 8 Mei 2012. Certification ‘fit to fly’ is after the reassesment on 8. Till then, hopefully everyone understand and may we be together on our prayer and du’as.