AN EXCUSE

For those who have tagged me, I am sorry that I can't comply. Apparently, my current state of emotion is not conducive enough to join in with the tag-a-thon. Anyway, I have the following list of blog descriptions to offer as an equal substitute, if not better. Below are the various blogs that I got acquainted for the past couple of years. Scrutinizing each of them, I have found certain uniqueness. These are real people with real life and virtual portrayal. These are people I have grown fond and close to. Many I haven't met but their poignant entries would inarguably leave me in a state of literally being in the realms of their lives.


Scratch that itch
- a blogger who definitely has an itch to be scratched : an itch to only paste photos!


A tale of Sarah and Amar
- Sarah is a gregarious young girl whilst Amar is a profound down-to-earth young chap! But the mom is a totally different story!


Scribblings of an empty mind
- His mind may be empty as he claims but his scribblings are definitely not!


Hmm
- the mysterious one who has made Bangkok his second home


Panglima
- a blog with erratic and seasonal entries but definitely a blogger with a good heart!



Gentleways
- She who writes 'deep' entries




KenaKeLayan?
- a blogger who is in the 'midst of everything' (including accumulating MTG cards)


OK- another blog with seasonal entries and after a long pause, it has decided to test the water but with no apparent result or so it seems!


Keng
- cynical entries but with profound message



Kak Teh
- a Malay Londoner who writes endless exquisite musings



AJ- entries often with strong message laced with critical vulgarities


Planetrodong and Beneath The Black Desk- both bloggers have transmigrated to fotopages, flaunting their photography skills and drawing extraordinary visitors.


Has's Psychological Cabinet- a cabinet that is filled with magical healing powers including organic greens


Maklang- a sewing genius who is good at multitasking


Anggerik Merah- the laments of a PhD pursuer


Musings from the heart
- a sweet, petite queen who blogs on anything under her reign



Jokontan
- a blog that employs a unique 'slang' of its own, often, leaving me baffled



Away with the mixer
- till today, I haven't really understood this phrase but it has something to
do with moving away from the normal crowd?


Crimsonsky- where art thou?

The quills of my heart
- a beautiful blog that stirs around the life of Hatice and Baddin.
Simah is a truly energetic woman who recently discovered that
blogging is more real that real life itself!


Fukai kokoro - a manga manic lost in Manipal

Afie
- a vivacious lass. Teasing is her forte



PrimaryBasic
- a blog that changes it's pretty curtains monthly



Em's Intricate Misadventure- the 'beady' women pouring her soul

Tersendeng
- this name was a tease for iFos's former xanga blog called Transcendence. Put on hold for many reasons

To exercise prudence in time management I have to minimize blog hopping and leaving comments but you guys are in my mind!

ALL PRAISES TO ALLAH SWT

It was roughly a month after the surgery and that was the time suggested by ikelah's neurosurgeon to repeat the MRI. It was an estimated span of time, sufficient for him to decide whether the tumor was efficiently removed or not and whether there was any left-over that would warrant radiotherapy.

Alhamdulillah. Allah swt has bestowed us another of His blessings. The radiologist gave ikelah a very reassuring remark and was very positive that his pituitary looks normal. We only got to see the neurosurgeon the next day as he was away snorkeling in Tioman and sported a very tanned face. He too was happy with the MRI although he thought that there was a very tiny area that appeared a bit dodgy which needed to be clarified with another repeat MRI in July.

We also saw the ENT surgeon who gave ikelah a nasal toilet. To which ikelah quipped "Kalau bab toilet ni yang aku seram dengar ni" Essentially, it's cleaning of scabs and mucous in the nostrils using suction and forceps, which left him beaming with pleasure as his breathing became much easier after that.

Nasal Toilet anyone??

After that we treated ourselves to a tasty lunch at Yuso* Hasla*s Restaurant next to Tawakkal. The keli bakar (grilled in charcoal, I think) was superb! I told ikelah that we have to eat there the next time we're in KL, :p

He was given MC till end of this month. Hope he'll be able to work normally then. Thanks for the prayers, everyone!

CAN ANYONE SPARE ME THEIR ANNUAL LEAVE???

No, I haven't finished with the 'epic' yet but thought I needed to break here a bit. Life has been very hectic lately for many reasons. My mental state too is suffering causing some inner emotional turmoil which incidentally is not the subject of discussion here. Physical and mental exhaustion would overwhelm me by mid-day.

People been telling me to take a long vacation but hello? I just consumed 12 days of my annual leave recently, remember? And I am entitled to 17 days per year only! If my arithmetic serves me right, I still have 5 days left, which I have to subtract another 2 days, come Friday and Saturday, leaving me ..hhmmm....3 miserable days!! (and on the 16th of April I need to take another day off to send Aliah to MRSM Gemencheh) Yes, we are going to KL tomorrow as the repeat MRI is on Friday and the appointment with the neurosurgeon is on Saturday. Please pray that the MRI is normal and insyallah that everything will turn out A okay!

So by April, I will be left with 2 days of available leave to last me till the end of the year!! Help!! At times like this, I wish for Doraemon's magic gadgets that can churn out any imaginable hopes and dreams. Read this: kotak cuti.

Recently KKL and OK have been telling me, how insane my working hours are. I can't help it, guys. If it was up to me, I'd opt for a 9 to 5 job. If only! When things are at the brim, ready to overflow, I'd start thinking of my 'retirement' days. I have this dream of settling in either Madinah or Syria or any quaint Arab towns, studying religion and going to the mosque daily. To this ikelah would sarcastically remark "If you leave Malaysia, you're running from your responsibility towards your country" ....oh well, there goes my retirement dreams.....

Looking out for SIADH and Diabetes Insipidus
In order to understand better regarding pituitary tumor, it's best that we know the normal pituitary, it's anatomy and physiology. I hope this entry is not too academic for you. In fact, it's good to have some basic medical knowledge to spice up your social conversations, :p

The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea that sits in a small, bony cavity (pituitary fossa) covered by a dural fold (sellar diaphragm) at the base of the brain. The pituitary fossa, in which the pituitary gland sits, is situated in the sphenoid bone in the middle cranial fossa at the base of the brain. The pituitary gland secretes hormones regulating homeostasis, including trophic hormones that stimulate other endocrine glands. It is functionally connected to the hypothalamus by the median eminence.

It is divided into two lobes: the anterior or front lobe (adenohypophysis) and the posterior or rear lobe (neurohypophysis). The hormones secreted by the posterior pituitary are Oxytocin and Antidiuretic hormone (ADH - also known as vasopressin and AVP, arginine vasopressin). Anterior pituitary secrete growth hormone, prolactin, follicle-stimulating hormone, luteinizing hormone , thyroid-stimulating hormone , adrenocorticotropic hormone (ACTH),endorphins .

The most common risk of a pituitary surgery is damage to the normal pituitary gland. This means that new hormone replacement might be required after the surgery, possibly including thyroid hormone, cortisol and ADH. Thus, an endocrinologist was necessary to help in the joint management especially in assessing the hormonal disturbances, should there be any.

One of the immediate and serious complication after a pituitary operation is Diabetes Insipidus, a condition marked by frequent urination and excessive thirst, since the kidneys will no longer adequately concentrate the urine. In most cases, DI is self-limited and resolves within a week to 10 days after surgery.

The syndrome of inappropriate antidiuretic hormone (SIADH) is another condition commonly found after brain surgery. As the name states, this is a syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland . The result is hyponatremia, and sometimes fluid overload.

11th Feb
The next morning, with permission I managed to see him early. Alhamdulillah he was more alert albeit still weak and semi-drowsy. As one of the complication of general anesthesia, he had developed a right upper lobe lung collapse causing him to be dyspnoeic. For this he had to be on oxygen therapy via mask. With the nasal packing which forced him to breathe through his mouth and the lung collapse, the shortness of breath was exaggerated unbearably. The humidified dry oxygen caused his lips and tongue to be cracked and painful. Pinching my nose and trying to breathe through the mouth, simulating almost a similar state, I find it very taxing and burdensome to the point of almost gasping for air! Alhamdulillah that he was given great patience to not panic and endure the dire circumstance. I can't say the same if it was me! And to think that he was to suffer in that manner for almost 11 days!Subhanallah!

Meanwhile, the ICU staffs were diligently monitoring his input/output, in order to enable them to detect the slightest sign of emergence of SIADH and also DI. Once the urinary output exceeds 800 ml in 4 hours, they were instructed to administer Minirin (desmopressin) to prevent severe dehydration and hypernatremia (concentrated sodium in blood).

Managing DI can be quite exasperating as there are many overlapping symptoms originating from other causes and other post-op complications that can exaggerate the condition further which can tempt overzealous treatment. For instance, in Azmi's case, as he was on continuous oxygen inhalation through his mouth, dryness of the buccal mucosa triggered his thirst centre, which caused him to consume more fluids than usual and this would naturally increase his urine output. However despite the increased in output volume, his urine was always concentrated, a sure sign that DI had not set in.

A useful drinking gadget
Another thing that I marveled about Azmi's post-op disposition is his unaltered thinking capacity. He could grasp anything being explained by the surgeons regarding his illness and its treatment and apply on himself wherever possible. When he needed to have frequent sips of water to wet his dry mouth, he designed a drinking gadget in his mind and asked Dr Zurin to set it up. The long tube of a drip set was sacrificed and cut at both ends and connected to a drinking bottle. Incidentally the bottle, which was used to hold 'air zam-zam' had a special pout to smugly fit the tube and not easily slip through. Through out his 9 days in ICU, the gadget served as his drinking vessel, filled with 'air zam-zam'. Perhaps we should patent this idea eh? By the way, we had constant supply of air zam-zam, thanks to relatives and friends.

An unlikely menu
When he was allowed solids, we tried giving him rice porridge with soup. However he had difficulty in swallowing it without having some of the rice regurgitating into the back of his nostrils. Thus they requested blended porridge which is an unlikely item in his normal day menu! Once, they even pureed his oats! But, Alhamdulillah, he was very patient and feeding him was no problem at all.

Having a sip of air zam-zam from his 'designer' bottle

Caution: this is not an advertisement

Meanwhile, visitors kept popping in, in twos, i.e. the number of visitors allowed each time. As Azmi was weak , I had to do the talking. Mostly, I had to explain how the op was done as many were still unaware of the nature of the surgery. Alhamdulillah, this time, they restricted their visiting ado and quietly prayed for him. Even though he was still weak from the anesthesia and all, falling asleep off and on, his progress was very encouraging. And when the DI surveillance showed that he was fairly out of danger, they decided to move him out on 12th Feb, to an isolated private cubicle in CICU upstairs which offers more privacy and convenience for me as it was on the same floor as our ward-room.

Next: Lumbar drain and CSF leak

The night before surgery

Friends and relatives kept thronging in and the situation peaked on the night of surgery when his secondary school-mates jammed the room in one go. I was at my wits end and couldn't stand the commotion anymore. I was purely reticent. I shut myself up and totally ignored them. I was almost in a state of stupor. My eyes were closed but my ears could hear the multiple conversations around me, only that the sounds were reduced to irritating noise with a capital N!

Astonishingly, Azmi managed to entertain them albeit sitting on the hospital bed, enduring his headache. I knew I was rude and utterly unbecoming. In short, I wasn't my normal accommodative self. Suddenly, I felt a sudden wave of anger inside me, as though I hated them for taking the precious few hours I have left with my husband before surgery. When there was no sign of them leaving at all, I left the room and sought refuge in the corridor, all alone.

I know I was behaving rottenly but I was also rueful at the same time. I just couldn't help it. Sorry folks!

10th Feb
It was the surgery day. I was feeling rather apprehensive. The atmosphere in the room was almost gloomy, as though the sky outside was casting dark clouds. Unspoken feelings of worry and apprehension kept creeping in my mind and I assume, in the others too. I can't recall vividly what explicitly happened that particular morning but for sure, everything went around in a blurry fashion.

Late in the morning, close relatives trickled in, with the intention to see him off for the surgery. As always, Azmi's brother's were good at cracking wise jokes, making us forget about the surgery momentarily but much to the chagrin of an uncle who prefers to adopt a somber mood as he feels (I think) a serious occasion needs to be addressed appropriately.

To avoid the same commotion as the night before, whereby visitors swarmed the room like bees, i begged for the no visitor sign, only allowing close relatives only. Once, a family of friends came, bringing a bottle of water blessed with Surah Yassin. Letting Azmi rest in the room, I entertained them outside. In between conversation, I entered the room and wet his face with the blessed water. When he knew of their presence, he adamantly went out and greeted them. Sigh. One might wonder what the no-visitor-sign was for eh?

It was already 12.30pm and I signaled to Azmi that he needed to get ready. I requested one of his brothers to politely ask the rest to leave the room as we needed time for ourselves. after shaving and making ablution, Azmi waited for dzuhur to perform both dzuhur and asar combined. Azmi jokingly said that it was as though he was preparing for wukuf at Hajj. After praying, he made use of what time left to make small talks with my kids and also to beg forgiveness from my parents. When he uttered that he have always treated my mom like his own, she reacted vigorously and cried. My dad was more composed and even made an insightful remark,"Insyallah, you'll get through this unscathed. You still have got heaps more to do in this world".

At 2.15 pm, the nurses came pushing in the OT bed and made him lie down. Wearing the OT gown and cap, he was set to go. I moved alongside the bed, holding his hands and saying whatever dzikir I know. It was at this moment that I couldn't hold my welled up tears anymore. At the OT entrance, i gave my salam and in between rolling tears I told him that insyallah I'll be seeing him back after 3 hours, the estimated surgery time. Then, everyone else, whom by now was teary eyed, gave him a final embrace. Dr Zurin who was observing patiently at the side, must be thinking that this was the longest sending off goodbye he had ever witnessed!

It was probably the longest 4 hours of my life, in which I filled with saying dzikir in an adjacent waiting lounge or resting in the ward upstairs. At one point, I became so restless and paced the corridor endlessly, disregarding of what people might think of me. I kept checking the OT entrance, wanting to know of the surgery progress.

At almost 7 pm, I saw a sudden glimpse of Dr Solahuddin and in all excitement, I almost ran towards him. "ALhamdulillah, all went well" he said. He was in a haste to go back to Tawakkal to perform a tracheostomy on a patient. Moments later, Dr Zurin beckoned my children and I, towards him and showed us the specimen of the tumor. It was resected piece-meal and looked very much friable. "All in, the operation was a success" he said, conveying us the good news. Minutes later, Dr Helmi, the anesthetist, pushed Azmi out, still intubated and unconscious. As he had difficulties to wake up after the anesthetic reversal plus being not accustomed to breathing through the mouth (trans-sphenoidal surgery requires nasal packing to arrest bleeding), they had to keep him intubated till in the ICU. As they needed time to extubate him, we were adviced to go back and perform our maghrib prayers.

When I got to see him later, he was still in a very much drowsy state with a very slurred speech and incoherent gestures. However, he still managed to extend his hand towards my mum's when he saw her. As visiting hours was over for ICU, we left him to the nurses. Apparently at 2 am, he became fully awake and alert and asked for me. However in spite of his condition he was still thoughtful and cautioned the nurses to not wake me if I was asleep.

3 lines: 2 I/V lines, 1 Arterial line, another I/V line on his right leg. Another line: a lumbar drain at his lower back.

The CSF drainage

Next: 1st day post-op: Looking out for Diabetes Insipidus

CHRONOLOGY OF A LIFE-CHANGING ORDEAL (CONTINUATION)

Friends.

The most remarkable phenomena that rose from this test was the profound gestures of relatives and friends. The support, care and reassurances that they shower upon us were invaluable. From this point in life, we now know that we have relatives and friends whom we can count on in times of direness.

Whilst packing the next morning, more close friends came to well-wish and see us off. They even conducted a small doa ado. Since the early morning, Azmi began receiving phone calls and sms-es from all quarters: primary school friends, secondary school friends, Belia group members, Abim friends and also medical friends. You see, he has been in constant contact with his old school friends via their alumni's e-mail forum, by which, the news had travelled like fire. Perhaps what triggered their deep emotion was Azmi's persistent heart rendering statement that ended each conversation: please forgive me for all wrongs that I have done to you. Some even scolded him for the cheek to mention such words in such desperate moments. But he felt compelled to do so as no mortals know what looms ahead.

The endless thoughtful demonstrations by friends had rendered us flabbergasted and we thank Allah for bestowing us with beautiful friends. One, who badly wanted to see Azmi before we left for KL, waited patiently for us by the road side, before the Bukit Goh exit. Another, had experienced a premonition of some sort when he was bogged down with a deep urge to call Azmi. This friend would often call when he needed medical advice. The day prior, Azmi received a missed call from him. Thinking that he was in need of another advice, Azmi returned his call. When Azmi told him the news, he cried. Subhanallah! Azmi couldnt hold his composure and almost cried too. Everyday, he would sms to enquire of Azmi's progress and before both surgeries he had arranged for 70 tahfeez students to perform solat hajat for Azmi's wellbeing.

And yet another, whom we haven't met for more than 20 years, came all the way from Kulim and back, making a day trip. 2 good friends , husband and wife, from KB had traveled through the night to KL in an effort to see us. They even extended their stay to send us off to the next hospital.

Amongst our most treasured acquaintances are those we found through blogging. Some have become close that we take them as family friends. Pycno and Bea came before and after the surgery, asking us if there was anything they could help. Immediately after the first op, they visited Azmi at the ICU. After the second surgery, they continued with their kind warmth by remembering my birthday and brought me a sumptuous chocolate cake. Simah called me all the way from Istanbul. QOTH sms-ed, reassuring me with her prayers. Nisak and Mynn were so kind to help Muhammad in his rendezvous. And the rest gave comforting words via e-mails. Thanks to all!

Cutting a birthday cake in the ward can be fun! (if you're not the patient, that is!)

Few friends felt strongly against our decision to do the surgery and suggested various alternative treatments. One said, "I would have no qualms if the surgery involves other part of the body. Even if it was a heart surgery. But the brain??" Another called up to suggest trying a non-invasive technique using the gamma knife rays. To all these, Azmi answered politely that he had made a decision and insyallah would adhere to it steadfastly.


8th Feb

We left our house with a heavy heart and quietly prayed that everything remains in order in our absence. Little did I suspect that I personally would feel as heavy hearted to leave the hospital 2 weeks later!

Before pushing off to KL we made a last stop-over at my father-in-law's where Azmi filled his dad on his condition. At one juncture, when Azmi was not near him, he whispered to me, asking whether Azmi was fearful of the surgery, to which I answered, "I am sure there's some iota of it but he doesn't show it" However when I posed the exact question to him much later, he denied being scared of undergoing the surgery at any point in time. "I purely believe that whatever Allah has destined for us will happen and none can stop Him. If He has planned for the surgery to be successful, then , all praises are for Him. If not, it's beyond me and as a human being I have to accept it".

Even though we have finalized on the choice of surgeons, the GM of the hospital where he works was adamant that we saw Datuk Dr Rani, a renowned neurologist at Ampang Puteri, and sought his opinion for the best treatment available. We complied and headed straight to see him once we reached KL. We were glad that he approved of our choice, saying that they are amongst the best surgeons to go to.

Finally, Azmi was admitted at Tawakkal under Dr Solahuddin. That night we had an in depth discussion with both Dr Solahuddin and Dr Zurin regarding the operation.Both are old varsity friends and after long years of losing contact, I was so touched on the amicable treatment they gave us. Tying the features of the MRI and the severe headaches he had, Dr Zurin concluded that Azmi had a condition called pituitary 'apoplexy' caused by bleeding inside the tumor. In essence, we were actually sitting on a time-bomb!

It was also decided that night for the surgery to be conducted at Damansara Specialist Hospital instead due to certain logistic reasons. Which meant that we had to shift hospital the following afternoon.

As the pituitary gland secrete many important hormones, the first thing to do was the various hormonal assays, prior to the op. Another important assessment would be his visual acuity and field. Both were planned for the next morning.

9th Feb

In the morning, I accompanied him for a thorough eye perimetry. Detailed examination with the Humphrey visual field analyzer revealed a classical finding of bilateral hemianopia, a text-book case of pituitary tumor. All this while, we attributed his visual impairments to an earlier diagnosis made by not one but three ophthalmologists i.e. age-related macular degeration, an eye disease which currently has no satisfactory treatment. CT-scan was not suggested at that time as the eye-examination sufficed. Amazingly, the funduscopy this time showed no macular anamoly whatsoever! When I posed this query to Dr Zurin, he said that from his experience, the visual disturbances in patients with such tumor tend to change with time and they can't offer any explanation for the phenomena. What's more important is the high likeliness for his vision to improve in manifold after the surgery, once the tumor is removed.

In the afternoon, we drove to DSH, a well-equiped state-of-the-art hospital which we would call 'home' for the next 12 days.