Under Observation

Huwebes,  December 20, bumalik ako sa Industrial Clinic ng National Kidney and Transplant Institute (NKTI) para ipakita kay Dr. Arnel Chua ang result ng aking mga tests at ultrasound. sabi nya usually daw ang parapelvic cyst ay hindi naman nila ginagalaw (meaning surgery or tinutunaw) unless nakaka-obstruct o nakaka-interfere sa normal functions ng kidney at ng iba pang internal organs. pero dahil normal naman daw ang functions ng kidneys ko, normal ang crea ko at okey naman ang result ng cbc at urinalysis, yung cyst ko daw is benign at wala daw syang ibibigay na gamot muna. ang ending under observation ako for 3 months. after 3 months babalik ako para mag-test ulit. halfway sa consultation i  asked him if its okay to take kidney care sabi nya hindi daw nila ine-encourage or nire-recommend. hmmmm….bakit naman kaya?

So, yun, wait and see muna ang drama ko. thank God kasi benign ang cyst ko. pero syempre i have to cut down sa pagkain ng mga masyadong maalat at ma-cholesterol na food. at sabi pa ni doc mag-diet daw ako at mag-exercise. hayayay!  makaya ko sana ang mga itesh.

In fairness, natutuwa ako na wala namang damage na nagawa ang parapelvic cyst na yun sa center ng right kidney ko. kahit under observation pa sa ngayon at least nakakahinga na ako ng maluwag, di na masyadong nate-tense at  may peace of mind na ako. Thank God. 

isang panalangin

Dear Lord,
My fear has trapped and consumed me. But I am tired of living under the weight of my fears. I believe in Your presence and confirm that You are able to deliver me from my trouble. Please give me Your love and Your power to replace these fears. Your perfect love casts out my fear. I thank you for promising to give me the peace that only you can give. I receive that peace now as I ask you to still my troubled heart. Because you are with me, I don't have to be afraid. In Jesus Name, Amen.

hanggang sa susunod na check up….

Isang linggong mahigit na rin ang nakalipas mula ng makuha ko ang resulta ng aking ultra sound sa National Kidney and Transplant Institute (NKTI). pareho lang ang impression at resulta ng 2 ultrasound ko—-parapelvic cyst sa right kidney—ang difference lang eh yung sa NKTI, natukoy kung saang part ng right kidney ko—sa center daw. 

sa thursday babalik ako sa industrial clinic para sa check up. medyo nate-tense ang beauty ko sa mga developments na itesh as in. pero nag-pe-pray na lang ako, entrusting my life sa Kanya, alam ko naman na hindi nya ako pababayaan. sniff, sniff, sniff (with matching tulo ng tear sa left cheek).

so habang naghihintay ako ng araw ng aking pagbalik sa doctor, nagstart akong magbasa at magresearch ng tungkol sa parapelvic cyst sa kidney. at ayon sa isang website na napuntahan ko, ang parapelvic cyst daw ay isang "well encapsulated collection of fluid outside of the renal parenchyma". syempre di ko alam ano yung renal parenchyma kaya nag-google na naman ako. ayon sa www.thefreedictionary.com, ang parenchyma daw is "the tissue characteristic of an organ as distinguished from associated connective or supporting tissues. (ano daw? hay). syempre sige pa rin ako sa pagreresearch at karamihan sa mga napuntahan kong site eh may sinasabi na ang parapelvic cyst ay nagiging cause ng renal obstruction at karamihan ay nireremove by surgery. hay, scary naman.

ni-research ko rin ang definition ng cyst at eto naman ang mga nakuha ko:

• a "cyst" is a closed sac having a distinct membrane and division on the nearby tissue. they may contain air, fluids or semi-solid materials. once formed the cyst will remain in the tissue permanently and can be removed by surgery or by taking medication that will dissolve it. many cyst in the body are benign (functional) however a few are tumors or are produced within tumors and are potentially malignant (http://en.wikipedia.org/wiki/Cyst)
•  A cyst is a closed sac- or bladder-like structure that is not a normal part of the tissue where it is found. Cysts are common and can occur anywhere in the body in persons of any age. Cysts usually contain a gaseous, liquid, or semisolid substance. Cysts vary in size; they may be detectable only under a microscope or they can grow so large that they displace normal organs and tissues. The outer wall of a cyst is called the capsule. (http://www.medicinenet.com/script/main/art.asp?articlekey=55517)
• A cyst is generally formed on the surface of an organ or in the empty spaces between muscle and skin tissues. Generally speaking, most cysts are harmless (benign) and self-contained, filled with air, infected fluids or semi-solid substances such as sebum. (http://www.wisegeek.com/what-is-a-cyst.htm)

hay, i expect na sa next check up ko paguusapan na namin ng doctor ko yung management ng aking condition. please paki-pray naman ako. thank you. 

ultrasound sa NKTI

heto naman ang result ng aking repeated ultrasound:

RENAL URINARY BLADDER (KUB)

Right Kidney: 10.4 x 4.7 x 3.9 cms

Left Kidney: 9.7 x 4.8 x 4.9 cms

Both kidneys are within normal limits in size and configuration. Renal outlines are smooth and intact. Cortical echoes are homogeneous. No focal lesion nor calculi seen. Renal sinus is dense and centrally oriented with no evident dilatation odf the collecting system. Distinct cortico-medullary junction noted. A 2.3 x 2.9 x 3.0 cms cystic focus is noted in the middle segment of the right kidney.

The urinary bladder wall appears homogeneously echogenic. No demonstrable mass lesion nor lithiasis.

Impression:

1. Parapelvic cyst, right kidney

2. Normal left kidney and urinary bladder ultrasonically

NOTE: The abovementioned report is subjective medical opinion only based on the objective imaging findingsd and should be correlated with the clinical, biochemical, microbiological and other parameters before it can be used as basis for management.

resulta

heto ang result ng aking mga lab tests:

PHYSICAL EXAMINATION:

Color:  Yellow

Clarity: Clear

Spec. Gravity:  1.020

CHEMICAL ANALYSIS:

pH:       5.5

Protein:   Negative

Glucose:  Negative

Blood     Negative

Ketone:    Negative

Nitrite:   Negative

Bilirubin:   Negative

Urobilinogen:   0.2 EU/dl

Leukocytes:     Negative

URINE FLOWCYTOMETRY

WBC:   1/hpf      8/ul

RBC:    1/hpf      3/ul

Epith. Cells:  21/lpf    7/ul

Hyaline Cast:    0/lpf     0/ul

Bacteria:  323/hpf  1,792/ul

CREATININE

0.9 mg/dL

COMPLETE BLOOD COUNT (CBC)

WBC COUNT

Neutrophil  9.4  (10 3/uL)

Lymphocytes   25.8 %

Monocytes:   5.3%

Eosinophils:  2.8 %

Basophils:  0.3 %

RBC Count : 4.88

HGB Hemoglobin:  14.4 g/dL

HCT Hematocrit: 44.0 %

MCV Mean Cell Value: 90.2 fL

MCH Mean Corpuscular Hgb. : 29.4 pg

MCHC Mean Corpuscular Hgb. Conc.: 32.6 g/dL

RDW RBC Distribution Width: 13.8 %

Platelets: 436 x 10 3/uL

MPV:  7.2 fL

ang check up sa NKTI

December 6, 2007

Kasama ko ang aking sisterette na si Ate Etzhel, pumunta kami sa National Kidney and Transplant Institute (NKTI) para magpa-check up. First time ko lang pumunta doon kaya nung nasa road palang kami, madami akong nai-imagine na scenario. Medyo may di kasi magandang image sa akin ang mga government hospitals kaya iniisip ka na baka madumi, may amoy na di maganda, madumi ang CR, masungit at bugnutin ang mga staff, etcetera, etcetera.

Pero pagdating namin sa NKTI, nagulat ako. Ibang-iba ang nakita ko sa na-i-imagine ko kanina. friendly ang guards at ang linis ng lugar (floor, ceiling, elevators, stairs at  CR). pati nga si ate etzhel na-impress din. at take note habang papunta kami sa industrial clinic na nasa room 3212 ng annex 2 building, wala man lang akong naamoy na "amoy ospital".

After almost an hour of waiting, I finally met the kidney doctor, si Dr. Arnel Chua. i showed him the results of my recent ultrasound and after ng ilang tanong, he recommended na mag-undergo ako ng cbc, urinalysis at creatinine. he also told me na mas makabubuti daw na ulitin ang ultra sound ko kasi may mga time daw na kapag nag-ultra sound sa NKTI iba ang findings at para na rin daw makasigurado na talagang may parapelvic cyst nga ako sa right kidney. 

Pumunta na kami sa main building, sa department of laboratory medicine, para sa mga tests. kaka-impress ha: mabilis ang service, airconditioned ang waiting area, may queing number, malinis ang CR sa loob at mabait ang mga tao. after akong kuhanan ng dugo at urine samples, dumiretso na kami sa radiology department para naman sa ultrasound. nung malapit na kami sa area, napadaan kami sa social services division at bigla akong nalungkot. ito na kasi yung "charity" area eh, at ang daming tao, may mga naka-wheelchair pa. bigla ko tuloy natanong sa sarili ko, yung mga charity patients kaya pareho lang ang natatanggap na treatment sa pay patients? i mean yung convenience na naranasan ko ganun din kaya sa kanila. noon ko lang din naisip na kaya pala nung bago ako mag-start ng check up tinanong ako kung "pay patient" ako.  habang pinagmamasdan ko ang mga tao na naghihintay ng tulong mula sa social services division, nagpray ako na sana may magawa naman ako para makatulong in my own little way. hay. (mag-aral kaya ako ng medicine?)

pagdating sa radiology department binigyan ako ng parang request slip at pinabalik sa main building para magbayad ng ultrasound fee. after lunch na daw ako ma-u-ultra sound kasi lunch break. so after namin sa cashier,  sumugod na ang  mga beauty namin sa duck chow (yung resto sa 2/f ng cafeteria) para mag-lunch. in fairness ang cafeteria ay parang mini-fastfood sa mall. may mga kiosk sa loob. may nakita pa akong country style donut booth at kiss (yung may tindang kikiam at fishball). okay naman ang food sa duck chow kaya lang medyo mabagal ang service saka maliit ang space.

hindi na ako nasamahan ni ate etz sa ultrasound kasi kailangan na nyang bumalik sa resto nya. so around 2:30pm pumunta na ako sa ultrasound section. bago ang session, i was asked to drink 3 glasses of water kasi kailangan daw ang urinary bladder ko ay full. so mega inom naman ako. after a few minutes, tinawag na ako at pinapasok sa ultrasound room. cute at mabait naman yung doctor na nagperform ng ultrasound (sayang di ko nakuha ang name). after a while natense pa ang beauty ko kasi bigla syang lumabas at may tinawag na isa pang doctor at may kung anong tinuturo sa screen ng machine. kinabahan ang beauty ko. after a few minutes ay natapos na rin ang ultrasound ko. sinabihan ako na bumalik na lang next day for the results.

habang palabas ako ng radiology department, syempre napadaan na naman ako sa social services division. mas dumami pa ang tao doon at syempre naawa na naman ako. may nakita akong isang bata na siguro mga 7-9 years old, may mask sya at nakaupo sa wheelchair. nag-hello ako sa kanya at ngumiti naman ang kasama nyang babae. gusto ko sanang makipag usap sa kanila kaya lang hindi ko alam anong sasabihin ko. ngumiti na lang ulit ako at nagsabi ng God bless pagkatapos ay lumiko na ako para pumunta sa department of laboratory medicine for the results of my tests.

isang katotohanan ang malinaw sa akin sa mga oras na yun, lahat ng tao—mayaman, mahirap, bata, matanda, maganda, pangit—-pantay pantay lang pag may sakit…lahat nasasaktan…lahat nahihirapan…lahat nagagastusan…lahat nalulungkot…lahat naapektuhan…lahat nangangailangan ng tulong NIYA.

ang kidney..bow!

Your kidneys are bean-shaped organs, each about the size of your fist. They are located near the middle of your back, just below the rib cage. The kidneys are sophisticated reprocessing machines. Every day, your kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The waste and extra water become urine, which flows to your bladder through tubes called ureters. Your bladder stores urine until you go to the bathroom.

The wastes in your blood come from the normal breakdown of active tissues and from the food you eat. Your body uses the food for energy and self-repair. After your body has taken what it needs from the food, waste is sent to the blood. If your kidneys did not remove these wastes, the wastes would build up in the blood and damage your body.

The actual filtering occurs in tiny units inside your kidneys called nephrons. Every kidney has about a million nephrons. In the nephron, a glomerulus—which is a tiny blood vessel, or capillary—intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system.

At first, the tubules receive a combination of waste materials and chemicals that your body can still use. Your kidneys measure out chemicals like sodium, phosphorus, and potassium and release them back to the blood to return to the body. In this way, your kidneys regulate the body’s level of these substances. The right balance is necessary for life, but excess levels can be harmful.

In addition to removing wastes, your kidneys release three important hormones:

• erythropoietin (eh-RITH-ro-POY-eh-tin), or EPO, which stimulates the bone marrow to make red blood cells

• renin (REE-nin), which regulates blood pressure
• calcitriol (kal-suh-TRY-ul), the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body

SOURCE: http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/

wanted: kidney doctor

syempre after kong malaman na may parapelvic cyst ako sa right kidney ang next thing to do eh maghanap ng kidney doctor. wala pa naman kasing may kidney disease sa family ko kaya wala kaming masyadong kilalang nephrologist.

we called a cousin, a surgeon, and he referred me to a certain Dr. Alcantara sa National Kidney Institute, pero di na namin na-follow up. parang di rin ako masyadong kampante sa recommendations nya. i was then referred to another nephrologist sa SLMC, si Dr. Vic De Guzman, pero ewan ko ba, first time i step into his clinic i felt uncomfortable. plus yung secretary nya, ang weird, parang ayaw ibigay ang totoong clinic schedule nya, sabi 9am to 1pm daw tuesdays-thursdays tapos biglang sabi 9 to 10am lang daw pala. hello? one hour lang? may ganun ba? hmm.

the next day, i visited the website of the national kidney and transplant institute (NKTI) at tumawag sa information para syempre mag-inquire. naisip ko kasi baka nga mas mabuti kung doon ako magpagamot since kidney talaga ang specialty nila. friendly naman ang nakausap ko sa phone and i was told na since bagong patient ako, sa industrial clinic muna ako dapat magpunta.

hay, hopeful naman ako na may ibibigay sa akin si LORD na tamang kidney doctor soon.

God’s Will

November 30, holiday at supposedly nagpapahinga ako pero sugod ang beauty ko sa board meeting ng Lupong Pamunuan ng aming church. After so many years naging official member ulit ako ng Board at this time eh Pangulo ako ng Lupon sa Programa.

Habang papunta kami sa venue ng meeting, kinausap na ako ng ilang members  at sabi nila ino-nominate daw nila ako bilang chairman. naloka ang beauty ko. ako? chairman? kakatense naman ito. told them baka masyado pa akong "bata" para maging chairman. saka babae ako so dapat chairwoman. joke joke joke.

So, katulad ng inaasahan, i was nominated and when lots were drawn, pagbukas ko ng small piece of paper na nabunot ko, bumulaga sa akin ang nakasulat na "God's will". Nakakagulat, nakakatuwa at nakakatense. Ako, Board Chairman for 2008.

I'm sure maraming board members ang di pabor sa nangyari. feeling ko kasi ang tingin nila sa akin eh masyadong "bookish", "neophyte" at "opposition" pero well, wala akong magagawa, i believe na it was God who chose me.

i know may plan si Lord sa buhay ko kaya He gave me this big responsibility. i'm really scared kasi hindi ko maiwasan na hindi ma-feel yung inadequacy and somehow alam ko may mga expectations ang kapatiran sa akin. and of course, i know i have to give my best coz i'm  not just serving the church but my Lord and Savior Jesus Christ. sabi nga ni Diko Nathan, one of my cousins na member din ng Board, may plano si Lord sa akin kaya ako naging Chairman and also panahon na rin na bumalik ako sa ministry.

i'm really praying for His wisdom and guidance. i pray na magawa ko ang the best ko para sa Kanya. sabi nga sa Philippians 4:13:  "I can do all things through Christ who strengthens me".  

panibagong pagsubok

sabado, november 24, gumising ako na masakit ang tiyan. nung una akala ko na-e-ebs lang ako pero kakaiba talaga ang pain. tapos sabi ko dedma ko na lang at baka naman mawala din pero habang naliligo ako feel na feel ko na gumagrabe ang sakit as in. yung pain nya eh parang mahapdi na parang gutom. so after kong magbihis naisip ko na baka naman hyperacidity lang so nag-take ako ng zantac 75. ready na ko to leave the house for work ng biglang naging super grabe ang sakit kaya ang ending nagpadala na ako sa doctor. di na talaga kinaya ng powers ko as in.

muntik pa akong naimbyerna sa hospital kasi ba naman nung dumating kami sa entrance ng E.R. syempre di ako makalakad so nag-ask ako ng wheelchair. my God, mega-ask pa ang nurse kung para saan daw. hello? tapos nung nasa reception na ako ginawa akong guinea pig ng mga nursing students. as in twice kinuha ang temp ko at muntik nang thrice kuhanin ang bp ko buti na lang nag-protesta na ako. syempre nung tinawag na ang name ko, aba eh wala man lang nagtulak ng wheelchair ko papunta sa doctor's clinic so naglakad na lang ako. ang nakala-lyka pa dito, nagsabi pa ang nurse ng "ay kaya nyo na maglakad" na syempre mega-sagot ako ng "eh wala namang magtutulak ng chair papunta dyan eh so i have to walk kakaloka ang ospital nyo". o diva naman sa litanya ang beauty ko? ang ironic pa dito pagpasok ko sa doctor's clinic nakita ko pa ang tarpaulin announcing to the world na ang ospital daw na yun won an award as the best secondary hospital in region 3. omigosh! you gotta be kidding me.

so mega-interview ang chubby female doctor sa akin. mega-press pa sa mataba kong tummy. she gave me medicines for the pain and ang initial findings eh acute gastroenteritis. she also recommended na mag-undergo ako ng urinalysis at ultra sound para daw ma-check ang kidney at gall bladder ko. Pagkatapos ay  dumiretso na ako sa cashier for the payment of the doctor's pf na P150 lang naman at P1,000 para sa ultrasound.

next day

sunday, november 25. 8:30 am palang nasa hospital na ako for the ultra sound scheduled at 9am. aba ang receptionist di naalala na may urinalysis din ako and when we called her attention, dedma ang beauty nya. had my ultrasound mga 10am na yata and got the result almost 1pm. hay.

findings

Ultrasound of the Whole Abdomen

The liver is normal in size with smooth borders. There is diffuse increase in parenchymal echogenicity. No discrete solid or cystic mass noted. The intrahepatic ducts and veins are not dilated.

The gall bladder measures 2.4 cm in its widest transverse diameter. The lumen is echo free. The wall is not thickened.

The pancreas is normal in size and echogenicity. The pancreatic duct is not dilated.

The spleen is not enlarged. Negative for intrasplenic mass.

Both kidneys are normal in size with uniform cortical parenchymal echogenicity. The right kidney measures 10.3 x 4.4 cm with a cortical thickness of 1.4 cm while the left kidney measures 9.7 cm x 5.2 cm with a cortical thickness of 1.6 cm. There is a round anechoic structure in the parapelvic region of the right kidney measuring 3.4 x 2.2 cm. Negative for calculi or hydronephrosis, bilaterally.

The urinary bladder is distended with anechoic lumen. The wall is not thickened.

The uterus measures 6.1 x 2.6 x 3.5 cm. No focal mass noted. The endometrium is intact measuring 0.7 cm.

Negative for adnexal mass.

Impression:

1. Normal sized liver with fatty infiltration

2. Parapelvic cyst, right kidney

3. Normal ultrasound of the gallbladder, pancreas, spleen, left kidney, urinary bladder, uterus and adnexae.

syempre i tried to show a brave face when the findings were read and explained to me. i was advised to see a nephrologist as soon as possible para malaman ko kung ano ang susunod na gagawin.

i went home feeling so down and i cried my heart out kay Lord. hindi naman ako nag-ask ng "why me. why me" with matching moving of the hair. it was more of telling Him na i'm scared for my family and was sort of entrusting my fate in His hands. nag-pray din ako na tulungan Nya ako na makahanap ng maayos na kidney doctor.

hay. may panibagong pagsubok na naman sa buhay ko. buti na lang meron akong hindi nagbabagong Diyos kaya i'm sure i'll pass thru this.

Bagong Blog Site

Pagkatapos ng ilang linggong paghahanap ng malilipatan, finally, nakapag-desisyon ako na piliin ang "i.ph" bilang "bagong bahay" ng aking mga kwento. 

Nitong mga nakaraang araw, nagulantang ako sa sudden twist and turns sa aking so-called life. Wala pang 2008 pero feel na feel ko na ang mga katagang "ito ang panahon ng pagbabago" na dialogue ni gob vilma santos recto sa kanyang ariel commercial.

Kaya, tara na! Kwentuhan tayo! Malay nyo, ang kwento ko eh kwento nyo rin pala!