Month: July 2024

After a fall I landed in three hospitals – road to my recovery! My Story Part 3

Hospital C in Johor

After my discharge from Hospital B in Singapore, it appeared that the doctors knew what had gone wrong with me, as outlined in their reports. Another hospital which is about one hour drive from our home (in Singapore) is Hospital C. It is in Johor. We moved to Hospital C for 5 days from 11 June @15:18 to 15 June 2024 @10:31.

The great difference between B and C is that in Hospital C, you pay in Malaysian ringgit – indeed a huge difference compared to Singapore dollars!

In Hospital C, I underwent these procedures and treatments:

  • Lumbar X-ray

There is reduce lumbar lordosis. The alignment is preserved.

No fracture or dislocation.

Impression: Lumbar spondylosis with likely L2/L3 disc bulge.

  • CT brain – 11 June. Day 2 post mild head injury (after second fall).

Bilateral fronto- parietal hypodense subdural hemorrhage / effusion widest at frontal region, right measures 10 mm keft measures 13 mm in thickness.

There is hyperdense component seen at right parietal region (9 mm in thickness). Mild enhancement of the sulci bilaterally.

Gray-white matter differentiation fairly preserved.

No hydrocephalus.

No skull fracture.

Left parietal scalp swelling.

Impression: Bilateral fronto-parietal subdural hemorrhage as described.

  • CT brain. Comparison made with CT brain yesterday – 12 June 2024.

Impression: Right parietal extra-axil haemorrhage, stable in size compared to previous.

Bilateral fronto-temporo-parietal subdural hygroma.

No new intracranial haemorrhage.

Blood- Tests

11 June 2024 @14.44

White Blood Cells                      12.0  H   (4.0-11.0)

Neutrophils                                 82.0 H  (40 – 75.0)

Lymphocytes                              11.2  L    (20 – 45)

Neutrophils (absolute value)   9.8 H   (2.0-7.5)

Lymphocytes (absolute value)  1.3 L  (1.5-4.5)

Sodium                                          118 (critical)    (135-145)

Potassium                                        3.6     (3.5-5.1)

Chloride                                            91  L   (98-109)

Creatinine                                        48   L   (62-115)

Calcium                                            2.14   L   (2.18-2.60)

Adjusted calcium                            2.1  L    (2.18-2.60)

11 June 2024 @19.58

Sodium                    120 (critical)   

Potassium               3.4 L 

Chloride                   92 L

Serum osmolality  249 L   (280-301)

Free T4                    25.4 H   (12.2-22.4)

11 June 2024 @23.45

Sodium                 124 (critical)   

Potassium             36 

Chloride                95 L

Urea nitrogen     2.4 L  (2.5-6.5)

!3 June 2024 @6:31

Sodium              123 (critical)   

Potassium           36 

Chloride              92 L

Urea nitrogen    2.3 L

!3 June 2024 @11:53

Sodium            125 (critical)   

14 June 2024 @ 8.10

Sodium          123 (critical)   

Potassium     38 

Chloride        94 L

Urea  nitrogen  2.5

14 June 2024 @ 14:12

Sodium          127  L

15 June 2024 @ 6:34

Sodium          126 L   

Potassium     3.7 

Urea nitrogen  2.2 L

Staying in Hospital was about taking the following medications and monitoring of blood as above.

8am
1. Omeprazole x 1 capsule
2. Metoclopromide (maxalon) / domperidone (motilium) x 1 tab (either or)
3. Celebrax x 1 capsule
4. Paracetamol x 2 capsule

9am – 10am (breakfast timing)
1. NaCl x 1 capsule
2. Potassium Cl x 1 tablet
3. Neurobion x 1 tablet

1- 2pm (pre lunch)
1. Metoclopromide (maxalon) / domperidone (motilium) x 1 tab (either or if papa feels nauseated)
2. Paracetamol x 2 capsule
3. NaCl x 1 capsule

6pm
1. Omeprazole x 1 capsule
2. Metoclopromide (maxalon) / domperidone (motilium) x 1 tab (either or)
3. Celebrax x 1 capsule
4. Paracetamol x 2 capsule

8pm-9pm (after dinner)
1. Metformin XR x 1 tablet
2. NaCl x 1 capsule

11pm-midnight (before sleep)
1. Paracetamol x 2 capsule

In the morning of15 June 2024, I was discharged and returned to Singapore. Was I fully recovered? I am sorry, the answer is NO. I was still unable to walk by myself and had to use a walking frame.

Cost of Hospitalization in Hospital C for 5 days

The total cost of hospitalization is RM 14,308.05, covering the following items:

  1. Hospital Charges RM 12,197.04

Medication                                       1,970.64

Medical & surgical suppliers             890.00

Nursing procedure                              663.68

Imaging                                              1,561.60

Rehabilitation services                       880.00

Laboratory investigation                2,391.68

Nursing care                                         525.52

Administrative charges                         56.56

House supply                                          48.80

Miscellaneous                                         97.52

Medical officer fee                                 42.96

Room and board                                1,724.00

Equipment /instrumentation           1,333.08

  • Doctor Charges RM 2,111.00

Dr. A – consultation & assessment. First consultation     235.00

Gen Ward visit (Weekday 8 am to 6 pm)                            840.00

Dr. B – Rad Fee            60.00

Repeat Fee – Brain      120.00

Repeat Fee Xray           21.00

Dr. C; Imaging – repeat fee – CT brain    120.00

Rad fee – on call surcharge                         60.00

Dr. D – consultation & assessment. First consultation     235.00

Gen Ward visit (Weekday 8 am to 6 pm )                          420.00

When you are in the hospital, remember that everything you used or was provided with has a price. So don’t be surprised. Take for examples:

  1. Vomit bag. This costs RM12.80 each. I needed this bag when vomiting. Worse is, the vomit was induced by the consumption of the prescribed medications.
  2. Every time I urinated, the disposable bottle costs me RM7.84 each.

After a fall I landed in three hospitals – here is more of my story! Part 2

Hospital B in Singapore

On 6 June 2024 my children got me admitted into the Urgent Care Centre, Hospital B in Singapore. I was there for 1.5 days. We did the following:

  1. CT scan of the head. No contrast.Had fall with occipital haematoma. The scans demonstrate evidence of bilateral subdural hygromas slightly more prominent on the left side. This is associated with evidence of an acute subdural collection in the right parietal region. There is no associated midline shift noted. The 3rd and 4th ventricles are central in position.

  • MRI Stroke Screen which showed a small acute infarct at the right lentiform nucleus. Multiple foci of susceptibility are seen in both cerebral hemispheres, worse at the frontal regions, likely representing hemosiderin deposition.
  • Bilateral fronto-temporal cystic hygromas are note, measuring up to 1.0 cm in thickness.
  • No intracranial space occupying lesion.
  • No hydrocephalus or midline shift.
  • MRA: There is a mild narrowing and irregularity in the A1 segment of the right anterior cerebral artery and the M2 segment of the left middle cerebral artery (MCA). These may represent atherosclerotic changes or sequalae of a prior insult.
  • The rest of the MRA of the circle of Wilis demonstrates no other significant aneurysm, stenosis or vascular malformation. Normal vascular variations are present. Bilateral posterior communicating arteries are hypoplastic
  • Stenosis is demonstrated.
  • Final conclusion –  normal pulmonary artery pressure.
  • No intra thrombus or pericardial effusion.
  1. Blood test results on 6 June 2024:

Troponin T   14.6 High Sensitive. Result is critical.

Creatine Kinase-MB  1.2 (0.0 to 6.0 ng/mL)

Potassium   3.8   (3.3 to 5.0 mmol/L)

Sodium    133  Low  (135 – 150 mmol/L)

Uria, serum  8.1   High  (2.8 to 7.7 mmol/L)

Glucose, fasting   13.4   High  (3.6 to6.0 mmol/L)

Est GFR   86  Expected range >=60 mL/min/1.73 square metres

C-Reactive Protein    14.38   H (<=9.99 mg/L

Reason for admission: Stroke on 6 June 2024                                                                                                                            

Secondary diagnosis: Type 2 diabetes mellitus without complication.

Discharge date: 7 June 2024

A note from the neurosurgeon stated: He is not fit for any travelling meanwhile requires monitoring.

The total costs in Hospital B in Singapore, was SGD 10,346.58 or RM 36,112.51

Admission date: 6 June 2023, 20:16, Discharge date: 7 June 2023, 17.41

  • MRI Stroke Screen                                 GD 1,177.20
  • CT Brain                                                              698.99
  • Observation bed – 3hs                                    286.76
  • Single room                                                       787.16
  • Single room – half day                                    393.58
  • Consultation – office hour                             125.69       
  • Consultation – after hour                               148.62       
  • Hospital charges                                           1,790.74
  • Ultrasound                                                        905.80
  • Daily treatment fee                                         325.69
  • Doctor’s attendance fee                                436.00
  • General follow-up screen                              420.68
  • After hours surcharge                                    196.40
  • Physiotherapy                                                  205.25
  • Speech Therapy                                               350.37

From Hospital B, I learned the following:

  1. The reason why I fell could be due to a mild stroke.
  2. For the first time in my life, I have been told, once again, that I have diabetes – and it is a serious one at that!
  3. My blood was low in Sodium, this could be related / a contribution to the mild stroke.
  4. My blood pressure was also high.

It seems that an elderly man with no pain or any “health problems” can suddenly get “sick”!

So please careful.

After a fall I landed in three hospitals – here is my story! Part 1

In May 2024, my life was really “drained!” Too many patients with too serious problems wanted my help. As usual I tried my very best to help, unaware that I was at the same time just “digging my own grave!” Let me share what happened to me.

But first, in writing this story, let me be up front with you. I am not against medical science. I went to the hospitals believing that medical science can help me – although I am an herbalist. Understand that no one has the monopoly to make fellow-citizens well again. It is either you believe in what you are doing, or you don’t.

From the beginning, may I tender my sincere apology to anyone who reads this article and finds it “offensive or crude” for the comments that I made. I was just giving my frank opinions. Please forgive me!

All the doctors and nurses who helped while I was in these hospitals were very nice and friendly. A big thank you to you all.

The Fall – A big lump in the head

In the early morning of 4 June 2024, I woke up to rush to the toilet to pass urine. While half way doing this, I felt dizzy and wanted to lie down but it was too late. I passed out and knocked my head resulting in a big bump. The next days, I fell one more time!

Life has many lessons to teach us as we age awaiting our final departure. I failed my first test. My first fall did not teach enough about the seriousness of a fall – I shouul have learned and should have prevented the repeat of such a fall.

Hospital A in Penang

After the fall, on 4 June 2024, I went to a private hospital in Penang , for check up.

  • X-ray for done to check if I suffered any broken bones. My ribs and bones of the pelvic region were okay!
  • Alignment of shoulder joint was normal.

  • CT of brain showed bilateral small chronic subdural hematoma (CSDH) noted. There is no acute intracranial bleed. There is no area of infarct seen. Brain stem and basal cisterns are normal. There is no skull fracture seen. There is scalp swelling in left occipital region.
  • Venous blood test: Hemoglobin A1c(HbA1c)- 13.6% – High. Normal = <5.7
  • I-Stat Chem8

Na = 135 mmol/L – range138-146 mml/L

K = 3.9 mmol/L – range 3.5 – 4.9 mmol/L

Glucose = 20.5 mmol/L – range 3.9 – 5.8  mmol/L

Urea = 4.6 mmol/L – range 8.0 – 26.0 mmol/L

Creatinine = 51 umol/L – range 53 – 115 umol/L

The total costs in Hospital A = RM 1,543 :

  • Physician Consultant 1– first consultation RM 70.00
  • Laboratory tests 1 – RM 198.00
  • Pharmacy – RM 93.00
  • Physician Consultant 2 – first consultation RM 70.00
  • Lab tests 2 – RM291.00
  • CT Brain – RM 370.00
  • X-ray – RM 195
  • Medical officer charges – RM 30.00
  • ECG Consultant – RM 35.00

From Hospital A I learned the following:

  1. The swelling of my head was not in my brain but at the external area outside the skull. The doctor told me it does not pose any immediate danger. This is very good news indeed.
  2. From the blood test results, I was told that I have diabetes. The sugar reading was 20.5 while the normal range was 3.9 to 5.8. This is rather shocking news! More of such unexpected news later.

Sadly, what had happened to me caused a lot of distress to both Albert and Irene who are living in Singapore. The same day I fell, Irene flew back to Penang.