Update on Kawasaki Disease

Last Saturday we went for Aqeel's one year medical check up on Kawasaki Disease. The main purpose of this check up is to see whether the hole at his heart is close or shown indication of it getting smaller. If u want to read his history u can read my previous post on Patent Foramen Ovale. 

Based on the scan, the hole is still there and the size is about the same as previous year. The doctor further comment that by 5 years old, if the hole did not close means that it will never close. Hence, we have another 2 years to see what is the outcome.

However, if it does not close at all, no significant risk to be worried about. Things that he should not do is diving, buggy jumping and parachute. This is where our body will face different pressure. Such pressure will result our blood to have bubble in the blood and it is afraid that the bubble will go through that hole. If that ever happen, it will cause stroke.

There are way to fix that, which is by Amplatzer PFO Occluder. The AMPLATZER PFO Occluder is a transcatheter closure device used to treat PFO. It is made of two wire mesh discs filled with polyester fabric. It is folded into a special delivery catheter, similar to the catheter used to cross the heart defect during a catheterization. The catheter is inserted into a vein in the leg, advanced into the heart and through the defect.
When the catheter is in the proper position, the device slowly is pushed out of the catheter until the discs of the device sit on each side of the defect, like a sandwich. The two discs are linked together by a short connecting waist.  

Over time, heart tissue grows over the implant, and it becomes part of the heart. The cost of this device is RM15k. However, the doctor convince us that the hole is too small and if he did not go for such activities, there is no need to do such treatment as it carried risk. 

Hence, we have conclude to wait until he is 9 years old and we will do another check up for all the kids to check their heart. At least we know the condition and be prepared.

I opt not to go for annual check up since it will only make me nervous. Besides, he will not be doing those activities between now until he is 9 years old right...

Vaccination

 I always thought that it is good to take as many vaccine in order to prevent your loves one from getting sick. However, today while surfing the internet, I came across this blog.

http://drtenpenny.com/

There are a lot of stories written, but this is what I would like to share:-

When Parent Question Vaccination

As the use of vaccinations continues to grow, so do the controversies surrounding them. Numerous medical problems, including rising rates of autism, thimerosal/mercury toxicity, asthma, eczema, allergies, ADD/ADHD and even cancer, are being scrutinized as part of the vaccine-injury “spectrum.”

Research still is being performed to substantiate whatever connections may exist, but the problems with vaccines have caused enough concern to spark the formation of dozens of grassroots political organizations that promote the right of a parent to refuse inoculation for their children. In addition, The Vaccine Adverse Event Reporting System (VAERS) was created via a cooperative effort of the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). VAERS collects information about adverse-vaccine events and side effects.

Deciding whether to have a child vaccinated is one of the most important choices a parent will ever make. In the interest of informed consent, a pediatrician should present a full disclosure of the pros and cons of innoculation. Unfortunately, pediatricians rarely give parents the opportunity to learn about their option to not vaccinate. Often pediatricians or family doctors confront parents with strong opposition when merely questioned by parents about the potential risks of vaccination.

Parents should seek information on the pros and cons of vaccination on their own in order to make an educated, informed decision. A number of questions about vaccination follow. Each offers a statement commonly given by pediatricians and family doctors in support of vaccination. Information that rebuts this statement and supports the decision not to vaccinate follows.

1. Is vaccination necessary to prevent childhood disease?

Support of Vaccination:  Immunization has been repeatedly demonstrated to be one of the most effective medical interventions we have to prevent disease.

Rebuttal:  Most of the common childhood diseases were declining in terms of morbidity (complications) and mortality (death) prior to the introduction of vaccinations, according to information obtained directly from government sources.

2. How many lives does vaccination save?

Support of Vaccination:  It has been estimated that immunizations currently save three million lives per year throughout the world.

Rebuttal:  A negative cannot be proven. For example: how can you know that a vaccine saved a life? Do all people contract all infections? How do you know how many infections have been prevented by vaccines and how many infections have been prevented by other means?

3. Is vaccination cost-effective?

Support of Vaccination:  Immunization is one of the most cost-effective health interventions.

Rebuttal:  We do not know the actual cost of vaccination worldwide but a few costs are known:

The wholesale price for vaccines used in the U.S. pediatric schedule is more than $170 per child. Given that there are more than 77,000 live births per week in the U.S., that equals more than $13 million each week to prevent a few childhood infections.

More than $1.3 billion has been spent to eradicate polio from Third World countries.

The estimated lifetime cost of caring for one autistic (possibly vaccine-injured) child is more than $4.5 million.

4. Are vaccines safe?

Support of Vaccination:  Vaccines are safe and do not cause untoward effects on the immune system.

Rebuttal:  Safety studies have been too short, too small and too few in number to enable us to declare vaccines safe. In addition, the natural immune system of infants has not been studied and is not yet fully understood. The long-term consequences of vaccines on the immune systems of children under two years of age cannot be predicted. And as of yet, this information is not being tracked. If a child develops an autoimmune disorder, the cause is not studied; instead, a therapy/medication is developed to treat it.

5. Do vaccines contain toxic additives?

Support of Vaccination:  The additives in vaccines are in small concentrations and are non-toxic.

Rebuttal:  Vaccines contain a combination of at least 39 different toxic additives, preservatives and cell types introduced during the manufacturing process. The cumulative effect of these toxins, particularly the heavy metals, is hotly debated. Most vaccines are given in combination, and in doing so potentially create a cumulative effect of toxicity. In addition, vaccine contaminants have included bovine (cow), avian (chicken) and monkey viruses and bacteria such as streptococcus in the DTP (diphtheria, tetanus and pertussis) vaccine [Pediatrics, Vol. 75, No. 2, Feb 1985] and Serratia marcesens in the influenza vaccines [2004 influenza season].

For example, DTP, a common vaccine given to most newborns, is produced using formaldehyde, aluminum hydroxide, aluminum phosphate, polysorbate 80 and gelatin. In some cases, thimerosal still is used. The polio vaccine is produced using three types of polio virus and can contain formaldehyde, phenoxyethanol (antifreeze), sucrose (table sugar), neomycin, streptomycin, polymyxin B and VERO cells (a continuous line of monkey kidney cells).

It is also important to consider an infant’s developing filtering system for eliminating toxins. For example, aluminum is eliminated from the body primarily through the kidneys. Infant kidney function (glomerular filtration rate) is low at birth and does not reach full capacity until one to two years of age. [Simmer, K. Aluminium in Infancy. In: Zatta PF, Alfrey AC. (Eds) Aluminium Toxicity in Infants’ Health and Disease. 1997, World Scientific Publishing.]

6. What do vaccines protect against?

Support of Vaccination:  Vaccines provide high levels of protection against several diseases, as well as disability and death.

Rebuttal:  Vaccines vary in efficacy, and many who have been vaccinated still contract the disease. Therefore, vaccines do not necessarily protect against disability and death from disease. In addition, vaccines have been documented to cause certain disabilities, even death.

7. Are adverse side effects of vaccination common?

Support of Vaccination:  Serious adverse events following immunization are rare.

Rebuttal:  Between mid-1999 and Jan. 4, 2004 (for all vaccines and all reactions), 128,035 adverse reactions were reported to the Vaccine Adverse Event Reporting System (VAERS). It is estimated that only 10% of all reactions are actually reported to VAERS. Therefore, this may actually represent between 1.28 million (10%) and 12.8 million (1%) of all vaccine-associated adverse reactions. In that same period, there were 2,093 deaths reported to VAERS. This may actually represent between 20,930 (10%) and 209,300 (1%) of the deaths thought to be associated with vaccines.

Even though this data does not prove an association to vaccine-related injury and death, the magnitude of the numbers certainly takes exception to the concept of a “rare” event. It is worth mentioning that more than $1 billion has been paid in settlements to victims of vaccine-related injuries and death through the Vaccine Injury Compensation Program (VICP) since the program’s inception in 1988.

The decision to vaccinate or not is important and complex. Parents must take on the responsibility to seek enough information to make an educated, informed decision. Armed with as much information as possible, parents then can make the choice in consultation with their own health-care providers.

Pneumonia Fever

It started on Saturday 30 June when I had a really painful headache, nausea and everything. That evening I already felt slight fever. Took a couple of Actifast Panadol hoping that it will do miracle to me. The next day, still feeling fever and I decided to go to the clinic to get the antibiotic. The temperature is already 39C. The doctor did advice that by Tuesday if I did not get any better I need to do blood test since at my housing area, there is already dengue cases. 

On Monday, still fever getting worse and I decided to go to the hospital instead. Afraid that if I wait any longer, the viruses will be transferred to the kids. Reached Pantai Cheras hospital and the fever is already 39.7C. Did the blood test and xray. Doctor confirmed that I had pneumonia fever and he advised me to be admitted.

I thought that maybe I had to be admitted only for a day and that would be fine leaving my kids behind. Less than I know, I have to admitted for 3 days and the doctor just refuse to discharged me as I still have slight fever. Staying in the hospital room is soo exhausted. I rather be chasing the kids around rather than stay there..

The last day, I beg the doctor to just discharge me and he promise to do that during his check next morning. Like a drama I tell u..

Pumping session has gone haywire. Since I had to be put on IV drip so it is quite hard to pump as I dont like moving my hand as I will only caused pain..(I dont like needle or anything like that inserted inside my body). Beside I cannot do much wash as well. Hence resulted on low milk production even till now.

Hoping that it will get back to its normal production level before fasting.

Pneumococcal Vaccine

The pneumococcal disease is a group of diseases caused by the streptococcus pneumonia bacteria, or pneumococcus.  They live in the mucous lining of the nose and in the back of the throat. And when they're plentiful enough, they can cause an infection in the respiratory tract, middle ear, or sinus cavities. Antibiotics such as penicillin can kill them, but up to 40 percent of the strains are resistant to antibiotics.

Pneumococcal bacteria spread by close contact and through coughing and sneezing. Diseases such as meningitis and pneumonia can crop up within days of infection.

Symptoms of pneumococcal pneumonia usually include fever and chills with shaking or trembling, as well as chest pain, coughing, shortness of breath, rapid breathing, rapid heart rate, fatigue, and weakness. Nausea, vomiting, and headaches are also associated with pneumococcal pneumonia, but are less common.

Pneumococcal bacteria also cause some of the most serious ear infections in children.

Failure to receive treatment or a failed treatment may lead to hearing loss, learning difficulties, delayed speech development, paralysis and sometimes death. 

It is quite difficult to identify a pneumococcal infection since symptoms such as fever, chills and cough can be confused with other diseases. In fact, it requires a thorough medical checkup or laboratory tests to confirm the infection

The burden of pneumococcal disease in childhood in Malaysia is high, according to the Health Technology Assessment report. At least 500,000 cases annually of otitis media (middle ear infection) occur in children less than two years, with 25,000 of these progressing to chronic otorrhea (discharge of infected pus into the ear canal) with potential to develop hearing loss; 4,000 cases annually of childhood acute respiratory (lung) infections, 200 of which result in death, and 750 cases of pneumococcal bacteremia (blood infection), resulting in between 15-20 deaths may be expected4.

Despite the severity of the disease and its burdens, pneumococcal disease is the number one vaccine-preventable death in children under five.

Recommended number of doses
Four doses.

Recommended ages

• At 2 months
• At 4 months
• At 6 months
• Between 12 and 15 months

Price range from RM 220- RM 250 per dose

Who shouldn't get the Pneumococcal vaccine?

Children who've had a life-threatening allergic reaction to a previous Pneumococcal vaccine shot or to certain other vaccines should not get the Pneumococcal vaccine vaccine. If your child has had this type of severe reaction to any immunization, talk to her doctor about whether the Pneumococcal vaccine is advisable.

Are there any precautions I should take?

Mildly ill children can be vaccinated. But if your child has a high fever or a severe illness, such as pneumonia, wait until her health improves before taking her in for the vaccine. She'll be better able to handle the immunization when she's healthy.

What are the possible side effects?

About a third of vaccinated children have redness, discomfort, or swelling at the site of the injection. A third also develop a mild fever. One in 20 has a higher fever of over 102.2 degrees.

Severe allergic reactions are rare but possible with any vaccine. See what our expert says about how to tell whether your child is having an adverse reaction.

For those high risk group, getting pneumococcal vaccination is one of the defense mechanism we could use against dying from H1N1. You might still get H1N1 but at least you have a 30% lower risk of dying from H1N1.

This is because 30% of H1N1 pneumonia related deaths are due to Streptococcus pneumoniae. Getting yourself vaccinated means you have eliminated 30% of the possible risk of dying from H1N1 pneumonia.

G6PD

G6PD deficiency is an inherited condition in which the body doesn't have enough of the enzyme glucose-6-phosphate dehydrogenase, or G6PD, which helps red blood cells (RBCs) function normally. This deficiency can cause hemolytic anemia, usually after exposure to certain medications, foods, or even infections.

Most people with G6PD deficiency don't have any symptoms, while others develop symptoms of anemia only after RBCs have been destroyed, a condition called hemolysis. In these cases, the symptoms disappear once the cause, or trigger, is removed. In rare cases, G6PD deficiency leads to chronic anemia.

With the right precautions, a child with G6PD deficiency can lead a healthy and active life.

About G6PD Deficiency

G6PD is one of many enzymes that help the body process carbohydrates and turn them into energy. G6PD also protects red blood cells from potentially harmful byproducts that can accumulate when a person takes certain medications or when the body is fighting an infection.

In people with G6PD deficiency, either the RBCs do not make enough G6PD or what is produced cannot properly function. Without enough G6PD to protect them, RBCs can be damaged or destroyed. Hemolytic anemia occurs when the bone marrow (the soft, spongy part of the bone that produces new blood cells) cannot compensate for this destruction by increasing its production of RBCs.

Causes of G6PD Deficiency

G6PD deficiency is passed along in genes from one or both parents to a child. The gene responsible for this deficiency is on the X chromosome.

G6PD deficiency is most common in African-American males. Many African-American females are carriers of G6PD deficiency, meaning they can pass the gene for the deficiency to their children but do not have symptoms; only a few are actually affected by G6PD deficiency.

People of Mediterranean heritage, in

cluding Italians, Greeks, Arabs, and Sephardic Jews, also are commonly affected. The severity of G6PD deficiency varies among these groups — it tends to be milder in African-Americans and more severe in people of Mediterranean descent.

Why does G6PD deficiency occur more often in certain groups of people? It is known that Africa and the Mediterranean basin are high-risk areas for the infectious disease malaria. Researchers have found evidence that the parasite that causes this disease does not survive well in G6PD-deficient cells. So they believe that the deficiency may have developed as a protection against malaria.

G6PD Deficiency Symptom Triggers

Kids with G6PD deficiency typically do not show any symptoms of the disorder until their red blood cells are exposed to certain triggers, which can be:

• illness, such as bacterial and viral infections
• certain painkillers and fever-reducing drugs
• certain antibiotics (especially those that have "sulf" in their names)
• certain antimalarial drugs (especially those that have "quine" in their names)

Some kids with G6PD deficiency can tolerate the medications in small amounts; others cannot take them at all. Check with your doctor for more specific instructions, as well as a complete list of medications that could pose a problem for a child with G6PD deficiency.

Other substances can be harmful to kids with this condition when consumed — or even touched — such as fava beans and naphthalene (a chemical found in mothballs and moth crystals). Mothballs can be particularly harmful if a child accidentally swallows one, so ANY contact should be avoided.

Symptoms of G6PD Deficiency

A child with G6PD deficiency who is exposed to a medication or infection that triggers the destruction of RBCs may have no symptoms at all. In more serious cases, a child may exhibit symptoms of anemia (also known as a hemolytic crisis), including:

• paleness (in darker-skinned children paleness is sometimes best seen in the mouth, especially on the lips or tongue)
• extreme tiredness
• rapid heartbeat
• rapid breathing or shortness of breath
• jaundice, or yellowing of the skin and eyes, particularly in newborns
• an enlarged spleen
• dark, tea-colored urine

Once the trigger is removed or resolved, the symptoms of G6PD deficiency usually disappear fairly quickly, typically within a few weeks.

If symptoms are mild, no medical treatment is usually needed. As the body naturally makes new red blood cells, the anemia will improve. If symptoms are more severe, a child may need to be hospitalized for supportive medical care.

Diagnosing and Treating G6PD Deficiency

In most cases, cases of G6PD deficiency go undiagnosed until a child develops symptoms. If doctors suspect G6PD deficiency, blood tests usually are done to confirm the diagnosis and to rule out other possible causes of the anemia.

If you feel that your child may be at risk because of either a family history or your ethnic background, talk to your doctor about performing a screening with blood tests to check for G6PD deficiency.

Treating the symptoms associated with G6PD deficiency is usually as simple as removing the trigger — that is, treating the illness or infection or stopping the use of a certain drug. However, a child with severe anemia may require treatment in the hospital to receive oxygen, fluids, and, if needed, a transfusion of healthy blood cells. In rare cases, the deficiency can lead to other more serious health problems.

Caring for Your Child

The best way to care for a child with G6PD deficiency is to limit exposure to the triggers of its symptoms. With the proper precautions, G6PD deficiency should not keep your child from living a healthy, active life.

Jaundice

I think most of you have known that my baby boy has been admitted to PPUKM for severe jaudice. It is shocking since his SB reading is 457 which is already above the limit.

We notice that his eyes are yellowish but somehow, his skin is so reddish. So i thought that maybe he is having jaundice but minimal reading. We went to Pantai Cheras for baby follow up and somehow referred to PPUKM since their equipment is better.

The doctor explains to us in detail the reading and the option that we have. For SB reading above 428, they will go for blood transmission since there are too many red blood cells dying and it is not properly move through the digestive track.

So, baby and I were taken blood sample to be sent over to the Blood Bank. While waiting for Blood Bank respond, the baby was put under triple phototherapy.

When we were admitted, it was already 4pm and we have to wait until next day for Blood Bank to come back on the status. However, the SB reading has dropped to 359 by then. Hence, doctor concluded no blood transmission should be done. What a huge relief to me and the family members.

I of course am giving as much breast milk as I could. I only pump after I fed him and also making sure he is up every 2 hours for feeding. Based on study done, 60 to 70% jaundice happen to boys. I think because baby boy demand more milk than baby girl. Both my boys had jaundice. Aqeel was admitted to but his reading is not as high Aydin. Maybe because Aydin weight more than his brother.

However, we were discharged after 2 days stay and I must say it is such a horrible experience. Mom can only sleep at the ward at nights. There are room given to mom but it is quite far for moms who had just delivered. We have to eat, rest and go to toilet prepared in the room. 

Here are some read up about jaundice

Hemorrhoid Part 2

As promised, this is the continuance of my hemorrhoid story.

The next day after the surgery, he doctor checked and said that the cut he made is already close and the hemorrhoid is still there.  But the hemorrhoid does not look so tense. So he asked me to immerse that area in hot water mix with salt so that the hemorrhoid will shrink.

The next follow up will be this Friday, and if the hemorrhoid is still in the same condition, the surgeon advice me to do early delivery. So it's gonna be week 36. Hope everything went well.

In my case, the reason hemorrhoid exist is due to the pressure from the fetus on the abdomen and hormonal changes cause the hemorrhoidal vessels to enlarge. Delivery also leads to increased intra-abdominal pressures. Surgical treatment is rarely needed, as symptoms usually resolve post delivery.

The total bill is RM2k and alhamdulillah it was all covered by Maybank.

I have a family who support me in many ways. My dad offered to give me a ride and he even pull my wheelchair. He's been running here and there to pick up his granddaughters as well as taken care of me. My mom, in the other hand without hesitate offered to handle my two kids and sleep with them so that I can rest. She also worn me not to carry the kids as it will bring pressure to that area. My husband, beside the busy schedule he had in the office, he still be by my side. Knowing that i miss the kids very much, he will bring the kids up to the room very often.


Alhamdulillah, syukur that I have family who is concern about me. I love them very much too..

Hemorrhoid

Yes. I am having it right now during my 34 weeks of pregnancy. Some people might feel embarrass but for me heck no.

I started having it on Friday. The hemorrhoid is as large as 1 inch. So what i did was applied the cream called Neo Healer every now and then. It is a herbal cream and you will feel a bit of airy and cold. It is supposed to shrunken after a few times applied the cream. But in my case it is not. So i went to see mu gynae and she gave me a bullet medicine called Suppotory. I used the medicine for 3 days and on the Monday night after i put the medicine, blood coming out. So the next morning I went to see my gynae and she referred me to General Surgeon. 

Alhamdulillah the doctor is very nice and concern. Supposedly I cannot claim the medical chargers under insuance. However, upon registration, he wrote that this was not due to pregnancy. So hooraay!!..At least I don’t have to be worried about the money..

Subsequently, he checked through the hemorrhoid and found out that it is quite serious. There is already blood clot. He advice me to do minor surgery right then in his room.

I am pretty freaked out since he said its gonna be painful as he need to injected me with pain killer at the area. He gave 4 injections and he cut the hemorrhoid so that the blood clot can come out. He did not stitch because he afraid that the blood might stuck there again.

The pain is so damn painful. I was shaking badly as i have to be seated on the wheelchair and do the registration and admission all by myself. Of course the nurse is around to help me, but I don’t have the pleasure of lying on the bed and rest to avoid pressure at that area. Can you imagine, right after surgery you have to sit and put the pressure at your bottom for an hour before everything settled?

I must say that the pain is so much worse that the pain of delivering a baby. At least after i deliver, i lie down all the time and am given pain killer. But this time no pain killer was given as i will affect the baby. The only thing i can take is only panadol..

Why i have to do the registration and admission myself?
Because the husband had a meeting in the morning. I did not even thought that i gonna need a surgery. If not i would definitely asked him to cancelled everything. So i asked my dad to give a ride to the hospital. He waited with me to meet the surgeon and left me there to pick up my niece at Smart Reader Kids. So yup i am alone during the surgery. He reached hospital back when i was almost done with registration. So did my husband. I was crying at the registration thinking of the situation that i am facing and the pain that i have to bear. The staff at the counter just did not want to care of my condition even though the nurse accompanying me already informed her that i was in pain and just go through a surgery.

Readers, i will continue in part 2. The post is to long already and I'm in pain.