Hospitalized for feet’s bacterial infection: part 2 of 2

The first night after the acupuncture was terrible. I had to position my feet in a baby bathtub while laying on the bed the whole night. I hardly slept well. I felt my feet to be less swollen in the next two to three days. However, whenever I planned to move about, my feet had to be wrapped in tissue papers and plastic bags by my wife or my mother. It was very inconvenient, but at least I felt less resistance in moving my feet. The redness above my feet started to be more noticeable. Four days after acupuncture, the fluid drip had decreased dramatically but I was experiencing increasing pain whenever I moved. By the evening, I could not move my left feet was it was so red and swollen. I started rallying for prayer support. On the 8 Sep’11, I could hardly walked as my left foot was too painful. My wife called the TCM practitioner. His first question was whether we would like to have another house visit consultation, and we said no. He next said that I was his first patient to suffer from red swollen feet after five days of acupuncture. I had a gut feeling he did not know it was a case of bacterial infection. This would be the last time I would use his service, and I am still undecided whether to write a letter of complain to the TCM board in Singapore.

Thank God, I was visited by my hospice doctor and nurse on 8 Sep’11 who identified my condition as bacterial infection. Dr. Kee prescribed an antibiotic, Augmentin, for me, but I vomited it out two hours after consumption; and it happened twice. As I could no longer tolerate my bacterial infection, I discussed with my wife and mother the idea of hospitalization on the morning of 9 Sep’11 before consulting with Dr. Tay at Gleneagles Hospital whether it was possible to make such arrangement. He expedited the process and by afternoon, there was a bed vacancy for me in a four-bedded ward. As I was not scheduled for operation, I was allowed to wear my home clothing in the ward. Compared to Singapore General Hospital (SGH) where I had my radical nephrectomy, my dress code as a patient made me felt faceless as I was identical with other patients wearing the same hospital gown. What’s more, the nurses at SGH preferred the curtains separating each bed to be opened at all times so that nurses at the door could see what was happening at one glance. There was a loss of privacy. At Gleneagles, the curtains between beds were drawn all the time to maintain privacy.

The first night at Gleneagles, I was injected with liquid Augmentin to ensure the antibiotic traveled to the infected site immediately instead of passing through the digestive system. Every morning and evening, I had an antibiotic injection. I had another liquid diuretics injection to ease the swelling of my legs. Most of the time, my legs were propped up on pillows to facilitate blood circulation in my feet. In this ward, four patients were entitled to two toilets which included the shower room, unlike the ward I was in at SGH last year, five patients were entitled to one shower room and a separate toilet. Comparatively speaking, it was more comfortable recuperating at Gleneagles. The funny thing was when I was introduced by Dr. Tay to his colleague and the nurses on shift, I was known as “a church co-worker who has no money”.  

With each passing day, my swelling eased. I was able to walk slowly though it was still painful to exert pressure on my left foot. By the 3rd day of admission, I was given the option to discharge. However, the doctor in-charge of me preferred to to stay for one more day to monitor my situation and for additional doses of antibiotic. Since I could walk without much assistance, I tried to stand up on my own and walked to the toilet myself. Each successful attempt was a cause for celebration. In the initial two days when I had to rely on the wheelchair and my wife to push me, I had to use urinal to pass urine which felt awkward.

I was officially discharged on the 12th Sep’11 and still had to depend on wheelchair to move about. I was given one week of penicillin to manage the bacterial infection. When I was about to reach home, I did not particularly enjoy the stare of a lady in her fifties on the first floor of house elevator as if I were an alien or someone who looked like a possible source of her gossip. I also did not like the stare of my speechless neighbour that made me wish I were invisible. I still depended on wheelchair for movement during the first few days, and subsequently, I could finally move about more independently. The skin which was originally red and swollen became to come off and I had to apply intensive moisturizer often to ease the discomfort. Now, slightly more than two weeks after my discharge, I could say most of my ordeals with bacterial infection is almost over, and I thank God and God’s community of people for walking together with me. I felt God has been with me throughout this trial, and I was greatly comforted by my friends who have been lifting me up in their prayers. My wife and mother have also been taking very good care of me during this period of trial.

Now, I have to cope mainly with bloating tummy which my oncologist suggests is due to leaky blood vessels which will be alleviated by my chemo drug, Avastin. My sleep has also become irregular. I could at most catch a few hours of sleep before waking up again, and a few hours later on. My appetite has also shrunk, and I could only take frequent, small meal everyday to satisfy my hunger. I have to be careful with my diet because if I overate, I am almost certain to throw up.

How right is the advice of the Teacher when he says “Rejoice, young man, while you are young, and let your heart cheer you in the days of your youth. Follow the inclination of your heart and the desire of your eyes, but know that for all these things God will bring you into judgment.” (Ec 11:9) Enjoy while we still can, because there will be a day when our body cannot enjoy the pleasure of good food and the comfort of life anymore. Yet, in the process of enjoyment, we are to remember that God will take into account how we live our life.

Hospitalized for feet’s bacterial infection: part 1 of 2

It started with edema in the mid of August when I noticed my right foot to be swollen after teaching adult Christian education class one Sat morning. The swelling of both my feet coupled with increasing tiredness were telltale sign of the ineffectiveness of my 2nd chemo drug, Affinitor. After I stepped down from my teaching post at Jubilee School of Missions and the Peoples’ Presbyterian Church, and the Bible leader role from Providence Presbyterian Church at Jurong, I was able to rest more often, and had more time for reading. However, my edema  became more serious towards the end of August. Propping the legs above the heart level  every night was the only advice I had to from my oncologist to ease the swelling. I also noticed that my stomach had become bloated as well. I was told that my stomach was retaining water by my oncologist; because  it was not serious enough, it was not a cause for concern yet. Dr. Kee from HCA hospice care advised me to take in highly nutritious milk as my main food intake to make up for insufficient protein intake. He asked me whether I would like to try diuretics to ease the edema, and I guess I was not ready to for new medication yet. However, I bought more packets of ready-made milkshake for cancer patient to supplement my protein intake. 

By the end of August, the swelling in both legs had aggravated. I could only rest my feet on a higher support every now and then during the day to reduce the swell. At night, apart from wearing compression socks, and resting them on a pillow, there was nothing much I could do. The swell were usually less obtrusive in the day, and aggravated towards the evening. I had difficultly walking and felt clumsy in my movement. My mother borrowed a wheelchair and waling frame on my behalf to facilitate my movement at home. During my consultation with my oncologist on 23 Aug’11, I had to be wheeled in the hospital.

Finally, someone whom I am close to informed me of a registered practitioner in traditional Chinese medicine who is experienced in reducing water retention. His clinic is located at Upper Bukit Timah Road. After much hesitation, I decided to give it a try. The practitioner offers home consultation for a much higher fee than clinical visit, but since I had difficulty traveling, I asked him to come to my place. On 3 Sep’11 evening, he and his wife arrived and explained to me what he was going to do. He illustrated few examples of his success cases where his patients were relieved of their edema. According to him, my body could not absorb the excess nutrients and these had to be released. He commented that unlike the Western doctors who focused on draining off of fluids, his technique will in fact help the body to be strengthened eventually through acupuncture. He cited an example of his elder brother who was supposed to undergo surgery to remove his remaining kidney, but with two-year acupuncture treatment his elder brother’s kidney function was restored and was spared from the nightmare. He assured me that his technique will boost my overall immune system.

After heating his needle, which I assumed was his method of sterilization, and applying alcohol on my stomach and my feet, he started poking from my head, then to my feet where my mother, my wife, myself witnessed fluid oozing out from the acupuncture points. I felt a sense of relief as I thought I did not have to cope with edema much longer. Then the practitioner’s wife reminded him to poke my stomach. Fortunately, no fluid came out from my stomach. I was next given a used bottle of aloe vera cream to accelerate healing of the skin. What I did not know then was the beginning of bacterial infection for me. I was only told to wash my feet with clean water, to use toilet roll and towels to absorb outflowing fluid, and if fluid outflow was heavy, to use sanitary pad to wrap it. There was no sterilizing gauze or anti-bacterial solution in his concept. I was told not to use soap during bathing in the next few days, which I obediently followed. I was mentally prepared to expect heavy fluid outflow from both feet in the coming one to two days, and subsequent decreased in fluid flow three to five days after. The TCM practitioner left twenty minutes after his arrival, with a hefty sum of fee.

Moving from 1st to 4th line of treatment within two months

 

I started switching to Affinitor in the early July when my CT scan done on 28 Jun’11 revealed the ineffectiveness of Sutent (my 1st line of treatment) in managing my tumours. I decided to switch to another oncologist, Dr. Tay, at Gleneagles for 2nd opinion and for more personal advice. Dr. Tay was of the opinion I should also switch medication and knowing my situation, he was able to offer me a cheaper price for the same medication. After trying out for two months, it was clear from my 17 Aug’11 CT scan that Affinitor was not working for me either. Dr. Tay suggested me to switch to 3rd line of treatment, another oral anti-angiogenesis drug Votrient. By then my energy level was declining, and I was coping with the after-effect of radiotherapy.

My blood test result two weeks after I took Votrient revealed that this drug might be ineffective as well and my energy level was declining steadily. During that two weeks interval, I had asked my family members to be mentally prepared in case my health continued to spiral downwards. My sudden loss of weight after one week of radiotherapy from 18-25 Jul‘11 to kill tumours growing on my spinal cord did much damage to my body. Though each therapy session lasted for last than five minutes, and it was painless, I vomited on a daily basis then and ate little during that brief one week of treatment. I didn’t gained any weight since then, except experiencing edema. The therapy also left a burnt mark on my back. 

By end of August, my feet were so swollen and I felt so weak that I had to use a wheelchair when consulting my oncologist at his clinic in Gleneagles hospital on 23 Aug’11. My 17 Aug’11 CT scan did not look good, and my blood test did not look good either. Tumours have grown back on my spinal cord, and I am taking oral morphine to manage my pain. When Dr. Tay asked me how I felt about the my own condition, and I remembered saying “Not positive”. He advised me to be mentally prepared. I was given the option to stop treatment or to try the 4th line of treatment, using intravenous injection drug, Avastin. I heard of Avastin before, and it was the drug approved prior to Sutent by the US Food and Drug Administration, but a more expensive drug than Sutent. I would like to try everything within my means before giving up so I decided to give it a go. Dr. Tay also arranged the service of HCA Hospice Care for me.

I started Avastin on 23 Aug’11 and it has been a month. I believe my body is responding to Avastin as I did not feel my energy level to be dipping further and my blood test on 9 Sep’11 indicated that my liver’s and kidney’s function to be improving. I thank God for the extra time I have with my family members now. Dr. Kee, the hospice doctor, suggested that any extra day for me is an added bonus. Dr. Kee’s suggestion is a new paradigm for me. Each day is indeed a day of gratitude, though I have to cope with occasional swollen feet and bloated stomach now.

Stating my philosophy of life briefly

 

I have been asked whether life is meaningful if one were to die eventually. I would say a definite YES. I believe we live to create good memories with our cherished ones, and we leave behind memories while also taking it together with us. Grief is a natural process of detachment. Everyone is bound to attachments which will be naturally followed by detachments. The challenge is to live in the present NOW, because what exists is NOW. The deeper challenge is to create good memories for oneself and for others in the present NOW, knowing that we will be held accountable for how we lived (that is the last word of Ecclesiastes by the way). To refuse to let go of detachment is to trap oneself in a spiral of grief. I know this sounds a bit like Buddhism, but what makes this belief different is the assumption that the reality we construct now is a shadow of the perfect one that is to come, and will come. Paul says in Eph 1:13-14 "And you also were included in Christ when you heard the message of truth, the gospel of your salvation. When you believed, you were marked in him with a seal, the promised Holy Spirit, who is a deposit guaranteeing our inheritance until the redemption of those who are God’s possession." Since we have received the Holy Spirit, what God says will happen will definitely take place. "Meaningfulness" is dependent on God's promises while living in the present reality.

Community requires forgiveness by Henri Nouwen

There are different types of community life you have probably been part of. There are probably some where you enjoy and you feel like part of its whole. There might also be some where you wish some of the underlying problems could be resolved before the community moves on. There might be a few where hurts and grievances are not given room to be expressed and healing is not taking place. Instead, these hurts and pains are hidden, and allowed to corrupt the goodness of the community unconsciously. Depending on the culture and source of authority within the community, some deem it a disgrace to air grievances, while some simply re-interpret the experience and put the source of blame squarely on those who are suffering. Some simply lack the experience and skill to handle hurt and grievance, and choose to ignore it. Recently, I come across Henri Nouwen’s Spiritual Direction: Wisdom for the long walk of faith. There is a part on forgiveness within community that I would like to share with you, titled “Community requires forgiveness”.

COMMUNITY REQUIRES FORGIVENESS
Within the discipline of life in community are the twin gifts of forgiveness and celebration that need to be opened and used regularly. What is forgiveness? Forgiveness means that I continually am willing to forgive the other person for not fulfilling all my needs and desires. Forgiveness says, "I know you love me, but you don’t have to love me unconditionally, because only God can do that." I too must ask forgiveness for not being able to fulfill other peoples total needs, for no human being can do that.

We all have wounds. We all live in pain and disappointment. We all have feelings of loneliness that lurk beneath all our successes, feelings of uselessness that hide under all the praise, feelings of meaninglessness even when people say we are fantastic - and that is what makes us sometimes grab onto people and expect from them affection, affirmation, and love that they cannot give. If we want other people to give us something that only God can give, we are guilty of idolatry. We say, "Love me!” and before long we become demanding and manipulative. It is so important that we keep forgiving one another not once in a while but every moment of life. This is what makes community possible, when we can come together in a forgiving and undemanding way.

Our heart longs for satisfaction, for total communion. But human beings, whether it's your husband, your wife, your father, mother, brother, sister, or child, are all limited in giving the level of love and acceptance we all crave. But since we want so much and we get only part of what we want, we have to keep on forgiving people for not giving us all we want. So, I forgive you since you can only love me in a limited way. I forgive my mother that she is not everything I would like her to be. I forgive my father because he did the best he could. This is of enormous importance right now because constantly people look to blame their parents, their friends, and the church for not giving them what they need. Many people are so angry. They cannot forgive people for offering only limited expressions of an unlimited love. God's love is unlimited; our love is not. Any relationship you enter into - in communion, friendship, marriage, community, or church - will always be riddled with frustration and disappointment. So forgiveness becomes the word for divine love in the human context.

Community is not possible without the willingness to forgive one another "seventy-seven times” (Matthew 18:22). Forgiveness is the cement of community life. Forgiveness holds us all together through good and bad times, and it allows us to grow in mutual love.

As people who have hearts that long for perfect love, we have to forgive one another for not being able to give or receive that perfect love in our everyday lives. Our many needs constantly interfere with our desire to be there for the other unconditionally. Our love is always limited by spoken or unspoken conditions. What needs to be forgiven? We need to forgive one another for not being God!

(Henri Nouwen, Spiritual Direction: Wisdom for the long walk of faith. New York, NY: HarperCollins Publishers, 2006. pp.119-120.)

MY REFLECTION
When we project our needs onto others and expect them to fulfill it, we are bound to be disappointed and resentful, because we are unconsciously asking the others to be our superhero. We learn to put ourselves in others’ shoes when we realize that this is of no faults of others, and it is never easy to forgive when we ourselves are wounded in the first place. Unless we take the initiative to forgive, reconciliation will probably not take place. But the source of forgiveness does not come within ourselves, it comes from the God who loves us as who we are. I believe it is only when we recognize and acknowledge that each of us is a beloved child of God; that we have been forgiven by God for our trespasses; and deep within ourselves we realized we have received mercy and grace; only then should we continue to believe in the goodness of forgiving others. To forgive others is to break free of the chain that bind us to our hurt, pain and frustration.

However, forgiving others is easier said than done; it is even harder if the person is part of your community. Let us remember that Judas Iscariot was one of the twelve disciples, and lived with Jesus every day during Jesus’ ministry. Since I am not Jesus, how can I expect to be like Jesus? Jesus has set a prime example for all of us, and the Spirit within us is shaping us to conform to Christ’s image through a long and tedious process. (NRSV Ro. 8:29 For those whom he foreknew he also predestined to be conformed to the image of his Son, in order that he might be the firstborn within a large family.) Going back to Nouwen’s insights, “Forgiveness is the cement of community life. Forgiveness holds us all together through good and bad times, and it allows us to grow in mutual love.” As none of us is perfect, and recognizing our own limitations, it is by learning to forgive that we accept our own imperfections, our own limitations and the imperfections of others as well. Learning to forgive again and again is a process of acknowledging our mutual shortcomings, to create room for authentic love to take root, and to nourish the soil for authentic life in community to take place.

Disappointment with my AIA HealthShield Gold Plan A

I bought my AIA health insurance policy back in 2002 when I was still in the prime of my health and when I undergoing training as a professional school teacher. My policy underwent some revisions and it is now known as AIA HealthShield Gold Plan A. It was regrettable that I did not find out more from my ex-insurance agent (who has switched to another industry this year) about the the revision and other plans which offer better coverage. Currently, I am holding a policy which offers less coverage than NTUC Enhanced IncomeShield Basic plan and yet I am paying a higher premium. This is why I am disappointed with AIA. 

As I mentioned in the my previous blog entry, when one is scouting for health insurance policy, there are three criteria one should be comparing: 1) The amount of coverage during hospitalization; 2) The types of coverage after discharge, including out-patient treatment; 3) The claims limit per policy year and per lifetime. Let’s compare the benefits of AIA Plan A with NTUC Basic Plan.

AIA HealthShield Gold Plan A Benefits   

NTUC Enhanced IncomeShield Basic Plan

Now if I were to choose based on my first criterion, i.e. amount of in-patient coverage, and if I were to opt for a Class B1 ward (an air-con ward with four beds and an attached bathroom; B1 ward and above are considered non-subsidized ward), NTUC Basic Plan will pay as per charged, whereas AIA Plan A capped it at $830 per day in any ward or $1300 per day in ICU. But if I consider the surgical benefits, NTUC Basic Plan will pay as per charged, unlike AIA Plan A which has a cap limit. 

Next, if I were to compare the out-patient treatment benefits, AIA Plan A cannot hold a candle at all  to NTUC Basic Plan as the latter plan pays as per charged. AIA Plan A loses out by a wide margin in this category.

Lastly, if I were to compare the claim limit per policy year, AIA Plan A also loses out by another wide margin as well. AIA sets a cap limit of $120,000 per policy year, while NTUC Basic Plan sets $150,000. But for lifetime limit, there is no limit at all for NTUC Basic Plan, while AIA Plan A caps it at $5 million for lifetime. 

Now it is clear which is the winner. But if you think the premium for NTUC Basic Plan should cost at least twice AIA Plan A, here’s the truth.

Premium Table for AIA HealthShield Gold Plan A

 Premium Table for NTUC Enhanced IncomeShield Basic Plan

As you can see, if you are a Singaporean, you are paying a premium for NTUC Basic Plan at a price way below that of AIA Plan A. Even if you were a foreigner, it will still be cheaper if you were to purchase NTUC Basic Plan. In my previous blog entry, I have argued that if the premium is affordable for you, go for the NTUC Preferred Plan. In this blog entry, I am comparing the insurance policy I am holding now with NTUC Enhanced IncomeShield Basic Plan. It is very obvious which plan is more superior. I am disappointed that the insurance company which I have grown to trust so much is losing its edges, and is not revising its policy to maintain a competitive edge against other insurance companies. 

I would like to urge the AIA management team to re-examine the policy their company is offering their clients. What matters at the end of the day is that their clients can afford quality healthcare services and the insurance company can be proud to claim that they have their clients at heart. It is critical for an insurance company to be willing to go all the way to enhance its reputation as a trustworthy insurance company who values clients as their core mission, rather than profits, because ultimately insurance company is dealing with human's lives. The insurance agents themselves will derive great satisfaction from meeting the real needs of humans rather than selling a package deal for commission, and this itself is a great source of motivation.

May AIA one day rise to the challenge of meeting real human needs rather than being focussed on commission, and may they set the standard which other insurance company will hold up to one day.  

Comparing NTUC latest hospitalization insurance policy with AIA’s

As a cancer patient, I am heavily dependent on health insurance policy. It is unfortunate that I did not buy the health insurance policy that offers the most comprehensive coverage nine years ago, and I did not think about upgrading my policy during those nine years until I was diagnosed with cancer last year. While I was in the US, I had thought of cancelling my hospitalization policy in Singapore since I was already buying health insurance policy in Boston. Fortunately, my insurance agent dissuaded me from doing so.

Even though I am disqualified from upgrading my existing health insurance policy, at least I could still do a comparison and advise my family members which policy offers the best value. In this case, I am interested to compare between NTUC Income Health Insurance policy and AIA Healthshield plan. Both companies offer hospitalization policies which do not carry cash value, and are renewable every year. You are eligible to purchase the policy if you do not have any pre-condition that predisposes you to a critical illness.When buying hospitalization insurance policy, I suggest using three criteria for comparison. First, does it offer sufficient coverage during hospitalization? Second, after discharge from hospital, what kind of coverage is being offered? If I need long-term outpatient treatment, am I being covered? Third, is there a cap as to how much I can claim per policy year and lifetime? If the premiums are affordable, I would suggest looking for policy that covers as much as possible, and ideally the policy should pay as much as you are being charged.

According to NTUC IncomeShield Plan at http://www.income.com.sg/forms/brochure/EIS.pdf, there are three types of hospitalization insurance policies: Preferred, Advantage and Basic. The three types of policy will pay for the full hospitalization charges (minus 10% co-insurance & deductible) at private hospital, government/restructured A ward and below, and government/restructured B1 ward and below respectively. All three policies also pay for the full charges (minus 10% co-insurance & deductible) incurred due to chemotherapy (which is very critical for cancer patient), and other stated out-patient hospital treatment. The limit per policy year is $600,000; $400,000; and $150,000 respectively for each policy. How about the limit per lifetime? There is no limit for each policy. All three policies also offers up to 90 days full post-hospitalization charges.

AIA offers an equivalent hospitalization plan called AIA HealthShield Gold Max and AIA HealthShield Gold Max Essential. The HealthShield Gold Max is comparable to NTUC IncomeShield Preferred Plan. You can find out more details about AIA HealthShield plan at http://www.aia.com.sg/health/hiplans-healthshield-gold-max.html. the difference between HealthShield Gold Max and Gold Max Essential is that the latter policy covers co-insurance and deductibles as well. If you download the brochure, you will see that AIA covers 100 days pre-hospitalization and 100 days post-hospitalization charges. However the limit per policy year for HealthShield Gold Max is up to $500,000 while NTUC Preferred Plan offers up to $600,000 per policy year. This $100,000 difference is crucial if you are in intensive care unit. However, there is no limit for lifetime in the case of HealthShield Gold Max and it covers all charges incurred by out-patient hospital treatment including chemotherapy (remember to minus 10% co-insurance and deductible), which is the same as all the three plans offered by NTUC.

Having compared some elementary differences between AIA and NTUC hospitalization insurance plans, you might think that NTUC insurance plans should cost more than AIA’s. Let’s take a look at the chart below for comparison.

AIA HealthShield Gold Max Premiums

NTUC IncomeShield Premiums

Apparently, if you were to buy NTUC IncomeShield Preferred Plan, you are paying lesser premium than AIA’s equivalent hospitalization insurance plan. If I were looking for new hospitalization insurance policy, my choice is clear: I would prefer NTUC IncomeShield Preferred Plan. Few years ago, AIA used to set the industry standard for insurance plan, ranging from cash-valued policy to term policy. But now, NTUC seems to be setting a new standard for the rest of other insurance company in Singapore. I wish AIA insurance agents could exert pressure on their company’s management team to up their standard again for the benefits of their clients. 

(Disclaimer: I am not an insurance agent, neither do I earn any commission from writing this blog entry).