Saturday, November 27, 2010

Making progress

The good news is that we have made some progress albeit not quite as quickly as we would have liked. Two more cycles (four sessions) to go !

This makes December a busy month. In addition to the bi-weekly chemotherapy (if there are no delays due to neutrophil counts) Prof Wong has scheduled a CT Scan, blood tests and a test for levels of Vitamin D3. The latter is a new one to us and I am curious to know why the interest in Vitamin D3.

When I first mentioned D3 in May/June he was ambivalent about Vitamin D3 supplementation, so we'll see what he has to say about it when the test results come out.

About a month ago, Lin had headaches and was feeling rather nauseous. But we were prepared for this and had the panadol and anti-nausea pills at the ready. But it had not entered our heads that we should have gone to the Cancer Center to have the side effect checked out!

Prof Wong asked if we had come into the hospital and we told him it hadn't occurred to us that it was necessary!

It wasn't as if Lin was feeling dreadful or running a fever - and it seemed like pretty small stuff to bother the hospital about. But now we know - if it ever happens again we will be there.

My guess is that the study of cancer is very much a work in progress and the doctors want to see all the manifestations of side effects in various individuals since no one case is quite the same.

On a related topic, we are still working with BUPA Hong Kong on Lin's health insurance claims; this is taking time because we are dealing with a bureaucracy. 

Admittedly, we had been late with some of the early claims. They have a 90 day window in which claims must be filed and that window evaporates faster than alcohol in the presence of an alcoholic.

The days fast-forward when transplanting ourselves to another country and getting to terms with treatment and all things new in one's life because of the requirements of the illness. Emotionally too it is a fraught time and the last thing on one's mind is sitting down to interpret the arcane demands of the claim forms; and applying oneself to collecting, sorting and collating paperwork and filling in forms.

The last six weeks or so, we have been back and forth trying to sort out what they REALLY need because certified copies will not do (in case we are also making a claim against another insurer). 

Also they want a diagnosis from the Prof which includes details of the treatment; this will also have to substantiate anything else the Prof has had checked out - for example an, investigation of Lin's heart (a detail that first appeared in the pre-surgery report in Hong Kong and then in the report of his CT scan, done here a few months ago).

Dealing with a monolithic organisation is not easy at the best of times and it does not help to have the South China Sea in the way. 

I don't blame the clerk ticking the forms because he or she is going by the book. But at some point his supervisors will need to read all the material and information we sent - copies of the Prof's CV, etc - since they would not know him from Adam.

Also we have to explain Medisave, a component in one's Central Provident Fund which can be used towards approved medical expenses. Otherwise they will invariably interpret it as a contribution from another medical policy!

Sometimes I just wish insurance companies were as genial and prompt in handling claims as they are in selling a policy or receiving renewal payments!

But life could be worse.

Saturday, November 20, 2010

Long Time No See/Hear?

Little things crop up and life gets in the way of this blog, especially when one takes a couple of break in the last month or so.

Bloodwork, no chemotherapy, bloodwork, chemotherapy. That about sums up Lin's main activities of late. The good news being he was able to have his postponed chemotherapy on Thursday (a change from the usual Mondays) and will be going into NUH today to get shot of 'the brick' this afternoon.

He's in fine fettle and this week we had two friends from Hong Kong home to dins on separate occasions. Both said he looks a lot better as a  result of his change of lifestyle (no booze, eating properly - sometimes).

He's had nine holes of golf this week which he needs because he is accustomed to exercise. But it doesn't seem to have helped his expanding girth (at least, that is his complaint).

My suggestion is that he spend time in the club gym to tone all his muscles, not merely the legs and golf muscles.

When we came to Singapore for his adjuvant chemotherapy, the 'gold standard' was our experience with Lin's surgeon and the Baptist Hospital in Hong Kong.

Now that he has been treated at NUH (where I have met up with a few old friends who are also cancer patients) and a friend in Singapore has had her colorectal cancer treated at Singapore General Hospital, my horizons have been broadened.

So to answer a friend who recently asked me where I was going to breathe my last: Singapore. Very simple, thus far I can communicate with healthcare providers in English (until Singlish evolves further away from English) and we do have an excellent public health care system in place.

Hong Kong runs a close second, but there I am a Chinese who doesn't speak much Cantonese and no Mandarin! When one is old and gasping, it's going to be hard to be lucid in an unaccustomed tongue. And my pals will not be in the next beds interpreting for me!

Also, Hong Kong's public health, which is equally excellent, is already stretched in coping with current demand.

I will not comment on private health facilities as I have very limited experience of it in HK and no recent experience of it in Singapore. 

This has not stopped me from being inclined towards public health mainly because I know that the specialists are not going to send me for investigations and procedures to satisfy perceived gaps in information, or to show me they care.

On thing I will remark upon is that our GP in Singapore mentioned that healthcare providers in the USA recognise and accept the results of bloodwork tested in labs. in Singapore, which says quite a lot since most doctors and hospital around the world prefer to re-do the tests when a new patient arrives.

Also, I have read Lin's various test and pathology results from Hong Kong and more recently, I have read those of my friend's scans and various tests, including her pathology report. I have to say that apart from the standard of written English, the ones done at SGH do give more detail (margins, depth of penetration, etc).

I suppose it is like looking at a map that gives an overall picture of the terrain and then at a more detailed map of the same area.

Anyway, I don't know if this is going to be good or bad news for our government; probably a very mixed blessing if many other Singaporeans think as I do. They will have to beef up and increase our medical facilities as the 'silver tsunami' grows and more silver-haired Singaporeans come home to roost.

To Lasik or Not to Lasik?

As I am by nature curious, I asked several friends and relatives about their experiences with spectacles and sight correcting procedures. This was promoted by having to juggle sunglasses, reading and clear distance spectacles. It's purgatory not being able to read a menu!

It can be summed up in this one sentence: "why do you think most prominent eye surgeons/specialists still wear glasses".

By the time Lasik, PRK, Femto-whatsit and so on have been around 75 years I shall be long dead; in the meantime I shall put up with squinting, misplacing my specs. (and phone) and all that comes with relying on spectacles for clear vision.

Medical Tourism

When I was in HK, I tried to entice my pals to visit Singapore. 

One of the pretexts that I suggested they put forward to their husbands is having their annual medical checkups done here. Naturally I was delegated the task of doing further investigation.

So I trotted to various medical tourism sites and then to specific government hospital websites. 

My grouse is that not all the medical tourism websites I visited are up-to-date - which is not good considering how we pride ourselves at being at the leading edge of technology.

As for the hospitals' websites, they vary in quality and presentation. For example, I could not find good pictures of the hospitals in their settings - which would give visitors a good impression.

For example the brand new Khoo Teck Puat Hospital which is lauded for being in a garden-like setting seems to have only one small picture (the rest are indoors and of various dignitaries) and I am not sure if it is of an artist's impression or model (blame my eyesight if I am wrong!).

Mind you I just went back to their website and could not locate that picture - there is a nice one, however, of their shuttle bus. 

I lie, I lie! - I checked out their newsletters and their current issue has the new hospital in all its glory on the cover. I am now going to try to reproduce it for you.

I would have loved photos of the KTP hospital and gardens to send on. Tan Tock Seng Hospital is not bad looking either.

NUH is in a state of flux as it is being upgraded and a new block is being constructed so it has excuses for not being portrayed on the screen.

However when it comes to the information on the health screening or wellness packages, there really is no excuse for the paucity of information and the inelegance of their web page(s).

Tan Tock Seng's website sets out their checkups best but even then you have to sidestep their blurb about corporate packages to get to individual men's and women's health screening packages.

If I did not know where to go and had to choose on the basis of their websites, I would pick Tan Tock Seng Hospital. And my thirst for more information about KTPH would be left unslaked unless I emailed them for information.