Apicoectomy

I went to Dr. Andrew Johnson's office in Covington for an appointment last week and today he took the cyst/infection out. It took only like 30 minutes for him to do that and I was loopy the whole time. Right now I don't feel any pain at all and hopefully the problem with my ears will start to go away along with the removal of the infection on my tooth.

They gave me 3 kinds of medications; steroids, antibiotics and pain killers.

The doctor decided not to do the bone graft and it costs us $275 for the surgery. The insurance covers 80% of the rest.

Flu Shot

Today I got my flu shot for this year. It was given to me by my company's (MultiCare) employee health nurse, at no charge.

MRI Results

I went back to the neurologist today for my follow-up appointment. She told me my MRI results came back good; nothing notably wrong... only a bit of slight arthritis in my neck, which might explain why it often feels stiff for me. Brain looked normal. No sign of why I'm having headaches...

She talked to me about some options for medication for the headaches, primarily Topamax. It's a preventative med for headaches, meaning i would take it on a steady routine to help prevent them, instead of taking them only when headaches occur. It sounds like it might be a good way to go, but she explained a few of the side effects that may occur: tingling of fingertips, inability to focus at times, possible depression...etc. I didn't fill the prescription, because now that I know that nothing is seriously wrong with my head, I'm confident that it will feel more at ease in the coming months without medication, especially when Dian is finally with me.

I'm just going to talk with Dian about it first before deciding anything...

Cold

I woke up today with a cold. Stuffed up sinuses, headache, fatigue, sore throat, etc. Felt them coming on over the previous day or two. I slept for quite awhile last night... maybe 11 hours. I've been blowing my nose constantly today. My head is full of icky crap, but it's coming out. Napped for a couple hours today. Took a few cough drops, and Tylenol Cough & Sore Throat liquid medicine at night.

MRI Day

Today I went to Cascade Imaging (Auburn, WA) to have Brain and Neck (Cervical Spine) MRIs.

The MRIs went fine. It was an interesting experience, especially since I've never had an MRI done before. They gave me earplugs and slid me into the machine, where I had to lay still for about an hour and twenty minutes or so. They took many separate tests, each a few minutes long. And after the first forty minutes, they pulled me back out and shot me with contrast (gadolinium). This is an agent that goes into my veins to help them get a better visualization of my insides, from what I understand. After the shot, I began to feel a bit nauseous. They had me smell a tiny cloth with alcohol, and gave me a couple sips of water. That helped... Then I went back into the machine for another twenty-plus minutes of tests. After that, I was done.

Being slightly claustrophobic, the MRI wasn't as bad as I was expecting. I'm anxious to get the results, which should be within the next week.

Second HPV Vaccine

Today (10/14) I got my second HPV vaccine by dr. May Hizrani at MMC Hospital. My third and last HPV shot would be in March 2009.

Cervarix vaccine - Rp1,332,210.
Medical service (doctor) - Rp100,000.

Life In Mono

The blood test from after my neurology appointment said I'm positive for mononucleosis (commonly called "mono"). So I called my primary doctor this morning and made an appointment to get checked out. He said it's a mild case of it since I don't show many of the common symptoms of it, aside from fatigue and headaches. He finds it odd that I've had it before (when I was 17), and have it again now at 29. It's fairly rare for that to happen apparently...

He suggested to get plenty of rest and to not overexert myself for a couple weeks, and that I should start feeling better within two weeks or so. If I'm not feeling back to normal in four weeks, or notice that the headaches are getting worse, I should see him again. Aside from that, it should go away on its own.

He gave me a prescription for my headaches (Butalbital).

In the meantime, I should be hearing soon from Cascade Imaging, who will be scheduling my Brain and Neck MRIs...

Refill

I bought a refill to my liver and cholesterol medicine for the next month.

Becombion Forte Tab - Rp18,000
Lesichol 300mg Cap - Rp255,000
Simvastatin 20mg Tab - Rp20,250

My Last Hep A Shot

On lunch break today I got my second and last Hepatitis A shot by Dr. May Hizrani at MMC Hospital.

Medical Service - Rp100,000.
Havrix II vaccine - Rp572,047.

Migraine # 3

This morning I had a banana, a couple vanilla cream cookies, and a small handfull of goldfish crackers at work. At about 11:30a, my vision began to appear slightly "wavy" with little bright zig-zag spots, and I began to feel extremely tired. Even more so than usual. The headache began...

By 12:30p, the headache had only gotten worse. At that time, I had been feeling light-headed and slightly nauseous, as well as experiencing some hot flashes. It was already a migraine.

At about 1:00p - during our staff meeting - I decided to go downstairs and check into our facility's Urgent Care center. There, I explained everything to the doctor. She seemed concerned about my fatigue, low testosterone and cholesterol. She also asked me if I spend a lot of time using computers, which of course I do. She suggested I talk more with my regular doctor about my fatigue, etc, and that I might want to consider a head scan. Since I already have an appointment with a nuerologist on Wednesday, I have decided to ask them for one. In the meantime, the UCC doctor shot me in my ass with something to cut down the pain. Then she prescribed me Imitrex for future migraines.

After coming home after the check-up, I took an Imitrex pill, which helped the remaining head pain. Then I napped for a couple hours, and have felt better since.

Healthy Liver Care

Healthy Liver Diet, What foods are good for the liver

1. To have a healthy liver you have to have a healthy life style, moderate exercises, nourishing diet, avoiding food in unhygienic conditions to avoid illness like viral hepatitis or jaundice.
2. Alcohol is injurious to liver and is responsible for a condition called fatty liver in young adults so complete avoidance of alcohol is mandatory for a healthy liver.
3. As liver helps in excretion of drugs, long term intake of medicines like pain killers can be injurious to liver and so over the counter medicines without prescription from doctors should be avoided.

Home Remedies for a healthy live, Natural Liver Cleansing

1. Mix 20ml of juice extract of fresh margosa leaves and 20ml of pure honey. To this mixture add 3gms of black pepper powder and stir well. Take in equal doses in the mornings and evenings.
2. Mix 2 teaspoons of fresh lemon juice and 1 teaspoon crushed onion juice and take this mixture on empty stomach in the morning at least for three months.
3. Sugarcane juice should be taken for nutrition of liver and general health. Barley water should be taken by diabetic patients.
4. Add 10gms of pure turmeric powder to 50gms of yogurt and mix well and divide into equal parts. Drink one part in the morning and another in the evening.

Vaccination Record

Polio / IPV:

1. 12/10/79
2. 01/14/80
3. 02/15/80
4. 01/25/82

DTP (Diphtheria, Tetanus & Pertussis):

1. 12/10/79
2. 01/14/80
3. 02/15/80
4. 02/11/81

MMR (Measles, Mumps & Rubella):

1. 02/11/81

TB Tine:

1. 08/15/80

Typhoid:

1. 07/16/07

Hepatitis A:

1. 07/16/07
2. 01/22/08

Hepatitis B:

1. 08/15/08
2. 09/15/08

==================================
I have also had some others in the past, most notably Tetanus in 2003 I believe it was. I am still in the process of tracking down more of my past immunization records. These are all I have recorded to date...

Blood Pressure

How To Keep It In Control

There are number of people across the world who suffer from high blood pressure also called hypertension. It is easy to keep hypertension under control by following a few simple guidelines that we will discuss below:

1. LIMITED ALCOHOL CONSUMPTION: High consumption of alcohol affects high blood pressure. As per the Doctors studies it has been proved that those who do not drink or drink small amount of alcohol suffer less from high blood pressure than those who drink higher amount of alcohol.

2. TAKE CALCIUM: Consumption of calcium through normal diet seems to have a positive effect in controlling hypertension on some people. In other words calcium is generally good for people having high blood pressure.

3. BE VEGETARIAN: Vegetarians have been shown to have lower blood pressure than those who are non vegetarian. SO being a vegetarian may not be such a bad idea.

4. REGULAR WEIGHT CHECK: An obese person suffers more from hypertension than people having normal weight. If an obese person reduces a few kilos, they can achieve a near normal blood pressure even though they are still somewhat fat.

5. ADD POTASSIUM: Addition of the mineral potassium either through regular diet or through supplements may be valuable in controlling high blood pressure. Studies have show that maintaining a correct balance of the minerals sodium and potassium in your diet can help regulate hypertension.

6. CUT DOWN ON SALT: People should generally consume less salt in their diet. A little cut on the salt intake may produce a good effect on hypertension.

7. TRY AEROBICS AND AVOID ISOMETRICS: Studies have shown that aerobic exercise has a better effect on high blood pressure as compared to isometrics exercises such as weight lifting. Even including moderate amounts of swimming and walking into your exercise routine can be beneficial for hyper tension.

8. MEASURE YOUR BLOOD PRESSURE: People should take steps to regularly check their blood pressure at home. It provides feedback about how your diet, exercise and medication are affecting your blood pressure.

9. DON’T TALK MUCH: Arguing and fighting with people can leads to high blood pressure. So by being calm and quiet and talking less, you can improve your blood pressure.

10. CHECK YOUR SPOUSE’S PRESSURE, TOO: It is must for the people suffering from high blood pressure to check their spouse’s blood pressure because of their shared stress or other emotional factors. It is seen that the longer two people are married, the more similar their blood pressure readings become.

11. JUST BE HAPPY: Your emotions and health go hand in hand. Especially when it comes to hypertension. So leading a happy life can reduce high blood pressure.

Beating the Vaginal Infection

I went to the Ob/Gyn again today cause based on the pap smear result two weeks ago it said that I've had an infection from bacteria in my cervical area. She gave me prescription for Dalacin C Clindamycin 300 mg. I'm going to be taking them twice a day for a week and hopefully the infection will go away for good.

And then so long to vaginal discharge.

Antibiotics - Rp213,791.

New Vaccine Fights Breast Cancer Tumors

DNA Vaccination Kills Herceptin-Resistant Breast Tumors
By Daniel J. DeNoon
WebMD Health News

Sept. 15, 2008 -- An experimental breast cancer vaccine makes mice reject tumors -- even cancers no longer sensitive to Herceptin.

The vaccine targets breast cancers that grow wildly in response to a growth factor called HER-2. About 25% of women with breast cancer have HER-2 positive tumors.

Herceptin, a man-made antibody approved for the treatment of breast cancer, targets these cancers. But after a while, tumor cells often become resistant to Herceptin.

The new vaccine elicits immune responses that kill HER-2 positive breast tumors in mice, whether or not they've become Herceptin resistant, says Wei-Zen Wei, PhD, professor of immunology at Detroit's Karmanos Cancer Institute.

"Regardless of whether tumor cells are resistant, if immune cells are properly primed by immunization we can destroy these cells," Wei tells WebMD.

The vaccine developed by Wei's team uses DNA that carries the genetic code for a key piece of the HER-2 molecule. After injection of the DNA into the skin, a small electric pulse is administered to help cells take up the DNA and produce the protein that elicits immune responses.

Mice given the vaccine made anti-HER-2 antibodies. The vaccine also primed cellular immune responses that attacked breast cancer tumors. These cellular responses alone were enough to kill HER-2 positive cells in mice unable to make antibodies.

A version of the vaccine is now undergoing human safety tests.

Last April, a different HER-2 vaccine made headlines when it halved the number of deaths in women with HER-2 positive breast cancer. The vaccine also slowed breast cancer recurrence.

However, researchers at San Antonio's Brooke Army Medical Center found that 26 months after vaccination, there was no significant difference in cancer recurrence between vaccinated and unvaccinated women.

Gary Yang, MD, associate professor of radiation medicine at Roswell Park Cancer Institute in Buffalo, N.Y., says these human studies are a major step forward.

"These studies accomplished a lot -- but we need to find out why the immune system cannot sustain this efficacy," Yang tells WebMD.

Yang says that is why Wei's team's work is so important. What's learned in the lab must be tested in patients -- and then more lab work is needed to answer questions raised by human studies.

"The clinical research into breast cancer vaccines is not going to be a home run," he says.

Wei is convinced that in the long run, vaccines will prove to be powerful cancer treatments.

"Ultimately, we will be using the best defense we have to fight cancer -- the human immune system," she says. "It is a very challenging thing to do. We hope we have reached a point where we can make it useful to patients."

Wei and colleagues report their findings in the Sept. 15 issue of Cancer Research.

I'm A Rockstar!

After feeling quite tired this morning after a usual night's sleep, I decided to try a Rockstar Energy Drink with lunch. It turns out that I felt productive this afternoon. The drink seemed to really boost my energy levels, and I felt much better. However, I don't want to get in the habit of having energy drinks often.

Chronic Hepatitis Nutrition

What Should I Eat?

By Charles Daniel
Updated: September 8, 2008
Health's Disease and Condition content is reviewed by Susan Olender, MD

What should someone with chronic hepatitis eat? This is a common concern and the answer may surprise you. There's no single recommended diet -- because there's not much difference between a healthful diet for someone with chronic hepatitis and someone without! Even though several books and websites suggests otherwise, there are only guiding principles that you should understand. With these principles, you and your physician can develop a diet that gives your body the nutrition it needs without putting additional stress on your liver.

We all have very similar nutritional needs, whether we have chronic hepatitis, or not. These only change for people with decompensated cirrhosis, which is such extensive scarring (fibrosis) that the liver can't function properly. Distinguishing whether a person with chronic hepatitis has cirrhosis and the stage of their cirrhosis determines how much attention he or she should pay to a special diet.

Make Sure You're Eating...

Enough calories. Anorexia is a symptom associated with advanced cirrhosis that can make it difficult for someone to get enough calories. Usually, this only lasts a short period of time, brief enough for your body to get by on its reserves. However, if it lasts for several days or weeks, you probably aren't getting the nutrition you need. One solution is to discuss with your physician whether you're getting enough food or enough of the right foods.

The right amount of protein. Meats, milk, nuts and cheese are all good sources of protein. Protein is an important nutrient and it's absolutely necessary for good health. People with chronic hepatitis should be able to enjoy moderate amounts of protein without worry. As long as your liver is working properly, protein shouldn't be a problem. However, too much protein is bad for people with advanced cirrhosis and can lead to brain disease as the excess protein accumulates in the blood. Again, the liver is responsible for keeping protein at safe levels, but when the liver is damaged as is the case with decompensated cirrhosis, it can't do as much as it did before. While it's important to eat enough protein, too much is harmful. Talk with your doctor to determine what's the best amount of protein for you.

Enough vitamins and minerals. Some people with chronic hepatitis, especially those with alcoholic hepatitis or advanced cirrhosis, may not be getting enough of the fat-soluble vitamins and necessary minerals they need through their diet. Your doctor or nutritionist may measure your levels of vitamins A, D and E to check your clotting time. One solution to this deficiency is using doctor-prescribed supplements. Otherwise you'll need to make certain you get these vitamins and minerals the old-fashioned way: through a balanced diet.

Prepare Meals with Your Liver In Mind

Low-fat meals. The liver is an incredibly important organ to your body. It's involved with many aspects of nutrition. One important function of the liver is to produce bile, which the body uses to emulsify dietary fats, such as from potato chips or hamburgers. Before the body can absorb the fats and use their nutritional energy, all fats must be prepared by this process. However, depending on the damage to your liver, you might not be able to prepare enough bile to handle a meal high in fats. As a result, you might suffer indigestion because of the undigested fat. One solution is just to eat low-fat foods. An alternative is to eat very small amounts of a high-fat food.

Small meals. Because your liver is damaged, it isn't able to store as much energy as it once could. One of the jobs of the liver is to store the chemical glycogen, which it can quickly give back to the body when it needs immediate energy. Most people can store relatively large amounts of glycogen in their livers, but when the liver is damaged with fibrosis, the scar tissue takes away valuable storage space for glycogen. This explains one reason why people with chronic liver disease often get tired quickly. One solution is to eat small, frequent meals making sure to include carbohydrates. This gives your body the chance to replace its glycogen reserves.

Protect Your Liver

The liver is such a powerful filtering organ. Every five minutes, your entire blood supply is filtered through it. As blood filters through, the liver removes the toxins (anything poisonous to your body). The liver has an amazing capacity to keep doing its job even while damaged, but eventually too much damage will reduce liver function. Therefore, it's in your best interest to reduce toxins to your liver. Here's some common toxins to the liver:

* Alcohol. People with chronic hepatitis should avoid alcohol since it speeds progression to cirrhosis. People with cirrhosis should absolutely avoid alcohol.
* Unnecessary medicines. Even though medicines are beneficial, they are still toxic chemicals that must be processed by your liver. It's important to follow your doctor's advice and take the medicines that you need and avoid the ones that you don't. Check with your doctor before taking a medicine if you have liver disease.
* Pesticides and herbicides. Though these can absorb through your skin, they are still toxins ultimately processed by the liver.
* Household chemicals. We use chemicals daily, sometimes without a second thought. People with chronic hepatitis should take extra caution to reduce exposure of these through fumes, ingestion and skin absorption.
* Vitamins and supplements. Some vitamins (K, A, D and E) are very important and necessary for people with chronic hepatitis and many doctors will prescribe vitamin supplements. However, aside from physician-recommended vitamins, use caution with additional supplements because they may be toxins.
* Tobacco products
* Recreational drugs

Remember the Basics

Healthful foods. Your body needs good nutrition whether you have chronic hepatitis or not. To achieve good nutrition means that you're getting the nutrients you need (vitamins, minerals, protein, fat, carbohydrates, fiber) from the foods you eat. The quality and types of foods are important: fresh fruits and vegetables, lean meats (chicken, turkey, pork) and whole grains (barley, brown rice, whole wheat breads and oat meal).

Exercise. Along with nutrition, exercise is an essential part of good health. Some of the common symptoms associated with chronic hepatitis in the setting of no cirrhosis or cirrhosis that isn't too advanced, such as fatigue or depressed mood, may be improved with regular, moderate exercise. You should begin any exercise program gradually and, depending on your level of health, under a physician's guidance. Most exercise, however small the amount, is very beneficial to your health and well-being. It is an excellent complement to good nutrition.

---
Charles Daniel is a hepatitis advocate writing about hepatitis and its many aspects, specifically how this disease affects people and their communities.

Shot Info

Went in and got my second Hep B shot today. Everything went smoothly. Hep B shot #3 due on 02/15/09...

Pap Smear Result & HPV Shot

Today I got my pap smear result. It says negative for abnormal/malignant cells. But I'm suggested to get periodical smears.

Exactly a week ago, at the 6th of September, I got my first pap smear by Dr. Kencana Shinta, SpOG in MMC Hospital, and based on the result today, she gave me a go for HPV vaccine. So I got my first HPV vaccine today by dr. Endah.

First HPV shot and pap smear - Rp1,500,000.

Headache Diary

Splitting headache this evening:

For lunch, I ate a grilled chicken salad from Dairy Queen. Also had three pieces of sausage with saltines. Drank milk throughout the day.

Headache seemed to get better after taking two aspirin...

Lab Result

Clinical Chemistry
Liver Function
Total Protein: 7.8 g/dl
Albumin: 5.0 g/dl
Globulin: 2.8 g/dl
Total Bilirubin: 0.47 mg/dl
Direct Bilirubin: 0.15 mg/dl
Indirect Bilirubin: 0.32 mg/dl
Alkali Phospatase: 59 U/L
SGOT: 19 U/L
SGPT: 20 U/L
Gamma GT: 26 U/L

Renal Function
Uric Acid: 4.4 mg/dl

Serology/Immunology
Liver
HBsAg: Positive
S/CO: 120.0
Cut off: 10.8

Anti HBs: Negative miU/ml

Medical Check Up

Got my medical check up in Medikaloka today for the embassy requirement.

More details of the examination

Dr. Gunawan Kosasih - Type Adult USA Visa - Rp526,000
DT (0.5cc) - Rp31,000
Vaxigrip - Rp172,000
Laboratory - Rp484,000

Toxoid

I got Tetanus (Toxoid) vaccine today by dr. Raharjo.

Medical service - Rp100,000
Toxoid vaccine - Rp19,857

MMR and Polio Shots

To fulfill the embassy's requirement and since it's impossible for me to acquire my old immunizations records, I got MMR (Mumps, Measles, Rubella) and Polio vaccines today by Dr. Cornelia Jaqualina.

Medical service - Rp100,000
MMR and Polio vaccines - Rp119,687

Second Consultation with the Liver Specialist

After having two days off to let my foot healed, I went to see Prof. Dr. Sjaifoellah Noer again for consultation. I was supposed to see him Tuesday (08/26) when I got foot hurt. I waited three hours this time.

He said I didn't need any treatment right now since the hep B virus is inactive. So he gave me a prescription of Becombion (multivitamin), Lesichol 300 (for my liver) and Simvastatin (for my cholesterol) for two months. He also told me to get another blood test in two months time, a day before my next appointment with him.

I'd need to get a periodical blood test from now on to know if/when the virus attacks my liver. But for now, I just need to take the multivitamins and the prescription drugs.

Medical service - Rp280,000
Medication (for a month) - Rp320,364.

Hep A Shot & X-Ray

This morning a car ran into my right ankle and bruised it. I first thought it was only a minor bruise, on lunch break I could still walk to get a cab to MMC to get my lab results and to get my first hep A shot. While I was there I also asked for an X-Ray for my ankle. The doc said there was nothing wrong with my ankle bones. But at about 3 pm I realized my right ankle swelled up and I couldn't walk. There must have been something wrong with the muscles and/or tendons. Great, this is just all I need when I could have been getting everything else done. Fortunately that night I had someone (tukang urut) to correct all the wrong tendons so I'd let my foot heal in the next day or two.

Though, my life had to stop for awhile.

Lab result:
Routine Hematology
Hemoglobin: 12.0 g/dL
Hematocrite: 39.7%
Eritrosit: 4.16
Trombosit: 359
Leukocyte: 5.91

Erythrocyte sedimentation rate (ESR): 26 mm (H)

Kimia Darah
Total bilirubin: 1.03 mg/dL (H)
Direct bilirubin: 0.11 mg/dL
Indirect bilirubin: 0.92 mg/dL (H)
Alkali Phosphatase: 108 U/L
SGOT: 21 U/L
SGPT: 25 U/L
Gamma GT (GGT): 25 U/L
Ureum: 16 mg/dL
Kreatinin: 0.86 mg/dL
Uric Acid: 3.78 mg/dL
Triglyceride: 85 mg/dL
Total cholesterol: 216 mg/dL (H)
HDL cholesterol (direct): 58 mg/dL
LDL cholesterol (direct): 140 mg/dL (H)

Glucose (fasting): 91 mg/dL
Urine Glucose (fasting): negative (<100 br="br" dl="dl" mg="mg">
Blood Glucose 2 hr PP: 98 mg/dL
Urine Glucose 2 hr PP: negative (<100 br="br" dl="dl" mg="mg">
X-Ray - Rp117,00
Medical service - Rp100,000
Hep A shot - Rp568,019.

I should get my second and last hep A shot next month.

Lab Work and Ultrasound

I took a day off to get my blood test and ultrasound today. I got to the MMC at 9 am to get my blood and urine test after fasting for 12 hours and then I'd have another one after I ate.

Later this evening I got an ultrasound by the professor himself at the Mitra International hospital after fasting for 5 hours. The ultrasound result came out right after and it looked promising. He said there were no apparent damages to my liver and other organs.

I also showed him my hep A & C results and he suggested that I get a hep A vaccine as soon as possible. There is no hep C vaccine yet so I'll be getting a hep A shot tomorrow.

Lab work - Rp713,500
Ultrasound - Rp623,000.

Shot Info

I received my first shot in a series of three for Hep B today. Shot #2 is scheduled for next month (09/15/08). I'm looking forward to completing the series. I had previously assumed I had the Hep B vaccine years ago, but upon closer inspection of my immunization records, realized I may never have. Better to be safe than sorry...

Negative for Hep A and C

The result for my hep A & C came out.

Anti HAV total: 1.56 S/CO (non reactive)
Reference value: Non reactive: 1.001 - 3.000; Reactive: <= 1.000

Anti HCV total: 0.28 S/CO (non reactive)
Reference value: Non reactive: < 0.99; Reactive: >= 1.00

I was prepared for the worst but now I can breathe a sigh of relieve. At least I don't have hep A and/or C. I'm determined to get the hep A shot as soon as possible.

Consultation with the Liver Specialist

I went to MMC (again) later in the evening to see the liver specialist, Prof. Dr. Sjaifoellah Noer. I waited a solid two hours before it was finally my turn to see him. He asked me a few questions about my medical history and took a thorough look at my lab results. To be able to diagnosed me more accurately, basically he wanted me to get hep A and C checked as well later that night, he wrote a prescription of Becombion and Methycol for me to take for two weeks, and then I'd need to get an ultra sound of my liver in Mitra International hospital in the east Jakarta and a thorough lab work one day before my next appointment with him.

Medical service - Rp280,000
Medicine - Rp33,847
Lab work for hep A and C - Rp448,500.