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Friday, February 25, 2011

Post bypass Surgery Physiotherapy


Post bypass Surgery Physiotherapy
It is natural to feel tired and in pain, have occasional nightmares, loss of taste bud and appetite, after a cardiac surgery. It is hard to believe when the Doctor advised patients to begin physiotherapy immediately after the surgery rather than allowing a period of rest. The physiotherapy treatment during the hospital stay however consists of early mobilization, range of motion exercises and breathing exercises.
Before being discharged from IJN, its Physiotherapy and Rehabilitation Department prescribed a programmed in order to help me to go back to “most” of my original lifestyle as early as is possible.
With the correct exercises, I hope to become healthier than what I was before the cardiac surgery. The programme will help prevent or diminish postoperative complications and alleviate symptoms of cardiac diseases like chest pains, artery diseases, heart failures or cardiac arrests.
My physiotherapy and rehab programme (eight biweekly sessions) commences at IJN on 14 Feb 2011, about a month after my surgery. I have reserved Mondays and Wednesdays in my weekly schedule especially for this programme.
Upon registration for my first session, a stress test was administered to determine my fitness level i.e. my capacity for exercise and also to set on the target I would like to achieve at the end of this rehab programme. Based on this information, the physiotherapist was able to sketch out the routine for my physical therapy.
It is comforting for patients “like me” to perform the initial exercises in the presence of physiotherapist. I also observe that the subsequent sessions are also conducted under the vigilance of hospital staff to ensure the medical safety of the patient. In case there is any discomfort while performing these exercises, the medical personnel can immediately take over and manage the situation.
These exercises involve similar cardiovascular exercises as the first test session, like walking the treadmill and stationary bike, group aerobic, warming up, stretching etc. For each of the activity, the physiotherapist or assistance keeps a track and record the person's vital signs. This tracked data is collated and analyzed.
The workout was fun since it was conducted in a group and accompanied by suitable rhythmic music. Indeed, group participation supported by the professional and charming staffs and “friends of IJN” help sustain “my interest” in the exercise program. Oh yes, I do need strong motivating force since exercising has never been in my blood.
Unless we are facing severe complications, we are encouraged to continue with the exercise in the privacy of our homes three to five times weekly. Hey.. you.. couch potato.. stop warming your couch…yup I am addressing this to “yours truly”!
The progress of my physiotherapy treatment would help determine if I am allowed to include other activities in my routine. Generally, I was made to understand that it is possible for the patient to gradually perform all normal activities after the third month.
I have thus far achieved my target to have my weight at 73kg BMI. Hooray. The problem is that I have to new sets of clothing or settle with those I used in the seventies and eighties - that is if I still have them. Nonetheless, I am very pleased with my achievement. Without physiotherapy, I believe, a cardiac patient will remain weak and may even grow weaker.
As part of the rehab programme, we are required to participate in a one-hour nutrition workshop on Malaysia’s number one killer – heart disease – focusing on modifiable and non-modifiable risk factors. The workshop was very educational and informative. I hope this simple workshop should be made available to all Malaysian to help them CHANGE their lifestyle FOR THE BETTER through healthy diet, regular exercise, and stop smoking.
We should put this prevention strategy in a wider sense higher up the health care agenda of Malaysia in order to promote policies that will lead to long-term health improvements. Needless to say the objective of these policies is to encourage better diet and lifestyles which are key to the prevention of so many chronic diseases including the heart disease.  

Monday, February 14, 2011

Feel it, Live it & Enjoy it.

Feel it, Live it & Enjoy it.
What a splendid coincidence with my earlier posting as I received today a nice email from another good friend, Ambassador Ibrahim Benaouda Haci. I am happy to share the thoughtful reminder from Shakespeare with myfellow readers:

Shakespeare said:

I always feel happy, You know why?
Because I don't expect anything from anyone,
Expectations always hurt.. Life is short.. So love your life..
Be happy.. And Keep smiling.. Just Live for yourself and ...

Before you speak » Listen
Before you write » Think
Before you spend » Earn
Before you pray »   Forgive 
 
Before you hurt »   Feel
Before you hate »   Love
Before you quit »   Try
Before you die »     Live

That's Life...Feel it, Live it & Enjoy it.

Tuesday, February 8, 2011

To celebrate growing older

I am pleased to share hereunder what my good friend Ambassador Dr. Fawzi MY El Mashni emailed today: 

"To celebrate growing older:

1. Life isn't fair, but it's still good.
2. When in doubt, just take the next small step. 
3. Life is too short to waste time hating anyone. 
4. Your job won't take care of you when you are sick. Your friends and parents will. Stay in touch. 
5. Pay off your credit cards every month. 
6. You don't have to win every argument. Agree to disagree. 
7. Cry with someone. It's more healing than crying alone. 
8. It's OK to get angry with God. He can take it. 
9. Save for retirement starting with your first pay check. 
10. When it comes to chocolate, resistance is futile. 
11. Make peace with your past so it won't screw up the present. 
12. It's OK to let your children see you cry. 
13. Don't compare your life to others. You have no idea what their journey is all about. 
14. If a relationship has to be a secret, you shouldn't be in it. 
15. Everything can change in the blink of an eye. But don't worry; God never blinks. 
16.. Take a deep breath. It calms the mind. 
17. Get rid of anything that isn't useful, beautiful or joyful. 
18. Whatever doesn't kill you really does make you stronger.
19. It's never too late to have a happy childhood. But the second one is up to you and no one else . 
20. When it comes to going after what you love in life, don't take no for an answer. 
21. Burn the candles, use the nice sheets, wear the fancy lingerie. Don't save it for a special occasion. Today is special. 
22. Over prepare, then go with the flow. 
23. Be eccentric now. Don't wait for old age to wear purple. 
24. The most important sex organ is the brain. 
25. No one is in charge of your happiness but you. 
26. Frame every so-called disaster with these words 'In five years, will this matter?' 
27. Always choose life. 
28. Forgive everyone everything. 
29. What other people think of you is none of your business. 
30. Time heals almost everything. Give time time. 
31. However good or bad a situation is, it will change. 
32. Don't take yourself so seriously. No one else does. 
33. Believe in miracles.
34. God loves you because of who God is, not because of anything you did or didn't do. 
35. Don't audit life. Show up and make the most of it now. 
36. Growing old beats the alternative -- dying young. 
37. Your children get only one childhood. 
38. All that truly matters in the end is that you loved. 
39. Get outside every day. Miracles are waiting everywhere. 
40. If we all threw our problems in a pile and saw everyone else's, we'd grab ours back. 
41. Envy is a waste of time. You already have all you need. 
42. The best is yet to come...
43. No matter how you feel, get up, dress up and show up. 
44. Yield. 
45. Life isn't tied with a bow, but it's still a gift."

Wednesday, February 2, 2011

Health is Wealth


The Importance of Health
Awal tahun baru 2011 merupakan tahun yang amat bersejarah bagi saya dan keluarga. Pada 11hb. January saya telah menjalani pembedahan jantung quadruple bypass.
Saya berada 20 hari di  IJN mulai 4hb kerana asalnya untuk angiogram. Datuk Dr Azahari yang menjalankan prosedure itu pada 5hb telah medapati beberapa saluran darah ke jantung saya tersumbat dan terus mencadangkan pembedahan bypass.
Selama 35 tahun saya berkhidmat dengan kerajaan saya tidak pernah sakit dan dimasukkan ke ward hospital walau sehari pun. Kini saya baru bersara 1 tahun 5 bulan sudah pun menjalani pembedahan besar. Begitulah perubahan perjalanan kehidupan manusia yang sewajarnya kita boleh membuat pengajaran. Bahawasanya kesihatan itu amat penting demi kesejahteraan hidup yang produktif.
Kakitangan kerajaan diberi kemudahan lengkap perubatan dan pemeriksaan kesihatan berkala yang patut dilunaskan sepenuhnya demi mewujudkan tenagakerja yang sihat, cergas lagi produktif. Alhamdulillah, Malaysia adalah sabuah negara yang mempunyai perkhidmatan kesihatan dan industri perubatan yang standing dengan negara maju lagi membanggakan.   
Sympton Serangan Jantung
Symptom serangan jantung datang dalam berbagai rupa. Jangan ambil ringan atau tidak mengindahkannya langsung. Berusahalah untuk mengenalinya dan mendapat rawatan perubatan serta merta. Ia boleh mengurangkan masaalah kesihatan yang lebih serious.
Saya sendiri baharu sedar bahawasanya saya telah mengalami beberapa serangan kecil jantung sejak tiga tahun kebelakangan sebelum serangan serious pada November 2010.
Shortness of breath after a long walk or going up the staircase, after streaneous exercise, or due to extraordinary excitement, are just some of the symptoms. Do not be deceived by the the fact that you will recover and regain your breath after taking a short rest. The fact that you have experienced it was sufficient to trigger an immediate professional medical consultation to verify your true condition – i.e. to establish whether it was a heart attack or not. Your medical background – stressful work and lifestyle, family history, cholesterol, diabetic, blood pressure, etc. will be factored in the analysis.
Never take these warnings or signals lightly. Or you will never have this warning again.
I would like to underscore the benefit of having regular check-up and health screening as an important part of living healthy for the following reasons:-
  • Early detection of diseases is one of the great benefits of health screenings. It was pointed out that that 30 percent of heart attack victims do not make it to hospital on time. This could be prevented by getting screenings.
  • Certain diseases such as diabetes and high blood pressure do not exhibit symptoms until there is a major problem. By detecting these conditions early, doctors are better able to use preventative measures and treatments to avoid these conditions.
  • Scheduling regular health screenings allows people to develop a relationship with their doctor. These check-ups also allow people to learn more about warning signs that may signal a dangerous situation.
The Surgery
Pembedahan mengambil masa lebih dari lima jam. Team di ketuai oleh pakar bedah kardiologi Mr. Jeswant Dillon. Saya tidak merasai apa-apa kesakitan kerana telah di beri General Anasthetic. Sebahagian dari urat kaki kanan saya telah di harvest untuk mengganti empat saluran ke jantung yang telah tersumbat.
Post Surgery
Saya di masukkan ke HDU (High Dependency Unit) selepas pembedahan untuk proses pemulihan awal.  Selama 6 hari disini, saya mendapat pemerhatian rapi perubatan 24 jam.
In HDU, I was kept under close observation for post surgery internal bleeding, cardiac arrest, stroke and infection may occur. I have wires attached to my body in order to observe the pace of the heart. A tube is also connected to drain fluids from the chest. A pacemaker is attached to the wires to regularise my heartbeat.
Selama enam hari di HDU, saya telah memerhatikan bagaimana intense unit ini di selenggarakan dan betapa staffnya bertungkus lumus menjalan tugas dengan cekap lagi professional. Pun begitu bukan senang untuk menangangani kerenah setiap pesakit yang pelbagai ragam.
Ada pesakit yang hilang kawalan diri dan meludah merata-rata; ada yang mengalami sesak nafas sebab ghahak (flams) yang tidak habis disedut/dibuang; ada yang hilang daya makan sehingga melemahkan dayatahan untuk pulih; ada yang mengalami complication buah pinggang, dan anggota badan lain berikutan pembedahan; dan sebagainya. Masing-masing pesakit bertindak mengikut keadaan dan keupayaan menahan kesakitan mereka.   
Sehubungan itu saya ingin cadangkan perkara berikut:
  • HDU mengasingkan dibilek isolation setiap pesakit yang bermasalah – yang menganggu proses baikpulih pesakit lain yang ingin berehat terutama pada malamhari.
  • Supaya pihak JAKIM/Majlis Ugama Islam Wilayah Persekutuan menempatkan seorang pegaai ugama untuk membantu pesakit dan keluarga pesakit mengenai isu-isu berkaitan solat, tayamum bagi pesakit. Setidak-tidaknya JAKIM meletakkan brochures menerangkan perkara tersebut.
  • Supaya IJN memasukan makanan Jepun seperti shushi kedalam menu makanan sebagai pilihan tambahan kepada pesakit.   
Selepas itu saya di bawa ke ward biasa dimana rawatan perubatan, rehabilitation dan physiotherapy diteruskan sehingga saya dibenarkan keluar pada Isnin 24hb. January.
Cardiac Rehab
Before being discharged from IJN, I was given counsel on cardiac rehabilitation program which include nutrition and medications and an exercise regimen to promote strength and flexibility. The advise provided by the IJN dieticians and physiotherapist were most helpful in guiding me and my family with the new food regime and lifestyle.
The doctor gave prescription for medications among which to treat pain, high cholesterol, blood clots, indigestion, and constipation. I was expected to follow the instructions for proper administration of these medications.
Recovery Process
Generally speaking, the majority of heart bypass patients recover within 8 weeks after the surgery but for others, recovering takes longer. Side effects are common, but fortunately they are temporary. These include fatigue, loss of appetite, abnormal heart rhythm and increase of body fluid. If these symptoms persist and if new ones develop, the doctor will need tobe notified immediately.
Saya masih terasa denyutan dan sedikit kekebasan di kaki kanan saya di mana urat telah di tuai untuk mengganti saluran tersumbat. Saya diberitahu bahawa luka tersebut dalam proses sembuh, walaupun ia mengambil sedikit masa. Di nasihatkan supaya kaki berkenaan di letak di paras horizontal dengan badan atau sedikit lebih tinggi supaya mengelakkan dari bengkak.
Saya juga di kehendaki menjalanan regular “dressing” atas “wound” di dada yang dalam proses penyembuhan – Alhamdulillah setelah beberapa kali ke klinin Idham, kesan luka tersebut telah pulih sepenuhnya pada 31 January. 
I experience a change in my “taste bud” yang ketara. The regular food I use to take taste different and much to my dislike. For example my favourate kuah singgang taste flat and most unappetising. Some say it’s the effect of numerous prescription drug intakes. Even my tears taste bitter.  Hopefully this is a temporary phenomenon.
Lifestyle Change
In order to reduce heart problems after the surgery, patients must modify their lifestyle to decrease the risks for other heart problems in the future. It is important to reduce stress, quit smoking and adapt to a diet program that aims to lower cholesterol, diabetes and hypertension. Stress management is an important issu which require special attention for a complete life-changing well-being.
I am required to have a regular exercise regimen that is approved by the physician in order to promote and improve my physical fitness. These lifestyle changes will be able to greatly contribute to my speedy recovery from the bypass surgery.
I am required to maintain a BMI at 73kg. As of today I have been able to bring down my weight to 75kg from as high as 85kg before the operation.
Appreciation
A big thank you to Mr Jeswant Dillon cardiothoracic surgeon yang telah berjaya melakukan satu prosedur pembedahan yang terbaik keatas saya. Saya bersyukur kepada Allah subhanahuwataala yang telah meberi hidayah kepada beliau dan rakan-rakan beliau yang begitu professional.
Being the pioneer heart care and treatment centre, IJN consultant physicians have always been known to be innovative in introducing the latest and most effective techniques in the treatment of heart patients for both interventional cardiology procedures as well as heart surgeries.
The IJN has gained wider recognition as the leading Cardiovascular and Thoracic Health Centre in the region as the rising number of referrals for complicated and demanding cases and visits from foreign cardiologists. A special thanks to Tun Dr Mahathir for his contribution to the setting of the Centre in 1992.
Saya juga ingin merakam ucapan berbanyak terima kasih kepada semua nurses yang telah memberi perkhidmatan amat terpuji. Saya masih teringat betapa sedapnya rasa “tea-o” pertama yang saya minum selepas pembedahan. Saya ingin memohon maaf sekiranya saya telah memberi apa-apa kesusahan kepada mereka.
My immediate family (wife and our seven children),and my four sisters from Kelantan who came down to KL especially to be close to me during and post surgery and close friends and neighbours have all been very supportive during my ordeal. I do appreciate greatly their visits at IJN – even when I could barely recognise who they were especially during the early hours of my recovery from the operation. Thank you so very much.  
My mother, especially, has always been a great inspiration to me with her doa and prayers for my good health. At 86 years old, she is blessed with good health, supportive children, grand children and great grand children living close-by in Kelantan. Except for her gastritis link to the stomach ulcer (which is under control) and her sporadic absent mindedness, she is as healthy as a bull. She may not be able to be physically with me, but her precense was greatly felt by me.    
I also value the advice provided by several “Rakan IJN Members” who visited me before and after the surgery. Sharing their personal experience gave me great confort to go through the procedure and to dutifully follow the post operation rehab program.  
Health is Wealth
Kesihatan memang bukan segalanya tapi tanpa kesihatan semuanya menjadi tidak bererti. Menjadi sihat adalah rezeki dan kenikmatan yang tiada tara sehingga Rasulullah SAW berpesan agar selagi kita masih diberikan kesehatan maka perbanyaklah amal soleh yang nantinya itu akan berguna bagi diri kita sendiri, sebelum datang sakit.
Kawalan nafsu dorongan syaitan – melalui taqwa dan iman yang membolehkan amalan pemakanan sihat halalan tayyiba dari punca rezeki hingga menjadi darah daging. Dan carilah rezeki yang halal (tanpa rasuah) untuk membeli makanan yang halal lagi baik serta berkhasiat untuk diri sendiri serta keluarga.
The most important lesson learnt is that health is wealth. With health you can be a productive worker and lead a good life. Simply said, when you are in good health, you will be a happy person and enthusiastic about life. On the contrary, sickly people will dread every moment of their pain and will not be able lead life in peace and tranquility.
No known substance can extend life, but the chances of staying healthy and living a long time can be improved. Nonetheless the following tips (non-exhaustive) may be useful:-
  • Eat a balanced diet, including five helpings of fruits and vegetables a day
  • Exercise regularly (check with a doctor before starting an exercise program).
  • Get regular health check-ups.
  • Practice safety habits at home to prevent falls and fractures. Always wear your seatbelt in a car.
  • Stay in contact with family and friends.
  • Stay active through work, play, and community especially during retirement.
  • Avoid overexposure to the sun and the cold.
  • Don't smoke (it's never too late to quit).
  • Do not drink. While drinking may have a few benefits, its harm far exceeds its benefit.
  • Keep personal and financial records in order to simplify budgeting and investing.
  • Plan long-term housing and money needs.
  • Keep a positive attitude toward life. A positive attitude will draw many favourable events into our life.
  • Do things that make others happy to make you happy.
  • Keep your home and environment clean.
  • Life is worth living -love life, love your family, neighbours, friends.
  • Control your temper, temptation, and lead a moderate life.
Self discipline is indeed the order of the day. There is no turning back if one requires quality and sustainable lifestyle – less stressful etc.
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NB: Do not be distressed! The Maglish used in this posting is by design. It has got nothing to do with my post surgery syndrome or side effects. Harap maaf, wassalam.
Wednesday, 2 February, 2011