What a surprise

More than a month after the last consultation with Dr D, (about 4 days before my mum's admission to the psychiatric ward), my dad's leg pain occurred more frequently. As a result, my dad was taking more breakthrough than prescribed for. So, we consulted Dr D again:

(1) Dad could take the breakthrough (Oxynorm) up to 6 times a day (we thought the maximum was 3).

(2) She advised us to approach Pg GH's PCU as a walk-in patient and tell them what happened so that they could adjust and prescribe more Oxycontin and Oxynorm until the next appointment. It's much cheaper than getting it at Mount Miriam. She expected that they would double the dosage of Oxycontin.

We went to Pg GH the next day. During the consultation, the PCU specialist took up my dad's suggestion of looking at the PET/CT scan. As a result, he (after consultation with his senior), increased the dosage of Oxycontin (from 10mg twice a day to 20mg twice a day) and also asked my dad to see the oncologist too (1 week ahead of schedule).

The oncologist was agreeable with the PCU specialist's recommended dosage to manage the leg pain. However, unlike Dr D, she said there was no need to remove the two lumps (PET/CT scan didn't point them out as cancerous and that they could just be scarred tissues/folded skins from the surgery more than a year ago). She also said cannot perform radiotherapy on the leg again as it was already done once before. Regretfully, we forgot to ask why (we very nearly missed the visiting hours to see my mum).

I asked Dr D via e-mail (as it was already night and it was her off day that day too) about this. I was pleasantly surprised to receive her response later that night: "I agree.... manage it with pain killers first. Radiotherapy is last resort. Too much radiation to the same area can cause long term problems such as stiffness and brittle bones...that's why it's last resort if pain not well controlled."

Sliding backward

2 days after her last appointment with Dr N, I got call from mum. She had gotten worse. She couldn't think, head was heavy, face was stiff, she wanted to scream  and she was afraid she might take her life. Said that the day before she scratched herself with fork. I didn't know what to do except to tell her either she go to GH's A&E then or wait until a few days later for her appoint with Dr N. She didn't respond and so I offered a third choice i.e. I texted Dr N.

Dr N (via text messages and phone call) advised us to admit her to Penang GH's psychiatric ward. She contacted her ex-colleague there, briefing him about my mum. She asked us to bring mum to the GH's A&E, telling them that we had been asked to admit my mum and that mum's psychiatrist had spoken with the geriatric psychiatrist.

I was still in PJ then and would later be driven by Ban to Butterworth that night. Meanwhile, my sister and my dad brought my mum to GH's A&E. It took like 6 hours before she was admitted @@. When the resident doctor attended my mum, he was keen to get her agreement to be admitted. Some background: my mum had bad experience at Seremban GH's psychiatric ward, where nurses were rude and she was housed together with "crazier" patients.

This resident doctor assured her that the nurses here were nice and that "crazier" patients were housed separately. I heard that he was a nice doctor. Unfortunately, when my mum first steped through the "gate" of the ward, she was already scolded loudly by a nurse there to walk faster. Even in normal state, my mum couldn't walk fast, what more in such a dazed state.

Dad: Hey, how can you be so rough with a sick patient?
Nurse: If you don't like, you can get out.
Dad: Sick patient has to get in to get well, but you shouldn't be so rough on them.

Something like that. So my mum was even more anxious after that and wanted to get out. My sister waited to speak with the resident doctor, who was aghast at the nurse's behaviour and terribly embarrassed about it. Apparently, for psychiatric ward, once paper was signed, patient must stay for at least a night (if I'm not mistaken) and so my mum had no choice.

However, the resident doctor did the following: he got another nurse (who was quite nice at the start) to attend to mum and, someone, prevent the rude nurse from attending mum. Apparently it worked.

That night itself, they replaced Alprazolam with Lorazepam but, clearly, it didn't work because she slept only for an hour. Otherwise, she was pacing about, sometimes wanted to bang her head against the wall and punched the wall. She calmed down when the doctor talked to her but back to those actions again once he was gone.

So the next day, the team of doctors (geriatric doctor, HOD and resident doctor) decided to reinstate Alprazolam but at much lower dosage i.e. 0.5mg, increased Olanzapine back to 7.5mg and to increase Epilim to 200mg day 400mg night. We were told that she should stop taking Tramadol (as prolonged use would increase her "blurness") and just to rely on Gabapentin and paracetamol to manage her pain from fibromyalgia.

Future blood tests would test the absorption efficiency of the medicine.

Adjustment of another

I updated Dr N via text on the second change of medicine by the public hospital and what happened following that: mum improved daily but still had blank look and slept a lot i.e. 8pm to 9am next day; slept after breakfast and after lunch. It was hard for her to comment without seeing my mum and so I made an appointment for my mum to meet her almost a week later (it was supposed to be a few days later but mum had flu and so it was postponed).

Meanwhile, I got to know that for the first time a proper psychiatric specialist (instead of medical officers) would see my mum at her next appointment at the public hospital. My dad overheard his name, Dr A, and so thought it should be Dr N's friend.

On the appointment date with Dr N:

(1) Mum was unhappy even before her previous appointment. This was news to me. Dad said she pretended to be happy. After the session, I advised her, via my dad, to tell us and the doctor in future of such feelings (as it could matter to the doctor's decision on whether to adjust medication). Dr N had always asked about her feelings.

(2) Mum was unhappy and worried about when she could recover ("get out of this condition").

(3) Mum hadn't been sleeping well, felt restless/agitated.

(4) Dr N said that one possible side effect of Olanzapine is agitation. She also revealed that in future, it's possible to do away with this anti-psychotic medicine and just be on the mood stabiliser medicine, Epilim.

(5) Reduced Olanzapine from 7.5mg to 5mg night. Retain Epilim 200mg twice daily and the increased (by the publich hospital) dosage of Alprazolam (0.5mg day, 1mg night) as it helps with the restless/agitated feeling effect of Olanzapine.

(6) Dr N would see mum again within a week as she wanted to assess the efficacy of this adjustment.

(7) After I assuaged mum's concern about cost of medicine, she stated that she preferred to follow Dr N's prescribed medication until she's stabilised. Meanwhile, we would update the public hospital and then shift back there once she's stabilised.

After the session, Dr N called Dr A and then confirmed with me, via text, that it would be Dr A attending mum at her next appointment at the public hospital. Dr N will write a letter at the next appointment.

Hope mum will recover well.

Atlas Reactor: Garrison 3

Recently, I made one change to the mod compared to the previous build:

(3) Missile Barrage - Focus Fire (3 loadout points)

I'm still not sure whether this gives better value or not compared to Double Trouble: does it deal more damage overall? Double Trouble has longer CD but activates twice in a row. Focus Fire deals more damage when it activates and its CD synergises with Heavy Metal. Sometimes that additional damage is all that's needed to get a kill.

Here's a recent gameplay that I'm quite proud of:


The morning after the visit to the public hospital, she felt better but worsened towards the evening and that continued to the next day. They called me and I urged them to follow the instruction of the public psychiatrist: consult her if mum's condition worsened. Since it was already Thursday, I warned them that they should decide very soon because forgoing a visit on Friday means needing to wait untill Monday.

Later that day, I had a thought and I told my dad: for the first time ever, after the appointment with Dr N, my mum asked me why Alprazolam (anti-anxiety medicine) would eventually be cut off. I explained to her that it was not needed to treat bipolar disorder. It would be like giving cough syrup to someone down with fever. Since then, coincidental or not, her condition deteriorated. Hence, I suspected that she was anxious at the thought of forgoing this medicine in future. I strongly advised my dad to inform the public psychiatrist about this. To help him, I texted him my suspicion, which turned out to be helpful because he just showed it to the doctor. The doctor said the same thing as Dr N i.e. Alprazolam would be phased out.

So this time, they reverted to Dr N's prescribed anti-psychotic medicine i.e. stop taking Risperidone and back on Olanzapine, and added a dose of Alprazolam for day time:
  • Olanzapine 7.5mg night
  • Epilim 200mg twice daily
  • Alprazolam 0.5mg day and 1mg night
Hopefully mum will be back on track of recovery.


Three days after the last appointment with Dr N, my mum started experiencing this:
  • Felt numb
  • Not herself (wanted to scream)
  • Blur
  • Couldn't think well
  • Took time to sleep
It intensified the next day and so my parents asked me to tell Dr N.

After telling Dr N via sms and answering her questions, she increased Alprazolam back to 0.5mg per night and to observe.

Coincidentally, my mum had appointment with the public hospital's psychiatrist (both psychiatrists are aware of mum continuing to see both, and that the plan is to eventually go back to public system fully) and my parents updated her on the latest prescription by Dr N and the symptoms above.

As a result, the public psychiatrist prescribed the following:

(1) Continue Epilim 200mg twice daily

(2) Slowly replace Olanzapine with Risperidone (because they don't have the former). Hence, Olanzapine 5mg nightly for 1 week, then cut down to 2.5mg for 1 week and then off.

(3) Risperidone 1mg nightly.

(4) Increase Alprazolam to 1mg nightly.


While waiting for Monday's appointment, I discovered that, once again, my dad had acted as "doctor": few days ago, he decided to discontinue taking Gabapentine without consulting with any oncologist. Reason? Wanted to reduce medicine. The funny thing was that he had forgotten what it was for. Yet, he confidently stopped taking it.

I chided him (once again) for being naughty and told him that it was for his pain, so that he could sleep better at night. Guess what? Slept much better on the very night he resumed taking it.

Also, since letting out gas gave him much relief from his tummy pain, I suggested domperidone to him: a medicine that Penang GH's oncologist prescribed to him before. Fortunately, that helped a lot.

He remarked that his tummy ached after dinner but it wasn't the case after one particular dinner. The difference? Absence of rice was the obvious answer. So he would be trying to cut down on rice and increase intake of protein (on oncologist's advice) or substitute rice with other grain or carbo.

Summary of Monday's appointment with Dr D:

(1) PET/CT scan showed not much changes compared to the one taken at SJMC. In fact, some cancer spots have shrunk or disappeared. However, this means that the cancer on his left leg would need to be treated eventually (previously was treated with radiotherapy).

(2) It was not definitive that the 2 lumps are cancerous. They aren't highlighted in the scan. Probably need biopsy.

(3) Since currently my dad's pain is manageable (in fact, the leg pain is less now), Dr D believed that he can wait until his appointment with GH's oncologist, scheduled in less than a month time. She believed that GH would order a biopsy and then decide the next course of action.

(4) Dr D's recommendation: radiotherapy for the leg and minor surgery to remove the two lumps (they are superficial i.e. not deep inside affecting muscles). No point undergoing chemotherapy just to treat these two. Incidentally, my dad prefer not to undergo chemo again.

(5) If dad's pain worsens, he's advised to go to GH's emergency, give explanation and ask to consult an oncologist with the PET/CT scan results. It will be much cheaper to undergo radiotherapy and minor surgery at GH. Of course my dad can also go back to Dr D, something that we will let him decide as he will be the one suffering in pain.

(6) Dr D asked dad not to be "naughty" again i.e. unilaterally discontinuing medicine. Hahaha.

Oh, by the way, the cashier refunded me in cash the amount they overcharged me the last time :)