Follow Up @ SDMC and Sunmed

Follow up sarah kat sdmc on 5th april 2014.

Creatinin turun to 47 fron 57 ....getting better.

Ada trace of blood sikit but not alarming.

AFP 1.9

Alhamdulillah

Darwish pergi jumpa ENT specialist earlier than the scheduled follow up, sebab telinga gatal sangat. Takut infection so mintak doctor check lah just in case. Doctor kata ada wax block kat tube tu. So dia masukkan saline kot utk lembutkan pastu suck keluar guna a small vacuum thingy. 

Dia lagi kerap komplen pasal telinga tu, but we cant do much sbb doctor kata its normal.

Calories

Interesting. 2 hari lepas installed macam2 aps pasal nak track workout dgn calories intake. Byk yg tak bg full version so takleh pakai. Ni satu ni kira yg okaylah boleh adjust. Tapi calories semua kena refer kat kevin cekodok web. Kira-kira berapa banyak badan kita perlukan calories to sustain its function pun cari kat cekodok jugak. So selepas di kira-kira, i need 1900kCal. Tapi kat aps atas ni kata i need 1714kCal...whatever lah kita anggap approximation only. Anyhow, what i discovered was, i've been eating much less than what my body required if i keep on doing my workout. Thats my understandinglah. Does that mean my body will burn the unwanted fat? Eh salah, its not unwanted fat. i want to keep the fat, but i need to relocate or distribute it more evenly. heheh. Can we teach them to go where we want them to go?

Then teringat my weight gain last year. And bila kira2 what my body need months ago when i'm not doing much to no workout, i need about 1485kCal. I keep on gaining weight...steadily since lepas raya tahun lepas. Dari 46 to 51. Now i have a theory, sometime last year, my body metabolisme going down, so when i was eating normally, my body did not burn it as it used to be hence the weight gain. 

I thought i would never keep an ounce of fat but i guess i was wrong. Bazir duhet je dulu2 beli weight gain produk, naiknye 4 kilo, turun lagi 2 kilo. Rupanya my solution was wait until i'm 36++ years old. The fat were happily residing between my waist to my knee. Only i would be happier it they also want to fill up my cheek, chest, arms and legs. They did not of course, hence my current predicament.

So, looking back, i start to jog in mid november, bila cuti sekolah dah start. Nothing much change, my weight keep on dwindling between 49-50 depending on how much i've eaten for the day. Lately with workout, my weight is consistent at 48++. 48 is a good number, good because it will keep me in the healthy BMI range and keep my conscience at ease because i can convince myself, i'm generally ok...ok ok, not sticky thin but ok albeit a bit buncit. 

Yesterday, i buat experiment, i add more calories by snacking a lot,konon nak achieve calories target mcm kat atas tu . End up at night my weight shoot up to 49.9 and reduce to 49.2 this morning. Padahal before that i was at 48++,  when i had little snacking. Itu takpelah kot kan sebab small kilos apa sangat kan butttttttttttttt.... physically my round tummy (i can't see my toes!) is really something that i don't want to endure....even it was at night time. Its really disturbing when i can see it when i'm laying down. Macam belon ada isi air, feeling wobbly mcm jelly. 

That is why i eat very little nowdays, to keep buncit at bay. At the same time doing my workout to burn the calories or fat whatever, (even though technically my calorie intake is wayyyy below target that i don't need to burn it away) then some weight lifting to strengthen the muscle. Its a long journey. If tetiba pregnant??? Eh takpe, pregnant takyah sorok kan......=P. Tapi kalau tak pregnant then orang tanya pregnant ke....it mmg le.

Belly dance and so on

Hari rabu pagi ada belly dance tapi start awal gila, 7.45. Gedebak gedebuk lepas hantar sarah semua pukul 8 baru sampai gym. Amik towel letak beg semua gi tengok derang dah start dah pun. Since ni first time nak join kelas kan tak tau le plak kena ada shawl, so pakai je towel buat ganti shawl. Ada lagi 2 orang pun camtu hehe so takdelah segan bonar. Instructor tu chinese, pastu yg lain pun semua chinese so mmg cakap cina je lah satu hape pun tak paham. Dah le masuk lambat kan, terpinga-pinga plak tu so sangap sikitlah, tapi teruskan jelah walopon terasa gak mcm nak cha alif, tapi dah 2 hari buat benda sama so terasa lah nak try something else kan. Ada hari yg ada pilates, cardio dance lah apa tah lagi, tak ingat.

Selepas try a few rutin belly dance for sometime, punyelah keras badan ni hah, mcm kayu. Pastu manjang salah step, bak kata orang putih tu, ada 2 left feet hah. Adoyai....ni kalau ada kenkawn sekali mmg konfem bantai gelak. Bila tiba rutin balut shawl tu kat kepala and tinggalkan area mata ala arab tu, habih ku balut kepala sampai tak nampak apa2 terus. Nasiblah lone ranger je kat sini, kalu terasa lawak pun just sengih2 sendiri le. Takde orang luar nampak takpe. Oklah kan buat variety, tukar angin hehe walopon hancus.

Pukul 9 abih belly dance, gi naik lari kat treadmill tuh. Since dah hari ke3, gagah jugaklah nak keep on running. Kalau tak campur dgn 60% walking. Dapatlah buat 3km in 27min speed 6-6.5 (4 minit yg awal tu jalan je). Kalori 170++ camtu, pastu tak reti nak check incline ke heart rate ke hahaha sangap sungguh. Ambik gambar sambil lari kan eloklah goyang. Pastu sambung lagi 5 minit jalan kat situ utk cool down. Bila turun still terhoyong hayang cam orang mabuk. Sampai bila ek baru boleh get used? 

Lepas 5 minit break, sambung kayuh basikal yg sambil bersandar ni, apa nama eh? Set manual dgn 4W, ringan jek hahaha, kalau set lebih2 kang tak daya plak nak kayuh huhu. 4W tu hapa pun aku tak tau lagi hua hua hua, yg ku tau jadik berat kayuhan. Buat 2km je, dah pancit....tak larat nak kayuh lagi.

Lepas tu buat abdominal crunches ni. betul kan? Sebelum tu ada orang pakai mesin atas ni, so gi lah buat kat bench yg menonggeng tu. Mcm nak tercirit buat 15 kali...perghhh.....lambat lagi lah nak slim perut gue. Sbb tak larat so gi lah memain kat mesin kepit n kangkang peha (pardon my terms, tak kenal lagi weh)  sambil2 usha mesin crunches tu. Lepas 5 minit camtu, akhirnya dapat jugak duduk mesin atas ni. Memula set kat no 1, then buat 10 kali, then no 2 -20 kali, pastu no 3 -20 kali. Yg no3 tu mmg sampai gigil2 tak larat hahaha, takut terkepit tak lepas je sbb masa cekpen tunjuk tu ari terkepit sekejap. Kali ni berani try kat no3 tu sbb 2 hari sebelum ni dah buat sampai no 2, rasa ok je, tu yg increase ke no3 tu. Rasakan.

Bila tengok badan dari belakang dah roper makcik2 sgt skrg ni, tu yg semangat tu. 

Getting Gorgeous

Bulan doblas aritu bila cekpen tanya nak masuk gym ke, i tanya dia balik, boleh ke bayar utk 2 orang sbb dia pun still nak menten gym membership dia kan. So kira2 punya kira2, takpelah tunggu dulu, cekpen sorang je gi, renew je dia punye current membership tu. Masa tu i pikir, lama lagilah jawabnya sbb the next possible option is bila kitorang pindah ke shah alam, which is laaaammaaaaaaaaaa sgt lg. huhuhu.

Tup tup, baru ni, cekpen dpt additional fringe benefit, ada elaun utk clubhouse bla bla bla. Wahhhhh suker ler kitewwwwww sbb leh tumpang dua kaki utk gi gym hik hi. Since dia leh claim dia punye fee, mine was covered lah as per current monthly expenses. Alhamdulillah. Bolehlah sama2 fit hehehe.

Since before this i jog outdoor je, i belasah pakai suar flannel je(suar tido ala2 hello kitty tu ye bukan tracksuit), so cariklah suar yg semengah utk dipakai ke gym. Tshirt boleh belasah pakai cekpen punye yg dpt masa dia race2 tu, jimat sikit ;). hmmmm so excited hehehe. Poyo kan =P. Gi gym pun kecoh hahaha.

Follow Up

Semalam follow up Sarah kat SDMC. Lepas ambik darah terus pergi breakfast kat mamak Taj. Actually nak makan kat restoren Bawang, tapi Sarah taknak kat situ, Terpaksalah mama mengalah. Roti canai lagi padahal kat rumah pun roti canai jugak...versi instant.

 Dah makan 2 keping roti canai tak kenyang le pulak, so tambah telur tiga suku dua bijik. Sedappp.

Kali ni prof lambat ya ampun. Pukul 12.30 kot baru dia masuk klinik. Ramai patient kat wad n daycare kot. Nasiblah ada menda alah ni, boleh buat sarah leka buang masa berjam-jam.

Semalam prof buat renal n liver test. So far semua ok. Mana2 reading yg tinggi, prof cakap still normal cos she's still growing up. Then AFP reading is 1.7. Alhamdullillah. Follow up pun prof dah set every 2 month. Legalah sikit. Prof kata now dah complete 2 years, Sarah chances of free from relapse is 90%. So we will wait another 3 years to make it 100% kata prof. InsyaAllah.

Bujang ni pulak awal bulan ari tu follow up telinga dia. Masa december tu ada bleeding banyak kat telinga kanan (still ada t grommet). Bawak dia jumpa GP je. So masa follow up ngan ENT awal bulan ni, nampaklah darah beku banyak. Sampai sekarang still ada lagi walaupun dah letak eardrop. Agak bahaya jugaklah sbb kadang tu tak sure sbb apa bleeding. Sama ada dia korek2 sendiri or maybe sbb dok berendam sana sini. Dah le tinge kiri dah out, tinggal kanan je. hopefully nothing serious. Ameennnn.

Shifa Al-Hidayah 31 october 2012

Semalam Sarah punya follow up kat Shifa Al Hidayah. Keluar rumah pukul 7.15 sampai sana 8.30. Kali ni nampak macam kurang sikit orang berbanding sebelum ni. Kurang2 pun Sarah dapat no.12. Jenuh gak menunggu giliran yg akhirmya tiba @ 1.30pm. Lebam jugak le rasa punggung ni hah. Hati toksah cakaplah...tapi mulut tetap dijaga =B.

2 round breakfast kat mamak. Khatam womens weeksly. Sarah tertido dekat satu jam. Sarah keluar masuk cari kucing. Haih....kan bagus kalau ada ipad kan sarah kannnnn.....=P. 

Hj Lokman finding sama mcm yg sebelum ni. Sel dorman, non is active. Alhamdullilah. Dapat surah baru utk amalan selama 8 minggu. Tapi dah sampai rumah baru perasan derang letak next appointment in 4 weeks. Duhhh .....nak kena mintak derang tukar to 8 weeks, dah le susah sangat nak ada orang pick up phone bila call sana. hmmm...sabarrrr.

Brave little girl @ sdmc

Semalam trafik being nice, sekejap je dah sampai sdmc utk follow up sarah. Kaunter registration pun tak bukak lagi sbb baru pukul 8. Sementara nak tunggu 8.30 tu, sarah dah tak senang duduk lah. Masa menunggu ni keep on mantra kat sarah, 'jangan nangis, cucuk sikit je, sarah brave, eat nasi lemak, bla bla bla.' Alhamdullilah.....Sarah sikit pun tak nangis. Pecah rekod. First time tak nangis setelah dekat 2 tahun kuar masuk spital hehehe. Bravo sarah!

Ada video masa ambik darah tu, tapi tak boleh transfer ke pc lah pulak. Actually, semalam somehow, salur darah tu kecut je, so 3 minit baru siap. Sebab kecut jarum tu di pusing2, ke kiri ke kanan, ke atas ke bawah nak carik the right depth and position. Dah dapat sikit, lepas tu darah tak mo keluar , so korek lagi. Sepanjang prosedur tu, sarah tengok je jarum tu, mama pulak lepas seminit dah tak berani nak tengok. Mama siap nak muntah lagi sbb kengerian yg amat. euwwww...ngilu tengok jarum tu. Serius nak muntah...tak tau lah kenapa gag reflex yg bertindak utk situasi camtu.

Pukul 12 baru dapat jumpa prof. Sempat lah sarah tidur kat riba dekat 45 minit...pengsan mama. AFP 2.2, Alhamdullillah. Last follow-up @ 1.5. Prof macam biasa lah until next year baru boleh get better chance katanya. Next follow up 3 dec kena buat ctscan abdomen n chest sekali. Sarah dah nangis dah sbb taknak masuk dalam mesin ctscan tu....takpe byk masa lagi nak bina semangat dia. Harap2 takde masalh le nanti.

Darwish Follow-up @Sunmed

6 October Darwish ada follow-up kat Sunway medical center for his hearing. Same day dgn konsert sarah. Yang bestnya my calender alarmed dah reset sbb update software kan so takde reminder lah. So i lupa. Darwish pulak under strict rule utk buat ulangkaji so i tak teringat langsung pasal follow up ni. Bila dia cuba ingatkan dgn gaya yg i dah biasa iaitu gaya nak elak dari kena buat ulangkaji, i just get mad at him. Finally at 11.15 baru dia manage ckp pasal apmt ni, tu pun lepas i marah sbb dia menangis lama. Straight forward cakap taknak, dok pusing2 tanya "mother you don't remember eh"...hish. My tolerance level mmg low lah so i get easily annoyed and angered. Pergi jugaklah walopon dah lewat sbb kang sarah nak siap lagi kan. 

So at 1pm baru dapat jumpa doktor. Bukan doktor Koay pulak kali ni. Before masuk i keep on remind darwish not to move or flinch bila doktor asses telinga dia. But still lah dia dok elak tolak2 tangan doktor dan alihkan kepala. Sabor je lah. Sensitif betul bila orang usik telinga dia. Tengoklah rupa yg tengah keras suspen tu.

First time after so long, dapat tengok tiub dalam telinga kanan tu. Nampak oklah. Yg telinga kiri tu tiub dah lama tanggal, yg nampak kesan lubang je. But since hearing awish ok (doktor buat some low noise movement utk confirmkan), so no need to do anything. Doktor reassured that everything should be fine along with darwish growth. Ameeenn.

Next check up will be on saturday, first week of january. Still every 3 month check-up. I was hoping 6 month interval but takpelah. Pasrah.

Teka-teki

Just received a call from Prof Lin clinic. Nurse informed prof dah review all previous ct scan and compare it with last week ultra sound. Prof asked us to come on 11th July to do another AFP and FBC, a week earlier from schedule and to come again on 18th July for MRI. MRI??? Why not CT scan like we used to?

Pray harder...... -_-"

Not yet because....

Kejap kata pi kejap kata tunggu...takpelah...i follow je.

Pagi tadi bila blood test report Sarah siap, Prof decided not to let us go to UMMC. Blood count still tak naik naturally walaupun dah 18days after the 6th chemo started on 27 may.

Sarah looks very well, it may lead to wrong judgement at UMMC, that they might think she-is-not-so-critical-thus-no-urgency-for-admission and tell us to go home (ni prof Lin punya pendapat) ...which i'm more than happy to go home but also not so happy sebab kejadian 4 & 5 may June mungkin berulang dan juga pengalaman lain yg #$#@$%#^%^&.

Masa nak ambik barang2 yg dah masuk kat kereta (2 kali dah aku punggah barang masuk kereta pastu angkat balik masuk ward), terpandang paper Malay Mail ni. Tertarik sebab front page terpampang UMMC bukan main besar.



Hmmm..elok le prof tak kasi gi sana....dibuatnya gi sana pastu disuruh balik sbb takde bed ataupun Sarah is ok tak perlu admission (their terms)....dah kena buat admission lagi sekali kat sdmc nih..letih makcik. Sbb kalau balik rumah, takde TPN, takde drip, tak minum susu....harap makan nasi 3 sudu dgn air kosong je,memang konfem malnutrition n dehydration lagi sekali.

Road to Recovery

Nampaknya esok kena teruskan perjalanan ke UMMC.

Harapnya esok tidak menjadi 'bola yg di sepak' ...kalaupun disepak..harap ia berbaloi-baloi untuk pulihkan Sarah.

So wish us all the best.....semoga semuanya dipermudahkan...ameennnnn...

Sakit

Nak cerita pasal pesakit kat katil sebelah ni. She's 8 years old. Bone cancer. Mommy Indian, daddy chinese..very 1 malaysia. Mommy speak fluent the daddy's mother tounge language..amazing..seriously!

The girl sekarang tengah menahan sakit yg amat..not only kakinya sakit disebabkan kanser tu, now tekak adalah luka teruk!

Tak boleh menelan langsung! Dia menangis merintih ALL TIME!! This girl bukan jenis yg menangis melalak lalak (mcm Sarah), dia menangis perlahan tapi menangis dgn tona yg tersiksa!

I pernah sakit tekak, ulser yg dah jadi luka yg teruk...all around tonsil area, i ingat lagi, malam2 i turun gi dapur, try minum air suam air sejuk ubat tak tau nak buat apa...SAKIT GILA! Menangis terduduk sorang2 sbb tak tahan sakit. Itu baru gaya2 ulser kat tekak orang tua, dan mungkin sikit banding yg girl ni hadapi.

So i suggest kat mommy dia, bagitau kat doktor yg anak dia dah tahan sangat sakit tu. I suruh dia tanya if can increase the morphine dosage. Doktor bg 0.5ml/hour. I bgtau dia Sarah lepas buat operation derang bg sampai 5ml/hour. Kemudian reduce to 4.5 after 3 days, dan reduce again each day 0.5. Reason supaya Sarah tak rasa sakit.

Masa nurse buat round, mommy dia pun tanya, but nurse cepat je jawab, tak boleh sebab tu doktor yg set. I dengar kat sebelah nak je menjawab ...tanya lah doktor dulu!

Lepas tu mommy merayu lagi cakap anak dia sakit sangat dah. Nurse tanya balik "sakit sangat ke?" so mommy jawab "sangat, tak boleh telan air liur pun".

Nasib baik nurse lepas tu kata nak tanya doktor...haaa kan elok camtu.

Tak lama tu ...adalah 10 minit kot, doktor datang, tanya if the girl buang air ok ke tak. Then doktor kata boleh tambah. I tak tau lah berapa but at least dah increase sikit lah kot. At least kalau morfin tu banyak she might be able to sleep kan, takdelah menderita tahan sakit tu.

Bukan apa, i yg kat sebelah ni rasa nak menangis dengar rintihan girl tu, sambil mommy daddy dia duk pujuk (tapi i tak paham, depa cakap cine huhuhu).

+++++++++++++++++++++++++++++++++++++++++++++++++

Sarah pulak tadi men-cherry, dekat setengah jam pujuk change pampers tp dia kata belum selesai, siap ketuk2 kepala sendiri, sebab bengang mama keep on tanya dah sudah belum. Pastu kaki terajang2, terpaksalah duduk jauh sikit, kang tak pasal lebam mata.

Pastu bila nak wash montot, meraung2 kepedihan. Melecet kat surrounding anus dah baik, melecet kat belakang bum bum pulakkk. Dah tepek zinc oxice cream tebal2 pun kena jugak....sian Sarah.

Bittersweet

Sarah takde banyak ubat pun nak kena makan sepanjang dia kimo ni.

Satu-satunya yg dia kena menten makan adalah bakterim/ supreme. Rasanya pahit, pekat, ada tulis berperisa raspberry tapi tang mana tak tau la. Sebab mama dah rasa sikit takde pun rasa raspberry...bau tu adalah sikit2 bau raspberry.

Ubat ni utk elakkan sebarang lung infection which budak2 under kimo mmg senang kena.

Pernah try bg dia makan masa awal2 dulu tapi memang kena reject dan muntah balik. So lepas botol yg pertama tu habis gitu je, mama stop.

Bila mama teringat, mama akan tunjuk kat dia botol ubat tu dan bgtau dia, "this is white water, sarah must drink"

Perkataan 'ubat' mmg tak disebut sbb tu pantang/ alergik dia.

So, masa scan baru ni (khamis) setelah berhempas pulas pujuk sarah minum ubat tidur sarah taknak jugak (dia try rasa sikit je), so mama and nurse pun agree to sedate dia masa kat scan room tu.

So nurse pun simpan le ubat tidur pahit tu. Dalam 5 minit macam tu, tetiba sarah nak minum ubat tu. Mama mintak nurse cairkan sikit (campur air), lepas tu Sarah minum sampai habis, tapi dengan muka kelat dan terpisat-pisat menahan pahit. Mama a bit "surprise" sbb yg sebelum dia, infact yg masa nak buat hearing test 2 minggu lepas dia muntahkan balik tau.

Berbalik kepada citer supreme tu, so tadi mama tunjuk sarah 2 small cup. Satu supreme, satu lagi XP mix with honey. Tanya dia nak minum yg mana dulu. Dia cakap " i don't want".

Mama bg satu lagi option, campurkan dua2 tu. Dia agree. Then slowly mama pujuk Sarah minum, a sip at a time. Alhamdullillah...Sarah tak muntah dah.

Finally lepas dekat 30 minit, habis lah satu cup mix of supreme, honey and xp.

At least ada progresslah. So kalau lepas operate ni ada tambahan ubat yg pahit2 tu bolehlah kot sarah minum...hopefully tak banyak le..kalau tak perlu ubat langsung pun takpe..mama lagi rela.

Go home now

Hari ni Insyaallah boleh balik rumah..yippieee!

But this time tak lama...seminggu je dapat break...a lot more to go through.

Praying that all of us can pass this 'test' with flying colours.

Praying for miracles....

Today doctor manage to feel Sarah's abdomen. He confirmed again that he can't feel the tumor or the harden liver. Yeaaay! But anyhow, scan still need to be done to confirm the tumor, liver and lymph actual conditions.

He will discuss with the peads surgeon (Prof Ramajunam) later about Sarah case.

Doctor has always asked us to remain positive but at the same time not to expect too much. He is so right. Remember AFP ? Well, i was kinda putting too high hope that it will be single digit before we started the 4th chemo but I was wrong.

I was hoping for miracle actually....well...ideal case...if

AFP =0,

no tumor residue,

liver fully recovered

NO SURGERY.

Then we love happily ever after....T___T

Ok..wake-up wake-up.........I need to be more realistic and of course pray to Allah so that we can go through this journey till the end...and live happily ever after again...T_T

Tooth Fairy....

My top right wisdom tooth keep giving me pain lately. My mouth is rather small (doc says), so it's quite difficult to reach there during brushing. So it started to decay and i can feel pain after eating.

End of last year I already had my top left wisdom tooth extracted. So yesterday I went again to get the right side extracted pulak. So now I cacat...sort of... lack of 2 teeth..well actually 5. The other 3 never turn up...hidden somewhere inside my gum.

When i was small, i would have created thousands excuses not to go to see the tooth fairy dentist. Now, dah tua....sakit..cabut sajaaaa...

Anyway, this is the best dentist ever, well ...out of 3 dentist in Puchong that i had their service before.

No pain at all during extraction or scalling or filling. She even advised me not to proceed with crawning (eh dokter tak nak duit ke)...well not until Sarah sihat .

Thanks doc.

Kamus tatabahasa Sarah

Sekarang mama kena faham banyak maksud tersirat kata-kata Sarah. Kadang apa yg dia nak berlawanan dengan apa yg dia sebut. Mama tahu, orang lain memang tak boleh jaga Sarah, nanti tak faham, Sarah frustrated. Even bibik pun dah banyak yg dia tak faham apa Sarah nak.

Ni contoh maksud tersirat:

1) Put some more water

- sila rebus air/ boiled water.

- sila buat ais kiub.

2) Nasi too hot

- nasi kat pinggan ni dah sejuk, sarah nak nasi baru dari periuk..yg panas.

3) I want air teh

- sarah nak minum teh-o panas, sarah nak letak gula sendiri, lepas tu letak satu ketul ais kiub.

4) I want water

- Sarah nak air tin crysantimum tea. (Dulu dia panggil air ni 'minum')

5) I want drink

- Sarah nak minum vitagen kaler purple.

6) I want nasi giant.

- Sarah nak makan nasi ayam yg jual kat food court giant bandar kinrara.

7) You forget kakak.

- kenapa mama tak ambik kakak bawak balik rumah? (kakak=bibik)

8) Water finish, go home now.

- bila drip dan ubat2 habis, nanti bawak sarah balik rumah .( refer to hospital)

9) I want nasi sup pedas. (yg ni paling pening sbb too general)

- Sarah nak makan nasi dengan [asam pedas, gulai lemak cili api, sup tomyam, sup putih, kari, etc]..pengsan nak kena try satu2.

10) I want nasi sup pedas some more...

- (pening, sbb not necessary yg dia makan meal before that, it could be any sup pedas tah bila2).

11) Fish too small

- taknak makan ikan/ ayam dalam cubitan yg besar..nak cubit kecik2.

12) I don't want soton

- taknak bawang2/daun2/semak2 dlm sup.

13) Where's my towel?

- mana selimut sarah?

14) Water too hot.

- air ni sejuk, sarah nak mandi air panas.

15) I want to do

- Sarah nak tolong letak gula/ sukat beras/ tumbuk cili etc.

Ada banyak lagi ..... agak2 ada ke orang lain leh faham?

Around the world news

Macam-macam berlaku kat dunia ni....dari facebook jadi rusuhan, pemimpin2 letak jawatan di middle east, si Gadaffi (keturunan yahudi rupanya)dan bodigad pompuannya, pastu perang kristian islam, sampailah tsunami kat chile n Jepun....terasa begitu dinamik nya bumi Allah ni.

Tapi kan..tapi kan...aku tak check-out lagi dari SDMC dari 1/3 2011...

Takpe-takpe..Insyaallah isnin boleh cek-out...takpe docter...no rush...takde tsunami ..takpe..takpe...i can wait...we can wait...as long as Sarah free from germs n viruses.

Germ Cell Tumor - Yolk Sac Tumor

Finally i found the best site describing Sarah's Cancer (highlighted in orange).
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Taken from here

What are germ cell tumors?

Germ cell tumors are malignant (cancerous) or non-malignant (benign, non-cancerous) tumors that are comprised mostly of germ cells. Germ cells are the cells that develop in the embryo (fetus, or unborn baby) and become the cells that make up the reproductive system in males and females. These germ cell follow a midline path through the body after development and descend into the pelvis as ovarian cells or into the scrotal sac as testicular cells. Most ovarian tumors and testicular tumors are of germ cell origin. The ovaries and testes are called gonads.

Tumor sites outside the gonad are called extragonadal sites. The tumors also occur along the midline path and can be found in the head, chest, abdomen, pelvis, and sacrococcygeal (lower back) area.

Germ cell tumors are rare, as only about 2.4 children in one million will develop one of these tumors in a given year. Germ cell tumors account for 4 percent of all cancers in children and adolescents under the age of 20 years.

Germ cell tumors can spread (metastasize) to other parts of the body. The most common sites for metastasis are the lungs, liver, lymph nodes, and central nervous system. Rarely, germ cell tumors can spread to the bone, bone marrow, and other organs.


What causes germ cell tumors?

The cause of germ cell tumors is not completely understood. A number of inherited defects have also been associated with an increased risk of developing germ cell tumors including the central nervous system and genitourinary tract malformations and major malformations of the lower spine. Specifically, males with cryptorchidism (failure of the testes to descend into the scrotal sac) have an increased risk to develop testicular germ cell tumors. Cryptorchidism can occur alone, however, and is also present in some genetic syndromes.

In addition, cells from testicular germ cell tumors can have structural chromosome abnormalities involving chromosome #12, which may explain the uncontrolled cell growth and tumor formation.

Some genetic syndromes caused by extra or missing sex chromosomes can cause incomplete or abnormal development of the reproductive system.


What are the symptoms of germ cell tumors?

The following are the most common symptoms of germ cell tumors. However, each child may experience symptoms differently. Symptoms vary depending on the size and location of the tumor. Symptoms may include:

•a tumor, swelling, or mass that can be felt or seen


•elevated levels of alpha-fetoprotein (AFP)


•elevated levels of beta-human chorionic gonadotropin (β-HCG)


•constipation, incontinence, and leg weakness can occur if the tumor is in the sacrum (a segment of the vertebral column that forms the top part of the pelvis) compressing structures


•abnormal shape, or irregularity in, testicular size

The symptoms of germ cell tumors may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.


How are germ cell tumors diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for germ cell tumors may include:

•biopsy - a sample of tissue is removed from the tumor and examined under a microscope.


•complete blood count (CBC) - a measurement of size, number, and maturity of different blood cells in a specific volume of blood.


•additional blood tests - may include blood chemistries, evaluation of liver and kidney functions, and genetic studies.


•multiple imaging studies, including:


◦computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.


◦magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.


◦x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.


◦ultrasound (Also called sonography.) -a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.


◦bone scans - pictures or x-rays taken of the bone after a dye has been injected that is absorbed by bone tissue. These are used to detect tumors and bone abnormalities.


What are the different types of germ cells?

Diagnosis of germ cell tumors depends on the types of cells involved. The most common types of germ cell tumors include:

•teratomas
Teratomas contain cells from the three germ layers: ectoderm, mesoderm, and endoderm. Teratomas can be malignant or benign, depending on the maturity and other types of cells that may be involved. Teratomas are the most common germ cell tumor found in the ovaries. Sacrococcygeal (tail bone, or distal end of spinal column) teratomas are the most common germ cell tumors found in childhood. Because these sacrococcygeal tumors are often visible from the outside of the body, diagnosis is made early and treatment and/or surgery are initiated early, making the prognosis for this type of germ cell tumor very favorable.


•germinomas
Germinomas are malignant germ cell tumors. Germinomas are also termed dysgerminoma when located in the ovaries; and seminoma when located in the testes. Among children, germinoma, or dysgerminoma, occurs most frequently in the ovary of a pre-pubescent or adolescent female. Dysgerminoma is the most common malignant ovarian germ cell tumor seen in children and adolescents.


•endodermal sinus tumor or yolk sac tumors
Endodermal sinus tumor or yolk sac tumors are germ cell tumors that are most often malignant, but may also be benign. These tumors are most commonly found in the ovary, testes, and sacrococcygeal areas (tail bone, or distal end of spinal column). When found in the ovaries and testes, they are often very aggressive, malignant, and can spread rapidly through the lymphatic system and other organs in the body. Yolk sac tumors are the most common malignant testicular and ovarian tumors in children. Most yolk sac tumors will require surgery and chemotherapy, regardless of stage or presence of metastasis, because of the aggressive nature and recurrence of the disease.


•choriocarcinoma
Choriocarcinoma is a very rare, but often malignant germ cell tumor that arises from the cells in the chorion layer of the placenta (during pregnancy, a blood-rich structure through which the fetus takes in oxygen, food, and other substances while getting rid of waste products). These cells may form a tumor in the placental cells during pregnancy and spread (metastasize) to the infant and mother. When the tumor develops during pregnancy, it is called gestational choriocarcinoma. Gestational choriocarcinoma most often occurs in pregnant females that are 15 to19 years of age. If a non-pregnant young child develops choriocarcinoma from the chorion cells that originated from the placenta that are still in the body, the term used is non-gestational choriocarcinoma.


•embryonal carcinoma
Embryonal carcinoma cells are malignant cells that are usually mixed with other types of germ cell tumors. They occur most often in the testes. These types of cells have the ability to spread to other parts of the body. When these cells are mixed with an otherwise benign type of tumor (mature teratoma), the presence of embryonal carcinoma cells will cause it to become malignant (cancerous).

Many germ cell tumors have multiple types of cells involved. The diagnosis, treatment, and prognosis are based on the most malignant of the cells present and the majority type of cells that are present.


Treatment for germ cell tumors:

Specific treatment for germ cell tumors will be determined by your child's physician based on:

•your child's age, overall health, and medical history
•extent of the disease
•your child's tolerance for specific medications, procedures, or therapies
•expectations for the course of the disease
•your opinion or preference


Treatment may include (alone or in combination):

•surgery (to remove tumor and involved organs)
•chemotherapy
•radiation
•bone marrow transplantation
•supportive care (for the effects of treatment)
•hormonal replacement (if necessary)
•antibiotics (to prevent/treat infections)
•continuous follow-up care (to determine response to treatment, detect recurrent disease, and manage the late effects of treatment)


Long-term outlook of a child with a germ cell tumor:

Prognosis greatly depends on:

•the extent of the disease.
•the size and location of the tumor.
•presence or absence of metastasis.
•the tumor's response to therapy.
•the age and overall health of your child.
•your child's tolerance of specific medications, procedures, or therapies.
•new developments in treatment.

As with any cancer, prognosis and long-term survival can vary greatly from individual to individual. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with a germ cell tumor. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of germ cell tumors. New methods are continually being discovered to improve treatment and to decrease side effects.

Sleeping beauty

Sarah still sleeping......and its more than 14 hours already! Yesterday she started to sleep around 7pm... at 8pm temperature goes up to 39degC. I sponged her with wet towel, she don't even bother to wake up...occasionally she just open her eyes for few second when she wants milk.

I think she just got fed up...frustrated that she still in this very room...tired of nagging and scratching and crying and begging for me to bring her home.

Its really heartbreaking :(