##CAD implications

k_CAD

If I go to the U.S. I will need insurance. I will need frequent medical checks and consultations. WStC jobs will be less attractive given the expensive insurance.

A PSA/OC type of lower-stress dev job will become increasingly suitable for me. I maintain a decent effort with good attitude, and they will keep my job.

I will need to get my kids to take over my rental properties.

I will scale back on long-term risky investments, and allocate more towards stable assets just like retirees do.

Once a while I envy those in my cohort who are free of “my problems”. For years, I used to feel superior, lucky, one of the God’s favored children because I did good deeds and took care of my body for so long. Now I feel unlucky.

A classmate was suspected for some tumor (I won’t elaborate) and decided to google life expectancy for such patients. I refuse to do so. My new longevity target will become … 85?

For about 10 years I felt like immortal whenever I tell people that I plan to live till 95. Many long-term plans were made based on that optimism.

I tend to look at my running performance as a guage of my physical decline, but now I think denial of the natural decline can be harmful. No-decline is a good sign if it is natural and managed safely, not propped up artificially.

I hope to regain my sense of optimism and gratitude.

I hope to find something good in this challenging situation. I may not find any.

##CAD: grievings

Decades ago, many ordinary workers would spend many hour commuting by foot. They have to.
You may feel pity for them.
But that’s not a medical condition.


k_CAD .. k_ascetic  .. k_X_细水长流  .. k_sinkingXp

The CAD chance discovery was a sinking experience, a huge blow, a lightning strike, and I was temporarily disoriented. This bpost is a loose collection of various losses behind my grieving. In this introspection, precision is not required. (Note “griefs” and “grievings” are both rare plural words.)

Slowly, many of the griefs have been absorbed, /sunk in/. A few griefs were initially exaggerated and now look less grave than other challenges of everybody’s life. I feel this bpost has been effective in this process.

Q: what’s my biggest grief following the CAD diagnosis?
A: the reassuring and valuable “parachute” of WStC for the last chapter of my career. (A longer introspection could go into a separate bpost in the gz blog.)

For some people, smoke/alcohol are essential to quality of life. For me, Q@L includes intimacy, workout, fruits, cakes,, Losing these freedoms or cutting back on these pleasures really cut deep esp. for loss of intimacy. However, sicne my 40s I have progressively given up lots of cakes, fried starch,,,,

For GM, GP and Sherry, loss of mobility is a heavier grief, and heavier blow.

— life expectancy, my chance to stay with my kids till they grow to middle-age…. has dropped to a G5 item even before my 25 Apr review session. Not really my biggest grief.
In contrast, a cancer diagnosis is often more /grave/. Cancer is harder to arrest. Cancer treatments entail more sacrifices/suffering.

— With Yuyun, I briefly explored other traumatic/disabling diseases… Each a sinking feeling when it hits. What is the invisible thread that runs through?

  • I told Yuyun about EDyw .. prolonged grieving
  • I told Yuyun about colostomy
  • I told Yuyun about dreaded t2dm .. see notes about “ALL sweet”
  • I told Yuyun about dialysis .. 3 times a week. Huge loss of freedom
  • how about hearing loss .. grandma
  • how about mobility .. grandpa, young colleagues
  • how about 破相 ..

Level of grief depends on the age when we lose something valuable. See DALYs [ disability-adjusted life years]. At 50, I had a “50% CAD” diagnosis but no stent.

— grieving .. over .. the freedom to sleep late. Some healthy young people can sleep late without health impact (though it’s not a healthy habit).

I will need to avoid overnight flights, too.

Perhaps this grief is a nudge (or jolt) to improve my sleep higiene. Over the years, I often notice that morning noise is bad for my sleep.

Only in epa job, I had the precious option of swing shift, but after CAD, my wife urged to work regular hours.

— grieving over .. the freedom to enjoy a wide range of exercises .. has dropped to a G7 item. I was never able to do skating, rock-climbing,,,

Strech exercise … no “grief”

consider YY.T’s grieving over his freedom to run. He had to replace it with swimming.

chin-up

==== grieving over food freedom ..

I started my “grieving” 10+ years ago due to cholesterol. Even earlier, since my teenage, I have long given up the freedom to eat whatever I want, whenever I want it. Such an unconstrained freedom gave my kids constipation and tooth decay, and gave me overweight.

~~ How about Total Gastrectomy.. I have heard about two such cases within 2 weeks after my CAD diagnosis! Gastrectomy would entail huge diet restrictions. Still, the survivors can live a normal life.

~~ grieving over .. “sweet foods”
Q: to prevent t2dm, will I have to avoid (not eliminate) ALL sweet foods [cakes, chocolates, many fruits,,,]
I told Huimei that fortunately sugary foods without starch/fat are not so attractive to me…

However, when Dr Leow warned me about the very big impact (not “risk”) of t2dm, I had a sinking feeling .. I may need to further restrain myself.

Perhaps this is a valuable jolt (or nudge) to adopt more strict but healthier diet habits. Not ascetic though. I don’t think anyone in my shoes would become 100% strict. (Huimei said “quality of life”.) I refuse to benchmark myself with 苦行僧/ascetic, whose existence is in my imagination only. I refuse to beat myself up.

%%cond|white blood cell

==== white blood cell
Q: any concern over white blood cell?
Steffy: your case is not due to viral infection, so you may have a low baseline, common in this region.

Q: why such big variation like 3.1 to 2.55 ?
Steffy: That’s Normal. variation is inherent in the measurement.

Q: what level would be worrying?
Steffy: we look at the various types of white blood cells and their ratios.

Now I feel I should check white blood cell periodically.

neutropenia — is the condition.

–history

  • 3.3 @ 21 Mar 2014 — OCBC-sponsored. My very first Raffles Medical health check
  • 3.1 @ 2 Feb 2019 — Polyclinic, investigation into skin complexion
  • 2.55 @ 24 Sep 2019 — My 2nd Raffles Medical health check, reviewed by Dr Steffy
  • 3.9 @ 24 Oct 2019 — Sing Land Tower, much higher than 30 days ago.
  • 3.6 @ 17 Aug 2020 — Dr Lau of ICON
  • 4.1 @  15 Jan 2021 — Sing Land Tower
  • 4.12 @ 25 Nov 2022 — Shenton
  • 3.68 @ 30 Jan 2023 — Shenton Screening
  • 3.2 @4 Sep 2023 — Healthway
  • 4.08 @6 Nov 2023 — Sing Land Tower
  • 3.5 Jan 2024 — ICON
  • 4.xxx early Apr 2024 — DrLeow
  • 3.45 Aug 2024 – DrLeow

%%cond|Amox allergy check

NUH .. nurse said allergic reactions can come and go. Best to check with a doctor to check current allergy.

Polyclinic? will likely refer me to specialist, but cheaper. If I really want to find out about my current amox allergy, it’s better to go with polyclinic and run a test, but no urgency.

Check with Raffles Hospital? Can get a partial reassurance, better than nothing but is it worthwhile?

— allergy test? Amox allergy basically means penicillin allergy. I would need to avoid all penicillins, but it’s not as bad as it sounds, because there are plenty of other antibiotics. It’s unlikely that i would ever end up with Situation A: no choice but reconsider amox. Situation A would require allergy test.

Also, aging can weaken some people’s immune system and make them allergic to amox in later life. Therefore, age 47 testing doesn’t mean for-life.

The allergy test has medical risks, so if not in Situation A, then the risk is an unnecessary risk.

Dr Lam said there are dozens of allergists in Singapore who can run the tests.

— Cigna covers specialist consultation.
However, the follow-up tests may not be covered and should be done only after confirming with Cigna.

CAD drugs #Ezetrol++

k_CAD

I will need to take cholesterol medication every day for life, even on vacations. Need to keep my LDL below 80.

— How to memorize my prescription details

  • Ezetrol-10 sounds like ethernet-10GB. (Ingredient is ezetimibe)
  • Plavix-75,
  • Crestor-20,
  • Voncinti-10

— hypoCol .. I suspect that from 2021 to mid 2023 I relied solely on hypocol and the plaque built up? Dr Leow said possible

— Lipitor ..
Lipitor or generics (like Crestor) are similar. Same active ingredients, but different “carriers”.

CAD: diet, sleep

k_CAD

— diet

reduce oily fatty including nuts

salmon OK

egg yolk? up to 4/week

organ meats? eat in moderation

— late dinner is not recommended

I resisted but Dr Leow said such lifestyles can bring back the plaque and threaten my life

— Sleep .. lack of quality sleep is a factor. Learn to sleep early

%%cond|ear wax build-up

Ceruminosis can block the ear canal, cause tinnitus, hearing loss, itching. It can also /aggravate/ inflammation like in early Oct 2017.

I am more likely than average to get ear wax build-up, so I need to take special precaution.

How to reduce the chance of cerunminosis?

  • avoid excessive use of ear plugs
  • avoid using cotton swabs to clean out the ear

How to keep from getting ceruminosis?

  • monthly ear drop of mineral oil
  • loosen and soften cerumen by directing warm water at the ear when showering — worked 🙂

CAD monitoring #stroke

k_CAD

monitor my heart health .. by periodic check on LDL (keep below 80) every 6M, blood pressure.

— CT .. once every 5Y

— Treadmill test frequency? Once in 3Y for low-risk individuals; Annually for me

— stroke? Dr Leow said no periodic checks available.

Blood thinner and cholesterol medications are required to reduce stroke risk.