Archive for October, 2013

Day 10 (October 31)

Posted: October 31, 2013 in Daily update

Well, it’s Halloween here and everything looks normal except for all of these people dressed as doctors and nurses. Baseball is once again on TV, as the Japanese equivalent of the World Series continues to be played out. I think this is game #4 between the Yomiuri Giants and the Rakuten Eagles. Again there’s a nurse in the common room checking the score. “I hope the Eagles win”, proclaims our caretaker. “Rakuten will have a sale for sure.” Rakuten is an on-line shopping site similar in nature to Amazon. “If the Giants win, then nothing will happen. They’re not going to lower the price for newspaper subscriptions.” She had a point there, referring to Yomiuri’s strong hold on the newspaper market.

In other news, I had another blood test this morning. This time my INR was within range, so we’ll stay with the same dosage of warfarin until next week, when I have another drawing of blood. Next Monday is a national holiday in Japan and the hospital is ‘closed’ to regular patients, which means my doctor probably won’t be in. There’s not really much Dr. Tamura can do anyway, except to keep feeding me meds and to wait for the bacterial cultures to grow to grow in the lab. I’m not even close to being in a position where I’ll be released, but after I receive my first negative TB result in my sputum I’ll be allowed out of isolation and will be able to roam around the hospital freely. I can’t wait for that to happen. Being holed up here on the same 100 meter stretch of vinyl flooring for the last 10 days is beyond bearable.

IMG_0417

My home for the last 10 days

Medication

Posted: October 31, 2013 in TB medication

Here in Japan, the medication prescribed for tuberculosis is standardized throughout the country, and there are usually two different courses of treatment, depending on the age and liver condition of the patient. Most younger patients, including myself, are on treatment plan A, which consists of the following:

About two months:

Isoniazid (INH)

Rifampicin (RFP)

Ethambutol (EB)

Pyrazinamide (PZA)

At least 6 months:

Isoniazid (INH)

Rifampicin (RFP)

Ethambutol (EB) might also be extended, depending on my prognosis after 2 months.

My medication is administered once a day (in the morning) and consists of the following:

300mg of INH, 600mg of RFP, 1000mg of EB, and 1.5g of PZA. This is an awful lot of pills to be taking at one time, and can put quite a strain on the body. The first couple of days were rough, but the body adjusts to all of the drugs pretty quickly. Some of the side effects can be pretty bad, but so far they’ve been manageable. The worse thing about the medication is the PZA. It comes in powder form, just like those pesky stomach medicine packets the doctors prescribe when you have cold. For those who have never taken medicine in powder form, imagine chewing all of your medication before swallowing it and you can get the picture. Luckily PZA is not part of the long-term drug menu. And to think as I child, I had trouble swallowing just one pill.

IMG_0322

The two pills at the bottom of the picture are not part of the TB regimen, but are thrown in as extras. The red pill is a vitamin B6 pill (to counteract the side effects of INH). The white pill is to help settle the stomach and prevent nausea.

Day 9 (October 30)

Posted: October 30, 2013 in Daily update
Tags: ,

The kitchen staff must really be getting bored. How else could explain serving minestrone for breakfast and an omelette for dinner? I guess mixing it up every now and again is good for the patients as well. As the days turn into weeks, food really is the only thing that breaks the monotony of the day-to-day banality.

Talking of daily routines, here is a typical day in my new environment: the nurses come in around 7am to force us awake with the bright fluorescent lights. I usually roll back over, covering my head until breakfast is served at 8am. My meds are delivered at 8:30, after which I either head back to sleep or walk down to the common room to get on-line. After catching up on e-mail, I do a bit of writing until late morning, where I head back and wait for lunch, which is served preciously at noon. After that, I let the food settle until around 2pm, when the nurse comes to check up on me. Then it’s back on-line to do more work, followed by some time with a book and/or a nap until dinner time. I usually have a bath during this time as well, depending on when the shower is free. There’s a sign-up board outside of the shower and we can put our names in empty slots accordingly. Dinner comes at 6pm, after which I usually retreat back to the common room for more internet distraction until lights out at 9pm. I drift off to sleep some time after that, only to repeat the same thing over and over and over and over again.

I finally did laundry today. There’s a small laundromat in my ward that is surprisingly affordable. Only 100 yen for a load, followed by another 100 for the dryer. It’s nice to have clean clothes and definitely saves the hassle of giving it to Kanako to do. I wonder how many more times I’ll have to wash clothes before they let me out of here.

This afternoon a new patient was admitted and took the only available bunk in my room. I haven’t met the elderly gentleman yet, but overheard him talking to the doctors and nurses together with his wife. It looks like there’s an average of one new TB patient being admitted each week, and that’s only in my ward. Each floor has 2 wards, and there are two floors devoted entirely to TB patients, so the disease is far from being contained it seems.

And then there were 4

And then there were 4

Day 8 (October 29)

Posted: October 29, 2013 in Daily update
Tags: ,

Well, it’s been exactly one week since I was thrown in here, and I’m starting to see weekly patterns emerge. For instance, today my sheets were changed for the first time by the staff of assistants in pink uniforms. “We’re one day early,” explained the energetic leader. Last Wednesday they changed my roommates sheets but this week they decided to change them on Tuesday. Perhaps it’s been a slow week? Next week I’ll be able to tell for sure, but I’m sure they’ll show up on Monday just to throw me for a loop. I told them that my birthday was next month in hopes that they’d bring me a present. “Give me your blue eyes for Christmas!”, shouted the braver of the two.

Baseball is once again dominating the common room, and some of the nurses are even watching game 3 of the Japan Series. The nurses on my floor definitely aren’t as busy as the time I was hospitalized for heart surgery. I guess respiratory problems don’t tend to flare up as suddenly as cardiovascular challenges. Sure, some patients might have a sudden asthma attack, but rarely does TB suddenly send someone into cardiac arrest. It’s more of a slow killer that consumes the body from inside. Hence, the traditional pen name  for the disease.

Kanako once again came to visit after she finished work. I made some room in my bed for her as we settled in for a (fully clothed) nap. The only problem was the nurse kept interrupting us. Where are the Do Not Disturb signs when you need them?

IMG_0400

Patient and visitor. Which is which?

Day 7 (October 28)

Posted: October 28, 2013 in Daily update
Tags: ,

The lights twinkled softly in the mid-autumn shimmer of the chilly evening. Well, at least I think it was chilly out there. Ever since I entered the hospital I’ve been stuck in this climate-controlled environment and have no logical grasp on what is happening in the world beyond my double-paned glass. Is autumn arriving, or is it still unseasonably mild? Are the winter winds starting to pick up? Are the maple leaves starting to change?

I awoke shortly before 6am with a needle in my arm. The nurse diligently extracted my blood while I drifted in and out of a haze-lined consciousness. Do the blood tests really need to be done so early in the morning? After my regular regime of tasteless bread and bitter medicine, Dr. Tamura came to my bed with a look of shame. “We forgot to check your INR,” explained my caretaker is a very apologetic voice. “We need to take another sample.” Great, I thought, just stick me in the left art to even out the vessel damage. INR, for the uninitiated, is a ratio used to measure the clotting tendency of the blood. Because I take warfarin, an anticoagulant, this ratio is important for determining how much medicine to administer. The TB treatment is thought to interfere with warfarin’s effectiveness, so the doctors have been tinkering around with my dosage. This morning’s test result revealed my INR slightly out of range on the high end, so a slight tweak was made,  which will be followed by another blood test in a few days. I’ll be sure to remind the doctor not to forget to check my INR every time I see him.

The blood test revealed no abnormalities in my liver function, which means the TB meds haven’t wrecked my liver yet. My blood pressure has been higher than normal, but I’m not sure if that’s a side effect of the medication or the result of this privacy-deprived environment. I hope the blood pressure drops to normal levels soon. I’m on enough medication as it is!

In addition to the blood mishap, the only other exciting thing that happened today was the nurse brought in a menu of this week’s food. It turns out I can choose what I what to eat in the latter half of the week. Mondays and Tuesdays are fixed, but from Wednesdays to Fridays I have a choice between two different menus for lunch and dinner. I spent a few minutes deciding between choice A and B before giving the order form back to my nurse Sakai-san. Last week I wasn’t offered this luxury because I was admitted on a Tuesday. Next time I’ll be sure to check-in bright and early Monday morning.

IMG_0381

The night view from my bed

 

 

Day 6 (October 27)

Posted: October 27, 2013 in Daily update
Tags: ,

Despite making me feel groggy at times, it appears that the medication is starting to work its magic. My phlegm is tinged with red blood less and less, and the frequency of my coughing has diminished discernibly. I’ve had a nonstop cough for just about the last 4 years, so now I’m wondering if the true underlying cause was this TB, or if my cough will return whenever my asthma flares up. With a minimum of 6 months of daily medication ahead of me, I hope that my cough will forever be eradicated and I can start a new chapter in my life.

I received a package from Grace this morning, which Kanako promptly delivered to the hospital. Grace is my mountain kohai (junior/apprentice), who recently finished climbing Japan’s 100 Famous Mountains after being inspired by yours truly. Though I’m technically not supposed to supplement my caloric intake with food brought from the outside, she sent me an eggplant salad that was simply scrumptious: eggplant, bell peppers, black olives, mushrooms, and onions mixed together in olive oil and spices. This was my first non-Japanese dish in nearly a week and my stomach and taste buds are forever grateful for the brief respite. The castella cake and cookies she baked as well will make a great afternoon snack. I would have dug into them if not for the ice cream Kanako that snuck into my room for me. I wonder how many more rules I will end up breaking before they kick me out of here.

I finally had a chance to talk with one of my roommates, the middle-aged man who shares the adjacent curtain. Though we didn’t talk for long, he did divulge the fact that he’s been in here for over 3 weeks. He had some family visiting him today which was refreshing to see. The one thing I’ve noticed about every TB patient on my hall is that every single one of them is skinny as a rail. Is that a prerequisite, or is the food really that bad that everyone is on some kind of hunger strike?

With the weekend coming to a close, I’ll finally get to talk with my doctor again. Japanese hospitals are unique in that they pretty much close during the weekends. Got an emergency? It better not be on on a Sunday!

IMG_0380

Can you spot the odd one out?

 

Day 5 (October 26)

Posted: October 26, 2013 in Daily update

Again the common room is alight with activity. The baseball draft causing such excitement of a few days ago has been replaced by Game 1 of the Japanese equivalent of the World Series, with the Yomiuri Giants taking on the Rakuten Eagles. Osaka residents rarely take interest in any game that doesn’t involve the Hanshin Tigers, so despite the importance of the game, there isn’t very much visible excitement here. My hunch is that most are pulling for Rakuten, a Sendai-based team whose stadium was heavily damaged in the 2011 Tohoku earthquake and tsunami. Oh, the Giants just scored and no one cheered. Perhaps I was right!

The throng of visitors  I was anticipating failed to materialize. I get the feeling my hospital ward is doubling as a nursing home for some of the older patients who are no longer able to look after themselves. I really have no idea how many patients there are my floor, but yesterday evening I counted over twenty food trays.

Speaking of food, the lack of food variety is starting to become of of the toughest issues with my new life in the hospital. Usually in Osaka I find a good balance between traditional Japanese cuisine and hearty ethnic flavors, but I’m not offered that luxury here. Last night I finally negotiated with the nurse to lower the amount of white rice with my meals from 300 to 200 grams. Even with the smaller portions, I’m still unable to finish the sticky, glutinous lump of carbohydrates. I’m more of the long-grain, brown rice school of nutrition, so I fear that my affinity for white rice will be inversely proportional to the length of my stay.

Other than the rice, the main and side dishes aren’t bad. Ask me again in a few weeks and I might change my mind, but the food is definitely more palatable than what’s on offer aboard most flights and about what you’d expect to find in a school cafeteria. My daily game has been to try to guess what meals will be served as the meal trays are being carted down the hall to my room. Since I’m at the very end of the hall, I’m the very last person to receive my daily allotment of nutrients. I never need to check my watch to see when the food will be delivered. I only need to keep my ears peeled for “Mary Had a Little Lamb”, the chime that the cruel designers at Panasonic have built into the meal storage machine. Mary had a Little Lamb? Old McDonald is more like it!

Another satisfied customer

Another satisfied customer