We headed straight to Siloam Hospitals Kebon Jeruk (coz my grandfather had BPJS), arrived at 14.30 (took us almost 2 hours to drive from Bogor via Parung, and again, Winfrey on the wheel). He had his blood taken, MRI and ECG, and had some medications, blood pressure was 190mmHg systolic. Then we had to wait until 18.30 for confirmation of the room that he will be spending the next few days in. Everything was settled at 20.00. Grandpa insisted to go home several times, and we had to persuade him again and again that everything's okay.
The next day is Sunday, so there were no therapist available, both neurologist and cardiologist will have a look at grandpa around afternoon.
On Monday, doctor from rehab stopped by to check on him and to plan out his therapy sessions. He will have occupational therapy, speech therapy and physiotherapy everyday until he checks out from the hospital. His neurological motoric status for right arm is 2222 and right leg 3233. During the next few days in hospital, it was extremely hard for him to eat; he coughs a lot. So he had to focus and concentrate to swallow. He only ate 2 spoons (not spoonful) in every meal.
On Tuesday, we decided to consult to dr. Soewandi, SpRad (K) (interventional radiologist in Central Army Hospital) for the probability of DSA for grandpa. We only meet him for about 15 minutes to discuss about DSA, then we decided to wait until his therapy is finished at Siloam. After 3 days, grandpa is allowed to go home, but we decided to directly take him to RSPAD (Central Army Hospital). Just a note, to patients with BPJS and topup (eg. from first class to VIP), pay extra attention for examinations and medications which are suggested at the first hospital that we went to, because not all examinations and medications are necessary but patients without topup, it's fine.
He had chest XRAY and MRI (7 pieces of film plus MR Perfusion) that night. We were hoping that he can have DSA tomorrow or the day after, but we realized that it was Friday, and no procedures are planned during weekends at Central Army Hospital. After some discussions with dr. Erwin, SpS and another consultation with dr. Soewandi, SpRad (K), we decided to check out from Central Army Hospital early tomorrow morning, and take grandpa to Mitra Keluarga Kelapa Gading Hospital. There are few considerations to choose Mitra Keluarga Kelapa Gading:
1. We have MRI, thorax and lab results, we just need DSA.
2. DSA is available on weekends at 2 hospitals in Jakarta: Pluit Hospital and Mitra Keluarga Kelapa Gading Hospital. During weekdays, DSA is also available at Central Army Hospital.
3. Nearest hospital from Central Army Hospital is MKKG.
The next day (11th March 2017, 07.30am), my auntie, auntie's friend and I, arrived at the hospital. My cousin and I directly arrange for checking out from Central Army Hospital. All administration were finished at 9am. We headed to MKKG, arrived at 10am, submit some papers for admissions and were settled in the hospital room at 11am. Grandpa was already scheduled for DSA at 14.00, but had to run some blood tests again before the procedure. We had dr. Poppy K Sasmita, SpS, as grandpa's DPJP.
At around 11.30 or 12, blood test results came out, and his leukocyte was 16k-ish. dr. Soewandi, SpRad (K) then had to consult with dr. Iskandar, SpPD, and had to have Procalcitonin. This is marker to evaluate whether the patient has inflammation (infection) or not. If the result is positive, then we had to postpone the procedure and wait until it is negative. Thanks God, it was negative, so we are able to proceed with DSA. Grandpa was then brought to operating room at 16.45ish, and had DSA at 17.10.
We were all able to witness DSA in a room with windows overlooking the operating table and monitors which shows MR scans during the procedure, vital sings, etc. After about 30 minutes, procedure was finished, dr. Soewandi, SpRad (K) had grandpa lift his arm (surprisingly his motoric status was 5555!) and lift new infusion bottle (500mL), and miraculously did it!! We were so touched at the result and some of us can't bear our tears. We were all then told to go in and meet grandpa....
We had to make sure that grandpa should not bend his leg for the next 5 days to let the wound (which resulted from DSA) to heal. During the next few days, grandpa had speech therapy and physiotherapy. After 3 days, he gained his appetite and ate meals provided by hospital, plus snacks that we bought. After 5 days, we tested motoric status for his lower extremities, and it was 5555! We brought him to my home on 16th March 2017 to make sure grandpa is able to walk, take a bath, and do all daily activities by himself, then he will move back to Bogor.
Just a rough idea, for blood test, MRI and MR Perfusion at RSPAD is about 5mio, and the DSA itself differs in "healthy" patients and "sick". At MKKG for "healthy" patients, it's about 40ish mio (you only need to be hospitalized for one night, then you can go home, it's just to make sure that you don't bend your right leg). For "sick" patients, it's 40ish mio plus medications and blood tests, so it varies from one patient to another, depending on the diagnosis and condition. So others out there with similar experience, hopefully can get something out of this post, especially regarding DSA.
We celebrated his birthday yesterday, mom ordered "nasi tumpeng" from pandan (tumpeng from pandan turns out very tasty. The rendang is very recommended! But the satay is so-so.) Mami's friend also brought cake, but it wasn't very good, not recommended (from Grandville Island). Cely, me and my bf (Winfrey) bought a nice little cake at Lippo Mal Puri, well we bought it because it was very cute, and turns out it was good! Very recommended. Cely and I also prepared some balloons (transparent ballons: Happy, Birthday, Engkong, Gunawan, Hoesada; and some silver and gold doff balloons, just for decoration. That day, we also had grandpa to have acupuncture for both his right arm and leg, which took about 1 hour. This actually helped him to get his balance. He admitted to us that he felt improvement after acupuncture.
He's now able to slowly eat by himself with little help from mom to put food on the spoon, but he's able to lift spoon into his mouth. He sits and eat with us together around the dining table (in fact, a lot). Sometimes he walks from the room to family room to watch TV, then to the back porch with my uncle's staff from Bogor to guard his back or sides in case he looses balance. He exercises his feet and hands (with mom's help) every morning to gain more and more strength to his legs. I'm proud of his effort to gain strength although sometimes he still says that he's no longer useful and he can't do anything. All of us persuade and cheer him up every time so that he is also confident in himself.... I'm sure he's able to get back to his normal daily activities soon..... All of us are very grateful for Him, for His healing hand upon grandpa. Thank You, God!!
Grandpa showing his right arms are now strong!
(Left to Right) Top row: mami, mami's friend, dad, mom
Bottom row: me, grandpa, mak, Cely (my cousin).
He's actually 79.
Little birthday cake (Credits to Cely for the pictures)
Balloons Happy Birthday Engkong Gunawan Hoesada!
Last night (21st March 2017), we (mom, Cely, staff from Bogor and I, plus our driver) took grandpa to MKKG to have his appointment with dr. Poppy K Sasmita, SpS, and dr. Iskandar, SpPD. dr. Poppy was fascinated by grandpa's improvement, because the last time she saw grandpa, he was still taking itty bitty steps. She also said that grandpa is one of her patients with the fastest progress and improvement. She prescribed grandpa with Piracetam, Citicholine and Clopidogrel for one month. FYI, she's one of the most angelic physicians I know. Appointment with the internist was not very fruitful, though. He prescribed NaCl and Bisolvon (for nebulization because we asked him to, he was given nebulizer at Siloam and felt better from cough). And although he knew I was GP, he did not give FOC. Oh well...
This morning, grandpa had his second acupuncture appointment at home. After one-hour treatment, he was able to sit-stand-sit-stand for 12 times!! We were extremely touched and surprised. According to the shinshe's (we call him shinse), grandpa can have acupuncture for only one month because he his progressing very fast. Usually his patients have appointments for several months. Some patients even for one year. So grandpa is actually very lucky, thank You God!
