I feel it is not exactly right for me to comment one way or another on my stay at the Cardinal Santos Medical Center. It is not as if I have had major surgery at enough different hospitals that my opinion should matter.
That said, I just want to say that I experienced nothing that would make me want to avoid this particular medical institution in the future.
First of all, I am perfectly cognizant that the way a patient will define "efficient" will always be different from the way a hospital will define "efficient." In the end, we have to respect a hospital's efficiency because this is the only way they can be profitable, and it is only with profitability that they can make continuing investments in medical technology. Ultimately, it is what will make us a stronger, healthier society.
In the same vein, I will always try to answer even the most innane question from a medical intern or a nursing trainee. This is part of an educational process that will ensure continuing quality care for those who come after us, most expecially our children and their children.
At the end of day, all I ask from a hospital are three things: 1) competent personnel; 2) a genuine regard for the patient's rights and welfare, as reflected by a functioning sytem; and 3) not to nickel-and-dime us to death.
Under this standard, I'd return to CSMC again and again.
The Thank You Post
I suspect this blog of mine may have cemented some percolating notions that Kathy married something of a control freak (and yes, maybe she did) "My God this guy, he has rules for everything, dadalaw na lang, may rules pa!")
I will acknowldge that there was a subtle message I was trying to convey, which is this - I feel that many times we, all of us, when we hear of friends or relatives who have medical situations, we would like to be supportive; but we want to be suppportive on our own terms, at our own convenience, and at maximum brownie or pogi points.
The best attitude, I feel, was exemplified this time around by my own mother-in-law, Mrs. Anita Dy Sy, and I would like to take this opportunity to thank her with all my heart. Every morning, as the city slept, she would wake up (I imagine) at around the same time as the roosters and hens to make me some hot breakfast. She would then make the trip to CSMC and leave this hot food with my nurse. What impressed me the most was that I never heard her leave word as to why the food must be consumed. If it went to waste, and if by extension her efforts went to waste, it seemed to be fine with her. But as long as I woke up hungry, the hot food would be there. This is the spirit of humble supportiveness that over and above everyone I wish to thank, I emphasize here.
This is also my message. If it seems a bit preachy or judgmental, I apologize. But I will say this time and again: I will hold myself to same standard.
I will acknowldge that there was a subtle message I was trying to convey, which is this - I feel that many times we, all of us, when we hear of friends or relatives who have medical situations, we would like to be supportive; but we want to be suppportive on our own terms, at our own convenience, and at maximum brownie or pogi points.
The best attitude, I feel, was exemplified this time around by my own mother-in-law, Mrs. Anita Dy Sy, and I would like to take this opportunity to thank her with all my heart. Every morning, as the city slept, she would wake up (I imagine) at around the same time as the roosters and hens to make me some hot breakfast. She would then make the trip to CSMC and leave this hot food with my nurse. What impressed me the most was that I never heard her leave word as to why the food must be consumed. If it went to waste, and if by extension her efforts went to waste, it seemed to be fine with her. But as long as I woke up hungry, the hot food would be there. This is the spirit of humble supportiveness that over and above everyone I wish to thank, I emphasize here.
This is also my message. If it seems a bit preachy or judgmental, I apologize. But I will say this time and again: I will hold myself to same standard.
14 Days
Tomorrow will mark two full weeks, or 14 days, since my surgery. Overall my recovery is going very well and there are thankfully no major issues.
Of course the recovery period has not been without its share of difficulty.
Men are generally quite independent creatures. We take great pride in our wits. Not necessarily our "wit", but our "wits", meaning the ability to think things through, move around, get things done. I am no different. This is why men have a very diffficult time asking for directions. This simple act, usually one of convenience and expediency for women, has a whole different level of significance for men. To do so is tantamount to an act of surrender, an invalidation of an entire skill-set we hold so dear.
So imagine moving from this state of mind to another one wherein you have to wait for someone to help you put your pajamas on. Of course it's a frustrating process.
I'm trying to be patient. I recognize that the more I fight the recovery process, the more I will become a burden to my caregivers. So I'm doing my best to be cooperative and patient. We do want to avoid any accidents that could set back recovery.
Biggest problem remains to be the hiccups. I know it sounds so stupid, but literally, I spend every waking second in horror of the next onslaught. Eventually they will come, uncontrollable and relentless, disrupting all joy from life and recovery.
I reached my breaking point around three days ago. I reached the end of my resolve. The aspired-for stoicism simply shattered by hiccups at 4 in the morning. I screamed at Kathy.
Eventually, the only thing we found that encountered some measure of success controlling the hiccups is a very very cold drink. It must be the type that's cold enough to give one brain freeze, like a milk shake or a very cold smoothie. Then the trick is to drink big gulps and kinda "shock" the hiccups away. Hopefully, this will continue to work and I don't get sick in other ways from all the cold.
Of course the recovery period has not been without its share of difficulty.
Men are generally quite independent creatures. We take great pride in our wits. Not necessarily our "wit", but our "wits", meaning the ability to think things through, move around, get things done. I am no different. This is why men have a very diffficult time asking for directions. This simple act, usually one of convenience and expediency for women, has a whole different level of significance for men. To do so is tantamount to an act of surrender, an invalidation of an entire skill-set we hold so dear.
So imagine moving from this state of mind to another one wherein you have to wait for someone to help you put your pajamas on. Of course it's a frustrating process.
I'm trying to be patient. I recognize that the more I fight the recovery process, the more I will become a burden to my caregivers. So I'm doing my best to be cooperative and patient. We do want to avoid any accidents that could set back recovery.
Biggest problem remains to be the hiccups. I know it sounds so stupid, but literally, I spend every waking second in horror of the next onslaught. Eventually they will come, uncontrollable and relentless, disrupting all joy from life and recovery.
I reached my breaking point around three days ago. I reached the end of my resolve. The aspired-for stoicism simply shattered by hiccups at 4 in the morning. I screamed at Kathy.
Eventually, the only thing we found that encountered some measure of success controlling the hiccups is a very very cold drink. It must be the type that's cold enough to give one brain freeze, like a milk shake or a very cold smoothie. Then the trick is to drink big gulps and kinda "shock" the hiccups away. Hopefully, this will continue to work and I don't get sick in other ways from all the cold.
Desperation Time. Smoothie to the Rescue.
The hiccups returned around 12:30 midnight. Total desperation time. No help in sight, at least five hours until daylight.
Special thanks to my sister Shirley who prepared two glasses of lychee smoothies tonight. The second glass, still in the fridge, has worked for now. Now I try my best to go to sleep and extend this respite.
As for the health implications of gulping down an icy smoothie at midnight and going stright to bed, I agree it's cause for some valid concern. But, desperate needs call for desperate measures.
Special thanks to my sister Shirley who prepared two glasses of lychee smoothies tonight. The second glass, still in the fridge, has worked for now. Now I try my best to go to sleep and extend this respite.
As for the health implications of gulping down an icy smoothie at midnight and going stright to bed, I agree it's cause for some valid concern. But, desperate needs call for desperate measures.
First Check Up
Went to see Dr. Mercado Tuesday afternoon for my first check-up. He was quite pleased with what he saw, I think.
We also received the formal lab report that analysis of the tumor material removed showed it to be non-malignant. While this was never a big issue, it's still a additional relief to receive authoritative comfirmation. One less thing to worry about.
Dr. Mercado then proceeded to take out the staples from my skin incision. I was not looking forward to this but basically, I did't feel a thing. He now wants me to treat the surgical wounds as "normally" as possible.
We also received the formal lab report that analysis of the tumor material removed showed it to be non-malignant. While this was never a big issue, it's still a additional relief to receive authoritative comfirmation. One less thing to worry about.
Dr. Mercado then proceeded to take out the staples from my skin incision. I was not looking forward to this but basically, I did't feel a thing. He now wants me to treat the surgical wounds as "normally" as possible.
Status Update
Basically, I feel good. The hiccups are under control, and the only discernable effects from my surgery as far as I'm concerned is a stiffness of the head muscles, brought on by muscle tissue that were cut during surgery to expose or "reach" the tumor.
My days are still difficult to get through, mostly due to boredom. But this is partly my fault. I believe I have been taking it too easy, and so this total lack of exertion leads to inability to fall asleep at night.
At this point, I'm really quite a bit emberrassed for having called so much attention to my condition. I was just watching this hospital show on the History Channel, and some people have real problems. Really, what I've had to go through, was easy compared to these people. I hope I did not overly dramatize things.
Beginning tomorrow, I have to be more productive. Even if it's just reading a real book, I have to stop wasting all this time...
My days are still difficult to get through, mostly due to boredom. But this is partly my fault. I believe I have been taking it too easy, and so this total lack of exertion leads to inability to fall asleep at night.
At this point, I'm really quite a bit emberrassed for having called so much attention to my condition. I was just watching this hospital show on the History Channel, and some people have real problems. Really, what I've had to go through, was easy compared to these people. I hope I did not overly dramatize things.
Beginning tomorrow, I have to be more productive. Even if it's just reading a real book, I have to stop wasting all this time...
The Latest
I'm well. Showing no ill effects whatsoever from surgery. It's only a matter of recovering from the surgical wounds. So in that sense, by this point am no different from someone who underwent knee surgery or a c-section. In short, anyone who underwent surgery. So while I'm being cautious, I'm also a bit wary of over-babying myself. The latter can be equally counter-productive.
Philosophically am also at a same place. I'm almost ashamed to say that I had brain surgery. "Procedure to remove some excess tissue inside the ear" seems more apt, more correct. But I am also wary of trivializing the very real blessing that the operation went so well.
I'm blogging from a new Asus laptop with an ATOM processor. I dragged Kathy to SM yesterday to search for one yesterday. ATOM processors are made by Intel as part of an industry mission to make laptops, and therefore computing power, more accessible. I think the end goal is to get laptops out for less than $100. Things are still very far, since the current price point in the Philippines is around $450. At that price the whole thing makes very little sense since "regular" laptops with more established and superior processors start at $500, so I think they have to get things down to $250 or at least around P15,000 before the whole thing of having a "dumber" processor begins to make sense.
I plunked down P21,000 (6 installments of P3,500) for mine and my excuses to myself for the expenditure is that this thing is half the weight of my Lenovo (less of a strain on my surgical wounds. ha!) and therefore more mobile. Battery life will be key, because what's the use of mobility if its dead? This Asus promises 9.5 hours and backs it up with a 1-year warranty including the battery. As to whether or not it actually delivers on the 9.5 hours will be clearer a few months down the road.
Philosophically am also at a same place. I'm almost ashamed to say that I had brain surgery. "Procedure to remove some excess tissue inside the ear" seems more apt, more correct. But I am also wary of trivializing the very real blessing that the operation went so well.
I'm blogging from a new Asus laptop with an ATOM processor. I dragged Kathy to SM yesterday to search for one yesterday. ATOM processors are made by Intel as part of an industry mission to make laptops, and therefore computing power, more accessible. I think the end goal is to get laptops out for less than $100. Things are still very far, since the current price point in the Philippines is around $450. At that price the whole thing makes very little sense since "regular" laptops with more established and superior processors start at $500, so I think they have to get things down to $250 or at least around P15,000 before the whole thing of having a "dumber" processor begins to make sense.
I plunked down P21,000 (6 installments of P3,500) for mine and my excuses to myself for the expenditure is that this thing is half the weight of my Lenovo (less of a strain on my surgical wounds. ha!) and therefore more mobile. Battery life will be key, because what's the use of mobility if its dead? This Asus promises 9.5 hours and backs it up with a 1-year warranty including the battery. As to whether or not it actually delivers on the 9.5 hours will be clearer a few months down the road.
30 DAYS
Today is my 30th day post-op. It's an important milestone for us Chinese, a day when one who underwent surgery is supposed to have completed the most critical period of his recovery - the first month afterwards.
I do feel good. But ironically I've experienced more headaches this past week than during the days immediately following my surgery. I think this is because we started weaning myself off the steroids beginning my second check up roughly nine days ago. So the swelling is probably less artificially controlled and hence the headaches. I feel a general ache whenever my head hits the pillow but it disappears once I stand up so in that sense it's actually very manageable.
Some other things I've noticed:
1) My neck tires a bit more easily. This is to be expected I guess. My neck muscles were cut during surgery and then sewn back together so structurally they are now weaker. Like a concrete post that cracked during an earthquake, no matter how much you try to patch the concrete it probably ends up less strong afterwards. I understand they're fixing the Bay Bridge in the San Francisco Bay Area these few days, and it's probably exactly the same principle; no matter how good of a job they do, I doubt if it'll end up as strong and as sound as it was before it was damaged.
2) My right arm seems weaker. To be more accurate, my right shoulder seems weaker. I am less able to lift and extend my right arm with speed and confidence. I have no idea if this is related to the surgery or just from all the non-activity; but it does provide a convenient excuse for all the jumpers I will miss in the future.
This said, I do wish to emphasize that my surgery went remarkably well. The chap below, John Kelly, had surgery to remove a 4cm AN and ended up like this:
You can read his story here or his blog here. Know this: it is NOT just a matter of vanity, when you lose control of your facial muscles, it leads to very real health issues. You cannot voluntarily blink, so your eye is open even when you're asleep. The eyeball begins to degenerate, and you have to resort to taping the eye shut. Read John's November 25 entry in the Guardian to have a better idea.
I hope I can be 100% "normal" soon. Last Tuesday we took Steffi to Trinoma upon her request to ride the "yellow car". It's actually a two-seat mini-simulator. Like the one that used to be at the Shangrila Mall and like the RIALTO at Enchanted Kingdom, except instead of an entire theater sized thing it's in the form of an amusement center ride and can fit only two people. Makes sense, less overhead, less capacity costs. Anyway, I do not know if it was just my imagination, but when we were at the mall I thought I saw in Steffi's 4-year-old eyes some confusion: "This papa of mine is the biggest, strongest man I've known since I was born, the problem solver, the fixer of all broken toys. Why is he now the weakest, the slowest?" I do not want her to get used to the thought that her dad is handicapped.
I do feel good. But ironically I've experienced more headaches this past week than during the days immediately following my surgery. I think this is because we started weaning myself off the steroids beginning my second check up roughly nine days ago. So the swelling is probably less artificially controlled and hence the headaches. I feel a general ache whenever my head hits the pillow but it disappears once I stand up so in that sense it's actually very manageable.
Some other things I've noticed:
1) My neck tires a bit more easily. This is to be expected I guess. My neck muscles were cut during surgery and then sewn back together so structurally they are now weaker. Like a concrete post that cracked during an earthquake, no matter how much you try to patch the concrete it probably ends up less strong afterwards. I understand they're fixing the Bay Bridge in the San Francisco Bay Area these few days, and it's probably exactly the same principle; no matter how good of a job they do, I doubt if it'll end up as strong and as sound as it was before it was damaged.
2) My right arm seems weaker. To be more accurate, my right shoulder seems weaker. I am less able to lift and extend my right arm with speed and confidence. I have no idea if this is related to the surgery or just from all the non-activity; but it does provide a convenient excuse for all the jumpers I will miss in the future.
This said, I do wish to emphasize that my surgery went remarkably well. The chap below, John Kelly, had surgery to remove a 4cm AN and ended up like this:
You can read his story here or his blog here. Know this: it is NOT just a matter of vanity, when you lose control of your facial muscles, it leads to very real health issues. You cannot voluntarily blink, so your eye is open even when you're asleep. The eyeball begins to degenerate, and you have to resort to taping the eye shut. Read John's November 25 entry in the Guardian to have a better idea.I hope I can be 100% "normal" soon. Last Tuesday we took Steffi to Trinoma upon her request to ride the "yellow car". It's actually a two-seat mini-simulator. Like the one that used to be at the Shangrila Mall and like the RIALTO at Enchanted Kingdom, except instead of an entire theater sized thing it's in the form of an amusement center ride and can fit only two people. Makes sense, less overhead, less capacity costs. Anyway, I do not know if it was just my imagination, but when we were at the mall I thought I saw in Steffi's 4-year-old eyes some confusion: "This papa of mine is the biggest, strongest man I've known since I was born, the problem solver, the fixer of all broken toys. Why is he now the weakest, the slowest?" I do not want her to get used to the thought that her dad is handicapped.
The Most Expensive Five Hours of My Life
Next Wednesday, November 25, 2009, I am scheduled to undergo Gamma Knife RadioSurgery to "kill" or "deactivate" what remains of my Acoustic Neuroma.
First things first, just to be clear, there is actually no knife. The word "knife" is in this tool's name, I think, to present the idea that the gamma rays will accomplish what used to take a real knife to do. Basically it boils down to a machine shooting some (invisible) rays into me. It is called RadioSURGERY only to differentiate it from RadioTHERAPY. Radiosurgery uses a fairly large dose of radiation to zap the tumor in one sitting, while radiotherapy uses much smaller doses to accomplish the same thing over multiple sessions. At any rate, no cutting and no bleeding takes place.
That said, it still sounds like a fairly uncomfortable experience. Ironically, probably more uncomfortable than the surgery. In the surgery phase I felt no pain DURING (since I was asleep) but there was discomfort AFTER (during recovery). With this procedure it sounds like there will be discomfort DURING but none AFTER. I should be back to normal the very next day. Here's how it's supposed to go: (Note to Alvin and Alan - this is where you stop reading!)
First they take this metal frame and literally screw it onto my head (probably a little bleeding there, but nothing major). This frame will ensure that when they need my head absolutely immobile, it will be. Then they take this gadget taken from the pyramids of Egypt, left behind by aliens millions of years ago, and stick it onto my brain through my right nostril. Ok, joke lang that last statement. :-) With the frame attached to my head, they then take one final MRI and use the scans to plot the position of the tumor relative to my head and the frame so they can input these coordinates into the Gamma Knife machine. This tells the machine where to "shoot" and how large of a "bullet" to use. All this will take about five hours, and with the price tag for this procedure, this just about makes next Wednesday morning the most expensive five hours of my life..
First things first, just to be clear, there is actually no knife. The word "knife" is in this tool's name, I think, to present the idea that the gamma rays will accomplish what used to take a real knife to do. Basically it boils down to a machine shooting some (invisible) rays into me. It is called RadioSURGERY only to differentiate it from RadioTHERAPY. Radiosurgery uses a fairly large dose of radiation to zap the tumor in one sitting, while radiotherapy uses much smaller doses to accomplish the same thing over multiple sessions. At any rate, no cutting and no bleeding takes place.
That said, it still sounds like a fairly uncomfortable experience. Ironically, probably more uncomfortable than the surgery. In the surgery phase I felt no pain DURING (since I was asleep) but there was discomfort AFTER (during recovery). With this procedure it sounds like there will be discomfort DURING but none AFTER. I should be back to normal the very next day. Here's how it's supposed to go: (Note to Alvin and Alan - this is where you stop reading!)
First they take this metal frame and literally screw it onto my head (probably a little bleeding there, but nothing major). This frame will ensure that when they need my head absolutely immobile, it will be. Then they take this gadget taken from the pyramids of Egypt, left behind by aliens millions of years ago, and stick it onto my brain through my right nostril. Ok, joke lang that last statement. :-) With the frame attached to my head, they then take one final MRI and use the scans to plot the position of the tumor relative to my head and the frame so they can input these coordinates into the Gamma Knife machine. This tells the machine where to "shoot" and how large of a "bullet" to use. All this will take about five hours, and with the price tag for this procedure, this just about makes next Wednesday morning the most expensive five hours of my life..
Some Final Concerns
Last Saturday, November 14, about 90 days after my surgery I had my first post-op MRI. Here is the shot most comparable to the initial MRI which I earlier posted on the upper right hand portion of this blog:
If you look closely enough you can still see the tumor but it is now much lighter in color.
When I first read the report accompanying the MRI, my heart sank. The report stated that the remnant was a 3.5 cm tumor measuring 3.5 x 2.5 x 3.1. While this was significantly smaller then the pre-op size (a 4.1 cm tumor measuring 3.8 x 4.1 x 3.7), a 3.5cm tumor would still be larger than the theoretical maximum of 3 cm which would make it "gamma knife-able".
A visit to Dr. Mercado provided some comfort. He explained that since the tumor was now irregularly shaped (no longer round or spherical), the normal convention of using the longest dimension to describe a tumor was no longer applicable. In short, this is not really a 3.5cm tumor. When we have a computer compute the actual volume of this irregular shape it would be smaller than 3.5 cm., he said.
Ok, that made sense. In their original and untouched form, tumors tend to be spherical, which would mean they measure roughly the same in all directions:
(note my initial measurements of 3.8 x 4.1 x 3.7) No matter which direction we roll this sphere, we would get roughly the same measurement so it is reasonable to use the convention of using one side's measurement as the tumor size.
Once we cut away a portion of the tumor via surgery -
then things change because the tumor now becomes irregularly shaped or non-symmetrical. While one side might still be 4cm in length,
we cannot reasonably refer to this as a 4cm tumor because it is undeniably smaller than the original one.
So like I said, the consultation with Dr. Mercado brought some measure of comfort. So I made some agreeable noises, put on a reasonably happy face and acted like everything was great. As Amarillo "Slim" Preston once said: "There is no need for me to be a hardship on my family the times I do lose."
Still, I had three worries -
1) While I was convinced that the volume of the remaining tumor was less than 3.5cm, when I looked at the measurements 3.5 x 2.5 x 3.1 I also realized that the actual volume would definitely be greater than 2.5 cm, which would make it very close to the theoretical 3cm maximum. How do I know this? Well, how do we find the volume of an irregularly shaped tumor? One way would be to make it a spherical one so that we could use the original measurement conventions. In making it spherical we make it symmetrical. To make it symmetrical we make the longer sides shorter and the shorter sides longer until all three sides are equal. As the shortest side, the 2.5cm side would inevitably become longer, and that's how I knew that the actual volume could not be smaller than 2.5cm. It would be somewhere between 2.5cm and 3.5cm, maybe 3cm, dangerously close to the theoretical maximum. Using only a calculator we can even figure out the length of an "equalized" side by adding up the three dimensions and dividing by three. The result = 3.0333cm!! Right on the maximum! Now I was really starting to worry.
I went so far as to test my theory using clay. I cut out a piece of clay which would measure 3.5cm on 1 side
2.5cm on another
and 3.1cm on the third and final side
Then I rolled it into a sphere and measured that sphere
I don't know if that's 3.033 but it's close enough for me. So this was my obvious worry: if we're on the maximum "gamma knife-able" size would this mean that there would be a significant chance of failure?
2) Even if we were okay on volume, is it okay for one side to be more than 3cm? This is a real issue. For instance, airlines not only put a limit on the weight of our baggage but also on the dimensions, because if one dimension is too long, it might not fit in the baggage hold. As an exaggerated example, I could not bring onto a plane a very light but long stick that is longer than the plane. I might be ok weight-wise but it could never fit into the plane. Fortunately the answer to this second concern is more easily and definitively determined.
3) My final concern was that Dr. Mercado might not give me straight answers to concerns 1 and 2. Don't get me wrong, I am not questioning his honesty and integrity, but I worry that since a second surgery on the same spot to further reduce the tumor is not advisable, then he might spare me any bad news on the two concerns if there were no definite way to "fix" any issues that might exist. Still, I went back to see him today one final time, wanting to ask him my nagging questions in person.
I came out of his clinic an infinitely happier man. I asked him two series of questions:
Q: Why does the tumor appear much lighter on the latest MRI?
A: (after explanations about blood supply and contrast dyes) Basically, there are much less living tumor cells within the tumor. The tumor is less dense.
Q: If it is less dense, given two tumors of identical sizes, one never-been-touched and the other already debulked via surgery, would it be fair to say that it will take less to kill the latter even though it is of the same volume as the former? Since it is less dense after having been "debulked".
A: That is absolutely correct.
This exchange pleased me no end, because it gives me some assurance that even if the volume of my remaining tumor is indeed right on the maximum of 3 cm, chances are very good that the radiosurgery will be successful because the tumor is now already easier to kill. Furthermore, even at 3cm, they will probably not even have to use maximum radiation dose. A "fresh" or "untouched" 3cm tumor is not the same as a 3cm tumor that resulted from debulking a larger tumor. Going back to our orange peel analogy, the peel left behind might still be 3cm in volume, but it is just peel, not strong and healthy orange.
Q: The 3cm theoretical maximum refers to total volume and doesn't mean that all sides must be smaller than 3cm, right?
A: Yes. We can tailor the beams to any size. The concern is that if the total volume is too large, then the required dose of radiation will be too high and will spill over to the healthy neural structures.
Another good answer!
Finally, I think Dr. Mercado saw through my questions to my actual concerns because he volunteered this statement: "With all credibility, honesty, and sincerity I say to you that your tumor is now ideal for gamma knife."
Here we go...
If you look closely enough you can still see the tumor but it is now much lighter in color.
When I first read the report accompanying the MRI, my heart sank. The report stated that the remnant was a 3.5 cm tumor measuring 3.5 x 2.5 x 3.1. While this was significantly smaller then the pre-op size (a 4.1 cm tumor measuring 3.8 x 4.1 x 3.7), a 3.5cm tumor would still be larger than the theoretical maximum of 3 cm which would make it "gamma knife-able".
A visit to Dr. Mercado provided some comfort. He explained that since the tumor was now irregularly shaped (no longer round or spherical), the normal convention of using the longest dimension to describe a tumor was no longer applicable. In short, this is not really a 3.5cm tumor. When we have a computer compute the actual volume of this irregular shape it would be smaller than 3.5 cm., he said.
Ok, that made sense. In their original and untouched form, tumors tend to be spherical, which would mean they measure roughly the same in all directions:
(note my initial measurements of 3.8 x 4.1 x 3.7) No matter which direction we roll this sphere, we would get roughly the same measurement so it is reasonable to use the convention of using one side's measurement as the tumor size.Once we cut away a portion of the tumor via surgery -
then things change because the tumor now becomes irregularly shaped or non-symmetrical. While one side might still be 4cm in length,
we cannot reasonably refer to this as a 4cm tumor because it is undeniably smaller than the original one.So like I said, the consultation with Dr. Mercado brought some measure of comfort. So I made some agreeable noises, put on a reasonably happy face and acted like everything was great. As Amarillo "Slim" Preston once said: "There is no need for me to be a hardship on my family the times I do lose."
Still, I had three worries -
1) While I was convinced that the volume of the remaining tumor was less than 3.5cm, when I looked at the measurements 3.5 x 2.5 x 3.1 I also realized that the actual volume would definitely be greater than 2.5 cm, which would make it very close to the theoretical 3cm maximum. How do I know this? Well, how do we find the volume of an irregularly shaped tumor? One way would be to make it a spherical one so that we could use the original measurement conventions. In making it spherical we make it symmetrical. To make it symmetrical we make the longer sides shorter and the shorter sides longer until all three sides are equal. As the shortest side, the 2.5cm side would inevitably become longer, and that's how I knew that the actual volume could not be smaller than 2.5cm. It would be somewhere between 2.5cm and 3.5cm, maybe 3cm, dangerously close to the theoretical maximum. Using only a calculator we can even figure out the length of an "equalized" side by adding up the three dimensions and dividing by three. The result = 3.0333cm!! Right on the maximum! Now I was really starting to worry.
I went so far as to test my theory using clay. I cut out a piece of clay which would measure 3.5cm on 1 side
2.5cm on another
and 3.1cm on the third and final side
Then I rolled it into a sphere and measured that sphere
I don't know if that's 3.033 but it's close enough for me. So this was my obvious worry: if we're on the maximum "gamma knife-able" size would this mean that there would be a significant chance of failure?
2) Even if we were okay on volume, is it okay for one side to be more than 3cm? This is a real issue. For instance, airlines not only put a limit on the weight of our baggage but also on the dimensions, because if one dimension is too long, it might not fit in the baggage hold. As an exaggerated example, I could not bring onto a plane a very light but long stick that is longer than the plane. I might be ok weight-wise but it could never fit into the plane. Fortunately the answer to this second concern is more easily and definitively determined.
3) My final concern was that Dr. Mercado might not give me straight answers to concerns 1 and 2. Don't get me wrong, I am not questioning his honesty and integrity, but I worry that since a second surgery on the same spot to further reduce the tumor is not advisable, then he might spare me any bad news on the two concerns if there were no definite way to "fix" any issues that might exist. Still, I went back to see him today one final time, wanting to ask him my nagging questions in person.
I came out of his clinic an infinitely happier man. I asked him two series of questions:
Q: Why does the tumor appear much lighter on the latest MRI?
A: (after explanations about blood supply and contrast dyes) Basically, there are much less living tumor cells within the tumor. The tumor is less dense.
Q: If it is less dense, given two tumors of identical sizes, one never-been-touched and the other already debulked via surgery, would it be fair to say that it will take less to kill the latter even though it is of the same volume as the former? Since it is less dense after having been "debulked".
A: That is absolutely correct.
This exchange pleased me no end, because it gives me some assurance that even if the volume of my remaining tumor is indeed right on the maximum of 3 cm, chances are very good that the radiosurgery will be successful because the tumor is now already easier to kill. Furthermore, even at 3cm, they will probably not even have to use maximum radiation dose. A "fresh" or "untouched" 3cm tumor is not the same as a 3cm tumor that resulted from debulking a larger tumor. Going back to our orange peel analogy, the peel left behind might still be 3cm in volume, but it is just peel, not strong and healthy orange.
Q: The 3cm theoretical maximum refers to total volume and doesn't mean that all sides must be smaller than 3cm, right?
A: Yes. We can tailor the beams to any size. The concern is that if the total volume is too large, then the required dose of radiation will be too high and will spill over to the healthy neural structures.
Another good answer!
Finally, I think Dr. Mercado saw through my questions to my actual concerns because he volunteered this statement: "With all credibility, honesty, and sincerity I say to you that your tumor is now ideal for gamma knife."
Here we go...
Welcome the Pain
How does one psyche oneself up for the experience of getting his skull "clamped" by two screws at the temple? I'm trying to think back to a story I read when I was a young boy, about training that Indian warriors go through. They are made to run through the snow naked. To fight the cold they are told to welcome it. "Welcome the cold... It is your brother..."
"Welcome the pain..."
"Welcome the pain..."
"Welcome the pain..."
"Welcome the pain..."
Gamma Knifed
Last Wednesday, we went bright and early to The Philippine Gamma Knife Center located within the grounds of Cardinal Santos Medical Center. By around 7:30 they were attaching the frame to my head. While I wouldn't call the experience particularly bad, I must say I've done more enjoyable things in my life. Four screws, two at your temples and two near the base of your skull at the back (the fourth seemingly perilously close to my surgical "spot"), are used to attach an aluminum frame to your head. While uncomfortable, this frame is vital for accuracy. They "map" the location of the tumor relative to this frame, then attach the frame (with your head of course) to the machine, which I shall henceforth refer to as the "ray gun." This is how the ray gun knows the exact position to shoot its rays. In the days before Gamma Knife I understand that radiation consisted of shotgun approaches wherein rays are shot less discriminately into the general area of the tumor, causing harm to healthy structures in the process. Although they try not to needlessly worry us patients, apparently some people faint during this screwing, but I guess ignorance is bliss, because this Indian warrior made it through just fine.
Afterwards, frame and all, they took me for an MRI. This final scan would form the basis of the map with which the plan would be designed via computer. A typical plan goes something like this (in layman's terms):
with frame (and therefore head) in this position, turn rays on for 3 min.
Next, with frame (and therefore head) in this other position, turn rays on for 1 min.
and so on and so forth...
My plan called for 15 positions! Well at least we got our money's worth. :-) And how are these position changes accomplished? Well, the doctors, led by Dr. Mercado and Dr. Theodore "Dr. Ted" Vesagas (I think he's the technology hotshot over there) come in, literally unscrew you and screw you onto a new position. This is where I think knowledge led to the process being more uncomfortable than it had to be. With every turn of the screw, I could visualize the forces and stresses transferring from the screws onto the frame, and onto the four screws clamping my skull, so I was particularly attuned to the little neural twitches and pains here and there. If I had just gone in blissfully unaware, maybe, just maybe I would have felt even less discomfort. Maybe that's why Indian warriors-in-training have no access to the internet, less pain to welcome.
All in all, it was almost 2pm in the afternoon by the time we got out of CSMC. Not a torture session, but not exactly a party either.
Afterwards, frame and all, they took me for an MRI. This final scan would form the basis of the map with which the plan would be designed via computer. A typical plan goes something like this (in layman's terms):
with frame (and therefore head) in this position, turn rays on for 3 min.
Next, with frame (and therefore head) in this other position, turn rays on for 1 min.
and so on and so forth...
My plan called for 15 positions! Well at least we got our money's worth. :-) And how are these position changes accomplished? Well, the doctors, led by Dr. Mercado and Dr. Theodore "Dr. Ted" Vesagas (I think he's the technology hotshot over there) come in, literally unscrew you and screw you onto a new position. This is where I think knowledge led to the process being more uncomfortable than it had to be. With every turn of the screw, I could visualize the forces and stresses transferring from the screws onto the frame, and onto the four screws clamping my skull, so I was particularly attuned to the little neural twitches and pains here and there. If I had just gone in blissfully unaware, maybe, just maybe I would have felt even less discomfort. Maybe that's why Indian warriors-in-training have no access to the internet, less pain to welcome.
All in all, it was almost 2pm in the afternoon by the time we got out of CSMC. Not a torture session, but not exactly a party either.
The Aftermath
I was told that I would be back to normal the very next day, but the past three days have been very difficult. I am not saying that I was misled, but for some reason or another, my recovery has been much more uncomfortable than "normal".
I remember a story I read when I was a young boy. I cannot even remember the title now, but it was about spies and espionage, and the one thing I do remember was a part where they were talking about drugs used to break down captured spies and agents. The way one drug was described: "after it is injected, you will want to stand up when you are sitting down and you will want to sit down when you are standing up." That, is exactly how I have been feeling the past three days. Exactly.
First, there was terrible nausea and indigestion. My reasonable assessment is that this was probably not caused entirely by the gamma knife. The attack of indigestion was probably triggered by the fact that I had to fast for the procedure and had gone with neither food nor water from 10pm Tuesday night to 2pm Wednesday afternoon. I have a poor gastro-intestinal constitution (a confluence of hyperacidity and an easily-stressed disposition) and doctors cannot seem to decide if I have GERD or peptic ulcers but anyway this so belongs in another blog entirely. :-) Some additional nausea from the gamma knife simply added fuel to the fire.
By today, Saturday, the nausea was better but my head throbbed the whole day, especially near my surgical wound where the fourth screw was inserted. I think it's the bone in that area turning arthritic. At least that's what I hope it is. I don't what to think of the other possibilities.
Well, hopefully tomorrow I'll feel even better. Is the tumor dead now? Well, we're pretty sure it's not. But it's supposed to be dying, and we'll get some indications within 6 months and know for sure after a year.
I remember a story I read when I was a young boy. I cannot even remember the title now, but it was about spies and espionage, and the one thing I do remember was a part where they were talking about drugs used to break down captured spies and agents. The way one drug was described: "after it is injected, you will want to stand up when you are sitting down and you will want to sit down when you are standing up." That, is exactly how I have been feeling the past three days. Exactly.
First, there was terrible nausea and indigestion. My reasonable assessment is that this was probably not caused entirely by the gamma knife. The attack of indigestion was probably triggered by the fact that I had to fast for the procedure and had gone with neither food nor water from 10pm Tuesday night to 2pm Wednesday afternoon. I have a poor gastro-intestinal constitution (a confluence of hyperacidity and an easily-stressed disposition) and doctors cannot seem to decide if I have GERD or peptic ulcers but anyway this so belongs in another blog entirely. :-) Some additional nausea from the gamma knife simply added fuel to the fire.
By today, Saturday, the nausea was better but my head throbbed the whole day, especially near my surgical wound where the fourth screw was inserted. I think it's the bone in that area turning arthritic. At least that's what I hope it is. I don't what to think of the other possibilities.
Well, hopefully tomorrow I'll feel even better. Is the tumor dead now? Well, we're pretty sure it's not. But it's supposed to be dying, and we'll get some indications within 6 months and know for sure after a year.
Christmas 2009
It's been a year of upheaval obviously, but Christmas 2009 finds me in a thankful mood and counting my blessings. The following picture says it all:
There are a number of small problems that remain, but hey, the picture says it all.
Hearing in my left ear is now back down to 10% compared to my right side on the "self-perception scale." Before surgery, I put it at 10% and after surgery had it up to 40%, then after gamma knife I put it at 10% again. This is to be expected. As the tumor begins to "die" from having been shot by the gamma ray gun, it will first bloat or swell up. (Imagine a goon who has been beaten up by Fernando Poe Jr., before the goon dies he will be in the ICU all swollen up right?) So there is indeed the possibility that there will be a worsening of the acoustic neuroma symptoms for about six months. When we're out around people these days Kathy stays on my left side and slaps me on the arm when someone has spoken to me and it's obvious that I'm unaware. (Of course there are times when I've chosen to be unaware.) Small problems like this, mini-handicaps I call them.
The balance issues are back with a vengeance. "Dizziness" is not the correct term, since I feel perfectly normal when I'm sitting down. Driving is not even a problem. But when I walk, I find myself veering off to one side much like a drunk person, and I have to constantly catch myself and pull myself back. There's also the tendency to "tip over" when I put my weight on one leg, like when I'm putting my pants on. So I'm constantly making small adjustments and righting myself.
My saliva seems to taste "sour" and nothing tastes the same. Not even the roast goose we received as a present last week. Some minor nausea and "queasiness" has returned.
My head starts to ache the moment I lie down and hurts progressively more (imagine trying to get to sleep at night). I am not able to stay asleep for more than 3-4 hours because the pain wakes me up. After I wake up, it really feels like I have a bunch of elves playing drums inside my head. Strangely enough the pain disappears some time after I stand up, so at least it is not debilitating during the day.
Most, if not all of these are "common" symptoms of untreated acoustic neuroma. And like I said, it all makes sense because my tumor is now getting larger and behaving like an untreated AN. The important difference is that it is getting larger in the process of dying; and not because it is alive and well. Therefore, all these should disappear over the next six months.
A joyous Christmas to one and all. I have good days and bad days; but the picture says it all..
There are a number of small problems that remain, but hey, the picture says it all.
Hearing in my left ear is now back down to 10% compared to my right side on the "self-perception scale." Before surgery, I put it at 10% and after surgery had it up to 40%, then after gamma knife I put it at 10% again. This is to be expected. As the tumor begins to "die" from having been shot by the gamma ray gun, it will first bloat or swell up. (Imagine a goon who has been beaten up by Fernando Poe Jr., before the goon dies he will be in the ICU all swollen up right?) So there is indeed the possibility that there will be a worsening of the acoustic neuroma symptoms for about six months. When we're out around people these days Kathy stays on my left side and slaps me on the arm when someone has spoken to me and it's obvious that I'm unaware. (Of course there are times when I've chosen to be unaware.) Small problems like this, mini-handicaps I call them.
The balance issues are back with a vengeance. "Dizziness" is not the correct term, since I feel perfectly normal when I'm sitting down. Driving is not even a problem. But when I walk, I find myself veering off to one side much like a drunk person, and I have to constantly catch myself and pull myself back. There's also the tendency to "tip over" when I put my weight on one leg, like when I'm putting my pants on. So I'm constantly making small adjustments and righting myself.
My saliva seems to taste "sour" and nothing tastes the same. Not even the roast goose we received as a present last week. Some minor nausea and "queasiness" has returned.
My head starts to ache the moment I lie down and hurts progressively more (imagine trying to get to sleep at night). I am not able to stay asleep for more than 3-4 hours because the pain wakes me up. After I wake up, it really feels like I have a bunch of elves playing drums inside my head. Strangely enough the pain disappears some time after I stand up, so at least it is not debilitating during the day.
Most, if not all of these are "common" symptoms of untreated acoustic neuroma. And like I said, it all makes sense because my tumor is now getting larger and behaving like an untreated AN. The important difference is that it is getting larger in the process of dying; and not because it is alive and well. Therefore, all these should disappear over the next six months.
A joyous Christmas to one and all. I have good days and bad days; but the picture says it all..
A Nauseous New Year
The first week of the new year has been an uncomfortable one. I'll recapitulate my symptoms, described in the previous post, one more time here:
1) Decreased hearing in my affected ear. After surgery it had improved markedly, but now, after gamma knife, it seems to have deteriorated to a point where it is worse than it was before surgery.
2) Dis-equilibrium, or a loss of balance. Not really dizziness, but walking like a drunk person. The best way I have heard this described is a "loss of sure-footedness". Last Monday I joined my mom and an aunt to see a screening of "Mano Po 6". Inside the darkened theater, I really thought I might not make it to my seat. Made me promise myself never to grow impatient when walking behind any slow-moving person (although I still reserve my right to overtake them. If I can, that is...)
3) Nausea. This one causes the most misery, and is probably directly related to #2. With dis-equilibrium, I basically spent the entire day in a state similar to standing on a rowboat rocking in the river, thus resulting in significant nausea.
4) More jiggly eyeballs. Now unable to read a book inside a moving vehicle. All my life, I have been able to read inside cars, boats, trains, any moving vehicle. Now I have a very difficult time doing so.
5) The midnight sleep-shattering headaches are gone (thankfully), but I still wake up in the mornings to a mild, vague headache which disappears soon after I stand up.
At first I had very little apprehension over these symptoms, because it all made sense. If the tumor is swelling (remember the goon who got beat up by FPJ?) , then it is getting temporarily larger and causing the same "irritations" to the neural structures as it was when it was first growing. So it makes sense that I will have to go through a period of experiencing, once again, the symptoms of untreated ANs. It even makes sense that these symptoms will be more pronounced now, since the tumor is probably swelling up faster than it was growing naturally back when it was alive and well. For instance, if in the month following gamma knife my tumor swelled by 10%, then this would mean that my 3cm tumor "grew" by about 3mm in the past month. This is equivalent to a full year's growth of a "healthy" or "evil" AN.
Still, yesterday I was feeling so miserable that I googled "stomach cancer" and "hydrocephalus". Crap. Same symptoms for hydrocephalus. Panic mode.
Went to see Dr. Mercado today. Got assurance that there was no apparent hydrocephalus causing these symptoms. And it was almost a sure thing that these are being caused by a swelling tumor. The scientific term is "pseudo-progression" meaning that the tumor is behaving like it's growing but it's actually just swelling up getting ready to die. In my honest opinion, as with many medical terms, pseudo-progression is a bit of a misnomer, because there is nothing "pseudo" about the tumor getting bigger. It is really getting bigger and causing very very real symptoms. But I guess maybe the word "progression" is meant to convey "living growth". This is not "living growth" but "swelling at the gates of death".
To regulate the swelling and manage the symptoms, I was prescribed a week of oral steroids, and weekly check-ups, just to be sure.
Overall, this is all fairly good news. We're on track. Dr. Mercado even pointed out that these pronounced symptoms actually hide a piece of good news, that the tumor was truly hit by the gamma knife. Napuruhan, as FPJ might have put it.
Still, this week of musing did leave me with one sobering thought: the tumor does not immediately die after being shot by the gamma knife. It will fully die only after 12 months or so. Using the same logic, it will also take more than 12 months or so before we are fully 100% sure that the gamma knife did not hit anything else. Anything healthy I mean, like the cranial nerves, the cerebellum, the brain stem, etc. This will be long after we all think I am fully recovered. Pray for me.
1) Decreased hearing in my affected ear. After surgery it had improved markedly, but now, after gamma knife, it seems to have deteriorated to a point where it is worse than it was before surgery.
2) Dis-equilibrium, or a loss of balance. Not really dizziness, but walking like a drunk person. The best way I have heard this described is a "loss of sure-footedness". Last Monday I joined my mom and an aunt to see a screening of "Mano Po 6". Inside the darkened theater, I really thought I might not make it to my seat. Made me promise myself never to grow impatient when walking behind any slow-moving person (although I still reserve my right to overtake them. If I can, that is...)
3) Nausea. This one causes the most misery, and is probably directly related to #2. With dis-equilibrium, I basically spent the entire day in a state similar to standing on a rowboat rocking in the river, thus resulting in significant nausea.
4) More jiggly eyeballs. Now unable to read a book inside a moving vehicle. All my life, I have been able to read inside cars, boats, trains, any moving vehicle. Now I have a very difficult time doing so.
5) The midnight sleep-shattering headaches are gone (thankfully), but I still wake up in the mornings to a mild, vague headache which disappears soon after I stand up.
At first I had very little apprehension over these symptoms, because it all made sense. If the tumor is swelling (remember the goon who got beat up by FPJ?) , then it is getting temporarily larger and causing the same "irritations" to the neural structures as it was when it was first growing. So it makes sense that I will have to go through a period of experiencing, once again, the symptoms of untreated ANs. It even makes sense that these symptoms will be more pronounced now, since the tumor is probably swelling up faster than it was growing naturally back when it was alive and well. For instance, if in the month following gamma knife my tumor swelled by 10%, then this would mean that my 3cm tumor "grew" by about 3mm in the past month. This is equivalent to a full year's growth of a "healthy" or "evil" AN.
Still, yesterday I was feeling so miserable that I googled "stomach cancer" and "hydrocephalus". Crap. Same symptoms for hydrocephalus. Panic mode.
Went to see Dr. Mercado today. Got assurance that there was no apparent hydrocephalus causing these symptoms. And it was almost a sure thing that these are being caused by a swelling tumor. The scientific term is "pseudo-progression" meaning that the tumor is behaving like it's growing but it's actually just swelling up getting ready to die. In my honest opinion, as with many medical terms, pseudo-progression is a bit of a misnomer, because there is nothing "pseudo" about the tumor getting bigger. It is really getting bigger and causing very very real symptoms. But I guess maybe the word "progression" is meant to convey "living growth". This is not "living growth" but "swelling at the gates of death".
To regulate the swelling and manage the symptoms, I was prescribed a week of oral steroids, and weekly check-ups, just to be sure.
Overall, this is all fairly good news. We're on track. Dr. Mercado even pointed out that these pronounced symptoms actually hide a piece of good news, that the tumor was truly hit by the gamma knife. Napuruhan, as FPJ might have put it.
Still, this week of musing did leave me with one sobering thought: the tumor does not immediately die after being shot by the gamma knife. It will fully die only after 12 months or so. Using the same logic, it will also take more than 12 months or so before we are fully 100% sure that the gamma knife did not hit anything else. Anything healthy I mean, like the cranial nerves, the cerebellum, the brain stem, etc. This will be long after we all think I am fully recovered. Pray for me.
JawBones
I'm sorry but it's Steffi-brag time once more. This is her latest creation using JawBones, one of a number of Lego-inspired building sets of this day and age (given to her by her sa-ko and sa-ko-tiu):
Ok, I admit we can't really tell just exactly what it is. But you have to admit it kinda looks like a vehicle of some sort, a robotic one at that. The more important point is that she did this entirely on her own with no help whatsoever. It's not exactly a very simple toy. There are 16 different basic parts -
- and 12 basic connections -
In short, her forty-year old dad plays with it a lot. :-) And Steffi's not even five yet!
What makes me really happy when I see Steffi's creations is that 1) it shows a good basic mechanical sense, and 2) an intellectual curiosity to figure out how things work.
But fatherhood is never easy. Every joy, it seems, can have an accompanying worry.
Good mechanical sense today, huwag naman sana ganito 12 years from now:
Ok, I admit we can't really tell just exactly what it is. But you have to admit it kinda looks like a vehicle of some sort, a robotic one at that. The more important point is that she did this entirely on her own with no help whatsoever. It's not exactly a very simple toy. There are 16 different basic parts -
- and 12 basic connections -
In short, her forty-year old dad plays with it a lot. :-) And Steffi's not even five yet!
What makes me really happy when I see Steffi's creations is that 1) it shows a good basic mechanical sense, and 2) an intellectual curiosity to figure out how things work.
But fatherhood is never easy. Every joy, it seems, can have an accompanying worry.
Good mechanical sense today, huwag naman sana ganito 12 years from now:
Elocution Contest Second Placer
Before anything else I would like to set the record straight. This was not some school-wide contest. There were quite a number of sub-groups and Steffi's sub-group had a total of five contestants, so she bested three of them.
Still, you have to keep in mind, this is a child who as a baby would literally cry for hours upon seeing new faces; whom her pre-school was hesitant to admit at first because she refused to reply during her interview.
So we're very happy she seems to have come a long way. It's a decent performance wouldn't you agree?
(and apparently, to her mom's eternal relief, looks like she is not the shortest one at her grade level. :-) )
Still, you have to keep in mind, this is a child who as a baby would literally cry for hours upon seeing new faces; whom her pre-school was hesitant to admit at first because she refused to reply during her interview.
So we're very happy she seems to have come a long way. It's a decent performance wouldn't you agree?
(and apparently, to her mom's eternal relief, looks like she is not the shortest one at her grade level. :-) )
New York New York
I have always said that the lady who owns and runs my daughter's pre-school, Mother Goose Nursery School, has a natural talent for marketing. I really do not mean this in a bad way. Just that I think she, knowingly or unknowingly, has a taste for it and an aptitude for it. The school's annual "program" is just one example. It showcases the kids and makes the parents and grandparents very proud and happy, and there's simply no better advertising than that.
Here's one more for good measure:
Here's one more for good measure:
Graduation Day 2010
In earlier times when nursery school was probably considered a bit of a luxury, I bet no one imagined that one day, commencement exercises would be held for pre-school. But in a day and age where video game competitions are televised, I guess this is just par for the course. So, without further ado, we present the grand entrance:
Then before we continue, commercial muna:
Finally, the moment I'd been waiting for; the awarding of medals:
...and finally, the conferment of degree: :-))
Two years of tuition down, about 16 more to go! Presenting the new graduate:
Then before we continue, commercial muna:
Finally, the moment I'd been waiting for; the awarding of medals:
...and finally, the conferment of degree: :-))
Two years of tuition down, about 16 more to go! Presenting the new graduate:
Disneyland, HK
When Hong Kong Disneyland first opened a few years back and we started discussing when to take Steffi, I was resolute that she should be a minimum of 7 years old before we took her. Anything younger than that, I felt, and she would be unable to really appreciate both the place and how fortunate she was to travel abroad at such a young age.But as it turned out, maybe I'm a bit too old-fashioned. Every day (or at least what seemed like everyday), she would come home from school and regal us with stories of how this classmate or that schoolmate had just returned from Disneyland. I immediately recognized it as the pressure-papa-by-making-him-feel-that-I-am-the-only-child-left-who-hasn't-been-to-Disneyland ploy. Nevertheless, I must admit the tactic still turned out to be effective.
So in one of those father-daughter negotiation sessions, I promised her that if she met a number of behavioral conditions, then we would take her in March, 2010. She then promptly delivered, and promptly reminded me of our deal.
Still, I was determined that the trip would be a learning opportunity. I wanted her to understand that we were not stepping out to the mall, that this is a big thing. (That's papa-speak for a big expense)
So I took out of those square telephone memo pads and made a countdown calendar. I stuck it to her wall and told her to tear a page a day and when she tore all the way to zero then we would go to Disneyland. I wanted to pound into her young mind that this is something that she should view with much anticipation. At the time I made the calendar we were still 114 days away, and I was quite certain that she would lose interest around the 50-80 day range. But as it turned out she remembered everyday and now here we are
Tomorrow we head to the land of Winnie the Pooh and Mickey Mouse.
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