Up and Down

One day I am good, and the next day I am not. I am OK with this normal.

I was at the liver transplant centre yesterday. My endocrinologist had arranged this appointment to update me on the results and the necessary follow-up on my recent bone x-ray (bone mineral densitometry or BMD). The test results are as follows:

1. The x-ray shows that I have a fracture on my backbone, L11. From the x-ray, I could see my L11 has been compressed to a slightly smaller thickness as compared to my L12. In addition, I could see that there is also a dark layer, which is likely the fracture. I told my doctor that I do not feel anything at all and that I am perfectly well.

2. The results also show that the bone mass of my hip has deteriorated as compared to my last test done on 23 July 2024. He said that I need to go on medication. I expressed my concern that the medication will further damage my kidney. He agreed and recommended a 6-monthly injection. The medicine for the injection will not affect my kidney. As I have been bedridden and immobile for a long while, he told me to do brisk walks and exercises to build up my muscle mass. He added that I must not fall. I agreed. I can do it.

3. For the hydrocortisone that I have been taking twice daily, it has proven positive for my hormone therapy. However, he does not recommend an increased dosage, as it may damage my adrenal gland and prevent my body's ability to produce cortisol.

On the whole, he added that I am progressing well in my recovery.

To Know OR Not To Know?

To know or not to know, that is the question. There are situations where knowing the truth might be emotionally challenging. Under such situations, maybe ignorance is preferable. I am talking about knowing my mortality, or rather, when my life will end.

The thing is, knowing led me to insights, improved decision-making, and allowed me to take the right action. It empowers me to make informed decisions and take control of my life. But, on the other hand, such truth has been difficult, unsettling, and painful for me to face. It has led me to some extent of anxiety, fear, and depression.

Not knowing the truth of my situation is perhaps less daunting than facing a "known" for me. It may give me a sense of normalcy and hope.

Looking at the scale of knowing:

"Not knowing that you don't know.

Knowing that you don't know. Not knowing that you know.

Knowing that you know."

Here, I'm talking about knowing my survivability or mortality as a liver transplant patient with a complex medical condition. Having studied diligently the studies and survey statistics done on liver transplant patients by Singapore's NUH & SGH, the National Library of Medicine, and the Mayo Clinic, as well as other reputable studies, I have now arrived at my conclusion. I am not likely to live beyond 5 years after my transplant on 10 July 2024. Which means my expiry date is any time from now to 9 July 2029!

According to the various studies, the factors that will determine when I will expire are as follows :

1. Age Factor—At 69 years old now, my survivability is a lot poorer as compared to a younger person. In view of this, some liver specialists from the US had discussed whether to have a cutoff age of 68 for liver transplants. I had my liver transplant last year (July 2024) at 68 years old.

2. Patient Medical Issues—My damaged left kidney, which is medically induced, has serious implications for my survivability. The irreversible damage to my kidney is mainly caused by my lifelong anti-rejection drug "Advagraf."

3. Gender—The survivability for males is poorer than for females.

4. Source of my transplanted liver—My transplanted liver came from a deceased person. Survivability in this case is poorer compared to if the liver comes from a living donor.

In conclusion, based on the facts of my situation and the factors influencing my survivability, I'm not likely to live beyond 5 years. My age, my complex medical conditions, my gender, and my having a deceased liver will decide when, between now and July 2029, my life will expire.

On the whole, viewing my situations through a bird's-eye view has actually strengthened my resolve to live. Miracles do happen. And there are exceptions.