Side Effects

This large deer stag is screaming out loud in despair. Just like what I am feeling now—in despair. All because of the medications prescribed to me and the associated side effects they have on me. 

Every day, my alarm clock will wake me up at 5 am. By 6 am, I will start with my 1st phase of medications—1.5 mg of Advagraf, which is a very high dose, on an empty stomach. The regimen on Advagraf is very strict. I am not allowed to have any food 2 hours before my Advagraf and 1 hour after. It's an immunosuppressant drug that I have to take daily for as long as I live. Advagraf is supposed to raise my FK506 level so as to prevent my transplanted liver from being rejected by my body. The dosage is carefully adjusted by my liver team doctors.

There are many side effects that can come from Advagraf. Those that plague me include weakness in my body, blurring of vision, swelling and pain in my extremities, and painful chest. In the longer term, Advagraf is known to cause irreversible severe damage to my kidney and increase my cancer risk.

I can have my breakfast after 7am. Phase 2 of my medications will start right after my breakfast. The medications include 10 ml of atovaquone oral suspension, 10 mg of hydrocortisone, and 1000 IU of vitamin D.

Atovaquone was prescribed to me by the liver team because I am a liver transplant patient and am immunocompromised.

There are many different side effects for different people who take atovaquone. For me, the side effects are minimal. It's confined to dizziness, fatigue, and headache. However, it surprises me to learn that, while atovaquone is meant to help liver transplant patients, it also causes liver dysfunction. It's a contradiction.

The hydrocortisone was prescribed by my endocrinologist. It's a steroid hormone for my hormone replacement therapy. It has potent anti-inflammatory and immunosuppressive properties. Therefore, it serves very well in reducing my swelling, inflammation, arthritis, and painful joints. The relief offered by hydrocortisone can be felt about 2 hours after consuming it. It has to be taken twice daily—10 mg after breakfast and 5 mg at 3:30 pm.

The side effects and implications of hydrocortisone are severe and many. For me, the serious reactions from my body are headaches, dizziness, weakness, tiredness, and muscle aches. In the longer term, hydrocortisone will cause osteoporosis and weaken my body's ability to fight off infections.

The vitamin D that was prescribed to me is mainly to support my immune functions, reduce inflammation, and for my bone health. It helps in preventing muscle weakness as well as reducing the risk of autoimmune diseases and certain infections.

The side effects of vitamin D for me are confined to weakness in my leg and kidney damage. 

In conclusion, it's clear to me that all my medications have a damaging effect on my kidney. The overwhelming side effects that I will have to deal with daily include painful joints, dizziness, fatigue, and blurring of vision. Physically and mentally, I can endure all the side effects because I know I have no other choice. And I know I am very resilient.

Nuclear Medicine?

I was just curious about things. What! Nuclear Medicine? Why can't the hospitals and doctors just call it testing of bone mass or bone X-ray?

So, I was at the SGH Nuclear Medicine zone yesterday. As usual, I arrived very early. Not a single soul there. I have a habit of being early for my appointment. My endocrinologist sent me there for BMD, or bone mineral densitometry. This happened because I had a fractured left pinky toe a couple of months ago. It happened when I was undergoing my physiotherapy session. Furthermore, he also noticed that I have a record of sprains, which resulted in inflammation and swelling of my ankles, toes, and knees. He suspected that I have osteoporosis or deteriorated bone density. Moreover, because of my "high fall risk" status resulting from the side effects of my medications, he is concerned that the risk of me falling and breaking my spine or hips is very high. I would think that it is common to hear of old folks falling and breaking their hips. It happened to my mother before. 

As the crowd started to stream in, I noticed that the people coming for BMD are elderly with a maid or family member holding them. I probably appear to be the youngest and fittest of all. My endocrinologist and my liver team doctors seem to like to send me for all kinds of tests and scans. All these have taken up a lot of my available time and cost me a lot of money. But, are all these tests necessary? Yes and no.

Yes, because the doctors wanted to make sure that I can live on by constantly checking my condition and taking the necessary intervention. They have done it very well. In fact, they have brought me out of my deep slump. And I can see that my physical and mental capabilities have improved exponentially in the past 2 months.

No, because I am spending too much of my remaining time on all these tests. No, the intervention would mean medications. Medications bring with them side effects that lower my quality of life. No, because all these tests bring with them many disruptions and interruptions.

I find all these ironic. But my mind tells me that I should go along with my doctors. Because my target is to be able to start jogging by October 2025.