Eye Injury Recurrence

Perhaps regular readers of Juan Or and Mommy's blog may have noticed of Mommy's 'disappearance' from the blogging scene one more time shortly after the recent 'disappearance' during the last week of April till the 1st week of May. This time, Mommy's 'disappearance' was not due to work stress, instead Mommy went on medical leave for the first 4 days of the week followed by a day of annual leave. So Mommy was literally unconnected throughout the week.


So what caused Mommy to have to take medical leave? Actually Mommy had a recurring eye injury that was inflicted about a year ago (you can read about what happened here and here). In short, about a year ago, Juan Or, who was 12+ months old that time, had held a back-scratcher stick and hit Mommy's right eye, so causing Mommy's cornea to be scratched, but luckily the injury was only at the outermost layer of the cornea. The wound healed, but recurred. And when it recurred, Mommy didn't know it recurred because about 2 weeks approaching the day when Mommy really had to visit the eye specialist, Mommy noticed that whenever Mommy opened the eye after long hours of sleeping, Mommy experienced dryness in that eye. But after having blinked plus keeping the eye closed for some time, the dry sensation disappeared throughout the day, so Mommy didn't give much thought to it. Then on last Saturday, the climax of the dry eye incident came when Mommy couldn't even open the right eye after long hours of sleeping and it even felt painful (or rather a very irritating sensation!) to keep the eye open! However, the irritating sensation fluctuates (ranging from less irritating to very, very irritating) throughout the day and felt very much like there was foreign particle stuck in the eye.

That Saturday night itself, after coming back from teaching piano, Mommy called up Tun Hussein Onn Eye Hospital to see whether they are opened on Sundays. The staff explained that there will be no eye specialists available on Sundays (or is it weekends? Can't remember!) and that only medical officers will be on duty. However, the hospital can call up for an eye specialist to come immediately if it is really an emergency case (and Mommy thinks probably the hospital fee will be super high too for that matter!). So on Sunday, Mommy beared with the eye discomfort to wait for Monday.

On Monday, Papa fetched Juan Or and Mommy to his parents' house very early in the morning so that father-in-law can take Mommy to the eye hospital (Mommy can hardly open the eyes at all so cannot drive!). Mommy was assigned to the same eye doctor that treated Mommy last time, Dr. George Thomas. After checking Mommy's eye with the eye-checking machine, he found that the epithelium layer of the old injury spot on the cornea had broken down. So Mommy asked him how the layer can break down by itself to which Dr. George said Mommy could have rubbed the eye too hard. This time, Dr. George instructed the nurse to put an antibiotic eyedrop and then an eye patch (which was never done in the previous treatment) to prevent Mommy's eyes from opening so that the recovery process is faster. Dr. George said that Mommy could only open the eye patch 24 hours later and thereafter apply the antibiotic eyedrop (Tobrex) once in every 2 hours and artificial tears once every hour (except during sleeping time). He also put Mommy on 4 days medical leave and required Mommy to come to see him again for follow-up on the 4th day. The medical bill that day was RM120 (RM45 for consultation, RM5 for registration, RM5 for service and RM65 for medication).

What and how does it feel like to have the eye patch on? Well, it was really no fun as Mommy realized that having the eye patch on is just as inconvenient as having other parts of your body plastered although it was just the eye and not the limb. Mommy felt handicapped throughout the 'patchy' period and surprisingly, Mommy felt drowsy and sleepy most of the time even though oral medication was not prescribed at all. It was also a feeling of inactiveness plus clumsiness, probably because of the 'handicap psychology' lurking in Mommy's head. There were certain times throughout the day when the patched eye felt an irritating sensation (though not in so much a degree as before treatment) but Mommy cannot do anything yet because it was not yet time to remove the patch. Another thing about having the eye patch on was that the eating process became tremendously inefficient as the mouth cannot even open big enough (due to the surrounding tapes that fasten the patch in place) to scoop in dinner spoon! Little bits and pieces of rice kept spilling out as Mommy ate food. Even the appetite went rock bottom!

As the days went by, the eye improved a little. There was no more irrritating sensation but vision on that eye was blurred and both of Mommy's eyes could not withstand normal sunlight. Luckily by the 4th day (when it was time to go for follow-up consultation), Mommy was able to drive again though Mommy had to have the sunglasses on to minimize the glare but still Mommy's eyes had to blink quite often when in normal sunlight.

From the follow-up consultation, after checking Mommy's eyes, Dr. George concluded that Mommy's eye showed good progress although it has not healed completely. Nevertheless, there was already a layer or so of cells covering the main injury spot though there were still small spots here and there that looked raw. Now Dr. George recommends that Mommy only have to apply the antibiotic eyedrop twice a day and the artificial tears once in every 4 hours till the supply finishes. The doctor also explained that recurrence of an old eye injury is bound to happen within 2 to 3 years and after that period, things are likely to go back to normal subjected to the new cells sticking firmly and well on the wounded spot in the first place. The medical fee for the follow-up was RM55 (RM45 for consultation, RM5 for registration and RM5 for service).


Mommy also called up Mommy's insurance agent (Prudential) to see whether the medical fee is claimable or not to which he said that claims for recurrence of an old injury is only limited to one year from the time when the injury claim started and that no subsequent medical report is needed to back up the claim. Only the receipt, credit card receipt (if paid using credit card) and a photocopy of the medical chit is needed to make the claim.

So from now on, Mommy dare not rub the right eye anymore no matter how itchy it is. By the way, Dr. George also mentioned that Mommy can still rub the unaffected eye because there was no weakness in the cornea in the first place. As of this time of writing, vision in that eye is not as blur now though the image is still not as sharp as the other eye. Mommy no longer wants this kind of thing to happen again, if possible - it's really no fun to experience it.

A Visit to the Hospital for Hydronephrosis Check-up

Juan Or waiting for his turn at the ultrasound scan waiting area.

This is really an outdated post. Mommy was very busy during last year's December, so is late in putting up this update on Juan Or's status of mild bilateral hydronephrosis condition. Previous postings on this matter can be found here and here.

This visit to the hospital was on 16th December 2009. As usual, the procedure was to register Juan Or's attendance at Hospital Universiti Kebangsaan Malaysia (HUKM)'s paediatric clinic, after which Mommy took Juan Or to the Radiology Department for ultrasound scanning. The ultrasound scanning service costs RM20. While waiting for Juan Or's turn for ultrasound scan, Mommy happened to meet another couple with a near 12-month old baby boy who also has the same condition as Juan Or. And same as Juan Or, that baby boy has already been confirmed not to have any urinary tract blockage though the mild kidney dilation is still there. So that baby boy was also on trimetoprim medication up to the point of appointment, just like Juan Or. Along the way during the waiting time, Juan Or 'made friends' with an Indian boy of about 8 years old who is also waiting for his turn. The Indian boy seems to be fond of Juan Or at first sight. On the lighter side of the waiting period, Juan Or was very active and playful, walking and running around and even refused either Mommy or Grandpa in wanting to hold his hand while walking as shown in this video:

Finally, Juan Or's turn for ultrasound scan came and Mommy took him in. The moment the sonographer showed Juan Or the probe (yes, haven't even touched him!), Juan Or already started crying! Mommy knows Juan Or hates to have strangers do things on him, but what to do, that procedure has to be done. So as the scanning went on, Mommy held Juan Or to try to keep him as still as possible, but Mommy saw the scan image on the screen was constantly shaking! Oh dear! Finally, the sonographer conlcuded that the observation was the same as the last check-up, i.e., there's still a little something there but definitely, the dilation is gone already!

After the ultrasound scan, Mommy took Juan Or to the pediatric clinic section for consultation. Luckily the waiting time was not as long as the ultrasound one, but then Juan Or was already asleep in the babystroller by the time his turn came. So the paediatrician decided that Juan Or no longer needs to be on medication anymore. Hooray! Then the paediatrician did a milestone-development check-up on Juan Or, asking Mommy questions such as how many words can Juan Or say, it is more than 10 words, and whether Juan Or is already able to properly hold a pencil/pen. Juan Or's weight measurement was 9.8 kg, to which the paediatrician thinks he is still underweight. So the paediatrician recommended that Juan Or needs to be fed more solid food besides the 3 to 4 times of milk feed per day. In Mommy's head, Mommy was pondering on how to get Juan Or to eat more food since Juan Or refuses food or eats very little only once he is back home from babysitter's house. Mommy thinks probably why Juan Or seems to have better appetite when at babysitter's house is that there is another 3-year old boy whom the babysitter is also taking care of, so the competition to eat may be there. And Mommy also knows the babysitter did not purposely make the food look more attractive just to get Juan Or to eat more, yet he has better appetite there.

After that, the paediatrician opened up Juan Or's diaper (to which Juan Or was rudely awakened from sleep, so he cried loudly!) to check his penis if there is any abnormality associated with the hydronephrosis to which there is none. Finally, the paediatrician was done and Mommy took Juan Or out who was still crying.

Another Visit to the Hospital: Mild Bilateral Hydronephrosis

Today Mommy took leave from work to bring Juan Or for routine medical checkup (in HUKM) of his mild bilateral hydronephrosis condition (layman term: mild dilation on both kidneys).

Here are some background information about Juan Or's condition:

Juan Or was first diagnosed with this congenital condition since Mommy was 5 months pregnant. Doctors mentioned that usually mild hydronephrosis resolves by itself. The problem with hydronephrosis is that it makes the baby at higher risk for contracting urinary tract infection (UTI) due to obstruction in the urinary tract which in turn causes symptoms like backflow of the urine. Beause of this, Juan Or has been on antibiotic medication (trimetoprim) as a preventive measure since the day he was born. To date, Juan Or's kidney dilation has shown progress in that the dilation has reduced and his kidneys appear to be growing normally. So far, Juan Or has never experienced high fever not associated with cough/flu (which could be a sign of urinary tract infection) and his urine flow from the penis is of normal gush. Juan Or went for MCUG test (to confirm the source of obstruction and to check for urine backflow) previously but the test had to be aborted because the tube could not be inserted fully through the penis. Because the MCUG test failed, Juan Or has to be on trimetoprim until the condition resolves by itself or until he is 2 years old, whichever is sooner.

So how's the progress of Juan Or's hydronephrosis condition in today's hospital visit? Yay! Good news! Ultrasound scan result concludes that there is 'minimal splitting of both renal pelvis with no evidence of hydronephrosis' (Mommy is quoting directly from the ultrasound scan report!). So what does this mean? It means that the dilation has resolved by itself! There is no more kidney dilation! Yay! Here are the details of the ultrasound scan observation report:

• BPL right kidney is 6.12 cm and BPL left kidney is 6.18 cm.



• Both kidneys have normal echogenicity.



• Minimal splitting of renal pelvis seen. However, no blunting of calyces seen bilaterally.



• AP diameter of renal pelvis is 0.5 cm bilaterally.



• No dilated ureter seen bilaterally.



• Normal bladder. No calculi seen within.

How did Juan Or go through his ultrasound scan session? Well, Juan Or cried a lot (and loudly!) simply because he was rudely awakened from sleep when his turn came and that 'strangers' (the sonographers) had to touch him (Juan Or hates to be touched by strangers!).

Later on, after obtaining the ultrasound scan report, Mommy took Juan Or to the Paediatric Clinic section for consultation. During the waiting period, Mommy took Juan Or to be weighed and his height measured. Before weighing, the nurse instructed Mommy to take off his diaper. Then during the weighing process, Juan Or urinated! Later on, Juan Or dozed off again in the stroller and Mommy had to wake him up when his turn came. Luckily, this time, Juan Or didn't cry when Mommy carried him into the consultation room. Upon reaching the paediatrician's table, Juan Or saw an Incredibles toy figurine and quickly grabbed it. During the consultation, the paediatrician asked Mommy about how strong is Juan Or's urine flow, whether there's any occasion when there's blood in urine, whether Juan Or developed any unexplainable fever, his motor skill development and his weight gain progress. The paediatrician also concluded that Juan Or's weight gain has picked up and is currently at the lower range of the normal percentile. The paediatrician also agreed (with the private-practice paediatrician) that Juan Or should still continue with PediaSure milk. However, for his trimetoprim medication, the paediatrician was a little undecided whether or not to continue with it since the dilation is gone - the only thing of concern is whether the 'minimal splitting of renal pelvis' still poses risk of getting UTI. Because of this, the paediatrician asked about Mommy's preference. So Mommy answered that of course Mommy prefers Juan Or not to be on medication for prolonged period of time unless very necessary, but the possible risk of getting UTI may still be there (which can lead to kidney scarring and subsequent impaired kidney function). So the paediatrician and Mommy finally decided that Juan Or should still continue with trimetoprim until his next checkup at 1 year 7 months old. Mommy also asked the paediatrician whether there's any possibility that taking trimetoprim over a long period of time may have caused his poor weight gain by killing most of the friendly microorganisms in the gut that helps nutrient absorbtion. The paediatrician answered that it is highly unlikely because the dosage is very mild and that trimetoprim is not a broad-spectrum antibiotic.

All in all, Mommy paid RM 47 for the hospital visit: RM20 for ultrasound scan + RM5 for consultation + RM20 for medication + RM2 for parking. Mommy also managed to take some snapshots of Juan Or during the waiting time.

For previous posting of Juan Or's condition, please click here.


As an after-thought, Mommy wondered whether there is any genetic basis to hydronephrosis. A scientific article that Mommy found in the internet indicates that fetal hydronephrosis occurs in 1 of 100 births with at least 20% being clinically significant (luckily Juan Or's is not significant!). The article also mentions that the causes are unknown in most human cases although environmental influence and genetic determinants have been implicated. Genetic basis!? As far as Mommy knows, there are no relatives, both on Mommy's side and Papa's side, who have this condition or who have experienced UTI during toddlerhood or childhood. Could it be spontaneous mutation, then, for Juan Or's case? A further read in the article reveals that spontaneous mutations and targeted genetic modification has been described in a number of animal models to which the genetic defects in most of these naturally occuring mutants are still unknown. Huh!? Juan Or a mutant!? No comments....Perhaps Mommy can consider this a potential research topic for Mommy's final-year research project students - candidate genes for congenital hydronephrosis in human samples. But to do this, Mommy has to network with doctors who are handling such cases to get human DNA samples (Juan Or's DNA sample alone is not enough!). And to do this will involve a substantial amount of protocol (e.g. informed consent from babies' parents and perhaps permission from hospital). Never mind, Mommy will sort that out later....

Follow Up of Eye Treatment at Tun Hussein Onn National Eye Hospital

Remember how Juan Or hit the back-scratcher stick onto Mommy's right eye? Well, the eye did not get any better one day after the visit to the general practitioner (GP). The eye still had an irritating sensation whenever Mommy blinked the eye. And both eyes can hardly keep open even in normal lighting.

So on Friday late afternoon (29th May 2009), Father-in-law drove Mommy to see the same GP again to get a referral letter to go see an eye specialist in Hospital Universiti Kebangsaan Malaysia (HUKM). However, upon reaching there, the clinic assistant told Mommy that the doctor went out to eat and will be back by 4 pm. So, ok, Mommy thought, might as well go by Pediasure for Juan Or first before heading back to the clinic. So after buying, Mommy reached the clinic again at 4.15 pm and still the GP was not in. So Mommy decided to go back home and perhaps try again tonight.

However, upon reaching home, Sister-in-law mentioned that specialist clinics in HUKM are closed from 5 pm and during weekends, thus leaving Mommy with no choice but to go for a private hospital - and that is Tun Hussein Onn National Eye Hospital at Lorong Utara B, Petaling Jaya (PJ). So Father-in-law offered to tke Mommy there on the motorbike, if Mommy is brave enough to pillion ride, considering that the PJ should be jammed since it was near 5 pm already. Immediately, Mommy took the offer and hopped on the motorbike and reached the hospital in just 15-20 minutes' time - pretty fast since we were travelling mostly on the motorbike lane.

At the clinic, there was not many people, so Mommy's turn came quite quickly after registration. First a nurse took Mommy into an eyesight-checking room. The nurse put a piece of lens in front of the hurt right eye and pointed to alphabets in different rows and Mommy had to read them out. Then she shifted the lens to the left eye (the good eye) and did the same thing. After that Mommy was directed to go into the consultation room where a young Indian eye doctor attended to Mommy. Using some eye-checking machine, he found that apparently Mommy's cornea was scratched, but luckily the scratch was at the outermost layer. Had the scratch been on the third layer, then that would be problematic. He said that scratch on the outermost layer of the cornea will heal by itself. He even taught Mommy how to see the scratch: the scratch will appear as a dark green lump on the cornea. After that, the young eye doctor referred Mommy to a more senior eye doctor - one Dr. George Thomas - an elderly Indian doctor. So Mommy went into Dr. George's room and using the same machine, he checked Mommy's eyes again - probably to confirm the diagnosis done by the young doctor. Dr. George prescribed an eye drop for Mommy to put once in every 4 hours and arranged for a follow-up appointment on 1st June 2009 (Monday). The bill came up to RM79 which consisted of RM10 for registration, RM50 for consultation, RM14 for medicine and RM5 for services. Mommy considers this RM79 bill as 'not bad' because Mommy has a colleague who went to this same hospital for scratched cornea (as a result of contact lenses) with a bill of RM129! And hers was attended only by a young doctor and no referral was made to see a more senior eye doctor!

On Saturday, Mommy's right eye felt better in which there was no irritating sensation when blinking the eye. However, the eyes still cannot stand normal lighting intensity. By Sunday, Mommy's right eye felt a lot better, can stand normal lighting already and the swelling has decreased tremendously.

Today, Mommy went for the follow-up apointment and saw Dr. George Thomas again. After checking Mommy's eye with the eye machine, he said that Mommy's cornea has healed but it is not stable yet. So Mommy asked what he meant by 'not stable'. Dr. George explained that the outermost layer of the cornea is 5 cell-layers thick. So Mommy's cornea wound now is maybe 2 cell-layers thick. Then Dr. George prescribed Mommy to continue applying the eye drop prescribed that day and also to apply artificial tear drops once in every 3 hours. So Mommy left the hospital with a bill of RM86 which consisted of RM5 for registration, RM40 for consultation, RM36 for medicine and RM5 for services.

(The eye drop, Tobrex, on the left which was prescribed on Friday, and on the right is the artificial tears' vials which actually came in a much bigger packaging. Mommy took out a few vials at a time for the convenience of carrying them around.)

How is the service like in Tun Hussein Onn Eye Hospital? Well, Mommy would say it's very good - the nurses were very helpful, the administrative staff was also very helpful (one admin lady even helped Mommy to find Mommy's water bottle which Mommy left in one of the consultation rooms!). The parking is free (Yes, it had better be free because Mommy is paying RM5 for the services!) except for one elderly Chinese man manning the main pharmacy counter - he looked and sounded grumpy! Even Mommy's colleague did not have good experience with that Chinese man at the pharmacy counter!

By the way, Mommy decided to claim the hospital fee (RM79 + RM86) from Mommy's insurance (Prudential) considering that Mommy's employer impose a RM100 limit per month for medical expenses on a use-or-lose basis (but subjected to approval if you seek treatment from specialist). And Mommy's insurance agent has already confirmed that such minor accident is fully claimable! As for the GP's fee (RM35), Mommy will claim from the employer because it doesn't require any prior approval.

A Visit to the Hospital: Mild Bilateral Hydronephrosis

On 18th February 2009, Grandpa and Mommy took Juan Or to the hospital (Hospital Universiti Kebangsaan Malaysia) for follow-up check on his mildly dilated kidneys (mild bilateral hydronephrosis).

Some history on Juan Or's condition:

When Mommy was 5 months pregnant, the sonographer detected mild dilation on both of Juan Or's kidneys. Mommy was worried whether it was anything to do with Mommy's lifestyle of eating habits that cause this, but luckily the doctor assured Mommy that this condition has nothing to do with Mommy's part and that since the dilation is mild, hopefully the dilation will gradually disappear by itself as time goes by. By the time Mommy was in the 37th week of pregnancy, the ultrasound scan result indicated that the kidney dilation was still there, but still in mild stage.

Finally when Juan Or was born, particularly when he was 4 days old, the doctor did an ultrasound scan on his kidneys and found the condition to be still the same. So the doctor prescribed trimetophrime (which Mommy googled in the internet and found that it is a man-made antibiotic usually prescribed to urinary tract infection patients). Then the doctor recommended for follow-up check when he was 2 months old. And again, the result was the same. No improvement, and neither did it became worse. So the doctor recommended that Juan Or underwent MCUG test at 5 months old. In the MCUG test, some fluorescent dye was pumped into the urinary tract to see the source of blockage. So before the dye could be pumped in, the doctor had to insert a tiny tube into his penis. Boy! Juan Or cried and cried that day. And Mommy cried too! Mommy felt so pitiful for this little baby who had to endure such pain and discomfort at such a young age. However, the MCUG had to be aborted because the tube could only be inserted partially. Even a few paediatricians tried reinserting the tube, but failed. So in the end, Juan Or only had to do ultrasound scan and continue with his trimetophrime medication. The doctor explained that people with hydronephrosis has higher risk of getting urinary tract infection, so has to be on antibiotics as a preventive measure. Otherwise if there is infection, then the kidneys will be scarred and can interfere with the development of the growing kidneys. The doctor warned that the worst case scenario is that heavily scarred kidneys can lead to impaired kidney function. Oh...how scary!

Without fail, Mommy fed Juan Or with trimetophrime once every night. For the sake of Juan Or's health, Mommy is willing to do anything no matter how inconvenient it may be.

Things started showing a little improvement when Juan Or was 5 months old. The ultrasound scan result indicated that the dilation has reduced a little and the kidneys are growing normally. But Juan Or still had to continue with the medication.

So currently, at Juan Or's 9th month, the ultrasound scan result indicated that the dilation has reduced a little and the kidneys are growing normally. Mommy felt relieve.

On the lighter side, this time, Juan Or cried and cried when the sonographer placed the probe on his abdominal sides. In previous times, Juan Or acted cool when the same thing was done on him. Whatever happened to this baby? Has this baby become anti-social? Even when at the paediatrician's consultation room, Juan Or cried most of the time, except when the doctor gave him a toy to hold! The paediatrician also made physical examination of him including testing him on his behavioural development. The paediatrician hid a small purple colour teddy bear under a pillow, but Juan Or was uninterested and cried instead! Then the doctor dropped another toy onto the floor to see whether Juan Or's eyes followed to which he did. The doctor also commented that Juan Or's body weight is still in the normal range but seems to show a downward trend. So the doctor recommended that butter be added into the porridge or whatever food that Juan Or eats, and that Juan Or can eat more cheese. Later, when Mommy and Juan Or was out from the consultatation room, Juan Or was still crying. So Mommy placed Juan Or back into his stroller and let Grandpa do the pushing while Mommy went to get the next supply of trimetophrime. So along the way, Juan Or slept like a log....which brings to what conclusion? Juan Or was SLEEPY all along throughout the ultrasound scan right up to the paediatrician's consultation! That's why Juan Or was so fretful and in such bad mood! Even when Mommy transferred Juan Or from the stroller to Mommy's lab (when sitting in the car to go home), Juan Or was still fast asleep.

Mommy's baby.......zzzzzzzz.......Mommy will go buy butter and cheese to fatten you up, ya? Mommy loves The 'B'.