Dental Crown Replacement

Back in 1981, while kicking around a bottle cap with my schoolmates during recess, I fell flat on my face and caused a hairline fracture on one of my front tooth. My gums swelled and got infected. The dentist made in incision to drain the pus and recommended root canal treatment for both front teeth. The colour of the tooth with the hairline fracture turned progressively darker. One night, about eight years after that accident, it broke off totally.

The dentist at the Lam Wah Ee Hospital suggested a dental crown instead of dentures as my other teeth were in good condition. She charged a very nominal amount for the post, crown and materials only. The crown served me well. I had no problem eating with it and could enjoy corn on the cob and even chewing on sugar canes.

Dr. Ammar Musawi of IMU working on my dental crown
Dr. Ammar Musawi working on my crown at the Dental Clinic of the International Medical University in Bukit Jalil.

Over the years, while my natural teeth became a few shades yellower, the crown’s colour remained bright and unchanged. This discolouration is due to ageing and maybe from the occasional coffee, tea or cola that I indulged in. My gum had also receded, exposing some of the original discoloured tooth. Call me vain but I was very conscious of how it looked each time I smiled. I had wanted to get it fixed for the longest time.

As fate would have it, I got acquainted with Dr. Ammar Musawi of the International Medical University (IMU) Dental Faculty. He was looking for information on the distribution of disabled people in Malaysia for a project that he was working on. During one of our online conversations, I took the opportunity to consult him on replacing the crown with one that could make my smile more aesthetically pleasing.

Before and after dental crown replacement.

As I could not see him at the clinic on weekdays, he had kindly agreed to see me on Saturdays, first to take a dental impression and then to fit the replacement crown. I have a problem with stretching out on a dental chair – my legs would go into spasms. Each time the spasms struck, he would stop and let me get comfortable again before he continued. He also let me sit in upright position which helped in reducing spasms.

I could not be any happier when I held up the mirror and saw the result in the reflection. The colour matched perfectly. If I did not know any better, I would say that it is my natural tooth. Thank you, Dr. Ammar, for the excellent dental work. After so many years of muted grins, I now can smile again without being self-conscious.

Stage 4 Chronic Kidney Disease

In 2004, I was diagnosed with Stage 3 Chronic Kidney Disease with a serum creatinine of 188 umol/L. At this stage, the kidneys are moderately impaired with decreased function to filter out waste products from the bloodstream. The urologist put me on 1mg Detrusitol twice daily and advised me to continue perform clean intermittent catheterisation (CIC) every four hourly which I have been doing since 1991. That is to reduce the occurence of urine reflux back to the kidneys and damaging them further.

By the following year, my serum creatinine climbed to 262 umol/L and bumped the diagnosis to Stage 4 Chronic Kidney Disease (CKD). I have been living with Stage 4 CKD for the past seven years. At Stage 4, there is advanced kidney damage. It is likely that I will need dialysis or kidney transplant in the future. There are five stages of chronic kidney disease altogether. Stage 5 CKD is known as end stage renal disease (ESRD). This is the final stage of kidney disease where the kidneys have lost almost all their function and dialysis or kidney transplant is needed to live.

I have not thought much about how serious my kidney failure was until recently when I read up more on this disease. At Stage 4, my kidneys are teetering on the brink. Dr. Liong, the urologist at Lam Wah Ee Hospital in Penang, had warned me that life will be difficult not only for me but the family as well should I need to undergo dialysis. It will be a drain on finance and time. Each dialysis treatment costs about RM200.00, requires four hours and has to be performed three times per week. That was the reason he kept reminding to mantain my remaining kidney function as much as possible by catheterising religiously, cut down on protein intake and avoid red meat.

My low-potein diet is basically two matchbox-sized portions of meat per day. I am also to cut down on the intake sodium, phosphorous and purine. High phosphorous level in the bloodstream causes itching. I cut down on the consumption of carbonated drinks, dairy products, peas, beans, nut and chocolates. Purine is metabolised into uric acid. My kidneys are unable to keep the uric acid level optimal. This could lead to gout. To prevent this condition, I avoid spinach, cabbage, cauliflower, organ meats, sardines and mackerels.

Stage 4 CKD is associated with a host of symptoms that I have been experiencing for the last few years. I get exhausted easily because of anemia which is common in people with kidney disease. This condition is exacerbated by the fact that I also have alpha thalassemia trait that causes anemia and small red blood cells. The other apparent symptom is short attention span. This could be the reason why I have been unable to finish the books I have been reading and the lack of updates in this blog lately. I just could not keep my mind focused on one single task long enough to see it to completion.

Chronic kidney disease increases the risk of cardiovascular disease. This is already manifested by my undesirable cholesterol levels that necessitated the long term use of Lipitor to bring my cholesterol under control. The good news is that the electrocardiogram done in November last year did not show any problem with the heart. The other good news is that after a two-month therapy of Lipitor, my cholesterol levels showed marked improvements. At the same time, I did not suffer the potentially kidney-damaging side effects associated with the medicine.

Considering that the sword of Damocles is hanging over my head where my kidneys are concerned, I am quite laid-back about it now as compared to when it was first diagnosed, not that there is much I can do to reverse the condition. I can only slow down the progression of the disease by going for regular check-ups and following the advice of doctors and dieticians.

Of course there were the occasional anxieties, especially just before getting the blood test results or after indulging on more meat that I should. Otherwise, my daily routine is least disrupted. I am determined not to let it affect Wuan’s and my quality of life. It has not so far. My greatest hope is that the kidneys’ current condition will to hold for a long time to come. From the looks of the latest medical reports, there is a good reason for me to be cautiously optimistic. That aside, there is a nagging sense that I will be blindsided by a health condition I least expected, as if a Stage 4 CKD is not bad enough. Hopefully, that is just an overactive imagination working overtime.

Eat Now, Regret Right After

The chronic kidney disease has curbed my enthusiasm for good food since I was diagnosed with it in 2004. Mr. Liong, the urologist at Lam Wah Ee Hospital in Penang, gave me an advice that I remembered till today, that I should take good care of my failing kidneys, which if not, would cause a lot of undue hardship to my family when they fail totally and I need to go for dialysis. I took that advice to heart and have been keeping to a strict renal-friendly low-protein, low-sodium and practically low-everything to keep the decline in check.

I pride myself for adhering to having just two matchbox sized portions of meat daily most of the time. I also scrutinise the mineral contents in the food that I eat. As hard as I try, there have been occasions that I allowed temptation to get the better of me with the notion that I should reward myself with some taboo food for depriving myself for so long. So, I would tuck in the food and savour every mouthful like it was my last meal. Food never tasted so good.

And as always, inevitably, the moment I put down the cutlery, I would ask myself if I over-indulged. Did I eat more meat than I should? Was that gravy a tad too salty? I would regret even more should I start to itch and had to take anti-histamine tablets. I did say I stuck to the low-protein diet most of the time. Those other time I did not, I would be trouble over a period of time wondering if I overloaded my kidneys and tipped them over the edge.

I am writing this post because I have a scheduled blood extraction together with an ultrasound of the kidneys, ureters and bladder on Friday, and I am troubled by the few times I ate more than I was allowed to or did not catheterise as often as I should have. This is the same emotional cycle that I go through every time I have to go for blood tests and ultrasound. It would persist until I get the test result when during the scheduled medical appointment two weeks later.