My sister, Michelle-Ann Iking's 3% chance of conceiving naturally was a success! Here's her story:
(My apologies as I've been overwhelmed with personal matters. I've only managed to get to my desk. So finally got around posting this).
This is the story behind my sister's pregnancy struggle and how she shared her journey over her Facebook page.
Because some may have not caught her LIVE session chat with me (https://www.facebook.com/daphneiking/videos/687743128744960/) , or read her lengthy post (as it's a private page);
she's allowed me to copy and paste it over my wall, in case you need to know more about her thought process on how AND why she focused on the 3% success probability. Read on.
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Posted 10th May 2020.
FB Credit: Michelle-Ann Iking
A week ago today I celebrated becoming a mother to our second, long awaited child.
Please forgive this mother's LONG (self-indulgent) post, journalling what this significant milestone has meant for her personally, for her own fallible memory's sake as well as maybe to share one day with her son.
If all you were wondering was whether I had delivered and if mum and bub are OK, please be assured the whole KkLM family are thriving tremendously, and continue scrolling right along your Newsfeed 😁.
OUR 3% MIRACLE
All babies are miracles... and none more so than our precious Kiaen Aaryan (pronounced KEY-n AR-yen), whose name derives from Sanskrit origins meaning:
Grace of God
Spiritual
Kind
Benevolent
...words espousing the gratitude Kishore and I feel for Kiaen's arrival as our "3% miracle".
He was conceived, naturally, after 3 years of Kishore and I hoping, praying and 'endeavoring'... and only couples for whom the objective switches from pure recreation to (elusive) procreation will understand how this is less fun than it sounds ...
3 years during which time we had consensus from 3 different doctors that we, particularly I (with my advancing age etc etc) had only a 3% chance of natural conception and that our best hope for a sibling for our firstborn, Lara Anoushka, was via IVF.
Lara herself was an 'intervention baby', being one of the 20% of babies successfully conceived through the less intrusive IUI process, after a year and a half of trying naturally and already being told then my age was a debilitating factor.
We had tried another round of IUI for her sibling in 2017 when Lara was a year old. And that time we fell into the ranks of the 80% of would-be parents for whom it would be an exercise in futility... who would go home, comfort each other as best they could, while individually masking their own personal disappointment... hoping for the best, 'the next time around'...
So the improbability ratio of 97% against natural conception of our second baby, as concurred by the combined opinion of 3 medical professionals, was a very real, very daunting figure for us to have to mentally deal with.
Deep, DEEP, down in my heart however, though I had many a day of doubt... I kept a core kernel of faith that somehow, I would again experience the privilege of pregnancy, and again, have a chance at childbirth.
And so, the optimist in me would tell myself, "Well, there have to be people who fall in the 3% bucket... why shouldn't WE be part of the 3%?"
Those who know me well, understand my belief in the Law of Attraction, the philosophy of focusing your mind only on what you want to attract, not on what you don't want, and so even as Kishore and I prepared to go into significant personal debt to attempt IVF in the 2nd half of 2019, I marshalled a last ditch effort to hone in on that 3% chance of natural conception... through research coming across fertility supplements that I ordered from the US and sent to a friend in Singapore to redirect to me because the supplier would not deliver to Malaysia.
I made us as a couple take the supplements in the 3 month 'priming period' in the lead up to the IVF procedure - preconditioning our bodies for optimum results, if you will.
At the same time, I had invested in a sophisticated fertility monitor, with probes and digital sensors for daily tracking of saliva and other unmentionable fluid samples, designed to pinpoint with chemical accuracy my state of fertility on any given day.
(UPDATE: For those interested - I obtained the supplements and Ovacue Fertility Monitor from https://www.fairhavenhealth.com/. Though I had my supplies delivered to a friend in Singapore, and redirected to me here since the US site does not deliver to Malaysia, there are local distributors for these products, you will just have to research the trustworthiness of the vendors yourself...)
I had set an intention - in the 3 months of pre-IVF priming, I would consume what seemed like a pharmacy's worth of supplements, and track fertility religiously... in hopes that somehow, within the 3 month priming period, we would conceive naturally and potentially save ourselves a down payment on a new property... and this was just a projection on financial costs of IVF, not even considering the physical, emotional and mental toll it involves, with no guarantee of a baby at the end of it all...
It was a continuation of an intention embedded even with my first pregnancy, where all the big ticket baby items were consciously purchased for use by a future sibling, in gender neutral colours, in hopes that sibling would be a brother "for a balanced pair", though of course any healthy child would be a welcome blessing.
It was a very conscious determination to always skew my thoughts in service of what the end objective was. For example, when 3+year old Lara would innocently express impatience at not yet having a sibling, at one point suggesting that since we were "taking too long to give her a baby brother/sister", perhaps we should just "go buy a baby from a shop", instead of getting defensive or berating the baby that she herself was, we enlisted Lara's help to pray for her sibling... so in any place of worship, or sacred ground of any kind that we passed thereon, Lara would stop, close her eyes, bow her small head and place her tiny hands together in prayer, reciting earnestly, "Please God, please give me a baby brother or baby sister."
After months and months of watching Lara do this, in the constancy of her childlike chant, Kishore started feeling the pressure of possibly disappointing Lara if her prayer was not answered. Whereas for me, Lara's recitation of her simple wish became like a strengthening mantra, our collective intention imbued with greater power with each repetition, and the goal of a sibling kept very much in the forefront of our minds (hence our calling Lara our 'project manager' in this endeavour).
And somehow in the 2nd month of that 3 month period, a positive + sign appeared on one of the home pregnancy tests I had grown accustomed to taking - my version of the lottery tickets others keep buying in hopes of hitting the jackpot, with all the cyclical anticipation and more often than not, disappointment, that entails...
This time however I was not disappointed.
With God's Grace, (hence 'Kiaen', a variation of 'Kiaan' which means 'Grace of God'), my focus on our joining the ranks of the 3% had materialised.
It seems poetic then, that Kiaen chose to make his appearance on the 3rd May, ironically the same date that his paternal great-grandfather departed this world for the next... such that in the combined words of Kishore and his father Kai Vello Suppiah,
"The 1st generation Suppiah left on 3rd May and the 4th generation Suppiah arrived on 3rd May after 41yrs...
One leaves, another comes, the legacy lives on..."
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KIAEN AARYAN SUPPIAH'S BIRTH STORY
On Sunday 3rd May, I was 40 weeks and 5 days pregnant.
The baby was, in my mind, very UN-fashionably late past his due date of 29th April, so as much as I had willed and 'manifested' the privilege of pregnancy, to say I was keen to be done with it all was an understatement.
In the weeks leading to up to my full term, I had experienced increasingly intense Braxton-Hicks 'practice contractions' - annoying for me for the discomfort involved, stressful for Kishore who was on tenterhooks with the false alarms, on constant alert for when we would actually need to leave home for the hospital.
Having become a Hypnobirthing student and advocate from my first pregnancy with Lara, and thus being equipped with
(1) a lack of fear about childbirth in general and
(2) a basic understanding of how all the sensations I would experience fit into the big picture of my body bringing our baby closer to us,
I was less stressed - content to wait for the baby to be "fully cooked" and come out whenever he was ready... though I wouldn't have minded at all if the cooking time ended sooner, rather than later.
With Lara, I had been somewhat 'forced' into an induced labour, even though she was not yet due, and that had resulted in a 5 DAY LABOUR, a Birth Story for another post, so I was not inclined to chemically induce labour, even though I was assured that for second time mothers, it would be 'much faster and easier'...
That morning, I had a hunch *maybe* that day was the day, because in contrast to previous weeks' sensations of tightening, pressure and even spasms that were concentrated in the front of my abdomen and occasionally shot through my sides and legs, I felt period - like cramping in my lower back which I had not felt before throughout the pregnancy.
It was about 8am in the morning then, and my 'surges' were still relatively mild ('surges' being Hypnobirthing - speak for 'contractions', designed to frame them with the more positive connotations needed to counteract common language in which childbirth is presented as something that is unequivocally painful and traumatic, instead of the miraculous, powerful and natural phenomenon it actually is).
I recall (masochistically?) entertaining the thought of opting NOT to have an epidural JUST TO SEE WHAT IT WOULD BE LIKE...
I figured this would be the last time I would be pregnant and so it would be my 'last chance' to experience 'drug free labour' which, apart from the health benefits for baby and mother, might be *interesting* in a way that people who are curious about what getting a tattoo and skydiving and bungee jumping are like, might find these *interesting*...even knowing there will be pain and risk involved...
Since I have tried tattoos and skydiving (unfortunately not being able to squeeze in bungee-jumping while my life was purely my own to risk at no dependents' possible detriment) a similar curiousity about a no-epidural labour was on my mind...
In the absence of other signs of the onset of labour (like 'bloody show' or my waters breaking), I wanted to wait until the surges were coming every few minutes before we actually left the house for the hospital, not wanting to be one of those couples who rushed in too early and had interminable waits for the next stage in unfamiliar, clinical surroundings and/or were made to go home in an anti-climatic manner.
I was even calm enough through my surges to have the presence of mind to wash and blowdry my hair, knowing if I did deliver soon I would not be allowed this luxury for a while.
Around 9am I asked Kishore to prep for Lara and himself to be dressed and breakfasted so we could head to hospital soon, while I sent messages to family members on both sides informing them 'today might be the day.'
My mother, who had briefly served as a midwife before going back into general nursing and then becoming a nursing tutor, prophetically stated that if what I was experiencing was true labour, "the baby would be out by noon".
The pace in which my surges grew closer together was surprisingly quicker than I expected; and while I asked Lara to "Hurry up with breakfast" with only a tad more urgency than we normally tell her to do, little Missy being prone to dilly-dallying at meals, I probably freaked Kishore out when about 930am onwards, I had to instinctively get on my hands and knees a couple of times, eyes closed, trying to practice the Hypnobirthing breathing techniques I had revised to help along the process of my body birthing our child into the world.
I recall him saying a bit frantically as I knelt at our front door, doubled over as he waited for Lara to complete something or other, "Lara hurry up! Can't you see Mama is in so much pain and you are taking your own sweet time??!!"
SIDETRACK: Just the night before, Lara and I had watched a TV show in which a woman gave birth with the usual histrionics accompanying pop culture depictions of labour.
Lara watched the scene, transfixed.
I told her, simply and matter-of-factly, "That's what Mama has to do to get baby brother out Lara, and that's what I had to do for you also."
In most of interactions with my daughter, I have sought to equip her to face life's situations with calmness, truthful common sense, and ideally a minimum of drama.
Those who know the dramatic diva that Lara can be will know that this is a work-in-progress, but her response to me that night showed me some of my 'teachings' were sinking in:
She looked at me unfazed, "But Mama," she said. "You won't cry and scream like that lady, right? You will be BRAVE and stay calm, right?"
#nopressure.
So as we prepped to leave for the hospital I did indeed attempt to be that role model of calm for her, asking her only for her help in keeping very quiet,
"Because Mama needs to focus on bringing baby brother out and she needs quiet to concentrate...".
As we left the house at 10.11am, I texted Kishore's sister Geetha to please prep to pick up Lara from the hospital, and was grateful Kishore had the foresight to ask our gynae to prepare a letter for Geetha to show any police roadblocks between my in-laws' home in Subang Jaya and the hospital in Bangsar, this all happening under the Movement Control Order (MCO).
To Lara's credit, in the journey over to the hospital, she - probably sensing the gravity of the situation, sat very quietly in her seat at the back, and the silence was punctuated only by my occasional deep intakes of breath and some variation of my Ohmmm-like moans when the sensations were at their height.
By the time we got to Pantai Hospital at around 10.30am, my surges were strong enough I requested a wheelchair to assist me in getting to the labour ward, as I did not trust my own legs to support me... and Kishore would have to wait until Geetha had arrived to take Lara back to my in-laws' house before he himself could go up.
I slumped in the wheelchair and was wheeled up to the labour room with my eyes closed the whole time, trying to handle my surges.
I didn't even look up to see the attendant who pushed me... but did make the effort to thank him sincerely when he handed me over, with what seemed like a palpable sense of relief on his part, to the labour ward nurses.
The nurse attending me at Pantai was calm, steady and efficient. I answered some questions and changed into my labour gown while waiting for Kishore to come up, all the while managing the increasingly intense surges with my rusty Hypnobirthing breathing techniques.
By the time Kishore joined me at around 11am (I know these timings based on the timestamps of the 'WhatsApp live feed' of messages Kishore sent to his family), I was asking the nurse on duty, "How soon can I get an epidural??" thinking what crazy woman thought she could do this without drugs???!!!
The nurse checked my cervix dilation, I saw her bloodied glove indicating my mucous plug had dislodged, and she told me, "Well you are already at 7cm (which, for the uninitiated, is 70% of the way to the 10cm dilation needed for birthing), you are really doing well, if you made it this far without any drugs, if can you try and manage without it... I suspect within 2 hours or less you will deliver your baby and since it will take about that time for the anaesthesiologist to be called, epidural to be administered and kick in... it might all be for nothing... but of course the decision is completely up to you... "
So there I was, super torn, should I risk the sensations becoming worse... or risk the epidural becoming a waste?? And of course I was trying to decide this as my labour surges were coming at me stronger and stronger...
I was in such a dilemma...because as a 'recovering approval junkie' there was also a silly element of approval-seeking involved, ("The nurse thinks I can do this without drugs... maybe I CAN do this without drugs... Yay me!") mixed with that element of curiosity I mentioned earlier ("What if I actually CAN do this without drugs... plenty of other women have done it all over the world since time immemorial.. no big deal, how bad can it be...??") so then I thought I would use the financial aspect to be the 'tiebreaker' in my decision making...
I asked the nurse how much an epidural would cost and when she replied "Around MYR1.5k", I still remember Kishore's incredulous face as I asked the question, i.e."Seriously babe, you are gonna think about money right now? If you need the epidural TAKE IT, don't worry about the money!!!"... and while we are not rich by any stretch of the imagination, thankfully RM1.5k is not a quantum that made me swing towards a decision to "better save the money"...
So in the end, I guess my curiosity won out, and I turned down the epidural "just to see what it would be like and if I had it in me" (in addition of course to avoiding the side effects of any drugs introduced into my and the baby's body).
My labour occuring in the time of coronavirus, it was protocol for me to have a COVID19 test done, so the medical staff could apply the necessary precautions. I had heard from a friend Sharon Ruba that the test procedure was uncomfortable, so when the nurse came with the test kit as I was starting another surge, I asked, "Please can I just finish this surge before I do the test?" as I really didn't think I could multitask tackling multiple uncomfortable sensations in one go.
The COVID19 test involved what felt like a looong, skinny cotton bud being inserted into one nostril... I definitely felt more than a tickle as it went in and up, being told to take deep breaths by the nurse. Then she asked me to "Try to swallow" and I felt it go into my nasal cavities where I didn't think anything could go any further, but was proven wrong when she asked me to swallow again and the swab was probed even deeper. Then she warned me there would be some slight discomfort as she prepared to collect a sample... but at that point all I could think about was:
(i) I really don't have much of a choice
(ii) please let this be over before my next surge kicks in
(iii) if all the people breaking the MCO rules knew what it feels like to do this test maybe they won't put themselves at risk of the need to perform one...
In full disclosure as I was transferred into the actual delivery room at some point after 11am, another nurse offered me 'laughing gas' to ostensibly take some of the edge off... I took the self-operated breathing nozzle passed to me but don't recall it making any difference to my sensations..so didn't use it much as it seemed pretty pointless.
I recall some measure of relief when I heard my gynae Dr. Paul entering the room, greeting Kishore and me, and telling us it was going well and it wouldn't be long now and he would see us again shortly.
From my previous labour with Lara I knew the midwives pretty much take you 90% of the way through the labour and when the Dr is called in you are really at the home stretch, so was very relieved to hear his voice though knowing he would leave and come back later meant it wasn't quite over yet.
I do remember realising when I had crossed the Thinning and Opening Phase of labour to the Birthing Phase, by the change in sensations... it is still amazing to me that as the Hypnobirthing book mentioned, having this knowledge I was instinctively able to switch breathing techniques for the next stage of labour .
Was my opting against epidural the right choice for me?
Overall? Yes.
Don't get me wrong.
I *almost* regretted the decision several times during active labour... especially when I felt my body being taken over by an overwhelming compulsion to push that did not seem conscious and was accompanied by involuntary gutteral moans where I literally just thought to myself, "I surrender, God do with me what you will..." (super dramatic I know but VERY real at the time...).
I think I experienced 3-4 such natural explusive reflexes (?), rhythmically pushing the baby down the birth path, one of which was accompanied by what felt like a swoosh of water coming out of a hose with a diameter the size of a golf ball... this was when I realised my water had finally broken...
The nurses kept instructing me to do different things, to keep breathing, to move to my side, then to move to the middle, to raise my feet... and when I didn't comply, Kishore (who was with me throughout both my labours) tried to help them by repeating the instructions prefaced with "Sayang..." but I basically ignored all the intructions because I felt I had no capacity to direct any part of my body to do anything and someone else would have to physically manoeuvre that body part themselves.
When I heard Dr. Paul's voice again and the flurry of commotion surrounding his presence, I knew the time was close... and when I heard the nurse say to Kishore, "Sir, these are your gloves, for when you cut the baby's cord", it was music to my ears...
I'm very, VERY grateful Kiaen slid out after maybe the 4th of those involuntary pushes... the wave of RELIEF when he came out so quickly... it still boggles my mind that my mother was essentially right and as his birth time was 12.02pm, it was *only* about 1.5 hours between our arrival at the hospital and his arrival into the world.
Kiaen was placed on my chest for skin to skin bonding and remained there for a considerable time.
For our short stay in the hospital he would be with us in my maternity ward number C327... another trivially serendipitous sign for me because he was born on the 3rd (May) and our wedding anniversary is 27th (July).
I was discharged the following day 4th May at about 5.30pm, after I got an all clear on COVID19 and a paediatric surgeon did a small procedure on Kiaen to address a tongue-tie that would affect his breastfeeding latch... making the entire duration of our stay about 31 hours.
I have taken the time and effort to record all this down so that whenever life's challenges threaten to get me down I can remind myself, "Ignore the 97% failure probability, focus on the 3% success probability".
Also that the human condition is miraculous and it is such a privilege to experience it.
To our son Kiaen Aaryan, thank you for coming into our lives and choosing us as your parents.
Even though Papa and I are both zombies trying to settle into a night time feeding routine with you, I look forward to spending not only all future Mother's Days, but every day, with you and your Akka...
And last but not least, to my husband Kishore...without whom none of this would be possible - we did it sayang, I love you ❤️
Photo credit: Stayhome session with Samantha Yong Photography (http://samanthayong.com/)
同時也有10000部Youtube影片,追蹤數超過2,910的網紅コバにゃんチャンネル,也在其Youtube影片中提到,...
research protocol sample 在 賴叔閱事 Facebook 的精選貼文
恐慌嘅時候,更需要睇清楚啲。
肥人知道呢篇文真係寫得遲,本來我乜都唔想寫,依家見到個勢係全世界順水推舟圍堵中共就更加唔想寫,但係姣婆係好難守寡既,尤其是呢排成日俾班極度恐慌既人trigger… 我決定代肥控制員寫,因為我呢邊收視率高過佢。
好,開波!
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“We had better learn to doubt our inflated fears before they destroy us. Valid fear have their place; they cue us to danger. False and overdrawn fears only cause hardship. Even concerns about real dangers, when blown out of proportion, do demonstrable harm.” – Barry Glassner, American sociologist, author of The Culture of Fear.
網絡世界千奇百趣,好多網上既意見同評論,如果同傳媒製造既輿論結合(不論有心定無意),係會對社會有非常深切既影響。例如以前有政權會向群眾灌輸恐懼,挑起群眾之間既仇恨,或令群眾不知所措,進而控制群眾。呢種手法,不論以前納粹德國、現存或者已覆亡既共產國家、甚至自命民主自由既開放社會如美國都有出現。當政者及其黨羽,就係利用群眾既錯誤認知,以感性因素去扭曲大家既認知同決策能力,咁就可以達到佢地既政治目的啦。咩政治目的?好多種既,下至失敗政府要掩飾施政失誤,上至衝出國際統治全世界都有。
所以唔好話咁樣係「誇張」、「陰謀論」、同「乜都拉埋政治來講」呀,因為人類歷史就係充滿呢種叫 fearmongering既手段-用有目的地散播同誇大一樣不愉快既事情既手法,去引起大家既恐懼來控制群眾。現今世界,庸碌無能之輩當政比比皆是,唔識控制群眾既情緒,點樣遮掩政府既無能同做錯事既後果?不過肥人今次唔講法律,我學下一般既KOL咁「跨界別評論」先,所以呢篇文我講生物醫學,particularly 係將近來我係周遭聽聽埋埋既恐慌言論歸納一齊,逐點解釋。
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首先,等肥人我同大家重溫一下近來有關武漢肺炎既新聞標題:
信報報導「河南超長潛伏期病例疑94天確診」
HK01就話「逾5000疫廈元朗區最多 衛生署拒回應真偽」
Business Focus既報導就恐怖啦,話「肺炎突變新冠腦炎? 北京醫院首證病毒能侵襲中樞神經系統 感染肺炎併發腦炎北京醫院:患者意識曾陷入混亂」
CCTVB報導「私家醫生可收患者呼吸道樣本交政府陳肇始稱可及早減低傳播」
仲有零零星星報導例如:
「伊朗新冠肺炎疫情增至145死55歲國會議員不治」
「伊朗新型冠狀肺炎疫情失控,再有一位高級官員病逝。」
「【新冠肺炎・伊朗】數名官員先後染病身亡 23國會議員確診」
「新型冠狀病毒南韓確診個案累計增至逾7千宗死亡人數維持在44人。」
「【新冠肺炎.最新疫情】意大利確診個案逾萬 美國突破千宗」
上面堆報導實在睇到好多人好恐慌,尤其是本來對科學/病毒/醫療/疾病無咩認知既人,呢兩個月睇新聞就好似睇恐怖熱線咁。於是搞到好多心理質素差,表面受過教育既人墮入恐慌之中。
然後,我聽到身邊好多人竭斯底理咁驚叫:
「個肺花!個肺花!個肺花!個肺花呀!」
「呢個唔係流感呀!唔好再錯誤同流感比較啦!」
「潛伏期變長呀!無病徵既隱形病人都會傳染人架!」
(隔離果個choke到,咳兩聲)「我以後唔同你坐埋一齊呀!我唔想死呀!」
「如果唔係香港人衛生意識好,堅持戴口罩,香港一早淪陷啦!依家已經無新病例!你睇鬼佬幾污糟!又唔戴口罩,病又話唔使入醫院,返屋企休息,依家美國同意大利都爆發啦!」
「呢D廢老唔戴口罩,鬼唔望佢地中招死全家!政府應該強制人戴口罩!」
以上說話我全部聽過人講,最後一句我最撚火滾,你自己恐慌就好啦,咒人死仲要政府好 draconian 咁立法同執法?俾個民主自由既國會你仲可以普選,你都會選班人渣出來,然後大比數通過立法強制抽血抽組織,強制所有人有無問題都要戴口罩,仲可能要將人tag完再限制人出入自由。1984呀!
我日日做mon post狗睇網上既post,好多share出來又會令人恐懼既post,大部份都係有好多空間令人胡思亂想,如果你對科學尤其是 research methods, medical science, microbiology, virology等等唔認識的話,你鐵定會誤讀誤解再誤判… oh wait,睇返上面「利用群眾既錯誤認知,以感性因素去扭曲大家既認知同決策能力」,BINGO! 咁就搞掂你啦。為咩事要搞掂你?唔講啦,因為你會用陰毛論、陳雲信徒、唔好乜都政治化來駁我。
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依家太多post講呢個新型冠狀病毒,例如Facebook有個印度人既 Infographics on Covid-19,好詳盡,但咁又點呢?大家對病毒以致肺炎、流感、醫療系統等等都毫無認識,講到咁深入你地都會誤解或者一頭霧水。咁樣樣,好多人因為無足夠既basic knowledge,又先入為主咁因為自己既恐慌情緒相信左錯既資訊,要同佢地「解毒」,就好似同藍絲講咩叫法治一樣困難,真係太監洞房無撚用。
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好,依家開始【法網肥人講病毒】!
1. 眾所鳩知,武漢肺炎係由新型既冠狀病毒 Covid-19引起。Covid-19係冠狀病毒科 Coronaviridae裡面其中一種,佢係屬於 positive-sense, singled stranded RNA virus (正鏈單股核醣核酸病毒) 。RNA病毒有好高突變率,因為病毒既RNA polymerases缺乏 DNA polymerase 既proofreading能力,所以佢地好難有 nearly identical既 sequence。仲有一點好重要,病毒同病菌唔同,病毒係需要靠 host cell (宿主細胞)先可以生存,離開 host cell 佢地不能複製,不能運作,只有死路一條。所以一開始就話新病毒同SARS個sequence有幾多幾多 percent 相似,我即刻叮左一下,然後好多人傳話新病毒點點點可以生存好耐,我更加叮多兩下…. 邊個放呢D料出來既?
2. 另外,呢隻病毒並非 retrovirus (逆轉錄病毒, class VI single-stranded RNA-Reverse Transcriptase),唔會將自己既RNA用 reverse transcriptase (逆轉錄酶)塞入host cell既基因裡面,然後適時復發。咩係retrovirus呢? 例如會引起 T Cell Leukemia 既 Human T-cell lymphotropic virus type 1 (HTLV-1),或者引起愛滋病既 Human Immunodeficiency Virus (HIV)。呢個病毒,亦唔係好似肝病毒科乙型肝炎咁,唔係 retrovirus 但會有reverse transcriptase去將 viral genome incorporate 入host cell,所以就算不幸中左,都唔會話咩病者會成世帶住個病。所以我每一次聽到人講「就算中左都一世帶病呀」就會好抆,冠狀病毒變愛滋,黐L線!
3. 冠狀病毒既結構好簡單:一個 viral envelope,外面有protein spike,裡面有RNA,that’s it。佢地個replication mechanism (複製機制) 就係病毒接觸host cell後進入 host cell,然後係host cell個細胞核nucleus裡面複製。複製完之後就由host cell cytoplasm (細胞質)裡面製造既 necleocapsid (核蛋白衣) 加埋細胞核既 endoplasmic reticulum (內質網) 既phospholipid membrane (磷脂層)包住病毒RNA,經由host cell 既Golgi apparatus (高氏體)帶出host cell 繼續傳染人。呢個複製過程,當然會破壞甚至殺死 host cell啦。咁知道呢點有咩用?Phospholipid membrane係lipid bilayer (脂質雙分子層),lipid bilayer係怕番梘soap既!咁勤D用番梘洗手就得啦,使撚用甲醇咩屌你,你嫌命長?
4. 有人話:「咁基因突變都得架嘛!個病毒咪做到所有野囉!」喔,係咩?如果咁簡單,呢個世界既大學就唔需要有生物系,而且達爾文應該無人理。首先,病毒點解會有基因變異?簡單講就係 replication 之中,有polymerases 抄錯條 sequence,例如本來係 ATCG 既,抄成 ATTG,跟住無 proofread 就掉出去。又有一種變異,就好似屬於Orthomyxoviridae 既influenza A virus咁,裡面有八條 RNA segments,可以係 replication既時候洗牌。呢種 replication 既錯誤或者洗牌,積埋積埋,小則變成 genetic drift/antigenic drift,大則變成 genetic shift/antigenic shift。前者可能將某一個半個 surface protein 結構變左少少,整體來講人體免疫系統仲認得出,變異後既病毒殺傷力有限。後者可能將原有病毒變成新既 subtype,大部份人既免疫系統都認唔出而死傷無數。假設,新既冠狀病毒係由舊有冠狀病毒(包括 SARS)天然 antigenic shift 變出來既,咁點可能係短短兩三個月再次 antigenic shift 呢?如果基因突變去到呢個地步,肯定顛覆生物學界既認知。但好多本來就無讀過生物既人會唔認同,佢地會搏命咁話基因變異點能夠預測!肥人話你知,唔係預測,而係不符合現實同暫時無人能夠推翻既理論。如果新病毒可以係短時間內變成 retrovirus,可以無任何條件下生存好耐,隨意改變 latent period潛伏期,隨意改變傳染力同殺傷力的話,科學家應該點 classify 佢呢?簡單講,長頸鹿頸長先叫做長頸鹿,如果長頸鹿變成 Mike Tyson 條頸咁短,咁我地應該叫佢做 Mike Tyson 定長頸鹿?如果新冠狀病毒有 HTLV-1既retrovirus能力,有hepatitis B 既 reverse transcriptase,有 flu A 可以 shuffle RNA 既能力,又有 HIV 既超長 latent period,你會叫佢做 coronavirus 定 super virus?
5. 講基因變異,要一個變異既病毒基因可以流傳,病毒本身必須要不斷繁衍,宿主傳宿主咁一代傳一代,病毒先可以續存。呢個就係進化論,survival of the fittest。古代有好多生物不能續存,就係因為被環境淘汰,例如有理論認為三葉蟲因為蛻變機制 (instar and molting) 有問題,結果難以生存,最後被大自然淘汰。如果病毒勁到咩人都可以一野就殺死佢的話,佢點傳播?宿主死左,無人帶佢地去傳染其他人嘛!病毒唔係病菌,可以係環境種生存好耐,病毒只要離開宿主好快就會死,就算有飛沫帶住,我地環境中既太陽紫外光、oxidizing agents、濕度與氣溫等等會令佢地好快收皮。病毒唔係倪匡衛斯理《藍血人》裡面隻「獲殼依毒間」,可以變成游離電波周圍飄。大家明白進化論,就會明白病毒學101既常識,從而 debunk 左一個不斷流傳既流言:「隻病毒好勁,好多人死架,傳播得又快!」傳播得快,不等如勁,而太勁既病毒,難以傳播。係呢度,傳播得快,同隻病毒之間並無關係。病毒殺傷力勁,傳播範圍就會窄,傳播速度都會慢;病毒殺傷力一般如普通流感的話,傳播範圍先會闊,傳播速度先會快。如果新聞瘋狂報導好多人死就等如勁,咁非洲同中東都有好多基督徒男女老幼被人大規模屠殺,你會唔會覺得信耶穌係死路一條?
6. 又有人話:「呢隻病毒唔同流感呀!唔好再同流感比啦!呢隻病毒會死人架!呢隻病毒無藥醫架!」首先,除左冠狀病毒同流感病毒,仲有 Respiratory Synctical Virus (人類呼吸道合胞病毒) 同 Rhinovirus (鼻病毒) 都會引起呼吸道感染疾病,隻隻都係病毒,病毒一向未必有有效既藥物醫治,隻隻都會死人。你地以為流感有得醫?用 Tamiflu 都未必得架,而且有可能有嚴重副作用。咁冠狀病毒同流感病毒有咩唔同? 有人話death rate高,無vaccine,latent period又長又短,病人無病徵,但呢堆因素唔係用來分別病毒勁唔勁囉。Death rate 高低由咩決定,點計?Vaccine有咩用,target 咩?latent period 點解會長短不一?有無病徵同嚴重性有咩關係,係咪好似異形咁,你怕有人無病徵但會 sudden death?你地睇得太多 WhatsApp D人無啦啦訓低既片段啦,你又知人地係武漢肺炎死?New England Journal of Medicine 有篇叫 First Case of 2019 Novel Coronavirus in the United States既文,提到美國華盛頓州有個病人1月19日入廠,20日確診,一直都係 supportive care,直到染病第11日,即係入廠第7日,醫生先用 IV 俾 remdesivir (瑞德西韋),然後佢就退燒,其他症狀都消失或者減輕。咁又點解會係無得醫?大家記住remdesivir (瑞德西韋),遲下會再講。
7. 仲有,我最憎既「個肺花!個肺花!個肺花!個肺花呀!」呢句,我想同講呢句既人講,肺花,係因為照 X-ray 既時候個肺有 consolidation/infiltration,呢個問題唔單止係肺炎,肺癆甚至cancer都會肺花。你怕咩肺花?流感去到嚴重的話,都可能肺花,因為你有 pulmonary consolidation or infiltration。肺花係因為你個肺 filled with liquid, exudate, pus 甚至 blood from hemorrhage。理性少少,冷靜D,肺花講一次就得,repeat 幾次無幫助。
8. 孤勿論點,呢隻病毒都只係一隻呼吸道感染既病毒,一隻真病毒,一隻同流感一樣會令人病,亦會令人死既病毒,只係流感令人鼻塞,但一樣有機會令人肺炎。呢個新病毒佢所有既威力都係傳媒、WhatsApp片段、社交媒體既報導俾佢,就好似有D 人,你聽佢大名如雷灌耳,一見到真人原來係柒碌又無料到一樣(我懷疑我自己都係咁)。其實有無人真正去了解上面我所講既野?無人話你聽你可以當呢隻病毒無到,話之佢死,但係一開始就進入恐慌狀態,咁你係咪俾人耍緊呢?
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講完上面既病毒既基本知識,不如講多少少基本病毒檢測既知識。好,依家開始【法網肥人化身肥控制員】!
外面成日有人話:「哎呀,個病人21日後先確診呀!」「哎呀,佢隻狗弱陽性呀!」「哎呀,本來係陰性依家係陽性呀!」「哎呀,南韓同意大利爆發,突然好多人確診呀!」Now TV 更報導「鑽石公主號在日確診香港人 康復回港後再檢測呈陽性」
究竟,呢堆確診數字信唔信得過?我意思唔係話邊個國家信唔信得過,而係呢個 test method 同個 protocol 信唔信得過,會唔會有 uncertainty 或者error? 一開始,我地可以睇下 Journal of the American Medical Association 3月9日既文章,Diagnostic Testing for the Novel Coronavirus,裡面有講到 false positive/false negative 既問題,仲有病毒測試既regulation,測試既 guideline等等。文中有提到,開初發展出來既病毒測試有 false negative,顯示出呢個測試既設計應該係有問題。另外,FDA,CDC與美國各州政府之間都有分歧,州政府當然想為居民檢驗啦,但因為個測試係新開發,有大量問題同 uncertainy,所以FDA “made clear that laboratories were encouraged to develop tests but could not use them for clinical diagnosis without FDA’s “approval, clearance, or authorization during an emergency declaration.” 咁 what does that means? 如果你讀 law 的話,我expect你可以 read between the lines。
講返個測試,檢驗新病毒一般都係會用 RT-PCR (Reverse transcriptase-polymerase chain reaction 逆轉錄聚合酶鏈式反應)。好多人,包括肥人好多行家與同事甚至客仔,一聽到咩DNA測試,就以為呢個 test 無L敵啦,一定準確啦。Oh Sorry,no! 撇除所有「中國的會爆炸」同「中國有咩係真」呢兩個因素,一個test既結果是否可信係建基於樣本收集同檢驗方法,無論你係美國,意大利,南韓,日本定中國,樣本收集同檢驗方法先係 main point!
檢驗呼吸道感染疾病,你地話收集咩樣本好呀?Saliva? Sputum? Nasopharyngeal aspirate (NPA)? Bronchial lavage? 如果係上呼吸道病毒,咁 NPA都足夠既,sputum 都可以,但saliva 就應該要reject。但有時呢類既樣本都未必有足夠既病毒樣本去驗,病毒深入氣管去到肺氣泡(alveoli),樣本可能要係bronchial lavage先夠做。仲有,收集樣本既手法,部位,儲存方式,收集時間與檢驗時間既差距,樣樣都會影響結果。支棉花棒「了」得唔好,你或者都會無 result。
好啦,到講 RT-PCR啦。RT-PCR係需要 medical scientist 去砌一段 primer 出來開始做test。為左檢驗結果既可靠性,scientist通常會係新病毒入面抽一段比較穩定既 RNA segment 出來做 primer。可惜,有好多情況下,RT-PCR會俾個錯既答案你。
第一,primer 既設計好影響結果,上面都話段 primer 要係抽病毒一段比較穩定既 RNA segment 出來做,咁如果你抽錯左呢?第二,樣本既 DNA/RNA sequence 既integrity好差,甩頭甩骨咁,結果就會受影響。即係上面所講既樣本收集出現問題呀!第三,樣本純度低,或者份量少,又即係上面所講既樣本收集出現問題呀!咁個 tech 或者 scientist 要係咁加 PCR cycle去 amplify 個 sample,咁 amplify 出來既樣本就有好大機會係 false positive,呢點會影響所謂確診既可信度,亦係咁肥人我見到漁護處話瑞士花園個阿婆患者隻狗呈現弱陽性反應,我當下笑 L97 左出來。大佬呀,你是咪無足夠 sample 就鳩 amplify,然後個 result 根本有問題你都聽長官意志,鳩簽個名話係弱陽性呀?陽就陽,陰就陰。Result 唔 significant 或者 inconclusive,你出咩報告jack? Invalid 啦!仲有呀,病毒係 host specific 架,會傳染人既病毒,又點會無啦啦傳染狗? 眾所鳩知冠狀病毒係靠人類細胞上既 ACE2 (Angiotensin-converting enzyme 2,血管收縮素轉化酶2)來進入人體細胞啦,狗 ACE2既同人既一樣?
寫下寫下,喂,原來未寫數據演繹同政策問題,太長啦,下次再續!
#跨界別吹水
#本來要免於恐懼唔跟隨共匪起舞
#依家又俾共匪睇穿你班人既心理
#個勢變啦全世界同共匪切割了
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