Wednesday, December 31, 2008

Day +60 : Well Done ! Jin Han


Photo : Jin Han and my Son, Jin Hao
Today mark the 60 days after my first infusion of stem cell. 1 Nov 2008 was the date I received my sister stem cell. The GVH still bother me, doctor want the GVH continue for a while , as it is good to prevent relapse. The cyclopsorin which I taken, will suppress my immune system, thus some of the ulcer will take longer time to recover. Dr Alan have cut down my Cyclosporin from 250mg to 200mg per day, hope will further reduce in time to come.


I went for follow up yesterday.
My Blood Count on 30 Dec 2008: - Reading within the square bracket [] depicts the previous test result.
Haemogglobin (HB) = 12.4 [11.9] (Normal 13-18)
Platelet = 104 [104] (Normal 150-450)
Total White Blood Count (WBC) = 3.5 [3.1] (Normal 4 - 11)
Absolute Neutrophil Count (ANC) = 2.1 (Normal 1.5 - 8.0)
ALT = 102 [113] (Normal 30 – 65)
Magnesium=0.39 [0.37] ( Normal 0.74 - 0.99)


The blood count results is about the same as previous week. I have Magnesium infusion yesterday. I need to check the magnesium level in this coming Friday.

My nephew scored 7A for the recent PMR results, congratulation to Jin Han. We are pround of you.

Monday, December 29, 2008

Day +58 : BMT donor

I am well today, continue my story....

My Mum and Ah Siew wished that I did not have to do bone marrow transplant, as the risk mortality is high . They hoped if I repeat the cytogenetic analysis, the result would be more favorable. I brought them to to see Dr Alan in SJMC in order to get his opinion about my future treatment. The hematologist said that my case was very straight forward; the treatment had to clean the residual disease with cycles of chemotherapy , then follow by bone marrow transplant. From there onward, I was determined to go for bone marrow transplant even though I knew "it is a high risk business." But the return is, I have 75% chance getting cured, and 25% relapse. Without the transplant, I am subjected to 100% dead.

I started to arrange my brother and sister to have the matching test, the chance of getting a fully matched donor is 25% for each sibling. I have 5 brothers and sisters, naturally , I stand a good chance to get a HLA comptible. The results show my eldest and youngest sister fully matched and can be my donor for the BMT.

Saturday, December 27, 2008

Day +56 : Long Life

Today, I feel better. I just back from my morning walk which I have not done it for the last few days.

I went for follow up on Friday, the blood counts improved slightly. Total WBC is >3.0. Dr Alan Teh is still on X'mas leave, he have instructed the day care nurse to update him the results over the phone, he will decide what treatment to carry out for me. I will see him next Tuesday. Again, I received magnesium sulfate infusion. ( I just realise, if the magnesium sulfate given without dilution , it can be fatal)

Blood Counts on 26 Dec 2008 :
Hb: 11.9 ( normal 13.0 - 18.0)
Platelet : 104 ( normal 150 - 400)
Total WBC : 3.1 ( Normal 4.0 to 11.0)

ALT : 113 ( normal 30 - 65)
Magnesium: 0.37 ( 0.74 - 0.99)

Today, I am expecting a visitor from Kuala Terengganu, B L Lim. Lim is one of my client in Kuala Terengganu. He work for a readymixed company. He is very energetic even his is late 70 years old now. I really admired his health status. His family have long life history, his few uncle and brother leave 90+ before passing away. One of secret I found out is to keep yourself active.

Thursday, December 25, 2008

Mum's Birthday


Today, I feel tired, and low appetite.


We celebrated mum 64 years birthday yesterday.

My mother born in Mengkuang, Pahang, I won't forget my mum birthday date, it is on Christmas eve. I missed her 63 year old birthday celebration last year because mum was in hometown.It is really a great blessing for us to have her with us this year! May God bless her with good health and joyful heart everyday!

My sisters have bought a tiramisu cake to celebrate mum's birthday. Jin Hao and Xin yi enjoy themselves very much when there is birthday party.




































Tuesday, December 23, 2008

DAY +52 : Prognosis

I went to SJMC to have the flushing on my PICC, currently I need to flush my PICC with heparin twice a week to prevent the pipe getting block.

People with cancer will always ask this question, how is my prognosis. According to statistic by US, for Non Hogkin Lympoma (NHL), one year relative survival is 81%, 5 year survival 63% . 10 years after diagnosis with NHL survival rate declined to 49%.

Today, I met a young Leukaemia patient, he have two time transplant in a year. The deases replased after three months of transplant. He went for second mini transplant and currently the bloods count back to normal.

Monday, December 22, 2008

Day +51 : Mid-Winter Festival

Today, I am not feeling that well, the medicine have caused me a Little drowsy.

Yesterday, we celebrated the Mid Winter festival. Mum cook us stew pork leg with sea cucumber, butter chicken. Even I am not allow to eat the butter chicken, But I enjoyed greatly sea cucumber dish. We celebrated the mid-winter festival together with my sister who stay in Mahkota Cheras.

Ah Siew bought some " Tangyuan" from giant, the tangyuan has bean and peanut ingredient, and taste very good.

Last Friday, I seek a treatment from a Urologist, Dr. Kalai, he speak very fluent Mandarin, even the medical term. I was impressed.

Thursday, December 18, 2008

Day +46 : Misconcept about Cancer

The urine pain still bother me. Hope to get improve in the next few days. Yesterday, Teck Ann drove me to Selayang Hospital to attend the Sosco's Doctor Panel Interview, we waited for 2 hours, the interview session took 5 minutes only and wait for Sosco letter in two weeks time.

Visited the web page of Malaysia oncology, it talk about the common misconcept about cancer, like to share

Common Misconcept about cancer :
Mention the word “cancer” to Malaysians and three words would probably pop into their heads: incurable, pain and death. About a third of cancers are curable yet few people (including doctors) know this. Pain is not inevitable when cancer strikes. And even when there is pain, much can be done about it.Many other misconceptions about cancer abound. "We don't know what causes cancer." Of course we do. "Food has everything to do with cancer." Wrong again! In this article, we will ask (and answer) common questions about cancer:We don't know what causes cancer.The human body is made up of billions of cells. Cells have nuclei, which house their reproductive apparatus, i.e. DNA. Mistakes are made when cells reproduce. Occasionally, such mistakes accumulate and eventually the daughter cells form new blood vessels, invade neighbouring tissues and spread throughout the body. Consequently, vital organs get disrupted and the patient (if untreated) dies. We know the big picture. We are still fleshing out this picture with details.Does smoking cause cancer? And is cancer a lifestyle disease?There is no doubt whatsoever that smoking will increase your chances of contracting lung cancer (and half a dozen other types of cancers). Excessive alcohol consumption may lead to cirrhosis, which may lead to liver cancer. Beetle quid chewing (fortunately a dying habit) causes mouth cancer. Unfortunately, at least two thirds of all cancers cannot be linked to a particular lifestyle or causative agent. That does not mean we should not count our calories, load up on fresh fruit and vegetables and hit the gym. In any case, a good lifestyle will do wonders for your heart, psyche and sex life.

Doctor, what food should I avoid?
Food is not the most important cause of cancer. Neither is it an important modality in the treatment of cancer. It is important that cancer patients observe a diet high in protein, calories and vitamins while undergoing treatment. However, that is a far cry from saying that "this food will prevent cancer" or "that food will cause cancer!"I don't want to undergo cancer treatment because 'good' cells are killedCancer treatment is a judicious combination of surgery, radiotherapy, chemotherapy and molecularly targeted therapy. There is no such thing as medical treatment (for any disease, including cancer) that is devoid of side effects, just as there is no such thing as a free lunch. However, most side effects of cancer therapy are temporary, reversible and manageable. Much progress has been made in the control of nausea and vomiting, which is a frequent side effect of treatment. 'Growth factors' (G-CSF, erythropoietin) are available to combat bone marrow suppression, which is another common side effect of cancer therapy. And the list goes on… If cancer is left untreated, there will be great suffering. Death will ensue within two years in most cases.

What about alternative therapy?What about it? There is no alternative civil engineering, no alternative computer technology and no alternative chemistry. Any treatment for cancer has to be subjected to the rigours of scientific enquiry. This inevitably means a slow, laborious, intellectually honest process that starts in the laboratory, proceeds onto animal studies and finally studies on humans. There is only medicine that works and has been proven, and medicine that is not proven and may not workIs cancer contagious?The simple answer is no. You cannot 'catch' cancer from a patient by touching him or by sharing his utensils and personal effects. Cancer is not spread by air, water, injections and other vectors. Certain cancers are linked to viruses, such as the Human Papilloma Virus and cancer of the cervix, and cancer of the liver. Immunisation plays an important role in the prevention of liver cancer and clinical trials are on the way for the former (cervix). That certain cancers are causally linked to viral infection does not at all make cancer patients infectious. Cancer patients need all the care and compassion they can get. They should not be shunned. On the contrary, a hug and a kiss will go a long way to alleviate their suffering.

Isn't cancer a very painful disease?Cancer can be very painful, especially if cancer tissues directly infiltrate bones and nerves. However, this is not inevitable. More important is knowing that pain management has come a long way. Most pain can be controlled by following an algorithm (a logical stepwise sequence to achieve a goal) recommended by the World Health Organisation. Many new analgesic preparations and adjunctive drugs (or drugs used in parallel) are available. Pain is much less of a problem today.

Is cancer inherited?Only about 10 per cent of cancers can be inherited. Even if you are unfortunate enough to have parents afflicted with this subset of cancer, you may still not get cancer. Remember, you inherit the risk, not the cancer. What you really need is counseling and preventive measures.My sex life is over now that I have cancerFar from it! We aim to fully rehabilitate a cancer survivor. And sex, being the sublime expression of human love and emotion, is so very important. There is absolutely no reason why a cancer survivor cannot have a fulfilling sex life with counseling.

Finally, can we find a cure for cancer?Let us re-phrase that question: Can we find a cure for the two thirds of cancer that are not cured at present? Remember, one third of cancers are cured. Most patients who have their cancer diagnosed early in stage I (confined to the organ of origin) or stage II (only the first station of nodes are involved) are cured by existing modalities and technologies. We are talking here of 70 to 90 per cent cure rates. What about the rest, i.e. the two thirds of cancer patients who are not cured? Researchers now know a lot about the genetic basis of cancer and consequently the chemical messages cancer cells send to other cells. In the future, instead of telling someone 'You have liver cancer', we may say to that person 'Your cancer has a defect in the ras (an oncogene) pathway so you need compounds that are effective for this pathway.' The other theme is (molecularly) targeted therapy. We already have drugs in Malaysia that specifically target receptors (mainly growth factor receptors) found on cancer cell surfaces. These drugs are effective and have few side effects. Only a few patients in a few clinical scenarios are suitable candidates for such therapies. However, the future is bright and many more such therapies are in the pipeline. The wisest approach to the cancer problem is prevention, early diagnosis, appropriate therapy and palliative care. So much is available and so much more is expected in the coming decades.

CHINESE VERSION AVAILABLE. Please download here... The full article can be viewed here. If you have friends or relatives who are diagnosed with cancer, please refer this to them. I believe this would help them to clear a lot of unnecessary doubt.The MOS website is at http://www.malaysiaoncology.org/.

Tuesday, December 16, 2008

Day +45 : Chen Yoong's New House

I am not felling well today, encountered the urine pain. Checked with doctor, likely due to GVH, I have the urine culture and profile test done this afternoon. Results show be available in three days. Doctor also prescribe me some URAL to neutralize the urine acid, comfort during passing the urine.

Today, Chen Yoong is moving to his new house in Bandar Puteri Puchong, welcome Chen Yoong ! a 400 feet above ground ( Don't worry, it is not located at Bukit Antarabangsa), next to Ayer Hitem forest reserve, fresh air and good view.

Monday, December 15, 2008

Day +44 : Welcome to father club

Ka Kin promoted to father . Congratulation to Ka Kin and his wife , their first new born baby.
I just know from Ka Kin himself, a bay boy, 4 months old.

Sunday, December 14, 2008

Day +43 : KL Tan left

I am fine today, just feel a little bit tired, I don't sleep well last night . I received SMS from Betty, KL Tan has left and rest in peace on 12 Dec. KL Tan recently have the transplant at SJMC, but relapse few months later. We learn the Su Lang Yi Xi Gi Giong together, he gave me a lot of courage. He plan to attend his son graduation on March in Perth. His son study medical in Perth. My deepest condolences to Betty and his family.

Saturday, December 13, 2008

Day +42 : Total White Blood Count (WBC)

I am fine today, just back from 45 minutes morning walk. Yesterday, Teck Ann was my driver, I need him to drop me at SJMC, and Ah Siew will pick me up later .

Blood Counts Results :
12 Dec 2008 versus 9 Dec 2008
Red Blood Count (RBC) = 11.9[12.7](Normal 13.0-18.0)
Platelet = 111[113](Normal 150-400)
Total WBC (TWBC) = 2.9[3.5](Normal 4 - 11)

Calculated ANC = 2.2 (Normal 1.5 - 8.0)
Neutrophils = 77% ( Normal 40 -74 )
Magnesium = 0.51[0.44](Normal 0.74 - 0.99).
ALT : 162 [147]( Normal 30-65)

The white blood count drop further from 3.5 to 2.9, doctor commented this may due to some of drug I consumed. The magnesium level increase a little bit, but still below the normal range. I think the calcium magnesium tablets from AMWAY Nurtrile work well, and it is relatively economic with RM40+ for 180 tablets. While waiting for the bloods count results, I have a plate of fried key koay teow at cafeteria ( This is the only chance I can have outside food), The nurse have ring me asking where am I , she have to give me magnesium infusion. I reached home at 7:00pm

Doctor said even my WBC dropped, but still manageable. He have change my blood count to once a week. My next blood count will be 19 Dec 08.My Absolute Neutrophil Count (ANC) is 2.2, which is within the normal range1.5 to 8.0 . ANC is the actual number of neutrophil in the white blood cells. Neutrophil is one components of the white blood cells that helps to kill and digest microorganism. The other components are macrophage, basophil and eosinophil. We wouldn't know if a person is proned to infection just by looking at the white blood count alone. We have to calculate the ANC of a person to determine the risk of infection.ANC is calculated by multiplying the white blood count with the percentage of neutrophils in the white blood cells. Based on the blood report, my neutrophil percentage is 77%, therefore my ANC is equal to 2.9x77% = 2.2 . The risk of infection based on ANC is as follow:

Neutropenia = ANC < 2.0 (slight risk of infection)
Mild Neutropenia = 1.0 < ANC < 1.5 (minimal risk of infection)
Moderate Neutropenia = 0.5 < ANC < 1.0 (moderate risk of infection)
Severe Neutropenia = ANC < 0.5 (high risk of infection)

Thursday, December 11, 2008

DAY +40 : Magnesium

I am fine today, I have 10 minutes jogging and 30 minutes walk exercise this morning. Yesterday , Teck Ann have brought me calcium and magnesium tablet. Three tablets provide 600mg calcium and 400mg of magnesium. Hope this will help to boost up my magnesium level to require range of 0.75 to 0.99, then I don;t have to infuse with liquid magnesium. The magnesium helps our body to metabolise carbohydrates, calcium helps in formation and maintenance of bones and teeth. Adequate calcium intake is important, but the daily intake above 2,000mg are not likely to provide any benefit.

Tuesday, December 9, 2008

Day +38 : Follow up

I am fine today. Today the blood counts show almost the same as previous, except TWC slightly drop and ALT increase. Doctor said he is satisfied with my progress, but need me to have blood counts twice per week. Today, Boon Tiam is my driver, helped to pick me up at SJMC.

9 Dec 20008 blood counts versus 4 Dec:
HB : 12.7 [12] ( Normal 13.0 to 18.0)
Platelet : 113[113] ( Normal 150 to 450)
TWC: 3.5 [3.8] ( Normal 4.0 to 11)
ALT : 147 [119] ( Normal 30 to 65)
Magnesium : 0.44 [0.55] (0.74 to 0.99)

Expected I need magnesium infusion for today follow up. Presently magnesium is available in liquid form. But Dr Alan said oversea you probably can get oral magnesium. These will help to save cost and time. As very time , magnesium infusion, it need about 2 hours. Let me know if you find any table form.

Today, I met young patient , Andy Gan, he have transplant for leukaemia in May 08, but relapse after 5 months, and he went for second mini transplant in October 08. Currently have GVH on skin, bowel and liver. His ALT figure shot up as high as 900. So, I presume as long as my ALT below 900, I should be OK. Andy introduce me to drink MONA.VIE, fruit juice comprise of 19 type fruit. Andy said it help to boost up the blood counts. By the way Andy is the International Distributor for MONAVIE. Those interested can visit the web : www.monavie.com

Monday, December 8, 2008

Day +37 : Second Chemotherapy

I am fine today, continue my story at SJMC...

I have my second chemo on 9 April 2008, before starting the chemo, doctor need to check the blood counts, ensure I am fit to take the chemo. The blood counts confirm I meet minimum requirement with TWB 2.

Bloods Count on 9 April 2008:
Hb: 11 ( Normal 13 to 18), Platelet:111 ( Normal 150 -400 and TWB: 2 ( Normal 4 to 11). I discharged in the next day.
As the TWB expected to drop further, I was given growth factor Nuelastim, one dose of Nuelastim equal to about 8 dose of Neophogen, it help to boost up the TWB, which important to prevent nuetropenia to a certain extend and lessen the risk of infection. However they are expensive, Nuelastim cause RM3400+ per injection.

The bloods count on 14 April 2008
HB: 11
Platelet : 163
TWB : 0.9
So, I have to take the Nuelastim.

My hair starting to lose after the second chemo. Mum and I went to India Barber shop to get a clean cut. 见妈妈眼泪掉了,心底感到非常疼。

Sunday, December 7, 2008

Day +36 : First Chemotherapy

I am fine today. It is Sunday Morning, I have a donut and oat for my breakfast, follow by a bowl of mee after 1.5 hours later . Steroid drug keep me hunger most of time.

Continue the yesterday story, I have my first chemo treatment on 27 March 08, and discharged the next day. One of key drug used was Rituximab, it is Monoclonal antibody target on the cancer cell. Encouraging results are reported for treatment with NHL ( Non Hodgin Lymphoma) and in combination with chemotherapy has been shown to increase the Chance of respond rate and survival of diffuse large NHL in elderly patients. Doctor said the cured rate increase by 25%. This the most expensive drug which cost RM6000+ per treatment. I don't encountered much side effect for the first chemo. I will go through minimum 6 cycle of chemo at 2 weeks interval.

Saturday, December 6, 2008

Day +35 - History

I am fine today, managed to jog for about 10 minutes follow 30 minutes walk. Feel more energetic. Like to share how I was detected for Lymphoma.

Beginning of March, I have fever failed to subside, and blood test show it was likely due to Dengi ( Low platelet), I admitted 3 days in Columbia Hospital ( from 13 March to 15 March), Bandar Puteri Puchong. However the Dengi test is negative. Physician refer me SJMC and suspect it may be Lymphoma or TB. As I still have fever, again, I admitted to SJMC from 18 March to 28 March 2008. The bone marrow test results was out on 24 March 2008.The doctor told me that I had Lymphoma, Non Hogkin's, Stage 4. The doctor also said that my type of Lymphoma is curable. He then explained to me how they were going to treat me and the risk involved in the treatment.When I got this results, I know my family and I were going to face another crisis. I had been through number of crises in life, mostly related to my family members, but this time it directly involved me and the bone marrow test result again confirmed this.The first reaction came to everyone mind was, “Why I get this disease?” The doctor said the exact cause of lymphoma remain unknown. we know very little about the cause of Lymphoma apart from exposure to certain chemical in insecticides and wood preserving materials. Lymphoma are not contagious and can not passed down through families.

No one was satisfied with this answer, so everyone started to speculate how this disease developed.
“It must be your diet…” to them all diseases are due to food.
“It must be the computer…” because I worked in front of computer many hours a day.
“It must be the hand pone…” they suspected electromagnetic field is the culprit.
“It must be you work stress …” because I worked to meet sales target
“It must be you lack of exercise…” those who believed the body would secrete toxin through sweating.
“It must be due to accumulation of toxin in your body” those who believed some form of detoxification can prevent or cure all diseases.

Suddenly I was surrounded by a group of experts who know the causes of the Lymphoma than anyone else. I started to wonder how they could be more expert than the doctors and specialist. The first reason is the establishment of a lot of Multilevel Marketing (MLM) companies that sell magic products that claimed to kill all birds with one stone. The best strategy to sell the products is to tell you that your body accumulated too much toxins, it is too dangerous if you don't detoxify your body with their products. Driven by the dream of becoming financial independence within a short period of time and the promise of enjoying continuous effortless income for the generations to come, the MLM agents will penetrate every level of societies with the concept of body toxification and the necessity of detoxification. The 2nd reason is due to some very good public speakers who advocate natural therapy or alternative medicine, who always find their way into mass media to propagate their ideas.
I believe many of the concepts are very helpful to maintain a healthy living. But we also cannot take everything that they advocate as absolutely true as most of them claimed. As a patient who is just diagnosed with illness and struggling to accept the reality, expert ideas like these do not in any mean help. It only brings more confusion. I believe I am not the only one who encountered this. Others also experience this.

Friday, December 5, 2008

Day +33 : Age 81 ??



I am fine today. I missed my morning garden walk as it is raining.

I just subscribed E paper The Star, it cost RM12/mth, while previously I paid about RM40+ per month. The paper is ready by 5:30am, sound not bad.
At age 81, what we likely to do ? Lai Meng age 81 nominated for the best supporting actress in this coming Taiwan Golden Horse Award for the her pivotal role in self scarifying mother who been neglected by her three growth-up sons in Singaporean filmmaker Jaclk Neo's " Money not Enough 2". So, OLD IS GOOD

Thursday, December 4, 2008

Day +33 : Blood Count

I am fine today, Teck Ann had accompanied me to SJMC for today follow up. I must thanks to Teck Ann,he has been my driver for the last few months. (德安,谢谢您)
the blood count today show almost same results tested on Tuesday, except the white blood count drop to 3.9 from 6.8 ( normal range 4.0 to 11.0), and ALT ( liver) raise to 119 from 91 ( Normal range 30-65).

The magnesium level is 0.55 ( normal range 0.74 to 0.99), low magnesium level has cause my leg muscle cramp, I have magesium IV today. The low magnesium is probably due to Cylosporin drug.

Drop in TWC and raise in ALT (Liver), Doctor suspect suspect there may be due to mild GVH in liver. Despite the problems that GVH diseases creates, there is an invaluable bonus as the GVH reactions tends to destroy residual disease and the relapse rate of patients with GVH disease is lower. I am given Cylosporin and predinosole to control the GVH.

We met Lai (From Triang) today, his ALL (Acute Lymphoblastic Leukaemia) relapse after 2 years + Plus new disease -lymphoma. His spirit to fight the disease is extremely strong. Weekly, He or his wife will drive up to KL morning, and back to hometown evening, a journey probably take about 4 hours. I am sharing the transplant experiences with him. We both under the care of Dr Alan

Wednesday, December 3, 2008

Day +32 : Taste Bud

I am fine today. Besides losing the hair again, I also lose the taste bud. Doctor said it take about several weeks for the taste buds get back to normal. This is rather common complaint and patients feel that the food has no taste or no longer taste the same after received chemotherapy, and there is no ready cure for this complaint. Just have to wait.
My mum took care of my daily meal when When Ah Siew back to work. Yesterday's dinner is well done : steam bean curd with pork rib , fried bean, soup and brown rice.



Tuesday, December 2, 2008

+Day31 Blood Count

I am fine today, I did the blood count and bone narrow biopsy yesterday
Blood Count on 1 Dec 2008 : - Readings in square bracket [] are result from previous test.
Red Blood Count (HB) = 11.9[11.1] (Normal 13-18)
Platelet = 117[110] (Normal 150-450)
White Blood Count (WBC) = 6.8[5.1] (Normal 4 - 11)

All HB, platelet and white blood count readings steady increase, it is a good signs. The biopsy will confirm if any disease still present. The next visit will be coming Thursday. My current visit is twice per week. Patients post allogenic transplant tend to closer follow up for fear of GVHD ( Graft host versus disease). Transplant related mortality pose the greatest risk in first year transplant year .
The Malaysia National Transplant Registry 2006 show the major death cause continued to be relapse/underlying disease (44%) with sepsis(32%) being the second commonest cause of death. Surprisingly veno-occlusive diseaseof the liver contributed to 12% of deaths while graft-versus-host disease became thefourth most common cause of death (8%) - Transplant Outcomes
At the time of the third report (2006), a cumulative total of 1174 transplants had beenconducted by transplant centres in the country. The number of transplants recorded in2006, 124, saw a slight decrease over the previous year’s total of 147. In 2006, AmpangPuteri Specialist Hospital began transplantation services to add to the number oftransplant centres. Meanwhile Hospital Kuala Lumpur (adult transplants) moved to anew premise in Hospital Ampang