Post-Treatment Thoughts

Last Friday 20th March 2015, after 6 cycles of chemotherapy and 17 sessions of radiotherapy, I'm finally done with treatment!!! WOOHOOO. The road to recovery the past 6 months has been tough, but God has gifted me with so many graces to travel this road. Thank you all for soldiering on with me — the visits, prayers, well wishes, kind words of encouragement... they mean a lot! 

Can't believe these 6 months have gone on by so quickly. Not complaining though, just feeling very blessed. This journey has taught me many things, and I thought it'll be nice to share with you guys.

Health is wealth

Growing up, I was always involved in sports — netball, in particular. I've been playing netball competitively, representing my schools since I was 13. In primary school, I was a lazy bum. But a smart one, because I found out that I could list 'piano' as my CCA teehee... so I didn't have to go for any CCA practices etc and could spend more time watching tv at home. But I still liked running, so I was a runner for my House and participated during Sports Day every year. I remember winning my first gold medal in P3 at my first event, and actually slept with it around my neck because I refused to take it off (lol what was I thinking). 

I'm bringing all these up to show that I wasn't the most unhealthy person — yes, I eat McDonalds occasionally (side note: think I'm never gonna have macs again crai), but I exercised regularly too! Especially during netball days, no way was I unfit and unhealthy then. Ok, I admit that I stopped exercising regularly when I graduated, but at least I was still loving my fruits and vegetables?

Truth is, no one expected me to get cancer. Not now, not when I'm 22 and at the start of my career. 

It is so important to treat your body right. I can't emphasize how important it is to eat right — I'm not saying to convert to a vegetarian/stop eating sugar etc but moderation is definitely key. Being young doesn't mean the body is insusceptible to illnesses! Cancer doesn't only happen to old people. Apparently my kind of lymphoma happens mostly in young women... who would have known?! 

Like me, many young people take their health for granted. Not because we don't care... I guess it just doesn't strike us? We assume that our youth equates to health, and then it just disappears in our list of priorities. But we forget that without health, we can neither pursue our paper chase for qualifications, nor climb up that esteemed career ladder. 

"Smile, and you'd have won half the battle"

I am very touched by the comments which say that I've been strong, brave and positive... I really appreciate them — thank you for taking time to write to me, and for keeping me in your prayers. Honestly, what keeps me going is the faith that with God's grace, I will completely recover. Also, I draw my strength from the people around me (especially my family, and my close friends). I wouldn't have done it without them. They have supported me through everything. My parents would visit me twice a day when I was warded, giving me home-cooked lunch and dinner lovingly made by my grandma so that I didn't need to eat hospital meals. I am so blessed to be at the receiving end of such great love.

During my hospital stays, I've always had wonderful roomies (haha) to accompany me. Even though they may be three to four times my age, I enjoyed all our conversations. I believe that God placed these individuals there with a purpose — to keep me company, and make me laugh and be touched by their stories. During the period when I was just diagnosed, one elderly lady in the next bed asked me why I was there, and I started tearing when I shared my story. She then said something which resonated in me until today — "Girl ah... smile, and you'd have won half the battle". 

You can face anything, just do it afraid

I thought long and hard before posting up the photo of me and my baby-hair head. I decided to go ahead with it, because I wanted to show that there is nothing wrong with having less hair. Yes, I cried so much when I shaved it all off. But then I remembered that I wasn't alone. Thousands of other women have shaved their heads to fight hair loss, a distressing side-effect of chemotherapy. I can only wish that I am brave enough to leave out the wig when I'm out. 

I've also read about some women in the US who try to prevent hair loss by using ice caps during chemotherapy. Apparently by reducing blood flow to the scalp, this limits chemotherapy exposure to hair follicles. The thing is, it hurts like mad?!! Imagine having a block of ice on your head 24/7. But by doing this, there is also a concern that this reduces the effectiveness of treatment in that area. If you ask me to choose, I'd rather have my head shaved than all the other nasty side-effects of chemotherapy like vomiting. 

Anyway, I also learnt about the importance of eyebrows and eyelashes... They are SO important to a face's structure omg. The photo that I posted above is considered the 'nicer' version. So here's me, with a few tiny strands of eyebrows, and zero eyelashes. And a shiny bald head. (At least the flush from the drugs gave my face abit of colour haha)

I'll be recuperating at home for the next couple of weeks. I'll update whenever I can! Today, Singapore lost our founding father Mr Lee Kuan Yew. He was a great man who built Singapore, a place I proudly call Home. May he always be remembered. Rest in peace!

Link between my low LVEF and Radiation

Yesterday, I saw Dr Yeoh (radiation oncology) with my mom before I went for my radiotherapy session. Dr Eric (cardiology) was concerned about my weakened heart function with radiotherapy (read more about my low LVEF in my previous post), but Dr Yeoh cleared the air during the consultation.

1. Generally based on long-term research, lymphoma and breast cancer patients will suffer from cardiac problems (if any) only 5-10 years after radiotherapy.

2. Today's technology is so advanced, radiation oncologists are able to pinpoint the area they're shooting radiation at, and calculate the dosage of radiation that a vital organ might be getting. For my case, my mass is in my chest, but Dr Yeoh reassures us that the heart and lungs are only being affected minimally. Some statistics to give you a bigger picture:

- The safety limit which the heart receives radiation is at 10%; and at this level, 1% of patients got cardiac problems. 

- My heart is receiving radiation of 0.16%... so the risk of me getting cardiac problems due to radiation is really verrryyyy low. 

3. Dr Yeoh said that even before I started on radiotherapy, when he was checking the 3D images, I already had a huge heart. 

Me: *chuckles* "What do you mean by a huge heart?"

Dr Yeoh: Imagine working your arms with dumbbells every day, your muscles will grow right? Likewise, a heart is a muscle — it means that your heart has been working very hard with your Wolff Parkinson White (my underlying heart problem), and of course, lymphoma.

---

Dr Yeoh then gave a call to Dr Eric, and they had a 15 min discussion over the phone. They agreed that given that my echo scan was done after 3 radiation sessions, my low LVEF should be the cummulative effect of my WPW, lymphoma and chemotherapy. 

On a separate note, I messaged Dr Eric separately and told him about my side effects after taking the new medication. He told me to cut down the dosage by half, so hopefully everything will be better from now!

Another Bump in the Road

One Direction, On The Road Again Tour SG

I went for the One Direction concert on Wednesday!! It was my first time at the new National Stadium, and it was huge?! There were 33,000 people but there were still many empty seats behind the stage. Pretty impressed with the good crowd control — I could even find seats on the MRT on the way back. Aaaand... it was my first time taking public transport in 6 months haha I was pretty nervous and apprehensive but I think taking the MRT back would be even faster than finding a cab at the stadium.

Yesterday (13th March 2015) marks the 6th month mark since I got diagnosed. Happy 6th monthsary? Hahaha. Has it been half a year already?!

I had an appointment with my heart doctor, Dr Eric, yesterday as well. Not so good news. The recent echo scan that I went for showed that there's a fall in my LVEF. I have done 3 echo scans — it went from 50%, to 48%, and most recently, 36%. Here's more info, from here:

With each heartbeat, the heart contracts (or squeezes) and relaxes. Every contraction pushes blood out of the two pumping chambers (ventricles). When when heart relaxes, the ventricles refill with blood. The ejection fraction (EF) refers to the amount, or percentage, of blood that is pumped (or ejected) out of the ventricles with each contraction. This percentage, or EF number, helps your health care provider determine if you have heart failure or other types of heart disease. 

A normal heart pumps just over half the heart's volume of blood with each beat – a normal EF is 50 to 75 percent. 

A low EF number is an early sign of heart failure. This is a condition where the heart does not pump enough blood to the rest of the body. With treatment, many people live well with heart failure. 

So I've been put on two medications — Enalapril (5mg bd), and Bisoprolol (2.5mg bd). He says that with early treatment, there's a high chance of recovery. These two will decrease my blood pressure, and I have already felt some side effects last night. When I got up from watching tv, I got a bit dizzy and then my heart went into crazy racing mode (150 beats/min) for 5 minutes. 

Dr Eric says that the decreased function of my heart is due to the combination of chemotherapy and radiation. He even tried to call my cancer doctors to see if my radiation can be stopped as it's evidently weakening my heart. But... they didn't answer their calls sigh. Hopefully my body will be able to tolerate the medications! Will be doing another scan in the middle of April to see if they work.

I'm left with the last 5 sessions of radiotherapy! Lezzgo!

Treatment #2: Radiotherapy?

Supposed to post this earlier but I got lazy hahaha zzz now I have a backlog of updates:

Thursday, 29th January 2015

I had an appointment with Dr Lim to discuss the results of my PET scan done a few days before. This scan was done after 6 chemotherapy sessions, and was supposed to check on any signs of mass/cancer activity left in my body.

My scan showed that the mass has decreased — what's left measures 4.7 x 2.8cm (compared to the previous scan, 6.2 x 4.2cm). But there's a concern over the activity part, because it INCREASED from SUV3.6 to 7.0. This can mean two things:

1. The PET scan is very sensitive, and it may pick up activity from scarred tissue that will slowly go down given more time

2. There's still some disease left which means that radiotherapy is needed to zap it off

They've arranged for another PET scan after CNY on the 23rd Feb to try to make sense of things. But for now, my doctor is more keen on radiotherapy to get rid of the cancer totally. He says he rather 'overtreat' than miss out on something which can be worse.

But on the brighter side of things... I'm off my (blood thinner) injections and PICC line!!!!!! Major hallelujah! I have been injecting myself twice a day for the last 4 months my stomach got pretty badly bruised. I got used to the PICC line but yes, really really glad to get these two out of the way.

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Wednesday, 4th February 2015

Dr Lim discussed my case with other specialists (radiologists, radiation oncologists...) last Friday and he helped to arrange for me to meet Dr Yeoh, a senior consultant in radiation oncology today. I think the consultation was around an hour?! He explained radiotherapy thoroughly — the history, side-effects, my case... 

Honestly I wasn't keen on radiotherapy AT ALL. (HELLO... I WON'T SIGN UP FOR ANOTHER CANCER TO HAPPEN IN THE FUTURE!) I've always thought it was a really bad type of treatment (must be all the horrible stories of old technology radiotherapy). Ok la, then again, chemotherapy is equally horrible!!!! Scientists should find even better cures for cancers ASAP. But I can understand where the doctors are coming from, pros vs cons. Like what Dr Yeoh said, there can only be so much scans I can do. Plus, most of the time, he says that patients who keep doing scans, the results are hot-cold-hot-hotter... In other words, time is of the essence. We wouldn't want to wait and only find out one day that the cancer has deteriorated. *touch wood*

Because I started off with a HUGE tumour (12.6 by 6.5cm), chemotherapy can only do so much to shrink it. Most lymphoma patients will still have abit of cancer cells left because of the tendency that our tumours are naturally larger in the first place. Dr Yeoh described chemotherapy as a systematic type of treatment (i.e. it goes through the whole body), while radiotherapy is localized. 

With modern technology, radiologists are able to blast the radiation at precise locations that only hit the affected cancer cells. But every treatment comes with side-effects and risks right? Since my mass is at the chest area...

Short-term side effects:

- Redness of the skin ("You mean like sunburn?" "No, for sunburn there's peeling. But for this... It's like spending 2 hours walking at the beach")

- Dry cough

- Fatigue

Long-term side effects (20 years down the road):

- Secondary cancers: Skin, bone, lung, breast

- Heart and lung problems 

Dr Yeoh assured us that these secondary cancers only occur to a reallyyyyy small percentage of people. As we grow older, risk of cancer goes up anyway. I ran into Dr Lim at the entrance, so nice of him to say hi and check on me. After balancing the pros and cons, the doctors agree that getting rid of my current tumour entirely is the safest option, and an option that will give me a peace of mind, rather than playing the waiting game.

And since there's a pre-treatment session for radiotherapy for the doctors to decide on how they are going to carry out the treatment (e.g. how to localize the radiation such that it has minimum effect on my vital organs)... I have an appointment booked next week on the 11th. The real treatment begins on 29th Feb (if I decide to go through with it, after my PET scan on the 23rd Feb). It will last for 3 weeks every day (????!!!!), and 15 minutes each time. 

Gah.... why can't SGH be in the east?!

Dealing with Hair Loss

(L-R) Bob, Pixie, Just before going to the salon, Shaving halfway (couldn't resist taking a photo teehee I look so badass)

I have been keeping this blog post on hold because it means so much to me. Since my chemotherapy sessions have come to an end, I thought it would be a good time to share it here — not for the purpose for others, but rather, more for my myself to remember.

I shaved off my hair on 20th October 2014 after my second chemotherapy. In the mornings, my pillow would have collected strands of hair, and I will continue shedding hair throughout the day around the house. Honestly, it was getting frustrating, and emotionally draining whenever my hair dropped in clumps (especially when I showered!). 

I remember it being either the first or second day that I was back home after my second cycle... It popped up while I was talking to my mom, and it was rather impromptu I'd must say. I took half an hour to decide if it was the day to shave — I stared at the mirror, prayed for strength, and thought, sooner or later right?

The next important question: Which salon should I go to? 

I didn’t want to trouble my hair stylist to come down to my place (like how he came to SGH to cut my bob, and for my pixie style I actually went do to the salon at Siglap), and since I thought shaving didn’t need much skill; I did a quick google search and settled for the most random salon on the second floor at Elias Mall near home.

My mom accompanied me, and when I walked into the salon… “I would like to shave my hair, please”. The hairdresser asked softly, “all of it?” I nodded, and there weren’t any more questions.

Army boys have different ‘levels’ of shaving, so I thought this was the best thing to describe how short I wanted my hair to be. “Number 4!” … It turned out messy, and worse, patchy. Unfortunately, hair loss from chemotherapy is horribly uneven. For me, most of my hair loss is at the crown of my head, compared to the back. So from Number 4, it became Number 1, and then it just became 0 (i.e. the shortest the shaver could go).

—

I’ve always thought that those who shaved for Hair for Hope were really brave. I even remember having this conversation with a group of friends jokingly: “Maybe if you pay me $10,000 I’d go for it. Actually maybe $100,000??” 

Well, the joke’s on me now. I don’t know how to put this nicely… I guess for young males with shaved heads, people go, “oh, army boy”. For females, if it’s not during Hair for Hope, first reactions would usually be, “oh no, she has cancer”. It's like no matter how brave you are, it's just so damn hard to walk along the streets bald. 

I think my worst fear is for a kid to see me and to ask his/her mom, “Mummy, why doesn’t she have hair?” WAH I think I’ll cry. Thankfully, my mom thought well ahead, and brought me to buy my wig right after my first chemotherapy when I wasn’t shedding as much hair yet. True story: We were in the lift heading to the car park, when this boy (carried by his mom) PULLED MY WIG!!!!!! Um… Lucky it didn’t drop? The mom kept apologising, and I’m pretty sure she didn’t know it was a wig, but still?! Could the boy really recognise the fake hair? (Actually my wig is made of real hair haha but ok, not the point!)

—

Hair loss hasn’t been limited to my head — I’ve lost ALL my eyebrows and eyelashes too. I used to have longer than average eyelashes so I was quite sad when my last old eyelash dropped during my last chemotherapy (I really had the hope that it'll be the last one standing haha). But thank God they've been growing out pretty quickly such that it’s not fully bare at once. To think of it positively... at least it’s like a full body IPL? Hahaha

I’ve gotten used to my new (hair)style the past few months. It is definitely breezier and makes showering a whole lot easier. I have been reading Joyce Meyer’s Living Courageously — “You can face anything, just do it afraid”. I know I wouldn’t be able to walk around a mall without a wig (sorry this one really too extreme), but I thought I took a baby step forward when I walked around the hospital on two occasions au naturel. 

I have been refusing to wear a beanie cuz I think I look very sickly and weak, and I have horrible scarf tying skills… So the wig has been the best option for me. Of course, there are still a few days when I scroll through Instagram and feel sad when other girls caption ‘bad hair day’ when they still look gorgeous anyway. 

—

To be honest, it didn’t come easy. I curled up on my bed and cried like a baby when my first clump of hair came off in the shower. Hair loss has taught me many things — I know it may seem like a trivial side effect of chemotherapy because ‘hair can always grow back’, but I’m glad, and proud, that with God’s grace, I have learnt to slowly overcome this.

Yet having said all these, I’m still a girl, so… hair quickly grow back please!!!

Post-chemotherapy Round 6

Hello, I am back and I HAVE FINISHED ALL 6 CYCLES OF CHEMOTHERAPY!!!!!! I was home on 14th Jan, just in time to celebrate my mom's birthday on the 16th. I was fit enough to head out for her birthday dinner at Dempsey on the 2nd day post-chemo, so I was quite happy because usually the first 2 days I'll be having body pains (muscle/bone aches). 

Initially I thought my PICC line would be removed right away after my chemotherapy ended, but the doctor said he'll only take it off when I meet him on the 29th... just in case. My PET scan will be on the 26th — this scan will check if there's any more cancer-active cells left after these 6 rounds (TOLONG please no more ah). 

The doctor says the results will be classified using a scale of 1 to 5-

- 1 and 2: confirmed cancer-free 

- 3: unconfirmed, and a second scan will be needed 3 months later

- 4 and 5: still some cancer cells left, and the oncology team will need to discuss with the radiologists for potential radiotherapy

Praying really hard that it'll be a green light from the doctors on the 29th! *crossing fingers and toes*

Scare No. 2

I'm home for Christmas!!! Really glad I managed to push forward this round's chemotherapy. The ward was getting pretty quiet too... I guess people would want to hold off any treatment until after the festive season. There was even one night where I had the entire room to myself! 

On the last day of chemotherapy, while the nurse was cleaning up and flushing my line... My PICC line decided to throw me a second surprise this week- ONE OF THE STITCHES HOLDING IT DOWN DECIDED TO COME OFF???!! Sigh. Thank God that the ward on-call doctor was pretty efficient and did the stitch rather quickly. Since I was on local anesthetic, there wasn't any pain so I decided to look at how it was being stitched hahahaha had always been curious! 

Christmas this year will be a simple homemade dinner with the family- we are going to be roasting a duck instead of the usual turkey because it'd be too much! Fingers crossed it'll go well! 

Merry Christmas xx

Yesterday's scare

Had an appointment to see Dr Lim yesterday, and as usual, did my blood tests and the flushing/cleaning of my PICC line. There are two lumens on my line... one was alright but the other was not!!! There was no back flow, and worse, it couldn't be flushed. This meant that no liquid could flow through the tube as there was a clot somewhere, most probably due to fibrene. At that point, there were only two scenarios:

1. They'll inject some medication into the line, leave it there for an hour to unblock it, or;

2. If the above doesn't work... They'll remove the entire PICC line, and schedule me for surgery to re-insert it.

Honestly, I was so sian and heavy-hearted when I heard the second part.

But this morning, the moment of truth — when blood started gushing out into the syringe as it pulled back (the backflow)... The clot is gone! With God's grace, the medication worked!!! So thankful yay. Will be starting chemotherapy this afternoon, it'll be my 5th and second last cycle. It's a bit early this time round so that I'll be home just in time for Christmas :) Here we go!

Realized I haven't posted a photo of the line without it being wrapped up in dressing... For those who are interested, it looks like this! (p.s. Not for the faint-hearted hehe sorry it looks kinda gross)

Post-chemotherapy Round 4 / What goes on in the Ward

Can't believe I'm done with my 4th cycle, just 2 more and I'll be done! Pretty busy this week with 4 appointments — 2 blood tests, a CT scan, and a Heart Echo Scan. Went for my first blood test yesterday and I had a bit of fever (37.7). I was feeling really tired but all's good now!

Mind Your Body (The Straits Times) always has freebies to give out every week. Two weeks ago it was rosehip oil products and I asked my mom to join too to up my chances... AND WE WON!!!!! I have been using rosehip oil for my scars (esp from ablation), stretch marks etc and it works wonders. Plus it's organic, what's not to love!

I realized I hardly document what's it like during chemotherapy itself... So here's a sneak peek to what goes on during the 5 days I check into Ward 78 in SGH. Very specifically Ward 78 because it's the only ward which can administer chemotherapy drugs (there are only 4 in the whole hospital), and have the equipment to monitor my heart (i.e. the telemetry) together. 

The nicest view that I have got so far

These are my chemotherapy drugs — I will usually be hooked to two of these machines which control the flow of the drugs into my body. The flow is extremely slow, there will be one at 11ml/hour and the other one at 21ml/hour. Both will flow via my PICC line, a central line that is semi-permanent. I have had it since October and will only be able to take it out in January after chemotherapy. It can't touch water so when I shower it becomes a bit of a hassle because I'll have to wrap it up nicely. Dressing and flushing are changed and done once a week — if I'm home, my (super)mom does it. Otherwise the nurses at the hospital will take care of it. 

Anyway back to the drugs, the sequence for the 5 days usually goes like this:

- 1x of 4-6h drug

- 4x of a pair of 24h drugs

- 1x of a 15 min drug

Whoops I don't even know the names (I get very confused when I try to remember, all I know they make up these letters R-EPOCH hehe)... but the main gist of it is the 24h pair of drugs. For my safety, I'm not really allowed to move from my bed because if I do, I'll have to lug these machines around. 

Here's the telemetry that I was talking about! It is at least 1kg and there are 5 wires connected to my chest. Apparently from a giant monitor screen in some heart lab, there will be people monitoring. They'll know of any extreme dip or soaring of my heart rate because there will be an alarm, and they'll call the nurses immediately. There was once my heart rate was 34 (the 3rd chemotherapy) and they woke me up in the middle of the night to check on me... I didn't feel a thing but at least the machine is working and the people are very alert? Haha

#fromwhereIstand #hospital #ootd #telemetry #wires #havaianas #rolex (actually barcode scanner for medicine) 

Chemotherapy Round 4

Happy December everyone! I just got admitted for my 4th cycle of chemotherapy on the 1st, and just started the first round of drugs today. It usually takes a day for them to prepare the drugs. I've been trying to rush them... but I learnt that alot of people are involved in the process — the doctor will first calculate the concentration of the drugs from my height, weight, and BODY SURFACE AREA (which is 1.6 m2 btw lol), and then fax it over to the pharmacy lab to prepare the drugs, and which they will finally send it over to the ward when they are done. So I guess I can understand why they take so long every time!

For the next chemotherapy cycle, I am really hoping that it won't clash with christmas or new year's. Dr Lim says he'll try his best to push it forward so that it will end just before christmas but this will only happen IF my blood counts rise up in time after this 4th round... or there's a back up plan of coming in on boxing day, and going home on new year's eve. Don't wanna be in hospital on neither occasions, that'll be a major mood dampener but I know health comes first, so fingers crossed!

Anyway, here's some mid-week organic pasta cheer! Salmon (marinated with terriyaki sauce) with aglio olio, handmade chia meatballs (really proud of this one — second time making this, and the chia seeds make the meatballs so moist!) with tomato pesto fusilli, and a ~fusion~ miso salmon with miso pasta haha #domesticated

Post-chemotherapy Round 3

I have been resting really well at home the past few days! As usual, after the first 24h of post-chemotherapy, I would have to inject myself with the 'booster jab' to up my white blood counts. If anyone is wondering how it looks like... I took this photograph for Joel in my moment of panic when I couldn't remove the top needle cover. Some sort of weird suction/pressure ALWAYS makes it stuck. This one injection costs $510 and I don't understand why they have to make the user assemble it on his/her own?! A teeny weeny bit of the liquid was coming out as I tried to pull the cover off, didn't wanna waste it so I rubbed it on my stomach, hopefully it gets absorbed haha. But I think I finally managed to figure a way! Hopefully it'll work the next time. Lol sorry please excuse my polka dot pants

After one week of chemotherapy — we realized that my irregular heart beats will come and go. There were a couple of times when my heart rate was 38/hovering around 40... But I felt well/non-dizzy so it's not really an issue. Doctors say that they would rather my heart rate be low than high, but of course not too low as well. Just have to continue monitoring! 

Went for my first my post-chemotherapy blood count today; the next one will be on Friday. It took me by surprise when the receptionist recognized me, and she even realized that I didn't go for my previous blood count after my second chemotherapy. Told her I was re-admitted then (due to my heart palpitations), and that I had my bloods taken while being warded. She wished me well — how thoughtful of her. I was really touched! My cardiologist Dr Eric also dropped my mom a private whatsapp message asking if I was ok as he was overseas when I was discharged. The docs and nurses so far... really grateful to be treated by the kindest souls around.

I turn 22 tomorrow — not sure how I'm feeling about it yet, but I think I'm pretty excited!

Chemotherapy Round 3

I'm almost midway through!! In terms of both this cycle, and for all 6 cycles as well. I think my body is getting more used to the chemotherapy drugs because I have been coping pretty well. 

Plus, even more great news- Dr Eric (my cardiologist) came by the other day and said that my ECG this week didn't show anymore irregular heartbeats! Previously one day after the surgery it came back, but apparently that's because the heart is in the "healing process". Hopefully these irregular heartbeats will be gone forever!! But he mentioned that they'll only be able to confirm it after a few months when everything stabilizes. 

On a sidenote, the oncology team who visited me this morning told me that there's another girl (in her late 20s) who just got admitted in the next room with a similar condition as me. She just came over, and I was glad to be able to share my experiences. I hope I managed to make her feel more at ease - it's always comforting to know that you're not alone... I pray that she'll have a smooth recovery too!

Happy news and a change of plans

Happy news

The PET scan results are out, and I was so happy to hear that after 2 chemotherapy cycles, the tumour has shrunk by half!!! *\o/* (cheerleader emoji)

It used to be 13.5cm by 8cm, and now it's 6.5cm by 3.5cm. 13.5cm is MASSIVE I didn't even know?! 

Also, the level of activity of the cancer cells has gone down by 70%.

It's great that my body is receiving treatment well. Can't wait to get rid of these nasty ugh things!!! 

Change of plans

Yesterday evening when I was just about to check into hospital, my heart started racing again at dinner and instead of going to the admissions office, I ended up at A&E. 

Tomorrow I'll be going for ablation, a minor surgery to remove my extra electrical pathway in my heart. My 3rd chemotherapy cycle will be postponed to next week instead. This was really sudden and only decided this evening. At first we thought of only having this procedure done next year when I was done with chemotherapy, but the cardiologist team and my oncology doctors were getting worried about the recurring episodes of my palpitations and high heart rate... And my parents and I agree that this is the best option at this point in time. The pattern so far is that with each chemotherapy cycle, my palpitations get worse :( A worst case scenario is when an emergency ablation is needed during chemotherapy. 

The cardiologist said that this procedure has a 85-90% chance of success. But there's also a 1% risk of burning the main pathway, or even causing a hole in my heart... Which is TERRIBLE. But I trust God to be guiding the hands of the two senior consultants tomorrow.

Cardiac ablation is a procedure that is used to scar small areas in your heart that may be causing your heart rhythm problems. This can prevent the abnormal electrical signals or rhythms from moving through the heart. During the procedure, small wires called electrodes are placed inside your heart to measure your heart's electrical activity. These electrodes may also be used to destroy the bad areas of your heart.

Lifestyle changes

My typical kind of breakfast nowadays

I believe that chemotherapy alone will not be able to treat cancer. There's also a need for a change in mindset, and with that, a change in lifestyle — especially in terms of diet. I think it is essential to feed your body the right way so that it remains strong and well-equipped enough to fight these nasty cells. Plus, it doesn't help that chemotherapy kills BOTH good and bad cells. So the more it is important for the body to get as much nutrients and anti-oxidants as possible to cope with the battle!

My parents and I have been reading quite a fair bit online. Cancer cells feed on certain sugars... so I've been staying away from artificially sweet food. It's a big change for me because I have a mega sweet tooth and I love my desserts! Thank god for natural sweeteners like honey and fruits which keep these sugar pangs at bay haha but of course, everything in moderation.

I've also learnt about the importance of organic food! Especially since my immune system is lower than normal, and with chemotherapy, I feel that I should limit the unnecessary chemicals going into my body as much as possible. I used to personally think that there was little need for organic food because we have been eating normal food our whole lives and our bodies should have adapted right? Plus it's so expensive here in Singapore! 

But after everything now... imagining the amount of chemicals and pesticides that go into our everyday food — it just isn't natural for our bodies to take in so much nasty stuff!

Realistically I don't think there is a need to have a 100% organic lifestyle. For me, I just believe that if you're eating something raw/juicing, it'll be good that the fruits and vegetables are organic so that you know that your body is absorbing all the wonderful nutrients without any compromise. 

And it doesn't stop at organic food! I've also switched to organic skincare — using Kora Organics by Miranda Kerr now. Pricey, but I think super worth it! My skin remains less shiny throughout the day and I haven't had pimples in the last 2 months! I read on the Kora Organics blog that an average woman puts at least 200 chemicals on her face everyday?! I think this is pretty accurate because I was looking at my other products and true enough... I did not recognize any ingredient (all chemical names) except for "aqua/water". 

Ok I sound like an organic maniac haha but for my case now I really don't want any more unwanted and unnecessary chemicals to be in my body. Also, chemotherapy has caused my skin to be extra sensitive and dry. Decided to try Kora Organics because y'know... look good to feel good! Hehe

Anyway I've been really blessed to have my dad and his friends flying to organic paradises like USA and Australia to buy organic produce for me. Because it's locally produced it's so much cheaper and easily available! LOOK AT THESE BEAUTIFUL CARROTS AND BEETROOT FROM AUSTRALIA!!!! The carrots look exactly like the kind that Bugs Bunny eats. Like WHUT?! Honestly I haven't seen carrots and beetroots being sold like this with their leaves in Singapore... ever. Felt like a citygal noob when my dad showed them to me. 

There are a couple of organic stores in Singapore that my parents have gone to as well. As an alternative to dairy milk, I've been drinking unsweetened almond milk (prefer it to soy milk). One carton costs $8?! Madness. But my mom bought 4 for me to try anyway. So glad to have found it on iHerb.com at half the price!! I have another 4 cartons on the way to Singapore now. Just bought another bunch of stuff as well — organic pasta, organic granola... It's a great site to buy healthier products. 

They seriously stock everything organic/gluten-free/vegan, and products range from groceries to household items! And the best part — shipping is only SGD4 for max 6kg worth of stuff! Plus there's $10 off for your first order, and an extra 10% if your order's >$40! You may use my referral code BJS904. Good things must share! (Thanks Clare for recommending this site to me!!)

Wow that was a lengthy post — but just thought I'd share on how things have changed for me. There are soooo many articles on how people have changed their lives drastically (e.g. no meat diet, juice-only diet) to cure cancer. So much information and perspectives it was quite overwhelming. But I strongly believe that every individual copes differently. It's good to have all these information on hand, and from there, adjust accordingly to make it work for yourself. 

Post-chemotherapy Round 2

I was discharged on 18th Oct, so I'll be resting up at home for the next 3 weeks. The second chemotherapy went by smoothly — I was amazed at how 5 days went by so quickly! During this cycle they increased the dosage, and this will continue as long as my blood counts remain good enough. There were no nausea side effects this time, just fatigue. All I do is sleep and eat, I wasn't even allowed to walk to the toilet! Total nua mode. The nurses were really kind, one even bought me a madeline from flor patisserie :')

Remember how I was saying that the PICC line that was inserted before this cycle was so troublesome...? Well, it will remain inserted till the end of ALL my 6 chemotherapy cycles. My parents were taught how to clean the area once a week, it'll have to be super clean, dry and germ-free. Looks like I'll be in long-sleeved loose cardis when I go out for the next few months!

The past couple of days I've been slightly feverish (37.7-37.8 deg), although I feel not serious enough to go back to the hospital. Actually had high palpitations today for 5 minutes too sigh. Anyway, the doctors and nurses once cautioned that once there's a fever, I'd have to return to hospital — "a fever to others may just be part of a passing flu, but for you... it can be life-threatening!" But then again, body temperatures post-chemo are known to be abit higher too. I promise that I'm not acting tough or anything ah... but really, I think it's important to know your own body. I still feel the same as with a lower body temperature, so all's good!

Also, instead of the 7-day booster jabs that I needed to inject myself post-chemo, they gave me a 1-day one this time around! Apparently previous blood counts have shown that my body is pretty strong... so this one time jab actually has a few "layers" - it will self-activate every day without me injecting myself. Hurray!

Gearing up for chemotherapy Round 2

Went to SGH this afternoon for my appointment to insert the PICC line — a similar line to the one that I had at my groin (the femoral line) previously. 

The doctors had to use local anesthetic to numb the area, and then ultrasound scan to make sure that they're poking into the right vein (or artery?). Ended off with two stitches to fix the entire line down. 

Rested for an hour before I was allowed to go home. After the anesthetic began to wear off, wahhh the pain! Hurts more than the femoral line. Maybe cuz my arm is more active and I have to keep moving it? Hopefully the pain will be gone when I wake up tomorrow!

Not sure if this is gonna be semi-permanent/lasting for more than one chemo session, but it's so zuo-dang (best translation would probably be 'in the way')! Plus, it's on my dominant right hand. Guess this will train my left hand abit — shall start by brushing my teeth tonight!

Side-effects of Chemotherapy

I was hoping to hold on to this post until just before my second cycle of chemotherapy on 13th Oct 2014. This week marks the second week after my first cycle. So far, I have been very lucky that the side effects I've experienced is considered mild and very manageable. During the first cycle, I felt fatigue and abit of nausea (no vomitting though)— however, these quickly went away within 1-2 days after treatment ended. At home, my appetite has been great! And for that, I am very grateful because this meant that I could try my best to consume as much nutrients and energy as possible to gear my body up again for chemotherapy round 2! 

However, my greatest fear is not any pain/discomfort... but hair loss. Ever since the doctor mentioned chemotherapy, I've been trying to prepare for it mentally. It is inevitable, non-life threatening, and that it is temporary because hair will grow again. BUT IT IS SO HARD :'( Last night, while in the shower, I was combing through my hair with my fingers like I always do when I put conditioner. 

And then it happened... One clump of hair in my right palm. I couldn't help it, I started crying.

I didn't want it to happen so fast. I googled and it said that hair loss would usually happen 1-3 weeks after chemotherapy ends — so it is normal that I'm losing hair now. Actually for the past few days, my scalp has been slightly itchy, I read that it is a sign of hair loss already.

Well, hair loss can range from thinning of the hair to full hair loss. Cross fingers that it is the former? Hair loss is gradual though,  so it is assuring that I won't wake up and find that I am bald.

It will definitely take some time to overcome this barrier, but I will try my best!

---

About chemotherapy (from here):
Chemotherapy targets cells that are actively growing and dividing. Although this is a defining characteristic of cancerous cells, it is also a feature of some actively growing normal cells, such as cells in the blood, mouth, intestines, and hair. The types and intensity of these side effects vary from person to person and depend on the type and location of cancer, the treatment dose, and the person's overall health.

There are other side effects such as: sores in the mouth/throat, diarrhea, vomitting, constipation, blood disorders, nervous system effects (e.g. weakness/numbness in the hands and feet, loss of balance, loss of balance...), changes in thinking/memory, appetite loss.

1st week post-chemotherapy

Today marks the end of the first week after my first cycle of chemotherapy, which means that I'm done with the 7 booster jabs as well. At the hospital, the nurses gave a heads-up that the booster jab would abit painful... but for me, thankfully it turned out to be almost painless. I think the Clexane (the blood thinner) is worse! Yay this means I only have two injections to do

Went to the hospital to do a blood test today — cross fingers that my blood count will be alright. The next time I'll be seeing the doctor will be on 7th Oct!

Flashback Part 2

Monday, 22nd September 2014

Snip, snip! Apparently I made history when I asked Lucas (my usual hairdresser) to come down to give me a haircut. Decided to go for a bob because pixie's too badass for me. The last time I had short hair I was 15?!

How's my new hair?

Wednesday, 24th September 2014
Ended my first chemo cycle on Tuesday night 1030pm, so it was finally time to go home! Got rid of the femoral line (the one at my groin area) so it's definitely much more convenient to walk about.

Throughout my stay at Ward 48, the nurses and doctors were so genuinely wonderful. They took time to talk to me, to make sure I was alright. So blessed and grateful to have my friends, colleagues and family visit me as well. Thank you for the love, concern, gifts (especially the flowers and fruits haha I have week's supply of fruits in my fridge now)... You guys are the best!

Flashback: While in SGH

Saturday, 13th September 2014

At Changi General Hospital, A&E

Only 2 weeks ago, but so much has happened. It was a Saturday morning, and I had woken up with a swollen face/neck and a terrible cough. I have been coughing (with on and off fever) for 3 weeks, and my face has been swelling for a week as well. After 3 trips to 3 different GPs, I wanted to go to see the sinseh (Usually that's what people do right? If western medicine doesn't work, TCM to the rescue!). That morning, my dad returned from a flight and was still shocked that I was still having 'flu' — and worse, with a swollen face. I was sent to A&E at Changi General Hospital after breakfast.

The doctor could not figure out what was wrong with me — could it be a drug allergy? But she ruled it out because I've been taking normal cough mixtures and panadols... If it were to be a drug allergy, surely it would have sprung up at least once the past 22 years. So I was sent for the full checks — X-ray, urine and blood tests.

I was on drip, resting on a corner couch, almost sleeping. And then I was gently shook awake... "Amanda, the X-ray shows a mass in your chest. Do you smoke/drink? Do you have a family history of cancer?"

The rest was a whirlwind. I was transferred to Singapore General Hospital in an ambulance — lying in the stretcher, I was breathing through a portable oxygen tank, having a drip, and clamping my legs over a mega machine which was apparently able to keep track of my heart condition (side track: I have Wolff-Parkinson-White syndrome since young, an abnormal extra electrical pathway of the heart).

I stared out of the window as the trees along ECP swooshed by. When I awoke, I was being admitted into SGH already.

Monday, 15th September 2014

In the operation gown, face still as swollen as ever

Major test day! I was going for a biopsy to find out what exactly the mass in my chest was. It was scheduled to be at 9am, and I had to fast from midnight. As they wheeled me from my ward into the waiting area, I was so nervous I teared.

I had two major concerns:

- If the biopsy were to be unsuccessful, they would have to proceed with surgery to get a 'sample' of the growth (i.e. cutting my chest open)

- What if it's cancer!!!!! (Yes, I still had the little hope that it was just a benign mass)

The biopsy only started at 1130am. The local anesthesia was injected four times to numb the area for the pin-hole operation. I was on the super flat operating bed, and it became really uncomfortable because I kept coughing... I coughed so hard my chest hurt so badly, and tears started welling up in my eyes (I was in pain because of the cough, and not the biopsy). All these while they were poking me with the biopsy needle.  It was to the extent of not being able to breathe properly, so the doctor decided to take a short break. He gave me the plastic mask (the kind for general anesthesia) to inhale something that managed to suppress my cough for awhile. Thank God the biopsy was done 15 minutes after that, because my coughing kept going on, I felt my chest was going to burst.

The doctor then inserted the femoral line at my groin area — it is thicker than the normal drip line, and needed to be stitched. This was going to be there until the end of my first chemotherapy cycle. This line would allow them to draw blood, insert the drip, insert my chemotherapy drugs etc (basically everything).

I was in a daze lying on the bed face-up, staring at the white ceilings as they wheeled me back to my ward — I only turned to my side when the nurse accompanying me touched my hand and said, "stay strong, okay?"

"Okay."

Tuesday, 16th September 2014

Went for even more scans/tests in the morning... but the afternoon one was the highlight of the day — the bone marrow test. This test is to show whether there are cancer cells in my bone marrow. I've heard from everywhere that it would hurt. Well, thankfully the pain was manageable. In fact, on a scale of 1-10, it's only 2-3! They had to inject local anesthesia three times though. Apparently my bone is VERY hard hahaha the female doctor, Dr Kaavya, had difficulty and had to even get the male doctor to help her out with the pushing of the needle into my hip bone. Well, she says it is a good sign that my bones are strong. It means they are healthy!

On another note, the gynaecologists came to speak to me about the option of taking out one of my ovaries before chemotherapy. There was a risk that chemotherapy would affect my fertility in the future. BUT, the operation for this is major, and requires general anesthesia. If I decide to go through with this, chemotherapy would have to be pushed back 1-2 weeks, as my body will need to recuperate after the surgery.

My first thoughts:

- Having children in the future is important to me — but with this, does my body have the luxury of time to push back chemotherapy?

Thursday, 18th September 2014

I woke up at 4am to go to the toilet. The lady at the next bed was struggling for her life. Through the 2-3 days that she was here, I have gathered that she has brain cancer. The whole nurse team and two doctors were by her bed — they even pushed a trolley with orange sides and an orange box. I have never seen this trolley before... it meant that it was serious. I turned on my side and managed a glimpse of her.

At 5am, I stirred from my sleep and saw that family members were already gathering at the next bed, saying their last goodbyes. I couldn't help but tear. When the nurse came by to draw my blood, she decided to move me to a private room for the morning until everything was over. That was very thoughtful of her — I don't think I would have been able to take it. Not right now. 

Have been taking steroids, which suppressed the cough and got rid of the swelling!

Anyway, they forgot to take my breakfast order the previous day... so I was eating oatmeal and bread (definitely not my first choice). Breakfast was supposed to be muffins! I tried my luck, and asked one of the nurses to check if there was any extra left in the kitchen. Well, there weren't any left — so after her shift, she kindly surprised me with a pack of 3 muffins from the bakery downstairs. Nurses are the best people on earth!

Highlight of the day: Joel is finally home for 10 days!!!!! So so blessed and grateful that he's back. I know I initially told him that I was gonna be okay on my own — but he flew back anyway. Besides my family, he's my other pillar of support and with him going through the first phase of chemotherapy with me, I won't be going to battle alone.

Decided that I would be starting treatment the next day. Dr Tiffany said that chemotherapy would have an extremely low risk on my fertility — this confirmed my decision to go on with treatment immediately and to forgo the removal of one of my ovaries. The surgery is complex, and there was even a risk of my heart stopping?! I don't need that! Plus, any form of surgery would definitely weaken the body, and I wouldn't want to fight a war that way. My first priority is to kill the cancer cells!

Friday, 19th September 2014

Chemotherapy starts today! Chose to go for the R-EPOCH treatment rather than R-CHOP. Well, it was created to reduce recurrence, and to diminish the need for radiation. CANCER CELLS BE GONE!!!

Have been looking and reading at what to eat (e.g. antioxidants), what to avoid... 

Also, used pinterest for hairstyles (pixie? bob?)... I contacted Lucas my hairdresser, and he was going to come on Monday to cut my hair! Pretty excited.