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!

How Does Radiotherapy Work?

/edit @630PM

To Uncle J and Aunty AK (pretty sure you both will be reading this hehe):

Thank you so much for the lovely flowers, they were a wonderful surprise. Very touched by the handwritten note as well; really appreciate your kind words of encouragement and support. Would love to thank you both personally next time. God bless!

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Radiotherapy means the use of radiation, usually X-rays, to treat illness. X-rays were discovered in 1895 and since then radiation has been used in medicine for diagnosis and investigation (X-rays) and treatment (radiotherapy). 

Doctors have a lot of experience using radiotherapy in medicine. About 4 out of 10 people with cancer (40%) have radiotherapy as part of their treatment. It can be given in various ways, including from outside the body as external radiotherapy, using X-rays from linear accelerator machines, electrons, and more rarely other particles such as protons. 

Radiotherapy destroys the cancer cells in the treated area by damaging the DNA within these cells. Although normal cells are also affected by radiation, they are better at repairing themselves than the cancer cells.

Source: Cancer Research UK

I have gone for 3 radiotherapy sessions so far, and it has been really manageable. It is always at the same treatment room, with the same staff. That's really good because patients feel comfortable. Also, when you look up at the ceiling, there's a giant projection of a mountain and the sea. Makes you feel like you're on top of a mountain!

Did I mention that they play pop music too? It's great as it feels as if time passes really quickly. The second session was as long as 2 Bruno Mars songs, and 1 Capital Cities song. The third session played the extended version of Justin Timberlake's Mirrors... and as soon as the song ended I was already done! For one of the sessions, classical music was being played for another man who had treatment before me. Before my session started:

Me: Eh what happened to the pop music?

Radiotherapist: Haha, you like ah? Ok play for you.

Teehee now I use songs to have an inkling of how long every treatment takes.

In total, I'll have to go for 17 sessions. My last one will be on 20th March (my sister's birthday!). I was told that the first 4 sessions will be abit longer (~15 mins), and I'll have a doctor's appointment every Monday after treatment. Treatments will usually only last 5-10 minutes. As mentioned in the previous post, during treatment, I'll have to fit myself in the body mould and have my arms over my head. Most importantly, I can't move! I'll wriggle my fingers from time to time so that they won't freeze. 

When I get home, I'll apply lavender essential oil on the affected area, so that the skin will not be too dry. So far so good, no red patches whatsoever. 

Aaaaaand... I have to update everyone that my hair has been growing!!!! Eyelashes and eyebrows too. My eyebrows are actually growing so much I have started tweezing the stray ones lol. My head now is filled with baby hair hahaha I feel like a giant baby

Tadah!!! Shadow of my baby hair 

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).

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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!)

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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. 

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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!!!

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!

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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.

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.