"I don't have the best news..."

My doctor came into the room this morning and shared with me that my irregular heart beats returned at midnight. My second ablation procedure wasn't successful after all.

I felt sad, frustrated, fearful, nervous... It was the second time for the procedure, a re-do; it was supposed to be a success. Was this second ablation for nothing?

Prof Tan sat down by my bedside and took time to explain everything clearly, going through the different considerations he had to take.

1. Difficulty of the procedure

- Extra pathways (at birth) can be found at different parts of the heart, and mine happens to be at a relatively tricky position

- What makes it even harder is that my heart continues to beat/move as the doctor tries to aim the catheter at the extra pathway; the doctor has to make sure that the powered catheter doesn't hit the good parts of the heart (which can cause even more riskier complications)

2. Minimal level of risk

- Taking into account the above difficulties, Prof Tan did his best to damage my extra pathway at the least level of risk

- He could have powered the catheters at a higher amount of watts, but the trade-off was that he'll be doing it at higher risks (eg burning a hole in my heart), which would have dire consequences in terms of complications... And Prof Tan was not willing to do that "to a young heart"

3. Two options, moving forward

a) Going for a third ablation- which he advised against, due to the above reasons

b) Continue with my medicine, and hopefully with given time, the function of my heart will improve. Another plus point to consider is that the damages from the two ablations would have gotten rid of the palpitations completely (an earlier problem which I had during chemotherapy)

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In essence, the ablation was to improve my lower than average function of the heart (measured by LVEF). This could have been caused by my Wolffe-Parkinson-White syndrome, and/or the negative impacts of chemotherapy. We went ahead with the procedure, thinking it would at least eliminate one of the reasons for my low heart function.

But my extra pathway has been so stubborn- even with two ablation procedures, it just did not budge (and even if it did, it was only for a few hours). With it being so stubborn, as well as the addition of the increased risks in getting it ablated the third time... we decided against it. We would be patient, and I would continue to take my medicine and we'll see how it goes.

Prof Tan said that he had a patient who took 2 years to increase her heart function (and hers was really bad, at around 10%; they even considered doing a heart transplant). Mine's hovering around 40-45%, while the normal range is from 50-60%. It's just a bit more to go!

It is not the best news after everything, but God is still good. With no more palpitations, and with more time- I have faith that my heart will be strong again.

Updates for the past 3 months

For those who have asked how I've been the past three months — I'm good! Thank you all for keeping me in your thoughts and prayer. 

Also, many have been asking whether there's any more cancer left... Honestly, the doctors haven't explicitly told me that they're gone, but based on the CT scan that I did in June, cell activity has went down (generally cancer cells are crazy active). However, there's still some scar tissue left, which may or may not go away at all. As long as there are no cancer cells and it's just mass left, it's a good sign that I'm on my way to becoming a lymphoma survivor.

However, my heart function hasn't improved the way the doctors had hoped for. My extra accessory pathway (my pre-existing condition) seemed to have hindered my heart's recovery. Also, more problems such as a premature heartbeat and a below than average LVEF have surfaced recently. The doctor gave me two options to consider — to go for a heart ablation (strongly advised), or to continue my medication to try to boost the recovery. 

I have taken the doctor's advice, and would be going ahead for the heart ablation. I don't want to be stuck playing the waiting game again (waiting a few months, going for a scan to check if the medication works...) I kinda have the feeling that I'll ultimately need to go for the ablation anyway. Might as well be now right- to get to the root of it and get rid of it once and for all. The procedure is scheduled to be on 10 September. It is pretty soon, and I think I'm rather prepared. I've done the ablation before, during the period between my first and second chemotherapy. I am less nervous because I know what's going to happen during the procedure, and I believe that this ablation will help my heart heal, and hopefully be strong again.

P.S. My hair has grown... ALOT. Waiting for my hairdresser to be back in Singapore (he's back in Malaysia for awhile) to give it a nice trim and it'll be ready for the world!

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.

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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!