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.

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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!

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 

4th PET Scan + Results

On Monday, I went for my 4th PET scan. Thank God the wait wasn't as long as the previous one, it was surprising because I thought the hospital will be a madhouse with everyone scheduling their appointments after CNY. 

I got my scan results yesterday, and Dr Lim says "Your lymphoma is in remission". OMG, best 5 words I've heard this year. But but but!!!!! The scan shows that there is still a 'stable' mass left, with less activity compared to my previous scan. Since the scan is done a month after my chemotherapy ended, a decrease in activity = the mass left should probably be scarred tissue, and non-cancerous in nature.

That being said, taking my age into consideration, Dr Lim still feels the strong need for radiotherapy because it will kill the tiny possibility of any cancer cells lingering behind undetected by the scan. I guess that's the best way forward now. 

Radiotherapy starts tomorrow, let's go!

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Yesterday after the appointment, we were about to turn into MCE, when Joel and I made a spontaneous decision to go to Gardens by the Bay! Even paid to get up on the Giant Supertrees hahaha it was a wonderful time getting some fresh air and scenery.

So thankful.

Pre-Radiotherapy

Last Wednesday (11th Feb 2015), I went for my pre-radiotherapy session. It was supposed to take 45 minutes but it felt like ages. I reached National Cancer Centre pretty early, changed into the gown, and waited for my turn. As they were going to run a 'contrast' in my blood (from their screens, my lymph nodes will light up once the contrast is in my system), they inserted a plug at the back of my palm. I have very small veins, so when they're searching for veins to poke they always choose the most visible, i.e. it's always the same one! Also, chemotherapy causes my veins to shrink, in turn, causing the entire area to swell after every plug insertion. 

Before heading into the theatre, one of the radiotherapists gave me a briefing. The usual procedure process, things to look out for etc. I casually nodded my head in acknowledgement until she said....

Radiotherapist: You do know that you'll be having parmanent tattooed dots inked on you right?

Me: HUH WHAT? And by permanent do you mean... forever?

Radiotherapist: Um, yes. It'll be with you for life. It's just gonna be 4 small dots, pretty much like little moles.

Me: (My mouth was open for 5 seconds before I said a word) Ok... You sure there's no cream to remove it?! 

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The main purpose of me going for this pre-radiotherapy session is to do my body mould (again, for accuracy). This mould will be with me for the next 20 sessions, and I'm supposed to lie in that exact position everytime I go for treatment. Even my fingers had to be in the same position! Hence, it was imperative that I lay still and try to feel comfortable. Sucky thing is that my hands have to be above my head — I had to lie in that position for almost an hour, naked, in the freezing cold. Halfway through, my fingers were so numb I couldn't feel them anymore. I couldn't take it, I asked to rest. It was so bad, I couldn't bring my hands down on my own? The nurses had to massage them for the blood to flow. It was horrible!!! 

I can now say that I have been tattooed... FOUR DOTS. They were being serious, they used the needle/ink method. Haha it actually sounds ridiculous when I say it like this. But it isn't too bad, each dot is a size of a 0.38 uniball pen dot? It's on the top and bottom of my ribcage, and on each of my sides. These dots will help guide the laser, so that the procedure will be done accurately.

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On a happy note, I have had a very busy Valentine's Day weekend catching up with friends, family and Joel. We avoided the crowds and had an amazing affordable lunch at The Naked Finn on Friday. 

Will be doing another PET/CT scan next Monday to confirm if I'm going for radiotherapy. Praying for complete healing!

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?!