The Power of Distraction.

The past few days had been difficult.  There's the nausea coupled with the loss of appetite.  My waking hours were filled with dread and foreboding.  I tried to find a positive anchor.  It kept evading me and the general wretchedness continued to wear me down.

By evening yesterday, I was in a state of restlessness.  I needed a plan.  I needed a distraction.  It has always worked before.  I slept fitfully and dreamt all sorts of unwholesome dreams.  As I sat on my bean bag early this morning, I resolved to take charge of my life.

I drank my usual Millenium beverage.  Half an hour later, I had my usual coffee.  (I had stopped drinking coffee since my surgery and there's only so much milo you can drink till it sickens you.)  After two slices of walnut cake, I went out for a walk in the garden.  Some light exercises followed.  It felt good.

My wound began to feel sore so I knew it was time to stop.  I returned indoors to start practising on my calligraphy.  (I am learning to write my Chinese name.)  Calligraphy is difficult. Still, it was a good distraction.  I imagined that I am some ancient scholar writing a million dollar piece of art.  Imagination is a great thing.  It doesn't cost a thing and it carries us to worlds that never were.  Without it, we go nowhere.

I like nonsense, it wakes up the brain cells. Fantasy is a necessary ingredient in living, it's a way of looking at life through the wrong end of a telescope. Which is what I do, and that enables you to laugh at life's realities.  -  Dr. Seuss 

After the light exercises, I took my BP.  It's beginning to look good.  Surely, the passage to recovery begins today.  I feel optimistic.

I am going to pick up where I left off.  I shall return to the forums I used to belong to.  I shall continue playing silly word games.  Those were necessary distractions, as they always had been, as they always will be.

Chemotherapy - 1

It is the morning after.  I slept fitfully the night before and was ill-prepared for this session.

I reported to the hospital's Day Care to have my vital signs recorded.  Then I was led to a couch nearby where the treatment began.  FEC with two bags of saline to dilute the medication.  That's a total of five bags to be dripped intravenously into the veins of my right hand.

They started off with the first saline solution, switching back and forth between the saline and the chemo bags (FEC).  The first two chemo medication was clear while the third was a strong peach.  By the time the second bottle was half way in my body, I could feel small pricks going up my head.

It hit me suddenly without warning.  -  Grogginess first,  and then my sensation turned sluggish.  I laid back on the couch.  This strange feeling continued until the end.

Two hours later, I was ready to go home.  The grogginess is still there.  On top of that, I could feel my eyelid puffing up.

The nausea was unavoidable and my appetite was gone.

Pre Chemotherapy Blood Test

Walking towards the Oncology Ward was hard.  You get the sense that you are walking down a dark tunnel, the only way into obscurity, and the only way out.  The crowd which thronged the corridor thinned out significantly by the time you reached the Ward.  It wasn't a pretty sight.  You gaze upon a sea of adversed wretchedness and wondered how it was that you came to this.

I took a seat at the waiting room.  A woman wearing a scarf walked slowly towards me.  My mind screamed out.  "Don't sit next to me.  Please don't sit next to me."  Unfortunately, she sat right next to me while I made the slow transition from horror to realisation.  Who am I kidding?  I have become one of them. I widen the angle between us.  Too much reality on too bleak a morning.

They called my number so I went for the blood test.  While waiting outside, I met an elderly lady who was reading a book and listening to some Praise songs.  She told me she was a Div 1 civil servant.  I have no idea what that meant except that she teaches at the Methodist Boy School.

She too had breast cancer.  She spoke to me about the Book of Job and how I was not to allow anyone to judge me as Job's friends had judged him.  In the course of our conversation, she spoke about meditation. How the process of meditation clears one's mind and opens them up to the Devil.  She advised me not to delve into Yoga or Tai Chi since these meditative exercises carried with it plenty of spiritual symbolism.  She spoke of more but I was too befuddled to absorb them all.

After the blood test, we were asked to collect three packs of anti-nausea medication meant to be taken over three days.  Then we were referred to a nurse whose job it was to explain the entire procedure.  All things being in order, we were asked to return on the following morning for the chemotherapy.

Taming the Beast.

Now we know the Beast.  The Beast had a name.  Cancer is its name.  How does one tame the Beast? There is but one way.  Chemotherapy and Radiotherapy followed by Hormonal Therapy..

This treatment will set me back by about RM60K if I had it done at SDMC.  A similar treatment will cost about RM10K at UMMC.

CHEMOTHERAPY

According to oncologist Dr Rosita and her team, my treatment will begin with six chemotherapy every three weeks, each session lasting for something like 2 hours or so. Blood tests shall precede each treatment to ensure that my kidney, liver and white blood count are in order.  I am expected to go through nausea and dizziness immediately after the treatment so getting there by myself had to be ruled out.

I might lose some hair or I might not.  Apparently this varies from patient to patient.  What I need to look out for is Fever which invariably tells us all that an infection is happening somewhere in our body.  If a fever is detected, I was to admit myself into the Emergency Ward without delay.

I had a question.

As I occasionally suffer from Urinary Tract Infection (UTI), will Chemotherapy KILL all those E-Coli in my urinary tract?  Unfortunately, no, answered Dr Rosita with a smile. What a pity, I thought.

RADIOTHERAPY

Since my tumor went into the Deep Margin (and by that, I assume that means the deeper layers of my flesh), I will require Radiotherapy.  Mine will be a 15 + 8 session, the first 15 of which is compulsory and the latter depending on the outcome of the former.

My treatment may be a little dicey since it involves the left breast and its proximity to my heart may complicate matters.  Also, fibrosis of the lungs is another risk factor worth noting.  From what I understand, fibrosis happens when the treatment inadvertently killed some lung cells.  I may or may not develop an annoying cough which may or may not be my companion for life.

HORMONAL THERAPY

Tamoxifen is the medication used in Hormonal Therapy.  It is to be taken orally daily for the next 5 years. What it does is to block or lower estrogen levels in the body, thus controlling the Beast.

Hormonal therapy however, is different from hormone replacement therapy (HRT).  HRT is taken by some women to treat troublesome menopausal side effects such as hot flashes and mood swings. HRT is used to raise estrogen levels that drop after menopause. HRT contains estrogen and can contain progesterone and other hormones. 

Hormonal Therapy works the other way by blocking and lowering the hormones and thereby control the Beast.

Now, isn't that something?

Changes

Change is the only constant. -  Heraclitus

When I opted for the surgery, I thought all I'd lose is the breast.  Well, it isn't quite as simple.  You lose a little bit of yourself each time something like this happened.  And I meant that both literally and figuratively.

With that pound of flesh removed, I must weigh a little less.  I'm no taller.  An area of concern is the back. Now if your pound of flesh is substantial, its loss may cause an overall imbalance.  This put a strain on your spine.  In order to correct this imbalance, women with massive pounds of flesh may consider getting a prosthesis.

Then, there's lymphedema but I have written briefly about that in a previous post.

My blood pressure is another mystery.  Where it once rode on the high side (averaging 145/60 with medication) it now swayed demurely between 100-130 over 40-60. (without medication)  According to the good Professor, a patient's blood pressure is known to dip after surgery.  This explains why I was constantly feeling cold.

My sister-in-law had a special herbal recipe to help increase one's blood level:

Lean meat, preferably organic 4 black dates 4 Southern dates 10 red dates wolfberries

Method To be double-boiled 5 hours. The resulting soup is incredibly sweet. My palms were pale before. It is a shy pink now.

The iron pills made my throat sore, for one reason or another but my sister-in-law had a remedy for that too:

2 red apples 2 pears 3/4 pcs Moh Far Kor pinch of Lam Hang Pak Hang pinch of sar sam

Method Bring to the boil then simmer for an hour.   I noticed that this soup reduced my phlegm significantly. It is also believed to reduce internal heat.

When I was in my early twenties, my mother had a stroke.  She was bedridden for about four months and developed severe bed sores.  None of us knew anything about bed sores at the time till it turned really bad. Having seen what she went through, I acquired a habit of always sleeping on my side.

This now became a problem.  My wound is healing fast but the underlying tissues are still raw.  When I turn on my side, I could feel this load of flesh moving in sync.  Sleep is impossible until this load is at rest. When I turned to the other side (my ears hurt if I sleep on one side for too long) the entire ritual is repeated.

Some nerves were severed during the procedure.  So my underarm and left chest is in a constant state of numbness.  Not a great feeling.

Post Surgery

Back on the hospital bed at the ward, I was still chilled to the bones.  They threw two blankets over me.  I had an extra fleece jacket thrown above all that for added warmth.

The bandages were tight.  I was still on the drip (Glucose/plasma) and tubes drained fluid from the wound into two bottles by my side.  My fingers went numb so they reduce the flow from the drip.

Lymphedema was a concern.  Also known as lymphatic obstruction, this is a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system. The lymphatic system returns the interstitial fluid to the thoracic duct and then to the bloodstream, where it is recirculated back to the tissues. Tissues with lymphedema are at risk of infection.

In order to protect myself against lymphedema, I was told to follow an exercise routine and to lift my arm constantly.  This causes the fluid to flow back or some such thing.  A day or two after I started exercising my arm, I could feel two big bubbles moving from somewhere beneath my left clavicle towards the upper arm area.  These were followed by sporadic little burst of bubbles at or near the same location days later.  I suppose those were the fluids that my compromised lymphatic system had to handle.

The staff nurse on the midnight shift was sympathetic.  She told me to try moving my arm about and to keep up with the exercise routine.  She had her breast removed a couple of years ago.  Looking at her go about her nightly ritual, you wouldn't believe that she is in the same boat as me.

Someone (Molly) from the Breast Cancer Welfare Association visited me.  I wasn't aware of such an association before.  She gave me what she called the Comfy Kit which contains leaflets and aid to assist me in my exercise routine.  Apart from this, she shared with me some tips on chemotherapy, the dos and don'ts, the cost factor as well as the services provided by the Breast Cancer Association.

The Nursing Team at SDMC was excellent.  Before discharging me, they gave me a good hair wash and blow.  Still,  after 5 days at the hospital, it was time to go home.

The biopsy report was ready 2 days later:

The left breast shows an infiltrating ductal carcinoma measuring 5.5 cm in its maximum dimension.  The tumour infiltrates as solid sheets and clusters and tubule formation is hardly seen.  The tumour cells have moderate amount of eosinophilic cytoplasm and large pleomorphic nuclei with nucleoli.  Numerous mitoses are seen (in excess of 20 per 10 hpf).  A moderate infiltrate of chronic inflammatory cells is seen in the desmoplastic stroma around the tumour. Lymphatic invasion is seen.  Ductal carcinoma-in-situ (DCIS) is not seen. Microcalcifications are not seen.  The tumour infiltrates the muscle and is seen at the deep margin.  All the other margins are more than 1 cm away from the tumour.  The nipple and skin are free of tumour.  1 out of the 17 axillary lymph nodes is infiltrated by ductal carcinoma.

And that - was that!

The Surgery

I checked into the hospital on the evening of July 5, 2013.  The surgery was scheduled for 8 on the following morning.

It was a long night.  Sleep conspired with the hands on the wall clock to rob me of much needed rest. Time ploughed excruciatingly towards 6 the following morning.  I was forbidden all fluid since midnight.  There is a reason for this.  Fluid is known to complicate the surgery by entering the lungs.

At precisely 7 am, I was given a bottle of surgical shower-gel and told to shower.

At 8-30 am, I was wheeled towards the Operating Theatre.  Eyes shut tight, you won't feel what you can't see.  My son and husband whispered brief encouragement which I heard between the squeals of the wheels.

Outside the Operating Theatre, (i.e. the Scrubbing Area) the anaesthetist stuck a needle into my veins explaining that it was for the drip.   She explained what it meant to be administered the General Anaesthesia and what to expect, got me to sign some papers (Let me tell you I'll sign anything at that point) and proceeded to wheel me into the Operating Theatre.  I found myself inside a well-lit and small windowless room with an overhead surgical light.  The upper section of the walls were replaced with glass but nobody stood outside to observe the surgery.  A black mask was held over my nostril and that was the last thing I remembered.

When I came to, there were two things on my mind.  First, the anaesthetist had a bad cold. Second, I was chilled to the bones and practically jabbering incoherently.  A heating device was placed on my body.  It blew hot air all over my torso and slowly, warmth returned.  I was wheeled back to the ward.

Man, it was cold!

The Masterpiece

Amy and Beth were two sisters living in a London apartment at a time when influenza was deadly. Both were old spinsters and patron of the arts, often spending their days at art galleries and exhibition. The winter that year was especially harsh and Amy caught the flu. Confined as she was to her bed, she fell into a depression and refused all food and nourishment.

Jack, the janitor was a friendly old geezer who often bumped into the sisters and spoke at length about his lofty plans to create a masterpiece someday.

Beth, distraught by her sister's appalling condition confided daily in Jack whose soft grunts expressed his disapproval.

The sister's apartment came with a solitary window which opened out to the brick walls of another building. On the wall, a creeping ivy clung in defiance against the winter chill.

"Look at the ivy outside, Beth. See how stubbornly it clung to life. Yet, they too shall perish. And when the last leaf falls, so shall I."

And Beth, so hearing her sister's words hurried to the window to have the drapes drawn. This became the daily ritual as Amy's illness worsen. Each morning, she asked to be shown the ivy. She counted the number of leaves remaining and repeated her prophetic words.

As the winter progressed, only three leaves remained one morning when Amy looked out.

"Look at the leaves, Beth. See how the edges are dying. By morning all three leaves will fall and so shall I."

"What utter rubbish," cried Beth as she thrust another spoonful of chicken soup towards Amy who once again waved it away.

This went on for a few days. Each morning, a perplexed Amy watched with unbelieving eyes.  The three dying leaves clung to the cold frosty wall. On the third morning, Amy called for Beth.

"Prepare me some chicken soup, Beth. I shall fight this cold and recover. If those three leaves survive this winter, so shall I."

The story ended well. Amy drank her soup and slowly recovered from her illness. By and by, they started going out for walks. And they started missing Jack.

Bumping into the landlord one day, Amy asked. "What's happened to old Jack? We haven't seen him for days."

"What? Old Jack? The damned fool. Went out sloshing in knee-high snow every night to paint his masterpiece. Caught the cold and died he did just last week."

The sisters rushed into their apartment to look out the window. And there it was, Jack's masterpiece, the three miserable leaves captured forever in its dying grace.

Today, I find myself looking out that same window and thinking the same prophetic thoughts. The difference is that there is no masterpiece on my wall.

Adversity brings out the best in us.

The friend in my adversity I shall always cherish most. I can better trust those who helped to relieve the gloom of my dark hours than those who are so ready to enjoy with me the sunshine of my prosperity.  -  Ulysses S. Grant

I feel blessed.  Friends and relatives gathered around me in my hour of need.

My nieces (Kat and Serena) were among the first few to know about the Beast.  They helped me pull through my depression by constantly reminding me to stay positive.  My husband was a source of great comfort.  For any negative report I hear, he countered them with something positive.  The rest of my relative on both sides of the marital divide gathered to give me moral support as well as exchange encouraging anecdotes from cancer survivors they knew.

On top of that, I received several offers to transport me to the hospital for my chemotherapy sessions.  I was deeply touched by these thoughtful offers.  Adversity brings out the kindness and compassion in people.  This much is true.

Despite their busy lives, my sisters-in-law came by daily to help with the daily chores. Christian brothers and sisters gathered around me in prayer.  Friends from Sarawak prayed for me over the phone and through emails.  A fellow Church member I did not know prayed for me at Professor Yip's clinic in the waiting room.

And there were so many success stories.  My husband's boss had her breast removed in 1982.  Today, she is a bubbly successful corporate figure living a normal life.

A Christian couple (Kelvin/Lydia) spoke about an old man who was healed after he repeatedly raised his hands in church to pray a simple prayer.  "Heal me, Oh Lord, and I shall be healed.  Save me, Oh Lord, and I shall be saved."

My niece (Kat) had a business contact who survived breast cancer after 15 years.  Her friend's mother had two breasts removed.

Sisters-in-law had buddies and colleagues who survived breast cancer and lived to talk about it.

There's Tay's mother and Kok Hoon's aunt, both in their eighties, who survived cancer.  My sister's neighbour who survived cancer and lived for 30 years.

My cousin's friend, another survivor.

The list went on.  I feel encouraged.

There is hope yet ...  for me.

Surely.

Millennium Powder Beverage

The first thing my niece (Kat) did when she heard about my predicament was to call up her entire network of business contacts and friends within the family circle. You might say, she scoured the earth for breast cancer survivors to glean any information she could from them. I was deeply touched by her effort and grateful. When you don't have a daughter, nieces are the next best thing in life, I thought. Thank God for nieces. The Millennium Powder Beverage is a delicious blend of cactus, orange, lemon and stevia to form an excellent source of phytochemicals and antioxidants.

It's main component, the cactus is apparently one of nature's finest source for bolstering the immune system. The sheer number of phytochemicals found in nearly all species of cactus made it a highly desirable and sought-after plant food.

Many cancer survivors swear by this herbal beverage.  Best taken dissolved in warm water half an hour before your meals.  It is expensive though.  A box containing 30 sachets will set you back by about RM500+.

I am now taking 2 sachets before breakfast and dinner.  Hopefully, it will boost up my immunity system and prepare me for the forthcoming chemotherapy sessions.

UPDATE: Read Supplements.

Sabah Snake Grass

It was said by them who knew, that Sabah Snake Grass had some cancer fighting abilities. However, local researches across various campuses revealed inconclusive results. Still, when you are where you are, you'd try anything.

I blended about 50 leaves with a green apple and swallowed the residue for three consecutive days. Although it wasn't chronic, I started purging.  It had something to do with DETOXIFICATION, or so I was told. I noticed that I slept better at night and the lump in my breast wasn't as inflamed. Hearing news about a man whose 7 cm tumor disappeared after he blended and swallowed 100 said leaves with a green apple as well as many other miraculous healing, I thought I'd give this a try, which I did, for four consecutive days. 100 Leaves Sabah Snake Grass 1 green apple 2 ice cubes

I developed a modest cough and lots of phlegm.  With my scheduled surgery just around the corner, I thought I'd just give this a break.

Conclusive Evidence

So the previous needle prick biopsy wasn't conclusive.  They needed a bigger chunk from me, said my new GP when I consulted him after seeing Professor Yip.    Fine for him to say something like this.  Think how much trauma that put me through.  I imagined them with a huge needle drilling into the core of my lump to get at those sample and poor me,  pale from all that drilling, panting from the effort and probably dripping blood all over the well sanitised floor.

We were there 45 minutes before the procedure.  I was restless and distraught, cold with anxiety and flushed from the effort.

In any case, the procedure was delayed to about 3pm.  Dr Malkit explained the procedure to me.  Local anaesthesia, after which they insert a bigger needle one minute later, three times into different parts of my lump to extract three different tissue samples.

"Whatever you do, doc, just don't let me see the needle," I said as I laid myself down.

The local anaesthesia wasn't that bad.  Pin prick though I probably made a fuss before it was administered.  I shut my eyes tight and prepared myself for the first drill.  It was different from what I had imagined.

Thruup!  Thruupp!  Like how you stapled a bunch of papers together.

Not to be outdone, I gave a little yelp.

"Was it that painful?", asked the surprised doctor.

"Just a little," I answered, thoroughly unabashed.

I prepared myself for the second drilling.  It was on another part of the lump.  This time, I told the doctor, that she may have ten samples if she so wished since it was virtually painless.  She laughed.

By the time she finished the third drill, I asked her if she needed a fourth.  I know I am such a show-off sometimes.

Anyway, I heard them comment that my tissue samples were white.  I wondered what that meant.  Doc said, "... can't tell because fibroids are also known to be white."

The report was out 3 days later:

Three fragmented cores are seen, infiltrated by malignant cells.  The tumour cells are small and cuboidal, and form tubular structures and solid cords.  The lining cells demonstrate prominent small central nuclei, generally hyperchromatic.  Nucleoli are single and small.  There is no in-situ component seen in the sample examined.  Diagnosis: infiltrating ductal carcinoma of breast, Grade 2.

And there's that word again.  "Malignant", the Beast.

I found myself wading through a thick fog in slow motion, not being able to see what lies ahead and not knowing what is behind.  My knees became weak and wobbly and why were the lights dimming out?  I watched the Professor's lips move but could not grasp its meaning.

Time was of the essence.  My surgery was scheduled for July 6, 2013 whereupon the entire left breast will be surgically removed.

How it began.

Sometime in May 2013, I discovered a huge lump on my left breast.  At the time, all it did was to give me the occasional stabbing pain.  It soon intensified to one which robbed me of my sleep.  I went to see Professor Dato Dr Yip, a leading breast surgeon with Sime Darby Medical Center.  She said my lump was huge and unusual, probably a cyst considering my age and menopausal probabilities.  Although cancer cannot be ruled out, she opined that it was unlikely since lumps typically grow to such a size over a long period.  Off to ultrasound I went.

The radiologist was grim when she gave a curt diagnosis.  "Could be infection but cannot rule out cancer."

This time, Prof Yip said "Hmmm... not good.  We will need a biopsy.". She sank a needle into my lump and said  "This is gritty.  It feels like cancer."

The day came with its ups and down and I swung between Hope and Despair.

A couple of days later, the biopsy report was ready:

The smears are hypercellular and show numerous atypical duct epithelial cells in loose cluster and singly distributed.  Stromal cells and myoepithelial cells are seen focally.  The atypical cells show high N/C ratio, irregular nuclear membrane and occasional nucleoli.  Large bare nuclei with irregular chromatin and small nucleoli are also seen.

These reports are typically incoherently worded to alienate the likes of us from the comprehension of Science and those who practices it.  As a recipient of one such report for which you pay an exorbitant price, you must resign yourself to searching the faces of the man or woman of science and accepting, whether or not you like it, the statement he or she made.

I knew a thing or two about separating the Beauty from the Beast,  "Benign" is the Beauty.  "Malignant" is the Beast.  Thus informed, I searched the report for the word.  I was overwhelmed with relief when I saw that the word "malignant" was absent.

I was wrong.

Apparently the keyword was "Atypical" and further tests were required.

It is surreal.

I can't believe I'm going through this stage in my life.  When I hit the pillow at night, I had to pinch myself to ascertain if all this is just a bad dream.  Even my waking moments are surreal.  I can't believe that God will allow such an atrocity to befall me.  What have I done, God?  What could I have possibly done?

My mind wandered without an anchor.  On good days, a calm serenity enshrouds me.  Isn't this what you wanted?  Didn't you tell God that between your husband and yourself, you wanted to be the first to go?  Why then the protest?

Bad days cascade over me like an annoying cough which wouldn't let me be.  A stray memory from a distant past. A memory which left an indelible mark on me.  I remembered her name - Dayang.  It was an unusual name.  Strange that I carried this picture in my mind through the years.  Late 90s it was.  Dayang was a staff of a finance company right next door to my office.  She was probably a Melanau.    I wouldn't know.  She's fair of face, pretty and I remembered her as being a little on the bosomy side.  There was also whispers about an affair,  a forbidden office romance or some such thing.  Not that it matters.

Dayang died of breast cancer.  The story goes that her death was so agonising that she screamed about being burnt alive.  It wasn't a pretty picture to carry in one's mind.  If my time is up, this is not the way I want to go.  I would like to have a calm smile upon my face as I walked with Jesus and/or God towards the bright light. I don't want to walk alone.