A Second Opinion

"In future, you will not be able to carry anything heavier than 5 kg...", said the nurse-counsellor as she brandished about a small plastic bottle which she had minutes ago informed me would be hanging from my armpit to allow for lymphatic drainage after the axillary clearance operation. I was SHELL-SHOCKED.... and my calm composure, carefully maintained during the earlier consultation with my first surgical oncologist, slowly disintegrated as tears started to bunch up in my eyes!

"Oh no... I won't be able to carry my baby niece and nephew anymore as they are already past 5-kg in weight... oh no... will I still be able to carry my SLR camera and go for photo-jaunts?... oh no... does that mean I won't be able to carry heavy pots and pans in the kitchen?", the potential consequences of losing my lymph nodes really came crashing down that afternoon.

When I first got my mammogram results back, I was sent by my company doctor to a government hospital (which I will not name here) where the surgical oncologist who examined me had recommended that I be admitted as soon as possible for surgery to remove the lump, and if tested to be cancerous then, to proceed immediately to remove the lymph nodes under my armpit on the side of my affected breast (known as an axillary clearance), which he explained was the standard operating procedure for breast cancer surgery. I had been prepared to do a lumpectomy to remove the lump but had not factored in the loss of my lymph nodes and the risk of lymphoedema (swelling of the arm) and other attendant risks of infection to the arm arising from the removal of the lymph nodes. I was bloody scared - in fact more scared of the axillary clearance than the lumpectomy!

Hubby insisted on a second opinion, and thankfully with C's help, we managed to get an appointment the very next day with Dr Zen (C's surgical oncologist). [Dr Zen is my nickname for my surgical oncologist, as he is the direct polar opposite of Doc Smiley being at all times very serious and reassuring in manner, explaining all the important stuff in his low and calming voice, hardly ever joking - very very zen-like!]

Dr Zen did a very thorough examination of my breasts, armpit and neck areas to check for any unusual lumps other than the one that I had felt. He recommended that a core-cut biopsy be done immediately on the day of consultation to confirm that the lump was indeed cancerous. Thereafter, he told me in a very serious manner that I had small breasts and that although I could get away with breast-conservation surgery - i.e. a lumpectomy (instead of a mastectomy - removal of the entire breast), it may distort the shape of my breast. Hold on a minute here... I may not have been a D-cup but I was definitely not an A-cup either... there and then I should have been instantly insulted, even hubby would not dare to call my breasts small... but somehow, Dr Zen managed to get away with that comment delivered in the gravest and calmest of tones!

What was more important though about this 2nd opinion was that Dr Zen had recommended that a sentinel node biopsy be done, a new technique which allows the surgeon to check whether the cancer cells have spread to the sentinel (guard) nodes before deciding on whether to do the axillary clearance of all the lymph nodes in the armpit. Premised on the fact that fluid from the breast first drains to a limited number of nodes in the armpit, any cancer cells which may have spread to the lymph nodes would get trapped first in the sentinel nodes, the procedure involved injecting some kind medicine (which contains a tiny amount of radioactivity and a blue dye) into the breast to track the path of drainage of the fluids from the breast to the armpit. During the surgery to remove the lump, Dr Zen would also remove the sentinel nodes and have them immediately examined for cancer cells. Only if the sentinel nodes had cancer cells would he proceed to do a complete axillary clearance to remove the lymph nodes under the armpit. For me, this was the Lord's answer to my prayers over the fears of the axillary clearance.

I was so anxious about my lymph nodes that my first two words uttered to hubby when I woke up after my surgery from my GA(general anaesthetic)-induced unconsciousness were "lymph nodes?". Total relief flooded through me when he gave me the all-clear - the cancer had not spread to the lymph nodes - all praise and glory be to the Lord for answering our prayers!

Immediately after my surgery, I ended up with a blue breast (due to the blue dye that was injected for the sentinel node biopsy) which was quite alien-looking but thankfully, the discoloration has reduced over the weeks - a small price to pay for going thru' this procedure.

Seeking that second opinion turned out to be such an important turning point in the course of treatment for my breast cancer that I cannot recommend enough to any one seeking medical treatment for any form of cancer to have a second or even third medical opinion, whether to get confirmation on the type of treatment recommended or to be aware of the alternative medical procedures available.



The above was my celebratory salad two weeks after my surgery - a green salad of fresh sweet figs, a couple slices of prosciutto (parma ham), shavings of parmesan cheese, and a light dressing of balsamic vinegar, dijon mustard and extra-virgin olive oil! A celebration of the fullness of life provided by the Lord!

As for Dr Zen's concern on the reduced size or potential distortion of my breast after surgery, I leave you with this light-hearted story (which a friend forwarded to me) (and no religious offence meant to any one):

"A man walked into the Lingerie Department of Macy's in New York City. He tells the saleslady, "I would like a Jewish bra for my wife, size 34B." With a quizzical look, the saleslady asked, "What kind of bra?"

He repeated "A Jewish bra. She said to tell you that she wanted a Jewish bra, and that you would know what she wanted." "Ah, now I remember," said the saleslady. "We don't get as many requests for them as we used to. Mostly our customers lately want the Catholic bra, the Salvation Army bra, or the Presbyterian bra."

Confused, and a little flustered, the man asked "So, what are the differences?"

The saleslady responded. "It is all really quite simple. The Catholic bra supports the masses. The Salvation Army lifts up the fallen, and the Presbyterian bra keeps them staunch and upright."

He mused on that information for a minute and said: "Hmmm. I know I'll regret asking, but what does the Jewish bra do?"

"A Jewish bra," she replied, "makes mountains out of molehills."

Looks like I need to find me a Jewish bra as well! :-P

Get Yourself Mammo-ed!

Today's post is dedicated to a very special friend who discovered she had breast cancer just a few months before I discovered my own lump in the breast.

Breast cancer is the most common cancer amongst Singapore women and I'm sure we've all read at one time or another newspaper or women's magazine articles quoting horrendous world and national statistics on breast cancer, and maybe even bought a pink ribbon pin in support of the cause during the month of October, designated as Breast Cancer Awareness Month worldwide. And yet despite all the exhortations to go for breast screening, I bet many of us have said to ourselves, "it won't happen to me" and postponed yet another mammogram appointment.

That was me for the last few years, until the day C, my very good 'makan kaki' (singlish for dining companion) and traveling companion told me she had been diagnosed with breast cancer. Somehow, the threat of breast cancer had never seemed real until someone close to you gets it. As the 'makan kaki' gang gathered around C in support, we also became individually more anxious for our own mammary glands and I particularly started to feel extremely guilt-ridden over those missed mammograms.

Well, the guilt didn't last long as a couple of weeks later, after feeling a slight lump in my right breast, I was scheduled for my first mammogram.

Ah... yes, most of us have heard horror stories of that evil contraption that clamps our precious breasts in its vise-like grip like an instrument of torture left over from the Spanish Inquisition. Obviously designed by a man who never had his own breast clamped and flattened, my only tip to women - steel yourself and follow strictly the instructions of the technician as she tells you to hold on tight and hold your breath (which is a no-brainer since all breath ...oof... will be forced out of you once those metal plates come pressing down) - remember, if she doesn't get a good x-ray, she is likely to repeat the process and who in the world is that masochistic!

Going through an annual mammogram is a necessary evil for women who've hit their 40s, and the several seconds of pain for each breast is a small price to pay for early detection of any cancerous mass.

By the time I had surgery to remove my lump, it was 1.5 cm in diameter and I was extremely lucky that the cancer had not spread to any of my lymph nodes in the armpit or neck area - Doc Smiley commented that I must have had really sensitive fingers to have detected the lump, but methinks it was the Lord's guiding hands thru' heightened awareness after C's diagnosis! Early detection saved my lymph nodes and I'm truly thankful!



October is Breast Cancer Awareness Month - do not let the message just float through your consciousness - if you haven't gone for any breast screening, let me encourage you to do it now and do it regularly.

For more information, you may wish to drop in at this latest website launched by KK Women's and Children's Hospital - it is definitely worth a tour on breast-cancer related concerns.

hair today, gone tomorrow

When I started my first session of chemotherapy, Doc Smiley assured me that I will definitely lose my hair within 2 weeks of the session. I didn't believe him as I had heard that some other patients may take longer to lose all of their hair and I was hoping my hair follicles were stronger than most (though I really had no basis at all for such blind hope).

Nothing happened for 13 days and I was cautiously hopeful... and then the 14th day came and that morning as I shampooed my hair, it started ... I ran my fingers through my hair and an inordinately large amount of hair strands fell away in my hand ... wah leow! could certainly have done without Doc Smiley's absolutely spot-on predictive powers in this instance :-((

Argggghhhh ... I would sit quietly and shed hair like a golden retriever ... there was hair in my bathtub, hair on the sofa, hair on my bed and on the floor ... that day I also discovered hair in my lunch and dinner ... this would not do ...

And so, to the hairdresser I went ... and now I'm as light-headed as I ever will be :-)

Yes, instead of dragging out the agony of seeing more hair come away each time I run my fingers thru' my hair, I decided to lop it all off. For $10, the deed was cleanly done with a proper hair-shearer at this wig-shop I went to in Lucky Plaza which had curtains that could be drawn around your seat-station for privacy during the shave. A very good idea in my view, as the shock of me seeing myself bald for the 1st time can only be described as 'mouth-gaping horror' - not being tough, toned and tanned enough to be GI Jane, nor demure and pale enough to pass off as an Emei nun - alamak... looked like my bald pate needed cover!

I had bought a wig from the same shop some time back after the Doc had mentioned about the impending hair-loss - and boy oh boy, did I have FUN FUN FUN trying out all kinds of hair-styles then. The wig that I eventually chose was very different from my usual hair-style - had decided I needed an upward change of image to brighten up my day and went with a 'Mod Tai-tai' style - nice loose bangs in a layered style with lovely curls ending at my collar-bone, dyed a lovely medium brown with highlights - what the heck, thought I might as well go the full hog since I was living the 'pseudo tai-tai' lifestyle with my days spent at home (except when the chemo side effects kicked in and I didn't feel like a tai-tai)!

How did my family and friends take to the new hairstyle?

• hubby loved it.. though he seemed to like touching my bald pate every now and then and has encouraged me to go 'commando' in public (i.e. no cover for that scalp) - what a horrifying thought, never!
• both my sisters-in- law loved the new style, and my bro-in-law has recommended that I take a picture of this new style and when my hair grows back in future, show my regular hairdresser the pic to get back into this style - hmm, my bro-in-law is quite the impeccable dresser, so I'm now wondering what he thought of my previous hair-styles.. scratching scalp!
  
• my close friends loved it, and one whispered in my ear the other day that this is the best hair-style that I've ever had! OK.. point taken, all previous hair-styles of the past few decades will be trashed ... maybe I should change my hairdresser (just joking ... I really like her!)
• even Doc Smiley liked the new look at the last consult and this sparked off a discussion on the prices of wigs in the market... hmm, can never quite figure out the man - couldn't believe he actually keeps track of such prices :-P

Unfortunately, my chemotherapy drugs affect the normal cells in the body as they go about doing their job of attacking the cancer cells and disrupting their growth. Normal cells which include the cells of the hair follicles thus causing hair loss. And to my horror at first and delight later (upon acceptance of the fact), this included the hair follicles at the pubic area as well - wow, no need to go for bikini-line or brazilian waxing for the time being - save a bundle!

And now as I go through my day, wondering whether and when my hair will grow back (Doc Smiley has promised it would and I'm holding him to that!), getting to grips with the heat of wearing a wig, the impossibility of scratching any itch when a wig is donned (a dead giveaway of a wig, for as one scratches, the bloody thing moves up and down as well!), the constant reminder to myself to grab the wig or a hat before I leave the house (I dread the day when I become so comfortable with my light-headed status that I will conveniently forget, and then wonder who everyone is staring at!), wondering how to shampoo and lather the scalp (since there is no hair to lather - and currently have resorted to using mild Johnson's Baby Shampoo so as not to further dry the scalp) ... I can only offer all these anxieties (big and small) to the Lord, and know that He in his goodness, will provide the right solution at the right time, having so wonderfully provided me with positive emotional support and laughter from all quarters after I went bald!

"Humble yourselves therefore under the mighty hand of God, that he may exalt you in due time:
Casting all your care upon him; for he careth for you."
- 1 Peter 5 : verse 6-7 (KJV)

And so, I think it apt (or maybe ironic?) that whilst I lose my hair, I end this post and leave you with these food shots of a lovely 'angel-hair' pasta tossed with asparagus stalks and strips of parma ham which have both been cooked lightly in garlic-infused olive oil and some boursin garlic cheese for a light creamy touch! A couple of good wrist actions with the black pepper grinder and lunch is ready :-)

Angel-hair pasta is easy to cook (2 minutes in boiling water - almost like instant noodles) and is not as heavy on the palate as spaghetti or fettuccine - perfect for those days when I just want a quick meal without too much trouble. Oh and in case you're wondering - asparagus is folate-rich (has one of the B vitamins), has high levels of ready-made glutathione (which is the main antioxidant in cells, helps to detoxify carcinogens and other pollutants, boosts the immune system, helps to form new blood cells and prevent anaemia), and is also a good source of rutin (a type of flavonoid which helps to strengthen capillary walls and improve blood circulation) - sourced from various extracts of the book Hot Potatoes & Cool Bananas (Healthy Food - What, Why & How) by Anne Perrera, Carolyn Lister & Lesley Hedges (you can look for it in Popular Bookstores, which was where I bought the same).

With that, bon appetit to a healthy lunch :-)

Sunny "Soup" Up

"super-charged"... "hungry"... "full-alert"... my choice of descriptive words on how I felt during my first few days of chemotherapy!

I started chemotherapy within a week of my surgery - thanks to my very efficient medical oncologist, Doc Smiley (of course, that's my nick for the dear doctor largely attributed to his sense of humor, which can be a wee wicked at times too). At that first consultation, when asked about the duration of my chemotherapy, Doc Smiley started marking out in pink highlighter on one of a stack of pocket calendars on his desk the various treatment dates and handed it over to me. Six courses in all over a duration of approximately four months. The first course was highlighted to start on the date of the consult. I looked at him in puzzlement and said, "This is only for illustration, right? We are surely not starting chemo TODAY, right?". He looked at me with a twinkle in the eye and said, "Don't see why not - you look healthy enough, we can start this afternoon if you have no objections." Duh... uhh... for starters, I wasn't mentally prepared ... but Doc Smiley assured me that the treatment would be a breeze taking no more than an hour in all.

And with that, I started my first course of chemotherapy, going into his clinic for daily 1-hour intravenous-injections-cum-drip sessions over a 3-day period, and my goodness, did I feel like a 'superwoman' then. I was adrenalin-charged, sleeping only a couple of hours each night, waking up at intervals at 3 am and 5 am each day (like an aged person suffering from insomnia), going for early morning 2.4 km brisk walks, and eating like my 4-month nephew (hunger pangs struck every 3 hours or so). I thought to myself, "Hey, if this is how 'chemo' is like, I can go back to work pronto!"

Told Doc Smiley about my 'superman' status, and he reluctantly told me that such transient superpowers were the result of steriods that had been added to my intravenous drip (to counter nausea and vomiting) and an appetite-inducing drug that he had prescribed. When I completed my 3rd day of treatment, my 'superman' powers vanished into thin air and from day 4 onwards until day 8 or so, I suddenly turned into an 80-year old 'clark kent' suffering from constant fatigue and body aches. Sheesh....

During this period, eating (which requires the mouth to chew and swallow) was not a much sought-after activity (not to mention the unappetizing metallic taste in the mouth) and cooking any form of elaborate meal would be akin to climbing a very very high mountain. Soups (both Chinese and western ones) came to the forefront as being the easiest to prep and to ingest and digest.

This sunny-looking soup was one of my favourites. Liquidized carrots, cauliflower and onion, with a touch of sea salt, cumin and black pepper to spice up the same.

• saute one medium onion (quartered) in a pan of heated olive oil for a few minutes
• add 3 to 4 carrots (cut into chunks) and half a head of cauliflower (cut into chunks), a dash of sea salt and half a teaspoon of ground cumin
• add 3 cups of water and bring to boil - then lower heat to a small fire and let simmer for 15 t0 20 minutes until the vegetables are soft
• liquidize contents in a glass blender
• and lunch / dinner is ready in less than half an hour - either serve with brown rice or wholemeal bread slices for more substance
  

A Stormy Period

"It's confirmed." And with those two words from my doctor, my usually uneventful life became a roller-coaster of emotions for my family and I.

Several weeks ago, I discovered a lump in my breast and after going through the standard procedure of a mammogram, an ultra-sound scan, and finally a core-section biopsy, my oncologist spoke the two dreaded words that I was praying would not come true. But yes, the biopsy had confirmed that the lump in my breast was cancerous.

There were no tears in the consulting room that day - for whatever tears I could afford on myself had already been wept and spent in the earlier days since I discovered the lump - tears of anxiety, apprehension, frustration and fear. But now that I knew what it was, I had to get down to the business of removing this interfering blot in my health and life.

And with that firmly held in mind, the last two and a half weeks have been a whirlwind of activities with first the surgery to remove the tumour, and then the start of my first course of chemotherapy. It's been tiring, to say the least, but the support of hubby, family, friends and my doctors, and even strangers from time to time, have filled the past weeks with warmth and lots of humour (.... laughter is after all the best medicine!). And never forgetting to praise the Lord who has kept me in the palm of His hands, answering our prayers and guiding us along this difficult path.

You may think from the above that I sound pretty strong and positive about this 'big C' episode - and I am - but it's definitely not from my puny internal resources - it comes all from the 'big Lord' Himself. Several months ago, my hubby and I had decided that we should up our ante in our spiritual life, and when the 'big C' came knocking on my door, I was hard put wondering if the Lord had sent this on as a test of our faith. I shared this with my hubby's cousin, who is a pastor, and his take was that the Lord had wonderfully prepared the foundation for us so that when we go through this very trying period, we can and will be able to dip into that foundation of faith, grace and mercy and find solace and comfort! Now that is one comforting take, which I hold dearly in my heart :-)

"Trust in the Lord with all thine heart, and lean not unto thine own understanding.
In all thy ways acknowledge him, and he shall direct thy paths."
- Proverbs 3: 5-6

And just like the above picture I've taken of the scene from my living room, it may seem that there are dark and stormy skies hanging overhead now, but the bright and warm lights shine like a beacon leading the way to solace and comfort.