Clinical Updates, June 2013, #03

Yes, yes… it has been almost a week now since I had last posted and I am not exaggerating the fact that this was how uncomfortable that I was and still are and that I really don’t feel like switching on my computer and write.  I have not read any book in the last few weeks and the only reading I made were the newspaper in the morning during breakfast or the online version of Channel News Asia on my Smartphone in the evening. The rest of the times were spent sleeping, lying down, sitting or watching the TV. Eating is also getting progressive difficult due to the pain, bloated-ness and the occasional vomiting.

Sounds bad huh?

Probably is quite bad or probably not as bad as some other folks but it has been difficult. In fact, “uncomfortable” may be an understatement but I don’t have any other words that seem to be more suitable because I am not quite miserable nor in extreme agony although occasionally it had reach that stage but thank God that they were transient and lasted only a short while.

Last Thursday, I saw the Gastroenterologist as part of the follow-up for my duodenum and bile duct stenting. Both seem to be stable and need not put too much attention on it but since I was there at the clinic, I explained about the Radiation Gastritis but the Gastroenterologist wasn’t quite convinced that it was all due to the Gastritis as some symptoms are odd but there are some indications for it. Anyway, she increased my Nexium dose from 20mg twice daily to 40mg twice daily for 2 weeks and it does help but not to the fullest extent. Suspect that the discomfort is due to both the gastritis and cancer tumor.

I ask that you pray:

·       That I recover from the Radiation Gastritis quickly as then I only have to deal with the pain from the tumor and that is so much easier to manage with just pain killers.

·       For now, food intake is low and I am losing weight gradually and would be hitting 51kg very soon. Pray that whatever I eat, I can absorb the nutrient and thus to maintain and increase my weight.

·       “Peaceful” sleep and rest is hard to come by. Pray that the pain would be resolved and that the food would pass through the stomach smoothly so that I don’t have bloated-ness.

Some people who saw me may not think that I am going through all these pain and discomfort or that I may be exaggerating but I got to put on a brave front and be stoic for the family sake and the tolerance is also by God’s grace and mercy. Stay with me a couple of hours and you will start noticing the discomfort that I am going through  as occasionally I will zone out from trying not to focus on the pain and discomfort.

Nathan was ill over the weekend and from observing this son of mine, he seem to be as stoic as me in that he usually cries for a very short while whenever he fell and cuts himself or knock against sometime hard and most time he does even react to the “pain”. Last weekend however, he was clinging to the mother and complains of pain in the tommy area and cried quite a bit and we had no choice but to send him to the hospital to have a look and he was hospitalised on Sunday evening for observation for possible intussusception (i.e. obstruction caused by infolding of one part of the intestine into another) due to his recent history of fever and coughs or viral illness (e.g. stomach flu). Fortunately, the pain got resolved and Nathan was supposed to be discharged on Monday but we kept him in KKH for one more day just to be certain.

In God We Trust and in Christ alone my hope is found.

Hebrews 11:1

What’s Next?

Psalm 23 (NASB)

1   The Lord is my shepherd, I shall not want.

2   He makes me lie down in green pastures;

     He leads me beside quiet waters.

3   He restores my soul;

     He guides me in the paths of righteousness for His name’s sake.

4   Even though I walk through the valley of the shadow of death,

     I fear no evil, for You are with me;

     Your rod and Your staff, they comfort me.

5   You prepare a table before me in the presence of my enemies;

     You have anointed my head with oil; My cup overflows.

6   Surely goodness and lovingkindness will follow me all the days of my life,

     And I will dwell in the house of the Lord forever.

Truth be told, I do feel miserable currently but that do not translate into misery in my life and Psalm 23 still holds much truth for me despite the circumstances that I am going through.

I keep talking about my pains and discomforts and they were really a constant in my life for the last 2 weeks. Last night was quite bad and I hardly slept for about 3 hours intermittently despite the morphine. So what is next?

I won’t deny that in the last 2 weeks I have not thought too much about God as most waking moments had been locked up in trying to tolerate and finding means of easing the pain and discomfort. It thus makes me thinks about what happened to my belief and my effort to try and live a life where God is ever present and that He should not be far from my thoughts at all times. I admit that I was trying to fight this pain and discomfort on my own strength and also trying to see how far I could go on before I say “I give up, I surrender!”. Well… I am at that point now where there is really no one else I can really depend on except God.

God had been gracious and I know he will continue to be gracious despite my temporary loss of common sense and tried to depend on my own strength. How do I know that He is with me? Despite Nathan and Josie coming down ill a few times in that last few weeks, I was spared that illness that would have complicated my medical conditions. My last medical review was positive, Josie is holding up well and I know God was with her and strengthening her. Nathan saw a General Medicine Consultant today at KKH and we were told that his frequent illnesses were not unexpected since he started childcare and that he is holding up quite well actually. Nathan is also starting to “understand” things more and we are thankful that he slightly less (only slightly but better than no improvement) sticky and demanding and personally for me, that he will occasionally sit with me when mommy is busy. Ah… such heartwarming occasions.

In God We Trust and in Christ alone my hope is found.

Hebrews 11:1

What Else?

Once again I know I had not posted for a few days and some of you might be wondering what is happening to me? I had consciously not posted anything because I do not wish my post to be just about the pain and the discomfort. It would either be the pain is here and then there, how it is giving me sleepless night or the discomfort is making me less willing to move about as every step that I take focuses somehow onto the bloated feeling in the stomach. I am also not quite up to writing as most of my time was spent lying or sitting down or sleeping.

I still have to put in some update but what else can I write?

For those hoping for something a little different and perhaps uplifting, I have to disappoint you for a little longer.

The new medication is helping but only to a certain extend as the pain still comes and go but at lesser intensity. Occasionally, there will be a sharp pain that runs through from my right side near the stomach to the middle of the chest on the right. I’m still talking the morphine but I had reduced the amount I took as the pain is less intense. Since what I am having is Radiation Gastritis, I’m assuming that the vomiting is part of it too. In the last one week, I had vomited three times from bloated-ness but I believe this is not because of the duodenum obstruction like the last time but simply because of the direct effect of having Gastritis. I really got to watch the quantum, the frequency and the texture (not too hard) of the food that I eat. In the meanwhile, I will having to depend a little more on the Glucerna supplement for my nutrient intake.

Josie is coping as best as she could and emotionally she is far stronger now than she was when this journey started. I believe God’s gift of Nathan had helped in this development as she has sort of a “distraction” and also a reason to remain strong. I wonder how she would have coped if all her attentions and focus is just on me alone and seeing what I am going through especially during this period when I’m having this Gastritis.

As a kind of record, I had asked Josie to take pictures of me while I sleep, sit of simply lying down and the various postures that I adopt just to ease the pain and discomfort. I kind of joked that I could be a yoga teacher because some of the posture I had adopted would showcase my flexibility.

In God We Trust and in Christ alone my hope is found.

Hebrews 11:1

Clinical Updates, June 2013, #02

The last 2-3 days can be considered bad days for me because the pain was quite excruciating. Fortunately it had not developed to a “debilitating” state but it came very close to it.

On Monday, I saw my Med-Oncologist and a couple of things to report:

a)     The blood test results were alright, not the best but alright. Kidney and Liver functions are within normal range and that’s good. Platelet was 102. Could be better but I’m thankful because it could have been worse. Lymphocytes number was borderline low but it is within the patterns observed from previous tests and not much to worry about. The CA19-9 Tumor marker had dropped to 158 from 300+. Still can’t make much out of it because at 300+ the reading is not definitive and thus a reading of 158 may seem like an improvement but again it is not definitive but a good indication none the less.

b)     The stomach pain is also as expected and my Med-Oncologist suspects that the “worsening” symptoms were probably due to the higher radiation dose used in my radiotherapy. My medication had been changed:

              i.         The Fentanyl dose was increased from 25mcg to 37mcg.

            ii.         Omeparzole was replaced with Nexium (Esomeprazole), kind of a more potent form of Omeparzole.

          iii.         Buscopan was replaced with Sucralfate although I can take both at the same time since they function differently.

          iv.         Given some more morphine and advised to take as much as I need (not “want”) within the prescribed dose to ease the pain.

After a couple of doses under the new medication, they do help to ease the pain but not totally. I have to make sure I don’t put any pressure on the stomach like sitting in a slouch position as it compresses the stomach and that often create quite sharp intense pain.

I have a CT scan scheduled on 2 July and follow-up with both my Med and Rad-Oncologists on 8 July. Depending on my current condition especially whether I would have recovered from the Radiation Gastritis and the result of the next blood test, my Med-Oncologist would restart me on Chemotherapy.

It has been nearly one year now (11 months to be exact) since the preliminary discovery of the “mass” at the pancreatic head with “invasion” of the liver and duodenum. A tough 1 year and clinically the best news was that the cancer in the liver is gone but beyond the fight against the cancer, the year was also rewarding in terms of building relationship with family and friends and more importantly with God.

Don’t really want to say the journey is coming to an end because the journey never ends. The end of one part of the journey is beginning of the next and I pray that God will grant me the opportunity to enter into a fresh new journey with Him when He call to a closure this current journey on this current path.

In God We Trust and in Christ alone my hope is found.

Hebrews 11:1

Clinical Updates, June 2013, #01

I will be having an appointment with my Med-Oncologist tomorrow and I had gone to TTSH yesterday to have my blood taken for tests and at the same time have my porta-Cath flushed to keep it patent.

I had originally intended to post only after the appointment with my Med-Oncologist and sort of “save” one post but the last couple of days were horrible with the pain in the stomach. I had written to my Rad-Oncologist and he replied that the symptom that I am experiencing is radiation gastritis and that it will last probable another 2 to 3 more weeks. Sigh… That is another 2 to 3 more weeks of agony. The pain had gotten so bad that I am on regular morphine and no longer just at night to help me sleep and most of the time, I have to sleep in a sitting position in order to ease the pain and get some form of decent sleep. It helps also if I twist my ankle or wrist at certain angle in order to “create” some pain and thus divert the attention of the pain away from the stomach. I know it sounds kind of funny but it is true and in my case it does helps because by releasing the tension on my ankle or wrist I can ease the pain away relatively quickly and the pain doesn’t last, not like to pain in the stomach.

I hope my Med-Oncologist will have some means of helping me get pass these few weeks other than Omeprazole because other than the “normal” and regular pain, I got very sharp and short intense pain whenever I eat. Fortunately, these pains after meal does not last very long and were only very short but very intense. These of course make it psychologically difficult in attempting to eat but eat I must in order to maintain the energy and not to lose weight.

Spoke to the oncology nurse yesterday as she was flushing my porta-cath and generally chemotherapy will not resume under such circumstances. My Med-Oncologist will probably assess the situation tomorrow and will assess me again probably in another 4 to 6 weeks to see when I can proceed to next phase of therapy. The nurse also mentioned that I am “darker” but then it is also normal for someone on Xeloda (the chemotherapy drug) and the “dirty” patches on my feet.

The bright side is that if my Rad-Oncologist is correct, the pain will last only the next 2 to 3 weeks and by God’s grace, if I can get past these 2 to 3 weeks then I should be alright and as for prayer, please pray that the pain will subside quickly and that I will have the extra measure of “strength” to tolerate the pain.

In God We Trust and in Christ alone my hope is found.

Hebrews 11:1

Promises

I received a message from a fellow brother from church that my presence was missed in church camp. This reminded me that when Josie and I got married, we had promised ourselves that we will not miss any of the following:

a)      Christmas Service

b)      Good Friday Service

c)      Easter  Service

d)     New Years’ Eve (Watch-night) Service

e)      Church Camp

Already for this year, I had missed Good Friday Service, Easter  Service and Church Camp due to my condition. It was a situation that I am not fond of and the decisions weren’t taken lightly.

By the grace of God, I pray that I won’t have to miss anymore of the above services or church camp.

In God We Trust and in Christ alone my hope is found.

Hebrews 11:1

Radiotherapy: Post Therapy Updates #02

I am just going to come out straight ask for your prayer because I have been having bad pain in stomach area in the last 2 days.

The pain that I am experiencing is not just in the area where the tumor is but in the abdominal region near the stomach. There is slight food retention and last night I vomited at about 11:30pm and I can notice from the food vomited that it included food consumed during dinner at about 7:00pm. The pain is sufficiently bad enough that I am taking morphine during the day where I normally would just take at night just to help me sleep but it does not seem to working very well. This is on top of the 25mcg Fentanyl (pain killer) patch. The pain is not just a direct pain but is also kind of "pressure" pain like the stomach is distended and also like bad gastric pain. There is a lot of gas especially after every meal. Overall effect is that it is causing me to lose appetite but I am still "forcing" myself to eat but in smaller quantity.

It is very uncomfortable and disturbing and I had just written to my Rad-Oncologist to seek his advice.

I am assuming at this point that it is a kind of delayed side-effect of the radiotherapy and that there is some means of alleviating the pain or that it would go away after a few more days.

Tried distracting myself by going to the movie in the afternoon and watched Star Trek Into Darkness. Well… it helped for the 2 hours that the movie was on and for Treky out there, yes, yes, yes, it is worth watching as the story link together the original Star Trek TV series, the original Star Trek movie franchise and this new Star Trek movie franchise. The Klingons have a slightly new look.

In God We Trust and in Christ alone my hope is found.

Hebrews 11:1

Closure

For those who were looking forward to reading some new posts, my apology if I have not posted regularly for the last week or so. Still trying to rebuild my strength and it has been hard with ups and downs (more downs than ups) occurring throughout the week and within the day.

In the last few days, a couple of thoughts kept popping up in my mind and I guess it is again one of those prompting that I cannot ignore. In fact, over the years these thoughts and feelings had occasionally cropped up but I had no means of addressing them but now that I have this blog, I guess I have an avenue to seek closure for these past events.

When I was studying in Saint Andrew’s Junior College (SAJC), I knew this guy who was in the same year as me and who was a member of my present church and who was also in the Senior Youth Fellowship. We were sort of close but not to the “best friend” extend. I was trying to get to know him and there was once I asked him if he would join me for a movie and he agreed. Can’t remember what we watched but I remembered that at the end of the movie, he got into a sort of altercation with the person sitting behind him as it seem that guy was continuously kicking my friend’s seat throughout the movie. What happened next is not what I was particularly proud of as I walked away while my friend was continuing with the “conversation” with the guy behind him. It was a cowardly act and over the years I was beating myself over my sort of “abandonment” of my friend. After we graduated, he for some reason also left church and we lost contact. I had not been able to trace him and had not been able to seek closure for my cowardly behavior then.

When I enlisted and was undergoing Basic Military Training (BMT), I wasn’t the strongest or fittest guy in my platoon. I weigh about 55kg and could hardly do 3 pull up and failed my 2.4km run several times. Physically, it was really difficult for me. There was once the platoon was punished for something that I forgotten what it was and the platoon was ordered to run up a small sloping track to a particular tree and touch the tree and run back to where we started. For those who had undergone BMT in the 80’s, you would know what I was talking about. The platoon was running together and obviously some were faster and some slower. There was a small group of guys led by this Eurasian chap who took it upon themselves to be the kind of “guardian” for the platoon and they held everyone back and got everyone to run as a group which was good in terms of “teamwork”. As I mentioned, I wasn’t the fittest guy and thus was one of the slowest but the pace these guys was leading the pack/platoon was so slow that I knew we would get some more punishment from our instructors. Wasn’t the brightest thing to do but I broke from the platoon and ran on ahead towards the tree and my thoughts then was that if majority of us could reach the tree quickly, the few who were fittest could always turn back to help the slower folks. Anyway, we did get it from our instructors for the slow pace regardless of the “teamwork”. Anyway, concerning this Eurasian guy, I got plenty of expletives that I can use on him and one of his mantra was “do onto others what you would not want others to do onto you”. He was a good looking guy, charismatic, well to do financially and he got a bunch of backers in the platoon. Needless to say, my life got pretty much unpleasant after that with cut boot and shoe laces, missing tower that I had to buy to replace, toothpaste in my boots, etc. Why you might ask why is this one of the closure I seek? I really don’t know because I don’t know if I had to go through the same thing again, will I still make the same decision? What I knew is that I had made the choice then based on what I could have tolerated physically but obviously, these are the least of concerns for those guys who put “teamwork” ahead of others physical suffering or tolerance. From BMT, I made it to Non-Commissioned Officer School and from there to Officer Cadet School (OCS). You can guess the surprise on this Eurasian guy’s face when he saw me in OCS. I did not make it through OCS though. I was so weak that I had a relapse of my asthma that was in remission since I was 14 and had to drop out of OCS.

That’s it. I know it is kind of a selfish post as I seek closure for myself.

Please pray for me as physically I feel worse now than when I was in BMT. My weight is lower at 53.7kg compared to my peak of 68kg.

In God We Trust and in Christ alone my hope is found.

Hebrews 11:1

Radiotherapy: Post Therapy Updates #01 and Thoughts

Radiotherapy is over. I kind of have a strange feeling because after 6 weeks of radiotherapy, I had gotten used to the routine of waking up early, getting prepared to go and beat the morning school traffic, go for breakfast and head to NUH. I just asked Josie what we are going to do tomorrow and I guess for her it was a relieved too of not having to wake up early anymore and she just gave a simple reply “I’ll send Nathan to school tomorrow”

I am still sort of recovering from the effects of radiotherapy and the sequence are generally great in the morning, slowing down in the afternoon, not so great in the evening and trying not to think too much about the discomfort before bed. I got craving for the sweet stuff but obviously I can’t indulge and for someone who used to love to eat, the smell of food sometime turns me off. Still got to eat and so nowadays, my diet is kind of boring as it usually comprises the same things that don’t turn me off.

In the last 2 days, honestly, I wasn’t thinking much about God and I feel guilty about it. Had wanted to go to church this morning but because I had an awful night last night, I had decided then not to go to church this morning. Anyway, Josie was still coughing.

I thought I’ll post something tonight and I guess since I am writing this post, I could not really “run away” from God and I remembered a programme on National Geographic Channel recently about the Yakuza (Japanese Gangsters). In it, there was a Yakuza member who was jailed for a petty crime and while in jail found God and when he was released, sought permission from his “Boss” to quit the gang. To cut a long story short, his boss allowed him to go and he is now a pastor of a small Baptist Church. In his church, there was also a young former yakuza member and he said something that is really at the core of Christian belief. He said “You cannot be loyal to 2 bosses. Either you are loyal to God or not”. There is nothing more I would like to add and just leave you with this to think about.

In God We Trust and in Christ alone my hope is found.

Hebrews 11:1