Wednesday 23 February 2011

Decided therapies

I have been quiet for weeks, because I need time to think about what therapies to go for.

After weighing the pros / cons and my cancer stage, I have decided not to undergo any western therapies that are recommended by doctor. I do understand the good intention of the therapies, and I should not undertreat my disease.

In fact, I will take alternate therapies, a combination of below:
- Consume healthier food, reduce meat and chicken intake
- Chinese medication
- Consume fresh vegetable and fruit juice few times a day

Am going to write emails to update some of the doctors, and am sure they will persuade + advice me further. Will see la...

Saturday 12 February 2011

Side effects after surgery & CT Scan?

Have discovered serious hair drop and dandruff problem these few days.

Are these the side effects after
- the radioactive contrast material that was injected for CT Scan, and
- the electronic wave from the CT Scan machine, and
- the anaesthesia used for the surgery
???

Monday 7 February 2011

3rd Oncologist Advice

Went to meet Dr Manivanan from Wijaya International Medical Centre, located at PJ.

He first examine my report and body.

Some simple practical rules from him
- mastectomy, no need radiotherapy
- ER/PR -ve, must do chemotherapy
- ER/PR +ve, do hormone therapy

About radiotherapy, IMRT is only suitable for organ or area that is in inner body, like kidney, stomach etc. 3D  CRT is the most common and suitable used for breast cancer, as it is considers located at outside of the body, with minimized radiowave into other body organs. About 1% of lung will get damage, the wave will kill the lung cell; 1cm depth start from the edge that is close enough to the breast. He suggests to do 4 weeks shooting on whole breast and another 5 days for boost. Side effects are similar to what other doctors said, darker skin (temporary), nausea, cough, vomit etc. Dr Azrif from Prince Court told me there will be 3 tattoo dots on my body, but Dr Manivanan says there will be only removable marks but not tattoo. Somemore is invisible marks. Cost is about RM15k to RM20k, Dr Mani give me an estimated figure only.

There are 2 types of drug being used in hormone therapy, i.e. Tamoxifen and something called Armidex (not sure about the spelling, assuming this is correct now). Tamoxifen is a very old medication, which is being used for almost 30 yrs. It is very effective and less expensive. Armidex is being used for 5-6 yrs (most is 10 yrs only), better than Tamoxifen in a way, it reduces the side effects. But is about 5-7times more expensive than Tamoxifen. Less assume Tamoxifen is about RM100 / month, this Armidex will cost RM500 or RM700 per month then. According to Dr Mani, Armidex can cause osteoporosis. These medication will actually stop cancer cell from attaching to ER, but not to stop ER production. This is something I misunderstand about this medication previously.

If cancer come back again on the same breast, definitely it will at higher stage and chemotherapy is a must by then.
I dont have the option to do only radiotherapy but not hormone. If decided to go for therapies, must do both.
It is useless to only start the therapies at 6 months later. He mentioned something like, the therapy must start as soon as possible after surgery, otherwise is not much helpful for the cure. He used one very technical term when trying to explain to me, but, I couldnt catch.

4th Oncologist Advice

Made an appointment with Dr Ho Gwo Fuang from UMSC at 5.30PM, but only able to go into his room at around 7PM.

Before I meet him, one of my fren told me that she did meet Dr Ho at UMMC for her father's disease. My fren says he is a very soft spoken doctor (till my fren hardly to catch his words each time) that makes her dont have much confidence in him. I also feel hesitate to see him after I heard my friend's comment about Dr Ho. But luckily, I met him, and I got some useful information from him. He is a nice doctor and willing to spare me information.

He is scrupulous and smart. He gives me a very good impression for the start!
I passed him the pathology report, he read through. While he is reading, I start brief him about my journey, how I detected the lump and end up surgery in Prince Court. He noticed from the report that I have another lump in right ovary! This is what other doctor didnt noticed, may be except Dr Azrif, since he is Prince Court and can access my CT Scan report easily.

Dr Ho requested the scan report from me if I have. I passed him the CD (soft copy) of the CT Scan, I myself also never open it. I thought it is definitely something I will only get ??????? in my brain when I open it. It is an interesting CD . It contains a software which can open a series of images saved in the CD. These images are the images took by the machine during the scan. I can see all my body organs, lumps etc clearly! Dr Ho also shows me where my ovary and breast lump is.

I only discussed radiotherapy and hormone therapy with him, as I told him that whether will or will not he recommend chemo to me, I will insist NO to chemo.

He started with me discussing the ovary lump, which is something not in his scope . By using the images in the CD, he shows me that my lump is "light" color inside. He says this tumor is undecidable on the type as it is not something "dark" color like the edge of the tumor which can classified as a cyst. He recommended me to see Dr BK Lim from UMSC. He says he is a nice doctor.

About radiotherapy
- 3D CRT
- Commonly 5 weeks shooting for whole breast, and 1 1/2 weeks for boost. But studies shows that 3 weeks whole breast shooting is also efficient enough for the cure. Therefore he recommended 3 weeks and follow by 1 1/2 weeks boost for me. This treatment will be conducted in SJMC.
- Lung damage, about 1cm depth, starts from the edge closest to breast. But this damage is not significant to us, but yes to a marathon runner.
- Without radiotherapy, it is about 25% to 30% local recurrent. With radiotherapy, it reduces to < 5%.
- Use marks but not tattoo. There is option for me to choose. Mark is fine and good enough for breast.
- Treated breast is firmer, tends to be long term. But degree is patient dependent.
- Treated breast will be swollen.
- Treatment course will take 4 weeks in SJMC, and will meet Dr Ho once a week or once every 2 weeks.
- Treatment must starts within 6 weeks after surgery. Therefore I must decide before end of February.
- Cost is a little bit cheaper than other hospital.

About hormone therapy
- When consuming Tamoxifen, cannot get pregnant as it is harmful to baby.
- < 50 yo women get more benefits from chemotherapy.
- >= 50 yo women get more benefits from hormone therapy.
- http://www.adjuvantonline.com, a website that shows me some statistics about the relapse and alive rate. This is the tool Dr Harjit is using that day!
- ovary ablation will stop ER production, but not Tamoxifen.
- Tamoxifen is to stop cancer from attaching to ER.
- AI, another name (?) of Armidex that was told by Dr Manivanan, is more effective for women in post menopause. AI can be prescribed following by ovary ablation. But the result is not significant for women > 30 yo. The result of Tamoxifen as compare to ovary ablation and follow by AI is the same.
- AI will cause osteoporosis.
- Something new to me, Tamoxifen will pause menses, uterus lining get thicker after some times, could then cause uterine cancer, especially to post menopause women. But reported case is only about 1%.

Before I leave his room, Dr Ho told me Dr Azrif is his best friend.