Tuesday, May 26, 2009

Stomach-cancer has NO Respect

This week in May2009, my first patient from Port Dickson, who refused surgery 3 times last year and insisted on alternative treatment despite my persistant counselling, contacted me and told me that she is in Hospital Tuanku Jaafar Seremban (HTJS). She can't eat, has diarrhoea and blood in her urine.

Through an endoscopy, Dr Ramesh the G.I. surgeon, found that her stomach had swollen as the tumour had grown bigger and he couldn't operate. He then tried to insert a stent (cost RM2,800) into her oesophagus but it was blocked. The patient told me that it was so painful that she screamed out loudly. Next, Dr Ramesh did a duodenotomy by opening a hole into her small intestines and inserted a tube for external feeding - that is only for fluids like water, milk and blended food to be poured into the tube.

Now she is so thin and frail + gaunt-looking. It is very sad to see her like this and she regretted that it was too late for any hope of surgery to be done to save her. She had spent thousands of ringgit in buying health products from her direct-selling friends, went for countless healing sessions and even bought an infra-red bed to sleep on. It was her choice and it was a futile wish now to turn back the clock. It was very difficult for me to comfort her and offer her solace. We can both pray together and we hope that she can advise all her family members and friends with stomach-cancer to go for surgery as soon as possible. It is vital and urgent to cut out the cancerous part of the stomach immediately, as the cancer cells are very aggressive and can spread fast to the other organs if surgery is delayed.

Still Dr Ramesh is trying his best. Tomorrow (27/5/09) the patient will undergo a cystoscopy to check her gall-bladder + urinary bladder as she still bleeds in her urine.
We can only pray and hope for the best. One of our support group member will try to help the patient get SOSCO + MAKNA bursary aid . Dr Ramesh will also arrange for her to get palliative care and chemotherapy.

Last month, April 2009, Ms Goh and I saw the patient from Mersing in HTJ S.eremban. He had problem in swallowing and could not eat much. Dr Ramesh did an endoscopy examination and successfully widen his stent inside his oesophagus. We were afraid that the stent has "collapsed" as it had been 6 months old. Now we were relieved when Dr Ramesh said that the stent could last another 3 or 4 months. Ms Goh tried to get help from MAKNA in supplying him some high protein Ensure milk for his nutrition. This June school-holidays, the Mersing patient will take his 2 children to meet his nephew and family in Muar, Johor, so that if anything should happen to him at least his 2 children will be cared for in future. He always has a cheerful disposition and he has a lovely smile when he shakes his head and said " Boh pien" ('No choice' in Hokkien dialect ) as he accepted his condition meekly.

The young doctor who had total gastrectomy last year, completed successfully all his chemo + radiation treatment last month. Now, he is helping to guide 2 new patients in their journey of chemo + radiotherapy treatment and advise through email another patient in Penang about post chemo-treatment. It is wonderful and big-hearted of him to help others.

It has been a year and 3 months since my operation last year. Time flies past and I am lucky to be given a clean bill of health. I had a CT Scan done recently and there is no recurrence - everything is normal. I thanked God daily and appreciate life more ! Comparing my illness with the other patients, I was very fortunate to have partial gastrectomy at 1st stage with none of my lymph nodes infected. Thus, I have no need to go for chemo and radiotherapy. I am very very lucky.

This is why it is so important to create awareness of this stomach-cancer. Any pain or uncomfortable ache in the abdomen that does not go away after medication but keeps coming on and off, it is best to seek an endoscopy and send the stomach tissues for biopsy. If it's cancerous cells, surgery is the immediate option. The earlier the better.

I noticed from the patients'symptoms that if they suffer the abdomen pain or discomfort for less than 6 months, the stomach cancer is usually at 1st stage. But if the pain lasts for a year, most of the patients are 2nd to 3rd stage. This is how fast the cancer cells spread. So time is the essence! There are a few patients who had these pains for more than a year; because of work commitments and responsibilities they finally see a doctor when the pain becomes unbearable. By then the cancer cells had spread to the intestines and surrounding areas around the stomach, got ascites (fluid retention) or the tumour has grown swollen in the stomach and spread upwards into the oesophagus...........
Sometimes, it is inoperable or the patient has to go through radiotherapy or chemotherapy to shrink the tumour first before surgery and mostly it is total gastrectomy, that is whole stomach cut out followed by intensive chemo + radiotherapy course.

Stomach cancer has no respect for anyone; whether one is rich or poor, educated or not, old or young....... if it happens, it happened. Some of my patients ask why ? how?
All I can say is that it happened and is there and it must be taken out....surgery first. Life is more important - LIVE for your loved ones before it is too late !

We have patients from all walks of life :- business tycoon, diplomat, architect, doctor, professional retirees, supervisor, tractor/van drivers, factory operator, child-minder, housewives etc.......and as young as 20 year-old-plus to as old as an 82 year old man.
Most of them were refered to Dr Ramesh through their doctors, family members or friends, some through the media - newspapers / google search. As Dr Ramesh 's fame become known as one of the top GI surgeons in Malaysia, so do the number of patients increase. Although stomach cancer is not as well-known and popular as breast or colon cancer, we hope to create more awareness.

Usually, Dr Ramesh the surgeon, will let me know when a new patient is to be operated. Doctor will give the patient my phone number and he/she will phone me or I will call the patient and ask him or her to visit me. I will then give the patient some notes on stomach-cancer plus notes on what to do during and after his hospital stay that is before and after his surgery. I will visit the patient during his stay at the hospital until his discharge.
Next, I will follow up by phone counselling on his diet and convalescing at home.

If the patient needs to go through chemotherapy and radiotherapy, I will inform other members cancer-survivors who had underwent this treatment to guide and advise the new patient. It is very important to see the patient go through the surgery and recover it well. Encouragement and positive mental outlook are essential.

Fortunately, mostly or nearly all the patients referred by the surgeon to me so far went through the surgery successfully and recovered except for one or 2 who were too advanced in their stages of cancer to do anything. The surgeon normally arranged them to go for palliative chemo treatment.

The main purpose of our group support is to create awareness and hope for the patients and their caregivers.

The most important message for those diagnosed with stomach-cancer is :

1. Do NOT wait and waste time. Get surgery done immediately.
Remember the cancer cells are aggressive + spread fast.

2. Don't be treated by non-medical personnels but rely on qualified medical professionals.

3. BELIEVE in your doctor + surgeon as they are professional and experienced in their fields. Trust them.

4. Early treatment is crucial and important.


Monday, February 16, 2009


I felt very sad and helpless when some of our patients and their loved ones faced the side-effects of their chemotherapy and radiation course. While undergoing chemo + radiation treatment, the patients experience terrible depression, have extreme mood swings, are often bad-tempered and angry, become 'crazy' and forgetful, erratic feelings and behavior that seems abnormal to their loved ones and caregivers.

It is at these times that our group members counsel their loved ones to have lots of patience and tolerance and sometimes to walk away to avoid arguments and quarrels or to leave the patients alone for a while.

This will go on not for a few days or a few weeks but months and months of the chemo +radiation treatment course. Just when the patients feel well, sane and recovered, the cycle of these terrible roller-coaster feelings will start again with the next treatment.

Usually there are 2 sets or phases of 30 times chemo+radiation treatment (total 60 times)
One set or phase of 30 times means 6 months x 5 times treatment . e.g. In every month there is a full cycle of 5 days non-stop chemo+radiation therapy treatment course followed by a rest of 21 days ( 3 weeks). Then in the next month, the cycle starts all over again.

If I phone the patients during their treatment days, I could sense their anger and frustrations in their talk. Some even cut short abruptly or hang up their calls. It is at these moments that I worried and prayed for them and their loved ones + caregivers. But during their rest days of in-between periods of treatment, the patients sound normal + their usual self.

There is one patient (43 years old) from Kajang. He went for 3 times chemotherapy in KL before his operation. This is to shrink the size of the tumour. His wife told me that during those 3 days of chemo, his temper was awful. She just walked away to the garden.
Now he is recovering well in HTJS (Hospital Tuanku Jafaar Seremban). He had partial of his stomach (60%) + oesophagus cut off and the remaining part of his stomach ( about 1/3 left ) + oesophagus joined together and placed up into his chest cavity ( Ivor Lewis Oesophagogastrectomy operation) .

I admired his strong fortitude and positive mental outlook. On every visit he had a cheerful smile. Once he told Iris, my daughter, that he is blessed and lucky to have Dr Ramesh and survived the operation when compare to the fate of those victims trapped in the China earthquake incident.

He even helped to give encouragement to a new patient ( an 80 year old man from Kuala Pilah)
I brought this old gentleman (before his operation) to this Kajang man as they were in the same ward in HTJS, for him to learn how to use the spirometer ( a gadget with 3 balls to suck up and exercise the lungs after the operation)

Today, this old man is recovering well from his subtotal gastrectomy operation ( Bilroth 2 with 70% of his stomach cut off and remainder 1/4 stomach joined to the intestines ) + his bed is opposite the Kajang man. It is good and nice to see these 2 gentlemen recovering well and I thanked God and ask Him to Bless them always.

Some people asked me why should an 80-year-old man had to undergo a major operation. I believed and trust my surgeon, Dr Ramesh. He has his reasons and I know that he is a very careful surgeon. He will make sure that his patient is fit enough to be operated on and usually warded the patient a few days earlier in HTJS to go through some necessary tests. When everything is well, then the patient will be operated. Life is precious and worth saving ! If a patient can't eat well and is in pain all the time, how can he live without eating + drinking ?

Last month Ms Goh and I met the Mersing patient from Johor in HTJS. He is the patient with the sponsored stent in his oesophagus. He looked well and cheerful and was happy to see us. He told us he could eat well. We asked him about his children's welfare and his eyes shone when he narrated about their mischievousness and children's play. Ms Goh has an anonymous benefactor from KL who is ready to take care of the children's welfare and needs when the time comes. He understood and will look into it. He has some relatives but they stay far away in Muar and has lost contact...not really close with them. His ex-employer's family is now looking after them, sending the children to school in the mornings and cooking meals for them. At least now, the Mersing patient has some MAKNA Bursary assistance ....monthly income of RM200 for a year. Ms Goh's friend from KL also gave him a big "ang-pow" to celebrate the Chinese New Year (CNY) festival with his children. There are many 'guardian angels' still around. God is great !

The young doctor and architect are now tolerating their second phase of chemo + radiation treatment. Other stomach-cancer survivors are doing well. Positive attitude, hope and good nutrition are important to beat this cancer.

When I started to help the surgeon Dr Ramesh in March last year (2008), my first patient who refused to be operated and was given a few months to live, is still alive . During my recent phone call on CNY this year, she sounded strong and cheerful and could eat well. I was very happy to hear her but she still refused to meet me. I prayed that one day we will meet.

A few patients passed away. When their cancer cells has spread to other parts of the body, when they have problem eating and keep losing weight, when they lose hope and are unhappy.......
My surgeon tried his best to save them, but when the spread is too advanced , only palliative care and pain-killer drugs or radiation are given.Through the Hospice and Unit Palliative, we try to give as much comfort and care to the patients and their caregivers. Faith and prayers can give them hope or acceptance/ deliverance from their pain.

We always try to advise patients not to give up hope, think positive, eat well and maintain their weight especially after surgery. Do light stretching exercises, go for walks, make short attainable goals, contact friends and family, get new hobbies to avoid boredom and enjoy living.

We as stomach-cancer survivors can "train" whatever remaining portion of our stomachs or intestines (those who had total gastrectomy Roux-en-Y operation= that is whole stomach cut off) to expand in time. At first we eat little amounts but often as many as 6 to 7 times a day. Others may remark that we are greedy as we eat non-stop but in time we can put on weight like some members in our support group. Only we must eat wisely and healthily, more protein food and fresh fruits + vegetables and drink high-protein milk.