Saturday, May 22, 2010

Back To The Beginning

This background is for those of you who, through my accidental omission, did not receive our earlier news:

Your many well wishes, emails and telephone calls have lifted Lin's spirits and speeded up his recovery, without taking any credit away from the doctors and the staff at the Baptist Hospital.

We could not have been more pleased with our decision to eschew the much fancier and upmarket HK Sanatorium for the Baptist Hospital even though the Baptist is over the water in Kowloon (hence more convenient for the golf club than our home on the island). The building that Lin was in is new and is superbly maintained and the staff have been outstanding.

They are professional and friendly, very, very helpful and all tried their best to converse with Lin in English. It is evident they care for their patients and this is hard to find anywhere in the world.

It is a far cry from Mt Elizabeth (Singapore) where my mother spent her last days in her bout with lung cancer and where my brother had his vertebrae repaired after he had slipped and fallen outside the SICC gym complex

Some of you may know some of the background, but perhaps as I have the time and opportunity while waiting for the green light to go home I could clue in the rest of you from on the beginning of the saga.

Many years ago doctors in Singapore kept draining his sinuses for his sniffles and it was not until Bill Simmons sent Lin to Melbourne that Lin met Sir John Williams of the Melbourne Herald. Sir John arranged for Lin to consult with a few doctors and kindly accompanied Lin to his appointments. The first doctor was immaculately dressed and expressed full confidence he could handle the growth behind and below Lin's left eye although he had never performed such a procedure. Sir John was not impressed by this elegant fellow's brimming confidence, and they consulted two more physicians.

The third said he had come across this before and knew what to do, but he had never done that procedure. Thus it was decided that Lin would head to the Royal Marsden in London where he was fortunate enough to come under the care of an extraordinary surgeon called H.J. Shaw.

They agreed on the treatment; at that time both radiation and chemo therapy were rudimentary at best and so it was decided to cut out anything remotely cancerous and a margin of surrounding bone and tissue - and hope for the best.

Thanks to Mr Shaw's extensive surgery, the cancer was excised and did not return. He also managed to save Lin's left eye.

Then in 1999 Lin underwent brachytherapy (seeding of radioactive rice grain size particles into his prostate) at MD Anderson. By that time the Americans had overtaken the British in cancer treatment, partly by opening their coffers to British talent to entice them to American universities and hospitals.

Lin's health was uneventful for a while - until 2007 when his primary care doctor suggested another colonoscopy. For whatever reason,  he ended up with a shorter exploration, a sigmoidoscopy - which proved to be clear in that portion of the colon.

In March/April 2010 he did not feel well and had a colonoscopy on April 21, which lead to the discovery of a growth in his colon. He went to see a surgeon the very next day and was warded into the Baptist Hospital Kowloon two days later.

Pre op xrays showed that a few 'seeds' from the brachytherapy had migrated upwards via the venous system and lodged themselves elsewhere in his thoracic cavity. Fortunately nothing serious.

We just have to remember to inform the radiologists should Lin ever need an MRI.

But to return to the matter at hand:

He had laparoscopic surgery on April 27 and today, May 4 we have the clearance from the surgeon to go home. Perhaps I have a bit of the Stockholm Syndrome but I am a tiny bit sad to leave mainly because everyone we met from the cleaners to the nurses and doctors were so good to us.

Our days here were marked by visits to check his temperature and BP, to check on his IVs and collection bags. And pain injections every now and again. Sidebar events came in the form of worry about congestion in his chest from lying down and crepitus (gas beneath the skin). Then in the last few days the priorities were to get him to pass loud gas, to pee without his catheter and finally to do the 'big job'.

The best thing that happened was discovering by chance that my cousin from Los Angeles was arriving for a vacation and being able to contact her (Carolyn is a radiation oncologist and very knowledgeable and communicative in the manner of US-trained physicians).Her friend, Roger is an anaesthesiologist.

They both came last evening and we all gathered for a useful and highly informative chat with our surgeon, and they were here again this morning to listen to a medical oncologist and his recommendations.

Before our surgeon came up, Carolyn quizzed Lin on his medical history. He'd almost forgotten that as a young boy he had been treated for mastoids; we are not certain if in those days they also treated him with something that sounded to me like "kilerwatt" (a primitive form of cobalt or other beam). If so, Carolyn feels that could well have caused his maxillofacial cancer in his 30's/early 40's as such cancers happen between 10 and 20 years after exposure to radiation.

When we went on to relate his experience with brachytherapy for prostate cancer at MD Anderson, in 1999, and I remarked that the pre op xrays showed the migration of a few of the radioactive seeds she was like a bloodhound on the scent and wanted to know just where these seeds ended up. As it happens one was lodged near the splenic flexure; now whether it caused this cancer is moot, but there is a possibility.

The lesson to be learnt is to be very careful about radiation which one cannot see and feel; that's why in the USA they do not as a rule do mammograms on young women. And some doctors do not like their patients to have mammograms too often.

Carolyn had discovered when checking patients' backgrounds that those of a certain age group had said they did not have radiation therapy, but on further questioning mentioned they had undergone "light therapy" for acne, apparently quite a common practice in those days. Well, that "light therapy was a form of radiation and while it eradicated the acne, there was payback some 10-20 years afterwards. So do be careful what beams are directed at you!

You will by now have started to wonder: where do we go from here.

Well, having seen one oncologist we will be seeing another for a second opinion and then will have to decide what to do if anything - based on the data and options available and how Lin wants to live for the next several months and years.

Here's wishing you all the best of health!

Anne and Lin

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