Monday, June 28, 2010

Chemo Postponed A Week - Good or Bad News?

Lin had a blood draw this morning and then we returned for our 2:00pm with the oncologist. We were greeted by Edna (Prof Wong's nurse clinician) at the entrance to the Cancer Center who told us that his white blood cell count was still low and the day's chemotherapy session would be postponed.

So we talked to the oncologist and reviewed the past two weeks and his reaction to the chemotherapy thus far. When we got to the topic of the maybe gout, Dr Chin put in for a test for his uric acid levels. And we left her with omeprazole (Prilosec) and Ibuprofen which is to be taken as needed - instead of the Voltaren.

Voltaren (diclofenac) can be rough on the stomach and cause internal bleeding, so they were taking no risks. I knew this because years and years ago a friend was on Voltaren and was cautioned never to take it on an empty stomach. So although Lin had been taking Voltaren, he was not allowed to do so before having some food.

His hands (apart from the maybe gout) are in good shape and they are now the poster boys for intensive hand care!

So where does this leave us?

A date for a blood draw on Monday, July 5 and then a date with Prof. Wong who will be back in the saddle. Maybe he'll refine the dosage so that Lin's WGB can return to normal within two weeks? Or he might suggest something else.

In the meantime our boy has lost weight (he swears they do not know how to take his weight measurements!) and so the week's mission is to build him up.

Saturday, June 26, 2010

Time Flies!

A few days of 'enforced' rest and  time has whirled by! The rest and medicines seem to have done the trick and I am almost back to my usual self.

Of course, nothing stays quiet for long so I started hearing gasps from Lin on Thursday, June 24. Alarmed I ask him what might be the trouble and he complains about the little finger of his right hand. I can hardly see it as he holds it curled up in his left palm, so assume it's just his old pal "Arthur Itis" paying a little visit.

I pay it and him no heed as by now we have a fresh new recruit to our household from the Philippines and I am busy settling her. So it wasn't until last night (Friday) when we arrived for dinner at a friends' home and he consulted our host that the word 'gout' came up.

Anyway, in lieu of a medically qualified doctor and no doubt to the horror of Lin's when he finds out, he comes away from dinner with some of our host's Voltaren pills. I happen to have some Voltaren cream at home and so that went on externally. Voltaren pill and cream to thwart the perceived 'gout' from both inside and out!

Talk about sometimes wrong but never in doubt, that just about describes this little episode!

Today, Saturday, he professes it hurts less although I can see there is some redness and swelling towards the base of the finger and at the back of his palm. But as it is not life threatening I've let him move furniture around so that he can find a spot to watch TV and not catch his death of a cold.

So we now wait until Monday for the blood work to see if it is all systems go for his second chemotherapy session in the afternoon. As his oncologist is on holiday Lin is down to see a lady oncologist; I hope she also knows something about inflamed little fingers.

We cannot figure it out as it's not an injury. And it doesn't seem like an insect sting. Gout sort of fits the bill as it erupts without warning - but then he's never had gout before. Could it be some side effect that has suddenly manifested itself?

Watch this space.

Wednesday, June 23, 2010

A Short Hiatus

Gosh, almost a week has gone by and I have not updated this blog. No, we did not get swept away by the floods or subsequent rain storms!

First I was trying to take Lin's mind off the side effects and then I fell victim to the dreaded Singapore flu. I am posting this short message to say we are alive and kicking and, all being well, Lin will be having his next chemotherapy session on Monday, June 28.

We are not sure if it was a combination of the chemo drugs and the anti-nausea medication but he improved after he stopped taking the pills (which I had read cause - among other things - diarrhea and depression).

A bit of trivia, here's the 'shopping' list of the side effects of metoclopramide (some would not apply to him!):

Metoclopramide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
  • drowsiness
  • excessive tiredness
  • weakness
  • headache
  • dizziness
  • diarrhea
  • nausea
  • vomiting
  • breast enlargement or discharge
  • missed menstrual period
  • decreased sexual ability
  • frequent urination
  • inability to control urination
Some side effects can be serious. If you experience any of the following symptoms, or those mentioned in the IMPORTANT WARNING section, call your doctor immediately:
  • tightening of the muscles, especially in the jaw or neck
  • speech problems
  • depression
  • thinking about harming or killing yourself
  • fever
  • muscle stiffness
  • confusion
  • fast, slow, or irregular heartbeat
  • sweating
  • restlessness
  • nervousness or jitteriness
  • agitation
  • difficulty falling asleep or staying asleep
  • pacing
  • foot tapping
  • slow or stiff movements
  • blank facial expression
  • uncontrollable shaking of a part of the body
  • difficulty keeping your balance
  • rash
  • hives
  • swelling of the eyes, face, lips, tongue, mouth, throat, arms, hands, feet, ankles, or lower legs
  • sudden weight gain
  • difficulty breathing or swallowing
  • high-pitched sounds while breathing
  • vision problems
Maybe they will try him on another anti-nausea medication next time around. But that too will have its own set of quirks.

Anyway the good news is that he has perked up; just in time to look forward to a new session!

As for me, I am isolating myself in his study until I can shake this tenacious bug which has blocked my nose, caused a headache and a sore throat.

Keep healthy you all.

Friday, June 18, 2010

First Reactions and A Flood

Fortunately the nastiest thing about the first few nights was the intermittent buzzing and presence of "the Pump". Lin had found that the most comfortable thing to do was to place it on the bed somewhere between his shoulders and mine. So every time it did it's work and pumped the cocktail into his system it would emit a short buzz.

After the first night I had become used to the noise, but he was always conscious of the line to his portacath and so did not rest well. Being so skinny and devoid of muscle and fat, he said it would be too uncomfortable to sleep with it strapped against his body - imagine trying to sleep with the weight of a brick on your torso (maybe the next generation will feature lighter but more expensive batteries).

Monday night and Tuesday were good; hardly any ill effects. A nagging headache (mild) and chills. I resorted to turning off the air conditioning at night and heating his side of the bed with hot water bottles.

Wednesday and Thursday were not good; he could not explain it but I sensed a feeling of despair, desperation and despondency. I am only guessing but maybe he was thinking, "is this what I can expect each session for the next six or more months? Can I put up with it? Is it going to be worthwhile?"

He would not not eat, so I've tried him on Ensure, Fortisip and then Resource Plus. I had a tiny sip of each and they all were pretty much the same to me, like a sweet-ish malted drink. I could live on any one of these if I had no time to enjoy a decent meal! He had the occasional banana (soft food for his sore mouth - sore more because of his obturator than an eruption of mucositis).

Even the barley water I cooked up was no longer acceptable. "Yukk", he said, so I have been the beneficiary of barley's goodness!

He'e faithfully been taking his metoclopramide (helps with the nausea) , his iron pills (he's been anaemic since the cancer popped up), vitamin D3 and calcium (the ONLY 2 supplements allowed by Prof. Wong).

Touch wood, no fever.

He's spent most of the time in bed which is unusual for a person who likes to be up and about and never takes a nap in the afternoons (I am the total opposite, I'll lie down when I can sit!).

In the meantime, I have been to Takashimaya to check out the showroom display of Hitachi's 12 kg version of our new washing machine and chatting to Ann about the foggy, scratched panel on our machine. I told her that the control panel came with a plastic shield, but not the see through pane.

She immediately got on the phone to someone and assured me that when they receive a new shipment they will change out the door assembly for us.

Pretty amazing service and assuredly NOT the usual run of the mill Best Denki sales representative! If ever in the market for a washing machine go and see Ann at Best Denki at Ngee Ann city; she has me for life!

By comparison, Hitachi sent FIVE men (one a qualified Hitachi technician) to rectify their installation. As this happened on Wednesday afternoon when Lin was having "The Pump" removed (hooray!), I was not at home and only communicated with the technician by phone.

Despite my repeated comments about the see through pane not being see through, he steadfastly maintained that it was a dark colour and hence looked like it did. I held fast and kept saying that I have seen dark colored plastic panels before and they did not look like they had fine scratches on them (imagine the 'satin' effect that you find on stainless steel but on plastic instead). We ended our conversations at an impasse - until Ann intervened yesterday.

Wednesday also marked the BIG FLOOD on Orchard and Scotts roads in Singapore; quite unheard of because our drainage systems have been improved over the years. But then more buildings have gone up and even more are in a state of construction.

I did wonder, when it started to thunder and pour down, if Bukit Timah and Thomson Road were flooding, not imagining that Orchard and Scotts would be inundated. I could not see the flood waters for the intervening buildings, but I could see a solid traffic jam along Orchard Road in front of Wheelock Place and Far East Shopping Centre.

Someone sent me an email with the picture I am using here - thanks to the anonymous photographer! This is the famous Orchard Road and Scotts Road junction with the new ION shopping development in the background.

Good thing that our appointment at NUH was in the opposite direction and at 3:30pm, which gave time for the floods to subside.

As soon as we arrived at NUH, I left Lin to check in and headed straight for the Nasi Padang stall - I was famished as I had kept him company during his chemo side effect-induced fast. There wasn't much to choose from as it was between lunch and dinner sessions, so I had rice, lontong gravy with a bit of veg, a piece of tempe, Chinese spinach and bean sprouts. I spotted a veggie fritter and ordered one. And asked for lots of belacan (hot chilis pounded with shrimp paste). No trouble wolfing it all down!

When I had enjoyed my repast, Lin was waiting for a vacant chair. It turned out to be the same one he had when "The Pump" went on. Taking it off was much simpler and quicker.

Speaking as the "care-giver" (a misnomer in my case) I think that every one experiences different reactions to the chemo and each day that passes adds to the learning experience. 

No wonder the oncologists and clinicians could not say with conviction what one could expect; they just had to recite the 'shopping list' of side effects. There's no second guessing each patient's reactions and the severity of the side effects.

In Lin's case, I hope that between now and his second session on June 28, that it is a steady upward trend rather than than peaks and troughs.

One thing I am pretty sure about is that chemotherapy certainly kills the good and the bad - and it is not restricted to one's cells.

I am convinced that it tries to kill one's spirit and will, as if in itself it is a test of one's resolve and determination to vanquish the beast of cancer.

And while it is early days yet, it seems evident to me that the place to treat cancer is in a public, teaching institution unless you have a bottomless bank account or a health insurance policy to die for (unfortunate pun!) for all the investigations, incidental medication and diagnostics - never mind the oncologist's fees and hospital and/or clinic charges.

Moreover, that's only the tip of the iceberg and only from the financial perspective. In my opinionated opinion, a holistic approach and a team are essential. Sure it can be done in other ways, but then the burden is so much heavier on the patient and the care-giver.

You are in your own hands and the hands of one man or woman. You don't have access to a cancer panel, neither does your oncologist. But then it doesn't matter as long as you are 100% confident in him or her.

Wednesday, June 16, 2010

For The Very First Time - "The PUMP"!

The first thing that happened after we arrived for our appointment was that we were packed off in search of some food! We were told that as the chemo session was going to start at 1245 and would take about five hours; we should put some food in our tummies.

Kopitiam, Singapore's ubiquitous "coffee shop experience", has a lock on many institutions as it facilitates the feeding of the hungry crowds. However, for the consumer, it has made hawker food much less tasty and if I could eat elsewhere, I would.

I sampled a bowl of fishball tanghoon (fish balls in a soup base with transparent mung bean noodles); so much soup was ladled out it that it overflowed onto the tray. Very clear, very bland. So Lin and I shared a poh piah (fresh spring roll) - somewhat more taste. His main dish, if one can call it that, was a small quiche from Delifrance (not very good he said).

That being done we sauntered back to the Cancer Center just in time to be ushered to his little cubicle where I also had a chair.

We were entertained to a short introductory video (chemotherapy 101) which covered all the bits and pieces we had heard, seen and read about in the past few weeks.

After that a cute Chinese nurse (from Hunan province, here for two years) explained what she was going to do, warned us of pitfalls such as falling, what could happen after chemotherapy and where we should call or go if certain conditions manifested themselves. This included avoiding crowds, gargling with salt water, avoiding certain foods, being careful with cold drinks and foods, being careful with very hot drinks and foods and avoiding supplements.

As we knew all this before I had no problems following her explanation which was well executed except for her accent (Lin had difficulties with it). In talking to her I discovered she had been sent to Hong Kong for training so she is a bright and able young person; she just needs more practice in speaking, no matter whether English or Singlish.

NUH has a veritable United Nations of employees and should have classes and or tapes for them to improve their spoken English. This is not a complaint but an observation. Those from certain areas of the PRC generally roll their R's and this makes it difficult to understand what they say.

Anyway, it was quite an experience watching her work. She removed the dressing protecting the portacath and told Lin that his incisions were healing very nicely and she seemed genuinely pleased. Then she inserted what looked like a big, barbless fish hook into the portacath.

This was followed by some flushing of tubes (cannulas?) and so on. It was quite confusing as she prepared medications for various things and it seemed like a lot was going on. One of the early liquids was dexmethasone and perhaps other stuff as I could not catch the names.

In oncology, it is given to cancer patients undergoing chemotherapy, to counteract certain side-effects of their antitumor treatment. Dexamethasone can augment the antiemetic effect of 5-HT3 receptor antagonists like ondansetron

Finally what we had come for, Oxaliplatin and Leucovorin.

At each step of the way she or someone else would ask Lin for his identity card number; at least it started that way but was modified to his birthday as that was easier for him. Before an important drug, two nurses would check the details - one reading to the other.

Once the main cocktail was being given, I took off for a break at Ikea and returned in time for the last few minutes and subsequent attachment of "The Pump". 

But not before the pharmacist's talk about the pump, side effects, what to do and what not to do. A similar talk ensued with our little nurse although a few details were sightly different. Both were essentially the same but to my mind one was a mandatory standard procedure while the other was the Cancer Center's spiel, based on experience and what in fact works. They were equally well presented by the charming staff who were patient with answering questions and having to repeat what they said.

"The Pump" was started up and observed for half an hour to make sure it was working properly before we were allowed to head home.

After we had returned to deal with the Hitachi washing machine horror story, I had Lin take one of the medications we had been dispensed a few days earlier. This is metoclopramide hcl. I had been told it was better to start him on it than to wait for him to feel nauseous.

We went to bed with "The Pump" between us and because I'd had a few glasses of red wine (Lin was teetotal) it was not until the early hours of the morning that I thought my iPhone was behaving strangely, buzzing me every so often.

It turned out to be "The Pump"; I suppose if Lin had strapped it to his torso, it would have been muffled. Anyway, no one mentioned it so we will find out later today when we go to have "The Pump" detached.

Thus far, apart from feeling cold, especially in his extremities, a headache and fatigue he has not complained of any other side effects.

It's NOT All About The Medicine - Trials with Hitachi

Most of our followers have sent messages of encouragement to me, although I am not the one undergoing chemotherapy. I understand and appreciate where you are coming from and what you mean, but so far my English patient has been treated kindly by the chemo (it is early days yet) and has been cooperative.

My trials and tribulations are with businesses and organisations in my home town, Singapore.

The latest of which has been replacing our 'dead' washing machine; it expired on Friday night. Try buying a washing machine and getting it delivered ASAP in Singapore (probably more quickly here than the USA but I think I might get it quicker in HK than the average big-gish box store in Singapore).

My usual source of home appliances, Rina Electrical (Mrs Lim and staff),  could deliver a machine and get it working by Saturday afternoon. However, since I have used Maytags in Florida and HK, I have gone off Maytags in general.

Friends had suggested the new Hitachi 16 kg washer and so I did my research on Friday night and started calling on Saturday morning. Rina opens at 9am but others do not answer their phones before 10am or 11am.

Hitachi's web site listed Audio House, Best Denki and Harvey Norman among others. So I called them all (I called 2 branches of Audio House and 2 of Best Denki; the Harvey Norman Suntec femalel sales rep. was so awful on the phone I did not want to try another branch) to check the price (same price throughout, some have promotional give aways) and delivery. Long story short, Best Denki at Ngee Ann City came out tops thanks to sales rep. Ann (must be something to do with the name, but I also have encountered Anns and Annes I don't want to know).

They could deliver on Monday afternoon, but as with the others I had to go and purchase the machine. Good thing because in the course of our conversation I had to get an adapter for our tap (faucet in American) and had to think about drainage (NOTE for those of you about to buy a new washing machine - Japanese and Korean machines in Asia need floor traps or drain outlets. American machines will drain into a sink height outlet).

On Monday we were going to be at NUH for Lin's first chemo. session so our housekeeper stood in for me and did a great job despite the obstacles thrown her way by Hitachi's delivery 'cowhands'.

Read about it here (too long otherwise):
It's a blog run by a friend and which has been lauded in the TODAY newspaper in Singapore. Anyone with a bouquet or a grouse with service should email him at:

Suffice to say, it is Wednesday and when I called the Hitachi Service number around 5pm yesterday (after the hose connection had erupted and drenched me and our utility area), the soonest a technician could come round was this afternoon.

Once again I will not be here but I was assured a QUALIFIED person would be coming. Hope Hitachi gets it right this time.

Tuesday, June 15, 2010

We're On Our Way!

Am feeling a bit weary but must post this little bit of news - which has been highly anticipated! It took time (11:15am to 5:45p) , but Lin started his first cycle (out of twelve) yesterday. As I write, he is sleeping with his sidekick, a small pump which releases a 'cocktail' of 5FU and Folinic Acid (Leucovorin) into his bloodstream for a total of 46 hours.

So far so good, but I won't know until he wakes up. In the meantime I am off to the market to do a bit of grocery shopping and to catch up (over coffee and sweet bean curd) with some friends who are doing their Tuesday morning walk before going to the market.

At least I have an excuse for not walking with them today. But even before this,  I already had run out of excuses for not turning up to suffer physically and mentally. They just won't appreciate that exercise is against my religion!

Sunday, June 13, 2010

A Must Do In The USA!

Nope, not an eating place or even a watering hole. But if you are 60 and above (especially if you have had chickenpox) I strongly recommend you spend about USD$200 and get yourself a Zostavax jab.

I am excerpting bits from a New York Times article for info (the rest deals with why more Americans are not getting vaccinated - basically the reason is money from insurance, etc):

(read about Zostavax here:

Why Patients Aren’t Getting the Shingles Vaccine

Four years ago at age 78, R., a retired professional known as much for her small-town Minnesotan resilience as her commitment to public service, developed a fleeting rash over her left chest. The rash, which turned out to be shingles, or herpes zoster, was hardly noticeable.
But the complications were unforgettable.
For close to a year afterward, R. wrestled with the searing and relentless pain in the area where the rash had been. “It was ghastly, the worst possible pain anyone could have,” R. said recently, recalling the sleepless nights and fruitless search for relief. “I’ve had babies and that hurts a lot, but at least it goes away. This pain never let up. I felt like I was losing my mind for just a few minutes of peace.”
Shingles and its painful complication, called postherpetic neuralgia, result from reactivation of the chicken pox virus, which remains in the body after a childhood bout and is usually dormant in the adult. Up to a third of all adults who have had chicken pox will eventually develop one or both of these conditions, becoming debilitated for anywhere from a week to several years. That percentage translates into about one million Americans affected each year, with older adults, whose immune systems are less robust, being most vulnerable. Once the rash and its uncomfortable sequel appear, treatment options are limited at best and carry their own set of complications.
While the search for relief costs Americans over $500 million each year, the worst news until recently has been that shingles could happen to any one of us. There were no preventive measures available.
But in 2006, the Food and Drug Administration approved a new vaccine against shingles. Clinical trials on the vaccine revealed that it could, with relatively few side effects, reduce the risk of developing shingles by more than half and the risk of post-herpetic neuralgia by over two-thirds. In 2008, a national panel of experts on immunizations at the Centers for Disease Control and Prevention went on to recommend the vaccine to all adults age 60 and older.
At the time, the shingles vaccine seemed to embody the best of medicine, both old school and new. Its advent was contemporary medicine’s elegant response to a once intractable, age-old problem. It didn’t necessarily put an end to the spread of disease, in this case chicken pox; but it dramatically reduced the burden of illness for the affected individual. And, most notably, its utter simplicity was a metaphoric shot-in-the-arm for old-fashioned doctoring values. Among the increasingly complex and convoluted suggestions for health care reform that were brewing at that moment, here was a powerful intervention that relied on only three things: a needle, a syringe and a patient-doctor relationship rooted in promoting wellness.
In the two years since the vaccine became available, fewer than 10 percent of all eligible patients have received it. Despite the best intentions of patients and doctors (and no shortage of needles and syringes), the shingles vaccine has failed to take hold, in large part because of the most modern of obstacles. What should have been a widely successful and simple wellness intervention between doctors and their patients became a 21st century Rube Goldberg-esque nightmare.
Last month in The Annals of Internal Medicine, researchers from the University of Colorado in Denver and the C.D.C. surveyed almost 600 primary care physicians and found that fewer than half strongly recommended the shingles vaccine. Doctors were not worried about safety — a report in the same issue of the journal confirmed that the vaccine has few side effects; rather, they were concerned about patient cost.

Friday, June 11, 2010

Steady as we go!

Waking up early is no longer my preferred cup of tea. It was different when I was riding horses, but then I used to fall asleep at the dinner table in those days!

Now I only wake up early for golf games and sometimes to catch a plane.

Fortunately, once I wake up I am alert and good to go, I do not need to take time to 'warm up' as Lin does (no matter what time he awakens). I also have the gift of easily getting back into bed and resuming my slumber.

This morning it was vital to wake up and to wake Lin up too. Not only that, I had to make sure he got to NUH in time to get a plug put in (not a line as I had thought).

The purpose of the plug is to enable a fast response to any call for an infusion of drugs during surgery - I learn AT LEAST one thing a day these days!

It took us about 15 minutes door-to-door and we arrived before the nurses in the chemotherapy centre; so we were escorted up to Level 4 for the plug and then down to the Day Surgery Admission and Ward on Level 2.

After the Admission formalities were taken care of and Lin was shown to his bed, I left him in the care of some attractive young nurses (origins: Singapore, Philippines, PRC). His procedure was scheduled to 10:30am but a backlog built up and the doctors did not receive him until 12:30pm.

A little after 2:30pm I received a call to say he had returned from the OT, so I made my way back to NUH. He was bright eyed and bushy tailed and champing at the bit to go home.

He had the portacath put in under local anaesthetic by a cosmopolitan team led by an Indian doctor. Another doctor was Chinese. The nurses were Filipinas. Everyone mumbled to themselves in their mother tongue but business was taken care of in English and everything went like clockwork. He was much impressed by the teamwork and the the way each person switched languages without a pause.

Anyway, no amount of cajoling could get the nurse in charge (originally from Shandong province and now - after more than ten years in Singapore - speaks like a Singaporean) to agree to release him before 5:00pm. We did slide out with al the nurses' blessings and well wishes a few minutes before 5!

At one point during our wait, a nurse came to check his blood pressure and I asked to have mine checked out too! As he'd been lazing around, his BP was a low 112/65; as he returned to normalcy it read 125/78 just before we left. Mine came out as 119/67 as I had been hanging around reading the newspaper.

Lin, who likes to sit up while reading, suggested we swop places so that I could catch 40 winks in his bed and he could sit up in the chair to read the newspaper. Tempting as it was, I did not dare in case this would get us both chucked out of the hospital!

As it happened, Prof. Wong's nurse clinician, Ednajoy, came at about 4:30pm to check on Lin and to tell us that his chemo session on Monday would be at 11:30am instead of 2:00pm. Good thing we did not sneak out early or exchange places.

I am not sure if he'll feel some pain tomorrow, but he's fine right now and is very happy that we eventually chose NUH and Singapore.

The good thing about the influx of immigrants and workers from all parts of the world is that English is our common language - sometimes not the King's English, but we understand each other. And what is more, I can read all the signs and posters and understand what they say!

Prof. Wong also had us check on whether Lin had a pneumonia vaccination within the last five years and this resulted in him receiving one while in the Day Surgery ward this afternoon.

Which brings me to comments on ibuprofen and paracetamol (a.k.a. acetaminophen) which were kindly contributed by friends and friends of friends.

A pithy one from a pal: "Panadol is bad for the liver that is already compromised. Hence never take it for a hangover headache, instant rot." Now you know what NOT to take the morning after!

A radiation oncologist chipped in with:

The chemotherapy drugs have to be eliminated from the body after they have done their work.  This is usually done by the liver and kidneys.  Any drug that can decrease the kidney function may allow the chemotherapy drug to stay longer in the body and cause more side effects. Some chemotherapy drugs, by themselves, can lessen kidney fucntion.  

Wow, I would never have known this, so am grateful for the input.

The bactroban will try to reduce the chances of getting a staph infection by controlling the staph bacteria that usually grow and live peacefully in the skin and nostrils of  humans.  When the immune strength of the person falls (in this case due to the chemotherapy effects on the normal white blood cells) the staph overgrows and causes blood infections that can be risky to the person undergoing chemotherapy. 

It certainly has helped our understanding as to why he has to apply Bactroban twice daily until Monday. Looks like the Prof. is covering all the bases here.

We are glad we are here and in good hands as we progress on this journey.


I found the following on a web site and thought of my pals who refuse to take any pills at all. If Ibuprofen lessens kidney functions and Panadol can damage your liver, best not to take any pain meds.

"Acetaminophen is converted into other chemicals by the liver, in the presence of liver enzymes and then eliminated from the body. Excessive acetaminophen ingestion, therefore, can result in liver damage or failure, especially when taken along with alcohol or drugs, that also contain acetaminophen or those that have an adverse effect on the liver. In such situations, even a lower than the maximum recommended dose can cause acetaminophen toxicity."

Thursday, June 10, 2010

Getting Ready.......

It has been 50 days since Lin's cancer was discovered. 44 days since his surgery and 17 days since we arrived in Singapore and met with Prof. John Wong at NUH.

In some ways it seems like years and in others it seems like no time at all.

Many of our friends think that Lin has been undergoing chemotherapy for part of this time, but we are only now getting ready.

At 8:15am tomorrow (Friday, June 11) we go to Cancer Center @ Level 3, NUH for Lin's IV line to be put in; then downstairs to the Day Surgery centre on Level 2 to have his Bard portacath 'installed'. With any luck we should be home that night.

Today, we met with Prof. John Wong to review what will be happening. He looked at Lin's list of medications and agrees with Vitamin D3 (800mg) and Calcium (700mg).

He noticed Ibuprofen on the list and recommended against it. Curious, we asked why and he explained that it lessens kidney function in older people. So we have learnt yet another new thing from him! He suggested using Panadol (paracetamol or in the USA, acetaminophen) instead for pain.

Thus far Lin's blood pressure, kidney and liver functions appear to be in good order and so chemotherapy will start on Monday, June 14 at 2:00pm.

Tonight he will take some antibiotics and use an antibiotic called Bactroban (mupirocin), which he has to apply just within his nostrils. It did not occur to us to ask why but we will tomorrow or a later date. (From what I have read about it, Bactroban works against most staph infections.)

He had a blood draw this afternoon which should provide the baseline for the treatment. More draws scheduled for June 28 and July 12. Glad it's not me!

OK, some of you want to know what chemotherapy cocktail he will be served. It's called FOLFOX6 which basically means 5FU, Leucovorin and Oxaliplatin, and Prof. Wong is starting him on the recommended dosage.

And that is the plan for now subject, as always, to change depending on how his body reacts and what happens.

In case you want further reading, I like this UK site which will tell you about FOLFOX:

Tuesday, June 8, 2010

Keep Those Synapses Snapping Too!

We should also look after our minds while we are treating our bodies, hence the Information on fruit and diet and now cognitive training. 

I am told that Lumosity is excellent; just have not had the time to try engage with it.

You might find this interesting:

High level of evidence for cognitive training

Posted on June 7, 2010
Young woman playing Word Bubbles
A recently published report funded by the National Institutes of Health (NIH) reviews the extensive literature on cognitive decline and Alzheimer’s disease in search of factors that might delay or prevent these age-related conditions. Of all the factors reviewed, including diet and dietary supplements, physical exercise, social engagement, and other leisure activities, only cognitive training was found to have a high level of evidence for being associated with a decreased risk of cognitive decline. So, if you want to engage in activities that are known to be associated with a reduced risk of cognitive decline, this report says that cognitive training is the only thing that currently fits the bill.
The nearly 800-page manuscript was prepared by the Duke Evidence-based Practice Center for the Agency of Healthcare Research and Quality (AHRQ), a part of the U.S. Department of Health and Human Services. This exhaustive report was created to support the NIH State-of-the-Science Conference “Preventing Alzheimer’s Disease and Cognitive Decline.” The conference brought together health experts with specific expertise in aging and age-related changes in cognition to discuss the current state of knowledge related to treatments for age-related cognitive decline and Alzheimer’s disease. The report takes a very conservative approach to its evaluation of risk factors and potential treatments for age-related problems of cognition. In fact, only cognitive training was found to have a high degree of evidence for reducing the risk of age-related cognitive decline. Hundreds of studies were reviewed, and while many studies offered evidence that was suggestive of reducing risks, most were correlational, rather than experimental, in nature. For instance, some studies showed a relationship between eating a “Mediterranean diet” and reduced risk of cognitive decline. But these studies typically just ask people about their diet and correlate these factors to cognitive performance. Conversely, there have been several randomized, controlled trials that have shown improved cognitive performance through cognitive training. This higher degree of rigor earned cognitive training the “high degree of evidence” designation in this report.
Of course, that’s not to say you shouldn’t take care of yourself in other ways. Other factors such as a diet high in vegetables and omega-3 fatty acids, physical activity, and some leisure activities were found to be associated with a decreased risk of cognitive decline, albeit with alow level of evidence. In other words, these things are likely good for your brain, but the authors did not feel there was enough evidence to say so definitively. Given that most of these lifestyle factors are good for you in other ways, there’s certainly no harm in eating better, getting more exercise, or spending more time with friends and family. If you want to see how your lifestyle may be affecting your brain health, take our Brain Grade test.
This report is just another reason to make cognitive training — like — a regular part of your brain health routine.

Monday, June 7, 2010

The Proper Way to Eat Fruit

I received a piece about Dr Stephen Mak's prescription for curing cancer and tried to check it out. Seems like it is accepted by those who have come across these passages.

Also, to me they make sense, so I am sharing this with you for more healthful eating.

Dr Stephen Mak, How To Eat Fruit (and why)

Dr Stephen Mak,
“As of late, my success rate in curing cancer is about 80%. Cancer patients shouldn’t die. The cure for cancer is already found. It is whether you believe it or not? I am sorry for the hundreds of cancer patients who die under the conventional treatments.. Very few can live for 5 years under the conventional treatments and most live for only about 2 to 3 years. The conventional treatments do not make any difference because most cancer patients also live for about 2 to 3 years without undergoing any treatment. It is difficult to cure those cancer patients who have undergone chemo and radiotherapy as their cells are toxic and weak. When there is a relapse, the cancer will spread very fast as the resistance is poor.”


We all think eating fruits means just buying fruits, cutting it and just popping it into our mouths. It’s not as easy as you think. It’s important to know how and when to eat.
What is the correct way of eating fruits?
If you eat fruit like that, it will play a major role to detoxify your system, supplying you with a great deal of energy for weight loss and other life activities.
FRUIT IS THE MOST IMPORTANT FOOD. Let’s say you eat two slices of bread and then a slice of fruit. The slice of fruit is ready to go straight through the stomach into the intestines, but it is prevented from doing so.
In the meantime the whole meal rots and ferments and turns to acid. The minute the fruit comes into contact with the food in the stomach and digestive juices, the entire mass of food begins to spoil….
So please eat your fruits on an empty stomach or before your meals! You have heard people complaining every time I eat watermelon I burp, when I eat durian my stomach bloats up, when I eat a banana I feel like running to the toilet, etc, Actually all this will not arise if you eat the fruit on an empty stomach. The fruit mixes with, putrefying other food and produces gas and hence you will bloat!
Graying hair, balding, nervous outburst, and dark circles under the eyes all these will not happen if you take fruits on an empty stomach.
There is no such thing as some fruits, like orange and lemon are acidic, because all fruits become alkaline in our body, according to Dr. Herbert Shelton who did research on this matter. If you have mastered the correct way of eating fruits, you have the Secret of beauty, longevity, health, energy, happiness and normal weight.
When you need to drink fruit juice – drink only fresh fruit juice, NOT from the cans. Don’t even drink juice that has been heated up. Don’t eat cooked fruits because you don’t get the nutrients at all. You only get to taste. Cooking destroys all the vitamins.
But eating a whole fruit is better than drinking the juice. If you should drink the juice, drink it mouthful by mouthful slowly, because you must let it mix with your saliva before swallowing it. You can go on a 3-day fruit fast to cleanse your body. Just eat fruits and drink fruit juice throughout the 3 days and you will be surprised when your friends tell you how radiant you look!
KIWI: Tiny but mighty. This is a good source of potassium, magnesium, vitamin E & fiber. Its vitamin C content is twice that of an orange.
APPLE: An apple a day keeps the doctor away? Although an apple has a low vitamin C content, it has antioxidants & flavonoids which enhances the activity of vitamin C thereby helping to lower the risks of colon cancer, heart attack & stroke.
STRAWBERRY: Protective Fruit. Strawberries have the highest total antioxidant power among major fruits & protect the body from cancer-causing, blood vessel-clogging free radicals.
ORANGE: Sweetest medicine. Taking 2-4 oranges a day may help keep colds away, lower cholesterol, prevent & dissolve kidney stones as well as lessens the risk of colon cancer.
WATERMELON: Coolest thirst quencher. Composed of 92% water, it is also packed with a giant dose of glutathione, which helps boost our immune system. They are also a key source of lycopene, the cancer fighting oxidant. Other nutrients found in watermelon are vitamin C & Potassium.
GUAVA & PAPAYA: Top awards for vitamin C. They are the clear winners for their high vitamin C content. Guava is also rich in fiber, which helps prevent constipation. Papaya is rich in carotene; this is good for your eyes.
Drinking Cold water after a meal = Cancer! Can u believe this?? For those who like to drink cold water, this article is applicable to you. It is nice to have a cup of cold drink after a meal. However, the cold water will solidify the oily stuff that you have just consumed. It will slow down the digestion. Once this ’sludge’ reacts with the acid, it will break down and be absorbed by the intestine faster than the solid food. It will line the intestine. Very soon, this will turn into fats and lead to cancer. It is best to drink hot soup or warm water after a meal.
A serious note about heart attacks. Women should know that not every heart attack symptom is going to be the left arm hurting. Be aware of intense pain in the jaw line. You may never have the first chest pain during the course of a heart attack. Nausea and intense sweating are also common symptoms. Sixty percent of people who have a heart attack while they are asleep do not wake up. Pain in the jaw can wake you from a sound sleep. Let’s be careful and be aware. The more we know the better chance we could survive.
A cardiologist says if everyone who gets this mail sends it to 10 people, you can be sure that we’ll save at least one life.

Sunday, June 6, 2010

A Little of This and A Little of That (Letting Off Steam)

The good news is that BOTH Jack Sprat and his wife are putting on weight; his wife as a consequence of eating to keep him company!

Seriously, folks, we have dined out most of last week thanks to friends who undertook to feed Lin up and thanks to friends who cooked delicious food and brought the dishes over. I will bet that "meals on wheels" had nothing on this.

We enjoy lots of helpings of fruit from the vast array available in Singapore, especially fruit that come from neighbouring countries - mangosteen, papaya, sweet mangoes, plump and juicy pomelos. And that's not all, just his favourites.

So, from the fruit point of view this is the right choice. Somehow these fruit and more exotic ones are plentiful in our grocery stores and markets and at a fraction of the price one would have to pay in Hong Kong. Wider choice, lower prices - hard to beat!

I was ruminating on some of the other similarities and differences between Singapore and Hong Kong.

We have traffic jams in both cities, usually at peak hours. But the jams in Singapore seem to be more evenly spread out - and they only get worse at peak hours. And it is not as if one does not pay to drive into the city; I wonder if it is only a matter of time before the ERP (electronic road pricing) gantries are all over the island, extracting money as soon as we drive out of our homes.

In Hong Kong it is possible to live without a car unless one's job or hobby necessitates trips to the New Territories. We often travel by taxis or the estate's shuttle bus - less hassle, no need to pay hefty parking fees. And when dining out there's no risk of a breathalyzer test.

We have tried public transport from the centre of our universe in Singapore, Orchard Road. Not so convenient.

MRT improves its spread but one still has a hot and sweaty walk or a transfer at the other end. Taxis play Hide and seek games to bump up the total bill. Buses are great for heading down Orchard Road, but otherwise one has to call the hotline to find out which combinations to catch. And there are no little green mini buses to fill in the gaps.

Drivers here in Singapore are ignorant (as if all the rules of the road were wiped from their memory cells as soon as they had passed their driving tests), "kiasu" (a Singapore word for 'afraid to lose out', hence they don't give way lest they lose one second or a place in the jam) and uncivilised (what can you say when they drive against directional arrows in car parks to steal spaces from those who drive the stipulated way round).

We seem to be short of policemen and policewomen on the streets - and short of them doing traffic duty so drivers park or stop with impunity. What a waste of the traffic signs and road markings!

We have the Land Transport Authority (LTA) which works in conjunction with the Traffic Police (so it seems from their web site).  The LTA erects the bus stops, taxi stands and road signs and paints lines on the kerbs and roads. The Traffic Police enforces the rules. Great in theory, but lousy in practice.

But from my observation of the traffic in our little acre, the LTA decides and executes from on high and then sits back, its job deemed done. Once done, the fact that a taxi stand could be enlarged or improved or re-sited doesn't enter their heads.

And there aren't enough traffic cops to mete out the sentences. Auxiliary police answer calls about illegal parking and then scoot in on their scooters or small motorbikes to write tickets.

Just the other day I suddenly noticed squads of motorbike mounted traffic cops, but they were only practising motorcade escort duty for the VIPS attending the IISS 2010 (International Institute of Strategic Studies). I guess that's why VIPS are so impressed by Singapore - the vista from motorcades is rather different than from, say, a Suzuki Swift.

Calf's liver would be a food source of iron but I have not seen any in Singapore; it could be (I have not asked) that we no longer allow the importation of animal carcasses so, for example the beef is already cut and cleaned before it is packed and shipped to Singapore. This would explain the absence of innards with the exception of those animals slaughtered in Singapore.

Anyway, I have not had the energy or inclination to check! We have enough to eat.

Friday, June 4, 2010

Why Everyone Should Avoid Sugar

Here is a list of ways sugar can affect your health:

  • Sugar can suppress the immune system.
  • Sugar can upset the body's mineral balance.
  • Sugar can contribute to hyperactivity, anxiety, depression, concentration difficulties, and crankiness in children.
  • Sugar can produce a significant rise in triglycerides.
  • Sugar can cause drowsiness and decreased activity in children.
  • Sugar can reduce helpful high density cholesterol (HDLs).
  • Sugar can promote an elevation of harmful cholesterol (LDLs).
  • Sugar can cause hypoglycemia.
  • Sugar contributes to a weakened defense against bacterial infection.
  • Sugar can cause kidney damage.
  • Sugar can increase the risk of coronary heart disease.
  • Sugar may lead to chromium deficiency.
  • Sugar can cause copper deficiency.
  • Sugar interferes with absorption of calcium and magnesium.
  • Sugar can increase fasting levels of blood glucose.
  • Sugar can promote tooth decay.
  • Sugar can produce an acidic stomach.
  • Sugar can raise adrenaline levels in children.
  • Sugar can lead to periodontal disease.
  • Sugar can speed the aging process, causing wrinkles and grey hair.
  • Sugar can increase total cholesterol.
  • Sugar can contribute to weight gain and obesity.
  • High intake of sugar increases the risk of Crohn's disease and ulcerative colitis.
  • Sugar can contribute to diabetes.
  • Sugar can contribute to osteoporosis.
  • Sugar can cause a decrease in insulin sensitivity.
  • Sugar leads to decreased glucose tolerance.
  • Sugar can cause cardiovascular disease.
  • Sugar can increase systolic blood pressure.
  • Sugar causes food allergies.
  • Sugar can cause free radical formation in the bloodstream.
  • Sugar can cause toxemia during pregnancy.
  • Sugar can contribute to eczema in children.
  • Sugar can overstress the pancreas, causing damage.
  • Sugar can cause atherosclerosis.
  • Sugar can compromise the lining of the capillaries.
  • Sugar can cause liver cells to divide, increasing the size of the liver.
  • Sugar can increase the amount of fat in the liver.
  • Sugar can increase kidney size and produce pathological changes in the kidney.
  • Sugar can cause depression.
  • Sugar can increase the body's fluid retention.
  • Sugar can cause hormonal imbalance.
  • Sugar can cause hypertension.
  • Sugar can cause headaches, including migraines.
  • Sugar can cause an increase in delta, alpha and theta brain waves, which can alter the mind's ability to think clearly.
  • Sugar can increase blood platelet adhesiveness which increases risk of blood clots and strokes.
  • Sugar can increase insulin responses in those consuming high-sugar diets compared to low sugar diets.
  • Sugar increases bacterial fermentation in the colon.

Sugar and cancer

Of the over 4 million cancer patients being treated in the U.S. today, almost none are offered any scientifically guided nutrition therapy other than being told to "just eat good foods." Many cancer patients would have a major improvement in their conditions if they controlled the supply of cancer's preferred fuel: GLUCOSE. By slowing the cancer's growth, patients make it possible for their immune systems to catch up to the disease. Controlling one's blood-glucose levels through dietexercise, supplements, meditation and prescription drugs - when necessary - can be one of the most crucial components to a cancer treatment program. The saying "Sugar feeds cancer" is simple. The explanation is a little more involved.

German Otto Warburg, Ph.D., the 1931 Nobel laureate in medicine, first discovered that cancer cells have a fundamentally different energy metabolism compared to healthy cells. The gist of his Nobel thesis was this: malignant tumors frequently exhibit an increase in "anaerobic glycolysis" - a process whereby glucose is used by cancer cells as a fuel with lactic acid as an anaerobic by-product - compared to normal tissues.(1) The large amount of lactic acid produced by this fermentation of glucose from the cancer cells is then transported to the liver. This conversion of glucose to lactate creates a lower, more acidic PH in cancerous tissues as well as overall physical fatigue from lactic acid build-up.(2,3) Therefore, larger tumors tend to exhibit a more acidic PH.(4)

Hence, cancer therapies should attempt to regulate blood-glucose levels through diet, supplements, exercise, medication when necessary, gradual weight loss and stress reduction. Since cancer cells derive most of their energy from anaerobic glycolysis, the goal is not to eliminate sugars or carbohydrates entirely from the diet but rather to control blood-glucose within a narrow range to help starve the cancer cells and boost immune function.

Don’t assume that a cookie or soft drink made with raw sugar or agave nectar or something else “natural” is healthful. Organic junk is still junk. I don’t care if it’s a cookie made with USDA-certified organic evaporated cane juice plowed under a Fair Trade banner. Your body doesn’t care either. Sugar is sugar once it hits the stomach acid and bloodstream. Just because it’s sold at Whole Foods does not make it good for you.
So what’s the best sugar you can eat? None. If you need (and I use that term loosely) to add something to your food or drink, use the least processed that you can get, which would be either honey or probably evaporated cane juice, and use sparingly. In the end though, avoid sweeteners as much as possible and stick to the natural sweetness of blueberries, apples, and papaya. We can argue until we’re blue in the face about what fruits are best due to lower fructose content and all of that, but if I can get someone to drop the cakes, sodas, and cookies, I bet they can eat apples all day long and be just fine.