Wednesday, September 22, 2010

Mid-Autumn Festival (Moon Festival)

The Mid-Autumn Festival is held on the 15th day of the eighth month in the Chinese calendar, which is usually around late September or early October in the Gregorian calendar. It is a date that parallels the autumnal equinox of the solar calendar, when the moon is supposedly at its fullest and roundest. 

The traditional food of this festival is the mooncake, of which there are many different varieties. The original mooncakes were not elaborate or expensive, but nowadays restaurants and bakeries seem to be in a contest to see who can come up with the most exotic crusts and fillings.

And sometimes the boxes probably cost more than the contents!

We had a quiet dinner at home with my 89 year old aunt, my cousin and two close friends. Then, just like small children, we went downstairs to the koi pond and lit up our lanterns!

Monday, September 20, 2010

How Little Things Mean A Lot

First little thing:  a miniscule amount of blood drawn this morning meant the difference between Lin getting chemotherapy today - or not. Obviously Prof Wong made the right call in stopping Oxaliplatin because Lin "made the cut" for the 1:30 slot at the Cancer Center chemotherapy treatment room!

Another little thing: despite Abbot Labs' Singapore office's refusal to offer Vanilla flavoured powdered Prosure, Lin's weight is now a more respectable 70 kilograms (when he started chemotherapy in mid-June it was a puny 67 kilograms). I did some research, Prosure (in powder form) IS available in Malaysia, Hong Kong and the Philippines in Vanilla AND Orange.

It's a small thing for the head honchos at Abbott Labs Singapore (probably a savings in inventory cost), but a huge difference to someone taking Prosure to have a versatile flavour like Vanilla to which one can add flavouring. Otherwise it is orange day in and day out!

Will stop now to get the good news to you all; more later.

Monday, September 13, 2010

Twiddling Thumbs

Now that we have settled into a somewhat flexible routine, dictated by Lin's chemotherapy sessions or rather his WBC and Neutrophil counts, we have come up for some air.

However, we don't do anything particularly strenuous or adventurous.  Friends have offered to lend us DVDs but we've never been huge fans of watching the box. Summer sporting events on TV have filled in some time and provided some interest, and there have been some wonderful moments of tennis. I only wish that Roger Federer had done better at Wimbledon and the US Open.

Yet sometimes we turn on the TV and watch whatever is on, even if it is not particularly enthralling, such is the power of the medium. It seems easier to sit and watch and flick to other channels every now and again than to get up and do something more entertaining or rewarding. Maybe this form of inertia gave rise to the term "to veg. out".

On paper we have access to a wide range of programs and lots of channels, but in reality the fare leaves something to be desired. Not being an avid follower of any particular American or British TV series, we have no idea how far behind we lag when we watch. We work around what is available rather than make it a point to switch on in order to catch a film, an episode or a telecast of a match.

Sometime, I think, in July we realised that we needed Singtel MIO for Lin to watch some of the soccer leagues or series (whatever they are called). Yet most of the other channels that we were already familiar with were on Starhub.

It took us only 3 visits from a Singtel tech to get us up and running and we are considered fortunate. Some friends have had repeat visits and one even had a whole team in her flat - twice.

The tales of woe have somewhat abated, possibly because some potential subscribers have been put off by their friends' experiences and are sitting this round out.

I suppose it must be good for competition to have both cable tv providers bid for sports events, but in this case the combined offerings of both dominant players have not added better content to paying subscribers' viewing.

It means having two set top boxes, one connected via the telephone landline and the other via the cable tv/broadband co-axial cable. And just to rub a little salt into the wound, subscribers to Singtel MIO have to subscribe to additional landlines to watch MIO on a tv that's in another location within their homes.

Some bright spark must have thought this an excellent way to reverse the trend in landline demand (with the recent flood of immigrants and workers into Singapore demand for landlines may not have declined here)! Neat idea, but it does not endear Singtel to anyone and they have not done us any favours.

And it only means they will have to continue making winning bids for some sports channels or events to keep their subscribers - it doesn't take a brain to see that subscriptions are not going to be any more affordable in the future.

In America, AT&T has U-verse which uses fiber optics (for broadband, digital tv and home phones) and does not require additional phone line subscriptions. So alternatives which are not so troublesome to install and get running and more economical on phone subscriptions do exist.

Through this transition and having to get used to new remote controls makes me wish someone would invent a remote control that is really simple and easy to operate.

It would be an intelligent "remote control for dummies" and have only an ON/OFF button, and buttons for volume and the numerals 0-9. All one would need to do is enter the channel number.

Otherwise it would use voice recognition for more advanced requests such as 'Search', 'Search Sports' and so on - keeping these commands simple and featuring only the current 24 hours' programming.

Bye bye multiple remotes and all sorts of tiny buttons.

Thursday, September 9, 2010

Organic if possible

The Daily Green recommends eating the organic versions of these.

Bell Peppers
Leafy Greens

Staying focussed

Perhaps we have been lucky or, more likely,  NUH was well planned and executed. Lin and I have nothing but praise for the people we have chanced upon whenever we have gone for his consultations, chemotherapy sessions and other services.

Yesterday, Lin was given the all clear by Dr Teo, his new-found cardiologist. It would appear that despite the calcium deposits (not to be confused with plaque) the old ticker is still going strong - for someone his age. In fact, Dr Teo was pleased that Lin's good cholesterol is nice and high.

So it looks like he only lacks a decent White Blood Count which we hope that dropping Oxaliplatin will help.

This afternoon he goes in to return "the Pump". We are convinced that if  the manufacturer would make it smaller it would have a most beneficial effect on the mood and outlook of chemo patients - lugging that brick around and constantly being reminded of its presence has a depressing effect.

If you gave me one wish, it would be for NUH to improve  (or at least,  stay the same). 

This came to my mind because we were approached to participate in a service survey conducted for the organisation. After answering the questions, some of which I felt could have been better focussed, I wondered if positive comments might lead to complacency.

Will dealing with reality - life and death on a daily basis - keep the organisation soundly grounded? Or will the business and management whiz kids get their way and make it into a glitzy 'destination' spot for medical tourism?

Far from being altruistic in my wish for NUH, I am thinking of our future - especially mine! As sure as death and taxes I shall be needing to visit the hospital as a patient in the foreseeable future; not as a caregiver. And I would not like to see it expensive, overly business-minded and bottom line driven like some private hospitals,  government and government related organisations.

Going by what I have experienced on our buses and trains and reading the grouses of commuters I have no doubt that commuting is every bit as bad as they say. And I travel off peak when it's meant to be less crowded.

Stallkeepers at my favourite wet market say young people feel left out because they find it harder and harder to afford their first homes. 

But we also have our share of spoilt brats. True or not, I heard a that a young man doing his stint in National Service (NS) was given a Bentley by his indulgent father who thought that his son's Ferrari would be too ostentatious to drive to camp!

I have also heard of young people in the financial world who are earning the equivalent of ministers' salaries (highest in the world) in bonuses.

I wonder if this is going to give rise to a society that "knows the price of everything and the value of nothing".

Maybe not if their parents and peer groups have their heads screwed on right. People who are familiar with China say that there are the usual nouveaux riches whose children squander money, but also those who have groomed their children by sending them to the best  private schools and universities in the west and got them work for a living.

Even pre-1997 we were asked to recommend finishing schools in Europe which might be suitable for daughters of the 'establishment'. 

Many Singaporeans just do not realise that we have yet to reach a level of sophistication that the elite PRC Chinese  already had enjoyed pre-Mao (the pre-WW II Chinese ambassador's daughter to the court was a boarder at Cheltenham Ladies' College). So it was hardly surprising to read in the IHT not so long ago of Chinese debutants being presented at the Crillon Ball in Paris.

Continuing as we have done, we always will be the 'overseas Chinese', the rough diamonds. Which is fine because there is a place for everyone. 

But not if we have higher aspirations - or are so blinded by our own hype that we think we have arrived.

What kind of society are we that babies are not permitted to be fed on the Mass Rapid Transit (MRT) trains? That do not allow seeing eye dogs into shops, restaurants and offices? That does not have decent handicap access or lifts in all MRT stations. That does not have pedestrian underpasses which are fully accessible to those in wheelchairs or strollers?

Instead, we have Lamborghinis complete with blackout windows and windscreens parked - with total impunity - at the junction of busy roads (Claymore Hill/Claymore Rd behind the Thai Embassy and close to Shaw Centre). Approx 1pm on Tuesday, Sept 7th.

When they are not doing that they seem to be driving around showing off their fancy wheels and making an unholy din. More and more people are grumbling about the quiet of the night being disturbed by the irritating roar of loud (sometimes illegal) exhausts as they drive round and round certain roads.

Never mind exhaust and construction noise pollution, we also pay lip service to recycling and being eco friendly. 

Most of the businesses here use plastic bags, as ever, with gay abandon. Most homes do not recycle. Many homeowners rely on their domestic help, the majority of whom come from countries where recycling (as the developed western countries) know it does not exist.

This would not be so bad if we still had people going round buying old newspapers, bottles, etc  - 'karung guni' men. In HK and China recyclables are often removed from the public bins by scavengers who earn a little pocket money doing this so that there is minimal wastage.

Here, we are somewhere between the countries where people throw aluminium cans and plastic into the ponds, lakes, rivers and seas and the ecologically conscious countries where people break up cartons, bundle magazines and newspapers, separate recyclables from trash and dispose of them in public recycling and trash bins. 

Unfortunately we are closer to the ignorant end. 

According to the MSM (mainstream media) we are going to light up Singapore landmark buildings at night - I wonder how we are going set the city ablaze and still be ecologically responsible citizens of the world? 

Well, at least we can rejoice that our two polar bears are going to be provided quarters more suitable for their type than they have been housed in (hope they have not become too accustomed to the tropical heat).

Even though every country has its everyday travails, those that we seem to be experiencing lead one to wonder if our planning has been less than meticulous and the implementation subject to less than the most rigorous testing? In golf we call it 'taking the eye off the ball'.

Forget the very rich and very influential - they and theirs can live anywhere they please.

Monday, September 6, 2010

A New Dimension

Gosh, it's taken so long to complete four chemo sessions that I have almost lost track of time! Lin made the cut today and had his chemotherapy - minus Oxaliplatin this time. Hopefully this will see us get back on schedule to have a treatment every second week.

Tomorrow, bright and early, we will meet again with a cardiologist, an addition to Lin's team. This came about because the CT scan that was done on August 27th showed some calcification in his coronary arteries. 

Prior to this, a scan in Hong Kong showed up some minor stuff and we were told to inform his dentist so that Lin could get a course of antibiotics before dental work. Of course, all this was forgotten in the light of subsequent events - until the scan.

Anyway, Prof. Wong referred us to a very nice man, Dr Teo Swee Guan, at NUH and we met him on  Thursday, September 2nd. We made the right choice coming here because of the on-site, holistic care.

In our situation, we'd be looking around for recommendations for a cardiologist if we were elsewhere. But here, Lin was booked in for a Vasodilator Stress Myocardial Perfusion Imaging Test for the morning after our appointment with Dr Teo.

The name for the test is a big mouthful, but think of it as a Stress Test using a chemical rather than a treadmill to provide the stress.

Dr Teo was pretty cheerful and remarked on Lin being a picture of health. It was comforting to hear that some calcification is not unusual in a person Lin's age as long as there is no stenosis (narrowing of the arteries). But to play safe, Lin would undergo the test that did not require pounding on a treadmill.

It's a long procedure which requires abstaining from caffeine for the 12 hours preceding the test. On the day itself he had a cannula inserted for the radioactive chemical injection as well as a collection of ECG 'stick ons' (with their shiny metal knobs they looked like body piercings)!

After they had got him prepared, I disappeared since there was no point sitting around in a waiting area. I collected him more than 6 hours later (the procedure included a long break between tests).

The cardiology department is in the main hospital building and so is the functional imaging centre. This gave us a chance to see a bit more of this sprawling complex.

Almost every clinic and centre was busy, but nothing as crowded as hospitals in Hong Kong. 

According to Wikipedia and similar sources Singapore has got most places in the world beaten for density of population. Their list of sovereign states and dependent territories has Macau at 1, Monaco at 2, SINGAPORE at 3 and Hong Kong at number 4.

When you consider the land area that Singapore occupies (a minute 270 square miles, including some 46 square miles we claimed back from the sea), we are fortunate that we do not feel more claustrophobic.

In a recent newspaper report, Minister Mentor Lee Kuan Yew was reported as saying that 5.5 million was enough, 'an optimum size for the land that we have, to preserve the open spaces and the sense of comfort'.

Thank goodness for that because just this weekend we read in the newspapers that we now have 5.08 million people here!

The government is getting what they asked for, but the people of Singapore are somewhat ambivalent. Property prices have taken off and become a major issue here especially among prospective first time homeowners.

Lack of a viable public transport system has not weaned people from their dependence on motor cars yet.

Providing education and then jobs for new graduates should keep the midnight oil burning in some ministries.

Let's hope we can assimilate all these new people and that the country does not suffer from 'indigestion' as a consequence of swallowing these people as if we were in the famous Nathan's Hot Dog Eating Contest!

Saturday, September 4, 2010

Learning To Know The Enemy

Let me start this installment with a plea. Speak to your doctor before you try anything as a result of reading about it here!

Far from being an expert, I am learning as I go along. I kid you not that I have probably forgotten more useful information than I have managed to retain!

And the amount of information available is overwhelming - I am sure I have forgotten or not absorbed more I have managed to retain! Sometimes I feel that I am adrift on a vast ocean with no land in sight, casting around for some direction.

That direction comes in unexpected ways - such as an opportunity today to attend part of the 2010 Singapore Cancer Forum.

The purpose of the forum was to update medical professionals (including medical students) and caregivers on the current trends and management of the top 10 cancers of men and women in Singapore.

Welcome news for women is that thanks to screening and prevention cancer of the cervix, once lethal, feel from #2 (1968) to #5 ranking. Sadly colo-rectal cancer which was ranked #5 in 1968 rose to #2, reflecting changes in lifestyle and eating habits.

In Singapore men, lung cancer #1 in 1968 has been overtaken by colo-rectal cancer. Stomach and liver cancer were #2 and #3 in 1968. Prostate cancer is the new #3, but it is one of the better cancers to have, if there's anything good to say about cancer.

We heard and saw a video about laparascopic (key hole) surgery, learnt about molecular biology (very complex) which seems to be taking us towards 'personalized' cancer treatment and the remarkable advances in radiation therapy which enables the doctors to spare surrounding areas.

We also learnt about vaccines which have made some cancers preventable, the Hepatitis B vaccine for one.  And the more recent Human Papilloma Virus (HPV) vaccines, e.g. Gardasil which prevents HPV 6, 11, 16, and 18 in girls and women.

Unfortunately, due to a prior commitment I missed the afternoon sessions which covered holistic cancer care, Food and Cancer, Traditional Chinese Medicine (TCM) and cancer, Complementary Treatment and Relaxation Therapy.

For the sake of comparison I looked at statistics for Hong Kong:



Lest I be accused to massaging the statistics I shall leave you to draw your own conclusions, and if you don't feel snowed under yet, I can suggest you google for cancer statistics of your country and then compare the data.

And if you have come this far, the SHOCKING NEWS for us today is that ONE out of THREE of us sitting in the audience would get cancer.

But the good news is that not all cancers are a death sentence. And contrary to what some of us had thought, we are NOT born with cancer cells.

Cancer cells are rogue cells; they start off life as normal cells but do not die once they have fulfilled their purpose. Instead, they multiply by doubling (2x2, 4x4, 16x16 and so on). By the time they are noticeable they number a billion!

It's probably over simplification, but chemotherapy tricks cancer cells into self destruction, or by denying them from access to our life blood. Sometimes it works and sometimes it doesn't because they can become resistant to repeated courses of drugs.

However, on the whole it is encouraging because work is continuing on every front to improve the quality of health - and the quality and scope of cancer treatments.

Remember: be happy and relaxed, avoid stress, take some exercise, get adequate rest, eat and drink wisely (alkaline water, organic fruit and vegetables). Avoid synthetics, especially in food and drink.