Facing possible death and dealing with our volatile emotions...

Be kind to yourself and the rest around you, embrace life and death.

I have received numerous enquiries on diagnosis, laboratory results, treatment and coping mechanisms. Most enquiries were from cancer patients themselves, some from concerned family members. Questions were usually straight forward, mostly on diet and side effects of chemotherapy. However, some questions turned out to be lamentations of the heart, desperate for a willing listener.

Some people communicated with me via WhatsApp, others came over to my apartment for a visit. Reaching out to people can be both liberating and fascinating but sometimes a daunting task. I really have to be extra careful when speaking to either patients themselves or family members. Some patients or family members are friendly, understanding and optimistic and talking to them was a learning experience. However, some were tricky to deal with.

Anger mixed with sadness and desperation and feelings of hopelessness are some of the emotions I have encountered at times. Everybody is fearful towards death or the possibility of death. Death is taboo subject to most people, and not many would want to talk about it. Feelings of uncertainty, loss and anxiety crept in as soon as the diagnosis of a terminal condition is made known. It is definitely difficult to accept how cruel the reality can be. Why me? Why me? I have been taking care of my health for as long as I am alive! Why me? I have never done bad things in my life, what did I do to deserve this? Why me? I am a happy person!  Well, a happy person can turn out to be the angriest person you ever met.

Fortunately for me, I never really fell into that vulnerable stage of emotion. I somehow circumvented all that negative feelings by totally accepting my condition without fear. I embrace death as a natural process.  Instead of feeling angry, I was feeling grateful for the great childhood (despite being poor), for the challenging life so far and all the things I have achieved. I focus on the present and forget about the future. I let go.

It can be unimaginable to be in a cancer patient’s shoes, but there are certainly options to choose from, on how we handle our emotions. Having a terminal disease definitely does not mean we can simply throw tantrums and vent your anger at our friends or families. As much as they want to be a crying shoulder for u, they certainly don’t want to be punching bag at your disposal. Be thankful that they are sticking around.

It is definitely ok to feel sad and depressed when dealing with an unthinkable diagnosis. However, it is equally crucial to snap out of these emotions the sooner the better. Managing the challenges with a positive mind set will help reduce the stress and frustrations along the way.

Facing reality:

 Things beyond our control:

• The way we die
• The date and time we die
• The past and the future

Things we can control:

• Our actions
• Our emotions
• Now

Perhaps there are better ways in handling our emotions by asking these questions:

• How long have I been in this situation, feeling down or sad or angry?
• How long do I want to be at this stage of emotion?
• Have I got all the information needed to make a decision?
• Am I making progress with regards to these decisions?
• Is there anybody who can help me in some ways?
• Is there a need to seek help from another without feeling lousy?
• Is there a need to talk to someone whom I can trust?
• Am I reading enough to obtain information which may help in my condition?
• Am I taking positive actions with my diet and lifestyle?
• Am I taking actions with what I can do with the time l have?
• Am I humble enough to listen to my friends and family members?
• Am I humble enough to help other people facing the same predicament?

Some points to ponder:

• Mental wellbeing – try mindfulness, try meditation, try humor
• Physical wellbeing – try exercise, try stretching, try Yoga
• Positive and compassionate outlook –try to be a considerate friend first before making demands, don’t be an asshole!
• Peace – stay away from toxic relationships, in the same manner, don't be a toxic yourself!

Going gaga over beetroot

            Beetroot (Beta vulgaris L. ssp. vulgaris) is an interesting and high-nutrient vegetable grown for salads, juice, and natural pigments. The presence of betalains in the cell vacuoles gives beet its deep dark red colour.¹

Beetroot is known to have potent antioxidant activity and contain health-promoting compounds such as magnesium, folic acid, niacin, biotin, vitamin B6, iron, zinc, calcium, phosphorus, sodium, potassium and soluble fibre.²

Beetroot provides dietary nitrate, an important source of nitric oxide, via the nitrate-nitrite-NO pathway. Dietary nitrate is an important component of 'healthy diets', such as the DASH diet to lower blood pressure and the Mediterranean diet to lower cardiovascular and cancer risk.³ Dietary supplementation of nitrate with beetroot juice or other medicinal botanical derivatives (e.g., visnagin and Danshen), provides both antihypertensive properties and mitigates anthracycline-induced cardiotoxicity.⁴ Doxorubicin and epirubicin are anthracyclines and are usually part of breast cancer treatment protocol.

Beetroot contains 2 groups of betalain pigments: red-violet betacyanins and yellow betaxanthins. The betacyanins are mainly betanin (betanidin 5-O-β-glucoside) and isobetanin, which is the predominant isomer.⁵ Betanin is known for its nontoxic properties.

Apparently, beetroot is highly popular and widely used among cancer patients in German as well as Trinidad.^6,7 In Malaysia, there is yet a study to gauge the popularity of this awesome vegetable. However, based on words of mouth information, some cancer patients do routinely consume this vegetable as a drink, especially during chemotherapy, to boost energy and improve the blood counts.

Personally I think beetroot juice has helped me cope with the stress during the chemotherapy months. I enjoy both freshly made as well as the fermented juice (Biota Breuss Organic Beetroot Juice).  Interestingly, a study has indicated that the anticancer activity is stronger in the organic beetroot fermented juices as compared with the conventional ones.⁸ I guess it doesn’t really matter as long as we hope to harness the goodness of this superfood!  

Most studies on beetroot and cancer were carried out in vitro and in animal studies. No clinical trials were reported though.

Studies on beetroot’s nitrogenous compounds:

• Betacyanins have antioxidant and radical scavenging activities.^9,10
• Oral administration of betanin inhibited DMBA initiated and UV-B promoted skin tumorigenesis.¹¹
• Betanin has antiproliferative effects on human chronic myeloid leukemia cell line-K562.¹²
• Betanin significantly decreased tumor multiplicity and tumor load in two mouse lung tumor models.¹³
• Betanin and betaine extracted from beetroots have some antiproliferative effects against hepatocellular cells.¹⁴
• Betanin has anti-inflammatory and cancer prevention properties.¹⁵

Studies on beetroot juice or extracts:

• Beetroot extract prevents lung and skin cancer in mice.¹⁶
• Beetroot extract induces NOQ1 in the murine hepatoma cells, both in vitro and in vivo. NQO1 is a key enzyme responsible for detoxification of DMBA.¹⁷
• Oral consumption of red beetroot food color inhibits tumors in rat esophagus.¹⁸
• In vivo studies confirmed anticarcinogenic activity of beetroot in mouse lung, skin and liver carcinogenesis models.¹⁹
• Beetroot juice is protective against against N-nitrosodiethylamine (NDEA)-induced oxidative stress and liver injury in male rats.^20,21
• Beetroot juice protects female rat against DMBA-induced liver damage and reduces the markers of hepatic damage elevation as a result of DMBA treatment.²²
• Beetroot extracts and doxorubicin provide synergic cytotoxicity against human pancreatic, breast and prostate cancer cell lines. ²³
• Betanin-enriched beetroot extract induces apoptosis and autophagic cell death in breast cancer cells.²⁴

Unfortunately, only an isolated case report on beetroot and cancer that was published:

• 15 days of administration of beetroot-carrot juice therapy in a patient with chronic lymphocytic leukemia resulted in improved appetite, a sense of general well-being and increased vigor. Substantial reduction in leukocytes and lymphocytes count in peripheral blood and improvement in the relevant biochemical parameters were noted.²⁵

References

1.      Jackman RL, Smith JI. 1996. Natural food colourants. In: Hendry GAF, Houghton JD, editors. Anthocyanin and betalanins. 2nd ed. London, UK: Chapman & Hall.

2.     Wootton-Beard PC, Ryan L. 2011. A beetroot juice shot is a significant and convenient source of bioaccessible antioxidants. J Funkt Foods 3: 329–334.

3.     Mills CE, Khatri J, Maskell P, Odongerel C, Webb AJ. It is rocket science why dietary nitrate is hard to 'beet'! Part II: further mechanisms and therapeutic potential of the nitrate-nitrite-NO pathway. Br J Clin Pharmacol 2017 Jan;83(1):140-151.

4.     Kuriakose RK, Kukreja RC, Xi L. Potential Therapeutic Strategies for Hypertension-Exacerbated Cardiotoxicity of Anticancer Drugs. Oxid Med Cell Longev. 2016 .

5.     Nemzer B, Pietrzkowski Z, Sporna A, Stalica P, Thresher W, Michalowski T, Wybraniec S. 2011. Betalainic and nutritional profiles of pigment-enriched red beet root (Beta vulgaris L.) dried extracts. Food Chem 127(1):42–53.

6.     Obrist R, von Meiss M, Obrecht JP. [The use of paramedical treatment methods by cancer patients. A inquiry on 101 ambulatory patients]. Dtsch Med Wochenschr. 1986 Feb 21;111(8):283-7. German.

7.     Clement YN, Mahase V, Jagroop A, Kissoon K, Maharaj A, Mathura P, Quan CM, Ramadhin D, Mohammed C. Herbal remedies and functional foods used by cancer patients attending specialty oncology clinics in Trinidad. BMC Complement Altern Med. 2016 Oct 21;16(1):399.

8.     Kazimierczak R, Hallmann E, Lipowski J, Drela N, Kowalik A, Püssa T, Matt D, Luik A, Gozdowski D, Rembiałkowska E. Beetroot (Beta vulgaris L.) and naturally fermented beetroot juices from organic and conventional production: metabolomics, antioxidant levels and anticancer activity. J Sci Food Agric. 2014 Oct;94(13):2618-29.

9.     Pedreno MA, Escribano J. 2000. Studying the oxidation and the antiradical activity of betalain from beetroot. J Biol Educ 35(1):49–51.

10.   Kanner J, Harel S, Granit R. 2001. Betalains—a new class of dietary cationized antioxidants. J Agric Food Chem 49(11):5178–85.

11.    Kapadia GJ, Tokuda H, Konoshima T, Nishino H. 1996. Chemoprevention of lung and skin cancer by Beta vulgaris (beet) root extract. Cancer Lett 100: 211–214.

12.   Sreekanth D, Arunasree MK, Roy KR, Reddy C, Reddy GV, Reddanna P. 2007. Betanin a betacyanin pigment purified from fruits of Opunita ficus-indica induces apoptosis in human chronic myeloid leukemia cell line K562. Phytomedicine 14: 739–746.

13.   Zhang Q, Pan J, Wang Y, Lubet R, You M. Beetroot red (betanin) inhibits vinyl carbamate- and benzo(a)pyrene-induced lung tumorigenesis through apoptosis. Mol Carcinog. 2013 Sep;52(9):686-91.

14.   Lee EJ, An D, Nguyen CT, Patil BS, Kim J, Yoo KS. Betalain and betaine composition of greenhouse- or field-produced beetroot ( Beta vulgaris L.) and inhibition of HepG2 cell proliferation. J Agric Food Chem. 2014 Feb 12;62(6):1324-31.

15.   Zielińska-Przyjemska M, Olejnik A, Dobrowolska-Zachwieja A, Łuczak M, Baer-Dubowska W. DNA damage and apoptosis in blood neutrophils of inflammatory bowel disease patients and in Caco-2 cells in vitro exposed to betanin. Postepy Hig Med Dosw (Online). 2016 Apr 6;70:265-71.

16.   Kapadia GJ, Tokuda H, Konoshima T, Nishino H. Chemoprevention of lung and skin cancer by Beta vulgaris (beet) root extract. Cancer Lett. 1996 Feb 27;100(1-2):211-4.

17.   Lee CH-H, Wettasinghe M, Bolling B, Ji L-L, Parkin K. 2005.Betalains, phase II enzyme-inducing components from redbeetroot (Beta vulgaris L .) extracts. Nutr Cancer 53:91–103.

18.   Lechner JF, Wang LS, Rocha CM, Larue B, Henry C, McIntyre CM, Riedl KM, Schwartz SJ, Stoner GD. Drinking water with red beetroot food color antagonizes esophageal carcinogenesis in N-nitrosomethylbenzylamine-treated rats. J Med Food. 2010 Jun;13(3):733-9.

19.   Kapadia GJ, Rao GS. 2012. Anticancer effects of red beet pigments. In Red Beet Biotechnology. Food and Pharmaceutical Application, Bhagyalakshmi, Neelwarne, (ed.) Springer Sciences and Business Media: New York; 125–154.

20.   Kujawska M, Ignatowicz E, Murias M, Ewertowska M, Mikołaj czyk K,Jodynis-Liebert J. 2009. Protective effect of red beetroot againstcarbon tetrachloride- and N-nitrosodiethylamine-induced oxida-tive stress in rats. J Agric Food Chem 57:2570–2575.

21.   Krajka-Kuźniak V, Szaefer H, Ignatowicz E, Adamska T, Baer-Dubowska W. 2012. Beetroot juice protects againstN-nitrosodiethylamine-induced liver injury in rats. Food ChemToxicol 50: 2027–2033.

22.   Szaefer H, Krajka-Kuźniak V, Ignatowicz E, Adamska T, Baer-Dubowska W.2014. Evaluation of the effect of beetroot juice on DMBA-induced damage in liver and mammary gland of female Sprague-Dawley rats. Phytother Res Jan;28(1):55-61

23.   Kapadia GJ, Rao GS, Ramachandran C, Iida A, Suzuki N, Tokuda H. Synergistic cytotoxicity of red beetroot (Beta vulgaris L.) extract with doxorubicin in human pancreatic, breast and prostate cancer cell lines. J Complement Integr Med. 2013 Jun 26;10.

24.   Nowacki L, Vigneron P, Rotellini L, Cazzola H, Merlier F, Prost E, Ralanairina R, Gadonna JP, Rossi C, Vayssade M. Betanin-enriched red beetroot (Beta vulgaris L.) extract induces apoptosis and autophagic cell death in MCF-7 Cells. Phytother Res 2015 Dec;29(12):1964-73.

25.   Shakib MC, Gabrial SG, Gabrial GN. Beetroot-carrot juice intake either alone or in combination with antileukemic drug 'chlorambucil' as a potential treatment for chronic lymphocytic leukemia. Open Access Maced J Med Sci. 2015 Jun 15;3(2):331-6.

2 months post-chemotherapy and radiotherapy

I just could not ignore these beautiful blooms at the Penang Botanicals Garden....yes, be like a lotus, be grateful to the mud.....be grateful to the harsh realities of life and challenges ahead.... 

Life was definitely good (and busy) after I completed my chemotherapy in Nov 2016, followed by radiotherapy in Dec 2016. Hence, the silence! I was busy correcting students' theses, wrote a manuscript along the way, reviewed manuscripts for journals, submitted a grant proposal and currently working on a different grant application! I also took time to attend the viva voce of my students and I felt really proud that both of them passed with flying colours! Students who are highly motivated and with respectable character are definitely hard to come by...

Life was also quite routine, I cook on most days, do household chores, and allocated time for yoga and exercises.  I guess life after breast cancer treatment was more or less the same like before! I am lucky that I still have a few months more to rest and rewind. I hope to resume work soon.

Just when I thought that I will be going through a phase of recovery (with ease), a few side effects just cropped out from nowhere....sigh...

Right joint pain near shoulders and knee

I woke up with a sudden joint pain in my left knee one morning, and a few days later, stinging joint pain near my shoulders. Fortunately, the pain only occurs with certain movements or positions of the hand and leg, not severe enough to limit movement or cause loss of mobility. I took some celecoxib capsules (NSAID) daily for a few days but eventually stopped taking them when I realized that the pain killer provided no significant relief. I decided to manage the pain without drugs instead. Stretching exercises and yoga helps a lot, although the pain is still there with certain movements.

I understood that joint pain may be a delayed side effect of chemotherapy (Taxotere) or probably contributed by Tamoxifen. Whatever the circumstances, I have to learn to live with it.

Swelling in and around the left armpit and breast

For the past two weeks I have been living with a slightly inflated and heavier left breast! The left breast where the lumpectomy took place appeared to be swollen. The armpit felt tight, and there was decreased flexibility in the affected arm. Bra definitely felt tighter on one side, so I'd rather let it loose most of the time! I noticed the breast turned slightly red and I could feel some prickling and shooting pain at times. I guess these side effects are delayed onset reactions of radiotherapy.

I have decided not to see my doctor until March because I think I should be able to manage with hand exercises, massages and yoga. Exercising the hand and fingers with a grip ball appeared to improve the condition.

Numbness

Numbness usually set in in the middle of the night, probably a result of poor blood circulation in my hands, especially if I positioned them somewhere behind my head or under the pillow!. I have to move my hands down next to my body and rub my fingers to facilitate the blood flow. Recovery will take minutes. I am not sure if these are direct consequences of chemotherapy-induced peripheral neuropathy (caused by Taxotere), as the numbness only happen at night.

The sudden episodes of numbness disrupted my sleep at times. I am managing it with neurobion (Vit B1,B6, B12) tablets and gingko biloba (Tanakan) daily. and the symptoms appeared to occur less frequently now.

Fatigue

I normally don't feel tired. I have been exercising routinely, either walking on an incline thread mill for at least 30-45 minutes or taking a night romantic 2-3 km stroll along Persiaran Karpal Singh, Jelutong! I usually sleep better after that.

Diet

I have been on low carbohydrate diet for the past few months and I think I am doing great. The only problem was to figure out what to eat everyday!

Fasting glucose level

I have been checking on my fasting glucose levels routinely.  Unfortunately, the average levels remained somehow higher (between 5.5 - 6 mmol/L) as compared with levels before taxotere treatment, despite the low carbohydrate diet. I guess I need to give my body some time to adjust. Patience.

Leaving a small mark..................

Leaving a mark........

A lot of people asked me if I am comfortable revealing all the personal medical information and  documenting my inner feelings and emotions along the way......

When I first knew about my diagnosis, I googled frantically for information. Guess what? the most important and relevant information to me were from blogs and personal accounts of cancer survivors! Nothing beats information coming from the mouth of the sufferer! There was this sigh of relieve, feelings that you are not alone, anticipation that you will be able to manage whatever that comes along, emotions of gratitude and that "I am ready"! All these personal accounts have definitely helped me cope with life post-diagnosis. I thought I should do the same, hoping someone out there will be happy reading this blog.

Documenting personal experiences is therapeutic. Writing down emotions and feelings as in keeping a diary helps overcome upsets, feelings of uncertainty & anxiety. Naturally, mindfulness set in, followed by acceptance.

This blog will also serve as a memory for myself as well as for my loved ones in the future.

squabbling over an inheritance?

my retriever, bobby, who left us without an inheritance, but only sweet memories....

My father wanted to die at home and he was clear on that point. After he passed away, he left a bank account with some money for us to settle his funeral arrangements, including footing the bill for his own coffin! I think that was remarkable of him. He is known to be a man of principles and he taught me this “Nothing is free in this world; you have to work for it!” Believe it or not, I took this “mantra” seriously and I worked hard to be where I am today.

The blessings and miseries of families are not limited to holiday gatherings,  celebrations, graduations and weddings. They certainly exist at the period where a family member undergoes a transition from illness to death and of course the aftermath!  Family squabbles after someone dies are quite common among Asian families and the fights are not just about money alone. There are fights and quarrels over issues of care giving, over being treated unfairly, over memories, over being slighted, over who should be calling the shots and over almost everything! Things get more complicated when you have in-laws chipping in their thoughts and opinions!

When a person passes away, his or her money and belongings will only have three possible destinations, i.e his/her heirs, to charity or to the government (if there are no claims)! Traditional and modest Asian families usually do away with wills, or they rather spend on other things than spending on writing a will! “Only rich people do a will”, that’s what the old ones used to say. By the time they reach 70-80, they would have transferred the ownership of their hard-earned house or assets to their heir of choice, usually the sons. Daughters barely stand a chance to claim ownership! Anyway, things will get even more complicated if the one and only asset has to be shared by a couple of siblings! For those lucky ones where the deceased left a will, someone will be fighting over it somehow! So, it is all not that rosy. Heard the saying “when there is a will, there will be a war”?

Reasons for family squabbles

1.     Lack of communication

One possible reason for family squabbles after someone dies is the fact that the deceased never discussed their intentions with their family members or potential heirs. Thus, the contents of the will may come as a shock to them who may misinterpret the deceased's intentions and take omissions personally. Disappointment and jealousy eventually tear family apart.

Personally, I think it is important to let family members know what is in the will, as this will eliminates the element of surprise and family members can gather and discuss. Those who were not named should go home and do some reflection instead! If they are not satisfied with the given reasons, they can always renegotiate. If one feels one heir should receive more than another, that wish needs to be articulated in the planning. I think stating these wishes before one dies (the why, the how, the how much) and letting everybody know how one feels isn’t cruel at all. It helps prevent in-fighting later. This is also a testing time to see family members’ true colours!

Chinese New year or any other holiday seasons are not only the perfect time for families to strengthen bonds, it is an excellent time to discuss our wishes if we become ill, permanently disabled or even after we die!

2.    The perception of “fairness”

Although in some cases, where the deceased have laid down a legally sound will that clearly stated how they want their estate divided, siblings bickering still happens. A perceived unfairness – the “why-her/him-and-not-me?” question - is a common reason why siblings squabble over the issue of inheritance. Sentimental items from the deceased can be a big issue. Why mum’s bracelet was given to her? Why dad’s treasure chest was kept by him? Why mum’s favourite and expensive pressure cooker was brought into her home? In the past, family photos were a big issue, a problem that has since been eliminated by digital photography!

  It is quite unfortunate that different people have different perspectives on what is fair.  In the mind of a financially poorer sibling, a bigger portion of the inheritance should be given to her/him, and that’s being fair. Unfortunately, this will not be fair to the richer ones who have contributed in all ways, and being the poorer ones; they are usually the last ones to offer assistance. Are sons superior to daughters? Why are sons left with inheritance and nothing for the daughters? She did not take care of mum when she was alive, why was she given a cut of the wealth? I took care of him for 2 years, why was the bigger portion given to someone who failed to carry out their responsibility? So, what is fair?

Frankly, I think the deceased maintain full rights to give whatever and to whoever he wants; no further questions. To prevent bickering, details of his/her wishes have to be written down or conveyed clearly, unfortunately. 

3.    A false sense of entitlement

Each sibling/family member indefinitely strives to achieve his or her own means to the end, when it comes to inheritance.  And it's further complicated by adult children who feel entitled to their parent’s money and belongings.  A Geropsychology expert thinks that entitlement is a result of a money-obsessed culture. He mentioned that maximizing one’s financial position is a primary motivator and the opportunity to obtain money usually overrides ethical behaviour!  Some people may have lived their lives under the false assumption that their inheritance will fund their retirement or their children’s education plans! I guess they have conveniently forgotten their core responsibilities towards their parents. Shouldn’t we try to be caring and provide for our parents instead (despite their wealth)? And not eyeing their estate and belongings?

I may sound naive though. I guess the mantra “Nothing is free in this world; you have to work for it!” can be used to educate our own children from the beginning before it is too late.

4.     Lack of trust

Lack of trust among siblings, feeling of resentment, concern whether things were done in everyone’s best interests, questioning motives and actions often disrupt the family dynamics and makes the squabbling harder to bear. Being trustworthy in the 1^st place is crucial to gain trust from others. Harbouring ill thoughts and bad intentions are definitely recipes for disaster!

When I face the harsh reality of this diagnosis and the prospects of having to leave this world at an unstipulated time, I wasted no time in making a will and I have made it clear of my intentions and my wishes. Peace.

Acceptance and Mindfulness

Near the end of its life, a bromeliad plant may produce an inflorescence or flower, so beautiful, you can't believe the plant is actually dying......

 

In times of challenges like this, preaching others to stay strong is an oxymoron! How can one stay and pretend to be strong when there is no other choice? If you are good at faking, you can stay or pretend to be strong. However, if u cannot live up to people's expectations, then break down as you like it, but don't forget to bounce back!

Unfortunately, breaking down too often due to sadness will not help much in coping with the diagnosis and treatment. Feeling miserable and depressed will not only affect your emotional and physical health, it will make your loved one's life miserable! Do you want your husband, your boyfriend, your kids, your mum, dad and siblings feel miserable for you? Nope, that will be the last thing we want to do. Having a loved one diagnosed with a terminal disease is already hard to bear, what more having to live with them, and hearing their cries, sobs of despair and tantrums! So, give them a break. We need their support, thus, we need to make sure they are in both emotionally and physically fit condition!

The first step towards recovery is to have acceptance, accept the present condition, accept that you can do something about it and you can take appropriate actions, accept that you have tried your best, accept that our loved ones do not have to suffer like we do! 

In my opinion, when there is acceptance, one tend to remain calm, composed and realistic. Sadness can be balanced up by not thinking too much (of the future) but by being mindful and living each day as it comes. Stop and smell the roses, feel the rough stones beneath your feet, feel the cool breeze blowing your face, touch the face of your loved ones and see how perfect they are, send little notes to those you care, work on your pending assignments, cook a nice meal and taste each bite with gratitude! 

When we are mindful, we live in the present, we hear the sounds of our breathing, and we feel the sensations of our skin, we live each day as it comes. We really do not have time to feel sad and brood over things we cannot control!

Radiotherapy and my diary entries!

The room where the Linac machine is located

                                                 















 

The control room

                                     

The second stage of the breast cancer treatment was a daily course of radiotherapy to the affected breast for a total of 20 sessions over a 4-week period. Well, I survived!  Not without a scratch though… at this moment, my skin began to show signs of healing and I am getting more comfortable every day! I was also prescribed Tamoxifen 20 mg tablet daily, started about a month ago (which I am going to rant about in my other postings).

Radiotherapy is a critical component of treatment for the majority of women with breast cancer, particularly those who receive breast conserving surgery (me included). My present oncologist is also a qualified radiation oncologist, so I have no complaints. I trust that my oncologist will do the best for me.

“Good morning!”, as usual, his cheerful smile and warm greetings, “How are you?”. “ I am fine but I have a few things to report…..I am consistently having blurred vision for the past few weeks…” . I looked at him and he said. “Oh don’t worry, it will go off, but will take some time, most probably the lingering side effects of chemotherapy (Taxotere), why don’t you take Neurobion daily, it will help with the nerves…”  I reckoned he got it right, in addition to the blurred vision; I often wake up with numb hands, all these are signs of chemotherapy-induced neuropathy.

“I have another concern, I appeared to have sailed through chemotherapy quite easily, you know….my eyebrow and lashes are still intact and my blood cells recovered so well without the white blood cell booster, are these signs telling me that I am not responding to the treatment??” I knew I sounded stupid, but I was curious. “Nah, you are totally normal, as not everybody will experience the same side effects!”  I was relieved.

During the consultation session, we discussed the radiotherapy plans and he assured me that I won’t be having nausea or any side effects that will render me sick or weak (like chemotherapy!). The good news was that I should be able to drive and I won’t need anybody to accompany me during the sessions! Oh yes, I was also prescribed some Aloe Vera-based cream to apply  at the treatment areas at least twice a day.

After the consultation session, I was brought to the radiotherapy facility in the same morning.  I went through a CT planning scan. For the simulation session, some tattoo marks, which felt like needle pricks, were made on my skin to identify the treatment areas.  I was told to come back later for the radiation session, as the doctor have to calculate the radiation doses and determine the exact treatment area. Meanwhile, I was also given a crash course on dos and don’ts on the radiated skin. No soap, no cream (except prescribed by the doctor), no this and that….

After waited for a few hours, I was called to enter the treatment room, where the linear accelerator or Linac is located. During radiation treatment, I was asked to lie very still on the treatment table while the radiotherapists determined the alignment and position of the machine.

As far as I remembered, the machine rotated up to 3 location/angles and at each location, the radiation beam was delivered.  The radiotherapists will not be in the room during the treatment, which was the scary part. They monitored the treatment via a video camera and an audio connection with the treatment room.  When the radiation beam was given, I didn’t feel a single thing, neither heat nor sensation! The three angle radiation completed within 2-3 minutes! Later, the radiotherapist told me that the radiation area spans from under my left armpit to the affected breast and across the left side of my chest and shoulders, Hmm….quite a large area there!

Thus for the next few sessions I would be hanging around the hospital as early as 7.15 am and get it all done by 8.30-8,45 am. The ladies or rather the radiotherapists were friendly and very nice to everybody! The whole process was convenient, no hassle and I felt absolutely fine for the first 10 sessions. My daily diary entry was reduced to nothing!  

Unsurprisingly, by early of week 3, I began to develop a lump in my throat. It was irritating but somehow it disappeared after a few days.  I also noticed  redness around the treatment area. By early of week 4, I could see significant colour change and swelling, especially around the nipple. In addition, breast pain (not all the time though) and some days, the discomfort caused sleeplessness.

After I completed 15 sessions, I was called to the doctor’s office again for checking. He looked at the treatment area and said “Hmm...this is interesting…, but no worries, your skin will heal and the darkened area will return to normal eventually.” He took a marker pen and drew a heavy dotted line across the area and said, “For the next 5 sessions, the radiation will focus on the tumor and surgery site.” I looked at the red pen marks on my skin, rolled my eyes, stared at him for seconds which reduced to a simple nod and went straight to the radiotherapist room, counting my days...

By end of week 4, the swelling, itchiness and skin colour became worse, and I was prescribed fucidin cream (I bought another version with hydrocortisone). Anyway, 2 weeks after the last radiation session, I could see great improvement, no more pain or soreness. Darkened skin began peeling, revealing a nice colour underneath.  Nowadays I use Cetaphil moisturizing cream and it works equally well.

I was to see the doctor again in 3 months. Really looking forward to see the cheerful and charming doctor!

Just a note, throughout the radiotherapy sessions, I ate as normally as I could (minus the heavy carbs), I exercise and carried out routine work. The best part was that I managed to lose 2 kilos so far. My aim will be to reach my pre-chemotherapy weight in another 6 months, slow and steady. I still take my cactus extract drink, beet root juice etc. routinely. Although I felt tired at times, eg tend to sleep before 10 pm and waking up at wee hours in the morning, I think I have regained most of my energy back and I am good.  I attended my student’s viva voce a few days ago and I was glad she passed with flying colours, what a blessing!

I recently got to know a friend, who has been my frequent exercise and lunch buddy. We have a lot in common and I count this as another blessing! 

Moving forward, with gratitude and mindfulness.