Phase 2 first radiation session

Yesterday my brother David accompanied me to the hospital. I had a few routine check-ups to do there and I wanted to ask the dr for more medication. I also had another CT on the machine which would be giving me radiation treatment everyday. They re-drew the black lines across my tummy and darkened the markers for the alignment of my body under the machine. Good thing they removed the three pieces of tapes on me - those were making me itchy. Then I was in the room alone with the machine, which circled around me and did whatever it was supposed to do. Afterwards, the therapist told me they did a CT on me, as well as my first radiation treatment. My radiation oncologist inspected my CT results and instructed for the first dose of treatment on me. I didn't feel any different. Only that my right side of tummy has been hurting all day because I had run out of the pain killer. I also asked the dr to give me some medicine for relaxation and sleep because I'm afraid I won't be able to sleep at all on my first night of chemo. So we went home with my prescribed medicine.

When we got home, my tummy still hurt - I had taken a different pain killer and it hadn't kicked in yet. So I decided to go back to my room and lay in bed for a bit, with my laptop. I just suddenly felt sick. At first I thought it was just the tummy pain. But soon it became just a general sick feeling and then nausea. Suddenly I had to run to the bathroom to puke, barely missing the toilet. I was totally caught off guard at my reaction to the radiation. I quickly took Gravol but also got rid of it as quickly. In the next few hours I threw up 6 more times, got rid of whatever remained from lunch, as well as whatever little I tried to stuff down as dinner. One of the times I was too late to the toilet and threw up at the bathroom entrance. David kindly cleaned after me. I stayed in bed after that, with a bucket next to my bed. In the end I was just retching with nothing more to come out, totally exhausted. By that time, I felt it was probably safe to take Kytril - which is a once-a-day anti-nausea medication that cost about CAD$300 per week (I had 4 days left from Phase 1). Then I finally slept without waking up again.

Today I woke up feeling ok again. Just a little tired and drained from last night's activities. Kytril worked, and I have enough to last me till Monday. Hopefully I can get the same medicine here too. I couldn't believe how soon the radiation hit me. Usually the radiation side-effects don't kick in until at least a week later. But I guess my body already had radiation before so it took no time to react..? Anyway. I hope my nausea can be under control from now on.

In light of my cancer development..

In light of my cancer development, my family members have each decided how best to help me.

Mom is paying my medical bills and much of my living expenses (the helper who cleans and cooks for us, food, and many other miscellaneous expenses). She added a desk in her office at work so i'll have a place to go during the day when i feel up to it.

My brother David lets us stay with him in his condo. Stanley and i occupy his guest room, and when Evie moves in next year, he will empty his gym room for her usage. He's willing to modify his living style to accommendate us and in the near future - Evie.

Stanley's parents are taking care of Evie in Toronto. Stanley's sister Anita, brother-in-law Danny, and their one-year-old daughter Ella all live in the same house as Evie so she is well cared for over there. Evie also has the company of Ella so i think this is the best arrangement for her at the moment. They all love Evie and have no problem taking care of Evie for us..

My grandparents, aunt, and cousin in Toronto are visiting Evie every weekend. They usually bring lunch and eat with Evie, play with her until her afternoon nap time. My grandparents are over 80 years old and the car ride is quite long for them, but they do this for me every weekend..

Dad lives in Tainan (southern Taiwan) and has 2 little boys of his own, but he tries to visit me whenever he gets a chance. He offered to take care of Evie for us but we felt Evie would be more comfortable staying with her grandparents whom she's already close with.

Stanley is in Toronto arranging our move to Taiwan. He will come to Taiwan after he's done tying loose ends over there - we estimate in about a month or so. After he gets to Taiwan, he will apply for permanent residence here and start his job search. Before he gets a job, he will watch over me and keep me company. He's willing to move here for me even though his parents and friends all live in Canada and his job prospects are much better over there..

In addition to my immediate family, my aunts, uncles, and cousins have all expressed their encouragements and love to me. i don't know what i did right in my previous lives to deserve such loving and supporting family!!

i'm also in debt to my friends who talk to me, respond to my blogs, chat with me online, exchange messages with me via email or Facebook and etc. All of your words warm me up and give me strength to face what i need to do. i'm really thankful to have such loving family and friends. Words cannot describe how thankful i am and how lucky i am!

As treatment date approaches, i couldn't help but feel a little nervous and anxious. i'm terrified of the chemo, but i have to follow through with the program. my life depends on it. i'm not happy about leaving Evie in Toronto but i know once treatment begins, i will not be able to look after anybody. i miss Evie very much but this arrangement is the most worry-free for me. i need to focus on my treatment and recovery so that i will have a future with Evie and everybody else.

Thank you all for your love and support!

Treatment Phase 2 begins on 2009.06.01

i'm going to call the radiation+chemo treatment i received in 2008.12 and 2009.01 Phase 1. At the time, i thought it was the only treatment i was going to get for my cancer, but i had totally underestimated my adversary's power over me. Phase 1 was completed in Toronto. Now i've moved to Taipei and will begin Phase 2 on 2009.06.01.

Phase 2 includes radiation and chemotherapy, similar to Phase 1.

The chemo will be the same, except that in Taiwan, i will check in at noon and stay overnight at the hospital to receive the weekly chemo. The medicine used is called Cisplatin. It is the same as what i had received in Phase 1. This medicine needs a lot of fluids to wash out in order to preserve my kidneys. Therefore, i'll be given several bags of saline solution during my chemo stays at the hospital. (In Canada, i was simply told to drink 2 litres of water a day. My chemo sessions there only consisted of 1 bag of saline and 1 bag of Cisplatin.) As such, i'm not so hopeful that i would be unaffected by the side effects. But the good thing is that i won't need any catheter (人工血管) installed on my chest or arm for the i.v. Cisplatin is covered by insurance (健保) but hospital stays are only partially covered. Double room is NT$2,200 per day and single room is NT$4250 per day. Hospital food is about NT$390 per day. i will receive 6 chemo sessions in Phase 2. (In Phase 1 i only received 5 sessions of chemo.)

Radiation will be targeted at my abdomen area, as opposed to pelvic area in Phase 1. i was told that the upcoming radiation will go easier on me compared with Phase 1 because i'm paying a little extra money (about NT$28,000 for the course of Phase 2) to receive a better targeted radiation treatment. My Phase 1 radiation was basically a boxed-area treatment - hence the damages to my intestines. Hopefully Phase 2 radiation will only aim at the cancer cells and avoid my good cells, so as to minimize damages and side effects.

The radiation oncologist believes i will be able to work during treatment. However, i'm not so optimistic after speaking to the chemo oncologist.. In any case, whatever they say i may or may not experience is really irrelevant to me, because everybody reacts differently to these treatments. i will know how i feel when the time comes.. which is soon enough!!

Phase 2 is expected to be 6 weeks but the exact time frame isn't determined yet. i will go to the hospital 5 days a week to receive radiation, and stay overnight one day per week to receive chemo.

i was told that there's some unidentified water in my abdomen (腹水) that needs to be monitored. The dr said it could be cancerous, or it could be my body's reaction to the existing tumor. In any case the water is too little to be analyzed right now so we'll have to wait and see.

Phase 3, adjuvant chemotherapy, will begin a few weeks after Phase 2 ends. The date is not determined yet because it depends on how i react to Phase 2. Phase 3 will be chemo only. There are two options for me: 1) Cisplatin + Taxol and 2) Cisplatin + Topotecan. i will be given chemo once every 3 weeks, and i will need 6 cycles = 18 weeks in total. Cisplatin is covered by insurance but Taxol and Topotecan are self-paid. Option 1 will cost about NT$30,000 per session with 1 day of hospital stay, and option 2 will cost about NT$20,000 per session with 2 days of hospital stay. The dr said both provide about the same results but the side effects are different. i'm still trying to understand more about the two before i decide which to go with.

Cancer it is.

i just received the call from Dr. Chung at Sun Yat-Sen Cancer Center. He confirmed that the thing giving me trouble is indeed cancer. I'm glad we didn't get an inconclusive biopsy result because if we did then the treatment will be very difficult to plan. As it is now, we have no more doubt, and the dr can let us know precisely what our next steps are. We will see him first thing tomorrow morning and i will also have my radiation treatment planning session then. i think it means i'll get tatooed again (just a few tiny black spots) which will help aligning my body under the radiation machine so they can accurately beam me every time. i think radiation will start on Monday and it will be everyday from Monday to Friday, 10 minutes per day, and I will receive supplementary chemo once a week that will strengthen the radiation treatment. This treatment will take approximately 6 weeks. Then i'll get a couple months break before the chemo regime. Anyways. More details to follow on that.

Thanks for all of your prayers for me. Please don't be distressed by my illness. I'm happy about the biopsy result because it provides us a clear direction and there are proven technologies that will be used to take care of my case. And this time around, i have a much better connection with the doctors and nurses - oh man, language really matters in times like these... for me anyways! i'm much more communicative to the doctors and nurses in Taiwan. And i intend to be a good patient. So, please don't worry about me :)

waiting for biopsy results

the biopsy was done yesterday. it was quite painful, not where they poked me (they applied some local aesthetics), but i started having tummy crams half way through the biopsy. the pain was pretty bad. afterwards, they gave me a shot of pain killer, which finally killed the pain for me. but it also made me very super drowsy so i pretty much slept the rest of the day.

now i'm waiting for the biopsy results.

some people say waiting is the worst but i'm not so sure about that. at least right now we are not 100% certain it is cancer.. this might be a better thought than what the results are going to tell me in a couple of days.. whatever.

the doctor is being very realistic with us. he said, if it is cancer, this is going to be my last chance to fight it. we'll discuss the treatment plan in detail based on the biopsy results. but just to give us an idea, i'll most likely get radiation treatment for 6 wks daily with supplementary chemo once a wk. then rest for a month or two. then 4 months chemo. chemo scares me but i have to do it if that's what it takes to get rid of cancer..

these days i keep my mind occupied with shopping and reading (recently, thrillers by James Rollins). i try think less about the upcoming treatment, my sickness, my odds of survival, and what i should do right now in case my life shall end prematurely, etc. i don't want to be strong - what is being strong anyway? i don't think i'm strong. i rather avoid thinking about it altogether. i'm more at peace that way. i'll do what needs to be done to rid of the cancer but i don't want to think about cancer all the time.

i've read somewhere and also heard people telling me if i think positively it would help me get better sooner. but if thinking positively can be so effective, i should never have got cancer in the first place. i was so convinced i was at the height of my health about half a year after delivering evie. i felt good about myself. i was active because of evie; i was eating healthy because of breastfeeding. i was feeling great. then i got cancer. ok, fine. deal with it. i went through the 2 months treatment, all the time thinking after this was over, i'd say goodbye to cancer. i was so confident about returning to health. and now i got this new tumor. so you know what? i don't believe positive thinking has anything to do with this. unless my own thinking isn't powerful enough? people whose mind power stronger than mine are thinking my cancer is going to endanger my life? i don't know. in any case, i don't want to be told to think positively because i don't believe it works. i just want to be myself, which is - being realistic.

so, you got that right. i don't want to be strong, and i don't want to be positive. i just want to be myself. i'm not going to change my personality just because i have cancer. but i am changing my lifestyle. after some reading up, i think the reasons i got cancer is because 1) i used to consume a lot of packaged food and drinks and 2) i had avoided sun exposure for more than 10 years. my having cancer is because of my own wrongdoings.

now we are moving to taiwan because this is where i feel most comfortable fighting my last battle with cancer. i should say i'm considered already moved in. my husband and daughter haven't moved yet because they need to get some paperwork done before they can move here and stay long term. we are staying at my brother's place, which is in the same building as my mom's place. mom has employed a really nice lady for cleaning and now she's cooking for us as well. i feel i'm really super lucky. i've had so much support from stanley's family and my family. as a married daughter, canada is where i should be staying because my home is with stanley and his family. but my mom and bro welcomed me back. stanley is willing to make the move for me and his parents, sis, and bro-in-law are looking after evie for as long as we need them to. (the plan is to move evie here when i'm done and recovered from treatment.) everyone in the family supports us in every way we need, so that i can focus on getting better... i can never say enough "thank you" to everyone. i feel so sorry that my sickness is bringing so much trouble to all our families in canada and in taiwan. but such things are life. i'm thankful for living it.

back to reading thrillers..

I am going to WIN!

I just received word from my Canadian radiation oncologist Dr. Ackerman. After reviewing the PET/CT images I sent her, she says: Your treatment fields were to the pelvis and this looks like it can be treated without overlapping your previous pelvic radiation treatment area.

This is very good news!! Now I know for sure that I can beat this thing with the help of all these good doctors who are looking after me and the great support from my dearest family and friends...

I am going to WIN!

: )

Tumor confirmed

I got the result from last week's PET+CT scan and it is telling the same story as the PET scan from a week before. There is this approximately 2.5cm tumor in my abdominal lymph node. The medical term is "para-aortic recurrence." This is the cause of my strange abdominal pain that is sometimes on the right side, sometimes in the front, sometimes in the back and growing more painful week after week because it is touching some pain nerves there. I've been given pain killers for this - a regular type which I take twice daily, and an enmergency type which I take when needed. I hope the pain will not become worse and worse like the doctor said..

I will get another CT of abdomen so that they can see exactly where this tumor is in order to perform a CT-guided biopsy. The biopsy will take place next Monday, most likely, when I will literally get stabbed in the back. My brother said, "hey at least you know when it's happening. Normally people have no idea when they get stabbed in the back!" Alrighty bro.. The abdominal CT will help them see which path to take because the tumor is located very close to the two thickest veins in my body (主動脈, 主靜脈), as well as my right kidney, and intestines. If they accidentally stabbed any of that, I'll be in big big trouble. However, biopsy is necessary because if it is not cancer then the treatment will be totally different. Also, my cervical biopsy showed two types of cancer cells. It will be good to see what kind of cancer cell is in the new tumor because we have no other way of knowing whether it was there before cervical cancer or if it was originated from the cervical cancer.

The chance is pretty high that it is cancer because this spot is a common place where cervical cancer would move to. So, what next? That's where I'm having a headache right now because my next treatment hinges upon my past treatment. The problem is, there is a upper limit to how much radiation each part of our body can accept in its lifetime. Exceeding the dose will cause the body part to fail in about 6 months after the treatment. Therefore, I need to obtain the 3-D radiotherapy dose distribution and treatment planning data as well as the radiotherapy summary note from Sunnybrook Hospital. The oncologist in Taiwan cannot safely give me radiation without such information. It would make my life worse if they killed the cancer but also blasted my intestines and spinal cord so I'll become paralized and unable to digest food. Therefore, radiation cannot be done if I cannot obtain my previous treatment data.

Treatment back in Canada is an option but I am very reluctant to take this route. If I can indeed receive radiation again, Taiwan will radiate my abdomen as well as my upper body - where the cancer might go next. In the event that there are unseen cancer cells moving up, they will also get killed, and I will have a much higher chance of survival. If I'm receiving radiation in Canada, they might do what they did the last time: just radiate the area they have confirmed visable evidence of cancer cells. I'm afraid a couple months after the localized treatment, I will suffer from another new tumor and there will be no more tolerance for radiation left in me to fight. My treatment this time is crucial. I would prefer the battlefield be in my hometown, in my mother tonge, with the option for paid medical services, rather than in Canada, where I can only accept whatever that will be decided by the doctors with my half understanding of the implications and no opportunities to learn about or pay for more testings that might help with my diagnosis. I just hope Sunnybrook has a way to export the radiation data for the oncologists in Taiwan...

Worst case scenario is that I was already radiated full dosage in my abdomen the last time around. If this was the case, it would mean the new tumor is so strong that it survived the last treatment. There are two other ways they would be able to remove the tumor locally - only a few places in Taiwan have those expensive machines and those procedures will not guarantee a clean kill because they are very localized. If there are any invisible cancer cells left, then eventually I'll get more tumor later on.

Chemotherapy will be my last resort: it will inhibit further growth and spread of the cancer but it will not kill the cancer for me. Choosing chemo alone would mean giving up.

I'm very far from giving up. Right now I'm focusing on obtaining my previous treatment data from Sunnybrook. I just hope their system isn't too old to have the capability of data export... In the mean time, I wish there is something I could do to comfort my hubby, mom, bro, in-laws, and all my friends and family. I want everybody to know that they shouldn't worry about me because the doctors will help me get rid of this cancer.

i miss evie very much!

i haven't seen evie since 4/14. it's been almost a month... she's grown so much - outgrowing the clothes and shoes she had before i left, or so i was told. i can't really tell how much she's grown. She's not very enthusiastic when she sees me on Skype now though. Soon she will forget who ma ma is or what it means. i feel kinda stuck here, and very sad, whenever i think of her. i want to bring her over as soon as i can, but when is that going to be? when will i be able to take care of her myself?? i have no answers, just a lot of questions. and i wish she could be here with her mom and dad.

PET+CT Scan

OK.. so i saw the dr. who gave me the PET scan on Friday. his conclusion was that i should start chemo immediately. i was to report to the hospital on Sunday and get a catheter installed on my chest. i would be on chemo for 2 days per 3 week cycle, and i would need a minimum of 6 cycles - 18 weeks at least. we were in shock, mom, bro and i. but we signed up anyway thinking if it needs to be done, it needs to be done. i should get started on treatment while we make arrangements to get a second opinion on the side. (if the dr wanted me on chemo on Sunday, i must be in deep shit.. no?) however, after we separately consulted our own friends about this, it seemed to us that we should seek a second opinion before commiting to the treatment. also, our friends all recommended us to go to a particular cancer center. One of my friends, Theresa, helped me arrange an appointment to see a dr there on Monday. I'm so glad we did this. The cancer center was so much better than the general hospital we went last week. At the general hospital, there were 3-4 people sitting inside the room waiting for their turns while the dr told me i needed chemo right away. yup, all very rushed with no privacy whatsoever. At the cancer center, on the other hand, we meet with the dr. in a room, while other patients waited outside of that room. Also, because the cancer center is not a general hospital, the number of patients is significantly less. The atmosphere much more peaceful and pleasant. Most importantly, the dr. makes a lot of sense to me. He read through all my records from Toronto as well as from the general hospital from last week. He studied the PET scan i did last week. Really carefully, he told me the PET scan only told half of the story. At the cancer center, they do PET+CT scans together so that what shows in PET can be cross-referenced in CT. PET may show an area of cancer cells (in black), but the location and size is fussy, and it may not even be cancer cells depending on the circumstance. (For example, the image showed a lot of black around my neck. The technician told me we can ignore those black areas because that is due to my stiffness.) So according to my new dr., my PET scan from last week reall didn't give him any concrete evidence that i have cancer in my abdomen lymph node. He recommended me do a PET+CT scan. If PET+CT indeed identifies tumor in my abdomen lymph node and if it is large enough, the next step will be a CT-guided biopsy. If the biopsy reveals cancer, then the next step is to figure out what treatment i'll need............ so, we were so ahead of ourselves last week and had a good scare for a whole weekend. Of course, maybe what i'm doing at the cancer center may prove to be a mere delay to a full-blown chemo in the end, but at least by that time i'll be thoroughly convinced, and i'll be receiving treatment from a dr i feel comfortable talking to and an environment that makes me feel safe. big thanks to our friends who recommended this cancer center, especially to Theresa and her family! and my poor mom, wasted $ on that feeble PET scan last week...
i will return to the cancer center on Monday to see the results and discuss next steps with the dr.. until then.