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Living through cancer

Living through cancer
by Karen A., breast cancer survivor

ife can throw us some very unexpected surprises. It was a couple of weeks before Christmas 2016. I had noticed small stains on the inside of my bra, but did not think much of it. It was by chance that I finally noticed a bit of discharge from my nipple. In my late 40s, this was not the first time this had happened; the previous times had been one-off occurrences, and I shrugged it off again, thinking it had something to do with changing hormones due to menopause. However, over the days leading up to Christmas, I noticed more stains on my bra, and mentioned it to my mother. Always the worrier, she urged me to see a doctor about it.

I made an appointment at the polyclinic to put her worries to rest. Just after Christmas, the doctor performed an examination and delivered news that was not festive. She had found a lump in my left breast. I was not in the habit of doing regular self-examinations, and in retrospect, I now realise that I probably had not been doing it correctly anyway. I could barely feel the lump, and was not too worried. It seemed small. One of my sisters had gone through a similar experience, and in her case, the cyst had been benign. It was probably going to turn out the same for me, I thought. Nobody in our family had ever been diagnosed with cancer. The polyclinic referred me to the breast clinic at a government hospital the following week, just after the New Year holiday.

At the breast clinic, the doctor performed an examination and at a certain point I sensed a sharpening of focus and concern. She showed me where the lump in question was – in the lower outer quadrant of the breast, not an easy spot to find, from the underside and upward into the interior of the breast. Then she asked me if I could spend a little more time there, as she wanted to check if the clinic could conduct more detailed scans immediately. Thinking that it was a cyst, and that the doctor was simply being cautious, I agreed. The mammogram went normally, but the ultrasound technician kept scanning my left breast for a long time. When she started taking an equally long time at the armpit, I began to get worried.

The clinic was almost empty when the tests were done and I waited to see the doctor again. By this time, I was simply tired. When the doctor told me that not only did I have a large lump in my breast, there was also one in my armpit, I still thought, “It’s just cysts.” Nobody in our family had ever had cancer, so what she told me seemed inconceivable to me. I was in denial as we scheduled a series of baseline scans and tests to be done the next week. However, after a biopsy, bone scan and CT scans, doubt began to creep in. At this point, only my mother knew about this, because I insisted on thinking it wasn’t anything serious and didn’t want to alarm other people unnecessarily. I decided to share the news with one of my sisters, who is very level-headed. She accompanied my mother and I to get the results of the tests and scans the following week. I’m glad I had the extra company then, because the doctor told us that I had stage three breast cancer!

Reacting to the news

We were in shock. Thinking that you might have cancer is very different from being told that you do have cancer. The doctor was sympathetic, talking to us with tears in her eyes. It must not be easy to give patients that kind of news. However, she also asked us what we would decide on – chemotherapy or a mastectomy – so she could advise the next course of action. Having had no family history of cancer, we did not understand the implications of either choice. Since the doctor whom we saw was a surgeon, she did not offer us advice on the choices, but said that an oncologist might be able to shed more light on the options. The clinic staff scheduled an appointment with the oncologist in the same hospital at the end of the following week.

In the meantime, the clinic also put us in touch with volunteers from the Breast Cancer Foundation. We met one of them, a breast cancer survivor who shared her experience and encouraged me to be hopeful, assuring me that breast cancer is very treatable.

We also began to try to learn more about breast cancer and the treatment involved. My level-headed sister was relentless in her search, which was a good thing, because I was still grappling with accepting the news. We surfed the internet and approached people we knew who had gone through the “cancer journey”. Everyone had different advice. It was overwhelming! However, the most common message was, “Go private if you can because it’s faster.” I checked, and found that my insurance would indeed cover treatment at a private clinic.

And the journey begins…

Through fate, we were recommended to OncoCare Cancer Centre by different friends – cancer survivors – whom we trusted. My sister made an appointment over the weekend, and we met Dr Tay Miah Hiang on Monday afternoon. After the introductory consultation, he referred us to Dr Tan Sing Huang, who immediately got the ball rolling.

Grateful to Dr Tan Sing Huang for the excellent care! 

It was at this point that the government hospital finally informed me of the results of the tests – I had triple-negative breast cancer, meaning that the cancer tested negative for the estrogen and progesterone receptors and excess HER2 protein. “That’s bad,” a friend told me, herself a breast cancer survivor. Triple-negative breast cancer is considered to be more aggressive than other breast cancers, such as the hormone receptor-positive subtypes. However, Dr Tan Sing Huang was confident that the chemotherapy would be effective. She planned 24 weeks of treatment for me – four cycles of doxorubicin/cyclophosphamide, once every three weeks, and twelve weekly cycles of paclitaxel/carboplatin.

At this point, things began to happen very fast. I had to undergo a 2D echo to ensure my heart was able to withstand the upcoming treatment. We also had to choose and consult a breast surgeon prior to the start of chemotherapy. And last but not least, we went shopping for a wig.

Before I knew it, I was checking in at the hospital to undergo a small biopsy-like procedure by my surgeon, Dr Tan Yah Yuen, to insert three small metal clips to mark the locations of the lumps in my breast and lymph nodes – just in case the chemotherapy was successful and eradicated the cancerous growths completely. I called it the “X marks the spot” procedure. About two hours later, accompanied by my sister, I arrived at the OncoCare Cancer Centre clinic for my first chemotherapy session. The nurses were kind, and took the time to explain what they were going to do and how it would affect me. I also had to have a white count booster shot the following day, and they showed my sister and me how to administer the injection ourselves. We were squeamish about it, but went through the motions anyway. However, my sister and I had such a hassle the next day going to and from a clinic to do the shot that I decided to just avoid the trouble and do the jab myself thereafter. It would only be another three times anyway.

By the time I had finished my first chemotherapy session and the obligatory booster shot, it was the day I was supposed to have had my first consultation with the oncologist at the government hospital. Going private is definitely much faster. It was also Chinese New Year Eve.

Treatment

Chemotherapy was not fun. It always started with the nurses having to find a “good” vein. There were times when they would have to try both arms before they could get the cannula in. That was fine initially, when my sessions were three weeks apart; but when we started the weekly sessions, they would alternate this procedure between both arms because they didn’t want my veins to collapse. When they couldn’t get a vein on the back of my hand, they would have to search elsewhere on my arm. Knowing this, Dr Tan suggested using a porta-cath, but I was not keen on getting the implant. I am stubborn that way.

I knew that I would be hooked up to a machine that would dispense the chemicals, but I didn’t realise that there would be several different types. There would be at least four bottles hanging on the stand next to me. Some would have odd effects, like a hot flush; or that ants were running on my skin, causing a tingling sensation, or an unsavoury taste in my mouth. Sometimes the liquid was so cold that I could feel it flow up my arm. I was glad that none of them made me feel nauseous immediately. In fact, once things were underway, I would put on my earphones and listen to music. Often, I’d fall asleep. The nurses would keep coming around to check that I was alright. Treatments were usually uneventful for me, except for one occasion when I started getting an allergic reaction. The nurses stopped the treatment immediately, and called Dr Tan in. We waited until I felt better, and then restarted the treatment, at a slower pace. I think I was there for more than six hours that day.

My mother insisted on accompanying me for most of my treatments. She was then in her mid-eighties, and I worried about what she would do during the hours I was having chemotherapy. She had brought books to read, and was also still learning how to use her smartphone. If she needed to stretch her legs, she would explore the hospital and shops, or go for something to eat. Most times, though, she stayed at the clinic, and the nurses took it upon themselves to look after her. They would make sure she had a proper chair to sit on – not a stool – and would get her a hot drink and chat with her when they had time between patients. We built a rather strong relationship with the staff, and still look forward to meeting them when we’re at the clinic.

The effects of chemotherapy were not as horrific as I thought they would be. What I anticipated with dread was throwing up, but was provided with such good anti-nausea medication that it never happened. The day of treatment usually left me feeling exhausted. By the next day and the day after that, I would feel sick at the smell of food, and usually didn’t feel like eating. I also had a metallic taste in my mouth that didn’t help my appetite either.

The other thing I dreaded was losing my hair. In the first week after my initial treatment, I noticed more hair than normal dropping onto my shoulders. Just like in the movies, I ran my hand through my hair, and it came off in clumps! I would go to the bathroom and finger-comb my hair, removing everything that would come off, throwing it in the toilet. It broke my heart to see the toilet bowl full of hair that I then flushed away. Within days, my hair thinned drastically and became patchy. I called that my Gollum look because I felt ugly. However, my family and friends did not flinch when they saw me then. In fact, they rallied around me, with suggestions of what to do. I did try using the wig, but it was hot to wear, and I was afraid it would slip out of position, so finally I decided to wear hats instead. “You’ll lose all your hair,” Dr Tan told me, but I didn’t. It weakened to the point that it was thin and brittle, but even after all the treatment, I still had a light layer of fuzz covering my entire scalp. I took pleasure in pointing out to Dr Tan as many times as I could, without being too snarky, that I still had hair. You have to have some fun along the way when you can! I was very pleased to see how quickly my hair began to grow back as soon as the chemotherapy was over. Week by week, my head darkened with a new growth of hair, until I finally had my first haircut of the year, about four months after I completed the chemotherapy. It was just a bit of a trim, but a landmark moment for me, because it meant I finally had enough hair to cut again.

About three weeks after I finished chemotherapy, it was time for surgery. I had opted for breast conservation, so the surgery to be done would be to remove any remaining cancerous cells from the two sites, and save whatever was possible of the breast – or, a lumpectomy. I was now under the care of my breast surgeon, Dr Tan Yah Yuen, and plastic surgeon, Dr Karen Sng. Hours prior to the lumpectomy surgery, I underwent a hookwire guided wide local excision and sentinel lymph node biopsy – both procedures to identify where the cancer had been, and where to operate on.

The surgery went smoothly, and ten days later, the lab results returned revealing the stunning news that there was no trace of cancer in the samples sent for testing! Needless to say, we were, and still are, very grateful to Dr Tan Sing Huang for knowing how to treat my cancer. Thanks to the effectiveness of the chemotherapy, I only needed to have three lymph nodes removed, instead of all of them, which could have led to drastic long term effects, like lymphedema. After a month of recovery, I went back to work. Two months after surgery, I had to go for about four weeks of radiotherapy. When that was done, so were all my treatments.

Retrospect

I know that I was very lucky in how things worked out for me. Never in my wildest dreams did I think I would have a complete remission, but I did, and here are some of the things I did to help myself to get through living with cancer:

Don’t be afraid

Getting the news that you have cancer is a death knell to many people. I recall seeing a fairly young patient break down in tears as her first chemo session began. Yes, it’s scary. We’ve heard all kinds of stories about cancer and chemotherapy. But, you know something? Our oncologists are experts at what they do. I decided to leave my care in my doctor’s capable hands, and focus on how I could help myself. Yes, having cancer is scary, but having it doesn’t immediately doom us to death. With or without it, everyone passes away. All we as patients can do is to take these challenges in our stride, and focus our thoughts on what we can do ourselves. Leave the medical treatment to the doctors and nurses who know how to help you. That’s more effective than worrying incessantly.

And while we left my physical care to the medical experts, we relied on our faith as Catholics to keep our spirits strong. Knowing that my immune system would be weak while I was having chemotherapy, I chose to avoid going to crowded places, such as church – rather like what’s happening with the Covid-19 situation. So we prayed daily as a family for a good outcome. You have to find strength wherever you can, to get you through tough times.

Some people are afraid to tell others that they have cancer. I was, at first. It was awkward to talk about it with people I wasn’t close to. Who do you choose to tell? How do you break it to them? I avoided it until I faced situations like talking to someone who asked how I was, and I automatically replied, “Fine, thank you,” only to cringe inwardly at the blatant untruth. Or when I unexpectedly bumped into a good friend, and I simply blurted, “I have cancer!” Surprisingly, the answer came from Dr Tan Sing Huang. She made a comment about Facebook during one of my check-ups, and that gave me the idea to “drop the bomb” there. My Facebook network is just for my good friends and family, so it seemed like a good way to just get it out there. After that, news got around, and it was easier to face people. As my insurance agent told me, cancer is very common today, and there is no stigma attached to having it. The only taint is in our own minds. As I discovered, it is better to be open about it, because sooner or later, people will find out. You need to accept it and come to terms with it. Just be prepared to receive lots of messages about how to deal with cancer after that!

Have lots of support

I was so blessed to have my family and close friends to accompany me on this journey! I would have been very lost without the support of my mother and logical sister when we first got the news that I had cancer. Together with the rest of my family and friends, they made sure that my needs were met, helping to get things I needed, accompanying me to the clinics and constantly encouraging me. Friends who were cancer survivors shared lots of advice, including a friend whose husband was also then a cancer patient. At home, my family tried to give me meals that would keep my strength up, and my eldest sister supplied me with fresh fruits every week. One of my hobbies is gardening, and when I was told to take it easier, some of my dear friends came over to do the heavy work for me, in return for brunch! Another friend happened to have appointments at the same hospital, and timed them so she could give me a lift home after my treatment. People prayed and sent good thoughts my way. My employer was very supportive, and let me work from home for the duration of my treatment, with the lightest of workloads. I couldn’t have made it through without all these wonderful people around me.

Be positive

It may sound simplistic, but I focused my thoughts on happy, healthy things when I was going through my treatment. If I encountered something that dampened my mood, I avoided it. That meant being selective about the type of news that I read or watched, as well as who I had around me. I took inspiration from stories of strength, positivity and endurance, and had the end result mindset that everything was going to work out for the best. Little did I know that it would really work!

I also kept up with my hobbies – some light gardening, reading, listening to music, spending time with my dogs. It’s important to keep your mind focused on things that keep you occupied and happy.

One unexpected silver lining was the people at OncoCare – from the counter staff who greeted me by name when I arrived, to Dr Tan who had to endure my quirky humour, to the nursing staff who were kind, attentive and helpful, not just to me but also to my mother. Thanks to all of them, we looked forward to going to the clinic over those many months. I also have to give a special mention to Dr Tan for rearranging my chemo dates when she realised that my birthday would fall during the treatment period. She planned it so that I would not be feeling the worst effects on the day itself.

It was a happy occasion when I had my final chemotherapy session.

Eat properly

One of my friends is a nutritionist, and he gave some suggestions on what I should and shouldn’t eat. I gave up red meat, sugar and processed food, and ate the healthiest meals for more than six months. It was mainly steamed food – mostly chicken, fish, veggies and fresh fruits. I can hardly bring myself to eat fish now, because it reminds me of that period when I felt so lousy. However, the important thing at that time was to give my body the nutrients it needed to get through the trauma of chemotherapy.

Don’t get distracted by what you should or should not eat, though. There were those days after treatment when I couldn’t bear to eat anything, and I lost weight. At times like that, you should remember that it’s important to eat something to keep your strength up, and that was when I “cheated” with things like potato chips or peanut butter. No, I did not eat large quantities, but just listened to what my body indicated it could tolerate. As the treatment progressed, my sense of taste deteriorated, and we had to keep changing my meals just so I would eat. I recall having absolutely no appetite but forcing myself to eat what was on my plate. Then we began to experiment with things like homemade sushi (not the raw type) and flatbread, and that helped.

Above all, do listen to your doctor’s advice when it comes to your diet. There may be foods that interfere with your treatment. In my case it was certain fruits like grapefruit and pomegranate.

Also don’t get carried away with fads. The internet is full of “miracle cure” stories, particularly diets. It’s tempting to think that there’s something that can cure you faster, but it’s better to be cautious, even though there are some cases where certain foods or treatments may have been beneficial to some patients. Just bear in mind that they may work only for certain types of cancers. Stories tend to generalise and sensationalise the “miracle nature” of these things. Just check with your doctor before you decide to try any of these foods or natural treatments, as they may not be real, or could interfere with your course of treatment.

Stay active

It was only after I completed my treatment that I came across a report from Australia about how some cancer patients are prescribed specific targeted exercises designed for their own tumour type and treatment on the same day as they get their chemotherapy or radiotherapy. I had taken it very easy during my treatment and after my surgery, and it took a long while to get my stamina back. I wish I had been more persistent in that respect.

Post-treatment effects

When I finished all my chemotherapy, surgery and radiotherapy treatment, I thought everything was over and done with. All I had were regular followup check-ups with my different doctors. I had my complete cure, was regaining my strength slowly, and was back at work. However, after several weeks, I realised that something was wrong. It seemed unnaturally difficult to complete tasks, and I kept forgetting things. A whole day would go by, and at the end of it, I didn’t seem to have achieved much. It was so frustrating! It was then that I learned about “chemo brain”, a side-effect of my chemotherapy. Different people have different post-chemo reactions, and unfortunately, this was mine. It made things very difficult at the office, and in retrospect, I would not have returned to work so fast had I known how it would affect me. It tested the patience and faith of my colleagues, but after several more months, I managed to get over the worst of it and began to work properly again, slowly.

Insurance

Everyone should have an insurance policy to cover medical situations. If you’re healthy and you don’t have one, go and get one now, because when you get bad news about your health, you don’t want to have to worry more than necessary. I didn’t realise what I could get out of my insurance policy until I asked my agent. If not for that, I probably would have remained in the care of the government hospital, and who knows how long that would have taken? They have to look after too many patients, and can be stretched. Having healthcare insurance coverage gave me peace of mind that a portion of my treatment would be financially taken care of. The cost of all the tests and treatments can be quite alarming whether you have a healthy bank account or not. Singaporeans will be able to use Medisave and Medishield to subsidise some things, too.

It is now about two and a half years since I completed all my treatment. I’m back in the rat race known as “work” and am readjusting to things. My initial driving thought was to get back to my old life, but I soon realised that I was now on a different journey. Chemotherapy had triggered immediate menopause for me, and I had to adjust to those changes. I also had low stamina and bone/joint issues for several months, and teasingly blamed Dr Tan for giving me “old age” problems. However, like the chemo brain, they diminished when, at Dr Tan’s recommendation, I tried to live a more active, healthy life. It’s so strange, because before I had cancer, I took my health for granted. Today, I have to contend with all these “after-effects” of cancer, and middle age. My life turned a page and started a new, unlooked-for chapter.

I still don’t know why I had cancer, and guess that stress and food had something to do with it. All I, and any of us, can do is try to manage them the best we can. Gardening used to be my stress management tool, and I am happy that I can finally get back to it. It provides me with exercise, flowers, fruits, vegetables and vitamin D from being out in the sunlight. Staying positive is still important to me, as well as being a force for good to those around me. I also encourage all the women in my life to check regularly for lumps in their breasts and go for their screening mammograms. Early detection is better than late, or none at all. I hope that what I have shared can be of help to others who are going through the same journey.