A Word to Cancer Patients Out There

Do not give up!” – nah this is too cheesy. I would say “Be strong!!” because there are other cancer patients having it harder, having poked by needles more times than you, had grown weaker than you are and are in the later stages of cancer. During my chemotherapy sessions, I saw a mother who had to take care of her 3 kids while on drip whereas I had movies on iPad to accompany me. On another occasion, I had difficulties in opening the lid of my lunch takeaway because of the flexible tube in my forearm, an elderly (waiting for nurse to start drip on her) across me smiled and came forth to assist me. I was amazed at how carefree and that she takes chemo sessions as norm while I dreaded each visit. I have heard stories of cancer patients going for more than 20 sessions of chemo sessions and each longer than 4 hours whereas mine is only 7 sessions, 4 hours each.

Stay positive, try your best to complete all treatments, think of yourself and your loved ones. And don’t worry about cancer recurrence, though I worried that myself at times but there’s a little angel constantly whispering to me to make more effort this time round to show more concern and cherish every moment with my family.

Introduction

I had written 42 posts for TechSch but never had once thought of penning down my journey with Stage 2 Nasopharyngeal Cancer (Nose Cancer). Using words like ‘fight’ or ‘battle’ is exaggerating for my case because there are many cancer patients out there battling 10 times harder than I am and even had to go for surgery. So, why do I want to share my story now? This is because I came across a thread titled “If you got cancer will you bother go for treatment?” in one of the local forums Eat-Drink-Man-Woman (EDMW) this evening. There are many opinions and advices in the replies. Some said don’t need bother to go treatment if you got Stage 3 or 4 cancer. Others replied if you are e.g. 55 years old and above, then you should skip treatment, take the money and enjoy remaining life. Then, there is one whom had cared for his mum with cancer and is grateful that it extended her life.

As I am cured of cancer for now, I am biased and disagree with forgo treatments type of replies. However, it strikes me that I should write down my own experience, not to debunk that radiotherapy and chemotherapy treatments are useless or ineffective and a waste of money but to repay by sharing my story to tell cancer patients that it is not the end of the world. You see, I was disheartened when I found out that I am a suspected case of nose cancer and I went online to research on various stages of Nasopharyngeal Cancer and most importantly, I read stories about patients recovering from same cancer as me and had carried on living with their life and family. I have a wife and two kids so you can imagine how such stories motivated me and lift up my spirits even just for that brief moment.

Background

I never thought cancer would find me at age 38

Well, it did and I had learnt to accept the fact that it just happened to be me. I am a typical Singaporean guy. I obtained PSLE, O level, Diploma, Bachelor and went to National Service (NS). I started working, found my love, married and bought a HDB flat. After a few years of married life, we started a family and have 2 mischievous kids now. In between my work life, I changed 2 – 3 jobs but all are IT related and are 80% desk-bounded (e.g. programmer) whereas I had to move around to do end user support for remaining 20%.

I am healthy and fit in general

On a scale of (obese, lazy, extreme unhealthy lifestyle) 1 to 10 (super-fit, hard-working, exercise daily), I will rate myself a ‘6’. I went to National Service (NS) and I belong to the ‘siong’ training era where one is required to serve 2.5 years. My vocation was Commando Fighter and I was PES A till the day I completed all my 8 cycles of reservist and annual Individual Physical Proficiency Test (IPPT). My worst station is 2.4km run and there was once I manage to pass the run on my 5th attempt but I never had to do remedial training (RT) before. I had no history of major illness and seldom fall sick. On the average, I took less than 6 sick leave per year. I can walk long distance and jog 3km easily and can carry my little boy or girl and walk shopping malls while they fall asleep on my shoulder.

My Lifestyle

I had consumed less than 100 cans of beer in my entire life! I only drink alcoholic drinks during Chinese New Year and Christmas but in small quantities. For example, I would share a can of beer with my dad. And no, I don’t smoke or go clubbing. I have a mixed diet and I ate lots of meat and little vegetable, the ratio about 3:1. I will always order 2 meat/fish and 1 other non-vegetarian dish like sliced potatoes or fried egg for a plate of economic rice. Then either western food or fast-food once a week. I don’t go crazy to bubble tea or Starbucks coffee and I will have 1 – 2 cups of hot tea (teh) or coffee (kopi) after each meal which I consider as uncle’s favorite drinks at my age.

My bad habits include sleeping late, often at 2 – 3am in the morning, 1 bowl of instant noodle and 2 – 3 times of potato chips every week. I also drink half a cup of Jim Beam Cola which consists of Jim Beam (1cm depth) mixed with half a can of coke once a week. After I completed my reservist, I ‘downsized’ my exercise regimen to 1 – 2 times jogging every 2 weeks at my current workplace, distance ranging from 3 – 4km.

Annual company health screening reported nothing unusual

I always make an effort to sign up for my company annual health screening. I will also top up to upgrade the basic screening package to next tier in order to include more tests. For the past 10 years, all the lab reports never detected anything bad. The recent report (the year which I was diagnosed with cancer) concluded that I was slightly obese at 71kg weight and 1.71m height.

Timeline

Early November 2019 – Symptoms: Nose bleed, lump on neck and ear block

I felt a small painless lump on the lower right of my neck on day, the size smaller than a 1-cent coin and I got frequent right ear block as if the sound is muffled during those days. I hesitated to see a doctor and went on with my daily routine thinking that it might be some insect bite or it will go away in time. It bothered me for almost two weeks until one day, when I was eating tom yam flavor instant noodle at the dining table and half way through, I felt some liquid flow out of my nose. It was blood! Alright, so I thought maybe the noodle was too spicy. But within a week, I got nose bleed again, when I was doing work in front of my desktop. These two nose bleeds occurrences within a week coupled with the lump on my neck made me felt that something’s not quite right and it prompted me to go see a doctor the next day.

Mid November 2019 – Diagnosis: Doctor says “You got to prepare yourself…”

It was late evening around 5pm on a weekday when I went to visit my family doctor. I went in told him about my nose bleed and the neck lump. He did not check my nose and I can’t recall if he even feels the lump on my neck or because it could be visible to the naked eye. He was calm and told me yeah, you got to prepare yourself for what I’m going to say but before I could, he already let out the second sentence, you may have nose cancer (Nasopharyngeal Cancer). He explained that there are two paths which I can take for treatments. Visit Polyclinics and get deferment letters or head straight and check myself into the A&E. He mentioned about the longer waiting time for Polyclinics and recommended me to go the A&E route if I wanted fast.

At this point in time, I was feeling more confused than worried, perhaps because ‘cancer’ is still new to me and I left the clinic. I was walking back home when my mobile rang. It was the clinic asking me to return. I went back and the receptionist asked me to wait while the doctor wrote me a letter to pass to the next doctor whom I will see. Back home, I told my wife what the doctor said and that I will go A&E by myself after dinner, she wasn’t too worry I guess and it was dinner as usual for the whole family.

15 November 2019 – Checked myself into SGH A&E

I took a cab down to A&E by myself because my wife had to look after the kids. It was almost 8pm by the time I arrived at A&E. I took a queue number and was called up for ‘basic’ registration at about 10pm. Then, I waited again to do my blood test and after my blood sample was taken, it was like another 3 – 4 hours wait before the blood test results came out. The general doctor called me in and told me that my blood did not show any signs of cancer makers. I thought for a moment, alright, this is good news, maybe the entire episode is false alarm.

I waited again to see an Ear, Nose & Throat (ENT) specialist for a general diagnosis. She used a vacuum type medical machine to suck wax from my right ear. It only helped a little bit. She further explained that my ear is fine, no wax or anything and the irritation is caused by the lump on neck due to the fact that don’t know what liquid cannot discharge out normally. The ENT specialist then made a phone call to a senior doctor down to A&E to see me which by this time, I guess my cancer was more or less positive. He collected my nose swab (biopsy) by inserting a lubricated tube down into both nostrils to scrap the tissues. At the same time, photos were taken. He told me that I need to wait 1 – 2 weeks for the lab results to confirm if I really got nose cancer. And by the time I reached back home, it was already 5+ in the morning.

ENT specialist explained there is no medicine for my ear discomfort. Unconvinced, prior to my Taiwan trip, I went to see another family doctor at my place, told him all my symptoms and the hearing irritation that I wish him to help me with. Also informed him that I am suspected to have nose cancer pending results. He didn’t seem alarm and never offer any cancer-related advices. He just went ahead to prescribe some ‘tablet’ medicine for me to eat but it did not help. While I still have not alerted my parents up to this point of time, I did however share with my wife whatever the doctors told me. And I told myself, I did whatever I could, I sought A&E which is the fastest path after my GP advice on the same day. I did all tests given to me during my A&E visit and had to wait for lab results before knowing what the doctors can plan for me.

19 – 24 November 2019 – Taiwan Holidays

I was actually still very upbeat about the Taiwan trip with my family. We had talked about the trip for a couple of weeks now and finally purchased air tickets on 16 Oct which is before I discovered my nose bleeds and neck lump. In between the time after my A&E visit and before the Taiwan trip, I was actually more focus on the trip itinerary than my own health, probably because I didn’t know what lies ahead for me while waiting for the lab results.

It wasn’t a very enjoyable trip because my right ear was muffled most of the time which irritated me plenty. The feeling is equivalent to ear blocked at high altitudes. For most of the days, I had like 50% hearing loss on my right ear and I found myself talking louder than usual because of it. One day, I received 2 – 3 calls from an unknown Singapore (+65) phone number which I ignored. It was about 8+ pm local time when I finally decided to pick it up while I was out strolling alone (family resting in hotel) in one of the street night market. The caller was the senior doctor who did the nose swab for me during A&E visit.

He told me that my lab results are out and I need to go back for a review. I explained to him that I am now in Taiwan for holiday hence can only do so after I return. I asked him how was the results and he told me to come back for review then say. Sensing that he doesn’t want disclose the outcome, I ask him again, is it good or bad news. He replied, not good but also not that bad… still requesting that I return first and that I should continue to enjoy my holidays. After putting down the call, I continued to walk in the night market although in my heart, I know the meaning of ‘not good’ which means there is some truth to the nose cancer. Again, returning back to hotel room, I shared the phone conversation with my wife.

25 Nov – 16 Dec 2019 – Consultations happened one after another at accelerated speed

Back in Singapore, the senior doctor at SGH disclosed that the outcome of my test result is positive (Stage 2 Nasopharyngeal Cancer) but not too worried as it is potentially curable. He asked me questions like do I drink alcohol or eat salty meat? No, I only drink beers on occasions such as Chinese New Year and Christmas and I don’t eat salty meat. Do I smoke? No, I said. Do I ever smoke before? No, never before I said. He was kind of dumbfounded. Then he went on to explain to me that nose cancer is common among Singaporeans and is not age related. He arranged me to see a radiotherapy doctor in the radiation oncology department in National Cancer Centre (NCC) and booked a dental review with National Dental Centre (NCC). He also arranged a hearing test for me to check the irregular hearing of my right ear and results concluded that my right hearing is indeed affected to some extent when comparing the audible graph to my left ear.

1st Week Dec 2019 – Dental review and Tooth extraction

I had to clear my dental review before I can go for radiotherapy. This is because radiotherapy, in my case, will be targeted at my neck and nose areas which affect the mouth including saliva glands etc. For example, the mouth will be dry and gum will be weak during and after radiotherapy. If one ever had done tooth surgery during this period, then it will result in a slow recovery. In short, the gum is not going to recuperate as fast as it should. I have got an ‘extra’ tooth at the beginning of my right bottom row of teeth. A few years ago, a dentist advised me that this tooth got to go as it is useless, not helping me to chew food and could cause potential problem in future. I held back because I already had gum surgery and root canal with him and I need a break. But this time round, there is no running away, I literally had to do the tooth extraction. In all, I paid 4 – 5 visits to different dentists at NDC for initial review, extraction, remove stitches and last one for final review.

2nd Week Dec 2019 – Pre-book Radiotherapy and Chemotherapy sessions in National Cancer Centre (NCC)

My radiotherapy doctor scoped the back of my nose and took some pictures. As I disliked this procedure, I told her that the senior doctor over at ENT had done this already but she replied that they don’t share the information. She then explained that I have to attend 33 radiotherapy sessions and I questioned her why 33 times? She explained that medical studies had shown that 33 is the optimum number of times that a person receives radiotherapy for killing the cancer cells while having minimum side effects to the body. On top of that, she told me that my neck lump although small but still sizeable, hence she also advised me to go for chemotherapy which when combined with radiotherapy will have a more effective treatment outcome. Next, she arranged for me to meet my chemotherapy doctor who is also from NCC.

My chemotherapy doctor told that I will need to attend 1 chemotherapy session every week when the radiotherapy starts, all the way to the last week (inclusive) when radiotherapy ends. She pressed her calculator and it returned 6.x times of chemotherapy so she arranged for me to complete 7 sessions of chemotherapy as part of my cancer treatment. The drug that she is proposed for my case is Cisplatin and she mentioned this is a lighter variant of the chemotherapy drugs that will still have but not drastic side effects.

Thinking Back…

For many months, prior to the discovery of nose bleed and neck lump, I had always thought that my life is unbelievably smooth sailing, no major illness and no physical injuries. I never sustained any serve injuries in my entire 38 years of life, had never broken any parts of my body before and I survived 2.5 years of my NS with superficial cuts. Deep down, with a clean bill of health, I am a little worried that misfortune will strike me when I get older e.g. 60 years and above as I don’t believe a human life can be so perfectly fine without illness till the end of it. Premonition? Well, sort of.

A couple of things I felt I had to be thankful for. First, my family doctor diagnosed accurately about the suspected Nasopharyngeal Cancer. Not only that, he gave clear advices that prompted me to rush myself to A&E on the same day of his diagnosis and not just chuck it away, e.g., only attend to it at the end of my Taiwan trip. Second, I have no regrets picking SGH as my treatment facility. The appointments after my Taiwan trip are well coordinated and stacked tightly against one another from various departments (ENT, NCC and NDC) ensuring I was able to start my 1st radiotherapy session within 2 weeks of my return. Third, I had reviewed and bought insurance coverage for critical illness (CI) in 2018 hence all my expenses from SGH and NCC are covered except dental bills from National Dental Centre. Up till now, I had only updated my wife and not my parents nor my brother.

On 17 Dec 2019, my cancer treatment journey begins… (Part 2)