Thursday, November 29, 2007

Last Chemo. For Now.

I had my last dose of Navelbine today. From now on, I’ll just have Herceptin every three weeks. Navelbine is chemotherapy – it kills all fast-growing cells whether they’re cancer cells or healthy cells. Herceptin is immunotherapy. It slows down or stops the kind of breast cancer cells that I have from growing.

Because Herceptin targets breast cancer cells, it doesn’t have as many of the side effects that chemotherapy does. It does have one serious side effect though – it causes damage to the heart, especially when combined with certain chemotherapy drugs. So my heart is being monitored fairly closely.

So now what happens?

In four months, I’ll have another brain MRI and a PET/CT scan to see whether and where the cancer has spread. Depending on where and how much it’s spread, I’ll start another round of chemotherapy, maybe with Navelbine again or maybe with another chemotherapy drug.

The Herceptin will be for the rest of my life. I can’t get chemotherapy continuously for the rest of my life, since that would kill me. So we do a few cycles, wait, do a scan, do another few cycles, wait, do a scan, and so forth. The breaks give my body a chance to recover from the chemotherapy. Unfortunately, it also gives the cancer cells time to recover.

Here’s an analogy to illustrate how this all works:
Cancer cells = Enemy soldiers.
My immune system = My soldiers.
Chemotherapy = Allied planes carpet bombing the battlefield.
Herceptin = Allied soldiers blockading enemy supplies and reinforcements.
My anti-cancer diet, exercise = Battle conditions (weather, weaponry, etc.)

The chemotherapy was killing the enemy, but it was also killing my soldiers (healthy cells). It took out as many of the enemy as it could and left the rest to my soldiers. My allies (Herceptin) are blocking the enemy forces from regaining strength or growing. The enemy can still recoup and their soldiers can regain their strength. But if the weather changes in my favor AND my allies block them from getting fresh supplies, they might slowly freeze to death and waste away to a point where I won’t need the ally planes to carpet bomb again. My soldiers might be strong enough to beat the enemy, given the advantages of superior weapons, favorable weather and other battle conditions.

This is why it’s so important to me to keep up with the diet and exercise. More on that later.

Monday, November 26, 2007

Economics and the Meaning of Life

I’ve always thought about why I wanted to live and what, if anything, I wanted to leave behind when I died. My thinking has changed over the years and although getting cancer didn’t change my latest thoughts on this, the diagnosis has definitely made my desires more clear.

When I was in my twenties, I thought the world was a wonderful gift that existed for me. That might have been a by-product of my brush with Cartesian logic, extended to the belief that the world only exists because I perceive it, so it’s all there for me.

Later on, that became a bit more refined to: “Here’s the planet Earth. You have seventy-something years to enjoy it. The rules are 1) appreciate everything around you, 2) don’t hurt yourself, 3) don’t hurt others. If you can actually make other people’s lives better along the way, that’s an extra bonus.”

I thought, and still think, that we could all live by these basic rules and teach them to our children, since they cover pretty much everything. Three Commandments (plus an addendum) – a lot easier to remember than the Ten Commandments.

In all this time, I never really cared about leaving something of me behind – a great work of art, life-changing scientific research, whatever means of achieving immortality people fantasize about. My thinking was that after I’m dead, the world will no longer exist for me, so what do I care whether my art is hanging in some museum or people are reading my novels or singing my songs?

Since having children, I’ve begun to understand another reason why people might want to do something big and important with their lives. Maybe it’s not for egotistical reasons like wanting to be admired by future generations. Maybe it’s not even a desire for reassurance that their life meant something, that their time on Earth was not meaningless.

For me, I think it’s a matter of filling a gap. Think economics. If we take from a market more than we put in, then eventually, the market will become inefficient, with way-too-rich folks on one end, and starving children on the other. Unfortunately, that’s the way it is at the moment. I think I need to do my part to fill the gap. I’ve gotten a lot of pleasure from this world; I figure I need to put at least as much back in as I’ve taken.

So far, I’m in deficit. I’ve learned a lot from teachers, friends, even strangers. I’ve gotten a lot of happiness and laughs from people over the years. I’ve benefited from someone else’s hard work making the drugs that are saving my life. I hope I’ve taught some people some worthwhile things as a teacher and journalist. I hope I’ve made people laugh and brought them happiness. But I haven’t discovered any life-saving drugs. Deficit.

Since I’m not likely to find the cure for cancer before I die, I can tackle this deficit two ways: 1) Find some other means of repayment, or 2) Take a loan for future repayment. The first option would be me walking enough old ladies across the street to warrant my taking the fruits of some scientist’s blood, sweat and tears. The second option would be to groom my kids into cancer researchers or something else that would be equal in value in the world market. I’m trying to do both.

Of course, I don’t see any old ladies that need help crossing streets, but I see other breast cancer patients who need a reassuring word. I see a harried teacher who needs a parent’s understanding and support. I see a husband who needs encouragement and kind words. Little things. A LOT of little things.

As for future repayment… I’ve already brainwashed Josie into saying she wants to be a surgeon when she grows up. Actually, she says she wants to be a “princess surgeon”. I can only hope it’s the princess part she drops when she gets older and not the surgeon bit.

Friday, November 23, 2007


Happy Thanksgiving to my American friends and family. For those of you who aren’t versed in American culture, this is a time of year when families get together and feast on roast turkey and pumpkin pie. You’re also supposed to be thinking about all the things that you’re thankful for.

I’ve been thankful about a lot of things, before and after cancer, but since it’s Thanksgiving, I’ve compiled a list of things that I’m particularly thankful for this very moment (in no particular order).

1) I’m thankful that I’m not an Arab woman living in Saudi Arabia. I just heard on the news this morning that a 19-year-old Saudi Arabian woman who was gang-raped has been sentenced to 200 lashes and six months in jail. She was punished for being raped. I can’t imagine living in a society like that.

2) I’m thankful that I have two healthy, happy kids. I have too many friends who can’t have babies or whose children have been diagnosed with all manner of ailments. I think about how lucky I am almost every day.

3) I’m thankful that I have cancer and not my kids or Tony. Having cancer is no fun, but I don’t know how I’d handle watching my kids go through cancer treatment. And I’d rather deal with cancer myself than watch Tony do it. Plus, he has more earning power than I do, so after I die, he can provide for the kids. I’m not sure I could do the same if he were to die. Definitely not on a teacher’s or journalist’s salary. Yes, ever the pragmatist.

4) I’m thankful that I have such kind and clever friends. I’ve heard stories of people with cancer whose friends drop them or distance themselves. Most of my friends have gotten even more generous, kind, thoughtful, and fun. I’ve even made new friends or reconnected with long-lost friends since cancer. There’s nothing like the threat of never seeing someone again to make you want to get to know that person.

5) I’m thankful that someone is cooking me a Thanksgiving meal tonight. Can’t wait! I’ve been good all week, eating almost nothing but raw veggies for breakfast, lunch, and dinner. The only cooked stuff I’ve eaten is brown rice, organic brown bread, and beans. Plus, I’ve run 20 kilometers this week. I think I can make a teeny exception and have a bit of roast turkey tonight. I’m so excited! (I’m only doing this because I’ve just had chemo yesterday, and I assume the chemo will keep the negative effects of meat and sugar in check. That’s my rationale.)

Sunday, November 18, 2007

Thankful for Body Parts

A while ago, I was walking down the street thinking about how lucky I was to be able to walk down the street. I thought how hard it would be to be blind, deaf, or legless. I wouldn’t be able to see the sky or trees, hear the birds or traffic, saunter or skip down the sidewalk.

Or what if I had a constant toothache or migraines that wouldn’t go away? Even minor pains and discomforts could eat into your enjoyment of a simple thing like a walk down the street on a sunny, breezy day.

This was before I had cancer. Now that I have cancer, I’m even more grateful for every day that I’m not bedridden or incapacitated because I know that day will come.

I used to put a value on the things we take for granted with a game I called, “Choose Your Body Parts”. This was before cancer. I’d ask Tony what body part he’d most be willing to give up. I’d go through the pros and cons of losing an eye versus an arm – I’d rather lose one eye over an arm, but if it were BOTH eyes, I’d rather lose an arm.

Tony thought this was a sick game. But what I was doing was imagining what life would be like without basic things we take for granted, like our sight, our hearing, our ability to stand up and walk.

When I was a 5th grade teacher, we had the students tape their thumbs down to their palms for an entire day to see how it would feel. Here’s something unusual to hear from a ten-year-old: “Thank goodness we have opposable thumbs!” You should try it. You’ll come away appreciating something you’ve probably never even given a thought to. And maybe many other things as well.

Friday, November 16, 2007

Feeling Special

I was talking to a friend today about where to send our kids to school. I said I’d like to go back to teaching and get a job in a school I want my kids to attend when they’re in high school. As soon as those words left my mouth, I found myself thinking, “That assumes I’ll be alive when the kids are in high school. Wow, what a dream that would be.”

This is how living with cancer is different from living in the real world. I know that we’ll all die someday, but I doubt any of my non-cancer friends think about their lives five, ten years from now and think they’re stretching it to believe they’ll still be alive.

I go about my daily life like a normal person, and then there are fleeting moments like this one that nudge me back to Cancer World. I don’t necessarily get sad about it or dwell on it, but I’m just reminded that I live in a different world from everyone else I know.

Being different can be special or it can be lonely. I feel special because I have cancer. I think I have a perspective on things that only comes with having life curtailed. I also feel lonely at times because facing death isn’t something you can share with anyone, not even other cancer patients. It has to be done alone.

But I have to say I don’t feel the loneliness very much at all. Mostly, I feel pretty special. I sometimes want to wear a T-shirt that says, “Be extra nice to me. I have cancer.” But I suppose that wouldn’t be fair to people who don’t have cancer.

Monday, November 12, 2007

I'm Two!

Maybe that’s taking the under-reporting of age too far. I’m forty-one today, but this is the second birthday I’ve had since I was diagnosed with cancer.

I just read the Blog entry I wrote one year ago. I wrote then that I’d “hold out for one more year”. Well, I made it to one more year. I didn’t think I’d have cancer again at this point, but here I am.

Should I make a prediction about where I’ll be at my next birthday? I’ll still be in Singapore, I’ll still have cancer, I’ll still be alive. That sounds terribly boring. I hope I can do something between now and then to make that year worth having.

Saturday, November 10, 2007

What We Teach Our Kids

As parents, we assume we’ll be with our kids as they grow up, learning with them, teaching them the values that are important to us, hoping to mold them into better versions of ourselves.

But once you’ve got cancer, you’re not guaranteed to be around to do all that, so you feel like you have to cram everything in all at once.

Tony and I have a lot of similar values: compassion, tolerance, respect for others. But there are some things I value more than he does, and I want to pass these on to my kids before I die.

I want Josie and Toby to be strong, confident, independent, self-reliant, hard-working, disciplined and honest. I want them to recycle, clean up after themselves, help a mother get her stroller up the stairs when everyone else just walks by. I want them to prefer books over television, thank the person who made their dinner, and do a math problem over and over again until they get it right. I want them to fantasize about saving people’s lives rather than about the perfect house or car. I want them to pick themselves up when they fall, not cry or wait for someone to come along to help them. I want them to have the confidence and courage to point out that the Emperor is in his underwear.

These are big demands to make of anyone, but trying to instill these values in a two-year-old and a four-year-old is a bit silly.

For example, I’ve tried to explain to Josie why I turn off the water while I brush my teeth, why I don’t put my clothes in the laundry after just one wear, why I walk to the local shops instead of driving. But how do you explain depletion of natural resources, environmental pollution and global warming to a four-year-old? Al Gore can’t even get grown, educated adults to take environmental protection seriously. How do I instill respect for the environment in a pre-schooler?

I want my kids to think they’re better than everyone else, not because they have better grades, bigger houses, higher-paid jobs, but because they’re living a life they’re proud of (and that their mother would be proud of) and they struggle each day to do even better.

I need more time to pass on what’s important to me to my kids. But in case I don’t have that time, I’m talking about these things to Josie and Toby every day. I’m talking about them to my friends and family, so that they’ll know these things are important to me and they can pass them on to my kids if I’m not around to do it.

I’m not sure my family and friends know what I value. We don’t often sit around and talk about our values with each other. This isn’t exactly cocktail party conversation. Do you think your friends or even your family know what you consider to be important character traits and what you want your kids to value as they grow up?

You have the luxury of teaching your kids by example. I might not be that lucky, so I have to talk a lot and squeeze in as much as I can while I can. But maybe we should all talk a bit more about the things we value, regardless of whether or not our time is limited.

Thursday, November 8, 2007

Good News! (6:00 p.m.)

The PET/CT scan showed almost all of my tumors are gone. On the last CT, there were dozens of black dots all over the chest area, but only three showed up on this latest scan. And the large tumors in the lungs have almost disappeared.

One surprise was when the oncologist said there was “no more” spread in the bones. No more? I didn’t know there was any in the first place! She had said “sternum” rather than bone, so it hadn’t registered as bone spread.

The conclusion: I still have cancer in the lungs, chest (soft tissue), and bone (sternum), but much, much less than I had before.

I’ll have one more cycle of chemotherapy (once a week for three weeks) plus Herceptin (indefinitely). I’ll have another PET/CT scan and a brain MRI in four months to see how things are going.

My religious family and friends will say this good news is the work of God.

My naturopath-loving friends will say this is the result of my no meat, no dairy, no sugar diet, plus the 35 supplements I swallow each day.

My doctors will say this is the chemo working.

Maybe it’s a combination of all three. We can’t know for sure, so it doesn’t hurt to cover all bases.

To celebrate this good news, I’m going for a run tonight!

Getting Ready for Bad News (9:00 a.m.)

I have a meeting with my oncologist this afternoon to go over the results of my PET/CT scan. We’ll find out what’s happening with the tumors and whether the chemotherapy is working.

I know some people say it’s negative thinking to prepare for bad news, but I think it’s being practical. I’ve always prepared for worst-case scenarios, so that when they don’t come to pass, I’ll be pleasantly surprised.

That’s why I took it so well when we learned my cancer had come back. Tony was very shaken up. He’d been prepared for good news, so he was hit hard when the bad news came. Even my oncologist was shaken up. She’d been expecting good news as well.

So this is my armor. I’m ready for anything. Well, maybe not anything. I’m not ready for the doctor to tell me I have a few months to live. But that’s such an unlikely scenario that I’m not even thinking about that.

This is what I’m preparing for: the chemotherapy has shrunk some of my tumors but some new ones have popped up. There seems to be some kind of mass in my brain but we can’t be certain what it is, so we’ll do an MRI to find out.

This is what I’m hoping for: the chemotherapy has worked wonders and most of the tumors are completely gone. I’ll continue with the current chemotherapy and we’ll do another scan in three months’ time.

I’ll be back to the Blog later today with the results!

Wednesday, November 7, 2007


I had a PET/CT Scan today, the fourth one in two years. The radiographer told me each PET scan exposes you to radiation levels equivalent to ten X-rays. But the nurse showed me a brochure saying the PET radiation exposure is 3 mSv (millisieverts). That’s equivalent to about 150 chest X-Rays. So the radiographer was completely wrong.

I’m worried about my radiation exposure with all these tests. I know the risks of NOT doing these tests far outweigh the risks of radiation exposure, but I’m worried that doctors, radiographers and nurses have no idea what levels of radiation exposure they and their patients are subjected to.

When I asked my oncologist earlier this year how much radiation exposure was in a bone scan, she said “less than one chest X-ray”. Actually, it’s 200 X-rays.

I read about a study showing that less than 5% of doctors could accurately say how much radiation exposure was in a bone scan. So 95% of these doctors were recommending a diagnostic test based on false assumptions about how much radiation exposure was involved.

I read another study showing that healthcare workers in the U.K. who worked in mobile PET scan units had higher levels of radiation in their bodies than those who worked in hospital PET scan units. Why? Because those in the mobile units walked patients to bathrooms located a few meters away from the PET machines. Just walking next to their patients exposed these nurses to radiation.

I realize there are risks involved with radiation for both patients and healthcare workers. I know these risks have to be taken, and I’m thankful that doctors and nurses continue to work in this field despite the dangers. But I’m concerned that even the doctors and radiographers have no idea how much radiation is involved in these tests. And I worry that they’re not providing accurate information to their patients.

This is my biggest struggle with cancer treatment – having to fight for accurate information. Maybe I should worry about bigger things, like dying and facing the Great Unknown. But I like to worry about things I can get my hands on and my brain around. And facts are something solid that I can work with.

I’ll add this to my list of recommendations to the Health Ministry and the private hospitals, when I get a meeting with them someday.

Tuesday, November 6, 2007

What’s in a Date?

December 7 is an infamous date because it was the day the Japanese attacked Pearl Harbor, thereby drawing the U.S. into World War II. It’s also the date I found out I had breast cancer.

August 15 is another momentous date. It was the day Korea gained independence from Japanese colonial rule. It’s also the date I found out I had a recurrence of breast cancer.

I’m going to have a PET-CT scan tomorrow to see whether this chemo I’m getting is working, whether my cancer has spread, or tumors have shrunk. I wonder if November 6 has any historical significance.

I should be nervous about this test, even dreading this test. Instead, I’m looking forward to it like Christmas. I’m waiting for a big surprise and the anticipation is exciting and almost fun. Is something wrong with me?

I think I’m looking forward to this test with cheerful anticipation not because I expect it to show that my cancer has miraculously disappeared, but because I expect it to give me some more clarity about where my life is headed, literally.

I’ve been getting headaches for the past week or so, and I hardly ever get headaches. Maybe tomorrow’s test will show that I have a brain tumor. Or at least that I need to get another test, an MRI, to find out if I have a brain tumor. It might be a relief just to get that big hurdle over with.

It’s the difference between knowing there’s a monster somewhere out there waiting to get you but you don’t know when or where it will attack, and knowing exactly where the monster is and going straight for it on the offensive. As they say in sports, the best defense is a good offense.

Sunday, November 4, 2007

Dragon Boat Race

My Breast Cancer Foundation Dragon Boat team raced in Singapore’s annual River Regatta today. We competed in two 300-meter races and came in last in both. But we had a great time doing it.

There were about sixty to seventy teams at the race, mostly with big, hulky guys or young twenty-somethings at the prime of their physical strength. We were a team of mostly 60-year-old grannies with missing breasts, chest muscles, lymph nodes, some with rheumatism that made it hard to get in and out of the boats. Obviously, we’re not in it to win it.

So why do we do this? Why do I do it? I think it’s important for people to see us out there. We turn heads. I hope we also change people’s preconceptions of what a cancer patient is. I want people to look at us and think, “Wow, look at those ladies with breast cancer. They’ll never win a race, but boy, have they got guts!”

And while most of the team are older ladies, I hope the handful of younger women like me make people think twice about whether cancer is only for old people. I want to be a walking billboard that says, “I’m young, strong, and healthy. If breast cancer can happen to me, it can happen to you, so DO THOSE BREAST SELF-EXAMS EVERY MONTH!”

One of the ladies on the team was only 26 when she found a lump in her breast. She found it while doing a self-exam, because 26 is too young for a mammogram or any other kind of diagnostic test. What a smart girl for finding her cancer herself instead of letting it grow inside her for years and years, only to find out at the age of 40 (the age mammograms are recommended) that she has LATE stage breast cancer. So if you’re in your twenties, keep this in mind if you ever find yourself thinking you’re too young for breast cancer.

Saturday, November 3, 2007

Farewell Ceremony

I went to my Dragon Boat teammate Sue’s memorial ceremony tonight. The team paid a tribute to her with a dance to the tune of Gloria Gaynor’s “I Will Survive”, which I barely survived because I didn’t know the steps. And we sang a song for her about holding on together, which I could barely do through the teary eyes (plus, I didn’t know the words!) I know Sue would not only forgive us for our blunders through the dance and song in her honor, she’d be laughing.

The ceremony was in a church with the usual things you expect from a Christian ceremony – hymns, tributes, and a sermon from the pastor. The pastor said we should thank God for Sue’s talents, her energy, her enthusiasm, and her compassion. I thought secretly to myself, “I thank SUE for all of those things. Why do we have to give God credit for all that?” As Casey the preacher said in The Grapes of Wrath, “Why do we got to hang it all on God? Maybe the Holy Sperit is the Human Sperit?” Go Casey.

But I also thought about how much comfort it gave Sue’s family and friends to think that God had led her life and that she was now with God. And if she hadn’t died so suddenly, she might have felt peace in her final moments as she looked forward to meeting her creator. I guess some people need to hang it on God.

Thursday, November 1, 2007

Last Chemo Before Scan

Today was chemo # 9, with the last of the side effect drugs gone (Zofran for nausea), AND with the white blood cell booster shot immediately after, instead of 24 hours later. So far, no nausea. A slight fever and achy legs, but the aches are from the G-CSF (blood cell booster) shot and the fever is from my kids. Josie and Toby have both had fevers this week so I assume I’ve got whatever they had.

This completes three cycles of chemotherapy and now we see if it’s done anything to the tumors. I’ll have a PET-CT scan next week to find out. That’s the test where they inject you with a radioactive glucose solution, then put you through a tunnel machine. And you have to lie perfectly still for an hour or so while the machine takes pictures of your body from head to toes. The bits that light up are the places where the cancer cells are most active because they feed on sugar and metabolize sugar much faster than healthy cells.

This PET-CT scan is about the most accurate test available, but apparently, no scan can pick up a tumor smaller than a pea. Also, this scan’s not that great for finding cancer in the brain, which is a real worry for me since, in my case, that’s the most likely part of the body for my cancer to travel to.

One of my Dragon Boat teammates died recently of Deep Vein Thrombosis after being diagnosed with a recurrence of breast cancer for the third time – in her lungs and liver. Her death had nothing to do with cancer. But the autopsy showed that she had a 3-centimeter wide tumor in her brain. The PET-CT she had just two weeks earlier had not picked that up.

So I could have a golf ball-sized tumor in my head and this high-tech, radioactive, $3,000 test won’t even detect it. If I really want to know what’s going on in my brain, I’ll have to get a brain MRI in addition to the PET-CT. That’s more money. And I’d probably have to do this every three months for the rest of my life – a life that could be shortened by all the radiation exposure from these tests! What a Catch-22!