Jumaat, 30 Mac 2012


OK, coming back to the DH’s shock of yesterday:

Two of DH’s chemo-friends (same cancer and same chemotherapy) had early recurrence, one died about 8 months after completion of chemo and this particular one had recurrence two years after completion of chemo. The first had cancer colon (transverse colon) but with cancerous cells detected in the omentum (the fatty layer in front of the stomach), and the second had cancer in the colon proximal to the rectum, with two lymph nodes affected. She also received radiotherapy.

To my non-oncologic mind, I knew very well, these two unfortunate patients should have received oxaliplatin in their chemo regime, but was only given 5-flurouracil intravenously. The same chemo that my hubby had received. But my hubby’s cancer though very large, had not penetrated the outer wall of the colon, and he has been a very physically active survivor.

Not all patients go into the intellectual mode of information finding and second or third opinions. Not all want to believe that their cancer may come back, and not many had the attitude of wanting to study their cancer histopathological report. They trusted their treating oncologist, and most unfortunately, when they also did not receive motivation for life-style or diet changes. Their oncologist had said, “You can eat anything in moderation.”

Unfortunately, the two sufferers were also not the types who were active and interested in diet that is not promoting cancer. Typical with many Malay patients, when X-ray and scans did not detect cancer activity, they rejoiced and claimed that they are cancer free, until the reality dawned on them when they are too fatigued and cachexic to take immune boosting diet. When cancer had secured its dominance, it will make the host lose his or her appetite. Then nothing will disturb its invasion into the surrounding and other distant parts in the body. Cancer can easily outsmart you. –  Memanglah apabila kimo dan radioterapi merosakkan sel sel dan sistem pertahanan semulajadi manusia, penyakit lain dan tumour recurrence boleh berlaku…

I sound judgmental, did I? Yes, I know. Probably my frustration. I myself can’t change my hubby’s way of eating, what more do I expect to do with many cancer patients. I have bought many books and many I spread on the kitchen table and cabinet tops, to attract DH to read. I am aware of my limitation. I can’t force and I shouldn’t be too judgmental. Isn’t there a saying that it is more difficult to change a person’s way of eating than to change his or her religion. However, I am reaassured by the fact that the recurrence of colon cancer is reducing fast with increasing survival years, not like breast cancer.

Seeing a terminally ill patient awaiting death is not easy. Especially hard if the perceiving person is himself or herself suffering from cancer and worst if the cancer is the same type of cancer. For me, that is routine in my profession. For my hubby, he was affected badly, though he compensated with lots of positive reappraisals, intellectualization and planning. Good for him.

So, when my high power blender was processing the juice for last night, DH asked for some. That was good, because he is scheduled for a CECT scan of abdomen and virtual colonoscopy on this Wednesday. Though the radiation is minimal or most often quoted by radiologist and oncologist as safe, I preferred him to overdose on the anti-oxidants as protection. Knowing that DH hates green juice, last night compliance with my belief was probably from seeing the ghost of his chemo-mate, immobilized with little flesh on the her skeleton and absolutely no appetite or effort at eating and drinking.

OK, fast rewind of her treatment experience. When she went for radiotherapy, oncologist think that vegetable and fruits juices will render the therapy ineffective. There has been research result that failed to prove this understanding, but it was in journals that are not controlled by the industries that generated expensive chemo drugs. The journals that big time doctors or oncologists do not read. To some doctors, their CME is entirely from drug talks and drug reps.

So, yes, the radiotherapy killed all the cancer cells, but practically all organs in the vicinity of the targeted organ got affected too. Many oncologists will laugh at you if you said so, but did they really see their patients when they turned up with problems that are handled by their colleagues in other field of medicine? Many patients still turned up with fried and tangled internal organs many months after the radioterapy. Patients receiving radiotherapy to their rectum or colon, came back years after the radiation with recurring cystitis and blood in urine. Not just the symptoms were frightening, but laced with the most terrible kind of pain. The patient that we visited yesterday received radiotherapy and when she was receiving the treatment, I already could see her very difficult path down the road. It did happened about 18 months after the treatment. First she had deep vein thrombosis, and then she was put on warfarin and special caution not to eat greens. –
Currently she came back with bleeding problems (a case of too much of one and lacking of another), bleeding from anus and urine, bladder and kidney shutdown that need peritoneal dialysis. Also a suspicion of recurrence. She is too cachexic and bruised and I can’t imagine how she could receive the appropriate chemo (the one that should have been given earlier). Since having the complication, the patient had been pushed to other disciplines other than oncology: like ortho, surgery and now medicine, but not oncology. So the one who had given the initial treatment did not really appreciate the outcome. To my non-oncologic mind, it was better to give oxiplatin with/without avastin rather than 5-flurouracil and radiotherapy.

My reminder to colon cancer sufferers and patient on radiotherapy:

1. When your cancer had penetrated the outer wall, or when the lymph nodes are affected and when the cancer contaminated the abdominal cavity, then 5-Flurouracil or Xeloda is not enough. If you happened to have only that chemo, then go all out in diet and lifestyle changes to reduce cancer recurrence rates. More appropriate chemo should include oxaliplatin.
2. If you have to have radiotherapy, then overdose on anti-oxidants that you process yourself before and after therapy. Watermelon is good enough if you can't do it and none to help you. – Wahai kawan, saya ada dengar chemical disuntik dalam tampuk tembikai bagi menyebabkannya menjadi warna merah… Adakah kita ambil tahu 25 tahun lalu buah tembikai berasa amat manis dan jenuh buang bijinya. Hari ini tembikai kurang manis tetapi berwarna merah dan tiada berbiji!!!  Radiotherapy is very effective in destroying cancer cells, but your healthy cells suffered too. It is true that you don’t want to disturb the mechanism of radiotherapy that rely on free radicals, but I think it should have been in enough intensity and dosage to kill off cancer cells in spite of your internal milieu being bathed with alkalinizing juices and anti-oxidants.

3. Again and again, diet and movement is important to reduce further complication and recurrence. As a cancer survivor you need to work hard to reduce any form of inflammation and clotting tendencies in your body. Keep the cholesterol and the c-reactive protein down and low.

4. An important question that cancer patients should think hard is not just the effectiveness of the therapy, but what kind of life they will lead after the treatment.

Remember, surgery, chemo and radiotherapy are all very effective in controlling or removing cancer, but you need to complement to ensure your body could withstand the treatment and that your healthy tissues are least affected. You don't want to die because of cancer, but you also don't want to have lingering complications that leads you to your death bed in a poor quality of life ending.

Of course, after saying all that, we know Allah know best, that goes without saying. We can't have absolute control over what may come our way. Remember, I advocate radiotherapy when it is indicated. However I am against selection of low cost treatment that eventually translated into high cost of hospitalization and care, and the consequences to the sufferers' quality of life as well as their care-givers. 

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