what did ENT say?

Thyroid Ultrasound & Biopsy Results
The ultrasound showed 2 lesions of 0.6cm & 0.5cm in the upper pole and a small nodule of 0.7cm x 0.4cm in the lower pole of my left thyroid. But they appear benign.

Occasional dizzy spells & falling sensation
Dr Ng did some physical tests on me. I was asked to stand with eyes closed, lie down, turn my head & so on. I think I "failed" the tests. He suspected I might have problem with my inner ear. He said this could be caused by radiation & explained that low blood pressure was not the cause but could make my condition worse. He prescribed Betahistine & Prochloperazine to stabilise my dizzy spells. I have to take this medication for the next 3 months before coming back to do Vestibular Battery Test (VBT) in Dec. The test will take 1-1.5 hours.

• Vestibular testing consists of a number of tests that help determine if there is something wrong with the vestibular (balance) portion of the inner ear.
• These tests can help isolate dizziness symptoms to a specific cause that can often be treated.
• If dizziness is not caused by the inner ear, it might be caused by the brain, by medical disorders such as low blood pressure or by psychological problems such as anxiety.

Choking Experiences
Occasionally I feel choked by a lump of "phlegm" in my throat. Breathing becomes difficult. I have to drain down the "phlegm" with lots of water. I notice that I often feel hungry too, even after a meal. From the symptoms I described, Dr Ng suspected I might be suffering from gastroesophageal reflux. He explained that it was not phlegm but acid that came back to my throat from the stomach.

• Stomach contents are normally acidic & are kept inside the stomach by a valve at the lower end of the esophagus (food tube or gullet).
• Gastroesophageal reflux is the term used when stomach acids come back into the esophagus or throat.
• Symptoms result from direct irritation by acid & stomach enzymes or by reflex tightening of throat muscles.
• The sense of a lump in the throat is called globus & may result from chronic reflux laryngitis or increased tension in the upper esophageal muscles behind the voice box.
• An increase in secretions in the throat results in habitual throat clearing. These secretions may be mistaken as post-nasal drip or "phlegm".
• A patient with night-time reflux may awaken with a sore, irritated throat & a gravely hoarse voice.
• Muscle tension in the larynx may lead to vocal difficulty, trouble swallowing & in severe cases to choking spells & airway obstruction.
• Heartburn is a typical symptom of gastroesophageal reflux.

Dr Ng put me on Omeprazole to decrease the amount of acid produced in my stomach. Omeprazole is used to treat symptoms of gastroesophageal reflux and other conditions caused by excess stomach acid.

Is my body slowly breaking down because of radiation? Did I inherit all these "diseases" from radiation? I sometimes joke that I may die from these symptoms but not from cancer!

I thank God that I can live each day by His grace, with or without cancer.

tsk tsk

fibroids

My earlier PET scan results had suspected fibroids in my womb. So my oncologist had referred me to SGH's O&G clinic for further checks & investigations.

The ultrasound results now confirmed there are 5 fibroids in my womb, ranging from 3.0cm to 5.5cm in size. I am surprised there are so many fibroids in my womb as I have never experienced any symptoms all these years. My gynaecologist said this result was quite characteristic of single-unmarried women or women who had never given birth. My gynae suggested surgery or hysterectomy but I refused. He said there is no other way of shrinking or removing the fibroids, so he will monitor me every 2 months.

For those who wish to know more about fibroids, this is what I found out from the internet :
(1) Fibroids are tumours that grow in the uterus (womb). They are benign (not cancerous) & are made up of muscle fibre.
(2) About 20-50% of women have or will have fibroids at some time in their lives. Fibroids are most common in women in their 30's & 40's & tend to shrink after menopause.
(3) As many as 75% of women do not know they have fibroids as they experience no symptoms at all, symptoms such as heavy menstrual bleeding, pain during menstruation, abdominal pain or pressure, changes in bladder & bowel patterns, etc.
(4) There are 4 types of fibroids : intramural, subserous, submucous & cervical.
(5) The exact cause of fibroids is unknown but they seem to be influenced by oestrogen. This might explain why fibroids appear in a woman's middle years when oestrogen levels are high and stop after menopause when oestrogen levels drop.
(6) If you have fibroids, you may have one or many; you may also have one type of fibroid or a number of different types.
(7) As the cause of fibroids is still not known, there are no clear guidelines for preventing them.
(8) Because there are often no symptoms, you may only find out you have fibroids when you go for an internal examination. You may be given an ultrasound scan to confirm if you have fibroids. Other tests include hysteroscopy & laparoscopy.
(9) The main treatments for fibroids are myomectomy (operation to remove fibroids individually, leaving the womb intact); hysterectomy (removing the womb entirely); and uterine artery embolisation (blocking the blood supply to the fibroids).

As a nose cancer survivor, the doctor might be overly concerned about my fibroids. But somehow I'm not the least worried. I've read that TCM can be effective in shrinking, or in some cases, even in removing the fibroids. What I intend to do is to consult my TCM physician to find out more on this. If all else fails, then I will reluctantly go for surgery as my last resort, but only if I begin to suffer some unbearable symptoms.

thanks for keeping me in your prayers,
tsk tsk

EBV infection

Ever heard of EBV infection? I heard this term for the first time during the NPC support group meeting yesterday. Oncologist Dr John Low spoke on "Side-Effects of Radiotherapy & Chemotherapy in Nasopharyngeal Cancer (NPC)". Dr Low mentioned in his talk that the causes of NPC are EBV infection, genetic & diet rich in salted fish, meat & veg. I was curious about this EBV thing so I surfed the internet to find out more.

(1) EBV = Epstein-Bar Virus
(2) There is a complex link between EBV infection and NPC. Many studies have found high levels of this virus in the blood of people with NPC.
(3) EBV is known to cause cells in the nasopharynx to become cancerous. Most people infected with EBV develop only infectious mononucleosis, and their immune system is able to recognize and destroy the virus. These patients recover without any long-term problems.
(4) In some cases, however, pieces of viral DNA mix with the DNA of cells in the nasopharynx. When a cell is infected with the virus, the viral DNA may mix with the normal human DNA. EBV DNA is able to instruct the cells of the nasopharynx to divide and grow in an abnormal way.
(5) EBV infection rarely results in NPC. Eating a diet high in salted fish and meat seems to increase the ability of EBV to cause NPC. Studies indicate that foods preserved in this way may undergo changes that produce chemicals that can damage DNA. The damaged DNA alters the cells’ ability to properly regulate growth and replication.

This info on EBV is interesting. I didn't know I had the EB Virus in my blood. I'm grateful that the Lord had helped me to detect it early & to receive treatment early. Dr Low said there are long-term & late side-effects of radiation. Knowing this will help me to be better prepared for the long walk ahead.

thanks for journeying with me,
tsk tsk

how radiation can cause thyroid disorders

In Sep, the test result showed my TSH (Thyroid Stimulating Hormone) reading was quite high. I had to do another blood test in Oct to confirm the result. Today, my oncologist's assistant reviewed this 2nd result with me. It showed my TSH reading had increased further. The result confirms I am hypothyroid.

What is hypothyroidism? Doctors normally don't spend time explaining illnesses to patients. So I went to the internet to find out more.

Hypothyroidism is an underactive thyroid gland. Hypothyroidism means that the thyroid gland can’t make enough thyroid hormone to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in the blood. Common causes are autoimmune disease, surgical removal of the thyroid and radiation treatment.

Radiation used to treat cancers of the head and neck can affect the thyroid gland and may lead to hypothyroidism. Thyroid problems are common in cancer survivors who had head or neck radiation.

Read on if you want to know more about thyroid disorders. Women are 8 times more likely than men to suffer from thyroid problems.

What is the role of our thyroid gland? The thyroid gland is located in the front of the neck just below the larynx (voice box). It secretes hormones that control the body's metabolism. These hormones are thyroxine (T4) and triiodothyronine (T3). The secretion of T3 and T4 is controlled by the pituitary gland which is part of the brain.

The pituitary gland makes a chemical called thyroid-stimulating hormone (TSH) which travels in the blood stream to the thyroid. TSH stimulates the thyroid gland to make the thyroid hormones, T3 and T4. When levels of T3 and T4 are low, the brain increases the production of TSH which in turn tries to make the thyroid gland produce more T3 and T4. Conversely, if the level of either T3 or T4 is too high, the brain senses this and decreases the production of TSH which leads to less production of T3 and T4.

When thyroid hormone levels are too low, the body’s cells can’t get enough thyroid hormone and the body’s processes start slowing down. As the body slows, you may notice that you feel colder, you tire more easily, your skin is getting drier, you’re becoming forgetful and depressed, and you’ve started getting constipated.

There is no cure for hypothyroidism, and most patients have it for life. You have to make a lifetime commitment to treatment. If you take your pills every day and work with your doctor to get and keep your thyroxine dose right, you should be able to keep your hypothyroidism completely controlled throughout your life. If you keep your hypothyroidism well-controlled, it will not shorten your life span.

This is frightening. Frightening to experience the destructive effects of radiation. Frightening at the thought of lifetime medication. Frightening to see my body parts breaking down one by one. "Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day" (2 Cor 4:16).

thanks for walking with me through this long & lonely journey,

tsk tsk

How am I doing 6 months after cancer treatment?

It's almost 6 months since I completed my radiation treatment on 30 Oct 2006. In the language of cancer patients, I am a "six-month-old cancer survivor". Compared to 6 months ago, my condition has definitely improved many times except for my weight which has gone down from 47.5kg (22 Jan) to 42.8kg (18 Apr), a drop of 4.7kg or about 10 pounds. My weight remains my biggest challenge & concern.

My saliva is back about 50%, although not sufficient to enable me to eat solid food. But that is a great improvement compared to 6 months ago when I could only take liquid food, Novasource. I am thankful to God for the little improvements each day although it is human to wish that things could move a bit faster! The day I could begin to take chicken rice or beef rendang would indeed be a day for celebration.

Follow-up consultation is a must after cancer treatment. I see the oncologist once every 2 months, ENT specialist once every 3 months & TCM physician once every 2-3 weeks. Cancer treatment may take only 2 months but recovery may take many months.

Last Wed (18 Apr) was my ENT appointment. Lately, I had been experiencing occasional echoing in my left ear. According to Dr Tham, there is some water in the ear & this could have caused the echo. Since this echoing problem does not happen all the time, I will just leave it alone for the time being & learn to live with it, just like I've learned to live with the ringing sound (tinnitus) in my left ear since Jun 2006.

There are permanent side effects of radiation that NPC survivors have to learn to live with. From the talks that I've attended, I learn that late side effects might occur months or even years after radiation. They are :

* oral complications
* ear & eye complications
* swallowing problems
* pituitary problems
* neck stiffness & ache
* numbness of hands, neck, face
* loss of sense of smell
* radiation-induced cancers

Knowing this will not instil fear in me for I know that God is my Creator who "created my inmost being & knit me together in my mother's womb" (Psalm 139:13). My Creator God is the One who knows & understands my body more than even the best doctor. Shouid my body fail to function normally or should there be any defective parts, I trust my Heavenly Father will know what to do. Father knows best. "My flesh & my heart may fail, but God is the strength of my heart and my portion forever" (Psalm 73:26).

I was reading 2 Corinthians 1:3-11 during my Quiet time this morning & Apostle Paul's testimony about the hardships he suffered encouraged me :

"We were under great pressure, far beyond our ability to endure, so that we despaired even of life. Indeed, in our hearts, we felt the sentence of death. But this happened that we might not rely on ourselves but on God, who raised the dead. He has delivered us from such a deadly peril, and He will deliver us. On Him we have set our hope that He will continue to deliver us, as you help us by your prayers."

Yes, the problems I am facing are far beyond my ability to endure so that I despair even of life. Indeed, in my heart, I sometimes feel as if I were sentenced to death. But this happened that I might not rely on myself but on God. God has delivered me from the deadly disease of cancer, and He will deliver me. On Him I have set my hope that He will continue to deliver me, as you, my brothers & sisters in Christ help me by your prayers.

thanks for journeying with me,
tsk tsk

Late side effects of RT

I attended the NPC support group meeting last Friday. The talk was given by Dr Tham, an ENT specialist, on "Coping with the side effects of radiotherapy". Although I am an NPC survivor, I still have much to learn about nasopharyngeal cancer (NPC) or nose cancer. Most of the time, we patients don't get much info from our oncologists due to the very tight consultation time. So attending talks like this & meeting fellow survivors are very helpful.

This is something new I learn from the talk -- late side effects of RT could surface 3 months after the end of RT & even beyond. They include : oral complications, swallowing problems, ear complications, eye complications, radiation induced cancers & pituitary problems. This information is very useful as it helps me to be better prepared should such side effects occur later in life. It also provides useful advice on what I could do now to prevent or minimise the side effects.

I am praying against all these side effects in the Lord's name. I will continue to trust the Lord all the way, that He will heal & restore me completely.

thanks for journeying with me,
tsk tsk