Thursday, November 3, 2016

Good Article : My Experience With Nasopharyngeal Carcinoma (NPC) Treatment

https://www.healthxchange.sg/cancer/nose-cancer/my-experience-nasopharyngeal-carcinoma-npc-treatment

Name of Patient: Lim Cheng Koon
Age: 60+
Diagnosed: Stage 4 - NPC
Date Confirmed NPC: 18 July 2016
Treatment Period: 02 Aug 2016 to 16 Sept 2016
Treatment Pattern: 33 Sessions of RT c/w 7 Cycles of CT

History & Radiotherapy Treatment

I recall my first encounter with NPC or nose cancer. It was sometime in July 2015 when I discovered a small lump on my right neck just behind my right ear. Initially I did not pay much attention to it. It was not until September 2015 when I was admitted to Changi General Hospital (CGH) due to the sudden loss of strength in my entire right arm and I was unable to lift up my whole arm.
During the hospitalization, I alerted the doctor to the lump behind my neck. The doctor concluded, after he has conducted a non-systematic check, that it was just a small muscle and had no relation to the movement of my arm.

However, in June 2016, I noticed that the lump had grown bigger. Feeling uncomfortable, I went to see a General Practitioner and was given antibiotics for 2 weeks. Thereafter, he referred me to the ENT Specialist in CGH where I was confirmed to have contracted NPC on 13th July 2016. I was then referred to the National Cancer Centre, Singapore (NCCS) for treatment.

I still can recall the turmoil in my mind after I was told I had contracted NPC. I had even contemplated ending my own life. I was also suffering from a serious nose block that often left me feeling breathless. On my request for medication to clear the blockage, the radiation doctor told me it was caused by the tumor and there was nothing he could do about it. This added to my misery.
Fortunately, my good friends and colleagues came alongside to encourage and console me. My children advised me to look for volunteer groups to seek their advice and learn from their experience. From the internet search, I found the NCCS NPC Support Group and contacted their programme leader, Teo Thiam Chye (TC as he is known), who is also a 13th year NPC survivor.

From the experience sharing by TC, I came to understand that I was not alone in my cancer journey where 465 survivors from the Support Group have successfully undergone their treatment and returned to living as normal a life as possible. This had given me further encouragement to face my treatment.

My treatment at NCCS began on 2nd August 2016 with 7 cycles of chemotherapy (chemo) and 33 sessions of radiotherapy (RT). The sharing by TC on “Managing the 4 major side effects of Radiotherapy” played a big role in helping me through the treatment with minimal pain and discomfort, (https://www.healthxchange.sg/cancer/nose-cancer/nose-cancer-managing-four-major-side-effects-radiotherapy)

From my treatment journey, I would like to share some of my own personal experiences in the hope that it may also help the next person: -
  1. A week before RT treatment, I drank concentrated Manuka Honey UMF 10+ as least 3 times a day. I also try to drink as much water as I can.
  2. After the 5th RT, when my mouth and throat felt very dry and eating became uncomfortable, I continued to drink lots of fluids especially ice water. Chinese cooling drink such as “Ling Yang”, “Yi Mi Jui” and fresh coconut juice helped to cool my body from the RT exposure.
  3. After every RT session, I take a cool shower immediately when I reach home. For 15 minutes I direct the shower to my forehead, side and back of the neck and head area which was exposed to radiation. The cool water helped to reduce the heat from the radiation of the day.
  4. Even though my saliva had thickened and the taste changed, I continued to eat as best as I can in order not to lose more weight.
  5. The use of the Nystatin Suspension prescribed by the doctor had helped me tremendously in managing the mouth fungus. I gargle my mouth after every meal, every morning and before sleep, especially targeted at the area with fungus. After gargling, I swallowed the solution slowly into the throat to further prevent throat infection. I have also requested from the doctor antibiotic tablets for fungus prevention.
  6. Apart from the Chinese cooling drinks, every morning I will take 2 “Daneuron” tablets which contain Vitamin B7 & B12 together with one tablet of “Vitamin C”. It worked well until I reached 30 RT without any ulcers in mouth and throat.
  7. Apart from my own discovery I followed TC’s instruction strictly in managing oral hygiene and keep my mouth clean after every meal. I have also consumed 2 bottles of Manuka Honey UMF +10 during the entire course of treatment. Indeed, it was effective in keeping the ulcers away.
  8. The aloe vera gel applied at least 4 to 5 times a days and immediately after the RT worked well until I completed my 30 RT without any tears on the skin of my neck. The signs of tears appeared after the 31st session but it was still manageable.

Painful Throat

A day after I have completed my 30 RT, I felt my entire throat beginning to feel more and more painful. After a physical examination, the RT doctor re-affirmed that I did not have any ulcers and that the cause of the pain was due to the radiation burns to the throat, which he claimed all patients will face at the end of the treatment.

Although the Doctor had prescribed to me stronger Morphine Patch sticker it did not suppressed the pain fully. It is difficult to describe the pain in words. All I felt was that it was the most painful episode that I have ever encountered in my life. But I told myself that I have to bear with it. A price I had to pay for getting rid of the cancer from the body.

Chemotherapy - 2 Major But Bearable Side Effects:

In my first three cycles of chemo, I did not feel much side effects to my body. I began to feel the side effects from the 4 cycle and it became more serious through to the 5th & 6th cycle.
Here are the 2 major side effects which I encountered:
  1. Nausea & Bloated Stomach
    From the 3rd to 5th day after the chemo, my stomach started to feel very uneasy. Nausea effects took place and I began to feel like vomiting. The stomach kept bloating especially at night. The anti-nausea/vomit tablets issued by the doctor helped somewhat to contain the problem.
  2. Constipation
    I went 2 to 3 days without any morning bowel movement. Another side effect from chemo. Constipation tablets as well as liquid medication to soften the stool will help. If constipation persists for more than 2 days, request for the insert medication. It will work well.

Conclusion

I understand that every person is different and each may face and experience different side effects from exposure to chemo and RT. What I have shared is my own treatment experience in the hope that it will help the next person better manage his/her own journey.

Contributed By: Lim Cheng Koon
Date: 12 Sept 2016

Monday, October 31, 2016

Talk by Speech Therapist - Topic related to Cancer treatment side effects

NPC oneHeart Support Group Monthly Talk

 https://www.dropbox.com/s/vpzh62adlo5zfvw/Cancer%20Treatment%20Side%20Effects%20by%20Ms%20Susan%20Goh.pdf?dl=0

Talk by Speech Therapist - Topic related to Cancer treatment side effects - Ms Susan Goh

Synopsis of Talk:
  • Patients who are diagnosed with cancer of the Head & Neck and the nose receive treatment in one or more the modalities i.e. chemotherapy, radiotherapy and/or surgery. Most of these patients experience a certain degree of difficulty in speech, voice and swallowing functions. Such difficulties can happen before, during and after treatment. In this talk Susan aims to share some of her experiences in helping these patients, as well as some practical pointers that may be helpful for the participants. 

About Susan Goh:

  • Susan graduated from Flinders University (South Australia) more than 20 years ago. She has worked in hospital settings since 1996. She has been working with ENT doctors in managing patients diagnosed with Head and Neck cancers, with a side interest in voice rehabilitation. Susan visits the New Voice Club at times, a support group for laryngectomees at the Singapore Cancer Society, of which she has been appointed to the committee of the club as a clinical support member since 3 years ago

. The Talk details:
- Date: Thu, 23 June 2016
 Time: 7pm
 Venue: TTSH, CareConnect

Friday, June 17, 2016

Voice Of Hope

Voice Of Hope

I mention we meet Sylvia during my wife treatment. She gave us new hope. Here is Sylvia story :

https://sparkatncis.wordpress.com/2016/06/16/issue-15-voice-of-hope/#more-563





63 year old Sylvia Khoh, who was diagnosed with Stage 1 Nasopharyngeal Cancer (NPC) in 2010


In the flesh, Sylvia is immaculately dressed, her hair unfurling in soft coils, her face radiating a rosy glow. Looking a little over 50 years of age, we were pleasantly surprised to learn that Sylvia turns 63 this year, as she chuckled and said that she gets this response from strangers all the time. Her secret to looking young? A positive mindset, and always remembering to smile.

Sylvia’s positive energy is infectious indeed. While most people her age look forward to enjoying their retirement, Sylvia proudly tells us that she loves her job; the empowerment it gives and the satisfaction it brings. A financial manager, Sylvia is presently into her sixteenth year at her job and has no plans of retirement in the near future.

As Sylvia goes about her five-day work week, she also juggles her time between her hobby – singing, a passion she has had since she was young, and which she continued to grow after her friend encouraged her to pick-up pop music back in 2010. After enrolling into the class, her vocal coach discovered the unique tonality in her voice and propelled her towards opera instead. A Teochew, Sylvia had to learn the Cantonese dialect from scratch in order to master the trade. It was a challenge, but Sylvia dedicated herself to perfecting the enunciation of the dialect.

Sylvia’s hard work and effort paid off and seven months into classes, she gave her first stage performance. Today, she is a seasoned opera singer who regularly performs at the China Cultural Centre, NAFA, Lee Foundation, Kreta Ayer People’s Theatre and community centres.

It would seem that Sylvia has it all – good looks, an established career, a raw talent and a close-knitted family. But there was a time when Sylvia thought she would lose her soprano and no longer be able to perform opera, and this is her story.
 
It was during the Chinese New Year of 2010, and festivities were running high. Sylvia had scheduled a line-up of performances but to her dismay, found herself unwell in between performances to the point that she was no longer able to reach the high notes. This affected Sylvia greatly, as singing was her life’s passion. Suspecting nodules in her throat, she headed down to the ENT Department for a check.

The check proved her suspicions right, as soft nodules were discovered in her throat. But to her relief, her vocal chords were not affected. Thinking that her worst fears were allayed, Sylvia was in for a rude shock as her Doctor discovered two grained sized cancerous lumps at the back of her nose and diagnosed her with Stage 1 Nasopharyngeal Cancer (NPC). Sylvia’s first thoughts were “why me?” and “how did this happen?”, but she later accepted her diagnosis with calm and peace with the belief that her cancer was a sign from a higher calling for her to ruminate on her life.

 
 Sylvia and her close-knitted family. She has one son, and two daughters.

 Sylvia took comfort in the fact that the disease was discovered early and the cancer was contained in her nose. Upon her Doctor’s advice, she started on radiation therapy. Sylvia underwent a total of 35 radiation sessions over a period of seven weeks. During this seven-week period, Sylvia went about her daily life, undergoing treatment in the morning, and heading back to work right after treatment. Her boss was exceptionally understanding during this period, constantly checking in on her well-being and granting her permission to take the day off if she felt unwell. And of course, Sylvia did not give up on singing. She continued with her biweekly singing classes and continued training her vocal chords. To Sylvia, all these served as a good distraction and busied her mind from worrying about the cancer.

Voice of Hope

Not long later, the side effects of treatment started kicking in – sore throats, loss of appetite, drastic weight loss. Sylvia, who is naturally petite, lost a total of 13kg, from her initial weight of 62kg to 49kg at her lowest. Her friends jokingly teased her by saying that she looked like a little girl from behind. Despite these, Sylvia took everything in her stride and kept her spirits up.

She joined the NPC oneHeart Support Group and actively participated in talks and support group activities. Sylvia found the talks, conducted by professionals, especially useful in coping and managing with her condition and side effects. Through the support group, Sylvia also forged close bonds and friendships with the support group members whom she still meets up with regularly for social outings.

An active person, Sylvia also kick started a monthly walk at the Botanic Gardens for the group to bond while keeping a healthy lifestyle. To keep the group in positive spirits, Sylvia makes it a point to prepare homecooked fare the day before to spur them on on the day of the walk.

 
Sylvia and the members of the NPC oneHeart Support Group, at a Chinese New Year gathering at her house

 After one year of treatment, Sylvia’s scans turned up clear and the cancer was gone. Today, Sylvia has achieved remission and is a proud survivor of NPC.

The cancer may be gone, but it has changed Sylvia’s life in more ways than one. Before she was diagnosed, Sylvia focused her time and energy on herself and her family. But her cancer journey has taught her that there is more to life, and it includes caring for other people as well. Now, Sylvia gives back to the community by doing voluntary work such as coordinating haircut sessions for the old folk as well as cooking for them.
She feels her cancer journey has changed her for the better, and her vocal coach has encouraged fellow students to “learn from her spirit”. And what lies ahead? Sylvia hopes to continue doing more volunteer work, pursue her passion in opera, stay beautiful, and most importantly, stay happy.
To fellow cancer patients and survivors, this is what Sylvia has to say:
“Be positive, never submit yourself to the disease. Know there is always hope somewhere. Make sure you mix with the right people who can help you, but never wallow in self-pity. I find that sharing my experience with others in the support group has helped me learn from their experiences as well.

Keep a healthy diet and lifestyle. For me, I make it a point to drink nourishing double-boiled soups every day. Root-based soups are particularly helpful for my recovery process as it helps build up my immune system to promote self-healing.  I try to abstain from red meat and heaty food, but consume more fish, vegetables and manuka honey to soothe my throat. Today, I have gained back half the weight I lost during treatment.

I also meditate and practice qigong regularly, as this helps calm me down and increase my mindfulness.

The journey after cancer is more important than the treatment itself. Always remember to fight the disease and defend against it or it will be easier for it to beat you.”


Monday, June 13, 2016

Penyebab dan Tanda-tanda Kanker Nasofaring (Jawa Pos)

PENYEBAB MUNCULNYA KANKER NASOFARING

http://www.jawapos.com/read/2016/06/13/33899/serang-tenggorokan-dan-hidung-ini-penyebab-munculnya-kanker-nasofaring-

JawaPos.com - Karsinoma Nasofaring (KNF) merupakan salah satu jenis  kanker  terganas yang berada di urutan ke-4 setelah kanker leher rahim, kanker payudara, dan kanker paru. KNF biasa  muncul pada area di atas tenggor‎okan dan belakang hidung penderitanya.
 
Sejumlah faktor menjadi penyebab munculnya kanker nasofaring ini. 

Dokter ahli Telinga Hidung Tenggorokan‎ (THT) - Kepala Leher (KL) dr. Cita Herawati, SpTHT-KL mengatakan, diantaranya Epstein-Barr Virus (peningkatan antibodi, genom virus pada sel tumor). Terpaparnya bahan zat kimia juga menjadi salah satu penyebabnya, termasuk‎ asap. 

"Asap rokok, dupa atau kemenyan,  serta  asap kayu bakar. Pekerjaan yang menghasilkan serbuk-serbuk kimia, seperti peleburan besi dan serbuk kayu," ujar dr. Cita saat ditemui di Jakarta. 

Tak hanya itu, konsumsi jenis makanan juga memicu kanker nasofaring ini. Misalnya, ikan asin dan sayuran yang diawetkan, dan makanan yang difermentasi. 

"Konsumsi jenis makanan ini akan menghasilkan kandungan nitrosamine ataupun precursor nitro yang akan menjadi pemicu terjadinya proses KNF," terang dr. Cita. 

 Kendati demikian, dokter yang berprakter di Sahid Sahirman Memorial Hospital itu memaparkan, untuk bahaya ikan asin memicu kanker nasofaring belum ditemukan adanya laporan yang jelas. "Selama ini, lebih banyak dipengaruhi oleh asap dan bukan makanan," ucapnya. 

Asap lebih berpengaruh, dia menjabarkan, lantaran asap bisa menahan di ruangan hingga akhirnya hidung harus menyaring asap dan debu yang masuk sekaligus. "Terpapar dengan racun karsigenik yang harus dibersihkan ini akhirnya picu kanker nasofaring," tandas dr. Cita.  

Dr. Hilman Tadjoebin, SpPD, KHOM menambahkan, ‎orang yang bekerja di pertambangan juga memiliki kecenderungan terkena kanker nasofaring. 

Selain itu, makanan pun ikut berperan keganasan kanker tersebut. "Itu terjadi karena  kanker nasofaring dipicu oleh zat kimia tertentu yang masuk ke dalam hidung," tutupnya.
GEJALA TERJADINYA KANKER NASOFARING

 JawaPos.com - Waspada terhadap kanker nasofaring. Masih banyak orang  belum menyadari bila sering terpaparnya asap, zat kimia, hingga mengonsumsi makanan tertentu bisa mengakibatkan kanker nasofaring.
Kanker tersebut muncul pada area di atas tenggorokan dan di belakang hidung. Untuk mengetahuinya, paling tidak harus memahami emoat gejala terkena kanker nasofaring. 

"Yaitu, gejala hidung berupa mimisan ringan sampai berat dan berulang, terasa sumbatan di hidung, kadang sering dirasakan pilek lama seperti gejala sinusitis, hingga kesulitan bernapas," ujar ‎Dokter ahli Telinga Hidung Tenggorokan‎ (THT) - Kepala Leher (KL) dr. Cita Herawati, SpTHT-KL saat ditemui di Jakarta. 

Dia menyatakan, gejala telinga karena tumor terletak di dekat muara tuba Eustachius atau fossa Rosenmuller yang akan menimbulkan rasa tidak nyaman. "Misalnya, telinga tersumbat, berdengung (tinitus), bahkan sering ada rasa nyeri (otalgia) sampai pendengaran berkurang," sebutnya. 

Lalu, dr. Cita melanjutkan, gejala mata dan saraf‎. Tumor yang mulai masuk ke dalam lubang-lubang tengkorak dimana banyak melalui saraf. "Akibatnya, membuat saraf terjepit yang memengaruhi penglihatan dobel atau ganda dan dirasakan nyeri di daerah pipi dan sekitarnya (trigeminal pain), hingga sakit kepala," sambungnya. 

Dokter yang berprakter di Sahid Sahirman Memorial Hospital itu menuturkan, ciri lainnya merasakan berbagai gangguan menelan, berbicara, kelemahan otot bahu, dan leher. Terakhir, adalah gejala metastasis lokal atau leher. ‎"Terdapat benjolan di leher di satu sisi maupun dua sisi leher," ungkapnya. (rka/JPG)

Setelah baca artikel di atas saya makin yakin dokter-dokter THT di Bandung yang dikunjungi istri saya sangat tidak kompeten. Gejala-gejala nya jelas dialami istri saya. Betul-betul bikin sesak dada. 
Gelarnya saja pakai embel-embel professor dan spesialis. Sales perusahaan farmasi mereka itu semua.

Saturday, June 4, 2016

FAQ about Nasopharyngeal Carcinoma from NPC OneHeart

FAQ about Nasopharyngeal Carcinoma from NPC OneHeart's FB pages


https://www.dropbox.com/l/s/vlgYswmxj138W3qtGPllHu

Example :

A : Dr. Choo, why chemo doctor advises patient not to take beet root and other antioxidant food/fruits during chemotherapy.
D : To answer whether antioxidant can be used during chemo is that it can as most natural antioxidant is weak and does not affect the effectiveness of the chemo or radiotherapy.
Chemo and radio aim to disrupt and kill cells by an oxidant effect and so, antioxidant reduces their effect - this is possible interaction only.

A : Dr. Choo, how to treat burnt skin caused by radiation? It takes long time to heal and get back to normal skin colour.

D : Choose a moisturiser without perfume ie if it smells nice, then don't apply to radiotherapy skin. Silver sulphadiaxine cream is by doctor prescription only and only needed during the 4 weeks of completion of RT when skin layer is peeled off. It is a cream used in all fire and water burns and used only in hospital. After 4 weeks, can use any moisturiser like QV, Aquoes, Cetaphil, aloe vera, bio oil , physiogel. All the functions are really into sealing in moisture in the skin. Use 2-3 times a day frequently is more important than what type of cream to put on. More specialise cream includes 10% urea for itch and Restoderm by Cetaphil for eczema as it contains ceramide. But more expensive. I advise patient to expect permanent dry skin as hence moisturiser is for life, but expect the darken skin to get back to normal 3-6 months on completion of radiotherapy.
The itch is due to dry skin, darken skin is due to poor healing as skin is too dry. Skin scarring is more due to dry skin. So, moisturiser for dry skin will help. The reason for dry skin is radiotherapy damages the sweat gland of the skin and so the skin does not sweat like normal and will always be dry.