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1 FREE May 2010 HealthNews Inspiring and informative stories for patients MICA (P) No. 054/02/2010 Not now, please! Yu Ian (with his wife and son) was hit by cancer of the lymph glands at the worst possible time, but he recovered. He tells his story of courage and determination It s been two years since I was first diagnosed with Non-Hodgkin s Lymphoma. It couldn t have happened at a worse time. It happened in 2007, when my wife was due to give birth to our first child in four months. I was also busy studying at graduate school, and had eight months to go before I completed my studies. The diagnosis also came in the same month that I was preparing for my performance review at work. It came as a real shock. I sought help from Parkway Cancer Centre, and was seen to by Dr Ang Peng Tiam and Dr Freddy Teo Cheng Peng. From the start, they were candid in their approaches. They explained to me that Non- Hodgkin s Lymphoma is a cancer of the lymph glands. Some types, they said, could be very aggressive and difficult to treat. Fortunately, the type that I suffered from was a more common one, and even though I had a rather large tumour, I had a good chance of recovering. I was most relieved to hear that the type I suffered from usually responds well to treatment, and carries a good chance of a cure. This helped me to get over the initial shock of my diagnosis. I was Stories of HOPE Continued next page put on chemotherapy and monoclonal antibodies, a form of immunotherapy, and my body responded well to it. Despite the shock and fear, I was determined not to wallow in self-pity and despair, and decided that I would deal with the problem. This attitude, the doctors said later, helped in my recovery. I was very cooperative, Dr Teo said of me later, and always had a positive attitude. It helped to make finishing the treatment a breeze, and also made handling the side effects and complications of my treatment easy, he added. IN THIS ISSUE: 减低您的患癌风险 From no cure to curable New dietetic services

2 Stories of Hope From cover page Editorial team Fong Mue Chern, Vincent Tan, Woan Fei Publisher Preston Communications Printer Advance Printing No portion of this magazine may be reproduced in any language, stored in or introduced into a retrieval system, or transmitted, re-sold, redistributed, in any form or by any means without the prior written permission of the publisher. Information provided in this magazine is not intended to replace the advice of your health professional. The two doctors were supportive throughout my treatment, and this helped to raise my confidence level a great deal. They also had my best interests at heart. I remember trying to debate with Dr Teo one day. We had a schedule for my treatment, but my white blood count was too low below the mark deemed safe. But I was determined to stick to the schedule. Like many patients, I wanted to finish the chemotherapy treatment as soon as possible. I also believed that I needed some kind of treatment that day, and refused to go home without any treatment. But Dr Teo stuck to his guns, and in the end it was Chemo-No. There are times when it is not safe to do so, explained Dr Teo. So, sometimes, as much as we would like to accede to patients requests, safety concerns must always be our primary target. Giving chemotherapy when white cells are low is dangerous. Dr Teo insisted that I take a break from the chemotherapy and rest a few days, then put me back on the treatment safely. Dr Ang later praised my courage and determination to beat the cancer. Through my years of looking after cancer patients, I truly believe that those with a strong spirit to live, do better than those who have mentally lost the battle, he said. But beyond the expertise in the treatment, it was really the support that I got from all the doctors, nurses and others who helped in managing and administering my treatment, that made the difference. Looking back, I dare say that it actually felt good. No, not the treatment itself, but the way I was treated. Sister Tay and Sister Lek, for instance, were most motherly. They were always careful in checking and double-checking the dosages for my medication. Sister Tay would not only advise me about the types of food that I could or could not eat, but also give my wife advice on what type of food was good for pregnant women. Senior nurses Julia and Rose, the experienced nurses who administered my treatment, always prepared me for what was coming up, telling me what and when to expect it, and how I could cope with the treatment. Then there were nurses and other PCC staff like Guan, Lydia, Yeo and Mei Ling, who never failed to check on me, and Ani, Cynthia and Mary, who were always very jovial and also efficient in arranging subsequent follow ups for me. They made the atmosphere and environment warm and light-hearted, every time I stepped into PCC. This was very important for me, as it took my mind off the intensity of the issue at that time. And they cared about my family too. Before my son was born, all of them would ask, How s your wife? before asking how I was. Now that my son is around, they ask, How s your son and wife? then ask how I am. My heartiest thanks to the whole team. It was the best attitude and approach any patient could have. He was very cooperative and always had a positive attitude. With this, finishing the treatment was a breeze and handling the side effects and complications was easy. Dr Freddy Teo Cheng Peng, on treating Yu Ian What impressed me most was his courage and determination to beat the cancer. Instead of wallowing in despair and self-pity, he garnered all his courage to deal with the problem. Dr Ang Peng Tiam

3 希望的故事患癌的最糟时机陈耀恩在最不恰当的时机患上了淋巴腺癌, 不过他康复了他为我们述说他的故事我被诊断出患有非霍奇金淋巴瘤已经有两年了在任何时候被诊断出患有癌症都比那个时候好事发在 2007 年当时, 还有 4 个月我太太就要产下我们的第一个爱情结晶我当时还是一名研究生, 还有 8 个月才毕业被确诊的那个月也刚好是我在准备工作表现评估的时候患癌的消息突如其来, 简直打乱了我的生活我向百汇癌症中心求助中心介绍我找洪炳添医生和张俊平医生他们一开始就很坦白他们向我解释, 非霍奇金淋巴瘤是一种淋巴腺癌症他们说, 一些淋巴瘤可能非常厉害, 很难治疗虽然我的肿瘤相当大但幸好属于比较常见的普通肿瘤, 康复的几率相当高当我听到自己所患上的肿瘤通常对治疗的反应良好, 康复的机会良好时, 我整个人都松了一口气, 紧张的情绪也舒缓了许多我接受了化疗和一种名为单元抗体的免疫疗法我的身体对两种疗法的反应相当好即使处于震惊和担忧中, 我决心不让自己拘泥于自怜和沮丧中我会好好地面对问题医生后来告诉我, 这样的态度对我的康复起来一定的帮助张医生说我很合作, 而且态度永远非常积极这样的态度让我能轻而易举地完成疗程, 也让我可以应付治疗所带来的副作用和并发症两位医生在整个治疗过程中给了我很大的支持, 大大提高了我对治疗的信心他们处处都为我着想我记得有一天跟张医生发生了争执那天我原本预约要接受疗程但白血球指数太低了 - 在安全水平以下但跟很多病人一样, 我也希望尽早完成化疗我还是坚持按照原本的计划接受疗程而且我也坚信自己当天需要接受疗程, 如果没有安排我接受治疗, 我就不肯回家但张医生就是不肯让步, 结果是没有化疗张医生解释说 : 有些时候进行化疗是不安全的虽然我们希望尽量配合病人的要求, 但安全考量必须是指引我们做出决定的主要准则在白血球指数过低的时候让病人接受化疗是相当危险的张医生坚持要我暂时停止接受化疗几天, 然后才在安全的情况下让我重新接受治疗洪医生后来称赞我打败癌症的勇气和毅力他说 : 多年照顾癌症病人的经验告诉我, 那些有坚强生存意志的病人疗后结果一般上都比那些还没打仗就已经在心理上认输的人来得好除了医疗上的专业照顾外, 医生护士和所有其他在我接受治疗过程中提供帮助的人员所给予的支持才是让我的治疗过程与众不同之处回头想想, 要说我其实享受整个疗程也不为过不是, 不是治疗本身, 而是癌症中心对待病人的方式例如护士长戴淑霞和陆美琴母亲般的关怀他们总是一而再, 再而三不厌其烦地小心确保药物的剂量没有错戴淑霞护士长不只提醒我应该吃什么, 不应该吃什么 ; 也给了我太太待产期间饮食的建议为我提供治疗的资深护士朱丽雅和露丝总是会事先告诉我接下来他们会做什么, 什么时候会这么做, 要如何面对等其他护士和百汇癌症中心的职员也时时表示关怀他们总是笑脸迎人, 总是那么开怀, 在安排复诊日期时总是那么有效率他们让我每次走进百汇癌症中心时都能感受到空气中温馨轻松的环境这能够让我暂时忘记自己所面对的问题的严重性, 对我来说非常重要他们也很关心我的家人在我的儿子出世前, 他们都会问 : 你太太还好吗? 然后才问候我现在孩子出世了, 他们就问 : 你的孩子和太太还好吗? 然后才问候我我衷心感谢整个团队

4 Fighting Cancer 1. Don t smoke; don t be a passive smoker Some 85 per cent of lung cancer cases are a result of smoking, making the link between tobacco use and cancer too strong to ignore. Not smoking or quitting is, thus, one of the most important health decisions you can make, reducing your own cancer risk as well as your family s exposure to secondhand smoke. And it s not just lung cancer you can avoid: Tobacco use is also a cause of cancers of the liver, pharynx, oesophagus and stomach. way 10avoi About 40 per cent of cancers ca changes in lifestyle. Here are so 2. Protect yourself from the sun Most skin cancers occur on exposed parts of your body, such as the face, hands, forearms and ears. Thus, while repeated exposure to X-rays or contact with certain chemicals may cause skin cancer, the most common cause is still sun exposure. Detected early, most cases of skin cancer are treatable but it s, of course, best to avoid it altogether. 3. Maintain a healthy weight Studies show that those with a healthy weight lower their risk of certain cancers, such as breast and colorectal cancers. Use the Body Mass Index (BMI) to determine your ideal weight. According to the World Health Organisations, for Asians, a BMI of 23 or more moderately increases risks of cancer, while a BMI of 27.5 or more represents a high risk. BMI = weight (kg) / height (m) 2 4. Lead an active life Even if you re not trying to lose weight, physical activity on its own may lower risk of cancers such as breast and colon cancer. Exercise or be physically active as often as you can, even if it s just walking the dog or playing with kids in the park. 减低您的患癌风险只要改变生活习惯就可以预防约 40% 的癌症这里是 10 个协助你降低风险的简单方法 1. 不要吸烟 ; 不要吸二手烟在所有肺癌病例中,85% 是由吸烟所导致的, 凸显了吸烟和肺癌之间的因果关系因此不吸烟或戒烟是减低您的患癌风险, 同时避免让您的家人接触二手烟的重要决定其实肺癌不是你唯一的隐忧吸烟也可能导致肝癌鼻咽癌食道癌和胃癌 2. 做好防晒措施多数皮肤癌都发生在脸部手前手臂和耳朵等没有遮盖的部位即使多次接触 X 光或某种化学物也可能导致皮肤癌, 该癌症的最普遍导因还是同阳光的接触如果及早发现, 多数皮肤癌是可以治愈的但最好还是完全避免患上这类癌症 3. 维持健康体重研究显示, 拥有健康体重的人患上乳癌和结肠直肠癌等癌症的风险比较低您可使用 BMI 体重指数来确定您的理想体重根据世界卫生组织资料, 亚洲人体重指数一旦超过 23 就会适度提高患癌风险, 而体重指数超过 27.5 者则属于患癌高风险群体重指数 = 体重 ( 公斤 ) / ( 身高 ( 公尺 )X 身高 ( 公尺 )) 4. 保持活跃生活即使您没有计划减肥, 多做运动也可降低患上乳癌和结肠直肠癌等癌症的风险所以您应该尽可能多运动保持身体活跃, 即使只是溜溜狗或在公园里和小孩玩耍

5 对抗癌症 s to d cancer n be prevented by simple me ways to reduce your risk 5. Eat more plant-based foods What you eat can hurt you, but it can also help you. A variety of greens and other plant-based foods, such as garlic, grapes and blueberries, broccoli and cauliflower, as well as green tea are said to repair damaged cells and help prevent cancer. 6. Limit meats/processed foods Meanwhile, eating a diet high in animal fats and processed meats, such as ham, bacon and sausages, have also been linked to certain cancers, especially bowel or colorectal cancer. 7. Drink in moderation The risk of cancers such as mouth, throat, kidney, liver and breast cancers increase with the amount of alcohol you drink and how long (i.e. the number of years) you ve been drinking regularly. 8. Get screened Women who go routinely for Pap smear screenings rarely die from cervical cancer. And, almost no one would die of colorectal (bowel) cancer if everyone went for a colonoscopy every three years. These are cancers which can be detected at pre-cancerous stage. For a woman over the age of 40, an annual mammogram may save her life by detecting cancer at an early stage, even before symptoms are felt. With surgery alone, the cure rate is 100 per cent for stage 0 breast cancer, 70 to 80 per cent for stage I cancer, and is one of the most treatable and curable of all the cancers. 9. Get vaccinated Cancers which are linked to viral infections may be prevented with immunisation. These include Hepatitis B (which may cause liver cancer) and HPV or human papillomavirus (which causes cervical cancer). Check with your doctor whether vaccination will be beneficial to you. 10. Know your body Finally, while this doesn t prevent cancer, understanding your body increases your chances of surviving it. Self examinations and being aware of any changes in your body a sore that refuses to heal, lumps, unusual bleeding or discharge, changes in a mole or wart increases your chances of early detection and cure. With thanks to Parkway Cancer Centre for information and fi gures 5. 多吃蔬菜类食物您所吃下的食物可以对您的身体造成伤害, 但也可能对您有益多种蔬菜和蔬菜类食物, 如蒜头葡萄蓝莓, 花椰菜和椰菜花, 以及绿茶据说都有修复坏损细胞和预防癌症的功效 6. 少吃肉类和加工食物与此同时, 研究也显示, 多吃火腿培根和香肠等高脂肪加工肉类也同某些癌症有直接关系, 尤其是肠癌或结肠直肠癌 7. 适量地摄取酒精酒精摄取量越高经常喝酒的酒龄越高, 患上口腔癌喉癌肾脏癌肝癌乳癌的风险也会相应提高 8. 定期做体检定期接受子宫抹片检查的妇女很少会因为子宫颈癌而死亡如果每个人每三年就做一次结肠内窥镜检查, 几乎没有人会死于结肠直肠癌 ( 肠癌 ) 这些都是可在癌症病发前就探测出来的癌症每年接受一次乳房 X 光检查则可以帮助 40 岁以上的妇女在还没有出现任何症状之前就及早检查出乳癌只要接受手术, 乳癌零期和第一期的治愈率分别是 100% 和 70% 到 80%, 属于所有癌症中治愈率最高的癌症 9. 注射疫苗注射疫苗可避免患上因为病毒感染而引起的癌症这包括可导致肝癌的 B 型肝炎和可导致子宫颈癌的人类乳头状病毒 (HPV) 您可咨询医生的意见, 看看疫苗是否对你有益 10. 了解自己的身体虽然了解自己的身体不能让您避免患上癌症, 但却能提高你战胜癌症的可能自我检查可让你及时发现久久不愈的疮伤和硬块, 及早察觉和治疗癌症的可能不寻常的流血症状或粘液痣或疣出现变化和其他身体上的变化, 提高你及早检查和治疗癌症的可能感谢百汇癌症中心提供资料和数据

6 Serving You New on the menu: Parkway Cancer Centre s new dietitian Fahma Sunarja helps design patients diets to aid in their recovery What keeps me going is seeing patients getting their freedom in eating. Fahma (above) One of Fahma Sunarja s greatest joys is seeing patients enjoy their food even though they are recovering from a surgery or treatment. Many patients tend to restrict their diets after treatment, but she knows that different people can benefit from diets that are tailored to their needs. Upon diagnosis, patients tend to follow certain diet restrictions, she notes. It may be something that they read on the Internet or in books, or on advice by well-meaning relatives and friends. This is where Fahma comes in. As Parkway Cancer Centre s (PCC) first-ever dietitian, her mission is to help patients create individualised, suitable diets that can help them cope with their treatments for cancer. This could be helping them tailor-make a regime for tube feeding, or even something as simple as adding egg whites to their porridge, which will increase their protein intake. Such diets can make a difference in the outcome of patients treatment, both in physical terms and also in motivating them. What keeps me going is seeing patients getting their freedom in eating, says Fahma. Seeing them doing well with the treatment is the greatest motivation for me. It is this motivation that drove Fahma to help PCC roll out its new dietetic services, which aim to provide nutrition support for patients undergoing cancer treatment. By building up patients nutritional status and providing sound nutritional advice, the cancer centre hopes to help patients cope with cancer treatment better and improve the results as well, says Dr Khoo Kei Siong, Deputy Medical Director and Senior Consultant, Medical Oncology, at PCC. Fahma has already laid out a long list of plans for the cancer centre. For a start, she aims to set up an all-round nutrition service for cancer patients, developing resources such as booklets, handouts and recipe books that patients and their caregivers can use to ensure they get good nutrition. I want to translate the science of nutrition into everyday information about food, she says. This means educating patients and their families on nutritional principles, dietary plans and diet modifications, and showing them the finer points of food selection and preparation, she explains. But beyond just teaching patients, Fahma will also help patients assess their nutritional needs and counsel them on good eating plans, which will help prepare them for cancer treatment. Her work does not stop there: Fahma will then continue to help these patients cope with the effects of their cancer treatment, ensuring that they maintain a good nutritional intake throughout. She also has plans to spread the word about nutrition, conducting nutrition workshops for cancer patients and their caregivers. These will allow her to share the basic rules of good nutrition and healthy eating habits, and teach patients how to monitor their nutrition so that they can improve their quality of life and the outcome of their treatment.

7 Serving You A taste of recovery PCC s new dietetic services Full nutrition services started in April 2010: Nutrition services for individuals Anthropometric assessment of height, weight, sums of skinfolds Energy & nutrient assessment Enteral nutrition assessment eg. nasogastric tube feeding Parenteral nutrition assessment Food intake analysis Meal planning Dietary advice eg. high-protein, high-energy diets; food safety during cancer treatment; weight management; texture-modified diets, diets for chronic diseases Nutrition supplementation advice Nutrition services for groups Nutrition workshops eg. eating well before, during and after cancer treatment; weight management; understanding food labels; reviews on various diets in relation to cancer such as organic diet, vegetarian diet, low-carbohydrate diets Cooking demonstrations/classes Supermarket tours Fahma (right) answering questions at a workshop. For more information, contact CanHOPE at: Cancer Counselling and Hotline: (65) enquiry@canhope.org CanHOPE is a non-profit cancer counselling service and hotline by Parkway Cancer Centre She will also run hands-on cooking demonstrations, and show patients how to prepare such things as highenergy and protein-blended food, and also how to include nutrition supplements in their meals. Liaising with the pharmaceutical and food industries, she will also keep patients updated on nutritional supplements and the latest products available. It is all part of a mission that the dietitian has been pursuing ever since she went to university. After studying nutrition and dietetics at the University of Otago in New Zealand, Fahma took many more steps to perfect the art of nutrition, specialising in paediatrics liver transplant nutrition management as well as sport nutrition. She comes to PCC with much experience in the field, having spent six years as a clinical dietitian at the National University Hospital in Singapore, where she handled paediatrics nutrition management, metabolic syndrome nutrition management and food service nutrition consultation. She also developed an electronic hospital meals ordering system, which improved the delivery of diet therapy at the hospital. Fahma spent six years heading the sport nutrition unit at the Singapore Sports Council, where she worked closely with top athletes in adjusting their nutrition to achieve their best in the field. Apart from helping them plan their menus, she was also instrumental in setting up a mobile nutrition recovery service for athletes as they prepared for major regional and international competitions such as the Southeast Asian Games, Asian Games and the Olympics. Fahma has even co-written a book of sport nutrition recipes, titled Asian Flavour of Fitness Recipes for the sporting individual. Working with patients, she says, has given her a new perspective on life. It made me appreciate good health, which we often take for granted until it is taken away from us, she says.

8 The Doctor Is In From no hope......to curable A doctor spots a germ cell cancer and turns an earlier prognosis on its head Matters of science, like doctors, have limitations... doctors too hazard guesses, play our hunches and hope for the best. I was reviewing the blood test results of a young patient in his early 30s when my heart leapt with joy his pregnancy test was positive! The rejoicing wasn t because I found a pregnant man but because a positive pregnancy test in a male with cancer suggests that he most likely had a highly curable germ cell cancer. I shared the good news with him. I could sense his bewilderment. Just a day earlier, he had been told that he had an incurable cancer with not long to live. The next day, he is told that he has a cancer that responds extremely well to chemotherapy, with greater than 80 per cent chance of cure. He didn t quite know who or what to believe but since he had already decided to leave his care in my hands, he pleaded with me, Please just do your best. I m too young to die! Germ cell cancers can be cured. But they can also be easily missed. When this patient first came to see me, he said despairingly: They say I have stage IV cancer and that even if I respond well to treatment, there is no hope of a cure. He came with his wife, also in her early 30s. He had just been seen by another doctor the same day, and had been told of the bad news. Wasting no time, he came for a second opinion, hoping against hope that I would say something different. A few months ago, he noticed a lump on the left side of his neck, just next to the mid-line. He saw a doctor and was told that he had tuberculosis (TB). When it continued to grow despite anti-tb treatment, a biopsy was done. The results confirmed that he had poorly differentiated cancer, which meant cancer with no identifying features. A whole body scan showed enlarged cancerous lymph nodes in the neck, behind the heart and in the abdomen adjacent to the main artery called the aorta. Despite their best efforts, the doctors could not determine where the cancer originated. The patient was labelled as cancer of unknown primary and offered palliative chemotherapy treatment aimed at trying to buy him some more time. What struck me were the patient s age and the pattern of spread. This man was relatively young and his cancer appeared to involve only the lymph nodes along the mid-line. There is a rare cancer, highly curable, that presents a similar pattern of spread called germ cell tumour. This occurs mainly in young males - between the second to the third decades of life. It most commonly originates in the testes but can also occur along the mid-line either in the chest or the abdomen. Without raising false hopes, I suggested that he allowed me to carry out further blood tests and to retrieve the biopsy specimen from his doctors, to allow us to carry out another review by our internal panel of pathologists. He was a little reluctant, as he had just gone through so much over the past week that he felt emotionally exhausted. All he wanted was for me to take over management and start him on chemotherapy as soon as possible. However, I explained that these tests were needed and that I was prepared to start treatment the next day, once the blood test results were ready. Left with no choice, he acceded to my requests. To my great relief, I was able to tell him that there is a good chance that he will be cured. Cure means that the cancer will disappear completely and never come back again. Cure means that he will live to a ripe old age of 70 or 80, God willing! I started him on chemotherapy that same day. The family eventually managed to retrieve the biopsy. The specimen was subjected to special tests and our pathologists confirmed that he had germ cell tumour. When I saw him a week after treatment, a different man walked through the door. He was visibly more relaxed. I think I m getting better, because this lump in my neck has become smaller, he said with a smile. I grinned back at him, but a chill went down my back what could have happened to this young man, had he not decided to go for a second opinion and proceeded with palliative chemotherapy? Worse still, what if he decided not to go for any treatment or if he took his own life because he had terminal cancer? These are unprofitable thoughts and as a man of science, I ought not to entertain them. But matters of science, like doctors, have limitations. We use such words prognosticate but the truth is, doctors too hazard guesses, play our hunches and hope for the best. I am thankful that I was sharp enough this time to help this patient. But I am not always at my sharpest. The lesson for me is to always be careful the price for a doctor s mistake is often too high to be paid. By Dr Ang Peng Tiam

Microsoft Word - 第四組心得.doc

Microsoft Word - 第四組心得.doc 徐婉真這四天的綠島人權體驗營令我印象深刻, 尤其第三天晚上吳豪人教授的那堂課, 他讓我聽到不同於以往的正義之聲轉型正義, 透過他幽默熱情的語調激起了我對政治的興趣, 願意在未來多關心社會多了解政治第一天抵達綠島不久,