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1 FREE November 2011 HealthNews Inspiring and informative stories for patients MICA (P) No. 153/01/2011 Fighting leukaemia with semangat Despite having to go through intensive chemotherapy and several setbacks, George persisted in his battle, with his mother s support When George Wiza Widyabahkti arrived in Singapore in June 2010, he had been given four weeks to live. But thanks to swift aggressive treatment and a fierce will to live, George emerged victorious. It started with nausea and a headache that would not go away. Eventually, George, then 18, checked in to a hospital in Jakarta to see what was wrong. However, the hospital there kept giving him conflicting information and finally, in desperation, his parents decided to send him to Singapore. By that time, George was so weak that he could not walk and his mother had to push him in a wheelchair. When Dr Freddy Teo, Senior Consultant, Haematology, at Parkway Cancer Stories of HOPE Centre (PCC), saw George, he immediately ordered a test of his bone marrow which confirmed that he was suffering from advanced acute lymphocytic leukaemia. According to Dr Teo, George was between two and four weeks away from death. The next day, just three days after arriving in Singapore, George began an intensive form of chemotherapy regime which involved five chemotherapeutic agents. The chemotherapy drugs were administered almost continuously over a four-week period. This is a very intensive schedule and the treatment, according to Dr Teo, has a mortality risk of 5 to 10 per cent. Because of the advanced nature of the cancer and the aggressive treatment, it was not smooth sailing for George. After the first round of chemotherapy, the damage to his nervous system left him unable to walk and this affected his treatment. Normally, patients like George would have chemotherapy administered into the cerebral spinal fluid to prevent the leukaemia from spreading to the brain. However, because George s nervous system was already damaged, he had to undergo radiotherapy instead of chemotherapy. The damage to his nervous system was a blow Continued next page IN THIS ISSUE: Understanding leukaemia Celebrating life 了解白血病

2 Stories of Hope From cover page but George did not give up. He had a strong will to live and went on to complete the five rounds of chemotherapy. He attributed this to semangat, the Indonesian word for spirit. We must have the fighting spirit to fight against cancer, said George. Over time, he became stronger, and eventually, George no longer needed his wheelchair and was able to fly back to Indonesia in-between treatments. Nonetheless, he still had to spend quite a lot of time in Singapore. As he got better, George became restless staying in the apartment. Itching to do something more useful than watching Kemenang Melawan L Right: George with his mother, who supported him throughout his journey battling cancer. Far right: George presents Dr Teo with a remotecontrolled car that he assembled specially for the doctor, who has the same hobby. Connect with us on at parkwaycancercentre Editorial team Fong Mue Chern, Vincent Tan, Nuraisha Teng, Woan Fei, Jimmy Yap Publisher Preston Communications Printer Impress 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. television, he decided to do something with his hands. George had a hobby of building scale models of cars. As soon as he felt well enough, he decided to continue this hobby in Singapore as well. One such model, a remote-controlled Mini Cooper now sits proudly in Dr Teo s office. Apart from buying the kit to assemble, George also printed out the PCC logo and stuck it to the side of the Mini Cooper to personalise the car. George completed his last course of chemotherapy in April this year, and things are now looking up. He responded well and his leukaemia is in complete remission, said Dr Teo. He is as well as he can be. There is no evidence of any recurrence. However, George is not out of the woods yet. He has a good chance of a cure but it is not guaranteed, said Dr Teo. It will take between two to three years of being free of the disease before he can be pronounced cured. Dr Teo s advice to others in George s position is to take treatment one step at a time. It is difficult to plan too far ahead, as complications and side effects may upset the treatment plans. Last but not least, stay positive and follow the advice of your doctors. The patient needs to help the doctors to help him. As for George, he is determined to make the most of his new lease of life. In order to live the life that God has given to me to the fullest, I hope to inspire those who are on the same journey as me, he said. And his advice to others is to keep fighting. Through our prayers and perseverance, I believe that we will emerge as winners one day. Di atas: George mempersembahkan mobil remotejuga memiliki hobi yang sama. Kiri: George dan mamanya, yang selalu mendukung Walau diharuskan menjalani chemotherapy yang intens dan menghadapi tantangan, George tetap teguh di dalam perjuangannya Saat George Wiza Widyabahkti tiba di Singapura pada bulan Juni 2010, ia telah divonis hanya bertahan hidup selama 4 minggu. Namun, terima kasih kepada teknologi perawatan yang mutakhir dan semangat hidup yang mengebu-gebu, George berhasil di dalam perjuangannya. Diawali dari rasa mual dan pusing yang berlarutlarut. George, yang berusia 18 tahun, mengunjungi sebuah rumah sakit di Jakarta untuk mengetahui asal muasal penyebabnya. Namun demikian, rumah sakit berulang kali memberikan informasi yang membingungkan, dan pada akhirnya di tengah kepanikan, orang tua George memutuskan membawa George untuk diperiksa ke Singapura.

3 Kisah Penuh Harapan an Atas Perjuangan eukaemia control yang dirakitnya khusus untuk Dr Teo, yang dalam perjuangannya melawan kanker. Pada waktu itu, saking tak berdayanya, George telah tidak mampu berjalan dan harus didorong mamanya dengan kursi roda. Ketika Dr Freddy Teo, Senior Consultant Haematology (Konsultan Senior, Bagian Darah) di Parkway Cancer Centre memeriksa George, tulang sumsum belakangnya segera didiagnosa dan terbukti bahwa ia menderita acute lymphocytic leukaemia tingkat lanjut. Menurut Dr Teo, harapan hidup George hanya tersisa 2 hingga 4 minggu. Keesokan harinya, 3 hari setelah kedatangannya di Singapura, George langsung menjalani rutinitas chemotherapy yang melingkupi lima proses chemotherapy. Proses chemotherapy-nya harus diberikan secara terus menerus dalam jangka waktu 4 minggu tersebut. Ini adalah pengobatan dengan dosis yang sangat kuat dan intens, menurut Dr Teo, memiliki resiko kematian 5 hingga 10 persen. Karena kankernya telah berada dalam tingkat lanjut dan taraf pengobatan yang sangat kuat, perjuangan George tidak selalu mulus. Setelah chemotherapy yang pertama, kerusakan sistem syaraf membuat kakinya lumpuh dan hal ini berpengaruh terhadap kelangsungan perawatannya. Biasanya, untuk pasien seperti George, chemotherapy harus dijalani lewat tulang belakang untuk menghindari penyebaran leukemia ke otak. Akan tetapi, karena terganggunya sistem syaraf George, ia harus diberikan radiotherapy sebagai pengganti dari chemotherapy. Kerusakan pada system syarafnya merupakan sebuah pukulan, tapi George tetap pantang menyerah. Ia memiliki semangat hidup yang sangat tinggi dan berhasil menuntaskan kelima tahap chemotherapynya. Kita harus punya semangat tempur dalam melawan kanker, ucap George. Seiring berjalannya waktu, George menjadi lebih kuat hingga tak membutuhkan lagi kursi rodanya dan mampu balik ke Indonesia di sela-sela perawatannya. Namun demikian, ia masih harus menjalani waktu pengobatan yang panjang di Singapura. Setelah ia menjadi lebih sehat, George tak bisa diam saja di apartemennya. Ia ingin melakukan sesuatu yang lebih bernilai daripada hanya menonton televisi, ia memutuskan untuk melakukan sesuatu. George mempunyai hobi dalam merakit model mainan mobil. Saat ia merasa sehat, ia memutuskan untuk tetap melanjutkan hobinya di Singapura. Salah satu dari model rancangannya, sebuah Mini Cooper yang dijalankan dengan remote control, kini dipajang dengan bangga di kantor Dr Teo. Di samping membeli komponen mobil untuk dirakit sendiri, George juga mencetak logo Parkway Cancer Centre dan menempelnya di sisi Mini Coopernya untuk mempersonalisasinya. George telah menuntaskan keseluruhan tahap perawatan chemotherapy-nya di bulan April tahun ini, dan hasilnya berdampak memuaskan dan cerah. Tubuhnya memberikan respon yang baik terhadap perawatan dan berangsur-angsur pulih total dari leukemia, kata Dr Teo. Ia benar-benar sembuh. Tak ada indikasi akan keterjangkitan lagi. Nasihat Dr Teo pada pasien lain seperti George adalah untuk menjalani pengobatan setahap demi setahap. Sangat sulit untuk merencanakan sesuatu yang terlalu jauh ke depan, karena komplikasi dan efek samping selama masa perawatan dapat mengganggu rencana perawatan. Yang paling penting, tetap positif dan mengikuti nasihat dokter anda. Pasien sangat membutuhkan pertolongan dari dokter. Di pihak George, ia sangat bersemangat dalam menjalani hidupnya yang baru. Dalam menjalani kehidupan yang telah Tuhan berikan kepada saya sepenuhnya, saya berharap untuk menginspirasi teman-teman yang mempunyai perjalanan seperti saya, katanya. Dan nasihatnya kepada yang lain untuk tetap berjuang. Lewat doa dan kegigihan, saya percaya kalau suatu hari kitalah yang akan menjadi pemenangnya. Dalam menjalani kehidupan yang telah Tuhan berikan kepada saya sepenuhnya, saya berharap untuk menginspirasi temanteman yang mempunyai perjalanan seperti saya. George

4 Fighting Cancer For more information on leukaemia or support for patients or caregivers, call CanHOPE at or What is leukaemia? Leukaemia is a cancer of the body s blood-forming tissues, which include the bone marrow and lymphatic system. It usually causes an uncontrolled production of abnormal white blood cells. In healthy individuals, blood cells are released by the bone marrow upon maturity. However, for leukaemia patients, the body produces and accumulates immature white blood cells, resulting in a highly-compromised immune system. What causes this cancer? There is no known cause doctors can t explain why one person develops it but not another. Some known risk factors, however, include exposure to high levels of radiation and industrial chemicals. Patients who have been treated with anticancer drugs also tend to be at greater risk, and may develop leukaemia years later. Genetic factors that increase risk of leukaemia include Down s Syndrome or blood disorders such as Myelodysplastic Syndrome (MDS). Patients with MDS, sometimes known as pre-leukaemia, often develop severe anaemia and require frequent blood transfusions. What are the symptoms? Symptoms vary but common ones include fever or chills, persistent fatigue, loss of appetite or weight, swollen lymph nodes, an enlarged liver or spleen, easy bruising, nose bleeds or tiny red spots on the skin, shortness of breath or excessive sweating especially at night, bone pain or tenderness, as well as frequent infections as the immune system is compromised. How is it diagnosed? Blood tests and a bone marrow examination can determine if a patient has leukaemia. A blood sample Underst LEUKA This blood cancer may be cancers in children and youn many cases, it is curable. He is taken and the red blood cells, white blood cells and platelet counts are examined to see if they fall within the normal range. In acute leukaemia, blood counts tend to show low red blood cells, low mature white blood cells and low platelets. A bone marrow biopsy and aspiration is then conducted, where marrow samples from the body, usually the back of the hip bone, are taken for testing. A lumbar puncture or spinal tap, where spinal fluid is removed from the lower back, may also be done to determine if the leukaemia has spread to the central nervous system. The major types of leukaemia include: Acute myelogenous leukaemia (AML), which is the most common type 了解白血病虽然这类血癌是新加坡儿童和年轻人最普遍患上的癌症, 但很多病患其实是可以治愈的以下是一些你需要知道的资料什么是白血病? 白血病是一种源自于如骨髓和淋巴系统等制造血液身体组织的癌症这类血癌通常会导致白血细胞不受控制地大量生长在健康的成人体内, 血细胞只有在成熟时才会由骨髓释放出来但白血病人的身体会累积未成熟的白血细胞, 大大影响病人的免疫系统白血病的导因有哪些? 白血病并没有明确的导因医生没有办法解释为什么某人会罹患白血病而另一个人却不会但一些已知的高风险因素包括接触大量的放射物质和工业化学物质那些曾经服用抗癌药物的病人也属于高风险群, 并可能在几年后患上白血病唐氏综合征 (Down s Syndrome) 或骨髓增生异常综合征 (Myelodysplastic Syndrome) 等血液失调病症也可能成为提高患上白血病风险的基因因素患上被认为是白血病前症的骨髓增生异常综合征的病人通常会出现贫血的情况, 并需要经常输血白血病的病征是什么? 每个病人的病征都不同, 但一般的症状包括发烧或发冷持续疲劳失去食欲或体重下降淋巴结肿胀肝脏或脾脏胀大容易瘀伤流鼻血, 又或者皮肤也可能出现小红点呼吸短促或多汗, 尤其是在夜里骨头疼痛或发软, 以及因为免疫系统受损所导致的经常性感染白血病如何诊断? 医生可以通过为病人进行血液检验和骨髓检查来确定病人是否患上白血病在检验中, 医护人员会采取病人的血液样本, 并对样本中的红血细胞白血细胞和血小板指数进行计数, 确定数量是否属于正常范围急性白血病人的血液样本中往往会显示低数量的白血细胞成熟白血细胞以及血小板之后, 医护人员会为病人进行骨髓切片和抽取以便进行化验 ; 这类程序通常会通过身体的盆骨后方进行在某些情况下, 医护人员也可能为病人进行腰椎

5 对抗癌症 anding EMIA among the most common g adults in Singapore but in re s what you need to know Acute lymphocytic leukaemia (ALL) is the most common leukaemia among young children, accounting for over 40 per cent of childhood cancers in Singapore Chronic lymphocytic leukaemia (CLL), a common adult leukaemia Chronic myelogenous leukaemia (CML) also mainly affects adults In acute leukaemia, the disease progresses rapidly affecting cells that are unformed or not fully developed. These immature cells are thus unable to carry out their normal functions. In chronic leukaemia, the disease progresses slowly allowing for the growth of greater numbers of more developed cells, which can thus carry out some of their normal functions. What are the treatment options? Chemotherapy is the most common treatment for leukaemia and the patient may receive a single drug or combination of drugs depending on the type of leukaemia the patient suffers from. These drugs are given orally, intravenously (injection directly into a vein), through a catheter placed in a large vein (to minimise the need for multiple injections) or by injection directly into the cerebrospinal fluid and work to kill or slow the growth of cancer cells. Side effects include hair loss, mouth ulcers and nausea, and a patient may be at increased risk of infection, heavy bleeding and fatigue. Biological therapy may be administered to improve a patient s natural defences against cancer. Through injections via a vein, antibodies may be given to kill leukaemia cells in the blood and marrow or to slow their growth. Some side effects include fatigue, or flu-like symptoms like fever, chills and appetite loss. Radiotherapy or radiation therapy uses highenergy rays to kill leukaemia cells. For most patients, a machine directs radiation at a specific part of the body where leukaemia cells may have collected but total-body irradiation may be given if a patient is about to undergo a bone marrow transplant. Side effects include tiredness, itchy or dry skin, and some hair loss. These are mostly temporary. Stem cell transplantation allows a patient to be treated with high doses of drugs, radiation or both, destroying both leukaemia cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells through a flexible tube placed in the neck or chest area. The patient then needs to remain in hospital for several weeks to protect from infection until transplanted cells begin to produce enough white blood cells. Blood works Blood is produced in the bone marrow and consists of blood cells and plasma. The latter is the fl uid which transports blood cells, which are made up of red blood cells, white blood cells and platelets. The purpose of each are: Red blood cells transport oxygen from the lungs to the rest of the body and a shortage of these cells leads to anaemia. White blood cells help fi ght off infections and a shortage results in a weakened immune system. Platelets are essential for blood clotting or coagulation, which stops excessive blood from leaving the body when there is a cut or wound, as well as prevents bacteria from entering the body. Insuffi cient platelets result in prolonged bleeding and blood loss. 或脊髓穿刺程序, 让脊髓液体从后背下部流出, 以便确定白血病是否扩散到中枢神经系统白血病的主要类别包括 : 急性骨髓性白血病 (Acute myelogenous leukaemia)- 最常见的白血病急性淋巴细胞白血病 (Acute lymphocytic leukaemia) 年幼儿童最普遍患上的白血病在新加坡儿童癌症病患中, 超过 40% 患上这类白血病慢性淋巴细胞白血病 (Chronic lymphocytic leukaemia)- 常见的成人白血病慢性骨髓性白血病 (Chronic myelogenous leukaemia)- 多数影响成人急性白血病病人的病情往往快速恶化, 癌细胞迅速扩散到周边其他未成型或成熟的细胞这导致这些未成熟细胞无法正常运作慢性白血病患者的病情恶化速度较缓慢这让更多细胞有机会发育完成, 发挥正常功能白血病的治疗方法有哪些? 化疗是治疗白血病的最普遍治疗, 病人可能需要一种或多种药物治疗, 视所患白血病类别而定化疗药物可能是口服或通过安装在大静脉上的导管 ( 避免需要多次注射 ) 注射入静脉, 又或者直接注射进脑脊髓液, 逐渐杀死或放慢癌细胞的生长副作用包括脱发长口疮和恶心 ; 病人也受感染大量出血和疲劳的可能性也可能提高生化治疗可以用来改善病人本身对抗癌症的能力医生可能把抗生素注射到病人的静脉, 帮助杀死血液和骨髓内的白血细胞, 或放缓它们的生长副作用包括疲劳或发烧发冷和丧失胃口等感冒症状化疗或放射性治疗利用高能量光线杀死白血细胞多数病人只需要在白血细胞聚集的身体部位接受放射治疗, 但如果病人需要接受骨髓移植手术, 他就需要接受全身放射治疗副作用包括疲劳皮肤发痒或干燥, 脱发但这些通常都是暂时的肝细胞移植病人同时接受大量的药物放射治疗或双管齐下, 破坏骨髓内的白血细胞和正常血细胞之后, 病人通过安装在颈部或胸腔的软管输入健康的肝细胞病人之后需要住院观察数周, 避免出现感染, 直到新移植的细胞生产足够的白血细胞为止欲知更多有关白血病或病患及家属扶持计划, 可拨电或电邮至 enquiry@canhope.org 血液的运作机制包含血细胞和血浆的血液由骨髓制造血浆是一种含有红血细胞白血细胞和血小板的液体, 负责运输血细胞到身体其他部位以下是各种细胞的作用 : 红血细胞负责从肺部运输氧气到身体其他部位, 缺乏这类细胞可导致贫血白血细胞可帮助人体抑制感染, 缺乏这类细胞可导致免疫系统变差血小板对凝血起关键作用, 避免身体遭割伤或切伤时, 流失过量的血, 也避免细菌侵入身体血小板不足可导致长时间流血及血液流失 Picture istockphoto.com/health_news

6 Community Outreach A celebration of life Ms Yeo Yi Lin (extreme right) Cancer Warrior since August 2004, bone cancer Parkway Cancer Centre (PCC) launched the I am Cancer Warrior campaign this year as part of its efforts to educate and create public awareness on cancer. On its 5th anniversary, PCC held a photo exhibition featuring portraits of 13 such warriors who were celebrating their remission and recovery. They had battled with cancer bravely, and won, with the help of their families, caregivers, doctors and healthcare workers all warriors too. Their achievement brings hope and encouragement to other cancer patients in their battle with the disease. Mr Phillip Ling Cancer Warrior since April 2007, non-hodgkin s lymphoma Mr Ting Beng Chin (left) Cancer Warrior since July 2002, colon cancer Mr Lim Chee Kien (centre) Cancer Warrior since June 1998, stomach cancer Madam Tan Siew Eng (2nd from right) Cancer Warrior since January 2005, throat cancer Mr Omar Bin Mahmood (centre, in black) Cancer Warrior since July 2002, nasopharyngeal cancer

7 Community Outreach Mr Cheow Heng Yin (centre) Cancer Warrior since May 2006, stomach cancer Madam Lim Mei Leng Cancer Warrior since June 2000, lymphoma Madam Low Kah Wei Cancer Warrior since June 2006, breast cancer We wanted to capture these moments to show other cancer patients that cancer is not a death sentence. Dr Ang Peng Tiam, PCC Medical Director Warrior: someone who displays courage, strength, unconditional love and a fighting spirit Madam Ooi Soo Nee (3rd from left) Cancer Warrior since March 2005, womb cancer Mr Gan Cheng Hor (right) Cancer Warrior since June 2005, colon cancer Madam Nellie Tan Cancer Warrior since January 2006, ovarian cancer Ms Yunny Christine Cancer Warrior since May 2006, colon cancer with liver metastases

8 Community Outreach Victorious Cancer Warriors get a warm welcome and hearty applause (left). They were later also presented with speciallycommissioned portraits (above right) from doctors like Dr Ang, and serenaded by guitarist Mr Peter Lim (bottom right). Warriors mark PCC s 5th year For Mr Omar Bin Mahmood, who beat cancer nearly 10 years ago, there s always something to celebrate. Cancer survivors or warriors who passed the fiveyear mark after a brush with cancer celebrated life in style at Singapore s Old Parliament House. Held in conjunction with Parkway Cancer Centre s fifth anniversary, the event was organised to recognise patients who have accomplished the milestone of remission and recovery. As Dr Ang Peng Tiam, Medical Director of PCC, told a crowd of doctors, family members and friends in his opening speech: There is a good chance that you are cured of cancer; you have probably beaten the disease. The event, held on 8 October, started with 13 cancer warriors striding confidently into the hall, to cheers and applause from the lively crowd. The spotlight was also on the dedicated caregivers who were the pillar of strength for patients. The joyous atmosphere carried on well into the afternoon, with a string quartet, Fritz Quartet, performing six soothing melodies including Josh Groban s inspirational You raise me up. The highlight of the day came when the cancer warrior photo exhibition was officially opened, showing portraits of the 13 cancer warriors with their loved ones. Said Dr Ang: We wanted to capture these moments to show other cancer patients that cancer is not a death sentence; it can be beaten and these are the living examples of those who have fought against the disease. The day ended on a high note as cancer warriors, along with their families and friends, joined guitarist Mr Peter Lim in his serenade of You ve got a friend in me. Dr Khoo Kei Siong, PCC s Deputy Medical Director, said he was confident that the cancer warriors would continue to inspire others. To cancer warriors, a happy fifth anniversary, he told them. I look forward to seeing you on our tenth anniversary.

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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,