Update on Sah Kor

Dear friends and family, this is the latest news on Sah Ee. As you know, she has been in a great deal of pain over the last two weeks. The pain began in her fixed hip joint, moved up her spine and then down the sciatic nerve. Her team of doctors, that included the orthopedic specialist and her oncologist, wanted to have her take a bone scan to make sure that the pain was not being caused by the cancer moving to the bones. She reviewed the results of the bone scan with her oncologist, F.K. Lim, today and the scan does not show anything. However, her cancer count has gone way up to 863…double what it was a couple of months ago. While the count in itself is not an infallible indicator, the trending of it is quite reliable. He did a complete physical exam of her ovarian area and says that he can feel something. He believes that the cancerous tumor is back and it is pressing on nerves to create the pain. He has ordered a scan for April 9 to confirm his findings. She will then see him again on April 15. At that time, she will have a better idea of what she will be able to do to treat the cancer and manage the pain. Professor Lim indicates that it does not make sense to have another operation based on where he believes the tumor to be…(it is not growing in an area that it can be removed in totality) …also that her cancer seems very resistant to chemotherapy and that any treatment would have a very low possibility of being effective…and that the radiation treatment that she had at the beginning of last year was radical enough to preclude having another bout of treatments. If she chooses not to pursue radiation or chemotherapy than her only choice will be to leave it as is and manage the symptoms.

Dear Family and Friends, It has been quite a while since I have updated you on Sah Ee's health. Life for her has not been easy since her second surgery. She has not able to recover her energy and her spirit in the same manner as she did from her first surgery. Not only did she have to deal with the pain from a much more invasive surgery, being forced to have a colostomy bag but she also had to deal with her fears of radiation therapy. In her typical manner, she quietly overcame her fears and is now half way through the most intensive part of her radiation. The radiation therapy is divided into three parts: 28 days, daily, covering the pelvic region, then for 3 weeks, weekly, more localized and intensive firings, then the final session is an insertion to the area with a final firing. After all this is said and done...then what. We wait...around a month after she completes the program she will begin her normal testing: the scans and the tumor marker blood test. Then and only then will we have any idea if the radiation did any good.

As to her overall health, she is tired. The fatigue causes her to draw into herself. She gets frustrated with the lack of any apparent progress or change. She is inconvenienced by the bag and is just now getting use to it. This also tends to make her more restricted in her activities. But as you know, she is a strong woman and she has her relationship with God to help her fight the good fight. If you want to drop her a line or come visit our address is: Khoo Bee Guat, 1 Swiss View #01-01, La Suisse 2, Singapore 288007. Her personal telephone number is 467-7271.

She came through the bowel resectioning surgery well. The surgeons believe that they removed the entire tumor but they are concerned that there may be microscopic cancer cells in the pelvic region. Because of that they have recommended that Sah Ee go for a radiotherapy treatment. This treatment comes in three sections. The first is everyday for 28 days and covers the entire pelvic region. The second is for 4 weeks, once a week, concentrating the area to where the tumor was located. And the third is a concentration to the top of the vaginal area.

She is healing nicely but her wounds are not completely healed so she is a bit uncomfortable walking...and feels very "unrefreshed" because she can not fully shower. She is getting use to the bag now and has even been out a couple of times. She has reconciled herself to the fact that she will probably have it for a long time.

She has good days and bad days...but she is always her gentle self. Love to you all, lani

Sah Ee just finished a long surgery to resection her bowels in order to remove a tumor. Prof Lim, her oncologist, said that the operation was very difficult but it looks like the tumor was completely removed. He looked around for other signs of the cancer and said that if it was there it was microscopic. He however has clipped the area in case it is determined that she should have radiotherapy at a later date. They will be running tests on the tumor and as this time have made no determination on the best future treatment. She has had to have a temporary (which we hope will remain temporary) colostomy attached. Right now she is in a great deal of pain, resting and on a self administered morphine drip. She will be in NUH for approximate 10 days while they watch her recovery. She is in room 41, bed 36. She has Doris' handphone which is 96786072.

Sah Ee was rather surprised to hear that her cancer count has gone up. Doctor Lim is going to have another discussion with the bowel surgeon but it looks like they are going to operate on either Nov 19 or Nov 26. He made her realize that if she did not go through with the surgery then the tumor would just grow and eventually obstruct the bowel...causing all sorts of problems. Since she has had surgery once, and found it so painful, she is very tentative and fearful.

Sah Ee's cancer has returned. It appears that her tumor is resistent to chemotherapy. She has had a scan and two cancer counts which indicate that the tumor has returned. She will be having a MRI next Tuesday to clearify the tumor and to determine if it has spread to other part of the body. She will then have a decision to make: leave it alone, treat it with chemotherapy with minimum hope of any effect, or to have surgery. These are very scary times.

Today, 2 April, I took Sah Ee to see her doctor, Professor Lim F.K. He said that the results of her blood test were quite good only she was a little bit low in her white cell count which should be at 3000 but was at 2800. He will see her again in two weeks when she will take another full blood count in order for him to calculate the chemotherapy dosage. This will be her fourth treatment out of six. After her last treatment she was quite weak up to the 7th day. The doctor feels that this is only due to the level of drugs that are in her system and encouraged her to rest during the recovery period. She of course wants to garden. She will not be able to go out into crowds, including church, until all the treatments are over. She does however appreciate company. If you are well, stop by to see her especially the week before her next treatment. She goes in on April 18.

On 18 Jan, Sah Ee underwent surgery to explore a growth found in her left ovarian tube via a MRI scan. The surgeon found a stage one B growth in the womb and a stage one C growth in her left ovary. The growth in the womb was removed and they hold little concern for the continuing effects of this tumor. They are however still concerned about the tumor in the ovary because it was stuck to the bowels and poorly differentiated. They also found a swollen lymph node which was removed and examine. The results came back negative as the node was clear. Prior to the operation her tumor marker was 1600, after surgery it fell to 500. In a normal healthy person the level should be around 35 so they will begin chemotherapy on her today. While the tumors were removed she will receive the chemotherapy as an insurance policy. She will be receiving a combination of taxol and carboplatin. The side effects are very individual but she can expect some hair loss and nausea. There may also be some risk of an allergic reaction. This is a relatively "friendly" chemotherapy treatment. (The doctor's words, not mine) which has a 70% response rate. As this is her first treatment she will be warded at Ward 61 (her old ward) for the day and probably the night. The morning will be receiving premedications to ensure she is can take the treatment (by checking her magnesium levels, etc) and giving her anti-nausea drugs to help with the after side effects. The treatment which is given intravenously last about 2 hours and will be given in the afternoon. They have to watch her very carefully as the chemotherapy attacks rapidly dividing cells and that includes not only the cancer cells but hair and bone marrow. They will be monitoring her white cell, platelets and clotting cell counts which will be dropping because of the therapy via frequent blood tests. The treatment will be given at 3 to 4 week intervals based on the results of her blood and general health condition. Because her white cell count will be low she is to avoid going to crowded places where she will be unnecessarily exposed to infectious diseases. According to her doctor, she can carry on normally with her food and should just eat a well balanced diet.