Platelets Needed

I've already activated some of you for the above.
And I know I would have many more potential donors if I'd call on the rest of you. But if you haven't gotten an SMS or call from me, don't worry it only means that we have sufficient for now. Thank you!

What are Platelets?
Platelets is one of the components of whole blood. Whole blood is made of several components including red blood cells, white blood cells, platelets and plasma. Each component plays a special role and platelets help to prevent bleeding.

What is Platelet Donation (plateletpheresis)?
This is a special kind of blood donation that allows for platelets to be extracted from whole blood. Whole blood is withdrawn from the donor and separated into its various components by a blood separator machine. The rest of its components are returned to the donor except for the platelets.

How does it work and how long does it take?
The procedure is exactly like normal blood donation/transfusion and requires about 2 hours to complete.

Why does Joanne need this?
Patients with cancer will need platelet transfusion to prevent bleeding. Many times during her chemotherapy treatment (and radiotherapy treatment) both cancer and healthy cells are destroyed, thus lowering their ability to prevent bleeding.

Also, Jo will be doing a small procedure next week to have a tube attached to her stomach so as to have the water drain constantly instead of having to come back to NCC regularly.

Is This Safe?
1. Yes. Each donation is closely supervised by trained staff who will observe you throughout the process. During the donation you will may experience mild side effects like a tingling sensation around the lips and nose. This is due to the anticoagulant used in the procedure. Serious side effects like hypotension and fainting spells are uncommon.

2. The donation does not significantly reduce the platelets in you as your body will replace platelets quickly. You should experience no bleeding problems.

Who can be a Donor?
a. Between 18-45 years old
b. Weigh at least 50kg
c. Must be of 0+ Blood Type
d. Be in good health (not sick) or have not taken antibiotics, aspirin or products containing aspirin or other anti-inflammatory medications for 72 hours.
e. Have good prominent veins on both arms.

Where Must I Go For This?
Apheresis Suite at the National Cancer Centre (NCC) is located at Ambulatory Treatment Unit (ATU), Level 3. Please obtain a set of screening forms from the nurses in the ward. If required, you will be issued with an excuse cert for time spent for screening and donation.

National Cancer Centre11 Hospital Drive Singapore 169610

Main Tel & Fax No Tel: +65 6436 8000Fax: +65 6225 6283

Operating Hours:

Mondays to Fridays - 8.00am to 5.30 pm

How do I Get Here?

http://www.nccs.com.sg/visitor/pb02_2.htm

Discharged Today?...No Tomorrow...

We'll be out of SGH today in about 2 hours time....and so I thought.

Then Jo started throwing up for the 4th time at 1:30pm and we decided along with the doctors to stay on for another day at least till this is resolved.

Yesterday's pleural tap part 2 removed some 850ml of water from her right lung. She's in stable condition, not eating much but definitely glad to have the water out.

Again, many thanks for the prayer cover and all who came.

Today she needs to catch up on her rest.

God Bless
Alex

Breathless!!

So here I am blogging from Ward 48 Room 20 of SGH...you can't even begin to imagine the ordeal that just transpired barely 24 hrs ago...

How It All Began...
It all started last evening at about 9:30pm. Jo said that she was tired and wanted to call it an early night. Since I was zonked out playing FIFA 2007 (PC Football game) most of yesterday afternoon, I too decided to turn in early. After she washed up and laid down for about 5 mins, she suddenly complained of breathing difficulties. I jumped up straight away as I realised it was not subsiding. She began clutching her chest and neck saying "very hard to breathe...can't breathe!" and I was at this point pale with fear and partially "brain dead". CS came to mind immediately (our "resident" Small Group doctor :) and I called him and he came running by to check Jo's breathing and heart rate.

After deep prayer for some 5 mins, her breathing started to improve and we thot we might just ride it out. Just then the breathlessness returned and CS contacted Dr Tien suggesting that we should check in to the A&E @ SGH.

Ambulance For The First Time
We called 995 and the ambulance arrived promptly and whisked us off to SGH. She was provided oxygen in the vehicle and it helped to alleviate the situation.

The wait at the A&E wasnt too bad and within 2 hours she had the last bed in the room and was resting rather fine.

Pricked, Pricked and Pricked...ahhh
Then came the unnecessary pricks to her hand which so agitated and frustrated me. I know it's not always easy finding the veins but pricking her 3 x to find a vein is ridiculous! Ok ok calm down Alex...(fuming)

In the morning Dr Leong did her rounds and said that the pleural tap (lung) and abdominal tap would be done soon after she was given an infusion of platelets. Dr Tien was present to carry out the 2 procedures.
The Procedures
At the end of the day, some 1.2 litres was extracted from the abdomen and another 730mls from the right lung. We thank God immensely for the successful procedures. The pleural tap was done by a needle pricking thru her right back between the rib bones accessing a small cavity area laden with water within the right lung. Doc says that the X-rays had shown some 3-4 litres of water present in both lungs. This is the very first time she's doing it.

If all is fine, Doc will extract more water from the lungs tomorrow. The colour of the water looks like beer.

After the procedure, she had her fav noodles with duck soup from the kopi tiam below. Ahh, what a relieve to see her eat...and eat well.

Again, I thank you all for your prayers and presence for those who came by. Really really appreciate it. We continue to hold fast that all will be well tomorrow. I reckon the earliest she'll be discharged is probably Wednesday...will keep ya all posted.

*SGH - Singapore General Hospital

Updates - 26 May 2007

Sorry for the long delay. Needed sometime off to chill and besides was rather busy too.

The NUH Clinical Trial Saga ... (driving me mad)
We will be @ NUH on Monday, 28 May to meet with Dr Goh and find out once and for all the exact trial timetable for Jo. What gets me all worked up is the inefficiency of the trial coordinator who keeps saying she's gonna call us for updates on this without ever calling back! That's the key peeve I have with NUH/NCI vs NCC, just can't understand how clueless they can get...

So to all, no the trial won't start this coming week, but rather sometime in June. I just hope it doesn't clash with CommunicAsia 2007 which I'm involved in.

Bloated, Bloated, Bloated
Jo's still feeling really bloated to the point that the water seems to be all over her mid abdomen area, thighs and knee area. Her feet and ankle are nearly always bloated as long as she doesn't lay them straight.

Just yesterday she vomited twice for no real apparent reason, once at home and the other at our Small Group...arrrgh, just hate this. God help us.

Marche's
We managed to go by Marches for dinner on Thursday and it did a whole lot of good for her. She had a bit of steak, rostie's, ham & cheese crepe and some veggie dish. She's hardly out of the house anyway since walking can get painful due to the bloatedness...pain in the joins etc etc.

Small Group
Last night we were quite adamant to attending our Small Group since we've missed it for nearly 3 months now, and Jo really misses this. From the moment we sat down at CS's place she was already feeling a little queasy. After her throwing up, we left at 10-ish.

Audio Sermons
We've finally seriously started our quest to listen to God's messages via audio sermons (both online & offline) since it's hard for Jo to go to church nowadays. After David's & CS's recommendation of Pastor Benny Ho's "Nurturing Your Inner Life" series, we decided to borrow it from our Church's AV library. It was great listening and after that we started getting hungry for more, so we tune back into our favourite site - Strength for the Journet @ www.rbc.org with Pastor Jo Stowell. Nice crisp and simple messages that last between 12-20 mins. What I do is that I run the player on my laptop (with wireless broadband), plug the headphones in and share it between the 2 of us. After the message, we discuss and recap the key points. It's helped mine and Jo's Spiritual intake very much now. It's like atteding Sunday service every evening, and Jo says that its the best time of the day which she looks forward to always.

You should try it too.

All Went Well + Makan @ Bluespoon Cafe (Ghim Moh)

Thanks for the prayer cover all! All went well. The wait was unbearable but hey, we're used to it now. While waiting for our turn, Jo's cousin (ah bing) & daughter came by to chat with us since they were in the area. It was good to catch up.

We got started @ 3:30pm instead and the procedure was done quite quickly due to the ever conscientious Dr Richard Yap, a filipino medical oncologist we've been seeing for this. Last time round the attending doc didn't exactly do a great job, but that's ok. Khatija (top right) is an expert at massaging the abdomen to aid the flow of the water.

After plugging Jo (top left) at the lower left abdomen, he let the water flow on its own - about 30 mins later he came by to manually extract the water into the drip bag with a large syringe hooked onto the "tap". This was very efficient although a little tedious (see second & third row pix) and went on for about 15mins until the drip bag was full of 1.1 liters of "yellow stuff".

Julia (senior nurse, top left) came by to plug Jo for the 100ml of Albumin/Protein to aid against the water retention. CS came by with food and prayed with us when we ended @ 5:45pm.

Bluespoon
Block 21 Ghim Moh Road #01-213 (S) 270021
Tel: 6455-6455
Open: 10am to 10pm on weekdays; 9am to 10pm on weekends; closed on Mondays
www.bluespoongourmet.com

The last time we came here, it was closed. Finally we've conquered it! We came here for lunch since the appointment time was about 3:00pm.

This is a quaint little outlet smacked right in the heart of heartlander Ghim Moh estate (directly opposite from the mini bus terminal)...though after serious contemplation, the owner's might have gotten it quite right since this is District 10 and Mt Sinai folks are just round the corner along with lotsa expats...good target market. Bluespoon is actually a restaurant or cafe if you like stocked with a frozen corner serving gourment food. You could take away most of their items on the menu! So what did we have? (Read the reviews from Asiaone)

Jo had her Lampchops (3 pieces for $11.90) and I - the Striploin @ $14.90. Ok to start of with, I didn't like skinny fries unless they're done the Russett Burbank style aka MacDonald's. I felt it was just too skinny and straight off from the supermarket packet. But, hey Jo likes it. :) My Striploin was quite tender but there was a constant mild bitter taste to it which I couldn't place a finger to...was it my numb tongue or what? There was salad and corn on the side too. Jo was ok with the Lambchops though the lamb scent was a little strong. We had coffee and coke with it. Go check it out.

Abdominal Tap - Part 2

Jo still feels uncomfortable with her bloatedness and she's decided that she wants to do the "water tap" procedure tomorrow morning (Friday, 18 May) @ NCC. The first time when we did this last Monday, she'd been eating a fair bit during and just after the procedure.

But somehow it didn't last long as you recalled.
So let's keep the Faith that tomorrow's procedure effects would be better. Amen!

We'll be in @ 11:30am to see the doc. The procedure should begin about 1pm and I reckon with all the delays we should be out by 5pm. The flow usually takes a couple of hours.

Botak Jones

I guess this column of ours has reduced significantly since both of us have hardly been out to eat except to ta pao (take away) food. Anyway, the renown Botak Jones has moved into our neighbourhood about a month back. The burgers are great especially the patties which aren't like your cookie cutter burger joints. The patties may not look huge but they are densely packed and ARE filling! I had the double botak burger...and man did I feel full. Many years ago, I could still finish the "U-Crazy What?" (Thriple beef patties, 450gm of pure meat!!)...man...I was younger than. :)

The pix from the top clockwise are:

1. Chicken Gumbo (Soup) - 6.00 (large)

2. Double Botak Burger - $8.50

"300 GRAMS (150gm per patty) OF HAND FORMED BEEF. ALL THE BURGERS ARE SUPPOSED TO COME OUT MEDIUM WELL, WHICH, IF DONE CORRECTLY, WILL LEAVE THEM VERY JUICY. IF YOU LIKE YOURS WELL DONE AND DRY, JUST GIVE US THE WORD" (From their online menu)

3. The boss himself??

"Exam Time" (May 15, Strength for the Journey by Jo Stowell)

“God tested Abraham” Genesis 22:1

In universities everywhere, mid-May brings late-night study sessions, caffeine-fueled writing binges, and ulcer-inducing stress as students are preparing for final exams—those critically important tests to determine how well the student has learned the lessons of the semester.

Let’s look at a familiar incident in the life of Abraham through that lens.

Genesis 22 begins by saying, “God tested Abraham.” In other words, it’s like Abraham’s big exam. And what is the test? God is about to test Abraham’s allegiance to the one true God in a most stressful way.

So let’s review: God called out Abraham to the city of Ur. Ur was an advanced culture and a highly sophisticated town, but it was rampant with idolatry. When God passed out this test to Abraham, Abraham was wandering through Canaan—yet another pagan, idolatrous region. And keep in mind that in pagan idolatry, the highest demonstration of loyalty to one’s god was to offer—you guessed it—your children as a sacrifice.

With that in mind, look back at Genesis 22:1. The text actually says that it is the God who tests Abraham. This is in contrast to those lifeless forms of wood and stone that were the idols of the pagan Canaanites. And it’s the one true God who comes to Abraham and gives him the following test.

Would the loyalty and allegiance of Abraham to the genuine Creator God match the misplaced loyalty and devotion of the surrounding nations to their false idols? The test is simple yet very demanding: “Abraham,” God says, “Take your son, your only son, Isaac, whom you love . . . and sacrifice him.”

That’s the test, plain and simple. It’s a pass/fail exam with no room for grading on the curve. If Abraham obeys, demonstrating his allegiance, loyalty, and trust in the promises of God, he passes the test. If he refuses, he retains control over his son’s destiny, but fails to demonstrate his commitment to following God no matter what the cost.

Well, we know the rest of the story. In fact, it’s amplified and explained beautifully in the book of Hebrews where the writer explains that Abraham by faith obeyed, reckoning that even if Isaac died, God could raise him from the dead (Hebrews 11:17-19).

So what does Abraham’s test have to do with us? While God won’t ask you to literally sacrifice a child on an altar, He does often require the things in your life that are precious to you. Think about it. Isaac was God’s gift to Abraham. All of God’s promises were wrapped up in that miracle child. How easy it would have been for Abraham to love Isaac more than he loved God. Or to put it another way, to love the gift more than the Giver! The test may be the same for you. God always wants to know that nothing in your life is more important or more valuable than your relationship to Him. It may even be a sinful pattern that for some reason provides temporary kicks, comfort, or security. Do you love Him more than the sin in your life?

If by faith you can believe with Abraham that when God takes something from you, God will give something back in even better terms, then you will pass the test and give Him all He demands and all He desires. Whether it’s your money, your possessions, your career, your dreams, or even your children to His service—everything we give to Him is an opportunity to pass the test and in worship prove to Him that nothing in our lives is of greater value than His friendship and fellowship.

As you face the tests of this week, know that your Tester loves you deeply and is ready to help you pass, like Abraham, with flying colors!

YOUR JOURNEY…

What tests are you currently facing?

What can you learn from the example of Abraham to help you pass the test with flying colors?

James 1:2-4 also addresses the issue of tests. Based on this passage, what is God testing and why?

If you’re one of those people who has always dreaded taking exams, ask the Lord to change your perspective about His tests. Think through the reasons that He wants to test you, and trust Him to supply the courage and faith you need to pass the exam in a way that glorifies Him.

Updates - 13 May 2007

Esther (Pastoral Care) and Sandy (YM) from Church came by on Wednesday to chat and pray with Jo...not forgetting Dave too. Thank you for your prayer support.

Bloatedness - Tummy and Feet

Seems to have gone back to the previous size. As you can see from the pix - her tummy is almost similar to that of a 3-4 month pregnant lady. Mainly air / gas trapped within along with water. Because it's so enlarged (tummy) it causes back pains and stretches the skin so much it becomes dry. We apply moisturising cream to both feet and her tummy in the evening.

Her feet has remained bloated similarly. It's an interesting pix you see above. You can't even make out her veins and ankle joints. It gets a little pain in walking since the skin is quite stretched. She sleeps with her feet raised on a pillow at night.

I leave you with the words of Paul in 2 Corinthians 4:16-5:1

"Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal. Now we know that if the earthly tent we live in is destroyed, we have a building from God, an eternal house in heaven, not built by human hands."


We remain focus on what He has in store for us..

Still (Reuben Morgan)

So often when we face a crisis or problem, we try to do everything humanly possible to resolve, to take control of the situation. But really being Still is what's needed at times.. to come before God in total surrender and submission. Only then will one truly realise that we will and can soar above the storm. This song has always ministered to me and has kept me mindful of this fact and for the often occasions when I'm rushing about in the affairs of this world...to be still.

Hide me now under Your wings

Cover me within Your mighty hand

Chorus

When the oceans rise and thunders roar

I will soar with you above the storm

Father, You are King over the flood

I will be still and know You are God

Find rest my soul in Christ alone

Know His power in quietness and trust

Constipation then Diarrhoea...

Jo called me at 2pm today while I was lunching with a client and I rushed back immediately.

She complained of pain in the stomach, more like that of severe constipation...it was so excruciating that we were considering going back to the hospital. We decided to wait awhile and she took some morphine to calm down and ease the pain.

Earlier on she had taken a couple of laxatives to aid her bowel movement...and it worked...too well. At this point, she's gone to the loo nearly 8 times and now she's got diarrhoea! Arrgh.

Poor girl, she's exhausted and drained...didn't eat anything till this evening where she had a tiny bit of porridge. Appreciate your prayers here that all will be well tomorrow.

Looks like we get these "surprises" more often these days.

He will cover you with his pinions,
And under His wings you may seek refuge;
His faithfulness is a shield and bulwark.
For He will give His angels
charge concerning you,
To guard you in all your ways,
They will bear you
up in their hands,
Lest you strike your foot against a stone
Psalm 91:4,11-12

Procedure Completed!

Thanks for all the prayer cover. Amen that all went smoothly this morning.

Sorry if the pixes are too graphic, it helps you appreciate and understand what Jo goes thru' from time to time...

We arrived this morning at NCC all ready for the procedure. The procedure/treatment room was in the Morning Glory suite and resembled more of a C1 Ward with several beds.

Blood Transfusion
After Jo had laid down, Julia (senior nurse) came by to prepare the plug on her left arm. Jo was also informed that the blood transfusion would take place. A total of 367ml of blood 0+ was to be transfused. Transfusion time: 3hrs.

Abdominal Tap
About half an hour later, the doctor arrived to perform the abdominal tap. They first injected local anaesthetic to the lower left abdomen area. After that a needle and almost micro cathether is inserted into the abdomen. Gradually yellow liquid (water)flowed from the tube into a bag hanging by the side of the bed. A total of 1.2 litres of water was extracted.

It took some 4-5 hours for whole procedure partly due to the slow flowing process.

At the end of the day, Jo seemed slightly better. Stomach doesn't look too big now but it's still bloated.

She's still sleeping now and was feeling quite fatigued throughout. Hopefully she should be able to eat more and feel less bloated from here on.

Updates - 4 May 2007

We had a rather busy morning (and afternoon) meeting with Dr Leong and Dr Cythia Goh (Palliative Medicine) today.

Jo's Lethargy & Bloatedness
The above symptoms that Jo has been experiencing for the last month can be diagnosed with the following solutions:

a) Blood Transfusion - to increase her low haemogloblin count. Doc will decide whether this is required on Monday.

b) Thyroid Hormone Replacement - since she has low thyroid hormone production (due to her Radiotheraphy to the neck in 2001 affecting her thyroid gland located in the neck) The medication (Levothyroxine Sodium) serves to increase the metabolic rate of cells of all tissues in the body. In adults, thyroid hormone helps to maintain brain function, food metabolism, and body temperature, among other effects. She should feel less tired in the future with this medication.

c) Abdominal Tap - see below

Jo's Monday (7 May) Procedure - Peritoneal Tap / Abdominal Tap
Jo will undergo an outpatient procedure called the abdominal tap @ NCC on Monday. The following has been extracted from Healthline.com to better explain this process.




Definition
An abdominal tap is a procedure in which a needle is inserted through the abdominal wall to remove fluid from the abdomen. Normally, the abdomen contains only a small amount of fluid. In certain conditions, large amounts of fluid can accumulate in the abdomen.

How the test is performed
This test will be conducted in NCC. The puncture site will be cleansed and shaved, if necessary. The patient receives a local anesthetic. The tap needle is inserted 1 to 2 inches into the abdomen. The fluid is then withdrawn into a syringe. The needle is removed, and a dressing is applied to the puncture site.

Why the test is performed
An abdominal tap may be performed to diagnose the cause of fluid accumulation, to diagnose infected abdominal fluid, or to remove a large amount of fluid to reduce abdominal pain.

Prayer Request
a) That there will not be any complications with the Abdominal Tap procedure.
b) Jo's energy to return.
c) Jo's appetite to increase.
d) Jo's faith and spirit to remain like a strong fortress - unwaivering.

Thank you and may the Lord Bless you all.

New Trial @ NUH

We were back @ NUH on Wednesday to meet with Dr Goh.

He had suggested another clinical trial which Jo is eligible for and we have decided to take this up. This trial in essence is similar to the current Avastin drug that Jo has been taking on the last 2 occasions, except...much more potent. The details spelt out below:

Clinical Trial Details
The trial will begin probably on Monday, 28 May 2007.

This trial is a targeted therapy developed through better understanding of the differences between cancer cells and normal cells. One such difference is the high blood vessel development of the cancer, and this is caused by production of a class of molecules called VEGF (vascular endothelial growth factor) and PDGF (platelet derived growth factor). The trial drug targets these receptors and can interrupt the process of blood vessel production in the cancer.

The purpose of this trial is to determine the dose of this trial drug that is suitable for use in further studies in specific cancers, its drug levels and the safety profile of this drug at different dose levels.

Treatment Plan
This is divided into 2 parts, part 1 & part 2. The drug is administered in liquid form and taken at night. Each treatment cycle is 21 days. Dosing is continuous and there is no break in between cycles, unless side effects warrant stopping treatment.

Blood Tests Required
Jo will have to go through the "vampire" treatment again, as with most clinical trials, there will be lotsa blood "donation."

2 days before the 1st cycle begins: 0 (pre-dose), 1, 3, 4, 6, 8, and 24 hours. 4ml of blood (ie. 1 teaspoon)

Day 1 of cycle 1: 0 (pre-dose), 1, 3, 4, 6, 8, 24 and 48 hours. 4ml of blood per sample.

Day 15 of cycle 1: 0 (pre-dose), 1, 3, 4, 6, 8 hours. 4ml of blood (ie. 1 teaspoon)
At cycle 3, a 4ml of blood sample will be collected and then at every 2 cycles thereafter.

As for cycle 2, it is somewhat similar to the above format...so you get the picture now eh?

Scans, Scans, Scans...
There will be a number of routine CT and MRI scans throughout. Even if Jo proceeds after Cycle 2, she will have to take a CT Scan every 6 weeks for 1 year.

Side Effects/Risks of the Trial
Very Common - Protein in the Urine, Dryness in the mouth, Tiredness, Muscle and bone pain, skin rash, raised blood pressure
Common - Loss of appetite, nausea, vomiting
Less Common - Lower blood cell count, bleeding, diarrhoea

Problems with Blogger!

Very sorry for the delay, I know everyone has been waiting for an update...and I have lots of it.

Had major problems trying to log into Blogger from Wed until this evening.

How Great Is Our God (Chris Tomlin)

One of my all time favourites. Play it and worship along...

Let My Words Be Few (Phillips, Craig & Dean)