Updates - 3 April 2007

We couldn't wait any longer for the trial @ NUH since the assistant said that it may take some 6-8 weeks before she started the screening process which would see her in hospital for about 3 days. The pain and overall discomfort was getting worse and this couldn't go on.

New Medication

We caught Dr Goh yesterday at noon and discussed the alternative possibilities. My suggestion was to first arrest the growing tumour in Jo's liver (left lobe) before beginning the trial - since there was some lag time. Dr Goh suggested Avastin - a medication similar to that of the clinical trial. Avastin is a VEGF (Vascular endothelial growth factor) inhibitor.

What It Does

In essence all tumours are fed and kept alive by numerous intricate blood vessels that feed it. To cut off the blood supply would mean to retard and hopefully kill off the tumour. This in essence is what it does. VEGF inhibitors are not toxic in nature and therefore do not have the major side effects of normal chemotherapy medications. It does however have the following possible side effects:

• clotting,
• gastrointestinal perforation,
• bleeding,
• high blood pressure

Avastin is to be administered via infusion taking abour 30 mins.

Back to the National Cancer Centre (NCC)

So we told Dr Goh that we were very comfortable with the staff at NCC and he said that Dr Leong could also administer this drug, and so he made an appointment for us to be there this morning.

It was was bitter sweet stepping back into NCC. Bitter since we still had to "step back". Sweet because everyone here was so much more nicer, warm and friendly. We first met Rosie on entering the building at level 2. She's been serving at Clinic C - and all this while radiating her warm smile and friendly disposition. "Here comes Joanne and her hubby" she would sometimes call out. Annie the admin staff at the ATU department is another example. Then you have the very efficient blood takers - Prudence and the malay lady (can't recall her name) Not forgetting doctor support staff and the nursing team @ Jasmine & the Morning Glory suite. We only have words of praise to them all.

Met Up with Dr Leong

Dr Leong suggested immediately for a CT Scan and Blood Test to assess Jo's situation. What followed was hours of waiting and waiting, while I was freezing all this time in "sub-zero" temperatures. Jo had to maintain an empty stomach for the CT Scan which by then was already about noon time and she was getting hungry. Later on we got some siew mai to munch on.

After the scans, we saw Dr Leong for the full assessment and it wasn't very good...

New Tumour Sites - Lungs

The CT Scan showed new nodules in Jo's lungs. Somehow, the tumour was spreading aggressively...first the left liver, spine and now the lungs. When Dr mentioned this, we both looked at each other and we understood...what that meant. It was tough, but I strongly sensed God's calming presence. The left liver had several small ones, but the largest were 1.8cm and another at 3.2cm. Dr also mentioned that there was water retention at the base of the lungs which has caused Jo to be breathless at times.

Added Medication

Dr Leong suggested to add 2 chemo drugs along with Avastin - Cyclophosphamide and Methotrexate. The drugs would aid more in killing off the tumour. Thank God that these were small dosages and importantly - tablets and taken orally!

Next Steps

Treatment will begin Thursday afternoons. Jo will take chemo pills the day after. This should be the normal cycle every week for the next few weeks.

About Us
To say we're fine is to lie. But neither are we entirely upset about it. As we've mentioned before, Jo and I have come to a new understanding in God's workings. We don't always understand or have to understand how He works...we just know that at the end of the day - He IS at work...and that's all that matters.