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)

More Rest...

I know quite a few of you wanted to catch up with Jo during this week, but it's simply quite difficult for her to ascertain when her body is really up to it.

The past 2 days she's gone back to the "no eat all sleep" routine. Again this is reminiscent of the 1st Avastin treatment and I guess it's the primary cause. She's been extremely tried, just waking to eat or go to the toilet. When awake, she seems really drowsy.

Her appetite is really small. Last night she only had 2/3 rds of a small cup of chawanmushi that her sis made. For lunch today, she had yong tau foo minus the noodles and tonite she'll have minestrone soup that a friend has made.

So I'll keep you all posted when she's feeling better. Thanks for your understanding...

In the mean time, do keep your SMSes coming cos' she reads them. God Bless!

Rest

We both missed our Small Group time last night cos' we were just exhausted.

Unfortunately she had a small bout of vomiting at about 9pm...and then was back to sleep. I think it's how she lies. The flatter you are, the easier the acid is able to reflux up from the stomach thereby causing heartburn and ultimately vomiting. So we try to ensure she sleeps at an incline of about 20 degrees or more.

Personal Bell (Pictured above)
Since I'm usually out and about in the house and can't hear Jo when she calls for me either when she's in the room or in the living room, I'd requested for suggestions from friends to recommend a good "baby monitor". Thanks to a friend, he'd suggested using one of those wireless digital door bells (runs on batteries). It was great, cos' now all Jo needs to do is press the button and I'll come running in! The bell has got a 16 chime variation...and I'm using one that sounds like bird chirpings...chirp chirp!

SGH - Day 2 & Home!

Ahh, finally managed to catch my breath after a hectic day @ SGH.

Day 2 - 26 April 2007
We bumped into an old sunday school student of ours Dr Andrew Wong. Instantly
he recalled who I was, what a small world ain't it? Interestingly enough he was tasked to "plugging" Jo which he did a good job of.

Then we bumped into Dr Mark Tien, our Small Group friend who was working in the ward. Was really thankful that God had placed these people at strategic occasions for us. Mark shared the amazing testimony of a Mennonite pastor who recently passed on...we have been encouraged!

Protein Drip
Dr Darren Lim came by to chat a bit and said that Jo was required to have an Albumin (Protein) drip since her blood test showed low levels of this. The nurse plugged the yellow glass bottle and within 30 mins it was done. Albumin would serve to reduce the water retention in Jo's body.

"Albumin refers generally to any protein with water solubility, which is moderately soluble in concentrated salt solutions, and experiences heat coagulation (protein denaturation). Substances containing albumin, such as egg white, are called albuminoids."

Avastin Treatment
Nurse came by @ 3pm yesterday and it was done within the hour. No side effects post treatment so far though. Amen!

A few friends came by from late afternoon all the way to the evening. Thank you all for being with us.

Palliative Care Nurse
A nurse from Palliative Medicine came by and had a long chat with us - asking about Jo's current symptoms, sharing about pain management and current medication history.

Palliative care is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms or slowing the disease's progress, rather than providing a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. (Wikipedia)

Day 3 - 27 April 2007

Didn't really get a good nite's sleep since the aircon was freezing in the room. However managed to sleep outside in the common lounge area. Dr Leong finally came by this morning and discussed about her case. We will continue to see her next Friday morning. Dr Leong also mentioned if the bloatedness got really bad, that was an option to remove the liquid via small procedure.

Dr Alethia Yee

Dr Yee (Palliative Medicine) came by and had a long chat with Jo too. She chatted everything from pain management to discussing our treatment goals...as in what do we hope to achieve with Jo's current state of health - quality of life or etc etc. Importantly, she added another dimension in answering Jo's many questions about medication, treatment and home care options. Wow, it was a handful just taking all that in in one go, but it was very helpful.

Going Home

We finally checked out of the hospital @ about 4:00pm.

SGH - Day 1

Wireless @ SG
Finally got the darn Wireless@SG thing going...almost impossible to obtain a good reception where I am (between 37% to 45%). Had to tilt multiple angles and all...anyway here I am blogging away again.

This Morning
We saw Dr Leong this morning and she commented that the blood test was fine, in fact it was a marginal improvement over the initial test 3 weeks ago. She then proceeded to admit us to SGH. The nurse confirmed that it was a packed day today as no one seemed to be checking out from the A1 or A1+ Wards. We settled for a B1 Ward anyway when the nurse called us at 3pm. (We had decided to go home and await the nurse's call when she had confirmed the ward details)

At SGH (Ward 48, Level 8 Room 11)
On arrival, I ushered Jo to her already vacant bed in the 4 bedded room. There were 3 other ladies here. Ward 48 is a Medical Oncology ward specialised in caring for Cancer patients. I tucked Jo into her bed and got her comfy then rushed down to get the admission done...little did I know that it took some 1.5 hours to complete this!!!

Treatment Postponed
By the time I got up at 5:10pm, the attending MO had mentioned that it was too late for the treatment and we would have to wait till tomorrow morning. I was flustered as we wanted this done today - that was the sole purpose of coming in. Anyway, I soon calmed down. Jo should have the treatment done 1st thing in the morning and prayerfully without major side effects. The infusion will last 60 mins as compared to 90 mins previously.

CS and wife & friend (Apple) came by and got a little piggy & card for her. A really cute one :) Thanks folks for your prayers too.

As of 1:00am, she's sleeping soundly having taken Lorezapam (sleeping pill). She had some chicken rice thingy for dinner but that couldn't quite make it for her and CS went down to the foodcourt to get some fish porridge which she enjoyed. Her parents came by too.

Please contact me first before coming by, am not too sure how she'll be feeling tomorrow. In any case she would love to have your company.

Once again, thank you for your continued prayer support.

Tonite

© Copyright 2007 by Christian-pics. http://www.christian-pics.com/index.php

Jo told me just a few hours ago that she wasn't feeling good at all. In fact she was depressed...really depressed. She poured out all that was on her mind... She hasn't been eating or sleeping well. Nausea, bloatedness and aches all over. Watching TV, reading or eating doesn't even excite her anymore...restlessness... In essence her quality of life has deterioratated.

She said that she just looks forward to the end of day, so that she can sleep...sleep it all off.

And it doesn't help when the evil one lurks and puts stupid thoughts in her mind. And so I prayed fervently in Jesus name to cast out every evil influence in whatever form upon her. Mark 16:17 states that we have power over demons and the evil one.

It's easy for me to say that God demands Jo's fullest attention at this point...yet I know she's been praying unceasingly for His will to be done. So what does God want of her at this time? But perhaps to continue living in FULL faith knowing that He is our only Hope. No "answers" will answer all our questions, or take us through life's hard times. However I've learned a little gem from "Bruised But Not Broken" (Stanley Baldwin, Multnomah Press 1985) that "It is not what we know but whom we know that is critical to our survival. It is Christ who is our Rock. It is in Christ we can do all things."

Tomorrow
We will see Dr Leong tomorrow morning for the usual check up. If her blood test results are fine, then she'll be taking the next round of Avastin treatment either the same day if not on Thursday.

Admission to SGH
Jo wants to be admitted to SGH for the treatment just in case the side effects return. She'll probably be warded for 2-3 days pending nothing serious happens post treatment. We'll most likely be @ Ward 78. We'll keep you posted on developments.

Made Me Glad (Hillsongs)

Darlene Zschech, 2002 Integrity Music (USA)

I will bless the Lord forever
I will trust Him at all times
He has delivered me from all fear
He has set my feet upon a rock
I will not be moved
And I'll say of the Lord

Chorus
You are my shield
My strength
My portion
Deliverer
My shelter
Strong tower
My very present help in time of need

Whom have I in heaven but You
There's none I desire besides You
You have made me glad
And I'll say of the Lord

Updates - 23 April 2007

With each passing day I thank God for little blessings that come our way: when Jo eats, when she smiles, when she doesn't feel any discomfort or pain...

All was fine last Thursday till Sunday evening. She'd been dining out with a couple of friends for lunch and dinner...her appetite typically increases a little more when she's out eating.

But...

Yesterday
She had fish & chips for lunch and she'd vomited that out the moment we got home...

This early morning, she wretched and wretched at the toilet bowl but nothing came out...her stomach was churning again...

Today
For lunch, she had a little chawanmushi and still she threw them out about a half hour later...we thot that this was the "safest" food for her since it's totally reminiscence of the same event that happened 2 weeks ago after her chemo treatment...

For dinner, her parents cooked porridge and steamed egg...and yet she threw it out too...

It was a really tough day for her... at times she couldn't lie down for no position was comfortable...

Our Prayer Requests that the following will stop:
- Body aches
- Nauseas and vomiting
- Headaches
- Stomach bloatedness
- Water retention @ feet

And that she would be able to just eat & sleep well

He brought me out into a spacious place; he rescued me
because He delighted in me. Psalms 18:19

Holy Communion @ Home & Banana Leaf Apolo

Another wonderful day today. Jo had requested to eat at The Banana Leaf Apolo @ Race Course Road today.

After my morning meeting, we arranged with our other SG members to join us in this. David, CS and Ruth were with us.

We had Briyani rice, Tandoori Chicken, Curry Fish head and Mutton Masala. We had papadums on the side. For drinks we had their famous lime juice. Overall a fantastic meal with great company. Rice and papadums are free flow for your information. Above all, we thank God that Jo ate really well today - she loved the briyani rice, Chicken and Fish.

Since Jo had often missed Holy Communion at Wesley, I decided to call Pastor Alvin to come by to celebrate this with us.

Friends@Jelita

Last Sunday evening, Jo suggested that we try this new outlet at Jelita called "Friends."
On getting dressed I usually ask her what kind of an outlet is it - casual / formal etc etc. She knows I'm a really laidback dresser loving to hang out in my berms and flip flops... and so she said it was a casual dining place... and lo and behold I reached out for my fav berms and fav Arsenal T-Shirt!

On arriving, it was a different story as you see above. I was quite surprised to see a really nice set up with plush dining tables, wine glasses, napkins and rather nicely dressed customers. Even then we were greeted nicely by the waiter while we were flipping through the menu placed outside the restaurant.

What We Ate
So, to cut the story short this is what we both had:
Jo - Roasted rock garoupa on warm nicoise salad with garlica anchovy butter sauce
Me - Set menu - Friends salad, ukranian borsch soup, roasted beef tenderloin, onion marmalade, pistachio potato puree and beef glazed. Dessert was baked fuji apple topped with vanilla ice cream.

The beef was really good and I'm glad I had it cooked medium. Onion was really unique and tasted great too. A first for me. The garoupa was prepared really well. Overall a very good dining experience. We were the only ones left in the restaurant when we finished and had a short chat with the waiter. The original outlet is located at Serangoon Gardens near the Chomp Chomp hawker centre.

Witnessing of Baptism@CEFC

Sunday was a busy day for us. After rushing back from Youth Ministry, we headed down to Covenant Evangelical Free Church to witness Jo's friend's baptism (who is also her ex-boss).

The whole ceremony was simple, solemn and touching. Touching because the testimonies were simple yet so powerful in that it all pointed to Christ - our sustainer, rock and redeemer. The testimonies showed the God's power can change and transform lives even when it seems impossible.

For Christians, Baptism is a journey we all must take as Christ had commanded (Matt 28:19). Baptism is an outward expression of an inward Faith. It's simply the individual taking that next step of commitment with God saying "Lord, I'm ready to be all that You want me to be. I avail myself to being obedient and to do Your will" Baptism is symbolic for the Christian because the act identifies us with Christ (and is also conducted publicly for all to see) When the Christian is submerged in the water, it symbolizes death and burial of the old sinful selves. When he/she emerges from the water the symbolism is freedom from sin's power.

At the end of the day, Jo and I were just happy to welcome more brother's and sister's into the family of Christ.

For me, I was even happier that Jo was well to make the trip (all the way to Bukit Panjang) and hang out with her friends for some 2 hours. Amen!

Updates - 14 April 2007

We had a slight mixed up in terms of Jo's treatment regime. Currently:
a. Oral Chemo (daily)
b. Avastin VEGF treatment (infusion) - once every 3 weeks.
Next treatment, 60 mins on April 25 or 26th.

1. In general, she's been sleeping alot. Averaging 14 hours per day. Its a combination of the medicine making her tired (chemo drugs) and sleepy (morphine) together with her already weakened body.

2. Now she has occasional cough with phlegm deep within. As mentioned, she's had water retention detected in her lungs 2 weeks back. She's taking medication for this too.

3. Her medications:
a. Maxalon before meals - to aid digestion
b. Morphine - for pain management
c. Chemo drugs - 2 varieties
d. Magnesium Carbonate - to relieve gas buildup
e. Flumucil - to relieve water retention
f. Kytril - for nausea (when necessary)
g. Arcoxia - for fever

4. How she feels:
a. Bodily aches everywhere
b. Pain when coughing
c. Mouth dryness
d. Rib pains
e. Bloatedness
f. Indigestion
g. Lack of appetite
h. Tiredness
i. Weak, not able to climb stairs or stay out for too long

Out of the House
It's good that she managed to get out of the house for the 1st time in 7 days to attend our Elim Small Group last night. It was an enriching time that we had as always. We did Bible Study on Psalms 40 and ended off praying for each other and for Joanne specifically.