Money is the most important thing in this world. This is truly my mother’s motto. Yup, money to her is the most important thing, not people. The next important thing to her is her health. It makes sense because with money she can take care of her health. Without health she can’t enjoy her money.

After my father passed away, my mother lived alone. She was healthy, energetic and always on the move. She was never the stay-at-home kind of mother. Somehow, she always had things to do outside the house. She had been this way as far back as I can remember. One night, she decided to walk to get her dinner. On her way, she fell into a monsoon drain when she had to avoid an oncoming car.

She was taken to a hospital for treatment and had to stay for observation and a series of tests. Nothing serious but the bill was quite exorbitant for a two-night stay. Another thing about my mother is that she has a fondness for private hospitals. The least you can do for her is to give her a second-class room.

After the incident, my siblings and I didn’t like the idea that she was living alone but she was adamant in her decision. She is hard of hearing. She has been like this ever since she was in her 40s. She said she consumed too much medicine in her salad days. It caused her partial hearing loss.

Several months later, she decided to give it a try, to stay with her children. She rotated her stay from one household to another. Four places, all in different areas for her to choose. She wasn’t happy for she felt she had lost her freedom to move around. Not that there was any restriction but she was staying in new places and some of these new residential areas had no bus services and taxi fares were too expensive for her to go out every day. She felt trapped and a loss of power in the sense that she was no longer the mistress of the house. Instead of being part of the family, she considered herself a guest to the extent that she felt uncomfortable and unhappy when she wasn’t treated like a special guest.

So she went back to her house and lived alone. My sister decided to let her Indonesian workers to live with our mother so that they could keep an eye on her when they returned to our mother’s house after work. It wasn’t long enough she started to find faults with them. Her issues with them were the wastage of electricity and water and these women kept her awake by staying up late, even though my sister assured her that she would take care of the extra. My elder brother paid for our mother’s utility bills.

One day, she just ordered my sister to remove these people from her house. She said she couldn’t take away the fear that anyone of them might burn down her house when they forgot to turn off the gas after using the stove to cook their supper. So back to square one, my mother was all alone again.

Two things happened that made her realize that living alone could be dangerous for an old, defenseless and almost deaf woman. One day, a long-lost nephew came for a visit and some time after he had left, she realized that her late husband’s photo on the cupboard top was missing. It was just a souvenir kind of photo taken by a photographer who did his trade for the tourists. My father’s photo was stuck on a round piece of marble frame. The gate padlock was missing too. It made her worry about her safety and then there was the matter about termites.

She had no plan to move out of the house when the mystery of the missing photo was solved. We found out that my cousin took it. So it was no break-in. As for the termites, the exterminator came and fixed the problem.

When she was admitted to the hospital for appendectomy, she gave my elder brother RM1400 to pay for the medical bill. During her stay in the hospital she was constantly telling us about her contribution. My sister-in-law took her to the hospital and the credit card took care of the deposit. It really got on our nerves. At one point, my sister-in-law retorted that her money couldn’t even cover the deposit. I told them she was feeling the heartburn of her financial loss. Money is something very important to her, it is her security blanket. When she was recuperating, her money was given back to her.

I left my family for two weeks to take care of her in my sister’s house. My mother’s house was closed up. Truth be known, I didn’t want to be stuck alone with her. At least by evening I would have the company of my sister when she returned home from work. When I returned home, my mother returned to her house. The minute my back was turned, she complained that I was heavy with the salt. In actual fact she was adding light soy sauce to every meal I cooked for her furtively. I purposely cut down on salt and sugar. Anybody over 40 should watch their fat intake, salt and sugar consumption.

We figured out as long as her house was there, she would never want to leave it. So we convinced her to sell her house and the money from the sale went to her. Second time around but same set of problems she brought with her when she came to stay with her children.

“I don’t know what to do, this cannot and that cannot. I can’t live alone and I can’t live with people. What am I supposed to do? Short of standing in front of a moving vehicle to end my life,” she said, looking at me searchingly.

“You have to think happy, feel happy, if not every where you go you’ll feel unhappy. You have to adopt a positive mental attitude. Make yourself at home in your own children’s place. Help yourself to the food, if you don’t like the cooking, go and cook whatever you want to eat. You don’t have to act like a guest because you are not,” I advised her but my advice fell on ears that were selectively deaf.

Then, my mother started having health problems. She complained of regurgitation with gasping during the night or while lying down. We took her to a private hospital for a thorough check-up. Right after my father passed away, she underwent a medical check up. She was given a clean bill of health. At that time she was mildly diabetic. She has been on pills since then. This time, she was told that she had heartburn. For years she has been telling her children that she’s had heart problem though it wasn’t proven medically. Every time she wanted us to toe the line she would mention about her heart.

When she was discharged after a few days of hospitalization, she told me that my brother, the second son didn’t sign for her the letter of consent to have a coronary heart bypass. I told her it was heartburn. She continued without hearing a word. She said she didn’t mind the operation, either it would cure or kill her. If she died on the operation table, so be it as she wouldn’t have felt any pain. It didn’t bother her whenever she incurred any medical bills. She has no medical insurance. It would be mental anguish for her if her money is used. “You, your brothers and sisters sit down and see how much each of you can contribute to settle my medical bill,” she instructed weakly while lying in the hospital bed.

My sister and I coughed up more than RM500 when we took her for her follow-up. The heartburn specialist charged RM160 for consultation and the cardiologist charged RM160 for consultation. The balance was for the cost of the medication. Two days later, in a fit of anger she threw the new medication into the dustbin. She hadn’t even started taking them because she still had the old ones to finish. She said my sister’s maids were making fun of her. Maybe she was oversensitive because of her hearing loss or she just needed a reason to show her anger. The moment she set eyes on my sister, she grabbed her pre-packed bag and told my surprised sister that she was leaving. Before she walked out of the house she was very vocal about her displeasure with the maids. She didn’t call for taxi and there was no bus service. The maid went after her and brought her back to the house.

My mother attempted suicide when she was staying with my elder brother and family. My sister-in-law told her college-going daughter to buy take-away after class for her grandmother. When she returned home with the food, my mother refused to eat and told her that she’d taken almost a cup of floor cleaner. She even showed the bottle of floor cleaner to her. My poor niece panicked and called her parents and aunt. Several hours later my niece took my mother to the hospital to meet up with her father. Why the long wait? Why nobody rushed her to the hospital to get her stomach pumped? Well, she didn’t seem to suffer from any severe stomach pain or cramp.

Actually, nobody really takes my mother seriously simply because she has been manipulative in her dealing with her children. We believe she could resort to using suicide to get our attention. She can’t stand pain. She’d make a mountain out of a mole hill over the slightest pain.

My mother unashamedly told the attending nurse that she’d tried to kill herself. She was given no treatment and was asked a lot of questions by the attending doctor. My mother’s deafness was very pronounced as she could hardly hear anything. My brother took her to a University Hospital with a recommendation letter from the doctor. When she caught sight of the hospital, she asked why she didn’t get treatment from the private hospital. At first she refused to enter the hospital.

My brother and mother were questioned by the psychiatrist. The psychiatrist got very frustrated talking to a stone-deaf woman. She had the same effect on the heartburn specialist who shouted his question into her ear several times before she could respond. She told him she would wear her hearing aid when she recovered from her sickness. My brother wasn’t much of help either as he was totally unaware what made my mother tick.

During her stay in the UH, none of her children turned up to visit her. Her sister-in-law, our aunt told us that we had been very accommodating to her every whim and fancy. After the passing of our father, her hold over us was losing the grip. She could sense it and was afraid. Hence, she used suicide to frighten us. When her children turned up to fetch her home, she appeared meek. The first stop was her sister-in-law’s house so that she could talk some sense into her.

The first time I met up with her after the so-called suicide attempt she told me what she did (as if I didn’t know already). I told her if she really did commit suicide, did she know the repercussion on us especially on my elder brother, whose house where she committed suicide? The police investigation, the gossip of the neighbors that her son and daughter-in-law must have ill-treated her that she had to take her life.

Before the incident she never stayed in one house more than a week. After what happened, she was to stay with my younger brother and family during the weekdays. Her weekend stay was on rotation for other siblings. When my sister-in-law, a housewife whom she stayed with during the weekdays, had health problem, my mother was thinking of the worst scenario. It was her suggestion to find her a place in an old folk home. We found her a place in a retirement community. She lives in her own unit and her fellow residents are people whose ages range from 50 – 90. Her grandson said his grandmother who had never worked in her life can afford to retire in a retirement home.

My middle sister used to treat my mother with a kid’s gloves. No longer does she do that, whenever my mother says something hurtful she will ignore my mother until she cools down. Just to prove to my mother she isn’t the malleable child that she used to be, during those occasions when she was mad at my mother she didn’t even fetch her from the retirement home when it was her turn.

There are some changes in my mother too. She seems to be so frail, and her eyes sometimes take on a vacant look. She hardly speaks and when she does, her voice sounds so feeble. At first glance it is not the almost unlined face that ages her; it’s her demeanor that has brought about the change. She is acting like an old woman with Alzheimer but she doesn’t have Alzheimer and this is for the benefit of her children. When she is with people she doesn’t want to impress as a feeble old woman, she behaves almost like her old self of the past. According to some of the residents in the retirement home she is the most active among them. She pops in and out of her unit several times a day. She has most of her meals in the nearby hawker center or restaurant. Her one bad habit that is complained by those people who live close to her is that she likes to slam her door hard. Hearing loss is no excuse for being inconsiderate. Some of the complainers are several years older than my mother. Imagine, day in and day out these old people are being shocked out of their quiet existence by the rude slamming of the door. It doesn’t happen once or twice but several times a day. These are the people who hardly move around or leave the retirement home unlike my mother who is away during the weekends or the festive season.

My youngest sister came home for a 2-week holiday to celebrate Chinese New Year this year after almost 19 years not celebrating this festive occasion. Three years ago, she came home with her husband and two kids for a 2-week stay too. At that time my mother had already showed the early signs of her present self. So she wasn’t surprised that my mother seemed to have deteriorated further. However, on one occasion while my middle sister was out, my youngest sister and I stayed back with our mother. She was behaving like her normal self, keeping to herself and taking catnap.

Then she did something so uncharacteristic of her. She was walking back and forth, back and forth and even helped herself to the festive tidbits and cookies that my middle sister kept for her guests. My mother even started talking, asking in her feeble voice where my sister had gone to. I left it to my youngest sister to have a chit-chat with her while my attention was on the TV. I did notice something with my mouth closed and my ears open.

“Not looking at her but listening to her voice now I can easily picture our mother back in those days when our father was alive. She doesn’t sound feeble,” I said, thinking it’s hard to believe but seeing is believing.

My youngest sister said I was ignoring my mother. I was thinking it was pointless to have a conservation with her because most of the time she would say she couldn’t hear me.

“You know it’s customary for her old self to complain. Now she sounds so much like her old self, you’ll start her complaining next,” I predicted. Sure enough, my mother started talking about my middle sister, not complimentary remarks. When she didn’t get our full attention she went back to her favorite seat and stopped talking. By then my middle sister had just arrived home. And my mother reverted to her frail and feeble self. It was as if the glimpse of her old self had never happened. Maybe she didn’t have to pretend in front of us. I live outstation and my youngest sister live in overseas.

I must admit I did have moments when I suspected that my mother could be suffering from depression. Being depressed can bring out physical disorder. Depression and physical effects are inextricably linked. Now I am not so sure. My mother is like a chameleon. She seems to change her characters to suit the occasions.

Nowadays, she doesn’t simply go to seek medical treatment because of her tendency to be a hypochondriac. She knows her children can be unreasonable if she is unreasonable. One time, she paid RM450 for the treatment of constipation. It was RM150 per treatment. She said the treatments weren't even working. She went on and on about the payment but nobody reimbursed her the money.

My mother chooses to live alone. She feels she has the freedom to be herself; she can go out, eat out, sleep one whole day if she wants to, doesn’t have to clean the house as there are no watchful eyes to criticize her and most importantly, not to be treated the way she had treated her late mother-in-law. She left the care of her children to her mother-in-law who lived with us. She knew her mother-in-law disapprove of her going out almost every day but it didn’t stop her.

Few months ago, this relative of mine was under the weather. It started off with a cough. However, the cough had gone out of control. In the beginning, she thought it was just a cough and bought over-the-counter cough drop. When her cough showed no improvement, she went to seek treatment from the clinic. Prescription medicine didn’t make her get better. Eventually, she went to the hospital to treat her cough.

Of course, her relatives didn’t know about her cough until she was diagnosed with Acute myelogenous leukemia. Her children were of mixed minds on whether she should be treated with chemotherapy. They know chemotherapy is horrible, that hair falls out and there are other unknown side effects to consider.

She was hospitalized for a few days. During her stay in the hospital, she was given antibiotics to fight infection. A few days after her discharge, she was taken back to the hospital by ambulance. She was much too weak as she couldn’t even do the simple task of going to the toilet. She had no appetite and vomited out her small food intake.

She was given blood and platelet transfusions. After another treatment of blood and platelet transfusions, her children decided to let her have a go at chemotherapy. During the treatment she was placed in a special germ-free room. Only her children were allowed to visit her.

Her first course of chemotherapy wasn’t that effective and she was advised to begin a new course of chemotherapy, even though the prognosis wasn’t hopeful. My husband and I traveled more than six hours to see her when she checked into the hospital for the new course of chemotherapy.

I felt kind of relief when I caught my first sight of her. She looked almost her normal self, no sign of weight loss. She looked better than what I would have expected. I felt shocked and upset when my husband told me about her diagnosis. Privately, I was worried about her but I didn’t show it during my visit with her.

I am a fatalist. I do believe it’s all in the hands of God. If one’s number isn’t called, it’s just not one’s time to go yet even though one’s doctor has nothing much to offer. It’s all bogged down to God, miracles and treatments.

Acute Myelogenous Leukemia (AML)
Acute myelogenous leukemia (AML) is a fast-growing cancer of the blood and bone marrow. In AML, the bone marrow makes many unformed cells called blasts. Blasts normally develop into white blood cells that fight infection. However, the blasts are abnormal in AML. They do not develop and cannot fight infections. The bone marrow may also make abnormal red blood cells and platelets. The number of abnormal cells (or leukemia cells) grows quickly. They crowd out the normal red blood cells, white blood cells and platelets the body needs.
On this page:Acute Myelogenous Leukemia Symptoms and DiagnosisTreatment Options for Acute Myelogenous LeukemiaChemotherapy for AMLBone Marrow or Cord Blood Transplant for AMLMaking Treatment Decisions
Acute Myelogenous Leukemia Symptoms and Diagnosis
AML is the most common type of leukemia. More than 11,900 new cases occur in the United States each year, mostly in older adults. The average age of a person with AML is 65 years. Fewer than 10% of people with AML are children. Acute myelogenous leukemia is also called acute myeloblastic leukemia, acute myeloid leukemia, acute granulocytic leukemia or acute nonlymphocytic leukemia.
Symptoms
The symptoms of AML are caused by low numbers of healthy blood cells and high numbers of leukemia cells.
White blood cells fight infection. Low numbers can lead to fever and frequent infections.
Red blood cells carry oxygen throughout the body. Low numbers can lead to anemia -- feeling tired or weak, being short of breath and looking pale.
Platelets control bleeding. Low numbers can lead to easy bleeding or bruising and tiny red spots under the skin (petechiae).
High numbers of leukemia cells may cause pain in the bones or joints.
A person with AML may feel generally unwell and run-down. He or she may also have other, less common symptoms.
Diagnosis
AML is diagnosed when blood and bone marrow samples show a large number of leukemia cells. AML has eight subtypes, labeled M0 through M7. The subtypes are based on the type of blood cells affected. To find out the sub type and how well the leukemia might respond to treatment, the samples are looked at to find:
The number of healthy blood cells.
The size and number of leukemia cells.
The changes that appear in the chromosomes of the leukemia cells. This is called cytogenetics.
Doctors also examine the patient to find out if leukemia cells have spread outside the blood and bone marrow. Doctors may use a chest X-ray and an ultrasound of the abdomen to look at the organs and tissues inside. They may also use a test called a lumbar puncture (spinal tap) to find out whether there are leukemia cells in the fluid around the brain and spinal cord.

Treatment Options for Acute Myelogenous Leukemia
AML can get worse quickly, so doctors usually begin treatment right away. To plan treatment, doctors look at a patient's risk factors (also called prognostic factors). Risk factors are patient and disease traits that clinical studies have linked to better or worse outcomes from treatment. Examples of risk factors are a patient's age and subtype of AML. To learn more about AML risk factors as well as how treatment options may differ for children or for adults older than age 60, see Risk Factors for Planning Treatment of AML.
For a patient with AML, the treatment plan may include:
Chemotherapy -- drugs that destroy cancer cells or stop them from growing (described below).
A bone marrow or cord blood transplant (described below).
All-trans retinoic acid (ATRA) if he or she has the subtype of AML known as promyelocytic leukemia.
Gemtuzumab ozogamicin (Mylotarg) -- a type of monoclonal antibody. Monoclonal antibodies are proteins designed to attach to leukemia cells and help the immune system destroy them.
Other newer treatments that were recently developed or are still being studied in clinical trials -- you can ask your doctor whether any newer treatments may be options for you.
Whichever treatment you and your doctor choose, you may be asked to be part of a clinical trial. Even standard treatments continue to be studied in clinical trials. These studies help doctors learn more about which treatments work best for which patients.


Chemotherapy for AML
Induction Chemotherapy
For most patients, the standard first phase of AML treatment is induction chemotherapy. The goal of induction chemotherapy is to bring the disease into remission. Remission is when the patient's blood counts return to normal and bone marrow samples show no sign of disease (less than 5% of cells are leukemia cells).
Induction chemotherapy is very intense. It usually lasts one week, followed by three or more weeks for the patient to recover from the treatment. Often two drugs are used:
Cytarabine (ara-C)
An anthracycline drug such as daunorubicin (Daunomycin) or idarubicin (Idamycin)
Some patients may also be given additional drugs or different drugs. Patients who have the AML subtype promyelocytic leukemia also are given all-trans retinoic acid (ATRA).
If one week of treatment does not bring a remission, treatment may be repeated once or twice. Induction brings a complete remission in:
About 70% to 80% of adults under age 60.
About 50% of adults over age 60.
More than 90% of children.
Successful induction chemotherapy destroys most of the leukemia cells, but a few will be left in the body. If these cells are not destroyed, they can cause a relapse of the disease. More treatment is needed to destroy the remaining leukemia cells. The next step may be consolidation chemotherapy or a transplant, depending on the treatment plan.
Consolidation Chemotherapy
The second phase of chemotherapy is often called consolidation chemotherapy. The goal of consolidation chemotherapy is to destroy any remaining leukemia cells. A common treatment is high doses of cytarabine (ara-C) given in three or more cycles. Doctors may also use different drugs and schedules.
Consolidation chemotherapy is used to treat many patients with AML. It is the standard treatment at first remission for adults with low-risk cytogenetic factors (changes in the chromosomes of leukemia cells), especially adults younger than age 60.


Bone Marrow or Cord Blood Transplant for AML
For some patients, a bone marrow or cord blood transplant may offer the best chance for a long-term remission. A transplant is a strong treatment with risks of serious side effects, so it is not used for all patients with AML. A transplant is used when chemotherapy alone is unlikely to provide a long-term remission.
Autologous Transplant
An autologous transplant uses blood-forming cells collected from the patient. If an autologous transplant is a treatment option for you, you will have blood-forming cells collected from your blood stream. The cells are usually collected as soon as induction therapy has brought the AML into remission. The cells are frozen until you are ready for transplant. You may receive an autologous transplant soon after your induction therapy is completed, or your cells may be saved as a backup option in case you relapse after receiving consolidation chemotherapy.
Autologous transplants have risks of serious side effects, but these risks are lower than for allogeneic transplants. However, a patient has higher risks of a leukemia relapse after an autologous transplant. This is because leukemia cells may be returned to the patient along with his or her blood-forming cells.
Allogeneic Transplant
An allogeneic transplant replaces the abnormal cells in a patient's bone marrow with healthy blood-forming cells from a family member or unrelated donor or cord blood unit. An allogeneic transplant has a higher risk of serious side effects than consolidation chemotherapy or an autologous transplant. However, the risk of relapse is lower after an allogeneic transplant.
Choosing a Donor or Cord Blood Unit
If an allogeneic transplant may be an option for you, your doctor will do a test to find out your HLA tissue type. Your doctor will also test possible donors in your family to find out if they are a suitable match for you. If you do not have a suitable donor in your family, your doctor can search the National Marrow Donor Program (NMDP) Registry for an unrelated donor or cord blood unit. To save time, your doctor may check for potential donors on the NMDP Registry at the same time he or she is testing for donors in your family.
The closeness of the donor match can affect a patient's chances of a good transplant outcome. In general, transplants using matched sibling donors have had the best results. However, outcomes for unrelated donor transplants have improved in the last decade. For some groups of patients, outcomes for sibling donor and unrelated donor transplants are similar.
Reduced-Intensity and Non-Myeloablative Transplants
For some people with AML, an allogeneic transplant may offer the best chance for a long-term remission. However, more than half of people with AML are over age 60. Many people older than age 60 are unable to tolerate the intense treatment of a standard transplant. People with other health problems, such as heart disease or organ damage from previous chemotherapy, may also be unable to tolerate a standard transplant. An allogeneic transplant using less intense treatment may be an option for some of these patients. This type of transplant is called a reduced-intensity transplant or non-myeloablative transplant.
Transplant Success Rates
Transplants have risks of serious complications, but a transplant offers some patients the best chance for a long-term remission. If transplant is an option for you, your doctor can talk with you about the possible risks and benefits of a transplant. For statistics showing patients' results after transplant, see AML Transplant Outcomes.


Making Treatment Decisions
AML is an acute disease that can get worse quickly. Most patients begin treatment with induction chemotherapy soon after diagnosis. Many patients reach remission, but relapse of AML is common. All patients need a second phase of treatment to try to prevent relapse. The second phase of treatment is based on a patient's risk factors. (For more information, see Risk Factors for Planning Treatment of AML.) It is important to discuss your risk factors and your treatment options with a doctor who is experienced in treating AML.
Planning for a Possible Transplant
All patients with AML may want to talk with their doctors about including the possibility of a transplant in their treatment plan. A transplant may be the first choice or it may be a backup plan. When transplant is not the first treatment, early planning may allow for more flexibility in treatment options and a quicker transplant later, if it is needed. In general, to prepare for the possibility of transplant:
Patients with AML should be HLA tissue typed at diagnosis.
Patients should be referred to a transplant doctor for consultation at an appropriate time based on risk factors.
Family members who might be suitable donors should be tested at the same time as the patient or soon after.
Doctors can take an early look at potential unrelated donors and cord blood units on the NMDP Registry as soon as they know the patient's HLA tissue type. This first look is free of charge.
Patients who have no suitable related donor and few potential unrelated donors may want to discuss storing their own blood-forming cells for a possible autologous transplant.
The only patients who may not benefit from this planning are those who would clearly be unable to tolerate even a reduced-intensity transplant. Some older patients and patients who have organ damage or other health problems may be unable to tolerate a transplant. If you want to consider a transplant, a transplant doctor can examine you to see whether a transplant is a good option.
It is important to talk about your treatment options with a doctor who is experienced in treating AML. Your doctor can discuss your specific risk factors and treatment options with you. For more information to help you talk to your doctor about whether a transplant is an option for you, you can share the referral guidelines (PDF) from the Physician Resources section of this Web site with your doctor.
More Information on AML
You can get further information about AML from disease-specific organizations, such as:
Leukemia and Lymphoma Society: AML:http://www.leukemia-lymphoma.org/all_page
American Cancer Society: What is acute myeloid leukemia?:http://www.cancer.org/docroot/CRI/content/CRI_2_2_1x_What_Is_Acute_Myeloid_Leukemia_AML.asp
National Cancer Institute: Adult AML (PDQ®): Treatment:http://www.cancer.gov/cancertopics/pdq/treatment/adultAML/patient
For other organizations that offer information and resources, see Organizations That Can Help: A Searchable Directory.
Contributing Editors
C. F. LeMaistre, M.D., Southwest Texas Methodist Hospital, San Antonio, TexasAnthony S. Stein, M.D., City of Hope National Medical Center, Duarte, Calif.
Last Updated: February 2006

When one is told one has cancer, inevitably, one will be filled with terror and sorrow. One’s loved ones will be frightened on one’s behalf. Family members are grieving and feeling helpless and all they can do is hope for the best. It only takes a disease like cancer to blow apart the ordinary lives.

I came to know about cancer at the tender age of eleven years old. At that time I didn’t know much about cancer, yet I knew it could be devastating to have it. My two aunts who were stricken died in the same year. The following year, my maternal grandfather died of cancer too.

For a long time I wouldn’t dare to call it by its name. When I was older I called it the big C, for I read it was what John Wayne called it as he battled the big C for fifteen years before he succumbed to it. Whenever I heard that someone has fallen ill, the first thing that would come into my mind is, “Oh no, please don’t let it be cancer.”

Recently, it seems colorectal cancer has been making the news in my circle. It has happened to my sister’s friend, my husband’s ex-colleague, somebody’s friend’s wife and….. Gosh, it is so dreadful because when we visit the sick we have nothing else to offer except to appear optimistic. Privately, we have this awful thought of what if…..
this will happen to us one day.

Prevention is better than cure, we say. Hence, it’s high time we learnt about the colorectal cancer. Recently, I read an article in The Star (21 Feb 2007) by Dr Milton Lum who said that colorectal cancer is the most common in males and the third most common cancer in females in Malaysia. According to this good doctor, cancer can arise anywhere in the large intestine but commonly can be found in the descending and sigmoid colon or the rectum. The lining of the colon and rectum comprises cells which are constantly renewed. Sometimes there is an excessive growth of cells forming polyps. Most polyps are non-cancerous (benign). However, some polyps may, over time (usually years), develop into cancer.

If diagnosed and treated in its very early stages, colon and rectum cancers have a high rate of cure, therefore early detection is vital. The stages of colorectal cancer are: Stage 0- the cancer is found in the innermost lining of the large intestine only. Stage 1- the cancer has spread beyond the innermost lining to the second and third layers and involves the inside wall of the large intestine, but it has not spread to the outer wall or outside the large intestine. Stage 2- the cancer has spread outside the large intestine to nearby tissue but it has not spread to the lymph nodes. Stage 3- the cancer has spread to nearby lymph nodes but it has not spread to other parts of the body like liver or lungs. Stage 4- the cancer has spread to the other parts of the body like liver or lungs.

Symptoms: A change in bowel habits; diarrhea, constipation or a feeling of incomplete emptying; bright red or very dark blood in the stools; stools that are narrower than usual; general abdominal discomfort like bloating, fullness, frequent gas pains or cramps; unexplained weight loss; constant tiredness or vomiting. Any change in bowel habits that persists should signal the need for physician consultation.

Treatment: Fecal occult blood test examines the stools for hidden (occult) blood, i.e it cannot be seen by naked eye. This test doesn’t say whether the person has colorectal cancer as benign conditions like piles, anal tears and benign colonic polyps can also result in a positive test. However, its result will help the doctor decide whether an examination of the large intestine is needed.

Colonoscopy is a procedure in which a thin, lighted instrument is used to view the entire colon and rectum for cancerous or benign growths. Any polyp or abnormal areas seen are removed for microscopic examination. The procedure is usually carried out under sedation.

The basic treatment is the surgical removal of the cancer and the regional lymph nodes for localized disease. The procedures include local excision, which is the removal of very early cancer by colonoscopy; partial removal of the cancer and surrounding healthy tissues (colectomy) and lymph nodes with healthy parts stitched together (anastomosis); or colectomy and colostomy. If the two ends of the colon or rectum cannot be stitched back together, an opening (colostomy) is made on the outside of the body for the stools to pass through. Sometimes, the colostomy or stoma is needed only until the lower colon has healed and then it can be reversed. If the entire colon or rectum needs to be removed, then the colostomy will be permanent.

Even if all cancers that can be seen at the time of the operation are removed, some patients may be offered chemotherapy to destroy any cancer cells that may be left.

There appears to be a lower incidence of colon-rectal cancer among those who follow a diet high in fiber (vegetables, fruits and whole grains) than in those who follow a diet low in fiber and high in red meats, carbohydrates, fats and refined foods. Those at high risk with a family history of colon-rectal cancer; a history of non-cancerous polyps in colon; a history of ulcerative colitis; certain inherited conditions like familial adenomatous polyposis and hereditary non-cancerous polyposis colon cancer should be evaluated periodically for the disease.

Living with a stoma: According to Reader’s Digest Guide to Medical Cures and Treatment (my medical bible), a stoma is an opening in the lower, left abdomen through which the stools pass through. Patients who require a stoma must learn how to care for themselves and make some changes in daily routines. In time, they can resume the full range of normal activities, including work, sex, and most sports.
Here are some of the tips on making the adjustment: 1) Learn how to be proficient in all aspects of stoma care before leaving the hospital. Learn how to empty and change the ostomy pouch and how to care for the skin around the stoma. 2) Learn how to perform colostomy irrigation. This procedure, which takes time to master, involves instilling about one quart of water in the stoma to remove waste from the colon. If irrigation is performed every day or two, a colostomy pouch may be unnecessary; a gauze pad can be placed over the ostomy instead. 3) Use a specially formulated colostomy pouch deodorant to control odor. 4) Eat in moderation and on a fairly regular schedule. Try small servings of different foods to see if any one food causes problems. 5) Avoid fried products and foods that cause constipation, such as refined, low-fiber foods. 6) Limit consumption of foods that can cause diarrhea. Common offenders are beans, bran cereals, and raw fruits. 7) Wear regular clothes, but be sure that belts and waistbands are not directly over the stoma. Some men switch to suspenders to avoid discomfort from a belt. Ostomy pouches are made to lie flat against the body, so that they do not show. 8) Do not participate in rough contact sports such as football and ice hockey, and exercise caution in sports such as weight lifting and calisthenics, which may strain the abdominal muscles. 9) Empty the ostomy pouch before swimming and wear a wide-belted athletic supporter or girdle in the water. 10) Empty the ostomy pouch before any sexual activity.

Some time ago, I heard this story from somebody. It was the run-off-mill story of how a seemingly healthy middle-aged man suddenly collapsed and after going through all the tests, discovered he needed a coronary bypass.

The patient underwent a successful coronary bypass, spent a short while in the intensive care unit and then was transferred to the ward. He recovered sufficiently to have an appetite but he wasn’t happy with the meals served by the hospital, so he requested nasi lemak from his loved ones. He didn’t even cause a stir when he pushed the nasi lemak down his throat and other unhealthy foodstuff he asked for. All these happened while he was still in the hospital bed.
The only thing unusual about this story is that he was eating inappropriate food as if the coronary bypass had never happened.

Obviously, he didn’t have a dietitian to advise him about post-care and proper nutrition after a coronary bypass surgery. He went on to indulge on his favorite food which most probably caused the narrowing of his arteries.

At one time during his recuperation he had this sudden pain in his chest which was brought on when he carried something heavy. He said he wasn’t told that he wasn’t supposed to carry anything heavy.

Check this out…

Heart Smart Diet and
Nutrition for a Healthy Heart
compiled by the HealthCastle Health Team

Heart Smart Diet

TLC Diet for High Cholesterolrecommended by the National Cholesterol Education Program NCEP & the American Heart Association AHA
DASH Diet for High Blood Pressurerecommended by the National High Blood Pressure Education Program NHBPEP
Heart Smart Diet Facts (Sponsor) Try risk free the Heart Smart Plan developed by eDiets to help lower blood cholesterol



Healthy Eating GuidelinesLook for recommendations on healthy eating from various countries. Free tools can also be found here to help keep track of your eating habits.




Heart Smart Diet FAQ


Cholesterol
Cholesterol Numbers 101 - what do they mean?
Good and Bad Cholesterol
How to lower triglycerides?
Cholesterol-lowering foods work especially when eaten in combination

Seafood
The Myth of Cholesterol
Myths of Seafood and Fish

Egg
Eggs and Cholesterol - are some eggs healthier than others?

Vitamins
Benefits of Vitamin E and Heart Disease?
Folic Acid supplements cannot prevent Stroke and Heart Attacks
Vitamin D may be an anti-inflammatory agent for Heart Failure

Psyllium
Psyllium Husk for High Cholesterol

Garlic
Benefits of Garlic in Heart Disease

Fruits & Vegetables
Fruits and Vegetables reduce stroke risk
Potassium and High Blood Pressure
Pomegranate Juice helps fight Heart Disease

Beverage
Benefits of Coffee - high in antioxidants
Coffee causes no harm to Heart?
Coffee may prevent Heart Disease in Women
Health Benefits of Tea
Green Tea benefits fight against Heart Disease
Red Wine - Heart Health Benefits?
Alcohol Benefits Heart in Men

Soy
Powerful Benefits of Soy
Benefits of Soy milk in Heart Disease: cholesterol lowering
AHA no longer recommends Soy for Heart Disease

Whole Grains
Whole Grains Guide - Health Benefits
Barley for High Cholesterol
Oats for High Cholesterol

Fat
Trans Fatty Acids
Butter or Margarine - which one is better for my health?
Trans Fat in Packaged Foods
Fats 101 - Good Fats and Bad Fats
The best Cooking Oils?
Saturated Fat in Coconut Oil is bad for your heart
Why do we always focus on Fat?
Everyday ways to cut back on FAT!
Shopping and Eating Tips for Low Fat Eating
A look at Fat Substitutes

Omega 3 Fatty Acids
Is omega 3 fatty acid good for me?
Can eating Salmon help lower your blood cholesterol?
Fish, Fish Oil, Omega 3 fatty acids and Heart Disease
Flax seed: Benefits of Flax seed in Heart Disease
Health Benefits of Nuts
Health Benefits of Walnuts

Salt
Low Sodium Diet
UK sets Salt Reduction Targets for Packaged Foods

Chocolate / Cocoa
Health Benefits of Chocolate?
Heart-Healthy Chocolate Bar: What's the deal?

Miscellaneous
Mediterranean Diet - Heart Health Benefits
Antioxidants 101 - What and Where?
What are Empty Calories?
Top 4 must-have Healthy Snacks
Selenium only benefits cancer, but not Heart
Ginseng and High Blood Pressure
Understanding Nutrition Food Labeling
American Heart Association revises Diet Recommendations
New Heart Disease Prevention Guideline published by the American Heart Association

Once my husband was found to have heart disease, there was this thirst on my part to know more about coronary bypass surgery, especially when it was a necessity for my husband to have it.

We didn’t pay much attention when my husband’s casual friend was diagnosed with heart problem. Though my husband went to see him before and after his operation, my husband didn’t know much except that it was his friend’s heart that needed surgery urgently. We were shocked that my husband’s seemingly healthy friend was walking around with a weak heart, so to speak.

Even when my husband was told to have a coronary bypass surgery, he didn’t bother to find out the details about it. He didn’t want to know about the procedures of this kind of surgery. Maybe he took comfort in the belief that ignorance is bliss. What he didn’t know wouldn’t hurt him. Hence, he appeared to be very calm right until the day of the operation. At least, he didn’t worry himself silly.

I, on the other hand, took trouble to check out some facts in the medical books.
Of course, I was reading the abridged versions just to get a rough idea. When I met the wife of my husband’s friend, I asked her about the surgery that her husband underwent.

It was a good thing that I asked. It turned out her husband had heart valve disorders. His valvular disease existed for some years without causing symptoms. When he had breathlessness, fatigue and dizzy spells, he went to seek treatment was told that he had to replace his damaged valve. I read in the medical book that when a synthetic valve is implanted, the patient must take anti-coagulant drugs to prevent blood clogs.

Many months later, it came as a surprise when we heard of his sudden demise. He collapsed after climbing up a flight of stairs. The few times I saw him, he seemed so normal. Even after his operation and during his recuperation he didn’t lose that much of weight.

Clearly, my husband lost weight and his gaunt face was a good indication of how much weight he’d lost. When he went back to work he was a slimmer version of his old self. I wouldn’t believe that I’d have preferred the medium-built man he once was.

But slowly and steadily my husband regained his strength and weight. In those days, I had trouble getting him to stick to a low-fat diet that is high in fiber. I was his food policewoman. When we dined out, he was annoyed when I stopped him from eating too much oily food. He said I stopped his fun of eating. Yeah, the kind of fun that led him to a coronary bypass surgery. It’s so true that people tend to have a short memory. Nowadays, he does have his straying moments from eating healthily.

When my husband checked out from the hospital, he was wheeled out. He was put in a wheelchair at the airport. We traveled first class, first to embark and disembark. It was also the beginning of a long recuperation.

My husband must be very stoical in his suffering. The surgeon had to saw open his ribs before he could reach his heart. Yet, there wasn’t a moan or a groan from him. Of course, he was in pain and in how much pain, he only knew.

When his mother was dying, she had this very bad case of foot ulcer. Gangrene set in and the big toe started to rot. She was advised to have her leg amputated. She would rather die than to be the one-legged survivor. My husband used to marvel at her stoicism in the face of such excruciating pain. Probably my husband had this notion that he would emulate his mother.

When bad things happen to people around you, it is normal for you to feel some empathy and sympathy but when it happens to your spouse or child it brings a sense of desperation, helplessness and despair. So when it happened to my husband I couldn’t help thinking it would be me one day. When my time comes, I’ll try to be cheerful about it. I know it is next to impossible especially when I truly believe that I have a low threshold of pains.

Imagine I’m dying and the disease is killing me, no matter how fast or slow it is still dying and if I have my own way, I’d rather have my family with me and nobody else. Until now I still have full admiration for my late friend who managed to appear cheerful when chemotherapy robbed her of her hair, her vitality, her weight, her looks as her eyes grew larger day by day and they sunk deeper and the fact remained that her days were numbered. Yet she was more cheerful than her well-wishers.

While my husband was recuperating I’d have had these morbid thoughts. Just cough from one of my kids, my initial reaction would start me thinking of the worst scenario. I had stopped taking things for granted.

During his convalescence, my husband’s immunity was pretty low and even a common cold would give him pain. Coughing and sneezing would make him feel strained around his chest area where his ribs were on the mend. In our Asian society, we are too polite to tell the well-wishers to stay away during the period of convalescence. It’s a cultural norm to visit the sick. So my husband had to receive visitors regardless his state of mind. In his good days he would enjoy some good company.

He had to adapt his taste buds to bland food. At this time I had to reduce salt, sugar and oil in the cooking. It had to be a feat to fry fish in 2 teaspoons of oil. When I shopped for my groceries I had to buy cholesterol-free stuff. I cooked more vegetable dishes.

Then I had this brainwave, I thought it would benefit the whole family to eat the same healthy stuff. My children were still young enough to change their mindset.

It was a very nervous me who took the lift to the operation room. The operation took more than seven hours. By the time I reached the operation room, my unconscious husband was already wheeled outside the operation room. I managed to have a glance at him before the nurses pushed the bed on castors and all into the lift. He looked so pale and lifeless. I was told to wait for the call in the waiting room.

I met my husband’s two friends outside the waiting room. I told them what little I’d known. They didn’t stay long as it was pointless when my husband was in the intensive care unit.

When the call came, a voice told me to go to see the surgeon in his room. The surgeon was already in his room and told me to take a seat. He told me he did 6 bypass grafts instead of 3 as intended. He explained he did 3 more bypass grafts on the minor blockages he discovered that the angiogram had missed. He said he might as well fix them while he was at it. I’ll always be grateful to the meticulous surgeon.

I also paid the dietitian a visit who advised me on nutrition therapy. I was told to prepare low-fat, high-fiber meals for my husband. In the past I couldn’t even get my husband to cut down on his high-fat food. She gave me guidelines on what to eat and what not to eat.

Before I left the hospital, I went to see my husband in the intensive care unit. The seriousness of the unit was obvious when I had to remove my footwear and put on the ones provided by the hospital. I also had to wear a hospital gown over my outfit.

The surgeon was with him. He was looking at the monitors. I could see a few tubes that were attached to both sides of his body. I can remember clearly there was a bag to collect blood and a drip-feed above his head. My husband was barely breathing, he was so still, didn’t move or stir.

My husband was in the intensive care unit for 2 days. He spent 5 days in the hospital room before he was discharged. The first day he was out of the intensive care unit, he was asked to walk. My husband knew what was good for him and faithfully did what he was asked to do, even though he had to walk together with his drip-feed.

Both my husband and I slept fitfully during our stay in the hospital. Nurses came to take blood pressure and give out medication; surgeon came to check on him. It seemed to be a round-the-clock service.

One time while my husband was out walking in the ward, I took over the bed and covered myself with the blanket. I was awoken by the nurse who wanted to take my blood pressure. I told her I wasn’t the patient but the patient’s wife.