Friday, 31 July 2009

Here we go again...

Assalamualaikum wbt

It's been quite a while since I last posted an entry into the blog. So many things have been happening over the last 2 weeks, many of which are significant ones.

Firstly, the good news. Alhamdulillah, after a challenging (challenging is probably an understatement) last 6 months, by the will of Allah, I have officially obtained my medical degree from the University of Sheffield.

Now, the not so good news.

The CT scan I had on the 16th July 2009 further reinforced the results of my recent PET Scan. The disease is back. Hodgkin's lymphoma, which was found to be completely eradicated halfway down the treatment back in April, has relapsed.

Whilst waiting for my treating consultant at the 02 Day Ward waiting room this morning, I had already half-expected what was to come. I know managing a relapsing Hodgkin's Lymphoma will not be as straight-forward as the initial ABVD-chemotherapy. I was just not sure how intensive will the treatment be.

At the end of the consultation, it just dawned on me what an immense test I am likely to go through in the next 6 months.

Autologous Stem Cell Transplant. It basically means high dose anti-cancer treatment followed by a transfusion of my own stem-cells.

What I will have is very high-doses of chemotherapy, one that will completely kill all the remaining cancer cells in my body, but unfortunately the one that will also lead to IRREVERSIBLE bone marrow damage. This is because the marrow is highly sensitive to chemo/radiotherapy.

The transfusion of stem cells after high dose chemotherapy should supposedly allow my marrow to recover. They will move from my blood back to my bone marrow, where they start making more bone marrow and stem cells. Gradually, hopefully my bone marrow will recover and my blood count will return to a safe level.

For that purpose, I will also have my stem cells harvested sometime in the future. Here's a good explanation about how stem cells are harvested from the body.

In general, what will happen over the next few months are:

i. 2 courses of Chemotherapy over the next 2 months (to further reduce the number of cancer cells before stem cells are suitable to be harvested).

ii.. Stem cell harvesting

iii. High dose chemotherapy (I can't imagine how will I feel once my bone marrow is literally 'gone' when they give the high-dose chemotherapy)

* Bone marrow is where you make all your blood cells (red blood cell to carry oxygen, white blood cells to fight against infection, platelets that clots the blood to prevent further blood loss in case you have a wound). So imagine if your bone marrow is damaged!

iv. Stem cells transplanted

v. Hopefully clear remission from disease

Below is a nice diagram of the stages involved in an autologous stem cell transplant.

I have just had another neck biopsy taken this morning, and they have also arranged for a bone marrow biopsy to be done (not again!) as soon as possible. It does feel like going through the whole cycle again.

It's natural for a human being to be left feeling so frustrated having been so strong in facing such a big adversity, and coming out of it standing tall and proud, only to be knocked down again by an even bigger test almost immediately.

But as a Muslim, it is imperative that I believe in Allah's plannings. It might be that Allah is not giving me the ray of sunshine just yet, rather pouring me with heavy rains, only so that He can give me the beauty of the rainbow by the end of it. Insya Allah! =)

"Bila Allah uji kita dengan sakit, tandanya Dia sayangkan kita..Dia mahu kita jumpa Dia suci dari segala dosa dan hina kita di dunia..."

This is indeed, not a primrose path.


Wednesday, 15 July 2009

Nobody said this journey was easy...

Assalamualaikum wbt

I'd firstly like to say thank you very much to a lot of my concerned friends out there who have been eager to know the result of my PET Scan done on the 5th July 2009. The scan went well, alhamdulillah, although the technician initially struggled to put a cannula into my vein (which is understandable, semua my veins pun dah merajuk sebab dah 6 bulan kena torture kot!).

My CT scan back in March was promising but unfortunately it wasn't the case this time around. I've been told by my Consultant that the PET scan showed some hot spots in the mediastinum, lungs and left side of my neck.

Senang cerita, mediastinum ni region antara the two lungs, ie bahagian tengah.

Now let me try and simplify how a PET scan works. With a PET scan you first have an injection of a very small amount of a radioactive version of glucose. The radioactive glucose travels to places in your body where glucose is used for energy. Since cancer cells are more active and take up more glucose than normal cells do, they become intensely bright on the scan and this is where the term “hot spot” comes from.

A handy information about PET Scan for those interested.

The tricky bit about hot spots are that they can also be caused by things other than cancer, for instance infections like viral illness or Tuberculosis. Although my consultant feels that the hot spots found in my scan are quite likely active cancer cells, he doesn't want to jump immediately into second-line treatment (stronger chemotherapy and possibly bone marrow transplant) due to their long-term effects.

We therefore felt that a wait-and-see policy is probably the best approach at the moment. My consultant has also decided to arrange for another CT scan tomorrow morning which should hopefully be a helpful adjunct on top of the PET scan findings. Insya Allah.

Since management of my condition will take at least months of close monitoring, I have been recommended to remain in the country. Which has certainly thrown my Plan A into a bit of an uncertainty. [Plan A = To return home and start work in possibly Serdang/Putrajaya Hospital]. These last few days have been spent sorting out my FY1 (Foundation Year 1) job in Royal Preston Hospital, as I am due to report for my induction next Monday (ie 20th July 2009).

I must admit there are so many uncertainties running through my mind at the moment.

Not being sure how things might pan out in the future in regards to my condition.

If I do start working as a doctor in UK, how will it be affected if I am to have further treatment for my condition?

If my sponsor does insist on me returning home, will I be sure that there will be no glitch in transferring the management of my condition to the Malaysian hospitals? How will the treatment and healthcare be like back home?

Indeed, no one said this journey was gonna be easy.

Tapi kita kan ada Allah. Ya 'Azim. Ya Rahman. Ya Rahim.

There is nothing easy except what You make easy. And You make the difficult easy if it be Your will.

p/s: In myself, I couldn't have asked for more alhamdulillah. Feeling good, fitness gradually picking up, my hair looking long enough to even consider visiting the barber! =)

Friday, 3 July 2009

Sesi Penghargaan

Assalamualaikum wbt

5 weeks ago, on this day, I had my 12th and last chemotherapy. It might have been quite a while now, but the whole experience of battling against the drugs is still vividly clear in my head, as if it has only happened yesterday.

Alhamdulillah, I am gradually picking up my level of fitness as days go by, thanks to the easily accessible swimming pool and gymnasium in my university. Contrary to my initial perception that people undergoing chemotherapy usually loses weight, I have actually gained almost 7kg over the past 6 months (dun wori, takdelah nampak bulat sangat =)

It's not that this weight gain is bothering me, rather it makes me feel blessed. Blessed that during the 6-months time when I was having my treatment, the people of Sheffield has played their part in helping out.

Today, as I was perusing through my inbox , I saw this email, sent about 4 months ago which reminds me just how thoughtful Malaysians in Sheffield are.


Assalamualaikum & salam sejahtera kawan-kawan,:D

Sebagaimana yang telah kita tahu,kini saudara Mas Afzal sedang menjalani rawatan chemotheraphy dan amat memerlukan sokongan kita.

Jadi,beberapa minggu lepas, saya telah menghantar email secara personal kepada beberapa orang ahli smsa di kawasan Broomhall menanyakan kesudian mereka memasak dan menghantar makanan kepadauntuk saudara Mas Afzal.

Di bawah saya sertakan jadual giliran memasak pada mereka yang telah membalas email saya









Not forgetting my dearest housemates especially Mr Chef Khairuddin aka M, and my neighbor Kak Lida for always dropping by to offer some of the foods that she had cook.

To all these people above, and their fellow housemates, I only have Allah to thank each and every one of you. May Allah allow all of you the opportunity to enjoy the reward of your deeds in Khurfat-ul-Jannah, the fruit garden of heaven, as has been mentioned by the Prophet Muhammad (may peace be upon him) for the people who visit and look after the sick.

This Monday at 1030am, I am due to be in Northern General Hospital for my next PET Scan. I'm assuming that the options possible once the result is up will either be :

i) Declared cancer-free and thus only occasional follow-ups in the clinic
ii) Further chemotherapy/ consider radiotherapy if localized

Insya Allah, whatever the outcome will be, I will need to tell myself that it is part of Allah's plannings for His servants and put my sheer reliance (tawakkal) on it.

Before I conclude, I'd just like to share with you a beautiful hadeeth that was forwarded to me from a very special friend of mine.

The magnitude of otherworldly reward is proportionate to the magnitude of worldly tribulation. When God loves a people, He tries them. Whoever is content will have divine pleasure. Whoever is displeased will have divine wrath. [ At-Tirmidzi]