* * Sakura Haruka | Singapore Parenting and Lifestyle Blog * *

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

2023-01-25T15:00:00.006+08:00

As I only had to take my Lucrin jab and not see any doctors or do any other treatments/ tests on Wed 26 Jan 2023, Dr Samuel suggested that I go to one of the NCIS on the Go locations to do it as the waiting time is shorter, and might be more convenient to get to from home.

NCIS on the Go programme offers 3 convenient locations in the West region, for cancer treatment and care to National University Cancer Institute Singapore {NCIS} patients. These are located at Jurong Medical Centre {5 mins from Boon Lay MRT station}, Keat Hong Community Club {5 mins from Choa Chu Kang MRT station} and Frontier Family Medicine Clinic {5 mins from Clementi MRT station}.

Basic oncology service is provided by their professional, trained oncology nurses and it is as safe as undergoing the procedures in the hospital. Should an emergency or critical situation occur, the patient will be sent to the hospital via an ambulance.

The main services offered include:

0900hrs - 1000hrs: blood-taking only
1000hrs - 1200hrs: flushing/ dressing/ care of central venous line only
1200hrs - 1600hrs: s/c injection for chemotherapy, non-chemo injections and vaccines only

Lunch is from 1300hrs - 1400hrs.

No walk-ins are allowed, and NCIS patients need to make an appointment at least one day in advance, before 3pm. Appointments made after 3pm will be scheduled for 2 working days later.

I chose to do my Lucrin jab at Keat Hong that day and my appointment was for 12.30pm. It was very easy to get to Keat Hong Community Club from Choa Chu Kang MRT station, exit B. However, finding my way to the Keat Hong Family Clinic inside the Community Club took a while as the directions were not very clear and the escalators don't seem to go to Level 3. You have to take the lifts.

I arrived earlier about 12 noon and the staff at the registration counter told me to go to Room 2. There were no other patients when I arrived.

Apparently, NCIS on the Go @ Keat Hong only rents a room from the Family Clinic there and there is no need for registration on the day of your appointment. Just inform the nurse at Room 2 when you are there and wait for her to call you in.

Since I was wearing a hoodie and hat, and walked from the MRT station, my temperature was higher than usual {38°C} so the nurse told me to wait a while and see if my temperature fell as if I had a fever, she had to call Dr Samuel to check what to do next.

I took off my hoodie and hat and waited for about 10-15mins. Luckily, my temperature fell {37.3°C} so she allowed me to proceed with my jab. Was very thankful for that as I did not want to come back another day for my jab if I could help it!

After checking my vitals, she video-called her colleague for the colleague to verify my ID again and check the medicine that she was going to give me. Impressed that they are still thorough like that.

Overall, it was very fast with hardly any waiting {except for my temp to drop} and was all over in about 15 mins. I reckon if I can do without going to NUH for just my jabs or blood tests, I will come here to Keat Hong instead.

I wonder why NCIS on the Go is only offered in the West region of Singapore. They really should open up more locations around the whole island for the benefit of their patients... the crowd and wait at NUH Cancer Clinic is really horrible most of the times.

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Third Chemotherapy and Herceptin Jab Session

2023-01-17T19:00:00.011+08:00

Two down, two more to go. Seems quite fast that I'm past the halfway mark with my chemotherapy treatment. But truthfully speaking, living through it is a sloooow torture... After reading other people's experiences, I know I don't have it as bad, but still during the worst of it, I wouldn't want anybody to go through it at all.

View this post on Instagram

A post shared by アイ・サクラ  (@aisakuraharuka)

I went for my third chemotherapy and Herceptin jab session on Tue 17 Jan 2023, just a few days before Chinese New Year. My blood tests and check-up with Dr Samuel was on Mon 16 Jan 2023 and as my test results seemed ok, he cleared me to go for my chemo session the next day.

As I'd already shaved my head, Dr Samuel said I don't need to do the scalp cooling anymore. He also prescribed me stronger painkillers {Anarex}, lozenges and melatonin to help me sleep better.

As usual, I registered for my session an hour before on the OneNUHS app and verified by identity at the counter on arrival. The staff there wrote down the wrong queue number so another staff there checked and said that I was supposed to go to Level 10 to see my doctor {Chemotherapy Centre is on Level 9}, and my chemo session was the next day.

I told them I already saw my doctor the day before, and my chemo session was that morning. My doc confirmed it and it also does not make sense that I received notification for SMS and the app that asked and allowed me to register for my chemo session if it was meant to be for the next day.

Another staff came by and also repeated to me the same thing about what the system shows. After back and forth for 5-10 mins, finally one of the staff realised that they were checking on the info for another patient as the first staff wrote down the wrong queue number..........

Oh well. Still managed to check my vitals and get to my chemo session on time at 8.30am since I arrived early.

This is what my third chemotherapy session was like:

0800hrs Arrive at hospital

0810hrs Verify ID with counter {registered 1hr earlier with OneNUHS app}

0820hrs Check vitals and the pharmacy will prep medicine

0825hrs Go to Chemotherapy Bay

0830hrs Cannulate and run through with saline

0850hrs Run pre-meds drip for anti-allergy and to protect stomach for 15mins

0907hrs Start Docetaxel drip for 1hr

0910hrs Herceptin jab on right tummy

1005hrs Saline drip flush for 10mins and toilet break

1025hrs Pharmacist came to dispense home meds and Peglasta syringe

1030hrs Start Cyclophosphamide drip for 30mins

1105hrs Take out hand canula

1110hrs Go to pharmacy to collect anti-nausea meds as pharmacist wanted to

check if I needed it before dispensing it but did not come back in time

1115hrs Go home

My third chemo session was much shorter than my first and second sessions without the scalp cooling treatment. Much prefer it this way...

I think the nurses also started treatment earlier at 8.30am {instead of the usual 9am+} to pack more patients in as they close during public holidays... and there were 2 CNY public holidays coming up the week after.

Read about my first chemotherapy session experience to find out more on what it's like at a Chemo Bay and some tips for having a more pleasant session.

You can read about what to expect for a chemotherapy cycle and tips to manage its side effects at home here.

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Second Chemotherapy and Herceptin Jab Session

2022-12-27T20:00:00.053+08:00

My session for adjuvant chemotherapy and Herceptin jab second cycle {Tue 27 Jan 2022} commenced much better than the first.

I took my Dexamethasone pills {8mg} correctly for the 3 days for a start, and the session itself went quite ok. I thought it might end a bit earlier than the first session but since I had to get the scalp cooling cap fitted properly again, it took about the same duration.

The nurses informed me that not all of them are trained for scalp cooling cap fitting so I had to wait until about 11+am before one of the trained nurses arrived at the Chemo Bay {F12} to assist me with that. Most of them know how to operate the machine though.

It seems as if they have a limited number of caps for each size, so if you are doing scalp cooling therapy during your chemotherapy sessions, I suggest that you try to start your sessions as early as possible so that you have a higher chance of getting the correct sized caps and starting your sessions on time.

I remembered to bring a small back support pillow and gloves for extra comfort so that was good. It seems as if I'm the only one that feels so cold at the Chemo Bay haha... I used 2 blankets, wore long pjs, long socks and gloves and still felt a tad chilly.

Maybe because I'm sitting there so long, and maybe because of the scalp cooling therapy too. Other patients I saw, who are mostly older folks, wore usual t-shirts/ shirts and berms or pants and used just 1 blanket.

Didn't feel like watching any shows so just passed the time reading my book and watching CNA. No appetite for lunch so just ate an almond croissant and drank Koi Earl Grey milk tea with coffee jelly.

This is what my second chemotherapy session was like:

0815hrs Arrive at hospital

0820hrs Verify ID with counter {registered 1hr earlier on One NUHS app}

0830hrs Check vitals and the pharmacy will prep the medicine

0845hrs Go to Chemotherapy Bay

0900hrs Chemo Bay nurses start to come in

0910hrs Chemo Bay nurse checked verified my ID

Started scalp cooling cap machine and IV preparation

0915hrs Toilet break

0920hrs Cannulate and run through with saline

0945hrs Run pre-meds drip for anti-allergy and to protect stomach for 15mins

Start scalp cooling therapy

1015hrs Right arm started to feel weak and hurt a bit. Only a while.

1030hrs Flush pre-meds with saline

1035hrs Toilet break

1045hrs Lucrine jab on right tummy, Herceptin jab on left tummy

1100hrs Toilet break

1110hrs Work scalp cooling caps - L for blue inner cap, M for outer cloth cap

Start scalp cooling therapy

1125hrs Pharmacist came to dispense home meds and Peglasta syringe {to boost

white blood cells to fight off infections - will be kept at the Chemo Bay

fridge and to collect before going home}

1155hrs Start Docetaxel drip for 1hr

1305hrs Start Cyclophosphamide drip for 30mins

1345hrs Toilet break

1355hrs Saline drip flush for 10mins

1400hrs Continue with cooling cap therapy for extra 1.5hrs post-chemo

1430hrs Take out hand canula

1530hrs End scalp cooling therapy and wait 5 mins with cap on

1545hrs Collect meds and leave Chemo Bay

1600hrs Go home

My hair dropped a fair bit more after I took off the caps for the scalp cooling therapy. I'd say it has dropped about 70% since chemo started. Doesn't seem to be working well for me but I think I'd just continue to use it during my chemotherapy sessions {2 more after today!!} as the nurses say it may help with faster hair recovery/ regrowth after chemotherapy ends too, even if it did not help much for reduced hair fall.

To say that I'm not sad or affected would be a lie but I know that this is just a passing phase...

There were about 3-4 nurses at the Chemo Bay today. As usual, it was quite busy but the nurses were still all very attentive and patient, not letting the stress of their work affect their attitude and behaviour.

I must say that most of the nurses I have met at NUH are like that for all the different clinics I've been to. Cheerful, friendly and kind. They try to show empathy and don't talk down to you. Some would really go the extra mile to assist you with your needs and questions.

Counter staff, like those at registration or payment counters, are different though. Yes, they are polite, but they are mostly "customer service polite" without much empathy and more efficiency-based. You can tell that they would want you to pass through their counter as quickly as possible so that they can attend to the next customer. They handle stress of a different kind and I've seen them let out their frustrations a few times to the customers, albeit in a controlled manner.

Read about my first chemotherapy session experience to find out more on what it's like at a Chemo Bay and some tips for having a more pleasant session.

You can read about what to expect for a chemotherapy cycle and tips to manage its side effects at home here.

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: First Chemotherapy and Herceptin Jab Session

2022-12-05T20:00:00.040+08:00

My first adjuvant chemotherapy and Herceptin jab cycle {Mon 5 Dec 2022} did not start off right. Le sigh.

Firstly, I had set my phone alarm to remind me to take my Dexamethasone pills in the morning of the day before my first session, but I still forgot and went out to exercise so took it later in the afternoon when I returned... and pushed back the second dose too.

Secondly, I accidentally took only ONE pill {4mg} for the first 3 doses and only realised I was supposed to take TWO pills {8mg} each time during my chemo session oops... it was because I was booked for 2 chemo sessions so when they gave me 12 pills, I thought I was supposed to take only ONE pill for each dose, since I had to take 6 doses per cycle. Quite silly but not an inconceivable mistake to make right??

Thirdly, and this is not my fault, the NCIS Pharmacy dispensed only 10 pills when I was supposed to receive 12 {3 days x 2 doses x 2 pills} for 1 cycle. I only realised this when I checked my pills at home while taking my first dose. This is the first time I was given the wrong amount of medicine so was quite surprised. Who is to know you are supposed to count your pills when you leave the pharmacy?? I didn't. Anyway, I told Dr Samuel and he said to just inform the pharmacy to give me the missing pills and luckily, they didn't make a big fuss and gave it to me with no trouble, just some time wasted.

Finally, and this got me a tad annoyed & sad, my cooling cap wasn't fitted properly. It was too small and precisely the way the manufacturer said patients should not wear it. I will explain more further down in my post.

But other than these little glitches, overall I reckon my first chemo session went pretty well. The nurses at the Chemo Bay were attentive, although quite busy since it was full-house, and the patient cubicles were spacious, clean and comfortable. Did not feel sick during the session or in the initial 2 days after.

There are I reckon 5-6 Chemo Bays at NUH Chemotherapy Centre.

Each Chemo Bay has 2-3 nurses stationed there and two toilets. There are 10 patient cubicles and each cubicle can house 1-2 patients who receive treatment on a recliner chair. When you have an appointment for your chemotherapy session, you are allocated a cubicle but actually once you reach the Chemo Bay for your appointment, you may choose whichever cubicle you like on a first-come-first-serve basis.

I was at Chemo Bay F15 for my first session.

Note: The green recliner chairs seem newer than the blue recliner chairs. They also have a longer leg rest. However, the blue recliner chairs come with their own side tables which will be useful during the session as you don't need to reach far to get your food/drinks.

Each cubicle also has a TV {think local channels only}, a table and computer for the nurses to use when they check and dispense the medicine, a noticeboard to note the patient's regime and data, an air purifier? and a seat for one visitor.

There are rolling side tables available for sharing, and the lights at each cubicle can be adjusted.

The chemo sessions for each patients last differently. I saw some that last for maybe two hours, while others like me may come for around 5-6 hours. I was basically there for half a day from 8am - 4pm, including all the wait time.

Once done, patients can leave and another will quickly take the cubicle space.

I'm not sure if the chairs are wiped after the patients left before the next patient use it {didn't notice that} but I'm sure the cubicles are cleaned somehow because NUH Cancer Centre {NCIS} is very particular and protective of their cancer patients.

Blankets are available but you are advised to dress warmly. I chose to wear my cotton Muji pjs, socks and slippers for comfort and used two blankets. Other patients wore normal outing clothes hehe.

View this post on Instagram

A post shared by アイ・サクラ  (@aisakuraharuka)

This is what my first chemotherapy session was like:

0815hrs Arrive at hospital

0820hrs Verify ID with counter {registered 1hr earlier on One NUHS app}

0830hrs Check vitals and the pharmacy will prep the medicine

0850hrs Go to Chemotherapy Bay

0900hrs Chemo Bay nurses start to come in

0915hrs Chemo Bay nurse checked verified my ID and stats

0930hrs Toilet break

0940hrs Start scalp cooling cap machine and pre-meds preparation

1000hrs Cannulate and run through with saline

1020hrs Try on cooling caps for correct size. Still got it wrong. Le sigh.

1030hrs Run pre-meds drip for anti-allergy and to protect stomach for 15mins

Start scalp cooling therapy

1050hrs Right arm started to feel weak and hurt a bit. Only a while.

1105hrs Flush pre-meds with saline

1110hrs Pharmacist came to dispense home meds and Peglasta syringe {to boost

white blood cells to fight off infections - will be kept at the Chemo Bay

fridge and to collect before going home}

1120hrs Start Docetaxel drip for 1hr and jabbed Herceptin {thick liquid so 45s jab}

1125hrs Toilet break {unplugged to cooling cap machine but roll drip IV to toilet}

1245hrs Toilet break

1310hrs Start Cyclophosphamide drip for 30mins

1355hrs Continue with cooling cap therapy for extra 1.5hrs post-chemo

1540hrs End scalp cooling therapy and take out hand canula

1550hrs Collect meds and leave Chemo Bay

1600hrs Go home

I'll share more on scalp cooling in another post but you can read a brief introduction here.

Before the first scalp cooling session, a nurse will conduct a patient cap size selection to ensure the patients are wearing the correct sized cooling cap to help avoid any patchy areas of hair loss and bald spots following the scalp cooling treatment.

The nurse that did this with me was friendly and actually very patient. However, the size I ended up with was still the wrong fit, as shown in the cap fitting guidance from the manufactor's guide that came with the machines. If I did not read the guide, I would not have known I was wearing the wrong cap size too.

S is actually a typical Asian size {maybe because Asians have smaller heads??} but it was still too small for me perhaps due to my thicker hair, and I wore an M as recommended by the nurse.

After I read the manufacturer's guide nearing the end of the session, I realised that I should have worn a L instead though because my hairline was not fully covered, especially above the ears and behind. Looks exactly like the wrong way to wear it in the guide... right??!

I was quite understandably annoyed / upset when I found out since I wanted the best outcome for this therapy, and worried that if I wore the smaller cap, it did not fit properly and would not have a successful outcome (πーπ)

I mean, I expect hair loss and understand that even with scalp cooling the success rates in patients for reduced hair loss, not zero hair loss... are about 50 - 70%... but if it starts off badly then I'd have even less hair to "save" for future chemo sessions. Quite heart-pain especially with everything going on and knowing that this could have been easily prevented, you know?

Anyway the outer cap I wore this time was small and seemed ok. For the next session, I will try a L for the cooling cap but perhaps M will be ok as my hair is much, much thinner.

Other than the cap fitting hiccup, I did not have much problems with the scalp cooling therapy. Just some slight headache at the beginning, and it was kinda cold.. but not unbearably so.

Tips:

Wear warm and comfortable, especially if you have a long chemo session {ask your oncologist or the nurse navigator for the estimated duration}.
It really does get cold, so don't be afraid to ask for extra blankets if needed. I wore long pants and sleeves pjs, and long socks. Used two blankets but still felt cold, especially at my hands so for the next session I will also bring gloves. Sounds kiasu but I'd rather be comfortable..
Bring food and drinks, especially a big water bottle. Important to stay hydrated. I brought a box of snacks, fruits {cut persimmon} and lunch {tomato-based meat pasta} since I knew I was going to be there for a long time over lunch. However, I did not eat my lunch, just the fruits and protein bars since I didn't have much appetite.
There is no water cooler inside the Chemo Bay but the nurses will assist to refill your water.
The nurses can give you water, hot milo and crackers upon request too. However, they are really busy.
I do not think that you can ask them to help you buy food or order delivery food {unless absolutely necessary maybe..?}
I have a bad back and the recliner chair does not provide a good back support so for my next session I will bring a back support pillow too.
If you go alone for your session, you might want to use the blue recliner chairs instead of green as they have attached small side tables where you can put your food, drinks, books, mobile, iPad etc. The green chairs do not and the rolling side tables are on a share basis.
Bring enough books or devices to entertain you during the session.
Bring ear plugs and eye mask if you intend to nap during the session.
Do not bring unnecessary valuables and money.
One visitor is allowed at any time. No registration is required but they are not allowed to eat there.
The nurse will assist you to the toilets because of risk of falling. You have to tell them whenever you need to go.
Inform the nurse if you feel any discomfort or pain e.g. body pain, heart ache, fast palpitations, nausea, vomiting etc. during the session. For the first few chemo sessions you might want to sit closer to the nurse's station in the front so that they can monitor you more closely.
Bring a cooler bag with a small ice pack to bring your Peglasta syringe home. It needs to be kept chilled.

You can read about what to expect for a chemotherapy cycle and tips to manage its side effects at home here.

First chemotherapy and Herceptin Jab {including home meds}: S$2,619.40

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

2022-12-01T15:00:00.087+08:00

Chemotherapy is no doubt, brutal on the body. Cancer cells tend to grow fast, and chemo drugs kill the fast-growing tumour cells. However, the drugs don't just target the cancer cells, but also affect normal, healthy cells that are fast-growing too. The damage to these healthy cells cause side effects, which can be rather severe.

That's why before each chemotherapy cycle, I need to do a blood test to check that I'm healthy enough to go through the cycle. The blood test will check my complete blood count {red blood cells, white blood cells and platelets} is at healthy levels, and my kidneys and livers are working properly.

If my blood counts are too low, or if my organs are not working well, then I might have to delay my treatment or change its dosage. The blood test may also check to see if the chemotherapy is working or if there's any cancer markers.

I went for my the blood test for my first cycle on Tue 28 Nov at National University Cancer Institute, Singapore {NCIS}, Level 10. It was a fast test whereby the nurse took 4 tubes of my blood for testing. I was in and out in about 10 minutes.

On top of the blood test to check my general health, I also had to do an echocardiogram to check my heart health. This needs to be done every 3 months during my adjuvant chemotherapy and Herceptin jab treatment as both can cause possible heart damage or failure.

An echocardiogram {aka "echo"} is a type of ultrasound scan to check the structure of the heart and surrounding blood vessels, analyse how blood flows through them and assess the pumping chambers of the heart.

I did my first-ever echo on the same day as my blood test at the National University Heart Centre Singapore {NUHCS}. The heart clinic is at the Main Building, tucked away near the glass lift in the main lobby. Got a bit lost finding it as I had never been there before.

I had registered via the OneNUHS app and told the registration counter when I arrived. Now after a recent update, there's a "I have arrived" button to press in the app but sometimes the app hangs.

Anyway, I did not have to wait long before the sonographer asked me into a private room. I undressed the top half of my clothing and wore a front-opening hospital gown before lying on the bed for the scan. She then covered me with a blanket.

The sonographer stuck 3 sticky electrode sensors to my chest. They were connected to a machine that monitored my heart rhythm during the test.

She then asked me to lie on my left side. Not gonna lie, but it was really uncomfortable to lie on my left side as I had the surgeries on my left breast, and I don't usually like to lie on my sides due to my scoliosis op. I told her about my surgeries and the implant, and she tried her very best to make me as comfortable as possible.

During the test, she had to press the probe rather firmly as she moved the probe across my chest, left breast, and left side of the body as she tried to record clear images of my heart.

I was honestly quite scared my implant would burst or shift during the test! But I guess as professionals, they would have come across many breast cancer patients with implants and know what they are doing... she was really apologetic about it though and kept saying sorry.

From time to time, she also switched on the sound to hear my heart beating and perhaps the sound of the blood flow through my heart?

The whole procedure was not relaxing at all for me even though the room was dark and quiet. I think it lasted about 1 hour.

I did not have to fast or do any preparation for both the blood and heart tests. The results of both tests were given to Dr Samuel and he went through the results with me during my meeting with him two days later on Thu 1 Dec 2022.

Basically I cleared both my blood test and echocardiogram so Dr Samuel confirmed that my first chemotherapy cycle will start on Mon 5 Dec 2002. My Vitamin D level is slightly insufficient {29, where sufficient range is 30-100} and I think he said my "heart strength" was 56 {normal score is 50}??

Ok at least all those dreadful hours I suffered doing cardio paid off somewhat to prepare me with a slightly healthier-than-normal heart haha... I forgot to ask for a copy of the results.

I'm partly happy that I'm finally starting chemotherapy just to "get over it faster", but also partly scared of the possible severe side effects that I've been reading about and the medical staff have been preparing me for.

I think what I'm most worried about is the weakened immune system which may make every small trigger lead to severe infections, and the weakened heart which may lead to heart failure (*ﾟﾛﾟ)

However, I pray that since I had a rather easy pregnancy with Lil Pumpkin {just massive fatigue in the first trimester, but no morning sickness, vomiting or nausea}, I'm hoping that I will not suffer any common bad side effects from chemotherapy or the Herceptin jab too???!

I mean, there's probably zero relations but that's just a way I'm comforting myself for now. We will see how it goes next week.

Please continue to pray for me that the second part of my breast cancer fight will go just as well as the first part when I went for my mastectomy and breast implants. Thank you!!

Blood test: S$245.58

Echocardiogram: S$446.19

Dr Samuel 4th visit: S$99.51

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Tips to Manage Chemotherapy Side Effects at Home

2022-11-28T19:30:00.018+08:00

Possible side effects from chemotherapy are hair loss, nausea and/or vomiting, diarrhea or constipation, mouth ulcers, fatigue, numbness, fever or infections.

Each patient reacts to chemotherapy differently so it's hard to say which side effects will affect me or how severe I will get them. Many side effects go away fairly quickly, but some might take months or even years to go away completely. These are called late effects.

Sometimes the side effects can last a lifetime, such as when chemo causes long-term damage to the heart, lungs, kidneys, or reproductive organs o(TヘTo)

One thing is for sure though - I will definitely have hair loss.

However, as I will be using a scalp cooling cap, hopefully my hair loss will be reduced. Success rates in patients for reduced hair loss, not zero hair loss... are about 50 - 70%.

By cooling the scalp, scalp blood vessels narrow, which results in less chemotherapy reaching the hair follicles. In addition, cooler hair follicles become inactive, making them less susceptible to the treatment so hair loss can be reduced. Also, scalp cooling results in the faster recovery of hair volume after chemo.

Based on what my cancer nurse navigator, Nurse Meera, said and on what I read, here are some tips I've learnt to manage the other side effects at home:

Infections

Chemotherapy reduces the body's ability to fight infection. This makes me more likely to get infections that can get me seriously ill.

wash hands regularly with soap and water, especially after going to the toilet or before preparing food and eating.
wear a mask when I am out and avoid crowded places or people who are sick to avoid infections. However, for my mental well-being, I should not coop myself indoors all the time if I feel well enough to go out as it can cause depression.
ok to take public transport, but remember to mask up.

Fatigue

Chemotherapy may make people feel tired a lot of the time or get tired very easly doing everyday tasks.

get plenty of rest.
keep active to fight tiredness caused by chemotherapy and improve physical/ mental health. Not too vigourous though, as chemo and the Herceptin jabs may weaken the heart. Nurse Meera was very cautious but Dr Samuel, who knows me better, said around Zone 2 or even 3 should be safe for me, as I was already pretty active to begin with. He said I should listen to my body and just look out for any heart pain or breathlessness. Note: My trusted personal trainer, Superman, will be helping to plan my exercise program during my breast cancer treatment journey.
take time off work or work from home to recuperate properly.
plan activities for the time of the day when I feel most energetic.
ask for help from family/friends when needed.

Sore mouth

Chemotherapy can make the lining of the mouth sore and irritated aka mucositis. Symptoms include mouth ulcers, discomfort when eating, drinking and/or talking, dry mouth, reduced sense of taste etc.

gargle with salt water {not mouthwash} every morning and after every meal to prevent mouth ulcer. Nurse Meera said that this is very important as it helps to prevent the loss of taste too.
avoid spicy, salty or sharp foods.

Loss of appetite

Chemotherapy may lower my appetite or change the way food tastes or smells. Important to still force myself to drink plenty of fluids and eat what I can.

eat smaller meals more often instead of 3 larger meals each day.
eat healthy snacks regularly to make sure I get enough nutrients.
be active as being active can actually increase appetite.

Tingling/ numb hands or feet

Having tingling (“pins and needles”) or numbness in the hands or feet may occur after chemotherapy. This is called peripheral neuropathy. It may last for a few months after treatment finishes or it may be permanent... eeks!

keep myself warm and avoid touching things directly with bare hands {wear kitchen gloves} from the fridge. Also, to use the fan and avoid air-con if possible. This is to prevent numbness of the limbs and fingers.
wear well-fitting shoes with non-slippery soles.
wear socks to sleep to keep feet warm.

Diarrhea

Chemotherapy may irritate the lining of my digestive system. Also, since my immune system is down, it is easy for me to get stomach upset or food poisoning.

drink plenty of clear fluids {8-12 glasses per day} e.g. water, clear soup, clear juices, electrolyte drinks
avoid raw food, half-cooked or overnight food to prevent food poisoning.
avoid food that may trigger or worsen diarrhea e.g. raw food like sashimi, unwashed food, fatty food, greasy food, unpasterised food
milk and probiotics are ok, but best to avoid yogurt.
eating hawker food is fine, but try to avoid those that have been prepared early and put on display e.g. economy rice food. Choose those that are cooked on order.

Brain fog

There may be problems with short-term memory, concentration and attention span during chemotherapy. Routine tasks may take much longer than usual.

use lists, post-it notes or calendars to help remember things. This is one reason why I'm journaling down my breast cancer journey on the blog too...
eat well and get enough rest.

You can read about what to expect from a typical chemotherapy treatment cycle here.

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Chemotherapy - What to Expect

2022-11-28T15:00:00.135+08:00

In NUH, they have a patient-nurse buddy system for cancer patients. These "nurse navigators" offer practical and emotional support to cancer patients and their families.

I met my friendly nurse navigator, Nurse Meera, on Tue 28 Nov, the same day I did the first blood test and echocardiography for my adjuvant chemotherapy and Herceptin jabs treatment plan. We talked for about an hour at the National University Cancer Institute, Singapore {NCIS}.

Nurse Meera went into the nitty gritty of what I needed to do before, during, and after each chemotherapy cycle... as well as the possible side effects and how to manage them at home.

Basically for each cycle:

A few days before chemo session

see Dr Samuel
take a blood test to check for complete blood count, as well as kidney and liver health

Day before chemo session

take Dexamethasone pills at 8am and 6pm to prevent nausea and vomiting during and after chemotherapy {will be prescribed and collected after the doctor's consultation}

Day of chemo session

take Dexamethasone pill at 6am
go for chemo session at the Chemotherapy Centre, NUH Medical Centre, Level 9 at least 30mins before scheduled appointment for vitals screening and for pharmacy to start medicine preparation for chemotherapy and Herceptin jab. Each Chemo Bay has 10 patient cubicles, and each cubicle can house 1-2 patients who receive treatment on a recliner chair. The session will take half a day, or around 4 - 5 hours, excluding 1 - 1.5hrs needed to prep the medicine, and including the extra 30mins needed for scalp cooling before and 1.5hrs after the chemo. I can eat and go to toilet during the session, and to dress warmly as it can get quite cold {blankets are available}.
collect Peglasta syringe from the pharmacist {needs to be refrigerated}
take Dexamethasone pill at 6pm

Day after chemo session

take Dexamethasone pills at 8am and 6pm to prevent nausea and vomiting during and after chemotherapy
inject myself with Peglasta at least 24 hours after my chemo session ended {up to 36 hours}. Peglasta helps to stimulate the body to produce white blood cells to fight off infections. Side effects include muscle aches and joint pain, swelling, difficulty breathing, fast heartbeat, spleen rupture and kidney injury....

I also have to take my temperature daily and if I have a fever, I should not self-medicate. Instead, I need to call Nurse Meera or the NCIS Cancerline if there's a slight fever {37.5 - 37.9°C} or go to A&E if it is 38°C and above.

During my chemotherapy, I need to avoid raw food, half-cooked or overnight food to prevent food poisoning. No traditional medicines, vitamin supplements or herbal products, and 4 specific fruits - pomelo, pomegranate, grapefruit and starfruit. Other citrus fruits like oranges and lemons are ok.

Milk and properly washed fresh fruits/vegetables are ok but I should avoid yogurt and cheese as well in case of diarrhea.

Nurse Meera also debunked some myths like sugar causing cancer to grow.

In fact, specifically for breast cancer, there is no relation between food intake and breast cancer according to research and I need not avoid sugar completely, just eat in moderation.

I shared more on the side effects and tips on how to manage it at home here.

The "nurse navigator" system seems like a good idea as I can reach Nurse Meera anytime via text or call on weekdays, 8am - 5pm. It is personalised and direct, and I don't need to jump hoops and go through red tape to talk to a random hospital staff who may not understand my case if I need to find out something quickly regarding my chemo treatment or appointments. Nurse Meera also responds relatively quickly.

Unfortunately outside of the office hours, I will need to go to A&E for anything urgent as Nurse Meera is unavailable and there is no 24hrs hotline for cancer patients.

Note:

Cancerline - free counselling hotline managed by trained oncology nurses

Tel: +65 9722 0569

Open: 8.30am - 5.30pm {Mon - Fri}

Closed: Weekends and public holidays

Consultation with nurse navigator: FREE

{probably the only time I can say a NUH medical service is free haha!!}

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

2022-11-25T10:30:00.327+08:00

Recovery after a surgery does not mean staying in bed all day. Actually, physical activity is just as important as rest to aid in recovery and can ease treatment-related side effects {e.g. fatigue, pain, depression, lymphedema} and reduce the risk of breast cancer recurrence, as well as the risk of developing breast cancer in the first place.

This is supported by my doctors.

In fact, the day after my mastectomy and breast reconstruction surgeries, they called in the hospital physiotherapist to come teach me some specific exercises to keep the range of motion in my shoulder and arm, relieve stiffness and pain, and reduce swelling.

As someone who is used to exercising almost daily, it is very important to me that I restarted my fitness activities as soon as possible, if not for my health, but for my sanity as well. Even if it was for something as simple as walking, which I started doing 2hrs after my surgeries.

The important thing is to ease back into exercise gradually to avoid overloading the system, and of course follow your doctors' orders. Best if you have a trusted trainer/ exercise specialist to advise and guide you as well.

Dr Jane's general instructions are that I can do simple upper body exercises and stretches except for anything that stretches the chest, and not lift anything more than 2kg for at least 4 weeks. After 8 weeks when my wounds have completely healed, I can start doing heavier weights. If not, the wounds may open and the implant may shift.

Below are some of the physical activities I did for the first 4 weeks post-surgery. Mostly, I avoided vigorous exercises and heavy lifting so that my wounds have a chance to heal nicely.

Also including a bit more background reference about me below to manage expectations if you haven't been following my blog, as what I did may/ will not be the same for anyone else due to different circumstances:

At the time of my surgery {see part 1 and part 2}, I was 38 years old. I have been active since young and pre-surgery, I used to exercise by weight-lifting, cycling, climbing stairs, hiking or walking about 6x a week. My overall health and fitness levels is pretty ok.

I also have an experienced personal trainer, Superman, whom I've been training with the past 7-8 years and has helped me through various injuries {mainly bad knees and chronic back pain} and health issues. He understands my limitations and helps guide and monitor my physical activities and diet.

Week 1

I started with assisted walking 2hrs after my surgery, mainly because I wanted to pee naturally in the toilet instead of using a bed pan.

The day after my surgeries, a physiotherapist came to teach me how to do some simple exercises which can be performed from the first day after surgery. These included neck-stretching, shoulder rolls, shoulder pinch, forward arm wall walk and side arm wall walk. He recommended doing 10 reps, 3-5 sets a day.

I was quite surprised that I was allowed to raise my left arm overhead so early as I had read that I could only raise it to shoulder level for the first few weeks post-surgery. However, the physiotherapist assured me that the doctors allowed it as it was they who asked him to come and I checked with Dr Jane again that day and she said it was ok.

Other than the really gentle upper body stretches and mobility exercises, I tried to walk around 1-2k steps a day, using my FitBit to monitor. In the beginning while I was still at the hospital, I'd walk around the ward twice a day after breakfast and dinner. Then when I returned home, I'd walk around the apartment or downstairs at the void deck in the evening when there was less people and the weather was cooler.

Week 2

I continued with my walking into week 2 and slowly increased the steps. I had no issue with slow walks and my first appointment back to the hospital was that week with Dr Jane on Wed 2 Nov anyway.

No vigourous cardio, even though I felt up for it, because of the suture healing and also because I still had my wound dressings and drainage tube in, so did not want to perspire that much as I couldn't bathe properly yet.

I started doing simple bodyweight exercises to maintain my muscle mass and strength somewhat and prevent muscle atrophy. Easy bodyweight squats with tempo, bicep curls, lats side raises and shoulder raises for 10 reps, 4-5 sets each.

Constant easy stretching for the upper body whenever I can to keep my mobility.

Week 3

I walked more to go for my hospital visits and also did grocery shopping.

That week, I also went to the club gym {with my drainage tube!} one early morning with no crowd to do my bodyweight knee rehab exercises, weighted leg press {110lb, 12 reps, 5 sets} and seated hamstring curl {50lb, 12 reps, 5 sets} and light upper body exercises {1kg, 5 reps, 12 sets}.

Dr Mikael and Dr Jane said I was fine to cycle if I wanted to, so after my wound dressings and drainage tube were completely removed on Wed 16 Nov, I went for an easy 27km cycle during the weekend.

For cardio, I also stair-climbed for 20 mins at the end of the week.

Week 4

I progressed and did a session with Superman at his home gym. No upper body exercises, just a simple lower body program to ease me back into gym workouts and work on my squats, hip thrusts, tibia, hamstrings, and calves.

As I would be starting on my chemotherapy treatment, we had no idea how my body would react and how the side effects would affect me, so these are the basic lower body exercises that I can easily do to maintain my fitness somewhat for now. Superman would help to plan the programming.

My aim for the next year is not to get stronger or to lose fat as before. The main focus would be to maintain a base level of fitness and stay healthy enough to undergo the grueling adjuvant chemotherapy and Herceptin jabs treatment, and not start from ground zero from when I do want to restart my strength training again.

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Surgical Drains Removal After Mastectomy and Breast Reconstruction

2022-11-16T10:27:00.005+08:00

After what seems like a very long time, I finally got to remove my surgical drain after nearly 3 weeks during my visit with Dr Jane on Wed 16 Nov 2022! *throws confetti*

Surgical drains are tubes inserted into the soft tissue of your breast after surgery to help drain excess fluids that build up inside your body. This fluid is normal and fills the space where breast tissue was removed during surgery. If not drained properly, excess fluid may misshapen implants, cause infections, and other complications.

Drains are left in until the fluid output reaches a low level. This is usually less than 20-30ml per day for two consecutive days, but according to a nurse at NUH Aesthetic Plastic Surgery Clinic, they prefer to take it out when it's about 10-20ml for a few consecutive days. Most drains are removed one to three weeks after surgery. If they stay in longer than three weeks, the risk of infection increases.

For the last few days, my fluid output was about 15-20ml. I think for the past 3 weeks, I used about 7 x 200ml bottles.. not to the full capacity but I changed about every 2-3 days when the suction cap popped out.

The drain was inserted quite high up my chest and I thought it would be rather painful when Dr Jane removed it. However, it was really quick and I didn't feel a thing at all! Thank God for no infection either.

So so happy to finally have it removed (◕‿◕) It was more troublesome than painful...

The drain hole where the drain is inserted into my skin is just below my left breast, on my top abs. During the first few days of surgery, it hurt slightly especially when I needed to crunch and move to sit up or lie down. After a few days, the pain subsided there but in the last few days, the drain site actually felt rather uncomfortably like something was poking at my skin, especially when I was lying down. Think it was the needle head. Did not require pain medication though.

Dr Jane removed the surgery wound dressing and today I got to see my full left breast while standing for the first time when I went home. My skin has "fluffed" up more since surgery so the bottom part of my left breast's shape and size is similar to my right breast. However, the top part still looks kinda flat since there's no more breast fat tissue there, and my left nipple is much higher than the right so it looks really weird. Reminds me of Quasimodo...

The first few days I felt so emotional over it. Probably from the shock of seeing how "bad" it was and sadness in my body change. I felt so ugly and such a "freak".

I'm usually quite body-positive and take all my fat, scars, injuries and imperfections in my stride but this really tore me down. Don't get me wrong, I am grateful and I know I know... it could be much worst and the most important thing is that I can be healthy again, but still... it will need getting used to.

Hopefully it will look slightly better once the implant settles properly. Dr Jane said we can add fat to fill out the empty space too next time. Oh well.

I told her that Dr Mikael thinks the tiny lump was due to fat necrosis and the skin discolouration was due to the injected dye used to locate my sentinel lymph node. She does not think so since there is no breast fat left in my left breast, and the discolouration doesn't look like that from the injected dye.

Anyway, Dr Jane was ready to remove the tiny lump but it seems to have gotten less smaller/ visible since my last visit. We will monitor and see how it goes and decide if I should remove it at my next visit with her 3 months later. If Dr Mikael wants to do anything to the lump when I see him next month, she said that she needs to be there just in case it affects the implant.

Dr Jane prescribed Dermatix Ultra {$80.25 per 15g gel tube - should last 2 months} for my scar-healing and Physiogel AI {$57.65 per 100ml cream tube} for the dry skin on my left breast. I can apply both 1-2x a day after showers.

She also gave the go-ahead for me to start chemotherapy.

Dr Jane 4th visit cost {including consumables & medicine}: S$433.88

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

2022-11-14T16:48:00.060+08:00

Every time I go to the National University Cancer Institute, Singapore {NCIS} to meet Dr Samuel, it is always so terribly crowded.

My appointment with him on Mon 14 Nov 2022 was at 3pm, so I registered via the OneNUHS app around 2pm, and we arrived there at 2.45pm. Lil Pumpkin came with us this time as she had her science enrichment class in the evening and we wanted to send her to class after my appointment.

I did my heart-rate and blood pressure screening, then waited until 3.40pm to see Dr Samuel. While waiting, 2 students/ research assistants?? approached me to take part in their respective surveys or research studies on cancer.

Is this because NUH is a teaching hospital? I had already taken part in a breast cancer research study previously when one of Dr Mikael's students approached me last time and even gave my blood, but these 2 students/ research assistants were not related at all to my doctors, but seemed to already know my name and background of my case... hmmm, I wonder if this will happen frequently whenever I'm at NCIS or the Breast Care Centre.

My meeting with Dr Samuel gave a clearer view on the follow-up treatment after my mastectomy and breast reconstruction surgeries.

Basically, based on the Surgical Pathology Report, I have Stage 1A left breast cancer. My mastectomy surgery was a success {part 1 and part 2} and since my sentinel lymph node biopsy showed no spread of the cancer, I am currently considered cured and there is no need for radiotherapy.

However, as the largest cancerous tumour was more than 1cm {1.7cm to be exact}, and I have HER2+ and ER- {so not positive for hormone receptors making hormone therapy ineffective} grade 3 breast cancer, the cancer is considered aggressive and I need to undergo adjuvant chemotherapy and herceptin injections to lower the chance of the cancer returning, and to improve the outcome of first-line treatment i.e. my mastectomy.

The total length for this post-surgery part of my treatment is about 1 year.

Adjuvant chemotherapy is when you get chemo after the primary treatment, usually surgery. Sometimes cancer cells can be left behind after surgery. It’s also possible that cancer cells may be circulating in the bloodstream or lymphatic system so the traveling cancer cells don’t show up on imaging tests. Without follow-up treatment, they can find their way to distant organs to form new tumors.

Since I have early stage cancer, Dr Samuel planned for me to undergo chemotherapy for 3 months, instead of a longer regimen.

I will do a TC Regimen, which consists of two drugs - Docetaxel and Cyclophosphamide. This will be given intravenously once every 3 weeks, for 4 cycles. Dr Samuel said each session may take around 4-5 hours, including time to use a cooling cap to help reduce chemotherapy-related hair loss.

Charlene actually went through the chemo same treatment for her breast cancer {but her surgery and breast reconstruction procedures were different}, and she said her first session took 7 hours! Goodness.. subsequently, it took around 5-6 hours zzzzz The boy said I should bring an iPad to pass the time, but Charlene also said the drugs made her sleepy so can nap haha..

Before each chemo cycle, I've to do a hormone shot to make my ovaries "sleep" as the chemo may cause premature menopause, and screen my blood and heart to make sure that I'm fit enough for the chemotheraphy cycle. A day after the session, I have to take a blood booster to help boost my immune system as it will be drastically compromised during chemo. Dr Samuel said the boy can help to administer this at home.

More details on what a typical chemotherapy cycle looks like for me here.

Other side effects of chemotherapy include allergy, fatigue, increased risk of bruising or bleeding, nausea or vomiting, bladder inflammation, mouth ulcers, body aches or joint pain, numbness or tingling in the hands/ feet etc.

Oh well. We gotta do what we gotta do.

Concurrent with my TC regimen chemotherapy, I have to take a Herceptin jab every 3 weeks for 18 rounds. This treatment course is known as “AC➝TH”.

Herceptin is a HER2 inhibitor targeted therapy. It works against HER2+ breast cancers by blocking the ability of the cancer cells to receive chemical signals that tell the cells to grow.

It may cause severe problems with the heart, lung problems and low white blood cell counts. Other common side effects are nausea or vomiting, headaches, shortness of breath, fatigue, rash, muscle pain, diarrhea, fever etc.

My oh my. The second part of my treatment sounds really dreadful and makes my surgery experience seem like a breeze?!! I mean... apart from the trauma of losing a body part (ToT)

Really praying for strength and positivity to overcome the next year... please pray for me too.

As I still have my drainage tube zzzz, I've to check with Dr Jane on Wed 16 Nov 2022 if my wounds would have healed in time for my chemotherapy to start on Mon 5 Dec 2022.

I can only start chemotherapy if my wounds have completely healed, and I clear my heart and blood tests.

Dr Samuel 3rd visit: S$99.51

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Fat Necrosis and Prolonged Skin Discolouration Due to Dye?

2022-11-08T11:20:00.012+08:00

I met Dr Mikael about 1.5 weeks after I was discharged for my mastectomy and breast reconstruction surgeries {read about part 1 and part 2} on Tue 8 Nov 2022 at NUH Breast Care Centre.

Registered via the OneNUHS app early about 8.30am, but still saw him around the appointment time at 9.50am. He was assisted by Nurse Zhenna today.

He started off by telling me briefly that the Surgical Pathological Report shows that the cancer has not spread beyond the breast area into my sentinel lymph nodes, so that is good and it is likely pathological Stage 1 cancer.

Even then, as my breast cancer type is aggressive, I would still need to do chemotherapy. It's ok, I understood that from the beginning and have come to terms with it.

Then we talked briefly about the tiny lump and skin discolouration and what Dr Jane told me about them before he examined my surgery wounds and left breast.

He cannot confirm without further testing, but thinks that the tiny lump may be due to fat necrosis. Fat necrosis is a benign condition that most commonly develops after an injury or trauma to the breast tissue. A lump can form if an area of the fatty breast tissue is damaged, for example like when I went for my surgeries. It could be a round, firm lump... but as mine is round but soft, I think it might also be an oil cyst due to the fat necrosis?

Dr Mikael didn't seem worried about it and said we can monitor and see how it goes. At my next appointment with him, he can also arrange for an ultrasound to check it out further. He is not sure if it will disappear on its own, although it might.

For my skin discolouration, he said it might also be bruising or caused by the injected dye used to locate the sentinel nodes. By right the dye leaves the body on its own 24-48 hours after the surgery, however sometimes there may be blue dye staining of the skin on the breast which may last even up to 3 years, I've read. Again, it is harmless and since it is not causing me any pain or discomfort, Dr Mikael is not too concerned over it.

After that, I told him about having to change the drainage bottle every 2 days and he said that it's a fine balance between keeping the drainage tube in until the fluid output is at a low enough level, and taking it out early to prevent infection or complications from having an open wound and a foreign object {the drainage tube} in the body. Most drains come out 1-3 weeks after surgery.

I sense that he thinks the tube can/ should? come out this week but as Dr Jane isn't around and my appointment with her is next Wed, I should leave it in as she planned. Nurse Zhenna also said that the Aesthetics Clinic prefer to leave the tubes in until the output is very low.

Later when I went back to Aesthetics Clinic to get 4 more bottles to last me through the week the nurse there also said they would usually take the tube out when the output is about 10-20ml for a few days. Oh, the nurse there also said that they prefer patients not wipe the tube and bottle tips with alcohol wipes, unlike what the ward teaches.

Currently for the last 2 days, my drainage fluid output is about 30ml/day.

I checked with Dr Mikael to see if increased activity would cause an increase in fluid output. He said it's hard to say as it has a "life of its own" but doing activities is good as it aids recovery.

He even said I can cycle now if I want! Just that it is impractical with my drainage tube and bottle, and that if I do I should take it easy.

I asked him about a scar cream for lightening my scars as I think my scar for the sentinel lymph node dissection incision looks like it is forming a keloid. He recommended Dermatix but said I should ask Dr Jane about it at my next appointment with her.

Hmmm.. I think regarding anything about my wounds or scars, since Dr Jane is the care doctor as she did the last surgery after him and "closed me up", he doesn't want to overstep and leave all the surgery wound healing after-care decisions to her. Fair enough. If I just did the mastectomy, he would take control of the decisions I feel.

Anyway, he also said that I can start massaging my scar tissue gently next week. Scarring is part of the body's natural healing process after tissue is damaged. When the skin is wounded, the tissues break, which causes a protein called collagen to be released. Collagen builds up where the tissue is damaged, helping to heal and strengthen the wound.

However, unlike healthy tissue, scar tissue forms in random, criss-crossing patterns. It is not as flexible or as functional as the tissue that it is replacing. It has poor circulation, which limits the supply of fresh oxygen and nutrients. Scar tissue also is more sensitive to pain because it has more pain receptors than the original tissues, and it tightens up when you sleep.

Sooo.. it not only can cause more pain, but also limit the normal function of the muscle or area. Already I feel a bit stiff and tight when I lift my arms due to the scar tissue forming where the sentinel lymph node dissection occurred, and a bit at my chest area..

In other words, scar tissue is helpful when the wound is healing. However, too much left after the wound has healed isn't good as it can cause you to be stiffer and lose your range of motion.

In regards to lymphoedema due to my sentinel lymph node dissection, he said the risk is very low and I can treat my arm as per normal. He even said I can still tattoo my left arm more if I want in the future hahaha

Overall, my wounds are healing and I barely feel any pain or even soreness nowadays. I think in part this is due to the severing of the nerves that provide feeling to my breast and nipple. When nerves are severed, nerve signals are disrupted. This can result in numbness and permanent loss of sensation to the breast area...

Maybe just some heaviness when I wake up due to some fluid build-up when I sleep. More discomfort from not being to exercise/ bathe properly, and slight irritation from having to drag a drainage tube and bottle everywhere.

Sometimes, I do feel rather sad when I look at my body and see all the scars and wounds, and how different my boobs look and feel from one another... but I try to stay positive and just focus on the good.

There is still a long, hard way to go with the second part of my treatment - chemotherapy.

Dr Mikael 3rd visit cost: S$108.05

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration Due to Dye?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Skin Discolouration and Tiny Lump After Surgery

2022-11-02T11:45:00.004+08:00

My first appointment with Dr Jane after being discharged from the hospital was supposed to be on Fri 4 Nov 2022. However, as I noticed some skin discolouration {faint blue-black} and tiny lump {0.5cm?} below my nipple on Tue 1 Nov 2022, I emailed Dr Jane and Nurse Jessica from the Aesthetics Plastic Surgery Clinic with a picture to ask if it was ok.

I wasn't too worried over it that I wanted to go in for an emergency visit, but just disturbed enough that I had to ask.

I had kind of noticed the lump in the hospital but it seemed a bit more obvious at home maybe because I changed out of my clothes and looked at my wounds more. In the hospital usually the doctors or nurses would check my wounds. Plus the lights are usually dimmer.

Dr Jane had previously mentioned that because my skin was thin after the mastectomy, there was a possibility that the implant would show through as a blue-ish or grey tinge.

Even though I had an under-the-muscle breast implant for reconstruction, Dr Mikael had cut away the lower part of my chest muscle as the some of the cancerous breast lumps was resting on it. Thus, not all of the implant can be covered by muscle and was actually directly under my thin skin.

Anyway, that skin discolouration might just be the implant showing through... but I was also worried that it might be post-surgery skin necrosis.

After a mastectomy with immediate breast reconstruction, sometimes the breast skin doesn’t heal properly because the network of blood vessels that supply blood to the tissue were damaged. The skin may have been thinned too much when tissue was removed during the mastectomy, like mine. When there isn’t enough blood flow to the skin, portions of the skin can wither and scab. This is a significant problem after mastectomy.

I did not experience common early signs of skin necrosis like swelling, redness, pain, warmth at the surgery site or a fever that day though.

Later that afternoon, Nurse Jessica called to tell me that she checked with Dr Jane who said that the lump could be from the drainage tube. However, Dr Jane asked me to come in earlier on Wed 3 Nov 2022 to have a better look. I agreed and Nurse Jessica helped me to reschedule my appointment. Dr Jane also replied my email that she couldn't really tell for sure from the picture what was happening and also asked me to come in the next day.

On Wed 2 Nov, I registered about 9.30am to see Dr Jane even though my appointment was at 10.30am since there wasn't much to do. Luckily, Dr Jane was free and saw me earlier.

She was relieved to see that the skin discolouration was just the faint blue-black and not purplish or red as that would mean that it might be skin necrosis. It was just the implant showing through as I had thought as well. In the future, I could add on fat as another layer to "pad" my left breast up if the discolouration bothered me or if I wanted "extra protection"... but that would be another day surgery at least a year later.

As 5 days had already passed since the surgeries, Dr Jane said that it was fine for her to open and change the dressing.

That day was the first time I saw the long incision across my left breast that was used for the mastectomy and breast reconstruction surgeries. Other than some dead black skin at the end of the incision and on my nipple that Dr Jane said would scab away, the wound was healing well with no infection and my nipple was saved. Hurray!

Dr Jane took off the dressing completely for the cut that they made under my armpits to take out my lymph nodes as that one has closed already and the dressing was causing a small blister. She gave me a small tube of Chlortralim ointment which is an antibiotic that works by stopping the growth of bacteria to apply at the wound and blister twice a day... forgot I already had a tube at home from the big bag of medicine prescribed when I was discharged.

The nurse assisting her also helped to change my drainage bottle and Dr Jane issued me another 3 extra bottles to use at home, just in case. She had checked the wound where my drainage tube came out and said that there was no leakage there, and couldn't tell for sure why the suction cap popped so fast the day after I left the hospital.

I like Dr Jane as she is very friendly and has a cheeky sense of humour, even though she is obviously a very experienced and knowledgeable doctor. No air of arrogance or rudeness around her. I joked with her that the drainage bottle was like my pet Tamagotchi - I had to bring it around everywhere and "feed it" with me... and she just laughed.

At first, she thought that perhaps the small lump was from the drainage tube inside my body or a marker from the implant. However, she realised that the implant marker was somewhere else and she didn't know what that small lump was. Dr Jane will talk to Dr Mikael to see what it could be.

Case in point of her cheekiness? She drew a tiny smiley face over the small lump to mark it out for Dr Mikael to see during my appointment with him on Tue 8 Nov 2022 hahaha.

As she was going away for a conference 6-15 Nov, my next appointment with Dr Jane is on Wed 16 Nov 2022. She didn't think that my wound dressing needed any changing until then but if something happened and I needed to see a doctor while she was away, her colleague, Dr Yap Yan Lin, would be around on Mon 8 Nov or Wed 10 Nov.

Dr Jane also gave me a copy of my Surgical Pathological Report to have a look before my meeting with Dr Mikael, who will go through it with me.

Dr Jane 3rd visit cost {including consumables & medicine}: S$193.38

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Mastectomy and Breast Implant Reconstruction Surgeries Part 2

2022-10-27T19:30:00.239+08:00

I finally woke up drowsily from anaesthesia around 5pm after my mastectomy and breast reconstruction surgeries at the operating theatre's patients' observation area. I think the whole operation took around 3.5hrs?

I was acutely aware of the time because previously while waiting at Ward 2A, one of the nurses told me that they stopped serving dinner in the wards at 7.30pm so I checked the time immediately when I woke up to see if I made it in time to eat hehehe...

Dr Jane came by for a quick update and check. Basically no complications but she had to use a smaller implant than expected {160cc vs 195cc} as the breast skin left after mastectomy was very thin. She said that she would call the boy to give him an update that I was out of the operation too.

I stayed in the observation area for about an hour. Around 6pm, they wheeled me on a bed to Ward 7A, Kent Ridge Wing. Since I woke up, I did not experience any nausea or vomiting, just some numbness, soreness and dull pain in my left breast and under my left arm pit.

Once I was moved to my own ward bed, I told the nurses that I wanted to eat and get out of the bed to pee. She offered me a bed pan but I knew I just couldn't pee in one so declined. I wanted to pee naturally as soon as possible.

You see, I was immensely relieved that I did not have a urinary catheter in me after the operation. When I was 15, I had my scoliosis operation where I needed to have a urinary catheter inserted in me for a few weeks. When they took it out, I had trouble peeing naturally again so they had to re-insert it in me again for a while before I tried again. It was rather traumatic and I still have a "phobia" of using urinary catheters.

Anyway, seeing that I was lucid and capable, she let me out of the bed to slowly walk to the toilet assisted around 6.40pm. The nurse said usually patients get out of bed only after 6hrs heh. Oh well.

I changed into the pink hospital pjs and ate dinner about 7pm. Some sort of mince meat & veg pasta and the boy also brought pork chop for my extra protein... yum yum yum. I also asked the orderly to make me an iced Milo hehe.

Clearly, my appetite wasn't affected （＾ω＾）

For the most part, I was feeling pretty good and couldn't really believe that I just had 2 surgeries a few hours ago. Anyone who saw my post-operation photos did not think that I just had an operation too... Honestly, I felt much worst when I was down with Covid-19!

Extremely thankful for a smooth operation and fast recovery! I believe there are 3 good reasons for this..

Firstly, through God's grace and the many, MANY loving prayers I received from my family and friends. Secondly, I am generally fit and healthy through regular exercise since young, and especially from my PT training with Superman. Lastly, I have amazingly skilled and experienced doctors/ nurses who performed the operation and took good care of me #blessed

My ward room was a single-bed ensuite room with a side sofa bed by the window. Pretty spacious and comfortable. You are only allocated your chosen type of ward room based on availability after the operation so I was really happy to get my own private room as I am a really light sleeper, and prefer not to bunk with strangers.

The TV channels were rather limited but they did have HBO. Good thing I brought the iPad but it can only connect to the internet via WiFi. NUH wards do not have their own WiFi network and the nurses said I needed to connect to Wireless@SG network if we wanted to use it.

The nurses came to check my wounds and vital stats, or give me medicine, almost every hour until midnight. I had some slight fever when they checked at 9pm so they gave me some Panadol around 10pm as they needed some time for the doctor to approve the order. The fever came down around midnight.

I tried to sleep whenever there was a short break between the checks. Still found the room too bright with the machine lights and asked the nurse for an eye-mask. Thankfully they have those available and gave me a set of eye-mask and ear buds. Much better but was still awakened by their 4-hourly checks through the night.

The nurses will ask patients to rank their pain level: 1-3 for low pain, 4-7 for moderate pain, 8-10 for high pain.

My pain level was mostly low pain, around level 3. I did not need to ask for any additional pain medication that day as it was tolerable.

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Mastectomy and Breast Implant Reconstruction Surgeries Part 1

2022-10-27T09:30:00.324+08:00

After about 2 months of tests and doctor appointments, my breast cancer treatment finally started with the mastectomy and breast reconstruction surgeries on Thu 27 Oct 2022.

The day before, I received a call from NUH about 2.30pm to inform me about the reporting time and venue, and the time to start fasting. NUH will provide the hospital attire and toiletries, and obviously food during my stay, so I didn't really need to pack anything else other than my going-home clothes and other stuff that I wanted for my own comfort.

I packed like I was going for a short 3D2N staycation hahaha and brought a set of pjs to go home, a fleece hoodie, 2x front zip bras, 2x underwear, 3x socks {because I know it's so cold in the hospital and I like to sleep with socks on}, my own toiletries and moisturisers, an iPad, my chargers, the small bag I bought to put my drainage bottle, my test reports, plus extra snacks like chocolate, protein bars and nuts to the hospital in case I was hungry between meals.

As I had to fast before 6am, I woke up about 5.40am to have a light breakfast. I wasn't hungry but thought I should have something in case my surgery was delayed past the estimated time of 1pm.

The nurse who called told me that for fasting I wasn't supposed to eat or drink anything, even water. For breakfast I could have 2 slices of plain white bread and just black coffee or tea, no milk or any dairy. We didn't have any bread at home, so I just had a packet of plain Meiji biscuits and about 3 big cups of water.

Throughout the morning I just rinsed my mouth with water if it felt dry, without swallowing.

Was still feeling a bit sleepy but Lil Pumpkin still had classes so about 6.30am we left home to send her to school then go to the hospital while I slept in the car. Woke up and didn't have anything to do {couldn't go eat breakfast anyway} so went to register early at 8.30am at Ward 2A, Kent Ridge Wing even though I had to report only at 9.30am.

Only had to wait a minute or two before I was called and registration was a breeze. Good thing our insurance agent gave us the Letter of Guarantee and the boy printed a hard copy to bring along, even though one of the nurses said it was not needed if they were going to e-file the cost of my surgeries and hospital stay, as the staff asked for it during registration.

note: a Letter of Guarantee is a letter from your company/ insurer to the hospital stating the amount the company/ insurer is paying for the patient, co-payment required from patient {if any} and other terms and conditions. The hospital will then bill your company/ insurer accordingly. They will need to know the estimated cost from the hospital before they can give this.

I cannot stress how important it is to have good medical insurance, even in times of good health. Really appreciate the boy for his forward-thinking and planning to get the whole family covered early on. Up to surgery day, I think I've already spent about S$4-5k just on tests and doctor appointments. My surgeries and hospital stay is estimated to be maybe S$25k and chemotherapy around S$1.5k per cycle... not including all the additional doc appointments and tests after the surgeries. Of course, insurance won't cover everything but it will cover a bulk of my medical expenses. We still have to pay upfront most of the time though.

Still had to wait until about 9.30am before I was called into the Pre-Operation Waiting Area, but a few more patients came that time to register as well so at least I didn't have to queue for registration.

A nurse came to verify my identity and confirm my surgery details before I changed into the hospital gown and robe to go to Diagnostic Imaging @ MB1 to inject some radioactive substance into me before the operation.

They insisted I sit on a wheelchair to be wheeled around wherever I went hehe.

At Diagnostic Imaging @ MB1, it was really crowded. I sat in the wheelchair to wait a while then a Dr Ong came to talk to me to explain that during my surgery, Dr Mikael will perform a sentinal lymph node dissection and remove the first few lymph nodes under my arm to figure out the extent of cancer involvement. The dye injection I'm about to receive will help him to locate the sentinal lymph node. Once he removes the sentinel node and those closest to it, a pathologist will examine them for signs of cancer and the results can be out during the whole mastectomy procedure.

The idea behind sentinel node dissection is that instead of removing 10 or more lymph nodes and analysing all of them to look for cancer, remove only the one node that is most likely to have it. If this node is clean, chances are the other nodes have not been affected and do not need to be removed.

Cancer in the lymph nodes is associated with an increased risk of having cancer cells in the other parts of the body. Our lymph nodes act as filters for the body's lymphatic drainage system. That's why the lymph nodes are likely to "catch" or filter out cancer cells that might be floating in the fluid that drains away from the cancerous area of the breast.

Sentinel lymph node dissection is a good option for people with early-stage, invasive breast cancer who have a low to moderate risk of lymph node involvement.

The dye injection for the sentinel node dissection procedure was the more painful than usual, as Dr Ong warned me, even though they use a needle smaller than the usual injection needle because it was at a sensitive area near the nipple.

It was over in a jiffy then I had to wait about 20 mins for a porter before being wheeled back to Ward 2A. Then, waited about 40 mins before I asked a nurse there what I was waiting for. She checked then said that I was supposed to go to for the dye injection around 11.30am but since I had already done it, now I just had to wait to be called for my operation.

She verified my identity, checked my vitals, explained what I could wear/bring during the surgery {basically nothing, although she let me wear my own socks}, and that the boy could expect a call when I woke up after surgery and be told where my ward room was to meet me. The nurse said the whole operation would take about 4.5hrs and after I wake up, I would be under observation for an hour before I was taken to the ward.

Then, she let me out to the public waiting area at Ward 2A to wait with the boy. Poor thing he came with me and was lugging my little luggage around while I went to all the different areas. Next time if I ever have to do this all over again *touch wood*, I'd only bring the luggage in after the surgeries as my ward room won't be ready until then and the hospital won't keep your belongings for you pre-surgery while you wait.

About 12.05pm I was called into the patients waiting area for Dr Jane to make some markings on my left breast and underarm for the surgeries. Then I went out again to the public waiting area, before being called in again around 12.45pm for my surgeries.... finally.

They verified my identity and confirmed my surgeries with me again before I sat on the wheelchair to go the my operating theatre in the Main Building.

At the operating theatre waiting area, two of Dr Mikael's students came to ask if they could examine and ask me some questions for their learning purposes before the surgery. I was already feeling quite nervous and anxious then so I just wanted to pray, calm my mind and just do what was necessary so I politely declined and said they could come after the surgery if they wanted.

The anesthetics doctor during my operation, Dr Aileen Tan, came to verify my identity and confirm my surgeries with me, yet again. She was very jovial and friendly. Dr Tan then went through what was going to happen while I was under general anesthetics, and the discomfort/ pain or vomiting I might get when I woke up. I told her that I got really bad vomiting from using morphine last time for my scoliosis operations and she said it's ok, she can use another cocktail of medicine to try and prevent that. She tried to calm my nerves and I told her... "please don't let me not wake up" haha

After that a doctor from Dr Mikael's team came to check that I had my body markings then said I was good to go.

Going into the operating theatre, Dr Aileen got me ready to go under GA and Dr Jane came in to check on me. Still did not see Dr Mikael yet but it's ok. The OT bed was very narrow but nice and warm.

I saw the clock and think it was about 1.30pm... soon enough, I drifted of to sleep.

Everything in God's mighty hands now.

Read Part 2 after the surgery here.

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Hello. I have breast cancer.

2022-10-26T08:39:00.018+08:00

Well. It's been a long while, and I guess I should start by saying...

I have Stage 1 HER2-positive aggressive breast cancer.

I mulled very long before deciding to come out and say I have cancer publicly like this.

When I first heard the news, I only told the boy, a few of my closest friends and those like my work superiors who needed to know.

Part of me didn't want to burden others with this sad news, part of me wanted to wait until after Mummy's birthday before telling my extended family, and also part of me wanted to grieve quietly and not want to deal with all the questions, advice and messages, however well-meaning, while I was still processing the news myself and didn't have all the answers.

Even for Lil Pumpkin, she only found out recently on Mon 10 Oct after her Seconday 1 year end exams as we did not want to affect her exams. I mean, she knew I was seeing the doctor and getting check-ups and everything but she didn't know how bad it was.

Lil Pumpkin was shocked when she heard, but don't worry, our darling girl is coping well and did not cry at all.

In the beginning, I also felt like I needed my own space and every time I thought or talked about having cancer, I would cry. Definitely less so now, about a month after my diagnosis.

As much as I appreciate the love and concern, I didn't want to be reminded about my cancer or handle having so many people ask me "are you ok?", "shall I come visit?", "do you want me to go to your appointments with you?" or "what did the doctor say?" ever so often as I know would happen.

I didn't want to hear "you should stop exercising and rest" or "you should eat this or that" or "I heard XXX is good for cancer treatment".

However, I think the time has now come where I'm ready to open up more about having cancer... especially since I will be going for my breast mastectomy and reconstruction surgeries tomorrow {Thu 27 Oct}.

There's a very low possibility that anything bad would happen, but in the event that anything did, I don't want to leave without a word to all my other family and friends, whether IRL or online.

I still don't want to be treated like a sick person and I also want to go about my days as "normally" as possible without someone pointing out that I have cancer though #fyithanks

If all goes well after my surgeries, I will continue recording my cancer journey on the blog as writing makes me happy, and helps me to process my thoughts and emotions. Plus, I'd need something to keep me occupied when I'm recuperating haha.

It is also to easily update everyone on what's happening without me repeating myself countless times to individual people, provide information to anyone that seeks it {I found a lot of hope reading other survivor stories and yet I also find some breast cancer & training after a mastectomy information lacking}, as well as to just note down everything that happens as I fear perhaps, Lil Pumpkin may suffer the same fate... and we need to look back on this chapter of my life.

Some of you may have questions about how I came to discover I have cancer or how my doctors are so far, so feel free to check out what's been happening since the early detection in the posts below.

Just like my Genesis Gym or fitness training with Superman diary, I really have to emphasize that my breast cancer fight is personal.

It is my personal truth, no holds barred as I don't owe anyone anything or have any sponsorship affiliation with them. What I write about my experiences with my doctors, hospital staff, medicine, products I use etc. is truly my own, and you may or may not encounter the same thing, good or bad.

If you need to, take my account for reference but please don't judge whatever or whoever I talk about based on my experiences only. My situation may be different from yours. I'm not here to influence you but perhaps if you are a lady, it would be good if you are reminded to be proactive about your breast health and increase your survival rate by detecting breast cancer early.

As my dad says, "cancer shows no respect to age".

Do not take for granted that youth or fitness equates to health. They do not.

I am considered young for breast cancer, live/ eat relatively healthily and am definitely fit... and yet, this has happened.

These are dark days but thank you for any encouragement you may show me. I would of course appreciate you keeping me in your prayers too.

For now, physically, I really am feeling top form and not sick at all. If you see me now, you won't know that I have cancer. I have been celebrating life these past few weeks and doing all the physical activities and gym training with my PT, Superman I love and know I will miss in the months that I'm on treatment when I would likely need to slow down.

Mentally and emotionally, I am weary and scared at times, of course. Spiritually, I'm not lamenting or blaming God. I know He has plans for me and some of which I may not understand or grasp like this but I still believe my God is a loving God who will have mercy and protect me.

Overall, I am ok and have come to accept my fate.

It's a tough pill to swallow for someone as active as me to hit this wall, but as with everything tough I've come across, I will take it as a challenge to overcome and come out the other side stronger than before. I will stay positive and survive to thrive.

You may follow my breast cancer journey here on the blog, Facebook, or Instagram {#AiFightsCancer}.

*****

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Pre-Surgery Blood Test & Consent-Taking

2022-10-21T21:44:00.131+08:00

The week before the surgery, I went back to NUH on Fri 21 Oct in the morning to take a blood test and meet Dr Jane at the Aesthetic Plastic Surgery Centre.

A few days earlier on Mon 17 Oct, Nurse Jessica from the Aesthetic Plastic Surgery Centre had already emailed me the estimated cost for my surgeries and hospital stay aka what they call "financial counselling". She also had been most helpful in answering some questions about the hospital stay and my doctor appointments.

The blood test was to test my full blood count and kidney function to see that I was fit to take the surgery. It took only about 5 minutes to draw my blood and the results was out about 2 hours later.

After that I met up with Dr Jane to address any last concerns about my breast reconstruction surgery, confirm the details {under the muscle using a silicone-filled textured, tear-drop implant} and sign the consent form for both the mastectomy and breast reconstruction surgeries.

The boy asked me "what did I want to avoid the most?" when choosing between under the muscle vs over the muscle breast implant. Both come with risks and benefits, but I guess what I want to avoid the most was infection and capsular contracture the most... so that would mean going for under the muscle.

I asked Dr Jane if the implant would move up towards the arm pits as I read some do for under the muscle surgeries. She said for those types of breast augmentation, they usually cut underneath the arm pits or near there to create a "tunnel" so there would be space for the implant to move. For me, she would not be doing that and the implant cavity would be small so not likely to move.

Dr Jane told me that after the surgery, most likely I will stay for 3 days, but can go back earlier if I'm up to it. She will give me 4 weeks MC to rest from work.

Before and after the surgery, I should avoid eating vitamin E, gingko, ginseng, omega-3, protein power which may include blood thinners as they work to increase blood circulation and may increase my risk of excessive bleeding during and after the surgery.

Ok, yes Ma'am.

In the afternoon I went to the Anaesthesia, Pain Management and Acupuncture Clinic to meet an anaesthetist to ask me some questions about my past surgeries and experience with anaesthetia, check my health stats and teeth {scared I choke during the surgery?} and explain to me about how they would administer the anaesthetics and pain medication during and after the surgery.

Even though I've gone for a few surgeries for my scoliosis and caesarean, this was the first time I talked to an anaesthetist pre-surgery I think. The boy also said he didn't talk to one when he went for his shoulder surgery...

Of course, there is always a fear that I might not wake up from the surgery... especially with the recent news of the local girl that passed away from an allergy with the anaesthetia used during her wisdom teeth extraction surgery... but I will need to quieten my heart and mind and pray hard to God for calmness and His protection.

All the pre-surgery blood test {S$83.45} and doctor appointments will be charged under my surgery cost so I did not have to make any payments that day.

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Genetic Testing Results

2022-10-17T17:00:00.024+08:00

I had an appointment with Dr Samuel Ow on Thu 6 Oct 2022 to go through my PET-CT scan and genetic testing results. The appointment was on-time and I saw him from about 12.15pm - 12.45pm. I note this because I usually have to wait a long time to see my doctors or get tests done haha..

I'd already been told by Dr Mikael about my PET-CT scan results but Dr Samuel went through it in slightly more detailed explanation. After all, he was the one that ordered it to be sure that there was no cancer spread, even though there was a very low risk of that at my early stage...

I asked him about brain activity masking the cancer spots in the PET-CT scans and he said that is possible, and hence why they don't usually use that to detect brain cancer, but other scans and tests instead. However, the PET-CT scans can detect abnormal swelling in the brain, which might indicate brain cancer as well to call for further tests.

In any cases, the scans are analysed by nuclear medicine specialists who are able to read and interpret the scans properly... which is reassuring in a sense but then there was still a typo in my scan report??!

Ya, after my appointment with Dr Mikael I had a look at my scan report and noticed that it was written in 2 different sections there that was "a hypermetabolic lesion in the medial aspect of the right breast, compatible with known breast-CA".

That didn't seem right as it should be my left breast.

I asked Dr Samuel about it and he said that he noticed it too and brought it up with the doctor who wrote the report and they will rectify it as it is important for them to do so.

I saw that the human error likely occurred because the report was entered, co-read and approved all by the same doctor....... which really kinda defeats the purpose and system of peer review.

Anyway...

note to self: never assume or take any information or reports for granted

We talked a bit about the breast reconstruction as I have some worries about it. I asked him point-blank if he thinks that the benefits of breast reconstruction outweighs the risks and he said, yes... he thinks so, especially for mental well-being as it might affect women detrimentally when they lose their breasts.

He has not seen any patients with lymphoma caused from breast reconstruction yet, and if I do have to do radiation therapy afterwards, it may affect the tissues and implant.

My gene testing result from Invitae Diagnostic Testing {US-based} was not out that day and we agreed to have a tele-consult on Mon 17 Oct for him to call and tell me the results. After which, it will be decided if I should remove one or both breasts... or maybe even ovaries if there was any gene mutations that might cause cancer there.

Although I was prepared to remove both breasts no matter what just for a peace of mind and he said in the US actually doctors are more inclined to remove both once there is breast cancer in even one, the doctors here do not want do overtreat and remove both breasts if not needed.

Of course, in the future there might be a chance of breast cancer occurrence in the other breast but we should only do what is medically necessary now. There might be regret in removing both if not medically needed, and it will be even more traumatising for the body to remove and have breast reconstruction both breasts.

On Mon 17 Oct, he gave me a call around 4.30pm to tell me the good news that my genetic testing result was negative for the evaluation of 49 genes for genetic changes that are associated with genetic disorders.

Phew! That's a big relief.

From here, we can move forward to confirm the surgery and move forward with my treatment plan.

2-3 weeks after my surgery, I will meet him again and my chemotherapy will start 4-6 weeks later. At the very most, 8-12 weeks after surgery but no later than that.

Dr Samuel 2nd visit cost: $99.51

Dr Samuel tele-consult cost {10 mins call}: $99.51

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Over the Muscle vs Under the Muscle Breast Implant Reconstruction

2022-10-07T16:35:00.043+08:00

I'd decided that after mastectomy, I would use an implant for breast reconstruction. Basically after my first talk with Dr Jane, the boy and I saw that there were 3 options ahead for me in terms of breast reconstruction.

Firstly, don't do anything at all... which is the safest option without the added risk from having additional surgeries for breast reconstruction or from any other complications caused by the implants. This is the preferred choice for the boy if he had to choose, and I did consider it.. but then I think I would honestly be very miserable if I saw my body with just one/no boobs at all!!!（πーπ）

Secondly, I could use muscle or fat transplanted from another place of my body, such as belly, back, thighs or butt, to form a breast shape. Using muscle is a definite no-no, and I "didn't have enough fat" according to the doctor, so this is out.

Thirdly, there was the breast implant which is a round, flexible silicone shell filled with either saline {salt water} or silicone gel. It would need to be replaced after 10-18? years and has some risks involved, but this seems like the best option for me if I want to have my breast reconstructed.

Breast implants can be placed either over the chest muscle {subgandular} or underneath {submuscular} part or all of the chest muscle. The implant replaces the breast tissue that is removed during mastectomy, restoring the shape and volume of the breast.

Choosing the breast implant for breast reconstruction seemed like an "easy" choice. Now the harder part was deciding if I wanted it over or under the muscle, as both come with risks and one would affect my performance in the gym more, and as you probably already know, to me #gymislife

Advantages for under-the-muscle placement include lower risk of implant rippling or wrinkling as the chest muscle on top of the implant can help prevent the outlines of the implant from being visible through the skin, capsular contracture {tightening of scar tissue around the implant that causes pain and distorts the shape of the breast} may be less likely to occur, and the skin is better protected when it's healing.

However it would probably take a longer recovery from the surgery and there is a higher risk of dynamic distortion {or animation deformity}, which makes the breast move in unnatural ways when you flex your chest muscle... like when you exercise.

Also, because you cut and stretch the chest muscle, it will cause strength loss and may prevent me from doing some exercises properly or even at all.. and that really worried me. I mean, I love doing deadlifts, pull-ups, push-ups etc... all of which require a certain amount of use for my chest muscles. I'd hate to completely cut out any exercise for good!

Advantages for over-the-muscle placement include less pain/ tightness/ weakness during and after recovery, and lower risk of animation deformity. However, there is a potential risk of implant rippling and wrinkling showing through the skin if the implant is not covered by enough soft tissue, a slightly higher risk of developing an infection around the implant, and a possible risk that the implant shifts out of the correct position over time, if my skin is thin...

Actually I might not even have a choice in this as all of my breast tissue would be removed, and the remaining breast skin may not be thick or healthy enough after the tissue has been removed.

On the second visit to see Dr Jane on Fri 7 Oct, she told me that if my breast skin was healthy and thick enough {unlikely due to the mastectomy and because I already have quite thin skin to begin with}, she could also use a acellular dermal matrix {ADM} to keep the implant in place while the cavity heals if I wanted to do over-the-muscle placement.

Ahhhh so tough!! There is so much information out there which makes it even more confusing as there are pros and cons for both.

Most athletes or women in fitness that do breast implants prefer over-the-muscle placement as it affects their training less, but then they also go for bigger implants and may not have to suffer a mastectomy too so their situations are different from mine.

The boy thinks that under-the-muscle would be the better option due to less post-surgery complications {especially infection risk!}, and I spend most of my time outside the gym so better for the implant to look as natural as possible in general. Also since I don't do massively heavy lifting and it isn't going to be very big, the implant should not affect my training that much.

Mmmm... ok.

Dr Jane 2nd visit cost: S$108.07

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Colour Enhanced Mammogram & PET-CT Scan Results

2022-10-04T11:00:00.044+08:00

My second appointment with Dr Mikael was on Tue 4 Oct 2022.

This was going to be a very tiring week. I have 3 appointments with each of my doctor and unfortunately, they all can't be done on the same day. NUH now seems like my "second home".

After dropping Lil Pumpkin at school, the boy and I went to have breakfast at Kaffe & Toast, NUH Medical Centre.

I find the kopi there pretty good, and the boy agrees too. Decided to indulge in a calorie-dense {i.e. fatty and unhealthy!} kaya & butter toast set since I haven't had it for a while and have been thinking about it every time I get kopi from there before my appointments.

I haven't been as strict in my diet recently or been keeping count of my daily calories as much, although I do still try to eat more high-protein and low-carb food, as I keep thinking that once my chemo treatment starts, my selection of approved food will be pretty limited. So... might as well eat what I can when I can now haha.

I registered for my appointment once online registration opened in OneNUHS app about 8am, an hour before my actual appointment, while we had breakfast. We went up to NUH Breast Care Centre about 8.45am and although I've been there a few times already, it was the first time I realised that I needed to go to the registration counter immediately if I registered via OneNUHS to let them know I was there physically, and not wait for my number to be called.

Dr Mikael was late and we went into his office about 9.35am. Not too bad as I had to wait more than an hour past my appointment time to see him the last time.

This time, Dr Mikael seemed more relax and talkative. Perhaps less stress from having to tell me bad news?

He asked how I was and I told him that I've mostly processed the news and calmed down, which is true... did not even cry during our appointment.

Then, he proceeded to briefly explain how Colour Enhanced Mammogram and PET-CT scans work, show us my scan images and explain the results of both scans.

Basically, the scans show that the cancer is only in my left breast and has not spread to other parts of my body, which is good. I was worried that it might have spread to my brain as I sometimes get frequent headaches so this was a relief to hear but after thinking about it, I wonder if the brain activity colours masked the cancer activity in the scans?? Forgot to ask during our appointment and shall do so when we see Dr Samuel, my oncologist on Thursday.

Dr Mikael asked me what Dr Jane, my aesthetics surgery doctor, told me and I told him that based on my lifestyle and body type, she recommends implants for breast reconstruction. However, it does come with risks such as lymphoma.

He said that as my doctor, she was obliged to tell me about the risks, however, it is a low risk and I need not worry about it. It put my mind at ease hearing that.. as I really was worried about getting cancer from breast implants and going through all this again.

I am prepared to go for double mastectomy, but we shall wait for my genetic testing results to be out before we decide on that. Dr Mikael thinks I have just a 15% chance of a positive result for gene mutation... which seems low, but then I've been told that 10-20% of biopsies have positive cancer results, and only 20% of breast cancers are the aggressive HER2-positive kind so..... yah.

It seems like I tend to fall into the unlucky "low possibility" region. Oh well.

We talked a bit more about the surgery itself - like I've to stay maybe 1-2 nights in the hospital, he will make a long incision next to the nipple and one on top of the breast, he will try to save the nipple and breast skin but I will likely lose sensation in my breast after the mastectomy etc.

Dr Mikael will be going on leave 6-17 Oct and I will probably not see him again until my surgery, which is likely going to be in late Oct.

Dr Mikael 2nd visit cost: S$108.05

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Care Fight: Dr Jane Lim, Senior Consultant, NUH Aesthetic Plastic Surgery Centre

2022-09-28T14:30:00.012+08:00

I met with Dr Jane Lim in the afternoon of Wed 28 Sep 2022 to discuss about my breast reconstruction after mastectomy.

Dr Mikael will try to preserve my breast skin, nipple and areola during the mastectomy, while Dr Jane will try to rebuild the shape of my removed breast using either skin/fat, muscle and/or implants.

After my PET-CT scan, I went to have lunch and headed back to my office to clear some work and take back some of my snacks and protein bars.

My supervisor has been very understanding and allowed me to work-from-home while I sought treatment for my cancer, so unless absolutely necessary, I don't need to go into the office at the moment and I didn't want the food at my desk to go to waste like during the lockdown!

I found it a hassle to go to Dr Jane's office as you have to use your i/c to tap in and out just to get to the lift. As NUH Aestheritc Plastic Surgery Centre is in KR Wing, you can't register for your appointment early via the OneNUHS app either.

It didn't take long that day to register at the counter though and she kept to our appointment time too.

Dr Jane seemed kind and patient. I think I've been really blessed with my doctors. Other than choosing my own breast care specialist, Dr Mikael, my oncologist, Dr Samuel, and aethestic sugery specialist, Dr Jane, were assigned to me.

She took the time to explain the various breast reconstruction surgery options and made me feel at ease during this weird, dreadful time.

A funny thing was, she looked at me and said that I must work out a lot... not enough fat to use for the surgery! hahaha.. I think not true?? I have a little tummy.. how is that not enough to use for my small boob??

In all seriousness though, based on my lifestyle and body, Dr Jane recommended me to use breast implants for my breast reconstruction. For this, implants {recommended tear-drop shaped, textured, saline ones} are inserted underneath the skin or chest muscle following the mastectomy.

Using implants come with risks though of lymphoma, implant rupture and need to remove/change the implants after 10+ years as they have a limited life span. Hmmmm...

When I told the boy and my PT, Superman, about the surgery options for breast reconstruction, they were both adamant that I do not even consider using muscles! Dr Jane was not keen on this option too as she would need to take one part of my abs and cover that part with a mesh {no more 6-pack!!!}, and she knows that I do weightlifting and need to brace hard often.

Anyway, I decided that I needed the boy to help me decide so would come back again to see her after my other doctors decided if I was going to remove one or two breasts.

Dr Jane Lim first consultation cost: S$145.50

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: PET-CT Scan @ NUH Diagnostic Imaging

2022-09-28T08:30:00.042+08:00

A PET-CT scan combines a CT scan and a PET scan. They are generally thought to be more accurate in diagnosing cancer than PET or CT scans alone.

A CT scan takes a series of x-rays all around the body and puts them together to create a 3D picture. The PET scan uses a mildly radioactive drug to show areas of your body where cells are more active than usual... like in cancer-affected areas.

Since I had already been diagnosed to have early stage breast cancer, Dr Samuel asked me to do a PET-CT scan to see whether it had spread from the molecular activity of my body cells, as I had the aggressive HER2-positive type.

After my first appointment with him, we went to Diagnostic Imaging @ KR Wing L3 to make a deposit and have a briefing with the radiographer.

It is an expensive scan for the patient, and the cost of operating the machine is expensive for the hospital too so to maximise its usage and prevent missed appointments, you have to make a non-refundable and sizeable deposit first before they confirm the appointment with you to ensure that you will turn up.

My appointment was at 8.30am on Wed 28 Sep 2022. To prepare for the scan, I was told to fast for 6hrs before the scan and not do any streneous exercises for 12hrs prior.

Since we were paying so much for the scan, I wanted the best optimal results and also made sure not to drink coffee or eat any sugar or carbs 24hrs before my scan as it might alter the distribution of the PET tracer in my body and lead to a suboptimal scan. I didn't even take my usual supplements, protein shake, Coke Zero or eat any starchy veg!

For clinics at KR Wing, I realise that you can't do early registration via the OneNUHS app. That day, I registered about 8.20am at the clinic and at 8.30am they brought me in for the nurse to check my details, poke the IV needle, remove my jewelry, change into a hospital gown {as I was wearing tights I could keep it on as it did not have any metal parts} and put my belongings into the locker. I could keep my socks and shoes on.

After that I had my own little private room to rest in {monitored by CCTV} and I was injected with the FDG radiotracer {some sort of glucose} about 9am. I was told to rest and avoid moving too much for an hour to allow the radiotracer to spread through my body and tissues. Cancer cells are more metabolically active and may absorb glucose at a higher rate. This higher rate can be seen on PET scans.

It was best if I didn't use my phone to calm my mind and body too so I dimmed the lights and just closed my eyes in bed. I was still allowed to drink water and go to the toilet, if I needed.

About 9.50am the radiographer, Donald, brought me into the scanning room. I was surprised to see that the PET-CT machine was shaped like a large doughnut as I was expecting a big tunnel-like machine.

I lay down on the machine couch with my hands above my head. Donald said that I don't have to hold my breaths when they take the scans like for CT scans. Ok that's good.

However, I still had to stay still while the machine couch slowly slid backwards and forwards through the scanner to take the pictures.

The scan itself was pretty fast and took maybe about 15-20mins. After that I sat outside while the nurse removed my IV needle and waited for the radiologist to review the scans and check that they were ok or needed further clarity before I could leave.

By about 10.30am I paid the bill and was done. I could claim part of the bill from Medisave, but had to pay most of it upfront.

PET-CT scan cost: S$1,938.52 {including deposit of S$600}

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Cancer Fight: Colour-Enhanced Mammogram @ NUH Breast Care Imaging

2022-09-27T14:30:00.042+08:00

Colour-Enhanced Mammogram is an imaging technique that uses iodinated intravenous contrast in combination with a standard digital mammogram. Some cancers that are not visible in standard mammograms can be seen with contrast enhancement. The iodinated contrast agents are identical to the ones used in CT scans, but different from the ones used in MRI.

Cancers typically have more vessels and leaky vessels relative to normal tissue and therefore more contrast agent. In Colour-Enhanced Mammograms, areas where there there is more of the contrast agent appear white, whereas normal breast tissue {dense and non-dense} and benign {non-cancerous} lesions usually appear dark. For this reason, most cancers are easier to spot this way as compared to normal mammograms.

I went for my Colour-Enhanced Mammogram on Tue 27 Sep 2022 to assess the extent of my cancer and to check again if there was any cancer activity in my right breast that my previous scans did not pick up.

I was the first patient after their lunch break so registration was fast and the nurse saw me soon after to put the needle in and check on my last day of period.

After that, I went to the room for mammograms, undressed my top half and put on a robe. The radiographer then injected the contrast agent through the needle. As she mentioned and as I read earlier, I immediately felt a warm tingly feeling all over, a sudden need to pee, and a slight metallic taste in my mouth.

A few minutes later, the radiographer then took my mammogram shots at the machine. Unlike at Radlink where there were 3 radiographers to position and compress my breasts, there was only 1 this time. And she only took 2 positions for each breast.

I was done about 2.35pm but had to wait for the radiologist to review the scans and approve my leave. However, at 3.20pm, Dr Ee Lin came out to tell me that I needed to do an impromptu ultrasound on the left breast. Aiya....

By then, I was feeling very tired, hungry and a little faint as I had been fasting from 10am for the colour-enhanced mammogram. And cold too so the nurses gave me a blanket.

Even before that, I ate quite little {only some homemade chicken soup} and no coffee, sugar or carbs as I was limiting my food intake to prepare for my PET-CT scan the next day.

Took about 30mins before I went into another room for my ultrasound. The radiographer spent some time going over my armpits which I'm suspecting she was checking my lymph nodes. Got me a bit scared as I thought they might have picked up some cancer spread there.

A radiologist, Dr Eric, came in to do the ultrasound himself too. After scanning, he briefly told me that based on a quick review of the day's scans and comparison with my previous scans, there was no changes, further spread of the cancer and the lumps did not get bigger. Phew!

Finally left NUH about 2.5hrs later even though it was just supposed to be a "quick scan" day..

Colour-Enhanced Mammogram {both breasts} cost: S$403.80

Ultrasound {left breast} cost: S$143.81

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Care Fight: Dr Samuel Ow, Consultant, NUH Cancer Centre (NCIS)

2022-09-22T02:26:00.010+08:00

I first met Dr Samuel on Thu 22 Sep 2022.

Dr Samuel came highly recommended from Nurse Joanna, and also from Kitty's friend who works at NUH who said I quote, "Samuel brilliant fellow, I will trust my friend/ family with him".

Even though Thursday isn't his usual consultation day, he still took the time to see me earlier and discuss with me my cancer treatment plan.

So going in, I had a good impression of him and he did not disappoint.

Dr Samuel was approachable, patient, and took the time to explain to us about my biopsy report, breast cancer in general, genetic testing for breast cancer and how he would use chemotherapy etc. for my treatment.

He highlighted that based on my current test results and available information, it showed that I had a clinical Stage 1 breast cancer that was HER2-positive. After my surgery, the doctors would be able to come to a pathological stage after examining the tumours microscopically and that would be more accurate in determining how to proceed with therapy.

Dr Samuel shared that if we did chemotherapy before surgery, it would need to be longer and more aggressive as he would like to anticipate that it might be a Stage 2 or 3 cancer.

However, if I was prepared to go for surgery first, and the pathological stage still showed a Stage 1, my chemotherapy sessions would likely be shorter and less aggressive.

I mean on hearing that, obviously I'd want to go for surgery first?? In any case, I would need to have a mastectomy because there were multiple cancerous lumps around my left breast and it's not like I can save my breasts if I went to chemotherapy first.

The boy and I decided that I would not conserve my eggs as I didn't want to delay my treatment any further and were prepared not to have any further children.

I'd read a bit up on HER2-positive breast cancer and it made me quite scared really. HER2 is a protein that helps breast cancer cells grow quickly. Breast cancer cells with higher than normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than breast cancers that are HER2-negative, but are much more likely to respond to treatment with drugs that target the HER2 protein.

Since, it was more aggressive, Dr Samuel asked me to do a PET-CT scan to help see if the cancer has spread to other parts of my body.

It was a very fruitful session with Dr Samuel and I liked that at the end, he told me step-by-step on what I needed to do as follow-up actions. It made me feel less "lost" in this whole process.

Straight after that meeting, a nurse took my blood for the genetic testing and that would be sent over to a lab in the US. Results would usually take a few weeks but Dr Samuel would ask them to send results for the BCRA gene first. Payment for this genetic test is made in 2 parts to NUH for the delivery {$109}, and also directly to the lab for the processing {US$299}.

A positive test result means that you have a mutation in one of the breast cancer genes, BRCA1 or BRCA2, and therefore a much higher risk of developing breast cancer or ovarian cancer compared with someone who doesn't have the mutation. However, a positive result doesn't necessarily mean that I'm certain to develop cancer.

Knowing whether I have this gene mutation would help decide if I need/ want to have a mastectomy on my right breast too, if it currently does not show to have any cancer cells on my other scans and tests.

Dr Samuel Ow first consultation cost: S$118

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Care Fight: The Diagnosis with Dr Mikael Hartman, Head, NUH Breast Care Centre

2022-09-20T09:30:00.010+08:00

Dr Celene Ng was apparently pregnant and went on maternity leave. I didn't even notice! She didn't bring it up during our appointment either so was quite surprised when the nurse called to tell me that my case was going to be taken over by another Breast Care Centre doctor.

At first they assigned me to a young lady doctor, but I wanted a more experienced, senior doctor and did not mind a male doctor, so they recommended Dr Mikael Hartman, who is actually the head of NUH Breast Care Centre.

Can't get any more experienced than that, I suppose! hehe

First impression of Dr Mikael when I met him on Tue 20 Sep is that he seemed quite tired and a little solemn. I suppose when you have to keep telling patients bad news, it does wear you down...

And yes, I did receive bad news.

Dr Mikael told me that I had early stage cancer.

At that time, he can't say for sure what stage as further testing was required but it was early stage and likely Stage 1. However, 3 out of the 4 sites from the biopsy were malignant and because it was at multiple sites, I would have to have a mastectomy to remove my left breast tissue completely and it would not be possible to just do a lumpectomy to conserve the breast. Dr Mikael would of course try to conserve the nipple and skin so that I can have breast reconstruction to restore the size and shape of my breast after mastectomy.

As I was HER2-positive, it meant that my breast cancer was more aggressive than other types of breast cancer and I needed to have chemotherapy too.

And that meant that if the boy and I wanted to have more children, I would need to consider freezing my eggs as chemotherapy would affect my childbearing abilities.

Even though I was mentally prepared for bad news, my heart still sank and I couldn't help but cry from the shock and sadness. My life was about to change, and not in a good way.

There was a lot to take in and everything seemed like a blur. I think Dr Mikael didn't want to bombard me with information either so he did not go through my biopsy results in detail nor explain much about why it was considered an aggressive cancer. He did say that I should do a Colour-Enhanced Mammogram to see if other areas were affected by the cancer, and a genetic testing to determine if I have mutations in my DNA that increase the risk of breast cancer.

I did manage to ask some questions in the midst of my crying and shock like how long would my cancer treatment be {ans: probably about 1 year}, would I lose my hair during chemotherapy {ans: yes}, could it reoccur {ans: yes, but treatable}...

There really was a lot to take in and there certainly was a sense of lost at what to do... and the heavy decisions to make.

For one, even though the boy and I have basically decided to stop at one with Lil Pumpkin, I did want to have an option for more if we wanted. To be told that maybe we might never be able to again just seemed a bit harsh. Even more so than being told that I will lose one boob.. maybe even two depending on how the additional tests are.

Dr Mikael was solemn but not cold. He even offered me to take his tissue box when I left his room haha...

After seeing Dr Mikael, I met a Nurse Joanna who was from NUH Cancer Centre who counselled me on what to expect from chemotherapy and other resources I could look into, as well as try to get me an early appointment with my oncologist, Dr Samuel Ow.

That day after my diagnosis, I mourned but I still decided to go for training as I was determined not to let cancer get me down and stop me from living my life.

Having cancer is a lot to process. For the few days after my diagnosis, it felt so surreal and I couldn't believe it. I'm young and fit. How could I have cancer?? And an aggressive type?? Physically, I feel strong and healthy. It just seemed so impossible.

And yet, it is.

That day, I told my close gal friends about my diagnosis. My friends since young and sisters in Christ, their reminders of our faith and God's protection helped me through the darkness.

Didn't want to tell my parents or sisters yet as mummy's birthday was coming up and didn't want to mar the event or worry them as yet.

Others who know have also been praying and sharing about God's faithfulness with me.

With time came some sort of peace and understanding. No time is a good time to have cancer, but it is precisely because I am young and healthy that I know that I can get through this and win the cancer fight.

God planned for this and God will provide.

Dr Mikael Hartman first consultation cost: S$167.99

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre

Colour-Enhanced Mammogram and Ultrasound Scan

PET-CT Scan @ NUH Diagnostic Imaging

First consultation with Dr Jane Lim, NUH Aesthetic Plastic Surgery Centre

Colour-Enhanced Mammogram and PET-CT Scan Results

Genetic Testing Results

Over the Muscle vs Under the Muscle Breast Implant Reconstruction

Pre-surgery Blood Test and Consent-taking

After mastectomy and breast reconstruction surgeries

Mastectomy and Breast Implant Reconstruction Surgeries Part 1

Mastectomy and Breast Implant Reconstruction Surgeries Part 2

Skin Discolouration and Tiny Lump After Surgery

Fat Necrosis and Prolonged Skin Discolouration?

Adjuvant Chemotherapy and Herceptin Injections After Mastectomy

Surgical Drains Removal After Mastectomy and Breast Reconstruction

Exercise After Mastectomy and Breast Reconstruction {First 4 Weeks}

Adjuvant Chemotherapy and Herceptin Injections

Blood Test and Echocardiogram for Chemotherapy and Herceptin Jabs

Chemotherapy - What to Expect

Chemotherapy - Tips to Handle Side Effects at Home

First Chemotherapy and Herceptin Jab Session

Second Chemotherapy and Herceptin Jab Session

Third Chemotherapy and Herceptin Jab Session

NCIS on the Go - Keat Hong Family Clinic @ Choa Chu Kang

Breast Care Fight: Biopsy @ NUH Breast Care Imaging

2022-09-13T14:30:00.021+08:00

My breast lumps biopsy was considered a day surgery and required at least one incision at my left breast to take samples from 4 lumps that were suspicious for underlying malignant disease.

As such, I knew that I couldn't do my usual workouts and exercises for at least a few days after that.

Leading up to my biopsy, I tested my 1RM for squats and weighted chin-up. I had been progressing steadily in my squats in recent times, while even though I hadn't been training my weighted chin-ups until very recently with baby weights, Superman just wanted to see how far I could go now.

View this post on Instagram

A post shared by アイ・サクラ  (@aisakuraharuka)

I had already tested my 1RM for deadlift earlier this year and reached 100kg... finally!

View this post on Instagram

A post shared by アイ・サクラ  (@aisakuraharuka)

For my squats, I managed to do a 74kg while my weighted chin-ups was most surprising as I managed to a 25kg...

On the day of my biopsy on Tue 13 Sep 2022, I took a nice long shower as I was told it was best if I didn't bathe for 2 days to not get my wound wet. I could try to cover the dressing with plastic but it would be a risk. Also, NUH does not want to use waterproof dressing as they think that it causes skin irritation.

My appointment was at 2.15pm and it registration was pretty quick. After that I was taken to a small room where a young lady doctor, Dr Tan Ee Lin, briefly explained what the ultrasound-guided biopsy procedure was about, how long it was expected to take {about 15 mins for each sample}, expected size and length of the incisions and how to care for my wounds.

Then I waited for the day surgery room to be ready about 3+ and went in. There was a motherly nurse assisting Dr Tan and first they located the 4 lumps via ultrasound, while taking reference from my Radlink scans. One of the lump was really small and hard to find so that took a terribly long time.

When they finally started the biopsy procedure, Dr Tan injected my left boob with local anesthesia to numb the areas each time she took a sample from each of the lumps with a long core needle, which is a long, hollow tube to obtain a sample of tissue.

I was surprised that it took effect so fast and I barely felt anything... thankfully, haha. She managed to cut only 2 small incisions to get to the 4 lumps. They were so small that no stitches were required, and were closed using surgical tape.

Overall, I think we ended about 5.30pm... which was much, much later than expected. By the time I left, the centre was closing and I didn't even get to see my bill as they were helping me to e-file and claim via Medisave and insurance.

My wounds felt a bit sore and bruised for a few days. I think the most uncomfortable part was not being able to bathe or wash my hair for 2 days haha.. or move my upper body much so as to not risk opening the wounds.

I rested mostly in bed the next day. Felt like such a slob and was quite miserable actually. On Thursday, 2 days after the biopsy, I went for a short walk and did my light knee rehab exercises. Nothing that required me to lift my arms overhead or stretch my chest area.

By Saturday I was feeling better and even headed out for a ride with some friends into Malaysia. It felt so good to sweat it out and move out in the sun after having limited mobility for a few days!

View this post on Instagram

A post shared by アイ・サクラ  (@aisakuraharuka)

I really wondered how I am going to survive if I can't manage to exercise at all if I had cancer and had to undergo a worst surgery and longer treatment...

Breast biopsy cost: S$2,435.70

*****

Follow my breast cancer fight on the blog, Facebook or Instagram {#AiFightsCancer}

HelIo. I have breast cancer.

Before mastectomy and breast reconstruction surgeries

The Discovery and Early Detection

Mammogram and Ultrasound @ Radlink Paragon

Radlink Ultrasound and Mammogram Scan Results

First consultation with Dr Celene Ng, NUH Breast Care Centre

Breast biopsy @ NUH Breast Care Imaging

The Diagnosis with Dr Mikael Hartmann, NUH Breast Care Centre

First consultation with Dr Samuel Ow, NUH Cancer Centre