The Proverbial Treadmill

Diagnosed at 27. Fighting since 2014. Defying the odds and statistics.

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Further Tests

Before leaving the Institute of Digestive and Liver Diseases, my gastroenterologist pulled my mom, dad and I into a small consultation room. She had a few sheets of paper in hand, with photos from the colonoscopy cascading across them. As a I had a look at various screenshots that were captioned with the words “rectosigmoid mass”, “cecum”, and “normal colonic segment”, I did not know what to make of it. Perhaps that was what was snipped out of my colon during the procedure?

A few more pieces of paper were handed over to my mom. Among them was a referral to another specialist and request for some blood tests.

We headed over to St Luke’s Pathology Department. A unit within the hospital with rows of benches filled with patients watching a morning talk show while waiting for their ticket number to flash on the queueing system’s digital signage.

My mom, dad and I took our seat on one of the benches after grabbing a queuing ticket. It appeared that the standard operating procedure at St Luke’s was that the full payment needed to be settled before any requested service, test, or procedure was to be conducted. After all, it was a private hospital. I started to catch on.

After the brief transaction at the cashier, an official receipt was printed and handed to us along with some green slips. We sat down and waited a few more minutes for my number to be called into the blood extraction room.

As soon as my number was called in, I was led into a smaller room lined with phlebotomy chairs. The type of chair with a hinged armrest that swings into a position where you can comfortably rest your elbows while the nurse works their venipuncture magic.

The phlebotomist, who does the blood extraction, then begins with the usual formalities of asking your name and date of birth to verify your identity.

After grabbing a fresh pair of surgical gloves, the phlebotomist tore off a rubber tourniquet and had a look at the veins on the inside of both my left and right elbows. She tightly wrapped the tourniquet midway across my left arm, pressed on the skin on the inner part of my elbow lightly, and found a vein that she could use.

Skillfully unwrapping a syringe, needle and grabbing three vials to contain my blood samples, she then told me to follow her prompt and breath in just as she inserted the needle. So I did. And surprisingly, the breathing instructions were effective at minimizing the pain of the needle puncture.

Before I knew it, the vials were filled and the puncture was covered up with a piece of gauze and secured in place with a strip of surgical tape. I was done. All I needed to do claim the results the next day.

And so the following morning, I made my way back to the Results Claiming section of the Pathology Department. They printed off the results on three sheets of paper. Each sheet corresponding to the three vials of blood that were collected and subsequently tested for different things.

I walked out of the Pathology Department staring at the results I had just been given. It turned out that they ran: a complete blood test, a creatinine and liver profile test, and a test for carcinoembryonic antigen (CEA) levels in my blood. All of it might has well have been Greek to me. Words like Hematocrit or Neutrophils and the numbers in the column beside them meant nothing to me. So I did the one thing that we millennials are most adept at doing.

Whip out our smart phone and search for answers.

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The ‘Surprise’ Colonoscopy

They say that ignorance is bliss. This cliche certainly rang true in the case of my ‘surprise’ colonoscopy, however, I wish I had known the sheer horror which the pre-procedure preparations would inflict, so I could at least brace myself for what soon followed.

I was scheduled in for my sigmoidoscopy on a Wednesday morning at 7:00am at the Institute of Digestive and Liver Diseases at St Luke’s Medical Center in Quezon City (Philippines). The instructions of my gastroenterologist was that I undergo a bowel cleanse the night before, as my colon needed to be completely empty for the procedure. I was prescribed a combination of laxatives, which produced an incessant churning in my stomach that made sprint to the bathroom at regular intervals throughout the night.

It certainly did not help that I had attended my godson’s birthday party at McDonald’s only hours prior to this happening. The combination greasy fast food, soft serve ice cream and the prescribed concoction only made my stomach feel like war just broke out!

After what turned out to be a sleepless night, my parents and I made our way to St Luke’s at the break of dawn. Still exhausted from the sprints to the toilet. I was surprised, that in spite of it all, I still managed mask my brewing sense of anxiety with a smile and a bit of morning cheer.

As soon as forms were signed and payments were processed, a nurse led me into the back of the Institute. She handed me what I thought was a hospital gown, which upon closer inspection, turned out to be an oversized v-neck shirt and a pair of drawstring shorts, with a liftable flap on the backside.

After changing into the uber stylish hospital garb, the same nurse then returned with a clipboard, hospital wristband with my name and details on it, and a steel trolley with wheels that rattled across the floor as she pulled it. She then formally introduced herself and needed to do a few formalities. However, a quick glimpse over the supplies carefully laid out on the medical trolley proved to be enough of a distraction.

There was a pair of latex gloves, little packets of disinfecting wipes, surgical tape, and among other items, a needle. A needle! I was going to be hooked up onto an IV drip. I have never been hooked up to an IV drip ever in my life. Which was most likely going to be used for hydration and infusion of anesthetic. Needless to say, I was beginning to develop a sense of panic.

The IV insertion process turned out to be less painful and eventful than I had anticipated. Thanks to the skill and precision of the nurse. After this was done, I breathed a sigh of relief and was led into the procedure room where I was asked to lie on the table and face the wall to the left with my legs bent close to my torso - in fetal position.

Just as the nurse was attaching all sorts of probes and tubes, a lady doctor with a cheerful smile and a thermos cup in hand drew the curtain and introduced herself.

I had not seen her before, but assumed she was the anesthesiologist. Her candor immediately calmed my nerves as we chatted idly while waiting for my gastroenterologist. Not long after, both of them were present and ready to jump right into the procedure.

The mood turned somber as my anesthesiologist started to pick up small glass vials and a syringe. Vials containing the sedatives that would knock me out for the next hour. She then told me not to worry and that it would just feel like I was falling asleep. Before I knew it, my vision began to blur and I drifted into unconsciousness.

I woke up after what seemed like a good night’s sleep. Turned out it was only 9:00am. A couple of hours from when I was sedated. Just as I was propping myself up from the bed in the recovery room, I was approached by another nurse, who told me to take it easy, as I might lose balance and fall over from my grogginess. I was just glad that the procedure was over without me realizing what happened, that there was hardly any pain, apart from the anxiety leading up to the procedure. Plus, it was still early enough in the day for me to resume my scheduled list of activities.

After changing back into my own clothes, I strode out to the waiting area where my parents were waiting, gleaming at the thought that I managed to come out of the procedure unscathed. What I was completely oblivious to though, were the findings during the procedure, which began as a sigmoidoscopy, as initially planned, but ended up as a full on colonoscopy.

Little did I know that those findings were also what would alter the course of my life.

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Gastroenterologist Visit

Before finding out the gravity of my health issues, I had a vague idea of the hurdles a sick person has to take to be properly diagnosed and treated.

So that morning that I walked into the clinic of my gastroenterologist, I was cloaked with the naive impression that I’d be able to walk out, with medicine prescriptions in hand, and show up for a pampering session at the nail salon afterwards.

But the consultation did not pan out the way.

The consult began with the usual pleasantries and small talk, but then the doctor began scrolling through her phone to pull up my mom’s text message.

“Your mom wants me to schedule you in for a colonoscopy.”

A colonoscopy. An invasive procedure. One that involved sticking a tube with a tiny camera up your back side. The thought of it alone made my glutes clench in fear.

She then reasoned that a full colonoscopy may not be necessary as I was still young, and began to suggest an option which, from the outset, was less daunting. A sigmoidoscopy. Something I had not heard off before. 

She then began to explain that a sigmoidoscopy is also an invasive procedure, but rather than traversing the depths of the large intestine, would only go as far as the lower portion. It already seemed like a better option to me. Until I was told that I would be wide awake and fully conscious as they conduct the procedure. Unfortunately enough, this also happened to be my deal breaker.

And so a negotiation ensued.

I would agree to a sigmoidoscopy only if I could be given some form of anesthesia or sedation. There was no way I could stomach the ‘slight discomfort’, as she put it. Or even deal with the humiliation having medical paraphernalia shoved up where the sun don’t shine, while idly watching the fiber optic tube’s trip up my bowels like it’s just science documentary on National Geographic.

Phone calls were made, and after a few minutes of twiddling my thumbs while looking at posters of the digestive system plastered across the wall, we had some good news. She was able to book me in for a sigmoidoscopy, and coordinated with her partner anesthesiologist to sedate me for the procedure.

All was well and good. I just needed follow a set of pre-procedure instructions and preparations which she scribbled on her notepad and handed over to me.

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The lead up to my Diagnosis

It was May 2014, and amidst the chaos of meeting printing deadlines and publishing material for the end of the week for work, I received a text from my mom who had recently moved back from Singapore and was based in Manila at the time. The condition of my grandma who had been confined in the Critical Care Unit for five months was rapidly deteriorating. She wanted me to speak with her. Regardless of her not being able to utter a response.

So I rang them up the moment I got home, not knowing what to say. My mom’s voice crackled, as she told me that it wasn’t looking good. What followed was a deafening silence. Both of us knowing the inevitable. So she then told me to say something to my grandma, and immediately placed the mobile phone by her ear. I could not recall the exact words that started spilling out of my mouth, but I do remember sobbing uncontrollably and telling her to wait for me to come home. 

And so after hanging up the phone, I immediately pulled up the Philippine Airlines website on my laptop and booked the next available flight back.

The Funeral

My grandma passed away a few hours after I had spoken with her, which unfortunately meant that I only got back in time to attend the funeral and her burial. The wake went on for five days and was attended by most of our extended family and friends, or colleagues that wished to pay their respects. On the day of her burial, a mass was held at the funeral home followed by a solemn procession to the cemetery where she was to be laid  to rest alongside my late grandpa. At the entrance of the cemetery, we all alighted from our cars and walked alongside the hearse under the sweltering heat of the Philippine sun.

My workplace had allowed me to take a week’s worth of bereavement leave, which meant that I had a couple of days after the funeral to do what I wanted, before flying back to Australia. And I intended to maximize the time I had, as leave days were scarce and trips back to Manila seldomly happened.

Although I had intended to book myself in for a manicure, pedicure, haircut and other cheap hedonistic pursuits, my mom insisted that I prioritize a visit to her gastroenterologist. She remembered my persistent health issues and was not going to let it go unresolved. Unfortunately, it was something I could not avoid either, as I finally had the time, and my mom had already texted the doctor to confirm my appointment. And so my fate was locked in.

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The Symptoms

The symptoms of colorectal cancer crept up to me like a thief in the night. As early as December 2013, there were times where I noticed blood in my stool during bowel movements, and gradually started frequenting the toilet more often, feeling like I still had ‘unfinished business’. As this slowly became the norm, I was grateful that our new house had two bathrooms. Other than these two things, I felt no pain, and only felt fatigued after a long day of work followed by routine household chores.

With these two symptoms in mind, I’d stealthily scour the medical sites on the internet to get an idea of what I was potentially dealing with, all while I was having my morning tea at work. There were two main things that made me brush off cancer as a potential health issue at the time: first, I was young, healthy  and do not fit the usual profile of a colorectal cancer patient, and second, the symptoms could lead to countless other possibilities. Namely, constipation, hemmorhoids, anal fissures, inflammatory bowel disease, Crohn’s disease. And then of course, the phone would ring and my work beckoned once again.  

Part of me, at the time, was also hoping that the issues would just disappear and resolve themselves without having to take time off to visit a doctor. After all, I was busy, and a trip to the doctor to literally talk about ‘shit’, was an inconvenient interruption.

That said though, I hope that if you ever find yourself in the same situation that I was in, be more sensible. Listen to your body and don’t take such symptoms lightly. Visit your GP and ask for a referral to a gastroenterologist who would agree to do a colonoscopy or sigmoidoscopy at the very least.

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So, what is it like?

This is perhaps what many would like to ask me, but only the bravest of the brave would be able to. And so most of the news is shared to the grapevine. But here it is, straight from the source.

When people see me for the first time after hearing about my diagnosis, many are pleasantly surprised that I look relatively ‘normal’. Make up has done a fantastic job at hiding any other visible skin imperfections. I dress normally and do not exhibit signs of cachexia (weight loss). I am able to function within reasonable limits. Perhaps the only exception would be my hair (or lack of it) at some given point in time. But to the untrained eye, I look well and good, and will probably even be mistaken as ‘healed from cancer’.

But beneath the surface, what you don’t know is that it has been a long and arduous journey. One with many ups and downs, but with an abundance of love, faith, hope, laughter and positivity. 

To date, these are the main procedures and treatments that I have soldiered through:

Colonoscopy (the procedure which is what led to my diagnosis)

CT, PET scans and blood tests

Proctoscopy (another procedure in preparation for surgery)

Low Anterior Resection (surgery to remove the portion of my bowel where the cancer was located)

First-line chemotherapy - 12 rounds of FOLFOX

More CT, PET scans and blood tests

Percutaneous lung biopsy (a procedure where a needle is inserted into my lung to obtain tissue sample for a genetic test of the KRAS gene)

Port-a-cath implantation (minor surgery to implant a subclavian port-a-cath)

Second-line chemotherapy & targeted therapy - 12 rounds of FOLFIRI & Avastin

Third-line chemotherapy - Xeloda

Phase 3 Clinical Trial - Lonsurf (a relatively new oral chemotherapy drug)

Stereotactic Radiosurgery for brain lesions in my cerebellum and right temporal lobe

Whole brain radiation for 4 other sub-centimeter brain lesions

Radiation to the sacrum, sternum and lung.

I consider myself incredibly blessed to have been able to withstand such long treatment history, and still be in a position to further withstand more. It is incredibly rare for someone to be part of a tiny percentage of advanced colorectal cancer patients who have yet to kick the bucket in spite of the cancer having spread to my lung, liver, brain and bones (believe me, I’ve scoured many online patient forums).

Though the prognosis and general outlook may be grim, I still take pride in how far my faith and current medical advancements have brought me in terms of defying the odds and statistics.

Stay tuned for more posts about each of those experiences!

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The Story Behind the Name

First things first. Let me address the question with regards to the name of my blog. The Proverbial Treadmill. I know it sounds rather bleak and monotonous but let me tell you what this allegory is all about.

When I started my first round of chemotherapy, one of the medical oncology fellows at the hospital I was admitted at noticed that I liked reading. He then asked whether I’ve heard of this book by Siddhartha Mukherjee titled The Emperor of All Maladies:  A Biography of Cancer. With my literary preferences leaning more to towards the fiction genre, of course I haven’t. In fact, I probably would not have even considered it, had I not been diagnosed. But the next day when he came to visit with the book in hand, I decided to give the chunky piece of literature a shot. After all, I started to develop a voracious appetite for cancer related articles online, and had endless hours (and cancer cells) to kill. It took my close to two month to plough through it. But it was probably one of the best introductions any one could have to the field of oncology. 

It gave me an understanding of the historical, political, social and economic forces that have shaped the profession today, and a confidence in the manner in which cancer is treated. Perhaps the only thing I was left craving for by the end of the book was the desire to know what’s next. Whether the next discovery in cancer treatment will finally be a cure. Whether there will ever be consistency in the availability of all these options to patients, regardless of their age, race, geographical location or financial capacity.

There was one metaphor which was mentioned in the book which served as the inspiration for my blog title. In a nutshell, the field of oncology, whether it is surgical, radiology or medical, is one that is very dynamic. Because of cancer’s ability to always stay one step ahead of technological and pharmaceutical advancements, it appears as if all of us who are affected by it – from those involved in cancer research, to those who provide treatment, and even the patients and families affected by this dreaded ailment, need to trudge along on this proverbial treadmill. A treadmill in which falling off one end could ultimately mean death, and the other end looking out into a space laden with undiscovered opportunities armored with nothing more than the hope of of a cure.

That’s basically what sums up how I see the whole experience. Like a walk/run on the treadmill. A treadmill on which the speed is varied, the incline is steep, but the outlook is promising. But perhaps what reassures me most is the knowledge that there are other people running alongside me.

I hope that regardless of what kind of proverbial treadmill you run, that you too, would take the time not just to look ahead, but to look at who are by your side. It definitely makes the run seem less lonely.

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So, I decided to blog.

Ok, so maybe I am not making a shocking declaration about a closeted aspect of my identity. But, I just decided to start a blog. A blog that I have been meaning to create ever since the beginning of my cancer journey in May 2014. A window into my hermit-like existence as I retreated into a whirlpool of medical tests, procedures, surgeries and chemotherapy sessions. Some of you may be wondering why I decided to do this. Or perhaps why only now. 

Well, the reality with cancer patients is that when you get blindsided with a diagnosis, you virtually spend every waking hour after that doing what needs to be done to cope. In my case, I decided to fight back. There was no time to spare wallowing in self-pity. 

Now that I am in a position where I have the benefit of hindsight and a little bit more breathing room to take in the events of the past three years – I am finally in a position to give you a glimpse of what it was (and is) like being a Stage 4 colorectal cancer warrior in my early 30′s. 

I hope that if you decide to follow the posts about running my “proverbial treadmill”, that you may go away from it with a little something…whether it is cancer awareness, compassion for those who are affected by the disease, or even a push to change your diet and lifestyle. There is this one particular line from Baz Luhrmann’s song Everybody is Free to Wear Sunscreen says:

“Advice is a form of nostalgia, dispensing it is a way of fishing the past from the disposal, wiping it off, painting over the ugly parts, and recycling it for more than it’s worth”

(Read more: Baz Luhrmann – Everybody’s Free (to Wear Sunscreen) Lyrics | MetroLyrics)

So for what it’s worth, I hope that my blog serves these three greater purposes: 

providing advice to be heeded 

giving hope where it is needed, and 

celebrating life undefeated

Tune in for my latest posts and updates and feel free to leave me any comments or questions. I’d be enjoy hearing from all you visitors to my blog. Happy reading!