All Clear: 2 Years On

Last Thursday I went back for my now-annual checkup with my favourite breast specialist in the world, Dr Hoe Ah Leong.

That was after nearly 4 hours of ultrasounds and X-rays and the mammogram and waiting around for my films and report.

The mammogram technologist that served me was so funny. Whenever I go back for my scans, I need to bring my old films so that the doctors who write up the reports have a comparison, and so would my surgeon. The technologist, a pretty young Filipina, shook my old films out, and stood, stunned for 20 seconds.

“Ma’am, you did your mammogram last year?”
“How come I only have your films for one breast, there should be films for two.”
“I wish there was two. I had a mastectomy in 2010, my dear.”
“OHHHHH!” Pause. “I’m sorry, I’m sorry!”

I must have unnerved her because as she was positioning me for the mammogram on my left breast she kept failing to get my boob in the right position. She knocked my collarbone. She pinched my armpit. She raised the plate. She lowered the plate. Finally, she just squashed it as much as she could and took the darn shot. I could have told her she didn’t press the plates down hard enough. (True enough Dr Hoe later said, “Hmm, this mammogram is a bit fuzzy at the bottom.”)

Next was the ultrasound. My doctor had ordered up scans for my breast, my liver and my gall bladder. There’s something about an ultrasound scan that always makes me edgy. Especially if the technologist is scarily silent. Good thing i got another chatty PInoy girl. Still, the few moments she rolled over one spot from every angle made my heart skip a beat.

After the long wait for my films and reports, I hoofed it to Dr Hoe’s clinic on the third floor of the main medical centre.

Christine, the nurse who christened me Liang Po Po two years ago, took one look at me and said, “How about you go and take a nice long tea break?”

My buttocks were complaining that I was oppressing them with so much sitting down, but I took a look at the two poor teenagers asleep on the waiting area couch as their mother and father waited to see Dr Hoe, and I made an about-turn and went to get a coffee from Delifrance.

Finally at 5.45pm I saw my beloved doctor, looking as cheery as ever, with his ubiquitous blue shirt as neat as it probably had been at 8am.

“You look good, Theresa!”
“You too, Dr Hoe!”
We grinned at one another.
“Okay, so your reports look good. Come come, let’s take a look.”

One thing I love about Dr Hoe is how he operates like a teacher. My mammograms, chest X-ray and ultrasound scans were all clipped up on the lightbox for examination.

There is a single calcification in my left breast, which had been there last year too. Calcifications are not a good sign if they appear in a cluster. My right breast mammogram, two years ago, was peppered with large clusters of calcifications especially just above the nipple area.

“But this single calcification is all right, nothing to worry about,” he assured me.

For breast cancer patients, if cancer recurs, it would usually be in the other breast, the lungs, or the organs nearest to the breast area, like the liver and gall bladder.

All my scans were clear. The only thing of note was that I had a little cyst in my left breast, which also showed up in last year’s scans.

“Probably a fatty piece,” said Dr Hoe with such confidence that any worry I had melted away.

With the help of his nurse, I lay on the examination bed while he palpated my breast, neck and armpit areas. There are also instances where lumps form in the neck or armpit, “but your lymph nodes were clear—remember we did the test on the sentinel nodes. DCIS prognosis is excellent.”

I was deeply happy to hear all he said. Some days, I admit, I take my survival for granted. Some days, I forget, had I not acted on the weird pain my breast, I might be facing a very different today.

True, every time I see Dr Hoe I am reminded that cancer could recur. Some days, that casts a shadow over my heart.

But I thank God that I have Him—and truly, I am living on time that He has so kindly given me. I am determined to make the best use of it as I can, but I am also peaceful, knowing “to live is Christ, to die is gain.”

Dark Day: Another Friend Diagnosed With Breast Cancer

Yesterday, a good friend SMS’d me.

“Just read your article in Lifewise. Looking good, girl 🙂 I just got diagnosed yesterday evening – “abundant malignant cells”. Doctors says chemo likely. My surgery on Wednesday to discover extent. Will be reading your blog regularly.”

My heart sank like a huge rock. I don’t wish cancer on anyone — but it really breaks my heart when the sweetest, fittest, healthiest people who really have no reason to get cancer, get it. And this friend is just one such. After my surgery, she came over for dinner and brought macaroons from ET Artisan Sweets (they really are artisanal — my favourite is the Black Forest with the brandied cherry in the chocolate ganache filling). She made me laugh out loud with her funny stories, including the one about how she signed up for a 10km run and was so unhappy with herself because she walked some sections of the route. I thought to myself, “I’d be happy if I could run 1km!” And now I can, because she inspired me to think it is possible.

Hers is the fourth case I have heard in two weeks. Two of them, thankfully, have cysts in the breast, which are being removed surgically. Another one hasn’t updated me… I really hope she’s taken my advice.

My best friend Karen had a scare too, about a month ago. But thank God hers turned out to be a fibroid, not cancerous in any way.

I have a feeling more cases of breast cancer are discovered in the month of October, thanks to the fact it is Breast Cancer month. And although it’s terrible to discover it, it’s still better than not discovering it early enough for treatment to be had.

I saw my oncologist two weeks ago (you can read about my latest dilemma soon at this blog). You might wonder why, after my breast surgeon Dr Hoe Ah Leong had basically given me a clean bill, I had to see an oncologist. Dr Hoe said he felt it was safer for me to get an expert opinion as an oncologist is a doctor that deals specifically with cancers, while a breast surgeon may deal with different ailments relating to the breast, whether cysts, fibroids, or cancerous growths.

In short, Dr Tan Yew Oo of Gleneagles concurred with Dr Hoe, based on my histological reports which showed that, given my hormones levels, it would not be profitable for me to go on tamoxifen, which is often prescribed for patients who have had one mastectomy and tested ER+ (estrogen receptor positive). Tamoxifen is understood to help reduce chances of cancer in the second breast. It’s also used in many preventive situations, including male breast cancers. (See here for more on tamoxifen.)

Anyway, Dr Tan gave me some useful literature on breast self-exam. I learned how to do a self-exam when I was 20 — my mom showed me, standing in front of the mirror. I realise that most moms wouldn’t (though I do plan to teach my 2 girls), and so it would be useful for someone who’s trying to find out exactly how to do a breast self-exam (BSE) to download this diagram and practise. I’ve been told the best time to do your BSE is just after your period has ended. I personally use the circular method — mainly because I’ve used it for 22 years!

Ultimately, I have to say that I think BSE saved my life. Even though it wasn’t quite a lump, I was familiar enough with my breasts by this year to know when something didn’t feel quite right.

Breast Self-Exam Diagram

Right now I am praying for my friend, whose surgery happens this Wednesday. She is a real “can-do” lady. I am very sure she’s going to pull out of this and she will have a long, fulfilling life ahead of her. I intend to live as many years as God will give me, and I know she shares my sentiments. So though right now, it seems a tragedy, this is not the end for either of us. We shall live on and fight.