Part 2: Come back and see me again after a week!

Part 1: The mantra of  NO CURE BUT THERE ARE TREATMENTS is meaningless.

Part 2: Come back and see me again after a week!

Part 3: Praise God, She did not die!

On the second day, the 2 sisters came again. The family was fully aware of the seriousness of the problem. The family decided to get GM out of the hospital — no more medical treatment for her. Accordingly to the sister even the oncologist agreed that GM should not get anymore chemo! So GM had no choice but to come to us for help. One sister said, Nowhere else to go. Go to any hospital,  they will give her chemotherapy and radiotherapy! They wanted to try out the herbs – for better or for worse, with the understanding that GM might die anytime.

Oncologist’s Medical Report

(Note: This medical report is rewritten in layman’s language. The facts remain unchanged while the medical terminologies are omitted for our better understanding).

1 August 2016

To Whom It May Concern

NUT Midline Carcinoma T4N2M1 (bone)

• Chemotherapy: TPF — Cisplatin, Docetaxel and 5-FU from April to June 2016)
• Palliative radiotherapy to head and neck, 13 times (abandoned due to disease progression).
• Doxorubicin, Ifosfamide and Vincristine from 15 to 17 July 2016.

1. This 33-year-old lady came to my attention on 20 April 2016 when she came for an opinion. She had left sino-nasal tumour. Presented with severe protrusion of the left eyeball, swelling of the left cheek, blurred vision and severe headache.
2. The post-nasal biopsy on 19 April 2016 was reported as a squamous cell carcinoma. But I consulted Prof P who communicated to me that it was a NUT Midline Carcinoma.
3. CT whole body on 25 April 2016 revealed an extensive left sino-nasal tumour with extension into the left orbit.
4. I made it clear to her and her family that this was a stage 4 cancer and the aim of the treatment was palliative in nature.
5. On 26 April 2016, patient had a chemo-port inserted to facilitate the administration of chemotherapy.
6. By Day 4 of chemotherapy, her eyes started to feel better but she began to develop a fever.
7. She was given antibiotics — Co-Amoxiclav, Ciprofloxacin and Teicoplanin. Her fever failed to settle.
8. Suspected infection of chemo-port. This was removed. Her fever subsequently settled after removal.
9. Patient had a very good response to chemotherapy. She received 2 further cycles of TPF chemo.
10. After completion of the third chemo, she was planned for radiotherapy — IMRT which was to start on 27 June 2016.
11. But she complained that her left eye was starting to swell up again in the last few days.
12. A repeat CT was performed. Unfortunately, she had developed progressive disease within 3 weeks of her last TPF chemotherapy.
13. Nevertheless, we started her on radiotherapy and she responded after 5 to 6 times. Left eye swelling was reduced.
14. Patient at the same time received 1 cycles of chemo with Cisplatin on 28 June 2016.
15. After the 8th sessions of radiotherapy she was increasingly lethargic and listless with general weakness of her peripheral limbs.
16. Her blood test showed severely hypercalcaemic with slightly raised urea and creatinine. This was associated with daily raised body temperature and fever of 38 C.
17. Patient was given Zoledronic and Co-Amoxiclav. Her platelets were gradually dropping from 384 (on 4 July 2016) to 214 (on 8 July 2016) to 100 (on 11 July 2016). This was associated with a persistent fever and body pelvic pain.
18. We felt that there were increasing bony metastases. She was having progressive systemic metastases as evidenced by the severe hypercalcaemia.
19. We offered her second line chemotherapy using Doxorubicin, Ifosfamide and Vincristine.
20. Patient’s radiotherapy was discontinued after 12 times.
21. A chemo-port was again inserted on 11 July 2016 with a 3-day regime of Dox/Ifos and Vincristine.
22. She developed a DVT in her left calf requiring anticoagulants. (DVT = Deep vein thrombosis — this occurs when a blood clot forms in one or more of the deep veins in the body, usually legs.)
23. She had persistent fever even before her chemo-port insertion and her antibiotics were switched to meropenem infusion.
24. By Day 3 of chemo, her platelets were down to 53 and her calcium levels dropped to 1.75. Despite infusion of calcium gluconate she had persistent low calcium. Her Magnesium and Phosphate levels were low. Her urine output was high.
25. It was felt that she had developed Ifosfamide-induced Fanconi’s Syndrome causing renal tubular leakage of her electrolytes and nephrogenic diabetes insipidus. Patient also suffered transient episodes of agitation which was attributed to post-Ifosfamide Grade 1 encephalopathy (see explanation below).
26. Her platelets which had been on a reducing trend before chemo, continued to drop during and after chemotherapy. She required daily infusion of platelets since Day 3 of chemo to prevent bleeding.
27. Xarelto which had been her DVT was discontinued.
28. To correct her electrolyte imbalance she was given daily infusion and oral calcium, phosphate and potassium supplementation. Desmopressin was given daily to reduce her urine output but she developed fluid retention.
29. Her persistent high body temperature and fever continued. She was switched from Meropenem (completed one week) to Gentamicin and Ciprofloxacin. Patient was kept on regular paracetamol.
30. Patient developed neutropenia (low white blood cell) on Day 6 after the chemo. She was given daily G-CSF and Pegylated-GCSF.
31. Due to the persistent fever and the clinical diagnosis that she may have tumour-related fever. Her Gentamicin and Ciprofloxacin antibiotics have now been stopped after 5 days of infusion.
32. She no longer required any platelet transfusion.
33. Patient is mainly bed-bound but is able to mobilise with the assistance of 1 to the toilet.
34. Her CT was repeated yesterday and shows progressive skeletal metastases. There is some mild basal atelectasis (one or more areas of the lungs collapse or don’t inflate properly) and likely reactive mild left pleural effusion (fluid in the lung).
35. Her prognosis remains poor. Overall, her disease management has been challenging. Her disease improves dramatically but also relapses rapidly. Her chemotherapy was also complicated by the uncommon adverse effect of renal dysfuntion.

Yours sincerely,

Consultant Radiotherapist & Oncologist.

Comments

• Thank Sir, for your detailed 3-page-report. It was well written and well understood. You must have taken a lot of your precious time to write this. Also, we appreciate your frankness in telling us what had happened.

• I must admit I felt intimidated after reading your report. You tried your best and your medicine failed you. We understand that. Then as a last resort, the patient’s family came to us for help. So what help can we give her? Nothing much, the like of those expensive, potent and destructive drugs that you prescribed. What we can offer is a simple advice. We could not offer GM what the doctor did. We are not doctors! And we don’t think like doctors too. We only used our commonsense to reason things out and try to figure out why GM went into that “bottomless pit.” So this is what we said and did.

• Our advice: Go home and let her die in peace and without suffering. Heaven is a better place where no one suffers from any cancer. Courage is not about fighting a battle that you know you cannot win. Courage is not about fighting a battle you have to suffer before you lose. Here, radiation and chemo were given. GM suffered blood clot in her left calf. Then there was the chemo-induced Fanconi Syndrome, kidney failure and diabetes. Her platelets and blood counts were nearly wiped out by these toxic drugs. Her immune system was probably destroyed. Her body became sick with high temperature and stubborn fever which no drugs in the hospital could fix the problem. So to us, courage is about accepting reality and giving up that fight which seemed to be the cause of more problems. So to us, if this reality is accepted, we have won the first round of the battle. 

• Four months before this disaster (in April) GM was still a “healthy” person and was able to sell curry mee in her stall. Then she had “flu-like” symptoms and took a variety of antibiotics. Within three weeks her left eye and face were swollen. Her sister said the left eye was “swollen like the eyes of gold fish”. So, common sense is needed here. How could this be? What caused the swelling? Unknown to many people antibiotics can cause havoc in some people. Paul Ruggieri, in his book Confessions of a surgeon (pg.39), wrote about one of his patient. I am sure Mrs. Grady had contracted an infection in her large intestine … she had contracted the infection from the oral antibiotics prescribed by her family physician. The antibiotics used to treat her pneumonia inadvertently wiped out some of the “good” bacteria living in her large intestine.  Mrs. Grady was on this antibiotic for just 10 days. Mrs. Grady had stopped making urine and her kidneys had completely shut down. Mrs. Grady had to undergo a major surgery to remove her large intestine. In another book, Bitter Pills, Stephen Fried wrote about his wife, Diane, who was give antibiotic  pill to treat her urinary infection which she didn’t know she had. Diane swallowed the first pale yellow oval tablet with breakfast. Six hours later Diana landed in the emergency room. She was disoriented and hallucinating. Her mouth was dry and she felt tingling in her left arm and hand. She was having trouble talking. When she went to lie down, she started shaking uncontrollably and then saw white. She was sure she was dying.

• Chemotherapy caused drastic drop in blood counts and platelets. GM’s platelets count was low yet she developed blood clot in her left calf. How could this be? From the internet we learn that, ” When you don’t have enoughplatelets in your blood, your body cannot form clots.”  Otis Brawley, an oncologist, in his book How We Do Harm, wrote: Cancer patients are often given this blood boosting injections (erythropoiesis stimulating agent — ESA) after chemo causes drastic drop of blood counts. ESA are shown to increase risk of blood clot in the veins.  If what Dr. Brawley wrote is true, one cannot help but ask if the ESA injections that GM received be the cause of her Deep Vein Thrombosis? 

• Common sense also prompted us to ask — Is the cancer that aggressive? Or is it the treatments that make the cancer aggressive? The literature in the internet is replete with this kind of statement: Patients do not die of their cancer, they die of their treatments. 

• Having said that, our priority for now is not to go for the cancer yet! Let us fix the problems of the stubborn fever and high body temperature. That was what prompted GM to tell her family that she preferred to die. So we prescribed the minimum of herbs. After stopping the chemo and antibiotics from the hospital, my suggestion was to take the juice of young papaya shoots! This may sound like a bad joke! This advice costs nothing, and the papaya shoots can be obtained from plants grown in the garden or roadside. So, this is the battle between traditional knowledge versus modern scientific medicine!  Over the years, my experience showed me that the very bitter juice of papaya shoots help in cases of low blood / platelets or stubborn fevers! My son (medical student!) had very high fevers that did not respond to 2 rounds of antibiotics. One shot of papaya shoot extract solved the problem within a few hours! Read more here: https://cancercaremalaysia.com/2016/03/07/from-gods-awesome-natural-pharmacy-papaya-leaf-for-stubborn-high-fever/

• After prescribing some herbs, this were my last words to the sisters: Come back and see me again next week (if she is still alive.)