My Reply to "John"!

Dear John,

You left a comment in yesterday's posting, and as you didn't provide me with your personal email address, allow me to reply you using today's posting, which other readers may also benefit from same.

First of all, may I seek your understanding that I am not in a position to provide you with any "medical advise". Although I am a semi-profession (with knowledge in the pharmaceutical side), I am not a medical professional and therefore should not provide any medical advise. In additional to this, without having assess to the complete file of your mother, I personally fear that any "medical advise" is irresponsible and should not be provided. Meantime, by reading your elaboration of the situation, I can sense the difficult dilemma that you are in. Please do take note that you are not alone, the dilemma that your mother and you are in are very similar to a lot of other cancer fellows, desperately seeking the best treatment approach for themselves. If I may offer my 2 cents worth of advise, and assuming if I were in your position, the following would be what I will do IF I were in your situation:

1) Communicate with your mom, respect her "gut feeling". Ask her whether she would prefer the western route of treatment, or if she is more comfortable with the Chinese way of treatment. What is important is that she would need to understand the "possible outcome" of each approach, i.e. in the case of Western approach, what would be the side effects and possible outcome of the chemotherapy, and in the case of Chinese approach, then it may take longer time and unproven track records of recovery, etc. In Canada, one more consideration is that if Chinese way of treatment is chosen, there is a financial burden attached to it, which can be higher than the western approach. The good thing is if the treatment approach is being chosen by your mom, then she shall laid confidence in the treatment approach and can possibly avoid her "blame or regret" in future.

2) If for whatever reason that your mom is too weak, too emotional unstable to choose among the two approaches, then you, possibly in consultation with your family members, e.g. your brothers and sisters, to jointly make a decision. Important is once the decision is made, try to go with either one of them. Betting on both of them can be a torture to the patient. I was told that there are Chinese Medicine Practitioners who are willing to work with patients undergoing western treatment. In this case, basically the Chinese treatment would become the "complementary" treatment approach, i.e. to support the western treatment approach, and focus mainly in reduction of side effects of western treatment.

3) Quality of Life: This is really something we need to focus on. As a cancer patient, everyday we have a lot of different challenges, especially on management of our pain and the side effects of the drug. But this really becomes our prime duty everyday.

For Pain Management: Good that your mom is now under morphine, and what's important is not to allow her to suffer from any pain. Repeat, the key objective of pain management is try NOT to have any pain. And once the pain is under control, and the dose of morphine (and time for taking the dose) becomes routine, than the quality of life would improve a lot (as the pain is no longer a threat to daily life). Some patients think bad about morphine, which is wrong, they should be allowed to take as much morphine as they feel like, and I am sure you are aware about the term "breakthrough" which allows the patient to take as much morphine whenever needed.

For the side effects of the drug, nowadays, it's good that most of these side effects are known, and I would assume the doctors or the nurses would have informed you regarding how to manage the side effects. What's important is those information provided is really general information and being a cancer patient ourselves, we should try to work on it and work out the best approach for our individual needs. Using constipation as an example, after using morphine, constipation is almost ascertained, but the important question is how should we manage this issue using the drugs (laxatives) available to us. Usually you would be prescribed with Sennosides, Lactulose and Docusate, they are there for different reasons. Sennosides is commonly use as laxatives, Lactulose is to allow more water in the poo-poo, while Docusate is to breakdown the poo-poo into small pieces. Depends on your mom's situation, usually taking Sennosides once in the morning and once in the evening, together with Lactulose once a day would be sufficient, but some people may need one more dose a day. However, some people may react better to Docusate but not reacting so well to Lactulose. Thus, some trial and error is required here. Don't get easily frustrated if the trial failed the very first time, be patient and work out the best approach, with the objective to improve the quality of life for yourself. Yes, it's for yourself. Imagine once you achieve the best balance, you would then back to your "good quality of life". For constipation, some exercises, e.g. contraction for the anus muscle, some leg movements and simply walking (to allow the abdominal cavity to move) are very useful. Of course, it would be good if it can be assisted by diet input, e.g. eating food with higher fibre content.

Likewise, for sleeping problem and lack of appetite, all these issues can be worked out, closely with your mom. If she can take the lead, it would be the best. She is incharge of her life and she should continue doing so. Having a positive attitude is really the first step of a good recovery!

I will try to address some other issues in my future posting, but John, your mom's emotional state is the most important part, once she is strong emotionally, the other issues would be easier to deal with.

Yours, Matthew

[This picture is sent by David C. Per David, this photo was taken 38,000 feet and it was a sun rise. The words were added by David's friend.]