Category: For Seniors

Words Lim Teck Choon

Vertigo is one of Alfred Hitchcock’s more well-known psychological thrillers, named thus because the protagonist suffered from that condition as well as fear of heights. Unfortunately, the popularity of that movie led some to assume that vertigo, dizziness and fear of heights are one and the same. Consultant ear, nose and throat surgeon Dato’ Paduka Dr Balwant Singh Gendeh sheds some insight into vertigo and how it can be treated.

Entirety with

Vertigo 101

• Spinning around. “Vertigo specifically refers to a feeling of disorientation because we think that we, or the world around us, are moving, when we are actually not,” explains Dato’ Paduka Dr Balwant Singh Gendeh. It should not be confused with motion sickness and dizziness.
• It’s about the ears. In the past, it was assumed that vertigo was a sign that something was not quite right with the brain. Now, we know that the affected area is the inner part of the ear that helps maintain our sense of balance.
• It’s a symptom. Vertigo is not considered an illness; instead, it is viewed as a symptom of a problem that affects the sense of balance. Therefore, the duration and severity of vertigo can vary, depending on the problem that gives rise to it. We will look closer at some of these problems later.

First, let’s take a closer look at how our body maintains our sense of balance.

A Balancing Act

If we look at diagrams of our ear, we will come across what seems like a snail with a big head located in the inner ear. This “snail” is called the bony labyrinth, and like its name would suggest, its outer wall is composed of rigid bony layers to protect the soft tissue inside.

There are basically three components of the bony labyrinth: the cochlea, the three semicircular canals and the vestibule.

The cochlea is involved in maintaining our hearing rather than balance, so we won’t be focusing on it in this article. We are more interested in the other two components, the semicircular canals and the vestibule. These two components work closely together with other parts of our body such as the eyes and the nerves as well as bones to help maintain our position, whether we are staying still or in motion.

The semicircular canals. The three canals are filled with a fluid called endolymph. Each canal also has a cup-like structure called cupula. Every time we move, the endolymph also flows in the direction of the movement, and this movement is detected by thin hair-like cells in the inner lining of the cupula. These cells then generate signals, sent via nerve cells, to the brain.

The vestibule. The vestibule also has thin hair-like cells, found in the utricle and saccule. These cells help to detect movements in a straight line as well as acceleration in a horizontal direction.

Additionally, the utricle and succule has a jelly-like covering lined with tiny calcium crystals. Whenever we tilt our head or change our body’s position with respect to gravity (such as when we lie down), the calcium crystals get displaced in the direction of the movement and cause the hair-like cells to bend. These hair-like cells then send signals to the brain informing it about the change in our body’s position.

Our brain pieces the information received from the inner ear together with information sent through our eyes, skeletal system, etc in order to coordinate the maintenance of our sense of balance.

We now delve into three common issues associated with vertigo, but we should keep in mind that there are several other possible conditions that may give rise to vertigo as one of the symptoms. These include injuries and trauma, conditions that cause a sudden decrease in blood supply to the brain such as clots in a blood vessel and more.

Therefore, if we experience bothersome or frequent bouts of vertigo, it’s a good idea to consult an ENT specialist for a more thorough examination.

Benign Paroxysmal Positioning Vertigo (BPPV)

BPPV is the most common form of vertigo. “During a BPPV episode, we experience a sudden, brief sensation that we are spinning,” explains Dr Balwant.

An episode is normally triggered by specific changes in our head’s position, such as when we tilt our head or when we sit upright after lying down to sleep. BPPV can spur mild to intense dizziness that may last for a short period of time (a few seconds to a minute).

Is it serious? BPPV is rarely serious, and the affected person’s hearing will not be affected.

However, Dr Balwant cautions that the elderly may be more prone to falls should they experience a BPPV episode. Given how falls may lead to life-threatening fractures among people in that age group, he advises those affected to consult an ENT specialist if the episodes are frequent.

What causes it? BPPV could be due to the calcium crystals in the utricule getting dislodged and finding their way into a semicircular canal, where they interfere with the flow of the endolymph and make the brain think that we are moving when we are actually staying still.

Diagnosing BPPV. Interestingly, no sophisticated equipment is necessary. This is because when our head is moved into a position that triggers the BPPV, the brain will let us know that we are moving (when we aren’t) and our eyes react by moving in a specific pattern known as “nystagmus”. Thus, during the diagnosis process, the ENT specialist will ask for the patient to move his or her head into various positions while watching for signs of nystagmus.

How do we treat it? The ENT specialist will instruct us on a series of gradual positioning techniques called the Epley manoeuvre, designed to allow the dislodged crystals in the semicircular canal to find their way back to the utricle. We will also be asked to come back a week later for a follow-up examination.

If the episodes are intense, anti-vertigo medications such as betahistine dihydrochloride may also be prescribed.

Labyrinthitis Or Vestibular Neuronitis

Just like most tissues and organs in our body, various components of the bony labyrinth can also become the target of uninvited microorganisms such as bacteria and viruses. When infection occurs in one of the two nerves that connect the inner ear with the brain – called the vestibular nerves – that’s when a condition known as labyrinthitis or vestibula neuronitis arises.

Is it serious? Dr Balwant shares that people affected by labyrinthitis typically experience vertigo alongside dizziness, nausea and even loss of hearing. The hearing loss is normally temporary, but in very rare cases, it may become permanent.

These symptoms tend to occur abruptly, without warning, often after sudden movements of the head, and they may last for several days.

While these symptoms are normally not life-threatening, they can be intense and uncomfortable to undergo. They also disrupt our ability to work, drive and perform other routine activities.

What causes it? It can due to infection of the inner ear. It can also be brought upon by infection of other parts of the body, such as the lungs, stomach, etc. Just like with other infections, we become more susceptible if we smoke, drink excessive amounts of alcohol or indulge in other activities that can weaken our immune system. Allergies and stress may also be risk factors.

How do we treat it? The specialist will prescribe medications based on the cause of the infection. Bacterial infection, for example, can be treated with antibiotics, but infections caused by viruses will require a different type of treatment. Therefore, the specialist will evaluate the best treatment options on a case by case basis.

In the meantime, we should take plenty of rest and drink plenty of water to help us recover better and faster.

Ménière’s Disease

Ménière’s disease is quite rare, with studies reporting the prevalence rate as ranging from 3.5 per 100,000 people to 513 per 100,000.¹ This rarity will be small consolation to those affected by this disease, however, as the symptoms tend to be severe.

At a glance

Usually only one ear is affected, and the affected person can experience episodic attacks, during which the following typically occur:

• Vertigo. This often comes up without warning, and can last from 20 minutes to several hours.
• Hearing loss. This usually comes and goes during the early stages, but over time, the affected person’s hearing loss may become permanent.
• Tinnitus. The affected person will hear persistent noise (ringing, buzzing, whistling, hissing, etc) in the ear even when there is no external sound present.
• A “full” sensation in the ear. There is build-up of pressure in the affected ear or on the side of the head where the affected ear is.
• Attacks of dizziness.

Episodic attacks may occur in close succession over a few days.

Some people may also experience “brain fog”: they find it difficult to concentrate or recall things, and they are also prone to feeling fatigued and/or demotivated. Consequently, their abilities to sustain meaningful relationships as well as to perform at work or school are affected.

What causes it? Dr Balwant shares that one theory is that Ménière’s disease is the result of excessive endolymph in the inner ear. Normally, the endolymph is contained within a semicircular canal by a membrane. When there is excessive endolymph, the resulting pressure causes the membrane to rupture.

Now, the endolymph is rich in potassium ions, which is positively charged. When it leaks into the surrounding space of the inner ear, it brings with it excess positive charges, which disrupt the ability of the nerve cells in the inner ear to properly generate electrical signals to the brain.

Other researchers speculate that this disease is probably the result of blood vessels experiencing constrictions that reduce the amount of blood passing through them. Some also theorize that Ménière’s disease may be due to viral infections, genetic abnormalities and other factors that prevent the body from regulating the amount of endolymph fluid in the inner ear.

How do we treat it? Unfortunately, we have yet to find a cure. Dr Balwant explains that current treatment regime focuses on managing the symptoms.

• Medications can be prescribed for severe dizziness, vertigo, nausea, etc.
• Consumption of salt should be restricted to reduce the amount of fluid retained by the body (this will lead to a reduction of fluid volume and pressure in the inner ear).
• Smoking, caffeine, alcohol and chocolates should be avoided.
• Those experiencing emotional issues may find counselling and participation in support groups helpful.

Reference:

1. Alexander, T.H., & Harris, J.P. (2010). Current epidemiology of Meniere’s syndrome. Otolaryngol Clin North Am.;43(5):965-70. Retrieved in June 1, 2018 from https://www.ncbi.nlm.nih.gov/pubmed/20713236

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WORDS LIM TECK CHOON

There is no clear- cut answer to that question,” consultant geriatrician Professor Dr Tan Maw Pin says when we ask her this question. “There are many factors to consider.”

For one thing, the answer depends on whether the person has any existing health conditions. Someone with type 2 diabetes, for example, may find their sense of touch being affected by the condition over time, especially if their diabetes is not properly controlled.

Other factors may include physical geography and cultural elements. People in the Himalayan region, for example, have a high prevalence of eye problems such as cataract. In Nepal, glaucoma (an eye condition that can lead to blindness) is prevalent as the people in that country age – a survey from the World Health Organization and the Nepal Blindness Survey estimated that the rate could range from 3.2 percent to as high as 9 percent. It is thought that the prevalence of these problems could be due to a combination of poor nutrition, lack of proper sanitation, the climate and other issues.

“There are many variables, and therefore which sense will be affected first by ageing can differ from person to person,” Prof Dr Tan says. “There is no ‘secret formula’, sadly, as everyone is a unique individual! It may be more worthwhile to focus on how we can go for certain screenings as we age to detect potential problems early.”

Let’s find out what these recommended screenings are.

BLOOD PRESSURE

Have our blood pressure checked every year or two.

Where? At any clinic.

Why? Age is a risk factor for high blood pressure. The older we are, the more likely we develop this condition. Earlier detection will allow for better management and reduced risk of heart problems in the future.

EYESIGHT

When we are 40 or older, we should go for an eye screening every 1-2 years.

Where? At an optometrist’s clinic.

Why? This is to check for eye problems such as glaucoma and cataract. Glaucoma is a leading cause of blindness, and our risk of developing this condition increases the older we are.

GUMS & TEETH

Contrary to popular belief, we lose our teeth as we grow older because of gum disease (periodontitis), not age! “It’s possible to have a full set of teeth no matter how old you are!” says Prof Dr Tan.

She recommends going to the dentist once every 6 months, so that gum diseases and other tooth issues can be detected and treated early.

TYPE 2 DIABETES

Age (45 years or older) is a risk factor for type 2 diabetes. The risk increases if we are also sedentary, overweight and/or have high blood pressure and other risk factors.

Where? At any clinic. The test consists of taking our urine sample and using a dipstick to detect the presence of glucose. If the results are normal, the doctor may recommend repeating the screening every few years.

An added advantage of this test is that we can also detect the presence of problems in the bladder or kidneys by analyzing the presence of blood, nitrites, protein and white blood cells in the urine sample.

Why? Early detection of type 2 diabetes will allow for better control and a delay in the development of health problems in the eyes, kidneys, heart and more. If we are found to be at risk of developing type 2 diabetes, the doctor can advise us on making the necessary changes to our daily habits to prevent this.

IF WE HAVE A FAMILY HISTORY OF HIGH BLOOD PRESSURE, HEART DISEASE OR TYPE 2 DIABETES, IT IS WORTHWHILE TO BE SCREENED FOR THESE CONDITIONS EVERY YEAR OR TWO.

WHILE SOME SCREENING TESTS MAY SEEM EMBARRASSING OR UNCOMFORTABLE, THE BENEFITS MAY BE WORTH THE TEMPORARY BOTHER

HEARING

Routine hearing screening is not viable due to the low pick-up rate, but Prof Dr Tan says that the test is actually quite simple.

The doctor will run some simple activities, such as whispering near our ears and asking us to repeat what has been said.

If we have difficulties hearing normal conversations, we should consult an audiologist for further examination.

CERVICAL CANCER

Women should routinely get a Pap smear every 3 years from the time they turn 21 years old to the time they hit 65. This test is useful to detect cervical cancer and other abnormal conditions of the cervix.

BREAST CANCER

Women are advised to go for a mammogram every 2-3 years from the time they turn 45 or 55 (different guidelines offer different age suggestions), earlier if they have a family history. We can discuss this further with our doctor.

After the age of 70, the benefits of breast cancer screening are not clearly defined, but some people choose to continue going for it.

Where? Most hospitals and medical centres should be able to offer this.

Why? If breast cancer is detected while it is in an early stage, there is a higher chance of recovery.

PROSTATE CANCER

While there is a screening test for prostate cancer in men, called the prostate- specific antigen (PSA) test, Prof Dr Tan says that a more effective screening method is to have a physical rectal exam performed by a healthcare provider. It may seem like an uncomfortable or embarrassing experience to some people, but it is actually a simple and quick (about a minute or two) procedure. This method also allows for detection of haemorrhoids, lumps and other unusual growths in the rectal area.

MEMORY & BRAIN FUNCTION

Perhaps lesser known compared to other screenings, the memory test (also called a neuropsychological test) allows for the measuring of the capacity of our brain to function in areas such as memory and language skills. This test consists of simple question-and-answer sessions, and the results will be measured against a standardized model.

Where? Most government health clinics have special health documents for older persons which include memory screening. Also, Prof Tan mentions that it is recommended that doctors do this opportunistically when an older person attends their clinic or hospital.

Why? This test can allow for early detection of issues such as memory loss, dementia, Alzheimer’s disease and other often age-related brain function issues.

SOME COMMON SCREENING TESTS MAY NOT BE AS USEFUL WHEN WE GROW OLDER, WHILE OTHER TESTS BECOME MORE USEFUL.

These days, we can walk into any screening facility, and pick and choose for ourselves the ones we want from a list of available screening tests. However, we do not necessarily need to take all of them – some screening tests may actually offer negligible benefits to people in the older age group.

A ggod rule of thumb to follow is to first discuss with a are professional on the types of screening that will the most value for our Ringgit. HT

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WORDS PANK JIT SIN

In conjunction with World Alzheimer’s Day on 21st September, HealthToday shares 10 ways to prevent Alzheimer’s disease (AD) which were presented by Professor Karl J. Neeser, of the College of Public Health Science, Chulalongkorn University Bangkok, Thailand, at the 3rd World Congress on Anti-Aging, Aesthetic, Regenerative, Nutritional and Exercise Medicine 2019 in Kuala Lumpur.

1. KEEP YOUR BRAIN HEALTHY

Using our brain to solve complex tasks and puzzles, and engage in discussions will help prevent the brain from growing ‘stale.’

2. KEEP YOUR BODY HEALTHY BY EXERCISING

Exercise gets the blood flowing to all parts of the body. As we know, blood carries oxygen. The lack of oxygen interferes with the metabolism of our brain neurotransmitters. Exercise also triggers the production of endorphins, serotonin, dopamine, and norepinephrine. These are chemicals which carry signals in the brain, hence any increase in these chemicals improves brain function. Older folk can engage in yoga, tai chi and qigong as forms of physical exercise.

Click on this QR code to see what the MIND diet is all about.

3. EAT A BRAIN-HEALTHY DIET

In general, what’s good for the heart is good for the brain. Therefore, the Mediterranean diet, which consists of fresh fish, nuts, fruit and vegetables, and very little red meat or processed carbohydrates, is great for the brain. More recently, US researchers came up with the MIND diet, which is a modification of the Mediterranean diet, and another diet called the Dietary Approaches to Stop Hypertension (DASH).

4. CUT DOWN ON SUGAR, ESPECIALLY FRUCTOSE

Did you know that sugar is one of the most addictive substances on earth? Yes, it is just as addictive as some drugs. Also, sugar damages our brain neurons and make them more likely to die. High levels of sugar in the brain is also linked to memory loss. Here’s the catch—fructose found in fruit is more dangerous than glucose in terms of causing damage to the brain. Therefore, we need to limit our consumption of sweet fruit, too.

5. REDUCE STRESS

Avoid stress whenever possible as stress makes your brain release corticosterone, a type of hormone that blocks the brain from receiving and retrieving information. This is the reason why we sometimes cannot remember the details of a particularly stressful event.

6. KEEP ACTIVE SOCIALLY

A Harvard Health Report on AD 2018 reveals that healthy social relationship with family and friends is linked to better mental longevity. Additionally, a healthy sex life contributes the same benefit.

7. HAVE ENOUGH SLEEP

The same Harvard Health Report also reveals the clear link between sufficient sleep and lower risk of brain disease. Sufficient sleep isn’t enough though, as the sleep should also be of good quality. Lack of sufficient quality sleep causes brain plaque to build up, thus leading to a decline in brain health.

8. GET VITAMIN D, PREFERABLY FROM SUNLIGHT

Vitamin D helps in the transfer of information in the brain. Those persons with higher levels of vitamin D in their blood are less likely to develop brain disorders such as dementia and AD. Vitamin D deficiency is also linked to a higher risk of depression and other diseases such as type 2 diabetes.

9. MAINTAIN A HEALTHY BODY WEIGHT

Yes, everything is linked. If we eat a brain-healthy diet and exercise, then it is very likely that our weight is within a healthy range. If not, then we will have to contemplate extra measures to reduce weight. Maintaining a healthy body weight isn’t just good for the brain and heart, it is also good for the joints.

10. PROTECT THE BRAIN FROM TOXINS AND ELECTROMAGNETIC WAVES

Pollution in the form of pesticides, mercury, cadmium, benzene, formaldehyde and many more harm our health by disrupting our biological processes. Therefore, any step we take to reduce exposure to these pollutants will be beneficial to our wellbeing in the long run. With the advent of smartphones and tablet devices, there is the worry of exposure to electromagnetic radiation as well. The claim that electromagnetic radiation is safe and within a certain limit could be a fallacy, as recent epidemiological studies suggest the only safe exposure level is zero. HT

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WORDS RACHEL SOON

Like many couples, Shahreen Hazaline and Muhamad Shukor are a pair of complementary opposites; one bubbling over with energy and laughter, the other calmer and more soft-spoken. Yet both share similarly warm smiles when they look at each other. It’s hard to imagine that just over 3 years ago, in the middle of Shahreen’s fourth pregnancy, they found themselves facing her diagnosis of stage 3 breast cancer. For this HealthToday issue, they share their story of a road travelled together.

NOVEMBER 2014: SUSPICION

It was in the 12^th week of her pregnancy when Shahreen noticed the lump in her breast that wouldn’t disappear.

“I could feel something inside, like biji-biji (seeds).” She waves a hand over her chest as she recalls. “When people breastfeed, they sometimes get lumps because of mastitis or [blocked] ducts. But those usually go away if you rub repeatedly at them. This didn’t.”

What she found doubly strange was that she wasn’t even breastfeeding anymore by then; her third child had been weaned some weeks ago. Curious, she brought the matter up to her gynaecologist on her next routine check-up. Examining Shahreen, she scheduled an ultrasound that same day.

The lump appeared to be a liquid-filled cyst. Uneasy with the results, the gynaecologist referred her to a breast surgeon, who did a biopsy.

“The surgeon didn’t say ‘cancer’, just ‘something’s wrong’. But I already started to cry a lot. I cried as we walked by people in the hospital, like someone had passed away.” Shahreen mimics a dramatic wail, then laughs. “It was bad enough before with the hormone imbalance from pregnancy. My gynae referred me to a counsellor; I think she was alarmed at how upset I was.”

The surgeon recommended an operation to remove the lump when the baby was 16 weeks old and fully formed, to reduce any risks from anaesthesia. Alternately, they could wait until after the pregnancy, but there was a high risk the cancer—if it really was cancer—would progress rapidly in that time, especially due to Shahreen’s increased oestrogen levels.

Shahreen left the final decision to Shukor. His heart fell.

“I had to make a decision for two lives,” he tells me. “How could I let go of either one?”

In the end, they chose to go ahead with it. They felt that knowing the truth was better than uncertainty. And there was no ignoring the lump itself.

DECEMBER 2014: CONFIRMATION

A month later, they operated. The results indicated stage 2 breast cancer.

Shahreen was advised to start chemotherapy as soon as possible. Her doctors assured the couple that the baby would not be affected, as the drugs would not cross the placental barrier.

It was still frightening. They had never bothered to learn much about the disease. After all, she checked none of the usual boxes of risk factors: she had no family history, she was under 40 years old, she had breastfed all her children, she didn’t smoke or eat much junk food.

December was supposed to be their long-awaited umrah pilgrimage. But treatment couldn’t be postponed, the oncologist said, as the cancer could go far in 2 weeks. Neither could she start treatment before the trip; her immune system would be so weak that the crowds at Mecca would put her at risk of infections.

Instead of boarding a plane, Shahreen found herself entering the hospital’s cancer centre, where she saw a patient being wheeled out from a chemotherapy session. Right before her eyes, the woman abruptly vomited in the hallway. She wondered if that would be her eventually, too.

How did this happen? In her mind, thoughts overcrowded. Day and night, she couldn’t stop crying. Cancer is a taboo in Malaysia. How will people react to the news? What have I done wrong? Was it a sentence by God, a kind of retribution for something I’ve done?

In fact, just 2 weeks before, Shahreen had resigned from her job in the government and joined her husband to work as an independent unit trust agent. She wondered if other people would point fingers at things like that, saying she had brought the cancer on herself. Maybe it was sceptical of her, she says, but it was a real fear.

She asked Shukor to keep her diagnosis a secret. Only their respective parents and Shukor’s older brother were informed, and Shukor always obtained her consent first before telling anyone new.

At one point, she tried sending an email to the National Cancer Council Malaysia (MAKNA), the only cancer society she knew then.

“I told them about my diagnosis. They replied and asked for my phone number; they wanted to advise me.” Shahreen smiles. “But I backed off, because I was afraid.”

JANUARY–FEBRUARY 2015: STRUGGLE

Shukor did his best to support his wife in her isolation. She was scheduled for six cycles of chemotherapy up to April, each lasting 3 weeks.

“It was a very stressful time for her,” he tells me. “So I took her to the hospital whenever she wanted to go, stayed with her when she was admitted to the ward. I let go of a lot of other things to spend more time with her.”

It helped that their self-employment allowed some flexibility. Nevertheless, finances were a struggle. No longer eligible for a government employee’s medical coverage, Shahreen had a private medical card, but with how recently it had been obtained, she and Shukor would still need to pay for the first few hefty bills out of pocket first.

But there was little choice. She was pregnant and needed treatment as soon as possible.

“We had to tighten our belts. It definitely affected the time I had for the business. But if I was working under a company, I wouldn’t have been able to take so much leave.” Shukor’s smile is soft as he looks at his wife. “Because I was working independently, I could take care of her more.”

Was it frustrating for him at any point to be a caregiver? Shukor shakes his head.

“It was more a sadness. Everybody who has a life partner, a spouse … they already have things planned for their lives, right?” He takes her hand. “So when something like this happens, those dreams—you just keep them aside to deal with whatever is happening to her, right now.”

MARCH 2015: COMING TO TERMS

Things changed for Shahreen when she met another cancer survivor for the first time.

Her counsellor had advised her to come for a patient support group meeting at the hospital. But being afraid, she made up her mind to arrive late, hoping it would have finished without her and she wouldn’t have to actually talk to anyone.

“But when I arrived, as it turned out, the meeting had been cancelled.” She laughs. “The counsellor was like—’what a pity, she’s come all this way’ and tried to find something else for me.”

Coincidentally, there was an ongoing art exhibition in the hospital by Elaine Therese Lim, a painter who had survived ovarian cancer. The counsellor introduced Shahreen to her and left them to talk.

“So we chit-chatted … and I told her all the things I was feeling. And she said to me: the fact you got this disease isn’t because God wants to punish you, or that you’ve made a mistake. None of that. If God wants to give it, anyone can have it. There’s no need to think so hard on the reasons.”

It was like a weight lifted from Shahreen’s shoulders.

“After meeting her and being comforted by her, I felt really good. It was the first time I’d met a cancer survivor. And I started to accept the fact that … okay, I’ve got this. Fine. So get through it.”

A few days after that encounter, Shahreen opened her Facebook page and posted, for the first time, a status update acknowledging she had cancer. Dated 15^th March 2015, it begins with: “God always has a better plan.”

“To my surprise, there was no negative feedback,” she says. “All of my friends just gave encouragement and support.”

It emboldened her and removed her doubts. In subsequent posts, she wrote all the details down: about her disease, about the chemotherapy she was going through, about the ‘chemo baby’ she carried.

“After meeting Elaine Therese, I thought: why not share these things?” Shahreen smiles. “I thought it might help someone out there who needed—not the medical details, but the knowledge that it can be done, even during a pregnancy. Maybe one of the reasons God gave me the cancer was so I could do that.”

APRIL 2015: DELIVERY

At the end of April, Shahreen’s fourth child, Zhafran, arrived with no complications. To her relief, she was able to give birth to him naturally as she had her other three children; as her gynaecologist had promised, the chemotherapy had no effect on that.

She shows me a phone photo of a healthy, chubby-cheeked young boy sitting in front of a plate of cake.

“Alhamdullilah, he’s okay. He turned 4 on 28^th April this year.” She beams as she swipes through more photos of her son’s birthday celebration. “In fact, when I gave birth to him, he was around 3.85 kg! That’s normal for our family. My eldest was around 3.95 kg.”

Unlike most pregnant women, Shahreen’s overall weight had remained unchanged for months until her delivery date. Her body had been shrinking while her son’s had been growing.

Two weeks after Zhafran’s birth, Shahreen left him in the care of a friend while she underwent a positron emission tomography (PET) scan and a second operation on her lymph nodes. Due to the involvement of radioactive particles, she wasn’t allowed to be near her son for some days.

After the operation, based on the number of affected lymph nodes and the size of her tumours, the doctors modified her diagnosis to stage 3 breast cancer, which initially shocked her. Hadn’t she been doing chemotherapy all this time? But it was explained that the initial diagnosis had been incomplete as they couldn’t assess more than the breast lumps while she was pregnant.

Furthermore, many cancer cells in the lymph nodes were dead, which meant the chemo was working. Shahreen would still have to go through another four cycles of chemotherapy on a different medication, with an additional month of radiotherapy, but there was hope.

To her disappointment, unlike with her previous three children, this meant she would not be able to breastfeed her newborn son for his first year. Patients undergoing chemotherapy were generally recommended to wait until 6 months after their final cycle to prevent health risks to the child.

“Even with a pill to suppress the milk, it would just come out, and I would have to let it be.” Shahreen pauses, for once without a smile. “You have to understand … I breastfed my first three children until all of them were 3. When it’s something so natural to you, to have to just wipe or throw it all away … it felt very sad.”

MAY 2015, AND ONWARDS: LIFE GOES ON

When I ask if they had childcare issues, the couple exchange looks and laugh.

“He can cook very well!” Shahreen says proudly. Shukor is more self-deprecating and explains that they had a hired helper to take care of the children. Though yes, he did cook as well.

With her eldest being 8 at the time, the couple aren’t sure the children understood what their mother’s illness meant, even with her weight loss, her falling hair and eventually (with Shukor’s help) her shaved scalp.

“We explained to them that mum was ill. But for them, ‘being ill’ normally meant having a fever for a little while and then getting better, right?” Shukor says. “Something like cancer, that goes on for months … it was a bit harder to understand, I think.”

Shahreen thinks that the sense of normalcy was also helped by the fact that she never had to stay at the hospital for more than 2-3 days at a time, even during her initial cycles. By the third cycle, she was asking the oncologist about going back to work, and got the green light based on her blood count and her physical condition.

“I was bored staying at home and not going anywhere. So I would do chemo, and after 2-3 days I would just go out and work. The children didn’t seem to notice a difference.” Shahreen raises an eyebrow. “Is that a good or a bad thing?”

One of the things Shukor also had to handle was a barrage of well-intended recommendations for alternative treatments from others. He tried to filter through them with the help of Shahreen’s doctors and friends of his own who had medical backgrounds.

One of them, who had done research in the field of alternative medicine, explained to the couple that clinical research was a multi-stage process, and some products labelled as ‘clinically researched’ might have only been tested in animals.

“After learning more about it, I thought it’s better to follow what the doctors said.” Shukor smiles. “Especially because she was pregnant, I didn’t want to take the risk on whether the hospital’s medicines and alternative ones would complement or fight each other.”

DECEMBER 2015: REMISSION

Thirteen months after her diagnosis, the doctors declared Shahreen no longer needed treatment. She was to come in for a follow up every 6 months; in 2018, the oncologist changed it to once a year.

Even though it’s been more than 3 years, they still feel the difference in their lives.

“When you’re healthy,” Shukor says, “you feel like you’re going to live till 60 or 70 years old. But when something happens, you feel like your life will be shorter … everything we planned for the long term needed to be adjusted.”

“Before this, we used to think: okay, we have a lot of time, we can do whatever whenever, next year, or the year after,” Shahreen adds. “Like—when I was in secondary school, I was a hiker. But after getting married, I just stopped, thinking that’s something from the school days, no time for that now.”

In 2017, Shahreen hiked up Mount Kinabalu with a group of fellow survivors. It was one of over 10 mountains and hills she tackled that year. She also launched herself into things she had never considered doing before, like dragon boat racing and bowling with others from the Breast Cancer Welfare Association (BCWA).

“At university, I used to work part-time at a bowling alley. We had free games, but I never played, always thinking ‘oh no, what if my ball goes in the drain and people laugh at me?’” Shahreen grins. “But now I’m more open to whatever happens. ‘Just do it!’ Us survivors, we feel like we have a second chance. There’s so many more things we want to try.”

I ask if the two of them have advice for those starting their own cancer journeys, or with loved ones doing so.

“Don’t wait,” they both say.

Shahreen tells me about stories from her support groups; people would delay their treatment, looking for alternatives, only to come back when the cancer had progressed even further. It was ironic, she says, that people were willing to entrust hospitals with a credible diagnosis of their condition, but not with credible treatment.

To friends and family of patients, the couple also advises that they not add too much stress to the patient, and instead try to find means of emotional support.

“When someone has cancer, they’re already weighed down by heavy thoughts,” says Shukor. “Things like how easily the cancer can spread, or when they’re going to die.”

“The easiest thing you can do is to find them a support group, whether on Facebook or elsewhere. Those groups have survivors, even doctors,” Shahreen adds. “A patient can sometimes be afraid of taking that step. Help take them there.”

“Also? Don’t Google everything.” They laugh together. HT

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