Celebrating a Life Well-Lived, and a Heart Well-Loved

For those who may wish to say “till we meet again” to Fiona, and celebrate a life well lived, and a heart who loved and gave much, come and join us as we remember her.

Wake Services will be held on Saturday and Sunday evenings, the 6th and 7th of September, at 8pm, at Parlour 5, PJ Modern Casket, Jalan 229, Section 51A, Petaling Jaya. Because of the many people who will wish to be there, we are suggesting that the Saturday service be attended by members of Agape Chapel and her sister churches (PJGH, SSGC, BSGC, SJGC, BPGC), and the Sunday service by friends, colleagues, and people who know her through her work. Relatives are welcome to attend at any time.

Finally, a brief funeral service will be held at the same location at 10am on Monday, 8th September, followed by burial at Subang Lutheran Garden, Subang Permai. For those who do not wish to drive to SLG, a bus service will be provided. Priority will be for from out-of-town relatives, but others are free to use this as well if there are vacancies.

In The Arms of the Lord

Dearly beloved, Fiona has gone home to the Lord. After a few days of fighting increasing breathlessness, she succumbed to breathing difficulties at 10.15am on the morning of Friday, September 5, 2008.

In the couple of days before this, Fiona's breathing difficulties were increasing to the point where she required constant sedation. Even in this state, her breathing was far from easy, and her few waking moments were very uncomfortable, to say the least. As caregivers, our hearts were breaking to see her like that.

Our prayers, then, were still for God to touch her with His healing hand. But if it was not to be, then we asked for His mercies to take her quickly. Fiona's fears have always been of pain, something that most cancer patients have to contend with.

Her going home quickly then was an answer to our prayer. She experienced but a few days of discomfort before her home calling. Our response, amidst the grief, was “Thank you, Lord”. Our God is gracious, even in our times of trouble.

"I have fought the good fight, I have finished the race, I have kept the faith." 2Tim 4:7

Today, we believe and know, Fiona is enjoying the incredible delights of being in God's presence. In His presence, there is no pain, no sadness. In His presence, there is only unending joy and peace. In His presence, she has her full reward for her faith in her Lord and Savior Jesus Christ.

We know this because she held on to her faith and never let go. In her last days, she spoke of going home to Jesus, and spoke it with a quiet and confident assurance. Jesus, thank you for your grace, so precious.

"Sure goodness and love will follow me all the days of my life, and I will dwell in the house of the LORD forever." Psalm 23:6

As family members, we grieve the loss of one who was so special, and we have no words to describe our pain. Our grief is great, but less than what could be, because we know where she is now, and know we will surely see her again. We count the moment, days, and years one by one till we will meet her face to face again in the presence of the Lord.

"The LORD gave and the Lord has taken away; may the name of the Lord be praised." Job 1:21

Amen.

A Quiet Rest

Fiona has finally had a relatively quiet day with only minor episodes. After days of heart-rendering struggles with breathlessness, the doctors have sedated her with a constant supply of morphine.

However, this also has the obvious effect of keeping her asleep or at least very groggy at all times. In addition, her dependence on oxygen is increased and she requires a mask at all times (as compared to just a nasal prong previously).  We are thankful, however, that she at least has been able to get some quiet rest, albeit in a sedated state.

Fiona's second chemo appointment has been cancelled.  The oncologist has determined that this is best as, in her assessment, the chemo will more likely cause harm than good at this point.  Given Fiona's severely weakened state, we agreed with this.

We continue to be thankful for the many supportive wishes and offers of help we have received. We are thankful too for the many prayers.  We continue to believe that God can still work a miracle at this point.  Please pray for Fiona to receive peace at this time, that she will have good rest.

Upheavals

It has been a trying two days for Fiona.  Her resting has been interrupted by severe panic attacks manifested in great breathing difficulties.  During these attacks, she requires a face mask and a maximum oxygen flow of 15lpm, and even then breathing requires a huge amount of effort.  In the midst of these attacks, it is clear that she is in great distress and anxiety.

Something to give thanks for:  The doctors say that the fluid in her lungs are clearing well.  Her airways sound clear and her intake of air is not obstructed.

It would seem then that the episodes are at least partially psychological. However, this does not make it any less real for her.  The episodes take an enormous amount of physical, emotional, and mental energy out of her.  To address this, the doctors have prescribed some medication, but this will take some time to work.  

Please, please pray against fear, and for God's peace to prevail at all times.  She should then regain her strength faster and be in better shape for the ongoing battle.  Pray too for upliftment in her mind and spirit. She is feeling mentally, physically, and emotionally tired from these episodes, and needs a recharge.  Pray for a spiritual recharge for her entire being.

Angels Watching Over Her

Through the turmoil of the last 24 hours, we are convinced that God has sent angels to watch over Fiona. Some of these are in the guise of people who amaze us with their compassion and dedication to blessing others.

One such person is Dr Loh Ee Chin, who is one of the very few palliative care doctors in Malaysia. Dr Loh was a true blessing today.

Last night, at about 1.30am, Fiona's breathing worsened. She was put on nebulizer to clear her lungs but she eventually required the oxygen supply to be turned up to the maximum level of 15 litres per minute due to increasing severe breathlessness. This lasted well into the morning, and even at 15lpm, she was experiencing panic attacks. The deterioration was shocking.

When contacted, Dr Loh immediately came to the hospital despite it being a Sunday and having her own plans for the day. After an examination, Dr Loh proceeded to check and clear the catheters coming from Fiona's lungs, and drain whatever fluid she could. This was a long procedure but made comfortable by Dr Loh's gentle and caring touch. Within a couple of hours of the procedure, Fiona was able to reduce her oxygen intake to about 4lpm.

At the time of this entry, she is sleeping well, after having had a simple but tasty late dinner of porridge and papaya (which she enjoyed immensely). She is on 3-4lpm and is comfortable. All praise and thanks to God for the angels He sends in different guises to remind us of His love and faithfulness.

No Words

The doctors believe the cancer has infiltrated the lungs, as evidenced by the way Fiona is breathing.

She is resting now, under some sedation by drugs meant to clear congestion in her chest. She will remain partially sedated for the next 3 days in an attempt to help her regain her strength. Her breathing remains very laboured. We hope this will improve with medication.

At this time, she remains under close watch by Jeff and his sister Marianne. We would ask for no visitors for the next few days so that Fiona has 100% chance at rest and recovering her strength. Thanks for understanding.

Rough Seas

The past two days have been very tough for Fiona. She started Chemotherapy as planned, a long series of IV drips. It has caused a fair bit of discomfort, but she seemed to ride through it fine.

Last night, however, Fiona went into a series of panic attacks where she had great difficulty breathing. As this entry is posted, that dificulty continues, even with greatly increased oxygen supply. Observing her effort to take each breath, it looks as if she is fighting for her life. The doctors are speculating as to the cause of this but we do not yet have a clear answer.

Please continue to pray for relief from this difficulty.

Busy Rest

Even as Fiona seeks to regain her strength at the hospital, many things are happening.

On Monday afternoon, the procedure to insert catheters into both lungs took place as planned. We give thanks that it went well. Much fluid was extracted and the catheters are staying in for up to a week to allow the lungs to fully drain.

The planned CTPA scan took place on Tuesday. We are very thankful that Fiona's lungs and heart looked fine. However we are much concerned that the radiologist believes that there may be small lesions in the liver. The oncologist believes that this is consistent with recent liver test results which have not been good.

As a result of the continued breathlessness and liver findings, it has been recommended that Fiona starts a new round of Chemo sooner rather than later. We expect the first cycle to begin Thursday.

Day to day, Fiona is getting good rest at the hospital. She is sleeping much better now. We continue to hope that the breathlessness will cease. Right now, she continues to be dependent on the oxygen supply. While she is awake, we continue to be very thankful that she is being well looked after. Thank you again to all those who are spending time with her or cooking for her. You are a great blessing to us.

Please continue to pray hard. Pray for the breathlessness to clear, and for the chemotherapy to work well without causing side effects. God bless.

Still Running

With the weekend over, Fiona is pretty much where she was on Saturday afternoon i.e. breathing on less oxygen, but still dependent on it. She is able to come off for short periods (a minute or two), but any exertion, such as taking a few steps, or even coughing, and she will need relief from the oxygen supply.

Later today, she will undergo another procedure to insert a "pig-tail catheter", ultrasound guided, into her right lung to drain more fluid. We're hoping that this helps the breathlessness sufficiently to allow her to go off the oxygen. A CTPA scan (CT Pulmonary Artery) is also planned tomorrow to rule out the possibility of a pulmonary embolism (blood clot).

When she strengthens, we will restart chemotherapy, probably on Gemcitabine+Cisplatin. The disease is progressing, and the doctors suggest that we need to address that as soon as Fiona is strong enough.

Either way, Fiona will have to remain in the hospital until at least the end of the week.

For those who have called to find out her progress and/or have visited, thanks for your concern and prayers, they are much appreciated. Many thanks too to those who have already provided help in so many ways, from taking care of the kids to sitting with Fiona while Jeff dashes home for a bit.

We also great appreciate Jeff's colleagues and clients who are so understanding when he needs to take time off to be with Fiona. The flexibility they have exhibited is unprecedented and a real blessing.

If you plan to visit, Fiona is at UH, Menara Timur, Ward 7TE, bed 6. Do call Jeff first to check on Fiona's condition. There may be days when she requires recovery time from one procedure or another, or just tired. Visits should not exceed 9pm, as she does need her rest badly. (And if you are not well, it would be better if you didn't come as she can't really handle any further problems at this time!)

In terms of help, we are so blessed to be getting lots of it. Our family members and church friends have covered Fiona's needs completely for food and company. They have our unending thanks.

If you do call or SMS and do not get a response, please forgive us. As you can imagine, we have been fairly inundated with these and may miss out responding to some. Check this blog and please tell others about it. We will keep it updated every couple of days or so. It would be a lot stressful than having to individually respond to every message and missed call.

Above all, thanks for your prayers, and don't stop praying.

The Calm after the Storm

It has been a tumultuous few days but there is a calm after the storm and for this we are so thankful.

After the last visit to see the doctor, Fiona's breathing had steadily deteriorated and breathlessness started with less and less exertions. On Wednesday, this looked so bad that we contacted Prof Yip to get us connected to Hospis Malaysia. This connection took place very quickly and we were able to pick up an Oxygen Concentrator to assist Fiona in her breathing.

The machine seemed to become a double-edged sword as Fiona immediately was able to breathe better, but also quickly became dependent on the oxygen supply, so much so that she quickly became distressed without it. Rather than allow her to grow stronger through better rest, it seemed to worsen her ability to breathe independently. Worse, her sleep quality did not improve as her continued and repeated breathless episodes at night prevented her from getting any real rest.

This all came to a head on Friday morning when we realised that the worsening of her condition needed intervention in the form of another visit to the hospital. Even the trip to the hospital was difficult, as it required Fiona to use a portable oxygen tank. Upon arrival at the hospital, we realised the extent of the deterioration of her condition when she was not able to make the walk into the hospital but required a wheelchair and a continuous supply of oxygen.

A quick X-ray revealed that the amount of fluid in both lungs had visibly increased. And Prof Yip's assessment of her condition was that she needed immediate hospitalization. So Fiona was admitted on Friday morning. With an acute shortage of space, Fiona was given a bed in an open ward rather than a preferred single room. Still, it was a peaceful ward, and the environment seemed alright.

Arriving at her bed, Prof wasted no time and began the procedure to extract the liquid from Fiona's right lung. After a painful 30 minutes, some 700ml had been extracted. This was followed by a painful few hours of recovery, as the local anesthesia wore off and Fiona experienced the full pain of having had a thick needle in her back. After the pain had dimmed to a bearable level, it became apparent that there was little effect on Fiona's breathing. She was still as dependent on the oxygen.

Still, the night bore some good fruit. Fiona was able to get more rest than on previous nights.

In the morning, Prof decided to repeat the lung tap, but this time on the left lung. This procedure, as painful as the first, extracted some 900ml of fluid. Worse, this was followed by terrible coughing spasms lasting 90 minutes, an awful experience. When this finally ceased, Fiona was able to rest, but it seemed that the second procedure also had had little effect on Fiona's breathing and dependence on oxygen.

We then decided that she should stay in the hospital for at least a few more days as it would be very difficult to cope at home without medical care. After this, Fiona rested.

Things were very different in the afternoon. Waking from her sleep, she declared that she felt better and decided to try weaning herself off the oxygen supply. Amazingly, she was able to stay off for 20 minutes when she could barely have managed 20 seconds earlier that day! However, because her blood oxygen levels were measured to be below normal, we decided to put her back onto the oxygen supply, but at no more than half the previous flow rate.

Things only got better from then on. She was able to have dinner with little oxygen assistance, she was able to make a trip to the bathroom (something we so easily take for granted), and she was able to speak to visitors (when breathing would previously have caused breathlessness). Her energy levels were clearly picking up, and smiles were more forthcoming and frequent.

Even as this entry is posted, she sleeps soundly, breathing smoothly and seemingly effortlessly, something not seen a while.

There is little to say except to praise God for His mercies and His quiet miracles to remind us that, even in a storm, He is still a sovereign and faithful God. Thank you Lord.

And for all your prayers and kind thoughts and wishes, thank you and God bless you.  Please keep praying.

Tough Going

Fiona had breathing problems in the last day or two, especially at night. We paid a visit to Prof Yip today and her assessment is that the disease may have spread into the lungs, thereby causing even greater problems than just the water alone. She suggested that we restart some form of treatment right away. We agreed on Aromasin (a form of Hormone Therapy) and that will start today. She has also suggested that we look to a Hospice to get a tank of oxygen for Fiona should she need it. This is not someplace we wanted to get to. Please keep praying.

Slow Recovery

Hi all. This is just a quick update on Fiona's condition.

Wish we could report that all is well. Unfortunately, Fiona continues to experience breathlessness and coughing. The coughing comes and goes, but the breathlessness has not shown any improvement. If anything, it might be getting a bit worse.

The coughing also got especially bad yesterday. A quick visit to the local GP revealed that she has developed a throat infection. It's back onto antibiotics for now. Will be contacting the doctors at UMMC to see if anything can or should be done about the breathlessness.

Directions

Our visit to UMMC yesterday revealed possible reasons for Fiona's slow recovery as well as some new options for treatment.

Firstly, a chest X-ray revealed a penumothorax (a pocket of air outside the lung) and a partial collapse of the right lung. These are likely the cause for Fiona's continued breathlessness. (She is able to move about well, but gets breathless after climbing a flight of stairs or walking a short distance.) The doctors say that this should improve over time, maybe a few weeks. Please pray that this happens quickly.

There is also the possibility that the Pleurodesis procedure was not successful, which means that, after all the effort, it will not stop the increase of water in the lungs.

We have been asked to consider restarting some form of treatment soon. It has been suggested that Fiona starts another course of Hormone Therapy, either Aromasin (Exemestane) or Faslodex (Fulvestrant). While these are less toxic than chemo, they still have their side effects. Please pray along with us for wisdom in this decision.

Our next appointment will be on September 2.

On The Road to Recovery

Hello all!  Thank you for the many messages expressing your caring and concern.  It has been good hearing from so many of you and we appreciate your fellowship.  We have also received some suggestions for persons to contact regarding Oncologists in Singapore.  Thank you for those, they are very helpful.

As a quick update, we are glad that Fiona is recovering from her last procedure.  The recovery is a bit slow.  She continues to cough and the pain in the ribs and back are still there, albeit reduced in intensity and frequency.  Her gastric pains are also significantly less but not all gone yet.  Of greater concern is that she still has a tendency to get breathless after minor exertions like climbing the stairs.  Our next appointment with Prof Yip is on Tuesday.  In the meantime, we would appreciate your prayers for a complete recovery from these and regaining of strength.

Oh Yum!

It's great to celebrate family events. Good food, great company ... and did I say good food? :-) Last night, we had a small dinner with lots of food to celebrate Fiona's mum's birthday. A scrumptious chinese meal at the new Overseas Restaurant at Jaya One. Pork ribs, "Ham Yee Fa Lam Po", and much much more were on the menu. Mmmm.

Fiona did "a Fiona" and we ended up with food enough for twice as many people as were present (as usual)! To her credit, no one complained as we all tucked in. And we finished it up with a lovely cheesecake. Happy Birthday, Mum!

Natural Recovery

Following her pleurodesis procedure last friday, Fiona has been recovering. However, we had to make a trip to the local GP as we suspected that she might also have an Upper Respiratory Tract infection, evidenced by the ongoing coughing and low grade fever. The GP confirmed our suspicions and gave her, among other things, antibiotics to fight the infection and voltaren tablets to "open up" her lungs.

Since then, much of the pain from the procedure has subsided but there is still some. And she is still feeling some breathlessness. We suspect that this is because of the short, shallow breaths she takes to avoid pain. Please pray for these symptoms to subside, and for complete healing from the procedure.

Moving forward, we are restarting her juicing regime. Apart from the usual apples and carrots, we are also looking into lemongrass and soursop. Even as we take this break from chemo drugs, we believe that the natural goodness that God has created can help her build up her own body's immunity to fight the disease. Please pray with us over these few months as we move in this direction.

p/s We are also still looking for a good recommendation for an oncologist to speak to in Singapore. Does anyone have a suggestion?

A Finished Race

We said goodbye to a dear uncle today, the youngest brother of Jeff's dad. Jacob Tham Mook Chee, you will be missed, but we know that you are with our Lord now. You have run your race, and you have fought the good fight and now you wear the crown of glory that has been prepared for you. We grieve, but our joy is that we too have a risen hope in Christ, and so we will see you again in but a little while. Dear friends, please pray for the young family that he leaves behind, that they will be comforted and know God's grace and provision even at this time.

A Long Day, but All Done

After a lot of waiting, from 2pm thru 6pm, the radiologist finally freed up to do the pleurodesis procedure for Fiona. Because it was already at the end of the day, they put her at UMMC's observation ward at the Trauma Centre, where there would be someone to observe her after the procedure.

The procedure involved injecting Tetracycline into the pleural space (i.e. the cavity between the chest walls and the lung lining) and leaving it there for 2 hours. The idea was to create sufficient irritation that the lungs would "stick" to the chest wall, thereby sealing off the space and not allowing future accumulation of fluid. They warned us that this was going to hurt a lot, and we were quite concerned, given Fiona's high sensitivity to pain, even with the morphine they would give her. From past experience, we knew that morphine did little for Fiona other than to take the edge of any pain.

It was quite a miracle. During the injecting and the 2 hours of waiting, Fiona felt absolutely no pain, nothing, zip. She even went as far as to question if they had done the procedure at all. We were filled with a sense of wonder. Someone had obviously been praying hard, and our God had answered. We were very thankful.

At the end of the 2 hours, they drained the fluid. Again, no discomfort. Then they took out the tube that had been inserted into Fiona's lung and had been there for the past 2 days, a very uncomfortable and painful thing. She looked quite well at the end of the procedure as they cleaned her up applied a gauze dressing or two.

We finally got home at about 10pm. Tired, but very thankful that it was all over. And still with a sense that God had been at work today, watching over Fiona, and with a sovereign hand to play in the events. Thank you, almighty and gracious God.

Better Morning

Hi all, thanks for your prayers. Fiona is feeling better this morning. Still has a tendency to cough a bit much, to the point where it can be a challenge to keep food down. Please pray for that to subside. The gastric is better today and the back soreness is more bearable.

We're heading to UMMC in a while to see if we can get the tubes out and the pleurodesis done. It will be an uncomfortable procedure, so please cover Fiona in prayer. God bless.

Double Ouch

There was apparently a kink in the tube under the dressing. We discovered this in the Chest X-Ray Fiona was asked to do upon arriving at UMMC. Well .. we didn't see the kink in the X-Ray. We just saw a lot of remaining water in the lung.

After waiting from 2pm to almost 4pm, they finally ushered Fiona into the room. After removing the kink, they extracted another 1.1 litres of fluid, then reapplied the dressing. Poor Fiona was badly in pain.

The pain wasn't just from the procedure. She also gave herself a bad case of gastritis from taking her Tramidol painkillers without antacids. So back pain plus stomach cramps. So we're home again, and she's taken all the pills to stop the two sources of pain.

Back to the hospital tomorrow, 2pm, for what we planned to do today i.e. remove the tube, then pleurodesis. The latter will be very uncomfortable. Would appreciate your prayers for Fiona.

A Painful Tube

Following our discussion with Dr Marniza, we were ushered to Radiology where Prof BJ was to do an ultrasound-guided procedure to extract the fluid from Fiona's right lung.  This is meant to provide relief from symptoms of breathlessness and coughing.

Ouch. Despite 2 rounds of local anaesthesia and a Pethadine (sp?) shot, Fiona still felt the pain as they inserted a tube into her back and into her lung, and attached a bag to collect the fluid.  Some 1.2 litres was drained.

She has come home now, with the bag by her side, in the hope that the remainder of the liquid in her lung will drain completely overnight.  The plan is then to perform a procedure tomorrow called "Pleurodesis" which means to stop the liquid from forming and accumulating.  We will go back to the hospital tomorrow at 2pm.

Please pray for a good rest for Fiona and no pain.

Taking a Break

Hi friends and praying pals.  Today was supposed to be a day of discussion with the doctor, to confirm if there was disease progression, and then to decide what to do next.

So the Oncologist, Dr Marniza Saad, did indeed confirm, in her professional opinion, that there was disease progression, and decided to therefore take Fiona off the study drug (Avastin) programme as it was apparently doing no further good.  We were then left to decide whether or not to start a new round of chemo.  Chemo is tough.  It kills the good cells and the bad.  Sort of a "scorched earth" approach.  So we've decided to take a break.  No chemo for the next 6 months.

During this duration, Fiona will return to a healthy regime of juicing, anti-oxidants, exercise, and de-tox, to allow her body to rest while rebuilding her immune system. We will also continue regular visits to the Oncologist, and have scheduled CT scans once every 3 months, to keep an eye on things. If there are signs of further progression, then we will revisit our decision.

On top of this, we are also considering seeking a second opinion, probably from Singapore. Does anyone know of a good Oncologist there?

Catching Up

Hi dear friends. We know you are keen to know what has been happening with Fiona, and there has been quite a bit happening indeed.

To bring you all up to speed, Fiona recently (April 2008) completed her 3rd round of Chemo (Xeloda + Avastin study drug). At that point, she was relatively symptomless, with no pain but with some breathlessness due to the liquid in her right lung. The plan then was to just continue with the study drug and to keep monitoring her condition. Day-to-day, Fiona was quite well and able to move around, and even working on a part-time/freelance basis for a couple of days a week.

However, about a week ago, she detected a new lump in her left breast. The question is: Is this new? Or just not previously detected?  The doctors need to revisit earlier scans to determine this.  The implications are real.  If this is new, then existing treatments must not be working and will be stopped.  A new round of chemo will likely ollow.  If this is not new, then existing treatments can continue for now.

We will be seeing the doctor again next Wednesday.  Your prayers would be most coveted.

Reboot

Hi all, dear friends, family members, fellow journeymen (and women) through this existence! As a family, we used to have a little blog on a private web domain. Was fun for a while, but we've decided to move to Blogspot. Saves us maintaining a website just for a blog, and these guys (who belong to Google, in case you did not know!) do a wonderful job for free. So here we have moved and shall remain for the foreseeable future. We will be moving our old posts here eventually, perhaps in some archive space, in case you want some sense of history. So cheerio, and see you soon!