Before GH

One thing I forgot to mention about our discussion with the Penang office rep of St Stamford Modern Cancer Hospital Guangzhou was that he did offer to pass information on my dad's case to the doctors at the hospital. So a few days later my dad called the office to obtain updates. In short, their preliminary suggestions are cryotherapy and immunotherapy.

So when we met Dr D, we had lots of questions and obtained much information. In summary,

(1) Cryotherapy is not suitable for dad because it merely removes tumours, not treating the cancer as a whole since my dad's cancer is of unknown primary source (highly suspect pancreas though).

(2) There is immunotherapy for pancreatic cancer but it's still at experimental stage, with success rate of less than 20%.

(3) Certain immunotherapies have become gold standard for treatment e.g. of lung cancer. Unfortunately, not for pancreatic cancer.

(4) However, the hospitals in China have their own method of immunotherapy and so Dr D had no comment on that.

(5) Treatment such as immunotherapy can be considered after having gone through all other gold standard treatments i.e. as a last resort. My dad is not at that stage yet since FOLFOX is a viable option for him.

(6) At Mount Miriam, FOLFOX is administered via chemo port and so patient doesn't need to be warded but it'll cost about RM4k-5k per cycle. There is also oral option but it'll be stronger dose and it's 3 weeks per cycle (total cost is similar). We can attempt to ask GH for these alternatives.

(7) If after having exhausted the standard treatments and yet still not working, then, cost aside (it's my hypothetical question to Dr D), she would recommend biopsy on the existing lumps and also sent for Next Generation Sequencing (NGS) to better understand the cancer cells. She cautioned, however, that the use of the latter is based on the theory that mutation causes cancer, which may or may not be true. Thereafter, immunotherapy can be considered.

So our current plan now is to ask GH's oncologist for (in this sequence) oral FOLFOX, chemo port or reclining bed. If they can't offer of these, dad is willing to try the regimen for 2-3 cycles. If sleeping in the ward turns out to be a significant problem, then he'll continue at Mount Miriam.

By the way, once again my dad didn't follow doctor's prescription: he didn't take omeprazole everyday. During my last trip, I reminded him a few times that the PCU specialist said, except for the breakthrough painkiller Oxynorm, all other medicine are to be taken everyday. Haiz.

Autism: the positives

Autism the positives

Atlas Reactor: NEV:3

NEV:3 is quite an unusual firepower freelancer. Like Gremolitions Inc., hitting one target does less damage than a typical firepower freelancer but hitting more than one deals significantly higher damage. She is good against enemies who love to bunch up together and/or line up in a straight line. Quite strong versus melee freelancers, if she can survive.

This is my current build:
(read this wikia for details on abilities and mods)

(1) Catarang - Kitten Mittens (2 loadout points)

This mod increases NEV:3's survival, especially since her catarang can hit all targets in its path. I don't like Inertia and Meowch because they are too conditional to get value out of them. Frisky is ok since energy mod is kind of neutral.

(2) Embiggify - Fat Cat (2 loadout points)

More shield! Collar mod is a favourite of many players but I prefer slow to root. Frisky is too conditional.

(3) Mousetrap - (unequipped)

No leftover loadout points. Previously when I used haste mod on the dash ability, I took Feline Good.

(4) Acrocat - Disc Fever (3 loadout points)

Oftentimes, I can choose to dash in such a way the return catarang can hit at least one target and so this mod is great in giving more pain. Previously, I used Catwalk, which was pretty good too. I guess it depends on whether you want to be a little more aggressive or defensive.

I don't think Hot Tin Roof is a good mod as it takes away the flexibility in positioning.

(5) Cataclysm - Feral (3 loadout points)

This mod performs consistently for me. Catnip is not bad too but positioning is difficult if you want to get value out of this mod by ensuring returning catarangs hit some targets. Being mighted and hitting a chosen target the following turn takes less guesswork.


In these gameplays, my NEV:3 here was using the haste mod on her dash.



Kwong Wah

I have found the best chendol in PJ and possibly in Malaysia:

Kwong Wah chendol 1

Kwong Wah chendol 2

(Apologies for the photos' quality. The chendol looks better than what's depicted here).

It's by Kwong Wah at Happy Mansion, Block C.

It is also the most expensive (RM 5.50) but it's worth it. The ice is soft. Not too greasy from coconut milk. The gula Melaka (Malaysia's special palm sugar) is not overpowering. Chednol is the soft type but doesn't disntegrate at a mere touch.

Chendol lovers, go try it. I'm certain you'll like it.

Char Kuay Teow @Ming Tien

Ming Tien is the name of  popular food centre in PJ. It used to be located at Taman Megah. Ban and I had been there only a few times because finding carpark was difficult. It has since relocated to a covered one-and-half storey (first floor is noticeably smaller than second floor) building at Bandar Utama, with both outdoor and indoor carpark.

On my second visit, I tried the so-called Penang Char Kuay Teow:

Ming Tien

The portion was huge, but priced at RM 7 / 7.50 (can't remember). Ingredients were ok. It was, however, oily and salty, making it a bad dish. The following week, an acquaintance tried it and thought it was ok. Hmmm I'm not sure I'll try it again though.

CEP

One day, I walked into the master room and saw this:

CEP

Me: *smiled and laughed* What are they doing?
Ban: The Council of Eminent Persons are having a meeting.
Me: What? Hahahaha.

(inspired by Malaysia's Council of Eminent Persons)

To decide

There were more information from my dad to add on to the previous update:
  • The upper back pain was much more manageable. He took Tramadol and paracetamol for his lower back pain instead
  • Started limping a little. Taking Oxynorm 1-2 times a day
  • The 2 hard lumps at his waist grew bigger. There was a third small one that emerged
  • Feet and palms felt easily felt cold
  • Vomitted twice a week
  • Hospice nurse raised the possibility that the hard lumps could be indirectly causing the vomiting
During his appointment with palliative care unit specialist:
  • Increased Oxycontin from 20mg to 30mg. Initially, try 30mg day 20mg night (or swap them if leg pain is more acute at night). Can increase to 30mg x2 if needed
  • All medicine, except for Oxynorm, are supposed to be taken on a daily basis. Previously, we thought that Tramadol, paracetamol and Omeprazole were to be taken on ad hoc basis. However, can reduce Tramadol if back pain improves
  • It is ok for my dad to continue physiotherapy at the private practice since it helps and the methods used are safe
During his appointment with oncologist:
  • Vomiting could be due to cancer growth displacing organs within
  • Initial thought was to refer dad to surgeon but deferred judgement to her senior specialist
  • The doctor came back with senior specialist who then proclaimed dad to be fit enough for second-line of chemotherapy to hopefully treat all 3 symptoms. This time on FOLFOX regimen
  • One cycle of FOLFOX consists of Day 1: 22 hours of infusion, Day 2: 22 hours of infusion, Day 3-14: rest. Need to be warded for 2 nights. 
  • After 6 cycles, test its effectiveness e.g. whether the lumps decrease in size. If effective and my dad tolerates it well, then continue for another 6 cycles. If dad feels uncomfortable, then continue for 4 more cycles instead
  • Potential side effects: vomit, nausea, peripheral numbness, diarrhea, constipation
Dad is supposed to let them know his decision in 3 weeks time.

In the afternoon, we went to the Penang office of St Stamford Modern Cancer Hospital Guangzhou. Their hospital is in Guangzhou, China. My uncle highlighted this hospital to my dad recently. I tried searching the internet for information and review of this hospital. I managed to get only about 4 to 5 opinions (I ignored testimonials on the hospital's website), which was paltry. They had positive feedback though.

We went there with the objective of just listening to what options they might have that are better than chemotherapy and refrain from committing to anything. My dad doesn't like chemotherapy because it's tedious and makes him very tired on treatment day (and sometimes the day after too). However, note that unlike other patients, he suffered no other side effects. FOLFOX regimen is longer and needs dad to be warded for two nights. Hospital beds, so far, are not comfortable for him i.e. it causes pain to his back (this predates cancer diagnosis), regardless of public or private hospitals.

The surgeon consultant at the office stated that they couldn't help my dad because they needed to know the location of tumour in order to treat it. They're focused on treatment, rather than investigation. He was quite skeptical of Penang GH's oncologist's recommendation to undergo chemotherapy and advised us to seek second opinion from Dr D at Mount Miriam (we provided him medical reports and letters, and hence Dr D's name). Bear in mind that he is a surgeon, not an oncologist.

We think consulting Dr D is a great idea as dad is very comfortable with her and so we will meet her a weekend before meeting GH's oncologist.