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.