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Re-vaccination after Childhood Cancer 

Under Singapore law, all children born here must be vaccinated as per scheduled.

“The School Health Service (SHS) provides immunisation to school children, according to the National Childhood Immunisation Programme. Please refer to the immunisation schedule below.”

Disease Type of Vaccine Primary Course Booster
Tuberculosis BCG At birth
Hepatitis B Hepatitis B

At birth
– 1st dose
1 month
– 2nd dose
5 to 6 months
– 3rd dose

Pneumococcal PCV 3 months
– 1st dose
5 months
– 2nd dose
1 to 2 years
Diphtheria*,
Pertussis & Tetanus
DTaP/DT/Tdap

3 months
– 1st dose
4 months
– 2nd dose
5 months
– 3rd dose

18 months
– 1st booster

10-11 years
– 2nd booster

Poliovirus IPV/OPV

3 months
– 1st dose
4 months
– 2nd dose
5 months
– 3rd dose

18 months
– 1st booster

10-11 years
– 2nd booster
&

Haemophilus influenzae type b Hib 3 months
– 1st dose
4 months
– 2nd dose
5 months
– 3rd dose
18 months
– 1st booster
Measles*, Mumps & Rubella MMR

12 months
– 1st dose
15-18 months
– 2nd dose

Table adopted from Health Promotion Board Singapore

Since Wawa is currently in the remission status. Her Oncologist has arranged her to meet the Immunisation Consultant for plans to re-vaccine.

During her first visit with the Immunisation Consultant on Feb 2017, she was given two jabs at one go simultaneously on both arms. As usual, she did not cry.. Good job Wawa!! The jabs were booster for Hepatitis B and Pneumococcal. The side effects are soreness & redness on the jabbed area and fever for a day or two. Paracetamol has been fed on a six hourly basis for fever.

Two more sessions of jabs have been arranged for every fortnightly. All taken vaccinations will be updated to her national health report with Singapore Ministry of Health.

Her planned revaccination (Fortnightly):

  • Hepatitis B & Pneumococcal
  • DPT & Polio
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Remission Status – Then?

So what comes next when your child’s doctor declares remission status?

It means… Good News!!! For cancer patients once they have completed all courses of treatments and scans with no new cells found, Doctor will announce you as in Remission Status, which also mean 99% cured!

Weird right? That’s because the average timeline for 100% is about 10 years. Hence, whats the fuss about that 1% right?

Yeah! Wawa has been announced to be in remission status in the month of September 2016.. Rejoice!! No more treatments.. Only quarterly planned scans for her and of course reviewing with her Oncologist, Plastic Surgeon and Speech Therapist.

Being in a remission mode, Wawa’s doctors have also made planned for her to be re-vaccinated.

So now, no more ipad, baby talks and “holiday at KKH” for her.. It’s back to serious schooling curriculum. Hehe….

We continue to pray for all other patients at KKH WARD 76 to fight strong and get well!!

A good read on remission can be found here

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Wawa & Her Enemy (Rhabdoid Tumour)

Wawa ~ my princess, my queen and my life is a chirpy and bright 8 years old girl. She was being diagnosed for Maglinant Rhabdoid Tumour on 2015’s Boxing Day.

Yes.. On Boxing Day, a round solid “golf ball” was found at her right neck, area below her ear lobe. My nightmare begins….

Maglinant Rhabdod Tumour is a rare and aggressive cancerous Tumour normally found at the kidney or brain area. Hers? Found on the neck. Yes! First case in Singapore.

Just to get the diagnosis right, she has gone through a series of scans (MRI, PET, CT, Ultrasound, X-ray, Bone, Heart, Ear), Fine Needle Analysis, Surgical Biopsy, Blood Test under the care of a team of dedicated Senior Consultant from KKH ENT & Oncology.

What to expect (Family Conference 1)

We as her family members will have to go through family conference arranged by the medical team. Me? All of sudden I have got so many authorization forms (I called them autographs) to sign.

  • Prepare your sets of questions prior your meeting session with the experts. Bring a pen and a notebook to jot down notes
  • Stay calm to meet the team of doctors in charged and assigned social workers

She has been given a project plan. A project with 9 cycles of chemotherapy, a surgery (Performed by a team of Professors and Senior Consultants from the Anthestic, ENT, Plastic, Neurology, Oncology) and sets of radiotherapy

Insertion of Port-a-Cath

Before any treatments can be given, all cancer children undergoing chemotherapy will need to insert a port onto their chest right below their shoulder.

Think of the positive.. I carried her and we laugh it out while walking down the aisle to the operating theatre. As it was our very 1st surgery though we’ve done biopsy, the doctors and the nurses started introducing themselves and the environment making it less stress and friendly in the operating theatre. Slowly as she laid on my arm with the gas mask attached on, she fell asleep in seconds. I hesitantly left the theatre with tears.

The overall procedure including recovery from anesthesia takes 3 hours.

Gently reminder ~ Do not give solid food right after the surgery. If they complain of hungry, just like my wawa.. Seek permission from the nurses to feed them sips of Warm water. Nurses will be there to guide you.

Chemotherapy

Soon after the operation, she’s able to talk and smile, not complaining any pain!

Doctors came in, accessed her port to hook up hydration drips. In no time, her first packet of chemotherapy begins.

We keep our fingers crossed.. Thankfully there were no side effects..

I believe different diagnosis would have different treatment procedures. Clear your doubts with the professionals.

Wawa’s started her first chemo before any removal surgery is because

  • The tumour was too big and it’s location was too closed to her facial nerves
  • The Tumour seems to be growing too fast overnight giving her really bad headaches causing her to bang her head hard on the bed, screaming and yelling.
  • To contain the spread of maglinant cells and hopefully to shrink the “golf ball” as much as possible for easy surgical removal at the later stage.

Amazingly on the 2nd day of her first set of chemotherapy, the Tumour shrunk significantly.

Slowly days passed by and here we are in the 2nd cycle of the chemotherapy. Hair starts to fall. I began reassuring her to say that it’s okay as the naughty hair are going gone. Pretty and clever hair will soon pop out.

Smiles continues…..

Warmth by the nurses led me on during countless sleepless night in the hospital….

What to expect (Pre-Chemotheraphy)

  • Pre-admission procedures such as height & weight, temperature taking, blood tests and/or urine tests are done to ensure the child’s body is in good condition
  • Children will be made to implant port-a-cath onto their right or left chest. This is being done by a 2 hours short surgery procedure. Don’t be surprised if pre-chemotherapy procedure starts right after the surgery.
  • Pre-hydration will be given before the actual chemotherapy begins. Chemotherapy will also end with at least 24 hours of hydration.

What to expect (Post chemotherapy)

  • Neutropenic Fever – This is very
  • common due to low neutrophil count. Body temperature above 38°C must seek immediate attention at the A&E
  • Vomiting, diarrhoea, constipation – Usually anti-vomitting will be given. However if symptoms worsen, head straight to the A&E
  • Lost in weights
  • Low count in white blood cells, red blood cells and platelets – Usually if they’re low in blood count. Their lips will be pale and they will feel lethargic. There is a minimum threshold the doctors will take into concern before performing any form blood transfusion. Be reminded to inform doctors if your child is prone to any allergic reactions. Anti-allergy medicine may be prescribed prior blood transfusion.
  • Drink lots of water.
  • Keep out of crowded places and ensure top notch personal hygiene.

Knowing the treatment process, getting yourself involves makes you grow your medical knowledge and train your mind to stay cool.

What to expect (Family Conference 2)

After completing 5 cycles of chemotherapy, the Head of this surgery project told me that even if wawa is accepting the chemotherapy well, Tumour shrunk, the active cancer cells are still there.

Hence, they gave me project plan 2 – SURGERY! A 30 hours long marathon surgery (Performed by a team of Professors and Senior Consultants from the Anthestic, ENT, Plastic, Neurology, Oncology).

  • Prepare your sets of questions prior your meeting session with the experts. Bring a pen and a notebook to jot down notes
  • Doctors being doctors. Imagine, I was in the room with my dad facing 5 Senior Consultants from the ENT, Onco, Plastic, Neurology and Anesthetist team, and 2 social workers who are making sure I don’t freak out. They will be very honest and blunt telling you to prepare yourself for the worst.
  • Get someone whom you trust to join you in the discussion

Well, let me share with you on my experince on the most horror decision I have to make. They gave me 2 difficult options:

  • If I do not agree to the surgery procedure, she will be left with 6 months to live.
  • If I were to agree to proceed with the surgery, success rate is only estimated to be 70%.

Being left with this kind of option, what would you do if you were me. My thinking process told me this… She was being brought to earth by me. It is not fair for me to not give her a chance to live. A chance.. Yes a chance to live!! So without much delay, I took up my biggest responsibility and guts to agree to the procedure.

Luckily, I managed to calm down and stand firm on my decisions made.

The Marathon Surgery

Held her hands and wheeled her into a brightly lighted operating theatre accompanied by her favourite soft toys and OT nurses dressed in gowns followed by a count down from 10 to 0 after being injected with anesthesia. Off she goes into dreamland filled with Disney cruises and Princess fantasies.

“”南無大慈大悲观世音菩萨”

Our prayers to the magnificent buddha above are being heard.

With much highs and lows, she has successfully fought the 30 hours long marathon surgery making it the longest children marathon surgery in KKH.

Good news – The tumour has been taken out & she survived with all facial nerves preserved.

Neutral news – Her speech will be soft. Her pronunciation will be unclear. Her legs will be weak. Due to poor swallowing ability, a NG feeding tube will be inserted from her nose down to her tummy.

Bad news – She has permanently lost her hearing of the affected ear.

Whatever it takes, the surgery recovery process ended with a month of hospitalization stay without any tears in May 2016!

NO TEARS AT ALL!! And with praises like “Best loveable patient” given from the team of doctors. I am very proud of her and I take my hats of her!!! I’m grateful to all the Doctors and Nurses from ICU, HD ward, Onco ward and therapists from physio and speech.

Next set of treatments & series of scans (such as MRI, PET, CT, Bone, Heart, Ear) continues….

And the report shows ALL MARGINS ARE CLEAR! NO VISIBLE CELLS ARE SEEN!! 🙂 🙂 🙂

CCF keeps them buzzing with FUN

Wii time at the CCF KKH Playroom

Night shopping at Cheers

Cookies making class organized by CCF

What to expect (Family Conference 3)

So chemotherapy checked. Surgery checked. Cells cleared. What’s next then?

For a more thorough recovery approach, I was being arranged to meet the Senior Consultant of Radiotherapy at SGH National Cancer Center.

He showed us his 25 sessions of intensive radiotherapy. Each session last for about 10 minutes. They are being given 5 days a week, leaving the weekends to rest.

Tomo Radiotherapy

Prior radiotherapy, wawa have to go through CT simulation to make her mask and to plot the x-y axis for rays to shoot.

Radiotherapy begins….. The team of radiologist were superb! The assigned social worker from Children Cancer Foundation were fabulous too! They decorated the machine with loads of duckling pictures (Wawa’s favourite Ming Ming Duck from Wonder Pets).

Brave wawa went through the 25 sessions herself!

Note: Parents are not allowed during the radiotherapy procedure. Children whom are unable to stay still will be put under General Anesthesia throughout the 10 minutes.

Things to note (Before radiotherapy)

  • Do not wash your skin with soap. Ensure the area is clean and moisturiser free
  • Take note the child is not having any form of fever

Things to note (After radiotherapy)

  • Apply doctors approved moisturiser (we used QV cream) onto the burned wound.
  • After sessions of radiotherapy, the skin will looked like sunburnt. Do if the skin is dry, apply huge amount of moisturiser. Do not be tempted to scratch the itchy patchy dry skin.
  • Drink lots of fluid to keep hydrated
  • Talk to your radiotherapy for more assistance.
  • Side effects includes lost of taste, unable to open her mouth wide, dry mouth

She’s done with all the chemo & radiotherapy

Some recommended care

  • Practice good hygiene. I have requested to make arrangements with the in-house Dentist for regular checkups. She has recommended wawa to use tooth paste, mouth wash and mouth hydration gel from the Oral 7 series.

Oral7 Dry Mouth Moisturizing Mouthwash, 8.5oz

Oral7 Dry Mouth Moisturizing Toothpaste, 2.5 oz

  • Mild body cleansing soap (e.g. Cetaphil). Try not to use SebaMed Baby Bubble Bath. I realized that it will caused the skin to dry out.

Cetaphil Gentle Skin Cleanser, For all skin types, 16-Ounce Bottles (Pack of 2)

Cetaphil Baby Wash and Shampoo with Organic Calendula, 7.8 Ounce

  • Moisturize the skin as often as you like using good non-greasy moisturizer (e.g. QV)

QV Cream For Dry Skin Conditions 500g

Qv Intensive Body Moisturiser for Extremely Dry Skin (Made in Australia) (450g)

“Listen to the professionals.”

“Don’t dwell on things you have no control over it at all.”

There will be sunshine and rainbow after the storm. In early August, she’s able to get out to play with the NG tube removed and all chemotherapy and radiotheraphy done!

She’s enjoying herself at Sentosa in August 2016. Still masking on for viruses prevention.

September 2016 arrives.. She is finally back to her mainstream school annnnd she has being given the green light to eat anything she wants!!! 

Upcoming next will be a list of monthly reviews with the Senior Consultants and scheduled scans.

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How to care for a cancer stricken child?

A cancer child needs extra love, attention and nutrition more than anyone else in the world.

Love

  • Spend quality time with loads of hugs, kisses and reassurance
  • Play with them. Baby talk to them
  • Cheers them. Motivate them.
  • Give them your full attention. Leave your mobile phones aside.
  • When they are bored on bed during chemotherapy session, do some arts & crafts, watch cartoons, sing a song or even read a book.
  • Talk to the social worker. Let them do the talking to your child, making them learn what they will be going through. Do not lie to them! Kids nowadays ain’t stupid!
  • Go to the library and borrow some pictorial books on cancer. Teach them what are cancer. Use baby descriptive words at first. Gradually introduce big words such as tumour, cancer, surgery and etc to them.
  • Encourage them to mingle and make new friends. Tell them they will never be alone.
  • Hold their hands or carry them to any procedures and/or during procedures. For surgeries if you can, try asking the doctors for permission to walk them into the theatre, and waiting for them at the recovery centre. Do try ask if the child can bring their closest items (e.g. soft toys, pillows, blankies and etc) with them into the operating theatre.
  • Reward them with gifts for achieving a task (e.g. medicine taking, injections and etc) done.
  • Do what you’ve promised. Don’t give them empty promises!

Aesthetics

  • Hair falling is traumatic espically for girls. Coax them to the hairdresser for a new short hairstyle. Be sensitive and patience. Try not to convince them to shave their hair off at one go.
  • Buy a hat. Any of those they like.
  • During shower time, use a mild soap to bathe them and to wash their hair. Slowly use your fingers to go through their hair. This will allow the hair to come off easily. Again, reassure them nice new pretty hair will grow out in no time.

Nutrition

  • Children under chemotherapy and radiotherapy treatments have very low immunity. Practice good hygiene such as washing & sanitising of hands frequently. Wear a surgical mask.
  • Ensure all foods served are freshly made and well cooked
  • Talk to your children’s dietician. Read up for more details on what can and cannot be eaten
  • Treatment causes them to puke and lost of appetite. Try not to force them to eat or drink. Serve sips of water or juices.
  • Feed them frequently in small portions. Changing of cutlery sets to plastics may help due to change in taste and smell
  • Buy them what they want to eat.

Be Responsible

  • Take ownership on your child’s condition. Many a time though you’re in the hospital, responsibilities are on parents. Feed them if you need. Entertain them if you can. Bathe & clean them if you can. 
  • Learn to read your child’s body symptoms.
  • Check with your financial advisors on the policies that you have bought for your child
  • Talk to your social workers for financial assistance scheme 

What to expect (Pre-Chemotheraphy)

  • Pre-admission procedures such as height & weight, temperature taking, blood tests and/or urine tests are done to ensure the child’s body is in good condition
  • Children will be made to implant port-a-cath onto their right or left chest. This is being done by a 2 hours short surgery procedure. Don’t be surprised if pre-chemotherapy procedure starts right after the surgery.
  • Pre-hydration will be given before the actual chemotherapy begins. Chemotherapy will also end with at least 24 hours of hydration.

    What to expect (Post chemotherapy)

    • Neutropenic Fever – This is very 
    • common due to low neutrophil count. Body temperature above 38°C must seek immediate attention at the A&E
    • Vomiting, diarrhoea, constipation – Usually anti-vomitting will be given. However if symptoms worsen, head straight to the A&E
    • Lost in weights
    • Low count in white blood cells, red blood cells and platelets – Usually if they’re low in blood count. Their lips will be pale and they will feel lethargic. There is a minimum threshold the doctors will take into concern before performing any form blood transfusion. Be reminded to inform doctors if your child is prone to any allergic reactions. Anti-allergy medicine may be prescribed prior blood transfusion.
    • Drink lots of water.
    • Keep out of crowded places and ensure top notch personal hygiene.
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    My child has cancer.. So what’s next?

    You are NOT alone! It’s NOT the end!

    Getting to know from the doctors telling you that your child has cancer.. You’ve got basically only a minute or two to go on the “What the hell!!!” mode.

    So what’s next??

    Prepare yourself

    • Oftenly, people surrounding you will tell you to seek second opinion. Don’t!! Don’t waste unnecessary time thinking of the otherwise..
    • Hear from the experts. Let them tell you more. Let them tell you what is the next step
    • Read up. Learn more about your children’s problem. 
    • Make friends to the other parents in the ward

    Trust your six sense

    • Decisions making ain’t easy especially on life threatening conditions where you have to sign loads of authorisation forms.
    • Do not self blame. No one wants this to happen.
    • Trust the experts and your decisions so as not to delay any process.
    • Learn to take baby steps.. Take one day at a time.

      Love yourself

      • Battling cancer is no longer just between you and your child. Family stands united.
      • Free yourself from stress for awhile. Love yourself. Go for some ME time entrusting your little one to their grandparents.
      • It is no wrong to cry out loud! Cry your whole heart out…

      Stand strong

      • Chemotherapy and radiotherapy is not going to be easy on your child.Stand strong. Cheer your little one up. You will be amazed how these little warriors fight through the war themselves
      • Take this time as a bonding session between you and your children

      Professional Help

      Renember no one wants their children to be sick. Cancer isn’t contagious. Cancer isn’t anyone’s fault.

      Oh ya! Doctors being doctors. Don’t be taken a step back when they tell you bombastic vocabularies and how bad the situation is. Be brave & steady. Fight together with your child!!