CASES MANAGED

LESSONS FROM MY PATIENTS

 Overview

 It is essential for patients embarking on the healing journey to get a fair idea of the power inherent in healing therapies.    Hence, we felt that the e-guidebook would not be complete without recording some of the clinical cases that we have managed using the integrated cancer care protocol. 

We have treated hundreds of patient using the integrated approach, however it is not possible to describe all the cases managed in this guidebook.  We have thus selected a spectrum of cases that demonstrate the principles of integrated cancer treatment.

 Each of the cases described has been individually managed and therefore differ in not following a set-protocol.

 Treatment outcomes

In standard oncological practice, treatment outcomes are often measured along the following parameters:

Þ    Response rates

Þ    Remission – full /partial (pathological, clinical, radiological, biochemical, etc)

Þ    5 year survival figures

Þ    Disease free/Progression free survival period.

We have been offering integrated cancer care since August 2011 and therefore the longest period of follow up is about 3 ½ years.   We are mindful of the fact that this does not meet 5 the year survival statistic, which is considered the gold standard of conventional oncology.  However, it is also noteworthy that in the majority of cancers, more than 80%  that  remain in remission for 2 years or more, have an excellent chance of beating the disease.  In other words, recurrence risks generally diminish with time, although late recurrences are still possible.

Therefore, for the purpose of objectivity/ comparison with conventional treatment outcomes, only patients with at least 2 years disease free survival are described.   This information is being shared as we strongly feel that the knowledge we have acquired in this period is significant enough that it should be shared with other patients.  Most importantly, these approaches (and therapies) have  excellent safety record as it involves nutritional and metabolic interventions devoid of ‘drugs’.

Lessons from my patients

Each of them in their unique way have enlightened me and advanced my own understanding of cancer.  They have been crucial as they have guided my own research.  In overcoming their cancers I was able to formulate new concepts directed toward improving the results of conventional treatments of cancer.   Often times I am humbled by their gratitude as they triumphed over serious disease without the use of toxic drugs and the courage that they have taken to follow the road less travelled. This journey would not have been possible without their participation and I owe them immeasurably.

 Case 1.  Advanced breast cancer stage 3

 Name                 :            Mdm A 

Diagnosis          :            Advanced breast cancer Stage 3

Age                    :            72

Date first seen  :            July 2011

Background  

Mdm. A’s cancer was deemed inoperable due to its advanced stage and she was counseled by the breast surgeon and oncologist for radical radiotherapy and chemotherapy.  As she was terrified of the treatment complications, she had flatly refused this line of treatment and looked for an alternative.

 She came to our clinic in July of 2011.  When I first saw her, her overall general condition was satisfactory but she had a 5-6 cm ulcerated growth in the left breast which had infiltrated into the chest wall.   She had severe left upper limb lymphedema (swollen upper arm) with sever impairment of function. 

Under our care, she underwent a combination of nutritional therapy, orthomolecular supplementation, detoxification and major auto hemotherapy (ozone therapy).  No chemo and radiation was administered.

The first signs of improvement occurred around 3 weeks.  Her lymphedema gradually subsided and the veins in her left fore-arm were more easily visible for vene-puncture.  Over the next 10 weeks, 80% of the lymphedema cleared and she regained almost full function in the upper limb.

At this stage the cancer did not show any signs of increasing in size, neither was there any reduction in size.   However, the patient was quite certain this is what she is comfortable with and she had great faith.  By the 3rd month, we started seeing signs of healing in the ulcer and over the next 9 months the lesion gradually decreased in size, until it was a 2 cm superficial ulcer which had a scab over it.

There was no further change in the next 4 months.   She was persuaded to undergo surgery to excise the residual growth.  In January 2013 she underwent a nipple–sparring ‘wide local incision’ which completely removed the growth and Histology confirmed it to be an invasive ductal carcinoma of the breast.

It has been 3 ½ years now and she remains cancer free.  Most importantly, she prevailed over the cancer and did not have to suffer the ill-effects and complication associated with chemotherapy and radiation.    She also did not lose her breast.

 Case 2.  Persistent high grade CIN III

 Name                 :            Ms. F 

Diagnosis          :            Persistent high grade Cervical-intraepithelial neoplasia

Age                    :            31

Date first seen  :            June 2012

Background  

Ms. F was referred to me by a fellow gynecologist with a recurrent high grade CIN (cervical intra-epithelial neoplasia).   This young lady was first diagnosed with high grade CIN III during a routine cervical screening.   She underwent an excision called LLETZ (Large Loop Excision of the Transformation Zone) and the Histology confirmed a high grade CINIII with associated HPV infection and all the margins of excision were free of neoplastic changes.

 Note: CIN III is considered the same as carcinoma in situ (CIS) or Stage 0 cervical cancer. The pre-cancer has not yet invaded deeper tissues. However, if not treated, there is a high chance it can progress to invasive cancer.

 On follow-up 9 months later, she had a recurrence of the CINIII and was counseled for a ‘cone biopsy’ of the cervix.   This was promptly done.

Her problems however resurfaced less than 1 year later.  At this point she was counseled by several gynecologists towards a hysterectomy* (with ovarian preservation) as the persistent high-risk HPV infection and the recurrent CINIII was considered a high risk for progression to cervical cancer.   

She was hesitant as the recommendation meant the removal of her uterus.  She desperately wanted to conserve her uterus as she has yet to complete her family.  She was then referred to me for another opinion and consideration of alternative approaches.   

 

She came to our clinic on the June 2012.   After careful consideration of all the possible options she decided to take ‘a route less travelled’ and underwent metabolic and nutritional therapy with no surgery.

On regular follow up at 3 monthly intervals (liquid based cytology and biopsy as indicated) we saw a gradual normalization of the cervical cytology.   By December 2012 she had fully recovered; including an amazing restoration of much of the cervical anatomy, and deemed disease free.

 At 2 years follow up she remains well with no recurrence of the cervical pathology.  Even more significantly, is that throughout the follow-up period she has not suffered from any illnesses.  Prior to undergoing the metabolic and nutritional therapy she had several episodes of upper respiratory tract infections per year.  She also managed to retain her uterus.

 Hysterectomy -  A surgery to remove a woman's uterus or womb. The uterus is the place where a baby grows when a woman is pregnant.  After a hysterectomy, you no longer have menstrual periods and can't become pregnant. 

Case 3.  Ovarian Cancer stage 3C

 Name                 :            Ms. C 

Diagnosis          :            Ovarian cancer stage 3C

Age                    :            19

Date first seen  :            Jan 2012

 Background

This unfortunate girl, following several weeks of non-specific symptoms (mainly abdominal distension and discomfort) was diagnosed with advanced ovarian cancer.  She had sought the opinion of several gynecologists and all of them offered the following 2 options:

Þ Immediate surgery for removal of the cancer and a hysterectomy (removal of the uterus).  To be followed by 6 cycles of chemotherapy.

Þ Immediate chemotherapy (neo-adjuvant) for 3 cycles and followed with debulking / completion surgery.  This will then be followed with a further 3 cycles of chemotherapy for a total of six cycles.

In effect both methods would have rendered her sterile (infertile) and would have induced a menopause.  For the stage of cancer that she had, she was given a 20-30% chance of 5 years survival. 

The young girl and her family could not accept this and wanted other options.  There was none ‘offered’ under the conventional method.    Ms. C was then referred to me by another  gynecologist for the further management of ovarian cancer.

I first saw her in January of 2012.   She had gross abdominal distension, severe ascites (fluid accumulation in the peritoneal cavity) and bilateral leg swelling.  Imaging by high resolution ultra-sound showed a 15 cm right ovarian tumor highly suggestive of malignancy.  Her tumor markers were grossly elevated (CA-125 in excess of 34,000).

After long discussions with the family, they opted for ‘limited’ surgery ie. Removal of the cancer and the right ovary and conservation of the uterus and the left ovary.

During surgery, she was noted to have metastatic spread to the peritoneal surfaces and a cancer arising from the right ovary.  We did a right oophorectomy (removal of the ovary) and ‘debulking’ surgery with omentectomy and lymph node sampling.   She was surgically staged as Stage 3C.

She made an excellent post-operative recovery and we were able to institute concurrent nutritional/ metabolic therapy in the post operative period.

Upon discharge, she was reviewed weekly with ultra-sound scanning and CA125.  Over 8 ½ weeks, her markers gradually normalized and we were able to confirm she was in remission with no active cancer.  All these was achieved without the need for chemotherapy and through the ‘limited surgery’ we were able to avoid the hysterectomy thus saving her uterus.  She had returned to normal function including establishing normal menstrual cycles.  She was married about 18 months later and had a successful pregnancy soon after. 

It has been more than 3 years since the diagnosis of stage 3C ovarian cancer and she remains cancer free and on continued surveillance.

Note:  Ovarian cancer is notorious for presenting very late (>75% in stage III or IV) and is associated with poor prognosis in its advanced stages. 

Case 4.  Recurrent ovarian cancer stage 4

 Name                 :            Mdm. D 

Diagnosis             :            Recurrent Ovarian Cancer refractory

               (not responding) to chemotherapy, for  palliative care

Age                    :            47

Date first seen  :            April 2012

 

 Background

In April of 2012, Mdm. D was referred by fellow gynecologist with the problem of recurrent ovarian cancer having tried multiple cycles of chemotherapy and considered to be refractory (resistant or not responding to chemotherapy) with a view towards palliative care!

She had a complicated and long history, summarized as below:

-- She was 47 years of age and had 2 children, both delivered via C-section.  Prior to the childbirth, she had severe endometriosis and underwent 2 surgeries for the removal of the endometriotic cysts.

-- In 2010, she developed stage 4 ovarian cancer with (lung metastases) and had a ‘laparotomy’ and hysterectomy and debulking surgery.  This was followed by 6 cycles of chemotherapy.

-- The cancer showed response but was not in remission.  She was subsequently given a 2nd line of chemotherapy with limited success.

-- About 1 year after initial diagnosis, she was showing evidence of progressive cancer. 

-- A second surgery (in actual fact this was her 6th surgery overall) was attempted to try and debulk the recurrent cancer.  However the surgery was abandoned as the adhesions were too severe and the cancer too extensive.  She was then advised to try a 3rd line of chemotherapy which she duly complied for 9 cycles.   Unfortunately for her, the cancer was progressive in spite of the chemotherapy.

She sought several opinions from oncologists in Jakarta, Singapore, Penang and she was told there was little else on offer and that she should get her ‘affairs in order’ and advised that the treatment be palliative only from now.

Despite all that she had gone through, she was not ready to give up and that’s how she ended up in our clinic.

  

She walked into our clinic in quite a terrible state, having lost considerable weight and in severe pain despite multiple analgesics (pain killers).  In fact she found sitting in the consultation chair unbearable.

From clinical assessment and imaging (CT and MRI) she had a very large invasive cancer about the size of a ‘melon’ ie. 25cm in dimension.  The cancer involved the urinary bladder, the ureters bilaterally, the rectum, sigmoid and descending colon, small intestines and the anterior abdominal wall.

The situation didn’t look good and conventional options had been exhausted.  We explored the possibility of ‘palliative radiotherapy’ as we had some experience in this being useful for palliation but this was fraught with potentially life threatening complications especially bowel  perforation.

 After going through much discussion and looking at the various possibilities, we decided on the following:

 Þ debulk the tumor as much as possible (mindful of the fact that she had 6 previous surgeries and the last one was ‘open-close’ and then to

Þ follow - on with metabolic therapy.

The reason behind this was to try and achieve immediate pain control and reduce the tumor volume.

She was commenced on intensive nutritional support pre-operatively to improve her health and to prepare her for the surgery. 

She underwent the surgery in April 2012.  Needless to say it was a very complex surgery, needing reconstruction of the bladder, re-implantation of the ureters and considerable bowel surgery.  There was considerable blood loss, but we were able to avoid ‘colostomy and urinary diversion’.

Though surgery was able to remove about 90% of the cancer, there was still considerable residual tumor in the bowel, bladder walls and other parts of the pelvis and this was decided best left to be dealt with by other means.

She recovered well from her surgery and within 48 hours was able to establish bowel activity.  By the 2nd day was able to take orally. 

We continued with the concurrent nutritional and metabolic therapy.  She stayed for a total of 12 days in the hospital, with excellent return of function and mobility.

5 1/2 weeks after surgery and with metabolic therapy we were elated not just with her progress and recovery but the fact that she was deemed cancer free.   Her tumor markers had normalized and imaging showed no traces of cancer.

She continued with her regular follow up sessions and after 3 years, she remains ‘cancer-free’ and on continued surveillance.

Case 5.  Primary Vaginal Cancer

 Name                 :            Mdm. E 

Diagnosis          :            Primary vaginal cancer

Age                    :            42

Date first seen  :            October 2012

 Background

Mdm. E had 2 children both delivered by C-section and for many years had  been suffering from severe dysmenorrhea (period pains) and heavy menstrual flow.  She was diagnosed with severe adenomyosis and pelvic endometriosis and having failed all sorts of medical management finally agreed to a hysterectomy on September 2011.

She was well for almost 1 year when she developed bloody vaginal discharge and post coital (after sexual intercourse) bleeding.  She was found to have growth in the vagina and a biopsy confirmed it to be a cancer.   

She had been given 2 options: 

Þ Radical radiotherapy with concurrent chemotherapy

Þ Radical surgery (ie. Vaginectomy) and reconstruction of the vagina.

She was extremely distraught and devastated with this diagnosis.  She knew that both treatments carried morbidities  that could severely affect her sexual functions as well as potential bladder and bowel complications.

She saw several gynecologists and the options were the same.   She finally came to see us.

 

I first saw her on the Oct 2012.   On assessment, she had multifocal disease.  A diffuse small volume cancer at the vault (roof of the vagina) and a 2.5 cm growth in the mid portion of the  posterior vaginal wall.  There was no evidence the cancer had spread to adjacent tissue or distally.

We discussed at length the alternative view points regarding cancer and she was determined to give this a try as she desperately wanted to avoid surgery and radiotherapy.   She was informed that the treatment will take several months and we would then be able to evaluate the progress of the treatment as the cancer was in a location where it was easily ‘assessable’.

She underwent a minor procedure to ablate the vaginal growth with ‘cautery’ (burning of the tissue) and subsequently was put through metabolic and nutritional therapies which she did with no adverse effects.

On follow- up 3 weeks later, vaginal examination showed complete healing and no traces of  cancer and this was confirmed on cytological assessment.   She was rather confused and exhilarated at the same time as she couldn’t believe that she was indeed cancer free and had avoided the dreaded Chemotherapy/ Radiotherapy/ surgery. 

She has been on follow up for more than 2 years and remains cancer-free and leads a normal life.

 

 

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