My Recent Medical Crisis

During the past 5 months (starting from 6 November 2012 to 4 April 2013), I kept praying and claiming Jesus’ promise: “I will never turn away anyone who comes to Me”(John 6:37 TEV) and God has comforted and guided me. My family, relatives and friends prayed for me and somehow God has worked through them to help me. On my part I have to be constantly alert to His direction and to listen carefully.

    When we go through a medical crisis or any major problem, we go through practically the same human reaction, although not covering all of them or following the same order or sequence. Recently I had a medical crisis––two tiny growths in my liver. I suffered a period of great stress and I find that the range of emotions can best be described by the acronym:- S A R A H Begs Delay!

S	Surprise, Shock, Stress, Suppression, Stubbornness, Stiff-necked, Spirit unease.
A	Annoyance, Anxiety, Anger, Afraid, Agony, Abandoned, Apathy, Afflicted, Alienated.
R	Reprimand, Refusal, Restraint, Resistance, Revenge, Resentment, Rejection, Resign, Resetting the mind control button.
A	Acceptance, Awakening, Acknowledgement, Admit.
H	Hope in God, Hope in His grace and mercy to see us through, Hope in family and friends for loving support and listening ears, Halleluiah!
B	Beg, Bargain, Bitterness, Blame, Believe. Betrayer, Better, Blessing, Befriend.
D	Delay, Despair, Denial, Deafness, Depression, Distress, Defeated, Discomfort, Doubt, Desolate, Dejected, Disoriented,  Deadlock, Disappointed, Directional change needed.

     The ideal response is to go quickly from shock to acceptance and taking action immediately.

But until the doctor or helper acknowledges and empathizes with me (the patient), my focus will still be deadlocked in my deep seated fear and I find it very difficult to change my rigid way of thinking.

My Medical Crisis started on 6 November 2012 with the Ultrasound detecting the following:

“An echogenic hepatic nodule is seen in the right liver lobe, which was not apparent on the previous study.

“A multiphasic CT scan is recommended for further evaluation.”

Two days later, I had a CT Scan on 8 November 2012 and the finding was:

“The lesion in question in segment VIII was demonstrated as a hypodense focus in the portal venous and equilibrium phases of enhancement. It should be viewed with great suspicion as a tumour recurrence.

“There was a tiny hypervascular focus seen just beneath the dome of the diaphragm in segment IVa. This was indeterminate in nature but it should be closely followed-up especially in light of the appearance of a nodule in segment VIII”

     I followed up, about 3 months later on 29 January 2013, with a PET-MRI Scan. This is considered to be the golden standard in Scan technology and the result was:  

“Two mildly enhancing nodules with restricted diffusion and mild FDG-avidity, as well as non-contrast uptake in the hepatocyte specific phase of imaging, in segment 8 and at right surgical margin of the remnant liver, are suspicious of tumour recurrence.”

Throughout my life, I have always been reluctant to trouble relatives or friends but now I felt compelled to seek help. Since I was so fearful of tumour recurring, I forced myself to write to a few relatives and friends who are doctors as follows:

I did my PET-MRI three days’ ago on 29 Jan 2013 and I am not happy with the vague wording of the finding that says “suspicious of tumor recurrence”. This is the same wording as the CT Scan of 8 November 2012 as a follow up to my Ultrasound on 6 November 2012. This expression “suspicious of tumor recurrence” put an enormous stress on me. I am filled with unnecessary worry and dread. I thought that after the Ultrasound and with CT Scan and PET-MRI studies they should give a more definite finding and state whether it is cancerous or not!
    I was very angry at the end of the PET-MRI study. It took all in all 4 hours. The actual PET-MRI took one and a half hours, one hour for the doing the brain and chest MRI and half hour on the liver; the rest of the time was spent on waiting and injecting the FDG. When the nurse went through the PET-MRI procedure with me, I questioned why they wanted to do the PET-MRI on my chest and brain. They did not give me a satisfactory answer but said that it was the standard procedure. Since there was no X-ray, I decided not to question further. After they had completed the PET-MRI, the nurse routinely told me to wait outside for another CT scan to get a clearer picture of my chest. I refused as I did not want to have more X-ray on my body; anyway I told them that I just had a recent CT Scan on my liver. I saw no relevance in doing a CT Scan on my chest. They told me “Oh, this CT Scan is free and they want a better image of your chest.” My wife heard my voice from the waiting area and came in to say very firmly that we didn’t want any scan done on my chest without my liver consultant’s specific request.        
       In view of the PET-MRI report, my liver consultant said that I should do a CT Scan on the liver in 3 months’ time. I told him that I do not want another CT Scan so soon. He said that then I could do an Ultrasound or MRI instead.

 I learned, from the Internet, about the following functions of PET-MRI Scan:

        “Differentiation between malignant and benign growths. PET is capable of accurate location of lesions, identification of benign versus malignant lesions, and differentiation from scar tissue. 
         “Detection of cancer recurrence. PET is the most sensitive method for detecting early recurrence and metastatic spread in many cancers. Early detection of cancer recurrence allows early initiation of treatment. 
         “Differentiation between cancer recurrence and post therapy structural change. Since PET imaging detects metabolic changes rather than structural changes, it is more specific than CT or MRI and is able to distinguish cancer recurrence from post therapy structural changes. This allows doctors to decide if further treatment is necessary.”

     I also understand from the Internet that liver cancer doubles itself every 2 months.

     As a layman, all I wanted to know is whether, based on my current PET-MRI study, do I have a benign or cancerous tumour recurring? What is the radiologist’s assessment? I would like to know the truth so I can decide what to do. Is the tumour malignant? I do not want another 3 months of fear and anxiety. I had this enormous worry for 3 months after my CT scan on 8 November 2012. I just do not want another 3 more months of unnecessary fear and stress before my next scheduled test. 

     Since the PET-MRI procedure is said to give a clear interpretation according to the write-up in the Internet, I fail to comprehend such vague wording as “suspicious of tumor recurrence.” To a layman this is a very fearful pronouncement and a Draconian sword over my head. 

I seek your help in getting me a second radiologist opinion on the PET-MRI. 

After my local relative talked to my liver surgeon, he asked for a review. 

On 6 February, the chief Radiologist provided an Addendum, which stated as follows:

“The two nodules demonstrated in the right lobe are again confirmed with mild restricted diffusion identified on the DWI sequences.

“On the post contrast sequences, there is no specific uptake demonstrated related to these that can be matched.

“The differential diagnosis would include high-grade dysplastic nodules.

“These require close follow-up.”

Being a layman, I wish the reports could be written for a layman to understand clearly! I was still in the dark as to what the reports meant. I talked to my liver surgeon and he advised that according to the PET-MRI scan the small nodules were indeterminate and had to be monitored. I was advised to go for the normal MRI scan in 3 months’ time. 

Since I had my second radiologist opinion, I told everyone to stop getting another radiologist opinion. I could see another 3 months of fearful wait and perhaps a further 3 more months of MRI Scan. What a stressful way to live. I was stubborn not to do anything until I was certain that the lesions were cancerous because of my two past traumatic liver surgery experiences. I was troubled but God works in the most wonderful manner.

Meanwhile, I was watching YouTube on liver tumors, laparoscopy liver surgery, etc. I did not look out for such information before. I was not fully aware as to how wonderfully blessed I was to have been successfully operated on in 1999. It is a miracle that I am still alive after my first HCC surgery 14 years ago. I am grateful that God has been kind and merciful to me. 

Now, on hindsight, I remembered that my liver surgeon did mention, after the PET-MRI result, that since my lesions were small, an alternative solution would be to carry out a RF ablation. But I was adamant about not having any surgery, unless absolutely required. I was hoping that the lesions were totally benign and thus did not need surgery. Besides, with my limited medical knowledge, I did not ask about RF ablation. My mind just shut down and I was not opened to any new information or option. My mind was held captive by my terrifying fear of a third surgery.  My mind was not open to any alternative solution, of which I had no knowledge.

But my overseas relatives persisted in helping me and consulted her Radiologist colleagues. They were concerned about the two lesions, which they said should be taken care of immediately, when they’re small, rather than later, when that would be a much more complicated affair. Some treatment options were cryoablation, surgical removal and RF ablation.

I went to the Internet to find out what cryoablation and RF ablation were. The procedures were quite similar to a needle biopsy, except that one uses heat while the other uses freezing to ablate the tumor. 

However, I was still on denial and I tried to delay making the decision immediately. I wrote back and said so far no one has conclusively said that the small lesions are cancerous. What if it is benign? If so, would it then be OK to just let them be and check regularly to see whether there is any further growth? By the end of April, it will be 6 months since my last CT Scan and I will be going for another CT Scan. To date my Alpha-protein tumor marker, HBV DNA and Liver function tests were all OK. Maybe by end of April and after my CT Scan, it will be clearer and easier for me to decide. At the same time, my spirit was not at ease. I was troubled. I prayed and again claimed Jesus’ promises: “I will never turn away anyone who comes to Me”(John 6:37 TEV) and “I will never leave you; I will never abandon you.” (Hebrew 13:5 TEV)

I now can see that mine is a classic case of how a lay individual faces a medical crisis. My reaction was one of sadness, anger and distress when both the CT Scan and PET-MRI Radiologists reported that in view of my liver history the small lesions were likely to be “suspicious of tumor recurring”. So I sought another opinion and delayed taking action still hoping that in my case it will be benign and not cancerous. I reasoned that should it be proven to be benign, then I didn’t need surgery. With no knowledge of other options for the small lesions, I was focused on  avoiding surgery at all cost. Due to my past two open liver surgery experiences, I was afraid of a third surgery on my liver, so I delayed and denied the seriousness of my case with further inaction.     
      Even when they told me that it was better to remove it when small rather than later, I delayed and was deaf to any alternative solution.

 Only when my overseas relative acknowledged and empathized with my tremendous fear of a third liver surgical operation, I was then able to refocus and change my mindset to look at other options. If she had not addressed my underlying terror, I would have stubbornly resisted any other option. I would be stiff-necked enough not to take any immediate action. Her suggestion was to do a minimally invasive surgery like RF ablation, cryoablation or microwave ablation. This directional change in mindset made it easy for me to decide. I prayed and in the silent of dawn the direction came to see my liver surgeon the next working day. 

On 30^th March, I expressed to the liver surgeon my anxiety and asked what could be done now and what the risks were. He strongly recommended me to do the RF ablation and arranged for me to see the Radiologist on 2^nd April.

On 2^nd April 2013, I saw the radiologist who was going to carry out the RF ablation. He is a very understanding person and he spent some time explaining the whole thing. In his opinion the 2 lesions were cancer tumors recurring, due to my history. He explained that when the tumors are small, less than 3cm (mine was 1.8cm), there are several options:

        1. is to use chemo on the tumors, 

        2. to use RF ablation and 

        3. to use a combination of chemo and RF ablation.

        The best is surgery but there are problems associated with surgery too, he said.

        One of the lesions will have no problem at all as it will be easy to perform using RF ablation. The other lesion is next to a major artery and that he feels is a little more complicated with RF ablation alone. Why? While the tumor is being burnt next to the major artery, the blood in the artery will cool the RF ablation. The cooling effect of the blood is like a car radiator cooling the area around it and he cannot be absolutely certain that the tumor is fully burnt off. He will try to be more certain by positioning the probe in a few areas around the lesion. He cannot over-cook or under-cook. If it is under-cooked it will have to be done again sometimes later. The alternative is use a combination of chemo and RF ablation, then it will be a more certain procedure. We asked what was the risk of using this combination. He said that the risk is of liver failure. However, this risk is extremely small because the amount of chemo used will be very little. Since there is this minute chance of liver failure we were hesitant. He said that in view of my age and if I was his relative, he will not use this procedure. He will however discuss with my liver surgeon. It was finally agreed that I should go for the RF ablation alone and if ever needed, to do the RF ablation again sometime later. He will of course aim to get the RF ablation done well the first time round.

On 4^th April, my friend, being prompted by the Holy Spirit, insisted on taking my wife and me to the hospital in order that I would not be held up the taxi service. The RF ablation went smoothly at 11.45 am and I was able to go back home by 7pm on the same day. They sedated me and I was not aware of anything. The whole process took about an hour. My doctor relative checked with the radiologist who performed the RF ablation and he was satisfied with the whole process. I was given 7 days of antibiotics and pain medication to take. 

The loving support and listening ears of family, relatives and friends are invaluable. When I shared my sufferings with close friends and relatives, the going seems much easier and lighter. This is similar to sharing our affliction with a sympathetic support group–like AA or Cancer Society where there is a mutual desire to lighten each other’s load. 

I share this experience with the desire that it may provide comfort, strength and hope for anyone who may be faced with a medical crisis.  

I believe in God and prayed for His grace and mercy to see me through. I see that God is love and He pursues me with His love by showing it to me through the care of my family, relatives and friends; also, by unblocking my traumatic fear of a third liver surgery and opening my mind to an alternative solution. If it was not for my overseas relatives’ persistence and the Holy Spirit’s prompting, I would have delayed and resisted seeking an alternative solution. I am sure I would be stiff-necked enough, to not agree to any surgery, until I was sure that it was cancerous. This would invariably lead to the very thing I was most afraid of—a third major, open liver surgery! I felt that it was the timely intervention of the Holy Spirit and the persistence of my overseas relatives that got me to change my inflexible attitude and saved me from open liver surgery. Now that I am open to accepting an alternative solution, I was able to take action immediately and decided on the minimally invasive surgery in RF ablation. The RF ablation was performed 7 days after my overseas relatives told me about this option. It could not have been done faster–from consulting the radiologist and hospital scheduling for doing the RF ablation. Having successfully gone through the RF ablation, my mind is now at peace. God is faithful in constantly guiding me through my trial in the past 5 months. Praise the Lord, for HE is good! Halleluiah!!

              Written on 6^th April 2013

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2^nd Radio Frequency Ablation (RFA) on 17 Oct 2014

    I followed up with regular MRI on 7 Nov 2013 for my liver, but on 15 Oct 2014, it was found that there was a new tumour nodule demonstrated in segment 8 just lateral to the previously ablated focus. It measures 0.9 x 1.4 x 1.3 cm in size.

     I saw my liver surgeon the next day and he recommended doing a second RFA. Because of the successful first RFA experience, I had no hesitation to do a second RFA on the next day, 17 Oct 2014.

     The RFA report stated, “Under CT fluoroscope guidance, a 3 x 15 cm Cool-Tip RF electrode was inserted and a standard cycle of ablation was performed. Post ablation CT with low-dose intravenous contrast showed satisfactory visual results. Immediate and 4-hour delay post ablation CT showed no significant subcapsular haematomas.”

     I did not feel any discomfort or pain after the RFA. I would thus recommend anyone who has to do an RFA to do so immediately.