My heart is heavy. My head is busy. I am sad and teary. I don’t want to be but I can’t help it. I want to be strong. I am and I’m not. I’ve been in a tailspin of worry and fear. This, on top of my preoccupation with my mum’s health.

4th stage cancer was indicated for brother number1. This was the diagnosis by the attending physician on 8 November after CT thorax and CT adrenal scans were done. What about stages 1-3?  I read, ‘Lung cancer is the leading cause of cancer death, and that’s because many of its symptoms don’t become apparent until the cancer is in an advanced stage. Since the lungs cannot be seen or felt, it’s harder to detect if something is wrong until troublesome symptoms appear, such as a persistent cough, chest pain, shortness of breath and unexplained weight loss. However, individuals who may be at higher risk for the condition—such as those who smoke or have smoked in the past—can be proactive about their lung health by undergoing annual lung cancer screenings[1].’

Brother number1 was a smoker. I knew he smoked. But didn’t realise it was for over 4 decades. There were no symptoms. Yes, I’ve heard him cough. Yes, I’ve heard him clear his throat. So do I. He used to organise competitive races. He reece-ed the sites. Climbed hills and mountains, crossed rivers, and guided groups on treks into jungles. Admittedly, all these were in the pre-pandemic years. He was fit and well. Maybe, there were symptoms that I hadn’t noticed. Last year, when my mum needed round-the-clock care, brother number1 was always tired after his ‘shift.’ And, there were episodes of breathlessness and tiredness this year that he attributed to the Covid booster shot.

Was I remiss? I don’t know. What I do know and remember were the abundant advice, cajoles and threats levelled at him about his smoking habit. They just went over his head. Life’s problems and hiccups were/are a little forgotten and assuaged with cigarettes.  I use the same excuse with chocolates, ice-cream and cakes. I know it’s seriously bad for me especially the quantities I consume. But I haven’t stopped or tried to cut down.

Back to the scans. The CT thorax discovered mass and fluids in the lungs and a mass on the right kidney. The CT abdomen revealed that the lymph nodes were severely inflamed and the adrenal mass above the kidney was not suggestive of benign adenoma, which meant it was cancerous. 

9 days later, the first biopsy was done on the lung tissue. 7 days later, the report returned with inconclusive results. Further tests were then conducted. At that point, it was mentioned that if the results were still inconclusive, a second biopsy would be needed. 5 days later, a second biopsy was scheduled. 4 samples from the same spot on the upper back were obtained. A night’s stay at the hospital was required for observation. The procedure was successful. The results would be ready in one week.

In the interim, my niece, brother number1’s daughter arranged for a separate blood test that included tumour markers. She also identified oncologists, endocrinologists, and urologists. Appointments were made pending the second biopsy result. The young lady placed her dad on a ketogenic or keto diet almost immediately. She now sources for clean produce and prepares his daily meals. This, in addition, to holding on to a day job.

What is ketogenic or keto diet? ‘The ketogenic diet, a high-fat, low-carbohydrate diet with adequate amounts of protein, appears to sensitize most cancers to standard treatment by exploiting the reprogramed metabolism of cancer cells, making the diet a promising candidate as an adjuvant cancer therapy… The ketogenic diet probably creates an unfavourable metabolic environment for cancer cells and thus can be regarded as a promising adjuvant as a patient-specific multifactorial therapy.[2]’

Brother number1 has been on the keto diet for over 3 weeks now. Visually, his skin has improved. He has lost weight. He feels he has less energy as he is now fuelled by fats rather than carbohydrates. The meals are not not-tasty. They are. They look inviting and healthy. For example, keto-friendly cauliflower rice, chicken or salmon, and vegetables. It’s just that they don’t contain the usual spices, sauces and other stuff used to make food more tasty. Which is generally alright if there are no alarming health issues to consider.  Brother number1 misses rice. And, noodles that he has always maintained that he cannot help but eat quickly and completely. Both carbohydrates. To his credit, he has steadfastly adhered to the keto diet as he values his daughter’s dedication, and his wife, son and family’s love and care for him.  

 The full biopsy 2 report is due today. Prayers.