DOCTOR PROFILE: 2010 Pink Ribbon of Hope Awardee Dr. Tina Santos

AUTHOR'S NOTES: This is the complete interview/profile that I did with Dr. Tina Santos, this year's 2010 Pink Ribbon of Hope Awardee. The condensed version of this article was published in the Oct. 1-15, 2010 issue of Woman Today.

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DR. TINA SANTOS: TRUE CALLING

Many noted breast cancer survivors go into the advocacy because they or their loved ones have survived this dreaded disease. In the case of breast cancer surgery specialist and Gift2Life Founder Dr. Tina Santos, her choice to become a breast cancer advocate resulted from a true calling from God.

Please narrate to us how you became a breast cancer advocate. Were there personal reasons (such as a death of a loved one from the disease) which prompted you to go into breast cancer advocacy? When this is all happen?

There was no personal reason which prompted me to go into the breast cancer advocacy like a death of a loved one from the disease. I believe that my being a physician, becoming a general surgeon, and then differentiating into my current practice as a breast cancer surgery specialist and commitment to community breast cancer awareness are all God’s calling in my life. Looking back, I had been an average student in search of a potential niche in society. I felt then that my life had been trials & errors hoping to hit the role that will provide my comfort zones until the years 2000-2004 when I was clueless of where to find the true meaning of life. I prayerfully seek God and asked Him to help me discern His special plan and calling for my life, and asked Him to give me the faith and courage to follow, wherever He may lead me.

It was towards the end of 2004 that I realized that God had been pruning me into this mission even before I entered medical school but I was just too stubborn at times to follow His plans. I can say that since 2005, in the middle of God’s will and plan, I have been happiest and full of joy in my heart, regardless of the odds, in this mission called “breast cancer awareness” which God called me into with my Gift2Life Team.


What difficulties did you encounter when you first established your advocacy? How were you able to overcome these difficulties/obstacles?

The breast cancer awareness advocacy requires volunteerism, team work, and collaboration; and the initial and continuing difficulties range from:

• finding the core team players with the passion and commitment to the cause;
  
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• building, motivating, and sustaining the core team;
  
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• creating the non-profit organization, Gift2Life Inc, that truly embodies God’s will and plan for this mission called “breast cancer awareness”
  
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• building partnerships and collaborations for the cause and not for any branding / marketing purposes; resistance to change and politicking; personality differences; lack of resources to use; value-added strategies to consider and implement.
  

Proverbs 3: 5-6 has always been my refuge during these difficulties and please believe me, things just fall into places: “Trust in the Lord with all your heart, do not depend on your own understanding. Seek His will in all you do and He will direct your paths”.

Given your experiences with breast cancer patients, has there been an improvement with regards to information dissemination for early disease detection? What more needs to be done?

Yes, there have been improvements with regards to information dissemination for early disease detection because we have had several cases diagnosed during the early stages of breast cancer after our recommendations for mammogram, ultrasound, or on-site biopsy based on our risk factor assessment, clinical breast examination, and follow-up from our breast cancer awareness seminars and exhibits. Though sad to say, we still having a number of late stage and neglected cases of breast cancer from our breast cancer awareness seminars nationwide.

So much more are needed to be done for the following:

• collaboration of mission-based groups / organizations with similar purpose for maximization of resources and wider reach;
  
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• availability, accessibility, and affordability of clinical breast exam, screening mammography, breast ultrasound, breast biopsy, definitive breast cancer treatments to really achieve early detection and appropriate, timely, early treatment of breast cancer in the Philippines;
  

Please name some of the projects of your advocacy. Which particular project is most memorable to you?

Gift2Life has its all year round Free Breast Health Empowerment through:

• Breast Cancer Awareness (BCA) Advocacy Seminars (Empowerment Lecture, BSE Demo, Inspiring Breast Cancer Survivor Testimonies, and Question & Answer Portion) with On-site Breast Cancer Screening (Risk Factor Assessment, Clinical Breast Examination with Biopsy if needed, and One-on-One Consultation);
  
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• (BCA) Advocacy Exhibits (Information Exhibit Panels with on-going BCA DVD presentation) with On-site Breast Cancer Screening (Risk Factor Assessment, Clinical Breast Examination, and One-on-One Consultation);
  
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• Collaborative Definitive Breast Cancer Surgery with Our Lady of Peace Hospital in Las Piñas;
  
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• Collaborative Breast Cancer Clinic & Definitive Breast Cancer Surgery with Manila Naval Hospital in Fort Bonifacio, in partnership with the Philippine Navy Officers’ Wives Association (soon).
  

For the BCA Advocacy Seminars, we have activities in partnership with Philippine Wacoal Corporation which we call “Keep Abreast” and we have stand alone activities which we call Advocate Breast Cancer Consciousness Daily (“ABCD”) or Ating Breast Cancer Kaalaman Dagdagan (“ABaKaDa”), tailored to the social classification of the participants we have per activity.

For the BCA Advocacy Exhibits, we are always in partnership with Philippine Wacoal Corporation.

Benchmarking from our humble beginnings from 15 Dec 2007 until 11 September 2010, we have accomplished 156 breast cancer awareness seminars and 21 exhibits; advised > 5,000 individuals found to be at risk for breast cancer (of whom, 60% were recommended to have mammography and 40% to have breast ultrasound, on regular bases, for their breast health surveillances); and diagnosed > 50 patients with breast cancer from our on-site biopsies.

On an organizational level, the Keep Abreast Seminars are the most memorable to me because these seminars helped us create and propagate the breast cancer awareness domino effects. On a personal level, these seminars gave me the opportunities to develop my potentials as a community breast cancer awareness resource person. We started this in October of 2005 as an experimental breast cancer awareness seminar series held every Saturdays of October under the leadership of Ms. Ann Christine Palisoc, the Chief Operating Officer of Philippine Wacoal Corporation. I was then the President of another non-profit breast cancer organization. Keep Abreast developed into a commitment and partnership. Over time and with the birth of Gift2Life Inc, the Keep Abreast Seminars evolved to become an all year round collaborative campaign, now on its 5th year! In October of 2008, we developed and started the Keep Abreast Exhibits in malls, call centers, fun runs, and expos.

Please share with us your feelings on being given the Pink Ribbon of Hope Award. What opportunities do you feel would this award open to you and your advocacy?

I feel so blessed, delighted, and honored to be given the Pink Ribbon of Hope Award for 2010.
Kindly allow me to sincerely thank Senator Loren Legarda, Chairwoman and Founder of the Bessie B. Legarda Memorial Foundation, and Ms. Monica Aveo, Assistant Publisher and General Manager of Woman Today and President of the Bessie B. Legarda Memorial Foundation for this remarkable recognition. This will be a lifetime source of inspiration for me and for Gift2Life Inc, our nonprofit organization. I would like to share this award to the Board Members, Officers, Breast Cancer Awareness Core Team, and volunteers of Gift2Life and to all our partners and collaborators. This is the sweet fruit of our passion and efforts, and that together, we are making a difference! To all breast cancer survivors, patients, caregivers, and those who lost a loved one from breast cancer, this represents our faith and anticipation that someday breast cancer will also come to pass.

This award and media exposure will open more opportunities for partnerships and collaborations for the breast cancer awareness cause and will help save more lives among Filipinos both here and abroad. This award would not have been possible without God’s special plan and calling in my life hence, I would like to give back all the glory, honor, and praises to God with this award!

Is there a dream project that you would still like to undertake with your advocacy? What is this?

Yes, our dream project is the establishment of an Ambulatory Breast Cancer Specialty Center that will provide holistic breast cancer diagnosis, appropriate treatment, and surveillance services with:

• Short stay breast cancer surgery
  
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• Chemotherapy infusion
  
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• Hormonal and targeted therapies
  
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• Radiation therapy
  
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• Complimentary and holistic medicine
  
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• Treatment care of side effects
  
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• Screening, Diagnosis, and Surveillance
  
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• Consultation and Referral
  

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About Dr. Tina Santos

Dr. Tina Santos is a Physician of good standing since 1992, a practicing General Surgeon since 1997, and Breast Cancer Surgery Specialist since 2005.

She holds a Bachelor of Science Major in Psychology degree from Centro Escolar University and finished her Doctor of Medicine from Fatima College of Medicine in Metro Manila. She finished 3 months Clinical Clerkship Program in Surgery at Brooklyn Caledonian Hospital in New York. She completed 1 year Post Graduate Internship and 4 year - Residency Training in General Surgery at East Avenue Medical Center in Quezon City. She then underwent 6 months post doc research Fellowship Training in Breast Cancer and Melanoma Surgery at the University of California in San Francisco (UCSF).

She is a Fellow of good standing of the Philippine College of Surgeons, Philippine Society of Oncologists, Association of Women Surgeons, and American Society of Breast Surgeons. She has been a Resource Person for Breast Cancer Awareness Campaigns in the Philippines since 2005.
Having served > 200 different communities, government and private offices, church groups, schools, malls, call centers and still searching for more, some of her recent recognitions include:
1 of the 10 “Unsung Women Heroes Awardee 2010” given by the Soroptimist International Philippine Region last April 16, 2010;

Soroptimist International Ruby Awardee: “Making a Difference For Women Helping Women” given by the Soroptimist International-Metro Manila Southeast District and the Soroptimist International of Ortigas and Environs Club last March 6, 2010;

"Selfless Devotion in a Cause that contributes to Women and Society" by Philippine Wacoal Corporation given in June 2009, making her one of the Wacoal Women of 2009;

"Salute the Filipinas Exhibit during the Women's Health Month" given by SM Fairview in March 2009;

"Making a Difference For Women Helping Women" given by the Soroptimist International of Ortigas and Environs Club in February 2009;

"Commitment to Breast Cancer Awareness Advocacy by Sharing Medical Expertise to Promote Women's Health" given by Woman Today Asia Magazine in November 2006;

She is also the invited "Keep Abreast" Resource Speaker of the Philippine Wacoal Corporation since 2005 and the International Resource Person of Morishita-Seggs Pharmaceuticals Inc. since 2006.

Having more than seven (7) years experience in non-profit organizational management, she has MBA credits from the Asian Institute of Management, Philippines where Gift2Life is her on-going Strategic Management Project. She became past Chairwoman from 2006-2007 and past President from 2001-2007 of the Philippine Foundation for Breast Care, Inc.

"Doc Tina" is the current president of Gift2Life Inc.

CANCER SURVIVOR STORY: Interview with Rely Silayan

AUTHOR'S NOTES: This inspiring interview with Rely Silayan -- son of the legendary actor Vic Silayan and beauty queen Chat Silayan (herself a cancer fighter prior to her death) -- was originally published in Woman Today.

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FAITH & HOPE IN THE MIDST OF FAMILY CRISIS:
INTERVIEW WITH RELY SILAYAN

To those who don't know him, Rely Silayan may seem like an unfamiliar name. However, mention his father the late great actor Vic Silayan and his elder sister Chat Silayan, then you would know that he comes from a prominent family of newsmakers. To the members of St. Luke's Medical Center's cancer support group Corridor of Hope, Rely is a pillar of strength for his fellow cancer survivors.

In this exclusive interview, Rely shares with us his unique experiences as both a caregiver for Chat and, later on, as a cancer survivor himself, and how that special Silayan resiliency has helped them in their battles against this dreaded disease.

Rely, what was it like growing up in a family with the legendary Filipino actor Vic Silayan as your father?

We were just like any normal Filipino family. My Dad was pretty low profile. As an actor, he was not the 'boy next door' type; he was a character actor. But he was most popularly known for his voice. He was a favorite among past Philippine presidents and he was always asked to be Master of Ceremonies when there were state visitors.

Did your Dad ever encourage you and your siblings to go into acting?

He discouraged us actually. When we were studying, he told us not to make any decisions about going into acting until after we finished our studies. He said it's not a stable job, especially in the Philippines. It's best that we finish our studies. True enough, after we graduated, we lost all interest in acting. In the case of Chat, we were no longer able to prevent her from going into showbiz because she became a beauty queen. She was Third Runner-up in Miss Universe. So when she came back, it was natural that she would get a lot of offers, but she had already finished college by that time.

When was your family first stricken by cancer?

Just to clarify first, my Dad did not die of cancer. He died of heart failure. The first in my family to have cancer was my half-sister Mavic, who is married to former Quezon City mayor Jun Simon. She is a five-year survivor of breast since 2002-2003. Next was Chat. She succumbed to colon cancer in April 2006 after a two-and-a-half year battle. Then, five months after we buried Chat in Sept. 2006, I was diagnosed to have Non-Hodgkin's lymphoma. It's not just in my immediate family that cancer had hit us hard. Even in my wife's family. I lost my mother-in-law to lymphoma six years ago. In Oct. 2006 and April 2007 respectively, my brother-in-law and my wife's uncle died of colon cancer. So you can see our exposure to this disease.

With all these incidences of cancer, would you say that your family has a genetic predisposition for this disease?

Originally, I didn't think so, although my Mom had a lumpectomy a long time ago. She's 75 now and living in the U.S. We only found out during Chat's wake from our cousins on our father's side that we have relatives who had cancer.

Please narrate to us how you were diagnosed with Non-Hodkin's lymphoma.

It was in March 2006 while I was taking care of Chat. I found a lump ("kulani") in my groin area. I didn't think much of it because I was used to getting enlarged lymph nodes as a kid because I was always getting into the usual scrapes. I never told Chat about it. But later on, I found another lump. After Chat died, I went back to work in July. I was on a diet and my weight dropped from 160-165 to 123 pounds. I thought it was the diet working. However, when the first enlarged lymph node that I found grew to the size of a golf ball, I realized something was wrong. I decided to consult with Dr. Joven Cuanang, Medical Director of St. Luke's who was an old friend of Chat's. He ordered a thorough work-up. After three days, I found out that it was malignant. Dr. Cuanang entrusted me into the care of the Cancer Institute's Dr. Charity Gorospe.

How did you react when you found out that you too had cancer?

It really didn't strike me as a surprise because of our family history. When it came to me, I never thought to ask "Why me?" My question to God was "Did You prepare me for this?" Because I wasn't surprised, I didn't get angry. Initially, I was saddened, but I thought there's a reason for this.

How were you able to cope, to actually live with this disease?

The first step obviously was to learn more about Non-Hodgkin's lymphoma, and in this area, I am grateful that Dr. Gorospe thoroughly educated me about the disease, its treatments and its possible side effects. I have to admit that I was concerned when Dr. Gorospe told me that I would lose all my hair. I couldn't imagine myself bald. I haven't started chemo yet, but I was already thinking about how to manage the hair loss because I knew that it would be a source of depression. I was always conscious about how I look so I didn't like to see myself bald and looking sickly. The following weekend, I went to the mall with my family. I went off on my own and had my ear pierced and started wearing an earring. Three days after my first chemo, sure enough, my hair started falling off in clumps. I then remembered what my uncle – my Dad's brother – told me: "Give it a good fight, Rely. Don't be depressed." That very morning, I asked my son to accompany me to the barber and had my hair shaved off. At that time, I already had an earring, so I was smiling at my reflection in the mirror. I looked hip, a fashionista. As a show of support, my two sons also had their hair cut really short. From this example, you could see that I never really allowed it to affect me emotionally. I'm really giving this disease a good fight.

From whom did you get this positive attitude?

In general, I would say that the Silayan family always had a positive outlook in life. Even during depressing moments, we would find something to celebrate in it. If you saw us during Chat's wake and funeral, you would think that we're one wacky family. I think this positive attitude is one thing I also got from my Dad. Yes, he does look serious and he is strict, but he's a very jolly person. We had a lot of light moments with my Dad. Then, there are my experiences with my two sisters. Mavic is very supportive. We would share materials on cancer and new treatment methods. As for Chat, there is one thing I learned from her. As you know, when you're sick, your tendency is to look for attention and comfort. With Chat, it was the other way around. She would always comfort me and say, "It's okay, Rely. The Lord knows what He's doing." I only came to realize this after Chat died. Until her last breath, she was at peace. For her, it was more important to give comfort than to receive it, because she knew that she'll be leaving soon and that it would be more difficult for her loved ones who would be left behind.

It's very obvious that faith and spirituality is very strong in your family.

True, although I should say we never really saw my Dad as a very spiritual person because he wasn't really active in religious organizations. But one time in the late 70s, my Dad brought me along during one of his shootings in Sombrero Island in Batangas. For three days, we would sit near the seaside and wait for the sunset. He would say, "Son, wait until the sun touches the water" and then he would lead me into a prayer. That was personal experience with my Dad.

The spirituality of my sisters is really helping me, because the journey of a cancer survivor should be managed mind, body and spirit. You should be at peace with yourself and the world. You should have a constant communication with the Lord wherein you offer to Him all your fears and anxieties, because He will help you. Always pray.

While others find cancer a curse, have there been any blessings that have come out of this for you?

I feel thankful because if I had this twenty or thirty years ago, this disease is considered a death sentence. One thing good about being a survivor in this generation is that there are medical treatments available. Yes, it's expensive, but never forget that the Lord provides. I am also grateful to be given the opportunity to prepare for a graceful exit and to prepare my loved ones as well. There's this saying that you'll know your friends when the chips are down. With this experience, I have been most thankful for the support I'm getting from my doctors, family, the entire Silayan clan, and friends and former colleagues who stand by me in this fight. I really feel loved and cared for.

Having experienced being both a caregiver and a cancer survivor, what advice can you give to our readers who are experiencing similar trials?

If you are a caregiver, always give comfort and support to your loved one. It would give them the strength to give a good fight against this disease. If you have a relative or a friend who is sick, always offer a prayer for them. While you may not be able to help financially or in some other ways, there is great power in a heartfelt prayer.

For those who are cancer survivors like me, do not be ashamed to tell your stories to others. It is a form of therapy and it will help unburden your heart of the pain you are feeling. Also, by sharing your experiences, as I am doing with the members of Corridor of Hope, you also learn from your co-survivors not only how to cope with the disease, but actually draw strength and comfort from one another. After all, no one knows the trials that you are going through better than a fellow cancer survivor.

Diarrhea And Cancer: Interview with Dr. Roel Tolentino

AUTHOR'S NOTES: This interview with St. Luke's Medical Center's Dr. Roel Tolentino was originally published in The Big C Magazine.

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DIARRHEA AND CANCER

Most people do not associate diarrhea with cancer, the former especially being a common symptom of an infection of the gastrointestinal tract. While considered as an uncommon symptom, diarrhea can occur as a consequence of the cancer itself or as a side effect of the various treatments of this dreaded disease.

Diarrhea As A Direct Consequence of Cancer

According to Dr. Roel Tolentino, surgical oncologist with the St. Luke's Medical Center Cancer Institute, "Most of the time, we see diarrhea after surgery. But with regards to diarrhea during cancer, it's very rare, although we do see it in patients with carcinoid syndrome, pancreatic cancer, gallbladder cancer, and especially those with biliary tract cancer.

"In these patients, there is a disturbance in the enterohepatic circulation caused by an obstruction of the bile ducts by the tumor. If these patients eat fatty foods, these foods will not be absorbed by the small intestines. The fats will act as osmotic particles that will attract water into the lumen of the colon, thereby producing diarrhea. Another mechanism by which diarrhea occurs is that bile also does not get absorbed in the small intestines and when it goes into the colon, it becomes an irritant, producing watery diarrhea."

Diarrhea As A Direct Consequence of Treatment

In patients undergoing treatment for cancer, diarrhea is one of the most common side effects of therapy.

Chemotherapy. "The highest incidence of diarrhea would be found in patients undergoing chemotherapy," explains Dr. Tolentino. "The chemotherapeutic agents affect the rapidly-dividing cells in the body, which include the cells in the gastrointestinal tract. These cells become atrophic and would irritate the lining of the intestines. The thickness of the intestinal lining would be affected and there would be diarrhea because of inflammation."
Diarrhea rates as high as 50 to 80 percent have been documented in chemotherapeutic regimens containing fluoropyrimidines (Ex. 5-fluorouracil) or irinotecan. Reviews of several clinical trials involving a combination of irinotecan, high-dose fluorouracil and leucoverin in colorectal cancer showed early death rates of 2.2 to 4.8 percent as a result of gastrointestinal toxicity."

It is not just these drugs that could cause diarrhea. Says Dr. Tolentino, "Cisplatin can also produce diarrhea, as well as cyclophosphamide, methotrexate and oxaloplatin. Almost all of the major chemotherapeutic drugs can cause diarrhea."

Radiation Therapy. According to Dr. Tolentino, "With radiation therapy, the occurrence of diarrhea would depend upon the dose of radiation and the site in the abdomen that is being irradiated. Usually, a dose of 4,500 to 5,500 rads would produce minimal diarrhea, but as you go higher, the diarrhea becomes a great problem for the patient."

Changes in normal bowel functions can also be expected in radiation therapy to the abdominal, pelvic, lumbar or para-aortic fields. Aside from diarrhea, common side effects of radiation include cramping, gas, bloating and malabsorption.

Surgery. Postsurgical complications of gastrointestinal surgery that may lead to the development of diarrhea include increased transit time, fat malabsorption, gastroparesis, fluid and electrolyte imbalance, and dumping syndrome.

"When we do resection of the small intestine or colon," explains Dr. Tolentino, "the length of the gastrointestinal tract becomes shorter. Because of the faster transit time, food goes down immediately to the distal gastrointestinal tract. Surgery might alter your intestines' ability to absorb nutrients or fat and may result in diarrhea."

What about the current targeted therapies? Can diarrhea also develop? "Targeted therapies are a different kind of therapy. The side effects, including diarrhea, are lesser because these drugs target a specific metabolic pathway. These monoclonal antibodies are different from the usual chemotherapeutic drugs."

Infectious Diarrhea vs. Diarrhea in Cancer

The term diarrhea per se means that there is bowel movement that is more frequent than normal. But how would you differentiate diarrhea as caused by an infectious agent from diarrhea in cancer?

"The clinical presentation is the same," says Dr. Tolentino. "The patients would present with abdominal colic, the same crampy symptoms. The differentiating factor, however, would be fever, which is more common in infectious diarrhea. Fever is not common in patients with cancer. Also, if there is colon or rectal cancer, the first symptom would be constipation, not diarrhea, because the stools cannot pass beyond the obstruction. However, when there is an increase in pressure in the partially obstructed intestinal lumen because of trapped digested food, the stools will just come out, producing bloody, explosive diarrhea."

Treatment and Prevention

According to Dr. Tolentino, the treatment for diarrhea in cancer is the same as the treatment for infectious diarrhea. Oral rehydration preparations are given to prevent dehydration and to correct fluid and electrolyte imbalance. Antidiarrheal drugs such as loperamide and diphenoxylate HCl are not contraindicated.

However, it is the opinion of the good doctor that all cancer patients should seek medical advice for their ailments. "Patients should consult their attending physicians because they are immuno-compromised already. Antibiotics might be needed, and the antibiotic regimen for infectious diarrhea is different from diarrhea in cancer. In infection, we can give metronidazole and chloramphenicol, but in cancer patients, we may give neomycin, which is not absorbed by the intestine. Plus, antidiarrheal agents might not be adequate. It may be necessary to decrease dosage or temporarily stop chemotherapy, allowing a window of healing of about 2 to 3 weeks. After the diarrhea has been resolved, treatment can be continued."

Can a doctor predict which patients will develop diarrhea? "It depends upon the immune system and overall state of health of the patient. If the patient has a good immune system, he/she can resist the side effects of the various therapies. If they are healthy, the side effects, including diarrhea, would be lesser in severity."

Dr. Tolentino says that an ounce of prevention is worth a pound of cure. "Instead of eating three big meals a day, we advise patients with diarrhea to eat six small, frequent meals. Patients should avoid spicy foods and foods with lactose (such as milk and dairy products), and those that are rich in carbohydrates and fats. In those patients with mild diarrhea, they should eat more bulk-forming foods, especially the BRAT (bananas, rice, apples, toast) diet to reduce frequency of stools. Fluid intake should also be increased to at least 3 liters per day. Avoid alcohol and caffeine-containing drinks. From my clinical experience, probiotic foods such as yogurt help modify harmful gut microorganisms that have been implicated in the development of diarrhea."

Diarrhea need not be a life-threatening side effect of a treatment that is meant to save or prolong a life. With the right diet and strict medical supervision, cancer patients will not have diarrhea to add to their physical and emotional distress.