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.