At the age of 55, it's not surprising that one might consider taking an early retirement. For former sales manager Mohd Salleh Yusof, however, the fact that he only has one lung left played a major role in his decision to "take a rest" from the corporate life. Health, as he says, is indeed more important than wealth and spending time with the family is top priority.
His health problems, however, didn't start with his lungs. Five years ago, he experienced such a severe pain at his right abdomen that he couldn't even drive himself home to Seremban from his office in Nilai, Negeri Sembilan, after a work trip to Kuala Lumpur.
A visit to the hospital discovered that he had a swollen liver due to a tumour. Although the doctors couldn't initially confirm whether it was benign or malignant, his tumour marker levels were increased, indicating that it was more likely to be malignant.
"When the doctor informed me that they suspected I had cancer based on my tumour marker levels, I couldn't say anything. I just started crying, and my wife sitting next to me also started crying," Salleh shares. "I just thought, 'Why?' I was really down. It took about an hour or so to just console myself and my wife."
Fortunately, further tests indicated that the cancer had not spread and was contained within the liver. His doctor referred him to a liver surgeon. In just over a week, Salleh underwent an operation to remove the entire 12cm tumour, which was confirmed to be late stage 2 hepatocellular carcinoma (HCC).
"They said if I had waited a few more days, it would have jumped up to stage 3 or 4 because they said my cancer cells are the 'crazy' type. The doctor said it was very lucky I was willing to go for the operation immediately. If I had delayed, it would have been much worse," he shares.
HCC is the most common form of primary liver cancer. It arises from hepatocytes, the main type of cell that forms the liver. In stage 2 HCC, the tumour(s) has not yet spread to the lymph nodes or any other part of the body. It can consist of a single tumour that has grown into one of the liver's blood vessels - as in Salleh's case - or a number of tumours not larger than 5cm each, but which have not grown into any blood vessels.
Thanks to Salleh's otherwise good health, he recovered from the operation well and was even able to return to work within three months post-surgery. An even better hope was that his doctor said he could be considered cured if he remained cancer-free for two years.
But it was not to be.
UPS AND DOWNS
The following year brought the discovery of two small tumours in the lower lobe of his left lung. His HCC had spread. Salleh was treated with radiofrequency ablation, where electric current is passed into tumours via fine needles to heat and kill the cancer cells.
The treatment seemed to work, but within a year Salleh started coughing frequently, and occasionally experiencing difficulty in breathing after he returned from performing the haj. By January 2015, two more small tumours had appeared in the same area as the previous lung tumours.
As he was now seeing an oncologist in Hospital Kuala Lumpur due to the strain on his personal finances, he was recommended to start on a targeted therapy called sorafenib. This kinase inhibitor drug works by blocking tumour growth and its blood supply.
Although it is not a cure, as Salleh was informed, at least it would corral the tumours and hopefully prevent them from growing any larger or spreading elsewhere.
"It's good as my body's response was good. I don't have many side effects from this medication," he says, adding that his doctor had told him some patients had such bad side effects that they quit the drug after just one week. Salleh experiences mostly skin peeling off his hands and feet, with the occasional bout of diarrhoea.
But a serious lung infection requiring hospitalisation six months later required him to stop the sorafenib in order to get treated. The one-month break from the cancer treatment resulted in a sharp increase in his tumour markers.
By the time of his next CT scan in January 2016, the two small tumours measuring 1cm and 2cm respectively, had appeared to combine into one 6cm growth. He was also coughing constantly and experiencing shortness of breath.
When his next appointment with the oncologist came up that April, he was told that he had to be referred to the cardiothoracic surgeon.
"I was very lucky to be able to meet with the cardiothoracic surgeon on the same day. I was with the oncologist in the morning, and in the afternoon the surgeon was free," says Salleh.
After reviewing his case, the surgeon suggested a lobectomy to remove the cancer-affected lobe of his lung and, more miraculously, had a slot open the very next week. Without hesitation, Salleh agreed.
However, he shares that this was the procedure that frightened him the most. "Actually, this was the operation that most worried me. I was really scared because both of my lungs had to be stopped, and I had to be put on the ventilator for the operation," he shares.
While the procedure generally went well, the surgeon ended up having to remove Salleh's entire left lung.
"Actually, the first plan was to just cut out the lower lobe because the tumour was only 6cm. But when they opened it, the tumour was more like 14cm and it was already going into the upper part of the lung. The lung was actually collapsed, which was why I was facing difficulty in breathing," he says.
It's taken Salleh over a year to get to his new normal with just one lung to support his body's needs.
"The first few months I was struggling to adjust my lifestyle. That time I couldn't walk very far, not even 10m - just a short distance and I had to stop and sit down," he says.
Upon returning to work after three months' leave, he realised he wasn't up to a full-time job anymore, especially as he couldn't even drive. With the support of his doctor, he decided to resign and take it easy in July 2016.
Nowadays, he takes on more of a chauffeur-cum-cook kind of role at home, sending and fetching his wife Azalina Sharif, and their youngest son, 15, to work and school respectively, as well as doing some cooking at home.
"My hobby now is cooking," he says with a smile, adding though that he has undergone a total diet change from before he got cancer, rarely eating meat or frying nowadays.
Azalina, who works with the Jabatan Penilaian Dan Perkhidmatan Harta in Seremban, contemplated retiring early to accompany Salleh, but decided against it in the end.
"At first I thought of retiring too, but nowadays with expenses and the sponsorship the Government is giving for his medication, I thought it would be better for me to work. Especially as he is still strong and can still walk," says the 56-year-old.
Salleh's targeted therapy is being sponsored equally by the Government and the Malaysian Liver Foundation.
Azalina adds, with a laugh, that she would probably end up sitting at home more than her husband if she retired. "He doesn't stay at home that much. He likes to go out," she says. Salleh jumps in: "For me, it's like, why should I stay at home? There's nothing for me to do."
Azalina shares that as a car enthusiast, he drops by his friend's workshop regularly to chat, and has also started acting as an unofficial real estate agent for her sister and his friend. Salleh says, "I have to find a way to fulfil my time. If you stay at home, you will start thinking all sorts of things."
Throughout his cancer journey, two things have struck him the most. The first is the importance of family support. "Actually, the most important is the support from the family, including from my brothers and sisters. They were actually even more worried than me," he says.
The other is the importance of not mixing modern medicines with other traditional remedies or supplements.
"From these two years of taking this targeted therapy and the cancer spreading to my lungs, I realised that when you're taking hospital medication, don't mix with other traditional medicines.
"What my oncologist said was that the kidney cannot take it because the kidney has to process everything," he says, adding that his neighbour who was diagnosed with lung cancer and was taking traditional medications had experienced kidney failure.
He concludes: "My opinion is that, what the doctor advises, that is good advice. Don't seek second opinions from outside, they will tell you to go for traditional treatments, etc."