Haematologist helps patients maintain their 'balance'

Dr Yvonne Loh is a specialist in haematology and consultant at Raffles Cancer Centre at Raffles Hospital.

I specialise in haematology because...

There are constantly evolving developments in this field which boost our understanding of diseases and increase the number of ways we have to treat them.

For instance, most patients with multiple myeloma, a type of blood cancer, used to die within three years of their diagnosis.

While it is still an incurable disease, patients are able to live beyond a decade due to various treatment options with novel agents.

Blood is fascinating because...

It is everywhere in the body. However, this also means "misbehaving" blood cancer cells can go everywhere, too.

Doctors then harness the immune system, which comprises white blood cells that recognise foreign substances, to fight cancer.

One little known fact about treating patients with severe autoimmune diseases is...

They may be suitable to undergo a procedure known as a blood stem cell transplant.

Blood stem cells are first harvested from the patient and stored. He then receives immunosuppressive medication to deplete the misbehaving cells which are responsible for attacking his own body.

The stored stem cells are then given back to the patient and these grow into healthy red blood cells, white blood cells and platelets, and shortens his recovery time.

In addition, the patient's immune system is repopulated by cells derived from the blood stem cells, and these learn not to attack his own body.

I have come across all types of cases...

Patients who have been unwell, for no known reason, for several months before coming to see me.

Others have had a fever for months before they are diagnosed with lymphoma.

There are also those who had a blood test for some other reason and are surprised to learn they have leukaemia.

If I were to give an analogy for what I do, I would be...

An assistant or coach to the tight-rope walker, who is the patient.

I help to adjust the long pole he holds to maintain his balance.

During blood stem cell transplants, I introduce a new donor-derived immune system into the recipient, whose own immune system has been so weakened that it is unable to fight the blood cancer.

However, there is also a chance of the donor's immune cells or "soldiers" not recognising its new home and launching attacks on the patient's body and tissues.

We want the "soldiers" to fight the cancer cells and not the patent's normal cells - somewhat like keeping things in the correct balance.

A typical day for me starts…

Before 6am if I choose to run before going to work. I feed and play with my cats, read the Bible and pray before setting off for work.

The day starts with a ward round, followed by consultations with patients in the clinic. Most of my workday is spent with patients.

I also teach other doctors and nurses, and give talks at regional and local meetings.

I knock off at 5.30pm and will usually go for a run, either near my home or my workplace if I'm meeting friends for dinner in town.

I love patients who are...

Motivated to get well, learn more about their condition and take an active role in their battle with cancer.

Patients who get my goat are…

Those who are abusive to nurses and other healthcare staff.

We are all part of the same team that is fighting cancer, so abusing them is like taking potshots at your teammates.

Things that put a smile on my face are…

When patients surprise me with how closely they follow my instructions.

During blood stem cell transplants, patients are told to eat only freshly cut fruit which have thick skin, to reduce the likelihood of contamination.

I told a patient this before his transplant and saw his relative helping him cut open a durian in the ward. As it was freshly cut and there aren't many fruits with thicker skins than that, what could I say?

It breaks my heart when…

I have to tell patients that their cancer has relapsed. These patients have often resumed their normal life after initial treatment. They go back to work, establish a family routine and even make plans for the future.

And, of course, when I lose patients I have known for a while.

I wouldn't trade places for the world because…

Haematology is a field which combines science and the excitement of new and novel treatments, the prospect of cure with the intangible rewards of connecting and making a difference to human lives. There's no job like it.

My best tip…

Sign up to be a volunteer bone marrow donor.

This is the only type of "organ" donation which does not require surgery, has minimal risks, and what is donated grows back completely within weeks, with no lasting ill effects on the donor.


This article was first published on June 4, 2015.
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