SILVER LININGS 2008
September 6
Aegean Room, Waterfront Hotel, Lahug, Cebu City
Speaker : Dr. Cecilia Llave
Topic : Fertility In Young Women With Breast Cancer
Host  : Maritoni Fernandez  

Mundy: Cebu Daily News of the Philippine Daily Inquirer group of publications is sponsoring room sessions here at Silver Linings for I Can Serve. I’m Mundy.  Good afternoon. This morning we had a very, very interesting topic and we were well-attended also. This room is—I think the theme is more on family dito sa atin.  This afternoon naman, we have a long afternoon ahead of us so I hope you could stay on ‘cause we have two very significant, very special topics. One is fertility of young women with breast cancer and the other one is how the significant other – the husbands, the family copes with the whole experience.

And then to facilitate and also to moderate the whole afternoon for us, we have a very special guest. She is a film and TV personality and she herself has her own experiences to share. Ladies and gentlemen, please welcome Ms. Maritoni Fernandez.  

Maritoni Fernandez:  Good afternoon sa inyong lahat.  Kumain na ba kayo?

Audience:  Yes.  

Maritoni Fernandez: Busog na lahat, ha. Medyo mahaba-haba itong kwentuhan natin kaya hindi puedeng gutom.  Ha.  Pa’no ba ‘to?  Pa’no ba mag-say ng good afternoon sa Cebuano?  Maayong hapon kaninyong tanan.  Okay na ba?  Tama ba?  O, ‘di ba.  

Thank you so much for inviting me here today. It’s really a pleasure to be here.  And the topic is very close to my heart, itong ating topic na having children after breast cancer or battling cancer dahil po ito po ay talagang nangyari sa buhay ko.  When I was undergoing chemotherapy, okay lang ba mag-Tag-lish?  Okay lang, ‘no?  

Audience: Okay lang.

Maritoni Fernandez: Okay, ‘di naman tayo lahat Inglesera dito or Tagalog talaga?  Okay, good.  You have to tell me, okay?  Okay lang, ha.  

So I had cancer when I was 31 years old. And this year, I’m turning 40. So, it’s been a while. Tagal na, ‘no? Ilang taon na—ilang taon na ba ‘yun?  Do you still count?  Me, I don’t count anymore how old I am basta I’m happy to be alive. The only—my only way of judging how old I am is by seeing my children grow.  Parang biglang may teenager na pala ako sa bahay. Hindi na ako yung nagsasabi kung ano’ng gagawin nila. Ngayon, sila na yung nagsasabi, “Mommy, what time are you coming home?  Why so late?” Baliktad na ang mundo ko.  That’s how it is nowadays.  

I got breast cancer when I was 31 years old and I had one daughter, she was six years old at that time. It was very difficult because I felt like, “Naku, eh, papa’no ‘yung anak ko, kung namatay ako?”  

Alam mo, karamihan po ng tao na nagkakasakit, they become close to the Lord.  With me, I was very blessed because I was already a very spiritual person before I got sick. It’s very important to be spiritual. Hindi po religious. Iba ‘yung religious sa spiritual.  

Ang religious, nagsisimba, nagpupunta dun, nagdadasal pero paglabas, nagmumura.  Okay? Iba po yung klaseng taong yun. Ang spiritual po, eh, kahit ‘di ka nagpupunta sa simbahan, basta may relationship ka with God at kahit ano’ng ginagawa mo sa buhay mo, lagi Siyang kasama, then you are a spiritual person.  ‘Di ba?  

So when I was diagnosed with breast cancer, napakaswerte ko talaga kasi may relasyon na ako with Jesus Christ. And so I was given the opportunity to have a honeymoon with Him during the time na nagkasakit ako. But my biggest fear was not dying because alam kong tatanggapin ako sa heaven, ‘di ba, alam ko naman, eh.  Kasi okay na ‘ko sa Kanya, okay Siya sa akin, we have a relationship.  My biggest fear was that my daughter would grow up without a mom.  And worse is mag-isa lang siya kasi wala siyang kapatid.  ‘Di ba? 

Ngayon, nung nagka-chemo ako, nagki-chemo ako and everything, ang sabi naman sa akin ng doktor, “Hindi ko maga-guarantee sa ‘yo na mabubuhay ka.”  Pero worse pa than that kasi hindi naman ako takot mamatay na, sad lang ako dahil ayoko siyang iwanan, bata pa.  

Pero naisip mo na rin, alam mo pag ganun ang sitwasyon, naiisip mo na rin na kung sino naman ang mga nandiyan para mag-alaga sa anak mo after you’re gone.  And you know, I have a very, very—I’m very blessed with a very wonderful family and support group sa pamilya ko. Mabait ang asawa ko noon, ‘di ba?  ‘Di ko na siya asawa ngayon, ha, pero he was a wonderful dad and he still is.  So I knew that my daughter would always be well-taken care of. She had that.  Although iba pa rin ang may mommy, ‘di ba?  You have to have—you have—you need a mommy until a certain age, anyway, ‘di ba?  And even when you’re old na.  Me, I’m already old, I still have days where I feel like I need my mom, ‘di ba?  

So, what happened was I told my doctor, “Okay, if I don’t make it, at least tell me that I can still have one more child because I don’t want my daughter to grow up mother-less and sibling-less.”  Mahirap po yung nag-iisa sa mundo. And yet, I was told that I could never have children again. Kasi daw ang chemotherapy will cause me to go into menopause and my ovaries will be completely shut down.  

I took Tamoxifen which is a drug that’s a estrogen suppressant because the kind of cancer I had fed on estrogen. Ibig sabihin kung may estrogen pa sa katawan ko, posibleng bumalik yung cancer at pag bumalik ang cancer, baka mas malala pa.  

So binibigyan nila ako ng drugs na para hindi bumalik yung cancer.  Ang ibig sabihin nun sinu-suppress niya yung estrogen sa katawan. But I was a very naughty girl, I was taking food supplements, ‘di ba, na talagang—eh, alam mo pagka—kasi minsan, pagka may sakit ka, alangan naman umasa ka na lang sa doktor mo.  Dapat talaga gawin mo yung sabi ng doktor mo. Gagawin natin yun. But aside from that, I believe that you have to help yourself, you learn more about your own disease and that’s exactly what I did.  I searched the Internet for everything under the sun that could help me.  

Kasi tuwing naki-chemo ako para akong gulay.  Hindi ako makabangon, hindi ako maka-c.r. nang mag-isa, lahat na lang ng hirap naranasan ko po.  As I’m sure most breast cancer survivors have experienced. They gave me the toughest drugs that there were out there at that time. And you know, I meet people nowadays battling breast cancer, I feel like, “Wow, if only I had breast cancer now, instead of nine years ago.  It’s so easy now compared to how it used to be.”  

You know, before when they remove your lymph nodes, mano-mano.  They remove every single one.  Now, they go for the sentinel node and that’s it.  They don’t even—wala—ni-wala kang scar.  They don’t even open you up anymore.  

Sabi sa ‘kin nung doktor ko.  “You know, Maritoni,” ironic ‘to, “you know, Maritoni, of all the cancers to get, you got the best one.”  “Huh?”  Meron ba’ng ‘best one’ na cancer?  Sabi niya, “Yes, because breast cancer is the most treatable.” ‘Di ba? Not only is it treatable, you can help yourself.  

On the Internet, I researched everything about breast cancer and about how it—chemotherapy would react to your body, the toxins that are put in, why, you know, why chemotherapy is necessary, what it does to all the fast-producing cells in your body, and how am I supposed to help myself. I discovered, through alternative medicine, that I can do this – which is a completely different story but, anyway, because of the alternative medicine that I was taking, eventually, my body corrected itself and I was able to produce a son. Which is why I am a living testimony that alternative medicine does work.  

Imagine, nabaog po ako ng tatlong taon. Three years, my period was completely gone. And yet, after three years, it came back. And now I have a bouncing baby three-year-old boy, which is really amazing. And yet, the only thing I do, the only thing I do for myself is take alternative. That is after all the chemotherapy, the radiation, the Tamoxifen, lahat po ng utos ng doktor, ginawa ko. Pero tinulungan ko din po ang sarili ko.  

Now, I’m not advocating anything other than please doing what your doctor tells you to do.  But I don’t want also for young women to feel that there is no hope because there is always hope. Marami po kasing nagkakasakit na iniisip, ayan, wala na, wala nang pag-asang magkaanak. There is always a chance.  

There are many different kinds of cancers. Nagkataon lang po yung cancer is talagang yung tipong hindi na puedeng manganak after kung ayaw mong magkasakit ulit.  

But, you know, I always believe that knowledge is power and if you keep searching and you search hard enough, you will find a solution with God’s help.  

So with no further ado, I will introduce our next speaker, our beautiful doktora.  Mamaya, mag-ku-question-and-answer portion tayo para ma-enlighten ko pa kayo with all your many questions I’m—I know that you must have.  

Dra. Cecilia Llave, I would like to introduce her. Sandali. Ito na. Alam niyo, the only thing that went when I turned 40 are my eyesight. Isn’t that amazing? It’s instant. As soon as you turn 40, you have to wear glasses.  Okay. ‘Di naman halata yung edad ko, ‘di ba?  

Audience:  Yes. 

Maritoni Fernandez:  Halata ba?  ‘Di naman, ‘no?  Pasensya na kayo ha. From the UP-PGH Cancer Institute, Oncologist, Gynecologist Dra. Cecilia Llave.  Thank you, Doktora.  

Dra. Cecilia Llave:  Thank you very much, Maritoni.  Good afternoon, ladies and gentlemen.  

Audience:  Good afternoon.

Dra. Cecilia Llave:  First of all, I’d like to thank Silver Linings, specifically Kara and Crisann for the honor and opportunity to speak to you this morning on issues on fertility of breast cancer patients.  We don’t have a remote?  

So I’d like to start with a story of one of our patients. The name is Lisa.  Lisa is 25 years old and engaged to be married in a month. One morning, she woke up and she felt there’s a small corn-sized lump in the left side of her breast. So she thought, “That is probably just because of my menstruation.” So she went on preparing for her wedding.  

Three months after her wedding, she felt that the lump had gotten bigger.  So alarmed, she consulted a doctor and a biopsy was done. It was cancer.  

After mastectomy and chemotherapy, she felt alienated to her womanhood.  She abandoned her beautiful dresses, her long black dresses. She felt her husband was alienating her.  

But what really broke her new-found life in marriage was when she was told that she might not have children anymore.  

We know that for us our goal, our priority is to save the lives of our patients who are sick. However, there are still a lot of women who feel that the saving of our lives is equally important as having children. We know that, isn’t it? And we have very good testimonies and survivors who had shown and who had championed and had shown that there is life after cancer. And in spite of cancer, they have gotten pregnant and had successfully given birth and they are celebrating life and they are survivors.  

So we’d like to acknowledge our champions. We have Crisann over here.  Please stand up to be acknowledged. Yes. And of course, Maritoni. Yes.  

Well, dapat siguro whistle bomb clap. Marunong ba kayo nun? Whistle bomb applause for them. It’s like this. Okay, everybody clap your hands going around.  Shh, shh…boom! O, ulitin natin!  Shh…shh…boom! Ganon nga ang fertility, eh, laging nag-boo-boom!  

Okay, so, I want this to be very interactive. Ayoko naman yung—mas maganda yung talagang meron tayong interaction.  So kung may questions kayo, anytime, please feel free to ask me and I’ll try very hard to make this very, very simple.  

So we know that the breast cancer is the most common invasive cancer among women. And 1 in 8 women will develop breast cancer in the United States. In the Philippines, ganon din siguro. Kanina nga, eh, one of our survivors over there who is a nurse from the Philippine General Hospital, “Ma’am,” was telling me, “Parang kalian lang, mga 11 years ago ata, eh, parang ang dami-dami na daw niyo ngayon.” Which is why wonder of wonders, it’s because of medical breakthroughs, because of the advances in science, ang dami-dami nang survivors.  

And therefore, ang problem na natin ngayon is quality of life. Yung mga survivors natin have found out na ang cancer naman pala hindi judgement na pag may cancer ka, mamamatay ka na.  Hindi. Puede ka pa ring mabuhay.  

So there is life after cancer. And not only that. There is also a chance that you can still become pregnant. However, maraming risk, sinabi na nga kanina ni Maritoni na marami talagang risk. And as a woman ages, the risk of cancer increases.  

So because ang breast cancer affects women, especially young women in the active reproductive age, alam natin na na-a-affect talaga yung sexuality at yung ability natin to bear children.  

But there are options for women who may want to have children after breast cancer. But mahirap nga yun kaya bilib talaga ako kay Maritoni ‘tsaka kay Crisann because it takes a lot of guts and power, super power talaga! But ang kagandahan nun, na-prove talaga nila na mukhang nawala na talaga yung cancer sa katawan nila.  

Kaya for that, clap naman tayo ulit! Shh…shh…boom! O, ‘di ba, ang galing na niyo after a while, ‘di ba?  

So, ang importante, once you are diagnosed of cancer, you should be able to discuss with your doctor kung papaano ka gagamutin. Importante yun because why?  Especially if you want to have a chance to be pregnant later on. Kasi kung 25 years old ka lang, wala ka pang anak, eh gustong-gusto mong magkaanak at gusto mo naman mapakita mo dun sa iyong mapapangasawa na puede ka ring makapagbigay sa kanya ng baby. So it becomes a very—it’s—you know, the psychological problems that it evokes are too much to bear for a woman.  

So this fertility should be discussed even before the treatment starts, with your doctor. I mean a lot of times, yung mga doctor naman, siguro very busy din and there are so many issues that are involved, ang hirap i-discuss din, ‘di ba? So if your doctor does not discuss it, mag-volunteer ka na. Sabihin mo na sa kanya na, “Doktor, kasi baka naman may chance pa akong mag-buntis later on at baka gusto ko rin din naman magpa-dede,” ‘di ba?  

And we’ve heard a lot of women who had—who still had—nagpapa-breast feeding din sila kahit after cancer treatment, ‘di ba? I don’t know, Crisann, did you have breast feeding?  

So, ‘di ba, ang galing! Palakpakan naman! Whistle bomb ulit! Shh…shh…boom!  O, ‘di ba?  Tingnan mo, meron na tayong model.  

Anyway, so it’s important that you discuss it with your doctor so that your doctor will choose a strategy so that yung ma-improve yung chances ng fertility mo at ma-avoid yung premature menopause without affecting your chances of cure.  

Alam kasi natin ang pregnancy produces hormones. Yun, sinabi na sa inyo ni Maritoni kanina na yung hormones na yun, yun ang pagkain ng cancer cells mo.  Eh, kung ang cancer cells mo ay positive for estrogen receptor, progesterone receptors, so, kung meron ka pa ring mga estrogen sa katawan mo, yun ang kinakain niya—yun ang pagkain niya, eh.  

So pag marami kang ganon, you’re—ang worry mo is your cancer might progress especially kung na-diagnose ka na buntis ka na at malapit ka nang manganak. Wala ka nang choice. You have to continue that pregnancy and delay your treatment.  

But there’s a risk that your cancer can progress very fast. Or pag di-ne-lay mo naman, magkaka-problema ka rin. So it’s important really that you should discuss this with your doctor.  But of course, kung ikaw ay menopause na, matanda na, hindi na yun question. At saka hindi ka na mag-i-isip nang mabuti kung ano bang option ang dapat gawin mo.  

So, of course, kung meron kang bukol sa dede mo na kailangang tanggalin ang bukol, sasabihin mo, “Ay, nako, tatanggalin mo ang dede ko.  Ito na nga yung pinakamagandang parte ng katawan ko, Doktor, aalisin mo pa yan?” So parang nawawala yung iyong pagkababae.  

But now, may mga ways na ginagawa ang mga doktor. Ang tawag dun yun ay ‘Breast Preserving Surgery.’ Hindi radical ang pag-o-opera, hindi lahat ng dede tinatanggal na. May na-se-save pa ring mga tissues such that there are reports na merong ngang mga survivors nakakapagpa-dede pa sila dun sa breast na tinanggalan ng cancer. Merong ganong cases.  

But of course, kung ang lesion mo ay napakalaki at it has involved already many tissues in the breast and even in the armpit, okay, positive for estrogen and progesterone receptor, ang HER-2 over expressed, okay, eh, may desire ka pa bang mag-buntis?  Siyempre, hindi.  

So mainly, itong issue na ito ay for women who are young, desirous of pregnancy, were assured na clear siya of cancer, ‘di ba?  Importante yun, ‘no.  Kaya importanteng you sit down with your doctor. Hindi puede, “Eh, kasi, ang hirap kausapin si Doktor, eh.”  ‘Di ba ganon?  You should discuss it with your doctor, lahat ng feelings niyo kasi affected ang paggagamot nung doktor kung hindi niya naiintindihan kung ano’ng mga desires mo. Okay.  

So this one, na-mention ko na sa inyo kanina na dahil dumadami ang survivor, our worry now is the quality of life of our survivors. So parang nagbabago na yung trend ng treatment. We now have to take care of so many survivors with many problems and issues and yet, we don’t have studies or research to back up on how—kung ano ba’ng gagawin natin, kung papa’no gagamutin itong mga survivors na ‘to.  Kulang ang ating research or studies.  

And so if Silver Linings and I Can Serve can do some programs like that, it will really help the doctor. So hindi lang advocacy ang gagawin niyo, o intellectual pa ang dating, ‘di ba?  So maybe, I don’t know, we’ll be thinking of ways and means we can connect with you from the academe if we can do programs on survivorship because we don’t have so much knowledge on how we will be really able to treat our survivors. Iba na, eh, nag-i-iba na ang landscape ng treatment.  And 25% of our breast cancer patients had stated that the infertility had affected their treatment decisions. Okay.  

So, eto, na-emphasize na ito kanina na ang estrogen talagang pagkain yan ng breast cancer. Nakita natin yan na ang risk for breast cancer, nakikita mo pag may early menarchy, yung maagang mag-regla or puberty. Late menopause, first pregnancy after 30, estrogen hormone replacement therapy. But of course we know there’s a genetic factor, ‘di ba, such that if your mother or your sister or any relative na very close sa iyo ay positive for breast cancer, your risk is 50%. ‘Di ba ang laki, ‘no? Kaya, very important yan na once pagka meron ka na ganitong sakit, you should also be checking on your sisters.  Okay?  Okay.  

So papa’no ba ang breast cancer treatment ay ma-a-affect ang reproductive system? Such that nag-wo-worry ka na ngayon tungkol dun sa fertility mo nga.  When you talk of surgery and radiotherapy, it rarely, hindi niya masyadong na-a-affect ang reproductive system, ‘di ba? Kasi ang surgery ay localized to the breast. At ang radiation dito mo naman ini-irradiate, hindi mo naman ini-irradiate dito sa pelvis, ‘no. So it rarely affects yung fertility mo. Unless the doctor would suggest that your ovaries be removed para mawalan ng hormone supply yung cancer mo.  

‘Di ba, may mga cases na yung inyong mastectomy ay sinasabay sa oophorectomy.  ‘Di ba, merong mga ganong case na narinig kayo? Ang reason do’n is because of the hormone supply. However, if it’s chemotherapy and hormone therapy, yun ang nakaka-affect ng fertility and you develop premature ovarian failure. So nakita natin kay Maritoni na three years siya nawalan ng mens. Pero wonder of wonders, ang galing siguro talaga magdasal, ‘no, ay bumalik ang regla niya.  Hindi siya nag-tuluy-tuloy na menopause na, okay, kaya siya naging pregnant.  

So it’s either bionic talaga ang sperm or talagang bionic din ang egg mo, ‘di ba, yes, okay.  Yes, praise the Lord, okay.  

So, when you talk about fertility, you always talk about of the ovaries. When you were born, nung pinanganak kayo, you were born with two bags of eggs in your ovaries. Eksaktong number ang itlog ninyo. And when you reach puberty, inilalabas niyong itlog na yun isa-isa lang buwan-buwan para ikaw ay mag-buntis.  So yung reserba mo, pag naubos, dun ka nag-me-menopause.  Okay.  

So by that time, pag tumatanda ka, nauubos ang reserve ng itlog mo, tumatanda ang itlog mo, na-a-affect yung itlog mo.  Puede din siyang ma-damage. Now, kung nag-chemotherapy ka, ma-sa-subject talaga yun sa insult. So what happens is mabilis nauubos ang iyong ovarian reserve. At siya ay talagang na-sha-shut down. Parang tumatahimik, tamilmil, hindi siya makagalaw kasi ang tapang-tapang ng chemotherapy. And sometimes, hindi na fuma-function ang ovary mo kasi by that time nag-chemo ka, konti na lang pala ang natitira, hindi pa maganda yung mga itlog na yun, therefore, hindi na bumabalik ang iyong menstruation.  Hindi ka na nangingitlog and, therefore, kung wala kang itlog, ang inahin, hindi manganganak ang inahin.  Kailangan mo ng itlog para ikaw ay mag-buntis.  Eh, kung ubos na’ng itlog mo, or ang itlog mo’y na-damage ng chemotherapy, therefore, it’s gone.  

So, nakita natin na ang ganda-ganda pa ng itlog ni Maritoni at saka ni Crisann, hindi lang maganda ang mukha, maganda din ang mga itlog nila. And I want to add, pati ang kanilang pepe. ‘Di ba? Okay.  

Now, okay.  Now, pag kayo ay nagpa-opera, ano’ng goal ng operation when you have cancer?  The goal is to remove all the tissues with cancer. ‘Di ba, tanggalin mo lahat. Pero pag tinanggal mo ‘tong, halimbawa ang bukol ko narito, ‘no.  Isang bilog na bukol na tatlong centimeters. Ang doktor, hindi lang tatanggalin yung three centimeters na bukol, pati yung normal tissues around it, tatanggalin niya. Pagka minsan pa, tatanggalin talaga yung buong dede mo. At hindi lang yun, pati yung mga kulani mo sa kili-kili.  

Sasabihin mo sa doktor, “Eh, bakit naman, Doktor, puede bang tanggalin mo na lang yung aking bukol?  Eh pati naman pa yung ibang tissue ko tatanggalin mo? ‘Di wala nang natira diyan, ‘di ba, wala nang natira diyan sa dede ko, eh, ‘di papa’no naman yun?  Tabingi na siya.”  

So you’re so concerned with it kasi yung femininity, ang pakiramdam mo, nakabase sa dede mo.  Okay. Pero hindi naman pala. Kahit mawalan ka ng dede, mawalan ka ng matres at mawalan ka ng obaryo, babaeng-babae ka pa rin, sister. Hindi ka magiging lalaki at hindi ka rin magiging bakla. So it’s in the mind. So all that’s very important, it’s in the mind. Okay.  

So kung ikaw may cancer, ang tendency mo sasabihin ng nanay mo, “Eh may cancer na nga yan, patanggal mo na lahat talaga yang dede mo, pati na yung kabila kahit wala pang cancer, tanggalin mo na para pantay na, nang hindi na bumalik,” ganon ang sinasabi ng nanay mo, ‘no.  Pero ngayon, meron na tayong tinatawag na ‘Breast Preserving Surgery’ na ginagawa for smaller lesions na walang metastasis and these are yung lumpectomy, lumpectomy…

Gaano ka-sigurado itong doctor na ‘to na inoperahan ako na walang natitira na cancer dito sa tinanggalan niya. Okay? So pag binasa sa ‘yo ng doctor ang histopath, sasabihin sa ‘yo ng doctor, “Oh, all the lines of resection are negative of cancer.” Very important yun kasi pag sinabi ng doctor na, “The lines of resection are still positive for cancer,” meron ka pang natitirang cancer dun.  Kaya ang doktor pag nag-o-opera ng dede or bukol, nagsasama siya ng normal tissue kasi hindi niya makikita sa mata niya kung may cancer na yung katabi.  Eh, wala naman siyang microscope habang siya nag-o-opera, di ba? Okay. At wala rin naman siyang makapang bukol dun and yet, yung tissueng yun, kahit wala pang bukol, meron nang cancer kasi microscopically dun sa cells noong tissues na yun, sa dugo ng tissues na yun, ay meron nang cancer pero wala kang makapang bukol, wala kang masalat na bukol, pero microscopically, may cancer na yun.  

So papa’no ka maa-assure ng doktor na ito lang ang tinanggal niya, wala nang natira?  Okay, dito pumapasok yung mga naglu-lumpectomy para assured sila na wala pang metastasis yung sa kili-kili. Tandaan ninyo may mga babae walang bukol sa dede pero may bukol sa kili-kili dahil ang problema nila nagsimula sa dede pero lumaki sa kili-kili. Merong ganon. Yung metastatic lesion ay mas malaki, ‘no? So, eto yung tinatawag nating auxiliary lymph node dissection or sentinel node biopsy. So para makasigurado yung doctor mo na nasaid niya lahat at wala pang kumakalat sa kili-kili mo, because your lymph nodes, yung lymph nodes mo ay tagakuha ng dumi ng katawan. Dun pumupunta ang dumi, dun pumupunta ang cancer, okay. So iba-biopsy mo yung mga kulani.  

Yun namang iba ayaw basta mag-biopsy kasi pag tinanggal mo yun, buong dede mo na ang tatanggalin hanggang kili-kili, di ba. Kaya nga ang sakit pagkatpos ‘di ba walang nerves para hindi mo—wala, nawawala pati yung nerves, hindi mo maramdaman, ‘no.  

So, ang ginagawa nila ay yung sentinel node biopsy. Ano yun? During the surgery, i-injectionan nila yung tissue that goes to the kili-kili and from there makikita mo kung positive na din yung kili-kili. At saka mo siya kukunan nung nodes dun sa kili-kili. So, mas marami kang pri-neserve na breast tissue. Kasi nga ang tendency mo dahil ayaw mong ma-disfigure ang iyong katawan, sasabihin mo sa doktor na, “Huwag mo naman ako i-disfigure, magtira ka naman ng konti.”  Eh, yun naman doktor hindi naman siya sigurado na ma-a-assure ka na wala nang matitira dun. Eh mapapahiya naman siya kung maganda nga ang dede mo pero nagpo-progress naman ang cancer mo. Maganda nga ang dede mo pero go-away ka naman. Mahirap din naman yun, ‘di ba?  

So, ang problema nito is papa’no mo ba ma-a-assure na pag inoperahan ako ng doktor na ‘to, sabi niya okay lang sa akin ang lumpectomy, yun pala may natira.  Eh ‘di o-operahan na naman ako, ‘di ba?  Ang laking problema yun.  

Now, some studies have shown that even for in situ carcinoma or Stage 0, yung cancer nagsisimula pa lang. And, mind you, merong cancer na tumor-less.  Walang bukol kang makikita.  Nakikita mo lang namumula ang balat.  Pero wala kang makapang bukol.  Ang tawag dun Paget’s disease, tumor-less siya.  Okay.  And yet, nung ni-review nila, ilan ang chances na ang cancer mo ay mag-recur if you did mastectomy na ‘to, ah, mastectomy in an early Stage 0? Your recurrence is 1% to 2%. Ano na ‘yun, ah, mastectomy na ‘yun.  Eh, this is early cancer, ‘no.  

Eh, dahil siguro matanda siya, tinanggal na lahat ng doktor, ‘no. But if you just did breast-conserving surgery, your recurrence will be 26% to 43%, which is very high, ‘di ba, ‘no?  At kahit dagdagan mo ng radiotherapy, your recurrence will be 7% to 13.4%.  

Kaya nga yung mga cases na nilu-lumpectomy at hindi sigurado ang doktor ninyo na nasaid niya, this—sinasabayan nila ng lymph node dissection para ma-assure nila kung may natitira pa. And this is followed by radiation to assure na hindi na rin babalik. Kasi studies have shown na kahit early stage, pag ginawa mo ay simple operation lang, ang chances for recurrence is high. Nakita niyo diyan, ‘di ba?  But if you add hormone treatment, usually your Tamoxifen, nag-i-improve yung less than 44%, okay, ang recurrence. So malaking tulong talaga yung inyong Tamoxifen because Tamoxifen ay sinu-suppress niya yung estrogen, anti-estrogen yun, eh.  Kaya kailangan niyo yun.  Binibigay sa inyo yun for five years.  

Tinanong ba niyo ang doktor kung bakit pinapainom ka nito for five years?  Ako, “Ano ka ba naman, Doktor, ang tagal mo pinapainom ako ng Tamoxifen, ang lakas-lakas ko nga. Ang mahal-mahal naman nitong gamot na ‘to.”  Sino makakasagot? Tinanong niyo ba sa doktor yun? Hindi. Bakit? Bakit limang taon ang sinasabi ng doktor? Kasi na-found out nila na ang recurrence, ‘no, ng breast cancer, occurs within the first two years, ‘no. And as the years go by, ‘no, nababawasan na yung risk mo mag-recur. And by the time you reach five years, the chances, eh, kokonti na, ‘no. 

Kaya nga kung gusto mag-buntis, the best time is after two years to five years.  Pinaka-best five years kaya ganon ginawa ni Maritoni at saka ni Crisann, ‘di ba?  More than two years, ‘di ba?  

So yung mga adjunctive therapy na sinabi ko sa inyo kanina, nakita niyo dun sa slide na ‘yun kung gaano ka-helpful sila na hindi mag-re-recur yung cancer niyo.  You have the Tamoxifen, ‘di ba? And you know that there’s a decrease by 50% of the recurrence if you take that regularly and there’s a 28% decrease in mortality. Now, in some patients, kahit normal ang ovaries nila, tinatanggal yung ovary para wala nang supply of estrogen. Kaya lang, malaki’ng problema mo.  Magiging ka talagang early menopause and marami din yung side effects, ‘di ba?  Mahirap din ‘yun, ‘no.  

There are other treatments like your aromatase inhibitors and I don’t know if some of you are already taking that, ‘no, na ginagamit niyo yun. Kaya lang, medyo napakamahal. I think it’s already available here, ‘no, pero masyadong mahal. Then you also have this glycerine, ‘no. All of these are adjuvant hormonal therapy para ma-suppress yung inyong estrogen, ‘no, kasi yun nga ang pagkain ng cancer mo. And we know that adjunctive chemotherapy decreases the cancer mortality by as much as 25%.  

So, puedeng ibigay itong chemotherapy mo bago ka operahan kasi ang laki-laki ng bukol mo such that mas malaki ang matatanggal ng doktor. So ang ginagawa niya, iki-chemotherapy muna niya, ang tawag – Neo-adjuvant. So alam mo ba ang ibig sabihin ng adjuvant?  Sino makakataas ng kamay?  

Ay, Ma’am, ano po ba’ng adjuvant?  

Female Guest:  Supplementary.

Dr. Llave: Something like that. Okay. Ibig sabihin nun, yung primary treatment nabigay mo na, which is surgery. So adjuvant is yung additional treatment na ibibigay mo, ‘no.  Puede yang neo-adjuvant, neo-adjuvant means yung treatment na binigay mo bago ma-opera.  Okay.  So, ang purpose nun para ma-shrink yung bukol mo para mas maliit, mas madaling mag-opera. Or for early breast cancer to prevent metastasis and for late breast cancer, to reduce the tumor size, okay.  It’s administered usually every two to three weeks, for three to six months after surgery.  

Now, when—this is the latest recommendation of the Society of Oncolo—Breast Oncologists that if your nodes are positive, you should always have really adjunctive treatment. Surgery is not enough. Okay. And if your nodes are negative, which ito nga, nagitla din ako dito, eh, dito sa findings na ‘to, if your nodes are negative, puede ka lang hindi mag-chemotherapy kung ang bukol mo ay less than 0.5 centimeters. Ang liit nun, sister. Baka lahat kayo dapat i-chemotherapy kasi by that time you’re able to feel your bukol, 1 cm or more na ‘yan, eh, ‘di ba?  Ang mga 0.5, ‘di mo na-pi-feel yun. So, at sinabi din naman nila dito na for invasive ductal and lobular carcinoma, 0.61 cm, chemotherapy if with unfavorable features. Ito yung mga unfavorable features. Ibig sabihin yung grade ng cancer.  

Yung cancer, may kanya-kanyang grade. Merong matapang, merong hindi masyadong matapang.  Pag hindi masyadong matapang at alam mo na kaya mong labanan yun kasi yung immunity mo malakas.  Kaya nga ang immunity mo dapat i-strengthen mo, papalakasin mo ang immunity mo. And this is where your healthy living or healthy lifestyle comes in.  Okay, ‘di ba, yun yun.  

So, ang suggestion nila is for all invasive cancer that is more than 1 cm, we immediately give chemotherapy with Tamoxifen. Pag histologic types, ito yung mahihinang cancer. Puedeng bigay muna yung chemo if they are larger than 3 cm. So magtataka ka kung bakit yung kaibigan mo ay chinemo, ikaw hindi chinemo.  Ibig sabihin magkaiba kayo ng storya, hindi puedeng pare-parehong storya ninyo. Okay. 

So these are the list of the chemotherapy regimens ng breast cancer.  Ang dami-dami niyan. Merong apat na gamot, may tatlong gamot, may dalawang gamot.  In other words, ang dami-dami niya, ang mahal-mahal pa niya, ’no. And these are—these drugs can cause gonadal failure. Mag-fe-fail yung ovary mo talaga if you are given this chemotherapy. Kanya-kanya lang ng tapang. Kung ganon kalakas yung risk for the failure of that ovary. It can be higher risk if you have cyclophosphamide, melfalan, procarbazine. Ewan ko kung natatandaan ninyo kung ano mga pangalan ng chemo ninyo, unless nakalimutan na ninyo, ‘no. But you’ll see that most of them really affect the function of the ovaries. Nag-fe-fail talaga yung ovary, ‘no, whether high-risk or low-risk. Okay. 

So chemotherapy really damages your limited supply of eggs and it affects your ovaries to be able to produce hormones. And therefore, nagkakaroon ka ng infertility, nagkakaroon ka ng premature ovarian failure and you go into menopause even before you become 40.  

So success yung narinig nating kay Crisann at saka kay Maritoni, pero meron kaya tayong mga pasyente na 20 years old pa lang, menopause na? Hindi na bumalik yung kanilang menstruation. So problema pa yun kasi pagka menopause ka, maraming abnormality kang nakikita, ‘di ba? Okay.  

So, eto yung talagang nakaka-gitla din, ‘no. 50% of women under 40 years old will stop having the period, ‘no. Imagine, 50% talagang totally nawawala yung menstruation.  And some will regain their ovarian function after treatment but less than 11%, kung more than 40 years old ka. A 22% to 56% among those less than 40, so very lucky si Crisann at si Maritoni because they are among those na bumalik ang kanilang function ng ovary. So ang galing siguro talaga nilang dumasal, ‘di ba?  

So yung mga hindi sana siguro natin magiging problema ito kung if women will pay much attention to the breast like men do, ‘di ba?  Kasi yung mga lalaki, mas nag-pe-pay attention sa boobs natin, eh. Pero tayo, hindi tayo nag-pe-pay attention. Kaya let’s pay attention to our breast.  Okay. 

Now, when you have this problem, it’s important that there is a multi-disciplinary approach. Meaning, yung doktor mo sa cancer, hindi enough yun kung gusto mo, meron kang fertility or magbubuntis ka. So dapat multi-disciplinary approach.  Matutulungan ka naman ng doktor mo. So hindi lang isa ang doktor mo. Meron kang oncologist, whether medical siya, surgical or radiation oncologist, meron ka pang reproductive endocrinologist or fertility specialist. Kaya napaka-salimuot din, ‘di ba tsaka napakagastos din kasi madami kang doktor, ‘no, okay. But importante na all of them will really be talking to each other and to you regularly, ‘no.  Kasi hindi naman madali yun na nagbuntis ka after cancer. So kailangan bantayan ka talagang mabuti because at any time that you are in pregnant state, your cancer can recur. Ang problema hindi mo rin ma-pick up kasi tense yung iyong dede, ‘di ba, pag pregnant ka, malaki ang boobs mo.  So kung meron kang ma-de-develop ng bukol dun, ang hirap. So it has to be planned very well. Yung monitoring mo, kailangan maganda, ‘no.  

So, now, halimbawa na lang, ‘no, bago ka gamutin, gusto mo talaga na magkaka-baby ka, ano’ng puede mong gawin?  This is where bago ka gamutin, alam na talagang puedeng gamot—dapat gamutin ka, hindi ka sure kung babalik yung iyong mens after you’re treated.  

So you can do embryo freezing. Ano ba yung embryo freezing? Embryo, baby na ‘yun. So ano’ng gagawin? Bibigyan ka ng hormone para ma-stimulate yung iyong ovary na mag-produce ng maraming egg, okay. And these eggs will be harvested, okay, and will be fertilized in the laboratory with your husband’s sperm, kaya lang nasa test tube. And it becomes already a baby. Pag may baby na ‘yun, embryo na ‘yun, tsaka mo siya i-fe-freeze. At pag magaling ka na sa cancer mo, tsaka ilalagay sa ‘yo yun. Unless, you don’t want to carry that baby, then, you can have a surrogate mother na magbubuntis para sa ‘yo.  

So, so, yun ang isang option, ‘no, na the pregnancy rate is 10% to 25% and it takes two to six weeks and this is available already in our country. Puede na niyong ipa-freeze ang inyong mga kuting. ‘Di ba? Okay. Kaya lang, napakamahal and it’s available in the Victory Center near Makati Medical Center and one in a center in the University of the East. Kaya lang it’s too expensive. Worth isang car just to have embryo freezing or even more. Parang isang kotse para lang magtago tayo ng kuting.  Okay.  

Ngayon, kung ikaw naman ay wala kang partner, you’re single, ‘no, and you don’t—wala kang donor sperm para ma-fertilize yun, okay, so puedeng yung iyong itlog ipa-freeze mo. Okay. Pero experimental pa siya, eh. At saka the pregnancy rate is very low. Up until now, iisa pa lang yung naririnig natin all over the world na naging—na nabuntis with this.  Okay.

Now, kung wala ka namang option for the little time for ovarian stimulation, then, your only option is tanggalin ang parte ng iyong ovary, get an ovarian tissue from your body and this will be frozen. I-fe-freeze mo yung part ng ovary mo kasi later on pag puede ka na magbuntis, yung iyong ovary na pina-freeze mo, i-implant ulit dun sa ovary mong na-shut down ng chemotherapy so may bago kang ovary dun na mag-re-regenerate, na puedeng mag-produce ng eggs. Kaya lang wala tayong ganito sa Pilipinas. And experimental pa siya. And, I’m sorry to say, wala pang pregnancy to date na napapakita all over the world. ‘Di ba, ang hirap, ‘di ba? And during preg—during treatment, okay, para di ma-shut down yung ovaries mo, during chemotherapy, para hindi siya masyadong ma-affect, lalagyan mo ng GnRH (gonadotropin-releasing hormone), pero experimental pa rin ito at saka hindi mo malaman kung safe ba siya or effective ba siya. It’s something like nagki-chemo ka na, na katakut-takot na insult ang inilalagay mo sa ovary mo, bibigyan mo pa nito, to protect that ovary para di ma-shut down siya, eh, ‘di, mahihilo na yung ovary mo kasi ang dami-dami nang tinatanggap mo, ‘di ba? Kaya ako, hindi ako strongly believe dito, eh. Parang hilo ka na dun sa chemo mo, dinagdagan mo pa ng isa, mas lalong magkakaproblema, ‘di ba, that’s what I feel, ‘no.  Okay. 

And after treatment, you can have your natural and assisted conception, ‘no.  Pero ang problema kasi yung assisted conception, hormones pa rin ang binibigay mo.  So malaking problema baka mag-risk kang magbalik yung cancer mo, okay.  

So I think yours is natural, ‘di ba? And Maritoni’s also natural, ‘di ba? After treatment, kung ayaw pa magbuntis nung babae and she wants to delay it, then, she can also have that embryo freezing and freezing of ovarian tissue sampling.  Of course, you can have donor eggs and donor embryos kung ayaw mo manggaling sa ‘yo or hindi nanggaling sa ‘yo, ‘no. And I talked to you a while ago about surrogate mothers na magbubuntis for you. Pero parang ang hirap, ano. Aalagaan mo kasi yun baka mamaya, habulin sa ‘yo.  

And of course, you can adopt. Tingnan mo si Angelina Jolie, ang dami-dami niyang in-adopt kahit wala siyang breast cancer. Adopt siya nang adopt, o, ‘di ba?  Okay. 

So ang role ng hormones naman is to stimulate the eggs to have many, many eggs para yun ang ma-freeze mo. Kaya lang problema nito, estrogen levels are high, so you still have the risk na baka bumalik ang cancer mo.  

So there are other safer ways to stimulate the ovary like the natural cycle pero makukuha mo lang one egg every month. Whereas kung ini-stimulate mo with hormones and then you get more, okay. So, kaya lang ang daming problema din noon, ‘no.  

So, yung iba, ima-mature nila yung egg mo in the test tube. Kaya lang, wala dito sa Pilipinas, okay, at kung sa abroad naman yan, siguro millions yan of dollars kaya hindi natin kailangan yun, ‘no.  

Pregnancy and children in patients with breast cancer, only 3% get pregnant.  Kaya Crisann and Maritoni, you’re just one of the few 3% and congratulations.  Oh, we all clap-clap ulit.  Shhh!  Shhh!  Boom!  O, ‘di ba?  Ang galing naman, 3%, ‘no.  

So is it safe during or soon after breast cancer to get pregnant? Mahirap. There’s worse prognosis particularly if the age is less than 30. Kaya nga risky yung ginawa ni Crisann tsaka ni Maritoni, eh. Kasi they’re—you were less than 30 then or more than?  

Female Voice:  When we were diagnosed or—

Dr. Cecilia Llave:  When you got pregnant?  

Female Voice:  I got pregnant at 34.

Dr. Cecilia Llave:  34, so early 30s.  

Female Voice:  I had twins.  

Dr. Cecilia Llave: Wow! Induced ba ‘yan? Ang galing naman. And you have only one ovary and twins pa, kaya ang galing talaga! God loves you!  That’s a miracle!  Clap naman tayo!  Whistle bomb clap ulit!  Shh!  Shh!  Boom!  Okay.  

So ang problema kasi if you get pregnant during or soon after breast cancer, there’s a chance na mag-progress into an advanced stage at baka ma-delay yung treatment mo. So, there’s a more—during pregnancy—during treatment of breast cancer, mahirap, eh, kasi dun papasok yung chemotherapy should be avoided in the first trimester and so on and so forth. Okay.  

So theoretically, the safest time to have pregnancy after breast cancer is after two to five years of being cancer-free. Ito yung sinasabi ko sa inyong five-year survival rates. Ang interval ng pregnancy mula sa six months, survival is 54.  Pero pag more than five years, 100% ang survival. So the best is to wait for the time. Okay, the best is to wait for three to five years before you can get pregnant.  And make sure that you are fully worked up, kung kaya mo yun, ‘no. 

For future conception based on the prognosis, kung ikaw ay Stage 4, you should not get pregnant. Ikaw ay Stage 3, you defer pregnancy after five years. Kung ikaw ay recurrent cancer pero Stage 1 or Stage 2, you can contemplate conception pero ang prognosis is not good, ‘no.  Okay.  

So, ito naman, itong table na ‘to, next—puede kong ibigay sa inyo para tingnan ninyo kung ano’ng dapat gawin ninyo. Kung—okay. Like this one. Kung ako ay bibigyan ng Tamoxifen, okay, yes, okay yan pero I should be very well, kung may desire ako maging pregnant. Kung ako ay age less than 32, kailangang meron kang parang family planning kasi baka mag-pregnant ka in between. So I’ll just give the slide to you para hindi tayo tumagal.  

So I think this is the last of my slides. It’s important that both the patient and the partner should consult with your doctor and a fertility specialist if you really want to get pregnant after diagnosis of breast cancer and make sure that it is after two to five years that you are cancer-free. Okay. You weigh the pros and cons, the risks and the benefits. Is it worth taking the risk? If it is worth taking the risk, go, ‘no, kasi for you, ang feeling mo, your life is equal to having a new life. Merong ganong babae, eh. Ganon ang feeling niya. But if you feel na, “Teka muna, may cancer na nga ako, eh, gusto mo pa akong mabuntis. Eh ang aking body is already ravaged by cancer and then magbubuntis pa ako.” That’s another parang insult to your body. And yung energy mo malu-lose din, ‘di ba? Ganon ang thinking mo. Pero nakita naman natin na meron tayong dalawang success stories. And they are in the pink of health, ‘no, they’re very happy women, they’re more beautiful, they have children pa in spite of cancer.  

So you see, that in spite of cancer, you will have a life and you can get pregnant and you can also breastfeed. It’s just a matter of deciding and planning for it, ‘no.  

So for that, I’d like to thank you very much for this afternoon. And isang whistle bomb clap ulit!  Shh! Shh!  Boom!  Okay, thank you.  

Ma’am, Maritoni, question and answer.  

Maritoni Fernandez: Palakpakan natin ulit si Dra. Cecilia Llave. Hay, naku, magku-question and answer portion pa ba tayo, Dra.? Too tired ka na. O, sige, ako na lang ang question-and-answer portion niyo, gusto niyo? May mga questions ba? Kahit ano under the sun, wag lang showbiz. Kasi hindi po bakla si Bobby Yan, Bobby Yan tuloy. Si Piolo. Dahil ‘di ba ang huling show ko kay Piolo?  Ang daming nagtatanong sa ‘kin, “Maritoni, bakla ba talaga yan?”  “Hindi po siya bakla. Guwapo,Kristiyano po siyang tao.”  

Okay, go, question and answer. Kahit ano, kahit pagbubuntis, kahit anong gusto niyong itanong. Delikado po bang magbuntis habang—pagkatapos magka-cancer. Opo, delikado. Pero sira po ang ulo ko kaya ako pumayag magbuntis.  O, ano pa?  O, inunahan ko na kayo, yes.  

Doctor: This is a question. When you had your pregnancy, were you taking Tamoxifen?

Maritoni: I was until I found out and then I quit immediately. But it was a very big risk definitely. Importanteng—it’s a very good question. I quit immediately also knowing that there may have been side effects to the baby.  

Doctor:  I asked this question because—by the way, I’m a surgeon.  

Maritoni:  Hi. 

Doctor: This is the usual question that our patients would ask us. Can I still get pregnant? Can I be a pregnant or is there a chance for us? If we—if you ask me, I lay down the cards on the patient. This is the risk of recurrence. Recurrence is very important—

Maritoni:  Yes.

Doctor:  For these patients to be pregnant, okay. But I appreciated your first statement that you had a relationship with the Lord. When I have been—I—my—I am connected with Aboitiz Cancer Foundation and I have been lecturing on cancer.  At the end of my lecture, after having said this, I still believe in miracles.  

Maritoni:  Yes, amen.  

Doctor:  It is always the Lord that creates miracles. And according to the nun in EWTN, Sister—I forgot the name, “If you do the ridiculous, that’s the time you experience miracles.”  

Maritoni:  Very true.

Doctor:  And if you do the—if you follow the most unorthodox technique, just follow the Lord and that’s the time you experience some miracles. And what really hap—and you are only the few patients that I’ve learned about who wants to be pregnant after treatment of breast cancer. Most of these patients will tell us, “Doc, ayoko na maging pregnant.”  

Maritoni: Doc, meron akong kuwento sa ‘yo naman. My doctor told me upon giving me my--what do you call it? Your path to freedom, ‘di ba?  Bibigyan ka nila ng list of things to follow. Yung iyong kailangan gawin. Number one, magki-chemo ka, apat na beses yan, once every three weeks.  Pangalawa, pagkatapos mo mag-chemo, may one month break. You can do whatever you want, you can eat anything you like within that one month. After that one month, balik ka, six weeks radiation therapy. After six weeks radiation therapy, you’re free, you are on your own. He will give you Tamoxifen, you come back every three months for your check ups but he cannot do anything more for you. The rest is up to you.  Or should I say, up to God.  

Doctor:  Yes. So just to continue my comment on it. So that’s what I think now, it’s really miracles that happened to you. And what I learned also, by the way, I’m not a priest, I’m a surgeon.

Maritoni:  Are you sure?

Doctor: Yes. Don’t come to me for confession, come to me for consultation later.  Anyway, what I’m saying is that if you come to the Lord in brokenness, what’s that—what really happened to you and most of the patients, not only cancer patients but in any disease for that matter, definitely the Lord will answer you.  What answers? It’s you only and the Lord who know. Maybe yes, maybe no.  See, in your case, you really wanted to have a child and I was asking Tamoxifen when you were taking Tamoxifen and you got pregnant. By the way, before I became a doctor, I’m a chemist and I know how chemicals work in our body.  And I know the effect of Tamoxifen on estrogen, ovaries and everything, fertility for that matter. It’s hard to conceptualize and it’s hard to think that your baby is normal in spite of those drugs that you have taken in which it has been proven that it has some teratogenic effect. That means it will cause some defect on the babies. And yet it happened that it—your baby is normal. So for me, it’s really a miracle and I know that you asked for it from the Lord and the Lord gave you your heart’s desire.

Maritoni:  I didn’t ask, I claimed.  

Doctor:  Ah, okay.  That’s nice.  Okay. So…

Maritoni:  Thank you, Doc. You know, it was actually my doctor who said to me, he said to me after my second chemo treatment he said, “Maritoni, you will never have children again.” It broke my heart. My daughter was six years old and I knew I could die. And if I die, she will be alone. I don’t want my daughter to grow up alone. So I told the doctor, “No, you know what? You’re wrong. I was promised a son. And I am going to have a son.” And I went through all my treatments and I took my Tamoxifen as I was supposed to. And like I said, I had my son. God is amazing. There is nothing that He cannot do. And if you, you know, I cannot tell people enough. They always say, “Maritoni, you’re so strong.  You know, it’s amazing, what-what a miracle in your life.” God has shown me many miracles. My son is just one of them.  

The fact that I—I don’t know how many of you know my story but the fact that when I went to America, it wasn’t even me who was sick, it was my mom who was sick. I was taking her to America to get treatment. And it was by chance that they found out that I was the one who was sick. That alone is already a miracle. The fact that I’m not an American citizen and yet they treated me in America and they did it for free. I got free treatment in the United States of America. How? Don’t ask me. My God did it. Because to this day, I cannot teach you how to go about that. People, alam niyo, nilalapitan ako ng mga tao, “Ano?  Binigyan ka ng libreng gamot sa America?” “Opo.  Chemotherapy, radiation, all my operations were free.” I kid you not. I didn’t pay a single penny for it. And what do I attribute that to? Hindi po ako pastora, ha. I am far from it, okay. But I tithed, I tithed every week because I believe in advancing the kingdom of heaven. And because I was a faithful tither. Alam niyo po mahirap—alam mo pag sampung piso ang kita ninyo, madaling magbigay ng piso. Pero pag sampung libo na ang pera mo, medyo mahirap nang magbigay ng isang libo. Pag isang daang libo na ang kita mo, medyo ayaw mo nang magbigay ng sampung libo. Totoo ba, hindi?  

There were days when I would go to church and I had earned half a million pesos. I have to give 50,000? There is that looming feeling in the back of your mind. I don’t want to give 50,000. That’s one sem already ng pag-aaral ng anak ko or one year. These thoughts always went into my head.  But you know what?  I did it faithfully anyway.  

Somebody in our church, artista din, si Coney Reyes, kilala niyo naman siya.  She would always tell me, “Ton, pikit-mata mo na lang gawin,” and that’s exactly what I did. Pikit-mata ako magsusulat ng tseke, ibibigay ko na lang. Wala na akong pakialam. I don’t want to know where it went. But I did it anyway. And look how He repaid, how He gave me in return. This is my testimony. Up to now, umiiyak ako.  Bakit? It’s been nine years and I still cry because God is such an amazing God.  

You know, every time I went for treatment in America in the hospital, my surgery first, it was tanggalin yung lump. I had a lumpectomy on my right breast. They removed the lump that surgery. I asked for the bill. “You don’t need the bill,” sabi sa akin. It’s paid for. “By whom?”  “By AID.” “What is AID?” “Medical AID, American Medical AID.” “But I’m not American.” “Don’t worry about it, just fight your fight,” they used to say to me. You know how important that is to be told, you don’t have to worry about money? Just to fight. Just that gives you so much peace in your heart na hindi mo na kailangan intindihin kung saan manggagaling yung pera. And yet, I still kept making kulit. “Just give me the bill, please, just give me the bill.” Kasi natatakot ako baka pagkatapos ng lahat ng treatment ko, tsaka nila ako bagsakan ng bill!  

So I collected all my bills, all of them, week after week, every blood test, every cleansing of my port. Imagine, nagpalagay pa ako ng port, ha. Hindi na dito dumadaan yung gamot, dito diretso sa may puso ko para hindi na mag-burn yung mga veins ko dito. I got world-class treatment and I collected all the bills, thank you.  

And, you know, at the end of all my treatments which was nine months after, I had a stack of bills this thick. Naisip ko, “Pa’no yun? Tapos na ‘ko bukas. ‘Di kaya bukas, bigyan ako ng bill?” ‘Cause I’ve been going to just the same doctors, the same hospital the whole time. After nine months, I went back for my last check up with my doctor. My last, kung baga, eto na, this is it. Last day. After this, you’re on your own. Bye, guys. “Good luck,” is what they tell you. “Good luck and we hope never to see you again,” that’s what your doctors will tell you.  

I went there with a stack of bills. I had added them up the night before. And my bill was 120,000 U.S. dollars. That’s what it came to. All the chemo, the radiation, lahat po. In pesos po, 5 million pesos. Sa’n ko kukunin ang limang milyon?  Kahit na po 15 years na ‘kong artista, alam niyo, ang pag-a-artista, oo, malaki ang kita pero malaki din ang gastos. And you don’t think of the future that way when you’re in your 30s, early 30s. Iniisip mo lagi, “Ay, I will have forever to make more money.”  So I may have had a little bit saved up but definitely not 5 million.  But God was—who is my amazing God, provided for me again and I didn’t pay, not a single cent.  

Do you know that even my first two years of Tamoxifen was free? Not many people know that because I have not talked about it before openly. Why don’t I talk about it openly? Because baka isipin nila pag nagpunta sila ng America, they will get it also. It is not that—it doesn’t work that way. It was a favor from God.  

You know Americans themselves don’t get AID? Not all of them get it and yet, I got it. So tumatayo po ako dito sa harapan ninyo and I take every opportunity to go you know where Kara asks me to go, I go because, you know, for me it’s a little way, a little way of giving back for all the blessings in my life. Talagang imaginin ninyo sinabihan ako ‘di na ‘ko magkakaanak. May anak po ako. And, you know, he’s not just healthy. He’s more than healthy. Madaling magkaanak pero paglabas, may diperensiya, ‘di ba?  My son is a bouncing boy, he’s a monkey.  He swings from wall to wall, that’s how healthy he is.  

So I am so blessed, grabe po. ‘Wag kayong maniniwala kahit for one second na hindi puedeng mangyari sa inyo ang nangyari sa akin.  But I will tell you the secret.  The secret is never doubt your God.  Never kasi alam niyo they say even the smallest mustard seed of doubt and what you hope for is gone. Why am I still alive today?  Because I never doubted that I would live. It’s hard, ‘di ba, to be sick and not think about the fact na mamamatay ka. You think about it but me, the minute it enters my mind, I kill it.  That’s not from God, that’s from the Devil.  

Our doctors will tell us to do this, that—the other—do what your doctor tells you to do. But beyond that, you pray. They always say, “Maritoni, bakit ‘di ka nawawalan ng project sa showbiz?” Kasi sa Diyos ako humihingi, hindi sa producer. I’ve been in showbiz 20 years. Ako po ang tumatanggi sa project.  “Ba’t ‘di ka tumataba?” Sinabi ko kay God ayoko tumaba.  

I’m telling you there is nothing you can ask for that He will not give you if you believe. I can’t stress that—talagang ang kulit ko, ‘no, pero totoo yun. Alam niyo, sorry ha.  I know it’s mayabang, it comes across really—however you may take it. I am a favorite, I am one of Jesus’ favorites. Why?  Because I’m makulit. Don’t you like it when your children are makulit?  “Mommy, please?  Mommy, mommy, kiss me na, please, Mommy, kiss me.”  Don’t you love it?  “Ano ba, mamaya na!”  “Mommy naman now na!”  I love my kids doing that.  I don’t want them to be sitting in some corner away from me.  

Fertility, yes, it’s a big issue, it really is.  And like Doctora said, it’s a big risk to take. But like I said I’m a crazy woman and I believe in my God. So I take crazy risks. My doctor in America he told me straight I would never have kids again. I told him, “You’re wrong. God promised me I will have a son.”  And then, when he turned out right because my period didn’t come back anymore, I didn’t even think about it. I took whatever he told me to take, but after that, I knew it would come back. I knew it.  

Alam niyo, hindi pa ‘ko nag-uumpisa mag-Tamoxifen, ‘di pa ‘ko tapos mag-chemo, may pangalan na ‘ko para sa magiging anak ko. Ganon ako kasigurado.  

You know my son’s middle name is Malachi?  Those of you who know your Bible know why. Those of you who don’t, go home and look it up. I’m not going to tell you. It is amazing. Once you look it up at home, you will think to yourself, “Kaya pala.” It’s one of God’s amazing promises and I claimed it upon knowing I was sick. Yes, I’m strong, I’m a fighter, yes. In life, yes. In showbiz, you have to be.  It’s true. Pag hindi makapal ang mukha mo sa showbiz, walang mangyayari sa ‘yo. Hindi mo alam kung saan ka pupulutin. Tapos na ang show. And you know, my background is a little strange because I come from a big family. We’re—actually six kami but my parents remarried, remarried, remarried so altogether we’re six siblings. But I’m the eldest. I was sent off to school at 10 years old, I lived in China alone with foster parents.  

So, yes, toughness, I have it ‘cause I was sent all over the place at a very young age. I never grew up with a mom and dad. I grew up--grew up alone.  My parents divorced when I was 10, you grow up overnight when your parents divorce.  

You know I remember my dad telling me one day. “Well, your mother and I, it’s over.” I burst out into tears. He whacked me over the head and he said, “Grow up.” That’s how I was raised. My dad was British. You know you don’t cry to your dad.  

So yes, I’m tough and some people misunderstand my toughness but that’s okay. It’s what got me through my cancer. As long as you know who you are deep in your heart and you don’t let anybody else judge you and you know who you are to God, yun lang naman importante. Lahat po yan ibibigay Niya sa ‘yo.  

Meron po ba tayong mga tao dito na gustong magbuntis after cancer? Meron?  You have, yes. Two, two, yes, three, yes, a lot. I hope that being here today has given you inspiration truly. And somehow when you go home tonight, you just—you know what?  Get down on your knees and you claim it.  

You don’t say, “Please, God, give it to me.” No. You say, “God, I want this.  Thank you. You’re going to give it to me.” Pasalamat ka kaagad dahil iyo na ‘yan.  He doesn’t want to keep anything you want from you. Just believe it.  

Are there any more questions before we move on to the next topic?  No more?  No more?  Wala na po?  Okay, well, then, I will go back to—eto na, salamin, sandali.  

Okay, so tapos na po yung session natin today for fertility. Okay. Thank you very, very much, Dra. Llave, thank you for joining us. Please be reminded that throughout the day there will be free bone density and fasting, blood sugar testing at the Adriatic Room on the first floor and free consultation, free breast exam and healthy food tips on breast cancer at the Caspian Room on the first floor.