Severe and persistent headaches turned out to be the start of a nightmare for 40-year-old Loo Pei Ying who had to undergo surgery five times in 11 years to treat a recurring glioma.

An avid traveller, passionate violinist and keen scuba diver, Loo Pei Ying was an adventurous, independent and fun-loving 20-something-year-old. Unfortunately, all this changed when she suffered a seizure on a bus ride home from her work at the age of 30, which led to a shocking and unexpected diagnosis.

ForLife (FL): Tell us about yourself, Pei Ying.

Pei Ying (PY): I am a 40 year-old Singaporean. Before my diagnosis, I thoroughly enjoyed an active and healthy lifestyle, relishing my freedom and independence. I was deeply engaged in activities like swimming, running, scuba diving, solo traveling, and playing the violin. I love to travel and have been known to do so at a moment’s notice.

Professionally, I worked in clinical service divisions across various healthcare organisations, conducting inspections and staying on my feet for extended periods of time. I prioritised my well-being by maintaining a balanced diet, taking vitamins, ensuring proper sleep, and leading an overall healthy and active life.

FL: When did you first realise that something was wrong? What prompted you to visit a doctor?

PY: I started experiencing severe and persistent headaches in my late twenties, but did not suspect they could indicate a more serious issue. At that time, I attributed these headaches to the stress of adapting to a new job in a completely different field; I used to be in banking before I switched to healthcare. I consulted several general practitioners (GPs), who diagnosed them as tension or stress-related headaches, likely linked to my career switch.

FL: When and how were you eventually diagnosed with brain tumour?

PY: In 2013, at the age of 30, I experienced my first seizure on the bus while returning home from work, and lost consciousness. Fortunately, I was in the company of a colleague who acted swiftly to seek assistance.

After the incident, I was taken to Changi General Hospital (CGH) where I underwent a series of tests over the course of one week. These included a magnetic resonance imaging (MRI) scan, a computed tomography (CT) scan, and a lumbar puncture, which was a painful procedure.  At the end of all the tests, a consultant visited me and delivered the news: I had a brain tumour. I was in shock; I had never expected to receive such a life-altering diagnosis at such a young age, especially as my career was just beginning to flourish.

A while later, I had an outpatient consultation with a neurosurgeon at the National University Hospital Singapore (NUHS), who arranged for yet another MRI scan. During the subsequent appointment, I was informed that I had type of brain tumour known as a glioma. I was shattered when learned  the prognosis of certain primary brain cancers such as gliomas can be as little as between 10 months to two years.

The neurosurgeon recommended surgery as the optimal approach to remove as much of the tumour as was possible.  I was fortunate to have had a mentor at work, who encouraged me to proceed with surgery. She was undergoing cancer treatment herself at the time. She assuaged my fears regarding surgery by saying I was fortunate that my tumour was operable, as not all brain tumour patients are eligible for surgery. Four months later in May 2013, I underwent my first surgery.

Loo Pei Ying's first surgery left her a large scar on her head at the incision site that looked like a centipede.

Loo Pei Ying’s first surgery left her a large scar on her head at the incision site that looked like a centipede.

FL: What was recovery like?

PY: I was awake and alert, but struggled with extreme vomiting for two days. I recuperated in the hospital for 10 days after surgery. I had a large scar on my head at the incision site that looked like a centipede.

I felt perfectly fine after I was discharged, and I even went for a jog three weeks post-surgery. This surprised my neurosurgeon as he did not expect me to hit the ground running, pun intended, so soon. I was given two months of hospitalisation leave from work for me to rest at home, I resumed playing my violin in that time. I was asymptomatic for three years after that.

FL: What happened then?

PY: In 2016, I had a breakthrough seizure, which is when an individual experiences a seizure episode despite being on seizure control medication for over 12 months. This time, I collapsed at work and was rushed to the nearest emergency department. An MRI showed my tumour had returned and I was advised to undergo surgery as soon as possible. I underwent surgery two weeks later.

I bounced back almost immediately after my second surgery. The doctor had reopened the same incision site from the previous surgery, while also making a new incision, which together now looked like a giant ‘M’. As soon as I could move unaided, I was back at work. Life continued without a hitch, until 2019, approximately three years after my second surgery. A routine MRI showed I had developed yet another tumour and had to undergo a third surgery.

FL: What was different about this surgery compared to the previous two?

PY: My neurosurgeon discovered the tumour had spread and was very close to my motor function control area. He suggested I undergo a craniotomy, or commonly known as “awake brain surgery”, which is a surgical procedure performed on the brain while the patient is awake for part of the time. This surgery is performed in the safest way possible to preserve motor and speech functions in brain tumour patients. I agreed to it because I wanted to preserve my motor functions so I could resume playing the violin.

However, after doing online research about awake brain surgeries I felt overwhelmed with information. This caused me to procrastinate on making a decision. Ten months passed before I felt ready to put myself through this new surgical procedure.

Unlike my previous two surgeries, this time I had to undergo a pre-operative cognitive assessment, which took between two to three hours, depending on the patient’s abilities to answer the questions. The tests were used to measure a range of cognitive capabilities, in order to establish a baseline for my speed, memory and accuracy in answering the questions. I was required to undergo the same tests after surgery to see if any areas that had been operated on had weakened after surgery.

As well as being monitored regularly to assess my progress and function and overall wellness every three to six months, there were no major changes between my pre and post-operative assessments, and so I returned to work and resumed normal life.

Unfortunately this was short-lived. In September 2021, at the height of the COVID-19 pandemic, I began struggling with seizures that were increasingly frequent in spite of having taken seizure control medication. A scan revealed that the tumour was back with a vengeance. There was a sense of urgency to remove the tumour as fast as possible. Surgery was scheduled two weeks after we found the tumour, right before my birthday.

FL: How was recovery after the fourth surgery?

Recovery was extremely tough this time around.  it was the height of the pandemic, hospital patients were not allowed any visitors, so I spent my recorvey without the support of family and friends. The worst part was waking up in the High Dependency Ward with hemiplegia on the left side, a condition known as supplementary motor area (SMA) syndrome, which meant I could not move the left side of my body at all! I also struggled to talk and could not make myself heard when I spoke. All this frightened me and I only had Dr Teo and neuropsychologist Dr Chan for support when I woke up from surgery. However, Dr Teo assured me that with intensive rehabilitation, I would be able to get up and move about in a month or two.

I was put through a gruelling schedule of daily physiotherapy, occupational therapy, and speech therapy. I had to relearn how to speak, and how to use my left hand and leg. I wanted to play my violin, to run and swim, and I wanted to be able to move freely again. I was determined to walk out of the hospital without being in diapers or a wheelchair, and this motivated me to work hard at my rehabilitation. Dr Teo encouraged me to document every single one of my improvements to motivate me, where I also had to send him a report of my progress on alternate days. Thanks to the intensive rehabilitation programme, it took a month for movements in my leg and hand to be noticeable after the surgery. I kept to this rigorous schedule for two months, before I was certified fit for discharge.

After I was discharged, I sought out therapists who specialised in neuro-rehabilitation. A friend recommended me a neurophysiotherapist and neuro-occupational therapist at a private clinic, which catered to physiotherapy for non-stroke patients. Dr Teo had confirmed that my paralysis was not due to a stroke as I was able to feel pain in my feet and pain in my muscles when I stretched just after a few days of therapy. After work, I went to the clinic to undergo my rehabilitation programme three times a week for one year.

I know I have more surgeries looming ahead of me, as gliomas have been known to recur and progress in grades.

FL: How have you continued to keep your spirits up despite numerous setbacks?

PY: Having this tumour does not stop me from exploring the world, I travelled now as much as I did before, to faraway places like Finland and Russia. I take precautions on all my travels, and ensure that I always took my medication with me, along with adequate travel insurance. I have also run marathons and am back to playing high risk sports, and still scuba dive.

I am determined to beat the odds and live freely according to my terms, instead of allowing this disease to rule my life.

Pei Ying now travels more than she did before, determined to live life to the fullest. She takes precautions on all her travels, and ensure that she always takes her medication with her, along with adequate travel insurance. She also continues playing high-risk sports.

Pei Ying now travels more than she did before, determined to live life to the fullest. She takes precautions on all her travels, and ensure that she always takes her medication with her, along with adequate travel insurance. She also continues playing high-risk sports.

FL: Any words of advice for others who might be struggling with brain tumours?

PY: I would like to tell people who are in the same boat as me to not be ashamed of having this condition. Be confident; you can live a full life even with this depressing diagnosis. I do not see myself as a sick person, and I keep telling myself that I will be okay, and that I can do anything. This journey has reshaped my perspective on life, prompting me to embrace gratitude and find strength in adversity. Look at me – 11 years since being diagnosed with a brain tumour and I am still standing!