Radiotherapy begins

I've now had 4 sessions of radiotherapy, and I have 15 more to go until I'm finished. It's going well so far. Each weekday morning I head into St Bart's and go to the basement, where the radiotherapy suites are located. Radiotherapy is often administered in hospital basements as the rooms have to be lined with lead to prevent the radiation from escaping. I have all 19 of my appointments (bar one) scheduled for either 8.45 or 9.00 in the morning, so that I can head off to work afterwards. There are five radiotherapy machines, and each is named after a planet. So far I have been treated on Saturn and Venus, and I also have treatments scheduled on Mars. The radiotherapy team are all extremely friendly, and the atmosphere in the department is one of jovial calm.

Treatment takes only a brief time, around 3-5 minutes, but the pre-amble makes it take a little longer. Basically I have to remove my clothes from the waist upwards, and lie on a plinth with my arms resting in armrests above my head. They use the tattoo dots on my body to line me up with some green lasers, according to the precise measurements they took at my planning appointment. They usually move me around a bit (I've been instructed to not help them, they need to move me sometimes by very small amounts) and they talk over the top of me, using numbers and codes and things that I don't understand, and they draw all over me with pen. It's very lovely though, at my first appointment they explained that they would need to talk over me while they were getting me in position, and that I shouldn't worry. They then leave the room and the robot-like machine blasts my boob with radiation, moves a bit, blasts it again from a different angle, and then I'm done. While it's doing its thing, I gaze at the ceiling, where there is a lovely artwork in the ceiling tiles, to distract me. On Saturn it's a Japanese cherry blossom tree and on Venus it's a fern-lined pool of water.

I can't feel the radiation, or see it, so it basically feels as though nothing is happening. Afterwards I have to apply thick cream to my whole breast, which I have to apply again at night. This is because one of the side effects can be something similar to sunburn on the skin where the radiation is targeting. I have aloe vera, which I'm keeping in the fridge so it's extra soothing, cetraben, and a cream called 'moo goo udder cream' which started out as a cream to treat sore udders on cows! Well, let's face it, this is basically the same thing! So far, it's felt a little sore but nothing too dramatic. The other main side effect is fatigue, but I'm feeling that already, so nothing new there. I'm resting in the evenings, making very few arrangements, and preserving as much energy as possible. Apparently the fatigue will be cumulative, so I'm expecting it to kick in properly in the next week or so. And it will last for a couple of months post-radiotherapy, so I'm keeping a low profile until the spring.

Generally though, I'm feeling much better than when I last posted. I've regained lots of my movement in my arm, I think the infection in my wound has pretty much cleared up, and I'm regaining strength each day. I'm enjoying being busy at work and getting back into things, and having more strength to do things around the home. This past weekend we had two of Tanai's friends over for dinner, visiting from Zurich and Milan. I was very pleased that my right arm was strong enough for me to bake a cake (folding in the egg whites took quite a bit of work, and I have not had the strength to do this since surgery). It was a flourless chocolate cake from the new Ottolenghi 'Sweet' book, layered with rosewater cream and caramelised walnuts. Delicious! We also went out with them for brunch near King's Cross the following morning, before they set off to the airport, which was really lovely. The autumn days here in London are blue-skied and sunny, but there's a chill in the air, and the temperature has not ventured above 10 degrees for some time.

Delicious cake!

A stroll near St Paul's Cathedral in the autumn sun

Brunch with the Italians

This coming weekend, we are planning to put up the Christmas decorations and make the flat all festive. I'm really looking forward to a very quiet, relaxed Christmas in our little flat, as I recover from my year of treatment.

New tattoos

This week I got three new tattoos! Sadly nothing as exciting as my first tattoo. These are three small black dots, given to me by the radiographer at St Bart's so they can align the laser beams while they're giving me radiotherapy. One is right in the middle of my chest and the others are on either side of my body, about where your elbow is when your arms are by your side. Radiotherapy has to be incredibly precise and it takes place every weekday for a month, so they can't afford to give me dots that might rub off over the course of that time. I was measured up on Wednesday morning, had my CT scan, and now they are fully planning what dosage and angles and everything, and I'm scheduled to start on 23 November (this coming Thursday) so if all goes to plan I'll be finished with radiotherapy just in time for Christmas.

The last couple of weeks have been pretty tough. I developed an infection in my armpit wound and while they drained some liquid out and sent it off to the lab to be tested, they prescribed me with a general course of antibiotics to get rid of it. Unfortunately a week later I found out that the infection was resistant to penicillin, so they had to switch me onto a different kind of antibiotics. So I still have an infection and I feel as though I lost a whole week trying to get rid of it. There is a lot of pain around my wound, it's red and inflamed, and I've lost a lot of the range of motion I was gaining by doing my daily physio exercises. I'm still doing them but recovery is much slower now. I'm also feeling generally really unwell. I'm tired, off my food, and a little impatient to be back on the road to recovery. I've been back at work but I've struggled with the long days and I'm not feeling very resilient at the moment. Plus the antibiotics are giving me diarrhoea which isn't great! I have struggled a bit with my commute, and the other day I had to say aloud on the tube, 'please could someone give me their seat', as I really couldn't remain standing. These kinds of situations can be pretty challenging for someone who is usually so independent and capable like me.

Commuting

And, to be honest, I'm feeling pretty emotionally vulnerable. It's difficult because I had such positive pathology results and so people are jubilant, but they're saying things like 'So you're almost done!', or 'You did it!', or they think I'm finished with treatment now. But there's still so much treatment to come, and I'm running on the fumes of an empty tank every day in terms of energy, I just don't feel like celebrating. Radiotherapy is apparently also very draining, so I'm genuinely wondering how I'm going to have the strength to get through the next couple of months. And after that, I still have a whole heap of other treatment still to come. I'll still be a regular at St Bart's for the forseeable future, and I'll still be dealing with side effects every day, managing the changes in my body and trying to get on with my life. People talk about a 'new normal' after cancer treatment and now I understand what they mean. I need to spend the next few months working out what my 'new normal' is because Past Carmel is never coming back.

So this weekend Tanai and I did some talking, thinking and planning, to come up with some practical measures to help me get through the next few months, and also some emotional parameters, to make sure that I don't bottle up my emotions but allow myself to feel the way I feel, to acknowledge the emotions, and then allow them to pass, without consuming me. I'm feeling a little more emotionally robust, much more prepared for the next few stages of treatment, and more able to get on with things. I've reduced my hours at work slightly, to 10am-4pm, so that I can avoid travelling at rush hour, and preserve some strength and energy during radiotherapy, while also ensuring that I'm there for my team. This should take me to the end of the year, and then I can start 2018 afresh, and put 2017 behind me. So next stop: radiotherapy.

Surgery results, Carmel 1: Cancer 0.

My surgery was 10 days ago, and today I had to go back into hospital to get my pathology results. These are the results from the lab where they have analysed the two lymph nodes they removed from my armpit, and the remainder of the lump they removed. And happily, it's all good news. There was no cancer in my lymph nodes, which means I don't need to have any further surgery, and the remaining lump was also clear, which means that the chemo had properly killed all the cancer in my breast. I'm so relieved and happy, this is a huge milestone on my treatment journey.

 

Sticking two fingers up at cancer!

My surgeon, Miss L___, removed my dressings, which I've had on since surgery, so it was the first time I've actually seen both of the wounds. They look incredible, she's done a fabulous job. My armpit wound is a small nick about 2cm long, under the armpit, barely noticeable. She very cleverly made the incision for the lump by cutting a crescent shape around my nipple, and then tunnelling in to get the lump. This means I'll have no visible scar in my cleavage, and once it heals, it will be practically invisible. There is a lot of bruising and swelling at the moment, but I already love my post-surgery body, and when I look at myself in the mirror, I see a strong, beautiful woman who has been through so much over the past few months, and I'm so proud of her for getting this far.

Today we also discussed the next steps, as my treatment isn't over yet! In a couple of weeks I will get measured up for radiotherapy: they'll do a CT scan and I will get two little tattoos on my chest so that they can properly line up the lasers, and then, as long as my wounds heal well, I should start radiotherapy about a week after that. I will have 19 sessions in total, every weekday for almost a month, and then I will be finished with what they call 'active treatment'. The radiotherapy is really belts and braces, to mop up any stray cancer cells and reduce the risk of the cancer coming back. The side effects are not as severe as chemotherapy, but most people say that the significant one is fatigue, which can last up to a couple of months after radiotherapy is finished. I'm preparing myself for another few weeks of having a minimal social life. Luckily the nights are drawing in and the temperature is getting wintry, so I'll just curl up at home with some good books, podcasts, movies and hearty food.

I have been given some exercises, which I'm diligently doing three times a day, to regain as much movement as possible in my right arm. At the moment it's quite difficult to lift my arm up over my head, and I'm still avoiding lifting anything heavy, but I'm doing well. Tanai took a week off work after my surgery and we mooched about at home, chilling out and resting. It's actually been quite lovely to rest and recuperate properly after surgery; I realised that I didn't properly rest through chemo and probably pushed myself a little too hard. I go back to work next Thursday so I'm making the most of my final rest days. 

My daily exercises

So, all being well, I should be done with active treatment by the end of the year. I'm looking forward to bidding 2017 farewell, to be honest, and we already have some fun things planned for 2018. I will continue having Herceptin injections every 3 weeks until July next year, and I have just received my first prescription of Tamoxifen, the tablet I'll be on for the next 10 years. I've decided I'm not going to start taking it until after radiotherapy, as I am not keen on having both side effects at once. Today the clinical oncologist also talked about giving me Zoladex injections every month for at least the next two years. This is because I'm pre-menopausal, and my cancer is fed by oestrogen. What do your ovaries do? Produce oestrogen! So Zoladex suppresses your ovaries to reduce the risk of the cancer returning. And along with that there is another injection they want to give me every 6 months to prevent the cancer returning in my bones. I've decided to take some time to research these other options before signing up, as I've heard they can also have some pretty nasty side effects. I want to be certain that their efficacy and the benefits I will receive from them is worth the potential impact on my quality of life. So more on here when I know what I've decided! Until then, I shall continue to be pretty happy with today's news and celebrate this weekend with friends at the Lewes bonfire.