Chemo delays

I was supposed to have my second round of chemo last week but it was delayed and I ended up having it yesterday instead. I went to see the oncologist last Wednesday as usual and all seemed fine. I reported my side effects from the first round to him, and then we discussed various things. Firstly, I asked if I could skip the steroids this time. I'm convinced that the majority of my side effects are from the steroids rather than the chemo, and they just make me feel like crap. He said their only use was anti-sickness, and I have plenty of domperidone which are my regular anti-sickness, so I should be fine to skip them. He prescribed them for me just in case, so I can take them if I feel I need to. Then I asked if I can have the GCSF injections, which are the ones I took last time I had chemo to boost my neutrophils. He said to wait until next time, which kind of pissed me off as I feel that now is the time to start taking those, and aren't they cheaper for the NHS than a trip to A&E? But sometimes you just have to accept no for an answer. Next up I mentioned that my pelvis is still quite swollen post-op and I'm a bit worried about it. He examined me and said it's just a regular oedema and it should go away, but to keep an eye on it. I might go and get a second opinion. Finally he informed me that the results of my kidney function tests were in, and the good news is that my dose of carboplatin chemo, which was 790mg for the first round, will only be 450mg from now on! This is great news, as it's almost half of what I had before, so should mean I get reduced side effects.

So I trooped up to the 7th floor the next day feeling chipper. I'd made a picnic lunch of gimbab (Korean sushi) for me and Becky, who had taken the day off work to come with me. Unfortunately when the nurses called me in, they said that my platelet counts were too low. They need to be at least 100 but they were only 62. They took some more blood and sent me home, saying they'd call me in about 3 hours and if my bloods were good, I'd have chemo that day, but if not we would have to delay. So Becky and I went back to my flat (I'm so glad I live so close by!) and made some of her famous granola (it is incredibly delicious, hit me up for the recipe if you like). And ate lunch and sat and chilled. Eventually I got a call from the nurse saying my platelets were no better, and actually my neutrophils had dropped to 0.9, which is in the danger zone, so I needed to come back to the hospital to pick up some GCSF injections (vindicated! I was right in the first place, Mr. Oncologist!). They wanted to push chemo back to Monday, but I insisted that they push it back a whole week, to the following Thursday, so that it didn't disrupt my life too much. I know that treatment is important, but I'm also trying to get on with my life, and I didn't want the entire working week to be written off. Becky was incredibly gracious about it, and said she enjoyed hanging out and the day off work was not wasted (thanks love!). And I tried very hard not to get upset about the delay. This will push my entire schedule back a week, so I won't have my final chemo until September now. Fingers crossed there will be no more delays.

 Becky's amazing granola

I googled how to increase platelet counts, and got lots of advice about eating papaya, pomegranate and pumpkin, as well as brocolli and leafy greens. I've enjoyed quite a few pomegranate smoothies in the intervening week.

Wonderful medicinal papaya

Medicinal fruits

So yesterday my friend Rima came with me to Bart's, and my platelets were a stonking 173! Happy times. How amusing to be so jubilant about receiving chemo! We had a very chatty Portugese nurse and we wiled away the time with great chats ourselves. It's such a fab opportunity to catch up with friends, if a little strange for them to come into that environment. I'm so used to it now, Bart's is like my second home, but I suppose it's all a bit alien to someone who isn't in 'the system'. We came home in time for lunch and then Rima went off to do some work and I napped for a couple of hours. Then we went out to see a talk at the Roundhouse, and I managed really well. I'm feeling pretty good today, the nausea is low and my energy is good, but the side effects didn't really kick in until the weekend last time so I'm bracing myself. I made quite a few plans for today and tomorrow, thinking it would be one of my 'good' weeks, so fingers crossed I'm okay.

Administering my GCSF injection

My ever-expanding diagnosis list in medical lingo

Tanai has been away this week in Canada at a conference, but he arrives home tomorrow. It's great that I have so many fabulous friends who can help me out in the meantime, but also to give him a break. My next chemo appointment is Thursday 4 July, so with luck, there will be no dramas in the meantime.

Ding Dong: Round Two

So I have had some pretty shitty news. As you know, a few weeks ago I went into hospital for a preventative oophorectomy, to remove my ovaries and fallopian tubes in order to prevent me from getting ovarian cancer to which I am genetically pre-disposed. After removing them, they sent them off to the lab, and unfortunately ovarian cancer had already started to grow. So now I'm facing another few months of treatment to tackle this second cancer diagnosis, just as I was starting to feel strong again after beating breast cancer.

It will all start on Tuesday (yes, they're moving fast!) with some more surgery. This time it's a significantly more major procedure. They will open me up properly from navel to chest and remove a whole bunch of my insides: my uterus, cervix, all my lymph nodes and my omentum, which is part of the peritoneum, which is the layer of tissue which keeps all my organs in place (hopefully they won't move around too much after it's gone!). Also, while the surgeon is in there, he'll take a look around, and if he sees anything dodgy he'll take that too. The operation will take about 5 and a half hours, then I'll be in the HDU (High Dependency Unit) for a couple of days, and then on the ward for about a week before they'll let me go home. They'll send everything they remove to the lab again, and then we will know 100% what we're dealing with.

And then three weeks later I will have to start chemotherapy again. This time 6 rounds of chemo, every 3 weeks as before, which should take me up to September sometime. The drugs for ovarian cancer are different from the ones I had for breast cancer. I will be having carboplatin and paclitaxel. So the side effects may be slightly different, but the basics are the same (fatigue, hair loss, damage to nails and skin, compromised immune system etc).

Needless to say, I'm gutted, and Tanai and I have been quite upset these last few days. It just seems so frustrating that when I'm finally feeling strong and we are starting once more to talk about the future and get excited about things, that I get kicked down once again by cancer. But, in my usual approach to these things, I am determined to fight it and do my best to get through it once again. I'm seeing it as a bump in the road rather than a complete disaster. Plus, I'm going into it with my eyes open this time, having been through treatment once before. This will have its differences, but I know I can get through it. And I will actually use my learnings from last time to tackle it slightly differently this time.

I will try to exercise much more through chemo, if I can handle it with the fatigue. Last time I had chemo I put on 10 kilos (a stone and a half) and it's taken me a year and a half to almost get rid of it all! Now that I'm in medically-induced menopause and on Tamoxifen, combined with my residual cancer-related fatigue,  it's much harder to lose weight, so I'm going to try to avoid putting too much on during treatment. I will do little lunchtime walks to Primrose Hill and gentle exercises at home, once I'm healed from surgery. I will also ensure I eat a healthy, nutrient-rich diet. I do this anyway, but I will be conscious of it much more, and won't be as indulgent as I was last time during chemo. Also my hair has just started to get to a length where it's feeling like a hair style again! So I'm going to attempt to keep my hair. I will only wash it once a week and tie it up with headbands, and hope that it only thins, rather than comes out completely. This may be a pipe dream but I shall try! At least I have kept all my headscarves from last time if it does end up coming out.

The good news is that a CT scan I had on Tuesday shows that it's unlikely to have spread. I have a high grade cancer, which means it's fast growing and aggressive (as was my breast cancer) but it feels as though I've caught it early and I have every chance of beating it. I will have to postpone my preventative mastectomy, and hopefully that won't cause me similar problems, but I'm still planning on having that done as soon as possible.

As with last time, my employer is being very supportive and, once I'm recovered from surgery, I'm planning to work throughout treatment. However, I'm due to run out of paid sick leave soon, so one of my biggest worries about all of this is about finances. So I've decided to put myself out for small freelance jobs -- proofreading, copywriting, baking, strategic planning -- basically anything I can put my mind to in my spare time. Hopefully I can ensure we can make ends meet.

The other change this time is that I will be more willing to ask for help. Tanai and I shouldered the majority of the burden ourselves last time, and we are both still exhausted from that. Tanai especially as I couldn't do as much. So this time we will be putting the word out and asking for help. I'll put a post up in a couple of weeks with more specific requests for support and for paid work for me, but in the meantime any offers of healthy home-cooked food are very welcome. I have not had time to fill my freezer with batch-cooked meals and I want to eat as healthily as possible. Tanai is a great cook and I know he can cook for us both, but it's a nice way to ease the burden and help us out financially at the same time.

Anyway, that's enough info for now. First things first: I need to get through Tuesday's surgery and recover from that. Then once I'm home I'll do a bit more logistical planning and will post again with more info.

It sucks, but I'm feeling hopeful and as strong as I can be in the circumstances. And so very glad that I pushed and pushed to have the BRCA test after my oncologist said 'no' three times, and then once I had a positive result, to immediately get the ball rolling to have my ovaries removed. I have given myself the best possible fighting chance. Now our NHS have to do the rest.

Changing directions

When they say cancer is a rollercoaster, they are really not kidding. This week was definitely testament to that. On Thursday I finally met my oncologist, Dr S___. I instantly loved her, and I know that we are going to get on; she's my kind of lady. An older, Indian woman with a whole heap of experience, she has worked all over the world, run medical trials, presented at conferences and is a total cancer rockstar. And she has a no-nonsense, pragmatic attitude which suits me down to the ground. She talked me through some options but on Thursday they were still awaiting the results of the HER2 test which could potentially make a significant difference to my treatment plan.

As an aside, each time I visit anyone for a consultation at St Bart's, they write up the consultation outcomes and send them to my GP. I get a letter in the mail (yes, snailmail) which is a 'cc' of the letter which goes to my GP. The last one, from my surgeon, Miss L___, had contained a worrying line. It said 'I think cosmetically she would benefit from neoadjuvant chemotherapy'. Cosmetically? This is not high on my list of concerns! I care more about getting the best treatment and ridding my body of cancer than what my cleavage will look like post-surgery! Neoadjuvant means to receive treatment such as chemo before surgery rather than afterwards (which is called 'adjuvant'). I had googled this (of course) and read that chemo has the same effectiveness whether it's given before or after surgery, but it can make a difference to the surgical outcomes (for example, make the tumour smaller so less of my boob is removed).

Anyway, when I mentioned to Dr S___ that I really wasn't concerned about any 'cosmetic' outcomes she totally stopped in her tracks. Apparently if I am HER2 negative, I could have surgery and not even need chemo at all! This stunned me. My surgeon was making assumptions about me rather than giving me options. In the same way that she assumed I would want fertility treatment, she was assuming that I was concerned about what my cleavage looks like. (In case you haven't guessed yet, this made me kind of angry.) To have made a decision about my treatment which meant that I could have unnecessary chemo was astounding to me.

Anyway, we could not make the decision until the HER2 results were in, so Dr S___ immediately stopped my consultation. She said she would chase the results but that I should consider that I may be going into surgery next week rather than chemo, as she predicted I would be HER2 negative (apparently my tumour is so receptive to oestrogen and it's rare that these types of cancers are also HER2 positive).

I then went into work rather light on my feet for the rest of the day! There is a chance I might not need chemo after all! Gosh, what a glimmer of hope.

Sadly, the glimmer was shortlived. She called around 6pm and said that I am HER2 positive and so should definitely have chemo first. Oh, and could I come back at 9.30 the next morning! So Tanai and I were back at St Bart's early this morning to get the full picture. Apparently only 10% of cancers are both HER2 positive and receptive to oestrogen, so I guess I'm rather rare. Not sure how I feel about that as I'd rather be in the statistically predictable group, but there it is. So this morning Dr S___ gave me the full low-down on chemo and I signed a consent form so that they can progress with my treatment.

She explained some of the main side effects, and some of the regular tests I'll be getting over the coming months, and why. Also, in true project manager style, I'd written down lots of questions in my blue notebook, each with a space left for the answers, so we went through those too. Tanai and I have been doing quite a bit of research: each time I get a letter with the results of the consultation we google all the acronyms and write down any questions we have, so that we can go through them in our next visit. I imagine this will become quite a routine during my treatment. So here is a bit of a summary.

I will need to have a few more tests to check certain parts of my body that can be affected by the chemo. So I have to have an 'echo' test which is to check my heart, because the drugs can impact on my heart. They will keep checking this every 3 months and if my 'ejection fraction' goes down by more than 10% they will either reduce the dosage or pause/stop treatment. I also need a CT scan and a full body bone scan. The drugs I will be on can affect my bones, my liver, my kidneys, my blood, in rare cases chemo can cause cancer (ah, the irony!), nerve damage and, to top it all, it will probably bring on early menopause. Thank goodness it will also nuke my breast cancer, otherwise this is a ridiculous thing to sign up to by choice.

The more 'regular' side effects are that I will feel nauseous (Dr S___ prescribed me some kick-arse anti-nausea medication), tired, I will be more susceptible to catching viruses, I will probably lose my hair and I will probably lose my sense of taste (this makes me very sad, but thankfully it's only during treatment, not forever). For my birthday, the wonderful Rosser family in Sydney bought Tanai and I 'high tea' at the Ritz, so I've decided to save this as my treat when I'm all done with chemo and get my taste buds back. It's great to have something wonderful like that to look forward to.

When I told her that I was planning to continue going to work all the way through my treatment she was very pleased. She said she encourages all her patients to continue working, and she said if I feel as though I have the energy, I should continue to cycle into work too! She advised that if I do want to take the tube, I should avoid the rush hour, as it's likely I will catch any germs going around.

So, once we were all done, I trotted off to get my bloods done, got my appointments booked in for my CT and bone scans, and headed into work.

All in all, I'm quite glad we're still doing it this way round. Having chemo first does mean that the surgery is likely to be less invasive, as the tumour will be smaller. Also it means I get to have Pertuzumab, which has only been licenced since December 2016 and has fantastic effects. It increases the effectiveness of the other drugs and dramatically reduces the chances of the cancer returning. But this drug is only available to patients having chemo before surgery, not afterwards, so I'm very lucky to be having this.

Tomorrow I'm going shopping with a couple of girlfriends to buy some headscarves, and we are going to work out how to tie them somewhat stylishly by studying youtube videos, as I really want to be prepared for this. Should be fun!

Finally, somewhat of a plan

This morning was results day, so Tanai and I arrived at St Bart's somewhat bleary-eyed after a late night (at a great Sampha gig) and broken sleep. I felt very calm and eager to find out what's what. So, here we go.

There's a lot of good news and I'm generally feeling very positive. I have a tough few months ahead but my inner project manager is kicking in, and soon I'll have a proper plan (complete with spreadsheets and gant charts, ha ha).

Thankfully, my left breast is fine, and the small lump in my right breast is benign, so the only cancer is the large lump in my right breast. It's a ductal carcinoma grade 3 (which means that it's a cancer in my milk ducts, looks different to normal breast cells and is fast-growing, or 'aggressive'). It's oestrogen receptive 7 and they're still waiting for the HER2 receptor results. This is relevant to deciding which drugs will be most effective to nuke the cancer.

I was expecting to have surgery first and then additional treatment, but my surgeon is advising me to have a course of chemotherapy first and then surgery. This is primarily because this cancer is likely to be receptive to chemo and hormone treatment, so it could be significantly reduced in size and may even be nuked completely by the drugs (although unlikely) so this is the best way round. They are making me an appointment with an oncologist for next week where I will discuss my chemo schedule, but it's likely that this will begin in a couple of weeks. They are also going to give me Pertuzumab which is a new drug only recently licenced, which is pretty cool. (I'm not used to being an 'early adopter' but why not start now!)

The general schedule for chemo is once every 3 weeks, for 6 rounds, which will pretty much take me through the summer (fun times!) and then some more tests and likely surgery in the autumn (September-ish). Hopefully the chemo will have shrunk the tumour to a teeny size so the surgery won't be too bad. When they remove the lump they will do more tests on it, and check my lymph nodes at the same time. Depending on the results of those tests (which will determine if it has spread) I may have to have a) more surgery, b) radiotherapy or c) nothing at all.

So, first things first. On the way home from the hospital Tanai and I stopped by St John's Bakery and got a couple of lemon cream-filled donuts to have with coffee as we digested the news. When life gives you lemons, eat delicious lemon cream-filled donuts!

My initial thoughts are very positive. It feels containable and treatable. It's also highly likely that I can continue to go to work while having chemo treatment, and with a combination of strategic allocation of my one day off a week, and timing of treatment, I could end up having minimum time off. It's likely that I would need to take a chunk of time off after surgery (eg 6 weeks) in the autumn but the doctors don't know for sure yet. And of course I don't know how my body will respond to the chemo so a degree of flexibility will have to be involved.

My surgeon, Miss L___, followed up her news about my results today with, "So of course, we will have to talk about fertility treatment..." I'd barely let her get the words out before I said "No we're not, we don't want kids!". She was a little taken aback. I suppose most childless women my age who are diagnosed have an initial response of "Will I still be able to have kids?", and they have various strategies to increase the possibility of future conception, such as egg harvesting. It's probably rare that someone is as blunt as I am, and blurts out that my only worry is that the hormone treatment interferes with my birth control and I accidentally end up pregnant! Poor Miss L___, my style is far too direct for her. I wonder if she will mellow a little over time.

Anyway, the news is still fresh, so I'm going to digest it today and have a low-key weekend working out what the practical next steps are. Buying wigs, etc. My style is to keep going, be honest about things but be positive and encourage people around me to be positive too, but I also need to develop a good way of assessing whether or not some days I'm better off staying at home and just letting myself have a Shit Day.

I'm not underestimating how huge this is, I know that chemo is a bastard and I've got a tough few months ahead, but I'd like to try to keep going as much as possible and I know that I have an amazingly supportive network of friends, family and colleagues around me. And of course Tanai is being awesome as ever. Now that we've eaten our yummy donuts he's gone off to work and I am going to enjoy the rest of my day off doing some Life Admin and trying to catch up on emails. I've had some lovely messages from people far and wide with really supportive and encouraging words. I will try to respond to everyone, but know that your positive thoughts are reaching me and giving me strength.

Cx

New considerations

Last night we had a huge fundraising event at work, our biannual gala which raises a significant amount of the budget we need to do our charitable work. It's one of those events where everyone spends months working their arses off in the lead-up, and then in one night it's all over! It's a glittery, starry affair, featuring entertainment and a fancy dinner, and the fundraising elements include a live auction, a silent auction and a raffle.

It was only when I was trying to decide on my outfit that I realised that I ran the risk of having nothing to wear. The dressings from my most recent biopsies extended out into my cleavage and quite high on my chest, and almost all of my 'dressy' dresses are V-neck or at least a little bit cleavage-revealing. I suppose I've always opted for flaunting my assets (ie dresses that accentuate my lovely boobs and small waist) and hiding my bum/thighs (I often have a very 50s style). In fact, I found only 2 frocks which had a high enough neckline to cover the dressings and not cling to, and therefore reveal, the pressure bandages! Hmmmm, I hope a complete wardrobe change is not required in the future. So I popped one on, slapped on a bit of make-up and pepped myself up for the evening.

Pre-event toilet selfie!

I had actually toyed with the notion of bowing out and not working the event, but I'm really glad I persuaded myself to go. It was a fascinating evening and so intriguing to see a live auction in action! Part of the reason I wavered was because my manager took me off the official list of helpers, so I didn't have a specific task for the evening. I'm sure she was doing this to protect me, to make me feel like I wasn't pressured into coming if I didn't want to, and to prepare me for the inevitability of the future, where I will probably have to duck out of work events and projects, but it actually ended up making me quite upset. I felt as though I was being pushed out before I even have my prognosis, as though she is being practical and taking me off projects already, knowing that I will probably be out of action work-wise in just a few weeks, or because she now sees me as unreliable. I take so much pride in my work, and I'm so dedicated to my job and my team, I took this quite badly, feeling useless and unappreciated. I know this is my own issue, and I'm extremely grateful to my workplace for being so flexible and understanding about my diagnosis, but I couldn't help my emotional response.

The other new feelings I felt during the evening were about the fact that a small handful of people at work now know about my diagnosis, even though I've not made it completely public. So a couple of them came up to me during the event and discreetly said lovely things like 'I heard your news, I'm so sorry'. I wasn't prepared for how much this would hit me: I felt a prickling behind my eyes, the shock of hearing the news anew. I know they mean well, and again, I'm so grateful for their support and positive wishes, but it's a new feeling for me to be on the receiving end of this sympathy; this pity. I was then very conscious for the rest of the evening of the differentiation between those colleagues who know and those who don't. I felt self-conscious when smiling or laughing with colleagues or guests, and being observed by people who knew my news. And the worst of it was, feeling terrible for the potential negative impact my presence had on those who knew. I started to think that perhaps I had been taken off the list not for my own sake, but for the sake of others. Those who don't wish to be reminded of my situation. Those who don't want a dampener put on a celebratory, fun evening.

I'm sure this isn't the case, but I'm intrigued by these new feelings, these new considerations, and I'm committed to documenting this journey with honesty, so there it is. Let's see how these feelings progress as my news becomes more widely known, and if I develop better coping mechanisms as I repeatedly experience the response of others. I know I somehow have to try to find a way of prioritising self-care over protecting the feelings of others. I think this is going to be quite a challenge.

In the end, I snuck off shortly after midnight, when the evening was winding down and the staff were starting to feel relieved of their duties. I know that the night kicked on until quite late, but I just wasn't feeling it. In a way I wish I'd summoned up the energy to celebrate and dance with my colleagues, but these complex new thoughts are somewhat getting in the way of unbridled enjoyment.

Delays

Today was supposed to be results day, but it didn't quite work out that way. Tanai and I arrived at St Bart's promptly for my 9am appointment with my surgeon, Miss L___, but it didn't go to plan. She didn't yet have the report from Wednesday's MRI scan and apparently some of the biopsy results were inconclusive, so it's going to take a little while longer to know what is going on. She is fairly certain that the large lump is a cancer, but the results from the small lump are inconclusive, so I have to have another biopsy on Monday 20 March. This one will be a different kind (a vacuum one, hmmmm), and then I get my results on 31 March. THREE MORE WEEKS OF WAITING! Argh!

But apparently the results from the cells taken from my lymph node in my armpit were clear, which indicates that it's unlikely that the cancer has spread too far, which bodes well. I'm trying not to get too optimistic, but I'm certainly feeling more positive today. She is going to book me in for a provisional surgery date in April so at least I have a vague timeframe now.

On the way out of the hospital after a frustrating morning, we popped into the hospital museum. Yes, due to its fascinating history, St Bart's has a little museum, filled with medieval medical instruments and incredible facts. For example, I had no idea that, upon returning from Afghanistan, a Dr Watson met a certain Sherlock Holmes in a lab at St Bartholomew's:

Or that in the 1700s, the hospital had its own brewhouse, and patients drank beer as part of their diet (which was considerably better for them than the water of the time). Here is a malt shovel from the hospital's brewhouse:

There are also two magnificent Hogarth paintings on the stairs, one of the Good Samaritan and one of Christ healing the sick:

I wasn't as impressed by the amputation instruments from the 1500s, they looked pretty gruesome. On the way out of the hospital, we also realised that William Wallace, who fought for Scotland's independence in the 1200s, was hanged, drawn and quartered on a site very close to here:

Such a fascinating, history-filled area. Plenty to distract myself with while I play the waiting game for another three weeks.

Testing, testing...

This afternoon I went back to St Bart's for an MRI scan. This is a very interesting scan where you are placed in a kind of huge tube and they take detailed images of the inside of your body using strong magnetic fields and radio waves. It's all very sci-fi.

First I had to take all my clothes off and get gowned up. You have to take anything metal off, as it could react badly with the strong magnetic fields, but I could keep in my titanium belly button ring because titanium is not magnetic. It's so ridiculous, I got my belly button pierced at a music festival when I was about 16, and I've never taken it out since then! And it's not as though I go around wearing crop-tops and hip-height jeans any more. But I have just never bothered to take it out. Oh well, it can stay in for at least a while longer, an ode to Teenage Indie-kid Carmel.

A very friendly nurse put in a cannula, which I was not expecting, as they planned to feed some dye into my veins so that certain tissues and blood vessels show up more clearly. Apparently, because I am young, my breast tissue is quite dense, so MRIs show things more clearly than ultrasounds. I was pretty rubbish when the cannula went in. I mean, I'm pretty rubbish in general, I'm so squeamish! I can't even watch medical dramas on TV, they make me feel nauseous, and I'm terrible at visiting people in hospitals. I almost fainted today when the nurse put a vial of saline through the cannula to test it. He had to fan me with his clipboard! Ha ha. What will I be like if I have to have months of full-on treatment? Rubbish, that's what I will be like. Anyway, one step at a time.

So then I went to the MRI room. I had to lie on my front and put my boobs through two holes in the bed so they hung down. If you haven't had an MRI they are kind of weird. They don't hurt, and if you're not claustrophobic (which I'm not) they are totally fine, but they are incredibly loud, and make hard, repetitive noises kind of like really shit house music. So you have to lie there, in an enclosed space, enduring these weird loud noises, and after each cycle the nurses call over the tannoy (they are in the next room, operating the machine (and even the dye in my veins!) remotely. They were so lovely, checking in with me to see if I was okay, and telling me when we only had one round to go. I just closed my eyes, tried to breathe without moving too much, and attempted to make songs from the beats I was hearing.

So only two more sleeps and then we find out what the hell this is and what the plan is to beat it. I'm feeling resigned, calm and prepared. Whatever it is, bring it on, and I'll fight this thing!

I'm sorry, what?

So it all started in a fairly nonchalant way, as so many of life's most momentous events do. I had travelled to Colombia with my relatively new husband, Tanai, to meet his family for the first time, to roll out my terrible Spanish, celebrate Christmas there and to see the town where he was born. We were laying on a bed in his aunt's house in Monteria, Tanai's hometown, mid-December 2016, relaxing under the ceiling fan in the 35-degree heat, trying to move as little as possible so as to preserve energy (I'm not very good in hot climates!). Suddenly I felt a lump in my right breast that I'd not felt before, and it felt a little ominous.

"Tanai, check this out, do you think it's a lump? Should we get it looked at?" I asked.

We decided to get it checked out as soon as we were back home in the UK. Occasionally during the rest of our holiday my hand wandered to my boob, checking to see if the lump was still there, and it was, persistently.

We arrived back in London in early January but had to suddenly move house. What with essay deadlines for uni (I'm doing a Masters at the moment), finding somewhere new to live, actually moving house and registering with a new GP in our area, I didn't actually get the lump checked out by my GP until Friday 10 February 2017. Still, pretty swift moving, I reckon.

My GP decided to refer me to the hospital for more tests, "just to be on the safe side", which was why I found myself in the Breast Clinic at St Bartholomew's Hospital, near Spitalfields Market, this Monday, 27 February.

Let's take a moment to rewind about 8 years, when I was living in Australia, and I found a lump in my left breast. I visited a rather swanky clinic in Sydney and paid a few hundred dollars for a very painful biopsy, only to be told it was just a cyst, and I was fine. I naively imagined that this new lump would result in pretty much the same outcome, and when Tanai asked if I wanted him to come with me, I didn't think it was necessary. He insisted, and, in retrospect, how grateful I am that he was with me.

St Bartholomew's (affectionately known as St Bart's) is the oldest hospital in Britain still providing medical care, and was founded in 1123. Its funding was removed at the dissolution of the monasteries but King Henry VIII refounded it in 1546, and it was known as 'The House of the Poore in West Smithfield in the Suburbs of the City of London'. The Breast Clinic is in the West Wing, built in 1752 and situated through a rather grand old courtyard, but inside it's all modern, clean and efficient, with some lovely artwork in the waiting rooms. The place was packed with women of all ages, here for various tests, and we were warned it would take a while.

First up for me was the ultrasound. I was surprised as I'd been told in the leaflet I got in the mail that I would have to have a mammogram first but apparently they are not routine if you are under 40, so they started with the ultrasound. This is where they put some squidgy gel onto your boob and then use a hand-held scanning probe to scan your breast. You can immediately see the inside of your boob on the screen in front of you in black and white, which is pretty cool. My radiologist's name was Dr S___*, and she was really lovely. We casually chatted about art and culture while she scanned my boob, including her recent trip to Melbourne where she saw the Hockney exhibition at the NGV (with which so many of my Facebook friends back in Australia had recently flooded my feed!). She had also taken her family to see a recent show at the place where I work, called The Mad Hatter's Tea Party, a hip hop musical based on Alice in Wonderland, and they'd loved it. She was so lovely I almost forgot why I was there. She then said that they would like me to have a mammogram after all, so I was to pop back into the waiting room and someone would get me for that.

Mammograms are not much fun, if any of you have had one. They basically get a big machine and squish your boob between two plastic sheets so that they can take a 'flat' X-Ray of it. You have 4 X-Rays in total, two of each boob, at different angles. It's pretty uncomfortable, and you have to stay really still, but it doesn't last very long.

Then back to the waiting room for more waiting. Luckily, Tanai had brought his book and I had brought 2 essays with me that I had to read for uni, so the time passed. Then back to Dr S___'s room where she was going to take a biopsy.

Here's the bit where you look away if you don't like needles! There are several different types of biopsy, and I had 'stereotactic core biopsies'. A biopsy is where they take a large needle to take some samples of the lump inside your boob that is causing concern. These samples are then sent to a lab for testing. With a 'stereotactic' biopsy they use the ultrasound scanner on your boob at the same time, so that they can guide the needle into the right place. It helps them get the exact position so that you don't have to get the procedure repeated again (and believe me, you don't want it repeating!). First, they put two small needles of local anaesthetic in to numb the area, so that the biopsy needles don't hurt. Once it was numb, I didn't feel a thing. They make a loud 'click' noise when they're taking the samples, and Dr S___ and her assistant, F___, made sure they warned me each time I was going to hear a click.

They did 9 biopsies in total, which was a lot more than I was expecting, (5 from the big lump I had felt in Colombia and 4 from another little one which Dr S___ had spotted on the screen), and they then put a fine needle into my armpit to get some cells from a lymph node. That one hurt a lot, as there was no anaesthetic, but by then I was feeling very brave and just closed my eyes and breathed.

Then it was back down to the waiting room to wait for a consultant to give me the results. By this stage I was getting kind of suspicious. Everyone was being so incredibly nice to me, and kept asking if I wanted any water or a cup of tea. I mean, everyone knows the NHS is amazing, but really, this felt a little excessive. When the nurse (F___) came to get me, she suggested that Tanai come too. Then I was introduced to my surgeon, Miss L___, who checked my breasts and asked me some further questions about my health, before saying that she'd like me to come back on Friday 10 March to get the results of the biopsies, but that the lump was indeed very suspicious looking from what they could see on the ultrasound and mammograms, and that it's very likely that I have breast cancer.

Gosh, that's the first time I've written it out. In black and white. I have breast cancer. It's pretty shocking, I wasn't expecting to hear these words, or indeed to get such a diagnosis straight away, so it didn't immediately sink in.

Tanai asked some questions, and the staff were very lovely, but there's a limit to what they can tell us until we have the biopsy results next week. Now we just have to wait (what feels like forever!) to know the details, such as what stage it's at, and what my treatment plan is.

We walked home a little in shock, and got on with making lunch. I didn't go back into work as planned as I was feeling very sore from the biopsies (my boob is black and blue, I felt like I'd been beaten up!) and exhausted from the emotional rollercoaster. We simply held each other, talked a bit about it, cried a little, and tried to give each other as much support as possible. I had a movie to watch for one of my uni modules so we started watching that. And then we watched some videos on the Breast Cancer Care website about 'How to Tell Family and Friends about your Diagnosis' and I called my mum and my dad. Those calls were a bit strange as I didn't really have any facts to tell them, so I kept it brief and said I'd call them again when I got my results. And now I don't feel like telling anyone else. The only other person who knows is my manager at work, who has been incredibly supportive, and I've decided I don't want to tell anyone until I know what I'm actually telling them. It feels so speculative at the moment and I don't want people to worry if they don't have to. I know I will need to be strong for the people around me so I need to wait until I have a bit more information in order to do that.

F___ called back the same afternoon and said they've booked me in for an MRI scan on Wednesday 8 March. Because I'm relatively young (in comparison to most women who are diagnosed with breast cancer), my breast tissue is very dense, so the imaging on MRI scans is much clearer than on a mammogram or an ultrasound. So I guess this is for them to be very certain about it. I also had to pop back that afternoon for blood tests. All of the needles!

It's very strange, I've never imagined this would happen to me. And I've just reached a stage of my life where I'm so incredibly happy. In my work, my relationship, my home life, my studying, my friendships -- what a terrible blow. At my lowest moments I am heartbroken -- how can this happen to me? It's not fair! I'm so young! And then I know I can't think like that and I have to just be strong, and get through this. Cancer is a total lottery, I got (un)lucky. I took the tube to work the next day and was sitting on the train, looking around at the faces of Londoners heading to work, thinking 'I have a sad sad secret. What secrets do you have?'.

I was actually really thankful to be able to go into work. It's giving me something to concentrate on, to distract myself from negative thoughts, and believe me, I am concentrating hard. Occasionally a stupid thought will come into my head, like 'I need to write down all my passwords so that Tanai can log into things if he has to' and then I just feel silly, and dismiss the thought. We need to stay positive. We need to keep finding things to smile about, and laugh at. We need to still feel happiness in our day and not let this get us down. When I was crying over the Breast Cancer Care videos the other day, the stormy skies outside the flat cast a beautiful glowing light through the blind, and the daffodils on the windowsill made a lovely silhouette against the blind. I paused the video to point out the lovely image. I can't let this stop me finding the beauty in the everyday.

It's now Wednesday, two days after my diagnosis. I've been very busy at work. This morning I had to do a large presentation to 85 students from King's College, studying for their MA in Cultural Management. And then I had class myself at LSE this afternoon. Now I'm home and I've just put dinner in the oven. I have decided to start this blog as a record of my journey through whatever happens in the coming days, weeks and months. I don't really care if no-one reads it, but I think it will help me process what I'm going through, record my thoughts and feelings, and provide me with a bit of an outlet. And who knows, one day it may help someone else going through the same thing. So here it is, a blog I never thought I'd write: Carmel's Cancer Journey.

Cx

* Everyone in the NHS has been lovely, and most of them introduce themselves by name when you first meet them, and wear name badges. However, due to patient-doctor confidentiality, I'm not going to write any of their names in full on this blog.