Surgery (and some cool research projects)

Yesterday was my surgery day, and it seems to have all gone well. Here's a little summary of the day. One of the things I was most dreading was having to fast all day before surgery, so we cooked up a delicious meal the night before. I've been getting creative with the contents of our weekly veg box, and this week we got some celeriac, so made a celeriac hash, with ham hock, mustard, gruyere and duck eggs. Absolutely delicious! I then permitted myself two pints of water at 5.50am on the morning of surgery, and that was it. We had to be at the Percival Potts ward at 7am, situated in the attic of one of the old St Bart's buildings. With pointed windows and a sloping roof, it felt more like a school dorm than a hospital wing! I had to give an extra urine sample so they could do a pregnancy test (hilarious!) and then was ushered into my own room, which was ridiculously overheated and the windows were painted shut. 

Then followed a stream of various people wanting various things. Firstly, a nurse to issue sexy compression socks for me to wear during surgery (to avoid blood clots), take my blood pressure, check allergies etc. Next up was a woman from the clinical trials unit at Queen Mary University, with detail of two programmes they were asking me to participate in. Regular readers will know of my desire to get involved in clinical trials and 'give back' to medical science and potentially help cancer patients in the future, so I was very interested. The first research programme is a tissue bank, and they are requesting that I agree to a piece of the tissue from my cancer being stored in this bank in order that they can conduct research on it, compare it with other cancer tissue, study its molecules and potentially see how it could respond to different drugs. Of course I complied and signed all the forms, totally happy to help out! The second programme is a huge NHS initiative run by Genomics England (a company owned by the UK Department of Health) and is called The 100,000 Genomes Project and is really pretty cool. This is a huge country-wide project and will definitely change the future of cancer treatment, so I was very keen to be involved. It will involve my whole genome being sequenced (Tanai was a bit jealous!) and it differs from usual research projects in that the data is not anonymised. They wanted to collect a blood sample and a sample of my cancer, and will use this to shape the personalised medicine of the future. In the not too distant future, people will not be routinely given the same old treatment as everyone else. No, their DNA will be sequenced and they will be given the appropriate treatment for their very specific needs. In order to be able to gather as much data as possible for this, they need to be able to access my entire medical history, and will continue to access it for the rest of my life, and beyond. It will be analysed by several global teams and compared with the 99,000 other genomes they choose to sequence. They will also contact me if any of the research on my sample unearths anything of interest or relevance to me. Of course I signed up straight away, and it feels great to be able to contribute to such a groundbreaking project.

My next visitor was the anaesthetist, a tall, skinny guy with an infectiously calm manner. He asked me various questions and explained what he would be doing later to get me ready for surgery. Not only would he administer my anaesthetic, but would also have to place a breathing tube down my throat in order for me to breathe during surgery. And after he left, my surgeon, Miss L___, and a registrar came to visit me. They asked me to explain in my own words what I thought was going to happen. They seemed content with my response and she then rather unceremoniously scribbled all over my chest just below my collarbone to remind her what to do later on, I suppose, so she didn't mix me up with any of the three other women she was operating on that day. We also discussed my allergy to the various dressings they use at the hospital, and sticking plasters. She said she would use a milder dressing, but we shall see if it works.

R = Right breast, WGWLE = Wire Guided Wide Local Excision, SNB = Sentinel Node Biopsy

Sexy compression socks

My first task for the day was to pop over to the West Wing and have a wire inserted into my breast so that the surgeon could later locate the cancer (I explained a bit about this here). When the ultrasound technician tried to find the remaining cancer she had trouble: apparently it has shrunk to less than half a centimetre! So instead of using the ultrasound to guide in the wire, I had to have it guided in while being compressed in a mammogram machine. Those of you who have had a mammogram will know how uncomfortable that was. This was because they decided to aim for the titanium clip which remains in my breast from the biopsy, rather than aiming for a tiny tumour remnant. They know that this clip was placed in the original tumour, so if they aim for that, they should catch what's left of the cancer. I suppose it's quite difficult for the surgeon to operate, when she can't see the cancer (it doesn't look any different from my normal body from the inside, I suppose). So she operates with all my ultrasound and x-ray photos all around her, guiding her as to where it is likely to be located in my breast. The wire helps with that, as she can just remove it and a bunch of tissue around the base of it, and hope she got it all. I wonder if in future someone will invent glasses that surgeons can wear that will give them the ability to see cancer.

As an aside, while I was having my ultrasound, the nurse in the room just happened to be the same nurse who was there in February when I had my first biopsies, F___. Back then, before I had even received my diagnosis, she held my hand through 9 painful biopsies, and was so kind and thoughtful, I have not forgotten it. I was so glad to have the chance to tell her how much that had meant to me, and thank her for her kindness.

So with a wire hanging out of my boob (no, really!) I went back to my room to wait. And I waited, hungrily, for hours. I was 3rd out of the 4 women having surgery that day, but I think they scheduled the most complicated op first. Finally, at 3.30pm, I made my way to the theatre. My lovely anaesthetist was there, and we had a delightful chat about hiking on the Isle of Skye while I slowly drifted off to sleep. And 3 hours later, I woke up! It really is quite remarkable, medical science. 

The other part of the op, which I mentioned before, was the removal of some lymph nodes. Having been injected with radioactive dye the day before, they apparently used a geiger counter to find where the radioactivity was collecting, and that, combined with the blue dye, helped them locate the sentinel nodes to remove. I just find that so astonishing, what an incredible technique.

Coming round from the anaesthetic wasn't too much fun, but after a bit of anti-nausea medication and some sips of water (finally!) I felt vaguely human again, so they wheeled me back to my room, and to the welcoming arms of a rather worried-looking Tanai. I then proceeded to gingerly eat some of the leftovers from the day before (I'm sure I'm the only person to have broken their surgery fast with celeriac hash and duck eggs) and soon felt much more stable. Miss L____ came to check in on me, informed me that she'd removed two lymph nodes (as far as she could tell) and that it all seemed to have gone well. I'm to keep my dressings on until I go and see her on 3 November, when I'll also receive my pathology reports. So that's when I'll find out if the surgery was successful in removing all of the cancer, and if my lymph nodes are cancer-free. Fingers crossed I won't have to have any further surgery.

I then got dressed and we made our way downstairs. All along when preparing for surgery, everyone we've spoken to has insisted that we get a cab home, but it was such a charming, cool evening and I was feeling strong, so we defied advice and walked home through Smithfields market. It's only an 8-minute walk and we made it home fine. After some pumpkin soup which I'd made the day before I collapsed, exhausted into bed and slept very soundly.

So that's it! Surgery is ticked off the list (hopefully for good). I feel fine today, a little sore but I haven't had to have pain relief yet, and I still have some movement in my right arm. I keep having to remember not to pick things up with my right hand (which is tough as I'm right handed), and Tanai has taken the week off work to help me out. We managed a little afternoon walk today in the autumn sunshine and now I'm resting on the sofa. I'm wearing very comfortable clothes, a soft post-surgery bra (which I also have to sleep in) and I have a fabulous pillow which my friend Dee sent me, which hooks over my right shoulder and prevents my arm from chafing my armpit wound. I can shower as normal as the dressings are all waterproof. I'm sure it will get sore over the coming days, especially when I start to do my exercises (which I've been given in order to maintain movement in my right arm) but hopefully all will be well. If I have any problems I can just head straight over to St Bart's and they'll sort things out. So now I just have to rest and recuperate, and spend some time relaxing, reading books, listening to podcasts and catching up on some movies.

My fabulous arm pillow

This afternoon's walk through the St Bart's courtyard

Final pre-op prep

I'm heading in for my surgery tomorrow so just thought I'd update you on the final things that have happened this week. Since my pre-op check-up I have seen the cardio oncologist again, for the results of my various heart tests. She was very reassuring and said all the test results seem fine. She suspects I have what is called Ventricular Ectopy, where my heart decides to give an extra beat every now and again, for a short burst, which explains my chest pain and the fact that I'm feeling my heart beating quite aggressively. She said it's nothing to worry about in the short term, that I'm fine to proceed with surgery, but that if it's still happening in a couple of months I should head back in to see her. She did, however, point out that my blood results show I'm anaemic, so she has advised that I receive a blood transfusion after my surgery rather than simply being left to build my bloods back up on my own.

I also received a call this week from the clinic to say my bloods needed doing again, so it appears that they are not as good as they could be. The nurse told me my magnesium and potassium are low, or something like that (I didn't take notes) and she took three more vials from me to do further tests. Due to 6 months of sustained chemotherapy, my veins are not as good as they used to be, and have a tendency to collapse when someone tries to put a needle in them. She tried her hardest but had to use a vein that was quite deep, and now I have a huge bruise on my left arm! I asked the google what I could do about collapsed veins, thinking there might be some things I could do to help them regain their strength (such as drinking lots of water doing exercises etc) but all I unearthed were helpful websites urging me to stop doing drugs! It seems as though that's the main cause of collapsed veins, and the advice is all very admonishing, so I retreated. Anyway, hopefully they got what they needed at the hospital and my bloods are getting better.

Finally, this morning I had to go into the nuclear medicine department again so that they could inject me with some radioactivity. The nurse was fabulous and explained how it all works, before injecting it into my boob near the nipple. It only stung a little and now I'm back home. After the injection, she took a marker pen, circled the area she had injected and put a little arrow towards it with 'INJ' next to it! I suspect that is not the last time I will be written on with marker pen. Oh well, if it helps the surgeons I really don't mind. So tomorrow they will apparently use a Geiger counter to see where the radioactivity has gathered, and this will help them see where my primary lymph nodes are, to aid them in taking them out. It's all so fascinating.

At the nuclear medicine dept this morning. Far too early for Tanai!

On the way home, we stopped at St John's bakery and bought two donuts. They make delicious fresh donuts every day and fill them with different creams and custards. Tanai got one with honey and brandy cream, and I got one with a delicious spiced custard. This has become a bit of a tradition now, buying St John's donuts at each stage of my treatment. It's so lovely to have it to look forward to.

Today's yummy donuts

This weekend I also went to my first gig at the Roundhouse since the day before I received my prognosis back in March (we went to see Sampha and the very next day got all the test results). There was an all-day festival featuring some really funky music, including the Hot 8 Brass Band, who were great. I managed a whole glass of wine and we stayed out until 9pm! Crazy. After 6 months of being very boring and primarily staying home, it felt like a real treat.

I finally have a social life again

We also spent Sunday ferociously batch cooking, so that we have a freezer full of food in readiness. Although Tanai does love cooking, it's likely I will have mobility issues for a while in my right arm, so might not be able to cook for a while. Rather than have him cook every single night, I thought it would be nice to stock up on some yummy meals in our freezer. The flat still smells delicious!

Chef Cardona

We also did some DIY and installed a new ceiling light in the kitchen to brighten up a dark corner. We received a lesson from my dad over video whatsapp and then turned off the electric at the mains and wired in the light. A bit nervewracking but it worked!

Lovely new ceiling lamp

I have finally ditched the headscarves as I now have enough hair to look plausibly like another short-haired person, and I feel great. It's a little windy round my ears though, I wasn't prepared for the cold! But I'm enjoying how low-maintenance it is. Someone at work said 'big earrings and lippy' so I've taken that on board.

Rocking the short hair

I'll update you all after the op! Fingers crossed it all goes well.

Preparing for surgery

My surgery has been confirmed for Tuesday 24 October, so for the last couple of weeks I've been attending various appointments to prepare for the op. I saw my oncologist again on 2 October: my standard post-chemo check-up. She was really happy with my progress and I don't have to see her again until 4 December! It feels so strange, after seeing the oncology team every 3 weeks for the last 6 months, to have such a huge gap before seeing them next. As my treatment progresses my schedule of appointments will change, and once I'm done with radiotherapy I will drop down to seeing my oncologist and surgeon every 3 months, then every 6 months, and eventually I will only have to have annual check-ups. But I'm getting ahead of myself...

On 4 October I had my first Herceptin injection. Regular readers will know that this is a monoclonal antibody (I explained how they work here) which I have had intravenously during my last 4 rounds of chemo, along with Docetaxel and Pertuzumab. Its actual name is Trastuzumab but Herceptin is the brand name and widely used. Herceptin blocks the growth factor HER2 from helping the cancer cells to grow, and so the cancer cells eventually die. It has been shown to be hugely effective at preventing cancer from returning, so I have to continue receiving a dose of it every 3 weeks for a year in total. It took about an hour to receive it through an IV but now it's administered via a large needle in the thigh for a couple of minutes. Although this is much more convenient it bloody stings! My friend Jana came with me and distracted me and held my hand while the needle went in.

Next up was my pre-op assessment on 10 October, at my regular Breast Clinic in the West Wing of St Bart's. First they weighed and measured me again, so that they can calculate how much anaesthetic I need, then they took my blood pressure, took some blood for testing, and swabbed my nose, mouth and groin to check for staphyloccocus. I explained that I had actually had an outbreak of staphyloccocus aureous on my skin recently, but was on a course of antibiotics to get rid of it. It's highly infectious apparently, and can have major developments if not treated properly, so they have to control its spread in hospitals. Apparently if the tests come back positive, I will have to be last on the operating table that day, so they can scrub thoroughly after me.

Then I had to answer a whole heap of questions from a nurse, including whether I'd had general anaesthetic before, when I last had bronchitis, whether my ankles had swollen recently, and loads of other seemingly non-related questions. I had a general anaesthetic when I was a child for a multiple tooth extraction, I haven't had bronchitis since 2014 and yes, my ankles are swelling every day at the moment, in case you're interested. They are particularly concerned about some of the questions we're investigating to do with my heart, so they sent me off for another ECG and a doctor came to listen to my heart. Once again, the ECG seemed fine, but as I have an appointment with the cardio-oncologist next week, they're going to hold final judgement until then. Fingers crossed I'll be good to go for surgery on 24 October.

The patterns my heart makes

The nurse explained a little about what would happen which I will outline here for those of you interested. Firstly, the day before surgery, on Monday 23 October, I have to visit the nuclear medicine department for a Sentinel Node Scan. They'll inject some tracer near my breast and they track its progress in the lymph system by taking pictures over the course of 3 hours using a gamma camera. So basically I have to lie extremely still in a huge nuclear camera machine for the best part of half a day. Fun times. This will then guide the surgeon who will be removing my sentinel lymph node as well as the rest of my cancerous lump.

Then on the morning of 24 October I am not allowed to eat anything. Those of you who know how hangry I can get can appreciate that this is one of the things I'm most worried about. No food from midnight onwards and no water from 6am onwards. I'm going to get cranky! I also have to remove all nail varnish, and I'm not allowed to moisturise that morning or use an oil-based shower gel. I have to arrive at the hospital at 7am when I'll be greeted by the team and meet my anaesthetist. At this stage I don't know what time my surgery will be, as they decide on the day what order they will do everyone in.

So essentially the procedure is this. I am having two surgeries in one. Firstly, a Wire-Guided Wide Local Excision. This is the name of the procedure for removing the remainder of my cancerous lump. In the morning, they will use an ultrasound machine to guide a wire into my breast and they will leave the end of it right at the base of the remaining cancer. I will then have to go about with a wire hanging out of my boob until I head into surgery! This is to guide the surgeon, Miss L___, as she removes the cancer including a margin of healthy tissue so that we can be happy it's all gone. She will go down to the end of the wire and remove that along with the cancer. She will also take out the titanium clip which they put in there right back in February when they were doing my original biopsies.

And secondly, I'm having a Sentinel Lymph Node Biopsy. This is to check that the cancer has not spread into other parts of my body. The Lymph nodes are small, bean-shaped glands throughout the body. They are part of the lymph system, which carries fluid, nutrients and waste material between the body tissues and the bloodstream, and is an important part of the immune system. Cancer co-opts the lymph system in order to travel around the body and settle elsewhere, which is why it's possible to have Breast Cancer in your lungs, brain, and other organs. If my cancer has spread, it would do so via the lymph nodes in my armpit, so the surgeon is going to remove the first couple of glands and send them off to the lab, to see if they can find traces of cancer in there. The way they do this is quite funny. While I'm under anaesthetic, they inject my boob with blue dye, and then see where it goes. The first couple of nodes it appears in are the ones they will remove. They will take out 1-5 nodes (the average is 2.2). Apparently my breast can remain blue for up to 18 months after surgery! I think that Smurf Boob will be my new pirate name. Maybe I should audition for the next Avatar movie!

Once they're done, as long as there have been no complications, I can leave hospital the same day, and don't have to stay overnight. The lump and nodes will go off to a lab, and I will get the results 2 weeks later. If they have managed to take enough margin round the lump and my nodes are clear of cancer, I will not have to have any further surgery, and can go on to have radiotherapy a few weeks later. If the margins are not clear, or if there's cancer in the nodes, they will have to operate further.

I have been given an information sheet from Breast Cancer Care containing exercises I must do each day to ensure I get my full motion back in my right arm. There is a risk of Lymphodema, which is a permanent swelling of the arm due to there not being enough lymph nodes to fully drain from the arm and upper body. Also, I will not be able to have any blood pressure tests or blood taken from my right arm for the rest of my life! Let's hope my left arm can do all of that for me in future.

So now I'm feeling quite prepared for the surgery. I will take 2 weeks off work afterwards to recover, and hopefully will be fine to return after that.

And to further examine my heart, yesterday I had what's called a 'stress test' on my heart. This was quite a tricky test, I had to sit on a kind of exercise bike, but one where I was laying back at 45 degrees so they could put heart monitors around my chest and back. They set the 'bike' on a course which got increasingly difficult, and I had to keep pedalling in order to push my heart rate up. The tricky part was that they had to tilt the machine to the left in order to get the ultrasound wand and take photos of my heart. Riding a bike until your heart rate reaches 150, while tilted to the left so you feel as though you're going to fall off is quite challenging! But we made it in the end and they got all the pictures and videos they needed. I will see the cardio-oncologist on Tuesday for the results.

And my other hospital visit this week was on Wednesday, when I went back to the Royal London for the results of the biopsy on the skin tag I had removed a while ago. All good, I don't have skin cancer, hurrah! It was just a bundle of blood vessels so nothing to worry about.

One more week until surgery! It's a busy week at work but I'll be resting lots in the evenings and continuing to build strength and energy to help me see it through.

Chemo 6, and the rollercoaster continues

This week was my 6th chemo session, leaving me with only 2 rounds left to go. It's somewhat strange as the majority of cancer patients I'm in touch with only have 6 chemo sessions in total, so here's where a lot of people get off the chemo train. But I get 2 extra doses of weedkiller so I'm not quite done yet. It's been an eventful few days, reminding me that this journey is never going to run smooth, but I'm doing okay, convalescing at home this weekend and waiting for the worst of the side effects to kick in.

On Monday I saw the oncologist as usual before my chemo session, to talk through how I am, and prepare anything different from the last time. I've seen three different oncologists from the team since my diagnosis, and for the last couple of rounds I've seen the head honcho guy, Prof. S___. He leads the team and is very distinguished in his field, having written heaps of papers and run lots of studies. He's a lovely chap with a friendly manner and a no-nonsense approach to what I'm going through. We discussed my little trip to A&E and I went through my notebook with all my new questions since last time (I write them down over the intervening weeks and go through them in my oncology session). We checked my bloods, and thanks to the GCSF injections my neutrophils were a healthy 5, so that was good. He then mentioned that he wasn't hugely happy about proceeding with chemo on Wednesday until I'd seen a dentist and could confirm 100% that I didn't have an abscess on my tooth. The risk is too great, apparently. So I left his office on Monday afternoon, having not registered with a dentist since returning from Australia, with a pretty hard deadline for getting my teeth checked out.

A cursory google and a few phonecalls later and I was booked into a dental clinic near the Barbican, near where I live, for the next morning. I had to shift some meetings around at work but I was so determined to avoid anything delaying my chemo schedule I became a little single-minded about it. Luckily, I hit the dentist jackpot. Not only is my new dentist lovely and efficient, she also happens to work in an NHS hospital as well as her private practice, and sees lots of cancer patients with teeth problems so completely knows her stuff. She had a thorough grounding of the impacts of chemo and radiotherapy on teeth, the key risks and things to look out for, and exactly what I should do in my situation. X-rays showed that I was abscess-free (yay!) so chemo could go ahead, but we have also come up with a plan for things we need to do between chemo and radiotherapy to ensure my teeth are impacted as little as possible by the effects of the rads. She has also prescribed me with high-fluoride toothpaste to protect my teeth from the effects of my cancer treatment, and she has given me a little blunt syringe so that I can get mouthwash into the niggling cracks around my wisdom tooth, to avoid an infection delaying chemo. I left feeling very happy and with a plan for October/November to ensure my teeth are also looked after through this.

Wednesday went ahead as planned, with my wonderful friend Caroline joining me on the chemo ward for a picnic lunch and a natter. I had the smiley nurses G___ and G___ again. Unfortunately, this was the first time they didn't get my cannula into a vein on the first go. It took 4 goes to find a vein as my poor little veins were collapsing, which was quite distressing (they ended up having to call the head nurse to do it!). I've been lucky so far and have had good veins, avoiding getting a PICC line fitted, but this time was tough, and I really hope my veins hold up to having 2 more rounds before I'm done. My hands are quite bruised now!

Selfie on the ward for chemo 6

As per last time I had quite a bit of energy (somewhat steroid-induced) for the couple of days following chemo, so I did some work and tried to keep busy. Then the rollercoaster came along again! I received a call on Thursday evening from my GP saying that UCLH had sent over a report following my visit to A&E and that they'd seen something a little worrying on my chest X-ray, so could I come in to see them. Friday morning I rock up at the GP and we go over how I am. She checked my breathing, asked me loads of questions about my heart, chest pain, the little flutter I've started to feel since shifting onto this new drug cocktail. She suspects that if the 'cluster' on the X-ray was the beginning of an infection, the antibiotics which I received at UCLH probably got rid of it, but she asked me to get another chest X-ray just in case. She also referred me for an ECG test (electrocardiogram) to check my heart is working as it should be. So I ended up spending most of Friday wandering round various hospitals of London (St Bart's and UCLH, because unfortunately the tests couldn't be done in the same hospital!) getting tests done. The results will be sent to my GP in the next few days, but hopefully it's not anything to worry about. To be honest, the main takeaway I had from all of this was a realisation of my GP's role in all of this. Each time I visit the oncology team, a letter gets typed up and sent to my GP, and of course they received the A&E report. Knowing that they are taking note of what's happening to me, and even called me when they thought something was awry, gives me great comfort as I go through this. Another example of our amazing NHS!

Display at UCLH of early anatomical drawings

This time around I have been given the GCSF injections in advance, so Tanai is administering a shot each day in my belly for the 3 days following chemo. Hopefully this should ensure that my neutrophils don't drop below the required levels and I can stick to my timeline. I've had my MRI booked in for early September, just before my last chemo, so that the surgeon has some up-to-date imagery to work from when planning my surgery, and I will meet with them before my last chemo. The light at the end of the chemo tunnel is finally visible, and I'm so ready to move onto the next stage of treatment: surgery. Chemo sucks, and I hope I never have to go through it again after all of this.

I now have my own sharps disposal unit for the used GCSF needles!

On Wednesday Tanai will go to Portugal, on the holiday we were supposed to be enjoying together, for his friend's wedding. I'll be sad to be without him for a week, and of course gutted that I miss out on a holiday and on meeting lots of his friends, but we have already started to plan some fun trips for next year, and soon we will have other holidays in the diary to look forward to. In the meantime, I have a host of friends who will hopefully swing by and see me during my week flying solo during treatment. Let's hope there's not another A&E visit next weekend!

A&E & Neutropenia

So, I guess it had to happen at some stage, and you could tell from my last post that I suspected the time would come soon. Yesterday we spent the whole day in A&E at UCLH (University College London Hospital, my nearest hospital with an A&E department, as St Bart's doesn't have an A&E).

I have been experiencing bone pain with the Docetaxel, including pain in my teeth and jaw, but over the last few days the pain has become concentrated on my lower left wisdom tooth, and my cheek and mouth has become swollen in that area. By Saturday evening the pain was intense, so I called the chemo hotline. The chemo hotline is a phone number I can call if I'm experiencing anything in a list of symptoms and I get through immediately to a nurse on my chemo ward. The number is attended 24/7 and they do encourage you to ring no matter how trivial you think the call to be, as they can help you decide what to do. Generally, the answer is 'Go to A&E!' but at least you feel as though it's legit.

I called again on Sunday morning and although the nurse was quite keen that I see a dentist to check out what was wrong, she was more concerned about the possibility of me being neutropenic, so advised I get myself down to A&E. Tanai and I headed over to Euston Square station and UCLH, and with my chemo platinum card I was fast-tracked through the people who had arrived at A&E on foot.

They did general observations, blood pressure, took a blood and urine sample, took jaw and chest x-rays and gave me my own room. I saw a doctor who advised that the x-rays came up okay, and I didn't seem to have an infection, but that I was indeed neutropenic. My neutrophils were 0.5 ('normal' is between 2 and 7, anything less than 1 is neutropenic) so they considered keeping me hospital in for observation. Meanwhile they gave me morphine for the pain and some intravenous antibiotics in case my tooth had an infection. They sent one of their oncologists to see me, a lovely woman called Dr O___, and she asked me lots of questions. She decided to give me my first G-CSF injection (granulocyte colony stimulating factor), which stimulates the production of white blood cells in the bone marrow. I received that and a 2-week course of antibiotics to take at home, and was discharged.

In my room at UCLH

Today I popped into St Bart's to see the team, and they have given me some codeine for the tooth pain (I do still need to see a dentist) and 5 more G-CSF injections for me to take at home, in order to try to build up my neutrophils so I can still have my next chemo on schedule on 2 August. So tonight, Tanai became a different kind of Dr to the one he's used to being, and injected me with my G-CSF. He was a bit nervous, and so was I! You have to pinch a bit of your belly and jab it sharply into the flesh, and then push the liquid in (it doesn't go in a vein). Neither of us really knew what we were doing but we googled it and then just went for it! But now we know how it's done, the next few should be relatively easy. I will now get these injections each time I have chemo, in order to boost my neuts for the next round.

Dr Cardona in the house!

As I'm neutropenic they have also advised me to be cautious and not expose myself to infection, so I'm working from home this week and trying to get as much sleep as possible, to allow my body the best chance to recover. I keep taking my temperature regularly and if it goes above 37.5 I will call the hotline. It's touch and go whether I will need to go back to A&E this week, but hopefully these injections and the antibiotics will do their job. I'm a little nervous that the tooth problem is significant, as it's generally not advised to have a tooth extracted during chemo (due to the risk of infection), but we'll see what the dentist says (if I ever manage to register with one and get an appointment!). All in all, not the most fun weekend I've had, but at least it wasn't too dramatic.

Chemo #2

Yesterday I was back at St Bart's for round 2 of chemo, after a lovely, relaxed weekend of fun, making the most of my last few days of relatively good energy levels. I did a few hours of work on Monday morning and then headed to the hospital for my 3pm appointment. One of the ladies I met at Saturday's meet-up lunch joked that the chemo ward at St Bart's is a little like a day spa, as it's on the 7th floor of the hospital with some pretty spectacular panoramic views of the city. Everyone gets their own plush chair, their own dedicated nurse, in smaller rooms of about 5-6 per room. Almost as if to confirm this fantasy, yesterday there was a lovely Italian masseuse who was offering complementary therapies, so I had a relaxing shiatsu foot massage while my drip sent the chemo drugs through my cannula. It really helped me relax and lowered my anxiety levels, what a fabulous idea. She started out as a volunteer one day a week outside of her own practice, but now she's employed by a charity to come to St Bart's every Monday to give out treatments. Unfortunately, from my next session I'm back on the Wednesday cycle, but it was a real treat.

I had the same treatments as last time, including the Doxorubicin, which the nurse, J___, administered by hand. This one is nicknamed 'The Red Devil', due to its extensive side-effects. It can also cause heart failure, which is why I had my heart checked out before starting. It's pretty nasty. It also turns my pee pink!

I chatted with a few other patients on the ward, including one cheery girl who was on her third batch of chemo! Her cancer spread from her breast to her lung, and it's just spread to her brain. But she was remarkably upbeat, chatting familiarly with all the nurses and sending me her facebook page. I love how resilient people are in the face of adversity. It's so inspiring.

The computer systems are still down at St Bart's and apparently the back-up has also been attacked, so everything is still being written out by hand, and triple checked with the consultants. However, the nurses are expected to get through the same number of patients in a day, leaving many of them somewhat frazzled. It's quite distressing seeing first hand the negative impact on the NHS which has been brought about by the Tory government. Although the care I am receiving is exceptional, the staff are all overworked, and yesterday the nurses were even joking about leaving the NHS and getting a job in Asda, as it pays better and is less stressful! It's maddening for me, someone who is currently having their life saved by the NHS, to know that in 10-20 years time it might not exist and I would have a very different prognosis.

So after three hours, I was all done, and this time my mum popped by the ward, having taken the train from Lancaster to stay with us for a few days. Tanai went back to work today and mum has been looking after me, making delicious food and keeping me company. Thus far, I have responded much better than the first time, in terms of side-effects. I slept fitfully last night but didn't suffer as much as last time with the nausea. On the day after chemo #1, I didn't leave my PJs, but today I got dressed and we went for a little walk round the Barbican. I even baked a batch of ginger biscuits to help combat the nausea! So I'm hoping I stay this way, and don't crash later instead. I'll keep you posted.

Mum doing some batch cooking!

And so it all kicks off

Today is Friday, and on Wednesday this week I had my first chemotherapy session. I can officially report that it's Not Much Fun. But I'm doing okay. Here's how it all went down.

I only got the call on Monday that my appointment was to be on Wednesday, so after a prolonged few weeks getting test results, they are now moving quite quickly, which I'm pretty happy about. Wednesday is my regular day off work (I only work 4 days a week) so I already had a load of Life Admin planned (you know, appointment at the bank, sight test, getting a bed delivered etc) but luckily it all fitted in timing-wise for me to be free for my heart echo test at 1.15pm.

I did, however, still have a list of things to buy in order to feel fully prepared for chemo, so Tanai and I went on a little shopping spree on Tuesday evening after work, to get the last few things. In my 'project manager' approach to all of this, I had made a list of things recommended to have on standby following chemo, which included: a water bottle (I had to thrown mine out a while ago so needed a new 1-litre bottle) as apparently you become dehydrated following treatment; lip balm and unscented moisturiser (for the same reasons); a thermometer (so I can accurately record my temperature under the tongue, and if it goes above 37.5 I have to immediately go to A&E); hand sanitiser (for guests, as I will be susceptible to viruses); rubber gloves (to protect my hands while doing the washing up, as my fingernails are likely to fall off, ew); Corsadyl mouthwash (another side-effect is mouth ulcers, so this is an attempt to ward those off); light ginger beer (apparently this is good for nausea); boiled sweets (to eradicate the metallic taste you get while having chemo) and dark nail polish. This last one is interesting: I've read in various places that wearing dark nail polish reduces the risk of your nails falling off, and apparently there are now medical trials being conducted to verify this hypothesis. I went to Whole Foods and chose an eco matte blue, which feels weird as I never wear nail polish, but may as well try it!

A lovely cardiologist, V___, conducted the heart echo test, which is an advanced ultrasound of the heart, where high frequency sound waves are emitted and they measure how they bounce off the heart. She put some electrodes on my chest and used the probe to see my heart, and then took various measurements. From these I will get my 'ejection fraction' number, and they will keep testing my heart every 3 months. If my ejection fraction goes down by more than 10% they will alter the dosage of my chemo drugs, or pause treatment. I have to say, it was pretty cool seeing my heart beating there, on the screen.

Then Tanai and I came home for lunch before heading back to St Bart's for my 3.30pm chemo appointment. I'm so lucky to be living only a 5-minute walk from my hospital, it will make the next few months so much easier. I have been watching some videos made by Victoria Derbyshire, which, as an aside, I highly recommend. She is a BBC Two news presenter, and was diagnosed with breast cancer in 2015. She made 6 x 15-minute diaries about her treatment and they do go towards demystifying the process. She had to drive an 80-minute round trip for her Radiotherapy, every weekday for 6 weeks! So I feel very grateful that I have access to great treatment, for free, just a short walk from my home.

Another thing everyone has been telling me is that my tastebuds will be nuked by the chemo, so I won't be able to taste anything. To be honest, I think this is the side-effect I'm least looking forward to, as I absolutely love my food! For my 'Last Lunch' I made poached eggs which I placed on top of avocado on toast, sprinkled with salt and pepper and a dab of pesto. Simple but delicious.

And so, to the chemo clinic, which is on the 7th floor of St Bart's, with some great city views. I had a little chat with a nurse who gave me the low-down on what to expect over the coming months, and was then seated in a comfy chair to have my anti-nausea meds first. The nurse, N___, put a cannula in the back of my left hand, which is a needle attached to a screw valve that they can attach a number of different meds to, so that they don't need to place a needle in my vein for every new drug, and they started with a flush of saline to check the line. In true Carmel form, I only went and fainted! Ha ha. It was actually pretty scary for Tanai, who has never seen me faint before, and apparently had to hold my head up while I stared at him with vacant eyes and purple lips, completely lifeless! The nurse hit the panic button and within seconds there were about 12 people round my bed, reviving me, shoving an oxygen mask in my face and making sure I was okay. I came round, with the usual disorientation following a fainting, and called for Tanai. Just a temporary setback though, we pressed on with treatment. Most of the drugs were fed into my hand via intravenous drip, suspended from bags hanging from a tall drip stand. The nurse hooked up each bag on there, set a timer and then popped off to do whatever other stuff she had to do. Tanai and I had brought mags and books to pass the time, but in the end we just chatted, it all felt so strange and new. After the anti-nausea meds, the first chemo drug I had, doxorubicin, is a bright pink colour, and cannot be given by drip, but has to be administered by hand, by the nurse. She screwed a huge plastic syringe onto the cannula line, which was merged with a saline line, and she hand merged them, slowly allowing the drug to go in. Every now and then she pulled the end of the syringe, just to pull a bit of blood out of my vein, to check that it was all going in the right place. It was kind of cool, seeing it all happen, and I couldn't feel a thing. No pain, no nausea, just a little chill and a blossoming fatigue. Luckily, we had brought a big red blanket from home, so I was nice and warm. The next drug, cyclophosphamide, was administered by drip, and then I had a little bag of saline, to 'flush out my veins', and then I could go home!

Receiving chemo

Most of the other chemo patients were much older than I am (I suspect this will usually be the case), but to our left were a French couple, and she was my age, so I got chatting to her just before I left. She had tried to 'cold cap', which is where they place an ice cold cap on your head in an attempt to prevent hair loss. They literally bring your head to an induced hypothermia. I had decided already that I didn't want to do this -- the results are variable and it sounds really horrid and gives you headaches, but she had tried it and didn't like it at all. She has two daughters though, and thought it might make it easier for them if she keeps her hair. I told her all about my headwrap shopping, and shared the secret facebook group I have joined, for those who have been diagnosed with breast cancer under the age of 45. I hope she joins it, as it has given me so much help, support and strength.

We got home around 8.30pm and Tanai made dinner. I had heard that I should categorically not have my favourite food straight after chemo as you can often hate that meal for a long time! Tanai joked that he should make me cucumber salad (cucumbers are the only things he doesn't like, so he thought it would be handy if I didn't like them either!), but instead we had a simple pasta, and I wanted to sleep pretty soon after. As I am still waiting for my belongings to be shipped over from Australia, we have been sleeping on a sofabed, but some wonderful friends have lent me their spare bed for the next three months, so I can convalesce properly and not simply turn the living room into a sick room. It was so nice to be able to sleep in a proper bed after chemo, so thanks Jess and Martin!

Now, despite my positive attitude, I have to share that the first night was really rather horrid. I woke up at 23.15 and 02.22 with horrific, overwhelming nausea. I didn't actually vomit, which I'm thankful for, but it was overbearing and very unpleasant. I slept fitfully and woke up feeling extremely nauseous too. I felt as though the chemo drugs were so strong and powerful, and they were finally making their way through my small, fragile body. It was not a pleasant feeling. Thursday, my first day post-chemo, was a quiet day. I am on a cocktail of anti-nausea meds. Four different kinds which need taking at different times, some with food, some before, some two tablets twice a day, some one tablet 3 times a day (yes, I made a chart!). I stayed in my PJs all day, pretty much just moved from the bed to the sofa, and did very little. Tanai made sure I ate little and often, but I had absolutely no appetite. I desperately hoped these feelings would not last long.

Thankfully, today has been a much better day. I slept quite well (although woke up about 8 times in the night to pee! Drinking all this water to stay hydrated is having its own side effects) and took a bath this morning. I actually put some clothes on and, shock horror, we left the flat! We just went for a short walk through some local parks, to St John's bakery to buy some hot cross buns, but it was good to get out of the house. I was totally drained after half an hour though, which is a strange feeling. I have been eating much more today too, although things do taste a little funny, metallic, and weird. I introduced Tanai to one of my favourite films, Stand By Me, and now I'm updating you all as to my progress while Tanai cooks a wholesome and restorative chicken soup for dinner.

Made it out of the house! Resting in the Garden of the Order of St John

I am keeping a symptom/side effect diary, where I am noting my symptoms, the timing of them and their severity on a scale of 0-10. I suspect I won't remember many of the details, so this will be a useful record, but also an indicator of what to expect next time, and I can share them with my oncologist in case they are useful for her. Generally, I'm getting small waves of nausea, I am extremely low on energy, feeling fatigued, colder than usual, and having small headaches periodically. But really I feel fine. I'm taking my temperature regularly and it's riding a nice line between 36.3 and 36.6, so pretty normal.

So there we go, one chemo session down, only 7 more to go! (Actually not really looking forward to that prospect, but there's a light at the end of the tunnel.) My next session is on Monday 8 May. I will keep you updated as to how I go over the intervening weeks. And thank you all so much for your overwhelming support. I've had such lovely messages, from texts, to emails, to lovely cards in the post offering practical support. It's all made me feel happy and strong, to know I have a wonderful support group all over the world sending me their energy and happy to do whatever it takes to help me get through this. Yesterday I received a lovely parcel of cotton PJs from M&S, courtesy of my mum, so I can wear fresh PJs every day. And some beautiful white orchids from Kim to liven up our home. And so many other little rays of sunshine have come our way. I will try to respond to all the messages but there are so many, please be patient with me, and know that I have received them with such gratitude and wonder. I'm truly so lucky to have such amazing people in my life.

Vacuums

Today I was back at St Bart's for some new biopsies, as my tests thus far have proved inconclusive (see previous post). My radiologist today was Dr D___, the first male doctor to treat me and definitely the most formal. So far, every single NHS employee who has met me has looked me in the eye and said 'Hello, my name is...' and used their first name. (Which, as an aside, has an incredible effect on me. I feel like a real person and not just someone on a conveyor belt. It creates a connection, however fleeting, and does wonders for your wellbeing.) This chap said 'Hello, my name is Dr D___', surname, not first name, so I knew there was no messing with him. Business rules apply.

I still had my usual cheery disposition though. For some reason, I have no idea why this happens, I put on this kind of goofy cheery persona when I'm seeing medical professionals. I almost apologise for being ill and taking up their time, and laugh at how silly this all is. I marvel at the science behind all of their medicine, asking loads of questions and being inquisitive about the details, while looking away during any procedure. Perhaps this is my nervous way of coping with it, but I'm sure it comes across as a little strange.

Today's biopsies were different from the previous ones, as these were 'vacuum biopsies'. They used a bigger needle than last time (we're talking industrial size, the length of your forearm and thicker than a fork prong) that was hooked up to a computer, which vacuumed out slices of tissue (ew, gross). I had the usual series of local anaesthetic beforehand so it was pain-free but the noises were weird. No clicking this time though. Afterwards the doctor put 2 little titanium clips inside my boob to mark where they'd taken the biopsies, just in case they need to go back in, or operate. Bionic woman!

No results today, so I'm back at home and catching up on some work. 

Here's a photo of a knackered looking me on the sofa with a bag of frozen peas pressed against my boob. Classy.

Today as we left the hospital Tanai declared that he's decided my pirate name is 'Black Boob Carmel', in honour of my incredibly bruised boob. He has a fantastic ability to make me laugh, even when things are shit. When I asked him what I should call this blog he thought about it for quite some time and then replied, in all sincerity: 'The Inevitability of Biology'. He's such a dork, but I love him, and I feel strong through this with him by my side.

Cx

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.