Cancer in the time of Coronavirus

It's been a few months, so I thought I'd post a little update. I have been re-reading over some of my past blog posts recently as I'm writing my Masters dissertation on 'Cancer and the Construction of the Self', and it's been fascinating to me seeing how I articulated my feelings during treatment. I'm so glad I kept this record, and I know that it has really helped others who are going through something similar.

I finished active treatment (again) towards the end of last year, with my final preventative breast surgery. I still have a number of appointments in the diary, a regular check-up with my ovarian oncology team; blood tests for ovarian cancer markers (both 3-monthly); visits to the menopause clinic and the Lymphedema clinic (both 6-monthly); Zometa infusions on the chemo ward (also every 6 months for a total of 3 years); and I have to regularly pick up prescriptions from the pharmacy for Tamoxifen and various other things I have on repeat prescription. 

In early March, as we could see what was happening in China and Italy, Tanai and I decided to self-isolate at home, to protect us both from the coronavirus. My immune system is still compromised post-treatment and I didn't want to take any risks. Tanai started working from home, and all my work could be done from home, so it was relatively easy to do. A week later, the government mandated a country-wide lockdown, and I was sent a letter and a text from the government requiring me to 'shield' for 12 weeks. This meant not leaving the house, and making sure no-one in my household exposed themselves to the virus, as I would be a burden on the NHS if I caught it. As we were already doing this anyway, nothing much changed. At first we struggled to get provisions, and were using up our storecupboard food (and toilet roll!). I couldn't get an online shop as all slots were taken, and our veg box became extremely unreliable with most things missing each week as they struggled with the surge of orders. For a few weeks we received a government box with essential provisions, and it was literally a lifeline to us until I managed to get on the Sainsbury's 'vulnerable list' so could get a grocery delivery once a week. We dutifully didn't leave the house, which has been quite tough, as we live in a small one-bedroomed flat with no outside area, and May was the sunniest month on record! Eventually we decided to leave the house for one hour a day, either early in the morning or late at night, for a walk or run. Luckily we live in an area which is full of offices, and very few residents, so we have felt quite safe as the streets are relatively empty. I'm hugely grateful for the fact that we have been able to properly shield, that Tanai has been able to work from home the whole time (actually the university closed so he had to work from home!) and I was able to switch the freelance work I had to remote work. 

Out for a dusk walk

NHS text

Most of my medical appointments have either been cancelled, or moved to phone appointments. I have missed one of my ovarian cancer blood tests, which will leave 6 months between tests instead of 3, but as I'm low risk they are not too worried. My local Boots closed, so we had to walk further for my prescriptions, but the Boots branches have implemented plastic shields for their staff and a limit to the number of people in the store at once, so again, I feel very safe. 

Since January, I have been working as a volunteer phone counsellor for Breast Cancer Now, supporting other women with a diagnosis on their 'Someone Like Me' phone line. I get paired up with women who have a similar situation to mine in some way, and we chat on the phone for an hour or so, with the regularity determined by their needs (some weekly, some monthly, some for just a one-off chat). I have found it very rewarding, as I love to help other people through their own cancer journey, and use my experiences for good. It's also making good use of my coaching training, as we are not there to give medical advice, just to share our experiences and help others see through the fog of their treatment and build their own resilience, finding their own resources to cope. Since Covid-19 hit, demand for the service has increased, perhaps because the NHS is so swamped, and I have had quite a few 'clients'. And of course, lots of the advice I give is no longer always valid! Their experience of going through treatment in these strange times is very different from mine. They are not allowed to take anyone with them to any of their appointments. They can't organise 'treats' for themselves on a good week such as going to a restaurant. And it must be incredibly stressful putting yourself in an immunocompromised position when there's a respiratory disease doing the rounds. There are quite a lot of changes happening. Elective surgery was paused for quite a while, and the women I'm talking to are not allowed to have immediate reconstruction during their surgery if they have a mastectomy. Understandably, many of them are very anxious, and it's nice to be able to help them in the small way I can.

I suspect I will also have to make compromises: my next Zometa is scheduled for August, and I'm reluctant to go into hospital for my infusion during this pandemic. The Zometa gives me another 2% reduction of the potential of recurrence, as well as protecting my bones from the affects of my treatment, so I have to weight that up against the risks. I am getting very worried about my bones, however, so I have decided to go into the hospital for this infusion. My bones are at risk due to the chemo drugs I have had, and the medical menopause I'm now experiencing, as well as the Tamoxifen that I am on for 3 years. Already I am experiencing a lot of bone pain, often so bad it wakes me up at night, and I really want to be able to still do the things that I love, like hiking and yoga, so I need to give my bones all the protection I can.

I am also experiencing incredible pain in my hands and arms at the moment. I am writing my dissertation for uni so I'm at the keyboard a lot, and the nerves in my hands have been damaged by the chemo. I get shooting pains in the back of my hand almost constantly, and the pain is waking me up at night.

Another long term side effect is lymphodema, which I have sporadically in my right arm, hand, leg and foot, and permanently in my abdomen and torso. This is because I've had so many of my lymph nodes removed, so my lymph fluid gets stuck and builds up. It gets worse when the weather is warm, which is a lot at the moment. My abdomen is so swollen that most of my clothes don't fit me any more! They are too loose where my boobs used to be, and too tight around my hips! So I've been selling a load of my clothes on eBay. I've actually been really enjoying it. Some of them only sell for 99p but it feels great to be getting rid of them and sending them to a new home. I have worn some lovely frocks in my time, and now it's someone else's turn. I'm also really loving my new flat figure, and experimenting with different looks. I've embraced being bra-less every day, and I've got some good ideas of the kinds of clothes I'd like to try. But as we are still mainly at home I'm rotating between the same small number of outfits for the moment!

I realise there are some niggles and moans here, but it's important that I am honest. I know I'm incredibly lucky that I've managed to get rid of cancer twice, and I have given myself the best possible chance of a long and happy life, but I do have permanent disabilities which have resulted from my treatment which are affecting me on a daily basis. I'm finding work-arounds and ways of dealing with them but that doesn't make it any less difficult on most days. 

Some of the swelling on my torso is making me a bit worried, as I have some strange swelling on the left hand side above my belly button. It could just be scar tissue, but my oncologist has referred me for an ultrasound, which I should have in the next couple of weeks, so fingers crossed that is nothing to worry about. I can't quite work out if it's always been there but my boobs were in the way when I looked down so I couldn't see it! Ha ha.

Anyway, my next blog post is going to be a guest post! Very exciting. So watch this space...

Here are some more govt and NHS messages and flyers that I have received.

Cancer survivorship course and lymphedema clinic

It's been a week since my second round of chemo and I'm doing well, despite not taking my steroids this time. As with last time, the first couple of days were fine, I felt well and had loads of energy. Then days 3-5 (Saturday to Monday) I felt pretty rubbish, the nausea kicked in and the fatigue hit me. Unfortunately, as I hadn't planned on this week being a chemo week (but my treatment was delayed) I had made quite a few plans. Lunches, coffees and dinners with friends and visitors from overseas. I soldiered on through them all, and then crashed on Sunday, exhausted. I tried to make it into work on Monday but the nausea was overwhelming, so as soon as I arrived I had to turn around again and come home. But by Tuesday morning I felt fine again and I have been doing okay since then, cycling into work, or walking home, trying to ensure my resting heart rate doesn't creep back up too much.

My hair is doing really well too. I'm loving my new hair style. A few strands of hair come out each time I wash my hair, but nowhere near as bad as the clumps that were falling out when I had chemo in 2017. I'm restricting myself to only washing my hair twice a week to minimise hair loss, so hopefully I'll get to the end of chemo with just a bit of thinning. I did keep all of my headscarves from last time I had chemo, but it's nice not to have to use them again. Although I have been wearing some of them as regular scarves, as they're so beautiful!

New earrings!

On Monday evening I started an online course on 'Cancer Survivorship' which I think is going to be interesting. It's from 7-9pm on Monday evenings and we all join each other from all over the country via Zoom, an online meeting software. It's for people of any gender, age and cancer type, and includes participants with primary and secondary cancer. It has four main components, focussing on our psychological, physiological, immunological and emotional health. It's run by a passionate, knowledgeable and enthusiastic guy called Sam and he has run this within the NHS before, and many times online. It's evidence-based, but also rooted in positive psychology and influenced by ayurvedic medicine. He cites some incredible case studies to back up his advice, and over the next few weeks we will gain lots of knowledge and techniques, which I'm looking forward to. The intro session laid the foundations, focussing a lot on positive psychology, and how we can use our minds to determine some incredible physical outcomes. I think it will be really useful, I'll keep you posted.

Joining the class

This week I also had my appointment at the lymphedema clinic, where I saw a nurse who gave me some advice about the swelling I now have around my pelvis and abdomen following the removal of my pelvic lymph nodes. She has taught me some 'MLD', or manual lymphatic drainage, which is basically where you perform massage on various parts of your body to encourage the lymph to drain and reduce swelling. She also gave me some kinesiology tape, and showed me how to stick it from my back around to my stomach, so that it massages my lymph around my body while I'm walking along. She has also ordered me some compression tights which should help, and she told me to buy some cheap spanx-type shorts to create more compression around that area. LOL. I also have to get a gel cover for my bike saddle to protect my lady parts from problems caused by my surgery. She said that you can pay to have manual lymphatic drainage done privately by experts, but that it's better to try to get someone to teach me techniques so that I can ensure I'm doing this frequently and getting maximum benefit. 

Tanai heads off to Colombia for 3 weeks on Wednesday, so I'll be home solo for a while. I've got a few little bits and bobs planned but I'm hoping to have a relaxed summer and continue to recover from my surgery and build my strength.

The end, and yet just the beginning

So today is a pretty big milestone: I had my final radiotherapy this morning, which marks the end of 'active treatment' for me. After a challenging year, I'm so pleased I've reached this day just in time for Christmas. So this is the end of the treatment the NHS give me to nuke the cancer we found in February. As far as they're concerned, there's no evidence of it remaining in my body. From now on, all the treatment I receive (and there is still a considerable amount!) is to try to stop it from coming back, rather than treating what's there.

Tomorrow I take my first Tamoxifen: the little white tablet I have to take every day for 10 years, which aims to prevent the oestrogen my body produces from latching onto and feeding any future cancer cells. I will still have Herceptin every 3 weeks until the summer, and in February I will start my monthly Zoladex injections, which shut my ovaries down (again, trying to combat that damned oestrogen!). These medications will have their own side effects, but with my hair growing back post-chemo, and my strength returning little by little, I feel confident I'll find a way to cope.

Tanai and I are planning a quiet, relaxing Christmas at home in our little flat, where we'll cook yummy food and make plans for 2018. After the year we've had, we deserve to have our fortunes change next year.

I'm sure I will be a little contemplative over the next couple of weeks, and I plan to post something here about how I'm feeling in this transitional time. While I'm coming to the end of my active treatment, I know that this is just the beginning of the rest of my life as someone with a cancer diagnosis. I will have to navigate life in a new way, live with the knowledge that my body has changed, and will continue to be affected by my medication, and to learn how to deal with the fear of recurrence. In the meantime I plan to rest lots (I'm so exhausted after the last 10 months!), practice self-care, and slowly increase my exercise and social life again. Tomorrow is the first day of the rest of my life, and it's time to carpe the crap out of the diem!

New tattoos

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

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

Commuting

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

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

Venturing out: art class

Now that I have finished chemotherapy, each day I can feel my body grow stronger and it's so wonderful to know that I won't have to take on any more poison just when I'm starting to feel human again. I feel as though I'm finally able to start healing, even though there is still more treatment to come. My surgery will be on 24 October, so I'm concentrating on trying to get as strong and well as I can before then, to give myself the best possible chance to recover from surgery quickly. But today's post is less about what's going on with my body, which is very well documented here, but more about what's been going on with my mind. While my body is healing well now, I've been emotionally quite vulnerable this last week, and it manifested itself in many ways when I went to my first art class last Wednesday. I'd like to share it with you here, as my mental health is also an important part of this journey, and as so much of this is new to me, I want to document my experience with honesty and openness.

I decided to enrol on the art class partly because I wanted something gentle and creative to do while recovering from treatment. I've spent 6 months doing very little other than work and having treatment, but I know that my energy levels won't suddenly bounce back to how they were before. I loved painting when I was at school, and I've always wanted to try it again. Plus my friend Jana has been attending this class for a couple of years, and she has been producing some wonderful work, so in a way it was a 'tried and tested' class. So I went along last Wednesday, excited to be doing something new and wondering what I would learn. The class is made up of about 8 people (although I think more will join us in week 2), many of whom have been attending this particular class for many years. Some of them have even sold paintings! The teacher is an artist herself and for week 1 she led us in a collage exercise so that we could create compositions that we will eventually paint. I had never done anything like this before, and I found it quite interesting, as ideas generation has always been the area where I fall down. I think this is why I have so often copied paintings in the past, but of course original work is what we should be striving for. 

I think I had failed to appreciate the significance of this class in so many ways relating to my cancer. This was the first time I had done something new, and met new people, since my diagnosis back in February. Before diagnosis I would not have thought twice about putting myself in a situation where I was meeting new people. I am generally quite confident in social situations and love meeting new people, but on Wednesday I felt vulnerable and unsure of myself, and I leaned on my friend Jana who was also in the class, almost clinging closely to her. I'm sure they are a lovely bunch of people, but I felt awkward and self-conscious about how I came across. The cognitive impairment brought about by diagnosis (sometimes called 'chemo brain') is very real, and I still struggle to be as fast and articulate as I used to be. So when the teacher asked me conversationally what artists I liked, my mind went blank and I could not think of any! I madly searched the recesses of my mind but struggled to know how to answer. I then felt so self-conscious about sounding stupid and disinterested (I'm in an art class for goodness' sake! And I can't name any artists I like!) which made the whole thing even worse. 

The other challenge I faced was whether or not to actually tell them I have cancer. While I've been open and candid with the people in my life over the last few months, these were people I was meeting for the first time, with whom I was going to develop a relationship over the next 11 weeks. I was reluctant to be 'the cancer girl' -- I'm very conscious of not wanting to be defined by this. Therefore I decided not to tell them, and simply present myself on face value. But then of course my challenge was that 'face value' is a very depleted, fatigued girl. By 9.30pm I was exhausted, and running out of steam. I almost started to shut down! But I'm much younger than most of the people in the class, so how do I explain that it's way past my usual bedtime and I have very limited energy these days due to treatment? To compound this, that day was the first day I ventured out of the house without a headscarf on. In retrospect I feel that it was way too early (I've worn the scarves ever since). Although I'm excited about finally growing some new hair, it really is still very short, and I garnered many more stares than I ever have with the scarves. So I suppose they also had no explanation for my appearance either.

Perhaps I'm making too much of it, but all I know is that the evening had a significant impact on me emotionally. I got home and cried and cried. So many thoughts were swimming around in my head. I will have to re-learn how to socialise. I have to learn how to navigate meeting new people and whether (or how) I reveal my diagnosis. I physically can't do what I used to be able to do. I have to learn how to 'be me' when I have changed significantly. I'm sure that over time it will get easier but it was quite an unexpected shock to be feeling these feelings from something as unassuming as an art class. I also then grappled with whether or not to return to the class, as I am worried that if I don't, I may never re-learn how to navigate the world, and that, a bit like falling off a horse, I really ought to see it through. 

I suppose the main lesson is that which I've been conscious of all along. My mental health is just as important as my physical health, and I need to practice just as much self-care in nurturing my emotional resilience as I do resting and looking after my body. I will grow stronger both physically and mentally over the coming weeks and months, and I will need to also make adjustments in my life, both physically and mentally. Once again, I need to ensure I'm not too hard on myself, and I give myself time to find my 'new normal'. So I shall go back to class this week, and try to be as strong as possible, and it will get easier each week. And who knows, I may even paint something awesome!

My new baby fluffy hair

A biomorphic collage

Stitching your parachute

My wonderful friend Dom accompanied me to my fourth round of chemo last month and while we were having a 5-hour natter about various things (we're both very good at talking!) he reminded me of the concept of 'stitching your parachute before you need it'. He couldn't remember if it was my advice in the first place or our mutual friend Caitlin's, but either way, it rang a bell for me and it's something I've been very aware of as I've researched the concept of resilience in light of my diagnosis. I suppose in very simple terms it refers to taking time to do the work of building your own personal and emotional resilience before you hit a crisis point. If you stitch up any holes in your parachute when you're happy and resting on the ground, it's ready for whenever you need it. If you leave it until you're in the tumbling aeroplane, it's too late, and it won't be adequate to save you.

As part of my own work looking after my mental health over the last few months, I've been pleased to discover that I'm already quite good at regularly stitching my parachute, and although I may not have had the vocabulary to describe it, self-care has always been something I've practiced. Whether it's something as simple as taking a Sunday evening bath, dropping some essential oils into the water and popping the Wittertainment podcast playing on my phone while I soak, or something as concerted as signing up to the Headspace app and resolving to practice 20 minutes of mindfulness each day, I've always taken time out for myself. I find walking incredibly restorative for my mental health, and would often walk the hour to and from work, pacing briskly and listening to a podcast or audio book, enjoying the changing seasons over the weeks. Cooking is another way I wind down and I usually cook my meals from scratch, enjoying the time it takes to prepare food, the creativity involved and the delicious rewards at the end. I often take myself round museums and galleries on my own, and enjoy 'me time' amongst the art or stories from other times and peoples. All these things are little ways over the years I've practiced self-care, taken some time for myself and shored up my mental health reserves.

Being resilient is not about being hard and impervious to the knocks and stresses life places upon you. It's about being flexible and able to cope in the face of adversity, to draw on internal strengths and those of the networks you've built around you. It means that when you suffer stress or trauma, you have the ability to adapt, to bend and stretch in the face of it, and to somewhat 'bounce back'. Importantly, however, it's not about being hard or unfeeling, or trying not to be affected by life's events; it's more about allowing the stress or trauma to take you in an unexpected new direction and allowing yourself to go with it, and not try to force your life, or yourself, to be a certain way.

With wonderful serendipity, just after my diagnosis my employer teamed up with the mental health charity, Mind, and decided to roll out some Emotional Resilience training for all staff in the organisation. We had an interesting presentation and were given time to think about what was in our 'resilience toolbox'. We discussed the pillars of resilience, and how we can cultivate emotional resilience in our lives and more effectively manage stress. There were some really useful tips in the presentation and it definitely made me think about this whole thing in a different way. Interestingly, it advocated writing as a way to step back from negative thoughts and get some distance. The presentation summarised the five ways to wellbeing thus:

Give: your time, your words, your presence
Keep learning: embrace new experiences, see opportunities, surprise yourself
Be active: do what you can, enjoy what you do, move your mood
Connect: talk and listen, be there, feel connected
Take notice: remember the simple things that give you joy

I think these are all small things that can contribute to positive mental health, and a stock of resilience for when life gets touch. They are great ways of stitching up one's parachute in preparation.

Another thing I've started to read about is post-traumatic growth, and positive psychology. These are theories about things you can put in place to ensure you grow from adversity, rather than being beaten down by it and suffering post-traumatic stress disorder. The theories acknowledge that post-traumatic stress is inevitable, following something as traumatic as a cancer diagnosis, but that there are measures we can put in place to deal with this stress, to go with it, and to emerge at the end with increased strength, wellbeing, and a practical pathway to positive change. It all sounds rather pop-psych but I do think there's some truth in it all, and I'm interested in reading more. One book I read summarised five dimensions of post-traumatic growth:

Recognise and use personal strengths
Nurture closer relationships
Enjoy a greater appreciation of life
Search out and embrace new possibilities
Deepen spiritual development

Again, all great advice, which according to Aristotle, can lead to a form of happiness called Eudaimonic wellbeing, which is particularly flourishing and fulfilled. Well, we'll see about that, at this stage I'm just grateful to be engaging in these thoughts, to continue to function at work and at home, and to cultivate hope and optimism while I'm going through this. With chemo side-effects robbing me of many of my usual forms of self-care (no energy to walk, changed tastebuds affecting my enjoyment of food, lack of sleep etc) it's taking most of my strength just to get through each day. I'll save the real rebuilding work until I'm done with active treatment.

A running theme through a lot of the things I've been reading around this topic is the importance of building strong networks around you. I've always had a huge capacity for friendship and have cultivated relationships with people all over the world throughout the years. This is undoubtedly a huge source of strength for me at the moment, as I receive messages, gifts, thoughtful cards and offers of assistance from many of you, my global team of cheerleaders as I navigate this particularly tricky time. Even when I have a wobble, you've got my back, so thanks everyone. You're the best tool in my resilience toolkit. (Naw!)