Cancerversary and the long road to recovery

Thursday 27 February was exactly one year since I received my diagnosis, otherwise known as my 'Cancerversary'. I wasn't planning on marking it in any way, as it's only a few days after my birthday and I had enjoyed a lovely weekend of birthday celebrations, but Tanai and I braved the cold and had dinner in a Peruvian restaurant, toasting ourselves with pisco sours for getting through this last tough year.

So now that I've seen off the cancer, my life has become primarily about making sure it doesn't return. The Tamoxifen and Zoladex (which I explained more here) have properly kicked in, and I'm currently experiencing the full force of menopausal symptoms. I have a couple of hot flushes every hour during the day, and several times at night, which is waking me up 3-4 times every night. I'm struggling a little with how this is affecting my sleep, so I'm trying to do as much as I can to reduce the impact they have on me. (I've also decided that 'hot flushes' is a ridiculous name for them. More like 'power surges' -- honestly they are so full on!) I'm doing a 4-week self-guided CBT course to try to reduce their impact and frequency, and I've even bought a 'lady magnet', a small magnet that you wear attached to your undies which, in some women, reduces the severity of hot flushes (I told you I'd try anything!). At the Bart's menopause clinic they have prescribed me with some anti-hypertension drugs which reduce hot flushes as a side effect. But I'm just going to wait a few weeks before taking them, preferring first to see if I can do something more natural. They are absolutely horrid though, and I can see how they are quite debilitating, especially in a work situation. It's so difficult to describe them but it's almost as if your bodily temperature gauge is broken, and your temperature oscillates between freezing and boiling all through the day and night. Because my sleep is being so interrupted, I'm having to try to ensure I have many hours in bed each night, in order that I can get as much sleep as possible just to feel rested.

I also received a phone call from my GP practice, saying that they knew I'd come to the end of my active treatment, and that they were now responsible for my care, so did I want to come in and have a chat? Quite astonishing, how pro-active they are! So I went to see my GP (who is lovely) and she helped me out with a few things. She's referred me for a DEXA scan (a bone density scan) so I can see how my bones are faring, and she's referred me for some counselling, to help me make sure my mental health is holding up after a challenging year. I feel as though I've done really well so far,  but I'm finding it hard to deal with the affects of the drugs on my body, the sleepless nights, and the lingering fatigue. Everyone thinks I'm 'done with cancer' and well again, but I'm still going through a lot, and trying really hard to maintain my strength and positivity. It's starting to take its toll, so I figured a few sessions with a professional wouldn't go amiss. I'm also probably putting a little too much pressure on myself to quickly get back to some kind of 'normality', when I should instead be gentle with myself and allow a long and effective convalescence. It's just so hard when I feel I've pressed the 'pause' button on life for so long already, and I'm itching to get back into the swing of things.

The GP also recommended some retail therapy. No, really! I was talking about how I was trying to lose my treatment weight but it was taking its sweet time (2.5kg down, 7.5kg to go!) and she said 'why don't you go out and buy some new clothes, so you feel good about yourself'. I took her literally and bought a cute little pinafore dress.

We have just come back from our first holiday post-treatment, a week in Nice in the South of France. It was a perfect way to relax after this last year, and we really enjoyed the early Spring sunshine on our skin as we explored the Riviera. We bought a book called 'Walk and Eat near Nice' and we did a few of the walks in it, taking a bus to quaint nearby villages and walking through the mountains back towards Nice, admiring the spectacular views of the coast and exploring ancient forts and medieval towns. We also ate some fabulous food and I caught up on sleep. Heavenly!

 

I also thought I'd give you an update on my chemo blanket project. Some of you may remember that I decided to teach myself how to crochet at the beginning of my chemotherapy. This was because I wanted to do something to pass the time while recovering from each round of chemo, that wasn't too taxing on the brain. I bought a copy of 'The Happy Hooker' and taught myself some different techniques. I started with some simple granny squares and graduated to some more complicated ones, with multiple colours. Then I eventually stitched them all together. It's only a small blanket which I've draped over the back of the sofa, but I'm really proud of it, and can see my progression in it. I'm now moving onto another project for a friend, so watch this space!

Finding my new normal

Hi folks. I thought I'd give you a little update as to how I'm getting along now that active treatment has finished. It's been over a month now since I had my final radiotherapy session, and 2018 has started well. I'm feeling stronger and healthier every day, my hair is growing and I'm adjusting to life post-cancer treatment. Of course, treatment isn't exactly over, but what I'm doing now is trying to prevent the cancer from returning, as there's no evidence of any left in my body.

My hair is growing nicely and I've started getting it cut in a unisex hair salon called Barber Streisand, to avoid the extortionate 'women's' haircut prices. My main aim is just to let it grow and try to keep it tame-ish while it does. It's darker than my old hair and has a definite kink in it, but we'll see what happens as it grows out. My eyebrows and eyelashes are also growing back, although very slowly, and I put mascara on for the first time in months the other day! It's the little things...

I've put on 10kg of weight since I started treatment in April 2017 (that's about a stone and a half in old money). It's gone on evenly all over my body, so while lots of people are graciously saying 'you can't tell', I'm currently unable to fit into most of my clothes and it's starting to really bug me. I'm doing as much exercise as my body will allow me to, and I'm eating very healthily, but it's proving difficult to shift. So far this year (3 weeks in) I've lost only 1kg, so still 9kg to go! Urgh.

On Friday I saw my oncologist again. My appointments with the oncology team are now getting less frequent. While during chemo I saw them every 3 weeks, now I see them every 3 months, and soon that will change to every 6 months, and finally only once a year. They're phasing me out! We had a great chat and she's given me the green light to start swimming again, so hopefully that will help me with shifting my chemo weight. Although chemo has finished, I'm still having Herceptin injections every three weeks (this is the monoclonal antibody I started having in June and explained about here) so I need to have heart scans every 3 months to check that it's not adversely affecting my heart. Last week's heart test results show that my heart is actually improving, which is great news! (Not that surprising as I've finished chemo and exercising much more these days.)

I've also started taking Tamoxifen, a white tablet that I have to take every morning for the next 10 years. And in 2 weeks I will start having Zoladex injections once a month. These are both hormone therapies. My cancer was fed by oestrogen, so the injections will shut down my ovaries to prevent them from producing oestrogen, and the Tamoxifen works by preventing any oestrogen from latching onto and feeding potential cancer cells. These drugs will send me immediately into an early menopause, and I'll keep having the Zoladex until my oncologist is happy that my body is post-menopausal naturally (so potentially until I'm 50 or so!). A medically-induced menopause is usually more severe than a natural one, which takes place gradually over many years, so I've been referred to the Bart's menopause clinic, where I will learn some techniques for dealing with the side effects. One of the main side effects is that my bone density will reduce, leaving me at greater risk of fractures and osteoporosis. To combat this I will start having bisphosphonate infusions (Zometa) every 6 months for 5 years, which slow down the rate of bone thinning, and also help prevent the cancer from returning. The other recommendation is that I do lots of 'weight-bearing' exercise, so I am making sure I get in at least 10,000 steps a day (walking is good weight-bearing exercise) and I have a stretchy band that I use to do a series of exercises every day with my arms to keep my bones healthy in my upper body. Although I love cycling and swimming, neither of these are weight-bearing so I need to make sure I mix it up.

My scars are both healing nicely and I have regained full movement in my right arm. I do have stiffness still, so I'm continuing with the physio exercises until that goes away, but I'm really pleased with how that's going. I also have some numbness in my armpit and just below my shoulder on the outer side of my arm, and unfortunately that's permanent nerve damage. It's a bit strange but I'm sure I'll get used to it. Weirdly, I've stopped sweating in my underarm completely, and the other women in my support groups tell me this is common. Bonus!

My breast looks pretty much the same as before, and the scar is almost imperceptible. When I self-examine, however, there is a big lumpy patch right where I found the original lump, and this is scar tissue. I will have to get used to how my breasts feel again and continue to self-examine regularly (as should you!).

My fingernails and toenails didn't quite survive after chemo. I lost a few of my toenails completely, and my fingernails started to crack and peel about half way down each nail. I'm now keeping them extremely short until the new nails grow, which is kind of annoying (I don't think I realised how much I used my fingernails for everyday things before!). I'm still getting quite bad bone pain semi-regularly, but this is a side effect of Herceptin, which I will finish in June this year.

I also found out that I am ineligible for the Add-Aspirin trial which I thought I would be on, so that won't be going ahead. I am, however, still part of the 100,000 Genome project, and I've been asked to take part in a focus group at St Bart's in February, to help them improve care for younger women diagnosed with breast cancer.

There's a lot of crap on the internet about cancer prevention (turmeric, anyone?) and in actual fact there's only one 'natural remedy' that studies prove genuinely reduces the chances of the cancer coming back, and that's exercise. So now that I have a little more strength and energy, I'm slowly reintroducing exercise back into my daily routine. I want my convalescence to be slow and effective, not rushed and ineffective, so I'm trying to be gentle with myself and not push myself too hard. But I've got a FitBit and I'm getting a little obsessed with the metrics. Firstly there's the step counter, and I'm aiming for a minimum of 10,000 steps a day. I've aced it almost every day so far this year, with my best day being 29,665 steps, and my worst day only showing 8,335 because I cycled everywhere that day. My average is around 15,000. Then there's the 'active minutes' metric, ie how many minutes per day that you're doing activity that gets your heart rate up. I'm averaging 100 minutes a day this year, which I think is pretty good going. I also want to avoid reverting back to Past Carmel's ridiculously packed social schedule, as I've realised the benefits of downtime and relaxation. So I'm not over-committing, and I'm being selective about what social activities I say yes to. Tanai bought me a place on a meditation course as a Christmas present, and I went last weekend. I've never done non-guided meditation before and it was quite amazing. I'm now meditating solo every day, 20 minutes in the morning and 20 minutes in the early evening. It's possibly too soon to ascertain the benefits but I definitely feel calmer and less irritable. And of course I'm still doing yoga with the magnificent Adriene. I don't quite feel strong enough to go out to a full yoga class yet, but I've found a class in Islington which is a short walk away from our flat, which is specifically for people who have had cancer, so I'm going to try that as soon as I feel up to it.

So there we are, I'm now project managing my recovery! I'll post here whenever anything significant occurs, but not with as much regularity as before. I may also include some musings and ponderings about my mental health, cancer in general, and what I've learned from this experience. But I'm keen to try to get away from the dominance cancer has had over my life for the last year, and have other things to think and talk about. Look forward to talking with you online and IRL about that other stuff.

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!

Radiotherapy begins

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

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

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

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

Delicious cake!

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

Brunch with the Italians

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

New tattoos

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

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

Commuting

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

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

Surgery results, Carmel 1: Cancer 0.

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

 

Sticking two fingers up at cancer!

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

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

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

My daily exercises

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

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