Scanxiety

Throughout my treatment last year, many women in my support groups would talk about ‘scanxiety’, which is the period between having scans (or being referred for scans) and being told the outcome, whether it’s good or bad. During this window of the unknown, your mind can wander down all the possible pathways, and in many ways the ‘not knowing’ is worse than bad news. I definitely felt this to some extent in the first five weeks after my initial diagnosis, before I found out my full prognosis and had a treatment plan. But generally, I’ve not experienced this over the past 18 months of my treatment. Instead, I would go for my scan, and await the outcome, knowing full well that I could not influence it with any amount of worry so why worry until you get the results, right?

Well this last couple of weeks I’ve come to know the true feeling of scanxiety and it’s not much fun. Basically, I went to my GP to talk about this hip pain I’ve been experiencing lately. I’ve always had problems with my hip and back, and I just thought that it’s being exacerbated by the fact that I’ve increased the amount of exercise I’ve been doing lately, to shift my chemo weight. But I’ve been experiencing acute pain in my right hip, and it’s been getting worse. I asked her to refer me to a physio, which she did, but at the same time she referred me for an X-Ray, just to check there wasn’t anything structurally wrong with my hip. A few days later she called me, and said that my bones look fine, but they spotted a ‘subtle lucency’ (shadow) on my X-Ray behind the bone which concerns them, so they need me to have some more scans so we can find out what it is. So this Monday I had a full body bone scan, and on Friday I will have an MRI. Right now I don’t know what the outcomes of these scans will be, but because I have spent the last 18 months reading and researching about cancer, and hanging out in online support groups with all kinds of women at various stages of the disease, I have a pretty good idea of what the different possibilities are. And instead of keeping my cool, awaiting the outcomes, my mind is wandering down the various paths in a way that is keeping me awake at night.

I want to be open and honest about how hard this period is for me, and not sugar coat it. I know that I’m looking much healthier than I did when I was going through chemo – I’m gaining hair and losing weight, my skin is much better, my nails have grown back and I have much more energy. But right now is the hardest time in many ways, because I’m coming to terms with what this whole experience means for the rest of my life. No, I haven’t ‘kicked cancer’s arse’, it is living with me, and will live with me forever. I have to re-learn how to be in the world and navigate everything that comes with it. I am trying to be positive and optimistic, but in reality I have to live with the sword of Damocles over my head. At any time the cancer could return. And I have no watertight way of preventing it from doing so. My challenge is to embrace my chance to live, without having any level of certainty about my long-term health. And this is hard. Exhausting, actually. But what’s even more exhausting is navigating the expectations of others that I should ‘move on’, and ‘put the cancer behind me’. As if it’s that easy, surely I can just forget about it and get on with my life. But this is my life, I can never go back to the person I was before my diagnosis, and I want to give myself the space and the permission to feel the emotions I’m feeling. I don’t want to have to cover up my pain and frustration just to make other people feel better.

Over the last few days I have had thoughts about my own death which I have not had at all for the last 18 months. Stupid things, like waking up at 4am and mentally writing a practical checklist of the things I need to send Tanai, like my Australian superannuation details and my social media passwords. Being choosy about what books I pick up because I probably won’t have enough time to read all the books on my ‘to read’ list. Composing speeches to my co-workers. Feeling bad for leaving Tanai before we have the chance to grow old together. Looking at old people in the street or on the tube and thinking how fucking unfair it is that some people get to grow old and other people don’t. I remember the moment a few years ago when I realised I was becoming a proper adult, when I made a significant purchase (I can’t remember what it was, a sofa or a suitcase or something) and I though ‘I wonder if that’s the last one of those I’ll ever buy’. Well now I’m thinking that about vitamins. Is this the last packet of cod liver oil tablets I’ll ever buy, because I’ll run out of time before they run out? And I don’t want to be thinking these thoughts, they’re just coming into my head, unbidden, and taking over. I thought that maybe by writing this down I would feel a little better, like I’d shared my problem, and relinquished some of the burden. And I do, a little, I think. Thank you.

So there you have it, no resolve, just scanxiety. I’ll fill you in when I have my results.

Studies and courses

Here's another update from me, to let you know how I've been getting on. I'm doing well, generally, and continuing my road to recovery. I'm feeling stronger every day, and have more energy too. My hair is growing back, which is great, although it has a distinct wave to it (it was completely straight before) and it's much darker than my old hair, but I'm taking that in my stride (I've always wanted curly hair!).

A few weeks ago I took part in a study at a London university which was examining cognitive function and psychological health in women with a breast cancer diagnosis. I spent 3 hours in a room in the basement answering questions and attempting difficult tasks on a computer while wearing an EEG cap to measure the activity in my brain. It was quite fascinating and I'm dying to know what they found over the course of the study. They were researching 60 women with a diagnosis and a control group of other women of a similar age and education level. Although I feel as though my cognitive abilities are definitely coming back (no more 'chemo brain'!) I'm still finding that I get frustrated with myself more easily when I get things wrong, or struggle to find my words. I suspect that is what they found when they analysed my brain. When I got things wrong that I felt I ought to have got right, I became so frustrated with myself that it affected my ability to get the next few things right too. I definitely came away feeling as though I should be a little less harsh on myself.

Wearing my EEG cap like a muppet

I've also been doing a 7-week course at the new Maggie's Centre in the grounds of St Bart's hospital, called 'Where Now?'. Designed for people who have finished their active treatment for cancer, it's perfect timing for me to be getting help and advice on getting back into the swing of things and coping with the after effects of treatment. There are 12 of us in the group, of mixed ages and cancer types (I'm the youngest) and we meet every Wednesday from 12-3pm. We start in the hospital gym and do an hour's worth of circuit training, with the wonderful physio, Claus, ensuring that our activity is tailored to our abilities. Then we have an hour's talk on a different topic each week (the first week was nutrition, the second exercise, and coming up are stress management and other useful topics) and then we have lunch together. So far I'm finding it really useful, and the Maggie's building is such a calm, beautiful haven. Anyone can go in there at any time, make a cup of tea, and talk to some of the specialist staff there. 

Inside Maggie's

I'm doing plenty of exercise and making sure I do lots of active minutes each day. Regular exercise which increases the heart rate significantly (160 minutes a week) has been proven to reduce the changes of the cancer coming back by 40%. This is significant enough for me to be fully prioritising working out! Over treatment I put on 10kg (a stone and a half in old money) and I've already lost a third of this already. It's slow going but I'm making sure I'm still feeding my body plenty of nutrients to aid its recovery. I'm eating lots of leafy veg and eating oily fish to help my bones. I've bought a 'Nutri Ninja' and I've been making delicious smoothies, including many green ones. Getting all my vitamins and minerals!

A beetroot smoothie

I've also had continuing appointments, so although I'm done with active treatment, I'm still a regular at St Bart's. I have a few Herceptin injections left and I'm on the Zoladex indefinitely. I try to ensure as many of my appointments are on a Wednesday as possible, and I keep my fingers crossed that the clinics are all running to time. Sometimes I have to wait hours for my medicines to arrive from the pharmacy. I kind of didn't mind the wait when I was having chemo, but now I'm only getting injections I'm keen to be in and out as quickly as possible. Everyone's so lovely there, though, and most of the nurses know me by now, so there is quite a jovial atmosphere and I'm always happy to see familiar faces. Over the last couple of weeks I've also had my regular echocardiogram test, to ensure my heart is still working well despite the Herceptin; a DEXA bone scan to see how my bone density is now that I'm being forced into the menopause; my regular oncology appointment; and I've also had to go to the dentist to get some work done (it never rains but it pours!). I've also had a follow-up with my GP too, it's one thing after another! But I feel as though I'm in safe hands, and it's nice to be easing myself out of treatment rather than disappearing suddenly. My GP has referred me to a sleep clinic as I'm struggling with my sleep at the moment, and this is affecting my daily life. I'm not having any problems falling asleep at the beginning of the night, but I'm waking up 4-5 times each night and I'm struggling to get back to sleep. Hopefully they will be able to help a bit.

NHS chic

During treatment I couldn't go swimming because my neutrophils were low and I was at high risk of sepsis, but now my immune system is doing much better I've started to go swimming in the mornings again. I go to a lovely pool in Kentish Town, near where I work. It's a Grade II listed building and was a public baths back in the Victorian era. Built in 1898 it was where working class people (who didn't have washing facilities at home) used to come and do their laundry, and wash themselves. Now it's been completely restored and I enjoy a tranquil swim under the sunlight-filled roof before work.

One of the other risks my surgery brought about was that of lymphoedema, which is a permanent swelling of the arm and hand on your surgery side. Basically our bodies have a lymphatic system which is constantly moving lymphatic fluid around all the  time, and as I had some lymph nodes removed from under my right armpit during surgery, my lymphatic system is now compromised, so the risk of localised fluid retention and tissue swelling in my right arm has increased. I only had 2 nodes removed, in order for them to check whether or not the cancer had spread, and as they were fine, I didn't have any more removed (some people have them all removed, putting them at a much higher risk), so I didn't think it was likely. I have been diligently doing the exercises given to me post-surgery in order to keep my lymph system going as well as possible. However, last weekend was a very hot weekend by the UK's standards (highs of 29 degrees!) and unfortunately on Sunday my right hand started to swell.

Fat right hand

The swelling remained for a few days so I called my Breast Care Nurse (everyone has a dedicated nurse they can call at any time) and she advised me to pop into the clinic to see her. She measured the circumference of my arm and hand at various points between my knuckle and my upper arm, and at all the points, my right arm was a centimetre wider! But they're still not 100% sure it's lymphoedema, so she's referred me to the specialist clinic. She's also ordered me a compression sleeve and glove for my right arm and hand, which I should wear to encourage the circulation of my lymph fluid. Strangely I'm finding this quite upsetting, even though I suppose in the grand scheme of things it's nothing! But I can see it all the time and it's a constant reminder of the changes my body has been going through. Fingers crossed it's just the heat and it will go down a bit when the weather cools.

[A few days later]
The hand swelling has gone down quite a lot! It's not quite the same as the left hand but it's no longer quite so fat and sore. Hurrah!

I'd better sign off for now, as this is getting very long. Will do another update soon.

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.