Posts Tagged ‘Breast Cancer Care’

http://www.breastcancercare.org.uk/news/blog/my-christmas-wishes

As I write this post, the festive season is upon us. Admittedly I’m not that keen on Christmas. I’ve always felt more ‘Bah! Humbug!’ than ‘Ho, ho, ho’ about Yuletide. All that forced jollity makes me turn all Ebenezer. But, ’tis the season to be jolly, so in an attempt to rekindle the joy and excitement of Christmas past, I’ve decided to write to Santa Claus and see if he can make some of my festive dreams come true.

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Dear Santa…

It’s been a few years since I last wrote to you and, although I’m not one to hold a grudge, you never did give me that pony. OK, maybe I was asking for a bit much, but what about the Barbie house and the Cabbage Patch Kid? I know you’re busy, but you’ve got some serious making up to do.

Here is my wish list in no particular order.

1) I’d like my old body back please. I was more than happy with the old one. Perhaps my boobs were a little wonky but they were a damn sight prettier than what’s there now. I realise this is a tall order, but can you please erase the scars and the general wonkiness this disease has inflicted on my body. I’m not asking for much, just a little symmetry.

2) While we’re on the subject of boobs – can I have a new nipple please? The one that was started earlier this year never got finished. I am still ‘blind’ on one side. Yes I’ve got secondary cancer, but I’d still like to look normal. I don’t think this is too much to ask. By the way, I’m curious to know what happens to all the old nipples? Is there a nipple heaven? This is a question that fascinates me and my nipple-less friends.

3) Oh, and I’d like some tattoos. You know the kind of thing – something pretty, floral and feminine that might also disguise some of the scars. I reckon if you find a clever tattoo artist they might even be able to make me look symmetrical.

4) I’d also like some padding (like a ‘foob’ or prosthesis but bigger) for my right buttock. Perhaps I should elaborate. My right buttock came to the rescue in my hour of need (tissue from my bottom was used to create my reconstructed breast) and is now quite literally staring me in the face. I’m very grateful to my derriere for helping me out, but it’s left me slightly lopsided. This can make life quite uncomfortable. Have you tried riding your sleigh with one butt-cheek?

5) Can I have some more hair please – but only on my head? Anything below the nose is surplus to requirement. You know what I’m talking about, Santa. Those pesky chin hairs and the pubic triangle, which for some reason always grows back quicker than anything else. Isn’t there a button you can press to make the head-hair grow faster? It’s winter, my head is cold and I’m fed up with people thinking my crew cut is a ‘lifestyle’ choice. And no, a wig won’t suffice. I want real hair, the kind that clogs up the bath. I want to swish again!

6) This is a big ask, but can you please transport me back to my old life for just one weekend? I’d like to remember what it’s like to wake in the morning without the cloud of cancer slapping me in the face. I promise I won’t take anything for granted ever again. Please.

7) Can you ask one of your elves to create a dating website for people with life-limiting illnesses? Secondary cancer isn’t exactly what you’d call a big selling point. We single folks need some help with marketing ourselves. Friends tell me that the dating world is full of commitment-phobic men, so perhaps we’re at an advantage? Here’s my profile header to get you started: ‘Breast cancer patient seeks understanding man with dark sense of humour for short-term commitment. Must like scars.’

8) I want to grow old and wrinkly. No, really I do. Before my cancer diagnosis I used to slather my face in Boots ‘Protect and Perfect’ anti-ageing serum. Nowadays my benefits payments don’t stretch to wrinkle cream, and even if they did I wouldn’t waste the money. Wrinkles are now very low down my list of priorities. Everyone else is obsessed with staying young, but I want to grow old. I’ll never be a grandparent, or even a parent, but I’ll gladly settle for being a dotty old aunt.

9) Can you please give me and all the other women living with this horrific disease a little more time? I’m sure most of us would settle for chronic disease status, until they find the elusive cure. I’d happily trade all of the above if you can give us all a little more time. Actually, make that a lot more time.

10) They keep saying we’re going to ‘beat cancer sooner’. This is a bit too vague for me and everyone else living with cancer. Sooner can’t come soon enough. I’d be really grateful if you can ask ‘them’ to be more specific and perhaps bring sooner forward. I’ve got a life to plan, and I’d like to put some dates in the diary.

I realise I’ve already given you a big list and I know it can be difficult shopping for other people. If you’re still looking for inspiration though, I’d also like a new dressing gown, some Liz Earle No. 15 perfume, a Vitamix, some Diptyque candles and some new slippers.

It’s not long till Christmas, Santa. You’d better get to it!

Katherine

PS Merry Christmas

You can read more from Katherine on her own blog killerkath.wordpress.com and also on Twitter @killerkath

Vita bloggers’ views are their own and do not necessarily represent those of Breast Cancer Care or Vita magazine.

 

Here’s my latest Vita Blog Post: http://www.breastcancercare.org.uk/news/blog/i-m-living-cancer-not-fighting-war

As a cancer patient and blogger, words are something I obsess about. A couple of weeks ago, in the midst of last-minute holiday preparations, I got a call asking if I’d be interested in going on BBC Breakfast to give a patient’s perspective on the language used around cancer. Never mind that I hate public speaking and had less than 24 hours to prepare, this is a subject that really interests me, so I accepted the challenge.

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The discussion got off to a bad start when I was mistakenly introduced as someone with ‘terminal’ cancer. This was a simple misunderstanding. However, it highlights the importance of using appropriate language with cancer patients. The word terminal only applies when patients have run out of treatment options and are reaching the end of life. I have secondary, not terminal, disease.

The discussion I took part in refers to recently published research which highlights that the use of military metaphors (like bravery, fighting and battling) can be damaging to patients with terminal cancer. Although research in this area is long overdue, the findings won’t come as a surprise to those living with the disease.

Mind your language

I first became aware of the peculiar language around cancer after my primary breast cancer diagnosis in 2012. My curiosity was tweaked by the well-intentioned messages of support I received from friends and family.

Suddenly everyone had an opinion on how I should tackle the disease. I should eat less cheese; eat more broccoli; juice 13 times a day; eliminate stress; restore my pH balance; and deal with those unresolved emotional issues, undoubtedly (I was told) the root of my disease. But more than anything I should fight, I should battle and wage war on those renegade cells intent on killing me.

The message was clear: I had a battle ahead, but if I adopted the right attitude, my bravery and courage (and let’s not forget positive thinking, the most powerful weapon of all) would be rewarded with the ultimate victory, survival.

To begin with I played by the rules. When my target was a tangible one, I found the language of battle empowering. As I quaffed my daily juice I imagined the cancer cells running for cover: ‘Quick run, she’s drafted in the broccoli!’ I pounded the pavements and began a daily yoga practice. Every stride and stretch brought me another step closer to victory.

I developed an inner warrior, as suggested by one of the numerous ‘beat cancer’ books I read. Mine was Ellen Ripley, the shaven-headed heroine from the Alien films. I envisaged her blasting the cancer cells into submission. I thought I’d found the perfect ally until my brother pointed out that the aliens in the film have a tendency to erupt from victim’s chests. This parallel was a little too close for comfort.

I ditched the inner warrior and as someone now facing a lifelong ‘battle’, the language of war no longer sits comfortably with me.

Bravery

When you’re a cancer patient, you get used to people commending you on your bravery and courage. But I’ve always felt awkward about wearing these badges of honour.

Bravery implies strength and fearlessness, but labelling people in this way puts added pressure on them to be good and uncomplaining patients. In the ‘battlefield’ of cancer, fear, anger and depression (normal reactions to a cancer diagnosis) are viewed as weak and negative traits, perhaps even cowardly. You’ve got to ‘be strong’ and you ‘have to fight this’.

Fighting

I consider myself both strong and resilient, but when you’re living from scan to scan you realise that mental strength has no effect on the result. It can be quite demoralising continually being told you can fight this, when actually the weapons are in the hands of the doctors treating you and the researchers working on the next generation of cancer drugs.

This might sound like I’ve resigned myself to fate, but I take a very active role in my treatment. I look after myself physically and mentally and I’m always aiming towards a cancer-free future. However, cancer is an unpredictable and pernicious disease. It takes more than attitude to fight it.

Losing the battle

Like many before me, I believed that my fighting spirit and positive attitude played a part in me beating the disease. But my cancer returned, not once but twice. I now face a battle which will never end. Is it my fault that the cancer came back? If I lose the battle is it because I didn’t try hard enough?

The implication of guilt and failure is a common sentiment among those living with secondary and terminal disease. As if it’s not bad enough living with a life-limiting illness, we live under the shadow that we may have failed in some way.

Perhaps if I hadn’t eaten that cheese sandwich; if I’d juiced 13 times a day; if I felt more ‘blessed’ (cancer is a lesson, don’t you know?) and less stressed about having this horrific disease then it might not have come back. Perhaps I should have tried harder. I’ll never know, but these are sticks I and other cancer patients beat themselves with.

A fighting spirit gives rise to hope and optimism and there’s definitely a place for these for patients at any stage of treatment. However, military metaphors offer little protection for those on the front line and we need to think of better ways of talking about cancer. It’s a disease, not a war.

My attitude today is more one of hope and optimism than GI Jane. Some days I struggle. Some days I cope. I accept the treatments offered and manage the side effects to minimise the impact on my life. I live to the best of my ability with a disease for which there is no cure.

I am living with – not dying of – secondary cancer.

You can read more from Katherine on her own blog killerkath.wordpress.com and also on Twitter @killerkath

Vita bloggers’ views are their own and do not necessarily represent those of Breast Cancer Care or Vita magazine.

Here’s my latest Vita Blog post for Breast Cancer Care:

http://www.breastcancercare.org.uk/news/blog/clearing-myths-misunderstandings-about-secondary-breast-cancer

By the time this post is published, we’ll be halfway through the fuchsia-tinted month of ‘Pinktober’, or Breast Cancer Awareness Month.

Pinktober generates mixed feelings among the breast cancer community. While it has been a spectacular success in celebrating survival and generating funding for much needed services and research, there is still very little awareness around the more deadly form of the disease: secondary breast cancer.

There’s a lot of ignorance about secondary breast cancer, so I want to use this post to unravel a few of the myths surrounding the disease.

My #sbcselfie for YBCN

My secondary breast cancer selfie for the Younger Breast Cancer Network (UK)

There is no cure for secondary breast cancer

For many, breast cancer is now viewed as ‘cancer-lite’. It’s no longer perceived as life-threatening, even though 12,000 women die from the disease every year in the UK.

Statistics released by Breast Cancer Campaign illustrate how misinformed people are about the disease. Figures show that less than 25% of Britons realise that when breast cancer spreads, there is currently no cure. Over 75% believe that it can still be cured when it spreads to another part of the body.

For clarification here’s Breast Cancer Care’s definition:

‘Secondary (metastatic) breast cancer happens when breast cancer cells spread from the (primary) tumour in the breast to another part of the body. This may happen through the lymphatic or blood system to other parts of the body. This is also referred to as metastases, advanced breast cancer, secondary tumours, secondaries or stage 4 breast cancer.’

Once the cancer has moved from the original (primary) site, it cannot be cured.

Fear

Much of the stigma around cancer is fuelled by ignorance and fear. It’s a scary disease. People don’t like talking about it because it means facing subjects most of us would rather avoid.

Whether you have primary or secondary cancer, dealing with other people’s discomfort about the disease is something you get used to. When you’re diagnosed with secondaries, people’s reactions become even more extreme.

I’ve got used to people gasping in horror. However, being on the receiving end of this type of reaction isn’t easy. If you’re anything like me, you concoct a more palatable version of the truth, the version where they find a cure and you live happily ever after.

There’s even a code of silence between primary and secondary breast cancer patients. They’re frightened of becoming one of us and we don’t want to scare them.

During a recent trip to the chemotherapy ward, a newly diagnosed patient asked when I would be finished treatment. It was her very first chemotherapy session. She was terrified and needed some reassurance. I didn’t have the heart to tell her that this was the second time I’d lost my hair, and for me treatment would never end.

The discomfort people have with talking about secondary disease can make you feel like the Grim Reaper. We are an unwelcome reminder to the rest of humanity that our time here is finite. Death is an unfortunate reality we all have to face. Yes reader, cancer or no cancer, one day you will die.

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Before my secondary diagnosis, I knew very little about the disease. My scant awareness was limited to the knowledge of a secondaries support group in my local Maggie’s Centre. My worst fear was joining that group and I avoided any association with it. For me, even being in the same room as people with secondaries was a risky business: stand too close and you might catch it.

My ignorance about secondary breast cancer was reinforced by those around me. After losing a friend to secondary breast cancer, I was shocked when a mutual acquaintance commented that ‘She always had a bad attitude towards the disease,’ as if she’d somehow brought it upon herself. I was reassured that with my positive attitude I would never become ‘one of them’.

The belief that the right attitude can have a positive effect on your prognosis is one of the most common misconceptions about the disease. But it’s a myth we’ve all bought into. In order to be a survivor, you have to conform to the ‘smiling, battling warrior’ ideal. Those who don’t will lose the battle.

Cancer is stigmatising enough, but for those with secondary disease the stigma is even greater. For as well as failing at survival, there’s an assumption that perhaps we didn’t try hard enough to beat it. It’s much easier for people to assume that we didn’t play the game than to accept the possibility it might happen to them one day.

There’s no doubt that having a positive attitude can enable people to get through treatment. However, research doesn’t support the idea that positive thinking can have an effect on prognosis, but suggests that pressure to engage in positive thinking may add to the psychological burden of cancer patients.

Until we destroy this mythical relationship between positive thinking and cancer survival, those of us with secondary disease are saddled with the added guilt that perhaps we didn’t try hard enough.

The future

It’s not all doom and gloom. Breast cancer charities are beginning to listen and give women with secondary breast cancer a voice.

Currently only one day of Pinktober is devoted to Secondary Breast Cancer Awareness Day. However, Breast Cancer Care has devoted a whole week towards highlighting some of the #hiddeneffects of the disease. Breast Cancer Campaign is raising awareness of secondary breast cancer with their spreadtheword campaign andBreakthrough Breast Cancer is campaigning to demand a fairer price for life-extending drugs.

As well as this, Breast Cancer Care and Breakthrough have worked with hospitals all over the UK to create a Secondary Breast Cancer Service Pledge, with a focus on improving standards of care and allowing secondary cancer patients to have their say.

Breast Cancer Care  is also addressing the issues faced by younger women, when it hosts the first ever Living with Secondary Breast Cancer as a Younger Woman event in London later this month. Breast cancer is much less common in younger women (one breast cancer in five is diagnosed in women under 50) and this is a rare opportunity for those of us with secondaries to meet up.

Writing this post has made me realise that we have a long way to go when it comes to spreading the word about secondary breast cancer. My own lack of awareness was due to fear and ignorance, and it’s unfortunate that it took a secondary diagnosis to make me more aware of secondary breast cancer. Until we become more comfortable with talking about it, secondary breast cancer will remain the pink elephant in the room.

You can read more from Katherine on her own blog killerkath.wordpress.com and also on Twitter @killerkath

Vita bloggers’ views are their own and do not necessarily represent those of Breast Cancer Care or Vita magazine.

 

Here’s my latest Vita Blog Post: http://www.breastcancercare.org.uk/news/blog/getting-support-counselling-support-groups-mindfulness

I love picking fruit and today I spent a couple of hours picking blackberries. It requires patience and perseverance but it’s incredibly rewarding seeing the fruits of your labour bubbling away on the stove.

One of the reasons I love picking fruit is because it’s one of the only times I switch off. This is something I strive for when I meditate but never quite achieve. When I’m picking blackberries, all I’m focused on is reaching for the next berry. It’s very therapeutic and for a few blissful hours I forget I’ve got this vile disease. Making jam

Switching off is difficult at the best of times, but when you’re going through treatment, worries can be all consuming. Not only are you dealing with the rollercoaster of treatment, but there are often financial, emotional and practical issues to contend with. Anxieties about paying the bills, body image and fears of recurrence are just a few of the things a cancer patient has to face, along with the physical and psychological impact of treatment.

The constant stress of treatment can take its toll, and it’s no surprise that depression and anxiety are common among cancer patients. Mental health has been in the news recently with research showing that between 6 and 13% of cancer patients have clinical depression, compared with 2% of the general population.

Like many cancer patients, I struggled to get any psychological support when I was first diagnosed. A cancer diagnosis wasn’t considered serious enough to warrant an urgent referral and I was told I’d have a 6–12 month wait for counselling. It was only through accessing the support of my local Maggie’s centre that I got the psychological help I needed.

It seems like we have a lot of catching up to do when it comes to looking after the mental health of cancer patients. However, there are many resources you can access to help you cope with the ups and downs of treatment.

Counselling

Asking for help is nothing to be ashamed about. It can be really hard for loved ones to give you the emotional support you need while you’re going through treatment. It’s also really difficult to be completely honest with them. Counselling provides a neutral space for you to talk openly about how you are feeling. It allows you to put aside the brave face that you put on for family and friends.

I’ve had contrasting experiences while being treated under different authorities and every health authority varies in the availability of psychological support for cancer patients. Some hospitals have dedicated psycho-oncology units and your breast care nurse, consultant or GP can refer you. Charities such as Maggie’s and The Haven also offer counselling.

Alternatively you can chat to someone on the Breast Cancer Care or Macmillan helplines. Breast Cancer Care also has a brilliant telephone support service called Someone like me, which matches you with someone who’s been on a similar journey.

Find a support group

There’s no better support than from those in the same boat as you. No one else can comprehend what you’re going through unless they’ve been there themselves. There are breast cancer support groups all over the country. You should be able to find one through your breast care nurse, your local hospital or through Maggie’s, Macmillan or The Haven.

Breast Cancer Care offers practical courses for people at different stages of treatment as well as monthly support groups for those living with secondary breast cancer. For women under 45, their Younger Women Together meet-ups are a great way to make friends and create new support networks.

There are also online support groups such as the Younger Breast Cancer Network (UK) on Facebook and the online Forum at Breast Cancer Care, where you can get support from other women going through treatment.

Meditation and mindfulness

5253I started meditation classes a few months before my primary breast cancer diagnosis in 2012 and this really helped me cope with the trauma of a cancer diagnosis. You don’t have to be a Buddhist to meditate and many places now offer courses in mindful meditation or mindfulness based stress reduction (MBSR).

We spend most of our time in autopilot mode, thinking about the past or the future and paying little attention to what is going on in the present. The busyness of modern life and the technologies we surround ourselves with encourage us to be even less mindful. Mindfulness encourages you to be in the here and now using techniques such as meditation, yoga and focusing on breathing. It enables you to be more engaged with your feelings and emotions so that you are better able to manage them.

And it really works. Meditation can reduce anxiety and stress, as well as helping to control problems like pain and high blood pressure.

You don’t have to sit and meditate to be mindful. Mindfulness can be incorporated into your everyday life. Everyday activities such as baking a cake, going for a walk or even reading a book can all be mindful.

There are many avenues to explore if you’re interested in learning some mindful meditation techniques. The Be Mindful website has a list of courses all over the UK as well as online courses. Your local hospital or cancer support centre might run courses. If you just want to dip your toe in the water there are some great podcasts on the Mental Health Foundation website and at the University of Oxford Mindfulness Centre.

Picking blackberries and meditation aren’t for everyone and you might find other things work better for you. When I’m feeling well I like to keep myself active. Walking and yoga are the things that help me feel stronger both physically and mentally. On bad days I find getting lost in a book or watching a film are really great distraction techniques. I hope you find something that works for you.

You can read more from Katherine on her own blog killerkath.wordpress.com and also on Twitter @killerkath

My latest Vita post for Breast Cancer Care http://www.breastcancercare.org.uk/news/blog/chemotherapy-neutropenia

The only certainty when you’re living with a secondary cancer diagnosis is uncertainty. At every appointment I’ve had recently they’ve thrown me another curveball. The clinical trial I talked about in my last post is now yesterday’s news.

I was all psyched up to start treatment when the hospital called to tell me that I’m no longer eligible to take part. They had expected the metastases on my lungs to grow (they have to be over 1cm) and they haven’t. The tumours have remained stable between my first scan in May and my second scan in June. I was disappointed at being dropped from the trial, but ecstatic when they explained why.

After six weeks of delays, shifting goalposts and false starts, I finally started chemotherapy two weeks ago. I’m now on a weekly regime of paclitaxel and gemcitabine. The drug cycle I’m on is two weeks on, followed by one week off.

Lines and Ports

My first treatment was straightforward, if a little slow. The worst part was having a cannula inserted.

I don’t have a phobia of needles. However, I don’t particularly enjoy being stabbed in the arm. It really hurts and it’s something you never get used to.

If you’re having regular treatment or if you have poor veins, you might be offered a PICC line, central line or port. There are advantages and disadvantages to all of these.

I had a PICC line during my first round of chemotherapy and I found it really difficult to live with. The main disadvantages are: risk of infection, weekly trips to hospital to get it flushed, and restriction of sports and other daily activities.

I managed to do a yoga routine at home, although I had to adapt some postures to avoid pulling out the PICC line. My Warrior 2 looked more like ‘I’m a little teapot’. Having a long hot soak in the bath is also tricky, but I managed to adapt this by elevating my arm. Your arm can go numb, so it’s not very relaxing, but I refused to let it beat me.

On the other hand, having a line or port means that you don’t have to endure being constantly jabbed in the arm while they locate undamaged veins. This makes having blood taken or receiving drugs intravenously a much less painful experience. It also reduces the risk of ‘extravasation’ (when a specific type of drug leaks out of your veins) and damage to your veins.

Neutropenia

I felt OK for the first few days after chemo – the steroid high – but deteriorated towards the end of the week. By day five I had throat and urine infections and ended up at A&E. Scrabble is a great distraction from chemo

I went for my second treatment on day eight, only to find out that I’m neutropenic. This means that my second treatment has been delayed.

The chemo-veterans among you will no doubt be familiar with neutropenia. Chemotherapy lowers your body’s immunity, and neutropenia happens when your white blood cell (neutrophil) count is low or at zero. White blood cells are the body’s primary defence against bacteria and if you don’t have any, then you’re at much greater risk of infection.

I was hospitalised with a neutropenic infection during my first round of FEC chemotherapy two years ago. It was all very dramatic and I felt like ET the first time it happened. Fans of the film might remember the scene where ET and Elliot are quarantined. Thankfully the medical team don’t wear quarantine suits. However, you are isolated from other patients and they write ‘NEUTROPENIC’ in big letters outside your door. It’s quite frightening.

As a repeat offender, I wasn’t so scared the second time round. However, I’ve been taking it easy over the last week. I’ve had very little energy and I’m trying to avoid mixing with too many people. I’m still on antibiotics, so hopefully they will address any unwanted visitors.

If you are having chemotherapy and are worried that you might have a neutropenic infection, don’t be afraid to call your chemotherapy department. It can be really difficult to distinguish between the side effects of chemotherapy and a real infection. However, there are certain signs to look out for: feeling feverish or shivery; hot and cold sweats; sore throat; diarrhoea; breathlessness; redness around a wound; a temperature above 37.5C or below 36C. Don’t delay in calling your medical team if you feel unwell.

G-CSF

When I saw my consultant last week I assumed I would be offered G-CSF (granulocyte-colony stimulating factor).

G-CSF is a drug given to people whose white blood cell count is persistently low. It works by stimulating your bone marrow to produce white blood cells and reduces the length of time that they are low. It also helps to reduce some of the horrible side effects of chemotherapy. Receiving G-CSF injections during my treatment for primary cancer made chemotherapy much more bearable.

I thought that G-CSF was the standard treatment after a neutropenic episode, but my consultant wants to try a different approach this time. Instead of stimulating my immune system with G-CSF, he wants to try reducing my chemotherapy drugs, to see if my body can tolerate a smaller dose. He explained that using G-CSF is like putting your foot on the accelerator with the handbrake on. My immune system has already been battered by previous treatment, so it’s more beneficial to give me a dose of chemotherapy that my body can tolerate than to whack it into submission artificially. If I become neutropenic again, G-CSF might be an option.

G-CSF is an expensive drug and I wondered whether my consultant’s reluctance to prescribe it was influenced by financial constraints. However, his explanation does make sense. I’ve never been a passive patient and always question clinical decisions, but sometimes doctor does know best.

As I finish this post, my hair is beginning to moult. Being the ostrich that I am, I’m clinging to the hope that it might just thin. I know that hair loss is insignificant when weighed against your health, but it’s taken me 18 months to get my hair to a length that I’m happy with. It seems so unfair to lose it all over again.

Preparation baldness has commenced. My to-do list reads something like this: shave head when hair loss gets too messy; get my wig ‘Stevie’ restyled; go to Headstart or Headstrong and practice scarf wearing techniques; take photographic evidence of eyebrows for future reference.

There’s never a dull moment in cancer world.

You can read more from Katherine on her own blog killerkath.wordpress.com and also on Twitter @killerkath

Vita bloggers’ views are their own and do not necessarily represent those of Breast Cancer Care or Vita magazine.