Cancer: It’s the pits

“Enemy combatants this is your final warning, please evacuate. I repeat this is your final warning!”

Everyone loves a military cliché when it comes to cancer, so my secret mission for this blog post was to try to squeeze in as many as possible. I must stress that military clichés are reserved for people with the disease and there’ll be no bravery awards on my watch.

When I filled out my cancer return for 2012/2013 I wrongly assumed I’d repaid my karmic debt and my recent diagnosis proves that I still have plenty of credits in the bad-shit bank. My sense of normal has been severely warped in the past couple of years and I wonder if I’ve just resigned myself to life being shit, as it took the nice young doctor examining me before surgery to remind me how abnormal my life has become. His four words “you’ve been in the wars” were enough to unleash a torrent of tears.

Two weeks ago I had surgery – axillary clearance – to remove the lymph nodes from my right axilla: that’s the ‘armpit’, or ‘oxter‘ to you and I. In the war against renegade cells, the battleground of my body has been subjected to another assault. Unlike the sentinel node biopsy I had last year, this operation was much more invasive and they ripped out half my armpit. I think the NHS should scrap the latin and start using slang: “Aye we’re gonnae clear yer oxters” sounds much less intimidating than the militaristic “we’re going in for axillary clearance”.

As is the norm in my world, I thought I’d be fully recovered after a couple of days, however it’s taken me much longer to recover than I expected. You’d think my body would be hardened by previous battles but perhaps the relentless chemical and surgical assaults are starting to take their toll. They do a lot of rooting around to get to the nodes, nerves can be damaged, and tissue-fluid can build up in the axilla (armpit). This can result in a number of not very pleasant side effects. 

For the first couple of days, there was a definite rumble in the jungle of my armpit: I was mightily pissed off about having to go through surgery again, so it’s understandable that my armpit might want to communicate its discontent. By the end of the first week I was starting to resemble a human-bagpipe, and could have joined a ceilidh band with the ever-growing bulge and chorus emanating from my right oxter.

An extreme reaction to axillary lymph node clearance

I’m surprised my body isn’t screaming, the damage that’s been inflicted in the last year: the FECin Chemotherapy; the now seemingly pointless Sentinel node biopsy; the Mastectomy with bottom transplant; the skin-shedding Radiotherapy; the ‘let’s give the other one a bit of attention’ Mastopexy; and the bagpipe inducing Axillary lymph node clearance. That’s 4 operations, some heavy duty chemicals and a ton of radiation.

It’s not a competition, however I am considering starting a new Facebook game called “Disease Top Trumps”. Having been diagnosed with cancer twice in the last year, I do get slightly irritated when I read a Facebook status update that says “feeling rubbish today, sore throat 😦 “. It’s all relative and everyone’s entitled to a whinge, but from where I’m standing, anything that can be treated with paracetamol does not require a Facebook status update, and the next time I see one of these updates I’m going to find it hard not to play my cancer top trump: “I HAVE CANCER – WOULD YOU CARE TO SWAP?!” Or maybe I’ll just start doing tumour status updates: “Tumour feels bigger today, think it’s terminal 😦 ” and see what response I get.

I promise I will never give tumour status updates on Facebook, in fact I hope I never have to talk about this insidious disease ever again (at least not my cancer), because on Wednesday something incredible happened. Last week I had appointments, with both the surgical and oncology teams, to get the results from surgery and discuss the rest of my treatment plan. The results were irrelevant, I knew I was starting chemotherapy again in December, I just wanted a date, so that I could book a much needed holiday from the cancer that’s taken over my life for the last 18 months.

My apathy turned to shock, when I received the news, that of the 18 lymph nodes removed, only 1 was cancerous. The minimum requirement for treatment is 4 positive nodes and I only had 1, which means no further treatment, besides monthly injections of Goserelin (Zoladex).

You’re probably wondering how did this happen again? The answer is nobody knows. They can’t tell if the tumour was completely new, or if it stemmed from cells which migrated from the previous site. I had quite a large gap between finishing chemotherapy and having my mastectomy during my last course of treatment, so there’s every possibility that a few cells jumped ship when no-one was looking.

Obviously I’m ecstatic that I don’t have to go through chemotherapy and radiotherapy again, but it’s scuppered my weight loss & hair removal plans. I’ve been fattening myself up in preparation for the chemotherapy I thought I’d be having. The chemotherapy diet is cancer’s best kept secret: ‘Feeling flabby? Watch the pounds melt away on the chemo-diet!’ I also expected to be as bald as a coot by xmas so I gave up on depilation: losing your eyebrows and lashes can make you look like an alien, however it means you don’t have to shave your legs for a whole 6 months. Perhaps if they emphasised these positive side effects of chemotherapy they might get more takers?

Dorothy and Alice contemplate the meaning of life

Those of you who know me well and who follow my blog will know that this recent recurrence has thrown my whole life into complete disarray, again. Friends and family have commented on how well I’ve coped with my recent diagnosis, but I’m a great believer in bottling things up & letting them out in inappropriate places. I’m joking, it’s actually really hard to contain your emotions when you think you’re going to die, and simple things like a trip to the supermarket are made even more stressful by the prospect of bumping into someone you know or bursting into tears at the checkout. You realise that the small-talk that people make in these environments is mostly just meaningless waffle. When people ask “how are you today?” they don’t want to know the truth and this for me is one of the most difficult parts of having cancer: it’s an exercise in people management. You’re continually thrown into situations where you have to predict and mop up other people’s emotions. Having the disease is stigmatising enough, but I’ve been in so many situations where I’ve lied because I can’t cope with other people’s reaction to my disease. It’s much easier to say “yeah I’ve got breast cancer but I’m feeling really positive and treatment is going really well” than to say “actually I’m beginning to question the meaning of my existence and wondering what I’ve got to live for”. It’s deep man, but it’s normal to ponder these questions when the grim reaper comes a knockin’.

I was ecstatic when they gave me the good news on Wednesday, however my elation has faded into quiet contemplation as I consider the enormity of what I’ve been through. I’ve survived cancer for a second time and I’m trying not to feel bitter about my recurrence, because if I do that, it means the cancer has won. I need time to lick my wounds and get my head around the fact that I’m not going to die before I start thinking about life again. I’ve earned my stripes, I’m hanging up my boots and I hope I never have to face this disease ever again.

Getting even

The past few weeks have been really crazy. As well as moving out of two houses, moving into another, getting my Salford house fixed up for rental and getting myself ready to go back to work, I managed to squeeze in some reconstructive surgery. The surgery was all last-minute and two weeks after moving back to Manchester, I found myself back at my parents, recuperating.

I also had my first Cancerversary on the 1st of June, my AD 1, so it’s been a strange time of transition and recollection. I had to pinch myself to check I was all still there when I woke up last Saturday.

Being back in Manchester was weird. It’s not like I haven’t visited, but since moving back, everything feels completely different. It’s as if somebody hit the pause button on Manchester world. Now I’m back on the carousel, everything is moving in fast forward, and I could quite happily jump off again.

A postcard from Manchester

The operation last Monday gave me some respite and allowed me to delay my inevitable return to life. My version of normal has been severely warped over the past year. I’ve been living in a completely different world, one of hospitals and support groups. I’ve faced my mortality at an age when most still consider themselves immortal. It feels like I’m waking from the dead.

So here I am again, all taped up, a little bruised and swollen but another step closer to normal. Post-cancer, I’m so blasé about any kind of medical intervention that I wasn’t the slightest bit phased by the prospect of more surgery. I have absolute faith in the plastics team at Ninewells, and before the operation my main concern was placing my order for post-op coffee and toast. Hospital toast always tastes so good. Why is that?

The operation I had last Monday is called a Mastopexy: Greek for “up-lifting of droopy breasts”. This doesn’t require any explanation however I’ve had some tweaks and adjustments on my healthy breast to balance things out. People asked if I wanted to go up a few sizes, but this was never an option, besides, I’m neither blonde nor dumb enough to want double GG’s.

It’s now 10 days post-surgery, and today I returned to hospital to get the dressings removed. I was anxious about seeing my breast, as all I’ve seen for the past week is a bruised, swollen mass, however I am really pleased with the result. As with my reconstructive surgery the only scarring is around the nipple, so it’s a very neat job. It feels good being symmetrical again and I’m proudly sporting a much younger, perter looking pair than I had before.

Mine aren’t mystic, just symmetrical

I’m trying to be really positive about the breast reconstruction saga, as my body has been mutilated in so many ways over the last year. In a previous life I tried internet dating, and I wonder what my profile header would read today: ‘Breast cancer survivor seeks short-sighted man. Must like scars’.

In ‘more cancer news’, there have been some interesting developments in both mine and my mother’s treatment for cancer. Mum has recalled that some of her aunties may have had breast or ovarian cancer, suggesting a familial history, so our oncologist has recommended we go for genetic screening. It does have implications for future treatment, however at this stage I’m not worried, just curious to find out more.

The chances of mum and I having a hereditary link like Angelina Jolie are very slim, as only 5% of breast cancers are caused by genetic mutations. If we do, there’s a possibility we will be offered preventative treatment. I’m all for prophylactic surgery and Angelina has done much to raise the profile of hereditary breast cancers, however I think there should be more focus on preventing the 95% of cancers that aren’t caused by genetic mutations, as research shows that a large proportion of these are preventable.

There are many things I could have done to reduce my risk. I could have reproduced when I was younger & more fertile; I could have breast-fed those babies for 12 months; I could have used a non-hormone based contraception; I could have reduced my alcohol consumption and I could have made my life a bit less stressful. These are all factors which can alter hormone levels in your body, huge risk factors in a cancer like mine which was both Oestrogen+ and Progesterone+, risks I only became aware of after my diagnosis. This angers me, as I think many young women are unaware of the long-term consequences of lifestyle choices such as delaying parenthood. It’s no coincidence that the rise in breast cancer in women under 40 is rising steadily with the average age for childbirth.

Hindsight is a wonderful thing and I’ll never know exactly what caused my cancer, however there’s no point in blaming yourself. How many of you were ready to have children before you were 20? How many of you considered your mortality when you were out enjoying yourself at 21? How many of you actually read the ‘Risks & Contraindications’ blurb on your contraceptive pill packet?

So what can you do to minimise the risks? Keeping fit and maintaining a healthy weight are the main ones and this was my primary goal throughout treatment. Diet is really important and many anti-cancer diets promote a plant-based, sugar-free, dairy-free diet. Breast-cancer-prevention-diets suggest consuming lots of green tea, broccoli, mushrooms (shiitake, maitake, reishi) and as much turmeric as you can stomach in one day. Vitamin D is really important too, as studies in the US show that the incidence of breast is much lower in the sunshine states. Alcohol is a huge risk factor and research shows that the risks increase exponentially with consumption. As little as 1.5 units a day (that’s 125ml of wine or  ½ a pint of lager) can increase your risk by 5% and each additional daily unit increases the risk by 7-10%. Perhaps it’s time to ditch that ‘healthy’ glass of red?

Being healthy during treatment was much easier as it gave me a focus, but back in the real world, avoiding the bad stuff is really difficult. I try to avoid dairy, then someone buys me a cream filled cupcake; I want to reduce my alcohol intake then someone offers me a glass of wine; I need to minimise stress in my life but I have to go back to work; I want to eat less meat, then my mum cooks me the best beef casserole in the world. It’s incredibly difficult to eliminate all of the risks, so if anyone can tell me how to survive as a tee-total, sugar-avoiding vegan whilst everyone around me is gorging themselves on red wine and steak then I’d love to hear from you.  So although I am trying, perhaps I should heed the guidance Yoda gave to Luke Skywalker:

“Try not. Do. Or do not!! There is no try”