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Cancer

[CANCER] Talking to the Oncologist about Treatment Plans on #WorldCancerDay #BusyLivingWithMets

So, today has been a funny day… it’s #WorldCancerDay, so social media is full of extra content encouraging us all to be vigilant in looking for symptoms of any kind of cancer, and to keep focusing on funding to be able to provide more treatments. My (new) cancer if I’d had it 10-12 years ago would have been ‘I’m sorry, there’s not much we can do longterm’, whereas now there are a range of very good treatment options… so I carry on seeking to live with metastatic cancer.

Swimathon

My team at Manchester Met Uni are taking part in a Swimathon for Cancer Research UK and Marie Curie Care. As I was going to an appointment with oncologist today, to discuss chemotherapy, I decided it was an appropriate day to stretch myself and do my share of the Swimathon early (as if I have chemotherapy I won’t be allowed to swim – infection risk). I’ve been getting up to 40 lengths reasonably frequently, so 60 lengths (1.5k) was my stretch target today … and I made it:


Oncologist

This afternoon it was back into the waiting room at Stepping Hill – thanks Suzanne for your company – and we’d settled in for a long wait, when we got called in only 30 minutes late!

 

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It’s #waitingroomfeet again today #worldcancerday – time to talk to the oncologist about chemotherapy etc …

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The appointment was relatively fast, because apparently I am ‘an unusual case’, with HER2 not in my original tumour (despite the extra DISH test), and now showing in the new tumour (which is definitely a metastatic tumour) – so there are lots of conversations and no 100% obvious route for treatment. They are now looking for more information from my original tumour, and my spinal biopsy cells – with them being subjected to the FISH test at the Christie.

So, today, there’s no changes in the systemic treatment – I will continue with the Zoladex and Exemastane, and tomorrow I will sign up for the CORE trial, and then find out if I’ve been put in the 50% for stereotactic radiotherapy (with a wait), or 50% with standard radiotherapy (which means we get going). Essentially they want to get rid of as much of the tumour on my spine as possible (they’re not expecting to eradicate it, but to control it), and that treatment is in process of happening, before anything else happens.

Once that has completed, we start looking at more systemic treatment, such as chemotherapy – which they’re still keen not to give me as I’m looking pretty well, so there may be an option to just give me Herceptin. There will be a lot of discussion, and I am expected to be an active participant in this – now I’ve been told about the gold standard drugs that come with chemotherapy, obviously I want them, even if I don’t want the chemotherapy – but happy that lots of things are being discussed – and they’ve clearly got my health as a whole in mind – and want to do best for overall treatment and wellbeing.

There is no change in prognosis, but as the hormonal treatments have already shrunk the tumour, that take the pressure off other treatment… so I see the oncologist again in 3 weeks. I was hoping that by end of this week I’d know what my plan was – instead – sit with the uncertainty and lack of control a little longer, knowing at the heart of this is a desire to not over-treat!

Photo by Martha Dominguez de Gouveia on Unsplash

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Cancer

[CANCER] Talking Radiotherapy Options @TheChristieNHS

After having had my zoladex at the GPs, I headed off to The Christie, ready to talk radiotherapy with Dr Misra, and whether I want to be entered into the CORE trial – I will be having radiotherapy either way, but it may be standard treatment, or stereotactic ablative radiotherapy (which seems to be used quite widely in the rest of the world, but the NHS doesn’t routinely fund it). I am eligible for the trial because I have less than three metastatic tumours (just one), of less than 3cm – in other words, I have oligometastatic tumours.

I have another appointment with Dr Misra next Tuesday to sign up for the trial, assuming I say yes, once I’ve read the 18 page consent form. If I say yes, the form then heads off to London, and the randomisation determines which kind of radiotherapy I get, and then the process starts.

He asked why I sighed when he asked how I was doing – well, no one wants more cancer treatment do they?

Standard Radiotherapy

This could start within a couple of weeks, with a CT planning scan probably within a week of being assigned standard radiotherapy. Standard dose is 10-15 treatments, typically 10, and this would likely happen before any chemotherapy.

Side effects (which is the bit I really care about) are mostly local, including temporary stiffening and tenderness around the treatment area (which I think is T11, not T10 as had originally been mentioned); redness on the treated site, and nausea (which they would seek to keep on top of with medication). The fatigue which I am particularly nervous about (as that is still impacting), but the expectation is that it shouldn’t be as severe, because a smaller area is being treated.

Late effects can either weaken the bones and lead to a possibility of fracture, or (more commonly) harden the bones and reduce damage.

Stereotactic Radiotherapy

There may be a waiting list for this to start, in which case, Dr Chittalia (my oncologist) would likely start the chemotherapy, as we want to get going with the treatment (although as I’m still on exemastane and zoladex, which is what the tumour appears to have been reacting to, it’s not as urgent as it could be) and and the radiotherapy would be fitted in at an appropriate time in the midst of treatment. I’ll see Dr C next Monday.

The potential side effects for this are largely the same as standard radiotherapy, with an increased risk of fractures in the long term, because it has focused so tightly on one area. It’s often ‘sold’ as ‘without nausea’, but if the beam ends up being sent through the front of the body, it can still cause nausea (joy).

What does it mean for the gym?

I’ve been building up my time at the gym, but I’ve been a little confused about what’s OK to do, and what’s not OK. For now, they want me to be cautious, but not freaked out. Once treatment is over, can be reassessed, so is not necessarily for ever but:

  • Nothing unsupported
  • Machine weights with max 10kg – and keeping an eye on what body doing – should be OK
  • Cycling/swimming are good
  • NO LIFTING AT ALL

Oh, and I thought this clip was excellent:

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Cancer

[CANCER] Where are we now, on the ‘journey’ of #BreastCancer?

Not that we are necessarily huge fans of the term ‘journey’, but thesaurus not giving me too many options… though I do remember saying at the beginning, I describe myself on Twitter as a ‘Life Explorer’, so cancer is just one of the crappier sides of life to ‘explore’!

Recap: Diagnosis (30th August 2017)

I finally took myself to the doctors after noticing something weird at a bra fitting, then feeling ‘a bit of a lump’, telling one friend, so I couldn’t bail out – although I still waited too long because ‘I was busy’ (and I wanted to see a female GP, which took a couple of extra weeks). The GP put me straight on the ‘cancer pathway’, though at this stage she said it didn’t necessarily mean anything.

A week later (Weds), I was at the Bobby Moore Unit in Stepping Hill, undergoing clinical examination, mammogram, and ultrasound + biopsy (including armpit), and was sent home with the words ‘there’s a suspicious looking area’ ringing in my ears, fast-tracked for an MRI appointment the following Tuesday, with biopsy results expected Wednesday. By this point I had told a few other people, including my Mum, who agreed to come to the next week’s appointment, whilst I kept myself occupied by going to Greenbelt for the bank holiday weekend. No one was saying to me, but the armpit biopsy meant everyone (including me) was thinking ‘it is cancer’, but no one was saying this to anyone else! The copy of the surgeon’s letter I later got a copy of meant that I saw that he’d told the GP that he had ‘given strong warning shots across the bows’.

Recap: Surgery (21st September 2017)

Various tests indicated that surgery was the way to go first, and this happened pretty fast. On the day of diagnosis I was asked to decide within 48 hours whether I wanted to be treated in Manchester (or move in with parents for 6+ months), whether I wanted fertility treatment (chemotherapy often kills this off), and whether I wanted a mastectomy or a lumpectomy. It was an early start + 36+ hours in hospital before being sent home to recuperate (with the help of my mum for a coupe of weeks – yes, I wanted to stay in my own home).

Officially from this point I have been NED (No Evidence of Disease) – the term typically used instead of ‘Remission’ these day, and any treatment from this point on is to try and stop the cancer coming back (I was Stage 3, Grade 3, 12cm tumour + 5 lymph nodes, so relatively high risk).

Recap: Chemo (1st December 2017 – 30th March 2018)

There was quite a lot of waiting, as I joined the Optima trial (which gave a 25% chance of not having what would otherwise be definite chemotherapy): after 4 weeks the results came back – yes, chemotherapy was required, and I would have a central line/portacath inserted for drug infusion, as my veins are so difficult to work with! I was more scared of chemotherapy than surgery, but as others in Facebook groups have said ‘it’s crap, but it’s doable’, and to-be-honest, much of the time it was a whole heap of small, irritating side effects (ear infection, eye infection, nausea, hair loss, bloody nose, insomnia, steroids, etc) – aside from the full of dizziness in week one of the first drug (3 treatments 3 weeks apart) – with the second drug (9 treatments 1 week apart)…and the painfulness of the cold cap (which worked exceptionally well).

People were right, it’s crap, your immune system is shot, you sleep a lot, but you just keep plodding away day by day. I worked (from home) weeks 2 & 3 of of the first two chemos, then took time off sick til towards the end of March, returning to work on my journal article ‘Social Media, Peer Surveillance, Spiritual Formation and Mission: Practicing Christian Faith in a Surveilled Public Space‘.

Recap: Radiotherapy (25th April – 21st May 2018)

Three or so weeks were allowed between chemotherapy and radiotherapy, to give my body a chance to recover before being dosed with more treatment. Ironically, as I’d expected this to be straightforward, I found this much more stressful (and added a layer of tiredness) than chemo! Only 15 sessions, but EVERY day, and often having to lie in a strange position for quite some time, and having to be ‘reset’. I took 3.5 weeks off work for radiotherapy, although I ended up working on a funding bid for Macmillan to look at cancer/social media.

I also started Tamoxifen, a week or two before radiotherapy, and whilst radiotherapy was ongoing, I continued decluttering, and had a kitchen fitted:

Recap: Post-Hospital Treatment

So far, since being released from hospital, I’ve had a physical check-up at the Bobby Moore Unit, attended a play based upon discussions in the Breast Cancer Care Forum, spoken at a couple of events about social media at work; healthy social media policies – where I mentioned the overlap with personal ‘journey’ – and ended up being featured in Business Cloud UK, been featured in The Guardian and The Telegraph and on UCB Radio, attended the Engage Researchers Academy, and Georgette Heyer conference, and a couple of weddings, met up with a number of friends (including some new #BreastCancer friends), been on a couple of canal cruises with The Liquorists, had a lovely holiday in Porto… and had a fireplace fitted ready for winter (and yes, I’m really tired – no great surprises – not quite got my balance right):

What’s Happening Now?

So, right now, it’s all about the emotional fallout. I am currently halfway through the ‘Moving Forward’ course, run between Breast Cancer Care and the breast care nurses from Stepping Hill, and I’ve had 3 counselling sessions so far at the Christie (CBT/CFT) – I have always used work and food to distract, so we’ll see what comes out of this:

It’s a challenge trying to ‘reintegrate into normal life’ again, managing other people’s expectations, and my expectations of myself – and as the counsellor said, you’re trying out different things, knowing that there’s a ‘new normal’ to adapt to, and sometimes bumping into challenges as this unfolds.

I’m also officially ‘back at work’, although continuing largely with the ‘working at home’. I met with Occupational Health last week and because

  1. it’s not actually that long since I finished MASSIVE amounts of treatment
  2. I’ve got more new treatment to come (Zoladex (every month for maybe 2 years)/Anastrazole (every day for maybe 10 years) which also have side effects
  3. I’m struggling with fatigue – rarely out of bed for more than about 12 hours, and getting stressed relatively easily – especially by inflexible things with a short time-pressure.

I’m still waiting for the email, but she is suggesting that I only need to be physically at work for one (short) day a week, limiting pressures and teaching time (got plenty of research, public engagement, etc. to keep me busy). She originally suggested no teaching, but we think it’s a good idea to ‘get back in the ring’! I can’t really remember what else we talked about to be honest, so I’m awaiting that email!

All of these things may feature as their own blog posts, once I have a little energy, including the topic of ‘hair’ and ‘breast prosthesis’!

I’m still suffering with peripheral neuropathy (other friends post-treatment say this may not go away, breast care nurse suggests bringing it up in 6 months).

What Happens Next?

I have my ‘annual mammogram’ (on the one you have left, as one of the surgeons helpfully said) on 6th August, and will see the oncologist again in January 2019. Meantime, I’m waiting for a letter sending me for blood tests at the Christie to kick off the process to start on Zoladex and Anastrazole (basically to kickstart a chemical menopause), and find out how that affects me.

As the counsellor said, when I said I like to ‘be prepared’ – ‘you couldn’t be prepared for cancer, and you dealt with it’… so with that ringing in my ears… it must be nearly time for bed… but I’ve got a few things to look forward to, including another wedding, a trip to Jersey and:

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Cancer

[CANCER] A week after #Radiotherapy Finishes #CancerLife

This time last week I was still trying to process that ‘active treatment’ had finished... hence the little video of ringing the ‘End of Treatment’ Bell (and a few pics if you click through)… thanks to Karen who came with me – I really wasn’t sure how I’d feel – a little bit emotional, but mostly (as throughout treatment) a bit ‘what just happened, did that happen to me?’:


Radiotherapy staff are lovely, but the going in EVERY day and lying in an odd position (hips to the right, arm up on the left, feet wedged on an uncomfortable metal platform) whilst you get tugged about by the staff. If it all goes to plan, you’re in and out in 15-20 minutes, but it didn’t always go to plan. Often I would hear an extra set of footsteps coming in! Once again I took in chocolate biscuit cake for the staff… then popped home for a Magnum ice cream (not champers unfortunately – still not feeling massively like alcohol!)..

I then had to head off to Stepping Hill Hospital for an appointment with my surgeon. Was happy to run into a friend there, and got lots of cheers/hugs from the staff for having finished radiotherapy (before I had to take my t-shirt off for the, ahem, ‘gown’:

Waiting to be seen. #cancerlife #breastcancer #steppinghill

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Didn’t get to see my surgeon, so a little bit weird being poked and prodded by someone new, but the most important thing is that they can’t feel anything to worry about – so it’s now my job until August when I have my ‘one year mammogram’ (diagnosed 30 Aug 17) to keep an eye on everything.

Since last week there’s been a whole lot of sleeping going on (some poor night’s sleep, but thank you Netflix for keeping me company), interspersed with seeing a few friends, working on a bid for Macmillan re social media/cancer, and decluttering. I officially returned to work last Friday, although I’m on leave for the next couple of days, back in the office Thursday… although I’m not expecting to go in much over the summer and have a whole host of leave to take (and a holiday in Porto to look forward to).

Thanks to friends who have come and helped with kitchen unpacking, tip runs, and building furniture… along with the ongoing support online. My dream of having a decluttered house is almost there (7 small areas + the garage to go)… although I still have ‘too many’ books (if there’s such a thing), and my cousin is coming to help see if my wardrobe needs any streamlining. I’ll blog about hair, prosthetics, and hormone treatment at some point too…

Still trying to work out what ‘the new normal’ is, but oncologist warned me that skin will get worse for fortnight post-treatment – I’ve got a ‘lovely’ red square, it’s like having my own radiator under my arm, and small bits of peeling skin. He also warned me to expect fatigue for at least the next 2 months, but I’m still looking forward to seeing A Space for Sharing on Friday, family on Saturday, and attending Engage Researchers’ Academy next week… oh, and on 1pm, 9th June, am going on the Rum-Runner’s Revenge by the Liquorists – usually £60, but we have a spare ticket going for £40 if you want to join us!

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Cancer

[CANCER] Quarter of the way through #Radiotherapy

After last week’s #Take1 for radiotherapy, this Tuesday we went for #Take2. I had to go back into the CT scanner on Thursday (didn’t need to see the Dr), and new measurements were taken, and then the planning has to be done, so they couldn’t start that day.

Everyone who’s done chemotherapy says this is a ‘walk in the park’ compared to chemo, although one of the staff in Maggie’s (and various others who have been before) – be prepared for THE FATIGUE! Hence why I’m officially off sick at the moment (again)….

Julie, my lovely cleaner (best self-care £ I spend every week), said this is the first week that I actually look tired in the whole time she’s seen me throughout treatment – especially round the eyes… and yes, I am!

#Radiotherapy #Take2

So, with some trepidation, back into the Christie, back round to ‘Suite 4’ (people are each assigned to a numbered suite – guess it helps with the familiarity, although they’re all pretty much the same!).

Here goes #radiotherapy attempt #take2

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It felt like a realllly long session – and it was – about an hour (rather than 20ish minutes anticipated). Kept wondering if I was moving, or what was going on, but the radiotherapists said it’s quite common to have a lot of set-up time, especially in the first few days!

After they disappeared in/out of the room several times…  a piece of the machine moved/made sounds that had never done so before (well, not with me on it anyway!), and we were finally ‘off’! Here’s my VERY relieved face as I headed out down the corridor – there’s a couple of walls between the radiation room, and where the staff monitor the imaging, so they don’t get excessive radiation – zig-zagging out of the room, down the corridor, and back round to the changing room.

Long one, but it worked – I think … #radiotherapy

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#Day2: Radiotherapy

At some point I was determined to get a selfie with the machine – maybe another pic to have at the end of treatment – though there’s also another treatment bell!

This time I was in Suite 12 (behind the door to The Christie Private Healthcare – just the same!) … but with same calm, smiling, ‘please stay very still now’ staff. This did take a while to set up again, and after they disappeared to ‘quickly’ take the ‘checking image’ (on positioning), I was left lying there listening to the music for 4-5 tracks (explicit lyrics on one song – wonder who’s CD that was!) and started to wonder if everyone had just gone home, whilst resisting scratching the bits of my face that were now itching like mad…

They did come back in, with an extra (more senior, I think) member of staff, and was asked to sit back up, and reset – then hips went to the right, whilst other bits of my body were put into shape … and eventually we got there. They said don’t be surprised if it’s 40-45 minutes, rather than 15… so..

#Day3: Radiotherapy

This appointment took about 40ish minutes maybe, so faster than the day before. We did have to do a re-set though, and the senior member of staff came back in. Maybe I’m just a difficult case … but we got there!

Flushed face = 3/15 done. #radiotherapy

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#Day4: Radiotherapy

This was a late one – 6.30pm (and I was clearly the last of the day) – very weird going into the hospital at that time – my usual entrance was closed so had to walk the long way round (was told a shortcut to get out!)…. got to the reception desk by 6.25pm, and they were apparently just waiting for me, so I went straight in!

Here we go again #radiotherapy 4/15 … which takeaway after?!

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And today – we managed to ‘get it in one go’ – so I was out, and had ordered my takeaway (pizza, in case you’re wondering) *still no fully working kitchen, so I think we were done in about 20 minutes 🙂 They had popped out for ‘the first image’, and then I heard the machine move behind my head, then it rotated, whirred and beeped (sounds quite like someone pushing a bell push for a long time), before they popped in to check the final line up – and drew some more lines on my scar area!

I asked about the ‘beep’ I could hear as they left the room, as I was trying to work out if that was a manual push or some kind of clever automatic ‘everyone but the patient has left the room’. It’s a manual push, and I was shown that at the end of the ‘zag’ there’s another button with some kind of laser beam across, which if anyone walks across it, the radiotherapy machine automatically stops any radiation – so that staff can safely walk in/out of the room.

As I was leaving, managed to get a shot of the imaging area (no people, no paperwork visible) – all of which is behind a passcode locked door into the waiting room:


Knowing what is coming really does help reduce the fear….! Anyway, I now get a break for the weekend (not for bank holiday Monday)…