Zoladex #1

I had an amazing summer, spent amongst family and best friends. On my return to the UK in September, it was time to catch up with oncologist Dr. Cleator. As always, arriving at her office left me with mixed feelings. Both I guess memories flooding back but there’s also something about the conversations with her that are so different to those with my surgeon. The energy is different. I also think I associate Dr. Cleator with chemo, tablets and treatment in general so this also makes a difference.

We briefly discussed the results of my hormone test, which I did together with my nutritionist Jo Gamble to find out what my hormone levels are like before embarking on any additional hormonal treatment. Unfortunately the test results showed relatively high levels of estrogen (the opposite to what I was hoping it would show) and with that in mind, I had already made up my mind to give the Zoladex injections a go. This was of course also the recommendation by Dr. Cleator. She said that some experience the side effects, of what is essentially the onset of the menopause, which Zoladex brings on, in different ways. As with everything, every body is different so we will see. I had a small taste of the menopause post-chemo when my menstrual cycle stopped and I started sweating during the night. We discussed other side effects like low mood for example. As with previous treatment, I didn’t want to dwell on the side effects and we agreed that I would give it a try for three months and we would re-assess. If things get unbearable, there are always options to come off the medication.

So this morning, my friend Mati sweetly came with me to the clinic. For some reason I wasn’t expecting to be back in the chemo unit downstairs and as we walked in, I was overwhelmed by emotions and memories. I cried a little and refused to actually sit in the chair that I sat in to receive the chemo treatments. Instead, I sat on the visitor’s chairs.

The nurses were sweet and totally fine with it. I’m going to see if I can shift the location at which I receive these injections as I’m not sure I want to go back to the same place.

Once heart rate and blood pressure were taken, the nurse arrived with the needle. I asked about any potential allergic reactions or immediate side effects but there are rarely any. I also said I didn’t want to talk about the actual Zoladex side effects as I already know what they could be and didn’t want them reinforced. We also discussed using a pain relief cream which would need to be applied 45mins beforehand but I decided to go without.

He pre-warned me that it was going to be a big needle and so I was expecting to see a monster. Yes it was a big needle and it stung when it went in and was painful afterwards but it was totally bearable. I can imagine that the area will feel bruised over the next few days but that’s it. The substance will slowly release over the next 3-4 weeks so let’s see.

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Released for the rest of summer

I had a short follow up with my surgeon Mrs Hogben today to see how things are progressing post radiotherapy. She said the skin looked great and the implant still feels soft. She also felt around the right hand side and under my arms and said all felt normal.

I asked her about the chances of recurrence in case of radical mastectomies and whether or not there are less chances of recurrence with those. This is something my brother mentioned while speaking to his professor oncologist in Germany. Apparently and having looked at my lab report from first diagnosis, in Germany they would have recommended a radical mastectomy to reduce the risk of recurrence.

Mrs Hogben wasn’t convinced that this would necessarily be the case. She also said that in almost all cases, a recurrence on a mastectomy would always appear around the scar area. In my case, the tumour was so close to the skin that some cells were probably left there and started to slowly grow.

I’m due back to see her in October for a mammogram on my healthy side and an MRI on both sides. Until then, it was ‘have a great summer’ and I’m relieved to go away with a bit of time off from doctors!

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Finito

Radio therapy is now officially over! I feel both relieved and released. My skin seems mostly fine, I have noticed a little bit of redness and itchiness towards the top of my chest but so far so good.

The radio therapists mentioned that the effect of it can start to show up to two weeks after treatment but will then ease up a week after that. I’m optimistic that my skin will be fine.

SO looking forward to starting my mornings in whichever way I want to, instead of running into town for treatment. Feels like it’s been a long three weeks!

Hello Friday

…. and hello end of week 2! The second half of the week, treatment continued but this time without the bolus and it really made a difference. Looks like I’m now in and out of treatment within 20 minutes. I have also mastered the breathing technique so all in all the whole process feels a lot smoother.

My skin is still not showing any signs of the treatment which is wonderful. The area on my side feels a little more sensitive and like it has maybe turned a tiny shade darker but there’s no pain or burning.

I had a quick chat with the breast nurse after my session today who just wanted to check that all is fine. She said that some people have more side effects than others and as with everything else, it’s important to rest when tired, to eat well, sleep well etc which is exactly what I’m doing.

I’m also learning to talk a bit more openly about the process and I hope that this is part of an acceptance of everything.

I’m happy it’s Friday and I get two days off from going to the clinic. Bring on the weekend!

Nearing end of week #1 of radio

I’m really looking forward to the weekend. Looking forward to a break from lying back with my arms above my head, from being positioned and re positioned, marked, breathing with an expanded chest, trying to get it right – over and over again. I had a double dose of radiotherapy yesterday and thought that going to the clinic twice would have been difficult but I actually found today more challenging. For some reason I couldn’t get the breathing right for what seemed like ages.

I think I put myself under pressure, thinking that I must get it absolutely right for it to be safe – even though I know that the machine actually wouldn’t deliver any zaps if the ‘zone’ wasn’t right. As I was trying to explain to my therapist today: It goes against all the things I learnt about how to breathe through my belly in order to soothe the system, stay calm and find peace. I find myself feeling anxious every time the actual treatment is delivered for the 7-8 seconds, not being able to use my breath as a way to stay calm.

On the plus side, the radiology team is very sweet and encouraging. They even make sure they turn the music up before they leave the room as they know that it helps me somehow. They’re also never tired of answering the many questions I have after each session. Another great source of knowledge, advice and info has been the MacMillan Breast Cancer Forum and its ‘Radio May 2018’ discussion thread.

I’m taking a whole bunch of supplements during this time to strengthen my immune system. These all come recommended by my nutritionist who also advised me to eat anti-inflammatory foods like oily fish, turmeric and ginger (easy enough) as well as foods rich in nucleosides, such as liver, kidney, heart etc. – not sure I can get myself to eat those.

I feel good physically, I don’t feel any more tired or any different. Emotionally, today was more difficult. I think probably because of the combination of a more challenging radio session this morning and a heavy therapy session. It seems that I have gone into ‘do’ mode again, trying to get through this process as best as possible. I know though that this approach doesn’t allow much room to feel. I experienced this last time round. I soldiered through all the treatment only to crash and burn emotionally afterwards. I need to be more in touch with how I feel and allow myself to be sad, to be angry, to be frustrated and whatever else comes up. My therapist is brilliant and the conversation really helped me see that I’m up to my ‘old ways’ of just getting on with things. So I have been given some homework to do in the next couple of weeks which involves confronting some of the things I’ve been avoiding and having more open conversations, creating more space to feel and knowing that that’s okay.

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Good to see this

Finally some sound advice which is actually being handed out at the London Breast Institute. This should be everywhere rather than bowls of sweets and chocolate biscuits which I too often see around these clinics!

Great to see a London clinic promote the benefits of certain foods and things like curcumin, green tea and flaxseeds. Way to go London Breast Institute!

1 down 14 to go

First radiotherapy treatment is done and it was quite uneventful. Following the planning meeting a couple of weeks ago, I knew what to expect and this morning one of the radiologist nurses went through everything again and answered any additional questions.

The challenging part of the treatment was the Deep inspiration breath-hold (DIBH) which is meant to limit any radiation exposure to my heart and lungs, since the treatment is taking place on my left hand-side. We had practised the method during the planning meeting already and today it was time for the real thing. Grateful for the meditation and yoga that I have done so far – it definitely helped with this. It seems that for the first seven or so sessions, I will have a weighted gel pad on my chest which makes it a little more difficult to raise my chest with the DIBH. Apparently the pad enables the radiation to be closer to the skin’s surface, since the recurrence was literally under the skin.

I was positioned on the bed (Bob Marley was playing in the background, making me wish I was on a beach somewhere) and after a lot of back and forth and tests to get exact measurements, the rays were delivered and it was over within minutes. The whole set up is so sophisticated in terms of the technology used.

It’s such a bizarre experience as you don’t feel anything, yet this is powerful stuff that kills cells in a carefully marked area of the chest. The nurse reiterated the potential side effects of burnt skin and fatigue towards the end of the treatment. I was given a specific skin care product to use in the morning and evening and sent off to return tomorrow for a double dose. My oncologist wants me to finish treatment on a Friday and since we started on a Tuesday after a bank holiday, tomorrow will see one treatment in the morning and one in the evening.

So far so good – 1 down, 14 to go…!

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Radiotherapy

Three weeks post surgery and it was time to see my oncologist. I had planned to take a friend with me but when the day came, I felt there was something about the appointment that I wanted to handle on my own. The London Oncology Centre will always bring back memories of chemotherapy and of heavy times discussing the cancer and treatment options. For this appointment, I wanted to face the place alone, together with my feelings about it.

We had a long conversation about next steps. First up of course radiotherapy. My oncologist said that this time she couldn’t really see a way around it. I was already prepared for this, following conversations with my surgeon. She took her time to give me lots of details about the treatment and answer any questions I had. I agreed to follow her guidance and have 15 sessions of radiotherapy. She assured me that most people went through the treatment without significant side effects. Apparently the days of burnt skins, blisters and exit points are now over. I still find the concept of having high energy rays so close to my heart frightening. It is scary, but not half as scary as chemotherapy was. And of course, as with most western medicine’s cancer treatments, there are risks of secondary cancers, namely lung cancer. Apparently it is a low risk, much higher risk in smokers. Tamoxifen, of course, also has risks of secondary cancers of the womb. Sometimes I want to despair of the fact that after all these years we are still left with options to burn, poison and cut out cancer.

Talking of Tamoxifen, she also addressed the issue of hormone therapy. The lab results had finally come back and shown that it’s once again 7/8 estrogen and 8/8 progesterone hungry. The results on HER2 were negative again – which was good news. I asked her whether she’d agree that the tamoxifen I’ve been taking for over 2.5 years had basically not worked. While not that simple and it may have slowed the growth of things, it is not doing its job as well as it could. So, with that in mind, we will be having conversations about chemically shutting down my ovaries with a different tablet and monthly injections. Apparently there aren’t that many other options apart from removing the ovaries altogether which seems like a drastic step at the moment. I felt immediately worried about going into some chemically induced menopausal state again. I remember too well how I felt when I had a phase of this for 6 weeks post chemo. I felt all over the place, hot flushes at night and sometimes during the day. I feel upset about the prospect of this again but know that we need to do something. We said we would discuss this in more detail in a few weeks following radiotherapy.

Radio therapy will start at the end of May and will run for 15 consecutive days. I feel strangely calm about this, maybe that will change on the actual day of having the treatment. I’m more nervous about hormone therapy.

I felt heavy and upset when I left my oncology appointment and kept thinking: why is this happening again? Why me? Why now? The same kind of questions I asked myself not too long ago. Luckily, I was heading to a dinner party straight afterwards which was probably the best thing that could have happened. It gave me enough time en route to digest the conversation but not enough time to throw myself into worrying and get into a spin about everything. I had a great evening, followed by another great evening, hosting a Eurovision song party at my place. At one point in the evening, I looked around the room and felt so much Love for everyone and for everything in my life. It really touched me deeply. Grateful!

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Cancer free!

One day post-surgery and I feel great. And most importantly cancer-free! The surgery came and went so quickly. I checked into the hospital at 7am with Mati and D by my side and there was a lot of waiting around for this and that.

Once in the pre-theatre room, a lovely Turkish nurse looked after me and we chatted about Turkey, Istanbul etc. I remember seeing the clock on the wall at 9.45am as the anesthetist injected a painkiller and told me I would feel drunk. Just as I was explaining that I didn’t feel anything, the anesthesia went in and I passed out immediately.

Next thing I remember is waking up in the recovery room, feeling wide awake and chatty. The last couple of surgeries were so different. I was really anxious about not waking up, about the procedure, about everything. This time was different. They soon took me back to the room and I spent another couple of hours eating and drinking and waiting to be discharged. Mrs Hogben came by to tell me that all went according to plan and that she’d see me in a week’s time to check on the stitches. Prior to surgery, they used an ultrasound scan to mark the area on my breast and ensure that enough margins are taken out. She seemed confident that all was taken out.

Meanwhile outside it was the most beautiful day of the year. Super sunny and properly warm. I couldn’t wait to get out of that hospital and into the park. So D and I picked up some food and spent all afternoon in Regent’s Park under the trees, looking up at the blue blue sky, relaxing. It was the perfect recovery choice. Later in the day, a few friends came with food & drinks and we had a wonderful picnic in Regent’s park, chatting and laughing, laughing so much… the best form of medicine.

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