Salted peanuts, citrus fruits and vinegar – they’re all back on the menu!

I am both relieved and happy to report that the two dreadfully painful mouth and tongue sores that I’d had for the past couple of weeks have gone.

The sores were a side effect of one of the two new drugs that I started taking just over three weeks ago for the secondary breast cancer that’s in my bones and bone marrow.

I made it very clear in my previous post just how awful these sores were. These past few days, though, I’ve been eating salted peanuts again – a favourite snack to accompany a pre-dinner drink. Not just that, I had an orange earlier today for the first time in almost three weeks. Finally, I am happy for my husband to start putting vinegar in the salad dressing again! 

Everything is back on the menu. At least it is for the moment. Mouth sores can come and go while you’re taking this drug – everolimus (Afinitor) – so we’ll enjoy this mouthsore-free period for as long as it lasts. I’ve been mouthwashing assiduously with the two rinses the oncologist prescribed for me. I guess I’ll continue to do so as a preventative measure.

Also this past week, I had the stitches taken out from the two wounds I have from the skin lesion removal procedures I had a few weeks ago. The wound on my right calf has healed beautifully but the one on the sole of my right foot has not. There has been a certain amount of discomfort associated with the “non-healing” and it means I’ll be off the tennis courts and off the bike for yet another couple of weeks. 

In case you’re wondering, yes, it was indeed painful having the stitches removed, especially those in my foot. I had to ask the nurse who was removing them to stop two or three if not four times so I could take a breather. In the end, the nurse had to call in one of the doctors – an expert in stitches removal apparently- to finish the job.

How painful was it? Well, as we all know, pain is very hard to measure objectively. However, I suspect that if it had been a person very close to me who’d been having this done, he might have fainted! He knows who he is – it’s not hard to guess his identity! – and he’s ok with me writing that. I did check!

I was due to get the results of the biopsies they did on the removed tissue on Thursday this past week, but instead I got a phone call to say the report’s not available yet.

Away from the medical stuff, we’ve been continuing to enjoy the easing of the pandemic-related lockdown restrictions. 

We’ve been out and about, enjoying the late Spring. Indeed we had a very eventful experience just a couple of days ago, during a trip to the beautiful space in southwest London that is Richmond Park.

I can’t remember the last time I was in the park without my bike; regular readers of this blog will know that it is a great place for cycling.

This time, however, my husband and I were on foot. We were going specifically to see the annual display of camelias, azaleas and bluebells in an area of the park called the Isabella Plantation. (There were lots of other flowers too, but I’m afraid my flower-identifying knowledge is extremely limited.)

Walking though the park after we’d seen the flowers, we came across a family of Egyptian geese.

When we first encountered this charming group, there were eight goslings and the mother was trapped inside a small enclosure in the park (photo on the left).

The father was outside the enclosure, unable to help. Both adult birds were clearly distressed – there was lots of squawking and heavy breathing. 

As it turns out, I was instrumental in facilitating the release of the mother, upon which the family hotfooted it towards the nearest pond (photo on the right). It’s a long story but the “rescue” was enabled by the actions of two helpful but distinctly underwhelmed members of the Metropolitan Police who had the misfortune to be in the area at the time!

The pond was about a ten-minute waddle from the enclosure. We followed, taking photos. It was all very cute and exciting.

A happy ending, you may be thinking. Sadly, it wasn’t so. On the way to the pond, disaster struck! To my horror, a big crow swooped down and snatched one of the goslings. As a result, only seven of them made it to the pond. In just a few seconds I went from feeling like a hero to feeling responsible for the death of a gosling. Nature can indeed be cruel.

As for the flowers in the Isabella Plantation, what can I say other than that they are an absolute delight.

In other developments, we’ve booked another couple of trips away over the next month or so – one to Manchester with friends and one to Wales to stay with some very good friends. We’ll catch up with some relatives while we’re in Manchester and, in Wales, I’m very much looking forward to seeing my teenaged goddaughter. That is despite the fact that she has said that, as well as looking forward to seeing me too, she “can’t wait to beat you at chess”. Mmm.

May 17th is an important day in England in terms of the restrictions easing. Museums and art galleries can open again, you can once again eat inside at pubs and restaurants, hotels can fully open again and you can stay overnight with relatives or friends. I’ve already bought tickets for a couple of exhibitions, one of which I’ll enjoy with an old friend who’s coming to London for the day the week after next. Also, tomorrow evening, I’ll be eating inside, at a (hopefully well-ventilated) pub restaurant, with friends, for the first time since last summer.

I’m well aware that we’re far from being out of the woods on the pandemic front – variants of concern, localised spikes in cases here in the UK, the tragic situation in India, etc. However, I’m determined, safely, to make the most of our newly returned freedoms while we have them. I’d like to have been able not to write the last four words in that previous sentence, but I’m sure I’m not alone in thinking that restrictions will come and go depending on how the situation evolves. That said, I tweeted recently that I intended to “carpe the sodding diem” out of this summer. That’s still my plan, the pandemic and my health allowing. 

I am, of course, also well aware that we still don’t know how much protection the vaccines give to people such as myself who have compromised immune systems. I won’t be diving in for big hugs with all and sundry and I think I’ll be steering clear of full-capacity cinemas and theatres for some time to come. I did feel uncomfortable on the London Underground the other day; while almost everyone was wearing a mask, it was much busier than it’s been in the past few months.

Back to medical practicalities. I’m less than one week away from finishing my first 30-day cycle of this new line of treatment. On Wednesday I go to the hospital for blood tests and a chest x-ray; the latter is to see whether there’s any damage to my lungs (another potential side effect). I see the consultant on Thursday for the blood test and x-ray results and to discuss how things are going.

This latest treatment consists of a combination of two drugs – everolimus and exemestane (Aromasin). I take one tablet of each every day. It may still be too early to tell whether they are having an effect as it can take some time for this to show. Other than the mouth sores, the only side effect I’ve noticed is the odd night sweat, similar to those many women get when they’re going through the menopause. They are not pleasant – who wants to have to change out wet nightwear at 2 or 3am? Finally, I wouldn’t be surprised to hear my haemoglobin level has dropped further.

We shall see. For now, though, I’m off to suck on a lemon.

Restrictions lifting and moving on to the next treatment

Pandemic restrictions are loosening and things are looking up on that front. 

We’ve been limited to meeting up with just one other person outside for exercise since December but now the rule of six – whereby you are allowed to gather outside in groups of up to six, including in your back garden – is back. I’m already taking advantage of it. 

In the fading sunshine one evening last week, my husband and I had beers on Tooting Common at the bottom of our street with some friends who live locally. 

We were all so happy to see each other and to be able to actually sit down and relax and enjoy each other’s company. We’ve been meeting up on Zoom and we’ve had some really fun evenings. However, as everyone knows, it’s really, really, really not the same as meeting up in person. This group largely comprises people who were parents of children who attended the primary school at the time our two sons went there. Before the pandemic, we’d meet up once a month in a local pub. Our boys are now 22 and 20 and it’s been a great way of keeping in touch and maintaining friendships. There are way more than six of us; we did more or less manage to arrange ourselves into groups of six. 

Talking of our sons, one is already back home from uni for the Easter holidays. The other is due back later today or tomorrow. We haven’t seen them in three months. That’s not long compared with a lot of people, I know, but this is longest we haven’t seen each other in person. On Easter Sunday, the four of us will have lunch in our garden with my two London-based nieces. Blankets may be involved, depending on the weather. 

Tomorrow morning I’m meeting up, again on the common, with some other good, local friends, all women this time. We’ll be having coffee and pastries rather than beer! Before the pandemic, we would meet up in each other’s houses once a month to catch up, watch a film and discuss it afterwards. We’ve continued throughout the pandemic, remotely. Someone chooses a film, we have a chat on Zoom then we each watch the film in our own homes and we catch up again afterwards on Zoom to discuss the film. It’s been great. There are five of us in this little group, and I think it’s safe to say we all very much appreciate, and take strength and comfort from, each other. Since last August, the group has experienced three bereavements. My mum died from an infection, one member lost her sister to dementia, and another her husband, tragically to COVID. 

Later on next week, I have a game of tennis planned with my four very special tennis buddies, followed by a birthday lunch for one of them hosted in the back garden of another of them. 

Also in our short-term plans is a drive an hour or so out of London to meet and have a walk with some friends we haven’t seen since last August.

Pubs can serve food outside to groups of up to six as of 12th April. Not only have we managed to make two evening reservations for that and the following week, some friends have invited us to celebrate the 60th birthday of one of them one evening that first week at a pub where they managed to get a reservation. Also, an early supper is in the diary one evening over the next two weeks with the tennis crowd. Finally, the BellaVelo cycling club I’m a member of has booked all the outdoor tables at pub on 21st April and I’m due to attend that too. There can be no mixing between tables but it will still be lovely. 

Finally, we’ve booked to eat out – inside!!! – with four friends on the very first day that’s allowed, 17th May. 

If I sound rather desperate to be out and about again and see people, it’s because I am.

We’re also having a mini revamp done of our garden. That is very exciting, especially as we’ll probably be spending a lot of time there this Spring and Summer.

Staying with the good news, I’m due to have my second dose of the Pfizer/BioNTech COVID-19 vaccine this coming Tuesday. It’s not known how much protection the vaccines provide for immunocompromised individuals such as myself, but it has to be higher than zero, so that’s something. 

On the downside, I didn’t get the best results from my most recent set of scans. 

There are some positives. My secondary breast cancer is still confined to my bones and bone marrow; it hasn’t spread to organs such as my liver or lungs. Also, the cancer that’s in my spine isn’t exerting pressure on my spinal cord. 

The bad news is that the cancer has spread within my bones. It is showing up on scans in places that were clear before. “Disease progression with widespread metastatic disease activity now apparent”, reads the report from the combined PET-CT scan of my body from the top of my spine to my mid thighs. The MRI scan I had of my spine shows “widespread diffuse abnormal marrow signal throughout the spine, in keeping with metastatic infiltration”. That said, “overall appearances [of the spine] are relatively stable” compared to the previous MRI scan I had, almost a year ago.

In addition to there having been progression, the relevant tumour marker level in my blood is continuing to rise and my haemoglobin level has been falling. This means it’s time to come off capecitabine, the oral chemo I’ve been on for the past 10 or 11 months and move on to what will be my third line of treatment since my diagnosis of secondary breast cancer two years ago.

There are a couple or perhaps even several treatment options, each of which comes with its own delightful set of potential side effects. We’re still working out what is best and what is possible. I see the oncologist again this coming week, when we will have some more information to inform what the next steps will be. In the meantime, I’m still on capecitabine.

In light of the scan results, we made a change to the other treatment I’d been on.

With bone mets, the cancer weakens your bones. You’re therefore given one or other of two drugs that are aimed at reducing the risk of what are known as “skeletal-related events”, that is fractures, spinal cord compression, bone pain requiring palliative radiotherapy, and orthopaedic surgery. 

In my case, as well as taking capecitabine tablets morning and evening on a one-week on, one-week off basis, I’d been having monthly injections of denosumab (brand name Xgeva), one of the two above-mentioned bone-strengthening drugs.

On seeing the scan results, my oncologist changed from me from denosumab back to Zometa/zoledronic acid, which has the same aim as denosumab but works in a different way. The idea is that trying something different, even though I’ve been on Zometa before, will have a positive effect. I’m fine with that. My position is that almost anything is worth a go, despite the fact that long-term use of Zometa is associated with a higher risk of dental problems than denosumab, such as sore gums and tooth loosening.

I’d only just got used to giving myself the denosumab injections at home. Now it’s back to the treatment day unit at the hospital every four weeks for an iv infusion of Zometa. The procedure only takes half an hour so I guess I shouldn’t complain too much. However, I hadn’t been hooked up to a drip for more than a year (other than to have a blood transfusion last July) and I have to say it felt weird.

Also, because I don’t do things by half, I’m to have two freckles/moles/lesions/whatever removed and biopsied. The dermatologists who examined me said they don’t think they’re suspicious but they advise removal given my current situation and my history of melanoma. 

One lesion is on the sole of my right foot and the other is on my right calf, near the scar from where I had a microinvasive melanoma removed in 2017. The latter has been there forever; the one on the sole of my foot is new. I contacted my GP, who referred me to the dermatology department at the hospital where I’m having my breast cancer treatment. “I’m here so often I should bring a sleeping bag,” I said to my oncologist when I told her about this latest news. I thought it was funny.

I’m waiting to hear when my appointment to remove the moles will be. 

Since I completed my big athletic achievement in early March, I’ve been taking it easy on the exercise front to give my poor feet a rest after subjecting them to such a pounding in January and February. The throbbing - a side effect of capecitabine combined with pre-existing damage from the chemo I had in 2015 – has definitely subsided but it is so much worse at night than during the day. I could count on one hand the number of proper sleeps I’ve had this month. Getting up in the middle of the night to wrap my feet in a cold, wet towel in an effort to sooth the throbbing is not an uncommon event.

I’ve also been feeling knackered – probably due to a mix of a lack of sleep, the cancer having spread, a low haemoglobin level, general pandemic-related general fed-upness, and – perhaps ironically – not doing much exercise other than walking. Seriously, exercise is known to help reducing cancer-related fatigue. And as we all know, if we can exercise, it does make us feel better.

I’ll give the running a rest for another while, but hopefully I’ll start getting some proper bike rides in soon. As for what playing tennis will do for my feet, I have no idea, but I want to play and so I will. I’m not sure my feet can be much worse than they have already been.

Finishing off, we’ll just have to see how it goes with whatever new treatments I end up on. I was on each of the two previous lines of treatment for almost a year. Let’s see how long I last on this next one. Keep your fingers crossed for me.

An update

In the grand scheme of things, I’m quite relieved at the results of my latest round of blood tests.

I met the oncologist earlier this week to discuss the results of the tests I’d had done the previous day. The best I could have hoped for was for my tumour marker to have stayed at the level it had jumped to in December. I figured that was unlikely given that it had risen by a whopping 20% between the November and December blood tests. In the event, it went up by around another 10%.

On the upside, on the blood front things are good. The secondary breast cancer that has spread to my bones has also infiltrated my bone marrow and so reduces my body’s ability to make healthy blood. It was therefore good to hear that my haemoglobin count is up from last month and is again within the normal range, albeit at the very lower end. My neutrophils, while still below the normal range (they’ll never be there again), are 40% up on last month. That means I’m a little better placed to face any infection that comes my way – a positive in the current climate.

Once again, it’s swings and roundabouts. The tumour marker is up but bloods are ok.

With the pandemic still on the rampage, every effort is being made to minimise the number of trips patients on treatment make to hospital. For example, every other appointment with the consultant over the past nine months has been on the phone rather than in person. In fact, I may have had more over the phone than not. Some people don’t like this way of communicating but it’s fine by me. In addition, for my next two rounds of treatment, I’m going to self-inject at home the bone strengthening drug (denosumab/Xgeva) that I have at the start of every new cycle. It’s usually done by one of the oncology nurses at the day treatment unit at the hospital. I did it myself last month at the unit under supervision and that too was fine.

The fact that the marker is going up indicates that there is increased cancer activity somewhere in my body. That’s what happens with secondary cancer. It eventually outwits every possibly treatment. While these latest results were far from disastrous, you do have to be practical. The oncologist therefore discussed with me what drug(s) I might move onto if the scans I’m to have in seven weeks show signs that the cancer has progressed to the extent that we need to change to another treatment. The scans could show any number of things. While you can’t predict a precise course of action in advance as you don’t know what you’ll see, you can be thinking of what might need to happen under various scenarios.

The discussion was quite sobering. But let’s not pre-empt things. That decision – if indeed a decision needs to be taken – is eight weeks away. In the meantime, I carry on with my current treatment and just get on with things.

One of those things is reporting my health status daily on the Covid Symptom Study app – covid.joinzoe.com – that is used to study the symptoms of COVID-19 and track the spread of this virus that is causing such devastation and unimaginable heartache to so many. (On a personal level, next week will see the funeral of a good friend’s husband who died from COVID-19 just after Christmas. His death was heartbreaking on many levels.)

It seems heartless to carry on writing about my own experiences having just written those previous two sentences, but the case is that I reported having a runny nose on the Zoe app, as it’s known, one day last week. While a runny nose is not a symptom of infection with the virus, I, together with any other household members, was “invited” via the app to take a test. It was all very efficient. The test kits were delivered the day after we requested them, we posted them back the following day and got the results – negative in the case of both myself and my husband – 36 hours later via text and email.

I reckoned the results would be negative but, with transmission rates as high as they are, you can obviously never be sure. Our two boys are back at uni and so it’s just my husband and me in the house. I work from home so it’s been a few weeks since I’ve been out for anything other than to exercise or attend hospital appointments. In my husband’s case, it’s for exercise or shopping. I now exercise on my own; I’ve even stopped the walks with friends that had become such a regular and welcome feature of life.

I’m feeling well on the whole and another thing that I’m doing now that I don’t meet up with friends for walks is go out almost every day either for a run or a bike ride. The reason is that I have signed up to a bit of a mad challenge that involves running and/or cycling a total of 192 miles between the beginning of January and the end of March. I could do it all on the bike but I’ve decided to do as much of it as I can on my own two feet rather than on two wheels. Running is so much more challenging than cycling, at least it is for me given the pace at which I cycle. I run incredibly slowly but I guess it still counts as running in that I do overtake people who are simply walking!

There’s no way I’d be running if a friend hadn’t suggested we both sign up for this challenge. Even after having signed up, I’ve had to come up with an incentive to get me out running. I wanted to listen to Transmissions, a multi-episode podcast that I’d heard was really good – about the iconic Manchester bands from the 1980s, Joy Division and New Order. I decided I would only listen to the podcast while running. It was a good plan and it works both ways. I’m loving the podcast so much that I go out running so I can listen to another episode and listening to the podcast makes the runs easier.

This has been a good week for running. I’ve got the week off work, so I’ve got no excuse really. I’m in the category of people for whom work has never been busier and I worked part, if not all, of each of the four working days between December 24th and 31st. It has been so relaxing to have a big chunk of time off. The house is very quiet now that the boys are away again. We had a lovely Christmas together. It’s usually just the four of us anyway on Christmas Day so in that sense at least it wasn’t so different from other years.

The photo above on the left is of me on the 25th, relaxing on the sofa with two of my presents after an almost two-hour spin on the bike – out to Richmond Park, a favourite destination around seven miles away.

The photo on the right was taken in our garden by my husband not long after the bells on New Year’s Eve.

Hogmanay, as we Scots say, normally makes me feel quite melancholic. This year, though, presumably because of all the sadness that 2020 held, it felt important to celebrate and look forward – both because of and despite what the future may bring.

Expectations? It’s hard not to have them.

It’s sometimes good to have positive expectations – I think as humans we need them – but I should know by now that it really doesn’t do to raise your hopes in this cancer business. 

I don’t want to overdramatise things, but I have to confess to feeling rather annoyed at myself for daring to hope that things might have been different from how they turned out last week.

After just two months of staying where it was, that old tumour marker level is up again. This cancer of mine is doing a damn good job of fighting against the drugs that I’m on to try and contain it.

I’m – still – a glass half-full person and I couldn’t help but let myself hope that this “period of stability” might last for slightly longer than two paltry months. In fact, it wasn’t even two months; it was eight weeks. But it wasn’t to be. 

There I was, early Wednesday afternoon last week, feeling pretty good, in the middle of a regular, super busy day at work – working from home, of course. My oncologist was due to call with the results of the blood tests I’d had the previous day, at the end of my latest four-week cycle of oral chemotherapy for the secondary breast cancer that’s in my bones and bone marrow.

Was it too much to ask that the tumour marker level might have remained stable for even just another month? Apparently so.

The results showed my haemoglobin level was down. That’s not such a big deal as it fluctuates from month to month and it’s still at a decent enough level. My neutrophils were also down – to the level where it is just ok to go ahead with the next cycle of chemo. That’s ok, they’ve been there before. But, disappointingly, my tumour marker level was up by almost 20% over last month and is back up to where it was in August. I said already that I don’t want to overdramatise things. Specifically, it’s nowhere near as high as it was when I was first diagnosed in Spring 2019 or when I switched on to the drug I’m on now, in May this year. But that period of stability I had dared hope for never materialised. Also, the level never got as low on this drug as it did with the first drug I was on.

My oncologist knew I’d be disappointed and said she wished she had better news for me. We’ll carry on as is. My next scans are due early on in 2021 anyway. They may or may not show what’s causing the rise in the tumour marker level. I don’t expect the level will go down again although I guess it’s possible. It could stay where it is or it could be that it’s on an upward trajectory that will ultimately lead to my having to change on to the next line of treatment – whatever and whenever that may be. What will be, will be.

The standard regimen for the capecitabine oral chemo that I’m on is two weeks on, one week off. You take tablets every morning and evening for fourteen days then you have a week off and have blood tests at the end of the three-week cycle. I had been tolerating treatment well and my cancer was also responding well so a few months ago I switched to a four-week cycle under which you have one week on tablets followed by one week followed by the same again. It’s easier on the body. Should we go back to the more intensive regime, I asked my oncologist, thinking that might give the cancer more of a run for its money. But it’s not as simple as that. She doesn’t think my bone marrow would tolerate well “two weeks on, one week off” and that if I were to switch, I’d end up needing a dose reduction, which would defeat the purpose of switching.

How can this be, I think to myself. Physically I’ve been feeling really great. In the past few weeks, I’ve played tennis, I’ve been on the bike (outdoors and indoors), and I’ve done a 7k run – a very slow one with two stops for errands but it was still a run. Feeling well physically makes you feel well mentally so, to be fair to me, those two things probably contributed to my allowing myself to think things might have been under control cancer-wise.

I started my latest four-week cycle of capecitabine at the beginning of this week. Four weeks will take me well beyond the pandemic-restricted Christmas season, which we plan to enjoy regardless.  

The tree has been up for a while and I indulged myself this year and bought three funny-to-start-with-then-really-annoying singing trolls. They sing The Jingle Bell Rock and it impossible to get them all singing it at the same time. They do make you laugh when you set them off, though, and laughs are just what we need at the moment.

My husband has not only already made the gravy for Christmas dinner in advance, he has also prepared the stuffing and made a Christmas cake. Our two sons are home from uni, which is lovely.  Their very presence lifts the sprits. I’ve even made myself appreciate the sound of them singing in the shower to music, much of which is really not my taste and is far too loud even when I like it! What I really find amusing is coming down in the morning and trying to work out what they’ve eaten since I  went to bed the previous evening. This morning there was an empty cereal box beside the recycling bin and an empty hummus container in the bin itself  – neither of which was there at midnight last night! It reminds me of my own youth back in Glasgow, although with me it was cheese toasties rather than cereal. As for hummus, I’d never even heard the word, never mind eaten the stuff!

We have plenty of things planned over the Cristmas break – either with or without the boys, in case they read this and start panicking that they will be asked to go on a walk. There will be indoor and outdoor games, films, long walks, bike rides, and Christmas Day catch-ups on Zoom with friends and family. I will enjoy the four weeks of this cycle and will aim to have no expectations one way or the other in advance of my next blood tests and appointments in mid-January.

I had got used to taking things a month at a time and will pretty easily revert to having that mindset. Interestingly, the pandemic is forcing everyone to focus on the shorter term. This is something those of us with life-limiting illnesses have already had to learn to enable us to live with some modicum of peace. It’s not such a bad way to live your life. 

Still looking on the brighter side of things, it seems there’s no reason I shouldn’t be vaccinated against COVID-19 when the time comes. It doesn’t feel like it when I’m on the tennis courts or sweating buckets during an indoor cycling session on my newly purchased smart turbo trainer, but I’m in the “clinically extremely vulnerable” category.

That means I’m pretty high up there in terms of who gets offered the vaccine, although it will still be some time before it’s my turn.

No cancer patients were included in the trials of the vaccine; the big question is how much immunity it will give people like me, on chemo with compromised immune systems. I guess like many things relating to the pandemic, we won’t know until we know.

Before this latest lockdown, we’d gone out for a few pub meals – outside, as was allowed, in heated beer garden areas. At the beginning of this week, the NHS Covid app alerted me to the fact that I had been in contact with someone who had the virus and advised me to isolate for all of two days, which I did. I’m assuming it was related to eating out. I had to cancel a trip to the bike shop and a long walk with a friend that I was very much looking forward to; you’ve got to do the right thing. I’ve had no symptoms and so haven’t had a test myself.

I’ve had much to celebrate and enjoy this year but there’s also been a lot of sadness and sorrow, related to the pandemic or otherwise.

There have been too many deaths and too much serious illness among relatives, friends and acquaintances. A couple of the deaths have been far too premature and/or have happened in heartbreaking circumstances.

Even when a death goes well, as it were (as it did with my mum , this past August), it’s still hard. When I was diagnosed with primary cancer back in the summer of 2015, I wrote a piece about how it was ok to cry. Well this year, I have cried so many tears. Just the other day, Everybody Hurts by REM was playing on Spotify and half-way through I felt the floodgates open and there was nothing I could do except go with it. Sometimes you just have to let it all out. Grieving is a process that lasts a long time, and that’s ok. Also, I think the pandemic has made many of us more fragile than we were before. Things you might have batted off easily in pre-pandemic times can these days tip you over the edge.

Along with the grief, there has been a lot of joy. I will remember this year with fondness along with extreme sadness. Fundamentally, I am so grateful still to be so well physically. Also, the pandemic has led to people showing so much kindness and generosity of spirit. The older you get and/or the more the going gets tough, the more you appreciate that it’s connections with others and taking pleasure from everyday occurrences that matter most. I can’t deny that managing to do the Hadrian’s Wall Walk in northern England in September and escaping to Greece for ten days in early October also helped! 

Anyway, enough about me. Even in the best of times, it can’t be easy to make calls such as the one I received from my oncologist, can it? And let’s face it, there’s news far worse than that that they have to impart. So let’s spare a thought for all the healthcare professionals who are under intense and immense pressure at the moment, trying to manage the pandemic on top of everything else. This article by Lucy Gossage, the oncologist who co-founded the ‘5K Your Way, Move Against Cancer’ initiative, provides a great insight into how challenging things are, and that’s just in oncology – https://www.theguardian.com/society/2020/oct/29/watching-cancer-patients-treatment-alone-heartbreaking

Back to me (that didn’t take long!). This year I’ve found it hard to write Christmas cards. My heart has just not been in it. The naively exuberant words that that are printed in some of the cards somehow seem inappropriate when for so many it’s been a really dreadful year. The last thing lots of people will be having is the “wonderful Christmas” they’re being wished in the cards we send. Perhaps I should have made more of an effort, though, as I do appreciate how nice it is to receive cards.

I really do hope for a safer, saner and brighter year for everyone in 2021. If that’s not possible, then I wish calm and peace for those who are grieving or struggling or dealing with problems of whatever kind. 

Let’s finish with a smile, with a photo that was “Christmassed up” by my brother Stephen – so many thanks to him for that.

The original photo is from when my husband, the boys and I went wakeboarding in London’s Docklands for our younger son’s 20th birthday in August. I love this photo.

That day was one of the many highlights of 2020. I fully expect – here come those expectations again – that whatever 2021 brings, it too will have plenty of highlights. Best wishes to all. Thanks for reading.

 

A cathartic week in Scotland

I very recently got back from Scotland, where I spent a whole week visiting family and friends I’d not seen since last November.

I feel like a weight has been lifted from me. I also swear that for much of the time I was there, I came as close as I possibly could to forgetting that I have incurable breast cancer.

The main reason I went to Scotland was to see my mum. This wonderful lady is 83, has dementia and lives in a care home in my home city of Glasgow. She is very well looked after but things are tough with the pandemic. The restrictions on visiting are very tight – for example, indoor visiting is banned. In common with thousands like her, my mum is struggling to understand what is happening and is suffering quite badly from among other things the lack of social interaction and physical contact.

Over the course of seven days, I saw as much of my mum as I possibly could. I also spent time with each of my five brothers. I saw nine of my eleven nieces and nephews (the other two live here in London). I visited a few good friends, and, thanks to the good organisational skills of one brother, I managed to combine a lovely bike ride out in the countryside south of Glasgow with a visit to a cousin who recently lost her mum – my own mum’s last remaining sibling.I had four 30-minute “window visits” where I spoke to my mum on the phone while standing outside her room with her inside at the window. I also had one 30-minute socially distanced face-to-face visit in the grounds of the care home. 

While my mum now struggles to remember who we are, there’s definitely still a connection. Even if she can’t process the fact that the person standing there in front of her is her daughter, she knows that the concept of daughter is important and that the person talking to her is important to her and that she is to him or her.

The proof lies in the following anecdote.

On my first visit, I suggest that my mum write in her diary that I’m coming to see her the following day. She gets her diary out, opens it on the July 27 page, and I suggest she write “Maureen”. She writes “Maureen to visit today” in that still lovely and still neat handwriting that I’d recognise anywhere. I’m aware that the more memory prompts she has, the more likely it is that she’ll make sense of what she’s written. I therefore suggest that she also write “daughter”.  She duly writes daughter. Then, out of nowhere, she adds a little tick and a few kisses. As she adds the final “x”, she looks up, gives me a massive smile, and says with great satisfaction and pride, “there”. I can’t describe how happy that made me.

I felt relaxed, cared for and loved throughout the whole trip. Despite talking about my situation at length to anyone who cared to and was brave enough to ask, I became aware many, many times throughout my stay that the fact that I have incurable breast cancer was as far back in my consciousness as it’s been since I was diagnosed over a year ago.

It helped that the week I was there coincided with my week off treatment. Under the drug regime I’ve been on for the past few months, I’ve been taking a certain number of tablets of the oral chemo drug capecitabine twice a day – every day, morning and evening, more or less 12 hours apart – for two weeks then I have the third week off. You have to take each set of tablets within 30 minutes of eating.On the week off, I don’t have to eat at a specific time, twice a day. I can skip breakfast if I want. I can have a late supper without having to remember to eat a snack a couple of hours earlier to stay within the 11-13 hour range that I think is acceptable. I don’t have to think about whether I need to take that evening’s supply of tablets out with me in case I’m not at home. I turn off the “Tablets AM” and “Tablets PM” reminders on my phone. It’s nice.

I packed a lot into the week but it never felt rushed. 

I visited friends and family in various places – Glasgow, Killearn, Perth. I rode a tandem for the first time. I had my first ride on an e-bike. I discovered a new park in Glasgow. I was introduced to the music of a couple of bands I hadn’t come across before. I had some really great food. I played tennis. I went on two bike rides, one of 35 miles and one of 20 miles. I breakfasted on wild raspberries during a walk in a park in Perth. I had my first meal out since lockdown was introduced in mid-March. I also managed to read a whole book – Hamnet by Maggie O’Farrell.

If you’ve read the post I wrote for the Institute of Cancer Research, you’ll know that I don’t have a bucket list. That said, being on the tandem was such good fun that retrospectively I’m adding “have a go on a tandem” to and ticking it off from that non-existent bucket list! The e-bike was fun too, but not bucket list material. It may yet become so, I guess, once getting up hills on a regular road bike becomes too much of an effort.

On the book front, parts of Hamnet moved me to tears. The protagonist in this beautifully written novel is Agnes (William Shakespeare’s wife). In one particular scene, it’s Agnes’s wedding day and she’s thinking of her mother, who died years earlier. O’Farrell writes:

“[Agnes] senses, too, somewhere off to the left, her own mother. She would be here with her had life taken a different turn… So it follows, of course, that she will be here now, in whatever form she can manage. Agnes does not need to turn her head, does not want to frighten her away. It is enough to know that she is there, manifest, hovering, insubstantial. I see you, she thinks. I know you are here.”

Again, as I wrote in the ICR blog, I try not to worry about possibly not being here for specific events such as weddings – the events we fear we’ll miss may never happen – but that passage did make me tearful. Indeed it’s not exactly easy writing this now. I find the words sad but also hugely comforting. I hope that when I’m gone and people feel they have need of me, they’ll think along those lines and find some sort of peace. I recommend the book, not just for that passage.

You should get the message loud and clear from reading this that I had a really lovely time. If I’m in any doubt at all myself as to whether I had a lot of fun, I have a physical reminder that I did. I’ve got a sodding big cold sore on my bottom lip.

I’m an atheist but I was brought up a catholic and I can’t dissuade myself from thinking in a very Old Testament-esque way that cold sores are God’s way of punishing me for enjoying myself too much.

I get them quite regularly, in exactly the same place on my bottom lip. They never just happen, though. They always happen in the immediate wake of my having done something that’s really fun – skiing, being on holiday in the sun, cycling on a sunny or windy day (that’s what caused the one I have now). Of course I know that bright sunlight and the cold and the wind can trigger cold sores but I have fun thinking divine retribution is to blame.* I hate them. They are horribly painful and can make you feel really low. The Scottish word “louping” seems tailor-made to describe how your lip feels when you have a cold sore. In addition, of course, they’re unsightly – so much so this time round that I’m quite thankful I have an excuse to wear a mask in public places!

Going back to the god issue, I have to confess that I went skiing several times earlier this year and, despite skiing in glorious sunshine on some days and in bitter cold on others, I didn’t get any cold sores. I like to think that was god giving me a bit of a break cos he/she knew that 1) the scans I was due to have soon after I got back would show signs of progression and I’d have to move on to a new line of treatment and 2) coronavirus was around the corner.

The pandemic forces us to make choices. You balance the risk of catching or unknowingly spreading the virus against your desire and/or need to go to certain places and do certain things. I didn’t need to go to Scotland but I chose to go. I took care on the hygiene front and on the social distancing front I did what I could. Everyone was very accommodating. Almost everyone I came across was complying with the recommendations on social distancing and mask-wearing. I felt pretty safe. 

I also didn’t need to have a massive hug with each of my brothers or they with me, but hug we did.

It was sad that I couldn’t hug my mum. This photo shows how close we were allowed to get to each other on the outside visit. It was far from ideal but, under the circumstances, it was the best I could do. It was enough. It had to be. I feel like a different person after my trip. I realised in hindsight how concerned I’d been about my mum.

I hadn’t seen her in eight months. That’s a long time. It was a huge relief just to see her – even within the very limited boundaries of what was possible. It was also so good to be in the company of so many family members and good friends. 

I got back from Glasgow on Sunday evening. First thing yesterday I went down to the hospital to have blood taken for the regular end-of-cycle tests. Today I saw the oncologist for the results. I’m tolerating capecitabine well, the relevant tumour marker is down again and all the other blood test results were good enough to switch from a three-week cycle of two weeks on and one week off to a four-week cycle of one week on and one week off times two. I start cycle #4 this evening. Back to enforced breakfasts and reminders on my phone and, more importantly, taking the cancer treatment that for the moment at least is enabling me to get on with living my life.

*While this image made me howl with laughter, I do of course realise that it is based on an outdated stereotype. One of my mum’s sisters was a nun and she was the life and soul of the party. More pertinently, my mum’s care home is run by nuns. Before lockdown, there was plenty of singing and dancing and fun and frivolity. I hope they can return to those days soon.

Please don’t ask to see my feet

I have three pieces of good news.

One, after getting pretty positive blood test results on Tuesday, I started on round three of oral chemo that evening.

Two, I have had a post-lockdown haircut.

Three, in another very welcome development, it turns out that the seven cases of COVID-19 that had been diagnosed at the care home where my mum lives in Glasgow were false positives.

I had blood tests done on Monday, on Day 21 of my second three-week cycle of the capecitabine that I’m taking as treatment for secondary breast cancer. I saw the consultant for the results the following day. The relevant tumour marker level has fallen again by a huge amount. In just two cycles of chemo, it has more than halved. It’s only one part of the jigsaw but that’s very good news.

My haemoglobin count was fine; it has held steady since the blood transfusion I had around a month ago after my first round of capecitabine. My white blood cell count is also healthy enough, and within that, without any additional pharmacological support, my neutrophil count is ok too. Various other measures – to do with my liver, for example – are also fine.

At my appointment with her, the oncologist talks me through the results and asks how I’ve been. She has previously warned me specifically to watch out for two main side effects of capecitabine – diarrhoea and palmar-plantar or hand-foot syndrome, where your hands and feet can become red and sore and swollen.

No diarrhoea whatsoever, I report happily. “Hands and feet?”, she asks. Fine, I say, showing her my hands. My nails never recovered from chemo first time round and the treatment I was on for a year before I moved on to this current treatment made them even worse. They’re not at all painful but they are not pretty. That’s just my nails, though. My hands themselves are fine, with no sign of the dreaded syndrome. 

This is going well, I think. And then it hits me. “Please don’t ask to see my feet, please don’t ask to see my feet,” I think. I mustn’t give her any cause for concern, I think. My left foot in particular is a bit of a mess at the moment, with a couple of large and unsightly blisters at varying stages of healing (reasons below). What if she suspects they’re caused by the chemo?

Anyway, she doesn’t ask – at least not then. Next comes the physical examination. I undress to the waist and get on the examination table. The consultant does the usual (usual in normal times, that is; this is the first time this has happened since February), feeling for lumps and bumps in my chest and abdomen and getting me to take deep breaths in and out while she listens with her stethoscope. 

And then it happens. While I’m still on the table, she says “shall we have a look at your feet?” Shit. As I take my sandals off, I start wittering on about how she has to believe me when I say that the fact my feet are a mess has nothing to do with the treatment and everything to do with new pumps I bought and wore without socks and ended up with several big and really painful blood blisters and one popped and I had to cut away the skin because it was making it worse and that’s why it’s got a plaster on and I’m listening to myself and I’m saying to myself, “Maureen, shut up, just show her your feet” but I keep going and now I’m telling her – and the breast cancer nurse who’s also there – how I have a permanent flap of hard skin under my big toe as a result of a bunion-removal operation a million years ago that blisters really easily, and, really, really, this has nothing to do with the treatment.

I finally shut up. I take the plaster off to expose all. She looks and says, “that’s fine, it’s healing”, applies a fresh plaster, checks between my toes, and we’re done.

Next time, I’ll just show her.

Incidentally, these side effects can develop at any time while you’re on this drug. You can have been on it for months without any problems and then they appear.

Anyway, the end result is that I‘m on Day 3 of round three of capecitabine – at a slightly higher dose than I was on for the first two cycles. 

Everyone has a maximum dose based on their body surface area. I started on 85% of my maximum dose and now I’m on 87.5%. Ideally it would have been 90% but the tablets only come in certain strengths and that’s the closest they could get. It doesn’t seem much of an increase but these are highly toxic drugs and I guess you have to take things slowly. 

If there’s evidence that the capecitabine (also known as Xeloda) is working well  and you’re also tolerating it well, you can be switched from a 21-day cycle of two weeks on and one week off to a 28-day cycle of one week on, one week off, one week on, one week off. On this longer cycle, you have less capecitabine overall even at the higher dose and your body has more recovery time within each cycle. IMG_20200712_133309898You also have fewer blood tests and fewer hospital trips; you have four weeks at a time to live your life, as it were, rather than three*. You may also be switched if you’re not tolerating the three-week cycle well. Luckily it looks as if I might be in the former category.

In terms of knowing whether the drug is working, we currently have the CA 15-3 tumour marker level and other blood test results to go on. My first scan or scans to assess the full impact will be sometime in the autumn.

As for the haircut, it looked great when I left the hairdressers – all moussed up, blow-dried and straightened. It won’t last five minutes under a bike helmet, I thought. Having done several bike rides since, I have been proved right, but at least I know what it can look like!

I wrote about the COVID-19 scare at my mum’s care home in my previous blog post. A few days later, the seven people who had tested positive were retested and the results came back negative. To everyone’s huge relief, the original results were deemed to have been false positives. I’m getting closer and closer to deciding to go up and visit, even if it’s through a window. The fact that two friends have just very recently lost their mums has made me even more aware that this is something I have to find a way of doing, pandemic or not.

*It’s hard to keep everything in sync when you’re on treatments with different dosing schedules. For example, I have to go back to the hospital next week, just one week into my three-week cycle, for the other part of my treatment. That’s the monthly injection of denosumab, the bone strengthener that’s given to people like me whose primary cancer has spread to their bones, to reduce the incidence of “skeletal-related events” such as fractures, radiation or surgery to the bone, and spinal cord compression. Hopefully from next month I’ll be able to give myself that injection at home.

Cycling jersey memoirs, Part 1

Shortly after I moved on to oral chemotherapy at the end of May, I got it into my head that I would do a bike ride of over 50 kilometres in each of the seven cycling jerseys that I own.

There’s a story to each jersey. This challenge, I reckoned, would provide me with an opportunity to reflect on each one of those stories. As for the distance, I reckoned fifty kilometres constituted a proper bike ride. It’s sufficiently long that you have to plan and decide where you’re going, but not so long as to feel intimidating before you even set off. 

There will come a time for most of us when we’re no longer able to do the things we love. In my case, that time is likely to come far sooner than it will for most people my age. I was 57 a couple of days ago* and I view every day that I can still get on my bike and ride any distance at all as a bonus. 

I’m on treatment for advanced, currently treatable but ultimately incurable breast cancer. I’ve been on treatment for just over a year, since May 2019, but I only recently moved on to chemotherapy. I take tablets of a chemo drug called capecitabine (also known as Xeloda) in the morning and evening every day for two weeks then I have a week off. I’m coming to the end of the week off in the second cycle. I have blood tests tomorrow and I see the consultant for the results on Tuesday and she’ll tell me whether I can move on to round number three.

I’ve cycled all my life but it was only after I was treated for primary breast cancer in 2015/16 that I took up road cycling in a serious way. Before then, I’d never owned a cycling jersey. Four years on, I have seven. You may think that’s a lot. All I can say is don’t judge until you’ve read the stories. 

There wasn’t a hint of sadness involved in the decision about the jerseys and the rides. It was more a case of providing myself with an opportunity to reflect on and celebrate all the great times I’ve had on and off the bike in the past few years. Also, as I say above, it was a challenge and, as everyone who knows me is aware, I’m a bit of a fan of those.

I managed to complete the seven rides in exactly one calendar month. Or rather, I almost did. One was 42 kilometres, but it was such a nice ride that I’ve decided to include it. It’s my game and I make the rules! Anyway, I’ve included an eighth ride, which was longer than 50k and so more than makes up for the shorter one. 

This post covers three jerseys and the first three rides, in chronological order. I originally meant to cover all the rides in the one blog post but I found myself writing more than I had intended. I did these three rides with my husband, who has only just started riding a road bike again after many years of riding a hybrid for commuting and short leisure rides. He’s loving it and for me it’s great having a new and enthusiastic riding buddy who very conveniently lives in the same household!

Number 1

31 May, 68k

I wore my Mellow Jersey top for this fabulous ride of 68k from our house in Balham in southwest London out to a place in the county of Surrey called Reigate Hill. This was on 31 May, just three days after I’d started taking the capecitabine tablets and I was feeling fine. It was one of the sunniest – and hottest – days of the year so far and there was a lot of climbing involved. This was the first time my husband had used a road bike in more than three decades. Also, he hadn’t ridden anywhere near that distance before. On top of that, it was the first time he’d ridden with cycling cleats.

There was a real sense of freedom with this ride. The sun was shining and it was blazing hot, I was just grateful be out riding and my husband was loving it too. The view from the top of Reigate Hill was amazing, as you can see from the photo. Cafes were opening again in the wake of the loosening of the coronavirus restrictions and there was almost a party atmosphere at the cafe where we stopped for a break. Everyone was clearly happy to be out and about; we were no exception.

As for the kit, I hadn’t really given any thought to which jersey I’d wear for which ride. However, given that there was a lot of climbing, it was fitting that I chose the Mellow Jersey top for this one.

Mellow Jersey is a cycling tour company that runs cycling camps in the UK, France and on the stunning Spanish island of Mallorca. I’ve been to Mallorca with Mellow Jersey three times now on women-only camps and I cannot praise the organisers of these camps highly enough. My most recent trip, in March this year, was cut short by the coronavirus pandemic, but each time I’ve gone, the team has been incredibly accommodating and supportive and has got me up hills I never would have dreamt of tackling on my own.

I’ve always been a very slow climber and I’m even more so now. My haemoglobin count is low as a result of the disease and the treatment and I just don’t have anything extra to give on the hills. I make up for it somewhat on the descents, though, and I’ve never ridden faster than I have in Mallorca with the folks at Mellow Jersey!

Such great memories every time I wear this jersey – especially as all the times I’ve been on these camps, I’ve been in the company of friends and/or fellow cyclists from either one or both of the two cycling clubs I’m a member of here in London.

Number 2

7 June, 56k

The jersey I wore on the 56k ride we did on 7 June is part of the kit for one of the two clubs I’m a member of, in this case the Balham Cycling Club. 

I largely have this club to thank for the fact that I can call myself a road cyclist. I joined this super friendly and open group early in 2017, not long after I’d decided to sign up for a closed-road, mass participation, 100-mile charity bike ride known as Ride London. I did some googling and it turned out my luck was in. The club had just re-established itself, having originally been set up in 1897!

I got in touch, signed up and started riding out with the club straight away, in the “steadiest” (ie slowest – love that euphemism) group. I loved it right from the start. I told a few friends who were also cyclists about it and they joined too. Soon I was regularly doing rides of between 60 and 80k. As Ride London neared, the club organised recces of the three main hills on the 100-mile route so that those who hadn’t done it before knew what to expect on the day. It was the perfect preparation for the ride itself (more on this in the next post).

As for the kit, this was my first cycling jersey.

The coronavirus pandemic has led to all club cycling being cancelled. Even before the outbreak, I hadn’t ridden with the club for a good while. I can do distances but I’m slow and I don’t like the thought of potentially holding back even the steadiest group. I’m fine with that. I still do plenty of cycling in the club kit and am in regular contact through various social media groups.

It’s great when you’re out on a ride and you come across fellow club members. Also, it’s a truly local club; there’s even one member who lives on the same road as me and another few who live close by that you bump into off the bike from time to time.

The friends I introduced to the club have become quite involved, which has been nice to see. I have huge affection for this and my other club, BellaVelo. Last October, in a hugely moving gesture, the two clubs came together and organised a 100 kilometre bike ride in my honour and to raise funds for research into secondary breast cancer.

As for the ride in mid-June, it was put together by the club’s ride captain during lockdown. It too has some beautiful views – not to mention some sharp hills that appear from nowhere!

Number 3

14 June, 59k

I bought the jersey I wore on this mid-June ride of almost 60k in Manhattan when I was there almost a year ago, in September 2019.

I’d gone to New York to visit two aunts of whom I’m extremely fond. They’re my late dad’s sisters and one of them is my godmother.

Wearing this jersey reminds me of that lovely trip and also of the almost two years I spent living in New York in the mid 1990s.

The make of this jersey is Rapha. It’s a high-end brand, is very expensive and cyclists either love it or hate it. As for me, I loved this jersey as soon as I tried it on and I decided to buy it there and then, as a massive treat to myself. You can imagine how pleased I was to find out when I went to pay that it was in the sale at a vastly reduced price! 

The photo here is of me enjoying a well-deserved ice cream near the end of what turned out to be yet another hilly ride on yet another very hot day. If I look sweaty and exhausted, it’s because I was!  

Writing about these rides has reminded me just how much of what we enjoy about life has to do with the people we share it with. 

I didn’t know what to expect when I was first diagnosed with this life-limiting illness in March 2019.  I’m not sure I thought that almost 16 months on I’d be managing to cycle 50 kilometre rides once or twice a week. Who knows for how much longer I’ll be able to do that? At this precise moment, I don’t feel any need to dwell on that question.

The stories for jerseys and rides four to eight will follow.

*My birthday on Friday involved family, friends, tennis, cycling, cake, prosecco, being cooked for, and some very nice gifts. How could that be anything other than hugely enjoyable? On the downside, yesterday we heard that seven cases of COVID-19 – all asymptomatic – have been identified among the residents and the staff and the nuns who run the care home my mum is in up in my native city of Glasgow. They had done so well; these are the first cases they’ve had, or at least identified, and everyone is devastated. Just as they’d announced that limited face-to-face visiting would be allowed for the first time since the start of the epidemic in March, they’re having to impose even stricter restrictions. My mum has dementia and is really struggling with the isolation. Where will it end? Things like this really ram home what a very difficult time this is for so, so many people.

 

Back on treatment, feeling mellow

Thankfully the break in my treatment for secondary breast cancer lasted only five days.

I saw the consultant on Tuesday to find out how my blood was looking after the blood transfusion and filgrastim injection the previous week. The answer was good and I was straight on to my second round of capecitabine oral chemotherapy that very evening.

I’d had blood tests the day before. The results showed that the transfusion and injection did what they were expected to do on the haemoglobin and neutrophil front respectively. My haemoglobin count was up by a whopping 36% (it has to be said it was rather low to start with) and my neutrophil count had almost trebled.

Apparently the rise in the haemoglobin level could be accounted for partially by the fact that I’d been doing a fair amount of cycling. More on that below. Also, we don’t know how much of the fall was due to the new treatment and how much was due to the cancer. Whatever the reason, my haemoglobin was at a decent level.

The consultant is as pleased as I am about the big fall in the tumour marker level. The details are all in my previous post but, after just one cycle of capecitabine (two weeks of daily tablets), it had fallen by almost a third. While the chemo had a negative effect on my bone marrow function, it also clearly had a marked anti-cancer effect. The sooner I got back on treatment the better, the consultant and I agreed. The only objective of the breast cancer that’s already spread to my bones and infiltrated my bone marrow is to grow and spread further and cause even more havoc. You don’t want to leave that untreated any longer than is absolutely necessary.

I’m on the same dose of capecitabine as during the first cycle – 85% of my maximum possible dose, three tablets on the morning and four more 12 hours later. Because there was such a dive in my haemoglobin during the first cycle, I’m to have a blood test half way through this second cycle to check how things are going. So it’s back to the hospital – I’m lucky to live so close – first thing on Wednesday this coming week to have blood taken. The consultant will call me later that day, hopefully to say it’s ok for me to continue with the second week of the tablets. If things have gone awry again… well, we’ll face that bridge if we come to it.

I should have been back at the hospital on Thursday for my monthly injection of the bone strengthening drug, denosumab. However, the consultant brought the appointment forward so I wouldn’t have to make yet another trip to hospital that week. Instead I had the injection at the day treatment unit when I went to pick up my capecitabine tablets a couple of hours after having seen the consultant.

The consultant again emphasised the need for good foot care given the fact that a common side effect of capecitabine is the dreaded palmar-plantar or hand-foot syndrome, where your hands and feet can become red and sore and swollen. This, I’ve just found out, is caused when small amounts of chemo leak out of your capillaries, affecting, most commonly, the skin on your hands and your feet. Nasty.

So what does good feet hygiene entail?

To start with, plenty of moisturising, and, basically, socks at all times – even at home. Yes, really. No more padding about bare-footed  in the house, to lower the risk of getting small cuts that might get infected. No wearing flip flops or sandals that have that a strap that goes between your toes in case the friction caused by the strap causes the skin, which is likely to be fragile, to break. Given that I’m not prepared to walk round the house in trainers or shoes, that leaves me pretty much with the option of that footwear which is de rigeur for Young Folk but pretty much a criminal offence for anyone over the age of 30 – sliders and socks!

IMG_20200627_183057200We used to laugh at our dads for wearing socks with sandals but now it’s an art form. Even if it does become the norm for me indoors, I’m not sure I could ever own it quite to the extent our elder son is doing in this photo!

On the coronavirus front, my thoughts are now turning to when I might be able to go up to Scotland and see my mum and my brothers and their families. That would be very nice indeed. Our younger son gets access to his second year university accommodation in Leeds at the beginning of July. He’s keen to go up sooner than later to settle in and spend some time with his new housemates. I can’t say I blame him. A plan is forming; we could drive together up to Leeds, drop him off then drive on up to Scotland.

I don’t want to get ahead of myself but it’s nice even to think that I might get to see my mum again soon. I haven’t seen her since November. She’s in a care home in Glasgow that thankfully has managed to keep the coronavirus at bay, but she’s struggling with the lack of contact. My brothers up in Glasgow have been as brilliant as ever. They’ve “visited” regularly and talked to her, sang with her and played games with her through a slightly open window but it’s hard on everyone.

Going on a trip – if and when it happens – will be weird. Everyone’s experience of the pandemic is different but it has made a lot of people’s lives much smaller in a geographical sense.

In my case, my policy of “not shielding but being careful” and working from home means that until a couple of weeks ago I hadn’t been inside a building that wasn’t my own house for more than three months – excluding the hospital and the odd cafe for a takeaway coffee or cold drink when I’d been out for a walk or out on the bike.

Also, other than going on long bike rides, I hadn’t been travelling much further than a two-mile radius from the house. The only car journeys I’d been on until very recently were to the hospital, which is less than two miles away. I really should cycle there but I still can’t bring myself to lock my bike up at the hospital. I have PTSD from April 2019 when my bike got stolen outside the breast cancer centre on the very day my diagnosis of advanced breast cancer was confirmed. (Note to self: “You really need to get over that. Just make sure you have decent locks.”)

I know there are lots of issues and challenges regarding the loosening of lockdown restrictions. For me personally, it’s been a joy. Playing tennis in the sunshine with friends you’ve been keeping in touch with through WhatsApp or the odd Zoom call. Meeting up with friends on the common at the bottom of our road to share socially distanced coffees or cold beers or Prosecco on picnic blankets. Stopping off for cold water, a cup of tea and a chat at friends’ houses on the way back from bike rides on scorching hot days. And, more recently, an even bigger change, and all the more pleasurable for it – suppers with friends in their back gardens. One was local; the other I drove to. If it hadn’t been for the pandemic, we’d have taken public transport and probably got a taxi back; I’m not ready for either yet if I have the choice. I’m still being careful, like any sensible person.

IMG_20200627_134204830_HDRI’m four days into this second round of oral chemo and I’m feeling good. I’m writing this sitting on the sofa, feeling mellow and enjoying the view – of flowers inside and out, bike sheds and bins, and blue skies and clouds.

In my previous blog, I said I was going to put that blood transfusion  to good use by going on a long bike ride. Father’s Day dawned last Sunday, the weather was beautiful, and off my other half and I went – on a beautiful, flat and slow 100 kilometre cycle from home in Balham in southwest London into the leafy lanes of Surrey and back. It was my husband’s first 100k ride. Flat or not, that is a fair distance for anyone. I‘ve done a fair few rides of that distance and more, but I‘d be lying if I didn’t admit to being amazed and grateful that, with all this shit going on inside, I can still manage it.

We got back just in time to have showers before settling down to the classy Father’s Day supper our two boys had prepared while we were out. It was pretty much a perfect day.

Moving to oral chemo: different treatment, different approach, fingers crossed

It was pretty clear to me even before I got my latest blood test and scan results that I’d got as much benefit as I was going to get from the treatment I was on for advanced breast cancer. I more or less knew that when I had my next meeting with the oncologist, I’d be moving to a new treatment.

That was indeed what happened. On direction from the oncologist when we met at the end of May, I agreed to stop the treatment I’d been on since I was diagnosed a little over a year ago, skip the next possible treatment and move on to an oral chemotherapy drug called capecitabine. The treatment I’d been on didn’t involve chemo.

A change had been on the cards and while it’s disappointing to know that one’s exhausted the first in a finite number of potential treatments, at least it wasn’t a surprise or a shock. 

This new treatment is in tablet form. IMG_20200528_183239668

You take it orally but it’s still chemo, as you’re reminded by the yellow warning sticker on the box the tablets come in telling you that the contents are cytotoxic and should be “handled with care“.

On to the rationale for moving on to capecitabine, which is also known by its brand name Xeloda. 

Well, there is no sign of any cancer outside of my bones and nor is there any sign that the cancer that’s in my spine is pressing on my spinal cord, where it could do serious damage – positives among the negatives. Things have progressed, though. There are new “skeletal lesions” in certain areas including in my pelvis and sacrum and in my right hip and left collarbone. In addition, my bone marrow is “more infiltrated”.

There are two aspects to my disease. The breast cancer for which I was originally treated for in 2015/16 has spread, or metastasised, to my bones. “Bone mets” weakens your bones and this in turn increases the risk of fracture among other things. It can also cause immense pain. As if that weren’t enough, the breast cancer has also “infiltrated” my bone marrow and so reduces my body’s ability to make healthy blood. Both aspects need to be managed in parallel. 

We’d known for months there was increasing cancer activity. Monthly blood tests had shown that levels of the relevant breast tumour marker (CA 15-3) had been rising since November. My bone marrow function remained stable, though, and rising tumour markers weren’t enough on their own to prompt a change of treatment. Also, the scans I’d had in November and February hadn’t picked up any meaningful or actionable change.

More recently, though, the blood test results overall had been showing a “continued though minor deterioration”. Among other things, my haemoglobin level had been falling. Despite this, I’d been feeling fine but over the past couple of months I’d become increasingly aware that certain physical exertions were leaving me breathless or were becoming too hard even to do.

So even before I got the results from the scans I had in mid-May, I knew things had changed. This time round, to no-one’s surprise, there was something to see.

Bone mets is hard to measure radiologically but there was enough change in the combined near full-body PET CT scan that I had compared to previous scans to be able to say for the first time that things were worse. According to the official report, “The interval change within the skeletal lesions in particular within the pelvis raises suspicion of disease progression.”

I’m in no pain so all this is happening without my having any awareness of it.

As for the MRI scan I had of my spine, “The pattern of marrow infiltration appears to be slightly more diffuse than previously and is concerning for progression.” It also confirmed “extensive metastatic disease throughout the visualised spine and sacrum.”

The blood tests confirmed that the tumour marker is still rising and that my haemoglobin level had indeed continued to fall. The former is not yet at the high level it was at when I was diagnosed in April 2019 although given the rate at which it’s been rising, it’d be there in a couple of months. As for the haemoglobin level, it’s near to what it was when, this time last year, the oncologist started discussing the potential need for a blood transfusion – which I subsequently had.

The results regarding the haemoglobin didn’t surprise me. Most obviously, just briskly walking up the two flights of stairs in our house to the loo had been leaving me breathless. (We’re lucky enough to have two bathrooms. At the moment, while we’re in pandemic mode, the one in the loft extension has been designated for my sole use.) 

Also, I’m playing tennis now that the courts are open and, while I love it, those explosive movements you make all the time have my poor heart pounding. FB_IMG_1591398352510As for running, I’ve more or less given up as I can’t even run fast enough to break a sweat.

Cycling is absolutely fine – you go at your own pace, you can stop and start when you want – and I’ve been doing plenty of that. The photo on the right was taken at the top of Reigate Hill in Surrey, half-way through a hilly, 40-mile ride with my husband a few days after moving on to chemo.

When I started treatment last May with abemaciclib (Verzenios) and fulvestrant (Faslodex), I was one of the first people in my situation to be put on this new combination at the hospital in southwest London where I’m being treated.

The most obvious next treatment was what I’d have been given had the abemaciclib/fulvestrant combination not been available then – a combination of two drugs called everolimus (Afinitor) and exemestane (Aromasin). While everolimus is also oral chemo, the combination is aimed at doing much the same thing as the drugs I’d been on, both over the past year and in the three years between finishing active treatment for primary breast cancer and being diagnosed with secondary – that is, stopping my cancer one way or another from getting the oestrogen it needs to grow. Capecitabine uses a different approach.

There was no reason to suggest the everolimus and exemestane combination wouldn’t work so I understand why the oncologist said things weren’t straightforward. However, to paraphrase in an extremely liberal way, I think her bottom-line recommendation was “let’s not faff about with more of the same and see instead if we can get a quick response with capecitabine”.

Depending on how things go, I could go back and try the treatment I’m skipping. Clearly at this stage I have no idea how likely that is but it is good to know.

With capecitabine, it’s a three-week cycle initially; two weeks on the tablets and one week off, with blood tests at the end of each three-week period. It can take time to find to right dosage.

If I tolerate capecitabine ok and it keeps things in check (remember we have the cancer in the bones and in the bone marrow to worry about), I’ll be on it for as long as it keeps working. Whether that’ll be weeks, months or years, we don’t know. It’ll be at least nine weeks before I have a scan to determine what effect it might be having. In the meantime, the regular blood tests that I’ll be having will give us some idea.

Also in the meantime, I continue with the four-weekly injections of the bone-strengthening drug denosumab at the day treatment unit.

My appointment with the oncologist – in-person, with masks – was on the last Thursday in May. I started on capecitabine the very next day. Having seen the way things were going, the oncologist had me tested a couple of months ago to see if I was in the group of people whose bodies are unable to metabolise capecitabine and would be likely to develop very severe side effects. I wasn’t. It’s strange what you become thankful for.

I was forced to make lifestyle changes from Day 1. For years on weekdays I’ve rarely eaten anything before 11am. However, I need to take these new tablets twice a day, at more or less 12 hours apart, within half an hour of eating. Given we have supper at about 8pm, I have to have had something to eat by around 9am. That really is not me but it’s amazing how quickly you adapt when you have no choice.

For breakfast on the first day, I had stewed prunes and yoghurt – a strange choice given that one of the very common side effects of capecitabine is diarrhoea. On that particular day, though, there happened to be some prunes in the fridge and, since I’m the only one in the family who likes them, I couldn’t let them go to waste. In fact, more than simply disliking them, my long-suffering husband can’t stand the smell of either prunes or yoghurt and refuses to be in the kitchen when I’m eating them! I usually drizzle some warm honey on top but he still can’t bear it.

The second day, a Saturday, I had a poached egg on toast. If I’m going to be forced to have an early breakfast, I decided, it may as well be nice. My resolve has petered out already, however; now I have a quick slice of toast and marmalade or jam, some fruit and a cup of tea, and I’m done.

Capecitabine can cause many of the same horrible side effects as other chemo drugs that are given via infusion. However, it works in a more targeted way compared with regular chemo and some of the standard side effects can be less severe. For good measure, though, there are some additional side effects that are specific to capecitabine.

On the hair front, I’ve been told to expect thinning but not loss. That’s something. I really wouldn’t have thought my hair could get much thinner than it is already but I guess I’m about to be proved wrong.

One of the more common side effects – that I’m looking out for and dreading getting – is palmar-plantar, or hand-feet, syndrome. IMG-20200528-WA0002With this, the palms of your hands and the soles of your feet can become red and  dry and flaky and sore and numb and swollen. It sounds horrendous and some people get it really badly. No-one needs that but for someone who plays tennis and cycles, it seems particularly cruel. I have already started moisturising my feet morning and evening in anticipation.

Exhausting one treatment and moving on to another is quite a sobering milestone psychologically.

Physically, ten days in on cycle #1 and I’m feeling fine. I wanted to write and post this before any side effects rear their ugly head. Once again, we can but hope for the best and see how it all goes.

Chocolate deliveries, bike rides, giraffes and scans

I have taken delivery of not one but two substantial amounts of chocolate over the past week or so.

How so?

I posted on facebook that I’d had to enlist our elder son to buy me some chocolate because my husband, who’s doing the shopping at the moment, eats too healthily and it just doesn’t occur to him to chuck a couple of chocolate bars in the trolley as he makes his way round the supermarket. It took a while, but at least now he does deign to bring home as standard a couple of packets of biscuits – but still no chocolate bars. 

Now I’m no addict, but I do have the odd bar on an ad hoc basis. However, I can’t currently indulge that habit while we’re in the midst of this coronavirus pandemic. My immunity is low as a result of the anti-cancer treatment I’m on and while I do go outside quite a lot now for walks and to exercise, I generally tend to not to go into shops. So no impulse buying of chocolate bars for me!

The photo I posted of me looking gleeful holding the bars my son brought back for me made a lot of people laugh and sympathise.

A couple of chocolate-loving friends – a huge thank you again, you know who you are! – were clearly feeling my pain to such an extent that they took things a step further and actually sent me supplies. We haven’t laughed so much in ages. My husband says he’s going to post that he’s got a craving for beer.

As you can see from the photo, I am now spoilt for choice. And that’s just one box.

I’ve given some away, the boys and I have been partaking, and the rest are “hidden for safe-keeping”, if you get my meaning. 

On the micro level things are still going largely fine on the lockdown front.

There are the chocolate deliveries for a start. Also, I’ve got most of this week off work and the weather is glorious. The roses in our garden have started blooming; they are gorgeous and there are dozens and dozens of buds, so it’ll only get more and more beautiful. Don’t look too closely or you’ll see all the aphids.

Yesterday I went out for a bike ride with a friend that involved seeking out and tackling the not insubstantial hills of south-east London, around Crystal Palace. There was blazing sunshine, there’s still far less traffic than there normally would be, and we enjoyed some incredible views over central London from the tops of the hills. 

We slogged up a fair few hills (with my friend overtaking me every time) and were rewarded with some lovely descents (with me doing the overtaking here). Before heading home, we bought some take-away coffee and chilled soft drinks and drank them in the welcome shade of a tree in Dulwich Park. It felt like we were genuinely on holiday.

On another bike ride, this time with my husband, we cycled past London Zoo in Regent’s Park and were delighted to see that the giraffes had come out for a stroll. There are two and there’s a sign there with their names on (I’ve forgotten their names*). Like everything else, the zoo is closed but we shouted over the gate and asked the zookeepers in attendance which was which. We don’t know, they told us excitedly, we’re from the other side of the zoo and don’t often get to see the giraffes. Their excitement was lovely to see.

On yet another ride into central London, we enjoyed great views of the river.

Those clear skies are good to see but they’ve come at a dreadful human and economic cost. We must never forget that.

Part of the reason I took time off work this week was that I was already taking time off to have scans. It’s that time again. I had a half-body PET CT scan this morning and tomorrow I’ll have an MRI scan of my spine. Both tests are to check to see whether there’s been any meaningful spread of the metastatic breast cancer I was diagnosed with just over a year ago. If there has been, we’ll be moving on to the next appropriate line of treatment.

I tell myself that I don’t generally get what’s known as “scanxiety”, ie worrying in the run-up to having the scans themselves and then again while you wait for the results (a week in this case). However, I really don’t think you can avoid it entirely.

You think it’s all fine then you realise you’re more argumentative at home than usual – and as those of you who know me are well aware, I’m pretty darn argumentative at the best of times. Or you’ll catch yourself doing too much forward thinking, dwelling on things you usually manage not to think about. Realising I’m doing this is usually enough to bring me back to the present. You just find yourself doing it more often than usual around scan time.

In this particular present, there’s a hedge that’s needs trimming out front. And afterwards, of course, there’s chocolate to be had as a reward!

* The giraffes are called Molly and Maggie, London Zoo told me in a reply to my tweet asking what their names were! I love Twitter when it works like that. Thanks to London Zoo for the reply!