Covid, etc

Note: I updated this post on April 15th to give a more realistic picture regarding what was happening cancer-wise even before I got Covid.

I managed to avoid it for the best part of two years, but Covid finally caught up with me. I had a mild dose and I seem to have recovered well. Of the five days that I was out of sorts, there was just one day when I felt really rough.

I was more upset about the fact that a session of chemo had to be cancelled than about the fact I had Covid. The only thing worse than being on chemo is not being on it when you should be.

It didn’t end there. When I next went to the hospital to start back on chemo, they took my temperature at the entrance to the treatment unit as they always do. It was sky high. I hadn’t realised. Almost immediately it was decided I couldn’t possibly have treatment. Several hours later, I was tentatively diagnosed with a bacterial infection and sent home with a seven-day course of antibiotics. I had now missed two chemo sessions – the equivalent of a whole cycle. I felt lower then than I had felt in a long time. I reckoned the last thing my cancer needed was a free rein to cause even more havoc than it’s already caused.

Back to Covid. After testing positive, I took up the offer of one of the new antiviral drug treatments for Covid that are now available for “clinically extremely vulnerable” individuals such as myself. There’s no way of knowing whether the drugs made a difference but my dose remained mild and I’m glad I was offered them.

I sent off the priority PCR test that I had at home soon after testing positive on an LFT. The NHS has been issuing these priority kits to people classed as CEV as part of a programme to get us tested quickly if we develop symptoms and, if positive and if appropriate, onto one of the new treatments. 

The drugs have been shown to reduce the risk of CEV individuals with mild to moderate Covid from progressing to severe disease and all that entails – hospitalisation and worse. They have to be started within five days of you developing symptoms. 

It was all very efficient. I was notified of a positive PCR result less than 24 hours after sending off the test. I got a call some hours later from an infectious disease doctor from the Covid Medicines Delivery Unit based at the hospital in southwest London where I’m being treated for my secondary breast cancer. I took delivery of a five-day course of an antiviral treatment called Paxlovid that evening and I started taking the tablets immediately. I started the course around 2.5 days after developing my first symptom.

Paxlovid is the brand name for the treatment, which is a combination of an existing HIV drug called ritonavir and a new antiviral drug called nirmatrelvir. The former helps the latter stay active in the body longer.

These are strong drugs. As the patient information leaflet says, “not many people have taken Paxlovid” and “serious and unexpected side effects may happen”. Within the CEV category, there is clearly a broad spectrum. Currently, I am clearly not at the most-at-risk end of it. Nonetheless, I decided to take the extra help.

Those of you who follow this blog know that I really only fully shielded for a few weeks at the very beginning of lockdown, back in March 2020. I did take care, adhering to guidance on social distancing and avoiding shops, supermarkets and public transport for a very long time, for example. However, I jumped at the chance to get out and exercise, socialise and travel as soon as it was allowed. With the Omicron variant being so transmissible, I’m aware I certainly could have been more cautious over the period when I must have caught the virus.

I know people with no underlying health conditions who’ve been far more cautious than I’ve been throughout the whole pandemic. Everyone decides on their own risk threshold but I do think that many people who were classed as CEV and who shielded for many, many months – and who indeed may be still shielding – were done a disservice by the government. Blanket guidance was issued for what very clearly was not a one-size-fits-all situation.

I was quite happy self-isolating while I had Covid. I work from home and there are some weeks where I don’t leave the house for a few days at a time anyway other than to get fresh air or meet friends locally. My symptoms were a sore throat, a headache and tiredness. I slept through most of the day I felt roughest. I’m quite happy in my own company so I didn’t suffer on that front. I listened to a book on Audible, my first time. I recommend the book – Unsettled Ground by Clare Fuller. It covers issues such as homelessness and it took on a special resonance, reading it as I was in the comfort of a big, warm, comfortable house.

My husband kept me fed and watered throughout (as he does anyway, it has to be said). He too likes his own company. He asked me on Day 5 when I thought I might stop self-isolating. When I said “possibly tomorrow”, he quipped back “steady on, there’s no rush”. Cheeky or what? In the end, I was in isolation for seven days.

The self-isolation was fine logistically but the disruption it caused was hard to deal with, emotionally and practically. Among other things, I had to cancel a trip to Glasgow that I’d really been looking forward to. I felt I was letting a lot of people down by not going. I had to send multiple begging emails in an effort to get refunds or credit vouchers for the cost of unused train tickets, hotel reservations and theatre tickets. I also had to rearrange or cancel several appointments or events in London.

I currently have treatment with intravenous eribulin at the hospital on Day 1 and Day 8 of a 21-day cycle. I have blood tests on Day 7 and Day 21. I also tend to see the consultant on Day 21 or Day 1. When you’re tied to the hospital so much, you have to organise your time really carefully. I’ve become very skilled at this but the slightest change to what you think is going to be your routine can cause havoc. For example, the upset to my chemo routine caused by these recent events in combination with a rescheduled PET CT scan will mean having to cut short a trip to Spain in the run-up to Easter, with the extra cost and inconvenience this entails. First-world problems certainly, but they’re still problems. I was so low and frustrated at one point that I told my husband I wasn’t booking anything ever again. That’s how bad it was. That didn’t last for long, you won’t be surprised to read.

It doesn’t look like the four weeks I went without treatment made much difference to my situation. Having been at its lowest level since I was diagnosed almost three years ago, my tumour marker level had already started to edge up even before I got Covid. It continued to rise during my time off treatment and it’s risen again since I’ve been back on chemo. Nothing about that is good in any way.

More positively, I haven’t needed a red blood cell transfusion since January 17th. I started on eribulin on December 1st last year. Given that I’d been having transfusions at least monthly for almost a year, I’ve been delighted at this outcome. Even here, though, while my haemoglobin level went up, it didn’t stay at that level and has been slowly falling – again even before I got Covid.

Rising tumour marker levels and falling haemoglobin levels. That’s not a good combination.

As I’ve said before, I’ve generally largely felt really well on this chemo. In fact, I would say it’s been the easiest of all five treatments I’ve had in the past three years.

I have had a couple of MRI scans done in recent months on a specific area to check for problems there but I don’t want to dwell on that here.

Also, I will find out for sure soon whether my cancer is now spreading elsewhere; my first half-body PET CT scan since starting on this treatment is scheduled for April 14th. It was meant to have been on March 12th but the scanner was broken and the appointment had to be rescheduled.

Covid and the subsequent infection – followed by a rotten cold, because I hadn’t suffered enough – didn’t spoil everything.

The four of us (my husband, our two boys and I) still managed to get away to the French Alps for a few days’ skiing that coincided with my husband’s 60th birthday. We had a fabulous time. It was so lovely that we were able to spend this important milestone together, in the place where we’ve had such fabulous family holidays in the past.

I then went to the beautiful Spanish island of Mallorca and joined for a few days a women’s cycling camp I’d been to a few times before; I did precious little cycling but the achievement was doing any at all.

Even going was a big deal. I was so deflated at having to miss a second session of chemo that I totally lost my mojo and couldn’t see myself summoning the energy even to pack, never mind get on a plane. My husband persuaded me to go and I’m very glad he did. I didn’t do any group riding; that was never in the plan. However, despite not having been out on my bike back home since last October but hugely inspired by the enthusiasm of the other women on the camp, I hired a bike. Among other things, I did a short ride to a beautiful cove that I’d never have visited had I not been on the bike. It felt unbelievably good to be on the bike again. I got to spend some time with a friend from London who was also there, hang out with some women who are members of Bella Velo, the women’s club I’m still a member of here at home, and see again some women I’d met before on previous camps run by the same lovely company, Mellow Jersey. I am so grateful to Emma and Tony of Mellow Jersey for suggesting I come out. The last time I was there was right at the start of the coronavirus pandemic, when in very dramatic fashion we had to evacuate the island from one day to the next.

Finally, just last weekend, I made it up to my native Glasgow for my older brother’s 60th birthday party. It was such a joyous occasion, filled with so much positive energy. It’s not often my five brothers and I all manage to get together at the same time and it always feels very special when we do. I think the last time we were together may have been at our mum’s funeral in September 2020, mid-pandemic. The pandemic is very much still with us, with rates particularly high in Scotland. Regardless, the party went ahead and there was lots of dancing and singing – including a Karaoke rendition by my older brother and me of an old family favourite, The Gambler, that would have had the original singer Kenny Rogers turning in his grave!

All three trips were priceless, especially as it really wasn’t certain that any of them would happen pretty much right up until the last minute.

I’m relieved to be back on chemo, even though I’m aware I may not get too much more out of this particular one. I’ve had both sessions of Cycle 6 of eribulin and am now a few days into the two-week break.

Regardless of what the PET CT scan shows, it appears that an unconnected issue is brewing that may need addressing in rather a brutal way. Thus the MRI scan.

Back to today, though. One son is back home from uni for the Easter holidays and I’m already enjoying basking in his presence. Also, I’m looking forward to heading off to Spain next weekend where my husband and I will spend time with some very good friends, eat some good food and hopefully feel some sun on our shoulders.

Notching up Cycle 3 of my latest chemo

Last week I went ahead with the first session of the third cycle of the iv chemo that I’m on. This afternoon I had a blood transfusion that will enable me to go ahead later this week with the second of the two sessions that make up the cycle.

Things are far from perfect on the blood front – thus today’s blood transfusion, for example – but they’re not disastrous. I’m just relieved to be notching up another cycle of the chemo that I started at the beginning of December.

The fact that I’ve only been on this chemo – eribulin – for a month-and-a-half means it’s still early days in terms of knowing whether it will be successful in keeping in check for a decent length of time the metastatic breast cancer for which I’ve been having treatment since late Spring 2019.

That said, there is another thing about which to feel relieved – indeed perhaps encouraged. My tumour marker, which in my case is a good indicator of cancer activity, has fallen again. While we don’t have bang up-to-date results, the test done early in Cycle 2 showed that it’s the lowest it’s been since I was first diagnosed. It’s not everything, but it is a very important part of the overall picture. Things can change very quickly, but falling levels at any time are clearly far better than rising levels.

Eribulin, also known as Halaven, is the fifth treatment I’ve been on. The previous four worked for varying lengths of time before my cancer outwitted them and spread a little more each time. The last treatment – paclitaxel, also iv chemo – only worked for a few months so it’s understandable I’m nervous about how I’ll fare on this latest one.

The cancer is in my bone marrow among other places and is preventing my body from making healthy blood, particularly red blood cells. Blood transfusions* – to increase my haemoglobin level – have become a way of life. I’ve been having them almost monthly since May last year. However, on the past two occasions, ie since starting on eribulin, I’ve needed one unit rather than two. In my world, where not bad news pretty much equates to good news, that’s a positive.

Any side-effects I had from eribulin over the first two cycles have subsided or are under control and I’m feeling really well. Each cycle lasts 21 days. Treatment sessions are on Day 1 and Day 8. My Day 8 session of Cycle 3 is on Wednesday this week. Barring any mishaps, there will then be a full 12-day gap before my next hospital appointment, which will be for blood tests towards Day 21 of this cycle. Then the whole thing starts again, beginning with an appointment with the consultant where you find out whether you need another transfusion, whether your tumour marker has gone up or down, whether things are looking good or whether there are signs of trouble and, ultimately, whether you will – as you fervently hope – go ahead with the next cycle.

I’ve been at the hospital twice almost every week since starting on eribulin. I’ll accept whatever it takes to keep me well, but sometimes it can feel pretty relentless. I’m really looking forward to the break. 

*Our two boys promised me as a birthday present last July that they would both become blood donors. Covid jabs, Covid infections, colds and other assorted obstacles got in the way but the older one (23) is indeed now a donor. I’m delighted. The younger one (21) almost made it but found out on the day he was due to donate that he’d have to wait another two months as he’d recently had his ear pierced. He’ll get there.

My festive A to Z (chemo side effects included)

I’m very close to the end of my second 21-day cycle of eribulin, the iv chemo I moved on to at the beginning of December as part of the latest pharmacological effort to stop my metastatic breast cancer from spreading further around my body. 

There have been side effects but they’ve been tolerable. Physically, on the whole, I’ve been feeling more than fine. Emotionally, too, I’ve been feeling stronger. I’ve largely put behind me the disappointment of the PET CT scan that showed that my cancer had outwitted paclitaxel, the chemo I was on before I switched to eribulin. 

I look back over the past six weeks and, despite multiple trips to hospital for treatment sessions and associated blood tests and/or blood transfusions, cancer has definitely not been front and centre.

There has, of course, been Christmas. With the Omicron variant of the coronavirus rampaging around the country, there were very few of us whose plans for the holiday period were not disrupted at least to some extent. Thankfully, we escaped pretty much unscathed, disappointing as it was to cancel several social engagements we’d really been looking forward to.

Christmas is a time for lists, whether you’re writing to Santa or shopping for presents or for the food for Christmas dinner.

Here’s another list of sorts that you may be interested in. It’s my festive A to Z!

A

Appetite. This was all over the place during the first cycle of eribulin. Some days I had no appetite. Other days I had a huge appetite. On yet other days I wanted to eat but my mouth was so dry that I found it hard to swallow. Things are much more stable now.

B

Beef Wellington. For the third Boxing Day in a row, our two boys made Beef Wellington for dinner. The shape may not have been perfect this year but it was just as good as the previous two offerings! What an absolute treat.

Blood tests. I had my latest round of tests this morning. I’ll get the results on Wednesday when I see the consultant. All going well, I’ll start Cycle 3 of eribulin later the same day.

C

Chemo. Each 21-day cycle of eribulin – also known as Halaven – comprises two treatment sessions. These take place on Day 1 and Day 8 of the cycle, with blood tests done one or two days before each session to check to see whether it’s ok to go ahead with the next one.

Christmas Day. An extremely pleasant relaxing and relaxed day that involved for my husband and me a walk across Tooting Common, a pint in a local pub followed by drinks at a friends’ house across the road, then, later at home with the boys, a delicious traditional Christmas dinner, board games and a film.

D

Dry. We did think that we might do “Dry January”, where you go the whole of the month without drinking any alcohol. It didn’t take us long to decide life was too short for such sacrifices so we’ve decided instead to cut down. Perhaps “damp” rather than ”dry” would be more appropriate for this entry!

E

Exhibitions. My husband and I have been taking advantage of the fact that central London is very quiet to visit a few of the exhibitions that are on at the city’s museums and art galleries. It’s been fun.

F

Fatigue. I’ve experienced this in its extreme form where you feel like you’re walking through treacle and you really just have to stop and, ideally, sit or lie down. I’ve also experienced bog-standard fatigue, mild fatigue, and no fatigue at all. It’s fair to say chemo takes it out of you.

G

Gin. Sloe gin made by a friend or gin from Tiree, the tiny Hebridean island where we spent a week in October. I’m not fussy.

H

Hair. Ongoing thinning and loss of head and body hair.

Head. Shaving thereof.

Haemoglobin. The cancer is in my bone marrow among other places, affecting my body’s ability to make healthy blood. It particularly affects my red blood cells. My haemoglobin level is constantly low. If it goes below a certain level, I can’t have chemo. During both of these first two cycles of eribulin, I’ve had to go to hospital on or around Day 15 for blood tests to have it checked. I had one unit of blood transfused during the first cycle but I haven’t needed one during the second cycle. That is good. 

Heartburn. A side effect of eribulin. Painful, not pleasant.

I

Indecision. I’ve spent hours looking at flights to various places but haven’t yet taken the plunge and booked to go a somewhere. Watch this space.

J

Jelly. Yes, jelly, that weirdly coloured gooey stuff you should really only eat at children’s birthday parties. It was a godsend on days during my first chemo cycle when I had no appetite and/or a dry mouth. 

K

Kleenex. Nose hair is one of those things most people (or at least most women) don’t realise they have. However, you notice when you don’t have it (see above under ”Hair”) as you have a runny nose much more frequently than you used to. You therefore need plenty of tissues – not necessarily Kleenex but it was the best I could think of for the letter ”K”!

L

Lateral flow tests. I’ve lost count of how many I’ve done. Thankfully, they’ve all been negative.

M

Metoclopramide. This is an anti-nausea drug I take to stop me feeling sick after I’ve eaten. I’ve more or less got this under control now. 

Metal. Some food tastes metallic in the days following chemo, after which it goes back to normal.

N

Nata. As in “pasteis de nata”, those delicious little Portuguese egg custard tarts. A good friend made a surprise delivery of a box of four. Yum!

O

Optician’s. I stepped on my glasses and broke them. I don’t have a spare pair (thank goodness I also have contact lenses). An appointment has been made at the optician’s for an eye test and to buy a new pair of specs.

P

Priority PCR test. I’ve been sent one of these as part of a government initiative to ensure that clinically extremely vulnerable (CEV) individuals such as myself, should we catch Covid, get timely access to one of the new drugs that are now available for treating the illness.

Pubs. There have been plenty of visits to the pub. Again, we’ve taken advantage of the fact things have been quiet.

Q

The Queen’s Speech on Christmas Day. We somehow missed this!

R

Roast potatoes. You can never have too many of these with your Christmas dinner!

Rummikub. We played a few rounds of this on Christmas Day. 

S 

Steroids. I take these for two days after each chemo session, to help prevent nausea. I have a huge appetite for two days and, once I start talking, it’s hard to stop.

Swimming. I managed a couple of sessions in early December, before the start of the massive surge in Covid cases. It may be time to start thinking about going again.

T 

Tumour marker. In my case, my tumour marker is a good measure of how active my cancer is. The marker level went down during the first cycle. I’ll find out on Wednesday what it’s done in Cycle 2. Fingers crossed that it’s stayed where it is or has gone down further.

Tennis. I still can’t quite believe that I have been back on the courts. This disease saps your confidence and I’d convinced myself that, with my haemoglobin level being so low, I wouldn’t have the energy to play. In the end I played for around 40 minutes, with a fabulous bunch of women from the tennis club of which I’m still a member. I hadn’t played for many, many months and I absolutely loved it.

Theatre. A friend very generously invited me to the theatre in the run-up to Christmas. That too was a lovely treat.

U 

University. Both our sons came home from uni for the Christmas holidays. As always, it was/is great to have them around. The older one has gone back; the younger one is still with us. Both are in the middle of final year exams. These are still being done online. By the time they finish, they will have had less than six months of “normal” university – from a three-year degree.

V

Vaccines. I’ve now had my booster jab, bringing to four the number I’ve had overall. CEV individuals were offered three jabs as part of the primary vaccination programme and then also a booster.

Volunteering. On New Year’s Day morning, I volunteered at my local Parkrun. I put back in order some of the bar codes of the 299 people who turned out that morning to run, jog or walk the 5k route. I’ve volunteered a couple of times now since I myself stopped running.

W

Wig. I have renewed my acquaintance with the wig that I last wore in February 2017.

Walking. Lots and lots and lots of walking.

X

This may be cheating but ”x” is for the challenging letter ”x” in Banagrams and Scrabble, two of our favourite word games. We played both of these more than a few times time over the holidays.

Y

Year. Another year has passed. It’s been very hard for many on many fronts. On a personal level regarding my health, it’s hugely disappointing that three different lines of treatment stopped working over the course of just 12 months. In many ways, though, it’s been a wonderful year. If you follow this blog, you’ll have followed the many ups and downs.

Z

Zoom. We hadn’t used the Zoom online chat service for a while but it came back into its own over Christmas. My book group had its Christmas meet-up on Zoom where, instead of the Secret Santa we would have done had we met in person, we bought ourselves a present and did “show and tell”! On another occasion, we were able to chat to our friends in Madrid.

And that’s it. Happy New Year, everyone!

From one chemo to another

I had hoped to go the full six, 28-day cycles with paclitaxel, the intravenous chemo I was on as part of my treatment for the breast cancer that’s spread to my bones and is in my bone marrow, affecting my body’s ability to produce healthy blood.

That would have taken me to early/mid February next year. Frustratingly, my cancer had other ideas. I’m now no longer on paclitaxel and I’m due to start a different chemo – eribulin – on Wednesday this coming week. 

Yes, I was annoyed and frustrated and angry and sad and, yes, I swore a huge amount out loud to myself once the results of the half-body PET CT scan that sealed my fate with regard to paclitaxel had sunk in. I got the results on Tuesday this past week. I’m not going into detail but they showed “progression of the skeletal metastatic disease” and “nodal and widespread metastatic activity… suggestive of disease progression”. The paclitaxel session I was due to have two days later was duly cancelled.

A few days on, I’m more settled but I’m still also massively pissed off.

Of course it could be worse. However, most of you know that I’m a great advocate of the sentiment “just because it’s not worse doesn’t mean it’s not shit”. It is shit. Every time a drug in your limited treatment arsenal stops working is shit. That said, there’s still no visceral spread and there are no concerns regarding spinal cord compression. There are options and there is a plan. That plan is eribulin (brand name Halaven).

My tumour marker level had tumbled during the first and second 28-day cycles of paclitaxel almost to an all-time low since my secondary breast diagnosis in Spring 2019. When my tumour marker level is falling, it tends to mean the cancer is less active. It had edged up a little during the third cycle but it was still very low relative to where it had been when I started on paclitaxel in mid-August.

The fact that the marker had gone up at all was disappointing, but not disastrous. I’d also been experiencing some pain in a couple of joints on a sporadic basis. On a positive note, the results of the spinal MRI scan I’d had recently had come through, showing no change from my previous one, in July. It was decided when I saw the consultant at the end of Cycle 3, on Wednesday 17th November, that I should go ahead with Cycle 4. I had the first session a couple of days later, on Friday 19th, following the now seemingly standard blood transfusion. On Thursday 18th, I had a half-body PET CT scan, which covers from the top of your head to above your knees. As with the MRI scan, my last PET CT scan had also been in July.

It’s fair to say things started to get a bit messy on the Wednesday night (17th). I awoke with considerable pain in various joints on my left hand-side at various points during the night. It largely eased after I took some strong pain killers. It happened again the following two nights, although the episodes on Wednesday were by far the worst.

Things were largely ok during the day. I’d signed up as a volunteer at my local Parkrun on Tooting Common in southwest London at 9am on the morning of Saturday 20th. I was due to be one of the barcode scanners at the end of the run. I felt wrecked but I wasn’t in pain so I went along and did that. I’m glad I did. I’ve had so much out of Parkrun; it’s good to give back.

To cut an even longer story short, some pain returned on the Saturday morning after I got home from Parkrun. I’d run out of strong painkillers and I was exhausted but couldn’t sleep. I ended up being admitted to the hospital where I’m being treated and kept in overnight while they sorted out my pain meds. I was not screaming in pain or anything like it but it was not pleasant. I was discharged on Sunday afternoon, by which time I was absolutely fine. I left with copious amounts of both strong and very strong painkillers.

I cannot fault the care I received in hospital but it was all rather frustrating as I’m pretty sure I could have resolved the matter at home had I not run out of my usual painkillers.

On the Monday, I was contacted by the superbly efficient clinical nurse specialist who’s a critical part of the breast cancer team at the hospital. She said she and the consultant were fully aware I’d had an overnight stay and that the consultant would like to see me the following day. I didn’t realise it at the time, but the results of the PET CT scan were already through. Those, together with the pain-related episodes, meant it was time to move on from paclitaxel. 

With Tuesday came a detailed review of the scan results and my signing the consent form to start eribulin.

So what is this new treatment? 

With paclitaxel, it was a 28-day cycle. Each cycle consisted of three iv treatment sessions. These took place on Days 1, 8 and 15, with blood tests the day before each session and then again at the end of each cycle, followed by a meeting with the consultant on or around Day 28. Each treatment session took a couple of hours or so, with the first session of each cycle taking an additional hour or so as this was when I received my monthly infusion (also intravenously) of the bone-strengthening drug, Zometa (zoledronic acid). The standard number of cycles one has on paclitaxel if things are going ok is four but this can be upped to six.

With eribulin, it’s a 21-day cycle, with each cycle consisting of two treatment sessions. Treatment is on Days 1 and 8. As with paclitaxel, there are blood tests the day before each session, to check that it’s ok for that session to proceed. There are also blood tests at the end of the cycle, followed by an appointment with the consultant 1) to go over the blood test results; 2) to discuss how you’ve been coping with the treatment; and 3) hopefully that you can go ahead with the next cycle.

Unlike with paclitaxel, there is no limit to the number of cycles of eribulin you can have. As long as you’re tolerating it well and it’s working, you keep taking it. The longest the consultant has had a patient on it is 13 months. Fingers crossed it works for me and that any side effects are tolerable – as they were, it has to be said, with paclitaxel. My feet feel better than they’ve been in years and I’m pleasantly surprised not to have lost all my hair. I was also feeling really well overall.

There are some overlapping potential side effects between paclitaxel and eribulin, but of course each drug also has some that are unique. Somewhat strangely, bone marrow suppression is a potential side effect of eribulin – but that’s also precisely among the things we’re trying to treat.

On the bone-strengthening drugs front, I’m switching from Zometa to denosumab (Xgeva). We’ve switched between the two before. The idea is that a drug that works in a different way will have a more beneficial effect. That, in essence, is also the idea behind switching to eribulin. 

Eribulin is delivered intravenously – that’ll be through my port – over a period of just two to five minutes. Denosumab is given as a quick injection – in my case to the abdomen – once every four weeks. It’s clear treatment sessions at the hospital will be much shorter than when I was on paclitaxel and Zometa.

With my haemoglobin level and resulting energy levels being largely low, I now rarely cycle and I don’t run at all.  Swimming has become my new favourite pastime. I don’t swim far and I don’t swim fast but I’ve always loved swimming and now I do it once or twice a week. I’d like to do it outdoors but I get cold very quickly and if I don’t have a way of getting warm immediately, I’m cold for hours.

This desire to feel the sun on my shoulders was in grand part behind my decision to escape to a beautifully warm and sunny – and beautiful – Cyprus for a week in early November. 

Yes, you read correctly. Cyprus. Photo number one to the left.

And yes, you’re also right, my husband and I had indeed just been to Madrid.

The photo to the right was taken on the trip to Spain. It’s of me and two of my dearest friends, both of whom I met in Madrid in the early to mid-1980s when I lived there teaching English as a foreign language before coming back to Glasgow to finish my degree (in Spanish, what else!). We were in Madrid for a wedding; the woman in the middle is the mother of the groom.

My now husband and I met in Madrid in those same early days. We loved the city this time round as much as we’d always done.

And, yes, there is even more on the travel front. Before the Madrid trip, we had been to Tiree, a tiny island off the west coast of Scotland.

My husband and I were in Tiree with one of my brothers, John, his wife and my niece, one of their four children. We had a lovely week.

Madrid and Scotland had been in the diary for a long time. After months of coronavirus-related uncertainty – combined with uncertainty over how I might be feeling health-wise – we were delighted that we were able to do both trips.

Cyprus was an impulse booking, done the day before I had my port inserted on 1 November. I just Googled ”Where’s hot in Europe?” and Cyprus won.

I’m happy to say I swam outside every day of the Cyprus holiday in the sunshine, either in the pool or in the sea – indeed sometimes both on the same day!

There is little that can beat the feel of the sun on your shoulders drying you off after you’ve been swimming.

The sea was warm, the water was clear. It was an absolute delight. I went with one of my brothers, Peter. We took dozens of photos. The one above on the left is among my favourites. 

I couldn’t stay in the water for long at any one time as I’d only recently had my port inserted. The wounds from the two incisions from the procedure were healing well and while I wasn’t concerned about getting them wet, I didn’t want to overdo it.

Before I had the port inserted, I thought I was ok with the chemo nurses taking several attempts to find a decent vein through which to administer chemo or blood transfusions. Since I’ve had the port inserted and we’ve now used it several times, I have to say it is a game-changer. It makes things so much easier.

The procedure to insert the port only took some 40 minutes. However, with the pre-procedure preparation and the post-procedure monitoring, I was at the hospital for the best part of the day. The procedure, which is done under local anaesthetic, was the weirdest experience. You feel the sensation of cutting, pushing and shoving – but no pain. The port stands out from my chest; it looks weird but I’m totally fine with it.

Several other events have happened in my life, not relating to my treatment or travels. On my last day in Cyprus, I awoke to the news that the 57-year-old husband of one of my best friends back in Glasgow had died very suddenly and unexpectedly the previous night. A day or so later, the husband of my beloved aunt and godmother in New Jersey died, of advanced prostate cancer.

It’s easy to say, but this first tragic event in particular illustrates why worrying about one’s own mortality – or indeed about the mortality of sick parents, friends or relatives – is so futile. Enough sad/bad things happen that aren’t even on the radar. Be concerned, yes, but try not to over-worry. Events such as these will happen regardless. If anxiety about your or someone else’s future is becoming overwhelming, please seek help. And let the people you’re worrying about know you love them. That should make you and them feel better.

I’m hoping to go up to Glasgow for my friend’s husband’s funeral later this month. It will depend on how I feel after starting this new chemo and on the ever-changing situation with regard to the never-ending pandemic. 

In the meantime, I’ll be booking regular swim sessions at the two local leisure centres to which I’m fortunate to have access. I may also be on the lookout for another break that involves winter sun and warm seas. If you have any ideas, let me know!

To finish, fingers crossed eribulin works for longer than either paclitaxel or indeed the drugs I was on before that. I’m not aiming for or expecting anything, but more than just a few months would be very welcome.