Laying to rest the ghosts of mammograms past (and making up for a cancelled bike ride)

I’ve had a couple of weeks of laying old ghosts to rest.

First of all, I got the results of the review of the clear mammogram I had in October 2014, nine months before my diagnosis with Stage IIIa breast cancer (The details) in July 2015. The review found nothing remotely suspect in the original images; nothing was missed. The tumour I had in my right breast therefore grew from nothing – or at least from being undetectable on a mammogram – to probably bigger than 5cm* and out into the lymph nodes in my right armpit within the space of eight or nine months.

Secondly, I did a two-day bike ride that a friend and I had said we’d do together once my treatment was over and I felt up to it. This was to make up for my having had to cancel a long-distance bike ride to Brussels last September as by then I’d started chemo.

Clear mammograms

The results of clear mammograms that are followed by so-called “interval” breast cancers – ie cancers that are diagnosed between routine mammograms – are reviewed as a matter of course and the women notified of the results. I don’t know how soon after the fact the reviews usually take place but a couple of months ago I went ahead and requested that mine be done.

I had two mammograms in the 18 months preceding my diagnosis, one in January 2014 and one later that same year, in October (So you think you’re breast aware). Both were reported as clear at the time and, following the review that’s just been done, nothing has changed. The consultant radiologist who went through the results with me two weeks ago yesterday said that the team of five reviewers, four of whom were also consultant radiologists, could see “no malignant features or subtle signs of cancer” in the images. The official classification is “Category 1: normal/benign features”.

At least now I’ve got the results. This had been on my mind ever since I was diagnosed. I can now draw a line and move on.

It’s hard to predict the rate at which tumours grow. My cancer was Grade 3, the most aggressive grade. I’d known it was possible for the tumour to have grown within the space of eight to nine months to the size it was when I was diagnosed (it won’t surprise you to hear I’d discussed it with my oncologist). Nonetheless, I found getting the results of the reviews very upsetting. I’d been proactive in ensuring I was screened. I thought I was pretty “breast aware”. I felt, however misguidedly, that to be diagnosed with Stage IIIa breast cancer (after Stages IIIb and IIIc comes Stage IV, which is incurable) after having had two clear mammograms was not just ironic but massively unfair. I’d been doing pretty well with the whole “looking forward, moving on” thing, but this brought everything back. I felt I was in the middle of it all again instead of almost seven months out of treatment. The consultant and the breast care nurse who was also at the meeting were very sympathetic.

Of course I’m pleased that nothing was missed. If I’m completely honest, however, I think that if things had gone the other way a tiny, tiny part of me would have been relieved that I could put at least some of the “blame” for my cancer having got to Stage IIIa by the time I was diagnosed on something or someone else other than myself. People have said I did well to act when I did but I will always wonder whether I could and/or should have acted sooner. The further I get from last July, though, the less I’m able to remember how long I might have been wondering whether something was wrong. Anyway, you can’t change the past but you can change how you feel about it. There’s no point beating myself up about something I can’t change.

I turned 50 in July 2013 and, instead of waiting to be called in for a routine mammogram under the NHS breast cancer screening programme, towards the end of the year I phoned and asked for an appointment. I had my first mammogram in January 2014. They kept me on the system and nine months later, in October, I had what would have been my routine mammogram.

Mammograms are no more than a snap shot of a moment in time and screening picks up around one third of breast cancers. Considerably more breast cancers are found by women themselves than are found through routine mammograms so what happened to me is not unusual. I do wonder whether having had two clear mammograms in relatively quick succession gave me a false sense of security. Also, I wonder at which point my tumour would have shown up in a mammogram before I’d have been able to feel it. What if I’d had that second mammogram three or two months or even one month later? Would it have shown up then, when it was perhaps at an earlier stage? If it’d been found earlier, my risk of recurrence would be lower than it is and perhaps I wouldn’t have had to have so much treatment. I know better than to dwell on thoughts such as these but I don’t stop having them in the first place.

Bike trip
There are only so many tears you can cry in one day so a few hours after getting home from the review meeting I finally called a halt to my pity party for one. That evening I headed off to the pub to meet my friend Juliette to plan the bike ride we’d be doing the following week in the New Forest in Hampshire. I’d done a 63-mile bike ride with Juliette just days before I was diagnosed and, at some point after I’d cancelled the long-distance ride to Belgium that was planned for last September, Juliette suggested we do a trip together the following summer to make up for it. And so we did. And what a fabulous couple of days it was.

Getting the results of the mammogram reviews helped me put one ghost to rest. Two days last week spent cycling in the sunshine through forests and along coastal roads, and past ponies, thatched cottages and duck ponds, enabled me to put another one to rest. I’d been worried about how long it might be after surgery before I’d be able to cycle long distances again… or indeed whether I’d be able to do such bike rides at all (Stopping the downward spiral). So a huge thanks to Juliette.

There’s more. The day after I got the results of the mammogram reviews, Andy, the boys and I headed up to Cumbria and Yorkshire to join our friend Dave Clark on a 14.5 mile leg of the 200-mile coast-to-coast trek from the Lake District in the west of the country to Robin Hood’s Bay in the east that Dave had started out on a few days earlier. Dave was diagnosed with Parkinson’s five years ago. He’s just turned 50; I’ve mentioned him before (Don’t wait for the rain to stop, dance – or cycle – in the rain).

Dave completed the walk in 13 days (https://www.justgiving.com/fundraising/ClarkysC2C, #ClarkysC2C & http://bit.ly/2dswuyQ) in an effort that was nothing short of heroic, helping raise £100,000 for Parkinson’s UK along the way. I’m sure Dave has his dark days but every step of that walk was life-affirming and a lesson to us all that what matters is the present and that making the moment count beats the hell out of dwelling on regrets about the past or worries about the future. This post’s for you, Dave.

*While my tumour was estimated to be probably bigger than 5cm, we never found out the precise size because I had chemo before I had surgery. I had such a positive response to the chemo (A busy week with welcome news – “no mass identified” and “no further surgery necessary”) that by the time I had my mastectomy there was essentially nothing left of the tumour to measure. Can’t complain about that although at the time it did freak me out that I’d never know the exact size of the beast growing inside me.

Same run, but no tears this time

That’s two Saturdays in a row I’ve done the 5k Parkrun on Tooting Common here in south London. Last Saturday there were tears as I crossed the finish line; yesterday there weren’t.

I’d run 5k round the common once on my own (Passing the Velux window test and “running” 5k) since finishing seven months of treatment for breast cancer at the end of February. So as I set off last Saturday at 9am with around 250 other runners and with my husband Andy running beside me, I was confident I’d be fine. But I couldn’t hold back the tears as I crossed the finish line. I guess running the same route at the same time as all these other people – and knowing thousands others were doing exactly the same thing in Parkruns up and down the country – in some way made me feel I was back in the real world after having been in some sort of parallel universe since I was diagnosed last July. Andy – for the millionth time over these past months, it seems – provided a shoulder to cry on. Thanks also to our friend and neighbour Steve, who finished just before me and ended up with me crying on his shoulder too. Seconds later, I was fine again.

Yesterday there were no tears. I finished – two minutes faster than last week – with a smile and a feeling I was moving forward on the road towards my “new normal”, whatever that ends up being.

#iloveparkrun #keepitfree

“…3, 2, 1 and relax. Congratulations!”

I’d heard the radiographers count down from three then tell me to relax dozens of times during the 15 sessions of radiotherapy that I’d already had.

I’d to hold my breath seven times during each session as the radiation was delivered (A very strange position to be in (Radiotherapy Part 1)).  “3, 2, 1… and relax” was what the radiographers said through the intercom at the end of each hold to let me know I could start breathing normally again.

This time was different. It was Friday 26th February and it was a big day. It was my 16th and final radiotherapy session and it marked the end of the hospital-based phase of my breast cancer treatment. That’s why the radiographer guiding me through that session added “congratulations” after his final instruction to relax. Now for all I know they say that to everyone at the end of their last session. Regardless, I really appreciated the gesture. The moment deserved to be acknowledged. I’d been preparing for, having or recovering from treatment for seven months. Since last July, I’d had chemotherapy, major surgery involving a mastectomy, immediate breast reconstruction and axillary lymph node clearance, and finally, radiotherapy. Less than a month after I’d had surgery, my dad died. His funeral was in Glasgow on 1st February, I came back home to London on the 3rd and started radiotherapy on the 4th.

The day of that final session was an emotional one. I’d been in tears within seconds of waking up, from relief at having got to this point. I’d been expecting to burst into tears the second my last radiotherapy session was over but I was distracted by the radiographers chatting to me about how I felt the sessions had gone, asking about my plans for the rest of the day, getting me to sign the treatment completion form, warning me that the side effects from radiotherapy can continue to happen for another couple of weeks and giving me a leaflet about finishing treatment. My composure didn’t last long, though. I’d to have dressings reapplied to where my skin had reacted badly to the radiotherapy and I started to lose it as I walked from the radiotherapy suite over to the treatment room. Once inside, I sat down on the nearest chair and out it came. The tears only lasted a minute or two and I think I can be forgiven for feeling somewhat overwhelmed by the occasion. The radiography assistant who applied the dressings was very understanding. I guess they’re used to it.

There were more tears throughout the day when the enormity of what I’d gone through would hit me or I’d think of how different the day would have been if my dad had been around to share it.

I’m glad I waited a while to write this. I look back now and recall a lovely day. Cycling back from my appointment in the sunshine later that morning (Bike 8 – Car 7. Victory is mine.), I remember feeling immense gratitude towards everyone involved in my treatment. Just as I got back home I bumped into a neighbour I hadn’t seen for a while and we’d a bit of a chat. I got a massive hug from our cleaning lady. I had lunch with my tennis buddies, tea later in the afternoon with some good friends and lots of people got in touch to say congratulations. Andy, the boys and I finished the day off with our traditional celebratory family meal. You know the one (More good news)… lasagna, garlic bread and salad. This time the champagne was better than usual. We toasted ourselves and we toasted my dad.

In the end it was a day of huge relief and quiet celebration. It’s a day I won’t easily forget.

 

Don’t wait for the rain to stop, dance – or cycle – in the rain

In the epic Bike vs Car duel that I am currently playing out on the not so mean streets of southwest London, the score now stands at Car 7 – Bike 5.

I’m trying to cycle to more sessions of radiotherapy than I drive to (Cycling challenges and lowering expectations). It’s an eleven mile round trip. Yesterday, Monday, was the critical day. It was raining (lightly, but it was still raining) and I could so easily have hopped in the car and driven. What a bad start to the week that would have been. It wouldn’t have counted towards the overall score as I’d decided that if the weather was bad, I could drive and it wouldn’t count. I reckoned that was fair. However, it would have meant that, even if I cycled to my final four radiotherapy sessions over the rest of this week, the best I could get would be a 7 – 7 draw. If I wanted a win, I had no choice but to cycle, despite the rain. Now, an 8 – 7 win is still in sight.

I did briefly consider phoning the clinic at 9 o’clock yesterrday morning to ask if they could change my appointment to the afternoon when the forecast was better, but I decided that would have been taking things too far. So I put on my waterproof trousers and jacket and off I went. I got wet, but not soaked. It wasn’t cold and it felt good. By the time I left the clinic to come home, it had stopped raining.

On the way back, I bumped into a good friend and neighbour, the Sky Sports presenter, Dave Clark.

Dave, who’s 49, was diagnosed with Parkinson’s disease five years ago and is living life to the absolute full (Dave Clark interview: Darts presenter lifts lid on five years of battling Parkinson’s – and refusing to throw in the towel). We started chatting about where we might go on holiday this summer. We’re thinking of going where Dave and his family went last year. He said a few things about how beautiful it was then remarked that it rained a lot at that time of year. No sooner had he said that, though, than he followed it with “*But don’t wait for the rain to stop, dance in the rain, eh?” We both knew exactly what he meant. That’s why I cycled to radiotherapy in the rain yesterday and that’s why, in September, Dave will be tackling the 200 mile coast-to-coast walk across the north of England, raising funds along the way for Parkinson’s UK…  but hopefully not in the rain! We hope to be with Dave for part of the trip. Way to go, Clarky.

* I’d never heard it before yesterday but I think the original phrase is “Life isn’t about waiting for the storm to pass… It’s about learning to dance in the rain.” I’m not usually one for cod philosohpy, but this one struck home. 

In the end, the wig ditched me

I was feeling really exhausted and fed up on Monday evening. When I woke up feeling much the same on Tuesday morning, I decided radical action was needed. The bike, I thought, could be the answer. I would cycle to my fourth radiotherapy session. It would be the first time in around three months that I’d done any cycling.

Just making the decision made me start to feel better. I got the bike out and pumped up the tyres. I stuffed the pump and everything else I needed into a little backpack and, with my cycling headband* and winter cycling gloves on, I set off.

The bike, as always, is part of the solution (Love that bike! & A lesson on living in the now). I loved every second of the 5.7 mile ride to the clinic, even the hill, and I felt great when I arrived. I locked the bike up, looked in the backpack for my wig to throw it on before making my way inside and realised to my horror that it wasn’t there.

I swear my heart skipped a beat. It was the same feeling of utter horror that I’d had when I was out having a meal with some friends to celebrate finishing chemo last November and realised that I’d forgotten to give myself my critical post-chemo injection (Emergency delivery of post-chemo injection – to the pub!). That time, my older son brought the needed item to the pub. That wasn’t an option this time.

I lost my hair to chemo last September. I hadn’t gone out in public without some sort of head covering since. I finished chemo at the end of November and so my hair is growing back, but I hadn’t yet taken the plunge. Now I had no choice. I simply (?) had to take a few deep breaths and go for it.

I remember thinking this must be what a panic attack feels like.

I phoned my husband Andy for some moral support. While frantically pacing the clinic car park, I treated him to a monologue that consisted mainly of me repeating down the phone the same four-letter word over and over and over (think the opening scenes of the film Four Weddings and a Funeral). I then phoned a friend who’s a couple of weeks ahead of me in terms of treatment (although it has to be said she didn’t lose her hair). This is the friend who said she wouldn’t have worried about not having had the injection and would just have waited until she’d got back home. The two of them found my discomfort all highly amusing, which I have to say did calm me down somewhat. As they pointed out, I couldn’t have picked a more receptive audience for my wigless public debut.

Deep breaths taken, I walked in. It wasn’t easy. Of course everyone I met said how good I looked, how well my hair was growing back, etc, etc, etc. I could literally feel the tension fading away. And when I explained it had been an accident and how it had come about, it felt even better.

It turns out I’d put the wig in one backpack and the rest of the stuff in another. If you must know, I swapped because the first one clashed with the cycling jacket I was wearing! (Bet that surprised you, my fashionista nieces Louise and Shereen.)

I haven’t worn the wig since. And it’s such a relief. Perhaps something was going on subconsciously that morning, because just a few days earlier I’d written about how and why I couldn’t wait to ditch it (One’s changing relationship with one’s wig). In the end, the wig ditched me.

Whether the wig stays unworn depends, I guess, on how my hair grows out. But so far, so good, and I’ve got a story I’ll be able to dine out on for a long time!

*No helmet, I’m afraid. In the three months of having been bike-inactive for want of a better term, my helmet appears to have “got lost”. No-one in the house is taking responsibility for said loss, but I didn’t lose it and I’d bet my life Andy didn’t either. That leaves just two possible culprits. They know who they are. 

Tennis II

A few of you have asked whether I did in the end challenge my two teenage sons to a tennis match before I started chemo. That was after I’d written a post (Tennis I) way back in the summer saying they hadn’t yet beaten me. Should I leave well alone or risk defeat, I wondered.

Well I had a knock-about with the older lad before that first chemo session back on 19 August. We played and chatted for around half an hour then he suggested we play a “friendly tie break”. He won 7-5. Now does that count as beating me in an official sense? I’ll leave it to you to decide.

I genuinely thought I’d be hanging up my tennis racket as soon as I started chemo. I really can’t put into words how delighted – not to mention astonished – I am to have been able to keep playing throughout. I pulled out of the ladies doubles team I was in and out of the club leagues, but I have played a fair amount.

Every time I got out there on the court was a bonus. I surprised myself when I won – although that hasn’t happened for a good while now – but in all honesty I was happy just to be playing. I no longer run for balls that a few months ago I’d have got to no problem and my lovely doubles partner has had to get used to losing not just some but all of the time. I still love it though.

And what a massive treat to get a session through our tennis club at one of the indoor practice courts at Wimbledon one evening last week! My older son (yes, he’s the one in the photo), my doubles partner and another friend from the ladies team I was in and I turned up a little early… to find Davis Cup TV commentators Andrew Castle and Jamie Baker playing on the court we would play on ten minutes later! And yes, we were told to wear “whites”.

So a million thanks to the lovely young man my son is turning out to be and to the fabulous women who’ve made time to play over the past four months. I’ve got two matches planned for this coming week, the final one for Friday, the day before my operation. You’ve got to really, haven’t you, especially when you have no idea when you might play again.

 

 

It’s not all bad

If I hadn’t had a cancer diagnosis, I wouldn’t be sitting here now feeling  cherished in my parents’ flat in Glasgow where I’ve come for a couple of days because I’m feeling ok after that third round of chemo last Wednesday. I wouldn’t be sitting here writing this in the bed that my dad lovingly made up for me last night, counting my blessings as my mum cooks me bacon and eggs in the kitchen.

If I hadn’t had a cancer diagnosis, I wouldn’t have got back in touch with friends I hadn’t been in contact with for years because life is normally just so darn busy.

If I hadn’t had a cancer diagnosis, my many friends – and something like this makes you realise just how many friends you have – might never have felt the need to tell me they consider me to be strong, determined, resilient, courageous, focussed and a fighter. I’m not sure the cancer cares about any of that, but it’s good to feel the love!

And if I didn’t already know what a rock my husband is, I certainly do now.

And if I hadn’t come up to Glasgow this weekend, I wouldn’t have got tickets for the final day of the Davis Cup semi-final and I wouldn’t be sitting here now looking forward to going to see Andy Murray in a few hours hopefully take Great Britain into the finals of the tennis world cup for the first time since 1978!

And I wouldn’t be looking forward to seeing my brothers and sisters-in-law and nieces and nephews and some old school friends before I go back to London to see my own two lovely boys again on Tuesday.

A cancer diagnosis turns your life upside down, but once things settle down and you take stock, you realise there’s a lot to be thankful for. I clearly wish my cancer had been caught sooner, but the bottom line surely has to be that it’s being treated with curative intent. Given that and all of the above, I am very much aware that things could be a lot worse.

The old ways are sometimes the best

Surrounded by high-tech machines measuring, bleeping and pumping at chemo session No 3 yesterday, it was reassuring to see that in some instances the old ways are still the best. Need to dilate the veins in your arms so the needle goes in more easily? No problem, just stick your arm in a bucket of warm water for a few minutes!

I can’t exactly say I left home for the clinic with a spring in my step yesterday morning. However, knowing I wasn’t going to have to suffer scalp cooling meant I was definitely far less anxious than I was the last time.

The session still took a good while – more than three hours in all – although the last hour or so flew by as an old friend I hadn’t seen for ages came to chat and keep me company. With the cool cap out of the picture, I can allow myself to have what is known as “chemo company” (one of the many new terms I’ve learnt since becoming involved in the world of cancer). Thanks, S, I’ll enjoy the sweets and will look forward to the tennis match we arranged – our first ever after all these years!

This is what happens when you turn up for your 9.30am appointment:

• You check in with the nurses on the chemo unit and choose where to sit. I always pick a station with a good view of the unit so I can see what’s going on.
• Before you even sit down, you’re weighed by the chemo nurse assigned to you for the day. The dosage of the chemo drugs depends on your weight and height so you’re weighed before each session.
• You have your vital signs checked.
• You’re given the first of the many anti-nausea drugs you’ll be taking over the course of the day and the following three days. The first, Emend (aprepitant), is in tablet form, and has to be taken one hour before chemotherapy.
• They put in place the cannula, a small, flexible plastic tube that’s inserted through the skin via a needle into a vein to administer medication. They then connect a nifty little extension set with two connectors. One of the connectors is for the drugs that’ll be administered via a drip. The second connector is for the drugs that are given as injections.
• They inject a small amount of saline solution to check the cannula is in the right position.
• You’re given via injection through the cannula another anti-emetic, the steroid dexamethasone.
• The electric heat pad on which you rest or wrap your arm for the rest of the process (to keep the vein dilated) is plugged in.
• They start the saline drip – a litre of the stuff – which helps flush the chemo through the body and will later be used to dilute the doxorubicin as it’s being delivered.
• You’re given the third and last of your pre-chemo anti-emetics, Aloxi (palonosetron), again via injection.
• Only now do they start with the actual chemo. The doxorubicin comes first, and is injected by the nurse manually, slowly and carefully. It mixes with the saline solution that’s coming in from the drip so that it goes into the body diluted. That’s the doxorubicin in the syringe in the picture. More about “the red devil” – another one of those new terms – in a later blog.
• Once that’s done, you’re given the second chemo drug, cyclophosphamide, as a drip over the course of at least half an hour.
• Finally, they give you a final flush of saline to wash through the last of the chemo through the cannula.

In between all of that, you’re brought tea and croissants and, if you’re there long enough (as I have been every time), lunch. Also, the pharmacist appears at some point and asks you how you got on with your take-home meds the last time and then puts together and brings you your next lot.

Before you leave, you pick up from the nurses’ fridge the lipegfilgrastim injection that you’ve got to give yourself 24 hours later.

And that’s it, at just after 1pm, you’re gone.