How do you eat an elephant? The same way you live with cancer - bite size chunks. The overall picture is too much to cope with so we live with each chunk and each phase as it happens.
And today's phase is a good one. I have my scan results and they show an 'excellent response' to the chemotherapy. The tumours in my liver have shrunk a lot and those in my lungs even more. I have gone from a very serious and advanced stage of the disease to regression of the tumours and a result beyond management to a battle victory. My prognosis has shifted from what was months to years so this is all good.
As I expected there is no miracle result and it does seem as though I will having some form of chemotherapy (on off) for several years. Localised treatment and an all clear result still isn't an option and I need to put thoughts of that out of my head. Cancer is increasingly treated as a chronic condition and this is the way it will be managed in my case. The recommended strategy of my oncology team seems to be to use chemotherapy to keep it at bay, then give me a 2 month break from the chemotherapy then start chemotherapy again to knock the cancer back some more.
And this is what I need to focus on. The whole elephant is too much to take in and I can't live my life thinking about when I will die, or when I will be cured. Instead I must focus on each manageable chunk and the fact that I am alive; and that I have won my first three month battle.
I am also focusing on the fact that there should be a break from chemotherapy in 3 months time. I love those drugs for saving my life but they're hard work and 2 months of normalcy will be just lovely.
Wednesday, 21 November 2012
In which I am absolutely terrified.
Today I get my scan results. I think. Logically I know that they will say that the liver tumours have shrunk - if nothing else. I know that my liver isn't as swollen - I can't feel it protruding for a start and the liver function tests showed huge improvement. I also know that the aim of this first stage of chemo was to get the disease under control, before we go for shrinking the tumours, then (hopefully) localised treatment. And I am confident that the first objective has been achieved, if not some of the second. And as chemo trashes all cancer in its wake then my lung mets (this is cancer kid speak for metases - or secondary tumours) and colon cancer should have taken a knocking too but of course I am still terrified. Terrified that it will have failed and everything is worse; and here's my secret fear also terrified to hear the truth that there won't be a miraculous 'it's all gone' result. But God how I have fantasised about that moment; imagining telling everyone that joy of joys it's all gone. I am the lucky survivor, that it is all okay. I am, of course, in reality more likely to win the lottery than get this response, and I don't buy a ticket. So yes I am scared.
I should be used to this feeling as a lot of the time living with cancer (or any life threatening disease) is living with constant fear. It is having to shrug off negativity on an hourly basis. It is being grateful for a night without bad dreams and for not waking up thinking about cancer. It is being envious of other people for their happy cancer free lives and reminding yourself that "into each life a little rain must fall" but wishing, just wishing, that you hadn't had such a deluge. It is finding yourself crying for no reason and begging God to let you survive. It is talking to the air. It is living in hope and trying not to drown in despair. It is the horrible realisation that you probably won't see your kids grow old and trying to come to terms with this. Trying not to imagine their pain if you die or your partner's or family's or friend's. Longing not to put anyone through that, and feeling a little bit self indulgent for thinking about it quite so much.
And it is, of course, laughing and shouting and bickering and just doing stuff because all the time that cancer is in your head, life goes on. Dogs have to be walked, kids have to be fed and vice versa.
But on days like this it's hard. The tension which is ever present is so palpable and I just want to have it over.
Wish me luck. I'm going in.
I should be used to this feeling as a lot of the time living with cancer (or any life threatening disease) is living with constant fear. It is having to shrug off negativity on an hourly basis. It is being grateful for a night without bad dreams and for not waking up thinking about cancer. It is being envious of other people for their happy cancer free lives and reminding yourself that "into each life a little rain must fall" but wishing, just wishing, that you hadn't had such a deluge. It is finding yourself crying for no reason and begging God to let you survive. It is talking to the air. It is living in hope and trying not to drown in despair. It is the horrible realisation that you probably won't see your kids grow old and trying to come to terms with this. Trying not to imagine their pain if you die or your partner's or family's or friend's. Longing not to put anyone through that, and feeling a little bit self indulgent for thinking about it quite so much.
And it is, of course, laughing and shouting and bickering and just doing stuff because all the time that cancer is in your head, life goes on. Dogs have to be walked, kids have to be fed and vice versa.
But on days like this it's hard. The tension which is ever present is so palpable and I just want to have it over.
Wish me luck. I'm going in.
Wednesday, 7 November 2012
I actually have good news
Normally this blog is a bit of a rambling collection of thoughts about my journey on the cancer roller coaster. Mainly because I have realised that once the initial flurry of tests and results are over and established, there's not a huge amount to report back. Like most aspects of life, cancer takes on a routine, it's just slightly more fraught than average...
Anyway today I have actual news.
Every two weeks I have a blood test at the St Luke's cancer centre. The primary purpose of these is to establish how my immune system is coping with the battering it's given by chemotherapy. However my liver function is also assessed as this is where my unwelcome guest is at its most dangerous.
When I first started chemotherapy there were a proliferation of enzymes in my blood that demonstrated how hard my liver was working to keep going. In one test where a normal level is 70, mine was 700 and in another it was 59 where it should be under 20.
Please forgive me for not knowing what these special enzymes or levels of stuff are called. I just know that they are released when your liver is in a bad old way.
So today I asked what these figures are now (after 4 sessions of chemotherapy) and it's good news. Actual good news. Yes, good news!! In fact the first good news since this hideous thing kicked off. The 700 figure has dropped to 300 and the 59 is now 17 and normal! While ultimately my chances of having surgery are determined by the size and position of the lesions on my liver, this is a positive sign. It shows that my chemotherapy is working and that this disease is being controlled.
It's blooming lovely getting good news - and actually just as lovely sharing it.
Me and Obama eh!
You can be ill and I can be well
Cancer isn't a happy topic and it isn't always easy to know how to respond or what's appropriate to say. This blog offering isn't critical of anyone (this cancer journey is bearable because of all my friends and family's support) but I do want to knock down a couple of taboos.
One of the slightly more random side effects of cancer is other people's embarrassment about being ill around you. I appreciate that cancer is pretty much up there in the hierarchy of diseases but at the end of the day other people's illnesses, colds and trials still count.
Whether it's a rotten cold, a chronic ailment, a condition that means you're worried you might never be able to fall in love for fear of passing it on or a searing headache; pretty much anything (other than man flu) is deserving of sympathy. Cancer doesn't make anyone else's sinuses less blocked, tiredness vanish or stress and worry disappear, so please feel free to have a cold and don't feel bad about telling me. I will still drum up sympathy and look kind. I'm not about to pull out the cancer card and play top trumps. Plus I've had a cold/tummy bug all week and it's been horrible.
And the other thing is that other than having a life threatening illness I am actually quite well (despite the weird cold/tummy bug) So it's okay to say to me 'I hope you're well'. Being well is what is keeping me going throughout this thing, that and a full time job, three kids, two dogs, a cat, and a loving husband. I feel well. I don't take painkillers, once I'm off the steroids I stop eating like a person possessed. And when the post-chemo week is over I'm actually pretty energetic. I even talk about exercise. Oh yes. I have plans. Unfulfilled. But I plan to exercise a lot.
Cancer isn't easy for anyone and there are topics I'd rather avoid. Some of my fellow patients on the chilworth day unit may love recounting how many people they know who've died, but I hate it. I don't like hearing how desperately hard cancer is and I don't like pity; but I can still empathise, and I need encouragement so please keep saying that you hope I'm well because I hope so too.
Friday, 26 October 2012
Loose lips sink ships
Not a great doctors appointment this Wednesday. My usual oncologist was on holiday and his registrar wasn't available so I saw Dr Doom (not her real name) instead. We were about 5 minutes in and discussing my next scan. I think she was feeling frustrated as I had answered 'fine' and 'coping well' to most of her questions. Note to self; more misery is expected from a cancer victim. So I asked what they were looking for from the next scan in terms of what was success and what were the expectations. Years of marketing and sales mean that I am of course, a results driven person.
Anyway she blurted out "well it's not curable, we're just giving you more time" adding, and very badly backtracking, "I mean never say never, but it's unlikely".
Whilst I am not living in cloud cuckoo land and expecting my first mid-chemo scan to reveal that low and behold all the cancer has gone and that everything is fine again; I am trying to remain positive and focus on the fact that there are people who survive advanced cancer, so it is possible. It's a tough battle and the numbers aren't in my favour but after five years there's a long tail of survival and I want to be in that group. I am also very aware from the conversations that I have had with her boss (my usual doctor, and leader in his field) that the aim is to manage, shrink, then get rid of these things. He hasn't given up on me.
The blunt and thoughtless crushing of my hopes by Dr Doom highlights how fragile my positive state is. It's a pretty constant battle to remain upbeat and not be consumed by the over-whelming presence of cancer. There were a lot of tears on Wednesday and Thursday from Al and me; and the knowledge that my children may well grow up without a mother felt very real. I wonder if Dr Doom lay in bed crying for their loss that night? I doubt she gave me a second thought. Her casually flung out words were as useless as they were destructive.
Doctors have power, whilst we know that they are not infallible and like us they are just human and can get it wrong; as patients we are vulnerable to their superior knowledge. They hold the medical file and make all the big decisions, backed with science and evidence, but decisions and choices nonetheless. This is the file that I have not been allowed to see; with all its charts and notes and plans and answers. It is held away from me and flicked through; and the medical team give me crumbs of hope or cast out stones of despair. I resent the lack of control and knowledge I have. I want to read the file, scour the words for hope, and understand it and find a way through. On the other hand I am terrified that, like Dr Doom, it condemns me to just a few years of painful procedures and toxic drugs. It's a horribly vulnerable position to be and Dr Doom needs to know that. She needs to understand the fear that comes with cancer. The icing on the cherry tumours. The constant desire to see old age, the nasty thoughts that accompany every plan over a few months old. Do I renew my season ticket? Yes. Will I see Rosie start school? Please please God.
Dr Doom needs to know the struggle that all cancer patients have not to give in to the despair. Ultimately she needs to be a bit more freakin' sensitive. Careless talk and all that...
Sent from my iPhone
Anyway she blurted out "well it's not curable, we're just giving you more time" adding, and very badly backtracking, "I mean never say never, but it's unlikely".
Whilst I am not living in cloud cuckoo land and expecting my first mid-chemo scan to reveal that low and behold all the cancer has gone and that everything is fine again; I am trying to remain positive and focus on the fact that there are people who survive advanced cancer, so it is possible. It's a tough battle and the numbers aren't in my favour but after five years there's a long tail of survival and I want to be in that group. I am also very aware from the conversations that I have had with her boss (my usual doctor, and leader in his field) that the aim is to manage, shrink, then get rid of these things. He hasn't given up on me.
The blunt and thoughtless crushing of my hopes by Dr Doom highlights how fragile my positive state is. It's a pretty constant battle to remain upbeat and not be consumed by the over-whelming presence of cancer. There were a lot of tears on Wednesday and Thursday from Al and me; and the knowledge that my children may well grow up without a mother felt very real. I wonder if Dr Doom lay in bed crying for their loss that night? I doubt she gave me a second thought. Her casually flung out words were as useless as they were destructive.
Doctors have power, whilst we know that they are not infallible and like us they are just human and can get it wrong; as patients we are vulnerable to their superior knowledge. They hold the medical file and make all the big decisions, backed with science and evidence, but decisions and choices nonetheless. This is the file that I have not been allowed to see; with all its charts and notes and plans and answers. It is held away from me and flicked through; and the medical team give me crumbs of hope or cast out stones of despair. I resent the lack of control and knowledge I have. I want to read the file, scour the words for hope, and understand it and find a way through. On the other hand I am terrified that, like Dr Doom, it condemns me to just a few years of painful procedures and toxic drugs. It's a horribly vulnerable position to be and Dr Doom needs to know that. She needs to understand the fear that comes with cancer. The icing on the cherry tumours. The constant desire to see old age, the nasty thoughts that accompany every plan over a few months old. Do I renew my season ticket? Yes. Will I see Rosie start school? Please please God.
Dr Doom needs to know the struggle that all cancer patients have not to give in to the despair. Ultimately she needs to be a bit more freakin' sensitive. Careless talk and all that...
Sent from my iPhone
Monday, 22 October 2012
Tumour on board
I am constantly bemused by how similar my cancer/chemo symptoms are to those of pregnancy. The heightened sense of smell, a constant feeling of slight nausea (during post-chemo week) that is only resolved by eating vast amounts of carbohydrates, the consequent weight gain (also steroid induced) and bloating, various skin issues, bleeding gums and tiredness. Obviously there are a few obvious differences, the lack of congratulations and associated gifts (hard to believe I know), I don't get offered a seat on the train and there's staggering different objectives in mind - basically I don't want these little parasites to grow.
A predictable cycle of symptoms
Unlike pregnancy my symptoms have a nice 'easy' pattern that I can try and follow, aim to anticipate and that actually help remind me that there's improvement on the horizon. I can even map their progress in a PowerPoint chart (apologies to Bryan Scott and Linda Grant for the poor visuals).
The Sunday after chemotherapy
The first indication that I am in the post-chemo zone is what I now call my 'chemo cold'. This consists of a constantly runny nose, sores inside my nose and several small/tiny nose bleeds a day.
Monday/Tuesday
For the first 2 days directly after the pump is removed there is the post-chemo and steroids tiredness. A bone aching weariness that finds me propping myself up against tables when I am standing and leaves me with precisely no patience when it comes to dealing with 3 kids and 2 dogs. Apologies to the small and tall residents of Slyvan Way.
Tuesday onwards
The spots start multiplying this week too but they are so much better since I've upped to the antibiotics, that compared to everything else they are really quite minor irritation (the scalp ones are still pretty itchy and awful though).
Monday to Thursday
My levels of indigestion and stomach cramps start to increase from Tuesday culminating in my regular Thursday morning attack of terrible pain and vomiting. The bucket and I are reacquainted and the cold sweats and cramps make for a hideous but regular diary entry. I now have this marked as a meeting in my work diary so I can be late if required. However once it's done I take a loperamide and it's over for another 2 weeks.
The Nadir
The Saturday (8 days after chemo) is my immune system's nadir. My immune system is at its weakest and apparently I am very vulnerable to infections. I've yet to experience this in an obvious way but this is when the mouth ulcers kick in. Lining my tongue, lips or inside my mouth. They pick their position and bed in for at least 5 days. I have a great new mouth wash that leaves the inside of my mouth completely numb and helps hugely.
One week after chemotherapy
My skin also reaches new levels of dryness this weekend. Patches appear on my eye lids, round my nose, and across my cheeks. Again it's all pretty manageable and now I have the antibiotics skin issues are signifcantly less of a challenge.
10 days after
It all starts improving. The chemo cold is pretty much over by Wednesday, mouth ulcers have disappeared by Tuesday, my gums stop bleeding on Thursday, my skin starts is clearer and less dry towards the end of the week and my energy levels return; just in time for it to all start all over again.
2 weeks after - like poor old Michael Finnegan it's time to begin-again
7 hours of hardcore drugs pumped into my arm in the cold grey dull space that is the Chilworth Day Unit.
I am lucky (although getting cancer itself isn't that fortunate), my chemotherapy symptoms are more of a series of staggered niggles rather than the complete wipeout that lots of people experience. I am able to work pretty much full time and cope with everything with support and help from Al, my mum and Battersea all of who are being amazingly wonderful. A lot of people, especially those with more aggressive cancers, are sick constantly, lose their hair and find the treatment as tough as the disease to deal with. I am not one of those and I am very grateful.
In terms of the pregnancy likeness of it all, I am also aware that, as I am fairly regularly reminded, that apparently I whined a lot more when I was pregnant. Now there's an irony.
Saturday, 6 October 2012
Steve Jobs - one of my heroes.
Besides a love of Apple, and my desperate desire to be a bit of rebel (within a conformist environment), Steve Jobs and I finally have something in common.
Cancer.
It wouldn't have been my first choice.
A glittering career as an innovative world changer would have preferable but I guess you can't win 'em all. And whilst I am no slouch in the fundraising area I expect Steve was slightly ahead of my game by the time he hit 40.
But like me, and millions of others he joined the cancer club. Membership lasted 8 years and right now that seems like a lifetime. In 8 years time Rosie will be approaching 11, Zak will be at University and Ilias will be a stroppy 15 year old. It feels so much better than leaving now, or in the next three years, but I know that it is always too soon. Once you're in the cancer club every future dream, every hope, every 'next year' is tinged with a mental 'please God, let me be here'. That's the reality and I don't expect it ever goes away.
But Steve Jobs is a hero of mine and he died a year ago. He's one of my heroes because he was an innovator, because he'd 'rather be a pirate than join the navy' and because Steve Jobs founded one of the world's most creative and amazing companies that embraced difference and challenged the usual way of doing things. So in remembering Steve Jobs I hope I embrace his spirit in my life and my work and that in doing so, we have more in common than cancer.
Cancer.
It wouldn't have been my first choice.
A glittering career as an innovative world changer would have preferable but I guess you can't win 'em all. And whilst I am no slouch in the fundraising area I expect Steve was slightly ahead of my game by the time he hit 40.
But like me, and millions of others he joined the cancer club. Membership lasted 8 years and right now that seems like a lifetime. In 8 years time Rosie will be approaching 11, Zak will be at University and Ilias will be a stroppy 15 year old. It feels so much better than leaving now, or in the next three years, but I know that it is always too soon. Once you're in the cancer club every future dream, every hope, every 'next year' is tinged with a mental 'please God, let me be here'. That's the reality and I don't expect it ever goes away.
But Steve Jobs is a hero of mine and he died a year ago. He's one of my heroes because he was an innovator, because he'd 'rather be a pirate than join the navy' and because Steve Jobs founded one of the world's most creative and amazing companies that embraced difference and challenged the usual way of doing things. So in remembering Steve Jobs I hope I embrace his spirit in my life and my work and that in doing so, we have more in common than cancer.
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