Symptoms of Breast Cancer.

Breast_Cancer_1Breast cancer affects both men and women. However, breast cancer has been the most common cancer in the UK since 1997, but is rare in men. It is by far the most common cancer among women in the UK (2011), accounting for 30% of all new cases of cancer in females. In 2011, there were 50,285 new cases of breast cancer in the UK: 49,936 (99%) in women and 349 (less than 1%) in men. Female breast cancer incidence is strongly related to age, with the highest incidence rates found in older women. This supports a link with hormonal status. In the UK between 2009 and 2011, an average of 80% of breast cancer cases were diagnosed in women over 50. Indeed, around a quarter (24%) were diagnosed in women aged 75 and over. I therefore find it very frightening that many older women ignore the risks of contracting breast cancer and are ignorant of the symptoms of the disease, with the exception of finding a lump. Finding a lump may be the most common sympton of breast cancer, however, in many cases finding a lump will be one of the last symptoms to become obvious, especially if the tumour is seated deep in the breast tissue. This is important because the earlier the disease is treated,the more successful that treatment is likely to be.

Some of the signs and symptoms of breast cancer include:

1) a lump in the breast
A lump in the breast is the most common symptom of breast cancer. Most breast lumps are not cancerous. They are usually fluid-filled lumps,cysts or a fibroadenoma, which is made up of fibrous and glandular tissue. But it is important to get a lump checked by a doctor straight away. If a lump or other symptoms is caused by breast cancer, the earlier treatment is received the more successful it is likely to be.

2) a change in the size or shape of the breast
The warning signs of breast cancer are not the same for all women. One of the common signs are a change in the look or feel or size of the breast. Breast enlargement alone is not necessarily a sign of inflammatory breast cancer. I see a lot of women who are worried about a change in breast size, and inflammatory cancer is rarebreast size

3) dimpling of the skin or thickening in the breast tissue
You may become aware of dimpling or tethering of the skin of the breast during a self-exam. It is an important part of the self exam to look in the mirror and look for a dimple. The breast should be outwardly round—it should curve outward and not pull in. If you have had breast surgery before and you have some scars, you might find that the breast will pull in around a scar. Of course, this is a different situation. A dimple is a pulling in of the skin, and it may occur when you raise your arm or lean forward. When you lean forward and raise your arm, the breast should stay outwardly round; it should not pull back in. That may be a sign of cancer, and it should be checked.

4) inverted nipple, a nipple that’s turned in
Every body is different. Some people are born with inverted nipples. That is not a worry or unusual for them. However, if you notice a change in your breasts that result in development of an inverted nipple, so you were not born with one,and the nipple cannot be drawn out, this should be checked by a doctor. it may suggest a lump behind the nipple that is pulling it in.

5) a rash on the breast or the nipple
Although tumors are the most common symptom of breast cancer, they are certainly not the only symptom. Women with a rare form of the disease called inflammatory breast cancer can develop a red, pink, or purple rash across part of their breast. The skin of the breast might also appear puckered, like the skin of an orange. If you notice symptoms like these, have them checked out by a doctor right away. Inflammatory breast cancer can spread quickly.breast cancer rash
6) discharge or bleeding from the nipple
Nipple discharge is a normal part of breast function during pregnancy or breast-feeding. It also may be associated with menstrual hormone changes. It appears spontaneously and involves a single duct. Although the bloody discharge may resolve on its own, this situation requires evaluation with an ultrasound of the area behind the nipple and areola. If the ultrasound shows a lesion, you may need a biopsy to confirm whether it is a papilloma or something more sinister. Although most often, nipple discharge stems from a benign condition. However, breast cancer is a possibility, especially if it is combined with one or more of the following: you have a lump in your breast, only one breast is affected, the discharge contains blood, yhe discharge is spontaneous or the discharge affects only a single duct.
7) swelling or a lump in the armpit
An armpit lump refers to the enlargement of at least one of the lymph nodes under your arm. Lymph nodes are small, oval-shaped glands that are located throughout the body and play an important role in the immune system. Most lumps are harmless and are usually the result of abnormal tissue growth. However, armpit lumps can be related to a more serious underlying health problem. Any unusual lumps should be evaluated by a doctor. Armpit lumps can occur in men and women of all ages. However, finding an armpit lump is most alarming for women because it may indicate breast cancer. Women should perform monthly breast exams and report any lumps to a doctor right away.Note that breasts undergo hormonal changes during the menstrual cycle, and may tend to feel more tender or lumpy during this time. This is completely normal. For the most accurate results, perform breast self-exams about one week after your period starts.

The advice you must consider is this: whether man or woman, old or young, if you become aware of a change in the area of your breasts seek medical attention sooner rather than later. Time is valuable: time is life.

Valerie Penny

Life on Letrozole After Breast Cancer

letrozoleAfter completion of my chemotherapy and just as my radiotherapy started I required to start taking letrozole: just one 2.5mg tablet per day. A 2.5mg tablet each day for 5 years. This is because my breast cancer wasa type that needs the hormone oestrogen to grow. In women who have been through the menopause, the main source of oestrogen is through the change of sex hormones called androgens into oestrogen. An enzyme called ‘aromatase’ is needed for this change to occur. Letrozole works by inhibiting (or blocking) this enzyme. This reduces the amount of oestrogen in your body, which slows the growth of the cancer cells, should they recur. It is my fervent hope that they will not.

I am ashamed to say that I never read the information given with medication, although I know I should. The manufacturer’s leaflet will give more information about letrozole and a full list of the side effects which may be experienced from taking it. I have to take other tablets daily as well. So I take one 2.5 mg tablet of letrozole each morning with my other medication, although you may take letrozole at whatever time of day you find easiest to remember, but try to take your doses at the same time each day. This will helps to avoid missing any doses. You can take the tablets before or after your meals. If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, skip the missed dose. Do not take two doses together to make up for a forgotten dose. I suppose one tablet out of 5 years will not make much difference.

However, along with their useful effects, most medicines can cause unwanted side effects although not everyone breast-cancerexperiences them. If you have read other articles in this blog, you will realise, that my primary mind set is always that these things cannot happen to me. Of course, sometimes they can and they do. That is just life. Also, because I do not read the manufacturers leaflets, I did not know the side effects to expect. However, Letrozole has a raft of side effects and I seem to have been blessed with most of them. The common side effects are as follows:

1) Hot flushes and sweating: yes, I get this one! I thought it was my time of life, but no, I owe this joy to Letrozole so I try to keep cool by wearing light, airy clothes or in winter, I wear layers, so I can take them off as required.
2) Headache, muscle or joint pain: oh wow! I have this one in spades. You can ask your doctor or pharmacist to recommend a suitable painkiller but I do not like to take any more tablets than I have to, so I try to manage the pain with rest, hot water bottles or ignoring it before I give in to the painkillers. The dull ache of the joint and pain is a persistent, nagging pain that drains the drive and strength out of me. It is inescapable.
3) Feeling tired, weak or dizzy: Oh, you guessed, I find this side effect really, really debilitating. I simply cannot do all that I did before I got ill. Some days I cannot get up, some days I have to take a nap, sometimes I just cannot move. I get so indescribably weary and tired. I get cross with myself and irritated but it does not explain this side effect to say that I get tired. The tiredness makes me bone weary. My limbs feel heavy, my concentration is affected. My eyes cannot stay open. At other times I cannot sleep at night, so that makes me tired too. I do not drive or use tools or machines until I feel fit enough to do that.
4) Feeling or being sick, indigestion, abdominal pain: Hurrah! I do not get this one! I stick to simple meals, generally avoid rich or spicy foods and I am very careful about my diet.
5) Constipation: I occasionally suffer from this one but I try to eat a well-balanced diet and drink several glasses of water each day.I also drink copious amounts of tea, mostly English Breakfast tea, sometimes Earl Grey.
6) Diarrhoea: Nope, I do not get this one: if you do, remember to drink plenty of water to replace the lost fluids.
7) Appetite changes, weight changes, feeling depressed, hair loss, skin rash, swollen legs or feet, vaginal bleeding: I am blessed with some of these, the most immediately obvious is that my hair has become very thin. Sometimes I wear a hat because my head gets cold, my hairdresser is a magician and always makes me look and feel like a million dollars. The other one of these side effects that I have to cope with is depression. I have suffered depressionfrom depression for many years any way and now it is reasonably well controlled. It is just difficult having another potential source of that mental health problem.
8) High blood levels of cholesterol or high blood pressure. I do not suffer from either of these. I am lucky in that my blood pressure sits fairly low anyway and my doctor also arranges for me to regular have tests to check that these side effects are not rearing their ugly heads.

As I suffer with so many side effects of Letrozole, I have been offered the opportunity to change to another tablet. However, I have declined to do so. I know what the side effects of Letrozole are and I can cope with them, more importantly my long suffering husband knows what they are and he can also cope with them. So for the remainder of the 5 year period, I will cope and I will be grateful that I am being successfully treated for breast cancer. I am a lucky woman.

Valerie Penny

Risk of Recurrence of Breast Cancer

herceptin_drugMy body has endured surgery, chemotherapy and radiotherapy. As a result of this I have lost my hair and my energy. Still, that tumour the size of a baked bean is perceived as a threat. Its return must be further discouraged. My oncologist therefore insists on mammograms every six months and prescribes Letrozole. I must take one 2.5mg tablet each day for 5 years.

Breast cancer is often discussed as a general condition, but there are several different types that require different treatments. One way to distinguish breast cancer cells is through your genes. When you are diagnosed with breast cancer, your doctor will test the cancerous cells to determine their genetic makeup. My tumour had more of the HER2 protein in it than it should have had. HER2 is a protein that stimulates the growth of breast cancer cells. It can be found in your blood and urine. Sometimes it is referred to as a tumour marker. Tumor markers like HER2 cannot be used for cancer diagnosis, but they can provide other important information and the presence of HER2 helps the doctor predict how likely the breast cancer is to respond to treatment.

It is estimated that about 20 percent of breast cancers are HER2-positive. Younger women are more likely to be her_2_geneHER2-positive than older women. HER2-positive breast cancer tends to be more aggressive and to spread more quickly than other cancers. That is why it is important to find out if the cancer cells in your body contain this protein. If your breast cancer is HER2-positive, you have a much better chance of successful treatment with methods that target the HER2 protein specifically. Results show that those who tested positive for HER2 at an early stage of the condition (with tumours 1 centimeter or smaller) had a higher risk of recurrence. Researchers have also found that HER2-positive patients had a 77.1 percent five-year survival rate, with no recurrence. However, they also are
around five times more likely to suffer recurrence than those who were HER-2 negative and have close to three times the risk of recurrence of those who tested negative for HER2. So I am absolutely sure I want to discourage recurrence.

Tumours that are HER2-positive are more often associated with factors that increase recurrence rates. For example, HER2 tumours are more likely to occur in younger women and have higher nuclear grade. Generally, the higher the nuclear grade, the more aggressive the tumour. HER2 tumours are also more likely to show positive margins during breast surgery. Positive margins occur when cancer cells extend beyond the edge of tissue that is removed. HER2 tumours also have a higher likelihood of residual disease being found when additional tissue is removed. Up to 70 percent of patients with HER2-positive breast cancer respond to treatment. However, total remission for the condition occurs only in around 7 to 8 percent of patients. Targeted treatments (medicines that target the HER2 protein, like the Herceptin I was treated with) have improved the prognosis for HER2-positive patients. Remissions can also be lengthy, offering another bright spot in prognosis and reports show that remission can last more than 15 years for some patients.

tabletI was diagnosed HER2-positive and this brings special challenges in my recovery from breast cancer. The HER2 protein can make the breast cancer more aggressive. It can also make it harder to treat with hormone treatments used for other types of breast cancer. However, drugs like trastuzumab (Herceptin) target HER2 directly and effectively. This drug, when used in combination with other drugs, shows some very promising results for improving prognosis and survival rates for patients with HER2 cancer. However, there is a small but real risk of heart damage and possible lung damage. Scientists are still studying how long women should take Herceptin for the greatest benefit. I am not ashamed to tell you that I hope their studies are successfully concluded soonest. I have a vested interest in this, as my tumour was HER-2 positive.

All in all, having made the decision to stay alive long enough to thoroughly embarrass my children, when the oncologist tells me that I must take one 2.5mg tablet of Letrozole each day for the next five years, I will do just that. Letrozole has side effects but I have decided that whatever they are, they have to be better than allowing the tumour to return.

Valerie Penny

After Radiotherapy

It is hard to imagine a treatment that only lasts a few seconds, minutes if you count the set up time, causing after effects.  Believe me when I tell you that it does.  There are side effects of any medical treatments, of course.  With radiotherapy these can be quite frightening.  There is some concern that after treating the brain (particularly if combined with chemotherapy) the patient may develop memory problems.

Radiation therapy works by damaging the DNA (genes) of tumour cells.  DNA damage stops tumour cells from dividing, growing and spreading.  Radiotherapy is a useful tool for treating cancer because cancer cells grow and divide more rapidly than most normal cells around them.  Although some normal cells are affected by radiation, most normal cells appear to recover more fully from the effects of radiation than do cancer cells. Radiation oncologists carefully limit the intensity of treatments and the area being treated so that the cancer will be affected more than the normal tissues.  This is why the set up for the treatment often lasts longer than the treatment itself.

Modern radiotherapy has advanced dramatically over the recent years.  It is now possible to focus radiotherapy with extreme precision. This allows the radiation dose to be targeted to the areas of tumour while sparing most adjacent normal tissues even in seemingly complicated and difficult parts of the body.

brain_lateral_adam

Radiotherapy affects different people to greater or lesser extents.  My friend Ismay, who is a real inspiration to me, is facing terminal cancer with and bravery that is awe-inspiring.  She found the radiotherapy to her head (to shrink a brain tumour) really difficult.  She was left with burns to her scalp.  Her hair that had grown back after chemotherapy, was lost again and the burns to her head made it impossible to wear her wig for weeks.  The pain and distress were hard to bear: but bear it she did. along with some forgetfulness, with her relentless courage and humour.

My treatment was to my right breast.  It was targeted to the area from which my tumour had been removed.  I had been told the radiotherapy would make me feel tired.  I had also been told the effect was cumulative. Unsurprisingly, me being me, when I felt no particular effects after the first dose or so, I felt I had beaten the system.  I had been told the cumulative effects would also include burning to my skin.  Again, initially, I deduced my skin was different to everybody else’s.  It is    not.  However, the effects do not kick in immediately, but do last a long time after the treatment has finished.  Radiation_breast

I have found the after effects of the radiotherapy quite depressing.  The burning under my breast was soothed by aqueous cream but the skin burnt and peeled the way it might with sunburn.  I am now six moths out after radiotherapy has finished.  The burns are healed but my breast still looks tanned compared to the other and I still find I get tired far faster than I expected this far on.  I still cannot walk as far as I used to.  One of my favourite hobbies is dancing, but I cannot dance for as long or as energetically as I did before my treatment.

I continue to find it difficult to concentrate for prolonged periods and the exhaustion is debilitating.  I was becoming increasingly upset about this and was speaking to my friend Margaret.  Margaret survived breast cancer and got her all clear about eighteen months ago.  She has been immensely supportive during my cancer journey.  The wonderful Margaret told me that, even yet, she gets bone tired sometimes.  It is not like the tiredness you feel after a busy day or a late night.  It is a wave of weariness that is all encompassing.  The big problem is it can arrive, unannounced, at any time.  So I have no confidence that, if I start a long or complicated task, I will have the energy to finish it.  This is what I find most exasperating.

However, the side effect that I had feared most was depression.  When the radiotherapy comes to an end, you come off the treatment merry-go-round.  All the attention stops and this can cause the depression the doctors and nurses warned me about.  I suppose when you have been using all your energies to defeat this disease, when it comes to an end so suddenly, it can result in an emotional vacuum.  I have mental health problems anyway and I really feared this problem.  I was lucky, it did not happen to me.  Other friends were not so lucky.  They did feel the sudden stop of treatment and attention left a void that led to depression.

Now I am at the stage where I get check up appointments with the consultant approximately every three months. Before I see the consultant I go to the hospital for an echo scan.  It is also called an echo-cardiogram is an ultrasound scan of the heart. It is sometimes just called an ‘ECHO’. Ultrasound is a very high-frequency sound that you cannot hear, but it can be emitted and detected by special machines. The scan can give accurate pictures of the heart muscle, the heart chambers, and structures within the heart such as the valves.  An ECHO can be carried out for many different reasons.   I have it done to check how well your heart is working after the radiotherapy and to look at how well the valves are moving inside the heart.   An ECHO can also help to see any fluid that may have collected around the heart.  So far my heart is holding up well.

I need to undress to the waist and lie on the couch. A probe is placed on my chest (it is a bit like a very thick blunt pen).   Also, lubricating jelly is put on the probe so it makes good contact with the skin.   The probe is connected by a wire to the ultrasound machine and monitor.   Pulses of ultrasound are sent from the probe through the skin towards your heart. The ultrasound waves then echo (‘bounce back’) from the heart and various structures in the heart.  They make a sort of swooshing noise.

featured-breast-cancer

The consultant also arranges for my blood to be checked to make sure my calcium and haemoglobin levels are high enough.  So far, so good.  This is especially important because for the next five years I require to take a medication known as letrozole.   Amongst the more common side effects of letrozole are hot flushes, hair loss, joint and bonepain, muscle pain, tiredness, unusual sweating, nausea, diarrhea, dizziness, and trouble sleeping.  I have certainly suffered the tiredness as well as the joint, bone and muscle pain.   I was told by other patients it should lessen after 8-10 months.  The doctors have not confirmed this!

So I have complained about my difficulties and honestly reported my progress.  I am aware that I am very lucky. The disease was diagnosed early after a mammogram.  The necessary surgery was carried out quickly.  I am to get another mammogram later this month to confirm that I continue to survive breast cancer now.

Valerie Penny

 

 

 

Time for Reading and Writing and Sharing and Being treated for Breast Cancer

One of the things I have found while I am undergoing my treatment for breast cancer is that as I have less energy to do physical exercise or physical work, I am finding myself able to indulge in other interests. I find I am able to do more reading and writing. I enjoy this.

One of the books I read recently was “In The Dark” by Mark Billingham.  The book is reviewed here: https://bookreviewstoday.wordpress.com/2013/04/05/in-the-dark-by-mark-billingham/

On a rainy city night, a handgun is fired at random. A struck car swerves and plows into a bus stop, killing an unsuspecting bystander. In an explosive instant, a cold-blooded gang initiation ends one life and forever changes three others: the desperate teenager who pulled the trigger. A policewoman is on maternity leave and an aging is gangster plotting a terrifying revenge. The truth about the shocking incident will tie them all together in a lethal blood knot. And nothing is what it seems.

In the Dark” is the most powerful and unflinching crime novel yet from the remarkable Mark Billingham–a gripping journey into the modern urban darkness where violence is both indiscriminate and meticulously planned, and youth gangs take on established criminals for rule of the streets.

In a completely different vein is the novel by Jane Green ” Second Chance“. That book is reviewed here: https://bookreviewstoday.wordpress.com/2013/04/05/second-chance-by-jane-green/. Jane Green has become a nationally bestselling author with legions of fans through her novels about the true-life dilemmas of real women, their relationships, their careers, their loves, their triumphs and disappointments. In her latest book, Green tells the story of a group of people who haven’t seen each other since they were best friends at school. When one of them dies in a terrible tragedy, the reunited friends work through their grief together and find that each of their lives is impacted in ways they could have never foreseen. Warm, witty, and as wise as ever, this is a story of friendship, of family, and of life coming full circle.

I also managed to contribute work to the blog wkwriters.wordpress.com. Here is an example.

Jubilee  

So many years you’ve worked in a job

You never sought to do it did you, Ma’am?

But your Uncle married Wallis Simpson

It was then so unavoidable: so set

You would be Queen: you were: you are now

Those 60 years have passed, how fast they flew

With you upon the throne you saw the change

You see the change and yet you rise above

Consistent in a land you love, a land you serve

Duty, dignity, experience still

Few would trade you places if they could, you know

None could hope to do your job so well.

I also read the book promoted by my book group.  

The first novel by Peter Ho Davies is “The Welsh Girl“. It is reviewed here: https://bookreviewstoday.wordpress.com/2013/04/05/the-welsh-girl…eter-ho-davies/. The Welsh Girl is set in 1944, as World War II grinds through its final year. But of course his characters don’t know that they are within sight of the finishing-post. Instead, they inhabit the confusions of the present tense. Rotheram, a German Jewish refugee, came to Britain in 1936 and now works as a translator for Political Intelligence. Seventeen-year-old Esther, daughter of a Welsh shepherd, lives in a remote village where war impinges in the form of evacuees and English sappers building a prisoner-of-war camp. Karsten, a captured German naval infantryman, will become one of the first prisoners in the new camp.

The Welsh Girl is preoccupied with ideas of identity, belonging and alienation. Ho Davies explores the ways in which war ruptures the relationship between a human being and the place (or country) that is called home. Some forms of belonging are obvious as the novel begins to weave its strands. The sheep on the Welsh hills know their territory and don’t stray from it. This sense of belonging – cynefin – is passed on down the female line, from the ewes to the ewe-lambs, because the ram lambs are sent for slaughter. If the herd loses contact with its territory, it cannot thrive. This hard fact becomes a metaphor throughout the novel. It may be over-used, but it remains potent. Esther, who has lost her mother and is a little lost within her own life, will eventually give birth to an identity which allows her to reconnect, in her own way, with home and origins.

Language is a key marker of belonging in this fictional village. Certain thoughts and ideas belong within Welsh, resisting translation because they embody what is specific to that culture. Ho Davies describes his fictional setting as “a nationalist village, passionately so. It’s what holds the place together, like a cracked and glued china teapot.” However his treatment of the very complex and controversial subject of Welsh nationalist attitudes to the war is somewhat bland. Characters take an overview of their situation, and describe their feelings and thoughts to themselves in a way which robs these of life. Esther, for example, hears Churchill’s speech revealing the invasion of France, and reflects that “most of the locals are as filled with excitement as she is, even if they’re reluctant to admit it.” It seems very unlikely that a girl of 17 would think of the friends and family with whom she’s grown up as “the locals”.

Ho Davies is much more assured in his handling of characters who are uprooted. Rotheram, for example, has gone through a long battle over both his Germanness and his Jewishness. It is only towards the end of the novel that his Jewishness becomes real to him, because he has made his own bridge between what other people say he is, and where he feels he can belong. Karsten, like all the other prisoners, is stripped of the identity – or sustaining fantasy – supplied by Nazism. Already, however, a different fantasy is supplanting it: the prisoners begin to consider themselves both innocent and victimised, subtly entitled to resentment and furious when they are confronted with film of the liberation of Belsen. Esther, coerced into sex by her English sapper boyfriend, has to lie about what really happened for the rest of her life. Within this lie, the novel seems to argue that Esther finds a deeper truth which links her to her dead mother, and enables her to claim back her own territory.

The Welsh Girl handles its complex thematic structure with secure craft, intelligence and sense of direction. The introduction of a major historical figure into this fictional world may shake the scenery, but the novel recovers.

Rotheram is the most subtly-drawn and interesting character in the book. This may be because Ho Davies has not decided the outcome of his story as firmly as he appears to have done with Esther and Karsten, but has treated Rotheram with some of the uncertainty and passion which brings a character to life. In his characterisation of Esther, there is distance.

Ho Davies has already earned a reputation as a short-story writer, but that skill may not make it easier to risk the excess, embarrassment and commitment of a book which takes its author way beyond where he expected to find himself. Nevertheless, The Welsh Girl is good enough to suggest that he may become an impressive novelist once he is into his stride.

Everything has advantages and disadvantages. One of the few advantages of having breast cancer is that I have time to catch up with my reading, writing reviews of the books and even some poetry and sharing it all with you.

Valerie Penny

Symptoms of the Cure for Breast Cancer

My cancer is breast cancer but was found early and surgery (hopefully) removed the tumour.  As a result of that I had had no symptoms that I noticed from my disease. Looking back, there were several signs that I ignored. The discharge from my right nipple and the least exertion made me very tired. Still, It never occurred to me that I had cancer. That would not happen to me. It could happen to other people, but not to me. It is therefore, I am told, unsurprising that, when I started having symptoms from the cure, I became quite resentful of that.  The flowers friends and family continued to send made the long days at home more easily endured.    Visits phone calls, texts and emails helped too. I like to feel part of the world and community, even if I don’t get out much.  I am so very lucky to have that network of support and love and prayer: I do not take any of that for granted.  

I have, however, taken my good digestive system and ability to sleep well, whatever the circumstances, for granted for many years.  When the side effects to my chemotherapy included constipation that was so bad it made me scream followed, a few days later, by constipation that made me weep, I felt miserable.  I also have had difficulty getting to sleep and staying asleep during periods of my chemotherapy cycle. I am not sure if that is caused by stress or by the treatment. Whatever caused it, I found it unusual and depressing.

I also find that food tastes a bit tinny this is quite unnerving. I find myself drawn to sweet and salty foods.  I also find that my eating habits have changed. I am finding myself eating little and often (or sometimes just little) rather than 3 square meals a day.

Another distressing side effect has been sudden, sometimes lengthy, nosebleeds. That has been quite upsetting for me and for my husband.  

I have found myself to be tired and lethargic. This has been compounded by pains in my joints, severe cramps in all the large muscle masses of my body and also tender muscles. These have required painkillers, easing with hot water bottles and comfort from cushions. I like to keep busy, with work, hobbies, interests and pursuits with family and friends. When I find myself so tired and my energy at a premium, I have just to get used to doing what I can when I can and not set my targets too high. That results in frustration and low mood. It is difficult to cope with this and having to take naps in the afternoon or sleeping longer into the morning. Still, I will just have to get used to my current limitations while my treatment is ongoing.

Late into my three week cycle two other side effects came to light.

The first of these was the dreaded hair thinning and subsequently hair loss. I had really not thought this would upset me too much as I have had thin hair due to an under-active thyroid. However, I did find it distressing and took up the offer of a wig financed through the NHS and am grateful for it.  It looks very realistic and is comfortable to wear.  I went to a local hairdresser and wig provider, Amanda who operates from Francis Hair and Beauty Salon at 29-31 Bridge Street, Galston, Ayrshire, Scotland.    I was very nervous and found the visits quite stressful. However, I need not have done. The staff were all so very kind and helpful and Amanda is knowledgeable. There were wigs to choose from in stock. She did, however, advise that she order up another couple of wigs so that I had an even larger choice to select from. as my hair loss was not so serious at this point, I took her advice to wait and make a full choice.

The second of the later side-effects was the development of a nasty chemical burn on my left hand. This, combined with the bad bruising caused by the use of a cannula to administer the chemotherapy, has resulted in a very sore and multi-coloured left hand.  The installation of a hickman line for future chemotherapies has been advised. Doubtless this will come.   I am not looking forward to yet another operation, but must be advised by the oncologist.

There is no doubt that many of the troublesome side effects do not become obvious for two or three days after the chemo has been administered and they do lessen towards the end of the three week cycle. Just about the time for the whole thing to start all over again!

Valerie Penny

The Longest Day of Chemotherapy

It was Tuesday, 5th June, Jubilee Day. Most of the UK was celebrating the 60 years of the reign of Queen Elizabeth II with an extra public holiday.   I marked the day with my first day of chemotherapy.   It was certainly memorable!

I met with the oncologist at 9.30 am.   She told me my blood results and scans from the previous week were satisfactory as a result of this,  I could go ahead with chemotherapy today as planned. This was both a relief and a challenge.  A relief because, due to my depression, I am not good at dealing with changes in plan.  A challenge, of course, because this meant, again,  it was made real to me that I had breast cancer a condition that required lengthy and invasive treatment.  Reality struck again.

Fortunately my husband was with me.  His very presence keeps me calm.  It was during this appointment that my breast cancer nurse, Angela Wallace, began to explain some of the side effects of the chemotherapy that I might expect. These were difficult to hear. The cancer had been caught so early that I had not recognised any symptoms of the disease in myself.  I felt quite resentful to hear of the side effects I might suffer from the cure.

She explained to me that I would be entitled to a wig, in case I suffered from hair loss.  She also told me that the hair loss would be likely to be from all over my body and that I could expect, among other things, to suffer from a dripping nose. It all sounded distressing and disgusting.

I told Angela that I did not think I would bother with a wig.  I thought it would be too hot during the summer. However, she explained to me that it can sometimes be easier for other people if I wear a wig, especially my mother and my children.   She also drew to my attention that my treatment would last well into October and therefore it would be the end of the year, a much colder time of year, before my hair would begin to grow back.  This was another reality check.

Chemotherapy is a treatment which uses anti-cancer drugs to destroy cancer cells. The drugs work by attacking the cancer cells and disrupting their growth. Unfortunately, they can also affect the normal cells in the body, including the cells of the hair follicles. This causes hair loss, also known as alopecia. Unlike cancer cells, however, the normal cells quickly recover, so if you lose your hair due to chemotherapy it will almost always grow back when your treatment is over.  Before you start chemotherapy, your doctor or chemotherapy nurse will discuss the possibility of hair loss and other side effects with you.

Not all chemotherapy drugs make your hair fall out, and sometimes the loss is so small it is hardly noticeable. However, some people will have temporary, partial or complete baldness.  Some chemotherapy drugs make other body hair fall out, such as eyebrows, eyelashes, nasal hair, beard, moustache, chest, underarm, leg and pubic hair. The amount of hair that falls out depends on the drug or combination of drugs used, the doses given and the way that your body reacts to the drug.

If your hair is going to fall out, it usually starts within two to three weeks of starting chemotherapy, although very occasionally it can start within a few days. The first thing you may notice is that your hair starts to come out more when you brush, comb or wash it. You may also find hair on your pillow in the morning.

Hair may just thin and become dry, fragile and break easily. For other people their hair may carry on falling out over a few weeks so that they become completely bald. Sometimes the hair comes out very quickly over 1-2 days, which can be very upsetting. Some people find that their scalp feels tender.

It was all so much to take in.

Angela explained to me about a method of trying to prevent or reduce hair loss. By cooling the scalp.  It is sometimes possible to reduce the amount of chemotherapy drugs that reach the hair follicles on your scalp. This reduces, and in some cases prevents, the hair from falling out. It is done by using a ‘cold cap’ or a machine that cools the scalp.  I decided to try that.  I was to go to the ward for my chemotherapy by 11am, so my husband and I had time for coffee in the hospital canteen before we went up, but life is never that simple! It is Jubilee Day. The canteen was closed for the public holiday – so we settled for coffee from a machine. Yugh!

  When we went to the ward, I was reminded of all my friend, Margaret Boe, had told me. She had been given the all clear after her breast cancer last October. She said that the ward was a surprisingly happy place. She told me every body, staff and patients alike were very friendly. She said everybody was happy there, but her husband, Billy, said he had not been happy and he found the whole experience of being present at Margaret’s treatment terribly difficult no matter how pleasant the surroundings were. In any event, I was glad to have my husband’s company and support. While this was a long day for me, at least I was the centre of attention. It was an even longer day for him. I was nervous and anxious. It was so important to me to have him there.

I was shown into the treatment room. There were 12 treatment chairs and I was shown to one that accommodated the use of a cool cap too. In the corner of the room a TV high up on the wall ran the Jubilee Day celebrations all day. In our neck of the woods the weather was beautiful but we watched the Royal Family enduring the downpour in London, England for  hours as they stood waving to the crowd. While I sat on the chair waiting for my treatment to start I was anxious. I was pleased to be starting my treatment, anxious about what it held for me and even more pleased that I was not in London getting drenched watching the Flotilla on the River Thames.   

The first struggle for the nursing staff was to get a cannula fitted into a vein in my left hand. That proved to be more of a struggle than expected so the staff began talking about getting a Hickman Line inserted into my chest.  This was to make taking blood and inserting chemotherapy easier in the future.  I was put more at ease when a woman came round and offered us all a cup of tea or coffee and a biscuit. Even the visitors got offered one. My husband was pleased!

In the meantime my treatment today began with a saline solution being inserted into my vein before two different antihistamines were added to the cocktail.  Antihistamines are a type of medicine often used to treat a number of allergic health conditions. Antihistamines work by blocking the effects of a protein called histamine.

Histamine is a protein that the immune system uses to help protect the body’s cells against infection. The immune system is the body’s natural defence against illness and infection.  If the immune system detects a harmful foreign object, such as bacteria or a virus, it will release histamine into nearby cells. The histamine causes small blood vessels to expand and the surrounding skin to swell. This is known as inflammation.  

The expansion of the blood vessels allows an increased number of infection-fighting white blood cells to be sent to the site of the infection. The swelling of the surrounding skin also makes it harder for an infection to spread to other parts of the body.

Histamine is usually a useful protein, but if you’re having an allergic reaction it’s sometimes necessary to block its effects. Allergic reactions occur when your immune system mistakes a harmless substance, such as pollen, as a threat.  The release of histamine causes the process of inflammation to begin and leads to nearby tissue becoming red and swollen. It can also affect the nerves in the skin, making the skin feel itchy.

I had been in the cancer treatment ward for over 2 hours and the chemotherapy itself had not started.  The next excitement was that the woman who had come round with the tea earlier came back. This time with bowls of soup and a choice of sandwiches for all the patients and the visitors. By this point she was my favourite member of staff!

Another nurse set me up for more saline drip: another half hour passed. It was only then the chemotherapy began and I got hooked up for my course of herceptin. The time lapse was this was to be another hour and a half. My husband took an opportunity to go for a walk and buy a magazine and a paper at the hospital shop. This opened in the afternoon notwithstanding the public holiday. He needed to stretch his legs and move around a bit. I really didn’t blame him for that.  By now it was almost 2pm and we had left the house more than 5 hours previously, it was clear it was going to be a long day: a very long day.

While the herceptin dripped into my vein I sat and flicked through another magazine left by someone in the ward. Herceptin is a cancer medication.   It interferes with the growth of cancer cells and slows their growth and spread in your body.  Herceptin is used to treat breast cancer that has progressed after treatment with other chemotherapy.

I was glad when my husband got back. I know the day was boring for him, but I was happy to have his company and support. I am not sure I ever told him that. I just expected him to know. When he did come back I did the puzzles in the magazine. It was something new to look at and think about apart from the unceasing coverage of the Queen and the Duke of Edinburgh endlessly waving to the crowds in the rain.  

The afternoon rumbled on and my favourite staff member came round again, this time with another cup of tea or coffee for the patients and family members with them. This woman secured her place in my heart!

After the dose of herceptin had completed, I was given another dose of saline and then the cool cap was switched on so that it would be ready for me to wear by the time I was ready for my dose of docetaxyl. Time continued to pass.  My favourite nurse was the person who put the cool cap on for me. It had to go on a full half hour before I started taking the docetaxyl at 4.50pm.

My husband was getting bored again. Who can blame him for that? He left the ward to go down to the car park. It was emptying fast as staff came to the end of their day and clinics ended, yet evening visiting had not yet started in the wards. He took the chance to move our car closer to the hospital so that I would not have so far to walk when we, eventually were able to make our way home. That time still seemed so far away to me.

Almost all the chairs in the ward had been used during the day. Now there was only one other patient, no great surprise really, most of the staff in the ward finished their shift at 5pm. This really was a marathon session.

The other patient in the room was a woman who was further into her treatment than me. Her daughter and two grandchildren were with her. The grand daughter was asking about the cool cap I was wearing. It did look a bit like a cycle cap and felt a bit like it does when you are standing in New York City, New York, USA in January waiting for a taxi. The only difference is there is no wind in the cool cap!

It was quite re-assuring to notice how accepting the family were of the woman’s hair loss and treatment. I am not looking forward to the prospect of losing my hair. My hair has been thin for some years due to an under-active thyroid, but the thought of losing it all together makes me very self-conscious.

So another hour passed while I sat with the docetaxyl dripping into me. By 6pm even the woman with the grandchildren had left and my husband and I were alone in the ward waiting for a nurse to come and unhook my drip. Even then the day was not over. When, eventually, the last nurse on duty in the ward came back in she told us the cool cap needed to stay on for another 20 minutes.  The nurse’s shift ended and she left. My husband and I were alone in the ward. He had been given instructions by the nurse as to how to turn off the cool cap and remove it from my head. It felt strange to be leaving from a completely empty ward.

My goodness I was tired by the end of all that. Not just because it had been such a long day, but also because everything was new and strange and stressful. The shops were shut when we were driving home by the time we got there we had been away from the house for over 11 hours. It was as long a day and as stressful day as I could remember. We were both too tired to cook, so we decided to pick up a meal from our local Chinese takeaway restaurant. This was a welcome end to the longest day.

Valerie Penny

Surviving Breast Cancer: More Reading, Listening and Sharing

Breast cancer re-aligns your priorities. The importance of family, friends and time to be with them and do things you enjoy become paramount.

I was glad of the opportunity to re-read Bill Bryson’s “Made in America” The book is reviewed here: https://bookreviewstoday.wordpress.com/2013/04/05/made-in-america-by-bill-bryson/. The text is an entertaining compendium of possible and less possible word origins. Does “okay” come from Martin Van Buren’s nickname, Old Kinderhook? Or from the fact that Andrew Jackson was reported to write “oll korrect”? Or is it from the Greek ollakalla(all good)? Bryson offers a cogent discussion of sexism in the language, and there’s a lot of orthography, etymology, and toponymy. But this isn’t just a book about language. It’s also a bestiary of American pop culture, many of whose stereotypes Bryson debunks (a back-formation from Buncombe County, N.C., of course): Ellis Island, in its original splendor, wasn’t half bad; the Puritans enjoyed a good time just like the rest of us; and Ray Kroc hadn’t the inventiveness of the Brothers MacDonald, after all. Bryson tells us a lot we surely never thought about. There’s the cost of sending a letter by Postal Express and the reason for the bump on the fuselage of the Boeing 747. “Debugging” of computers began, we are told, on the day 50 years ago when a moth entered a Navy computer. There are, however, some facts that aren’t facts. Bryson places the Polish-born British writer Joseph Conrad among the group of Americans whose names were changed from awkward foreignness. And, surprisingly for a lexicographer, he indulges in the popular confusion of the 18th-century “long s” and the modern “f.” This offering won’t replace the popular works by Flexner, much less the majestic Mencken, but the style is engaging and the narrative diverting. An index is appended, but there is no useful list of words and phrases.

If, as Winston Churchill has it, England and America are two countries divided by a common language, here’s some disarming help sent by a Yank from the other side of the pond.

Gerry McGrath’s first collection of poetry is published in his book “A to B”. It is reviewed here: https://bookreviewstoday.wordpress.com/2013/04/05/from-a-to-b-by-gerry-mcgrath/. He read from this when he came to visit a meeting of wkwriters. 

As well as being a highly visually stimulating poet, Gerry McGrath is also a poet concerned with humanity, with nature, with love and loss and how the prosaic and the poetic interact in day to day life.  The use of unconventional metaphors and similes gave many pleasant surprises as I saw things expressed in a way in which made perfect and beautiful sense however strange. Gerry McGrath describes ‘Untamed Lightning, Knees like Emaciated skulls, the sky…clean-shaven, Drowsy sail-cloth of your skin, Gossamer rain, Zany Butterflies, Pastry Roofs and Nicotine Grass.’ These are just a few examples of the arresting imagery which runs through this poetry collection. Some of the poems are as delicate as the ‘gossamer rain’ described by McGrath in the poem Sycamores. His poem Elegy appears in full here: https://survivingbreastcancernow.wordpress.com/2012/07/01/time-to-recover-watching-reading-listening-sharing/

I liked the later poems in this collection more than the earlier ones, although I do not know whether this was because they carried more depth of feeling or because by the time I reached them (I was more accustomed to and in tune with the poet’s tone of voice. The poems Secrets and Gift, which explore the art of writing poetry, struck me as particularly interesting as the creative process is highly individual to all writers and it is always interesting to be given a glimpse at how a poet writes. In Secrets he refers to a poet beginning with nothing and holding it ‘until it bleeds a secret’ a metaphor I found at once eerie and beautiful. In the poem Gift he refers to the way in which poets have the gift to observe ‘tiny immensities’, a gift which Gerry McGrath certainly has.

I think that ‘Tiny Immensities’ is such a beautiful and truthful phrase that it would make a good name for this collection of poetry, better than the current title A to B, which I found slightly off-putting. I understand that the collection was called A to B as it represents a journey, yet I feel that this title does not do the work as a whole any justice. The poem A to B from which I guess the title was taken, is my least favourite poem in the entire collection. In the poem McGrath tells us about butterflies, red-backed beetles and a dead marten but ends with ‘But let me tell you about the butterflies.’ While I realise that this premature ending was intentional I didn’t like it and felt let down that the poem did not go on to tell us about the butterflies as it seemingly promised to do. It only occurred to me later that this might refer to the other poems in the collection, some of which are as vulnerable and glorious as butterflies.

Some of the poems, particularly in the latter third of the book, were not so much poems, but snapshots of incidents, told in prose as precise as poetry. This was most apparent in the poems Busy, Currency, A Milky Sunlight, Two Friends, Mint Tea, Blue Light and Basics. I liked these almost poems best of all for the simplicity and honesty with which they were laid out and the way in which they all told an entire story in a snap shot. The scarcity of the language meant that by using fewer words McGrath was actually able to say more by imbuing his words with a deeper sense of meaning. The poem busy portrays someone cutting the poets hair while hearing about her Grandmother’s worsening condition. The combination of the prosaic ‘hair-clippings went flying out’ with the tragic ‘age, infirmity, depression, were all getting the better of her, pulling her down’ creates a beautiful sense of pathos, which runs on through the poems in this collection.

Every day is precious. Sometimes, in this blog, I may sound ungrateful. I am not. I know how lucky I am that my disease was found and treated early. I just do not like some of the results of my treatment. Still, it has made me slow down and given me time to spend time with those I love. Reading new books and some old favourites, sharing these with my family and friends and listening to all their views.

Valerie Penny

A Pleasant Interlude Before Chemotherapy for Breast Cancer

There is a time of year, it is usually around the second half of May when school children and students are studying for exams. They spend hours and days inside and in the libraries, so what happens? The sun comes out!  

This year was no different. During that sunny weather at the end of May, before the chemotherapy for my breast cancer began. My husband and I arranged for my mother to visit with us for a few days holiday, before I suffered hairloss and other side effects of the treatment. A mother should not have to witness that, if it can be avoided. During that week I did have to meet with my psychologist for my usual two-weekly therapy session.

I was able to air my feeling of resentment that I have never smoked, do not drink excessively and do take exercise. Nevertheless, cancer was the card I had drawn.  One day was interrupted when I had to go back to the hospital, this time for an initial set of blood readings to be taken before my chemotherapy sessions start. The hospital even did a pregnancy test! As if my long suffering husband did not have enough to worry about! I also had to go to the hospital for a cancer clinic visit with the oncologist and collect medications that I would need to take before chemotherapy began at the beginning of June.

We went to lunch with Mum and she had time to visit her friend who lives in the South of the county. Sometimes it was warm enough, just to sit in the sunshine in the garden and relax.

I was glad my mother was able to visit before the chemotherapy started and to see me still looking and acting like me. I had felt able to do plenty of home cooking and baking so we were able to ensure that many of her favourite recipes were served during her stay.  My mother had been treated for bowel cancer about four years ago and is presently cancer free.

She dealt with her ailments with dignity and an uncomplaining grace, even when the hospital infected her wound with MRSA. MRSA stands for methicillin-resistant Staphylococcus aureus.  Staphylococcus aureus is a species of bacterium commonly found on the skin and/or in the noses of healthy people. Although it is usually harmless at these sites, it may occasionally get into the body (eg through breaks in the skin such as abrasions, cuts, wounds, surgical incisions or indwelling catheters) and cause infections.

Patients may be colonised with MRSA when they leave hospital, and there has long been concern that MRSA might spread from hospitals into the community.  It was certainly true with my mother. Her condition was complicated by the fact she is allergic to penicillin.

I try to emulate her dignity and calm, but fall far short of the mark, I fear.  During my Mother’s visit the wkwriters had a visit from Gerry McGrath who read some of his poetry to us and focused on Blank Verse. One of Gerry’s anthologies of poetry is reviewed at https://bookreviewstoday.wordpress.com/2013/04/05/from-a-to-b-by-gerry-mcgrath/ My mother was able to join us for that meeting. I also re-read Made in America by Bill Bryson which I have reviewed at https://bookreviewstoday.wordpress.com/2013/04/05/made-in-america-by-bill-bryson/. The visit was a pleasant interlude and allowed me to divert my thoughts from cancer.

Valerie Penny

Countdown to Chemotherapy

I have said it before, I am a lucky woman. Nevertheless, during that time when I knew chemotherapy would need to be endured, I resented it. I resented the fact that I had had no symptoms from the breast cancer, but that I knew I would have symptoms, or side effects from the cure. It seemed unfair and ironic. Cancer is not fair.

I took great joy from the continuing good wishes of family and friends  and the huge number of cards and continuing bouquets of flowers that I received.  They were so pretty and they filled the house with colour and  light. It was so lovely to have so many vases in use!

Still, occasionally my husband and I would have a moment or so of tension or worry as we looked into the unknown and the void that is chemotherapy.  My husband works full time, he works 12 hour shifts at a time. Luckily, he had a day off on the day my first chemotherapy was scheduled. I was thrilled that I would have his support and company.

Funnily enough, during this period I got the most amazing help, supprt and advice from a man I have never met!

My friend Jane and I go line dancing to classes run by the amazing Danny and Sadie Kerr. Jane has taken me to hospital appointments that I would otherwise have to attend alone. It is wonderful to have company. Jane is particularly knowledgeable about hospitals and cancer treatments in particular as her brother, Michael, has been treated for many  cancerous tumours. I doubt there is a treatment that he has not endured.  Sadly, Michael has now been told that there are no more treatments that can help him. Michael’s condition is terminal.  

When I think of this I get embarrassed by my own moaning and frailty. Michael, through Jane, explained to me some of the side effects of chemotherapy. He explained to me the trauma of hair loss when it falls out in clumps.  His advice: to get it shaved off before that happens.

Jane explained to me how Michael had suffered severe pains in his joints. That the taste of his food changed and was so tinny.  Then Jane told me the most poignant thing that Michael had said.  The last time he finished chemotherapy he had said he never wanted to suffer like that any more.  Now he has been told that chemotherapy cannot help him any more he feels he is not ready to go yet. He would take chemotherapy or anything that would prolong his life.

I view this as a year of inconvenience. A scary and strange journey. I have learned a lot from Michael. I salute him and thank him for sharing his experiences with me. It was generous.

The flowers help to raise my mood and decorate the house.   The chemotherapy is scary but is a means to defeating this potentially deadly disease.  So roll on chemo: surely my imagination cannot be worse than reality.

Valerie Penny

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