Osteoporosis and Breast Cancer

Osteoporosis literally means porous bones. The result is that the bones can become thin or snap. Osteoporosis cannot be cured and often is not found until after bones break. It affects half of women over 50 and one in five men in that age range and some people who receive treatment for breast cancer are at an increased risk of ostoeporosis, however, treatments are available to try to keep bones strong and less likely to break.

Women who have not gone through the menopause before they are treated for breast cancer have an increased risk of osteoporosis. Indeed, chemotherapy can cause an early menopause and a rapid, significant reduction in bone density and result in osteoporosis.Even women who have been through the menopause may be at increased risk of osteoporosis because of the hormone therapies they take for breast cancer.

balanced her 2.jpgI am being treated with letrozole for my breast cancer. My tumour was of the fast growing HER2 positive variety. The letrozole is one of the drugs that reduces the amount of oestrogen circulating in my body and this could result in osteoporosis. I have my bone density checked with a bone density scan and, so far, I do not show signs of osteoporosis. Generally speaking, people with a good bone density before getting treatment for breast cancer are less likely to develop osteoporosis while taking an aromatase inhibitor such as letrozole.

I have been careful to put some simple lifestyle choices to help keep my bones strong and healthy. I ensure that, although I am vegetarian, I have a well-balanced diet. Although dietbalanced-diet changes will not cure bone defects, it may stop them osteoporosis getting worse. Eating meals that incorporate a wide variety of foods including fruit and vegetables, carbohydrates, milk and dairy products and proteins help achieve this. As a general rule it is recommended that we eat at least five portions of fruit and vegetables a day. You would be amazed how many people, including vegetarians, do not manage this! I have also significantly reduced my alcohol intake and the amount of fizzy drinks I take.

Calcium is a vital mineral for teeth and bones. It gives them strength and rigidity. Most of the calcium found in our bodies is in our bones. Dairy produce is our main source of calcium. People  can usually get enough calium through a healthy diet that includes dairy products. If your diet did not include dairy produce you would need to ensure you got calium from another source such as a calcium supplement.

I also have to bear in mind that vitamin D is needed to help my body absorb calcium. The best source of vitamin D is sunlight. Human bodies use the sunshine to make vitamin D in the skin. The vitamin D is fat-soluble and the body stores it for use in the winter months. balanced sunWe only need to be out in the sun for about quarter of an hour a day during the summer months to give most people enough vitamin D for the whole year. So a walk, some gardening or a round of golf should make sure we get enough vitamin D. In addition to that, margarine, egg yolks and oily fish also contain vitamin D.

Regular weight-bearing exercise is also important to put force through the bones. This helps stimulate growth and strength and keep bones strong and healthy. Such exercise includes skipping, aerobics, tennis, and dancing are good bone building activities, even a brisk walk can be of benefit to bones. I try to do some exercise at least three times a week in order to combat the cancer-related fatigue I suffer and the potential for weight gain that my medication induces. I really try very hard to make sure that I do not add osteoporosis to my list of worries.

Valerie Penny

 

FEC Chemotherapy for Breast Cancer

When I was diagnosed with breast cancer, apart from being completely taken aback that something like this could happen to me, I got detailed advice from the oncologist about the type of treatment I would need.

fecI was told that after surgery to remove the tumours, the oncologist told me that I would receive chemotherapy and then  radiotherapy. The chemotherapy I received was called FEC. This is a combination of three chemotherapy drugs 5 fluorouracil, epirubican and cyclophosphamide. FEC takes its name from the initial of these three drugs.It is normally used to treat people with primary breast cancer that has not spread to other parts of the body. Chemotherapy destroys cancer cells by interfering with their ability to divide and grow.

All cells in our bodies continually divide and grow. This enables growth and repair of body tissue. Cancer cells are different because they grow by dividing in a disorderly and uncontrolled way. Different chemotherapy drugs work in different ways and attack the cancer cells at different stages of their growth. This is why a combination of drugs is often more effective than just one drug.

I was given my FEC intravenously. I had a Hickman line fitted because the veins in my hands did not allow easy acces for the cancer nurses.  All my medication was given through my Hickman line. I did not like having it, but it was useful. I was given the FEC as an out patient, every three weeks for 18 weeks. This meant I could go home on the same day after treatment, that was nice, but the days were long and tiring. The time involved is not just that required to give the drugs, but also waiting time, blood tests and time for the drugs to be prepared.fec tired

I suffered side effects with FEC. The common side effects include bone marrow suppression.Bone marrow suppression or myelotoxicity is the decrease in production of cells responsible for providing immunity, carrying oxygen and those responsible for normal blood clotting. Bone marrow suppression is a serious side effect of chemotherapy. The decrease in blood cell counts does not occur right at the start of chemotherapy because the drugs do not destroy the cells already in the bloodstream. However, the drugs affect new blood cells that are being made by the bone marrow. The suppression of bone marrow activity causes a deficiency of blood cells. This condition can rapidly lead to life-threatening infection, as the body cannot respond to invading bacteria and viruses.It can also leading to anaemia due to a lack of red blood cells and spontaneous severe bleeding due to deficiency of platelets. This resulted in me suffering from severe tiredness and exhaustion. It is difficult to describe the depth of the feelings of exhaustion. I also had several spontaneous nose bleeds.

Other side effects include nausea and vomiting. The hospital supplied medication to minimise this. I was instructed to take the medication at specified times after my treatment. However, the most visual side effect of chemotherapy is hair loss. I did try an ice-cap to reduce that, but to no avail. It did not work.

fec baldWhen people think of hair loss, they, and women in particular think of the loss of hair on their head. Certainly that does go. The result is a cold head in winter! However, all of the hair on my body was lost. This included the hair on my limbs and inside my nose. The good news was that I did not need to shave my legs for a year, the bad news is that it meant there were no hairs to stop my nose from running. Always carry a handkerchief!

I was not going to bother buying a wig. However, my cancer nurse advised that I should. This was partly because it might make the sight of me during my illness less difficult for my children and my elderly mother. She also pointed out that it would keep my head warmer, especially in winter. She was right on both counts.

Cancer affects not just the person who is diagnosed, but all the people who love them: their friends and family. I hope you never suffer such a diagnosis, but if you do, bear in mind the agony of those around you.

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

Post Cancer Fatigue

Cancer related fatigue (CRF) is very common.   I had just no idea how long I would suffer from fatigue after my treatment had finished.  Fatigue can often be confused with tiredness, but there are differences between the two conditions.

chronic-fatigue

Tiredness happens to everyone, especially after certain activities or chemotherapy however,  fatigue is less common and is an excessive whole-body tiredness that is not relieved with sleep.   This debilitating condition can impact your quality of life. It certainly impacts upon mine.  I am still unable to walk for the kind of distances I did previously and only do half a line dancing class instead of a full one.  My 18 weeks of chemotherapy ended almost 10 months ago.

Fatigue can be acute (lasting a month or less) or chronic (lasting from one month to six months or longer).   Mine is clearly chronic.  The precise reason for this intensive tiredness is unknown, but practitioners believe it may be related to the process of cancer itself or chemotherapies and radiation treatments.  Although  CRF is one of the most common side effects of cancer and its associated treatments, nobody told me about it or warned me I might suffer from it.  Therefore, I thought I was just being lazy and not pulling myself together properly.   I was quite wrong.

Usually  it comes on suddenly, and does not result from activity or exertion.   Although in my case exertion makes it worse.  The fatigue is often described as “paralyzing.”  It may continue for months, even after treatment is complete.

If you are a cancer survivor and feeling tired or fatigued even long after your treatment is finished, you must know you are not alone.

fatigue

About one-third of breast cancer survivors experience CRF for periods of time ranging anywhere from a year to several years post-treatment.  While there is no conventional therapy to resolve it, studies are increasingly showing yoga and other gentle exercises can help. Some patients with different cancers report relief with exercise.

Valerie Penny

Radiotherapy After Breast Cancer Surgery

So here I am, the beginning of my radiotherapy, four weeks of travelling up and down from the Beatson Hospital in Glasgow, Scotland.  The journey takes more than an hour each way and while the treatment only takes ten minutes, it rarely starts on time. Image When I eventually get called through I have to walk along a lengthy corridor with a large room at the end of it.  Two technicians were there setting the machine up for me.  It has to be changed and cleaned after each patient and that was still being done as I entered the room.  There is no where take off my clothes but in the room in the full view of the technicians.  Now, I appreciate there is nothing special about me, however I am, by nature quite reserved.  I am not given to disrobing readily and I was quite embarrassed when I was told just to strip to the waist and put my clothes on the chair near the entry to the room.  I was handed a paper towel with which to cover my modesty as I walked from the chair to the machine. This was horrid.  The paper was not wide enough to cover both my breasts at once and as often as not fell to the floor as soon as I got on to the machine. radio_treatment         On the occasion of my first treatment the technicians introduced themselves.  I believe they should have done this on each occasion that I had different people treating me.  That did not happen.  Indeed, even when there was a student present, whether male or female, I was neither asked for permission to have the student present, nor introduced, nor told that a male member of staff would be present. Now, I am being treated for breast cancer.  I am of an age and disposition that does not readily strip off in the presence of strangers. The stress is appalling anyway, and being treated like cattle, or meat, certainly not as a valuable patient, was very upsetting. It added to my tension rather than easing it. There was no consistency of times for appointments either.  I was fortunate that most of my appointments were between 11.00 and 12.00 each day.  However, speaking to other patients that was unusual.  Having to go to hospital each day is difficult enough, but if it is at around the same time of day you can get into a routine of sorts.  I found radiotherapy even more difficult to cope with than chemotherapy for these reasons.  It definitely intrudes into “real life”. Of course, I had heard that radiotherapy would make me tired and I would suffer from burns around the area being treated.  I had no such effects initially and, if you have read the rest of this blog, it will not surprise you to know that I believed none of this would happen to me. Neither will it surprise you to know that I was wrong again. MRSA After six or seven treatments I began to feel so very tired. Tired and bone weary. Getting up in the morning was increasingly difficult, although I always did.  However, I often needed to go for an afternoon nap when I  got home from radiotherapy.  The feelings of tiredness increased.  I could not work out whether this was due to the travelling or the treatment.  In the end I decided it was both, exacerbated by the chemotherapy that I had already received.  
Tiredness caused by the radiotherapy treatment itself, is thought to be due in part to the type of toxins released during the breakdown of some of the cells within the treatment area. Drinking fluids to keep hydrated,appears to help flush these toxins out of your system. Eating regularly throughout the day, and not missing meals, will also help to maintain your energy levels.   In addition my skin around the area getting treated by radiotherapy was becoming increasingly red and sore. Th radiotherapy is very precisely applied to the exact same area each day.  My breast around my operation scar became increasingly sore but the burning was worst underneath my breast.   Most patients will notice a reddening,  darkening, or burning of the skin within the treatment area, this is called erythema.   This reddening is sometimes likened to a mild sunburn. 220px-Aqueous_cream_B.P. There are some occasions for example when the doctor wishes to treat close to the skin’s surface.   In these instances the reddening may be worse, but you will have been informed about this in the initial consultation. Most patient’s will only have a very mild reaction.   The hospital prescribed aqueous cream and pain killers.   You can help reduce skin reactions by looking after your skin.   It is clear that skin that is well moisturised has less significant side effects than skin that is not. During my radiotherapy treatment I kept my skin well moisturised, and regularly applied (2-3 times per day) the Aqueous Cream provided by the hospital.  This is a pure water based moisturiser. Four weeks, or 19 sessions after it started my radiotherapy was over.  I walked out of the hospital and the routine I had built up during the period of radiotherapy was terminated.  The medical attention and support I had been receiving for months was brought to an end. What a strange feeling.

Valerie Penny

Cancer Treatment After Chemotherapy

My chemotherapy lasted 18 weeks.  The treatments were every 3 weeks.  At first, I really thought I had beat the system and that, with the help of the cool cap, my hair would not fall out.  I was wrong, it did.  I had thought I would not want a wig, what does it matter if I am bald or not?  I was wrong, I did.

The wig was useful for three reasons: first, it keeps your head warm!  Second, it makes things easier for loved ones who do not want to think of you as really ill, even when they know you are.  Last, it helped me to feel “normal” and not to advertise my illness.  I do not want to be defined by any one aspect of my life, especially cancer.

I had also thought, somewhat conceitedly, that I would not get so very tired from the chemotherapy and life would go on as normal, just punctuated by the treatments.  Guess what?  I was wrong again!  The chemotherapy builds up over the period of time and I got bone tired sometimes.  I was so tired that getting up was an effort and I accomplished very little some days.  However, every day I got up, I got dressed and I did something, even if it was just make a cup of tea, write my diary or phone a friend.  Some days I needed a nap and others I felt so good I would bake a cake, clean the bathroom and present my writing class.  Believe me when I tell you I paid for those days for 2 or 3 days afterwards.

Bearing in mind the number of times I had been wrong before, it will not surprise you that I was wrong again when I considered the 5 week break between chemotherapy and the beginning of my radiotherapy was unnecessary.  That period allowed me to be just a little less tired each day and my husband and I did a few things together that I could not have contemplated if I had gone directly from one form of treatment to the next.

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My husband took me to the Ayr Flower Show. We were only there for 3 hours, but it was lovely to see the flowers and stalls where the vendors had some useful things on sale.  Some fine plants and pretty accessories available too.  There was a stand showing birds of prey that was really interesting.  I was also surprised at the wide variety of stalls providing food and snacks.  We particularly enjoyed looking at the Bonsai Trees.

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All too soon the weeks of freedom came to an end.  My radiotherapy started.  There was one big difference between the chemotherapy and the radiotherapy.  I had to attend hospital every week day for 19 days to complete the required radiotherapy.

My sessions started on a Tuesday so for the next 4 weeks I must endure the 70 minute drive to and from home to the hospital  for my 10 minute radiotherapy sessions.  It was a huge intrusion into the day.  It was also difficult to lead any semblance of a normal life during this period because my days from 10.00 to about 1.30 were taken up by the daily trips to The Beatson West of Scotland Cancer Centre. It is a specialised cancer care centre in Glasgow, Scotland. I was lucky because there is a local charity, North Ayrshire Cancer Care, that provides volunteer drivers to drive people to and from cancer treatments.  This makes a big difference.  Patients are advised against driving after treatment and it would be difficult to find family and friends able to make the trip daily for such a long period of time.  There is such a time commitment each day.

So, radiotherapy, here I come.

Valerie Penny

More Reading Writing and Sharing During Cancer Treatment

In the time when I am undergoing chemotherapy I am unable to go out as often as I would like and often cannot mix with friends so I spend much of my time reading and writing.   Here I share some of my work and views with you.

SACRED HEARTS  

1570 in the Italian city of Ferrara, and the convent of Santa Caterina is filled with noble women who are married to Christ because they cannot find husbands on the outside. Enter 16 year old Serafina, howling with rage and hormones and determined to escape. Her arrival disrupts the harmony and stability of the convent, as overseen by Madonna Chiara, an abbess as fluent in politics as she is in prayer. She assigns the novice into the care of Suora Zuana, the scholarly nun who runs the dispensary and treats all manner of sickness, from pestilence and melancholy to self-inflicted wounds. As an unlikely relationship builds between the two women, others figures stand watching and waiting; most notably theå novice mistress, Suora Umiliana, a crusader for God and ever stricter piety and the mysterious, decrepit Suora Magdalena, incarcerated in her cell with a history of ecstasy and visions.

This book is well researched and well crafted, and the descriptions are detailed. Perhaps too detailed to keep the work interesting.  The author is keen for you too appreciate how clever she is and how much work she has put into her research. This gets old very fast.  The story line is completely unbelievable and a very secondary part of the piece when compared to the description of life in a 16th Century convent so I cannot recommend this work.

Believe  

Ultrasound then surgery

C T scan – lumpectomy

Felt great before they worked on me

Can you believe it?

To Glasgow for a hickman line

On good days, though I do feel fine

It hardly seems this life is mine

Can you believe it?

Coloured capsules: lots of pills

Hygiene, mouthwash ulcerous ills

Nosebleeds leaving bright red spills

Can you believe it?

Lethargy and long, long naps

Daytime TV: memory gaps

Sleepless nights spent reading pap

Can you believe it?

Urine dark as Grandpa’s tea

Baldy pate & sore left knee

The doctors say they’re curing me –

Can you believe it?

By Christmas time – I’m truly blessed

Accepting someone else knows best

Cured and  healed with time for rest

You can believe it.

Valerie Penny

Virals

Tory Brennan, niece of acclaimed forensic anthropologist Temperance Brennan (of the Bones novels and hit TV show), is the leader of a ragtag band of teenage “sci-philes” who live on a secluded island off the coast of South Carolina. When the group rescues a dog caged for medical testing on a nearby island, they are exposed to an experimental strain of canine parvovirus that changes their lives forever.

As the friends discover their heightened senses and animal-quick reflexes, they must combine their scientific curiosity with their newfound physical gifts to solve a cold-case murder that has suddenly become very hot-if they can stay alive long enough to catch the killer’s scent.

Fortunately, they are now more than friends- they’re a pack. They are Virals.  Unfortunately, this is a very poor book and not up to Kathy Reichs’ usual standards.  It really disappointed me. The storyline is far-fetched, the characters not well drawn and I certainly cannot recommend this work.

I can only do what I have the energy to do from day to day. If that is reading writing and sharing my views, as I recover, so be it. Bear with me while I heal.

Valerie Penny

The Psychological Effects of Cancer

There are other effects of cancer and its treatment that are not so widely known or discussed.  I have only discovered this recently and these are side-effects that affect not only me but also those close to me who are nearest. These are the psychological effects of cancer that make everything doubly hard: for everybody.

It was only when I was chatting to my cousin about cancer suffered by another member of our family and the outbursts of temper they displayed, that I began to understand that cancer results not only in physical, but also psychological effects.  The emotional effects of chemotherapy can be just as debilitating as the physical effects. From the initial diagnosis of cancer to the final dose of chemotherapy, patients undergo levels of emotional distress well beyond a healthy limit. The emotional effects of chemotherapy can be directly related to the medication or to external factors such as family, work and social life. The range of emotional distress felt by patients depends a lot on their particular support network and  their rate of recovery.  Emotions run high for the whole family during chemotherapy.  It made sense when I thought about it, but I never had.   

I asked my husband if I had ever displayed any outbursts of temper. I was sure I had not, until he reminded me of an uncharacteristic and ugly diatribe to which I subjected my daughter during a telephone conversation.  I felt so guilty because he was right.

The outburst to which I subjected my daughter is not the only evidence of my fragile mental state during cancer treatment, at present.  When the District Nurse arrived to clean my hickman line and take my pre-chemo bloods at a time different to that arranged I lost the plot and ended up asking her to leave. Oh dear! The problem is it all seemed so logical at the time.

Chemotherapy can have an emotional impact on patients because the treatment itself is a sign of emotional self-preservation. The choice to fight cancer does not end with the first dose of the medication and patients often feel emotionally taxed when recovery is slow. The physical side effects can contribute significantly to emotional distress. Insomnia, constant nausea, weight loss, hair loss and a diminished sex life can all make a patient feel emotionally distraught. Family and friends bear their pain too.

Chemotherapy also affects patients because of a perceived burden of loss on family, friends and work. Patients may feel isolated from participating in family activities due to fatigue and medical appointments. Social life is also dramatically affected by chemotherapy due to fatigue and often shame.  Therefore, some of the classical negative emotions during chemotherapy include anger, fear, anxiety, depression and isolation. The emotional distress from chemotherapy may come from a sense of not having any control over the matter.   Cognitive function and emotional health are strongly interconnected and chemotherapy can take a serious toll on both of them. In some cases, emotional distress can affect cognitive function, while in other cases, impaired cognition can alter judgment and emotional responses during cancer treatment.

However, I have to confess that, perhaps unsurprisingly, my worst outburst to date has been reserved for my long-suffering husband. This combination of temper and depression was my worst to date.  When I asked my cancer nurse if this was a normal side effect she replied in the affirmative. My husband just said very quietly, “But that does not make if acceptable.”  Of course he is right and none of the victims of my temper deserved it.

Depression is a persistent sadness that interferes with usual activities and ability to carry out roles at home, work, community, or school. Depression may also be known as sadness, feeling “down,” despair, or hopelessness. Depression and its side effects affect both men and women.  There are several risk factors that increase the potential for development of depression in the patient with cancer.  Medications commonly prescribed for cancer patients can be one of those risk factors.  There are many classes of medications that may have depression as their side effects.  Some examples are: analgesics, anticonvulsants, antihistamines, anti-inflammatory agents, antineoplastics, chemotherapy agents, hormones, immunosuppressive agents, and steroids.

Depression during chemotherapy, and generally can be managed, but it has to be admitted first.  You need to recognise what puts you at risk of depression.  Triggers include –

    • History of depression in yourself or your family.
    • Pessimistic view of life.
    • Living with a chronic disease like cancer.
    • Stressful events in your life.
    • Effects of some medications & chemotherapy.
    • Lack of support from family or friends.
    • Unrelieved physical symptoms (like pain).
    • Alcohol or drug abuse.
    • Unrelieved grief (not working through feelings of angry about how cancer & its treatment have affected your life).
    • Any persistent change in your mood, with the signs of depression listed above.
    • If you feel suicidal you must tell someone and get help. It is not safe to be on your own at these times.  

I am told it is not unusual to have times when you feel very low after a diagnosis of cancer, and during or after treatment. Many people feel physically and emotionally exhausted from the treatment, and this can lower their mood. However, for some people affected by cancer their low mood may continue or get worse and they may need specialist help or treatment. Some people find that their sadness gives way to a situation where their mood is low most of the time for several weeks or more, and they are depressed.

The relationship between cancer and depression is complex. Depression may be triggered by the diagnosis of cancer, other issues related to the cancer and its treatment, or the impact of the cancer on a person’s life. However, depression may occur by chance or be related to other difficult events, either in the past or in the present, which are nothing to do with cancer, such as the loss of a loved one.    Depression can develop slowly, making it very difficult for either you or your family to recognise when it started. In other cases it can seem to hit you suddenly – one day you wake up and realise that you feel hopeless and helpless and are engulfed in a ‘black cloud’ or, as Winston Churchill called it “black dog” of depression.  

Depression can affect anyone at any age. It is extremely common – one in five (20%) people are affected by depression at some time in their lives. Depression is not a sign of personal failure or inability to cope. You can’t ‘pull yourself together’ or ‘snap out of it’.  Depression can usually be successfully treated. The first step to feeling better is to admit the problem, then to get appropriate help.

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

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

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