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

 

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Breast Cancer and Herceptin (Trastuzumab)

During my treatment for breast cancer, I was part of a medical trial in relation to the effecacy of the drug Herceotin (Trastuzumab). Herceptin is a drug that belongs to the group of drug treatments called targetted or biological therapies. It stops specific ways that breat cancer cells divide and grow. I was treated with Herceptin because my cancer cells were found to have a higher than normal level of the protein Human Epidermal growth factor receptor 2 (HER2) on their surfaces. That stimulates the cancer cells to breast-cancer-s10-photo-of-her-2-genegrow. Herceptin works by attaching itself to the HER2 receptors so that the cancer cells no longer grow. it also stimulates the body’s immune system to fight the cancer cells.

I am one of the 20% of breast cancer patients to benefit from Herceptin as my tumours were the fast growing ones that are HER2 positive. I was given the Herceptin along with chemotherapy after my surgery in order to reduce the chance of the tumours spreading or returning. If your breast cancer is not HER2 positive or, indeed, HER2 negative, Herceptin will not be effective to you.

The Herceptin treatment I was given for my breast cancer was given to me intravenously through my Hickman line on the same days as my other chemotherapy. I was treated every three weeks as an out patient. However, the days were long, as the Herceptin was given over 90 minutes with additional time taken to give me saline solutions and my chemotherapy. I had to stay in hospital for several hours in case I was allergic to the treatment. Luckily I was not. However, like all drugs, Herceptin has side effects.

The common side effects of Herceptin include: feeling like you have flu, nausea and diarrhoea. I had all of these. I felt pain in my muscles and joints and often felt breast-cancer-s2-breast-cancer-illustrationlike I had a temperature so I swung between feeling hot and cold. I also had to have treatment with anit-sickness drugs for the servere nausea I suffered. I also got medecine from the hospital to counter the diarrhoea that I suffered.

The trial I was part of was looking into reducing the period of time that women are treated with herceptin, to see if it makes a difference to the efficacy. The usual period for getting Herceptin is about a year. I was treated with it for 9 weeks. I found the hospital visits and the side effects very draining, so, although I had initially felt diappointed that I was only receiving the treatment for a shorter period, in the end I was quite glad to get to the end of the course of Herceptin.

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

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

Hard Truths about Cancer

Over the next few days I had an appointment about my breast cancer with my consultant, Mr Osman. He explained to me that the  tumour he had removed was slightly bigger than anticipated. It was about 8mm long. He had expected it to be about 5mm. It still did not sound big to me, but I knew bigger, in this case, did not equate to better.

Mr Osman also explained to me in some detail that the tumour was HER2 positive and that I would benefit from treatment with the drug Herceptin. HER2 is a receptor found on the surface of certain cancer cells.  It is made by a specific gene called the HER2/neu gene. HER2 is a receptor for a particular growth factor called human epidermal growth factor, which occurs naturally in the body. When human epidermal growth factor attaches itself to HER2 receptors on breast cancer cells, it can stimulate the cells to divide and grow.

He told me that some breast cancer cells have a lot more HER2 receptors than others. In my case, the tumour is described as being HER2-positive and that it is thought that about 1 in 5 women with breast cancer will have HER2-positive tumours.  HER2 is a gene that sends control signals to the cells, telling them to grow, divide, and make repairs. A healthy breast cell has 2 copies of the HER2 gene. Some kinds of breast cancer get started when a breast cell has more than 2 copies of that gene, and those copies start over-producing the HER2 protein. As a result, the affected cells grow and divide much too quickly.

This genetic problem is not inherited from your parents. The most likely cause of this problem is aging, and wear and tear on the body. It is not yet known if environmental factors (pollution, smoke, fumes) are part of the cause of this problem.  If your breast cancer is tested for HER2 status, the results will be graded as positive or negative. As my results were graded as HER2 positive that meant that my HER2 genes were over-producing the HER2 protein, and that those cells are growing rapidly and creating the cancer. Mr Osman thought that he had removed all the cancer from my body with the surgery but in order to be sure of this and to minimise the risk of return, he recommended that the oncologist discuss with me the benefit chemotherapy would offer me.  

The oncologist, Dr Lumsden, recommended that I should have three lots of three weekly cycles of chemotherapy. The first 3 would be Herceptin and then docetaxel in a liquid that I would get through a drip (infusion) into a vein (intravenously). Each infusion of herceptin takes about 90 minutes, the docetaxyl takes about an hour and I would have one treatent every 3 weeks for 9 weeks. He recommended that I would then have chemotherapy as a course of 3 cycles of FEC (fluorouracil, epirubicin and cyclophosphamide) for a further 9 weeks.

Docetaxel can cause an allergic reaction. To try to prevent this, Mr Lumsden explained I would be given steroid tablets to take, usually for 3 days, starting the day before each treatment. He went on to tell me that FEC treatment would be given to me as a day patient. Before I started treatment, I would need to have a blood test a day beforehand. He also told me that I would be seen by a doctor or specialist nurse. If the results of my blood test were normal, the pharmacy would prepare my chemotherapy drugs. All of this might take 2-3 hours.

A nurse would insert a thin, flexible tube (cannula) into a vein in my hand. Dr Lumsden told me also that some people need to have their chemotherapy given through a thin, plastic tube that is inserted under the skin and into a vein near the collarbone (hickman line). He did not know if this would be necessary for me. I was also to be given some anti-sickness drugs as tablets, or more usually by injection through the cannula, which is often connected to a drip.

The chemotherapy drugs are then given separately after this.

It was so much to take in. The disease had been found so early that I had had no symptoms that I was aware of. Looking back, the extreme tiredness and exhaustion caused by any degree of physical effort, so typical of cancer, had already started to show. I just did not know to consider it. Still, it sounded like the cure was going to be worse than the disease. All of a sudden it was emphasised to me that my condition was serious and needed to be fully eradicated.  I was forced to face some hard truths that, until then, I had preferred to try to ignore.

Valerie Penny

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