The meaning of a logo

Have you ever noticed that when a news item becomes a bit more serious or drawn out it gets a logo on the BBC? The global economic downturn had one, the US Elections, the referendum etc. Brexit has had several, a made up name and it even got a dictionary entry!  I’m clearly not that newsworthy, but as I am now about to enter into my 18th month of cancer treatment I thought it was time The Cancer Gap got a logo.  So here it is.

The beady eyed of you will have noticed it at the top of the search bar or on social media.

I could have asked or paid one of my design colleagues or contacts to do this, but I thought I’d ask my friend who is teaching herself design.  She loved working on something real.  Or so she told me.  She explored a few options and together we came up with this.  She even dragged her IT husband into the task.  This is just one of many examples I have of people in my community going above and beyond to help and to contribute somehow.

I thought I’d do this update now as its pretty slow getting all the eligibility scans in place for the trial protocol.  It is only when I’m through this that they can confirm that I will be put on the trial.  

Distinct marque

For those of your following previous posts, the tiny maggot sized and coloured piece of me that was extracted with a punch biopsy a week or so ago turned out to be malignant.  So that distinct shape, wasn’t scar tissue, fat necrosis or my paranoia, it was a mass of cancer cells that have grown from some microscopic cancer being left behind. This is why you always want clear margins, the bigger the better.  Mine weren’t clear. Ever. So this is not a surprise. 

I first felt the lump as a pin head (that’s when they thought I was a bit hyper vigilant or even paranoid) and now its the size of a sweetcorn kernel and is a adenocarcinoma (a cancer tumour made of glandular cells).  They’ve sliced this little tiny maggot up into slithers like a cucumber into tiny rounds and put it on slides.  They have tested it for hormone receptors.  It has none.  No targets for treatment.  So as well as being a grade 3 tumour, it has 2 out of the 3 markers it needs to be classed as ‘triple negative’.  The HER2 status (the third marker) takes another week or so and I’m sure it will be negative again.  So it is the same Triple Negative Breast Cancer.  This cancer can sometimes mutate to be HER2 positive, so we have to go through this motion.  Once my tumour has finished its little trip around the labs of the south west of the UK, it (or another piece from one of the other tumours) will be put in some formalin and flown to the US or Switzerland.  Whilst my body is pretty much grounded, little chopped off bits of me are able to travel passport and insurance free.

Invasive breast cancer is tricky.  It starts small and undetectable and then eventually the cells join up to cause a lump you can actually feel.  A lot of breast cancers are ‘ductal carcinomas in situ’ or DCIS and never become invasive.  These are more like a boiled egg still in its shell, easier to cut around and remove. Whereas invasive cancer is more like scrambled or powdered war time egg or a Jackson Pollock painting. 

A pathology slide showing different types of breast cancer
(Image from Memorial Sloan Kettering Cancer Centre)

One of those little microscopic bits has grown into something that is still not traceable on a ultrasound. I even sharpie-ed up the spot beforehand.  The sonographer felt it with her hand, but the scan didn’t show it.  The PET-CT and CT scans didn’t show it either as there is so much other activity going on around this place from the surgery, scar tissue and radioactivity damage.  My surgeon said he always prefers physical examination for this kind of local reoccurrence.  

‘Once again, the grope test wins over tech then, but I guess you can’t say that’. 

My response to the surgeon.

Well, that got a little side tracked from talking about logos, but at least you are up to speed.

Tune into your intuition

If I could sign off with one thing it is this: don’t delay if you have symptoms or lumps you are not sure of.  Don’t be paranoid, but get to know your body.  You are so often the best judge of any changes or suspicious activity.  Tune into your intuition. 

I already have the mastectomy scars branding me a ‘breast cancer victim’.  However, a little lump, like a logo could be a recognisable symbol of early cancer or re-occurrence.  Its distinctive design, this time of cells, the malignant or benign deciding factor.  

Either way, for me, it is always better to know and to act.

Unequivocal disease progression. Placebo.

I can’t really dress that up in a fancy headline. Before this week ends I’m going to attempt to capture 48hrs in the life of a mTNBC patient fighting the system for treatment and their life. I wasn’t going to write this post at all. Firstly I’m in it up to my neck and it’s hard to get enough perspective or space to write coherently. Secondly the situation is shifting all the time. However I think if I don’t try and capture some of these recent events I won’t even believe it happened and I’m living it. 

If you read this to the end I hope it helps you understand why sometimes people with cancer and serious disease just smile and say ‘I’m good thanks’. 

Tuesday PM

On Tuesday this week the facts came at me:

– ‘We now have unequivocal evidence that your disease has progressed and is functionally active’.  
– ‘You are no longer on the trial’
– ‘We’ve applied to unblind you and you were on the placebo’
– ‘We don’t have any immediate options at this hospital’
– ‘We will refer you to another hospital who might have something for you, but we don’t know what’

Bang. Bang. Bang. Bang. Bang. The news kept coming. 

Despite knowing in my heart that my disease had progressed, hearing it finally confirmed was brutal. Not a surprise, but a shock none the less. I felt like I was being ejected off my plastic hospital seat into the ether. Abandoned by the system and the lack of treatment for TNBC again. Left to come up with my own plan (or at least that’s what it felt like). 

But this is what I do best. It’s my calling. I make stuff happen. I go around problems. I try to look ahead as much as I can, to scenario plan my next move. I often have a strategy. I breathed, I had one here too. 

However, I was upset. Not angry, but mourning my future. Grieving the reality. Trying to accept the injustice and bad luck of not getting the drug I researched so heavily back in March. The trial that so many people helped me get on within 3 weeks of my secondary diagnosis. The hope ebbed away. I felt hollowed out. Not done, but desperate to catch a break in this relentless, once hopeful, now seemingly futile journey. 

Saying goodbye

I looked around at the wonderful NHS hospital that has held me close for 6 months. I smiled at yet another person I knew by name, knew about her children, where she trained.  I must know about 30 people by first name in this hospital. It felt intimidating back in March when I knew no-one and now I felt sad to leave the building and the people who has enveloped me for this part of the fight. I was sad. I was letting go in a way that I haven’t normally done when the bad news comes. The work on myself and even this blog meant I was feeling it deeply, not disassociating. This is good and bad. 

I walked to the train with my husband, we were in a bit of a trance. Then a switch flicked.  I literally got back on the train metaphorically and physically. I had to make a decision to detach again. To pretend this was work. A mammoth project to direct. A big problem to solve, move forward and take control of. People to mobilise and mindsets to shift. Starting with mine. I could not let this happen to me.  I had to get back in the driving seat. Fast. 

What did I know?
Who did I Know?
How long would it take my current hospital to send a referral letter?
What were my options?
Who else might have a perspective on those options?

I was manic, but straight away I remembered a kind and determined woman I had been exchanging posts with on an invaluable forum I belong to. She was on a clinical trial at the hospital they were talking about referring me to.  If it was anything like the hospital I was leaving she would have a direct line number into the trials team. I private messaged her. She astounded me with her speed and quality of response. She is a kindred sprit. She sent a screen grab of names, direct lines, mobiles and emails within a minute or so. I was getting intermittent WiFi and reception. She messaged that she thought the trial might be closed. It sounded ambiguous though – ‘thought’.  My mind was racing.  While I was in a tunnel, on her own initiative, she called the trials team.  Out the tunnel – another message. ‘There’s one place left, you’ll have to move fast’. I felt sick, but excited.

There has got to be more relaxing ways to die.

WhatsApp to my family

Whilst on the train, I used my mobile, genius-scan and dropbox to scan all the recent scans and letters I had. I copied the bold ‘diagnosis title’ at the top of the paper. I frantically tapped my recent medical history, NHS number etc. into my phone. The file I carry around and the data in my head was coming into its own. Not to mention the digital revolution. Once off the train I finished the scanning in the waiting room (If that isn’t a metaphor for how I feel I don’t know what is).

Send. Phew!

No one could say I’d missed an opportunity, by not acting fast enough. This is the exact opposite of an appropriate epitaph for me! 

I spoke to the fab forum woman (you know who you are) on the phone. It was the first time I’d ever heard her voice aurally. We have never spoken or met face to face, yet I knew her and this week she did for me what I try to do for others. She got me back into action mode fast. Thank you.

I followed up my email to the hospital with a friendly call.  They hadn’t seen my email yet, they’d just come out of a busy clinic, they hadn’t seen an email from my hospital either.  I briefly explained the situation, mindful that she probably looks after many trials and patients.  She was effable and kind, but sadly updated me: ‘That place has now gone’. ‘The trial is closed’. ‘Sorry’. 

My heart fell inside again. I slumped on the worktop. I knew it was the only 2nd line trial (second lot of treatment for a secondary cancer) in Europe that I had a chance of being eligible for. The only way to get Atezolizumab.  I’d used up my 1st line life on the previous trial and got the placebo. I felt sick and exhausted.  I was still on the phone though, chatting about trial recruitment and safety reviews. The work part of me conversed with the hospital trial manager I’d never met to understand the process and the system. I asked her to keep my details and if possible start a wait list for a place in the unlikely event that someone pulled out or wasn’t eligible. A total long shot, but I want my husband and children to know I did everything in my power to be here for them for as long as possible. 

I went for a swim. 20 lengths. A change of tempo and location. The water on my skin. I felt alive. I had reasons to be alive (to coin Matt Haig). I just had to find a way to keep alive. 

Wednesday PM

Late afternoon the next day, I had a pre-scheduled appointment with my original surgeon at my local hospital. I had planned to discuss the surgery or radiotherapy options.  Except these were no longer options. Off the table. 

It was still worth seeing him though because I wanted to understand more about the lymph glands and the small lump I suspected was a reoccurrence.  He and the breast care nurse were first class and continued the action mode.  I ended up having a mammogram. I had to laugh when the radiographer said ‘Are we just doing the left side?’. She had looked up at my naked torso before I had a chance to answer, so my response was redundant.

The purpose of the mammogram was to rule out any spread of disease in the left breast. I’ve been banging on about having both boobs off since the day I was diagnosed so it was mildly disappointing that the mammogram was clear. Whilst my breast was mangled in the machine, I could see a persistent ‘no caller ID’ call coming up on my apple watch. I’m all for answering on the go, but this seemed extreme, even comical. It might be after school club as I’d just received a text from another parent, it could be my mum…or it could be a hospital. I wriggled free and tried to answer it. Missed it. I got dressed and waited to see the surgeon again. The phone rang again just before I was called back in for a core biopsy (undressing (3rd time) local anaesthetic, shot of adrenalin (like I needed it), scalpel, core punched, tweezers, stitches, dressing) on the right side (I kid you not).

It was 5.12pm on the Wednesday. A two minute call. There was a place on the trial. If I could read the c20 pages of consent form tonight, and be at the hospital for 9.15am the next day, it was mine. I was ecstatic. 18 months ago I could not have imagined using that adjective to describe entering my body into a lottery to get either my third lot of chemotherapy or two experimental drugs (one of which is Atezolizumab). If this was fiction it would seem far fetched, but this is my life and subject to eligibility scans next week, I’m going to be able to get some treatment. It still hasn’t really sunk in.

‘Welcome back to the arena! The fight ain’t over! Buckle up we’re off!’

My youngest sister’s message to the family WhatsApp

I was awake at 5am. I got up at 6am and travelled to the clinic. I met the new oncologist, signed the tome of consent paperwork and as of lunchtime we might have a treatment plan. Just a few more scans, blood tests, ECG’s and biopsies and we should be done. So that’s next week covered.

Telling the kids

We updated the kids this morning as they have antennae for a change of mood. 

‘Mummy’s cancer lumps aren’t shrinking anymore and it turns out that I wasn’t getting the proper medicine, but the good news is we found another doctor and he’s going to try and give me a different medicine’. 

That’s what you call the distilled version. 

‘Why didn’t they give you the proper one the first time?’ As an adult it’s pretty hard to accept the way clinical trials work and when you say it in lay terms to a child it seems absurd. Especially when you are talking about how long their mummy will live.  What’s worse for children is if I get the right drug it will probably make me tired and ill before it even starts to make a dent in a tumour. 

Cancer and its treatment are impossible to explain to children, but we have to try, we can’t shut them out.  Anyway, that’s a post for another time, I’m off to watch Fleabag at the National Theatre Live. 

Friday 20th September 2019

Isn’t it all a distraction until we die?

I have been distracting myself quite nicely this week by filling my time with productive ‘busy-ness’. I often do this when I don’t want to think about big things. It drives my husband crazy.  Watching telly and reading books are tricky as my mind wanders easily and there also seems to be someone dying of cancer or being diagnosed with it on every channel or page.  I guess that’s representative as 1 in 2 of us will get cancer and 1 in 7 women will be diagnosed with breast cancer.  It’s still annoying when you are trying to get away from cancer for a bit.

I can’t wait for next month and breast cancer awareness! It’s always annoyed me even before I had breast cancer – all those pink ribbons and decorated bras. Granted the awareness job cannot be denied – 5,000 people will be diagnosed next month. However, that pale pink ribbon seems a bit pathetic when it’s the second most common cause of cancer death in UK women.  That accounts for about 11,500 deaths a year.  So roughly 31 women died of breast cancer yesterday, today, tomorrow and the next day. 

When you spend time with women or being a woman on chemo for life, fighting the spread of breast cancer, dealing with lymphoedema, mastectomy nerve damage, one or no boobs, skin mets bursting out of their chest, a dainty pink ribbon seems a bit trite. It has become a ‘thing’ in its own right and I wonder whether people see beyond knowing what it stands for?

God, there’s two weeks to go and it’s already winding me up. I’ve also got to get through the Macmillan Coffee mornings. Last year I was invited to several and most people didn’t know I had cancer. At least this year I’m out and proud, maybe I’ll go in sequins and represent cancer pride? I’m clearly not proud to have cancer, but I am proud that I am still here smiling (mostly). I am not going to hide my cancer (diagnosis) in any closet. I am also proud of my friends and family for all their support and ability to hold themselves together (around me at least). 

So apart from turning out cupboards and tidying sheds (can’t blame the steroids anymore) I’ve also been doing some ‘nice’ things. 

I’ve always had a bit of a creative side. I like painting, design and making things. I’ve resisted getting back into painting for fear of what might end up on the canvas.  I thought the anger (which is only recently making an appearance) might spill out through the end of my paint brushes creating a disturbing legacy of my inner mind. Stuff obviously needed to come out though, which is why I think the poems turned up in my life at the beginning of this year. 

Last month I signed up for a last minute art course at our local art place.  I saw it on social media late one evening and thought ‘I fancy doing that’.  Often this would be accompanied by ‘one day’, but I’m more of a ‘now’ person than ever before (for obvious reasons).  It’s very liberating.

If there is something you love doing or think you’d like to have a go at, do it. Don’t wait. 

The course was in geli plate printing. You use a silicone plate a bit like a giant slice of posh grown up jelly dessert or quince jelly on the side of a cheese board. You use this instead of a press or a screen to make a monotype print. I have never done this before, but I did textile design and screen printing at school and I absolutely loved it. I still have my work in the loft somewhere (that’s next for the turn out). I assumed the course was for a couple of hours. It was actually for a day. Husband was very accommodating, so all worked out brilliantly.

The course was absorbing, fun and very therapeutic as no one on the course knew me or that I had advanced cancer. The technique was also very conducive to my state of mind as it allowed me to be totally captive to something else with little room for the busy mind to race.  The teacher taught us a 3/3/3 principle which was the number of seconds you have to put the paint on, arrange your relief material (leaves in this case) and print. Then peel off and print again. Then more paint and go again. It was fast. Fast process, fast results. The total opposite of treating cancer. No time to think. Perfect for my anxious cancer obsessed mind. 

So since the day I spent covered in paint and immersed in creating prints at high speed, I have bought my own press and had a go at home.  Aside from the resulting prints (which are of mixed quality and success) the actual process was so engaging and cathartic that I’ll be trying it again. 

It got me thinking much more deeply about art and creativity. 

We tend to judge art on the end result and not the enjoyment of the process. The thing, not the experience. I genuinely like experiencing and trying new things. I get a thrill from learning to do something different, from the learning itself. It’s a cliche, but I guess we could all learn to enjoy the ride and not focus solely on the destination. After all, we are all going to end up in the same place.  The ride differentiates us. 

Statistic from Breast Cancer Care and Cancer Research websites.

Time for Palliative Care?

Feeling pretty low today. A full day of appointments and scans in various hospitals. I think I’ve been triggered into a bit of a pensive mood by the text that came through about my psychologists appointment. It’s in the main hospital in palliative care not the main cancer centre.

Not dying to go through these doors – no pun intended!

The word ‘palliative’ has slightly freaked me out.

Intellectually I know that palliative care can happen at any time in your cancer journey, but it’s typically associated with end of life. It doesn’t help that when you google the definition. The other material or searches are about things like ‘the death rattle’; ‘do people’s eyes close when they die?’; ‘Does death smell?’ (Yes it does I have been up close and personal to that with my beloved Nan) and ‘end of life care options’.

Turns out google or their previous searchers aren’t up to speed with the broader definition of palliative either. It’s not just me then.

Reflecting on all of this, I’m wondering aren’t we all trying to ‘live as well as we can until we die’? If you’re not, don’t wait for stage 4 cancer to do it!

Back to my mood. I’m also feeling concerned. This is the closest succession of PET-CT scans I’ve ever had. My scans are so historically unreliable we want to do some additional ones to see if the picture is clearer and if I am on or off the trial and treatment programme.

So after my psychologists session, I’m waiting in line for yet another radioactive injection for my PET-CT, then to talk about family counselling and then for a CT scan. All in 4 different locations and 3 sites.

There is no way on earth that CT scan is not going to show disease progression. I can feel the secondary tumour under my arm, it’s making carrying my bag hard, there is also a suspected local reoccurrence near my mastectomy scar. This latter one I can feel and see and yet it hasn’t shown on any of the scans. Even the sonographer saw it and felt it with her finger, but nothing on the scan. Not big enough.

I’ve been bringing it up at every appointment. I know my body. I massage those massive scars across my chest every night and every morning so the muscle and skin doesn’t lock up further. All the layers of fascia that separate muscle from organs and bones are melted together by radiotherapy. This was once described to me as putting several layers of cling film on top of each other and then popping them in the microwave.

You get the picture.

Anyway back to the little lump. I know what my chest feels like and I know what is new. It was new in June and it’s still there. Just a bit bigger. It might be scar tissue or fat necrosis (think this means dead cells from fatty tissue). But I would bet a lot, perhaps even my life, that it is not.

I hope I’m wrong.

‘Have surgery, cut it/them out’ I hear you cry. It’s just not that bloody simple. I wish it was.

If I’m taken off this trial there is still no targeted treatment (or cure, that’s long gone) for Triple Negative Breast Cancer. The only way to get anything that MIGHT slow the spread is to find another clinical trial. Those of you that know me will not be surprised to know I have one in mind. BUT here’s the tricky bit: in order to get on a clinical trial you need a big enough piece of measurable disease. If we do surgery I won’t have this, but I won’t have the cancer lumps either. If it has spread elsewhere, we need something systemic (whole body), like more chemo. If we do surgery, this will delay more chemo. It will also be another big op. to recover from which will eat into quality of life in the short to medium term (which might be all we have).

It’s such a conundrum!

All my years in innovation, problem solving, insight and consulting are being stretched to their limit. I wish I was working on someone else’s problem not mine.

My gut feel says surgery. They are also talking about and recommending (until the latest growth) radiotherapy in the contralateral (left) side.

My gut still says surgery. I want us to get a good look at what is actually there, not what it looks like is there. I’m a reality girl. I just hope either surgery or rads are still on the cards.

I can’t bear the thought of just waiting for cancer to pop up and say ‘hi guys, I’m over here now, you can’t catch me!’.

I’m the meantime while contemplating all this I am rammed in my eighth carriage of the day and wishing I’d worn my ‘cancer on board badge’. Although wearing that feels like admitting defeat and I look and feel physically good and well today. I just have a scrabbled head and a growing sadness in my core.

Time to grab life with both hands again and get distracted for a few days…

Tears (Poem 14)

Some weeks there are no words, no tears –
It’s not my life, I detach to keep going.
Other weeks they just keep coming –
tears, tears, words and more tears
I sob and howl at the likely lost years,
The futileness of it all,
I curl up in a warm cosy ball,
I hide under the blankets –
I try to block out you all,
I give in to the mets’
I go to ground and hide,
Sometimes I need to prorogue this ride.

10th September 2019

A magic cure for cancer

(Image borrowed from the article below and credited above)

1 in 2 of us will get cancer.  

Cancer effects communities, not just individuals.  It is my family, friends and wider community who have held me upright or put me back upright.  

It is a harrowing and relentless journey, so I need this support group. In their bid to help some of these ‘cures’ have been offered by my community and in my own sometimes desperate search to stop the spread I have looked into lots of these ‘cures’ myself.  

Social media, tabloid media and forums are continually peddling these conspiracy theories and magic bullets. As a cancer patient it is exhausting and disconcerting to constantly have to fend these suggestions off, research them or question your own traditional yet barbaric medical choices.  

In the end we don’t know what will or won’t work because there is so much unknown about cancer and it is a catch all phrase for so many different types of cancer. 

What I do know is that I am donating my body and life to helping pharmaceutical companies, the medical profession and top teaching hospitals search for a cure or at least something that elongates the life of people with Triple Negative Breast Cancer. It might not help me, but it will help others. This is not how they research whether turmeric or kale (and those are sane suggestions of things I like) cures cancer. 

Only 15% of breast cancers are Triple Negative. Even this is a catch all bucket for aggressive, invasive breast cancers they don’t understand or can’t easily predict. We do not have any targeted therapies for this kind of breast cancer. The prognosis is grim. We are not the same as your Mum’s neighbour’s best friend who had breast cancer and a magic potion bought on line will not save my life. 

There is a place for complementary therapies in self and palliative care (another post I’m sure) but not in curing cancer.  

I know you don’t know what to say or do, but a good place to start would be checking out or reading around a claim before you pass it on to someone as the answer to every cancer. Something you read on Facebook or in The Daily Mail is unlikely to be something that the oncologists and pharmaceutical companies have missed. 

This article from earlier in the summer articulates this beautifully. This was shared in one of the forums I belong to. They have moderators who give their time free to keep the forum clear from people pretending to have cancer and then peddling hope for profit. Seriously.

https://www.theguardian.com/science/2019/jul/14/cancer-fake-news-clinics-suppressing-disease-cure

Back in the purple chair

It is astonishing how quickly 3 weeks goes and here I am back in the purple chair. Despite the smile (and the Simon Le Bon roots), this time it is with some sadness as this was likely my last day on this trial.

Yesterday was a day of mixed results. The bone scans and MRI’s were good, normal wear and tear (felt like scraping through my bone MOT), but all clear from any potential tumours. Sigmoidoscopy all good too – so just a free enema and a bit more dignity lost. Sadly though the ultrasound confirmed what my instincts and prodding had suspected. This increase in secondary tumour size plus the lump on my mascetomy scar will almost certainly count as disease progression.

There are 3 main reasons you come of a trial 1) disease progression 2) unacceptability toxicity 3) patient says ‘enough’. When they told me back in my consenting appointment I said ‘or number 4 you cark it’. My lovely oncologist, who was not entirely used to my directness or sense of humour (then) rather dryly said – ‘that’s included in number 1’.

So the next couple of weeks are going to be a bit hairy. I will need more scans (PET-CT & CT). Oh goodie! They will then have a big old chat about what to do next. The decision tree looks something like this scrappy sketch I did (yes Mum, I know the hand writing is horrendous, but as I keep telling you I have other qualities):

So this is why today was tinged with a bit of sadness. If the scans prove ‘too much’ disease progression we will apply to be unblinded from the trial. If I am getting the immuno drug and the disease has still progressed then I guess it is back to chemo only. Although I’m hoping I will be able to have surgery and/or radiotherapy to my contralateral (‘other’ to you and me) side as there is something more physical and real about these treatments even if the cells are hiding from the scanners elsewhere.

If I am getting a bag of water every three weeks, I hope to still be able to try immunotherapy via another trial. I can feel the all nighters on clinical trial databases coming on again (see Magpie scientist) and visits to other hospitals.

Whilst all this is going on I plan to distract myself with some creative projects, a VAT Return (that will be factual), some consulting work and a good house sort out. I will also continue to catch up on all the half written posts and poems I have lurking in books from the early days of the last 16 months. Expect some flashbacks to those days whilst I wrestle mentally and physically with what the next couple of weeks mean.