Cancer leaves no room for complacency

I'm quickly approaching the first anniversary of being told I have breast cancer and, while I don't generally dwell on it, I was nevertheless somewhat nervous about last week's annual mammogram - albeit I don't get to join the 'screening mammogram' club anymore (as my oncologist described it). I'm now in the diagnostic mammogram club, at least for a year or two anyway.

And it was at last week's follow-up mammo (the first since just prior to my diagnosis) that I learned my small cancer actually didn't even shown up on last year's screening mammo. It was only by having noticed the small lump myself and mentioning it to my GP a few days prior, that I even had a pre-cautionary ultrasound to check it out. Had I not noticed it nor mentioned anything (given I'd already become aware of the lump a few months earlier but had decided to wait until the screening mammo, believing it was probably nothing) then I might never have got the diagnosis last year and it could still have been growing..... It doesn't bear thinking about!

Although I've made virtually no mention of the whole breast cancer thing on Facebook (I'm not that public about my life), I felt compelled to share this latest, quite shocking news, and similarly I'm writing it here, as a serious warning to all women, in the event anyone actually looks at this blog:

I wanted to post a personal note to my female friends on the importance of getting to know your boobs: In May 2012 I was diagnosed with breast cancer (thankfully very small & early stage) for which I had a lumpectomy, several weeks of radiation and will take the medication Tamoxifen for 5 years.

Imagine my surprise when, at a follow-up mammogram this morning, the technician confirmed that my ‘screening mammogram’ last year didn’t actually pick up any sign of the cancer, even though I’d indicated where I felt a small lump! Thankfully I had mentioned it to my GP around the same time (thinking it was probably just a gland) and she’d suggested getting a diagnostic ultra-sound just to be sure. As it turned out, that ultra-sound led to a biopsy and then the Big-C result no-one wants to hear.

I just wanted to stress how important it is to really get to know your boobs and how they feel, because a regular screening mammogram isn’t 100% reliable. Within 2 weeks of an ‘all-clear’ screening mammogram, I was told I had breast cancer. I’m definitely not trying to instill fear, I’m just saying you owe it to yourself, not to mention your loved ones, to get intimate with your boobs….so to speak. :-)

(Besides, I'm sure there are plenty of men who are only too willing to help out!)

Anyway, the lesson in all of this? You really cannot afford to be complacent - ever! I'm the first to admit that I lived thinking (somewhat naiively) that I was okay 'because we don't have a family history of breast cancer'. And then Vicky got it in 2009....and I thought it was freaky but it nagged at me nevertheless. But I still wasn't all that diligent about self-checking, even after Vicky's diagnosis (head-in-the-sand maybe?), though I must've been doing it subconsciously since I managed to notice that little lump on my right side, towards my armpit.......and I'm so thankful that I did!

Moreover, my cancer was small and early stage but was already classed as invasive - i.e. it had started to spread beyond its original location. Imagine I had merrily relied upon the apparent 'all clear' results of last year's screening mammogram, my story might have turned out quite differently indeed!

If I can help even one female (or male come to that) by sharing this unexpected revelation, then it's the very least I can do.

So listen up, people - it takes hands-on experience and diligence. Literally. What are you waiting for? There really is NO time to waste!

Dear Tamoxifen

As previously discussed, you are hereby contracted for a term not expected to exceed 5 years, wherein your principal focus is to be devoted to one task and one task only:

• To unreservedly kick the absolute CRAP out of this cancer malarky and ensure its toxic and insidious ass is kept the hell away from me!

And in so doing, you are respectfully commanded to honour your host, thus committing your equal and undivided care and attention in avoiding (or, at the very least, limiting to a bare and tolerable minimum) all of the following:

• Mood swings
• Hot flashes
• Weight gain
• Nausea
• Tiredness
• Memory loss
• Depression
• Insomnia
• Swelling of hands/feet
• Other menopause-type 'joys' not listed above
• Muscle/joint pain
• Endometrial cancer
• Risk of stroke
• Risk of blood clots
• Cataracts

In other words, make sure you do your job.....do it well!....and please be kind to me in the process.

And so, without further ado, let us seal both obligatory and honourary terms of this agreement, for the period of one thousand eight hundred and twenty six days (inclusive of the 2016 leap year and taking into account any additional/exclusive time-period as deemed appropriate by qualified oncologists).

I hereby raise this glass of water and.....3....2....1......

Dose #1 is down the hatch!!!

Repeat ultrasound - côté gauche

Don't ask me why I felt I should say 'left side' in french, it just seemed to feel right.....or rather, left.

So I'm really not quite sure what took so long but today, being my weekly check-in with an oncologist, I finally got the report from the October 10th ultrasound done on my left breast, which was a follow-up to the one they did just before our UK trip back in June. The results, while thankfully not indicating cancer at this stage, are nevertheless still somewhat vague and they've suggested another repeat in 4 months.

Admittedly I had felt at the time, that the technician doing the exam was really very thorough. She could feel/see the same lumpy areas that I had indicated and confirmed at least a couple of those appear to be just small cysts, which is actually quite common and nothing to worry about. I was even relieved when she showed me on the monitor that the couple of areas previously identified as perhaps a lump, are in fact spots where two adjacent ducts run parallel/criss-cross, which is what makes them palpable and only when the ultrasound wand is moved in a certain way do you actually see where the ducts separate as opposed to seeing them as a single, enlarged unit. That said, they do appear to be a little dilated - but hopefully not because of any cancer developing in there.

Basically the final report indicates an "atypical cyst" in the 3 o'clock position which seems unchanged from the previous exam (potentially a good sign) but they also add that it's hard to determine for sure "in view of the difficulty in comparing ultrasounds done on 2 different machines by two different operators". Great.

They also note a couple of other areas that look to be cysts (per above) that seem largely unchanged in size, as well as the two adjacent (palpable) focally dilated ducts.

All-in-all my left 'lumpy-bumpy' breast has a few areas to monitor but at least nothing too scary is showing at this point. Sort of a relief, I suppose, but not entirely. I guess we'll see how things look next February - hopefully without being examined by a third operator on a 3rd machine simply adding to the apparent ambiguity. Either way, at least I know they're on it ..... so to speak ;-)

Understandably perhaps, I'm not feeling out of the woods just yet - but then, I also suspect I may never have that feeling again, since this is just part of my new reality. Tagged for the foreseeable future. It will always be there, in the back of my mind, with every check-up, mammogram and ultrasound. The legacy of breast cancer gently poking me as a subtle reminder to never again take anything for granted. Not that I ever really did actually, especially not since the very sudden and untimely death of my dad back in '96, my brother Graham's heart attack in '07 (at just 33 years old) or Vicky's breast cancer in '09. I've never pretended that things can't all change at a moment's notice. While I've endeavoured not to dwell on this cancer thing, for fear it would immobilize me if I let panic set in, I strongly suspect it will always have a spot, tucked away in the corner.

Ho-hum, said Pooh.

My sister & I share everything....even breast cancer.

Hard to believe it's almost a year since I posted anything on this blog. I'm not really sure what happened. I guess part of me felt like I had nothing really to say, no words of wisdom, nothing hilarious to recount, little motivation to write anything out in glorious detail and no big "aha" moment or anything remotely profound to share. If anything, things were just ticking over nicely for a while and so, being the professional procrastinator that I am, update blog simply became one more item gathering dust on my 'To Do' list.

And suddenly it was April. Spring slowly endeavoured to make an appearance, the days started to stretch just a little longer, the Easter Bunny was on his way and I lost my job at the Canadian Cancer Society. Boom!

Coro's Gail Platt (Actress Helen Worth)

Following a couple of awkward conversations with the Human Resources manager (an extremely fake woman who bears an uncanny and rather unfortunate resemblance to Coronation Street's, Gail Platt) and mumblings of 'I just wish we had something else to offer you here', I signed off on a reasonable severance package, cleared my desk and left quietly that same day.

I was hugely disappointed - not least because I was enjoying my work and the feeling of finally contributing to something significantly more worthwhile than lining the bloated pockets of wealthy corporate execs - but I'd be lying if I said my spidey senses hadn't already started to sense that something along the lines of 'restructuring' might be afoot.

While I certainly felt let down, deflated and abandoned, it also meant that I could take the next couple of months off, Lorne & I would still do our 3-week UK trip in June as planned, after which I'd be eligible for EI while looking for work. So all-in-all, the prospect of a 3-month break wasn't actually looking too bad.

Imagine then, the smack of bitter irony when - just as my severance period came to an end - I received a diagnosis of breast cancer! Double-Boom! - if you'll excuse the pun. WTF???

Even as I sit here now, typing this out several months later, I confess I still haven't quite managed to wrap my head around it all.

Let me start by backtracking slightly......albeit I'll endeavour to be concise or I might never finish this post.

May 2012:
Enjoying my time off and still receiving full pay and benefits, I naturally thought it prudent to catch up on any dental visits, eye exams, physio, chiro and any other medical appointments, such as dutifully booking my annual screening mammogram. Oddly enough I had noticed a small, firm lump in the upper corner of my right breast a few months earlier but figured it was likely just a lymph node or perhaps a small cyst. At first I could only really feel it around the 'time of the month' but gradually it seemed to be there all the time (just a teeny-tiny pea-shaped thing) so I planned to mention it during my May 11th mammo anyway. Three days beforehand, during an appointment with my new GP (my first visit with her since my previous Doc had retired), she carried out a routine breast exam and also felt the bump, which I told her had been there at least a couple of months. She checked deeper into my armpit/breast area and thought she could feel another in the same area, perhaps a little smaller. 'Just as a precaution' she referred me for a diagnostic ultrasound to follow the scheduled mammogram.

Despite the fact my sister, Victoria, was diagnosed with breast cancer just a couple of years ago, I can't deny I was nevertheless thinking (hoping?) this was all just very routine and would turn out to be nothing - still believing in my security blanket that breast cancer isn't in our family history. So I was a little surprised when, further to my May 16th ultrasound, it was suggested they follow up with a biopsy 'as an added precaution'.

All this talk of precautions and 'ruling things out' was starting to unnerve me a little and suddenly I wasn't sure what to think. I planned to meet with my sister and get her take on things, especially since she'd already started on this same route late 2009 but, at the same time, I didn't want to be getting unnecessarily alarmed or come across as over-anxious. People regularly go for more tests and biopsies (don't they?) and it was probably just a cyst or fatty tissue or something (wasn't it?). Besides, I also knew Vicky had a lot on her plate and getting together at relatively short notice wasn't easy. Perhaps surprisingly - now that I look back on it - I wanted to talk about it face-to-face not really over the phone, so with not being able to meet up and chat in person, I didn't mention it, still expecting that surely it's all just very routine and probably nothing to worry about anyway, so why not just wait until later, when I actually know for sure? That typically stoic british, stiff upper-lip thing of 'not wanting to make a fuss'. Not always the best approach, I might add.

The morning of May 22 I endured close to 90 minutes of staring at the stark and dirty walls of a treatment room while a female doctor and nurse poked, jabbed, stabbed & punched me with what sounded like a broken, dollarstore cowboy pistol. Despite trying to focus my mind on creating drawings from the dents and scuffs on the bare walls, and no matter how much they injected me with more freezing goop, I could still feel every poke, scrape and jammed-up pistol in all its painful, scary glory - especially when said gun decided it wasn't going to retract! That was at the 60-min mark and I'd already had just about enough. Having tried to remain calm and statue-still thus far, I felt my armour fall apart when the Dr began huffing, puffing and tugging at the gun, now embedded in my breast tissue. "Could you call Dr X in here right away, I can't get this thing out." Sooo NOT what I needed to hear. Suddenly the tears flowed, I began to tremble uncontrollably and just about fainted. A flurry of nurses brought me tissues and a cold, damp facecloth for my forehead, with smelling salts on standby.

Amid this kerfuffle Dr X finally arrived only to exclaim, in a cold, matter-of-fact tone, "Well, there's only one way it can go - it has to come out!" A renewed wave of nausea and light-headedness came over me. "You're just going to have to hold tight and pull it hard." I almost threw up.

I came out of there dazed, bruised. slightly faint and with a small bag of frozen peas stuffed in my bra (yes, they actually gave me a little baggy of frozen peas!) to help minimize swelling. It all felt very weird and I wandered down West Broadway in a somewhat bewildered state, feeling like I deserved a sugary/cakey treat after going through all that, yet still too wobbly to really believe I'd enjoy it.

And so began the wait....of more than a week...during which I did a surprisingly good job of staying neutral, feeling that no amount of worrying would change the outcome one way or the other, so why get myself all worked up by dwelling on the unknown. Of course it still niggled from the back of my mind as I endeavoured to steer myself away from thoughts of how Vicky'd gone through all this too, just over 2 years ago, only it didn't turn out so well.

May 30 - With a greeting of, "Hello there, so did they contact you with a surgery date?" I abruptly discovered my new Doctor/GP is desperately lacking in diplomatic bedside manner!

"Surgery?" (i.e. What the f*ck???)
"Yes, your biopsy results came back positive for breast cancer." Holy cow, she just waded right on in, blurting out facts-in-hand without offering up even the slightest preamble to soften the blow. Nicely done....Not!

"Wow.... erm.... well.... no - I haven't heard anything yet. I didn't know."

She pulled up a chair and quickly skimmed over the 5-page report; a blur of technical jargon, lab-speak and references to 'biomarkers' and 'estrogen receptors'. I scanned the words on the page but nothing seemed to make sense. That is, until she hit the header "Diagnosis" - circled in pen and marked with an asterix.

There it was in capital letters - loud and clear. I felt my insides pull tight as blood retreated from my face. Still the doctor rushed full steam ahead; "Bla, bla.... positive for cancer.... always verified by two doctors.... bla, bla.... so the second signature right here confirms the diagnosis.... How are you doing? You seem to be okay with this." (Did she really just say that? I was more more stunned than 'okay'.)

"Well, I guess I knew coming in here that this could go either way, I suppose I'm just trying to wrap my head around it."

"So the next step is you'll meet with a surgeon, probably sometime in the next few weeks, they'll call you. Okay?"

Apparently my 10 minutes were up.

"Do you have any questions?"
"Erm, I'm not sure. I'm not even sure what to ask."

And that was it. Wham, bang, thank you ma'am. I couldn't decide if she was just blunt, callous, uncomfortable or just eager to get me out of the door. I suspect all of the above.

I wandered out into the waiting area and sat down. I texted my sister - "Ductal carcinoma, same as you :-(" She called me right away, clearly shocked but asking practical questions - based on her own expertise - and being ever the caring big sister.

"Did they say it's In Situ?"
"No, I don't think so, I'm not sure."
"You should ask. You need to know if it's In Situ - DCIS."

I went back to the desk to see if I could ask the doctor just one more question. They were hesitant but the doctor heard me ask and came over with the report in-hand.

"I'm wondering if the results say it's In Situ."
"In Situ? No it's not, your cancer is invasive." She pointed to the capitalized diagnosis we'd glossed over earlier. "See here, it says invasive. You have ductal carcinoma but it's invasive, not in situ. Okay? I'll give you a copy of the report." And off she went, whipped off a photocopy and shuffled me away with it.

And that was it. May 30th, 2012 around 9:45am I found out that, at 44 years old and just like my dear sister before me, I too have breast cancer.

Well this officially sucks!