Friday, 3 June 2011

The Patient's Voice

A couple of weeks ago I was at the Association of Breast Surgery's conference in Manchester. I had intended to post about it before but seem to have been incredibly busy.

I was there with the Independent Cancer Patient's Voice (ICPV), an organisation that aims to bring the patient's voice into clinical trials; which liaises with researchers and encourages, trains and supports patients to get involved.  We had a stand in the exhibition and spent the conference networking and attending sessions.  It was an excellent opportunity to hear about new developments and catch up on new and existing trials and research.

Perhaps the most controversial development that was presented was the 23 Hour Pathway - in effect day surgery but with a possible overnight stay for all non-reconstructive surgery.  While this is, in effect, what happens with great success for many people at the moment, there was some considerable disquiet at the thought of it becoming standard.

There were several reasons for the disquiet. One was a fear of complications and one surgeon pointed out that she operates on a Friday which would mean less back-up being available for a patient at home the day after surgery. Another point raised was that some people's circumstances don't lend themselves to day surgery and if it was standard that might be overlooked. There was a fear that if day surgery is routine it might be seen to imply that it was minor surgery whereas it is usually only the starting point of a potentially difficult treatment process with emotional and psychological impact. It was also pointed out that less time in hospital might make it impossible for Breast Care Nurses and physios to see patients and check on them after their surgery, with a possible detrimental effect on physical and psychological recovery.

ICPV had previously held a study day that included this topic and had produced a briefing paper so we were able to hand this to visitors to our stand as well as to feed into the discussion. It looks likely that this will be rolled out nationally but hopefully the concerns will be noted and the process modified where necessary to take these into account.

Personally I was very pleased to be discharged after slightly more than 23 hours and a night in hospital. But I was also glad that there had been time for my BCN to visit me before surgery and again the next day, and that I had a visit from the physio to check that I knew how and when to do the exercises.

Wednesday, 4 May 2011

A long way in two years

This time two years ago I was on holiday following my post-radiotherapy check-up. I was feeling encouraged by a positive appointment and had booked a few days in the Yorkshire Dales at a HF Holidays house. I opted to do my own thing rather than book on the guided walks because I knew that I wouldn't be up to a whole day of walking. This turned out to be a wise decision because not only did I tire after a short distance but my rucksack pulled on the surgery scar. However, it was no trouble to amuse myself in such a beautiful area and being back at the house before everyone else meant that I had the swimming pool to myself!

It was a bit frustrating not being able to do a decent walk because walking has been something I have always enjoyed, but I reminded myself that it was early days yet. Sure enough, as time went on I was able to build up to some shortish walks and the 7 mile walk I did with a friend that autumn was a great encouragement. But then I seemed to get stuck. Anything over 8 miles left me struggling and totally exhausted for the next few days. Until Monday.

On Monday, with sunny but not hot weather I took a look at the local OS Explorer map and planned a route that gave me several options along the way. Then I packed my rucksack (a better one these days!) and set off over the footpaths and green lanes around the local farmland and villages. I took it at a steady pace with plenty of stops to admire the butterflies and take the odd photograph or two.

By lunchtime I was still feeling fine and, looking at the map, I decided that I might even manage the extended version of the walk. Refreshed by the picnic I set off again and did indeed extend it, putting in a few extra miles and being rewarded by crossing a field with sheep and lambs who were unusually curious and didn't just run off as I approached.

Back home I looked at the map again and calculated how far I'd walked - just over 11.5 miles. Further by a good deal than I have managed in the last couple of years. Yes, I was very tired that night and was in bed early not only on Monday but also on Tuesday, and no, it is still nowhere near what I would have done before cancer, but it was very satisfying and encouraging.

Fatigue is still an issue for me and I can't dash from one thing to another the way I used to, but I know that I have come a long way since I struggled to do a few miles in the Dales two years ago.

Thursday, 14 April 2011

Ready to Swim in Deeper Waters

I had my regular 6 monthly oncology check up yesterday. It is now two years since I finished the acute stage of treatment. I'm delighted to say that all appears to be well.

The "how are you doing?" conversation, which starts as I enter, always carries on while I'm undressing for the 'grope and poke' with which the consultation starts. I'm not sure if he does this to save time or whether he feel it helps dispel any awkwardness that might be felt. Whatever the reason it seems a businesslike approach that works for me. Afterwards he always tells me to take my time getting re-dressed and shuts the door, going back into his office - presumably to have another quick squint at my notes before I get settled into asking questions!

We spent some time discussing how I'm doing on Aromasin and going through the results of my bone density scan. In spite of some ominous rumblings in the letter he sent me back in November with the scan results, it seems that he isn't too worried about that. As I'm now on a weekly bisphosphonate that I seem to be "tolerating well" (and 'tolerating' is probably a highly appropriate word here!), he is happy for me to continue on Aromasin until the five years are up. I'm very happy with this. Although my joints are much stiffer and ache more, my hair is thinning and there are other side effects, I'm feeling so much better in myself than I was on tamoxifen.

But the Big Story is that he feels I can go from 6 monthly oncology checks plus annual mammogram and check up down to a single annual check-up next year. And as the surgical team does the mammogram and subsequent check up, he doesn't plan to see me again. He did make it clear that he isn't dropping out of my follow up care completely as he will liaise with my surgeon before and after my appointments. But yesterday there was no orange form for me to drop in the box at reception as I left; the form that tells the clinic secretary that another appointment is to be made.

I'm left slightly torn between two emotions. The stronger is my delight that he feels it is safe for me to drop to annual check ups, not to mention the less frequent anticipatory anxiety. At the same time, it is a bit scary. It isn't that I feel in any way that I'm being abandoned and I know that the door is open should I need to return. It is just that there is now less of a safety net, and possibly that I'm now taking back more responsibility for monitoring myself. On balance I'm actually very pleased.

As we shook hands and the end of the consultation and hoped (in the nicest possible way) not to see each other again, I was aware of a nervous thrill at the fact that I am now moving away from paddling in the shallow water lapping at the shores of the island that is diagnosis and treatment. Instead I am starting to swim in the deeper waters of the sea that takes me to the land of New Normal.

Wednesday, 23 February 2011

Celebrating Friendship

Last year I started thinking about making a Friendship Quilt for the Storm Riders. This group of women came together online in late 2008 and since then have supported, and continue to support, each other through the storm of breast cancer diagnosis, treatment and moving beyond into the land of New Normal. In part this was done through a frontier-style scenario so the making of a quilt seemed to me a suitably fitting way to celebrate and commemorate our friendship.

I rejected as impractical one traditional method of constructing such a quilt; that of each person piecing her chosen block to a given size and then collecting and assembling them.  Instead I have asked each person to sign a square and then I will embroider the signatures and piece them into a quilt.

Contrary to all the advice given in quiltmaking books, I did not start by planning out the design. This was primarily because I wasn't sure just how many would be returned to me ... What I did do was to use the idea as an excuse to visit my local textile craft shop, which specialises in patchwork and quilting supplies. I then had a thoroughly enjoyable time selecting a series of fabrics that seemed to be in keeping with the scenario, including a pale one for the signatures. I suspect I won't use all those I bought but there were a couple that I just couldn't resist!

Whenever a few of us have been meeting I have taken along squares to be signed and am posting out others to people I'm less likely to see. Fortunately the idea has been received with some enthusiasm on the part of most people. I started embroidering the first batch when I was on holiday last year. Obviously the precious squares travelled in my hand luggage while the needles and scissors went in the checked baggage.

This is a long-term project and one of many occupying my time so it will be a while before it is completed. The Aromasin makes my hands rather stiff at times and so all handwork now takes longer than it used to take. It is, however, a most enjoyable project and it feels a lovely way in which to celebrate an amazing group of women.

Wednesday, 2 February 2011

Pink: to reclaim or not to reclaim

There has been a bit of discussion, blogging, etc. recently around those issues I think of as BC politics (lower case 'p'). I'm thinking of the whole Pink (upper case 'p') debate, questions of language and terminology. One of these - on language - has come from my old school friend, the Feisty Blue Gecko and the other - on Pink - from a newly found friend, the Accidental Amazon.

It isn't unusual to find that someone with a strong opinion on one of these issues also has a strong opinion on the other. Surprise, surprise, I have strong opinions on both! Starting with Pink...

I have no problem with pink as a colour, but I do find its connotations of "sugar and spice" etc severely irritating. Pink as a colour can be strong and vibrant, but oh no, instead it is used to imply giggly, girly, trivial and often more than a little weak and feeble. These implications are totally inappropriate for those who have been/are being treated for and/or are living with breast cancer. These are strong determined women and men who have dealt with and are dealing with the difficulties of treatment and the implications of living with a life-threatening illness from which there is no magical "all clear".

Inappropriate as that may be, when taken into the sphere of campaigning and awareness raising this type of Pinkness can be positively dangerous. All too easily breast cancer can be trivialised into an entertaining, amusing and not really serious disease. It leads people to think that it is okay as cancers go; something easily "cured"and no longer life-threatening - which we all know is not the case. Yes, there have been great improvements in survival thanks to new more effective treatments, but far too many women and men still die of this disease. And for most of us, the treatment is hardly easy (let alone amusing) and learning to live with the uncertainty can be difficult.

There is a school of thought that says that all publicity is good publicity and that if Pinkness helps raise awareness in just a few women or can raise any money for cancer charities, it is a Good Thing. I am not at all convinced by this. My thinking is that all the Pink Trivia can detract from the serious business of investing in long-term research into prevention or ways of controlling the disease for a natural life span. For many women living with breast cancer the Pinkness is irritating at least and often trivialises their experiences.

Personally I am thoroughly uncomfortable with the image of people in pink wigs brandishing pink feather dusters and shrieking around. I'm really not convinced that their antics generate sufficiently significant funding for the image I find far more comforting and exciting - that of people in lab coats working away on the long term research I mentioned above - to make up for the lack of respect their attitude to the disease engenders.

I feel that I would like to reclaim the colour pink; emphasising the strong and vibrant. Rather in the way that some Black and Gay communities have reclaimed words with negative connotations. I'd love that to happen, but I fear that it will prove very difficult because the Pink Trivia is so firmly embedded in popular culture. Looking back at the 1980's Women's Movement I wonder, how on earth did we let this happen? Is it possible to reclaim pink, or is it forever blighted by sugar 'n' spice 'n' all things silly?

We don't have people wearing red wigs, waving red feather dusters and generally being silly in December, yet the events held are usually good fun while at the same time raising funds and awareness. So why can't breast cancer fund and awareness raising be as dignified as that for HIV/AIDS?

Tuesday, 18 January 2011

Chemical Handshake or It's All Electrons

Today has seen a series of breakfast meetings being held at locations around the world by women chemists.  These meetings have celebrated the work and life of Marie Curie, who won the Nobel Prize for Chemistry 100 years ago, and have been an opportunity for networking and discussion. They are also a prequel to the International Year of Chemistry, the official opening of which takes place in Paris at the end of the month. The Breakfasts have used social networking to link together in a chemical handshake around the globe.

I took part in a three time zone breakfast which we held as a Skype conference call. It all started as a bit of a giggle after I posted the Breakfast link to Facebook and two friends thought it would be a fun thing to do. Before long we were into serious planning involving Skype, Twitter and SMS and the result was our conference call this morning. Kathi, being on GMT -5 hours got up alarmingly early to join the Breakfast while for Debbie (GMT +1) and me (GMT) it was a good deal easier! None of us are professional chemists, but all have been interested in chemistry since childhood and have maintained that interest in various ways.

We chatted for about an hour, with Debbie doing a quick "experiment" and uploading the photos to Twitter for us all to see! We sent greetings to the Breakfasts taking place in two UK schools as well as to one taking place in Prague and another at the Open University, UK. We have also greeted the Breakfasts in New Zealand (where they stated the global handshake over 24 hours ago) and in Peru. We talked about what drew us to chemistry and the part it plays in our lives today. It was a fun thing to do and I think we are now looking for opportunities to do something similar again (possibly at a time that doesn't involve one of us getting up at silly o' clock!).

It was particularly meaningful for me as my late father was a chemist and I grew up reading journals such as Chemistry and Industry and Education in Chemistry (not forgetting Plastics and Polymers). He died four years ago today, so joining this Breakfast and my niece being at one organised by her school seems a fitting way to celebrate his life and express thankfulness for the enthusiasm he imparted and the encouragement he gave. It meant that, for me, our Breakfast linked three generations as well as three time zones.

More information about the event at the Twitter tags   

Tuesday, 4 January 2011

Christmas Past

This post has very little, if anything, to do with life in New Normal and isn't really my own thoughts, but it seemed an interesting diversion.

I spent Christmas with my mother. We had a quiet but enjoyable time and got talking about her wartime Christmases and the Christmas of 1944 in particular. Clearly nothing new about that and, knowing my family, possibly normal would be stretching things a bit!

The family background is that her maternal grandparents (who had a large family) had a shop selling records, sheet music, small musical instruments and music sundries such a gramophone needles. She, her brother and mother lived round the corner, her father having died before the war (though for a few years after his death they had moved back with the grandparents). At that point one of her mother's sisters and her two children were living with them and that Christmas the sister's husband was also there on leave and was pressed into service in the shop. Other family members also lived near and the grandparents lived over the shop with their unmarried sons, one of whom was not away as he was in a reserved occupation. One of the married sons was also in the house that Christmas, at home on leave and staying there with his wife.

The run up to Christmas was always busy and as well as the records out in the shop they kept a reserve supply lined up on the dining room table, with record boxes open and sitting in their lids ready for a quick grab. That year the song "White Christmas" was very popular again and it seems to have taken them a bit unawares as it was selling out in the week before Christmas. The son home on leave had to be dispatched to the wholesaler to pick up more. The shop only shut on Christmas Eve (a Sunday that year) when the last of the customers had gone and that was often quite late.  Only when the shop was shut and all the children were in bed or gone to their own homes was the Christmas tree put up and decorated. On top of the tree was a new fairy doll dressed by their grandmother. On Christmas morning it was not unusual to have customers knocking at the side door because they had forgotten to buy such necessaries as gramophone needles and sheet music.

The family had relatives in the Norfolk farming community and my mother remembers them sending up Christmas food on the train each year, including the war years.  It always included one of their turkeys and a box of their cox apples. The family in Norfolk would send a postcard to say the time of the train on which the package had been sent and someone would collect it from the station. Clearly a slightly different postal service from that of today!

After Christmas morning in their own home they walked to their grandparents for Christmas Dinner, the table being extended by the protective top to the billiard table ... Then after dinner the family gathered in the large sitting room of the house in which there was a piano and various members played and sung. Mother recalled that by Christmas 1944 they all knew that the war was drawing to a close. However, there were still rocket attacks from the V2s and there was little or no warning of these.

Because my mother's birthday is two days after Twelfth Night, the decorations were always left up until after her birthday - a tradition we usually continue and are following again this year.

So - quite a contrast with our much quieter Christmas, but then I'm not entirely sure we could take the pace today!

Wishing you all a happy, healthy and peaceful New Year.