MarySmith’sPlace ~ Cancer update #41: Dithering over decisions and walking with llamas

I’m still dithering over what to decide about the chemotherapy treatment option.

I have had a meeting with the palliative care consultant which was helpful and reassuring in that chemotherapy and palliative care are not an either or scenario and if I decide to go ahead with the chemo, I can still be seen in palliative care for help managing any symptoms from either the disease or from the treatment. Knowing support is available in managing symptoms caused by the treatment is reassuring.

Other topics discussed with the consultant included resuscitation and whether or not I should have a DNR in place and also whether or not I would want to treatment interventions such as ventilation (I think that’s a no).

I started on the SafeFit trial established by University Hospital Southampton NHS Foundation Trust, Macmillan Cancer Support and other medical bodies to enable people with a cancer diagnosis retain or regain physical fitness levels. After a very lengthy process or questionnaires both online and over the telephone – plus a bit of a hiatus in my application because of the unexpected appearance of cancer cells in my lymph nodes after my treatment ended – I was accepted and assigned an instructor. For the first four weeks I have one-to-one online exercise sessions, tailored to my fitness levels and needs. It’s very much a holistic approach so my instructor always checks on my stress levels – not sure she expected me to burst into tears on our first meeting but she coped very well.

I also re-started Pilates classes after a break and that felt good, too. Over the period of lockdown, which more or less coincided with my cancer diagnosis and treatment, the class has been so important – the exercise but also seeing people, even if only on screen.

All in all, I’ve been feeling fairly well – and although I can see the lymph nodes in my neck expanding they aren’t bothering me too much yet – though I do worry about winter when I usually wear polo neck jumpers, which I suspect will be an irritation. But then, as always seems to be the case, whenever I’m doing the things I’m supposed to be doing to improve my health, to stay as physically strong as possible, something knocks me back. This time, I put my back out. I was putting the cat’s breakfast down on the floor – forgot to engage my core and bend my knees. Mea culpa.

I reached for the frozen peas followed by the heat pad. Dug out the lumbar brace and took paracetamol, expecting it to ease off after a few days. It didn’t and I had to give in and make an appointment with my GP. Before cancer, I was rarely at the doctor. I was brought up by parents who believed the NHS was a wonderful privilege never to be abused – so you had to be seriously ill before the doctor was consulted – and so I still hate to feel I’m making a fuss about nothing.

Oh, my goodness, what a difference strong painkillers and a muscle relaxant made! When I woke up three days later (I’m kidding) I couldn’t believe how much the pain had receded. Before the pills, I couldn’t have sat for long enough to type this far. I should apologise here to the many people waiting for a reply to their emails, letters and cards – now you know why I’ve not been able to keep up.

The llama who has firmly turned her back on me is the llama I was going to take for a walk!

The one thing which did help my back when it was bad was walking, which really eased it. I was delighted to be invited by a friend to take one of her llamas for a walk. It was a lovely.

Annie the llama did grumble a bit at first about being made to go for a walk but she soon stopped complaining and seemed to enjoy looking about her. Occasionally, she turned to stare at me as if to say: “I don’t know who the hell you are but I think we can manage this together.”

Me and my new bestie

I’m so looking forward to my trip to Islay with Wee-sis, which is still a couple of weeks away. Isn’t it odd how time moves slowly at times? Before Islay, though, I have another exciting event – a wedding. I can’t remember when I was last at a wedding. I can’t remember when I last wore heels!

The week I come back from Islay (16-24), I’ll meet the oncologist, try to get answers to my questions and make my decision.

MarySmith’sPlace ~ CancerDiary #40

It’s been almost a month since my last blog post – and what a month of highs and lows and bits in between it has been. Get the drinks and snack ready for a long post!

Soon after the meeting with my oncologist, while waiting for the requested PET scan, I was on the beautiful island of Arran where I’d been invited on a writers’ retreat. I’ve visited Arran, with the DH, several times and on most visits we’d climbed Goatfell so I was concerned I’d be depressed knowing I can no longer do such climbs, nor many of the other walks I’ve previously enjoyed. Rather than be depressed, the combination of being in such a magical place with glorious sunshine, talking writing with three wonderful women, I felt exhilarated and by the end of the week had convinced myself I could climb Goatfell. I’d have to start early as it would take me all day with the number of rests I’d have to take but I was sure I could do it. I was also sure I was getting my writing mojo back.

It’s not often I’m up on time to see a sunrise – this from my window on Arran.

We were there to write but we did have a day out around the island and visited the standing stones on Machrie Moor. I’ve put photos of them on a past blog post. Sue Vincent and I hoped we would make it there together, possibly after she came to visit Cairn Holy last April. Sadly, that was not to be. It was a warm sunny day (first time I’ve seen the Stones in sunshine) and we saw two buzzards and a red kite so we knew for sure Sue was around.

Standing Stones on Machrie Moor, Arran

My lovely GP had posted the oncologist’s report from the meeting to me. Unlike seemingly everyone on the oncology team my GP believes the patient should have access to reports and letters. And is happy to explain things I don’t understand. The report made clear if the cancer is confined to the lymph nodes in my neck the oncologist is suggesting an aggressive radical course of therapy – ensuring “the overlap (from previous treatment) was minimal and the doses to the normal structures such as the spinal cord and the brachial plexus are within acceptable limits.”  I think that makes it clear why a) it’s important for the patient to be able to read the report and b) have things explained before the next meeting.

If the cancer has spread radiotherapy isn’t an option and neither are targeted treatments, nor immunotherapy, which can cause pneumonitis. Remember the trouble I had with that!  Chemotherapy “potentially with Docetaxel and Nintedanib,” the side-effucks of which sound even more horrendous than my previous chemo drugs.

My PET scan was booked for the Monday after my return but an appointment letter was waiting for me saying I’d to be there on Tuesday, not Monday. I phoned to check and was told the date had been changed because it was a Bank Holiday in England and the fluorodeoxyglucose (FDG) they inject into the vein wouldn’t arrive on time. The DH had to change the hotel booking we’d made for the Sunday night to the Monday. Luckily, the hotel wasn’t fully booked. We checked in, booked a table in the restaurant and had a pleasant evening. In the morning I’d just come out of the shower when they phoned to say the scan had been cancelled. We drove straight home – at least I was able to have coffee and breakfast – not in the mood to linger in Edinburgh.

The next two scans were booked and postponed. Finally, it happened on September 06. We didn’t go up the night before so it wasn’t the pleasantest of mornings on what is a pretty horrible drive anyway and worse when not being able to have a coffee. I could drink water though wasn’t able to have any cough syrup or pastilles, though.

I only found out by chance about not taking cough medicine. Every pre-scan discussion which stresses the need to fast also says it’s all right to take medication as usual. I don’t know what prompted me to say I use codeine linctus but when I did I was startled by the vehemence of the response. “Oh, no, you mustn’t. Because of the sugars it contains it can cause false positives in the scan.” Well, wasn’t it good I asked! If it had been discovered I’d been swigging cough syrup the scan would have been cancelled.

Top Tip for anyone having a PET scan – when they say you can take medication as usual during the pre-scan fasting period – do check if it really is OK to take the medicine you have.

Of the various ups and downs over the month the biggest down of all with Taliban back in power in Afghanistan. A few, a very few, of my friends have got out. Most have not. Having people I love and care about begging for help I can’t provide is heart breaking and soul destroying for us all.

And, so to the last down in this post – the PET scan result. My appointment was today, though not with my oncologist who has Covid, but with one of her colleagues and it was a video conference. Not an ideal situation.

Unfortunately, it shows the cancer has not been contained in the lymph nodes in my neck but has affected lymph nodes in several places. This means radiotherapy is not an option. I was dreading making a decision about whether or not to have radiotherapy, especially when described as aggressive, knowing how much it f****d up my lungs last time. And this time it would have been risky because of the proximity to the spinal cord and the brachial plexus. Anyway, I don’t have to decide on that as it’s not going to happen.

The only possibility is a course of chemotherapy – a much more brutal combination of drugs than last time, and which might give me a few extra months to ‘live’. I include the inverted commas because spending several months feeling ill, fatigued and unable to do much does not sound like living to me – existing maybe but not living. The difference between having treatment and not having treatment in terms of ‘overall survival’ is about two and a half months. It appears the main benefits of the chemo may be that it would relieve symptoms. I don’t yet have any and don’t know what they might be. I will ask. I will have other questions, too.

I have requested to speak to a palliative treatment consultant before making any decision. Guided by my wonderful mentor at Maggie’s Centre in Edinburgh, I actually asked about this a week ago but the message was missed because my specialist nurse has been working from home and until this week had been unable to pick up messages on his work phone. I didn’t like the implication at the last meeting I had with the oncologist that if I decided to go for palliative treatment I’d be discharged by her and referred to a palliative doctor.

When today I asked for the PET scan report, which of course hadn’t been sent to me, this is what I was given! I had my eyes tested last week and the optician said they hadn’t change since the last test but I couldn’t read this report without a magnifying glass – or scanning it and zooming in.

Anyway, that’s where I’m at – the cancer is back, is not going to go away. I have decisions to make – should I plant more spring bulbs? – but for now I’m mostly looking forward to a holiday with Wee-sis on Islay next month.

A surprise gift of sunshine from a friend continues to brighten my days

MarySmith’sPlace ~ Whatever’s next means more waiting! Cancer update#39

Monday, 16 August: Just a quick update to let everyone know how my meeting with the oncologist went today.

A biopsy of the lump in my neck, formed by three small lymph nodes, had shown metastatic adenocarcinoma; the CT scan was to find out where else the cancer may have spread.

The good news is that it seems not to have spread anywhere else and is, so far, confined to those lymph nodes.

Chemotherapy isn’t really an option. I can probably explain why not after I listen again to the recording of our meeting but as the recording is over an hour I’ll have to search for relevant bits to pass on. The oncologist does seem to think, however, that a four week course of targeted aggressive radiotherapy could be a useful treatment, even if not curable.     

I need to replay our discussion, in particular listen to the probably side-effucks. Even if the memory of the really painful throat, the burnt skin and the extreme tiredness has dimmed a bit (like after childbirth) it is still there. And I remember clearly the pneumonitis, the inflammation in my lung, in particular I’ll never forget the horrendous stay in the assessment unit where they misdiagnosed and mistreated the condition. The radiation-induced fibrosis has never left me causing the breathlessness and the cough, which have so adversely impacted my life. I need to listen and think and research and ask further questions.

If I do nothing then the oncologist thinks perhaps I’d have about six months (she gave me seven last time!) but with treatment that could be extended to a year or more. What I don’t know is how well I would actually be for those extra months. If how I am now – breathless on the slightest exertion, coughing when I’m talking, tired and lacking energy – is as good as it gets then I worry about how I would feel if I ended up still breathing but feeling even more wretched. Don’t worry, I’m not asking you to decide what I should do! This is my decision – but I may ponder aloud.

The next step is to have a PET (Positron emission tomography) scan to check if there are any ‘hot spots’ the CT scan missed. I’ve agreed the oncologist should go ahead and book this while I’m making my decision. It will be about a fortnight before the appointment is through – then however long for the scan result – then more waiting to see the oncologist again.

The one thing I have learned about this world of cancer is that the only certainty for any of us is that it will involve a lot of waiting.

A wee while ago I posted some photos of Belted Galloways in a field near Threave Castle. One of them has just had a calf. If we’re looking for signs and portents I’m taking new life coming into the world as a good sign.

MarySmith’sPlace ~ It’s back (or did it ever really go away?) Cancer Diary #38

Saturday 07, August: The biopsy result on the lymph nodes shows the cancer is now metastatic. To quote from the report: “The morphological features and immunoprofile are consistent with metastatic adenocarcinoma from the lung.”

I had a CT scan on Friday including neck, chest, abdomen and pelvis to identify where the cancer has spread. And, so, I wait again for the next result.

This must be the shortest update I’ve written because I haven’t yet processed what I’m feeling/thinking – and probably won’t until the scan result comes through and the wait to see the oncologist and find out what, if anything, can be done.

A tour of Dumfries and my review of Secret Dumfries by Mary Smith and Keith Kirk

I’m delighted to share a post by my friend Robbie Cheadle who travelled from home in South Africa to visit me in Dumfries after reading Secret Dumfries. It was lovely to meet up in real life and be her tour guide for a day – and her review of Secret Dumfries makes my heart sing.

In my Thursday Doors post last week, I said that my family had travelled to Dumfries to meet blogger and author, Mary Smith. Mary took us on a short tour of this fascinating town.

Dumfries Museum

A few interesting artifacts from the Dumfries Museum:

The story of the Siller Gun

James VI of Scotland and I of England presented the Seven Trades with a trophy – the Siller Gun – to be awarded in its annual shooting competition.  At a time when tradesmen had to be prepared to defend the town, the King’s intention was to encourage their shooting skill.

It is believed that the gun originally took the form of a miniature cannon mounted on a wheeled carriage.  It was remodelled to resemble a flintlock musket by David Gray after it was broken in 1808.  The individual responsible for the…

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MarySmith’sPlace ~ biopsies, blood clots & garden pics in CancerDiary#37

Saturday, 31 July: I’ve not yet quite got into the swing of regular blogging after my break and was shocked to find over a week had gone since I last posted.

On Wednesday, 20 July I had the ultrasound on the lump on my neck, which turned out to be three small lymph nodes, suspicious enough in appearance for the doctor to decide to do a biopsy. He said in the lab they will be looking to see if the cells are cancerous or not. If there are cancerous cells he thinks the oncologist will want to look at treatment options.

I’m not sure when I’ll hear the result and I so hate the waiting. Since the tumour in my lung was discovered last July, there have been endless periods of waiting – during which my imagination runs riot, scaring myself stupid with ‘what ifs’. Funny they never include a ‘what if, there’s a totally innocuous reason for the dodgy lymph nodes and all’s well! No, it’s what if the cancer is back, what of it has spread to …. (name every organ in the body) or …?

In the meantime, since Saturday, 16 July I’ve had a painful right calf. I initially assumed I’d pulled a muscle but not only did the pain become more painful, the leg began to feel hot. When, on Wednesday night, I asked the DH if one leg looked bigger than the other he insisted on taking me to A&E. Two hours later, the doctor said someone would call me next morning to come in for an ultrasound on my leg for a suspected deep vein thrombosis (DVT).

The ultrasound was done on Friday (all the slots for the next day had already been taken by the time the A&E doctor put through the request – it was about 2am by then) and the DVT was confirmed. By this time my right ankle had vanished into the general puffiness, my shin was hot with skin so red and shiny it looked like it might just burst open and it was painful.

As the ultrasound request came from A&E it was to there the report was to be sent and I guided back to A&E. Things became slightly bizarre then. First, I was surprised to be called into the triage nurse’s room where she asked me what had brought me to A&E this morning. I explained I’d just had an ultrasound which confirmed a DVT and the report – I pointed to the computer – should according to the radiologist, be there and I was to see a doctor. The nurse maintained she’d never heard of such a system and sent me out to wait.

Bandit the cat inspecting the dead patch of lawn!
Deciding dead lawns are too exhausting to think about!

It wasn’t long before I was called by a doctor, who must have received the report, and who showed me to a bay. He excused himself, saying he’d back in two minutes. A nurse came in and asked if I’d mind moving to a different bay. As she started to push the bed out the door ‘my’ doctor returned to ask where she was going with his patient. “Two bays down,” she replied, “as it will be easier to carry out her eye procedure there.”

This year the DH managed to prevent the delphiniums snapping off in the wind.

Luckily, the confusion was soon sorted out (and it soon would have been anyway the moment someone tried to get anywhere near my eyes!) and after an examination I was prescribed Dalteparin injections. The doctor said a nurse would come to administer the first one and teach me how to do it. Sometime later, saying the nurse was ‘too busy’, he returned to give me the injection (can’t say it constituted a teaching session). The prescription pad was finished and he said he didn’t know how long I’d have to wait until a new one appeared but I could leave if I wanted, with three injections, and call my GP practice to ask for more. I said I’d leave.

My GP was able to write up a prescription for more injections so I’m now stocked up for a few weeks – though I still need to be shown properly how to administer the jags myself. The DH, fortunately, is very competent but if I want to go away by myself I need to learn.

On Monday, 26 July I was taken aback when my oncologist phoned me. It’s only the second time she’s ever called. The biopsy report hasn’t come through, of course, but she’d been informed about the lump and the biopsy and the DVT. She is arranging for me to have a CT scan as soon as possible so she can see exactly what’s going on. And so, I wait.

I hope by this time next week I’ll have news of results.

My friend Farah’s fig tree.

MarySmith’sPlace ~ So much to tell you! Cancer Diary #36

Isle of Lewis

Tuesday, 20 July: When I took my blogging break at the beginning of June I expected it to be for two weeks. Yet, here we are: over six weeks later and I’m only now getting myself together to write an update. It’s a long one, but I’ll put in some nice pics to break it up a bit.

I’d decided to take a break from blogging and social media partly because I was heading off for our first holiday since 2019 with the DH, our son and his partner and partly because for the first time ever, writing wasn’t helping me to process what I was feeling about my cancer and what was happening in my life. Although there was the really good news the cancer was under control for now, I was worried about my cough and breathlessness, which the oncologist seemed to think wasn’t likely to get much better. The research I did about my radiation-induced fibrosis was also pretty disheartening.

We went to the Isle of Lewis and Harris, the main island of the Outer Hebrides. It is stunningly beautiful from moorland to mountain, from lochs to beaches with miles of white sand and the amazing Calanais Standing Stones. Visiting them has been on my must-see list for a long time and was also partly a pilgrimage in Sue’s name as she was there two years before.

Social distancing was not an issue on such beaches
Calanais Stones, Lewis – older even than Stonehenge

I have to say, though, the edge was taken off my enjoyment because of my fears about the fibrosis. At the back of my mind was a constant niggle about how I’ve been left with worse health issues than before I started treatment. Alive, yes, which I wouldn’t have been without treatment, but … It’s hard to explain without sounding totally ungrateful for the treatment which has kept me alive – though it has scarred my lung, left me breathless and unable to enjoy the walking which was so much a part of my life and has even given talking to friends on the phone a nightmarish quality as I have to keep pausing to cough. Getting dressed has me puffing and panting. There are books I want to write, and poems, but my brain isn’t functioning at that level and I fear it might never again. That’s before the weight gain which I hate. It’s taken me less than a year to put on two stone (28 pounds but you’ll have to work out the kilos if that’s your thing) and it will take about two years to lose it again – do I really want to spend that amount of time counting calories and trying to exercise more. Back we come to the breathlessness on exertion.

Got to get a lamb in somehow!

Once back home I continued to try to find out more about pulmonary fibrosis. I asked the specialist nurse to ask the oncologist what, if anything can be done to alleviate the symptoms – because, of course, I can’t ask directly. When I meet the oncologist I always have my list of questions ready but other questions arise depending on the responses and sometimes it’s after the meeting ends I work out what I need to ask.

I had another telephone consultation with the lung physio who previously provided me with various techniques to suppress my cough – though this was before we knew about the fibrosis. She spent time explaining that my fibrosis is not the progressive kind and now that the cause – radiation – has been removed it should not become worse. She also said she’d ask the respiratory consultant to speak to me – which she did the same day in the evening. If only I’d had such detailed explanations earlier I would have enjoyed my holiday so much more.

I find it puzzling how some people in the medical profession are excellent at understanding how the patient feels and at communicating in a clear, understandable way – and, best of all, don’t seem to mind the questions – yet others seem so totally focussed on the treatments they lose sight of the patient’s need to know and understand what’s going on.

The conversations with these two people made me feel much more positive, not least because the consultant explained the tiredness from treatment was likely, in her experience, to continue for about a year and I shouldn’t be despondent about not returning immediately to my past fitness levels.

I was planning to re-join the blogosphere – when the DH went down with Covid. He has been super-cautious since my cancer diagnosis last summer when the oncologist warned me if I contracted Covid it would kill me as the chemotherapy would destroy my immune system. He never left the house without a mask, kept his distance from people and had been double-vaccinated.

I was rather chuffed with my lupins this year – and so grateful I had a garden in which to potter while self-isolating

I received a text telling me to get tested and to self-isolate. This was easy enough when the DH was in hospital but when he was discharged and we have to continue the self-isolation under one roof it was a bit trickier – thank goodness we have a large flat and we have a garden. Anyone thinking it would be a mild dose as he’d been vaccinated should hope they don’t get to find out what a mild dose is really like. I hate to think what it would have been like had he not been vaccinated because his cough was horrific. For a while, it was far worse than mine. He couldn’t even record a message on the answering machine to say he would be off work for a week and not responding to calls or texts without having paroxysms of coughing. It didn’t stop someone leaving a message practically the next day asking him to order equipment but on the whole his clients were patient and supportive.

How I didn’t get it, I don’t know. I can only assume my immune system has bucked up since I finished chemo and radiotherapy and have been eating well and taking a liquid iron supplement and getting out whenever I can.

I could fill several blog posts on the absolute nightmare of trying to find a venue in Dumfries & Galloway where the personnel on duty will actually carry out the Covid test rather than supervise people doing it themselves. I do not believe I am the only person in the region who is too much of a wimp to stick an extra-long cotton bud down to her tonsils and so far up her nose her brain cells start to explode. I can just about cope when a qualified person is carrying out the test as long as I have something to hang on to and twist!  I spent a day online and ringing round and finally a wonderful person on the NHS feedback phone line said she’d see what she could do and turned up trumps by getting me an appointment where a nurse would do the test.

I’ve managed to get out for walks but whereas a couple of months ago this walk round the Threave Castle osprey walk would have taken 40 minutes (if I didn’t stop to talk) I now have to stop a couple of times to rest.
Lovely Belted Galloway cattle – poor sods can hardly pause in their munching because the nutrition levels in this field are practically zero because the farmer isn’t allowed to fertilise the field.

The DH is slowly recovering – his cough is not quite as bad as mine now – and so I thought again about getting back to my blog. Then, I found a strange lump on my neck which I’d not noticed before. The GP thought it might be an enlarged lymph node, took bloods to check for any infection and as there was no sign of any, contacted the oncologist’s secretary. The specialist nurse called to tell me he was going to arrange a CT scan. When I asked where, he said in the local hospital. I said I meant where on me, which bit of me was to be scanned? He said chest and abdomen. I pointed out the lump was on my neck.

Someone called the next day to say I’d been booked in for an ultrasound. If it shows up anything suspicious I’ll have a biopsy done. Specialist nurse had gone to the radiology department to explain the situation (and my comment about the lump being on my neck) and it had been suggested an ultrasound would be a better first step than a CT scan. I’m just so glad I made a point of mentioning the lump is in my neck.

The ultrasound is tomorrow, Wednesday 21 July. I looked at last year’s diary and I had my PET scan on 29 July. I’m hoping it might be nothing more than an indication I have had an infection recently – maybe I was the one who got Covid and recovered! But, I have to be honest and admit I’m very nervous about what might be found. And, it is far too hot here to wear the kick ass boots!   

Anyway, this must be the longest update I’ve written done which I suppose serves me right for not keeping up to date with things.

I want to say a big thank you to everyone who has been checking up on me, whether directly or through mutual friends and bloggers. I truly appreciate your concern and kind thoughts.  

I want to go back to Lewis & Harris

MarySmith’sPlace ~ CancerDiary#35 Goodbye to cancer, hello to fibrosis!

Going for my CT scan and enjoying my few moments playing an extra in Holby City

Wednesday, 02 June: I met with the oncologist on Monday 31 May to hear the result of the CT scan, which was done on Thursday 27 May.

I won’t keep you in suspense. The cancer, it seems, is under control for now. Talking us through the scan showing on her screen, the oncologist said: “We can still see there is a bit of a lump there. But the hope is … that’s dead tissue. But can I say that every single cancer cell has been killed? No, I can’t.  But this is as positive a result as we could possibly have hoped for.

“No signs of any growth, no signs of any progression, no signs of any spread and the disease that is there has responded and the hope is it’s dead tissue. Realistically the only way we know that for sure is with time.”

We’ll meet again in three months to see how things are going.

I should have been shouting joyously from the rooftops but when I asked the consultant about my shortness of breath she said that realistically things might be as good as they are going to get. She didn’t mention lung fibrosis but on my copy of the scan report I read: “Resolution of the radiation induced pneumonitis, now prominent radiation induced fibrosis.”  

Radiation-induced fibrosis is a long-term side effect of external beam radiation therapy, which results in many symptoms, including shortness of breath, that have a significant impact on quality of life. It’s progressive. Average life expectancy from the time of diagnosis is between three and five years.

You can understand why my delight at being – at least for now – seemingly free of cancer is tempered by despair at what else I have to cope with.

I said to someone a few weeks ago that every time I feel I’m making progress something takes the feet out from under me and I have to scramble back up again. I do wonder how many times I’m going to be able to scramble back up again.

I will get my head round this but I am going to take a complete blogging break for the next couple of weeks. I will be back.