‘Twas the Night Before (Last) Chemo

Wow. Here I am. And this is it. Last chemo tomorrow morning. I have to say the whole thing has gone so fast it makes my head spin. I’m really not sure what to be thinking right now.


Here is a picture of what I look like now with absolutely not a trace of make-up on. It is not particularly pretty. Losing the eyebrows and eyelashes isn’t a good look. But I think I may soon do a post on how to glamify when one looks like this. So here it is. At least I have some colour in my cheeks.

I spent my day shopping for an appropriate farewell to chemo (read: final fuck you to any random cancer cells floating around) outfit. I have a couple of contenders and will make the final determination tomorrow morning. But I think I know what I’m going with. One day I have to do a post on hi/lo fashion. You know, high being the expensive stuff and low being the cheaper stuff. I like to mix and match. Good shoes, but cheap t-shirt, and so forth.

Tomorrow we are definitely going for low. British low in honour of the recent Diamond Jubilee celebrating Her Majesty’s sixty years on the throne. I bought everything at Top Shop. If you don’t know what Top Shop is, it’s sort of like the British H&M. If you don’t know what H&M is, you are probably one of my parents or similarly aged relatives. This is okay. You can always Google it.

Maybe I should just go naked and paint my body with a big Union Jack. I mean everything in this place has been “Jubileed.” There was a chick on the tube this afternoon with pink, press-on Union Jack finger nails. But I have to admit I kind of liked them. She only did the thumb and ring fingers, so it was understated tacky. Just my thing. I bet you could get a Union Jack merkin in Soho. If you still don’t know what a merkin is you have to read Vag Toupee immediately.

Back to the white elephant in the room.

So, what is the meaning of last chemo? After tomorrow’s potion wears off, no more poison coursing through my veins, which is good and bad. Good because the side effects will eventually start to wear off and I will start feeling normal again. Bad because then it is up to my body to repair any bad cells. Although I will be on Tamoxifen (endocrine therapy) for five years starting in a couple of weeks, so my body will still have some help fighting this SOB, just in case.

I had chemotherapy because I needed it. So it is good that I did it. But damn, are there things that I will not miss. Let me list some of them for you here, so that I can simultaneously remind myself and share with you what they are:

Thrush (in mouth) going on about four times now, queasiness, taste bud changes, metallic taste in mouth, skin rashes, dry skin, breaking out, bloody nose, runny nose, bloody other places that I won’t go into detail about, pink urine from the red doxorubicin, loss of hair on head, and now, finally, eyebrows and eyelashes (starting to go I’m afraid), night sweats, shingles outbreak on back of head, pain under finger nails, brown spots under finger nails, pain in bones, pain in joints, fatigue, steroids (fast heartbeat, trouble sleeping, “irascible” behaviour according to close relatives), constipation, yucky bitter-tasting anti-nausea meds, being on so many meds generally, skin tenderness (so bad at times it hurt to be touched), discolouration (hyper-pigmentation) of skin, particularly knuckles, old-looking, dry, peeling and wizened hands, and the portacath that is now living under my skin (gross).

Yeah, WHATEVER. Is that all you can throw at me? That shit is child’s play. I went to Paris last weekend for crying out loud. And walked all over creation. And stayed out late. And drank champagne. And ate escargots. So I can handle all of those stupid side effects and other crap if it means I killed it. I bet there isn’t even anything left to kill in there. There probably hasn’t been for weeks now, if there ever was. So there. Take THAT, you microscopic pieces of you-know-what.

Excuse me. Now that that’s done, here are the things that I liked about chemo: the superb and attentive staff at the LOC chemo suite, having visitors during treatments, having reflexology during treatments, cheering up other patients, white leather adjustable Dr. Evil chairs, my chemo outfits and umm, let’s see, oh yeah, NUKING cancer. Chemo may be draconian and there may be new drugs coming out soon that target cancer cells and meanwhile do not harm good cells, but for now this is it and it is effective. So.

Now I have to read a chapter or two of the second book in the Hunger Games series and then get some sleep. Tomorrow is my farewell to chemo party.

Do you think anyone will bring a cupcake with the number eight on it?


You know what’s great? The second chemo drug I am on, Taxol, has not caused me the queasiness, metal mouth, taste bud changes and other annoying shit that the first drugs (AC) caused. Consequently I’ve been eating my way through the month of May. And cooking up a storm. I’ve definitely put on a couple pounds because of it too, which probably isn’t a bad thing.

You might think that cooking is the last thing a chemo patient would want to do. But it’s become one of my favourite activities. Makes me feel rejuvenated. Healthy. In control of what I’m eating and what I’m tasting. ALIVE. It’s, as Martha Stewart would say, a good thing.

I really have to thank my friend, Dee, who gifted me The Cancer-Fighting Kitchen by Rebecca Katz. This is not just a cookbook for people who have, had or are being treated for cancer. It’s something anyone can enjoy if the name doesn’t give you the schkeeves. And if it does would you put-lease just grow up and get over it? Who couldn’t use some good cancer-fighting chow in his kitchen, anyhow?

Tonight I made carrot fennel soup. I bought this ridiculously overpriced American blender (the Blendtek) and I have been using it a lot to justify the price tag. Well, it was my fortieth birthday present to myself, so it didn’t require that much justification. But still. I’ve been having fresh fruit and vegetables delivered every week from an organic farm (no it isn’t Abel & Cole so don’t ask me that) and the fun part is that I never know what’s coming. So when the ingredients arrive, I take a look and figure out what I’m going to make.

The cookbook has had a recipe for me every time. Tonight’s contained olive oil, onion, fennel, carrots, cinnamon, cumin, allspice, red pepper flakes, sea salt, orange zest, fresh orange and lemon juice and vegetable broth. Ooh and a dash of maple syrup. That’s right! There’s nothing bad for you in there (unless you put too much salt or syrup but we don’t do that here).

One of my kids said it was delicious. The other one didn’t rave but at least kept dipping her green beans in it during the meal. I had two bowls. And my husband will be home soon so I better hear spoon scraping the bottom of the bowl in the next thirty minutes. Or I’ll be pissed (in the American sense — I am not on a bender).

I’d like to give some to the crying baby next door, maybe with an extra dose of red pepper flakes for the parents. I swear these people don’t know how to put a child to sleep. Two days with me and the kid would go right to bed. It seriously cries every night and we have been here almost a year. WTF.

This book contains a glossary of ingredients and their cancer-fighting properties. I haven’t vetted the science behind the claims but the recipes are great and easy, the food tastes wonderful and it all makes me feel so… so… so… cancer free. So I think it is working. Helping me kill it but in a very tasty way. Lots more fun than surgery, chemo and radiation combined.

So thank you, Dee, for this wonderful gift that just keeps on giving. I can’t wait until the next farm delivery so I can whip up another winner. And I need to have you over soon so that I can show you what all the fuss is about.

Summer Buzzies Are Out

For the (wow I’ve already lost track so fill in blank) day, the weather in London has been absolutely, positively supercalifragilisticexpialidocious. I don’t think I saw a single cloud today and that is something else considering how the wind blows things across this island.

We had a mellow day. My big event was walking to Hampstead for a polish change, a medical necessity to help strengthen my nails (sort of hard hit by the chemo drugs). Plus it gives a bald girl a lift. A little colour is always good.

I slathered on SPF 50 and put on the bare minimum of clothing, having worn my parka just last week! (Do you think that warranted an exclamation point, or what is overkill?) A black GAP body tank top, my H&M striped miniskirt, flip-flops and an apple-print headscarf (also H&M). I’d post a pic but I am in my pyjamas now and that train has left the station.

Then I hoofed it up the hill to the Beauty Boutique on Flask Walk. I love this place because it is low-key, friendly, they know who I am and act normal toward me. How nice.

With good weather comes skimpy clothing. People of all shapes and sizes partake, and there were indeed some eye-catching ensembles this afternoon.

The thing I noticed most was how everyone’s tits were out. Lots of tank tops, bustiers, revealing sundresses, you name it. A little sunshine and all hell broke loose. The women of north London were practically serving them up on a plate.

Lots and lots of cleavage. And bouncing scoops of flesh.

As I mentioned in “One to Go,” after chemo on Thursday I saw the radiation oncologist. She warned that there was a good chance the radiation would foul up the reconstruction on my right side. Nothing to be done about that but wait and hope for the best. Expect the worst.

I am not gonna lie. I ain’t thrilled about this. But it wasn’t new information. It just sort of sucked to hear it again when I am about to kick chemo’s ass and embark on the next phase. Got to hand it to the docs, though, they are on the ball. Yesterday I got my entire radiation schedule e-mailed to me, with times and everything. It’s on my iCal, waiting to be crossed off.

I just hope that at the end of the day I won’t have too many complications. Radiation has what my reconstruction surgeon calls “the bystander effect.” For every one bad cell that you are targeting, it destroys or alters about a billion healthy cells. This is too bad. But Das ist so.

Having implant-only based reconstruction surgery following (or prior to) radiation can be problematic. Your skin acts different, the blood supply is affected and you are more prone to bleeding, infections and capsular contracture. Capsular contracture is when scar tissue forms around the implant and sort of squeezes it. It can cause the implant to be hard and/or misshapen. And sometimes further surgery is required, including eventually removing the implant.

I don’t really want to be an Amazon.

I’ll tell you what, though. If that shit happens, if that is my lot, then I’ll take it over the cancer.  I’d rather be an unwitting Amazon than have a great set of reconstructed boobs for two years and then find out I have a recurrence in my chest wall.

If that shit happens, I will become Katniss (from The Hunger Games, people) and take up the bow and arrow (although it is reputed that the Amazons had their left breast removed not their right, so that they could shoot arrows and throw spears more freely, despite being depicted with both breasts in artwork).

I will admit that it is not my first choice, and it would definitely cramp my fashion style. However, sometimes you have to make a sacrifice in order to kill it. And my reconstruction surgeon has more than one trick up his sleeve. So we’ll play it by ear. And meanwhile I will continue to watch the parade of large, jiggly buzzies romping up and down the high street.

An unruly sea to which I not so long ago belonged.

Party in the Chemo Suite

I’m coming to you live from the chemo suite, people. So inspired am I.

Today there are a lot of drawn curtains (lame — I like to spy on my fellow sufferers and make faces at them) and someone is hacking up a lung (makes you want to run out and get a big juicy steak, doesn’t it, and eat it off the floor). Unacceptable. What this place needs is a couppla disco balls. Maybe a conga line. The choreography might get a little complicated with all of us on a drip, which hangs from this metal coat rack thingy on wheels, but it’s nothing me and Paula Abdul couldn’t work around.

My blood work came back and I am — naturally — good to go.  White blood cells up from my immune booster that I jab into my stomach the day after every treatment. Actually I kind of enjoy that. I should have been a nurse (well I do share a birthday with Florence Nightingale and that’s about all we have in common) or maybe a torturer.

Now they are pumping me full of steroids and then antihistamine (like Benadryl) and anti tummy upset and lots of sodium chloride mixed in to flush the line, all to ward off any unpleasant reaction to the Taxol. A lot of people are allergic to Taxol, which is derived from the Pacific yew, by the way. Did you think that everything “natural” was good for you? Don’t be a dumbass. What about poisonous mushrooms? One bite and you’re dead.

I don’t care for the Benadryl. Although it doesn’t put me to sleep (this is because I am defective and cannot nap during the day no matter what they do to me), it makes me a little sluggish, so I am chugging a flat white (I described this in What I Wore To Chemo Today so you had better catch UP), which my awesome friend Paige brought me from Gail’s, my fave coffee shop and bakery. I am also chugging tea. It’s England so everyone drinks tea constantly — it’s really true. And water. This makes for a lot of trips to the loo wheeling my coat rack to and fro. But it’s good to take in fluids. Flush the system. Stretch the legs. Sashay around in my absurd outfit.

Ooh goody. My machine is beeping. That means the bag of sodium chloride is empty and it will soon be time for the poison. Linda, Uma, Katniss? Get ready, girls. Get your gold cuffs and your Hattori Hanzo and your bow and arrows because we’re gonna fire it up, beeyotches.  (Read Chicks I Dig Vol. 1 if this makes no sense to you).

Speaking of artillery, does anyone know where I can get me one of those long leather (nylon would do as well) belts with bullets in it so that I could incorporate that into my outfit? Can you get that shit on Amazon?

So the stuff is going in now, slowly over three hours. I thought I just had a tinge of metal mouth, which I did not experience two weeks ago. It is one of my least favourite side effects so I am plenty pissed off about it. These things can be cumulative. But I ate my lunch and that tasted fine, so maybe I am imagining it. Grr.

My bum is falling asleep. I need to do some gluteal clenches while I’m sitting here. One… two… three…….. Might as well multitask. And this really is the ideal environment for that. I mean, what else can you do? Sit here and think about cancer? Bo-ring. So I write and I talk incessantly when there is someone to listen, and I visualise the chicks I dig doing violence to any remaining cancer cell.

I imagine one trying to flee from Uma’s sword. Nowhere to run, nowhere to hide, MF. You have met your maker and she happens to be hot. Hot and lethal, that’s a great combination. Oh, sorry, she just eradicated your ass, as lickety-split as she plucked that eyeball out of Elle Driver (Daryl Hannah’s character in Kill Bill), the other eye having been plucked out by Pai Mei, who trained both Driver and Kiddo in martial arts the likes of which I could really get into. It was kind of mean when Kiddo then stepped on the eye-ball and squished it. But I respect that decision.

This is Elle Driver when she is about to try to inject a comatose Beatrix Kiddo with some red shit to kill her for good. I would pluck someone’s eyeball out too if they were standing over me with red shit. That looks just like chemo medicine numero uno, which was that same colour and some really naaaaaaaasty stuff.

On a separate note, Hannah is killing the ole one-eye look, dontcha think? Let’s hope that’s a look I don’t have to rock, but given my retina’s tendency to misbehave I have had to wear the occasional eye patch after a procedure. If it ever happens again I’m going to commission a Louis Vuitton eye patch with my initials on it. Not really, but it would be hilarious to see the salesperson’s reaction. All horrified yet awkwardly trying to be polite, as I stand there looking earnest amidst a sea of shoppers who just want the latest Neverfull. But I digress… blame it on the Benadryl or the chemo or whatever. Though Florence Nightingale did say “I attribute my success to this — I never gave or took any excuse.” So just blame ME. I don’t care.

Three hours after the Taxol drip started I’m outta there. Now I’m back home.

So do you want to see today’s outfit? Come on, do ya? I’m afraid it was not possible to top the last one but I made a valiant effort.

I know, the pic isn’t great quality but I was pretty far away from the computer so deal with it. I like to think of this look as Coco Chanel meets sixties biker chick (the boots have buckles and zip up the back). Badass from the neck down but sort of classy from the neck up. Classy badass. It’s the new thing. My fabulous new French buddy lent me the cute black hat. It has that je ne sais quoi, non? The flower is one of my recent acquisitions from H&M. You don’t have to pay Chanel prices, dear.

Well, now that I have killed it for the sixth time I have to make my meds chart so I don’t do the wrong thing. I have so many pills and fluids in me you could shake me and I’d rattle and slosh. But I am doing fine.

Because today I am one step closer to putting this puppy to bed.

I’ll leave you with one more quote from Florence Nightingale: “How very little can be done under the spirit of fear.” A lot, however, can be done under the spirit of KILLING IT.

So take that, MF.


Why Laughter Really is the Best Medicine

Approaching life with humour is not something that I learned to do. It is something that I have always done, from the time I was a wee one. I cannot take any credit for being that way. It was Mother Nature’s gift.

In fact, I do not know how one can learn to see things through that lens if it doesn’t come naturally, but I suppose it must happen. Maybe on the heels of a life changing event, such as, a-hem, a cancer diagnosis. Any of you who were born all serious and buttoned up who later learned to see the funny in things please pipe up and tell me how that came about (and how it’s working out for you).

Now don’t get me wrong. Not everything is funny. Some things are just plain ole horrible or sad or grotesque or infuriating. And that’s life. But a lot is funny that might not appear to be on the surface. Living life that way is all I have ever known and it is sure one helpful tool when the gauntlet has been thrown down.

Some things would be funny to almost anyone, such as the time my mother and I were in an argument about God knows what (I was a teenager so…) and as things really hottened up I noticed that she had a glob of sour cream on her eyebrow, at which point I burst into laughter and the argument was over.

Other things are funny to one person and absolutely unfunny to the next, such as the time one of my good college friends, Jen, was looking to see if her roommate was in the Georgetown Kinko’s (now FedEx for you youngsters). Squinting to combat the glare, she approached that window slowly but surely until she misjudged and walked right into the plate-glass, slamming her forehead into it, clapping her hand to the area and yelling “ow!” Having seen this unfold (and after making a snap determination that first aid was not required), I fell right on the sidewalk when my knees buckled due to uncontrollable laughter. I know my mother would not have found this funny. But I did. Sorry, Mom.

A third category is things that are probably not very funny to most people, but are to a select few of us weirdos. Like the fact that after brushing off (so to speak) hair loss, deciding to shave my head, and embracing my new look, I promptly got, on the back of my head, simultaneously, a case of the shingles and a red bumpy rash due to being immunosuppressed by the chemotherapy. So I went from being bald and badass to bald and rashy and rather un-badass in a matter of days. Lovely. But to me, kind of funny, because what can you do?

Things brings me to a public service announcement: If you are over a certain age, had the chicken pox as a child and have not been vaccinated for the shingles, you might want to get on that. Shingles isn’t tons of fun, but I was lucky and mine was not that bad, considering that one description I read (on the internet — oops) indicated that the site felt like a hot ice pick was being inserted into it intermittently. That might not have been funny to me either.

So back to humour. Humour is why I am actually looking forward to my sixth chemotherapy treatment tomorrow. When I strode in two weeks ago in my ridiculous leopard-print outfit (see What I Wore To  Chemo Today if you haven’t read it yet), I made a lot of people laugh. And that made me laugh, and made me happy. Then it really wasn’t so bad to be there. It lightened the mood, made us forget a little bit why we were there.

The only thing that isn’t funny about the whole thing is now I feel a mounting pressure to come up with an equally groovy outfit to wear to chemo tomorrow, and I don’t know if I can deliver! So I am going to distract myself by making some cancer-killing roasted Roma tomato soup from The Cancer-Fighting Kitchen, an excellent cook book that my friend Dee  got for me. Whether you need to kill it or just cook up some tasty meals (don’t let the c-word in the title put you off).

Ciao for now.

Why Sometimes I Let Myself Go There

For some reason whenever I ride the tube in London I get introspective. Especially if I am alone, quietly observing the other passengers as the cars clickety-clack along. There is something about sitting there without speaking that makes me wonder what other people are thinking.

Today I needed to take my younger daughter to a birthday party in Northwest London and, being at a friend’s house about an hour away in Southwest London, we had quite a journey ahead of us. For about the first nine stops there were no seats and Charlotte and I stood side by side, holding hands. When I am standing I feel more powerful and imposing, because I am relatively tall. I don’t wonder so much what anyone around me might be thinking. But when I sit down and shrink to everyone else’s size, I start to feel a little vulnerable.

When we made our switch there was one seat available and I told Charlotte to take it. The man next to her looked at me and offered me his seat. I happily accepted and thanked him. I wasn’t sure if he gave it up so that I could sit next to my young child, or because he knew I was a cancer patient.

I started to think about how I perceive myself versus how others perceive me. Do I look like a cancer patient even when I don’t feel like one? And how about when I do? When I am tired and have dark circles under my eyes do people notice? Do I make them feel sad? Or disgusted? Today, did that man look at the five-year-old child by my side and pity her? Did he wonder if she would have a mother in a year or two? Did he think that it was unfair for such a young child to have a mother like me?

These thoughts violated my mind in rapid succession as the train hurtled toward Bond Street, where we would get off and meet my husband. He had finished work for the day and had agreed to take Charlotte the rest of the way to the party, shortening my journey and enabling him to spend some time with her.

We found him on the platform. I handed her off and gave him a quick peck. Then the next train came and they were gone. I started toward the exit (“way out” we call it here). I paused. My hand felt conspicuously empty. I looked at it. Reminded myself that I was no longer holding Charlotte’s hand, that I had relinquished her and the bag containing the birthday present, card and directions to the party to Bill. She was safe. She was okay.

I walked up the short flight of stairs and rode the long escalator up. Stopped in an inexpensive store to study a collection of clip-on flowers for my head scarves. I bought three. Felt a little bit better. Then I emerged from Bond Street Station and looked up Oxford Street. A light drizzle spattered my parka, which I had hoped by now would be stored until next winter. I looked toward Selfridges department store, looming across the street with its grand facade and its flags. Glitzy retail beckoning. But I didn’t want it. Not today.

I crossed the street. H&M was right there. More my speed. Cheap. Almost disposable. I walked in and was assaulted by pop music, whatever sweet perfume they were pushing and brightly coloured sequined tops and tropical-print bikinis. I found the accessories and selected more flowers. I had now amassed a bouquet, but wasn’t ready to leave.

I surveyed the store and picked up an inappropriately short colour-blocked mini skirt and a gauzy leaf-print beach cover-up. There was a long line at the fitting room. I bought everything without trying on. Screw it.

Pure unadulterated retail therapy. Cheap retail. Maybe the best kind and the purest form.

My mood lifted. I’m killing it again, I thought, picturing myself striding out of the house in that striped miniskirt with black combat boots and a black beaded flower perched on the side of my head.

This was one of those days. When I let myself go there. I let myself think about the fact that I have a life-threatening illness. About what it could mean. About what it has meant for others before me. But then I pull myself back. I was just visiting. I won’t linger. I will not. It won’t be me.

It’s okay for me to visit. I never stay long. But then I know that I am really dealing with this and it isn’t all for show. Not just a brave facade. Not just for you. I know what could be. And have chosen to reject it.

Because I’m killing it. Fuck you, cancer.

Chicks I Dig Vol. 1

No, this is not a post about my long-lost lesbian loves. Hate to disappoint. (If you don’t get that joke read May 1st’s post — it’s a shorty — entitled Spam spam spam spam….) Rather, it’s about the famous female characters who have inspired me over the years and why I dig them.

It’s almost like someone out there knew that I would need serious inspiration of the female persuasion later in life, so they started to stack the deck for me when I was but a tender age.

No. 1: Wonder Woman

Come on, WW = hot! She has a great rack… and that outfit! To die for. I love that she could look so badass but at the same time still manage to have a slightly vulnerable expression on her face (while kicking your butt). If I encountered this (or I should say these) in an ally I would just surrender my weapon and bow down. She may not have been a killing machine per se but she was definitely killing it. Go Linda.

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When I was five I had a Wonder Woman bathing suit. I wore it around the house (and at other people’s houses) at all times, refusing to take it off. Of course, I was a kid with legs the diameter of pencils, stringy brown hair and buck teeth, so perhaps slightly less badass in my ensemble. But still, I thought I was the shit. By the time I outgrew that bathing suit, the thing was so faded it looked as though it had been left out in the desert for a year.

No. 2: Beatrix Kiddo in Kill Bill Vols. 1 and 2

My favourite killer of all time. I mean, she’s killing it (or preparing to kill it) for practically the entire thing, totally righteous and smokin’ hot in every gripping minute. Even after she is buried alive and emerges, mad as hell and covered in dirt from head to toe, and walks to that diner to ask for a glass of water, she looks wicked pisser (that’s South Boston for super fine).

I’m gonna have to get me a yellow track suit for one of my chemos… Alas, so many fashion ideas and so few treatments left. I also need to book a flight to Japan and commission a Hattori Hanzo samurai sword in case anyone even thinks about messing with me. You can’t lose with Uma. She’s a first-class assassin.

No. 3: Katniss Everdeen in The Hunger Games

Now before you get all excited there will be no picture here because I have deliberately not seen the movie yet. I have read only the first book and do not want images of actors colouring my perceptions while I finish the trilogy. So this heroine for me is as she exists in my own imagination.

I picture her with bow and arrow drawn, dark lustrous hair pleated down her back, tan skin smudged with blood and smelling slightly of earth and sweat and hope. Poised for the kill that she was forced to make for her own survival. Sound familiar? She did what she had to do. And damn did she kill it. And kill it and kill it and kill it.

God, I love these chicks. That’s why I’m bringing them with me every step of the way and beyond. For fuckin-ever.

Breast Cancer for Dummies Part Deux

Because I started my blog in the midst of chemotherapy, rather than at the beginning of my story, I have jumped around quite a lot. This has turned out fine, because — at least in my experience — life is rarely linear. However, I do feel that it is time to continue with the story of how I ended up here, five out of eight chemos in, fighting breast cancer. This leads me to the second instalment of Breast Cancer for Dummies.

As I mentioned in my first post on this topic, “Breast Cancer for Dummies Part I,” I am not a doctor, nor do I have any expertise on this subject other than what I have learned along the way in dealing with my own disease. Nevertheless, I believe that you will find the following useful if you ever wanted to know more about breast cancer without reading a text-book, or if you are just curious to know how I got to this point. If this grabs you then you should start with Part I above if you haven’t already read it, or maybe give it a skim to refresh your recollection if you have read it. Conversely, if you find this all too technical and “involved,” fear not. More silly posts about this, that and the other thing are forthcoming. And I won’t be offended if you skip this one.

Moving right along…

Where did I leave off? Ah, yes. I took you through finding my lump, having imaging, getting biopsies and initial diagnosis. So here we are in the first week of January 2012 and we have, in the right breast, multifocal, ER+, PR+, HER2-, Grade II Ductal Carcinoma in Situ (DCIS) and Invasive Ductal Carcinoma (IDC) with no apparent lymphovascular invasion. The biopsies reveal at least two tumours, oriented radially, each appearing to measure under a centimetre.

Oh, and I won’t make you take a multiple choice quiz this time because I know you were upset about that in Part I and it made you have flashbacks from the SAT or whatever torturous British or [insert appropriate nationality] exams you had to take. I don’t want you breaking out into a cold sweat and shorting out your computer, tablet or smart phone. Isn’t that nice of me?

Anyhoo, when we left off I had just been diagnosed with breast cancer. What then? The first order of business with cancer like mine was to see a breast surgeon. When I was told this it sort of took me aback. What about an oncologist? What about “the whole picture?” Well, how it works is, they like to get the tumour(s) out of you first and then they figure out the whole picture. So breast surgeon it is. He looks at the pathology from your biopsies and your imagining and recommends what kind of surgery you need. This becomes step one in the big “killing it” game plan.

I found that putting in place the game plan was a big deal. Once I began to do so, I started feeling a hell of a lot more in control, because I knew what step one was. This was instrumental in moving beyond the initial shock of “how can I have cancer?!” and “why me?!” and all of that unproductive Nancy Kerrigan-esque jazz. No one likes a whiner.

Now, if you read my first post, “Halfway Through Chemo… How Did I Get Here?” you may recall that having spoken to Beth, my plastics/breast reconstruction surgeon buddy, I had already begun to wrap my head around removing the entire breast (maybe both) even before I had my diagnosis. Beth had seen and heard about a number of women who had opted for lumpectomies and then ended up with a recurrence in the same breast and thus a mastectomy anyhow. She had also seen women who had opted for a single mastectomy who ended up back under the knife for mastectomy number two after a recurrence in the “healthy” breast.

That being said, the most common surgery for breast cancer remains lumpectomy. With lumpectomy, the tumour is removed and then generally the patient is given radiotherapy to reduce the risk of a local recurrence in case any cancer cells remain at or near the site. Sometimes more surgery is required after the pathologist examines the removed “lump,” which you can think of as a cube of tissue, each side of which is rubbed with ink to determine whether there are “clean” or “dirty” margins. This is not an exact science, but the gist is that the surgeon wants to get a clear margin around the tumour so that dirty a/k/a cancer cells are not left in the patient.

So there I was, back in London, armed with my initial pathology. And I needed a breast surgeon.

One of the greatest sources of stress we faced was figuring out whether we were going to be comfortable doing my surgery and any additional (if any) treatment in London, having lived here for exactly five months, or whether we felt we needed to haul ass back to the US. So after we made some enquiries about the best and the brightest — hee hee! I almost wrote “the breast and the bightest,” — I started calling around. I went totally honey badger on the situation. (By the way if you still do not know what the honey badger is, I am going to get a little annoyed at you. So please watch Randall’s YouTube video linked above and get caught up.) I managed to secure two appointments with London-based breast surgeons on very short notice. A good sign.

Days later I saw the first guy. He was both a breast and reconstruction surgeon. He recommended based on my pathology and imaging that I have a mastectomy in the right breast and monitor the left breast. He ordered an MRI to try to get a better sense of the locations and sizes of my tumours.

Three days later, I saw the second surgeon. He also did both breast surgery and reconstruction and concurred that I needed a mastectomy. That the cancer was multifocal warranted removing all the breast tissue. I was comfortable with this and frankly relieved that both surgeons recommended the course of action I had already envisioned based on my conversations with Beth. I thought about the healthy left breast. I had been told that in the UK, many surgeons are loath to do a risk-reducing mastectomy when the unaffected breast can be “monitored” going forward, as surgeon no. 1 recommended.

I have to say, I didn’t like the idea of that. I did not ever want to deal with this again. Plus, I figured at the end of the day if I was going to lose one boob I might as well just do them both. One boob, two boobs, whatever. Just kill it.

I pushed the second surgeon on it. “If I were your sister, would you advise me to remove the other breast?” His head nodded an emphatic “yes” before “breast” even left my lips. His eyes never left mine as he said the word. Okay, this was my guy. He was honest and straightforward and aggressive. That was what I needed, wanted. So I decided I would have them both done. By him. Step one of the game plan firmly in place. Check one box. Kill it.

I know. This post is kind of heavy, not as much fun as the beer fermenting in the bathroom or wearing leopard print to chemo. But you have to take the bitter with the sweet, my friend. It is part and parcel of the whole picture and I want you to understand where I am and where I was.

And did I mention there is a silver lining? When you do a bilateral mastectomy, you do tend to have an easier time getting a more symmetrical cosmetic result. So that was a plus in my mind right there. No cancer and matching boobs. Good show!

Step two was a visit to a reconstruction surgeon. Now, as I mentioned, some breast surgeons (these are the folks who do lumpectomies and mastectomies — their job is to remove the cancer) do their own reconstructions and are “oncoplastic” (onco being cancer and plastic, well, duh…).  But there are some pretty tricky reconstruction procedures to choose from these days, and many breast surgeons do not dabble in some of the more involved techniques.

I was told I could have an immediate reconstruction following skin-sparing bilateral mastectomies, which means that they were going to give me new (temporary) boobs right away after removing all of my breast tissue, but keeping as much of my own skin as possible. That way you look down and see your own skin. It’s just what’s inside that’s all new.

This is quite a departure from a radical mastectomy, which for years was all that was available to women, leaving them with a scar from armpit to midline. Of course, some patients today still require a radical mastectomy, depending on the extent of their cancer. Yet for many of these women, a delayed reconstruction remains a possibility. I was simply fortunate enough to be a candidate for instant gratification. An immediate boob swap, as it were.

But what kind of boob swap?

I went to see the breast recon guru so that I could consider all the possibilities. This guy is known not only for his excellent breast reconstructions but for his fabulous boob jobs to the stars. Aim high, I always say. I liked him immediately. He was gentle and kind and sympathetic, and I felt comfortable in his hands (literally — I mean all modesty goes out the window with this, people). I stripped and he felt me up. And then he pinched my tummy and my bottom and the inside of my thigh. Why? He was weighing his options. There are some pretty amazing microvascular surgeries they can do now where they take a bit of tissue from your abdomen, inner thigh or rear-end and make a boob out of it. Really. The benefit of these surgeries, although they do involve a site scar and require a long recovery period, is that the reconstructed boob can last indefinitely if all goes well. This is because it is made of your own tissue and fat, so it looks and acts more like a natural boob, which is — as we all know — mostly fat.

He didn’t pinch me for long, however, before it became clear that these fancy procedures were not an option for me. Not enough extra tissue, he said. I hadn’t eaten enough fries (chips if you are a limey). In a way I was relieved. It was sort of nice to be told that I was too thin for that option (aw shucks). Also, then I didn’t have to decide whether I wanted to deal with a seven-hour surgery that would require months of recovery while trying to take care of a five-year-old and a seven-year-old.

Now don’t get me wrong, the autologous tissue flap, as these things are called, is an excellent and desirable option. If done well and pulled off without complications it yields a more natural breast and can last forever. But it is a big deal. And there just wasn’t enough fat on me to do it so that was that.

Implants it is, he said. Okay. Do it up.

Have you ever seen a silicone implant? Most of them are shaped like M&Ms. They are symmetrical. But being in Europe has its advantages. Here, they have been using “shaped” implants for well over ten years, implants that are still in clinical trial in the United States. These are also known as gummy-bear or 410 implants and are made from cohesive silicone that is less liquid-y than the traditional silicone implant (thus the comparison to a gummy bear, though I wouldn’t want to eat one). These implants are interesting for breast reconstructions because they are shaped more like a natural breast, with a slope and a projection. That is, they are flatter at the top and rounder and fuller at the bottom. More boob-like.

Well, thanks to a friend of mine whose two buddies recently had breast cancer in the US and whose surgeon happened to be participating in the clinical trial, I knew about the gummy-bear implants. I asked the recon guru. Yes, he said. He liked them and would use them on me. But first I would get saline expanders (basically temporary implants that are inflated with salt water) in order to make a nice pocket for the permanent silicone implants. Getting them primed for boob swap number two later on down the line. Patience is a virtue…

By the way did you hear about that son of a bitch in France who sold all those implants made out of industrial grade silicone? I cannot even tell you what I want to do to him but I think you can imagine. It involves a honey badger.

Okay then, step two in place: reconstruction. I had started to assemble my dream team. And they would work together, the breast surgeon doing the mastectomy on one side with the reconstruction surgeon following on his heels, and then onto the other side.

But we need to back up. There was another order of business to address. This was the sentinel node biopsy. Before beginning the mastectomies, the breast surgeon would remove one or more lymph nodes from under my right arm to find out if they contained any cancer cells. The sentinel nodes are like the guardsmen lymph nodes — the first line of defence. A technician locates them by injecting you with a radio isotope near the tumour and then tracking to which lymph nodes that isotope drains. X marks the spot and the breast surgeon removes this node(s) at the beginning of surgery so that it can be tested for cancer cells, often while the patient is on the table. If cancer cells are found, the surgeon will perform an axillary lymph node dissection (ALND), which is when they remove a number of other (or all) the lymph nodes.

The long and short of it is that you don’t want to find cancer cells in your lymph nodes, because it means that the cancer has started to spread. You can still kill it of course, but it isn’t what you want. If they find cancer in your sentinel nodes, they remove more nodes to see how many of them contain cancer cells. And all of this factors into your treatment plan. Whether you will need chemotherapy to seek and destroy any cancer cells floating around in other parts of your body/bloodstream and/or radiation to kill any cancer cells that are hanging out at or near the site from which the tumour was removed.

The night before the surgery I slept well. Really, I did. I was calm and ready to get on with it. D-Day was February 7 and I had waited about a month after diagnosis for my surgery. Although this sounds scary, I was assured by doctors on two continents that unless you have a very aggressive form of cancer, waiting a month or even two should not make a difference because breast cancer is slow-growing.

Still, the waiting was not easy. Indeed, it was the hardest part. This is because you cannot progress with the next step of your game plan until after the tumours are removed during surgery and then analysed by the pathologists. So you wait, and noodle and try not to be too mental. I dealt with it by going to the gym a lot, which you know if you read “Work It Out.”

The morning of the surgery, my husband took me to the hospital, to be joined later by my mother who had stayed at home to see the girls off to school. Once I was in my room, each surgeon came to see me, separately. Each explained what he was going to do and the recon guru marked up my boobs with a permanent marker and took pictures. Again — all modesty out the window. I smiled for the camera. A little while after that, I waved to Bill and they wheeled me out of the room. The anaesthesiologist had me out in about 20 seconds.

I woke up to my name being called. “Emily… Emily.” I blinked, had no idea where I was. I snapped back into focus. “The node, was it negative?” I asked. The nurse didn’t know. “The node…” I said. The anaesthesiologist rounded the corner and confirmed: the node had been negative. I exhaled. So they hadn’t removed any other nodes. All had gone according to plan.

Shortly thereafter, they wheeled me back into my room. I started ordering my poor husband around immediately, telling him to send an email to everyone that all had gone well and I was fine. I had killed it.

But alas. I still had to wait for my final pathology report. And that is why cancer is such a BITCH. Because just when you think you have won one battle, it sucker punches you right in the face.

I went into the hospital on a Tuesday. On Saturday morning, (still in the hospital) the breast surgeon came to see me. I was happy to see him. We chatted briefly before he got that serious look that doctors get and told me he had some pathology results. Bill was still at home with the girls.

“Were there any surprises?” I asked. “Yes,” he said. I got my notebook. Sat down.

They say that when you get difficult news, you should always have someone with you because you only absorb about 20% of what you are told. I’d like to give myself credit for about 80%, but it is harder when you aren’t prepared.

The breast surgeon said that there were three things we had not expected:

(1) The tumours were larger than the imaging had indicated, because one area of what appeared to be discrete little spots were actually interconnected and therefore counted as one tumour. That one measured 30 mm or 3 cm. The other one was about 14 mm. Shit.

(2) Although the sentinel nodes were clear, two other tiny nodes that happened to come out as part of the mastectomy revealed “micrometastases,” which are bits of tumour that are 0.2 mm to 2 mm in size. These nodes needed to be further analysed to determine whether the cancer cells were in fact that tiny, and therefore less significant, or whether they were bigger and posed more of a threat. If “macrometastases” were found, they might eventually have to go in and do that axillary dissection.

In any event, (1) + (2) = chemotherapy for me. This was not easy news to digest. But I kept writing, determined to take intelligible notes so that I could make sense of it all later.

And he wasn’t finished.

(3) Even though I had had all of my breast tissue removed (the whole point of the mastectomy), the margins of the tissue removed in the right breast were not great. Tumour was “present” at the margins, meaning in my case that it had abutted the natural barriers of my chest wall, posteriorly, and my skin, anteriorly. Therefore, he thought, I needed radiation, something we had been about 85% sure I wasn’t going to face.

That Saturday was rough. And it marked the beginning of yet another waiting period.

But the next bit of news we got was good. A week later, we saw the oncologist and he confirmed that the nodes had only micrometastases. Micro mets used to be undetectable but modern technology has allowed us to find these tiny cells. Some doctors treat the presence of micro mets no differently than finding nothing in the nodes (i.e., they treat such a patient as “node negative”). My doctors, although very encouraged by this news, did feel that the presence of the micro mets plus the size of the tumours warranted a more aggressive stance on both chemotherapy and radiation, tipping the scales in favour of both. Part of this had to do with my age. They tend to be more aggressive with breast cancer when you are young.

When I asked the breast surgeon why there might have been tiny deposits of cancer in these random nodes that “happened” to come out with the mastectomy but not in my sentinel nodes, he indicated that when one has cancer there are probably micro mets present somewhere. It happens. And this does not mean that they will ever grow into tumours. Or that you have a bigger metastasis elsewhere. But it still blows your mind.

And that is how I ended up where I am today, five treatments in. Counting down to June 7, five short weeks from now. My last chemo.

Two weeks after that I will begin radiation, five days a week for five weeks (my, that’s a lot of fives). Whew.

If you got through all of that I commend you. It sure as hell pooped me out.

What I Wore To Chemo Today

My treasured friend Susan of 17 years came all the way from America to visit with me today. That visit happened to coincide with my first of four doses of Taxol (see my last post, Countdown, for details on that). Thus, our visit was conducted in the chemo treatment suite in white leather chairs. Susan is the director of the most prestigious public interest fellowships in the law, “a legal Peace Corps” as described by The Los Angeles Times.

Back in the days of good posture and (naturally) perky boobs (see Boob Retrospective — don’t you want to read it just for the title?), I was Susan’s legal assistant at the New York law firm that established the fellowships. We bonded immediately. She has too many qualities to list in the time I have before the fatigue hits me so just trust me on my compact description — she is HIGH QUALITY in every respect. But I do have to mention some specifics: she is both a philanthropist and a fashionista, has a wicked sense of humour, is not afraid to say “fuck,” is a hot ticket, is highly intelligent and has a true gift for friendship. And that just scratches the surface.

Anyhow, years ago, after I had left the firm and was a One L at Harvard Law School, Susan came to speak to the students about the fellowships. A Two L aspiring fellow had called her with some questions on the application process and Susan had told her to come to the talk and meet me (a built-in resource, having been through the process as Susan’s right-hand gal) so that I could help her and any other public interest students so-inclined.

Susan is very fashionable, but always very tasteful, and she had kindly bestowed upon me a number of designer suits that she no longer needed. She figured I would be wearing one at the meeting to please her and make a good impression on the students. Pale blue Armani, perhaps? Crimson Feraud?

Of course when she showed up I was sitting on the floor in a cheetah print mini dress I got at the ten-dollar store and knee-high boots. Oops.

So last night when I thought about seeing Susan after quite a long stretch of not having seen her, I realised that an appropriate ensemble was in order. I mean I didn’t want to embarrass her again and make her feel uncomfortable in the chemo suite, for Christ’s sake. She flew across an ocean. And to top it off I am bald now, which doesn’t help one’s appearance.

This morning I scoured my closet, keeping in mind that I had to allow decent access to my port site near my left axilla for blood draws and administration of chemo. I selected and then rejected several choices as inappropriate, but finally settled on the perfect kit (look it up, Americans, it’s Breeteesh). At this point of course I was late. So pathetic to be late to one’s own chemo. And to top it off the nifty phone apps I downloaded in order to get a taxi to show up at my door refused to work and the cabs and car services were all popping up with “unavailable in your area” messages. Unacceptable. And there was no “FU I have cancer come anyway” button.

At that point I had no choice and gulped down the rest of my flat white (like a latte but better), wiped the cinnamon from the corners of my mouth with the back of my hand, and dashed out the door to get to the tube. It was raining again and so I put on my silver wellies so I wouldn’t soil my outfit. I had not planned to be sloshing about — thought I’d be cabbing it door to door.  Grrr.

I dashed into the tube, which of course crawwwwwled along. Blasted Northern Line. When I finally reached my stop I catapulted myself onto the platform, ran (yes ran) up two escalators and flung myself outdoors to hail a taxi. I was still a good 15-minute walk from treatment. Luckily I found a cabbie right away. He dropped me off in front of the clinic (most people know it’s a cancer place) and then refused to make me pay for the fare. It was lovely, really, and I was touched if not a little surprised. I mean people get dropped off there all the time and I am sure they usually have to pay. It must have been the combination of my elegant attire and — oh — the fact that he knew I was a cancer patient.

So, I was about ten minutes late. Not fatal. But I was concerned about getting a good seat under the skylight. I practically jumped down the stair case and was scolded by a lady not to rush (good point — headline: “she makes it through four chemos only to hurl herself down a flight of stairs at chemo and end up a quadriplegic”).

The staff ushered me to a nice, sunny pod. I yanked off my wellies, hung my coat up and waited for my friend. I hoped that she would like my outfit. I did not want to let her down. Again.

A blond breath of fresh air in a red and gold silk scarf, persimmon sweater and chocolate trousers breezed through the door. Susan had arrived. She saw me. She smiled.

What? You were expecting Rene Lezard? Please, people.

Nothing says “cancer, kiss my ass,” like matching leopard print tops and tails.

We killed it today, Susan and I. Easiest bloody chemo I ever did.

Yippee ki-yay, motherfucker.


Hi folks. It is always a little odd how much I enjoy the day before a chemo treatment. It approaches so quickly… and suddenly there it is. That normal Wednesday every two weeks before the Thursday festivities. Unfortunately the weather continues to suck here. It is cold, rainy and windy and not showing signs of improvement. And here I thought having chemo in the spring would be so lovely — sun on my bald head, showing off my bare legs with the latest in shorts. And so forth.

Anyhow, tomorrow I start the big countdown. For the first four chemo treatments I counted up. But those are over now. And I do believe that NASA would agree a countdown is more appropriate for the final four.

Whenever I go for chemo I try to get inside my head and get psyched up to do battle. If you are taking a drug that has bad side effects, you have to focus on the positive: namely, that the positive outweighs the negative and that this drug is exactly what you need even if it isn’t exactly what you want. So when I settle into my white leather chair tomorrow morning at 0900 London time and 45 minutes later my blood work comes back showing a fabulously high white blood cell count indicating “all systems go,” I will do my battle cry.

It goes a little something like this: “Die, motherfuckers.”

Sometimes I wonder if there is even anything bad in there left to kill. But just in case, we’re going in. And they will never see it coming. I feel almost sorry for them (not).

The really great news is that people say my “new” chemo drug, Taxol, is easier for many to take than my previous drugs (AC). But there are still some pesky side effects to watch out for. I read a laundry list of them once but it started to piss me off so I filed that information sheet and now I am starting to forget. But I do remember that they include joint, muscle and bone pain, tingling in the hands and feet, alopecia (I know I am already bald but I do still have eyebrows and lashes to worry about), nail changes, including discolouration and loss of nails (that sounds pleasant and attractive) and well, lots of other icky stuff. The queasiness isn’t supposed to be as bad and I am very excited about that because I get testy when anything interferes with my meals. I love food and I love to eat. And the thing that bummed me out about the first four treatments more than any other symptom was the combination of queasiness, metal mouth and taste bud changes.

What were we talking about? Oh yeah, the new drug, Taxol. Sorry I am tired and my writing today is rather random. I’m gonna go with it.

My cousin was on Taxol a long time ago when it was experimental and she said the joint pain was so bad she had to walk with a cane for a while. But that doesn’t scare me, because if I need a cane I will get a really badass one with a stainless steel skull on the top and a retractable knife in the base and I will go around clubbing people who make inappropriate comments and picking up trash on my street with the knife in order to beautify the neighbourhood (what you thought I would really stab someone? Come on I am not that mean and the riots are over — for now). She also still sometimes has residual tingling from nerve damage. That does make me a bit nervous, pun intended. Tee hee.

So to ward off these ill effects, today I visited the special doctor. The one who does complementary therapy. I had acupuncture, which helped enormously with my fourth and final AC treatment, and also some homeopathy. Phosphorous. I like the idea of that. The idea of sparks, of flames and of powerful energy banishing unwanted sensations. I am girl on fire, like Katniss in The Hunger Games. As I lay with the acupuncture needles in me, I imagined myself floating above the table, aglow with sparks. Invincible. Ready to do battle.

Ready to kill it.

Now don’t get all serious and depressed on me. Tomorrow I have a funny one planned. Promise.