Some thoughts on the ten year milestone

Hooray! I did it! I survived ten years after a diagnosis with four triple negative breast cancer tumours in my left breast. Fortunately, nobody on my medical team told me that they had all agreed I probably wouldn’t have made it past eighteen months. I don’t know if that knowledge might have changed my chances of survival but I suspect so.

I hit ten years back in July. I realised I had actually stopped counting years when I posted to social media that I was at nine years, and then Facebook showed me an image of myself around the time of my diagnosis from ten years ago. I had to go and check the dates. It’s interesting that counting years is not the big deal that it used to be. The only good thing about triple negative breast cancer is that if you make it to five years post diagnosis, your risk of breast cancer drops back to being the same as everyone else. I’ve also put a lot of time into practicing Acceptance Commitment Therapy (ACT); connecting to the present, knowing the difference between myself and the stories my mind is telling me and asking “is this story useful?” has been endlessly beneficial, but the real winner has been connecting to my values and using them as my true north for finding real meaning and direction in my life.

My book about using ACT to deal with a cancer diagnosis and fear of recurrence continues to sell steadily, even though I do very little to promote it. I have promised to do a “non cancer” version but so far life has just been too busy with other things. If you’d like to check out the book you can find it here and get if for free on Kindle: https://www.amazon.com.au/Free-Fear-Living-after-cancer/dp/1521249377

My big news is that my beautiful daughter and her lovely husband are expecting their first baby. The single greatest motivator during my treatment was living long enough to meet my grandchildren, so to say I’m excited would be an understatement. There are still mixed emotions. I think the threat of my imminent death was particularly difficult for my daughter. At one point during treatment when we thought I had recurrence we actually had THAT conversation: “Treatment hasn’t worked. I have recurrence. That means I’m not going to live much longer.” This was obviously incorrect. In the end the cells remaining after radiation turned out to be random cells from the original cancer not killed by radiation treatment (radiation resistance is my superpower!). I feel that having been to emotional hell and back, my daughter has sensibly built independence and resilience.

I had imagined being present at her birth, as my mother was at mine, and being close by to help with all the hard work involved in a new baby so that she and her husband could relax and rest. Neither of those things is going to happen. They would rather pay a doula and plan on spending their first six weeks in a bubble, with minimal interaction with the outside world. I respect and understand their decision, but I do wonder to what extent my cancer impacted our relationship and these decisions. My daughter was in her early 20’s when I was diagnosed and just finding her adult feet. It must have been horrible for her. I’m not surprised that she has created boundary around herself, but I do hope she comes to understand that it really is better to just love with all your heart and deal with the grief, than to avoid that love for the sake of minimising grieving. As hard as it is, grief can be endured, and can even help to shape our lives in positive ways.

Thinking about her choices has left me contemplating how often we inflict our own misery through expectations. There is a gap between the relationship we have, and the relationship I hoped for, but that’s nobody’s fault. We all imagine ideal situations and then live with reality. How much better to just accept reality, with all its prickliness. I wonder how many times she’s been around a loop that sounds like this: “Mum’s not dying. Mum’s still dying but just not dying yet.” Fear makes prisoners of our hearts.

I’m still hopeful that the birth of her own child will give her an insight into the great dilemma that faces all birthing mothers; they start life as part of our bodies and then gradually get further and further away from us. At each stage there is a tiny, often unspoken grief. We hope that they will not completely disconnect from us, that they will stay grateful and loving towards us, and that we will find ways to have adult relationships of mutual admiration and respect, but there are no guarantees. We all hope our children will outlive us, but we know this means that they must endure our deaths.

While I wait for her to define my role as grandmother I look back on the big lessons of the last ten years. I think the biggest one was this: NEVER LET ANYONE STEAL YOUR HOPE! Most people survive breast cancer and even people with an awful prognosis can surprise their doctors. I did. Regardless of how bad the news is, where there is life there really is hope, and each day of your life is another day to live.

I know that because of the title of this blog there are a lot of people that think I’m a fan of “positive thinking” but I’m not. What I’ve learnt over the course of my treatment is that it is completely unrealistic to expect anyone, particularly anyone dealing with cancer, to remain positive. What matters more to our mental health and recovery is honestly naming and expressing our emotions. It’s not only okay to be terrified, angry, jealous of well people, frustrated, sad, melancholy and anxious, it would be seriously worrying if we were not. How much better to just be, and how distressing it is for those with cancer to have their anxiety compounded by the thought that their anxiety might somehow feed their cancer. So my second big lesson was to feel what I was feeling, and to share it.

My third big lesson was to take responsibility for my health. I met a lot of other patients during treatment who just relied upon their medical team to “fix” them, as if they were a mechanical device that needed a service, but there are so many things that we can do to support our recovery. For me, that included meditation, yoga, good nutrition, more water than I usually drink, medicinal cannabis (now thankfully legal), lots and lots of sleep, laughter, the love of friends and family, practical help from friends and family and, perhaps surprisingly, lots of Disney cartoons. I also did a lot of online research into my illness and treatment options, I kept a notebook of questions I wanted to ask my doctors and took it with me every visit. About two years into treatment I met oncology masseuse, Maryanne Losurdo, and I still see her every week. I’m pretty sure she’s the reason I don’t have any lymphedema.

If you’re in treatment then your list might have some things in common with mine, and it might not. What matters is that you make choices you can live with. I say that rather than “good choices” because in all honesty you will find yourself in lots of situations where there is no clear good choice, and sometimes just less-shit ones.

Which leads me to lesson four: I made a commitment to never second guess myself. Having heard from the specialists, talked to family and done my own research (and I am talking actual published research papers here, not articles in magazines or online forums), I would make the best call I could, and then I would commit to not looking back. I didn’t always keep that promise, and I still wish I could go back in time and ask my surgeon to save my nipples, because it turns out they DO still have feeling even after a mastectomy, but otherwise I just remind myself that I made the best decision with what I knew at the time.

Lesson five is to say a great big yes to all offers of help. Just say yes and then figure out how people can help you later or, better yet, have a really close friend or family member coordinate your volunteers for you. The people that offer really do want to do something useful and it’s a great way for them to cope with your diagnosis. Also, you will need lots and lots of help.

Lesson six is to learn Acceptance Commitment Therapy. I’m not trying to sell copies of the book and there are lots of other great books on the subject. I also make no profit at all on the ebook version of mine because I wanted as many people as possible to be able to access this life-changing model for getting out of your head and into your life. They should teach this stuff in school. Parents should teach it to their kids. We are not broken. We have protective minds that are just trying to keep us safe, even if they sometimes don’t do that in a very useful way.

Lesson seven is to do nice things for yourself. There are people that will find this one self-evident but for many people, and I would suggest particularly women, there is a weird guilt associated with taking some time for ourselves, especially when spending money is involved. We shouldn’t have to get cancer to be okay with this one.

Lesson eight is to forgive the friends that walk away and don’t come back. I know that for the first few years after my Dad’s death from cancer I just couldn’t stand to be around cancer. We have no idea what others are going through (and yes, some people are just uncomfortable around any kind of illness).

Lesson nine is to keep a folder. I picked up this tip from someone on the Breast Cancer Australia site and it was so beneficial. I got a ring binder with plastic sleeves and paper with the holes already punched, and I just kept adding to it. I kept test results, doctors’ reports, my own questions and answers, a few really good research documents and recommendations. The folder was great for checking which treatment I had when and for double checking what doctors had recommended. You might prefer an online version, but whichever way you choose to record everything don’t let it become too much of a chore. This is why a physical folder wins; you just drop documents into sleeves and don’t need to scan them.

Lesson ten is to live your best life, every day. The term “present and mindful” never meant much to me before diagnosis, but I do think that the great gift of cancer was to force me to sit holding hands with death for a while, to realise that my life, all life, is finite, and that’s what makes it so wonderful. Now I take time to cherish the people I love, the friends I’ve made and the endless beauty of the natural world. In the last decade I have studied and taught permaculture and expanded our wondrous garden. I do spend time remembering the past and looking forward to the future, but most of my life is spent in the here and now, grateful for this bonus round of life that nobody expected me to have.

Except my husband and my daughter. I sometimes think I’m still here just because they refused to accept a world without me.

Happy New Year!

This site will turn ten years old in 2023. Yes, it will be ten years since my diagnosis! It’s heartening to know that there are still people finding this site and using it to help them navigate treatment. Thank you for your messages and please know that I am deeply grateful that my own experiences have helped you.

It’s New Year’s Eve and I thought it might be a good opportunity to write about how many of us, having survived cancer, can develop a habit of being much too harsh on ourselves, particularly at this time of year when the culture of self-reflection and impossible promises is rife. “Why am I drinking so much!” “Why am I eating junk food!” “Why do I do what I know is bad for me!” I’m not a fan of New Year’s Resolutions, having found the tradition to be mostly punitive and futile. Many people will make promises tonight and most will fail to keep them.

I think some of the reasons these promises fail is that they often require us to stop doing something, to give something up, and to motivate ourselves with dissatisfaction or even disgust. “I’m a fat pig and I need to lose weight!” I’d like to suggest that instead of beating ourselves up we celebrate our survival, and then think of things that we can joyfully do more of.

I’d like to honour my body for the amazing survivor that it is. I long ago let go of any external notions about how bodies “should” look and any concerns with my weight have been about keeping my risk of cancer as low as possible rather than the aesthetics. Even before cancer, managing my weight was about being as healthy as I could be and while I once managed to diet my 5’6″ Celtic frame down to a size 10, I felt way too thin in spite of the flood of compliments (Why? This was not a healthy weight for me! Surely we all know that being too this is dangerous?). When I think of all the people I admire I notice that their weight is never a factor, unless it’s within the context of being inspired by how well they care for their health.

I am not defined by my body shape.

I am smart and kind and sometimes funny, and generous and talented and sometimes awful and unkind and boring. In other words, human. I will not punish my body with pointless “diets” (they never work) or shame. Like many people, I gained weight during COVID and my motivation to lose it is entirely to do with keeping cancer away. I know that the link between weight and health is not as clear cut as many would have us believe and that healthy people come in all different shapes and sizes, AND I know that there are a whole range of conditions where my weight is definitely a factor. Risk of cancer is one of them. I know that there are a long list of factors that contribute to weight gain AND I know that my food choices are significant. I also know that punishing myself with diets doesn’t work any better for me than it does for most people. My “ideal” weight is wherever I end up when I make healthy choices most of the time. That includes choosing to fast for two days each week in order to trigger “autophagy”; that mechanism by which my body burns damaged cells for fuel. Doing this is probably the best tool I have for remaining cancer free and I have the science to back that up, but this is just what works for my body. Many people find fasting emotionally distressing or triggering, especially those with eating disorders.

So if you would like my take on the new year, here it is. Focus on MORE because making yourself feel ashamed or disgusted is not something you would ever do to someone else, and it’s not helpful or useful to do it to yourself. Celebrate your survival more. You are a warrior! You either beat cancer or you’re still battling it. Go you good thing!

Give yourself more rest, more of the people you love, more of the things you enjoy, more delicious, healthy food, more water, more walks through places that lift your heart, more self-care, more self-compassion and more kindness. Let go gently of that which no longer serves you, including self-bullying and perfectionism. Be okay with making good choices most of the time and be kinder to yourself when you don’t. Embrace the messiness and unpredictability of life and remember it’s not good or bad, it’s just weather. Go out and play during sunny times, and stay in during storms while remembering that it’s okay to dance in the gentle rain and escape the baking heat.

Cancer helped me to understand the profound gift that life truly is, and in a way that I don’t think is possible for those that have never faced a life-threatening illness. What a privilege it is to be alive. What an endless source of adventure and joy. Wherever you are in your quest for better health, my best wishes for a great 2023 and my hope that you continue to find the joy in those little moments that we only notice when we realise how truly precious they are.

Much love
Meg

Nine years post diagnosis and still going strong!

Hi everyone, and thank you to all those that send me messages to let me know that this site continues to support people with breast cancer, particularly triple negative breast cancer, some nine years after I started writing it. I’m not here very often these days. I’m usually over on my other WordPress blog, Smarter Than Crows, where I write about all kinds of non-cancer related things, including permaculture.

Today I’m reflecting on reaching nine years since my first diagnosis with cancer. As you all know, I had a bit of a roller coaster journey with my treatment, ultimately opting for a bilateral mastectomy without reconstruction. I’ve been free from cancer ever since. So first up, if you’ve had a triple negative breast cancer diagnosis, or any kind of breast cancer diagnosis, know that nine years and more are not only possible but likely. Don’t be put off by those ‘rare and aggressive’ reports, because triple negative breast cancer still has a really good survival rate compared to many other types of cancer. Also, you are not a statistic! You’re a human being with choices and making good ones can have a big impact on the outcome of your treatment.

The other day my daughter commented that she knows two versions of me; the one before cancer and the one after. I meant to ask her about the differences but the conversation went in another direction, but her comment confirms my own sense of having somehow been transformed by the experience. I know this is common for many of us that travel through the long, dark tunnel of cancer treatment, and not everyone emerges better for it.

I’m one of the more fortunate ones. I still have aches and pains that might be a consequence of treatment or might just be age. My peripheral neuropathy has been much improved by yoga, physiotherapy and remembering to keep my hands and feet warmer than I usually would. Fingerless gloves are my best friend!

My vaginal atrophy responded well to Mona Lisa Touch Therapy but you need to keep going back for top-ups which are costly and uncomfortable. I’d like to blame COVID for not getting back there but I think it’s just something I’ve been avoiding with everything else going on. Note to self; book GP appointment and get another referral.

I think the pandemic made me anxious and sometimes irrational. I noticed that for most people, maintaining good mental health was a struggle. People became short-tempered or withdrawn and even on good days there was an undercurrent of things being not quite right. I was particularly concerned by reports from overseas where cancer survivors were denied treatment so that those with better survival odds could be offered beds. It didn’t happen here, but at the time of the reports we didn’t know what would happen.

As I write this, the Australian community seems to be acting as if the pandemic is over, and we can all go back to normal (just as soon as we decide what normal is!) but I know from friends in the health industry that admission rates and death rates are still way too high, and we’re about to enter winter.

I found it interesting to notice how well cancer prepared me for dealing with a pandemic. Chemotherapy gave me lots of practice in negotiating public spaces without exposing myself to pathogens; avoid touching anything unless I need to, use my scarf to open doors rather than my hands and keep a good distance from other people. At least with a pandemic, everyone else was playing the same game.

Cancer also gave me the opportunity to reflect upon my own mortality, and to come to terms with death. I hope it’s now at least a couple of decades off (when I’ll turn 80) but I know that it’s coming and there is nothing I can do to prevent it. This brings with it a deep wisdom. Time is finite. Do what matters. Don’t sweat the small stuff. So dealing with a potentially fatal illness spreading throughout the community was possibly less shocking. It also helped that permaculture has connected me to people living in refugee camps. I asked my friend, Bemeriki, about the pandemic. “It’s just one more fatal disease that we have to live with, and at least it doesn’t kill our children.” Suddenly arguments about masks and vaccinations seem to be a symptom of extreme privilege.

I turned 60 at the end of last year and it was a huge celebration. I excitedly applied for my Senior’s Card and took a mad train journey with another friend my age to activate my Gold Opal Card. In NSW having one of these means I can travel on public transport for $2.50 a day. Woohoo! I’m embracing ageing because I nearly didn’t get any older.

Staying as well as I can continues to be a bit of a sine wave. Sometimes I’m really dedicated and my daily yoga, weekly fasting and healthy eating seem like the most natural thing in the world. Other times it’s too much alcohol, sugar and Netflix. I’ve just hit the upswing again and I’m feeling good about it.

My friend, Michelle, sent me this poem recently:

I love this. It reminds me that all choices have consequences and that any change requires effort. At the moment, it’s motivating me to do all of those things that I know will lead to optimising my health and my survival. I hope you find it useful too.

I will not complain about growing old. Ever.

I was writing over at my Smarter Than Crows blog yesterday and accidentally clicked through to this site. What a surprise to find that all these years later it’s still providing advice and support to women going through treatment for breast cancer. I’m so pleased that you’re all finding it useful.

I just wanted to let you know that I am alive and well, even though my talented team of medical experts all expected me to die. When I went for my five year check up with my oncologist she was surprised to see me. It turns out that my prognosis was an eighteen month progression to eventual death.

This matters.

Never let anyone steal your hope.

I’m very glad that my medical team waited five years to tell me that they didn’t expect me to survive. We now know how important state of mind can be to recovery. The placebo effect has an evil twin known as the nocebo effect. Essentially, we often get what we expect. What a testament to the power of the human mind.

So here I am, seven years later, alive and well and cancer free. When I asked my oncologist what she thought made all the difference she had no idea. “Some patients just don’t follow the normal trajectory.”

This matters too.

Even when you have been handed a poor prognosis for your illness there is the possibility that your doctor is just wrong. Statistics are great for researchers and averages can be useful for deciding if a particular treatment is worth pursuing, but there will always be outliers; those people that don’t fit the pattern. For all of the accumulated medical wisdom we possess there is still so much about the human body that we just don’t know.

Where there is life, there is hope. Every single day that you are alive is another day to live and love and breathe and laugh and cry and hold onto those you love.

I got through cancer by remembering that any one of us could die suddenly at any time, which might seem like a rather morbid thought, but it allowed me to let go of obsessing over whether or not cancer would be the cause of my death and to focus on living instead.

I highly recommend it.

I’m still standing!

Hi everyone. How are you all? I know it’s been a while but I just wanted to stop by and let you know that, contrary to medical expectations, I’m still alive! I’m not on this site much any more because my life is now very much focused on permaculture and my other blog that lives here:

Smarter than Crows

So how is life after triple negative breast cancer? Well, it’s actually a lot like life before triple negative breast cancer, and yet somehow just slightly better.

I can remember being at a function a few years back when we were seated with strangers. My husband commented that we were celebrating four years since my diagnosis and the man opposite him said, “After a while that stops being a thing.” He told us his wife was also a long time survivor but that they no longer paid much attention to how many years had passed. It was a bit of a shock at the time. Cancer had loomed large in our lives for so long that any alternative seemed unlikely. He was right. After a while it does stop being a thing. But for me it’s still there in the background and an important part of who I am.

Looking back I’m humbled by all the amazing support I received. I know it’s a cliche but you really do find out who your friends are (and who they aren’t!). I’m also just a bit proud that I used the whole experience as an opportunity to grow a better version of me, and to help other people going through the same thing. It’s heartening that six years on the blog still draws a fair amount of traffic and the sales of the book, Free From Fear, Living Well After Cancer are steady, even though I do zero in terms of promotion.

Anniversaries are a useful point of reflection. My daily yoga practice has slipped but I still attend my weekly class. Time to recommit to daily practice. I’m eating much less meat and a lot more vegetables, and I have also increased my intake of seeds, nuts and as many different kinds of mushrooms as I can find. I make my own sourdough and ferment water kefir and apple scrap vinegar. The garden overflows with organic food and provides about 80% of our vegetables and a good portion of our fruit.

I still drink more alcohol than I should but the counter to that is that I’m not on any pharmaceuticals for pain. When I look at the side effects of any of the medications they offered me, good quality organic wine seems like a better option. I’m now exploring medicinal cannabis as an even better alternative but sadly, it continues to be illegal in Australia. I was fasting twice a week and that has dropped off too. Time to lift my game. It’s so easy to fall back into old patterns!

Although I purchased foobs (prosthetic breast forms) I don’t wear them. They are heavy and if the bilateral mastectomy had any benefits at all it was that losing my F cup breasts meant not having to wear a bra. I still miss my nipples and replay that moment when my surgeon asked me if I wanted to keep them, explaining that the two surgeries on my left breast meant saving the nipple on that side would put it in an awkward position. I wish someone (my surgeon?) had explained to me that saved nipples would still have sensation once they healed. Intimacy without nipples is, for me, a bit like intimacy with my eyes closed. It’s still beautiful, of course, but there’s something missing.

My marriage survived breast cancer. I am deeply grateful. So many don’t. My husband has returned to pretty much the same pattern that existed before the cancer. There’s a part of me that misses his tenderness and the way he was with me when he thought that he might lose me, and a bigger part of me that hopes to never put him in that position again. We are a good team, close friends, and happy to have the opportunity to grow old together. He prefers not to talk about sex so we don’t. We are still loving and affectionate but rarely passionate. He’s over 60 and I’m close to it. I suppose this is just part of growing older but it still makes me just a little sad.

My daughter and her husband celebrated their first anniversary this month. What a joy to have been at their wedding! They are now in the early stages of thinking about children and the possibility that I may live to meet them is now very real. This is my greatest source of happiness. Like all young couples they struggle to figure out the balance between careers and family life. They talk of moving back here if and when a baby arrives. I am beyond excited at the prospect of being able to support them during those early years when most other cultures recognise the huge benefits of having extended family near by.

There are still times when it all comes flooding back. There are still times when I feel like I did that cool, bending over backwards thing that Keanau Reeves does in The Matrix. The bullet should have hit me and somehow I seem to have bent time and space to avoid it. Or something else did. Either way I am grateful.

I have friends with cancer, and friends with other serious health issues. It’s their turn now. I do what I can to help. I spent today with a friend in her 80’s hearing her talk about her battles with incontinence; “Humiliation is the price we pay for longevity,” she said. True enough. I’ll take it over early death though. Any day.

 

Did you know I wrote a book?

WordPress has just sent me a message telling me that this site is getting a lot of traffic right how. Hello and welcome! Please feel free to leave comments and to share anything you found useful with others. The whole purpose for keeping this blog was to help other women (or men) going through that long, dark tunnel that cancer offers us.

If you’re new here you may not know that I wrote a book about dealing with the fear of recurrence that is a common and perfectly normal consequence of recovering from cancer. I wrote it after a dear friend, who I met because of this blog, suggested it. Ricki was an amazing women who participated in as many experimental medical treatments as possible before her death, “Because I know I’m dying, Meg, but at least I can help other women before I go…”

When she got the news that there was nothing more doctors could do for her I made a trip down to Sydney to visit her. When I arrived, she was sitting up in bed, smiling and joking. I was gobsmacked! I told Ricki that I was all prepared for a weepy session and she said, “What your book taught me, Meg, is that every single day is precious. I’m alive today. I can still cherish my family for today, still be grateful for my life, still recognise how fortunate I have been compared to so many people in the world. You also taught me that I shouldn’t waste and of the precious time I have feeling sorry for my self!”

I wish I could say that the book will have this kind of impact on everyone that reads it (and what an amazing gift to the world that would be!) but I am certain that Ricki was just an exceptionally positive and giving person, and I am grateful for any part my book played in making the end of her life a little easier. Death is hard, even for joyful people and those that love them.

Ricki started following my blog soon after I started writing it, and her thoughtful and encouraging comments kept me writing when I might have given up. In a private exchange I once told her that I was feeling a bit swamped by all of the women that were contacting me to ask about dealing with that slow and creeping fear that the cancer would return. I had what I thought was good advice, but it was becoming increasingly demanding to repeat myself. “You should write a book!” she replied. So I did. Here’s the link:

Free From Fear: Living Well After Cancer

When I was choosing a title, I wondered how people like Ricki would feel. She knew by the time I had finished the book that her cancer was metastatic and considered incurable. “I like it. You’re living well after your cancer diagnosis and I’m living well after my cancer diagnosis. I don’t think you’ve excluded anyone.”

All profits I make from the book go back into charities that fund cancer research or support people with cancer.

The Post Chemo Brain

I’ve had some interesting insights lately into what has happened to my brain since treatment. I was asked by Dan Palmer from ‘Making Permaculture Stronger’ to talk about how I apply permaculture design principles. He’s a joy to speak with, and asks the kinds of questions that stretch my mind. During the interview I talked about soft systems methodology as I understood it and Dan commented that my understanding differed from his. Following the interview I googled it. Sure enough, the articles and diagrams I found to explain soft systems bore no resemblance whatsoever to my understanding of it! What was going on? How could I be so certain about this knowledge and yet so wrong?

I think it’s something to do with chemotherapy. Chemotherapy is like a wildfire that consumes a huge chunk of cognitive ability and what grows after it continues to surprise me. My brain was not commonplace to start with (and I suspect that if I had been born into this generation I may have been diagnosed as mildly autistic) so this new version seems to be some kind of unusual evolution from that.

I feel as if the chemotherapy burnt away all the detail and allowed me to see the underlying structure in things. It also seems to have fused different categories of knowledge together in unusual ways. Following treatment I had difficulty remembering my phone number and I intentionally pursued ways to rebuild my brain. That included rereading and relearning things I had known well before treatment. I enrolled in permaculture courses because I loved the subject and once understood it well, but found that post-treatment I struggled to articulate even the basic principles. Sure enough, the neural pathways started to rebuild, sometimes connecting with a flash of insight.

I pause here to apologise to the very tolerant teachers on the Milkwood permaculture courses that tolerated by often excited interruptions to their excellent training. I must have been one of the most disruptive students ever, and yet you remained empathetic. Thank you. I am deeply grateful.

It seems that like a forest after a fire I am creating something new from the devastation. It’s hard to say. I can’t return to thinking the way I used to think so I have no honest comparison. I do know that as I recovered from treatment I intentionally designed my own pathways back to health. I’m starting to suspect that I modelled the rebuild on permaculture. It seems that I may have bundled some of my previous knowledge together and developed some new and unusual connections. I feel like this evolution of my brain is a new and improved version. I allow for the possibility that my thinking is actually very ordinary, but just novel to me because my cognitive function was so poor for a couple of years. I may just be a three year old discovering the joy of twirling around in circles.

In any case, it’s great fun to think and explore and design and create. I am perhaps the bird that broke its wings only to rediscover the joy of flight. I have a new appreciation that can only come from spending time unable to fly. I dip and swerve and soar for the sheer joy of it, and delight in the company of anyone that wants to play along side me. I feel like an eagle. I may be just a delusional sparrow, but this does not in any way detract from the joy of flight.

PS: Thank you to everyone that has remained interested in this blog and my apologies for not writing more frequently. I’ve been busy. If you enjoy my writing and want to read about something other than cancer I have another site here:
Smarter than crows

I’ll be copying this post to there, but everything else on that site is different to this one. It’s kind of a parking space for my new brain.

My Daughter’s Wedding

It’s taken me just over a month to write this post.

I keep crying.

Happy tears. Sorry to have scared you. I’m fine.

On the 2nd of June 2018 my beautiful daughter married her boyfriend of nine years in a pine forest, in winter, surrounded by friends and family.

I was there.

I spent the year before the wedding teaching myself floristry, partly to save them the cost of flowers but mostly as an act of love. I wanted to do something special for them both on their big day. I’ve always been a gardener. Flowers seemed a good fit. It was a way to squeeze every bit of love into the day. I made bouquets and my husband posed with them so she could get an idea of scale. He became a minor facebook sensation. It was great fun. On the day she had a huge bouquet that was exactly what she wanted, complete with orchids from my garden and silver wattle from her primary school.

I also made 100 metres of environmentally friendly bunting from hessian tape and recycled bed sheets. It only occurred to me after we had made it that they were almost like prayer flags. My daughter and her partner lived with us before they had a place of their own and sheets were a communal thing, so all of us have dreamed and loved and planned our futures on those sheets. There’s a fair chance that a decent forensic lab might even be able to detect the residue of my chemotherapy. I would have woken up between those sheets more than once, certain I would never see my daughter’s wedding. And here were all those nightmares cut into joyful triangles and hung from the ceiling.

It was an emotional day. The groom teared up when the bride appeared at the edge of the forest with both her dads, one by birth and the other by marriage, red eyed and shaking with the emotion of it all. I could hardly see anyone for the tears. My daughter’s childhood friend and head bridesmaid spent most of the service looking at the treetops and trying not to sob. The vows were punctuated with deep breaths and strategic tissues. I’ve never seen so much happiness.

These two have been dating since high school. They’ve never wavered in their love for each other and they’ve weathered the storms that come with enduring my breast cancer and, at one point, receiving the news that it might be necessary for them to bring their wedding forward so that I could at least attend it. Rumours of my death proved to be false 😀

There was a kind of silent agreement that cancer would not be invited to the wedding. My daughter asked me to do a reading during the service rather than make a speech or walk her down the aisle. She told me that it was necessary to find a way to contain the almost overwhelming memory of the possibility that I might not have been there at all. Her father knew not to mention the cancer in his speech, and so did the best man. Then my daughter rose to thank the long list of people that have loved and supported them. There was something about ‘my Mum….who almost wasn’t here….’ and we both lost it. I cried and waved her on and she took a deep breath and change the subject.

It can be awkward when you have two dads, knowing which one you should dance with first. She danced with me instead. The song was something about female power. I don’t remember. I danced and danced. At one point the DJ announced there were only three songs left to play and I realised it was just me and all the young people on the dance floor. I was too happy to sit down.

Tomorrow I have an appointment with my surgeon. It’s my last one. It’s been five years since my diagnosis next Wednesday. I am well.

And deeply, deeply grateful.

 

Why Mammograms?

A post by BreastScreen popped up in my Facebook feed today. For those from overseas, this Australian government initiative provides free mammograms to women, with a focus on those between 50 and 74 years of age.

The age restrictions aren’t arbitrary. They are based on evidence that this is the window where a mammogram is most likely to detect cancer. All Australian women within this group are offered a free test every two years.

Women between 40 and 50 are advised to talk to their doctor about whether or not a mammogram is advisable. They can attend BreastScreen for a free test if there’s a reason to do so, such as a family history of breast cancer, or a medical history that leads a doctor to conclude that a patient is at higher risk. This history might not be related to previous cancer or benign tumours. It could be that someone has ‘lifestyle factors’ like smoking, obesity or excessive alcohol consumption that put them at higher risk.

Mammograms are not routinely offered to women under 40 because the test is likely to be less effective. Breast density declines with age and it can be difficult to detect cancer using a mammogram in younger women. For women 75 and over, routine testing is no longer considered necessary. Generally, if you’re going to get breast cancer you will have developed it before this age. That’s not to say that women in this age bracket shouldn’t continue to practice self-examination and to request a test via their doctor if they suspect anything is wrong. It’s just that the incidence of cancer in this age group doesn’t justify the cost, inconvenience and small risk associated with testing.

Yes. Small risk.

It’s not uncommon to see any post about mammograms followed by at least a few comments recommending against them. The arguments usually state that the radiation is toxic and that testing may actually cause cancer. There are also concerns about ‘false positives’ which result in women receiving unnecessary and potentially life-threatening treatment, ‘false negatives’ where a woman with cancer is told she doesn’t have it, and a reliance upon research that is cited as evidence that free mammograms have no benefit. Here’s a typical article:

Why you shouldn’t have mammograms

This is another example of a very complex issue being dumbed down in pursuit of internet popularity. The truth is a lot more subtle. There’s the usual difficulty with any piece of research related to breast cancer; we’ve seen huge changes in treatment and technology in the last two decades. We now have lower radiation used in diagnostic equipment, better treatment following diagnosis and ongoing research that will continue to impact upon detection and treatment.

One of the greatest discoveries since the introduction of free mammograms and the subsequent analysis of data was that some early cancers seem to heal themselves. This is why the early detection of DCIS (ductal carcinoma in situ) may have previously resulted in treating a condition that would have gone away all on its own. But here’s the catch. Not ALL DCIS goes away on its own! If you were previously diagnosed and treated for DCIS then it could be that any treatment you had was entirely unnecessary. It could also be that this early treatment saved your life and your breast.

Research is now focused on figuring out which types of DCIS are likely to resolve all on their own. It’s hoped that in the future, doctors will be able to determine which cases need treatment and which should be given a bit more time to see if they resolve on their own. In the mean time, I would still be recommending screening on the basis that I’m not prepared to accept a dice roll when it comes to cancer.

Of course I need to declare a bias. BreastScreen detected four tumours in my left breast the very first time I had a free mammogram. This was not DCIS. This was full blown triple negative breast cancer. My tumours were doubling every three weeks and I was fortunate enough to have received my BreastScreen invitation at a Goldilocks moment; my tumours were just large enough to be detected but had not yet metastasised.

You should know that at the time, I was, to all outward appearances, physically fit. I was probably about 15 kilos over my ideal weight, but hardly obese. I was a non-smoker who enjoyed sharing a bottle of wine with my husband over dinner (before I discovered it was a category one carcinogen, just like cigarettes) and I regularly practiced self-examination after every menstrual cycle. I had no palpable lumps in my breasts but the mammogram found four tumours.

To say that this test saved my life is not an exaggeration. Without it, I would have had no indication that anything was wrong until the impact of the cancer spreading throughout my body became apparent. Triple negative is rarer and more aggressive than other types of breast cancer, with a lower survival rate.

You see this is my bottom line about research and data. None of it counts for anything much if yours is the life that’s saved. Here’s a link to one of the pieces of research that’s often cited when demonising breast screening:

Possible net harms of breast cancer screening

It’s always useful to go to the source when the internet scares you. The most significant thing about this research in my opinion is that they do not dispute the fact that mammograms save lives. Their argument is that screening also results in a reduction of quality of life in those women incorrectly diagnosed and treated because of the ‘months of psychological distress’ they experience. They also argue a reduction in quality of life for those whose cancer goes undetected.

I’ll deal with the last group first. If a mammogram did not detect your cancer then it is usually the case that you had no other evidence of cancer. Lumps, swelling, pain or any other abnormality of the breast would warrant further testing, including ultrasound and biopsy. The fact that screening does not have a 100% detection rate needs to be balanced agains the fact that mammograms save lives.

The over treatment of some women is a serious issue and there can be no doubt that waiting several weeks (rarely months) while you worry about a suspicious lump is definitely distressing. There can be no question that the research into reducing this type of event will greatly improve this situation. In the mean time I’d like you to consider things from a personal perspective. These are the possible outcomes from your routine mammogram:

  1. It detects a cancer that you didn’t know you had and this detection saves your life.
  2. It detects a cancer that you didn’t know you had and that cancer ultimately kills you. Treatment may or may not give you a few more precious months or years with those you love. Certainly early detection will improve your chances.
  3. It detects a cancer that you didn’t know you had and you die as a consequence of your treatment (neutropenia, staph infection, heart failure during surgery etc) but left untreated the cancer was killing you in any case.
  4. It detects a cancer or a pre-cancerous condition that you didn’t know you had that would have resolved itself without medical intervention and this results in you being anxious. It may also result in you having a lumpectomy that reveals a benign lump. This will be frightening but will ultimately reassure you that you don’t have cancer (and probably also inspires you to reassess your life and the choices you make).
  5. No cancer is detected, even though you have cancer. In time your cancer will either resolve itself or become apparent. If you have any symptoms you should request other forms of testing and not rely upon a negative mammogram.
  6. No cancer is detected because you do not have cancer.

Here’s the thing. There is absolutely no way of knowing which of these categories you fall into without actually having the mammogram. Take a good look at point number one again and ask yourself, “Am I prepared to take that risk?”

Before you roll that particular dice it would be a good idea to know your odds. I mean, if the risk of getting breast cancer was one in a million you’d be justified in wondering if the discomfort and low radiation dose associated with a mammogram was worth it. But if you’re an Australian woman your odds of developing breast cancer are one in eight.

One in eight.

The risk is similar throughout the developed world. Here’s a link with the current statistics:

Breast cancer statistics

Add to that the clear evidence that early detection improves survival, and helps to minimise the risks and side effects associated with treatment.

Thanks to early detection I had no spread of cancer to my lymph nodes. Once triple negative escapes to the lymphatic system it spreads, typically to bone, lungs or brain. Give me early detection.

Early detection might also mean that you can have a lump excised and keep your breast, rather than having the breast removed. It could mean that you avoid the risks, discomfort and possible side effects of chemotherapy or radiation. It could mean faster and fuller recovery from cancer.

So the next time someone tries to tell you that a mammogram will kill you, you might like to respond with this:

How do you know that?

It’s my favourite question for people quoting an internet article. In fact the research clearly shows that mammograms save lives. You might also like to send them this excellent article about the mammogram controversy:

Mammograms save lives

I know. It would be easier to just smile and nod and walk away, but these people are dangerous. I have met women that refuse to have free testing because of the scare campaigns. I just hope they aren’t one of the one in eight that will develop breast cancer, because, by the time they do it might be too late to save them.

For Terry

Regular readers will remember that I recently lost my dear friend, Ricki, and wrote about it on this site. I was shocked and honoured when her priest and family referenced my words at her funeral. It was a sad day, but a wonderful celebration of a life well lived. Her husband, Terry, is still struggling without her and after yesterday’s post he wrote to tell me he’s been having a tough time recently. I was going to respond directly but it ended up being a long piece about grief that I thought might be helpful for others going through the same thing. So I’m posting it here:

Dear Terry,
I’d say you were about due for a rough week. I remember once reading a book about grief that described it as a series of stages. Having been through it, I’d say it’s a lot more like a swamp. Sure, there’s denial and anger and bargaining and sorrow and acceptance but they don’t unpack into a row of neat little boxes. Instead we lurch from one relatively stable island to the next, sometimes falling back into the swamp and spending the day waist deep in mud, or feeling like we’re going to drown in it. This is normal.

Moving into sadness might feel like the hardest thing you will ever do but my experience is that tears are the river through the swamp and acknowledging your sadness is the fastest way through it. I know that grief can feel like it is all consuming but somehow we survive it. Even on those days when the swamp pulls us under, we somehow drag ourselves out and keep going. This is a heroes journey and you are up for it.

Opening up to the grief and getting in touch with the present feels like the exact opposite of what most of us want to do. It’s why people use distraction, or avoidance, or numbing themselves with alcohol or drugs. All of these are akin to sitting on an island in the middle of the swamp and refusing to move. There might be times when this is part of your recovery but as a long term strategy it’s self defeating.

Writing about how you are feeling will help. It’s a way of letting your mind know that you are acknowledging all of the emotions that are bubbling up for you. I’d suggest starting a journal and just spending a bit of time each night recording how you felt that day, without judgement. It might not feel like it now, but at some point you will notice that you had a whole day on dry land. Between then and now you will have days of misery. It is what it is. This too shall pass.

The exercises in my book will help you, but think of them as a kind of walking stick to assist you across the swamp rather than a way to airlift out. There are many paths through the swamp and some are more difficult than others, but sooner or later you must cross it. Knowing that there is definitely dry land ahead of you somewhere will help. The swamp is not endless. Just horribly difficult. Get in touch with your own values and what really matters to you. Who do you want to be in this situation? What do you want to stand for?

It’s a cruel time to be made redundant. As if you didn’t have enough to grieve. I can understand why you’re not excited about buying a new car. In the current circumstances it will feel like a chore to even pick it up. This is normal.

When you feel ready, it’s a good idea to find a few group activities that you enjoy. I know the company of strangers possibly feels like the last thing you want right now but that will change. Company is the best antidote to loneliness and all of us need connection to others. Baby steps. Some people find joining a group that specifically deals with grief is helpful and others find it too overwhelming.

Know that your home will transition over time. Right now it is a reminder of Ricki’s absence and a source of pain but as you progress through your grief it will start to become a reminder of all the great times you shared. It’s common to advise people not to sell their home before at least one year has passed. I agree.

I also think getting a referral to a good psychologist is always worth doing when a major life crisis hits. Just having someone to talk to about what you are going through is hugely beneficial. Your GP can refer you for up to 10 visits on Medicare and ten more after that if you still need them (and you will probably still need them).

As a man of faith you may also find support through your church. I know other Christians often say it was their faith that got them through times like this. I do not believe in any god, but I believe in the power of faith and the significant part it plays in the lives of those that have it.

I think when you are feeling most lonely it can help to connect to the common experience of fellow human beings. Everyone alive has either lost a person they loved, or they will at some point in the future. You are surrounded by people that have already been through the swamp and others that are yet to get their feet wet, but who will benefit from your experience. We all die.

You are already a living example of how one human can greatly love another and this has been a significant influence on so many people, including your children. Now you are becoming a living example of how someone survives such a great loss. This is no small thing. If we cannot see examples of how to recover from losing our beloved then why would we ever risk ourselves to that kind of love? If the pain was too much to bear then surely we would hold ourselves apart from love.

I know that you will show all of us that even though the grief is sometimes overwhelming, love makes all grief worth it. The only way to avoid grief is to avoid love, and who would not want the kind of marriage that you and Ricki enjoyed.

My best wishes on your journey across the swamp and know that I am here, out on the edge, to shout out encouragement when the going gets tough. I wish I could wade into the swamp and pull you out but unfortunately grief doesn’t work that way. Each of us must find our own way.

You’ve got this.

Love

Meg
XXX