Op. Day – 3. Mammary Mia

The knock of the knot –  Breast Cancer with Lacanian Angles

Facing Magazine 2010 Again

Transported back to wait for the next step I soaked up my wholeness. More than me, I had additions. Semi-cyborg! A Seven of Nine with all her thoracic metal implants! I tucked the blankets around my knees again. Those old glossy magazines smiling, grinning knowingly at my side. A wide berth. Who would touch them? And who do I tell that their existence was rather abhorrent. The bustle of medical staff in and around the corridors. If those magazines could tell their tale. How many patients in the last five years? How much weight of patience and emotional if not physical pain was held in this corridor, contained here and seen awry by the existence of such old magazines. They’d survived the duration, not even dogeared. Or perhaps some kindly soul had just recently left these magazines as a good will gesture. But five years since they’d been published. How many millions of births and indeed deaths since then. How many graduations, retirements, parties, partings? How many therapeutic hands had grappled with a condemned cancerous breast. How many daily squirts of antibacterial gel? How many others have recoiled at the magazines from 2010?

Mama Mia – Mammary mia!

Almost immediately a new team member in yet another white coat led me into a small room with a lethal radioactive sign looming on its door. Mammogram time! This time to record the position of the wire which acts as the tumor marker. The wire localization is for the surgeon to use the wire as a guide to locate and remove the tumor. During surgery the wire will also be removed. Stripped above the waist the vertical contortion began. Thank goodness for the desensitized breast asleep with its heavy dose of local anaesthetic. Oblivious to the wire inside as I moved it around. The struggle that women of a certain cup size know only too well. A mammogram dance of breast, shoulders, chin, arms and moving the other breast away to stop its natural tendency to sit squarely adjacent to its injured twin like a sympathetic watchman. Oh yes you younger readers what joys arrive with middle age protocols. Scorned for moving my hand the radiologist bid me to stay still. Yet she was clearly relieved to see me remove the unwanted alright breast (the wrong breast not the wronged breast) from the picture-frame to come. The radiographer slipped behind her screen. She was the observer, no hands-on for her. Watch the birdie, say cheese.

scan wire
Wire Insertion – Tumor Marker

A click click accompanied by a gasp of failure, irritation towards a failed irradiation. Of course the wire was so high up under the arm, it was out of shot. A new photo-session commenced. This time at a more appropriate sideways angle. Like a David Bailey model standing square, half naked in a surgical gown posing to the commands: chin high, shoulder back, stomach tensed, jaw relaxed. A tight vice like squeeze. Who knows what was happening inside, but the local anaesthetic was so recently administered that pain was not part of the experience. Permitted to sneak a peek I saw the three images. Two of which had captured the wire insertion.

Outside in the corridor the pile of magazines lay untouched. Possibly untouched over the course of five years. Me done and dusted I waited in the wings for Michael, my guardian. It was a cool forty minute wait. I eyed the smiling magazines, they smiled in return as I nestled into the blankets. Composed and trustful, awaiting the next step and the procedure that lay ahead, back there on the surgical ward.

Speed and dope

Busy Michael returned as my loyal escort at almost ten o’clock. No longer hugging my several accumulated blankets quite so tightly I was returned to the ward and my bed by the window in the female bay. I wanted to text home, to report the success of the wire-insertion. Amazed that the procedure was over. It was a bright October morning. Sunlight poured through the window. Seconds after sitting down there was no time to contemplate because my blood pressure needed to be taken. Next the cannula team approached. As I suspected my veins had retracted under my skin. Typically not to be found in my arms, never in my arms, not by hook nor crook nor to my surprise in my hands. Before I could react, the largest most muscular team-member swooped over my shoulder (across the side I’d been protecting) and grabbed my forearm. With both hands bearing down upon the thin flesh protecting my radius and ulna he explained that if he squeezed (which he did with much skill) the veins would most certainly pop up and indeed they did. With no more ado the needle was inside the vein and the cannula was expertly fixed to the back of my hand. Someone approached with a label for my rucksack and in the next moment I’d been received by the anaesthetist. Moments later there was a short walk to the surgical room. Yes there would be time for a final trip to the toilet, how relieving, I’d drunk so much water, in preparation, the midnight before. I found myself led into the adjacent room perched and on the medical bed slipping my arms out of the gown as instructed. There was still time. Time to be introduced to members of the team. I was in the ante-room and the anaesthetic was being attached. I was introduced to students, did I mind, no, how could I? When would the blue-dye be administered? Just before surgery, not to worry.

Sentinel Lymph Node Biopsy (SLNB)

A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed and examined to determine whether cancer cells are present. Early yesterday morning the injection of radioactive liquid, or tracer, was administered. Once under anaesthetic the blue-dye is immediately injected into the breast and it adheres to the radioactive tracer to easily locate the sentinel lymph node. A sentinel lymph node is the first lymph node to which cancer cells are most likely to spread from the primary tumor.

sentinel node biopsy.pngThe surgical team watch as the dye collects in the first lymph nodes. This process of lymph node mapping assists swift and accurate identification of the cells. The surgeon removes about 1 to 3 of these nodes and sends them to be analysed to see if they contain cancer cells. A negative SLNB result will suggest that the cancer has not spread to the nearby lymph nodes or on to other organs. A positive SLNB result indicates the contrary, that cancer is present in the sentinel lymph nodes and may also have spread to regional lymph nodes and possibly other organs. With this information the laboratory report will help the surgical team determine the stage of the cancer and the extent of disease within the body in order to develop an appropriate treatment plan.

 

Back in the room, my underwear was riding up. Could I wriggle it downward. I fidgeted, would it make any difference at all? Would that be the first thing I fixed when I awoke? It was busy in the room ahead, one wheeled out and me wheeled in. Doped, I shifted my head back. It was exactly half past ten.

 

Op. Day – 2. The Wire, Why Her?

The knock of the knot –  Breast Cancer with Lacanian Angles

Queueing behind the curtain

Soon after our arrival the first batch of patient patients were called by name. Addressed by a woman in crocs hugging a clipboard and chewing a pen. Each already signed off to their fate. Permission slips of all possible legal outcomes acknowledged in ink. I agree to… How they moved: toddling off, a macabre scene in its sombre innocence, as they were led away behind their clinical tour guide. The morning sunlight edged forward casting tubules of fairy dust, as a caretaker rhythmically mopped. Then nothing: an ellipses, ripples on still water. Time in its own dimension of now and then. An anticipation of next and another beat of the heart. Ten minutes later “our” subset were called. A mirror image where they’d gone right, we were led left. Equally obedient, six men and six women. As a member of the latter set once inside we were separated again. Our bay was female. The ladies placed their bags upon their beds. Oh cosy inmates. Each bed, made into a cubicle by a thin curtain tracked by ceiling rails. I was empty handed.

http://www.epsomandewellhistoryexplorer.org.uk/images/WestPark19Jun1991ByJRRifkin-2.jpg
“Alice:How long is forever? White Rabbit:Sometimes, just one second.” ― Lewis Carroll, Alice in Wonderland

Confidently or cluelessly or trustingly, I’d left my “just in case” rucksack in the waiting room with my dedicated personal waiter. Yes I’m very fortunate to have my significant other there awaiting – but the choices leading to what made us “us” are another rambling story of on-line intrigue, anonymity and perseverance. Did he feel the weight of the bag or the weight of the wait? The white coats granted me permission to return – to retrace those steps through heavy security doors. Several long prismatic corridors, sometimes with glaring blinking windows, other times gloomy claustrophobic burrows. Hey I’m back, I escaped the group. My nose twitched: clinical smells. The abandonned mop waited. The rucksack which included the cell phone was held aloft. A final “final kiss” and this Alice chose to start again. Or was I the rabbit? Or was there really any choice at all? Enjoy your jouissance!

Meeting Michael my Chaperone

The curtained bay was cold. A draught from the adjacent window. I watched as my legs took refuge under the blanket provided. Automaton. Self preservation. A nurse came by to take blood pressure and I asked if I was going to have the blue-dye injection or the wire insertion. Blinking I knew the protocol by heart, in theory at least. Ah yes she said, yes, Michael will be here shortly to escort you. I had time to locate the loo and then meet my anaesthetist (another tall white coat) and then Michael arrived, flying in from a previous quest. I imagined him as an invincible Icarus sweeping down valiantly as the plot twists in a medical dystopian version of Brazil.

magazines.png
Magazines Out of Time

In a jot we’d left River View and had entered the specialised breast clinic zone. Michael said to wait. He’d be back. So here I waited. Waiting again but that was fine. It was part of the conveyer-belt process: not too fast. I did what I was told. No need to think. At 8:40 I was spotted and given another blanket. As I sat I fed it between my knees. Me myself and I. I studied the corridor. There on the side table lay magazines. I never had been a fan of those glossies out-of-place in a clinical world. So much for anti-bacterial gel when some of those magazines obscenely revealed their date of issue as being five years previously. Five years. The golden aspiration of those who hope to be survivors or in remission after this bleak diagnosis. Those magazines ensconced in their own timeless gasp of horror.

Rabbit in the wire

Led to the ultrasound and wire insertion room. Upon the surgical couch they discussed how I should lay. The cancer being situated high up, situated in an almost under arm area of breast tissue. This meant that lying flat was not possible. How can they view the eleven o’clock flesh? Those of you who understand or have observed the behaviour of the larger breast will know that once prone they don’t sit pert and neat, aloft on the chest. They relax out and downwards sinking with gravity into the arm pit. They sank and took eleven o’clock along with them, daliesque. As my accused breast sank, so the clinician realised a sideways stance would be the only way. Wriggled into a “recovery” type position my face was still able to glance behind. The ultrasound screen was in view. I wasn’t going to turn into a pillar of salt…frozen in time, that would be too easy an end. This adventure required a willing participation in the suffering ahead. But at least I had a front row seat to view the performance. Let’s repeat: Enjoy your jouissance!

http://www.thebushcraftstore.co.uk/ekmps/shops/bduimportsltd/images/6-ply-rabbit-snares-various-set-ups-and-combinations-%5B2%5D-3130-p.jpg
Wire Wound

With plenty of reassurance the area was numbed. A local anaesthetic needle glinted and was applied around the areola. Fortunately I’d been quick to ask exactly where that “sharp” was going in. This was déjà vue, I was here only yesterday and I’d read the blogs. I knew the lesson and this lessened the shock. Sharp scratch and it stung like a bee. For those who need details of the level of pain: the depth reached by the needle filled anaesthetic was barely felt, before even more anaesthetic was introduced. The area was numbed, comfortably numb and then came the posturing for the wire. Compliant I was shifted leg and buttock. Next the re-posturing of the breast. The professional with her hands-on-job to move mountains. Like Muhammed if that mountain didn’t come to her she would grasp “it” with more vigor. The guilty “it” that numb part of myself that had betrayed me and led me to here. That apologetic breast which so carelessly, innocently, flaunted cleavage on the beach less than only a month ago. Placing the wire in the flesh of course required some manhandling of the floppity yet fibrous tissues. Manhandle is that an outdated term? Handled like a man, by a woman? Floppity and yet not so floppity. This is dense tissue we’re dealing with here. A lollipop figure. This is tissue with a mind of its own. Tissue that fills tensely according to the hormonal tides. The hands on approach with a push-pull pressure increased to extract the needle after the wire was in place. The experts apologised for their exertion. Almost straddling my body and heave-ho! My, my that was a struggle to retrieve. In my googling I’d already read about this possibility. The shared experience put me at ease. It was a physical effort to achieve and retract but now with the wire in place the needle was out. Pretty painless. The ends of the wire were flattened and taped across my skin. A brooch but not one of valor. I was the receptacle. I contained the treasure, I was the x that marks the spot. I was the prize ready for the next monochrome photo shoot. I didn’t pay much attention to the what, nor the why. No bravery just obedience.

Enjoy your jouissance!

 

Op. Day – 1. The Curtain Call

The knock of the knot –  Breast Cancer with Lacanian Angles

No Universal Reality

We arrived on the day of surgery, October 8th at 7:30, pretty much on the dot. Dot dot dash dash, yes it seemed a bit of a dash but no elaborate preparations were made. The appointment was for a “speedy” out-patients operation so no toothbrush, only my cell phone and a choice of after-op boneless non-scaffolded underwears. Despite doubting their efficacy they were purchased precisely for their purpose and weren’t that easy to hunt down. Bravisimo was the chosen retailer for obvious reasons. Although there is still little out there informing about fit and comfort for pre-op purchasing. In September Stella McCartney, whose mother passed away from breast cancer in 1998, launched her “Louise Listening Bra” sizes S/M.

http://www.stellamccartney.com/gb/stella-mccartney/bra_cod48167088bw.html
Louise Listening Bra by Stella McCartney

 Quite a snazzy front zip fastening mastectomy compression bra, the proceeds from which will help benefit the Hello Beautiful Foundation. After much deliberation I chose a 32G maternity model the Royce Ava Bra (1154) that promised to accommodate my post lumpectomy breast. Without underwires it had a release catch (for breast feeding) but this seemed appropriate to relieve possible pain from pressure along the top of the chest and to give space for the surgical

maternity bra
Royce Ava Bra

gauze. The second design I preferred had a padded shell design. The cup was scaffolded to enable the breast to nestle in supported elevation and the side wires were set back more laterally against the ribs. Both of these bras needed customising with a scissor snip to cut away material under the arm. This was to avoid any clash and rub of stitching both animal, mine post surgery and mineral, the hemmed elasticated zigger zagger fabric in the underarm design.

Only a week ago I’d optimistically booked a batch of five yoga classes. Shockingly I managed just three on my “old-self” schedule: Wednesday and Saturday were part of my old-normality but the night before my hospitalisation the call to yoga was just irrelevant. So, essentially the guru yoga instructor is still in the dark as to the gravity of my seemingly casual absenteeism. This “mind before body” pre-op karmic choice, brings me one session closer to losing my toned arms and fitness. So instead of the chaturanga and chanting, the evening before the morning after involved a nice supper, easy chillax and a good grateful sleep. A clinging to just being. I’ve always, since birth, slept on my front so this too was a last chance to retire freely bellydown. A last sleep without pain. The last chance to be me before an unknown “x” that marks the spot. Nope, not even a pre-hospital hair appt. Neither preparation of an over night bag. All optimistic details, swamped out by just sucking in the last hours of normality, my normality…because is there ever a universal reality?

Zero Hour Arrives

The morning arrives and the taxi has little traffic to navigate. It all seems so ridiculously early. Up and active far earlier than a work day. Our timing was impeccable and we sat. Sitting in public. Sitting in the waiting room. Waiting to begin. Waiting as a pause. But isn’t sitting usually about waiting? Sitting involves anticipating, feeling the time, being “immersed in” the moment, whether it be travelling from here to there, driving or being driven, or taking in the time: sitting to relax, sitting back embraced by the hands of time, engulfed in the lap of time, gazing into the watch-face. Using the minutes to breathe, to be, to pause. Sitting as one waits: to eat, digest, or to hear the other person who sits and shares that time with you. (If you are, of course,  fortunate to have comfortable company). A companion to weigh the time with. Oh heavy hour. Be light with me.

Sitting, waiting: it’s actually unlike me not to make eye contact with others, but looking here into the eyes of those who reflected the same situation as me, looking at them seemed so inappropriate. An intimacy shared in a moment seared and pierced by the obscene audacity of gaze, of daring to look them in the eye. Risking seeing myself, my fears, my doubts, mirrored back. Stepping in, making that advance, that cut in their reality, invading the moment of the other. I didn’t look. The power of the “gaze” and the gaze-returned. The gaze of the other freezing us in time. Seeing myself perhaps as another rabbit willingly waiting to see where this road will lead. Not yet trapped in a path of no return but given hope to cross and continue. Let’s face those lights, it’s not bravery, but a combination of ignorance and trust. A faith in science. A belief in statistics. Each person waiting was mentally and emotionally preparing for a scalpel that could prove to save their life. In the headlights, the footlights, the theatrical light, waiting for the curtain to move and for their newly assigned role to begin.

 

The smile without the cat: Pre-Op Grins

The knock of the knot –  A Breast Cancer Blog with Lacanian Angles Curves

Needlework and Syringes

Keeping my routines as normal as possible helped me prepare mentally and physically for the lumpectomy, which some sources call a partial mastectomy, excisional biopsy or breast-conserving surgery BCS. Clinicians regard BCS as the gold standard for early stage breast cancer treatment. Surgeons skilfully accomplish “acceptable” cosmetic outcomes by removing just enough breast tissue to achieve adequate surgical margins. My life was as busy as normal. This fake normality was fuelled by a creeping inner denial. At work I kept schtum maintaining a professional secrecy – apart from my over arching boss, work colleagues were in the dark. The only giveaway sign was my attitude, more positive, stiffly smiley, unusually chipper. I was the smile without the cat.

Three days before surgery an NHS letter arrived advising me as a woman of a certain age to come for a routine mammogram for early cancer detection. Eye roll. Despite our state of the art technology this monumental failure of “joined up working” perpetually creates these painfully ironic events. Action-reaction: I gave them a call to cancel and mentioned that for their records my breast was already being treated for cancer. The following day I received a phone call asking if I was still up for the op. That took me by surprise, I was astounded to discover that clearly there must be women who do a runner, change their minds or simply say no thanks to surgery.

At 8:30am the day before my surgery I was summoned to the hospital’s Nuclear Medicine Department to have the necessary radioactive injection. injecting the radioisotopePreparing myself for the same intravenous syringes (in the arm or hand) problematic hidden veins were not permissible. I drank a ton of water and tried to keep my veins visible by arriving briskly on foot, wearing gloves and keeping warm with lots of hand/finger agility moves. The big surprise was discovering that the needle enters around the areola. Ouch!

With my arms bent obediently behind my head, the needle injecting the radioisotope was expertly entered several times. The nurse warned me that it would hurt. Its path was numbed by doses of lidocaine, a local anaesthetic. The eye on the needle steady as if measuring across the face of a clock. The expression “sharp scratch” was replaced by a trill anecdotal comment about how patients acquaint this pain to a “bee sting” – a formulaic “sound-bite” indeed, but painwise none of this needlework caused undue discomfort.

pain embroidery
The Fabric of Pain

Imagining the pain and playing through worst case scenarios were par for the course but in-the-act going with the flow wasn’t too horrendous. It felt barbaric yes, the nurses injecting around such an intimate part in full light of day and then massaging down to ensure the radioactive liquid was absorbed. It felt bizarre and a tad torturous. But the huge bruises (on the back of my hand) from the cannulas, (needed for the breast MRi and bone scan) were more sore and a greater nuisance to every day life. Nerve healing zings of pain, a week after the three core needle biopsies from the breast, took the biscuit. These sudden unannounced debilitating zings of excruciating but momentary agony went on 24-7 for several weeks. But perhaps this is individual. Instead of pain, the greater trauma was from not knowing the details of procedures. This made me feel cumbersome and  “done to” a vulnerability shrouded by my own ignorance and heightened feelings of useless ineptitude.

As part of the lumpectomy procedure the surgical oncologist had explained that the radioisotope and blue dye injections were essential to locating the exact nodes for SNB (sentinel node biopsy). The injected nuclear fluid tracks around the lymph nodes which light up once the blue dye is absorbed. For a lumpectomy to be successful the clinical team must ensure that no tumour cells have infiltrated the lymphatic system. This is now the clinical standard of care replacing the more complex full axillary node dissection which more frequently exacerbated fluid build up and swelling in the arm called lymphodema. This condition is still a classed as a possible side effect. A set of simple thrice daily exercises are recommended to reduce the chances of accumulated fluids. http://www.lymphedivas.com/  is a phenomenal outlet for fashion compression sleeves. Their blog is informative too.

https://www.lymphedivas.com/en/shop/mariposa-pink
Mariposa Pink

The detection and treatment of breast cancer is like a biological game of hide-and-seek. Deciding if cancer is present, how widely it has spread and how to remove it are all part of the algorithm. I could not feel my cancer, it was non-palpable. What I did feel was a normal cyst. The cancer did not show up on the mammogram. I have learned that mammograms have limitations. At present they provide two-dimensional images of the three-dimensional breast. Glandular tissue and tumours are similar in density and remain occult especially in women with dense breast tissue.

cell types
Cancer Cells

My cancer barely showed on the ultrasound as an area suspicious for malignancy tucked alongside the cyst. DCIS means the cancer is still contained within the ducts. The biopsy gave confirmation that my cancer has a name, it’s called IDC and tomorrow we’ll find out if it has spread to the lymph. Above is a diagram of the types of cells, assisting to verify the stage of cancer. I would love to see what these cells are really like. Daring to ask the surgeon to keep it for me, he asked if I’d like it in a jar. In earnest I nodded. He thought I was joking.

Mind the Gap between Diagnostics and Surgery

The knock of the knot – A Breast Cancer Blog with Lacanian Angles Curves

 Cancer Tests…Patience! Warrior or Worrier?

Who knows the depths of this rabbit hole? When will the falling stop? We came away with the diagnosis of IDC Invasive Ductal Carcinoma. “Cancer Patient” what an earth does one do with that title? What a hot potato! The recent history of vitamin D deficiencies and femur pain alerted the specialists to arrange a full body CT scan and MRi, the results of which would be known before surgery. In the meantime celebrations were in order for remaining whole. It seemed appropriate to run the first of the month 10K. Who knew how the surgery and treatment would alter my running ability. My breasts, my lungs, my thorax and my general ability to be me.

run girl 3b run girl run britania yoga

The run was steady and just over the hour. My PB stands at 54 minutes but that was several years ago and before the Half Marathon Training. My times had become slower after learning to run over longer distances. My Barcelona Half Marathon Time (la Mitja Marató) was two hours and seven minutes. Considering all that had happened throughout August I was not going to beat myself up with some ‘self-flagellation’ for taking a few extra minutes on such an amazingly sunny day. Running in London in a crop top at 48, who wouldn’t scream “Carpe Diem” and take a few snaps. What’s wrong with being a self voyeuring narcissist! In fact why hadn’t pictures been taken more frequently! Notice the word “pictures” not “selfies”. Perhaps because a body is taken for granted on the day-to-day and no-one expects alterations to come out of the blue.Who ever expects a personal Frankenstein to step into their lives? In fact who wonders if they will become the next wretched monster. With the zing of post- biopsy nerve pain easing, to run was bliss.

http://www.shockabsorber.co.uk/bounce-o-meter/

My preferred sports’ bras are both Royce and Shock Absorber. I combine but tend always to wear two bras if I want to go under the radar. The visible jiggle, joggle, jug-gle is both discomforting for me and distracting for onlookers. Not to mention damaging for the jugs in the frame! Mine are still pretty pert – two sports bras, see! We don’t wish for casualties!

http://www.napkindad.com/blog/2015/05/06/the-ill-fitted-sports-bra-cartoons-and-controversy/
2 reasons for 2

The knock had come as a warning to wise up, chivvy and prepare for an impending change. Atishoo, atisshoo, pass me a tissue as self indulgent tears are welling, not of pain but of fear and impotence. Dates are marked on the calendar as time slows whilst smiling like a super-trouper to keep up the formal normalcy of each working week.http://www.drugs.com/mcp/breast-biopsy#Image_What_you_can_expect  September 7th and it’s time for the bone scan. Why oh why do my veins vanish when shiny needles appear. Of course it was impossible to put the cannula in the crook of my arm. Deep veins, narrow veins, delicate veins, I’ve heard it all. So the tube was plugged into one of the bulbous veins in the transparent skin upon the back of my bony hand. Ouchy. Stripped into the hospital robe I lay upon the machine as the nurses fled for cover in their little bunker. Once switched on, a burning hot sensation seeped into my hand as the radioactive liquid rushed into my body. It was burny. I called out in case that was unusual. My voice was swallowed by emptiness as no-one replied. Silently, eyes closed the machine whirred. It’s drone-like shadow inches from my face. It’s metallic greyness leaving a cybernetic taste upon my lips. In a different life those mineral atoms and molecules may have become a mountain bike or a child’s scooter and these living cells of mine may have had a reprise: no hawk-eyed nurse, with hours of CPD training would have noticed tell tale signs of cells showing suspicion of malignancy. Who is this person being scanned for cancer?

Some days after the whole body bone scan came the breast MRi. Wearing two medical gowns the specialist eyed my veins which once again hid away, having to be coaxed into action from the dark bruises on the back of my hand. A cannula was attached and a cold dye injected in order to achieve clear images once the machine was activated. Despite waiting some time before my turn came, no-one had explained the postures required. A slight confusion and sense of humiliation and impotence flooded over me as I was asked to mount the machine on all fours. I felt incompetent like a child and emotion chugged hot behind my eyes. Clambering upon my hands and knees I lurched my stomach forward lizard-like, before lowering these pendulous dugs into the hollow depressions within the scanner. How ungraceful. The clinician adjusted my chin on a padded rest and fiddled with the side openings where my body dangled. If only I had seen a photo of the machine and ungraceful posturing then maybe the sting of salt would have been prevented. It was tolerable and over in a flash but those moments of confusion had left a heave of sadness and desolation. On September 11th the results came through to confirm that things were as before, no worse, no better, although the lumpectomy and sentinel node biopsy would bring the final judgement by determining if the lymph nodes were clear. All that was left was to wait for the date of surgery. Breathing into these events my hope was to maintain a modicum of normality.

 

 

 

 

 

Tick Tock – Run Rabbit Run!

The knock of the knot –  A Breast Cancer Blog with Lacanian Angles Curves

There is no “if”

The recommended hospital check up on August 17th became a dizzy drama which had ended in the collection of three biopsy samples tagged with the verbal verdict “suspicious of malignancy”. We now fast forward a week to August 24th for the consultant’s truths and the clinical evaluations of the extracted tissue. Cancer is bad enough. But breast cancer is not just a question of removing the invasive tissue, the damage is more often than not on display for all to witness. Sweaters or shirts, yoga or work, small is beautiful, big is better, size doesn’t matter, asymmetry is the new me. Aesthetics are examined because the gaze is where it’s at and choices are weighed according to appearance. Seen, gazed upon, evaluated by well qualified clinicians and ones own inner critic. Yet only the survivor will know how or what they feel. Once the “C” word has been uttered the die is cast – the journey has begun.  And how different it is to be the follower of the path rather than the one who watches the follower trip-trap, trembling into the face of the unknown.

http://www.keepcalm-o-matic.co.uk/p/keep-calm-and-run-rabbit-run-2/
Run Rabbit Run!

The speed of events leading to that place called “diagnosis” leaves a cut that strikes to the quick. The cancer journey traverses the path of the Lacanian Borromean Knot at a surreal pace. The criss-crossing shifts between the raw horror of the Real Order to the incomprehensible medical spiel in the Symbolic Order. Here one hears a series of numbers and ciphers that announce the severity and spread of the tumours. All of it takes a while to sink in. How does a mere mortal with no medical knowledge interpret, contemplate, face or side step these truths? How if not with flights of fancy, fear and fortitude? The Imaginary Order assists to re-play all possibilities no matter how far fetched.

For one who enjoys contemplating all case scenarios in order not to get nasty surprises a mastectomy or even wide spread malignancy were in that worst category. How does one deal with the receipt of such news? In the past week my knowledge and reading about breast cancer had increased exponentially. I had over forty windows open on my cell phone. The most difficult to assimilate was recent publicity regarding over-diagnosis. Particularly I was concerned about an apparently benign type of cell disorder namely DCIS, ductal carcinoma in-situ. Yet this bugger of a stage zero cancer pointed to all sorts of possible future complications and is often treated with double mastectomy. Okay if a huge tumour were present then a mastectomy had to be the course of action but if they’d discovered one of these supposedly benign dubiousities what would be the decision then? Throughout the week my imaginings ran riot and my non-medical brain clung to “watchful waiting” an expression that seemed to do very nicely. My semi-subconscious had affirmed that if it were all neat and small then it would be permissible to “just wait and see”. Maybe the bad cells would slip away unobserved if they weren’t given the centre stage. Mastectomy however was on another astral plane. Of course anyone in this situation goes through the list of “what ifs” and it is necessary to do so. It is necessary to prepare oneself for the decision making to come; to arm oneself with the knowledge and try to find the strength to take the next step. It is natural to consult and scan the evidence from: medical trials, hospital case studies and those who’ve had first hand experiences in blogs and forums.

If a mastectomy were needed then so be it. There is no choice remaining if that is the considered treatment. So easy to say and so quickly contemplated in that safe imaginary space. But then what? Then comes chemotherapy, being irradiated and the immediate discussions about remaining flat or facing reconstruction. Now that is a biggie because often it is the patient’s choice. Never have been good with choice – how can anyone know what is for the best? As a big breasted gal having part of my body replaced with a prosthesis goes against the grain. I like my breasts. I’m slim, I maintain that lollipop shape and I like my breasts. But maybe that is the reaction of many. Would choosing flat be closer to remaining me? Remaining authentic?  Would a unilateral operation then soon imply the need for a double mastectomy just for gravitational balance? What would the physical complications be if the healthy side remained a 30GG? Becoming so lopsided is probably asking for future structural and musculoskeletal complications! A one breasted quasimodo!

alice 2In the consultant’s room I had the letter in hand, the classification was U4. Falling into the biopsy procedure seemed almost an accident yet a lump had been noticed. It wasn’t just routine. I myself had flagged up the possibility that maybe there was an irregularity, an irregularity that was part of my body topography and that had been noticeable as a visible palpable knot for months. I heard myself explaining this as the consultant sat squeezed in front of us in quite a tiny room. About to embark on my “leave well alone” strategy I began to speak, “If it is a cancer….” Before I could say more the consultant had doubled in size. He rose up in his seat and rapidly stiffened, bracing himself to reply. His response to my bargaining plea almost knocked me into the back wall. In retrospect I don’t think he spoke loudly but his tone and gust of breath gave no room for nonsense. “IF…if… there is NO place here for if. It is cancer!”

That piece of straight talking brought us all into the here and now. No menacing real, no vague cloud of symbolism and no room for imaginative reprise. Yet all the Borromean elements were present. The real like a spectre in the corner. The symbolic of voice, body language, gaze and scientific convention opened a chasm between us. The rabbit hole was widening as I was falling further and further away from what I new as tierra firme.

U = ultrasoundThey’d not discovered a benign lesion. It was a baddie. It was not DCIS or a cyst or fibrous tissue. It was IDC. Invasive Ductal Carcinoma that the biopsy had siphoned out. Leaving rogue cells (that had already broken out of their region) to possibly spread further around the body was out of the question. There were no ifs nor buts, it had to be excised: scalpel brandished and incisions made. The consultant wasn’t part of the team I had seen on the day my world was turned on its head. He gave little room for chat. He was very matter of fact and an operation was going to be planned. The lump was to be removed, clear margins sought and the sentinel lymph nodes biopsied. Only after the surgery would the specialists really know what they were dealing with. What imposter was I harbouring? BUPA was mentioned. Could BUPA be a saving grace? Everything was already moving way to fast and the surgeon most likely would be the same guy whether I were to choose private or not. Why fast track to BUPA?  I’ll stick with the NHS. The word “lucky” began to infiltrate into conversations. Lucky to be in a part of the planet with a pretty amazing healthy care system. Lucky that the malignancy had been found early.  Lucky to live not so far from the hospital. Lucky not to have to consider those worst case scenarios. Lucky to be relatively young, very fit and healthy. Healthy! Yes healthy – Bah humbug – Lucky Lucky Lucky.

 

Swallowing the Rabbit Whole!

The knock of the knot –  A Breast Cancer Blog with Lacanian Angles Curves

Being whole is taken for granted – The Scare Begins

Despite assuming that we are whole, we all have holes, gaps, absences we’d like to fill. But those are part of who we are. Some holes we parade, others we hide. To our best ability we suture with pride, nobility, secrecy and these become part of our life-armour as we grow in experience. Our life scars, from old sutured wounds that have mapped our journey conceal the cuts and cavities within us. Being pre-advised of a future harm gives time to prepare. To throw on the chain-mail to choose our weapon.

https://www.flickr.com/photos/sugarock/3550003350/
Down the Rabbit Hole

Reading the writing on the wall or seeing “las orejas del lobo” is very different to suddenly facing the Lacanian real in the lion’s den. Where did the lion come in? Where fight, flight or freeze are inappropriate. Ready to be eaten alive, the cancer patient struggles as the very jaws of unspeakable change close around us. Hurled into a foreign future by one life changing incident.  When do the wheels of fate turned irreversibly?  How will this duel in the gladiator’s ring terminate?

August 17th 2015 – From Friend to Foe

http://www.vitamindwiki.com/dl1485&display
Safe Doses of Vitamin D

My first appointment was casual. How crazy is that. I’m not a pill popper, I take no daily nor occasional medicines nor am I a believer in herbal snake oils. However a month earlier, in July, after mentioning pain in my legs.  The pain emanated from the bones not the joints. Tests had shown quite a significant ‘vitamin D deficiency’ for which I was prescribed a 20,000 IU supplement to be taken twice weekly. Or in Spanish un suplementazo containing 20,000 IU of Vitamin D per capsule. Now a pill is a pill but this dose was huge when compared to a similar capsule from Vitabiotics. The Vitabiotics dose is a measly 25 microgram (1000 IU) and a typical Cod Liver Oil tablet with its heavy load of Vitamin A has 200 IU of vitamin D.  An eye opener and certainly confirmation of deficiency. Fortunately the blood test results had indicated that everything else was fine.

https://www.flickr.com/photos/hdr-marwin/15696680643/
The Knot

Regarding the breast, I knew there was a nodule, a knot of tissue that had slowly risen to the surface over a year or so, to make itself known as an unknown. The GP had thought it fine, part of dense tissue but symmetrical and in harmony with my shape. Clearly being sent to the specialist clinic was the precautionary part of the government’s latest “routine” services. So I rocked up alone and confident. The appointment unravelled in three parts.

At each step I was getting closer to the finding myself lost in the forest of Hansel and Gretel with no way back. Or was I the trusting Little Red ready to be gullible, tricked and misled. But it wasn’t a crow that ate the bread it was me. Did I mark out the path? Did I even have bread or anything to use as a sign to bring me back to safety? At what point did the shadow of the trees enclose in? Part of me is still there in that forest waiting to find my way out. Back running, stumbling toward the sunny day I’d left behind. Back to normal. Before the knot. Before the knock.

Being called in promptly, the first part involved seeing a young nurse, much like my GP. My GP oftentimes sits with her legs underneath her on the swivel chair, casual and youthful. This nurse had me manoeuvre my arms above my head, to feel for symmetry. She happily stated that all appeared fine. The depth of precaution still as part of the routine check, led me to part two, the mammogram which showed nothing. This machine was already known to me. When I lived abroad it was normal to scan at around 35 years, thirteen years ago. The machine was maybe a bit more high tech and the human side was impressive with sincere apologies for any pain incurred by the pressure of the clamps. Being told that I had dense and firm tissue for my age gave more optimism. Apparently it is normal to get an unclear image, the experts understand that mammograms fail to pick up any shadows with larger or firmer breasted patients.

So is it surprising that I ate the bread? How was I to know that I would be trapped and would never get out the same way that I came in. I was unconcerned. In a sunny place, relaxed and calm. Behind me I could still make out the start of the path in the sunlight. I would soon be home and fine. It was all friendly, no sign of evil until the hissing began from the audience. Oh nurse, what a grand machine you have! All the better to examine you with my dear!

The third part is where things cloud quickly over. Skipping footloose and fancy free into the final room I prepared for the ultrasound. By coincidence I had to lie on my left side facing the wall and by facing the wall I couldn’t see the ultrasound screen to my right. I was pretty much out of the picture, blotted out, as a sideways silhouette stretched prone on the medical couch with my arms askew. There were two nurses and a lot of murmuring. I was listening but only aware that tones were not so chirpy. None of this was pleasant and time seemed to be speeding up. My mouth became dry.

The sunny glade was still bright but by now I think my confidence was getting a knocking. There was no longer a way forward, nor apparently a way out.

The fourth part made me blink. The question asked was not a question it was a statement. Here I realised I had certainly become part of a medical algorithm. If you can’t turn anywhere on the compass-rose then start downward digging. They were preparing to take a biopsy and wanted me to twist further to the wall. Whoa! Hold those horses, I came here for a regular check. I didn’t sign up for this. I wasn’t even warned that instruments and pain may be part of the outcome. Ha! I whisked out my phone and asked to make a call before the needle.

At least I’d used my chance to send a search party into the forest, however twisted out of shape with shock I may get. I could see myself sitting in the glade. No longer warm but chilly and shocked at my own original optimism. Ready to face the fact that I had no control. Yet somehow a narrator was reassuring me that this whole chapter was being re-written for my own good. This was how my story began taking a turn into greyscale.
http://noboobsaboutit.org/breast-cancer-2/core-needle-biopsy-may-result-in-under-staging-of-breast-cancer/
Core Biopsy Procedure

Before the needle, calling home was reassuring but nothing was going to change. Surely it was for the best to acquiesce to the professional care. Coming back on a different date was not a suggestion.  The core needle dove in under the skin allowing the clipper that clipped, to snip and sample an area that defied a simple visual or manual appraisal. The procedure wasn’t that uncomfortable, just totally unexpected. Anaesthetic squirted in ahead of the gouge. They took three samples. They gauzed me up with instructions to leave the padding on for 24 hours and so I gathered myself together and was led back out to the waiting room. Once in the corridor somehow the day was not as bright as I first remembered. Though I now had a comforting hand to hold, my someone special to hug and their caring company, to walk with me outside and into the street. Shock is a funny thing. Shivering in the cold light of the truth, it was slowly dawning that a part of me had been taken to a laboratory for analysis. This could be the start of something quite unexpected. My place was now limbo. Lost on a spectrum between healthy and any degree of eyebrow raising antonym. With cold sweaty palms, my heart fluttered hard in my chest. I felt sick.