"Dying is a very dull, dreary affair. And my advice to you is to have nothing whatever to do with it". (Somerset Maugham)

January to June 2006...

Well, 2005...I'm not likely to forget it! After the lumpectomy in May, followed by the mastectomy in July, only a few weeks later, to my dismay, I discovered little nodules in the conserved skin and yes, it was a local recurrence. So in September, I had two of them removed and was home by evening. Unfortunately, barely two weeks later, they were back rearing their ugly heads and I had no choice but book my biggest operation yet, a "back-flap" (click and hold down Shift key to open in separate window) reconstruction. This is a procedure whereby a flap of skin is taken from the area below the shoulder-blade, to replace the breast skin lost, and a back muscle, known as "latissimus dorsi", re-routed with its blood supply to form a pocket, which replaces the lost breast tissue. Under that was placed a new implant-expander to help stretch the remaining surrounding skin. This operation took place in October 2005 and lasted 4 hours. I came round feeling very ill indeed, had anaemia and very low blood pressure, but after a couple of days, I started getting out of my hospital bed and walking about. The most unpleasant bit of this whole episode was the removal of the four drains in my side! I was home after a week, and three weeks later, flew to South Africa with my husband to put the dreariness of winter behind us for a while.

Three months later, I was pretty much back to normal. I did practice simple yoga exercises as soon as my wounds were healed, which helped to ease the tightness in my back (I have a 9 inch horizontal scar where the flap was cut out). It still feels a bit tight but it is painless and does not hinder my movements. Am I happy with the cosmetic result? Yes, very much so. Almost immediately, I recovered a balanced look and was able to wear a normal bra without the need for a prostheses to redress the asymmetry. I hadn't been able to do that since 2001! Buying clothes is once more a pleasure. The expander-implant was filled in with saline on two occasions since the operation, to enable the skin to stretch to size. Later this year, I will have a nipple created from the new breast skin, and a new implant inserted in place of the current one, to give the breast a softer and more natural feel. It is a big operation and you do need to give yourself time to recover, but I would never do anything differently if I had to. To me, being able to feel almost "normal" after all this is a miracle, and a luxury my own mother never had. Perhaps it's because of my young age but I don't think so. Shortly before having this operation, I met another patient of my surgeon's, an older lady who had had the same operation done 14 years earlier. The conversation I had with her was heart-warming! There is no age to believe that you can still look the best you can, and if that's important to you, why let cancer spoil it for you?

In November, I also started on a fairly new and expensive hormonal treatment known as "Zoladex" (also known as Goserilin). Zoladex is prescribed to pre-menopausal women, whose cancer tumours have oestrogen receptors (around 75%). The tumours use oestrogen to grow, so the aim is to reduce its production in the body. Zoladex temporarily shuts down ovaries (for the duration of the treatment), the main oestrogen production site in pre-menopausal women. It is administered in the form of an injection in the stomach (under local anaesthetic) every four weeks. This drug is a slow-release paste, which produces menopausal side-effects such as hot flushes, headaches, tiredness and other more or less common symptoms. Those symptoms are usually mild, temporary and reversible.

But my respite from the scalpel was to be short-lived. By February, I had to have another operation to remove tiny nodules located in the scar of my skin flap. My surgeon decided to put me on "Letrozole" (or Femara), an "aromatase-inhibitor" drug, which works by suppressing the production of oestrogen in the rest of the body. This, it was hoped, would prevent further recurrences, and slow down the disease. We enjoyed a wonderful trip to Rome, Paris and Brussels in April, and soon after that, I was on the operating table yet again, to remove another minute nodule from the scar. Two months later, in June, I returned to have the whole length of the bottom part of my flap's scar removed, as it was studded with a "rash" of cancer. I was then switched to another aromatase-inhibitor drug known as "Exemestane" (or Aromasin). Cancer is a cellular disease. Although it may seem small and inconsequent, it lurks in the body, waiting for the right moment to strike. It has a mind of its own, so to speak, and it is not uncommon for it to return in or close to the surgical wound. Getting used to the artificial menopause engendered by the drugs has been a bit of a challenge, but I have not experienced any of the more common side-effects such as hot flushes. I seem to have struggled with low blood pressure, headaches, poor concentration, fatigue and just recently, a urinary tract infection. So this is where I am at right now: 12 years, 6 cancers and 15 operations later!

"Death smiles at us all, the least you can do is smile back". (Russell Crowe in "Gladiator")