You didn't hear it from me

This certificate is the proof that I was an honorary NHS groupie for the day yesterday. I went to the annual South West Breast Screening Education Day in Taunton. I gave a couple of presentations about what it's like to be a DCIS patient and go through mastectomy and reconstruction. The whole day was amazing. Regrettably, I can't tell you what else happened there because then you would know too much and it could be dangerous. I certainly feel quite dangerous at the minute. Especially because the education day comes with 4 so-called CPD credits from the Royal College of Physicians. I don't know what it means, but it sounds like a disease to me.

Help. I've got CPD.

Food for thought

My friend R gave me the most wonderful book for my birthday: Cutting for Stone, by Abraham Verghese. It intrigued me from the very beginning, partly because it's so eloquent, but mostly because it is written from the perspective of a surgeon (and they intrigue me even more than language at this point in my life.) I haven't finished the book yet, but I want to share the following paragraph:

Yes! A treasure trove of words! That's what you find in medicine. Take the food metaphors we use to describe disease: the nutmeg liver, the sago spleen, the anchovy sauce sputum, or currant jelly stools. Why, if you consider just fruits alone you have the strawberry tongue of scarlet fever, which the next day becomes raspberry tongue. Or how about the strawberry angioma, the watermelon stomach, the apple core lesion of cancer, the peau d'orange appearance of breast cancer ... and that's just fruits! Don't get me started on the nonvegetarian stuff!

The descriptions are so vivid, they make the diseases sound strangely beautiful. Or perhaps it's the fascination, the act of looking closely, that I find beautiful. Of course, the phrase, "the peau d'orange appearance of breast cancer" — evoking dimpling of the skin — gave me a jolt, given my orange surgery metaphor.  I texted Mr A to see if he'd heard of the "peau d'orange" expression. (He has.) It reminded me also of a conversation we had some time ago about food, medicine and belief.

Mr A advised the use of manuka honey to heal a large, necrotic hole in my newly reconstructed breast, and it was an extraordinary experience to watch the healing process. (Actually, it was an extraordinary experience trying to get manuka honey from the NHS on prescription. But I digress.) I've since incorporated manuka honey into my diet, inspired by the conversation we had.

"Imagine," he said, "If the honey can work wonders on the outside, what it can do to your inside." He announced he was a Muslim; tit for tat, I said I was a Jew. We talked about miraculous foods in the Qu'ran: dates, he thought, were one of four magical foods that get a special mention, alongside honey. But he couldn't remember the stories, let alone the remaining foods, and said he would consult a learned friend and get back to me. (He did. More soon.)

Meanwhile, I've been shopping. And bought some dates.

(But not here. I went to Sainsbury's.)

Image by Zaphgod at Flickr.com

Rock on, OSNA!

MY SISTER'S LYMPH NODES ARE NEGATIVE AND THE MARGINS LOOK GOOD TOO!!!!!

A prayer, sort of

Family Fortunes

As usual when I hit bad news, a song (sometimes an inappropriate one) comes into my head. The theme tune from our '70s Saturday night favourite Family Fortunes is buzzing around it at the moment as a backdrop to yet another shocker. Last week we found out that one of my sisters has breast cancer. A lump the size of a marble, hidden behind the nipple, was found during routine breast screening. She rang me from where she lives in Australia: "Um, it's not like really terrible or anything, but um, I have breast cancer." 

She's having surgery tomorrow — or today, depending on your location. She's staring it in the face right now. I rang her a moment ago; it's 10.40 pm here but over there it's gone half past seven in the morning. She just went out of the front door to have a sentinel node biopsy and lumpectomy, and when she comes round, she will find out via OSNA if there is any disease in the lymph nodes. At least I think that's right — it's so hard for a patient to remember what the surgeon tells you when you're trying to process the news. We've had a few garbled conversations with both of us trying to understand it all. All I know at the moment is the doctors think they have found the disease early. But it doesn't matter what they say until the results are in. Nothing stokes anxiety like the unknown.

As it happens, OSNA has just come to the South West — Mr A did his first one last week to much fanfare on, um, Radio Cornwall (that's a story for another day). I asked him to clarify what OSNA is when I heard my sister's news and he emailed me: "It stands for one step nucleic acid amplification. Allows intra-operative analysis of the node and if it is positive all the nodes are cleared. If it's negative then the patient is told on recovering from anaesthesia. This prevents a second surgery for some patients (approximately 30%)." So when I wake up in the morning, we will find out if the cancer has begun to move.

P.S. If you've read more recent posts, you'll know now that we have had good news. I feel I can post this clip from Family Fortunes now, with Bob Monkhouse for you to enjoy. It's simply marvellous.

Meat: The latissimus dorsi, up close and personal

A couple of months ago, Mr A took a video into the operating theatre, and with the patient's permission, recorded key moments in the midst of LD flap reconstruction. I tried to upload 30 seconds of the four-hour surgery into blogger, but back in July it didn't work. I tried again today and — wowser! — it worked. And a good thing too; as I prepare my workshop for the pros, I need to remind myself of some of the surgery's spectacular details so that I don't end up looking like a thicko at the conference.

***GORY BITS ALERT. DON'T READ ON IF YOU'RE A WOBBLY SORT***

If you don't look too hard, the image in the video's initial frame looks like someone's having a Cornish pasty while they work. But what you're seeing is in fact an ellipse-shaped piece of skin, attached to the LD muscle, which has been harvested — separated from the body — with the exception of a large blood vessel which, like an umbilical cord, keeps the muscle alive. The surgeons are holding the muscle out like a picnic blanket. Or if you're Lady Gaga, like a skirt steak (check out her meat wardrobe here. Tasteful).

The muscle and skin are bundled into the body and tucked safely under the arm for safekeeping while the back is sewn up. That's where this video ends. Then the patient is turned over so that the surgeons can tunnel the muscle under the armpit and through to the front of the body, where they begin the second half of the reconstruction: shaping the breast and creating the areola with the ellipse of skin. I'm not sure if Mr A captured the second part of the surgery for me. I need to chase that up. Meanwhile, without further ado: Meet the LD.

Getting technical

I'm stocking up on oranges again. I've been asked to give a couple of workshops to breast screening health professionals at a regional education day at the end of September. Like, y'know, the patient perspective. I'm excited. And scared. I've only got 20 minutes per workshop to show my LD surgery skills on an orange and explain why this fruity equivalent to stitch and bitch could be worthwhile (beyond me and my friends having fun sculpting oranges and drinking Pimm's. Which is very worthwhile indeed).

I'm sorry to say, I won't be writing about the contents of the day because the organiser asked me not to: "The day is very much a forum of ideas amongst those working within the field of breast cancer and cancer screening (and) I will have to ask you to sign a comprehensive confidentiality agreement." Which makes me feel very privileged and important. And actually, I'm not all that sorry, because it means I can engage fully in the day and not feel guilty at counting the number of moustaches in the room if it gets a bit, y'know, technical.

Source: Cooking for Geeks at Flickr.com

Born in the shape of a question mark

When my husband Dan was about eleven, he got into big, big trouble by asking his teacher, who was really getting on his nerves and asking too many questions, whether he was born in the shape of a question mark. It's not just a really cheeky question to throw back at your teacher (and to get you thrown out of the classroom); it's also bizarre, because Dan is one of the shyest men that I know.

I, on the other hand, am not shy, and I know that I was definitely born in the shape of a question mark. I just can't stop asking questions. It's in the blood. And for the first time since I've known Mr A, I felt that my curiosity exasperated him. In a follow-up meeting with nurse J, I realised I had been asking a lot of my consultant, and had started to take for granted the easy relationship we had developed. It's not that I crossed the line exactly — it's the fact that I had started to think that there wasn't one. But — disappointed! — there is.

Image (and quote) from HydrogenPops at Flickr.com

Giant Panty Whisk

Sculpting Pants with Whisk, by Kelly Stevens

This is, quite possibly, one of my favourite photographs inspired by recent days, with its Mad Men-styled matronliness and culinary slant. Several friends rather like it too. And an additional plus is that, because I shared this image on Facebook, I discovered that my American friend Andrew used to be in a band called "Giant Panty Whisk". Go figure.

Pork chops 'n' porky pants

Saw J, my fab breast care nurse today. I asked her about my lipo-modelling — fat from my stomach has been used to augment my new breast — and why I have to wear a hang-glider-sized* squeeze-me corset for knickers. Apparently the surgeon has to wrench the fat from your stomach, and the procedure is brutal (a fact that was also discussed at the breast cancer support group last night.) I must have got a medically-approved beating. That explains the bruises, then. No wonder Mr A said he "couldn't" film the operation for me. I asked J about the pants - what difference do they make?

"Well," she said in her matter-of-fact Irish way. "You know the fat in a piece of pork. If you imagine going at it for a while with a pokey thing" (can't remember what she said - stick? skewer? screwdriver?) "you'd get a load of holes in it, wouldn't you? That's what you've got inside your belly — a load of holes that the remaining fat needs to fill. So the tight pants push the stomach down and spread the fat around (it's fluid, you know) — and it fills the holes."

Well! It's amazing what food you can learn from. And, quite by coincidence, we had pork chops for dinner.

*My mother-in-law's so fat, you can make hang-gliders out of her knickers. (Apparently mother-in-law jokes are back. It said so in the Daily Mail, so it must be true. Is this one of Les Dawson's? Answers on a postcard, please.)

The return of the cleavage

Yesterday I was lying in bed when my three year-old daughter, Lola (also known as The Rooster), came in to regale us with song and dance, as she does every morning. We spend giggly minutes together before we get up. Usually that means the Rooster singing nonsense songs, bouncing on the bed and trying to make us laugh. But sometimes she just wants a big cuddle, and while we were having one of those she asked: "What's that?"

I realised she was pointing down my pyjama top. She's very interested in the rehabilitation of my breasts (she still asks if she can have some milk.) And lo and behold, I looked down at myself and I saw: Cleavage. Today I'm getting my pink donut bandage and assorted dressings changed for the first time since I left hospital, so I will be able to see the progress much better for myself. I don't care what they say — I'm going to look in the mirror for a while before the dressings get put on again. The return of the cleavage! I didn't think I cared.

Oh yeah. And this post has no photograph for a reason.