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When you’ve been diagnosed with cancer, you don’t need to learn on the job, you need short-cuts.

Monday, October 7th, 2013

As a single parent, running a busy household as well as a business, I really didn’t have time for illness. So, in July 2004, when I was diagnosed with breast cancer, my first thought was the terrifying-but-normal ‘I’m going to die’. My second was ‘how long will I have to take off work?’

Becoming a cancer statistic was the easy bit, being well prepared was almost impossible. There was no shortage of books and leaflets on the subject and, with ‘cancer’ being the second most searched topic after ‘pornography’, plenty to read online too. I should have been pretty well informed before my treatment began but I wasn’t; what was missing was frightening, and I had to learn on the job. In 2009 I turned that knowledge into a guide called Even the eyebrows? to give cancer patients the information to stop them putting their lives on hold, and to help them carry on carrying on.

Within months of writing it, at my five-year check up, I was diagnosed with breast cancer again. As devastating as the news was, I knew what to expect and decided to try a few things differently and put my past experiences to the test. I’ve condensed my findings into easy to follow short-cuts that give everyone – patients, family, friends and employers – access to practical advice and solutions that help turn a difficult journey into a manageable one.

1. Keep your children in the loop
Telling your children you have cancer is right up there with subjects you’d rather tackle at a later date. Unlike sex education and synchronising your computer with your BlackBerry, cancer can’t wait. I decided very early on, given the ages and maturity of my children (eight, ten and 14), that honesty was the best policy, and even the hardest-to-take information can be delivered with gentleness and tact. When I told them they were naturally frightened and upset and, as open and reassuring as I was about my situation, I knew they would have lots of niggling doubts. To prevent them from bottling things up and suffering in silence, I gave them an alternative sounding board in the shape of my sister. Her role was to be their confidante, informant and second mum; she was there to answer any questions they didn’t want to ask me – and they had plenty – and that helped in more ways than one. They knew that their opinions, thoughts and feelings mattered and that they wouldn’t be deserted or overlooked. The downside for my sister was that, as a source of information, she had to do some serious swotting because “I don’t knows” and “I’m not sures” don’t cut it with kids do they? (Tragically their father died when I was four months into the treatment, so that alternative sounding board became a crucial component in helping my children cope with a cruel double whammy.)

2. Jesus is coming, look busy
Everyone’s cancer is unique, as is your attitude towards it; ‘feeling rubbish’ after chemotherapy is, on the other hand, fairly universal, but you can do something about it. I was told to take things easy, rest, conserve my energy. This all made sense, but I was under a lot of pressure to carry on working to pay the bills, so there was no way I could contemplate taking a lot of time off. And, strangely, work was my salvation. By having so much to occupy my mind every day, ‘feeling rubbish’ was constantly being relegated to a minor position. Five years on I decided to be kinder on myself, take everything a little easier; I was therefore more in tune with my body and I actually felt far worse. This isn’t about having a positive mental attitude, or a job; it’s all about keeping busy. By focusing your mind on getting things done, whether it’s the crossword, filling in your tax return, painting by numbers or rearranging your knicker drawer, there’s less time to dwell on how you’re really feeling which, at this particular time, is a bonus.

3. You shouldn’t have to queue for chemo
The majority of people don’t get the ‘opportunity’ to experience chemotherapy on the NHS and privately, but I did. And the comparison is worth talking about. In terms of patient care, knowledge and experience you couldn’t slide a fag paper between them; I felt in excellent hands always. With private medical cover however I was able to choose where I had chemotherapy: hospital or home. I chose home and that was bliss. My children would see me plumbed in and could see it wasn’t remotely scary, I was surrounded by my own things which made me feel relaxed and I had the freedom to arrange a time of day to suit me. The treatment took around two and a half hours, but on the NHS you could easily double the time. Driving to and from the hospital took an hour, but then I’d have to queue to get in the car park, queue to see my oncologist and then queue to have the chemotherapy itself. In time all patients should be given the choice between home and hospital, whether they have private medical cover or not. Trials have already been conducted in Bristol and Birmingham by Healthcare At Home which shows that it makes economic sense to treat cancer patients at home. And, let’s face it, if you’ve got cancer, should you really have to queue for chemo?

4. Ping off!
A lumpectomy (an operation to remove the tumour from the breast) is what I had both times. It’s a simple procedure, in comparison to a mastectomy, and recuperation is fast, but you must exercise to keep your arm and shoulder mobile. After my first lumpectomy I was very diligent about following the physiotherapist’s gentle exercise programme, but a week or so later I started feeling extreme pain in my arm and underarm when trying to reach for or move things. I also noticed a strange bony line forming under the skin in my arm which ran down to my hand. Had I been overdoing the workout and done some damage? No, the physiotherapist at the hospital knew exactly what it was: cording or hardened lymphatic vessel which can form after this kind of operation. The only way to get instant relief was to ‘ping it off’. What’s pinging off? A method of stretching the vessel until you feel, and sometimes hear, a small popping sound. That’s the vessel snapping! If this sounds too brutal, a gentler approach involves massaging and stretching the cording until it breaks or you could just put up with it. I preferred a faster result.

5. Shit happens
It’s a well-known fact that diarrhoea could be a side effect of chemotherapy but what should you do about it? Sit on a loo for days on end just to be safe, or carry on as normal in the belief you’ll get ample warning? I can tell you from my own personal and bitter experience that you don’t need to sit on that loo, but you’ll wish you had. One week after my third chemotherapy session I was leaving a meeting in London when my bowels decided on a mass evacuation. Luckily, I was near a loo so I could sort myself out, before enduring a gut-wrenching, buttock-clenching 60-minutes of misery on the train journey home, as I anxiously pictured the scene should my bowels let me down on the London to Colchester fast train. It was upsetting, humiliating and unnecessary. After that I never left home without my bespoke, top-of-the-range emergency shit kit: Imodium Instants, spare knickers, night-time sanitary towels, wet wipes and perfumed nappy sacks. This wasn’t just a physical help – it had a very positive psychological effect; I felt far more secure knowing I had back up, and it meant I could carry on as normal. Almost.

6. Camouflage or go commando?
The thought of losing my hair came a close second to learning I’d got cancer. Everyone’s different, but I was told that on my drugs, my hair would start falling out around two-and-a-half weeks after my first chemotherapy session, and it did; I literally started to moult ferociously. I knew the only way to avoid a shocking hairstyle and my children eating hair, was to shave the lot off. This all sounds very matter of fact, but it was heart breaking and I cried buckets. Weeks before reaching this stage I’d already discussed my options with my family: wig, scarf or go commando? I chose wig. With make-up and my brilliant wig I worked, shopped, went on holiday and felt completely confident (except in a high wind) but I missed my hair and it seemed to take an age to grow back. So, second time round, I decided to see whether I could hold on to my hair by using ‘scalp cooling’ (or the cold cap).

The cold cap looks like a helmet (and is kept at a constant minus 5.5º Celsius) that you wear during chemotherapy to reduce the blood flow to the scalp, and therefore the amount of drugs reaching the hair follicles on the head. It was successful in that I got to my second chemotherapy session without any hair loss but in the end I lost 80% of it. As I kept the hair around my hairline, I had the option of wearing glamorous turbans as well as a wig and I had a head start on growing my hair back. For me the end result outweighed the discomfort. And I have a deep and new-found respect for all those men I ever berated for comb-overs.

7. Even the eyebrows?
Sadly I lost my eyebrows and eyelashes too, but they grew back, although my eyebrows were a bit of a let-down after the first lot of chemotherapy. Second time round they refused to come back at all so I became quite expert at putting on my eyebrows every day, and most people thought they were actually mine, rather than carefully applied eye shadow. But during the hot weather that summer I’d often come home with one-and-a-half eyebrows, and sometimes just half; it wasn’t a good look so I decided to get my first-ever tattoo and regain my eyebrows.

Getting your eyebrows tattooed on is quick and easy, finding the right person to do it is where you need to spend the time. Through talking to people, then checking with experts I trust, Debra Robson-Lawrence, was recommended to me. After an initial consultation at her Harley Street offices where we experimented colour and shape, my eyebrows were tattooed on. It only took around 30 minutes and the end result is very natural and far better than the originals. How long the tattoo lasts depends on your skin type but in another six to 12 months I should have a colour boost to refresh them. Right now I don’t even need to touch them. At around £300 an eyebrow, dropping down to £115 each for regular half-yearly visits, it’s not cheap, but for me it’s an investment I happily make.

8. Employers: angels or demons?
We’re all aware that employers can behave like an alien breed when it comes to protecting their business, and nothing gets them going quite like: “I’m pregnant” and “maternity leave”. “I’ve got cancer” often has a similar effect. There are very specific guidelines concerning maternity leave and everyone knows where they stand. Cancer’s different because until you have it there’s no way of telling how you’re going to respond, both physically and mentally; how much time you’ll need off work; and whether you can do your job if it’s physically demanding. But work is important, not just as a source of income, but as a coping mechanism, keeping things ‘normal’. The last thing an employee needs is to feel is that he or she has to ‘watch their back’. Of course the Disability Discrimination Act is there to help but there are some employers who will exploit every opportunity to undermine an employee, causing him or her to take on a new (lesser) position or resign altogether. With almost 46,000 women and 300 men being diagnosed with breast cancer each year, employers will be dealing with this very serious illness more regularly. It’s not rocket science, but people who are treated with respect during what is for them an intensely traumatic period, will return to full time work more committed, loyal and positive. Everyone’s a winner.