14. Graduation

10am today in Hobart was my graduation ceremony for Bachelor of Dementia Care. I would have been wearing a black gown where the hood would be lined with 5cm of dark purple coloured silk ribbon and a black trencher cap with black tassel. I watched most of the ceremony live on YouTube and saw some fellow students in the ceremony. I will get my official graduation documents in the mail in 4-6 weeks.

Another graduation in my life today was moving from my breast surgeon Dr Inder's care to my oncologist Dr Man as my primary care person. Appointment was at 12.30am. Mither came with me to Sutho Hospital. We met, he introduced himself and gave me his email and phone number for contact. He tells me my PET scan was clear. That's a relief. No Hectorites have gone on a rampage beyond the lymph nodes. Seems like Lionel was a scout but no movement beyond. Then he wanted to hear about me, who I am and my cancer journey so far. "You should've read my blog" I say. He was interested and said he would like to have the link. I sketch out a brief version of the last couple of months of my life. He asked about my job, was interested in my degree and says there is a huge need for dementia specialists so good on me for graduating. He asks about what I like to do, interests, hobbies etc. He asks about medical history. I tell him about my eyes. We discuss injuries.. He decides to write 'various sports injuries and accidents'. Wise choice. He was typing the details, no need to worry the pen ink would run out. No other medical issues. No medication. He takes my height and weight measurements.

First, final pathology report is in. I have Stage 3A breast cancer. I've been bumped up a stage. This mean that Hector is under 2cm and between 3-9 lymph nodes have cancer cells. 7 out of the 34 taken had cancer, one of them was Lionel. I wonder which one. Maybe the sentinel node. I envision a vague outline holding a spear standing on the edge of a cliff guarding while other minions gather to battle and a few slip along as advance scouts. Hector, 19mm, is a Grade 3 invasive carcinoma. Oestrogen receptor positive. Progesterone receptor positive. HER2 negative. Not that much different but a confirmation about what the HER2 was doing.

Treatment plan. Would I want to know survival numbers. Sure, I know that research can change rapidly and percentage numbers can vary so much. I'm ok with a ball park figure. I like information and I'll store it away for later. I'm interested to know details, I don't freak out and I don't get stressed easily. I said that I am going to do an advance care plan and he appears to digest this in a positive way and says that with my work and degree in dementia care that I have a different perspective of life and care needs than many people. He nods and seems happy that he can move forward with what he had written down.

1) Surgery + radiotherapy only - 75% chance cancer will recur

2) Surgery + radiotherapy + hormone therapy - 45-55% chance cancer will recur

3) Surgery + radiotherapy + hormone therapy + chemotherapy - 30-40% chance cancer will recur.

Let's go with plan number 3 then. Surgery done, that's ticked off the list. Chemo is the first therapy to start next. Dr Man says it is in 2 parts. The first is a hard and fast offensive to make sure that any of Hector floating around can be found and obliterated. He used the name Hector! I like this doctor. He also used the term gremlins. I have a flashback to when I saw that movie when I was young and inwardly shudder a bit. That is the reason I don't like marshmallows. There is a connection I assure you. When gremlins get wet they go all yucky and bubbly. I saw the movie when I was pretty young and that freaked me out quite a bit. How does this link to marshmallows? I was toasting one in the fire sometime when I was younger and it fell off the stick. When it got into the hot coals is bubbled and swelled and looked like the gremlins did. Weird I know but it's also a texture thing, and they are sort of bit stinky like bad bathroom toilet spray perfume. I have a very good sense of smell and some smells just get to me a lot more than others, like cloves. Yuck, instant headache. Chemo will probably change my taste buds for a while though. Maybe I should do some sniff tests and see at which week of treatment I can tolerate smelling marshmallows or cloves. I digress. Part one is chemically punch Hector and Lionel in the balls and see them crumple treatment. Starting January 10th and then every 2 weeks, 4 times.

Part 2 is once a week for 12 weeks. It is more a search and destroy and not quite so vicious. Any of Hector or Lionel bits that are still around will be found and obliterated. This will take me up to mid May. Unfortunately I won't be able to do my FIFO job while this is happening. The side effects would interfere too much and with my immune system weakened also not so good travelling around a lot. I need to write to my boss and see if there is any other position I could do. If not, I guess I'll see if I can find something else part time. Physical strength in my right arm, shoulder and side also needs to be worked on before I would be able to do the manual side of the FIFO job. If it had just been Hector's ejection surgery I may have been able to do some work before chemo but Lionel and friends took that option away.

After offensive Part 1 and Part 2 it will be radiotherapy. No time line for that yet. There are a few months to get through before we start talking about that. Hormone therapy could be injections and tablets. This is to limit my oestrogen as it is Hector and Lionel's main food source. Bring on menopause - BAM! Symptoms could include hot flushes or night sweats, mood changes, vaginal dryness, irregular or no periods, trouble sleeping. Chemo can also bring on these symptoms.

Talking about symptoms, Dr Man almost hesitantly said that around week 2 or 3 I will lose my hair. I said "Yep, I know. I've had an almost shaved head before and I quite like it. It's summer so I was thinking it was time for a hair cut anyway". I think he smiled behind his mask, it as hard to tell. His voice changed and it was warmer and lighter. I guess the losing hair information can be a real challenge for some people to hear. As the session progressed I could tell her realised that there wasn't going to be any freak outs, tears, stress etc. Those are entirely valid responses if someone needs to express their emotions that way but we are all different, it's not me. Other treatments talked about were some other tablets that can specifically target cancer cells that can move around the body. Also, injections to help with strengthening bones every 6 months for 3 years.

Blood test. I went and got one after the session with Dr Man. You have to have one before chemo starts. It was nice that it wasn't a fasting one. Been there, done that the last couple of weeks, twice! It was getting the cells counts, clotting count etc. My left arm has been stuck a number of times now as the right can't be used at the moment because of the surgery. Usually my left arm doesn't work very well for donating plasma but for blood tests and cannulas it seems to have been fine.

Heart ECHO. An ultrasound (really need to get shares in the gel) of my heart, measuring the blood flow and surrounding areas to make sure all is ok. Chemo possibly could have an effect on the heart. Already booked in for next week.

PORT insertion. That will happen before Jan 10th. Dr Man said I'll be called about the date and time once the blood test results come back. It will go on the right side, between the boob and collarbone areas. He said light sedation and it may take about an hour.

What else did we talk about. Exercise - hold off on boxing for a while...but other strengthening and stretching is really essential. It helps fitness but also can help alleviate some of the symptoms of chemo. Physio - if I feel I need a more targeted approach for my arm, shoulder area. Massage - YES PLEASE! I have missed my monthly treatments. My wonderful massage therapist I have been going for since 2015 almost once a month (bar holidays and covid lockdowns) is trained in oncology massage. Also, having a sister who also does Bowen therapy and aromatherapy will be something I will use too. Homeopathic remedies - Dr Man said just let him know what it is as some treatments may actually increase oestrogen which would be a bad thing. He says that complementary therapies can work well with mainstream therapies.

On the way out I got booked in for my next appointment with Dr Man, Jan 6th and my first chemo. 8am educational session. I can bring someone with me. Then 9-11am chemo which I have to do that alone. Always have a negative rat before treatments. I get given a little folded card with my appointments. The nurse says she will write the direct phone number on it and realises that all the details are for St George hospital. She scribbles them out and writes the correct details on. Did the delivery get stuffed up? Does the St George oncology department has the Sutho ones?

I want to see if I can find a good bra to hoist the ladies up. The ones I have, the band cuts right across the drain wound area and a big area where my skin is all scabby from reacting to the dressings. Head over to Miranda Fair and go to Myer as the cancer council booklet suggests it is good and they have staff that are professional fitters. I had looked online and there was a bra I found that said it was for post surgery and it looks like the band would be lower down my torso. I show the picture to the lady and she shows me a bra (different brand) but similar in design. What size she asks, looking at my boobs (which were at her eye level). "The biggest one" says I. I look at it, not really going to work, the band is still going to be in the wrong spot. I try it on anyway, it does up at the front. 10 hooks! You wouldn't want to have issues doing up a hook and eye fitting. I was right, not going to work at all. Mither and I look around but everything was similar.

We head to Bras and Things. Yeah nah, not going to work there either. Similar design. Best & Less.....nope! Maybe Big W or David Jones? On the way there I glance at a shop window and see a manikin that is not your usual petit size with apricots for boobs. It's wearing a sports bra and Lycra workout pants. The shop is called Fayt. That might work as the bra band is lower. We got into the shop and I found the sports bra...maybe??? I can try it on and see. Mither finds a crop top type of thing. That looks good. There are another crop top design as well. I take them into the change room. The original sports bra I saw might work when I could actually use my arm and shoulder properly again but at this point not going to be able to get it on without great pain and possibly tearing of scars. The one Mither found.....better but not great. The other one. Yes, this one works quite well. Just enough squish to hold the ladies in and up, it goes down to past my waist and doesn't ride up so no band cutting into scabs and scars. I can get it on ok with some grunting and need a bit of help to get it off. I get a white and a blue one. The lady in the shop was happy to cut the tag off the one I was wearing. $109.90 for two tops. The Myer post op bras were $99.95 for one. I got the better deal I think. Boobs contained again is making me feel a little further along the recovery route and it will also help keep the dressing in place over the drain wound until Monday.

Back track a bit - Justin came before 10am today. Changed my dressing to a waterproof one. I am going to enjoy my next shower that's for sure! He'll be back on Monday for his last visit. It doesn't look like I'm getting any fluid build up but he said to keep note of any changes in pain or swelling, colour, heat etc. The Southcare community nurses have been really great. I was given a feedback form which I'll be sure to fill out.