Cancer 53
Posted on June 12, 2023 Leave a Comment
What is happiness? Many people have tried to define it over the years. It is very difficult because happiness means different things to different people. I had better deal with this because it has been suggested that a few of my recent posts have been a little negative. I suspect this is more to do with my fears regarding the start of my chemotherapy (tomorrow) rather than any kind of accurate reflection of my general mood.
There is a problem with most of the literature around dealing with cancer. I have been given thousands of booklets and leaflets, and connected to thousands of websites. The common theme in them is how to cope with the anxiety and depression associated with having cancer. But I am not anxious (unduly – I get anxious when I am going to be prodded and poked and generally messed around with. I have had enough of it), and I am certainly not depressed. I almost look forward to enforced sitting while undergoing chemo as it will ensure I have time to read and write (I am slowly working on my novel. I don’t mention it much because the emphasis is on the word slowly), and no one will be suggesting I should do otherwise. My biggest fear for the hospital element of chemo is that I will be sitting next to a smelly smoker (yes, you do smell even when not smoking) or the TV will be on.
Back to happiness. I think I am happy. Going back to points made before I have had what I think is a pretty good life. I don’t believe that a person needs to experience the spectacular to be happy, contented, and fulfilled. There was someone on the radio coming back from the hospital today talking about going across Antarctica, Greenland, having various world records and so on, suggesting implicitly that without such experiences a person cannot be fulfilled. Nonsense. Epicurean philosophy proposes – I believe rightly – that we can be content with the simple things in life. Epicurus suggests that we need three elements to achieve happiness; friends, freedom and an analysed life. I have all three of these, or at least I perceive I do, which is the main thing.
Brendan Kelly from Trinity College, Dublin, has recently suggested there are a number of strategies for happiness. These include:
- create a regular routine
- Build movement into your day
- Practise meditation
- Take time out for lunch
- Mix with happy people
- Eat with others
- Read before bed
I wouldn’t call this a comprehensive list. It doesn’t include specifically relating to family and friends, achieving anything important to you, having satisfaction in work and leisure, and so on, but it is a good start. How do I feel about these strategies?
Create a regular routine. I have never been convinced by this. Apart from getting up reasonably early and (nowadays) going to bed early I like to break with routine. Where I do agree is that life is not about being spontaneous all the time. That would be very tiring and boring.
Build movement. This is an obvious one. Going for a walk or doing the gardening (I don’t do much of either at the moment) is satisfying. Going for a walk can resolve all manner of problems and provides opportunities to admire nature (I am assuming walks in the countryside). Sport is very enjoyable (again not for me now), though I remain unconvinced by the utility of the gym.
Practise meditation. Just no.
Take time out for lunch. Always.
Mix with happy people. I think I do this generally. It is also a two way process. If I am happy then the people I interact with are more likely to be happy and vice versa. Happiness is in the relationship.
Eat with others. Yes, or eat alone. Just eat. Perhaps that is part of my problem.
Read before bed. You mean there are people who don’t?
Brendan Kelly has written a book about this. Perhaps I should write a book about being happy with your cancer. It would sell millions as there is an ever-renewable population. I think I am happy. I still find satisfaction in most of what I do. While it is frustrating not to be able to do things, and I am now going to be living to a strict regime (routine?) underlying it all is a general sense of happiness and satisfaction with life. While I should not compare myself to others I inevitably do so and there are some miserable buggers around who have not had a happy life (by their own definitions). Fortunately most people seem to be reasonably happy and I am one of them.
Epicurian
Cancer 52
Posted on June 11, 2023 Leave a Comment
I have been talking about my reactions to cancer throughout these blogs, but I have not really said what the problem is. At one level I suppose this does not matter. I have cancer, it is going to kill me, I am not sure when. The health service has not yet established all the facts (sorry, Mr Gradgrind). We are still waiting for the results of further biopsies, and I will have a CT scan later today to determine the extent to which the cancer has spread over the last couple of months. We also do not know how well or badly I will respond to the chemotherapy, and whether the chemotherapy will need to be changed as a result of these awaited tests.
What do we know? After various signs and symptoms followed by tests I underwent an open Hartmann’s procedure. The post-operative histology confirmed a poorly differentiated mucinous carcinoma of the sigmoid colon. The biopsy confirmed the tumour deposits, meaning I have N1 disease (cancer in nearby lymph nodes), and there was also evidence of extra mural venous and lymphatic invasion, but no evidence of perineural invasion. pT4a means my cancer has grown throughout the layers of the colon, but not attached to other organs or structures. pN2b indicates the cancer is in nearby lymph nodes.
While there are overall survival rates for this type of cancer it cannot of course be specific to an individual. The consultant, when asked, gave an estimate of 50% survival rate at 24-30 months. We haven’t started treatment yet so it will help when we see how I respond to that treatment. While I am happy that the people in the NHS will do their best perhaps the most important thing for me is to stay positive and to eat a reasonable diet.
The treatment plan. I have my PICC line fitted tomorrow (in the vein, from my upper arm to above my heart: covered ith a dressing when not in use) and chemotherapy starts on Tuesday. I will be sitting in hospital with a drip for about 4 hours on Tuesday, and then sent home with a bottle attached for a further 48 hours. On Thursday the district nurse detaches the bottles and cleans the PICC line. I am then free for 6 days. On the following Thursday the district nurse takes a blood sample and recleans the PICC line. On the Friday I see the consultant to see how things are going, and then the following Tuesday it starts all over again.
Assuming I respond well and can cope with the side effects (I have decided not to have any) this will be repeated every two weeks for three months, and then a further CT scan will indicate whether it is working. If so, then I will probably have another three months and then take a break from treatment to go and spend a month or two somewhere warm. If things work out well this will be my life between Tuesday and death, however long or short that may be.
I am going to have combination chemotherapy with FOLFIRI +/- Cetuximab depending on my further results. I can look forward to the possibility of a range of side effects, including skin toxicity (stay out of the sun, use moisturiser!), sore mouth and ulcers, cardiac toxicity (due to heart failure), bowel problems, high stoma output, risk of low blood counts, risk of infection, and life threatening neurotropenic sepsis – it is funny how ‘life-threatening’ only comes up at that point. I had the vague idea that the cancer itself is somewhat life threatening (stay positive…).
Right, I am off to fix some skirting boards. Stay tuned for updates on the side effects of chemotherapy.
Cancer 51
Posted on June 11, 2023 Leave a Comment
I suppose reaching fifty blogs on the subject of cancer is something of a milestone. I have had quite a few positive comments so I must be doing something right. I am probably repeating myself at times but I don’t care, the blog is more about a stream of consciousness than an attempt to write a logically constructed account of the process of living with and dying from cancer. It is the same with grammar and spelling. I don’t tend to go back and review or revise anything that I am writing. You get it as it is. I should perhaps do more research when I start blathering about books or people but I can’t be bothered. I am not attempting to write a logically constructed and empirically informed account of the process of living with and dying from cancer. If there are errors then blame my comprehensive school education.
I have written about, and I think about, the meaning of life. As I have said before, I see life as essentially meaningless. Any meaning attached to life is the meaning you as an individual attach to it, whether that relates to relationships with others, the acquisition of knowledge, admiring natural beauty, or even believing in fairy stories about a badly dressed beard god sitting on a cloud called heaven. That is all there is, and once you are dead those meanings die with you. That is not to say some of these meanings are not shared between many members of the human race. I have no empirical evidence (see above), but I suspect that if you ask everyone in the world about what meaning their lives have, most would mention relationships with others. It is probably top of the list.
While I like to think of myself as a – usually – reasonably kind and nice person (apologies for the ego) there is a part of me, especially now, that is incredibly selfish. I want to live. I want to be alive. I want to breathe. I want to be in my home. I want to travel to places. I want to smell grass. I want to smell cattle shit. I want to listen to birds and insects. I want to be with other people. I want to sit in the dappled sunshine under a tree. Me, me, me. It is all about me, not you.
Nevertheless there is also the selfless element. I don’t want to upset people. I want them to be happy. I want them to get on with whatever they want to get on with. If they have a relationship with me I want them to continue with it. So truthfully it is not just me, it is you too.
But on the scale of things this is all meaningless. In the end none of it matters. In 100 years we will all be dead. We will all be forgotten, so what if I am dead this year or in 30 years? It makes no difference in the end.
Cancer 49
Posted on June 7, 2023 Leave a Comment
I have just developed a new fear. It happened while I was scrambling down a vertiginous slope while walking at Hadrian’s Wall. I realised that if I fell, and it was rather precarious, especially with my aching bones, I may well break a leg ir two and spend the rest of my foreshortened life in hospital, in traction, in pain unrelated to any rapidly spreading cancer. To be in hospital with cancer is a nightmare, to be in hospital because of my own stupidity when I could be at home dying of cancer is a worse nightmare. I don’t think I will walk anywhere ever again just in case I get injured. I had better not drive in case I am in an accident. I had better not stay at home in case Libyans decide to blow up an airliner somewhere above my house – sorry, that is in bad taste. We have just driven past Lockerbie. I drove past it 36 hours after the plane crashed there and there were bits of aeroplane everywhere, especially lining the sides of the road.
The problem with black humour is that while a lot of modern folk disapprove (how can you make jokes about race, sex, the Holocaust, pet cats, etc?), when you are sitting dying black humour is one of the best ways of staying cheerful. I have heard some good cancer jokes while I have been ill. I can’t remember them partly because I never remember jokes – my humour is spontaneous folks! – and partly because for the last few months the part of my brain critical for inputting new long term memories, the hippocampus, seems to have metamorphosed into a cancerous lump. I can’t remember new things in the way I could. Actually I have no idea if I have cancer in my brain if anyone is worried.
If anyone knows any good cancer jokes, the sicker the better, please send them to me. Perhaps they could become a blog.
The part of Hadrian’s Wall we were visiting is near to that part that is somewhere between where Robin Hood Prince of Thieves landed on the south coast and Robin’s Dad’s castle presumably in Snottinghamshire. If anyone isn’t aware ofnthe basic geography of England you don’t need to go via Hadrian’s Wall to make this trip.
The story of Robin Hood (not the Prince of Thieves version) has always inspired my basic socialism. I realise that many people do not think Robin existed, but of course he did. Who else wouls fight against the basic inequities extant in the feudal system sometime in the (probably) 13th Century? I know he existed. My Aunty May made me a Robin Hood suit when I was little. Armed with a Dad-made bow and arrows (a bit of a plastic downpipe for a quiver, baling twine for a bow string), I conquered our woods and extracted a toll from all comers to give to the poor.
And don’t give me this nonsense about Robin coming from Nottinghamshire. He was from Loxley on the disputed Derbyshire-Yorkshire border. He holed up in the Peak District when not robbing ruch people on the Great North Road, in both Yorkshire and Nottinghamshire, and the Sheriff of Nottingham at the time was a Peverill from Castleton in Derbyshire. The two counties, Derbyshire and Snottinghamshire were a unitary council at the time.
I just thought I had better make that clear.
What kind of punctuation mark am I? A semicolon cancer.
There, those random jottings might convince you my brain is addled (riddled?). I will just sit here quietly.
Cancer 50
Posted on June 7, 2023 Leave a Comment
A few years ago a very good book on traumatic stress was written by Bessel van der Kolk, who works in Boston (Massachusetts, not Lincolnshire). It is called The Body Keeps the Score, and is well worth a read. The fundamental point of the book is that when negative things happen to you these are remembered by the mind/body, and these can be then expressed as traumatic stress or PTSD. Van der Kolk discusses the techniques that can be used to effectively deal with these problems.
The body keeps the score in many ways. We all know this. It is certainly not just about traumatic stress. The old phrase life fast die young has meaning, not that I would claim to have lived fast, though I think the latter is a near certainty (yes, I am saying 60 is young. Deal with it). I used to smoke in my teens and twenties. I used to drink more alcohol than I should. I love red meat, bacon and sausage, along with black pudding, haggis, and most other forms of processed meat. I have never been a drug taker apart from in my teenage years the odd bit of cannabis (about five times in total perhaps) and a few years of seasonal magic mushrooms, where I tended to double up with each dosage, so fortunately the season was short. I have never, to my knowledge, seen cannabis or heroin. As with most people there have been a number of other risky activities in my life. Nevertheless, my risk count seems to have added up and indicated that it is time for me to have cancer (and heart disease). The body keeps the score. Inevitably there are other factors, such as genetics and personality, but the score probably matters.
I have always known about the risks involved with some of these activities, but as a youngster I was, like most people, immortal, and by the time I realised I was mortal all the bad habits had set in. There is often a disjuncture between when we know and what we do. It is probably a problem associated with the way the mind works. How would I know, I am just a psychologist? Why do so many people (traditionally mostly men) know what they should eat and how they should behave but do the opposite? What is wrong with us? Presumably the common assumption is that it will happen to others, otr that it will happen in a distant future when it won’t matter. There is also plenty of evidence that we are poor at using risk and probability in everyday life. And bacon is delicious.
This talk of body and mind suggests a classic Cartesian dualist perspective, where the body functions independently of the mind, and the mind itself has separate elements. Dualism is at one level utter nonsense because the brain – generally acknowledged to be the seat of the mind (I said I was a psychologist) – is just another bodily organ like the liver or the heart; but at another level the body and the mind appear to be functionally distinct, with the mind being partially conscious and, it appears, partially non-conscious, and there is often conflict between various elements, which may explain risky behaviour.
As a glass half full person my conscious mind is largely concerned with the positive aspects of life and the non-negative aspects. I try to live my life in a satisfactory and enjoyable way, taking an interest in what I and those around me do, reading good books, and admiring the countryside. I sometimes fail. I am sometimes anxious, I am sometimes depressed, but it rarely lasts for long. A good rule of life is to enjoy the positives for a long time and ensure the negatives are brief. Football is a good example for me. As a fair weather supporter of Derby County and England, as I watch a match I will be suitably enthusiastic, and if they win I will enjoy the pleasure of that for a day or two. If they lose, then I will be down for about five minutes, and then forget about it. It doesn’t matter, and what is the point of negative thinking? It is a good strategy for football and it is a good strategy for life. Unfortunately, it does not always work this way.
The other day I drove through the Highlands of Scotland, which has two fundamental pleasures for me (apart from being with the wife), being in a beautiful place and driving; but cancer got in the way. As I was driving I started thinking that this is likely to be the last time I drive here because I will soon be dead. This stopped my enjoyment of both the scenery and the driving. This sort of thing is usually momentary, but on this occasion it lasted for minutes before I knocked it out of myself. I do wonder if this is going to be an increasing problem, like the growth of my tumours. I will have to fight it.
The body might keep the score, but I don’t have to constantly take notice of that score, especially as the world is such a beautiful place.
Dr Nigel Hunt 