It ain’t over till the fat lady swims…

Day 129 

General status update

FEC cycle 6, day 14

Fatigue/weakness: getting a little stronger every day, and I hope to be back in the swimming pool on Monday. Just 5 days to go.

Nausea demon: getting demob happy.

Despair Demon: every time I catch sight of myself in the mirror he hisses ‘look at you – you’re SPHERICAL’

Chemo Muse: she can’t wait for me to get back in the pool again, as she rather fancies herself as a swimming coach.

Chemo Brian: he abhors all forms of exercise, except exotic horticulture and baking enhanced brownies; it’s just occurred to me how well he would get on with my mother.

State of mind: resolved on pursuing the Path of Righteousness asap (see below)

Last summer, before my cancer was diagnosed, I was swimming about 5 miles a week and possessed, in addition to quite sensational triceps, a clearly discernible waist; over the last eight months of cancer treatment this has been replaced by what can only be described as a circumference.

Thus, very visibly, has my lifelong delusion that ‘cancer makes you thin’ been dispelled. Weight loss only happens, apparently, if you get to the terminal stage; treatment for early stage cancer, and in particular breast cancer, has quite the opposite effect, adding the third element to the Breast Cancer ‘hey, let’s TOTALLY destroy this woman’s self-esteem as well as trying to kill her’ Trifecta:

1) mutilation

2) baldness from the chemo

3) significant weight gain

My oncologist warned me before the chemo started that I would probably put on a stone during the treatment, and she was right. No one seems quite clear why it happens, but the weight gain is probably a multi-factorial phenomenon, with various contributing causes, including:

1) carbohydrate cravings caused by the chemotherapy drugs (or as the nutritionist at the Haven put it ‘chemo makes you crave JUNK’);

2) general increase in appetite caused by the steroids they give you to ease the side effects of the chemo;

3) metabolic changes caused by the chemo drugs increasing fat storage on the body;

4) inability to exercise as normal during the 18 weeks of chemotherapy treatment

5) comfort eating because you are just so utterly miserable during chemotherapy treatment, and beyond caring about the consequences.

I got off quite lightly with parts 1 and 2 of the Breast Cancer Trifecta: my breast is in pretty good shape now after the lumpectomy, and the Cold Cap stopped my hair from falling out. On the other hand, I’ve put on so much weight around my middle that I look like a watermelon with legs - a giant watermelon with a little head perched on top.

And before you say ‘Oh, don’t beat yourself up about that, you just need to recover slowly and gently and worry about the weight later’, you need to remember one very important fact: being overweight is a very significant risk factor for breast cancer recurrence. Fat makes oestrogen, and breast cancer cells – my breast cancer cells, anyway - feed on oestrogen; I keep hearing in my head the remark of a friend’s oncologist that ‘body fat is the third ovary’.

Excess fat also stimulates the production of IGF1 (Insulin Growth Factor 1), and thence glucose, which cancer cells also love to feed on, so every pound of excess weight not only puts a strain on your body, but also provides a selection of hors d’oeuvres for any surviving CTCs (circulating tumour cells) out on the razzle and looking for a snack.

Had I expanded into the shape of a butternut squash, rather than a watermelon, it would be much less worrying – it seems that excess weight carried around the stomach is particularly dangerous, but around your hips and thighs, less so.  So here I am, at the end of my chemo treatment, wondering if I’m one of the 92% of women with my type of cancer for whom chemo doesn’t work, and with my body perfectly primed to be a MacDonald’s for circulating tumour cells.

It’s a truly sobering thought.

You can’t spend all your time obsessing about whether the cancer is going to come back after the doctors have done their work, but you can try your hardest to prevent it from doing so; from everything I have read on the subject the single most important thing I can do to lower my risk of a recurrence is to reduce my body weight, and that goes hand in hand with resuming regular and vigorous exercise as soon as possible, and eating a diet high in vegetables, fruit, pulses and whole grains, and low in refined carbohydrates and animal fats.

My prognosis is that I only have a 1 in 10 chance of the cancer recurring within the next ten years; read the on-line breast cancer forums, though, and you are struck by how many women posting there have seen their cancer come back within a year or two of their initial diagnosis and treatment.

That terrifies me.

There has never been a greater incentive to pursue the path of righteousness, and that path is paved with swimming, spinach and chickpeas.

If the fear of death doesn’t give me sufficient incentive to stay on the straight and narrow, then nothing will…

ps Apologies to  shinester, Deborah and Jen- some comments you made on earlier posts have only just showed up in the comments moderation box, I have no idea why, so they have just been very belatedly published.