Islands of Excellence: Angelina Jolie

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Wednesday, 20 March 2013

Break The Trust and You Break The Patient.

Posted on 09:18 by rajveer

I was lucky to win two tickets for the UK Premiere of G.I.Joe. Walking the red carpet and a free night out before my next oncology appointment tomorrow is a welcomed diversion. Sophia was disappointed that she was not going, but the rules of the competition were over 18 only.

As I walked down the red carpet wearing a cream faux fur collar jacket I could not help but wave at the autograph dealers like I was the star. At first they did not recognise me, but my smart appearance did not fool them for long. My friend who I had brought along to experience the furore that I and Sophia have seen so many times thought it was madness. How could people wait hours in the freezing cold and rain? It baffled her because she is not fazed by the entertainment world. I said for some of those people it revolves around money, but for me and Sophia it’s a day out. Most the time we are away from these individuals and have friends that are collectors. My friend still could not understand the appeal, but it is our thing, and away from the cancer bubble.

We walked the sodden wet red carpet into the foyer of the cinema and my friend caught a glimpse of Dwayne 'The Rock' Johnson. I nudged her to get her camera out and snap a picture. Dwayne 'The Rock' Johnson was chatting with David Hayes the British heavyweight boxer. Sadly my friend took too long trying to set her camera up and security moved us on. I was a little faster and managed to get a couple of pictures in the foyer.


Our seats were at the front of the cinema. This meant when they did the intro I would get some excellent film footage on my camera to share with Sophia. And thankfully my friend would be able to take some pictures to show her son. The usual complementary bag of popcorn and bottle of water was waiting.


The following day I believed I would receive some sort of reassurance that my cancer had finally gone, but yet again I was left upset and disappointed. On arriving at clinic 8 the sister started to panic thinking I was there for a port flush. She instantly started to babble on about not having any port needles to do a flush. I said but I’m not here for a port flush that I had an appointment with Mr L.

I booked myself into the clinic and took a seat to wait for my name to be called. One hour and a half later still my name is not called. I go to the reception desk querying my wait. The receptionist went to investigate and returned saying the nurse will call you shortly. I take a seat again and wait a further thirty minutes to be weighed and sent back into the clinic. Another twenty minutes go by and finally I’m seen by a registrar. He is all apologises and explains my notes are missing. Then I’m told to sign a piece of paper for Herceptin to begin. He explains how they have been using Herceptin fifteen years and still have not got to grasp on the side effects. That it can damage your heart, but the heart seems to recover with time. And did I understand all of this?
Well yes of course I understood because thankfully I have other BC ladies at hand advising me. I signed the piece of paper and then explained I was having issues with the Tamoxifen. I was told I had to take it up with my GP and he would refer me onto a Gynaecologist. That there was nothing they could do there. I calmly said ok and left without even trying to get into any further conversation about my concerns. I wasn’t told if my cancer had gone because this man had never met me before. My notes were nowhere to be found, so it was pointless trying to ask. I was sent up to floor 5 to book an echo of the heart to be done in April. I thought to myself well that was bloody productive. As I walk up the four flights of stairs to level 5 I ring my husband up. I tell him in detail what has just happened and he said not again. He wanted to know when I start the Herceptin. I said ops! I forgot about that, so instead of going back to clinic 8 I go to level 6, chemotherapy and ask them. After all it will be them administering the drug every three weeks.

I return home with friend’s texting me, so has the cancer gone? My reply I don’t know because no-one seems interested in telling me anything.

Today I leave a message on the answer machine for my BC nurse to contact me. Two hours later she rang me back asking what the matter is. I said I want a referral to the R M. I want to be placed under one roof where my treatment can be monitored properly. I’m tired of the miss communication and errors.  She wanted me to explain even further and I did not see the point in doing so. We had already been down this road already and I did not want to keep repeating myself. I said look I have two very serious illnesses that impact on each other and no-one is taking into account my stress level. Every time something goes wrong at that hospital my heart sinks. And I should not be having that sinking feeling. I have been treated under several hospitals and bar one instance I have not had any issues with treatment or staffs. She said she understood and that my concerns were being noted. She said I should speak to Mr L and ask for the referral. I instantly said no and the reason I say no is I have only ever seen Mr L twice, once in July 2012 and the next January 2013 for radiotherapy to begin. Again I repeated to her if I don’t care about me then who will. I’m sorry but I want a referral for a legit reason and that is my sanity. I said only twenty minutes back I snapped at my husband because I’m at breaking point. Is that validation enough for you? Not to mention the fact my feet are dry cracked and if my diabetic nurse sees them she will hit the roof. I said Tamoxifen affects and creates Diabetes do you think I’ve not read the piece of information that comes with those pills before taking them. No-one is asking or monitoring me and to top it all are losing my medical information. She asked when the Herceptin starts. Friday was my reply. Oh! She replied. I said look I can wait until I’m transferred. The BC nurse instantly said no which I knew she would. No fool in their right mind would delay their treatment. I was advised to go have my first session and she would sort the referral out for me with Mr L herself.

Result!!!!

Well yes for me, but I should take some of the responsibility for things going pear shaped in the first place. If I had ignored what my GP said back in 2010 about referrals making thing awkward I would not be in this mess.

I cannot help but wonder about ladies that are in a similar position. What about those ladies with silent tears that no-one is picking up on? The NHS is a good system, but for that system to work without error or fault it must be transparent. Consultants, doctors and nurses must all be speaking the same language. Compassion and showing an interest is important to a patient’s recovery. If the staffs show they are not bothered then it creates issues of trust. Break the trust and you break the patient.
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Posted in Being Pro-Active on Breast Cancer, Cancer Care, Changing Hospitals, Herceptin, NHS | No comments

Sunday, 17 March 2013

Body Image and Breast Cancer

Posted on 05:14 by rajveer

I love taking the piss out of myself. I do not take myself serious as an individual at all. I know I have faults and those faults I tend to fixate on when really I should be using them. So recently I went rummaging through old bits of art work I had done in my twenties and came across a cartoon caricature of myself. Now the original was drawn by some else, but all those years ago I had changed it into various avatars for my MSN because I hated actual photographic images of myself. The original artist picked the faults on my face like the ridge in my nose that had been broken as a child. And the shape of my chin and blew them up BAM! In my face, but in defiance of shying away from the image drawn, I learned to celebrate those ugly parts realising early on that what I fixated on is not important. Actions tend to speak louder than words in my world.

My confidence has grown over many years and a few bashes. This has helped me get past the image I now see in the mirror from numerous surgeries to both breasts. I do not ignore or disguise my scars. I hate them, I resent them, but acceptance of such scars is hard to swallow, but I will not be pulled, pushed, cut or bruised into feeling I am less than the next person because my image does not fit the beauty persona society creates. The kindness of a good heart and the warmth of my soul will always shine that and being a stubborn shit that will not be stopped. I have learned to take me not so serious, but take the good parts of my personality and use them to the max. The numerous natural talents that I hold come in handy when expressing my true feelings to this disease.

And to finish of this blog post I have corrected and improved an image someone posted on my FB page. I thought it needed some extra info added on the symptoms of breast cancer this included links. Awareness is not just about checking your breasts it is about understanding your body and its changes. I believe in the natural instinct that tells you something is not right, the internal kick up the arse that we tend to ignore. 



So please, please if in doubt shout!

Do not leave it because you think you are alright. It is better to face up than ignore these subtle changes that could mean pushing up the daisies or being with your family. In other words, ‘It is better to be safe than sorry.’
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Posted in Being Pro-Active on Breast Cancer, Body Image and Breast Cancer, Symptoms of Breast Cancer | No comments

Tuesday, 12 March 2013

The Cost of Herceptin

Posted on 13:50 by rajveer

Every time you walk into an office with a consultant waiting to greet you. The firm hand-shake and smile leaves questions. I knew the radiotherapy could create extra issues down the line, but when a consultant goes through the gritty details of what if. All I want to do is bury my head in my hands blocking my ears. I do not want to be the individual that falls into that dark hole they are describing. I look at this man direct in the eyes and say with a smile, ‘but that isn’t me, I know it could be, but fingers crossed that will not be the case.’

‘Well you do realize radiotherapy can affect the reconstruction a year from now. It is very complicated because no-one can predict the outcome.’ He says


My implant has a ten year shelf life and it has already used four of those ten years. Thankfully recon is changing by using stomach fat and skin avoiding the traditional implant, but for a few skinny creatures with zero fat to spare the implant is the only option. Even while I sat in that room discussing the possibilities of the damage done and how I had options. The consultant’s main comment was about my slender frame which limited those options.

‘Being skinny and having breast cancer has its complications.’ I repeat to a friend. She said, ‘look Sarah don’t feel down you have come this far don’t look at the negatives’, but in my eyes not far enough. When talking to my friends I don’t want to create a pity me story in their minds, but three years playing the same record can create scratches. The cancer may have been beaten into remission, but the torment of the mirror remains. You are searching for consistency and trust in strangers eyes. Then the words you heard only an hour ago of did you know so and so passed away today she was only forty-seven causes the mercury of fear to rise.

Recently I was informed Herceptin is being studied. The length of time and the cost of this treatment are under fire. The pharmaceutical company insist it is right for Herceptin to be taken for a year no more or no less, but at the cost of just over £40’000 to the NHS per person means it is being investigated. HER2 is amplified in 20% of breast cancers cases. Those with a HER2 positive result have a hard time in the survival statistics. That is why you become reliant on this drug doing its job. Chemotherapy, radiotherapy kills the cancer cells, whereas Tamoxifen and Herceptin could prevent the breast cancer from returning.


Herceptin is administered every three weeks via intravenous unlike the daily oral consumption of Tamoxifen. Tamoxifen costing less than £800 over five years starves cancer cells of oestrogen, whereas Herceptin binds the cancerous cells preventing the erratic growth. I will have eighteen Herceptin treatments at a cost of around £3000 each. You can see why the NHS has started a yearlong study on Herceptin and its benefits.

This means that Herceptin could be reduced to a six month course in the UK rather than the year the drugs company advice. This is not the first time Herceptin and time frames have come under scrutiny. Of late the pharmaceutical companies have had to explain on a number of drugs produced for cancer and cost. Yet it seems these drugs companies have the final say when it comes to treatment and health care. This of course generates the theories on whether the cure is out there because of the amount of money that could be lost.

Personally I have an appointment to visit the Breakthrough Breast Cancer Research Lab on the 10th October. It is a long way away from this visit, but sometimes it is better to wait than rush these things. 
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Posted in Being Pro-Active on Cancer, Breast Cancer Treatment, Herceptin, Tamoxifen | No comments

Sunday, 10 March 2013

Mothering Sunday With Breast Cancer

Posted on 03:55 by rajveer


As I lay in bed on this very chilly Mothering Sunday morning my mind turns to the book Peter Pan. 


Peter Pan

Mrs. Darling first heard of Peter when she was tidying up her children's minds. It is the nightly custom of every good mother after her children are asleep to rummage in their minds and put things straight for next morning, repacking into their proper places the many articles that have wandered during the day. If you keep awake (but of course you can't) you would see your own mother doing this, and you would find it very interesting to watch her. It is quite like tidying up drawers.

You would see her on her knees, I expect, lingering humorously over some of your contents, wondering where on earth you had picked this thing up, making discoveries sweet and not so sweet, pressing this to her cheek as if it were as nice as a kitten, and hurriedly stowing that out of sight. When you wake in the morning, the naughtiness and evil passions with which you went to bed have been folded up small and placed at the bottom of your mind; and the top, beautifully aired, are spread out your prettier thoughts, ready for you to put on.

- J M Barrie
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Posted in Being Pro-Active on Breast Cancer, J M Barrie, Mothering Sunday, Peter Pan | No comments

Thursday, 7 March 2013

Beating Chemo Blues

Posted on 06:14 by rajveer

Having the Chemo blues is one strange sensation. The shock of going through all this treatment is now sinking in. The only way to describe how I feel is to say I’m at the bottom of a very steep hill, and my mind and body are fighting to scramble up. Reaching the top seems easy, but the fear of the not knowing makes the hill much steeper.
  
The 19th is slowly creeping up and I will get the results on whether the zapping worked. The ‘If’ of cancer treatment is always there lurking it never goes away especially when you have a recurrence. It sort of shrinks the percentages that the breast cancer lottery feeds on. I did try asking those that were zapping me if it had gone, but their lips were firmly sealed. The fear of knowing that they still could dismantle my MX breast is a path I don’t want to walk down.

To switch my brain off from those worries I have I still kept myself busy.



http://www.ealinggazette.co.uk/ealing-news/local-ealing-news/2013/02/26/give-your-body-an-mot-and-help-beat-cancer-64767-32886058/

Book week meant I had another reason to dig the sewing machine out once again. This will be the third costume in 2 months. The receptionist at Sophia’s junior school said I put certain mums to shame. My reply Nah, I just make it look easy because I have the machines sat gathering dust. But the truth is I don’t want to use the excuse of cancer for her not having a costume. I want Sophia to be like every other child, excited about being her favorite book character. 
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Posted in Beating Chemo Blues, Being Pro-Active on Breast Cancer | No comments

Wednesday, 6 March 2013

What Kind of Doctor Is This?

Posted on 08:44 by rajveer
My phone rang a few weeks ago, the morning of January 26th. It was my brother saying "Mom has cancer in her spine. I'm bringing her to the hospital this afternoon. They're operating Monday."

I threw my stuff in my suitcase, jumped in the car and drove back home from the conference that moments before had seemed so important.

But before I left, I spoke at length with the orthopedist who'd delivered the diagnosis and would be doing the surgery. I called him on his cell phone, which I could do, because he'd given my mother the number (and with assurances I would use it judiciously). It was a Saturday morning. Dr. P. spoke to me for half an hour, answering my zillion questions in a calm, thorough and detailed way-- what you might expect from a family member. Only he wasn't family. In fact I'd only met him once before, five or six years earlier, when mom saw him and got a diagnosis of spinal stenosis, a painful narrowing of the spinal collumn made bearable in her case with injections.

When I got to the hospital, mom was already propped in the bed, a bit dazed, clearly not having fully processed that at 82, she'd be undergoing major surgery and an uncertain prognosis. I looked around the room. I couldn't be sure, but this might have been one of the very rooms my father had stayed in seven years ago, when he'd entered for routine surgery on his neck, and died six months later from complications of an infection.

The next day Dr. P. came into the hospital early to visit my mom. I was calling from home and felt bad that I'd miss a chance to talk to him in person. He said he'd stay and do some work, and wait for me to get there. (This is Sunday morning, remember.) I drove up with my husband. While mom was out getting a test, Dr. P. sat across from us and answered the next zillion questions I'd come up with since we'd last spoken.

Monday at noon, I walked with mom through the pre-op process, and finally let go of her hand as she was wheeled into the OR. The surgery was supposed to take three hours. Six and a half hours later, Dr. P. (who's been in the OR since 7 AM; it was now 6:30 PM), came to my mom's room, where I was awaiting word. He told me things in the OR had gotten tricky. He pulled mom's films up on the computer, showing me the area of tumor he'd cut out. How he'd had to tease the cancer tissue off of the nerves that feed her legs, and allow her to walk. He showed me the metal pins and screws he'd had to use to shore up mom's vertebrae-- because the bone had flaked when he touched it. Mom was now in the ICU, he said, on a ventilator, at least for overnight, because her blood pressure had been funky during the whole procedure. Could I go see her? Yes, he said, I'll walk you there.

So we walked...through the crazy labyrinth of corridors you find in urban hospitals, to the ICU, where Dr. P. went in ahead of me, made sure mom was settled, and then brought me in. He answered a couple more questions. He had to leave town for a few days, he said, but would be guiding Mom's care through his colleagues, and I could text or call him. He left. It was nearly 8 PM.

The days turned into weeks, and mom struggled, but was recovering as well as we could hope (strong Dutch genes). I did text Dr. P. about concerns along the way, several times. From wherever he was, he made things happen, things that needed to happen. 

We had to reschedule mom's follow-up visit with Dr. P., because of a snafu on our end. He texted me a question: What rehab hospital is your mom in? I texted back and got no response.  The next day, I went in to see mom. Guess who came to see me last night? she said. Who? I asked. Dr. P.!, she said. He came last night around 9 o'clock.  Really? I said, did he come to check your incision? I was thinking, how nice...he did the re-check here, saving her the trip. No, she said, he didn't examine me. He came on his way home from the hospital, and just sat on the bed next to me, and held my hand, and asked how I was doing. We just talked, for about half an hour.

That doctor is Dr. Mark Palumbo or Providence, RI. He doesn't wear a superhero costume, and I doubt he can walk on water. But he is a great doctor, and a Superstar human being.

As a patient advocate, I've seen the best and worst medical outcomes. My dad died in the hospital at 76, but my older brother was saved three years ago in that same hospital after surgery for a grim cancer diagnosis. I know mistakes happen in hospitals, and harm occurs, because trying to fix that is the stuff of my work these days. I understand a lot of the harm happens because there are so many hand-offs to a variety of staff, and tasks that providers are juggling, and that perfection isn't attainable. But the biggest asset of a hospital-- the biggest determinant of good care-- is the people who provide it. Doctors like Mark Palumbo, and Mary Ann Fenton (mom's oncologist) and Dr. Tom DiPetrillo (radiation oncologist), and the many, many kind nurses and staffers who've touched my mother's life and helped our family, humble me with their compassion and kindness.

Yes, it's something of a miracle that six weeks after her surgery, mom is in less pain than before, and can actually take a few steps without a walker. She is on track to take us up this month on our Christmas gift to her: her first cruise, along with me and my two daughters. She's hoping to find a bridge game while on board.

What do you-- can you-- say to the people who saved your mother's life?


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Posted in doctor, hospital, mark palumbo, Mary Ann Fenton, mom, patient safety, physician, Thomas DiPetrillo | No comments

Friday, 1 March 2013

Humoring Cancer

Posted on 14:11 by rajveer

These are the everyday sentences that gravitate my way and my replies.  

1.     Your strong
Like most people I’m a brilliant actor.
2.    You look better now than you did last month…
Hmm! I do believe you said that last month. Do I sense a white lie?
3.    You should be taking it easy…
Yes, but I need to breath too
4.    So does this mean you’re done?
Well the oncologist thought I was, but I keep going back because I love her bedside manner.
5.    I like your hat
Yeah I'm auditioning for the new Hovis advert



6.    My Aunt had cancer and died
Sorry to hear about that, but I’m Sarah Mendoza and I'm very much alive.
7.    How do you cope?
I don't... do you?
8.     I don’t know what I would do if someone cut my breasts?
Well I don’t think you’ll have much choice it is that or pushing up the daisies.
9.     I like your attitude
Tell my husband that 
10. I have breast pain what do I do?
Why are you stood here talking to me get to your GP and get it checked?

And I do hear some of these sentences over and over again and my replies remain the same... 
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Posted in Being Pro-Active on Breast Cancer, Cancer humor | No comments
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