One Year Post Mastectomy

Fanfare please!

It’s been one year since my bilateral mastectomy.

It seems like an appropriate time to post an update on my recovery and to reflect on what’s helped, what’s hindered and what needs to happen during the next year.

There will be photos, so if you’re squeamish about scars then best skip this one.

The short version; I feel great. Lately I’ve actually been feeling well, really well, for the first time since my surgery. I’m amazed by the body’s ability to heal and surprised at how long it’s taking.

If you’d asked me just after surgery how long I thought my recovery would take I would have guessed three months or so. Even one whole year later there’s still a little way to go before my body is done.

This is important.

There have been times during the last year when I’ve thought, ‘Is this as good as it gets?’ It seems to me that healing will happen for a while and then there will be a plateau where nothing much changes. I’ve come to think of these plateaus as the body taking a rest from the hard work of healing.

The whole experience has been an opportunity for me to take a hard look at my life and my habits. I suspect there are people whose recovery is passive. They wait and hope, trusting that whatever medical treatment they received will do all the work for them.

It’s been my long experience that recovery from anything needs to be active. We can support or hinder our recovery with some very simple choices, like what we put in our bodies, how much sleep we get and how much stress we’re prepared to tolerate.

I’ve been actively participating in my recovery.

I’ve cared for my skin, particularly the site of my surgery, by using a body oil after my shower. I’ve also taken care of lymphatic drainage from my left side by using gentle massage throughout the day. This area has had a lot of damage following three surgeries and radiation. While I haven’t had any signs of lymphodema, I see regular lymph drainage as an important preventative measure. I’ll be doing this for the rest of my life.

I’ve lost weight using The Fast Diet. My doctor recommended this because there are statistics showing that excess weight can contribute to breast cancer risk. Fasting also triggers autophagy, the body’s natural mechanism for cleaning up dead and damaged cells. Anyone whose experienced triple negative breast cancer knows that we don’t have any of the new ‘wonder drugs’ available to us. Fasting seems like the best thing I can do to prevent recurrence. I’ll be doing this for the rest of my life.

Yoga has probably made the single greatest contribution to my recovery. I do at least one class a week (two when my husband joins me) and I practice at home every day. When I wake up in the morning I get dressed in my yoga gear. I have coffee and check my messages and daily schedule and then it’s straight into yoga before breakfast. I’m able to do things with my body that I couldn’t do before I was diagnosed. Of course the point of yoga is not to twist your body into increasingly difficult poses. Yoga is about integrating the mind, the body, the spirit and the breath. Yoga has helped me to love my post-cancer body and to feel strong and flexible, mentally and physically. I’ll be doing this for the rest of my life.

Massage has also been a big part of my recovery. I found a local massage therapist with specialist oncology training. As well as regularly helping me to move back into my own body she’s gently massaged my surgery site and this has greatly assisted in settling all of the nerve pain and helping me to regain sensation in that part of my body. It’s also deeply relaxing.

I was eating fairly well before diagnosis and treatment has been an opportunity to review what goes on my plate. We’re shifting towards more and more vegetarian meals. I rarely eat gluten any more and I feel better for it. I’m naturally eating less food thanks to The Fast Diet and the impact on my appetite. We’ve adopted the SLOW principles as much as possible; Seasonal, Local, Organic, Wholefoods.

I’m eating much less sugar and finding that I can’t eat anything really sweet anymore. I suspect this is because fasting has killed off the gut bacteria that trick my brain into wanting more sugar. The recent discoveries in relation to the gut biome continue to fascinate me. I’m sure we’re only just beginning to understand how important this work is for our future health. It’s certainly a strong motivator to avoid processed foods with all their additives and preservatives that prevent bacterial growth.

Thanks to a couple of visits with a psychologist with ACT (Acceptance Commitment Therapy) training and Russ Harris’s books on the subject, I’m now very clear about what’s important to me, what I value and what I want my life to stand for. To celebrate my one year anniversary I’ve enrolled in a permaculture course. There are those that would argue I don’t need this training because I’ve been practicing permaculture all of my adult life.

My friend Cecilia challenged me to ‘become a world famous permaculture teacher’ which is what motivated me to finally enrol. She’s clever. I don’t really need to become famous (nor do I want to) but I really do want to teach the skills I’ve been practicing for so many years. Permaculture is simply the best way to be human and the map for the survival of our species.

One of my favourite quotes has always been ‘Be the change you want in the world’. When I was a teenager I looked at a photograph of the planet from space showing all of the lights of civilisation and spontaneously thought ‘human cancer’. I was distressed by the damage we were doing to the planet and a sense of helplessness. For me, permaculture holds the key to healing humanity’s cancerous impact on the planet. It’s probably going to keep me well too.

So here’s my latest photos.

As you can see, I’ve come a long way since surgery.

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My chest has gone from being almost completely numb to almost completely recovering sensation. I still have numbness along the scar lines and there’s an area of nerve damage above my original surgery scar (that’s the little arc high on my left side). Nerve damage feels like electricity under the skin. It’s continued to improve with massage and I’m hopeful that it will eventually disappear.

My chest still feels a little tight, as if I’ve got a large sticking plaster on it, but this has improved and I believe it will also vanish in time. For most of last year I felt like I was wearing an undersized bra (how ironic) and the tightness extended all the way across my back. That’s resolved now and I only have my chest to deal with. Yoga and massage both help with this.

I still need to remember to keep my shoulders back and to hold my body up. My doctor tells me it’s common for mastectomy patients to develop a stooped back and rounded shoulders. I suspect this is a combination of relieving that sensation of tightness and, perhaps, embarrassment at having no breasts. I regularly roll my shoulders up and back, particularly when I’m at the computer.

My neck has taken a while to adjust to the absence of two F cup breasts. Removing close to two kilos of weight left my neck and shoulders in a state of shock and once again, yoga and massage have helped. A friend showed me this neat trick; point your index finger at the sky; now bring your finger so it touches your chin and the tip of your nose; push back until you feel your neck is back in alignment. You can also push your head back firmly into a pillow when you’re in bed, or the head rest when you’re in a car. This simple exercise has had more impact on my neck pain than anything else.

As for the other side effects from treatment, I’ve also seen big improvement. I rarely experience any peripheral neuropathy in my feet. I still wake with sore hands but they warm up quickly. I need to be careful with any activity where I hold my hand in the same position for any length of time, such as drawing or sewing. My hands tends to cramp up and become painful. I haven’t given up on my body’s ability to regrow nerves. While one doctor told me I’d probably be stuck with whatever I had at twelve months post chemo, another said it can take six years for nerves to regrow. I’ve already had improvement since my twelve month mark so I’m going with option B.

I have a mild hum in my ears. This is probably also chemo related nerve damage but it could just be age. My Mum has age related hearing loss. It’s important to remember that not everything going on with our bodies is related to treatment. I don’t have that awful metallic taste in my mouth any more and I think this is also a form of peripheral neuropathy. Food tastes wonderful again, particularly straight after fasting.

I wonder to what extent the fasting has promoted healing. The science indicates that it should make a difference. In early days, I certainly noticed more rapid healing following a fast. I’ve observed that if I have any kind of skin blemish it’s usually completely healed after fast day.

As you can see from the photos, the radiation damage to my skin has greatly improved. As well as the circulatory benefits of massage, I think the regular application of rose hip oil has made a huge difference.

As you’ve probably already guessed, my mental state is great. People recovering from mastectomy are, not surprisingly, at high risk of depression. I’m very grateful that the care I’ve received and the work that I’ve done have helped me to avoid that particular complication. In many ways, depression is a worse disease than cancer and certainly at least as deadly. I think avoiding depression has involved a combination of things but particularly the information about ACT, practicing ACT and the benefits of yoga.

The most significant contribution to my state of mind has been the love and support I’ve received from so many people. Special mention must go to my beautiful husband who has continued to love and cherish me through all of this. I’m still beautiful to him. It’s an enormous advantage to have someone like that in my life and I grieve for those women that go through this on their own, or whose partners leave them during treatment.

I no longer experience ‘chemo brain’. I feel as mentally alert as I ever did. I’m also calmer, happier and less stressed than at any other time in my life.

I’m now taking stock and asking ‘What else can I do to continue with my recovery and to improve my health?’ I’ll also be doing this for the rest of my life. I believe that there is no upper limit to how well I can be. To put it another way, no matter how well recovered our bodies seems to be, there is always more we can do to improve our health.

Thanks to everyone that’s been following the blog and the accompanying Facebook page. Special thanks to those that have taken the time to let me know that something they’ve read has helped them with their own recovery. You’re the reason I keep writing.

Go well. Live well. My best wishes for your continuing recovery.

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Don’t Say Don’t And Ban The Bullies

Sometimes there’s a confluence, an influx of information that all seems to resonate. I’ve had one of those weeks.

It started with this thought:

What if, the next time you went to see your doctor, they told you that no matter what you did you would never weigh less than you do today? What if your doctor said you had some rare metabolic condition, so it was possible for you to gain weight but not to lose it. Ever. You could become fitter and better toned through exercise. You could improve your health and the appearance of your skin, hair and eyes with diet, but you could never, ever lose weight.

What would change?

My thinking around this issue started with last week’s post about The Fast Diet. While I’ve had great success with it, I think the key to sticking with it started before I read the book. I decided to love my body exactly as it was. I decided to abandon negative self-talk and criticism and to focus on what I loved about my body. At the time I was dealing with an extra six kilos as a consequence of treatment. Contrary to popular belief, cancer treatment doesn’t make everyone thin! I was also carrying the same ten kilos that I gained during my pregnancy over twenty years ago.

I can remember what triggered my shift in attitude. I saw photographs of myself from a night out with my family. I thought, “Oh no! Look how fat I am!” I had gone out feeling great and thinking I looked stylish and when I looked at these images all I could see was a huge, middle aged fat lady in a sequinned top. I cried. Then my daughter said, “Oh Mum! Please stop being so hard on yourself. Your body is fighting cancer! That’s enough for now. You can worry about your weight later.”

My daughter is very wise. This isn’t the first time she’s shifted my thinking. I realised that I’d been indulging in the worst kind of bullying. I had been speaking to myself in a way that I would never, ever speak to someone else.

I stopped beating myself up. I started noticing what I liked about my body. What I liked most of all was how aggressively my body pushed back against the cancer. During chemotherapy my doctor was amazed by my blood work. During radiation my skin held up under the onslaught and my mind pushed back against the overwhelming sense that I was now a commodity to be farmed, like a sack of potatoes on a conveyor belt. (The barcode they gave me at the clinic didn’t help.)

I kept up my yoga all through treatment and noticed the difference in my energy levels when ever I would spend time on my mat. Slowly, slowly as I recovered from treatment I found a new strength and flexibility. My yoga teacher, Emma, reminds me to “be in the body you have today” and to recognise that the body I am in tomorrow will be a different body. This was a powerful message to me when I was dealing with the long term side effects of chemotherapy, radiation and surgical removal of both breasts.

This week, Emma and I had a coffee together and she remarked on how far I’d come. I was told I’d have permanently compromised range of movement in my arms. I don’t. I was told that the arthritis they picked up in my bone scans would mean a life-long requirement for daily pain relief. It doesn’t. Lately I’m noticing how well I’m feeling.

People sometimes comment on how well I coped with the mastectomy. I suppose I just accepted it. I grieved. And then I moved on. It is what it is. I don’t look in the mirror and wish I had breasts. I look in the mirror and think about how amazing it is that I’m still alive. I think about all that my body has been through and how amazing it is that, in spite of all that, the body wants to heal. We are all programmed for good health. I will never have breasts again by my body has done everything possible to work around this massive surgery.

This week I’ve been reading articles about climate change and how, if we want people to understand that crisis, we need to talk about the kind of future we could have in a positive way. Scare tactics just send people in the opposite direction. Nobody wants to bullied or terrified.

I’ve also read an article about the sub-conscious mind and an author’s theory that it can’t understand a negative statement. His theory, essentially, is that when you say “don’t eat chocolate!” your subconscious hears “Eat chocolate!”. His cure for insomnia is to stop saying “I can’t sleep” and to start saying “When I go to bed tonight I’m going to have a deep and restful sleep” because your subconscious will agree with either statement. So if you say “I can’t sleep” your subconscious says, “Okay.”

It’s an interesting theory. Perhaps it’s even simpler. Perhaps it’s just that we all respond the same way to negativity, bullying and catastrophising. We push back.

When I made the decision to love my body exactly the way it is, it naturally followed that I wanted to feed my body well. I wanted to make sure I ate healthy food, avoided alcohol and looked for ways to maximise my chances of living a long and healthy life. I didn’t start The Fast Diet to lose weight or because I was ashamed of the way I looked. I started it because I was convinced by the research that it would help me to prevent cancer.

I’ve always considered myself a work in progress. Over the years I’ve broken bad habits (even that language is interesting), I’ve improved my mind, I’ve become more tolerant and compassionate and I’ve come to feel more and more comfortable in my own skin. Looking back, I can see that change usually happened because an idea was compelling, a truth was apparent or because someone close to me kindly and gently invited me to change. My failures have all included attempts at bullying, either internally or externally.

Nobody likes to give a bully what they want, even when they are the bully.

So I’m heading off to a yoga retreat for some self-nurturing and some time with one of the wisest people I know. We’ll eat healthy food, stretch and breathe and delight in our bodies and return home refreshed and recharged.

It seems to me that being positive has a much deeper meaning than the way it is commonly understood. If we’re going to achieve any lasting change we need to frame it in a positive way. “I will eat nourishing food” is far more powerful than “I won’t eat sugar”. “I will devote some time each day to being physically fitter” is far more powerful than “I will lose weight.” It’s a lot more enjoyable to achieve something than to avoid it.

So back to my original proposition. What if your doctor told you that you could never lose weight? I think the answer for most of us is that we would accept the diagnosis and start focusing on what we COULD do. We’d eat well and enjoy our food without self-recrimination. We’d abandon self-bullying diets and adopt the kind of eating pattern that included a few treats while emphasising sound nutrition. We’d exercise for the pleasure of it, enjoying it for its own sake without jumping on the scales to see if we’d dropped weight.

This is just a thought exercise but a lot of us have already had some practice. My breasts aren’t growing back. I have chosen not to have reconstruction, but those that have chosen it tell me that they still need to accept that their bodies will not be the same. We know that if we’re going to overcome what cancer has done to us, then acceptance and loving the body we have right now is part of it.

So this is my invitation to love your amazing, wonderful body. Think about all of the extraordinary things your body achieves every single day. Listen to the way you talk to yourself and apply this simple test; if you said that out loud to someone else, how would they respond?

Cancer and Yoga

I’ve wanted to write a post about yoga for a long time. I keep running it around in my head, trying to find something compelling to say about it. The trouble is that I can remember what my attitude used to be to people that tried to convince me to try yoga. They often seemed evangelical. I wondered how anyone could get that excited about an exercise class.

Now I laugh at my own ignorance. Yoga is so much more than an exercise class but I don’t expect you to take my word for it.

I suppose the best thing to do is to just tell my story.

I really do hope that, after reading this, you go and try out a few yoga classes and that you go for long enough to get over the perfectly natural embarrassment you feel when trying something new. I honestly believe it will be worth it. And if you don’t, that’s okay too.

I started yoga about five years ago, before I’d been diagnosed with cancer. My friend, Trish, says that everyone in a yoga class has a back story, many of them involving chronic illness or mental health issues, but my reasons for starting were much simpler; I couldn’t stand on one leg.

I’d joined the gym and one of the staff was studying to be a personal trainer. She asked if I’d like a free fitness assessment. When she tried to check my balance I was shocked to discover that I couldn’t keep one foot off the ground for longer than a few seconds. She told me that loss of balance is common as we age and one of the reasons elderly people have so many falls. I was in my late 40’s and hardly geriatric. She recommended yoga.

I’d been diagnosed with fibromyalgia many years before. It’s a chronic pain condition that feels a lot like that ache you get when the flu is about to hit you, or, ironically, like the ache you get if you overdo it at the gym. When I explained this to Emma, the resident yoga teacher, she told me to find my ‘intelligent edge’, not to hurt myself, to practice non-violence towards myself. I spent about half the class in a position called ‘pose of a child’.

But I kept going.

Thoughts of broken hips and walking frames motivated me. For the first month or so I felt like this:

funny-cartoon-fist-time-yoga

I love this cartoon. I think it sums up beautifully the reasons why a lot of people give up on yoga. It can be intimidating to be in a room full of people that seem to be able to bend themselves like pretzels. Then there’s the weird Indian names for positions and the weird Indian music. Although I did very quickly come to find the music surprisingly relaxing. My friend, Dayasaga Saraswati (yes, she teaches yoga) tells me that the Indian view of music is spiritual and that they believe it can resonate with us at a subconscious level to promote good health. I’ve come to believe they are definitely onto something.

After about two months I finally made it through a class without having to rest or stop and look at the teacher every fifteen seconds. I felt a small sense of triumph and then remembered that a yoga class is no place for ego. Emma often says ‘Honour the body that you’re in today. It’s a different body to yesterday. You’ll have a different body tomorrow.”

After about three months I found myself really looking forward to Thursday morning yoga classes. I had my own favourite spot on the floor. I was on smiling and nodding terms with a lot of the other regulars. Best of all, I could now stand on one leg. I could also stand on one leg, hold the foot of the other leg with my hand, make a mudra with my other hand and bow forwards in a dancer pose. My body felt energised after classes. Without thinking about it, I naturally started to eat better and to appreciate my body. I could now bend and balance in ways that I didn’t think would ever be possible.

I also noticed that I’d stopped worrying about how I looked or what anyone else in the room was doing. My mat had become a kind of magic carpet. When I stepped onto it I was fully present. When my mind started to drift I would gently pull it back onto the mat. I felt as if I had moved back into my own body. I started noticing that this state of mindfulness stayed with me after class. I would find myself fascinated by mundane tasks and deeply appreciative of special moments. I spent a lot more time in the present and a lot less reflecting on the past or planning for the future. Yoga had done this:

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One day in class, Emma made a comment about incorporating something into home practice. Home practice? You mean one class a week wasn’t all the yoga I needed? Emma and Dayasagar both told me that even five or ten minutes of yoga a day could be life changing. At the time I thought it was highly unlikely that such a small investment of time could have such impressive returns, but I figured it would probably help me to manage my fibromyalgia pain and to stay fit and flexible.

Starting home practice was just like starting class. I was back to feeling awkward and self conscious all over again. I’d do half a dozen cat stretches and then wonder what to do next. I decided to build my home practice a bit like the way we used to learn dances at school. Start at the beginning and just keep adding bits on. I eventually settled into a steady practice that included plenty of different poses. I tended to stick with this basic pattern, occasionally adding in something from that week’s class.

Over time my morning yoga became as essential to my day as my morning shower. I figured out how to pack an old yoga mat into luggage when I travelled. Friends booked a weekend away and kindly made sure there would be somewhere for me to practice.

I realised that yoga had become an essential part of my life. I was feeling fitter, stronger and happier than I could ever remember feeling. My fibromyalgia didn’t vanish, but I was in less pain less often and I could modify class according to how I was feeling. On one occasion when I’d had a serious relapse I turned up at class and burst into tears. “I’m right back where I started!” I told Emma. “It’s okay,” she told me. “You’ve been here before and overcome it. Just honour the body you have today.” To our mutual surprise I managed a whole class. Yoga had conquered fibromyalgia.

Then I was diagnosed with cancer.

My first class after diagnosis was difficult. I knew I’d cry when I saw Emma. I knew I’d be in that uncomfortable position where some people in the room knew something incredibly personal about me while most had no idea. I wondered if I’d be better off giving up class. By the end of that class I knew I had to keep coming. I still had cancer but the fear and horror of my diagnosis had settled. I felt calm. Ready. This is the body I have today and it has cancer. But I’m still here. I also knew that I had to practice non violence towards my own body. I would not bully myself or beat myself up over my cancer diagnosis. I accepted the reality. I resolved to breathe into my diagnosis, to make room for it and to accept it.

When my hair fell out the whole room could see what was going on. People that had smiled and nodded all those years started to talk to me, to ask how I was going, to tell me they thought I was brave or inspirational. As chemotherapy progressed I considered giving up class, concerned that I might pick up a cold. Most people don’t know that a head cold can kill you when you’re going through chemotherapy. Instead I chose to bring a can of disinfectant spray and to use that to create my own little decontamination zone. Friends knew not to kiss or hug me. Class went on. I went back to spending half of it in pose of a child because of the fatigue but I always came away calmer, stronger and feeling at peace. Yoga was a weekly reminder that my chemo ravaged body wasn’t permanent. I would come through this.

Home practice was one of the most beneficial things for dealing with chemotherapy. I would roll out my mat and start with cat stretches. I would immediately feel my energy start to rise and my distress start to dissipate. Some days I would feel to sick or tired and my husband would remind me, “The days you least feel like yoga are the days you most need yoga.” So true.

In the middle of chemotherapy I developed a fever and nearly wound up in hospital with neutropenia. I dodged that bullet but had to miss two weeks of classes. Emma kept in touch via Facebook. Home practice became more important than ever.

Following my first surgery the Breastcare Nurses commented on my extraordinary range of arm movement. I’d had a slice taken out of my breast and a string of lymph nodes removed and I could put my hands into reverse prayer position behind my back. When they showed me the physiotherapy exercises and advised that I work up to them slowly I demonstrated my ability to do all of them and asked when I could get back to class. Three weeks later with the wound carefully taped I was back doing a modified version with Emma’s support and advice. Five weeks later I was back doing a full class. That’s what yoga can do for you.

When the radiation clinic asked me what time would suit me for my six weeks of daily zaps I made sure they didn’t clash with yoga class. My husband was so impressed with what yoga had done for me that he started going to a Monday night class and I went with him as often as possible. After radiation I missed two weeks while my skin became raw but as soon as possible I was back on my mat.

When I got the news in July this year that the cancer had come back and I would need a mastectomy it was yoga that helped me more than anything else. Practice non-violence with my own body and accept what is. This is not the body I will have a month from now because that body won’t have breasts. But it will still be my body.

When I was offered reconstruction one of the critical factors for me was my return to yoga. With reconstruction, my surgeon thought I would probably need to stop all yoga for at least three months and as long as six months, depending on how well I healed. Without reconstruction I could probably be back at class in about six weeks. This is the point at which I really understood how essential my yoga practice had become to me. The thought of not being able to do yoga for six months was distressing.

I realised that yoga, for me, had become so much more than standing on one leg. I had become calmer, kinder, less judgemental. I had noticed improvements in my balance, flexibility and posture, which you would expect but there were also subtle and unexpected consequences. I realised that part of the legacy of my policing career was a tendency to hold my breath, or to breathe in a very shallow way. If you’re doing a warehouse search for an armed offender this is a good skill to have but to do it on a regular basis starves your body of oxygen. There’s a reason yoga instructors include advice about inhaling and exhaling. My sleep improved. My mood improved. I was healthier and happier, even while I had cancer.

Following the double mastectomy in August this year I was still able to put my hands into reverse prayer to the amazement of the nursing staff. One of the old, wise nurses said, “We get two kinds of mastectomy patients. Those that do yoga and those that don’t.” While other patients lay in their beds and watched television I started walking laps of the ward. Forbidden yoga for a couple of weeks I still felt the need for some kind of exercise.

I returned to a modified daily practice as soon as I was released from hospital, nine days after surgery. My doctor cleared me for class after three weeks. I’ve been back ever since.

I am certain that yoga, and Emma’s class in particular, has made an enormous contribution to my acceptance of life without breasts. This is my body and I love it. I am strong, flexible and grounded. Thanks to yoga I also have pretty good legs for a woman in her 50s! I haven’t felt the need for prosthetics and part of that is the complete acceptance of my new body.

One of my yoga friends, Jan, is naturally flat chested. Before my surgery she told me we’d be flat mates. What a wonderful thing to say. Funny that I’d never even noticed she was flat chested until she pointed it out, and that was a reassuring thought too.

There are no words to fully describe what yoga has done for me. Some of it is beyond language. It is deeper. It’s like trying to describe great music, or love, or the colour blue. Sometimes you just have to experience something for yourself. When it comes to explaining yoga, words are like a documentary about Australia. The documentary can show you images of the country but that’s nothing like travelling here, meeting the people and seeing the land. Yoga is the same. If you do it, and keep doing it for long enough, then you understand.

Yesterday I managed a yoga move I’d never done before. It’s difficult. It’s a side plank, which requires me to support my body weight with one arm, followed by a move where I put the top leg behind me and arch my back. I was momentarily pleased with myself and then I remembered that yoga class is no place for my ego. That was yesterday’s body. Cancer has taught me that anything could happen. My body might be very different next week. Even so, I can now say that for the moment, I am officially fitter than I was before the mastectomy. I am also able to support my body weight on either arm. Please think about that for a minute.

I keep trying to thank Emma. She pushes back. “It’s not me. It’s the yoga.” Yes, it is the yoga and it’s also having a teacher that creates a safe space, where I can be weak and ill and full of pain and still welcome. It’s about weaving the philosophy of yoga into each class so that it gently shifts my own thinking. It’s about being a living example of everything she teaches, including humility, which I suppose is why she doesn’t accept any credit.

So this post is for you, Emma. It’s my way of attempting to express the profound impact your classes have had on my life. Thank you. My cancer treatment would have been so much harder without yoga. My life would be so much poorer without yoga and all it has given me. Namaste. You have my deep gratitude and sincere love.

And for everyone else, please consider trying yoga. Not just one class, which I promise will leave you feeling awkward and embarrassed, but try it for a few months. You might just find that it opens up a treasure chest of benefits and even if it doesn’t, at least you’ll be able to stand on one leg.

 

 

 

 

Two Months Post Mastectomy

WARNING: This post includes photos of my surgical scars. Please skip it if you don’t want to see them.

It’s two months today since I had my bilateral mastectomy. I thought I’d make a record of what’s going on physically and emotionally.

I’m healing well. The small scar from my previous (and now ironically named) breast conserving surgery has finally healed although it still looks a little fragile. The two mastectomy scars have healed well. The one on my right side was the healthy breast and that tissue wasn’t damaged by radiation therapy, so the scar is fine and flat. As you can see in the photo, large breasts mean long scars and mine head off under my arms. There’s still a bit of swelling under the scar but most of the fluid that built up (called a seroma) has been reabsorbed. I’m not sure if that bulge you can see under the scar will be permanent. It feels quite hard and might soften over time.

The left breast (also known as the evil breast) was subject to radiation and two prior surgeries and it’s not as neat. Please note these shots are ‘selflies’ using a mirror so things might seem back to front. I’m sure you can tell which breast is which from the photos. The left side has got quite a large lump under the arm, and some puckering just to the side of it. I’ve been assured that this is all ‘normal’ and that compared to a lot of post-radiation mastectomies, mine is one of the good ones. That makes me shudder. The smaller scar is from the breast conserving surgery that discovered the invasive cancer. It was unstable for a while but it seems to be healing well now. This side continues to have weird sensations, a bit like mild electric shocks along with the occasional sharp pain. This is also normal but I’m curious as to why I haven’t had any of these sensations on my right side.

Because of the radiation to this side the skin is weaker and will stay that way for over a decade. The pores look larger and the whole area is discoloured. You can see there’s a couple of odd red patches. Although it looks painful, it isn’t. Because of the nerve pain associated with this type of surgery the most uncomfortable spot is actually the middle of my back.

I’m massaging the scars and the bumpy bits regularly with plenty of rose hip oil or hemp oil. This will help to smooth things out and to minimise the scars.

It’s stating the obvious that none of this is pretty. I am very (VERY) fortunate to have had the love and support of my husband who continues to declare me beautiful, even when I’m naked, and who has no qualms at all about touching my scarred chest. I think that this has had more impact than anything else on my emotional recovery. I know some women don’t even want their partner to look at their scars, let alone touch them, but for me this has helped me to feel just as beautiful as I did when I had breasts. Beauty is not just in the eye of the beholder. It’s also a gift that one person can give to another. If he can look at me and see beauty then so can I. Simple.

The whole area has been numb to touch since surgery but now I’ve got some sensation returning. I’m told that I’ll eventually have good sensation again. Time heals. I continue to be very happy about my decision not to have reconstruction. Tissue transplant involves microsurgery to connect the blood supply but they can’t connect the nerves so although the ‘mounds’ they give you are warm and soft to the touch you can’t feel it. I like this better. I also like that my tummy is intact.

When I look at these photos I wince. They look so brutal. I don’t feel brutalised and most of the time I forget I’ve even had a mastectomy. I can still feel my breasts, and my nipples. I’m told some women find this disturbing. I see it as my body’s way of helping me cope with the loss. I suppose the phantom breasts will fade with time as I become more and more accustomed to life without them. I want to caption them; “Not as bad as they look!” I post them to help other women facing this type of surgery. I found similar photos from other generous women really helpful. I’ll post updated photos as I heal.

As the weather warms up I really am enjoying the freedom that comes from not having breasts any more. I do not miss bras. The sundress with shoe string straps that used to be confined to my home now gets worn out, although I do need to be careful bending forward in it. I’ve discovered that wearing my singlet tops backwards stops them from being too low in the front. Because I can see my tummy when I look down, I’m standing straighter and paying more attention to what I eat. I was 86 kilos during chemotherapy. Contrary to popular belief, not everyone gets thin and wasted. The steroids make you gain weight. I’m now down to 78 kilos and well on the way to 75, which I consider to be my best weight.

Although now that I think of it, I probably need to revise that down to 73 to allow for the two kilos I’ve had surgically removed.

After the drama with the gabapentin prescribed for the nerve pain in my chest, hands, feet and legs (it made me think that suicide was a really sensible option) my doctor prescribed Tegretol (Carbamazepine Sandoz). I took it for three days and it had no impact on the nerve pain but it did make me feel like I was stoned. I hated it. My nerve pain was at very low levels prior to my surgery so recovery without drugs is theoretically possible. I’ve decided to put up with it and see if it improves rather than take these horrible drugs. They all come with a long list of awful potential side effects.

The same is true for the NSAIDs prescribed for my lower back pain. It’s really only a problem at night and eases as soon as I do my yoga in the morning. I’m considering an electronic bed so I can sleep with my legs elevated but they’re expensive. I’ve tried using a pillow under my knees but it shifts around during the night and doesn’t seem to help. I’ve tried several different kinds of mattress topper without seeing much difference. Memory foam made things worse and it also has a smell that’s a cross between a swamp and a chemical factory. Something that was supposed to be latex felt harder than the floor. At the moment I’m using one of those ‘egg crate’ toppers made with foam and it’s not bad. I wonder if the Mater Hospital would let me come and stay a couple of nights on one of their beds so I can determine if it was that or the heavy pain medication that made such a difference during my admission. No. Probably not.

All of the NSAIDs I’ve been prescribed, including Naproxen and Feldene, come with warnings that they may cause bleeding into the stomach and that they should not be taken by anyone who has previously had a stomach ulcer. That would be me! What was my doctor thinking? I need to go back and have another conversation about pain relief. I also make the observation that it’s up to all of us to check and double check everything we’re prescribed. Doctors are human. They make mistakes. Sometimes they’re working too hard and sometimes, just like the rest of us, they have a lapse in concentration.

I am now certain that my surgeon made a mistake when she left the marker clip in my breast during my first surgery. It was interesting that one of the doctors at the imaging centre essentially tried to cover for her when I went back to have a marker wire inserted before the second surgery. For a while I thought it had been left in on purpose but the clues have been there. The last time I saw her she made a point of telling me that there was new research into triple negative breast cancer showing that having a mastectomy as the first form of treatment (rather than chemotherapy) led to worse survival rates. I knew this. I keep up to date with the research. I said this to her:

“Kylie, I want you to know that I am very happy with the treatment I’ve received. I know that having chemotherapy first was the best thing I could have done. I know that it would be easy with hindsight to say that we should have just gone with a mastectomy but it was worth trying to save my breast. We couldn’t have known the cancer would come back. And you’ve got to stop beating yourself up about the clip!”

She replied, “I do beat myself up.:

I said, “I look at it this way. If you hadn’t left the clip in then we probably would have been happy with a biopsy when the one year scans picked up something suspicious. Because the clip was there you decided to do another surgery and because of that we picked up invasive cancer at one millimetre. A biopsy probably would have missed it. I know you didn’t mean to leave it in there but it’s probably a really good thing that you did.”

This is honestly how I feel. We both missed the part of the original pathology that clearly mentioned the absence of the clip. At the time we were both focused on the unexpected ductal carcinoma in situ that was under my remaining tumour. It’s all good. Did the clip have anything to do with the recurrence? Who knows. If it had been taken out with the original surgery would I have still had recurrence? Who knows. This woman is one of the finest breast surgeons in the country. I do know that. I worry that the fear of litigation makes it harder for doctors to admit their mistakes and that creates a risk for all of us. If you can’t share information about what went wrong you can’t learn from each other, or even from your own mistakes.

I used to see the same attitude in policing. We were often expected to be super human. Mistakes attracted media criticism, judicial sanction and sometimes a loss of career. Humans will be humans. Mistakes are inevitable. Creating environments where we pretend otherwise is dangerous and unrealistic.

My strength is returning. The aches and pains are annoying but I’d had fibromyalgia for years before all of this so living happily with chronic pain is my forte. It’s likely that some of what I’m feeling is fibromyalgia. It’s triggered by trauma. I’m pretty sure I’ve just experienced a bit of that.

I’m back at my regular yoga classes and I’m only modifying the back bends. Everything else is fine. I usually need to take a few more rests than I did before surgery but I’m doing well after only eight weeks. My range of movement through my arms and upper body is excellent and I’ve only got one tight area left that needs a bit more work. If you put your arm straight out from your shoulder, move it up to about 45 degrees and then try to move it backwards you’ll have found my sticking point. Now if you move your hand in a circle about the size of a large mixing bowl you’ll have defined it. Pretty good really, given that many women have permanently restricted movement. I’m certain this is down to my yoga.

I’m also back into my neglected garden and moving mulch like a human wheelbarrow. It’s very satisfying and a great way to rebuild my strength. It’s spring, so the blossoms are glorious and it’s a great source of joy to be out there with the worms and the soil and fine weather.

Most of the time my mood is great. I am just so happy to be alive. You know those times when you’re driving and you almost have a serious accident but somehow, you JUST miss it? I’ve got that feeling. A little to the left of here, a smidgen to the right of here, and I wouldn’t be here at all. I’d like to write some more about how coming so close to dying can have such a profound effect on living, but not tonight.

I do think about the cancer coming back but it’s not a frequent or particularly troubling thought. I am the sky. My thoughts are the weather. Everything passes with time. I’ll write some more about dealing with fear of recurrence another time. Anyway, here’s the photos I pr0mised:

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As I said, not as bad as it looks.

Next week my husband and I are off to beautiful Palm Cove in far north Queensland. I’ve told him this is his holiday. We’re going to do anything he wants to do. It’s spring so, just quietly, I’d rather stay home and work on my garden. But he’s had a rough time for just over a year now. His wife’s had cancer. He seriously needs a holiday.

 

Silicone, Scarves and Singlets

When the breast care nurse brought me some samples of silicone prosthetic breast in hospital I juggled them. We laughed, and I told her I really just wanted to put something on my Facebook status about juggling breasts.

They are heavier than I thought they would be. Of course, if I had only had one breast removed then having something that weighed about the same would be important. I’m told women in this situation can have problems with neck pain, shoulder pain and even balance if they don’t wear a prosthetic breast. It’s less of an issue if you’re naturally small breasted but mine were large. My pathology tells me they were close to a kilo each.

Of course, having had both removed means I now have the option. Prosthetic breasts or no prosthetic breasts? It’s not a question I ever imagined having to ask myself. I’m still undecided.

I can’t really wear anything just yet. I’m still healing. I have seromas, a build up of fluid under the skin, on both sides so best to stick with singlets for now. I have the contact details of a woman that will come to my home and fit me with artificial breasts and bras to go with them. I also have the address of a shop in the nearest major city. If I want to wear something swimming there are special ‘light weight’ prosthetic breasts, but the breast care nurse tells me that the standard silicone ones are fine. You would think so. They make bake ware out of silicone.

The Breast Cancer Network Australia sent me a bra and some ‘soft form’ inserts to wear while I’m recovering. I asked for something in a C cup rather than my original F. They look strange. They look stranger to me than my dolphin chest. They remind me of embarrassing performances by footballers at end of year functions where dressing up as women is something of a tradition. They look really obviously fake. I don’t know if bigger ones would look any better. Decisions, decisions.

I still get a shock when I look in the mirror. I want to make jokes about someone stealing my breasts while I slept but I suspect I’m the only one that will find that even remotely amusing. I don’t hate how I look. It’s just a shock. When you’ve been large breasted all of your adult life, suddenly being flat chested takes some getting used to. The bonus is not having to wear a bra. I’m loving it. I’m inclined to not wear one ever again. That would mean just dressing for my new body shape.

My friend, Jo, always looks fabulous. When she first had her double mastectomy she didn’t bother with prosthetic breasts but in recent times she’s decided that there are some outfits that just look better with them. I’m the kind of person that doesn’t wear fake eyelashes. I stopped colouring my hair when I turned 50. I also think it would be odd for me to spend most of my time just not bothering and then to wear breasts occasionally. Will it be a thing that people notice and comment on? “Is Meg wearing fake boobs tonight?” Worse, will it be a thing that people notice and think is odd, but don’t comment on?

I decided to spend this week going through my wardrobe. Yes, I’ve only been home from hospital for a week and I knew this was going to be upsetting, but my thinking was that this was a task best done early and quickly. A bit like ripping off a bandaid. What I didn’t want was months of standing in front of my wardrobe, choosing something to wear and then putting it on to find it looked terrible. I pulled whole sections out and dumped it all on the bed. It took me a couple of days and only a few tears to get through it all.

I’m about 168cm tall (5’6″) and a size 12 or 14. At 52, I don’t have a lot of low cut or revealing clothing but the first thing to go was anything that clearly needed breasts. That included tailored shirts with darts (which look like arrows pointing to where my breast used to be!) and anything cleavage dependant. Surprisingly, some cross over tops still work but I need something under them.

Queue the joy of singlets. I already had a large collection of singlets, mostly from Target and Big W, that I wear under sheer shirts and jumpers. It turns out that a lot of things I can’t wear on their own work just fine with a singlet underneath. Same goes for scarves. There’s now a lot of great Youtube videos on tying scarves in all kinds of ways. Here’s one of my favourites:

The one about half way through called ‘the magic trick’ is a personal favourite. The great thing about a scarf is that they give you interest and detail at the neck line and help to disguise the lack of a bust line. Before I consigned anything to the chuck pile I tried it with a scarf. I still managed to almost halve my wardrobe.

It did help that my daughter was getting first pick of anything I didn’t want. There were a few things that I knew she’d wanted since I’d bought them. She was so excited to get the floral cardigan that looks wonderful with her curves but odd with my lack of them.

It was also an opportunity to seriously reconsider some of those time travellers from the 80’s and the 90’s. I cried over the red velvet Mr K evening gown. Ever notice how really beautiful evening wear never goes out of fashion. I bought this dress for a ball many years ago, wore it to a work event in China where I met Pelé and to a Police function in Wollongong with my new boyfriend that I met on the internet. We’d only been dating a few months and it was a big call to walk into that room with me. He’s fearless. It’s part of why I married him. When he discovered me crying over that dress he put his arms around me and held me and told me that he loved me.

There were also some pleasant surprises. Some things work better without breasts. Anything with a cowl neck, unstructured jackets and shirts, and coats that fall mid thigh all look great. Anything with a large collar or pockets and detail across the chest, and caftan style tops with big patterns are also back in the wardrobe. Detail is my new best friend.

Out are tops with waterfall hems that used to balance out my large breasts but now make me look bottom heavy and triangular. Things in plain, solid colours are now relegated to under-wear. They’ll be fine under shirts and jackets but they show every little ridge and bump in my chest. Same goes for gypsy skirts that hang to my mid calf and have a bit of gathering at the waist. Nope. On the bright side I think I’m going to be able to wear shorter, straight skirts that show off my legs. Thank you (again) yoga!

One of my favourite cardigans almost went out until my husband suggested changing the way I wear it. By wrapping it across my body and pinning it at the side it looked great. This sent me back to the chuck out pile to see if anything else could be worn differently. Nope.

Most of my knitwear made the cut and all of the pants and jeans are just fine. I no longer own a single yoga top. The built in shelf bras now sit almost as low as my waist. Lucky I have all those singlets.

It worked through all of my clothes over the course of two days and I now have a wardrobe full of things that I know will look great. I’ve got some new combinations that are going to work really well and a bit of a wish list for the next time I go shopping.

And boy do I have a really great reason to go shopping!

Once I’d sorted everything I went back through my chuck out pile and asked myself if there was anything that I loved so much I would want to wear artificial breasts to keep it. There wasn’t. Not even the red velvet dress. Clothes are just clothes.

This is my new body. I love how brilliantly it’s stood up to all of the awful things I’ve put it through. I’m not embarrassed by it or ashamed of it. I think it looks just fine without breasts and until that changes I’ll be passing on the silicone and sticking with the scarves and singlets.

I’m also open to the possibility that, like Jo, I might decide somewhere down the track to wear prostheses. And it would give me another reason to go shopping.

 

The Day After Surgery

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It’s over.

I booked into hospital yesterday morning and headed straight to nuclear medicine for some radioactive dye. This is injected to help my surgeon identify the closest lymph nodes so they can be removed for pathology. Not having any cancer in the lymph nodes is a very good indicator that the cancer hasn’t, and probably won’t, spread.

Then it was the long wait for surgery. Around about three (or was it four) I was wheeled down to the operating theatre. I was having so much fun chatting to my surgeon that the anaesthetist said, “I don’t mean to be rude, but do you think we might be doing any surgery today?”

I woke up today feeling great. I’m sure the yoga helps me bounce. I also think the liver I had for lunch yesterday helped. I’m not a huge fan but it sure does get that red blood cell count up. I used it the same way during chemotherapy and consistently had a higher than expected red blood cell count. Fortunately we’ve got an organic shop near us that sells organic lambs fry.

It’s a curious thing, looking down at my new, breast-less body. I’ve been mildly annoyed over the last couple of weeks about comments implying that my decision not to have a reconstruction has anything to do with how fond I am (was) of my breasts. I thought of a good analogy:

We used to have the most amazing cat. Toby was my gardening buddy for fourteen years. He’d follow me around the garden and supervise all planting and mulching. If I’d been away from home he’d greet me with a meow that sounded just like ‘Hello’. His favourite trick was to get down the far end of the house and call ‘Mum’ in exactly the same voice as my daughter. I’d call back, call again and then go to see what she wanted, only to find she wasn’t at home at all. Toby seemed to find this funny.

One day I heard him making the most dreadful noise. I found him collapsed in amongst the Jerusalem artichokes. We rushed him to the vet and he died on the table as they tried to resuscitate him. We wept for days. We had no idea what had killed him and we didn’t want an autopsy to find out. The vet suspected the feline equivalent of a stroke. We suddenly realised what a special cat he’d been.

A friend suggested a trip to the RSPCA to get another cat. Her own cat had died a few months before and she’d replaced him within a month. I explained that Toby couldn’t be replaced. I had loved him. He was gone. My grief was an appropriate reflection of that love. Another cat just wouldn’t be the same.

I have loved my breasts. They have nurtured my baby girl. They have been an important part of my sexuality. They have attracted plenty of admiration (sometimes unwanted but often desired). I am grateful to have had them. Sadly, the dense tissue that made them still reasonably shaped for fifty two year old breasts is the same dense tissue that makes cancer hard to detect and easy to grow. They stopped being my beautiful breasts and became two potential tumour sites. I will miss them but I am not sorry to have lost them.

I can completely understand why many women want reconstruction. I have a friend with the most beautiful implants (sadly not for me due to radiation) and I’ve read the stories of many other women that are happy with their cosmetic surgery. I’ve also seen some horror stories.

Reconstruction is a very personal decision and while I really do understand the appeal, it’s not for me. Ultimately my breasts are like Toby. I will grieve the loss of them, but having something else attached to my chest (like the skin and tissue from my tummy) would not replace my breasts. I would not regain my sensitive nipples (which I will grieve most of all) and anything transplanted will have less sensation than my neatly scarred chest.

I don’t have less regard for my breasts than someone having a reconstruction. I don’t feel less female without them. It’s been a wonderful coincidence that all of the nurses caring for me have been very small breasted, and two of them quite flat chested. They are beautiful, feminine women with naturally small breasts. I will be proud to look like them.

My surgeon called in while my husband was here and we all had a look at my chest without the binder on. I’m told a lot of women don’t want to look at their scars and avoid it for a long time. I really wanted to see them. I gave Graham the choice and he decided he wanted to see them too. Afterwards he said, “You’re going to look gorgeous when you’re healed.” Then he took this glamour shot of me.

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How I love him.

Also, not bad for one day after surgery, I’d say. I’m calling this my new svelte look.

I’m not in any pain. I’m on panadol, something to prevent nerve pain and intravenous antibiotics. I feel great, and greatly relieved. I am finally, absolutely cancer free. I’ve also greatly reduced my risk of recurrence and metastasising cancer. I’ve been warned that the blues kick in around day three (just like baby blues) so Graham has planned to be back here in case I need a shoulder to cry on. My beautiful daughter and her partner are calling in tomorrow, along with a couple of very close friends.

Meanwhile I’m enjoying the excellent quality of care at the Mater, North Sydney. There’s a reason this place keeps winning awards. The nursing staff are just outstanding. Even the food is great. Seriously.

Does This Cancer Make My Bum Look Big?

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There’s a lot of stuff written about women and body image. It seems to me that it’s all ironic: while women are writing about body image, good or bad, they’re also perpetuating the obsession with body image. At the risk of adding to the irony, here’s my take on body image.

Look how you want to look. Wear what you want to wear. Stop judging others by their appearance. Value people for their kindness, or their intellect or their humour.

Stop telling little girls (or little boys) that they are pretty and start asking them what they think about something instead, or which book they’re reading, or what sport they enjoy playing.

It’s okay to express your opinion about your own body but mind your own business about anyone else’s. For example, “I choose not to have cosmetic surgery.” rather than “Nobody should have cosmetic surgery.”

Love your body. Without it you are nothing. Care for your health. Not to meet some arbitrary standard of beauty, but because your health is what sustains your body, and without it you are nothing.

That’s about it really.

I don’t worry about what famous people are doing with or to their bodies. I remember reading a piece by a 50-ish writer about how she was angry with a whole group of middle aged celebrities and actors for having cosmetic surgery and, in doing so, placing unwelcome pressure on her to do the same. It was a funny, well written diatribe but, even before I was diagnosed with cancer, it struck me as hypocritical. You can’t go on about wanting to be valued for your intellect, your humour, your compassion and your strength if you’re obsessing about how Cate Blanchett’s suspected eye-lift has undermined your confidence. Really?

I’m never bothered by what famous women do to themselves, other than being grateful that I don’t work in an industry where my personal appearance is so important that I’d let someone cut into my body. There’s a lot of banging on about the ‘message’ they send. The message I hear is that personal appearance is much more important if you want to be a celebrity than it is for anyone else.  I don’t aspire to be famous. I think having your private life (or someone’s made up version of your private life) printed in magazines is a special kind of hell. The idea of not being able to leave my home without being recognised appalls me.

I’ve known since I was a teenager that there’s only a very tiny number of women considered suitable for modelling, and most of them are made up and digitally enhanced beyond recognition. If you saw them in public you’d probably think they were a very tall, very thin woman but you wouldn’t necessarily find them beautiful. It never bothered me that a Vogue talent scout was unlikely to stop me in the street. I always thought modelling would be a very boring job with a short life span. I wanted to do something worthwhile with my life and spending it as a human coat hanger just didn’t cut it.

On the day I received my diagnosis, my husband said this to me:

“You are not your breasts. I want you to know that the most important thing to me is that you survive this. If you need to lose your breasts to do that then so be it. I love you. That’s not going to change.”

Beautiful.

I’d independently had exactly the same thought. I imagined myself with what I would call my ‘dolphin chest’, all smooth and sleek. I recalled my friend, Jo, who talks about how she looks at her mastectomy scars as evidence of a life-saving operation. She cherishes her scars, her body and her survival. I told my surgeon that my priority was best medical outcome and that any cosmetic consideration was secondary. If I needed to have both of my breasts removed to live, then I would do that.

Turns out I don’t need to. I’m not even going to lose the cancerous breast. I had my planning session with my surgeon last week for surgery in January 2014. Now that three of my tumours have vanished and the fourth looks like it’s on the way out, she’s planning on breast conserving surgery. I’m lucky because the cancer is in my naturally larger breast so she’s confident of a good cosmetic result. It’s possible I’ll get a breast lift as a bonus. Okay. Excellent news. I like my breasts and keeping them is definitely better than losing them. I’m still okay with losing them at some point in the future if that’s what I have to do to stay alive.

Since Angelina Jolie’s famously public double mastectomy there’s been a lot more acceptance of this option for women with a high genetic risk of breast cancer. Curiously, it’s not always the case that taking away your breast tissue will provide you with the lowest chance of recurrence. My surgeon tells me that taking the breast off makes no difference to my survival odds. She also tells me that there may be an advantage in having breast tissue; triple negative cancer has a high rate of recurrence and a tendency to metastasise somewhere else in the body. There’s a possibility that leaving breast tissue means that it’s more likely to appear there, rather than in a vital organ. It’s much easier to treat breast cancer when it’s still in a breast.

I’ve never been particularly vain. I’m not ‘high maintenance’ and I’m married to a man that thinks I look beautiful without the assistance of makeup, hair product, expensive clothing or uncomfortable shoes. I save dressing up for special occasions and he makes the appropriate complimentary noises when I do, but he’s inclined to grab the camera and photograph me when I’m out in the garden in my unflattering sun hat, wearing a man’s shirt for protection along with practical cargo pants. He says he likes having pictures of me looking as happy as I do when I’m gardening.

I adore him. Gentlemen’s Quarterly are unlikely to use him as a model but I love every inch of him. He is, simply, the most attractive man I know. You might not think so, but then you need to apply my standard for ‘attractive’ to understand what I mean.

My standard for attractive, whether we’re talking about men or women, is a simple one:

1. Attractive people are healthy. They don’t need to be rake thin but they’re not obese either. They eat healthy food most of the time and it shows. They also enjoy ‘sometimes food’ some of the time without being guilty about it. They enjoy staying fit. They have a vitality about them that’s appealing, regardless of their genetic inheritance. They don’t subject themselves to fad foods and diets.

2. Attractive people smile most of the time and laugh easily. Everyone describes themselves as having a good sense of humour but attractive people will be described this way by their friends.

3. Attractive people are kind and generous. It doesn’t matter how lucky you were in the gene lottery, if your unkind, greedy or mean you are not attractive. Attractive people tread gently on the planet. They stop the car to move an animal off the road. They minimise their environmental footprint. Their kindness and generosity is not limited to humans.

4. Attractive people have good personal hygiene. Yep. There’s no way around this one.

5. Attractive people are interesting. The use their minds. They know about all kinds of things and they’re happy to share their knowledge. They’re also interested in you.

6. Attractive people are positive. They talk about what’s good, possible, worthwhile, healthy, constructive and beautiful. They spend much less time than most of us talking about illness and pain, or complaining. They don’t gossip about other people. They look on the bright side.

7. And finally, attractive people are comfortable in their own skin. They don’t obsess about their appearance. They aren’t anxious about the size or shape of any particular part of their body because it’s all their body and they know that it’s the only one they have. Hating it means hating themselves.

When I want to work on being more attractive, this is the list I use. I don’t think wrinkles or grey hair or weighing ten kilos more than I did when I was thirty have anything to do with how attractive I am.

There’s a whole industry out there that tries to make us feel bad about our appearance in order to get us to spend money. But we don’t need to pay attention to their messages. If you don’t read ‘women’s magazines’ (really just endless advertisements) or spend too much time in front of the television then this stuff can’t touch you. If you surround yourself with people that appreciate you then the temptation to see your crows feet as a crime against the state will vanish.

I love my body. Right now I love the way my body is fighting cancer, coping with chemotherapy, enjoying yoga, making food and words and gardens and paintings. The last time I loved my body this much I had given birth to my daughter. My belly was stretched from pregnancy and it insisted on forming a loose bag of flesh beside me on the bed. My breasts were swollen and tender. I looked at my baby girl and thought, “I made another human with my body!” Now I look at my slides and check, over and over, that the three tumours are gone. I feel the dull pain of the remaining tumour caving under the impact of my excellent cancer drugs. Wonderful. Go you good thing.

Does my bum look big? I have no idea.