Tag Archives: ovarian cancer

Poetic Discourse

National Poetry Month, which takes place each April, is a celebration of poetry introduced in 1996. National Poetry Month began in the U.S. spearheaded by the Academy of American Poets on the steps of a post office in New York City. There, the story goes, Academy staff members handed out copies of T.S. Eliot’s poem, “The Waste Land,” which begins, “April is the cruellest month…” to individuals waiting in line to mail their tax returns.

Those of you who follow The Teal Diaries are aware that I write prose, however I’ve been inspired during my cancer treatments to pen a small collection of poetry. Here I’ve chosen to share two of my short poems. My compositions Patient’s Lab Results and A Visit to the Emergency Room both explore the life altering power of a cancer diagnosis.

 

Patient’s Lab Results

The sun is preparing to set on a late autumn afternoon,
its rays hold me together as I fall asleep dreaming of
my immaculate incision. Scarcely a week since my surgery.
I almost laugh to think I was such a novice.
Such a common virgin.

I pass through sliding doors to a point of no return.
Then I enter a vacant waiting room,
a place that is sinister, foreboding.
How many women have waited in these chairs?
How many innocent lives transformed?

“The ultrasound shows a growth on your ovary.”
“You need surgery to remove your uterus and right ovary.”
“You have cancer.”

Ultimately, he arrives, seeming anxious to print the pages.
“Here, this is for you.”
His words turn to ice as he offers me the pathology report.
Warmth as he grasps my hand, lending some reassurance.

My world dissolves as I take ownership of a disease.
The rapidly dividing cells, the cancerous tumors,
the abhorrent malignancy.

“Adenocarcinoma of the endometrium”
“The uterine cavity is completely filled with light tan neoplasm.”
“Right ovary with synchronous endometroid adenocarcinoma”

 

Immunotherapy one

 

A Visit to the Emergency Room

Riding unending waves of pain and nausea,
I take a secret pride in my endurance.
The sign over the door says MINOR EMERGENCIES.
Should I draw attention to this irony?

The young nurses seem aloof, peering out from
behind their curtain. I sense that we are to be
endured until morning comes. Around me
are the homeless, the destitute the addicted.

The fluorescent lights have been turned low,
casting a pale greenish tinge across the room.
Beeping monitors and moaning
patients provide the soundtrack.

I wonder if these souls feel entirely unaided,
abandoned, alone amid the chaos.
Each of us is fighting a singular
and solitary battle.

A torrent of frustration, then drowning I panic.
I want to scream that I’m a cancer patient
and my bowels are blocked.
I long for them to have evidence.
When will they be convinced?
I’m a bloated organ about to rupture.

The pre-dawn hours break like a fever
and I emerge from my delirium.
The kind eyes of the doctor and the
contrite look on the nurse’s face.

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Five-Year Survivor: On Reaching Another Cancer Milestone

timepiece

In just a few weeks I’ll face an emotional and bittersweet milestone, the fifth anniversary of my cancer diagnosis. Above all I’m grateful that I made it through the grueling medical treatments that I had in 2011 and 2012. There were moments when I felt so sick and physically weak from surgery or chemotherapy that I was afraid I might die. I thank God for my oncology team; they were always there and never stopped encouraging me. It turns out they were right to be optimistic about my prognosis, or at least to be confident that I could achieve remission. I’ve been in remission from ovarian cancer, a disease that many refer to as the silent killer of women, for four years now.

As my cancer anniversary approaches, I’ve been thinking a great deal about how much things have changed for me. Personally, I’ve discovered that physical attractiveness, material possessions and social status all matter less to me now. These things frequently seem to fade into irrelevance as I confront a life-threatening illness. Meanwhile, my relationships with other people, discovering ways that I can make a difference in the world and learning more about the essence of who I am are currently at the forefront of my agenda and have an extremely high priority to me.  Most of all, I’m aware of time and of the immeasurable value of each day that I’m alive. Here are some powerful meditations that I though I would share.

“I ask you to imagine that there is a bank account that credits your account each morning with $86,400. It carries over no balance from day to day. Every evening the bank deletes whatever part of the balance you failed to use during the day. What would you do? Draw out every cent, of course.

Each of us has such a bank, its name is time. Every morning, it credits you 86,400 seconds. Every night it writes off at a loss, whatever of this you failed to invest to a good purpose. It carries over no balance. It allows no overdraft. Each day it opens a new account for you. Each night it burns the remains of the day. If you fail to use the day’s deposits, the loss is yours.

There is no drawing against “tomorrow.” You must live in the present on today’s deposits. Invest it so as to get from it the utmost in happiness and health. The clock is running. Make the most of today.”

 — Marc Levy, French novelist

“It’s being here now that’s important. There’s no past and there’s no future. Time is a very misleading thing. All there is ever is the now. We can gain experience from the past, but we can’t relive it; and we can hope for the future, but we don’t know if there is one.”

― George Harrison

“You must live in the present, launch yourself on every wave, find your eternity in each moment. Fools stand on their island of opportunities and look toward another land. There is no other land; there is no other life but this.”

— Henry David Thoreau

 

dead-poets-society1

In the film Dead Poets Society Robin Williams plays an unconventional English teacher named John Keating. In one of the movie’s most memorable scenes the teacher stands with his students gazing at some vintage school portraits. As they view the photographs of previous generations, this is what Keating tells the group of young men in his class:

“They’re not that different from you, are they? Same haircuts. Full of hormones,  just like you. Invincible,  just like you feel. The world is their oyster. They believe they’re destined for great things,  just like many of you, their eyes are full of hope,  just like you. Did they wait until it was too late to make from their lives even one iota of what they were capable? Because, you see gentlemen, these boys are now fertilizing daffodils. But if you listen real close, you can hear them whisper their legacy to you. Go on, lean in. Listen, you hear it?   Carpe   hear it?   Carpe, carpe diem, seize the day boys, make your lives extraordinary.”

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Because it’s 2016: A New Era for Cancer Patients

Few doctors in this country seem to be involved with the non-life-threatening side effects of cancer therapy. In the United States, baldness, nausea and vomiting, diarrhea, clogged veins, financial problems, broken marriages, disturbed children, loss of libido, loss of self-esteem, and body image are nurses’ turf.

Rose Kushner

One of the most stunning realizations that I’ve had since being diagnosed with cancer is how much cancer impacts the whole person—the disease can undermine almost every aspect of a person’s life. The field of oncology acknowledges this, at least more than it did four decades ago when American journalist Rose Kushner spoke these words. Today most cancer patients, including myself, have access to social workers, psychologists, dieticians and other skilled professionals. Treating the whole person and recognizing that each patient has unique issues and needs have become firmly entrenched and are part of the philosophy of cancer care.

At my cancer centre there are now two forms that patients are asked to fill out at every checkup. The first contains questions to gage a patient’s physical wellbeing as they go thorough treatment, but a second questionnaire was recently added. This latest form is used to gather information about the various psychosocial issues that are associated with cancer. Certain social, financial or mental health issues may need to be addressed. While I sometimes resent having to answer what I consider highly personal questions, I realize the importance of asking cancer patients about almost every aspect of their lives.

 

Research Breakthroughs

 

immunotherapy two

Dr. Barbara Vanderhyden, one of Canada’s preeminent ovarian cancer researchers, recalls that when she began her work she was one of the only people in Canada researching the disease. Over a decade ago Vanderhyden started the Canadian Conference on Ovarian Cancer Research and now the community has grown from three people to more than 60 ovarian cancer researchers across the country. This flourishing research community has led to a number of recent discoveries. For instance, it is now known that ovarian cancer is not one disease but a spectrum of diseases with different responses to treatment.

I’m frequently amazed at the lightening speed at which new cancer treatments are being discovered and implemented. For example, immunotherapy is an emerging approach to treatment that boosts the immune response to cancer. It enables the body to target and destroy cancer cells. There are three main areas of immunotherapy that are showing promise.

  • Vaccines that enhance immune system response
  • Inhibitors that affect how the immune system regulates itself
  • Adoptive T-cell transfer, which removes a patient’s cancer-fighting T-cells and activates them before returning them to the bloodstream

Although gynecological cancers, such as mine, have seen only modest breakthroughs in immunotherapy, melanoma and lung cancer are areas that are witnessing great progress.

 

New Targeted Treatments

 

Immunotherapy one

According to many scientists a new era of cancer treatment is beginning in which patients get drugs matched specifically to their tumour. Patients experience longer survival and fewer toxic effects through this approach, which is being made possible by advances in genetic profiling of the tumour itself. Conventional chemotherapy and radiation treatments have both short-term and long-term side effects and can be absolutely brutal for patients to endure. These treatments kill a significant number of healthy cells in addition to the cancer cells. “At the moment it’s more like using a cannonball to kill an ant – and creating a whole lot of damage at the same time,” explains professor Roy Herbst, chief of medical oncology at Yale Cancer Centre.

Meanwhile a UK trial, called Optima, is being run by University College London and Cambridge University and funded by Cancer Research UK. Beginning this summer, it will recruit 4,500 women with breast cancer. The women’s tumours will be genetically tested as soon as they are diagnosed to establish which will respond to chemotherapy and which will not. Of the 50,000 or so women diagnosed with breast cancer in the UK each year, about 40 per cent, or 20,000, are currently given chemotherapy but only half of them do well as a result of it; in the other half, the benefit is unclear. The researchers hope to find out which of the latter group actually need chemotherapy. As one oncologist emphasized: “In some ways it is simple – it means that you can make sure you are giving the right drug to the right person at the right time. In others it is very complex, because there are so many pieces to the jigsaw. We need to put the puzzle together.”

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Unit 42 Haiku

National Poetry Month, which takes place each April, is a celebration of poetry introduced in 1996. Those of you who follow The Teal Diaries are aware that I don’t normally write poetry, however I’ve been inspired during my cancer treatments to pen a small collection. There are few experiences in life as distressing or traumatic as being hospitalized for cancer surgery. In December 2011, I underwent surgery and was cared for on Unit 42 at Calgary’s Foothills Hospital. Many of the events that transpired are represented in the poetry that you will read here. I’ve chosen to write haiku because of the format’s simplicity and it’s ability to convey powerful emotions or striking images.

blue slippers and gown
an eternity passes
in the pre-op room

when he cuts me open
no tumour for my collection
crave smooth healthy organs

anesthesia mask
a few deep breaths are drawn
on my way to oblivion

recovery room
the bright lights overhead
I’m dropped into darkness

conscious, I arrive
the darkness welcomes me
on a winter night

the room is spinning
I long for perfect stillness
let this voyage end

van-gogh-starry-night

I have nurse Crystal
the post surgery hours pass
finally, the dawn

they manage my pain
senses are dulled with morphine
the standard dosage

compression bandage
covers my fresh incision
my surgeon’s trademark

first blood transfusion
my outstretched arm is waiting
for type O to come

my blanket is thin
comfort of warm flannel sheets
during the still night

this building is old
mid-twentieth century
these rooms are vintage

generations past
have walked slowly down these halls
now I follow them

19th Century Surgery

I have a roommate
a Dutch Lutheran woman
her prognosis is grave

new complications
nausea, fluid leaks out
doctors seem unsure

hard recovery
my progress has been so slow
a mountain each day

my carcinoma
hides under a microscope
in some nearby lab

the truth will ooze out
why conceal my pathology
daze me with a pill

he stops by my room
cancer spread to one lymph node
the truth is laid bare

too much of this place
even the walls scream go home
find the strength to heal

past empty wheelchairs
through the lobby Christmas Eve
out hospital doors

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It Takes Lady Balls

As an ovarian cancer patient I’ll admit that I often feel overwhelmed by the dismal survival statistics and apparent futility of fighting such a deadly disease. Approximately 2,800 Canadian women are diagnosed with ovarian cancer each year and five women die from the disease every day. Currently, there are more than 17,000 of us in Canada living with the disease. The relative statistics are similar in the United States where 21,000 women will be diagnosed with ovarian cancer this year, and 14,000 will die from it.

Because the symptoms are usually subtle and there is no reliable screening test, ovarian cancer is frequently misdiagnosed or not discovered until it has reached an advanced stage. This makes treatment difficult, which is a key contributor to its high mortality rate. Ovarian cancer has a five-year survival rate of around 46 per cent, compared to nearly 90 per cent for breast cancer.

Each year at the Ovarian Cancer Canada Walk of Hope I’m proud to join a small but dedicated group of teal shirted survivors. Other participants in this key fundraising event wear white shirts— many in attendance at the walk are the husbands, children or grandchildren of those who have recently passed away. Unfortunately, since so many of us diagnosed with ovarian cancer die quickly after our diagnosis, the support network that typically forms around a cancer patient moves on quickly, creating what some have called a “leaky bucket” of advocates for the disease.

ladyballs

I was delighted this January when Ovarian Cancer Canada launched Ladyballs, their boldest and most successful marketing campaign to date. Their marketing team knew that to be successful they would need to create a slogan that could be heard above the din of other national campaigns. So rather than focusing on sad facts to illicit sympathy, the team at Ovarian Cancer Canada chose to focus on the tremendous strength of survivors and the power we all have to do something about women’s most fatal cancer.

Marketing executive and ovarian cancer survivor, Lauren Richards, spearheaded Ladyballs. Richards is a former Cossette Media and Starcom MediaVest Group executive who has operated her own Toronto media consultancy since 2013. She enlisted Canadian broadcasters, newspapers, magazines and online publishers to donate several million dollars worth of space and time for the campaign.

Those behind the promotion knew from the start that they were up against organizations that have become brands in and of themselves. For example, Movember is a brand for prostate cancer and Run for the Cure is an iconic brand in the fight against breast cancer. Knowing they had such low awareness and little money, it was a daunting task.

The Ladyballs campaign’s most visible component is a video spot in which women show their so-called “lady balls” by demonstrating chutzpah in the face of pressure or adversity. “Check out the lady balls on her,” one woman says to her co-worker after a female employee disagrees with a male boss’s decision during a meeting. “Look at the lady balls on her,” says a male announcer when another woman goes all-in during a televised poker tournament. In the concluding voiceover an announcer informs viewers that women have balls–their ovaries–and they’re always at risk. Viewers are then directed to donate to the cause at ladyballs.org.

ladyballs2

As expected, the campaign has been highly controversial. Some critics say the ad insults women by comparing a uniquely female body part–the ovaries–to men’s testicles. They say that women don’t have to stoop to that level to promote an informed discussion. However, I personally disagree with this view. I hold the same opinion as Matt Miggins, a nursing student at St. Clair College in Windsor.

“They are not mad five women a day die from this?  I find it ironic that they are mad about words. People should be mad at the fact this is happening to our mothers, sisters and wives,” said Miggins. He said he thinks people should put things into perspective. “People need to ask themselves, if the word balls saves just one life, is it then worth it?”

According to Ovarian Cancer Canada, the campaign has been instrumental in raising awareness. Ladyballs has been responsible for a significant increase in requests for By Your Side, a resource provided to women diagnosed with the disease. It’s also led to a spike in calls to offices across the country, with callers citing the campaign as their reason for reaching out. One woman who heard a Ladyballs radio commercial immediately pledged $100,000 to the organization, and the campaign has garnered approximately $60 million in earned media impressions since its January debut.

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Five Ovarian Cancer Myths

One of the most disturbing issues for me as an ovarian cancer survivor is the lack of awareness and misinformation that persists. Only with a thorough and proper understanding can women protect themselves from this devastating, and often fatal illness. I admit that before my personal diagnosis a few years ago my own knowledge concerning ovarian cancer was quite limited. In this post I’ll examine several of the most commonly held falsehoods or misunderstandings about ovarian cancer, but first some basic details.

Ovaries are two small almond-shaped organs located on each side of the uterus that store eggs or germ cells. Ovarian cancer is a disease in which malignant (cancerous) cells are found in one or both ovaries. Thousands of women are living with ovarian cancer in Canada. It’s estimated that this year 2,800 Canadian women will be newly diagnosed with this disease. Ovarian cancer is the fifth most common cancer for women and is the most serious women’s cancer.

clh-tom-baker

Myth 1: Many people believe that there is a screening test for ovarian cancer or the related myth that a Pap test detects ovarian cancer.

Fact: According to research more than half of women think a Pap test will detect ovarian cancer. Actually the cervical smear is designed to detect precancerous changes to the cervix, and it does not detect ovarian cancer. You may be familiar with the CA-125 test, it’s used on women who have ovarian cancer or who are at high risk of developing the disease. Unfortunately according to the majority of experts, the CA-125 test is proven to be ineffective in diagnosing ovarian cancer. This blood test is used mainly as a guideline for oncologists during treatment of ovarian cancer because CA-125 (a sugar-associated protein found in the blood) often goes down if the treatment is working. However, the test is not reliable for diagnosing ovarian cancer. Researchers continue to look for a dependable screening test, but currently there is none.

Myth 2: There is often a false assumption that women who have had multiple sexual partners are at a greater risk of developing ovarian cancer or that the HPV vaccine can help prevent it.

Fact: Some women mistakenly believe that the number of sexual partners they may have had, or the age at which they became sexually active, has some bearing on their chances of developing ovarian cancer. This is incorrect. The spread of the HPV virus, which can lead to cervical cancer, is associated with sexual activity, but is not connected in any way to ovarian cancer. The HPV vaccine will help to reduce the risk of cervical cancer, but not ovarian cancer.

OvarianCancerPain

Myth 3: Many women become convinced that an ovarian cancer diagnosis is always fatal and they won’t survive.

Fact: A diagnosis of ovarian cancer is extremely serious, but it’s not invariably fatal. Combing data collected on thousands of California ovarian cancer patients, UC Davis researchers recently determined that almost one-third survived at least 10 years after diagnosis. The unprecedented findings upend the notion that women diagnosed with cancer of the ovary always face a poor chance of survival. Indeed, while the study confirmed earlier findings about characteristics associated with ovarian cancer survival (younger age, earlier stage and lower grade tumors at diagnosis) it also identified a surprising number of long-term survivors who didn’t meet those criteria.

Myth 4: It’s common to believe that if you don’t have a family history of ovarian cancer you are not at risk of getting the disease.

Fact: Only about 10 to 15 per cent of women diagnosed with ovarian cancer have a family history of this disease. Complex variables and numerous risk factors beyond genetics are usually involved and the exact reason a woman develops ovarian cancer often remains unknown.

Myth 5: Many people think that there are no early symptoms or warning signs of ovarian cancer.

Fact: It’s a widely held belief that ovarian cancer is a “silent killer” with symptoms only presenting in the later stages of the disease, even some doctors consider this to be a medical fact. However, there is now clear evidence that most women who are diagnosed with early stage disease do experience symptoms. The problem is that women often delay seeking advice about their symptoms, and their GPs often don’t immediately think ovarian cancer may be a possibility. A lot of women experience considerable delays in receiving their diagnosis and ovarian cancer is usually detected at stage 3 or 4.

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A Matter of Trust

trust-brokenEven before my cancer diagnosis three years ago I understood that trust is one of the central features of the patient-physician relationship. Ideally when I come under a physician’s care I should trust in my doctor’s competency and in their commitment to me as a patient. When I undergo medical treatment I must also trust my physician or surgeon to put my welfare above his or her own self-interest. Ethically my physician should always place my needs above obligations to other groups and advocate for my welfare.

This bond of trust has played a dominant role throughout my cancer journey, especially when I’ve undergone major surgery or consented to treatments such as chemotherapy. I met my oncologist in November 2011 and I continue to trust in his medical expertise and sound judgment when it comes to treating my disease. I know he and other members of the team at the Tom Baker Cancer Centre have placed my best interests before anything else. Still I regret to say that there was a critical point during my cancer treatment when I began to have irrational doubts about my surgeon and his medical colleagues.

Doctor's Touch

Looking back, several factors were instrumental in causing me to temporality lose confidence in my surgeon. In the spring of 2012 complications arose due to my cancer treatments. Two previous surgeries had resulted in scarring and adhesion of my bowel and at the time the blockage was probably being exacerbated by the chemotherapy I was undergoing. I was terrified of what might happen and despondent about my situation when I ended up a patient on the genealogic oncology unit for the third time. I was admitted through the emergency department and I could sense that my situation was extremely serious or potentially life-threatening. Worst of all I was in a tremendously weakened physical condition and my psychological state could best be described as anxious and confused.

My trust in my surgeon began to deteriorate due to communication issues. While he is a highly skilled oncological surgeon, like many doctors he is not strong when it comes to exercising interpersonal communication skills. He rarely spoke to me or came by my room—we never really had a conversation to reassure me or to discuss my condition in detail. Instead it was typically surgical residents completing their 7 a.m. rounds that I saw for a few minutes each morning. In about the second or third week of being confined to a hospital bed with orders not to consume food my fear and imagination began to run out of control. Was my surgeon really qualified and capable? Had he played any role in creating the serious complications I was now facing?

Meanwhile, some family members and other non-medically trained individuals only increased these suspicions and fears. They suggested that perhaps I should not trust my surgeon and that I should try to get another specialist to operate on my bowel blockage. As the scheduled date for my surgery approached I became virtually obsessed with how vulnerable I was and how I would be literally placing my life in my surgeon’s hands.

Surgical-Instruments

I had previously trusted my surgeon and thought of him as a conscientious and vigilant medical practitioner, now I had almost convinced myself that he might be the opposite. Was he a cowboy? As explained in Dr. Brian Goldman’s book The Secret Language of Doctors cowboy is a slang term to describe a surgeon who is excessively reckless or careless with patients. In the bestseller a cowboy is described as someone who rides by the seat of his pants. It’s someone who kind of does things quickly. They’re trying hurriedly to do everything in a somewhat haphazard fashion, hoping like hell it all comes together at the end. Cowboy is also used to refer to a surgeon who perhaps doesn’t have the best judgment—someone who operates first and asks questions later.

Of course there were moments when I had nagging doubts that I could endure another surgery, I had just been through two major operations. This had made me all too familiar with the overwhelming physical and emotional impact that abdominal cancer surgery has on a woman. In essence I agree with Dr. Goldman’s opinion regarding the consequences of surgery.

The thing I find many surgeons fail to appreciate is that an operation is a form of controlled violence on the patient. If surgeons thought about what they do to patients on a daily basis, I suspect many wouldn’t do it. Even the most successful surgery causes severe (albeit manageable) pain. For patients relieved of their condition, post-operative pain is bearable—but not so much when the surgery results in complications or worse.

Brian Goldman, The Secret Language of Doctors

Finally on June 18, 2012, I signed the appropriate documents and critical surgery was skillfully performed. When I awoke in the recovery room I sensed that my crisis was at last resolved. Although only half-conscious, I was filled with elation as they informed me that the procedure to correct my obstruction had been successful. The primary cause was established to be scar tissue from my previous operations and now my digestive system was expected to function normally again. Most of all, I was comforted and reassured by the fact that my ovarian cancer had not visibly metastasized to other organs in my body. After a long, tumultuous journey my fundamental trust in my surgeon had ultimately been restored.

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