THE JOYS OF SPRING

Time for a quick update I think - although it's only a fortnight since my last post, several people have contacted me wondering if I'm OK as I haven't written in a while. I very much appreciate the concern behind this, but in this case it stems from a very welcome week of rediscovering life outside of cancer and health concerns!

I'm very glad to say that I've been recovering well from the SIRT treatment, and the side-effects I worried about haven't really been an issue. If anything, it's been the long-familiar effects of the chemo which are the nuisance - I haven't really noticed anything extra from the radiation. But as it's now 4 weeks since the last chemo, those are gradually but systematically improving: I have more energy, the nosebleeds from low platelets have stopped, I no longer feel cold to the bones all the time regardless of the weather, and I spend less time fishing hair from the plughole after washing my hair; and all these things are brilliant for the morale. The neuropathy in my fingers is the one thing which hasn't improved, but my alternative doctor in Sussex has recommended a supplement (alpha lipoic acid, an antioxidant which is well-established as helping counteract nerve damage, not just for people on chemotherapy but also in type 2 diabetes) so I feel much less anxious about that than before. Of course I'll still have to wait and see whether it recovers, but I'm not focused on it and worrying like I was before.

The other thing which has made a difference is that, following the SIRT, I have to take steroids for a month (in a decreasing dose throughout that period). In many ways I hate steroids, as they give a kind of brittle, wired sensation which can make it hard to relax or sleep, but I think they've boosted my mood considerably, as well as giving me the energy to talk animatedly with the lovely friends and family who have come and visited me during this recuperation phase. They also stimulate the appetite, and although my sense of taste is pretty poor still from the chemo, which makes eating fairly unrewarding, it's been great to be able to eat decent portions and to have an incentive to eat. It sounds a small thing, but it's really broken that very negative association I'd been feeling with food over the past 4 months, which had made every meal time a chore, a struggle and a burden because of the discomfort and inflammation in my stomach and intestinal tract. And of course, eating more gives extra energy in itself.

So I'm feeling considerably better than I was a fortnight ago. I'm beginning to realise just how stressful March was, with the lack of information about the SIRT, the uncertainty about whether I'd make it to the States for the wedding, the physical toll of travelling, and the fears about how I'd cope with the radiation treatment when I was in such a depleted state after 10 cycles of chemo. It was very tough, and trying to prepare myself for up to 6 weeks of convalescence when I already felt exhausted was a pretty bleak prospect. Now that it's all over, and I've tolerated it so much better than I'd expected, and the chemo is working itself out of my system, I feel a huge sense of relief. 

I know at some point I'll have to face finding out whether SIRT has worked in stabilising the tumours, and to deal with there being no more medical options left - but that's not for another couple of months yet, so I've now got a window where I can actually enjoy life again. Now that I'm coming out of it, I can see how throughout the chemo my "normal" was feeling a bit rubbish, and when you're not feeling great physically it's almost impossible (in my view) not to feel a bit low mentally too. It's only now, when I've started to actually find myself thinking "ooh, sunny day, how lovely", or "maybe I'll do x y z that I've procrastinated over for so many weeks / months" that I can see how depleted I've been and what a struggle it's been. (Of course, my usual caveat: I know very well that many many people have a much harder time on chemo than I've had, with serious health complications and painful and / or distressing symptoms - all the same, that doesn't diminish what it's been like for me.) 

I can also see now to what extent my world had shrunk down to medical and health appointments, keeping up with close friends, and making it through orchestra rehearsals - but even within that, every day was an ongoing series of anxious decisions - what to eat; whether I could face another cup of green tea to get up to my required 2 litres of fluids a day; whether the positives of seeing a friend and feeling cheered up outweighed the negatives of being tired by the effort of socialising; whether I should distract myself with the easy options of reading or watching TV or do nurturing things like writing my journal or meditating. Running through everything there were endless "shoulds" and worries about choosing the right thing. I'll say more about all this in another post, as it's something I've been thinking about a lot. 

But for now, even though I still don't have a huge amount of energy, I'm aiming to lighten up and enjoy things in a way that I just couldn't during the chemo months. Of course I'm not the only person who's found this a long, dark, cold winter - but the metaphorical elements of new light, life and energy appearing with the spring has a particular resonance for me this year. I haven't been doing anything special, and nothing's dramatically different externally, I've simply been able to take  pleasure in normal activities, and be interested in life again. Of course there are still days when I'm weary, stressed, low or frustrated, but it's just fantastic also to have times when I find myself spontaneously feeling uplifted, or enthusiastic, or humorous, or optimistic, for no particular reason. I like it!

And even more precious new life....

Xavier, my friend Sheila's son, born in February

My cousin Amanda and her husband Jon's new baby, Freddy, born 3 weeks ago

TREATMENT COMPLETE!

I'm sorry that it's taken me a while to update this...

I'm glad to say that the SIRT treatment (Selective Internal Radiation Treatment) all went ahead smoothly last Tuesday. As far as I know it all went to plan, but they gave me a higher dose of sedatives this time and I was very sleepy and woozy throughout most of it (which I was quite happy about! - as with the first part four weeks ago, I spent around two hours on the operating table and then another hour having scans to check all was as it should be, so dozing my way through it was very welcome.)

I spent a further night in the Marsden and was discharged on Wednesday afternoon. I'm on some follow-up medication - steroids, to prevent inflammation in the liver, guard against any allergic reaction to the beads, and give the immune system a bit of a boost; antacids to protect the stomach and gut from any adverse effects; and a drug to prevent any irritation to the gall bladder (which can get inflamed if any of the radioactive beads get into it) - and will have regular blood tests over the next couple of months to monitor how things are going. There'll be a scan done in 3 months and from that they'll be able to see what the impact of the SIRT has been. It feels a big relief to have some time without as much intensive contact with hospitals as I've had recently.

In the meantime I'm feeling better than I'd expected (or feared) - tired, and not wanting to do much, but thankfully no nausea or pain. Over the first couple of days I felt some sensations of discomfort at times in my liver, but nothing major, and it was kind of reassuring to feel that the radioactive beads were doing something. The radiation wears off within a week or so, and I'm glad to say no-one treated me as if I was contagious!

Close friends and family have been wonderful in setting up a rota of daily visits, to help out with shopping and cooking, and to provide moral support and company while I'm recovering, and that's boosted my mood immeasurably. Resting and doing very little can be good physically but can also feel quite depressing and limiting, as I found out in the week before the procedure - there's definitely a balance to strike. So I feel lucky to have such good support around me, and very relieved that so far I seem to be tolerating it pretty well. 

The challenges of the last few weeks have forced me to question where I'm at and  how I go on from here, so there may be a couple of more reflective posts coming up at some stage, but I'll leave it here for now. Thank you all again for your messages of support and good wishes - it means a great deal to me.

YOU COULDN'T MAKE IT UP...

A bizarre and very unexpected twist in the story! I went into the Marsden on Monday early evening as planned; I had preliminary blood tests done to check that everything was OK for the next day's procedure; I was given antacids to protect my stomach, and intravenous fluids overnight, as I had to fast from midnight. On Monday morning I was given anti-sickness medication and steroids (to prevent an allergic reaction to the radioactive beads), then, with a nurse escort, I was taken in hospital transport down to Chelsea & Westminster, arriving feeling a little nervous but psyched up for the treatment...

...only to discover that in C&W's diary, I was booked in for next week, not this. 

... and seven days

Clearly there'd been a major breakdown of communication between C&W and the Marsden, and somehow the fact that they each had different dates for the procedure hadn't been picked up. Everyone was terribly nice and extremely apologetic (while we were waiting for transport back the nurse bought me breakfast!), but it still means that I have to come back next week. (The beads are specially ordered from manufacturers in Australia, and go via Germany to be activated with radioactivity, then are delivered - presumably in a well-sealed container - to the UK within hours of the insertion, so there was no way the procedure could be brought forward.)

I was fairly assertive with a Marsden SHO, and later on the phone with my specialist nurse (I think the problem arose as she'd just come back from sick leave but it wasn't clear what her colleague was still dealing with on her behalf and what she was assumed to have picked up), but in fact I was rather relieved not to have to face the treatment just yet, and to have more time to recover from jetlag and chemo. It was nice coming home early, and feeling relatively well and independent - a bit like an unexpected day off work when it snows! So, apart from having to rearrange kind friends and family who have set up a rota to look after me, I'm treating this week like a "bonus week" to relax and take things easy. For a control freak, this seems a remarkably sanguine reaction! yet it doesn't really make much difference - it's just one of those things. I guess we never know if things happening at a different time would have changed the outcome.

So thank you for the good wishes that many of you have sent me, and I hope you've still got some left over for next week! It'll be the same timetable: going in on Monday afternoon, the procedure done on Tuesday morning, and a night or two in the Marsden before coming home to my lovely team of helpers. Thoughts, prayers, healing vibes or whatever you believe in all gratefully accepted!

BACK INTO THE MEDICAL FRAY

After the relative respite of being in the States, it wasn't easy coming back into being confronted with all the medical issues again. I landed at Heathrow at 7 a.m. after barely any sleep, and by 10.30 that day was at the Marsden having blood tests. Demoralisingly, even after an extra week off chemo, the results aren't great: I'm quite anaemic, which explains (along with the trip away) how exhausted I am, and my platelets and immune system markers are still pretty low (the low platelets mean I have nosebleeds, which I find very trying), but they were OK enough to go ahead with chemo. However, over the past cycle I've noticed that the tingling and numbness in my fingertips has become constant, which is known as neuropathy and is a side-effect of one of the chemo drugs, oxaliplatin, which affects the nervous system. Mostly it wears off after chemo finishes, but in some case it can continue to get worse, and for some people the damage is irreversible and permanent. It's a very scary thought, and I've worried a lot about it: as well as making difficult things like fastening buttons and writing, it would jeopardise playing the violin, which would be gutting (at the moment I can feel it when I play but it doesn't get in the way). So the doctor cancelled the oxaliplatin for this last cycle, and instead I just had the other drug, fluorouracil. (That's the one administered over 24 hours, so sadly I still had to have the pump!)

It felt weird to be having my last cycle of chemo, probably ever - on the one hand I just could not wait to be finished with it (and counted down the hours till the pump was disconnected for the last time), but at the same time it's quite frightening to lose the routine and reassurance that something's being done to fight the cancer. Thank goodness for the radiation treatment - if that wasn't happening I think this would be a very bleak time.

Especially as it was decided, that same first day back, spaced-out with jetlag and exhaustion, that I should have a CT scan to evaluate the effect of the chemo before the radiation treatment. It meant a lot of extra waiting around but it makes sense to be able to differentiate between the effects of each of the treatments. Unfortunately the results (which I got 2 days later, when I was having the chemo) were disappointing: there's been further growth in all the tumours. This makes it fairly clear that the last four cycles of chemo haven't worked, and it's a huge blow that things have continued to get worse. I've struggled over the week with fear, anxiety and upset, and I've felt quite fragile and demoralised. Ironically a number of people have commented on how well I look at the moment, especially in the wedding photos, and while of course I don't at all want to look ill, it feels confusing and misleading to be congratulated on looking well when things inside my body are so very different. The one good thing is that the cancer hasn't spread outside the liver, so the SIRT treatment can still go ahead as planned. There's certainly a lot riding on it....

So I go into hospital today, Easter Monday, with the treatment taking place the following day, and I'll be in for two or three nights. I'm not sure how I'll feel afterwards - reactions seem to vary considerably across different people - but I'll update the blog when I feel up to it and in the mood to write. Side-effects can include abdominal pain, fever, nausea, and extreme tiredness, so don't worry if you don't hear anything for a bit - I'm planning to take things pretty easy for a couple of weeks.

In this rather downbeat, grim and nerve-racking time, it seems a good moment to share with you the story of someone who's been following my blog and who kindly sent me the story of his experiences caring for his wife while she had cancer. I've found it inspiring and encouraging to hear that recovery can happen, even against the odds, so at his request I'm copying it here, in his (and my) hope that it will be useful and uplifting for you as well.

Finding the Strength:  One Battle with Cancer

In November of 2005, my wife Heather was diagnosed with rare and deadly cancer called malignant pleural mesothelioma.  It was only 3 months earlier that we’d celebrated the birth of Lily, our first and only daughter, and we could not have been more devastated by the news.  

Among the options the doctor gave us for our next step was Dr. Sugarbaker, a mesothelioma specialist in Boston.  My wife and I decided that if she was going to have any chance of beating this terrible disease, she would need the best care possible, and we were prepared to do anything to get her just that.  We told our doctor that we would be going to Boston to meet with Dr. Sugarbaker.

Shortly after the diagnosis, my wife was unable to work.  I could only work part time, in order to be there to care for her and Lily.  The majority of my time was spent handling my wife’s medical arrangements and taking care of our daughter.  It wasn’t long before I found myself awash with fear of my wife dying and leaving me alone to raise our daughter by myself.  I saw myself as a broke, homeless, widower and single father.  More than once I sat on the floor bawling like a baby until I could push that feeling of hopelessness aside.  I knew I had to be stronger for Heather.  The last thing she needed was to see my fears.

Luckily, we were blessed with help from all corners.  We’ll never be able to truly thank everyone who extended a helping hand to us in our time of need.  If I had any advice to offer to those struggling like this, it is to accept every offer of help that comes your way, big or small.  Any offer of help can be a huge weight off your shoulders, and at the very least will serve as a reminder that you are not alone in the fight.

With the emotional and financial support of family, friends and even strangers, we fought the battle and weathered the worst of times.  Heather went through mesothelioma surgery, radiation and chemo.  Despite the odds against her, she managed to beat this disease.  Seven years later my wife is cancer free and healthy.

Not surprisingly, the entire ordeal has reminded me how precious time is.  How fortunate I am to have a good family and a support system that kept me going even when I thought I couldn’t.  Two years after Heather’s diagnose, I went back to school to study Information Technology full time, a dream I thought I might never accomplish.  I graduated with honors and was the class speaker at my graduation ceremony.  Considering my situation at home, I could never have imagined I’d have been on that stage, giving that speech.  I told my fellow graduates that within each of us, there is the strength to accomplish incredible, even impossible things, if we just believe in ourselves and never give up hope. Lily and her mother were in the audience to cheer me on, and that was the greatest reward of all. 

Cameron von St James

Thank you, Cameron, for this message of hope.

WEDDING IN SAVANNAH

I was delighted to be invited to the wedding of a good friend, Kristin, in Savannah, Georgia, USA. I got to know her nearly a decade ago when she lived in London; she now lives in Switzerland, but her family and her fiancé are American. 

However, deciding whether or not I should go was a huge dilemma. Much as I wanted to be there, I was nervous about travelling while on chemo, especially with two long flights for my body to deal with, and these fears were fuelled by being unable to get any travel insurance which would cover illness related to the cancer or treatment. I rang 27 different insurance companies, all claiming to specialise in covering medical conditions, and was refused by all but one, who offered cover only if I could show normal blood counts just before travel. Not surprisingly, my blood counts weren't up to scratch (as you'd expect on chemo), and although my medical team were happy for me to go, the interactions with the insurance companies really shook my faith and made me wonder whether I was being totally reckless to consider the trip. There was no problem getting insurance that didn't cover cancer-related problems, but if I'd ended up in hospital with an infection or blood clot, the medical bills could have been astronomical, and I was scared I'd blame myself for being so stupid (or arrogant) as to think I could possibly get away with it.

It was also a difficult decision to make because in one way I wanted to refuse to let cancer stop me doing what I want, yet I've also come to recognise that I do need to accept that it (and certainly the chemo) inevitably limit what I'm capable of coping with at the moment. I found it hard, in the middle of all this agonising, to work out whether wanting to go was a positive determination to live life to the fullest, or a kind of bloody-mindedness to do the kinds of things I used to do no matter what the toll on my body might be (especially as, to fit around my treatment here, I could only spare 4 days there, plus a day either side travelling).

In the end I realised that, to me, the reason for having treatment and making so much effort to stay as well as possible for as long as possible is to be able to be part of significant life events, and to share experiences with the people who matter to me. So off I went! and I'm so glad I did.

It was an amazing few days - because many people had travelled a long way, there were several days of events, including a welcome dinner, a bridal shower, the rehearsal dinner at a historic fort, and then the ceremony itself in Savannah's main park, with the reception at a nearby hotel. 

With Mischa (left) and Kristin at the welcome barbeque

With Mischa and Sharon at the rehearsal dinner in the fort

The wedding venue in the park

The lovely Kristin and Bruce

All glammed up with Sharon and bridesmaid Mischa

Morning-after brunch with the London lot

There were half a dozen friends I already knew, and other guests were very friendly. Savannah's historic district is beautiful, with big elegant colonial houses set around verdant squares, and we managed to explore most of it and hang out at some of the cafes. Sadly the weather wasn't as warm as usual for the time of year, but it was sunny some of the time, the trees were in blossom and there were large bushes of flowering azaleas everywhere - and I was very happy to have missed the snow in the UK! 

I stayed in a rental house with Sharon, which was cosy, stylish, and much more relaxed than a hotel. 

It wasn't easy some of the time: having spent the last 6 months reducing my horizons and living in a bit of a bubble, I found I was quite nervous about being out of my comfort zone. I worried a lot about getting tired, and not having so much control over what I ate. Having done so much travelling in the past - including intrepid trips on my own to challenging destinations - it was humbling, and painful, to discover how neurotic and vulnerable I felt at times being in an unfamiliar place. But counterbalancing all that was that it was just lovely to be part of the wedding, to be there for Kristin and Bruce, and not to feel excluded from "normal life". It was a very special time, and I know it meant a great deal to them as well for me to be there. And after the roller-coaster of "will I / won't I be able to go" it felt like a small miracle to get there and for everything to go OK; I'm very relieved and grateful.

Sunset over the riverfront

MORPHINE AND RADIOACTIVE DYE FOR BREAKFAST

I'm afraid I couldn't resist a tabloid-style headline! Things have happened quite quickly recently: back in January the consultant, in a slightly throw-away manner, said he'd email a radiologist to see whether I might be eligible for any radiotherapy treatment, but warned me not to count on it. Over the next cycles of chemo I asked the various doctors several times whether there had been any feedback, but with no luck, and I didn't think much about it. Then last week I got an appointment letter informing me I'd been booked in for the treatment just after Easter, but with a preliminary planning procedure to take place at the beginning of this week (i.e. with less than a week's notice). It felt quite stressful, because no-one at the Marsden seemed to know anything about the treatment process or what it  involved, and although I did (of course) scour the internet to find out as much as I could, it's not the same as being told what it means for me personally - including the risks and potential benefits. Over those few days I felt disempowered, frustrated, and scared by not having enough information, and it reminded me how much I need at least some illusion of choice and control.

It helped enormously when I discovered that the reason no-one could tell me much about it was that the treatment is carried out at Chelsea & Westminster hospital, not at the Marsden, so at least that made sense and stopped me feeling so outraged. Apparently my clinical nurse specialist would usually have been the person to liaise with them and explain things to me, but she's been on sick leave since November and it seems that no-one else knew about this particular treatment (not many people are suitable for it, and I'm the first person to be referred by my oncology team since she's been absent). I personally still think that's pretty poor handling of the referral, but I figured that when I went in for the planning procedure I could find out more (which I did - everyone at Chelsea & Westminster was great in answering all my questions).

The treatment is Selective Internal Radiation Treatment (SIRT), sometimes called radioembolisation. As you might guess, it works on the same principle as chemoembolisation, which I had nine times in Germany. Traditional external radiotherapy is generally no good for cancer in the liver, as it damages too much healthy tissue, so SIRT cunningly injects microscopic radioactive beads into the tumours directly, via a catheter (tube) into the femoral artery in the groin and the hepatic artery, to the tumour site(s). The radioactivity wears off over two weeks, and only extends 2.5 mm around each bead, so damage to normal liver cells is minimised; and in addition the beads (which are about a third of the diameter of a human hair) lodge in the tiny blood vessels supplying the tumours and thereby block off blood and nutrients, so there's a dual action. Some of the beads gradually get cleared by the blood flow, while the rest stay in the liver permanently, but I'm assured they're harmless.

So it's a very clever process - it was developed in Australia in the 1980s and was approved in Europe more than a decade ago. When given alongside chemotherapy, there's some evidence that the stabilisation or shrinkage of tumours is better than when using either treatment alone. (This is probably another reason I wasn't given much notice, so that it could be fitted in before the end of my chemo.) However the main risk with the procedure is that some of the beads could get carried by the bloodstream into other organs such as the stomach, gall bladder or lungs, where they can cause inflammation and other potentially serious problems. The preliminary planning stage is therefore essential, to minimise that risk, and is at least as complex as the treatment itself.

So very early on Monday morning I checked in to the Marsden (I still counted as their patient) and was escorted by a nurse the half-mile or so down the road to Chelsea & Westminster. There, I met with the interventional radiologist who was to carry out the procedure, and he explained everything very clearly and reassuringly - he's clearly an expert in his field, and I liked and trusted him. I then changed into one of those delightfully fetching hospital gowns, and was hooked up to a drip in the procedure room, which was full of impressively high-tech equipment. 

The radiologist gave me local anaesthetic in my groin, then inserted a catheter into the artery and fed in a thinner tube up through my blood vessels till he reached the liver. The process was done using angiography (a kind of sophisticated X-ray scanner which shows the blood vessels - although how he manoeuvres the catheter to the right place is beyond my comprehension), and at intervals he injected contrast dye which, under the X-rays, shows how the blood flows through the vessels. He also took a number of photographs (presumably like a screen shot by the scanner, but I couldn't really see), for which I needed to hold my breath for seven or eight seconds so that my diaphragm didn't move and blur the image.

From this, he identified the main blood vessels which could carry the radioactive beads towards other organs, and he then embolised (blocked) them - I'm afraid I don't know what material he used. The blockages are permanent, but cause no problems because every part of the liver (and probably all other organs and tissues in the body, I assume) is supplied with blood from more than one vessel. In this way he could make sure that when they do the procedure the risk of beads going astray is minimal. He used contrast dye again to check that the sealing-off was effective, and took more photographs, before withdrawing the catheter. Because my platelets are low from the chemo, which means my blood isn't as good at clotting, he inserted a collagen "plug" into the incision, to reduce the risk of bleeding (which, after puncturing a major artery, would obviously be very serious). The plug will dissolve over 28 days and can barely be felt under the skin. 

I was very impressed with all this technology, and also with the radiologist - it's incredibly skilled work, and he had a team of about five nurses and radiologists in with him. Professor Vogl, who did my chemoembolisations in Frankfurt, is a world leader in these kinds of techniques, but I have equal faith in the radiologist here. (Out of interest, I looked into prices for SIRT in the UK and Europe if paying privately, and they seem to be around £25 000. Much more than the €4000 for a chemoembolisation, but nowhere near what I read on one message board by an American: $44 000 for the angiogram and $115 000 for the actual procedure!! Shockingly silly money. I know I've had my gripes with the Marsden, but I'm incredibly grateful for a health system which - at least in my health authority - funds these cutting-edge treatments. Isn't the NHS amazing?)

The whole process took over two hours, and although I don't think I would have been in any pain it's a long time to keep still and stay relaxed, so they sedated me with a very low dose of morphine before we started. I'm sorry to report that I didn't feel any amazing effects from it! but I had a very pleasant sense of well-being and comfort - a bit like after a couple of glasses of wine when you look around the room and think how nice everything is - and was completely unbothered by how long it took.

The final stage was that they injected a radioactive dye and sent me off to the department of Nuclear Medicine, where I spent the next hour having two kinds of scan new to me - one was a gamma camera, the other a specialised form of CT scanner, which together produce high-quality 3D images of the blood flow. This means they could track the progress of the dye and get a clear idea of where the beads will go when we do the process for real. If they identify any "leakage", they'll embolise the relevant blood vessels next time before inserting the beads.

So it was quite a morning! I felt fine while I was transferred back to a ward at the Marsden - this time in an ambulance, as, like after the chemoembolisations, I had to lie flat and still for a few hours - but as the afternoon wore on I felt rather washed-out. After all, I'd had a great deal of contrast dye pumped into me, plus the morphine, plus a drug which dilated the blood vessels during the embolisation, plus the radioactive dye, not to mention having tubes poked around my insides for two hours. I didn't have any pain, but although it was lovely to have a couple of friends come and visit, and to have supportive texts from those people who knew I was there, I felt pretty weary and was very happy to stay in bed. I was kept in overnight (which reminded me how very unrestful places wards are!) and was discharged the following morning with instructions to take things easy for the rest of the week and drink lots of water to hep flush out the dyes. I still feel quite tired, but it's manageable, and although I've had some discomfort in my abdomen again, I'm pretty sure it's from the chemo last week, not the procedure on Monday. 

So the plan for the next few weeks is this: next week I've got a rare and welcome week off medicine and being a patient when I go to a friend's wedding in the States (I'll do a separate post about that when I get back, as it feels significant for many reasons). As soon as I get back, the week before Easter, I have my final (as far as I know) cycle of chemo, then the following week I'll have the SIRT. This will involve between one and three nights in hospital afterwards, and although people vary in how they tolerate it, there can be some side-effects for at least a week and possibly several weeks, so I'm planning in some convalescence time through the rest of April. I'm not yet sure how much I'll want visitors or social commitments, for those of you who are London-based, but will keep you updated here.

SCOTTISH RETREAT

I've just returned from a week in Scotland, staying at the Findhorn Foundation, about 20 miles west of Inverness. This is an alternative community based on principles of sustainability, spiritual awareness, living in harmony with nature, and sharing their vision through educational programmes and workshops. In my week there I only really scratched the surface of understanding their philosophy, so rather than trying to describe it I'll refer any interested readers to their website: 

http://www.findhorn.org/aboutus/#.UTOOgY5-Q20

My main reason for going was to have some sessions with a healer who works close by, who was highly recommended to me by a friend, Fiona, who I met at the German clinic in early 2012. Fiona lives in Scotland but she and I have stayed in regular phone contact over the past year, and as she told me about some of the healer's remarkable successes with cancer (including with Fiona), I decided it was worth a trip up north to see for myself. I found him a remarkable man: charismatic, warm, and wise, and I found my sessions with him powerful and thought-provoking. Whether there's any effect at the physical level I'll have to wait and see, but he asked insightful questions which gave me a new perspective and clarified some unhelpful beliefs which affect how I cope with challenging situations, so I've come away feeling noticeably more positive and less judgemental about myself - a definite result in itself! Of course a miraculous remission would be fantastic, but to me healing is also about making peace with whatever life throws at us and finding ways to appreciate the here and now without it all feeling spoilt by fears or resentment about what the future might hold - not surprisingly something I've struggled with a great deal in the past 2 years. 

As well as some emotional shifts from the sessions, I found the experience of staying in Findhorn very nourishing. Fiona overlapped with me for a few days, and it was lovely to see her again - as well as always having interesting and inspiring conversations, it's great to have someone who completely "gets" what it's like living with cancer. It was also a good balance of having time on my own at the beginning and end, but company in the middle. We were lucky enough to be able to stay in the house of friends of hers who were abroad, and this gave me a delightful, peaceful and cosy base right in the centre of the community - much nicer than being in a bed and breakfast! It was a charming eco-house, with a turf roof, solar panels, constructed mainly of local timber, and heated by a wood-burning stove.

The community sits in a beautiful location between the coastline of the Moray Firth and the almost-enclosed Findhorn Bay. There are forests, a belt of gorse, heather and pines, and sand dunes leading to miles of sandy beach. I went for long walks and revelled in the clean air, lack of noise, and a very welcome spell of glorious sunny weather. 

Don't be fooled by the sunshine - there was frost on the beach all day!

One day Fiona and I walked to the fishing community of Findhorn village, a mile or two away on the bay, for lunch at an organic cafe and bakery - again, the peace, and the intensity of the light, was extraordinary.

As well as going out walking, I slept for around 10 hours a night; I cooked healthy meals; I read loads (mainly self-help and inspirational books but also a couple of Jane Austen novels for light relief); I really enjoyed taking photos (as you can see by the number I've included in this post!); and I spent time every day meditating, either in the communal sessions every morning and evening, or on my own in the meditation sanctuary. I was surprised by how much calmer I felt, and how much more grounded, by simply switching off my thoughts for 20 minutes or so each day, and it's something I intend to try and keep up back at home. 

I'm planning to go back to Findhorn in early May, if all goes to schedule, and I'm very glad to have found both the healer and the place itself - the week felt like a real respite from the stress and "shoulds" of daily life (even my scaled-down current lifestyle!), and after a pretty tough few months it was a much-needed tonic both physically and emotionally. 

Sunset at low tide in Findhorn Bay