[2021-12-07] Quarterly review and gratitude
Three-month ovarian cancer follow-up
I had my first three-month follow-up with a member of The Ottawa Hospital's gynecologic oncology team today.
As I explained on September 3 in Wear Teal Day, I have now moved from follow-ups with the team every month to discussions four times per year. I'm comfortable with this given that I continue to get my blood checked each month and to receive the results directly through MyChart. For me, the most important number is my CA125, a measure of the cancer antigen in my blood. My doctors are looking for a stable number below 35, which is considered normal.
Throughout 2021, my results have been low and steady. I started with a 10 in January 2021, after having gotten a 19 in December 2020—the first time my CA125 had been in the normal range since it was measured at 920 in July 2020, when my ovarian cancer was discovered. That figure of 19 was last year's early Christmas present, signifying that the surgery and just three rounds of chemotherapy had dramatically lowered the cancer antigen in my body. My happiness with 19 and giddiness with 10 turned to joy in February when my CA125 dropped to 8. May brought further bliss when my CA125 settled at 7, where it would stay for the next five months.
However, I was a little concerned when my CA125 nudged up to 8 from 7, as I shared on October 26 in Keep going. Would this be the beginning of a progressive climb in the number, I wondered? I was anxious to see where it would be a month later. My most recent result of another 8 brought a sigh of relief—once again, it was an early Christmas present.
My doctor today, Dr. Beltran, stated that there's no significant difference between 7 and 8, or even 10. She reiterated what her colleagues have said in the past: they would be concerned by a doubling of the CA125, from 7 to 14 and from 14 to 28. For now, she said, "You're exactly where we would want you to be."
Gratitude
I'm very grateful for this result. Coincidentally, last night, I decided to listen to a TED Talk. I landed on How gratitude rewires your brain by psychologist Christina Costa. She studies well-being and resilience, and brings a personal perspective to her research as someone who was diagnosed with and treated for brain cancer.
Ironically, years before the discovery of a tumour in her brain, Costa would ask her middle school science students to kiss their brain. They would put their index and middle fingers together, then bring them to their mouths and subsequently transmit the kiss to their brains by touching the top of their heads. It was an expression of gratitude for everything their brains enabled them to accomplish.
Costa would remember this activity years later when she was dealing with brain cancer; kissing her brain would remind her to have gratitude for her body. This viewpoint was in contrast to the fight narrative so prevalent in the cancer dialogue. Costa hated the idea that she would be at war with her body. She didn't want to name her tumour. She didn't want to picture chemotherapy as an army coming to battle the cancer cells.
A few weeks after receiving the pathology report on her tumour, she wrote:
Fighter. I tried it on to see how it felt because I kept hearing those words next to my name, like a job, like an identity, like a role. Fighter. I look at myself in the mirror. It felt OK at first, but soon it became exhausting, too heavy to lift, too much to carry, too burdensome to bear. I took it off and left it on the floor. War was not for me. A body is not a battlefield.
While she understood why the fight narrative could be empowering for others, she knew it wasn't right for her.
I came to the same conclusion early in my cancer journey. I realized how random cancer can be. If another ovarian cancer survivor's CA125 starts to rise and mine doesn't, it's not because I am fighting harder than they are. It may be because my BRCA2 gene mutation makes my cancer more responsive to chemotherapy. Or it could be because I am eligible for a drug that inhibits the growth of tumours. And if my cancer does return, despite all the scientific and medical efforts made on my behalf, it won't be because I wasn't "courageous" enough in "battling" the disease.
Instead of fighting her body and the disease, Costa started focusing on practicing gratitude.
I tried to stop focusing on what my body had done "wrong" and focus on the gratitude I had for my body instead. And really, I realized this is something I had been doing when I was kissing my brain those days leading up to and after surgery. Gratitude became the tool that helped me restructure my vision of illness and disability when the world was telling me I should fight it instead.
Rather than dwell on what was amiss in her body, Costa focused on what was going right—not only what her body was doing to heal itself, but also what her healthcare team was doing to treat her cancer.
I started to feel such an immense sense of gratitude for science, medicine and my medical team, that those thoughts started to drown out the "What is my life going to be like?" thoughts.
Her practice of gratitude included thanking her brain for its amazing work, jotting down three things she was grateful for each morning, and writing thank you notes to her heroes in health care. She recognized nurses who successfully inserted the IV the first time, the anesthesiology resident who held her hand during the awake portions of her surgery, the radiation therapist who played her playlist during treatment, and administrative staff who greeted her every time she walked into the hospital.
Costa reiterated that she wasn't dismissing people who might be emboldened by the fight narrative. And she acknowledged that it isn't easy to be grateful in the face of adversity.
But I do want to empower those that feel like me, that there's another way to go through whatever your journey may be, that loving your body doesn't have to be conditional. And that by practicing gratitude we can actually wire our brains to help us build resilience.
Costa's TED Talk resonated with me. She put into words a point of view that I share. Like her, gratitude works for me: appreciating my body's ability to heal from two surgeries in less than two years, valuing science that identified my BRCA2 gene mutation and giving me the chance to reduce my risk of additional cancers, acknowledging the advancements in science that have enabled me to reach and maintain a normal CA125 level, recognizing all the healthcare professionals who have supported me so spectacularly to date, and loving all the friends and family members who have walked with me on this journey.
