VIJAYA-The one who fights to win

Vijaya and I have been friends for many years. We stay in touch no matter how busy we may be. I remember a time when I stopped receiving her texts and it worried me. This was very unlike her. I sent her this message “Vijaya, is everything ok? I have not heard from you in some time.” She replied, “Vandana, things are not ok with me. I have been diagnosed with breast cancer.” As her friend, I stayed connected with her all through her treatment, and today, we have a very special relationship. Vijaya told her that she would never forget the day she received the biopsy report. That was the day that changed her life forever. The biopsy result confirmed the malignancy. HOW DID IT ALL BEGIN? Vijaya was very scared. A few months ago, she had felt a small lump, the size of a green moong bean, in her left breast. It reminded her of one of her friends who had undergone treatment for breast cancer a few years ago. Vijaya had witnessed her struggle and was by her friend’s side through it all. Back then, there was hardly any awareness about the importance of breast self-examination. Vijaya had always been very careful about her health. She regularly checked her breasts and during one such breast self-examination, she had felt a lump. She brushed off her fears by telling herself, that only obese and inactive women are prone to breast cancer. She was physically active and berated herself for unnecessarily doing this self-checkup and getting concerned about something that was not going to happen to her. However, the fear that the lump could be cancer preyed on her mind. She sought an appointment with a gynecologist. In her words, “As fate would have it, the gynecologist I had been consulting for many years was busy with an emergency operation; thus, another doctor saw me. It was as if I was being warned by the universe.” After examining the spot where Vijaya had felt the lump, the doctor told her that there was no lump in the left breast, but instead, she felt something in the right breast! Vijaya was confused and taken aback. She immediately underwent sonography of the breasts; the report of the scan was inconclusive. The next step was to do a mammogram. Scared and tensed, she rushed to the diagnostics center. After the completion of the scan, Vijaya noticed that the radiologist seemed concerned; it was then that Vijaya had a sense of foreboding of what was coming next. Strangely, the lump was detected in the left breast and not in the right as predicted by the gynecologist. This scared and confused Vijaya even more. Whom was she supposed to believe? Vijaya went numb when she was told that the lump could be malignant. She soon got a hold of herself and called her husband who rushed to be with her. What followed was a battery of tests, and a biopsy was then performed. The word biopsy sent a shiver down the spines of both Vijaya and her husband. Vijaya thought to herself, “This cannot be happening to me.” She did not want to inform her daughter until the biopsy results were declared. Those 7 days of waiting until the report was available were agonizingly difficult, Vijaya shared with me. Their worst fears were confirmed. The lump was malignant. Then began the process of consulting the doctors in the family and amongst close friends. Quoting Vijaya, “Disclosing the diagnosis to my daughter was very difficult. When she burst into tears, I did not know how to console her. I was in a very fragile state and seeing her cry added to my fears. However, I wanted to be truthful and not hide anything from her. She hugged me and we promised that we would get through it together. I confided in my close friends who were my pillars of support throughout the journey. They cried, but surprisingly, my tear glands seemed to have dried up. I was numb and did not cry even once.” Vijaya underwent breast conservation surgery. She was diagnosed with invasive lobular carcinoma of the left breast, stage 2A. She received four cycles of adjuvant chemotherapy with docetaxel and cyclophosphamide, which was followed by radiotherapy: 28 fractions over 5 weeks of external radiotherapy to the entire left breast, and then a boost to the lumpectomy cavity. Today, Vijaya does not like to talk about the treatment as it brings back the trauma she experienced during chemotherapy. Memories of her hair loss (alopecia) and darkening of the nails followed by their auto-amputation make her shudder even today. She says, “The loss of hair during chemo is quite devastating for a woman and it takes time to come to terms with that. I had ordered a wig before starting chemotherapy. Wearing the wig gave me a sense of normalcy. I was unsettled by the darkening of my nails. To help deal with it, I painted my nails with a dark shade of nail polish during chemotherapy. I am grateful to the medical oncologist who gave me this wonderful advice. My eyelashes also started to fall. All these were a big blow to my self-image. I feel that concerns about body image are not addressed by most treating teams.1 No one recognizes the impact that these side effects have. I dreaded going out, I became so conscious about my appearance that I would not want to meet anyone. This only added to my insecurity, causing anxiety that was not easy to manage. Today, 8 years after my diagnosis, I regularly feel a kind of tingling sensation and pinpricks over my body, which I have been told is a side effect of chemotherapy. It is a constant reminder of the ordeal I have been through.” Vijaya was prescribed a Religrast injection after each chemotherapy cycle. It had to be taken for 4 consecutive days to help improve the white blood cell count. This too had side effects such as body pain and sometimes, low-grade fever. Furthermore, radiotherapy was followed by hormone therapy, which had to be continued for 10 years with a change in the hormone tablet after a few years based on the doctor’s advice. The hormone therapy was started with tamoxifen once a day along with calcium. After 5 years, tamoxifen was changed to anastrozole. Along with it, she was prescribed an injection of Zoladex to be taken once every 3 months. She was also put on a bone-strengthening zoledronic acid injection to be taken every 6 months. It was during this time that Vijaya met another lady who was undergoing the same treatment. Vijaya shared, “There were some things that I could not discuss with my family and friends but could easily discuss with her as we felt each other’s pain and fears. We became each other’s biggest support. We would about the wigs, our diet, our reactions, fears, and insecurities and it made the journey a little easier. Now she is a friend whom I never want to lose.” After this experience, Vijaya advocates for patient and caregiver support groups, and supports many women undergoing treatment for breast cancer. When I asked Vijaya what kept her going, she replied, “I went through the treatment with full faith in the doctors and followed every instruction that was given to me. From the beginning, I was clear about whom I would share my diagnosis with, and I made sure to stay away from any negativity, and from people who might not understand the situation. During chemotherapy, I ate nutritious food, tried my level best to stay positive, and read spiritual texts, which kept me calm. I chose not to browse the internet for any information regarding my treatment. I was not going to give up, come what may. I firmly believe that this extra strength was a gift from God at the right time. It was amply aided by support from my family and close friends. One’s life is never the same after a cancer diagnosis and treatment. I now value life so much more. Sometimes the thought of recurrence bothers me, but I have learned to brush it aside and concentrate and live in the now. I had faced several stressful events in life leading up to the diagnosis, and sometimes I feel that may be the reason I got cancer. I believe mind and body work together and it is important to keep stress at bay. Good health and a happy mind may not prevent all illnesses but definitely help in crossing the hurdles with confidence and strength.” About the patient Vijaya (name has been changed to protect the identity of the patient) is a post-graduate homemaker and a devoted mother who volunteers her free time for social service. She is a hopeless optimist in spite of facing life’s many challenges. She loves nature and enjoys traveling. She remains physically active, and yoga is what helps her to stay fit. She feels life is a gift to be celebrated and that it is a continuous learning process. Her motto is, “Honesty and truthfulness go a long way in reducing many of life’s problems.” About the author Ms. Vandana Mahajan is a palliative care and cancer counselor. She is associated with the Mumbai-based non-government organization, Cope with cancer-Madat Trust. She volunteers as a counselor in the thoracic disease management group at the Tata Memorial Hospital and also provides cancer counseling across India via online platforms. She is a cancer survivor too! Email: email protected Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.