An epiphany

IMG_2644Those days of the Big Checks in Bangkok are in the past in many ways. Many years were punctuated by three monthly check ups, and then six monthly with more thorough checks annually. These were a Big Deal in my post diagnosis life. I was fortunate to have such thorough follow up from the end of the heavy treatment in mid 2010 until I left Asia in mid 2016. Another world, another lifetime, it often seems. Now checking is different in frequency and nature. The past is indeed a different country.

Every year in October, in addition to the three month or six monthly checks, I would turn up at the hospital for what Dr W fondly called the “Big Check”. He had explained to me at diagnosis, that once the active treatment was completed I would be called back for checks every three months for the first two years, and every six months after that until I reached the five year point. Then I would graduate on to annual checks. The three and six monthly checks would be lighter, but at the one year point I would additionally have a mammogram, ultrasound and any other checks indicated.

Those checks were a mixed blessing. I approached each round of checks with trepidation, and the annual Big Check with nothing short of dread and fear. I knew that I was incredibly fortunate to have a variety of bloodwork, physical examinations, mammogram and ultrasound and if indicated, further scans such as CT. I knew that if there were any nasty activities underway and any signs of progression or recurrence, there was a very high chance that these would be spotted during the Big Checks. And of course, that was my greatest fear. That there was some nasty malignant beavering away of cell multiplication out of view. Yet, alongside that Big Fear, there was the attraction of knowing that if the checks all came back without any worrisome results, then in all likelihood I was in very good health and the designation of NED (No Evidence of Disease). And NED is exactly in whose company I wanted to be.  If I passed through these major checks with no worrying results, then I would be rewarded with enormous relief and reassurance.  l could then breathe out and get on with some serious living until the next round. My first followup checks were in early July of 2010, thus by by strange coincidence my first Big Check took place in October 2010. Exactly a year from diagnosis. And also the start of the visible Breast Cancer Awareness month which was even present in Bangkok.

Those first checks set me on a path of appointments, blood taking and other checks regularly until I left Yangon in June 2016 to my new life in Rwanda, saying goodbye fondly to Drs W and W2, and the teams which had looked after me. We had been a team for 7 years and had been through a lot of hiccups and nastier moments together.

As well as the checks, my ongoing followup consisted of taking Tamoxifen once the active treatment was completed in the May of 2010. This was not a pleasant experience with its many side effects including the very nasty one which tried to do away with me altogether – the pulmonary embolism which appeared in July 2012. When I was first prescribed Tamoxifen, research and trials indicated that the prognosis was best when patients took the drug for 5 years. The prospect of 5 years on a medication with such heavy side effects is daunting. When the embolism happened I was taken off Tamoxifen immediately. And prescribed Femara/Letrozole. This is an aromatase inhibitor and works in a different way to Tamoxifen which is a selective estrogen-receptor modulator (the wiki link is need to explain that as I am not able to do so!) Femara is more usually prescribed for women who are post menopausal. It has just as many side effects, equally heavy and unpleasant such as joint pain, weight gain, fatigue, dizziness, increased cholesterol just to name a few and I was both thankful and frustrated about these “extras“.

As I was approaching four years of taking the hormone therapy Tamoxifen and then Femara, and almost able to touch the five year point when I would be able to stop, new research findings were hitting the breast cancer headlines. What an ironic blow to learn that women who took the medications for ten years had better outcomes than those who did not, or who took them for five years. I knew what was ahead before the next round of checks. And sure enough. Dr W2 recommended that I keep on taking the Femara. For an additional five years. Five. Whole. Years. That felt like for ever! Or until mid 2020 …

Leaving Asia and the attention of Drs W and W2 with the reassurance of the Big Checks, was a massive step out of a comfort zone which I loved to hate, and really valued. Moving to Rwanda, meant that I had an annual mammogram in Scotland around the time of the checks in 2016 and my unexpected return to Scotland in 2017 meant a very different approach to cancer follow up, particularly as I approached the ten year point from diagnosis. This involves an annual mammo and a letter to let me know if there is any need for follow up, and a separate check up with the breast nurse. No single day to focus on both with dread, and knowing that clarity would be provided. No bloodwork and tumour markers with my record and trends. Instead, lighter checks over several days or weeks. A very different experience, particularly psychologically.

This year, I had to juggle the dates around as my nurse appointment was scheduled earlier than the mammo so results would not have been available at the consultation. So with some phone conversations, and a house move all underway, it was agreed that I would have the mammo and then see the consultant prior to moving to a new area. This took place, ten years to the day from my formal diagnosis and surgery by some very bizarre coincidence. These checks are not nearly as stressful as the Big Checks in Bangkok because they do not include bloodwork so I have no idea if tumour markers are within the trend that was clear throughout the regular testing in Asia. Occasional testing of markers is not useful, so I did not miss the results, just the ongoing knowledge that these were stable. The significantly lessened stress of these checks is balanced by the limited reassurance. A little sigh of relief, but the underlying nagging uncertainty of NED status.

So after a very short wait, the  consultant invited me into his consulting room, and noted that I had had much of my treatment overseas, asking me if it had been Paris or Singapore? I began to explain …

The mammo result was unremarkable, happily and we talked through my general health and the worries that I always harbour. Then we talked about the Femara. I was fully expecting there to be some new research which indicated that results for women who took the medication for 15 years had better outcomes … and prepared for that news. To my surprise, he said that the latest research and analysis shows that there is no marked benefit in staying on Femara beyond 10 years. He also said that there was a kind of a ‘hangover’ of the medication as the benefits stay in the system for some time after it is stopped. This was the precursor to him advising me that I could stop taking Femara. After TEN YEARS. He asked how many tablets I had left before I would need a new prescription. I had around 3 months, and that would take me through to early January. “Then, I suggest, that you continue to take these until they are finished. And then stop. There is no benefit in getting a new prescription, you can stop when they run out”.

And  just like that, I was given permission and the advice to move forward by a giant step.

I have been taking this feeling of lethargy, joint pain, and general effort needed for everything I do for granted for so many years, I did not actually believe the day would come when I would no longer be taking this heavy, albeit probably life preserving medication.

And so around 20 days ago, on Twelfth Night, 6 January,  I had my own personal epiphany. The realisation that this ten year phase had come to a close. As I prepared to go to bed, I took my glass of water and the last Femara in the packet. Hopefully, my last ever Femara. The end of an era indeed.

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I am looking forward to seeing if there is any change in how I feel. Let’s see. One thing is for sure – I am bound to tell you.

Disorientation

And so the sun sets on another week, and I find myself in a different continent.

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Under an African sky – in front of my eyes

I returned to Africa a week ago after an unexpected, and unwelcome reason for extension to my stay in Scotland. I should have returned two weeks earlier, after a short visit but things always take a surprise turn in that post diagnosis cancer world. I am fine, no nasty cancer surprises but I can attribute what happened directly to cancer.

So what happened, that warranted hospital admission and being unable to return for two whole weeks? A nosebleed, that’s what. Yes, a nosebleed. And one I blame unequivocally on cancer!

It started fairly innocently just before I had an optician’s appointment. One of a series of things to be done, while on home leave. The bleed would not stop, and reluctantly I had to cancel the optician. I pinched my nose, and waited patiently as the time for another appointment approached. The bleeding continued and worsened. I called the medical practice and was advised that I should go the Accident and Emergency Unit at the local hospital where they would be able to deal with the bleeding. The last thing I wanted to do, but with my history and being on blood thinners this was the correct and only course of action.

Treatment was not pleasant or nice, and for something as trivial-sounding as a nosebleed it was frightening to see how quickly a situation can become worrying. I was admitted to hospital and with the various procedures the bleeding was eventually staunched. I was allowed home the following day, with a strict set of instructions. No hot showers, no exertion, no flying or travel and the worst? NO TEA! That was a serious struggle. I have never craved tea so much in my life! But heat or exertion can re-start the bleeding and that is not a risk to be taken, so no tea and no immediate return to Africa.

How can I blame cancer? Quite easily in fact, the nose bone is quite clearly connected to the cancer bone in my case. Blood thinners were the cause of the nosebleed, and those blood thinners are a consequence of the Pulmonary Embolism I had, which was attributed to Tamoxifen. PE is a relatively rare but dangerous side effect of Tamoxifen. And of course,Tamoxifen is prescribed following hormone receptive cancer diagnosis. Thanks, cancer!

The sides and afters of cancer and its treatments continue to rumble on and we are reminded that even at times of NED (No Evidence of Disease) we exist with vulnerability and fragility.

I am enormously thankful that this medical hiccup has been dealt with relatively easily, but my confidence has again been damaged. I am approaching 7 years from diagnosis and am in pretty good health overall. Yet the fallout from cancer, while it might not be visible or evident apart from to me, is not to be underestimated. Life is fragile, precious and unpredictable. At the hospital, the ENT specialist advised me to be cautious and not to trust my body as it has let me down before. Interesting words from a doctor, validating anxieties and vigilance.

So I am pleased to have returned to my new life in Africa, though being in three continents in as many months has proved disorienting briefly. It is good to be able to look ahead with no immediate plans of long distance travel and to concentrate on my reorientation. My three word mantra for the year powerfully reminding me of my focus for the year. The time is right to seek to crystalize and settle now and I have a very clear reminder of my middle word – nurture – timely and so pertinent.

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I returned home yesterday late afternoon as the sun was sinking in the sky and I was treated to a spectacular sunset. And I was present in every sense to witness and appreciate it. With no thanks to cancer!

 

Costly and subdued.

The promised update.

The latest round of checks is behind me and I am breathing out.  That means one thing – that the important tests were mostly fine, and that I can breathe out slowly again.

I have been surrounded by support and care, and cannot express how much I value that.  There is never a time with these checks that you can truly put it all behind you and consider it “done”.  But it is good for now and I am just that little bit closer to NED (the precious No Evidence of Disease) than I felt last time.

My two cancer Docs, Dr W and Dr W2 were both happy and thorough.  My tumour markers remain elevated but stable.  As in almost exactly the same now over the past 18 months, and in fact since the rise which prompted the scary scans in October 2012. So this meant no bone scan this time.  Which was very welcome news! It does mean that there will be a number of scans and extras in the upcoming Annual Big Checks in October. But that is ok, because for now I can breathe out.

My aspiration is for Dr W2 to call me “boring” and I have still to attain those dizzy heights.  Last time he saw me I was “complicated” which is much better than “interesting” but still not boring.  This time I am in a better place in the scale – “expensive”! He asked me if I need more meds, and I said that I did.  I said that I could get some myself, but he expressed concern that they might not be good quality or genuine and I agree that it is better that he prescribes these.  However, that comes at a cost! Confidence that the meds are genuine means that they are also expensive.  And as time wears on, I gather more meds instead of shedding any.  Added to that, I am fighting off a couple of infections at the moment and needed to add an antibiotic to the mix.

medsDr W2 also said that I seemed to be one of a small number of long-standing patients.  I was surprised and he told me that many stop consulting him after their acute treatment, and many return back to their original countries.  So I have some kind of loyalty pass which is rather comforting.  Dr W similarly spoke very warmly with me, offered support to the Yangon Breast Cancer Friendship Group which we are establishing and was generally very encouraging.

It was not all so warm and cosy though.  My endocrinologist was less happy with my bloodwork.  My previously wondrous cholestrol levels have been steadily rising as are my sugar levels.  I am working hard to keep diabetes (which has been in my mother’s side of the family for generations) at bay and it seems that this is not going to last much longer if the trends continue.  I find this so frustrating when I exercise so consistently and eat very carefully.  I showed him my exercise log (ok, it’s a rather obsessive log of how far I swim daily, how far I cycle and how long I exercise for – I find it really motivating).  I find that I exercise between 180 and 250 minutes a week on average. He told me not to blame myself as if there is a strong genetic predisposition then I cannot halt that.  However, I also consulted with a nutritionist to see if there is something I am missing or not doing properly.  With her, I worked through a typical day and exactly what I eat.  She looked up at me and noted that my diet is more healthy than hers!  She suggested a few adjustments – such as reducing my fruit intake and adding some protein to my evening meal.  So I will give that a try.  She also noted that the lack of thyroid function is significant in metabolism and weight issues, even taking the synthetic thyroid which also made me feel better.  But then she suggested I am for a 3 kg loss for my next appointment.  Which totally deflated me.  I feel that aiming for a specific weight goal just does not work.  I struggle and work so hard not to gain, I feel an automatic failure if I cannot lose kilos.  I prefer to ensure that what I do is right and if that leads to weight loss then that is great, but what matters is to eat carefully and exercise.

Ironically, Drs W and W2 (my oncologist and surgeon) were happy to recall me in my usual six months, but the endocrinologist wants to see me again in three months.  Sigh.  A step backwards, it feels.

The ray of sunshine in this though, came from Dr W.  He knows me well and asked me if I still swim and cycle and I confirmed that I do and that this season is perfect for the morning routine.  I told him that there were concerns about my cholestrol and weight and he instantly said that this is well known of Femara.  Which was enormously reassuring and validating, and is very much what I suspected as these issues emerged from the very first checks following the switch from Tamoxifen. And as another friend said “cholestrol is better than cancer” and for sure, it is!  It is not great but the Femara is there to keep the bigger demon at bay.

As I move forward then, I juggle the bonus combo of a genetic propensity to diabetes and high cholesterol, lack of thyroid function and the side effect tactics of Femara. None of which I can do anything about, except continue as I am.

Water music

So here I am, again on the other side of a round of checks.  Again slowly breathing out.  And again subdued. I might not be “boring” but I am expensive so that must make me rather classy – right?

And whatever else I am, I am beyond thankful.

 

Skin deeper

There has been an elephant in the room, and not one which sits quietly in the corner.  It has been rampaging through the house causing destruction and damage in its wake. I wrote Skin Deep over many days and did not actually believe I would put it “out there” online but as I felt myself sinking deeper and flinching from those small incidents which are on the surface slight, with tears in my eyes I finally pressed the “bare my soul” button.

I do not really know what I expected from the post.  Being honest, I had not thought ahead.  The purpose of writing was to vent and pour out the distress in my heart.  So I was astounded by the response to Skin Deep. As well as numerous comments on the post itself, I received personal emails and Facebook messages and a number of people here reached out with love and understanding.  I had not anticipated the many thoughtful messages reassuring me that physical appearance is not the same as beauty. I have been emotionally overwhelmed and it has taken time to put my thoughts in order and prepare this reflection and learning.

As I read through and responded to the comments, replied to emails, spoke with friends who reached out and quietly reflected, the clearer a picture developed of a whole host of people struggling silently.  So many live with constant debilitating side and after effects and swallow the assumptions that everything is behind us and rosy now. Many of us are silently absorbing assumptions of our appearance, while struggling with a variety of conditions which impact on how we look, so many of which are beyond our control.  I had lifted the lid off some Pandora’s box.

I still feel fragile, emotionally and the wellbeing and appearance issues are unlikely to change.  But I learned a great deal from writing the post, reading and reflecting on the responses and bringing together these thoughts into some key messages.

I am not alone

I am incredulous at the number of people struggling with these interconnected issues, in silence and isolation.  We are dealing with a host of issues – side effects from many meds, after effects from current and previous treatments, disfiguring surgery, pain, destruction of functions including thyroid. We may look well but be living with debilitating conditions, or we may look unfit and unhealthy yet are following extremely healthy lifestyles as far as we can. In summary, as “cancer in my thirties” said in her comment

“many people fail to realize how horrible the side effects of our treatments can be — and how much they impact our lives each and every day”.

Even if I struggle with these, knowing I am not alone somehow helps emotionally and validates these feelings.  However, another side is that very few of us expect or are prepared for such debilitating side and after effects. We should be grateful that we are alive – and of course we are, but that doesn’t mean that this is something that can be wrapped up and put easily in the past when we live it every day.

Far too many are silently living with this.

Intent

I did not intend to make people feel uncomfortable.  My post did not point fingers at any individual but aimed to draw out the consistency of reaction.  I particularly want to stress that I do not for a moment believe that there is unkind intent in many of the comments and looks I experience.  My friend Becky wrote very powerfully of her experience and in particular placed it in the context here.

“Being called fat in SE Asia isn’t necessarily a negative thing. It’s quite acceptable here to talk about people’s size. ……………

In some countries, being told you’re big can be a compliment. I sense it’s not necessarily a compliment here, but rather an observation (perhaps without much judgment).“

It is so important to hold on to this, and try and remember it is more an observation.  The challenge is that of course I come from a context where it is broadly offensive to comment on a person’s weight.  And that is why it hurts.  Purely and simply, I struggle terribly to be on the receiving end without it that stab of pain and shame.

It doesn’t matter how much I rationalise and understand – it still hurts.

Reaching out

I have found that not only writing and releasing these highly personal and innermost thoughts and feelings but then listening to the responses and reactions of others is helping me to process this.  Chronic illness, mortality, cancer and the whole psychological and emotional and invisible side to diagnosis continue in my view to be underestimated even within ourselves.  We are often caught up in our own pain and unable to see how enormously difficult for those around us themselves to deal with life-threatening diagnoses in their loved ones.

Open your eyes

Indeed, I really did not have a clear purpose in my mind when I started on this journey of exposing my soul. I did not expect such a powerful reaction. I think that in the back of my mind, I was screaming silently that I wanted to be heard. To be understood. And not to be judged.

This path is and will continue to be painful.  Yet for now, I can say that I do indeed feel heard. I feel far less alone.  And I feel more understood.  I hope that applies to us all.

The elephant is still in the room.  I doubt if it will completely disappear. But it does seem to have quieted a little and become less obtrusive.

Skin deep

Dear people

This is a plea to myself as much as it is to others. This is an appeal to each of us, to pause and think before we judge others, especially on appearance.

I know what you think when you see me, whether for the first time or as a longer acquaintance.  I can read it in your eyes.  I see the belief that I look the way I do because I do not care about myself, I am gluttonous and lazy. I know that look which betrays pity and blame combined. Which cuts into my soul.

I know that I have not worn my years kindly.  But I do not think you know just how much I struggle with that, every time I look in a mirror and each time I see myself reflected in the eyes of judging strangers.

I do not want to have to tell in advance, that I know how it seems. As if I live a life of sloth.  But I yearn to challenge that judgement, and preface a conversation by saying just how hard I push against the forces which shape me.

I will give you an example. I move increasingly awkwardly. Femara is a drug which decreases the probability of my cancer recurring or progressing. For which I am thankful.  How can I not be?  Despite the accumulating side effects which conspire to make my mobility increasingly constrained and painful.  I push myself to get up and move about, despite the pain because I know it helps a little and that inactivity is an enemy. Despite that pain when I rise to my feet and the jarring pain in the first steps, which gradually reduces to an ache and awkwardness.  But I can tell by your looks, that you think my bulkiness is causing this lumbering gait.

I hear comments on my weight and suggestions that I should walk a little. I know that the intent is not unkind, but still I fight back tears. I hate my defensive tone when I try to explain gently that I have cycled five kilometres that very morning, as I do most mornings.  That I have swum half a mile, as I do most mornings. That I am probably fitter than I have ever been since my teenage years. The irony slaps me, knocking me sideways. I know you don’t really believe me.  I know that because, if you see me by chance one morning on my bicycle or swimming, your expression is of surprise.

I can no long walk freely.  My toes have retained that numbness of peripheral neuropathy from chemotherapy. I am frightened of falling.  I stumble even in the house and earlier this year had one bad fall. Those numb toes caught on a paving stone, slightly upturned and I fell heavily on both knees. Those tender, already painful knees.  My confidence has been dashed, and my love of walking is a memory as I pick tentative, cautious and painful steps.

Dear people, I had no idea that there were so many long term effects from treatment which has probably saved, and at the very least significantly prolonged my life. When I learned that my thyroid function had been annihilated by chemotherapy my initial reaction was one of vindication.  Here is a major reason why I struggle with my weight despite being more active and physically fit than I have ever been.  It is not sloth or gluttony.  Zero thyroid function is a very clear medical reason behind stubborn extra pounds. Every morning before my day begins, even before I put on my swimwear as the sky slowly lightens, I have to take synthetic thyroid.  Every day I take this, and will for the rest of my life.  Any hope that this artificial medication would re-shape me was however dashed as the months after this bonus diagnosis and new medication slipped by without any sign of weight loss.  An hour of exercise in the morning maintains a fairly steady or even mildly gaining weight.  Any reduction in activity results in rapid weight gain.  Which does not reduce no matter how active I am.  This is sickening and frustrating.

It is human to judge and to make assumptions. We are wrapped in our social and cultural baggage which nurtures beliefs deep within us. It is also human to smart when we are on the receiving end of those suppositions.judgementI know that I should accept the way I look.  Even my doctor has told me I am doing everything right and that I should try not to be so hard on myself.  That is one part of the question.  The other part is how not to take it so much to heart when others are unintentionally hard on me.

shoesAnd that is the one I can’t crack.  I can rationalise the comments and looks, and can attempt to reassure myself that I am not who I appear to be.  But I can’t stop it hurting.  I can’t prevent involuntary sickening twist-in-the-gut  reaction when yet another person remarks. That lingering sense of sorrow and shame which descends on my spirit. The futility of defending myself, knowing that it just does not appear credible, and minds are already made up.

Dear people, you do not know how much I hesitated to write this. How bare my soul feels putting these words on the page.  How exposed and vulnerable this makes me feel.  How sensitive and susceptible to more judgement as a result of disclosing my innermost anxieties and insecurities.  How uncomfortable about such a self- indulgent outpouring.

We do not know what innermost struggles there are within each individual, hidden by smiles and a seeming lightness of the spirit. Painting a smile and crafting gentle words while the soul writhes in pain takes enormous effort.

do not judge me

To paraphrase a well known saying – let us aim to be kind to others , for we cannot know what private turmoil there is within each one of us.

Future tenses

I have arrived.  I have no idea, and no good reason for this being my very first visit to Malaysia despite living so near for over a decade.  All I do know is that I am here now, and very glad to be.

I think that the impression I have always had, particularly of Kuala Lumpur, has been that it is a highly modern, futuristic city with of course the iconic Petronas Towers.  Now I am kicking myself that I have waited so long!  It is an incredible city, with a rich mix of architecture and culture.

So what could be more fitting than a sneak preview of the many photos and tales to come, with a change of background and some funky pics of the futuristic Petronas Tower high above the skyscrapers on the skyline, such as this one reflected in the table I was sitting at the first evening I arrived in KL.

Reflection of the iconic Petronas Towers in Kuala Lumpur

A classic view of the Tower itself, for the current background.

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And a couple of “preview” images of the diversity that is KL with a promise of much more to follow.

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This year has taken such a toll, and although I continue to struggle with the heavy side effects of potentially life waving meds, as well as that overbearing, ever present grief, it is good to have a diversity of surroundings such as the KL setting.

A setting to inspire and remind of the past, the present and the future.

After Words

I was astonished by the level of interest and response to my “thanks, but no thanks” rant last week.  I was in part reassured to know that I am not alone in the physical and emotional space and that these “afters” and “sides” of cancer and its treatment are very real and encroaching.  However, at the same time I was saddened and frustrated that so many of us are struggling.  Often silently, because we do not want to appear ungrateful or to upset family, friends and those around us.

From the outset in this cancer experience I have always reminded myself that there are many things which are not in my control, but many which are.  And how I live the cancer deal is one of those in my control.  I would rather be flippant and feisty, and poke fun at cancer than dwell in the doldrums and feel unhappy with my lot.  It just is what it is and I get on with it.  Mostly.

What came across clearly in the comments and conversations prompted by the rant, was the fact that amidst this weariness, we feel compelled to maintain a positive outlook and we feel guilty when we sometimes want to scream and stamp our feet.  Well perhaps not stamp the feet as they hurt too much!  There was a widely shared sense that we do not allow ourselves to have off days, and times of frustration or anguish.

I have been adjusting to these side effects of these meds for some time, and last week reached the point where I lifted my head out of the sand and realised that the pain and discomfort are such that there are many things which physically I can no longer do.  I have had to acknowledge with some resistance, that the break I have booked for next month will be far more physically challenging than I have prepared myself for and that is beyond frustrating.  This is not about inconvenience, this is about debilitating physical effects which are stopping me doing what I have long taken for granted.   For example, one of the favourite parts of my work, visits to our project sites are increasingly difficult – I used to hop on and off of boats, sit on the floor in villages and walk for days in the Himalayas.  Much of that is now too painful, unsafe or, sadly, beyond my capacity now.

That is when I reached that tipping point and this rant took shape.  I feel better for venting, but nothing of course changes the physical deal, the side effects are still there, and I still have difficulty walking. But it is what it is.  I deal with it. I get on with it and adjust as far as possible.  Mostly with a smile, but sometimes, it just gets too much and I weep.  Not often, but sometimes.

These past weeks have been tough ones, and the prospect of more of the same in terms of side effects feels heavy.  But I do work hard to balance this and make the most of what I DO have, and carpe that diem.

Most days I am incredulous that I have been able to realise my dream and ambition to live and work overseas, in such extraordinary places.  I have now been in Asia for 13 years, and am humbled and moved by the incredible experiences I have been through and the wealth of inspiring and amazing people I have known.  I love my life, and I have no significant regrets.  There are of course a heap of things I still would love to do, sitting in my wish bucket.  But, I have so much to be thankful for and if someone called “time” tomorrow, I would not plead for the chance to do that something I have not managed to get round to.

Even as I sit here, looking out onto the lush garden, the wind whispering in the mango tree, frogs croaking as more rains approach, I still have that sense of naïve wonder and fresh enthusiasm at being in such a place.

However, some days it just takes that extra energy and determination to get on with the day to day, and I find that the reserves have run low and it is just out of reach.

It is what it is.

Sometimes even geckoes have to rant.

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