Prescribing Pizza

The Road to Recovery

Lucy Begging for Creon

Another day, another appointment. Today it was with one of the dieticians at Manchester Royal Infirmary (MRI). It was extremely useful and I recommend to anyone who has a Hepato-Pancreato-Biliary (HPB) disease, such as Pancreatic Cancer, to get in touch with a dietician from their hospital as early on in the treatment process as possible. I feel like I have had drips of information from other parts of my treatment, but nothing like the level of help that I received today. A lot of the strategies and knowledge I have utilised so far have come from research that I have done myself, or through discussions with other cancer sufferers. There was a really useful call that I joined with Pancreatic Cancer UK which lay out the fundamentals of Creon and why I need to take it, but that was a group call; having a 1-2-1 with a dietician allows you to dig deeper into the specifics of your individual case. No two cases of cancer are exactly the same after all.

Not only did I learn more about diet whilst suffering from pancreatic cancer generally, but I also learned a lot about diet when approaching a major surgery. Want to know the good news or the bad news first? Let’s get the bad news out of the way first… My assumption that getting as healthy as possible before surgery, by eating healthy foods and losing some weight, was totally wrong. Solid stuff, Dan – typical know it all idiot deciding that you know everything about the world and jumping to conclusions.

It turns out that the average person who has had a Whipple procedure will lose about 10% of their body weight post-surgery. That means that you want to put on weight before surgery to try to minimise the impact that this has on your body. Even if you are not having a Whipple, you will still lose weight after a major surgery due to the abundance of drugs and suffering appetite during recovery. Of course, I am assuming that you are a healthy weight before surgery; if you are overweight, I don’t think the advice would be the same. Then again, I’m not sure – I’ve had a single meeting with a dietician, so you probably want to take everything I say with a pinch of salt (and a whole trough of full-fat cream if you are trying to pile on weight before your own Whipple procedure, like I now am).

The good news is that I now get to eat whatever I want for a few weeks! Success! I’ve been encouraged to give away absolutely none of the cakes I bake and to eat them all myself. I essentially have a doctors note telling me that I NEED to eat as many calories as possible. Not only that, but I was given a leaflet which instructs me to eat pizza, cheese and crackers and fatty snacks like scones. It’s unusual to find myself praising surgery or cancer, but I have to give them both a tip of the hat here. I’m not sure I’ve ever heard medical professionals advising me to eat pizza; it feels like a trap.

My goal is now to turn up to the surgery, step onto the scales, and see the nurse’s eyes widen as she records my weight. “Two seconds sir, I just need to check something with the doctors,” she says, trying to hide the panic in her face. I’d stand there with a smug smile smudged across my face. Next thing I see is the doctor running around the corner – “Hello Daniel. It appears your weight has doubled in 10 days – how on earth did you manage such a feat?” He’d ask. I’d proudly reply “I started to blend scones and cream together to drink alongside my 16″ pizzas… and that is just my breakfast routine.” They’d praise my ingenuity before informing me that they can no longer proceed with surgery as I have eaten myself out of qualification… you win some you lose some, I guess.

In my case, though, I have been warned that I am unlikely to have a Whipple procedure. Due to where my tumour is, at the head of the pancreas and surrounding a major artery, it is unlikely that it will be possible. The fact that the pancreas is already in a difficult place to operate on, alongside the fact that the tumour is in an awkward position on my awkward pancreas, means it is near impossible to operate on in a conventional way (conventional being the Whipple procedure, which is anything but conventional; it essentially involves removing various organs from the digestive tract before attaching it back together in a new order). Further to this, today I learned that having a tumour in the head of the pancreas is more damaging than having one in the tail as the head is where the main pancreatic activity is; it is the part of the organ which produces insulin, as well as the part which creates the enzymes that break down fats. A tumour in the head of the pancreas may also physically block the enzymes from getting into the stomach.

I’ve tried to explain it all a little better in the following paragraph, which I wrote over a long period of time and with great effort. I ensured I did plenty of research before writing it, and am confident that it clearly demonstrates the functions of the pancreas, and why having a tumour in the head of the pancreas is so damaging to your body. Not only does it clearly demonstrate these things, but it does so in a way that the layman can understand, like you and I. Whether the mainstream medical journals choose to praise me for achieving what they never could, is up to them; if it is too edgy then so be it, not everyone can take my raw and direct approach.

The reason that the Whipple procedure is so difficult is because your stupid pancreas is behind your stupid stomach, so it is already hard to operate on in stupid surgery. The pancreas produces stupid insulin to control your stupid blood-sugar levels in your stupid body, but it also creates stupid enzymes which help break down stupid fats in your stupid stomach. When you have a stupid tumour in the stupid head of the stupid pancreas, it disrupts all of this stupid activity because the stupid head of the stupid pancreas is the part which is stupidly responsible for producing and releasing these stupid enzymes and stupid insulin. That means that if you have a stupid tumour in the stupid head of your stupid pancreas then your stupid body starts struggling to supply the stupid enzymes to the stupid stomach which help it in breaking down the stupid fats. That is why stupid Creon, a stupid tablet that you have to take a stupid amount of with meals, is so stupidly necessary when you have a stupid tumour in the head of your stupid pancreas. Further to all of this, the individual who stupidly allowed a stupid tumour to grow in the head of the stupid pancreas has an increased chance of developing stupid diabetes because of the stupid pancreas not producing enough stupid insulin anymore. Capiche? Good. Glad I got that off my chest. Probably some of my best writing, if I may be so bold.

Seeing as a Whipple procedure is so unlikely in my case, you may be wondering why they are going to be slicing my entire abdomen open and spending hours operating on me. This is where Irreversible Electroporation (IRE), also known as NanoKnife, comes into play. I’m not sure why it has two names, which seem to introduce it as two quite different things, at least linguistically. Irreversible Electroportation makes it sound technical and cutting edge. NanoKnife makes it sound like the surgeon requests the extra small knife for this part of the procedure, before grasping it with the thumb and finger and delicately shaving the tumour away. Although the second is far more entertaining to imagine, I believe that the first far better describes the technique. A small electric shock is applied to the tumour, attempting to kill the cells. Its success in treating pancreatic cancer is little documented and not really understood, so we are in “uncharted waters,” to quote the surgeon in my first meeting with him. They do not commonly agree to do a major operation, only to use an experimental form of treatment with little documentation over whether it is likely to improve the situation or not. The treatment does seem to have good results with prostate cancer, though, so I really am positive that it is a good alternative if a Whipple cannot be done.

What I don’t like is the use of the word ‘Irreversible’. I can’t think of many medical contexts where you want to hear the word ‘irreversible’ used. Perhaps if there was a procedure called ‘Irreversible Cancer Killer’ which irreversibly killed all cancer cells in your body, I’d be on board. I haven’t heard of such a procedure, though. In this case, the word ‘irreversible’ just makes me think that I’ll be sat in a meeting in 5 months time, reviewing a new batch of scans of my pancreas. As the doctor explains to me that the electric shocks have irreversibly damaged my pancreas, I’ll sit with a confused look on my face. “I thought this was meant to help? Is there nothing you can do?” The doctor then smugly laughs and says to me, “I’m sorry Daniel, do you understand the definition of irreversible? The clue is really in the name.” I absolutely do not believe any of my oncologists would speak to me like this, but it is fun to have a bad guy in a story. I hope none of them read this blog… Who am I kidding, they’re far too busy to read this nonsense.

Anyway, this all relates to diet because a Whipple procedure takes a lot longer to recover from. The dietician told me that they make three new ‘joins’ in your digestive tract when doing a Whipple. I’m pretty sure I cringed when I heard her say the word ‘joins’ in relation to my digestive tract; it makes me view my abdomen as a kitchen sink, and the surgeon as a plumber rearranging the pipes. There’s something disturbing about it. I don’t like it. Those new joins make digesting food difficult for a long time, as the area is tender.

The nurse told me that a Whipple procedure would probably take 2 – 3 months recovery to even be eating normally again. NanoKnife would be considerably less than this. When I asked the anaesthetist yesterday how long I’d have to wait to find out which procedure they had done after waking up, she told me to check the time on my phone once I’m awake and sitting up. “If it’s 18:00 or later – they’ve done a Whipple.” I guess I’ll be waking up and grabbing my phone straight away, like the modern-day millennial I am. The nurses will probably think I’m Twitter-mad or something.

I know that in reality, it does not matter, though. The surgeons don’t know what they are doing yet; it is all about what they see when they open me up and what is deemed possible. Either way, I’ll wake up and will be forced to deal with the consequences. I need to let go of wanting to understand both scenarios and how awful they may be for me in terms of recovery. What I need to focus on is what the dietician told me to do before the surgery – do more strength training in the gym, keep up the running, and EAT EAT EAT! Alongside this, I need to keep good dental hygiene; this is to try and prevent myself from getting any chest infections or bugs during or after treatment. Apparently, most of these bugs are transmitted from your mouth, so the better your oral health, the less likely you are to develop any of these issues.

I also learned a little more about Creon use. The nurse seemed to mostly praise my use of Creon but did tell me a few useful things. Mainly that you should only be taking Creon when there is food in your stomach; taking any before or after is pointless. You should take your first one just after starting to eat, and your last one just before the last few mouthfuls. Alongside this, if you suffer from acid reflux, you need to have an anti-acid prescribed to you to ensure that the capsules travel through your body without the enzymes being damaged. I suffer from acid reflux badly, so this is a key problem for me. I have Omeprazole prescribed to help with this issue, but my GP in Alsager, my home town, keep saying that it is not on a repeat prescription, despite being on my medication list whenever I pick up prescriptions from there… very unusual. The dietician said she would send them a letter and resolve this issue. Another reason to see the dietician as early as possible – they get shit done (or mine did, at least)!

So, another day and another meeting at MRI. Today’s was good. I left it feeling positive. It is good to learn new things about managing your cancer better and I felt empowered by the whole process. Any directorate to eat everything you want is good in my book – I’m going to go baking mad and not feel any guilt for any of it, not that I felt that much guilt anyway. I just didn’t eat too much of it myself before. That’s about to change…

Lastly, as I finished writing this post, I saw a headline on my phone stating that Dame Deborah James has died at the age of 40. She was truly defiant in the face of her diagnosis, raising millions of pounds for charity and raising awareness, with courage, wit and openness. The image of a beautiful woman fighting a deadly cancer is powerful in itself, disbanding the common idea that cancer sufferers are older, weaker and frailer than the rest of society. It surprises people to learn that I have stage 3 pancreatic cancer, and although I am charmed by these remarks, they demonstrate the fact that many expect your cancer to be visible; they expect you to be worn down by it. Of course, there comes a point where the cancer will get the better of you if you cannot get rid of it, and you will change physically, as anyone does when they near their end. Life is not infinite, though. We fight to stay with our families, friends and loved ones, but we grow ever more aware that the fight may be in vain. Deborah chose to use her position for good, channelling tremendous energy into that fight, as well as the one against her cancer. I’m sure both fed into the other, making her an even stronger person. She’s an inspiration to me as I write these blog posts, and knowing that she was originally a cancer blogger makes her even more inspiring.

Rest in peace, Deborah. Your suffering is over now; I hope that your loved ones take some comfort in that fact. I know I’d want mine to.

Surgery and Yellow Mayonnaise

Taken 04.06.22 at a Music Festival

It has been a few days since the meeting with the surgeon. The response has been a bit varied among my family and friends. Surgery certainly makes everything more real. Knowing it is a major operation which carries so many risks brings an entirely different element of worry to the situation, I get that. If the situation with the tumour was more positive and the surgeon was more confident he could do a full removal, the decision to push on with surgery would bring a further level of comfort that it is the best decision. Seeing as this is not the case and that the tumour seems to be surrounding the artery still, it brings much more anxiety for all involved. For me, I will not be conscious for any of the surgery, or even most of the intensive aftercare. It is everyone else who will have to painstakingly sit for hours, waiting for the news of how the surgery has gone, what they managed to do, and if there were any ‘complications’. By the time I’ve found out these details, it’ll likely be days after the operation. I’ll be off in dreamland, so deep under the influence of drugs that I’ll probably be exploring Narnia from my vantage point, riding on a dragon’s back (I’ve never had a dream like this so I’m not sure why I would start now, but it’s nice to dream about the potential of your dreams).

There have been a lot more tears since Tuesday. Perhaps it is a combination of learning what my staging is and having it clearly communicated that a full removal is unlikely. It could still happen if the scan failed to be accurate in its portrayal of the tumour, but he seemed to doubt it would be so wrong. I did do another CT scan at the hospital, so I’m waiting for the surgeon to call me with the results of that. Perhaps he will be more confident of what will be done in surgery once he has reviewed it, assuming the scan is better quality than the last one and offers more insight. Nano-knife is the most likely outcome. A full removal is not out of the question eventually, I believe, but the surgeon didn’t seem willing to discuss such a scenario. I didn’t try, to be fair. He had an air of confidence about him which was tantalising. Every sentence was carefully thought out, every word scrutinised in his head before it left his mouth. These situations are tense; you could tell that he was experienced in dealing with them.

I’m unsure whether he will do some form of partial Whipple no matter what he decides is possible with the tumour. I need to ask him when he calls me about the scan results, but it’s one of those things that I’m unsure whether getting an answer is better for me. It seems easier to just wake up after surgery and face the music then. The outcomes sound so varied depending on what they see during the operation that I doubt I’d get a straight answer anyway. At least I trust this guy to tell me that the answer isn’t easy and I’d believe him if he said as such. The fact that there is a cyst on the other side of the pancreas to the tumour indicates that the surgeon will have to do more than just deal with the tumour. We did ask him if he would be removing the cyst despite what happened with the tumour, and he said that he would. It was funny – his reaction was almost like this was a total afterthought – an irrelevancy in the face of the cancer. “Oh yeah, there is a cyst there too, isn’t there? Yeah, we’ll get that out,” he casually said when the question was put to him by Anna. Surgeons are so casual. They must realise that their job terrifies the other 99.9% of people on planet earth. I’m sure that there’s a smugness that comes with that territory. I’d certainly be smug about it if I were one. He didn’t seem particularly smug at all. After arranging the CT scan on the phone with the radiology department, he said that he needs to get a nurse to put the cannula in. “I can do surgery on you but I can’t cannulate you,” he chuckled – I suspected this was that smugness coming in to play.

One of the things I have changed about my behaviour recently is my diet. Since learning a little about the immune system and how it is constantly fighting ‘bad’ cells being created in your body, I have been much more taken into the idea that your immune system plays a vital role in how your body battles cancer. Before, I thought whether you developed cancer or not was more a thing of luck, with a heavy dose of genetic makeup. The book I am reading seems to suggest that this is not the case. He references a study about fostered children. The study was conducted in New Zealand as apparently they have detailed records about births and biological parents. In the study, they measured the cancer rate among a group of people who were fostered from a young age. If the formation of cancer was more down to genetics, the numbers in people who suffered from cancer would be similar between the focus group and their biological parents, irrespective of whether they were raised by foster parents or not. If the formation of cancer was more down to behavioural patterns rather than genetics (e.g. diet, exercise habits etc), then there would be less significance between children and their biological parents, and more significance in the trends between the foster parents and the children they adopted. The study showed the latter, indicating that the formation of cancer was effected more by behaviour than genetics.

Now, I’m not suggesting this single study proves the point entirely, and more importantly, I have not looked into this study myself and do not plan to. It is enough to convince me that behaviour must be more important than I perhaps anticipated. As a result, I’m trying to avoid processed food as much as possible, based on some scrutiny of these types of foods. Turning over a food packet to look at the ingredients and seeing different types of sulphites listed is a little concerning to me, even with my limited knowledge of sulphites (and believe me, my knowledge is limited). A quick Google tells you that they are only dangerous for a small number of people who have problems with asthma. Does this mean that it is only an immediate risk to these people, though? I can’t imagine digesting a lot of additional sulphites is good for you, never mind the fact that they are added to foods to preserve them. Anything that makes it harder for the world to digest the food (i.e. through the process of bacteria breaking it down), sure means that it is harder for your body to break it down. The more unnatural the ingredient is that you are adding to preserve the food, the more dangerous it would be for your body, I would assume. It makes logical sense to me. The world isn’t always logical, though, so maybe I’m barking up the wrong tree here.

Yesterday morning, I decided to Google ‘should you avoid food preserved with sulfites’ to test my theory. I had seen ‘Sulphite Dioxide’ on the back of the packet for some dried apricots and it got me interested. Notice that I did not add ‘if I have cancer’ onto the end of the question; I’m not even getting into that with Google. Searching for anything specific to cancer with Google can lead you to all sorts of dark corners of the internet. It seems to be the most prolific hearsay topic on the planet.

The first article I clicked on was one titled 5 Food Additives You Should Avoid. According to this list, and after doing more reading around, it seems that sulphite dioxide has a low toxicity for humans in most cases, so is generally regarded as safe. As I stated previously, though, I’m sure it isn’t completely inconsequential eating it in a lot of your food, but anyway. The thing in the article which got my attention more was food additive number 1 in the list – Sodium nitrates. Want to know why? Because it states that they increase your risk of pancreatic or colorectal cancers. If there is one way to grab my attention, it is by throwing around the name of my beloved cancer. Pancreatic. Dancreatic. Dan’s Dancreas. Dan’s Dancreactic Dancer. Anyway…

Apparently, sodium nitrates are mainly added to meat to stop it from discolouring. That should make them extremely low risk for me, an individual who does not and has not eaten meat since 2016. Perhaps this is another cruel irony of the world, like when a non-smoker gets lung cancer. During the digestion process, toxic chemicals are released due to the sodium nitrates being broken down by stomach acid. It is them which pose a threat to humans according to the limited research I did on the web. Rather than always researching other people’s research, I thought I’d conduct my own. I headed down to the kitchen, opened the fridge and found a packet of bacon. It had come from Waitrose, one of the more expensive supermarkets here in the UK. I turned the packet over and read the ingredients. Just like that, I completed my study. Sodium Nitrate. Confirmed – it is indeed added to meat. Study complete. Science is so easy. You probably thought I was somehow going to confirm that the breaking down of sodium nitrates in the stomach releases deadly toxins didn’t you? I’m not that good – go speak to a real life scientist if you want real research.

It just feels like a minefield trying to investigate diet further. Information seems so inconsistent and you wonder how things get approved for use if they truly are so bad for you. What is true, apparently, is that cancer rates in the west are much higher than in the east, and it would make sense to me that the key difference between us is diet. We have been eating highly processed foods for longer in the West, with the quick growth of fast food since chains like McDonald’s grew in popularity. Now processed food is everywhere and considered very normal. We look at things like butter as being intrinsically bad, despite us being able to comprehend how butter is made. Look at the back of a margarine tub and try to figure out what on earth the ingredients are in it – half of them sound like they belong on the back of a toothpaste packet or something. Do we really feel better eating that just because it is lower in calories? Fats are very useful to us humans, we seem to forget that fact. My body struggles to process them now and I have to take supplements constantly to ensure they are being absorbed by my body. What I’m trying to say is that you should revel in the fact that your body can absorb fats naturally (if it can) and utilise it by eating full fat butter, damn it! I do it now more than ever and it is a beautiful luxury.

Sometimes I find myself pondering whether knowledge is power or not. Do I find myself feeling empowered by it or intimidated by it? The question never feels more applicable than when trying to research diet and cancer. My new thing is to mercilessly avoid food with preservatives in it, where possible. All of a sudden, I am not eating any crisps, baked goods from the shop or heavily processed chocolate bars; those of you who know me personally will understand what a huge deal that is for me. If I want something sweet, I try and bake something quickly. For example, I’ll bake apricot and walnut bars to have at breakfast, alongside fruit. I’ve started making my own mayonnaise instead of having it out of a bottle; the home-made stuff is much more yellow than white – it’s strange when you have only just started making it yourself. It really does taste lovely when fresh and you can mix up how much mustard you put in it, which is nice. The next step is to learn to make loafs of wholemeal bread but I’m building myself up to that. It’ll probably take me a morning to get into it as dough is not something I have worked with so far. Rivetting stuff, dear reader, I know. This blog is probably your guilty pleasure these days with such innane ramblings about diet and food, if you even try to have any pleasure from it. At least it isn’t all cancer cancer cancer; it also makes you feel guilty about enjoying the foods you’d normally mindlessly eat.

Yet, this obsession with avoiding preservates is probably just a new scheme to feel in control of the diagnosis. I’m not suggesting that it doesn’t assist in the fight against cancer too, but plenty of people have spent their entire life eating terribly, not having a care in the world about how many preservatives are in their bacon sandwich, yet don’t develop cancer. It is difficult to reconcile that, as I believe I’ve lived a fairly healthy life so far and still managed to get cancer. The fact that I likely ran 100km with the beginnings of cancer brewing in my pancreas is almost comical to me at this point. It was after I had originally got to the doctor’s complaining of stomach issues. The result of that was multiple scans at the hospital, but with no meaningful results. Their conclusion was that I had a strange form of constipation; it never convinced me. I guess when your tumour is 3.2cm at its largest, it is difficult to see with conventional scans. You have to step up to the expensive PET scan which they weren’t willing to do at the time. They don’t tend to assume that an otherwise healthy adult in their late 20’s would have pancreatic cancer; I know that from the first few weeks when trying to be diagnosed – “It’s probably pancreatitis but we can’t rule out cancer, although it’s very unlikely to be that.” I can’t remember how many times I heard words to that effect, but it was a lot.

So, here I am. Dan with the Dancreatic Dancer trying to research diet in an attempt to stop the Dancer getting the better of the Dan. Maybe the fight against preservatives will provide a useful distraction over the next few weeks, until the surgery day comes. Making everything from scratch is certainly time consuming. I’m getting used to the yellow coloured mayonnaise now, anyway.

Physical and Mental Wellbeing in Fighting Cancer

Lucy and I, Staying Mentally Well Together

In general, I’ve stayed away from cancer literature. There seem to be so many different approaches and opinions that you can find evidence for any approach that you want to take. Want to eat bacon for every other meal? Find a website that promotes The Atkinson Diet and mentions a random study on decreasing cancer cell growth – success! A reader of the blog reached out to me on Twitter and recommended a book called Anticancer: A New Way of Life by David Servan-Schreiber. After Googling it and reading about the author, I was certainly interested. He managed to survive for almost 20 years after being diagnosed with a brain tumour, something which is absolutely amazing and shocking. Dealing with such a diagnosis for that amount of time is astounding, it must have been extremely draining both physically and mentally. He was treated for a brain tumour twice during this time, before unfortunately succumbing to brain cancer in 2011.

Some of the accolades awarded to him in his lifetime are quite astonishing. He was one of the founding members of the US arm of Médecins Sans Frontières, a medical humanitarian organisation best known for its work in conflict zones. The organisation received the Nobel Peace Prize in 1999. Looking through his work, he seemed to dedicate himself as a physician, assisting sick people in conflict zones for years. Places he spent time include Iraq, India and Kosovo, among other places. The accumulation of his work resulted in him being awarded the Pennsylvania Psychiatric Society Presidential Award for Outstanding Career in Psychiatry in 2002. What all of this information said to me is that this is a person who really does want to help people; he dedicated his life to doing so, and likely put himself in a lot of danger in the process. Couple that passion for helping others with a scientifically trained mind and a personal vendetta against cancer, and you have an incredibly powerful set of circumstances. It made me want to read the book. I ordered it off Amazon (I’m afraid to say), and it arrived the next day.

I’ve had it for a few days but only started reading it properly around two days ago. Some of it has been difficult to read, which is slowing me down. I’ll come back to that, though. The version I got is a second edition. Before the chapters started, there is a preface where the author discusses the changes between editions. Part of those changes was to add more evidence to chapter 9 – “The Anticancer Mind”. I haven’t read it yet, but he states that the chapter focuses on how keeping yourself mentally well can help your body fight cancer. The author states that people speak much more highly of the chapters on diet and foods that promote the healthy processes in the body which fight back against cancerous cells. These chapters seem to be Chapter 8 – ‘Anticancer Foods’, and Chapter 8(a) – ‘Anticancer Foods in Daily Practice’. Again, I haven’t read any of these chapters yet, but it seems fairly obvious what they are about; what foods can help promote the body’s natural defences against tumours and how to apply them in your day to day life. I may be proven wrong of course but if I am, that is because the author hasn’t described the chapters well enough. I, Dan Godley, can do no wrong! Although there is that phrase that to assume makes an ass of you and me. I’m only making an ass out of myself here if I am wrong. The author hoped by adding more case studies into Chapter 9 that people will take the anticancer mind more seriously and recognise its value.

I started thinking more about why people are less complimentary about a chapter on mental wellbeing as opposed to dietary changes. It is clear that diet is something physical. We generally know what foods are considered healthy. It would be more than a faux pas if we sat telling our work colleagues that we were on a diet over lunch, to help explain why we were digging into an entire cake and washing it down with squirty cream. There are some whacky diets around, but this would constitute a total failure of the educational system.

Things like pulses, fruit, brown bread etc, are considered to be healthy (or healthier) foods. Foods that are processed or contain a lot of saturated fat are generally thought to be less healthy. Of course, there are healthy fats, like those you get in nuts, but I believe that it is still better for you to consume these things in moderation. Similarly, you will benefit from an amount of things like butter in your diet, but they probably aren’t good in large quantities. If you regularly eat out at restaurants and wonder how they make the food taste so nice, the answer is probably butter and/or oil; lots of it. If you are trying to do some sort of diet, it is much better to make your own food. At least you know for certain what has been put into it and can control the ingredients. For example, Ottolenghi, a favourite chef of mine who makes incredible cookbooks, frequently uses large quantities of olive oil in his recipes. I will frequently tone this element of the dish down unless it is being used to create a flavoured oil, which I can save to use on other things I make.

When we have been eating healthier foods, we typically will have tangible evidence that it is benefitting us. Our weight may go down, we may feel more energised or, if we are also exercising, we may notice a change in the way we feel whilst we’re pushing our bodies. If I eat a takeaway and run the next day, I sometimes feel as if my body is having to work harder to produce the same levels of performance; it may be in my head, but I doubt it. Takeaway food will typically be much higher in things like fat and salt, which will likely impact your performance. I also generally eat a lot more when I get a takeaway, partially because the food is there and I want to eat it, but also probably because of things like MSG being added to the food.

We may feel more hungry if we are changing our eating habits, but we accept that there are sacrifices to be made in the pursuit of a healthier lifestyle. If our own standard of eating was to order a pizza every night, changing to a salad will feel difficult for a while. We know that but consider it worth the payoff, if we are in pursuit of a healthier lifestyle. If we don’t consider it worth the payoff, we don’t stick to the diet. I’ve seen adverts on Youtube for people claiming to eat whatever they want and never doing any cardiovascular exercise, yet having Hurcules-esque bodies. It is usually promoting a brand new trend of the ‘make no changes, look amazing’ school of diet and exercise. I don’t buy it personally, but perhaps they truly do know more than me and I’m an idiot for eating well and exercising. I think they’re preying on this instinct that we have, though – to look good but eat what we want; to be both ‘healthy’ but not have to change any behaviours to get that way. Life doesn’t tend to work like that. We make certain sacrifices to gain benefits elsewhere. The more we dedicate ourselves to those sacrifices, the more they become behaviours that we stand by. I used to never enjoy eating salads when I was younger as they just seemed boring. These days, I love finding a nice salad recipe for a Saturday afternoon. I made a lentil salad a few days ago that was delicious, and since discovering za’atar, I’ve really enjoyed making salad dressings which use the herb mix.

Improving your mental state is far more difficult to measure, though, which may make it more difficult to justify. We may feel happier if we begin to practice yoga but it does not guarantee that we will feel vastly better all of the time; how much of the time is considered a success? And how do we know that we wouldn’t haven’t felt that happy anyway – is it easy to attribute feeling happier to the yoga specifically? What if it is that new cake diet you’ve embarked on?

The two things, physical and mental health, may also be at odds with each other. Your mental health may suffer if you are obsessing over the right foods to eat, and how anything outside of them will promote cancer in your body. The book states that a quarter of us will die of cancer – that leaves three quarters who won’t. Do those people avoid it because they never smoked a cigarette, ate a beef burger or had ten drinks with their friends? I highly doubt it. Were they all masters of zen, facing any adversity with a level head and a wise proverb to teach? I still doubt it. My grandad smoked most of his life, was a little overweight and, to my knowledge, never burnt a single calorie with the primary intention to exercise. Did he die of cancer? He did not. Did he make it to his late 70s? You bet he did. If I had asked him what ‘mindfulness’ meant, he’d have told me to get a dictionary and check. It wasn’t a concept he knew anything about. I remember he was a big fan of Star Trek. Perhaps that’s the secret.

My grandad seemed to be an extremely happy, positive and carefree individual, though. He didn’t need to work extensively on mindfulness to be content, or he was extremely successful in hiding it if he did. My brother in law Keiran is very similar in that respect. Keiran’s intentions in the world seem fairly simple – to make people laugh. I lived with him and my sister for three years when I first moved to London and he managed to be in that headspace 99% of the time. He’s very successful at it too and is one of the funniest people I know. If he fails to make someone laugh the first time, he’ll try again and again and again. Eventually, he gets somewhere. The other 1% of his headspace seemed to be dedicated to shouting at Fifa, a computer game that has the capacity to turn the nicest human into a bitter, angry individual. It can make you feel like the world is plotting against you, and there is nothing you can do about it but sit there and watch. No one is perfect.

My point is this: some people never have issues with their mental health, some people may have but never identify or understand it and some people are in a constant war with it. Individuals arent restricted to these categories and probably float between them depending on what is going on in their lives, and it can probably vary depending on the particular issue at hand. It is more of a scale than a restrictive list of categories. I feel like I am good at reflecting on why I behaved a certain way, but not so good at identifying it at the time. As a result, I can respond to something quite irrationally, only identifying that I had done so after the fact when it is sitting on my mind, bothering me. Over the years I have been much better at not doing this as I’ve matured and learnt more about myself, and the world around me, but it still happens from time to time.

Diet affects everyone in some way, whereas improving ones mental health may be less applicable depending on the individual. I know that the same case can be made for diet too, with some people having better metabolisms etc, but I still believe the intangible nature of mental health makes it far more difficult to define and measure improvements in, making it more difficult to convince every individual that it is helpful. Someone can be skinny whilst eating pizza every night, but it doesn’t mean that they are actually healthy. They probably have high blood pressure and a heart which is crying out for a more complex range of nutrients.

It is especially true in the face of a cancer diagnosis. Everyone accepts that in the face of such news, especially where the diagnosis is more damning, an individual will experience a range of volatile emotions. The emotions will come and go, and we expect them to last for months, even years in some cases. People may never get over them until the day they die. That makes it permissible for an individual’s mental health to deteriorate during this period. Of course, some breakdown of mental stability is sometimes necessary. I’ve cried uncontrollably at times, I’ve woke up scared and not remembered why, and I’ve felt incredibly angry at perceived injustices I’ve experienced; my employer not making it easy for me to return to work, or the original diagnosis at the hospital not being specific enough and carrying a lot of negative energy. It can be necessary to feel these things to help you process them. That is how I reflect on them, and it provides them with a lesson that you can apply in the future. You hope that next time, that lesson will stop you going to those same places mentally. When I speak to people about these things, they tell me that I’m right to feel that way. Sometimes, though, they remind me that there are much bigger things at play here and that keeping myself in a positive mindset is essential. I’ve felt the power of it and it has certainly changed me as a person.

Feeling scared, sad and angry over a period of time really takes its toll on you. In my experience, it makes me far more irrational, seeking narratives which support those negative feelings and using them to intensify the emotions even further. You get locked in that mindset and it keeps you prisoner. It has never benefitted me more to respond to events in this volatile manner. I can’t converse with my family in a positive way, I don’t allow myself to enjoy the things in my life that are special and I find myself moping about, not actually trying to sort out the issues which have made me feel that way in the first place.

I’m not sure what the science is behind it yet and I hope the relevant chapters in the book will shed some light on it, but I can see how allowing yourself to remain in this state could promote the growth of cancer cells in the body. The feelings are debilitating – they can actually stop you from getting out of bed in the morning. If that is how they manifest physically in your behaviours, why wouldn’t they do something similar to the processes going on within your body? If our bodies are constantly creating ‘bad’ cells, as I read in the introduction of the book, but also has processes for dealing with them and stopping them from getting out of control, why wouldn’t those processes also be affected by these intensely negative emotions? All of it makes logical sense to me. I’ve experienced the difference in mindset between a good day and bad day of dealing with cancer; I’ll take the good days every time if I have a choice, and I do have a choice.

Nurturing behaviours that promote both physical and mental wellbeing are essential to me. My key techniques for keeping myself physically well are very similar to the mental ones really. Physical exercise, such as running and yoga, help improve both my physical and mental health. When I am in the zone with exercise, I feel a state of both intense contemplation, yet complete calm. It’s strange. I feel like my brain is ordering and dealing with things that are bothering me, but I can rarely recall any of it specifically afterwards. It is especially true of running. During yoga, I try to bat away thoughts and focus on the position and how it feels, which offers a different wealth of benefits.

Eating well is another technique for improving both my mental and physical health. The physical benefits are quite obvious and I spoke about them earlier, but the mental ones are more abstract. Eating well can make you feel better for the plain fact that you know you’re doing something that is good for you. The process of cooking is also great for me mentally. Sometimes during chemotherapy, cooking an evening meal was the only thing that got me out of bed or off the sofa. I found the energy to do it despite not finding the energy to do anything else all day. It is such a satisfying process, creating something from scratch that you then get to consume. Even when it is not the healthiest dish, you still feel a level of satisfaction that you do not get if you did not make it yourself. It is yours, and you can give it to the people around you that you love.

Finally, I want to talk a bit about the first two chapters, and why it was difficult for me to get through. The author discusses how he discovered he had a brain tumour. He was running a laboratory on functional brain imaging with his good friend and colleague, Jonathan Cohen. They had access to a new type of MRI scanner which was far more accurate than the ones widely available in hospitals at the time, which allowed them to create studies to investigate the prefrontal cortex of the brain. He states that this is a particularly difficult part of the brain to observe, so little research had been done up to this point. With access to this new type of MRI scanner and a devised technique for getting this part of the brain to show up on the scans, they had the perfect formula to start their research. Subjects would come into the lab and be put into the MRI scanner to be observed. Firstly, a scan would be taken of their brain before undergoing the task, then the subject would complete the task whilst another scan was taken. The task required them to use the prefrontal cortex as it required them to remember something and answer a question based on it, a feature which requires the use of this part of the brain.

One day, a subject didn’t show up. David was the least technical out of the people running the scans – he had come up with the method for testing subjects, but did not specialise in operating the equipment. They suggested that they scan him so the time slot is not wasted. After doing the initial brain scan, they told him that something was wrong with the equipment. They did another test, before entering the room and breaking the news to him… The equipment wasn’t broken, there was something the size of a walnut on his brain. They sent the scans over to the relevant department for investigation but David states that he knew what it meant. He had seen plenty of brain scans and could recognise when there was something abnormal going on. This was certainly abnormal. He speaks about going home that night and laying next to his girlfriend whilst she slept, smoking a cigarette and staring at the ceiling, thinking about how he was going to die at 31. I had to stop reading and take a minute to compose myself.

I’d been in that exact place. Reading it was so strange. When you read things, you experience them in a very different way to other mediums, such as film. That person’s thoughts are temporarily placed in your brain, with you still present but temporarily allowing yourself to experience the world through their thoughts. You get a feel for what they are like, what drives them and how they respond to things. A narrative is created in your head and that character sits there throughout the book. I had hardly read any of this book, and here was a man describing a situation and mindset that I had experienced. Not only had I experienced it, but it was the lowest point of my life. Laying in the hospital bed the night of my diagnosis, I stared at the ceiling whilst Anna slept beside me. All I could think was ‘how has this happened? I’m 28; I keep myself healthy. What have I done to deserve this?’ I was incredibly scared. David’s girlfriend is also called Anna which made it feel even closer to home. It was eerie.

After taking a few minutes, I continued to read. The next part really shocked me. I’ve taken a cut of it below, not wanting to paraphrase or misinterpret his words.

“Just as I was repeating, ‘It can’t be happening to me; it’s impossible,’ the other voice said, ‘You know what, David? It’s perfectly possible, and it’s all OK.’ Something happened then that was both astonishing and incomprehensible. From that second onwards I was no longer paralyzed. It was obvious; yes, it was possible. It was part of the human experience. Many others had experienced it before me and I wasn’t special. There was nothing wrong with being simply, completely human.” – Dr David Servan-Schreiber, Anticancer, Page 21

Sometimes you read something so apt that you are certain that you’ve thought it before. It is a sort of deja vu but for thoughts. It perfectly summarises the power your mind has over your emotions, and how they can define your response to a situation. David turned over those thoughts of fear and anguish in a few minutes using nothing but his own brain – a particularly powerful brain, of course. It demonstrates the power of mental wellbeing and how it can define how you deal (or do not deal) with a situation.

He says himself that the techniques in the book will not create miracles and that people should adopt the parts of it which work for them. I’m interested to see which parts really resonate with me, and to challenge myself to take more accountability in my fight against cancer. Up to now, I have mostly accepted that the oncology team provides the techniques and acumen to beat this cancer. Ultimately, they will always hold the keys to getting cured, especially where surgery is a requirement, such as with my cancer and diagnosis.

The author is not claiming that making these changes will miraculously get rid of your cancer, or replace the role that chemotherapy, radiotherapy, and other medical techniques hold in the process. The changes may provide that little edge that you need, though. Whether that edge helps get you another week, month, year, or all the way to being cured, it’s worth using them and seeing (in my opinion). Feeling in control of your life is difficult when dealing with cancer; even if these techniques only give you a new means of feeling in control of the situation, I think that is a strong argument that they have value. It is like every behaviour in life – so long as they do not dominate, delude and control your thinking, they can be used at your discretion where you find them useful.