Shortly after being diagnosed with breast cancer and finding out that through chemo therapy I would lose my hair… I dyed it green” confessed 21 year old Josan Sutherland during our three hour conversation, forcing from me, an unexpected grin. After having her right limb below the knee amputated at only 12 years old due to osteosarcoma, at age 15, Josan confided in her friend that if ever she had to face the ‘big C’ again she would just let the cancer have its way with her. “Chemo therapy is an awful experience. At times fatigue and hot flashes combined with the
excruciating and unbearable pain can send you to a place of ‘Oh Lord just take me now’… you feel as if you are knocking on death’s door.” While studying one afternoon for her CAPE Mathematics examinations, through comfort and habit Josan had put her hand in her shirt resting on her left breast.
Immediately her heart skipped a million beats. She felt a lump. Could this be happening all over again? After the initial reaction of the possibilities she alerted her mother and made her way to her doctor. However the tumour was malignant. A year later, she discovered another lump and followed protocol. In September of 2013, at the age of 21, Josan during her routine shower was to find a third lump which after doing a biopsy was diagnosed with breast cancer. “When faced with the situation, it’s scarier not to try” admitted Josan, “even though chemotherapy is challenging and at times your course of treatment might not be enough it would have been harder for me to live with the ‘what ifs’ than to allow the cancer to invade my body”.
“Breast cancer is the leading cause of cancer related death among Jamaican women” says Yulit Gordon, executive director of the Jamaica Cancer Society. Based on figures received from the Jamaica Cancer Society and Dr. Derrida Cornwall, Head of Radiology at the University of the West Indies Hospital, an average of 45.15 in 100,000 women were diagnosed with breast cancer in the parishes of Kingston and St Andrew in 2013. Women between the ages of 40 -75 represent the high-risk group comprising a screening population of 400,000 women. One in every twenty-one women will develop breast cancer, she says.
A student of the University of the West Indies, her diagnosis came during her first semester of final year. Josan pushed her doctors to delay treatment as much as possible so that she could go to classes and finish her examinations. Despite this fact, during her second semester, she balanced going to school as well as doing her examinations while undergoing over five months of surgeries, chemotherapy and medication.
“I took my treatments via an out – patient basis so that I would have the opportunity to go to school”. Josan’s treatment consisted of chemotherapy via infusion for two hours in one sitting approximately every three weeks. “The decision to undergo a bilateral mastectomy was an easier task in comparison to coming to terms with the fact that I’d have to tackle the dreadful side effects that came along with chemotherapy.
Yes at 21 I’d lose both my breasts, but at this point I’d do anything to lower the risk of reoccurrence plus with advances in science and technology implants look and feel like real breasts”. Josan also explained that having to deal with chemotherapy and school was a difficult journey. Each day would have to be planned out, taking into consideration mode of transportation, if she would be standing for long hours or be in the sun, access to food and what type, amongst many other basic everyday situations.
“Chemo compromises your immune system, the treatment doesn’t have the ability to differentiate between your good and bad cells. Someone simply sneezing on you could result in you developing pneumonia”. Each daily task came down to the little things, from the choice of a toothbrush, as bristles too rough could cut your gums and you could end up with an infection. Fruits would have to be washed and peeled in case of any pesticides that may have been used as this would further compromise her immune system.
Through it all, Josan has remained vibrant. She explained that it was just her personality. “You have to be able to manage your life, my family and friends are very supportive combined with frequent attendance of meetings with the ‘Reach to Recovery’ group I was able to gain emotional strength. Your mental status controls your physical status. There is power in prayer, and you have to believe that your doctors know what they are doing and the medicine will work. Yes it’s a disease that you have to fight but you can still have fun before during and after”. During chemotherapy Josan described side effects she experienced; her tongue would have a fuzzy feeling and food would begin tasting really salty and as the treatment progressed foods would have a metallic taste.
There was nausea, vomiting, diarrhoea and abdominal pain. Medically induced menopause caused bouts of hot flashes where Josan joked that cutting off her hair made that a little easier. Her skin would strip and she had what would be likened to prepubescent acne on her face and back.
She could not emphasize enough how the drowsiness and fatigue were the worst. She spent most of the hours each day sleeping as this was one of the major side effects and the drug made you really weak. The treatment would also cause tingling and numbness in the finger tips and her nails would turn black. “I couldn’t stand to see my nails black so a couple days before I went for treatment I would go to the nail salon and get my finger nails and toenails painted a fun colour like blue or yellow”. She smiled at the memories.
Dr. Cornwall urges women forty years and over to do a mammogram once every year. She pointed out, however, that in many instances there are exceptions; women who have had first degree relatives having cancer before age 50 should start their mammograms ten years before the earliest age at which the relative was diagnosed. If an individual had undergone radiation between the ages of 10 and 30 cancer may show up within 10 years after treatment. These individuals are recommended to start screening 8 years after exposure to radiation.
For Josan, according to her doctors both of her cancers were unrelated. They did advise her however to do genetic testing for the P53 gene
mutation which translates in the same way that she had experienced so far and might later on in life develop skin cancer. Depending on the type of cancer someone is diagnosed with; cost of treatment may differ. Chemotherapy cost ranges between $8000 and $250,000 per dosage. Josan went through 4 dosages while in other cases a minimum of 18 dosages is required for the year. Josan was able to manage financially with the assistance of personal savings, help from family members and also through health insurance subsidy. She recounts interaction with other
individuals undergoing treatment and explained that it is a very expensive disease and it is very difficult for one person to find $250,000 for one dose of treatment without any insurance. NHF covers many cancer drugs, but in many cases it only covers one single dose. In addition there are several other drugs needed to help with the side effects of the chemotherapy.
Education is key was a common point stressed. It is necessary to educate yourself about the disease. Josan remembered that as soon as the day after she was diagnosed, she and her friends gathered unlimited information from the internet about the effects of the disease, different methods of treatment, types of foods may or may not be consumed all in an effort to understand her situation better. “It helped me to relax and make better decisions. It is my body and even though I trust my doctors, I know what I am comfortable with.” She even explained that at one point there was a doctor who was not being fully open with her and she requested that individual to be removed from her treatment team. “I learnt that sugar feeds the cancer so I eliminated sugar from my diet. Despite the fact that my taste became heightened and I couldn’t eat any fast food and it would just taste like eating raw oil, it was better for my body to eat healthy food. I ate food as raw as possible in order to get the most possible nutrients available.” She explained that advice came from all angles as to what natural remedies to try. She took all this advice with a smile. “What works for one person might not work for another, everything in moderation. My medication combined with eating healthy was working for me. I drank leaf of life and aloe vera along with lots of fruits and natural juices with consistency in my vitamins and lots of water.”
“A lot of persons don’t know how to react to an individual with cancer, however I relate to people in the same way I expect them to respond to me. Yes when I lost my eyelashes and eye brows there were stares and points and whispers and comments. But some people just don’t know any better. I used my eyebrow pencils and head wraps whenever I wanted to go out but some comments you just have to ignore”. Josan urges all females to do their simple self-breast examinations and explains that “it’s not confirming that you have cancer but rather testing to ensure that you’re fine, two minutes each day, incorporating it in your regular routine like a shower. If you don’t know how, read it up online or as a health professional to show you.” She stressed that early detection saves lives. Most persons have the lump and do nothing out of fear. It is better to check it out and find out that it is harmless rather than sit with it and it may be detrimental. Finally Josan said “Even though a lot of people die, a lot survive. Know your body, do self-examinations and be informed”.