Oesophageal Cancer - Triathlon

The start of my journey into triathlons started on the 24^th January 2009 the day I was diagnosed with adenocarcinoma of the oesophagus. First bit of advice if you having an endoscopy always go for sedation, however being aware meant I knew that something had been found, and I had no doubt what it was when the endoscopist asked for the biopsy kit. Having been symptomatic for a number of months, seen by my GP who made a diagnosis of helicobacter for my symptoms, something I had never been convinced about, I knew this was not good. Not being sedated meant that I could ask that question, but I will always remember the photograph taken via the endoscope which I knew to be an oesophageal cancer, so the question was somewhat mute.  I was told that it wasn't good. Not good meant adenocarcinoma of the oesophagus, T3N2M0. Treatment was oesophagectomy and chemotherapy epirubicin, cisplatinin and capecitabine (ECX).

Sport, exercise, keeping fit were all abstract concepts of no relevance to me at this point, likelihood of death perioperatively (4%) 5 year survival (32%) significant morbidity if I survived. With my surgeon we made the decision for surgery followed by chemotherapy, somewhat controversial even ten years later. The surgery was an oesophagectomy with a single left thoracatomy incision, with partialresection ofa single rib for access. Post operatively I had a single chest drain, nasogastric tube and catheter. One overnight stay on ITU and a uneventful postoperative recovery. I was in hospital for 10 days in total. The surgery I always felt was manageable, painful but that was to be expected. The pain team couldn't have done more. Despite multiple contacts with health care professionals there was no impetus to push the exercise issue, and although there was regular contact with the physiotherapists this was simply for chest physiotherapy and mobilising out of bed.

Chemotherapy is something I would describe as akin to having your soul sucked out (regardless of whether you are religious or not). The side effects from nausea, vomitting and diarrhoea were initially the most debilitating, but the chronic tiredness with the peripheral neuropathy (numbness) in the feet with severe chronic pain made walking difficult. It is something to be endured, but can take you to dark places physically and mentally. 

The awfullness of the chemotherapy was replaced by routine and tedium, there is only so much daytime television you can watch, but despite the support and of family and friends was stilla lonely time, waiting for the next chemotherapy cycle. Slowly things did improve, and exercise provided an outlet. When I say exercise simply walking nothing more exciting. The first walk was approximately 400m to a local park, the toughest achievement to date, but the most fulfilling in sense of achievement, and for the first time sitting on a park bench eating a salad in the spring sunshine I thought that maybe I might just survive this thing. Small steps and all that, I had no idea where this would ultimatelylead. These walks became established over the weeks during chemotherapy, and were made so much more enjoyable and fulfilling when being accompanied by a friend. The importance of these walks in terms of my recovery in terms of physical and mental health cannot be underestimated.

Chemotherapy completed life returned to a kind of normality punctured by outpatient appointments . Everyone going through this will relate to the increased anxiety the thought of these appointments brings, not the scans, xrays or tests but the results and that simple question and answer which goes through your head every time, has it come back? For 4 years the answer was always no, and the closer that 5 years got the more I started to hope and believe that I was going to survive this thing. That August on a hot Sunday afternoon I looked at a hybrid bike that I had bought 10 years previous with all the good intentions of getting fit, and never ridden it. I looked at it and thought sell it or ride it. 

I did ride it, and found it so much harder than I remember, not far, but far enough. I continued to ride, the joy of riding in the countryside, appreciating the changing seasons, and that feeling of well being made everything seem so much better and manageable. However the single most importantfactor in further encouraging my cycling was not from the health community, but a random find an article on Strava. The impact of this free appcannot be underestimated. It provided a virtual community which I could be part of, but allowed me to see how my performance improved objectively to the point where the decision was made to buy a road bike. 

I have been extremely fortunate in that I have had essentially no significant problems following my oesophageal surgery and chemotherapy. Swallowing problems/strictures are common, and although adviced to have small regular meals, I can and regularly do have nomal size portions, although do know about it when I over eat.  Pain particularly around the scar site is similarly common, but was never a problem. The numbness in my hands resolved completely, although I still have some altered sensation in the soles of my feet but otherwise nothing. I did however discover the concept and reality of boinking, cycling further than expected (getting lost) and ending up on a bench outside a shop eating a huge amount of sugar, in various forms, I have subsequently found out this is a common cyclist thing. There is however the phenomenon of dumping, which is particular to oesophageal surgery. Essentially eating to much sugery stuff creates the feeling of Boinking but with the added bonus of explosive diarrhoea. Nutrition has therefore become an issue as my cycling increased in terms of distance and time. By trial and error nutrition largely resolves around careful planning , fig rolls, bananas and gels, but still a work in progress. Five years 5 months after surgery I completed my first sportif, 52 miles with a mountain biker for company and support. An exhilarating experience, something I would never have considered prior to my illness, but a personal achievement which redefined my perception of sport and exercise, and my relation to my disease. The following year I completed my second sportif 100miles of suffering, but it taught me that nutrition is essential, but it also inspired me to want to take on new challenges.

Triathlon is something the other people did, I remember reading an article on triathlons, but then aged 32 I thought I was too old. In my 50s, age was not the issue, swimming was. I had not swam regularly since I was a child, those old enough will remember the bronze, silver and gold swimming awards which involved swimming whatever strokes, pyjamas and bricks, and no front crawl. I started swimming again in a 10m pool, and managed 100m in 30 minutes and really did think I was going to die. Despite this I continued to swim. The first visit to the local council swimmimg pool did raise the issue of my scar in my mind, but it left with that swim. To date it simply a reminder of where I have come from, and no more. The swimming progressed to swimming in an 50 m pool, and then open water.  I also started running about the same time, slowly and really struggled to start with. The combinatiion of having your stomach in your chest, and a very tight chest scar made it difficult. As Strava had transformed my cycling Parkrun transformed my running. Its aims in terms of community, health and running continue to play a pivotal role in my running. 

The impact of sport and in particular triathlon has transformed my life, it defines who I am, rather than my illness. There have been setback (my first real attempt at a super sprint triathlon where two of the organisers tried to kill me, you know who you are Tanja and Liz), finishing last in my first sprint triathlon, but I am now swimming in the pack, and competing, on the bike and in the run. I now plan my life around the triathlon season, I do think about my illness on occasion, and lest I forget one of my colleagues only last week pointed out I am more likely to die of something else now.