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by Dr Vanessa Atienza-Hipolito, Founding Member, The Brilliant Foundation
COTTESLOE, WESTERN AUSTRALIA (WA) - I met Dr Pamela Hendry about 6 years ago when I gave an educational talk on the Update of Breast Cancer Diagnostic Testing in Moderate-to-High-Risk Women for the Australian Medical Association (AMA) Nedlands WA. After my presentation, Pamela (Pam) introduced herself as a Founding Director of The Ladybird Foundation. Since then, we connected and in Pamela’s words we became “Breast Friends Forever”.
I wanted to help her with her advocacy and introduced Pam to Ian Wee. Ian Wee is an Occupational Therapist who focuses on musculoskeletal injuries. Ian is the Founding Director and Principal Practitioner of the Perth Integrated Health Clinic. The synergy with Ian, Pam and I led to several fundraising cycling and running events and educational health talks. Personally, I raised funds for The Ladybird Foundation through my completion of a full marathon and ironman 70.3 (half ironman) events.
Photo (From Left to Right) : Dr Pam Hendry and Ian Wee supporting Ladybird Foundation through Tour de Gracetown Cycling fundraising events.
Dr. Vanessa-Atienza Hipolito (Vanessa) : “Tell me about yourself and your childhood?”
Dr. Pamela Hendry (Pamela): “I was born in Gnowangerup (a very small town in Rural Western Australia) 65 years ago and was very fortunate to grow up with my brother in a loving supportive family in the country. I attended primary school in the country and came to Perth to boarding school for my secondary schooling. I studied Medicine at University of Western Australia (UWA) and graduated in 1980.
I am a doctor (GP), a director of a small charity (The Ladybird Foundation), and a breast cancer survivor (8 years and counting). I am also blessed to have made some lovely enduring friendships over the years.
I am a mother and stepmother of 3 adult children, wife of a doctor, sister, sister-in-law aunt, great-aunt and member of a large extended family. No grandchildren so far!
Vanessa : “What were you doing prior to your diagnosis?”
Pamela: “Prior to my breast cancer diagnosis, I was working part-time as a General Practitioner in a busy metropolitan practice as well as being a full-time Mum and wife. I also helped my elderly mother who was living with dementia at home until she moved into residential care shortly before my diagnosis.”
Vanessa : “What do you do for Exercise? Fitness? Daily routine?”
Pamela: “I have always enjoyed a moderately active lifestyle, keeping reasonably fit with regular walking several days a week while I was working in part-time GP. I carried out the usual activities around the home including garden and pool maintenance. More recently, I have returned to running and discovered Yin yoga.”
Vanessa : “Your personal achievements?”
Pamela: “I consider my main achievement to be motherhood (including step-parenting) and contributing to maintaining a medical marriage that has lasted for over 30 years.
I worked as a GP for 30 years and was privileged to look after many loyal long-term patients during that time. I also taught medical students for many years, both in my General Practice and on campus at UWA.
Shortly after my breast cancer diagnosis, I became involved in the establishment of a small volunteer charity called The Ladybird Foundation which supports breast and gynaecologic cancer research in Western Australia and has provided essential funding to 4 important research trials so far. I consider this is one way I can thank my own doctors for their excellent personal treatment and for the follow-up I continue to receive.”
Vanessa: “Do you have a regular breast examination and imaging?”
Pamela: “I have regular annual breast examinations by my oncologist and an annual check-up followed by imaging arranged by my GP.
1. Mammogram? Yes
2. Ultrasound? Yes
3. How often? Annual
4. Since when? I commenced regular mammograms and ultrasound from age 40.
5. When did you get diagnosed with breast cancer? 5th February 2013.
6. How old are you now? 65 years old
In February 2021 I am in excellent health and cancer-free, pending the outcome of my annual mammogram and breast ultrasound on 17th February!
I would qualify this by adding that I do experience a number of survivorship “souvenirs”, which are variously related to the initial breast surgery (scarring and asymmetry following unilateral mastectomy and reconstruction), the subsequent lymph node clearance surgery (mild intermittent lymphoedema), adjuvant chemotherapy (finger and toe nail changes) and continuing prophylactic treatment with an aromatase inhibitor (experiencing most of the reported significant side effects – joint and soft tissue aches and pains, genitourinary system symptoms, flushes, mood disturbance, raised LDL cholesterol, reduced bone density).
I am reluctant to stop taking the Aromatase inhibitor (AI) as I think of it as a sort of insurance policy against recurrence of the Estrogen Receptor disease which, despite better 5-year survival statistics, can apparently come back to “bite” you for up to 20-30 years after the original diagnosis!”
Pamela: “I always feel a sense of trepidation and anxiety in the lead up to when I have routine appointments with my oncologist, GP or for routine annual breast imaging. I think it is a form of PTSD experienced by many cancer survivors who have felt their lives to be prematurely threatened by a potentially life-threatening condition.
I am also arguably fitter at this point than I might have been had I not been through the breast cancer experience as I subsequently had more time and greater motivation to exercise more than I had been doing prior to diagnosis”
Vanessa: “What age when you were diagnosed?”
Pamela: “57 at time of diagnosis.”
Vanessa: “Do you remember what happened on the day of your diagnosis?”
Pamela: “I still remember the events of 5th February 2013 quite clearly. I had been to see my GP for a routine breast check when she could only feel my pre-existing benign cyst and ever-present general lumpiness for which I had always undergone ultrasound in addition to screening mammography.
My mammogram was unremarkable, although in retrospect it did show that I had very dense breasts which were not subject to grading and reporting at that time. In retrospect, increased breast density was probably my main risk factor.
I was aware that the sonographer carrying out my ultrasound was not entirely happy about one area in my right breast as she went over this area repeatedly before excusing herself to have a word with the Radiologist whom I knew professionally. He came into the room and had the unenviable task of telling a colleague (me!) that I had an abnormal area and that it was almost certainly malignant.”
Vanessa: “Do you remember what were you thinking during and after your breast biopsy?”
Pamela: “The Radiologist said that I must feel shocked to be hearing this. I was a little surprised to be told that I must feel shocked but, on reflection, this was really the best word to describe the initial feeling. I proceeded immediately to having a core biopsy (not painful) before leaving Women's Breast Imaging and driving home.”
Vanessa: “What about the days while waiting for your test results?”
Pamela: “I think my medical training kicked in straight away and it was a case of “Keep Calm & Carry On” from this point.
I remember telling myself I needed to extra mindful and concentrate on driving carefully in coming days so I didn’t have an accident on the way home! Once I arrived home I made a cup of tea and sat down to think about who to tell and what to do. Initially I rang my best GP girlfriend who had always been ready to drop whatever she was doing and come to my aid.
She is an excellent GP with plenty of experience of her own patients who had been through breast cancer so she told me which breast surgeon she thought would be best as well as someone else to provide a second opinion.
Doctors often make the worst patients because we don’t quite know how to trust our colleagues! I definitely did not want the burden of being responsible for making this decision myself, despite my own professional experience, so was grateful to have my own GP and my GP friend to ask about this.
With my agreement, she rang and arranged appointments for me with both surgeons. Now that I already had the beginnings of a treatment plan in place, I rang my husband who was at work and told him what had happened. He was wanting to reassure me that the biopsy could still come back benign but I know I was very certain the imaging would be confirmed.
I also rang my GP colleague at work to tell him what had happened and to ask him to let me know if I did not seem to be managing well at work in the next couple of weeks ahead of my surgery. I had a full schedule of patient appointments for the next two weeks and I had decided to work through this so nobody else would be inconvenienced unnecessarily at that point. This was my workaholic nature and over-developed sense of responsibility coming to the fore, neither of which probably should have been there on this occasion. I delayed my initial surgery by a week to satisfy them!
I felt quite numb by this stage late in the afternoon and decided to go to my monthly Book Club meeting that evening since my husband could not get home from his own demanding specialist practice until much later and I didn’t want to sit at home on my own. Our university student son had left to go to Italy for a year of exchange study a week before, one of my step daughters was interstate and one was living independently in Perth.
"I did not tell any other family members or close friends at that time as I wanted the diagnosis and surgery plans to be confirmed so I could reassure everyone I had this all under control. I had to compose a script to tell two of the children about the diagnosis, treatment plan and prognosis via Skype calls which was quite difficult for them and very hard for me. Somehow I felt like I had let myself and many other people down by becoming sick, even though I felt healthy. I was embarrassed that I had not been able to prevent this situation despite my best efforts at living a healthy life.”
Vanessa: “What happened after when your GP told you your diagnosis?”
Pamela: “My Radiologist colleague rang me directly and confirmed the result of the core biopsy as we both knew this is what I would want. My GP had also been informed that I knew the result and she rang me to discuss what had happened in the meantime, including my appointment plans. She was very supportive of me as her patient and GP colleague and totally understanding about this process. I made an appointment to see my GP to obtain the necessary referrals to the breast surgeons.”
Vanessa: “What happened during your surgery and further treatment?”
Pamela: “This was an unexpected “roller-coaster ride”!
Initially I underwent a total right mastectomy with immediate silicone implant reconstruction plus sentinel lymph node biopsy. Excision was complete. It was great that I only needed one combined surgery for the initial treatment and reconstruction and I am still happy that this was available, although it probably made the immediate post-operative period more painful.
I experienced quite a lot of pain following cessation of the self-administered analgesic infusion and, on reflection, I probably should have continued the infusion for a while longer. However, I was intent on getting out of hospital as soon as possible which meant being off the infusion for 24 hours, as well as having the acceptable amount of drainage from the wound to allow me to be discharged.
The frozen section of the sentinel lymph node at the time of surgery was clear but the full histopathology report a few days later showed a small area of spread within this lymph node so I underwent a total axillary lymph node clearance two weeks after the mastectomy. My surgeon rang to tell me this showed no other lymph nodes were involved which was a huge relief.
I experienced several bouts of painful seroma over the initial weeks which necessitated drainage of fluid at the surgeon’s rooms. I also had cording and lymphoedema which were treated by an accredited lymphoedema physiotherapist who also ran the cancer Pilates rehabilitation sessions I commenced about 6 weeks after the surgery. I did my arm and shoulder exercises meticulously as I was highly motivated to regain full range of movement in my right arm. One of my friends had shown me her excellent result so I knew this was possible.
I chose a very senior experienced breast oncologist to plan my further treatment and I am very pleased I did. My husband is a very experienced specialist in the area of haematological oncology and was able to help with making these decisions. I underwent the standard workup ahead of what we had initially thought would be a course of adjuvant chemotherapy but I had a bumpy ride before I finally got the green light for the chemotherapy.
My bone scan showed a couple of areas that looked like secondaries in my ribs and this was a huge shock for me. I was not at all prepared that a breast cancer that one surgeon had said would possibly only require treatment with an aromatase inhibitor and not chemotherapy would suddenly turn out to have possibly metastasised to my bones. This would have meant an entirely different prognosis and approach to treatment.
I felt really angry to think that this disease would most likely kill me when I had been expecting a good chance of a cure with treatment. Fortunately a follow-up MRI and a PET-CT did not show up the same areas so I was allowed to go ahead with adjuvant chemotherapy. I think I was probably one of the most grateful and highly motivated people in the chemo lounge during my 4 cycles of chemotherapy!”
Vanessa: “How long was your treatment?”
Pamela: “My adjuvant chemotherapy consisted of 4 cycles three weeks apart but I had a longer break between the initial cycle and the second cycle to enable my husband and me to go ahead with a planned trip to Italy to see our son.
The oncologist was very understanding and supportive as she knew how much this meant to me. It really gave me much more strength to undergo the remaining chemotherapy as soon as we returned. It was important for me to be able to show our son that I was OK and would continue to be OK.
Vanessa: “What changes did you do with your daily routine during your treatment?”
Pamela: “My husband started bringing me a cup of tea in bed first thing in the morning and has continued to do this on most days. Small caring gestures like this made a huge difference to me as I was used to being in the carer role.
I slept in a spare room when I was recovering after the surgeries so I didn’t disturb my husband during the night when I needed to get up for any reason (analgesia, bathroom) or when I was trying to get comfortable. I had an afternoon rest on my own bed every day for several weeks, listening to music and occasionally having a nap.
I didn’t go to work.
I went out for a coffee to a café with a friend occasionally to have a change of scenery.
I walked every day for exercise plus did my prescribed exercises. I commenced supervised Pilates-based cancer rehabilitation exercise six weeks after my surgery.
I did some meditation.”
Vanessa: “What were your fears? Concerns?”
Pamela: “I feared my life would be cut short by breast cancer. I would miss many family milestones and have to leave my husband and children, and possibly my elderly mother, to manage without my support.
Initially I was concerned that I would not be able to hide my diagnosis from anyone who saw me if I had to stay in hospital more than a couple of days. I was concerned that I would not be able to tolerate pain post-operatively and could suffer nausea and more serious side-effects during chemotherapy.
I was concerned that I would lose my hair during chemotherapy so there would be no hiding the fact that I was wearing a wig or a headscarf. I was concerned I would not be able to hide my diagnosis from my elderly mother and mother-in-law who I wanted to shield from this worry. I was concerned that my husband should be able to feel free of undue worry about me and be able to continue his work schedule normally so his patients would not be impacted at all.
I was not overly concerned about scarring from my surgery as I have never felt my small breasts were a particularly spectacular feature of my appearance. They had served their biological purpose of breast-feeding so were now proving to be more of a bother than a benefit.”
Vanessa: “ Did you have any concerns during COVID-19?”
Pamela: “No particular concerns as I was fortunate to be able to keep my annual appointments with my oncologist and my GP, as well as having an annual zoledronate infusion (prevention of bone secondaries and also treatment for osteoporosis) as things have turned out.”
Photo (From Left to Right) : Dr Vanessa Atienza-Hipolito, Dr Pam Hendry, Jill Hunter (Podiatrist), Sarah Gwaze (massage therapist)Pi and Ian Wee (Managing Director at Perth Integrated Health) at Perth Integrated Health Balcatta.
Vanessa: “When did you start going back to normal? activities? Exercise?”
Pamela: “I resumed walking daily as soon as I came home from hospital. I also did my prescribed arm and shoulder exercises and commenced cancer rehabilitation exercise classes (Pilates-based) six weeks after surgery. I continued to manage all the household activities with some minor modifications like using the clothes dryer and airing rack more instead of hanging clothes on the clothesline outside.
Family and friends provided some meals for the first week after I came home from hospital but I was able to manage shopping and cooking for two thereafter.
The one big thing I felt unable to do was return to working in a General Practice setting. I had thought I might need a few months away to manage chemotherapy but, when I tried to think about going back to work, I was filled with unexpected anxiety.
I realised this came from the fear that I would not be able to devote the necessary physical and emotional time and energy to looking after my own health if I returned to work where I felt compelled to give 110% of my energy to looking after my patients indefinitely. I knew I would probably be unable to change my style of practice after 30 years which had culminated in a patient base of many people requiring quite a lot of time.
Subsequently, I have continued to practice medicine in different settings with opportunities to use my skills and experience in areas I would previously had not thought possible. This has been the ‘silver lining’ of my professional journey.”
Vanessa: “What are your goals for 2021-22?”
Pamela: “Show more loving kindness to myself and others, especially my nearest and dearest. Steer The Ladybird Foundation through another challenging year. Grow my professional knowledge and implement this more effectively in my workplace. Finish the decluttering challenge that was scheduled for 2013 and derailed by my diagnosis at that time but has remained in the “to do” list since!”
Vanessa: “What about for your SELF?”
Pamela: “Show more loving kindness to myself and others, especially my nearest and dearest. Stay connected to people who are an important part of my life.
I am improving my fitness with walking/running, exercise bike, swimming. I am hoping to maintain and improve my personal wellbeing with meditation, Yin yoga, healthy eating, good quality sleep and regular health checks (including annual breast imaging).”
Vanessa: “What is your message to women?”
Pamela: “Prioritise genuine Self-care in your daily life as this is essential if you are going to be able to nurture and care for your loved ones, as well as achieve your own personal goals in all aspects of your life. This is NOT a selfish thing to do and need not take much of your time. Just taking a minute to pause and breathe during your busy and often unpredictable daily life counts! Schedule regular routine health checks!”
Vanessa: “What about your message to family members?
Pamela: “Practise loving kindness and good manners in all your relationships.
Tell your loved ones you love them more often, even when you find it difficult to feel loving towards people at times: these are different things.
Ask for help more often, even if you are the best person to do any and every task! You will be surprised how capable others can be when given the chance!”
Vanessa: “What are your lessons learned?”
Pamela: “I am not indispensable and I am a natural workaholic. And I am not always right! Be authentic to your own DNA and live your life accordingly whenever possible.
Accept and love yourself for who you truly are and know you are “enough”, even if others do not treat you well. Cherish and nurture relationships with people who value you for being yourself. Hope springs eternal, as the saying goes, so never give up on it!”
Vanessa: “What is your message to The Brilliant Foundation readers?
Pamela: “Your Life is a journey, not a destination. Value each and every day, no matter what it brings. Spread loving kindness (a smile counts) wherever you go. Never give up hope for the future!”
THE PREMIER SOUTH WEST CHARITY RIDE will be on 23rd October 2021. Please help us support Pam’s advocacy.
-THE END -
Editor : Dr Renée Ralph, Co-Founder, The Brilliant Foundation
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