A thrill seeker who had just diced with death by diving with sharks on a once-in-a-lifetime vacation to Costa Rica returned home to her biggest challenge yet – a battle with stage four bowel cancer.
Left infertile by her treatment, ironically, when managing director Zu Rafalat, 38, first visited her GP with abdominal pains and severe bloating, she was asked if she could be pregnant.
Knowing it was impossible, super-fit Zu, of Finsbury Park, north London, who is single, at first thought she had caught a vacation bug in Central America, and ate chicken broth and green vegetable smoothies in a bid to reduce her bloating.
But, after six weeks with her symptoms persisting, she saw a private doctor using her work insurance, leading to investigations which revealed she had stage four bowel cancer.
She said: “Just a couple of months before my diagnosis, I was diving with sharks a 30-hour sail from the Costa Rican mainland in Central America.
“The instructor warned us that if anything went wrong we were a long way from the nearest hospital."
She continued: “Little did I know that while he was telling us to beware of sharks, I was already dicing with death, with a ticking time bomb inside me."
After the two-week break, which Zu had taken alone in December 2018, she had been looking forward to spending Christmas with her retired mom, Krysia, 66, dad Andy, 69, a former restaurateur, and film director brother, Rob, 36.
But there was less festive cheer than usual, because she was laid low by severe bloating and painful stomach cramps.
“I started feeling quite rough not long after I stepped off the plane," she recalled.
“I thought I'd caught a bug, but it felt a lot more abdominal than your usual bug. I was constipated and not very comfortable at all."
After her symptoms had persisted for two weeks she saw her GP, who took one look at her swollen belly and asked if she could be pregnant.
She said: “My tummy was so swollen that I had to buy maternity jeans and it looked like I was six months pregnant.
“I knew I wasn't, it would have been impossible, so when that was ruled out, I was sent away with peppermint oil tablets for irritable bowel syndrome (IBS)."
Six weeks later, having returned to see the doctor, when she was still no better, Zu decided to see someone privately through work.
“I couldn't eat and I had no appetite. I was living on a diet of chicken broth and green vegetable smoothies," she added.
“On February 20, I saw a private GP, who came to my office. She asked me a few questions and when she gave me an examination, she seemed quite worried.
“That's when she said I should see a gastric specialist as soon as possible."
She added: “I had meetings to get to but, luckily, I was able to organize an appointment at 7pm that evening."
Referred to The London Clinic, in Marylebone, central London, Zu had a CT scan and, two hours later, was told by doctors that a mass had been detected on her right ovary.
Scheduled for a biopsy that afternoon, having initially suspected she had ovarian cancer, three days later, doctors told Zu they now thought the cancer was in her bowel.
“I was hoping, best case scenario, that the mass was a benign tumor on my right ovary and that would be it," she said. “Sadly that wasn't the case."
Following further tests, including another CT scan, an MRI scan, an ultrasound and a colonoscopy, looking inside her bowel that same week, doctors confirmed she had stage four bowel cancer.
“It was a lot to take in, but getting upset about things doesn't do any good," she recalled.
She continued: “I just wanted a plan of action. Straight away I asked the doctor when he could book me in for surgery – I wanted him to get this cancer out of my body.
“I told him I was happy for him to take whatever was necessary out to get rid of the cancer."
Waking up after the eight-hour operation at The London Clinic on March 18, Zu was told by her surgeon that they had removed as much cancer as possible – but this had also meant taking out her ovaries, womb, fallopian tubes, uterus and spleen. Tumors had also been removed from her bowel, liver and diaphragm.
Discussing the moment she realized she would not be able to have her own biological children, Zu said: “I hadn't thought about having children, as I'd never met the right person to have them with.
“I've lived a very full life. Lots of people feel under pressure at around my age to have children.
“To be honest, I felt a sense of relief, that the choice not to have children had been made for me."
Recovering quickly from the invasive surgery, Zu was back on her feet in a matter of weeks – something she claims her healthy lifestyle played a key part in.
But, while the “surgery chapter was easy to deal with," she struggled with the grueling chemotherapy that followed at Mount Vernon Hospital, in Northwood, north-west London.
Her drugs were administered through a chemotherapy port, a small implantable reservoir with a silicone tube which attaches to a vein.
Given six hours of chemotherapy through an IV, followed by 48 hours of chemotherapy through her port, she then had 11 days off. Initially it was intended that this cycle would be repeated 12 times – but this treatment plan was soon abandoned.
She said: “The doctor reeled off the possible side effects and I expected to get one or two, but I experienced every single one of them.
“Rashes, sores, vomiting – I lost about 30% of my hair, too."
She continued: “I would wake up and find it physically impossible to move. I had to stay with my parents it was that bad."
After four cycles, with no sign of the side effects improving, Zu tested positive for a dihydropyrimidine dehydrogenase deficiency (DPD), an enzyme deficiency, which makes the side effects of chemotherapy harsher.
As a result, she was switched to a new form of chemo at a lower dose. But, after three more cycles, in September doctors decided the side effects outweighed the benefits and she was taken off the treatment.
“I was not very well by that point," she explained. “The chemotherapy had destroyed my digestive system.
“My body couldn't absorb water, it became so bad, and I had be fed through an IV."
At a follow-up scan at The London Clinic last week, Zu was told that “trace amounts" of cancer have returned in her peritoneum – the lining of the abdomen.
“I hadn't even heard of a peritoneum and now it's something I think about every day," she said.
Now having regular scans every three months for the next two years, to see if the cancer has spread, Zu hopes to have further surgery at some point in the future.
“Right now the only drugs I'm taking are follow-up medication from my operation to help my immune system but I'm hoping for surgery in the future to get rid of any tumors that might appear," she said.
“I haven't been given a prognosis by doctors, they're not sure what the outcome will be," she continued.
“But despite being diagnosed with stage four cancer, I've only got traces left in my body and that's got to be a good thing."
Throwing herself back into her healthy lifestyle, including walking 10,000 steps a day and doing yoga daily, Zu remains hopeful for the future.
“I look at cancer as a condition I have to live with for as long as possible," she said.
“But, ultimately, I'd rather live a short but good life, than a long bad one.
“Doctors might not have used the word terminal, but I know I'm unlikely live to a ripe old age. The risk of reoccurrence in this type of cancer is very, very high."
“The thought of living to 90 is very unrealistic – I'm aiming for 60. But you never know," she added.
Now working with the charity Bowel Cancer UK to raise awareness and fight the perception that bowel cancer is an older person's disease, Zu said: “I've been fit and healthy for my entire life. I never dreamed I could get bowel cancer at my age.
“Doctors have asked if I need therapy to deal with the past six months, but my therapy is talking about it. I've handled it surprisingly well, as I'm a realist."
She concluded: “Hope keeps me going and you never know what might change.
“I always laugh with my family that I only need to stay alive long enough for them to develop the next step in treatment.
“But for now, I just want to raise awareness and put bowel cancer on the radar."
For more information about Bowel Cancer UK, visit www.bowelcanceruk.org.uk
@thejenniwren.teamlh.social/Bluesky
@NancyMace/X