And now for another starting line

With my radiation burn healing up nicely, I had my worst-part-is-over appointment with my oncologist late last week and talked through the pros and cons of two options for the next phase of my cancer treatment: hormone therapy. 1. Ten years on Tamoxifen, the drug that most women my age and with my type of breast cancer take (a daily pill) to block the body's uptake of estrogen.

2. Three years of aromatase inhibitors (also a daily pill), plus periodic injections that would would essentially turn off my body's estrogen spigot. Traditionally, only post-menopausal women take the aromatase inhibitors route, because the drugs don't work if you're still ovulating. But recent studies have shown that after inducing early menopause, aromatase inhibitors can work better than Tamoxifen — especially for women like me, with cancer that metastasized to nearby lymph nodes. So, option 2, it is! Both forms of hormone therapy come with some gnarly side-effects. With aromatase inhibitors, the biggies are joint and muscle pain and an elevated risk of osteoporosis. I'm going to be diligent about taking calcium and vitamin D supplements, in addition to eating healthy and doing lots of good weight-bearing exercise, both good for the bones (mind, body and soul, too, of course).

After a month, if I'm tolerating the aromatase inhibitors well, I'll continue getting the ovary shut-down injections every four months and might also get a supplemental treatment to lower my risk of osteoporosis. If I do, get this: Studies have shown it may decrease the risk of breast cancer. Go figure!

If aromatase inhibitors really kick my ass, I can switch to Tamoxifen.

In the weeks since I celebrated the end of radiation, many of you have asked if there's some sort of scan or test I'll get to declare my cancer fight an official victory. The answer is no. While CT and PET scans can pick up signs of breast cancer recurrence a few months before there's any palpable tumor regrowth, those scans don't do anything to increase survival rates.

So aside from hormone therapy, my next step is a mammogram of my right breast in six months. In the meantime, I'll closely monitor my ex-breast; most recurring tumors are pretty easy to spot because they crop up close to the skin. I'll see my oncologist again in three months, with periodic phone check-ins with him and my primary care doc as needed.

Am I anxious about this next phase? You betchya.

I'm trying my best to feel grateful that because my cancer was estrogen-sensitive, I can get this additional treatment to increase my odds of kicking it for good. It's as important for my survival as chemo was.

So here I go ... again.

UPDATE: Since I first wrote this, guidelines for aromatase inhibitors have changed. I'll be on them for the next 10 years, not just three.

#CaringBridge #cancer #startingline #hormonetherapy #aromataseinhibitors #menopause #Tamoxifen

So over you, radiation

RadiationCertificate

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Man, oh man, the last couple weeks of radiation sure tested my resilience. That not-so-bad light pink radiation burn from the first 20 treatments started to peel in spots, turning most of my left chest wall various shades of painful red.

I stayed on top of my ultra-diligent moisturizing routine, got crafty with patches of non-stick gauze, did lots of whining that nobody ever seemed to hold against me. And now ... I'm done! Thirty radiation treatments, check! My awesome radiation therapists shouted "Woo hoooooo!!!!" over the intercom after I got my last dose of electrons this morning. Then they gave me a certificate congratulating me for completing radiation therapy and for "my proficiency in the art of being CHEERFUL, COURAGEOUS, TOLERANT AND DETERMINED." They chuckled good and hard when I played them F*ck That: An Honest Meditation. "Breathe in strength ... breathe out bullshit." Sean and I took the day off, had an indulgent breakfast, lounged around watching TV and napping, watching TV and napping, then took the kids out to an indulgent dinner. Felt great to be celebrating this milestone. My skin should start healing up good in about two weeks, when I start the next phase of my treatment: hormone therapy for the next five (plus?) years. I've heard Tamoxifen can be a bitch. But it's kept a lot of breast cancer bitches like me alive over the years, so I'll suck it up, deal with whatever unpleasant side effects I get and keep on keepin' on. At least it's just a pill, and I won't have to go to the dang hospital day after day after day after day. I am not going to miss one damn thing about the commute to and from and to and from and to and from Group Health. So glad to be moving on ...

#CaringBridge #cancer #radiation #meditation #GroupHealth

Bouncing back, halfway there and other good stuff

Time sure flies when you're having fun — and when you're going through radiation therapy, which is not at all fun, but also not all that bad. Aside from the gobs of time that go POOF! when you have to drive a half hour (more like 45 minutes at rush hour) or carve out an hour to take a bus that may or may not arrive on time to go to an appointment that usually takes less than 20 minutes — then turn around, go home and get started on your day. Bye-bye, two-plus hours times five days a week = OMG, how am I supposed to stay on top of work and exercise and be a cheerful and present parent and chillax every now and then? Yeah, I've been getting wound up pretty good over all the time I've been "losing" going to and from and to and from and to and from radiation. It's surely one of the reasons I've struggled with insomnia in recent weeks. Speaking of insomnia, things have gotten a little better since I shared my woe-is-me radiation haiku. What a difference a few consecutive days of subpar-but-not-awful sleep can make! The fog starts lifting. Mole hills don't loom like the Mount Everests they aren't. The world seems full (or at least not devoid) of hope and possibility. Then you count the days, and all of a sudden you're halfway to the finish line. What? That was quick! Yep, I crossed the halfway point today: 15 treatments down, 15 to go. My skin's holding up well. I have the beginnings of a mild whompy-jawed rhombus-shaped "radiation burn" on my left chest and under my arm. I've been bullish about lubing up with moisturizer and some anti-inflammatory steroid cream. I was warned that my skin might blister up and break (ewww), so it's comforting to make it this far with minimal damage to my skin. The breath-holding thing hasn't been difficult, either. I only have to do it six times per treatment: two for practice and once for each dose of radiation. Each time, I think about my heart and how each deep breath I take in is protecting it from radiation it doesn't need. A little plastic box my radiation techs tape onto the top of my belly tells them if I'm breathing in enough, too much, or too little. I've gotten it just right just about every single time. Once during today's treatment, they asked me to let out a little air partway through one of my radiation doses. The precision of radiation treatment floors me sometimes. After about 20 seconds, I get the all clear to breathe again and sometimes think back to that hilarious "f*ck that" meditation that went viral not long after I was diagnosed. I feel a surge of calm strength as I "let the horse shit of the external world fade from my awareness.” Ahhhh ... ha ha ha ha ha ha! :-) I should play it for my radiation techs one of these days. They'd appreciate it. They're awesome like that. When each treatment is over, we say our "See you tomorrows" and I walk away feeling grateful to be one step closer to finishing this process.

#CaringBridge #cancer #radiation #meditation #radiationburn #gratitude #insomnia #exercise