How to turn a pear into an apple

Just had my first mammogram since my surgery, and I'm relieved to say that the radiologist saw nothing out of the ordinary.

My oncologist recommended taking aspirin or ibuprofen about half an hour before the screening. Mammography is a low-dose x-ray of the breast while compressed to the thickness of luncheon meat. I have some internal scar tissue, and the muscles leading from my armpit to my ribs are pretty tight. On top of big squeeze, it felt like my entire right side was being slowly pulled apart like taffy.

What's with all the food analogies, you ask? I blame my current anti-cancer drug, tamoxifen. I gained about fifteen pounds during chemo, and put on another five during radiation. I don't eat more than I did a year ago, and my activity level is about the same, so what gives? My oncologist said "Some people blame tamoxifen, but it's probably just menopause." I have noticed that doctors are reluctant to admit the extent of drug side effects. This kind of dismissal always drives me straight to MedLine, which is why I'm such a pain-in-the-ass patient.

There's some relatively recent literature linking tamoxifen to excess visceral fat. Visceral, as in gut. I'm trying to get used to my new belly. Ever since I hit puberty, off-the-rack pants ballooned around my waist, even while they were too snug in the hips and thighs. I guess I should thank tamoxifen for transforming me into a more conventionally-shaped fat woman.

"Relationships between tamoxifen use, liver fat and body fat distribution in women with breast cancer." Intl. J. of Obesity. Feb. 2001. [Link]

Weather Report

Gahh!! Once again, for about the kajillionth time this winter, the skies dumped a load of snow on our city. I shoveled the wet stuff as quickly as I could, pausing to reflect that I had a lot more energy than when I was on radiation. I talked to my sister-in-law yesterday, and she mentioned that I seemed to have dropped cancer as a topic in this blog. I have neglected to tie up the loose ends of my treatment, the more aggressive part of which ended a little over a month ago.

I had my first post-radiation appointment with the oncologist on February 14. While I was in the waiting room, I noticed a man sitting across from me. He wasn't a kid, but was obviously younger than me, dressed in business casual and checking the messages on his cell. Maybe he was waiting for an elderly parent? We kept casting glances at each other and finally struck up conversation about the complimentary beverages. "I didn't discover the coffee until my seventh chemo," I told him. "Oh, did you finish treatment? I'm just starting."

Brian had just been diagnosed with Hodgkin's lymphoma. He was taking a shower when he discovered a lump near his collar bone. "I guess we caught it early; it hasn't traveled below my pelvis." Hodgkin's lymphoma, a cancer of the lymphocytes, or white blood cells, has a cure rate of over 90 percent. "It's the cancer you want to get..." he said, adding "...though I'm sick of hearing healthy people tell me that." Brian is only 38, and was just starting a second career when this hit. We exchanged cards, promising to keep in touch.

Dr. T., the resident working with my oncologist Dr. C., was the first to see me. I secretly hoped that Brian had the same oncology team, because her appearance would have brightened the mood of any heterosexual male. Dr. T. is HOT, as in Gray's Anatomy hot, and on Valentine's Day, she kicked it up a notch: wine-colored wrap dress, boots and fishnet stockings. "You look cute," she said to me, taking in my outfit. "So do YOU!" I answered. "Everyone has commented on my appearance today. They keep asking me if I'm going out tonight." Was she? "No. This is my only chance to look pretty today." And give male cancer patients heart-attacks.

Dr. C. came in after a few minutes. We discussed my post-radiation treatment. "I'm going to put you on Tamoxifen for a year," she said. She explained that since Tamoxifen was only effective at blocking the action of estrogen, most of which is produced by the ovaries, it wasn't ideal for post-menopausal cancer patients. "We'll test your hormone levels in a year to confirm that you're really in menopause." If confirmed, then I'll switch to an aromatase inhibitor, a drug which is believed to be more effective with menopausal women. "Tamoxifen increases your chance of developing cervical cancer, but the risk is very small. It most likely will increase the incidence of hot flashes. But, nobody has ever died of a hot flash." True, but I could kill someone while I'm having one.

So, I'm taking an anti-cancer drug, and will see the oncologist once every three months. In addition to physical check-ups, I need to order a mammogram for May, and also meet with my surgeon again. The rest of my body, neglected for a year, is overdue for a tune-up. I might as well get used to doctors' offices.

Funny Post

Ha...gotcha! Have you ever noticed how women are encouraged to joke about menopause? Oye, the hot flashes! Cue laugh track.

Yesterday, I had at least twenty separate hot flashes, and none of them have been funny. Each one seemed to wash away a little bit more of me, like the surf carving away a sand castle. This morning I cried out to my husband as the worse one hit, a nearly indescribable combination of fire and ice, followed up by nausea and abdominal cramps. He stroked my soaking wet head as I trembled and wept.

I'm being turned into a eunuch. In my pelvis, there's a deadness. The flush of estrogen from my body also brings geriatric problems, like sometimes peeing myself when I cough or sneeze. I cried the last time it happened, as much from nostalgia as humiliation. I was a normal woman a little while ago...remember what that was like?

A friend naively asked, "can't you do hormone replacement therapy?" If you haven't gotten that memo, doctors no longer recommend estrogen replacement for menopausal women, especially those with estrogen-receptor sensitive breast cancer, such as myself. Instead, we are instructed to take tamoxifen, a drug that blocks estrogen. Kill the woman to save the person: that's the prevailing theory. Tamoxifen is carcinogenic in itself; taking it doubles the chance of endometrial cancer. I've haunted countless listservs looking for information from cancer survivors, and those taking tamoxifen uniformly complain of non-stop hot flashes, loss of libido, anorgasmia (inability to have an orgasm) and other problems associated with low estrogen. The term "castrated" is often used by women to describe their symptoms.

Anyway, a co-worker told me how she liked the way I mix up the content in my blog: funny combined with "sad, struggly stuff." I'm afraid my funny bone is estrogen-receptor sensitive, just like my cancer, and the sad, struggly stuff is what's left for now.