Health Update- A Med Change and Needles the Size of Coffee Stirrers

{18 Gauge Needle–ugh!}

I have been taking a medication called Tamoxifen for 2 1/2 years.  My breast cancer had estrogen receptors, and the growth of these tumors can be stimulated by estrogen.  Tamoxifen is like a key that fits into the keyhole (receptor) of tumor cells so estrogen cannot get in there and cause growth.  Even though it blocks estrogen, it also stimulates estrogen production, so much so that it is used for infertility.

I have not been doing well on this drug.  It was never a walk in the park from the beginning, but I got over the typical joint aches and moodiness that came with it.  But lately, my side effects from this med have been pretty rough.  Hot flashes so intense I want to crawl out of my own skin, joint aches, ovarian cysts, uterine lining growth (first stages of uterine cancer–a big concern) and the worst one for me–fatigue.  I have always had to take naps on this drug, but the last few months the fatigue was ridiculous.  I would need 2-3 hour naps most days and it was a very deep, drug induced sleep, and I would wake up feeling old and creaky and just plain yuck.

For my recent surgery, I had to go off the Tamoxifen, and OH MY DEAR FRIENDS I cannot tell you how much better I felt.  For those of you who have been reading along my cancer journey the last few weeks, you know I had to have surgery twice in a week, and had a lung infection called pleurisy.

Guess what?  I was LESS TIRED having two surgeries and pleurisy than I was on Tamoxifen.  It has been so great to feel energy even through healing from surgery.  It really put into perspective just how much Tamoxifen had been effecting my life.

My OB has been hinting around about taking me off the drug as he is very concerned about the uterine lining growth.  I have had to get ultrasounds to check lining and cysts every 3 months, but recently he has been checking me monthly, and it has not looked good.  I have an appointment with him soon and I know he will be relieved that I am off Tamoxifen, and I am sure he would have suggested it anyway.

I met with my Oncologist today, told her I feel better after 2 surgeries and a lung infection than I do on Tamoxifen, told her about my uterine problems, and she agreed I need to come off the drug.  She said I gave it my best, and was pleased I almost made it to the 3 year mark.  A study just came out that increased the time for women to take this drug from 5 years to 10 years, which made me cry when I read it.  I thought MAYBE I could make it to 5 years, but NO WAY ten years.  The statistics of being protective against recurrence is impressive, so it was hard to finally give up, but I know it is for the best.

So what now?

There are only 2 other options for me.

Because I am premenapausal, they have to make me postmenopausal.  The goal now since I am stopping the drug that blocks estrogen is to eliminate estrogen.  There are 2 ways to do this:

1. Monthly shots that shut down the ovaries–instant menopause  OR

2. Full hysterectomy–this includes the ovaries.  This is not your typical hysterectomy, most hysterectomies done these days leave the ovaries, which in turn leaves hormones.  Breast cancer survivors don’t get that luxury.

With both options, they start you on an aromatase inhibitor.  This takes care of any estrogen that is found in your muscles, fat, liver and in breast tumors.

I chose the shots, as I am young and I like that it is not permanent.  Taking all hormones out of the body and going for full hysterectomy has its own set of problems.  It increases chance of heart disease, which is the #1 killer of woman, and my chances for that are already sky high due to my chemo and radiation.

I got my first shot today.  I will start on Arimidex in 2 weeks.

How do I feel about all this?

A nervous peacefulness, a little sad, and nauseous.

I am nervous because the nurses read all the side effects of Goserelin shots and Arimidex and they sure sound very much like the side effects I already experienced on Tamoxifen, minus the cysts and uterine lining growth.  Oh how I pray I am one of the lucky ones who do not have too severe of side effects.

I am at peace because today God just keeps reassuring me of His faithfulness.  Not only that, it looked like insurance was going to be stubborn in covering the shots, but at last minute said yes.  My particular insurance usually takes forever making these decisions, so to have the billing manager come and tell me I was approved and could get the shot TODAY was surprising and reassuring.

I am sad because…hmm…how to put into words.  My poor ovaries are gonna shrivel up!  I don’t know….I’m used to seeing them every month on ultrasound and they helped create 3 beautiful girls and maybe it is because to me they mean youth?  I was always so proud of my body for continuing to cycle despite chemo, radiation, & Tamoxifen. My doctors marveled at that. I guess I got it in my head that a young, strong body is a body that cycles regularly so for me it became about youth and strength.  Time to let go of that belief.  Adios ovaries…maybe someday after these shots you will work again.

I am nauseous because I had my first shot today, and it was the FIRST TIME EVER that I have gotten queasy and faint from a procedure, and you all know I’ve had my share of procedures!   These shots are given in the stomach, and they place a pellet under the skin.  The nurse told me she would numb the area first, which in itself was surprisingly painful–it burned a lot.

I then asked her if I would be able to see the pellet under my skin and she said “oh yes, it will be right here under the skin, it is good size.” Then she held up the needle that contained the pellet, and that is when my heart started beating faster.  My glance was brief, but my first thought was “that is the size of a coffee stirrer!”  She said “I sure hope this goes where it is supposed to, you are so skinny” as she pushed it in…and that did me in.  I felt it, it seemed like she could have waited a bit longer for the numbing meds to take.  She sat me up, and that is when my head felt weird and she told me I looked green and to lay back down.  That was an hour ago and I’m still queasy.  I’m sure it is not the med side effects yet…I just think the idea of a pellet and that big needle under my skin got…well.. under my skin!