Moving back into the mainstream

Well, I’ve been working on this posting in my head since the 27th of July, when I finished radiation. What a wonderful day!!! As a new “graduate,” I got to ring the ship’s bell in Radiation Therapy on my way out. Guess I’ve been celebrating ever since.

The burn from the first 25 treatments was well on the way to healing by the time the boost was finished. The boost site became sensitive, but not too sensitive to wear clothes and continue all normal activities. And now, 3 weeks later, there’s hardly a trace of “sunburn” left. I will have my 1-month follow up with my radiation oncologist the first week of September and there will be a 3-month follow up. Not sure what the frequency will be after that.

We met with my medical oncologist on July 30th. The main topic of our discussion was hormone therapy. But we did a general recap, and I went in with a list of questions both general and specific to hormone therapy.

We went through the numbers again (using Adjuvant Online). Statistically, for a cancer with my characteristics (2.5 cm, 2 positive nodes), chemo alone can be expected to reduce probability of recurrence by 23%. Hormonal therapy alone can be expected to reduce the probability by 26%. A combination of chemo and hormonal therapy is expected to reduce probability by 39%. So I’m going for 39%.

Because my cancer was estrogen and progesterone (ER/PR) positive, meaning that estrogen and progesterone facilitate my cancer, the goal of hormonal therapy is to negate the effect. Tamoxifen has been around a long time. It inhibits the ability of estrogen and progesterone to bind to the tumor. Aromatase inhibitors, newer and only used for post-menopausal patients, actually prevents the production of aromatase, which turns estradiol into estrogen. Ergo, no estrogen at all. Study or studies have shown aromatase inhibitors to be 2% better than Tamoxifen. That makes it 41%.

There are 4 choices of aromatase inhibitor. Faslodex is in shot form – scratch that. The others are Femara, Armimidex, and Aromasin. My oncologist’s choice is Femara. I’m taking 2.5 mg per day. I’ll be taking it for at least 5 years, based on current practice. But studies are already emerging that suggest longer is better, so by the time 5 years is up, I may be taking it for the rest of my life – or not all. New options could well emerge in the interim. I’m tolerating the Femara very well so far. The most common side effects are osteopenia (reduced bone density), joint aches, and hot flashes. I have particular concern about the osteopenia, based on family history of osteoporosis. We talked about proactive measures to prevent bone loss. Twice-yearly infusions of Zometa are an option. I had a new dexa scan to see where I stand now and am awaiting results.

A co-worker asked me some questions I wasn’t sure I had the answer to, so I had an email exchange with my doctor. The questions were “Are you now cancer free?” and “Are you in remission?” So I wrote the doctor “I told her about our discussion in which you pointed out that there’s no test to confirm it’s gone. I figure I’m cancer free unless I show new symptoms. Would you agree? And does the term “in remission” apply?” He responded “All correct. There is no way to absolutely detect minute disease, but remission is a good term, and you are cancer free as far as we know.”

I have and continue to receive physical therapy twice a week to improve range of motion of the left arm. The extreme range forward and up and sideways and up are slightly impaired, but most daily activities are unaffected – golf included. Next Tuesday, I will begin a 12-week Fit for Life Wellness Program with my physical therapist at New Horizons Physical Therapy. It is designed to jump start a return to a healthier aerobic endurance and weight bearing exercise. You may have seen reports of a study in the news in the last couple of weeks that show that exercise is good for lymphedema patients. The extension of that hypothesis is that it is good prevention to maintain a healthy exercise plan. New motivation to get to work!

For the near term, I will be seeing my medical oncologist every 3 months. I asked what these checks would consist of. They’ll be asking about changes like shortness of breath, coughing, pain, nausea and vomiting, etc. I’m thinking if I have anything like those, which seem serious in themselves, I won’t be waiting for my periodic check!

Of course, I sort of missed all of the medical appointments (not!), so once finished with treatment, I got hot on some preventive maintenance that had been deferred — annual physical (for the parts not of interest to the oncology team) and a dental crown. Oh, joy. 😦 I have part 2 of the crown (the finale) on the 28th.

Recapping, I was diagnosed on 26 September 2008. Since then, I have had breast conservation surgery (lumpectomy) and sentinel node biopsy, re-excision and axillary node dissection, 4 doses of Adriamycin + Cytoxan (AC) and 4 of Taxol (T) over 3 1/2 months, and 34 radiation treatments over 7 weeks, and am now embarked on a long-term program of hormonal therapy. I think I got off light on side effects, given the long list of potential nasties.

I am feeling good now. I have my energy back (though still can take a mean nap and have a hard time dragging myself out of bed in the morning!). My hair is growing – maybe not quite an inch yet, but looking more like hair every day. So far, it seems very straight, which would be a change, but it may be that it’s simply not long enough to curl. I’ve been told that it is darker than it used to be and that I don’t have as much gray as I did before I lost it. I’ve put my wigs away. Brows and lashes seem back to normal. I have a couple of areas on my shoulder that seem mildly dry or papery in the wake of radiation, which I continue to treat with Aquafore. My nails are growing out and the chemo effects seem to be doing the same.

What have I changed? I’m working on the 3 areas that my radiation oncologist said were the ones in which I could make the most difference in probability of recurrence:

  • Exercise: I’m walking more. I’m going to be embarking on the Fit for Life Wellness Program.
  • Diet: I’m trying to work on diet – more fruits and vegetables, less animal protein, organic when I can (including eggs). I’ve got a lot of work to do on reducing sugar and white flour! 😦 I’ve added a mushroom supplement, as advised by a good friend who is “into” complimentary medicine and my radiation oncologist, to boost my immune system. I’ve cut back on alcohol (none is best, but I’m not there yet).
  • Stress reduction: Working on “doing something mindful every day.” Yoga. Meditation. Avoiding aggravating situations (like bad traffic). Getting away from my desk at lunch (more walking.)

Going to wrap this up and go have some fun! Going to see my cousins’ new house and new granddaughter. 🙂 And eat planked salmon. Yum!

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