My visits with the oncologist are always somewhat depressing for me. Like, is there ever going to be an end to this?
Every time I go in I have to have my blood checked to see if my liver is holding up under the onslaught of the Femara (the estrogen blocking drug). And she always wants more tests – a bone scan, a lung x-ray, a colonoscopy. Will I ever be considered “cured” of cancer? All this looking is nerve-wracking. One of my computer clients says that they will look until they find something.
When my oncologist saw my reconstructed breast, she said “oh no, no, who did this to you? Why do they always insist on cleavage rather than softness? You must get this fixed!”
So … just when I think I’m getting to the end of this saga, it seems I’m still somewhere deep within it.
I still haven't started the antidepressant that she says will make me "feel better". I have yet to determine just what it is that I'm trying to make my way through here.
Showing posts with label oncology. Show all posts
Showing posts with label oncology. Show all posts
Thursday, April 10, 2008
Monday, March 10, 2008
surgery jitters and more drugs
The woman before me in exercise class this morning was tall and thin. She used the high step and kept up well with the instructor, so she was easy for me to follow as well. When I looked at her in the mirror, though, I noticed that she had very high (and large and round) breasts. She wore a low top, and at times her breasts looked like they were going to jump out!
My gosh. Why do women do this? And yet here I am, 2 days away from “doing it”! I called my plastic surgeon’s office this afternoon and spoke to Leah again. I won’t end up like this, will I? I mean, I’m almost 60 years old, and breasts like that would make me look like a freak. Leah assured me that Dr. L knew what I was expecting from the reconstruction surgery, and that I would not end up with such exaggerated breasts.
Last minute jitters, I guess. I am nervous about the surgery – more about the anesthesia than everything else, though.
I saw my oncologist today and complained to her about the femara. The hot flashes are so pronounced through the night that I don’t get a lot of sleep, and end up very tired most of the time. Along with my bones and joints aching more, I’m pretty cranky. She suggested an antidepressant – Effixor – says that it will relieve much of the night sweating and help me to sleep better.
I’ve never taken an anti-depressant before. Even though I have my moments of feeling “down”, I’ve never considered myself to be clinically depressed. And I’m hesitant to take yet another drug to cover the side effects of a drug.
Anyway, we’ll see. I’m going to get through this next surgery, with all the pain pills and antibiotics that go with it, before I consider taking another drug.
My gosh. Why do women do this? And yet here I am, 2 days away from “doing it”! I called my plastic surgeon’s office this afternoon and spoke to Leah again. I won’t end up like this, will I? I mean, I’m almost 60 years old, and breasts like that would make me look like a freak. Leah assured me that Dr. L knew what I was expecting from the reconstruction surgery, and that I would not end up with such exaggerated breasts.
Last minute jitters, I guess. I am nervous about the surgery – more about the anesthesia than everything else, though.
I saw my oncologist today and complained to her about the femara. The hot flashes are so pronounced through the night that I don’t get a lot of sleep, and end up very tired most of the time. Along with my bones and joints aching more, I’m pretty cranky. She suggested an antidepressant – Effixor – says that it will relieve much of the night sweating and help me to sleep better.
I’ve never taken an anti-depressant before. Even though I have my moments of feeling “down”, I’ve never considered myself to be clinically depressed. And I’m hesitant to take yet another drug to cover the side effects of a drug.
Anyway, we’ll see. I’m going to get through this next surgery, with all the pain pills and antibiotics that go with it, before I consider taking another drug.
Thursday, February 28, 2008
recurring cancer
I have been thinking about cancer lately.
Over Xmas, my sister’s brother in law was complaining of a cough, night sweats. They discovered cancer – in his lungs, his bones, his lymph nodes. They don’t know where the primary cancer began, just that over the last few years it had metastasized everywhere without his knowing. He’s undergoing chemotherapy now, but they don’t expect him to live more than 6 months. Verne has always been healthy, he ate right, his father is still alive and 95 years old.
When I was discovering my breast cancer, another friend of my sister was discovering hers. We were both on the same page – 2 cancers in one breast, so a mastectomy was required. She underwent reconstruction during her mastectomy a week before mine; they took tissue from her tummy to make a breast. Her surgery lasted 7 ½ hours. I had an expander put in. Though my initial mastectomy surgery and recovery was easier, I’m now facing another 3 ½ hour surgery next month (in less than 2 weeks, as a matter of fact).
Her cancer was HER2 positive but was not estrogen responsive. Mine was HER2 positive and estrogen responsive. She is undergoing chemotherapy now. I’m taking the estrogen blocker for 5 years.
The big fear is a recurrence of cancer. My cancer was small, only detectable by MRI – but it was invasive. The cancer cells could have gotten into my blood or lymphatic system and spread somewhere else in my body – my bones, my brain.
A recurrent cancer is much more problematic than another primary cancer. A primary cancer can be removed and then treated with chemotherapy. A recurrent cancer means that a cancer has ventured out of its site of origin, and there’s no telling where it will turn up next.
I guess I’ve sobered up some on this issue of cancer. I no longer feel so invincible. I take my Femara every day, even though I blame every ache and pain and sleepless night on it.
Over Xmas, my sister’s brother in law was complaining of a cough, night sweats. They discovered cancer – in his lungs, his bones, his lymph nodes. They don’t know where the primary cancer began, just that over the last few years it had metastasized everywhere without his knowing. He’s undergoing chemotherapy now, but they don’t expect him to live more than 6 months. Verne has always been healthy, he ate right, his father is still alive and 95 years old.
When I was discovering my breast cancer, another friend of my sister was discovering hers. We were both on the same page – 2 cancers in one breast, so a mastectomy was required. She underwent reconstruction during her mastectomy a week before mine; they took tissue from her tummy to make a breast. Her surgery lasted 7 ½ hours. I had an expander put in. Though my initial mastectomy surgery and recovery was easier, I’m now facing another 3 ½ hour surgery next month (in less than 2 weeks, as a matter of fact).
Her cancer was HER2 positive but was not estrogen responsive. Mine was HER2 positive and estrogen responsive. She is undergoing chemotherapy now. I’m taking the estrogen blocker for 5 years.
The big fear is a recurrence of cancer. My cancer was small, only detectable by MRI – but it was invasive. The cancer cells could have gotten into my blood or lymphatic system and spread somewhere else in my body – my bones, my brain.
A recurrent cancer is much more problematic than another primary cancer. A primary cancer can be removed and then treated with chemotherapy. A recurrent cancer means that a cancer has ventured out of its site of origin, and there’s no telling where it will turn up next.
I guess I’ve sobered up some on this issue of cancer. I no longer feel so invincible. I take my Femara every day, even though I blame every ache and pain and sleepless night on it.
Sunday, February 17, 2008
Femara
I suppose because I squeaked my way out of chemotherapy, I didn’t put up much of a fuss when Dr. Bertrand prescribed the Femara.
Femara is an estrogen blocking drug. The invasive cancer that was removed from my breast was 10% estrogen-responsive, which means that in the presence of estrogen, it grew faster. The theory now is that if there are any more of those cancer cells in my body, if there is no estrogen around, they will not grow or spread.
Since I am post-menopausal, most of the estrogen in my body comes from adrenal androgens rather than my ovaries. These androgens are converted into estrogen by an enzyme – the aromatose enzyme – and Femara works by blocking this enzyme.
My problem with all of this is that there must be a reason that my body continues to produce and need estrogen after menopause. Long term effects of blocking estrogen are not known. Of course, the Femara website touts the wonder of the drug with happy-looking women graphics. Just like they did when they prescribed Hormone replacements en masse for women 10 years ago - before they admitted that women who took the drug had increased chance for breast cancer.
But the doctors seem to think that my chance for a recurring cancer outweighs the risks of taking the drug. And they want me to take it for 5 years!
I’m on my 5th day.
The list of side effects is daunting. Hot flashes, sleeplessness, muscle aches, fluid retention, weight gain, fatigue, headache, dizziness, bone fractures, nausea, etc.
I try not to focus on the list because I’m susceptible to psychological suggestion side effects – if you tell me I could get it, I will. But I do feel tired, ach-y, and bloated. My throat is dry and sore. I think that I have bad breath. This is after a few weeks of feeling really good after the mastectomy.
I guess I am feeling a bit depressed of late.
John and I are trying to get away some before my reconstruction surgery on March 12th. We visited Eric in Fort Myers, and are going to Kiawah Island the last week of February. I am hoping that things work out so that we can get to the Southwest in April.
But I’m learning not to make too many plans, rather to be attentive and follow the cues of life as they are given. Something is unfolding. Trying too hard to impose my own agenda screws up the unfolding.
Femara is an estrogen blocking drug. The invasive cancer that was removed from my breast was 10% estrogen-responsive, which means that in the presence of estrogen, it grew faster. The theory now is that if there are any more of those cancer cells in my body, if there is no estrogen around, they will not grow or spread.
Since I am post-menopausal, most of the estrogen in my body comes from adrenal androgens rather than my ovaries. These androgens are converted into estrogen by an enzyme – the aromatose enzyme – and Femara works by blocking this enzyme.
My problem with all of this is that there must be a reason that my body continues to produce and need estrogen after menopause. Long term effects of blocking estrogen are not known. Of course, the Femara website touts the wonder of the drug with happy-looking women graphics. Just like they did when they prescribed Hormone replacements en masse for women 10 years ago - before they admitted that women who took the drug had increased chance for breast cancer.
But the doctors seem to think that my chance for a recurring cancer outweighs the risks of taking the drug. And they want me to take it for 5 years!
I’m on my 5th day.
The list of side effects is daunting. Hot flashes, sleeplessness, muscle aches, fluid retention, weight gain, fatigue, headache, dizziness, bone fractures, nausea, etc.
I try not to focus on the list because I’m susceptible to psychological suggestion side effects – if you tell me I could get it, I will. But I do feel tired, ach-y, and bloated. My throat is dry and sore. I think that I have bad breath. This is after a few weeks of feeling really good after the mastectomy.
I guess I am feeling a bit depressed of late.
John and I are trying to get away some before my reconstruction surgery on March 12th. We visited Eric in Fort Myers, and are going to Kiawah Island the last week of February. I am hoping that things work out so that we can get to the Southwest in April.
But I’m learning not to make too many plans, rather to be attentive and follow the cues of life as they are given. Something is unfolding. Trying too hard to impose my own agenda screws up the unfolding.
Friday, February 8, 2008
oncotype dx assay results
I passed the test! Or, at least I scored low enough that I was able to convince my oncologist that I could take my chances and forego chemotherapy.Dr. Bertrand is a tough doctor who aggressively fights cancers. She tends to want to err on the side of “over-treatment”. I am more inclined to trust the integrity of my body with as little drug interference as possible. Without a low score on this test, I would have had a difficult time arguing my case with Dr. B. I think that she must see a lot of people die from cancer.
The test basically says that my chance for a recurrence of the cancer within 10 years is 9%. Chemotherapy would lower that risk to 7%. 2% is not worth it, in my opinion.
She did prescribe an estrogen blocker, Femara. There are some side effects – hot flashes, muscle aches, fatigue, fluid retention … and the long-term safety has not been established. Gee. We’ll see how this goes.
I have tentatively scheduled my breast reconstruction surgery for March 12th, Dr. L’s first available surgical time.
And the good news is that after my appointment with Dr. Rimmer today, I will have no more medical appointments for at least 3 weeks! This is the first time since last October that I have not had 2 or 3 or more doctor things to do in a week.
Sunday, February 3, 2008
the health insurance dilemma and other worries
To add yet another wrinkle to this saga, last week my husband was laid off from his job. We got our health insurance through his company. Not only does this make me incredibly mad – John had worked for this company for 11 ½ years, was a dedicated and gifted engineer – it also makes me sad that the bottom line always takes precedence over lives in this country.
Anyway – I guess for the next 30 days we are covered, and after that we are assured by “cobra” that if we pay for it ourselves, we can continue the coverage for another 6 months. I am expecting that the cost will be more than $1000 per month. Gee. We’ve already lost John’s income, so I’m not sure exactly how we are going to manage. I don’t know what happens after 6 months.
Universal Healthcare sure would be nice.
On Thursday I should get the results of the Oncotype DX assay test and know whether or not I am high risk for cancer recurrence. Supposedly 50% of the women who are in my category - early stage cancer, estrogen responsive, and clean lymph nodes – are in the low risk range and do not need chemotherapy. Another 25% are in the high risk range, and the other 25 % are somewhere in the middle.
I guess this means that my odds are good. Last week Dr. Rimmer said that he "would be very surprised if I needed chemo." I keep remembering the day I saw the MRI of my cancer on a computer screen. It looked shiny and bright, like a small diamond.
Anyway – I guess for the next 30 days we are covered, and after that we are assured by “cobra” that if we pay for it ourselves, we can continue the coverage for another 6 months. I am expecting that the cost will be more than $1000 per month. Gee. We’ve already lost John’s income, so I’m not sure exactly how we are going to manage. I don’t know what happens after 6 months.
Universal Healthcare sure would be nice.
On Thursday I should get the results of the Oncotype DX assay test and know whether or not I am high risk for cancer recurrence. Supposedly 50% of the women who are in my category - early stage cancer, estrogen responsive, and clean lymph nodes – are in the low risk range and do not need chemotherapy. Another 25% are in the high risk range, and the other 25 % are somewhere in the middle.
I guess this means that my odds are good. Last week Dr. Rimmer said that he "would be very surprised if I needed chemo." I keep remembering the day I saw the MRI of my cancer on a computer screen. It looked shiny and bright, like a small diamond.
Friday, January 25, 2008
2nd thoughts on cancer
If indeed I do have this more serious form of cancer – this genetic predisposition toward producing a protein that feeds cancer cells – then I am not going to worry. I am not going to become mired in self-pity or even pious prayer.
Instead I am going to be me, to live, to rejoice in the gift that I bring to the world and life. I am going to receive and enjoy everything that is given to me.
And I’m not going to do things that I don’t want to do.
(It may be that I need to start planning that trip to the Clairvaux prison in France.)
Instead I am going to be me, to live, to rejoice in the gift that I bring to the world and life. I am going to receive and enjoy everything that is given to me.
And I’m not going to do things that I don’t want to do.
(It may be that I need to start planning that trip to the Clairvaux prison in France.)
Thursday, January 24, 2008
still in the woods
Just when I thought I was out of the woods, home free, exercising, getting my life back together …
The pathologies from my mastectomy looked pretty good to me. Small tumors, clean nodes, clear margins. Even Dr. Rimmer said that I had come out on the good side of the numbers, with a 9mm tumor which is 1 mm shy of the size at which they would recommend chemo.
It seems that there are other factors. Like HER2/neu.
HER2 is a protein that promotes the growth of cancer cells. One of every four breast cancers over-produce this protein, which means that the cancer is more aggressive. They think that breast cancers that test positive for HER2/neu are more likely to recur.
I had 2 primary cancers in the breast that was removed. Both were relatively small. The DCIS was more extensive (2.5 cm) but showed small places (1mm) where it was getting out of the duct and becoming invasive (micro-invasion). Both cancer sites tested positive for HER2. The invasive site was less positive (rated 2.something), the DCIS site was more positive (rated 9 something). I don’t have a copy of the report.
If it were not for the HER2 distinction of my cancers, I would definitely not benefit from chemotherapy. As it stands now, it’s unclear whether or not I should be given the drug, Herceptin, which, according to Dr. Bertand, my oncologist, is given with (or as) chemo-therapy. (I still don’t really understand cytotoxic therapy, I’ve been avoiding the topic).
But there is this test - the Oncotype DX assay. It can predict the likelihood of breast cancer recurrence in women with newly diagnosed, early stage invasive breast cancer. That’s me. Oncotype DX also assesses the benefit from chemotherapy.
The test is also very expensive. Like thousands of dollars. Evidently it analyzes the genetic makeup of the cells. Dr. Bertrand says that the results are a good guide to whether or not chemotherapy should be prescribed for people like me. She says that it will help us to decide.
I’m not sure if my insurance will cover it. I have told Dr. Bertrand that if my insurance does not cover it, I am not inclined to pay for it myself. I would rather take my chances and NOT have chemo.
Somehow, I still don’t feel like I have cancer! I feel more like a number on a chart. Maybe all of this radical treatment (mastectomy, chemotherapy) would be easier if I had BIG cancer tumors, or if my lymph nodes were infected with cancer cells and I knew I was in trouble.
Anyway, we’ll see. The test takes 10 days. Dr. Bertrand is going to order it. I have another appointment with her in 2 weeks.
The pathologies from my mastectomy looked pretty good to me. Small tumors, clean nodes, clear margins. Even Dr. Rimmer said that I had come out on the good side of the numbers, with a 9mm tumor which is 1 mm shy of the size at which they would recommend chemo.
It seems that there are other factors. Like HER2/neu.
HER2 is a protein that promotes the growth of cancer cells. One of every four breast cancers over-produce this protein, which means that the cancer is more aggressive. They think that breast cancers that test positive for HER2/neu are more likely to recur.
I had 2 primary cancers in the breast that was removed. Both were relatively small. The DCIS was more extensive (2.5 cm) but showed small places (1mm) where it was getting out of the duct and becoming invasive (micro-invasion). Both cancer sites tested positive for HER2. The invasive site was less positive (rated 2.something), the DCIS site was more positive (rated 9 something). I don’t have a copy of the report.
If it were not for the HER2 distinction of my cancers, I would definitely not benefit from chemotherapy. As it stands now, it’s unclear whether or not I should be given the drug, Herceptin, which, according to Dr. Bertand, my oncologist, is given with (or as) chemo-therapy. (I still don’t really understand cytotoxic therapy, I’ve been avoiding the topic).
But there is this test - the Oncotype DX assay. It can predict the likelihood of breast cancer recurrence in women with newly diagnosed, early stage invasive breast cancer. That’s me. Oncotype DX also assesses the benefit from chemotherapy.
The test is also very expensive. Like thousands of dollars. Evidently it analyzes the genetic makeup of the cells. Dr. Bertrand says that the results are a good guide to whether or not chemotherapy should be prescribed for people like me. She says that it will help us to decide.
I’m not sure if my insurance will cover it. I have told Dr. Bertrand that if my insurance does not cover it, I am not inclined to pay for it myself. I would rather take my chances and NOT have chemo.
Somehow, I still don’t feel like I have cancer! I feel more like a number on a chart. Maybe all of this radical treatment (mastectomy, chemotherapy) would be easier if I had BIG cancer tumors, or if my lymph nodes were infected with cancer cells and I knew I was in trouble.
Anyway, we’ll see. The test takes 10 days. Dr. Bertrand is going to order it. I have another appointment with her in 2 weeks.
Sunday, January 13, 2008
oncology
I am dragging my feet on going to see the oncologist. My pathology report came back looking pretty good – clean nodes, clean margins, small tumor. According to Dr. Rimmer, the tumor was 1 mm shy of warranting chemo.
So, I’m assuming that I’m relatively safe, as far as cancer goes. And that I am very lucky. I even feel out of place at the breast cancer support group where most all of the women have had to go through chemo. My own cosmetic concerns seem trivial.
One of the reasons I’m dragging my feet is because I want to heal from the surgery. Everything happened so fast before the surgery, and now I like having the freedom to do things on my own time. The other is that I know that she will want to put me on an estrogen-blocking drug, and I don’t like that idea.
But I know that I need to at least argue my case with her.
So, I’m assuming that I’m relatively safe, as far as cancer goes. And that I am very lucky. I even feel out of place at the breast cancer support group where most all of the women have had to go through chemo. My own cosmetic concerns seem trivial.
One of the reasons I’m dragging my feet is because I want to heal from the surgery. Everything happened so fast before the surgery, and now I like having the freedom to do things on my own time. The other is that I know that she will want to put me on an estrogen-blocking drug, and I don’t like that idea.
But I know that I need to at least argue my case with her.
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