After a bilateral mastectomy removed the cancerous tumors and precancerous tissue. After four cycles of chemotherapy and bone marrow infusions to kill any other remaining cancerous cells and to kick start menopause. To improve my chances staying in remission, I need to subject my body to hormone suppression and hormone blockers. A couple weeks ago, my eyes had some flaring. In conjunction with increasingly blurry vision and extremely deprecated night vision, I felt it necessary to talk to my oncologist. She sent me to my ophthalmologist right away. Not only did my prescription change, I have cataracts and extremely dry eyes. This is my first tangible chemo scar since the hair loss. This also forced my oncologist to change direction with hormone treatment.
These past few months of no treatment have been intense. I’m grateful for having the physical break so my mind and heart could start catching up. I am painstakingly processing a tremendous amount of information at every angle in life. It’s a lot. There are days I am hanging by a thread. Yet, I don’t cry. My brain feels like someone opened the window and the table full of my handwritten manuscript, blew everywhere. I’m sitting at the table and staring at my entire life in total disorder.
When I first met her, my oncologist had an entire treatment plan. She respectfully and politely explained the common course of treatment for my markers. The courses of action were explained, and the physical side effects described. After our first meeting, I knew endocrine therapy would be the last stop, five years from now.
I have carefully done my homework. I've spent a lot of time reading medical journals, dictionaries, and medical textbooks. Anytime it got too heavy or scary, I stopped. I tried to relax and not stress about the pending treatment, but all the while in the back of my mind was this giant elephant.
When I was 18, I went on the trendy birth control shot, Depo Provera. I was on that regimen for a year. The sweet spot for long-term side effects. The only reason I ended use was because it turned out I was allergic to it. The reaction I had could have potentially killed me. I refused to take any kind of birth control after that.
When I was 24, I was diagnosed with PCOS. This was my first introduction to endocrine treatments. I was prescribed a series of Clomid to help with trying to get pregnant. It didn't work. I gained 20 pounds, had chronic migraines, dealt with some depression, and a few other minor irritations. I wasn't on it long enough to really see major impacts, but it was enough to entertain for the situation. Through natural methods, I was able to have three more children.
Not long after I had Ben, we had to medically manipulate my hormones again. This time because I had an influx of ovarian cysts populate in my uterus. Over the course of the year after he was born, I didn't have an active and intense period for about two months. Ten months of a period. The doctor wanted to put me on birth control to help regulate. We had a significant debate.
Through compromise, I agreed to entertain an IUD with a low dose of progesterone. We elected to use Mirena. Vainly, I was vehemently against the mere idea of gaining weight. Dealing with the side effects from the Mirena were weighed against the side effects of my cyst filled uterus. He asked me to give him 6 weeks with the IUD to evaluate. We scheduled the IUD placement and the follow-up visit. Six weeks later, we were taking it out. I gained 15 pounds and there was no change.
Ultimately, I opted for a non-surgical procedure to take care of the problem. I didn't want to undergo any type of hysterectomy, so the uterine ablation made the most sense. The ablation would give me relief from the cysts for at least 5 years (there's a theme with that timeframe). If the situation returned, I would be faced with the decision for partial hysterectomy. Today, I still have my uterus!
Needless to say, I don't have a strong track record with hormone manipulation. When breast cancer showed up and pathology indicated my breast cancer loves hormones, the irony was not lost on me. To keep the cancer from growing again, the treatment plan calls for killing estrogen and progesterone production in my body. With my body's history of not playing nice with endocrine therapy, I am extremely uncomfortable.
If you aren't familiar with the way your hormones impact your day to day, I strongly encourage you to get that way. Not only does estrogen get produced in your ovaries (ladies), but it is also created in your adrenal glands and fat! My ignorance thought it was all coming from one spot! While the chemo did the job of starting menopause, the hormone suppression/blockers will take care of the rest of the localities. It's said that menopause takes five years. The plan is to block hormones and suppress hormones for that duration.
Side effects of doing this are:
Nausea, bone loss, headaches, weight gain/loss, mood swings, hot flashes, brain fog, sleep disruption, joint pain, cramping, brain function, cataracts, eye damage, skin changes, loss of libido, dry everything, blah, blah, blah, blah.
By the time I was sitting in front of my oncologist again, I had a lot of opinions and questions. We discussed my cataracts, and she identified that one of the drugs she planned on using would exacerbate that condition. Thus, she scheduled the Lupron (hormone suppressant) injection. The Lupron has more severe long-term impacts. Bone density loss, heart issues, severe depression, and metabolic syndrome. We talked about those. I expressed heavily the dependency I have on brain function and if doing this treatment plan would deprecate that, we would need to talk about other options. This led us to discuss the compromise.
I asked how quickly I would start to see/feel side effects after I started the injection. Since I would know how it would make me feel within a couple of weeks, that would give me enough time to decide continuing the therapy or not. The length of time I would need to take the daily pill would still be the five years. Depending on what my levels looks like in my bloodwork, I could potentially not need the hormone suppression. Before surgery and chemotherapy, I was already premenopausal. I left that appointment with an injection date scheduled and the oral medication ordered.
Lab results came back AFTER I got my first hormone suppression injection and indicate that I am in fact POST MENOPAUSE! The oncologist called me last night and let me know that I won't need to keep doing the injections. She's going to have me do one, possibly two more injections and then I'll start the daily medication on the first of January.
At this point, everything I’m doing is to add as many years as possible to my life without fighting cancer again. The trade I have had to make is shitty. Doing the endocrine therapy will improve my time without cancer by about 15%. I’m following their direction to achieve the same goals! I’m now in the next phase of seeing how I tolerate things. It’s my hope that this will be minimally impactful. The pile of daily symptoms I’m now accepting as part of my new normal will evolve and I’m coming to terms with it.
I am so happy that the Lupron is going to be short-lived. That one had me the most distressed. Fingers are crossed tightly that the side effects from the daily pill aren’t too much to handle. But in all honesty, I am intimidated by the way this body is going to feel without estrogen. Learning the role estrogen plays has only increased my sadness and trepidation. The grieving continues. The acceptance continues.
The table has the pages of my life all over it and out of order. The story is still there. I’m putting it all back together, but the plot has shifted. The days will keep challenging me and forcing me to figure things out. I will. I always do. The next few months will give me new information to introduce to the chaos! I need a vacation.