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Back to the Drawing Board

Today marks the start of a new school year for many of us.  We all remember what that first day is like; the anticipation, counting of school supplies, ransacking of wardrobes to select that perfect outfit, reuniting with old classmates, and the excitement of new friends, new teachers and new routines.  Growing up I loved school, and in my twenties I worked teaching English abroad, so I have a soft spot for this time of year.

It was fitting that I update you today as I too am about to embark on a new chapter and new phase of treatment right after my kids head to school.

Let me just get it out there - so far so good, I am still cancer-free.  I've had a couple of CT scans over the past few months and nothing to report.  But as I've come to realize over the past six months, you don't get the all-clear until the 5-year mark, but more importantly, that 5-year mark is rather arbitrary as recurrence can occur beyond 5 years.  The risk just becomes less and less as time goes on.  I'm approaching 2.5 years since diagnosis and like to think my glass is half full.

Up until now, my endocrine treatment, Tamoxifen, has focused on blocking estrogen from binding to my cells. Estrogen, along with progesterone, are the rebel hormone duo which triggered my tumour's growth.  Tamoxifen has been used for years and is regarded as the first-line of defence for hormone-sensitive breast cancers such as mine in pre-menopausal women.  

The problem is, Tamoxifen can have many unpleasant side effects.  I had been warned, but was adamant that I would carry out the full 5-year recommended course.  But I am a year and a half in and am throwing in the towel. Aside from the extreme fatigue which may or many not be solely attributable to the medication, it paralyzes me every morning by stiffening my back and neck muscles to the point that I feel like an 80-year-old.  It also knocks me out (so I sleep really well) but keeps me in an almost comatose state each morning.  I average about 45 minutes to an hour from waking to getting out of bed.  Doesn't jive well when the young ones are at their peak of energy first thing in the morning!  I know it is the medication as I had a trial break from Tamoxifen (under the advice of my oncologist) and the symptoms disappeared in mere days.  Then returned when I started up again. So what are my alternatives?

There exists another class of drugs called Aromatase Inhibitors (AIs) which have recently been proven via the SOFT and TEXT clinical trials to be slightly more effective at preventing recurrence than Tamoxifen when combined with ovarian suppression/ablation.  AIs to date have been given to post-menopausal women only as you cannot take them if your ovaries are still active.  So in order for me to switch to this class of medication, I must shut down my ovaries, either chemically (with monthly injections of Zoladex) or by having an oophorectomy (ovary removal). The injections are painful, ridiculously expensive, have their own set of side effects, and more importantly, are only a temporary treatment - I would still eventually need to have an oophorectomy.  The oophorectomy is permanent, so there is no going back, no having more children, and will induce instant menopause. 

After much research and discussion with my oncologists I have decided to proceed with the surgery.  We all agreed that targeting the source of estrogen production would be my best chance at preventing recurrence.  Post-surgery I can then try an AI (there are a couple of different ones) to see which offers the least side effects.

I knew all along that there was a potential need for this surgery, and to be honest, I had inquired about it two years ago and was told to wait until after I had had a trial run on Tamoxifen.  I'm not really sure why, it is something I plan to raise at my next follow up, but I understand that early (permanent) menopause in women my age may come with its own host of long-term health issues, so perhaps that could explain the desire to delay it as long as possible.  Although I would have preferred to have all of the surgeries done in succession (particularly as I am now gearing up for a transition back to work), I do feel fortunate that I have had the past year to focus on recovery without any other procedures.

Well, my surgery is later today.  I lucked out and don't have to be at the hospital until mid-morning so I can accompany both of my school-age kids to find their teachers and classrooms before I head out.  Thank goodness for small miracles!

For you science geeks (really, most of my friends), I am having a laparoscopic bilateral salpingo-oophorectomy. Man I wish that had a cool acronym.  I am having both my ovaries and fallopian tubes removed, and it is a day surgery so I expect to be home tomorrow evening.  Wow, laparoscopic=camera.  Given my love of photography, I am so incredibly fascinated that the surgeon will be using a camera to guide the surgery!  It is terribly fitting, is it not?  Picture-perfect, actually.  I wonder if she'll save me some screen shots if I tip her?  Hope she doesn't think negatively of me for asking.  I shutter to think what she'll say if that's the case.

So I must rest before the big day begins, but I wish you all good luck with your back-to-school munchkins, your returns-to-work and fresh starts in a new direction. I will post a more pun-filled and less medically-heavy update post-surgery.  

I'll leave you with a three-item blessings report.  It sums up my decision to change my treatment, but really, I could apply them to every aspect of my life.

Blessings Report:

Recognizing when something isn't working
Seeking out alternatives
Having the courage to try them in the absence of guarantees  

Hugs to you all!

2014 Canadian Breast Cancer Foundation CIBC Run for the Cure
Sunday, October 5th, 2014
Team Keeping Abreast of Ellen


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