Switching Gears
You may have noticed that issues 5 and 6 have not been made public. This is purposeful. Here is the latest issue.
Yesterday, after an hour + wait for Dr. Omene at the Rutgers Cancer Institute, I met with my medical oncologist and her nurse Trish (before and after Dr. Omene) for over an hour. We discussed at length the now three medications that will be on my horizon for some time: Tamoxifen, Zoladex, and Zometa. I had many questions, which Dr. Omene and Trish took the time to answer.
The amount of information I wrote down and received in print outs, as well as the papers Dr. Omene cited (thanks to Mom and Dave for their searches) is sizeable. I've been a bit overwhelmed by all of it and the implications of what I'm about to put my body through. On the other side of the coin, as you'll read later, there is good reason to go to such lengths. So, I've been making sense of it in pieces.
First, I will be taking a 20-mg pill of Tamoxifen daily for 7 years as an estrogen blocker. It's been given for decades to women like me whose cancer is positive for estrogen receptors. The tamoxifen binds to estrogen receptors, preventing cancer cells from connecting to them to feed.
While it's long been used to prevent a secondary breast cancer or recurrence in the same breast, it comes with a host of side effects, although some are stronger than others. Most are consistent with menopause, such as hot flashes; night sweats; irregular bleeding; and vaginal discharge, dryness, and itching. Tamoxifen also has a history of causing uterine cancer, strokes, cataracts, and blood clots in some patients.
Once a month for approximately 2 years, I will be given Zoladex in a separate treatment area at the Cancer Institute by an oncology nurse. The goal of Zoladex is to suppress my ovaries and send me into menopause. The shot is actually a small, 3.6-mg pellet that's injected just under the skin in my abdomen. Then, it will spend the next 28 days dispersing, then suppressing my ovaries.
I've been told to expect intense menopausal symptoms for the first few months until my body evens out. In addition to the ones listed above for Tamoxifen, there may be a loss of libido, leg cramps, headaches, mood swings, and other side effects. After 2 months, Dr. Omene will test my blood for lutenizing hormone and follicle-stimulating hormone to see the effectiveness of the ovarian suppression. Within 4 months of taking this treatment, menopause should be achieved.
Separately, I'll be contacting my primary care doc, to whom I've been asking all the oncology folks to send my records. Dr. Omene said that they don't do the kind of surveillance that I'd like (instead watching for signs and symptoms), but recommended I call my GP for annual physicals and a full blood panel to watch for abnormal levels.
Speaking of testing, Dr. Omene put in an order to test me for BRCA mutations. I haven't been tested for them previously because I am the first in my family to have breast cancer. This testing will be done remotely. I'll have a phone or zoom conversation with the Rutgers Cancer Institute's Genetics Department to get a full background interview. They, in turn, will mail me a saliva test to return to them, similar to the popular DNA kits. If it turns out that I am positive, I'll discontinue the Zoladex and have my ovaries removed.
Moving on to drug #3. After I'm menopausal, every three months for 2 years I will receive a 4-mg IV infusion of Zometa. It's a completely different kind of drug, a biophosphate that targets osteoclasts, and is typically given to patients with osteoporosis to strengthen bones. It's been shown to reduce breast cancer spreading to the bones when used as a treatment in women with my prognostic indicators. More importantly, there is evidence that it cuts the recurrence rate significantly in post-menopausal women. So, getting the Zoladex to do its magic first is key.
The side effects with Zometa suck. There's also a lot of blood monitoring and examining kidney function. I'll feel highly crappy for a few days after the infusion -- flu-like symptoms, aches and bone pain, headaches, etc. The scariest side effect is osteonecrosis of the jaw. I'm someone who has had a LOT of dental work, including a cyst removed from my jaw, so it has me a bit worried. I have a call in to Dr. Omene's nurse to ask some questions and let them know about my extensive dental surgery history.
In case you're interested in learning more about the meta-analyses of Zometa trials that Dr. Omene based her treatment plan on, here's the link: https://pubmed.ncbi.nlm.nih.gov/26211824/.
It's all a bit much at the moment, but as with everything else in this journey, I'll keep on going and writing about it.
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