The Next Leg of Treatment and Some Updates
Yesterday, I met with Dr. Omene to map out my treatment now that I've had the oophorectomy and am menopausal. She answered all of my questions and explained what I can expect moving forward.
I will begin taking Letrozole, an aromatase inhibitor, once daily as a pill. The enzyme aromatase is found all over the body in muscle, skin, and breast tissues, as well as in fat. Its job is to convert hormones known as androgens into estrogen. By blocking aromatase, my cancer, which loves estrogen (and progesterone), won't have fuel to feed new tumors.
Letrozole has a really good record of preventing recurrence, so, if I can tolerate it, that's the way I'm going to fight cancer recurrence for the next 7 years. Like every other drug, it has its share of side effects. Most commonly, these appear as menopausal symptoms.
I'm already experiencing those, especially hot flashing. A couple of days ago, I discovered that Dijon mustard brings on a hot flash. Rest assured, that will not stop me from using it.
Other common side effects include difficulty sleeping (have I mentioned my insomnia?), fatigue, nausea, loss of appetite, arthritis in the hands, rash, hair loss, depression, vaginal dryness/bleeding, high cholesterol, and osteoporosis.
To combat the last one, I'm taking calcium and vitamin D supplements. On Saturday morning, I will have a bone density scan to get a baseline early in treatment. I had one of these scans back in 2017, when I was having trouble with my back, and I know there's nothing to it. I'll be horizontal on a table for about 15 minutes as they run the X-ray machine over my body. A part of me wonders about all of this radiation I'm experiencing. Causes cancer, you know.
Before my next regular appointment with my endocrinologist, I'll get my cholesterol checked, as well as my thyroid numbers. We do that every 6 months anyway.
I did ask Dr. Omene what kinds of monitoring she'll be doing. Turns out, periodic blood tests are not the standard anymore. Oncologists found that they did not impact the patient's survival. Instead, she'll be looking for "signs and symptoms." Whether that's a indicative rash, other changes in the same breast, fluid in the lungs, profound headaches that just won't pass, or something else, as always, I'll be keeping a diary of exactly what I'm experiencing on a daily basis.
I will receive a bone density scan every 2 years, though, because once you start tinkering with estrogen, brittle bones can become a thing. In the beginning, I will see Dr. Omene every couple of months (2 to start). Then, it will be every 6 months, if all goes well. In the meantime, my other docs will do their monitoring.
Sad News
It's not really sad news; I'm just bit bummed about it. When I saw Dr. McManus (also yesterday), she said that she will be retiring in July. This visit, my 6-month follow-up, would be my last one with her.
She introduced me to Valerie Shander, my new nurse practitioner from here on out. She impressed me as being attentive and sharp, and asked all the questions you'd want your medical professional to ask (and in the right way). My new breast surgeon will be Dr. Lisa Hopkins, whom I haven't met yet.
Dr. McManus was dismayed to see that the burn inflammation, redness, and irritation in the inframammary fold have returned. There had been so much improvement since I started using tacrolimus. But, since late last week, there has been a gradual return of the radiation burn symptoms. It's disappointing and painful.
My hypothesis is that because I've been wearing compression garments to deal with the lymphedema, the skin in that area hasn't been getting the kind of airflow that it has enjoyed previously. In any case, it's inflamed and sensitive. I've resumed using the clobetasol ointment to deal with it. Most importantly, I'm off compression for a bit until it heals up, and the physical therapist needs to avoid the area.
The good news about the compression, though, is that it works. I dropped a full cup size of swelling, from DDD to DD. That's a big deal. Unfortunately, I have to find some kind of balance with compression and the burn area.
Dr. McManus had asked if I had been exercising. I do the post-surgical and lymphedema exercises every morning and night. I get out and walk daily, and have been gradually increasing my pace. I'm nearly at my regular walking rate, and will likely be there next week, all things being equal. I've also begun to try basic yoga stretches. Some I can do, some I can't yet. But, I'll keep at it, slowly.
Otherwise, I am still healing up from the oophorectomy. There is still some discomfort when I bend or move certain ways, but each day, I feel a bit more like myself. The crazy mood swings are gone, thankfully. The hot flashes are mostly unpredictable. Some days, I'm hot all the time. Today, not so much.
I have been having headaches most days, which sucks. Whether hormones, allergies, or weather, it's painful and annoying. Thankfully, they have been treatable.
Emotionally speaking, I'm feeling more like myself, but a much calmer me thanks to a lot of meditation. Recently, during my solo walks, I have been listening to inspiring guided meditations on an app called Insight Timer.
Even though there are the ongoing challenges of the burn resurgence and lymphedema, I feel as if I've emerged from a long haul of difficult days. Which is not to say that trying the new medication won't have it's own challenges, but I'm really hoping that they are manageable enough to stick with it for the 7-year treatment.
As always, I am grateful for all your support, love, kindness, funny jokes, silly comics, in-person visits, calls, texts, letters, adventure day company, shares of experience, prayers, and gifts.
Remember to get your screenings, folks. Early detection is key.
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