As some of you know, Greg and I recently returned from spending some time in Chattanooga TN. It was great! Hi Chattanooga, you guys are great! After all the events of the last year and a half, we really needed a little while away, and it was really fun. Among other things, for me, it was a much needed respite from constant contact with the medical world.
Although my active treatment slowed when I finished chemo (3-31-10), and was limited to one huge surgery and a couple smaller ones over the summer and fall, even in the in between times I was still spending a lot of time at the doctor. Part of this is because I'm lucky enough to go to an amazing oncologist's practice where I also see a nutritionist and an acupuncturist- hi Deb! Bay Area, go to Deb Follingstad for acupuncture of ALL kinds, not just for cancer patients! - but, anyway, the result was that I was still going there 1-2 times a week, on top of going to the free clinic to get herbs, the hospital for surgery related appts, and many other similar things. Additionally, my doctor and I had still been working on stabilizing my estrogen levels right up until I left (more on that soon). So finally getting to a stable place where I had a set routine, medically, and could just live for a while- it was a really nice break.
I knew that when I came back I would need to get back into treatment a bit, but I had hoped I could mostly coast for quite a while longer and continue the illusion of being somewhat past this that I was able to foster in Tennessee, but apparently it is a little premature yet for that. Warning! -here comes the medical details section!
As a patient with a hormonally driven cancer, it is important to limit the amount of estrogen and progesterone in my body, as the cancer feeds on them. While it's true that the original tumor has been removed, any person with an invasive tumor already has circulating cancer cells sent out as sort of scouts for colonization. These are all throughout my body and cannot be removed. The idea of systemic therapies such as chemo is to kill so many of these cells that the survivors are too few to regroup and take hold anywhere in my body. Like colonizers they are insidious and must have their power taken away before they can do any damage to the native populations!! (In this scenario, my healthy liver or bone marrow or lung tissue cells, for example). Ahem. Right. Medical. Although --may I just sidebar for a moment here?-- may I add that political metaphors in the cancer treatment world are not just common but indeed the RULE and sometimes they are really intense and creepy!! I would love to look into how they change to reflect the political climates and times someday...
Anywho- should they take hold and grow, I would develop a tumor, which would be a beast cancer tumor, wherever in the body it was located, and thus a metastasis of the original cancer, not a new cancer. This is important both because different cancers have different qualities and treatments, and because a metastasis would mean that treatment had failed and I would not be able to be cured- only treated to extend my life. SOOOO- it's
really important to keep these cells DOWN!!
I do a lot to achieve this in my life- I have a pretty rigorous program of diet, exercise, herbs and supplements which I adhere to strictly. It's hard and expensive. But the biggest tool we have for this is estrogen limiting. There are new drugs which do this incredibly effectively and are saving a lot of lives- enough that I imagine over the next few decades we'll see mortality statistics drop for Breast Cancer from 1 in 4 to something lower, from this advance alone. The problem is, they may work too well for some of us. The idea is to get my estrogen very low, but
not non-existent, because it's a really necessary part of our systems and we need it to live! When I started on the drugs (AIs) last summer, it didn't go well. Even before I got to the point where the physical side effects started kicking in, I began to lose my mind, sort of literally. I became severely anxious, distraught and depressed. I was experiencing bouts of hysterical, I-feel-like-the-world-is-ending tears every day, dealing with uncontrollable inappropriate attacks of anger, and having suicidal thoughts for the first time in my life. It was, obviously, unsustainable. The problem was that the drugs were scouring out too much of my estrogen- discussion about how hormones control what we think of as our "selves" and preferences sometime? fascinating stuff!- despite the fact that by the time I went off them I was taking only a quarter pill every other day. However, hallelujah, I was able to put together a plan of nothing but holistic remedies which kept my estrogen low enough without side effects! Hooray! All was well...
Until just now when I got home and it turns out it stopped working. My levels are up and rising. My options are to do nothing and hope it's ok, that my good response to chemo killed enough cells that the remainder won't be able to take hold even with an estrogen smorgasbord, or to go back on the pills. I can take less and less of the pills, but little is known, as yet, about how they work. So, for example, is it better to take one a week and potentially experience ups and downs in my levels each week (including possibly dangerous spikes, constantly) or to maintain an even level, though it may be higher?
For now I'm going back on the pill, a half every 4 days, but there's no real reason to think it will be better. Which leaves me with some hard choices ahead. I'm not looking forward to this.
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The other tool I have at my disposal is a drug called Zometa. It is a chemo treatment which has long been in use for treatment of osteopenia (weak bones) and cancer which has metastasized into the bones (the most common site of BC mets), but in recent years studies have shown it to be effective in reducing recurrences in BC patients with my general disease profile (the most common form) and personal stats. The trials that would have tipped it over the edge into general use completed earlier this year- but it didn't show effectiveness in a wider setting. Meaning the drug company pulled FDA application, meaning insurance won't pay for it unless I get mets- IE, too late! It looks good for me. My doctor wants me to get it. I want it. But costs $1500.00 per treatment- I could do once a year, but if I'm not going to be on the AIs I really want to do it twice a year (for 5 years). But I don't even have enough $ to do once a year for 5 years, so that's a problem! I'm getting it once for sure, next week, and I'm just going to pay for it. But after that.... this is a truly wretched situation. If anyone has or knows someone who actually really has a lot of money and would sponsor me for an entire treatment, or part of one? That would be a real relief. Other than that, I don't have a lot of ideas. I've been putting this off and hoping the problem will somehow solve itself, for a long time now, and it just doesn't seem to be happening. I prefer not to think about it because it seems there just isn't much to be done but this, too, is becoming an unavoidable problem over the next year or so.
(note on the financial aspect- that price is wholesale, my doctor is already not charging me the normal price, and patient co-pay assistance orgs won't help because they only help with things covered by insurance. I have been trying every avenue for a year- I should've started this at least 12 months ago, that's why I haven't)
Anyway. That's what's happening. So I have to say, I feel stressed being back home. I definitely feel right back in the middle of it, which is sad. But maybe it was too soon. There's no question that I was anxious to put treatment behind me (who wouldn't be!) and maybe I tried to rush it a bit. So if you see me and I don't seem so so happy to be home... well I am in some ways. But it's a little hard too. It was nice to pretend I was someone else for a bit. And someday I will be that person again. But for now, I have a little more of this to endure. Happily, I am enduring it in a place where there are many people, places and things that brighten my days and enjoying my favorite time of year here in San Francisco, with the mist and drizzle and the sun and the mild days. I could live without the wind, but like most things, it won't last long.