Archive for January, 2008

27
Jan
08

January 27, 2008

Last week was my second week of being back to work in the office. I’m up to 32 hours per week already, and still feeling pretty tired at the end of the day; but as long as I get to bed early enough, I seem to have enough energy to get me through the day. I have been spending this weekend recuperating, preparing for next week. I do have to go grocery shopping today, but I’m more worried about road conditions than my energy level at this point.

After last week’s supercold weather (well, for Portland, anyway), we’re still having cold weather, but now it’s raining instead of clear. That means that we’ve got icy roads to contend with. Unfortunately, because I wasn’t driving last fall, I didn’t buy studded tires for my Mini. Hopefully it’ll be far enough above freezing when I go out this afternoon that the well-traveled roads won’t still be icy.

I haven’t heard back from the surgery scheduler yet, so still don’t have a date for my next surgery. I would like to think they would have called me if there were some problem with scheduling it for the 29th of February as we discussed, but based on the previous failure to get started in a timely manner, I don’t hold a lot of hope for that. I will call on Monday to see what I can find out, and if necessary light a fire, as it were.

It’s weird to think that after the surgery I will wake up in menopause. How long does it take one’s body to realize that it’s not producing estrogen any more, and start reacting? The normal process typically approaches menopause slowly and women start to have symptoms a little at a time (of course, everyone is different, but presumably the average is accrual of symptoms over time). From a little bit of web research, it sounds as if the symptoms hit quickly and harder than they do when going through natural menopause. I can hardly wait. . .

It has been four weeks as of Friday since my last chemo session, and I think I’m finally starting to see (well, at this point, it’s not visible, so “feel” is probably a more appropriate verb) some hair growing on my scalp. Lucky me, I get to go through the Velcro stage again! I’ve been wearing hats and scarves constantly, unlike earlier in the process when it was warm enough to go bare-headed. Even the wig is not warm enough, at least not when I’m outdoors. The inside of the wig is a sort of netted mesh, which is no doubt pleasant enough during the warm weather, and keeps one from sweating underneath it; but in the cold, it just feels like it’s got a draft.

As I’ve waded through this breast cancer journey, with little stops at the roadside attractions of pulmonary embolism and emotional rollercoaster, I’ve come to realize that I really have a strong desire and will to live. Unfortunately, I haven’t taken very good care of my body the last 10 years or so. I used to be a lot more active, and kept my weight down without trying very hard. My current weight and activity level leaves me open to all sorts of dread diseases, such as diabetes, blood clots, heart disease, and cancer, just to name the most common ones. While I was going through chemotherapy, the doctor was insistent that chemo is not to be used as a weight-loss program (this wasn’t likely to be a problem with me, since the whole idea of bulimia as a way of controlling weight grosses me out). At my last chemo session, I asked the doctor when I could start losing weight – after warning me off of “weird diets”, he said “two weeks after the last chemo”. So I joined Weight Watchers two weeks ago. So far, I haven’t seen a lot of downwards action on the scale, but following the plan is a lot easier than it was previously (I had been on Weight Watchers in the late ’90s, and although I lost some weight, sticking to the plan was difficult, mostly because of attitude on my part). Perhaps because of the fear of mortality hitting me, my motivation is very high at this point.

My bigger struggle now is becoming more active. Most of my pleasures are sedentary – reading, knitting, beading, quilting, gaming. I’m not your typical couch potato, in that I don’t watch TV (we pretty much only watch DVDs, and that only occasionally – we canceled the cable service at the end of December because once I could focus on reading again after the surgery, I never turned the TV on). Instead, I’m a “craft potato”. My physical therapy is helping, but I have to force myself to make time at home to do my stretches and exercises. Taking the dog for walks is usually easier to do, although the recent cold and icy weather has made it both less appealing and more dangerous (for humans, at least – between having four legs and natural traction from his toenails, Robin does pretty well on slick pavement). Last week, we took him over to the training arena and started working him on the agility equipment again – Brian is working for a client today, and I can’t manage the equipment on my own, or I would take him today, also. If the pavement isn’t too icy this afternoon, I’m going to take him for a walk.

So life for now is getting back into a routine – approaching normal, I would say. Normal is good.

22
Jan
08

January 22, 2008

Last week was my first week back to work part-time after the chemo (in the office – I’ve been working from home some since mid-December) – it went well, although I don’t have a lot of stamina back yet.  Just the extra focus required for driving in and home again after work made me very tired.  However, this kind of tired was a much more natural tired than that engendered by the chemo – plus, although I’m still having problems coming up with a word now and then, the brain-fog has lifted, and I can concentrate again.   By the end of the week, I definitely felt that I wasn’t as tired after work as I had been at the beginning of the week.

I started back in physical therapy on Monday this week.  I’m hoping that by the time my next surgery rolls around that I’ll be somewhere near the same condition I was in prior to the mastectomy.  All in all, I think that the physical therapy prior to that surgery made a major difference in how well I recovered, and how well I tolerated the chemotherapy.  My record for following through on exercising every day is suffering, however.  Right now, I’m avoiding taking the dog out into the incredibly cold weather by blogging.  I know he’ll forgive me, although his sad eyes may haunt me for the rest of my life . . .

I don’t have a date yet for the combined ovary/implant surgery.  I called the doctor’s office today, and it turned out that the doctor hadn’t yet put in the scheduling request.  The day we had the consultation was the day their office was packing to move to a new building, so everything was rather chaotic.  As it turns out, all the information was in my file, it just hadn’t made it from there to the surgery scheduler.  I got the ball rolling today, so hopefully I should have a firm date within the next few days.  We’re targeting the 29th of February (then I don’t have to face yet another painful anniversary except once every four years!), although it will depend on if the pole position (i.e., the first surgery of the morning) is available.  I actually didn’t catch why that made a difference, but I think it had something to do with the fact that the laparoscopic robot-assist machine needed to be worked into the plan – apparently there’s only one of them.

I’m now in the “maintenance” phase of taking the blood thinner, and I have to go in every two weeks or so to have my INR (blood-clotting time) level checked.  Depending on where it falls, my dosage gets adjusted, and I have to rearrange my pill case.  It’s really kind of a pain in the patootie – but having another pulmonary embolism could be even worse – dead doesn’t really sound like much fun.

Not really much else to add at this point, except that I’m starting to feel my mood come up out of the dumps.  Certainly part of the problem was the chemo itself, as it depresses one’s body, which has an inevitable effect of depressing one’s emotions.  Now that I’m getting past the physical effects of the chemo and I’m starting to feel better, I know that is helping with my mood.  Being able to go into the office and be part of the group again also helps.  But I think a big part is that I’ve begun to accept that the ovarian surgery really is necessary – and besides, reading the statistics about pulmonary embolisms scared the bejeezus out of me, which made me realize that I really don’t want to take any additional risk of getting another one.  Mortality is a wonderful motivator!

Julie

12
Jan
08

January 12, 2008

Well, nuts to the theory that I’m handling all this so well!

I’ve been hibernating for the last two weeks, partly because this last chemo (December 28th) was the hardest of all – I mostly avoided the nausea, because the last round taught me that it’s best to do what the doctor says and take your anti-nausea drugs on time, even if you don’t feel you need them right then. But the mental fog was so bad that I could barely carry on a conversation in person, and talking to people on the phone was right out – trying to focus without seeing someone in person was a failed effort. Then there was the fatigue, which was so bad for a couple days that it was a struggle to force myself to get up and use the bathroom. Even as the fog lifted, the anemia symptoms (pounding heart, shortness of breath, even more fatigue) kept me from getting around much – climbing the stairs usually meant that whatever I’d come up for required a lie-down before I could do it. All the other effects just added to the general malaise, and bad attitude.

And having an end in sight just made me more impatient for the end to get here, rather than patiently waiting it out knowing that soon I’ll be starting to get back to normal.

The other reason for hibernating is that I was given unpleasant news at the last pre-chemo meeting: I need to have my ovaries taken out. End in sight? No, here, let’s just add another surgery and recovery period to the mix – surely this is just a little thing compared to having had cancer, so buck up, right?

The Top 3 Reasons for Having My Ovaries Removed:

3. Women who have had breast cancer have an increased risk of having ovarian cancer.

2. My family history of breast cancer predicts that I probably have an *additional* increased risk of getting ovarian cancer.

And the number one reason for having my ovaries removed:

1. Tamoxifen (used to treat pre-menopausal women after breast cancer) carries a risk of causing blood clots, and with my history of having had pulmonary embolisms in both lungs, I need to avoid any additional risk.

(Some PE statistics culled from the American Heart Association: Over 200,000 new cases of VTE occur annually. Of these, 30 percent die within 30 days, one-fifth suffer sudden death due to PE, and about 30 percent develop recurrent VTE within 10 years. Independent predictors for recurrence include increasing age, obesity, malignant neoplasm and extremity paresis. (Heir JA. Venous thromboembolism epidemiology. Semin Thromb Hemost. 2002;28(suppl 2):3-13.). VTE=venous thromboembolism, aka blood clot; PE=pulmonary embolism, aka lung blood clot. PE is a result of VTE, usually by deep vein thrombosis (DVT, aka leg blood clot) Ain’t the jargon fun? I had no idea I was such a walking time bomb…)

The aromatase inhibitors that are used to treat post-menopausal women don’t have this risk; and even though it is possible that chemotherapy could induce menopause, I haven’t shown any signs of it so far (I *knew* thinking of myself as having a 30 – 50% chance of *not* going into menopause would work ;-} ). Even if they tested me and my FSH showed that I was menopausal, it wouldn’t be official until a year had passed with that level of FSH, so they can’t treat me with aromatase inhibitors until that year has passed.

As you probably have gathered, I didn’t take this news well, and was firmly into denial about even having an increased risk of getting another type of cancer. I mean, they tell you up front what your chances are after treatment of recurrence or a new case of breast cancer. But then they don’t want to overwhelm you, so they wait until your last chemo to tell you that there’s this other bogeyman, sort of a sister to breast cancer, that is waiting in the wings to take over where the breast cancer left off. How many pieces of me do I have to remove to pacify the heathen spirits? It’s only *not* self-mutilation because I can’t get to my ovaries myself.

However, we met with the gynecological oncologist yesterday, and I was very impressed, and liked her a lot. As well as explaining about the likely cause of my pulmonary embolism (cancer patients tend to be hypercoagulative, meaning that one’s blood clots more easily and quickly than normal; and that it could have come from anywhere, not just my legs, even though that’s the normal route for PE’s to develop), she also made the whole process seem a lot more palatable. Particularly because this laparoscopic surgery can be combined with my final implant surgery, so that I only have to undergo one surgery, one general anesthesia, and one recovery period. Fortunately, the recovery period will end up being only as long as the longer of the two – typically laparoscopic surgery has a 2-4 week recovery, although most of the time people are functional within a week; for the implant surgery, there will again be a 2-week period where I cannot use my arms for much of anything, but after that, typically another two weeks (so a total of 4 weeks) should see me fully recovered. So either way, in theory I should be completely recovered in 4 weeks (unless there are complications, of course).

Interestingly, my attitude changed almost the moment she said the two surgeries could be combined. Obviously, that was a big part of my resistance; although I had mostly convinced myself that it was the right thing to do, so that must have played a part, also. The thing that really helped me change my mind is the fact that Tamoxifen causes menopause-like symptoms (hot flashes, etc.), although it doesn’t actually bring on menopause. Since I’m probably within 5-7 years of entering menopause anyway, there’s no point in going through 5 years of menopause-like symptoms, only to have a little break and then go through the real thing. Might as well get it over with now.

The plastic surgeon had told me already that the final implant surgery has to wait until two months after my last chemotherapy, to be sure that I am fully recovered from that. The ovary surgeon has said she can do it any time, although the most pressing reason to do it sooner rather than later is that we can’t delay the hormonal treatment indefinitely. So it will probably be late February or early March before I can have the surgery – I’m hoping to have it either on the 27th or 29th of February, so that my 4-week recovery period ending coincides with the end of March. That would mean that I got everything out of the way in the first quarter, and I can get on with life as normal.

What I really want to know is: when do I get a vacation? Having surgery and chemotherapy and surgery is definitely not my idea of a good time!

Julie

p.s. – the good news is that the lung clots have apparently dissolved, so now I just have to stay on the warfarin to prevent any new clots – they may increase the length of time I have to take it due to the next surgery, but at least I am currently clot free!

07
Jan
08

January 7, 2008

Keyboard silence again – chemo has hit hard this time, although I’m slowly swimming my way up to the land of the sentient.  Will write again in the next few days.

The good thing is that, whatever else I’m hit with, chemo is over and done with!  If I had the energy, I’d whoop and holler.  Inside, I’m whooping and hollering.

More later,

jkm




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