For People Living With Metastatic Breast Cancer: Change is Coming

Originally posted on MBCNbuzz:

Marc Hurlbert, Alliance project leader; Karen Durham, patient advocate, DeAngelo Williams, Carolina Panthers; Shirley Mertz, MBCN

Marc Hurlbert, Alliance project leader; Karen Durham, patient advocate, DeAngelo Williams, Carolina Panthers; Shirley Mertz, MBCN

By Katherine O’Brien, MBCN Secretary

This past Monday, I joined MBCN board members Shirley Mertz and Ginny Knackmuhs in New York City for a press conference. On October 13–National Metastatic Breast Cancer Awareness Day– the MBC Alliance released the results of its Landscape Report, Changing the Landscape for People Living with Metastatic Breast Cancer.

Over the past the year, the Alliance, which represents 29 cancer organization, conducted a comprehensive analysis of current MBC research and patient needs, as well as information and services. As I listened to the presentations, I was reminded of something John F. Kennedy said about the early days of his presidency: “When we got into office, the thing that surprised me most was to find that things were just as bad as we’d been saying they are.”

Key findings…

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October 13

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STFU

So I’ve been attempting to write post after post after post, inevitably trashing them all. I tried one on depression, one on anxiety, one on pink. Whatever I tried it just never worked. And I have to say that through it all I learned one thing: I’m sick of this shit.

I thought it was writer’s block, but it wasn’t. I realized that I was sick of writing about my breast cancer. The crises–at least the two I experienced thus far–are over. I’ve bitched and praised doctors. I’m certainly not surprised anymore. I’m smack in the middle of chronic maintenance. And how boring is that.

It’s cancer. I like boring. But what can I say that I haven’t said a hundred times? My latest scans are stable, except that my primary tumor is growing again. But a post about my primary tumor is boring because I don’t know why that–and nothing else–is growing. I’m not experiencing any awful side effects of my medications. In fact, I’ve cut back and take Oxycontin only once a day, and I’d like to bring down the dose of the Lyrica. Exemestane and me are still buddies for the time being. See? All good, but boring.

Then October. I don’t give a shit. Well, until a woman with hair was told not to attend a segment of the TODAY show because she had hair. That got my pantyhose in a bunch and the producers at TODAY were schooled with some serious social media organization. Now that’s been resolved. MBC seems to be making the rounds of the talk shows, and I think I’ve played one of many parts in changing that conversation. (Mind you, I say “one of many,” because so many were digging that path long before I came in with my shovel.)

Last week, after a miserable two weeks with some malicious and tenacious virus that had me on my ass, I developed crippling anxiety. I didn’t want to leave my apartment–and I didn’t. I cried, I felt helpless and alone, and I didn’t move. I was afraid of something. I didn’t want to bug my friends and whine. Then I asked one of my friends if she would pick up some milk and yogurt for me. When she arrived she read me the riot act. “Get the hell out of this apartment and get back to work!” She even bought me a small milk and one yogurt so it wouldn’t last and I’d have to go out.

I was grateful. She was right. How did I go from strong woman to whiney bitch? I was terrified to leave my apartment. “Stop reading those damned cancer blogs and get the hell out of here!”

I spoke to two other friends over the weekend and then the fog started to clear: I was caught in a cancer loop. When some Komen shill on Beyond the Pink Moon (Facebook) started to talk about “cure rates” in defense of Komen’s efforts, I knew I had to get out of this loop. For the cancer loop was becoming more toxic than the cancer itself. “Cure rates?” Fuck you! (Sure, bring on the hate mail. It’s still fuck you.)

I pulled out of every cancer group on Facebook. I even pulled out of the Knitting group; those moderators were nuttier than fruitcakes. Who needed to join a group with a bunch of shrews who deleted your post because you were “off topic” (whatever the fuck that meant). A bunch of dummies drunk on the nectar of being Facebook group moderators. All of this instantly stopped the noise. There is reason in silence; there is no reason in noise.

internetNoise like people who post to a FB group afraid that their port has shifted because of a bulge in their neck and then ask, “What do you think I should do?” What the fuck do we know? Go to the fucking emergency room! What the fuck? Or the “surround yourself with positive people and your positive thoughts will make you happy and then, in turn, make you well” people. Seriously? Go fuck yourself and the horse you rode in on. And all the goddamned ribbons and pink and bitching and moaning and whining (of which I was one). And all the noise about cannabis curing cancer. Let me tell you something, if that were true I should have never even developed cancer, if you get my meaning.

There is a time and place when we seek answers, camaraderie, and solace. But even in Cancertown there is a time where we stick a Poise pad on our panties, pull ‘em way up, and move along. The cancer loop sparked and then fed my anxiety. I tried to find answers among the many posts that I scrolled through daily. Instead, I was finding nothing but a bunch of other people looking for answers where there were none. No one there was going to know why my tumor was growing and nothing else wasn’t–that’s why I have an oncologist who went to medical school, fer crissakes. What a dumbass!

On Monday I returned to work and I was pretty fragile. I had anxiety all day, but after dinner I was feeling considerably better. I was looking forward to Tuesday. I woke up, got my affairs in order, suited up, and headed out for the office.  I felt I had purpose again. I wasn’t going to go away quietly. And, best of all, I was out of that poisonous loop. No noise.

Thing is, this noise wasn’t replaced by “happy happy joy joy” noise. It was replaced with my life. Not that it’s exciting, by any stretch of the imagination, but it wasn’t fucking cancer 24/7.

Cancer is the one thing that we can’t escape. It’s in our bodies or in our minds all of the time. If you’re a “survivor,” you don’t know that your safe. And if you have MBC, you never know what the next scan will show. We have a lot of ways to deal with that: we have our friends, we have blogs and Facebook groups that can give us information and/or support, and then we have the choice to turn it off. Each of these has a time and place, and the road isn’t always smooth by any means. But if we start to dig a hole for ourselves with only one choice, we’re going to die down there. Alone and miserable. And isn’t having cancer bad enough?

 

 

 

 

 

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Open Letter to Joan Lunden

I want to thank Joan Lunden and the people of TODAY of putting the spotlight, however brief, on metastatic breast cancer–the one that no one talks about.  A link to the TODAY spot is below.

http://www.joanlunden.com/category/35-breast-cancer/item/453-today-show-pinkpower-day-3

Dear Ms. Lunden,

You are an inspiration to many women and, rightfully or not, by virtue that you developed this disease you shine a spotlight on women with breast cancer. To support one of your upcoming reports on the TODAY show, a friend was contacted to be on the show to talk about metastatic breast cancer. Well, she thought she was, but what TODAY show producers wanted, it turns out, was a sea of exclusively bald women for a backdrop. When they learned she had hair, they told her not to show up.

CaptureNot all women lose their hair as a result of treatments. Many agents do not cause hair loss. I am 54, I was diagnosed with metastatic breast cancer right away, and I have had neither surgery nor chemotherapy (though I may as my disease advances). I will die of this disease. Indeed, every single woman who has had breast cancer could go on to develop metastatic disease. A full one third do — some a full twenty years after they have successfully completed treatment — and yet only 2-3% of the funds raised go to research on metastatic disease. There is no cure.

Pink is just a color, it is not a cure for breast cancer. Please honor us and swim against the tide that will always pink wash this disease. Please call attention to metastatic disease–it takes 40,000 women a year in the USA alone — and honestly portray the variety of women that breast cancer touches. It is time that we educate the public, not pander to producers who want women with breast cancer to fit a certain look while they continue to die. I hope that you agree.

I wish you good health.

Scorchy Barrington

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Remission

The Catch-22 of having metastatic breast cancer is this: when you’re caught in a period of crisis all you hope for is that your scans will improve, the pain will lessen or go away, your energy will return, and that you will at the very least be stable: i.e., no progression.  But the rub is that when you are not in a period of crisis, your scans are stable or better, you have energy, and you’re not in pain, you wonder when the next period of crisis will be and if it will be the last.

One thing I hadn’t considered, however, is that my oncologist would tell me that if my PET/CT isn’t lighting up she will likely pronounce me in remission. I had always attached remission to something like leukemia, only because that is the context in which I had heard the term. Someone is gravely ill, experiences hellish treatment, and then the cancer is gone–remission.  I never thought about that for myself. And, frankly, no one ever mentioned it–doctors, advocates, fellow patients.

All things considered, I suppose it is likely since tumors I had in L4 and the sacrum have responded really well to radiation to where there is little to no activity in these areas. The lung lesions–which were tiny to begin with–were gone within a few months of taking Tamoxifen. Tumor markers are down considerably. I still have my primary breast tumor that is smaller and with less uptake of the radioactive tracer (my physician talked about it being metabolically stable).  Of course, it’s only remission if I continue monthly visits with my oncologist, take Exemestane daily, Xgeva monthly, and have quarterly shorts of Lupron and scans to evaluate the efficacy of it all.

When I look back over the last 20 months or so, the entire period was one of crisis.  I can divide it between the experiences of Tumor I and Tumor II. All in all I had lived through twenty months–give or take–of craptastic glory. Other folks may have had it much worse or much better, but the only thing that mattered at that time was my own private Idaho. All of it was something that I never experienced before and it took a long, long time to heal. Gosh, I still needed help getting meds and running short errands up until about three weeks ago.

Two weeks ago I was able to work for four full days in a row; I had not been able to do that since April 2013. After the workday I could do little more than walk home, prepare dinner for me and the felines, and lounge. But I had worked  full days. I cannot begin to tell you the emotions of satisfaction, pride, and self-worth that I felt when that week ended. A week ago Sunday I joined my friends for brunch to watch the World Cup. As I left the house I was struck by the fact that I had no pain and walked to the subway entrance like I had never been ill. With little effort I descended the stairs and then caught myself smiling as I grabbed a seat and traveled in the subway to socialize for the the first time in a year. I walked the two flights out of the subway at 23rd street with ease and smiled as I walked to 22nd and down to 6th. I savored every step I took. Each one was a personal victory. Brunch was spectacular! I so enjoy the company of my friends Tammy, Lori, Mike, and Joanne. We talked and laughed and cheered with the rest of the restaurant as the game progressed and Netherlands–our team of choice–won the game. I cherished every moment, at one point just sitting back and watching my friends talk and laugh. Would that I could have put but some of that energy into a jar to save it. I savored every step home and after I arrived, I slept for four hours.

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But you know, as much as I embrace the present state of affairs and every moment, I am also aware very aware that I am walking on an ice sheet. To say that I feel considerably better seems like an understatement, but I continue to navigate painful episodes. Once I stand it takes about four steps for me to walk without effort.  I still tire easily and this last round of radiation left some residual damage. Some of the nerves that are associated with my bladder have been damaged. And there is also other associated nerve damage that results in a sensation of both numbness and burning pain in my right buttock. That last symptom immediately had my pain specialist thinking shingles, but that is not the case. It is believed that the nerves will likely regenerate, but only time will tell.

When I first started blogging, I recall thinking about what was happening to me and at one point I said to myself “I am dying.” I knew I wasn’t in a critical state of organ failure or anything like that so it wasn’t like the lights were about to go out. Rather, it was the realization that I had been rather newly diagnosed with metastasis and had no clue what was going to happen as time moved forward. All I had was a diagnosis and a chart showing the mean survival rates of women with metastatic breast cancer. Fast forward 17 months and the load on my shoulders doesn’t feel quite so heavy and my oncologist is using a word like “remission,” but I’m not off the ice just yet.

My therapy is working exceptionally well, but were I to stop the routine I would eventually be on some pretty thin ice. Indeed, for all I know the cells in my primary tumor could decide it’s time to party and my present therapy would no longer be effective. It could change characteristics and become aggressive and fast growing. The ice beneath my feet could become so thin that I break through and succumb to the disease.

We never know what life is going to throw at us. The only way for me to deal with this moving forward is to let the physicians worry about the disease. For me, I want to savor the moments of real value to me: time with friends, my mother, my sister, and my feline friends. I need to be thankful that I can resume my career, for there were days when I wondered if I would ever be able to return to work again. I want to replace the palpable fear with which I lived every day for months with meditation and intellectual fulfillment. And I want to refine and hone my knitting skills for the simple reason that it makes me happy.

I don’t know how long this remission will last, but I intend to live a life of real joy, compassion, and personal fulfillment while it does. Within that weird Catch-22 world of metastatic breast cancer, I’m carving out a space for myself. It’s going to be a really cool happy place. And I am going to share it with you.

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Xgeva

tang

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Released from Prison

Where the hell have I been these past few months? Well, ever since my last episode with radiation of a painful bone tumor in my sacrum, I seem to have misplaced my voice. It could likely be lost among my yarn stash, but if only were it that simple. For not only have I misplaced my voice, but I am afraid to venture out into the world. Instead, I prefer to stay inside my little nest. On some level I must think that if I just stay here everything will stay like it is and I won’t hurt anymore. Hey, it’s not like I don’t have cause.

I’ve been in pain since September 2012, the cause of this direct and indirect pain has been the bone lesions in L4 and my sacrum. Last summer the crisis was all about L4: narcotics, bowel impaction, nerve ablation, radiation. The Letrozole I was taking from May through December caused such fatigue and joint pain. With it I had no quality of life and it made working next to impossible. I finally stopped it in December and though it took a few weeks, on January 27 I woke up with energy. Real energy! FINALLY! I felt like myself again. Exemestane was easier on my body and I was hopeful for the future.  And then, two weeks later, BAM! The lesion in my sacrum placed me flat on my back. I had only been back at the office for two days. TWO DAYS!

From lessons learned last summer, the process of diagnosis and treatment was faster and I was down for about seven weeks–as opposed to 15.  Radiation didn’t freak me out like it did last year and the nerve ablation was a piece of cake. I experienced some brief depression at the end, just as before. But as excited as I was to return to the office I found–and continue to find–it very hard to move out into the world.

To be sure, I feel wonderful. I am able to walk (in moderation)! In some sense, I feel almost as good as I did before I was diagnosed. I stroll along the streets with a real smile on my face (and in the beginning walked so much that I pulled a groin muscle, but I digress). But apart from my walking success, I feel as if I am sitting on the edge of the chair, just ready to rise up, but all I can do is stay in place. And because I feel as if I’m being tossed around in a dryer at the moment, this might be the most incoherent post I’ve written thus far.

For one thing I have an overwhelming feeling of guilt. So many women with Stage IV cancer are in more peril than I.Young mothers in precarious health. Men and women newly diagnosed. Yet here I am feeling wonderful. How can I have any right to feel so great when so many are still hurting, suffering, and seeing that expiration date speeding toward them at lightening speed? Well, none of this is in my control, of course, and I am not responsible for other people’s lives. However, it is not until you have cancer that your capacity to empathize gets thrown into overdrive. When you are well you feel the pain of others. When you feel your own pain, you want to help others feel better. At least that is how it is with me.

CaptureFor another, I have been living in the “Scorchy Cocoon” for 18 months. That is 18 months of physical pain and emotional distress. Although I was well read and remained current with news and life, it really was Cancer 24/7: doctor’s visits, scans, tests, shots, and treatments. I felt pain all of the time. Every week I had something medical to do. Facebook became my outlet for sanity and keeping up with my friends and family because I couldn’t really travel anywhere–even in my neighborhood. I haven’t been that self-absorbed since I was thirteen. It was, in a very real sense, a kind of prison.

And now that I have been released from that prison and I don’t quite know what to do with myself.

My Job. Folks have been fine without me. I am so proud of my staff as they kept things moving so well. My previous boss had become vindictive and petty and, I believe, scared of my disease. I was afraid I would lose my job (though in academia you could walk naked through campus holding the standard to the 13th Roman Legion and still be employed). But after he left, senior management made it clear that I was an asset to the organization and they wanted me well and in place. My organization has been so supportive and I am grateful beyond measure. But after such a long break, I just naturally question my knowledge and expertise. I have disappeared from annual and local meetings. What is my worth? Do my colleagues feel that I have worth? Do my colleagues want what I have to offer? Indeed, do I even have anything to offer anymore? 

Social Life. I want to be with my friends and enjoy the city. But I am cautious. I cannot plan for weeks in advance for I have no idea if I will be well on that date. Instead I live day to day–which is the hardest thing I have ever done. I can make plans, but my friends must understand that I may have to cancel at the last minute. And if I do that I feel guilty and weak. To date, my social life has consisted of the occasional dinner and logging into Facebook. Sex in the City indeed.

Cancer. I am a master at compartmentalization. With all of the baggage of life, I think I over compartmentalize. Indeed, it wasn’t until I began living with cancer that I realized I had a heightened ability to cloak those compartments in complete and total denial. Not just denial, but a veritable black hole of nothingness. I mean think about it: my entire diagnosis is a story of denial.  Today, despite my past ignorance, I am in a good place: the two bone tumors that existed responded very well to radiation; scans are stable and improving; my pain is under control with the occasional flare. On paper, at least, I can live again.

One day I rose with my alarm, showered, dressed, and then just sat on a chair in my living room. I was paralyzed. I sat there for about an hour. I wasn’t in panic. Indeed, I sat there thinking of little more than the weather. And then simply decided I would not go in to the office. I undressed and spent the day as I had for the previous 18 months: in my PJs with cats. Once again I felt safe and secure.

But at the the same time I felt a tremendous sense of remorse and confusion. What the hell was I doing? I want to work. I love what I do. Why would I jeopardize not only my career but my entire life? I am no longer in prison, so why is it so hard to live?

After seeking some counsel, I decided that intellectual engagement may well be the thing that dissolves my fear of leaving my cocoon. That is to say that I need to immerse myself in my work once again and rediscover the real joy I feel in doing it. I went to the office yesterday, as a matter of fact, and I do think that this is the thing that will work for me.

As painful and confusing as my 18 month odyssey was, it was also a time of odd comfort. When I was under the weather, so to speak, friends rallied around me. They told me how much I was loved and how special I am to them. Friends and family really wanted to know about me. Gifts, favors, and treats arrived with love. I surrounded myself with soft blankets and comforting food and drink.

However, as I improved, many of those things naturally fell to the wayside with the expectation that it was now time to move on with my life. But after such a long time in crisis, I am now left raw and vulnerable. I need to relearn my limits, build my confidence, and live with some modicum of comfort with my disease. This transition from intense illness to wellness is a potentially fragile time for some of us–and we may not even be aware of it until it is upon us.

Intellectual engagement may be my path to easing the uncertainty of my future. Only time will tell. But I cannot possibly be the only person to experience this paralyzing fear of wellness. I just can’t be.

Physicians are focused on their specialty, fair enough, but they might do well to consider the emotional state of their patients as they transition from acute crisis to wellness (as well as wellness to illness). It may be a time of jubilation and excitement. But those feelings are expected to some degree, are they not? I know I told everyone how excited I was to return to my life. And I was. But under it all I was afraid and, even more so, embarrassed to admit that to anyone–even to myself.

I am confident that I will emerge from this mentally healthy and engaged. But like most things I have learned as a result of this cancer experience, transitioning from protracted illness to wellness is a delicate shift. And I don’t think it is on anyone’s radar. When faced with a challenge like this we need to be kind to ourselves first and foremost. Listen to that inner force–if it doesn’t feel right, then it isn’t. Our physicians need to be aware of this as well and ask their patients about how they feel about this transition and if they need help moving through it. Otherwise we may well find ourselves moving from one prison to another. Not only will that continue to cause mental distress, but that will not aid our physical condition.

No one deserves to live in a prison of uncertainty and fear. Least of all anyone who has been hit with cancer, regardless of type or stage. Ain’t nobody got time for that!

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The Breastless Nude

Recently I went on quite a tear when it was revealed that Kohl’s and Komen had co-opted METAvivor’s intellectual property for an ad campaign. It really rakes my last nerve when people do this; rather than call up an original idea–which I’m sure their advertising departments could have done–they chose to take an idea already copyrighted and trademarked.  And what bothered me most was that the campaign, which had no mention of Stage IV breast cancer, was built on the backs of Stage IV women and men via METAvivor.  But now there’s something else that’s got my pantyhose in a bunch.

I came across a project by photographer Charise Isis called Grace.  Isis, inspired by Hellenic sculpture, has assembled a collection of photographs of women who have had mastectomies as an “exploration into the grace of their humanity.”

It is a project that speaks about the strength and beauty that women who have survived Breast Cancer possess. . . In photographing the project, I loosely use Hellenic sculpture as a visual reference for the portraits, taking inspiration from such artifacts as the “Venus De Milo” and “Nike of Samathrace”. These dismembered artifacts have survived the trauma of history and are still valued as objects of beauty within our culture.

Yawn.

venus

People start taking photographs of women with mastectomy scars and suddenly it’s pushing the aesthetic envelope.  It begs the audience to empathize and then hold these women in high esteem because they have a disease, have gone through treatment, and survived. It must be noted that women and men with breast cancer are no braver, stronger, or aesthetically pleasing than anyone else who goes through the experience of cancer. Then why the imagery?

Women–particularly their breasts–have been objectified for centuries.  Now we witness the objectification of mastectomy scars.  Indeed, Isis emphasized that sculptures of antiquity, despite their amputations and scars, survived and are “valued as objects of beauty within our culture.” Is the corollary, then, to value women as “objects of beauty” in society?  Do mastectomy and further surgery scars become “objects” of beauty and bravery in breast cancer culture?

This project also perpetuates the iconic mythology of breast cancer–that to conquer breast cancer one must be strong and brave. It is the responsibility of the woman to defeat her disease and become a survivor.  If she doesn’t survive? Well, she didn’t try hard enough.

Of course, in Grace they’ve all had cancer. We should not be surprised that women living with metastatic disease are absent from yet another pithy piece on breast cancer survivors. The ugly scars hold no interest if they are on a woman who has metastatic disease. Breast cancer isn’t about death. It is about pink ribbons, endurance, and survivorship.

I am not particularly moved by this project.  The images try very hard, but they seem forced and largely uninspired.  And although some may find inspiration in its images, my view is that as a body of work it objectifies the surgery, the scars, the physical detritus of breast cancer. Although I have only just heard of it, the project has been traveling the United States for the past two years “showcasing the brave subjects who bared their bodies for the camera, in the name of survivor solidarity.” (Source.)

Bullshit.

I am an enthusiastic supporter of David Jay’s SCAR Project. And it is largely because of the foundation on which the project has been constructed: “The SCAR Project is an exercise in awareness, hope, reflection and healing. The mission is three-fold: raise public consciousness of early onset breast cancer, raise funds for breast cancer research/outreach programs and help young survivors see their scars, faces, figures and experiences through a new, honest and ultimately empowering lens.”  Jay also includes men among his subjects.

The women who pose for the SCAR Project are not representing some existential depiction of disease. They are there to show the pain, the disfigurement, the life changing hell that this is breast cancer. Indeed, as the project proclaims: breast cancer is not a pink ribbon.

I think that it is time to rip to shreds the idea that breast cancer is a rite of passage for women.  We need to acknowledge that despite the pink camouflage, those of us with breast cancer withstand the barrage of treatments most other cancer patients undergo: oral drugs/chemotherapy, IV chemotherapy, radiation, and surgery because we have a disease that can kill.

We must stop romanticizing this deadly disease through ideas of bravery and survival skill. Breast cancer patients are no braver, stronger, or aesthetically pleasing than anyone else who must experience this dreadful disease. And remember that many with metastatic disease have no outward signs that they have breast cancer.

And we need to stop putting women on pedestals, for as soon as a woman stands there she loses her identity. She is reduced to her being identified with her body parts or how she appears to the senses. She becomes a scar, an implant, a loss.

I am much more than that. We are much more than that. It is time that we demanded nothing less.

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DONE

Radiation: Day Five

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Let’s Make a Deal

In what has become an early spring event, I am looking at my second bone tumor crisis. Just at the moment that I felt fabulous and had an energy level that I had not felt since before I was diagnosed with this sludge, I got nailed with intractable pain and disability from a tumor that has been in my sacrum since I was initially diagnosed with metastatic disease in August 2012.  I just couldn’t believe my luck.  Literally two days after telling my director that I couldn’t wait to dig in at last, I was felled with severe pain that truly came out of nowhere.

A routine PET/CT and one MRI later, it was revealed that the 2.7 cm tumor had grown to 3 cm. But the great news was that the primary tumor in my breast was smaller and nothing else was lighting up in my battered frame.  The site was biopsied and its makeup changed to a limited degree.  Where I was ER+/PR+, HER2- at initial diagnosis, this time I was PR-.

To deal with the pain and kill this thing, I am going through my second course of radiation. While radiation is no picnic, this time it hasn’t been so bad if you take the long view.

For one thing, the workflow in the radiation oncology unit has changed for the better.  The staff has been wonderfully supportive and professional–really outstanding!  I had to have a frame made to keep my legs in the right position, but that was not a big deal.  And while the reality of laying on a table while a total of 70 seconds of high dose radiation in six positions is beamed into my body still freaks me out, I’m tolerating it pretty well.

The first two days I had outrageous nausea and was drowned in fatigue (which caused me to miss the Black Sabbath concert, dammit!).  I am still in some pain that keeps me off my feet and the fatigue is like a cloud over my head, but I can detect mild improvement and hope to be pushing that damned boulder up the hill once again  in a few days.

So besides missing the concert it all seems to be moving along as planned.  Except for the email I received from the nurse practitioner on behalf of my physician.  Seems the doc wants to change up my medication since the tumor wasn’t responding to the Exemestane. She put before me a couple of choices.

door.1Behind Door Number One is the the choice of Exemestane + Affinitor. Yes, this little dandy of a drug is used to treat breast cancer (and other cancers), usually after other cancer medications have been tried without successful treatment. The more common side effects are bloody nose, chest pain, weight loss, cough, diarrhea, fever or chills, mouth sores, nausea, bleeding gums, extreme fatigue, and vomiting. Oral chemotherapy.  Fabulous!

door.2Behind Door Number Two is the choice of Exemestane + Faslodex. This is used to treat hormone receptive positive breast cancer in women who have gone through menopause and whose disease has spread after treatment with antiestrogen medication. This is given monthly via two injections into one’s gluteus maximus. Side effects include commonly reported side injection site pain, nausea, muscle, joint, and bone pain, headache, tiredness, hot flashes, vomiting, loss of appetite, weakness, cough, constipation, shortness of breath, and increased liver enzymes.  Sweet!

door.3

 

And there is always a Door Number Three. On first glance it doesn’t seem like much of a choice, but the lure of knitting fiber, wholesome milk, and adorable cartoon animals are the clear winners in this choice before me.  I pick this one!

 

Personally, I have some issues with the choices from the start.  Given that this tumor is now on its way to permanent destruction and everything else in my body has responded quite positively, I am quite content to wait until further scans to make one of these choices. After all, these two tumors have been there since the start and have always been active, even if they were stable.  I meet my new medical oncologist in a few days and will discuss it then. (My former oncologist has moved on to bigger and better things at Yale University, so this will make my fourth oncologist.)

First of all, I’m not crossing the line into chemotherapy–oral or no.  Psychologically I’m not there.  And, second, I already get one injection in my ass every month (Xgeva) and every three months another (Lupron). I’m not anxious to put my poor posterior up for more torture.

While personally this cancer experience has been pretty damned awful with regard to pain as the result of bone metastasis, in the grand scheme of things my cancer has been relatively well controlled.  The lymph nodes and tiny lung lesions were resolved shortly after starting Tamoxifen and have remained so.  I experience mischief in my axillary lymph nodes now and again (pain that comes and goes with no palpable nodes) and my primary tumor–though still intact–is much smaller.  Bottom line is that I’ve been able to hold steady with systemic hormonal therapy.  But chemotherapy?  That is the proverbial line in the sand.

When I have to make that choice, my desire to live out a full decade is drastically diminished (or at least I think so).  And even though I have to make all kinds of arrangements and contingency plans, I’ve predictably pushed it off.  I mean, I don’t feel like making funeral arrangements for myself.  But I suppose I have to face that all happening sooner rather than later; after all, people do it all of the time.  Oh, yeah, and probably goodbye career! And it is not that death is in any way imminent–it isn’t!–but once I use up that last line of hormonal defense there’s no going back.

Chemotherapy is the tipping point when I have to make a deal and choose not what I want to do in my life, but how far I am willing to go to have any life at all.

 

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