Complicated but Doable

We had my post-chemo medical review yesterday and all is well.  It's complicated but doable.  This next phase, basically the rest of my life, will be dedicated to eliminating cancer occurrence.  The next five years will involve hormone therapy.

Just to recap my diagnosis, the breast cancer I have is Estrogen and Progesterone positive AND I have Factor V which means I am high risk for blood clots.

So why Hormone Therapy? According to the National Cancer Institute

• The hormones estrogen and progesterone can stimulate the growth of some breast cancers. Hormone therapy is used to stop or slow the growth of these tumors.
• Hormone therapy is used to treat both early and advanced breast cancer, and to prevent breast cancer in women who are at high risk of developing the disease. (October 16, 2012)

Three options were presented to us...

#1 Tamoxifen for 5 years with Fragmin (blood thinner)

INVOLVES: daily oral pill of Tamoxifen and daily injections of Fragmin
PROS: Very successful with early stage breast cancer; promote bone density; used to treat pre-menopausal women
SIDE EFFECTS: The most common side effects are hot flashes, night sweats, and vaginal dryness (National Cancer Institute, 2012).  Other less common include risk of blood clots in the legs and lungs, stroke, cataracts, uterine cancer, mood swings and depression.
CONCERNS: Risk of blood clots

#2 Ovary Removal, Letrozole for 5 years with Warfarin (blood thinner)

INVOLVES: Immediate surgery for ovary removal; daily oral pill of Letrozole and Warfarin
PROS: No daily needles; easier to administer; More options for post-menopausal hormone therapy where there is no risk of blood clotting
SIDE EFFECTS: Immediate post menopausal side effects. Other side effects include risk of heart attack, angina, heart failure, and hypercholesterolemia, bone loss,  joint pain  and mood swings and depression (National Cancer Institute, 2012).
CONCERNS: Early onset of Osteoporosis; family heart health history; immediate gynoncologist referral and surgery to maximize benefits of treatment

#3 Combined Therapy - Tamoxifen for 2 years, Ovary Removal & Letrozole for 3 years

INVOLVES: All of the above
PROS: Reduces major concerns as per above; Provides time to schedule and meet with gynoncologist/surgery
SIDE EFFECTS: As per above
CONCERNS: .....as per above... however, this will be dependant on how well I tolerate the drugs.  If I can tolerate Tamoxifen, then the plan is as per above.  If I begin to develop blood clots and abnormalities in my blood then Option 2 will become more immediate (Dr. Kakamanu, 15 October 2012).

So #3 it is for now ~ I started Tamoxifen yesterday and blood work will be in one month's time unless other symptoms arise. I will apologize now for any mood swings I may have, fangs that may appears and other hormonal tendencies that may arise :) Remember this is temporary....at least until I find and adapt to this "new normal".....my poor family....

This combined therapy approach of mastectomy, chemo and hormone therapy will give me the best chance at a long and healthy life.  Recurrence is reduced to less than 10%.   Perhaps someday, recurrence will be 0%.    However, today, this is the best news for a long healthy life.

So my focus now is to get stronger! Exercise, rest well (OK, as well as the night sweats will allow) and healthy eating will be key! Healthy eating will need some work because I need to avoid excess phytoestrogens such as flax seed, soy, licorice, red raspberry, primrose,  etc to name a few.....the list is long.  There is lots to learn! Physio therapy continues to be twice a week....Lymphodema is still Stage 1 but getting better - I can feel improvements in my arm and side.  My scar tissues are beginning to move as well...this is good news!

Recovery is good...the mantra still holds....Eat, Pray & Walk/Exercise!

Cheers!! Shelley
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