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On Wednesday afternoon February 4, 2009, Kevin and I made the short trip to Boston to Dana Farber Cancer Institute to meet with my oncologist, Jennifer Ligibel. She seemed happy that I had no complications or side effects from the radiation therapy, and we resumed discussions about chemically induced ovarian suppression. 

For a moment or two, when she was discussing this therapy and a pending study she mentioned during our last appointment on another drug used to combat osteoporosis and cancer, called Zometa, that would be used with Lupron, the drug she planned to use for ovarian suppression, and how dissappointed she was that this study didn’t give the oncologists the information that they expected, I got a sick feeling in the pit of my stomach and wanted to bolt. It sounded as if we were headed down the chemotherapy path, again. Fortunately, this was not the case! We discussed the side effects of Lupron (possibly more severe hot flashes) and how to counteract the accelerated bone loss the drug would cause, which led to more discussions about using Zometa simultaneously with Lupron. She explained that a serious side effect of Zometa, deterioration of the jaw bone that some studies show are very rare, 1/2000, has been seen more frequently in her practice, that four of her own patients experienced this side effect. They don’t know why it happens or if it is reversible, although she did mention that one of these patients was OK enough to resume the drug. But, for this reason, she was not insisting that I start Zometa right now, and is still waiting for more studies on this drug.

We all agreed that the most reasonable next step to take is to start Lupron injections right away to shut down my ovaries so there is less estrogen in my system, which will reduce the chances of the cancer coming back. This produces the same results, statistically, as chemotherapy for the type of tumor I had, and other characteristics of my situation. We decided to give it a try, and if I tolerate it, we’ll continue. In the meantime I am scheduled for a bone density test in March, so that when I see her again in May, we’ll have a better idea of where I stand, and the treatment options based on that test.  I reminded her that I have been working out faithfully for four hours every week, all weight bearing as she suggested, to stress my bones to keep them strong. She said that it can take a year for exercise to show results after starting a bone building exercise program, so I am not dissapointed if I don’t see results right away. Since I have no basis, having never had a bone scan before, I won’t be dissappointed, but my plan is to hold off on the Zometa for as long as possible, especially if my bone building exercise program and taking calcium supplements is working. I am willing to add an extra hour, or even more, to my workout, and increase my weights before I will agree to take the Zometa infusions. Of course if my option becomes wheel chair or Zometa, the choice will be clear and worth the risk, but I plan to work at this, so that I have more control and more options. 

Before we left, I had my first Lupron injection in the hip/butt. The nurse first sprayed my skin to numb it, and the shot was pretty much painless. She advised taking Tylenol for a day or two for bone pain (what bone pain????). I wasn’t aware of any side effects other than the possibility of more hot flashes, so she printed out a sheet describing the drug and all the side effects. Naturally I worried about all of them, but my body didn’t fail me.  I didn’t need to take Tylenol – there was no pain or discomfort at all.  It’s been five days and I feel fine, in fact the occassional, mild hot flashes I had been having from the tamoxifen are actually becoming less frequent.

Again, I do realize that it’s not over ’til it’s over, and that this journey will never really end until my life is over. That’s the way cancer is. In my mind, it’s always “there”, lurking, waiting to rear its ugly head, or not. I know that cancer patients, or survivors, or whatever we are called, always wonder at some level if it will come back. The question then becomes, at what level does one concern herself or himself with the prospect of recurrence, and how does it affect their lives? I don’t know the answer right now.

I know that I am relatively unscathed, but I take nothing for granted. The experience has been unpleasant and at times desperate, but I have found ways to live/thrive with the unpleasantness, and I’ve gotten far above the feelings of desperation.  I believe that focusing on healthy things like exercise and eating the right foods has had a lot to do with how well I feel. Exercise has been a perfect, and very healthy distraction physically and emotionally, and makes it easy to leave the unpleasantness behind.

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