For anyone going through this though, you need to be aware of the weird stuff hormonal therapy drugs can do. You can Google the side effects and read them for yourself. I am experiencing some of them but I will figure out how to live with them until a better option becomes available.

Since I have been so very busy with work, I have fallen into the trap of not making exercise a priority every day. That doesn’t mean I haven’t been exercising, I have, but not for long enough and not hard enough. Not having the endorphins flowing (and probably side effects from the drugs) has effected my mood, so, I have changed my routine so I can fit in an hour a day first thing in the morning. I am back to doing my most challenging one-hour workouts.  I’m happy to report that it has made all the difference in my mood and productivity. I am also still struggling with that last ten pounds, and I am determined to make them dissappear no matter how much work it is. I keep hearing that little voice: “fat stores estrogen”!

We went to a four day dog show on the Cape this past weekend, and on Saturday, we walked over to our ring in the pouring rain. Now this isn’t ideal for a dog show, especially when your dogs are perfectly groomed with every hair in place. As we approached the tents, it was clear that none of us (we were with our friends and had 9 large dogs between us) was going to get under these crowded tents. So, we stood out in the rain with our umbrellas and did the best we could while we waited for some room to open up under the tent and for our classes to begin.

Once the class before ours was done, and there was a little room, we were able to find our way under the tent, but it was still very crowded, our dogs were dripping wet, and so were we. I began to think “Why are we doing this?” Then I realized how very lucky I am to even be at a dog show, doing something I love, with the dogs I love, and of course with my favorite person in the whole world, my husband, and all of my very dear friends.

When it was my turn to go into the ring with my dogs and run around the ring, it was pouring! And I ran around the ring laughing and jumped right through all the puddles, enjoying every minute. We did not win, but I had a great time! Sure beats a radiation treatment.

It will be one year next month that I found my lump and began this journey. It’s hard to believe that so much time has passed, and I am grateful that I’m still here and feeling so well. Yes I still have some numbness in my right arm and around the surgery site, and there is still some swelling after all this time, but it’s easy to live with and could be much, much worse.

On July 9 I go in for my first mammogram since this adventure began, and afterward I’ll see my surgeon for the first time since the surgery. It does make me nervous, but honestly I’m doing everything I can to prevent a recurrence. The rest just isn’t up to me.

Here’s what I’m doing:

1. After reading “The China Study” and several other books on nutrition and cancer plus a multitude of other diseases including the dreaded osteoporosis that I am threatened with from the drugs, heart disease, dementia and diabetes, Kevin and I have adopted a plant-based whole foods diet. This is going extremely well and the transisiton for Kevin and I has been easy. The food possibilites are literally endless, the health benefits are tremendous, and the food not only looks good, it tastes great. We crave our vegetables, pastas, and green smoothies! Kevin has actually lost ten pounds and reduced his blood pressure. He gave a copy of the book to our family physician who loves it (he’s about Kevin’s age) and says the science is absolutely correct, and told Kevin he’d help him get off all the blood pressure meds. Wow, is he looking buff! I haven’t lost much more weight, but having only ten pounds to lose makes it more of a challenge. This will come with increased exercise, which I am doing now. I launched a new web site for those of us who want to learn more and to make the transition to the healthiest lifestyle on the planet: Plant-Based Whole Foods Living. Please subscribe. 

2. I have been exercising regularly for one year now. What a difference in stamina, strength, flexibilty, and new muscles. Exercise is also important because if I don’t work my right arm it becomes tight, stiff and painful. My treadmill is serving me well, and I’m not just walking on it now, I do some jogging too in order to stress my hips, and keep the bones strong so that I don’t need to take Zometa, which has its own laundry list of side-effects.

3. I’m faithful to my meds and supplements: tamoxifen, Centrum Silver, Caltrate, Fish Oil, and vitamin E. And I go in form my Lupron injections every 12 weeks.

4. I think most importantly I keep things in perspective better now than in the past. Dealing with cancer is very much a “head thing”. I don’t sweat the small stuff, and I’m more aware of how I spend my precious time. I still feel that every day is a gift. I have even learned to enjoy the soothing sound of rain.

My base line bone density scan done in March was normal, I have had no side effects from the Lupron injections, and the occassional hot flash from the tamoxifen and Lupron is hardly worth mentioning. Radiation treatments ended in January, and although I was warned that some radiation patients experience fatigue long after treatments end, I had none. I have noticed that I am not sleeping quite as soundly lately, possibly a menopause symptom, but, I am not bothered by it as I am fine all day long. Since I’m up at about 5am with the dogs, I am accustomed to getting to bed early, so I seem to be getting plenty of rest.

Of concern is the looming decision about using Zometa infusions after talking with my dentist about osteonecrosis of the jaw, which appently is more common than we are led to believe. I realize that the risk is small, but this condition is not reversible, is painful, and can cause disfigurement and tooth loss. Since my bones are fine now, I have decided not use Zometa right away. Things will change if I develop osteoporosis from the Lupron. Also, the cancer fighting abilities of Zometa are significant in the study of 1800 women, but even so, the final tally is that 98% of  these women survived with no recurrence after 3 years. The other 2% did not, and some of these women were on Zometa. Since I am committed to helping myself and living a healthy lifestyle, I’ve decided to take my chances unless osteoporosis becomes a threat. Zometa has many other possible side-effects associated with it too, even though it is apparently an effective drug to treat osteoporosis. It will be interesting to hear what else Dr. Ligibel has to report on Zometa when we see her again next month.

I have continued with regular exercise although I have changed my routine to give some variety to my workouts. I like Jillian Michaels 30 Day Shred, a tough half hour workout. The intermediate Fluidity workout is another tough one, but it sure feels good. My treadmill and iPod are my “staples”. I am trying a Pilates class on Monday nights starting next week, after trying a ballet barre class a couple of weeks ago that I did not feel was really for me. The other two women in the class were experienced ballet dancers with lots of training, and I was reaching back to my ballet classes from forty years ago! All I could do was follow along in my new pink ballet slippers! It was a good workout though.

I am very fortunate and happy to report that my breast cancer experience hasn’t ended my world, but given me a new and more productive life. Things aren’t the same, they are actually better. There is a new awareness which makes me behave differently. I don’t take anything for granted. I am learning to live with having cancer, but I don’t feel hindered in any way by it. This is a far cry from my original reaction, that day in August when the phone rang and I learned that I had breast cancer. It was shock, disbelief and denial, surely a nightmare that I would soon awake from. But, life doesn’t work that way. I’ve learned that it is our responsibility as human beings, as family members, as friends and co-workers, to be diligent and strong, to take care of ourselves, to do whatever it takes to help ourselves. When all is said and done, that is the most meaningful way to show that you love someone, and to find peace.

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.

I have religiously kept up with my weekly workout: two hours on the treadmill walking and jogging, plus two hours of other exercise, which until two weeks ago was Classical Stretch Essentrics, which I love. The endorphins have relieved any significant pain, if I had any, and have acted as a great natural mood enhancer which I’m sure has helped me sail through this treatment, as the doctors, books and articles suggested. I resumed weight lifting to prepare for the next phase of treatment, which will accelerate bone loss. The articles warn that ovarian suppression can age bones by five years in the first year, so I am concentrating on maintaining or increasing bone density, which weight lifting and weight bearing exercise, like walking and running, accomplishes. And I have been taking Caltrate.The bone building workout by Joyce Vedral http://www.joycevedral.com/bonebuild.html even exercises my wrists, a common fracture site, and works at a comfortable pace with light weights, although I now need to buy a set of 10 pound dumbells because some of the exercises are too easy. It was interesting to me, and surprising, that my chest muscles were a little sore on the surgery side after doing the workout for the first time since before the surgery in October, even though the heaviest weight I used was 7 pounds. This tells me that even though I thought I was exercising and stretching all of those muscles, I wasn’t, so adding this workout makes sense.

Weight lifting also makes sense for another reason: for women entering menopause, which I will be doing chemically, another problem that increases breast cancer risk and the rate of recurrence, is the increased body fat that accompanies menopause, so I will be fighting that battle for the rest of my life. More muscle = less body fat. According to “The Breast Cancer Survivor’s Fitness Plan” written by the doctor that founded the Comprehensive Breast Health Center at Brigham & Women’s Hospital, where I go, a body mass index of between 18.5-22% is the healthiest for women, so that is what I will shoot to maintain. I’m at the high end of that now at 22%, but believe me when I tell you that I still have LOTS of body fat and plan to continue to work on building muscle! Since I feel so good and have made my workout a priority every week, this will be easy.

I must admit that it’s enjoyable to watch my belly flatten, my arms get firmer and thinner, my thighs shrink, and I still cannot believe that I have ribs and abdominal muscles. My flexibility and strength is better than it’s been in probably twenty years, and I can run for long stretches without huffing and puffing.  I have kept a pair of jeans that I wore comfortably in the 80s that I could not even get my legs into a year ago. Now I can zip them! I can’t wear them just yet because they will cut off the blood flow to and from the lower half of my body, but it gives me something to look forward to!

Off to our family doctor first thing on Tuesday morning, and again, nothing apparent. No swollen glands and no signs of strep or anything else, but she took a culture anyway, and said I probably have a virus. I kept up with the Ibuprofen and it not only helped my throat feel better, but it relieved the pain and swelling from the radiation too.

That same afternoon was my CT scan. I was led to the CT room this time, and laid on the table, head in a molded rack, arms grasping handles overhead, just like with the radiation treatments. This time, they had to remark all of my tattoos with a marker: a dot in the middle and a circle around each one, and they stuck a lead BB on each one. The CT scan was over pretty quickly, then I had my usual radiation treatment.

When I got home, Kevin was there, and I asked him to come upstairs so I could show him the marks all over me. It did look pretty funny. I lifted my shirt and asked if he thought we could take a photo for my blog without the photo looking inappropriate. He said “NO”!  So, readers, you will not get to see what remarked radiation tatoos look like, at least not on my blog!

Wednesday morning I felt fabulous. I did an hour on the treadmill before getting ready to go to Brockton for the day, and had two productive, pleasant meetings there. Last night at radiation, I met with Dr. Sawicka. I told her I feel great. She said my skin is looking good, and that I only have 8 more treatments to go: one more full treatment, then 7 “boosters” to the tumor sites. Then I am finished! There is no fatigue during the day - but I am going to bed a little early or taking a short nap on the couch after dinner.

Even now, it’s amazing to me that my imagination went wild on Monday over something  I would normally have pretty much ignored, and even the mild discomfort I was feeling from the radiation seemed to be magnified. Are all cancer patients so ultra sensitive whenever something is slightly amiss? Should we be? I don’t know the answer. I am guessing there is a balance to be found somewhere.   

I am further convinced that the trick to surviving cancer and thriving in life is keeping your head on straight, and exercising.

The technicians, nurses, and the oncologist, have all said that for the number of treatments I’ve received, 24, my skin is holding up very well. And, just in the nick of time – last night we made an appointment for a CT scan before my treatment on Tuesday afternoon to take a look at things (I think they are also looking for new tumors), and begin the process of mapping out the rest of the treatment, targeting the tumor sites directly instead of the larger rectangle. So, the parts of my skin that are black will have a break from radiation, hopefully next week, and can begin to heal.

I have been diligent about taking care of my skin. Right after treatment before I change back into my clothes, I slather on ice-cold aloe vera gel that I keep in the refrigerator at home and take with me. That takes the heat out of my skin right away. Once home I slather on the healing ointment the doctor told me to use, Eucerin Aquafor. In the shower, they said to use unscented Dove soap, because anything scented can irritate the skin. I am also using Eucerin’s Calming Daily Shower Oil all over the treatment area, which is also formulated for sensitive skin. It might seem like over kill, but it’s not – I have another lotion called Miaderm www.miaderm.com , that is lighter and absorbs better than the ointment and made to treat radiated skin – that is what I use during the day. And I have to use an antipersperant that does not contain aluminum, Tom’s of Maine is what was recommended.  

I had been warned by other survivors to take special care of my skin during treatment, and they were right. One woman I see fairly often in the waiting area, showed me her burned skin, and it wasn’t pretty. Another told me they had to stop her treatment for a week to allow her skin to heal. I have been very fortunate indeed. I do believe it’s my great Italian skin that is saving me from more serious burning.

Only 11 more treatments to go…..