Keep on keeping on

I know it's been a long time since I've blogged here, as a few of you have asked me when my next post will be.  I've composed a few little posts in my head over the last 6 weeks, but not really felt any of them were important enough to share.  But now there's a lot of little things.  

So this week marks a year since I started chemo.  It was strange to sit in the Cancer Center for my Herceptin infusion this week and think about that.  On one hand, it's been one looooong year.  On the other hand, it's only been a year since meeting all the oncology nurses and aides, and really getting to know them all so well (when you see them at least every three weeks, and as frequently as 2x/week, they become a big part of your life!).  

I had my third-to-last Herceptin this week on Wednesday.  If all goes well, my final infusion will be on April 13th.  I asked Dr. Shah if I could make an appointment with Dr. Lal on April 14th to pull out my port-a-cath and she laughed and told me she really prefers for her patients to keep them in for a year after treatment concludes (she didn't add the unspoken "just in case..." but I heard it anyway).  She said that she understood my desire to get rid of it, and if I really wanted to, I could get it taken out, but she recommended I see if Dr. Sterkin (the plastic surgeon) could just pull it out when he finished the reconstruction this Spring/Summer.  I have an appointment with him on March 21st, so I'll ask then.  

Several of my BC survivor friends are on aromatase inhibitors (Arimidex is most common) instead of Tamoxifen, as the early studies show that it is more effective, and without as many dangerous side-effects.  Tamoxifen can be used whether you're pre- or post-menopausal, but if you're still pre-menopausal, you can be given Lupron injections to essentially shut down your ovaries since Arimidex only blocks estrogen from non-ovary sources.  Dr. Shah and I had talked about me switching after about 2 years of being on Tamoxifen--to insure I'd gone through menopause and therefore wouldn't need the Lupron shots.  The more I've read about the aromatase inhibitors, the more I think it makes sense to get on them ASAP.  Studies have shown significant reduction of breast cancer recurrence in using them over using Tamoxifen, if you have cancer that's responsive to chemotherapy (If you don't need chemo, Tamoxifen is just as effective).  This is especially true in the first year (RR: 0.64 (0.52-0.78)) as well as in years 2-4 (RR: 0.80 (0.68-0.93)).  Furthermore, ten year mortality was also significantly lower with aromatase inhibitors (RR: 0.85 (0.75-0.96)).  All relative risks included for my Public Health friends.  :)  In addition, the already-known benefit of aromatase inhibitors is the decrease in endometrial cancers (RR: 0.33), though there is an increase in bone fractures over Tamoxifen use (RR: 1.42).

So I talked a bit more to Dr. Shah about it and since I will be 1 year LMP this month, she suggested they check my hormone levels to see if I'd gone through menopause on my own. She said that sometimes chemo causes reversible menopause, so she would want to re-check them in three months, but that almost gets me through the protection of Herceptin, so I feel okay about that.  I haven't talked to her yet, but I did get my hormone level results and they're pretty supportive of me having truly becoming menopausal:

FSH: 82.5 mIU/mL  (25.8 - 134 is indicative of being menopausal)
LH:  39.0 mIU/ml (pre-menopausal is 5-25; menopausal is 14.2-52.3)
Estradiol:  <5.0 pg/mL (pre-menopausal is 30-400; menopausal is 0-30)

I won't see Dr. Shah again until my last Herceptin (6 weeks), so I'm sure we'll discuss the plan at that point.  

As long as they were doing blood tests, she ran a CBC again.  Almost all my levels were good except for the platelets, of course.  They were 76 thou/mCL.  My hemoglobin is still low (11.7 gm/dL), but relatively high for me!  

Dr. Shah also scheduled me for my final (?) MUGA heart scan.  That's scheduled for the 21st.  Hopefully my score continues to climb and any potential heart damage from the chemo was reversed.

This week was also exciting because I was (again--third time's a charm?) discharged from OT.  As lovely as it has been to get a massage every week, I'm pretty happy to not have to make another trip to Water Tower Medical Commons.  I hit a kind of low point in February when the unfairness of having to use vacation time for my doctor appointments hit me (I don't have any sick leave yet).  In Grad School, I had tremendous guilt about taking any time off, so I'd planned to actually take a vacation after graduation, and then recovery was much rougher than I thought it would be, so very little fun was had.  Now I have a full-time job with paid vacation and I didn't plan to use it to attend medical appointments!  I shouldn't complain, because on the other hand, I *have* vacation time, so I can still be paid while seeing the doctor, the dentist, the OT, etc.  Many others do not.  I will finally have earned that sick leave about the time my appointments switch over to "infrequent."  Here's hoping I get to bank almost all of that earned sick leave.  :)

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I have to admit that my goal of increasing exercise has not come to fruition.  Even yoga hasn't happened, although much of that is because things keep popping up on Wednesdays.  I am telling myself that as the days get longer and warmer, I will be more inclined to exercise outdoors (I already know I hate indoor stuff).

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The rest of my time has been spent on something terribly exciting: remodeling the house!  When we moved in about 15 years ago, there were several things we wanted to change.  We then switched into more of the crisis reaction--replacing things as they broke and had to be fixed.  Now that we're in more of a normal routine (that is, two incomes, healthy :)), we started to look at some things we could do to fix up the house.  Fortuitously, interest rates are crazy low now, so we're refinancing and taking out money to re-do a bunch of stuff all at once.  I'm blogging about it (very simply--mostly just photos) at http://unpinkening.blogspot.com.

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Other than that, we've been having lots of fun.  Cara was home all January and then came back last weekend to see Travis in the HS production of Grease!  It's my favorite musical and it's a FABULOUS production.  I've gone four times.

This week Mira starts practice for the Middle School Musical--Shrek.  I love our school district and all that they do.

And it's March.  That's almost Spring, right?  

Routines and complaints

I started this post on Tuesday, when I was in a particularly cranky mood.  But I didn't hit "post" and some things have improved since then, so that's good.  :)  Updates included in italics.

I haven't written much because there hasn't been a lot to write about!  My life has fallen into a pretty nice routine.  I work full-time.  I do fun stuff many evenings and weekends.  I sleep--hard!

I did a spot check and I'm up to 112 appointments related to the breast cancer.  Yikes.  I'm also essentially done with the clinical trial.  I will have 4 boosters 6 months apart, and the big test is on February 3rd.  That's when they do the DTH to see if my body has developed an immune response to the vaccinations I've been getting (if they're real vaccines or the control).  If my immunology skills/memory is correct, I'm hoping for a response (red swelling) of 10 cm or greater.  

I've had a lot of people ask me how I'm feeling, and it's kind of a strange answer.  It's pretty obvious that the acute part of my treatment is over.  Even though I'm still doing Herceptin every 3 weeks, other than the vision issues the first week or so, it doesn't impact my life that much.  I'm taking the Tamoxifen and (knock wood loudly) it doesn't affect me much either.  However, I've crossed over into the land of long-term side effects.  There are numerous articles on the internet about such side effects (here's one), but they certainly are about as varied as are the short-term side effects of cancer treatments.  Some that have been particularly annoying follow.

*I developed TMJ problems last year. My dentist thinks it's at least partially due to my being anesthetized (and intubated) so long.  I've ground my teeth most of my life, but I didn't have this kind of jaw pain until last spring.  I had gotten to the point where I couldn't open my mouth wide enough to eat a sandwich or even a banana.  So I have a TMJ splint now.  I think it's too early to know whether it's fixing the TMJ, but it certainly has given me a lot of other annoyances.  Much like having braces, it makes my teeth ache and it has cut up my tongue and cheeks.  Besides that, I have this wonderful lisp since I have a big chunk of plastic in my mouth all the time.  Yes, it's an all-the-time splint and not just a night one.  It's hard to eat with it in.  I'm hopeful that it'll help me lose weight at least.  :) (Update: at my 10 day check, my dentist trimmed back the splint and it's a lot less annoying now.  I can tell there's significantly less pain in my jaw and I'm able to open it wider.  My lisp is lessened--though not gone--and I can eat a lot more foods with it in.)

*The radiation oncologist said I could continue to see "tissue changes" for several months after radiation was done.  The plastic surgeon said the same, which is why I won't get my permanent breasts until May or so.  I didn't believe them.  But about a month ago, my right side got really tight, my range of motion decreased, and I felt kind of bruised on my right side ribcage.  It's gotten gradually worse and my right arm is numb a lot of the time.  I've got a call in to the OT to have her measure me.  I hate to even say the dreaded word, but I fear it might be lymphedema.   Hoping it's just those "tissue changes."  (Update: I have an appointment with Audrey the OT on Monday morning.  She will measure me for lymphedema, and work on some lymphatic drainage and stretching.)

*I am still experiencing peripheral neuropathy, which is decidedly worse in the cold.  While the rest of my body is hot-flashing, my feet are always freezing.  And numb.  (Update: issues continue, but the temps are starting to climb back up and I'm hoping to get more walking and/or running in, in hopes that I can decrease the neuropathy that way.  I also went to yoga--once--and am trying to get myself to do that more regularly.  If anyone wants to do the simplest yoga with me on Wednesday nights at 7:30 at CORE El Centro, let me know.  My doctor said having an exercise buddy makes it tougher to back out!)

*I'm tired. I kept telling myself it was because of the chemo or the radiation or the fact that I was working two jobs or working more-than-fulltime or taking care of family.  But here I am, working one plain, ordinary 40 hour a week job.  No more chemo or radiation.  My mom's moved and the kids are pretty self-sufficient.  And I'm still tired.  Really, really, really tired.  Not chemo-so-tired-I-might-cry, but tired.  (See above about yoga--the idea of heading out into the cold at 7:30 when I'm so tired is NOT appealing.)

*Chemo brain is real.  And it's scary.  I've always had a fabulous memory for people, places, recipes, you-name-it.  And I can't remember entire conversations now.  Names?  Not a chance.  I am writing notes to myself everywhere, and sometimes I read those notes and if they weren't in my handwriting, I'd swear I'd never heard what they say.  It's embarrassing.  And it's frustrating.  The one thing I do promise myself is that I will not be upset if someone reminds me of something that I have said or done (or promised to do) and have forgotten.  So if you're reading this and I've forgotten something related to you, please let me know.  It's frustrating and embarrassing, but would be much worse if I weren't reminded.


OK, with all that complaining out of the way, I have to say that I'm still happier than I was my last year in Grad School.  :)

I've been enjoying what wonderful big people my kids have become.  Having Cara home this month has been great and I'll miss her so much when she heads back to the Twin Cities next week.

Cara & I working at Starbucks while Mira attends Girls Who Code

Travis has had a very busy month with finishing the semester, taking finals, writing college application essays, working at Culver's, and practicing for the HS musical (Grease).  He also earned an "A" in his very college course (3rd Semester Calculus).  

Mira is a completely delightful teenager (so far).  She seems to be not-hating the rest of her family as much as of late, and in addition to all her school activities, she's continuing with Girls Who Code at Marquette University and just started taking voice lessons.  And she's selling Girl Scout cookies, too, if anyone doesn't have another source.

All three kids have been great about playing games with Greg and I and we love learning more about them through that outlet.  I don't think I've laughed as much in this last month as I did the entire year before!  December and January have been a wonderful gift.

As I was cleaning out some clutter in my room, I came across the journal that my friend Magda gave me after my surgery.  I used the paper journal to write down things that I didn't really see the need to blog about.  It was the rawer version of my recovery.  And in reading it over, I can see how far I really have come in this last year.  It's easy to think that the acute part of my recovery was easier when it's behind me and the chronic stuff is here now, but reading my journal reminds me just how much easier the "now" is.  I'm glad I have that reminder (especially with how crappy my chemo-brain memory is!  LOL).

Blogaversary

I've been meaning to post for several weeks now, but life kind of took off and dragged me behind it...

However, TimeHop reminded me that a year ago was when I started this blog.  Prior to that, I'd only told a few close friends (and family) about my diagnosis, but I definitely went public with the creation of the blog.  Once again, the outpouring of support was awesome--and I'm so happy I decided to be public through it all.

So since the last time I posted, a few more things have happened.

I finished the immunization part of my clinical trial (will still have boosters every 6 months four more times).  This is exciting for two reasons.  First, it will cut my every-three-week Herceptin appointments in half time-wise.  Secondly, I'll be able to stop taking the preventative Claritin doses.    I don't remember if I shared how the immunizations are given. I get (got) 4 intradermal doses in my left thigh.  That's like the TB test where they put a bubble of liquid under the skin.  This is what they look like about 15 minutes after they're given.

Over the next 24 hours, the redness fades, then comes back unbelievably itchy!  

I'm also at the 9 month point in my 12 month Herceptin course.  That's good because at least one preliminary study showed similar efficacy of 9 months of Herceptin and 12 months, so even if I were to develop side effects that prevent me from completing the full course, I've gotten in the majority of treatment (and there's no sign of heart issues--my last MUGA scan in November actually showed improvement of heart function--68%--from the one done after chemo--56%).  

I no longer need blood work done at every appointment.  This last week Dr. Shah did some to check on a more routine basis.
WBC:  3.9K/mcL
Platelets:  85K/mcL  (low, but about normal for me)
Hemoglobin:  11.9 gm.dL (just barely low--pretty good for me!)

I've also been able to successfully titrate up to the full dose of Tamoxifen (20 mg/day) without the side effects I had when I first started it.  I've been splitting the dose and taking half in the morning and half at night, but I'm hoping to try to combine them into a single dose a day.  I hate having to remember pills twice a day.

The Effexor experiment was a terrible failure!  It's supposed to help with the side effects of taking Tamoxifen (hot flashes, mainly).  I think it was helping with that, but it had its own side effect of spiraling me down into a pit of anxiety!  The same thing happened when I tried a different anti-depressant (Wellbutrin) several years ago, so I'm thinking that I don't do well with non-SSRI antidepressants.  Unfortunately, SSRIs interfere with Tamoxifen.  On the bright side, though, I haven't needed one.  Fingers crossed that it keeps up through the winter.  I have my Happy Light at the ready just in case.  :)  

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I am now down to a single (full-time) job.  As much as I loved teaching, putting that on top of learning a new job was a bit stressful.  I do hope to be able to teach again in the not-too-distant future, but am enjoying some time off now.

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I've really enjoyed having nights and weekends free (see above) to hang out with my friends and family again.  Cara is home for the whole month of January, which is great.  We've spent a lot of time playing goofy family games (if you haven't checked out Jackbox.tv,  I highly recommend it!  You need an Xbox, PS or Steam account and a bunch of smart phones or tablets to play).  It's nice to also have time to cook--which I find very relaxing.

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And I've been knitting more again.  While moving Mom's stuff out of her house, I came across all her knitting stuff.  I'm working on "busting her stash" (that's knitting talk for using up the un-used yarn she had) and trying to finish some of her UFO's (unfinished objects).  I love my Thursday night knitting group (email or message me if you want to join us and I'll send you details). I've been on a dishcloth kick lately.

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Finally, I plan to try to get my weight under control with this new year.  I am ashamed to say that I have gained almost 35 lbs. over the course of my treatment.  I know it won't be easy to drop all that weight (possibly impossible, given that I'm now "post-menopausal" which makes weight loss a lot harder), but I feel generally yucky being this heavy.  I'm not going to focus so much on the weight loss, but on becoming healthier with exercise and hoping the weight goes with it.  I've stopped running and want to get back to that.  I also want to start yoga, but am not sure when or where or how to fit it in.  I'm open for taking walks anytime, anywhere, as that's always an easy way to bring in exercise.  And I'm open to FitBit challenges from anyone.  

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Here's to an amazing 2016 for all of us.  I'm making Hoppin John with greens today to help insure that.   :)

Happy lumpversary to me

One year ago today, while showering, I felt a lump in my right breast.
One year ago today, I said to Greg, "Give me your hand.  Can you feel that?"
One year ago today, Greg said, "It's probably nothing, but you should get it looked at just in case."


Since that time, I have had 103 medical appointments.  My world's been turned upside down.  My priorities have been reorganized.  And yet I think I'm in a much better place than I was a year ago.

A lot can happen in a year.  

Tamoxifen, take two

Though I am not a fan of snow, it's kind of nice to be "snowed in" today with the whole family.  Mira was up early and made pancakes from scratch for us all.  I had eggnog in my coffee this morning, deciding to embrace the snow instead of despise it, and I'll spend much of the day correcting papers, reviewing a book chapter and planning the rest of my semester of teaching.

This week I had another Herceptin infusion and #4 of 6 immunizations in my clinical trial.  Nothing new to report there--same immunization-related reaction (chills, low grade fever, exhaustion) on the day after my appointment.  Same itchiness and redness at the site of the intra-dermal injections.  It's been three months since my last one, so I get another MUGA scan of my heart, too.

At my appointment with Dr. Shah this week we discussed the Tamoxifen situation.  She *really* wants me on it (or another estrogen blocker) and does NOT want to put me on Lupron (which is a GnRH agonist resulting in blocking estrogen production), which would be necessary to try aromatase inhibitors (Arimidex).  She doesn't want to do Lupron because the side effects are similar to those I've been having with Tamoxifen, and then if you add in another med (Arimidex) and its potential side effects, you're kind of asking for trouble.  However, she did say that she would consider switching me over after one year (previously said two years).  I told her I could put up with the pain for a year, but she suggested we try something else instead.  So I'm on a half dose of Tamoxifen now to see if the side effects come back.  The plan is that if they don't (fingers crossed), then she will titrate me up to a full dose--possibly split between evening and morning--and maybe I'll tolerate it better that way.  

I've also started a low dose of Effexor (an antidepressant used off-label to combat hot flashes) in hopes that I won't be woken up so many times in the middle of the night due to the hot flashes.  I'm not sure if they've gotten worse since adding the Tamoxifen, or if it's worse with the temperatures dropping (so I'm constantly veering between boiling and freezing), but I thought I'd try to see if I could get some relief.  I should know within a week if it's working.

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In other news, I've been at my new job two weeks now.  I love it!  Almost everything about it is completely new--including all the terminology and acronyms--and my brain is getting quite a workout, but it's really, really cool!  I'm ridiculously giddy every time I get a physical reminder of how I'm now part of the team (got my business cards, my name got added to the phone system, I ordered tops with the health department logo on them, got my ID picture taken). I work in a village hall (in one of the 7 communities covered by the health department) and it reminds me so much of my mom's work environment at the Iron County courthouse.  Everything about it--from the police department being housed right there (but behind locked door--they even have the good soda vending machine) to the break room--makes me smile to think how my life's changed since then.  It gives me a nice sense of comfort to have the familiar in the midst of all the new.

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I'm looking forward to seeing Cara this week for Thanksgiving.  The stretch from August to Thanksgiving is always so long.  I get Thursday and Friday off of work, so we will do some Black Friday shopping.  And we'll be having turkey with Greg's family for the first time in several years, and that will be fun.  

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Mom's house is ready to be listed.  The realtor will be coming to take photos tomorrow and it should go on MLS on Monday.  It looks awesome.  I'll be sure to post the link on Facebook when it's released.  My brother came down last weekend to help move the rest of Mom's things up North (including her motorized recliner).  Although he drove down, loaded up, and turned right around to head home, it was nice to see him, however briefly.

Tamoxifen

Time is just flying by.  Since my last post, Mom made her move Up North (email/message me if you want her phone number and/or address), I have almost finished my part-time job at Zilber (which was bumped up to full-time for a few weeks, but that's a different story), and I started on Tamoxifen.

One of these things did NOT go as well as hoped.  :)

I really cannot complain too much, as it's not like the Tamoxifen is making me house-bound.  But it's pretty yucky just the same.  All my joints ache, but especially my hips.  By the end of the day, it hurts to walk (so you know what's happened to my exercise plan and my great ambitions using the FitBit). And it's upsetting my stomach, too.

This week at my meeting with Dr. Shah, I told her about all the yucky stuff I was feeling, and she said that my symptoms didn't sound like typical Tamoxifen side effects, so the first thing we had to do was figure out whether they were being caused by the Tamoxifen or something else.  (She thinks it might be the Herceptin or the clinical trial meds.)  That means I'm off the Tamoxifen for three weeks to see if the side effects disappear.  So far my stomach upset has stopped (yay!) and I'm not as achy, but that might be because I've been using Advil and Tylenol to counteract the effects of the clinical trial (typical vaccine-related, immune response symptoms).  We shall see...

I'm not quite sure what will happen if it is the Tamoxifen.  Standard of care is switching from 5 to 10 years on it, so while I could tough it out and put up with the ickies through either the clinical trial (9 more weeks) or Herceptin (6 more months), I'm not sure I could handle it for ten years.  Guess we'll see what the next three weeks hold.

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Mom's move went very well and she's settled in and, other than missing her recliner, very happy in her new digs.  She's had visits from many friends that she hadn't seen in years, and is thrilled to be closer to my brother.  I'm much relieved that everything went so well, and also occupied readying her house to go on the market next month (anyone want to buy a ready-to-move-in home in an awesome school district with FABULOUS neighbors?  ;)

~~~~~
And my last week of work at Zilber is crazy, but fun, too.  I decided to stay on to get through the travel stuff for the recruitment job, and that means that from today to next Thursday night, I have events non-stop, including an overnight trip to Delavan, a 3-day trip to Chicago, topped off with the UWM Grad School Fair next Thursday night.  Then I start my new job Friday morning.  Of course, I'm still teaching, too.  And I'm tired (very tired), but I'm not exhausted.  In June, when I could barely keep my eyes open enough to work one 8 hour shift, I never thought I'd be able to work full-time (plus) again.  It feels good!  Now if I could just shake the body aches... 

Major life changes--and some fear

I realize it's been almost a month since I last posted.  Partially it's because there's not been much cancer-wise to post about. Partially it's been because I've been so busy that I haven't actually had time to sit and write a post.  But mostly it's been because I haven't so desperately needed to blog lately.  I began this blog to give myself something to do during my (at the time) upcoming recovery, and to help myself remember my journey.  But it became a sanity-saver and a mood-booster, as I (selfishly) watched the numbers on Blogger's Stats page.  My highest count was 314 on one post.  314 of you read something I wrote (or a few of you read it many, many times...).  I doubt that anything I ever have written (publications?) or will write professionally will be read by that many people.  That's a huge bump to my ego.  :)  However, I haven't needed to see those numbers as much, as I'm re-entering, and slipping back into a less me-focused place.  As I have been going through treatment, I've found myself very self-centric.  I liken it somewhat to both the toddler and the teenage years, where it's difficult for the kid (or me!) to look at life through anyone else's lens but their own.  I realize that it's at least partially necessary, as healing takes so damn much energy!  But as I've regained energy, I've been more easily able to shift the focus from me-first.  That excites me.

So as an update, I'll start with the cancer stuff, following my appointment with Dr. Shah yesterday.

My weight is still up a little bit.  Admittedly, I haven't been trying too hard to eat healthy (busy life = quick food and too many carbs), and I'm not running much, although I have a FitBit now and that does make me work hard to get in at least 10K steps a day.

My labs are fine:
Hemoglobin 11.3 gm/dL
White Blood Cells 4.2 thou/mcL
Platelets 72 thou/mcL

I'm glad that I'm mostly maintaining my hemoglobin with only one iron tab a day, and that my platelets are hanging in there.

I had my second "Herceptin-only" infusion yesterday.  I'll have these every three weeks until April 13 (if I did the math correctly).  I didn't write after my last Herceptin infusion, because it didn't go all that well.  I mentioned earlier how I am taking part in a Phase II Clinical Trial for NeuVax ("the breast cancer vaccine").  I had my first inoculations (4 of them) last visit, and will have the same four given each of these first six Herceptin-only infusions.  After the first ones, which hurt like hell, by the way, I came home and crawled into bed, shivering horribly, with body aches, a fever, and generally feeling like I had the flu.  The injection sites had knots under them, were red and swollen, and itched like crazy for over a week.  As I was lying in bed that night, miserable, I started to look up more information about the NeuVax trials--which was a stupid idea in that state!  I did find something that said low platelets could be a reason to exclude a patient from the clinical trial, as could an autoimmune disease.  So that freaked me out a bit.  I then struggled mightily about what to do with my participation in this clinical trial.  I have, from the start, been absolutely sure that I wanted to do this, half-joking that I owed it to all the mice I sacrificed in the name of science for my doctoral research.  But now I was starting to have doubts--especially after reading the sensational posts about NeuVax and how it was doomed to fail, and actually increased the risk of breast cancer returning (ahem. I *teach* how to know a website that gives reliable health information from an unreliable one, and I was still being sucked in).

Anyway, I did call the Clinical Trial team and voiced my concerns.  They immediately contacted the lead PI on the trial and reassured me that I was still eligible (the platelet thing was in combination with other risk factors, but they will still watch my levels closely, and ITP is not an autoimmune disease that they were concerned about).  Furthermore, now that this trial had been going on awhile at different sites (did I mention that I was the first one enrolled in the trial at my site? First for the nurses to give the injections?), they had some tips to ease the side effects.  I also convinced myself (whether correctly or not) that if I had such severe reactions to the injections, I must SURELY be getting the real thing (I'm blinded to whether I'm getting drug or control).  So I took Tylenol before this round, and have kept up my levels since then.  The injections weren't so painful this time (nurse had more practice), and while I hit a wall of exhaustion last night, it wasn't as bad as the first time, and I didn't have the other flu-like symptoms.  Best of all, I'm helping out Science and Cancer Research in a way that not just anyone can do.  Take that, Pinktober!!!

Since I'm doing so well--almost no signs left post-radiation other than a bit of a tan around my right breast area--that meant that yesterday I got the all-clear to start the next phase of my treatment: hormone blocking.  My particular tumors were estrogen and progesterone receptor positive, so I need to take adjuvant therapy (pills) to block the hormone production. The big choices are Tamoxifen or an aromatase inhibitor (most common is Arimadex).  Most of the estrogen in the body is produced by the ovaries, and Tamoxifen blocks its production. Aromatase inhibitors only block hormone production by fat tissues.  As you can imagine, a drug that only acts on one type of tissue (fat tissue) would be expected to have fewer, less-serious side effects.  And that's the case.  So if your ovaries are no longer producing estrogen, aromatase inhibitors are for you.  However, if you're pre-menopausal, you need the bigger guns that act on your ovaries.

I'm not (yet) post-menopausal.  I've been lucky enough to be going through chemically-induced menopause most of this year, but I'm not clinically there yet.  So I get to at least start with Tamoxifen.  The plan is, if I've still not had a period in the next two years, to switch to an aromatase inhibitor at that point.  Recommendations are continually being revised as to the amount of time it is best to stay on hormone blockers.  Standard of care currently says five years, but there are multiple studies now looking at ten.  Who knows what they'll recommend in five years from now.

For some reason, the Tamoxifen is causing me much more fear than the other treatments I've had.  Maybe because I knew the others had a relatively short timeframe?  Maybe because I had no time to think about the other treatments without having to just DO them?  But mostly, I think, I'm afraid because this is supposed to be the "easiest" of the four (surgery, chemo, radiation, hormone therapy), and while I wouldn't call the other three pleasant, they haven't been as bad as I expected.  And now I'm afraid this will be even worse than I fear.  The side-effects scare me:  blood clots, uterine cancer, cataracts, intense menopausal symptoms, weight gain, depression, trouble sleeping, vision changes.  Maybe I'll be pleasantly surprised by how easy hormone therapy is, too.  If only I could convince my brain of that!

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There are a few major changes in my family, too.  One of the biggies is that my mom, who has lived next door to me for the last 7 1/2 years, is moving back Up North.  It's really her story to tell, so I won't elaborate much on it, but I know she is looking forward to seeing all her Hurley-area friends, and especially living close to Steve and Amy.  And I realize it's time.  I had her here for the majority of my kids' growing-up time.  She came down when Mira was  in Kindergarten, Travis finishing Elementary School, and Cara finishing Middle School.  She gave my kids a chance to have a grandparent be part of their everyday (every day!) lives, and she made it possible for me to go back to school and to earn my grad degree.  But now my brother should have a turn.  :)


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The other big news is that next month I will have a new job.  Not only will it be a full-time job (my first since 1997), but it will be a job in my field--the one I went to school for 5 1/2 years for.  Starting November 6th, I will be a Public Health Manager at the North Shore Health Department, which services seven suburbs in Milwaukee County.  I am beyond excited to start, while at the same time being sad to leave Zilber--especially all my co-workers (past and present).  I am lucky that I am able to continue to be Adjunct Faculty at Zilber, and will continue to teach PH101 this semester, and possibly other classes or give guest lectures in the future.  To be honest, I'm a little afraid to be leaving that cocoon, too.  I've been part of the School of Public Health for over 6 years.  But--again--I think it's time to do something else.

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Besides all that, life continues to be very good.  Mira had a great season with the Middle School Cross Country team and got second in her age group at the Panther Prowl today, running a 24:30 5K.

 Travis is getting ready to apply to colleges, and is enjoying his Senior Year.  This week was his last homecoming, and he's at the dance right now.

I assume my posts here will continue to be less frequent, but it's been really nice to write again, so I certainly won't stop entirely.  I'm also looking forward, with my new job, to have normal hours and therefore evenings and weekends off!  I've loved re-connecting with many of you, and hope we can continue.  I'll be crazy-busy between now and the end of the year, working 125% (full-time job plus 25% appointment teaching), getting Mom's house ready to put on the market, and all the other things that come with life.  But come that first week in January, I fully plan to celebrate my first year Cancerversary.  :)  It's giving me something to really look forward to.