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?
