Even the best type of cancer really sucks.

I've written before that I have a ridiculously low tolerance for stress. Seriously, I should probably be on some sort of anti-anxiety medication, but I hate taking medication (it stresses me out) and I also hate going to the doctor (it stresses me out), so these latter two points pretty much make the former impossible. And anyway, even if I went to the doctor and got a prescription for a chill pill, I probably wouldn't take it as I should, seeing as how I haven't even been able to take Vitamin D regularly despite knowing that I'm severely deficient. But that's not what I came here to write about. I actually came here to write simply because writing is one of the most effective outlets for my anxiety, so I create problems to write about. Okay, so that's not totally true. My problems are real; it's just that a person with a higher tolerance for stress would probably not see them as things worthy of writing about. They would just think, Eh, whatever, and get over it, then go clean the bathroom, which is what I should really be doing.

Yeah so anyway, where was I and why did I come here? LOL. It's like I have chemo brain, but wait... I'm not even doing chemo. Which, by the way, apparently makes my cancer 'not real' in some people's minds. It's not cancer without chemo. Whatever, people! It's like the moms who feel like you didn't actually have a 'birthing experience' if you didn't give birth to your kids naturally, without drugs, or worse, had a * gasp * C-section! OMG! It's hard enough being a mom in this insane world of competitive mom-ing (which I've already openly admitted to being DFL in); I don't exactly want to get into a pissing contest of My Cancer Is Worse Than Your Cancer.

Which is sort of why I am here, I think. The last paragraph provides a good segue, anyway. My cancer is not worse than your cancer; in fact, as far as cancer goes, it's pretty much the best cancer you can have, which is actually what my PCP told me when he broke the news to me. He said something like, 'If you have to have cancer, this is the best type to have.' In the large scheme of Cancer Land, I feel sort of guilty about having the best type of cancer: early stage, not overly aggressive, estrogen and progesterone positive ( = treatable), and in a body part that can be easily removed. But you know what? It still fucking sucks. Suckity, suckity, sucks. And I know that I'm supposed to feel grateful that I don't have advanced cancer, or triple negative cancer, or metastases, and trust me, I am, but having even the best type of cancer sucks way more than not having cancer at all. And I know this would all be much easier if I had a positive attitude, but seriously, after 40 years of being me, it is about as unrealistic to expect that I will miraculously become positive as it is to think that forgoing traditional treatments and ingesting various oils from the health food store will cure me. (Yes, someone actually suggested this to me. Seriously, even if you are tempted, resist the urge. I beg you.)

Not that I came here to have a pity party, but one of things that has been sinking in over the past few weeks is the reality of my 'new normal.' And speaking of 'new normal,' apparently this is one of those cute little catchy terms that is thrown around a lot in Cancer Land, along with things like 'cancerversaries' (which makes me want to throw up just reading it). I think when I was initially diagnosed, I was just so happy that I had the best prognosis possible that I got somewhat complacent, perhaps even smug. I felt like cancer was a little blip of inconvenience that was going to rob me of a summer vacation, but after all was said and done, I would go on with life and put it behind me. But as I move toward accepting my new reality, I realize this is so. so far from the truth. I was not wrong to rejoice in having 'the best cancer possible,' because I do have a good chance of going on to live a regular life and dying of something other than cancer (maybe something even worse), but the reality is that even the best cancer is no walk in the park. This is, at best, something that will cause me life-long anxiety, and at worst, come back in future in a location other than my breast (in cancer speak, a 'distant metastasis,' or simply 'mets') and kill me. Most people are familiar with the term 'remission,' but with breast cancer, they don't use the term remission, but instead 'no evidence of disease' or 'NED.' This is sort of unsettling; you are never truly cured. They can't ever say you don't have cancer; you could have it and they just can't see it. Sometimes they can't see it until it pops up somewhere else in your body, at which point it is life-threatening, and you are considered 'incurable' and terminal. And although I have the 'best cancer possible,' it is not The Very Best, because I am only 40. The Very Very Best in the My Cancer is Better Than Your Cancer scheme of things would be that I would have this cancer at age 80, or even 70, or 60, or 50. As my oncologist has reminded me, cancer at 40 is different than cancer at 60.

It has been surprisingly hard for me to wrap my mind around the idea of a mastectomy, and to be honest, I've been surprised by how hard it has been for me. I have a lot I could say about this, but I'll save it for a post of its own. For now I will just say that it is a difficult thing, no matter how you might feel about your breasts. However, looking waaaay forward, the mastectomy is not actually the most upsetting thing, and that's saying a lot, seeing as how I just wrote about how upsetting the mastectomy was. LOL. There is some relief in knowing that with a mastectomy, it's unlikely that I will need radiation, which is also much more difficult than many people realize. Unfortunately, a mastectomy will not eliminate my need for anti-hormone therapy. My cancer is strongly estrogen and progesterone positive, which is good news in that it is treatable, but bad news in that in order to treat it, I need to mess with my hormones. This is complicated, and has some really unpleasant side effects that while not life-threatening, can really diminish your quality of life. This is a long-term thing. It is quite possible that in the near future, I will not only have a mastectomy, but also have my ovaries, and perhaps uterus, removed. This is not a difficult surgery from a purely surgical standpoint, but as a biologist, I understand that ovaries do a lot more than make eggs so that we women can have babies. But I'll save all that for a post of its own. On top of this, if I go this route, I will need to take a medication called an aromatase inhibitor for ten years, which can have really bad and sometimes intolerable side effects. This is the best case scenario, that I live to experience all of this.

And again, I know I should be grateful I have a good chance of surviving this. I am. Don't get me wrong. I really truly am. I've been reading blogs by people in Stage IV who can't wait to have a mastectomy and radiation and chemo because anything that will give them a 5% chance of living for another six months is an amazing thing. If I were terminal, this post would be much, much different, and I am very grateful to not be terminal. At the same time, I don't believe that we should necessarily have to be happy all the time just because things could be worse. Things could always be worse, but they could also be better. I also understand that very few people who are terminal were terminal at the time of their first diagnosis; in fact, many started off like me. Of course, the Internet is biased toward the terminal, because terminal cancer provides more blogging material than I had cancer and now I'm over it does. I've never been a person to take a lot for granted; in fact, I feel that I've lived such a blessed life, I keep waiting for something horrible to happen. So, as morbid and pessimistic as it may seem, I am not going to take my 'best cancer possible' for granted. While I will continue to be grateful for what it is, I will never lose sight of the fact that this is something that can kill me. Maybe this is the beginning of the end of the crazy awesome luck I've had for the first 40 years of my life.

One of my colleagues is a very accomplished academic who, over the past year, has also become a good friend. This colleague's research is highly focused on breast cancer, so it did not surprise me when she told me that her mother had passed away of breast cancer. This was when my colleague was in high school and her mother was in her 40s. This colleague is a lot like me - not very open emotionally - so I don't know if her reluctance to talk about terminal breast cancer with me is that she just doesn't like to talk about it (which I get) or that she doesn't want to talk about it with me because she knows what I'm going through and her personal experience with this does not have a happy ending (which I get). At any rate, in the few discussions we've had about breast cancer, she shared with me that in the end, her mother had refused chemo because she was just done with everything. I never caught the full details but it's something like her mom had a mastectomy, had her ovaries and uterus removed, took tamoxifen, and was just... done. She said her mother felt like everything that could be taken from her had already been taken and saw no reason to keep fighting. So she refused chemo, and died. I get it, I do. I've had a few experiences with our medical system that make me truly understand why, at a certain point, many people feel like Just fuck this shit! And yet it hurts, knowing that my colleague went on to get a Ph.D. from Harvard, become a really amazing academic, marry and have two kids, and the whole nine yards. It must have been really bad for her mom to give up all chances of seeing this because she was done. It makes me worry just how bad this is going to get. Will I reach a point where I don't have any fight left in me? Where I just feel like a shell of a being with no reason to want to at least try to keep living? Is my colleague angry with her mother for not doing everything in her power to live to witness her accomplishments, to be Grandma to her children? Would my kids be angry with me if I just gave up, or would they understand?

A lot of people have told me that I've been very brave throughout all of this, but the truth is I have not. I have gone with the most straightforward choices in all cases, which is what any rational human being would do. I've also wallowed in self-pity, been self-centered, self-absorbed, short-tempered with my kids, I've lamented trivial things like not going on vacation, I haven't resumed my daughter's piano lessons because I'm still ticked off with her piano teacher, I've felt like I was at rock bottom even though I am aware it can and will get much, much worse, and might not ever get better, that my rock bottom now might very well be the baseline in my 'new normal.' In short, I feel like I've been a big, giant crybaby, minus perhaps the crying. It is not a good feeling.

But don't worry. I have a plan about how to get through this, how to stop wallowing in self-pity. It started with me going to see my PCP today to get a prescription for Ambien. (I started writing this yesterday.) With the exception of the first week of vacation, I've been averaging about 4-5 hours of sleep per night, in 1-2 hour increments, since about May 1st. This is not enough. This lack of sleep is certainly not helping my mental state. I am exhausted. Dr. A and I briefly discussed the possibility of me taking an anti-anxiety medication or an anti-depressant, but for now I am going to forget my worries about losing the ability to fall asleep on my own and take Ambien as needed. If this doesn't help significantly (though I believe it will), I will consider an anti-anxiety or anti-depressant. I've got other plans in place, too, but I will have to save those for another time. Right now, I need a nap.