Tamoxifen, Here I Come

I pushed it way too hard today. Sadly, 'pushing it' meant driving myself to my appointment, six blocks away, with my medical oncologist, dropping my daughter off at a friend's house along the way. I came home and was wasted tired, and despite napping, still feel horrid. It's beyond tired; it's that all-consuming, my body feels like it weighs 400 pounds tired.

Anyway, after scheduling appointments and canceling them I don't know how many times, I finally met with Dr. M to discuss part 2 of this never-ending nightmare. I fully expected to have a conversation about tamoxifen vs. ovarian suppression + something called an aromatase inhibitor, but it wasn't even an issue. It was so not an issue that I sort of questioned him about it, wondering if he remembered who I was, what my story was, the conversations we had had in the past.

To make a long story short, because I am tired, tired, tired, tamoxifen is the traditional route for pre-menopausal women. Or, to be more precise, it is the only route. Tamoxifen affects estrogen, and since my cancer is strongly estrogen-driven, taking tamoxifen will reduce my chances of a recurrence by 50%, according to Dr. M. I need to take it for at least five years, maybe ten. We'll cross that bridge when we get there, if I even get there. The only reason to not go this route is because of my history of DVT and the fact that I'm only 40. Tamoxifen can cause blood clots, and though it's fairly rare, I am at higher risk for this simply because of my history of DVT. As for being 40, which is 'very young' in Cancer Land, some oncologists would argue that I might want to be more aggressive. (In fact, one has.) Tamoxifen is the conservative route for me; ovarian suppression + aromatase inhibitor would be more aggressive.

I'll be honest - I've been DREADING ovarian suppression, which would mean getting shots every month to force me into menopause so that I could take an aromatase inhibitor. One of the major side effects of this is premature arthritis, and joint pain/degeneration, which is the second to last thing I need (second only to a recurrence, lol). I've gone back and forth between which route I want to go; there is a fine line between fending off a recurrence and ending up in a wheelchair. I had been leaning toward the more aggressive route after reading too many stories about how scary it is to have cancer at 40, but... I was easily persuaded back to tamoxifen with Dr. M's endorsement.

The more I think about it, no matter what route I choose, I'll never feel confident that the cancer won't come back and metastasize, and eventually kill me. Never. So quality of life matters to me. If I have a limited number of years in this body, I want them to be good years. Of course, we all have limited years. I keep thinking back to a professor I had in grad school who, despite being an exercise physiologist, complained about how the benefits of exercise were often exaggerated. As he used to say, we should not be espousing the idea that exercise will add years to your life, rather life to your years. It's about quality of life, not necessarily living longer. We can do everything right and still die before we think we should.

Dr. M said he was not overly concerned about my DVT, given that it was provoked by surgery. I don't have a clotting disorder, so my risk of developing blood clots as a result of being on tamoxifen is small. My cancer is not overly aggressive, and my oncotype DX, which predicts the probability of a recurrence, is low. Dr. M said the data showed that the women who benefited from a more aggressive therapy were those who had undergone chemotherapy for lymph node positive cancer who were under 35. So that seals it. Just as I didn't need convincing that I would have only a small benefit from chemo that was not worth the risk, I didn't need a ton of convincing that there was not compelling evidence that the benefits of the more aggressive route would outweigh the effects it would have on my quality of life.

I left with a prescription for tamoxifen, although Dr. M said I didn't need to start taking it right away - 'when you're ready.' He did say he would like me to start taking it before 2016, but that he understood that I've been through a lot, and this is all just... a lot. A lot to take in. He also said he did not think I would find the side effects to be horrid, and counseled me to not read too much on the Internet. LOL. After I've taken it for a month, I need to see him again so he can run some tests on me and make sure everything is copacetic. I made an appointment to see him again on November 20th, which means I need to start taking the tamoxifen by mid-October.

So basically I need to focus on recovering so that I can prepare to attack the natural order of my body in a new way. Fun stuff. Said no one, ever.