Goodnight Tamoxifen

I feel like my life is one big ping pong match in which I go back and forth between cancer and hips and cancer and hips and cancer and hips. It is one big story of damage control.

I've been sick all week with some nasty crud that keeps me awake all night coughing and has stolen my voice. As far as nasty crud goes, I've had worse, but the sleep deprivation is always what gets me. Plus, for someone who makes a living giving lectures, it's pretty inconvenient to not be able to talk. I had to cancel class on Tuesday because I literally had no voice.

Ever since my appointment last Thursday, I've gone through various stages of Kübler-Ross grieving, and shockingly, I'm in a pretty good place right now. I'll have to write about it later. Nevertheless, I'm sort of totally freaking out about next fall, and my job. There are some complexities of my job that I won't go into here, but I feel like I definitely need to work full-time next fall. It's not just because I took last fall off and the fall before that half-time - though that's huge - but there's other stuff as well. Lots of moving parts. And because of the nature of my job - teaching at a university - I can't really just take time off until I'm ready to come back. We don't have substitutes like in K-12, and trying to come back mid-semester is pretty tough. Obviously unexpected things happen, in which case you deal with them, but if you KNOW there's something that's very likely to happen, like having your hips sawed apart and screwed back together, that will very likely interfere with your job at a predictable time and in a predictable way, it's the responsible thing to do to make arrangements ahead of time.

I know my Chair is probably burnt out from dealing with my crises and from generally being overworked and underpaid, so I've been hesitant to say anything - plus, his wife is expecting a baby any day now, and holy crap, I forgot to ask how she was doing and I pray she did not actually have the baby yet because that would make me the hugest, self-centered jerk ever! However, stress got the best of me today, and because I'm super Type A, I just had to tell him what was up, because one of my 'solutions' for the fall is to make a change to one of my classes that needs to happen within the next few weeks, before students start registering. Today seemed like just as good a day as any to burden him with yet another of my problems. Now that I think about it, it's probably better now than after his baby is born (which hopefully it was not). I think I hit a new low, going into his office and squeaking about my hip problems in my barely-above-a-whisper voice. Like, gee, am I not the most pathetic employee EVER? I know, I know, I didn't ask for any of this to happen, but even my own mind is boggled over the ridiculous sequence of health catastrophes I've had over the past few years, and I have to admit that if I were an outsider looking in, it would come across as attention-seeking behavior. I mean Jesus Christ. Fortunately, my Chair is an outstanding human being, and I feel better now, because he held my hand (not literally) and told me it's going to be okay. Also, there has been a lot of crap coming down on me this year, and whereas I'd normally get snarky and combative about a lot of it, I've been extra chill, just because my department was sooooo supportive of me with the cancer ordeal, I feel like I need to grin and bear it and play nice. Now I'm suuuuuper glad I haven't been a jerk, even when I've wanted to be (and if you know me, you know it takes a lot of self-restraint for me to not be a jerk).

And oh my gosh, as you may have guessed by the title of this, that's not even what I came here to write about. On the other side of the ping-pong net, there's CANCER. A while ago, I wrote about how I was in what I suspected to be a tamoxifen-induced stupor. I re-read those words I wrote, and I can't believe those words came out of me. That wasn't me. I went to see my primary care doctor about this, and he really helped me out of the hole. I wish I had written about it then, because I don't really remember the details, although I do remember him telling me that if he thought I was going to harm myself, he was obligated to have me locked up for three days. I told him that even though I was hoping to die, I had no plans for how it would happen, and apparently that was okay. As long as there's no plan.

I took an anti-depressant for a little bit, but it made me feel horrible, so I stopped. I stopped everything - the anti-depressant, the tamoxifen, the baby aspirin. It was my own decision. My PCP did not really approve, and told me I needed to talk to Dr. M about it ASAP, although I do think he could see firsthand at my follow-up appointments that I was sooo much better, so he didn't push it too much. I think it was mostly due diligence. I also, somewhere in all of this, had an appointment with Dr. T, who, as usual, expressed concern over my weight. I briefly explained to him that I really felt like the tamoxifen had done a number on my appetite, but that I wasn't currently taking it, and I had actually gained weight since I stopped (which basically makes me the opposite of pretty much every other woman I know who has taken tamoxifen, but whatever). He obviously didn't approve, either, and urged me to see my oncologist about alternatives. Unfortunately, I know what the alternatives are, and they don't sound fun, either. And I just wanted to enjoy being myself for a while.

But stress of my recklessness eventually got the best of me, and so I made an appointment to see Dr. M. That appointment was today. I haven't taken the tamoxifen in about three months, so I think I have a pretty clear picture of the effects it was having on me. First and foremost, the severe depression was definitely the tamoxifen. I think it snuck up on me, though. I'm not a super happy person naturally. I don't handle stress well at all, and while I think I have a deep appreciation for life that might surprise people who don't read my blog, my default mood is more melancholy than happy. A low-level disgust with life in general is normal for me, lol, BUT, I've never experienced anything like I did in December, and it was quite honestly downright scary. Second, I've mentioned a couple of times that I felt like all those surgeries I had made me stupid, and I really wasn't kidding. Since cancer, I have not felt as mentally sharp as I used to be. Many people who have chemo talk about 'chemo brain,' which is a real thing. I didn't do chemo, so for a while I just thought I was having empathetic or guilt-induced chemo brain, or the exhaustion from all the surgeries and trauma of cancer in general zapped some brain cells, or at least some dendrites. The thing is it never got better, even a year later. I still felt foggy. When you're standing in a large lecture hall, lecturing to 85 people, and not only can you not think of words that you could once spout off in your sleep, but you also can't even remember what you were talking about to think of an alternative explanation, it becomes pretty clear you aren't just making it up. It turns out a lot of that was the tamoxifen. Not all of it, because these lapses still happen occasionally, BUT, I am so. much. better. And finally, there are the little things - nausea, loss of appetite, cramps, fatigue, hot flashes.

I reflected on all these effects before my appointment and decided that I could put up with the little things, and probably even the tamoxifen brain, but that I was so terrified of the depression that I was pretty sure I didn't ever want to take the tamoxifen again. Then again, there was a little voice inside of me that said maybe it was doable if I vowed to be extra vigilant about looking for signs that I was heading downhill. However, I was pretty worried about this, especially considering that with four impending surgeries and over a year of intense rehab ahead of me, I really need to be in as positive a state of mind as I can be.

These were the things on my mind as I headed off to my 4:30 appointment with Dr. M. I started off telling him in some detail of my slow decline October through December, ending with me crying in my PCP's office and on the brink of being locked up for three days. I told him I had stopped taking the tamoxifen, that I hadn't taken it in three months, and that I felt great. I basically told him most of what I wrote above. He listened very carefully, then said definitively that he was completely okay with me not taking the tamoxifen. I mean, obviously it's my choice and no one can make me take it, but he didn't say it in a you are being stupid or well it's up to you - I don't care if you die! type of way. He said it very thoughtfully.

Then he said he wanted to make a few things clear. I should not see tamoxifen as a 'life-saving' drug. The original cancer is gone. The mastectomy was what was 'life-saving.' Tamoxifen is simply a drug to help reduce the chances of a recurrence. Since I've already had cancer, and I still have breast tissue, I'm at a high risk for getting more cancer. But, a recurrence doesn't necessarily mean I will die - 'It just means that in a few years you might be sitting in my office again, going through the same thing you went through before, facing the same choices.' Weirdly enough, that statement was both alarming and comforting at the same time. Of course I don't want to deal with this again. At the same time, how bad was it? I mean, I'm here, after all. And there was a time in December when I really didn't think I would make it, nor did I want to. Dr. M did mention that there was a chance that the cancer would come back as metastatic cancer, but that could happen even I continue to take the tamoxifen. The cancer may come back, in any form, regardless. He concluded, 'When I hear that the tamoxifen has turned a perfectly good microbiology professor [sic] into a vegetable, I vote to stop it.'

He said the chances of a recurrence are approximately 20%, and the tamoxifen reduces that to around 10%. Which... wow, sounds like a lot. 20% sounds so high. Then again, so does an 80% chance of it NOT coming back. Of course, I'm a glass half empty type, so this is a tough one. Then he pulled up a web site called Adjuvant Online, which is a tool that supposedly more accurately predicts your chance of survival five and ten years out based on your age and cancer stats. We plugged in my stats, and he got a kick out of the fact that I had them memorized. He was looking around trying to find my Ki-67 value, and I informed him it was 11. LOL. According to Adjuvant Online, I have something like an 85% chance of being alive in five years and a 77% chance of being alive in ten years. (It's sort of a morbid tool, now that I think about it.) I would normally remember the exact numbers, but I was sort of fixated on how low they seemed! I mean, yikes, 77%, that's barely a C+ in my book! Then he said the problem with the tool is that the death rate didn't just include people who died from cancer; it included people who died from anything, including plane crashes, whatever. That made me feel a little better, but still. I asked him if 'survival' meant a cancer-free survival, or that you were just alive five and ten years later. He said that it just meant you were alive. So, you could have a recurrence, but so long as it didn't kill you, you'd still be in the 85%, or 77% (which would be possible with a recurrence of the same type of cancer in, say, my right breast, but unlikely if I had metastatic cancer). Somehow his conclusion from this was that I wasn't receiving a huge benefit from the tamoxifen, as my chances of being alive five and ten years from now didn't change a whole lot with hormone therapy, and based on what I had told him I should stop. This was a huge relief considering I had basically already decided I wasn't going to take it anymore anyway, but somehow I couldn't get that C+ out of my head. Yes, that's ALL DEATHS, but how many people actually die in, like, hiking accidents or random other tragic events?!

I was kind of surprised he didn't suggest an alternative, like shutting down my ovaries and trying a post-menopausal drug. I was pretty sure he would, and had all my excuses lined up. Like, I'm pretty sure I can't handle going through that and multiple hip surgeries at the same time. But he didn't even bring it up. I was relieved, but also a little disconcerted considering two oncologists suggested this instead of tamoxifen, simply because of my age. Ironically, I think I went with Dr. M because I liked his less aggressive style, and now I'm worried he isn't being aggressive enough. What can I say, I guess I am hard to please. In the end, we agreed I would continue to see him for breast checks every year, but otherwise we'll each go our merry ways. Then I asked him for something for this damn cough - something with a narcotic in it to help me sleep.

All in all, I felt like it was a good appointment, and overall a good day. I am willing to take my chances. I'm a little nervous, but let's be honest, I am going to be nervous no matter what. Lately, though, I've been feeling pretty optimistic about life in general, and I think that's probably because I haven't been on tamoxifen. Oh the irony. As I told my Chair, the fact that I'm considering the hip surgeries must mean I'm feeling optimistic that I'll live long enough to reap the benefits. Take the silver linings where you can.

So, goodnight tamoxifen, and goodnight to all. I'm going to go enjoy a big swig of my cough medicine and hope for some ZZZZZZs.

This is a post about my hips. I can't think of a catchy title. Hip, hip hooray seems stupid, and not accurate.

Wow, I'm so grateful for this blog. Since I no longer write here frequently, I had forgotten just how much I put down in writing - both in terms of practical information, as well as the things I've gone through emotionally. I started re-reading old entries a few weeks ago, when friend told me that she was going in for a mammogram after finding a lump in her breast. This, of course, brought back a flood of memories, and I remembered that I had written about my first mammogram here. Then, just a few days ago, a good friend told me that she had just been diagnosed with breast cancer. :( As I sat with her and drank wine and talked - about doctors, about logistics, about nerdy scientific details (she's also a biologist), and, most importantly, about how this just plain old suckity suckity sucks - I realized how far away it all seems for me now. I really couldn't put myself back into her shoes, even though I had already been there. So many details that were once so vivid in my mind that I thought I'd never forget are absolutely gone, erased from memory. I'm not sure if it's because all those cancer treatments changed my brain, because I've intentionally blocked certain things out, or because - as a friend lovingly pointed out to me - I'm getting old. LOL. Needless to say, I got a good kick out of this post about How to be an Amazing Friend. Who knew I'd need the information from my own public service announcement post?

Ultimately, my lack of memory is probably a good thing. Hopefully it's a sign that I'm truly moving on, and not that the cancer has metastasized to my brain. I'd add an LOL to that to let you know I'm saying that somewhat tongue in cheek, but I'm only semi-kidding. I used to worry a lot about my memory loss, only now I'm fairly sure that tamoxifen was playing a huge part in a lot of it. That, however, is a topic for another post. Last I wrote, I was in a deep, dark tamoxifen-induced hole. I'm not going to lie - it was terrible. I stopped taking the tamoxifen, and I've been tamoxifen-free in 2017. To make a long story short, I am doing so. much. better. I am going to see my oncologist on Thursday to talk to him about this. Stopping the tamoxifen was something I did on my own, and he doesn't know yet. I'm pretty sure that he won't approve, but I wanted to be confident in just how much the tamoxifen was affecting me before going to see him about it. I will write about that appointment next week.

I actually came to write about something else: my hips. OH YEAH, remember my hips? Remember why this blog is here in the first place? During my cancer ordeal, my hips were actually pretty good. I'm not sure if it was because they really were going through a good phase, or that I was distracted from the pain, or if there's only so much pain/trauma the body can process, or because I spent so much of the time lying around, on pain medications, and/or drinking with friends. (I just had to add that last part in there in the interest of being as transparent as possible.)

I'm certainly grateful for that temporary respite, but unfortunately it was just that - temporary. My hips began to give me constant low to medium levels of pain a while ago - I honestly can't remember exactly when. Then, about a month ago, I was walking home from my parents' house (three blocks away), and I was hit with that grinding, OMG I CANNOT WALK pain, which I haven't felt in AGES. That pain stayed for about three days and then got better. And, of course, I was thinking, Well, this is it: the beginning of the end. The beginning of the end that the last orthopedist I saw told me would play out in one of three ways: bilateral PAO surgeries, bilateral hip replacement surgeries, or me not being able to walk anymore. (Read more here and here.) Obviously this prognosis did not make me happy, so I did what I do when I don't like something, and that is find another doctor. Ha.

I decided to just go straight to the very best doctor I could get. I don't want to mess around with possibly incompetent doctors that I cannot trust; I don't have time for that. So I asked Dr. T to help me find a highly respected doctor who was trustworthy and current on every possible treatment for my condition, and he did that for me. I knew it meant that I would have to go up to University Hospital, but it is worth it to me to know that the opinion I'm getting is one that I believe 100%. As I explained to the medical assistant, there is no way I am even going to consider having my hip cut into three pieces and screwed back together without a second opinion. In fact, I've really been leaning toward hip replacements just because my colleague recently had one, and it didn't seem that bad. I mean, don't get me wrong, a hip replacement is no fun at all, either; it's just that she's fairly pain free and walking really well right now, and she most definitely did not spend three months on crutches.

Anyway.

On Thursday, I had my much anticipated appointment up at University Hospital with Highly Acclaimed Hip Doctor. I was suuuuper nervous about the appointment, 'cause I'm a needy patient who needs a lot of hand-holding, and after experiencing such compassionate care from cancer-related doctors, I knew that pretty much any orthopedist would seem unpalatable. (I even discussed this with Dr. L here.) I could tell this one wasn't going to be a good fit personality-wise after watching video clips with him in them. He's this super intense pro-athlete who does extreme stuff like jumping off cliffs with a set of fake wings, plus he's bald, has a sort of angry-looking face, and is 'foreign' (um, for lack of a better term), so he has a rather 'severe' appearance and semi-thick, gruff, accent. So basically I anticipated that it would be like having an appointment with the Terminator (and that turned out to not be far off the mark, haha). But then I reminded myself that I'm over NICE orthopedists. NICE is why I spent waaaay too much time with my first orthopedist, who I now know was a COMPLETE LOSER. I mean, NICE is a bonus, but not my top priority. And so I went, with the mindset that this was more of a business trip than a therapy session.

The first thing I did was have X-rays taken (because Dr. Terminator is very particular about how he likes his X-rays taken), then the next person I saw (after the medical assistant) was Dr. Terminator's fellow, which confused me at first, because he had hair. And it was black. So I was thinking, wow, maybe Dr. Terminator grew some hair?! until the fellow introduced himself as some name I didn't comprehend. And then I remember that at University Hospital you almost always see multiple people. At least I was spared the med students today! Dr. No-Name seemed a little uncomfortable at first, but got better. He took a thorough history, which was quite a challenge, because he had a thick accent and was difficult to understand at times. Indian, I guessed, which he later confirmed when I told him I was born in Thailand. (Oh! I'm from India! he said. So, nearby. Ummmm, okay? I mean, if by 'nearby' you mean the same continent. Ha.) Anyway, after the medical history, which took about 15 minutes, he did an orthopedic evaluation like I have never received before, evaluating my various functions (or lack thereof), ranges of motions, pain, etc., for, like, half an hour. As he did all of this, we chatted, and he warmed up a little. Then he told me that he would go see Dr. Terminator and come back. On his way out, though, he told me point blank, 'Your hips are bad. You need the cutting surgery ( = PAO). Sorry to say. I mean, look at that!' He waved his hand in the general direction of my X-rays, which he had pulled up on the computer screen. I guess to a person who spends all day looking at hip X-rays, they look glaringly awful, but to me they just look normal. (On a side note, my first orthopedist, Dr. Loser, NEVER took X-rays of my hips, which I now understand is pretty much bordering on negligent.)

I was sort of surprised, because in my experience with residents and fellows, they don't usually just tell you something so definitively, on their own. But after a while, he came back with Dr. Terminator, who concurred. Conservative treatment is absolutely not an option for me if I want to be able to walk within the next few years. I know this shouldn't have been a shock, but it still was. What can I say, I have an uncanny ability to stay in a state of completely delusional denial. I guess I was holding out hope for I don't know what. Maybe a new, cutting-edge, conservative treatment? That my hips aren't THAT bad? That I can just get by for the rest of my life using a combination of PT and great drugs? That Orthopedist #2 was a crackpot, just like the first one? I don't know. Orthopedist #2 told me I had a severe case of dysplasia, 'one of the worst we've seen in a long time,' but I felt like that was extreme? Liiiiike, hey buster, how many hips do you actually see in a day?! Because despite the fact that I live in what's now considered a real urban area, I guess I still see it as a 'small town,' with 'small town' doctors. But basically Dr. Terminator confirmed EVERYTHING Orthopedist #2 told me, and then some. It was pretty much a second opinion on steroids. Not only do I need to do something, but I also need to do it pretty much ASAP. Apparently when you have such severe dysplasia, once you start developing osteoarthritis - and apparently I have - you can go downhill very quickly. Meaning, if I do nothing, I could find myself unable to walk in a few years. So, that's a lot to wrap my head around.

He strongly recommended against hip replacement for me, because of my age and my activity level. Now, I know I've said before that I'm a bit of a couch potato, but that's not entirely true. I feel like a couch potato compared to my activity levels in my previous decades, but I guess compared to the general population, my lifestyle is considered active. I don't run or work out or do CrossFit or other fitness boot camps like some of my friends, but I do have a job where I'm on my feet all the time, and walk several miles a day just going to various places on campus to get to classes, meetings, and so forth. I also like to ski (we got 10+ days of skiing in this year), and I'm now coaching diving, too (not scuba diving - the type where you jump off a diving board). Granted, I'm COACHING, and not DIVING, but I lead warm-ups, dry-land activities, and I like to jump on the trampoline, and occasionally go off the diving board. These things would be mostly out, or come with severe restrictions, if I have my hips replaced. Also, if I do them, even if I'm not 'supposed' to (as a hard-core athlete, Dr. Terminator is all too familiar with people doing things they shouldn't), it will put more stress on my artificial hips and lead me to need new ones earlier. We did not talk about the actual restrictions in detail, and of course I came home and immediately started to Google some of them, because I know that my colleague who had her hip replaced is planning to ski in the future. But I think the point Dr. Terminator was trying to make is that the reality of a hip replacement for me is that 1. At my age, the hip replacement would not last, and would definitely require additional surgeries in the future; and 2. Would come with immediate and life-long restrictions. With respect to skiing, for example, it's probably fine if you just stick to green and maybe blue slopes. Or, if you were a world-class skier before the hip replacement and really know what you're doing (I don't), blacks are probably fine. I'm not a great skier, but I do like to do the occasional black, I'd love to learn how to ski moguls properly, I sometimes enjoy catching some air, and skiing a bowl is definitely on my bucket list. All of those would pretty much be out with a hip replacement - or if not out, then really, really stupid things to do. And a big concern with hip replacements is that they can dislocate if you engage in forbidden activities, which also sounds awful.

Another point I've been sort of mulling over while I think about this is the fact that part of the reason I'm not super active right now is because in addition to having cancer and serious hip pain that limits what I can do, I have a full-time job and young kids. In the past few years, I've spent a lot of time having surgery and recovering, and my activity levels have definitely declined. Now, I spend a lot of time in pain, but even without the pain, it's not as if I have tons of time to train for marathons. Not that I want to run a marathon or anything, but before I had kids, my husband and I played tennis, racquetball, lifted weights, did lots of things we haven't done in 11+ years. Maybe someday I'll want to do more than I'm doing right now. I mean, maybe not, but at the same time, I don't want to make a decision right now that will definitely put restrictions on me for the rest of my life. Dr. Terminator said the goal of PAO is to make a new hip, and once it is healed, you can do whatever you want. Hell, maybe I'll get inspired to make a comeback like Laura Wilkinson. HA!! In contrast to the feeling I got from Orthopedist #2, Dr. Terminator views PAO as a surgery that I would do INSTEAD OF hip replacement. Obviously he cannot guarantee that I'll never need a hip replacement if I do PAO, but the ultimate goal is that I won't need a hip replacement, ever. He stressed this more than Orthopedist #2, who sort of made it sound like PAO was something you did to delay hip replacement for a few years.

The other thing I was worried about is whether I'm too old for this type of surgery. In all my 'research' ( = consults with Dr. Google), this seems to be a surgery that is done on teens and people in their early 20's. Dr. Terminator told me that, yes, this was originally done on young people, but that's because that's when hip dysplasia is traditionally diagnosed. He said that the vast majority of his patients now were my age - between 40 and 50 - and offered to connect me with some of them so we could meet and talk.*

* Yesterday, someone from his office called me and left a message with the name and number of a woman who lives near me who is also one of Dr. Terminator's patients. She told me that this woman wasn't available tomorrow because she's running a 50K, but could talk on Sunday. Even if it's true, is that not the most overt, contrived type of 'advertisement' possible?! HA!

His plan for me, should I choose to go with him, would be to first have new MRIs done on both hips, as well as a CT scan. These will help him know if I'm even a candidate for PAO, and if I am, they will help him make a more precise surgical plan. If the articular cartilage is too shot, then I might not even be a candidate. (In a way, this would be easier because then I'd have no choice but to get hip replacements.) However, he did say that even if my cartilage isn't tip-top, he'd probably still recommend PAO for me, because of all of things discussed above.

As far as the surgery goes, each hip would actually involve two different surgeries. (UGH!) The first would be a hip arthroscopy to fix or reconstruct the labrum, clean out bits of cartilage, and possibly do a microfracture procedure on the bone to stimulate development of new cartilage. The idea is that the joint should be as clean and in as good shape as possible before the realignment procedure, so that once you're healed from the PAO, you're good to go. Then 7-10 days later, you do the PAO. You really can't do both at once because of the time constraints, and how much blood you lose. I said it was interesting because Orthopedist #2 had told me I should do the PAO first, then the arthroscopy. His reply was, 'That's because he obviously doesn't do this very much.' LOL. He said that in order to do the labral repair, you have to pull on the leg to make room in the joint, and you can't do that on a hip that has been sawed apart and screwed back together, so you'd have to wait for it to heal first - 'And most of my patients wouldn't appreciate having to turn right back around and go into another surgery after the PAO rehab.' It makes sense. And to be fair to Orthopedist #2, he doesn't actually do PAO, so it's not just that he doesn't do it much, he doesn't do it at all.

So... I'm not super thrilled about any of this, obviously, but I feel confident now that there are no other options, and the opinions and recommendations I've received from two orthopedists are valid. Dr. No-Name and Dr. Terminator were extremely thorough - Dr. Terminator even repeated much of the physical exam - and the appointment from start to finish took an hour and a half (!!). And yesterday, I was able to read the five-page report (!!) from our visit.

I haven't had time to get emotional about any of this, and in a way I think it helps that Dr. Terminator was so cut-to-the-chase blunt and unapologetic. Basically he doesn't know me, couldn't care less about what I'm feeling, couldn't care less what I do, which in some sort of weird way adds validity to his opinion. I went into the appointment with my game face on, and he gave it to me straight. He wasn't like, Yeah, poor you, I know you've been through a lot of shit lately, and might not be ready for this, so why don't you think about it and come back in six months? It was more like, yeah, you can cogitate, then come back and see me in six months to a year, in a wheelchair. Ha. Okay, so that's not totally true. He did actually allude to the fact that he had read my file, and understood I had been through a lot as of late, and understood why I put off dealing with this for the past year. Unfortunately, none of that matters. No matter how much I feel like I deserve some kind of break, I don't have that luxury. Cancer or no cancer, this isn't something that can wait, and I think I needed to hear it like it is.

Interestingly, the only time he really showed any sign of emotion, was when I was telling him about how things went down with Dr. Loser - and I didn't even get to the part about DVT. When I told him I had the hip arthroscopy done, he asked me, 'He didn't tell you that your hips are severely dysplastic and that it wouldn't work?!' He practically screamed it, and I'd say that he looked angry, though in my opinion he looked sort of angry, or at least grumpy, the whole time, so it's hard to say. LOL. I told him, no, that no one in that practice ever mentioned dysplasia to me. However, I had read the surgery report and Dr. Loser had written that I was 'borderline' dysplastic, with a center edge angle of about 20 degrees. (Center edge angle is commonly used in diagnosis of dysplasia. Anything above 25 is normal, 20 is 'borderline,' and below 20 is dysplastic. After reading Dr. No-Name and Dr. Terminator's report, I see they calculated my center edge angles to be 1 degree on the right and 5 degrees on the left.) Then we got to the part where I talked about trying cortisone injections. I said I had one before the surgery, to try to avoid surgery. Then I had one after surgery. He seemed a little baffled I had one AFTER surgery. When I told him that it was because my hip was still hurting a lot, he said, 'Of course it was, because the surgery wasn't ever going to work,' all the while shaking his head and looking disgusted. I think he might have even rolled his eyes. Later, when Dr. Terminator left, and it was just me and Dr. No-Name, I asked him if I should write a letter and complain about Dr. Loser. He said, 'I don't know about that, but what he did is really bad. I don't know how he missed this,' all the while shaking his head. He reiterated that my dysplasia is really severe and was shocked that no one informed me of this earlier in life. He added that he couldn't believe I put up with the pain for so long and based on my hip architecture, expressed surprise that I can still walk, which is pretty much the same thing Orthopedist #2 and his NP told me as well. So, yay, am I not amazing or what?! LOL.

Anyway, I'm not sure where I am with all of this. I was sooooo looking forward to summer, and now my summer is looking very different. Depending on when I can do the surgery (IF I do it - I'm not 100% decided yet), I may not even be able to recover in time for the fall. According to various sources, you can go back to a desk job in eight weeks and a manual labor job after 3-4 months. I don't do manual labor, but I also wouldn't consider my job a desk job. I've fully accepted that I will have to teach on crutches at some point - there's pretty much no way around that - but it's not just the crutches, it's that this is an exhausting recovery, with a lot of pain involved. At the same time, I don't know how I can NOT work next fall after taking the fall of 2015 off because of cancer and the fall of 2014 half-time because of DVT. And this is just one side. Then there's the left side. I'm just a jewel of an employee, aren't I? Not to mention, I'll be house-bound and USELESS for 2-3 weeks, and won't be able to drive for a couple of months, so I'll be a huge burden on everyone, and cancer pretty much used up all of my I need help around here! cards.

So right now, I'm fairly wrapped up in logistics, which is actually good because it keeps my mind away from the emotions of it all, which pretty much make me want to cry.

Death by Tamoxifen

I have really been struggling lately. A lot. At first I just thought it was my usual tendency to struggle, to hate life, rearing its ugly head. After all, it is the end of the semester, the time when my students push me to the brink of insanity, and it is Christmas, a time I have come to mostly dread. So there is a lot of stress, and as I've mentioned about 1,000 times before, I have the most pathetic level of tolerance for stress ever. I used to drive across town to ask a question in person rather than making a phone call, because phone calls are stressful. True story. (I've gotten better since then, thank goodness.)

But I feel like I am deteriorating, and rapidly so. I basically spent all of yesterday crying and hoping I would die. I kid you not. It felt like a true medical emergency. I have never felt that way before. I called my primary care doctor, but he had no appointments available. I called my medical oncologist, but he had no appointments available, either. I cried and told them it was urgent, but this did not make an appointment become available. I briefly considered going to the ER, but I didn't want to end up in a straight jacket in the psych ward, so I guess I haven't totally lost it yet. Thankfully I calmed down. Today, I feel flat, almost like a manic-depressive post-mania, except I've actually come up and not down.

And now I'm wondering - is this me, or is it the tamoxifen? After I took my daughter to school this morning, I crawled back into bed and couldn't make myself get out. After all, I didn't have to. 'Having to' is my only motivation to do anything these days. Eventually, I forced myself to get up because my husband was giving me weird looks. Instead of doing what I need to be doing (Christmas stuff), I went to see Dr. Google, who told me that this could very well be the tamoxifen. I figured the tamoxifen wasn't doing me any favors, but since I've been on it for over a year and haven't managed to kill myself, I didn't think that's what it was. And maybe it's not, but oddly enough, the idea that it might be is sort of comforting. I mean, yay, this medicine that is supposedly saving my life is giving me suicidal thoughts! What an awesome scenario! Apparently among those people who suffer from severe depression as a result of tamoxifen, the depression starts an average of eight months after they start taking tamoxifen. Oh, and Dr. Google also told me that most anti-depressants hugely reduce the effectiveness of tamoxifen because they are CYP2D6 inhibitors, and the enzyme CYP2D6 is what converts tamoxifen into its superhero status.

So here we are.

I'm going to discuss this with my doctor this afternoon. My husband begged and got me an appointment.

I wrote this elsewhere, but I am reposting it here now that I believe I may have written it in a tamoxifen-induced drunkenness.

This is how it feels.

In the morning, you wake up tired. You are always, always tired. It is dark outside, and it is dark inside. The darkness seeps into every tissue. You hit snooze. You close your eyes and try to go back to sleep, but when you close your eyes, all you see is blackness. The blackness swirls, like a tornado, and wraps around you, grinding at your heart and soul.

You try all your tricks. You take a deep breath in and tell yourself 'Blue skies in,' and try to imagine a blue sky with fluffy white clouds, entering your body, penetrating the darkness. But the blue sky isn't there anymore, only darkness. You breathe out and try to find the right words for what you are hoping to rid from your body, but you can't think of the right words, because your brain is fuzzy and at about 70% of what it used to be. But you can picture it. Some sort of insects fly out - locusts or flies - like in The Green Mile. But they don't go far; they swirl around in the darkness that envelops you and find their way back in.

You hit snooze again. You pull the covers over your head, and you wonder what would happen if you just didn't get out of bed. Then you realize you don't really need to wonder, because of course you are going to get out of bed, because you are an adult and two small people depend on you to get out of bed. It is warm in your bed. You try to soak up some of the warmness, hoping it will melt the black away.

You hit snooze again. As you start waking up, you realize that not only are you tired, but you are also nauseous. You don't know if it is a hangover, because you have been drinking every night, because that used to help take the edge off of your anxiety. It doesn't help anymore, but you do it in anyway, maybe because you're on a self-destructive path, or maybe, just maybe, you are daring the cancer to come back and kill you. Or maybe it is the tamoxifen, and menopause. Or maybe it is your job frustrations, your relationship frustrations, your terror about the future of the country, that have put your GI tract into a permanent, dysfunctional knot.

Your radio goes off again. The classical music doesn't soothe you anymore; it irritates. You realize that you absolutely have to get out of bed. Your kids have to go to school. You have to go to work. You count to ten to try to psych yourself up. Your blood pressure rises. Your heart is beating so hard and so fast that your carotid arteries expand with such vigor, it feels like a twitch.

You finally get out of bed, but mostly because you have to pee. The bathroom is cold. Your closet is cold. This is a part of your new condition; you are always, always cold. You aren't sure if it is actually cold, if it is the medicine, or if the darkness swirling inside you manifests itself as a constant chill, a metaphor sprung to life.

You wake your kids up. You have given up on your daughter. It is too late for her. The painfulness of this realization eats at you, because you know her shortcomings are direct reflections of your parenting failures. You focus on your son. There is still hope for him. He has an inflexible morning routine that starts with him cuddling in your bed with you. It is one of the only reasons you can make it through the day. At the end of the cuddling, you make it through another 24 hours so you can experience the joy of cuddling the next morning. You feel ridiculous that your life has been reduced to this.

You take the kids to school, you go to work. You are such an expert at hiding how you really feel that no one can see the darkness that blankets you. You push the darkness inside you, deep, deep, deep, where no one would suspect it. But that has a price. It struggles to escape, eating your insides in the process.

You pick your kids up from school, you go home. You take everything out on your daughter, because she is an easy target. Your relationship continues to deteriorate; you know you are stuck in a bad cycle, but you can't help yourself. You say things to her you cannot believe you are saying. It doesn't even feel like you when you are talking. You lavish praise on your son. You know you should try to do the same with your daughter, but there is not much to praise. It feels like a cosmic slap in the face to be a mother to someone with whom you are so incompatible.

If you're lucky, you manage to grab a nap, because you are tired. You are always tired. Then you try to cook dinner, but it's hard, because you don't enjoy most foods anymore. Eating is mostly a chore. But you try, because otherwise your doctor will lecture you, and your clothes will become unwearable, and you don't want to have to buy new clothes.

Your husband comes home. You don't talk a lot these days because there is so much to disagree about, it's better to just hold it inside. You drink. You don't drink wine anymore because white wine tastes like gas and red wine tastes like blood. Instead, you drink a martini because the taste is somewhat foul, but at least you know it tastes the way it is supposed to.

You get the kids to bed, then if you haven't had enough martinis, you choose another sleep aid: cannabis, melatonin, Ambien. You may or may not take your tamoxifen. You are confused. Part of you thinks the tamoxifen is doing this to you, making you so miserable you don't even care if the cancer comes back. But then you wonder if you stop taking it and start wanting to live again, will you be sad if the cancer comes back?

If you're lucky, the sleep aid will work, and you might get a few hours of sleep. Sleep wraps around you, temporarily removing the burden of darkness. It is your only escape. You wish you never had to wake up. But you congratulate yourself on making it through another day, and look forward to cuddling with your son in eight hours.

Weighty Issues

Now that I have confessed my personal failures in a public place, it is probably time for me to get back to stuff like, you know, cancer. I mentioned in my previous post that I spent a fair amount of time with Dr. T and his PA, Pamela, over the past year, as part of the application process for PA school. I also spent a fair amount of time seeing them as a patient. (Yes, it was/is a bit awkward at times.)

I had been seeing Dr. T to get steroid injections to decrease the thickness of my abdominal scar. The injections worked well, and my scar has flattened significantly. Unfortunately, the injections also caused the skin around the scars to become white ( = hypopigmentation in medical speak). As much as I would like to have white skin in Donald Trump's America, alas, I am not white. LOL. It was actually fairly alarming for a while, but it is getting better now that I am no longer getting the injections. So, every 4-6 weeks on average, I drive 60 miles to see Dr. T, he tells me the scar is getting better, then says to come back in another 4-6 weeks. It's sort of a waste of time, and gas, but I'll admit that I'm sort of dreading the day when he says, 'I don't need to see you anymore. Have a nice life!' After sharing such an intense experience with him with my reconstructive surgery, then tagging along with him and Pamela through many clinical hours and through many surgeries over the summer, it's hard to imagine the day when he won't be part of my life. I wonder if doctors feel the same way about their patients. Will he miss seeing me?

At my last appointment, about a month ago, he and I and Pamela spent most of the time talking about my upcoming interview. Eventually he remarked that my scar was looking better, and so was my skin. Then he asked me, seemingly out of the blue, 'Have you been swimming?' I was sort of like, 'Huh? No.' I don't swim. WTF? Only later did I realize that the reason he thinks I swim is because when I was recovering from surgery, I kept asking him when I could get into the water. Since I didn't want to admit that I really just wanted to sit in the hot tub, I told him I wanted to swim. I mean, same difference, right? And now he thinks I swim - HAHAHA!!

He wrinkled his mouth into a disapproving knot, then remarked, 'You've lost a lot of weight.' Then he went on to say that I've always been on the lean side, but I can see your obliques. He then proceeded to lecture me about how I need to take care of myself, as he has in the past. This always makes me a little uneasy. It's true, I've lost weight - about 10 pounds since the beginning of my cancer ordeal. But it's not like I'm underweight or anything. I had 10 pounds to spare, LOL. In fact, I'm pretty sure I weigh more than Pamela, and I probably weigh about the same as Dr. T! And it's not like I'm purposely starving myself. Between work and shuttling kids around, I work crazy hard, and I grab snacks when I can, but I don't eat lunch on most days. Add into this insane levels of stress, and you have the recipe for losing weight and keeping it off. I guess?

The thing is, I enjoy being thin. What is not to enjoy about it? Ha. For most of my adult life, I hovered about five pounds above what I would consider my ideal weight. I used to joke that the only way I could get to my ideal weight was to not drink alcohol, and that wasn't worth it to me. Now, inexplicably, I'm a few pounds below that 'ideal' weight - and with literally no effort on my part. I mean, I've always tried to eat well and be active, but it's not like I diet or do any type of organized exercise routine. I heard so many stories of women gaining a lot of weight on tamoxifen, and I was honestly a little worried about what a 15-20 pound weight gain would be like for me. So to me, the fact that I've lost weight just seems like crazy good luck!

I try to honor my promise to Dr. T that I'll 'take care of myself' but if I must be completely honest, gaining weight is not at the top of my priority list, or even on my list at all. I mean, hello, the weight is going to come back and then some, at some point, right? It seems vain to revel in being thin, but at the same time, have I not been through enough in the past couple of years? Can I not just sit back and enjoy the fact that for whatever reason, cancer made me thinner? If I could not have cancer and not have hot flashes and cramps and constant bruising from the baby aspirins I have to take so that tamoxifen won't give me a blood clot, I'd trade the ten pounds in a heartbeat. But that's not possible, so I think it's fair for me to try to soak up the tiny ray of light granted to me by this small and temporary consolation prize.

The Last Thanksgiving Lunch

When you check the stats on your almost-abandoned blog, and realize that most of the referring URLs are out-of-country sites that McAfee doesn't approve of, it is probably a sign that you should give it up. But. I don't think I was ever writing this for anyone but myself anyway. I mean, I was and I wasn't. I was writing it for myself with the hope that what I had to say might someday help someone in a similar situation, the same way that I found solace in other people's blogs that I suspect were also written mainly for themselves. So here I am. If you came here looking for pictures of Big Tits, I'm not going to apologize for letting you down.

And besides, I am on a Facebook hiatus following the aftermath of the U.S. Presidential Election. I just couldn't take it, even the stuff I agreed with. I'm now mostly Facebook free, and loving it. The only problem is that I have way too much time on my hands. OMG WHAT CAN I POSSIBLY DO ONCE I HAVE ANSWERED ALL MY E-MAILS?! Hence this post.

Believe me, I've been wanting to write. It's just that my life was very complicated for a while, and there's no way I could have explained everything that was going on, and there's no way anyone would have wanted to listen to it anyway. Now my life is calm again. I can breathe. I'm happier than I have been in a long, long time.

I've been working with my daughter on summarizing events in a brief and concise way, so that I can ask her about a movie or a book without having to listen to an excruciatingly long play-by-play recap of the entire story. I usually ask her to tell me about the book in one sentence, and after she fails, I give her a few more. Five, max. By the end of five (very long, run-on) sentences, I usually have a pretty good sense of what's going on, so that's what I'll try to do here. So:

1. I've mentioned in previous posts that I've been working on a career change.
2. That career change was applying to PA (physician assistant) school. 
3. After 16 years of working toward this goal, including three years in graduate school in biology, followed by nine years teaching biology at a university level, I finally got it together enough to apply. 
4. I came really close, but in the end, I didn't get in. 
5. I thought I would be devastated by not getting in, and although I was/am sad, I am also extremely relieved. 

There are many reasons for me to NOT go to PA school, including things like I have young children and I'd basically have to be away from them for three years, I have a husband, I have a life (a GOOD life!), I have job (what many would consider a GOOD job), I'm 42 years old (and a less energetic 40-something than I used to be after my whole cancer ordeal), PA school is expensive, and I'm not exactly made of money, and... and... and... In contrast, there's really only one reason for me to go to PA school, and that is that I think I'd really like being a PA - and I think I would be a really good one. When I lay it out like this, part of me wants to scream at myself, WHAT IN GOD'S NAME WERE YOU THINKING?! And the answer is very simple: I have no idea what I was thinking. And I think when I got up to the interview, and suddenly my fantasy world became very real, I panicked a little, and thought, OMFG WHAT WAS I THINKING?! I do NOT belong here! 

I've had a while to reflect on this whole experience, and I'm still not quite sure what I think. On a practical level, I feel mostly relief. I only applied to one PA school, because there is only one program that is even close to do-able for me at this point in time. And even so, it was going to be tough. I would have had to spend weekdays away from my family, in a different city, for 2-3 years, AND they probably would have had to move into a different house because without my income AND trying to pay for PA school, we really couldn't afford our house, AND we'd need more money for babysitters and summer care for the kids, and... and.... and...

Most of my sadness comes not from not getting in, but from a feeling of personal failure. I knew that applying to only one school was an extremely long shot, because PA schools are extremely competitive. In a way I think it might have been easier if I had just been flat-out rejected, rather than making it to the interview stage and then being rejected. According to the PA program I applied to, they got over 1,700 applications, and 144 people got an interview. From those 144 interviewees, they choose a class of 44. So... not being chosen in the original phase is understandable, but making it past that first stage and then not being chosen... that just seems more personal. Especially for someone like me, whose strength should supposedly be in interviewing.

The other hard part is that Dr. T and his PA, Pamela, were sooooo supportive of my exploit, I almost feel... embarrassed? I shadowed Pamela and Dr. T for hours and hours and got to see some super amazing things that I will never regret being able to see, even if I never become a medical professional. Pamela used to be an interviewer for the PA program she attended, and really tried to help me prepare for the interview. So on top of feeling that I have let myself down, I feel that I have let so many other people down as well. That is a hard feeling to swallow.

Ultimately, I think it's a good thing I didn't get in. I definitely had my doubts, but if I had gotten in, I would have gone. (I mean, who would NOT accept a spot in a program with a 2.5% acceptance rate?!) And I'm not convinced going would have been a good thing. I think, more than anything, that I needed the possibility for change. I needed to dream, to imagine a different future. For many years, this possibility of a different future kept me going, kept me from being stagnant, able to work toward something new, something exciting. Now that that possibility isn't there, I've realized that just because I didn't get into PA school doesn't mean I have to be stagnant, that I can't work toward new and exciting things, even if those things aren't what I once imagined they might be. And, of course, I could always reapply.

My daughter has been struggling a little academically, which has been part of my hesitation about committing to something as time-consuming as PA school. Even reading, which has always been a strong point for her, is difficult now that she is in fifth grade, and the expectations are much higher. She is supposed to be reading a book a week, but has been having trouble finding books that keep her interest. At our recent parent-teacher conference, her teacher said she had tried to get her to read Jennifer Murdley's Toad, a book she felt all her girls (and boys!) should read. I haven't read the book, but according to my daughter's teacher, it is a modern-day fairy tale about a girl who wants to be prettier, and has the opportunity to be prettier, but then realizes that the sacrifices she would have to make to be prettier aren't worth it, and ultimately realizes that she is happy the way she is.

In other words, it's my life, in a nutshell.

Not that I want to be prettier, but I want to be better in a lot of ways. (And, of course, I wouldn't mind being prettier, but it's not at the top of my wish list.)

I've never been a great mom, despite my best efforts, and I always assumed that my kids were better off spending their time with someone other than me. Maybe that's just a fancy way of saying I've felt minimal guilt in being a professional, working mom while rearing young children at the same time. However, something interesting happened yesterday. I dropped my daughter off at school, and as we were waiting for the bell to ring, I was standing around talking to some other moms. As we were talking, the son of one of the moms came up and whispered something quietly into his mom's ear. Eventually she said to him, 'Oh, okay, you want me to come have lunch with you today? I'll be there.' And I was reminded, at that point, that it was the Thursday before Thanksgiving, the Thursday when parents are invited to have a turkey lunch with their kids. My daughter had asked me to go, a few weeks ago when we were going over the school lunch menu, and I was non-committal about it, telling her, I'll make it if I can. She hadn't mentioned it since then, so I figured I was getting away with not going. And then the bell rang, so even if she had remembered that it was Thanksgiving Lunch Day, she didn't have the chance to run over to me and whisper in my ear.

So off I went to work. I gave a lecture, then had office hours, but the whole time I felt this pang of guilt, that I needed to be with my daughter for the Thanksgiving Lunch. My office hours ended at noon. Lunch was at 12:15. I could make it, maybe. I went back and forth in my mind, because I had so much fucking shit to do at work (pardon my French), and told myself that plenty of parents don't/can't go have lunch with their kids in the middle of the day in the middle of the work week, and besides, my daughter wasn't even expecting me. At the same time, I felt a sense of panic, a sense of urgency, a sense of You want change? Something better? WELL HERE IT IS!! So, at 11:57 AM, I decided, I am going to have lunch with my daughter. Because next year she'll be in middle school, and this is probably the last time she is going to want to have lunch with me at school, and it is a privilege that I have a job where I can go have lunch with her when she wants me to have lunch with her! I cut out of my office hours three minutes early so no one could trap me in my office, and I raced to my daughter's school.

I can't tell you how happy I am that I went to that lunch. It made so many things so much clearer in my mind. Unlike many parents at my daughter's school, I don't spend a lot of time at the school, so I feel like a bit of a stranger when I'm there during any time other than drop off or pick up. My daughter didn't know I was going to be there, so I felt insecure as I went onto the school grounds. I at least knew they had recess right before lunch, so I wanted to find her on the playground so she would guide me through the process of standing in the lunch line.

I was relieved to arrive at her school at 12:14, just enough time to scan the playground before the kids went into the gym for lunch. I was even more relieved that when she spotted me, she came running over to me and gave me a huge hug and wouldn't let go. When I told her I had come to have lunch with her, she thanked me over and over again, and held my hand all the way into the lunch room. She told me, I am so happy you made time to have lunch with me, and continued to thank me throughout the day, and thanked me numerous times before she went to bed that night - JUST FOR HAVING LUNCH WITH HER! I am crying just writing about it.

But here's the thing. I don't want anyone (as if anyone but me is reading this - but, you know, just in case!) to misinterpret my message as one of Hey women! You MUST stay home and take care of your babies! It's just more of a relief for me to understand that there are many paths to happiness, many of which are completely different from what I had imagined. Maybe I've never given motherhood a fair chance. Whatever the case may be, I feel almost giddy with the wide-open possibilities of a happy future.

Whether you are one of a few dear friends still reading this, or whether you are here looking for porn photos, Happy Thanksgiving to you all!

One year ago today...

Last night, I went to a PTA meeting for my daughter's school. I've never been to a PTA meeting before, and quite honestly, I went mainly because there was free pizza. (I don't think you ever outgrow the allure of a free meal.) When I walked in the door, one of my good friends, who was PTA president last year, gave me sort of a dirty look and said, 'I can't believe you're going to start coming to PTA meetings the year after I stop being president!' Since I did not want to admit that I, a grown woman with a job and a nice house, was just there for the pizza, I had to do some quick thinking.

I, um, was sort of busy last year. You know, I was working on my career change and stuff. And oh yeah... remember how I had cancer?! 

It's funny how cancer is not even the first thing that popped to into my mind as an excuse. Of course, I never went to a PTA meeting before I knew I had cancer, either. (What can I say? The pizza idea was brilliant.) But that's not the point. The point is that it is hard to believe that it was just last year that I was going through the most major ordeal of my life. In fact, exactly one year ago today, I was in the middle of the most major surgery I've ever had, and ever hope to have, in my lifetime.

In so many ways, cancer seems like such a distant memory, and in others, it is still with me, every day. It is a weird paradox to live with, not knowing if you had cancer or have cancer, whether you are a survivor or a patient. The physical scars from the surgeries remain somewhat problematic and serve as a constant reminder of cancer. I don't regret this, though. If I hadn't done reconstruction, I would have the constant reminder of cancer in a different way. Nonetheless, sometimes I feel a sense of inner loathing that I went through all of this mutilation for a sensationless lump of flesh with no function. And I am still receiving care for my scarring; in fact, I have an appointment with Dr. T tomorrow.

And then there is the tamoxifen, which I continue to blame for my hot flashes, cold flashes, general fatigue, and pretty much anything else I can blame on it. I've been extremely depressed lately, and because I cannot think of a reason I should be depressed, I blame the tamoxifen. But that's not my biggest gripe. In fact, I've spent so much of my life in various states of mental disarray, I'm used to it, and it could very well not be the tamoxifen and just the fact that I am me. My biggest gripe about the tamoxifen is that it gives me horrible leg cramps. HORRIBLE. I mentioned this to my oncologist the last time I saw him, and he pretty much blew me off, to the extent that I didn't even write about it. Later, however, I did some Googling to try to see why tamoxifen would cause cramps, and while I could find no explanation that could satisfy my nerdy mind, I did discover that this is apparently very common. In fact, many women who stop taking tamoxifen before they are supposed to cite leg cramps as the #1 reason they stop!

I've always had a bit of a problem with leg cramping, usually in the morning when I wake up and do my early morning stretch. But the tamoxifen-induced leg cramps are like the normal cramps on steroids. In the past, I used to get cramps on either the front of my leg OR the back of my leg, but these new ones involve the entire circumference of my leg, often both legs at the same time, often multiple times per night. Let me just tell you, it is extremely painful and also disruptive to my sleep. In fact, it's ridiculous. The other day I was sitting in my office and I got a cramp that crept all the way up my leg and along my hip, and it felt so weird that after a while I started to wonder if I was, like, having a stroke or something. And yesterday while teaching, I got a horrible cramp in my toes that then worked its way up my calf and shin and I seriously thought I might have to stop class. I could go on and on about this but I realize it is a super boring topic that probably reminds you of your Great Aunt Ethel going on and on about her hemorrhoids, so I'll stop. Just feel sorry for me, yada yada. 

And oh, remember my hip saga? Last night, I had a terrible nightmare that I had to wake myself up from. After realizing I had not actually killed anyone, and that my son was not actually dead, I tried to stay awake long enough to not lapse back into the same terrible dream. After a bit, I tried to go back to sleep, but realized that my hip was throbbing. And I mean throbbing. After about 15 minutes I realized my hip did not want me to go back to sleep, so I fumbled around and tried to find some Ibuprofen, which in itself was an ordeal, because I was sleepy and it was dark and I have 20/900 vision without my contacts and I keep the Ibuprofen right next to my tamoxifen (and it's actually in a tamoxifen bottle because I am an idiot) and even in my sleep-induced stupor, I realized the last thing I wanted to do was accidentally take a handful of tamoxifens. LOL. I would have taken something stronger than Ibuprofen because the pain was really that bad, but it was 3 AM, and I did not want to have an opioid hangover during class this morning. I think I got back to sleep around 4 AM, then woke up to - you guessed it - horrible leg cramps around 5 AM.

But OMG ISN'T LIFE AWESOME?! Ha. Really, life is awesome, it really is. It's just cancer and hip dysplasia that suck. :)

Absence of breast, acquired

There is no real reason for title of this post other than the fact that I was looking through my medical history on the patient portal, and I'm sorry, that is just sort of funny. Absence of breast, acquired. It makes me wonder what other ways there are to acquire an absence of breast other than a mastectomy. LOL.

It has been a long time, I know. As I alluded to in my last post, I've been pretty busy living happily ever after, yada yada yada. But in all seriousness, breast cancer seems like something that happened in the very distant past. It's hard for me to believe that whole trip from hell was just last year. Fortunately, I have Facebook memories to keep me abreast. (Get it? Abreast, hahaha.)

So, after all this time, you might be wondering what inspired me to grace you with my presence today. Well, I just had my first post-mastectomy mammogram. It was about four months overdue, but eh, whatever. Part of me just didn't feel like going and the other part of me just felt like living in ignorant bliss for a while. Plus, I was really insanely busy there for a while. (More on that later, perhaps.) You're probably used to the type of cancer survivor who is hyper vigilant about eating healthy and not drinking and exercising maniacally and getting all her screenings done STAT, but that is not me. I've always been a bit phobic of going to the doctor (especially a new doctor) and having procedures done (especially when they involve undressing) and DUDES, you'd think I'd be SOOOO over that by now, but alas, I am not. In fact, my life is so normal right now, I've just slipped right back to being the old me.

I set up my appointment last week, because the semester is getting ready to start and I'm going to have a rather insane schedule once it does. (More on that later, perhaps.) I figured if I didn't have the mammo done before classes start, I very likely would not have it done until Christmas break, which would be a seriously big no-no. Of course, I forgot about it until this morning, when I was transposing events from my planner onto the family calendar, and I went into a bit of a panic. In the end, it was probably a good thing because I didn't have time to get worked up about it. 

Interestingly, I was pretty surprised by how emotional I got about it. I don't quite understand what emotions I was feeling, but they made me a super jerk when I was filling out the required paperwork and doing the whole registration thing. I calmed down a little once I got back to do the mammogram because the tech was super sweet and has apparently worked with women who have had mastectomies before, so it was hard for me to be mean to her. Ha. After I got the pictures taken (right breast only; apparently the foob is considered safe), I went and waited while the radiologist read them. Apparently having cancer puts you on the fast track, and there's none of this 'We will read your mammogram and get back to you in a week' nonsense.

When I was waiting, I actually started crying. I'm not quite sure why, but I did. Maybe it was because I was overcome with the memory of crying in the same waiting room over a year ago. Or maybe it's because there are a lot of moving parts in my life right now, and I'm a bit overwhelmed by some of them.

Apparently I'm fine, or 'stable' as the tech reported. Ummm, yippee? I could lie and say I was hugely relieved, but I wasn't. I figured I was fine. Fine, as in, there's no mass in my breast. I've been checking occasionally. Having no lumps is good, don't get me wrong, but I don't think I'll rest easy ever again just because I have a clear mammogram. I mean, whatever. 

So now that I sound like I need to check myself into a psychiatric hospital, I should stop. But coming here was a good reminded of how cathartic writing is for me, so I promise to come back soon and write about something other than crying in a waiting room, because there is a lot more to life after cancer than that.