Treatments and Seattle in the fall

I’ve now read about the treatments I am supposed to receive after I get the cancer out, which is unfortunate, because now I feel less like partying and more like crying.

First let me say that I am incredibly grateful. I am grateful this was caught early, I am grateful the only surgery I have to undergo is lumpectomy, I am grateful for the amazing support of my friends and family. I am grateful that, as yet, chemotherapy doesn’t look like a necessity (although that can of course change after the lymph node biopsy). I am grateful that I am strong enough and healthy enough to do the breast cancer walk this weekend (HINT HINT http://main.acsevents.org/goto/katejig). I am actually grateful for the cancer, weirdly enough, because it has made me even more appreciative for all the blessings of my life, for all the good I get to experience every day, and for the way it has extremely strangely strengthened my bond with my dead father. Having said all of that, I am about to whine a little. If that annoys you, no hard feelings, but stop reading now.

First of all, the radiation. Don’t do a Google image search for breast radiation photos if you’re going to have breast radiation. It will not make you feel any better. It will not make you feel any more prepared. It will only make you feel SAD. And scared. There are only mild pain-related effects: sunburn, sore ribs for a year (!), swelling, tenderness. There are more short-term cosmetic effects: red skin, dry skin, peeling, etc. Then there are also long-term effects which again are only cosmetic but which I still don’t want! And I don’t care if that makes me vain. As I mentioned previously, I spent my whole life not liking my boobs and then I had two kids and I FINALLY like them and get this:

Over time, you may notice firmness or shrinkage of the breast. You may also have mild tanning of the skin where the breast was treated or red discoloration, especially around the surgical scar(s). These changes may be permanent. – See more at: http://ww5.komen.org/BreastCancer/SideEffectsofRadiationTherapy.html#sthash.J2bLvWFm.dpuf

Awesome! So I could have one normal boob and one boob that is tan, hard, and small! This sounds like a fantastic deal. Those of you who know me well may know that I am obsessed with symmetry, so the idea of my body being completely asymmetrical in a place that will be clearly noticeable is setting my OCD to high.

But wait! There’s more!

Rare side effects

Although rare with modern treatment, radiation therapy can injure the normal tissues near the radiation field of the breast or chest wall. Rare side effects include:

Rib fracture occurs when the radiation weakens the rib cage near the treatment area.

Heart problems may develop years after radiation therapy is given to the left side of the chest. Multiple techniques are now used to limit this risk though.

Radiation pneumonitis (NOO-moh-NY-tis) is an inflammation of the lungs that can cause shortness of breath, a dry cough and low-grade fever. Severe symptoms can often be relieved by anti-inflammatory drugs. Radiation pneumonitis almost always goes away with time.

Very rare side effects include:

Brachial plexopathy (BRAY-kee-ul pleks-AH-path-ee) can happen when radiation damages nerves in the upper chest. It may cause tingling, pain and weakness in the affected hand and arm that is usually permanent.

These conditions may occur a few months or years after radiation therapy.

Radiation therapy and risk of a second cancer

In rare cases, radiation therapy can cause a second cancer. The most common cancers that have been linked to radiation therapy are sarcomas (cancers of the connective tissue) [18-19]. However, the risk of a second cancer is very small and the benefits of radiation therapy almost always outweigh the risks.

– See more at: http://ww5.komen.org/BreastCancer/SideEffectsofRadiationTherapy.html#sthash.J2bLvWFm.dpuf

Yes, I realize these side effects are rare, but you know what else is rare? Having a non-functioning gallbladder almost your entire adult life and finding out at 37. Having a ruptured ectopic pregnancy. Being an anglophile your entire life and then by chance meeting the man of your dreams and having him be British. All rare, yet all happened to me. So really, rare is relative.

The other post-surgical treatment they want me to undergo is taking Tamoxifen for five years. May I share with you my favorite Tamoxifen side effects? Well too bad, here they are:

Tamoxifen and antidepressant use

Some types of antidepressants called selective serotonin reuptake inhibitors (SSRIs) can interfere with the metabolism of tamoxifen (how tamoxifen works in the body). Some SSRIs (such as fluoxetine (Prozac), buproprion (Wellbutrin), paroxetine (Paxil) and sertraline (Zoloft)) interfere with tamoxifen so much that they should be avoided while taking tamoxifen [58].

– See more at: http://ww5.komen.org/BreastCancer/Tamoxifen.html#sthash.CmD0irMy.dpuf

Super! I will totally go off my Prozac so that I can survive breast cancer, only to die by my own hand.

Figure 5.10 lists some possible side effects and health risks of tamoxifen in women.

Figure 5.10: Side effects and health risks of tamoxifen in women
Common	Hot flashes and night sweats Loss of sex drive Vaginal discharge Vaginal dryness or itching Irregular periods or spotting (uterine bleeding)
Rare	Blood clots in the large veins (deep venous thrombosis) Blood clots in the lungs (pulmonary emboli) Bone loss (premenopausal women only) Cancer of the uterus (uterine or endometrial cancer) Cataracts Stroke
Adapted from Rimawi MF and Osborne CK [66].

– See more at: http://ww5.komen.org/BreastCancer/SideEffectsofTamoxifen.html#sthash.8JHvUkpd.dpuf

Great! This is all great. This all sounds just – just totally manageable. Thank you, cancer. Thank you.

Oh and here’s this side effect from Wikipedia:

Central nervous system

Tamoxifen-treated breast cancer patients show evidence of reduced cognition,^[37] a major side effect of tamoxifen, and semantic memory scores.^[38]

So I guess, in a nutshell, this is why I am sad, scared, and angry: If I do all the recommended treatments, this is going to reduce the quality of a minimum of five years of my life. This isn’t like, okay, they take the lump out, I recover and move on. This is so much longer than that. Right now I have so much support and understanding and sympathy and compassion. But what about three years down the road when I have no libido and no one even really remembers that I had cancer? Will I feel lonely, depressed, isolated?

In the end: I am scared. I hate that this happened to me and that this happens to anyone. I hate that it took me getting breast cancer to even understand how long lasting the treatments and effects are. I hate that I feel powerless. And I really hate feeling whiny or ungrateful or petty but I feel like – I don’t know, like I am owed that, at least once. Because everything is relative and although I know a lot of women have it worse than I do, this still sucks, for me, right now.

Now go donate $5 to my Making Strides campaign to cleanse your soul after reading all my bitching. I’m going to atone by walking 3 miles in the rain tomorrow.  http://main.acsevents.org/goto/katejig