Happy New Year!

Happy New Year everyone!
I've been a bit quiet recently - the recent festivities took it out of me somewhat, it all rather sneaked up on me and I wasn't prepared in any way whatsoever. Me and several million other people feel the same, I guess, so I shouldn't complain.
Actually, things weren't quite that bad - I managed the creation of some fudge and some rather good chocolate truffles, but that was as far as my preparation went. Standard pressies from us seem to be truffles and sloe gin... probably not very imaginative, but always seems to go down well. However, since the festive season has faded into memory I have been pretty down for one reason and another; no job, waiting around for hospital appointments, general dissatisfaction with the world in general. I have probably been a complete bitch to be near recently - DH deserves several medals for putting up with me.

Things are starting up with the treatment once more - they might have told me that they cut all the cancer out, but they are still grabbing the opportunity to do awful things to me whenever they can! I saw the oncologist yesterday to talk about the next steps. He's prescribed a total of 23 radiotherapy treatments - fifteen general blasts at the boob, and what he called a "boost" - that's eight further zaps directed at the area where the tumour was sited. This may or may not make me suntanned or sunburnt, might but might not make me tired... oh and for a laugh it might make any hair under my arms fall out, and that hair might not grow back. As it happens, I have never ever had any hair under my arms, so the first benefit of the whole thing (never having to shave that armpit again) is totally wasted on me as I never had to do it in the first place! Hey ho...

It seems that the local NHS radiotherapy facility is so oversubscribed that waiting times are now regularly breaching the relevant targets. In an attempt to get through the backlog, the hospital is buying in time at the radiotherapy facility at a private hospital about forty miles away, and I have been referred there. Apparently the NHS will also pay my travelling expenses to get there, when they would not have contributed towards the expenses of getting to the NHS facility. This is ironic - I live roughly half way between the two, and it will be much easier to get to the private hospital, on faster roads, with easier and free parking. I won't be claiming the expenses...
Hopefully they will be contacting me over the next week or so with an appointment within two weeks of that.

I have also had a blood test to discern the state of my hormones. Chemo tends to bring on a fairly swift dose of the menopause; in younger women than this one is often a temporary matter, but in ladies of "a certain age" like me, it seems to be the real thing. I certainly seem to have a broken internal thermostat, hot and cold flushes whatever the weather. This is a somewhat significant threshold in any woman's life... however there is another issue with which to contend.
Breast cancer is often stimulated by the presence of the female hormone oestrogen (estrogen for those across the pond). The effect on the cancer is measured on a scale of 0-8, where 0 means that oestrogen isn't a factor at all, and 8 means that it's a major driver in the cancer. Anything over 3 on this scale is a candidate for "hormone therapy" after chemo and surgery have been performed. However, this is where the menopause comes in. In a pre-menopausal woman, the main source of oestrogen is the ovaries, which are busy generating the stuff all the time. To counteract the effects a drug called Tamoxifen can be used - it works by preventing oestrogen in the body from attaching to breast cancer cells and encouraging them to grow. In the "more mature" lady, the ovaries have given up on this production, and the main source of oestrogen is a process where other sex hormones (androgens) are turned into oestrogen in the fatty tissue of the body. A chemical in the body called aromatase makes this happen, so drugs called (unsurprisingly) "aromatase inhibitors" are prescribed to stop this happening.

My cancer is a 3, so they want to try one or other of these treatments, and they have to decide which one, hence the blood test to decide if I am pre or post menopausal. Those of you who have known me any time will be aware that I have been subject to bad temper, mood swings and lots of other things generally associated with menopause for the last thirty years, so it's necessary to check at a molecular level! However, after all that, as my cancer is - no, WAS - a 3 on that scale, it's a borderline case - they want to try hormone treatment but if it causes too many side effects they will cancel it without too much worry. If it was a 4 or more then they'd want to persevere for the full five years...

The side effects seem to be much the same for both...

The other drug often used in conjunction with chemo and surgery, and for some years afterwards, is Herceptin. This used to be very controversial and high-profile, as it was very expensive and there was much argument about whether it should be prescribed at all. Herceptin has been around a few years now, and the costs have dropped sharply - it's now considered a routine treatment. However, it's actually only suitable for about 30% of women, and I am not in that bracket, so I won't be having that one.

Anyway, that's the story so far - back on the treadmill once more!