How things change

A funny couple of weeks.  I've been getting more and more stressed... to be brutal, I haven't been coping very well.  Work is going fine, but instead of enjoying the challenge I have been resenting every minute I have spent on it.  Family have been having their own crises (and there have been some real shit bastard arse things going on for people I care about, and there's sweet stuff all that I can do about any of it) which have added to the tension.  Totally innocent people on internet fora (forums?  no doubt my Latin-fluent Ickle Bruv will correct this very soon) have made minor digs and been flamed properly for their trouble.  To call this "mood swings" seems just a little weak.  And some poor so and so lives with me and puts up with the bitch queen from hell every day...
I have been lying awake nights trying to go to sleep, but not wanting to face the nightmares.  When I wake up, shattered, I have had hands and feet so stiff that I couldn't pull the quilt back and walk to the bathroom.  I know it's been warm but I have never - NEVER - spent the night with no covers over me before - the fear of spiders walking over me in the night (yeah, ok, don't tell me whether it's silly or perfectly reasonable, I don't want to know) has always kept me under the quilt, whatever the weather.  Until this month.  Hot flushes four hours long.  Changing the sheets every few days because they are wringing wet by morning.

I don't know what made me look at the "Patient Information Leaflet" in the latest hormone therapy tablets I have been taking.  Possibly the thought that these haven't been any better than the last.  I was taking anastrazole (Arimidex), which was making the pain in my joints (which is a natural part of being post-menopausal, or so they tell me) much worse.  So I spoke to the Great Man, or rather to the BC nurses at the clinic who spoke on my behalf to the Great Man... he wrote to my GP saying that I should stop the Anastrazole and start on Exemestane, which might or might not reduce this particular side effect.  I didn't start them straight away but waited until I got back from a business trip, but I have been on them for almost a month.  Anyway, my poor claws have been getting more and more painful, so I thought idly that I would have a look and see what the bit of paper in every packet said.
Hmmm...

Very common side effects, (affecting more than 1 person in 10):

• Difficulty sleeping
• Headache
• Hot flushes
• Feeling sick (nausea)
• Increased sweating
• Muscle and joint pain (including osteoarthritis, back pain, arthritis and joint stiffness)
• Tiredness

Common side effects, (affecting between 1 to 10 people in 100):

• Loss of appetite
• Depression
• Dizziness, carpal tunnel syndrome (a combinations of pins and needles, numbness and pain affecting all of the hand except the little finger)
• Stomach ache, vomiting (being sick), constipation, indigestion, diarrhoea
• Skin rash, hair loss
• Thinning of bones which might decrease their strength (osteoporosis), leading to bone fractures (breaks or cracks) in some cases
• Pain, swollen hands and feet

Some of that sounds a bit familiar...
So I rang the BC Nurses and asked for advice.  Yep, I am taking Glucosamine & Chondroitin.  No, I am really not happy at all.  Yep, I would be pleased to see the Great Man to talk about this.  No, I am not sure that I want to stop taking anything, but I would like to do something other than this as it's pretty awful.  So they had a chat with the Great Man and I'm to stop taking them for now and go in and see him next week to talk about this.

Thing is, my cancer was 3 on the Oestrogen Receptive scale, which goes 1-8.  3 is the threshhold - higher than that, it's hormone therapy for five years.  Lower than that, it's of little or no benefit.  3?  That's the borderline.  It might be doing some good, but it might not.  It's making me feel a bit crummy (aka Blooming miserable) but do I want to take a chance that it is preventing recurrence or spread?  that seems like a big gamble to me.  There are too many people I know on the secondary BC path right now, and that's not a good place to be, so I am reluctant to give up anything that might have the slightest effect in keeping me out of there.

In other news, M has run away to sea.  He's currently in a taxi heading North from Schipol to Den Helder, where tomorrow, all things being equal, he and his chum will be setting sail for Blighty.  The weather forecast has the wind pointing in the right direction to get them home quickly - possibly just a little too much, though, it might be quite a bumpy ride.  So at least I have something else to fret about for a few days!

New adventures

Time to start the new pills today - the lovely oncologist decided I should try something else to see if the joint pain would be better since stopping the last drug (Anastrazole) for a month eased things decidedly.  Now I will be trying Exemestane to see if that causes me less grief.  The pills have been sitting on the shelf for a week as I thought it was probably a bad move to take a brand new drug just before getting on an aircraft for a very long two day trip away...

The trip was exciting enough without adding new drugs to the equation.  The choice was to fly from Gatwick at 06.50 or Southampton at 06:45... Gatwick won as the flights were cheaper and everything else was the same.  The two airports are both about an hour's drive away... So, working back, to fly at 06:50 meant checking in around 05:00, so leaving home around 04:00, so the alarm was set for 3am...  Up, shower, loaded the car, no problem, still running a few minutes late, still there's a good two hours for getting through security... Last time I flew to Dublin (first day in the new job) I cut it a little fine, left an hour to get through the airport thinking that would be plenty as I had no bag to check - got to security to find about 2000 people queueing and ended up running to the gate.  Never come so close to missing a flight... so taking no chances this time.
However, much surprise, Gatwick has been totally reorganised, and fifteen minutes after getting off the bus from the car park I had dropped my bag, gone through security and was stood in the departure area wondering what I was going to do for the next two hours!

The day was filled with work... but there was the promise of a sociable evening at the end, as the whole team went out for dinner.  Much fun was had by all, but by the end of the meal (about 10pm) I was fading, while the rest of the crew were gearing up to enjoy the best entertainment that Dublin could offer on a Tuesday evening.  I wimped out and headed for my bed at this point.  I was quite embarrassed at this - feeling most glum, thinking that I used to be able to get up early and still party the night away...  Having said that, they partied until 3am and spent a fortune, as I looked at the frail collection of colleagues in the hotel at breakfast I was quite glad I had retired early - and the sight that greeted us when we got to the office confirmed this.  The UK contingent had partied hard, but the local team had clearly been equally excited about getting a night on the tiles, and a few broken figures were slumped around the table...  Funny how business transformation didn't seem to hold their attention quite as it had the day before!
I got myself home around midnight on Wednesday, after chaos at the car park - I had contrived to lose the parking ticket, and then discovered that when I booked in I got my own registration number wrong, which added a whole level of confusion! Add to this the torrential rain, and I was very glad to see my bed that night.

I did spend a lot of time worrying that I was so tired, and that I should have coped better - blaming the after-effects of being a bit poorly last year - but on the whole I think any normal human would have been a bit whacked out after that little lot.  Once again, another exercise in realising that there is a level of normality to be had in life after cancer... and that sometimes being tired is normal!

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!