Wednesday, February 13, 2019

My bitter pill to swallow.

Note: So, I talked with my breast surgeon about the bruising on my tongue. She said she'd watched the anesthesiologist, who had some trouble getting the breathing tube seated properly, and he'd used his finger under my tongue to maneuver my jaw into place. Hence the bruises. Mystery solved. Now, back to our regularly scheduled programming...
With hormone receptor positive breast cancers, cancer growth is driven, at least in part, by the presence of estrogen. Any long-term treatment, then, virtually always includes endocrine therapy. At this point, there are two classes. One is the old standby, tamoxifen, a selective estrogen receptor modulator. It acts by mimicking estrogen and taking up the estrogen receptors in cancer cells. Sort of like getting dummy keys made for all your locks and then sticking them into the keyholes so that you can't use the real keys. A new drug, more often prescribed these days for post-menopausal women, is a class of drugs called aromatase inhibitors (AIs). These work by preventing the conversion of androgen to estrogen in various sites in the body (like the adrenal glands). But the choice is not as clear-cut as it might sound. AIs have a couple of ugly side effects, including joint paint and acceleration of bone loss. I already have osteopenia and I was not keen on worsening that or on risking jaw bone necrosis with a bone-building bisphosphenate. On the other hand, tamoxifen also carries risks, most notably blood clots and endometrial and uterine cancers. But I had already forfeited my uterus to cervical cancer and as a thin nonsmoker, my clotting risk is minimal. After a discussion with my medical oncologist, we decided to go with tamoxifen. He didn't like the bone loss risk for me and felt an AI offered only a very minimal advantage otherwise.  I asked if the plan was to switch to an AI at some point,  but the oncologist said he wanted me on tamoxifen for ten years and then we could talk about what next. Ten years! If I'm here in a decade to talk about what next, I'll be thankful.
Still, after much research, I started taking a baby aspirin daily with my tamoxifen, both to decrease the clotting risk and because there is some early evidence, per the NIH, that aspirin may lower the risk of metastases for a variety of possible reasons - because it acts as a weak aromatase inhibitor, it may interfere with stem cell formation, it has an anti-inflammatory effect, or maybe something else entirely. Whatever the reason for the finding, it seemed prudent to me to start taking aspirin. And melatonin, which NIH studies have shown to reduce the risk of cancer becoming tamoxifen-resistant. I've been taking tamoxifen for about ten weeks now, with no serious side effects that I can discern. Except mild wooziness. I feel constantly like I've very slightly drunk.
At my first post-chemo oncology visit last Friday, I had my port accessed for the last time. I asked my oncologist to add a cholesterol check while he was at it. One positive side effect is that tamoxifen cal actually lower cholesterol, an average of 13% in some studies. Mine had been steadily creeping up, and was 218 a year ago. My PCP said all my other risk factors were low so he didn't want to prescribe a statin for me. Yet. I was hoping for a decrease, but was shocked to get my labs back. 166! That's almost a 25% decrease! I told my breast surgeon when I saw her and she high-fived me.  The decrease was so impressive that I can't help but think it's a combination of the tamoxifen and my mostly plant-based diet since chemo ended. For instance, every single day I eat a bowl of oatmeal with dried fruit, nuts, cinnamon, and flax seed. I make up a dozen packets and keep them at work, then bring the bags home to refill.
In a comment, Sabine recommended a two-soup combo made with carrots and Brussels sprouts. I'm constitutionally incapable of sticking to a recipe even when there are measurements given, but I went a little nuts with this one. I thought about it and said to myself, "Ooh, you know what other color would be pretty?" Beets it was. I made each soup with a little white wine, vegetable broth, and yogurt, with a patch of yogurt added at the end. It was almost two pretty to stir it all together. But so good. We had a lettuce, red cabbage, dates, and almonds salad with it. And some whole wheat sourdough bread. I have to say, I was a little disappointed when I saw my PCP this morning that he wasn't more impressed with my results. But I am.

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