Today is Wednesday, July 10, 2013. The bug man came yesterday. I went to water aerobics this morning and got my hair cut this afternoon. I still have to stretch my pectoral muscles several times a day to loosen them up. Most of the time, it feels like there is a large multi-pronged clamp squeezing my new breast. It’s not painful, but it is distracting.
A YEAR AGO TODAY was a Tuesday. It was the day before my first reconstruction surgery.
The day before, on Monday, I had my appointment with the oncologist recommended by my general practitioner. Instead of the 45-50 minute drive required to get to my first oncologist, it took less than 15 minutes to get to this doctor. That was a nice change. His office was part of a fairly large cancer treatment and research center so it was big and busy. I wasn’t sure how much I liked that change but I was willing to give it a try. As my husband and I sat in the large waiting area I couldn’t help but look around at all of the people and try to figure out where they were in their battle.
After a relatively short wait we were taken back to a room where we met with the doctor’s registered nurse. She told us a little about her background including the fact that she has worked with over 2000 breast cancer patients. We liked her very matter of fact approach that was both professional and personable. I was now realizing that not all medical professionals were able to strike that balance.
The nurse seemed to be quite knowledgeable. We let her know we were there for a second opinion on my course of cancer prevention, specifically the aromatase inhibitors. Pretty much she repeated everything my first oncologist had told us. It is standard practice to give aromatase inhibitors. They prevent the production of the hormone estrogen. Hormones feed the kind of breast cancer I had. In addition to using the inhibitor to block the production of hormones, I should not take or do anything to introduce or “replace” hormones, including progesterone. I mention progesterone because a saliva test I had taken the previous fall indicated that my progesterone level was 1/10 of what it should be.
The nurse went on to explain the side effects of the inhibitor and other precautions I should take. Again this information was almost verbatim of what the first oncologist had said. There could be joint and muscle pain from the reduction in estrogen. Magnesium and vitamin E supplements would help reduce that. I should take calcium and vitamin D supplements, 1200 and 800 units per day, respectively, to support bone health. As far as diet, I should reduce my lipid intake which is primarily fats and oils. When possible, I should go organic. I should watch my meat and chicken consumption because of the hormones the animals are fed. This was an interesting conundrum because multiple doctors had encouraged me to increase my protein intake to help with healing and the reduction of blood sugar. For me that would that would mean eating more chicken and meat. Well, I guess if I wanted to both prevent cancer recurrence and promote healing and lower blood sugar, I would have to make a dietary shift. Fish and nuts, here we come.
The last thing we talked about before the nurse left and the doctor came in was the aromatase inhibitor. There were a couple of choices. The two most commonly prescribed are Arimidex and Femara. They both do the same thing which is to prevent the production of estrogen. There are studies which show that women taking Femara have a slightly lower cancer recurrence rate than those taking Arimedex, but the results of both are good. Which one I end up on will depend on which one of them I tolerate the best. I was starting to notice that the word “tolerate” was coming up more and more.
We had been pleased with the nurse. When the doctor came in, we were quickly pleased with him as well. The best way to describe the difference between this oncologist and my first one was that this doctor had a manner about him that made me feel like he was assessing me and my needs as an individual rather than as just one more breast cancer patient. It was very much like the way I felt when my plastic surgeon was drawing his incision marks on my chest before surgery. I was his current unique work of art. My body and its needs had his total focus. In order for him to be a success, I needed to be a success. In support of my feelings, the new oncologist had checked on the details of my health history as well as my current health status before he came in to meet us. What’s more, he remembered what he had read.
The oncologist’s first recommendation, in the nicest way, was to lose 10 to 15 pounds over the next 1 to 5 years. He explained that fat, especially belly fat, is where estrogen is stored. Get rid of the storage locker and you get rid of the estrogen reservoirs. Going just a bit further, he said that if there is no place to store the estrogen, it passes on out of the body leaving no food for cancer. He was the first one to explain it like that.
The next thing that he recommended that no one else had recommended was a yearly MRI starting two months after my final reconstruction surgery. I would definitely be talking to both my breast surgeon and my general practitioner about that. When we asked about precautions for our three daughters, he recommended they start mammograms at age 35. My breast surgeon had said the same. As with my general practitioner, the oncologist wanted me to get my colonoscopy as soon as possible. He suggested that I wait until about two months after my surgery. I was planning on 6 weeks but had no problem adding 2 more to the schedule.
Last on the list of topics was the aromatase inhibitor. He was prescribing Femara. I should start taking it 1-2 weeks after my upcoming surgery and then come to see him a month after that. Before that appointment I should get a bone density scan. Since the nurse had already covered the topic of the aromatase inhibitors so well, we didn’t have any other questions for him. We were done. I definitely felt more connected with this doctor and his nurse than with my first oncologist. My husband agreed. I had a new oncologist.
The next morning I had a massage. I thought it would be good for me both mentally and physically to have an hour of relaxation facilitated by the healing touch of our massage therapist. Her fingers truly work magic. I scheduled her to come to our house two days after my surgery to do a chair massage. In the afternoon, after my massage, I went for my bone density scan. I went to the imaging center recommended by my breast surgeon. It was both pain and incident free. Yay!
By the end of the day I was about as ready as I was going to be for my fourth surgery in five months.