From the category archives:

Hormone Therapy

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After my farewell to the radiation oncology department, I take the elevator up to the lobby and meander through the hospital complex to meet with Dr. Weary, my oncologist. (My heart feels heavy because Dr. Alpha is no longer my guardian angel and in my purse I have reams of computer print outs about the side effects of Arimidex, Dr. Weary’s drug of choice.)

Dr. Weary is late. I study my computer print outs for more than an hour, sitting alone in the small exam room. I feel clammy and light headed as I read other women, my cancer sisters, enumerate the side effects of Arimidex:  joint pain, bone pain, loss of concentration and memory, dizziness and insomia, hot flashes, nausea, hair loss, aging skin, vaginal dryness, trigger finger, loose joints,  anxiety,  leg cramping and  fuzzy brain. One woman writes: I hobble out of bed like a 90-year old, I will quit taking this pill. I’d rather die than live like this.

I  am about to fall off my stool and faint when Dr. Weary finally appears. He looks, well, weary. He apologizes profusely about letting me wait so long. But in the middle of his “I- am- so- sorries,”  his cell phone rings. He sighs. At first he looks like he plans to ignore it then glances and the number and answers. It is clear to me, it is another physician calling. And it is clear to me it is about a serious matter. “Go ahead, don’t worry,” I tell Dr. Weary has he excuses himself and leaves to continue the call out of my ear shot.

When he returns, I waste no time. I hand him the two-inch thick ream of Arimidex complaints. And just so he won’t have to read all the pages, I verbally high light the awful side-effects. Dr. Weary sighs again. He reaches out and takes the pages out of my hand, but instead of reading them, he dumps them in his waste basket with a thud, sits down and stares me straight into the eye: “You read too much,”  he says calmly.  “The only women who will go on  the internet are those who have complaints. For every woman you have read about, there are a thousand with no complaints.”

Dr. Weary scribbles my dreaded Arimidex prescription on his pads, rips it off, and hands it to me. “Here, the pharmacy is across the hall. If you don’t feel good, call me and I will put you on something else.” His cell phone buzzes again. Our session is over. Normally I would feel dismissed, not validated, and mad as a hornet. But somehow Dr. Weary makes me realize that his primary concern are those patients of his who are in immediate danger. Right now, I don’t need him all that much. As far as he is concerned I am making mountains out of mole hills,  and loosing sight of the real reason for the medication in the first place: To stop the spread of cancer. And if, or when, I do need Dr. Weary, he will be there for me.

I leave a bit befuddled, but calmer. I will be eating Arimidex pills for five years. The University Medical Center oncologist suggested Tamoxifen for 2 1/2 years and Arimidex for another 2 1/2 years. According to the National Cancer Institute the benefit of tamoxifen as a treatment for breast cancer is firmly established and far outweigh the potential risks of blood clots, uterine cancer, and many of the same side effects as Arimidex. Over thirty years, Tamoxifen has shown effective on pre-menopausal and post-menopausal alike.

Arimidex, on the other hand, is a fairly new drug without the same track record. So why am I on Arimidex only? Dr. Weary never explained why.  On the other hand, Tamoxifen works by binding up estrogen in a woman’s breast so it cannot feed the caner. But Arimidex prevents estrogen to develop in post menopausal women.  Somehow Arimidex makes more sense in my un-scientific mind. I buy my first jar. It costs $35 because I have health insurance. The cost is $378.70 for 30 pills  if I did not have insurance. Time will tell how I will feel and how much good they will do. By the way AstraZeneca’s profits for the first quarter of 2010 were on the order of  $3.73 billion.

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The sign “Magnolia Cancer Center” does not look as surreal as it has during my previous visits. After all, I do have breast cancer and this center is for me. Although I do not yet have the hollow eyes, the waxy complexion, the bloated body, or the shuffling gate of so many of the other cancer patients I see here. I suppose it is because I have yet to start my treatments.

A large black woman with a gap between her teeth greets me. Her look is that of kindness and concern, but not pity. I must have “new patient” written all over me. Eventually, I ,too, will be ground down by all the chemicals and look like the others: a shadow of former self.

The oncology department’s reception is as spacious as a hotel lobby, and lit by large windows. Someone has obviously dumped a serious amount of capital into this interior. (Although not enough money to allow the purchase of scanners to allow the doctors to email reports to patients.) Yet, the setting is remarkably different from Dr. Weary’s crowded, and a bit shabby, office.

The first person to check me is not Professor Oncology. It is a short, slightly round faced man in a white coat. I assume he is a student at first. Then I notice his  name tag.  He is already a doctor,  a  fellow in oncology, he explains. He seems kind, serious, and gentle. He weighs me in fully dressed and I wish I had kicked off my shoes to reduce my chart by a pound.

Professor Oncology looks Indian and seems too young to be a full Professor and Cancer specialist . Had I met her in a hospital corridor I would have taken her, too,  for a  medical student. Her black straight hair hangs down below her shoulders as does her drab navy skirt which goes inches below her knees and her white coat.  Her face is completely devoid of makeup. Her hands have a pianist’s sinewy, long fingers. Carefully, she feels about my neck, looking for signs of swollen nodes. She feels my breasts, and my armpits. She asks for permission for Dr. Fellow to examine me also.

Dr. Fellow stops with both hands around my neck and looks over at the Professor. He must think that he found something. I tense up, but she shakes her head. I immediately relax as does he.

The professor does not print out an adjuvant online graph like both Dr. Guru and Dr. Weary did. Instead, she  scribbles a few things on the back of a piece of paper. She tells me what I already know: stage 1, node negative, ER/PR + strongly so, HER/2 neg. grade 1 tumor. Like Dr. Weary, she is a bit baffled by my relatively high oncodx score.  It is 23. But she is still convinced that chemo would only improve my odds by 2%.  The professor, more than any of the others, stress the toxicity of chemo therapy: Leukemia, heart problems, bone marrow loss, risk for other infections.

Unlike, Dr. Weary, she does not agonize even a bit about skipping chemo. To my immense relief, she seems to have no doubts. She does not wring her hands, does not stand up only to abruptly sit down.

She draws up a five-year plan for hormone therapy: five years on Tamoxifen.  Or, she suggest,  we can do 21/2 years  and then switch to Arimidex, an aromatase inhibitor. I look aghast. “Oh well, Tamoxifen then,”  she shrugs. She does not ask what I have against Arimidex. She gives me an appointment for two months later when radiation will, supposedly, be over. She does not explain why I can not be on hormone blockers while on radiation. She does not bring up insufficient margins. I do not tell her about Dr. Alpha other than to mention that I will have radiation at a hospital closer to home.

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My Gynecologist Was a Drug Pusher

August 1, 2009

Dr. Bored, my gynecologist for more than a decade, was a drug pusher and his drug of choice was Premarin. -Take this and you will feel great. -But I feel great. A little insomnia perhaps, but don’t you need less sleep as you age? -Premarin will take care of it. -A little creaky sometimes. -Premarin […]

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