New Year, New Goals

 

I've been feeling the pull to get back to writing here, so today's the day. Looking back at my last post and its title ("And...done!") made me laugh a little. I have known since my diagnosis that the end of treatment (not that I'm there yet) isn't an end to the changes cancer brings. You can find lots of information about the challenges cancer patients face when treatment is finished; feeling cut off from the medical team that has been caring for you for months is a difficult adjustment for most people. In my case, I'm not really done yet, as my immunotherapy treatments will continue every three weeks. I have nine more treatments, so that means I'll continue seeing my cancer care team until at least July. This continued connection means I have time to ease more slowly into the challenges of recovery and 'survivorship,' and for that I suppose I am grateful.

In the middle of December I started a new drug regimen to suppress my estrogen production and ensure that my body stays in a state of menopause. Since my cancer cells respond to estrogen, it's best to not have any around. In terms of cancer recurrence it is a really good thing to be able to limit estrogen. In terms of my recovery, clinically-induced menopause carries with it another layer of challenges for my body and brain.

The first drug I'm taking to ensure menopause is Zoladex (Goserelin). It's purpose is to suppress my ovaries and prevent them from making estrogen. It does this by stopping production of luteinizing hormone (LH) by the pituitary gland in the brain. The ovaries need LH in order to function in the regular way. I will be getting an injection of this drug four times a year for five years. The injection is a small pellet (about the size of a grain of rice) into my belly fat where it slowly releases the medication over three months. Fun fact: the same drug is used for prostate cancer patients who need to suppress testicular function.

I am also taking a second drug called Exemestane (Aromasin) daily as a pill. This drug stops the function of an enzyme that makes estrogen in the body. Lots of estrogen is made in the ovaries, but it is also made in the adrenal glands and in fat tissue. Taking this drug helps ensure that my body is not making estrogen. I will also be taking this pill for five years.

So...what does this all mean? For practical purposes, it means the menu of side effects my body may experience is a long one! These lists are just the MOST COMMON side effects:

• My immunotherapy (Kadcyla): liver function changes; bruising, bleeding gums or nose bleeds due to low platelets; Numbness or tingling in fingers or toes; anemia; diarrhoea/constipation; dry mouth; UTIs; trouble sleeping; headaches; cramps; joint and muscle pain; tiredness/weakness.
  
  
• Zoladex (menopause symptoms): hot flushes, night sweats, vaginal dryness, mood changes and a decrease in libido (sex drive)
  
  
• Exemestane: hot flashes, fatigue, joint pain and stiffness, headache, insomnia, mental depression, weight gain, bone loss, swelling of the hands, ankles, feet, or lower legs

So far I'm managing fairly well, though I've only been taking the Exemestane for about 3 weeks. Symptoms I have been experiencing include joint pain (started with the Kadcyla; may or may not have been made worse from the Exemestane), low platelets (I've had nosebleeds and sensitive gums), numbness in fingers/toes (though it has never really gone away after chemo), tiredness/fatigue (worse just after Kadcyla treatment but sometimes comes when I least expect it), cramps (I've had some muscle cramps in my legs and feet), and of course some menopause symptoms (very mild hot flashes, vaginal dryness, decrease in libido).

I've been doing lots of reading and listening about how to best manage my symptoms going forward. In the long term I am most concerned about my bones. Knowing that the drugs I'm on can cause bone loss make it really important that I stay active and eat well. I'm taking vitamin D and making sure I have enough calcium in my diet and am ready to start adding more weight-bearing exercises to my fitness routine. 

One great resource I found is as podcast called Menopause and Cancer; it covers the whole range of topics I'm interested in: fitness, diet, returning to work, mental health, sexual health, etc. I think my favourite part is that since it focuses on those who have entered menopause as a result of cancer treatment I have heard lots of voices around my age (or younger) and as a result the delivery is more geared to an audience that finds themselves in menopause earlier than expected AND are dealing with those symptoms on top of the physical and mental side effects of a cancer diagnosis and treatment. 

My goals for the next month are to slowly ramp up my fitness routine, get lots of fresh air, and continue to write as much as I can about things that have been boiling on the back burner of my brain.

Oh...and here's a photo of me taken after I jumped into Kempenfelt Bay on New Year's Day! It was cold but oh-so-satisfying. :)