risks and rewards
Some days, I don’t feel nauseous at all. I don’t feel exhausted at all, except for the kind of tired that comes from working all day and carting kids around after school and coming home to homework and dinner and showers and, really, life. Some days, some glorious days, I wake up and only remember for a fleeting moment that I had breast cancer a couple months ago, and the thought passes as quickly as it came, and I barely flinch.
Today, though, I can hardly see straight because the fatigue is so bad. Today, every time I swallow, I wonder if this will be the time I finally throw up. It’s an awful way to live, really, the constant wondering if I am going to vomit, and if I do, will it be in front of someone, or will I make it to a bathroom? All of this to say that nearly four months post-surgery for stage one breast cancer, nearly six months post-diagnosis, things could be worse. I am alive, I am healing, I am grateful. But they could also be better: I am struggling to adjust to the medicine I didn’t want to take (Tamoxifen) and some days I don’t know why I am taking it at all.
Tamoxifen is a preventative drug for breast cancer patients like me, who have an increased risk of breast cancer and whose cancer is hormone positive. The drug, a tiny white tablet I take every morning, is meant to block the estrogen that produced my cancer. It’s kind of designed to send me into early menopause. I haven’t experienced those symptoms (yet?) but I have definitely felt a kind of exhaustion that leaves me wanting to nap for hours in the middle of the day, and some lightheadedness that makes concentration fun. But most crippling, however, has been the nausea. Because I never know when it will come, or for how long it will last, and while most days I don’t actually throw up, do you know how annoying it is to feel like you’re going to for hours on end? My doctor promises that the effects will eventually fade. I want to believe her, but two months after I started taking the pill, they haven’t. I am trying to come to grips with that, especially since my doctor recommends I take it for up to 10 years.
I don’t want to debate the pros or cons of taking Tamoxifen. People have very strong opinions in support and against. I have always been very middle, keenly aware that there are few cancers that have the luxury of a preventative medication. Inherently, I am someone who believes my body wants to heal, and it should be left alone to do that. I am not someone who takes pills regularly, except for an occasional aspirin for a bad headache and some vitamins to boost my immune system. Taking medication regularly has been an adjustment, first in remembering to take it, and then remembering WHY I am taking it (there’s that c-word again). There are some scary risks associated with it, of course, of increases in uterine cancer, and of blood clotting, and of stroke. There are some dangers for people with liver problems. Severe side effects happen in about three percent of patients.
Most women have side effects like mine, that last a while before your body adjusts and you’re at a new normal. For me, the side effects seem innocuous enough but are actually quite debilitating. But those side effects pale in comparison to the potential impacts of chemotherapy or radiation. The chance of my cancer reoccurring, based on a biopsy of the tumor that was removed, is eight percent. Taking Tamoxifen reduces that chance to four percent. Is that four percent reduction that big of a deal? For me it is, because if the cancer comes back I hardly think I’d be able to live with myself for not having done whatever I could to prevent it. But as my doctor pointed out, there are no guarantees. So really it comes down to what you can live with, right? What are the risks you’re comfortable living with?
It’s an interesting question, and one I feel like I’m living every day. I take the medicine, but I don’t take it at EXACTLY the same time everyday. It’s usually a two hour window, to give myself some grace on the weekends when I want to lie in bed a little longer. Drinking alcohol is discouraged, but I don’t abstain. I like beer and wine and I drink it when I want it. I still eat pretty healthy, but I haven’t made the major changes I’ve read others have to their diet post-cancer diagnoses. Because I am a big believer in the mind-body connection, I try to focus on the idea that the pill is really just like another vitamin I would take to keep me healthy, and that the side effects won’t last. Some days it works, and I feel nothing. Some days, like today, it doesn’t, and I feel like shit. But mostly, I just want to live my life. I want to respect the cancer, but I can’t let it define me. I can’t allow it to be the THING that happened to me; it is A thing that happened to me. And now it’s gone, and I want to keep it that way, so I take the stupid pill, and I pray for more days where nausea skips over me, and I find a home in my new normal.
