Saturday, August 28, 2010

Some Peace of Mind

I met with my new oncologist on Thursday. I was nervous. I had a list of questions and was determined not to get diverted. I needed some honest answers even if those answers were, "we just don't know".

First, though, I had to get through bloodwork, which was not fun. I don't particularly dread getting needles in my arm anymore and I haven't for decades. I have learned that I have very small, rolly veins and that it's difficult to find them with a needle. It usually takes more than one poke to achieve success and I don't have any problem with that. Inevitably, when presented with my right arm, it only takes a moment before the nurse will ask if we can use the other one. But since that side of my body has been ravaged, I'm not to get needles in that arm so we're stuck ... so to speak ... with my right arm. To tell you the truth, I don't think the left arm was ever any better. So yesterday I had three pokes in my arm ... no success. And then they had to take from my hand, which I dread because that really freaking hurts! At least the few times they've had to resort to my hand, it has really hurt. I keep thinking that, just like the arm, sometimes it will and sometimes it won't. So far, this time, too, it has ALWAYS hurt! Even the veins in my hand ran for cover. The nurses could only find a vein in my hand by asking me to dangle my arm for a while and then applying hot compresses. Not fun. Not fun at all.

By the way, I've recently taken to asking nurses if there's any particular reason that some people have extra small veins and if there's anything one can do about it. Mostly I'm told that it's probably just genetic and that drinking a lot of fluid before having blood taken can make the veins easier to locate. I make sure I do that now before having bloodwork done. I asked the nurses at this appointment and one of them said that she has noticed quite consistently that people who have been on chemo end up with smaller veins afterward. Interesting.  If that's true, mine must be even tinier than they were before and they were plenty challenging enough before.  It's a wonder I have any kind of circulation at all!  I'd better be careful not to clog any of them.

After my bloodwork ordeal Kevin joined me to meet my new "assigned" oncologist. I have a new oncological nurse, too. I was very happy with both of them. It was comforting to realize that they had both truly reviewed my file. The doctor examined my breasts. The left one and the surrounding area is still all very tender, which is par for the course, I guess. No new apparent lumps! YEAH! And then we talked.

I asked about the below and above normals on my previous bloodwork (from May) and was told that they don't know why my liver enzymes had spiked but they had noted that as something to watch. It was good to hear that they were back within the normal range in this bloodwork. YEAH! The low platelets on the previous report were nothing to be concerned about and they are now in the normal range, too. YEAH! Hemoglobin at 12. That's even high for me. I'm historically at 11 or less. YEAH! In fact, they told me that everything in my preliminary bloodwork looked good. Some numbers weren't back yet. I asked for a report to be mailed to me when available and then I can review and compare it for myself.

And then we went over my list of questions. My doctor feels that the joint/tendon/muscle/bone pain is most certainly a lingering result of a bad reaction to the Arimidex. He feels quite certain that, in time, it will go away but he can't hazard a guess as to how long that might take. It's possible that the Tamoxifen, which can cause some bone and joint discomfort (thought not as badly as reported with Arimidex), is preventing recovery, which means it could be a very long time before I get my limbs back. That said, based on my pathology (a largish, aggressive, estrogen receptor positive tumour), he strongly recommends that I continue with the Tamoxifen. When I told him that I have an eventual appointment with a rheumatologist, he encouraged me to keep that appointment because even if any tests that Doctor might run might rule out any other issues.

I explained to the Doctor what my family doctor and I had been trying recently to replicate the happy effect the morphine had had on my limbs. He said that he would rather not have me go on morphine because of it's addictive nature but he prescribed me a drug that's a step up from the Tylenol IIIs, which didn't work. It's Ultram - 50 mg 2 x per day. I took the first one this morning. No difference yet. I was happy that he's willing to help me find something to relieve the pain and stiffness and to improve my quality of life. YEAH!

We talked about my what seems to be worsening fatigue. Fatigue is one of the many possible side effects of Tamoxifen and it is, of course, a lingering side effect of both chemo and radiation. Of course I'm tired still. The doctor and nurse both acknowledge my "brain fuzziness" and memory problems as problems associated with both chemo and Tamoxifen. Tamoxifen is also the likely culprit for the difficulty I'm having with my weight and, in particular, with a increasing pudginess in my belly. Why the Tamoxifen causes that particular type of weight gain, I don't understand. Unfortunately there's not much I can do about that except try to eat well and get some exercise and try not to gain more weight. Tamoxifen is the cause of these hot flashes, which is a very common experience for women taking this drug. The strength and frequency of the hot flashes can also contribute to fatigue. Weepiness is also a common experience for women on Tamoxifen. There's a reason that many women on Tamoxifen are also prescribed anti-depressants. I sometimes wonder if I'm a little depressed but as I've expressed before, I don't know that I can tell if I'm depressed or not. I mean, having to deal with breast cancer and the treatments is potentially depressing enough but what's normal for that and what's beyond that? Maybe I'm just a little battle-weary? Maybe it's just being so tired and not being able to fully engage in life the way I used to? Maybe I am depressed? I don't know. I do know that crying inappropriately makes me very uncomfortable and that still happens sometimes, though not often. Then again, having breast cancer and going through the hellish but life-saving (we hope) treatments is probably makes some occasional tearing up quite legitimate. It's so hard to know.  I have no frame of reference for "normal" and for when I need help.

My oncologist feels that my fatigue is probably worsened by the pain and stiffness in my joints. If this drug he's given me helps relieve that, he thinks it might possibly increase my energy levels and alleviate some of the fatigue. If the fatigue and the associated lethargy continues to be a problem, he might prescribe a mild anti-depressant for me.

All in all ... I was very happy to have had my appointment and very pleased, too, with the new oncologist. I see him again in 3 months. I came out with a feeling of hope and a bit drained, too, just from the anxiety of wondering if I would get any satisfying answers. I did. YEAH!!

I didn't have much time to reflect on it, though, because I had to hurry home and get ready for my splurge club pals to arrive!

These photos are from the riverboat excursion we took last night with Kevin's colleagues and board members. It was such a lovely night for it. We had a nice dinner on the boat, a quick cruise up and down the river and then we were done. I was glad to be home early.
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