The Not Quite Incredible Shrinking Woman

Speaking of weight, I'm surprised and cautiously optimistic about my recent slow but steady weight loss! I'm almost afraid to mention it in case I jinx it!

While I lost weight with some of my chemo drugs (FEC, to be specific), I gained weight on the other (taxotere). Overall, I gained 10 to 15 pounds during the course of my cancer treatments ... caused by a combination of chemo, steroids, inactivity. Fifteen pounds is considered the average weight gain one might expect during cancer treatments. Now that cancer treatments are over, I have the responsibility for losing what I gained. Oh joy! It's important for many reasons to maintain a healthy body weight. Women who maintain a healthy body weight are less likely to have their cancers recur. That's one of several incentives.

I have been struggling against weight gain for the past 7 years. It just slowly started creeping up on me after never having had to worry about it before. I've never had any particular problems with overeating or eating too much high-calorie junk. When I made concerted efforts to lose weight, I found it very hard. I could muster the will power and stick to it for a good, long time but even then, I could only lose a little weight and then I would plateau and it seemed like no matter what I did, I couldn't lose any more. This was one of the reasons I was seeing my doctor at the time I was diagnosed with breast cancer. He told me to "get more exercise", which was frustrating to hear and I knew that wasn't the complete answer.

Since having breast cancer and learning a little more about hormones, I've learned that weight gain and a drop in metabolism can be symptoms of estrogen dominance. That explains some of the problem if not all of the problem. I learned about estrogen dominance when I was researching my breast cancer, after getting the pathology report that indicated that my tumour was very high in estrogen and low in progesterone. In other words, I had an estrogen-fed tumour and had too much estrogen in my system, which is why I will now take estrogen blockers for the next 5 or more years. Read this short article about estrogen dominance and weight and how balancing your estrogen can not only help you manage your weight, it might also save your life (from breast cancer ); something I wish I had known a few years ago. If I had, I might not have developed breast cancer at all. I should also say that estrogen dominance isn't typically recognized by mainstream medicine and is more in the realm of the naturopathic doctors. I haven't met any mainstream doctors that give a hoot about balancing hormones, except for cutting my estrogen AFTER breast cancer, but from the personal experience of being a woman, I know hormones figure into almost everything. I do believe it's a fine balance. I believe that recognizing and treating estrogen dominance in the first place can prevent some breast cancers.

Since there's no turning back the clock to "prevention", here I am in treatment and doing what I have to do to live. Maybe someone out there will see themselves in my symptoms prior to breast cancer and perhaps prevent themselves from getting breast cancer. That would make me very happy.

Back to weighty things ... I was dismayed to learn that the drug I'm to take for the next 5 years (tamoxifen) can cause weight gain in much the same way that birth control pills can. It felt like just another kick in the boob. But so far that hasn't been the case for me. Not yet anyway. In fact, I've been slowly and steadily losing weight, which is making me SO happy! I can hardly believe it! I've lost at least 5 pounds in the past two or three weeks. And I'm not even trying! That's the surprising part! Previously I would have gained weight drinking water and eating celery! This is too good to be true! I haven't been cutting out breads ... or mayo ... or cheese ... or butter on my potatoes ... or chips and dip on special occasions (such as Olympic hockey games) ... What's going on?! How can this be?

I have no explanation. Maybe if I understood more about estrogen and my other hormones but from what I'm reading, even though estrogen dominance can cause weight gain, so can decreasing estrogen (as happens during menopause, which is where cancer treatments have put me). I find all the hormone information just too difficult to understand. It seems very complex.

Here's a possible theory for my new ability to lost weight. Vitamin D. Was I previously unable to lose weight because I was Vitamin D deficient? Read this article that links increased Vitamin D levels to weight loss. Could it be that just upping my Vitamin D is allowing my body to shed some weight? At last? Remember (I find this hard to keep in mind) ... Vitamin D3 is not actually a vitamin. It's a hormone. Then why do they call it "Vitamin D" instead of "Hormone D"? I don't get it! Well now I do, because I looked it up and found it here. It seems that it was in the early 70's that scientists discovered that Vitamin D is a hormone and not a vitamin:

"One of the reasons vitamin D was a puzzle to scientists for so many years was that it was initially misidentified as a true vitamin, that is an essential substance that our bodies cannot manufacture and which therefore, can only be obtained from our food. But, unlike essential dietary trace elements, such as vitamins A, B, and C, which humans must get directly from food, vitamin D can be produced in the body through a photosynthetic reaction when the skin is exposed to sunlight. The resulting substance is only a precursor, however, which must then undergo two transformations--first in the liver and then in the kidney--to become the biologically active substance the body uses. This active form of vitamin D is a hormone, chemically akin to familiar steroid hormones, such as the sex regulators testosterone and estrogen and the stress regulator cortisol."

Whatever the reason for my recent miracle weight loss, I don't understand it and I'm afraid to get too excited! It's too bizarre! I just hope it continues for a while longer! I would so love to feel like my smaller self again! If I figure it out, I'll let you know. If you have any ideas, please share.

Just think ... if I start adding more exercise to the mix, at this rate I would be slimmish again before next fall! That would be too much to hope for. I know it.

The Not Quite Incredible Shrinking Woman

Gritty Details About my Breast Cancer

For those of you who find my blog and who will benefit from the details about my particular breast tumour, I'm providing as much information as I know below.

I have Invasive Ductal Carcinoma. My tumour was 3 cm (about the size of a golf ball) and was grade 3 and located on the left side of my left breast. I'm at stage II breast cancer, though I was initially told stage III. I like the sounds of stage II better, so I'm sticking with that.

I had a sentinel node lumpectomy on March 18, 2009, 13 days after my diagnosis. Two lymph nodes were removed and they showed micrometastesis. My margins were clear, though very close in at least one area. For this reason, it has been recommended that I have additional surgery after my chemotherapy. As to what that will entail, we'll cross that bridge when we get there. Meanwhile, my medical team felt it was important to first treat my systemic system with chemotherapy because my cancer is an aggressive type.

My bone and liver scans were clear. Those were the only scans I've had aside from a chest x-ray and a MUGA (heart test), which they do to keep tabs on my heart because of the potential damage to it from one of the chemo drugs.

I started Chemo on June 10. I will be undergoing 3 cycles of FEC (three different chemo drugs ... Fluorouracil, Epirubicin, and Cyclophosphamide) followed by 3 cycles of Taxotere (another chemo drug), each treatment 21 days apart. A PICC-line catheter was surgically "installed" in my right arm through which to deliver the drugs and from which to take blood.

After my chemo, more surgery. After surgery, 6 weeks of radiation. After that, 5 years of a daily estrogen blocker (pills).

How was my tumour discovered?

In August 2007, I felt a big lump in my breast. It was tender and a bit inflamed on the outside. I saw my Doctor and he told me "no worries - it's a cyst". It did subside a bit but never entirely and I was always aware of it. Occasionally it would bother me. I mentioned it to my Doctor a few times and he assured me that it was nothing to worry about.

Last December I booked myself for a physical. I was due for one but I was also concerned about my feeling uncommonly fatigued, I could not keep my weight gain in check, I felt lethargic and not interested in doing a lot of the things I used to enjoy. I was sure something was out of whack. When I saw my Doctor I also reminded him about my lump and told him that sometimes it really bothers me and I was concerned about the possibility that it might burst. I asked him about a mammogram (again ... I'd been asking since my early 40s and he always told me I wouldn't need one until I was 50). I would be 50 in February and my Doctor was in no hurry to book me for a mammogram. He told me to wait until I get a letter from the screening program telling me it was time. Meanwhile, though, he did book me for an ultrasound to look at that cyst and he ran some bloodwork.

When my bloodwork results came back, my Doctor told me everything was perfectly normal. I asked him if perhaps some things were low or high normals that might account for the way I've been feeling. He said no. He asked me if I thought I was depressed. I said "no, though the way I feel is depressING". I asked him if it might be hormonal and if, perhaps, there's something we could do about that? I asked him what my hormone levels were. He didn't really answer that except to note that I haven't had any hot flashes, even though I told him that my Mom didn't get any so maybe I wouldn't either. He then looked me in the eye and he said, "There is no medical reason for the way you feel. Get some exercise!". I was so deflated after that. Yes, I know I need more exercise but I hardly have the energy after a day of work to even get off the couch. Very unlike me and very frustrating. I decided then that I would need to get a new Doctor and dig deeper because I KNEW something was NOT RIGHT.

Then, a few weeks later, I went for my ultrasound. The radiologist said it didn't look like a cyst so I immediately had a mammogram. Two hours later they were booking me for a biopsy. A month later, I was told I have breast cancer. SHIT!!

Also worth noting is that my surgeon commented that I have "very dense breasts". Breast density, I've since learned, is a risk factor for breast cancer. It is caused by estrogen gone wild ... unchecked by progesterone. I was told initially that my tumour was very small. It wasn't until the surgeon got in there that they found it was bigger than expected and that's mostly because, I believe, of the breast density. Dense breast tissue shows up white in mammograms. So do tumours, so it's hard to see the borders or even to detect tumours at all sometimes. If you think you might have dense breasts, make sure that your next mammogram is done using one of the new digital mammogram machines. They're better at detecting tumours in dense breasts. Some women with dense breasts get MRI's instead of mammograms.

I also learned that my tumour is estrogen fed. The estrogen in my tumour was at 100% and the progesterone was 15%. I did a little research on that and learned about "estrogen dominance". It, too, is a risk factor for breast cancer. The symptoms of "estrogen dominance" are almost exactly the symptoms I've been experiencing over the past 5 years ... fatigue, weight gain, dry skin, etc. Obviously my Doctor doesn't believe that women's hormones factor into anything. Obviously they do.

Other details about my tumour are that it is HER2 Negative.

As I learn more about my particular situation, I'll add them here.

Update: January 15, 2010:

I decided against having additional surgery. My surgeon supported that decision. I've finished chemo and radiation. I experienced many side effects and had lots of ups and downs but still got away without experiencing some of the nastier side effects.

My worst and most lingering side effect has been from the Arimidex (the estrogen blocker I was to take for the next 5 years). Six weeks after being taken off that drug, I'm still experiencing joint, muscle, and tendon aches and pains and troubles walking and using my joints in general. It makes me feel older than old and I often have to move very slowly and with limited range of motion. This side effect started almost immediately after starting on Arimidex toward the end of October but it wasn't until more than a month later that I finally figured out that problem wasn't related to the edema I'd been experiencing and that it was, in fact, a relatively common (30% of women experience this) side effect of the Arimidex! Amazing that the doctors know about this side effect but that it's not listed in any of the information that was given to me about the drug. So, for 6 weeks I was on Arimidex and now for 6 weeks I've been off of it ... 3 months of feeling like a decrepit, old thing!! I was told that my joints should be getting better by now but so far there have been no real improvements. I just saw an oncologist 3 days ago and I'm to try Tamoxifen instead of Armidex but I'm waiting another little while before I start it to see if my joints improve first.

My intention is to start back to work on a graduated schedule starting 4 weeks from now on Tuesday, February 16. I really hope my joints are moving normally by then and that my energy levels and strength improve considerably and quickly!

Gritty Details About my Breast Cancer