Tamoxifen Blues

Tamoxifen is prescribed for premenopausal women, when the breast cancer is determined to be estrogen receptor positive. It is to be taken for 5 long years (or longer, if newer studies are to be believed).

Every morning I look at the little white pill and have to remind myself of the abundant scientific evidence from the last 30 years to prevent recurrence, so that I work up the will to take it. But I resent the side effects that accompanies this medication. Five years of diminished quality of life.
There is a whole host of side effects: https://www.drugs.com/sfx/tamoxifen-side-effects.html Side effects that I experience are

• brain fog/memory lapses. Reduction in cognitive function is very disturbing! Sometimes this may lead to forgetting to take the little white pill.
• red face. I mean really red. Chin and up red, throat and down white. Heat, cold, stress, thinking thoughts that make me tense, and more, can bring it on. This is really weird at the work place.
• depression
• dry skin and dry, itchy eyes (terrible in my job having to work on a computer a lot)

I must admit that in the beginning I skipped some doses, and then for a while I took only half the dose (10mg). It is a long acting drug, and will stay in the body for months after stopping, so it is not terrible to skip a day. 

What may help to prevent such side effects:

• relaxation (to remove stress)
• plenty of water (2.5 liters a day, red face points to inflammation processes)
• lots and lots of exercise (it is always better afterwards even if only for a little while)
• some women swear by supplements: vitamin D3, vitamin B12, magnesium (I don't know, but I take it anyway)

For somebody who has never used supplements or avoided putting foreign substances such as medications in my body, this is a downer. The alternative is to take more drugs to combat the side effects.  Another drug is Aromatose inhibitors (AIs) prescribed for postmenopausal women but comes with its own side effects. Common is the drastic reduction in bone mineral density. I am weightlifter! This activity might make fractures more likely when taking AIs. And switching medication will require another application to the US Anti Doping Agency and a lengthy process to get a Therapeutic Use Exemption. These drugs do nothing for performance enhancements, but are on the forbidden list because they mask side effects of steroid use in men.

The side effects are supposed to get better the longer one takes the drug. Let's hope!

Christmas after cancer diagnosis

Christmas is a good time to be surrounded by loved ones or to feel loved by our global circle of friends and family.

The first Christmas after a cancer diagnosis can be an emotional time. We have done all we can (and continue to do so) to rid our bodies of cancer cells and make it much less likely to recur. At this time of the year the breast cancer sisterhood on dedicated breast cancer social media sites reaches out with good wishes and prayers and encouragements for things to get better or not to get worse. Some women post Christmas wishes, but their loneliness in their struggles can shine through.

We reflect on where we are, such as constantly watching out and being careful about activities. We can be easily frustrated about not being able to do things that we wouldn't have thought twice about before. We are worried about not having the same energy level as previously, or we may be battling side effects from medications. 

We reflect on where we were, and it fills us with astonishment how far we have come. Here are a few reflections on some practical experiences from the gym:

• needing a pillow under the seat belt straps to protect the scars when driving to the gym
• needing a shoe horn to put on weightlifting shoes, because bending forward after a mastectomy is painful
• needing great abdominal strength, so that lying down to rest and recuperate and getting back up is easy during the training 
• needing a helper to carry 10 kg weight plates and set up the rack to get ready for back squats every single time
• Being super, super grateful for the presence of other weightlifters, encouraging, helping, showing interest.

Christmas season is the time we can offer encouragement to other women with breast cancer, sharing our experiences and our paths, we can listen and offer our cyberspace presence, and hopefully alleviate some of the loneliness. 

We also need to give ourselves permission not to be Superwoman to clean, cook, bake, shop,  and prepare for the Christmas celebrations. Forge new experiences or new traditions by having faith in others and letting them do things their way!

Enjoying massage at 7 and 8 months post mastectomy

Getting a massage marks another milestone in recovery: I can lie on my front!
At 7 months post mastectomy I received my first full massage and know for sure I can lie on my front without discomfort. I didn't try before as I have been sleeping on my back since the mastectomy.
There are a couple of things to be aware of:
1. The fascia of the pectoralis muscles was removed during surgery. Thus deep tissue or trigger point massage is not a good idea on the chest! Lighter strokes and going deeper within the comfort level feels wonderful.
2. It is nice to have someone else do a scar massage. After initially worrying about it, I stopped doing anything special (other than acupuncture). My scars are healing very well. The scars are almost gone under the arms, where weightlifting training activates muscles. On the right side (where the lymph nodes were taken) it looks even better. This is the side where I regularly do self lymph drainage massage.
3. Seven months marks also the time when the edema on the right has resolved, or a fluid accumulation occurs rarely.  The first 6 months post mastectomy I had edema almost all the time, during the 7th month it was less frequent, and hopefully it has disappeared now at 8 months.  This was a considerable worry and annoyance as general guidelines point to weeks instead of months. But then again I was always hypersensitive about it ("excessively worried").
Looking forward to my next massage!

In the work place

For a few weeks after mastectomy I was fortunate to be able to work online at much reduced hours. It was very helpful to devote time to recovery and taking frequent naps. So it took a while before seeing my colleagues (mostly male) again.

One decision before returning to work after mastectomy is about looks. I love the breast-free feel. I don't like bras unless they are super comfortable and I can breathe and expand my rib cage.  I had so gotten used to being breast-free in just 9 weeks post surgery that wearing breast prostheses felt like trying on high heels as a little kid. Neither my husband nor my son cared.  So before going back to work I made the decision not to wear breast prostheses. Everybody would just have to get used to my fabulous new physique. In the weeks away from the office I lost a lot of weight by watching my nutrition and spending much time in the gym. To recover from surgery and combat side effects of Tamoxifen it helps to 1. exercise often, 2. drink a lot of water, 3. eat plenty of greens, and 4. sleep.

After returning to work a few colleagues felt sorry for me because of the breast cancer, they probably thought the weight loss was due to the cancer treatments.  But the overwhelming reaction from my colleagues had to do with how fit (and slim) I looked. They were impressed and envious.  So timing the return to work this way was a great boost to the ego.
Beyond my immediate office environment it was a study in communication networks. People don't notice a flat chest, unless they know about the mastectomy. So when someone stared at my chest, I knew that they must be well connected to the grapevine.
More recently, my colleagues found out about my weightlifting successes, and found it interesting and inspiring for themselves. So now they can see me without thinking about breast cancer. And it is less on my mind also.
I did ask for a lighter work load and made sure the key people knew that I am less energetic at the moment and am dealing with tamoxifen side effects. So hopefully it was understood and forgiven when I skipped committee meetings. After 7 months I still have less energy, although every week brings improvement. It is astonishing that even though I felt recovered when I first returned to work, I clearly notice how much better it is now from only a few weeks ago. And weightlifting keeps getting better and better. It also helped to have a thick exercise mat that can be folded up, and a pillow. This is so that I could lie down to take short naps (and I did fall asleep briefly sometimes even weeks after going back to work).

American Masters Weightlifting Championships 2016

This is exciting: 2nd place at the American Masters Weightlifting Championships at 6.5 months post mastectomy. And I was able to lift more than at the Worlds one month ago. My shoulder stability is improving.

Being confronted with having to do my own warm-up timing was daunting, but I gained confidence in doing so. It would be great, if at all competitions an updated start list with declared starting attempts would be easily accessible to lifters and coaches.