Tamoxifen Update - two months on

Is it really just 8 weeks since I started taking Tamoxifen?  Two months down and 58 to go? Funny how it feels like it's been a while and yet not very long at all. Time seems to have stretched out these past few months, in a somewhat dream-like haze, maybe because I'm hovering in a bit of a no-man's land (job-wise and post-cancer scare). This must be one of the few - very few, in fact - periods in my life where I find myself moving through one day at a time, taking each as I find it, rather than beating myself senseless about the future. Giving the steering wheel over to fate for this part of the journey while everything in the rear view mirror lingers, as if held in suspended animation.

It's an odd, yet pleasant sensation and I've decided just to go with it, at least while it lasts anyway. I'm curious (but for once not too daunted...yet) where things might go from here. Feeling this way is somewhat new territory for me and maybe it's part of the overall sense of 'reconnecting' that I've been feeling of late - connecting with myself and the people and environment around me in a way that has changed for the better, even if I couldn't tell you how exactly. If it's down to the meds then damn they're good!

Nevertheless I'm not kidding myself that ye olde familiar sunami of anxiety will no doubt rear its ugly head again at some point - and I haven't totally lost the small voice that pops up at the back of my mind wondering 'if everything's feeling okay, then what's about to go wrong?' - but right now I'd like to savour this otherwise quiet sense of...dare I even say it...serenity.

In a previous post (Sept. 2012) I blubbed out my anxieties at the idea of having to take Tamoxifen for the next 5 years, even though I know it's going to help kick butt against any cancer cells that think they can merrily grab onto my estrogen, beef themselves up and multiply in my breasts or elsewhere. And it was with some trepidation that I even took my first dose (Nov. 16, 2012). So, as a reminder to myself and as information for anyone else facing the same concerns I had/still have about taking Tamoxifen, I thought I'd share what I've personally encountered thus far, in my mere 8 weeks of taking it. (Spoiler alert: Overall, I'm pleased to report it hasn't yet turned into the nightmare I was expecting....fingers crossed!)

• Hot flashes: Thankfully not something I've really noticed and definitely no bursts of sweating cobs or wafting my armpits to cool down (which I plan NEVER to do anyway!) That said, I'm also taking Effexor (about which I'll explain more in a moment) and am told this helps with hot flashes than can be experienced while taking tamoxifen. I suppose I did feel a little warmer in the first few weeks but it was late November so I was actually glad of it. I normally feel the cold very easily and hate being chilled. 
• Mood: Apart from an isolated incident early December - where an old Christmas song playing in a store caught me completely off guard by nearly making me cry right there and then - I have felt surprisingly good lately. In fact better than I have for quite some time. I've never really been a moody person (though I've had my moments) and one of my main concerns about tamoxifen/menopause is that it could send me completely wacky or erratic. Thankfully so far so good and even my PMS was no worse than usual, though I count myself lucky that it's never been all that severe for me anyways.
• Periods: I'm one of the fortunate few to be blessed with relatively easy, short and very regular periods all my life (amen) and for now I'm still having them but hey, it's only been two months on the meds so that might yet change.
• Weight: Well, here's the interesting thing. While I'm definitely not overweight, before starting tamoxifen I decided to invest in a couple of cute, loose-fitting tops and even a skirt and pair of jeans that were slightly loose on me, figuring I should have them on hand, reluctantly anticipating the medication's common side effect of weight gain. At the same time, I also decided to change up my gym workouts a little, increasing the length of my aerobic exercise on the cross-trainer and backing off on the leg weights by a couple of pounds. To my surprise I haven't even been getting as hungry lately nor snacking much between meals so, all-in-all, I've actually lost a few pounds and - more surprisingly - almost an inch off each thigh! Even my 'bubble-bum' (the long-term legacy of having been a figure-skater?) has shrunk a little, which wasn't necessarily my intention. At this point I haven't needed the bigger clothes, which is a pleasant contradiction to what I'd anticipated might happen, but I know it's still only early days so they're there in the closet if things change.
• Muscle aches: One thing I definitely noticed in the first couple of weeks of starting tamoxifen, was that my bum cheeks and legs felt really sore and achey; painful if I sat for long periods and painful during the night, as if the muscles were in a semi-cramp all the time. Although some joint/muscle ache is one of the usual side-effects of tamoxifen, specifically getting aches around the bum/thigh isn't very common. Maybe it was the increased cross-training, firming up muscles that hadn't previously been worked so hard - the same ones I re-discover whenever I go horseback riding. Either way it was bloody uncomfortable and annoying there for the first two weeks or so and regularly woke me up at night. I also had back-ache just on the right side, around/below my kidney (which has happened to a few people on this medication). Thanks to my wonderful - and downright hilarious - chiropractor, Dr. David Mallory, and a few cracking, crunching, twisting and squishing sessions, it has greatly improved and now feels fine. He also taught me a wonderful stretching exercise to target the painful bum muscles that seemed to be in spasm and it's worked a treat!
• Concentration/Memory: Darn, I've forgotten what I wanted to write here. What were we talking about? (Hardy-haaaa.) Actually, this is another area where I'm genuinely relieved since I actually feel a lot less foggy than I have in ages. I feel more awake, 'with-it' and connected, like I'm able to think more clearly, remember things, I'm getting more done and generally being more productive overall. Naturally some of that could be from not being stressed/tired from work etc. - this freelancing gig is very free-ing (so to speak) in that respect. Maybe also because the underlying worries and uncertainties I went through for most of last year have now lifted mostly from my shoulders. I'm not sure, but I'm very glad to feel this overall clarity, it's been gone far too long.
• Overall health: In all honesty I have to say, I feel great. Even though I've led a pretty healthy lifestyle and exercised regularly for years, I'm not sure when I really last felt quite so energized, fit and healthy. Naturally (thanks to that niggling little voice again) I'm expecting to break a leg or something anytime soon - surely something's going to kaibosh this fabulous sense of renouvellement.
• Negative effects?: The only negative effect I've felt thus far (aside from the achey-bum as per above) is that my right boob - the one they found the cancer in - has been quite swollen and tender the past couple of weeks, which might just be down to post-radiation rather than tamoxifen. It started just before Christmas as a regular part of my PMS but still seems to be somewhat swollen and visibly larger than my left boob. It doesn't feel particularly sore anywhere and, even though there's a slight pinkish tone to its lower half and underside, there's no specific sign of infection or anything. I'm not complaining about having a larger boob, I just wish the other side would catch up. My cleavage (minimal though it is) looks like I've stuffed a chicken fillet into just one side of my bra. Anyhow, after two weeks of swelling and no change I finally called my Oncologist (Dr. N.) a few days ago. He's not overly concerned and feels it's fairly common to notice such post-radiation changes in the boob and advised me to take anti-inflammatories 3x/day and go to see him if there's no improvement in 10 days. Unfortunately that will coincide with my next period, so it'll be even more swollen at that point, so I may have to see how things go for the next 15 days or so before deciding whether I should go back to see him.

During my Dec. 14th follow-up appointment with Dr N, we discussed how my first 4 weeks on Tamoxifen had been and how I was feeling overall. I was pleased to have him tell me, "Well, if you're doing ok after this first month, that's a very positive sign - you're obviously tolerating it very well and the exercise is going to help too." Wohoooo! Maybe I can fight off many of the common side-effects after all.

Of course one thing to note, having listed all of the above, is that I also switched my anti-depressants about 3 months ago, from Zoloft to Effexor, after reading several articles that zoloft and tamoxifen don't mix very well, since zoloft (as well as Paxil and Prozac) can inhibit the anti-estrogen effects of tamoxifien. My oncologist also confirmed this and had recommended I switch to Effexor instead (which I'd never heard of before) especially because it also helps with the hot flashes than can be a side-effect of tamoxifen.

So I'm guessing my current sense of wellbeing is likely aided, though not soley a result of, the change to Effexor, even though I'm taking the lowest dose of just 37.5mg/day (and even on Zoloft I took a baby dose of just 25mg every other day, somewhat sporadically at that).

It's odd for me to write about anti-depressants here, since I don't really tell anyone about it and its taken me years to even get comfortable with the whole idea myself. Partly down to that British stiff upper lip that, even when the going gets tough, you should just soldier on through it, silently and just "buck up and stop feeling sorry for yourself". Unfortunately, for those of us living with the legacy of seratonin issues and varying degrees of depression and/or seasonal affective disorder (SAD), we'd happily ignore the dark and overwhelming feelings that sometimes virtually suffocate us and simply 'snap out of it', if only it were that easy!

But that whole converstion will be in my next post. For now, I'd just like to say, I'm feeling FAB-u-lous and very glad to be able to say so!!!