Meet Metformin - Tamoxifen's BFF

Just over a month ago, I wrote a rather exasperated update about my continued frustrations with the weight gain and distinct difficulty in getting any of it to shift, despite my pumped-up workouts. Well, since then, I've been working out even harder - to the point I'm putting in approx. 40% more effort and have even added an extra weekly workout to my usual 3-4. Now, ordinarily (i.e. for the past 15 years) such increase in effort would easily have the weight dropping off me. Even early last year, I dropped about 10 lbs within just a few weeks simply from a slight increase in effort and switching things up a little. But that was then and this is now - and heaven knows I'm probably putting more into my workouts now than I ever have......and, while I have FINALLY started to notice an improvement - the effects are nevertheless somewhat minimal and slooooooow.

That said, in doing a little more research into Tamoxifen and its apparent tendency to 'encourage' weight gain, I happened to come across some rather interesting information about Metformin, a drug ordinarily used for people with type-2 diabetes or other signs of insulin resistance. In fact, I even took it myself for quite a while about 10 years ago when I was diagnosed with PCOS (Polycystic Ovary Syndrome) when my weight was going up and my skin erupted in acne (something I've been prone to all my life - for worse....and even worse.) Back then I was prescribed a pretty high dose of metformin (about 2500mg/day) by my dermatologist in an effort to help clear the acne. And, while I didn't necessarily notice much improvement in that department, I did happen to shed close to 12 lbs! Not that I needed to lose 15, in fact it was getting a little ridiculous how much my clothes began hanging on me, but I felt fine on the meds (mostly - except for when they tried upping the dose to 3,000 mg/day which soon had me feeling like utter crap).

Anyhoooo, it turns out metformin has medically proven benefits in cancer-fighting, particularly in breast cancer and especially in combination with tamoxifen. How about that? And WHY has this never been mentioned to me before? Thanks to Dr. Google I've found quite a few reports on just how beneficial it is against ER+ breast cancer, even for those without type-2 diabetes, especially in enhancing the estrogen-fighting properties of tamoxifen. And of course the other nice benefit to metformin? - It helps you lose weight, or at least keep it somewhat under control anyway.

So I booked to see my Doc, explained my utter frustrations about the weight gain and the apparently futile efforts of my increased workouts, and we talked about the metformin thing. She agreed with the research, it's definitely been found to be beneficial in enhancing the cancer-fighting properties of tamoxifen and it probably wouldn't hurt to get me started on a low dose - 500mg/day. I was so happy - I literally thought I would have to beg and cry to get a prescription, not least because it's not like I'm fat, just that I've gained a few pounds and, despite my best efforts, am struggling to keep it from continuing going up.

Well, it's been about 3 weeks and I can honestly say - "YAY!!!!!!!" - I am finally starting to see some improvements. I've been pushing the workouts (despite the chronic glute issues in my left bum-cheek that have had me in physio the last several weeks - but that's another story) and I've felt determined to get things under control before we head off to England in a couple of weeks for my brother's wedding....and at long last, all things are finally combining to create a noticeable improvement - in my health, size, wellbeing and improved self-esteem. I feel like I'm back in control once again, even if it is with the help of metformin but hey - from what I've read - there are only benefits to be enjoyed from my low dose and to think it even plays nicely with tamoxifen, what more could I ask for?

Anyway, blah, blah, blah - I'm pleased to report that, while my actual weight has changed very little (which is as I suspected because I'm increasing muscle mass), the needle has finally dropped a couple of pounds - wohoo! Not that weight is so much what bothers me as size and the fit of my clothes. So I also took my measurements the other day and compared them to a month ago - I've lost about 1" on my waist, more than half an inch off each thigh and about an inch around my hips/bum. And that's already enough to make my clothes look and feel so much better - which makes me mentally feel much better too. I can't believe it, I was seriously beginning to doubt I'd get things back under control. And it's not like my weight/size sky-rocketed upwards, don't get me wrong. But relative to my usual stats and the fact I've managed to stay that way for nearly 20 years and that working out like I have been doing would normally be rewarded with much greater improvements, in a much shorter space of time, I am nevertheless very happy to see a small but positive change in the right direction. What's more, I feel great!

The Dr. gave me a 3-month prescription of metformin, so that will at least see me through our vacation (in England and Prague) which I'm glad about. It's always hard when you're eating out all the time, not to mention the fact there are some fantastic Czech beers that I know we're going to be 'sampling'....in varying quantities, as one must - especially on vacation, right?

So YAY! So far so good and hopefully I won't have to feel like a badly over-stuffed sausage in the dress I want to wear at Graham's wedding :-). And for anyone else out there who's struggling against the 'spread' that comes with tamoxifen, I hope this will help. Not that adding metformin is the absolute answer, it's certainly not. You also have to put in the work - and it's definitely worth the extra effort, mentally as well as physically!

A new approach.....again!

Well I haven't posted anything for a few weeks here - not even photos, although I have been adding some to my Flickr page and getting some nice feedback.

Anyhooo, in the weeks that have passed, I'm continuing to fight the somewhat relentless battle of the impending bulge as my body seems determined to gain weight. Admittedly I can't be 100% sure whether the upward-creeping scales and tightness of my clothes - especially as I pull out summer clothes that fitted perfectly just last year but look positively shrink-wrapped on me this year - is down to the cancer-fighting, estrogen-zapping Tamoxifen that I'm taking, or whether it's the onset of that dreaded middle-age-spread....not helped any by my penchant for hoppy West Coast craft beers!

So, not in the least bit impressed that my bum and thighs have literally gone up nearly an inch and my summer clothes are all feeling awkwardly 'snug', I've decided to try another revamp of my workout routine plus I've added a few dietary supplements, to see if they help. Gaawd knows the whole Garcinia Cambogia and Raspberry Keytone thing was a big fat waste of time. The first time I've ever bought into the 'Dr. Oz' hype (and I don't even like that show). And, wouldn't you know it, there are many stories in today's news that even chastise him for it. I tried GC for about 9 months and the RK for about 6 months - religiously - to ZERO effect. Not one scrap of difference..... in anything; appetite, weight, energy, size - nothing! I'd say it was a complete waste of money too, except that I ended up being refunded for most of what I bought after taking legitimate advantage of the company's Money-Back Satisfaction Guarantee. Just as well, since both products proved to be nothing more than utterly useless and made not one ounce (literally) of difference!

But, I haven't quite given up on the supplement thing yet - I hear good things about Green Tea Extract, including it's cancer-fighting properties, and have also read up on how Tamoxifen can negatively impact the body's handling of calcium, insulin etc. and fat in cells. So I'm armed with about 90 days' supply of Green Tea Extract, Calcium Citrate tablets and a Magnesium supplement, on top of my usual Iron, B-Complex and Vitamin D. Bloody hell, it's a wonder I don't rattle from all these pills.

Added to that, I read a little more about how to improve my workouts in the face of Tamoxifen's potentially negative side-effects, of which weight-gain seems to be a common, though not quite medically proven, feature. In fact, for me personally, I'd say that's the only thing I've noticed, otherwise I've been fine so far (in the 18 months I've been taking it). But, like I said, even I'm not convinced the weight/size gain is down to the meds, it really could just be one more 'joy' of aging.

Because Tamoxifen is rumoured to affect your body's absorption - and processing - of fats and insulin and such, it's important to focus on weight-training exercises (to deplete fat storage) rather than putting too much emphasis on aerobic exercise. With that in mind (and on the recommendation of a couple of different websites), I've toned down my cross-trainer time to about 25mins, though I've made that time a little more intensive - working harder at it for a slightly shorter period. For my weight training, I've stepped up from two sets to three of 20 reps per machine/exercise. On a couple of machines I might tone down the weight slightly for the 3rd set (mainly due to dodgey, unpredictable shoulders - one of which used to dislocate frequently prior to surgery) and a continuously sore glute/bum cheek - which appears now to affect my left side more than it used to on the right. I'm at the point where I may even need to look into physio for my arse.....if I can just pluck up the nerve. Sitting all day at work doesn't help matters and, lately, really seems to be making it worse.

I was actually hoping to get back into running this summer and, on a gorgeous day a couple of weeks ago, I finally took the plunge and went for my first outdoor run in nearly 2 years. It started off well, despite the noticeably slower pace than I used to have, but I've had pain in my left bum cheek/hamstring almost every day since then, enough that I haven't been able to attempt another run. Maybe I pushed it by running for a full 35mins for my first time back at it, or maybe I have just completely knackered my glutes, since most exercise seems to aggravate the issue, even a short walk.

Anyhow, I'm determined to push through and get some of this weight shifted. And, like I've said many times before, I know it's not so much about the 'weight' per se, and there's every chance that will continue to go up with the boost to my weight-training, but rather it's about size and how I fit into my clothes. Right now my thighs and bum are definitely larger and my clothes are all fitting just a little too snug around those same parts, so this will be the best way to (hopefully) burn it off again.

I started the new supplements last week and boosted my two workouts (then we went away to Portland for a few days where I didn't exercise but ate plenty and took advantage of their fantastic beers - doh!). So basically I'm considering this week as my start, and I have 7 weeks to our vacation/Graham's wedding back in England, by which time I aim to be back down to my usual measurements. I have to give it my best effort anyway, nip this thing in the bud before things keep getting tighter and I feel more despondent. I have to say, the workouts are knackering but I'm excited to see the results. I really doubt the supplements will make any noticeable difference, although I can't decide if perhaps the green Tea Extract is actually helping to keep my appetite in check, but we'll see. I'm sure the combination of all these things is going to help - way more so than getting upset and fed up about it....which (many moons ago) used to lead to me eating too much out of frustration and resentment. And THAT's a road I do not wish to go down again, that's for sure!

So, let's see how this goes!

Weighing up Tamoxifen, 1 year in.

 'Twould appear I've unwittingly succumbed to one of the possible side-effects of Tamoxifen - memory loss - since I was convinced I didn't start taking it until Dec. 16th last year and was getting ready to post a 1-year update, however, in referring back to my blog post last year, my anniversary was actually November 16. Doh! But then, how would you know if you're suffering memory loss anyway, since you can't remember what it is you're supposed to have forgotten? Hmmmm.

So here I am, one year down with four more to go and, while I don't want to speak too soon, I'd have to say so far, so good - up to this point anyway (mostly). From the list of possible side-effects I’ve really only noticed two or three; the struggle to maintain my weight, some joint aches/pains and the fact my PMS symptoms (especially irritability) seem to kick in a lot sooner each month. 

Weight: Weight gain seems to be the thing most people comment on with regard to tamoxifen and the thought niggles at me too, although I actually lost about 10lbs during the first several months. Admittedly I also kicked up my gym workouts in a pre-emptive attempt to combat potential weight-gain, but for a couple of months the pounds just seemed to fall off. I felt great, very healthy and lean, although I did reach a point where my clothes were just about hanging off me. 

Alas, this has definitely turned around, particularly in the last 3 months. While my workouts haven't changed and I’m not eating any more than usual - literally 3 meals a day with perhaps the occasional cracker in-between, and I never eat junk food or pastries - I’m nevertheless noticing my weight is creeping upwards, clothes are getting tighter on me and my thighs have regained an inch compared to where they were in March of this year. It’s incredibly frustrating because, for years and years, I’ve always been so ridiculously disciplined about what I eat, making my own meals for the most part, and equally so about working out at least every other day for 90mins at a time, of which 45mins is ripping up a storm on the cross-trainer.

I know I’m not fat (at 5’5” I’ve generally averaged 130lbs, give or take, for the past 15-20 years thanks to diet and regular exercise) but I'm definitely noticing it's becoming increasingly difficult just to maintain my weight when, by all accounts, I should probably even be losing some. Of course it could simply be down to age/metabolism (being mid-f-f-f-forties after all) but if I’m going to watch the scales creep upwards then I’d really rather be stuffing my face full of muffins, fish ‘n’ chips and chocolates, thank you very much. At least then it’d feel somewhat warranted. Heck, I work with people who are snacking constantly, always eating out and regularly feasting on treats around the office, but they don't seem to gain weight. Waaaahhhhhhhh!!! And if the scales are sneaking upwards now, then I dread to think what havoc a couple of weeks of Christmas goodies might wreak. (I don't often weigh myself other than to keep an eye on things when my clothes are feeling tighter and, for the record, I'm sure I probably sound like I'm making a huge issue out of nothing here but, having been so horribly miserable during a period in my life where I was a good 40lbs heavier, I can't deny I have an inner fear of it happening again and feeling as horrible about myself as I did back then, although honestly, even those feelings were really about much more than just my weight. Either way, it's a part of my life that I have no desire to revisit if I can avoid it.)

Anyway, in desperation, and for the first time ever, I recently surrendered to an advertising ploy that popped up alongside my Facebook page and decided to try a natural health supplement, Garcinia Cambogia, that’s rumoured (having apparently been featured on Dr. Oz) to be the very latest and greatest in weight loss/maintenance, especially when combined with a healthy diet and regular exercise regimen. Errr, yup – that would be me! I'm not necessarily trying to lose weight, but I don't want to watch the pounds pile on either. Basically I already live in a constant state of denying myself what I’d like to eat and sticking with what I should eat instead, and I've exercised regularly most of my life. Anyhow, I’ll write more on this supposedly ‘Dr. Oz recommended miracle diet treatment’ in a separate post but, suffice to say, I’m not all that impressed thus far and if you've been considering it, you might be better advised to save your money.

Joint aches/pains: This probably bothers me moreso at night if anything and I’d blame our mattress except that it’s still relatively new (2 years or so?). The soreness/stiffness is especially noticeable in my hips/bum. For the past few years I’ve had ongoing muscle soreness in my glutes/bum cheeks, to the extent I had to give up running about 2 years ago, and it could even be related to my gym workouts, I guess. (It also doesn’t help when our three adorable cats decide they’re going to snuggle in with us all night and I end up with my legs stuck in one position too long.) Sometimes when I’m working out, I feel like I’ve already done a full workout just 5 mins earlier, everything feels tired and stiff already. 

PMS: Historically I’ve always felt I had it relatively easy when it comes down to that ‘monthly visitor’. Other than a few days of insatiable appetite and craving starchy/sugary things and feeling bloated, depressed and irritable the day of or just a couple of days beforehand, my PMS symptoms have generally been of little consequence. I’ve definitely noticed that changing the past 6 months or more, to the extent I start to feel all the ‘day of’ joys about 10 days ahead of schedule and they last longer too. The main one being waves of extreme irritability, like all my nerves are on edge, my skin feels too tight and I’m about ready to completely blow a gasket. Just wanting to lose it - throw or smash something, violently overturn display racks in a store, shove somebody out of my way or pull their hair. I’m definitely not an angry person and I’ve never been prone to losing my temper or arguing, even if I’ve really wanted to or had every right to. But lately, about 7-10 days before my period, I get intense surges of extreme ‘f*ck this goddamn sh*t all to hell’ pissed-offness gripping my entire body, almost like electricity tensing up every nerve. Especially if I drop something, have yet another battle with unruly coat hangers or can't find something in my closet, drawers or purse - which usually leads to the whole contents being pulled/tipped out and furiously thrown into a pile. Obviously I don’t let this rampage show, unless I’m on my own and I might then scream out a series of expletives as I kick, throw or bash something. Though generally even my so-called ‘angry’ outbursts are actually pretty pathetic on a general scale of ‘losing it’, although it feels frighteningly intense on the inside. To me anyway, ye olde Ms. Eternally Placid Peace-Keeper (for better or worse)!

So there you have it, my first year on tamoxifen and, thankfully, relatively little to report - and not much that can’t simply be put down to age or regular day-to-day stuff anyway. Hard to believe the time has flown by so fast. As long as it’s still doing its highly-praised cancer-fighting job, I can count myself very lucky and very grateful.

Various Updates on This 'n' That

I thought I'd do an update on a few things I've posted about over recent months, not that I've anything massive or particularly mind-blowing to report, just the usual blather, I guess:

Tamoxifen Update - 8 months on
I first started taking Tamoxifen mid-November last year and was quite panicked about potential side-effects; primarily, being pushed into early menopause and also possible weight gain. In January I was pleased to post a positive two-month update on just how the treatment was going. And suddenly here we are, last day of July, and I realize I meant to do a 6-month update....two months ago! So, for anyone interested, here's how it's going:

1. Overall: On the whole, still feeling pretty good and no strong or particularly adverse side-effects. Yay!
2. Eyesight: I do feel like my eyesight's deteriorated quite a lot, I'm struggling to read menus, labels, texts and other such small print, which I'm finding incredibly frustrating. Admittedly it might purely be age (having hit the mid-forties point in May - eeek), but I also know that it can definitely be a side-effect of the medication and I intend to mention it at my next appointment with the oncologist in September.
3. Hot flashes: Thankfully still no hot flashes to report, nothing really noticeable anyway, and even the night sweats are taking a welcome break at the moment, which is odd since the weather's been so hot and the nights very muggy lately.
4. Monthlies: My periods have stretched from being every 32 days to about 37 lately, but no noticeable difference otherwise.
5. Weight: I've gained weight lately. Well, it's more that I appear to have re-gained the 7 or so pounds that I lost in the first few months of this year and similarly the inches are creeping back up too. I'm still working out regularly and haven't changed my eating but I've certainly felt pudgier and generally bloated for the last several months which may/may not be down to being on Tamoxifen that bit longer. Bugger - because I was really enjoying looking and feeling much leaner, energetic and in great shape. I felt better in my clothes (although some were getting a bit too big on me). Even my ex-figure-skater bubble-bum is visibly making a comeback. I wasn't trying to get rid of it but, now that it's making a re-apperance, I'm not too happy about it. Besides, if I known I'd add back the 7lbs then I would have at least stuffed my face full of cakes, muffins & fish 'n' chips! Nothing more frustrating than inexplicable weight gain :-(
6. Skin/acne: I don't know if it's related to hormones or tamoxifen, since I always believed testosterone not estrogen to be the main hormonal culprit of acne breakouts, but I'm tentatively pleased to say my skin has been noticeably clearer the past 6 months or so - perhaps the longest I've gone without using some sort of prescription cream, tablets or stinky tea-tree oil. I've suffered breakouts to a lesser or much greater degree my whole life (so much for 'growing out of it when you're 18'!). Believe me, I've had some ugly and severe bouts of acne in my time (though thankfully bear very few physical scars) and wonder if this significant improvement is in any part due to the Tamoxifen or else the amazing natural product 'Pure Tamanu Oil' that I discovered early this year, which makes my skin feel great and is quite possibly delivering its well-reputed and very gentle acne-fighting properties. I don't know for sure but I'm certainly thrilled with my skin lately and it's a huge novelty to report that I very rarely have breakouts lately. I'd highly recommend pure Tamanu Oil (I've tried the Aura Cacia brand at approx CAD $17 to $30 for a 30ml bottle, which I find lasts 4-6 months even using it twice a day).

Other than that, no real change on Tamoxifen. Admittedly I'm disappointed about the weight thing, which might seem a little odd given that I've maintained the same weight (132 to 134lbs) for over 15 years but, being 7lbs lighter felt so good, that I'm now feeling uncomfortably chunky being back at my usual weight.

Oh well - so long as the meds are still doing their cancer-fighting job, that's really all I ask.

False Economy? - when thrift store shoes go bad
Back in February I confessed my clandestine penchant for popping tags at thrift stores - 'cos I loves me bargains along with recycling wherever possible. Now that we've moved back to Kits, I have not one, but two Salvation Army thrift stores within a short walk as well as several consignment stores and an SPCA thrift store that I've regularly donated to for years. I've had some great finds for summer clothes; shorts, a dress, jeans, t-shirts etc. despite the fact prices at the Sally Ann are getting ridiculous - name-brand jeans at more than $25 or shoes/boots averaging $20-$45. ("Hellooooo, you do realize you get this stuff donated, right?....as in FREE! And that you're a thrift store not a consignment store.").

Anyhooo, I recently got a bargain-buzz when I found a fabulous pair of brand new, incredibly comfortable, funky black sandals with a cute kitten heel for just $6 at the SPCA store! I got lots of compliments the first day I wore them and knew they'd look great with most everything in my wardrobe. Alas, much to my chagrin, by the end of that first day, a strap on each shoe had clearly started to come away, revealing the glue and elastic underneath. I was so disappointed but remained hopeful it wouldn't get any worse - besides, it's not like the shoes feel tight or pinch my foot anywhere. But.... they are in fact falling apart. Darn, you just can't get good quality for a whole $6 these days, eh?

Since they cost next to nothing and I really like them AND I want to take them on holiday with me next week, I decided to get them repaired....which apparently entailed all 4 thinning straps (2 on each shoe) to be re-stitched at $10/strap. I hesitated but then determined that, even totaling $46, they'd still be worth it...or so I thought. Let's just say it's all turning out to be a grand false economy on my part, the repair looked okay but in reality gave them little more than an hour's extra life. First wear post-repair (I'm a poet) and the exact same thing happened all over again, a design flaw and shoddy work in the shoes' original manufacture I'd say:

Broken straps and dollar-store nail tattoos.

But, not feeling ready to give up on them just yet (especially after spending the additional $40 hoping they'd be fixed), I decided on one last ditch attempt that wouldn't cost me a single penny. Et voilà, the high-tech tools of my latest and greatest shoe repair endeavours:

High-tech tools of the trade.

That's right, I stapled the straps back in place, then used a black permanent marker to colour over the silver staples so they wouldn't show....much. (Blue Peter eat your heart out!)

Staples? Are you kidding me? Like I'd seriously stick my
shoes together with staples! Haha. Whatever next?

And you know what? It worked! You can hardly see the staples at all, the straps have so far stayed put and naturally I'm kicking myself (with said shoes) that I didn't just try this before and save myself the $40 on a wasted repair. Hey, it could be worse, I could have used duct tape!  I don't expect they'll last long and, quite honestly, I don't need them to. I just hope to wear them at least a couple of evenings while we're on holiday, that's all. And if anyone's looking close enough to see I've actually stapled my shoes back together and covered this wardrobe malfunction with black marker pen, then chances are my foot's in their face and there's a whole bigger situation going on anyway, so who cares?

It's not even the first time I've done my own shoe repairs either - I recently discovered I had a pale pink nail-polish that matched an unfortunate scuff in a cute pair of shoes so perfectly that, when I put it on, the scuff simply disappeared from view, just like that! You would honestly never know!

Anyhow, so far it's working much better for me than the time I tried desperately to hold up my lace-top 'stay-up' stockings which simply refused to actually...stay up! Since I could hardly go jabbing staples into my thigh, I cleverly lined up a row of sticking plasters/band-aids around the otherwise sexy lace-top, to get them to stay stuck to my thigh and it did the trick....for all of about 15 minutes. Yes, definitely one of those days where the little voice in your head begs and pleads that you don't get run over for fear handsome paramedics discover the abstract mess you've got going on underneath that elegant dress.

So...moving right on to my next update:

Ella (aka Ella-Bella) - the latest addition to our feline family
Remember that terrible dilemma and crippling guilt I blubbed about back in May, when we welcomed little Ella (formerly known as Mudd) into our home? I'm pleased to say she's settled in wonderfully and is a truly adorable, easy-going and fearless little girl. She seems to love her new home and quickly took up residence in the top level of the kitty condo from where she likes to do that bizarre feline chirpy/clicky thing as she 'stalks' crows and other birds on the neighbouring rooftops. Our cats are strictly indoor cats so she doesn't get to test her claws and teeth - other than the way she's helped Mel shred the fabric off one corner of the couch and has started on a second. Not too impressed with that part.

Ella (left) sharing the top of the condo with Mel.

Mel's tried to join her in the condo a couple of times (as you can see - very cute) but mostly he likes to swing from it like a demented monkey and swat at Ella's tail to get her to play. He's sometimes a little too forthright for her but on the whole they play well together, especially when it's Tube-Time ie the cat tunnel - the best $20 spent on a cat toy ever!

While Mel and Louis definitely seem quite fond of Ella, we've recently had to install an extra Feliway plug around the house because Louis has not only taken to being a little too aggressive with Ella and stares her down/chases her just for fun and intimidation tactics, but he's also taken to overgrooming on one of his forelegs to the point of creating a bald patch. Ordinarily he's a friendly, lazy and pretty docile cat, though he's evidently in a bid to assert some level of being Alpha cat that wasn't necessary before Ella came along. Perhaps because they had immediately accepted Mishka as alpha-cat and matriarch without further question. (Oh Mishka, we still miss you!)

On the whole everything is really good, Lorne loves Ella just as much as me, the boys love playing with her (she and Mel play a lot together) but just sometimes they get a little rough and purposefully chase her into a corner or until she hides behind the TV (Louis moreso than Mel, although Mel's taken to doing it too lately), so we're having to keep an eye on them and use a water spritzer to dissuade the boys from picking on her.

She's such a sweetheart and very affectionate, it'd be awful to see her become timid and anxious because of her rowdy brothers but so far she's handling it well. (Men, eh?!!!)

And, like Mishka before her, 'twould appear Ella's also a sun-worshipper. Here she is thoroughly enjoying the sunny spot created by the skylight just above our bedroom door.

Meanwhile, in the ongoing state of flux that is my professional life.....

Drifting from contract to contract
I'm very pleased to wave goodbye to my current contract - which ended today - wohooo! Grateful to be moving from the bum-wiping life of an Executive Assistant (EA) back to the world of marketing, writing/editing, desktop publishing and more creativity. Hard to believe I've only been in this current position two months, it certainly feels l-o-n-g-e-r! But it's served as a true reminder that my days as an EA are (and should stay) far behind me. I've moved onto greater and more challenging things, where I have my own job rather than existing simply to make someone else look good. It took a while to break the type-cast of being an EA several years ago and these past 9 weeks have been a distinct reminder of just why that role is not for me (far too much temptation to verbalize inner thoughts of "book your own stupid flights, you know when/where you want to travel, not me!" or "Instead of telling me to tell her to call me to set up an appointment with you so I can tell her your schedule and get her calendar to book her to speak with you and confirm it works for you then invite you and her to the meeting of you both - just pick up the Goddamn phone and call her yourself!" Half an EA's day is spent as a gofer, the other half as a go-between. While the person I've worked for this time has actually been pleasant, appreciative and easy to reach, I've previously been an EA for complete pigs who seemed to have the attitude I should do EVERYTHING for them and stick a broom up my arse to sweep as I go along.

As of tomorrow I'll be back to my old haunt, Omicron - full time contract and better $ - at least until late October anyway, so that nicely buys me more time to get on that whole job-hunting thaaang.

Anyway, that's my not-so-short jibber-jabber update. Now that I have a wee dram of Cask Strength Bowmore at hand, it's time for me to sign off and savour the rather delectable taste of Islay before bed.

Nighty-Night.

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!!!

Dear Tamoxifen

As previously discussed, you are hereby contracted for a term not expected to exceed 5 years, wherein your principal focus is to be devoted to one task and one task only:

• To unreservedly kick the absolute CRAP out of this cancer malarky and ensure its toxic and insidious ass is kept the hell away from me!

And in so doing, you are respectfully commanded to honour your host, thus committing your equal and undivided care and attention in avoiding (or, at the very least, limiting to a bare and tolerable minimum) all of the following:

• Mood swings
• Hot flashes
• Weight gain
• Nausea
• Tiredness
• Memory loss
• Depression
• Insomnia
• Swelling of hands/feet
• Other menopause-type 'joys' not listed above
• Muscle/joint pain
• Endometrial cancer
• Risk of stroke
• Risk of blood clots
• Cataracts

In other words, make sure you do your job.....do it well!....and please be kind to me in the process.

And so, without further ado, let us seal both obligatory and honourary terms of this agreement, for the period of one thousand eight hundred and twenty six days (inclusive of the 2016 leap year and taking into account any additional/exclusive time-period as deemed appropriate by qualified oncologists).

I hereby raise this glass of water and.....3....2....1......

Dose #1 is down the hatch!!!

Medication meltdown

So today I met my oncologist (yet another word that I never anticipated using in reference to myself). Dr N. is a pale, slightly built and timid looking man of a seemingly nervous disposition. I couldn't decide whether his previous client had scared the sh*t out of him or was it me he was afraid of? Or maybe everyone has that effect on him. I fought the urge to shout "BOO!" for fear he might literally pee his pants.

He brought with him a female trainee/intern (or whatever it is they call them), who was similarly fragile and had the handshake of limp lettuce. I wondered if they were anticipating I'd burst into floods of tears upon discussing the treatment plan. If that was the case they'd be relieved - or disappointed - since the one thing I haven't done up till now is shed any tears about all this, which is perhaps a little odd, I don't know.

After another round of stripping down and being poked, prodded and even being told by the Doc that I have "what we call lumpy, bumpy breasts" (charmed, I'm sure), we sat down to discuss the treatment plan; 16 radiation treatments to the entire breast plus a further 6 'booster' treatments concentrated on the area where a few cancer cells were left behind (the spot where I'd narrowly escaped a second surgery). I was still doing okay up to that point, despite having previously been led to believe I'd need only 3 weeks of radiation but hey, if they need to do 6 extra treatments to make sure they zap those last remaining cancer cells, then I'm certainly okay with that.

It was the next part of our discussion that was, for me, the kicker.

"Now, you were probably told already that your cancer tested estrogen receptor-positive (ER+)." Which, as he  went on to explain, means the cancer cells bind with estrogen and use it to fuel their growth and it can also enable cancer cells to be carried through the bloodstream to other parts of the body. Yikes, I hadn't even thought about that. And naturally it suddenly flashed through my mind, what if these cancer cells have already gone elsewhere???? And why has nobody explained this whole ER+ thing to me before now?

"The good news is," (Thank goodness - at least there's still some good news) "there are several medications that have proven highly successful in blocking estrogen, the most commonly prescribed being Tamoxifen - which is very effective in preventing the recurrence of this type of breast cancer in pre-menopausal women like yourself. So we'd like to get you started on that two weeks after completing your radiation. This course of treatment is generally prescribed for 5 years."

I know he was offering up a positive solution but I can't deny that my heart sank. I'd read a little bit about Tamoxifen - for which the main 'side effect' (in most cases) is that, as an estrogen blocker, it actually brings on menopause that bit sooner. Brilliant! The very thing I've been dreading - I mean DREADING -  for years but had hoped to keep at bay for at least another 8-12 years. Now I'm inwardly terrified that, joy of joys, I get to start on that miserable road even earlier - turning into a 55 year old when I'm only 44.

Dr N. dutifully detailed many of the potential side-effects of Tamoxifen, including the possibility of endometrial cancer, blood clots, stroke, cataracts etc. but I could only focus on the whole menopause thing because of all the 'delights' it entails: mood swings, weight gain, hot flashes, memory loss, depression, insomnia....to name just a few.

By the time I left the cancer agency, I was consumed with an underlying sense of dread and despair - moreso even than when I received the initial breast cancer diagnosis. While I know I should be (and I am) eternally grateful that such a medication exists, I'm nevertheless terrified of the person I'll become once I start taking it, albeit I would have to enter menopause at some point in the coming years anyway.

I went home, pulled out all the info I could on tamoxifen and menopause and sank a beer while I wallowed in my fears and dread. By the time poor Lorne came home from work I could barely tell him about the appointment before my words washed away amid a flood of tears. I was devastated - mortified that I'm going to change into a sweaty, moody, fat and depressed mess of my present self. "I'm afraid I'll become a different person and that person might well be an absolute nightmare to live with." I blubbed. "I'll become a miserable, irrational, moody, overweight and psychotic monster. It'll be like having PMS 24/7/365 only on a much bigger scale. I don't want to be that person. Added to which  the weight gain will make me feel worse about myself. What a treat! It's bad enough I've dreaded menopause anyway but the thought of having to face it even earlier terrifies me. I feel like I just won't be myself anymore!"

Poor Lorne, I don't think he quite knew what to do/say. I was a stressed, wailing mess.....perhaps an early glimpse of exactly the type of emotional wreck I'll be once I'm on this medication anyway, only minus the sweaty pits. (For now at least.)

On the one hand, I know it seems irrational that I'd be this upset over a medication that, to all intents and purposes, will help prevent the recurrence of this awful disease - and it's nowhere near as drastic as chemo and I get to keep my hair, but I could almost live with the whole breast cancer thing knowing that I'm at least still the same person I was before it. The thought of taking tamoxifen and starting menopause makes me feel that I'll lose that. I won't be myself any more. I won't be the same Katrina - the one Lorne knows and loves. I'll be moody, paranoid and irrational and the prospect of a 15-30lb weight gain really bothers me; a) because I have a wardrobe full of nice clothes that just won't fit anymore and b) because, added to feeling crappy, I'll also feel bad about myself being heavier - God knows I suffered hideously low self-esteem for long enough in throughout my teens and 20's. The last thing I want is to go back to feeling as shitty about myself as I did back then. I was downright miserable, self-conscious and depressed.

I realize I must sound shamefully vain. That my dread of menopause must make me seem so horribly ungrateful for the fact there's even a medication available to me to help protect my health. On the contrary, I'm extremely grateful and I also know just how lucky I am to not need chemo, or worse, and to be living in a country where such treatment is even available to me and it's paid for by the government. Incredibly lucky. How ridiculous then to be crying over potential side-effects that may - or may not - even happen, or at least perhaps not to such a great extent.

The more sensible part of me suspects that maybe my upset and tears are moreso the result of a culmination of events from the past several months rather than actually just centered on the (by all accounts) irrational fear of menopause. I've stoically navigated my emotions through the diagnosis, surgery and upcoming plans for radiation while feeling thus far incredibly 'lucky' that it was found so early, perfectly treatable, and that my outlook really is among the best case scenarios for breast cancer.

So to find myself so ridiculously distraught over the thought of menopause starting a few years early makes me wonder if my upset isn't somewhat misplaced. Having felt that my scenario was, in many ways, a good one (I got the cleanest point of a shitty stick), I'm not sure I've even allowed myself to really address how I feel about all this - it's a bit of a life-changer after all. The fear of menopause and all its glory has perhaps given me the outlet, albeit somewhat misdirected, for spewing an accumulation of feelings/fears/uncertainties that I haven't yet been able to face about all this. In being so grateful that my prognosis is so much more positive compared to many, many others who get a cancer diagnosis, being upset about it just seemed pithy and self-absorbed. I felt like I'd merely dabbled' with breast cancer and - by and large - had a 'lucky escape'. Clearly the british side of me was all set to simply brush it under the carpet, treat it as a minor misdemeanour, say nothing more about it and just be grateful that nothing got too damaged. Yeah - not quite so fast there, Missy!