Blog Party, APA style

The American Psychological Association knows how to throw a party. Well, a blog party anyway. The APA is sponsoring a Mental Health Blog Party today, and I’m happy to participate. Many thanks to Marie at JBBC for spreading the word about the MHBP. If I didn’t know better, I might think it’s an acronym party, as well.

The topic of mental health is scary, uncomfortable, and unpleasant for a lot of people. Add cancer to the discomfort of mental health and watch people run screaming from the room or back away slowly, never breaking eye contact. Perhaps that’s part of why the APA is throwing the Mental Health Blog Party; to de-stigmatize mental health issues the way pioneers such as former First Lady Betty Ford and Dr Susan Love have taken the shame out of breast cancer.

Yesterday I got a call from the nurse case manager provided to me by our health insurance company. We’ve had this particular health insurance, United Health Care, since September, but the NCM just got around to calling me. When I was first diagnosed, and under another insurance company, the NCM was fantastic. She was a great resource not only for insurance issues but also knew the medical side of my problem too. She went to bat for me and got the insurance company to pay for my Oncotype DX test, which costs a fortune but is instrumental in making a decision about treatment options.

Anyhoo, I was surprised to get a call from the United Health Care NCM out of the blue yesterday. I suppose she — or someone in her group — just noticed my unusually thick file, chock full of cancer calamities and infection ills and figured I warranted a phone.

We went through the usual laundry list of details: date of diagnosis, surgeries (yes, plural surgeries), and treatment status. Then there was the recitation of the everyday meds post-cancer: tamoxifen to prevent recurrence, Effexor for menopause symptoms, levothyroxine for sluggish thyroid, and Ambien to help my worried mind shut down and get some sleep. Oh, and don’t forget the glucosamine for my rotten joints (thanks, tamoxifen!), Ferrex iron boost for anemia (thanks, mycobacterium!), and calcium for osteopenia (thanks, menopause!). I’ve recently added an Omega fatty acids supplement too to help jump-start my addled brain (thanks, PTSD).

Although I clearly stated that the Effexor is to help manage the hot flashes, night sweats, and moodiness of menopause, the NCM asked me if it’s helping me manage the depression brought on by my cancer diagnosis.

I reiterated that I’m not taking it for depression but to get some much-needed relief from the atrocities of chemically induced menopause. I don’t think she believed one word I said. Either that or she’s hard of hearing because she again asked how I’m coping with the depression and reminded me that it’s ok and even expected to feel sad after being faced with cancer.

I finally told her in an exasperated voice that I don’t suffer from depression, and if I did, I’d have no qualms whatsoever about taking an antidepressant. To me, depression is no different from any other medical condition that requires daily medication. Where’s the stigma surrounding statins for high cholesterol? Or beta blockers for high blood pressure? Or insulin for diabetes? Why should the stigma just be attached to depression? That sweet woman got more than an earful from me. I still think she doesn’t believe me about the depression thing, and she ended our phone call by reminding me that my health insurance plan covers 8 free counseling sessions. Just in case I need some help with that depression.

I understand completely why cancer patients and cancer survivors may be prone to depression. The list is long, very long, of reasons for cancer patients and survivors to be depressed, sad, out of sorts, unmotivated, fatigued, unable to concentrate, easily confused, guilty, hopeless, worried, unable to sleep and full of chronic aches & pains.

Webmd has an entire online community devoted to cancer. From the web site:

“Depression is a comorbid disabling syndrome that affects approximately 15% to 25% of cancer patients. Depression is believed to affect men and women with cancer equally, and gender-related differences in prevalence and severity have not been adequately evaluated. Individuals and families who face a diagnosis of cancer will experience varying levels of stress and emotional upset. Depression in patients with cancer not only affects the patients themselves but also has a major negative impact on their families. A survey in England of women with breast cancer showed that among several factors, depression was the strongest predictor of emotional and behavioral problems in their children. Fear of death, disruption of life plans, changes in body image and self-esteem, changes in social role and lifestyle, and financial and legal concerns are significant issues in the life of any person with cancer, yet serious depression or anxiety is not experienced by everyone who is diagnosed with cancer.”

While webmd quotes 15 percent to 25 percent of cancer patients suffering from depression, and the Lancet says it’s more like 16 percent, who knows if either number is anywhere near correct because so many people are ashamed to admit to depression. The fact that more cancer patients and cancer survivors aren’t depressed is what surprises me.
New York Times columnist Dana Jennings blogs about his bout with advanced prostate cancer, and speaks of being “ambushed by depression” after enduring the grueling treatments and being back on the road to good health. He quotes the 25 percent as well, and compares that to 7 percent of the general population suffering from depression. He refers to it as less about sadness and more about feeling oppressed “as if I were trapped, wrapped up in some thick fog coming in off the North Atlantic.” Jennings goes on to admit that writing about prostate cancer and all its embarrassing aftereffects is easier than admitting he’s depressed.

“It’s harder to write about the weight of depression than it is to write about prostate cancer and its physical indignities. Cancer is clear biological bad luck. But depression, no matter how much we know about it, makes part of me feel as if it’s somehow my fault, that I’m guilty of something that I can’t quite articulate.”

That is staggering.
Because Jennings is a professional writer, he conveys much more eloquently than I the impact of depression after cancer. I’ll close with this, and will ponder his words as I attend the APA’s Mental Health Blog Party.

“Partly, I think, I’m grieving for the person I was before I learned I had cancer. Mortality is no longer abstract, and a certain innocence has been lost. And while the physical trauma is past, the stress lingers and brings with it days washed in fine shades of gray. In the same way that radiation has a half-life, stress does, too. We all ache to be the heroes of our own tales, right? Well, I’m not feeling too heroic these days. Cancer pushes lots of difficult buttons. It lays bare our basic vulnerability and underlines the uncertainty of this life. And prostate cancer attacks our culture’s ideal of manhood. The steely-eyed Marlboro Man isn’t expected to worry about incontinence and erectile dysfunction. Cancer feels bleaker than other diseases. Even though my health keeps improving, and there’s a good chance that I’m cancer free, I still feel stalked, as if the cancer were perched on my shoulder like some unrepentant imp.”


Becoming Benjamin Button

I haven’t seen that movie, but I feel Benjamin’s pain with premature aging. I don’t recall anyone telling me in the early days of this cancer “journey” that being thrown into menopause a decade earlier than normal would be such a bear. In fact, I don’t recall hearing anything at all about being thrown into early menopause. Yet another lovely bit of fallout from a cancer diagnosis, for sure (insert a boatload of sarcasm here).

Menopause is a bitch on any level. It’s certainly not a contest, and some women have it way worse than others. I’m thinking of one darling friend in particular who’s been dealing with the ‘pause for 10 years. Yuk. It just sucks, and I’m because I’m officially old and crotchety, I’m not in the mood to look on the bright side or try to find something positive about this shitty situation. Correction: I just found something positive — it gives me an excuse to use the word shitty, one of my faves in the cursing arsenal.

I first came face-to-face with chemically-induced menopause two summers ago when my favorite oncologist recommended hormone suppression since my breast cancer was fueled by estrogen. Get rid of the food supply, starve the cancer; makes perfect sense. Suppressing the estrogen for me was achieved by the dynamic duo of Tamoxifen and Lupron. For the lucky uninitiated, Tamoxifen is a pill-form of chemo that we members of the pink ribbon club take every single day for 5 years, minimum. The Lupron is delivered once every three months via a gigantic needle that left me bruised for weeks.

Enduring the injection was a piece of cake, though, compared to the side effects of Lupron: constipation, joint pain, bone pain, general body pain, dizziness, hot flashes, fatigue, stuffy nose, nausea, sweating, insomnia, weakness.

Great.

Add that to the side effects of Tamoxifen–bone pain, hot flashes, loss of balance or coordination, persistent fatigue or weakness, among the highlights–and you’ve got a hot mess.

No wonder I feel bad.

Then I look in the mirror and I feel even worse.

Side effects of menopause are just as fun as the drugs’ side effects: hot flashes, osteoporosis, hot flashes, mood swings, hot flashes, changes in your female gear, hot flashes, mood changes, hot flashes, change in vision, fatigue, hot flashes, night sweats, hot flashes, joint pain, hot flashes.

Did I mention the hot flashes?

The combination of the drugs’ side effects and general menopause side effects are mind-boggling.

The unsung side effects from all this mess are mostly vanity-related but no less troubling. A thinning of the hair on one’s head accompanied by a growth spurt in the hair on one’s face. Decreased collagen in the skin. Dry skin. Dark circles under the eyes. Brittle nails. Wrinkles. More wrinkles. Changes in hair color and texture.

Any part of this would be unpleasant enough when dealing with it at the “normal” time, whatever the hell normal is anymore. Going through the ‘pause with girlfriends could be fun: let’s stay up all night, sweating and hot-flashing, while watching our moustaches grow. Sure, we’ll be extra tired and grumpy the next day, but hey — we’d be tired and grumpy anyway, right? If I’m going to become an old bitty before my very eyes, I want to do it with my BFFs.

But wait, I’m on an accelerated schedule. I’ve got the Fast Pass to menopausal hell, while the women in my peer group are still relishing their early 40s. Botox is for fun, not necessity, and plucking billy goat chin hairs is reserved for grannies. 40 is the new 20, right? Except for me; 40 is the new 60. I am the granny in this scenario. I’m feeling more kinship with Betty White than with J-Lo.

To quote Sheryl Crow, “No one said it would be easy. But no one said it’d be this hard.”

 


Oncology report

My latest visit to Dr Darcourt was uneventful, which is my favorite kind of doctor visit. Despite the fact that I have to get stuck for blood work and step on the scale every time I go see him, I still like going. As much as you can like going to an oncology visit.

In the beginning of this “cancer journey,” it freaked me out to say “my” and “oncologist” in the same sentence. Not something one usually wishes for, to say the least. But if I have to have an oncologist, my guy is pretty great. Not just because he’s young and Peruvian, either. Although that doesn’t hurt.

Since you’re probably going to google him now, I’ll make it easy on you: 

There ya go.

Just a disclaimer: he was the third oncologist I consulted, and didn’t choose him based on the fact that he’s young and Peruvian. Not just.

Ok, so the appointment was uneventful, and he said the words I love to hear: “I have no reason to think your cancer will come back.” Music to my ears. We talked about Tamoxifen, the chemo pill I take every day and will stay on for 5 years, and the artificially-induced menopause brought on by it and the Lupron shot I get every three months for hormone suppression. In a nutshell, since my cancer was fed by estrogen, it’s easy to control it by depriving it of estrogen. It means I go through menopause a bit early, but that’s a small trade-off for ensuring the cancer doesn’t come back.

The trick is to determine if I’m really in menopause or if once we stop the Lupron shots, we also stop the ‘pause. This is important because it affects the chemo pill I take. Tamoxifen is for pre-menopausal women, i.e., if you weren’t in menopause at the time of diagnosis, you take it. If you’re post-menopausal, you take a different drug, mainly Femara or Arimidex. Either way, I will be on one of these drugs for 5 years. I’m ok with that, because I’m pretty reliable at remembering to take it every day, and it’s another weapon in my arsenal against my cancer.

And taking a pill every day is much easier than getting that Lupron shot. Even though Ionly get it once every 3 months, it’s dreadful. The needle is really big: 20 gauge.

dispensingsolutions.com

The 20 gauge needle is what is used for port access. It has to be big enough in diameter to not only pierce the skin and the membrane of the port, but also allow for blood to be drawn back out through it.

That’s a big needle.

If you don’t like needles, like me, you may get a little squirmy right about now. That’s ok. Don’t worry if your palms start to sweat, if your heart races, and you feel a little nauseated. All normal reactions to seeing a wonking big needle. But if I have to see it, so do you. I’m good at sharing.

The drug itself is very thick, and has to be warmed before being injected. You know it’s going to hurt. Because it’s thick, it takes several seconds to push the drug through the needle into the body. So the pain lasts. Then once the drug is in, it burns. On the skin and inside. I literally can feel the drug trailing into my body. And yet, I do it willingly. Because I want to starve any cancer cells that may be entertaining thoughts of reforming. I don’t want any uprisings on my watch.

I may take that shot willingly, but I still complain about it. I get it in my left arm, and the bruise from the previous shot, 3 months ago, is always still visible. For several weeks, I will have a hard little knot at the injection site. My arm will be sore for the rest of the day after I get the shot, but then life goes on and it’s business as usual, for the next 3 months.

But yesterday, I made a BIG mistake when getting the shot. I glanced over my shoulder as the nurse was getting ready to inject it. I saw that big-ass needle, glinting in the florescent lights, looking as menacing as an inaninate object can.

Oh, I wish I hadn’t seen that. Somehow the visual reality makes it so much worse. I had to grit my teeth and concentrate on not yelling.

I usually console myself with a beer or a glass of wine on shot days. But yesterday, I was trying to dry out from our Napa trip, so I tried to refrain. I didn’t get very far, and ended up with a Pinot Noir in my glass. But now I’m back to drying out, because I was reading one of my favorite blogs today, and misread one of the lines. It describes waking up and “waiting for the new day to open like a spring margarita.” Oh, wait–it’s
“spring magnolia.” Oops. Guess I’d better get on the wagon, sore arm and all.


A Funny Thing Happened…

I was at Walgreens (again) to pick up (yet another) prescription, and had one of the best belly-laughs I’ve had in a while. Thank heavens Macy was with me, or I might have embarrassed myself, and the pharmacist, even more.

To set the scene: I go to Walgreens a lot. They know me there, kind of like how it was for Norm on Cheers, but without the drinks and witty repartee. I have lots of prescriptions, all of which are on a slightly different schedule, so that I can’t ever manage to go pick up a month’s worth of all my drugs but instead make multiple trips every month.

Usually, there’s either a grandfatherly pharmacist or a host of young female techs. This visit, though, I found a sweet young male tech behind the register, and another sweet young male pharmacist. While these two fellas were plenty easy on the eyes and seemed competent at their jobs, I do prefer the grandfatherly pharmacist because he always calls me “miss” instead of “ma’am.” I know, it’s a farce, and I know I’m way more “ma’am” than “miss” at this stage of the game, but I like it anyway.

The young whippersnappers both referred to me as ma’am, but I’m not going to hold that against them. The young tech went to get my order, and the young pharmacist butted in to ask if I had any questions about my meds. I thanked him but said no, I’m a frequent flyer here, quite the pro at taking these drugs. He couldn’t just leave it at that, he had to be extra thorough and read the warning labels on one of the drugs, either one of my antibiotics (yes, I’m STILL on them both) or my iron supplement, I’m not sure which.

So he looked at the label and asked me, in all seriousness, if I might be pregnant or am breastfeeding. I can’t decide which scenario is most amusing: pregnant me, in all my forced-menopause hot-flashing, hormonalness; or the idea of breastfeeding with no um, breasts. Those poor sweet young men behind the counter didn’t know and can’t be blamed. And I’m pretty sure both were quite horrified when I told them, in no uncertain terms, that both scenarios are quite impossible for me and that any baby relying on me for breastfeeding would be utterly starved to pieces.

We had a good hee-haw about it, and the tech said something about the fact that I look young for a cancer patient. Shows how much he knows: there’s no mean demographic for cancer. The pharmacist said, any age is too young to be a cancer patient. And how.


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