Cancer log 198: aromatase and fat transfer

Three hours this morning in follow-up appointments; more than anything, I continue to be irritated by how much time cancer has stolen from me. Sometimes I was able to bring a laptop and get some work done, but it’s hard to work in choppy pieces. Mostly I read or played dumb games on my phone; sometimes I just read shelter magazines from the waiting rooms. Annoying.

I started to say something about not complaining about small things, since every day without recurrence is a day to celebrate, but the loss of time isn’t a small thing, really. In the end, time is all we have. Everything else in our lives, all the pleasures and joys and sadnesses too, are composed of time. Take that away, take everything.

(As I get older, I get more and more resentful of my time being wasted or stolen, and my attention too. Cue separate rant about Facebook and the internet as a giant time-suck, about billboards and credit card ads I’m forced to listen to on planes and the spam phone calls that disrupt my day even when I don’t answer them, etc. and so on.)

But the follow-ups went well enough. The first was with my main oncologist; everything looks good, but it’s time to switch from tamoxifen to an aromatase inhibitor, since I’ve been in chemo-induced menopause now for more than a year. Aromatase inhibitors work by blocking the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body. This means that less estrogen is available to stimulate the growth of hormone-receptor-positive breast cancer cells.

There are a host of possible side effects, hot flashes, etc., but the aromatase inhibitor has a better rate on avoiding recurrence than tamoxifen, so it seems worth trying — but only in the single digits, and there aren’t long-term studies of more than ten years yet. Hopefully I won’t get the side effects (10-30% likely, depending on which ones), but if they’re bad, I can always switch back to tamoxifen. She recommended waiting until after any holiday travel, just in case, so I’ll plan to switch just after Christmas.

I’ll also be getting a bone density scan this week, and checking my vitamin D levels, to set a baseline; one thing to be careful of is increased risk of bone thinning. Will be curious to see how my bone density is; I don’t think I’ve ever had that checked, and my mom tells me I’m developing a hunch (too many hours bent over the computer, I suspect). I try to remember to stand up and sit up straight, but I am not good at it. I would rather not get a hunch, though, or at least not for some decades to come. Forty-six seems young for it.

The oncologist asked how the fat transfers were going, and I told her that I thought this was going to be my last one. Each one (three so far) has done a good job of reducing scarring, taking the deep puckered scar from the initial lumpectomy (because the oncology surgeon was more concerned with getting the cancer out than pretty, and rightly so) to a relatively fine and unpuckered line; something I can happily live with. The actual fat transfer part, though, has been a very slow process, with each transfer only making the smallest of differences to the fullness of the breast, as much of the transferred fat gets reabsorbed by the body. And it’s really not that visible in clothes at this point, and if I look a little lopsided in a swimsuit, I can live with that. I’m irritated enough by how much muscle tone I lose from the requisite inactivity after each surgery that I am reluctant to do this again; I think I’m done. I almost didn’t do this last one, actually.

But what’s interesting is that hearing all of this, and how the reason we’re not doing a lift on the other breast to attack the symmetry problem from that side, is because my prior breast reduction means that the plastic surgeon doesn’t feel he can guarantee maintaining nerve function (he wouldn’t know what available blood flow would look like until he got in there), my oncologist said that maybe we should be following up with MRI, rather than just mammograms, because my breasts are dense (since I’m young) and complex (due to the surgeries). Heh. It amuses me, having dense, complex breasts.

I don’t love MRIs — getting the IV needle in the hand for contrast irritates me. But increased scrutiny is, I think, worth a little irritation; the one thing I want is for them to catch any recurrence as early as possible. She’s going to talk to the oncologist surgeon and get back to me; we’ll see what they say.

Then I went on to the plastic surgeon follow-up, which was relatively straightforward by contrast. He scolded me for being too active in the last week, and I refrained from telling him that if he hadn’t summarily rescheduled my surgery for three weeks later than originally planned, I wouldn’t have been trying to cook party food for 80 while only a week out from surgery.

I had lots and lots and lots of help, and I tried REALLY hard not to lift anything heavy; I even had the grocery people put my bags in the car, which I felt super-lazy to be asking for. But there was an inevitable amount of twisting at the waist while driving, stirring, etc., which is where the bulk of the fat was transferred from, and by the end of each day this past week, I admit to being in more pain than was probably ideal. (Not enough to need painkillers, though, beyond a couple Advil, so please don’t worry). The problem really is that I feel fine, and so I do things, and then it starts to hurt, but by that point, the damage has been done. I am so very bad at sitting still.

No real harm done, though, and he just said that I should try to take it easy from this point on, which is, in fact, the plan. Well, easy this week, anyway; I’m leaving for a week in Hawaii on Sunday, which will hopefully involve some mild physical activity along with the relaxing on a beach parts. He said it should be fine, as long as I don’t go too deep, as pressure changes can be an issue. I’m not doing scuba, so I’m guessing it’ll be fine.

See, I’m guessing some of you were feeling sorry for me, but now that you know I’m going to Hawaii, you’re feeling much less sorry for me, which is as it should be. It’s Jed’s and my 20th anniversary; I’ve never been there. Looking forward!

And that’s the update! Long, complicated, but basically everything is chugging along in reasonable manner. 2 years and 9 months since diagnosis, all signs good. Onwards.

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