Then Wendy saw the shadow on the floor, looking so draggled, and she was frightfully sorry for Peter. “How awful!” she said, but she could not help smiling when she saw that he had been trying to stick it on with soap….
Fortunately she knew at once what to do. “It must be sewn on,” she said, just a little patronisingly.
“What’s sewn?” he asked.
“You’re dreadfully ignorant.”
“No, I’m not.”
But she was exulting in his ignorance. “I shall sew it on for you, my little man,…….”I daresay it will hurt a little,” she warned him.
“Oh, I shan’t cry,” said Peter, who was already of the opinion that he had never cried in his life. And he clenched his teeth and did not cry, and soon his shadow was behaving properly, though still a little creased.”
– J.M Barrie
The side effects of cancer can be like a shadow over a patient as they move past hospital treatment and into life after diagnosis. The words ‘maintenance drugs’, are the final stamp on your release from regular hospital visits. They can make us feel safe and secure in the knowledge they are helping our bodies fight against this disease and protecting us but they can also make us feel frustrated and out of control. The roller coaster ride of balancing those side effects is constantly ongoing. Peter Pan loosing his shadow is a great illustration of our vulnerability, conveying how underneath that ‘boy/girl who can fly’ can be a bit of a ‘draggled’ kid simply trying to get back to Neverland.
On my initial diagnosis I was put on the drug Tamoxifen. Tamoxifen is a small white pill, taken daily by patients with a hormonally receptive breast cancer. After a year of treatment this was my one and only maintenance drug. After the array of drugs I had had that year, one small white pill was nothing! I was told, under no uncertain terms, to stay on it for the course of my five year remission.
‘ Tamoxifen acts as a weak estrogen by competing for estrogen receptors. Tamoxifen has mild estrogenic properties but is considered an anti-estrogen since it inhibits the activity of regular estrogens. More accurately, tamoxifen is an estrogen-blocker. It fights breast cancer by competing with estrogen for space on estrogen receptors in the tumor tissue. Every tamoxifen molecule that hooks onto an estrogen receptor prevents an estrogen molecule from linking up at the same site. Without a steady supply of estrogen, cells in an estrogen-receptor-positive (ER+) tumor do not thrive and the tumor’s ability to spread is reduced.’
– Tamoxifen: A Major Medical Mistake? By Sherrill Sellman
Doctors do not divulge the side effects of maintenance drugs too deeply. They are prescribing them to help your body maintain a balance and work alongside the treatment they have over seen thus far. It was up to me to research and learn more but my experience of Tamoxifen initially was pretty uneventful. The only major problem was a delay to my starting a family, which had worried me the most on diagnosis, at the ripe old age of twenty seven, but as I admitted to myself early on, it might help having a partner first! So, I gallantly rode through five years of remission, found myself a husband and then counted the days!
Having thought it may take forever, after waiting the three months after coming off the drug so it was safe, we fell pregnant incredibly quickly. I consider it a literal miracle that within a month the test came back positive. I wonder now if the fact that Tamoxifen had actually been first approved for use as a birth-control pill but proved to induce rather than inhibit ovulation, had anything to do with this!
So, after five years of worrying my ovaries were getting a bashing from all the medical interference, this little pill could have been helping my fertility! Oh the irony! However, on my second diagnosis, there was no time spared before I was put back onto this drug and this time, the side effects were not so easy.
No one ever really talks about how much Tamoxifen can be such a nuisance. Everyone hails it as a wonder drug, but as Sherrill Sellman’s recent blog points out, there is always another side.
While the initial findings of tamoxifen’s role in breast cancer treatment seemed so promising, as with so many of the synthetic hormone drugs, further research presented grave concerns for its widespread use. In fact, the MIMS Annual lists 25 adverse reactions to tamoxifen…
– Sherrill Sellman
In a BBC report a while ago, they discussed how the drug should be available to women at high risk, as well as those who had had breast cancer. Sure, lets talk about prevention, but did anyone care to discuss that there could be huge side effects, primarily menopause symptoms but also pyschological symptoms such as depression as well as blood clots, eye damage and asthma in very sensitive patients? That’s a huge decision for any woman to make, breast cancer or not and making informed decisions has never been so important.
I have struggled with Tamoxifen. I am having wonderful counselling (another blog due about this for BDC soon!) but I go through periods hating how, as a medicine, it is making me feel mood and energy wise as well as battling with having the major choice of having another child taken out of my hands and processing the sense of grief I feel about this. Following a meeting with my oncologist two years ago, to discuss all this, I was also referred to a gynecologist who specialises in hormonal issues.
Sometimes I say the medication is even tougher than the illness.
– Sanya Richards-Ross
Things became clearer when she explained how so many other patients have similar side effects and how common it was to feel like this, emotionally as well as physically. The real knock on effects for a female, of having her natural oestrogen levels disrupted, are rarely publicly discussed so the sense of reassurance and sheer relief I felt after talking to her, were huge. She diagnosed Polysistic Ovaries (whats another diagnosis at this stage?!) and I felt strangely elated with the diagnosis of Insulin Resistance (a major cause of PCOS) as the extensive research into the relationship between this and breast cancer made so much sense to me. I’ve learnt just how important diet and stress levels are to working in conjunction with these drugs that are paramount in my recovery.
Yet, with another diagnosis comes another drug (whose counting?!) and I was prescribed Metformin to help my body process my insulin and work in conjunction with the Tamoxifen. My cravings stabilised and my mood swings improved too. I certainly felt like I had turned a corner and then just as I am getting my head around all of this, along comes Zoladex.
Since a third diagnosis earlier this year, I have started taking Zoladex in addition to Tamoxifen. I had met Zoladex while undergoing chemo. It was prescribed to protect my ovaries from the chemo drugs, but this time, it has been prescribed to down regulate my oestrogen production indefinitely. Clearly my body and oestrogen are hell-bent arch enemies and Zoladex is Batman’s Catwoman, brought in as reinforcements (well, a woman’s touch is always invaluable!)
Zoladex is an implant in a syringe, injected just under the skin every twenty-eight days to three months. It is given into the tummy by a nurse or doctor and it’s pretty clever as it deposits the implant which the body takes as and when it needs it.
Before the menopause, oestrogen is mainly produced by the ovaries. As oestrogen stimulates some breast cancers to grow, Zoladex works by stopping the production of oestrogen from the ovaries. It does this by interfering with hormone signals from the brain that control how the ovaries work. This is known as ovarian suppression.
– Breastcancer Care Org.
I recently had another dose and was surprised to hear that some people actually have a local anaesthetic before this jab! Catwoman eat your heart out! Zoladex is the ‘big gun’ but when I saw the box on the nurses desk the other day, I became an emotional puddle on the floor, reminded again just how these ‘life saving’ drugs can cast a shadow over huge areas of simply ‘living’.
Tamoxifen may have its down sides but compared to Zoladex it was a more straight forward drug. My periods returned three months after chemo finished and the hot flushes were minimal, but fast forward nine years and I have no periods, no oestrogen and every morning, regular as clock work, I wake to a boiling hot drenching of sweat as my body wakes up to face the day. Ice bucket challenges have never been so welcome!!
These are just the drugs I am on, there are so many others to treat all different diseases, all with their own pros and cons. At thirty-six I never expected to be in a drug induced menopause, debating Testosterone implants and wondering if, by the time this remission is over, whether it might actually be possible to start your periods at a mere 41 years old! It’s that familiar pause button, hovering over my head and sometimes making me a crazy lady in limbo!
The effects this all has on a relationship are huge and this often gets overlooked. I’m lucky, I have an amazing husband but it has been testing and a challenge for us as a couple at our age, and certain, not so fun conversations have had to be had, of which most couples wouldn’t have to consider having until at least a few more grey hairs had been plucked! I’ve got an incredible team around me but having had a cancer that, like a bad smell, has just been very stubborn about f’ing off, I’ve had to be doubly pro active in finding ways of living with these far-reaching side effects.
Time is a great healer, on all accounts. Remission isn’t five years for nothing. Just because the main treatment is over, doesn’t mean the daily treatment is. Every day, those pills get washed down and I visualize them keeping my cells clean and clear. They are maintaining my cancer free body but I am also a pro active patient. I try to be massively conscientious in researching the best nutritional advice, new forms of exercise that ground and calm me and courses that can help me manage my daily anxieties, such as mindfulness. It’s one huge mixing pot of trial and error and it never ends. As I look forward, when and if I come off the drugs, I’ll be that much older and will then have to deal with my bodies natural changes and those side effects. I feel like I have had a rather massive head start but just as Peter Pan realises how much he needs his shadow and attempts to stick it back on with soap, maybe we just need some patience too and our own ‘Wendy’ to give us that love, understanding and support, to sew it back on now and again, reminding us how much we need it, and in turn accepting our slightly ‘creased’ appearance. After all, sometimes its just nice to believe in boys/girls who can fly and that;
“All the world is made of faith, and trust, and pixie dust.”
― J.M. Barrie, Peter Pan