Breast Cancer – The Side-Effects of Tamoxifen

mammogramI have had breast cancer. After the surgery, the chemotherapy and the radiotherapy, I have spent the last 5 years being treated by the drug letrozole to avoid recurrence of the disease. Last month, I had my annual check-up and mammogram and was found to be 5 years cancer free. Result! However, my tumour was HER2+ and therefore my oncologist has advised another 5 years of endocrine teatment with Tamoxifen.

I suffered from almost every side-effect of Letrozole, so it is important to me to be aware of the side effects I may have to endure while taking Tamoxifen. Everybody reacts differently to drugs and some people experience more severe side effects than others, some are really lucky and are not aware of any side effects.

The most common side effects that people have when taking Tamoxifen are much like Tamoxofen packetthe symptoms of the menopause. They include hot flushes, night sweats and sleep disturbance. Other common side effects are vaginal irritation, loss of sex drive and mood changes. Women who have regular periods are likely to find the flow may be lighter, irregular or stop altogether. However, vaginal discharge is common while taking Tamoxifen and so you should be aware of the possibility of infection,.

One of the positive side effects of Tamoxifen for women who are post-menopausal is that this drug is found to slow down the progress of osteoporosis which is thinning of the bones. Conversely, women sho are pre menopausal may be at risk of thinning bones while taking Tamoxifen.

pulmonary embolismThere are other side effects of Tamoxifen that are less common. The drug increase the risk of getting blood clots including deep vein thrombosis (DVT). This can be very serious as people with DVT are at risk of developing a pulomary embolism. Therefore people taking Tamoxifen need to be aware of blood clots and ways of helping to reduce this. Lengthy periods of inactivity can increase the risk of developing bood clots. Those who take long flights, car journeys or train trips need to be aware of the this.

My oncologist also warned me about the fact that Tamoxifen can afftect the lining of the womb and cause it to thicken. In a few cases Tamoxifen can even cause polyps, ovarian cysts or womb cancer. As my family is complete, I have told the doctors that I would look to have a hysterectomy, should that occur.

letrozole-hairA change in hair may also occur. A small number of women may find they notice an increase in downy facial hair and changes to their singing voice. Others find they suffer hair loss or thinning while taking tamoxifen. I suffered hair loss while taking Letrozole, so will be particularly alert for this side effect.

Sight may also change. Make sure to make your regular visits to your optician during treatment.

Tamoxifen can also cause changes to liver function. However, the changes to the liver are usually mild and you may not notice them. At the end f your Tamoxifen treatment your liver will probably return to normal.

Amongst the other side effects are joint pain, tiredness, difficulty concentrating, letrozole-fluidheadaches and leg cramps at nght. Some women also suffer weight increase.

My oncologist has told me that Tamoxifen usually only results in mild side effects. However, I encountered many of the side effects with Letrozole and fear Tamoxifen may be the same. They cause me distress, pain and make me self conscious. However, if Tamoxifen keeps the dreaded breast cancer at bay, I will take the tablets and live.

Valerie Penny

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Breast Cancer Treated With Tamoxofen

I am lucky, I have just been for my annual mammogram and breast cancer check up and I have learned that I am still clear of this horrible disease. It is now 5 years since I wasbreast mammogram diagnosed and treated for breast cancer. 5 years clear: wonderful. However, that does not mean I am treatment free. I have been taking Letrozole for these first five years. The side effects of that drug are many and various. I think I suffered all of them, except high blood pressure! Anyway, the oncologist says it is time to move on from Letrozole to Tamoxifen.

Tamoxifen is another form of hormone treatment, known as endocrine therapy, for those who have had breast cancer. It is only prescribed if the breast cancer had receptors within the cell that bind it to oestrogen. All breast cancers are tested for oestrogen using tissue from a biopsy or after surgery. My tumour was found to be HER2+ and, as this can stimulate cancer tumours to grow, Tamoxifen is prescribed to help stop any cancer cells from growing.

If you are found to be hormone receptor negative, then Tamoxifen will not be of any benefit to you.

Tamoxofen

Primary breast cancer, which has not spread beyond the breast and lymph glands, may be treated with Tamoxifen after surgery. The lymph glands are under your arms. Tamoxifen is used as additional treatment to reduce the risk of the cancer returning and also to reduce the risk of new cancers developing. This is called adjuvant therapy.

Occasionally, Tamoxifen may be used as the first treatment for breast cancer. This may be when surgery is not appropriate or before surgery to shrink a large breast cancer tumour. Shrinking a large tumour in this way may mean that a mastectomy (breast removal) may be avoided and a lumpectomy (removal of the tumour and surrounding tissue) may be sufficient treatment. Also, Tamoxifen may be used for breast cancer that has returned into the breast or surrounding area. It can also be used if you are diagnosed with secondary breast cancer. This is when cancer cells from the breast have spread to other parts of the body.

Tamoxofen packetIn some instances, Tamoxifen may be an option for some people who have a high risk of developing breast cancer because of family history of the disease. This is in order to reduce the risk of development of breast cancer.

 

Tamoxifen is usually taken as a tablet, but may be prescribed as a liquid for those who find swallowing difficult. The recommended dose for the majority of people is 20mg. It is best to take one at the same time each day, but, if you miss a dose, it is not necessary to take an extra tablet because there will be a high enough level of the drug in your body from the previous day.

Usually, you will be prescibed Tamoxifen for a period of between 5 and 10 years. I have been told I should take the drug for a 5 year period. So, here goes, Tamoxifen here I come!

Valerie Penny

 

Breast Cancer – Side Effects of Letrozole (Femara)

letrozoleI was diagnosed with breast cancer. After surgery, chemotherapy and radiotherapy, I was prescribed Letrozole (Femara) and must take one 2.5mg tablet each day for a perios of 5 years. Letrozole is a hormonal therapy drug. It is used to treat breast cancer in women who have been through the menopause. Letrozole has been prescribed in order to reduce the liklihood of the cancer recurring, so I am taking it. However, Letrozole does have many unpleasant side-effects and I suffer with most if them. I was not told about these. I think I should have been.

Letrozole is used after surgery and other treatments to reduce the risk of breast cancer coming back. You will usually take it for a few years. Doctors sometimes prescribe it before or after you have another type of hormonal therapy drug. Sometimes doctors give letrozole before surgery to try to reduce the size of the cancer and avoid having a mastectomy (removal of the breast). Letrozole is also used to control breast cancer that has spread to other parts of the body (secondary breast cancer)

Many breast cancers rely on the hormone oestrogen to grow. This type of breast cancer is called oestrogen receptor-positive (ER positive) breast cancer. My breast cancer fell into this category.

Hormones are substances produced naturally in the body. They act as chemical letrozole-tabletsmessengers and help control the activity of cells and organs. Hormonal therapies interfere with the way hormones are made or how they work in the body. After the menopause, oestrogen is no longer made in the ovaries. Instead it’s made in the fatty tissues of the body. This happens when an enzyme called aromatase changes other hormones into oestrogen. Letrozole is a drug called an aromatase inhibitor. It blocks this process and reduces the amount of oestrogen in the body.

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I will explain the most common side effects of letrozole here but it is sensible to tell your doctor or nurse about the side effects you have. They can prescribe drugs to help control some of them and give you advice about managing them.

Hot flushes and sweats

These are common and are often mild, but this can vary. Hot flushes and sweats may lessen after the first few months. Cutting down on nicotine, alcohol and hot drinks containing caffeine, such as tea and coffee, can help. Dress in layers, so you can remove clothes as needed. Natural fabrics, such as cotton, may feel more comfortable. If hot flushes are troublesome, tell your doctor. Low doses of certain antidepressant drugs can help to reduce flushes.

Bone thinning

Taking letrozole for a few years increases your risk of bone thinning, called osteoporosis. This can increase your risk of a broken bone (fracture). You will usually have a bone density scan to check your bone health before and during treatment. If you are at risk of osteoporosis, your doctor may prescribe drugs called bisphosphonates to protect your bones. They will also usually advise you to take calcium and vitamin D supplements. Regular walking, eating a healthy diet, not smoking and sticking to sensible drinking guidelines will also help to strengthen your bones.

Tiredness and lack of energy

You may feel tired, sleepy or feel like you have no energy when you start taking letrozole. Try to pace yourself until this improves. It is important to get the right balance of having enough rest and being physically active. Regular short walks will help you to feel less tired. If you feel sleepy, don’t drive or operate machinery.

Joint and muscle pain

You may have pain and stiffness in your joints, and sometimes in your muscles, while taking letrozole. Let your doctor or nurse know if this happens. They can prescribe painkillers and give you advice. Being physically active and maintaining a healthy weight can help reduce joint pain and keep them flexible. Let your doctor know if it doesn’t get better.

Feeling sick and indigestion or tummy pain

Any sickness is usually mild, but let your doctor or nurse know if this happens. Letrozole may also cause indigestion or tummy pain. Let them know if you have any of these symptoms. They can prescribe drugs to help.

Change in appetite

If you do not have much appetite, try eating small meals often and regularly. If problems with eating don’t get better talk to your doctor or nurse. Some women find their appetite increases. Eating healthily and being physically active will help if you have concerns about your weight, but staying active when you are tired and have joint and muscle pain can be difficult.

Hair thinningletrozole-hair

Some women notice that their hair becomes thinner while taking letrozole. This is usually mild. Your hair will get thicker after treatment finishes. I hope this is true. The hair thinning is quite embarrassing for a woman.

Skin rashes

You may get a mild skin rash . Tell your doctor or nurse if this happens. It is very important to contact your doctor straightaway if you get a severe skin rash.

Mood and behaviour changes

Some women may find they have a low mood while taking letrozole. Or you may have problems concentrating, feel anxious or have difficulty sleeping. Talk to your nurse or doctor if you have these changes so they can give you support and advice.

Headaches

If you have headaches let your doctor or nurse know. They can usually be controlled with painkillers you can buy yourself.

Feeling dizzy

Letrozole may cause dizziness. Let your doctor or nurse know if this is a problem.

Weight gain

You may put on weight when you’re taking hormonal therapy. Eating healthily and being physically active can help to keep you to a healthy weight: however, it is difficult to be physically acive when you also have the side effects of tiredness or joint and muscle pain.

Vaginal bleeding

Letrozole rarely causes vaginal bleeding. If this happens it is most likely in the first few weeks of treatment, or when you change from another hormonal therapy to letrozole. If bleeding continues for more than a few days, tell your doctor or nurse.

Raised blood pressure

Tell your doctor or nurse if you have ever had any problems with your blood pressure. Your nurse will check it regularly during your treatment. This is one of the few side-effect I do not get!

Raised cholesterol level

Your doctor may check your cholesterol levels with a blood test.

Build-up of fluidletrozole-fluid

You may get swollen feet and ankles because of fluid building up. If you notice this or any other swelling let your doctor know.

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In addition to these more common side-effects of Letrozole, there are other possible side-effects that are less common.

Vaginal dryness

Non-hormonal creams and gels or lubricants can help reduce dryness and discomfort during sex. You can buy these at a chemist or your doctor can prescribe them.

Urine infection

Let your doctor know if you have pain or discomfort when you pass urine, or if you need to go more often, or your urine is cloudy or smelly. Drink lots of fluids if you think you may have an infection.

Eye problems

Occasionally women get sore eyes or blurry vision with letrozole. Always tell your doctor or nurse if you notice any change in your vision.

Changes to your heartbeat

If you notice changes to your heartbeat, such as it speeding up, let your doctor know. If you have pain or tightness in your chest, or feel breathless at any time during or after treatment, see a doctor straightaway.

letrozole-rash***

I was told that my side-effects would settle down after a few months. That has not been the case for me, nor ofr many other women who have contacted me. Still, we keep taking the tablets. I would rather complain than have to explain to my family that the breast cancer is back.

Valerie Penny

 

 

Osteoporosis and Breast Cancer

Osteoporosis literally means porous bones. The result is that the bones can become thin or snap. Osteoporosis cannot be cured and often is not found until after bones break. It affects half of women over 50 and one in five men in that age range and some people who receive treatment for breast cancer are at an increased risk of ostoeporosis, however, treatments are available to try to keep bones strong and less likely to break.

Women who have not gone through the menopause before they are treated for breast cancer have an increased risk of osteoporosis. Indeed, chemotherapy can cause an early menopause and a rapid, significant reduction in bone density and result in osteoporosis.Even women who have been through the menopause may be at increased risk of osteoporosis because of the hormone therapies they take for breast cancer.

balanced her 2.jpgI am being treated with letrozole for my breast cancer. My tumour was of the fast growing HER2 positive variety. The letrozole is one of the drugs that reduces the amount of oestrogen circulating in my body and this could result in osteoporosis. I have my bone density checked with a bone density scan and, so far, I do not show signs of osteoporosis. Generally speaking, people with a good bone density before getting treatment for breast cancer are less likely to develop osteoporosis while taking an aromatase inhibitor such as letrozole.

I have been careful to put some simple lifestyle choices to help keep my bones strong and healthy. I ensure that, although I am vegetarian, I have a well-balanced diet. Although dietbalanced-diet changes will not cure bone defects, it may stop them osteoporosis getting worse. Eating meals that incorporate a wide variety of foods including fruit and vegetables, carbohydrates, milk and dairy products and proteins help achieve this. As a general rule it is recommended that we eat at least five portions of fruit and vegetables a day. You would be amazed how many people, including vegetarians, do not manage this! I have also significantly reduced my alcohol intake and the amount of fizzy drinks I take.

Calcium is a vital mineral for teeth and bones. It gives them strength and rigidity. Most of the calcium found in our bodies is in our bones. Dairy produce is our main source of calcium. People  can usually get enough calium through a healthy diet that includes dairy products. If your diet did not include dairy produce you would need to ensure you got calium from another source such as a calcium supplement.

I also have to bear in mind that vitamin D is needed to help my body absorb calcium. The best source of vitamin D is sunlight. Human bodies use the sunshine to make vitamin D in the skin. The vitamin D is fat-soluble and the body stores it for use in the winter months. balanced sunWe only need to be out in the sun for about quarter of an hour a day during the summer months to give most people enough vitamin D for the whole year. So a walk, some gardening or a round of golf should make sure we get enough vitamin D. In addition to that, margarine, egg yolks and oily fish also contain vitamin D.

Regular weight-bearing exercise is also important to put force through the bones. This helps stimulate growth and strength and keep bones strong and healthy. Such exercise includes skipping, aerobics, tennis, and dancing are good bone building activities, even a brisk walk can be of benefit to bones. I try to do some exercise at least three times a week in order to combat the cancer-related fatigue I suffer and the potential for weight gain that my medication induces. I really try very hard to make sure that I do not add osteoporosis to my list of worries.

Valerie Penny

 

Life on Letrozole After Breast Cancer

letrozoleAfter completion of my chemotherapy and just as my radiotherapy started I required to start taking letrozole: just one 2.5mg tablet per day. A 2.5mg tablet each day for 5 years. This is because my breast cancer wasa type that needs the hormone oestrogen to grow. In women who have been through the menopause, the main source of oestrogen is through the change of sex hormones called androgens into oestrogen. An enzyme called ‘aromatase’ is needed for this change to occur. Letrozole works by inhibiting (or blocking) this enzyme. This reduces the amount of oestrogen in your body, which slows the growth of the cancer cells, should they recur. It is my fervent hope that they will not.

I am ashamed to say that I never read the information given with medication, although I know I should. The manufacturer’s leaflet will give more information about letrozole and a full list of the side effects which may be experienced from taking it. I have to take other tablets daily as well. So I take one 2.5 mg tablet of letrozole each morning with my other medication, although you may take letrozole at whatever time of day you find easiest to remember, but try to take your doses at the same time each day. This will helps to avoid missing any doses. You can take the tablets before or after your meals. If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, skip the missed dose. Do not take two doses together to make up for a forgotten dose. I suppose one tablet out of 5 years will not make much difference.

However, along with their useful effects, most medicines can cause unwanted side effects although not everyone breast-cancerexperiences them. If you have read other articles in this blog, you will realise, that my primary mind set is always that these things cannot happen to me. Of course, sometimes they can and they do. That is just life. Also, because I do not read the manufacturers leaflets, I did not know the side effects to expect. However, Letrozole has a raft of side effects and I seem to have been blessed with most of them. The common side effects are as follows:

1) Hot flushes and sweating: yes, I get this one! I thought it was my time of life, but no, I owe this joy to Letrozole so I try to keep cool by wearing light, airy clothes or in winter, I wear layers, so I can take them off as required.
2) Headache, muscle or joint pain: oh wow! I have this one in spades. You can ask your doctor or pharmacist to recommend a suitable painkiller but I do not like to take any more tablets than I have to, so I try to manage the pain with rest, hot water bottles or ignoring it before I give in to the painkillers. The dull ache of the joint and pain is a persistent, nagging pain that drains the drive and strength out of me. It is inescapable.
3) Feeling tired, weak or dizzy: Oh, you guessed, I find this side effect really, really debilitating. I simply cannot do all that I did before I got ill. Some days I cannot get up, some days I have to take a nap, sometimes I just cannot move. I get so indescribably weary and tired. I get cross with myself and irritated but it does not explain this side effect to say that I get tired. The tiredness makes me bone weary. My limbs feel heavy, my concentration is affected. My eyes cannot stay open. At other times I cannot sleep at night, so that makes me tired too. I do not drive or use tools or machines until I feel fit enough to do that.
4) Feeling or being sick, indigestion, abdominal pain: Hurrah! I do not get this one! I stick to simple meals, generally avoid rich or spicy foods and I am very careful about my diet.
5) Constipation: I occasionally suffer from this one but I try to eat a well-balanced diet and drink several glasses of water each day.I also drink copious amounts of tea, mostly English Breakfast tea, sometimes Earl Grey.
6) Diarrhoea: Nope, I do not get this one: if you do, remember to drink plenty of water to replace the lost fluids.
7) Appetite changes, weight changes, feeling depressed, hair loss, skin rash, swollen legs or feet, vaginal bleeding: I am blessed with some of these, the most immediately obvious is that my hair has become very thin. Sometimes I wear a hat because my head gets cold, my hairdresser is a magician and always makes me look and feel like a million dollars. The other one of these side effects that I have to cope with is depression. I have suffered depressionfrom depression for many years any way and now it is reasonably well controlled. It is just difficult having another potential source of that mental health problem.
8) High blood levels of cholesterol or high blood pressure. I do not suffer from either of these. I am lucky in that my blood pressure sits fairly low anyway and my doctor also arranges for me to regular have tests to check that these side effects are not rearing their ugly heads.

As I suffer with so many side effects of Letrozole, I have been offered the opportunity to change to another tablet. However, I have declined to do so. I know what the side effects of Letrozole are and I can cope with them, more importantly my long suffering husband knows what they are and he can also cope with them. So for the remainder of the 5 year period, I will cope and I will be grateful that I am being successfully treated for breast cancer. I am a lucky woman.

Valerie Penny

Risk of Recurrence of Breast Cancer

herceptin_drugMy body has endured surgery, chemotherapy and radiotherapy. As a result of this I have lost my hair and my energy. Still, that tumour the size of a baked bean is perceived as a threat. Its return must be further discouraged. My oncologist therefore insists on mammograms every six months and prescribes Letrozole. I must take one 2.5mg tablet each day for 5 years.

Breast cancer is often discussed as a general condition, but there are several different types that require different treatments. One way to distinguish breast cancer cells is through your genes. When you are diagnosed with breast cancer, your doctor will test the cancerous cells to determine their genetic makeup. My tumour had more of the HER2 protein in it than it should have had. HER2 is a protein that stimulates the growth of breast cancer cells. It can be found in your blood and urine. Sometimes it is referred to as a tumour marker. Tumor markers like HER2 cannot be used for cancer diagnosis, but they can provide other important information and the presence of HER2 helps the doctor predict how likely the breast cancer is to respond to treatment.

It is estimated that about 20 percent of breast cancers are HER2-positive. Younger women are more likely to be her_2_geneHER2-positive than older women. HER2-positive breast cancer tends to be more aggressive and to spread more quickly than other cancers. That is why it is important to find out if the cancer cells in your body contain this protein. If your breast cancer is HER2-positive, you have a much better chance of successful treatment with methods that target the HER2 protein specifically. Results show that those who tested positive for HER2 at an early stage of the condition (with tumours 1 centimeter or smaller) had a higher risk of recurrence. Researchers have also found that HER2-positive patients had a 77.1 percent five-year survival rate, with no recurrence. However, they also are
around five times more likely to suffer recurrence than those who were HER-2 negative and have close to three times the risk of recurrence of those who tested negative for HER2. So I am absolutely sure I want to discourage recurrence.

Tumours that are HER2-positive are more often associated with factors that increase recurrence rates. For example, HER2 tumours are more likely to occur in younger women and have higher nuclear grade. Generally, the higher the nuclear grade, the more aggressive the tumour. HER2 tumours are also more likely to show positive margins during breast surgery. Positive margins occur when cancer cells extend beyond the edge of tissue that is removed. HER2 tumours also have a higher likelihood of residual disease being found when additional tissue is removed. Up to 70 percent of patients with HER2-positive breast cancer respond to treatment. However, total remission for the condition occurs only in around 7 to 8 percent of patients. Targeted treatments (medicines that target the HER2 protein, like the Herceptin I was treated with) have improved the prognosis for HER2-positive patients. Remissions can also be lengthy, offering another bright spot in prognosis and reports show that remission can last more than 15 years for some patients.

tabletI was diagnosed HER2-positive and this brings special challenges in my recovery from breast cancer. The HER2 protein can make the breast cancer more aggressive. It can also make it harder to treat with hormone treatments used for other types of breast cancer. However, drugs like trastuzumab (Herceptin) target HER2 directly and effectively. This drug, when used in combination with other drugs, shows some very promising results for improving prognosis and survival rates for patients with HER2 cancer. However, there is a small but real risk of heart damage and possible lung damage. Scientists are still studying how long women should take Herceptin for the greatest benefit. I am not ashamed to tell you that I hope their studies are successfully concluded soonest. I have a vested interest in this, as my tumour was HER-2 positive.

All in all, having made the decision to stay alive long enough to thoroughly embarrass my children, when the oncologist tells me that I must take one 2.5mg tablet of Letrozole each day for the next five years, I will do just that. Letrozole has side effects but I have decided that whatever they are, they have to be better than allowing the tumour to return.

Valerie Penny

After Radiotherapy

It is hard to imagine a treatment that only lasts a few seconds, minutes if you count the set up time, causing after effects.  Believe me when I tell you that it does.  There are side effects of any medical treatments, of course.  With radiotherapy these can be quite frightening.  There is some concern that after treating the brain (particularly if combined with chemotherapy) the patient may develop memory problems.

Radiation therapy works by damaging the DNA (genes) of tumour cells.  DNA damage stops tumour cells from dividing, growing and spreading.  Radiotherapy is a useful tool for treating cancer because cancer cells grow and divide more rapidly than most normal cells around them.  Although some normal cells are affected by radiation, most normal cells appear to recover more fully from the effects of radiation than do cancer cells. Radiation oncologists carefully limit the intensity of treatments and the area being treated so that the cancer will be affected more than the normal tissues.  This is why the set up for the treatment often lasts longer than the treatment itself.

Modern radiotherapy has advanced dramatically over the recent years.  It is now possible to focus radiotherapy with extreme precision. This allows the radiation dose to be targeted to the areas of tumour while sparing most adjacent normal tissues even in seemingly complicated and difficult parts of the body.

brain_lateral_adam

Radiotherapy affects different people to greater or lesser extents.  My friend Ismay, who is a real inspiration to me, is facing terminal cancer with and bravery that is awe-inspiring.  She found the radiotherapy to her head (to shrink a brain tumour) really difficult.  She was left with burns to her scalp.  Her hair that had grown back after chemotherapy, was lost again and the burns to her head made it impossible to wear her wig for weeks.  The pain and distress were hard to bear: but bear it she did. along with some forgetfulness, with her relentless courage and humour.

My treatment was to my right breast.  It was targeted to the area from which my tumour had been removed.  I had been told the radiotherapy would make me feel tired.  I had also been told the effect was cumulative. Unsurprisingly, me being me, when I felt no particular effects after the first dose or so, I felt I had beaten the system.  I had been told the cumulative effects would also include burning to my skin.  Again, initially, I deduced my skin was different to everybody else’s.  It is    not.  However, the effects do not kick in immediately, but do last a long time after the treatment has finished.  Radiation_breast

I have found the after effects of the radiotherapy quite depressing.  The burning under my breast was soothed by aqueous cream but the skin burnt and peeled the way it might with sunburn.  I am now six moths out after radiotherapy has finished.  The burns are healed but my breast still looks tanned compared to the other and I still find I get tired far faster than I expected this far on.  I still cannot walk as far as I used to.  One of my favourite hobbies is dancing, but I cannot dance for as long or as energetically as I did before my treatment.

I continue to find it difficult to concentrate for prolonged periods and the exhaustion is debilitating.  I was becoming increasingly upset about this and was speaking to my friend Margaret.  Margaret survived breast cancer and got her all clear about eighteen months ago.  She has been immensely supportive during my cancer journey.  The wonderful Margaret told me that, even yet, she gets bone tired sometimes.  It is not like the tiredness you feel after a busy day or a late night.  It is a wave of weariness that is all encompassing.  The big problem is it can arrive, unannounced, at any time.  So I have no confidence that, if I start a long or complicated task, I will have the energy to finish it.  This is what I find most exasperating.

However, the side effect that I had feared most was depression.  When the radiotherapy comes to an end, you come off the treatment merry-go-round.  All the attention stops and this can cause the depression the doctors and nurses warned me about.  I suppose when you have been using all your energies to defeat this disease, when it comes to an end so suddenly, it can result in an emotional vacuum.  I have mental health problems anyway and I really feared this problem.  I was lucky, it did not happen to me.  Other friends were not so lucky.  They did feel the sudden stop of treatment and attention left a void that led to depression.

Now I am at the stage where I get check up appointments with the consultant approximately every three months. Before I see the consultant I go to the hospital for an echo scan.  It is also called an echo-cardiogram is an ultrasound scan of the heart. It is sometimes just called an ‘ECHO’. Ultrasound is a very high-frequency sound that you cannot hear, but it can be emitted and detected by special machines. The scan can give accurate pictures of the heart muscle, the heart chambers, and structures within the heart such as the valves.  An ECHO can be carried out for many different reasons.   I have it done to check how well your heart is working after the radiotherapy and to look at how well the valves are moving inside the heart.   An ECHO can also help to see any fluid that may have collected around the heart.  So far my heart is holding up well.

I need to undress to the waist and lie on the couch. A probe is placed on my chest (it is a bit like a very thick blunt pen).   Also, lubricating jelly is put on the probe so it makes good contact with the skin.   The probe is connected by a wire to the ultrasound machine and monitor.   Pulses of ultrasound are sent from the probe through the skin towards your heart. The ultrasound waves then echo (‘bounce back’) from the heart and various structures in the heart.  They make a sort of swooshing noise.

featured-breast-cancer

The consultant also arranges for my blood to be checked to make sure my calcium and haemoglobin levels are high enough.  So far, so good.  This is especially important because for the next five years I require to take a medication known as letrozole.   Amongst the more common side effects of letrozole are hot flushes, hair loss, joint and bonepain, muscle pain, tiredness, unusual sweating, nausea, diarrhea, dizziness, and trouble sleeping.  I have certainly suffered the tiredness as well as the joint, bone and muscle pain.   I was told by other patients it should lessen after 8-10 months.  The doctors have not confirmed this!

So I have complained about my difficulties and honestly reported my progress.  I am aware that I am very lucky. The disease was diagnosed early after a mammogram.  The necessary surgery was carried out quickly.  I am to get another mammogram later this month to confirm that I continue to survive breast cancer now.

Valerie Penny

 

 

 

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