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October 30, 2023

Hormone therapy

This might be the last Gory Details, my friends. With the acute phase of cancer care in the rear view mirror, I'm starting to turn my focus back to "real life" and feel like I have less to say about the cancer experience. Also these last few updates are starting to feel more like whinging and naval-gazing rather than storytelling, which I think means it's probably best to wrap it up.

Let's see, where did we leave off? Radiation finished up almost a month ago, and the side effects have largely come and gone. Some of the more dire predictions don't seem to have come true -- there was certainly about two weeks of skin irritation and sloughing*, but no real lingering effects outside a patch of persistently dry skin on my collarbone. I'm thinking vague thoughts about getting a little tattoo -- a bit of blackberry bramble, maybe.

My hair is properly starting to re-grow, to the point where I could probably use a haircut, so that's scheduled for this Wednesday. Today I had the 6-month follow-up ultrasound to check the little fibroadenoma they found in the MRI in the spring -- still looks small and cryptic and like a fibroadenoma, so that's great. I also met with my oncologist today one more time.

So now we're on to the five-year plan. A week ago I started tamoxifen, which is a daily pill that functions as an estrogen receptor blocker. It also comes with some side effects -- mainly hot flashes and night sweats -- as well as a slight increased risk of blood clots. Tamoxifen alone is supposed to reduce my risk of a recurrence by about half (on top of chemotherapy which reduces risk by about one third). Today's visit with the doctor was to discuss adding a second drug to the regimen for two years: the unpronounceable abemaciclib, which is a bit imperfectly characterized, but has at least one study that suggests it may reduce my risk by another 4%. So from a starting point of about 25% chance of recurrence, all these treatments together knock it down to something like 4-5%. This drug comes with a couple additional fun surprises -- it can knock down your white blood cells count, so you have to get monthly bloodwork to monitor that situation and adjust the dose accordingly. It also frequently comes with (drumroll) our favorite friend, diarrhea. Whee.

Better than more cancer, though.

I think this is the phase of the journey where I'm supposed to have something meditative and wise to say, to leave you with some sense of closure. But I'm pretty tired tonight, so I might just let this one go out with a whimper instead of a bang. Thanks for coming along on this ride with me. It's been real.


*[TMI WARNING] There was a really gross week or so when the underboob and nipple basically peeled off in big gummy patches... I'm very glad that's over! 😬

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