Saturday, July 11, 2009

4 Years and 361 Days To Go...

So I met with my regular cancer doctor almost two weeks ago. I haven't updated lately because I, truthfully, have been kind of lazy about it. Sorry.

Anyway, I met with my regular oncologist down at the new UH Ireland Cancer Center down at Chagrin Highlands. My regular oncologist is a woman named Dr. Lois Teston. She's an attractive woman in her mid to late 40's who DOESN'T scare me... unlike Dr. Persons. (Actually, Dr. Persons doesn't really scare me. It's just that she has a low tolerance for my shenanigans and - apparently - a very odd and somewhat vestigial sense of humor. She just doesn't know what to do with me. )

Dr. Teston did a full history of me and my family, or at least as much as I could tell her. I actually haven't spoken to anybody from my mother's side of the family in close to 20 years. There's various reasons for that, but mainly because my mother distanced herself from them and, by extension, so did myself and my sister.

I do know that my maternal grandfather died of heart problems and complications from diabetes. He was a good man who helped pay for some of my college, took me on camping and fishing trips to Thunder Bay in northern Ontario, had a cattle farm in West Virginia where I used to ride horses, and traveled the country. He traveled because he was an engineer who designed the majority of the nuclear plants in North America. He also loved whiskey and developed an Irish brogue when he'd had too much. My maternal grandmother died of heart problems when I was six.

So I have my mom tracking down info on her side of the family.

As for my dad's,the only cancer was with my grandfather. He had stomach, intestinal, and liver cancer and died the weekend of my senior prom. His death was undoubtedly drinking related. Besides that though... the only issue my dad's side has is colon problems. No cancer, just the occasional diverticulitis.

And that's the most confusing thing. There's no reason I should have gotten male breast cancer. In fact, it's even more mysterious because I'm so young. The oncologist said, in fact, that she's had only about 10 to 15 or so cases of male breast cancer in her 20 year career... and the youngest patient prior to myself was 58.

She honestly admitted to having no idea why I, being 20 years younger than that, should have breast cancer. In fact, she admitted at our consult that she had no idea what to do with me. She said she'd need to consult with several other doctors before deciding on a course of treatment.

She was stumped.

So, in lieu of that, she decided that she would follow the regular course she would with any other woman. (At this point, I of course rolled my eyes with manly irritation and growled with undisguised masculine aggression. You know, just like every other time I've been told this throughout this entire frikking ordeal.)

The usual course of treatment means no chemo and no radiation (wOOt!), but it does mean a five year course of a drug called Tamoxifen. But before I started it, she wanted me to get an ultrasound because, as I've mentioned a few times, I have a bad liver.

And Tamoxifen, being a hormone regulator, is processed through the liver.

So she sent me to get an ultrasound of my liver to make sure it's all right and not spontaneously combusting because I've, truthfully, taken to having a few more beers during a week than I normally have been. What can I say, I've been a little stressed.

I actually had a liver biopsy back in 2006 because, in the course of having some regular blood work, my liver function showedd up on the tests like I was in the midst of full blown cirrhosis. The biopsy determined that my liver was clean and pink, just a little bit crazy with its enzyme function. You can read more about that wondrous experience here.

Anyway, I've been really good about not drinking because; a) it was - in my eyes - chiefly responsible for my grandfather's death, hence there's a genetic component not to be trifled with b) I had to get a liver biopsy and, since that sucked ass and I DIDN'T want to get another, it was in my best interest to curb my drinking, and finally- and most importantly, c) Michelle rides my ass about it endlessly because of some nonsense about "wanting me around when she's old and not dead of acute liver failure"... or some nonsense like that.

But, this summer's been a little different. I had a month off and I spent the latter part of that month on my front porch with the wife every night at dusk, having a beer or two. I've grown accustomed to it and we both enjoy watching the kids play in the growing gloom, amidst the fairy twinkle of fireflies. And a beer tastes good then, you know?

So it was with some dread that I went to the ultrasound (which is FREE at this point! We've been getting the panoply of bills from University Hospitals and, at the last estimate, we are somewhere in the neighborhood of $45,000 at this point. Or, another way to look at it is -- each of my flabby man-teats cost me roughly $22,500 each. Were Jayne Mansfield's worth that much? Hell, were Jayne Cobb's? But I digress...)

What I found odd was that I've actually grown accustomed to the waiting rooms, and examinations, and - if they needed to - I'm sure I'd have been like, "Meh." if they needed to hit me with a needle. Like I said, you quickly grow accustomed to the invasive indignity of the institutional medical system and I endured my ultrasound because it was real low - almost non-existent in fact - on the medical discomfort scale.

The only thing that was almost unbearable was the endless chatter of the ultrasound tech. I'm quickly finding that women want to do nothing but talk about all the other women they know with breast cancer and how HORRIBLE it was for them. And I feel somewhat bad saying, "Yeah. that's tough that she got stage three, lost her boobs, and died anyway. By the way, I'm cured."

I think I'm starting to get that I'm part of some strange, scarred, boobless tribe... but I'm still an outsider. I remembered reading about the animosity some male breast cancer survivors experienced from women who felt like this was "their disease" or "their cause". Now I think I truly understand that.

So I went through the ultrasound and got a call back from my doctor 4 days ago.

My liver was fine and, as Dr. Teston said, just "fatty". A direct consequence of modern living and modern diets. Since my love of frothy adult beverages - thankfully - wasn't a problem, she gave me the green light to start the Taomxifen. I filled the prescription and I'm now officially four days into my 5 year course.

Tamoxifen, by the way, is a hormone blocker. I got breast cancer because somewhere in my body (most likely my liver), something was transforming hormones into estrogen. Estrogen goes to the tits and, in men, we get gynecomastia. My gynecomastia and the increased estrogen somehow gave me breast cancer. Tamoxifen blocks the development of estrogen and blocks the receptors for it in my cells. It's really effective, and increases five year survivability rates into almost double digits.

One of the bad parts of Tamoxifen is that it increases the likelihood of blood clots, so I've got to worry about loss of vision, slurred speech, or unilateral loss of motor control. that's right, folks! I've now got an increased risk of stroke and/or embolism. Yay!!! I also, because it's a hormone regulator, now get to share with the feminine gender of the species the wonder and the joy that is hot flashes. I haven't gotten any yet, (of course it's been like 90 degrees here in Cleveland for a week, so I'd have no idea whether or not I was having them anyway) but there's like an 80% chance.

But there are some disturbing side effects I am much more concerned about. They were in big, red letters and the literature made a point of making the side effects really, really, dangerously clear.

I'll quote them from the side effect warning I received with my first dose...

Possible Side Effects of Tamoxifen may include:
- Vaginal Discharge
- Irregular Menstrual Periods
- Vaginal Bleeding
- Ovarian Cysts
- Increased Occurrence and Likelihood of Uterine Cancer

What do you think? Should I be worried?