treatment side effects | My Eyes Are Up Here

Today, a “feminine hygiene product” fell out of my purse onto the passenger seat of my car. I looked at it like it was a space alien of sorts.

Why, do you ask? My last menstrual cycle was in 2012. I must be in menopause; I mean, it’s been over a year. Actually, it’s been over three years.

However, my menopause was chemically induced with Lupron injections as part of my breast cancer treatment. I had one cycle after the first injection and then no more. Lupron, incidentally, was not yet part of standard breast cancer treatment when I first started receiving my quarterly injections. It was, however, a part of standard treatment for prostate cancer. You see, Lupron disrupts the signal between the pituitary gland and whatever reproductive organ you might have. In the early days of the shots, there was always a photo of a man, “smiling Lupron man” on the box in which the Lupron syringe was contained. And yes, Lupron was also used with women to treat conditions associated with infertility but maybe the dose was different. I didn’t see women on those boxes in the early days. In time, it became more of a standard practice of treatment for hormone positive breast cancer.

Although I experienced intense and frequent hot flashes and night sweats as a result of jumping into menopause thanks to Lupron, I actually tolerated the treatment pretty well. Tolerating a treatment is pretty subjective. I experienced significant side effects, including up to 50 hot flashes a day, at one point, and disrupted, poor quality sleep. To me, it was a pain in the ass but a tolerable pain in the ass. And in time, the intensity and frequency of these side effects lessened somewhat.

I took my last Lupron shot in November of 2014. Each shot is effective for three months. And you know what? The effects of Lupron are not always permanent. I will turn 50 in November. I was experiencing peri-menopause when I was diagnosed with breast cancer at age 46. I was making my way to menopause. However, the path to menopause is quite variable. Peri-menopause can take years and years and years. During my last oncology appointment,

One of my colleagues has a book in her office called, Have You Started Yet? It’s a book for girls about puberty and periods. Remember that time? Not knowing when your cycles would start and hoping that you were neither the first nor the last?

For the record, I was 12. I was relieved. My body worked. I was not going to be left behind by my peers and be left out of the club of maturity. After about a year, began the monthly decent into menstruation Hell. Cramps worse than any labor pains I experienced in childbirth. (Knowing that labor pains were supposed to be 100 times worse than menstrual cramps, I asked for an epidural early and often until I got it. It kicked butt on pain.) The bleeding was horribly heavy, going on for 7-10 days, just like my mom. However, unlike my mom, my cycles were of irregular length, anywhere from 28-42 days. And then there was the nausea and vomiting.

This all improved enormously after pregnancy and childbirth. However, that was 20 years later! So losing my periods with Lupron was far and away the best cancer treatment side effect that I could hope for. Hurray! Yay! Yes, this change was also accompanied by facial hair and it becoming EVEN harder to maintain healthy weight. It still seemed like an awfully good deal to me!

I had my final Lupron shot in November. They last three months. During my last oncology appointment in the spring, Dr. Rinn said, “It could start back any time or not at all.”

So, just like a premenstrual 11 year-old girl, I keep supplies on hand, just in case.

I’ve written a couple of posts lately about how much things cost ranging from Botox to Lupron to high school year books. My last post was short, a bit flip, and on the humorous side. Shortly after I wrote it, I read this amazing post on Not Down or Out. I complimented Cheryl on her post and much to my surprise, she said it had been partially prompted by my “what things cost”-themed posts!

I’m not saying that I’m never deep because I know that’s not true. But I threw off those posts about costs and didn’t really think about them that deeply. So I started thinking about costs a bit more, relating them to my own cancer experience as well as of those about which I’ve read.

Breast cancer treatment costs a lot. We lose things we would have preferred to keep such as money, time, a sense of safety, taking our health for granted, relationships, a brain that works properly, and last but not least, body parts. We gain things we’d rather not have like nausea, fatigue, weight, neuropathy, hot flashes, aches and pains, and grief. Everybody’s experience is a bit different and for each individual, the experience can change over time.

Putting aside the fact in our lives as tainted test tubes, we don’t know for sure whether each ache or pain or other side effect is really due to cancer treatment. (Okay, I know some of them are pretty obvious, but generally speaking, we don’t always know.) But we do know our current day to day experience and what we like and don’t like about it. And a good number of things that we know about are costs of having cancer and having been treated for cancer.

What we don’t know are the costs of the roads we have not taken. Those of us who had surgery for DCIS will never know if left untreated, whether it would have become invasive or not. And those of use with early stage invasive cancer, don’t know what our outcomes would be if we’d foregone all or a portion of treatment. Finally, those of us with metastatic disease will never know if we chose the right balance between strategies to extend life verses those that preserve quality of life.

Instead, we must make decisions based on our understanding of research on assessment and treatment of our particular diseases, our other risk and protective factors, our personalities, what is important to each of us, and what is not important to each of us. And we must try to make well-reasoned decisions, accounting for all of these factors, while under incredible life stress. Not to mention the fact that we all have people who love us and depend on us. There are costs to family members and friends. As my friend Nancy says, “This disease has tentacles.”

And how many assessment and treatment decisions have each of us made in our experience with cancer? Tons, right? This means there are many paths not traveled. To really understand the costs of our decisions, we would need to be able to live many lives, each based on a different set of decisions.

We’ll never really know because each of us have just one life to live. I often write about my own decisions, “I made the best decisions I could based on the information I had at the time.” It may sound kind of nerdy but it frees me from a good deal of “what if” kind of thinking. I try not to dwell on the costs of the roads I didn’t take. I will never know what they are and to do so would have me walking in circles instead of pursuing the path I chose.