Friday, April 17, 2009

TAMOXIFEN OR NOT??


It was my second visit to the oncologist, Dr Deven Moodley, today.

The aim of the discussion was to establish whether or not I should start taking Tamoxifen.

I decided about a month ago not to do chemo and now I need to think about long term treatment to reduce my estrogen levels.

I had specific questions that I wanted answered. If Deven had better answers than mine, I would consider his treatment protocol.

His plan was that I would take Tamoxifen for 5yrs. Tamoxifen blocks estrogen receptors on all estrogen sensitive tissue, as well as breast cancer cells that are either still in the breast area or have moved to other parts of the body.

Estrogen stimulates cell division of estrogen sensitive cells so blocking estrogen reduces breast cancer cell division.

Once the cells are not getting any estrogen, they send a message to the brain saying 'We are not getting estrogen so make some more'.

The body then makes more estrogen and after 2 years of taking Tamoxifen, a woman usually has very high levels of estrogen circulating in the blood that can cause blood clots, osteoporosis, and uterine cancer.

After 5 yrs of being on the drug, the risks out way the benefits, so it is advised that women stop taking it.

There is a large study that has been going for about 12 years where researchers have followed the same group of women (about 700 odd) with all the variations of breast cancer, and various allopathic forms of treatment (NSABP).

From the study, it can be seen that there is a 'decrease in breast cancer recurrence' benefit that increases from year 1 to year 5 of taking Tamoxifen.

However, if a women dies from a side effect of Tamoxifen, ie. other than breast cancer, she falls off the study. If she gets healthy enough to prevent a recurrence, she also falls off the study.

My questions to Deven were the following:

HEIDI: I am 35 yrs old now. I have not been through menopause. After 5yrs on Tamoxifen, I have to stop taking Tamoxifen. I will then be 40yrs old. If, and when, my ovaries start up again, they may still produce significant amounts of estrogen. I may only go through menopause at 45yrs old ie. 5 years after stopping Tamoxifen. What was Deven's plan for after 5yrs on Tamoxifen?

DEVEN: The plan was to induce early menopause now with Tamoxifen to block estrogen receptors and another drug to stop my ovaries producing estrogen. After 5yrs, he would just reverse this state to prevent any long term side effects of the drugs. He did not have a plan beyond that - I would be on my own.

HEIDI: So if breast cancer did not get me in the next 5-10 yrs, a side effect of Tamoxifen or playing with my endocrine system, very well may.

HEIDI: If I took the Tamoxifen, would Deven monitor my estrogen levels using saliva, blood, and urine tests during the 5 yr period?

DEVEN: No, he would not do any tests at all, not even blood tests - he would only treat side effects of the drugs.

HEIDI: During this 5 yrs, and after I have stopped taking the Tamoxifen, how would Deven detect a metastasis?

DEVEN: He would not scan for metastasis periodically (thereby detecting any early on) - he would wait until I got symptoms (which is usually quite late).

HEIDI: I asked Deven whether he would be willing to review my periodic saliva, blood, and urine tests done by Dr Craige Golding over the next year while I tried more natural treatments? Could Deven tell me whether there were any warning signs I should be altered to?

DEVEN: He agreed to this.

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I left Deven's office in a better state than when I went in. I decided not take Tamoxifen, at least not for the next year.

I want to try more natural treatments first - ones that build up my immune system, block estrogen receptors naturally, aid the breakdown of strong estrogen to weak estrogen in my liver, and that reduce my cortisol levels and bring me back from a state of burnout.

Even if I had however long left to live, I don't want to live my life enduring side effects of a drug that does not have all the answers.

Thursday, April 16, 2009

3rd SALINE FILL




My plastic surgeon, Gareth Edwards, injected some more saline into my breast tissue expanders again today.

This was my 3rd saline fill. I was going every 10 days and can now go every week because the scar and surrounding tissue has healed well after surgery and so can now be stretched more.

I am seeing the oncologist, Deven Moodley, again tomorrow to discuss Tamoxifen some more.

Gareth is concerned that a breast cancer cell has strayed to somewhere else in the body. These cells still operate like breast cells so are still stimulated to grow by estrogen.

I will say this again: the breast surgery was a walk in the park compared to the decisions and years ahead.

Gareth is concerned that because I am still only 35 yrs old and so have normal / higher than normal / unopposed (by progesterone) estrogen, these breast cells can be stimulated to grow and the chance of a recurrence could be higher or sooner than someone postmenopause with the same diagnosis.

He does have a point so I am going to investigate some more before making my final decision. One can only take Tamoxifen for 5 yrs. I will then be 40yrs old. I may still not fully be postmenopausal by then so what is Deven's back up plan?

I am studying the intergrative medicine course nightly - it is fascinating! the first module is on the endocrine system.

I am learning all about natural ways to help prevent breast cancer and treatment protocols post diagnosis. I am still waiting for adaquate research trials from the USA that show where natural protocols have showed compariable results compared to Tamoxifen etc.

The manufacturers of Tamoxifen just have so much data because they stand to make so much money from their drug if it is shown to work in any way. I am still furiously searching the natural side though!

What I found that is most interesting is that women without breast cancer can have their estrogen and progesterone levels tested using saliva, blood and urine tests.

If the woman's progesterone is low, which can happen towards menopause (can even start in early 30's), her estrogen then becomes unopposed, even if it too is low.

Estrogen causes breast cells to grow and divide. Progesterone halts their growth. So both hormones work together to keep a balance and keep cells dividing at a normal rate.

When progesterone is low, estrogen is then unopposed and it's cell growth effect continues unchecked by progesterone. The risk for breast cancer then rises.

Women could have their hormones tested as early as in their 20's or 30's and start to take bioidentical progesterone (tabs or creasm depending on person's symptoms) and this could help lower their breast cancer risk!

What is even more interesting is how stress increases the risk of breast cancer. As a woman's stress levels rise so does her cortisol (stress hormone) levels. Cortisol, among other things, suppresses her immune system (the very system supposed to detect cancer cells) and it reduces her progesterone (leaving her estrogen unopposed)!

Finding ways to reduce stress levels is esential in prevention and treatment of breast cancer.

LiveHeidi

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