I Hope You Never Have to Make This Decision

Recovery from breast cancer treatment is complicated

I thought deciding to discontinue life support for my brother was hard. And it was. Even though we knew the liver failure and the cascading organ failure to follow pointed to one direction: Incompatibility with life. Death.

To continue life support or not was and is a decision I hope I never have to make again. The niggling possibility that maybe, just maaaaaaybe, he might recover made the difficulty even more acute.

But the doctor was clear. Brain activity was flat lining.

Dan drew his last breath just moments after removing the vent. It was a merciful ending to a life that was full of trauma and addiction. He was 47.

Since that time, I’ve often weighed the gravity of decisions compared to that gut wrenching choice.

Even the biggest, most pressing decisions we face daily shrink when compared to the “do we end life support” question. This has been a helpful tool for me when I wig out and get locked in a tail chasing pattern of indecision.

Chances are the decisions you are anguishing over will not result in someone’s death. Yes, some decisions have potential outcomes that require sobering consideration. But to put it crudely, even most of those decisions pale in the face of a “pulling the plug” decision.

I often said I wish to God that I or anyone else would never have to make that decision. (By the way, people, get your will and living will done. It will save your loved ones a mountain of grief.)

But now here I am facing a decision that could literally be life or death. I’m speaking a little dramatically. But trust me, the level of drama swirling about in my head cannot be understated. It’s fucking scary.

I hope you never have to face this. But my many of my sisters in the breast cancer community get it.

To take the hormone blockers or not.

That is the question.

It sounds innocuous enough. Just take a little pill once a day for 5–10 years and it will reduce the chances of recurrence significantly. I am not a statistics person at all, so my eyes glaze over when I hear numbers bandied about.

I asked my oncologist to break it down for me.

First, doing 4 rounds of chemotherapy reduced my risk for recurrence from 20% down to about 8–10%. This is over the course of 9 years.

That was a difficult decision, but I did it. Chemo is a hellish experience I would wish on no one but I knew it was short term.

The hormone blockers, she explained, will halve that 8–10% down to 4–5%. Sounds pretty good. I want to obliterate any estrogen seeking cancer cells right down to their malignant mitochondria. Take that, you asshole! No more estrogen for you! (I’m hearing that in the soup Nazi voice, btw.)

Even though cancers are wildly different with each person, there are enough similarities to predict which treatments are effective and which, not so much. (Shout out to the researchers who work tirelessly behind the scenes!)

The type of cancer I had was textbook: early stage Invasive Ductal Carcinoma, Estrogen positive, HER2 Negative, no lymph node involvement.

Treatment is also textbook. Off with the boobs, chemo and now a daily little pill.

And it’s that daily little pill that has me asking the question I hope you never have to entertain.

Do I continue taking this little pill?

Or stop knowing it increases my chances, however slightly, of recurrence? And I can almost hear my friends, who understand statistics, instruct me that this is a pretty big deal and it’s a no brainer to take the pills.

My oncologist would concur.

How would my future self feel if I discontinued and had a recurrence? One thing I have learned so far is that breast cancer usually doesn’t kill the first time around if it’s the garden variety like I had.

It’s the recurrence where things can get deadly. (Note however, treatment options for metastatic breast cancer are increasingly more effective at extending life.)

I don’t want to be making blanket statements here because every woman is different. Everyone responds to treatment differently.

I’m just trying to focus on ME.

Why oh why, you may ask, why I am perseverating on this question. Just take the damn pill, Theresa.

The side effects seem innocuous enough. Muscle, joint pain, GI issues, fatigue, etc.

As a former nurse, I know side effects are deemed as a necessary evil. With the healing effects, come side effects. Doctors deem the benefit of the drug far outweighs its liabilities.

I get it. Short course of antibiotics, eat yogurt. Anti-depressants-give it six weeks, side effects will fade. High blood pressure meds often need to be adjusted to find the right effectiveness with minimal side effects.

But my doctor is proposing 5–7 years. That’s a helluva amount of sustained side effects for a very long time.

She gave me a drug holiday after I told her that the pain levels have been unrelenting. My face looks like a pizza if I’m not diligent slathering on rosacea gel morning and night. I’m having trouble pulling on my jacket because of the shoulder pain.

Then there’s the melancholia/depression. A chunk of this is because of the hell I’ve been through the past few years. But the added weight of this medication makes it even more of a slog.

Some women have told me after a few months, the side effects fade into oblivion. I am hoping this is the case for me.

The doc started me on a different hormone blocker that I’ve been on for a month and let me tell you….it sucks. It’s just as awful as the first one I tried.

She tells me the next step would be to add another medication to mitigate the depression and constant aches and pains.

Great. Another drug. More side effects.

Or… we can try tamoxifen. Not the first choice for my situation. But still effective at preventing recurrence.

But at what cost? Throwing a blood clot? (One of its potential side effects among the others.)

What about the weight gain and my cholesterol which is creeping upward? What does this do to my risk of a heart attack? Heart attacks still kill far more women over 50 than cancer.

I am concerned that taking this drug brings side effects that will impact my ability to support myself.

I am concerned that not taking the drugs could eventually make it a moot point to support myself if I’m like, you know, dead.

Right now, my course of action is to hunker in and take the new prescription for another month. I will try some supplements other gals have found helpful (after first checking with my doctor), like tart cherry capsules.

They say exercise is a huge component in managing side effects, but how do you keep up the exercise when you can’t walk without a limp and a half hour swim unleashes agony in your shoulders?

But I will keep heading to the gym and reminding myself that all I need to right now is baby step.

I meet with my oncologist the end of January at which time I will have made my decision to continue or not.

Is the reduced risk of recurrence worth the diminished quality of life?

It may appear to be a no-brainer for you if you are not facing the decision. But trust me, it’s not as cut and dried as the side effects list would lead you to believe.

And I fervently hope it’s a decision you will never have to face.

Thanks so much for reading. You can find me around the internet at www.theresawinn.com, on Facebook, LinkedIn and Instagram. If you’d like to support my writing in a small way, feel free to contribute to my wishlist. (Right now it’s a one year subscription to Canva.)