Playing Chicken With Cancer, Part 1

80’S CANCER JAM OF THE DAY:

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth;

I’ve been reminded of this, my favorite poem, several times over the past few days as I wrestle with the decision of whether or not to take bioidentical hormones. I know, you’re thinking at this point that I’ve finally lost my mind. After all, I just finished treatment in December for a cancer that was 95% positive for both estrogen and progesterone receptors. Do I have a death wish?

Quite the contrary. I have a life wish, a desire for a full, vibrant life. For those who have been down the path of being suddenly and completely thrown into a premature hormonal black hole from the effects of chemotherapy, you can attest to the fact that it takes away something of your essence. You may not be a raving lunatic, but the light in your soul is dimmed.

Of course, some will fare better than others, but it nevertheless leaves you forever changed from the person you were before. Last June, I was a young woman with a regular (albeit overzealous) menstrual cycle; fertility was a stretch, but still within sight. Boom! In July, I was menopausal, my ovaries poisoned and relegated to the role of dusty internal decorations.

Now, if you are diagnosed with cancer in your 60’s, as most women are, hopefully you have been allowed to gracefully cross over the threshold of menopause, and perhaps some of the hormonal side effects of chemo are less pronounced. But at 45, or God forbid 30, like some of my blogging sisters, you are asked to live like a woman 20 or 30 years your senior and just be grateful to be alive at all.

To add insult to injury, the final step in breast cancer treatment is often Tamoxifen, Femara, or one of their ugly step-sisters. These drugs eliminate whatever poor, lonely molecule of estrogen that might remain in your body, trying desperately to hang on. The side effects of these drugs can include: joint pain (post-menopausal arthritis), mood swings, weight gain, cognitive impairment, depression, uterine cancer, osteoporosis, heart problems, etc. If you complain to your doctor, you’re likely to get a pat on the shoulder and a prescription for pain meds and anti-depressants.

I understand the thinking in the medical community that IF estrogen drives breast cancer, the best course of treatment is to eliminate the offending substance, thereby creating a “cure”. What puzzles me is that there are a few chinks in this hypothesis. First, the times in a woman’s life where she has the highest level of hormones, i.e. pregnancy and in her late teens/early 20’s, also happen to be the times with the lowest incidence of breast cancer. You are much more likely to be diagnosed in your 60’s or 70’s, when estrogen levels have been low for some time.

Also, I see all around me women on these blogs who have towed the party line, done the chemo, radiation, and estrogen-blocking drugs, only to see the cancer recur in a more aggressive, or metastatic form. Sometimes it works, sometimes not, which would lead me to believe that cancer is a multi-factorial disease which can’t be watered down to a simple “kill the estrogen” approach.

I wrote about the work of Dr. Jonathan Wright, the doctor for Suzanne Somers, in this post. Dr. Wright is the pioneer of bioidentical hormones in this country, and he has had Suzanne on them since her breast cancer diagnosis over 10 years ago. He believes that estrogen (in it’s natural form and when properly balanced) does not cause breast cancer and may help prevent it.

He uses a formula made of a small fraction of estradiol (the aggressive estrogen), and a large fraction of estriol (a weaker protective estrogen). He believes that the estriol acts as a sort of Tamoxifen, attaching to beta receptors on the cell, which actually discourages cell growth and proliferation. He then balances the formula with progesterone and other hormones as needed.

I’ve read his book, and it makes a lot of sense. But, being me, I feel more comfortable consulting with someone who is knowledgeable and respected in his field, so I had an appointment this week with an integrative MD. Yes, I’ve been down this road before, but the previous guy I saw, while a lovely person, didn’t project the confidence that I need to see in such a serious matter. I don’t mean this to sound arrogant, but most of the time I leave a doctor’s office feeling like I know more than he does about nutrition, supplements, and the relevant research that’s out there. I want to be wowed.

I spent 3 hours at the new doctor’s office on Tuesday. Good start. For the first hour, I sat with the nurse as she took a detailed history and listened to my issues. She then gave the doc a synopsis while I had vitals taken. The next hour was spent with the doctor, going over his thoughts on my case and his recommendations. He told me right off the bat that he is not an oncologist and he wants me to be monitored by my own doctor. He also said that while he is an MD, he would be offering things that no mainstream doctor is willing to do, often at the risk of being attacked by the medical board.

I appreciated his honesty and his willingness to step “out of line” in spite of the repercussions. It was clear that he must have tangled with oncologists before, as he included in my packet a “Dear Medical Oncologist” letter that he had written in response to an angry doctor who challenged his use of hormones in a breast cancer patient.

He wasn’t the kind of warm and fuzzy that I prefer, and I actually put off going to him because I had heard that he is very arrogant. In truth, he is not so much arrogant as confident and efficient. He stared at me intently as he laid out his plans in a no-nonsense fashion. I scanned his eyes for signs of hesitation or self-doubt as he spoke. I saw none. I asked tough questions. He answered them, sometimes in a surprising way.

So what did the doctor suggest as the next move in this high-stakes chess game? Stay tuned tomorrow for the results of my visit and my decision.