Next month will mark two years since my doctor found a lump in my breast during a routine exam. Given that I had a clean mammogram and sonogram 9 months before, exercise vigorously nearly every day, am not overweight, eat tons of fruits and vegetables and have no family history of breast cancer, the revelation was stunning. Duh. When isn’t it?
I’ve since learned that my maternal grandfather’s prostate cancer (a form of hormonal cancer, like breast cancer) may have elevated my risk. Having particularly dense breast tissue, not having children and taking birth control pills also may have played a role. Other studies show that women with vitamin D and Folic acid deficiencies and women who drink more than 2-3 alcoholic drinks a week can also up their chances. But since it is estimated that one out of every 7 women will get breast cancer, pretty much just being a woman is a risk. Sorry to be such a downer. But there is good news, as I’m sure you’ve heard. There is a much higher success rate in detecting and treating the disease than ever before. And I know this is due in no small part to the magnificent (and I mean truly magnificent) Evelyn Lauder and her tireless and phenomenal work with the Breast Cancer Research Foundation. And how's this for making lemonade out of lemons: With so many women experiencing it, there is now a treasure-trove of info. to help us get through the ordeal with more dignity, comfort, and peace of mind than was previously imaginable.
So in honor of Breast Cancer Awareness Month, here are the tips, tricks and products that made breast cancer slightly less of a pain in the ass for me, plus one that didn’t.
Best Advice: Don’t surf the net after diagnosis
Boy, did my surgeon have my number (I guess I’m not all that unique). After we discussed my course of treatment and probable outcome, she strongly advised me to steer clear of the internet and most books written about breast cancer. The reason? Many sites and books paint the worst-case scenarios, which can provoke crippling fear and anxiety. Like I didn’t have enough already? She did give me a big binder of of explanations, resources and tips compiled by California Pacific Medical Center, where I got my treatment. I chose not to look at it. And I have to say, that as crazy, neurotic and anxious as I am, I experienced far less emotional turmoil than some of my more investigative friends. Granted, my diagnosis and proposed treatments were very straightforward—pretty much the norm for stage 1 breast cancer with a low risk of recurrence and negative tests for BRCA genes. My agreed plan of attack was a lumpectomy, sentinel lymph node biopsy, two months of five days a week radiation and a five-year course of Tamoxifen—standard operating procedure. If things had been more complicated and extreme, I would have definitely done more research and gotten second opinions.
Most Important Part of Recovery: Acupuncture
I’ve written before about how acupuncture gave me my life back in terms of helping me finally recover from the aftermath of radiation (extreme fatigue, lethargy, depression, pain and swelling (aka lymphedema) for over a year after I concluded treatment) and managing my side effects from Tamoxifen (extreme fatigue, lethargy, depression, leg and feet cramps, weight gain and insomnia, to name a few). Acupuncture helped with all these symptoms, even mitigating my advanced arthritis, and I think made me slightly less neurotic, though my husband might argue that point.
Unfortunately, the Tamoxifen is so toxic to my system, I need to be stuck with needles every other week to maintain and hopefully advance acupuncture’s salubrious effects. And I simply loathe it. The other patients are on beds in other parts of the room thinking serene thoughts or blissfully snoring away. Meanwhile, I’m lying on the table hating their guts trying to soothe myself with the Allman Brothers Band on my IPOD so I don’t jump off the table and murder at least one of them. How Zen. But believe it or not, my one regret is that I didn’t start treatment sooner. A friend of mine who basically sailed through radiation did acupuncture concurrently. She might have had that outcome anyway—everyone responds differently to cancer and cancer treatments. And this is a great tidbit so I’ll repeat it, “Everyone responds differently to cancer and cancer treatments.” But given the myriad benefits acupuncture seems to impart, I can’t help but believe it might have made radiation a less grueling experience.
Most Flattering Sports Bra: Anita Maximum Control Momentum Wire-Free Sports Bra, $69 (barenecessities.com).
Typically, I’m a Champion Powersleek Sportsbra girl, $46 (champion.com). It’s a heavy duty number that can withstand high-impact activity with an adjustable back and straps —crucial features for small-across-the-back, large-across-the-front me. And these bras, which are rather roomy and customizable, were fabulous post-surgery at accommodating my dressing and swelling without adding to my discomfort. They’re also great at fitting compression pads, which I need at night as a result of the lymphedema. But these bras are completely unglamorous and bulky under clothes. So when the swelling went down and the dressing was gone, but the prospect of my regular underwire bras sent waves of terror down my spine, I switched to the more streamlined, also adjustable Anita style. It’s sleek, virtually invisible and gives a terrific shape.
Magic Tricks: Coping With Needles
Given how traumatized I am by acupuncture, it probably won’t surprise you that getting my blood drawn used to totally freak me out. And it doesn’t help that I have crappy veins. (I know. I know. I am such a baby!) Now that I am an old hat at it, it’s certainly less scary than it used to be, and I credit a super-kind phlebotomist for making the process almost a snap. He suggested drinking a lot of water and staying really warm prior to the test to help optimize circulation. Dehydration and being cold can all impede it. He noted that the better circulation is, the easier it is to find a vein and actually get blood from it. He also introduced me to the Butterfly Needle, a smaller, thinner number that works better on veins that like to roll over when they’re poked than the standard variety. When he’s not my guy, I always ask for that needle specifically and it makes a huge difference.
Dumbest Move: Hopping on the Lifecycle two days post surgery
A well-meaning friend told my husband that it was really important that I get moving as soon as possible after surgery. And exercise bulimic that I am (“I’m not going to lie around and get fat just because I’m recovering from breast cancer surgery”), I seized upon this advice and went to the gym to peddle furiously on the bike for 45 minutes. The result? I felt faint, nauseous and experienced excruciating pain in my breast. I actually almost passed out in the shower afterwards. From what I understand, there are several types of surgeries where the experts like you to walk and maybe even get on a treadmill almost immediately following surgery. Walking, not intense cycling, being the operative directive here. But breast cancer surgery, at least in my case, is not one of those instances. In fact, when my surgeon called me later that day to check in and deliver my pathology report and I told her of my athletic adventures, her response was, “Really, Cara? I mean, really? I think I’ve been crediting you with having far more IQ points than you actually have.” Ouch.
Not to sound superficia, but what the heck? To me, one of the biggest bummers about cancer is that you just don’t look like yourself for what seems like an interminable amount of time. And I didn’t even have chemo so I can only imagine how one feels going through those dramatic changes and acute side-effects, which are typically far more extreme than anything I experienced. I realize what a lucky girl I am. But even without it, I was just shocked to see the reflection staring back at me in the mirror. And even two years later, I don’t really feel like I’m “back.” Perhaps, because of the Tamoxifen? No one can really ‘splain it to me. Anyhow, here are some products that really seem to make a difference.
Aveeno Skin Relief Moisturizing Lotion, Fragrance Free, $9.49 (ulta.com): I found it to be the least greasy, fastest absorbing, least stinky and most comfortable lotion to combat the “sunburn,” and extreme flaking from radiation. My radiologist recommend Aquaphor, which I love for my lips but it was just too unctuous for such a large area and under clothes.
Vaniqa, $90 (by prescription): A godsend for Tamoxifen-induced chin hairs, http://www.carakagan.com/post/2012/07/10/Vaniqa-It-isnt-sexy-But-it-works.aspx
Nioxin Hair System: Successfully manages Tamoxifen-caused hair-thinning, $37.50,(sleekhair.com), http://www.carakagan.com/post/2012/04/16/Hair-There-and-Everywhere.aspx.
Bobbi Brown Extra SPF 25 Tinted Moisturizing Balm, $52 (bobbibrowncosmetics.com): Lightweight yet luscious and emollient, this imperceptible cream foundation evens out skin tone and adds just a little bit of a glow.
MAC Fast Response Eye Cream, $30, (nordstrom.com): The only de-puffing eye cream I know that doesn’t dehydrate skin and emphasize crows’ feet.
Nars Bronzer in Laguna, $34; Nars Blush in Amour, $28 (sephora.com): This brownish bronzer shot with gold shimmer topped with the peachy pink blush really enliven the complexion, imparting a fresh, healthy color and radiance.
Nars Matte Velvet Lip Pencil, $24 and Nars Lip Gloss, $24, both in Dolce Vida (sephora.com): The pencil delivers a precise, comfortable application of stay-put color with just the right amount of coverage—not too sheer, not too opaque. The gloss lends extra moisture and a sexy sheen. Dolce Vida, a medium-bright dusty rose, looks like my natural lip color turned up a notch or too. Pretty.
Dr. Dennis Gross Age Erase Recovery Mask, $48 (dgskincare.com): This mask is messy, drips and tastes terrible when it gets into your mouth, which it almost always does. But it’s well worth it. No matter how drawn, pale, exhausted and miserable I look, this mask always makes me look better. Always.
Ciao for now my friends. Stay happy and healthy and get your mammogram!
Now that I’ve got your attention…brace yourself boys and girls because I am going to talk about the Big C. So I may have mentioned once or twice that I had breast cancer last year. And it was and still is a huge pain in the ass. BTW, I do know that if the worst thing I can say about my cancer is that it’s a pain in the ass, I am a very lucky girl. And I am; my cancer was stage 1 and I only needed a lumpectomy, which went off without a hitch. I was also lucky enough to miss out on chemo. My treatment consisted of 7 weeks of daily radiation. And since my cancer was estrogen-positive, I am now on the anti-cancer drug, Tamoxifen, an estrogen-suppressant, which, when taken for five years, can reduce the risk of reoccurrence by 50%.
The thing is, radiation and Tamoxifen suck and no one really prepares you for how loudly they do. After just three days of radiation, my breast swelled up to epic proportions, got unbelievably sore and painful, completely sunburned and started to blister and flake like mad. The worst part, though, is the fatigue. I absolutely never knew that you could be that bone tired. I was so tired that I had to rest on every step leading down (forget about walking up) to the treatment center and sleep three hours every afternoon. I was told that these symptoms would clear up three months after treatment. They did not. While no one could really explain the lingering fatigue (two-hour long afternoon naps are a necessity), the pain and swelling was due to a condition called Lymphedema. Basically, the radiation compromised my lymphatic system, and quite possibly my nervous system, so the breast was no longer able to “drain.” Lymphedema more regularly occurs in the arms of breast cancer patients who’ve had lymph nodes removed. But it can happen in the breast, too.
I started wearing compression pads in a sports bra every night and embarked on daily lymphatic drainage treatments. They’re basically light, kind of creepy massages that are supposed to coax the body to open up other lymph channels to re-route the lymph out of the breast. But unfortunately, the treatments didn’t make all that big a difference, and the multi-hour-a-day commitment became a huge time suck. So a full year after I completed radiation, I had made very little progress. The affected breast was still a full cup-size larger than the untreated one and hurt like hell most of the time. I consulted with several doctors to see if the issue could be surgically corrected. All of them shook their heads, seemingly flummoxed by my condition, and noted that when the tissue is severely compromised from radiation, surgery is never an option because of bleeding issues and complications with healing. Not comforting.
The Many Joys of Tamoxifen
Now, let’s add Tamoxifen into the mix. The manufacturer lists the following “common” side-effects:
- bone pain
- hot flashes
- muscle pain
- weight loss
The last side-effect made me laugh! “Weight Gain” is more like it. Everyone I know has gained weight on Tamoxifen, and it is completely crazy-making because it is nearly impossible to control.
But wait there’s more! According to Tamoxifen’s manufacturer, you may also experience severe allergic reactions (rash, hives, itching, difficulty breathing, tightness in the chest, swelling of the mouth, face, lips, or tongue, and unexplained hoarseness); abnormal menstrual periods; chest pain; coughing up blood; decreased sexual desire or ability; depression; fever, chills, or persistent sore throat; groin or pelvic pain or pressure; loss of appetite; loss of balance or coordination; missed menstrual period; new or increased breast tumor or pain; new or unusual lumps; one-sided weakness; pain or swelling in one or both legs; red, swollen, blistered, or peeling skin; severe or persistent tiredness or weakness; shortness of breath; skin changes; stomach pain; sudden severe headache; swelling of the arms or the legs; unusual bleeding or bruising; vision or speech problems; yellowing of the eyes or skin.
Patients also report: sleeplessness, crippling nocturnal leg and feet cramps, thinning hair and chin hairs. Tamoxifen isn’t exactly a party in a pill. And after being on it for nearly eight months, roughly the time it takes for the full gamut of symptoms and weight gain to set in, the prospect of taking it for the recommended five years has many women--including myself--totally freaking out, because it just makes you look and feel like crap all of the time.
I am writing about all of this now—when it’s not even Breast Cancer Awareness month--because about five weeks ago, I started to get better—dramatically better, as in I ran six flights of stairs with my trainer better. And I am almost 100% sure that the reason is the weekly acupuncture sessions of I’ve been getting at the Alta Bates Cancer Treatment Center in Berkeley with Dr. Amy Matecki. Now I am not “alternative,” “ayurvedic” or holistic in the least. Bacon and diet coke are my favorite food groups, meditating gives me panic attacks and I am a total wuss about needles. In fact, I had a consultation with Dr. Mateki last year in the hopes of alleviating my fatigue, but chickened out when it came time to schedule an actual session out of sheer terror. But desperation is the mother of invention—not necessity, it turns out. So I found myself back in her office at the end of this March.
I had heard somewhere (Where?) that acupuncture needles are as thin as cats’ whiskers. They are not. Sewing machine needles are a more likely comparison. And while some people find their sessions relaxing, I hate every second of my treatments. The needles hurt, and I am bored to tears and beyond agitated as I try to lie still for 45 minutes thinking “happy thoughts.” But a day or so after the first session I noticed a huge improvement in my mood. I felt noticeably less depressed and more energized. And as I continued to get weekly sessions, I began to feel better and better, my nocturnal leg and feet cramps disappeared, my naps shrank down to 45 minutes and my breast swelling and pain started to recede. In fact, I am now nearly able to fit back into my regular bras, though sometimes I swell up toward the end of the day. We are now cutting me back to bi-weekly sessions. Dr. Matecki is optimistic that in another few weeks I can continue to achieve results by going just once a month.
Dr. Matecki is keen on supplements and she has me on a rather expensive regimen from NuSkin. It centers around Lifepak Nano packets of six daily pills ($152 for 60 packets), which include a ton of antioxidants, fish oil and the usual suspects of vitamins and minerals. I also take three Ageloc Vitality Capsules, which contain mushrooms, ginseng and fruit extracts ($63.90 for 90 capsules), plus two ReishiMax capsules filled with powdered mushroom extract ($87.30 for 60 capsules). Typically, Dr. Mateki has her patients take this regime twice a day, for a total of 22 pills. But I am holding fast at one—the indigestion brought on by these pills is no joke and the cost is prohibitive. It averages out to about $152 a month. But it’s all worth it to me in the end, even being pricked with all of those damn needles. Because for the first time in a long time, I feel like myself. And that is, as they say, priceless. Ciao for now my friends. Stay happy and healthy.
You know what really grinds my gears? Those “helpful” suggestions in magazines like: “Instead of eating pepperoni pizza, why not have a rice cake with string cheese, sliced tomato and one teaspoon of bacon bits? Why not? Because a rice cake, which is god awful in and of itself, topped with cheese that has the taste and consistency of plastic, is misery incarnate. Even with bacon bits(!) That’s why not.
Just the other day, I found the mother suggestion of them all: Instead of French Fries, slice up some parsnips; spritz with non-stick cooking spray, sprinkle with salt and pepper and bake for 30 minutes. Yup. That should do it. Craving quashed.
Hyperbole also gets my undies in a twist. I just read somewhere that hearts of romaine is “chock-full of vitamin C.” A quick internet search reveals that six leaves offer a mere 4% of the USRDA for vitamin C--not exactly “chock full of” proportions.
But what really chaps my rear is poor customer service. And in the last few weeks, I have run into some stunning examples of it. But rather than bitching about how mean everyone is to me, I am going to accentuate the positive. So here, the Notorious NYCK hit list of my best customer service experiences, ever. (Clearly, hyperbole is fine when it comes from me.)
murad.com: Your products arrive super fast— roughly three days--with free samples in mini- tubes or bottles instead of those creepy paper packettes that get all wet and slimy when you try to use them. Plus, there’s always gift-with-purchase and free-shipping offers depending on how much you spend and what products you buy.
nordstrom.com: I had been lusting over an Autumn Cashmere cropped cardigan since before Christmas and it finally went on sale last week. But the site no longer had my size. Bastards! The customer ratings all said that it “ran really small.” So against my better judgment, I ordered the medium. I am seldom, if ever, a medium. When the sweater was delivered, I was so overjoyed at how freaking cute it was, I cut the tags off and threw out the prepaid return label even before I tried it on. I recognize this is not the behavior of a sane person. But awareness is the first step to recovery, right? Not surprisingly, the sweater was too big and had to go back. But the gracious customer service rep emailed me a new return label in a matter of minutes and assured me I could make the return without the tags attached. (I put them in the box.) BTW, all shipping and returns at nordstrom.com are free.
Tiffany in Union Square, San Francisco: The lovely salesgirl let me return a necklace that was given to me a year ago without a gift receipt or any evidence of the sale in the system, since the item was still in “saleable condition” and in the original blue box and shopping bag.
piperlime.com: Neurotic woman that I am, 30 minutes after I placed an order, I changed my mind about it. The website clearly states, however, that you cannot change or cancel an order once you hit the “confirm” button. But to my surprise and delight, the customer service rep on the phone gave me the jeans in question at 50% off to “make it up to me.”
bluefly.com: Just one day after I ordered a sweater, it went on sale. Chalking it up to bad timing and not expecting much of anything, I called customer service and explained the situation. Lo and behold, Bluefly makes price adjustments up to 10 days after a transaction.
tweezerman.com: Tweezerman amazingly sharpens any Tweezerman tweezers for free. Just slip a clean pair into a padded envelope and mail to its New York headquarters. The site states that it takes six-to-eight weeks for the process. Unfortunately it took a good 10 weeks for me to get mine back, which is a dangerous thing for a girl on Tamoxifen since the always-glamorous chin hairs are a common side effect. So I had to hit the Walgreens and purchase another Tweezerman tweezers in the interim. But my refurbished tweezers arrived this week, all four of them, beautifully sharpened and neatly lined up in a clear plastic case with their ends capped to preserve their points. The best part? The company picked up the tab for the return shipping and sent me a package of purple “itty bitty” nail files as a gift. All is forgiven Tweezerman! Ciao for now my friends. Stay happy and healthy.