That horrible moment when you realize your life will never be the same...

Apparently, I'm in denial.

Personally I like denial, because it's a pleasant and happy place to be.  Life is nice here, like floating on the lake on a warm summer's day, leaning back to feel the hot sun on your face, dipping your fingertips in the cool water.

And then the heaven's open up with a crack of thunder and you're whirling around in a waterspout, hanging on for dear life.

Dammit.

I met with my medical oncologist today - not our usual nurse practitioner, and not the doctor we've seen in the past.  This is a new doctor, and I'm not certain why I saw him instead of my usual doctor, but I think it has to do with the fact that he's the devil.  Or, it's because he's very good at explaining statistics, and for that he's also the devil.

Which explains the waterspout of crap I heard in the office today.

He is glad to know that I'm feeling so much better since dropping Tami, "but let's talk about what that really means."  Several points emerged during our (one-sided - HIS) conversation:

• Because of the chemo, my bloodwork shows that I am currently post-menopausal, which means my body is producing less estrogen than when I was pre- or peri-menopausal.  "But your fat is still storing estrogen," he said.  What I heard was, "Lose weight, lady!"  Yeah, yeah...I'm working on it.
• My cancer is aggressive.  He says that the small size of my tumor and my node-negative status are still in my favor, "but that Oncotype score (42) is really troubling.  That test is very indicative of how your cancer behaves, and yours is aggressive."  I'm such an overachiever.
• "Recurrence means metastatic disease, which is incurable," he says.  "It's very rare to have another primary tumor, although it can happen."  Yeah, it can, cuz I know people it's happened to.  Thanks.
• Without the full benefit of chemo AND Tami, my recurrence rate changes from 28% (without any treatment) to about 23%.  Unless I take the Tami OR another hormone therapy, my recurrence rate will not reach the 18% quoted on the Oncotype test.  
• If I was triple negative (meaning ER-, PR- and HER2-), "we'd do chemo and radiation and send you on your way."  No hormone treatment because it doesn't work when there are no hormone receptors in the cancer.

Since he kept bringing up the Oncotype test I mention that the test shows I'm actually PR- and barely ER+ (6.5 is the cutoff, and I'm 6.6), so really I'm almost triple negative, and really, how much benefit am I getting from taking any hormonal therapy?  He checks the report (because I don't know what I'm talking about?) and then checks the original pathology report.  "I'm less than 10% PR+, and 50% ER positive," I say.  I know this report like the back of my hand; I can see it clear as day when I close my eyes.  "Yes, well, you're right," he says.  And then explains that the pathology describes the cancer make-up, and the Oncotype describes the cancer gene expression.  So they're two tests really testing for two different things.  I guess.

He spends the next several minutes quoting studies and statistics, down to the single percentage point of the benefits of each of the treatments.  He explains why it's important for me to do at least two, if not 10 years of hormonal therapy.   He talks about this as though it's a given, as though I don't understand the inherent risk of not doing it.  And I'm mad not because he's wrong - but because he's right.

He explains that I can forgo Tami but really should try one of the aromatase inhibitors (Arimidex, Femara or Aromasin), which is given to post-menopausal cancer survivors (and sometimes to those with metastatic cancer).  Of course unlike Tami - which is a bone-strengthener - the AI's will actually deplete my bones further.  "So, for someone like yourself who is osteopenic, we would also put you on Fosomax or another bisphosphonate."

So I could take an AI AND a bisphosphonate.  But wait...it gets better.

When I was first diagnosed with osteopenia our NP Dianne mentioned bisphosphonates are great at building bones, but come with a host of really nasty side effects, including jaw necrosis in a significant percentage of patients who use it.  It also often causes severe joint pain.

As do the AI's.  "But not as bad as Tamoxifen," says the doctor.  "But given your history of side effects, you may have trouble with the AI's, too." 

The additional benefit of AI's or Tami is the reduced recurrence for contralateral breast cancer (Ethel, not Lucy this time).  For every year after my original diagnosis, my risk of contralateral BC rises 0.5%.  "If you were 75 it might be different, but you've got 30 good years - that's a 15% increase - to think about."

"So," he says, "you have two choices.  One is to keep believing what you believe and hope your cancer doesn't come back, or try an AI and see if you can tolerate it."

I just sit there and stare at him, but I don't think he was really paying attention.  He writes me a prescription for Aromasin, and asks me to come back in three months.  "Of course, if it's too hard you can always stop.  But I'd really think about all we've talked about today.  So call us if you decide to stop."  He walks me to the front desk, and before I can say goodbye or thank you, he turns and walks away.

I'm not sure how I feel about all of this yet.  Ken wasn't able to come with me today because he was out of town, so we need to talk about our options.  But I can't help but feel that regardless of my choice, this whole stupid cancer thing isn't going to go away quietly or gently.  I never wanted a 100% guarantee that the cancer wouldn't return - I know I'm never going to have that, no one does - but I wanted to believe that I had done all the hard work already (slash, poison and burn) and that hormonal therapy was an "added bonus" of benefit.  Instead, what I heard this morning is it's just as important as everything else in keeping metastatic disease at bay.  And so my denial comes full circle, as I realize that I want to make an informed decision, and I just got more information than I necessarily wanted to hear.

I'm taking my M&M's, my fat ass, and my raft and going back out to the Sea of Denial...at least until Ken comes home later.

Thoughts, anyone?