Surviving Cancer

Dear Family and Friends,

All is going fine with me in my first few months as a ‘breast cancer survivor’. As you know I’ve completed all my treatments and I’m taking an Aromatase Inhibitor (daily pill). Here are some thoughts on the residual from each of the treatments:

Surgery: Lumpectomy and axillary sentinel node surgery. I was fortunate that I only needed surgery once (February 2009) because the margin from cancer tumor to normal tissue was large enough to indicate that the entire tumor was removed in the first and only breast surgery. I can honestly say that I have little noticeable scarring. There is one small scar about an inch long under my arm and an even smaller scar on my breast. For follow-up, I’ll see my breast surgeon in late January after I have a mammogram.

Chemotherapy: Four cycles of Taxotere and Cytoxan given every three weeks (last chemotherapy was at the end of May 2009). My blood counts are back to normal, however I feel the fatigue that continues to linger as a result of the chemotherapy. I have no signs of the needle marks on my left hand or forearm. My hair is about a 1/2 inch long all over and just as thick as it was before I lost it. People who don’t know me just assume that I have cut my hair very short. I don’t notice anyone looking at me with sympathy anymore so I truly believe that they just think this short hair cut is my "look." My medical oncologists continue to include all of the doctors at CCA and Cyndi Kresge (physician’s assistant). I will see one of them in December to review my Vit D level (see below). As I mentioned above, I started an Aromatase Inhibitor (AI) a couple of months ago. These are the anti-estrogen pills I take to eliminate as much estrogen as possible. I have few side effects from the AI. I do vacillate between hot and cold, so I wear layers of clothing and adjust as necessary. My face sometimes flushes which is embarrassing and bothersome but I don’t perspire.

Radiation: My skin still looks a little tan. I have no scars from the radiation despite how badly it appeared to be burned at the end of treatment. I also have a lumpy area where the tumor was removed and the booster portion of the radiation was given. I asked my radiation oncologist, Dr. Jannifer Stromberg, about it and she said it was normal. It would be impossible to detect a lump at this point because it feels lumpy. Just of note, I never used cream or moisturizer on the burned breast. The radiation technicians nearly put the fear of God in you that if you put something on it, they would be unable to give you the radiation treatments. Considering that it looks pretty normal now maybe that was the right decision. I have no pain in my breast and no itching (which was the first indicator of cancer).

Bone Health: I’m sure I talked about this in the past, however I’ll share it again. At least five years ago I had a Dexa-scan to assess my bone health. Dexa-scan is a commonly used test for measuring bone mineral density. Unfortunately, it indicated that I had osteopenia which is pre-osteoporosis. I started on Beneva, the oral pills that Sally Field advertises, taken monthly. I did that for a couple of years and then switched to Reclast. Reclast is a similar medication to Beneva but it is given as an infusion. I liked this much better than the monthly pill because I only needed to take a 20 minute infusion once a year. My last Dexa-scan indicated that everything improved with only a little osteopenia remaining in my wrists. Now that I’m on an Aromatase Inhibitor, I need to take another version of Reclast called Zometa. I took my first Zometa last month (it’s a 20 minute infusion) and I will repeat this every six months for three years or longer. I had no noticeable side effects from the Zometa. Just an added note, exercise helps to improve bone density too so I do resistence training for my wrist in addition to walking/jogging most days.

Vitamin D: More and more is being written on Vitamin D not only for its positive effects on bone health but also how it is related to breast cancer. The bottom line is that we just don’t know enough about vitamins, minerals and supplements. At CCA, we wrote a one-page information sheet on Vitamin D and its importance. I had my Vitamin D level tested last year and my score was 45mcg. Just this month, I had it retested and it was 33mcg. What’s going on? I know I didn’t go out in the sun much when I was in treatment and I often missed my vitamins and extra calcium and Vit D pills but that doesn't fully explain why mine plummeted. Much is being debated about what is a normal ‘level’ of Vitamin D. Our local hospital thinks anything above a 20mcg is ‘normal’. However, the newest research indicates 50-70mcg is ‘normal’ and beneficial. I’m going to err on the side of caution and aim for a higher level so I’m now taking a higher dose of Vitamin D3 and will have it retested in December.

Vitamins and Supplements: I’ve been really surprised when I speak with our cancer patients at how many are taking vitamins and supplements. Most only have a vague idea of what they're really taking and how many of the high dosed vitamins and supplements can interfere with their prescribed medications and chemotherapy. I hope you, family and friends, are mindful of that. Just this week I had a patient on a vitamin supplement that interferes with Coumadin. This is dangerous! What I take is safe and necessary for me – you need to determine what will work for you. I take a multi-vitamin from Shaklee called Shaklee Vitalizer Gold, available here http://reichenberger.myshaklee.com/us/en/welcome.html. I also take calcium, Vitamin D3, and CO-Q10.

All in all, surviving breast cancer is a long term commitment and one that doesn’t cease just because I’m done with surgery, chemotherapy and radiation. The emotional aspect is real – the uncertainty of the future lingers and returning to normal life is more difficult than I anticipated. Don’t underestimate the impact of this life-threatening illness on your psyche.

Love,

Veronica

Vitamin D: Bone Protector and More

Vitamin D: Information for Patients

BONE PROTECTION: Vitamin D plays an important role in protecting your bones. Your body requires Vitamin D to absorb calcium. When people do not get enough Vitamin D, they can experience bone loss. Studies show that people with low levels of Vitamin D do in fact have lower bone density or bone mass and are more likely to break bones as they age. Some cancer treatments deplete bone density, including treatments for patients with breast cancer, prostate cancer and multiple myeloma.

CANCER: The earliest modern connection to cancer and Vitamin D occurred in the 1930’s when scientists noticed that people who spent years in the sun (and subsequently developed a relatively benign form of skin cancer called squamous cell skin cancer) were less likely to develop deadly internal cancers, such as colon, breast or prostate cancers¹. Researchers are now studying the use of Vitamin D in the prevention and treatment of breast and prostate cancers¹.

WHAT IS VITAMIN D? Vitamin D is made in the skin when 7-dehydrocholesterol reacts with UVB ultraviolet light. These wavelengths are present in sunlight when the UV index is at a high level. The UV index is high or high enough to provide Vitamin D during spring and summer seasons in temperate regions (like Michigan), year round in tropical regions and almost never in the arctic regions. Only 10-15 minutes of high UV sun exposure two to three times per week is needed for most people to maintain adequate Vitamin D levels.

CAN YOU CHECK A VITAMIN D LEVEL? Yes, Vitamin D levels can be checked at either of the Cancer Care Associates labs or another certified lab. The blood test does not require fasting and usually takes two to five days for results to be returned. Currently, the optimal level of serum 25-dihydroxyvitamin D is 30-100 ng/mL however there is new research indicating that guidelines may change in the near future proposing higher levels (some indication they are moving toward 50-100 ng/ML)^2,3

WHAT TO DO IF YOUR VITAMIN D IS LOW: At CCA, we suggest you to speak with your doctor about the appropriate Vitamin D dosage needed to increase and maintain your Vitamin D level.

HOW TO MAINTAIN VITAMIN D:

• At CCA, we encourage 10-15 minutes daily of sun exposure during the spring and summer months (early or late in the day to prevent sunburn). Remember that any glass windows or sunblock with an SPF above 15 will block the UVB rays necessary for Vitamin D conversion. Also, it is not safe to rely on tanning beds as a primary source of Vitamin D because their lamps are usually calibrated to favor UVA rays not the URB rays that stimulate Vitamin D production⁴.
• A diet rich in Vitamin D including fish such as salmon, mackerel, and tuna as well as milk, eggs, beef and Swiss cheese may also be helpful in maintaining an acceptable Vitamin D level.
• During the sunny seasons in Michigan coupled with a diet rich in Vitamin D we recommend that only moderate Vitamin D supplementation is necessary. However, during Michigan’s long winter months or if you are unable to get outside during the sunny seasons, a Vitamin D₃ supplement of 1000-2000 IUs daily is recommended⁵.

References

1. www.vitamindcouncil.org
   
2. http://en.wikipedia.org/wiki/Vitamin_D
3. Michael Holick, 5 May 2007, http://www.uvadvantage.org/portals/0/pres/
4. www.womentowomen.com
5. http://dietary-supplements.info.nih.gov/factsheets/VitaminD_pf.asp