January 12, 2010

Dear Family and Friends,

All is going fine here. My hair continues to grow and I can tell my strength continues to return. It has been seven months now since chemotherapy treatments ended and four months since my last radiation treatment.

I want to talk about the milestone coming up in the next week. I am scheduled to have my first post treatment mammogram and bone density test than once the results are back, I will see Dr. Benitez (my breast surgeon) to go over the mammogram results and start the process of lifelong monitoring.

In regard to the annual mammogram, I’m just not too interested in it. As you may recall, my breast cancer was not discovered on a mammogram and even when they knew it was cancer, they still couldn’t detect the tumor on the mammogram. However, I’m knowledgeable enough to know though that just because it wasn’t caught on a mammogram the first time, doesn’t mean another tumor wouldn’t be caught another time.

The bone density test is a repeat of one I had a couple of years ago when they discovered I had Osteopenia (bone loss). Apparently, 40% of all adult women have Osteopenia and 7% have Osteoporosis. In addition to the history of Osteopenia, I began an aromatase inhibitor in September (2009) which stops the production of estrogen in post-menopausal women. Aromatase inhibitors work by blocking the enzyme aromatase which turns another enzyme, androgen, into small amounts of estrogen in the body. Aromatase inhibitors can cause bone loss (osteoporosis).

Cancer patients with symptoms of bone pain sometimes have bone scans to look for cancer that may have gone to the bone; e.g. breast cancer; prostate cancer; etc. A bone scan is different than a bone density scan. A bone density scan, or DEXA, uses a low amount of radiation (less than a chest X-ray) to measure your bone mineral (BMD) and predict the chance of fracture. The test takes about 20 minutes and the results are returned within a week. The DEXA scan results will come in the form of two scores:

* T-score: The T-score is the difference between my bone density and the bone density of young, healthy women. A score above -1 is considered normal. A score between -1 and -2.5 is classified as Osteopenia and a score below -2.5 is classified as osteoporosis. The score is used to estimate my risk of breaking a bone.
~ Results of scan in 7/2008: My T-score range was in the level for Osteopenia in my back and hip however it was in the osteoporosis level in my wrist. Oops – remember the wrist fracture while on a cruise to celebrate the end of chemotherapy in June 2009?

What have I been doing to help strengthen my bones?

* I walk two miles a day on a treadmill and lift weights (I started passive resistance training for my wrists late last summer).

* Zometa: In the past I took Boniva (ibandronate sodium) monthly for a couple of years. Boniva is the medication advertised on TV showing Sally Fields playing with her grandchildren. I didn’t like Boniva because I didn’t like having to get up early to take the pill and then waiting to eat breakfast. Plus it was monthly and I sometimes forgot to take it. Lastly, my insurance didn’t allow me to buy more than one month supply so I had to make monthly trips to the pharmacy and I had a co-payment each time.

I switched to Reclast (zoledronic acid). Reclast is given once annually as an infusion. I had the nurses at our office give it to me (nothing like experienced chemotherapy infusion nurses administering non-chemo medications painlessly). Now, as a breast cancer survivor, I’m taking Zometa (zoledronic acid). Reclast and Zometa are the same, both are zoledronic acid however the difference is that Reclast is FDA approved for the treatment of osteoporosis and Zometa for prevention and treatment of bone loss in cancer patients. Reclast is given once a year at a slightly higher level than Zometa and the latter can be given on a monthly basis or once every six months. I get Zometa every six months.

* Vitamin D

* Good nutrition (lots of vegetables and fruits).

~ I’m still trying to get my weight back to what it was before surgery in February 2009. You may recall that I gained nearly 10 pounds. I still have about 3 or 4 to lose.

* Multivitamin

I’ll update you once the results of my tests are in.

Thoughts and prayers are with you.

Love,
Veronica