Tamoxifen 2.0

Wild iris seen on Joe's Hike, while I received acupuncture Tuesday in Corbett.
Wild iris seen on the hike Joe took Tuesday in Corbett while I received acupuncture.

For months I have been researching and considering Tamoxifen, the one prescription drug I receive. Last week I decided to take a holiday from it. Wanting to figure out if the side effects I am experiencing are related to Tamoxifen, or some other issue, like turning into an old hag – this is my birthday month after all. On Tuesday we traveled into Portland to see my oncologist, and then out to Corbett to Hai Shan Center for an update on the Chinese medicine front. Any time I travel to my doctors I go loaded for bear with questions, this time they were about Tamoxifen, and about teeth.

When we arrived in Dr. Andersen’ s office at Compass Oncology the first question he asked was, “What’s new?” At which point I told him I was taking a holiday from Tamoxifen. He asked when it had started, and when it would be ending. He asked why, and what, if anything, I had noticed. We spoke of the difficulty getting any useful statistics for my situation. After we talked for a while he let me know that in his opinion tamoxifen is a drug for the long game, and taking a month holiday is not likely to make a huge impact on my outcome. Already I have noticed a decline in several side effects, namely hot flashes, foggy thinking, migraines, leg and foot cramps. He was not surprised.

He agreed to my idea of restarting at a 10mg dose, vs the 20mg dose I have been taking for the past two years.  He wrote a new prescription to that ends. He informed me that he doesn’t know of any studies that show 10mg has the same benefit as 20mg, but that he would rather I take some than none.  And if 10 seems to have a more neutral impact on side effects, than he encouraged me to try taking 15mg and see how that goes.  We will revisit all of it in September. By then I will be in a more informed place regarding my personal response to the drug.

Statistics can’t be applied to an individual, plus my situation is off the oncology roadmaps. That being said the retroactive Scottish study of costs associated with Tamoxifen published 2013 in the journal Nature, followed women who were taking tamoxifen, and tabulated outcomes for both five year Tamoxifen compliance and those who stopped taking it early. Reading the actual study, vs the sensationalized press articles showed a small measurable difference in outcomes. Rather than the image evoked of thousands keeling over after missing a dose.

My perennial question is what role does faith and hope (read that PLACEBO) have in outcomes?  For those who took Tamoxifen faithfully for five years did it represent a little daily spell of healing?  For those who stopped, did it represent a daily dose of a long slow death? Just another reminder that they were being stalked by the cancer boogie man?

This whole thing is a bit crazy making for me, because A) I have a strong aversion to gambling and B) I am increasingly lacking in any faith in the role Tamoxifen plays towards my continued disease free future. I have my doubts that it can be as effective without the benefits of placebo power. Is the slim margin of improvement available to me if I don’t believe?

Setting aside such unanswerable questions the plan is that the merry month of May will be a holiday from Tamoxifen, and come June I will move on to the 10mg phase in my trial of one. It will be interesting to see which brand the 10mg will be. I am particularly interested in what the “inert” majority seat ingredients will be. In my experience so far this is a detail that matters. I have noticed very different side effects from the two brands I have tried. (See my post A Tale of Two Tamoxifens for more on that)

The other function of the oncology world visit is the blood tests to look for evidence of resurgence of the ghosts of cancering past. No test results in yet- the whole tumor marker thing will come back next week.

On the Hai Shan side of things, they looked at my tongue, nails, and took my pulses. And encouraged me that from their prospective I am doing really well. I will continue my various herbs, minerals and vitamins from them. Dr. Metro updated my homeopathic to be taken with the Tamoxifen, and since I have failed to use it consistently, he encouraged compliance. This complicates my little study, as the question will then become are the side effects lessoned due to reduced dose, or the possible benefit of my custom homeopathic?

Beautiful Healthy teeth, early 20th century. As documented by Weston Price
Beautiful Healthy teeth, early 20th century.
As documented by Weston Price

Since I have been reading a bit about the impact of root canals on breast cancer, I asked Dr. Metro about the possibility of pursuing biological dentistry.  He both acknowledged that the teeth are very important to health, and that in his opinion it is likely that my dental history has impacted my situation. He also cautioned that doing any big invasive dental work is not something to take lightly, or dive into without consideration and research. He talked about how the teeth interact with the autonomic nervous system, and acupuncture meridians, and how our teeth tell us much about the health of the body. Which all adds up to more homework to do before my next visit with him at the end of June.

Any talk of teeth and health always makes me think back to the slides Steve Solomon put up during Urban Farm Class at UO, taken from the work of Weston Price.  We spent at least a week on soil mineralization and its impact on both plant and human health. We also talked about dairy cows on the Oregon Coast, and the impact of rain washed – mineral depleted soils on cow fertility.  So here I am 20 coastal living years later wondering at how my mineral depletion is contributing to this whole picture.

The rhythm of post cancering follow up keeps my thoughts tuned in to all sorts of minutia, I mean truly minutia – micro nutrients, micro biome, micro milligrams of drugs. Now that this week’s office visits are  behind me I look ahead to focusing more on household love, and making art in my newly cleaned studio. (Yet another example of a miraculous recovery…) I will take a break from reading dense scientific papers on Tamoxifen and simply enjoy the remainder of this Tamoxifen free holiday.  Though I will spend some time learning more about biological dentistry I think it will be easier on the brain than what I have been up to. Hopefully the beautiful macrocosm of May blossoms, returned barn swallows, and community celebrations will be the dominant forces in the coming weeks.


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