Medication Begins

I've allowed a whole month to go by without updating this blog, not because nothing happened in October, but because I didn't have the time or the mental energy to sit down and write it.

At 10.10 am on 10 / 10, I had my third appointment with Dr. Sarid, my oncologist and, as expected, he prescribed Tomoxifen.

Tomixifen is the medication of choice for hormonal-receptor positive cancer treatment. It received FDA approval in 1978 and its role is to block estrogen from binding to its receptors in the breast. There are some unpleasant and even life-threatening side-effects and I was curious to know why I wasn't being given Arimidex, which the informative lady at the 1 in 9 organization had told me is generally prescribed for post-menopausal women, such as myself. Arimidex is an aromatase inhibitor that prevents the conversion of steroids produced by the adrenal gland into estrogen and it has its own set of unpleasant but not necessarily life-threatening side-effects; however, it is thought to be superior to Tomoxifen in terms of preventing recurrence.

Dr. Sarid explained that Arimidex is very expensive and is not included in the basket of services in the first two and a half years of recovery from cancer. If I survive the first two and half years, I can expect to then be prescribed Arimidex, always presuming that it won't have been dropped entirely by then. Regardless of the cost, I wanted to know which medication was more likely to keep me alive. He said that in some cases, when the cancer was more advanced than mine, he recommends that the patient undertake the burden of paying for Arimidex. He seemed so convinced that I am going to survive that he was almost dismissive in asserting that Tomixifen is good enough for me. He wasn't receptive to the idea that I seek a second opinion, which the 1 in 9 lady had recommended. I managed to ask a few more questions before deferring to the feeling that I was taking up time he should be spending on other patients. I am now on a schedule of 3-monthly checkups. Perhaps at my appointment in January, I'll be able to ask another few questions. Prior to that, I'll need to have a blood test, a mammogram, ultra sound and check my bone mass.

Still feeling uneasy about the medication, I went to talk to Hannah, the nurse, and asked her if she thought I should get a second opinion and if so, what should I do if it differs from that of Dr. Sarid. She reminded me that Arimidex has been around for only about five years, compared to the decades that Tomoxifen has been in circulation, and that the long-term effects of Arimidex have still not been determined. Say no more - Tomixifen it is. She suggested I begin slowly, taking a quarter of a pill for two weeks, then half a pill for two weeks and working my way up to a full pill in a month in order to give my body time to adapt to it. In cases where there is a extremely unpleasant reaction to Tomoxifen, Kupat Holim (health fund) might be persuaded to switch funding to Arimidex.

In the end, I found that the pill itself is so small, chopping it into quarters is more trouble than it's worth. I began with half a pill which I took in the evening for two weeks. A few days ago, I began taking the pill whole.