Five days after I began taking Letrozole, I stopped.

The Season had its own set of anxieties and stresses without having the Master-Christmas-Event-Conductor jekyll-and-hiding as a Nice Mom and Raving Lunatic.

Within 48 hours, I returned to my new joyful, peace-filled self I had found post-Tamoxifen.

Then it hit me.

Frog boil!

Five days on Letrozole and its mental mind messing exposed the truth of my life on Tamoxifen – at least the last few years of it.

I began Tamoxifen in November 2008, in that crazy uncertain time of still having some bits of breast cancer left in me after my first surgery but not having secured a follow-up mastectomy or mastectomy-with-immediate-reconstruction surgery date.

Tamoxifen’s key role was to insert itself as a blocker between breast cancer cells and their food supply, estrogen. It’s most useful for pre-menopausal women who get breast cancer as it helps manage all that estrogen floating around and prevents the cancer from finding new places to return, set up camp, feed and live (until it unwittingly kills its whole host, and therefore, itself. Like, duh.).

I still had my periods, pretty regularly, the first two years after I started taking Tamoxifen. Whenever that was mentioned to a family medicine doc, or Chemo Doc, they kind of froze in terror and usually asked, “How is this possible? That you still have a period?”

Like, frig off.

You are the doctors. You’re supposed to be reading up on this stuff. Surely I was not the first woman – or the last – this happened to.

My response?

“I eat really well and exercise.” Unlike those doctors.

In October 2013, five years after I had started the drug, I was allowed to stop taking it for a period of six weeks to assess my hormonal state. Naturally.

Within two weeks, things changed.

My energy level rose and a fatigue I had been dragging around behind me like a wheel-less trunk vanished. I no longer needed naps if Husband and I wanted to have a nice evening out so I could be awake and actively contributing to the conversation.

I could actually drink a single glass of wine and not end up like a drunken soldier listing badly to the left when making my way to the bathroom at 3 a.m.

I exercised more intensely and frequently.

I enquired about becoming a Les Mills BodyFlow instructor. At 51!

I wanted to eat even more clean, healthy foods. I juiced more greens and had greater resistance to sweets. I had lost the urge to eat whatever was left on the children’s plates.

I stopped dropping sentences in mid-word, wondering what the hell I was going to say next. Even the kids noticed I was carrying complete thoughts and was no longer drifting off in mental mist.

More, I was excited about the next stage of living.

I was dreaming of writing. Of finishing this blog! I felt – for the first time in a very long time – that I had the energy to see this through. Actually. Focus. And. Complete. Something.

In just five days, Letrozole wiped that out. Its mad purpose was to remove every last vestige of estrogen my adrenals produced to starve the enemy – and in doing so, age my body twenty-five years in the next five. Ding Ding Ding! Joint ache! Hair loss! Bone thinning!

In just five days, Letrozole showed me why Tamoxifen had been dragging my butt around for the past two years.

Not content to mess around on the edges or slow boil me till I died, Letrozole went straight to the heart.

In just five days, I couldn’t get out of bed in the morning. I napped for hours at a time and still slept all night.

In just five days, I didn’t give a horse’s ass about my dreams.

Or about any of that other shit, either.

Like. Whatever.

Nearly six years after my original cancer diagnosis and three days after I had kind of come to grips with the seriousness of my diagnosis, I began new medication.

“Think of your cancer as a chronic disease,” the substitute oncologist said. “When we’re through the next five years, there will probably be another drug for another five years.”

Funny how my state of mind played with words.

I recall reading in a doctor’s office while going through chemotherapy in 2008 that breast cancer was moving into a realm of being treated as a chronic disease as opposed to a life-ending one. I drew immense comfort from this deciding, “I would live (a long life)!”

This time around? “Chronic disease” felt more like an ongoing death sentence. That falling beam I kept ducking to avoid until it swung around once again. Like now. Crap! Will I ever be able to completely shut this door?

Truth was, the past five years of drug intake hadn’t seemed like such a big deal. The first few months on Tamoxifen my fingernails completely flaked apart, but they got over it.

So I wasn’t too concerned about this next phase. Tra-la-la!

Once in possession of the new drug Letrozole, I scanned the list of possible complications and side effects. Common reactions included nausea. Dizziness. Fatigue. Joint ache. Hair loss. Bone thinning.

Joint ache? Hair loss? Bone thinning? Hmmm. Can’t quite put my finger on what really bothers me about this.

I’d learned long ago the info you put in your head could become the real deal in your body, so I scanned it. Then banned it.

Within 48 hours of taking the drug, I lost every shred of woman-assigned cultural graces I may have possessed. A rogue tornado stripped the niceness landscape of my brain. A swath of blatant disregard lay bare.

I was rude. Impatient. Wildly irrational. Wept unpredictably.

The filter between my not-so-nice thoughts and what I actually said was removed. Just like that.

Husband and the kids dodged the uncharacteristic bluntness as best they could.

I. Felt. Quite. Male.

I didn’t care what anybody thought about what I said. Or what I did not do because – quite frankly – I couldn’t be bothered. SO, this is how men live! It was a free – and very foreign – head space to be in.

I could have could have endured, heck, even embraced this side effect that left me oddly free of female social conformism – if it weren’t for the unrelenting and accumulative fatigue.

And nausea.

And dizziness.

And joint ache.

And that I no longer cared if I got out of bed.

I am a cold and ragged tree standing in icy snow, stretching upwards to find a warm ray of assurance from a hard grey sky.

Anger and sadness swirl. Chill dampens my spine. Reality and my mind collide just long enough to give fear room to entwine my feet.

The cancer wilderness repeats.  ~~

Mid-December, I had the most detailed, informative appointment ever. With a medical oncologist I had never before met. About my next steps as a cancer survivor. More drugs? Different drugs? No drugs?

More conversation in forty-five minutes than had perhaps taken place in the past five years.

Worse, I faced a truth. One I had chosen not to acknowledge from the start: Cancer staging.


Stage IIIa. Only Stages b and c separated me from Stage IV – metastatic cancer. The stage when stealth killer cells invade your bones fast-tracking you to dust.

Somehow, despite yearly mammograms showing a large lump in my breast and annual questions clearly recording my maternal family’s breast cancer histories, my cancer missed detection and exploratory testing from Stages 0 to IIIa. This means fourteen of nineteen steps within the staging were missed. I had had locally advanced breast cancer.

How was that possible?

Nothing. And then. Death’s Door. So. Close. I. Could. Touch. The. Knob.

Except my back was turned.

If I ignore my diagnosis, can it really kill me?

I began debating my cancer staging with this unfamiliar oncologist. He corrected me.

“It’s not only about the size of your tumour,” he said. “It’s about the number of lymph nodes that were affected. You had several nodes with cancer. Two of them broke into your bloodstream. That is how we rate your survival.”

It took me a moment to grasp what he said. La-la-la. La-la-la. Full stop. You mean the tumour size isn’t really a thing?

“Five years ago, your risk was this.” His hands held a six-inch parallel space. “It wasn’t good.”

“But now, five years later, it’s this!” The distance shrank to about two inches.

“Every year you’re alive, the risk of cancer returning is reduced by four percent – but it will never get to zero.”

No one’s risk is zero.

We all have cancer cells running around trying to find a weak spot within our bodies to land, make a shelter, and find food and blood to thrive. Their covert mission – Conquer the surrounding territory! Destroy under the cover of ignorance! Send missions to additional enemy camps! Plot silently! Avoid discovery. Until. It’s. Too. Late.

It was as though I was hearing my diagnosis for the very first time.

What do I do with it now?

As I mulled over my next breast reconstruction operation, I carried on with life. Mothering, mostly. Until the client I had so abruptly left, due to the dreaded diagnosis a year earlier, called and asked a question that was music to my ears.

“You finished rehab yet?”

“Indeed I am! What can I do for you?”

They asked me to re-write their organization’s strategic key messages and for the next six weeks I worked, with a blissful heart, on this project.

I knew exercise was critical to the long-term plan of chasing cancer cells away, so I also began training for my first 10K in Halifax’s Blue Nose Marathon with the goal of running it in under one hour.

Sometimes people looked at me as though I was a little crazy during this time. After four and a half months of chemo, ten hours of surgery and thirty rounds of radiation, I was training for a run?

Running was my strategy to act as though life was normal again. But it didn’t keep my mind off the niggles I was having over the next operation.

I decided to call back my BCANS survivor peer. Her DIEP flap had died and when they rebuilt it, they used a LAT flap the next time around.

“How do you like it?” I said.

“I love it! I am very small-chested, so I told the God of Breast Reconstruction to forget about the implant and just take as much muscle as he needed to make this option work,” she said. Drat! That is not going to work for me!

I couldn’t settle with the idea of using a muscle. Fat movement – hey! I was all over that. Fat offers poured in from women who would have happily donated it to my cause. Except that my body would have rejected it.

I kept spinning. Revisiting. Doubting. Questioning.

Keep the breast? If I did I would be faced wondering if those calcifications were going to go bad. I returned to the “odds” pile – one in nine of getting breast cancer, just like the average woman. Except that once you’ve had cancer, it seems you were more susceptible to getting it again.

Lose the breast and replace it with this less-than-ideal version? A fricking Hollywood implant? One back muscle removed from its God-given position attached to my spine and tunneled under my armpit to hold it up?  It just doesn’t sound right.

I decided to try my “peace place” exercise. I shut my eyes and imagined removing the breast and replacing it. How did that feel? It felt great to know all the breast cells would be gone. No more cancer possibilities if no tissue existed to feed it. And not so great knowing how it would be rebuilt.

Then I closed my eyes and imagined keeping the breast.

And was left with no end of worry.

On February 9, 2009, I returned to the Ultimate Alpha Male to discuss how we could remove and rebuild my left breast. The good one.

It seemed remarkable to me that I had spent most of 2008 trying to save my cancerous breast only to decide, in what seemed like the blink of an eye, to ditch the existing breast.

I moved into this next meeting blindly. Ignorantly. Defiantly. And a little afraid Alpha Male, with his frank talk, would make some judgmental comment about how it was too bad I hadn’t removed both breasts and rebuilt them at the same time three months earlier.

Navigating the entire cancer journey had been a perilous course. So many wrong directions, endless rotaries and dead-ends. So much misinformation and missed information. Like how a donor site, a stomach, could never be used again.

How would we build this second breast?

“I’ve looked at the numbers and the odds for recurring breast cancer,” I said. “I’ve already had two core biopsies done on calcifications on my existing breast and I’m only 46. Time is not on my side. I’ve decided I’m getting rid of the other one.  What are the options now?”

Ultimate Alpha Male was alert and present. Ready to go.

“Get your Johnny shirt on and we’ll find out where the next material is coming from. Oh, and this time, take everything off, even your underwear.” Even my underwear? My heart sank. I hated this part.

He left the room to fit in another patient’s appointment and returned a few minutes later.

I was sitting on the examination table.

“It’s better if you stand up.”

I stood before him.  He was seated on the round steno chair with its wheels, his face right at breast level.  He was dressed, I was not.

He squeezed his right reconstructed, nipple-less breast, in slight motions.

He looked up at me. “What do you think – about 400 mls?”

What on earth is he talking about? “I have no idea.”

“Yeah, I think so.”

“How do you know?”

“I used to work at a fish market.”


“No, I’m kidding!”  I whacked his arm.

He really did work with fish but I didn’t find that out for another two years.

“Turn around.”

At this point, my back and bum were facing him, Johnny shirt hauled to my left side as he lightly squeezed and cupped my right buttock, weighing fat and flesh in his mind. I stood, noting the odd place I found myself in. So vulnerable. So many self-critical thoughts about the state of my body.

“Hmmm … Do I have enough?” He said aloud.  He cupped and mulled some more.

“No, I don’t think we can do it,” he said.

“Do what?”

“Make a breast from your buttock.”

That left him and therefore, me, with the back muscle flap option and accompanying implant.

“How will that work long-term?”  I asked.  “I’ll have one naturally-made breast and one breast with an implant.  Won’t they age differently?”

“Good point.  I don’t know how that will work.”  Great.  I’ll be 80 with one perky boob.

“So this is it? This is the only option I have to rebuild?”

“It will look more natural than just an implant and I think you’ll be happy with the outcome,” he said.

I wasn’t completely comfortable with this plan. I just couldn’t put my finger on why.

By the middle of February 2009 – a year after the first shocking diagnosis – treatment was complete. At least as far as the cancer destruction program was concerned.

People constantly asked me, “Are you okay?”

Who knew?

What we did know was that I had done everything conventional medicine required in the repair department. Six rounds of chemo that whittled down twenty pounds of fat, ruined the veins in both my arms and would make extracting blood forever a problem.

Ten hours of surgery that revealed twenty inches of Hollywood scarring on my stomach, breast and right armpit.

Thirty rounds of radiation that left behind an odd and indiscriminate selection of blue tattooed dots on my right chest wall and side, altered skin on the reconstructed breast and a lifetime of what seemed like random limb-swelling threats.

Oh, and I gained a head of hair that grew back like that of a perfect stranger’s.

How could I ever define wellness after this plague on my house? I didn’t know, so I fired off an email to Rocket Man. I wanted to tell people I was well. Was that real?

Rocket Man replied, “I think you can lead your life as if you’ve been cured of cancer – which I am seeing as the truth.”

What oncologist actually writes that?

Thank God he did. I sent his words to all my friends in a “let’s close the book on this cancer stuff” and “thank you for your amazing support”.

The past year was like a cardboard box full of unwelcome memories I wanted to close up and put on the highest shelf in the basement. Out of sight. Pretend it all didn’t happen.

Except it did. And now, I didn’t know how to move forward.

I wondered if I should have genetic testing for BCRA1&2, the genes, that if detected, would tell me the odds I’d have of getting breast and ovarian cancer.

Rocket Man thought was a reasonable request so he put in the referral for me.

Not long after, the Maritime Medical Genetics Service sent back a form to fill out about my family health history.

I started to complete the form. Then I crumpled it up and threw it away. My mother is still alive at seventy-one, twenty-five years after her breast cancer. I’ll be fine! Tra-la-la!

I contacted Ultimate Alpha Male.

I would remove my healthy left breast. Without testing. The hell with it.

I’d heard enough of those stories of women who had conquered breast cancer – only to have another version of it show up in their other breast ten years later.

Damned if that was going to be me.