Riding the Cancer Roller Coaster

Because women with  invasive cancer never know they are cured until they die of something else, we have to learn how to handle the uncertainty this disease can bring.  We all have a tendency to think that a bruise is a sign of impending doom.

For most of us, our initial treatment will be all we ever need. Unfortunately, a certain percentage will face the disease again, either with a local recurrence or a metastatic one.  A diagnosis of breast cancer means you must live with the sword of Damocles hanging over you.  It may be swaying very high up, but it's forever there.

For well over three weeks, I have had a burning, aching pain in my lower left side/back that never goes away. It radiates down into my butt/hip. It may be spinal or it may be my hip bone or it may be muscle.   I know it's not tamoxifen-related, because that bone pain is pretty diffuse and this is specific and one-sided.  Pain medicine only helps briefly and then it comes back.

Naturally, the thought crossed my mind that the cancer has spread to my spine or hip. And, unlike the last scare I had in mid-July when I was called back for a bad mammogram after thinking everything was fine, this one is generated by my own imagination.

Here is the conversation I (and at some point, most cancer patients) have with themselves about these situations.

Emotion: My back hurts. OMG, it's spread to the spine or hip. I have metastatic cancer!

Intellect: Everybody gets these aches. You are 52 for crissakes and have been through a lot. They go away.

Emotion: It's mets! I have mets!

Intellect: You have been working 9-10 hour days, and because of the expander and hot flashes, have not been sleeping well. You are in a new office in an old chair. It's physical circumstances causing your pain. Don't be hysterical.

Emotion: It's mets! I have mets! I'm going to have to do treatment forever!  I'm going to have to do radiation!  

Intellect: Be logical!  You are still in treatment. They cut out the cancer, they killed any remaining cancer cells with chemo, and you are faithfully taking tamoxifen and herceptin to prevent recurrance The odds are excellent that you are fine. It would be a rare cancer patient who had disease progression at this stage.

Emotion: I know you are right, but it hurts. I only had a 2.6% chance of getting cancer last time, and only 20% of that small percentage be HER2+. Odds suck for me already.   It's mets!  I'm never going to see my grandchildren!

Intellect: Three weeks ago when the pain started,  you spent the entire weekend cleaning your kitchen. You pulled everything out of the cabinets, you bought containers for the pantry, you climbed on ladders to clean the top of the fridge, you even did a paint touch up. You probably pulled a muscle.

Emotion: I had cancer. It's not muscle, it's spread! (But doesn't the kitchen look nice?)

Intellect: Listen to me!.  You have had a very large, very hard plastic lump in your right breast for almost a year. You are a stomach sleeper. You probably are sleeping in awkward positions and straining your back. Your body has also changed and you may have adjustment strain.

Emotion: Yes, I know you are right. BUT IT'S METS!

Intellect, sighing: It's not Mets.

Logic and facts always win over emotion. (Unless I'm pissed off.  Then emotion wins.)  But, I learned a valuable lesson when I first found my cancer. Logic said it was just another cyst. Logic told me I had no risk factors. Logic told me that 80% of breast lumps are benign. I listened to logic for months and delayed the diagnosis.  Unfortunately, it turned out that logic failed me.

So, this time, despite my desire to ignore what is likely a muscle strain, and hope it goes away, I will listen to the illogical, emotional side and mention it to the doctor this Wednesday. He may order scans, or he may say it's nothing and let's wait and see.  I hope it's the latter as I have no time for more tests (I already have a MUGA this week), and I know the results will come back negative. I will have wasted everybody's time. But this time, I won't ignore it.

A lot of cancer patients institute the "two week rule" for contacting doctors. We know we are over-sensitive to aches and pains, and that our minds automatically run to disease progression. We also know we are normal people who get normal pains. On the other hand, we know invasive breast cancer is fickle. You may be cured.   It may return in five months, five years, or twenty-five years.  To cope with a mind that wants to run wild, we learn to wait.  It's been over three weeks now, so it's time to confess.

I imagine as you get closer to the magic five year mark, where the odds of your cancer returning go down, it becomes much easier to relax when you get these normal aches and pains.

Until then, finding the balance between your emotions and your intellect is the key to the recovery process.

I'm not sure I'm there yet, but I'm trying.