The Little White Pill

Date: February 13th, 2011

Time: Midday

Status: Tamoxifen

Info: We’ve enjoyed a truly blessed weekend.  Cindy and her beautiful daughter Giovanna came up this weekend.  With them was Molly, a Cavalier King Charles Spaniel who quickly became great friends with our bundle of bulldog LuLu.  Friday night was wine, beer and chinese food … Saturday afternoon was spent walking the streets of downtown Petaluma in the search of the grape – we found the grape, we found the sun and everyone around us heard the laughter!  Thank you Cindy for making the trip north – you’re all welcome here whenever. Molly too.

Our weekends, as you’ve read are cancer-free, and while Bonnie rests on the couch in the rays of the sun coming through the living room window a small bouquet of flowers await her in our bathroom … I was a little sneaky this morning while out shopping for bagels and was able to sneak them into our newly decorated bathroom without her noticing.  Our company has left, the dishes are done and the rest of the agenda-free day looks to be sedentary.  Before napping Bonnie mentioned she had forgotten to take her morning dose of Tamoxifen so after running to the bathroom and getting her glass of water I thought I’d share with all of you what this drug is all about … at least what I’ve found from my research.

So first off … let’s talk about two new terms we’ve recently learned; adjuvant and neoadjuvant therapy:

Both of these terms have special meanings in the world of oncology.  Adjuvant therapy refers to “additional treatment” usually given after surgery where all detectable disease has been removed, but where there remains a statistical risk of relapse due to occult disease.  If the known disease is left behind following surgery (and it better not be), then further treatment is not technically “adjuvant”.  Following so far?

The term neoadjuvant therapy is treatment given before primary therapy.  A woman may receive neoadjuvant therapy for breast cancer to shrink a tumor that is inoperable in its current state, so it can be surgically removed.  Also, a women whose tumor can be removed by mastectomy may instead receive neoadjuvant therapy to shrink the tumor enough to allow breast-conserving surgery.

In our case – we received a prescription for Tamoxifen from our oncologist because the surgery was still five weeks away.  This worried my wife enough to raise the issue with him.  No problem.  Here’s a prescription for Tamoxifen.  So after retrieving this little white pill for her this morning it got me thinking … what could this little white pill have in it that he was so ready to prescribe?

Here’s a few things I’ve found:

Tamoxifen (Nolvadex®) is a drug, taken orally as a tablet, which interferes with the activity of estrogen, a female hormone. Estrogen can promote the development of cancer in the breast. Tamoxifen is approved by the U.S. Food and Drug Administration (FDA) for the prevention of breast cancer and for the treatment of breast cancer, as well as other types of cancer.

Tamoxifen has been used for more than 30 years to treat breast cancer in women and men. Tamoxifen is used to treat patients with early-stage breast cancer, as well as those with metastatic breast cancer (cancer that has spread to other parts of the body). As adjuvant therapy (treatment given after the primary treatment to increase the chances of a cure), tamoxifen helps prevent the original breast cancer from returning and also helps prevent the development of new cancers in the other breast. As treatment for metastatic breast cancer, the drug slows or stops the growth of cancer cells that are present in the body.  Key words here … “slows or stops the growth of cancer cells that are present in the body”.

My question: “Why is Tamoxifen not part of a regular daily vitamin for ALL women over the age of 30?” I don’t have that answer and sometimes I yell through my fingers and the keyboard is the only one listening.  Sorry.  Valid question/concern? Probably.

What can we expect from side effects?  Right now the only thing we learned from our oncologist was “hot flashes” but seriously there must be other ones, right? Before I get into the research on additional side effects, let’s see how that little white pill works. It all starts with Estrogen.  Turns out the letter E in E-S-P-N does not stand for Estrogen 🙂 …

Estrogen can promote the growth of breast cancer cells. Some breast cancers are classified as estrogen receptor-positive (also known as hormone sensitive), which means that they have a protein to which estrogen will bind. These breast cancer cells need estrogen to grow. Tamoxifen works against the effects of estrogen on these cells. It is often called an antiestrogen or a SERM (Selective Estrogen Receptor Modulator).

Studies have shown that tamoxifen is only effective in treating estrogen receptor-positive breast cancers. Bonnie has this estrogen receptor-positive, as her tumor’s hormone receptor status has already been determined.

Although tamoxifen acts against the effects of estrogen in breast tissue, it acts like estrogen in other tissue. This means that women who take tamoxifen may derive many of the beneficial effects of menopausal estrogen replacement therapy, such as a decreased risk of osteoporosis. A GOOD THING!

Side effects ?

The known, serious side effects of tamoxifen are blood clots, strokes, uterine cancer, and cataracts. Other side effects of tamoxifen are similar to the symptoms of menopause – hot flashes. The most common side effects are hot flashes and vaginal discharge. Some women experience irregular menstrual periods, headaches, fatigue, nausea and/or vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash.  Sounds like one of those disclaimers on a televised ad for a new medicine, doesn’t it? As with menopause, not all women who take tamoxifen have these symptoms. More to follow on this subject as that little white pill becomes a regular part of Bonnie’s system.

Her system received a great dose of family this weekend and it was better than any doctor could ever prescribe.  A little hug goes a long, long way.

LuLu lies at the end of the couch, soaking in the rays and providing a cacaphony of peaceful bulldog noises, while Bonnie sleeps and prepares herself mentally for her tomorrow.

Keep her close you guys …

Annie – your card, well what can I say other than PRICELESS – it may be the best card she’s ever received.  EVER.

Taylor – your Valentine’s Day cards and gift for your sister was exactly what the doctor ordered – we love you and miss you terribly.

Cindy – another thank you from Big Pappa.  Good luck finding the new ringtone for your IPhone.  May it always ring with good news on the other end.











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