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Getting Cold Feet... Getting Cold Feet...

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Unread 05-11-2007, 03:06 AM
Getting Cold Feet...

I'm getting cold feet about my TAH BSO scheduled for May 21, and don't quite know how to handle the anxiety and doubts. I am 50 years old, pre-menopause, was diagnosed three years ago with atypical ductal hyperplasia in my breasts, have been on tamoxifen for 3 years (9 biopsies and three surgeries), blood levels past 9 months indicate extremely high estrogen levels, have cysts on both my left and right ovaries, and have long, painful, heavy periods, and cramping when I am not on my period. My GYN and my oncologist feel good about the surgery, but my breast surgeon was against it. Even with all of this I am doubting the procedure.

I'm concerned about hitting menopause like a brick wall and without the assistance of HRT because of the breast issues. Selfishly I am concerned about appearance changes such as skin (have always prided myself in very clear skin, and have heard that the skin loses its elasticity and texture due to lack of estrogen) and weight (I have worked hard the last year to lose 52 pounds and am depressed about the prospect of adding it back on). I'm a Type A personality, always going. What if my energy level doesn't pop back to the way it is now? I'm so concerned about being away from my job for 8 job is such that there isn't a replacement while I am gone (CFO)...everything will be waiting for me...ugh.

So, here it is 4:00 a.m. in the morning and I can't sleep. Any words of wisdom, encouragement, common sense would be great. Of course, a margarita right about now sounds good too!

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Unread 05-11-2007, 04:21 AM
Getting Cold Feet...

I'm sorry, the bar here isn't open yet but how about some coffee?
With your other issues, I can understand your reticence about your upcoming surgery. But, if I had 2 out of 3 doctors agreeing with the procedure, I would more than likely go ahead but that's me. You have to reach your own "comfort level" and maybe you're not there yet.
Re the menopause issues, there is no way to tell 100% that your concerns will become a reality for you, just as there is no way to tell if I'm a natural blonde. What you need to ask yourself is if a little more work post-op re your skin and weight is worth NOT being in pain from your periods. the constant cramping, etc. I would bet that in the end, just the fact that your "nether regions" aren't a constant, or almost constant, source of aggravation may make everything else so much more easily manageable.
Lots of "what ifs?" and not alot of answers but if it were me (okay, it kinda IS me, lol) I think I'd rather be rid of a major irritating organ, or organs as the case may be, that would allow me the ability to function like a normal person and give me the energy to refocus on what can't be surgically fixed, but can be fixed via other means.
I'd also suggest you read through the hormone jungle subforum and see how some other lovely ladies such as yourself have coped. In the interim, we're here for you but right now my crystal ball is on the fritz-maybe we could consult it later?
Unread 05-11-2007, 07:00 AM
Getting Cold Feet...

DITTO to Mrs0323.

I am 50 and had lots of the same issues. I as so glad that I had a TAH/BSO in Feb. I feel so much better and really did not know how bad I felt until I started to feel better It is like a fog has lifted.

I cannot take HRT due to many factor and only had one bad weekend of night sweats and hot flashes - come to find out my BP was in the 190/90 range. Once the BP came down and the fluid out - I have only had a few flushes since. ( I lost 6 pounds in 4 days from fluid)

In total - I have lost 20 pounds since the surgery, my skin looks great - only a little dry and I can do things that I could not before - like make plans and keep them - wear panties more than once, sleep through the night without an accident and wear white pants this summer

You should start to feel more normal at about 4 weeks - some earlier, some later. Can you do any of your work at home? The cabin fever was the worse for me once I started feeling better. You might feel up to doing some lite computer work or paper work at 2 to 3 weeks.
Just don't push yourself. i know your job is important, but your health is more important. You must heal properly the first time
I know that recovery seems slow and long - but I promise you will be glad to have all this "stuff" out of your life.

This site is the BEST!! The Sisters have all been there and know what you are going through. They are so supportive and caring - you can ask us anything and get an honest answer.

Good luck and keep us posted,

Mary Beth
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Unread 05-11-2007, 09:38 AM
Getting Cold Feet...

Mrs0323, thank you for your response. I wish you did have a crystal ball, or rather I wish I did, but obviously that isn't going to happen. I know that I am probably being a bit vain about things, and really should just be thanking the stars that I will finally be eliminating the problems that I have been experiencing over the years. Perhaps the thought of sacrificing some things to get rid of others is what is bothering me, but that is life.

Mary Beth, thank you for comments also. I will be able to have remote access to my office computer and files, which will help. I have worked at this job for 30 years, and while some co-workers can step in on a handful of duties, the majority of the responsibilities will need to remain with me primarily because of confidentiality issues. Thankfully our son is home from college for the summer, and his help will be wonderful while I recuperate...both in cooking, office work and things around the house. My husband will also be right there for me. I am continuing to remind myself that there is light at the end of the tunnel. The fact that I started my LAST one...two days ago and it is heavy and I'm running to the bathroom everytime I stand, is helping keep me in the right frame of mind.

My guess is that I am just scared about the whole, but it helps to have wonderful sisters like you both who can relate and help to calm the nerves.

Thanks again,
Unread 05-11-2007, 09:54 AM
Getting Cold Feet...

Kathy, I too was concerned about being off of work for so long, but my Mom put it in perspective for me when she said that I wasn't really giving my employer all that I could anyway since every month I am sick and in pain, so I cannot function at full speed (which if you take just 1 week per month, I am out-of-it for 3 months ever year). In reality she said that having this surgery and taking care of the problem, even if that means being off work 6 weeks will not only be better for me, but will be best for my employer too.

Unread 05-11-2007, 11:00 AM
Getting Cold Feet...

Hi (((Kathy))) I'm wondering... did your breast surgeon give a reason why he/she was against the idea of your having a TAH/BSO? And is that the DR who prescribed the Tamoxifen, presumably because of the ADH? My bet is because there wouldn't be any real benefit to your breasts of having the surgery.

I guess I'm trying to get a handle on the overall balance between risks and benefits here. I am coming at it from the other side... I had a TVH/BSO five years ago and have been diagnosed with DCIS and LCIS twice since then - once two years post hyst (had a lumpectomy) and once last year (lumpectomy + radiation). I am on transdermal, bioidentical HRT's and cannot take Tamoxifen (I tried).

I understand that Tamoxifen might be prescribed to inhibit the action of your ovaries' estrogen on your breasts. The problem is, Tamoxifen greatly increases the likelihood of endometrial proliferation, so some women who've been on Tamoxifen do end up having abnormal endometrial biopsies and/or endometrial cancer diagnoses and may have to have a hysterectomy.

But why remove the ovaries altogether, when they have so many other functions, if the Tamoxifen is taking care of the risk to your breasts? You mentioned that you are 50 years old, so you are probably fairly close to natural menopause anyway, at which point you could switch to Arimidex. The hormones your ovaries make affect so much more than just your breasts and uterus. There's bone density, for one; and cardiovascular and circulatory health. I know for me, if my estrogen dose is too low, my blood pressure goes through the roof; I get migraine headaches, blurred vision, and bone pain so bad I can't walk unassisted. What are your DRs planning to do to help you if you have a similar experience, if they won't allow you to use HRT?

BTW, you might want to take a look in our Resources directory, especially in the Breast Health section -- there is no additional breast cancer risk from estrogen-only HRT; the increased risk was in a specific group of women who were older, had already been through natural menopause and then used Prempro (a combination of Premarin and the synthetic progestin Provera) for several years. If you have a hysterectomy, you would not need to take Provera and could use estrogen-only HRT to manage your symptoms.

Since you are feeling unsettled about this, I might suggest getting another opinion from a DR who is not associated with any that you have been seeing -- someone who is looking at the whole "you" and takes an interest in your overall health from here on out. Good luck with whatever you decide to do.

Unread 05-11-2007, 11:02 AM
Getting Cold Feet...

Sandy, what a wise mother you have! She is so right! I wasn't looking at it like that, but she is correct. I normally gut it out (excuse the pun) when I am not doing well, and I would think my improved mood after surgery alone would be a welcome relief to the group at work! I'm ready to be "me" again!
Unread 05-11-2007, 11:23 AM
Getting Cold Feet...

Linda, the tamoxifen was prescribed by my oncologist, not the breast surgeon. The breast surgeon questioned the surgery (which is primarily being done to stop the estrogen production in my body which has sky rocketed over the last 9 months - levels are way too high and I am now in an estrogen dominance situation) because it is known that Tamoxifen can create high levels of estrogen in other areas of the body. She felt the high levels I was experiencing may be actually coming from the tamoxifen itself and not the ovaries with the cysts (which also push out the estrogen). Tamoxifen does not stop estrogen production, but rather acts as a lock-and-key and blocks the estrogen from going to the breasts. The two other doctors believe that while the breasts are being taken care of with the Tamoxifen, the increased estrogen being produced by the ovaries could create a breeding ground for other types of ovarian/cervical/uterine cancers. And because I am on Tamoxifen, my risk has increased. The twist to the whole thing is that it is possible once the TAH BSO has taken place that I will no longer need to take the Tamoxifen whatsoever. Time will tell.

As long as the estrogen levels are so high, the chance of going through natural menopause is unlikely, at least it appears for me. I have more periods more often and in greater length than I ever had...usually last 20 days and I can get them 7 days apart. Not good. I am now borderline anemic because of the blood loss.

Because of the high cancer risk (both my issues and the fact I have four immediate relatives with breast cancer), the estrogen replacement is not going to happen in my case. This site also has had a number of women who have gone through a hysterectomy without HRT with great success - I am hoping to join their club. I understand my two doctors concerns about stopping the estrogen, and also can understand the breast surgeon's concern. It really is a vicious circle, and can be so confusing.

Thanks for your comments, Linda. You have given me a lot to think about, and I appreciate your thoughts.

Unread 05-11-2007, 02:35 PM
Getting Cold Feet...

Each woman has to face different issues and make decisions that are best for us. In my case, my doctor felt that taking hormores of any kind would not be in my best interest. I had no hot flashes for the first 8 weeks post-op, and then had one weekend "from Hell" - at least that is where I thought I was

I was told that estrogen is stored in fat cells - so for a fluffy woman like me - it took a few weeks to get them all out of my body.

I figured millions of women have gone through menopause - natural or surgical - without the benefit of hormores. If they could do it - so could I. I think having a positive attitude goes a long way. If you need "help" - then take it. If not, you can handle that too.

I found that Fu Kang - a chinese herb product, helped control the flashes - now I only have a few each day - and they are more flushes than flashes.

I also purchased a small, handheld, battery operated fan....which I wore around my neck on a chain. Much to the delight of my teenaged children You do what you have to do to be comfortable. At 50, I take comfort over fashion any day

I am a little worried about the Virginia heat and humidity that is coming - but I feel so much better otherwise - that is no biggie.

I must add - my mood swings are gone! No more PMS!! ( which had gotten terrible in the last few years)

Just remind yourself - that in a few weeks - you are gonna feel so much better and have control over your life. You can do anything - and YES!!! there is light at the end of the tunnel.

Mary Beth
Unread 05-11-2007, 03:39 PM
Getting Cold Feet...

Mary Beth, what a ray of sunshine you are! Thank you for your words of encouragement. I was laughing out loud with the image of a fan hanging around my neck...whatever it takes to get the job done....most definitely to be cool! Currently my weapon of choice is a bottle of baby powder!

Honestly, I have heard wonderful things from other women about not taking hormones, and just doing it naturally. How many of our ancestors did just that and managed to survive it? I'm looking forward to not adding anything more chemically to my body other than what I already have. Everyone is different, but I am keeping my fingers crossed that I'm going to be a "natural". BUT, if I turn out to be the Bride of Frankenstein , well, I may need a little help.

I'm just anxious to get the surgery over with, get back in to my exercising and daily routine, and start feeling GREAT!

Thanks again...and Happy Mother's Day this Sunday!


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