An Anniversary

In August 2022, after years of declining health and mobility and increasing pain, I made a decision to change my life. This is a photo of me in September 2022.

And this is me today, 70 pounds lighter.

First I made the decision to get stronger, so I started strength training twice a week for 20 minutes at a time at a local specialty gym called The Exercise Coach. Then I added cardio to my habits; my favorite gym machine is the elliptical, and I'm a big fan of walking. After a couple of months, I was ready to reduce my intake of calories gradually and track what I ate. I figured there was no timeline except the rest of my life, so progress could be incremental. The practice of losing weight a few ounces per week is what kept me going, because I decided that all foods were acceptable to eat as long as I was honest and tracked it, that starvation would lead to exhaustion and rebellion, and the key to all this is feeling good in my body while shedding weight. 

After the first 25 pounds shed, I saw an endocrinologist who suggested I try a GLP-1 medication. She said it would likely help, as I had "hacked my own psychology" by doing healthy things. I would not be using the shot and expecting it to do all the work. So I tried it, and I am among the percentage of people who were not disabled by side effects and for whom it worked. It was very odd to experience the shift. "Food noise" is real. The medication quieted that. It also dampened my feeling of appetite for many other good things. But I've figured out a way to adapt. I imagine I will take this medication for the rest of my life, as part of the chronic condition of obesity.

I'm now at a weight I was in my thirties, and I was functional and strong. I can remember well-intended suggestions by men that if I just lost some weight, I'd be really pretty. But honestly? I feel and look good.

So yes, I could lose more weight. I'm technically in the "overweight" BMI for my height. However, I have figured out a way to live and enjoy my life, even with the limitations of exhaustion (from aging, from battling cancer, and surgery). So for the time being, I'll keep on as I have been. 

The New Reality

Selfie - hugging a tree in the Sierra Nevadas

I had five targeted doses of radiation over ten days in late June, during which I turned 63. I'm not feeling the latent fatigue they forecast, though I experienced it during treatment. Then I started the medication designed to reduce risk of recurring breast cancer or developing metastatic cancer if I take it five years, called anastrozole. At first I thought I was lucky -- no noticeable side effects in the first couple weeks. Alas, a month in, I'm experiencing what the obliteration of estrogen does to the body. Most prominent is joint pain, sore muscles, and stiffness all over. I feel it especially in my hands and wrists. This brings me back to the misery of my pre-weight loss era; I had so enjoyed pain-free movement the last few years. I experience restless legs while trying to fall asleep, as well as 4 a.m. awakenings. My thoughts are slower -- brain fog. And I feel, on a cellular level, an absence of energetic capacity. The shrunken reserve requires careful choices and an acceptance of the current reality, so I feel some grief too. I have a good life. What's occurring to me is normal. Aging happens, health declines, or is otherwise compromised. I don't love it. Then I look up from writing and glimpse six-point buck wandering through the yard! He lingered long enough to delight me. I hear my child singing upstairs in this rented cabin. No sweeter gift than that.

On Target

Today I received my first targeted radiation treatment. Because the cancer was caught so early and was so small, I'm eligible for partial breast radiation rather than whole breast. I have a total of five sessions, another benefit of early detection. The process took ten minutes, and I felt nothing but appreciation. 

I appreciate how something that could kill me can, in the right dose and delivery method, improve my healthspan. I appreciate the scientific method and the curiosity of humans who pursue questions and hypotheses that lead to such discoveries. 

I appreciate my life.

Rage Is What I Feel

Hearing "you have cancer" shifts everything. I don't want to be a fucking warrior and survivor. I want not to have cancer.

While the treatments have improved outcomes, they do so with heavy side effects and SERIOUS secondary risks to other vital organs and general health.

What I'm concerned about are cascading impacts. I'm not 45, I'm nearly 63; overall just older and more vulnerable. I have chronic kidney disease. So NSAIDS are out of the question. I have osteopenia. There may be other unidentified health issues that could emerge as a result of treatment impact. 

By cascading impact I'm thinking: Aromatase inhibitors can cause severe joint pain. This pain interferes with quality of life and reduces motivation to move, and no NSAIDS can be taken. Reluctance to push through pain and exercise thus increases, causing more poor health. Cheerleading to "push through" and exercise will only do so much. I spent years in all over body pain from my mid-40s until I dropped all my weight. I have relished feeling pain free (for the most part) and the vitality it offers. The prospective return to the pain state is depressing.

Radiation treatment can damage the heart, leading to surgery for repairs. It can damage lungs leading to breathing problems. It can cause secondary cancers. It's RADIATION.

And yes, cancer can be managed. There are people living with stage 4 cancers as chronic conditions. But it's a compromise, and capacity is reduced. Mobility and energy are severely impacted. 

Last year I was healthy. This year I have two malignant tumors. I have plans and goals that I may no longer have ability to pursue. I do not want my Mom's elderhood experience. It was miserable. It began in her mid-60s and was a long slide into pain and decrepitude.

So right now I'm enraged about this turn of events. I don't feel philosophical about this. I don't care that the big C isn't as lethal as it was decades ago. It's still lethal, and recurrence can happen, and it means living with this fact in the forefront of my mind for the rest of my days. And that's after I have surgery to amputate part or all of my breasts. Recovery from that can take painful months. Meds are hard on the body, and I get to take them for up to a decade so the breast cancer doesn't return in some other part of my body. While my bones disintegrate in the process on the medication.

We're all mortal and older, and we know this intellectually. I tell you that it feels very different, dire and scary, when it becomes the actual reality. This diagnosis feels like I got pushed off a cliff. And yes, I'm glad it's not stage 4. But it's still fucking cancer.

Comments attempting to reassure me of the good outcome possible blithely ignore the monumental impacts and suffering to potentially achieve this. Those comments are relevant to me strictly coming from women who have faced the same situation, options, and decisions.

As I learn about having multifocal/multicentric breast cancer, gather information about treatment, and face decisions, I'm not sure I have the desire or tolerance to share more details ongoing. I'm angry and grieving. I need to get through this with as much equanimity as possible. And I need to help my child cope with momma's illness while he's trying to graduate and be excited about college and launching into independence. It's fucking sad is what it is.

“rage” by roger901, CC BY-NC-SA 2.0

What The Doctor Said

What The Doctor Said

He said it doesn't look good
he said it looks bad in fact real bad
he said I counted thirty-two of them on one lung before
I quit counting them
I said I'm glad I wouldn't want to know
about any more being there than that
he said are you a religious man do you kneel down
in forest groves and let yourself ask for help
when you come to a waterfall
mist blowing against your face and arms
do you stop and ask for understanding at those moments
I said not yet but I intend to start today
he said I'm real sorry he said
I wish I had some other kind of news to give you
I said Amen and he said something else
I didn't catch and not knowing what else to do
and not wanting him to have to repeat it
and me to have to fully digest it
I just looked at him
for a minute and he looked back it was then
I jumped up and shook hands with this man who'd just given me
something no one else on earth had ever given me
I may have even thanked him habit being so strong

--Raymond Carver

It's NOT a Journey

Last Tuesday I learned that I have breast cancer. It wasn't a surprise, since it runs through the maternal line of my family. However, I'd hoped to be at least in my seventies before I heard the words. Because it does run in the family, I've been getting annual mammograms and MRIs for the past 15 years after a suspicious development was found and removed in 2011. The cancer was found via MRI.

Even though it was caught early, even though the tumors are small, even though I've been told it's slow-growing and have an excellent prognosis, the fact is that I have an illness that could eventually kill me.

I need to get genetic testing, because apparently there are new ways to identify vulnerability to cancers. I need to decide whether to do a lumpectomy + radiation + 5-10 years of medication (with gnarly side effects), or to get a bilateral mastectomy (major amputation surgery) and hope that this eliminates the risk. The problem is, cancer can come back in other locations. One stray cancer cell that evades treatment can migrate somewhere else and not be identified until it's quite advanced. Additionally, my mother had metastatic melanoma as well as breast cancer. She had both at the time of her death. So, I have a 50% chance of developing melanoma.

While we all die of something eventually, knowing shifts and hits different when you are told your body has been overtaken by renegade cells.

I'm 62, and I've worked hard over the past four years to get healthy, including losing 75 pounds, doing strength training and cardio regularly, and eating nutritious food. I appreciate my body and all it can do. I've cherished the improvement of my health; I made this change because I witnessed my mother's drastic and painful decline, which resulted partly from neglect, and I want a more functional elderhood. I was looking forward to launching my kid to college this fall and having an empty nest and new adventures with my husband.

Now all that comes to a screeching halt. 

I loathe the term "journey." It romanticizes an experience that is fucking traumatic. This is not a journey. Nor is it an expedition, a trek, a trip, a safari, or a passage of any kind. It is a goddamn inconvenience. It is frightening and painful and difficult. It is an obstacle to joy and thriving. If you want to help, don't use that word when communicating with me. I'm slow to anger, but these days my tolerance is paper-thin.