Is it hot in here, or just me?

As I near the bottom of my first 90 days worth of tamoxifen tablets, I want to make some observations. Tamoxifen citrate has been prescribed for post-BC patients for more than 20 years. Statistically, if a patient completes the full 5 years of tamoxifen treatment, there is a 41% increase in survival rates compared to no tamoxifen. This sounds pretty darn compelling, but there are problems.

First, it is only effective where the malignant tumor was estrogen-positive, in other words, fueled by the body's estrogen. It works by blocking the absorption of estrogen, taking up space on cells' estrogen receptor sites, and crowding out any estrogen trying to get in. Newer hormonal treatments such as aromatase inhibitors work by actually shutting down the production of estrogen, but they can only be used by post-menopausal women. There are some studies that show that recurrence rates can be diminished by a combination of tamoxifen and aromatase-inhibitors (2 - 3 years on one, then the remainder of the 5 years on the other) over using tamoxifen alone, but interestingly, there is no increase in overall survival rates. And all the hormonal treatments have some hefty side effects. The most serious for tamoxifen is an increased risk of endometrial and/or uterine cancer. Once again, I have to weigh the chances of that against the 41% statistical benefit of taking the drug to prevent a recurrence of breast cancer or metastases. I had an endometrial biopsy in April--I am good there, so far.

For now, tamoxifen is my only option, since I am still technically pre-menopausal. Not that you'd know, after 3 months of blocking my estrogen. I notice little things--the texture of my skin is starting to change, becoming rougher, hairier and drier. There's a little weight gain too, though that could just be the fact that Bill is home, I'm cooking more elaborately and pigging out myself, due to my usual lack of self-control.

The most dramatic side effect though, is what one would expect: pseudo-menopausal hot flashes and night sweats. With estrogen not getting through to the cells, my body thinks it's in full-blown menopause. During the day, it's manageable. I just spend a good portion of my waking hours changing clothes. I'm hot. I'm cold. I put on a shirt. I take it off. I change from jeans to shorts and back again. Socks on, socks off. I hardly think about it during the day.

Nightime however, is a different matter. I'm not sleeping all that well, mostly because my temperature gauge is totally out of whack. I awake in the dark several times a night, convinced I am about to burst into flames. This is of course impossible, not because spontaneous combustion is out of the realm of possibility, but because I am also soaking wet, clear through my pajamas and sheets. At best, I figure I would just smolder like a drowned campfire, and then the BS channel would do a special on the woman who mysteriously steamed herself to death in her own bed.

So, I get up. I run a cold washcloth over my face and whatever other portion of my body is bright red and raging, I change nightclothes and allow the sheets to dry out. Sometimes I wander into the living room, and lie on the couch under the ceiling fan until I chill down. Then, it's back to bed for rounds 2, 3, and sometimes 4.

Toasty-warm Bill usually manages to sleep through all of this up-and-down routine, and thankfully doesn't add to the problem by crowding me--this is because I barricade myself with a couple of throw pillows. He usually cuddles up to one of those, and presumably doesn't notice the difference in his sleep. And I am so okay with that. One more degree of warmth and I think I would indeed self-immolate.

This morning I woke up with a dream: I was lying on a beach somewhere, and "Ramon" came by asking if I would like a "spritz" to cool off? Hey! I could keep a squirt bottle on the nightstand instead of schlepping out of bed four times a night to wipe down with a washcloth! It wouldn't help the humidity/flop sweat problem at all, of course, but at least I wouldn't feel like I ran the marathon in the morning from all the getting up at night!

Now, all I have to do is figure out a way to groggily spritz myself without it turning into an unintended squirt-gun fight with Bill every night.