I thought it was time to give an update on my progress with hormone therapy. Fortunately, there is not a whole lot to say. This week I added the denosumab shot (Prolia). The purpose of this shot is to help my body begin to rebuild bones, since I have some reduced bone density. The issue could have been caused by the chemo, by celiac, and can be worsened by the aromatase inhibitor.
Ever since my oncologist described the bone building process, I have imagined by body filled with these little scrubbers (osteoblasts) that eat up my bones. They were out of check with the calcium that was needed to rebuild the bones. So with every ache or pain in my spine, I imagined little scrubbers working too hard sweeping my bones raw. It is a bit of a funny analogy.
The denosumab reduces the scrubbers, so that calcium can start to rebuild your bones. One concern is that you need to have enough calcium flowing in your blood to make up for the sudden uptake by your bones. To ensure that you won’t have trouble, you do blood tests in advance of the injection validating that you have enough calcium in your blood. Because of this, the injection which is subcutaneous, must be given by a nurse who validates your labs before giving it to you. Since I do it at the chemo infusion center, they use the same checks and balances they do with chemo, having a second nurse validate with the first that you are who they think you are and your medical records line up with the prescription they are about to give you.
With that, I’m now on officially on the full regime of hormone therapy. I get a shot every three months to block my ovaries (Lupron) from producing estrogen. This also reduces the signals sent by the pituitary glad telling the ovaries to make estrogen. I take a daily pill (anastrozole) that prevents my body from converting fat to estrogen and blocks whatever production was left in the pituitary. Finally, every six months I get a Prolia injection to help my body rebuild bones which is one of the side effects of not having any estrogen in my system. After about two years, we will do another bone scan and validate that the osteopenia has been reversed.
I’m happy to report that so far so good. I haven’t noticed any significant side effects from the Lupron, anastrozole, or Prolia. The whole process does have a lot of moving parts. The goal is to prevent my body from producing estrogen because my cancer (all three tumors) were more than 95% estrogen receptor positive (one only needs greater than 10% to be called estrogen receptor positive). This means that the primary fuel for all of my tumors was estrogen. Blocking it, reduces the risk of recurrence (or if it is inevitable, it delays it – we just don’t know what causes some breast cancer to spread and others not to, so we cannot say it will prevent it). I’m just happy to have found a combination that is currently working for me. I say currently because it could change. In six months, a year, two years, my body could decide that it doesn’t like the anastrozole and start giving me headaches again.
I find the name ‘hormone therapy’ an interesting choice because what it is really doing is blocking hormones. In many ways it is really anti-hormone therapy.
The one side effect that I am noticing is a change in my sleep. I’m finding that I’m not able to sleep nearly as much. In many ways this is a good thing. It has meant a shift in my lifestyle – one which I describe a little in my post about sleep. For now, this change is working for me.
So far so good.