Wednesday, March 28, 2012

O.M.G. What's an I.U.D.

Many times, I have felt that when I write, I vent and I don't necessarily want that to become a habit. I think because in my day to day life, I am always the one smiling or laughing and so when I am alone with my thoughts and writing about cancer, I think I write about what frustrates me or makes me sad or scared.

What's been on my mind a lot lately is the lack of options that cancer has provided me with. Cancer has robbed me of a lot and has limited what I have control over anymore. Many things that most young women get to decide have been decided for me. The bra shops that I go to are predetermined; the average bra is about $80 now and they are pretty generic (the word 'sexy' hasn't quite hit the mastectomy world yet), having children may not be a decision that we can make because it may have been made for us, if I do get pregnant, breastfeeding is not an option (or a choice) and contraception is extremely limited because of my hormone receptive cancer.

When it comes to birth control, I can't use anything that releases hormones so that means no pills, no rings, no shots, and no implants. We are limited to abstinence, condoms, diaphragms, and IUDs. Let's just cross abstinence off the list, male condoms have a variety of drawbacks and have you seen the size of the female condom, you could fit a small elephant in those suckers. Diaphragms need way too much preparation and IUDs require a 'procedure' to put it into place. So what's a girl to do who wants to get pregnant but can't get pregnant until she's done her 5 years of Tamoxifen? She goes with an IUD.

After chemo was over, I knew I had to do something about contraception but really, the odds of me being able to have a baby are as low as 40% so what are the odds of getting pregnant? And then I thought, the odds of me getting breast cancer at 26 years old were less than 1%, right, so, contraception it is. The thought of an IUD really grossed me out, and between my breast implant, my PICC line and all the chemicals that have been put through my system, I didn't know if I was ready to be poked and prodded once more.

I looked into it and really, everything I read said that there was some initial discomfort but the pros seemed to outweigh the cons. An IUD (Intrauterine Device) is a 'T' shaped device that is inserted into your uterus by a physician that kills sperm and prevents pregnancy. There are two different kinds of IUDs, one that releases hormones (that my family doctor assured me would be fine because it releases progesterone and my cancer was estrogen receptive but I don't want any extra hormones of any kind if I had an alternative, thank you very much), and one that is wrapped in copper (sperm apparently hate copper) which is the one I chose.

So after squirming through the thought of going through another procedure that cancer has cornered me into, I went to my family doctor and said 'I want an IUD'. Let me tell you the benefits first. It cost $68 (not covered by our drug plan) and it lasts for 5 years. That's a cost of about $1.11 a month. If for some reason you want it out before 5 years, it can easily be taken out by a physician. And, you can start trying to conceive a child after your next period once it's been removed. Another great thing is that I never have to remember to take it (or take it out), I don't have to stop what I'm 'doing' to put it on, and there are no hormones associated with it. Oh and once it's in, you can't feel it, I'd have no idea it's in there, it doesn't move, etc. etc. etc.

Luckily, my family doctor does it in her office (apparently not all family doctors do this). So, I made an 'insertion' appointment and mentally prepared myself for going through another procedure. I 'googled' IUD insertion and although many people advise against googling things like that, I always like being prepared. Google and I have been best friends since last March and I seem to be able to weed through the garbage and find the credible information. I would rather know every symptom that could happen and experience nothing than not know any symptoms and experience everything. The information that I found mostly discussed extreme cramping and the pain during the procedure. All I kept thinking was 'if I can make it through chemo, I can make it through this.'

So my doctor wrote 5 prescriptions at my consultation appointment that I needed to get filled before my next appointment. They like to insert the IUD the day after the last day of your period. The IUD is a prescription that you need to fill and bring with you to your 'insertion' appointment. My 5 prescriptions consisted of an IUD, 2 antibiotics (to prevent and 'cure' any infection the IUD may cause), 1 to prevent a yeast infection from the antibiotics and the last one was a pill that I had to insert vaginally to soften my cervix... You know, every know and again as I'm writing these blogs, I picture one of my brother's reading it and wonder if either one of them ever think 'You know, I know more about my sister's boobs/uterus/cervix than I ever wanted to.' But then I think about how many times I wish I could have found information about the 'stuff' that I write about from a real person's perspective and it makes it all worth it. So, if I'm your sister, daughter, aunt, niece, etc. etc., I'm really sorry.

Anyway, the day before the insertion, 3 vaginal pills are inserted (by you), one in the morning and two at night. The next day I went into the doctor's office, my name was called, I went into one of the rooms, disrobed, and before I knew it the car jack was in place. Now, I am 6'0 tall so I have longer everything. It never fails that my doctor inserts car jack #1 then says 'I can't see your cervix, I need to get the longer spreader-opener'. I call it Bazooka Joe but who really knows what it's called. ANYWAY, she props me open, does a pap-test (I mean, might as well make a day out of this and have 'the works' done while she's down there), and then she really cranks me open. She said 'Oh I can finally see your cervix.' I don't really know what to say so I think I may have said 'Oh, good' as if I thought it had fallen out or something.

So, from there she was trying to talk to me to distract me (I'm an expert at identifying when a medical professional is trying to distract me as I am a self proclaimed needle-phobic and distraction is the number one technique for them to try to calm me down) but I was just trying to focus on my breathing. She said 'this is going to pinch a little bit' and I know what 'pinch' and 'little bit' means in the medical world so I closed my eyes and bit my own finger to try to localize the pain somewhere else but nothing happened - I didn't feel anything. And then she said 'You have to be very still right now, this is the crucial part' and so my eyes slammed shut again and my teeth sunk into my finger a little more and then she said 'Ok, I'm done'. Huh? Isn't it supposed to hurt? I didn't even feel it. I asked if I could sit up and she said 'Sure, if you want to'. So, I started getting dressed and although for about 6 hours afterwards I was walking around with my legs kinda closed (I may have been a little nervous that it was going to fall out), it was entirely pain-free.

I did experience some cramping for about 48 hours but that was it. And since I've gotten the IUD, I have found out some interesting facts.
1. The IUD is the most effective form of contraception (the fact that there isn't any responsibility on you or your partner to take a pill or insert a device, etc. is taken into account here too).
2. North America is the only part of the world where the IUD isn't the most common form of birth control. We are a whole bunch of pill poppers.
3. An IUD was a form of birth control that was meant for women who have had children but in the past ten years that approach has changed and more and more childless women are using IUDs as their form of birth control.
4. All the cool kids are doing it.

So, the downside you ask? Well, the only main downside that I've read about but have not yet experienced is heavier, crampier periods (that's with the copper IUD, with the hormonal IUD, your periods can sometimes disappear). I have not yet had a period since I've had the IUD so I can't attest to that quite yet. Hopefully it's nothing a little Advil can't cure.

So now, I have made it my mission to spread the word about IUDs especially for breast cancer survivors who are still in their reproductive years. I wanted to let women know about IUDs because I didn't know much about them and what we don't know usually scares us. There is always talk amongst us young breast cancer survivors about the pill and whether it did have an impact on us getting breast cancer so young and many times my girlfriends ask me if I think there is a correlation between the pill and breast cancer in your 20s. To be honest, I have no idea and if I hadn't have gone through what I just went through over the past year, I would probably still be on the pill but now my train of thought is, if there is an alternative, why chance it? Even if the pill has nothing to do with breast cancer, is it a good idea to be pumping all those hormones into our systems? I guess the same could be said for leaving a copper device in my uterus for 5 years, maybe that's a bad idea too, so who am I to say?

Wednesday, March 14, 2012

The Gift of Cancer

The number eleven means different things to different people; there's Sept 11th, making a wish at 11:11, there are 11 points on the maple leaf on the Canadian flag, and lately the eleventh hour has become too much of a reality. Eleven is significant in my life because March 11th is the anniversary of my diagnosis.

Now, I've dealt with this whole breast cancer thing like a rockstar and at every new milestone (if you can call them that), although nervous, I seem to pull through with a smile on my face. Chemo was tough but I still found a way to laugh through it and being down one breast has opened up a whole new world of humour (let's just say Beyoncé's, 'All the Single Ladies' has an entirely new meaning).

I could write a book about how grateful I am or how lucky I feel, for a variety of reasons and very often I can see the positive side of things. Every time someone would tell me 'It's not fair that you have cancer', I would reply 'Well, at least it's a breast and not my liver' or 'Well, at least I'm 26 and not 3 years old' or even 'Well, at least I can one day be deemed cancer-free instead of having to live with cancer for the rest of my life'.

I'm telling you, I've been annoyingly positive about this whole thing but every now and again, I have a dark day, a day when I don't want anyone to 'fix' anything, a day when I need to vent without someone telling me how lucky I am. How lucky did you feel when you got cancer? I can pull myself out of these 'funks' but sometimes I need to be left in them. Some days I need to say how shitty it was and how shitty I still feel in order to move past it.

I wasn't sure how I was going to handle my first cancer anniversary; would I cry, would I need retail therapy, would I want to go out for drinks and celebrate or would I want to hide under the covers for the whole day? I felt like there was an expectation for me to celebrate and although I have managed to see the bright side of every situation since the beginning, I struggled with the bright side of having a cancer anniversary at 27 years old.

One of the annoying things is that every time I feel like this, I feel like either I am being super negative (rather than just not positive) or that I feel like I need to apologize for not putting a positive spin on things. I think a lot of the time I am positive for other people as well, to make them feel comfortable. People don't know what to do if I start crying or tell them I am scared that I won't see 30 years old but as soon as I crack a joke or make light of the situation, it puts them at ease. It doesn't really seem fair when I think about it that way, but I can't handle anymore tilted-head, teary eyed, mouth slightly opened looks when people hear that I had breast cancer. I'd rather say 'Keith doesn't like two breasted women anyway, so it all worked out' just to see a smile instead of that damn tilted head look.

I was lucky enough to be with 3 of my good girlfriends on Sunday so I didn't have the opportunity to hide under the covers all day, which ended up being a good thing because I think that's what I would have done had I been alone. I missed Keith a lot on Sunday because he seems to know when I need to hear something positive in order to get me back on track and when I just need him to listen to me. He knows I'll get myself out of the dark hole that I find myself in every now and again but until then, he knows he can't fix anything and I love that about him.

March 11th ended up being a day I wanted to get through, not a day I wanted to celebrate. I realized that my pre-cancer life is slowly getting farther away and now it's been over a year since I've had cancer which makes it feel more real for some reason. I wanted to forget and erase the day and I didn't consider it a blessing. I'm assuming that will change one day and maybe I will want to celebrate being alive, but for now, I feel a little jaded about being expected to be so grateful when really this past year has sucked.

I've heard people refer to cancer as 'a gift' and for those of you who have never had cancer, yes, you read that correctly, a gift. I think that stems from having a new perspective on life, taking fewer things for granted, treating life as precious as it is, etc. And, I think I am the first to say that I have been given a lot of opportunity since I've had cancer and yes, I do have a new perspective on life. I have made many friends, been given some incredible opportunities, (for example, next week, I get to do a photoshoot for a magazine where I even have my own stylist), I have been flown from here to there, I have spoken in front of hundreds of people, I've been given gifts, been in newspapers, magazines and on national t.v., I mean, if anyone understands the positive side of cancer it's me but in saying that, I would give it all back to not have had cancer. In my pre-cancer life, I may have been more ignorant, less perceptive, less equipped to deal with the real issues in the world and may not have amounted to a whole heck of a lot but damn a life without cancer sure does beat this. Even knowing that I would have remained the same naive, ignorant girl whose life was touched by cancer but who never really understood what it meant to go through it, I would gladly go back to March 10th and rewrite the future if I could, just to stop cancer's continual hold on my life. I hate that I will forever have an oncologist, I will always fear cancer's sequel and my right breast will always be missing.

Sometimes I just feel like I need to justify why I didn't spring out of bed with a huge smile on my face, thrilled to be alive. Most days I do wake up pretty happy to be alive, and I don't play the victim card that often but on the days when I wake up crying, and those days are so few and far between, I don't want to have to apologize, I don't want to consider myself lucky and I don't want to be grateful. On those days, I don't feel like a cancer rockstar, on those days I feel more like a one-breasted, emotionally overwhelmed, cancer victim.

Wednesday, March 7, 2012

March Madness, Indeed!

As we have entered the month of March, I am obviously bombarded with dates; March 1st, 11th, and 28th; biopsy, diagnosis, and mastectomy, respectively. And to be honest, it's more like March 1st, 11th, 16th, 19th, 23rd, 28th.

March 1st - I was so scared for the biopsy, the radiologist even called me the night before because she knew that I was terrified of needles. I begged them to let Keith come in and although they never let partners accompany patients, they made an exception in my case. I obviously thought the worst of it was over after they bandaged me up and although I was curious about the results, I certainly never suspected cancer.

March 11th was the day I found out. I still remember walking into my doctor's office and hearing Rihanna playing in the pharmacy beside the elevator. I was vibrating with nerves in the waiting room but still thought it was nothing; I was anxious for the results. The doctor came in and started making small talk, I told her I just wanted the results and her exact words were 'it's not good'. She told me it was cancer and my response was 'Holy shit, I wasn't expecting that.' Nothing can prepare you for that moment. My mom was withme and she was just as shocked as I was. I wanted to protect her and I'm sure she was thinking the same about me. I didn't want her to hear the news although I'm not sure how I would have told her. I was on the phone with the breast healthcentre within about 5 minutes to figure out the next steps. My chest was heavy and my legs were weak but I didn't feel like I had cancer. Nothing inside of me made me feel sick. We got in the car, and I called Keith. How do you tell someone that you love, that you have cancer?

The 16th was the first time the word 'mastectomy' became a part of my reality, the first time I found out that children may not be part of my future, the first time I found out I would lose a nipple, and the first time I found out how severe of a situation this was, and how little time they had to react and therefore I had, to make decisions.

The 19th was my MRI, which I'm sure isn't a big deal to most but it was my next big needle after the biopsy. Many fear the closed space of an MRI, I feared the needle. Once they had the IV hooked up, I was fine and to be honest I almost fell asleep in the confined space. The needle however, it caused many many many tears. I knew the MRI was going to show how much the cancer had spread and I knew that I didn't want the words 'liver', 'bones', or 'lymph nodes' said at my next appointment.

The 23rd was when I met my plastic surgeon. The whole expander process hadn't really been explained in detail so there were that many more tears in his office when I found out that they must inflate the 'implant in training' by injecting it with saline up to 12 times. I can't tell you how petrified I was sitting in that office. All that kept going through my head was 'is a breast that important?' I had 5 days to determine whether I wanted to go through with the process or not. I left his office thinking I was going to go through with it but on the drive home I wondered how I was going to handle each injection. Needless to say, I did figure out some way to get my breast back, well if you can call this a breast.

I don't suspect it will be an easy month but I am grateful that what I have gone through is in the past. I think the first of each occasion is difficult; first birthday post-diagnosis was a little tough considering I was in treatment, bald, not used to only having one breast, and going through hot flashes in the middle of August. My first Christmas post-treatment was a little teary eyed having not known if I was going to see Christmas back in March. And now this will be my first anniversary of my diagnosis and it is met with some opposing feelings.

Is it something we are supposed to recognize but not celebrate or am I supposed to be thrilled that the first year is behind me (the hardest year) and I feel pretty good about life? I can no longer say 'a year ago' to indicate my life before cancer, now I have to say 'over a year ago' which only makes me realize that I've had cancer for way too long. I'm assuming that most of these dates will fad away with the exception of the 11th; it will be an anniversary for the rest of my life and I hope I don't accumulate any more cancer anniversaries, because I feel like I have enough dates to keep track of as it is.

So, as an anniversary gift, I would appreciate that all you women check your breasts. At this point, I don't give a shit about guidelines and I think I'm living proof that 40 is just too late to start self examinations. So, if you're in your teens, twenties, thirties, or older - do self examinations once a month and I can't stress this enough; if you find something, tell your doctor. It probably is nothing but it's better to find out at stage 1 than stage 4.