How do you solve a problem like tamoxifen?

I take it and don't think about the side effects very often because I can't bear to. The oncologist said to take it so I take it. I know there's a chance of developing endometrial cancer, so I get checked out by the Smooth Gynecologist Who's Younger Than I Am But Acts Like She's Older. What tamoxifen does seems so direct: It cuts off the absorption of estrogen, which is what my tumor grew on. In August the New York Times told us that tamoxifen can cause the formation of a non-estrogen-sensitive and hard-to-treat tumor. And Tuesday's NYT tells of omission bias, a term for the phenomenon whereby a person worries more about a low risk of harm from something they do than about a higher risk of harm from doing nothing. In the story, the worry was about tamoxifen. The Times reported that women are afraid to take the drug. Out of 632 women in a study, 80 percent said they were worried about side effects, and most of the women said they wouldn't take tamoxifen.
At rowing practice (indoors) Monday night someone was complaining about tamoxifen's side effects, including weight gain. I feel like a fool to take it. But the good it can do is significant. Though now I read now that there's a chance of cataracts and blood clots. My polycythemia vera puts me at risk for clots, and I take hydroxyurea for the p. vera, even though the drug could cause leukemia, because the condition itself could cause leukemia, and my inhaled steroid for asthma could combine with my other drugs to make me even more liable to develop blood clots. But the hydroxyurea lowers my red blood cell count, which makes me less likely to have a clot. Red blood cells are those round red spheres in the image above.

It is a difficult, difficult thing to be alive.

The papers pile up and the news gets worse and there's another surge, the world is dangerous and the wind chill here at the moment is four below. The house is creaking from the cold. I'm wearing a flannel nightgown from Austria and L is asleep between flannel sheets with sketches of snowmen on them.

On the one hand, on the other hand, on the other other hand.

[shrug image from dreamstime.com]

Oh, Oh, it never ends

Diagnosed yesterday with fungal toe nails. I have to put special nail polish on them every night. The bottle will last about a month or two and costs NINETY-FOUR DOLLARS AND NINETY-NINE CENTS and is not reimbursed by our health insurance. Yesterday I also started Tamoxifen, a bargain at $7.50. I'd been so so so scared of it. And why not? It comes with a paper that warns: Since this drug can be absorbed through the skin and lungs, women who are pregnant or who may become pregnant should not handle this medication or breathe the dust from this tablet. It's supposed to soak up my estrogen but it can also be used by infertile women to cause ovulation. It's a shapeshifter, something for everyone. It can make you fertile, cure you of cancer, give you breast lumps or increase your bone pain. Not to mention give you cancer. Its most popular trinity of side effects: mood swings, hot flashes, weight gain. Which I can get on my own without having to take this scary pill. Tamoxifen comes from the yew, which we have in the front yard. I should just go out and chew me a branch. The way dogs naturally start chewing grass when they feel sick.

My acupuncturist had told me to try Vicks VapoRub for my toe nails, but I couldn't quite believe him. And I will put foot cream on my chest and Chapstick on my split ends. Now I look around the Internet and there is mention of the Vicks cure--it's on line so it must be true. I should follow the scientific method and put Vicks on one foot and the $94.99 toe nail polish on the other. At least it'd be a way of making the polish last longer. For more on Vicks and feet, click here.

Toys R on Us & the Bad Oncologist

Monday I met with my friend C from the Bay Area, in town to give a lecture and to celebrate his father's 80th birthday. After being an adjunct lecturer and a freelance editor for many years, he's finally gotten a job as chair of liberal studies in a university. He is an inspiration to us all. He's considered full time but just has to work 30 hours a week. That is truly inspirational. All this is an answer to the question: What can you do with a Ph.D. in English?


We had coffee and then he went with me to Tom Thumb Hobby & Crafts in Evanston, because I wanted to look at outdoor furniture to put on my head. I'm working on a proposal for an art installation called Chemo/Lawn and part of it will be made up of pictures of such things on my lawn-like head. I bought two miniature trees, a swing set, slide, see-saw and picket fence. I don't know how I'll get the fence and trees to stay up. I sort of jokingly/seriously said I'd use chewing gum. The sales clerk said that it doesn't come off. I said, Peanut butter is supposed to work. And he said, On the Simpsons, they tried peanut butter and oil and nothing worked. I said, That's a cartoon!


How can people get household hints from cartoons? I mean, it's one thing to get political news from the Daily Show, but at least Jon Stewart is a real person. Though Jon Stewart isn't his real name.


Now on to the Bad Oncologist. As a scientist deciding what potions to give me, he was probably good. Or excellent. Let's say he was excellent. But as a person, not so good. My psychiatrist, the Effusive Shrink, had told me early on that some of my anti-despair medicines would mix badly with Tamoxifen. I mentioned this to the first oncologist while I was in the middle of chemo and he waved me off, saying there was plenty of time yet. The Effusive Shrink had to call him twice before he called her back. Flash forward to the Girl Oncologist, who made me wait while she looked up drug interactions. She found one, with Cymbalta. She said she'd talk to the Effusive Shrink about substituting Effexor. I met with the Effusive Shrink today who said that another anti-nihilism drug that I take, Wellbutrin, also mixes badly with Tamoxifen. Our plan is to taper off the Cymbalta and start slowly on the Effexor. Then we'll substitute something else for the Wellbutrin. In the meantime, I don't want to start Tamoxifen because then I won't know whether any side effects I have are from the Effexor or the Tamoxifen. But see, if the Bad Oncologist hadn't waved me off, we could have started this back in May. Though we were also waiting for the results of my genetic testing. Or rather, I was thinking about genetic testing then, though my surgeon had said it wasn't necessary, and I finally got the testing in July. If I had the BRCA gene mutation, I'd probably get my remaining ovary removed, and then I'd definitely be in menopause and I probably wouldn't be taking Tamoxifen. So I guess the oncologist was right to wait.

How disappointing to realize that there's no one to blame.