Tamixofen Users - Don't Take Antidepressants, Too!!!!

Many women take Tamixofen, which cuts in half the chances of their estrogen-positive breast cancer from coming back. Because hormone pills are a no-no for such situations, antidepressants have been prescribed in the past to help fight hot flashes.

As everyone should know, drugs can interact and interfere with each other. Some drugs can diminish or completely cancel out the effectiveness of other drugs.

Recent cancer studies on about 1200 women over a year by Medco Health have found that some (not all) anti-depressants (Prozac, Paxil, Zoloft and others) decrease the effectiveness of Tamixofen. They found that about 7% of women not on anti-depressants have a cancer recurrance but this percentage doubles for women who are on anti-depressants.

Medco's chief medical officer, Dr. Robert Epstein recommends staying away from Prozac, Paxil and Zoloft for now. Dr. Claudine Isaacs, a breast specialist at Georgetown University's Lombardi Cancer Center, agrees and recommends erring on the side of caution and avoiding those three particular anti-depressants .

Back in 2006, an advisory panel recommended putting a warning label on Tamixofen but the FDA has yet to implement action.
Please see the other articles listed in the margin. You might also be interested in reading about: Hormone Receptor Postive Breast Cancer.

Chemo & Nerve Damage (Neuropathy)

One of the side effects of the some chemo drugs is nerve damage (neuropathy). Most of the time neuropathy affects the hands/arms and feet/legs but it can strike anywhere. A friend of mine who also went through chemo has it in her "lady parts." It can feel like being suddenly stabbed by a sewing needle, tingles, pain and then numbness. It's no fun (especially for my friend)!

Chemotherapy drugs can affect otherwise healthy nerve cells. The result ranges from tingling, numbness, weakness, to outright pain. Some people have difficulty dressing, grooming, sitting, walking or picking up objects. They appear to be clumsy. Internal nerve damage can cause digestion and bladder issues.

People suffering from neuropathy are likely to suffer injuries and accidents. It's best to avoid sharp and hot objects. Keep fingernails short because one can accidentally scratch too much causing injury to a numb area. Dropping things and falls are common.

The chemo drugs Cisplatin (Platinol), carboplatin (Paraplatin), vincristine (Oncovin, Vincasan, Vincrex), and Paclitaxel (Taxol, Nov-Onxol, Onxol, Paclitaxel NovaPlus) can strip the myelin sheath (nerve coatings). Patients receiving very high doses or frequent doses have the greatest chance of suffering from neuropathy.

One should know that chemo is not the only cause of neuropathy. It can also be caused by the cancer itself and radiation treatments, as well as by diabetes, kidney problems, and poor nutrition.

There are a few ways to prevent neuropathy. Calcium and/or magnesium IV's just before chemo starts can help. Amifostine (Ethyol) given just before chemotherapy begins can help as well. Ask the doctor in advance about which chemo drugs are planned and if any are likely to cause neuropathy. It's important to stay active and keep moving during the chemo treatment months.

Tell the doctor right away if any neuropathy symptoms are experienced. Luckily, there is treatment for neuropathy. A tricyclic antidepressant might be prescribed for tingling and numbness while an anti-convulsant might be prescribed for sharp stabbing pains. Sometimes a capsaicin cream or something else is recommended for pain in the hands and feet. See if the doctor is agreeable to trying out acupuncture.Vitamin B and magnesium levels are sometimes lowered by chemo or poor nutrition. These deficiencies can also cause neuropathy. The doctor might recommend Vitamin B, folic acid and magnesium supplements.

Sufferers of neuropathy need to keep moving, get the blood flowing to the extremities. Resist the temptation to become a couch potato. Make sure someone is nearby or assisting in case a fall or other accident.

Sometimes the neuropathy only occurs on the day of treatment or lingers for awhile but in some cases the nerve damage is permanent. Some people might need physical therapy or occupational therapy to regain mobility and independence.

Breast Reconstruction - Implants & Nipple/Areola Tattoos

The Women's Health & Cancer Rights Act of 1998 says that if an insurance plan or coverage provides medical and surgical benefits for a mastectomy, then it must also include coverage for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical or balanced appearance, the prostheses (or breast implant), and any physical complications at all stages of mastectomy, including lymphedema.

After a mastectomy, many women choose to get breast implants. They help restore the psychological sense of being female as well as help clothing fit better, especially items that are fitted. Implants come in different diameters. Choose the diameter that fits your skeleton best. Implants come in different sizes, similar to cup sizes, but they are labeled according to how much fluid they can hold. The plastic surgeon should have some samples to see.

One type of implant is a saline implant. It has a clear silicone shell that looks like a balloon and is filled with a sterile saline solution (salt water).

Silicone implants are the other option. For several years they were off the market because of public concerns that the silicone gel inside might leak and cause immune system problems. Subsequent studies have shown that silicone gel implants do not increase the risk of immune system problems and so they are once again available.

There are two approaches to breast reconstruction:

  1. One-Stage breast reconstruction can be done right after the mastectomy when the skin is preserved. After the surgeon removes the breast tissue, a plastic surgeon steps in and places the implant where the breast tissue used to be.

  2. In Two-Stage reconstruction, the skin and chest wall are tight and flat after the mastectomy. First, a deflated "tissue expander" is put into place. Think of it as a temporary implant. It's job is to slowly stretch the skin, making it ready to receive the permanent implant. The expander has a tiny valve that the surgeon injects a little bit of saline solution into during several visits over time. Once the skin over the breast area has stretched enough, there is a second surgery to remove the expander and put in the permanent implant. Some expanders can be left in place as the final implant. Two-Stage reconstruction also allows for the option of waiting until after radiation treatment to begin reconstruction.

Things you should know about implants:

  • Implants may not last a lifetime. They usually come with a "warranty" for a certain number of years but might need replacing in the future. That means surgery again.

  • There might be complications from any surgery such as scarring, pain and infection.

  • Contact sports and activities are no longer allowed because a blow to the chest can cause a break or leak to the implant.

  • Capsular contracture (hard scar tissue around the implant) might occur. The plastic surgeon will show the patient massage techniques to counteract this during the healing process but it's not a 100% guarantee. Only a few people have this problem.

  • The end result might not be the "beautiful breasts" that one dreams of. It's a reconstruction, not a recreation.

A word about nipples- believe it or not, new nipples/areolas can be tattooed on. Yes, the surgeon can do this! There is a little bit of post-operative care but it's easy.