02 March 2013

When phantom nipple syndrome is the least of my problems

I have Obsessive Compulsive Disorder, though apparently I forgot to tell the internet since there isn't an existing label for it. While I now freely admit that my functionality highly correlates to the number of milligrams of Paxil I took the night before, I used to be quite embarrassed about the whole situation. And with tidbit out of the way, we may now begin our story.

Normal people whose tumors with estrogen receptors have been thoroughly eradicated are prescribed five years of Tamoxifen. Assuming the patient doesn't ingest the entire supply at once, it prevents new tumors from growing. If things go as planned, the Tamoxifen gets to the receptors before any estrogen, making the cancerous cells too sad to multiply. It is the standard treatment for pre-menopausal women and slightly super important.

Why did I bother mentioning the OCD? Because combining Paxil and Tamoxifen is equivalent to combining matter and antimatter, so taking both is a laborious way of doing absolutely nothing useful. But wait! Oddly enough, it's common for cancer patients to be on anti-depressants such as Paxil, so there is a standard solution: Effexor for everybody!

The faster I switched to Effexor, the faster I could start preventing future tumors. Doctor Oncologist and Doctor Psychiatrist talked about me behind my back, and Doctor Psychiatrist prescribed an agressive titration from Paxil to Effexor.

To say that the Effexor didn't work would be an understatement. It anti-worked. It was such a fail boat that I missed work. Doctor Psychiatrist made the executive decision that not having me committed to a mental hospital was a higher priority then preventing theoretical future problems. An even more agressive titration back to Paxil was prescribed.

My brain had enough and went on sabbatical. Massive headaches prevailed. It ended up taking nearly three weeks to fully switch back to Paxil, and I ended up on a higher dose than when this mess started. But I was functional human being again! Hooray for the little things!

Doctor Psychiatrist declared her job done and sent me back to Doctor Oncologist. She clearly couldn't give me newfangled Tamoxifen, but she could use good old-fashioned estrogen prevention drugs. A monthly shot of Lupron makes my butt sad and prevents estrogen production in my ovaries. A daily Letrozole pill prevents estrogen production in my brain. While usually reserved for post-menopausal women, this regimen has a slightly better long-term outcome. If there's absolutely no estrogen production, none can elude the Tamoxifen and bind to a receptor.

Of course, Doctor Oncologist wants to do this for ten years. Only 120 shots in the butt with a three inch needle. But on the bright side, I get an equal number of skipped periods. I can think I can live with that.

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