The most powerful motivation

What does it take for us to do what we need to do?

When I started taking tamoxifen, after my first breast cancer diagnosis, I tried the new-agey technique of thinking about the cure when I took it: I imagined a white light flowing from my digestive system to my blood and cells. Sometimes I would look at the pill and imagine it blocking the cancer cells that had escaped surgery and radiation. I knew I had to take it for ten years. After that, freedom (still in time, I thought, to enjoy a few years with my hormones at normal levels before going through the menopause).

As soon as it was confirmed that I had metastases in my bones, the oncologist changed my medication to the following (and dear reader, if you're not interested in my layperson explanation of this medication, please skip to the next paragraph):

• Goserelin  interferes with the signals the brain sends to the ovaries to produce oestrogen, and switches off this production, inducing menopause. Goserelin is released through an implant placed in the stomach via an injection.

• Letrozole blocks an enzyme called aromatase, which produces oestrogen in other tissues of the body. Most oestrogen is produced in the ovaries and blocked by goserelin, but some oestrogen is also produced when aromatase transforms androgen into oestrogen, mainly in fatty tissues, muscle and skin.

• Ribociclib blocks growth stimulation proteins on breast cancer cells (cyclin-dependent kinases 4 and 6). This is the targeted therapy for my type of breast cancer (hormone receptor positive).

• Denosumab targets a protein essential for osteoclast survival. Osteoclasts work on our bones by degrading it and allowing  their remodelling. With less osteoclasts, bone loss and bone turnover (with potential cancer cells) will go down.

My pill-taking ritual changed. It took a little longer, and the accompanying emotions were stronger. 

I chose to take this cocktail while I had no symptoms, and the disease was only visible under PET scans and microscopes. This means that I have side effects (not many, thankfully) from the drugs before I even experience the disease. I know this also means that I am very lucky: I caught the disease early, before symptoms, and I am controlling it right from the start.

Every day, when I took my pills, I felt I should be grateful and imagine those little discs dissolving in my stomach, being absorbed into the walls of the intestine and spreading through the blood, and working to stop the growth of the cancer cells, one by one. I should be grateful because every day I take those pills is a day when the disease remains under control.

But as the days went by in the three-week cycle (I stop on the fourth week), sometimes I found myself wanting to get to the end of the box and get my energy back. I took them and thought, «Again?». When I felt worse, I felt like I was poisoning my body, and the white light spreading through the body turned into a black shadow.

At the same time, I know this is my best bet. If I’m lucky, I can take these pills for many years. I read about a woman who has been taking them for six years, since the clinical trials, which means six years of controlling the disease with few side effects.

On the other hand, sometimes I felt (feel?) discouraged when I think I have to do this for as long as I live. There will always be medication, maybe there will be more surgery and radiation, maybe chemo; there will alway be follow-up exams and doctor’s consultations. 

I know that if this treatment stops working or my body starts to reject it, whatever follows will be worse. So, I am grateful for taking the pills, for having a type of breast cancer that has this targeted therapy, and for not having to do chemotherapy at this point. It sucks, but it can always be worse. 

In those first months, I had a love/hate relationship with my treatment, maybe until I got the first evidence that it was working. Time passed, and I got used to it, up to the moment where I don't think about it, I just do it. It’s part of body maintenance, like brushing my teeth.

We say things like «the new normal», and there is truth in it. When I start something new, I tend to resist it, to question it, even when I’m very enthusiastic about it. It feels like my brain takes a long time to register new pathways and make them a part of the existing infrastructure. It also happens that once they are on the map, it is hard to change or obliterate them. This path is still being mapped out, but it's here to stay.

Maybe I could remember this when I am trying to implement a new routine. Especially with routines that take some effort in the short term but have a beneficial effect in the long run, like meditation and exercise. Maybe all it takes is a strong enough motivation, like not dying. It should be easy, right?