Menopause vs. ovulation

You may or may not know (though I do chat about it often) that I had taken Zoladex (goserelin) during my chemotherapy. What does Zoladex do? It shuts down your ovaries. Why was I taking it? In hopes that it might protect my ovaries and eggs while they were pumping in stuff to kill fast growing cells. What was the result? Bye bye period.

A potential risk of chemotherapy is the loss of fertility. Yes, ok, fair enough. So I asked the doctor: how will I know if I’m fertile? To which the doctor replied: You will get your period.

I’m not in the mood to freak out, but about two and a half months have passed since the Zoladex should have ‘worn off’. But for some women menstration doesn’t kick-in for months, so this delay is still in the range of normal.

Either it will come back eventually, or if chemotherapy killed my fertility, it will never come back at all.

Anyhow, so this has left me clinging to any and all signs of possible ovulation/PMS/period. Signs of ovulation/PMS/period:

Mood swings – I’m awesome one second and weeping the next. . . Similar to chemotherapy, actually.

I get randy –  like a week or two before my period a whole new kinda woman emerges (studies have shown that when women are ovulating they wear more revealing clothing. Interesting – we are programmed to project ourselves (and to notice others) when most fertile. Isn’t that fascinating? Next time you’re in a public place, look at the women around you guess who is ovulating.)

Cramps and bloating – the less fun side-effect of fertility and menstruation. Thank goodness for hot water bottles.

Food cravings!  And just this past moment I was nearly ACHING for dark chocolate. As this craving surged through me, I thought – hey, hold on, does this mean I’m ovulating? But then I was hit by a hot flash, so it’s quite possible I am not ovulating. Can a person ovulate and hot flash at the same time? Maybe . . .  isn’t that part of menopause? Not everyone turns off their ovaries with the pop of a pill.

Anyhow, why am I sharing this? Because it’s interesting and I’m in the mood to chat. But now it’s time to stop, because Zsolt’s abstract is waiting and I’m yet to look it over.

Final word: CHOCOLATE!!!

My Zoladex/Goserelin story

Zoladex is now over. It’s been a memorable journey, which I’d like to mark with a quick recap of injections. Five months of chemotherapy means five injections of Zoladex, otherwise known as Goserelin. Here goes (Dad, be aware, you might not want to read this – and that goes for anyone bad with needles):

Shot one: With time pressure, I agree to have the shot and leaving my decision on contiung for later. Zsolt, Mom and I had spent a busy afternoon trying to weigh up the pros and cons of Zoladex – will it save my eggs from chemo? Will it screw up my body? Are there any answers?

The message boards are full of stories about early menopause, several cases brought on by Zoladex, but every patient’s experience is different. Some women have terrible symptoms (hot flash, killed sex drive, aching body, mood swings) other women have less. But like the doctor said, “We can’t say how you’ll be affected.”

Anyhow. Immediately after my first AC chemo treatment I go into a consultation room and lay back on the bed. My shirt is rolled up, the nurse preps for the injection.

“Okay I’m going to shoot you with a numbing spray, then insert the needle. Tell me when it’s cold.”

I had heard she was the Zoladex expert. . . looking back I’m not positive about that assertion, but it was my first shot and I cannot be sure. She never again gave me a needle.

She sprays me with liquid cold. I say, “Okay, it’s cold.” And with me squeezing Zsolt’s hand, she injects the needle into the ‘numbed’ skin.

Sorry, did I said inject? She buries the damn needle – it’s length was never ending. All the while I’m breaking Zsolt’s hand and moaning with shock, wanting to kick this woman back, but instead simply repeating: “Ohhh my God, ohhh my God” over and over.

“Almost there,” says the Nurse One. And she pushes further.

*Click* goes the needle and the pill is inserted; I have officially entered menopause. The nurse takes out the rod of a needle: “There we go, all done!”

Yes, we were done. I was never getting that crazy-ass shot again.

Shot two: I am prepared for pain.

Having receiving advice from the doctor that while Zoladex isn’t unquestionably proven to protect fertility it’s also not shown to hurt, I decide to have another needle. By this point my hot flashes had set in, and time to time I would have back pain.

This is also the start of the nursing medical mantra: “Wow – big needle!” Because for a lot of these ladies (and gentleman) they’d never given, nor seen, a Zoladex shot before. Great.

Anyhow – all the nurses are avoiding me after my treatment as I wait in the green chair. I’d finished my AC about fifteen minutes earlier but still need my shot. Problem was, none of the ladies wanted to administer the giant needle. Ha, well, too bad for everyone.

Like fishing, we snagged one. Poor Nurse Two was passing by and inadvertently made eye contact.

She stopped. Looked away (looked for rescue?), and sighed.

“Okay.”

And off she went to prep for my Zoladex injection.

Frankly, this second injection was far less painful than the first. Maybe it’s because I knew what to expect, maybe not. Zsolt said that Nurse Two inserted the needle at a very shallow angle – but it hurt wayyy less, so who cares? And all the time she says, “What a big needle. That’s a big needle.”

*Click* over. We all laughed as I said thanks. She’d done a great job.

Shot three: Vomit bucket!

At this point in my therapy even the smell of chemo made me sick, but that wasn’t all . . . The doctor had called that previous Friday to say my platelets were low and I needed to miss a week of therapy. I felt crushed by the idea of missing Christmas in Canada – so my mental health was already fairly low. On top of that, I had to come into hospital and get a giant belly needle. Yay!

Arriving at the hospital, I made it halfway down the hall before throwing up. But you don’t need those details. Let’s just say, there’s a certain corridor where I often relive the public shame of vomiting without a bucket.

But I still needed my shot.

Going into the ward, I waiting for my picc line change (every week bandages must be changed, no skipping) and Zoladex. Okay, I vomited again as my bandages were changed – oh, did I ever hate that smell . . . actually, I hated the entire place, the whole establishment! And afterwards a new nurse, Nurse Three, arrived on scene with my third shot and a student nurse observing her work. Nurse Three and the student were about my age, maybe younger. I always enjoy the young nurses because I feel a sense of equality. They might be a nurse, but I know what they looked like drunk off their ass during fresher’s week; working with students for the past three years, I just can’t see these ladies as ‘in charge’ despite them being ‘in charge’. Maybe it’s ageist? But we have a different type of rapport, which I enjoy.

Right: teaching a student how to inject Zoladex.

“You need to get a good pinch of skin.” She pinches my belly, and yeah – she pinches really hard, harder than necessary, like, man, she has a handful of my belly, and there isn’t much to start with! The student nurse is making ‘oh yeah’ type noises. I’m holding Zsolt’s hand and cringing at the ceiling.

“Then you use the cold spray.” She shoots me with the cold spray. I tell her when to stop.

“How long does it last?” asks the student nurse.

“Oh, about a minute or so.” No, not true. Cold spray lasts seconds, yet I don’t correct her. She’s with a student; who wants to look back in front of a student? Mind you, that young woman now has the wrong impression of cold spray. Cold spray is wearing off. Nurse Three gets out my ‘giant needle.’

“Wow – giant needle,” says the student nurse.

“Huge,” agrees Nurse Three.

Awesome.

“Okay, so you put it in like this. Ready?”

“Yep,” I reply. And in goes the needle.

Hot damn that hurts! I’m doing my best not to freak-the-fuck-out, but it’s hard. Young nurses may be cool, but what pain! Zsolt’s eyes went saucers as I’m starting up into his face. Later he told me that Nurse Three inserted the needle at a ninety degree angle. So, squeezing my blob of belly fat, she vertically inserts this giant needle, and obviously it doesn’t go in far enough so she needs to push further, and further, and further.

*Click*

Wow, I’ve toughened up. First injection for the MRI and I passed out. Now I’m cringing my teeth as metal rods are being forced into my belly muscle. Ugh. Gross. But also, kinda amazing I’ve come this far. And afterwards, as always, we laugh.

Maybe laughing helps dispel the tension? We always laugh.

Shot four: A male nurse was training in C3, day-case unit, where I get my chemo. He’d never seen such a big needle, and couldn’t for the life of him stop letting me know.

Wow that’s a big need. Woah. Boy, I’ve never seen such a big need. Okay I’m going to stick it in, ready? Yeah? Are you sure, because this needle is huge!

I was looking away, but Zsolt later reported that Nurse Four used a very shallow angle. I hardly felt any pain, so despite all his going-ons it was a great job. (The lead nurse – the nursing mother – even asked him to stop telling me how big the needle was, but this poor guy couldn’t contain his amazement.)

Shot Five: Oh good, my last needle. Bring it on, Baby.

Again, like everyone else, Nurse Five had never given a Zolodex shot. In fact, she didn’t even look at the needle till before insertion – so this time there weren’t any exclamations about size. But she was nervous for sure.

“Can you please shoot me with cold spray right before injecting?”

By this point I know what I like. She was going to use cold spray immediatly before injection, and she’d be inserting at a thirty five degree angle.

But you can’t control a person’s nerves.

There we are behind the privacy screen, and I can only imagine what the other patients thought. Between the nurse asking, “Are you okay, Catherine?” as she slowly inserts the needle and I cringe at the ceiling, to my replying, “Yes, yes! Don’t worry – keep going!” to her asking, “Are you sure you’re okay, Catherine?” to my urgent assurance of, “Yes! Please! I’m okay!” And our voices are getting louder and louder and louder. . .

Well, who knows what others thought.

*Click* it was over. We laughed. For all the trauma, we laughed. It didn’t hurt this time round, it was just slowwww. But she did a good job. They all did.

And there you are: my Zolodex story. If  you’ve made it this far in reading, congratulations – you are tough. I hope your stomach is fine; mine’s full of holes.

Would I do Zolodex again? Whooo . . . please don’t even ask me. I hope I never need to do any of this again. With my final injection in place, the pill should last about a month. After that it’ll be a waiting game with crossed fingers. Please, oh please let my period return.

Last night I dreamt that Zsolt passed me a crying baby and I held it against my chest. It cried and cried, and I patted it’s back while singing a Jewel inspired lullaby. Eventually the little one quieted. And in my dream I said to Zsolt: okay, let’s start trying.

Then I remembered I was in the middle of chemotherapy, and next is radiotherapy, and after that it’s years worth of Tamoxifen. But nevertheless it was a beautiful moment, even if only a dream.

The shots were worth it, because I do want to have a family. Like my oncologist said – they don’t hurt, and they may help. Well, I’m taking all my chances; you’ve got to.

And that is the story of Zoladex.