Lessons Learned & Learning 18: 540 Days of Maintenance

Anastrazole Hijinks Edition

Prior maintenance updates: 30 days, 60 days, 90 days, 120 days, 150 days, 180 days, 210 days, 240 days, 270 days, 300 days, 330 days, 360 days, 390 days, 420 days, 450 days, 480 days, 510 days.

For this update, I'm presenting my eighteen-period comparison first. The vertical red line on my chart for average weight indicates the day that I had started taking anastrazole, the drug I'm on to try to prevent cancer recurrence. More on that in a bit:


My eighteenth 30 days looked like this:


Average calorie burn has increased, average total and net calories have decreased, weight has gone up. I'll give the stats first, followed by my analysis.

Weight: I had reached my goal weight of 150 lbs. on Dec. 17, 2013. According to MFP, that would place my net calories at 1600 for maintenance.

Between days 511 and 540 inclusive my weight averaged 150.3 and ranged from 149.5 to 151. My body fat caliper measurement on maintenance day 527 showed me at 29.8%, which is considered "ideal" for someone my age -- as compared with a measurement of 24.6% on maintenance day 329, which had placed me in the "lean" category. I had still been undergoing radiation back then and was less than a month past chemo.

Put another way, my body fat percentage is a source of consolation, because I am still just where I need to be.

Exercise Calories Burned:
I took 0 rest days during maintenance days 511-540, compared with 2 rest days (0 calories burned) during maintenance days 481-510, 1 rest day during maintenance days 451-480, 3 rest days during maintenance days 421-450, during maintenance days 391-420, 1 rest day during maintenance days 361-390, 0 rest days during maintenance days 331-360, 1 rest day during maintenance days 301-330, 1 rest day during maintenance days 271-300, 2 rest days during maintenance days 241-270, 1 rest day during maintenance days 211-240, 2 rest days during maintenance days 181-210, 1 rest day over days 151-180, 3 rest days over days 121-150, 5 rest days over days 91-120, 3 rest days over days 61-90, 4 rest days over days 31-60, and 2 rest days over days 1-30.

My average exercise calories burned for this period equaled 475/day (my highest average for any maintenance period). My highest burn was 718 on May 22, representing both stationary cycling and walking on my manual treadmill set at a 10-degree incline. On eight days I had added stepping, dancing, or treadmilling to my usual cycling workout, not so much to burn more calories (though that helps, all things considered) but to include weight-bearing aerobic exercise. My May 18 bone scan showed osteopenia in my right hip. In addition to weight gain, bone thinning is a side effect of anastrazole (my bones had been fine prior to cancer treatment). I'm also lifting weights, and have ordered the Better Bones and Balance DVD from Oregon State University.

Needless to say, the side effects piss me off, but not as much as cancer does.

Total and Net Calories Consumed:
Total calories for maintenance days 511-540 averaged 1802/day and ranged from 1449 (May 23) to 2091 (June 5). Net calories (total calories minus exercise calories burned) averaged 1327/day (83% of maintenance and my lowest average for any maintenance period) and ranged from 881 (May 23) to 1618 (June 6).

My main challenge these days is making sure I eat enough, while doing what I can to keep my weight at a healthy level and to deal with the other side effects of cancer treatment.

Analysis:

Anastrazole is a kind of drug called an aromatase inhibitor (AI). That class of drugs is given to post-menopausal women whose breast cancer was estrogen receptor-positive (ER+). That kind of cancer feeds on estrogen; the job of the AI is to starve any ER+ cancer that tries to start up again.

Being post-menopausal means that my ovaries no longer produce estrogen, but my adrenal glands still do. My adrenals actually produce androgen, which an enzyme called aromatase then converts to estrogen. The aromatase inhibitor puts the kibosh on that conversion.

Anastrazole has been shown to do a great job at preventing cancer recurrence, but stopping estrogen production entirely comes with a host of consequences. Weight gain is one side effect of the drug. A Concordia University study showed that estrogen deficiency affects women's fat absorption. "[P]ost-menopausal women burned less fat than their pre-menopausal colleagues," the study found. "These changes mean that their cells are not only storing more fat, but are also less willing to part with it. This combination is a recipe for rapid weight gain."

Through diet and exercise and religious logging at MFP, I had managed to drop 51 pounds to reach my goal weight even while post-menopausal. (To date I have missed only one day of logging in since September 12, 2012, and that was the day of my lumpectomy.) This weight gain from anastrazole is a whole 'nother animal. Granted, we're not looking at a lot of pounds here, but I don't like the trend.

I also considered -- and eliminated -- other possible causes of the weight gain. It could be that my calorie burn numbers for exercise, including added exercise, are inaccurate. Maybe I'm not burning as much as I think I am. But even if that's the case, I have decreased my calorie consumption. And even if my calorie counts are off, that would have meant that they had been equally off prior to my start on anastrazole. My eating habits show very little variation. The same behaviors that had worked for me prior to my start on the drug no longer maintain their effectiveness.

In fact, it's quite possible that my added exercise and decreased average calorie consumption are keeping my weight gain from being more pronounced.

Added sodium was another consideration. My oncologist had suggested that I increase my sodium intake due to my low blood pressure and occasional bouts of vertigo. Sodium causes water retention, which can lead to weight gain.

I had increased my sodium intake -- somewhat -- after that appointment, which had occurred on May 5; but my weight gain had begun prior to that. As the top graph shows, the start of that gain coincides almost on the nose with my start on anastrazole back on December 6, 2014. Also, even after increased consumption, my sodium intake is still relatively low:



The vertical red line marks the day after I had seen my oncologist, when I began making food substitutions, like regular rather than low-sodium V-8 and tongol tuna with sea salt rather than tuna with no salt added. My vertigo has decreased, though has not disappeared entirely. Adding the sodium seems to be good for me -- but I don't think it plays a major role in my weight gain.

My main job is fighting cancer. Any weight gain connected with that is part of the overall collateral damage, and I am facing a situation in which I might continue to gain weight through the five years (at least) that I am on this pill. (Insert long string of curse words here.)

So, I am reinstating my plateau mindset. While I was losing those 51 pounds, my longest plateau had lasted for 48 days and persisted no matter what I did. I kept telling myself that I knew I was doing all the right things, I would continue doing all the right things, and the bottom line was that I was in much better shape than when I started.

Faced with this weight gain challenge from anastrazole, I will continue to do all the right things, no matter what. And, along with my other side effects, I will report this one to my oncologist. Beyond that, I will keep on keepin' on. I've gotten the all-clear on my recent mammogram, the first since the one that had led to my cancer diagnosis. That's my bottom line these days, along with maintaining my healthy habits because those habits have been linked to improved survivability.

"Bloom" was the prompt for my May "Creativity Heals" meeting: