Congratulations, You Survived! (Sorry You Feel Like Crap)

A​​​​​​fter I had a partial mastectomy, 28 days of radiation, and a radical hysterectomy in six successive months, my dad hosted a little dinner party to celebrate the end of my treatment. “She’s cancer-free!” my husband happily announced. I was diagnosed with breast cancer on the heels of my mother’s sudden ovarian cancer diagnosis and passing. That I’d survived was, to put it mildly, a tremendous relief to everyone. It had been a hard year, and we were ready for it to be over.

Little did I know that it wasn’t over. I’d just started what was, for me, the hardest part of my treatment.

Breast cancer is strange this way. It’s the most common cancer among American women, affecting one in eight of us over a lifetime. Fortunately, it’s survivable when it’s caught early. But it’s also different: for the 80% of us with hormone receptor-positive cancers, the moment we’re declared “survivors,” we often experience a considerable decline in our quality of life.

To reduce the risk of recurrence, we’re put on very effective medications that block the hormones that fueled our initial breast cancer. Completing a full course reduces breast cancer mortality substantially. But the side-effect burden is significant, and I was learning firsthand why so many women go off these life-saving medications.

Collecting prescriptions like loyalty cards

For starters, I couldn’t sleep. Hot flashes, night sweats, and terrible leg cramps were waking me dozens of times a night. My doctors prescribed off-label use of the painkiller gabapentin, which did help, but it also worsened my fatigue and brain fog. A nurse later told me they call gabapentin the “stupid pill,” and when I learned that gabapentin is associated with increased cognitive decline and dementia, I stopped taking it.

I also felt like I already had dementia. Writing and speaking, I could never find the word I was looking for. My thoughts had to wade through molasses to get to me. I couldn’t focus or shift gears. I spent my days endlessly switching between browser tabs, starting things I never finished.

I also found myself uncharacteristically moody and irritable. I have always loved people, but suddenly everyone around me was SO ANNOYING. I jokingly diagnosed myself with “I hate all the things—especially you” syndrome. A psychiatrist prescribed an antidepressant and Adderall for ADHD, hoping to steady both my mood and my slipping cognition.

My primary care doctor added another antidepressant, one with an off-label use for the crippling morning arthritis that I’d started experiencing. Joint and muscle pain affects about half the women on the type of breast cancer drug I’m on, and is the single most common reason they go off it. It felt like sudden-onset arthritis in my feet, hands, knees, and hips when getting out of bed in the morning or getting up from the couch or my desk.

Also thanks to the endocrine therapy, I rapidly developed osteopenia. My oncologist added a bone-hardening medication, which gave me the worst heartburn I’d had since I was pregnant. My physician’s assistant suggested adding Tums and Pepcid to my daily regimen.

And another thing, not small: My blood sugar was so high I was bordering on having full-blown diabetes. Estrogen helps keep cells sensitive to insulin, and having none was making my cells insulin-resistant: my pancreas was pumping out more and more insulin to less and less effect. So I stopped eating carbs, and my cholesterol went through the roof from all the animal protein and fat I was eating instead.

Insulin is a fat-storage hormone, so my body kept stashing fat instead of burning it. With estrogen gone, it stashed it around my middle. I know this is getting complicated, but it’s worth understanding: estrogen directs fat storage to the hips and thighs (the classic “pear” shape). That steering was gone, so the fat redistributed around my organs instead (the “apple”). The problem wasn’t really that my jeans no longer fit, although that wasn’t fun. It was that deep belly fat acts like an organ, pumping out inflammatory signals, which, among other things, was making my joint pain worse.

One of my doctors prescribed metformin to control my blood sugar and a statin to lower my cholesterol, and told me to “exercise and watch what I eat.”

Also, since I’m already oversharing, I should tell you that my vagina dried up. This caused lots of problems with sex, incontinence, and Urinary Tract Infections (UTIs), which are common when the skin in your lady parts gets thin and dry. So more physical therapy, prescriptions and another surgery: the insertion of a mesh sling in my pelvis to support my urethra, several rounds of antibiotics, and a messy estrogen suppository.

Somewhere in there, my hair started falling out, so my dermatologist prescribed minoxidil. And all of these medications caused constipation so severe I needed treatment for an intestinal blockage.

I was taking a drug for every side effect, and each new drug produced new ones.

Behavior as medicine

Desperate to feel like myself again, I turned to PubMed. The best research, thank God, didn’t point to more pills. It pointed to ordinary, unglamorous things: specific exercises I wasn’t doing yet, food as medicine, simple sleep fixes, and even simpler stress management. These everyday behaviors eased my symptoms and are linked to a longer, healthier life.

Using behavior-as-medicine in deliberate, therapeutic doses is called “lifestyle medicine.” And almost no one gets it in a dose strong enough to work.

What I was going through wasn’t only a breast cancer story; it was also a menopause one. Estrogen deprivation is estrogen deprivation. My version was extreme—the drug I am on drives estrogen far lower than menopause does. But sleeplessness, brain fog, low mood and anxiety, weight gain, aching joints, and high blood sugar are familiar to most women in midlife. There are a lot of us. And the same tools help.

I turned myself into an experiment, measuring what was happening in my body, changing one thing at a time, watching my data, and slowly feeling myself come back. I am stronger now than I have ever been. I feel sharp and productive. I feel profound gratitude and joy most days. Importantly, I am still on the endocrine therapy prescribed to prevent breast cancer recurrence.

It worked so well that I created a program for other women grounded in research-grade data. I named it Annosa Health.

Sturdy as an annosa oak

Annosa is a Latin word meaning venerable, full of years, long-lived. The Roman poets loved it, and they used it most often to describe one thing: a beautiful old tree. Annosa quercus: the venerable, aged oak. The tree that took decades to grow, that stands through weather that would take down anything younger.

There’s an old proverb relevant here: Non annosa uno quercus deciditur ictu. An aged oak is not felled by a single stroke.

Like a sturdy oak, I am a resilient, deep-rooted thing that no single blow can bring down. And like that venerable tree, I didn’t get that way in a single dramatic moment. Growth happens through small, repeated acts, most of them too modest to feel like they matter, accumulating over months and years into something that does. That is exactly how you rebuild a life after your body has been remade without your permission. Not in a single moment, but in a hundred small ones.