For those of us who are hormone-positive (estrogen, progesterone, or both), taking medication to suppress or otherwise interfere with hormone production is a key part of treatment. For some, an aromatase inhibitor (AI) combined with some other therapy is effective. For example, I was on Ibrance and Letrozole for my first line of treatment and that combination kept me stable for the first two (2) years after my diagnosis. Then, I moved on to Piqray and Faslodex and it was a pretty steep learning curve!
My current treatment
Faslodex is an Estrogen receptor antagonist antineoplastic agent (try saying that five times fast) and is administered by two separate injections monthly, one in each butt cheek. We affectionately (ha) describe this as being stabbed in the butt in our household, which causes endless mirth for my boys, who are in elementary school. There is a certain element of needing to inject some fun into these harrowing experiences in our household because my kids are little and, hey, humor can be a good coping mechanism.
Over time, I've noticed that some nurses do a better job than others in terms of the administration of the shots and I've developed something of a cheat sheet that I use to question each new person who is assigned to me on the days that I get the shots. I've learned that if the nurse assigned to me isn't open to adjusting to my requests, then I simply need to ask for someone else. Their hurt feelings don't compare with the gigantic hard knots I've had in my butt for weeks if the administration isn't completed correctly and since the injections are super close to the sciatic nerve, placement is so key.
Don't forget, this list is just mine and doesn't constitute any kind of medical advice!
First, the injections go in easier when they are warm
There was some sort of change in 2019 where the vials of medicine can now be stored at room temperature rather than in a fridge, so many of the nurses have told me that it's no longer necessary to warm up the vials. Each time I've been told this, I've asked (usually politely) if that nurse has ever had a Faslodex injection. Since none of them have, I continue to ask for the vials ahead of time so that I can warm them in my armpits. I ask for this as soon as I've been checked in. I find that if I keep the vials in my armpits for 10-15 minutes, that's the sweet spot. One of the nurses will put them into a heated blanket ahead of time and that helps, but doesn't seem to help enough from my perspective.
Second, the muscles that make up your butt have to be completely relaxed
Whoever decided that an injection would need to be given into a completely relaxed muscle month after month when you know what is coming was probably a sadist - seriously! It's freaking hard to be relaxed when you know what is going to happen. Anyway, some people like to lay down for the injection, which I've not tried. What has worked for me is to face a chair, lift and place the knee of the leg where the injection will be administered on the seat cushion of that chair, and then lean towards the back. And then switch for the other side. In my experience, one side always hurts more than the other and there's no physical basis for that, but it happens!
Third, the instructions for the injection say that each one should be administered over two (2) whole minutes
In the years that I've gotten Faslodex, none of the nurses has taken that long; however, the slower the better. Any time a nurse is in a hurry and I didn't speak up, I was in more pain, so I've learned to speak up. I don't know that two (2) whole minutes is necessary, but definitely a minute per side.
Fourth, the nurse administering the Faslodex needs to push around the site of the injection during the process of the injection.
Some nurses will push a little medicine in, then apply pressure, others will press during the entire injection. I haven't seen a difference either way, just that the pressure is key to ensure that a knot doesn't form. If you have a chance to actually look at the medication, you will see that it is THICK and that's part of why it can be hard to inject and doesn't dissipate quickly.
Fifth, rather than a bandaid or gauze over the injection site, I always ask for the smaller versions of the compression bandages they use to cover our ports when it's accessed
In my experience, the extra pressure helps to ensure that a knot doesn't develop and then medication is absorbed evenly.
After the monthly injections, I've found that walking a bit helps at first, and then sitting on a heating pad for the day of can help. On the second and third day, I've found that Epsom salt baths are helpful, but I always make sure that the injection site has healed or is covered with a bandage designed to get wet just in case there is in the water. For me, extra achiness and hot flashes are the worst side effects, but other people have experienced different things.
So, now it's your turn -- what are your tips and tricks for making the Faslodex shots more manageable?
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