Breast cancer warrior in a pandemic: Fear, tamoxifen, anxiety, escitalopram

breast cancer warrior on a philippine bus

Last Updated on May 27, 2023 by Ellen

Sometimes, being a breast cancer warrior and survivor in a rural area of the Philippines during a pandemic with international border closures puts a little fear into me.

Other times, I couldn’t give two ‘you-know-whats’ – because I try to live the mantra: “Life is Now.” Also, the universe is gonna do what the universe is gonna do.

Of course, I try to ‘stack the deck’ in my favor. But how long I survive once the breast cancer (most? all?) was cut out of my body, is an ultimate unknown.

Breast cancer warrior in a pandemic


As with every other breast cancer warrior I know, I wonder if the disease will come back. We call this a fear of recurrence. I do not let it debilitate me.

Still, I do wonder now and then if there was one single cell that slipped through a lymph node and lodged elsewhere in my body… waiting to multiply into a tumor. When I feel fearful about it, I focus on faith and the moment of life at hand.

My type of cancer was caught at nearly the earliest stage possible. I had a double mastectomy without reconstruction in Croatia in 2018. A drug called tamoxifen might help lower my small chance for recurrence.


The first time I ordered tamoxifen at the nearest chain drug store in the nearest town, they ordered it and the delivery came from Manila after a few weeks. Easy peasy for a pandemic necessity.

This time, not so lucky. The local store didn’t have it and apparently wasn’t going to get it. But, the store in a city 1.5 hours away, did. So off I went to Kalibo again, to buy three more boxes of tamoxifen.

I’m lucky my last oncologist was in Cebu City, Philippines. The pharmacies on Panay Island can easily verify me with a call to her office.

I have a love/hate relationship with tamoxifen. I get frequent hot flashes that used to be accompanied by awful anxiety.


The anxiety crept up on me. I had become miserable. Tedly hated to see me suffer. He hated to see his strong, confident wife unable to cross a street like a scared kitten.

After several months of taking tamoxifen, and being miserable, we had a motorbike crash that sent me into panic attacks. I’ve lived through some shit in my life. Panic attacks are no joke. I couldn’t cross streets. This is a problem for a world traveler.

We ended up in Bangkok so I could see a psychiatrist. She believed my main issue was the damn drug tamoxifen. Anxiety is one of tamoxifen’s many side effects.


She prescribed the antidepressant escitalopram. After a few weeks I felt a lot better. After a several months, I felt practically like my old self. Except for the damn hot flashes. It does not appear those will stop anytime soon.

I also get many other negative side effects from tamoxifen that the antidepressants don’t alleviate, and I know my quality of life would improve by quitting tamoxifen. But then, would quitting I raise my recurrence risk? Opportunity cost of sorts weighs on this warrior, as I sit in the Philippines and sweat this out. Literally.

Prescription costs

A three-box supply of name-brand Nolvadex cost about $60 with no insurance at the Mercury Driig in Kalibo, Aklan, Philippines.

I wonder about the local women here in the Philippines who cannot afford this potentially life-saving or life-extending drug – or its generic – because of its cost.

I’m lucky to be able to afford Nolvadex. I buy the name brand at the recommendation of my latest oncologist as a way to possibly lessen side effects. Previously, I bought whatever generic was available in whatever country I happened to be in. So far, her idea hasn’t worked. Onward.

Three months of generic escitalopram cost $97 with no insurance at the same pharmacy.

Total for the prescriptions, including a 12 percent VAT tax of $17 (!), was $173. That’s an expense we haven’t had in a couple of months. It gets filed under ‘health care,’ with pictures of the receipt and the prescriptions themselves.


I wonder if potential panic over this pandemic is cloaked by the ‘happy’ drugs. Would my reactions to the events of 2020 be the same without antidepressants?

Will I be able to still get tamoxifen if we stay here longer than three months? What about my next oncologist visit? I am skipping my summer check up because of the pandemic.

Do I dare skip another biannual check up?

Does it matter?

boxes of nolvadex, name-brand tamoxifen
Novadex boxes Ellen bought in Kuala Lumpur, Malaysia, in 2018.

I have two oncologists in Malaysia. One in Kuala Lumpur, one in Penang. We are/were hoping to get to Malaysia by October.

Currently, Malaysia allows medical tourists. Great news, right? Well, except if you’re American.

If all you have is an American passport, you aren’t allowed into Malaysia. Period. I’m hoping that status will change in the weeks ahead.

A kind Scotsman I met in Kalibo tells me Iloilo Doctors’ Hospital has good, modern equipment and a full staff of specialty doctors. Iloilo is the largest city on Panay Island, a six-hour bus ride from where we are living at the moment. Iloilo is in a different province, and previous lockdowns prevented travel between Aklan (my province) and Iloilo.

If I went to Iloilo in December, could I get back into Aklan? Who knows what will happen in the future. But they just locked down Manila again. Should I go sooner? By all indications, it appears this pandemic will get worse before it gets better.

I ask myself again: Does it even matter?

Sometimes I sit in a place of ‘fuck it’. Life is now. Truly.

So I better simply enjoy it.

breast cancer warrior in a pandemic with her husband on white beach in borcay, philippines
Tedly and Ellen on White Beach, Boracay Island, Philippines, August 2020.

Thanks for reading, “Breast cancer warrior in a pandemic: Fear, tamoxifen, anxiety, escitalopram.”

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