1000 Cranes

Today was a challenging day. After the initial chemo recovery, about 7-10 days post chemo one experiences the fullest extent of the toxic side effects. Today, that means a lot of bone pain in the chest from the bone marrow stimulants, the greatest amount of hormonal fluctuation and muscle aches, along with significantly challenging cognitive dysfunction. As you might imagine, I was tired, cranky and missing a chunk of my sense of humor. So when I came home from work and found a cool surprise, my spirits were greatly elevated. Let me show you:

                                                             In the Living Room

                                                                    In the Bedroom

Three of my friends - Kim, Diana and Ruth - coordinated a forest of 1,000 origami cranes to be hung from my ceiling. They recruited my father and Tapwe to assist in this conspiracy.

Evidently, in Asian culture cranes represent good health and longevity - as you may recall from when I told you about my Daruma. Today, the practice of folding 1,000 cranes represents a form of healing and hope during challenging times. Chains are often given to someone suffering from illness, as a prayer for their recovery, as a wish of happiness, and as an expression of sympathy and peace. Diana tells me there are good wishes in every fold. As you can see below, that's a lot of good wishes. 

Per Kim these 1,000 cranes grants me a wish and a long life free from illness. I am admittedly honored beyond words with such a grand gift. I have become a putz so, of course, it brought tears to my eyes. Still does. Every time I lay down in bed and look at those three strands hanging next to the bed I get teary-eyed. Blessings to you all!

Post Chemo CBC

So far so good. My white cell count is 'acceptable' and my red cell count isn't 'too' low. It's low enough to make me take a break if I walk across the parking lot or take in a flight of stairs. Evidently, that's to be expected. I'm beginning to feel relatively 'normal' and can expect to enjoy the holidays. My taste isn't back to normal yet, so I'm saving most of my chocolate for next week when the taste buds regenerate. Other than that, I am simply reveling in the fact that I DON'T have to prep for another chemo. Such a small thing that is so HUGE in my mind. It is the most wonderful feeling to begin actually looking into the future to accomplish small projects... like organizing the apartment or planning an outing or developing a computer project. So very cool NOT to think about chemo.

HAPPY HOLIDAYS TO YOU ALL!

Gene Test Could Spare Women from Unnecessary Radiation

"This genomic test could be a good way for women to determine if they are really at risk.

The test, which analyzes 12 genes from a woman's tumor, helps predict which cases are most likely to be aggressive — requiring both surgery and radiation — and which are likely to be slow-growing, requiring surgery alone, says lead researcher Lawrence Solin, chairman of radiation oncology at Einstein Medical Center in Philadelphia."

"Until now, however, doctors haven't had a good way to tell which cases of DCIS are the most likely to spread, Solin says. Women with the condition often are treated as if they have a more advanced cancer, with lumpectomy and radiation, and sometimes years of hormonal therapies. In the case of DCIS, radiation reduces the risk of developing another tumor in the same breast, but doesn't improve survival, says Steve Shak, Genomic Health's chief medical officer.

And while radiation is generally safe, it can burn the skin and damage the underlying heart and lung tissue, Shak says. Going to radiation treatments also is time-consuming, requiring daily visits for five to seven weeks, Solin says."

"Women and their doctors may want to use this information to guide their treatment, Shak says. A similar test for women with early-stage invasive breast cancer has been available since 2004. That test, OncotypeDX, helps predict which patients may be able to skip chemotherapy, contributing to a 20% drop in chemo use, Shak says." Since chemo can also cause cancer it makes a lot of sense to avoid treatments that may not be necessary.

"For women who really don't want radiation therapy or a mastectomy, this might well be a way to determine whether they 'should take the risk,' " says surgeon Susan Love, president of the Dr. Susan Love Research Foundation. "It is the first step to being able to figure out which DCIS is important and which is not."

Read more:  http://yourlife.usatoday.com/health/medical/breastcancer/story/2011-12-06/Gene-test-could-spare-women-from-unnecessary-radiation/51678050/1

Below is a link to a site that has several article regarding the Oncotype DX testing. Exciting stuff!

http://content.usatoday.com/topics/topic/Oncotype+DX

Chemo Graduate!

So nice to be done with chemo. I received my last chemo without a hitch. Another bruise-less catheter placement... always appreciated. Surprisingly, this chemo has been much more tiring than the others. I gather it's catching up with me. Even during infusion I was tired. Afterward, I was achy all over and needed a 3 hour nap. I noted my feet swelled up some this time around. Not an unusual side effect of the dosetaxel but not one I've had before. Last night I woke up multiple times to urinate out the cytoxin metabolite. Yes, it wakes you up with a strong desire to go. Finally got up this am, tired and achy again. I suspect this will not be a particularly pleasant week but at least it's the last one like it. I'm truly grateful for that. I have some prepped articles to post so hopefully I'll at least feel well enough to push the post button every other day or so.

I saw an oncologist yesterday before infusion. It was informative in our discussion of hormone therapy post chemo but it was also a bit irritating. I want information, lots of it, so I can make an informed choice of how to move forward and get on with my life but the oncologists seem to expect the patient to just follow instructions without debating the merits of different treatments. I find that irritating. It's MY body and MY life at stake here, not theirs. I think a less pushy individual would likely cave in and just follow instructions, but I'm not willing to do that. So... the moral of this data is don't EVER stop self advocating. Push for info you want. Push for consideration for your thoughts and feelings. It's you that has to move on in life so cancer doesn't continue to stress you out daily. Push for the treatment of your choice.

What exactly do I want? I want my tumor Onchy-typed to see if I have a low, high or gray-zone chance of re-occurrence. If low, use the hormone treatment of tamoxifen for the next five years while monitoring closely for uterine concerns. This will provide me with good bone strength moving forward. If high, go for ovarian removal to eliminate the estrogen production, take aromatase inhibitors for the next five years so my adrenals don't stimulate estrogen production, and get Zometa infusion every six months for the next three years to strengthen the bones and make them unfriendly to cancer cells. If gray-zone, take tamoxifen for the next five years and get Zometa infusions every six months for the next three years. I don't know that my docs will go where I want to go but I'm surely going to push for it and I'll keep you appraised.

Bone Drug Gives Disease-Free Survival (DFS) Boost in Breast Cancer

Another supportive article regarding Zometa (zoledronic acid):

"All but the youngest patients with hormone-sensitive breast cancer had significant improvement in disease-free survival (DFS) when they received zoledronic acid (Zometa) in addition to endocrine therapy, results of two large trials showed.

The two trials -- known as ZO-FAST and ABCSG-12 -- both showed about a 30% reduction in the relative risk of progression in women treated with zoledronic acid, which also improved overall survival (a secondary endpoint) in the ZO-FAST trial. A comparison of immediate versus delayed initiation of the intravenous bisphosphonate demonstrated a significant advantage for starting the drug at the same time as endocrine therapy.

Subgroup analyses showed that only patients younger than 40 did not have improved DFS when treated with zoledronic acid, as reported here at the San Antonio Breast Cancer Symposium.

"Bone-targeted treatments may modify the bone microenvironment and may affect cancer stem cells," Michael Gnant, MD, of the Medical University of Vienna in Austria, said.

Long-term results from the ZO-FAST trial showed a 34% improvement in DFS (a secondary endpoint) in postmenopausal breast cancer patients who received zoledronic acid at the same time as the aromatase inhibitor letrozole, compared with women whose treatment with the bone-targeted drug did not start until occurrence of a prespecified clinical event.

ABCSG-12 trial involved 1,800 women with early-stage premenopausal breast cancer patients treated with endocrine therapy but no chemotherapy. Following surgery, all patients received goserelin and were randomized to tamoxifen or anastrozole with or without zoledronic acid, continued for three years.

The primary endpoint was DFS.

The patients had a median age of 45, and 22% of the study population was 40 or younger. Additionally, 78% of the patients had T1 disease, 67% had no nodal involvement, 80% had histologic grade 1 or 2, and fewer than 4% were estrogen-receptor (ER) negative.

Subgroup analysis showed a consistent trend in favor of treatment with the bisphosphonate, as results were similar regardless of nodal status, endocrine agent, ER expression level, grade, or stage.

ABCSG-12 also demonstrated the effectiveness of first-line endocrine therapy for early breast cancer without the use of chemotherapy, he added, as the study population had a seven-year overall survival exceeding 95%.

Zoledronic acid given concurrently with endocrine therapy was associated with a 34% improvement in DFS compared with delayed initiation of the bisphosphonate, according to an exploratory analysis of the ZO-FAST study, said Richard de Boer, MD, of the Royal Melbourne Hospital in Australia.

All patients received the aromatase inhibitor letrozole (Femara) and were randomized to start zoledronic acid immediately or to delay therapy until a decline in bone density T-score to less than -2, clinical fracture, or asymptomatic fracture at 36 months."

Read more: http://www.medpagetoday.com/MeetingCoverage/SABCS/30136 

Screening Mammography

Per National Cancer Institute, screening mammography in women aged 40 to 70 years decreases breast cancer mortality. The benefit is higher for older women, in part because their breast cancer risk is higher. On the other hand, screening mammography may lead to the following harms:  

1. Approximately 33% of breast cancers detected by screening mammograms represent overdiagnosis. The treatment of insignificant cancers can result in breast deformity, lymphedema, thromboembolic events, new cancers or chemotherapy-induced toxicities. What is an insignificant cancer, I wonder?
2. Additional testing in false positive mammograms are estimated to occur in 50% of women screened annually for 10 years, 25% of whom will have biopsies.
3. A false sense of security leading to a delay in cancer diagnosis (false-negatives). 6-46% of women with invasive cancer will have negative mammograms, especially if young, with dense breasts or with mucinous, lobular, or fast-growing cancers. Mine was one of these.
4. Radiation-induced mutations can cause breast cancer, especially if exposed before age 30 years. Latency is more than 10 years; the increased risk persists lifelong. Between 9.9 and 32 breast cancers per 10,000 women exposed to a cumulative dose of 1 Sv with the highest risk for younger women. I have to wonder if mine was one of these, also.

Bone Drug Boosts Breast Cancer Survival

My brother sent me some links to a very timely subject regarding post chemo adjuvant therapy. 

"Doctors were mostly hoping to prevent complications and relapses when they gave young women a medicine to keep their bones strong during breast cancer treatment. Seven years later, they found it did more than that: The bone drug improved survival, as much as many chemotherapies do.

Bone drugs called bisphosphonates — sold as Fosamax, Boniva and Actonel — have long been sold for treating osteoporosis. Those are daily pills. Zometa, made by the Swiss company Novartis AG, is given intravenously to treat cancer that has spread to the bone.

Hope that it could do more grew in 2008, when Gnant reported that it lowered the risk of a cancer recurrence in a study of 1,800 premenopausal women with early-stage breast cancer. All had surgery followed by hormone blockers, and half also received Zometa.

Now, with seven years of follow-up, researchers see that Zometa not only helped keep cancer from coming back, but also improved survival."

Read more: http://yourlife.usatoday.com/health/medical/breastcancer/story/2011-12-09/Study-Bone-drug-boosts-breast-cancer-survival/51759160/1

Holiday Preparation

Thanks to Carrie, Lydia and Loic we have a beautiful holiday tree! Lydia and Loic came over today complete with food and goodies to celebrate. Lydia and I ate and talked while Loic and Tapwe put together a beautiful tree. Check it out!

Some of those ornaments are actually little hollow chocolates. How cool is that?

Big Promise Seen in Two New Breast Cancer Drugs

Partial article information below:

"Breast cancer experts are cheering what could be some of the biggest advances in more than a decade: two new medicines that significantly delay the time until women with very advanced cases get worse.

In a large international study, an experimental drug from Genentech called pertuzumab (per-TOO-zoo-mab) held cancer at bay for a median of 18 months when given with standard treatment, versus 12 months for others given only the usual treatment. It also strongly appears to be improving survival, and follow-up is continuing to see if it does.

In a second study, another drug long used in organ transplants but not tried against breast cancer — everolimus, sold as Afinitor by Novartis AG — kept cancer in check for a median of 7 months in women whose disease was worsening despite treatment with hormone-blocking drugs. A comparison group that received only hormonal medicine had just a 3-month delay in disease progression. Most patients have tumors like those in this study — their growth is fueled by estrogen.

The new drugs are some of the first major developments since Herceptin came out in 1998. It has become standard treatment for a certain type of breast cancer.

A reality check: The new drugs are likely to be very expensive — up to $10,000 a month — and so far have not proved to be cures. Doctors hope they might be when given to women with early-stage cancers when cure is possible, rather than the very advanced cases treated in these studies.

The drug pertuzumab targets cells that make too much of a protein called HER2 — about one of every four or five breast cancer cases. Herceptin attacks the same target but in a different way, and the two medicines complement each other.

Another study is testing pertuzumab in 3,800 women with early breast cancer. Genentech says it has not set a price for pertuzumab, but sells Herceptin for $4,500 a month to doctors, who mark it up and add fees to infuse it. Herceptin's U.S. patent expires in 2019, so combination treatment might be more affordable once generic Herceptin is available.

"The two together have a much greater effect than you would expect from either alone," said study leader Dr. Gabriel Hortobagyi, breast cancer research chief at the University of Texas MD Anderson Cancer Center in Houston. "They snip two wires that are critical" for growth signals to continue, he said.

However, the combo led to more side effects — mouth sores, anemia, shortness of breath, high blood sugar, fatigue and lung inflammation."

Read more: http://old.news.yahoo.com/s/ap/20111208/ap_on_he_me/us_med_breast_cancer_drugs

Poisoning Cancer Cells with Sugar

By Elizabeth Cunningham Perkins in Health 12/05/2011

A new two-part therapy combining a modified sugar molecule with two cancer killing drugs causes many types of cancer cells to "commit suicide" by apoptosis, a type of programmed cell death."

Cancer loves sugar, so the researchers altered a sugar molecule into a new form called 2-DG that the cancer cells gobbles up thinking they have a gourmet meal. Instead, the 2-DG makes them sick by stopping cell growth and priming the cells for early death. Then a second drug (ABT-263/737), which is a combination of two cancer-fighting drugs, comes in and activates the cells' self-destruct sequence. Beautiful in its dastardliness.

"According to the team, a wide range of cancer cells primed for death by 2-DG then exposed to ABT-263/737 are affected, but not healthy brain cells that also take in lots of sugar, because the body's blood-brain barrier stops ABT-263/737. The 2-DG with ABT-263/737 treatment killed lung, liver, blood, cervical and breast cancer cells at multiple growth stages, and in a mouse trial the two-part treatment wiped out aggressive prostate cancer tumors in days, experiments demonstrated. But the new combined treatment does not work on all cancers because some cancers are resistant or it would cause serious side effects."

"Since both 2-DG and ABT-263 (Navitoclax) are already in Phase II clinical trials (for other treatments), we know something about the safety of these agents. Once we take precautionary measures, the 2-DG-ABT combination therapy may prove an effective alternative to some existing cancer therapies. We may have found a simple, partial solution to a very complex disease."

Read more: http://www.digitaljournal.com/article/315540#ixzz1fn7X7Nd2

Good Things About Having Cancer

With my post about brain damage, a friend of mine turned me on to the website called Luminosity that hosts brain games. They have core brain courses but also courses for medical conditions like ADHD, mild traumatic brain injury, post traumatic stress disorder and two levels of post-chemotherapy recovery. Click on the link below if you are interested:

http://www.lumosity.com/brain-games

So back to the thirteen good things about having breast cancer and undergoing chemo...

1. With all the catheters, surgery et al a blood draw or injection really isn't anything. It puts things into perspective.
2. Numb tongue, lips and poor taste provides for an excellent no fuss weight loss program.
3. Weight loss means you can eat full fat foods... when you're taste comes back. Mmm mmm good!
4. Fatigue makes it always ok to take a nap.
5. Hair loss makes hair care easy, if not non-existent. And you get to accessorize with scarfs and hats. It also allows for the anticipation of curly hair when it grows back in.
6. No breasts mean no constricting bras. Laying on the stomach is now incredibly comfortable. Prophylactic breasts allow for multiple size options... super-size me! Maybe not. 
7. No breasts mean the belly sticks out noticeably but that's just a great exercise-inducer. Weight watchers look out.
8. Chest scars just mean I constantly have two smiley faces. Always happy, that's me.
9. Runny eyes and nose is really irritating so I really had to stretch for this one. But if your getting teary-eyed you can always claim it's a chemo side effect.
10. Muscle soreness makes you feel like you've been working out and increases your body awareness.
11. Anemia is a great excuse not to go out in the cold and instead get a lot of paperwork or computer work done.
12. Chemo brain is a great excuse for forgetting things. Everyone else has to admit they're getting older.
13. Cancer in general is a great conversation starter. It also stimulates a lot of self re-evaluation and induces one to live more in the moment and not take so much for granted. People all around you help out and you realize how much people totally rock!

I couldn't think of ANYTHING good about bone pain. Anyone else have something to add? Make a comment!

Sentinel Nodes

Ever searching for a better understanding, I found an article about the value of sentinel node evaluation. For those of you that don't remember, sentinel nodes are the lymph nodes that drain directly from the site of a mass. This is found by injecting a dye at the site of the mass and then removing the lymph nodes that first take up the dye. The thought here is that if any cancer cells have moved beyond the mass they would be found lodged in these lymph nodes. I found it comforting to learn that my sentinel lymph nodes were clear of cancer cells until I read this.

"The detection of breast cancer cells in sentinel lymph nodes by immunochemistry—antibody-based techniques to detect cancer cells—in addition to standard tissue staining does not appear to help predict survival after treatment for breast cancer. These results, from the American College of Surgeons Oncology Group (ACOSOG) Z0010 study, were published online July 26 in JAMA.

ACOSOG researchers from 126 hospitals, led by Dr. Armando Giuliano of the John Wayne Cancer Institute in Santa Monica, CA, enrolled 5,119 women with early-stage breast cancer and identifiable sentinel lymph nodes in the prospective observational study between May 1999 and May 2003.

Most of the women had stage I, estrogen receptor-positive breast cancer. Ninety-one percent received whole-breast radiation, 83 percent received chemotherapy, and 68 percent received hormone therapy.

Standard tissue staining found cancer cells in the sentinel lymph nodes of almost one-quarter of the women. Of the remaining women, 85 percent were assessed using immunohistochemistry (IHC). In about 10 percent of those women, IHC found occult (initially undetected) metastases in the sentinel lymph nodes that standard tissue staining had failed to detect. However, the researchers did not see a statistically significant difference in overall survival between women who did and did not have IHC-detected cancer cells in their lymph nodes.

Using a similar test called immunocytochemistry, the researchers found occult (hidden) metastases in the bone marrow of 104 (3 percent) of the 3,413 women who had samples that could be tested. The presence of these cancer cells was associated with decreased overall survival. However, when other factors, such as age and tumor size, were included in the analysis, the association between occult bone marrow metastases and overall survival disappeared. The small number of women with positive bone marrow findings may explain this absence of statistical significance, noted the authors.

The researchers also pointed out that most patients in the Z0010 trial received adjuvant systemic therapy, which is standard practice in the United States, independent of immunohistochemical findings. “Thus,” wrote the authors, “although the effect of untreated micrometastases is unknown, it is not relevant to current practice” because occult (hidden) sentinel lymph node metastases treated with adjuvant systemic therapy do not affect survival.

Because IHC of the sentinel nodes did not help predict survival, and the incidence of occult bone marrow metastases was “too low to recommend incorporating bone marrow aspiration biopsy into routine practice” for patients with early-stage breast cancer, the authors concluded that routine immunochemical examination of sentinel nodes and bone marrow is “not clinically warranted” for these women."

Wow. Doesn't that give you pause. Oddly enough, in a way it's reassuring to know there are no guarantees. What is, is and you just have to deal with it and move on. Worrying about it won't help. It does, however, makes me really glad I decided to be aggressive with my treatment. I think that's enough research into cancer for now. I'm going to switch gears and give you more info on nutrition for awhile. Tomorrow I'll post a list of what is good about having cancer!

More Decisions to be Made

With my last chemo looming every closer... YAH!... I have some more decisions to make and information to absorb.

My brother sent me an article about how chemo damages a certain part of the brain thus impairing cognitive function, also known as chemo brain, at different levels depending on the person and the chemo drugs used. On the NCI site if found another reference stating:

"... results converge to suggest that high-dose chemotherapy for breast cancer is associated with long-term injury to white matter and gray matter with associated functional deficits. Using this multimodality approach we provide for the first time insight into the neural substrate underlying cognitive impairments following systemic administration of cytotoxic agents many years after treatment." 

It's a scary thought to suffer microscopic brain damage all to make yourself healthy. Thankfully, I haven't noted any significant impairment so far. At least nothing worse than anyone else around me. Nonetheless, with the completion of chemo I plan on exercising my brain to build new connections. I'll start using the Brain Builder program I got for Tapwe when we home-schooled and also re-start learning French. I'll see what other suggestions the oncologist has as well.

Then there is the decision of how to minimize estrogen effects in my body so it doesn't kick start any sensitive cells left. My options include the following:

• Selective Estrogen Receptor Modulators (SERMs) (ie tamoxifen, raloxifene) that compete for estrogen sites on the cells thereby interfering with estrogen uptake.  

1. Advantages: tamoxifen reduced breast cancer by about 50%. Treatment with raloxifene has a similar effect on reduction of invasive breast cancer but appears to be less effective for prevention of noninvasive tumors.
2. Disadvantages: tamoxifen treatment increases the risk of endometrial cancer, thrombotic vascular events (pulmonary embolism, stroke, deep venous thrombosis), and cataracts. Many of these risks, notably pulmonary embolism and deep venous thrombosis, are reduced after discontinuing active treatment with tamoxifen. Raloxifene also increases venous pulmonary embolism and deep venous thrombosis but not endometrial cancer.

• Aromatase inhibitors or inactivators (ie anastrozole, letrozole, exemestane) which inhibit the production of estrogen in the body.

1. Advantages: reduce the incidence of new breast cancers in postmenopausal women who have a history of breast cancer by 50%.
2. Disadvantages: decreased bone mineral density, increased falls, and decreased cognitive function.

• Prophylactic oophorectomy or ovarian ablation to eliminate the production of estrogen in the body.

1. Advantages: in women with BRCA gene mutations they can document lower breast cancer incidence. Similarly, oophorectomy or ovarian ablation is associated with decreased breast cancer incidence in normal women or in those who received chest radiation. Breast cancer incidence is decreased by 50%, but published study designs may have produced an overestimate. 
2. Disadvantages: may cause the abrupt onset of menopausal symptoms such as hot flashes, insomnia, anxiety, and depression. Long-term effects include decreased libido, vaginal dryness, and decreased bone mineral density. Nearly all women experience some sleep disturbances, mood changes, hot flashes, and bone demineralization, but the severity of these symptoms varies greatly.

None of the options are great but with cancer that is the norm and side effects become a part of life. Then there is the question of how to know if the cancer returns. What tests to run and when? NCI, ever helpful, had this to say about it: 

"Follow-up evidence from randomized trials indicates that periodic follow-up with bone scans, liver sonography, chest x-rays, and blood tests of liver function does not improve survival or quality of life when compared to routine physical examinations. Even when these tests permit earlier detection of recurrent disease, patient survival is unaffected. Based on these data, some investigators recommend that acceptable follow-up be limited to physical examination and annual mammography for asymptomatic patients who complete treatment for stage I to stage III breast cancer. The frequency of follow-up and the appropriateness of screening tests after the completion of primary treatment for stage I to stage III breast cancer remain controversial."

Hmmm, life after cancer. Go figure... it's a crap shoot just like everything else. Nothing was ever a given or guaranteed, but now that has become abundantly clear. A reality check, as it were. A blessing in its own way.

Breast Cancer Data from NCI - Factors Assoc with Breast Cancer Risk

Factors Associated With Increased Risk of Breast Cancer

• Hormone therapy - 26% increase in incidence of invasive breast cancer with the use of combination hormone replacement therapy (estrogen-progestin)

• Ionizing radiation treatment for cancers - sixfold increase in incidence with exposure of the breast starting 10 years after exposure and persisting lifelong. Risk depends on dose and age at exposure, with the highest risk occurring during puberty

• Obesity - it is uncertain whether reducing weight would decrease the risk in post menopausal women

• Alcohol - dose-dependent but it is uncertain whether decreasing alcohol exposure would decrease the risk

• Major inheritance susceptibility - those who inherit gene mutations associated with breast cancer have an increased risk that varies depending on gene mutation, family history, and other risk factors affecting gene expression

Factors Associated With Decreased Risk of Breast Cancer

• Exercise - exercising strenuously for more than 4 hours per week reduces risk by 30-40%. The effect may be greatest for premenopausal women of normal or low body weight.

• Early pregnancy - women who have a full-term pregnancy before age 20 years reduce their risk by 50% compared with women who give birth after age 35 years or never experience a full term pregnancy

• Breast-feeding - decreased risk by 4.3% for every 12 months of breast-feeding, in addition to 7% for each birth 

Take home message to ward of breast cancer:

Exercise a lot, stay thin, partake in alcoholic exploration minimally, get pregnant by 20 years old, breast feed the baby as long as possible and repeat the process several more times. Don't have radiation treatments for childhood cancers, and don't take hormone replacement therapy to make menopause livable. I jest but that IS what it implies.

Long Week

What a long week. Typical for chemo week but this one was particularly long. My taste was off until late Friday making most foods and drinks taste like flavored cardboard with texture. Some people brought brownies and I was cheated the true marvel of this staple food. Criminal! It was difficult to drink enough fluids because nothing tasted good. Even water didn't taste right. Juice, dairy, coconut water, sports drinks, green tea... all my mainstays and flavored items that usually work failed me. I finally resorted to some 7-up. Terrible for me to drink given the sugar content but it got me kick started back into my drinking regiment. My anemia is such that I was much more tired and out of breath than usual. The Neupogen pharmacist, the guy that tells me how many bone marrow stimulants to take and how often, changed it up again. It led to more bone pain and a concomitant difficulty sleeping and waking. My guts felt blah all week and are just beginning to function normally today. Such a delight to poo like a normal person. Laugh if you want, but you all take it for granted that you will produce normal stools and poop them out in a normal  fashion every day. When that doesn't happen, one realizes how heavenly it is to have normal bodily functions... especially pooping. Enough said... or maybe too much. Needless to say, I'm terrifically glad this week is over. Thanks to each of you that brought a meal. Tapwe enjoyed them immensely and I was grateful that each one had enough flavor and texture for me to eat them. I'm certain I didn't fully appreciate the flavors given the taste bud damage wrought this go around... and that makes me a bit sad. 

Two more weeks to round 4. I can't wait to get it over with, though I'm not looking forward to a repeat of this week... or worse.  At least then, I can focus on rebuilding red cells so I can start exercising again and move onto the next phase. Deciding on what post chemo adjunct targeted treatments I'm willing to pursue. Things like whether to: take Selective Estrogen Receptor Modulators (SERMs) like Tamoxifen, take aromatase inhibitors or inactivators to block estrogen, have my ovaries prophylacticly removed or some combination thereof. The "final" stage will be to find a way to psychologically and emotionally return to "normal" thought patterns. I'm not sure what that looks like yet, but I'll address it after I've determined my solution to the whole estrogen-blocking, blood-clot-forming, osteoporosis-inducing issue. Such fun subjects but... must be done with the least amount of muss, fuss and stress. In the mean time, I anxiously await my genetic testing results. The suspense is killing me!

National Cancer Institute a Wealth of Information

This is a great website for cancer understanding. If you or someone you love and care about has any type of cancer, this is an excellent website to check out. The website is:

http://www.cancer.gov/cancertopics/

There are some good videos discussing targeted therapies. Targeted therapies use vaccines, small molecules or antibodies to fight cancer vs chemotherapy, radiation therapy and surgical excision. They are generally used in conjunction with the traditional treatments. The following is the page which lists their targeted therapy videos: 

http://www.cancer.gov/cancertopics/understandingcancer/targetedtherapies

This is the link to the general targeted therapies video for any cancer. It's a little technical but has pretty good visuals and explanations to make it understandable:

http://www.cancer.gov/flash/targetedtherapies/flex/main.html#app=931b&121b-id=M01-S01-A0

This link directly addresses targeted therapies for breast cancer:

http://www.cancer.gov/flash/targetedtherapies/breast/main.html#app=b2b5&121b-id=M02-S01-A0

An excellent read on how to understanding how estrogen affects breast cancer and the use of the targeted therapy of tamoxifen and raloxifene:

http://www.cancer.gov/cancertopics/understandingcancer/estrogenreceptors/page1

An excellent video to understand how people post-chemo attempt to deal with rebuilding their lives. It is specific for breast cancer survivors but could apply to anyone with cancer:

http://www.cancer.gov/cancertopics/coping/survivorship/beyond-cancer-video

General Health Care Recommendations

Through all of my trials and tribulations along this interesting and unpleasant path, I have talked with many men and women with cancer diagnoses and made a list of general health care recommendations.

1. Be aware of your body. If something doesn't feel right get it checked out. DO breast exams monthly. If something feels wrong... even a little bit off... have it checked out. I met a gal that has a small breast lump but hasn't had it checked out because she's afraid of what she might learn. How crazy is that! Better to know and do something about it.
2. Find a doctor with whom you are comfortable. If your doctor poo poos your concerns, find someone else. This is the person that will be making recommendations about your health and well-being. They need to be someone you can talk to and trust... literally with your life. Doctors are like anyone else. They make mistakes. If you have a good relationship with your doctor, it will come to light earlier as you discuss your concerns so it can be corrected quickly. I know a gal that had knee pain for years. Her doctor suspected arthritis but never did xrays to confirm his/her suspicions. Nor did she request them. She assumed the doc knew best. When xrays were eventually done, it turned out she had a rare form of adult onset bone cancer. Luckily for her, they were able to handle it surgically. It could have been addressed much earlier with less pain, discomfort and long term effect.
3. If you have lumpy bumpy dense breasts, discuss with your doctor the value of irradiating your chest every year for mammograms. Women in their 20s and 30s are being diagnosed with breast cancer, yet the AMA isn't recommending mammograms until 40s? I had dense breasts and mammogram couldn't see the >1" diam mass right next to the nipple. Hmmmm. I'm not saying you shouldn't do mammograms but one should consider the radiation factor vs the value of a diagnostic test... any diagnostic test.
4. Understand what the diagnostic test does/is before it's done. What are the negatives and positives? They all have limitations. They all have potential side effects. Accept what your comfortable with. Learn more about what your aren't. Then decide whether or not to undergo that particular test. Obviously, the doctor needs the test to help define what's going on, so either you do the test or find out if there is some other test that they can run that you are more comfortable with. If you completely decline testing, the doctor may not be able to diagnosis your problem in a timely manner, if at all. I didn't decline any diagnostics but also was very comfortable with those recommended.
5. When you have a diagnostic test performed, request a copy of the results... the full written results. Several women have told me that the mammogram radiologist identified a 'benign' mass on their report but in their summary they identified the xrays as 'normal'. Their doctors in their rushed lives passed over the report, reading the summary but not the description. I'm just here to tell you, no radiologist can identify a mass as benign on xray.
6. Once received, sit down with your doctor and ask them to explain the written report to you. This pertains to any diagnostic you have done... including labwork. Take notes. Yes, get a mini medical education. This will be intimidating at first but little by little you'll get it. When you have your next diagnostic test, compare it with the one(s) previously done and discuss the trends seen with your doctor. You can see why a good relationship with your doctor is a must. If they don't want to teach you, insist... or find a different doctor. This is your body and your life, advocate for it. Understanding the histopath on my mass and the breasts submitted convinced me to be aggressive with treatment. It helped make the oncologists recommendations make sense.
7. Be a detective and research your concerns and your doctors' recommendations from reliable websites. That means, don't believe everything you read. Go to sites of Non-Profits, Associations, Med Schools, and other sites your dotors' recommend. Everyone's got an opinion but you need facts to make an informed choice. Use the information to ask your doctor clarifying questions to further your understanding.
8. Be sure you're seeing the right doctor. If your Family Doctor (General Practitioner) identifies blood pressure issues, you should seek the advice of a Cardiologist. If your having weird neural signs, you should see a neurologist. If your skin is flipping out, you should see a Dermatologist. You get the point. Your GP is here to field the symptoms, take care of straight forward issues and refer you to the specialist that can best address your more challenging condition(s). If you've seen your GP a couple of times and the issue isn't resolving or they aren't sure what's going on, ask for a referral.
9. Be aggressive in advocating for your health. Don't just accept whatever your doctor recommends. Don't stick your head in the sand. Research, ask questions, lots of questions, and push for what makes sense to you. I know that can be more than a little challenging when you're flipping out about a scary diagnosis, but if you don't then you will be blindly doing whatever the doctor wants you to do. You may, or may not, regret it later. When it comes to cancer, I felt most comfortable being aggressive in my treatment. I insisted on lumpectomy over wait-and-see or biopsy - that turned out to be a good idea since none of us expected cancer. I insisted on a double mastectomy for wide excision margins - that turned out to be a good idea since I was loaded with pre-cancer not seen on MRI. I accepted chemo treatments in case any cancer bypassed my lymph nodes. People diagnosed with cancer are at risk for cancer elsewhere so... can't be too careful. I haven't had to face the possibility of radiation treatment so I never researched it and have only a vague idea of how I would feel about it.
10. Understand what medications you are taking and why. What is it for? What does it do? How does it do it? How does your body get rid of it? Through your kidneys? Liver? What are its potential side effects? How might it interact with foods or other medications? Be sure you understand all these things so you have a better idea of what is going on in your body as you are taking them. 
11. Make use of support systems. Inform your trusted friends and family what is going on. Talk with others that have gone through similar situations. Support groups are everywhere. Make use of them. The more people that you talk with the better. No matter how private a person you are or how embarrassing the problem is, living in a vacuum isolates you. This increasing your stress level and feelings of loneliness which in turn worsen your health. In times of need, we just have to learn to accept kindness and compassion from others. My CareCalendar has allowed people to sign up for what they are willing and able to do. This has allowed me to feel like I'm not imposing on them but still asking and receiving the help I need. I'm used to giving, not receiving so this has been a really positive learning experience for me. One in which I feel more connected with my friends and family. Loved and cared for. I believe this has made me a better person, in many ways. That wouldn't have happened if I hadn't accepted the help others offered to help me shoulder the load. Physically and emotionally.

Three Quarters DONE!

I just finished my 3rd of 4 chemo deliverys. Another uneventful infusion with another excellent bruise-free catheter placement. Tapwe accompanied me this time. Nice for me and enlightening for him. All in all a good day... though I'm a bit tired and in need of a nap.

I'm grateful this infusion came AFTER Thanksgiving so I could enjoy all the good food yesterday. My sister puts on quite the spread. Starts at 8:30 am and goes to 7-8 pm with a different course meal every 2 hours or so. She's an amazing cook and always comes up with some interesting combinations no one else would think of. This years surprise to me was a Ruby Red Grape Pie. Sounds bland but was absolutely fabulous. It was outdone by the mini Pecan pies... so rich and decadent. Of course the anticipated staples of Raisin Yam Souffle and Mushroom-stuffed Venison Back-strap with Plum Sauce were also fantabulous. All in all, a good feast to celebrate my 3rd chemo. Hope everyone else had a wonderful Thanksgiving as well!

Four Days and Counting

Four days until chemo 3 of 4. I can't wait! No, not for the chemo exactly, but to finish the 3rd cycle and have only one left. Today and tomorrow are full of prep work for chemo week. 

I met with the oncologist this morning. Evidently, she is 'comfortable' with my hemoglobin dropping to 8.0 before transfusing. Since that doesn't usually happen with this chemo combo, she didn't think it was necessary for me to give blood prior to starting chemo. I'm satisfied with that answer... unless my hemoglobin drops below 8.0. I can't imagine being able to get through the day without being breathless on a hemoglobin much below 10.0 but we'll see how it goes. I trust she knows what she's doing since she does it every day.

Yesterday, I was at a get together with a group of people that only recently learned of my cancer diagnosis and chemo. We were talking about what a wake up call something this life disrupting can be. It's certainly a crappy thing to have happen but it also has some very positive effects. I have found it humbling to learn how many people care about me. The amount of help, large and small, that I have received is inspiring. I have determined that I have an inner femininity that I can tap into even without breasts and hair. There has been a lot of soul searching through this whole process. As silly as it may sound for someone of my age, I have come to the realization that I like me. Not that I don't have room for improvement, but overall I like who I am. 

I am not sure if I'll have the opportunity to post before Thanksgiving so just in case...

HAVE A WONDERFUL TURKEY DAY and thank you all for all your support!

How Estrogen Turns on Genes in Breast Cancer

To activate the genes in breast cancer cells, a protein recognizes when a common chemical process called methylation occurs in chromatin and then binds to the signal. "It’s like when you’re in your car and come to a red light," says study author Michael Stallcup. "The light doesn’t make you stop, but it is a signal that you have to interpret and then decide to stop." (Credit / Artist's rendering of breast cancer cell: MichaelTaylor / Shutterstock)

USC (US) — New research has determined the key process by which estrogen, the female sex hormone, activates genes in breast cancer cells, a finding that could eventually lead to new treatments for the disease.

Researchers found that a protein, TIP60, recognizes when a common chemical process called methylation occurs in chromatin, the material that enfolds all genes.

Methylation controls how genes are folded in the complex structure of chromatin, which determines whether the genes are active or inactive.

After recognizing the methylation signal, researchers discovered TIP60 then binds to the signal, connecting TIP60 to the chromatin and changing the chromatin’s structure—which helps to activate the gene. The methylation that TIP60 recognizes is generated by another protein, MLL1.

“It’s like when you’re in your car and come to a red light,” says Michael Stallcup, professor of biochemistry and molecular biology at University of Southern California.

“The light doesn’t make you stop, but it is a signal that you have to interpret and then decide to stop. In this case, the methylation modification that TIP60 recognizes is one of those signals, and then TIP60 acts on that signal.”

Published online in the journal Nature Structural & Molecular Biology, the findings build upon previous work of Stallcup’s lab that revealed that the methylation of chromatin and other proteins plays several important roles in controlling the activities of genes.

While the recent findings are significant, Stallcup stressed that there is much more to be discovered.
“We want to understand more about other steps in the process of gene activation,” Stallcup says. “In particular, we’re interested in the function of the MLL1 protein because we think it plays a key role in controlling chromatin structure and folding, which we think is critical for activation of genes by estrogen.”

While estrogen regulates just a few hundred of the tens of thousands of genes in every human cell, the research has broader implications, Stallcup says.

“While the process we’re studying is the regulation of gene activity by estrogen, the findings have potentially global significance,because the methylation modification of chromatin that TIP60 recognizes is found in all active and potentially active genes in human cells.”

Kwang Won Jeong, a postdoctoral student in Stallcup’s lab, is the paper’s first author.

More news from USC: http://uscnews.usc.edu/

DNA U-turn Gives Cancer a Second Chance

The DNA repair mechanism called recombination may have something to do with why some cancer cells become resistant to radiation and chemotherapy treatments that work by inducing DNA damage. (Credit: Sebastian Kaulitzki / Shutterstock)

UC DAVIS (US) — DNA repair in cancer cells is not a one-way street, according to a new study that clarifies how cancer cells can become resistance to damage-inducing treatments.

“What we discovered is that the DNA repair pathway called recombination is able to reverse itself,” says Wolf-Dietrich Heyer, professor of microbiology and of molecular and cellular biology at the University of California, Davis.

“That makes it a very robust process, allowing cancer cells to deal with DNA damage in many different ways. This repair mechanism may have something to do with why some cancer cells become resistant to radiation and chemotherapy treatments that work by inducing DNA damage.”

The self-correcting ability of the DNA repair system is like driving in a modern city, Heyer says, where U-turns and two-way streets make it easy to correct a wrong turn. “How much harder would it be to re-trace your path if you were in a medieval Italian city with only one-way streets?”

For the current study published online in Nature, Heyer and colleagues used yeast as a model system to clarify the mechanisms of DNA repair. They expect their findings, like most that come out of work on yeast, will be confirmed in humans. “Whether in yeast or humans, the pathways that repair DNA are the same,” he says.

The research team used electron microscopy to observe repair proteins in action on strands of DNA. They saw a presynaptic filament called Rad51 regulating the balance between one enzyme (Rad55-Rad57) that favors recombination repair and another (Srs2) that inhibits recombination repair.

By controlling the balance between the two enzymes, Rad51 can initiate genetic repair—or the U-turn—as needed. “It is a tug-of-war that has important implications for the cell because, if recombination occurs at the wrong time in the wrong place, the cell may die as a consequence,” Heyer says.

The ability of the repair system to abort ill-fated repair attempts, gives the cell a second shot, improving cellular survival after its DNA is damaged—exactly what is dreaded in cancer treatment.

“There are a lot of hints in the scientific literature suggesting that DNA repair contributes to resistance to treatments that are based on inducing DNA damage such as radiation or certain types of chemotherapy,” Heyer says.

“The ability of cancer cells to withstand DNA damage directly affects treatment outcome, and understanding the fundamental mechanisms of the DNA repair systems will enable new approaches to overcome treatment resistance.”

The team’s next step is to look at the enzyme system in humans and see whether they find the same principles at work. One application of this work will be to target the self-correcting mechanism in cancer cells as a way of sensitizing them to radiation and/or chemotherapy treatments.

“If we can confirm that these types of mechanisms exist in human cells, then we will have an approach for making cancer cells more sensitive to DNA damage-inducing treatments.”

The study was funded by the National Institutes of Health, the Tobacco-Related Disease Research Program, the European Community, the French National Centre for Scientific Research, the French Atomic Energy Commission and SystemsX.ch (The Swiss Initiative in Systems Biology).

More news from UC Davis: http://www.news.ucdavis.edu/

Blood Count Numbers Up... Again

My blood count on Friday came back good with a 4500 neutrophil count. Right where we wanted it. The additional two bone marrow stimulant injections brought it up to 36,000 today. Sigh. I truly am an over-achiever. The good news regarding this is that we will decrease the bone marrow stimulant injections by one with the next chemo. One day less of self injection is a Godsend. I HATE injecting myself. I don't mind being on the needle end of the syringe. I just don't like doing it to myself.

So the downside of all this is my progressing anemia. The white cells get hit the hardest initially because they don't live that long but the red cells eventually get hit, too. I started out with 38% of my total blood volume in red cells (RBCs) which is pretty normal (36-45%). Over the last five weeks or so it has dropped to 32%. Not terrible but notable - 9% below "normal". The more important number is the hemoglobin since that is what carries the oxygen in the RBC and delivers it to the tissues. I started with 12.0 gm/dl (12-16 gm/dl normal). This has declined to 10.4 gm/dl. A small number difference but a huge oxygen carrying capacity difference. After all, it is a 16.6% drop from the low end of normal. I knew something was up when I swam this am and could only do eight sloooowww lengths before I got dizzy. So... no more swimming. I'll have to walk... and eat RBC production food items. Evidently, they don't do red cell stimulant injections because they found an increase in mortality for chemo patients that were given these injections. Well, that's a good reason to avoid them. I'm still not interested in a transfusion, if it came to that.

I got sick of looking at my moth-eaten stubbly head appearance so I shaved it all off this morning. Wow, that was a huge improvement!

Roast Chicken Barbarism

Yesterday my good friend, Diana, brought us dinner. Roast chicken and brussel sprouts in cream... she's a brave soul bringing my most hated veggie. Tapwe and I never left the kitchen, we stood at the counter and devoured half of that bird and several scoops of sprouts... all as finger food. I swear we must have looked like a couple of cats squabbling over a carcass. I grabbed the wings before he could. He grabbed and tore off a leg thigh combination. Face stuffing ensued. Between mouthfuls a sprout would be popped in. It was fabulous but most impolite. I think we were done in about eight minutes. No words, just sounds. An objection sound when it looked like Tapwe was going to take one of my wings. Yummy enjoyment sounds with a bite that had a most delectable piece of skin. You know the drill.

It reminded me of a time some 25 years ago when I was living and studying in Mexico. I had been very ill with Montezuma's revenge and had acquired a protozoal parasite, giardia. I was dating this fabulous guy and he took me out to eat once I was in good enough shape to enjoy the experience. We went to a restaurant where I had baked ham enchiladas and a chicken. The similarity is, that I devoured that chicken... or was it half a chicken. Anyway, I ate the meat, the cartilage, and even broke some of the bones and ate the marrow. It was fabulous... the food and the company. Such a nice memory to relive during a cruddy chemo time.

It made we think about weight gain-loss during chemo, etc. I haven't lost any weight... so far... and how could I with such excellent cooks getting me by the hardest part of chemo? There is no way I would cook this well for myself during my sick and crappy week. Yet, it is such and important week. The whole GI tract is trashed. All the cells must be rebuilt. Normal peristaltic action moving ingesta from the mouth to the poop shoot slows to a creep. Absorption, too, must be dramatically impacted This is why constipation ensues and nothing just slides on out but damnable fecal balls are produced. To complicate matters, the bone marrow hit takes out the white and red cells so anemia is involved... to a varying extent. This is critical because every cell in the body needs that oxygen carried by the red cells to recoup, recover and regenerate. From a  physiological view, it's an even more daunting task than when I think of my 'plain 'ole' physical task. Let me explain how incredibly important these meals are for ones recovery... mine in this case. I have literally billions of cells to replace after each chemo - the gut and bone marrow being of primary importance to get things 'normalized' to accomplish the rest of my body's cells. I have to successfully digest food to get the needed building blocks to all the cells that need to regenerate. At the same time they cannot regenerate without the all important oxygen carried by the red cells. All those cells regenerating are made, predominantly, by fats for cell membranes and proteins for all the enzymes, and cell structures. I suspect this is why when someone brings in a high fat high protein meal, my body starts singing and we DIG IN fast and furious. It's also why I believe chicken or turkey soup is the critical 'first' meal on the worst of worst days. It's full of chicken fat and proteins in the broth which is very readily absorbed with minimal digestion. I also think my friends are incredibly talented chefs, cooks, food handlers or whatever else you like to call yourselves. I don't want to disrespect the veggie sides because their phytochemicals are critically important also. I'm just grateful that a small amount goes a long way.

All this talk about anemia reminded me of a discussion I had with my oncologist... a truly lovely and compassionate lady. Evidently, the current trend to handle anemia is to give blood transfusions rather than bone marrow stimulants. I don't recall the reasoning, but will delve into that some more. The reason I bring this up is that it doesn't make sense to me... from a logical point of view. First of all, why didn't they have me give blood prior to chemo so if I needed a transfusion we could use my own blood? I'm a little rusty on my transfusion medicine but it could be that it wouldn't have lasted long enough in cold storage. When I think this through, I can't imagine wanting to dump blood from someone else with all its associated foreign proteins into my body. It just seems like my body is already reeling from massive doses of toxins and that a hit with another invasion of 'substances unknown' wouldn't make my body happy about it. I'll find out more. It's not that I'm face with the necessity of a transfusion... so far... but I think it's good to think of these things in advance. Don't you?

Ghostly Transparent

It's been a long day today, so I'll keep things short and relatively simple. I had several people ask me how things went this time around compared to last time. I must say it was easier in that it was less painful since we started the bone marrow stimulants sooner and I took more drugs preemptively, but it was also harder knowing what was coming and dreading it. This is a process that takes a lot out of you, perhaps more emotionally than physically. The oncologist might disagree with me.

Yesterday when I drove to pick up Tapwe, I realized I felt not fully in this universe. I know that sounds weird, 'cause how can you not be here? It's not that I felt mentally out of touch, it just felt like I was somehow semi-transparent. I know I'm not doing this justice. I imagine perhaps this is how people feel when they are checking out. Not quite all here... but in a very physical, not a mental sense. I felt here mentally - very alert and with it - just not so much physically. Almost, ghostly. I know it seems bizarre. I can't really explain it well. It's not scary or even freaky when it happens, I just feel like I've lost touch with reality... the physical reality of the world. Perhaps that's why those calls on Tues after chemo are so important. They bring me back into focus... literally. It must be chemo brain. I'll let you mull that idea over for awhile.

Days 4 & 5

As anticipated, Days 4 & 5 were challenging. Better than last time, but still exhausting and painful from the bone marrow stimulants. Nonetheless, I feel much better this evening than I did even this morning. Thanks to everyone that made these two hellish days manageable!

I've done a reasonable amount of reading on diet so I'll try to start posting information regarding that all-important subject. I think we'll start with some basics and work up from there. You all will have to give me some input on how you like the organization of the data or if you have info you'd like me to look into. This could be both educational and a lot of fun. Certainly more fun than we telling you I had a bad or good day.

Nighty night.

Day 3 - So Far So Good

Getting tired... my sternum's sore from the bone marrow stimulant but otherwise things aren't too bad. Lots of little head hairs are abandoning ship. After only one day of constipation I had a BM, to which I am most grateful. Amazing how normal bodily functions become so heavenly when you're not totally well... when the abnormal becomes normal. I was looking back and thinking about how odd it is that not four months ago I was totally healthy and my life was 'normal'. Or so I thought. True, I had found a lump in my breast but I felt fine. I didn't feel like I was 'sick'. I didn't know what it felt like to have cancer. Unless cancer has compromised a major organ system it doesn't feel like anything. You aren't really sick at all... that you know of. You feel fine. It's not until you go down that path of cutting out the tumor(s) and filling your body with toxins that you actually feel 'sick'. All in such a whirlwind. Odd. It's such a head trip... don't let it trip you up.

Today I was reminded of how lucky I am... again. My neighbor came by today after dinner to drop off a plate of turkey and all the fixin's. No reason. She just thought of us. How kind is that? Truly, I am blessed.

So Far So Good

Not a bad day. I'm trying to listen to my body carefully so I rested a lot today in preparation for the next 3 days. A lot of burping and gassing... not that you wanted to hear that, but it is important. The burping told me I wasn't moving all the gas in a posterior direction so I took a metaclopromide to move thing is the correct direction. Although it has stopped the burping, no production yet from the other end. I am hopeful that stepping up the stool softeners and laxatives will produce... soon.

I remembered that when talking with the nurse practitioner yesterday, I expressed how I couldn't see how anyone worked full time through chemo. She agreed that working part time was the smart choice as it allowed for a faster, better recovery time both between chemo treatments and also in the long run. Chemo takes a big hit on your body and your body needs you to pay attention to help it heal. I also remembered ice chips to suck on this time around. So far my tongue has fared better. We'll see if that continues.

Half Way Done!

Round 2 complete! Feels wondrous. Docetaxal anaphylaxic reactions will occur on the first or second time. I cruised through with no problems. Well, almost no problems. All my checks and balances in meds failed but only because I didn't use them. So embarrassing. I only took half my doses of steroid yesterday and today which is to help avoid the anaphylaxis on chemo day and fluid retention. That meant we had to stop everything to give me the steroid IV, then flush it through with saline and give it time to take effect. Ultimately, it added two hours to the whole thing. Blast! Of course, in the end all was well. We will start the bone marrow stimulant tomorrow instead of Sun or Mon to avoid the bone marrow dump I had last time. We're also changing up the stool softeners to double doses twice daily and adding the laxative twice daily rather than once daily. Just in case, I've got metaclopramide (a bowel stimulant) to push things along if they aren't performing to specifications. Perhaps more information than you'd like to know... but not if you have to go through something like this some day.

I talked with the nurse practitioner before chemo and she was in tears when I told her about the awesome support group I had. Seriously, she was crying... and so was I. She told me how incredibly lucky I was. She has NEVER heard of anyone with such a large and supportive group. That just made me cry more. Really, all the little and big things you all do for me - cards, gifts, email, bringing meals, vacuuming, helping me cook, calling to chat - are so very very important. I can't say that enough. We'll have to have a little, or big, appreciation potluck some day when this is all in the rear view mirror.

I'm not truly bald yet so our plan for a henna party is still pending. I'd like to find out how many of you are interested in attending. I'm going to have Barbra henna my head but you all can henna your hands or feet. So who's interested in coming? You don't have to henna anything if you don't wan to. Just come hang out.

Ready for Round 2

Tomorrow is Round 2. I think I'm about as ready as I can be... food-wise, thanks to Julie Grossen, Ruth, Diana and everyone that's signed up to bring food... physically, thanks to many naps and early bedtimes... mentally, thanks to all the research I've been doing... and most importantly, emotionally, thanks to all the fabulous support you all are giving me. I'm actually looking forward to the chemo because it means I'm half way done. It's totally going to mess up Thanksgiving and Christmas but I should have a decent New Years. It really can't be done soon enough but one must be patient... dang it!

I've seen some blog comments requesting responses from me but there is no email address to which I can respond. SO keep making comments for all to see but either use your email address in the comments box OR you can email me directly at: ywikander@yahoo.com. Yes, I'm talking about you, Amanda. I don't want to publicize the CareCalendar information because the blog is visible to all of creation. That said, if you'd like to take part email me and I'd be more than happy to send you the link.

I must put in an early night. We'll chat soon...

Day 2 of Prep

Today was another big day of prep for my post chemo week but before I talk about that... the coolest thing happened to me yesterday. I went to pay my rent and the management informed me that a Good Samaritan had already paid it. Management wouldn't tell me who since the individual(s) wanted to remain anonymous. Since I cannot personally thank them, I feel a public thank you is in order. I don't know who you are but I thank you from the depths of my soul. Your generosity brought tears not just to my eyes but to the managers eyes as well. So before I get all gooey...

That chemo eating cookbook is amazing. I have yet to produce a yucky dish. To boot, they are not time consuming nor challenging to follow. Today I made:

• Hummus - I think it needs red peppers... next time I'll add that
• Southwest Bean Dip for constipation
• Creamy Mac and Cheese - this is Tapwe's favorite so I gave him a quarter of it
• Spicy Cream of Broccoli Soup

All of the recipes are made from scratch... pretty much. I've had to crack a can of chickpeas for the hummus as well as a can of white beans for the bean dip but the rest all comes from basic ingredients. As I learn more about nutrition, I will begin substituting better ingredients but for now I've just tried to buy all organic and leave it at that.

I don't believe I've told you about the naturopath yet. He gave me three sets of supplements and recommendations. First was nutritional supplements including Vit D, Vit B12 and Cod Liver Oil for the Omega 3 fatty acid content. Along with this he recommended high protein and fat for cellular rebuilding. This included a protein shake daily which I've found very challenging to incorporate into my day. Anytime I eat a carb he wants me to add a protein with it... not a new concept. He also recommended a powdered veggie supplement called Greens First. It's not really a substitute but until I'm into the groove of actually eating veggies it'll do. Second was immune stimulation with melatonin before bed. Up to 20 mg as long as the vivid dreams don't disturb my sleep. I've worked up to 9 mg so far and love the dreams I get. Third was a group of mucous membrane health items including L-glutamine, slippery elm bark, and HMF powder which is a human micro flora acidophilus supplement. The goal being at least four different micro flora strains and 10+ billion live cultures. To this all I added acytl L-carnitine for neural health in hopes of reducing the peripheral neuropathy that often comes with docetaxel. Between all these supplements and the medications I have to take from my oncologist I developed a sheet to keep me on track. Between my medication binder, all the bottles of "stuff", and my pill tray I take up half the dining room table!