Friday, November 14, 2008

Water gets deeper

The day we've all been waiting for...well, maybe it was just me waiting for it. Or pretending it wouldn't come. I met my oncologist yesterday and liked her very much. Her undergrad was with honors, she was chief resident at IU and then her MD from Vanderbilt, so she's no slouch. She's my age or a little younger. Very kind and nice.

She said all my situations fall in the middle of the road--the size of my cancer mass, my age, the aggressiveness of my cancer cells, are all mid-range. The onco-type test takes two weeks to get the results. Even if it comes back that I have a "low likelihood" of recurrence from that test, she would still be recommending that I do chemo, sooner rather than later. Also, there were cancer cells in the right breast tissue. They were immeasurable, but existed. So, another thing to be thankful for--getting them both done. PTL

She said chemo lowers your recurrence risk by 40%. Taking Tamoxifen after that lowers the remaining risk by another 18%, so they are worth doing. She felt like she was the bearer of bad news, although it isn't really bad news. It's a temporary tunnel you pass through to make the far end of the road longer, I guess.

She said my hair would fall out 19 days after the first treatment. I have to have four treatments, 21 days apart. She said you feel pretty crappy for about a week, then your blood counts drop and you need to be very careful about germs and fresh fruits and vegetables at that point. Then about the time you get feeling better it's time to do it again.

I cried. I admit it. It's so silly to cry over something that seems so shallow, but in reality, it's a BIG part of my identity. Handyman LOVES my hair. It is my one vanity solely because he has always gone on and on about how he loves it. I am glad it will be winter; and I am glad I really do like hats. I will hate having no eyelashes especially. But it gives me a chance to be humble and to pick out something else to identify me, I guess. How about a big blue blob? Oh, right, I can't be showing that to everyone. It is getting lighter in color, but the oncologist said it would last awhile. Wonder what her definition of "awhile" is?

It'll still be football season, so that'll help. And I'm signing up for Netflix. My concession to cancer?? Netflix. No late fees. I just have to walk to my mailbox. My friend RM is giving me some recipes for homemade calorie-intensive foods to boost my strength. I think I'm going to take #1 and #2 to Olive Garden for an early birthday dinner, while I still feel like eating.

I'm considering the whole hibernation thing--don't show my face until March 1. My blog b/c friend, Gail has been through her first treatment, so I have some hints of what goes on. I'm sure my friend Aibrean will have words to encourage me with, since she has walked this road, with a great sense of fashion, I might add.

Here's what I am chanting to myself: IT's TEMPORARY. IT's WORTH IT. THIS TOO SHALL PASS. (You'll look like a bowling pin.) Oh, that's probably not one I should keep repeating.

Well, I have to get a flu shot. I have intensive vacuuming to do. I'm off to search "homeschooling with chemo" and "chemo for the holidays". Bottom line, again: It ain't my pancreas. Thank you Lord that chemo exists. (Remind me of this in two weeks.)

Saturday, November 8, 2008

Of interest, before my oncology appt. Tamoxifen

Found this while looking into Tamoxifen, the drug that seems pretty likely in my future: (I added the bold type since it applies to me.)

Tamoxifen is the oldest of all the SERMs (Selective Estrogen Receptor Modulators). Tamoxifen is prescribed for women with hormone-receptor-positive breast cancer before and after menopause. While tamoxifen is the hormonal treatment of choice for pre-menopausal women, research suggests that tamoxifen is not quite as effective as the aromatase inhibitors for post-menopausal women.

Tamoxifen is used to reduce the risk of breast cancer for women who:

are at high risk of breast cancer but have no personal history of the disease, or
have non-invasive, hormone-receptor-positive breast cancer, or DCIS (ductal carcinoma in situ), or
have hormone-receptor-positive invasive breast cancer at any stage.
Tamoxifen is taken for up to five years. But women with advanced (metastatic) disease can continue taking tamoxifen as long as it is working well.

Tamoxifen has very weak estrogen activity. When you take tamoxifen, it passes into your bloodstream, joining all kinds of hormones, nutrients, oxygen, and other molecules as it circulates through the tissues of your body. If breast cancer cells are present, tamoxifen flows around them as well. If these cancer cells have estrogen receptors (about two-thirds do), tamoxifen slips into the receptor "locks," filling up a space that would normally be taken by the body's natural estrogen.

Cell with estrogen receptors blocked by tamoxifen and helper proteins.
Larger VersionBecause tamoxifen is such a weak estrogen, its estrogen signals don't stimulate very much cell growth. And because it has stolen the place away from more powerful estrogen, it blocks estrogen-stimulated cancer cell growth. In this way, tamoxifen acts like an "anti-estrogen."

Tamoxifen may also take the place of natural estrogen in the receptors of healthy breast cells. In that way it holds down growth activity, and possibly stops abnormal growth and the development of a totally new breast cancer. By blocking natural estrogen from getting to the receptors, tamoxifen is helpful in reducing the risk of breast cancer in women at high risk who have never had breast cancer. It also can help women who have already had breast cancer in one breast by lowering the risk of a new breast cancer forming in the other breast.

For pre-menopausal women, tamoxifen is the best hormonal therapy. But tamoxifen is no longer the first choice for post-menopausal women. If you've been on tamoxifen for two to three years and now you're in menopause, your doctor may recommend that you switch to an aromatase inhibitor to finish your five years of hormonal therapy. However, you can still get a lot of benefit if you take tamoxifen for up to five years and then switch to an aromatase inhibitor.

Over the years, it's important for you to be checked regularly so that you and your doctor can re-evaluate how the drug's potential benefits and side effects.

Tamoxifen plus other treatments
Hormonal therapy doesn't replace other forms of treatment. The value of each treatment adds up to give you a better overall benefit. Hormonal therapy may be recommended on its own or in addition to chemotherapy or radiation therapy (but not at the same time as chemotherapy).

One study found that radiation plus tamoxifen was much better than tamoxifen alone at reducing the risk of breast cancer coming back after a lumpectomy in women with hormone-receptor-positive breast cancer. This was true even for women with very small cancers (less than one centimeter). Another study showed similar results for women with very small cancers with no lymph node involvement. This means it's important to have radiation treatment after a lumpectomy, even if you have a very small cancer and are taking tamoxifen or other hormonal therapy.

How the benefits of tamoxifen and chemotherapy add up depends on your individual situation. In general, for women with hormone-receptor-positive breast cancer, hormonal therapy is more powerful than chemotherapy. But chemotherapy can also be very helpful if you have a high risk of the cancer coming back. For example, if you have lymph node involvement, you may want to take both forms of treatment to get your risk as low as possible.

One study found that tamoxifen AND chemotherapy improved survival rates by about 40–50% compared to taking one treatment or the other. (Again, tamoxifen and chemotherapy are not given at the same time.)

However, another study found that chemotherapy plus hormonal therapy was no better than hormonal therapy alone for women with hormone-receptor-positive cancers that had not spread to their lymph nodes. This was especially true for women age 40 or older. The benefits of two hormonal therapies, tamoxifen and Zoladex (chemical name: goserelin), together are the same as the benefit as CMF (cytoxan, methotrexate, 5-FU) chemotherapy in pre-menopausal women. (Zoladex shuts down the ovaries so that estrogen production stops.)

Should you consider chemotherapy if the breast cancer has not spread to your lymph nodes? If you've been diagnosed with lymph node–negative invasive breast cancer that is hormone-receptor-positive, chemotherapy may not add much benefit above and beyond hormonal therapy. Plus, side effects of chemotherapy tend to be more difficult to handle than those of hormonal therapy.


To help figure out whether chemotherapy might or might not add benefit, you could consider having a test, called Oncotype DX. The test is available for women who have hormone-receptor-positive, node-negative breast cancer. Ask your doctor if this test might be helpful in your situation, and if she or he can help get the cost (about $3,200) covered by your health insurance.

ANY further reduction of risk may seem worthwhile to you. Many women feel that they want to do anything and everything to keep lowering their risk.

Back to me--as I mentioned, I am having the Onco-Type test...I'm going to be sure to take this info with me to the appt.

Better

I was better yesterday. Hopefully it wasn't just the distraction of my friend, CD, who brought me a meal for today! Yea! Handyman graciously doffs his cap again and again to all of you who have contributed so generously to his nutritional needs. He is really over tostito crumbs with cheese melted in the microwave...did I mention that I am way okay with "rut eating"? My dad taught me this by insisting that mom cook in industrial-size batches EVERY meal. That way he could eat the leftovers for several days. And believe me, my mom doesn't throw out anything. You eat and re-save it over and over until there is more mass of green fungi than food.

When I got married, I didn't realize there was any use for smallish pots and pans. Then I learned that Handyman is okay with leftovers and he is frugal, but he is not a rut-eater like us. He doesn't do the "Friday Night Spaghetti" thing, every week the same. And, he has catered food at work. Now that isn't always as excited as you think--sometimes the "caterer" is Papa John's or Jimmie John's or someother John's. But sometimes it's a two-entree choice with vegetable sides and a soup.

ANYWAY--he is VERY thankful to all of you who have made the drive to Netherfield to sustain him. So I got to visit with CD, for the first time in a year and then went to Mom and Dad's for the first real meal I have eaten in a couple days and it was good--meatloaf with mashed potatoes and tomato-soup gravy. Then we watched Dancing With the Stars as is our habit.

#3 ate her meatloaf and her potatoes but mostly ate sweet pickles and olives and then had a big rootbeer float. Then Mom realized that she had forgotten to put out the deviled eggs! So, of course she got those out and #3 had one of those too. By this time I was popping a couple of antacid tablets and here came #3 breathing deviled egg/root beer breath in my face and it was almost too much for me. I told Mom, if I had to clean up puked-up root beer with deviled egg, I was going to kill her! Then, #3 says, "My belly hurts." and I look pointedly at Mom.

Fortunately, her digestive system was up to the strain. Mine is still in recovery mode. I did eat peanut butter toast this morning and in honor of my Gammie, I put butter under the peanut butter, because that's how she did it (and it's GREAT). That's the first morning I've wanted/eaten breakfast in several. So, improvement.

I have also scheduled myself for a 1/2 hour massage next Friday. My neck is kinked something fierce and I'm willing to pay for help. In fact, I may just make it a standing appointment because I can use my health savings account to pay for it! Needa's SIL is a massage therapist, so I have an "in".

So, I don't have to worry about food tonight and there's a chicken pot pie in the freezer for tomorrow after church! And then, there's a smoked chicken for later in the week...thank you Lord for FRIENDS!

Friday, November 7, 2008

Appointment

Okay, the big oncology appointment is next Thursday, I think at 10 am. He asked me whether I wanted to see a man or a woman oncologist, or did I care; and I told him I didn't care if a uterus was involved, I just wanted to see a good one.

So I am set up with a woman oncologist; no word on whether she has a uterus or not. She will order what's called an "onco type" test that involves 21 chromosomal markers (I think that's what he said.) They will compare the arrangement of my 21 markers with many gazillions of others who they have followed to determine if I have a low, moderate or high likelihood of recurrence. That will determine the chemo recommendation.

Oh, and my cancer was 2.7 centimeters, so that pushes me into Stage 2, although all my other things were clear, so I'm what they call a 2A, which means just barely at 2. My other cancer blob next to the biopsy site was only 4mm. And, my cancer is estrogen positive, which is good, because that means they have medicine that works on it. Estrogen negative is very challenging and not very responsive, I guess. He is almost positive I will have to take Tamoxifen which is an anti-estrogen, so I could plunge into menopause--Whooo whee! Whatever--better than bein' dead.

Sounds like more big decisions for me. Maybe I should just wait on someone from the government to tell me what to do...

On the abdominal front, I was miserable all evening last night, watching stupid tv shows, because I didn't even want to read. No wonder our country is going downhill so fast. If most homes have that schlock blaring 18 hrs. a day, I can see why peoples' brains have turned to oatmeal. Anyway, today I am feeling a little better, but usually do in the morning. We'll see what the evening brings. I am going to my folks to watch Dancing With the Stars--my one video weakness. (I saw who got voted off last night while perusing those dumb entertainment shows. Thank the Lord I found a This Old House rerun.)

It was great to take a shower without tubes hanging out of me. But, the blue blob shows no signs of fading. I can tell this abdominal thing is slimming me down, which just gives me more splurge room for the holidays. After all, it's EGG NOG season! Woooo hoooo!

Thursday, November 6, 2008

Up and down

Had my visit with the surgeon. He said he'd see me in 6 months and he doesn't know why I have a large blob of blue ink still in a strategic place. He found that pretty weird and promised me it would go away. I'm glad because if I was going to get a tatoo there, it would've been a little fancier.

He promised that my arms would be equally good when I finished healing. He encouraged me to stretch the painful one and not baby it. He doesn't want me to have my armpit aspirated again unless it is worse than it was when I saw him. And I do not think it is worse.

However, I feel sort of yukky. I have achy stomach and some tenderness at the bottom of my sternum. I could not get comfortable last night and ended up chewing two pepto bismol tablets and that settled me down. Then I woke up again at 2 and felt the same and fortunately had two tablets left. My eyes sort of popped open then and I thought, "I wonder if I have an ulcer."

Gee, I don't know--teenage angst ongoing issues (for oh 5 years now), in-law related stress on many topics, including hospitalization this week for my FIL, breast cancer, election trauma and I was on Celebrex for 10 days...can't see why I'd feel too stressed.

Sure enough, I looked it up online--the source of all knowledge--and it seems possible. My symptoms seem to fit. So I'm waiting on a call from the surgeon's nurse to see if they'll just call something in for me to see what'll happen.

My energy is good, other than this yukkiness and election depression. It was great to see all my cousins at the funeral yesterday. Handyman looked so great in his suit and my girls looked really grown up too. We got to see Auntie P., Uncle N. and Grandma from WVA there as well. A bonus for the girls!

My cousin Jules tried to tell Handyman that she read that you should never vacuum once you've been diagnosed with breast cancer--that it is off the list FOR GOOD! I don't think he was buying it. Gotta go, the dust bunnies have lifted the bed off the floor.

Tuesday, November 4, 2008

Drain free

Yeah, I'm livin' a drain-free life. What a treat it was to sleep last night without that stitch in my side, literally. It was a difficult night really, what with Dancing With the Stars on opposite channel from The Masked Magician Reveals. Thankfully, Monday Night Football was not on a local channel or it could have become violent. Then there's the whole issue of a family of four full-size humans and two dogs on a queen-size bed...and one remote.

Anyway, drain is out. She got about 60ml. out from under my arm, which is a lot less than before and we scheduled to try to take out more on Friday afternoon. Today, AFTER VOTING, I see the breast surgeon for his follow-up, when I will get a write-up of my lab reports and he will refer me to an oncologist, I guess.

Tomorrow is my grandma's funeral in Ohio, so I will get to thank all my cousin's first-hand for their cards and flowers and prayers.

Hopin' my state stays red...

Saturday, November 1, 2008

Catch Up

Well, Tonya brought us some food on Thursday afternoon, which I planned to make for supper on Friday, since we were going to my parents' house on Thursday night. Handyman saw the food, or maybe sniffed it out, and announced that we were having it for lunch, right then and there!

Tonya was somewhat frightened at the eating that went on around the table that day. Handyman, #1 and I announced that it was the best meal we'd had for three days. (Don't even ask what we had on Wednesday before Awana. Pathetic doesn't even begin to describe it.) Anyway, we just finished Tonya's pan of yummy enchiladas today. We've eaten on it for about 5 meals or so. THANK YOU TONYA! She also brought yummy pumpkin bread with icing and rice and beans. So appreciated.

Today, I dropped off #2 to go with Needa to her weekend cabin. Needa handed me a smoked chicken, frozen and sealed and three chicken potpies for the freezer. I'm still not sure who got the better end of that swap... ;)

BFF Debbie is coming Monday with something yummy from her and from PB as well. So, 2, 2, 2 meals in one trip! Woohooo! (That is really Handyman and the kids cheering--I think they're looking to trade me in on an upgrade or something.) Cindy is bringing us something yummy on Wednesday, to avoid that whole Awana/meal crisis that happened even when I wasn't incapacitated. Then, we also have a standing invite for CCW to come up here and make us amazing applesauce pancakes; so I'll be plugging that in sometime soon.

I also received a gift bag chock full o'wonders from the Whitaker b'day party that I missed last weekend. The piece getting the most mileage is the singing hamster card, that now travels with us, because you cannot fail to smile when there's a singing hamster in your car.

I did see the PA at the plastic surgeon's office yesterday, hoping to get my drain out. I told her that my left armpit was swollen and uncomfortably numb and she poked around on it and decided she would drain some fluid out with a syringe. Well, that went on and on and on and she kept saying things like, "Well, you've surprised me." End result: she drained 150 cc of serrous fluid out from under my arm. She said it is not something to be scared about and she may have to do it again. The drain that is still in does not drain that area. So, I'll go back in Monday afternoon to have the drain out (PTL) and perhaps get a re-suction.

I see Dr. T. the surgeon on Tuesday afternoon and that is when he will give me the full run-down on "my recipe" of cancer and recommend me to an Oncologist. I don't know if that appt. will already be set up or I will make it.

I'd say I feel about 80%. The armpit thing is holding me back a little. I am scooping poop, albeit with the kiddie poop fork, so that the loads aren't as heavy and I do that once in the morning. I would like to strip my bed, but haven't taken on that. The vacuum needs run upstairs, but I'm not doing that, but I did get the kitchen cleaned yesterday, for all of 42.5 minutes before it was undone. The weather is so beautiful it is a shame not to be riding horses, but I know that would be too much, too. Bummer.

Check out my other blog later to see new pictures of the "tree house" in progress.

Tomorrow is my 17th wedding anniversary! Yea! Which probably means that I get to go out to eat--yea!

Note to Auntie P. and Grandma R.: The house is falling to shambles without you! #3 asked, "why did they have to go back to WVA?!"

So what's it feel like to be rebuilt?? Imagine duct-taping a full waistpack to your chest so that it doesn't move. That's it. You know it's not you, but it's not going anywhere, so you might as well adjust. Weird.