let this year end

In with 2024

My New Year's goals for 2023 were to spend quality time with my family, finish some key writing projects, level up at work, and purchase a new TV couch. Six weeks into the new year, I discovered a lump in my breast during a regular self-check, and I had a prescient moment of clarity—without any factual support at that point—when I knew none of those goals would happen this year. 

I've had that same feeling before: April 1995. It's a feeling like a sharp slap in the face when I knew nothing would ever be the same. I wasn't wrong. Either time.

Which is why I'm looking forward to 2024 with hope and optimism for what's ahead and gratitude for the opportunity to live it. 

Treatment Update or How Are You Doing?

Baby tennis ball hair!

I hear myself telling people that I'm definitely feeling better but still feeling bad. It seems to be the most honest answer. 

Since the final big-bad infusion of chemotherapy (10/27/23), I continue to get the Phesgo shot every three weeks. This is the targeted HER2 anti-cancer immunotherapy drugs injected into my thigh. This shot has always been included with the earlier chemotherapy infusions, and the Oncologist wants to continue this part of my treatment into July 2024, for a total of 18 of these treatments. So far, so good. 

I also started radiation treatment after a (brief) six weeks of recovery from the final chemo infusion. The full plan is a daily series, Monday-Friday, excluding holidays (Christmas and New Years), for a total of 20 treatments. As of today, I have completed 16 of the 20. The target  has been a broad scope of the left breast and corresponding lymph nodes. The final four treatments will be a narrow target of the incision area where the original tumor was removed. 

Side effects of radiation are minimal. I have not experienced any surface tissue damage or irritation so far (knock on all the wood of the world). Fatigue and mild stomach and intestinal irritation persist, but I can't tell if those are remnants from the big-bad chemo drug (Taxotere), ongoing Phesgo shots, or from the radiation. 

Celebrating Healing and the Holidays

The worst of the chemo side-effects are fading, some faster than others. My hair is coming back! My fingernails are growing. Taste and smell are returning slowly, and coffee is lovely again. The muscle pain from that last round of chemo still remains, and the neuropathy is also slow to go. I remain optimistic. 

Thanksgiving arrived, and the kids made dinner for us (except Rick did the turkey and the gravy). All of the food was delicious. Christmas arrived, and luckily I'd had enough foresight to have done most of my holiday shopping back in July. So I did some last minute online shopping, and our celebrations were mostly stress-free. 

Big News in Healing: we went out. Mid-December, I felt well enough to risk a two-hour drive, and we spent two nights away from home on the Oregon coast. We rented a beach house overlooking Depoe Bay, ordered food in or made it ourselves, watched whales, the ocean, big winter storms, fishing boats and the rain, and we never left the house all weekend. It's the first traveling of the year that wasn't to/from a hospital. Our last big adventure out was last Christmas (2022) in Utah. 

Wow, it's been a long year. 

Celebrating Us

My seasonal holiday-card (pantry) door is covered top-to-bottom with cards and postcards and notes, holiday and/or otherwise. I hear your kind words of encouragement and love. Thank you!

Each of you has made a difference throughout this unexpected challenge, and I appreciate every big/little thing that connects me to you. 

I'm celebrating each of you as this long, hard year turns over to the new one. Here's to us all!

~ Sherri

talking about

how might I hold

my beholden out to you

and you hold yours out to me, 

how do we be holding each other,

                                            ~ Ross Gay, from Be Holding, a poem

ring the bell

10/27/23 Final Infusion

Friday, October 27, I rang the bell to celebrate the final chemotherapy infusion of my treatment plan. The whole team cheered, and I may not appear super excited, but behind the mask, I'm stoked. 

Post-infusion Plans

I've told more than one person that we've figured out how to survive the worst of it just in time for the end. Isn't that how it works? My sister Debbie flew in as the final support team. I had an open order for IV fluids to prevent the dangerous blood-pressure drops, meals planned, and white-cell booster shots scheduled. Of course, nothing ever really goes as planned. 

Survival Week

You know what they say about "the best-laid plans of mice and men...." The week started out slow and gradually tipped into all the regular symptoms (see previous posts for details), with some nuance. Merissa was exposed to Covid at work, so we had to pivot our plans for team support at the end of the week, as well as to adjust a family contingency to attend Merissa's fire academy graduation. Some change-of-season symptoms had us all masking up at one point. Ultimately, nobody got sick—knock on all the woods and all that.

To complicate everything, the new "surprise side effect" showed up by day 5: IV fluid retention. What was supposed to be helpful started causing problems. By the end of the week, Rick took me in to my final appointment for fluids, and we declined them. The Oncologist thought the new retention issue was more problematic than pushing oral fluids. I'd already made it through one night of low-low blood pressure (77/61) pushing KinderLyte and Salt Stick tablets without a crisis or an ER visit. So we checked out without any treatment on Friday. 

Let the Healing Begin

What I learned from that extra 4th week between Infusion 5 and 6 was that my body would start healing sooner than later. My skin began to heal, stomach settled, appetite increased, my hair started growing again, and even my taste started to recover—I had two days of normal-tasting coffee for the first time in five months! Infusion 6 immediately crashed all that progress, but I remain optimistic for the near future and the promise of a good cup of coffee. 

The Out-of-Work Elephant

Let's talk about my job. Officially, my role has been "eliminated" as part of a larger company-wide layoff, and I guess the way around my protected medical leave is to make my return-to-work date also my last day of employment. I have started the search for an attorney to manage the next steps. Until now, my priority has been to survive the last cycle of chemotherapy. 

Truthfully, I am not a huge fan of this job-loss scenario. I've never been "let go" from a job before, and it's baffling even without all the cancer-medical-leave complications. Best case for me would still be to go back to my job as Senior Technical Writer in three weeks. All the Survival Weeks put together should have landed me at work on Monday 11/27 with a full pre-medical-leave plan already completed and a full back-to-work plan ready to launch. 

The most tragic (ironic?) part of this is where I am let go from my job while out on protected medical leave for breast cancer treatment during Breast Cancer Awareness month. (Cue Alanis Morissette) Even if it's all legal, it's a super shitty thing to do to anyone. 

You can help if you've experienced a layoff. Email me your thoughts and experiences through the link up there in the top right corner of this blog. ↗️

You've Already Helped

Thank you, each and every one of you. You've given me so much. I've received your love, gifts, support, prayers, donations, phone calls, messages, emails, cards, stories, jokes, books, letters, and kindness. You are dear to me in ways I could never have anticipated. I can only hope to be able to return the support in kind whenever and wherever I am able. 

Thank you for being part of my life. You are seen, appreciated, and loved. To quote one of my heroes, "without this, there is nought." ❤️

Onward!

Sherri

fierce love to you

 

 I wished a way might be
 My Heart to subdivide—
 ‘Twould magnify— the Gratitude—
 And not reduce— the Gold—

  ~ Emily Dickinson, from "without this— there is nought"

5th round slog and delays

Infusion 5 #f@ckcancer (middle finger up)

My apologies for the delays in getting this post out into the world. #5 was a difficult round, more than any previous infusion cycle. My system feels strained. As usual, there are new symptoms that have popped up in addition to all the previous symptoms. 

The list goes on. . . . 

New Side Effects

Round 5 Infusion added fluid retention in my face, including numbness and swelling. The Oncologist has confirmed that my lungs are clear, and I have only minimal retention and swelling in my ankles and legs. I am reminded to make good use of those compression socks, push fluids and electrolytes. 

The mystery heart arrhythmias that have shown up in the last three infusions prove to be solved by increasing those electrolytes. In fact, the Cardiologist says, "Double everything." It seems to work!

As well, I am having increased muscle twitching and spasms, including in my core and under my ribs. The intensity of the spasms caused my Cardiologist to cross-check previous ultrasounds and that CT scan from the ER a few rounds back to rule out an abdominal aortic aneurysm (which sounds terrible). Good news! He reports that is not what I have. Instead, I get reactive muscle spasms Docs seem to think it are primarily in my diaphragm and core. It feels like a startled bird embedded under my sternum. Yay, me.

My fingernails are still a hot mess. Same with the weeping and twitching eyes, bloody nose, sensitive gut, and fatigue. Along with the worst of the responses in the first ten days after the infusion.

Things that Help

All those Electrolytes: they address the heart arrhythmias, low blood pressure, and dehydration issues. I've tried a bunch of different kinds, and landed on a few I like, mostly for less sodium less sugar. Here's what I've been using: 

• Salt Stick capsules - good balance of potassium, magnesium, and sodium; easy capsule dose; no sugar
• Salt Stick Fastchews - minimal potassium, magnesium, sodium; immediate release into system via chewable tablets (they are kind of like Sweet Tarts)
• Vali Electrolyte Salts - more potassium and less sodium than Salt Stick; easy capsule dose; no sugar
• Nature Made Potassium Gluconate - when you just need more potassium; 1 tablet per day
• DripDrop Electrolyte Powder - good balance of potassium, magnesium, and sodium; less sugar than other powder options; add to 8-12 oz water 
• KinderLyte Medical Grade Electrolyte Solution - premixed electrolyte drink like Pedialyte with less sugar; use alone or add to smoothies

IV Fluids: the Oncologist made an open order for IV fluids to be administered at either of the infusion centers (at either of the hospitals nearby). These are most easily added to my Granix shots (the white blood cell boosters) given to me for five days after the primary infusion. I can also schedule an infusion appointment for fluids by themselves. After Infusion #5, I did IV fluids on days 5, 6, 7 and 8—all of them helpful and, in retrospect, necessary to stabilize me during those first difficult days. 

Drink Water: The goal is 96 oz of water/fluids each day, excluding those days
when I get IV fluids (I need less on those days). I track intake using an awesome 32 oz water bottle, and most days, I get close or make the goal. Early days are more difficult because my entire system is slowed and compromised by the chemo drugs that attack the sensitive cells in the the mouth, throat, stomach, and intestinal linings.

Small Meals: My compromised systems cannot digest food very well either. The solution is to eat six to seven times during the day, each time about 1/4 of an actual meal. Anything more or faster than that is impossible to eat and/or digest.

Naps: The fatigue is REAL, and I have to ignore the overachiever in my head that tells me to push through it. Naps are good.

Exercise: It hasn't been that long ago that I was running 3-5 miles a day, and now I'm barely able to cycle (indoor) a few slow miles or do a handful of body-weight movements (yoga and/or other options). I haven't been stable enough to walk outside by myself, so I am limited to indoor activities. Anything helps. But also there are days when I cannot exercise, and on those days, I get a pass. I'd love to say I'm able to exercise every day, but that is not the case—there are definitely impossible days when I'm simply grateful to make the walk between the bedroom, living room couch, and bathroom. 

You: Thank you for your cards, letters, Facebook messages, texts, phone calls, gifts, prayers, love, encouragement, and support. ALL of it helps. 

What's Next

Last Friday was scheduled for Infusion #6; however, after meeting with the Oncologist, we decided it would be best to delay my final infusion for one week. My bloodwork indicated low red and white cell counts, and my overall well-being was also low. Doc said we could push through as scheduled only because it was the last one, but it would be brutal. My choice. I debated for about 30 seconds on that and made the call to wait. 

I feel like it was the right call. I'm already (3 days later) feeling slightly better, but still not as well as I've been prior to earlier infusions. Everyone warned me that each treatment would be harder and each recovery longer. They were all correct. 

Infusion #6 is scheduled for this Friday, October 27. I'll do bloodwork the day before, but unless it is off the chart detrimental, it won't change the infusion plan at this point. Of course, we all hope that my levels show progress from last week.

As well, the Oncologist will be reducing the dosage of the Taxotere (the chemo infusion drugs responsible for the most challenging side effects) by another 10%. It was reduced the first time for Infusion #3, which makes the overall dose now at 80%. At this point in the treatment, it doesn't compromise my chances for success or overall effectiveness of the treatment. 

Even with the extra week and the dose adjustment, I anticipate a difficult last round. It's still a systemic poisoning. But I'm all in. I want this crazy toxic thing to be over. I can't do the next thing until I get through this one, including the whole I-got-let-go-during-medical-leave-for-breast-cancer-treatment during Breast Cancer Awareness Month. But I'm still working on that on all fronts, so it has to wait for another post. 

What You Can Do

Send me Your Words - keep up those calls, texts, messages, letters, cards, emails. Click on the email link at the top right of this blog for my email or to ask for my mailing address. 

Contribute to the Cancer Support Fund - your contributions give dollars to my primary support team for gas, coffee, and travel expenses for those people who give of their own time to come take care of me for a week and/or are running my errands and driving me to appointments. Current balance is $2.00 after Infusion #5. Click on that same email link above to request my Venmo info and or mailing address. 

Gift via the Amazon registry: Hoffman Chemotherapy Support

Send Prayers and Good Healing Energy: Thanks! I need that. 

Donate to the National Breast Cancer Foundation: this month (October) is Breast Cancer Awareness Month, and every dollar toward research helps the next person with breast cancer. I'm grateful for all that research that helps me now.  

My deepest gratitude to each and every one of you who not only supports me, but also Rick and each of my family members and friends who are doing the bulk of the work to care for me. Thanks for being a part of our journey. 

Onward!

Sherri

Infusion #5

 Hi everyone, 

This morning Sherri received her 5th infusion. Based on her blood work prior to her 4th infusion we were not hopeful that her doctors would allow her to continue with treatment as planned today. We were expecting this to get pushed out an additional week to allow her body to continue to rest and produce the necessary platelets and blood cells. To all our surprise, her bloodwork came back with positive results and she was given the greenlight to continue as planned. 

Unfortunately she came home after the infusion today extremely exhausted. The brain fog is strong and the symptoms are already hitting. We jokingly discussed that is to be expected after spending a day filling your body full of toxins. She asked me to jump on and give a quick update: to let everyone know she made it through another round and she is so thankful for all the heartfelt reach outs she has received today. Please continue to send your love and good thoughts, but know her and Rick's emotion bandwidth and communication is pretty limited right now. 

The family took on additional stress this this week as we found out Sherri was let go from her job. I think that will be a post for a different day. 

We all have heavy boots, but continue to take things day by day. 

Send all your love and know as she will return calls and messages once things stabilize a bit. If you are ever wanting a more active update, you are always welcome to connect with me directly. If you do not have my phone number, you can connect with me via facebook. 

- Becca Young-Fahrenschon

infusion #4 - no sushi no knives

I might wear a different shirt next time?
#cancerfashion

This round, my pre-infusion labs came back with key data on the bottom ends of acceptable ranges, indicating my immune system is taking more time to recover. The Oncologist was on holiday, so the Oncologist-on-call gave a hesitant green light to the infusion with caveats. She reduced the dose of the two main chemo drugs (Taxotere and Carboplatin) by 10% and suggested a 4-week interval between the next infusion as needed to recover my system. The dose reduction also reduced the pre-meds accordingly. 

New rules

With a struggling immune system, I am instructed to get more rest and to avoid raw foods, injuries (cuts, bruises, burns), direct contact with organic matter, and exposure to illnesses. So I'm essentially banned from the kitchen. To be fair, I'm quite infamous for cutting my fingers in the kitchen; potato-chopping is the first most-frequent challenger to my dermal barrier. Hot oven racks are second.

Becca took over solely in the kitchen for the week, and there's no sushi on the menu anytime soon. Rick kicked off the weekend with an 11-hour smoked brisket, which I'm told was all kinds of heavenly. My taster remains on chemo-poisoned strike. 

Post-infusion Goalz

Our highest objective was to stay out of the Emergency Room this time. It avoids unknown exposure and allows for more rest, since every ER visit requires at least 8 hours of bouncing around from plastic chairs to hallways, dodging those who appear most compromised and/or least-inclined to mask up. From the end of Day 10 from Infusion, I call this one a win. 

This time, the Oncologist-on-call ordered IV Fluids for Day-5 and Day-7 (counted from Infusion as Day-1 on Friday 9/8). Because I have to go into the Infusion center for those five daily Granix shots (to boost white blood cell regeneration), I could be triaged each day, given my shot, and also given IV fluids if needed. I took fluids on Tuesday and Thursday. Historically, that ER visit has occurred on Tuesday or Wednesday nights in previous rounds.

Tuesday morning I had another hypotension "event," where my blood pressure dropped suddenly under duress. This time I was able to curb my panic, calm my breathing, get my feet up, etc. that prevented a full-on BP crash. Becca and I were able to calmly (Becca was calm) get to the Infusion Center where they started IV fluids in a very orderly, non-emergency way. ER averted. 

That dratted bone pain also came back early on Thursday morning (3am), and I was grateful to be able to recognize the same pattern of pain and treat it accordingly without an ER intervention. Whew.

As for the rest of the symptoms, they all came roaring back, just as challenging as ever. Overall, it's been a rough week but successful. (Knock on all the woods....)

Mindful baking

Today (Day 10) since Becca isn't here to make brownies for Rick, I ventured into the kitchen with intent. The recipe is my most familiar. However, the moment I said that my goal was "mindful baking," I flipped red cocoa powder across the front of me, the countertop, and floor. So much for mindfulness. Even after a rocky start, I did get out of the kitchen without any cuts, bruises or burns. Success! 

Traditional Birthday Brownies

Mix:

• 6 Tbsp unsalted butter, melted
• 1/2 C plus 2 Tbsp granulated sugar
• 1/4 C cocoa powder
• 1 egg, room temp
• 1 tsp vanilla

Sift dry ingredients into cocoa mix and stir until just combined:

• 3/4 C unbleached flour
• 1/2 tsp baking powder
• 1/8 tsp baking soda
• 3/4 tsp cinnamon
• Pinch of salt

Fold in liquid:

• 1/2 C milk, room temp

Bake in 8x8 at 350 F degrees for 20-25 mins.

Frosting for cooled brownie:

• 4 Tbsp butter, melted
• 1/4 C boiling water
• 2 1/2 C powdered sugar, sifted
• 1/4 C cocoa powder, sifted
• 1/2 tsp vanilla

Shout Outs

Thanks to everyone who called or messaged me this week. Thanks also for the gifts of love and some lovely flowers. I won't apologize for not responding in the moment, but I will thank each of you for every kind word, voicemail, email, and message of encouragement. There were a few days at the start of this week when I could only sleep, drink water, and watch Deadpool (I & II). 

Your words and support carried me through those hard days. Know that I appreciated each attempt to reach me in whatever form and that I saw your efforts and categorized them optimistically rather than thinking I owed you something, and you were calling to collect (you weren't, were you?)

What's Next

Infusion #5 is currently scheduled for Friday, 9/29/23. A delay won't be determined until after my labs are completed the day before. I'll try to post a delay notice if it occurs. 

It's a Gettin' Closer

Almost over the worst of the symptoms today-tomorrow, and for what it's worth, my soundtrack is Buddy Holly:  Every day seems a little longer, every way, love's a little stronger, come what may...

Thanks for taking the time to read my words.

Onward!

Sherri

third chemo round unpacked

My trusty Subaru saved my life in 2020

First the Musings

Cancer is not the first time I have faced an existential threat. It is, however, the slowest and most constrained. I have my own life-made list, from birth forward, and outside of global warming and aging, most all other threats are quick and/or violent in theory and/or action. 

The baffling response to cancer is also slow and ironic, as its year-long spiral of toxic chemotherapies and radiation are measured to kill me from the inside out, or at least to bring me to the brink before pulling me back. In theory.

Too dark? I'm a call-it-as-I-see-it kind of guy, sometimes to my detriment. I can acknowledge the healing part of this process in terms of the the long-game result potentialities, and of course I remain hopeful for those positive, cancer-free outcomes. 

Day-to-day, it's more productive for me to embrace the fact that my body is working hard to process a bucket-dump of deadly toxins. It allows me to accept feeling terrible so many days in a row. Then I can go about the daily task of juggling care of those active side effects alongside some basic nutrition and pain management, all under a regular bloom of brain-fog (totally real) that makes me walk to the kitchen again for something....what was I doing? 

I'm grateful for the find-your-phone button on my smart watch. For banana-raspberry-blueberry-chocolate smoothies that can hide things like protein powder, greens, and electrolytes. For soft hoodies. For tissues with coconut lotion and aloe. For silk pillowcases so my hair won't hurt. The list is much longer, but on hard days, the simple, tangible things are most accessible under duress. These days, that's what I need.

Grateful for You

Your messages of support and care continue to bring me joy through this long, strange process. Thank you for every kindness and gift and the outpouring of love and support. 

Thank you for each donation to the Cancer Support Team funds—every dollar goes to the support of my care team, whether it is for a cup of coffee, a tank of gas, travel expenses, or another box of gloves or masks to protect the team. All of us—team included—are extremely grateful. 

Chemo Infusion Round #3

The Oncologist (my primary doctor and head of the Cancer Team) ordered several additions to my pre-meds infused before the deadly toxins for this round: two additional antihistamines, a steroid, and what is essentially the pharmacy form of Pepsid-AC. These additions address the elevated allergic reaction to the chemo infusion, and apparently the Pepsid is some kind of facilitator to the antihistamines. 

The Oncologist also proposed reducing one of the chemo drugs due to the number and extent of the side effects I am fielding each time. To her concerns, I heard myself (in an out-of-body-what-are-you-doing kind of space) counter-argue to keep all the chemo drugs at full dose. 

Of course I would love a reprieve, but long-run, I hope to never have to do this gig again. Odds are better if I get the full treatment now. At least that was the argument. 

The Oncologist agreed. So we proceeded. 

Infusion was uneventful. The worst thing that happened was that the big dose of Benadryl gave me restless legs, which made me squirrely in the infusion chair for that part. 

Halfway Through? Not Yet

I can't count halfway until I am through the weeks of side effects. Three out of six infusions complete—that's where I am for now. 

New Side Effect and The ER (again)

Do we need a new side effect every round? I didn't think so. This round, it was acid reflux. I updated my Side Effects post to add it there, rather than make a new chart every time. 

After 72 hours of unresolvable acid reflux, the consequence was dehydration, which triggered a sudden and rather dramatic hypotension event: BP drops, weak rapid pulse, sweaty, cold, shaking. Rick and Becca were worried I was going to lose consciousness or go into shock or both. So they packed me into the car, and we ended up in the ER again. 

This trip was similar to the last one. I was relegated to a wheelchair the whole time since I could not walk myself into the hospital. Rick protected my space, several times wheeling me to a different part of the ER to create a bubble of space around us as we were often the only ones masked. 

The ER nurses got fluids going on me sooner, which stabilized me sooner. But the overall visit still took 8 hours before we had bloodwork and a doctor saw me. I was released around 6 a.m. Rick got me home in bed and then left for work on zero hours of sleep. 

I had a Granix shot scheduled (to boost new white blood cells), and during my 1.5 hours of sleep, I had repetitive dreams about Becca trying to wake me up before she woke me up (for the 3rd time, she says). She was amazing and had a smoothie ready for me, and we totally made it to the infusion center on time for my shot, got back home, and then I slept until 1 p.m. Rick was able to wrap his day early and came home and slept all afternoon. Becca had dinner ready, and then this household went to bed early, all of us exhausted.

Second IV Fluids On Purpose

Two days after the dramatic ER visit, I went in for another  Granix shot and a scheduled boost of IV fluids. Initially, I thought I might not need more fluids, but my blood pressure was still pretty low, so we went ahead with fluids, and it was well worth the hour. Preemptively, The Oncologist has added two scheduled IV fluids orders to my first week of the next infusion cycle. Still working to keep me out of the ER.

You Can Help

Amazon Registry: I have created a registry list where you can purchase a thing from the list and it will ship direct to me: Hoffman Chemotherapy Support. Several people have urged me to offer it as an option to let people help. Please do not feel obligated. Amazon made me identify an "event," so I set it for the end of chemotherapy, hypothetically on Halloween. It feels like the right target. 

The Cancer Support Team Funds are still accepting donations. Message me or Rick for my Venmo or mailing address. 

Snail mail a postcard, card, note, whatever you can get in an envelope with a stamp! I would love that. Message me or Rick for a mailing address. I love, love, love to get mail from you! 

Onward!

Sherri

side effects and solutions

The side effects of chemo continue to be interesting and baffling. It's everything from weeping eyes and dry skin to bone pain, and the way most meat tastes like tinfoil. Even my hair hurts. Even the side effects have side effects. Some days I feel like I am living inside that TV prescription drug commercial that spends most of its 30-seconds listing off potential side effects to a Musak soundtrack of classic rock.

I am assigned an Integrative Medicine specialist NP to help figure it out. Below is my current list.

Got good ideas? Leave your suggestions for solutions in the comments.

Side Effects and Solutions/Preventatives 

(cue Musak)

• fatigue - from chemo, immunotherapy, or radiation tx
• naps
• regular bedtime/morning routines
• daily exercise and/or stretching or yoga
• meditation
• daily nutrition/protein
• nausea
• prescription Compazine (procholorperazine) 1/2 to 4 tablets per day as needed
• Saltine crackers
• disposable vomit bags stashed everywhere, including the car
• mouth sores
• soda/salt mouthwash x3 daily (1/4 tsp baking soda, 1/4 tsp salt, 6 oz warm water)
• Prescription "magic mouthwash," which works well except that it's real side effect is diarrhea
• Sonic toothbrush to keep teeth and gums clean and gently 
• Outshine Creamy Coconut popsicles - non-acidic and cold
• diarrhea
• Imodium OTC, use as directed
• Prescription Lomotil (diphenoxylate/atropine) up to 4x daily
• Gas-X use with Lomotil for cramping
• Benefiber fiber supplement - 2 tsp x2 daily in a drink (hot or cold)
• Flax meal, 1 tsp add to Scottish oatmeal daily
• Align probiotic x1 nightly
• Dude Wipes On-the-Go flushable (not really flushable) wipes
• constipation
• regular hydration
• dried apricots 3-5 daily
• Miralax x1 daily as needed
• yeast infection (side effect of constipation/diarrhea cycle)
• Monistat 1
• cranberry supplement
• dehydration (side effect of constipation/diarrhea cycle) 
• Drip-Drop Electrolyte powder x1 daily in 10oz water
• Salt Stick Electrolyte Tablets x1 daily
• PowerAde Sports Freezer Bars (with electrolytes)
• Kinderlyte Electrolyte Drink
• 72 oz water daily
• IV hydration at hospital (as necessary)
• low white blood cells (compromised immune system)
• treatment with Granix - x5 doses, intramuscular shot, days 3-7 after infusion
• 100% masking out in the world and for non-quarantined visitors
• regular hand-washing
• daily showers w-antibacterial soap 
• low red blood cells (bruising, clotting issues)
• promote general nutrition
• adequate protein intake
• Green Smoothie: 1 c spinach, 3 oz plain greek yogurt, 1 frozen banana, 1 scoop It's Just Whey Protein Powder (unflavored), 1/2 c coconut water, drizzle of Torani Dark Chocolate Sauce, handful frozen raspberries, cherries, or blueberries. Blend in NutriBullet Blender
• Quest Chocolate Chip Protein Cookie
• Naked Peanut Butter powder - add to Scottish oatmeal daily 
• Kodiak Cakes Protein Pancake/Waffle mix
• blood transfusion (last resort)
• heart arrhythmia (may indicate other side effects - dehydration, infection, etc)
• monitor and take emergency action if not resolved
• increased blood sugar levels
• reduce and monitor sugar intake
• skin outbreak - hands, back, legs
• Aveeno Dry Skin lotion - non-greasy
• Aveeno Repairing Hand Masks - use nightly before bed
• Cerave Deep Hydration
• Aquaphor, cover with gauze
• gloves for protection 
• Liquid Skin for broken skin protection
• bone pain (side effect of chemo drugs plus the Granix shots to promote WB cell production)
• take an H-1 antihistamine daily (Zyrtek or Claritin) 
• prescription 600mg Ibuprofen
• prescription hydrocodone-acetaminophen (last resort to keep me out of the ER)
• Toradol (NSAID) administered at ER (last-last resort)
• peripheral neuropathy (numbness to fingers and toes)
• compression gloves and socks at symptom onset
• compression gloves/socks at infusion (preventative to restrict chemo drugs to capillaries)
• ice gloves at infusion (preventative)
• weeping, swollen eyes 
• Pataday antihistamine eye drops 0.10% solution (NOT the 0.20% extra strength because that makes my eyes twitch)
• bloody nose 
• MistAire Studio Cool Mist Humidifier is silent and runs all night on low
• Vaseline petroleum jelly (swab inside nose 2-3x per day)
• metallic taste and loss of salty/savory taste and smell - things that still taste normal:
• ginger hard-candy - Pri Nuggets Manuka Honey and Ginger
• raspberries, blueberries, cherries
• honey
• sourdough bread
• chocolate
• vanilla ice cream
• Scottish oatmeal
• chicken soup
• scalp/hair pain
• softest bamboo hats
• moisturize scalp - Oil of Olay
• silk pillowcase? (untested at this writing)
• hair loss (we knew that was coming)
• hats for warmth and protection
• Scotch-Brite Pet Extra Sticky Hair Lint Roller (roll the scalp daily)
• acid reflux
• prescription Prilosec 40mg daily (started 8/22)
• heart arrhythmia
• Alternating PVCs (non-series)
• high, non-aFib heart rate
• treat with increased (doubled) electrolyte tablets in addition to oral and IV fluid treatments for dehydration (started 9/26)
• fluid retention from IV fluids
• stop IV fluids for dehydration and push oral fluids (started 11/02)
• muscle pain
• legs: quads, hamstrings, calves (like shin-splints) - likely related to Taxotere (started mid-Nov)
• stay hydrated and keep up with electrolytes
• regular exercise and stretching
• inflammation between ribs (from radiation treatments)
• tenderness and aching of ribcage and spine
• treat pain with Ibuprofen or Tylenol
• skin irritation, redness, itching (from radiation treatments)
• irritation of radiated area of breast, underarm, and chest up to collarbone
• treat with oncology-lotion 3-4x per day
• do not use lotion within 2 hours of radiation treatments
• continue to use after conclusion of treatments 1-2 weeks 
• if skin lesions or internal burns break the skin, call radiology for treatment instructions

Daily Data

In my daily journal, my team and I track symptoms and care as well as count down the days from each infusion. We also monitor daily for things like infection, fever, unusual pain, Covid, flu, or cold symptoms, bleeding or bruising, anything new. All of it helps my Cancer Care Team make adjustments to my treatment plan as needed. 

• daily symptoms
• blood pressure - morning and evening
• temperature
• supplements: vitamins, fiber,
• medications: prescriptions and/or OTC as needed
• nutrition: calories, protein, nutrients
• electrolytes
• fluid intake: water plus other fluids
• exercise
• sleep

Onward!

 ~ Sherri

countdown to 3rd Infusion

Today is 19 days from the second infusion, and this Friday (8/18) is scheduled for my third infusion. Three out of six. Halfway, although it won't seem like halfway until I've gotten to this point on the other side of the next infusion and through the next wave of side effects. 

How I Am Doing

People keep asking, and I feel like I repeat myself. I was warned that it would feel worse each time, and that is true. Also each infusion seems to surprise us with something new. I still feel generally crappy, even at Day 19 when I am through the worst of the cycle. Today I haven't had to take any prescriptions for any dramatic side effects or new issues, and I'll consider that a win. Looking back, it's a daunting list of side effects—so many that I made a separate post for them (it will post after this update).

My care team at home has made sure I get what I need and then some. My Cancer Center Care team has also been quick to respond to every call, so I feel supported from all sides. At least these last few days before the next infusion feel less dramatic, even if I am still not feeling entirely well.

How You Can Help

People keep asking, and I haven't had a good answer until recently. I realized two things: 1) your words bring me joy; and 2) we have a need for unusual items and support for my care team.

Send Your Words

Our Christmas card tradition is to post cards and pics on our pantry door. Now it is repurposed as the Love Wall for your cards and notes, snakes and geckos. The refrigerator is also covered with cards and pictures and postcards from all y'all. 

Since I am essentially quarantined in my home, even the smallest touch from the outside brings me joy and reminds me that I am connected to my people in the greater world. 

Your digital presence also brings me your words. I love my writing group that continues to meet online, even though I've missed a few lately. I love every Zoom and Facetime coffee date with my friends and family, every DM, forwarded Tik-Tok, or text message. Keep doing that. 

Each kindness means so much when I can't get out and often feel so bad that I don't know what I need or want. Thank you for every touch, and if you think of it again, send me your words—by snail mail or the internets.

Support for the Home Care Team

My care team outside of Rick includes my daughters, nephew, and sister. They are each giving of themselves and their time to be here in the house and available during the worst of my recovery each time. This care has proven to also come with some expenses. So far, everyone has been able to work remotely, but there are travel expenses (Becca coming from the coast each time, Deb coming from Denver) as well as unexpected specialty items: gloves, cleaning supplies, masks, inordinate supplies of soothing-lotion Kleenexes, Pedialyte and fluids, lotions, soaps, bone broth and Saltines, food to keep the team fed and caffeinated, and gas to cover errands and pickups from the hospital, pharmacy, and store. 

This is not an ask, merely an option. If you wish to give dollars to support my home care team, you can message me for my Venmo info. Tag your donation CSF (Cancer Support Fund), and every dollar donated will go toward the care team and support expenses. Don't go crazy. We're not underwater over here, merely allowing that there's room for you to help if you wish. 

Doing Hard Things in Small Steps

When I was newly sober, I lived 800 miles away from my three daughters. I made a commitment to do the daily work to stay connected to them, even if it was difficult or painful, and even when it never felt like enough. Somewhere during my 3rd or 4th years of sobriety, someone asked me if I thought I was doing any of us any favors since I had tried and failed to get custody back. I remember thinking hard about it, and in my heart I knew that even the smallest step would make a difference in the end. I was in it for the long haul. It took seven years before we were all living under the same roof again, but the beauty was that our relationships with each other already existed, strengthened by those years of work in small steps to be consistent and stay connected.

The theory of accumulated strength is also what carried me through my PhD program while I was away at school in Milwaukee, WI—1756 miles away from my husband at home and my daughters. The kids had all made lives for themselves by then, but it was still hard to be so far away. And then I compounded it after graduation by getting a job at Marquette University, also in Milwaukee, for a few more years. Still the daily work accumulated to a success that has launched me forward into the next phase of my life.

So this cancer "project" isn't anything new in concept, only in the details. The solution is the same: do the work of the small, daily steps with a commitment to consistency and an eye on the long-game. 

Thanks to each of you for being a part of my journey. I see you, and you are loved. 

 ~ Sherri

"Be bold and mighty forces will come to your aid."
        ~ Hoffman Family Motto

 

second infusion week, scene 2

 So, if Sherri is the Negasonic Teenage Warhead (strong resemblance) and I am Deadpool (strange resemblance), I know what my role here is: lewd humor and racy double-entendre.

Okay...I know. This is a family show, so I'll be good.

(looking straight into the camera) I promise.

 

I just better not run into that big metal guy with his goody-two-shoes platitudes. Although, he may have come in handy in the ER the other night...but that's getting ahead of the story.

 

 

The weeks since the first infusion were uneventful...that is, if you ignore her dehydration on day 5 that required IV fluids, and the fairly constant gastrointestinal problems she had throughout the cycle. And the skin rash and breakout, but that was minor (easy for me to say...). And the mild nausea and general fatigue. And the tinglings of chemo-induced peripheral neuropathy (compression gloves and socks during infusion are supposed to help with that, she used them on chemo round 2). 

But it went as predicted: a couple of good days following infusion, then the poison starts to take its toll, symptoms worsen around day 4 through about day 7, then by day 10 it's not so bad. Except for the gut troubles. And the nausea. And the fatigue. Did I mention brain fog? At least she didn't experience any vomiting, which we were probably over-prepared for.

All in all we learned a lot, and that includes Merissa, who did a fantastic job of taking care of her mom that first week, in a badass paramedic/firefighter/drill sergeant/loving-and-concerned-daughter sort of way. With me at work, it was much relief to know she was there and Sherri would be well cared for.

Sherri's parents arrived for a visit the Wednesday before her second chemo treatment, which was on Friday 7/28. She was glad they came. During their nine days with us, her mom helped out by doing, among other things, 753 loads of laundry. She also baked 157 cookies, a quiche, a chicken pot pie, and a peach pie. And, she washed a lot of dishes and vacuumed the entire house. (Okay, 753 and 157 is probably an exaggeration. The rest is unembellished.)

 

 

Chemo day went well...except that Sherri had an allergic reaction to one of the drugs. It was mild with the first infusion and stronger with this one. It's really only a little bit unnerving when the nurses bring the crash-cart bedside before they start administering the offending drug. (Not really. It's a lot unnerving.) Now that we're sure the allergy is a thing, next time they'll add some things to the pre-meds BEFORE they give it to her, in hopes of mitigating the reaction.

  Becca left her home on the Oregon Coast to come take care of her mom on the Tuesday following chemo, which was nice because Wednesday was our 26th wedding anniversary. Work was slow, so I took the day off...and had a great time with DeVon and Dianne at Mt St Helens. It was fun playing tour guide, including taking them for a 3 mile hike near the Coldwater visitor center on an interesting trail I'd never walked before. We came home to a great dinner Becca prepared while we were away, and that was very nice, too. So was the marionberry pie Sherri made for our anniversary.

But Sherri and I still think this has been the weirdest anniversary we've ever had. We're going to have to make up for it next year. Maybe the next 10 years.

DeVon helped a lot with the everyday stuff during the visit, and watched baseball with Sherri every day. But where his presence and experience really came in handy was about 10PM on Thursday night, when Sherri started having a new symptom: pulsating pain in her lower back that seemed to radiate out to her abdomen. The pain was so intense that she could not lay down, and she came out to the family room to request a consult with Doc Hale. He performed a bit of an exam, which ruled out some things but left a lot of unknowns. He recommended she get ahold of the on-call doctor on her medical team, which she did.

That doctor told Sherri that it was probably a side-effect from the chemo, and it could either be an uncommon side effect that is uncomfortable but not serious, or a rare side effect with possible life threatening consequences, and the only way to determine which it was was a trip to the ER for medical testing. (Cue the big metal guy mentioned earlier...)

We got to the hospital just before midnight, did an intake, sat in the waiting area. That's where the first appearance of the security staff occurred, when a very drunk and very loud woman, who had been brought to the ER by ambulance, because she called 911 to be taken to the hospital by ambulance, got very angry about having been brought to the hospital by ambulance when there was clearly nothing wrong with her, nevermind the stroke symptoms she told the paramedics about. The security guys calmed her down, took her to the back corner of the waiting area and sat with her, and that's where she started vomiting. Good times.

We were soon called into a different room because the triage nurse had decided that, since Sherri was showing signs of dehydration again and already had a hospital order to receive a fluid infusion if needed on Friday, they'd just go ahead and do it then. The RN went over the procedure to access an IV port with the nurse intern and the nursing student also present. Sherri sat patiently through the nursing student's questioning, and didn't show any anxiety when the RN had to help the intern access Sherri's port to administer the IV. I even heard her tell them that she grew up around teaching hospitals. I wish I could say I wasn't nervous about it.

Back to the waiting room until we get called for the CT scan the on-call doc recommended. Just as I was about to relocate us in the waiting room, because I'd noticed that the girl about 10 feet from us who was sitting on the floor and leaning against the chairs next to her was quietly vomiting into an emesis bag, we got called back into the nursing area to sit in a hallway there to wait for the CT scan. More good times.

After the scan we got set up in a private room because they were concerned about a cancer patient being exposed to the general population of the waiting area, and there we waited for all the testing to come back. For hours.

In the middle of one of the nurses checking in on us, there was a disturbance just outside our room, by another angry person, probably drunk, who'd arrived by ambulance and was trying to sneak out the back door. We could hear one of the nurses insisting that he take his hands off her employee. 

That's when I noticed that one of the security guards on duty that night might as well have been the big metal guy, because he was about as wide as the door he had to duck to walk through. The nurse told the drunk, "The boys are here now, are you going to cooperate with us, or are they going to have to manhandle you?" He chose cooperation.

And that's when I came to the conclusion that it takes a special kind of medical professional to work overnight in an ER.

Sherri's tests came back (finally) and revealed none of the rare and potentially life-threatening side effects, just the annoying and painful uncommon ones. They treated her with a pain reliever. We went home about 7AM, with a prescription for more pain medication and a plan to treat the new symptoms as they appear.

So after a lot of sleeping this weekend, we've passed the 4-10 day low point after chemo. Sherri says brain fog is real, and there's other unpleasant side effects: like almost everything tastes like aluminum; there's a lot of general fatigue; and the skin rash and mouth sores are back. The chemo has taken almost all of her hair, even the cool mohawk. But she's feeling a little better every day. 

She even made me a big pan of brownies. She said it was for our anniversary, too. (Hey, the pie is gone already.) And we deserve a double anniversary. 

~Rick

Us, 8/2/2022, near our favorite place.

p.s. Shout out to JR, Nichole, Heather, Aly, and my siblings--Debbie, Brad, Amy, Scott, and Lori--for all their various forms of support, near or far, all of it full of love. 

p.p.s. Also know that I get great joy from each of your cards, notes, postcards, and messages! Our Christmas-card pantry door is filled with a rotating display from you guys. Thank you so much 💖 (Keep 'em coming!!)

        Love to each of you,

                    Sherri

second infusion week

 More to come soon, from your friendly neighborhood...oops, wrong costume...from a guestblogger. As soon as he writes it.

first infusion week

And we're off. On Friday (7/7), Rick and I checked in at 9am, met with my Oncologist, and then got a seat in the infusion center at 9:30am.

The Short Version

First infusion went like this: 

1. Subcutaneous injection in the leg
• 30 min wait
2. Pre-chemo meds to mediate reactions/symptoms
• 30 min wait
3. Chemo #1: into the port
• Slight reaction (coughing, throat swelling) = immediate stop and 30 min delay/wait
• Restart and complete chemo #1 infusion 
• 30 min wait
4. Chemo #2:  into the port
• 30 min wait

Checked out at 3:45pm. Long day, not unexpected. 

The Longer (Technical) Version

1. Subcutaneous injection (into leg): Phesgo (brand) - Pertuzumab, trastuzumab, and hyalurondase. This is a HER2 targeted antineoplastic agent and anti-HER2 monoclonal antibody. Treatment is every 3 weeks for 12 months. 8 minute injection plus 30 min wait. (1/17)

2. Pre-chemo meds: two different steroids to treat immediate reactions and delay the effects for a couple of days and Dexamethasone, an anti-inflammatory to balance the steroids and reduce fluid retention. 60 mins(?) plus delay. Tx every 3 weeks for 6 total. 30 mins plus 30 min wait. (1/6)

3. Infusion Chemo #1 (into port): Taxotere (brand) - doxetaxel. Anti-cancer antineoplastic cytotoxic. Slight reaction (cough, throat congestion) to the start of this infusion delayed it for 30 minutes while nurses assessed me for allergies and to let the steroids take hold. No reaction when they resumed the infusion. 40 mins plus 30 min delay plus 30 min wait. Tx every 3 weeks for 6 total infusions. (1/6)

4. Infusion Chemo #2 (into port): Paraplatin (brand) - carboplatin anticancer antineoplastic cytotoxic. No negative reaction. 30 mins plus 30 min wait. Tx every 3 weeks for 6 total infusions. (1/6)

The Days After 

Days 1-3: The steroids were still in full force during this time, which alleviated any of the expected side-effects (nausea, diarrhea, mouth sores). I woke up each day with a headache mild chest constriction, both attributed to the steroids. On the 3rd day, I woke up with my face flushed bright pink, but it was gone by the end of the day. The dexamethasone dose continued to reduce inflammation and fluid retention. 

Days 3-8: Granix (tbo-filgramsim) was ordered to stimulate white blood cell regrowth, since those guys are getting killed by the chemo drugs. My insurance denied the claim for the time release version, so it requires a shot in the infusion center every day for five days. So there's that. The shot is a subcutaneous injection in my arm. The anticipated side-effect is bone pain that is alleviated by an H1-antihistamine, like Zyrtec, which I already take every day (because I'm allergic to air, apparently) so I did not feel any side-effects. 

Days 4-7: Expected side-effects kicked in really on Day 4. I already deal with IBS (Irritable Bowel Syndrome), and it definitely crashed my gut, cycling between both extremes of cramping constipation and diarrhea. I also began to experience some heart palpitations in the evenings that didn't last, but gave us a red flag. By middle of Day 5, I was taking regular anti-nausea and anti-diarrhea meds, and the help nurse triaged me for dehydration. On Day 6, when I went in for my Granix shot, the infusion center re-triaged me and my BP was super low, so they went ahead and gave me IV fluids as well as the shot. It definitely made me feel better. 

I think the biggest thing we learned through this was how quickly the dehydration happened, and our takeaway was to be more aggressive proactively with the anti-meds. We also doubled my fluid intake and added a second round of electrolytes. 

Day 8: (today) I feel so much better, even though I am not 100%. My gut has (mostly) resolved, the nausea is less, and even the mouth sores seem to be healing. Although I also got a crazy prescription today for "magic mouthwash" that totally makes my mouth numb, like completely. Did it help? I can't tell yet.... still drooling. 

Final Thoughts

What a weird and crazy experience. My port is bruised black that freaks out the nurses. I've been wrung and wracked up-ways and back. My hair hasn't fallen out (although it is thinning). What seemed like a hardship with the Granix shots being required at the hospital turned out to be helpful since I was assessed every day as the worst of the side-effects kicked in, which resulted in the quick treatment with IV fluids on Wednesday. Successful? So far so good. 

Only five more infusions to go. I feel like poetry will help me through. 

Sherri

 

People Walking in Fog

by (the beloved) Marvin Bell 

 

They try to watch themselves, drifting in a white sigh, 

the boats and trees, and themselves, too,

when they think of it, spun from sheets of gauzy droplets

with which to tar the morning white and walk upon it.

The horizon yawns. The earth is liquid. They can feel

it, and not just it but the blanket meaning of it. 

Here, bravado is the pretense of the immortal

before the infinite. There being no other side, 

they must surrender to this, seeing they cannot

see far, find a door, hack a hole, or mark a spot.

Goats love fog. Parked lovers and beachcombers

love fog, and those who fear the authorities,

and the camera-shy love it, and they adore it

who wish to be wrapped in beauty so delicate

one must step outside it to be able to see it.  

correlation does not imply causation (this is a public service reminder)

July 7. 

The first and second chemotherapy infusions are scheduled, beginning on July 7. I'm not sure if I should be excited or terrified. Relieved? 

Sherri

Our lives aren't good but passable,
our mortgages and cancer loom, but birds
lead us outside where we belong.
Around here all the gods live in trees. 

~ Jim Harrison, from The Whisper

wishing there was more

I kept putting off posting again because there isn't anything new. Last night I said to one of my kids that as soon as I posted, I'd get the call to say we had start dates for chemo. Kid said maybe that's exactly what you want. 

Here's to trying anything once. 

Sherri

goodbye to the hair

This weekend, I opted to get my hair cut all the way off. It was an intentional act of autonomy against the inevitable. Something to give us space for our feelings—sadness, love, and a bit of defiance. 

I had asked Merissa to find an appointment for me, and she engaged her favorite hair stylist, Nikki, who suggested she could come to our home to do the work. And that made all the difference.

Sunday morning, Rick was up at the crack of dawn to smoke some pulled pork. Becca and Nate were here for the weekend, and they headed out into the world with my chore list. I got some bread in the oven. Missy arrived mid-day, and we regrouped to gather outside on the back deck. It was chilly, so we fired up the pellet stove. 

Nikki arrived to meet everyone. She unpacked her gear. Seated and draped me. She started to brush and braid my hair. It began to rain. The kids sat around the stove and talked and watched. Rick snuck in to me for an occasional kiss. 

Nikki explained each of her moves. To clip the braids and a lock to keep. To use the clippers for the rest of the hair. To trim up these swirls (my head is a mass of multi-color cowlicks). She was gentle and kind.

I didn't know what to expect or how it would go, but it was what it needed to be. Emotional without being sad. A letting go that gave us power. Ceremony without pomp. Small acts of kindness with big, meaningful impact. 

Now I am properly trimmed and equipped with a variety of hats and scarves to keep my bared head warm and beautiful. I am shored up by the love and support of family and friends, old and new. And ever grateful for each day of my life. 

Onward!

Sherri

stalled by insurance

Yup. Today I thought I would have the magical date for chemotherapy to start, and instead, we are stalled out by my medical insurance. They have denied my doctor's first request for pre-approval. 

I am told this is not unusual (although always annoying), and the cancer team is reviewing their options. They can deny the denial and request it again. They can put together a different formulary to submit. They can punt. 

The echocardiogram for a baseline was Monday with no issues. The medical port surgery (last Saturday) was far easier than tumor surgery. The port and the catheter line are placed under the skin, so it is mostly surface pain, nothing deep. I am recovering quickly, although there is a dramatic wash of bruises running down my right side from my collarbone. It's as if I've been in a boxing match with a one-armed fighter. Very impressive and slightly artistic. 

Until something changes, I am working normal hours at my job. However, Friday is my birthday day off, and Monday is a paid holiday (Juneteenth!). The long weekend is a good break with no treatments or surgeries scheduled. Perhaps I'll know more on Tuesday. 

Until then, I choose punt. 

Sherri

not entirely unexpected

Expect the unexpected

It's been a rough week. The Oncologist got definitive pathology results that prompted her to do an online appointment and initiate a new treatment plan for chemotherapy. It was never off the table as an option but not what we were all hoping for. I am still processing and feeling mostly overwhelmed with intermittent moments of acceptance and grief. 

Pathology Results

The Short Version 

Testing for HER2 is definitively positive. HER2 cells are problematic because this type of tumor cell grows at an accelerated rate, which makes them more dangerous for spread and recurrence. Recommended treatment plan is chemotherapy, endocrine therapy, and radiation treatment.

Oncologist's treatment recommendation is based on three things:  

1. HER2 positive results;
2. identification of lymphovascular invasion (cancer cells identified outside of the tumor but not yet in the lymph nodes); 
3. the final size of the tumor that reflects growth from 16 mm to 21 mm between March 13 and May 16. 

The Technical Data

Process: FISH, Solid Tumor Interpretation, left breast, lumpectomy: Invasive carcinoma

Results: HER2 GENE STATUS: POSITIVE

HER2: CEP17 Ratio: 2.0

Number of nuclei counted: 60

HER2: 4.33 mean signals per nucleus

CEP17: 2.12 mean signals per nucleus

Tester's Comments: HER2:CEP17 ratio greater or equal to 2 with an average HER2 copy number per tumor cell of greater or equal to 4 places this tumor in Group 1 (Positive) as defined by the 2018 ASCO-CAP Guidelines for breast HER2 testing. Breast cancers in this category are considered HER2 positive without further testing required. 

Treatment Plan

Chemotherapy

• 2 chemo medications for 6 cycles with treatment once every 3 weeks for 18 weeks
• 2 secondary agents (I'll ask more questions about what these are at my next appointment) are injected at the time of each chemo dose for 18 weeks, continuing after chemo is concluded for a total of 12 months
• Labs are required the day before each chemo treatment
• Echocardiogram are required between treatments to monitor for potential side effects to the heart from one of the agents

Endocrine therapy

• Estrogen blocker will be prescribed as a pill after chemotherapy is concluded since the tumor needs estrogen to grow. I think this is kind of like cutting off its food supply to prevent recurrence. This treatment continues for 5 years with the potential to be extended to 10 years as new data is starting to show the benefits of the longer treatment. 

Radiation treatment

• Targeted radiation treatments will start after chemotherapy is concluded on a schedule of 4-5 days per week for 6 weeks for a total of 20 treatments.  

Next Steps

1. Medical port placement under my right collarbone as the receiver for the chemotherapy drugs. This will save my veins from having to take a new needle injection each time, which stresses them and makes them unusable after awhile. This is an Outpatient surgery set for this Saturday, 6/10. The same surgeon who did my first surgery will do this placement.
2. Echocardiogram baseline needs to be done for comparison to the later ones in order to track progress. This is scheduled for Monday, 6/12.
3. Oncology appointment Thursday, 6/15 to confirm details of the chemotherapy process and prepare for the first round of treatment. 
4. Waiting for insurance approval of the plan 
5. First round of chemo treatment will start the week of 6/19 or 6/26. TBD.

Thanks for the Hug

So many of you have offered encouragement and offers to help, and I don't yet know exactly what I need. As I figure it out, I'll let you know. 

Again, so many of you have also sent such loving and supportive notes, cards, texts, wishes, prayers, hats, food, coffee, leaf fossil, warm blanket, journals, smoothie maker, cancer survival tools, flowers, an original painting, and an illustrated book manuscript about scientifically impossible river rapids. And while I appreciated the thought, I did turn down a batch of kittens. Every kindness is appreciated.

Sending love out to each of you taking the time to read this and for your ongoing support of me and my family. I feel your collective embrace, and it was much needed in the moment. 

Sherri