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

no news is no news

Nothing new! Still waiting for next round of test results. That appointment with the Oncologist on June 15 is the target for new information and (hopefully) a treatment plan. 

In the meantime, I'm working on this recovery thing. The docs tell me it's going well. It's easier to post test results and doctor's notes than to say how I feel. Feelings have complicated motion. Too much at stake. I feel like I'm fine for where I am, working through the process, which takes time and, of course, feels slow. 

My family and I are supported by all your thoughts, flowers, food, well-wishes, healing energy, good vibes and good coffee, love and prayers. Thanks for all of it. You make a difference in our lives. 

This week, even as I feel better overall, I have more pain. Apparently the nerves that were severed during surgery are coming back to life with a vengeance. Ice is my only friend there.

Also this week I returned to work. First day I made it until mid-afternoon before I was tired. Two meetings later, I was toast. Being knocked back with such fatigue pricks at all my familiar fears and overachievement drivers. Hoping for progress each day forward. 

Last week I talked to my daughters about how we are all a bit unsettled by this unexpected change of plans for the summer. Cancer. Not on anyone's wish list. But here we are. It's like writing a new story when an unexpected turn of events shows up on the page, and all the characters have to figure out what to do next.

That's us. We're figuring it out. 

Onward!

Sherri

 Help is On the Way

Time heals all wounds

except those

it

in-

flicts—and

in time even those.

 

  ~ John Brehm, Help Is On the Way - Poems