Last night sleep, that elusive muse, visited me! I started the night in the chair (for the heartburn) and ended it in my bed--- lying down, not on the pile of pillows I've been propped up on--- and what a treat that was!
I'm on the road to myself, it being Wednesday before a treatment, and am looking forward to having some energy back. This session had the addition of wobbly legs over the weekend which I've never experienced before in real life or chemo life- and it is really another life. It's odd to find yourself unsure of your legs when you have for your whole life been able to rely on them.
Another thing that's happening with chemo life is I'm learning to let things go mostly because I have to: I can't remember things. Now for a gal who has always been on top of keeping track that's a bit disconcerting. So, for the short term when I look at you as if I have no clue what you're talking about, help refresh my memory. Or, when I go to introduce a dear freind and cannot pull your name up from the foggy data base (so sorry Joyce!), please know that I know your name, just not right that second. It's all temporary, my memory, that is!
A hearty thank you to Ms. Kimbel J. Westerson for her poetic stylings--- which I can't locate right now on the site (a call has been placed to the Technical Services Department). All three poems brought much laughter! It was so good to hear from you!
I would like to include a little ditty that Janis and I had come up with a few days ago when the uninvited dinner guest was making its presence known: That's right! It hurts to die when you are cells that won't comply. It's hardly poetic and there isn't much style to it (for that we defer to Ms. Westerson) but that's what we came up with.
Hope you, dear friends and family, are having a great day! (Or did I say that already...?)
Wednesday, August 22, 2007
Monday, August 20, 2007
You've heard of Guest Hosts? Well, here's a Guest Post!
During our last trip to Rochester, Karen told Mom, Dad and me how truly powerful it has been to learn of all the people who are pulling for her in so many varied ways. Every pebble and stone dropped in the water creates a wave and its impact is being felt! We thank each one of you for the encouragement and love you have shown to date and for helping to maintain the positive momentum and energy in the months of this journey that remain.
I would like to take a moment to encourage everyone who reads this Blog to add comments to it. A few people have already added comments, and they have been quite wonderful. Don't stop! They mean so much to Karen. And I don't think that they have to be deep and meaningful — isn't there some guy who writes strange wise-cracks all the time? It is his way of telling her that she is not alone; she is being heard. This Blog is not a one-way communication tool; it works in two directions. Not only can Karen talk to you, telling you the things — important and mundane — that are happening in this moment of her life, but you can talk back to her as well. You can both talk with each other, in a public forum.
There are several reasons that this two-way communication is very important to Karen. The first reason that your comments are important to Karen is that she will know that you are there listening to what she is saying. In Blogging there can be a very unfortunate and empty feeling that there is no one there. You can let Karen know you are out there, listening, by leaving comments in her Blog Entries. And again, if you are unsure of how to do this, please see Janis' wonderful tutorial below about Lurkers (August 16th).
The other reason that your comments are so important is that this is Karen's record of what is happening in her life. This is her history being written before her — and our — very eyes. And when she has kicked this thing's ass, she is going to be able to come back and see all of this; to have a physical, living memory of these dark days when she held her head high and refused to be beaten down, and to be able to hold in her arms the words of those who love and support her in this battle.
That having been said, my intent is not to lecture you on how to support Karen's fight. I understand that we all support Karen in the ways that we can. And many of us, being Midwesterners of Scandihoovian decent, have a tendency to stoically go about our lives, not wanting to draw attention to ourselves. But I do believe that this is an incredible way for us to interact with Karen with frequency, even when we cannot be with her, or speak with her. And the fact that she can have this as her own personal history is very important as well: Karen can open her Blog and see the words any time of the day our night, and find in them the solace and strength that we offer.
So, please take a moment to write a comment to Karen . . . it means more than I think you or I can imagine.
Mark
Thanks Mark for showing your support by taking such an active role in the blog and sharing your thoughts on the impact of comments!
If you would like to "Guest Post" a blog entry, just let me or Karen know.
Karen's friend, Mark Neukom, added this comment a couple days ago. I thought it warranted a spot as a "Guest Post."
I would like to take a moment to encourage everyone who reads this Blog to add comments to it. A few people have already added comments, and they have been quite wonderful. Don't stop! They mean so much to Karen. And I don't think that they have to be deep and meaningful — isn't there some guy who writes strange wise-cracks all the time? It is his way of telling her that she is not alone; she is being heard. This Blog is not a one-way communication tool; it works in two directions. Not only can Karen talk to you, telling you the things — important and mundane — that are happening in this moment of her life, but you can talk back to her as well. You can both talk with each other, in a public forum.There are several reasons that this two-way communication is very important to Karen. The first reason that your comments are important to Karen is that she will know that you are there listening to what she is saying. In Blogging there can be a very unfortunate and empty feeling that there is no one there. You can let Karen know you are out there, listening, by leaving comments in her Blog Entries. And again, if you are unsure of how to do this, please see Janis' wonderful tutorial below about Lurkers (August 16th).
The other reason that your comments are so important is that this is Karen's record of what is happening in her life. This is her history being written before her — and our — very eyes. And when she has kicked this thing's ass, she is going to be able to come back and see all of this; to have a physical, living memory of these dark days when she held her head high and refused to be beaten down, and to be able to hold in her arms the words of those who love and support her in this battle.
That having been said, my intent is not to lecture you on how to support Karen's fight. I understand that we all support Karen in the ways that we can. And many of us, being Midwesterners of Scandihoovian decent, have a tendency to stoically go about our lives, not wanting to draw attention to ourselves. But I do believe that this is an incredible way for us to interact with Karen with frequency, even when we cannot be with her, or speak with her. And the fact that she can have this as her own personal history is very important as well: Karen can open her Blog and see the words any time of the day our night, and find in them the solace and strength that we offer.
So, please take a moment to write a comment to Karen . . . it means more than I think you or I can imagine.
Mark
Thanks Mark for showing your support by taking such an active role in the blog and sharing your thoughts on the impact of comments!
If you would like to "Guest Post" a blog entry, just let me or Karen know.
Friday, August 17, 2007
Photo opps
This is my beloved Oncologist, Dr. Peethambaram, and me at the end of our last meeting. She's given me the green light to continue with the third round of chemo as my blood work came back within the normal ranges.I'm sporting one of my beautiful new head wraps given to me by Mark and Shirley... thank you so much for such a thoughtful gift! They are easy to wear and ever so comfortable!
Here is the elusive photo my dad captured for us on this last trip: The Treat Lady!! It took quite some doing for him to get this photo- she's used to the paparazzi hounding her- but my dad got the shot!
She makes her rounds on Monday afternoons, my treatment days, plying her wares of Lorna Doones and other cookies and crackers to the patients and their families. Please take the treats! She earnestly wants you to take the treats!
We've really enjoyed seeing her each time and are so thankful that she and the rest of the staff are there caring for all of us. That has been one of the most impressive things about the Mayo: the consistency of care across the board.
The incredible shrinking spot!
Well the good news continues to be that the lump is shrinking! My dear friend Char has been calling it 'The Incredible Shrinking Spot', hence the title for this post. We've just completed treatment number three and found out that I am one of the few people for whom chemo works so quickly. It's amazing: my doctors are feeling it's now more of a thickening than a lump! Go to it you sassy piranhas, I say!
And speaking of piranhas, thank you to my dear friends who are helping me cheer on those hard working fish with all their beautiful gifts! Joe, I was so touched by your homer hanky from the Twins, who are known as Piranhas because of their tenacity and bite. And to Amy and Tom who found a sweat suit that has piranhas silk screened on the left side! Eat 'em up, I say! And take the uninvited dinner guest with you when you leave!
The side effects from the treatments remain quite manageable. And no, Mark, there has been no puking. Not now, not ever. I decided that very first night after the first treatment that I would not get sick and I haven't. Now that didn't stop my very pragmatic side from suggesting that having a bucket by the bed would sure be a comfort should I need it in the middle of the night and, only as as way to quiet this side of me- one that at times feels incongruous with the positive side- did I put the bucket by the bed --- and didn't use it.
This time around the nausea and heartburn have been a little more prevalent but I'm working with my acupuncturist to assist with the nausea and heat- wow do I feel toasty sometimes!- and I'm taking the extra anti-nausea medication when I need to. There is no buy-back or rebate program for unused pills at the end of all of this so I'm using them.
And thank you to those fine folks at Prilosec OTC for making such a good and useful product. Having never had heartburn before I have much sympathy to those who have dealt with it in their lifetime. It's no wonder you think you're having a heart attack because it feels like you're having a heart attack and/or a core sample of your body removed. Yipes!
Janis and I went last night to Merle Norman and bought a beautiful new hairdo for me. It's the perfect style for me: shake and go! And it's got more styling and volume than I could or would ever achieve with my own hair. I previewed the new 'do tonight and it was met with many accolades.I even got a "hello" from the doorman! What do you know?!
Thanks to everyone who continues to send their love and support in all the many ways you do. It's almost unbelieveable to me that so much progress is possible so quickly but I do believe that the combination of your support and love and my stregth and positive attitude are what are pulling me ahead. That and the two orders of nuns in South Dakota and Minnesota that are praying for me- thanks to my dear freind Mary! It never hurts to have nuns on your side...
And speaking of piranhas, thank you to my dear friends who are helping me cheer on those hard working fish with all their beautiful gifts! Joe, I was so touched by your homer hanky from the Twins, who are known as Piranhas because of their tenacity and bite. And to Amy and Tom who found a sweat suit that has piranhas silk screened on the left side! Eat 'em up, I say! And take the uninvited dinner guest with you when you leave!
The side effects from the treatments remain quite manageable. And no, Mark, there has been no puking. Not now, not ever. I decided that very first night after the first treatment that I would not get sick and I haven't. Now that didn't stop my very pragmatic side from suggesting that having a bucket by the bed would sure be a comfort should I need it in the middle of the night and, only as as way to quiet this side of me- one that at times feels incongruous with the positive side- did I put the bucket by the bed --- and didn't use it.
This time around the nausea and heartburn have been a little more prevalent but I'm working with my acupuncturist to assist with the nausea and heat- wow do I feel toasty sometimes!- and I'm taking the extra anti-nausea medication when I need to. There is no buy-back or rebate program for unused pills at the end of all of this so I'm using them.
And thank you to those fine folks at Prilosec OTC for making such a good and useful product. Having never had heartburn before I have much sympathy to those who have dealt with it in their lifetime. It's no wonder you think you're having a heart attack because it feels like you're having a heart attack and/or a core sample of your body removed. Yipes!
Janis and I went last night to Merle Norman and bought a beautiful new hairdo for me. It's the perfect style for me: shake and go! And it's got more styling and volume than I could or would ever achieve with my own hair. I previewed the new 'do tonight and it was met with many accolades.I even got a "hello" from the doorman! What do you know?!
Thanks to everyone who continues to send their love and support in all the many ways you do. It's almost unbelieveable to me that so much progress is possible so quickly but I do believe that the combination of your support and love and my stregth and positive attitude are what are pulling me ahead. That and the two orders of nuns in South Dakota and Minnesota that are praying for me- thanks to my dear freind Mary! It never hurts to have nuns on your side...
Treatment 3 and Summer Events Not To Be Missed!
Karen has more details to share about this last trip to Rochester, but just to update you all quickly, things continue to go very well. The doctors are impressed with how quickly they are are seeing results from the chemo. Karen's blood counts are still within normal ranges and she is managing the side effects easily.
The oncologist was able to give us an idea of what to expect from the second round chemo drug (Taxol) and that was encouraging. The meeting with the surgeon went well and more than anything, we are just so appreciative that she is willing to consider Karen's concerns and that she honestly never wants to see Karen there again. One of the few times in one's life when 'I never want to see you again' is a good thing.
Throughout this entire surreal journey, we continue to discover humor in the most unlikely places. While waiting for chemo treatment #3, I would read in the August issue of Rochester magazine that humor could be found August 3-5, just east of Rochester in LaCrescent, MN at the "Crucifixion Summer Fun Fest." I am NOT making this up. SEE!
What I love about this listing of community events is that the following two events are just as hilarious, albeit less shocking. I'm not sure how a Swiss festival is deemed more authentic than any other in the entire western hemisphere, but with offerings like the fahnenschwingen and the "ever-popular sackgumpen" how could Mantorville's Swissfest be challenged?
The oncologist was able to give us an idea of what to expect from the second round chemo drug (Taxol) and that was encouraging. The meeting with the surgeon went well and more than anything, we are just so appreciative that she is willing to consider Karen's concerns and that she honestly never wants to see Karen there again. One of the few times in one's life when 'I never want to see you again' is a good thing.
Throughout this entire surreal journey, we continue to discover humor in the most unlikely places. While waiting for chemo treatment #3, I would read in the August issue of Rochester magazine that humor could be found August 3-5, just east of Rochester in LaCrescent, MN at the "Crucifixion Summer Fun Fest." I am NOT making this up. SEE!
What I love about this listing of community events is that the following two events are just as hilarious, albeit less shocking. I'm not sure how a Swiss festival is deemed more authentic than any other in the entire western hemisphere, but with offerings like the fahnenschwingen and the "ever-popular sackgumpen" how could Mantorville's Swissfest be challenged?As for "Pickle It" Day at Historic Forestville, well, I think a misplaced pickled hen's egg are the least of their worries. This event is a recipe for disaster in my book! Consider the set-up here. 1) Farm staff - typically overworked and underpaid. 2) Farm staff dressed in costumes. 3) Picking vegetables in a costume in August. 4) The public. 5) Acidic kitchen ingredients. 6) Boiling water. Oh yeah, you'll find a pressure cooker there to be sure.
Can I tell you how bummed I am that I missed these gems? Next year, next year.
Thursday, August 16, 2007
Are you a lurker? (How to post comments)
I've put together a mini tutorial on how to participate in the blog for those who may lurking due to unfamiliarity with the forum.
Lurkers, in webspeak, are people who come to a blog to read the posts and comments but do not contribute (or only comment anonymously). It isn't criminal, or unexpected for that matter, to be a lurkers on a blog. However, like any good host/hostess, the blog author wants party guests to mingle, not stand in the corners!
1) Click the title of the post for the day and a single page will open containing the post along with any comments that have been left; or, 2) Find the "# Comments" at the bottom of the post to see how many comments have been left, then click on this link and the comments alone will open in a new window.
How do you add your own two-cents? Good question. Both of the options for viewing the comments allow for you to add comments as well. When you are reading the single page of blog entry and comments, look for the "Post A Comment" link in the bottom left
corner and click on it. If you are reading the comments in a separate window, the area to leave a comment is provided at the bottom.
Lurkers, in webspeak, are people who come to a blog to read the posts and comments but do not contribute (or only comment anonymously). It isn't criminal, or unexpected for that matter, to be a lurkers on a blog. However, like any good host/hostess, the blog author wants party guests to mingle, not stand in the corners!
I like to think of a blog (short for web log) as an online soapbox of sorts. One puts one's ideas out there for public consumption and comment. Folks might simply listen quietly from the sidelines (i.e. lurkers). They could get up close, cheer you on and wholeheartedly agree with you. Or, they could fervently disagree with you and have no qualms about letting you know (it is called flaming when it becomes zealous). Blogs provide an opportunity to connect with people you might not otherwise.
Now, most blogs will have near daily entries and some even post multiple entries in a day. As for this blog, we are striving for a weekly update. However, you are welcome to post responses to our entries or leave comments as often as you would like.
Oftentimes it can be just as interesting to read the comments left on a blog as it is to read the author's entries. So where are these comments? You can get there two ways.
1) Click the title of the post for the day and a single page will open containing the post along with any comments that have been left; or, 2) Find the "# Comments" at the bottom of the post to see how many comments have been left, then click on this link and the comments alone will open in a new window.How do you add your own two-cents? Good question. Both of the options for viewing the comments allow for you to add comments as well. When you are reading the single page of blog entry and comments, look for the "Post A Comment" link in the bottom left
corner and click on it. If you are reading the comments in a separate window, the area to leave a comment is provided at the bottom.In each case, fill in your comments in the box provided. Below this you will need to type in a series of characters. This is a security function that keeps automated spamming systems from posting spam on the blog.
Next, you will need to choose how you will have yourself identified with your comments.
If you sign in with your Google user id and password name that appears on your outgoing emails will appear in your comments.
You can select "Other" and type in your name and if you like, your web page address.
Or, choose to be "Anonymous" and have no name attached to your comments.
Lastly, you can either preview how your comments will look on the blog, or you can go right ahead and publish them. Be forewarned though that once you publish comments, you cannot go back to edit or delete them. (You must contact the blog author and ask them nicely to do that for you.) If your comments do not appear immediately, do not fear. Sometimes there is a lag between when you post and publishing. Just check back a bit later.
That's all there is to blog commenting. Go on... give it a try and stop with the lurking!
Monday, August 13, 2007
Blog subscriptions now available!
You can now have new blog entries emailed directly to you when they are posted!
It is quick and easy too. Here is what you need to do:
It is quick and easy too. Here is what you need to do:
Click on the link above Karen's photo, complete the "Email Subscription Request" in the window that opens, reply to the verification email you are sent to activate the subscription and Sha-zam! You're in the know!
Please note that because the blog updates come to you via email, you cannot read comments others have left in response to a post or leave a message of your own via your email program. To do so you will need to click on the blog link within the email and come visit the site directly.
If you ever want to unsubscribe, just send me a note. I'll remove you from the automatic send and you can simply check the blog at your convenience then.
Wednesday, August 8, 2007
"What can I do to help?"
Karen has received so many kind offers and inquiries of "What can I do to help?" We tried to brainstorm a few ideas, but realized that it is difficult to know what needs there will be. So perhaps, just offer.
If you are running to Target, ask if she would like you to pick up anything for her. If you could join her for a walk, that is a big help in fighting fatigue. She has been packing food to help control nausea through the work day. You could offer to make up some small meals or healthy snacks that she can grab-and-go? Perhaps a free of cancer-talk phone call.
Otherwise, just send an email or post a comment here on the blog. The calls, cards and messages she has received have been a huge boost. Never worry about what to say. Just share what is going on with you, something that made you laugh, a movie you saw, etc... Anything by way of support is invaluable - thoughts, prayers and positive energy especially!
Feel free to contact Karen if there is something you would like to offer; or, if you would like to contact me, my email is janiskelley at hot mail dotcom (string it all together with appropriate characters).
Big thanks - - Janis
If you are running to Target, ask if she would like you to pick up anything for her. If you could join her for a walk, that is a big help in fighting fatigue. She has been packing food to help control nausea through the work day. You could offer to make up some small meals or healthy snacks that she can grab-and-go? Perhaps a free of cancer-talk phone call.
Otherwise, just send an email or post a comment here on the blog. The calls, cards and messages she has received have been a huge boost. Never worry about what to say. Just share what is going on with you, something that made you laugh, a movie you saw, etc... Anything by way of support is invaluable - thoughts, prayers and positive energy especially!
Feel free to contact Karen if there is something you would like to offer; or, if you would like to contact me, my email is janiskelley at hot mail dotcom (string it all together with appropriate characters).
Big thanks - - Janis
Hair today, gone tomorrow...
On our way to the second chemo treatment last Monday I ran my hand through my newly cut short hair (thank you for recommending that, Maria!) and out came a small clump of hairs. Oh dear, I said, this can't be a good sign for keeping the hair.
It doesn't hurt when it comes out and that is actually odd since usually it would. I wondered if this was going to happen when after the first treatment my head got really hot and felt a little blistery. Go to it, Piranhas, I say. Take all the hair you want- just take the tumor with it when you go!
Dad took a picture later that Monday afternoon and thank goodness he did because on Tuesday a lot was left behind in the shower. On Wednesday Jan and I pulled much of it out that morning becuase it was everywhere I didn't want it to be: my hands, my shoulders, the tub. Oh, the tub. Through the early part of the weekend I thought I looked like Lidia from "Lidia's Italian Kitchen" on PBS but that is not the case this week as I am down to a smattering of hairs.
And I'm not quite ready to give up on them yet. Having had hair my whole life, taking a couple days to get used to having none is just fine. I have begun to understand why fellows with the single long hairs choose to hang on to them with dear life: once they're gone, they're gone.
When I am ready to remove what little remains I am going to take my friend Tom up on his offer to shave me 'ead right clean outside on their beautiful new deck in St. Louis Park. He's promised not to employ the "FlowBee" but just the regular trimmers he uses himself. We'll keep you posted with photos... if I can get that figured out.
It doesn't hurt when it comes out and that is actually odd since usually it would. I wondered if this was going to happen when after the first treatment my head got really hot and felt a little blistery. Go to it, Piranhas, I say. Take all the hair you want- just take the tumor with it when you go!
Dad took a picture later that Monday afternoon and thank goodness he did because on Tuesday a lot was left behind in the shower. On Wednesday Jan and I pulled much of it out that morning becuase it was everywhere I didn't want it to be: my hands, my shoulders, the tub. Oh, the tub. Through the early part of the weekend I thought I looked like Lidia from "Lidia's Italian Kitchen" on PBS but that is not the case this week as I am down to a smattering of hairs.
And I'm not quite ready to give up on them yet. Having had hair my whole life, taking a couple days to get used to having none is just fine. I have begun to understand why fellows with the single long hairs choose to hang on to them with dear life: once they're gone, they're gone.
When I am ready to remove what little remains I am going to take my friend Tom up on his offer to shave me 'ead right clean outside on their beautiful new deck in St. Louis Park. He's promised not to employ the "FlowBee" but just the regular trimmers he uses himself. We'll keep you posted with photos... if I can get that figured out.
How Karen and Her Family Spent Their Summer Vacation
Hello! We've set up this blog to help keep everyone informed of Karen's progress and the cancer's demise. You are welcome to post comments or questions (click on the title of each post and you can read the post and any comments that have been left all in one window as well as "Post a Comment" yourself, or look for the little "# Comments" at the bottom of each post on the main page, click it and follow the directions in the new window on how to add your own comments.) It is my aim to set up the notification function so you can sign up to receive an email whenever a new post is added to the blog. (If anyone is a blog guru and can explain "Feeds" and "Feed Burners" to me, I'd be so appreciative!) Until then, you are encouraged to check back often.
For those who are sketchy about all the details of this adventure or just want to relive it, I will do my best to bring you up to speed. There is quite a bit of detail here, so settle in! Consider it the diary of events thus far.
In late May, Karen had a very thorough breast exam at her annual exam and the physician did not find anything unusual. About four weeks later, Karen found a lump in her left breast while getting dressed in the morning. She made an appointment with her primary physician, Dr. Amy Gilbert, to have it checked but did not feel it was anything to be worried about. Dr. Gilbert agreed, but recommended a mammogram, an ultra sound and a biopsy to figure out what it was.
On Tuesday, June 26th, Karen went to St. Paul Radiology for the mammogram, ultrasound and biopsy. The radiologist said he believed the lump was cancerous which was, of course, a real shock. While the biopsy was being set up Karen called me to come to the appointment so I could be there to hear what the radiologist's thoughts were.
The radiologist told us that Dr. Gilbert would have the results of the biopsy two days later and he suggested scheduling a consultation with a surgeon in the mean time. By the time we made it out to the parking lot and call for an appointment to receive the results from Dr. Gilbert, the radiologist had already called her to inform her of his findings and his suspicion that it was cancer.
There was a lot of anxiety following the announcement and a lot of unanswered questions. Karen, however, decided because of what the radiologist said and how he said it, and what her doctor said and how she said it, that rather than waiting for results that she was simply waiting for confirmation of the cancer diagnosis and began what is an amazing effort on her part to remain positive and focus on the good.
Dr. Gilbert called on Thursday with the results and from the pathology report. As expected, the biopsy confirmed breast cancer; specifically, an Infiltrating Ductal Carcinoma or IDC. Additionally, the report stated that the tumor is estrogen and progesterone negative, meaning these hormones do not cause it to grow. (If it were hormone positive, then a woman can take hormone blocking drugs to lower the chance of a recurrence.) Not all the necessary tests could be performed locally and the pathology sample was sent to Mayo for HER-2/neu testing.
HER-2/neu is a growth-promoting protein and it is found that between 15-25% of breast cancers have too much of this protein and too many copies of the gene responsible for producing HER-2/neu. These cancers tend to grow and spread more rapidly than other breast cancers. Certain drugs and chemotherapies respond especially well to HER-2/neu positive cancers. We would learn later that Karen’s tumor is HER-2/neu negative.
Breast cancer cells are classified by where the cells originate – either lobular (in the milk producing glands) or ductal (in the milk delivering vessels leading from the lobes). They are also distinguished by whether they are contained (called in situ) or have broken through the duct wall and spread to the surrounding fatty tissue and invaded additional cells (called infiltrating or invasive). Almost 80% of all diagnosed breast cancers are infiltrating ductal carcinomas.
The stage of the cancer is determined using a TNM staging system that evaluates whether the cancer is invasive or in situ, the tumor size (T category), lymph node involvement (N category) and whether the cancer has metastasized (M category) in any distant tissue or organ. Once the criterion for each of these categories is known, the physician can determine the stage from 0-IV. Within stages II and III, there are subgroups as well, noted by A, B and in stage III, even a C. Determining the stage allows the patient and physician to make the best choices for treatment.
One week from the day of her mammogram, Karen, Mom, Dad, Karen’s friend Maria and I went for a consultation with Dr. Diane Ogren, the surgeon recommended by the radiologist and Dr. Gilbert. (Karen believes she is the same surgeon who performed her gall bladder surgery several years ago.) Dr. Ogren was very helpful and understanding in answering all the questions of the five of us had. Maria, whose family has a history of breast cancer, was able to ask questions that the rest of us were not aware needed to be asked.
Dr. Ogren ordered a breast-specific MRI that would be used in conjunction with ultrasound during the surgery to locate the tumor.The results of the MRI provided a more complete picture of the tumor and Dr. Ogren stated that rather than the original size estimate of 3cm, it was now believed to be 5cm. This was rather alarming as we were told that a tumor of that size might not allow for a lumpectomy, which Karen desired. Dr. Ogren stated that she could attempt a lumpectomy, but if the margins (the allowance of healthy cells around the tumor that are removed as a well) were too large that a mastectomy would be necessary. After a short period of recuperation from the surgery, she said Karen would go to an oncologist to begin chemotherapy.
Karen felt very comfortable with proceeding with Dr. Ogren and scheduled the surgery for two weeks later. Some of us were not so assured and wanted Karen to get a second opinion. Personally, I was concerned that a general surgeon would not have the most current training and knowledge of advancements in breast cancer surgery. When asked how it is known that all the tumor has been removed, Dr. Ogren’s answer was that she went by feel. This troubled me as cells are too small to be felt. I wanted a more definitive answer. Also, where I had heard/read that it was possible to do a mastectomy and retain the nipple and aureola; we were only presented with the two standard options of a lumpectomy or a mastectomy. I also was not enthused by the compartmentalized care it sounded like she would be receiving (surgery, handed off to oncology, handed off to radiology – all physicians at different facilities). From what I had read about the Mayo Clinic and the University of Minnesota Breast Cancer Center, they approach the issue as a team, no treatment/surgery is performed if the team is not in agreement and the patient is the key player on that team.
The breast-specific MRI ordered by Dr. Ogren was performed in St. Paul. She called with the results on Monday, 7/2, and confirmed it was still breast cancer and gave a estimation of the tumor size as 5cm. Also in the MRI it was noticed that the nodes under the left arm looked 'suspicious'.
Unbeknownst to the rest of us, Karen’s co-worker and dear friend, Tom, had encouraged her the day before the surgery consultation to make an appointment at the Mayo Clinic for a second opinion. He had taken his partner there when he had bladder cancer just a few years back and spoke so highly of the coordinated care offered there. After some consideration, Karen decided to keep the appointment at the Mayo and postpone the surgery scheduled here in town. Mom, Dad and I were thrilled and relieved.
On Tuesday, July 10th, we all drove to Rochester for Karen's 6:45 a.m. consultation check-in at the Mayo Clinic. We met with Dr. Connie Williams who performed an exam and took a history. She asked Karen for her thoughts and was very attentive and reassuring. She told us the results of the HER-2/neu testing (negative) and also arranged for some additional bloodwork to be done. She ordered a breast ultrasound and a fine needle aspiration of the lymph nodes to be done that day as well. Additionally, a "marker" was placed through a fine needle into the tumor so that it would appear on future imaging and track the tumor. When Karen saw on the ultrasound that the "marker" is actually a tiny, tiny highly recognizable icon, she joked, "What a minute. You put a breast cancer ribbon on my breast cancer?" Dr. Williams came back with, "I know. We get you all fancied up and no one can see it." It was great to have the doctor understand and appreciate Karen's sense of humor and already be comfortable enough to enjoy it herself.
Dr. Williams noticed that Karen was scheduled to meet with the Chief Resident for her surgery consultation and said that while he/she was a competent surgeon, she would recommend that we see a staff surgeon instead. She made arrangements for us to meet with Dr. Judy Boughey, a surgeon who specializes in breast surgery.
Karen wanted to explore having chemotherapy before surgery (called neo-adjuvant therapy) because she believes that once the tumor is removed, it is not possible to see if the chemotherapy is actually having an effect on the cancer cells. Dr. Williams noted that in doing chemo first, the tumor can shrink (on average 70% and sometimes completely which is why the marker is helpful) and reduce the amount of tissue that must be removed with the lumpectomy. She felt this was a viable option for Karen and arranged for us to meet with the oncologist, Dr. Prema Peethambaram.
Dr. Peethambaram was just as kind, respectful and reassuring as Dr. Williams. We have come to learn that this is the standard of care at the Mayo. The patient is the center of all the decisions that are made and the difference is notable. It occurred to me late in the day that none of the physicians we saw wore a white coat. I believe this really breaks down the stereotype of the doctor as having a special status above the patient. It was refreshing.
Dr. P stated that the survival rates for chemo/surgery/radiation were about equal to those for a mastectomy and that the choice belonged to Karen. Karen is firmly in favor of a lumpectomy and Dr. P said that she believed that neo-adjuvant therapy was the most prudent option then. She offered Karen the option to start chemotherapy that very afternoon, but Karen felt that was too big a step and wanted to wait the weekend. In her words, "You never imagine yourself saying, 'Yes, I would like to start with the chemotherapy, please.' but there it is!"
Karen will be receiving 4 cycles of Adriamycin and Cytoxan every other week (provided her blood cell counts are good). Following this, she will receive a 4 cycle dosing of Taxol every other week. Karen is imagining the chemo as piranhas being sent in to eat all the cancer until nothing remains. I love this image!
Finally, we met with Dr. Judy Boughey, the surgeon suggested by Dr. Williams, to discuss surgery options. We are thrilled to have Dr. Boughey on Karen's team as she specializes in breast surgeries. She completed a year long fellowship at MD Anderson Cancer Center in Texas focusing specifically on breast cancer and breast reconstruction. Dr. Boughey said that the result of the ultrasound that day shows the tumor to be just under 4cm, in fact, and she did not feel it would likely be problematic to perform a lumpectomy. We like this answer much better. Karen will check back in with Dr. Boughey toward the end of chemotherapy.
It was a very long day at the Mayo, but it was very fruitful. Karen decided that she really liked the team approach to her care, how everything she needed was right there in the same building, how they arrange for all of your appointments with the various physicians and departments/labs and as she said 'how the right hand knows what the left hand is doing.' We feel very confident that Karen is in the best hands with these physicians. After all, we are not interested in a measly 5 year cure rates. We intend to do everything possible as best we can and know we are focusing on the long-term 50 year cure rates.
On Monday, July 16, 2007, Karen, Mom, Dad and I drive to Rochester for Karen’s first chemotherapy treatment. Karen met her Pink Ribbon Mentor, Fay, a volunteer who has also undergone breast cancer treatment. She gave Karen a tour of the chemo wing and described what would happen during the treatments. (Fay also called Karen a week later just to check and see how she was doing!) As for the chemotherapy, Karen received two drugs intravenously, Adriamycin and Cytoxan. Because of the cost of these treatments, the pharmacy will not mix the drugs until the patient is sitting in the unit being given saline. Prior to receiving the chemo, she is given a big load of steroids and anti-nausea drugs as a prophylactic.
During the Adriamycin 'push' we learn that this drug is so vicious that it cannot touch the skin or any other tissue other than the vein. Karen is given a Popsicle or ice chips to suck on while she is receiving the push as studies have found that having the mouth cold when receiving the chemo lowers the chance for mouth sores as a side-effect. A study was also done to determine if the use of cold would hinder the loss of hair. The nurse told us that during the trial they had women with ice packs on their heads, shivering (the chemo drip is cold as well) and in the end it delayed the loss of their hair only by four days on average. Poor gals.
After the treatment was done (it takes about an hour), we checked into the hotel and went for a wonderful meal at Prescott’s. The service was fantastic, the food was wonderful and for dessert we share the most incredible Baked Alaska. It was just the kind of relaxing time we all needed after such a tense day. However, as we did not know what to expect that evening was rather anxiety-filled . Karen had decided and told herself that she was not going to be sick. However, she laughed and said that her pragmatic side said ‘But if you did get sick wouldn't it be nice to have a bucket by the bed and not have to run to the loo?' So in spite of being certain she wouldn't get sick, the garbage can was tucked beside the bed... and not used.
Twenty-four hours after the chemo, we returned to the clinic and Karen received an injection of Neulasta to help maintain her white blood cell count. We attended educational classes provided by the Mayo on 'What to Expect During Chemotherapy' and also looked at wigs. Karen had decided that with the aid of positive thinking she was not going to lose her hair; but, again, that damn practical side said ‘But if you did happen to lose your hair wouldn’t it nice to have already looked at some wigs?’
Karen is sent home with drugs to ward off nausea. She is to take more steroids every day for four days and is given Compazine to take as needed. On the whole, Karen does remarkably well with tolerating the chemo. She has a few small mouth sores and a bit of nausea, but finds that eating small meals throughout the day help to keep it in check.
The most annoying side effect comes from having to take the steroids. Now all she talks about is her performance and how much better her rbi stats are going to be. They advised her not to take them after 4:00 pm, but even at that, Karen found it revs her up and makes it difficult to fall asleep and stay asleep. When you've got a game to win, that's all you think about.
Ten days after the chemo treatment, Karen says that she finally feels like herself again. Four days later, we are headed back to Rochester for her second treatment. On the drive down, Karen had about ten strands of hair come out at once. “Oh, that can’t be good!” she laughed. (Later that afternoon as a nurse administered the IV push, she told us that with the drugs and the dosages Karen is taking that she will lose her hair. Apparently the power of positive thinking only goes so far in some instances. There are some chemo treatments with which people do not lose their hair, but with these particular drugs, everyone does.)
The morning is started with a blood draw and then a visit with Dr. Peethambaram. Again, Dr. P does a wonderful job of patiently answering all our questions and addressing our concerns. We are a logical science family and have a lot of questions. I asked how the chemotherapy knows which are the fast dividing cells to target and which are not? She explained that the chemo goes into every cell in the body. A typical, healthy cell will filter the chemo with little issue, but something in the fast growing cells does not allow the chemo to be processed. This interrupts its cell division and as a result, it dies. The cells of the mouth, stomach and hair follicles are also fast dividing, so they will react as well.
The most exciting news of the day though came during Dr. P’s exam. She said that all of Karen's bloodwork numbers were good (i.e. within normal range). Then she palpated the tumor and asked, "Where is it? It is more a thickening now than a lump." We couldn't believe what we heard and are thrilled that the piranhas are working so well so soon! It made losing hair a bit more bearable knowing the results are being shown so quickly. We returned the next day to attend a class on "Nutrition During and After Cancer Treatment" and so Karen could receive the Neulasta injection. We looked at wigs again, but decided to do a bit more looking for the right one.
By Wednesday morning, Karen's hair was coming out in large clumps and so we broke out her vintage hats! A couple days later, Karen's friends Mark and Shirley gave her a wonderful gift of some headwraps and caps. It was perfect timing as she is definitely sporting chemo hair.
Other side effects are still very manageable, some nausea and reflux has developed. A quick call to the Mayo, where they stressed 'Don't suffer through the side-effects. We can help with those,' and they provided some relief from the heartburn with the wonder drug Prilosec. She has also noticed some strange sensations in her body and she has had a couple of instances with her memory not being what it used to be (what is referred to as “chemo brain”).
Her third chemo treatment will be on Monday, August 13, 2007. Karen has also requested appointment with Dr. Boughey that day to discuss surgery options further. She feels strongly about wanting to keep as many of her lymph nodes as possible as they are key part of the body’s immune system. She believes that if, after the chemo, a biopsy of the ‘suspicious’ nodes still shows cancer in the nodes, then we wait with surgery and do more chemo. After all, if the chemo goes into every cell, shouldn’t it be able to kill all the cancer cells that are in the nodes? It seems reasonable. But, we have found that a lot of logical suppositions about cancer treatment just don’t follow, so this may or may not be something Dr. Boughey is willing to consider. However, Karen just wants her to think about options for being conservative with the nodes.
Well, this should bring you up to date. Karen and I will do our best to keep the blog current for you. I am working on trying to set it up to allow you to subscribe to the blog and then receive email notice automatically whenever anything new is posted.
Good things to you,
Janis
For those who are sketchy about all the details of this adventure or just want to relive it, I will do my best to bring you up to speed. There is quite a bit of detail here, so settle in! Consider it the diary of events thus far.
In late May, Karen had a very thorough breast exam at her annual exam and the physician did not find anything unusual. About four weeks later, Karen found a lump in her left breast while getting dressed in the morning. She made an appointment with her primary physician, Dr. Amy Gilbert, to have it checked but did not feel it was anything to be worried about. Dr. Gilbert agreed, but recommended a mammogram, an ultra sound and a biopsy to figure out what it was.
On Tuesday, June 26th, Karen went to St. Paul Radiology for the mammogram, ultrasound and biopsy. The radiologist said he believed the lump was cancerous which was, of course, a real shock. While the biopsy was being set up Karen called me to come to the appointment so I could be there to hear what the radiologist's thoughts were.
The radiologist told us that Dr. Gilbert would have the results of the biopsy two days later and he suggested scheduling a consultation with a surgeon in the mean time. By the time we made it out to the parking lot and call for an appointment to receive the results from Dr. Gilbert, the radiologist had already called her to inform her of his findings and his suspicion that it was cancer.
There was a lot of anxiety following the announcement and a lot of unanswered questions. Karen, however, decided because of what the radiologist said and how he said it, and what her doctor said and how she said it, that rather than waiting for results that she was simply waiting for confirmation of the cancer diagnosis and began what is an amazing effort on her part to remain positive and focus on the good.
Dr. Gilbert called on Thursday with the results and from the pathology report. As expected, the biopsy confirmed breast cancer; specifically, an Infiltrating Ductal Carcinoma or IDC. Additionally, the report stated that the tumor is estrogen and progesterone negative, meaning these hormones do not cause it to grow. (If it were hormone positive, then a woman can take hormone blocking drugs to lower the chance of a recurrence.) Not all the necessary tests could be performed locally and the pathology sample was sent to Mayo for HER-2/neu testing.
HER-2/neu is a growth-promoting protein and it is found that between 15-25% of breast cancers have too much of this protein and too many copies of the gene responsible for producing HER-2/neu. These cancers tend to grow and spread more rapidly than other breast cancers. Certain drugs and chemotherapies respond especially well to HER-2/neu positive cancers. We would learn later that Karen’s tumor is HER-2/neu negative.
Breast cancer cells are classified by where the cells originate – either lobular (in the milk producing glands) or ductal (in the milk delivering vessels leading from the lobes). They are also distinguished by whether they are contained (called in situ) or have broken through the duct wall and spread to the surrounding fatty tissue and invaded additional cells (called infiltrating or invasive). Almost 80% of all diagnosed breast cancers are infiltrating ductal carcinomas.
The stage of the cancer is determined using a TNM staging system that evaluates whether the cancer is invasive or in situ, the tumor size (T category), lymph node involvement (N category) and whether the cancer has metastasized (M category) in any distant tissue or organ. Once the criterion for each of these categories is known, the physician can determine the stage from 0-IV. Within stages II and III, there are subgroups as well, noted by A, B and in stage III, even a C. Determining the stage allows the patient and physician to make the best choices for treatment.
One week from the day of her mammogram, Karen, Mom, Dad, Karen’s friend Maria and I went for a consultation with Dr. Diane Ogren, the surgeon recommended by the radiologist and Dr. Gilbert. (Karen believes she is the same surgeon who performed her gall bladder surgery several years ago.) Dr. Ogren was very helpful and understanding in answering all the questions of the five of us had. Maria, whose family has a history of breast cancer, was able to ask questions that the rest of us were not aware needed to be asked.
Dr. Ogren ordered a breast-specific MRI that would be used in conjunction with ultrasound during the surgery to locate the tumor.The results of the MRI provided a more complete picture of the tumor and Dr. Ogren stated that rather than the original size estimate of 3cm, it was now believed to be 5cm. This was rather alarming as we were told that a tumor of that size might not allow for a lumpectomy, which Karen desired. Dr. Ogren stated that she could attempt a lumpectomy, but if the margins (the allowance of healthy cells around the tumor that are removed as a well) were too large that a mastectomy would be necessary. After a short period of recuperation from the surgery, she said Karen would go to an oncologist to begin chemotherapy.
Karen felt very comfortable with proceeding with Dr. Ogren and scheduled the surgery for two weeks later. Some of us were not so assured and wanted Karen to get a second opinion. Personally, I was concerned that a general surgeon would not have the most current training and knowledge of advancements in breast cancer surgery. When asked how it is known that all the tumor has been removed, Dr. Ogren’s answer was that she went by feel. This troubled me as cells are too small to be felt. I wanted a more definitive answer. Also, where I had heard/read that it was possible to do a mastectomy and retain the nipple and aureola; we were only presented with the two standard options of a lumpectomy or a mastectomy. I also was not enthused by the compartmentalized care it sounded like she would be receiving (surgery, handed off to oncology, handed off to radiology – all physicians at different facilities). From what I had read about the Mayo Clinic and the University of Minnesota Breast Cancer Center, they approach the issue as a team, no treatment/surgery is performed if the team is not in agreement and the patient is the key player on that team.
The breast-specific MRI ordered by Dr. Ogren was performed in St. Paul. She called with the results on Monday, 7/2, and confirmed it was still breast cancer and gave a estimation of the tumor size as 5cm. Also in the MRI it was noticed that the nodes under the left arm looked 'suspicious'.
Unbeknownst to the rest of us, Karen’s co-worker and dear friend, Tom, had encouraged her the day before the surgery consultation to make an appointment at the Mayo Clinic for a second opinion. He had taken his partner there when he had bladder cancer just a few years back and spoke so highly of the coordinated care offered there. After some consideration, Karen decided to keep the appointment at the Mayo and postpone the surgery scheduled here in town. Mom, Dad and I were thrilled and relieved.
On Tuesday, July 10th, we all drove to Rochester for Karen's 6:45 a.m. consultation check-in at the Mayo Clinic. We met with Dr. Connie Williams who performed an exam and took a history. She asked Karen for her thoughts and was very attentive and reassuring. She told us the results of the HER-2/neu testing (negative) and also arranged for some additional bloodwork to be done. She ordered a breast ultrasound and a fine needle aspiration of the lymph nodes to be done that day as well. Additionally, a "marker" was placed through a fine needle into the tumor so that it would appear on future imaging and track the tumor. When Karen saw on the ultrasound that the "marker" is actually a tiny, tiny highly recognizable icon, she joked, "What a minute. You put a breast cancer ribbon on my breast cancer?" Dr. Williams came back with, "I know. We get you all fancied up and no one can see it." It was great to have the doctor understand and appreciate Karen's sense of humor and already be comfortable enough to enjoy it herself.
Dr. Williams noticed that Karen was scheduled to meet with the Chief Resident for her surgery consultation and said that while he/she was a competent surgeon, she would recommend that we see a staff surgeon instead. She made arrangements for us to meet with Dr. Judy Boughey, a surgeon who specializes in breast surgery.
Karen wanted to explore having chemotherapy before surgery (called neo-adjuvant therapy) because she believes that once the tumor is removed, it is not possible to see if the chemotherapy is actually having an effect on the cancer cells. Dr. Williams noted that in doing chemo first, the tumor can shrink (on average 70% and sometimes completely which is why the marker is helpful) and reduce the amount of tissue that must be removed with the lumpectomy. She felt this was a viable option for Karen and arranged for us to meet with the oncologist, Dr. Prema Peethambaram.
Dr. Peethambaram was just as kind, respectful and reassuring as Dr. Williams. We have come to learn that this is the standard of care at the Mayo. The patient is the center of all the decisions that are made and the difference is notable. It occurred to me late in the day that none of the physicians we saw wore a white coat. I believe this really breaks down the stereotype of the doctor as having a special status above the patient. It was refreshing.
Dr. P stated that the survival rates for chemo/surgery/radiation were about equal to those for a mastectomy and that the choice belonged to Karen. Karen is firmly in favor of a lumpectomy and Dr. P said that she believed that neo-adjuvant therapy was the most prudent option then. She offered Karen the option to start chemotherapy that very afternoon, but Karen felt that was too big a step and wanted to wait the weekend. In her words, "You never imagine yourself saying, 'Yes, I would like to start with the chemotherapy, please.' but there it is!"
Karen will be receiving 4 cycles of Adriamycin and Cytoxan every other week (provided her blood cell counts are good). Following this, she will receive a 4 cycle dosing of Taxol every other week. Karen is imagining the chemo as piranhas being sent in to eat all the cancer until nothing remains. I love this image!
Finally, we met with Dr. Judy Boughey, the surgeon suggested by Dr. Williams, to discuss surgery options. We are thrilled to have Dr. Boughey on Karen's team as she specializes in breast surgeries. She completed a year long fellowship at MD Anderson Cancer Center in Texas focusing specifically on breast cancer and breast reconstruction. Dr. Boughey said that the result of the ultrasound that day shows the tumor to be just under 4cm, in fact, and she did not feel it would likely be problematic to perform a lumpectomy. We like this answer much better. Karen will check back in with Dr. Boughey toward the end of chemotherapy.
It was a very long day at the Mayo, but it was very fruitful. Karen decided that she really liked the team approach to her care, how everything she needed was right there in the same building, how they arrange for all of your appointments with the various physicians and departments/labs and as she said 'how the right hand knows what the left hand is doing.' We feel very confident that Karen is in the best hands with these physicians. After all, we are not interested in a measly 5 year cure rates. We intend to do everything possible as best we can and know we are focusing on the long-term 50 year cure rates.
On Monday, July 16, 2007, Karen, Mom, Dad and I drive to Rochester for Karen’s first chemotherapy treatment. Karen met her Pink Ribbon Mentor, Fay, a volunteer who has also undergone breast cancer treatment. She gave Karen a tour of the chemo wing and described what would happen during the treatments. (Fay also called Karen a week later just to check and see how she was doing!) As for the chemotherapy, Karen received two drugs intravenously, Adriamycin and Cytoxan. Because of the cost of these treatments, the pharmacy will not mix the drugs until the patient is sitting in the unit being given saline. Prior to receiving the chemo, she is given a big load of steroids and anti-nausea drugs as a prophylactic.
During the Adriamycin 'push' we learn that this drug is so vicious that it cannot touch the skin or any other tissue other than the vein. Karen is given a Popsicle or ice chips to suck on while she is receiving the push as studies have found that having the mouth cold when receiving the chemo lowers the chance for mouth sores as a side-effect. A study was also done to determine if the use of cold would hinder the loss of hair. The nurse told us that during the trial they had women with ice packs on their heads, shivering (the chemo drip is cold as well) and in the end it delayed the loss of their hair only by four days on average. Poor gals.
After the treatment was done (it takes about an hour), we checked into the hotel and went for a wonderful meal at Prescott’s. The service was fantastic, the food was wonderful and for dessert we share the most incredible Baked Alaska. It was just the kind of relaxing time we all needed after such a tense day. However, as we did not know what to expect that evening was rather anxiety-filled . Karen had decided and told herself that she was not going to be sick. However, she laughed and said that her pragmatic side said ‘But if you did get sick wouldn't it be nice to have a bucket by the bed and not have to run to the loo?' So in spite of being certain she wouldn't get sick, the garbage can was tucked beside the bed... and not used.
Twenty-four hours after the chemo, we returned to the clinic and Karen received an injection of Neulasta to help maintain her white blood cell count. We attended educational classes provided by the Mayo on 'What to Expect During Chemotherapy' and also looked at wigs. Karen had decided that with the aid of positive thinking she was not going to lose her hair; but, again, that damn practical side said ‘But if you did happen to lose your hair wouldn’t it nice to have already looked at some wigs?’
Karen is sent home with drugs to ward off nausea. She is to take more steroids every day for four days and is given Compazine to take as needed. On the whole, Karen does remarkably well with tolerating the chemo. She has a few small mouth sores and a bit of nausea, but finds that eating small meals throughout the day help to keep it in check.
The most annoying side effect comes from having to take the steroids. Now all she talks about is her performance and how much better her rbi stats are going to be. They advised her not to take them after 4:00 pm, but even at that, Karen found it revs her up and makes it difficult to fall asleep and stay asleep. When you've got a game to win, that's all you think about.
Ten days after the chemo treatment, Karen says that she finally feels like herself again. Four days later, we are headed back to Rochester for her second treatment. On the drive down, Karen had about ten strands of hair come out at once. “Oh, that can’t be good!” she laughed. (Later that afternoon as a nurse administered the IV push, she told us that with the drugs and the dosages Karen is taking that she will lose her hair. Apparently the power of positive thinking only goes so far in some instances. There are some chemo treatments with which people do not lose their hair, but with these particular drugs, everyone does.)
The morning is started with a blood draw and then a visit with Dr. Peethambaram. Again, Dr. P does a wonderful job of patiently answering all our questions and addressing our concerns. We are a logical science family and have a lot of questions. I asked how the chemotherapy knows which are the fast dividing cells to target and which are not? She explained that the chemo goes into every cell in the body. A typical, healthy cell will filter the chemo with little issue, but something in the fast growing cells does not allow the chemo to be processed. This interrupts its cell division and as a result, it dies. The cells of the mouth, stomach and hair follicles are also fast dividing, so they will react as well.
The most exciting news of the day though came during Dr. P’s exam. She said that all of Karen's bloodwork numbers were good (i.e. within normal range). Then she palpated the tumor and asked, "Where is it? It is more a thickening now than a lump." We couldn't believe what we heard and are thrilled that the piranhas are working so well so soon! It made losing hair a bit more bearable knowing the results are being shown so quickly. We returned the next day to attend a class on "Nutrition During and After Cancer Treatment" and so Karen could receive the Neulasta injection. We looked at wigs again, but decided to do a bit more looking for the right one.
By Wednesday morning, Karen's hair was coming out in large clumps and so we broke out her vintage hats! A couple days later, Karen's friends Mark and Shirley gave her a wonderful gift of some headwraps and caps. It was perfect timing as she is definitely sporting chemo hair.
Other side effects are still very manageable, some nausea and reflux has developed. A quick call to the Mayo, where they stressed 'Don't suffer through the side-effects. We can help with those,' and they provided some relief from the heartburn with the wonder drug Prilosec. She has also noticed some strange sensations in her body and she has had a couple of instances with her memory not being what it used to be (what is referred to as “chemo brain”).
Her third chemo treatment will be on Monday, August 13, 2007. Karen has also requested appointment with Dr. Boughey that day to discuss surgery options further. She feels strongly about wanting to keep as many of her lymph nodes as possible as they are key part of the body’s immune system. She believes that if, after the chemo, a biopsy of the ‘suspicious’ nodes still shows cancer in the nodes, then we wait with surgery and do more chemo. After all, if the chemo goes into every cell, shouldn’t it be able to kill all the cancer cells that are in the nodes? It seems reasonable. But, we have found that a lot of logical suppositions about cancer treatment just don’t follow, so this may or may not be something Dr. Boughey is willing to consider. However, Karen just wants her to think about options for being conservative with the nodes.
Well, this should bring you up to date. Karen and I will do our best to keep the blog current for you. I am working on trying to set it up to allow you to subscribe to the blog and then receive email notice automatically whenever anything new is posted.
Good things to you,
Janis
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