Where was my immune system?

 When you have all the time in the world to think, it is likely you'll question how you acquired a disease such as cancer. It can be quite a wormhole of thinking and can lead to unhelpful cognitive distortions, so instead, I shift to research.

 The following information is courtesy of the City of Hope Cancer Center website:

 If the human immune system is so strong and sophisticated, why do nearly two million Americans develop cancer every year?

 It may not be because of immune system failures. In fact, it’s likely that your immune system may regularly fight off cancer or pre-cancer on a regular basis without you even knowing it.

 "The immune system is absolutely critical in fighting cancer," Dr. Lynch says.

 Also, the immune system is better designed to fight foreign cells that invade the body from the outside, such as bacterial and viral pathogens. Cancer cells are the body’s own cells that have gone rogue, and the immune system may not always see them as a threat.

 When cancer cells thrive, it’s often because they:

• Evade or hide from immune cells using signals that healthy cells may use

• Shut down immune cells and sometime use them to proliferate

• Overwhelm or exhaust the immune system with sheer numbers and rapid growth

 A fine balance exists between the burden of cell mutation and how well the immune system may fight it off. The tipping point at which cancer begins to overwhelm the immune system is not always known.

Cognitive Distortions and Breathing

  Another pearl from the cognitive behavioral theory is recognition of cognitive distortions. We have all experienced at least one (if not many) of these in our lifetime, and likely will continue. The magic is when we recognize it and work through it so that it does not take over our thoughts and actions.

All-or-nothing thinking is so easy to do. It is what leads us into eating poorly the rest of the day after a co-worker brings in donuts for breakfast. Or that a single mistake can make it seem like an entire project is ruined.

 

 We've already talked about positive (or neutral) self-talk, but it also helps to stay "in the moment", assess fact vs. feeling, and to try out deep breathing, to recenter and give ourselves time to react.

• Staying "in the moment" - not always the easiest thing to do, but perhaps the most impactful.

• Assessing fact vs. feeling - is what I'm feeling an actual fact, or just a feeling I need to work through?

• Deep breathing

There are a few ways to do deep breathing, which can be done anytime and anywhere, so it is one of our most powerful tools.

Box Breathing

4 seconds in, 4 second hold, 4 seconds out, 4 seconds hold, and repeat

Kids (or adults) can use the palm of their hand and trace it like a box for a tactile input as well

4-7-8 Breathing

4 seconds in, 7 second hold, 8 seconds out

This should be an abdominal breath where your belly really sticks out, not the time to worry about your weight loss goals

5 Finger Breathing

Each finger is a different size, so tracing them allows for inhaling and exhaling at different lengths of time

The tactile input of tracing fingers also helps some

Remember, you can practice deep breathing at any time. In front of others, or in the bathroom or break room, it will allow you to reset and return to the present moment.

 Personally, I've done significant work in the areas of mental filtering, overgeneralizing, and should statements. I still have work to do in all-or-nothing thinking. 

 Do you recognize a cognitive distortion that seems to take over when things aren't going as planned?

TL;DR

• Cognitive distortions come in all shapes and sizes, and it is likely we have all experienced one or another in our lives.
• Positive self-talk, staying "in the moment", assessing fact vs. feeling, and deep breathing are all good techniques to work through and overcome these less than helpful thought patterns.
• Deep breathing can be done anywhere and at any time.

What a Year this Week has Been and ECHOs

 So the good news is the Perjeta and Herceptin are doing exactly what they need to be doing. The other news, that we’ll decide to call good, is that I get to stay on those infusions every 3 weeks for a full year. Yes, my friends, even when the two chemo drugs stop and I move into the surgery and radiation stages of my recovery, I continue to get targeted therapies to combat my triple positivities! Does that make me too (or three) positive? 🤔😂

 I’ve been a bit more tired this week 3 than in the past. It is all cumulative and sometimes I think I can eat spices and dairy like I used to, so this is a learning curve. Also, the last week before my next infusion is killer, but I’m learning to be patient, right?

 But speaking of positivity leading to better health of the heart, Perjeta and Herceptin can cause cardiotoxicity, (damage to the heart and/or cardiovascular system, including heart valves and vessels) requiring me to be monitored every 3-4 months by an echocardiogram. An echocardiogram (ECHO for short) is a noninvasive, painless test that uses high-frequency sound waves to visualize the shape, size, and movement of the structures of the heart. My initial ECHO was good and my next is mid-April. 

 I happen to have one of the best ECHO techs on the planet that I can call not only a skilled professional, but a good friend. (Her daughter was the one who hustled me so we have an even closer connection with the bracelet being so near and dear to my heart.) It is always helpful to have peace of mind when you know you’re getting exceptional care and a solid study that you can use to make decisions about your plan of care. 

 Something some of you may not know is my past heart surgery, a catheter ablation, for supraventricular tachycardia (SVT) when I was 21. Yes, it was done under conscious sedation so I was awake to tell them when I was in a rapid cycle and yes, they used heat to ablate so it felt like severe heartburn. They only put me fully out towards the end so I would stop asking so many darn questions! Fortunately, in a way, that was due to my electrical system rather than my structural heart, so I should be going into this as good as any other. 

TL;DR

• I will stay on Perjeta and Herceptin infusions every 3 weeks for a full year, even after chemo is done, because it is working!
• I will need heart monitoring in the form of an ECHO every 3-4 months due to the cardiotoxicity of these targeted therapies. 
• I have a great ECHO tech I can call my friend. 
• It brings peace of mind to know I get quality studies from this person which helps me to make solid decisions related to my plan or care.
• My past heart surgery of a catheter ablation for SVT should not have impacted my heart structure, so I should be good going into this since my first ECHO was good. 

Funny, Not Funny - All Things Chemo Brain

 Here are some chemo brain funnies, that are not that funny when you're living it, but enjoy!

The word finding issues are real, so you find yourself describing things to the best of your ability.

I stand by this.

Grow Hair and Your Choice

 I have a new addition to my to do list:

Did you know: Healthy human hair grows at an average rate of 0.01 inch per day, which adds up to roughly 0.5 inch per month, or 6 inches per year.

 There is so much cancer has taught me thus far and I anticipate it will continue to teach me so many things. 

 We all have a choice. 

Positive In = Positive Out

Here’s more Nice News in the form of CBT's (see prior post explaining that here) positivity mindset techniques:

Positivity plays a significant role in well-being. The benefits range from improved cardiovascular health to better coping skills and more.

It is 100% possible to foster an optimistic outlook, even for those who tend toward a "glass half-empty" way of thinking. By consistently practicing the science-backed exercises and techniques outlined below, anyone can make positive thinking a habit and shift their perspective for the better.​

• Challenge Negative Self-Talk

Something this can be hard. If you find that flipping the script from negative to positive self talk, try adding things like. “I’m learning to…” or “I am trying to…”. Start neutral and go from there!

 

• Look for the humor

• Implement a Growth Mindset

• Affirmations (my favorite affirmations card deck can be found here)

Another hard one some times. Printing these out and keep them around for when you may not be feeling it but the outside reminder is there to remind you how amazing you are!

 

• The "Three Good Things" Exercise

From Berkeley:

Time Required

10 minutes/day for at least one week.

How to Do It

Each day for at least one week, write down three things that went well for you today, and provide an explanation for why they went well. It is important to create a physical record of your items by writing them down; this can be more helpful than simply doing this exercise in your head. The items can be small, everyday events or more important milestones (e.g., “my partner made the coffee today,” "My grandparents were happy when I brought them groceries," or “I earned a big promotion”). To make this exercise part of your daily routine, some find that writing before bed is helpful.

Another printable to help master this skill because I love them!

Thank You and Moving Mountains

 

Scanxious and Amazing News!

 Scanxious. My dad made this word up after introducing scanxiety. Say it out loud and then never say it again. 😂

 Needless to say, yesterday's MRI results left me hanging, as it was not an obvious answer as to which direction we should go. I have an amazing team of physicians on my side, and my plastic surgeon called to ensure I was as informed as I could be as to not have too much scanxiety.

 Today, I received the best news I could ask for. My breast surgeon spoke directly with the radiologist who read both my January and March MRIs. With this comparison, while my mass is the same size, the bulk of the tumor has decreased by 20-40% (less cancerous cells present) and the lymph nodes show no further progression or involvement. This was the response we wanted as it has the potential to be a pathologic complete response which again, is the best news I could ask for.

 Plan moving forward is to stay the course of neoadjuvant chemotherapy to finish off my cycles on April 1st, April 22nd, and May 13th if all goes as well as it has been. Surgery would then be late June/early July as we want enough time between my last chemotherapy infusion to ensure I will heal from my surgery. After healing from surgery, I will then start my radiation which will be daily, Monday-Friday for about 15 minutes each day for 6 weeks.

This side won except for one clarification. While the mass stayed the same size, it was the fact that the bulk of the tumor shrunk which leads to the positive response to TCHP that we were hoping for.

 I have learned to say

and instead of freaking out yesterday and panicking, I decided to see what information would be provided to me today for us to then proceed with our decision making.

 TL;DR

• Scanxious is a word best said out loud, only once.
• While yesterday left me hanging, today brought great news and a more firm plan for moving forward.
• Good chance of pathologic complete response due to decreased bulk of the tumor (less cancerous cells present).
• Next chemo cycle planned for April 1st since we're continuing neoadjuvant chemo.
• Plan for surgery late June/early July.
• Radiation to follow surgery after healing.
• Consider saying "What if it all works out?" instead of worrying.

…

 I wish I knew more but I don’t. I am grateful for my docs who are taking the time to review current and past images and will ensure I’m headed in the right direction. A special thanks to a truly stand up guy (and doc) for contacting me tonight to ensure I’m as informed as can be at the moment.