The Digestive System

  The gastrointestinal side effects of chemo are real and…

 Found some fun graphics because I prefer to humor to misery. It’s such an efficient system.  

 Especially during chemo. 🤣

Rebounding

 

 The Friday after my infusion starts my lowest dip. I fortunately am able to rebound by my next infusion which I feel has been part of my success with having each infusion on schedule. 

 I received this message on my phone from a great app I have, Self-Care. I found it apropos and just what I needed that day.  The app is great and can be set to send you daily reminders which can be helpful to help you reset on those overwhelming days.

Oof.

  Now that my dex (dexamethasone steroid) high has fully weaned off, the fatigue is real. 

 I must say I was proud of myself for still showing up and doing yoga today (one of my favorites in case you missed it). 

I feel like it’s a game, but it’s not. Just humorous. 

Trying to get them all on the same team!

Thoughts > Emotions > Behavior

 When discussing CBT, I should have probably started with this as it is the basis of the entire theory and important to return to as we learn to retrain our brain for more positive thought > emotion > behavior pathways.

 While this infographic provides a good example, my favorite and go-to is either a very fast (scenario 1) or very slow (scenario 2) driver in your path. We know we can all relate.

Thoughts:

Scenario 1: "This guy is a maniac. Doesn't he see I'm going the speed limit? Who does he think he is?"

Scenario 2: "Doesn't this guy know I have some place to be? Why can't he get out of my way?"

Emotions:

Scenario 1 & 2: We may become frustrated or angry or raise our voice. We may also become scared for our safety, further elevating many other emotions.

Behavior:

Scenario 1: We may start to speed up, or slow down, or drive erratically, matching the driver's actions. We may raise our voice or talk to others in our vehicle in a less than kind manner.

Scenario 2: We may speed up and drive around them in the non-passing lane. We may rant to others in the vehicle about how the person is causing frustration to us.

 In these scenarios, we are allowing someone who is not even known to us to influence our thoughts, emotions, and behaviors. We likely will have longing emotions and behaviors well after the event has occurred. This could impact our next hour, day, or even weeks or months. Afterall, we don't even know this guy!

 The good thing is that just as this demonstrated a negative cycle, we can retrain ourselves to be more neutral or positive about the event. By using self-reflection or knowing what triggers exist, one can recognize the cycle when it begins and turn the tables to not allow the negative emotions and behaviors to occur.

 Let's revisit scenarios 1 & 2.

Thoughts:

Scenario 1: "I hope this guy is ok. He seems to be going fast. I'll just stay my speed and let him go around me."

Scenario 2: "This guy seems to be going pretty slow. I will go around him so I can continue on my way."

Emotions:

Scenario 1 & 2: We will likely have less strong emotions and will not have emotional escalation. 

Behavior:

Scenario 1: We will likely maintain our speed and stay in the lane where we are driving, allowing the fast driver to pass. 

Scenario 2: We will likely use the passing lane to pass the slower driver to continue to our destination.

 This just feels different. We are not giving the unknown person any power or control over us, and we are not letting them influence our hour, day, weeks or months. We are not escalating our emotions and can then have behaviors that are more positive and conducive to a more peaceful life.

 Now, let's translate this to my cancer. I could easily think "why me?" and "what if?", but instead, I think "I am in the best hands and am gaining the knowledge to best be involved in my care.", "I can only make decisions based on the facts I have at the time.", and my favorite "What if it all works out?"

 This allows me to have more positive emotions and therefore behaviors more conducive to healing. I use my energy to do yoga or walk. I try to get sunlight for my vitamin D levels. I am eating well and not getting angry so I do not channel negative vibes. This is a major part of my positive mindset.

 Remember, sometimes it takes a minute to catch yourself, and that is ok! It will get easier and easier the more you practice this skill.

A helpful worksheet:

Normal Screenings - are they enough?

  There was recent news that Olivia Munn was diagnosed with breast cancer in April 2023. This usually would not be news I care to share on here except for the interesting sequence of events that led to her diagnosis. 

• She took a genetic test in February 2023 that looks for 90 different cancer genes and tested negative for all of them, including the BRCA gene which substantially increases the risk for cancer.
• She also had a routine mammogram and the results came back normal, however, two months later she was diagnosed with breast cancer.
• Her OB/GYN calculated her Breast Cancer Risk Assessment Score, via the Tyrer-Cuzik Risk Calculator, that estimates your personal risk of developing breast cancer. She said without that tool, it is likely she would not have been diagnosed until the following year at her next scheduled mammogram. Her score was a 37%.
• Of note, she had a very aggressive form of breast cancer and required a double mastectomy. Who knows where one more year would have left her.

 Wednesday challenge - check your risk assessment score here (same link as above).

 Interestingly enough, my case was different. My mammogram indicated some findings that warranted a focused ultrasound followed by an ultrasound and immediate biopsy. An MRI assisted with further diagnostics due to the density of my tissue. I took the risk assessment today as I had never heard of it before and it indicated that I have a personal 10 year risk of 2.60% and a personal lifetime risk of 18.40%.

 This is why it will and can take all kinds of screenings to ensure you know your risk!

What do these scores mean?

 From Medical News Today:

Based on their Tyrer-Cuzick score, a doctor will put a person’s risk of developing breast cancer into one of three categories:

Average risk

Doctors generally consider a person with a Tyrer-Cuzick score of less than 15% at average risk of developing breast cancer. A score in this range indicates the person does not necessarily need additional tests outside those generally recommended.

The American Cancer Society currently suggests that people at average risk for breast cancer consider beginning to have annual mammograms from age 40. Those aged 45–54 should have a mammogram every year, switching to every other year from age 55 on if they wish. Other personal factors may also influence the frequency of testing.

Intermediate risk

A score of 15–19% indicates an intermediate risk of developing breast cancer. Doctors may recommend additional testing for some people at this risk level, such as those with dense breast tissue. Before proceeding, doctors will explain the issues that can arise from additional testing, such as false positives and other risks of mammogram tests.

High risk

Doctors typically consider a score over 20% high risk. They may recommend that people in the high risk group get additional screening tests every year, such as a breast MRI. Doctors may also have further recommendations for each individual, such as supplemental ultrasound testing for those with very dense breast tissue.

One more chemo cycle to go (for now)!

  While I do love this quote, I can't help but be excited that I only have one more chemo cycle to go (for now). I say (for now) due to the need to see the pathology results from my tumor after surgery to determine if I have a pathologic complete response (pCR).

 I received a great newsletter from Genentech who is the manufacturer of Perjeta and Herceptin in relation to pCR. 

Understanding the outcome of treatment before surgery

At this point in your treatment journey, you may be almost ready for surgery, and your pre-surgery treatment cycles should be nearly done. You might be wondering what comes next.

Remember, your doctor and healthcare team are your primary sources of information. Only they can give you medical advice about your disease and treatment.

Let’s talk about pCR

Pathological complete response, or pCR, is a measure your doctor uses to see how well your pre-surgery treatment worked. That’s what they’ll use to plan your next step.

After surgery, a doctor checks to see if any cancer cells are present in the breast tissue or lymph nodes removed during surgery. If there are no cancer cells present, that’s a pCR.

A pCR is not the same as a cure. Whether you get a pCR or not, it’s important to continue treatment after surgery. There are options for either outcome, and you and your doctor will decide what’s best for you.

 Based on my most recent MRI results, my chance of a pCR is very high; however, we will not know until after my tumor goes to pathology. So, my next steps are to await pathology results after my surgery in late June/early July to know if I will just continue Herceptin and Perjeta for one year, or if I will change my regimen completely or just add in another chemotherapy therapeutic.

 For now, May 13th is my next date to look forward to which will be my last chemotherapy/targeted therapy session until after surgery. Hopeful and anticipating being able to have that cycle on time as my body has been rebounding well enough with my red and white blood cells to not cause a delay! Way to go gran team!

 Thank you to everyone who is checking in on me. I truly appreciate it. But don't forget to:

They need it too!

 The yoga that brought me joy today! I love what she says at time 12:47 - "Notice what it feels like to be alive today, enjoy, enjoy, enjoy". Such a good message.

TL;DR

• You get the smorgasbord above. I'm on my dexamethasone steroid high so enjoy the chaos!

Cycle 5 is a go!

 

Power of Positivity

  I’d like to share an excerpt from John Maxwell’s book, Developing the Leaders Around You:

“The individual whose attitude causes him to approach life from an entirely positive perspective is someone who can be called a no-limit person. In other words, the person doesn’t accept the normal limitations of life as most people do. He or she is determined to walk to the very edge of his potential, or his product’s potential, before he accepts defeat. People with positive attitudes are able to go places where others can’t. They do things that others can’t. They are not restricted by self-imposed limitations. 

A person with a positive attitude is like a bumblebee. The bumblebee should not be able to fly, because the size, weight, and shape of its body in relationship to its wingspread makes flying aerodynamically impossible. But the bumblebee, being ignorant of scientific theory, flies anyway and makes honey every day. This no-limit mind-set allows a person to start each day with a positive disposition, as did an elevator operator I once read about. One Monday morning, in a full elevator, the man began humming a tune. One passenger, irritated by the man’s mood, snapped, “What are you so happy about?” “Well, sir,” replied the operator happily, “I ain’t never lived this day before.” Not only does the future look bright when the attitude is right, but the present is much more enjoyable too. The positive person understands that the journey is as enjoyable as the destination.”

Good Report

  I got the call from my oncologist's office stating my ECHO looks great without any significant changes that would put my chemo and targeted therapy on hold. So far, all is a go for Monday, April 22nd for my 5th of 6 cycles. We won't know for sure until my labs are drawn that morning but,

Outcomes4Me - The 2023 State of Patient Empowerment Report

https://outcomes4me.com/wp-content/uploads/2023/12/Outcomes4Me_2023_State-of-Patient-Empowerment-Report.pdf

ECHO, ECho, echo...

  More on echocardiograms (ECHOs) with help from my ECHO tech friend. A huge thank you to her for these references. 

 But first, a bit about the heart. The heart is a muscle that pumps blood through the body. With each beat, the heart pumps blood through the body’s cardiovascular system. The cardiovascular system is made up of the heart and a system of blood vessels (the circulatory system) that help circulate blood. The blood provides oxygen and nutrients to all the organs and tissues in the body. It also delivers carbon dioxide to the lungs and the lungs then exhale to remove carbon dioxide from the body. At the same time, blood picks up waste products that are filtered out of the body by the kidneys. 

• The heart is located between the lungs and pumps blood throughout the body's cardiovascular system. 
• The heart has four chambers. 
• The upper two chambers are the right atrium and left atrium. These are called "collecting chambers" because they collect the blood as it returns to the heart.
• The lower two chambers are the right ventricle and left ventricle. These are called "pumping chambers" because they pump the blood out of the heart to where it needs to go.
• The right and left sides of the heart are divided by a wall called the septum. 
• You can feel your pulse each time the ventricle pumps by feeling your wrist or side of your neck.

 I don't yet know how my ECHO results compare to my January ECHO, but here is some information to better educate yourself on why ECHOs are used to assess cancer therapeutics-related cardiac dysfunction. Cancer-therapeutics can be cardiotoxic (can cause damage to the heart) and require monitoring to assess for need for pause or change in plan of care.

 For me, it is my Herceptin and therefore, having an ECHO every 3 months will continue for my full year of treatment, and then beyond due to radiation therapy. As always, anything posted here is related to my type of cancer and situation. The full articles review more information for others going through other types of cancer therapeutics. Feel free to ask your doctor about your specific medications and if monitoring is needed for your or your loved one's care.

 Two amazing articles that go very in depth on cancer therapeutics-related cardiac dysfunction:

• Management of Cancer-Therapy-Induced Left Ventricular Dysfunction: Can the Guidelines Help?

• Practical guidance for echocardiography for cancer therapeutics-related cardiac dysfunction

This algorithm (B) is specifically for patients who have never received anthracyclines. 

You can find algorithm A in the link if you have received anthracyclines (such as Daunorubicin, Doxorubicin, Epirubicin, Idarubicin, Mitoxantrone, Valrubicin, etc.).

 Strain is another part of an ECHO that is reviewed when undergoing monitoring for cardiotoxicity. This website is very neat to see strain imaging and I will not even pretend to educate on all of it, but in case you're a visual person, this could help to visualize the difference in how the heart moves when there is pathological strain on the heart.

TL;DR

• I don't have an update on how my ECHO from yesterday compares to my ECHO from January, but hoping for good things. 
• A bit about the heart
• The heart is located between the lungs and pumps blood throughout the body's cardiovascular system. 
• The heart has four chambers. 
• The upper two chambers are the right atrium and left atrium. These are called "collecting chambers" because they collect the blood as it returns to the heart.
• The lower two chambers are the right ventricle and left ventricle. These are called "pumping chambers" because they pump the blood out of the heart to where it needs to go.
• My Herceptin requires monitoring of my heart via echocardiograms (ECHOs) every 3 months per guidelines.
• There are specific comparisons of measurements of function and size of my heart that will determine maintaining my current schedule of infusions, pausing treatment, or changing my treatment course. This is all dependent on how my heart handles my specific targeted therapy.
• Radiotherapy (radiation therapy) will also require monitoring of my heart for years after my treatment is complete (hopefully for good).
• Strain is a neat concept and can be seen visually on this website.

Sheer Amount of Time

 

 I came across this amazing timeline that shows the various steps one must take to navigate medical care after detecting early stage breast cancer. While all cancers, and their various stages, come with their own timeline, the sheer amount of time it takes from start to finish is absolutely astonishing. 

 Take me for example. For my timeline there on the right, I've estimated about 203 days of total initial treatment (not counting ongoing infusions of Herceptin and Perjeta for one year and oral Tamoxifen for 5-10 years), give or take a few weeks. Time from detection/diagnosis would actually be 249 days. Do you know what can happen in 249 days? Well, I thought I'd have a long list for you but all that comes up is early pregnancy and baby milestones, so... I'll spare you those details.

 Truthfully, it feels like a lifetime. Especially having to be away from work and all the people that fill my cup. While I'm usually the one bringing the energy to others, the rallying around me and meeting me where I am is amazing. I leave visits with others more energized than when I arrived and that is fulfilling.

 What can you do today to fill your cup? 

Younger but more prepared

  

 All data from this post is courtesy of the American Cancer Society (ACS), including the image above and below.

 

 The ACS report showed younger adults to be the only age group with an increase in overall cancer incidence between 1995 and 2020 - the rate has risen by 1% to 2% each year during that time period.

 For anyone who wants to really geek out, check out this JAMA article on Breast Cancer Incidence Among US Women Aged 20 to 49 Years by Race, Stage, and Hormone Receptor Status. 

 So how do we get ahead of screenings, when the ages of recommended screenings are often in the 40's and 50's? Little known to many, if you have a family member with cancer, it is advised to start screening 10 or even 15 years before your family member's diagnosis:

 From a Yale Medicine article:

• But talking to a doctor about a family history of colorectal cancer could prompt a screening referral at a younger age. “If there is a family history of either cancer or polyps, we usually start colonoscopy screening 10 to 15 years before the family member who had it was diagnosed,” says Dr. Kortmansky. “So, if a first-degree relative was diagnosed with cancer at 45, you would start screening at 30.”
• Likewise, women who are at average risk for breast cancer may start mammography screening at age 40, according to U.S. Preventive Services Task Force (USPTF) recommendations updated in 2023. But women with a family history of breast cancer are generally advised to start when they are 10 years younger than the first-degree relative (a mother and/or sister) was at their time of diagnosis.

 But how do you get someone to listen to you to get your screening? 

• Know your family history
• Bring the facts
• Bring a supportive friend or family member
• Be relentless about your own health
• Ask questions

 And if they still say no? My favorite:

• Ask them what the risks vs. benefits are and reasoning is for not doing a screening, and listen for a valid response. If there isn't one, decide whether to push back or see another provider that is more aligned with your healthcare goals.

 Here are two perspectives to consider on how to align goals of care with your provider when going into a medical visit:

The Provider Perspective

https://www.acpdecisions.org/goals-of-care-conversations-a-best-practice-step-by-step-approach/

The Patient Perspective

https://www.prevention.com/health/a41974607/how-to-get-your-doctor-to-listen/

TL;DR

• Overall cancer incidence rate has risen by 1% to 2% each year between 1995-2020.
• It is important to get screenings when suggested, but if you have a family history, speak with your doctor about starting screenings 10-15 years before their diagnosis (e.g. mother with colon cancer at age 50, you would get your colonoscopy at 35-40).
• Be your own self-advocate to receive these screenings when you need them. See the links above on some suggestions.