The stars have aligned

  The stars have aligned. They’re a bit janky, but I’ll take it. 

 I was able to find another resource for lodging and this one is nationwide. Extended Stay America is partnered with the American Cancer Society to provide free or discounted rooms to those traveling more than 40 miles away from home for cancer treatment. And. They. Accept. Pets. 

 

 Enter the newest additions to the Miller household. My goal is for them to travel with me providing much needed doggo support while I travel monthly. 

Meet Stella (left) and Gus (right)

 They are in addition to our already amazing, Cooper Duper! They’re seriously stealing my heart. 

Realizing I never gave him a debut, here you go. 

🌈🌉 IYKYK

Handsome fella. He is 1 year 3 months. Our main man. 

 Ok squirrel. Verzenio has been doing a number on my attention span. Back to my janky stars. 

 Here’s another link for the American Cancer Society resources. Apparently there’s an app. Onto that next, if I remember. 

 I haven’t been posting about the series of unfortunate events that I have been enduring. But that’s part of why I feel some janky stars have aligned. 

 I have been one of 9 Community Health Systems (CHS) employees to experience a “glitch” where my benefits have not been deducted from my paychecks since 6/28/26 pay period. Add that up. CHS employs approximately 90,000 employees. That means I’m the lucky 0.01%. I’ve been spending much of my time on the phone between this, a reimbursement TRICARE issue, and ongoing VA claims. Now I’m not saying all of this for boo-hoo pity party, I’m saying at all because of people ask me how I have to work so hard even while I’m having not the best go of life. I don’t know. Let’s just call it Stephanie’s Series of Unfortunate Events. 

 Anyway, those stars. ⭐⭒🌟

 I received a call from the only person who apparently knows what’s going on but does not have access to the ticket system we use to report a payroll issue. 

Summary:

• I will not lose my benefits. 
• I do not have to pay the thousands of dollars post-tax on an invoice from a direct pay request just because my benefits haven’t been coming out of my paycheck. The total will be “suppressed”. 
• I will have to pay back benefits pre-tax on my future paychecks. 

 I didn’t get to call TRICARE today which is probably good. I’ll stop while I’m ahead. I haven’t been ahead in a while. 

I’ll leave you with my beautiful, sparkly, janky stars

Day 12 Lab Results

 I will be monitored by labs every two weeks for the first two months to see how I am handling Verzenio. So far so good!

 My white cells are kicking butt. My red cells are a little low which is why I'm more tired, but not at a concerning level. My liver function tests are spectacular which is great since this is how Verzenio is metabolized. My kidney levels - creatinine is high and estimated glomerular filtration rate (eGFR) is low, but that is to be expected.

 Down the rabbit hole I go:

 Verzenio (abemaciclib) frequently raises blood creatinine levels by blocking kidney secretion transport, but it usually does not damage actual kidney function.

• Transporter Inhibition: Verzenio inhibits renal tubular transporters—specifically OCT2, MATE1, and MATE2-K.
• Decreased Secretion: These transporters normally help actively secrete creatinine into the urine.
• Elevated Blood Levels: When they are blocked, creatinine builds up in the blood stream (serum creatinine increases), making blood test numbers go up.

Key Clinical Facts

• Not Kidney Damage: Up to 95% of patients experience this rise, but it typically does not mean your kidneys are failing or injured. The actual filtration rate of the kidneys (GFR) remains normal.
• Timing: The increase usually happens early—often within the first 28-day cycle of taking the medication—and then stabilizes.
• Reversibility: The elevated creatinine levels are fully reversible and drop back to normal after stopping Verzenio.

My Brain on Drugs

 

Pac-Man is my cancer treatments.

Power Pellets (blinking circle) are Verzenio.

Ghosts are my cancer cells.

They thought they could win. 

Game on.

The Healing Spectrum

 

A collage made of sections of nine watercolors Leeds made in Art for Recovery workshops

Touch and Go and Travel Resources

 

 For my October visit to Philly, I will essentially be doing a touch and go. I will fly in one afternoon, have my appointment and get my next 28 doses of Verzenio the next day, and then fly out the next morning. I'm thankful for Alaska Airlines and Atmos Rewards as their rewards program have pulled us through some of these flights so far.

 I wanted to share the many resources offered to me as someone who is being treated for cancer in hopes that it may help you or someone you know, if you happen to be in this less than ideal situation:

https://angelflightwest.org/ -  Serving Alaska, Hawaii, Washington, Idaho, Montana, Wyoming, Colorado, Utah, Arizona, California, Nevada, and Oregon.

https://angelflighteast.org/ - All other states

https://www.mercymedical.org/

https://www.footprintsflights.org/

https://www.cancer.org/support-programs-and-services/patient-lodging.html - Hope Lodges in various areas and a discount with Extended Stay America

https://www.headstrong.org/ - Another place available in Philadelphia

https://www.nationalbreastcancer.org/nbcf-programs/hope-kit/ - Free to send to someone you know with cancer - Includes various items such as Fuzzy socks, Tumbler, Tea, Clean beauty product, Unscented lotion, Lip balm, Hard candy, HOPE journal & pen, Inspirational bracelet, Educational resources, Encouragement card. THE GIFT OF HOPE

 If you're cross country like me, Angel Flight West and Angel Flight East cannot combine to get you there. I tried. :)

Pill Fatigue

 I have 3 clinical research prescribed pills at 8 am and 8 pm. I have 12 other prescription medications, 3 of which are eye drops. I take 34 over the counter medications or supplements to manage the side effects of my prescription medications, with 2 of those being eye drops. 

 That is a total of 52 medications. A. Day. It’s a part time job just getting those down the hatch. 

 I have to put something in my stomach before I can take many of these meds and am finding myself less and less hungry each day. It appears I’m tolerating the Verzenio well. Imodium is my friend but not being needed often. Juven is still a great addition, in my opinion.

 Another day down. Really hoping to get my appointments for my ABBY trial for October-December tomorrow. 🤞🏻

Positive Energy

 

There's no place like home and my Verzenio regimen

  Back home with my two best guys. 

  Dogs make everything better.

 My medication regimen is taking 150 mg Verzenio, twice daily, exactly 12 hours apart. There is a +/- 1 hour window to take the medication or I have to skip it for that dose. I have to keep a log of when it was taken and any side effects that I experienced. I have specific parameters for temperature and GI issues to call the UPenn oncologist to get further advice as a dose adjustment can be made if I am not tolerating it well. The #1 side effect?

  I was prescribed the following medications to help manage these symptoms, in order of escalation if needed:

• Imodium (Loperimide)
• Treats acute and chronic diarrhea
• Side effects of constipation, dizziness, and mild stomach discomfort (concern for addiction due to opioid)
• Mechanism of action - An opioid receptor agonist that attaches to and activates opioid receptors in your brain and body to provide pain relief, relaxation, or other effects such as reducing the movement of fluids and food through your digestive tract and helping the intestines absorb more water and salts due to diarrhea
• Diphenoxylate-Atropine (Lotomil)
• Treats severe diarrhea
• Side effects of dry mouth, headache, dizziness, drowsiness, and constipation
• Mechanism of action
• Diphenoxylate is an opioid that slows down movement in your intestines allowing your body to absorb more water and makes your stool firmer (concern for addiction without added atropine as it is an opiod)
• Atropine is an anticholinergic medicine added in very small amount which causes unpleasant symptoms if someone tries to take too much of the drug to get high (since it is an opioid)
• Dicyclomine (Bentyl)
• Treats painful abdominal cramping and spasms
• Side effects of dry mouth, blurred vision, dizziness, drowsiness, and constipation
• Mechanism of action - Blocks the chemical messenger acetylcholine in the gut slowing down gut movements and relaxing smooth muscle in the stomach and intestines
• Ondansetron HCL (Zofran) 
• Treats nausea and vomiting
• Side effects of constipation (no sleepiness) - for use in daytime
• Mechanism of action - blocks serotonin from binding to 5-HT3 receptors in your gut and brain
• Prochlorperaine (Compazine)
• Treats severe nausea and vomiting
• Side effects of sleepiness - for use at night
• Mechanism of action - blocks dopamine D2 receptors in the brain, particularly in the chemoreceptor trigger zone, which stops signals that trigger nausea and vomiting

 Flashbacks to my nausea decision tree from chemotherapy.

 Is anyone else surprised to hear that anti-diarrheals are opioid agonists?

 Here's a helpful image for my medical professional readers out there! The more you know!

 Ok, now I'm really geeking out! What came first, the knowledge that opioids cause constipation therefore using this as the mechanism of action to prevent diarrhea or the development of an anti-diarrheals? The former!!!!

From Google AI:

Yes, traditional opioids came thousands of years before targeted synthetic opioid agonist anti-diarrheals. 

History of Traditional Opioids

• Ancient use: Humans have used raw opium (derived from the opium poppy, Papaver somniferum) for over 5,000 years, with cultivation dating back to ancient Mesopotamia around 3400 BCE. 
• Early anti-diarrheal use: Historical preparations like paregoric (a camphorated tincture of opium) and laudanum were used for centuries to treat severe diarrhea and pain by slowing down the digestive tract.
• Isolation: Pure opiate compounds like morphine were first isolated from opium in 1803 by German chemist Friedrich Sertürner.

History of Opioid Agonist Anti-Diarrheals

• Targeted synthesis: Modern, specialized synthetic opioid agonist anti-diarrheals that focus primarily on the gut without significant central nervous system effects were developed much later.
• Diphenoxylate: Synthesized in 1956 by Paul Janssen at Janssen Pharmaceutica, and commonly combined with atropine as Lomotil.
• Loperamide: Better known by the brand name Imodium, it was first synthesized in 1969 and introduced for medical use in 1976.

 Due to this very game being baseline for me, I am utilizing the Medications tracking option in the Apple Health App. It even allows me to set a critical alert if I have not marked "taken" within 30 minutes of my expected time to keep me on track for the specifics of the clinical trial.

 

How does Verzenio impact disseminated tumor cells?

My 5.5 hour flight from PHL to SEA has already been a great opportunity to study more about the theory of how Verzenio will help me prevent recurrence of cancer. Even without the addition of hydroxychloroquine at this time. What felt a bit like defeat, now feels like an opportunity, the opportunity I felt this clinical trial would bring me from the beginning.

 Abemaciclib (marketed as Verzenio) stops cancer cell division by blocking specific proteins called cyclin-dependent kinases 4 and 6 (CDK4 and CDK6). 

How It Stops the Cell Cycle

• Targeting Proteins: CDK4 and CDK6 normally team up with other molecules to push cells through their growth cycle so they can multiply.
• Blocking Signals: Verzenio inhibits these enzymes, preventing them from activating the retinoblastoma (Rb) protein.
• Causing Arrest: Without this activation, dormant or active tumor cells—including disseminated tumor cells hiding in the body—get stuck in the G1 phase and cannot copy their DNA to divide.

Leading to Cell Death

• Prolonged Stoppage: Continuous exposure to the drug keeps the cells from growing indefinitely. (I will not have continuous exposure to Verzenio. To start, it will be 6 months. Potential for 12 months if needed. No more.)
• Cell Senescence: Instead of multiplying, the arrested tumor cells enter a permanent state of non-division (senescence) or trigger programmed cell death (apoptosis). (Clarification on the word permanent. They enter a permanent state only while taking the CDK4/6 inhibitor (Verzenio) but can return to a potential of division (quiescent) after stopping the medication.)

• Preventing Recurrence: By keeping disseminated tumor cells from waking up and growing, the treatment helps lower the risk of advanced metastasis or cancer coming back. (Google AI)

I've recently started dabbling in AI for images. I couldn't find a good visual until I prompted this diagram on ChatGPT.

This is a good reminder of how disseminated tumor cells are created.

 Senescent or dormant disseminated tumor cells (DTCs) can still be detected in a bone marrow aspirate, but standard microscopic examination alone often misses them because they do not form large tumor clusters and look like single, resting cells. 

• Detection Details
• Specialized Testing: Standard routine stains (like an H&E stain on a basic smear) frequently fail to show single dormant cells. Laboratories must use sensitive methods like immunocytochemistry (using cytokeratin markers) or multiparameter flow cytometry and iFISH to find rare DTCs.
• Cell Cycle Status: Senescent cells are permanently growth-arrested, meaning they do not actively divide, but they remain structurally intact and present in the tissue microenvironment. 
• Clinical Significance: Finding these hidden cells indicates minimal residual disease (MRD), which carries a higher risk of future recurrence even when imaging scans (like PET or CT) show no evidence of spreading. (Google AI)

 Based off of my last pathology report, it states, "A cytokeratin immunostain was performed on the bone marrow cytospins for clinical trial purposes." I confirmed this is the same as "using cytokeratin markers". This tells me, even in their (best clinical trial Arm A outcome) senescent state, any existing disseminated tumor cells should be visible. More on that later. For now, we'll focus on the first 6 months.

Heading home

 

I’m going to let that photo sum up my last few posts. 

I’m sitting on a plane, on 9/11, and want to take some time for those we lost and for those who didn’t bat an eye at walking into the fire. Where were you that day? I was in chemistry class.