Stress and Cancer

 

 I enjoyed this article from Stanford Medicine article regarding stress and cancer:

 "In recent times, there has been a substantial shift in health care toward recognition of the wisdom of Plato’s creed, namely, that the mental and physical are not separate, isolated, and unrelated, but are instead vitally linked elements of a total person. Health is becoming increasingly recognized as a balance of many parts—physical and environmental factors, emotional and psychological states, nutritional habits, and exercise patterns. As part of that balance, the role of stress is well established as the cause of a broad range of disorders."

 "The role of stress in cancer is unclear. What is important for patients is that the reduction of stress may very well improve chances for recovery, improve quality of life, and provide an opportunity for greater participation in total treatment."

"Some researchers have attempted to clarify to what degree stressful life events are related to sickness. After long research, Drs. Thomas Holmes and Richard Rahe developed a scale based on forty-three common stressful experiences, in the order they were found to be related to illness. By checking the items that have occurred in the last year, you will arrive at a total score that indicates your supposed level of vulnerability to illness.

This scale reflects that change, whether positive or negative, tests our ability to adapt. The higher the score, the higher the probability that a person will become sick. High scores (above 300) do not necessarily mean a person will get sick, only that the risk is greater. For instance, in one study using this scale, the 30 percent with the highest scores had 90 percent more illnesses than the 30 percent with the lowest scores. In another study, 49 percent of the people in the high-risk group (scores above 300) became ill; 25 percent of the medium-risk group (200–299) became ill; but only 9 percent of the low-risk group (150–199) became ill."

 Here is the scale:

  Reducing stress can be an important part of your cancer treatment plan and can have important implications for both your mind and body. 

Ongoing Effects of Chemotherapy

  I had an epiphany yesterday. Each cycle I went through, I had no expectations from myself to do much of anything during weeks 1 and 2 post-infusion. Except for this last cycle. Apparently I had all the expectations for myself going into this one. So I reset. This Monday will be the start of my 3rd week and even then, I'll give myself more grace that I have been.

 Of course, this led me to do some research. Despite being done with chemo on May 13th, the ongoing effects of chemo will continue with me for some time. Here are some timelines courtesy of the Memorial Sloan Kettering Cancer Center:

Low Blood Counts: After your last dose of chemotherapy, your white blood cell count will go down. It should start to go back to normal about a month after your last treatment. Your red blood cell count may also go down, but it should go back to normal around the same time.

Hair Loss: If you lost your hair, you should start to see it grow back 14 to 21 days after your last chemotherapy treatment. The amount of time it takes to grow back is different for everyone. When your hair grows back, it may be a different color or texture. These changes are normal. Over time, most people’s hair goes back to its original color and texture, but some people may have long-term changes. 

Neuropathy: Some chemotherapy medications can cause neuropathy (numbness or tingling in your hands and feet). It may get worse after you have your last chemotherapy treatment. Most people notice that their neuropathy gets better 2 to 4 months after chemotherapy, but it can take up to 1 year to fully go away. For some people, it never completely goes away.

Nausea, Vomiting, and Taste Changes: You may experience nausea (feeling like you might throw up) and vomiting (throwing up) after your last chemotherapy treatment. It should go away in 2 to 3 weeks.

Your appetite may continue to be affected due to taste changes you may have experienced during your treatment. Your taste should go back to normal 1 to 2 months after chemotherapy. 

Fatigue: Your fatigue (feeling more tired or weak than usual) will get better over time. For some people, energy levels may return to normal within 6–12 months, but it can take longer for those who received intensive treatments like stem cell or bone marrow transplants. You may have lost some muscle and strength during your treatment and will need to build it up again slowly. Walking or doing another form of light exercise each day will help with this.

"Chemo Brain" and Stress: Many people experience mental changes after chemotherapy treatment. This is sometimes called “chemo brain.” You may have problems such as poor memory, trouble finding words, difficulty focusing. This can affect parts of your life, including caring for your family and managing your job. Try to avoid having goals for yourself that are too high. This can add to your stress level and frustration. Most people say it takes 6 to 12 months after they finish chemotherapy before they truly feel like themselves again. 

Fear of Cancer Coming Back: After treatment, many people might be afraid that their cancer will come back (recurrence). You may become concerned about new symptoms you’re having and wonder if they’re related to breast cancer.

I found this article and this infographic for more detailed information:

Margins

  When I get my surgery, there will be may parts coming together to ensure the entire area of tumor is removed. There is even a pathology component in the operating room to ensure my margins (areas next to the tumor) are not positive. Essentially, they keep removing tissue until it shows that there is no cancerous cells present in the tissue any longer. 

 

Meliorism

  I get a daily email from Random Acts of Kindness and this one was worth sharing. It is a new word for me but absolutely not a new concept.

 My MRI showed that my tumor is essentially the same if not just a bit smaller than at my midway point. It is most important that it did not grow and that no new tumors are present on either side or showing up in my lymph nodes. Again, my doctors do not cease to amaze me. They call me after long days of on-call and surgeries to keep me informed of any new information they know. It is really appreciated.

Next Steps

  I had a final MRI prior to surgery today to take a peek at my lovely tumor and see how the final targeted and chemotherapy annihilated it. At my last visit, my surgeon stated that it was less detectable so part of my pre-surgery plan is to get a seed implanted in the area of the tumor. Here is a video explaining that:

The seed looks like this:

It is 11 mm long and 2 mm in diameter.

 I will get the seed implanted on June 4th, have a few surgeon visits prior to my surgery, and then have surgery planned for June 25th at this time. Our plan is to conserve as much tissue as possible so a lumpectomy with oncoplastic intervention is what we are shooting for, unless the MRI shows right sided involvement or any other tumors on the left.

 A large part of the decision making for the type of surgery comes down to genetic testing and involvement of the tumor. Since I am not BRCA positive and my tumor looks to be localized only to the left, I don't have any major indications to proceed to a mastectomy. Please know that each person's situation is different in so many ways, so please do your research and speak with your team to decide what is best for you, if you ever have to do this (and I hope you never do!).

 Radiation therapy will follow as will my ongoing infusions of Herceptin and Perjeta (+ or - chemotherapy depending on pathology results post-surgery).

TL;DR

 

Happy Sunday

  Happy Sunday everyone! I hope this finds you well. I’m feeling cautiously better. It was a nice day for a drive so we went to Matanuska Glacier yesterday. 

It’s been a while so I wanted to share a smile cause they’re still coming.

Recovery is not linear

But it is moving in a positive direction. I’m feeling quite a bit better today and even enjoyed some sunshine while doing some yard work. Progress may look different each day, but it’s progress nonetheless. 

Overwhelmed

Really feeling fortunate that I’m done with my last round of chemo before surgery. Today is following suit on being a rougher day. I know I’ll get through it because it should be the end of the worst. 

 Trying to wrap my brain around next steps. I’m getting appointments lined up for my next steps before, for, and after surgery. I don’t often get overwhelmed but kind of feeling it now. I’m remembering to take it one day at a time and if past experience stays true, I should be over this hump by early next week. 

Everything will be so good so soon

 

 I'm not sure if I'm still on my dexamethasone high or not, because I feel kind of normal today. We will see after tomorrow when it tends to wear off, but I'm trying to absorb as much natural vitamin D and keep moving so my cells can rejuvenate for my upcoming surgery.

 I meet with the surgeon tomorrow to discuss next steps and hopefully firm up a date to move forward. We'll want my blood counts to all support natural healing, as being a Certified Wound Specialist, I know the implications of a non-healing wound all too well. 

 I feel a sense of relief having completed my current chemotherapy and targeted therapy regimens and have a refreshing outlook for my future.

Cycle 6 is a go!

  

 My body has been so kind and kept me right on schedule! Cycle 6, which is my final TCHP (for now), concludes the neoadjuvant (pre-chemo) portion of my treatment. Next step is surgery which will allow for pathology of the tumor that will guide my ongoing infusion needs (just Herceptin and Perjeta, or other chemo needs as well). Either way, radiation for 6 weeks Monday-Friday is a definite go. 

 Take what you need today, I know I am. 

Life is good

 

Heading in for my final chemo session (for now) tomorrow and 🤞🏻 that it’s a go! Feeling pretty good so hoping my labs show all is well. Feeling hopeful I won’t need more chemo later but we will have to await the pathology results after surgery to know for sure! Going to enjoy this sunny day and be thankful for how I’ve done so far!

Figuring it all out.

   While I can't truly say I'm "mourning the loss" of what I thought my life was going to be, I do find myself thinking about how different my life has evolved since my diagnosis with cancer. No one can possibly know what will occur in a day, let alone a week, month or year, but one can't help but consider how things might be different if things had been different. I just don't let it consume my life.

 Sometimes doing nothing is doing everything.

Am I forgetting something?

 

 This is me, every day. In part, due to chemo brain but also due to me being so used to having to "do" all the time. Dr. Jud Brewer, a neruroscientist and CBT guru, talks about us having become human doings instead of human beings. We are so used to doing and being judged by how much we do that we forget how to just be. I'll admit, I'm still sitting here hoping I'm not forgetting that thing I have to do, but for now, I'll just enjoy that I'm able to be.

 Here is an article to explore more about how to shift from a human doing to a human being.

Peripheral Neuropathy of the Teeth

So here’s a new one, peripheral neuropathy of the teeth. It started a couple of days ago and felt like a sharp stab followed by a throb, throb. It was in a back molar and all I could think of is “a cavity, now, really?” I made it a point to get a check up and cleaning right before starting chemo, since dental work is usually delayed until after chemo is complete. It seemed like a fast deterioration having just had a good checkup but who knows. But then Dad and I were talking and neither of us could remember every feeling a cavity when one was found, so I searched for tooth pain and chemo and found this:

“Peripheral neuropathy originated from cytotoxicity of chemotherapy drugs may cause severe localized pulpalgia in intact teeth.”

Allow me to define pulpalgia:

Pulpalgia is pain that originates from the dental pulp. In acute tooth pulpalgia, the affected tooth is usually very sensitive  

This article reports localized tooth pain as a possible outcome of administrating high dosage chemotherapy drugs particularly in the last cycles of application.

It feels a bit better today so I’m going to run with it. 

Rest is Necessary

 

You Decide

  I came across a remarkable 25 year retrospective cohort study (more here to understand the strength of this study type) from the University of Cambridge that highlights the risk of developing secondary primary cancers in breast cancer survivors. I share this information as it can highlight the ongoing need for preventative screenings, even after fighting breast cancer, but I also appreciate the sensitive nature of knowing more than needed when you’re already dealing with so much. This is why I am providing this preface and encouraging anyone who reads on to decide for themselves. This may be a post best returned to at a later date, if you wish. 

You decide. 

Quoted from article material is in black. My thoughts are in pink. 

Setting the stage. 

This study analyzed data from over 580,000 female and over 3,500 male breast cancer survivors diagnosed between 1995 and 2019 using the National Cancer Registration Dataset.

These are their findings as summarized by Becker’s Hospital Review.

1. Women who survived breast cancer had double the risk of contralateral breast cancer as the general population, and they were at 87% greater risk of endometrial cancer, 58% higher risk of myeloid leukemia and 25% greater risk of ovarian cancer. This one makes me think. All through my treatment, we’ve discussed recurrence rates of current cancer, but not necessarily potential of new primary cancer in the contralateral (other side) breast. This just increases my awareness of living a healthy lifestyle and needing ongoing preventative screenings to find any possible cancer early enough to be treated. It doesn’t change what’s in store for me now so it doesn’t personally make me go on doomsday thinking. An important addition from another summary of the article: One potential explanation is that a larger number of younger breast cancer survivors may have inherited genetic alterations that increase risk for multiple cancers. For example, women with inherited changes to the BRCA1 and BRCA2 genes are at increased risk of contralateral breast cancer, ovarian and pancreatic cancer. In my case, I do not fall into that category. I have negative genes all around. At least the ones we currently know about. 
2. Women diagnosed with breast cancer before age 50 were 86% more likely to develop a second primary cancer, whereas women diagnosed after age 50 had a 17% increased risk. I’m more at risk than others may be. I also will likely live longer given my current age which provides more time for other primary cancers to grow. Good to know. 
3. Women from more socioeconomically disadvantaged backgrounds were at a 35% higher risk of second primary cancer compared to those from less deprived backgrounds. The difference was driven by non-breast cancer risks, particularly for lung, kidney, head and neck, bladder, esophageal and stomach cancers. I have thought about this every step of the way. The Joint Commission has a National Patient Safety Goal for Social Determinants of Health (SDOH). This is why.
4. Male breast cancer survivors were 55 times more likely to develop contralateral breast cancer compared to the general male population. Likely an unknown fact.
5. Male breast cancer survivors were 58% more likely to develop prostate cancer. More reasons for preventative screening and trending Prostate-Specific Antigen (PSA) lab tests.
6. About 3 in every 100 men diagnosed with breast cancer at age 50 or older developed contralateral breast cancer during a 25-year period. Another likely unknown fact. 

Here is a link to another summary and then finally, the actual research article, in case anyone is interested.  

Now replace sadness with cancer and you’ll understand a bit more how I feel.