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