Anna's Book of Days

On the eve of my third cycle, I am so pleased to be able to say that Cycle 2 was even easier than Cycle 1. No side effects! Even after returning to work I still am not experiencing any fatigue. And more important than that - I feel really happy. I know it's a strange thing for a cancer patient to say, but life is good. ~ In non-cancer related news, I was notified today that a piece that I wrote was posted on LeanIn.org ( http://leanin.org/stories/ anna-jacobson/ ). I  wrote it about eighteen months ago, on the plane coming home from an excellent Women in Construction conference I attended in New York. I had read Sheryl Sandberg's book, Lean In , on the plane ride out, and between that and the conference, I was all fired up. I dashed off the essay and sent it into the website, soon forgetting all about it - but continuing to think a lot about the issues that I wrote about, which became even more immediate when I got pregnant a few months later. Re-reading my ...

I received the results of my BreastNext test, the full panel of genetic testing - all negative! This wasn't something I was worried about (I strongly feel that I have to be extremely selective about what I worry about these days), but it's always good to get good news. BreastNext utilizes next generation sequencing to offer a comprehensive testing panel for hereditary breast and/or ovarian cancer. They start by checking for mutations in  BRCA1  and  BRCA2,  which are responsible for 25-50% of hereditary breast cancers. These are the results that I got last month. If the BRCA results are negative, as mine were, they move on to the full  panel, which includes fifteen other identified genes ( ATM, BARD1, BRIP1, CDH1, CHEK2, MRE11A, MUTYH, NBN, NF1, PALB2, PTEN, RAD50, RAD51C, RAD51D  and  TP53) .  According to Ambry Genetics, the maker of the test, studies demonstrate that mutations in the genes on the BreastNext panel can confer an estimat...

I'm going back to work tomorrow. It's almost incomprehensible, how different my world is now from when I left work six months ago. Then, and for the prior fourteen years, my sense of self was rooted deeply in my professional life. But all that changed when I became a mother, and it changed again when I became a cancer patient. My highest priorities now are taking care of Ike and taking care of my health - so we'll see where that leaves my work. I hope to be able to give it the same focus and attention that I used to for the thirty-two hours a week that I'm doing it, but it can no longer be the all-absorbing passion that it had been in the past. It feels bittersweet that my maternity leave is ending, but the truth is that it actually ended, for all intents and purposes, when I got my diagnosis. Even though I still wasn't working, dealing with my disease became like a job - and the slow, gentle days of nursing and napping and playing with Ike were no more. I reall...

When we met with her last Thursday, Dr. Hurvitz was extremely excited about how much my tumor has shrunk. Even though she had said that it would start shrinking right away, she was as pleased as I was that it actually did, and I think she was surprised by how much. I keep having the urge to ask her what's typical or what's to be expected, and I have to remind myself that there  is  no "typical" or "expected" for this treatment with my type of cancer - it's a trial. What I experience will become someone else's "typical" if the treatment is successful and becomes the standard of care. Prior to the invention of Herceptin (trastuzumab) in the 1990s, HER2-positive breast cancer was the worst kind you could get - the most aggressive, the most likely to metasticize, the most deadly. When news spread in 1994 that Genentech had found a drug that could not only treat it, but in many cases could cure it, patients literally stormed the gates. Inspi...

Today's treatment went much like the first - we met with Dr. Hurvitz for a quick checkup and exam, then went upstairs for my infusion. Unfortunately, this time when the nurse connected the line to my port it was extremely painful - it felt like she was stabbing me in the chest, which I guess is actually what she was doing. I didn't expect it to hurt, though, since last time I didn't feel a thing. They're going to prescribe a numbing cream that I can apply ahead of time for my next treatment, so hopefully I don't have to feel that again. The infusions themselves were completely painless and easy - 30 minutes of Perjeta and 30 minutes of Kadcyla, with 30 minutes observation after each. We were done by 1:30 and went home to rest. ~ While Seth was out getting us lunch, a friend from my support group stopped by to chat. She had a double mastectomy in June and is starting her last cycle of chemotherapy next week. I can't even imagine what it would fee...

Today is the last day of my first cycle of treatment. I have been absolutely flattened by a nasty cold since last Monday, but controlling for that, I think this cycle has been blessedly easy. All told, I've had a few moments of nausea (five, to be exact) but no vomiting, a bit of mild digestive trouble (also five times), and some skin issues (although that could also be a product of hormonal changes from stopping breastfeeding). And I haven't noticed any changes at all in my energy, sleep, appetite, or mood. Heading into Cycle 2, I'm crossing my fingers that this continues to be the extent of my side effects. I had another biopsy today - and it showed that the drugs are working! At my last biopsy, on September 11, my tumor measured 7 cm x 4 cm. This time, it was 3 cm x 1.3 cm - a huge reduction, especially for only one cycle of chemo. We were told that this is what would happen, but even so, it feels magical.

Acupuncture is a central part of traditional Chinese medicine (TCM). In this ancient system of medicine, it is believed that vital energy, called qi, flows through twenty pathways, or meridians, which are connected by acupuncture points. If qi is blocked, the body can't function at its peak, so the goal of acupuncture is to open certain points on these pathways and release blocked qi.  A lot of research is being done on how acupuncture can help relieve some of the symptoms of cancer and side effects of cancer treatment. Acupuncture has been shown to help relieve fatigue, hot flashes, nausea, vomiting, and pain. Some examples: The most thorough study of acupuncture in breast cancer patients was published in Journal of the American Medical Association in 2000. In the study, 104 women undergoing high-dose chemotherapy were given traditional anti-nausea medication. In addition to taking the medication, the women were randomly chosen to receive 5 days of acupuncture, or no acu...

The five stages of grief are well-known, but the emotional stages of serious illness are not as well-defined. For me, shock was the first, and then activity - quickly mobilizing to take action to fight my cancer in as many ways as possible - was the second. But now that the shock has passed and there is nothing else to be done until my next treatment, I am entering a new stage - asking why. I don't mean "Why me?", maudlin self-pity. But on an intellectual level, I want to know why this happened. Certain genes control when our cells grow, divide into new cells, and die. Genes that speed up cell division are called oncogenes, while others that slow down cell division, or cause cells to die at the right time, are called tumor suppressor genes. Mutations in DNA that turn on oncogenes or turn off tumor suppressor genes can cause a normal breast cell to become cancerous. That cell divides and becomes two, then four, then eight, then sixteen, and so on until millions of can...