Anna's Book of Days

I learned today that I have been placed in Arm B of the clinical trial, which is T-DM1 + Perjeta - no chemotherapy! Chemotherapy drugs work by targeting quickly dividing cells. Cancer cells divide much more quickly than most normal cells, so chemo is effective at halting or even reversing the progression of cancer. However, the drugs can't distinguish between cancer cells and other quickly dividing but normal cells, including white blood cells and hair follicle cells. That's why chemo compromises the immune system, causes fatigue, and makes the hair fall out. By contrast, T-DM1 (also called ado-trastuzumab emtansine or Kadcyla) is an antibody-drug conjugate, one of a new class of highly potent biopharmaceutical drugs designed as a targeted cancer therapy. T-DM1 consists of the monoclonal antibody trastuzumab (Herceptin) linked to the cytotoxic agent mertansine (DM1). Trastuzumab stops growth of cancer cells by binding to the human epidermal growth ...

Today I got my portacath placed. The port is a  small medical appliance that is installed beneath the skin, in my case an inch or so below my right clavicle. A catheter then connects the port to a vein in my neck. Under the skin, the port has a septum through which my chemo drugs can be injected and blood samples can be drawn many times with less discomfort than a more typical needle stick (which is particularly uncomfortable for me and my tricky veins). It will stay in place for the next year; at the completion of my treatment I'll need another surgery to take it out.  I was under twilight sedation for the procedure, which took about an hour. I thought "twilight" meant that I'd be pretty out of it, but I was actually very aware of everything that was happening, even from under the paper tent that they placed over my head. There was little pain, but I could feel the very strange sensation of the catheter being snaked up to my neck from my chest. Dr. Kee, the...

I hope it goes without saying that my first priority in my war against breast cancer is saving my life. There is nothing that I wouldn't go through or give up in order to ensure that I can continue to be Ike's mommy and Seth's wife for decades to come. However, as I've begun to understand that my odds of survival are good, my mind has turned at times to some of the other, less critical losses that come with cancer. Hair is an obvious one. For my most of my life, even as a baby, I've had a lot of hair - and even in the brief interludes when it was short, I've never had hair shorter than chin-length. If I am assigned to Arm B of the clinical trial, then I won't get traditional chemotherapy and will avoid many of the chemo-related side effects. Dr. Hurvitz says I won't lose my hair, which is nice, but for me it pales in comparison to the benefit of not having other side effects. Even with chemo, they now have something called cold caps, which have been succ...

Thank God. It doesn't matter so much for me - after all, I still have cancer - but for Julia and Lauren and Alysia and Erica, and for all the other girls in our family who are yet to be born, I am incredibly relieved.

I just heard from the clinical trial coordinator, Monica - I've been approved by Roche and admitted to the trial! Dr. Hurvitz has seemed very confident that I would be, but I'm very glad that it's formalized. I'm going in for my trial biopsy and lab work tomorrow morning. Once that is complete, they can "randomize" me - assign me to Arm A or B. Monica thought that would happen on Monday or Tuesday next week. And one way or the other, I'll start treatment next Thursday.  This all seems both to be happening very fast and very slowly, like a dream. I think this altered sense of time is going to be my new reality until I'm through this treatment.

My PET scan and brain MRI were clean! We were pretty sure that my cancer was non-metastatic based on my lymph node biopsy, but there was a small chance that the biopsy could have missed the cancer cells, so it's wonderful to have this extra confirmation.

In addition to Chemo Teaching, I also had an electrocardiogram (EKG) and echocardiogram (ECHO) on Friday. Treatment with trastuzamab (Herceptin) can cause weakness of the heart muscle, which leads to problems pumping blood and potentially congestive heart failure. In clinical trials, about two to three percent of those treated with chemotherapy plus trastuzumab had heart failure, compared to fewer than one percent of those treated with chemotherapy alone. B ecause of this, patients' hearts are monitored throughout treatment using EKGs and ECHOs. This first set of tests was to establish a pre-treatment baseline. With each heartbeat, an electrical signal spreads from the top of the heart to the bottom. As it travels, the signal causes the heart to contract and pump blood. The process repeats with each new heartbeat.  The heart's electrical signals set the rhythm of the heartbeat.  An EKG is a simple test that records the heart's electrical activity. It  shows how  ...