Thursday, December 31, 2015

Notes about dietary information and Cancer that Shari Cleaned up for Me


  1. Green Tea - Several cups a day, hot or cold, unsweetend.  In fact cold brewing without boiling water will make your tea higher in antioxidants.
  2. Turmeric and black pepper together are a big yes.  Try to add them to your food and supplement if you aren't eating much in your diet.  It is an incredible anti inflammatory spice.
  3. For Omega 3 fatty acids eat walnuts, chia seeds, and flax seeds every day.  Do Not take fish oil supplements for Omega 3.  If you want to supplement try Deva Vegan DHA vitamins.  They are made from algae and contain no mercury or impurities.
  4. If your blood levels of Vitamin D are low, take Vitamin D3 supplements.  Low D3 is linked to breast cancer as well as low bone density and other medical conditions as well.
  5. Supplement Vitamin B12 with Methylcobalamin under the tongue.
  6. Don't eat processed foods
  7. Don't eat sugar
  8. No eggs
  9. No meat or dairy - no animal products
  10. No vegetable oil or sunflower oil - I only use olive oil as sparingly as possible. I usually cook with vegetable broth.
  11. High fiber - The more fiber the better.
  12. All fruits are good.  Berries are best. Cranberries and lemons are the best cancer killing fruits.
  13. If you eat grains, eat whole grains only.  No white flours or white bread or white rice - nutritionally dense whole foods only.
  14. Eat a 100% vegan whole food plant based diet.
  15. Try to eat foods that will keep your body in an alkaline state.  Cancers grow best in acidic conditions.  Meat, dairy and sugar are highly acidic. 

Firm believer of mushrooms. Immunity--- eat mushroom daily with green tea-- mushrooms stop estrogen from Adrenal Gland  

Milk thistle after chemo.  Broccoli sprouts after chemo. Grow my own.

"DVDs forks over knives" watch.

Try to eat these six things everyday:

  • Greens - leafy green vegetables and cruciferous vegetables.  Below are some cruciferous vegetables: 
arugula, bok choy, broccoli, broccoli rabe, brussels sprouts, cabbage, cauliflower, collards, kale, mustard greens, radish, red cabbage, turnips, turnip greens, watercress, kohlrabi

Cruciferous vegetables contain glucosinolates and in a different area of the cell, an enzyme called myrosinase. When we blend, chop or chew these vegetables, we break up the plant cells, allowing myrosinase to come into contact with glucosinolates, initiating a chemical reaction that produces isothiocyanates (ITCs) – powerful anti-cancer compounds. ITCs have been shown to detoxify and remove carcinogens, kill cancer cells, and prevent tumors from growing.  Cruciferous vegetables are especially helpful for preventing hormonal cancers, such as breast cancer, because some compounds (abundant in broccoli, Brussels sprouts and cabbage), can even help the body excrete estrogen and other hormones.  In a recent Chinese study, women who regularly ate one serving per day of cruciferous vegetables had a 50% reduced risk of breast cancer.  Plus, breast cancer survivors who eat cruciferous vegetables regularly have lower risk of cancer recurrence – the more cruciferous vegetables they ate, the lower their risk.  Don’t forget: chopping, chewing, blending, or juicing cruciferous vegetables is necessary to produce the anti-cancer ITCs.

  • Beans - Eating beans, peas or lentils has been found to decrease colon cancer risk by 50%.  Legume intake also provides significant protection against oral, larynx, pharynx, stomach, and kidney cancers
  • Onions, along with leeks, garlic, chives, shallots, and scallions, make up the Allium family of vegetables, which have beneficial effects on the cardiovascular and immune systems, as well as anti-diabetic and anti-cancer effects. Allium vegetables are known for their characteristic organosulfur compounds, similar to the ITCs in cruciferous vegetables, organosulfur compounds are released when onions are chopped, crushed or chewed. These compounds prevent the development of cancers by detoxifying carcinogens, halting cancer cell growth, and blocking angiogenesis.
  • Eating mushrooms regularly is associated with decreased risk of breast, stomach, and colorectal cancers. In one recent Chinese study, women who ate at least 10 grams of fresh mushrooms each day (about one mushroom per day) had a 64% decreased risk of breast cancer. Even more dramatic protection was gained by women who ate 10 grams of mushrooms and drank green tea daily—an 89% decrease in risk for premenopausal women, and 82% for postmenopausal women, respectively.  White, cremini, Portobello, oyster, shiitake, maitake, and reishi mushrooms all have anti-cancer properties—some are anti-inflammatory, stimulate the immune system, prevent DNA damage, slow cancer cell growth, cause programmed cancer cell death, and inhibit angiogenesis. In addition to these properties, mushrooms are unique in that they contain aromatase inhibitors—compounds that can block the production of estrogen. These compounds are thought to be largely responsible for the preventive effects of mushrooms against breast cancer—in fact, there are aromatase-inhibiting drugs on the market that are used to treat breast cancer. Regular consumption of dietary aromatase inhibitors is an excellent strategy for prevention, and it turns out that even the most commonly eaten mushrooms (white, cremini, and Portobello) have a high anti-aromatase activity.  Keep in mind that mushrooms should only be eaten cooked: several raw culinary mushrooms contain a potentially carcinogenic substance called agaritine, and cooking mushrooms significantly reduces their agaritine content.
  • Berries - Blueberries, strawberries, and blackberries are true super foods. Berries are low in sugar and high in nutrients – they are among the best foods you can eat. Their vibrant colors mean that they are full of antioxidants, including flavonoids and antioxidant vitamins—berries are some of the highest antioxidant foods in existence. Berries have anti-cancer effects, such as , reducing inflammation, preventing DNA damage, inhibiting tumor angiogenesis, and stimulating of the body’s own antioxidant enzymes.
  • Nuts and Seeds

Wednesday, December 30, 2015

Oh what a day I had-- Wednesday December 30, 2015

Well I was sitting down to write all of you about what my first day at chemo was like when i realized that my day started out long before chemo therapy was hooked up-
so i am debating-   should I write the long version with details? or shorter version- going straight to chemo experience?
long version with details?   straight to chemo experience?
 
Eureka! -----("Eureka" (/jʊərˈrkə/) is an interjection used to celebrate a discovery or invention)
 
 Straight to chemo experience! for everyone who wants this they can read this and go to bed! I can add the other information later. I am getting tired myself. 

Arrived at the facility around 10:20 am- taken promptly for a blood draw- weight check in ( 262 lbs) - amazing right!?!  blood pressure check -117/82 - amazing right?!??!!?!

Met with the  doctor substituting for Dr. Gor- He is Dr. Guggenheim- He was very kind and soft spoken and started to give me the run down on what was going to happen- i interrupted him and said I am up to date and besides, I am a medical social worker working at the former UMDNJ SOM, now Rowan  SOM- - He then told he went to UMDNJ but not SOM which he added he would not hold it against me that I work at SOM - MD are still snobs over DO ! Likely he thought he was being cute and joking- (OK- so this statement might not be as snobby as I thought) ha ha - He added that she at the top of her field in all of South Jersey and reassured me that I was in good hands- He indicated that she is smarter than he is because she went to PENN-She has scholarly published research and he does not yet.----She did put a note in my chart that I have a trip planned and he expects that she will approve my earlier next chemo if all goes well with this one. He was pleasant and easy to talk- she was not- you tell me who is the better physician. I was interested if they had a Dietitian or Nutritionist  on staff for their cancer patients- he said no.

I explained that I am accustomed for the jury to be out as far as diseases of the brain and especially dementia are concerned but I thought we had come further when it comes to cancer-He  agreed-  treatment has come further and the science behind the cancer treatment is far  more advanced but as far as nutrition- we still do not know- it is being studied aggressively now as the public wants that and at one time he thought he knew the role nutrition that played but he is no longer sure.  WOW  what a fabulous doctor he truly is.
 
Then he told me about the toy I was going to go home with which I am currently wearing. It saves me from having to go back to the center for this injection. Then he tells me to go pick a chair that I like and my nurse will be over shortly.- which I do and then I go get Janet who has been in waiting area.  So far so good- Right?!? 

Neulasta is a single subcutaneous injection of 6 mg administered once per chemotherapy cycle in adults. Do not administer Neulasta between 14 days before and 24 hours after administration of cytotoxic chemotherapy.  
What is this drug used for? 
  • This medicine is used to stimulate the growth of "healthy" white blood cells in the bone marrow, once chemotherapy is given.  White blood cells help the body to fight infection. This is not a chemotherapy drug. 
  • This medication is usually given at least 24 hours after chemotherapy to stimulate the growth of new, healthy, white blood cells (WBC).
  • Pegfilgrastim is a longer acting form of filgrastim and the manufacturer recommends that it should not be given within 14 days prior to chemotherapy.
  • Pegfilgrastim is given as a single injection.
IndicationNeulasta® is indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia.


 
So my sister Janet is a little uncertain of where she should sit. Chairs for companions are not placed in very convenient places. She starts out in one and then needs to spread out because we Altermans travel with stuff- I have my purse (aka pocketbook) a bag of my stuff and a pillow- My first nurse was Chris- lovely young lady that had to read to me each and every possible side effect before she started my IV. Which went in the hand so I could bend my elbow. Unfortunately it was in my right hand ( which it had to be because my dirty lymph node was in my left arm pit so they can not use that side!) So I signed consent form and off we went- Janet agreed with my assessment of the aesthetics of the place and she proceeded to tell each nurse that was involved with me. Neither of them really wanted to hear her opinion but one was a little more receptive as I was curious who designed the place.  Virtua built it as offices PERIOD. Center For Cancer and Hematologic Disease became Regional Cancer Care Associates LLC (RCCA), they are only renting the space..(one of the largest oncology physician networks in the United States, is transforming oncology care by ensuring that cancer patients have access to the highest- quality, most-comprehensive, cutting edge treatments in a compassionate and community-based setting. Patients can now receive this high-quality cancer care in convenient locations close to home, in New Jersey, Maryland and Washington D.C. through our network of expert physicians.) AND they are renting the space but  landlord and renters are not working together to improve the atmosphere- Renters are just making due with what they got there which is pretty awful.
When 2nd nurse came over- "This place is ugly" was Janet's greeting- oh well- so much for not talking. She went on to explain that she has an ulterior motive- then proceeded to go into her explanation of her son's business- she is, after-all,  a very proud Mama- but no one was really interested.  
Janet came prepared and brought with her some of the fabulous home made vegetable soup.  I had 2 bowls of it as my lunch- packed in a thermos -it stayed warm enough to really enjoy. There was a big story there too- She got it at the Melitta Company for a just a little more than dollar cuz it had a dent- she doesn't' think they have sales there anymore yada yada yada. Yes I am sending this out because it happened like this and I love Janet very much and she has a strong desire to express her thoughts-  in many ways-- at various times ---in public ----to whoever is interested in listening---- You know- she knows many things - she even beat the pants off of me, Charlie and Cassie in Trivial pursuit. 
Our first nurse was knowledgeable about good nutrition just a little and she was able to sneak out some information to Janet and about Bone Marrow soups, raw honey- etc... - She was very clear that she could get into trouble is they knew she gave that to us- "The information IS NOT endorsed by my employer. " ( Been there - Done that)  Janet sat and took lots of her own notes from the cook book that Harold gave me for fighting cancer, while I talked on the phone.
All you Star War Fans- you have heard of the Force- Well I then spent about an hour plus with the Source -I made  some notes which Shari is cleaning up for me- it was hard to take notes because the IV was in my right hand. So writing was a challenge.  She sent me 4 videos / websites for me to review as soon as i can(very excited) BUT I LEARNED SO MUCH FROM HER! Excellent Teacher for sure. What was also lovely is that she and I have never met face to face and we feel close to one another because of her Mom Carol always filling us in on one another over the years. (lots of  years)  So, 2 bags of  killer kemo later, they were ready to cut me loose and after kisses good-bye to Janet, by 2:20 pm, I was out the door, heading to work at NJISA ( New Jersey Institute for Successful Aging )
So far I feel fine- a little bad taste in my mouth and I have had bad taste in my mouth before so I know it is nothing to be concerned about- ( I once walked into a client's house and saw a bowl of tan curved things sitting in a bowl on the kitchen counter ( his name was Hal and i sometimes drove him back and forth to the day center) - they sure looked like cashews to me. So I reach in a took a handful as Hal was adjusting himself  at the kitchen table. He saw on my face that "I had a bad taste in my mouth" and started to laugh but not before he told me that I was eating their Dog's food. And no, I did not swallow- I spit it out in the kitchen sink!
Dr. Douglas E. Guggenheim, MD

MEDICAL SCHOOL

Rutgers Med Sch-Umdnj
Graduated in 2007

INTERNSHIP HOSPITAL

Thomas Jeff U Hosp

RESIDENCY HOSPITAL

Thomas Jeff U Hosp

FELLOWSHIP HOSPITAL

Weill Cornell Med Cntr

OTHER EDUCATION

Drew U

Dr. Priya Gor  


MEDICAL SCHOOL

University Of Medicine and Dentistry Of New Jersey

INTERNSHIP HOSPITAL

University Of Pennsylvania School Of Medicine Philadephia Pa

RESIDENCY HOSPITAL

University Of Pennsylvania School Of Medicine Philadephia Pa

FELLOWSHIP HOSPITAL

University Of Pennsylvania School Of Medicine Philadephia Pa


Carbohydrates: Another Dietary Link for Breast Cancer?  Gor PP1Su HIGray RJGimotty PAHorn MAplenc RVaughan WPTallman MSRebbeck TRDeMichele A.

The newest research suggests yet another dietary link to breast cancer. Eating a diet rich in carbohydrates may increase a woman's risk for developing breast cancer, according to a recent study. 
Researchers with the National Cancer Institute analyzed the eating habits of more than 60,000 women and followed their health for an average of 17 years. In particular, they looked at the glycemic load of each woman’s diet. To calculate glycemic load, they multiplied the amount of carbohydrates per serving of each food a woman ate by its glycemic index (GI), which is a measure of a food’s ability to raise blood sugar levels. They multiplied that result by the number of servings the woman ate.The scientists found that women whose diet had a high glycemic load had a significantly higher risk for breast cancer than those with a low glycemic load. In fact, women whose diets had the highest glycemic load had an 81 percent higher risk for one type of breast cancer than those with the lowest glycemic loads.
The researchers believe high-glycemic load diets may boost breast cancer risk by increasing concentrations of insulin and hormones in the body. This, in turn, may contribute to the development and spread of breast cancer cells.
The Takeaway: Quantity vs. Quality of Carbs
If you’ve been paying attention to the glycemic index of the foods you eat, it may be important to note that GI simply measures the overall quality of carbohydrates in a given food, according to Priya Gor, MD, MSCE, a hematologist and medical oncologist on staff at Our Lady of Lourdes Medical Center.

"By looking at glycemic load as well as GI, this research suggests that the combination of quality and quantity of carbohydrates in a woman’s diet may affect her breast cancer risk," said Dr. Gor.Learn More
Diet is just one factor that may affect your risk for breast cancer. To find out more about breast cancer, including risk factors, prevention and screening, visitwww.cancer.gov/cancertopics/types/breast.


Cyclophosphamide-metabolizing enzyme polymorphisms and survival outcomes after adjuvant chemotherapy for node-positive breast cancer: a retrospective cohort study.

Abstract

INTRODUCTION:

Cyclophosphamide-based adjuvant chemotherapy is a mainstay of treatment for women with node-positive breast cancer, but is not universally effective in preventing recurrence. Pharmacogenetic variability in drug metabolism is one possible mechanism of treatment failure. We hypothesize that functional single nucleotide polymorphisms (SNPs) in drug metabolizing enzymes (DMEs) that activate (CYPs) or metabolize (GSTs) cyclophosphamide account for some of the observed variability in disease outcomes.

METHODS:

We performed a retrospective cohort study of 350 women enrolled in a multicenter, randomized, adjuvant breast cancer chemotherapy trial (ECOG-2190/INT-0121). Subjects in this trial received standard-dose cyclophosphamide, doxorubicin and fluorouracil (CAF), followed by either observation or high-dose cyclophosphamide and thiotepa with stem cell rescue. We used bone marrow stem cell-derived genomic DNA from archival specimens to genotype CYP2B6, CYP2C9, CYP2D6, CYP3A4, CYP3A5, GSTM1, GSTT1, and GSTP1. Cox regression models were computed to determine associations between genotypes (individually or in combination) and disease-free survival (DFS) or overall survival (OS), adjusting for confounding clinical variables.

RESULTS:

In the full multivariable analysis, women with at least one CYP3A4 *1B variant allele had significantly worse DFS than those who were wild-type *1A/*1A (multivariate hazard ratio 2.79; 95% CI 1.52, 5.14). CYP2D6 genotype did not impact this association among patients with estrogen receptor (ER) -positive tumors scheduled to receive tamoxifen.

CONCLUSIONS:

These data support the hypothesis that genetic variability in cyclophosphamide metabolism independently impacts outcome from adjuvant chemotherapy for breast cancer.


Nancy M. Alterman

Tuesday, December 29, 2015

Twas the night before Chemotherapy

Twas the night before Chemotherapy, when all through the house
Not a creature was stirring, not even the cats, Philly Boy and Foxy Lady.

My bags were all packed, with water and snacks
Books to read, Ipads to play, journals to write.
And Madison in her sweats and I in my sports bra
Had finally settled in, from a long day at work .

The pantry had been purged, the refrigerator all cleaned
Tomorrow she'll vacuum, the rugs caused I asked
If only she could make, the mail disappear
My life would be easier, with no bills to fear

The cans were outside, for the men to come get,
My little one had collected, from all through the house.
The list laid on the table, with food for her to shop
Lean proteins for mama and vegetables for both

Big sister has been busy, in her kitchen next door
A big pot of red soup, with all the vegetables I adore
She is prepared to sit by my side, all quiet and peaceful
Not talking of stories, of what this may mean 

They said I should sleep, to get my rest
Those silly loved ones, don't know I'm at my best 
When writing, searching, and planning my life
My energy is swirling, it knows no strife

Visions of wide beaches, crystal waters, white sands
8 tiny islands, float in our heads
Final payment is made, the cabin all cozy
Our fun ship is ready and our dreams are all bright
 
My treatment is just another turn, along a long twisting road
With scenery not pretty, but no less valuable for me
Making promises to ask, when I need their help
As I reminded I am loved and worthy of all that care

When suddenly I realized, that my body was to change
I would be bald, skin all marked, from here to there 
With clean lymph nodes abound and estrogen down low
All uninvited guests, would be leaving, out through the flow

I heard Breast Cancer exclaim, as they drove out of sight

"Good bye my dear Nancy and to all a good night"


Nancy M. Alterman
Tuesday December 29, 2015

Saturday, December 19, 2015

Meeting the oncologist for the first time

Dear Friends and  Family

I am awake with stomach cramps so I figured I would write another update. I want all of you to know that I love writing these updates. My nephew Ben suggested I start a blog but I really do not have the desire to jump through those hoops to create it in that format right now----maybe I will change my mind later.

For starters- If you prefer NOT to receive these updates, just let me know and I will remove you from the list.
I am doing writing and sending these emails for several reasons-
 #1- I love to write

#2 - I receive a great deal of comfort by expressing myself - writing all of this helps me be visible and express my experience which for some reason is very satisfying. I cope through self expression when I am in a deep emotional experience. And trust me- this is going to be deep. 

#3- Easiest way I know to keep those that care, informed. No one has to call anyone on my behalf. I can do this one myself.

#4- Reduces margin of error with mis-information about me and my experience.

So here it goes-  

PHOTO Below is not VIRTUA but it looks as bad as this.


Oh what at a night! Had a 6 pm appointment at Cancer chemo center at Virtua. What an adventure in a odd world- This hospital (Virtua Voorhees) was very recently built and the decor for cancer patents was totally gross- I once painted my bathroom the green color of Comet cleanser and as soon as it hit the wall, I knew it was a mistake- the whole place is painted and decorated in this foamy type green like Comet cleanser. The chairs for receiving chemo in are so very hospital like - it in itself could make a girl nausea. Very unappealing- There are no curtains, partitions, or wooden cabinets to make the place feel good.  A BIG YUCK.

There are 2 cancer treatment centers at Viruta- The one that I am going to has longer hours than the other which is part of Fox Chase - after doing some research, I learned that in some places they are open 24/7.  I will be spending 4 hours there for 4 visits, 3 weeks apart. They are trying to squeeze me in before the end of the  year. and I mean "squeeze" because they are closed on both up coming holidays so those patients have already been pushed into Wednesday and Thursdays time slots if they are usually Friday's patients.

So I will receive a phone call Monday Morning to tell me where they can fit me in. I am pushing for Thursday 12-31-2015 so I do not have to cancel too many people which is what will happen if it Tuesday or Wednesday of that week.  It is a popular time in the MAP program as family come to town to visit and might want to chat with me. 

NOW as far as the doctor goes, I was taken back. She is was all wound up- Came into the  room, shook my hand and  off we went-    She said her "Speech" like she was at an auction- "so your breasts are made to supply milk and there are 2 common types of breast cancer we see most often and yours is this kind and what we do here is this and that. And the risk factors/side effects are thus and such- and a third will do this and out of that third another will  be that..... but :.......  My sister Janet had a question for me to ask so I waited until she took a breath and jumped in.   I said "There are medications that are advertised to be used to help with fatigue from anemia- are you familiar with those? "Oh you mean like PROCRIT - We don't do that here!" Well okay then- and on she went- She got very frustrated as the computer would not let her submit information to complete the algorithmto put in the start date to pin-point the end date of treatment. 

Her examination of my upper torso and healing sites was like bad sex at a Fraternity party. I barely knew what she was doing and then it was over. Very unsatisfying, 

AND I could not complain as I was in a down dog negotiating position. Let me elaborate.  THEY like people to wait 4 weeks after surgery before starting chemo. That would put me on January 8.  NOT GOOD!! It would mean that my last treatment would be 4 days before leaving on my cruise. So I went into my social worker mode of begging and flexibility. And with the shortened work week for the next 2 weeks- it was not an easy sell.  LIKE maybe I could change my plans - not an easy sell ! ( WILL investigate about travel insurance now though) She wont be there for the first chemo anyway but they are going to call me and see what they can do as the lady in charge of making those appointments was not there. Below is information about the type of chemo I will receive-  

"TC is a regimen or treatment plan that includes a combination of chemotherapy drugs that your doctor prescribed for the treatment of your cancer. TC contains: T: Taxotere® (Docetaxel) C: Cytoxan® (Cyclophosphamide) How is this regimen given? • Docetaxel and Cyclophosphamide are given into a vein (IV) on day 1 of your chemotherapy cycle. • This chemotherapy cycle is usually given every 21 days. • Docetaxel will be given IV over 1 hour. • Cyclophosphamide will be given IV over 30-60 minutes. • Your time in infusion will be longer than the drug administration times depending on other medications/fluids given."

The first time I will be there,  I will be seen by one of her associates and then on Jan 8. I will see her for a  "Toxicity check" which is one week after my first treatment. I had to sign a consent form so they can order my bag of shit to give me. I got a slip to get blood work also. I will get medication to reduce my side effects........ OH MY GOD!!! So she wanted to give  me a script for a wig. I politely said. "Oh, I am not going to do the wig thing- it will be hot and itch- I am gonna do hats and scarfs". To which she replied- "Take it " she said. "You head will get cold and you will want a wig" I replied- "Nah- I really don't think so"  to which she said. "Oh yeah- you will want a wig so just take this anyway--- "  so I did.

I was not sure if she was being a jerk because of me  or because she is just a insensitive person. I had to review my history with her so I did tell her about my depression and subsequent suicide attempt and yes I am staying on an antidepressant but I am well now. Or maybe because Madison's father died young and yes it was an accidental drug overdose etc....  She did ask about my mother and said "I am sorry" and I said thank you. God only knows if she believed that my mother's breast cancer likely did NOT start there. She said Lung cancer does not move to the breast- I explained that they thought it had actually started in a lower organ as part of the GI track as she had lower back pain for a while before discovering the cancer - Her "I am sorry" felt cold and routine  ---  I realize why we at NJISA in the MAP Program are so good at our jobs- we are genuine and authentic with our patients even if we are saying something that we have said 100 million times before. I see myself as a patient educator and not a  machine that just has to get through this so I can do something more important. 

There is more but I will write more later- I got to go get coffee at Janet's. It is Saturday. 

Nancy M. Alterman

my chemo contains these 2 kinds-

Brand name: Cytoxan
Chemical name: Cyclophosphamide
Class: Alkylating agent chemotherapy. Thiotepa is another alkylating agent.
How it works: Alkylating agents weaken or destroy breast cancer cells by damaging the cells’ genetic material.
Uses: Cytoxan usually is given in combination with other chemotherapy medicines. It's typically used:
  • after surgery and other treatments to reduce the risk of early-stage breast cancer coming back
  • before surgery to shrink large advanced-stage breast cancer tumors
  • after surgery and other treatments to treat advanced-stage breast cancer
How it's given: Cytoxan can be taken orally as a pill or given intravenously.
Side effects:
Brand name: Taxotere
Chemical name: Docetaxel
Class: Taxane chemotherapy. Abraxane and Taxol are other taxanes.
How it works: Taxanes interfere with the ability of cancer cells to divide.
Uses: Taxotere usually is given in combination with other chemotherapy medicines and is used after surgery to treat:
  • advanced-stage breast cancer that isn't responding to doxorubicin
  • advanced-stage breast cancer that has spread to other areas of the breast or other parts of the body after treatment with standard chemotherapy medicines
  • early-stage breast cancer that has spread to the lymph nodes after surgery
How it's given: Taxotere is given intravenously.
Additional information: Taxotere uses solvents to dissolve paclitaxel, the main ingredient, so the medicine can enter the bloodstream. These solvents may make Taxotere difficult to tolerate while being given. People usually take pre-medications to minimize reactions to the solvents. In 2011, the U.S. Food and Drug Administration approved a generic version of Taxotere.
Side effects:

Wednesday, December 16, 2015

12-16-15 Breast care for Nancy. meeting with surgeon - one week after surgery to remove lumps

Hi Guys and Gals-

Sorry for the delay in writing but there was lot to do after I left the doctor's office and it was a long wait once we arrived. Our doctor is very conscientious and does not rush through any of the needed explanations and you can imagine that I had asked quite a few very good questions as the good doctor pointed out.  It turns out that I will be needing chemotherapy after-all.  Once the chemotherapy is done- I will take a break and go on my 60th birthday celebration on a 14 day Caribbean Cruise, When I return- I will then start radiation therapy.

(For my work buddies- I told her I understood why I needed both kinds of follow treatments- one works like a seat belt and the other works like an air bag- very differently but BOTH there to save me) She loved it!

The surgeon extracted 3 lymph nodes and the first one- also know as the gate keeper was dirty (positive for cancer) and the 2 right behind it- were clean (negative) and I had other lymph nodes floating in my breast tissue that were also dirty with cancer.  

So in other words--- I am a N1- my Lymph Node is Positive because only the first one  was Positive and the other 2 were Negative.  Sometimes referred to a 1/3 (took out 3, one is positive ) Below is an article for those of you interested in the staging  etc..... Also, because I did have some cancer filled floating lymph nodes in the actual breast tissue, perfectly clean margins were not likely achieved at tumor site.

I will be receiving 4 doses of Adjuvant therapy. It is given to kill cancer cells that remain after surgery.  

I already did lots of the things they recommend before starting chemo- my teeth are being cleaned on Friday,  already had my annual Pap test last month-stopped all my vitamins- will see my hair dresser who was treated for breast cancer 4 years ago and she will coach me on my hair loss and options- Do not think I am into having a wig- likely will scarf it . 

My lovely daughter Madison  is still living at home and will step up to help me manage but I also know that many of you have offered to help in any way. My sister Janet is right behind me- my friend Harold is near by and so is my niece Beth- 

So that is it for now folks- I am looking at this an as inconvenience in my life because I have dealt with far worse situations over the years. I am not in harms way and alone. In fact, I am in great hands and have all of you to love and care for me. Yes, Inconvenient but not tragic. 

good night and sweet dreams to all of you- I love you dearly.

with all that I am, 

Nancy

"Ask for help around the house. The most common side effect of chemotherapy is fatigue/feeling tired. Ask someone close to you to help organize the chores you normally do, such as cleaning, grocery shopping, cooking, and carpooling. It can be hard to ask for and accept help from others, but in most cases your loved ones will be happy to do something that helps you in your fight against breast cancer."

Talk to your doctor about maintaining your routine while on chemotherapy. How much of your regular routine you can keep up while on chemotherapy will be different for every person and depend on your unique situation. Some people continue to work while others need to take time off. Your doctor and oncology nurse can help you figure out how you're going to feel and how much you may or may not be able to do based on your regimen and health history. It can help to mark all your treatment days and any follow-up appointments or lab tests on a calendar. For example, if you're having treatment every 3 weeks:
  • The first week after treatment, you may not have much of an appetite. If possible, try to avoid business lunches or big dinners.
  • At some point in the first 2 weeks after chemotherapy, you may feel tired and you may be more susceptible to infections. Try to avoid large groups of people (including business meetings), hotels, airplanes, and other crowded places. Be extra careful about washing your hands and watching for any signs of infection or fever.
  • The third week after chemotherapy you'll likely feel pretty good. This is the best time to plan business meetings or travel.
Once you go through the first treatment cycle, you'll have a better idea of how to plan.

Lymph Node Rating
Lymph Node RatingMeaning of Rating
N0Negative or clear - contains no cancer and no micrometastasis
N1, 2, 3: Positive (involved) lymph nodes
N1Cancer is found in 1-3 lymph nodes under the arm or lymph nodes within the breast
N2Cancer is found in 4-9 lymph nodes under the arm or lymph nodes within the breast
N3Cancer is found in 10 or more lymph nodes under the arm, or has spread under or over the collarbone. It may have been found in the underarm nodes as well as lymph nodes within the breast

Dr. Diane R. Gillum,

Specializes in Breast Surgery • Female • Age 62

The importance of the axillary lymph nodes: A discussion on diagnosis and staging workup from UpToDate
"One of the first sites of breast cancer spread is to the lymph nodes located in the armpit (axilla). These nodes (referred to as axillary lymph nodes) can become enlarged and can sometimes be felt during a breast examination. However, even if the lymph nodes are enlarged, the only way to determine if they truly contain cancer is to examine a sample of the tissue under the microscope.
The presence or absence of lymph node involvement is one of the most important factors in determining the long-term outcome of the cancer (prognosis), and it often guides decisions about treatment."

Why Are Lymph Nodes Important?
Breast cancer starts out with just a few cells, which group together in your breast tissue. They may be camping out in the system where breast milk is produced: your ducts and lobes. As these cells grow and divide, they may also invade nearby tissue. A growing tumor may shed a cell, or a clump of cells.
This independent cancer cell can use your blood or lymph system like a network of highways so it can travel throughout your body. Your lymph system works with your circulating blood to provide nutrients to all your cells, as well as remove cellular waste products. The lymph nodes are the "pit stops" on this highway system, where lymphatic fluid is filtered, mixed with immune cells (lymphocytes), and passed back into your circulating lymph fluid. So, if a loose cancer cell makes it to your lymph nodes, it's also possible that the cancer could get sent along to other parts of your body. If you get an infection, your lymph nodes near the affected area may swell because they have collected germs. And if you develop breast cancer, the lymph nodes in your armpit (axillary lymph nodes) is the most common place that cancer cells would lodge, causing those nodes to swell.

Why Do I Need a Lymph Node Biopsy?
Breast tissue itself contains some lymph nodes, which process lymphatic fluid and pass it along. Breast tumors tend to drain towards your axilla, or underarm area. Checking the underarm lymph node location should be part of a clinical breast exam, as well as your breast self-exam. Swollen lymph nodes might be evidence that cancer has spread beyond your breast, but the only way to know for sure is to have them removed and tested. There are two procedures for lymph node biopsy: sentinel node biopsy and axillary lymph node dissection (removal of all the nodes). The pathology report about these lymph nodes gives you your lymph node status.

How Does My Lymph Node Status Affect My Treatment Options?
Your lymph nodes may be clear of cancer, and if so, your lymph node status is negative, and rated N0. If you have a small tumor and clear nodes, it is less likely that you will need to have chemotherapy. That is not a guarantee, however, because your doctor will also consider your tumor grade, tumor size, hormone receptor status and how effective surgery can be for you. If your lymph nodes do contain cancer, they are consideredpositive, or involved, and are rated N1, N2, or N3 depending on the number affected and the location. Having involved lymph nodes suggests that the cancer has demonstrated an ability to spread beyond your breast, and you will be advised to have adjuvant systemic therapy, such as chemotherapy, after surgery to kill any additional cancer cells that persist in your body.

What Does All This Mean For My Prognosis?
Prognosis, also called outlook, is one way a doctor talks about how the odds for survival stack up for you, after you've completed treatment. Remember, having just one cancer cell in your body is one too many. Treatment is designed to kill off as many, if not all, of your cancer cells as possible. If you had clear lymph nodes and a small, low-grade tumor, your prognosis after treatment is pretty good. On the other end of the spectrum, if you had 10 or more involved lymph nodes and a larger tumor, your treatment will likely be more aggressive, and your outlook will be harder to determine, until after you've finished all treatments. No matter where your diagnosis fits on that scale, please know that survival rates are improving, treatments are becoming more efficient and effective, and even metastatic breast cancer can be managed like a chronic disease.
Want to learn more? See UpToDate's topic, "Patient information: Breast cancer guide to diagnosis and treatment: The importance of the axillary lymph nodes," for additional in-depth, current and unbiased medical information on breast cancer, including expert physician recommendations.

Lymph Node Rating
Lymph Node RatingMeaning of Rating
N0Negative or clear - contains no cancer and no micrometastasis
N1, 2, 3: Positive (involved) lymph nodes
N1Cancer is found in 1-3 lymph nodes under the arm or lymph nodes within the breast
N2Cancer is found in 4-9 lymph nodes under the arm or lymph nodes within the breast
N3Cancer is found in 10 or more lymph nodes under the arm, or has spread under or over the collarbone. It may have been found in the underarm nodes as well as lymph nodes within the breast


Definition: Chemotherapy


Chemotherapy is the use of medications to kill cancer cells or make them less active.

Chemotherapy medications work by killing rapidly dividing cells. Since cancer cells divide more rapidly than most cells, they are particularly susceptible to treatment. Other cells that divide rapidly, such as hair follicles and the bone marrow cells that make blood cells, can also be affected; they account for many of the side effects of chemotherapy.

Chemotherapy is considered a "systemic" treatment, meaning that it works to kill cancer cells anywhere in the body. This differs from "local" treatments, such as surgery and          
radiation, which treat cancer in a particular area.

Adjuvant therapy is a treatment given along with or after surgery for cancer to reduce the chances that it will come back.
Adjuvant therapy is given to kill cancer cells that remain after surgery but cannot be detected by means such as scanning. 

  • As an adjuvant therapy, used along with a treatment such as surgery to treat any spread of the cancer (micrometastases) that are too small to be detected on screening tests such as CT and MRI