Saturday, August 21, 2010

On to the next phase

I'm thinking that the Herceptin is to blame for the weird dreams I've been having after each visit to the poison palace. I had been blaming it on the chemo, but since I've now had another one, without the chemo, well . . . Thankfully, it seems to be just one nasty dream per session!

I've been a little slow to update my progress, because, for whatever reason, I spent most of the week in bed. When I wasn't going to the therapist, at least.

So - the next phase in this battle has begun. As my faithful readers may recall, part of my breast cancer diagnosis was that I am HER2+. HER2+ equals epidermal human growth factor 2 overexpressing, which is a more aggressive form of cancer (not just breast cancer). This form is also usually less receptive to hormone therapy. So there is a dual approach therapy from now on.

Herceptin (Trastuzumab) specifically targets HER2 and kills the cancer cells and reduces the risk of recurrence. (Gawd damn it's hard to type with this bloody lymphedema therapy club tripling the size of my hand and arm!!!) I received the Herceptin in conjunction with my chemotherapy, and now will continue for 11 more sessions of just the Herceptin IV (and that's not Roman numeral IV, that's needle in the port in my chest with a bag of fluid entering my vein IV). 10 more now, because I had the first on Tuesday.

It can also be used in combination with an aromatase inhibitor as a hormone blocking medication. I'm getting this too. More on that later.

My reaction to this, of course, was "oh goody, I'm going to become a man." But no, I'm told, that isn't the case because not only is the estrogen blocked and/or destroyed, so is the testosterone. Oh great. So I won't grow chest hair or a fuller mustache. I'll just lose moisture where I want it most, and have thinner hair and bones and nails and skin. No big deal.

Oh, and there is the minor potential side effect of congestive heart failure. Nice.

Back to HER2 cells. These are normal cells, part of normal breast cells, helping to make healthy cells grow. It's found in the DNA of a cell, and the HER2 gene contains the information for making the HER2 protein.

The HER2 protein, also called the HER2 receptor, is found on the surface of some normal cells in the body. In normal cells, HER2 proteins help send growth signals from outside the cell to the inside of the cell, telling the cell to it's time to grow and divide.

In HER2+ breast cancer, the cancer cells have an abnormally high number of HER2 genes per cell. When this happens, too much HER2 protein appears on the surface of these cancer cells. This is called HER2 protein overexpression. Too much HER2 protein is thought to cause cancer cells to grow and divide more quickly. This is why HER2+ breast cancer is considered aggressive.

Important to know, the cancer tumor's HER2 status is not hereditary!

As I mentioned, Herceptin can lead to heart problems - reduced heart function or congestive heart failure. Lung problems are possible, swelling or inflammation of the lungs, severe shortness of breath or very low blood pressure. Worsening of white or red blood counts - please, no more Neulasta shots, but I'll keep munching on celery stalks full of liverwurst!!

Other side effects include fever, nausea, fatigue (as in sleeping 15 or 16 hours a day??), diarrhea (as if I haven't had enough of that already!), swelling of ankles or legs, cough, headaches and muscle pain.

Somewhere in all my earlier research, I found a site that said that Herceptin is not considered 'chemo'therapy, because it is biological rather than chemical. So presumably it's side effects aren't as deadly as those from chemo itself. Hard to tell when you read the list though, isn't it!

Good thing the promises of good outweigh the potential bad!! Unfortunately, some patients do not respond to Herceptin and other develop resistance to it. And apparently, we don't know if it works or not until the cancer comes back. Periodic tests are given, and my heart will be tested regularly too. But it does have an overall good track record.

OK, so Tuesday I had my first dose of just the Herceptin. Took just about a half hour, which is great. Had my regular blood test first and it's still great, although I'm a little anemic again, so it's back to my favorite foods. Then I proceeded to sleep, and sleep some more, for about three days. Couldn't keep my eyes open. Is that the 'fatigue' they warned about?

Plus I received my first prescription for Femara (letrozole) - a daily pill, very tiny, aromatase inhibitor. A
n aromatase inhibitor is the best hormonal therapy to start with. When treating early-stage, hormone-receptor-positive breast cancer, aromatase inhibitors have more benefits and fewer serious side effects than tamoxifen, a name most of us are more familiar with. So I started that on Thursday.

Femara is for post-menopausal women only, whose cancer is hormone receptor positive, in the early stages. It lowers estrogen levels, which 'may' slow the growth of breast cancers that need estrogen to grow - like mine, estrogen positive.

Another lovely list of possible side effects - a decrease in bone density, resulting in bone fractures and osteoporosis; increase in cholesterol; fatigue, dizziness, drowsiness; decrease in white blood cell count, allergic reactions, joint pain,
vaginal irritation, pain in the extremities. blood clots, other cancers, stroke, heart attack and endometrial cancer. It may cause injury to unborn babies - at least I'm safe on that count! Just another scary list to look out for.

Apparently the major complaint against Femara is the joint pain and stiffness, which can be quite severe. A friend from here at the RV park suffered mightily from her Femara treatment. We found that there are two alternatives,
Arimidex (anastrozole) and Aromasin (exemestane) that offer a viable alternative to the pain Femara causes some patients, thankfully. Switching helped Diane!

All that said, I guess I'm doing fine, so far. Except that I'm currently depressed as hell.

I swore I wouldn't give in to this beast - but I have to admit that I'm finally feeling the trauma . . . the loss of femininity and strength (I walk with a cane in my left hand because I gimp around as a result of that long ago car accident, have this grotesque club from my fingertips to my shoulder on my right arm, no hair (actually there is some but it's thin and sparse and looks like it's gonna be sort of grey - I'm a blonde and proud of it - where are my golden locks?), no boob on one side and this baggy, saggy thing on the other, a gruesome scar that shows under my arm because I can only wear tank tops with the club attached to me all day, no color in my face because it's too damned hot to go outside, 12 eyelashes, total, count 'em, on both eyes. whimper, sob, oh woe is me. If I didn't have my incredible circle of friends, and a sweet Silver Fox threatening to return to Arizona some day soon, I'd probably jump off a cliff, if I could find one.

OK, I'm done complaining, for today at least. Have a great sunny laugh-filled weekend! Hug someone for me!

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