Anne has had a bit of a rocky road recovering from her first chemo but her thrush has abated and her diarrhea has slowed considerably. In addition to immodium she has started on probiotics which seem to be helping. More than anything she finally feels “normal” though her stamina is still limited. We actually went to a movie today. This was her first time out of the house in over a week. Hopefully she will build up a little strength by the time of her next treatment which is this Friday. According to her doctor’s nurse some people say that the first treatment is the worst and at least we know what to expect and can try and get ahead of the side effects. On the other hand, most of the drugs she is getting have a very long half life and will accumulate in her body over the entire time she is getting chemo.

Only time will tell.

Here’s how we got here. Many of you know that Anne had a squamous cell of her mouth which was resected including a partial jaw resection in 2015. Three months later a node popped up, this being in spite of a negative PET scan prior to her first surgery. She then got a neck dissection and radiation to the affected area. In April 2018 she had a spontaneous jaw fracture due to weakening from the surgery and radiation but no sign of cancer. The fracture required six weeks of having her jaw wired. She did well from this.

The same week that her jaw fracture was diagnosed she had a diagnostic mammogram due to an irregular fullness in her breast and was told that it was just more fibrocystic disease and nothing to worry about. Over time the fullness became more discrete. She went to see Dr. Liz Pritchard who got a biopsy that day and pathology showed pleomorphic lobular cancer. There is no sign that she has involvement of her lymph nodes but until she has surgery we won’t know for sure. It was positive for estrogen and progesterone which is good but also positive for HER2. HER2 is a growth hormone receptor that can make the tumor more aggressive which is bad news. The good news is that there is therapy for it which is directed at these receptors. That means that prior to surgery she will require what is referred to an neoadjuvant chemotherapy. She will get this treatment once every three weeks for 6 treatments and then have surgery. It is not decided whether this will be a lumpectomy or mastectomy.

Anne had her first chemotherapy on Monday, 12/31. She received 4 drugs. We were at West cancer clinic for 9.5 hours. This was due to a combination of their general inefficiency, giving loading doses of some of the agents and giving the drugs slower during the first treatment. Because some of her drugs are cardiac toxins she was supposed to get an echocardiogram prior to any treatment. This almost did not happen as it got scheduled for January 4. Fortunately, we were able to get her in on 12/28 and she had a normal echo.

On Monday, 12/31 she got treatment with 4 drugs. Perjeta and Herceptin are two agents called monoclonal antibodies that target the HER2 receptors. She also got two conventional chemotherapeutic agents; Taxotere and carboplatin. She tolerated the treatments fine for a couple of days and even let her friend Mary Fry take her wig shopping. However after a few days the side effects began setting in. Muscle aches and pains, diarrhea and sore mouth and throat. Because the mucosa in her mouth was already abnormal due to her previous radiation therapy this has really caused some suffering. It has mushroomed into a fungal infection called thrush. Fortunately we have gotten treatment for these side effects and she appears to finally be on the mend. Though food tastes different She can now eat and drink enough to stay hydrated and nourished. She does tire very easily. Ms. Anne is the strongest person I know. Thanks to everyone for your prayers and words of encouragement. I will keep you posted. The next chemo if Friday, January 18. JMW

Good company in a journey makes the way seem shorter. — Izaak Walton