Metastatic Breast Cancer: Liver Cancer

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

This is not a cancer you hear about frequently, though it is third worldwide after lung and stomach in the number of deaths each year. It is uncommon in the United States with three fourths of all cases diagnosed in Southeast Asia, Mozambique and South Africa.

It is one of the least common of the metastatic breast cancers with bone cancer being 70% of the metastases and brain cancer being 10%. The remaining 20% are distributed between liver, lung and non-specific systemic diseases.

Metastatic breast cancer-caused liver cancer can show up as a significant weight loss, jaundice (getting yellow skin – this condition is sometimes seen in newborns (our son was jaundiced at birth)), and elevated liver enzymes (Inflamed or injured liver cells leak higher than normal amounts of Alanine transaminase (ALT) [This enzyme causes certain reactions to happen in the body that provide for cell energy and brain signal transmission] and Aspartate transaminase (AST) [which helps in the formation of the amino acids used to make several different body proteins such as hemoglobin], into the bloodstream). Other symptoms of MBC are abdominal pain, loss of appetite, fevers, nausea, sweats and vomiting. In some cases, there are no symptoms.

Tests that may be done to diagnose liver metastases include a CT (Computer Assisted Tomography) scan of the abdomen, liver function tests (to check for the elevated enzymes mentioned above), MRI (Magnetic Resonance Imaging) of the abdomen, PET (Positron Emission Tomography) scans or ultrasound of the liver

Pain from this kind of liver cancer responds to chemotherapy and analgesia. Doctors can also try radiation therapy to relieve pain and shrink the cancers.

How well you do depends on the location of the original cancer and how much it has spread to the liver. As recently as January of 2011, doctors have added a new treatment to the arsenal: Resection (removing parts of the liver affected by the cancer) of breast cancer liver metastases paid off in a survival benefit in patients with chemotherapy-responsive, estrogen receptor (ER)-positive primary tumors, according to data from a retrospective chart review.

“Although the cases were small in number, they are relevant in the context of changing views about cancer that metastasizes to the liver…I think there has been a [dramatic change in thinking] over the past 10 years or so, where it has been realized that this surgery can lead to long-term survival…I don't think that was recognized previously…I think there has been something of a nihilistic attitude toward breast cancer metastasis to other organs in the past…Generally incurable, most liver metastases from breast cancer are treated with chemotherapy or hormonal therapy,” said Daniel E. Abbott, MD, of the University of Texas MD Anderson Cancer Center in Houston. “I think this information is most valuable when people are willing to counsel patients and make the tougher decisions about who should and should not have surgery and then let patients make informed decisions.”

References: http://www.breastcancer.org/treatment/surgery/new_research/20110123.jsp

http://en.wikipedia.org/wiki/Metastatic_breast_cancer

image: http://www.hpblondon.com/liver-tumours/index_files/fdg_pet_scan.jpg

Metastatic Breast Cancer: Lung Cancer

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Some fifteen years ago, my wife’s mother passed away from lung cancer.

A child of her times, she smoked often and heavily for a number of years while raising four children, then quit – long before I met her.

Diagnose with lung cancer in 1994, she took chemotherapy, went into remission and finally succumbed to the disease in (I think – and my wife will correct me!) 1997.

Her disease was DIFFERENT than the type of lung cancer that can flare up after a woman (or rarely a man) is treated initially for breast cancer. Lung cancer after breast cancer is most often caused by BREAST CANCER cells that have invaded other organs and therefore are called metastatic breast cancer. The word “metastatic” was used in the 1570s and comes from the Greek metastasis which means "transference, removal, change.” The roots are meta which means "over, across" plus the word histanai which means "to place, cause to stand.” The medical use for "shift of disease from one part of the body to another" dates from 1660s in English.

“Metastatic cancer to the lungs is the spread of cancer from another region of the body to the lungs. The place where cancer begins is called the primary cancer. For example, if breast cancer spreads to the lungs, it would be called breast cancer with metastasis (spread) to the lungs. In this case, breast cancer would be considered the ‘primary’ cancer.”

Symptoms that would lead doctors to believe that the breast cancer had metastasized to the lungs are similar to those of “regular” lung cancer and would be warning signs that a person would need to see their doctor as soon as possible. They include: a cough that persists over time, or does not go away with treatment; coughing up blood, difficulty breathing (due to decreased airflow by a tumor obstructing the large airways or spread through the lungs); wheezing (caused by the interference of airflow through an airway obstructed by a tumor); pain in the chest, back, shoulder, or arm (when a lung tumor presses on nerves around the lungs); repeated lung infections such as pneumonia or bronchitis; hoarseness; and lastly, lung cancer CAN have no apparent symptoms and only appear  when a chest x-ray is done for another reason.

As well, “general symptoms” of lung cancer can sometimes present with vague concerns such as fatigue, weight loss, loss of appetite, and even depression can be a symptom of lung cancer as well as many other conditions.

Treatment for cancer metastatic to the lungs is usually determined by the primary cancer, or origin of the cancer. Systemic therapy (chemotherapy, biological therapy, targeted therapy, hormonal therapy), local therapy – which might include surgery or radiation therapy), or a combination of these treatments. The choice of treatment generally depends on the size, location, and number of metastatic tumors; the patient’s age and general health; and the types of treatment the patient has had in the past.

References: http://lungcancer.about.com/od/symptomsoflungcance1/a/symptomslungca.htm

http://www.cancer.gov/cancertopics/factsheet/Sites-Types/metastatic

image: http://www.topcancernews.com/images/1/CancerMetastasis.jpg

Metastatic Breast Cancer: Bone Cancer

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

We just got news this week that a “cancer friend” of ours had a bone scan, and after an extended time of treatment, she is cancer free!

But just what IS bone cancer and why did she get it?

The cancer, while it can certainly occur by itself, is what is called metastatic breast cancer. It happens when cancer cells from the breast escape into the blood stream or the lymph system and invade MORE new flesh.

While bone cancer is the most common – 70% of metastatic breast cancers are of this ilk – the other 30% is made up of brain cancer (10%) and lymph, lung and liver cancer. Let me emphasize here that these cancers are NOT the peculiar type of cancer cells that initiate these diseases in people who have never had breast cancer. These cancers are BREAST CANCER cells that have invaded other organs and therefore are called metastatic breast cancer. The word “metastatic” was used in the 1570s and comes from the Greek metastasis which means "transference, removal, change.” The roots are meta which means "over, across" plus the word histanai which means "to place, cause to stand.” The medical use for "shift of disease from one part of the body to another" dates from 1660s in English.

Bone cancer caused by the invasion of breast cancer cells into the bones can first show up as back, bone, or joint pain lasting more than two to three weeks that seems to be getting worse; numbness or weakness in a particular part of the body; a change in bowel or bladder activity, such as problems with incontinence or not being able to urinate or have a bowel movement. This may be a sign that the nerves in your backbone are getting pinched by the cancer.

As well, blood tests can reveal a buildup of calcium or tumor markers (special proteins in the blood) like CEA (carcino-embryonic antigen), CA (cancer antigen) 15-3 or CA 27-29 that suggest the cancer might be in the bones. Calcium build up might also show up in a routine bone scan. These tests are NOT usual and are typically ordered only if the symptoms appear.

Metastatic bone disease (MBD) caused by invading breast cancer often behaves in a “mixed osteolytic (destroys bone cells) and osteoblastic (causes abnormal growth of bone cells) manner”. Bone destroying or bone growing MBD occurs because the different cancer cells give off chemicals that interfere with the naturally occurring cells in the bone and cause bone destruction, new bone formation, or both. MBD weakens the affected bones, people with the disease are prone to fractures. Broken bones caused by MBD are termed "pathological fractures."

The most common treatment options for MBD include radiation and medications to control pain and prevent further spread of the disease, and surgery to stabilize bone that is weak or broken. By killing the cancer cells, radiation relieves pain, stops the tumor from growing and can prevent the bone from breaking. Radiation can also be used to control the cancer after surgery to fix a broken bone.
MBD is a systemic (body-wide) problem and radiation therapy may be use just to lessen symptoms and pain in more advanced cases, or to completely destroy disease in the affected bone.

Different cancers respond differently to radiation. Several types of radiation therapy are available. Local field radiation is the most common type of radiation used to treat MBD in which radiation is directed at the metastatic tumor and the immediate adjacent tissue. Entire bone segments or multiple bones can be targeted by local field radiation, depending upon how many areas are affected by the disease. This usually results in complete pain relief in 50% to 60% of cases and partial relief in more than 80% of cases. How well MBD responds to radiation depends on many things, including cancer type (for example, breast cancer typically responds very well to radiation, while kidney cancer does not), and where the tumor is located.
Pain usually begins to subside in the first 1 to 2 weeks, but maximum relief may take several months. Therefore, pain medication is prescribed throughout the radiation treatment course.

For our “cancer friend”, the treatment has been effective and with the pain greatly reduced, we are planning to actually meet for the very first time for dinner over the holiday season!

References: http://www.breastcancer.org/symptoms/types/recur_metast/where_recur/local.jsp , http://orthoinfo.aaos.org/topic.cfm?topic=A00093

Image: http://www.meddean.luc.edu/lumen/meded/Radio/curriculum/Harrisons/Oncology/mets5b.jpg

Man Cancer and the Orchiectomy

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

So this week I got the news that two good friends of mine have cancer. One has colon cancer and will be undergoing a colECTOMY (ecto = Greek for “to cut out”) during the Christmas season.

The other is twenty-some years younger than me. He was diagnosed with testicular cancer and had a radical orchiectomy after which…well, we don’t know because they are in the specific diagnosis part of his New Normal. He said he’d let me know because I pray well for biological specifics – I can see the parts of the body that are affected – cancer, breaks, dislocations, flu. I am a great prayer for healing of body parts as well as for restoring the heart and mind.

At any rate, some time ago, my wife asked “Why do so many people have breast cancer?” I marshaled statistics in this post: http://breastcancerreaper.blogspot.com/2011/06/why-do-so-many-women-have-breast-cancer.html

The research led me to the statistics for other kinds of cancer – lung cancer, Liz’s mom died from this; blood cancer (leukemia), the son of close family friends; brain cancer, an old friend of mine died from this at 30; skin cancer, my sister, brother and sister-in-law have this; there are others with other cancers that I don’t care to enumerate at this time.

Testicular cancer has increased by 60% in the past 25 years. Why? Right now no one knows the answer, it just…has.

A student of mine, after we talked about why my wife’s hair all fell out during chemo. I talked about how the chemicals target fast-growing cancer cells – and kill the fast-growing hair cells “accidentally”. She then went on a rave about how we should make drugs that ONLY target cancer cells…and that got me to thinking.

Are all cancer cells created equal? Or are they egalitarian? Is testicular cancer the same as breast cancer? Brain cancer? Lung cancer? Skin cancer?

Questions – and today…no answers. Just more questions that I’m going to try to answer in the future…

Image: http://www.tc-cancer.com/images/img-cancer-cell.jpg

The NEXT Five Years – Anastrazole!!! What’s It DO???

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

All right – the mastectomy is done (not OVER, there are still deep emotions attached to that surgery that will never “disappear”). The chemotherapy is done (same thing there: deep emotions and memories that will be carved into my mind forever). While it’s never completely gone, the gut-wrenching worry has passed.

What now?

For the next FIVE years, in addition to some cosmetic surgery, checkups and maintenance, there are more DRUGS. Specific to breast cancer is the one I’ll talk about today: anastrazole.

Chemically, this is called 2,2'-[5-(1H-1,2,4-triazol-1-ylmethyl)-1,3-phenylene]bis(2-methylpropanenitrile) – it’s the picture you see above.

But what’s it DO?

In a nutshell it slows down the production of estrogen in a human body (BTW – men make estrogen, too, just not as much as women do. Women make testosterone, just not as much as men do).

So?

Estrogen, which at puberty initiates the maturation of a woman, causes among other things, the increased growth of the cells in the breast. This estrogen comes from the ovaries and is a totally normal response to a person growing up. Estrogen levels in the blood increase during every menstrual cycle – which means it stimulates the growth of breast cells.

Estrogen doesn’t just stop affecting the woman after puberty. “…life-long exposure to estrogen…plays an important role in determining breast cancer risk…the number of menstrual cycles a woman has, and hence the length of exposure to estrogen during her lifetime, affects her risk for breast cancer.”

So every time a woman has her period, estrogen travels through the blood. The molecule of estrogen affects cells in the body – but only certain kinds of cells like the ones found in the breast and uterus. These cells have “keyholes” in their walls that are called estrogen receptors. The estrogen and the estrogen receptor hook together to make a single molecule that enters the nucleus of the cell. Once it locks on the cell’s DNA, it directs it to do many things. Among the things it tells the cell to do is GROW.

You know by now that cancer happens when cells grow totally out of control. So every time the breast cells get a message from the estrogen, they grow. Breast cancer is the out-of-control growth of breast cells stimulated by estrogen.

Anastrazole BLOCKS estrogen from giving its message to breast (and other) cells. On the website listed below, the author states: “…the medication is directed at preventing recurrence [of cancer] other than just in breast tissue….The American Society of Clinical Oncologists stated recently: ‘To lengthen disease-free survival and lower risk for [cancer] recurrence in nearby tissues or distant tissues…’”

So in a single sentence – anastrazole blocks estrogen from giving its message to cells ANYWHERE IN THE BODY that like to take up estrogen and start growing wildly.

References: http://envirocancer.cornell.edu/factsheet/general/fs9.estrogen.cfm , http://www.medhelp.org/posts/Breast-Cancer/Why-Arimidex-Anastrozole-after-bilateral-mastectomy/show/1314813

Image: http://www.3dchem.com/imagesofmolecules/arimidex.jpg

A Big Hairy Deal

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

It’s been my experience that men don’t usually care that much about their hair. It’s also been my experience that hair is VERY important to women.

That’s why the most obvious result of chemotherapy – alopecia – has such a profound impact on women and the men who love them. Women who lose their hair are OBVIOUS to everyone who looks at them. They are noticed; they stand out in public in a way a bald man will never stand out. We admire it even – Kojack, The King of Siam, Captain Jean-Luc Picard are all heroes and we don’t even notice their shiny heads. But bald cops, Queens and starship Captains would be so odd that most of us wouldn’t even remember the rest of the record, reign or voyage.

As men with wives, girlfriends and mothers who will or who have lost their hair because of breast cancer, we stand in an unusual place.

We have to be honest encouragers.

“Honey, how does this wig look on me?”

“Is the scarf the right color for my skin?”

“If I wear a baseball cap every day, will you still think I’m sexy?”

“If I don’t wear anything on my head in public, will you be embarrassed?”

The first response to each question is initially: “It looks fine, dear”, “It looks fine, dear”, “Of course I will”, “Nothing you could wear or not wear would embarrass me”.

The problem with the response is that our loved ones are our loved ones and a diagnosis of “stupid” does NOT go hand-in-hand with a diagnosis of breast cancer. They know when we are patronizing. I learned the hard way not to patronize my wife. When she asked one of the questions above, I had to take my time and think. I had to consider my answer not because I wanted to be right, but in order to battle the deep-seated desire to avoid inflicting any more pain on a person worn out from the constant fight against cancer.

So I studied her as she modeled the wig, scarf, hat or bald pate.

Honestly responding, I gave my opinion. When it was honest, it gave her FEEDBACK and while the ultimate choice was still hers, she most likely felt that my response – especially before her hair started to grow back – was honest and another data point in her effort to decide what to wear that day.

Ultimately, I could do nothing more important that to be consciously HONEST!

Images: http://i536.photobucket.com/albums/ff323/MSBrady78/charpics/picard.jpg

Neulasta!!! What’s It DO???

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Hey! I'm back! And yes, I WAS in Portland, Oregon during Occupy Portland! I DID see the marchers and took pictures of them and watched them...occupy Portland for several days...and now, back to our regularly scheduled blog:

Though I talked very briefly some time ago about what the various chemotherapy drugs that my wife was treated with were “for”, I never really went into any kind of detail.

Now that chemo is “over”, I wanted to explore what some of the long-term and lasting effects of the treatment are. Because she reached that time – what with the odd numbing of her upper lip, the incision pains, swollen ankles and dry skin, I’d like to know which of those things is chemo-derived and which ones are not.

So we’ll g0 here next:

What’s “neulasta” and what does it do?

Chemically, “neulasta” is N-(3-hydroxypropyl)methionyl, 1-ether-alpha-methyl-omega-hydroxypoly(oxyethylene).

Looks like the picture up top. Complex. Lots of chemicals.

But what’s it DO?

“Neulasta”, is a special protein that’s based on sugar (an oligo-saccharide, meaning that the molecule has only a few small units, in this case a sugar ) that’s attached to a protein to form a glycoprotein.

The glycoprotein is a very important part of a cell wall – the cells that are being targeted are white blood cells. The white blood cells are also called neutrophils, granulocytes and stem cells and are the main part of the blood that destroys microscopic body invaders like bacterial infections, viruses or other germs. The glycoproteins help the white blood cells recognize the germs.

Neulasta makes the marrow in bones produce more white blood cells to replace the ones killed by Cytoxan, Adriamycin and Taxotere (which I talked about above) while they are busy killing cancer cells that are growing out of control.

The “colony” in the “colony stimulating factor” is the white blood cells in the bone marrow.

So – “neulasta” is injected just under the skin and gets into the bloodstream. It goes along until it reaches the bone marrow where it forces (also known as “stimulating”) the growth of new white blood cells to take the place of the older ones killed off by the chemicals in chemotherapy.

Side-effects? Sure. Any one of us who’s seen the Red Devil injected in his wife, mother or girlfriend knows what I’m talkin’ about here. With stuff like THAT going into a human body, to expect NO side-effects would be the crazy thing! There are “minor effects” – did any of the researchers experience any of these symptoms? If they had, would they have called the effects “minor”? – of the injection, things like hives; difficulty breathing; swelling (face, lips, tongue, or throat) as well as bone pain; pain in your arms or legs; or bruising, swelling, pain, redness, or a hard lump where the injection was given.

More serious side-effects (though according to the test trials, these rarely happened: sudden or severe pain in your left upper stomach spreading up to your shoulder; severe dizziness, skin rash, or flushing; rapid breathing or feeling short of breath; signs of infection such as fever, chills, sore throat, flu symptoms, easy bruising or bleeding (nosebleeds, bleeding gums), loss of appetite, nausea and vomiting, mouth sores, or unusual weakness.

My wife didn’t seem to experience any of the side-effects. In fact, though we expected WORSE, the chemotherapy (while horrible in its own right) only threw us a few curves. Because of the neulasta injections, she didn’t seem to catch any sort of germ at all and stayed (on the chemotherapy scale of things in our “new normal” world) pretty healthy.

References: http://en.wikipedia.org/wiki/Pegfilgrastim, http://www.drugs.com/neulasta.html,

Image: http://molecules.gnu-darwin.org/html/00150001_00175000/164419/164419.png

Cytoxan!!! What’s It DO???

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Though I talked very briefly some time ago about what the various chemotherapy drugs that my wife was treated with were “for”, I never really went into any kind of detail.

Now that chemo is “over”, I wanted to explore what some of the long-term and lasting effects of the treatment are. Because she reached that time – what with the odd numbing of her upper lip, the incision pains, swollen ankles and dry skin, I’d like to know which of those things is chemo-derived and which ones are not.

So we’ll g0 here next:

Cytoxan is the “third” drug of the cocktail she was force fed through the tubes and into her port every three weeks for six months. “Cytoxan is a cyclophosphamide that has been converted into a non-toxic ‘transport form’. This transport form is a ‘pro-drug’, subsequently actively transported into the cancer cells. Once in the cells, enzymes convert the drug into the active, toxic form that kills the cancer cell.”

Plain English, please!

OK – first stunning surprise is that Cytoxan is a cytotoxic chemotherapy agent similar to mustard gas.

Although used today as anti-cancer drugs, they can theoretically also be used for chemical warfare. Nitrogen mustards add chlorine atoms to the DNA of cancer cells, in effect poisoning the cancer cell.

Mustard gas was stockpiled by several nations during the Second World War, but it was never used in combat. Mustard gas and its related compounds are strong and long-lasting blister agents. Production and use is restricted.

How did we get from WWII mustard gas to anti-breast cancer drugs? During WWII nitrogen mustard gases were studied at Yale University and classified human clinical trials of nitrogen mustards for the treatment of cancer started in December 1942. Also during WWII, an incident during the air raid on Bari, Italy led to the release of mustard gas that affected several hundred soldiers and civilians. Medical examination of the survivors showed a decreased number of white blood cells. After WWII was over, the Bari incident and a Yale study came together prompting a search for other similar compounds. The nitrogen mustard became the first chemotherapy drug mustine.

Many people taking cytoxan do have serious side effects. Side-effects life nausea, vomit, bone marrow suppression, stomach ache, diarrhea, darkening of the skin/nails, hair loss or thinning of hair, changes in color and texture of the hair, and lethargy. Cytoxan can cause cancer, it can lower the body's ability to fight an infection as well as an unusual decrease in the amount of urine, mouth sores, unusual tiredness or weakness, joint pain, easy bruising/bleeding, existing wounds that are slow healing.

Image: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjmeUaW2nD_OBX9leZ30RBz_aWK0gF7QrwVFEDhJ2NrwplzaUmaVSVIUkELu_KkQyTNkg0iQ4kFr2BHrsklZUd2lf5lqnvT82BH5dWfhcTtsKkNVVBmLcAG9ZB2yOsrEbasbuo39giIv0fX/s1600/WW1-mustard-gas-attack.jpg

I Can't Say It Any Better Than This...

There are times I read something and think: "Dang! That's perfect!"

Well, my wife passed this on to me and it's perfect.

Link it: http://today.msnbc.msn.com/id/45077399/ns/today-today_health/t/breast-cancer-causes-foot-in-mouth-disease-others/#.Tqx6DzIQ69s.email

Read it.

Enjoy it!

Last thing to do: REFLECT and DO THE RIGHT THING (or continue to do the right thing) NEXT TIME!

image: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLrIH9gvEIBWrmgiYgtioA4SOSNHFqkNZFzC_NvktN5GUgKaqbkORy_f6uBI4U3yORVQ-FTZwEXUmD4ukpSe1N4N-nf-ME89OJH-lxRT96lIDw_AjOWgfRomvFxWyfcuknENUBNB-bbt8/s400/foot+in+mouth.jpg

Adriamycin!!! What’s It DO???

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Though I talked very briefly some time ago about what the various chemotherapy drugs that my wife was treated with were “for”, I never really went into any kind of detail.

Now that chemo is “over”, I wanted to explore what some of the long-term and lasting effects of the treatment are. Because she reached that time – what with the odd numbing of her upper lip, the incision pains, swollen ankles and dry skin, I’d like to know which of those things is chemo-derived and which ones are not.

So we’ll g0 here next:

Adriamycin is the “second” drug of the cocktail she was force fed through the tubes and into her port every three weeks for six months. At first we called it the “red devil” because it WAS red and delivered in two, brat-thick syringes attached to the port tube. The nurse always came dressed in surgical gown, goggles, gloves and a mask – because getting Adriamycin on your skin could cause BLISTERING. (“And you’re injecting that into my wife because…”

This all came clear after research:

“In the 50s, an Italian research company was trying to find anticancer compounds from germs that live in the ground. They found one that was promising in an area surrounding the Castel del Monte, a 13th century castle. A germ that was related to the common “strep” bug and was bright red worked in trials against certain kinds of cancer tumors. Some French researchers discovered the same kind of compound that the strep germ made, so they combined the name of an ancient tribe that had lived near the castle and the French word for ruby red and came up with the name of the compound: Dauno-rubicin.

They tested it against leukemia (blood cancer) and lymphoma (lymph node cancer) and it worked – but they found that it also damage the heart.

They tried mutating it and they got another, related drug that worked as well, but wasn’t so damaging to the heart. They named this new compound Adriamycin, after the Adriatic Sea. The name was later changed to “doxorubicin” to conform to the established naming habits of the drug and chemical industry.

Adriamycin acts by jamming itself in between pieces of DNA in cancer cells. Any cell needs to make new DNA to make new cells. Adriamycin messes up the work of an enzyme that uncoils DNA so it can copy itself – it forces the DNA to stay open so it can’t close up and start splitting the cell to make new ones. The original cells age, then die, never having made any new baby cancer cells to continue the destruction of a human being.

But Adriamycin is DANGEROUS. Aside from the usual nausea, vomiting, and irregular heartbeats, it can also kill white blood cells (that’s why my wife got a Neulasta shot the day after chemo), as well as causing complete hair loss. “A more mild side effect is discoloration of the urine, which can turn bright red for up to 48 hours after dosing.” (My daughter wrote about this one in her first or second blog post, “Toxic Pee”: http://twenty.o-my-soul.net/?p=24). From a Georgia Tech manual for handling toxic compounds, we find this:

“Doxorubicin (trade name Adriamycin)…is a mutagen, carcinogen, and teratogen, and is highly irritating to the eyes, skin, mucous membranes and upper respiratory tract. Statistically significant…genetic damage have been reported in hospital pharmacists and nurses exposed to [it]. The toxic effects of doxorubicin may be experienced if swallowed, inhaled, ingested or exposed to the skin.”

Sheesh! No wonder the whole scenario creeped us out!

So besides slaughtering cancer cells, what’s the “rest of the story”? Grave indeed – “the risks of developing cardiac side effects…dramatically increase.” Doxorubicin makes the mitochondria (the place that makes the power to run a cell) in the heart muscles less able to make ATP – which is the energy used to run a cell: less energy, less strength for beating. Also, when Adriamycin reacts with the iron in blood, it can damage the heart cells, causing the fibers that tighten and loosen (making the heart beat) to disappear as well as eating holes in the cell’s jelly-like insides. Also, some patients may have weeping sores on the palms of the hand or soles of the feet, swelling, pain and a rash-like reddening of the skin – sometimes making the skin or hair a different color.

So there you go – a brief but chilling rundown of what THIS drug does to your beloved…

Image: http://upload.wikimedia.org/wikipedia/commons/thumb/e/ee/Doxorubicin%E2%80%93DNA_complex_1D12.png/220px-Doxorubicin%E2%80%93DNA_complex_1D12.png

“The Port’s Been Overrun!”

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

The port came out yesterday!

It was – and it WILL be! – a celebration for the next few days.

But there was a sobering note that sounded yesterday as well.

First, however, I’ll explain WHAT a port is.

When my wife chose to go with an aggressive regimen of chemotherapy (amazingly, I talked about neither!) she had to have a port installed so that they wouldn’t have to go vein diving with a sharp needle in her arm every time we came in for a chemo session.

“Port” is short for “portal catheter”, which is slightly shorter for “totally implantable venous access system”. You can see a picture of it above both “out and about” and implanted.

Because she was going to have six, six-hour-long sessions of continuous injection of the therapy drugs. I’ve copied the Wikipedia entry, then translated the long words into English so that they are understandable: “A port is a quarter-sized bowl with a flat bottom and a plastic bubble across the top like a drum head. A tiny tube leads out of the bottom of the bowl and that can be attached to thin tubes – one that goes up the neck (for blood samples) and one that goes into the heart (where you want the drugs to go).

“To put the port in, the doctors make a diagonal slit just above the collarbone and slide it in between the muscles and the skin. They put a couple stitches in the muscles to hold it in place then glue the cut with superglue and put a clear plastic band aid over it. It looks like a bump under the skin below a red scratch. You don’t have to do anything special to take care of it because it’s completely inside your skin, so swimming and taking a shower are not a problem.

“The bubble is made of a special self-sealing silicone rubber; it can be punctured hundreds of times without popping. To do chemo or to draw blood, someone will disinfect the area. Then they’ll poke the skin with a 90° Huber point needle and tape the whole thing down. The hole it makes will be so tiny that it will look like the person got a mosquito bite when they pull it out.”

The worst part is that my wife was able to FEEL the catheters all the time and they pulled when she turned her head.

That’s all done now!

The sobering part of the morning came while I was in the waiting room. The intern wheeling her into the surgery asked what her surgery was (they do that like a bazillion time before anyone even PICKS UP a scalpel!). When she said that it was a port removal, the intern got serious and asked, “Is that good news or bad?”

My wife replied, “Good news!”

The intern replied with a smile and the removal went on. When she related the story to me, I realized that there was an implied message in the first sober response. For some people, the removal of the port would be a surrender to the inevitable – the port is no longer useful and we might as well make the coming end as comfortable as possible.

I’m not sad; nor has the joy of the port coming out diminished at all. I simply now have more to be thankful for than ever before and I can hold up in prayer those whose ports are coming out because this is the end of the line…

Image: http://images.ookaboo.com/photo/s/PAC_met_Gripper_erin_s.jpg

Image: http://upload.wikimedia.org/wikipedia/commons/thumb/9/9f/Portkatheter_R%C3%B6ntgen.JPG/220px-Portkatheter_R%C3%B6ntgen.JPG

“Awareness” and Action

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…
I’ve read my daughter’s blog three or four times now (http://twenty.o-my-soul.net/). She started when we found out my wife has breast cancer, and while she hasn’t been as regular in posting as she’d wanted to be, what she lacks there she makes up for in introspection and impact.

Her current entry is about Breast Cancer Awareness Month.

I confess I did NOT join the Making Strides Against Breast Cancer (http://makingstrides.acsevents.org/site/TR?sid=16393&type=fr_informational&pg=informational&fr_id=36135) walk this weekend even though Cooper High School where I work has a team. The team captain commented to me yesterday that she was disappointed there weren’t more people walking with them (a subtle inquiry as to why I wasn’t…)

I did NOT sponsor anyone during the Susan B. Komen 3-Day For The Cure run/walk.

I did not donate to the American Cancer Society.

Why not?

I confess that there may be some anger in it; rebellion against “other people” horning in on “my” grief. I KNOW I felt an anger similar to my daughter’s when I see pink ribbons, pink football sweat towels, cleats, and wristbands. But for me, it’s a bit tempered with the thought that “at least they’re trying”.

As I point out above and more than once in this blog, men have trouble talking about breast cancer. Lots of guys have trouble talking about feelings in general with anyone but their intimates – nah, let me amend that. Guys have NO trouble talking about rage, anger, hate, respect and love…of beer, steak, exploding things, cars and “wimmin”. It’s the more subtle feelings they have trouble talking about. In fact, trying to express the more subtle feelings of love will shut down even the loudest most obnoxious guy – even me.

My guess is that the pink Capella Tower lights were a man’s idea. As were the pink-soled football cleats and sweat towel you see above on Minnesota Viking Antoine Winfield (26).

Interpreting these as a man, I think they are an attempt by men to talk about and support the women they know who have fought breast cancer. They may be clumsy and gauche, but hey, they’re trying.

And me? Why am I not at the front of the Cooper squad making Strides Against Breast Cancer? Why am I not riding in the Breast Cancer Ride on August 4-5, 2012 when I rode and walked against diabetes four time?

Maybe I’m angry. Maybe “awareness” isn’t enough. I’m certainly “aware” of breast cancer now; intimately so. Maybe I just don’t know what to do and I haven’t found a way to really make a difference and until I do, I’m going to write this blog and nod pleasantly when people try…and try and figure out how I could make my writing into a weapon against breast cancer so that people like my wife and the wife of my science fiction writer friend wouldn’t have to suffer any more.

Image: http://bloximages.newyork1.vip.townnews.com/phillyburbs.com/content/tncms/assets/v3/editorial/a/62/a6252675-4a7a-5780-85ed-2cfa3dd8c8fa/4e90c82f974f5.preview-300.jpg

Taxotere!!!! What’s It DO???

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Though I talked very briefly some time ago about what the various chemotherapy drugs that my wife was treated with were “for”, I never really went into any kind of detail.

Now that chemo is “over”, I wanted to explore what some of the long-term and lasting effects of the treatment are. Because she reached that time – what with the odd numbing of her upper lip, the incision pains, swollen ankles and dry skin, I’d like to know which of those things is chemo-derived and which ones are not.

So we’ll start here:

Taxotere: (This is the “brand name” drug, its generic name is docetaxel) anti-mitotic chemotherapy medication (that is, it interferes with cell division). This is the “simple” answer I gave on May 7 (http://breastcancerreaper.blogspot.com/2011/05/bust-drug.html). But what exactly does it do and does it have long-term side-effects and any OTHER impact on the Human body?

From: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000987/#

“You may have a higher risk of developing certain serious side effects such as low levels of certain types of blood cells, severe mouth sores, severe skin reactions, and death. Docetaxel injection may cause low levels of white blood cells in the blood…fever, chills, sore throat, or other signs of infection…serious or life-threatening fluid retention. Fluid retention does not usually start immediately, and most commonly occurs around the fifth dosing cycle. If you experience any of the following symptoms, call your doctor immediately: swelling of the hands, feet, ankles, or lower legs; weight gain; shortness of breath; chest pain;cough; hiccups; rapid breathing; fainting; lightheadedness; swelling of the stomach area; pale, grayish skin; or pounding heartbeat…nausea, vomiting, diarrhea, constipation, changes in taste, extreme tiredness, muscle, joint, or bone pain, hair loss, nail changes, increased eye tearing, sores in the mouth and throat, redness, dryness, or swelling at the site where the medication was injected, blistering skin, numbness, tingling, or burning sensation in the hands or feet, weakness in the hands and feet, unusual bleeding or bruising, nosebleeds.”

OK – yes to some of those, no to lots of them.

From Wikipedia Taxotere:

“Docetaxel is partly-synthetic copy of Taxol, an extract from the bark of the rare Pacific yew tree. Due to scarcity of the tree, Taxotere was extracted from the common European yew tree.”

“Docetaxel is a white powder and is the active ingredient in Taxotere. The solution is a clear brown-yellow…a single dose contains ethanol, saline, sodium chloride or glucose for administration plus polysorbate 80…vials may be stored for 24 months below 25°C away from light.”

“The cell-killing activity of docetaxel promotes and stabilizes microtubule assembly (microtubules make up the cell structure called a “spindle” – it’s that happens when cells divide. It also prevents microtubule disassembly in the absence of GTP. This leads to a significant decrease in free tubulin, needed for microtubule formation and results in inhibition of mitotic cell division between metaphase and anaphase, preventing further cancer cells from forming. Because microtubules do not disassemble in the presence of docetaxel, they accumulate inside the cell and cause initiation of cell suicide (apoptosis).”

“Docetaxel is a chemotherapy drug and is a cell killing compound and so is effectively a biologically damaging drug...docetaxel is toxic to all dividing cells in the body. This includes tumour cells as well as hair follicles, bone marrow and other germ cells.”

From: http://www.cancersupportivecare.com/late.html

“Long-term effects are side effects or complications of therapy that persist when therapy is completed, requiring patients to develop compensatory treatment programs to relieve or control these side effects…chemotherapy can cause damage to vital organs, such as heart, lungs, kidneys, and the gastrointestinal tract. Older persons over 65 and 70 may have pre-existing heart, lung, kidney, gastrointestinal, or liver problems, which can be accentuated with anti-cancer therapy, as these organs may be more susceptible to side effects from treatment.

Peripheral neuropathy, for example, pain, numbness, tingling, loss of sensation or heat/cold sensitivity in extremities or body, is often a side effect for patients receiving Taxotere...”

From: http://www.caring.com/questions/taxotere-side-effects

“Melanie Haiken, (Caring.com senior editor) notes: Taxotere (brand name Taxol) has many of the same side effects of other chemo drugs, but some are better than others, some are worse…taxotere caused a lot of bone pain and muscle aches. Some say their arms and legs ache, while others say the pain is worst in the neck, back, and shoulders; neuropathy, or nerve damage, which makes feet and hands feel tingly or numb…The good news is that taxotere seems to cause less nausea for many cancer patients than other chemo drugs, such as the A/C it often follows. Hair loss may also be less of a problem…Side effects are very individual, and they also vary according to dosage.”

So, we’re still on the journey and while I by no means “understand” what’s been going on, others have and there are places to find information.

Keep looking; keep learning!

Image: http://w ww.emc.maricopa.edu/faculty/farabee/biobk/spindle.gif

Strange Pains and Feelings

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

I honestly thought the “pain” part was over once chemotherapy was done.

I don’t know for sure about my wife, but for some reason I thought that once the drugs had cleared her system, life would become a bed of roses. I thought the swelling ankles, aches, pains and wooziness and other symptoms we’d come to expect with chemo would be gone.

Then a few weeks ago, there was “the fever”. This happened during chemo, so we weren’t exactly surprised and I blogged about it here: http://breastcancerreaper.blogspot.com/2011/08/real-poop.html. There’ve been other aches and pains – at least I know about the ones she TALKS about – but nothing really serious.

Yesterday, she came home with chest pains – NOT THOSE KIND OF CHEST PAINS! – and we’ve been talking about it. I (of course) did some research and found the following:

“According to the University of Florida, the cut nerves can also cause shooting pains soon after surgery, and dull aching or burning pains for up to a year. The nerve pain will subside with time, and any pain can be treated with medication in the interim. The nervous system has a limited ability to repair itself following damage, and the numbness in the skin may persist for long after surgery.” (http://www.livestrong.com/article/113850-breast-mastectomy-complications/#ixzz1ZWy5RMZc)

I was aware that nerves grow slowly. That is a standard teaching to ALL biology students and an area of continued research in medicine. In fact, there’s still work being done on nerve regeneration and even to find out how to make limbs regrow themselves – a theme from an old book my master storyteller, Madeleine L’Engle called THE ARM OF THE STARFISH. Logic leads me to realize that growing nerves might just hurt.

However, I also found this: “Since mastectomy…I have muscle spasms in the pectoral muscle and pain along the incision area…I have a constant squeezing like a boa constrictor squeezing under my ribcage area and it goes around my entire body. [A couple of doctors respond] At the time of the mastectomy, the surgery extends down to the base of the breast, including the covering of the pectoralis muscle there. Many women…notice increased sensitivity at the ribcage after mastectomy…It's also common to see sensitivity at the rib with age with anyone. This is something called costochondritis.” (http://www.breastcancer.org/treatment/planning/ask_expert/2008_05/question_07.jsp)

As well, my wife realized that she’s been lifting things lately – likes tables, chairs and sometimes grandsons! It’s not something she’s been doing for the past seven months and she’s realized that it MAY just be the type of ache that comes from bringing yourself up to speed after a long break from exercise – so we relax a bit, keep a close watch on the condition and continue on…

image: http://image.shutterstock.com/display_pic_with_logo/270058/270058,1264070046,1/stock-photo-senior-woman-taking-a-break-after-doing-exercise-44980528.jpg

Ripples

The blog address came from an earlier title I tried for this blog. Didn’t work. The new title is a better reflection of me – and if you’re here, I hope it’s a reflection of you… http://breastcancerreaper.blogspot.com/search/label/Introductions

While my daughter doesn’t often blog on her 20: A Journey of Hope, she does on her other site (http://think.o-my-soul.net/). Currently on the right hand side is her twitterfeed regarding a car accident she and I witnessed.

An elderly woman was driving her very nice car south on Washington Ave, parallel to Interstate 94 at about 4:30 PM. I’d picked my daughter up from Augsburg College where she’d just spent eight hours of attending classes in biopsychology and research methods. Traffic was light. We were chatting.

Many people use Washington to skip the heavy traffic feeding on to the interstate directly from the downtown Minneapolis area. They take it for a short jaunt through the fascinating businesses in the old Warehouse District, then enter the ramp at 22^nd by crossing a usually light southbound lane of traffic.

I think the elderly woman missed the ramp, got on to the next stretch that runs between 26^th and Lowry and then, thinking the ramp was there, simply veered into oncoming traffic, looking for the ramp. She said to another bystander that she thought it was the turn on to Lowry she was making (and the Washington was a one way?). At any rate, what we saw was the woman’s car swerve deliberately into two oncoming cars.

My daughter says we experienced vicarious dissonance, “a type of vicarious discomfort resulting from imagining oneself in the speaker’s position, leading to efforts to restore consonance”. In other words, we couldn’t believe that the woman was driving that way because we KNEW that that kind of driving couldn’t happen. We KNEW she should be in the northbound lane.

The resulting head-on collisions destroyed both her car and badly damaged the other two. I was “first on the scene” and called 911, gave the address to dispatch then waited for the police to arrive -- moments later. Eventually, I reported what I saw to police officer in charge after the arrival of two squad cars and a fire truck. Then my daughter and I moved on to home, deeply shaken.

As I drove, I thought about the accident and the effects it would have. Aside from burning itself into my daughter’s mind – she just got her license a bit over a week ago – and my own, the lives of the people in those cars will be irrevocably affected as well. The young Asian man whose older model car doubtless carries only collision insurance is now car-less and likely will get piddly cash from the insurance company after endless wrangling over whether he caused the accident or not. The woman in the Volkswagen Beetle will experience the same thing, though by the newness of the car, it likely has more insurance.

And the elderly woman? Will she ever drive again? Will lawsuits (most likely formed by lawyerly vultures wishing to sue everyone in sight and retained by the elderly woman’s wealthy friends, cause the blame to fall on everyone but the woman) be brought, fought and bought? Who's going to come and pick up all of the victims and bring them home? Did any of them go to the hospital or just go home because their insurance doesn’t pay for something as minor as a non-lethal car accident?

Ripples.

What does a car accident on a Thursday afternoon have to do with breast cancer? Those of you who are THERE can easily guess. Those of you who are not, might consider this: the girlfriend of a good college friend of my daughter; has a mother who was just diagnosed with stage 4 breast cancer. Who next? How will the girlfriend's life change? And that of her father? Aunts? Uncles? Siblings?

Ripples, ripples, ripples…

image: http://priyaneelam.files.wordpress.com/2010/09/arnie-rosner-water-drop-and-ripples.jpg

When the Calm Descends

The blog address came from an earlier title I tried for this blog. Didn’t work. The new title is a better reflection of me – and if you’re here, I hope it’s a reflection of you…http://breastcancerreaper.blogspot.com/search/label/Introductions

Everyone knows that hurricanes have eyes: “The eye is a region of mostly calm weather found at the center of strong tropical cyclones. The eye of a storm is a roughly circular area and typically 20–40 miles in diameter. It is surrounded by the eyewall, a ring of towering thunderstorms where the most severe weather of a cyclone occurs. The cyclone's lowest barometric pressure occurs in the eye, and can be as much as 15% lower than the atmospheric pressure outside the storm.” (wiki reference).

It’s easy to say that the past six months have left the impression on our lives of hurricane-like disaster. Panic, pain, disruption, breakdown, and exhaustion left us wrung out and completely out of our normal world.

Medical help surrounded us.

Sympathy was everywhere.

Then the chemo ended and my wife has rarely felt better – she certainly feels better than she has for the past year!

My secret worry though is wondering if we are in the eye or at the trailing edge of the hurricane. The calm that we feel may be the relief of seeing the hurricane move on past us – and the queasy feeling that it is wreaking havoc, destruction and despair on the cities farther north. The hurricane that devastated our normal life has moved on but new victims lie in its path. (My wife wrote about just this experience in her Caringbridge blog – click on the link to your right and scroll down to the June 15 entry)

But that calm may also be the one at the center of the storm.

I pray it is the first, but deep down inside, I worry if it’s the second. A good friend of mine who is going through the storm with his wife finished the initial chemo to find a month later that they are now in a battle against bone cancer lesions all over her skeleton that require radiation treatment. I wept for them when we first heard – and I now in utter selfishness, pray that this will not happen to us. I pray that we are waving goodbye to the hurricane and while I do not for one instant WISH this monster on anyone; I am breathing deeply and giving thanks that it is moving away from us.

I continue to cultivate confidence.

image: http://chemistry.csudh.edu/faculty/jim/cozmay06best/wilma.jpg