Tag Archives: chemo

Cost of Herceptin . . .

1 Aug

One dose of Herceptin ranges in cost from $6,254.95 to $9,599.00. Ouch. I don’t know yet what UCLA would charge. But, this is the range I have found. This is the price I have found for the every three week dose. (This is three times the amount of the weekly dose that I currently receive). Since I had the one week dose last week, I am looking to have two weeks worth – not three. So, hopefully the cost of that will be much less.

Maybe my insurance company will pay for it, if I am able to successfully dispute my oncologist’s decision. But, I don’t know.

I have heard of women maxing out their insurance because of the high costs of cancer treatments. Being on Herceptin for one year costs nearly $80,00.oo. And, the chemotherapy treatments each ran into several thousand dollars per treatment. That is all past. But, still, it is a concern of mine as I do have surgeries and continued  treatment ahead.

I need to find out what my policy limits are and find out where I am with that.

Oncologist said no, now what?

1 Aug

My oncologist said no to my request that I not go off of Herceptin. I had consulted with UCLA (where Herceptin was developed) and they told me that I should not be off of Herceptin for any period of time until I was done with treatment. But, my oncologist disagrees. Yesterday I demanded that he give me a medical reason for his decision to not follow UCLA’s protocol. His reason was that Herceptin poses a heart risk.

I have been on Herceptin since April 2nd. The heart risk is 1%. I have had two echocardiograms which have both come back as normal (a baseline before treatment and another two months into treatment which shows my heart function to be normal). I have had chest pains off and on throughout treatment. But, have not had chest pains in a month.

The 1% heart risk was shown in studies that involved women of all ages, all levels of health (including women with existing heart problems, high blood pressure etc.). They have done no study on 44 year old healthy women with no underlying heart problems to see if the risk to the heart from Herceptin is lower than on percent. But, the presumption would be (I would think) that my risk would be even lower than one percent.

I spent most of the day arguing with my oncologist’s physician’s assistant. Then she would take my argument back to my doctor, he would tell her what to tell me, then I would dispute that, and then she would go back to him, back to me, back to him and so forth – that was my entire day. He can’t even pick up the phone and speak with me directly.

She just kept telling me that with the risk that Herceptin could damage my heart that my oncologist would not allow me to continue it until one month after surgery – or longer – depending upon how long it took me to recover. His feeling is that there is an increased heart risk with surgery (the strain of surgery on the heart coupled with being on Herceptin). But, it is such a low risk. I told her – “look, we KNOW that I have cancer. We KNOW that it is aggressive. And, we KNOW that Herceptin is extremely effective in killing my cancer. So, rather than allow a possible, remote risk keep us from preventing a KNOWN risk (that of my cancer growing at a rapid rate if it is allowed to go unchecked by the very drug designed to kill it) I would rather follow what UCLA would do”. It seems foolish to do otherwise.”

And, I told her that he can’t have it both ways – two days ago I asked him to order a more comprehensive heart test (one that shows more of the heart function than an echocardiogram). He refused on the basis that I do not seem to have a heart problem. His exact words were that my heart function was normal and that he did not think that Herceptin was posing a problem for me.  Now, he cites a concern over Herceptin affecting my heart as a basis for not following protocol and taking me off of Herceptin. I have checked – this is generally only done in patients who are elderly or who have an existing heart problem.

I got nowhere yesterday. And, the poor PA, she was practically in tears at the end of the day. I felt bad for her, but it is her doctor that has put her in this position. She agreed that if it were her – in my shoes – that she would have the same concerns.

So now I am waiting to hear back from UCLA to see if they can fit me in (at my own cost – which could be at a significant cost) for a Herceptin treatment next week. Or, to find out from Dr. Hurvitz if it is wise to skip a treatment.

I can’t believe I am having this fight with my oncologist. He is so arrogant. First of all, he made his decision without ever consulting the appropriate protocol (this was clear from the way he answered me in the first place: “Hmm, well, I guess . . . “). Not once did he ever point to a reason or basis for his guessing.

And, the PA yesterday kept telling me about “this one patient who had trouble . . . ”

To which I told her I did not want or need to hear about anecdotal situations. That I wanted my medical treatment based upon studies and current protocols. UCLA is one of the top breast cancer centers in the world. They developed the drug Herceptin and know best how it works and how and when to administer it. Yet my bafoon of an oncologist is so arrogant that he thinks he should supplant his opinion over UCLA’s well documented, studied and proven protocols. I am livid about this. The fact that I have to spend my time arguing over something like this is so frustrating.

I am putting it aside for the weekend (although UCLA may get back to me via email over the weekend – the nurse practictioner that I spoke to at the end of the day said she would see if she could get an answer from Dr. Hurvitz about my getting in for treatment next week – she said she might hear back over the weekend and that she would let me know via email – amazing). So maybe I will get some good news before Monday. But, either way, she said she would get back to me no later than Monday. Time is kind of the essence here.

In my reading today, I have learned that there are Herceptin resistant HER2 cancers. They do not know why some HER2+ tumors are resistent to Herceptin. But, they are developing new drugs that show promise and may be available in one to three years. I am wondering (from my little bit of back ground in microbiology) if, like strains of bacteria can become resistant to antibiotics, that HER2+ tumors can become resistant. This is what concerns me about the time off of Herceptin – if I am off of it for five weeks, will this give any remaining cancer an opportunity to continue to grow – unchecked by the Herceptin – and worse yet, will this unchecked cancer have the potential to become Herceptin resistant? I am not trying to borrow trouble here, but, the reason I can survive this cancer IS because of Herceptin. Without it the recurrence and mortality rate of this cancer is very high. Not good. Herceptin increases survival by leaps and bounds.

I do not know if the Herceptin is working on my cancer – I can only presume that it is because the cancer has defnitely decreased significantly during treatment. But, it is not known yet how much cancer is remaining (if any) and I don’t know if that is due only to the chemotherapy or to a combinatino of both. The only way I will know is to be on Herceptin and be monitored. In all likelihood the Herceptin is working and will work. But, I do not want to be off of it for any appreciable time.

Well, that is enough on that for now. I will write more when I know more. Please say prayers for me on this. I really appreciate it.

L.

AAAARGH!!!

31 Jul

Okay, so I called Dr. Hurvitz and asked about being off of Herceptin for five weeks and I was told, no way. That I shouldn’t be off of the drug at all, for any period of time, during treatment. As I thought. So now how to fix it. My current oncologist says I can’t have any more Herceptin until a month after surgery and that I should not even have a dose (as would normally be scheduled) next week because it is too close to surgery.

Yet, there is no evidence that this is what should be done. I don’t get it.

Anyway, I was told by Dr. Hurvitz’ office that I should get a triple does next week (or at least a double dose) so that then I can wait on my next treatment to be either two weeks or three weeks after surgery respectively. She said that either way, I should not be off of Herceptin for any time – meaning I need to increase the dose in order to allow for “time off”. But, it really isn’t time off because there will be a double or triple dose of the drug in the interim that will cover that period of time.

I called my oncologist and left a message with his physician’s assistant. Hopefully I will get a call back soon. I am inclined to go ahead with a double dose today (this would then make it three doses between today and yesterday). And then I would get my next dose (which would be  a triple dose) in three weeks from yesterday. That would allow me two weeks without a Herceptin treatment after surgery. I should be able to get in for a treatment of Herceptin two weeks after surgery without too much trouble I would presume.

This is so frustrating. I should not have to spend my time babysitting my own oncologist – checking up on him and making sure he has made the right call. Fortunately, his behavior makes it painfully obvious that he doesn’t know what he is talking about – which I think is very fortunate for me – otherwise I would bounce along and not know any better and be at risk. (Actually, I would still be double checking no matter what, it is in my nature. But, that being said, if I were with Dr. Hurvitz, I would not feel the need to double check, she is fantastic and she is at the source – where Herceptin was developed and studied). But, my oncologist . . . aaargh! I mean the idea that there may be microscopic cancer cells in my body that per this moron’s “advice” would go unchecked by Herceptin for the next five weeks and given the possibility to grow and land somewhere else in my body and wreak havoc is just maddening. Okay, now I AM mad at him. This is pathetic.

So, I am waiting for his PA to call me back. Since it is already after 1:00 pm, it is doubtful that there will be time for me to come in for another dose of Herceptin today. So, maybe I can do it on Monday. I am just so frustrated by this guy. I am going to call my insurance provider right now and demand a case manager be assigned to my case. This is so ridiculous. And, just so you know, this is the ONLY protocol for Herceptin. The drug was developed and studied at UCLA. So they (the doctors at UCLA) absolutely know what the treatment should be and how often. There should be no dispute what so ever and there should be no departure from what is the known, verified, proven by clinical trials, protocol.

Please say some prayers I don’t have to battle this out with my oncologist. I don’t get the sense that he is open to hearing someone else’s opinion – that seems fairly obvious from the fact that he has not even checked to see what the protocol is supposed to be for Herceptin treatment.

I am so done with this guy.

Seeing my oncologist today . . .

30 Jul

I spoke with my mentor MJ yesterday. She has been through breast cancer and has had much of the treatment that I have had and will have to have – sans the radiation. She said that I should insist on a Mugga test (a test of heart function) prior to surgery. I am slated only to have an EKG prior to surgery. MJ said that with the drugs that I have been on (chemotherapy and the Herceptin) that I should definitely have this mugga test to make sure that my heart has not been damaged by the drugs. In particular, she said that because I went into anaphylactic shock from the time that Taxotere was administered without steroids, that I should insist on getting a mugga test to rule out damage to the heart after that event. I agree. However, I don’t know that I will get any doctor to agree. But, we shall see.

I see my oncologist today (the one that doesn’t read my file). I cancelled our last appointment because I saw it as pointless and I had already seen the specialist up at UCLA the day before. My oncologist was pretty surprised by my canceling. But, I just could not meet with him. I felt my health depended upon my NOT meeting with him. He always brings me down with his ignorance. He really does not have a clue about the kind of cancer I have. He didn’t even know which chemo drugs I was on or that I was on Herceptin – or at least he didn’t know the significance of my being on Herceptin.  Instead, he talked about the possibility that I could get brain cancer because Herceptin does not reach the brain.

What a moron. I mean what is the point in telling me that? When I told the specialist up at UCLA what he had said, she was angry. She said that it was ridiculous for him to put that on the table and that the chances of that happening were very, very low. And, she said if it were to occur, that there was a drug for that too that is like Herceptin but that reaches the brain. (Dr. Doom instead told me that I would have to have brain surgery – – good Lord, what an idiot). I mean that is so pointless to talk about. It’s like saying, “You know if you trip and fall you might break your hip. You might get arthritis one day and have a lot of pain in your hip. Then you might have to have hip replacement surgery. Then you might have complications from the surgery and then . . . ”

I mean really, what is the point in telling me about some remote possibility and then describing in detail the treatment for that remote possibility and how problematic it is. What an idiot. The specialist up at UCLA was so upset by his telling me that. Her exact words were: “You need to get out of there, he doesn’t know what he is doing.”

She did, however, like my surgeon. She knows her, has a lot of confidence in her. So that is good. I like both of my surgeons very much. I have two surgeons, the surgeon who will remove my cancer and my reconstructive surgeon. They are both excellent.

I feel very lucky to have the reconstructive plastic surgeon that I have. She does amazing work. She is not part of my network. But, I was able to get her anyway (thankfully my insurance agreed to it). She is the only surgeon at Hoag (and one of a very few surgeons around) trained in a type of microsurgery for breast reconstruction. It is really amazing what they can now do. Unbelievable. So, I feel very lucky in that regard.

I have to say that when I was first diagnosed, the last thing I thought about was reconstruction. I just wanted them to go in and get it out. All I could think about was surviving. And, of course, that is my main focus. There is not much point in having pretty breasts or breasts at all if I still have cancer. So, it is all about becoming cancer free. And I will. But, I realize now that part of surviving is having great reconstruction results. So it is great to know that I have a top reconstructive surgeon. She specializes in reconstruction (where as most breast reconstruction surgeons that people get are also cosmetic surgeons and handle everything from botox to liposuction). I am grateful to have my surgeon.

So, I am bracing myself for another meeting with Dr. Doom. Even though I know he doesn’t really have a clue about my cancer or the significance of my getting Herceptin (the wonder drug for my kind of breast cancer), I am still affected by what he says. The last time I had a meeting with him I left the visit in tears. I hate to admit that this jerk – who has no time to read my file and argued with me about how many chemos I had been through – could reduce me to tears, but he did. It was a combination of the fact that he had not read my file, that I spent the entire time correcting him about very basic things in my treatment and diagnosis and that he told me that there was no way that I could have a complete response to chemotherapy. (A complete response means that the chemotherapy killed all of the cancer). As soon as he told me that, I knew he was wrong. Who is he God? He can not know that.

I knew that I should not give any credence to what he said that day because he is simply ignorant (ignorant about my type of cancer and ignorant – by choice – about me). But, even though I know this, it was impossible for me not to attach some significance to what he said – in spite of the fact that he was wrong about so much during our meeting. Still, it was so hard not to think that maybe he was right. And, it was just so upsetting to realize that he is not invested in my care at all. That felt horrible. But, that is why I am seeing the specialist up at UCLA. She says I am having a great response to the treatment so far. My surgeon also says that I am having a great response. In fact, she said she can not feel the cancer any longer and she thinks there is a good chance that we will find that I have had a complete response.

I am going to let him have it today if it becomes clear to me that he has not read my file. I should bring a tape recorder to tape that discussion. Maybe he will surprise me and he will have read it. I really hope so because it is so depressing to see him and to go through that – learning that he hasn’t bothered to prepare for our meeting and that he clearly has no idea what is going on with me.

I know he finds me difficult because I have expectations. I come in with my legal pad (I’m sure he loves that) and all of my questions and well, he doesn’t care for that I don’t think. But, he works for me. At least he is supposed to.

Well, hopefully the meeting goes well. Maybe he will do better after my canceling our last appointment. He didn’t get paid that day. He was really perplexed by my canceling. I was in the office for my Herceptin treatment and I told the nurse I didn’t want to meet with him. I told her why (that he doesn’t read my file and that he depresses me). So she told him that I didn’t have any questions and that I didn’t feel that I needed to meet with him that day. He came over and said, “So you don’t want to see me today, I am hurt”. I guess now he is a comedian. He then said that he had to see me before surgery and actually scheduled today’s appointment himself – that may be the most work he has done on my case to date – scheduling an appointment. 🙂

I have to think I am the first patient who was already there at the doctors office (had to be there for Herceptin) and told him to go away basically. I mean, I had to sit there for treatment anyway, so it wasn’t like I was saving time by not meeting with him or getting to go home early because I cancelled. Instead, it was a clear message that I did not want to see him. So maybe this time he will prepare for our meeting.

Well, I guess I am being pretty harsh. I do have to give him credit for suggesting that I take Claritin for the bone pain that is caused by Neulasta (the drug I get to boost white blood cell production). The Claritin really worked. But, he gets no points for his bedside manner or his lack of preparedness for our meetings.

Wish me luck with this guy today. I just can’t let him take me down. So, I won’t. In one ear out the other.

Day three is done, now onto day four . . .

19 Jul

So in chemo speak, day one is the day of chemo, day 2 is the day after, day 3 is the second day after and well, you can see where it goes from there.

So now I am just into day four (since it is now 3:16 in the morning, Sunday).

After a certain number of these numbered days you start to improve some each day and then you start counting your way back to feeling like yourself. I have been really lucky and for most part haven’t felt an incredible cumulative effect from these chemos. But, with chemo round five and now this last one, things have changed a bit for sure.  I think it is the heat. It was really hot the weekend of my fifth chemo and so I was not able to take walks through the day – the heat just turns me upside down. But, with the prior chemo rounds it was cool enough for me to walk most anytime of the day. In my fourth chemo round I was still walking a mile in the morning  or evening on Saturday (the day I am “hit” by the side affects of the chemo). But, it has been too hot to do that the past two rounds.

I did go for a short walk this am, while it was cool. And then I went for a walk around 1:30 am with Andrea who is my caretaker this evening. She was kind enough to go with me and walk my pup Molly at the same time. We heard and then saw a bat flying overhead (that was pretty neat). Anyway, it felt great to walk in the cool air and I felt much better after the walk. So, I think that it the key for me, being able to get exercise during this time, but also being able to stay cool.

Tomorrow (okay, today I mean) I am going to go out early and try to get in a long walk and then repeat it again in the evening.

Well, I am doing pretty well right now, happy to be nearly done with this last chemo and looking forward to the break ahead. From what I am told by women who have gone through this, everything else I have to go through with the treatment (surgery, reconstruction, radiation) the chemotherapy is the worst part of it. Nice to know I guess. And, if it is true then I am glad to be getting the worst part of it out of the way.

Please continue to keep me in your thoughts and prayers, it means so much.  And the traffic on my blog really makes me feel good to know that my friends are following me. Thank you.

LAST CHEMO IS TODAY!

16 Jul

Today is my last chemo. I can’t wait to be done. I am definitely weaker now and that is frustrating. But, considering everything, I am doing really great. I am having a great response to the chemo. My cancer has shrunk significantly.  So, all is good. And, even though I am pretty tired, I have worked full time (except for the actual days of chemo and the weekend following chemo). With each round so far, I have gone back to work the next day (on Friday) and met with clients and put in a full day. And, with most chemo rounds, I was working from home – laptop in bed – on Monday. I would work a little bit, rest a little bit, work a little bit and rest a little bit.  Fortunately, my work doesn’t require much physically. I am writing mostly. But, this last chemo round was not so easy.  I did get anemic and wow, I could really feel that.  I still feel it, although it feels as though I have improved in that regard (I will know when I see my blood work tomorrow morning).

What a crazy ride this has been. From incompetent doctors and a near death experience to the most amazing people showing up in my life in ways I could not have imagined they would, helping me in ways that I would not have expected. I don’t know what to say, except that I am so incredibly grateful for the latter part of course, not the incompetent doctors or the near death experience) 🙂 I am grateful for the incredible support of my family, friends, and new friends and I am so grateful for having only one more chemo left. (If you have read prior posts, you will see that Dr. Gloom had told me that I might need more chemo after surgery. But, I have since met with a specialist who specializes in my specific type of breast cancer and she has made it very clear that I will not receive more chemo).  My current oncologist is a general oncologist (not a breast cancer oncologist).  He deals with all types of cancer and just doesn’t really understand the treatment protocol for my type of breast cancer. Thankfully he follows whatever UCLA says he should do. But, in the interim he comes up with some wacky comments and doesn’t really seem to know how to filter what he is saying (as in he ought to really know what he is talking about before he talks . . . this is the same guy who argued with me about how may chemo rounds I had received . . . aaargh).

Anyway, this one is my last. So grateful for that.

I am bracing myself for the possibility that the sixth round may be as difficult as the fifth and, or, I suppose, could be worse. But, it could also be a lot easier (which is what I am really hoping and even expecting – why not? My third and fourth chemos were by far easier than my first two).  In either case, I am prepared and will recover and do well.

Okay, this post seems a little whinier than most. I am still going to post it.  But, I will do a follow up that is less whiny 🙂

Thank you so much for your continued prayers and support. I so greatly appreciate it!

Treatment Plan

26 May

Well, this is the crummy part.  I can not sleep.  It is three in the morning and I still can’t get any sleep.  Last night was the same, so I am going on two days without more than an hour or two of sleep.  And I was doing so well there for a while.

I will get back on track.  Hopefully tomorrow will be better.

So, since I am still awake, I might as well write.

Treatment Plan: So here is the treatment plan that I was given.  I am to have a total of six chemotherapy rounds.  In addition to the chemo, I am also on a targeted therapy called Herceptin.  Herceptin works on HER2+ cancer (the kind I have).  It is an amazing drug and I am so grateful that Dr. Slamon at UCLA developed it.  He has saved the lives of so many women, curing a type of breast cancer that once was really not curable. The chemo will be followed by surgery and then, most likely radiation. Reconstruction will fit in there somewhere – but, I am still doing research, interviewing plastic surgeons and learning about the different reconstruction options (especially given the likelihood that I will have radiation as part of my treatment).

Neo-adjuvant Treatment: When chemo is given prior to surgery it is called neo-adjuvant.  In some cases chemotherapy precedes surgery in order to shrink the cancer so that surgery can even be done.  That is not the case with me.  My tumors are small and as a result I could have surgery at any time.  However, the reason to do neo-adjuvant chemotherapy in my case is to see if we can watch the cancer shrink.

The advantage of doing chemotherapy prior to surgery is that we can watch and see that the chemotherapy is actually working.  If I were to have surgery first, followed by chemotherapy later, then there would really be no way of knowing if the chemotherapy was effective with my cancer because we could not watch it shrink during chemo since it would already be removed.

This is significant for me and was a major reason why I chose to do the chemotherapy first. Everyone responds differently to treatment. And while it is more likely that the chemotherapy will work, I will have a greater peace of mind if I can know for sure.

For me it is all about making sure that I do everything I can to fight this disease now, stop it in its tracks and prevent it from coming back.  If we can watch the cancer shrink, then we know that the chemo is working on my cancer and that it is then also killing the microscopic cancer cells that are floating around in my body (that without successful treatment, would come back).  The kind of cancer I have – invasive breast cancer, that is HER2+, has a very high reoccurrence rate.  That is why the treatment is so aggressive even though my tumors are very small.  By adding radiation to my treatment plan, I can further reduce the chance of having a reoccurrence.

The other possible (hopeful advantage of having chemotherapy first is that I could have what they call a “complete response”.  About 40% of women with the kind of cancer that I have, who undergo the kind of neo-adjuvant therapy that I am doing, experience a what is called a “complete response” – meaning that prior to surgery the cancer is eliminated.

If there is a complete response, then when I have surgery the surgeon is removing dead cancer.  This would be best. It doesn’t change the need for surgery. But, it makes the surgery easier because there is no risk of infecting healthy breast tissue with cancer because the cancer is dead.  So, that is what we are hoping for.

I am nervous about the upcoming breast MRI. The specialist I met with at UCLA said she would not do one until I was done with all six chemotherapy rounds. She said that she would not interrupt the chemotherapy. When I asked her what if I was not one of the 40% that has a complete response prior to surgery, she said “You’ll be on Herceptin for a year, what are you worried about?”  Um, dying . . . that’s what I am worried about.

It was good to hear that she was so confident. But, unfortunately I don’t get that kind of reassurance from my actual team.  Instead, I am told that I have a good prognosis. But, I am also told that the kind of cancer I have has the highest reoccurrence rate.  I am also told that some patients come back with brain cancer.  It’s not all rosy sounding.  Well, okay, none of it is actually.  But, I cope and I am grateful, so grateful that there is a drug that targets the kind of cancer that I have. Not all women respond to the treatment, but hopefully I will.

My Own Treatment Plan: In addition to the treatment plan that my oncologist and surgeon have put together, I have also put together my own “treatment plan” that includes a very changed diet and as much exercise as I can.

From the moment I was diagnosed I changed my diet. I considered myself pretty healthy before, even was a vegetarian for a number of years (although not most recently). But, after being diagnosed with breast cancer, I immediately changed my diet.  I knew that my cancer was hormone responsive – meaning that in the presence of hormones, my cancer flourishes apparently.  So, I decided to eliminate sources of hormones in my diet.  I had also heard that sugar feeds cancer.  I got a lot of information in the beginning (some of it pretty wacky) that made me pretty crazy.  But, after doing a lot of my own research I chose to make changes that to me make sense.

I don’t know about whether sugar feeds cancer or not.  But, I don’t get a lot of sugar anyway, so that wasn’t a big issue for me.

I have eliminated all dairy products and all meat except for some chicken and fish.  Because my cancer grows with hormones, I have chosen not to get any (at least as little as possible) in my diet.  I was told to avoid soy for the same reason because it is a plant based estrogen and would only encourage the growth of my cancer.

I have gone to a nearly completely organic diet.  I do go out to eat and enjoy that still. But, I make choices that are lower in risk – for example potatoes are very high on the pesticide index – so these are pretty bad unless organic.  But, broccoli, avocado and other vegetables and fruits are on the low end of the pesticide index and so are pretty safe to eat even if not organic.

No doctor has told me that I need to go organic.  But, for me it makes sense.  And, my doctors can’t believe how well I am doing – my white blood count has never left a normal range (normal, as in a normal person who is not going through chemotherapy) and my red blood count (something that typically gets low, causing anemia and pretty bad fatigue in chemo patients) is also within normal range.  I think this is due to my diet and exercise (maybe more from the exercise, I don’t know).  All I know is that so far, I am doing really well with the treatments (except of course for the time my first oncologist – who has since been fired – tried to kill me . . . I will save that for another separate post).

I have also eliminated caffeine.  I was told that caffeine was okay.  But, it is not.  I stopped having coffee months ago. But, only just yesterday found out that the drug Herceptin does not interact well with caffeine – that caffeine reduces the effectiveness of Herceptin. This was in a study, not even all that recent.  Yet, my doctors were not aware of this at all.  Amazing. There must be so much to keep track of I guess, especially if you are a doctor treating many different types of cancers.

Still, I am just so glad that I had eliminated caffeine. I would have been devastated to learn that caffeine reduces the effectiveness of Herceptin if I were still drinking coffee. I wish I could tell every woman that is getting Herceptin treatments about the bad interaction with caffeine.

In addition to diet, I have begun an exercise plan too.  Recent studies show that exercise during chemotherapy increases T cells and reduces the rate of anemia (caused by a reduction in red blood cells).  70% of chemotherapy patients get anemia.  But, for some reason those that exercise regularly throughout their treatment, have a lower rate of anemia. So, I am trying to prevent anemia by getting as much exercise as I can.

Obviously some days are simply not an option. But, I try to get in a one mile walk every day.  I was able to keep that up this past week. I plan on going to the gym next week (after the MRI and before my next chemo on June 4th). Assuming, of course, that the MRI results are good and that I am then still going ahead with the fourth chemo round.

Well, I think I have had enough, it is 3:40 am.  Maybe now I will be able to get some sleep.