Labs, labs, labs

CA 27.29

What is this crazy table you might ask? It is my gospel. I live and die by the numbers I get from this lab test every month.

The cancer antigen 27.29 (CA 27.29) is a blood test specifically for those with breast cancer and can be used for many things. It is considered a tumor marker and can be used in part with other tests to diagnose breast cancer, although it is rarely used as the only diagnostic criteria. It can be used to monitor how well someone is responding to treatment. If the levels rise, that might indicate that the cancer is progressing which means a different or more aggressive treatment is needed. If the levels fall (as thank god mine have), it might indicate that the current treatment is killing the cancer cells effectively. And finally, it can be an early indicator for those who had early-stage breast cancer who had been previously in remission that there might be a recurrence of their cancer and additional testing should be done.

I get super antsy as I near appointment time every month. My nerves become incredibly frayed and my temper and patience become non-existent. Before each appointment I have my blood drawn for a host of things, the most important being my tumor markers. It is the most important test of the bunch. Unfortunately? It is a test that gets sent to an outside laboratory.

This means each time I see my doctor and he tells me how pleased he is with my progress, there is always a dark cloud for another 36 hours or so. I don’t know for another couple days if my tumor markers have continued to trend down, or if the unthinkable has happened and they went up.

I have six days until my next appointment with my oncologist. Eight more days or so until I find out if I can do a happy dance or if I will find myself facing the worst case scenario after only two cycles of my new medication regimen.

Let the nervous breakdown begin.


Jennifer – Extensive mets to bones. Diagnosed de novo at 43 of ‘unknown cancer’ on 9/25/2018, official diagnosis of metastatic breast cancer with bone metastasis on 10/9/2018. Cancer won’t win. I won’t let it. Life’s too short not to fight for every minute.
Dx 10/9/2018, invasive ductal carcinoma (IDC), left breast, 1.5cm, Nottingham Grade 6, hormone receptor positive, ER+ (estrogen receptor)/PR+ (progesterone receptor), HER2- (human epidermal growth factor), BRACA- (genetic mutation), Stage IV, metastasized to bones
First CA 27.29 10/9/2018 83 (goal <38)
Hormonal Therapy 10/12/2018 Tamoxifen (Nolvadex, Apo-Tamox, Tamofen, Tamone) pills
Targeted Therapy 10/12/2018 Xgeva (Denosumab) injection
Hormonal Therapy 10/19/2018 Lupron Depot (Leuprolide Acetate) injection
Surgery 11/29/2018 Vaginal hysterectomy with bilateral salpingo-oophorectomy
First CA 27.29 post hysterectomy 12/10/2018 73 (goal <38)
Hormonal Therapy 12/11/2018 Femara (letrozole) pills
Targeted Therapy 12/23/2018 Ibrance (palbociclib) capsules
First CA 27.29 post medication change 1/10/2019 60 (goal <38)
Advertisements

But I thought you were on chemo….

Ibrance indications
One of the biggest questions I am asked when people find out I have breast cancer is about my chemotherapy. I take oral chemotherapy medications and a monthly injection, rather than one that is through an IV or a port. I take Ibrance along with a second medication called letrozole.

Before I go any further I want to comment on just how funny marketing departments are. Some days I wonder whether or not they even think about what they are saying in their advertisements. Today I received an email from the company that makes my medicine. As you can see, one of the indications is for women who have gone through menopause. Pretty simple, right?Before you take Ibrance

Then a little further down, it tells you to tell your doctor if you are able to become pregnant and if you are to use birth control. WHHHAATT? Please explain to me how a post-menopausal woman can become pregnant? Did I miss something in sex ed class?

Well in all fairness, I went to a Catholic high school in the early 90’s. I am not lying when I say that when we learned about AIDS it said something like ‘AIDS can be prevented by using {black marker}.’ Yes, anytime the word condom was used in the text, they marked over it with a black marker. No wonder I had three kids by 23. I thought if I had a black Sharpie in the bed with me, I wouldn’t get pregnant! 😂

But still. I can’t help but scratch my head as I try to wrap my head around ‘able to become pregnant’ and ‘post-menopausal.’ Feel free to comment if you can explain to me how these two things are compatible.

Anyway, back to my original point. I’m a nurse yet I was always led to believe that the only way chemotherapy was administered was through an IV. Breast cancer has opened my mind about how little I really knew about cancer treatments. Chemo can be given in lots of different ways. Through the traditional IV form, oral forms, shots just under the skin or into muscles, among many, many other ways.

Since my diagnosis I have had two chemotherapy agents that are administered through a shot into muscle. The first one is an antineoplastic agent called Lupron Depot (leuprolide acetate). Lupron is used for many things including treating prostate cancer, endometriosis and breast cancer.

In my case, I have a hormone positive cancer and the tumors were literally being fed by estrogen and progesterone. In order to bring that to an abrupt halt, I was given Lupron to block the hormones. Oh my goodness. My doctor warned me that it would send me into immediate menopause, but I was not prepared for what that would actually mean. Holy macaroni. I was no where near menopause. In fact, I was about as regular as someone could be. Periods literally every 27-29 days like clockwork. Menopause within days? Hot flash on top of hot flash. I am the most cold blooded person alive. I could literally be happy with the temperature being 80 degrees. Now I couldn’t find clothing light enough to not be cooking. Ugh.

The second medication I get through a monthly injection is Xgeva (denosumab) which is a targeted therapy to prevent further breakdown of my bones that had already been invaded by my breast cancer. My calcium levels need to be monitored closely to ensure they don’t go too low and I need to take calcium with vitamin D supplements. Calcium is such a horse pill. My goodness. Thank the heavens for gummies. Now that I have found them, I could seriously eat an entire bottle in one sitting. Thank you CVS!

Prior to my hysterectomy, I took a hormonal therapy medication in pill-form called tamoxifen. Yes, also a chemotherapy medication given for hormone positive breast cancer. It’s given to both women AND men. I still struggle to remember the guys. (Doesn’t everyone?) It is given to both early stage as well as metastatic breast cancer. Long story short, it prevents estrogen from binding from cells, preventing further growth and spread of cancer cells.

Step back to Lupron for a minute. There are some unpleasant side effects to that bad boy and my doctor recommended a hysterectomy and removal of my ovaries so I didn’t need to have further doses. Considering my baby boy (yes Sterling, you will always be my baby) is a 20-year-old sophomore in college, I am way past my baby birthing years. I am 43 years old. I am still young enough to enjoy life. The last thing I want is to be a mom all over again. So when he recommended the hysterectomy I was like cool, can I do it tomorrow?

So hysterectomy done, onto the next set of medications. Bye bye Lupron and tamoxifen, hello letrozole and Ibrance.

Femara (letrozole) is an oral hormone therapy in a drug class called aromatase inhibitors. Apparently, even though my ovaries have been removed, the body still produces some levels of estrogen. (I didn’t know this either!) Letrozole blocks enzyme aromatase (that can be found in the body’s muscle, skin, breast and fat), which is used to convert hormones produced by the adrenal glands into estrogen. I seriously never knew any of this! I swear I am learning more through cancer than I ever did in nursing school!

Ibrance (palbociclib) is an oral targeted therapy that is used in combination with aromatase inhibitors. It’s purpose is to block proteins and stop cells from dividing to make more cancer cells, thereby slowing cancer growth.

I am often also asked, so if you aren’t having regular chemotherapy that means none of the side effects, right? I would love to say that isn’t the case. Unfortunately I still do have side effects, although through experimentation I have found ways to reduce them.

I have dealt with terrible nausea at times. I have eaten only to find myself throwing up soon after. I have lost 40 pounds since my cancer journey began in September. My cancer has metastasized to my bones so bone pain was already an issue for me, and now I am taking medications that have a side effect of bone and joint pain. Fun combination. Unfortunately the medications cause fatigue and I feel like I am always tired no matter how much I sleep. And although I have always shed like a dog, I feel like lately that has become worse. Hair thinning is very common and I am researching ways to prevent it from becoming a serious issue.

Thank goodness I have learned some tricks to improve the side effects. Claritin. Seriously, Claritin? How does that help? The antihistamine helps reduce the increased histamines in the body and helps reduce the pain and lethargy caused by letrozole and Ibrance. A cheap little pill that has been a game changer for me. My doctor also recommended taking them before bed that way I slept through most of the nausea and fatigue. That also has helped immensely.

Metastatic breast cancer really is a journey without an end. So far, I have been incredibly blessed to only have to deal with blood draws, a few shots and more pills each day. My life could be so much worse. So far the cancer cells are responding very well and I feel better every day. My only real fear at this point is whether these medications continue to be effective for years to come. I see some women talk about them working well for them for years while others say it was only a few months before their cancer came back with a vengeance.

I suppose that is what metastatic breast cancer is. A lifetime of looking over your shoulder. A lifetime of that nagging fear. My life could be a year or it could be fifty years. My biggest prayer is that I live long enough for scientists to discover a cure for me and my sisters and brothers.

In the end, my goal is to be around long enough to drive my kids completely insane for decades to come. 🤣


Jennifer – Extensive mets to bones. Diagnosed de novo at 43 of ‘unknown cancer’ on 9/25/2018, official diagnosis of metastatic breast cancer with bone metastasis on 10/9/2018. Cancer won’t win. I won’t let it. Life’s too short not to fight for every minute.
Dx 10/9/2018, invasive ductal carcinoma (IDC), left breast, 1.5cm, Nottingham Grade 6, hormone receptor positive, ER+ (estrogen receptor)/PR+ (progesterone receptor), HER2- (human epidermal growth factor), BRACA- (genetic mutation), Stage IV, metastasized to bones
First CA 27.29 10/9/2018 83 (goal <38)
Hormonal Therapy 10/12/2018 Tamoxifen (Nolvadex, Apo-Tamox, Tamofen, Tamone) pills
Targeted Therapy 10/12/2018 Xgeva (Denosumab) injection
Hormonal Therapy 10/19/2018 Lupron Depot (Leuprolide Acetate) injection
Surgery 11/29/2018 Vaginal hysterectomy with bilateral salpingo-oophorectomy
First CA 27.29 post hysterectomy 12/10/2018 73 (goal <38)
Hormonal Therapy 12/11/2018 Femara (letrozole) pills
Targeted Therapy 12/23/2018 Ibrance (palbociclib) capsules
First CA 27.29 post medication change 1/10/2019 60 (goal <38)

What would Marquita do?

mbc-uterine-logo-small-1.jpg

One of the very first friends to reach out to me in the earliest days of my fight was a former co-worker from a hospital I used to work at. We were the unlikeliest of friends. When Marquita started as a charge nurse I didn’t know quite what to think of this spitfire bundle of energy. As a general rule, I put my initial thoughts aside, rather than deciding at first glance that I dislike a person and as time passed we formed a friendship.

We worked well as a team and shifts were always more fun when I had her to talk to. Marquita was an absolute wealth of knowledge and I think she may be in the top two teaching nurses I have ever worked with. Our unit could be burning to the ground and she never lost her cool. Honestly I can only hope one day someone will look back on their time working with me and have half the respect for me as I have for her.Junkstock, October 10, 2014

The more we talked we realized we had similar interests. One of the most fun times I have ever had was when we both drove up to Omaha, Nebraska to attend Junkstock. We wandered around the festival style flea market on a chilly October day and had more fun than I can describe. It was amazing to see the things people were able to make using common everyday junk. Marquita was drawn to every vendor display with purses. I began to wonder if an intervention was needed! We wrapped up our day of adventures with me introducing her to one of my favorite Italian buffets.

As time passed we moved in different places. I left the hospital we worked at together to take on a new challenge working on a women’s surgery unit. Shortly after I left, Marquita moved to another state to live closer to her family. Even through the distance we always maintained touch. Sometimes we would talk more often than others depending on how busy we were at the time, but no matter what, the friendship never faded.Marquita's quote

On October 10, 2018 I was still in the middle of the bad days. The days when simply moving around in bed caused so much pain. The bedside commode days. Worst of all? This was the day after my first oncologist appointment when I got the final diagnosis. Metastatic breast cancer. I was still so very numb. I was lying in my bed staring blankly at the wall as I did in the beginning. Suddenly my phone vibrated and I looked at it to see one of the most moving messages. The perfect message that I needed so very much in the midst of the crushing depression.

My buddy starts the text out with words of encouragement. Reminding me if I ever needed anyone to talk to, yell with, curse with, anything, she was there. We chatted for a bit before the truth came out. Two weeks prior, around the same time I was diagnosed with my ‘unknown’ cancer, she too was diagnosed with cancer. Stage 2 uterine cancer.Marquita begged me 'But Jen...just one purse...please??'

Who could ask for a better friend in life? Here Marquita is dealing with cancer on her own, worrying about me and trying to lift my spirits. The next week she popped in with funny pictures to make me laugh. I later learn this was after she passed out at work and was sent to the emergency room. While I have been ‘lounging around’ since my diagosis, this tough cookie worked up until she had surgery.

We both had our hysterectomies within a couple of weeks of each other. While I breezed through mine and took my bucket list trip soon after, Marquita had some complications. While I have been incredibly blessed to so far only need oral medications which has been kicking cancer’s ass, she had a port placed to begin chemotherapy and will also need radiation. While my hair might be falling out a tiny bit more because of my medications (hard to tell because I’ve always shed like a dog), Marquita asked the love of her life to shave hers off rather than watch it fall out during treatment.marquita

But through it all this badass is looking to me as an example. Marquita told me ‘So today when this started I said WWJD (what would Jen do). Ha ha. And I just sucked it up.’ What would Jen do? Oh girlfriend, what would you do? What would this beautiful, amazing, courageous woman do?

My friend is going through so much more than me, yet she looks to me as an example of strength. I sometimes wonder in the moments of darkness if I would be able to get through this without my cancer sister. My motivator. My laughter. My friend through thick and thin.The thoughts of a warrior

Cancer sucks. It really does. Our type of cancer might be different, but we are both facing the same beast. Cancer doesn’t care who you are. It will come for you just the same. I hate what it has done to me. I hate what it is doing to my beautiful friend. I hate that our lives have had to take a backseat to this terrible disease.  We won’t let cancer stop us. We are already making plans for the future. Together we are going to visit Junkstock again. We are going to take a roadtrip to see the world (or at least the US).

Everyday I thank God for sending my adopted sister to me. Marquita is my rock. She may think ‘what would Jen do,’ but to me I will always suck it up and ask myself ‘what would Marquita do.’


Jennifer – Extensive mets to bones. Diagnosed de novo at 43 of ‘unknown cancer’ on 9/25/2018, official diagnosis of metastatic breast cancer with bone metastasis on 10/9/2018. Cancer won’t win. I won’t let it. Life’s too short not to fight for every minute.
Dx 10/9/2018, invasive ductal carcinoma (IDC), left breast, 1.5cm, Nottingham Grade 6, hormone receptor positive, ER+ (estrogen receptor)/PR+ (progesterone receptor), HER2- (human epidermal growth factor), BRACA- (genetic mutation), Stage IV, metastasized to bones
First CA 27.29 10/9/2018 83 (goal <38)
Hormonal Therapy 10/12/2018 Tamoxifen (Nolvadex, Apo-Tamox, Tamofen, Tamone) pills
Targeted Therapy 10/12/2018 Xgeva (Denosumab) injection
Hormonal Therapy 10/19/2018 Lupron Depot (Leuprolide Acetate) injection
Surgery 11/29/2018 Vaginal hysterectomy with bilateral salpingo-oophorectomy
First CA 27.29 post hysterectomy 12/10/2018 73 (goal <38)
Hormonal Therapy 12/11/2018 Femara (letrozole) pills
Targeted Therapy 12/23/2018 Ibrance (palbociclib) capsules
First CA 27.29 post medication change 1/10/2019 60 (goal <38)