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)
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A million little things

A million little thingsEvery so often you run across a television show that you can completely identify with as you watch it each week.

I ran across this little gem at the exactly right time in my life. I was diagnosed with (an at the time undetermined) cancer on September 25, 2018. ‘A million little things’ premiered the following night.

I’m not going to lie. I had no clue what to expect the first time I tuned in. One of my favorite movies is ‘Office Space.’ To this day I watch it everytime it comes on so when I ran across a show with Ron Livingston in it I had to check it out. The last thing I expected was how much I would find myself relating to the characters and the situations they would deal with each week.

For those who aren’t familiar with ‘A million little things,’ the premise is how suicide effects everyone around that person after they are gone. That’s how it begins, but there is so much more. Four everyday joes get trapped in an elevator. While they are waiting they all start talking about their lives and things they enjoy. By the time the fire department comes to retrieve them a bond has formed and they become friends.

Okay, well it is kind of a weak basis, but that’s all right. Ironically, the reason I tuned in the first week was to see Ron Livingston, but the character that committed suicide (Jon) in the first episode was the one played by him. It didn’t matter. I was hooked already.Rome

I’m a survivor of a few suicide attempts when I was younger as well as someone who struggles with bipolar disorder. I know all too well just how hopeless things can become until one day you just can’t take it any longer and suicide seems like the best solution. As the pilot episode unfolds you learn that Rome (Romany Malco) was attempting suicide when his friend Gary (James Roday) calls to tell him Jon was dead. That phone call kept him from killing himself. If the call had come a few minutes later it would have been too late and he would have succeeded in his own attempt. In the coming weeks, Rome struggles to understand his own depression.gary cancer

The other topic that the show focuses a lot on is breast cancer, and shows how it’s not just a woman’s disease. Men can also get it. How perfect for me, right? I had literally just been diagnosed with what I would learn two weeks later was breast cancer. You meet Gary and learn he was one of the 1% of breast cancer cases that strike men. I’m not sure if I have ever seen another show tackle this topic as a major theme (or at all). Breast cancer is just for the ladies, right? It’s nice to see a mainstream television show provide awareness that men can get breast cancer too.

Maggie and Gary chemoIn the first episode, Gary meets Maggie (Allison Miller) at a breast cancer survivor’s group. During the episode ‘Friday Night Dinner’ that aired eight days after I learned that the ‘unknown’ cancer I had was metastatic breast cancer, Maggie learned that her cancer had returned and it had now invaded her lymph nodes (it’s unclear if it has moved to a distant site which would make it metastatic).

It is so painful to watch her try to work through the emotions of having believed she had put cancer in her past only to have to fight it again. She asked the question I was afraid to ask. She asked how long she had left only to be told without treatment she wouldn’t live longer than a year. The look on her face shows the emotions I felt as I read source after source that said the average life for a person with a metastatic breast cancer diagnosis is only 2 1/2 years.

As the season has progressed, Maggie continues to wrestle with the decision of whether to seek treatment or if she should accept whatever cancer would bring, even if that meant she would die. You see her struggle to decide whether to endure chemotherapy and deal with the nasty side effects it causes or if she should simply live the best life she could with whatever time she had left.

This is a decision I contemplate daily. While today my cancer is well managed with a strict regimen of oral medications, I realize the day might come when I am forced to make the choice of deciding how much fighting is enough. If it looks like things have gotten to the point that I lost any good quality of life, I think for me it would be difficult to continue to pump toxic medications into my body that did nothing to control or reduce the cancer if all they did was make me violently ill.

It’s not often I discover a show that I can’t wait to see each week. I couldn’t have run across this television show at a more perfect time. It deals with so many subjects that touch my life so deeply and has helped me think about the choices I will ultimately face someday. What a real gem in a television world of boring reality shows.

Note: ‘A million little things’ airs Thursday nights on ABC at 9pm eastern/8pm central.

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)

Tomorrow is another day

Proverbs 31-25It’s funny. I look back on my life pre-cancer and think about the things that were so ‘important’ and can’t help but laugh. I think about the things I thought were so earth shattering and realize just how very inconsequential they really were.

When you have cancer that all changes. Trying to figure out how you would pay this bill or if you had time to do this activity begins to look rather small when now what you need to worry about is will I be here in five years.

Cancer brings about a whole new group of fears. For me, I spend a good portion of the week before my monthly appointments with my oncologist thinking about my lab results, or more specifically the result of my CA 27.29. That test is my tumor marker. That test shows how well my cancer is responding to the treatment I am on.

What terrifies me most is knowing that even though it is working today, that could change so quickly. I read about the particular regimen I am currently on (Ibrance and letrozole) working five years or more for some people. When I read that I begin to feel so incredibly hopeful. Those are the good results. Unfortunately then I see other people saying it only works about six months for them before they need to find another treatment to move on to. When I see that my heart begins to race.

When I was first diagnosed with cancer, all of my hopes and dreams for the future vanished. I’ve been a nurse long enough to know what a stage IV cancer diagnosis means. It means chemotherapy and ports, it means a diminished quality of life and do-not-resuscitate orders. Stage IV means saying goodbye.

I have been so lucky. In many ways, my life hasn’t changed a great deal since being diagnosed with metastatic breast cancer. Physically I am improving and getting stronger every day. While I suffered from terrible pain in those early days, thanks to the monthly injection I receive my bones are recovering from the damage the the spreading tumors caused. I no longer move with a fear of breaking a bone simply by turning the wrong way in bed. I have regained the ability to get around without a walker or a cane and am no longer confined to my bed or home.

I am beginning to make plans for my future. I know that soon I will be able to return to the job that I love. Soon I will live out my dream to become a travel nurse and see the country while working with patients. Soon I will put the last few months behind me and move on.

As I begin to plan for tomorrow, it is hard to push the fear away. It’s hard not to think about the what if’s and the what could be. What if the medication stops working. Could the tumor get larger and move from my bones to my brain, liver, lung, or worse of all, my heart? Could I end up bedridden living out my last days waiting for the end to come?

Today is a good day. Today I am happy and incredibly healthy. Today I have a future. But having a ‘chronic’ cancer means never being able to relax completely. It means always wondering what is behind the next door. It means always looking over your shoulder and waiting for the next shoe to drop. Every day I fight to keep the fear in a small little bubble and to live each day to the fullest. Every day when I wake up I tell myself I will fight. I can’t let that fear take over my life.

The sun will rise tomorrow and tomorrow is another day.


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)