Research Studies (Metformin and Longitudinal Database)

I have been asked to participate in two research studies being done at Hopkins.

1. Phase III - Randomized Trial of Metformin vs Placebo on Recurrence and Survival of Early Stage Breast Cancer - I stopped this study in April 2013 after I continued to lose weight and was unable to maintain a normal level.  I will no longer be participating in this study.  

This study will help determine whether Metformin can decrease, or affect, the ability of breast cancer cells to grow and whether this drug will work with Tamoxifen to keep cancer from recurring.  Metformin is currently being used to treat diabetes.  This study will help determine if it is better to receive Metformin with usual treatments of breast cancer.  Half the participants in this study will receive Metformin in addition to other treatments, while the other half will receive a placebo.  Previous studies of Metformin have shown that it may decrease the growth of different types of cancer cells.  Meformin lowers the level of insulin, a hormone found in the blood that can be associated with worse breast cancer outcomes.  In addition to taking Metformin, blood samples are also taken at specified times during the study.  This is a double-blind study, meaning that neither myself or my doctors will know if I am taking Metformin or a placebo.

• Common side effects (likely)
• Diarrhea
• Nausea
• Vomiting
• Abdominal bloating
• Gas
• Loss of appetite
• Less likely
• Loss of taste or metallic tastes
• Minorweight loss
• Reduced appetite
• Rarely
• Rash, redness, or itchiness
• Decrease of B12
• Anemia
• Inflammation of the liver

I will start taking either the Metformin or the placebo on 1/11 when I start taking Tamoxifen.

      2. Breast Cancer Program Hormone Therapy Longitudinal Database

This study is being done to learn more about the side effects of breast cancer hormone therapy and if a person's genetic information may help to develop a way to predict the side effects a patient may have and how best to treat them.  It will also help the researchers to look at how the side effects of hormone therapy influences a participants willingness to continue hormonal treatments.

I will be filling out questionnaires periodically that will ask spesific questions about how I am feeling, if I am taking the medication regularly, and any changes to my medication list.  I completed a base line and will fill out one at 3, 6 and 12 months.  This is all computerized, so I will be able to see what has changed and it will highlight things that are out of range.  My oncologist and myself will have access to the results, and they can be used to facilitate conversation about any issues I am having.

16 Balloons

16 chemo treatments = 16 pink balloons!!!!!!  Thanks, Kevin & Julie, for the idea and for celebrating my last day of chemo. 

Chemo 100%

OMG............it's official............................I am 100% through a total of 16 chemo treatments.  Today is a good day.  I'm so excited.  There really are no words to describe how happy I am right now.

In honor of today, my girl Julie had a great idea to release 16 pink balloons into the air.  So, tonight that's what we are going to do to celebrate this huge milestone in our journey.  Hopefully, we get some good pictures that I can share.

I would like to take a moment for a HUGE THANK YOU to my girl's - Emily, Erin, Lauren, Julie, & Christel.  They provided chemo presents for each treatment.  They were just small things, but I looked forward to opening them.  I can't list everyone individually, but I have been blessed with lots of love from lots of people, including parents, siblings, aunts, uncles, co-workers, friends and co-survivors.  I received texts, cards, flowers, food and LOTS of LOVE.  If you showed me your love, I noticed and I appreciated everything even if I have not thanked you in person.  And I can't thank everyone enough for all their help with Charlotte.  I have needed lot of people to help watch her, and someone always came to the rescue.  Steve deserves an EXTRA HUGE thank you and big pat on the back.  He went to 15 chemo treatments with me and every doctors appointment I have had.  

Even though I still have more milestones to go before I am officially "done", chemo in my book is one of the biggest and most difficult.  I made it through and am coming out the other side smiling and extremely positive!!!!!!    

Rebounding

I have finally rebounded.  My ANC count today was 2,569.  That's a huge jump from Sunday's 190.  I will be able to have chemo on Friday as planned.  Things are looking up.  Thanks for all the prayers and thoughts.

Slowly but Surely

My counts are slowly on the rise and are currently 100 - Woo Hoo!  I am feeling good.  Just waiting for a good count so I can be released.  I am starting to go a little stir crazy being here and definitely missing my girl.  Hopefully, this time tomorrow I am home.  Six days here is plenty.         

Monday - 0
Tuesday - 0
Wednesday - 21
Thursday - 0
Friday - 41
Saturday - 100

Extended Stay at Hotel Hopkins

My counts took an exciting leap to 21 yesterday.  They have, however, taken a not-so-good decrease back to 0 today.  So far, all my bacterial and viral tests have been negative, so they are not really sure what is suppressing my bone marrow.  There are still some tests cooking that might point us in a direction of an infection in the next day or so.  I have not had a fever since my first day here, so that is definitely a good sign.  Overall, I am feeling pretty good.  Tired and a little run down feeling, but that’s to be expected from chemo and having low counts.  If my counts are still not up in 4-5 days, they will talk to the Hematologist here on what other options we can disucss to increase my ANC levels. 

I will be here for at least a few more days and quite possibly over the weekend.  My spirits are still holding strong, and I am trying not to get too discouraged about my counts.  I am definitely missing my baby girl.  Steve got to spend some good time with her yesterday evening, so it was nice she got to see her daddy for a little bit.

Thanks for all the prayers and thoughts over the last few days.  Continue to pray that my counts will increase (preferably on their own), and that I will be able to head home soon.  It is somewhat of a comfort to be here away from germs, not that I am 100% protected since I am in a hospital, but the protocol for my floor is pretty good at protecting the cancer patients from germy germs. 
       

Time to Rest and Regroup

Looks like I will be spending a few days of R&R in the hospital.  My ANC is officially 0.  Early Monday morning I woke with chills, fever, headache.......the works.  After two calls to the on-call Oncologist, we were told to head to the ER.  By the time we got to the ER, my temp was 101.8.  I was omitted really quickly.  Although it took all day for a bed to become available on the Oncology floor, I was in a nice holding room while we waited.

I have had lots of blood drawn.  It seems like they have taken it all.  They are doing cultures to see if they can find any bacterial infections so they can give me the proper antibiotics.  I am already on two antibiotics that cover a broad range of things.  I had a slight reaction to one of the meds.  I got red and blotchy and started to feel itchy.  My entire head got bright red.  Since that first reaction, I have been doing ok with this particular med.  I had what is called red man syndrome.  It's not an official allergy.  This morning they did a swab to test for any viruses.  Unfortunately, until those results are back (24-48hrs) I am in isolation, and everyone around me has to wear a gown, gloves, and masks.   

They are still optimistic my counts will start to rise on their own, so it's just a waiting game until then as they attempt to treat whatever is causing me to feel sick.  They think I will be here for a few more days, but I am hoping by Thursday I can go home.  They did say they won't release me until my ANC is at least 500, or at least constantly rising.  Hopefully, once they start to increase, they will do so fairly quickly.

So until then, I am resting, resting, and resting.  I have lots of girly magazines, my Nook, laptop and the TV to keep me entertained.  The real challenge is keeping Steve entertained.  He is definitely not enjoying the virus precaution he has to wear.

Charlotte is also a little under the weather.  In addition to cutting her top two teeth, she has her first ear infection.  It's hard for me not to be there with her when she is not feeling well, but I know she is in good hands with her mom-mom, pop-pop, Uncle Tommy and Uncle Ryan.  She will be so spoiled by the time we get to see each other, but I know she is having a blast with all the attention.      

Holding Steady

My counts have not changed from Wed and are holding steady at 80.  Unfortunately, they are not moving up, and I was, again, unable to receive chemo this week.  I am, however, feeling better so that's good news.  The nurses and my doctor both said a drop this drastic is very uncommon, and the nurse said she had never seen such a drastic drop.  It's even more uncommon not to see a rise in counts after 2 weeks without treatment.  They are a little stumped at why my bone marrow is not rebounding as it should.  They will recheck next Friday, and if its still not in a good place, we may start doing the shots again to give me a boost.  Although I hate the shot, and they make me feel like I have been hit by a truck, it's better than not being able to fight an infection.

Today is SHIT - Sure Happy It's Thursday.  (If you know me well, then you are probably very familiar with this saying).  It's also what I like to call Champagne Thursday, and although we have gotten out of the habit of regularly celebrating this day, it's one of my favorite things.  My girl Christel sent me this picture, and I just had to put it on here in honor of the day and the pink.  Cheers!!!!!  Have a wonderful weekend.   

Low ANC - Neutropenia

Here's a little medical education and what having a low blood count means.

The normal neutrophil count is 2,500-6,000.  When you have 1,000 or fewer neutrophils, your risk of infection is increased.  When it's lower than 500, you are at risk for getting a serious infection.  This condition is called neutropenia. 

Things I need to look for given my neutropenic status at 80 ANC count"

• Fever - 100.5 is the magic number
• Shaking chills
• Flushed skin
• Sweating (guessing my hot flashes don't count)
• Frequent urination or burning
• Redness, tenderness, or pain anywhere in the body  
• General feeling of tiredness or flu-like symptoms (sore throat, sneezing, runny nose, coughing, nausea, vomiting, diarrhea, shortness of breath, chest discomfort)

General precautions I can take:

• Wash, wash, wash, wash hands.
• Check temp. throughout the day - looking for that magic number.  No Tylenol products can be used since they suppress a temp., and we would want to know what it is.  
• Check for any sings of infection in cuts, mouth, etc.
• Shower or bathe daily - seems strange, but I guess people don't already do that. :o)
• Rinse teeth and gums after meals and at bed time.
• Use a soft toothbrush.
• No flossing. (Good thing I don't ever do this.) :o)
• Avoid contact with crowds, people with illness/infections, and public places.
• Avoid working with dirt/soil.
• Avoid cleaning bird cages, cat litter, and fish tanks. (Good thing Puddy became an outside kitty months ago.)
• No manicures or pedicures.
• No hot tubs and jacuzzis.
• Limit exposure to fresh flowers, house plants, and stagnant water.
• Be careful to avoid cuts and scrapes.
• Cook meat until well done, and limit exposure to restaurants since you don't know how the meat was prepared.
• No salad bars or buffets.

There are others, but they are a little TMI so I won't share them.

Today I have been trying to disinfect things and clean some of the toys that make it into C's mouth on a regular basis.  If only we could see germs.  This reminds me of the chorus to one of my favorite kid songs.  "I hide him in my pocket cause he's very, very small.  Germs, germs, my invisible dog."

There is, unfortunately, nothing I can do to increase my counts.  My body has to rebuild them on its own.  The only thing I can do is take precautions, and try and limit my exposure to germs so I do not end up in the ER or worse, spend days in the hospital.

Remember those nasty shots Steve was giving me during phase 1???  They were the only thing keeping me from taking this turn before.  Because they take cells from your bone marrow to make new white blood cells, they are hard on the body.  I know at this point they are not recommending I use this, so we will patiently wait for my body to kick back in gear.  I just hope once they are back up, I will be able to maintain a healthy level going forward so we are not continuing to push treatments back.

Moving in the Wrong Direction

My body is rebelling on me.  I have been fighting something since Sunday.  I am still clear of any fever, which is wonderful.  I am, however, feeling poopy and have what they think is a viral infection.  Since I was not feeling a whole lot better, my NP wanted to see me today.  They swabbed me for strep just in case, since one of my nieces had strep last week, and I might have been indirectly exposed through Grandmom.  Those results were not in when I left, but they will call if anything came up.  They also rechecked my counts, and they are on a downward spiral.  I think in my last post I said I was under 1,000.  I was actually under 200 last week.  I apparently need to take a class on how to read my lab reports.  Now that I am looking at the right line, my counts are down to 80.  Not the improvement we had hoped.  She said there is not much difference between 80 and 0 at this point.  I will most likely not be getting chemo on Friday, unless my body works very hard at replenishing my white cells.  In an effort to keep our exposure to germs to a minimal, Char will be staying home with me the rest of the week.  She was actually running a low grade fever this afternoon, which I think is just her top teeth breaking through.  If she comes down with something more serious than just teething, we will have to be separated until it passes.  They did put me on a strong antibiotic to help combat my exposure to things.  I am still checking my temperature several times a day.  A fever would not be good at this point. 

Please pray for a speedy recovery of my counts, and also, that Charlotte and Steve will stay healthy in the process.            

No-Go for Me

Today I arrived for chemo, excited to be 25% through phase 2 of my treatments.  I had my blood drawn and saw the doctor.  Unfortunately, when I got back to my cubby, my blood work had come in and my counts were very low.  Just to double-check, my nurse redrew it just to make sure it was not a lab error.  There was no change.  I am or have (not sure which) leukopenia.  My white blood count is under 1,000, so I was unable to receive my treatment.  As she was putting the fear of God in me about germs, eating meat that is not cooked properly, fever, chills, being in crowds, etc. .......I started to cry.  Aside from being disappointed it will be one week longer than I thought before I am done, I have to be super careful not to catch anything.  Having an 8 month old makes that difficult.  A fever or anything questionable will most likely land me in the hospital.

On a happier note, Charlotte and I started getting back into the groove this week.  Charlotte started back at Celebree.  She did great, aside from being so busy she didn't want to take the time to drink her bottles.  She is loving being back with all her friends and playing.  I also went back to work this week.  I wasn't sure how I would feel about it, but I am SO happy to be back!!!!  My first week went well, definitely a step in the right direction.  Given what we learned today, it's probably not ideal that we are both back in environments where there are lots of people and germs, but we will take the necessary precautions to hopefully limit some of our exposure.   

Phase 2 - 1 Down, 11 More to Go

I survived my first treatment of Taxol, and I must say it's pretty awesome in comparison to AC......at least so far.  I met a lady on Thursday when I was at Hopkins for blood work who was almost done her Taxol treatment.  She stopped over to say hi and get a peek at Charlotte (who was a hit with all the nurses and a few patients).  I asked her how Taxol was, and she said "It's like heaven compared to what you have already been through".  And so far I have to agree.  It's so much better.

It was a rather long treatment, but they said the first two would be the longest, and then they would be much faster.  I didn't have an allergic reaction, which was also great.  My blood work looked great, although it will probably not be the case as we progress through this phase.  Today, I felt pretty good.  I needed a nap this afternoon, but I was not on the couch feeling horrible and dreading the days to follow. 

1 down - 11 more to go!!!!!

The doctor commented on how good I am doing handling everything and said whatever you are doing, keep it up.  I'm not saying that I don't still have my ups and downs and emotional breakdowns.  I am not made of stone.  But, I know it has been everyone's prayers for both me and Steve over the last few months that have got me through.  And no matter how difficult it is at times to have an 8 month old baby when I am always tired, I 100% believe that God put Baby Charlotte in our lives at the exact right time.  There is no better thing than seeing her smiling face in the morning or tucking her in a night.  She is the best inspiration I could ever ask for. 

Taxol Here I Come

Friday will be my first of 12 treatments of Taxol.  This time around, the steroids are taken prior to going in, which entails talking 5 pills, yes 5, the night before and 5 the morning of chemo.  I am anticipating a very sleepless night Thursday since I will be hyped up.  I actually had a very sleepless night last night, so today I am definitely dragging as I am tired on top of my normal chemo tired.  I am looking forward to less nausea with this round as I have been told it's not nearly as bad as with AC.  I am hoping my appetite returns to something resembling normal as I continue to lose weight.  I am by far the smallest I have been in my adult life (some people will find this hard to believe).

I am happy to report that my hair is very slowly coming back, or at least it seems to be.  I am not sure if it will continue to grow as I progress through Taxol since hair loss is still a side effect.  I still have my eyebrows and lashes thanks to Alexis, who recommend using Brian Joseph's Lash and Brow Gel.  It seems to have done the trick, at least through phase 1 of chemo.    

There are certain smells that trigger my gag reflex now that didn't seem to bother me before chemo.  All are smells that I encounter during treatment.  The hospital smell, the smell/taste of the medicine they flush my port with at the end of treatment, and other whiffs I get that just remind me of those smells.  Just typing this makes me think of them, and I want to throw up on my lap top.  I also don't think I will be able to drink anything that is red ever again.  Hopefully cosmos will not trigger this or that will be so depressing.  One of the drugs used during phase 1 was red, and you see it being administered through the IV.  I actually hadn't really thought about that until the nurse and I were talking, and she mentioned how other patients have had a hard time with red liquid after they were all done treatment.  That definitely ruined it for me.

It's Official...I Have Chemo Brain

Chemo brain is here.  Since I will be having treatments for a few more months, it looks like my CB will be here for awhile.  I am not sure I ever fully recovered from the infamous prego/mommy brain, so at least those close to me are semi used to it. 

I will think of something I have to do in the morning, and by the afternoon, I have completely forgotten about it.  Sometimes I will remember hours after I should have done something, but most of the time I only remember if someone asks me or I see it written down.  Or sometimes, it just randomly pops back in my head.  I also have to be fully focused on what someone is saying, or I won't even remember conversations.  If you tell me something important, don't feel bad asking if I wrote it down.  It's like I am in a little fog.    

Easter Do-Over

Yesterday, we had Easter dinner #2 with my family.  Since we missed out the first time around, my mom hosted another meal for everyone.  My sister is also in town visiting from GA, so we all got to hang out and spend time together.  There were lots of yummy foods and good conversation.

It was also time for everyone to see me without hair.  I wore a scarf for most of the day.  When I took it off, the little girls would walk past and give me a little stare.  I'm not quite sure what they thought.  I got a few to rub my head and laugh.  We asked Nina, who is 2, what happened to my hair and she said it blew away.  My one niece, Faith, who is 4, is fascinated by it.  She has seen me a few times, so it's not new for her, but each time she laughs and says, "Your hair fell out".  Then, she will ask lots of questions about it.  Yesterday, I had a smooth head for the first time, and she said, "How come your prickly hair is gone?"  Kids really are the best medicine.     

Bald Is Fabulous

The morning of my second chemo treatment, my hair started falling out.  Since I didn't particularly want to see it all over the place, and I knew I would not be up for it over the weekend, I decided to call in the forces and shave my head.  Some of my close friends came over for some Friday night pizza and fun.  We made it a family affair, and everyone took a turn with the clippers.  I had a mohawk at one point :O)  Steve also joined in to show his support by shaving his head.  He's a little afraid it won't grow back since he has a little receding hair line already.  Oh, and our friend Crossie also shaved his head that night. 

Although it was traumatic to have to shave my head, everyone, including myself, held it together and there were no visible tears, just some teary eyes.  I am doing ok with not having any hair so far.  I look at it as one more step closer to being done and another thing to check off the list.  Plus, the added bonus of not having to shave all those girly places is very close in my future.  I am excited to use all the scarves I have been collecting.  I do have a pretty small head, so some of the hats I have are a little too big.  Baby C now officially has more hair than both her parents.  She even showed her support by coming home from Mom-Mom's with her own head wrapped in a bandanna.  It was really cute. 

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2nd Chemo Treatment

My second chemo treatment went well (now 50% through phase 1 of chemo).  After discussing some of my side effects with my doctor, he suggested changing a couple things.  First, he switched to a different anti-nausea medicine and second, they increased the drip time on one of the chemo meds.  I am not sure which one did the trick, but I did not get the horrible headache like the first go-round.  The first few days were still not pleasant, but I made it through, and it didn't seem to be quite as bad as the first.  I am sure part of that was because I knew what to expect.  I also increased my fluid intake and tried to drink an 8oz glass every hour. 

C had a little sleep over at her mom-mom's, so I had plenty of time to rest over the weekend.  She had lots of fun playing with Uncle Tommy & Uncle Ryan.  Poor Steve had to deal with not only a grouchy chemo girl, but also a grouchy PMSing one.  Poor guy, but he came out in one piece. 

Aside from the lingering fatigue (that is driving me crazy), I am trying to get back to normal.

Birthday Bust

I turned 31 last Saturday.  It was pretty much a bust since Baby C was still running a fever and was extremely unhappy.  I thought I was going to pull my hair out before it even had the chance to fall out.  Unfortunately, we had to cancel our dinner plans with friends.  Steve did, however, whip up a really yummy dinner for us at home, and our friends Jeff & Emily came over from next door.  I even got to blow out candles as they sang "Happy Birthday".

I am not looking forward to the long journey ahead in my 31st year.  It's going to be a difficult and hard year, and I will be extremely happy to turn 32 and say goodbye to 2012.  But, I do have LOTS to look forward to (not necessarily in this order):

• Finishing treatment (definitely #1 in terms of importance to me)
• The birth of Baby Girl Overcash
• My girl Christel's wedding and all the festivities that go along with being in her wedding
• Charlotte's 1st birthday
• My dad's 70th birthday
• Our 3rd wedding anniversary
• Family vacation in OBX
• My 1st Mother's Day (Steve says last year did not count even though I was pregnant)
• Boating with the Runds
• Watching Baby C grow and all the fun things she will be doing this year 

I am sure I am forgetting some and all the other yet-to-be planned events. 

Carbing It Up

I am feeling really good as I get ready for my 2nd chemo treatment.  Charlotte is finally better, as well.  Last week, after running a high fever for a couple days, we made a trip to the pediatrician's office.  One good thing about my current situation, I get called back right away and do not have to sit in the waiting room with the germs.  They also provided me with lots of face masks in case I need them at home or when I go in public.  Since C had a viral infection, I was worried all week I was going to come down with something, but so far so good.  My baby girl is finally happy again, and last night she finally got a good night's sleep. 

This week, I am trying to carb up and eat lots of yummy foods.  After the last Chemo treatment, I went two days unable to eat.  My appetite eventually came back, but not as quickly as I would have liked.  I am trying to gain a few extra pounds as my weight teeters at what I consider an unhealthy level.  My oncologist was not concerned about my weight, since the steroids I am given at each treatment should help me gain and not loose.  I am sure at the end of my 5-month chemo regimen, the steroids will have done a good job, and I will be writing about losing weight.  We shall see.

4 Days Post Chemo

Chemo is horrible.  I would not wish this on my worst enemy.  I am still feeling pretty crappy 4 days out.  My appetite seems to be regaining strength, although slowly.  I am drinking lots and lots of water.  Up until Sunday afternoon I had a horrible headache.  At first, I thought it was a side effect of the anti-nausea meds, but it turns out to be one of the many side effects from the chemo.  The headache is much better today, but is still lingering.  The nausea is being suppressed with the meds, but I still run to the bathroom a couple times in the mornings.  I am very tired and don't have tons of energy, but taking naps help.  I normally have too much energy.  Now it's the complete opposite.  If you know me, then you know I hate to nap, and it has never been my thing.  I think for the next couple months napping will be my new friend.

Our Easter weekend was a bust.  Steve and C were also down for the count.  Steve threw his back out on Saturday, and C ran a fever Sat-Sun.  Poor Charlotte missed her first Easter since we had to stay home and didn't get to go to Grandmom and Papa's for dinner and the Easter egg hunt.