3 July 2023
I met with Dr. Velez today at 2 pm and I feel better after the meeting. He explained that my diarrhea was due to the combination of Perjeta and Herceptin which blocked receptors in my colon and prevented the colon from absorbing anything – thus the watery diarrhea. It seems Perjeta is the major cause and it hasn’t been uncommon to see people admitted to the hospital with dehydration and kidney damage while on the drug. I’ll refrain from commenting about the previous doctor not explaining this.
My cancer is estrogen positive and HER2 positive. HER2 positive is an aggressive form of cancer. In males, breast cancer is most common in the left breast, as is mine.
Dr. Velez is recommending a protocol established by the Dana-Farber Cancer Institute in Boston. The treatment, after surgery, uses the drugs Herceptin, a monoclonal antibody and Taxol (Paclitaxel). It will involve nine weeks of Herceptin and Taxol and a follow up of Herceptin for one year every three weeks. The nine weeks will be folded into the one year so it will be a total of 12 sessions of just Herceptin. This has a 10 year survival rate of 97%. Without any chemotherapy, after surgery, it’s 75-80% survival rate.
They will monitor my heart function every three months with an echocardiogram and I will still be on Tamoxifen for five years.
Dr. Velez looked at the ultrasounds and mammogram and also agrees with Dr. Burgers that the lymph nodes are not infected. However, the day of the surgery, sentinel lymph nodes will be sampled and if they are infected, Dr. Velez will put me on TCH chemotherapy (Taxotere, Carboplatin, and Herceptin) every three weeks for one year. Then it will be one year on Nerlynx. One of the side effects of that drug is – diarrhea. That’s a worse case scenario with infected lymph nodes.
He was very dialed in with my diarrhea. He says that Herceptin should not have any serious side effects for me and that Taxol can have severe side effects in large doses (240 mg). He proposes to dose me with 80 mg and says the only real side effect should be fatigue for a couple of days. They will, at the day of infusion, also give me a steroid which should give me a boost of energy. I will not have to schedule follow up visits immediately after the infusion, so no 118 additional appointments. He also said he has an 80 year old woman on this same regimen and she hasn’t had any significant side effects.
He also stated my bout with diarrhea from the TCHP protocol should be coming to an end. He did recommend to take double the dosage of Imodium (two tabs instead of one every four hours). When I can go for 24 hours without a bowel movement, that would indicate I’m over the diarrhea.
Speaking of diarrhea, I had three episodes last night so I might have been a bit optimistic about being over it. I didn’t have much energy today.
Even though I was kinda down energy wise, I did manage to do my monthly cleaning. I clean house every week but at the end of the month, I do a more detailed cleaning. It took me three hours but it was the first real cleaning job after all the construction. I certainly feel better about the house and can relax a little when anyone stops over to visit. Next month I’ll use the excuse of my surgery to not do the monthly cleaning.
Stay tuned!
