Calling all triple negative breast cancer patients in the UK
Comments
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Thanks Sylvia.
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thanks Cathy appreciate it! Just went to have my second paxitaxol and they sent me home. They forgot to order it now I have to have Monday! I'm
Bloody devastated! Primed myself up for it now have to wait another 3 days
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Hello Kath,
I was shocked to read that you did not get your first session of taxol. It is unbelievable that they forgot to order the drug. Have they any idea of the anxiety and fear that patients go through while waiting for these appointments. You get all keyed up for the treatment, and then there is the big let down. I would be screaming mad at them.
Sending you fond thoughts.
Sylvia xxxx
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hi Sylvia
It was actually my second dose. I had my first last Friday and was all ready for today and when I get there they had forgotten to orde from Sydney! Can't have until Monday! I'm devastate
Devastated
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Hello Kath,
Thank you for your post. I have made a note about your second dose of Taxol on Monday November 7th. Try to have a good relaxing weekend.
Fond thoughts.
Sylvia xxxx
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thanks sylvia
They rang me this afternoon and are getting it flown in from Sydney tomorrow morning so homefully I should have by tomorrow lunch time. They are calling someone in because it was their mix up. It was terrible I have never cried so much in my life!
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Hello Barbed,
I have been reading your details and also a post on another thread, so I can see that you have really been through it.
I was so sorry to read that you have had a recurrence after being fifteen years in the clear. This does happen. I have a friend here who had hormonal breast cancer that came back after fifteen years, is now metastatic and doing oral chemotherapy. I am not sure how long she has been metastatic, but she looks fine and is very active.
I saw from your details that you did not have any docetaxel (Taxotere) the first time around. It may not have been available as I know when I had it in 2006 that it seemed to be quite new, but I am not sure. I saw that you did get it the second time around.
I am not quite sure where your recurrence occurred or whether it was a recurrence or a new primary. I am glad that all seems to be going well for you. I am not sure what your last surgery was for. Was it to do with reconstruction?
There is no doubt that docetaxel (Taxotere) does have nasty side effects. My oncologist told me that it was less harmful than paclitaxel (Taxol) and not so harmful to the heart, but I do not know how true this is. They are both taxanes, originally from yew trees, one species common to North America and the other to Europe. I had docetaxel in the second three months of my chemotherapy, after three months with epirubicin (Ellence) and cyclophosphamide (Cytoxan). My main side effect from those was hair loss. When I started on the docetaxel I quickly lost my eyebrows and eyelashes and developed a metallic taste in my mouth. Towards the end the soles of my feet felt strange and I took no notice while I went on to have my radiotherapy. At the end of the treatment I was even more aware of something wrong in my feet. I told my oncologist and she said it was definitely peripheral neuropathy from the docetaxel and that it would not go away. It is a strange feeling of numbness and hardness/stiffness on the soles of the feet. A podiatrist later did a needle test on my feet, and confirmed that I have no feeling there. However the circulation is very good. She also said that there is no cure or treatment.
Chemotherapy and radiotherapy do affect our bones. It is a good idea to have a DEXA scan (bone density) to check the state of your bones before treatment and after treatment. This is what I had. This is not the same as a bone nuclide scan, which checks for spread to the bones. After treatment I was diagnosed with osteoporosis and have been taking calcium citrate complex (Solgar) and 5,000 IUs of softgel vitamin D (Solgar) and trying to have a calcium rich diet.
I agree with you that there are long-lasting side effects from the toxic treatment that we are given to keep us alive. It is the price we pay.
The heart can also be affected and goodness what else.
It is true that most, but not all, TNBCs are grade 3. Some on the forum have been grade 2. Grade 3 means that the cancer cells are very much differentiated to the normal cells. The stage is important because it helps the oncologist to decide on treatment. Stage is based a lot on size and with a small tumour you may have a lumpectomy but with a larger one, as mine was, 6+cms, you are advised to have a mastectomy. I was also told I needed chemotherapy before surgery in order to make the surgery easier. The stages go 1 to 4 and stage 4 is of course metastatic, meaning it has gone to other organs.
When I was diagnosed in 2005 no one at the hospital mentioned TNBC. They just said the receptors were negative. What were you told back in 1999? I think patients are better informed now compared to back when I was diagnosed. I really read up everything for myself from a book entitled The Cancer Directory by Dr Rosie Daniels, new out in 2005. I then went to the hospital armed with questions about grade, stage, receptor status, treatment etc. All my questions were answered, but I was told it was most unusual for patients to ask questions and most did not want to ask anything, but just wanted the treatment.
I think that cancer treatment is very political and that NICE makes decisions largely on costs and on what drug will benefit the greatest number of people. Back in 2005 patients who were HER2+ were having to fight and go to court to get Herceptin. Fortunately they won their battles.
I have read that people with stage 4 or metastatic breast cancer are not treated as well as those with primary cancer. However, the person that I know here with stage 4 is very satisfied with her treatment.
We do pay for our treatment through taxation, so we should have access to available drugs. However, I think the NHS is under-funded and overwhelmed with patients. We are going through an epidemic of cancer of all kinds and of diabetes 2. We do not have a good record for cancer treatment in the UK.
I do hope you will stay with us and I do hope everything will work out for you.
Fond thoughts.
Sylvia xxxx
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Hello Tom,
I have not forgotten you and I shall be posting more later.
Best wishes.
Sylvia
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Hello Chris-ash,
we have not heard from you in a while and I know that you are going through chemotherapy. The last news we had was that you were finishing EC plus carboplatin and were going to start weekly paclitaxel (Taxol).
Hello Clauclau (Claudia),
We have not heard from you in a while, either. How is your chemotherapy AC + Taxol going? I hope all is well.
Hello lilyp6 (Pam),
How are things going? I think you should now have finished with all your chemotherapy treatment which was AC + Taxol + carboplatin.
Hello rlk58 (Rhonda),
If I remember correctly you were going through chemotherapy before surgery and were having AC and then Taxol. How is everything going?
Hello gmmiph (Gina),
I hope you are recovering nicely today from your chemotherapy.
To everyone, have a good weekend.
Best wishes.
Sylvia
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Hi, Sylvia,
I found the Sikora book on Amazon, it's about $12 in paperback. The hardcover copies are $800+ and $600+! I don't know who on earth would possibly pay that. I have not quite decided if I am going to order it. I have ordered 3 such during/post and post-cancer treatment books that were recommended to me and am not sure if I want another one. I liked the first one, Anti-Cancer: A New Way of Life. The next two resembled each other, and were just simplistic, common-sense suggestions of ways to adapt to your post-treatment life. One included a method of keeping a journal of day-to-day occurences relating to your new self, and the other I liked better. It included testimonials of people who had survived and were dealing with the aftermath. I did not think they were very remarkable.
There are so many women here now in various stages of treatment, I wish them all as easy a time as possible.
I will talk to you again soon,
Mary
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Hi, Gina,
Glad your first night went so well. A little red pee is not too bad, very temporary.
Take care of yourself when you get home.
Talk soon, Mary
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Hi, again, Sylvia,
I forgot to say I also have Chris Woolams' book Everything You Need to Know to Help You beat Cancer and also I have the DVDs of The Truth About Cancer plus the book of the same.
Later! Mary
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Hi to all; I wish you all (all of u!!) the best of luck with treatments. i want to share my chemotherapy experience.. I embarrassed the chemotherapy even spoke to it while it was injected in and during the next three or fours days after injection. I remember i used to say to it, to get into my bloodstream do its job and get rid of the cancer.. i used to imagine it in my blood and doing the job.. i found that helpful to my emotional state!
i know that cancer fight is long and feels like a roller coaster, i always try to find tricks to keep myself happy and positive .. not always easy.. but ultimately i think life is too short to worry.. i always remind myself of the usefulness of worrying .. if not useful then i take over my emotional state and do things that i enjoy doing!
Sometimes when bad thoughts take over, I read survivors stories and I realise that we could be one of them and pray for us to successfully pass those 5 crucial years!
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Hello Tom,
Thank you for your post. Thank you for your explanation of the drug APR-246 that Michael posted in a link.
It seems that p53 comes up a lot with reference to breast cancer. I remember in the early days of my diagnosis being told that a possible cause of my breast cancer was p53 mutating through a process called methylation. I really did not understand what it meant. My oncologist also spoke about how my triple negative receptor status did not necessarily start as such but may have arrived at it through mutation. At the time I was too busy getting through treatment.
Thank you for your explanation. I do wonder whether there will ever be a magic bullet.
I was most interested in what you said about TM. I am not going to type out the long chemical name, but sometimes I wonder where all these long names come from.
I know that copper is an important trace mineral in the body and that you only need small amounts of it, but I was wondering how people get too much copper in the body. I noted that you said this TM given to mice injected with breast cancer cells had fewer metastases than the control mice. I found that very interesting. Can it mean then that too much copper in the body is causing metastases in breast cancer patients? Can it mean that too much copper has somehow formed because of the breast cancer, or can it mean that too much copper might be implicated in breast cancer?
I was interested in the actual numbers of APR-246. This is because back in 2009 about December, an uncle of mine was diagnosed with throat cancer. He had a cancerous tumour on one of his tonsils. He was 83 and the treatment suggested to him in the way of surgery, chemotherapy and radiotherapy sounded horrendous. He watched a programme on the television about Dr Ros Taylor who was treating patients at a hospice in Hertfordshire. The medication was CV247 and was made up of salicylic acid, ascorbic acid, copper and manganese. Apparently there had been successful cases treated with this. My uncle did die the following year but apparently others had gone into spontaneous remission. Do you have any knowledge of this? Ros Taylor has now retired but she does have an important position somewhere, that I cannot remember.
At the moment I am busy reading the latest book by Professor Karol Sikora and am finding it most interesting. Some of it is a bit challenging but most of it is highly readable, especially the chapters on where we are going with radiotherapy and chemotherapy. I was very interested to learn that there was no known drug effective against cancer before 1943. During WWII the US military began experimenting with new chemical weapons. "They came across the alkylating agents, drugs which bind and damage DNA in every cell. These drugs completely destroy the mechanism whereby the DNA produces its message and replicates. The first of these agents was nitrogen mustard and many other related compounds were subsequently discovered."
if you want to read the story of what happened on a dark early December night in 1943 to the Allied fleet in Bari Harbour in Southern Itlay, and the consequences of that in relation to cancer drug treatment, you might like to read pages 35 and 36.
I found another story on page 36 most interesting. "High above the Adriatic Sea in Northern Italy, was an old tower built in Medieval times. The tower itself is still a crumbling ruin overgrown with moss and ivy. Samples of bacteria were taken from this beautiful tower, and a drug which interfered with DNA by inserting itself within its bases was identified. This drug was found to be remarkably effective in controlling breast cancer, Hodgkin's lymphoma and a number of other tumour types. The drug is known as doxorubicin but was given the brand name Adriamycin as it had been discovered on the Adriatic coast."
There are other examples of how cancer drugs were discovered by accident.
Since 1945 more than 300 cancer drugs have been discovered and are used regularly in clinical practice around the world.
That is all for now, Tom. I do hope you will have a good weekend with your wife and children.
Best wishes.
Sylvia
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Hello Mary,
I do understand that you will not buy the book. On this thread we have discussed many and I can understand how you feel. I think we have read enough to know all about the do's and dont's of our eating and drinking. I think we all know enough about the importance of physical and mental exercise. Moreover, whatever the experts say, I believe we need to avoid negative stress and negative people. Our poisoned environment is very challenging to control, is doing us no good, but we can try only to control our own little part of it.
I must say that the most enjoyable books are the simple ones written by patients going through treatment. There was a glut of them at one time, but not so many now. Has everything been said???!
I shall post bits and pieces from Karol Sikora's book.
Sending you very best wishes.
Sylvia xxxx
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Hello 4everStrong,
It was nice to see you on the thread. You certainly had a unique approach to chemotherapy. I can tell that you think a lot about everything. We are told that visualising things is good therapy.
You are dead right that life is too short to worry. We have only one shot at this and I think it is a human right to be happy while we have the chance. There is too much suffering in the world. Worrying serves no purpose.
Carry on living as you are and bringing your wise words to us.
Fond thoughts.
Sylvia xxxx
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Hi Sylvia, Mary, Cathytoo, Valstim, Kath and all,
I was offline for a day (I have been mainly sleeping due to the effects of the drugs) and was surpised to see a long line of wonderful informative and helpful posts here. This thread is very active and I think I am already buried with the many posts. I will try to catch up, even if i am a slow reader.
For those who are wondering what happened during my first chemo session, here's a recap...
So, two days after my first chemo (initially FEC), i feel great. No side effects yet, still have my taste buds and appetite, although last nite, i feel like my stomach is a bit full. I have taken all my post-chemo medicines, all oral, like placil for nausea, dexamethasone for aches, and iberet-active for iron/vit c supplement. i missed one med though, nexium which is for controlling stomach acid to avoid reflux. it should be taken before breakfast, and i already ate mine before i reviewed the prescription.
All went well during my actual chemo, which took about five hours, inclusive of preparations and pauses between each drugs. they gave me premeds aloxi for nausea and dexamethasone for pain, both thru iv. My MO said it is better for me to stay overnight at the hospital for monitoring against possible allergic reactions (none was found) and for hydration with saline solution (which started from the actual chemo 11am to 3am the following day). I left the hospital around 7:30am.
My MO told me to stop taking my vitamin supplements but she added iberet-active for iron/vit c supplementation, (i think it has vit B12 which is important) for 20 days after chemo. If my stomach cant accept it, as i have had previous problems with iberet, then find natural foods that contain the needed vitamins like in this case, i can change iberet with a cup of moringa leaf veggie which is also rich in iron. i am also planning to continue taking raw turmeric everday thru meals and smoothies. i've been taking it even before surgery and chemo, and i find it helpful against my rheumatic knees. The main thing is to EAT HEALTHY, more fruits and veggies, less meat and sugar.
Ok, this will be all for me today ladies and gents. I still have a lot of catching up to do with all the posts in this thread and with the others.
Thank you to all those who sent me their prayers and well wishes during my first chemo. I really appreciate it.
On with the journey.
gmmiph (Gina)
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Hello Everyone,
I'm just checking in from the chemo-front. I had my last one (AC) on Tues. In some ways it was easier, but I never had a port, and my vein is really sore and unhappy this time around. Also, I am really feeling the fatigue and the effects on my poor brain. I notice that I'm having trouble concentrating while I'm reading, that my thoughts feel really scrambled, and that I don't feel quite myself.
But here I am, functioning, and hoping to back up to speed soon. I've certainly felt worse than this during treatment. I'm waiting for a call to schedule my surgery, which will be early next month. In the meantime, I'm drinking as much water as I can handle, and doing my best to eat healthy food. It's hard to believe that chapter is (hopefully) over. And I'm really looking forward to having more good days than I've had since May. Anyway, I will be more coherent soon. Thanks for all of the good wishes and advice.
Pam
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Hi lily(Pam),
i just read your post. i am sorry to know you are having some problems with your chemo. how many have you had? Ive just had mine 2 days ago, and so far no side effects yet. i dont have a port also, my onc says there is no need coz i will only be having six sessions (via cannula vein). i was also asked to have my weekly cbc tests and that means needles again, hopefully in another part of my left arm. i cant use the right arm anymore becoz of the mx. like you, ive been drinking much liquids and eating healthy.
i hope all goes well with your problems soon and your upcoming surgery.
i will pray and send you positive thoughts sis.
Good luck,
gmmiph
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Thanks Gmmiph,
I've had 16 treatments, and the effects are cumulative, so there's nothing really unusual for me. I'll be fine. I'm glad to hear that you haven't had side effects. Keep up the good work! I'm wishing you a smooth ride during your remaining sessions.
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Thanks Pam
Hugs
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Hi Sylvia and others
I hope all is well with you. I haven't posted in a long time so I thought I'd let you know how things are going with me. There's probably an easy way to find out what I said when I last posted but I haven't managed to find this yet. So apologies if I'm repeating myself.
I've now completed the radiotherapy and I see my oncologist next week. I requested and received a copy of my medical records and so I am up to speed on my results anyway. I had a partial response to chemo (50-60%) and my pathology report states that my NPI (Nottingham prognostic indicator) is 4.18. This means I have a 70% chance for 5 year survival - these are good odds but I know this doesn't necessarily mean that the cancer won't come back within that time span (I think I read somewhere recently that the rate for disease free survival was 2.8 years).
I really just need to find out from the oncologist what the monitoring plan is to be as I continue to have neuropathic pain (hands, feet, both breasts and sometimes my head). I have been prescribed Amitriptyline form the doctor for this and I find it helps considerably even on such a low dose. I still get bone pain in my ribs (from radiotherapy I expect) and also left thigh and as I have other conditions (with symptoms that can be exacerbated through the breast cancer treatments e.g. Graves Disease, Chronic Kidney failure (Stage 3a) and arthritis/arthralgia) it's often difficult to know what's causing the different pains. I'm also to have genetic screening for the BRACA gene. (the odds of having a mutation on these genes are around 10% so I'm not expecting to have the genetic fault).
All in all I'm in good spirits and most of my bloods are showing that I'm heading in the right direction so I expect to feel less fatigued over the next few weeks. I hope to be able to get back to my work as a researcher in dementia early in the new year (if my chemo brain permits).
Warm Regards
Maggie
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Hi Sylvia and others
I hope all is well with you. I haven't posted in a long time so I thought I'd let you know how things are going with me. There's probably an easy way to find out what I said when I last posted but I haven't managed to find this yet. So apologies if I'm repeating myself.
I've now completed the radiotherapy and I see my oncologist next week. I requested and received a copy of my medical records and so I am up to speed on my results anyway. I had a partial response to chemo (50-60%) and my pathology report states that my NPI (Nottingham prognostic indicator) is 4.18. This means I have a 70% chance for 5 year survival - these are good odds but I know this doesn't necessarily mean that the cancer won't come back within that time span (I think I read somewhere recently that the rate for disease free survival was 2.8 years).
I really just need to find out from the oncologist what the monitoring plan is to be as I continue to have neuropathic pain (hands, feet, both breasts and sometimes my head). I have been prescribed Amitriptyline form the doctor for this and I find it helps considerably even on such a low dose. I still get bone pain in my ribs (from radiotherapy I expect) and also left thigh and as I have other conditions (with symptoms that can be exacerbated through the breast cancer treatments e.g. Graves Disease, Chronic Kidney failure (Stage 3a) and arthritis/arthralgia) it's often difficult to know what's causing the different pains. I'm also to have genetic screening for the BRACA gene.
(the odds of having a mutation on these genes are around 10% so I'm not expecting to have the genetic fault).
All in all I'm in good spirits and most of my bloods are showing that I'm heading in the right direction so I expect to feel less fatigued over the next few weeks. I hope to be able to get back to my work as a researcher in dementia early in the new year (if my chemo brain permits).
Warm Regards
Maggie
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2nd paxitaxol just finished a day late because of the stuff up but nevertheless all done! Time to rehydrate and slee
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It is good to hear that your chemotherapy finally pushed thru Kathseward. Now it is time to forget this disease for a while, lift all your problems to God, relax, get a good sleep and recharge for tomorrow will always be there for a fresh new hope. This is what life is all about.
Wishing you well always,
gmmiph
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Hi Sylvia and all,
I had my 3rd AC and am feeling a little more fatigued but
Not too bad.I spoke to my doctor about 12 weekly Taxol and she said she preferred that-I don't know why she
Didn't mention it before,maybe because I travel 2 hours
To get there.She wants to add carboplatin as well. Also there is a clinical trial for acupuncture but they wait for symptoms to present so I am not participating.I want to use acupuncture to help prevent neuropathy. I enjoyed my Ayurvedic massage-it was amazing.Dr. Jay only travels to this area 3 times a year.He is an md and also teachers in Los Angeles.He has a clinic in Beverly Hills.
- The massage was with oil and he worked from my head to my toes.The chanting was beautiful and it was the best massage I ever had
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Hello Gina,
I was glad to read that you are feeling great and let us hope this will continue. It is true that the thread is very busy so take your time with trying to catch up. It is important to read all the posts so that there is no gap in the information that is coming through.
I was reading through the medications that you were given and I am wondering about what you said with reference to dexamethasone. I had dexamethasone with my chemotherapy treatment and to take orally afterwards for three days and I was told it was a steroid that is used to alleviate the nausea and vomiting associated with chemotherapy. It can be taken through IV, injection, oral solution or tablets. Taken for short periods and in low doses there is rarely any serious side effects. Dexamethasone is the generic name. Aloxi is for nausea as you stated.
I can understand why you were given an iron/vitamin C supplement. I took iron supplements and vitamin C supplements all through my chemotherapy treatment. The iron is important to keep your red blood cells up to the right level. I also took B vitamins and I think they all kept me healthy during treatment.
The most important thing during chemotherapy treatment is to eat healthily, keep hydrated and rest as much as you need.
Keep up the good work and keep looking forward.
Fond thoughts.
Sylvia xxxx
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Hello Pam,
It was nice to hear from you and I am so glad to know that all is well after your last session of AC.
Having chemotherapy with a cannula on the back of the hand can cause problems and it does become harder to find a vein, so I can understand why you are feeling sore. You are bound not to feel completely up to par so do not worry if you find it difficult to concentrate. This will pass.
I do hope you will get your surgery date soon, but remember you do need time to recover from chemotherapy treatment. When I was going through treatment I finished my six months of chemotherapy on April 28th 2006 and I had my surgery for a mastectomy on May 17th. At that time I was kept in hospital ofr five days, until the inserted drains had cleared and then I came home.
You are doing the right thing keeping hydrated, but do not go over the top.
You have completed the hardest part of your cancer journey, so feel good about yourself and if you want have a little celebration when you feel up to it.
It would be useful if you could add the AC to your chemotherapy treatment on your profile.
Well done, Pam.
Fond thoughts.
Sylvia xxxx
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Hello Maggie,
I was so glad to find you back on the thread. If you want to find out about your posts in the past, you have only to click on your name (merscotland) and your post history will be displayed. By looking at that it will be easy for you to find your full posts on the thread. You posted mostly on this thread back in September. I think it was the 4th and 8th.
I do like to have my fellow Brits on the thread, as I did start this thread originally for them and so it is very important for me, even though we have gone Global! I am pretty sure the first posts on the thread were from Scotland and the first few pages were all UK. I remember jinglebell (Mary) and Freddydlh and hymil. If I re-read their posts I do wonder what happened to them and hope that they are out there enjoying life.
I was glad to know that you have completed radiotherapy and that you are waiting to see your oncologist next week. I hope all goes well. I was interested to know about your pathology report, because when I was going through treatment in 2005/6 I was not given one. I was just told that I had an excellent pathology report and that there was no visual evidence of disease (NED).
You must always be optimistic during and after treatment and tell yourself you are going to survive.
It would be very useful if you could put the details of your treatment in your profile section, so that we all have a reference to your treatment. For example, what regimen of drugs did you have for your chemotherapy? I know that the taxanes can cause peripheral neuropathy in the hands and or feet. I had docetaxel (Taxotere) for three months and I have neuropathy in the feet. My oncologist told me the docetaxel had caused the neuropathy and that there was no cure. Podiatrists have told me the same thing. Most of the time it does not bother me that much.
I must say that I have not heard anyone on the thread mention neuropathy in the breasts or head. What kind of sensations do you have? I am sure we shall all be interested to know about this.
I was interested to know that you have been prescribed Amitriptyline because it is a well known antidepressant and anxiety pill.
I do not feel any pain with my peripheral neuropathy in the feet. It is strange to describe but it is a strange numbness and stiffness which makes me feel as though the soles of my feet are very dry when in fact they are very well moisturised.
I was sorry to read that you get bone pain in your ribs and left thigh from the radiotherapy. I did not have this but I hope others will post to talk to you if they have experienced it.
How are you being treated for your Graves disease which I know is hyperthyroidism. A niece of mine had it as a teenager and I am not sure what goes on with her now. It seems that you are having to deal with quite a few chronic illnesses, and to have gone through breast cancer treatment on top of all this, cannot have been easy.
I do hope your oncologist will be able to help you post-cancer treatment. The usual thing in the UK seems to be to have regular physical check ups alternating between the oncologist and the breast cancer surgeon, starting with three monthly, then six monthly and then yearly, with regular mammograms. That is how it was for me.
Let us know what happens about the genetic screening for the BRCA genes.
I am assuming you are a young woman given that you are being offered the genetic tests for the faulty genes.
I was glad to know that you are in good spirits and that all is going well with your bloods.
Give yourself time to get over all of this as you can stay tired for quite a long time.
I was very interested to know that you work as a researcher in dementia. So many elderly people are being diagnosed with this. Make sure you feel strong and well before you go back to work.
Keep in touch and let us know how everything goes for you.
Fond thoughts.
Sylvia xxxx
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Hello Kath,
I just wanted to say that I was glad to know you finally got your second dose of paclitaxel.
Take care, especially during those first few days. Yes, indeed, keep hydrated, rest and keep looking forward with optimism.
Fond thoughts.
Sylvia xxxx
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