Hello and happy Monday! I am writing from the infusion area at my clinic, and I wanted to write an update to fill everyone in on the next phase of my treatment.

Last week I met with both my oncologist and my surgeon. They said I'm healing well and that my scar looks good. The pathology report showed that the tumor was removed with clear margins (which is good!), and there was no cancer found in the 3 lymph nodes that were removed (which is also good!). There was some residual tumor in the tissue that was removed, so based on that, my oncologist has started me on Kadcyla, which I will get via infusion every 3 weeks for 14 cycles. (In other words, for about 10 months!) Kadcyla is targeted therapy rather than systemic therapy, which means it doesn't cause hair loss or as many other side effects as the earlier chemo.

I did ask my oncologist what the goal of this phase of treatment is, since of course the tumor is now gone. She said that there's a chance there could be cancer cells circulating in my body that we have no way of detecting and that without further treatment, the chance of recurrence could be as high as 25%. So this phase of treatment is meant to reduce the chances of any recurrence as much as possible.

When I come back for my second Kadcyla infusion in 3 weeks, I'll also begin on ovarian suppression. As part of that I'll get a shot in my abdomen--my nurse today said it's a fairly big needle, and patients use an ice pack before getting the shot. (Yay?) Along with the shots, I'll also start taking a pill called letrozole. Because my tumor is estrogen and progesterone positive, it grew in response to the presence of those hormones, so the goal is to reduce levels in my body, and these treatments will have the effect of putting me into menopause. (Double yay?)

If I respond well to ovarian suppression, it sounds like patients often have their ovaries removed a few months later, but I can't say I'm excited by that prospect. Having just recently had surgery and discovering I don't especially enjoy the recovery process, I'm not especially looking forward to the prospect of more surgery anytime soon.

Speaking of which, I was very pleased that my surgeon gave me the okay to resume all regular activity when I saw her last Thursday. So I can go back to more vigorous exercise--I even managed 10 "knee pushups" yesterday and it went better than I thought it would. I continue needed just a little bit extra sleep, but I'm nowhere near as tired as I was at the end of chemo.

I have been doing a daily arm stretch, which I started when the drain was removed, but I am not back to my full range of motion. I have something called "cording," which is not well understood but often appears 2-4 weeks after surgery and involves the formation of things that look a bit like guitar strings running from my armpit down my inner arm on the side where I had surgery. It turns out that patients who are physically active and have a lower BMI are more likely to develop this issue. (Boo!) Fortunately, I enrolled in a study prior to surgery that includes an intervention for patients who are having issues, so I'll be starting PT via Zoom tomorrow morning and will have a total of 12 PT sessions.

Finally, we celebrated Oliver's 11th birthday with a party for his friends yesterday. We went to Lilli Putt for mini golf, bumper boats, and go karts, and the kids all had lots of fun and got soaked while doing bumper boats. Oliver is still wearing a boot most of the time for his sprained ankle, but it's much better and he took the boot off for bumper boats so it wouldn't get wet. As you can see from the photo, he had a great time!