Judy is in her fourth battle with cancer which is related to her first battle with cancer that began in 2006 so this is the fourth chapter in her cancer battles.
Here is a recap of chapters 1 through 3.
Chapter 1 was breast cancer discovered in September 2006. Judy had a mastectomy followed by chemo. The cancer did spread beyond the ducts but not into the lymph nodes or major organs. The cancer was determined to be triple negative. Triple negative means that there are no hormonal factors that aid treatment. Consequently, Judy had very strong chemo treatment over about six months. The battle was deemed complete after 5 years and no reoccurrence.
Chapter 2 was proactive cancer battle to reduce risk of cancer since Judy inherited a the BRAC2 cancer gene mutation and had a strong family history of breast cancer. Judy had a second mastectomy. However, a small amount of cancer cells was found in the post operation biopsy, so Judy had chemo for that. That chemo was only oral pills but caused her to have joint issues and forced her to have two separate trigger finger surgeries in less than three years. So, she completed only three out of the five years of recommended treatment and discontinued this therapy with her doctor’s consent.
The gene responsible for the breast cancer is also associated with ovarian cancer. Knowing that ovarian cancer is hard to diagnose and is often at an advanced stage when found Judy elected to have her ovaries removed. That was about 10 years ago.
Chapter 3 was a surprise in September 2020 when a cancerous mass was found during a colonoscopy and the biopsy showed that it was ovarian cancer. This was a stunning finding as we thought that should not happen if you have your ovaries removed. We learned that there is a roughly 1% chance of this happening. Chemo started at the end of October and was completed in April 2021, when Judy was in remission. Following chemo, she continued on a maintenance immunotherapy drugs which consisted of an infusion every three weeks at the Frauenshuh cancer center and daily pills. The pills cause various side effects. The chemo and immunotherapy reduced blood cell counts including the important white blood cells needed to fight infections. Consequently, Judy had a compromised immune system through most of the pandemic. In March, the series of infusions was complete, and the immunotherapy pills would need to be taken for another year. However, Judy’s white blood cell count and platelet count started dropping well below the normal range. Judy’s oncologist had her stop all immunotherapy to see if the blood counts would improve. In June 2021 Judy had a similar drop and stopped immunotherapy for a week and had a blood transfusion to help bring up her blood counts. When the counts continued dropping in April this year her oncologist ordered a bone marrow biopsy.
Chapter 4 started on with our visit with the oncologist on May 12th.we discovered that Judy had a therapy related myeloid neoplasm We learned this bone marrow disorder was a type of MDS and the cancer abnormalities are the same as Leukemia, so the treatment is the same as Leukemia. The surprise was that this cancer was due to damage from chemo for breast cancer in 2006-2007. That was very intense chemo and Judy was so weak that chemo had to be suspended for a month. We had been expecting that the cancer was due to the recent immunotherapy pills for her ovarian cancer which seems to not be the case.
This cancer was described as very serious, and the worst of those Judy has battled. Fortunately, Judy is in good health and no treatment option is off the table. The cancer can be reduced with chemo but the only treatment that can cure it is a stem cell transplant. Consequently, the treatment is chemotherapy followed by a bone marrow transplant. They use stem cell and bone marrow transplant interchangeably. Chemotherapy started almost immediately on May 16th. This chemo is a 28-day cycle with daily injections for seven days and a chemo pill every day. Blood tests are done weekly to monitor blood counts and effects on kidneys and liver. Judy learned to drink at least two quarts of water every day to flush the bad stuff out of her system. Potentially, there are numerous side effects. The main concern is severe reduction in white blood cells which reduce immunity. White cell fight infection by making antibodies. A temperature of 100.4 F is an indicator of an infection and the need to seek immediate medical attention. Infections are the main threat, and they can be life-threatening. Judy is taking antiviral and anti-fungal drug to reduce that risk. However, we learned that plants and gardening pose a fungal infection threat. We had not heard of that threat before. However, previous chemo was during frozen ground months when gardening is not an option. Judy enjoys gardening so that is difficult to give up.
Judy is at day 375 and had here 1 year anniversary checkup today. She had bone marrow biopsy number 8 on the 23rd as well as blood tests today. She had a pulmonary test today. A bone density measurement will be done next week. Beside checking for success of the transplant by the absence of cancer in the bone marrow the test also assesses whether the strong chemo has done any serious damage to organs and bones.
Judy is feeling well, and everything looks good. The early biopsy report said that there was no change since the last biopsy. She has 100% donor bone marrow. One more biopsy test result regarding bone marrow DNA damage (the old TP53 deletion) wasn't ready for today's oncology visit so the oncologist will call Judy when that is available. I did not sense and concern that this could show a problem, but the doctor can't speculate on results.
Judy's BMT oncology visit included two doctors in training, so she got extra attention today. Most of the discussion was about symptoms of chronic graft vs host disease and the doctors examined Judy for that. Judy had nothing for them to find so it was good for Judy. It is a bit hard to determine if you have graft vs host disease because the symptoms are things like a rash, swollen ankles. dry eyes or changes in taste.
Today Judy received 4 injections for vaccines normally received as children plus the shingles vaccine. She will receive boost shots in 2 months. Then she can stop taking the high dose of anti-viral medication, which is the last medication used for the bone marrow transplant.
Judy will have the same tests in one year at the end of the normal two-year recovery period, so she can look forward to bone marrow biopsy number 9. We should be able to recite all of the nurse instructions for the biopsy pre and recovery. Two years the time needed for her immune system to return to full strength, even though she is physically recovered.
Judy has been at or above normal energy levels for the last 6 months. In fact, I have not heard her ask me to slow down so she can keep up. It's possible that I've slowed, but I doubt that.
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