Hey folks! Nathan here with an update. Sorry we’ve been a bit MIA lately — I’d like to say we’ve been too busy,  but truthfully the more appropriate word is distracted (or at least trying to remain so).

First off, we want to extend a HUGE thank you for all the well wishes, good vibes, notes, hugs (in person or virtual), texts, gifts and care packages. Despite the hand we’ve been dealt we feel incredibly privileged to have such a caring group of friends and family. It’s really hard to express the overwhelming gratitude we have for everyone in our community. Thank you. Second-of-ly, want to give a shout out to Em for delivering the first few updates here and being our point person for much of the coordination since the diagnosis.

Onto the updates:

Baby: We're having a baby girl! One of the minor concerns undergoing chemotherapy while pregnant is a slightly higher risk of growth restriction.  We've had ultrasounds right before each cycle (full anatomy scan yesterday) and have been feeling her kick over the last couple weeks - she's right on track! It's starting to feel real and we can't wait to meet her. 

On the cancer front: Since the last check in here (post-surgery, first ultrasound), we needed to wait until week ~14 of the pregnancy to start the pre-delivery chemotherapy treatment. This treatment entails 6 cycles (or “rounds”) every 3-4 weeks from June until pregnancy week ~33.

Prior to the first chemo cycle, Steph underwent outpatient port placement surgery which places a port and catheter below the skin below her left clavicle. This allows for easier repeated access to veins for patients expecting to need a high number of infusions (and avoids multiple injection points in her arm throughout treatment). While this is considered a “minor” surgery, due to the relatively little pain-killers provided, proved to be one of the more physically painful parts of treatment thus far. The port will likely stay embedded for 18 months.

Here is how we're tracking against the pre-delivery chemo schedule to date. And below, are more details about what each cycle entails.

• June 2nd - done!
• June 30th - done!
• July 22nd - starting today
• August 11th
• September 8th
• October 6th

Chemo does quite the number on cancer and one of the reasons we are able to have an optimistic outlook for Steph. Chemo also fucking sucks, doing a number on the body as well. During each cycle (Friday-Monday, every 3-4 weeks), she navigates a gradual ramp up of side effects: fatigue, headaches, minor nausea. This type of fatigue isn’t simply “tired” — rather your body is exhausted such that sitting up in a chair or on the couch is draining and she can only do so for a bit at a time. We have been able to do some minor excursions (such as a Portland Thorns game!) but for the most part, we've been sticking close to  home. 

In each cycle, side effects hit the hardest on Tuesdays and Wednesdays following treatment: fatigue and nausea are at peak levels; she’s relegated to bed for most of the day, curled up and on the precipice of throwing up, though she’s been lucky (?) enough to not to have gotten to that point. 

Things get a bit better on Thursdays. Friday, she inches closer the feeling of “normalcy” — whatever that means for a pregnant person going through chemo. A full week after treatment she is usually able to live her (post-diagnosis) “normal” routine for a couple weeks before the next cycle — which, as most people reading this would expect, includes plenty of sun and twice-a-week spin classes. She’s a fucking champ, and also one of the tannest cancer/chemo patients you’ve ever seen. The growing baby bump is just the cherry on top. 

Before the first chemo cycle, Steph decided to get ahead of the game and chopped off most of her hair (with the help of Bryce and some girlfriends) to get a feel of what short-ish hair may look like once it eventually grows back. Soon after, we took some clippers to it in the back garden.  About a month ago, and on her birthday, Steph woke up to seeing hair on her pillow.... while I don't want to  speak for her, that period following was the hardest part for her since the original diagnosis. While she knew it was coming, the visceral realization of what the cancer and treatment is doing to her body was emotionally difficult. In the weeks since, confidence levels are on the rise, and it's of no surprise she’s braving a balding head with grace. No hair, tiny baby bump, a little bit lopsided chest — Steph is more beautiful than ever. I’m so proud of her.

A final note: We've (Emily and myself) gotten a lot of inquiries about gifts/care packages while Steph's going through this. For the most part, we've got most everything we need, at least materially - nearly every day we talk about how fortunate we are to have great health insurance and very understandable employers -- both things that many, if not most, folks going through similar experiences aren't lucky enough to have. 

With that said, we do have a baby on the way and have put together a baby registry. Of course, nothing is expected but anything is appreciated. 

Thank you all again for all the support over the past few months – we love every one of you and are so thankful to have you in our lives.

-Nathan

A bit more details about the ongoing chemo cycles, for those interested:

Each of these cycles entails three different chemotherapy agents over a three day period: flurouracil (5FU), doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan)

One full cycle includes:

Day 1 (Friday)

• MD/PA Oncology appointment
• Port Access
• Saline/Steroid infusion, latter of which to help with nausea, for about 30 mins
• 1st  5FU “Push”, administered manually by an RN, takes about 4 minutes
• Cytoxan (1 of 1) infusion via IV – 120 mins
• Adriamycin: pump set-up that Steph has to wear around her neck over the weekend, pumping about 1 mL/min over 72 hours
• Overall, Fridays are a mostly-full day at the doctor’s office before coming home

Day 2-3 (Saturday/Sunday): Rest at-home while Adriamycin pump continues, which Steph carries around in a "pouch". Said pump is a PITA (that's Pain in the Ass) to lug around/sleep with!

Day 4 (Monday afternoon)

• Pump detachment (15 mins)
• Saline/Steroid infusion (30 mins)
• 2nd 5FU Push (10 mins)
• Port de-access (15 mins)
• Monday is a couple hour foray at the office.

Rinse and repeat 3-4 weeks later for next cycle.

This Friday (tomorrow) is her 3rd cycle of 6 pre-delivery.  Subsequently, there's still a long road to go. While precise sequence is still TBD, rough summary of post-delivery treatment:

• Immunotherapies: Herceptin & Perjeta for 12 months. These are extremely effective against her particular type of cancer and fortunately should have relatively minor side effects.
• Chemotherapy: Taxol for ~3 months. This will likely have similar side effects to what she’s experiencing now.
• Surgeries:
  • Left mastectomy surgery, expander insertions (preparation for reconstruction).
  • Wait 3 months
  • Reconstruction surgery
• Radiation: none needed! Stroke of luck, oncologist deemed this would not be needed.