Dinner Sign-up, Round 2!

Hi Everyone:

The 1st round of dinner sign-ups are over and I want to personally thank each of you for making it a HUGE success. Trisha and Oak (I'm sure Caden too) are so very grateful for all of your support during this time. Given the success of the dinner program, I've created Round 2! I know this is a small way you all feel you can help this wonderful family get through this challenging time. Please feel free to sign up again.

http://www1.mysignup.com/cgi-bin/view.cgi?datafile=barrettfamily

Let me know if you have any questions.

Cerena

another tuesday, another can of chemo

ahhh its tuesday...
must mean a trip to store to pick up another can of chemotherapy..

so off to the stanford university cancer center we go..


8:15am: arrived for our 8:00am appt... imagine that

8:25am: seated for a blood draw from nurse christy

8:35am: heading downstairs for our 9:00am appt with dr. carlson. this is the first appt with dr. carlson in the past 4 weeks. we are now visiting him once a month.


hopefully trish's blood counts are good today. we gave her 4 shots of Neupogen (Filgrastim) this past week, as opposed to the three shots during the previous two weeks... her counts were borderline last week, we hope this wont be the case today.

keep your fingers crossed...

results should be back in an hour or so..

ill post back after the visit with the doc...



---------------------------------
update #1: 12:00pm
---------------------------------
9:25am - 10:50am: met with dr. telli, and discussed a little bit of everything from blood, surgery options, chemo schedule for the coming months, food, alternative medicine, vitamins, etc..
she also referred us to a surgical oncologist as well as a plastic surgeon.

it was nice to get caught up with dr. telli, as we haven't seen any of trish's doctors in the past month.

dr. carlson is out of the office today, so we setup an appointment to check in with him prior to next weeks chemo.


drumroll....

trish's blood counts are back up :)
there will be taxol today


blood counts:

white blood cells, Absolute neutrophil count (ANC):
--------------------------------------------------------------------
was 1.47
is 6.05


red blood cells, hematocrit (HCT):
--------------------------------------------------------------------
was 28.2
is 28.9



trish is litte bit anemic, but her red blood cell count has been down since beginning chemo.
this can be a result of being pregnant with caden, as pregnancies can deplete the body of iron and the body can take several years to recover. to help this, she will begin taking some iron supplements.

trish will continue receiving the nuepogen shots, four times week to keep her white blood count up. she isn't too thrilled about this, as lately this has been the hardest part of the treatment. the shots make her really achy in her bones (its all that marrow making some whiteys..)

there are corresponding drugs for red counts, Procrit or Epogen, but they are not recommended for those undergoing treatment for breast cancer.


11:10am: trish got her chemo chair... #C3
11:40am: nurse carol began trish's premeds of decadron and pepcid
12:05pm: begin the benadryl... might as well tap a bottle of wine, as this makes her loooopy...


ill give you another update later after she begins the chemo...


trish's mom, ria, is joining us today...
here is a pic taken a minute ago:








---------------------------------
update #2: 12:30pm
---------------------------------
12:30pm: premeds are done... trish is hooked up to the taxol.

the harp lady also just came in with her 5' tall harp..
shes strumming some tunes while trish is getting ready for la la land...

ETA of getting out of here is 3pm...

stay tuned..


---------------------------------
update #3: 3:00pm
---------------------------------
2:00pm taxol finished up, began on the herceptin
3:00pm: herceptin done
3:10pm: nurse carol flushed the mediport with anticoagulant, heparin


heading home...


another day in the bag...

chemo is spiffy, even when you blood counts are iffy..

back to stanford we go...


9am we arrived for trish's blood draw from nurse christy...

while waiting for the blood test results, we headed down to dr. calrson's office to get a note to excuse trish from the jury duty summons she got last week...

(if ya ever want to get out of jury duty... just go get yourself some cancer)

we headed back up to the infusion center at 10am to get the results of the blood test from nurse bev.

trish's counts were a little iffy today, but dr. carlson decided to continue with the treatment this week.

white blood cells, Absolute neutrophil count (ANC): 1.47 (cutoff is typically 1.5)
was 4.7 last week, and .6 a few weeks ago


red blood cells, hematocrit (HCT):: 28.2
was 30.3 last week and 28 a few weeks ago



anyhow...

its 11:30am and trish just finished up her first pre-drug of decadron and nurse bev just hooked up the benadryl. she will then get her pepcid, and then on with the taxol and herceptin.


the 6pm update..
--------------------------

trish began on her taxol around 12:15pm...
herceptin at 1:50pm...
we were done and walking out the door at 2:30pm


trish is looking and feeling good, but again, her immune system is pretty low.
she is more prone to getting sick, so caden did not go to storytime today, and we need to keep trish as healthy as possible.

if you want to come visit, please call first...


ill be giving her shots of neupogen beginning tommorrow for 4 days, in efforts to keep her white blood cell up..


so thats the update from the oak ridge estate..



here is a pic of trish and her new tshirt on saturday morning before we headed to the farmers market downtown...

"My Oncologist Is My Homeboy"

and here is a pic from this morning in the waiting room...

an order of herceptin, and a side of taxol please...

trish's blood counts are good! she will be getting taxol today...

she just began her dose of the steroid and nurse lea is giving her the pepcid right now.

blood counts:

white blood cells, Absolute neutrophil count (ANC):
--------------------------------------------------------------------
was 0.6
is 4.7



red blood cells, hematocrit (HCT):
--------------------------------------------------------------------
was 28
is 30.3 (a little below normal, but not low)



more updates later...


---update---
its 6:00pm... the herceptin is done, and we are heading home...
ill provide a little more detail later

happy birthday trish!

please, WASH YOUR HANDS!

as you hopefully know, we enjoy and appreciate all the visitors we get, but those planning a visit to see trish in the coming weeks, we ask that you please call and make arrangements with us prior to stopping by.

based on trish's blood counts today, her immune system is at a point where even a small cold could mean a trip to the emergency room.

we ask that if you do come, (after calling) please leave anyone who is sick, was sick, might be sick, could be sick, should be sick or will be sick at home.
this also means ABSOLUTELY NO CHILDREN, regardless of their current health.

and a reminder, if you do visit...

for your disinfecting pleasure we encourage you to please hose yourself off with the bottles of purel hand sanitizer conveniently located next to the front door.

thanks

oak

red, white..... and blue :(

so trish, her brother steve and myself headed off to chemo today...

trish had her blood drawn around 10:30am from nurse kyla, and by 11:45am we were back in the chemo chair getting ready for treatment with nurse chris.

unfortunately, nurse chris came back with trish's blood test results, and they were not what we had hoped. trish's white and red blood cell count were down from the week before, and her white count was at a point where dr. carlson canceled trish's weekly dose of taxol.

nurse chris continued on with trish's dose of herceptin around 12:15pm and about a 1/2 hour later trish was done. (the good news here is that trish didn't need the 3 pre-drugs that she would typically get with the taxol)

dr. carlson and nurse jan prescribed Neupogen (Filgrastim), a drug that helps convince the bone marrow to produce more white blood cells.

trish will get three shots of this a week, beginning today... administered by Dr. Oak, after the superb training i received by nurse chris today.

aside from an emotional blow of a skipping a treatment, trish is feeling good, but it is clear that her immune system is pretty much at an all time low.

it is now more important than ever
we keep trish from getting sick

this means caden will be limited in the activities he does with other kids (gym, story time and swimming) for the short term, we ask friends and family to call prior to any potential visits, and please no children even if you think they are healthy.

the neupogen shots should get trish back on schedule with her taxol and herceptin regimen next tuesday, and she will continue with the shots 3x a week until her blood counts stabilize.

this isn't a huge shock, as the doctors have prepped us for this possibility since the beginning of chemo, nonetheless we dont like it. the reason trish gets weekly blood tests is to monitor her blood counts, and low blood counts are all part of the chemo ball game...

so it wasn't necessarily bad news today, but it wasn't good news either.

home around 2:30pm... but we would have gladly stayed longer if taxol was an option.

live from palo alto, its tuesday afternoon

so another long day is almost in the books...

trish and i arrived at stanford at 10am this morning for her blood draw up at the infusion center. this was the first time we have watched as her mediport was accessed, but aside from a little pinch (ok... trish said it felt like a knife going through her chest), nurse pat had the keg tapped, and the beer flowing... err... port tapped and blood flowing, in no time.
i think next week, we will have trish put the numbing cream on a little earlier..

we then headed down to dr. carlson's waiting room at 10:40am for our 11:00am appointment. trish early for something... (insert your own sarcastic comment here)

at 12:30pm we got into an exam room and met with nurse jan, reviewing the previous 7 days of trish's reaction to her new treatment.

dr. carlson and dr. telli came in around 1pm to examine trish, and outlined the coming weeks. they are pleased with trish's response to the chemo, and we will now only see them on a once a month basis (or unless we feel a need to meet with them).

by 2pm trish and i were seated in her patient station, #B6...
around 2:20pm nurse mary had trish's three pre-drugs flowing:

decadron: steroid to hinder any allergic reactions
diphenhydramine: a antihistamine also known as benedryl (makes trish a little loopy and sleepy)
famotidine: an antacid, also known as pepcid

around 3:40pm trish began on her taxol and herceptin drips... both were flowing at the same time, but the herceptin was flowing at about 1/12th the full rate..
once the taxol finished around 5pm, the herceptin was pumped up to its full 500ml an hour and we should be done within the next 15 minutes..

everything is going good, and trish seems to be handing this new treatment really great. she has not experienced any nausea this past week, although she did have some achiness but nothing that kept her and caden from going camping with trish's parents saturday-monday. trish and caden got home monday morning, and come evening time, we headed down to san jose for a bbq at my coworker kevran's house to celebrate the completion of my project at work...

this was the first time trish had a chance to meet my boss, jane, who introduced us to the Healing Touch program at stanford. kevran cooked us a great dinner of bbq'd steak, chicken and veggies.. and caden had a great time exploring the palatial play structure Kevran has in her backyard, as well as playing with her daughter, kiley..


anyhow... thats the report from chair B6... her treatment is done, nurse mary just flushed trish's port with heparin and its time to go home and see caden...


10am - 6pm ugghhh... i hope the valet parking is still open..

tales, continued...

so wednesday morning, its back to stanford we go...

9:30am chemo appointment to pick up where we left off on tuesday night.

julie came along to keep trish company, as i had to do some work while we were there.
(hospitals with wifi, its a beautiful thing)

the nurses left the needle in trish's port from the night before, no blood tests were needed and we didn't meet with dr. carlson...
so we were already three steps ahead of the game

as with yesterday, the nurses started off the treatment with the 3 "pre-drugs" of benadryl, decadrone (i think) and something else i dont recal.

about an hour later, it was time for the Taxol. Taxol can sometimes cause allergic reactions, but trish experienced nothing of the sort.
again, the nurses took it slow, about 90 minutes... but everything went smoothly.

next tuesday trish will get back on the normal track of herceptin and taxol on the same day... about 45 minutes each...
plus the 45 minutes of the 3 other drugs, so it will be a 3-4 hour process.


the stanford cancer center is a really, really nice place in many ways.
the doctors offices and blood lab are on the street level, chemo is upstairs, radiation is downstairs. there is a pharmacy, boutique and cafe on site.

its a new building, so its bright, open, cheery and clean, and they will even valet park you car (but not free)

upstairs in the chemo rooms, there are large picture windows looking out to a grove of redwoods..
each patient station has a flat screen tv to watch (and hook our portable dvd player to)

all the people... employees, nurses and patients/families alike, are all there for the same reason and are really cordial and accommodating.
mark and pablo handle all the scheduling that comes out of dr. calrson's office. when you are planning months and months of chemo, blood tests, ekg's, etc..
its really nice to have a couple of guys that go out of their way to help you out. they know who to talk with and what strings to pull.

the nurses in dr. carlson's office and the chemo center are all really nice, sharing experiences and answering all our questions.

but the the people who really stand out are the volunteers..
there is always someone coming around with a cart of snacks, drinks, blankets, magazines, books, games, etc.
just trying to do whatever they can to make it easier on the patients.

today, we had a guy come in with a guitar and just sit down in the middle of the chemo room and strum some tunes..
another volunteer had an 'art cart' with plenty of pencils, paints, crafts, etc...

julie kinda got strong armed by the art cart lady, but she wound up tapping her inner jewlery making abilities, and created a couple fashionable bracelets that would look great on any tennis court.
maybe next time jules will conquer the more advanced necklace..

down the hall from the chemo rooms, there is a mediation room where you can go relax and find some peace and quiet.


so for a place that has all the reasons to be on the depressing side, its really quite the opposite.


our 'chemo neighbor' was a guy who looked to be in his mid 20's, and this was his first chemo treatment. he seemed a bit nervous to say the least, but trish, the veteran, chatted it up with the guy and shared her 'expertise'


typical trish, putting some good thoughts in his head and trying to make him feel better... all while she is going through the same thing.




here are some crappy cell phone pics...
but you can get an idea of what the stations look like, what the view from trish's chair.

tales from chemo land...

on tuesday 5/20, trish jumped back up on that chemo bandwagon.


it was long day...


trish, cerena and i arrived at stanford around 9am for her blood work, then headed to dr. carlson's office.
dr. carlson, dr. telli and nurse jan explained to trish what the coming weeks will bring in terms of side effects of the Herceptin / Taxol combo.
trish may feel achy for a few days, but she shouldn't experience any nausea from here on out..
we will meet with the doctors again next week, but the future schedule will be once every four weeks.

one less stop = shorter day (hopefully)


dr. carlson examined trish and seemed pleased with the progression of the treatment.


he could not feel trish's lump :)


this was really good news.

it makes you feel better knowing all the crap trish has been put through is working. this by no means affects how we will continue to battle this, but its sure a helluva lot better than hearing the doc say "the dang thing seems to have doubled".

a little positive news every once in while is kinda nice.


after our visit with dr. carlson, it was about 11am and we headed over to the ambulatory surgery department for trish's appointment to get her mediport installed.

a mediport is a little doohicky that is implanted beneath the skin, near the collarbone with a tube connecting to one of trish's veins.
basically, trish will no longer have needles inserted directly into her veins. needles will now go into the mediport, which is already connected to a vein.
its one of those rare times where a middleman is actually a good thing.. think of it as a dartboard under the skin, the nurse just needs to hit the dartboard, not even a bullseye.


the mediport is completely under her skin, and the only thing visible will be any residual scarring from the stitches.
trish's surgeon assured her that he was pretty anal about the quality of his stitches, so scarring should be limited.

since trish wasn't getting much luck from the nurses when it came time to find her veins, this will help out a lot.
her skin will still need to be punctured at the mediport location, but no more hunting for veins.
trish was given a numbing cream that she will put on her skin above the port prior to arriving for chemo, and this will help with any pain of getting pricked in the same spot week after week.

another nice thing about the port is that we no longer need to go to the blood lab prior to each chemo visit. trish can just head up to the chemo clinic, and they tap her, draw blood themselves, then give her the IV's

one less stop = shorter day (hopefully)


here are pictures of what a port looks like, and the special needles used to access it...








trish was awake during surgery, which lasted about 90 minutes, but was pretty loopy from the sedatives they gave her.

we left the ambulatory surgery center at 4:30pm...
we got there at 11am...

surgery was 90 minutes...

im still trying to figure out that math..


so we arrived back at the cancer center 5 1/2 hours after we left it, and a little late for trish's chemo appointment.
because we were so late, they decided to only administer the herceptin, and have us come back wednesday for the taxol.

with the new herceptin/taxol regimen, trish will also get 3 other IV's of drugs prior to her chemo. they are various antihistamines and steroids to help with any allergic reactions and side effects. these take about 45 minutes.

about 6pm trish started on the herceptin. this is a clear IV drip, and technically it isn't a chemo drug, its an antibody. the IV will typically take 45 minutes, but today it took 90 minutes as this was trish's first rodeo with herceptin, the nurses wanted to slow it down and make sure trish didnt have any unexpected reactions.

so...

a couple hours later.. around 8pm, we were heading out the door of the cancer center.

the end of an 11 hour day...

but... and there is always a but...

oh... the valet parking was closed, so we had to call security to track down our keys...

hey... whats another 15 minutes on a already long day..

the week in review...

here is a quick update of the past week....


thursday 5/8:

---

trish had her first appointment with her Healing Touch partner, chanda. she really enjoyed the session, and said she was able to really relax and feel the positive energy throughout her body.
i have no doubt that this will prove to be a great program for trish.

trish's sister, yvonne, flew in from holland for a visit. trish and yvonne only see each other about once every couple of years, so this is a special time for two of them to hang out..



friday 5/9:

---

trish went to the movies with her sister and mom, and saw 'Forgetting Sarah Marshall'

the house cleaners came... a bunch of our friends pitched it and paid for a years worth of house cleanings... thank you very much to all of you.

jen, robert and cooper tozi stopped by for a bit and dropped off some dinner..


saturday 5/10:

---

trish went shopping with yvonne, as our friend jay and myself played plumber for the day.

those familiar with our 4 year long master bathroom renovation (okay, maybe 5 year) will be happy to hear that we have all our tile done (thanks whitey), but more importantly, WE HAVE A WORKING TOILET... trish was quite happy to say the least... no more trips down the hall in the middle of the night to the other bathroom..

i plan on having the sink in sometime in the next 4 years.


sunday 5/11:

---

we had a very nice mother's day brunch over at steve & cerena's, with all of trish's family... we ate too much as we watched caden and cousin lucas play around in the backyard...



monday 5/12:

---

during the morning, trish and her dad brought caden to his gymnastics class down at the rec center...

yvonne made us a nice dutch dish for dinner...

in the late afternoon, trish decided it was time for a new, new do...
trish's hair was becoming easier to pull out. she wasn't to the point of losing clumps of hair, but her scalp was constantly itchy, and she was afraid scratching her head would pull too much hair out...

so..... it was time.

she had her brother, casey (an expert with the bald head), shave all but about 1/2" off..

it turned into a head shaving party as our friend eric, trish's dad judas, our nephew trevor, and my cousin kevin took part in the shaving as well... for some reason, bella (the dog) was no where to be found during all of this...

our biggest concern was how caden would react.... so while trish was getting her haircut, caden was right in front watching as trish's hair became shorter and shorter...

he took it great... he could care less if his mom has long or short hair... that makes two of us...


tuesday 5/13:

---

trish and yvonne spent the day in san francisco... hitting up the ferry building, ghiradelli square and union square... they made it back to redwood city in time for the tail end of story time at the library (trish and caden have been going to this for ~ 14 months)


wednesday 5/14:

---

trish, along with caden, lucas, yvonne and ria went to the San Francisco Zoo.

mr. and mrs. p... ron sr. and dianne puccinelli brought by some chicken, veggies and dessert...


thursday 5/15:

---

trish is currently at her 2nd session with chanda of the healing touch program




whats on tap for the coming week:


friday 5/16:

---

trish will meet with the cardiologist and get her baseline EKG.



saturday 5/17:

---

the plan is for trish to head to the wine country, and spend the night up there with her girlfriends... this will be trish's first night away from caden..... ever... stay tuned..



tuesday 5/20:

---

trish begins her new regimen of weekly taxol and herceptin IV drips





some pics from monday...

hair falling out...


so its time to cut it...


now she is ready for the 100 degree heatwave...

some pics from today...

trish, caden and myself took a nice long lunch at the spot we were married three years ago today, crystal springs golf course.

i had made earlier arrangements with the wedding planning staff so we could have some private time at the gazebo area. they were more than accommodating, and even brought us a bottle of apple cider, champagne flutes and some chocolate covered strawberries.
thank you very much lindsay, liesl and tracey.

with some sandwiches from one of trish's favorite delis, alotta's, in hand, we watched as caden ran up and down the hilly acre of nicely manicured golf course grass. the time together was great, and for a couple hours any worries we had were on hold.

we decided to push the trip over the hill to the coast off until the weekend, and just hang out at home tonight. trish went out and picked up some sushi, while i worked on getting caden ready for bed.

it was a great day.

oak



here are some pics from today
(click for bigger pics)

the first 14 days, the next 14 days...

today was the last days of trish's first chemo cycle!
14 days in the books...

the day was celebrated by trish taking her last 3 cytoxan pills this morning, and taking caden to the doctor in the afternoon.

this past wednesday and thursday were probably trish's worst days since beginning chemo on april 22nd, nonetheless she was out of the house and keeping busy. trish knows there is a big line between staying active and overdoing it, so she takes some extra time to relax and/or sleep, but overall the chemo has been pretty good to her. we aren't naive to the fact subsequent treatments may be tougher, but the last 14 days have been better than we both imagined them to be.

so whats next.... well, not much for the next 14 days. they will be chemo free, pill free and (almost) doctor free.

trish's next chemo appt will be tuesday may 20th, and at this time she will begin her new chemo schedule of 4 times a month, rather than twice. this regimen will consist of a combination of taxol and herceptin, both by IV... no pills :)

taxol is a drug typically administered once a week, while herceptin is every three weeks. but since trish will go in weekly for the taxol, it has been decided she will get 1/4 doses of herceptin at this time as well. the doctors believe the smaller, more frequent doses will help curb the severity of the nausea and fatigue.

the potential side effects of these drugs include damaging the heart's ability to pump blood effectively. this isn't a huge concern in trish's situation, as she is young and the owner of a healthy heart. regardless, her heart will be closely monitored throughout this treatment cycle with frequent electrocardiograms (EKG). this friday trish will visit with the cardiologist to get a baseline EKG of her heart's health. this baseline will then be compared to future EKGs she will receive during the course of her treatment.

again we feel very fortunate trish is surrounded by very knowledgeable and respected doctors in the field of oncology. Dr. Melinda Telli is a postdoctoral fellow working with Dr. Carlson in the treatment of trish. Dr. Telli was lead author of a study published in the Aug '07 Journal of Clinical Oncology discussing the effects of herceptin (trastuzumab) on the heart. It really does ease our minds knowing trish is receiving the best care available.

oddly enough, the past 14 days have been the most 'normal' we have experienced since this adventure began. we can finally relax and take a breath or two... trish isn't undergoing tests every day, we aren't waiting on the results of those tests and the visits to the doctor have become limited. we now know how she reacts to the chemo, we are getting into a solid routine and we have a very good understanding of what lies ahead of us for the coming months. trish, myself and our support system are ready to battle this together. the generosity from our families and friends continues to overwhelm us, and we can not begin to express how gracious we are.

THANK YOU ALL

tommorrow, may 7th, marks the 1 month anniversary of trish's diagnosis, as well as our 3 year wedding anniversary. its been an unbelievable month, but a tremendous three years. im taking trish and caden to lunch at a 'suprise' location, and later on heading over to the coast for dinner and a sunset.

trish has been dealt a crappy hand, but through all this, she has remained brave, caring and perhaps most importantly, humorous. she isn't going to let this beat her, or even get her down.

guess this just reminds me why i fell in love with the girl 8 years ago.

oak

healing touch program @ stanford

the one thing we quickly learned after trish's diagnoses was the more people we spoke to about the situation, the more doors it seemed to open.

after speaking to by boss, jane (not to be confused with sister in law jane), about trish, she recommended a program that she has been a part of for a number of years... and i didn't even know.

jane is involved with a Women's Health program at Stanford Hospital for Breast cancer patients called 'Healing Touch'.

from the 'Healing Partners' website:

the goals of the program are:

* To promote relaxation and reduce side effects in women undergoing treatment for breast cancer.

* To increase overall energy levels and the ability to cope with challenging life events.

* To serve as an adjunct to conventional cancer treatment.

* To monitor changes in physical symptoms, mood and quality of life in program participants.

Healing Partners is a community-service program that pairs women diagnosed with breast cancer with Healing Touch volunteers who provide ongoing sessions for six months.

Healing Touch is a gentle, non-invasive form of energy work that promotes deep relaxation and is used to manage the side effects of chemotherapy and radiation, such as fatigue, nausea, loss of appetite, pain and lymphedema.

Sessions last about 60 minutes and take place with the client lying fully-clothed on a massage table.

yesterday, during our break between the blood lab and dr. carlson, we met with the head of the program, Kathy Turner, and registered.
trish is really excited about this opportunity, and will begin her sessions next thursday.


oak

chemo, part II

as with most 'chemo' days, we met with dr. carlson and dr. telli on tuesday.
dr. carlson finally received the results of trish's her-2 test (a test that was supposedly ordered by PAMF the week of April 7th.)

the results of the her-2/neu test are positive, which means there will be a change in the chemo recipe and schedule. this is the same course of treatment trish would have began had the test results returned sooner.

trish finished up her "1B" cycle of CAF chemo yesterday (only took 1 nurse 2 attempts to find a vein), and will continue with her cytoxan pills for the next 7 days. she will still have 14 days of no pills/ivs/doctors/chemo/etc.. but beginning may 20th, her regimen will change.

trish will begin on the drugs taxol (paclitaxel) and herceptin (trastuzumab) by IV, once a week for 12 weeks.

when this course is completed, she will switch from 'CAF' to 'FEC' chemo every 21 days for 3 cycles. the cytoxan will now be administered by IV, rather than the 3-4 pills trish currently takes for 14 days. (this is good for trish)

FEC
-----------------------------
5 fluorouracil (5-FU)
epirubicin (Ellence)
cyclophosphomide (Cytoxan)


dr. carlson recommended the herceptin/taxol followed by 'FEC' regimen based on the conclusion of the Buzdar study at MD Anderson:

"Presenting the findings at the American Society of Clinical Oncology (ASCO) meeting, Aman Buzdar, M.D., professor in the Department of Breast Medical Oncology at M. D. Anderson, reported that more than 65 percent of early stage, HER-2 positive patients experienced a complete response rate after receiving Herceptin with chemotherapy compared to 26 percent of patients with similar tumor types who received chemotherapy only.

Buzdar said that because the results were so striking, the Phase III trial was halted early after accrual of 42 of the originally planned 164 patients. After reviewing results of 42 patients and finding the overwhelming increase in complete response, Buzdar and his team stopped and revised the trial so that all M. D. Anderson patients newly diagnosed with early stage, HER-2 positive tumors receive Herceptin plus chemotherapy prior to surgery. "

when this course is completed, trish will continue on herceptin alone every 3 weeks for a 12 month duration
it will be during this time that surgery will be scheduled.

trish is still feeling pretty much the same as the weekend... little nausea here and there, but nothing too bad..


oak

the new do...

our friend (and trish's hair stylist), jennifer tozi, came over today to give trish a new haircut.

trish is now sporting a cute little above the shoulder number. we both laughed when later in the night she tried to put her hair up in a ponytail, and there wasn't anything to ponytail...

it will be a few weeks before the doctors expect trish's hair to begin (un)naturally falling out, but trish wanted to go with a shorter feel prior to that.


oak

6 days later...

its been six days since trish began her chemo treatment. her next infusion will be tomorrow.

so far trish is feeling pretty good, all things considered. she experiences a little nausea and fatigue here and there, but nothing that has kept her in bed all day. her sleeping has been decent considering she hasn't taken any of the sleep medication prescribed in the past 7 days, nor any of the anti-nausea medication prior to bed over the past few nights.

each day she has been able to get out of the house and be active. this morning she went to caden's gym class down at the rec center and this past weekend was scattered with trips to the market, target, toysrus and church... along with plenty time spent with caden in his backyard sandbox.

in the past, trish has experienced really bad morning sickness lasting over 5 months. in a way this has helped her prepare for the chemo symptoms. she has been queasy and tired since january, so this isn't much of a change.

she knows it will get a little rougher after subsequent doses of chemo, but she is ready for it. tomorrow she will receive her two drug IV of adriamycin and 5-FU, while continuing to take her cytoxan pills over the next 8 days.
may 6th - may 19th will be a time of no treatments, no iv's, no pills... just relaxation when not chasing caden around.


we both would like thank everyone again for all their support...
the visits, phone calls, emails, cards, flowers and food have all made a our lives a little happier and easier these days... we truly, truly appreciate it.

we welcome folks to stop by, but there will be a sign on the door (thanks ginger and riley) if we are accepting visitors at that time. we ask you clean your hands with the purell next to the front door, and leave any sick ones at home. the next couple weeks, trish's immune system will be at its lowest, so its vital that we keep her healthy.


thanks all

oak

an update on tuesday's chemo treatment

On Tuesday, April 22nd Trish began her chemo regimen.

Dr. Robert Carlson has prescribed her 4-6 months of 'neoadjuvant' chemotherapy.
'neoadjuvant' is basically defined as chemo prior to surgery, with a goal of shrinking the cancer before it is surgically removed.

Trish's specific chemo is what as known as 'CAF', with a cycle that is two weeks on, followed by two weeks off.

the cycle:
--------------------------------------------------
4/22: chemo
4/29: chemo
5/6: off
5/13: off
5/20: chemo
5/27: chemo
etc..


the 'CAF' chemo:
--------------------------------------------------
cyclophosphomide (Cytoxan)
doxorubicin (Adriamycin)
5 fluorouracil (5-FU)

Cytoxan: these are 50mg pills which trish takes every morning of her 14 day chemo cycle, alternating between 3 and 4 pills a day.

Adriamycin: is red in color, 27ml are administered intravenously, via a syringe manually injected by a nurse. this process takes 12 minutes

5-FU: is clear in color, 18ml are administered intravenously, via a syringe manually injected by a nurse. this process takes 5 minutes



typical "chemo" day schedule:
--------------------------------------------------

• arrive at the cancer center on the campus of stanford university medical center
• go to the blood lab to get blood drawn for tests
• visit with Dr. Carlson, review blood test results and treatment progress
• go to the Infusion Center where the chemo is administered
• go home and rest
  

this whole process can take between 2 - 7 hours depending on how long we need to wait between appointments. the chemo injection itself is only 17 minutes long. tuesday took about 6 hours total, but 2 of these hours was during the time it took 3 different nurses, 4 attempts to find a vein of trisha's. another 2 were spent in the waiting room.

trish has experienced some fatigue and naseua over the past couple days, but not enough to keep her from doing a little cleaning around the house, some shopping and going to caden's swimming lessons.

Trish, Caden AND Oak

This is the family we know and love!

Some pictures to make you smile...

A quick note

Hi Everyone,

First, I want to say thank you for all of your prayers and good thoughts. We finally heard some good news that we have all been hoping for. Trisha still has a challenging journey ahead of her. With that said, I just wanted to publish a quick note about visiting the Barretts over the next few months. As you may or may not know, the chemo drugs put Trisha at a high risk for infection; her immune system will be weaker than it normally is. Please do not come over if you or your kids are sick. Also, there is hand sanitizer right outside her front door and on the inside - please use this. It's for you! :D

Thanks,
Cerena

P.S. Keep posting comments on the blog - Trisha and Oak read through all of them and it definitely helps them get through this challenging time.

finally... a little bit of good news

today we received the test results of the Bone Scan and CT Scan trish underwent last friday.

bone scan: negative... trish does not have any cancer in her bones
ct scan: showed cancer in the breast, but the cancer has not spread to any other organs


trish, cerena and i are currently sitting in the waiting room of the chemo department at stanford.

she will begin her first treatment sometime between now and 3:30pm.

Thank You Everyone

I truly feel blessed to have such a wonderful support system around me.

Thank you everyone for all of your positive thoughts and prayers.

The last few days have been very tough, but I am now ready to take this head on.

I know with everyone by my side, we will beat this.

Please don't be afraid to stop by and give me a hug.

Thank you again for your love, support and strength. All the little things everyone has done has made this easier to handle.


Love,
Trisha

Dinner Sign-Up Part 2

All,

Thank you all for your quick response to the dinner sign-ups. For a moment there I felt like I was selling Wiis... they were gone within minutes! I spoke to Trisha and Oak and they'd like to reopen up the field. I went into the sign-up list and removed everyone who volunteered for more than one day. Please understand that many people want to help, and this is a small way that they can. Please take one day and leave the next slot for someone else. This also gives Trisha and Oak the opportunity to visit with new family and friends.

http://www1.mysignup.com/cgi-bin/view.cgi?datafile=barrettfamily

Thanks for your understanding.
Cerena

P.S. Trisha is moving toward a very balanced diet in hopes that it'll help her beat this disease. Please try to bring veggies, fruit, chicken, fish and other healthy meals. We are meeting with a nutritionist and hope to have more guidance for you soon.

The Latest

Trisha had a Bone and CT Scan done on Friday at Stanford. These tests will determine if the cancer has spread to other parts of her body. Let's all pray that it hasn't! Tuesday is a very big day for Trisha. She meets with Dr. Carlson again to talk about the results of her tests, (Body scans, hormone receptor and HER2) to discuss the treatment options and to start her chemo.

You were sent as an angel...

You were sent as an angel, to be loved and adored
But God had a plan for you, to do so much more

Your presence brought to light, an illness so rare
That prompted an outpouring of loving and care

We will never know your smile or laugh,
But we know you created the clearest of paths

Our hearts will never forget what you mean,
To your mother, your father, your brother and me

Your purpose was not to be but one more,
But to give the chance to fight and be cured

Mama Lina, Framma, Poppie and more,
Wait for you with open arms at the door

As you enter Heaven, with the greatest of ease,
Please watch over us as we beat this disease…

Dinner Sign-ups!

All,

Many of you have expressed interest in making dinner for Trisha and Oak. In an effort to organize this, I've created a sign up sheet for Monday, Wednesday and Friday of each week through June. I will update the blog with preferred foods and drinks. Please visit the sign-up sheet today and sign-up!

http://www1.mysignup.com/cgi-bin/view.cgi?datafile=barrettfamily

Your support and help is appreciated.

Cerena

Recommended Course of Treatment

In my posting last night, I failed to mention what Trisha's suggested course of treatment is. The doctors have recommended the following: Chemo (Cytoxan, Adriamycin, and Fluorouracil)- This will start on Tuesday, April 22nd. She will go every 2 weeks for 4-6 months, depending on how she responds to the therapy. After that they will consider whether or not another drug (Taxol) needs to be added, which may add another 4+ months to the chemo treatment. After chemo, she'll have a mastectomy and then radiation. She may also need to go through Hormone therapy if her Hormone receptor tests come back positive. Keep in mind that this may change.

2nd Opinion at Stanford

Today, Trisha was fortunate enough to meet with one of the top Oncologists in the Bay Area, Dr. Bob Carlson. After examining her, he changed Trisha's diagnosis. It turns out that Trisha has a very rare and aggressive form of cancer called Inflammatory Breast Cancer (IBC). The cancer is diagnosed by how it looks (red, looks like the peel of an orange, etc) and feels. This type of cancer is usually late Stage 3 or Stage 4. Given this diagnosis, Trisha and Oak had to make a decision that no one ever wants to consider. They are going to terminate the pregnancy on Thursday so that Trisha can get the optimal care she needs for her well-being. It breaks my heart to have to report this, but I know you are all interested in how she's doing. She has a CT and Bone Scan on Friday at Stanford to see if the cancer has spread to other parts of her body. After she gets the results, she will be starting treatment at Stanford on Tuesday, April 22nd. As you can imagine, this is all happening so fast for all of us. Trisha is 100% committed to fighting this and she will do whatever it takes to get healthy. The next week is going to be unbearable. Please call first if you plan to visit and keep the visits short. Phone calls are always great too. I can always be reached at cfaggiolly@sbcglobal.net if you want to ask questions or check on her. Thank you all for your support and love. It is so very needed at this time.

Trisha's Team

Many years ago I made a commitment to myself to take a proactive stance in wiping out Breast Cancer.  It has touched many of our lives in ways that we cannot explain.  This year I have a new inspiration, my friend Trisha.  I would like to put together a team that will walk 60 miles in 3 days.  A team that will walk in Trisha's honor.  A team that will walk for hope.  Hope for a cure!  This year's 3 Day will take place the weekend of September 5-7, 2008.  If you are interested in walking please contact me by e-mail at jeanniewynne@yahoo.com.  If you would like more information please go to the 3 Day website at http://www.the3day.org.  Feel free to join me at an informational meeting that will take place on Tuesday, April 22nd from 6:00-7:30 at the Redwood City Public Library.  If you decide to attend this meeting you MUST RSVP by going to the 3 day website, clicking on calendar and selecting the "Get Started Meeting" on April 22nd in Redwood City.  Then you will be prompted to RSVP.  This journey will be challenging and very emotional, but such an amazing way to support Trish and all the other courageous women and men battling this disease!

Strike Out Cancer

5th Annual Strike Out Cancer Day at AT&T Park

Sunday, May 11, 2008 (Mother’s Day)
San Francisco Giants vs. Philadelphia Phillies
1:05 p.m.

In partnership with the San Francisco Giants and The Wellness Community, Genentech has teamed up for a fifth consecutive year in 2008 to help "Strike Out Cancer" in the Bay Area. The Strike Out Cancer program empowers people with cancer and their loved ones to take a team approach when facing cancer, and encourages them to learn about support networks and educational resources. For someone living with cancer, the support of fellow patients, professional counselors and loved ones can often be just as important as receiving the latest treatment regimen and medical care from their doctors and nurses. Through the Strike Out Cancer Program, Genentech makes a $200 donation to The Wellness Community for every strikeout thrown by a Giants pitcher in a regular season home game.

Sunday, May 11 (Mother’s Day) is Strike Out Cancer Day at AT&T Park. The first 20,000 fans will receive a commemorative pink SF Giants/Genentech baseball hat. Come out to the ballpark and show your support of the Strike Out Cancer program and the Giants as they take on the Phillies.

Thank you for your Support!

Trisha and Oak are so thankful for everyone's support during this challenging time. The calls, visits, cards, flowers, food (to name a few) have been appreciated. Please keep in mind that Trisha and Oak are in the process of making some critical decisions around next steps in getting Trisha healthy. Hopefully this site will provide a lot of the updates you are looking for. I can also field any questions that you have - just email me at cfaggiolly@sbcglobal.net.

Thanks again. Trisha and Oak are so lucky to have a great support system in place!! 

UCSF

Dr. Alvarado spoke with Trisha and Oak on Friday and suggested that they meet with the Oncologists at the Cancer Center. He said that in speaking with his colleagues, they are suggesting the Neo-adjuvant therapy (chemo first), then deliver the baby at 30 weeks, and then have surgery. Quite a different recommendation. Trisha is going to meet with the Oncologist sometime this week (week of April 14th). Trisha is probably going to start treatment sooner rather than later. The great thing is that the Oncologists at the center are nationally recognized doctors and they are the top specialists in this area so Trisha will be getting the very best care.

Back to the Oncologist

On Friday, April 11th, we went back to PAMF to meet with Dr. Priya again. Priya said that she believed it was entirely possible to continue with the pregnancy and the treatment. She had been in touch with some colleagues who had studied breast cancer during pregnancy. In a study in Texas of ~20 women, the overall outcome was that the women responded well to therapy and the babies turned out OK. She suggested that Trisha move forward with the surgery, then complete 2 cycles of chemo (once every 3 weeks) and then deliver the baby early. This is the timeline:

Currently 15 1/2 weeks Pregnant
Have Surgery within 2 weeks (17 weeks)
Takes 4-5 weeks to recover (22 weeks) She would even feel comfortable starting chemo at week 23
Do 2 cycles of Chemo - once every 3 weeks (29 weeks)
Recover for a few weeks
Deliver at 32 weeks

The chemo regimen that is being suggested is Adromycin and Cytoxin. Both are administered by IV. The treatments take 3-4 hours. The treatments can cause nausea but there are some medications that they can give to her that are safe for pregnant women.

After discussing the options, the doctor felt Trisha's lymph nodes and felt the growth. She suggested that Trisha get into surgery sooner rather than later.

Surgeon at UCSF

Trisha was lucky to get in touch with her nephew Daniel's English teacher at Sequoia High School. His teacher has gone through this herself and had a wealth of information and resources to share with Trisha. One of her recommendations was to get in touch with the Cancer Center at UCSF. After sending an email, Trisha received a call from the Head of the Surgery at the Cancer Center. She arranged for Trisha to meet with a surgeon on Thursday, April 10th. Trisha, Oak and Cerena met with Dr. Michael Alvarado, General Surgeon, on Thursday in the late afternoon. When we arrived, he met us at the front desk and suggested that Trisha do a mammogram and biopsy of the lymph nodes to get a better idea of what we were dealing with. Trisha was slightly hesitant (apparently the breast tissue in younger people is more dense and harder to see) but it turned out that it wasn't so bad. The people at the imaging center were very reassuring and accommodating. In meeting with Dr. Alvarado, we found out that there was in fact a mast in her lymph nodes. He saw something on the film and he felt it when he examined her. Ugh! We again went through the surgical options that Trisha has. The approach at the center is slight different than the approach PAMF was suggesting. Dr. Alvarado suggested a therapy called Neo-adjuvant. This is giving chemo up front and shrinking the tumor and the potential threats that may (or may not be) floating around the body; then having the surgery after. He said that a Lumpectomy was very possible because of the size of the tumor (2cm - which is relatively small). His next step was to get in touch with the Oncologists at the center and see if they would feel comfortable giving Chemo to Trisha while being pregnant and at what point. He said he would email the case to his colleagues and see what their recommendation is. He promised to get back to Trisha and Oak by Friday (the next day).

The Surgeon

After meeting with the Hi-Risk OB, we met with the Surgeon at PAMF, Dr. Runi Chattopadhyay. Dr. Runi went through some surgical options for Trisha. Dr. Runi explained that there are basically 2 options for women with breast cancer. Either A) A Lumpectomy (just remove the lump) or B) A Mastectomy (full breast removal). Each option has it's pros and cons. The Lumpectomy is a targeted surgery where the lump is only removed. While the majority of the breast is left in tact, there is a 15-20% risk for recurrence and a risk that the entire tumor was not removed. Given this, the surgeon recommend that Trisha do a mastectomy. She also suggested that Trisha meet with a plastic surgeon to have a tissue expander put into place during the removal surgery. This expander would allow for an implant later down the line. There are some risks with going into surgery while pregnant. For instance, the risk of blood clots is higher because of the cancer AND the pregnancy. After this meeting, we collectively decide that we should get a second opinion to hear what another surgeon might think.

Meeting the Hi-Risk OB/GYN

On Wednesday, April 9th, Trisha, Oak and Cerena went to meet with the Hi-Risk OB/GYN, Dr. Druzin at Lucile Packard. After some administrative complications, we finally met with the doctor. Dr. Druzin did not have the specifics of Trisha's situation, so Oak and Trisha tried to bring him up to speed as quickly as possible. He gave us a general overview of what considerations Trisha should make for the baby when considering treatment. Dr. Druzin's general message was that Trisha should get the treatment she needs irrespective of being pregnant - basically that her well-being is the most important thing. He said that after she met with the Surgeon and the Oncologist and received their recommendation for treatment, he would weigh in on the situation.

Meeting with the Medical Oncologist

The next week after the diagnosis was a complete whirl-wind. Trisha immediately met with the Medical Oncologist at PAMF, Dr. Priya Chakravarthi. Steve and Oak were there as her support system. The doctor went through the possibilities of treatment and discussed the uniqueness around Trisha's particular situation (being 15 weeks pregnant). She ordered further tests to help get a better understandings of Trisha's situation.

The Results

On Monday, April 7th, Dr. Hoff requested that Trisha come into the office for the results of her biopsy. Ria and Steve accompanied Trisha to her appointment for support. To everyone's shock and disappointment, Trisha was told that she did have breast cancer. Given the state of her pregnancy, Dr. Hoff recommended that Trisha get moving quickly on next steps. He put her in touch with a Medical Oncologist at the Palo Alto Medical Foundation (PAMF) and a Hi-Risk OB/GYN at Stanford.

The Ultrasound & Biopsy

On Friday, April 4th, Trisha & Oak visited the Palo Alto Medical Foundation so that she could have an ultrasound of the lump. The feedback was that they thought it was suspicious and they recommended that she have a biopsy. Trisha immediately went to have a biopsy of the lump. The procedure was pretty painful, but as you can expect, Trisha was a trooper.

A lump

During one of Trisha's prenatal visits, she mentioned that she discovered a lump in her breast during a routine self-exam. She asked the doctor to feel it to see what he thought of it. He felt it, and called the nurse in to get her opinion. Both were in agreement that she should have an ultrasound of the lump.