It's week 13 since diagnosis and Kathy's will receive the 7th cycle of chemotherapy tomorrow. (3rd cycle of Taxol)
Kathy's hematocrit continues to trend downward (from 42 at diagnosis to 29 last week), her nails have turned black/brittle, and her eyelashes have disappeared, but the worst is over. She's feeling fine, the tumor is undetectable, and she's tolerating Taxol very well.
Taxol typically does not cause a drop in hematocrit, so why the gradual downward trend over the past few weeks?
Kathy received Neulasta as part of her 4 cycles of Adriamycin/Cytoxan. Neulasta is a colony-stimulating factor that encourages hemopoietic stem cells to produce white blood cells, avoiding the neutropenia and susceptibility to infection that was previously a serious problem with chemotherapy. One issue with Neulasta is that it may encourage so many stem cells to differentiate into white blood cells that fewer red blood cells are produced, leading to a mild anemia. Over the next few weeks, her bone marrow should return to normal and her hematocrit should rise. The only consequence of a low hematocrit for Kathy has waning energy mid-day that necessitates a 15 minute nap. Otherwise, her activities of daily living (including packing the house for our upcoming move) remain unchanged.
Her hair is beginning to grow back. She wears head wraps for warmth around the house and while sleeping. When we go out to dinner, she wears a wig (interestedly termed a "hair protheses" for reimbursement purposes) that is so attractive, her friends and family have grown accustomed to the style. When her hair grows back, she'll likely get the same cut.
One unexpected consequence of having breast cancer is that Kathy has stopped eating Tofu and soy products that are estrogenic, given that her tumor is Estrogen Receptor positive and is "fueled" by estrogen. Minimizing estrogenic foods seems reasonable. She continues to get her protein from vegetable sources, but has also added eggs - remaining vegetarian but not vegan. Given that we'll soon have a coop of chickens on our new farm property, having at least one person in the family who eats eggs makes sense.
Thus, her trajectory is positive, her clinicians are optimistic, and we're pressing forward with life, balancing the needs of our personal lives, family lives, and work lives. We're in control, not the cancer.