best I can give her

Dear Jeff,

By all accounts, I would say that you have performed in outstanding fashion. This is one of the most detailed treatment write-ups I have seen to date. Nice advocate work! I few thoughts --

As indicated below by many, Herceptin and Navelbine, as well as Herceptin, taxotere and carboplatin, are two of the best treatment combinations currently available. One post suggested Zometa in connection with bone mets -- consider Aredia as well.

Many doctors, in response to your question as to whether scans improve your chances, will respond "no." To this comment, you should respond "Poppycock!" Although many doctors say sooner is no better than later in Stage IV, a scan that detects brain mets early, for example, may change the nature of your treatment. There is a difference between gamma knife alone (if brain mets caught early), and whole brain radiation plus gamma knife (if brain mets caught later) in terms of side effects and quality of life. In terms of patient treatment, I can't think of a situation where not knowing or knowing later is better than knowing sooner. Because your wife is in the midst of active treatment, she should be able to obtain periodic scans to determine the effectiveness of her treatment. If that is not the case, insist that she get tested.

Femara is an excellent anti-estrogen choice. Arguably, it is one of the best aromatase inhibitors for HER-2 positive breast cancer, based upon a small study performed by Dr. Matthew Ellis (St. Louis). If at a later date, you feel that Femara is not effective, speak to your doctor regarding use of Faslodex (an estrogen receptor down-regulator).

You're doing great Jeff. Hang in there until May and let's see how well that Navelbine/Herceptin combination works.