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Old 07-29-2006, 07:04 AM   #1
Sherry in WV
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Unhappy Doc says time to stop all treatment

I received herceptin yesterday. Was not day for MD visit, however he saw me walking down hall, with a cane, (new Addition) and stumbling to the left, also new. My eyes were very yellow, looked as if someone colored them with a highlighter pen, and skin had slight yellow cast. I am loosing about 1/2lb a day, no matter if I eat or not. He was alarmed at the changes in my in 3 weeks, I am also getting vein distention on breasts and stomach and abdomen, sign of portal HTN. He knows that I am about to see about compassion use of Tynib on Aut 1st, however, he believes that any treatment at all will end my life faster than no treatment at this time. I am not afraid to die, but I am not ready yet, My new Grandson is only 4 mos old and my Grand daughter (14) who lives with us begged me to stay around at least for her first home coming, she starts High School this year. I have fought a long fight, like all of you, had all chemos available, herceptin, chemo emblolization and nephrostomy tube place, which I HATE. I am not one to give up easily, however, yesterday upsetme, depressed me and for the first time in a long time, I cried myself to sleep. My Onc is good doctor and a good man, he kissed me on the check, hugged me and wiped a tear from him eye.
Now I am confused, I can feel my body failing daily, I am tired alot, but we went shopping for a little while yesterday, took a trip to Tn a week ago and I would like to go out to Ill to see my Daughters home, she just got marred this past Dec.
I have never given up, but it is getting harder and harder to stay focused on the positive. I have to be very careful what I take for pain, anything with acetemetifin turns me yellow.
He gave me a script for Fentynl patch yesterday, I gues I wll try it, but I don't want something that will make me sleep the rest of my life away.
I WILL NOT GO QUIETLY INTO THE NIGHT!!!!!!!!!!!

Dx Stage IV breast CA with mets to liver Sept 11, 2002
Thank all of you for listening, your support, emails, advice and love for all of us has kept me going and means a lot to me.,
love and peace
Sherry Poarch
Wellsburg, WV
But Oz gave nothing to the tin man, that he didn't, didn't already have.
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Old 07-29-2006, 07:45 AM   #2
CLTann
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Dear Sherry,

Although I don't know you well, yet I read many of your writings and have always felt that I know you. Your last message cried out for replies from your fellow BC sufferers. It was a message, so real and so frustrating. It is a difficult task to write a compassionate message, knowing the deteriorating conditions you are experiencing everyday.

The important point here is the quality of life. I would think that you would rather be free of the burdensome injections and tubes. Everyday we should all count as blessings to have your loved ones around you. Enjoy to see them as often as you can. Ask Him to be your guide. Peace and tranquility.

My sincere best wishes.

Ann
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Old 07-29-2006, 08:00 AM   #3
Patty H
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I know that this is a scary thought at the back of all our minds. It has been 6 years since my dx. I am progressing again right now. I am still feeling good but my family doesn't let me talk about the fact that I know there is no cure and I don't know how much longer or if treatments will help. There are little things that I notice, like I get tired easier and run out of breath quicker. It's got to be really hard to have your doctor tell you that treatments will no longer help. What ever it takes you need to work on quality of life and maybe you will even show them that you are not ready. I have to amitt that almost all the discomfort I have had from this cancer has been from treatments not the cancer. You really touch my heart. Patty H
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Old 07-29-2006, 08:31 AM   #4
heblaj01
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Sherry,
It is very important you stop loosing weight.
Ask your onc if you can take Omega 3 fish oil pills or L-glutamine which have been shown to be effective in many cases against weight loss.

Acemitophen (Tylenol or Atasol) in high doses is toxic to the liver & may be a cause of your yellow skin colour. NAcetyl L-Cysteine (NAC) pills can be taken with Acemitophen to prevent liver damage (check with your onc but NAC pills can be procured without prescription).

Once you are stabilized you should be able to benefit from Tykerb.
Good luck.
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Old 07-29-2006, 08:32 AM   #5
R.B.
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I think I have read that fish oil based lipid infusions help stem weight loss in cancer.

Fish oil based infusion are also being tried with low dose cox inhibitors as a treatment in varous cancer types see Geek diet post link below.

The article on the lung cancer patient is also thought provoking.

Dietary change should be discussed with you medical advisors. If the lipid infusion was of any interest you could always print out the trials and take them along.

I hope things improve.

You are being very brave about it all.

RB





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Old 07-29-2006, 08:50 AM   #6
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my two cents

I am hearing that you are not ready to "give up." Did your doc hear that? When you are ready counts for alot. That is one way people outlive their prognosis with will and spirit.

One possibility that you may consider is that it was hard for YOUR DOC to see you suffering. And that his words, as kind as they were, were also to help HIM. Just a thought.

Please keep posting and let me know how you are doing with this.

Peace and love.

Dilly
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Old 07-29-2006, 08:50 AM   #7
Barbara H.
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Hi Sherry,
Your post brought tears to my eyes. While you are such a fighter, I am also amazed at your courage to deal with your current situation. Nevertheless, there are a few members here that have been in the same situation with liver mets, and may have some ideas. If you haven't posted all the chemos and procedures you have had, it might help let those members know who may have some ideas. I know that Al went to the ends of the earth to find treatment for Linda, which gave her more extended time. I am also stage 4, and know that I will be in your place sometime down the road. I admire you.
Best wishes,
Barbara H.
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Old 07-29-2006, 08:57 AM   #8
Becky
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Dear Sherry

Since you need a pain killer, ask your doctor to prescribe Celibrex. It is a Cox 2 inhibitor pain killer. It can show some promise. It will NOT hurt and may help while you wait for Tykerb. Do it now, today.

What about Avastin? Can you also use that with Herceptin while you are waiting. Just thinking out loud here. Ask if you can slowly up the Omega 3 fish oil - don't know what you are taking to even make a suggestion. You can up CoQ10 to over 390mg per day. Shows anti cancer effects. Ask - you will need to up this over a 2 week period if given the ok.

Call about Celibrex today. It's worth a really good shot during the wait.

Love, Becky
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Old 07-29-2006, 10:24 AM   #9
cosmicdust
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Blessings to you Sherry...
Yesterday was history, Tomorrow will be a mystery
Today is a gift from God, and why it is called 'the Present'...

May you find the strength from within - and be guided by the 'powers that be'

Sheryl from Minnesota
DX 2005 Stage 4 mets to liver & spine
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Old 07-29-2006, 10:48 AM   #10
madubois63
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Since you say you are not ready - then give it all you got! I have been close to the end several times and just do not listen to what they keep telling me. Everyone has great advise. I'd like to suggest milk thistle for your liver and megace for weight gain. Sherry, you are in my prayers and I truly hope you get to see your 4 month old grandson's homecoming...
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Old 07-29-2006, 10:53 AM   #11
StephN
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Wink Avastin or other tx

Dear Sherry -
You have been posting off and on here for almost as long as I have.
You are a courageous fighter if there ever was one.
Thanks for sharing so much in your post.
So sorry to hear that your oncologist gave you that advice, even when he knows you want to try Tykerb. Sure we get tired and have a hard time carrying on at times, but you were vulnerable at that moment.

Aug 1 is right around the corner and you will have a better idea about this very soon.
As for Becky's idea of Avastin - this has been shown to be a good drug. I have a friend who started on it just last week, and she had to stop Herceptin when she started this. This lady is also on Abaraxane for the past month and wanted to beef up treatment with Avastin. She has no organ involvement.
My friend says that Avastin can also cause some bleeding as a side effect, so you may want to study the information if this therapy is of interest.

Sometimes crying yourself to sleep can be a good thing and give an outlet for these complex feelings and emotions that go along with this cursed disease.

Keep in touch, OK? Maybe try some high protein shakes to curb the weight loss.
Good thoughts coming your way.
__________________
"When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest." H.D. Thoreau
Live in the moment.

MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
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Old 07-29-2006, 10:57 AM   #12
Tom
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Smile

Dear Sherry,

The information you just received from all of these people that love you and worry about you, is right on the money. I think the first thing you must do, is to stop the weight loss. It would appear that your particular weight loss is genuine cachexia. This can be halted by drinking "milk" shakes of whey protein isolate. You can mix the two scoops of powder with water, milk, soy milk, Ensure, or any liquid. This will do two things for you. The first is to block the catabolic wasting process that is causing your weight loss, and enable you to maintain your current weight at the very least. The other benefit is that you will begin a process of selectively starving the malignant cells of glutathione, via a process known as feedback inhibition. The malignant cells MUST have glutathione to thrive, but they will not get what they need if you take the whey protein each day. There is a prescription version of the whey protein available, known as Immunocal. As your oncologist to write for it.

Your immediate goal is to survive until you can receive the Tykerb. Increase your Omega-3 intake as much as you can tolerate. Drink as much decaffeinated green tea as you can stomach, and take green tea supplements that contain EGCG. The best ones can be found at www.LEF.org. I know I must always sound like I am a representative of that company, but I quickly tired of searching for good, powerful, and pure supplements, and realized that the easiest way to get the best ones was to buy theirs. The product is called MEGA Green Tea Extract.
You should also try taking 900MG of curcumin each day. Not turmeric, or curry, but CURCUMIN. It may also be found at LEF. It is called SuperCurcumin w/bioperene. The bioperine helps your body absorb it. The advice given about CoQ-10 was great. Take 400MG of it daily, spread out over the day.

Stay away from ANY Tylenol. It is just about the worst thing for one's liver that anyone could ingest. Use ibuprofen for breakthrough pain if the Fentynl patch doesn't stop it completely. Just make sure you keep something in your stomach so as not to cause undue upset. You MUST manage your pain to maintain your willpower to fight.

Ask a family member to massage your neck gently each night. This will reduce your stress and strengthen your immune system as well. It also lets the family know that they are doing something positive that directly helps you.

Finally, light a bonfire under your onc's sphincter, and let him know that you don't want to throw in the towel until it needs a good washing. Tell him to get his butt into third gear and get that Tykerb for you post haste. Remind him that he is there for treatment advice, but that all decisions will be made by YOU. Be gentle with him though, as I suspect that even hardened oncologists have stressful days as well.

Please let us know how things are proceding, and come back here often for lots more love, support, and cheap advice. We are all pulling for you.

Sincerely,
Tom
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Old 07-29-2006, 01:58 PM   #13
R.B.
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Here are some trial results from the NCBI site re cancer weight loss and nutritional use of omega three etc.

The possible use of COX blockers is also mentioned a subject raised in another post.

Clearly you must dicuss dietary change or any administration of treatments with your medical advisors but these may assist in considering your options.

This is all fairly new and so as with so many things definative answers simply are not available.

RB




http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum


1: Curr Opin Clin Nutr Metab Care. 2005 May;8(3):265-9.Click here to read Links
Systemic inflammation, cachexia and prognosis in patients with cancer.

* Deans C,
* Wigmore SJ.

Tissue Injury and Repair Group, MRC Centre for Inflammation Research, Department of Clinical and Surgical Sciences, Medical School, Edinburgh University, Scotland, UK.

PURPOSE OF REVIEW: Cachexia remains an important cause of morbidity and mortality among cancer patients. The mechanisms underlying this syndrome remain unclear and are almost certainly multifactorial. Evidence from animal models suggests a compelling link between cachexia and inflammation, and a variety of pro-inflammatory cytokines play an integral role. This review summarizes current thinking relating to inflammation, cachexia and prognosis in cancer patients, with particular emphasis on studies relating to recent therapeutic advances. RECENT FINDINGS: Pro-inflammatory cytokines induce the acute phase protein response, a key marker of systemic inflammation. Recent evidence has also implicated other tumour-derived mediators, such as proteolysis-inducing factor and parathyroid hormone-related peptide. In addition, systemic inflammation has been found in association with many malignancies, and has been correlated with weight loss, hypermetabolism, anorexia, and adverse prognosis. Treatments such as fish oil, monoclonal antibodies, and non-steroidal anti-inflammatory drugs, have all been utilized to attenuate systemic inflammation and influence weight loss. Recent clinical studies have suggested that eicosapentaenoic acid and cyclo-oxygenase 2 inhibitors promote weight gain and downregulate the acute phase protein response. SUMMARY: Pro-inflammatory processes are clearly implicated in the hypermetabolism and weight loss associated with cancer-associated cachexia. In addition, the presence of systemic inflammation is now clearly linked with adverse prognosis in patients with cancer, which cannot be fully explained by the association with weight loss. Systemic inflammation remains an important area for novel therapeutic targets in combating cachexia, and eicosapentaenoic acid and cyclo-oxygenase 2 inhibitors appear to be efficacious in the armory against cachexia.

PMID: 15809528 [PubMed - indexed for MEDLINE]



http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12886666




1: Biol Res Nurs. 2003 Jul;5(1):3-17.Click here to read Links
Rethinking nutritional support for persons with cancer cachexia.

* McCarthy DO.

National Institute of Nursing Research, 31 Center Drive, Room 5B-13, Bethesda, MD 20892-2178, USA. mccarthd@mail.nih.gov

Cancer cachexia is a poorly understood syndrome of anorexia, weight loss, and muscle wasting that negatively impacts quality of life and survival in cancer patients. Research has clearly implicated pro-inflammatory cytokines in the biology of cancer cachexia. More recent research implicates products of arachidonic acid and suggests that cachexia may be a chronic inflammatory condition rather than a nutritional aberration. To date, nutritional support to slow weight loss has focused primarily on increasing calorie intake. Alternatively, many foods contain factors that can modulate the synthesis or activity of pro-inflammatory mediators, especially the synthesis of prostaglandin E2 from arachidonic acid. These factors and foods are sometimes called nutraceuticals, and research is needed to evaluate their efficacy in combating cancer cachexia.

PMID: 12886666 [PubMed - indexed for MEDLINE]
Related Links

* Cancer cachexia. [Surg Oncol. 1999] PMID: 11113664
* The cancer cachexia syndrome. [Surg Oncol Clin N Am. 2001] PMID: 11406454
* What we have learned about cachexia in gastrointestinal cancer. [Dig Dis. 2003] PMID: 14571093
* Systemic inflammation, cachexia and prognosis in patients with cancer. [Curr Opin Clin Nutr Metab Care. 2005] PMID: 15809528
* The biochemical basis of metabolism in cancer cachexia. [Dimens Crit Care Nurs

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum


1: Eur J Oncol Nurs. 2005;9 Suppl 2:S39-50.Click here to read Links
Cancer-associated malnutrition.

* Argiles JM.

Department of Biochemistry and Molecular Biology, University of Barcelona, Barcelona, Spain. argiles@porthos.bio.ub.es

Malnutrition is a common problem among patients with cancer, affecting up to 85% of patients with certain cancers (e.g. pancreas). In severe cases, malnutrition can progress to cachexia, a specific form of malnutrition characterised by loss of lean body mass, muscle wasting, and impaired immune, physical and mental function. Cancer cachexia is also associated with poor response to therapy, increased susceptibility to treatment-related adverse events, as well as poor outcome and quality of life. Cancer cachexia is a complex, multifactorial syndrome, which is thought to result from the actions of both host- and tumour-derived factors, including cytokines involved in a systemic inflammatory response to the tumour. Early intervention with nutritional supplementation has been shown to halt malnutrition, and may improve outcome in some patients. However, increasing nutritional intake is insufficient to prevent the development of cachexia, reflecting the complex pathogenesis of this condition. Nutritional supplements containing anti-inflammatory agents, for example the polyunsaturated fatty acid (PUFA) eicosapentanoic acid (EPA), have been shown to be more beneficial to malnourished patients than nutritional supplementation alone. EPA has been shown to interfere with multiple mechanisms implicated in the pathogenesis of cancer cachexia, and in clinical studies, has been associated with reversal of cachexia and improved survival.

PMID: 16437757 [PubMed - indexed for MEDLINE]


http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum


1: Clin Chim Acta. 2006 May 16; [Epub ahead of print]Click here to read Links
Omega-3 fatty acid effects on biochemical indices following cancer surgery.

* Stehr SN,
* Heller AR.

Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Dresden, Germany.

Epidemiological studies have indicated that a high intake of saturated fat and/or animal fat increases the risk of colon and breast cancer. Laboratory and clinical investigations have shown a reduced risk of colon carcinogenesis after alimentation with omega-3 fatty acids, as found in fish oil. Mechanisms accounting for these anti-tumor effects are reduced levels of PGE(2) and inducible NO synthase as well as an increased lipid peroxidation, or translation inhibition with subsequent cell cycle arrest. Further, omega-3 eicosapentaenoic acid is capable of down-regulating the production and effect of a number of mediators of cachexia, such as IL-1, IL-6, TNF-alpha and proteolysis-inducing factor. In patients with advanced cancer, it is possible to increase energy and protein intake via an enteral or parenteral route, but this seems to have little impact on progressive weight loss. Fish oil administration improved patients' conditions in cancer cachexia and during radio- and chemotherapy. In patients undergoing tumor resection surgery we observed improvement of liver and pancreas biochemical indices when omega-3 fatty acids were administered. This paper is a review of recent developments in the field of nutrition in cancer patients with emphasis on the acute phase response following cancer surgery and the beneficial aspects of fish oil administration.

PMID: 16796997 [PubMed - as supplied by publisher]
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Old 07-29-2006, 02:07 PM   #14
mom22girlz
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Your courage shows through strongly in youir post. I admire all you have done to fight this disease. If you are not ready to stop fighting, don't let someone else decide that for you. Let your doctor know you want to press on. Thoughts and prayers coming your way. Sincerely, Susan
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Old 07-29-2006, 03:32 PM   #15
Kaye
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Sherry, sorry to hear about what is going on. I want to say I don't know you. I don't know what treatments you have had or have not yet tried--but I do know others who have been where you are and have hung on. I don't know if that will be your fate either--but, at the least, I can share what was going on that may have enabled them to improve.

One gal I know was given similar feedback by her onc. She switched treatment facilities and 6 mos. later improved enough to go backpacking with her son in Europe. She changed dr's 2.5 yrs. ago.

I had a colleague who had a failed stem cell transplant. He was given a prognosis of 2 weeks to 2 mos. He came back to work and basically slept there. He didn't want to sit around at home waiting to die. He was allowed to continue with the medication he was on, Rituxin, despite progression. That was 4 years ago. He is still here.

There is a gal who was also given a 2 week prognosis--she was also quite yellow. She was given Navelbine and Herceptin first, I believe but if I recall correctly that either didn't help or helped for awhile. She then switched to Xeloda and Herceptin (although may have still had the Navelbine). Irregardless she improved enough to return to one of her favorite sports--skiing and the bc turned around. That was 3 years ago. It did return to her bones but she is still quite active.

I don't know if this will help or if you could even tolerate but there are alternatives that some have found helpful. These include the antibiotic Doxycycline (50 mg/twice/day or 100 mg/once?) and the non-steroid anti-inflammatory drug, Celebrex (400 mg/twice day=800 mg/day--which, supposedly when taken together have anti-cancer property. In addition, Lovastatin, the cholesterol medication may have anti-cancer properties.
Another possible way to target cancer cells is through pro-biotics--with kefir (liquid yogurt) which can either be homemade or bought at health foods store such as Whole Foods.

I don't know if any of the above is at all of interest or would even be helpful but wanted to share with possibility of such in mind. Take care, sending positive thoughts and prayers...peace and {{{hugs}}}
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Old 07-29-2006, 04:10 PM   #16
Tom
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Thumbs up More info

Sherry,

Here are two links that describe the actions of whey protein isolate, and it's effects on cancer and cancer-related weight loss. You can buy whey protein isolate powders at most health food stores such as The Vitamin Shoppe, and even at Trader Joe's markets if there is one near you. There is one brand that is called Designer Whey, that is very good. Whatever brand you buy, make sure that the whey is NOT denatured. It will tell you right on the can. Use the whey along with a good Omega-3 fish oil supplement as R.B. recommends. We expect to hear from you soon. Let's get this train rolling !

http://www.drugs.com/pdr/WHEY_PROTEIN_ISOLATE.html


http://www.lef.org/protocols/prtcls-txt/t-prtcl-029.html
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Old 07-29-2006, 04:44 PM   #17
Mary Anne in TX
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It makes me feel great

just hearing all the love being sent your way! You must have given so much to receive so much love.
I know that when I feel tired, defeated, and unsure I make goofy decisions. Sometimes just resting and waiting til peace comes helps me make wiser decisions for me. God bless you!
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Old 07-29-2006, 07:42 PM   #18
MJo
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I wish you all the very best. The fact that you've travelled to Tennessee and are planning a trip to Illinois sure sounds like you have a lot of kicking left in you. As for the Tykerb, it seems to me it's your body, your choice. Whatever you decide you have a whole board full of people pulling for you. MJo
PS Where are you in WVa. My mom grew up near Beckley.
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Old 07-29-2006, 08:12 PM   #19
mamacze
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Dear Sherry,
You are an incredible angel, to have heard a virtual death sentence from your well meaning oncologist who wanted to give you relief and instead handed you a boat load of worry. And after being up all night rightfully thinking of your goals and the loves of your life (daughters, grand daughter and cherub of a grandson), you had the overflowing kindness to get on the boards and share your most intimate pain with us. Do you remember your loudest statement to us at the end of that long night? I WILL NOT GO QUIETLY IN TO THE NIGHT!!! It sounds like that still small voice inside of you is no longer still and small...it is SHOUTING! It sounds like it is a loud "2x4 over the head" spriitual message that wants to be heard!
I believe in divine intervention, Sherry and the mere fact that you are discerning a huge worry, and connecting with the ones you love is telling of the strength that you still have inside of you. You will not go quietly into the night; nor should you. Listen to your still small... and the loud voices, hear your smart, compassionate b.c. sisters who stand by you, and feel us reach out to help you fight like hell. Stay with us . Know that you are loved and supported. This is a time when you need to rest in the arms of the ones who pray for you; and know that we are praying for you.
Love, Kim from CT
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Old 07-29-2006, 11:19 PM   #20
Rendi69CA
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I don't know you. But , your words are telling me that you are a very strong woman. I know it is hard to be positive. Don't give up! Please! It is hurting me that you and all of us going though this nasty disease. It hurt so bad. I want you here as long as possible to be with your family. I will PRAY for you and your family. I love you!
__________________
04/97- breast bx. diagnosis breast cancer.
05/97- radical mastectomy; 5cm tumor & 11 lymph nodes.
10/97- City of Hope, high dose chemotherapy.
11/97- 36 radiation therapy.
01/98- NED; tamoxifen.
02/02- breast reconstruction.
08/04- recurrence; mets to rt lung; thoracentesis; femara.
09/04- thoracentesis; ER/PR +, Her2+++.
10/04- total abdominal hysterectomy.
02/06- mets to 9th rib; monthly zometa; arimidex.
06/06- medi port insert; weekly herceptin.
10/06- 3 weeks herceptin treatment.
02/07- mets to liver; arimidex
11/07-liver clear
02/08-chemo taxol/herceptin weekly treatment
12/08-taxol not working
01/09-navelbine/herceptin weelky
03/09-navelbine not working
04/09-xeloda/tykerb
09/09-30 radation to neck; xeloda/tykerb not working
11/09-Gemzar/herceptin weekly
04/10-tykerb/herceptin weekly
06/10-cancer spread to left lung;stop treatment; tap
07/10-right lung collasps; TDM1
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