The Human Condition - A few years after Gloria’s dad died, her mom started “spending time” with a retired professor. Stan's area was biology-related, meaning he understood better than most the workings of the human body. One day after returning from the doctor, Stan declared in a calm manner that he had received his death sentence ... he now knew what was going to kill him.

He explained he had been diagnosed with an incurable blood cancer and the best that could be done was to "kick it down the road" some.

Stan did die ... but it was a number of years later and not of his cancer. He died of heart failure.

Stan was a smart guy and certainly knew that at his age, if the cancer could be put off some, he’d likely die of something else. But the emotions associated with cancer make it easy for any person - even one like Stan familiar with the science - to fixate on it alone.

And it isn’t just the person dealing with the disease. It becomes easy for friends and relatives to think first and foremost of the person’s illness. At the age of 64, my father was diagnosed with a blood cancer. He was told it was incurable and if all went well with the treatments, he might have five more years. Instead, he lived for 15 more, beating the national average for males by 5 years. During his latter years, his doctor told him he wasn’t even sure dad still had cancer. His death, in many regards, was very much like that of his own father ... he just sort of faded away, but not in the way many cancer victims do. Still, to this day, a number of my relatives invoke cancer as being a cause of his death.

In contrast, dad just saw its approach as a consequence of getting old!

Fortunately for both of us, Gloria is a farm gal who has repeatedly mentioned over our decades together her fondness for the notion, "to everything, there is a season." Gloria and I spend minimal time thinking about what we once could do, but now cannot. Neither of us will be 20 again, so acting as if we were would not just be foolish, but also frustrating, which, in turn, would kill the joy of life.

Youth is the time of cures - when a broken bone mends and we soon forget about ever having one. But most of us, if we are fortunate to live long enough, are like the characters in the Jack Nicholson-Helen Hunt movie "As Good As It Gets." It will never be perfect and often not even as good as it was, but it is still good. I once heard a comedian say that one of the advantages of getting older is eventually everything has a lifetime guarantee. The average life expectancy for a female of Gloria’s age is about 15 years. In my case, I’ve already passed my "use by" date. So we just keep enjoying life, and do what we can, to keep kicking things down the road. These treatments are part of that.

Meeting with Oncologist Travis Koeneke - Today, Monday, November 3, we had a 4 p.m. appointment with Dr. Travis Koeneke, an oncologist, to get the chemotherapy process started. Mary, one of the nurses Gloria had at the hospital after the mastectomy, didn’t hold back when she heard he was in our future. She, too, had breast cancer some years back and she exclaimed, "I just love him!"

That’s a good sign.

If at this point Gloria quits being "different," and settles into being plain old boring "average," the statistical likelihood of kicking this down the road to where it isn't relevant is in the better than 90% area.

Treatment Strategies - There really are only two cancer treatment strategies - cut it out or keep it from proliferating. The latter category includes those we can kill. Gloria has now ridden the former approach about as far as she can.

The second strategy is directed by an oncologist whose challenge is to make life hard for cancer cells, while allowing the non-cancerous ones to live long and prosper.

We commonly think of cancer cells as ones that reproduce too quickly, but the notion of "too quickly" is simplistic. Some body cells normally live less than a day - white blood cells, intestinal cells - and so require frequent replacement, while some nerve cells are thought to never reproduce. So reproduction rate alone is not sufficient to distinguish the good guys from the bad guys.

It is true that a cancer cell has a different genetic makeup than its noncancerous predecessor and neighbors. This suggests a therapy where the cancer's DNA is sequenced and its unique features used to create a pathogen that seeks it out and destroys it. This does work - sorta! At present, the process is laborious - meaning costly and time consuming - and its effectiveness is limited by the fact that today's cancer cell can mutate tonight into tomorrow's version that has a different genetic makeup.

So, despite the fact that we’ve been wrestling with cancer for years, even today, our most effective tools are blunt instruments that create a significant amount of collateral damage. Some of the chemicals Gloria will receive will be disproportionately taken in by rapidly dividing cells, likely killing them. But intestinal cells, white blood cells, hair cells and other quickly-dividing cells will be wounded and some killed in the fray.

Gloria spoke with her friend Judy recently who previously had breast cancer. All of her markers were negative, meaning her cancer did not respond to any other treatments than the poisons. In addition, hers was quite aggressive. But despite the options being limited and the prognosis poor, she not only lived five years, but is now at the seven-year mark with no cancer detected.

In contrast, all of Gloria’s markers were positive. The ER and PR markers indicate that the hormones estrogen and progesterone play a role in fueling her cancer cell proliferation, so one option is to give her medications that attempts to block their functioning. The HER2 protein also plays a role in cell multiplication. Gloria's cancer has an excess, so medication that interferes with its operation is also an option.

Day-Two treatment drugs

Koeneke's "Plan of Attack" - Our meeting was a 55 minute one, but when you remove the time the nurse used taking vitals and checking past medical history, the total time focused on the future was probably more like 30 minutes. Probably 10 minutes of that was Koeneke reviewing the pathology reports and comparing them with our understanding. His and our understanding of the situation matched completely. The only "news" was that the final HER2 test - the FISH Test - on that "surprise" third cancer came back and it was judged negative.

Koeneke's plan had two parts.

1. The first would involve six cycles of treatment where each cycle is three weeks in length. Each 3-week cycle would be as follows:

2. Part two of the plan begins after the six cycles are complete. She will then drop back to every 3-to-4 week Phesgo treatments for the remainder of the year.

Side Effects - There will be regular laboratory tests to monitor vital health elements to make certain all are within a healthy range. Other medications may be prescribed to deal with these side effects.

Anyone who has ever listened to a TV commercial for a new drug is aware that the possible side effects to most are numerous. For acetylsalicylic acid, the site drugs.com listed 46 side effects. Below those, was a section titled "Other Side Effects" that listed 11 more. In case acetylsalicylic acid is unfamiliar, it is the chemical name for aspirin. So I will address only those that are likely to occur and others only if they do occur down the road.

Common side effects include:

- loss of hair as the drugs also work against those rapidly dividing hair cells
- nausea as cells in the intestine are susceptible for the same reason
- tiredness due to the body using its energy to fight back

Final Thoughts - Koeneke did not want to begin until Gloria was at least four weeks out from her surgery, or sometime AFTER November 11. This was to give her chest time to heal.

She will also be given a CT scan as a baseline, looking for any cancers elsewhere. In addition, there will be bloodwork that is not entirely routine. There will be an update describing what that is about later. In addition, she'll have a heart echocardiogram. Rarely, these drugs do some heart muscle damage. This before-treatment echogram will give a baseline to compare with.