Dear Doctors: I’ve been diagnosed with breast cancer and really appreciate your recent columns on the subject. What can you tell me about Herceptin? My oncologist has suggested it for after chemotherapy is finished. What is it going to do?

Dear Readers: Herceptin is the brand name for a drug called trastuzumab. It’s a targeted therapy that’s often used in conjunction with chemotherapy to treat a certain type of breast cancer. Herceptin is one of a class of drugs known as monoclonal antibodies, which are lab-made proteins that play an important role in directing a patient’s immune response. It has also been approved for treating stomach cancers that have become metastatic, which means the cancer has spread beyond its original location and reached other parts of the body.

The fact that your doctor has recommended Herceptin suggests you have a type of cancer known as HER2-positive. That means the cancer cells have more than the normal amount of a certain type of protein on their surface. That protein is called human epidermal growth factor receptor 2, commonly shortened to HER2. Although the HER2 protein is present on the outside of all breast cells, some cancer cells have extra copies of the gene that makes the protein. When this is the case, it’s referred to as HER2-positive cancer, and it accounts for about one-fourth of all cases of breast cancer.

The presence of the HER2 protein makes these types of cancers more aggressive than those that are HER2-negative and plays a significant role in decisions as to the course of treatment. As a result, it’s recommended that all patients with invasive breast cancer be tested for their HER2 status. In addition to breast and stomach cancers, bladder, pancreatic and ovarian cancers can be HER2-positive. However, Herceptin has not been approved for use in all HER2-positive cancers.

Each cancer cell has an array of biologically active receptors on its surface. Herceptin works by preventing the HER2 receptors on a breast cancer cell from receiving chemical signals telling it to grow. The drug does this by physically binding to the receptors, which blocks and disables them.

The drug is most commonly delivered as an intravenous infusion. The first session takes about 90 minutes. Subsequent doses of the drug take about 30 minutes to deliver. A newer form of the drug is available as an injection.

As with most medications, Herceptin can cause a range of side effects. The most common include nausea, headache, fatigue, joint or back pain, diarrhea, weight loss and insomnia. The drug has been associated with heart problems, so your medical team will monitor your cardiac function during treatment. Because it can harm a developing fetus, it’s important to be vigilant about birth control during treatment with Herceptin, and for at least seven months after treatment has concluded.

The encouraging news is that treatment with Herceptin can be very effective, so much so that the advent of the drug has dramatically changed the prognoses for patients with this type of breast cancer.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I’m a mom of three great kids and have always been healthy. But after eight months of working from home, being the teacher and keeping everything going, I’ve started getting sick. Plus, it feels like I’m failing. Can being stressed out make you physically ill?

Dear Reader: As working mothers ourselves, your letter resonates deeply. Even before the pandemic upended everyone’s lives, the division of labor among working spouses was lopsided. These days, we’re asking moms to do more than ever. On top of the usual workload of a job, cooking, cleaning, shopping, laundry and organizing, which are just the tip of the mom-duties iceberg, we’ve added a daunting list of pandemic-driven tasks. These include supervising kids doing remote learning, keeping them engaged without access to friends, extended family or their usual activities, and working to keep everyone safe and healthy.

The upshot is we’re switching tasks and roles multiple times per day, if not per hour. Each shift of focus eats into reserves of energy and endurance that, no matter how hard you try, are finite. That you’ve made it this far before feeling like you might fall apart is a tribute to your strength and determination.

We understand why it feels like you’re failing, but the plain truth is it’s not possible to manage a workload this large in the long term. Not only have the demands of parenting during the pandemic led to widespread anxiety and exhaustion, particularly among moms and women of color, the resulting stresses are indeed affecting health. In our practices, and among our friends, we’ve seen an increase in a range of health problems, including headaches, colds, migraines, upset stomachs, hair loss, eczema flares, insomnia, anxiety, panic attacks and depression.

It sounds counterintuitive when caring for children and a spouse, but one of your priorities has to become self-care. We can’t fully give to others if we’re not well ourselves. Start small, with at least a 10-minute break every hour -- time that’s just for yourself. Do 10 minutes of deep breathing alone in the bathroom, 10 minutes of meditation with your bedroom door locked, a solo 10-minute walk around the block. Try outsourcing some of the daily chores to the kids, even the youngest ones, and try to be OK with results that are less than fabulous.

Involve the whole family in talking about the challenges they’re facing, and also in finding silver linings. It sounds corny, but it really does help to count your blessings, even when they seem few and far between. When we look outside of our households, we can see that others are struggling with problems much bigger than our own. And, yes, Zoom is weird, but it’s important for mental and emotional health to stay connected to family and friends.

We’re in the thick of it now, but this pandemic won’t last forever. With treatment advances and an effective vaccine, we’ll return to a more normal world. So, focus on the big picture. Children won’t remember the granular details of this time; what they’ll remember is how the home felt.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: Our dad is 82 years old and may need to get a pacemaker. My brother and I recently read that surgery is hard on older people, both physically and mentally. Is getting a pacemaker going to be risky? He’s physically pretty weak, and we’re worried the surgery will be too much for him.

Dear Reader: A pacemaker is a small medical device that keeps the heart beating at a steady rhythm. It consists of sensors, which monitor the heart rate, and a battery-operated pulse generator, which sends corrective impulses to the heart. A pacemaker can adjust a heartbeat that is too slow, and it can correct potentially dangerous heart arrhythmias. A catheter is used to thread the sensors through a vein that leads to the heart. The pulse generator, which is about the size of a matchbox (or smaller), is implanted just beneath the skin of the chest. (A new, tiny pacemaker known as a Micra, which consists of a single piece, is placed directly into the heart.)

For a patient who is in good health, the procedure to implant the two parts of the pacemaker is considered a minor surgery and is sometimes done on an outpatient basis. However, recent studies have shown that when older patients are also frail, even minor surgical procedures can be risky. Frailty is a term used to describe certain effects of aging that, when taken together, carry an increased risk of poor health outcomes. These include physical weakness, diminished endurance, poor balance, loss of skeletal mass and loss of muscle mass. When a physical assessment finds three or more of these characteristics, the person is considered to be frail. Visual and cognitive impairment can also play a role in a determination of frailty.

A study published last year in the Journal of the American Medical Association found that, compared to other patients in good health, older adults who are also frail are more likely to die after minor surgical procedures. That study looked at post-surgical mortality rates in 433,000 older patients, mostly men, who underwent procedures at Veterans Administration hospitals between 2010 and 2014. The patients who met the criteria for frailty had an increased risk of death in the weeks and months following the surgeries. The mortality rate rose dramatically for patients who were considered to be very frail.

We think it would be wise for you to begin by meeting with your father and his cardiologist to learn what specific condition the pacemaker will address. Your father should also undergo a frailty assessment. If, as you suspect, he meets the criteria for frailty, the next question for your father’s physician is: Which carries the greater risk -- the condition that the pacemaker is expected to treat or the procedure to implant it? If it’s decided that the pacemaker is necessary, a prehabilitation program may be helpful. That’s when a surgical patient prepares with a program of nutrition, exercises to improve strength and endurance, and mental training to manage stress. Your father's medical team can create a specific program for your dad, and help him prepare for the surgery.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)