This post is mostly for @birdman (if still paying attention to this thread) and @colleenyoung

Background first: My wife has been diagnosed recently with metastatic triple positive breast cancer (MBC). A large unilateral pleural effusion is what prompted seeking care. She had Stage III breast cancer in 2014 (ER+, PR+, HER-), age 47, with some cancer also found in right arm lymph nodes. Mastectomy and chemo. NED for 9+ years. The cancer and treatment kicked in her Type II diabetes (first started as gestational in 1998 then 2002) and early menopause. She's had—and hates!—hot flashes ever since. In 2015 she started Metformin but went off of it in late 2019 or early 2020, because in spring of 2019 she learned enough about diabetes to know she needed to radically alter her diet. Initially very low carb and high healthy fat. Her labs eventually showed her to be non-diabetic (though we understand once there, always there). All other labs have been beautiful. Non-smoker; no alcohol. Over the last year or so she moved more into true Keto and also carnivore, and has also been doing intermittent fasting and 2-4 day fasts for longer than that. She has been that rare exception who has had the discipline to not indulge in sugars, carbs, processed foods (read "poison"). And yet here we are with MBC.

She will not be doing chemo this go-round. We have seen the survival curves and she's just not interested in using her remaining time going through that kind of treatment. But...

She won't be giving up on the diet and we are considering the research and protocols suggested by Dr. Seyfried. Seeing as how you, @birdman, did what I am or was about to do, i.e. research it, will you be able to point me in the right direction to go directly to some understanding about the combination of diet and the drug DON(sp)? As you said:

"As for me, the deeper I dove into it, the *less* likely I think this to be a practical 'cure' for cancer. There are still many good reasons to utilize a Keto diet for health reasons, and that is what I do it for. Any benefit for my melanoma is 'extra'."

It seems we are on the same page, not looking for a "cure" and outright rejecting the obviously kooky stuff, and yet if there is enough to Seyfried's work and trying something along those lines, then living a bit longer without chemo, slowing the progression, it seems my wife is halfway there because of her dietary discipline.

Also, now more for @colleenyoung (or maybe others following this): my wife also has zero interest in leaving her home to chase down treatments. She is comfortable enough with her mortality that we won't be traveling to find a treatment. If she's going to be sick she'd rather be sick at home with her family and friends nearby. As such, how might one go about finding a legit (integrative?) doc in our area (SW Virginia) who would be willing to explore this with us? Does Mayo connect with docs away from their hospitals in such a fashion? My wife's oncologist is clearly standard-of-care oriented, pushing the chemo and other drugs.

Thanks.