ACTH vs TCH, especially looking at side effect profile?

This choice is difficult, and as with all aspects of treatment there are pluses and minuses to each.  With AC-TH the drugs are not given concurrently.  You would receive the AC portion first - usually dose dense, 4 treatments with two week intervals, then the Taxol and Herceptin given together either dose dense, or weekly.  The reason for separating the Adriamycin and Herceptin is for the cardiotoxicity you mention in your initial post, but it is important to also note that heart damage from Adriamycin is usually permanent, while decreased ejection fraction with Herceptin is usually not.  Herceptin on its own can cause decreased heart function, so having it with TC does not guarantee that you will be able to complete the year.  You should be monitored with quarterly MUGA or echocardiograms to keep tabs on your heart health regardless of which regimen you receive.  Adriamycin is usually associated with more nausea, taxane drugs with more bone/joint pain.  There is no rhyme or reason why some experience more side effects than others - fitness, age, etc., don't seem to have much correlation.  TCH is the regimen recommended by the doctor (Dennis Slamon from UCLA) who brought Herceptin to the market, I assume due to not wanting to administer two cardiotoxic drugs.  I had 6 cycles of TCH, 21 days apart, and did not work during that time, but I had five surgeries prior to starting chemo, so things did not go according to plan!  I did not experience much in the way of bone pain from either Taxotere or the Neulasta injection, and my overriding SE were the Big D and fatigue.  I laid low for the first week - mostly to stay close to the bathroom (sorry - TMI!), then did fine for the remaining days before the next infusion - could do all the normal household stuff, run errands, etc. My job was in the hospital, dealing directly with patient treatment, and I did not feel confident enough about being able to do that, on my feet, for 8 hours a day.  The department I worked in was often crisis driven and frequently we could not take breaks or lunch - or even sit down, so it was not a forgiving environment during chemo, not to mention the biohazards with a compromised immune system.  I was fortunate to have both short and long term disability and FMLA available, so I did not return to work until 30 days after the last infusion. If my job had been more sedentary I might have been able to work even with the surgeries prior to treatment.

I also see you are only 35. If you wish to have more children, just know that Cytoxan is hard on the ovaries. All types of chemo can cause premature menopause but Cytoxan is the worst.

jen - many do intermittent FMLA during chemo so you can take the day of chemo, and maybe odd days here and there.  I had infusions on Thursdays and didn't feel bad for a couple of days - you could try to time feeling bad with regular days off and supplement with another day of FMLA.  I have seen others do this successfully.