Tomorrow is the first day of chemotherapy. WTF? Did I really just write that? Really? Seems so surreal. Two messages from friends keep going through my mind:
- We. Can. Do. This.
- All you have to do is B R E A T H E.
- I’ll take the liberty (because I can) of adding: Focus on looking for and finding SL’s (silver linings)!
I’m ready, cognitively, but am feeling a little nervous (scared is way too strong of a word). After you read about all of the side effects, you will understand why. As a practicing nurse, I have seen all of these side effects first hand and let me tell you (when side effects are not properly managed): they ain’t pretty.
The good, no great, news is that I have an incredible team with whom I am working. I feel safe, secure and incredibly well cared for (SL!). I know that I will not have to manage the side effects on my own. While I will take an active part in the healing process, managing the side effects of chemotherapy takes a village. I feel so incredibly blessed and grateful to have the health care team that I do. It is truly a team. THIS is why I am not scared!
All that said, I am welcoming this Chemotherapy into my body to eradicate any and all cancer cells left (after the surgery). I am grateful for the opportunity to have a nuclear arsenal that will work magic.
Bring. It. On.
For those new to the world of cancer and its treatment, chemotherapy is a fluid that will be administered intravenously (IV) through my Port-A-Cath (http://www.brooksidebuzz.com/2010/12/port-a-cath-insertion/).
The arsenal of medications that I will be taking go by the acronym: TAC. I will be taking TAC every 3 weeks for 6 cycles, beginning December 27th, Monday.
TAC consists of:
- Docetaxel, which is commonly known as Taxotere®. Taxotere belongs to a class of chemotherapy drugs called plant alkaloids. Plant alkaloids are made from plants (DUH). The plant alkaloids are cell-cycle specific. This means they attack the cells during various phases of division. Taxotere inhibits the microtubule structures within the cell. Microtubules are part of the cell’s apparatus for dividing and replicating itself. Inhibition of these structures ultimately results in cancer cell death. In other words, Taxotere prevents cancer cell’s from dividing and therefore reproducing.
- Doxorubicin, which was originally called Adriamycin®. Adriamycin is classified as an antitumor antibiotic.
Adriamycin fights cancer by slowing or stopping the growth of cancer cells. This drug gets inside the DNA of cancer cells and prevents cell replication by inhibiting protein synthesis.
- Cyclophosphamide. Cytoxan works on cancer cells by damaging their RNA or DNA when they are in their resting phase (not dividing). Because Cytoxan causes breaks in the DNA of cancer cells, they can’t keep dividing, and they die.
Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. Chemotherapy will kill all cells that are rapidly dividing. The “normal” cells will grow back and be healthy but in the meantime, narley side effects can occur.
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. Everyone’s body is different. When people ask me what I expect, I say that I don’t really know and will have to wait to see how my body will respond. The unknown is the part that makes me nervous. Good or not so good, I really like to know what I’m dealing with. So, tomorrow, I will be entering the unknown (in terms of how my body will respond).
My philosophy that I always shared with my patients (as a palliative care nurse and social worker): Hope for the Best, but Prepare for the Worst.
The general side effects that tend to come with the TAC drug combination include:
- Lowered resistance to infection. TAC can reduce the production of white blood cells by the bone marrow, making a person more prone to infection. This effect can begin seven days after treatment has been given, and resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. The number of white blood cells (the cells of the immune system) will then increase steadily, and will usually have returned to normal levels before the next cycle of chemotherapy is due. I will have a blood test before having more chemotherapy to make sure that my number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if the number of blood cells is too low. Let’s hope not! It is because of this side effect that I have to be extremely careful about being around people who are ill. Additionally, I will be washing my hands constantly.
- Tiredness and Fatigue (“Aesthenia”). Many people feel extremely fatigued during chemotherapy, particularly towards the end of treatment. This is why having an “Energy Bank” (discussed in Bambino post) is so important. I will do my best to “store” energy for events like hiking, visits with friends or going out. This will, however, mean that I will have to pace myself, which tends to be a little challenging for me.
- Bruising or bleeding. TAC can reduce the production of platelets (which help the blood to clot and stop bleeding). Signs and symptoms include: unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums. I’ll be using an especially soft tooth brush during chemo.
- Anemia (low number of red blood cells). Anemia can make a person feel tired and breathless (more so than I usually am!). If ever there were a time to eat animal protein, this is it. Even though it completely grosses me out and I’ve bee 85% vegan for the past few years, I will probably be incorporating small amounts of meat into my diet during this period to avoid anemia.
- Feeling sick (nausea) and being sick (vomiting). There are very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting (SL!). Barfing is one of the things that really sends me over the edge. When I worked in the hospital and one of my patients barfed, I usually did as well, though right after I left their room. Barfing, for me, is brutal! Also, some anti-nausea drugs may cause constipation. Ohhhhhh nooooooo! Back to the Senekot-Miralax-Colace cocktail with which I am verrrrrry familiar!
- Hair loss (“Alopecia”). TAC chemotherapy often causes your hair to fall out. This usually starts about 2–3 weeks after the first dose of chemotherapy. Thinning and loss of eyelashes, eyebrows and other body hair is also likely. Hair loss is usually temporary and hair will almost always start to grow again once treatment is finished. (Pleeeeaaaaaaase let this be the case!)
- Sore mouth and ulcers. My mouth may become sore or dry, or I may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning my teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Additionally, gargling with salt and brushing with baking soda can help alleviate mouth sores. Also sounds like I’ll be stocking up on popsicles! Our 4 3/4 daughter will be very happy about this! (SL)
- Taste changes. Food tastes different. Normal taste will return when treatment ends.
- Bad taste in the mouth (“Dysgeuisa”). As if the appetite and taste issues were not challenging enough!
- Irritation of the bladder. Cyclophosphamide may irritate the bladder. It is important to drink as much fluid as possible (up to 2 liters) on the days when cyclophosphamide is given, to help to prevent irritation. Urine can become a pink-red color (at least they are my two favorite colors! Ok. That was sick.) This is caused by the red color of the doxorubicin.
- Indigestion and heartburn.
- Changes to mental function (“Cognitive dysfunction”). I DEFINITELY already have this! Not sure how much more memory loss and lack of mental clarity I can take!
- Skin changes. Itchy rashes as well as severe skin dryness are also possible. I’ll do a separate posting on the specific products that I’ll be using throughout this process.
- Sensitivity to the sun. During treatment, and for several months afterwards, sun sensitivity is heightened. As a consequence, my skin may burn more easily. I already have fair Irish skin, so this isn’t good! I am stocking up on sunscreen. Hey, here’s another SL: living in Southern California means that I GET TO stock up on sunscreen in January because we actually HAVE sun during the winter months! That’s a good one!
- Fluid retention. Weight and/or ankle and leg swelling are also side effects. FABULOUS. This decreases slowly once treatment has finished. To help reduce the chance of fluid retention, I will be given steroid tablets (usually dexamethasone) to take for three days beginning the day before treatment. The dexamethasone may also help to reduce the chance of an allergic reaction.
- Changes to nails. TAC commonly produces redness, drying and cracking of the hands and feet, and often quite severe drying and cracking of the nails. I was also advised to avoid manicures and pedicures (because of the sensitivity, etc.). So, I’m going for my last mani/pedi today. Will miss these.
- Cardiovascular. Cardiovascular side effects have included fluid retention, sodium retention, congestive heart failure, potassium loss, hypokalemic alkalosis (the most common metabolic abnormality resulting from vomiting and fluid loss).
- Altered menstrual cycle and early menopause. Can I just say: The Poooooor Husband!
- Muscle pains. (“Myalgia”) Pain in joints or muscles, especially in the back and legs may begins 2 to 3 days after treatment and may last up to 5 days. It feels like “’flu” pain, and may need strong pain killers.
- Loss of sensation. (“Sensory Neuropathy”) Docetaxel causes reversible damage to the sensory nerves. This leads to “pins and needles” in the fingers and toes, and sometimes tenderness or odd burning sensations in the palms and soles, but especially the feet. It comes on after about two months of treatment, and may take as long as nine months to resolve after the treatment finishes. Not everyone gets this problem and some women seem much more sensitive to it than others.
The drug-specific side effects are (www.livestrong.com):
- Taxotere Side Effects The most common side effects of this drug include: low white and red blood cell counts, which can lead to higher risk of infection and anemia; fluid retention; loss of hair; mouth sores; nausea and vomiting; peripheral neuropathy (nerve damage in fingers and toes resulting in numbness or “pins and needles”), and fatigue.
- Adriamycin Side Effects Typical side effects of adriamycin include: pain near the injection site; nausea and vomiting; low red and white blood cell counts; red urine (not bloody, and usually goes away in a few days); adverse effects on fertility, and darkening of the nail beds. This drug may have late effects on the heart. You will be monitored while you are on the drug, and regular followups post-treatment are strongly recommended.
- Cyclophosphamide Side Effects Typical side effects include low red and white blood cell counts; hair loss; nausea and vomiting; loss of appetite; adverse effects on fertility; mouth sores; changes in the color of your skin or nails, and diarrhea. Because this drug may cause bladder irritation, it is important to stay fully hydrated while being treated with cyclophosphamide.
So, this is what I’m up against. Vey is mere. To take it all in at one time is, well, overwhelming and makes me wonder how on earth I’ll be able to keep my head above water.
The fabulous SL here is that there is a wonderful array of medications and alternative treatments that can offset these side effects. As you know by now, at this point I’m not exactly shy about asking for what I need.
As I’ve been trying to do since the diagnosis, I am taking one day at a time….and sometimes one hour at a time.
What I know for sure is that: We. Can. Do. This.
As always, wishing you SL’s throughout your day!