Tag: chemotherapy

saltine

Heartburn Doth Strike

Heartburn appeared pretty much as soon as the cocktail of “pre-meds” wore off (one of which was a dose of Zantac). I felt really good on treatment day (apart from being high as a kite from the Benedryl), and the next day too. Then after a fab dinner of chili, Liam and I went to his Grade 9 Open House where I proceeded to SUFFER. 

As a consequence I am now armed with heartburn information and meds. Here are the highlights:

What is heartburn?

It’s often called Acid Reflux. Basically it’s when acid from your stomach that is there to digest your food goes starts to hurt you. Generally speaking, the acid in your stomach splashes up into your esophagus (food tube). There might be too much of it, your stomach might be too full or the muscle that acts as an elastic band between the stomach and esophagus might be too weak.

The official name for it is GERD (Gastroesophageal reflux disease) which is a disease that affects the muscle I was talking about. The official name is the Lower Esophageal Sphincter (there is more than one, sphincter! Ha!). As I mentioned, the LES is between the stomach and esophagus – it’s a band of muscle. GERD can also happen to pregnant women since the LES is more relaxed due to all of the hormones. Also, the baby pushes up against the stomach which drives food up through the LES. (I ate a lot of Tums.) Other folks who have a hiatal hernia can get GERD. That’s where part of the stomach and esophagus get pushed up into the chest wall where it doesn’t belong. 

Here’s a diagram that I drew for you (including my recent incisions and my portacath too). It  shows you where things are:

heartburn
Should have put the diaphragm in. Forgot that. 

Why does heartburn affect people on chemo? 

Chemo targets cells that divide at a really fast rate because that’s what cancer cells do, they multiply and take over and wreak havoc in the body. So any other cells in my body that also rapidly divide will be KILLED by the chemo. And the cells in the lining of my stomach and esophagus, which protect my digestive organs from acidic stomach acid are in the list of fast growing cells.

So basically, during chemo any stomach acid in my digestive system is going to hurt me because the protective coating (cells) are being killed off. I don’t have GERD per se, but during chemo I will have the same symptoms as GERD. Make sense?

What can I take for heartburn?

This is interesting! There are 4 different ways to go:

  • Tums, Rolaids: These are acid neutralizers that contain calcium and act as a buffer between you and the acid – but they can actually cause more acid to be produced once the barrier is gone (called acid rebound). Use occasionally. 
  • Gavisgon: This contains alginates (derived from algae) that also act as a barrier (coats the stomach). Very cool. Makes a “raft” and prevents the acid from getting up and out of the stomach. I think I will try the raft. 
  • Zantac: H2 receptor blockers (such as ratinidine) that reduces the amount of acid from building up but increase the risk of cardiovascular problems and osteoporosis – GAH! And I bought this! 
  • Nexium, Prevacid: Getting stronger now – prescription strength! These are “Proton Pump Inhibitors” that also prevent acid from forming – they seem to be like Zantac but are stronger, and not for occasional heartburn. These are for people who suffer badly from GERD and their esophagus is getting damaged. Lots of side effects. Avoid avoid! 

What can I do to avoid heartburn? 

Being a person who likes to avoid taking drugs, I am aiming to prevent heartburn rather than having to take the medications listed above. (Of course I WILL take it if I have to – I’m not into any extra suffering at this point!)

Prevention tips 1 and 2:

  • eat smaller amounts at a time
  • eat more regularly (this is a LOT harder than it seems)

Most importantly though, I have to stop ingesting:

  • caffeinated tea and dark chocolate – ok, anything with caffeine
  • wine / alcohol
  • oily / fatty foods (don’t even talk to me about this category, I can barely manage the first two)
  • citrus
  • tomato based foods
  • spicy foods
  • garlic & onion
  • more good stuff
  • more good stuff 
  • more good stuff

Basically, I’m going to eat BLAND food, very regularly, with lots of water. Oh boy. 

What is the silver lining? 

Let’s just be clear. When people mention the “silver lining” to a shitty situation, it’s akin to saying “there are plenty of fish in the sea”. Just shut up already. But if I had to pick the silver lining for this one, it’s 

Ok I can’t think of one. 

 

toxic logo

Toxic

Chemotherapy medicines are toxic. So therefore, when you’re receiving chemotherapy, anything that leaves your body is toxic. You have to be careful where it goes and who comes in contact with it.  

Naturally there are some basic safeguards – some that make tons of sense, some that are perhaps a bit surprising. Here’s the basic list:

1. Pee

You may not think that this is a big deal. Just flush it down and Bob’s your uncle (I know, he IS!). There are actually rules to the flushing. First one is to sit. Not a problem for me, as I always do. But dudes have to sit to pee. Not that that has anything to do with me, but I tought it was notable. Secondly, put the lid down before you flush. Who does that? Last, and the most disturbing to me, double flush! 

Flush sign

This may not seem upsetting to anyone … but I’m an environmentalist. Having grown up at a cottage, I’m already conditioned to NOT flush unless it’s very very yellow & stinky or brown. (Note: At home I do flush after I pee (promise), but I flush once.) So I find this to go against my principles. (I can tell you this, though, if I’m peeing during the time that I am receiving treatment at the cancer suite, you can bet I’ll be flushing twice! People track you with their eyes and likely listen for the double flush.)

The other thing about pee is that when you’re female of a certain age, it tends to be less able to stay in it’s correct location when coughing or sneezing or laughing or jumping on the trampoline.

I have been told that each time any pee gets on me I have to wash thoroughly (probably twice since that seems to be the norm) and if it gets on my clothing or sheets I have to wash them TWICE. Separate from other items. Geez. This seems like a lot of work. (Am I going to be wearing Depends?)

2. Sweat

I told the nurse that I don’t sweat. She raised her eyebrows as if to say “reeeeaally” or “you don’t sweat YET”. She then asked about hot flashes and night sweats. Hmm, well, I don’t sweat much …. ok, I’ll wash my sheets more often. Fine.  (But I’m not washing them twice.)

3. Vomit

I’m hoping I don’t have any issues in this department, but if I do, I have to follow the same rules as above – two flushes two washes. Of anything it touches. (I think I’m in denial on this one, but I’m not a puker.)

4. Stool

Who says stool?? It’s POOP, people!! I don’t think this will be a problem at all, since I haven’t generated very much since my 1st treatment. I know. It’s not a good thing. I’m on it …

poop inducers
Pear juice, herbal tea, bran muffins and a supportive mug. Bam!

5. Vaginal Fluid

Hold the bus. What? Yep – it’s toxic. So sex must involve covering it all up. Uh huh. A condom… and for other activities enjoyed by women, a dental dam. Ya, that’s not happening. 

What’s not on the list:

I asked the nurse why saliva is not on the list. I am going to try to reiterate what she said, but it didn’t make any sense to me so I’m not going to sound convincing. It’s ok because it is less likely to come in contact with someone. Um … what if I cough? Not enough. Or spit on someone? Funny look. What about kissing? Not enough. (Ok that woman must be a dry kisser.) I let it go. 

Some of the Additional Rules:

  • Anyone who deals with my “body fluids” has to (obviously wash it off their body asap, twice?), wear gloves and be given a medal. 
  • Any “body fluids” needing to be cleaned up are collected with paper towel that is then sealed in a plastic bag and put in the garbage – which is then sealed. (Of course I’m wondering what will happen if I toss it in the fire instead …)
  • If any of my “body fluids” get into my eyes or someone else’s eyes (ok … what??), the eyes must be flushed 2 or 3 times. Hard to get that image out of my mind. Projectile vomit? 

Good times, people, good times. 

And yes, you can visit me. Just stand back a safe distance. I’m toxic.

Waiting room

In the Brown Recliner

Prior to this cancer journey I didn’t pay any mind to the recliner chair. I began to see the light a few days back when I had my information session with a Cancer Centre nurse. Her job was to be sure I understood about the chemotherapy, the side effects, and the procedures at the Centre, but she actually helped me to understand the power of the recliner. Specifically the brown recliner.  

What I found out:

– The name of the place that I get my chemo is called “the suite”.
– The chairs for patients are all recliners.
– The brown chairs have a massage feature in them.
– It is chilly in the suite. Blankets are recommended.
– The brown chairs heat up. 
– There are less brown chairs than beige chairs.
– Wednesdays are the busiest days (this has to do with Tuesdays being the days that most of the oncologists meet with patients – which happens the day before treatment)
– Since I go on Wednesdays I may not get a brown chair.
– People can bring me food and drinks but they can’t eat or drink with me.
– TVs are all on mute. I must be able to read the closed captioning.
– There is one chair beside every beige and brown recliner … I can only have one visitor who is not eating or drinking.
– The washrooms in the suite are not for visitors.
– I cannot go to Tim Horton’s but I can go and pee with my IV pole. But not with my visitor. 

What I noticed on my tour:

– There are 4 sections in the suite, each one assigned to a different nurse. 
– Each section has 4 or 5 recliners. A couple of them are brown.
– There were only 6 patients in the suite, scattered in the different sections. All of them were in brown recliners. None of them were talking.
– As I walked through, each of the patients glanced at me with a knowing look.
– Chemo drip bags come through a hermetically sealed window at the far end of the suite. 
– There are 2 washrooms. (For patients.)

What I determined:

No picnics. No singing. No visits from loud friends. No way I’m missing out on a brown recliner. 

Brown chair
Coveted.

My first treatment is happening while I write this. And yes, I got here early, in hopes of a brown chair. Oh ya, you guessed it … I got one! 

Me in the chair.
Very comfy indeed.

My bum is nice and warm.  

What I’m Doing in the Chair Today:

Schedule for the today (week 1):

– begin with a “loading dose” of Herceptin (8ml / kg) that lasts 90 minutes (the next doses are not as big … they are called maintenance doses with 6ml/kg)
– They watch me for 1 hour. For side effects, but likely also to see what kind of patient I am … complainer? Rule breaker? Under prepared? No friends? Chatterbox? Eavesdropper?
– Then I get approx 1 hour of “pre-meds” before the taxol. They include 4 things:
1. Oral dose of anti-nausea pills that I have to remember to bring with me each week. Oh oh. 
2. Benadryl (oral)
3. 15 min of Zantac drip (coats the stomach, helps with nausea)
4. 15 min Dexamethadrone drip (steroid)
– FinallyI get the nasty stuff, Taxel for 1 hour and 15 min.
– Then I get a ride home at around 2.

My drip
Very impressive system!

Extra Curriculars:

I’ve got a load of things to keep me amused. All the technology: iPhone, iPod, ipad (yes, Apple junkie). Lunch & drinks. Knitting. Journal. Book & magazine. Etchasketch. 

Better get busy! Lots to do. 

 

 

Portacath

Port Me

Tomorrow I am going to have my toxic drug portal installed. It will deliver all of the nasty chemicals to my cells without any fuss or muss or burning skin. Ahh. How nice! It’s called a portacath, meaning a portable catheter. It’s made up of two parts: a small disk (port) and a long tube (catheter). Hence the name. 

Port-a-cath

Where does it go?

It will be inserted in my chest, just under the clavicle. Each time I go for a treatment – whether it be for the 12 doses of Paclitaxel (chemotherapy) in the first 12 weeks or the Herceptin (the targeted therapy) in the remainder of the year (18 doses) – the drugs will be delivered through the portacath. Nurses can also take blood through the portacath, even though my veins are quite charming and easy to take blood from. 

Giving blood
I think the nurse had performance anxiety. I can’t recall ever having had a drop of blood spill – or it hurting. Serves me right for taking a picture. 

How is it put in?

Usually this procedure is done in Surgical Outpatients and I would be knocked right out, requiring that a breathing tube be inserted. But as I’m obviously an early adopter, I’m having it done in the Diagnostic Imaging department instead with “twilight anesthesia” (yes, I’m the very first one). This means that I will be in a semi-conscious state. No pain, no anxiety, no need for a breathing tube, no memory of what happened. (This last part is unfortunate, because I’d really like to watch if I’m going to be semi-conscious. I have many questions.) 

In fact today during my teaching session (in which someone tried to teach me…) I asked the nurse how it’s done and waxed on about my vision of the procedure. She gave me a blank look. All she said was “There are 2 incisions.” Blew apart my whole vision, in which … of course I’m going to tell you … I think that the tube is inserted first – it looks like it has to run up and over the collar bone and then down into the Superior Vena Cava. (Remember that one from Biology class? It’s the large vein that runs in to the heart.) The disk is then attached to the tube, and slid under the skin. A couple of stitches later and it’s all done. But likely that’s not how it happens. If I come out of the twilight I will let you know what I see. 

Here is a professional diagram, proving that I am likely very close to being right. 

Diagram of Port-a-cath

How does it work?

Once it is in my chest, each week the nurse just has to poke the special needle through the skin into the top of the port and start the drip. It’s not inconvenient like a PICC line, which is inserted in the arm and has an external port that you have to look after. Apparently I can sleep on my stomach (although I’m not sure if it will be comfortable) and I can swim with it (you can’t with a PICC line). Plus it will make me look like I have an alien microchip implanted in my chest, and that’s cool. 

Bump in chest
See? Cool.
at Lakeridge

Word of the Day: Receptor

Before my breast cancer journey began, I might have guessed that a receptor is a mechanical part of a TV tower. Or something like that. Perhaps I wasn’t paying attention in Biology classes. (Sorry Mr. Bailey! But thanks for the quilt!)

receptor definition

What are Receptors?

Turns out receptors are a big deal when it comes to breast cancer. There are three types of receptors on a breast cancer cell:

  • estrogen receptors
  • progesterone receptors
  • HER2 receptors (human epidural growth factor receptor 2)
breast cancer cell
This drawing is similar to one that my surgeon drew for me (I added labels for your convenience).

What does it mean?

When you have breast tissue removed and sent to the lab, they identify whether or not the 3 receptors are positive or negative:

POSITIVE: This means that the cancer cell IS receiving signals from that hormone or protein, telling the cell to grow.

NEGATIVE: The cancer cell IS NOT receiving signals from that hormone or protein to grow. 

Why is this important?

It determines your treatment. If any of the receptors come back Positive, then you are a candidate for “targeted therapy” – treatments that target specific characteristics of cancer cells. Good thing. Because other therapies like chemotherapy is a systemic therapy that targets all quickly growing cells … such as those that are in your gut, mouth, vagina, and that grow hair and nails. Yes, vagina. 

So, for example, if you test positive for one of the two hormone receptors, then you can use hormone therapy to cut off the supply of estrogen and / or progesterone to the cells. These are called targeted therapies. Boom! Dead cancer cells without the need to throw a ton of chemotherapy at your body. (Note: This is when a positive result is actually positive … not like my last post when a Negative is a Positive.)

With that in mind, a triple negative pathology is NASTY … since only chemotherapy can be used. 

What’s my pathology?

Let’s take a look (this is the 2nd path report btw):

results

My hormone receptors are both negative – so no hormone therapy for me. Move on to the HER2 receptors. Positive. WOOT WOOT!

What’s HER2?

HER2 are proteins that control how a healthy breast cell grows – until they stop working properly, get out of control and replicate in a crazy ass way.

This is the first thing I read about HER2, from the American Cancer Society website:

“For about 1 in 5 women with breast cancer, the cancer cells have too much of a growth-promoting protein known as HER2/neu (or just HER2) on their surface. These cancers, known as HER2-positive breast cancers, tend to grow and spread more aggressively. ”

Oh great. That doesn’t sound so positive… 

So what’s next?

So to be sure that there there are no rogue cells journeying around my body, we have to hit those HER2 positive cancer cells with some drugs. And the best treatment is to combine some of the targeted therapy (good) with some of the systemic therapy (not as good). This is what my oncologist has recommended:

1. Herceptin (this is the brand name – the medical name, trastuzumab, is hard to say):

  • This is a monoclonal antibody (a man-made immune system protein).
  • It blocks the ability of the cancer cells to receive chemical signals that tell the cells to grow.
  • Sometimes it is given alone and sometimes accompanied with chemotherapy.
  • Causes flu like side effects (fever, chills, nausea, muscle aches).
  • Oh, and it can cause congestive heart failure … more on that in another blog post…

2. Taxol (chemical name Paclitaxel)

  • One of the taxane chemotherapies that interfere with the cell’s ability to divide.
  • In order for it to find the cancer cells it needs to hitch a ride on herceptin, which incredibly knows where to go (because it’s targeted …. remember?).
  • It uses solvents to dissolve paclitaxel, the main ingredient, so the medicine can enter the bloodstream. I will have to take pre-medications to minimize reactions to the solvents. Oh can’t wait for that.

So that’s where we’re at folks!! I know what’s coming … just have to firm up a few dates and get myself fitted with a portacath! 

Oh so many more stories to come… like what I’m going to do with this stunning hair before I lose it all!! 

hair that will fall out