A weighty issue with chemo

Who would ever have guessed that chemotherapy would put on extra pounds?  Not I !  I was actually looking at the bright side of all this and figured once I started chemo that I would actually lose a few pounds without any effort.  I had always pictured the stereotypical chemo patient as thin and gaunt.  Right? In the past yes, but not so much anymore.

No thanks to the drugs they have found that suppress the nausea and vomiting, a downside is that the steroid medication  given actually contributes to weight gain. Corticosteroids contribute to fluid retention and increase your appetite as well.  I had to take steroids beginning the day before a treatment until two days after, in addition to the ones they give you intravenously the day of treatment. Your metabolism slows down.  The chemo leaves you fatigued and you are much less active.  The strange taste bud changes take away your appetite. Then when you do feel like eating, it’s the wrong foods. Intense food cravings with chemo often involve sweets and carbohydrates.  There is a change in body composition as your body gains more body fat and loses lean muscle as they redistribute muscle mass from the extremities into the abdominal area as fat.

Unlike typical weight gain caused simply by overeating and lack of momentum, where you are gaining both lean and fatty tissue, the weight you gain during chemotherapy is comprised only of fat. The change in body composition that is brought on by chemotherapy is normally seen as a part of the normal aging process. Another “bonus” is that chemotherapy ages you. Depending on the type of chemo used, your body accelerates the aging process an average of 17 years, possibly 23 – 27 years for those treated with anthracycline-based treatment.  https://www.onclive.com/view/biomarkers-help-predict-the-role-of-chemotherapy-in-biologic-aging

Before each chemo infusion you have a mini checkup with a weigh in, temperature taken, blood pressure and blood work.  The scale is a digital one in a hospital calibrated to the tenths and I have a strange feeling that it is pretty accurate.  Each time I stepped on, it went higher.  It ended up averaging one pound per week over the course of treatment.  I now weigh more than I ever have in my life.  I started inquiring with other patients and heard that it was referred to as the “Chemo 30.”  Fortunately for me it was the “Chemo 20” although everything I have read says the typical gain is much less.  So much for being typical.

It’s bad enough going through chemo and losing your hair but then to have to deal with all the extra pounds is kind of discouraging.  I recently looked a full body picture of myself sitting with my daughters by the ocean and all I saw was a plump pirate!  I had to buy new clothes for the summer to fit into and really don’t want to buy a bigger size fall wardrobe.

OK, so for most of my life I never had to watch what I ate or how much I ate.  I had one of those metabolisms that everyone wants.  Even after three pregnancies I went back to my pre-baby weight within one  month after giving birth without even trying.  Then with a combination of my fourth pregnancy and nearing 40, the inevitable happened.  The pounds did not disappear and for the first time in my life I had to start watching what I ate.  After a few years I figured it was easier to carry the pounds around because now I was approaching middle age and it’s acceptable to not have a skinny waist.  Right?

I have never been to a gym.  However, prior to going back to work full time last year I worked as a dog walker.  I loved it.  I loved the dogs.  I loved being paid to walk daily.  I would push them to a brisk pace when possible although anyone who walks a dog knows that it is not always possible.  This was my exercise and I loved it.  Some pounds started coming back on once I had to stop dog walking and these were the pounds that I was hoping to LOSE once I started chemo!

Cancer survivors that are overweight are more likely to have a re-occurrence than those that are thin.  I WANT to lose this weight!  I NEED to!  Like I said, I don’t do the gym.  I do have to do something however.  I am hoping the GAIN part is over now that my chemo cocktail is finished.  I am blogging this so I can be accountable (and also so you understand why, yes, strangely I have put on extra weight).  I have a cousin who has lost over 100 pounds in the last year and is blogging about “Tomorrow is a lighter day.”  She has inspired me to do something about this.  So what will I do you ask?  I still feel crummy from my treatment last week but know that my energy will be returning.  I do have a mini trampoline and a stepper in my basement and found some exercise tapes.  They are all dusty and so is my basement.  I plan to dust them all off, well maybe not the basement.  I also plan on starting to walk again even though no one will be paying me!  Perhaps after a bit I will add a little running to it.  “Those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint,” Isaiah 40:31.  I did jog in high school and college and enjoyed it then, although that was over 30 years ago.  I need to be careful with any  upper body lifting to prevent lymphedema.  Any other suggestions?  I will take it slow so as not to get discouraged but I will start doing something!

I am really praying my taste buds straighten out so I can get on track with eating right again as well.  You have no idea what it is like when everything tastes like cardboard, metal, chalk or absolutely nothing.  You stand in front of the refrigerator or cabinets and nothing looks appealing.  Or you sink your teeth into something that does look appealing and then you can’t even take another bite.  One thing that has remained appealing through this ordeal has been the Word.  No surprises there.  Psalm 34:8 says, “Taste and see that the LORD is good; blessed is the one who takes refuge in him.”

I’m not going to be a “pirate who doesn’t do anything but stay home and lie around…” like in Veggie Tales.  I’m ready to soar…

 

Conquering Chemo

Whoever said winning isn’t everything didn’t have to fight cancer. Chemo does kill some good cells but it also saves lives by destroying cancer cells! Yesterday was my last day of my chemo treatments with the “full cocktail”!  I will still have to continue to go every three weeks through May 2013 (1 full year) to receive a short infusion of only one drug called herceptin which takes less than an hour that I can fit in after work.  Best news is it does not give any chemo side effects because it does not destroy good cells.  Yeah! It is designed to shut down a factor that stimulates the growth of new cancer cells (HER-2) which I tested positive for which is why I needed any chemo at all despite being diagnosed stage 1.

Before becoming a cancer patient myself I would hear people talk about their treatments and mention chemo and radiation.  I could never remember which was which and what was really involved.  To make things more complicated I never really understood that each cancer diagnosis is unique and catered to the patient as to drugs used, dosages, number of treatments, how often, etc.  Not everyone with the same diagnosis follows exactly the same course even with the same doctor.  Let me give you a little insight into what my chemo has been like.

“Chemotherapy is a general term used for any treatment that involves the use of drugs or chemicals to stop cancer cells from growing. You may receive one drug or a combination of drugs. You may also receive chemotherapy in addition to other treatments such as surgery, radiation, or biological therapy.  It works by destroying fast growing cancer cells.  Different types of chemotherapy drugs target the different growth patterns of cancer cells.  Each drug has a different way of working and is effective at a specific time in the life cycle of the cell.  Since it cannot tell the difference between cancer cells and normal cells, the normal healthy cells in your body are also affected by chemotherapy.  It can be given in different ways including: orally by mouth, injection (shot), vein(IV), body space (injected into the abdomen or around the lungs), or transdermal (application directly on skin).”

The chemo I received so far is by infusion with an IV over the course of several hours.  I have not had a port surgically inserted so they pick a new vein each time for the infusion, usually in my hand.  The “cocktail” I received for 6 treatments every three weeks was TCH – taxotere, carboplatin, and herceptin.  I’m not much of a drinker and kind of got a chuckle that now I would be getting a cocktail of drugs no less! I was also given an infusion of pre-meds each time of steroids, anti-nausea, and Benadryl before the cocktail.  The “infusion” center at the hospital I go to consists of 23 private treatment rooms with either reclining lounge chairs or beds.  They each have a flat screen TV, DVD player, and CD stereo player with WiFi access. They also have a community short stay room that accommodates 6 patients  for infusions of an hour or less which I will be in for my remaining infusions.  There is a refreshment area that provides coffee, tea, and other beverages as well as bagels and light snacks.  The staff and volunteers have been wonderful.

Not every infusion has gone smooth.  One drug is mixed according to my blood results that day and sometimes the lab has had problems or was backed up adding further wait time to my treatment.  Other times there have been blockages in the hookups.  Every bag of drugs runs through a pump that programs the flow time.  This pump has a beeping alarm that goes off to indicate a blockage somewhere as well as announcing when the bag has emptied.  It gets louder and louder until a nurse comes and can be pretty annoying.  One drug took several treatments to figure out the right way to time it and dilute it with saline because of the intense burning it created when it entered my vein.  I have had leakages occur too but the worst was when I did not realize it until that drug was almost done. It had been soaking up in a blanket I had over me. They brought me hospital scrubs to wear home and took my capris from me because they were “contaminated.”  I was afraid something like the scene from the movie Monsters Inc. was going to occur! Some IV sites have left the area more bruised or sore than others for days afterward.

Initially I was disappointed that we were secluded in private rooms but it turned out to be one of the biggest blessings.  From my first treatment my parents offered to come from Pennsylvania (sometimes the night before), drive me to the hospital, stay with me for the entire treatment, bring me home and then return to their home.  Quite the sacrifice of their time!  We were able to sit and share and talk and spend an entire day together every three weeks.  We don’t get to see each other that often on a regular basis and certainly don’t have hours alone when we are together.  We used the refreshment area but NEVER even used the TV, DVD, CD or WiFi in the room.  This turned out to be a precious time with my parents.

Because chemo drugs can also damage or destroy your normal cells you experience side effects from these drugs.  Side effects vary depending on the treatment and on the person receiving it.  Patients receiving similar treatments can experience different side effects. Thankfully with all the advances in breast cancer treatment, chemo side effects are not typical of what they once were.  Yes, certain drugs will still make your hair fall out (why haven’t they figured that one out?) but they have been able to come up with even more drugs to combat the nausea.  I HATE taking drugs but they practically guaranteed that I would not throw up if I took everything so I did and I never threw up and it was definitely worth it!

I tend to put myself in the category of a health conscious person.  Prior to receiving a cancer diagnosis myself I always thought that if that day came I would NEVER go the route of chemo and radiation but take a more holistic route once I had the surgery to cut it out.  Other than check-ups, we rarely run to the doctor for any ailments and even then don’t run to fill a prescription but have it as a last resort if necessary.  For me it was a whole different thing once I became the cancer patient.  I explored my options and had a peace about what I chose to do to conquer this.  It has not been as bad as what I had thought in the past but I definitely would not want to go through all this again and so far it has only been surgery (lumpectomy) and chemo (which will go until May to a lesser degree).  Radiation will begin in September and I’ll blog info on that then.

I purposely did not read the paperwork they gave me on the drugs I would be infused with because I did not want to subconsciously think I was having some of the side effects mentioned.  Every time you go for your chemo infusion you first have blood work done because chemo lowers your counts and they test your red blood cells, white blood cells, and platelets.  They also take your temperature and weigh you. Initially I thought this would be the time I would be losing weight.  WRONG!  No one told me that with all the steroids I would be given orally and intravenously that I would be GAINING.  I weigh more now than I did with any of my pregnancies! So much for that fallacy now a days with the thin gaunt chemo patient! Next you meet with your oncologist for a brief consultation before receiving the infusion.  Remember I said I purposely had not read about the side-effects?  Each time I met with my oncologist she would run down a list of questions asking if I had experienced “such and such”!

Fortunately for me the side effects I have experienced were hair loss, fatigue, upset stomach, loss of appetite, horrible taste changes, occasional swelling in ankles and feet, tingling of hands and feet, skin rash, jitteryness, nosebleeds, and ringing in ears.  It could have been worse. I did not have all the symptoms at the same time or even after each treatment.  Most are gone by the end of one week to 10 days after a treatment.  It has not stopped me from doing too much of anything and I was able to work through the first half of my treatments until school was out.  It has been nice having the remaining treatments over the summer.  I look back and wonder how I made it through the first half going to work daily.  I am thankful for all the support (physical and prayerful) that I have been receiving and know that is what has made going through this possible but more on that in another blog.

Because of the problems that some of these drugs can cause there are also different tests that are done prior to receiving the first treatment and then given periodically during the course of treatments.  I have had to have echo cardiograms (heart) and blood work to measure my kidney function.  The day after each infusion I return to the hospital and receive a shot called Neulasta to prevent or treat neutopenia which is having a lower than normal number of white blood cells.  Getting this shot lowers my risk of serious infection.  It must be a powerful shot because it costs $7,000 each time!  Initially it really wiped me out several days later with achy joints and muscles but got better as time went on.  I could not schedule much for the week following a treatment and had help with meals and other things but was still able to do things around the house and local driving.  I am thankful to close the chapter on this portion of my treatment.  I have survived, but not on my own strength!

Cancer is a horrible thing.  No one wants it.  No one wants anyone they know to get it.  But it happens.  Whether it is cancer you are trying to conquer or some other giant in your life don’t think for one moment that God is not good.  We may not understand what He is doing but He is still good and He is there with you through it all.  Nahum 1:7 says, “The Lord is good, a strong refuge when trouble comes.  He is close to those who trust in Him.” (NLT)  You may think life is difficult or that is unfair that you have to be going through whatever circumstance you are facing now.  Don’t let it overwhelm you to the point that you forget how much God loves you and is concerned for you down to every detail (like the number of hairs on your head-read my last post).  Don’t forget that “God causes everything to work together for the good of those who love God and are called according to His purpose for them” (Romans 8:28, NLT).  He has given me the strength I needed, the peace I needed, the courage I needed.  He has not forgotten you and doesn’t expect you to go through anything alone.  Trust Him, seek Him, rely on Him and His Word and He WILL get you through it.  Romans 8:37 says, “Yet in all these things we are more than conquerors through Him who loved us” (NKJV) .  Go out and conquer!