Chemotherapy Side Effects

Yes, everyone I've spoken with has a similar experience with chemo. I found that I could not concentrate and therefore reading was useless. Too bad, I love to read and learn - its exciting to learn by reading. Eating was not so hot either, my tasting ability was gone along with my appetite. So I ended up watching the clock tick, went for long slow walks. I improved physically as my body acclimated to the chemo. Then, I became much more active - reading, watching tv, walking, talking on the phone, checking out the internet, writing letters, and more.

My chiropractor has been great with trying to get them back in alignment. They were so off after chemo.

I also took it easy on exercising after chemo, started small and built up.

Kathleen,

Congratulations on making the decision not to tackle fitness goals alone. There are a wide variety of fitness tricks and nutritional approaches that might be helpful, however many find that the best approach is often the one that considers (in no particular order):

1) Life/family responsibilities (i.e. your energy demands)
2) How regularly & intensely you trained before chemo
3) Resources ($, access to exercise equipment, facilities, etc)
4) Current energy levels and your energy cycles (i.e. good day vs bad day)

Because those variables can really impact how you approach slimming down, I'll include just a few exercise-based and nutrition-based notes.


Exercise
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* Get a journal and record snapshots of your general activities, nutrition and exercise. Journaling will keep you honest and enable you to, truly listen to your body. Speaking of snapshots, you may also want to take before photos and put them in your journal and wallet. They can be powerful motivators.

* Listen to your body and obey it. This really bears repeating. Pay close attention to not only how your body feels right after a workout but how it feels 1-2 days later as well! The journaling will help a lot, review it weekly.

* In the beginning, start with short, low to moderate intensity workouts, 20-30mins long. Do them only on your higher energy days. Avoid exercising on low energy days at first...consider making gentle stretches the most that you do on low intensity days. Some people find that they can only handle 10-15mins. That's ok. You might even try doing 2 short but vigorous workouts of 10-15mins, gradually increasing the length of workout by a few minutes and decreasing intensity before increasing intensity and length.

* As you progress (after a few weeks or so) you may want to try incorporating 1-2 more intense interval (burst) style workouts per week. They are a great way to help boost the metabolism without introducing some of the inflammatory effects that could potentially accompany lots of long workout sessions.

* If you are more of an enthusiast and are ready for it, very controlled interval training using a modified tabata scheme, could be a useful strategy, minding the caveats above. The Tabata scheme is based on 4 minute exercise cycles composed of 8 continuous, 30-second rounds of exercise, where you work as hard as you can for 20 secs and rest for 10 secs. Initially, 20 secs will probably be way too much. Consider the following scheme for progression:

Initial Stage => Modified Tabatas, w/ 8 rounds of 5-10 secs full-out exercise followed by 20-25secs break.

Progression => Add 2-5 secs of work every 1-2 weeks or as tolerated.

* If you choose to work with a trainer, make sure to find one that's sensitive to not only the inevitable energy swings but also the importance of balancing movement around joints (e.g. pushes and pulls are balanced) as well as moving in all planes.

Nutritionally
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* Especially in the beginning, try to train only when you're both rested and well nourished (eat ideally 1-2hours beforehand). Smoothies/Shakes are great for pre/post workout meals since it can be a bit easier to absorb the nutrients easier.

* Eat every 3.5-4hours (~4-6x per day) and Eat your largest meals earlier in the day and taper your meals as it gets later. Last meal should be the smallest, though still complete.

* Typical meals should include (low GI & fibrous carbs, lean complete proteins, good, higher omega 3 fats). Of course, avoid processed foods in favor of loading up on leafy greens and the like (organic is best)!

* Discuss _any_ supplementation (multivitamin/mineral, probiotics, fish oil, etc) with your doctor first.

* Try to avoid snacking within ~2 hours of bedtime. If you must, try to limit the damage by stocking the fridge and cupboards with fibrous, low GI/GL foods (glycemic index/glycemic load)

I'll close by encouraging you to remember to periodically add to your mental/spiritual toolkit for navigating the almost inevitable bumps along the road to your body transformation, it's often great to add an inspirational quote, story or song to your journal, on your journal review day (for example). Sorry if that was waay more than you were bargaining for, but I hope you'll find the info useful. Enjoy!!!

Depression is a common experience among people with cancer. Two evidence-based treatments are medication and psychotherapy. In terms of psychotherapy, I highly recommend you find a therapist who is experienced in cognitive behavioral therapy. I also recommend this book which is aimed toward helping cancer patients overcome both depression and anxiety using behavior therapy. http://www.amazon.com/Cancer-Patients-Overcoming-Depression-Anxiety/dp/1572245042/ref=sr_1_1?ie=UTF8&qid=1332588387&sr=8-1 I also recommend Kris Carr’s books on cancer. Check her out on Amazon.com. As a cancer survivor, she has an empowering and fun view of recovery and survival.

I did 2 rounds of In Vitro Fertilization prior to starting chemotherapy. The first round was not very successful which is why we did it twice. In the end we were able to freeze several embryos.

This is a tough question for me. Taxol, to my knowledge does not commonly cause an autonomic neuropathy, rather a peripheral neuropathy. This generally presents as numbness and tingling of the hands and feet. I have never seen taxol cause an autonomic neuropahthy although this has been reported in the literature with rare case reports.

I think asking what were the most difficult side effects is like asking someone to describe the level of pain they are feeling. Two people can be experiencing the same exact thing yet their perception of it is very different. For me I think I had built up this idea that going through chemo would be the most horrid thing anyone could EVER experience and that was the bar I had set for myself. I was lucky and experienced minimal nausea thanks to anti-nausea medications. I also expereincved some slight neuropathy in my right foot which did cause some long term residual effects. I also had no appetite for 2-3 days after each chemo cycle. I had the tinny taste in my mouth when I ate. I was very tired all the time and just when I felt some energy returning it was time for the next treatment. I think the most difficult side effect was the bone pain. The overall body pain & exhaustion which, the closest thing I can compare it too is how your body aches when you have the flu then multiply it by 10. Emotionally painful was loosing my hair at first but ironically once it was gone I didn't feel as bad as I thought I would. Maybe it was because I was feeling so crummy overall, otherwise I just didnt care. I don't quite know for sure. For me though they were far from easy but I personally felt the side effects were manageable and I knew I had to deal with them because at least for me I had no choice but to have the chemo.

One of my patients was diagnosed with breast cancer when undergoing in vitro fertilization. She went through menopause and never got a period until over a year later when she didn't really feel well and was 3 months pregnant without any help! That child is now in school and doing fine - a true gift from god. Yes, many women come out of chemo pause. Some in a few months and others longer. There is no real way to predict except to say that the closer a patient is to menopause when starting chemotherapy, the less likely she will be to come out of chemo pause.

Homeopathy is a holistic treatment modality that prescribes an individual remedy based on a patient’s totality of symptoms; physical, mental and emotional. We seek to address the underlying cause for an ailment rather than simply working to relieve symptoms. We each experience our ailments and symptoms in unique ways so as homeopaths our job is to draw as full a picture as possible of the individual before us. This means no two cases will be alike and as such there are no ‘off the shelf’ remedy prescriptions.

In the case of thinning hair, we would rather work to address the cause in the hope that this will help relieve the physical symptom. For example, if hair was thinning due to an endocrine imbalance, we would work to address that problem first and then see improvement in hair growth.

Sadly, in the case of chemotherapy, I am not aware of any remedy that can arrest hair fall. Once the regimen of chemotherapy ends homeopathic remedies can help you restore health and vitality.

My period returned about 10 months after chemo had ended. The farther away from true menopause you were before chemo began, (i.e. the younger you were), the highly likelihood it would return, is what my oncologist told me. I was 45 years old when diagnosed. My mother didn't finish menopause until she was 65. If I follow in her footsteps, true menopause for me is still a ways off. As for relief during chemo, I used Black Cohosh but didn't feel like it helped me personally. Keep in mind you may begin Tamoxifen as soon as chemo ends and the symptoms may continue and have nothing at all to do with chemo and everyting to do with Tamoxifen. I found I had more vaginal dryness, shrinkage on Tamoxifen, and obviously after chemo ended this became a real problem. Other intollerable side effects on Tamoxifen caused me to discontinue it after 5 1/2 months use. Exercise, Dr. Schwartz is correct, is key to battling some of the menopausal side effects of treatment. It helped more than anything I put in my mouth.

Most of the pioneering and breakthrough studies in the field are mentioned in our book and I also write a blog (www.YourBrainAfterChemo.blogspot.com) that is completely devoted to the topic. There you'll find some of the more important recent studies, summarized for a general audience. PubMed.gov of the U.S. National Library of Medicine is also an excellent source.

If you're newly diagnosed and have not yet begun treatment, ask your oncologist for a referral to a neuropsychologist for a cognitive evaluation. That will provide you with a baseline of how your brain functions now in terms of memory, attention, mood, etc. Follow-up testing during and after treatment will help your doctors monitor your cognitive health over time.

Even if you've already begun treatment, this type of testing can help. Neuropsychologists - especially those who work with cancer patients -- can suggest individualized coping strategies. They may also suggest medication if they think you'll benefit.

And just as having cancer affects the entire family, so does chemo brain. I can't tell you how many stories I've collected from people who tell me that their spouses and/or children just don't understand why they continue to be so forgetful, even though they're long past treatment. So you might sit down with your family and explain that chemo brain is real and that it may continue to linger. You may want to ask them to work out organizational strategies with you so that everyone takes a bit more responsibility.

It may help for them to read "Your Brain After Chemo" where I tell the story of a husband who had testicular cancer, and his wife who was often frustrated at how spacey he had become. In the end, they set up a more structured way of dealing with appointments, including their roles in picking up their son after school. That created more harmony at home.

That's really hard to say. First, not everyone gets chemo brain. Of those who do, symptoms vary and cognitive problems can range from mild to severe. For example, if you work at a job where you need to remember facts and figures and rely on your wits, or if you're a parent running a busy household and need to keep track of everyone and everything while multitasking to boot, then you may keenly feel that you've lost your edge. But let's say you're retired with few responsibilities; you may wonder what all the fuss is about. That said, some of the hallmarks of chemo brain are problems with word retrieval, memory, concentration and attention, an inability to multitask as you once could and spatial disorientation (such as getting lost while driving in your own neighborhood, or sudden confusion in exiting a store). Processing speed is another big issue. Everything just takes so much longer, whether it's writing an email, following a recipe or making decisions.
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There are a few that top the list.

Physical exercise - There's plenty of research showing that physical exercise increases cerebral blood flow and promotes the growth of brain cells. Even getting out and vigorously walking two or three times a week can help.

Brain foods - Most people don't generally think about "fats" when it comes to our diet post-chemo. But there are good fats that promote brain health and bad fats that do just the opposite. Avoid saturated fats (i.e.: cheese, whole milk, fatty animal products, palm oil), and trans fats (found in some commercial baked goods, snacks such as potato chips, fried foods, etc.). Both types of fat can cause clogging of the arteries and poor blood flow to the brain.

The good-guy fats are omega-3 fatty acids found in seafood and some plant sources (there's a chart of omega-3 foods in our book). Omega-3 fats have been shown to fight inflammation and help with depression. And in studies of omega-3 supplements, subjects showed improved attention in tasks involving complex reasoning.

Get more fruits and vegetables into your diet. In a study out just last week (journal Neurology - online version, 12-28-11), researchers found that participants with high blood levels of vitamins B,C, D and E, scored better in the areas of attention, visuospatial skills and executive functioning (decision making, reasoning, planning ahead) than a control group. They also found that those with high levels of trans fat demonstrated worse overall functioning in the areas of attention, memory, language and processing speed.

Mind games - Some neuropsychologists believe that playing games such as sudoku, or working crossword puzzles, will help you improve at those specific games but may not help with overall cognitive impairment. That's why it's important to engage in a wide variety of cognitive activities, such as reading more (even if it takes you longer because of problems with concentration), or trying something completely novel, such as taking up piano if you've never played before.

Organizational strategies - Find a way to structure your life that works for you, whether that means relying on digital or day planners, bundling tasks (such as always taking your pills when you brush your teeth) so that one helps you remember the other), or laying out your clothes for the morning before you go to bed. Doing what you can to organize your life will reduce stress.

Of all the questions I receive from my readers, this is one that's most frustrating for me - and often for them! One explanation is that oncologists don't keep up with the medical literature. If indeed that is the case, there's no excuse. Although the study of cancer-related cognitive impairment is still a relatively new area of science, there is an abundance of research - reported in top journals - supporting the connection between cancer, cancer treatment and memory impairment and other cognitive issues.

Another explanation is that oncologists are more focused on cure rates than quality of life. They see so-called, "chemo brain" as a non-medical issue and therefore not their concern. But cancer-related cognitive impairment is a potentially serious side effect that doctors need to discuss with their patients from the get-go.

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Breast Cancer Network of Strength , formally known as Y-ME helps breast cancer patients and survivors regain their sense of well-being and self-confidence by providing bras, wigs, and/or prostheses at no cost to those with limited financial resources. www.y-me.org or 1-800-221-2141

CancerCare under their Women's Cancer Program, offers financial assistance and counseling, support groups, and patient education. They also provide free wigs and breast prostheses to women who have lost their hair or a breast as a result of their cancer treatment. 1-800-813-HOPE (4673)

Crickett's Answer for Cancer 1-301-935-4411 provides free wigs, mastectomy products, mastectomy and lymphedema massage, facials, and other pampering services, as a way to keep a woman feeling feminine and beautiful despite losing her hair and/or breasts.

I also use my smart phone to write in every single appointment, so I don't forget. I will do things to keep my brain active, such as learning a language and go grocery shopping without a list so I can help myself with recall. I also exercise. Keeping physically fit can help one feel better emotionally, so then chemobrain doesn't bother me as much as it can.

It is still a struggle for me, even 10 years after chemo. Just keep the mind and body as active as you can.

I have to preface this answer by saying that I am NOT a clinician of any kind. Chemotherapy frequently causes short-term anemia because it disproportionately affects rapidly dividing cells. Our blood cells, both red and white, come from rapidly dividing precursors that live in bone marrow. I would think that it is possible to have longer-term affects on red blood cell production/development as a result of chemotherapy. There could also be indirect causes of the anemia, like metabolic changes that hurt red cell development. Again, I am not a physician, but it certainly seems plausible. You should certainly see a physician about the problem and discuss any dietary changes as well.